text:
I am about done with Tracy McMillian, after reading her polemic screed in Huffpo. It seems that she feels that unmarried women are liars, sluts, bitches, shallow, selfish and simply not good enough.
1. You're a Bitch.
Here's what I mean by bitch. I mean you're angry. You probably don't think you're angry. You think you're super smart, or if you've been to a lot of therapy, that you're setting boundaries. But the truth is you're pissed. At your mom. At the military-industrial complex. At Sarah Palin. And it's scaring men off.
The deal is: most men just want to marry someone who is nice to them. I am the mother of a 13-year-old boy, which is like living with the single-cell protozoa version of a husband. Here's what my son wants out of life: macaroni and cheese, a video game, and Kim Kardashian. Have you ever seen Kim Kardashian angry? I didn't think so. You've seen Kim Kardashian smile, wiggle, and make a sex tape. Female anger terrifies men. I know it seems unfair that you have to work around a man's fear and insecurity in order to get married — but actually, it's perfect, since working around a man's fear and insecurity is big part of what you'll be doing as a wife. 2. You're Shallow.
When it comes to choosing a husband, only one thing really, truly matters: character. So it stands to reason that a man's character should be at the top of the list of things you are looking for, right? But if you're not married, I already know it isn't. Because if you were looking for a man of character, you would have found one by now. Men of character are, by definition, willing to commit.
Instead, you are looking for someone tall. Or rich. Or someone who knows what an Eames chair is. Unfortunately, this is not the thinking of a wife. This is the thinking of a teenaged girl. And men of character do not want to marry teenaged girls. Because teenage girls are never happy. And they never feel like cooking, either.
3. You're a Slut.
Hooking up with some guy in a hot tub on a rooftop is fine for the ladies of Jersey Shore — but they're not trying to get married. You are. Which means, unfortunately, that if you're having sex outside committed relationships, you will have to stop. Why? Because past a certain age, casual sex is like recreational heroin — it doesn't stay recreational for long.
That's due in part to this thing called oxytocin — a bonding hormone that is released when a woman a) nurses her baby and b) has an orgasm — that will totally mess up your casual-sex game. It's why you can be f**k-buddying with some dude who isn't even all that great and the next thing you know, you're totally strung out on him. And you have no idea how it happened. Oxytocin, that's how it happened. And since nature can't discriminate between marriage material and Charlie Sheen, you're going to have to start being way more selective than you are right now.
Is this woman projecting herself onto others?
First let's start off with the fact that she assumes heterosexuality in this piece. Not all women are searching for a man. There are plenty of women that are search of a hot looking woman with legs for days. It is also important to note that there are plenty of lesbians that would LOVE to be married, but cannot because it is NOT legal. The very assumption of heterosexuality, is absolutely an acknowledgment of McMillian's failure to acknowledge her privilege, but why make distinctions when the project is to shame all women.
I wonder what McMillan would have to say about women who are polyamourous and are looking for a third person to marry. Do they suffer from the same supposed issues? Are they to be excluded from a discussion about marriage because their involve more than two people? When we speak about institutions like marriage, without including certain bodies, we send a message that normalizes the majority, while penalizing the minorities for even existing. Ignoring them and erasing them because we feel that we have a larger point to make simply works to deny our personal privileges.
Relationships are complicated and to say that women who are not married are faulty individuals is sexist. Being single is not an indicator of one's moral failings. As you know, the unhusband and I have been together for over 20 years — and let me tell you — it is work. For a relationship to be successful, both parties have to be committed to working on their relationship, making sure that they don't take each other for granted, working on maintaining the lines of communication, and most importantly, nurturing the friendship that brought you together in the first place. One person doing a 100% of the labour is not a relationship.
From reading her anti-woman screed, it is clear to me that McMillan has internalized a lot of the misogyny that is so common place in this society. Nowhere in her screed, does she seek to make men equally responsible for any relationship problems, and instead McMillan asserts that it is women, that are at fault. In fact, judging women on their sexuality and calling women bitches for feeling angry at times, is specifically attacking them for not performing a submissive form of femininity. Why do women not have a right to their rage, but men are entitled to it? It seems to me, that she is suggesting women become perfect little stepford wives, to keep the men in their lives happy.
What never seems to occur to McMillan, is a woman's right to be happy. Let's just say for the sake of argument, that a woman completely changes who she is, to become this submissive stepford wife, that McMillan is suggesting, and is unhappy with her marriage, while her husband is content — how does this equal a positive, affirming relationship? If you have to change who you are, to make someone love or commit to you, then they are not the right person for you. It should never be marriage to the first person with a pulse, but marriage to someone who loves and respects you. I am sick and tired of women being told to change, or to lower their standards for the sake of a man. The very idea that there should be separate responsibilities for a man than a womanm tells me that we still have a long way to go before people stop overvaluing men, at the cost of women.
Editors Note: I made a mistake in the original post, and confused Terry McMillan with Tracy McMillan. Terry is the author of How Stella Got Her Groove Back and it was Terry who involved in the marriage with Johnathon. I apologize for my mistake.


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|You are in: Business
Tuesday, 12 March, 2002, 08:00 GMT
Enron auditor juggles two suitors
Andersen, the US accountancy firm at the centre of the Enron bankruptcy scandal, is reportedly in talks to sell itself to one of two major rivals.
If a deal is clinched with either Ernst & Young or Deloitte & Touche, Andersen would file for Chapter 11 bankruptcy protection in the US, the Financial Times has reported.
Andersen has lost several prestige clients and come under close scrutiny from others for its part in last year's collapse of US energy giant Enron with huge hidden losses.
Federal prosecutors are believed to have made clear to Andersen last week that they were willing to seek a criminal indictment against it.
Bankruptcy plan
Under the terms of the proposed take-over deals, Andersen would file for Chapter 11 bankruptcy protection, the FT said.
This would allow any merger partner to purchase Andersen's US assets and would in turn provide cash for the firm to settle any claims against it.
Andersen faces potential civil and criminal settlements, as well as legal fees, which together could add up to billions of dollars.
Such a cost could prove ruinous for the company and is one reason why any merger partner would proceed with caution.
If Andersen fails to find a new global partner, parts of the giant audit firm could break away.
The FT said it had learned the auditor's European partners in several countries were already in talks about a possible break-up plan, and were looking at options for local deals.
Final catalyst
Talks with Deloitte reportedly began last week in New York after it emerged that Andersen may be indicted by the US Justice Department on criminal charges for shredding documents relating to Enron's financial woes.
An obstruction of justice case could deal the final blow to the firm's reputation and client list.
Andersen's lawyers are reported to be negotiating with federal prosecutors in the hope of striking a deal that avoids criminal charges.
So far, Andersen is thought to have lost more than 30 clients which provided it with combined annual fees of about $100m.
Among the most high-profile clients to abandon Andersen were Merck, the multinational pharmaceutical company, which ended its 31-year relationship with the audit firm, and Delta Airlines, a top five US carrier.
Tie-up talks
The firm has denied feeling any financial ill-effects to its business, but admits its needs to change its structure to survive.
Talks with Deloitte are reportedly being held in New York, led by the chief executives of the two audit firms.
Andersen declined to comment on what it said were "rumours in the market".
The Andersen name is likely to disappear in any tie-up.
See also:
02 Mar 02 | Business
Andersen suffers double blow
05 Feb 02 | Business
Audit giants called to account
03 Feb 02 | Business
Andersen announces major restructuring
29 Jan 02 | Business
Andersen on the defensive
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Get an update on changes of the IACR web-page here. For questions, contact newsletter (at) iacr.org. You can also receive updates via:
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more appealing in terms of efficiency. According to the available research in this regard, our scheme is the first provable secure CBPS scheme with message recovery which is based on the elliptic curve discrete logarithm problem. We prove the security of the presented scheme against existential forgery under adaptive chosen message and ID attacks in the random oracle model. Moreover, the paper will also show how it would be possible to convert this scheme to the CBPS scheme without message recovery. This scheme has more applications in situations with limited bandwidth and power-constrained devices.
Let the variable sets belong to a fixed family $\\mathcal{X}=\\{X_1,\\ldots,X_m\\}$ while
the polynomials $f_i(X_i)$ are taken independently and uniformly at random from the set of all polynomials
of degree $\\leq q-1$ in each of the
variables in $X_i$. In particular, for $|X_i|\\le3$, $m=n$, we prove
the average complexity of finding all solutions to $f_i(X_i)=0, i=1,\\ldots,m$ by Gluing algorithm ( Semaev, Des. Codes Cryptogr., vol. 49 (2008), pp.47--60) is at most $
q^{\\frac{n}{5.7883}+O(\\log n)}$ for arbitrary $\\mathcal{X}$ and $q$. The proof results from a detailed analysis of 3-MaxMinMax problem, a novel problem for hyper-graphs.
We use a variation of the classical hard problem \\emph{Inhomogeneous Small Integer Solution} ISIS of lattice, say \\emph{Inhomogeneous Subset Sum Solution} ISSS. ISSS itself is a hash function. Proving the preimage sizes ISSS hash function images are almost the same, we construct a pseudorandom generator using the method in \\cite{GKL93}. Also, we construct a pseudoentropy generator using the method in \\cite{HILL99}. Most theoretical PRG constructions are not feasible in fact as they require rather long random bits as seeds. Our PRG construction only requires seed length to be $O(n^{2}\\log_{2} n)$ which is feasible practically.
$x^{n}+x^{n-1}+x^{k}+x+1$, where $n$ is odd and $1
- We first devise a new technique for RIBE that combines hierarchical IBE (HIBE) scheme and a public-key broadcast encryption (PKBE) scheme by using multilinear maps. In contrast to the previous technique for RIBE, our technique uses a PKBE scheme in bilinear maps for revocation to achieve short private keys and update keys.
- Following our new technique for RIBE, we propose an RIBE scheme in 3-leveled multilinear maps that combines the HIBE scheme of Boneh and Boyen and the PKBE scheme of Boneh, Gentry, and Waters. The private key and update key of our scheme have a constant number of group elements. To prove the security of our scheme, we introduce a new complexity assumption in multilinear maps, and prove its security in the selective revocation list model.
- Next, we propose another RIBE scheme that reduces the number of public parameters by using the parallel construction technique of PKBE. We could reduce the number of public parameters by using the fact that only the trusted authority in RIBE can broadcast an update key.


text:
Portland Police arrested 17-year-old Justin Hubbard for breaking into an apartment in Northeast Portland and trying to rape the woman inside. It happened at the Greenleaf Springs Apartments on 125th Place and Sandy Boulevard early Monday morning. Hubbard had a knife but the 26-year-old victim fought back and her fiance chased him away. Police tracked him to a neighboring apartment complex where he lives.
During the investigation, police determined he is the same person who sexually assaulted a Parkrose High School student back in March. The 16-year-old was walking to school near 131st and Prescott Drive when she was attacked. She reported the incident to school officials, who called police. At that time they didn't have enough information to name a suspect.
Hubbard will be in court Tuesday to face charges of Burglary in the First Degree, Sex Abuse in the First Degree and Attempted Rape in the First Degree. More charges will be added related to the attack in March.


text: On 02/21/2010 11:45, Ian Robinson wrote: > PCBSD 8.0-RC2-x86& Nvidia Legacy Driver Screen Corruption > > On 2/19/10, Kris Moore<kris at pcbsd.org> wrote: >> Thanks! BTW, I think the nvidia port just got updated today to fix that >> compile error, you may want to run portsnap again shortly to try >> recompiling. >> > > > I downloaded and compiled the new 96.43.16 successfully. > > Although the opening screens were promising because there was little > or no speckled dots at all on the screen. However, after approx 40 > minutes, the screen corrupted badly. The colors were much 'prettier' > which you can see from the attached screen capture but all menus were > unreadable. > > The system itself functioned without problem, but using it consisted > of a braille-like trial& error method (i.e., as if blind). For > example, to get the screen capture utility, I used the barely visible > search box function at the top of the kicker menu to locate 'screen > capture', clicked the corrupted choice, and clicked the corrupted > 'save' button. I rebooted with a 'reboot now' command in the terminal > window that lay behind everything. Thus, the system is functional if > you can guess where your mouse is clicking and type in the commands, > but the newest driver is not helpful for this corruption problem. The > cause remains unknown. > > Ian Robinson > Salem, Ohio Ok, that helps confirm at least that the issue still occurs in the latest drivers. Just for kicks again, can you re-confirm that switching back to "nv" or "vesa" gets rid of these problems? If we can for sure confirm that its only "nvidia" 96.43.xx related, we can then take this to nvidia with details. We'll need to let them know your particular card, with details about OS, such as FreeBSD 8.0 / xorg-server 1.6.5, etc: Here's where we've been communicating a lot with Christian Zander @ Nvidia. He's aware of some issues on 8.0 right now and will hopefully be fixing them soon, but if he doesn't know about this one we can get him to add it to the list :) http://www.nvnews.net/vbulletin/forumdisplay.php?f=47 -- Kris Moore PC-BSD Software http://www.pcbsd.com


text:
Henry olivier Hair Stylist
Katie of Dirt MansionModel Female Philadelphia, Pennsylvania, US
My Website: DiRT MANSiONMy MM URL: http://www.modelmayhem.com/smokestackstudios
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I'm a Singer Songwriter and a Fuckin Bitch!!! You do not want to get on my bad side .... I love being in the studio surrounding myself with chill ass stoners who love music as much as i do..In fact those who love MY music as much as I do, they are the ones I love hanging with the most... lets be honest... i am a bit In LOVE w myself haha I drink, I sing, I FIGHT FOR EQUALITY, I rinse, I repeat.I am so over the people in my life fucking me over and I have a brilliant plan to outshine all of them!! I encourage you all to listen to my message in my music...I am currently working with the worlds TOP producers including Rob Fusari (no no no, bootylicious, and LADY GAGA!!!!) also
Jonny, DEEKAY, NoizeTrip, The Matrax, Andy Marvel, Future Presidents, Just Hot Music, Shon Penn, Polished Productions, 40 Glocc, Sam Scarfo, and countless others....I am very proud of all the hard work that has been put in by these amazing talents, without them I would be another karaoke singer and sometimes poet.... THANK GOD for LARRY CAMPBELL my MENTOR and BEST FRIEND... we have developed a monster and I am forever grateful for your undying belief in me... From Mullens at lunch and the drop of a business card to three years later and some months later... I am truly living MY DREAM because of you!!! I also want to thank my friends and fans that have been on this journey with me.... your the reason why I am fighting TILL THE END for THIS Catch my tunes on facebook...
www.Facebook.com/dirtmansionmusic listen to me sing! www.dirtmansion.com
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text:
Hanson, Brewin Named to Board of Operation Lifesaver, Inc.; Stayton Is New Chair
WASHINGTON, D.C. — Polly Hanson, Chief of Amtrak Police, and Nicole Brewin, Assistant Vice President, Government Affairs, Railway Supply Institute (RSI), have been named to the Board of Directors for Operation Lifesaver Inc., (OLI, www.oli.org), the nonprofit rail safety organization. Cliff Stayton, Director-Community Affairs and Safety, CSX, is now the board's Chair, taking over from Reilly McCarren, Chairman of the Arkansas and Missouri Railroad.
Hanson, a veteran law enforcement professional who has served with the U.S. Department of the Interior, the Washington, DC Metropolitan Police, and the Washington Metropolitan Area Transit Authority, fills a seat previously held by Roy Deitchman, Amtrak's former Vice President for Environmental Health and Safety. "Polly Hanson has nearly 30 years of rail experience and is a great addition to Operation Lifesaver's board," said OLI Board Chair Cliff Stayton.
Brewin, who joined RSI in January 2001 from the staff of Congressman Peter Visclosky (D-IN), is taking over the Railway Supply Institute seat on the board held since 1988 by Thomas Simpson, RSI President.
"We are delighted to have Nicole join the board," said OLI President and CEO Joyce Rose. "Tom Simpson has been a faithful steward of Operation Lifesaver's public education mission for more than 20 years," she noted, "and we are grateful for his service."
Stayton, a community outreach expert and former locomotive engineer, is a "passionate safety advocate" who is spurring Operation Lifesaver to communicate its message to a broader audience, Rose said. She also expressed thanks to McCarren for his leadership over the past several years.
"While highway-rail crossing collisions have been reduced over the past 40 years, crossing safety and rail trespass prevention are still critical public safety issues," said Stayton. "As the demand for freight and passenger rail in the U.S. increases, Operation Lifesaver's safety education efforts are more important than ever."
Rose added, "These new board members are poised to make substantive contributions as we fulfill our mission to save lives."


text:
Interview with Daniel Humbel, Transa CEO
"We have an organic hierarchy"
Digitisation is changing all branches of industry and is more than just technology. New business models are creating services out of products, new customer experiences are attracting more attention and digital business processes are offering greater efficiency. Work is possible anywhere, anytime, and is changing our culture.
Use your login to access and manage your Swisscom services and solutions.


text:
London British television network ITV held talks with Ten Network Holdings about taking a strategic stake, in a move that suggests the Australian free-to-air broadcaster's high-profile shareholders are open to takeover offers.
It is understood ITV's executive vice-president of corporate development, Tom Betts, was in Australia in January to discuss programming with commercial broadcasters including Seven West Media and Nine Entertainment Co.
However, sources close to process said subsequent discussions with Ten "progressed well beyond the usual conversations about programming" and included scenarios such as the possibility of ITV investing directly in Ten.
The sources described the discussions as "preliminary" and said they had "not gone anywhere" in recent weeks but "there was no doubt there are parties kicking the tyres" ahead of potential changes to media regulation that would make it easier for Australian commercial broadcasters to merger with their regional counterparts.
ITV is a London-listed broadcaster and production company with a market capitalisation of almost £7 billion ($12.6 billion). The company behind Broadchurch, Downton Abbey and Doc Martin generated £2.4 billion in revenue and operating earning of £513 million for the 2013 calendar year.
This gives it enough financial firepower to look at Ten, a $743 million company which posted $660.9 million in revenue and $41.8 million in operating revenue for the 12 months ended August 31.
Around 40 per cent of Ten is controlled by four shareholders –
"The board would look at any offer that contained a premium for shareholders," said a source.
The shareholders bought in at prices around or above the $1.50 mark in recent years.
Reach law removal
However, Ten shares have slumped to as low as 25¢ this year due to weak ratings. The stock closed at 28.5¢ on Monday.
Ten has struggled to attract large audiences in the past three years.
But executive chairman
The potential removal of the reach laws in Australia that prevent mergers between metropolitan and regional commercial broadcasters could allow Ten to consider a deal with affiliate Southern Cross Austereo. ITV is keen to diversify its earnings away from its home base in the United Kingdom.
The media company is attempting to grow its production in the United States and other countries with Mr Betts is also charged with looking at strategic opportunities.
An ITV spokeswoman would not comment on the talks with Ten. Ten would not comment.
ITV paid $US360 million ($385 million) for an 80 per cent stake in the independent US producer Leftfield Entertainment Group in May.
It said the deal makes it "the largest unscripted independent producer in the US".
Shrinking margins and greater competition from internet platforms such as Netflix have prompted greater consolidation within the global broadcasting sector.
US media group Viacom acquired ITV rival, Channel 5, for £450 million earlier this month. Viacom owns pay television channels such as MTV and Nickelodeon.
The free-to-air deal is another example of a big media company broadening its reach across geographies and platforms.
The Australian Financial Review


text: Culture 13 December 2007 Winter warmers Vintage spirits are an ideal defence against the seasonal hordes Sign up for our weekly email * Before marriage and children cut off escape, I would defend myself against Christmas by inviting a fellow Santaphobe to stay. We would spend the day at our desks, and finish with a quiet supper of roast pork and claret. That and the meet of foxhounds on Boxing Day would preserve the joyous solitude that is otherwise the principal casualty of Christmas. Presents were forbidden between us and we treated church with the utmost caution, as another santastic and bambiferous place where you ran the added risk of being greeted. All that changed with the advent of a family. Now I have to survive Christmas on the same terms as more righteous people and - to be honest - I don't know how they do it, especially those good folk who have no place to which they can retire from the factitious merriment, or who cannot afford the secret store of whisky in the cupboard there. Well, we have to make the best of it, and the best of it should be in that cupboard. Christmas is the time to try out, with your fellow Santaphobes, the vintage whisky that you have stored for this event. And in the matter of vintage whisky let me recommend Berry Bros & Rudd, whose beautiful and unspoilt house in St James's Street lies next to the site of the old Texas embassy, and is as eccentric as that implies. Berry Bros has made a point of researching and storing whisky for two centuries. Its single malts have been matured with the same anxious concern for the final product as that bestowed by a mother on a favourite child. It also has a 30-year-old blended Scotch that takes the biscuit and also tastes of it. However, there is a slight problem in recommending vintage whisky as a defence against hoi polloi, which is that the bastards have discovered it themselves. There it is at every airport, packaged and santafied. There's probably a bottle on that Christmas tree, wrapped in non-degradable sheen and with your name on it. So, what is to be done? The answer is again to be found on Berry's list, and it is vintage rum. Almost nobody among the celebrating classes is aware of this drink, still less of the ability of rum, stored in the right cask and the right cellar, to become the perfect antidote to Christmas. Those loved ones next door, with their paper hats and rude jokes from the crackers, drink Bacardi, because the adverts tell them to. But what do they know of rum as it should be - the drink that can be absorbed without a headache and with ever-growing appreciation of its spicy, cigar-box flavour? What do they know of solitude, of rapture, of the primeval time before love, when a sip of distilled molasses could put you in touch with your self and keep you there? Sod them all, anyway. Roger Scruton is a philosopher and countryside campaigner as well as an author and broadcaster. Widely regarded as one of Britain's leading right wing thinkers, his publications include the Meaning of Conservatism. He has also written on fox hunting. Subscribe from just £1 per issue This article first appeared in the 17 December 2007 issue of the New Statesman, Christmas and New Year special 2007 More


text:
French Connection cotton-blend jumper meets the new season head on with a shot of neon. Turn heads and wear it with cool cotton chinos.
Fluro Textured Jumper has a crew neck, short sleeves, an open-textured knitted pattern and is finished with ribbed cuffs and hem.
Style code
* Wash As Wool
* 98% Cotton 1% Nylon 1% Elastane


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Forum: Other College Sports: Baseball, Softball, Volleyball, etc.
Have a favorite College Football team? An Alma Matter? If it's not Basketball or Football related then it's in here! Yeah we don't have the prettiest name for this Forum, but there's a lot of other College Sports that be discussed!


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6 week old who is up for 12 hours(6 Posts)
I know it's difficult not to, but I wouldn't worry about it too much and just go with it for now. In my experience babies calm down a lot and these extremes stop between about 8 and 12 weeks.
My DD used to sleep well and barely be awake (just for feeds and nappies) between about 1or 2am and 11am, have a nap in the afternoon and then be wide awake from about 5ish till around 1 or 2am again.
At about 9 weeks she started sleeping earlier in the evening, having proper naps and being awake more during the morning and at 10 weeks we gave her an early bedtime and she was sleeping from 6.30pm, waking around 6am (not sleeping through, I hasten to add) and having 4 distinct naps each day.
Another change today. About 30 minutes sleep since 7 this morning.
She hates the car seat, so the car is out unless I can get her in there asleep. The pram has about the same reaction. We have a sling - somewhere in a packing box. I will try that next.
oh sorry, just seen baby is only 6 weeks. Her sleeping patterns are likely to change alot over the next few months, its not unusual to go from a happy sleepy baby to one that never sleeps and vice versa. From what I understand, their sleeping patterns change the most around 4 months when they go from baby deep sleep to more adult type sleep with regular deep sleep/rousing patterns. Hang on in there. Sometimes you might just have to put her down and go and have a break, don't feel guilty!
i experienced it with dd2, after being attached to her constantly for 5.5 months i just couldn't do it any more, in the end i had to put her in her bed and leave her to cry it out (not something i like to do AT ALL, but i had come to the end of my tether). fwiw she's 3 now and an absolute dream. i know everyone says it, but it is a 'phase' that they do grow out off. dd3 is 4.5 months, i'm very conscious of having to go back to work in october so i am kind of 'enforcing' nap times. i give her a cuddle and feed then pop her up into her bed. she does shout but i think all i can do is always be calm and loving when i go back to her. I can't make her too dependent on me for cuddles all day long, for it all to suddenly disappear in a few months and leave her (and my sister/mum/dp) to deal with the fall out. sorry, i'm not sure if thats going to really have helped you. but yes, i do think its normal, and no, i don't think it'll last but you might have to decide how your going to deal with it and then steel yourself to follow it through?
No its not abnormal, some babies just don't sleep well, even as newborns.
My dd (now 14 mths) from 3 weeks old used to be awake from 8am-8pm without napping apart from the odd 10mins here or there. I tried co-sleeping, tried the pram, the car...nothing worked. In the end I carried her in a wrap sling after each feed (which was almost hourly) and periodically kept putting the dummy in her mouth each time she grisled. That worked for a few weeks though I was exhausted (with no chance to shower, eat or rest).
Have you tried the pram or a sling and a dummy? Just anything to get her to nap a bit at this stage. I started to see an improvement once I started solids and formula at 6 months though even then the naps were short.
It was without doubt the most lonely, tiring and demoralising period of my life so I do empathise. (And a belated thanks to the Mumsnetters who posted encouraging replies to my desperate posts at the time!)
My DD2 is like two different children in the morning and afternoon. Typically she will wake to be fed around 7/8 and then sleep till 10 have another feed and then wake between midday and 1.30. Then she is awake till at least half past midnight with only a 10 minute nap.
In the morning, she falls asleep on her own, without a soother, or being rocked. You can just put her into the moses basket when she looks sleepy and off she goes. In the afternoon, she must have a dummy in or my nipple. She grazes throughout the 12 hours and has occasional crying episodes. She is clearly tired, rubbing her eyes and yawning, but can not send herself to sleep as she can in the morning or stay asleep. It does not matter if I hold her or put her in her moses basket or our bed, she will wake with a shake of her head after 10 minutes. And it will take the good part of 4 hours to get here there.
My elder DD had colic and I wondered if it was a milder version of that. However, she farts - a lot -in her sleep and burps like a dock worker in the morning and afternoon/evening.
This has only been happening the last two weeks. She has never had a regular pattern, unlike her sister, but I was not initially worried.
Does anyone have any experience of this? Or does it seem a complete abnormality?
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Internal Revenue Bulletin: 2014-8
February 17, 2014
Table of Contents
These proposed regulations under section 707 of the Code relate to disguised sales of property to or by a partnership and under section 752 relating to the treatment of partnership liabilities. The proposed regulations address certain deficiencies and technical ambiguities in the section 707 regulations and certain issues in determining partners' shares of liabilities under section 752. Written or electronic comments and requests for a public hearing must be received by April 30, 2014.
|More Internal Revenue Bulletins


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Noninvasive Brain Stimulation With High-Frequency and Low-Intensity Repetitive Transcranial Magnetic Stimulation Treatment for Posttraumatic Stress Disorder
Paulo Sergio Boggio, PhD; Martha Rocha, BSc;
Maira Okada Oliveira, BSc; Shirley Fecteau, PhD; Roni B. Cohen, MD;
Camila Campanhã, BSc; Eduardo Ferreira-Santos, MD, PhD;
Alexandrina Meleiro, MD, PhD; Felipe Corchs, MD; Soroush Zaghi, BSc;
Alvaro Pascual-Leone, MD, PhD; and Felipe Fregni, MD, PhD
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Objective: We aimed to investigate the efficacy of 20 Hz repetitive transcranial magnetic stimulation (rTMS) of either right or left dorsolateral prefrontal cortex (DLPFC) as compared to sham rTMS for the relief of posttraumatic stress disorder (PTSD)–associated symptoms.
Method: In this double-blind, placebo-controlled phase II trial conducted between October 2005 and July 2008, 30 patients with
DSM-IV–diagnosed PTSD were randomly assigned to receive 1 of the following treatments: active 20 Hz rTMS of the right DLPFC, active 20 Hz rTMS of the left DLPFC, or sham rTMS. Treatments
were administered in 10 daily sessions over 2 weeks. A blinded rater assessed severity of core PTSD symptoms, depression, and anxiety before, during, and after completion of the treatment protocol. In addition, a battery of neuropsychological tests was measured before and after treatment.
Results: Results show that both active
conditions—20 Hz rTMS of left and right
DLPFC—induced a significant decrease in PTSD symptoms as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale; however, right rTMS induced a larger effect as compared to left rTMS. In addition, there was a significant improvement of mood after left rTMS and a significant reduction of anxiety following right rTMS. Improvements in PTSD symptoms were long lasting; effects were still significant at the 3-month follow-up. Finally, neuropsychological evaluation showed that active 20 Hz rTMS is not associated with cognitive worsening and is safe for use in
patients with PTSD.
Conclusions: These results support the notion that modulation of prefrontal cortex can alleviate the core symptoms of PTSD and suggest that high-frequency rTMS of right DLPFC might be
the optimal treatment strategy.
J Clin Psychiatry 2010;71(8):992–999
Submitted: August 25, 2008; accepted March 12, 2009.
Online ahead of print: December 29, 2009
Corresponding author: Felipe Fregni, MD, PhD, Berenson-Allen Center for Noninvasive Brain Stimulation, 330 Brookline Ave, KS 452, Boston, MA 02215 (firstname.lastname@example.com).
Paulo Sergio Boggio, PhD; Martha Rocha, BSc; Maira Okada Oliveira, BSc; Shirley Fecteau, PhD; Roni B. Cohen, MD; Camila Campanhã, BSc; Eduardo Ferreira-Santos, MD, PhD; Alexandrina Meleiro, MD, PhD; Felipe Corchs, MD; Soroush Zaghi, BSc; Alvaro Pascual-Leone, MD, PhD; and Felipe Fregni, MD, PhD
Method: In this double-blind, placebo-controlled phase II trial conducted between October 2005 and July 2008, 30 patients with DSM-IV–diagnosed PTSD were randomly assigned to receive 1 of the following treatments: active 20 Hz rTMS of the right DLPFC, active 20 Hz rTMS of the left DLPFC, or sham rTMS. Treatments were administered in 10 daily sessions over 2 weeks. A blinded rater assessed severity of core PTSD symptoms, depression, and anxiety before, during, and after completion of the treatment protocol. In addition, a battery of neuropsychological tests was measured before and after treatment.
Results: Results show that both active conditions—20 Hz rTMS of left and right DLPFC—induced a significant decrease in PTSD symptoms as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale; however, right rTMS induced a larger effect as compared to left rTMS. In addition, there was a significant improvement of mood after left rTMS and a significant reduction of anxiety following right rTMS. Improvements in PTSD symptoms were long lasting; effects were still significant at the 3-month follow-up. Finally, neuropsychological evaluation showed that active 20 Hz rTMS is not associated with cognitive worsening and is safe for use in patients with PTSD.
Conclusions: These results support the notion that modulation of prefrontal cortex can alleviate the core symptoms of PTSD and suggest that high-frequency rTMS of right DLPFC might be the optimal treatment strategy.
© Copyright 2009 Physicians Postgraduate Press, Inc.
Online ahead of print: December 29, 2009 (doi:10.4088/JCP.08m04638blu).
Posttraumatic stress disorder (PTSD) is an incapacitating anxiety disorder characterized by intrusive thoughts, hyperarousal, flashbacks, nightmares, sleep disturbances, emotional numbing, and withdrawal, among other clinical symptoms (as classified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]).1 Posttraumatic stress disorder has a lifetime prevalence of about 6.8% and may develop in susceptible individuals after exposure to a terrifying ordeal that involved physical harm or the threat of physical harm.2 This severe anxiety disorder affects about 7.7 million people each year and remains challenging to treat, with persistent symptoms leading to considerable social, occupational, and interpersonal dysfunction.3
Although selective serotonin reuptake inhibitors (SSRIs)—among other antidepressants—have resulted in various degrees of improvement in patients with PTSD, there is no definitive pharmacotherapy available to date for the treatment of this debilitating disorder. A review of 37 clinical trials of pharmacotherapies4 found inadequate evidence to determine the value of antidepressants, benzodiazepines, anticonvulsants, α-blockers, and second-generation antipsychotics for the treatment of PTSD. Even so, according to an American Psychiatric Association guideline,5 SSRIs remain the first line of treatment for PTSD. In addition, due to the complex nature of this disorder, individuals with PTSD also seem to benefit from 10 to 12 sessions of cognitive-behavioral therapy, prolonged-exposure therapy, or cognitive-processing therapy. Nevertheless, many individuals respond inadequately to currently available therapies, and research for more effective treatment paradigms is ongoing.
Most recently, repetitive transcranial magnetic stimulation (rTMS)—a method of noninvasive neuromodulation—has been emerging as a potentially effective technique in the treatment of PTSD. Indeed, rTMS has already been shown to be highly effective in the treatment of medically refractory depression6 and is now a clinically available form of treatment in certain settings. Similarly, there is evidence that rTMS can also be effective for the treatment of PTSD. In a prior open-label study,7 a single session of low-frequency (0.3 Hz) transcranial magnetic stimulation (TMS) applied to the left and right motor cortex was found to be transiently effective in lowering the core PTSD symptom of avoidance as well as somatization and symptoms of anxiety and depression. Stimulation with 10 Hz rTMS to the right DLPFC was then shown to generate even greater effects with an especially marked improvement in symptoms of re-experiencing and avoidance; these effects lasted for at least 2 weeks after the end of stimulation.8 Furthermore, 2 case studies suggest that stimulation of the right DLPFC with 1 Hz rTMS can, in fact, normalize the right frontal and paralimbic metabolic hyperactivity that is associated with PTSD as measured with positron emission tomography studies.9 In sum, these previous studies suggest that modulation of prefrontal activity, perhaps particularly on the right frontal cortex, with rTMS holds promise as a form of therapy in the treatment of PTSD.
Therefore, in this study, we aimed to investigate the clinical efficacy of high-frequency rTMS in the relief of core PTSD symptoms (such as hyperarousal, flashbacks, vigilance, intrusive thoughts, emotional numbness, and withdrawal) as well as PTSD-associated symptoms of anxiety and depression. In contrast to previous studies, here we investigate treatment with 20 Hz rTMS (higher frequency than previous studies), as there is evidence that higher-frequency stimulation may result in more substantial effects. In addition, we compare the effects of treatment of either right or left DLPFC ("left rTMS" and "right rTMS"), since rTMS is known to have side-specific effects. For example, in patients with major depression, rTMS can induce antidepressant effects either by enhancing left DLPFC excitability via high-frequency stimulation or by decreasing right DLPFC excitability via low-frequency stimulation.10 Finally, our study here also offers a longer follow-up period of 3 months' duration and an inclusion of an extensive battery of neuropsychological assessments. The main goal of this study was to evaluate the effects of high-frequency rTMS of right and left DLPFC, as compared to sham stimulation, on the clinical symptoms of PTSD. As secondary aims, we explored whether the clinical effects of stimulation were long lasting and associated with any cognitive changes as indexed by a battery of neuropsychological tests.
Study Population
This study was carried out from October 2005 to July 2008. Participants were recruited by means of newspaper advertisements as well as referred by psychiatrists working with PTSD. We enrolled participants according to the following criteria: participants fulfilling the DSM-IV diagnostic criteria of PTSD, as assessed by the Structured Clinical Interview for DSM-IV (SCID)11 by trained mental health professionals, and aged between 18 and 64 years old. We excluded individuals with head trauma, substance abuse disorder, or any other chronic medical conditions and contraindications to rTMS, such as pregnancy, use of pacemakers, and epilepsy.12 In addition, patients with severe episodes of depression immediately before the traumatic event were excluded. Patients signed an informed consent form that was approved by a local and national research ethics committee (http://portal.saude.gov.br/sisnep). The study was conducted at Mackenzie University (São Paulo, Brazil).
The traumatic events that were associated with PTSD included 6 assaults, 5 cases of sexual abuse, 15 cases of death or severe disease of a relative, and 4 incidences of psychological distress/perceived physical harm (eg, kidnapping, threat of death). The mean age of the subjects was 44.5 ± 4.4 years (mean ± SD). The mean time since occurrence of trauma was 3.9 ± 4.3 years (mean ± SD).
For participants who were taking medication, we used the same strategy used by Grisaru et al7: drug treatment was neither stopped nor changed in the 3 weeks before the study or during the study. In addition, patients continued to receive the same individual and group supportive psychotherapy as before the intervention. Successful use of this procedure has been reported by Cohen et al.8 However, we adopted a strategy of randomization (stratified randomization) to ensure that the groups were balanced regarding medication use.
Experimental Design
In this double-blind, placebo-controlled phase II trial, 30 patients were randomly assigned (1:1:1) to 1 of the 3 stimulation groups: active high-frequency rTMS of the left DLPFC (left rTMS), active high-frequency rTMS of the right DLPFC (right rTMS), and sham rTMS. We used a stratified randomization strategy with random blocks to ensure that the 3 groups had similar use of medications; therefore, we created 3 different groups of patients according to their medication use: antidepressants and/or benzodiazepines, benzodiazepines only, and neither benzodiazepines nor antidepressants.
Rationale for Site of Stimulation
The choice of prefrontal cortex as the site of stimulation is based on the properties of this area and previous research. The prefrontal cortex is involved in many complex cognitive and behavioral functions that are potentially relevant to PTSD, such as working memory,13,14 supervisory attentional control,15 reasoning and decision making,16,17 temporal organization of behavior,18 and emotional processing.19 In fact, structural and functional neuroimaging studies have demonstrated abnormalities in the prefrontal cortex in PTSD patients. For instance, patients with PTSD show a decreased regional cerebral blood flow in the prefrontal cortex (and an increased regional cerebral blood flow in the amygdala) in response to provocation of symptoms by script-driven imagery.20–23 These findings have been documented in both patients with combat-related PTSD and patients in whom PTSD was related to childhood abuse. Overall, functional neuroimaging studies reveal fairly consistent data indicating a hypoactivation of the prefrontal cortex (as well as a hyperresponsive amygdala) in PTSD patients.24–26 Taken together, these findings suggest that the prefrontal cortex (and the amygdala) is intimately involved with PTSD abnormalities and could potentially be the target of stimulation-based treatment strategies. Therefore, the site of stimulation in this study will focus on the right and left dorsolateral prefrontal cortex. We tested treatment with the left DLPFC in addition to the right DLPFC as in the previous study8 because it is not clear whether there is a lateralization of prefrontal dysfunction in PTSD and also because left DLPFC is the site used for the treatment of major depression—a condition commonly comorbid with PTSD—with rTMS.6 Finally, because the DLPFC is involved with cognitive processes, such as working memory and executive function, we performed a cognitive evaluation in these patients before and after the treatment as to assess the safety of this treatment.
Intervention: Transcranial Magnetic Stimulation
Transcranial magnetic stimulation was performed using a commercially available figure-8 coil (outside diameter of each wing = 7 cm) and a Magstim stimulator (1.5 Tesla version; Magstim Company Ltd, Wales, United Kingdom). The current wave form was biphasic, and the orientation of the stimulation coil was 45˚ from the midline with the handle pointing backward. Patients were randomly assigned to receive active rTMS (left or right DLPFC) and sham rTMS as detailed below.
Active rTMS treatment. There were 2 active rTMS groups (high-frequency rTMS of the left DLPFC [referred to in the text as "left rTMS"] and high-frequency rTMS of the right DLPFC [referred to in the text as "right rTMS"]). Patients received 10 TMS treatments that were administered 5 days per week (weekdays only) for 2 consecutive weeks. The TMS apparatus was equipped with a figure-8–shaped insulated coil. Repetitive transcranial magnetic stimulation was applied by positioning the stimulation coil over the appropriate position (DLPFC) on the subject's scalp following the guidelines of Pascual-Leone et al27 for the localization of the DLPFC. Transcranial magnetic stimulation at 20 Hz was applied at 80% of the patient's motor threshold. Each participant received 1,600 pulses per session (40 trains of 2 seconds with an intertrain interval of 28 seconds) over either the right or left DLPFC. These parameters are within the safe parameters according to the safety guidelines published by Wassermann.12 Two trained technicians administered the treatment for patients. These technicians had no contact with patients and were not involved in this study.
Sham rTMS treatment. The 10 sham rTMS treatments were administered with the same TMS methodology used for active rTMS treatments, except that no actual magnetic stimulation was released from the coil. We used a specially designed sham TMS coil that has the identical appearance and weight as the real coil. In addition, we installed a small electrical stimulator underneath this coil as to mimic the scalp sensation produced by the active rTMS similarly used by Okabe et al.28 Therefore, this device induced a small electric current (that was near the perception threshold and adjusted for each subject) in order to induce scalp sensation. Although we believe that this method improved the blinding in our study (as compared to standard sham TMS), we did not perform assessment of blinding. With respect to lateralization of sham rTMS, 5 subjects received left hemisphere sham stimulation and 5 subjects received right hemisphere sham stimulation. In this way, a total of 15 subjects had the electrode placed on the right side: 5 subjects received sham and 10 received active stimulation. Similarly, a total of 15 subjects had the electrode placed on the left side: 5 received sham and 10 received active stimulation. This methodology helped to ensure that lateralization would not inherently unblind the subjects. Although it is possible that placing the sham electrode on the left side has a different placebo effect than placing the electrode on the right side, the subjects were not aware that we were interested in comparing left and right rTMS, and so this is unlikely to have made a significant difference.
Methods of Measurement
Before the treatment, we collected data on demographic and clinical information, such as marital status, place of birth, education, place of residence, and the type of trauma that led them to seek help. We then assessed PTSD symptoms using a clinician-administered PTSD scale.29 In order to assess changes before, during, and after treatment, a blinded rater measured PTSD symptoms, anxiety, and depression. These measures were taken at 7 time points: before treatment (baseline), at day 5, at day 10, at day 24 (2 weeks after the end of the intervention), at day 38 (4 weeks after treatment), at day 66 (8 weeks after treatment), and at day 94 (12 weeks after treatment). The participants were assisted in answering the questions, if needed. The interviewer ensured that all participants clearly understood the content of each item and the different aspects of the various component questions. The 4 instruments were used as follows:
PTSD Checklist. The PTSD Checklist30 is a 17-item self-report checklist of PTSD symptoms based closely on the DSM-IV criteria. The respondents rated each item from 1 ("not at all") to 5 ("extremely") to indicate the degree to which they have been bothered by that particular symptom over the past month. Thus, the total scores range from 17 to 85.
Treatment Outcome PTSD Scale. The Treatment Outcome PTSD Scale31 is a clinician-rated instrument that measures the presence and severity of PTSD. This 8-item instrument measures symptoms that occur frequently within the PTSD population and is sensitive to the 3 major PTSD symptom dimensions: intrusive thoughts, avoidance behavior, and hyperarousal symptoms. Each symptom is rated on a defined scale (0 to 4). Higher scores reflect greater severity on each measure.
Hamilton Anxiety Rating Scale. The Hamilton Anxiety Rating Scale32 is a clinician-rated instrument that measures the presence and severity of anxiety. This instrument covers 14 symptoms. Each symptom is rated on a defined scale (0 to 4). A higher numeric rating reflects greater symptom severity.
Hamilton Depression Rating Scale. The Hamilton Depression Rating Scale33 is a 28-item instrument that measures the presence and severity of depression. Each symptom is rated on a defined scale (0 to 4), whereby a higher numeric rating reflects greater symptom severity.
In addition to these questionnaires and tasks, a battery of neuropsychological tests using alternate forms for repeated measures was performed to assess whether the treatment was associated with a detrimental effect on cognition and, therefore, to gather preliminary data on the safety of this treatment. This battery consists of the following tests: executive function (Wisconsin Card Sorting Test34 [number of categories and perseverative errors], Controlled Oral Word Association Test35 [phonemic category—letters F, A, S], Victoria version of the Stroop Test36 [colored words and interference card]); reasoning (Raven Colored Progressive Matrices37); and working memory (Digit Span Test38—forward and backward).
Statistical Analysis
The sample size calculation was based on the study of Cohen et al.6 These data show that the scores on the PTSD Checklist after 2 weeks of treatment were 43.5 (± 8.3) for the active group and 55 (± 4.9) for the sham group. For our sample size calculation, we assumed a type I error of 5% (α–2-tailed) and a type 2 error of 10% (β). Therefore, for a 90% power, 8 participants per arm were necessary (total of 24 participants). Conservatively, we increased this number to 30 participants (10 per arm) to account for unexpected factors such as a higher placebo response.
The ratings of psychopathology (PTSD Checklist, Treatment Outcome PTSD Scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale) were entered into a mixed 2-way repeated measures analysis of variance (ANOVA). The 2 fixed factors were group (active left rTMS, active right rTMS, and sham) and time (baseline, day 5, day 10) with repeated measures on time. The goal of this model was to detect if there was a significant interaction term between group and time. In addition, we included the random factor subject identification to account for within-subject variability. The main outcome in this study was PTSD symptom changes as assessed with the PTSD Checklist. The other instruments were used as secondary outcomes. If appropriate, paired post hoc tests with Bonferroni correction for multiple comparisons were also undertaken. In addition, we performed similar analyses for the cognitive tests.
We then assessed the long-lasting effects of this treatment, building a model in which we included time of treatment—including all the time points: baseline, day 5, day 10, day 24, day 38, day 66, and day 94—as the main variable and performed this model for the 2 active groups to assess each slope separately.
Finally, we performed exploratory paired correlation tests using Pearson correlation coefficient in which we compared clinical changes in PTSD with demographic characteristics.
There were only 4 dropouts in this study. We used the intention-to-treat analysis to handle missing data using the method of last-observation-carried-forward. This is considered a conservative approach as it leads the results toward the null hypothesis.
There were 4 dropouts (2 in the sham group and 2 in the active groups [1 in the left rTMS and 1 in the right rTMS group]). All of the dropouts were associated with difficulties in travel to the rTMS clinic for 10 consecutive days as most of these patients depended on family members to bring them to the rTMS clinic.
Click figure to enlarge
The demographic and clinical data are summarized in Table 1. Most of the study subjects (21 of 30) were female. There were no significant differences in demographic and clinical scores at baseline across the 3 groups of treatment. Patients tolerated treatment well. There were no seizures and only mild adverse effects, such as mild headache, neck pain, sleepiness, and dizziness, were reported similarly in the 3 groups of treatment.
Core PTSD Symptoms
We initially performed a full model to assess whether the interaction term was significant. This analysis showed a significant interaction term group versus time for the PTSD Checklist (F6,54 = 11.2; P < .001) and for the Treatment Outcome PTSD Scale (F6, 54 = 12.7; P < .001). We then performed post hoc analysis with Bonferroni correction for multiple comparisons.
For PTSD Checklist, right rTMS induced a significant decrease in PTSD symptoms after 5 days (P = .018, corrected P value) and 10 days (P = .0042, corrected P value). Similar results were found for left rTMS: significant decrease in core PTSD symptoms after 5 days (P = .012, corrected P value) and 10 days (P = .012, corrected P value). For sham stimulation, there was no significant difference in PTSD Checklist after 5 days (P = .42, corrected P value) and 10 days (P = .32, corrected P value) (Figure 1A).
Similar results were obtained for the Treatment Outcome PTSD Scale. After 5 and 10 days of stimulation, there was a significant decrease in core PTSD symptoms for right rTMS (P = .02 and P = .008, respectively, corrected P values) and left rTMS treatment (P = .0042 and P = .0039, respectively, corrected P values). For sham rTMS, similarly, there were no changes in PTSD symptoms (P = .18 and P = .36, respectively, corrected P values) (Figure 1B).
Moreover, when comparing left and right rTMS, the results show that improvement after right rTMS is larger as compared to left rTMS, and this difference was marginally significant (for PTSD Checklist: 36.9% [± 20.1] vs 23.1% [± 15.4], right and left rTMS, respectively; P = .03; for Treatment Outcome PTSD Scale: 48.6% [± 27.2] vs 22.8% [± 18.4], P = .051).
Finally, because both active treatments resulted in significant improvements in PTSD symptoms, we then analyzed whether one of these strategies is more effective according to the clusters of symptoms (eg, reexperiencing, avoidance, and hyperarousal). Initially, we ran a full model with the factors group (right and left rTMS), cluster, and time. This model revealed that the interaction term group versus time versus clusters was significant (F9,108 = 5.78; P < .0001); suggesting that clusters of symptoms changed differently across the 2 active groups of treatment. In fact, mixed ANOVA models for each cluster showed a significant difference between right and left rTMS for avoidance only (F1,18 = 6.83; P = .018) but not for reexperiencing (F1,18 = 0.18; P = .68). There was a trend for a differential effect for hyperarousal (F1,18 = 2.83; P = .10). In fact, whereas the improvement in avoidance and hyperarousal was larger for right rTMS as compared to left rTMS, for reexperiencing, improvement in both groups was similar.
Anxiety and Depression
We performed an analysis of symptoms of anxiety and depression in a manner similar to that of the PTSD symptoms. We initially executed a full-model analysis to assess whether the interaction term time versus group was significant. This analysis showed a significant interaction term group versus time for both the Hamilton Depression Rating Scale (F6,54 = 17.9; P < .001) and the Hamilton Anxiety Rating Scale (F6,54 = 6.7; P < .001). We then performed post hoc analysis with Bonferroni correction for multiple comparisons.
The post hoc analysis showed an interesting result: while depression scores were significantly improved only after left rTMS treatment (P < .0001 and P = .0006, for after 5 and 10 days, respectively, corrected P values), anxiety scores were significantly decreased only after right rTMS treatment (P = .0066 and P = .0096, after 5 and 10 days, respectively, corrected P values). Sham rTMS induced no significant changes in Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores (Figures 1C and 1D).
Cognitive Function
We then assessed whether rTMS was associated with cognitive worsening. Analysis with a mixed ANOVA model showed that the interaction term time versus group was not significant for the tests—Stroop Test, Digit Span Test (forward and backward), Raven Colored Progressive Matrices, and Wisconsin Card Sorting Test (Table 2, F and P values)—when comparing baseline to day 10 results. Interestingly, in all of these tests, the active groups had an increase in absolute values in performance following rTMS.
However, for the Controlled Oral Word Association Test, the interaction term was statistically significant (F3,27 = 3.24; P = .037). Post hoc comparisons showed that performance was only improved after right rTMS (P = .015, corrected P value). There were no significant changes after left rTMS (P = .99) and sham rTMS (P = .99) (see Table 2 for details).
Effect Durability
We initially performed a full model with all time points (baseline, day 5, day 10, day 24, day 38, day 66, day 94) and treatment groups (right, left, and sham rTMS). This model showed a significant interaction term time versus group for the PTSD Checklist (F18,162 = 6.54; P < .0001) and Treatment Outcome PTSD Scale (F18,162 = 6.85; P < .0001). We then performed separate models for right and left rTMS groups in order to assess whether the slope of time was significantly different from 0. Interestingly, the main effect of time was significant for left and right rTMS for both PTSD instruments: PTSD Checklist and Treatment Outcome PTSD Scale (F6,54 > 5 and P < .0001 for all 4 analyses); showing that the effects were long-lasting (Figures 1E and 1F). In fact, when comparing day 94 against baseline for both PTSD outcomes, this difference remained significant (P < .005 [corrected P value] for all 4 comparisons).
Finally, we correlated the effects of rTMS on PTSD symptoms (as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale) with demographic and baseline clinical characteristics. There was a marginally significant correlation between duration disease and PTSD symptom improvement at 10 days (r = −0.45 and P = .045 for PTSD Checklist and r = −0.43 and P = .058 for Treatment Outcome PTSD Scale), such that longer elapsed time since trauma was associated with a larger response.
In this study, 30 patients with PTSD were randomly assigned to receive treatment with 10 daily sessions of either 20 Hz rTMS of right DLPFC ("right rTMS"), 20 Hz rTMS of left DLPFC ("left rTMS"), or sham stimulation. Our results demonstrate that active stimulation of the right and left DLPFC were both effective in the relief of core PTSD symptoms (hyperarousal, vigilance, intrusive thoughts, emotional numbness, withdrawal, etc) at days 5 and 10 as determined by scores on the PTSD Checklist and Treatment Outcome PTSD Scale. Interestingly, right rTMS was associated with a greater improvement in core PTSD symptoms (ie, larger reduction in PTSD Checklist and Treatment Outcome PTSD Scale scores) when compared to left rTMS. On the other hand, left rTMS resulted in a significant improvement with respect to symptoms of depression (ie, significant reduction in Hamilton Depression Rating Scale scores) at days 5 and 10 whereas changes in symptoms of depression were not significant for right rTMS. Interestingly, right rTMS generated a significant improvement in the measure of anxiety (Hamilton Anxiety Rating Scale) at days 5 and 10 while left rTMS did not. Finally, with respect to the measures of cognitive performance (Stroop Test, Digit Span Test, Wisconsin Card Sorting Test, and Raven Colored Progressive Matrices), right and left rTMS were both associated with improvements in neuropsychological performance, although these results were not statistically significant (see Table 2). Unexpectedly, there was a significant improvement in verbal fluency—as indexed by Controlled Oral Word Association Test (phonemic category—letters F, A, S)—following right rTMS.
Our findings here support the results of Cohen et al,8 which show that 10 Hz rTMS applied to the right DLPFC results in improvements to both core PTSD symptoms and anxiety. Indeed, our study shows that 20 Hz rTMS of right DLPFC has similar effects as previously described for 10 Hz right TMS, namely improvements in core PTSD and anxiety symptoms; because of our longer follow-up period, we were also able to show that these beneficial effects persist for at least 3 months. Furthermore, here we also tested the efficacy of left DLPFC stimulation in PTSD and showed that, indeed, 20 Hz left rTMS improves symptoms of depression as well as core PTSD symptoms but not symptoms of anxiety. However, because the effect of left rTMS on core PTSD symptoms was significantly smaller in magnitude in comparison to the effects of right rTMS, the improvement seen with 20 Hz rTMS of left DLPFC may be secondary to the antidepressant effects of this mode of stimulation.
As demonstrated above, right rTMS has a significant effect in relieving the anxiety dimension of PTSD; this feature may be the primary factor underlying the beneficial effects observed. Longitudinal studies show that anxiety sensitivity and trait anxiety are important components of PTSD onset and vulnerability,39,40 and targeting central nervous system networks involved in the perpetuation of anxiety may be a highly effective approach. In addition, antidepressant SSRIs used in the treatment of PTSD have a common effect in reducing anxiety across the spectrum of anxiety disorders.39 Hence, we propose that high-frequency stimulation of right DLPFC may be an effective approach in the neuromodulatory treatment of PTSD and that it may function by decreasing the anxiety component of this disorder.
A functional magnetic resonance imaging (fMRI) study by Whalley et al41 provides additional evidence for the understanding of a potential mechanism that may explain the demonstrated anxiety-relieving capacity of right rTMS in patients with PTSD. In this imaging study of patients with either PTSD or depression as well as trauma-exposed controls, fMRI results for the contrast between old and new items during an episodic memory retrieval task revealed activation in a predominantly left-sided network of cortical regions, including the left middle temporal, bilateral posterior cingulate, and left prefrontal cortices for all groups. Furthermore, relative to the control and depressed groups, the PTSD group exhibited greater sensitivity to correctly recognized stimuli in the left amygdala/ventral striatum and right occipital cortex, and more specific sensitivity to items encoded in emotional contexts in the right precuneus, left superior frontal gyrus, and bilateral insula. These results are interesting as they demonstrate that, first of all, retrieval of episodic memory is a predominantly left-sided task; thus, it may be speculated that because high-frequency rTMS of right DLPFC is known to inhibit left-sided structures via transcollosal inhibition, excitatory neuromodulation of the right DLPFC with 20 Hz rTMS may, in fact, manifest its PTSD-alleviating effects via inhibition of left-sided memory retrieval networks. In this line, 1 Hz inhibitory rTMS of the left prefrontal cortex might also be an effective approach for the treatment of PTSD. Secondly, the study shows that patients with PTSD may have specific foci of hyperactivity/sensitivity in subcortical nuclei; therefore, prefrontal modulation might inhibit subcortical nuclei that are highly active in PTSD. An alternative suggestion for the mechanism of right rTMS may be based on work by Shin et al,42 which shows hypoactivation of the medial prefrontal cortex in patients with PTSD. In this case, enhancement of activity in right or left prefrontal areas with high-frequency rTMS could be compensating for deficient prefrontal regulation of memory retrieval. These hypotheses are in accordance with proposed neurobiological models for PTSD,43 which hold that the symptoms of flashbacks and intrusive thoughts, among other core PTSD symptoms, may be the result of either hyperactive transmission of fear-relevant information to the amygdala, which is independent of thalamic and hippocampal nuclei, but which relies strongly on visual areas of the inferior temporal cortex, and/or the result of hypoactivation of prefrontal cortex. Indeed, Koenigs et al44 show that ventral medial prefrontal cortex and amygdala are critically involved in the pathogenesis of PTSD.
An important limitation when using a device, especially rTMS, in clinical trials is the sham method. Although we tried to improve the sham method with the electrical stimulator attached to the sham coil and divided the sham group in right and left DLPFC stimulation, it is still possible that our blinding method was not effective, and this is an inherent limitation to rTMS studies.
Therefore, in summary, 10 daily sessions of high-frequency 20 Hz rTMS of right and left DLPFC resulted in improvements in core PTSD symptoms (right > left). Right rTMS also improves anxiety, while left rTMS improves depression. Our results show a long-lasting effect of rTMS—consistent with other applications of rTMS as in neuropathic pain45 and major depression46—and indicate that both right and left rTMS are safe as they are not associated with cognitive worsening and show only mild adverse effects in patients with PTSD. This study supports the continuation of clinical investigation of brain stimulation for the treatment of PTSD: our results confirm that high-frequency rTMS over the right DLPFC may be the best approach in most patients, yet we suggest that patients with high levels of depression may show greater benefit from high-frequency rTMS applied over left DLPFC.
Author affiliations: Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Drs Fecteau, Pascual-Leone, and Fregni and Mr Zaghi); Programa de Pós-Graduação em Distúrbios do Desenvolvimento e Núcleo de Neurociências do Comportamento, Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, São Paulo (Dr Boggio); Departmento de Psicologia, Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, São Paulo (Dr Boggio and Mss Rocha, Oliveira, and Campanhã); Centro Brasileiro de Estimulacao Magnetica Transcraniana, São Paulo (Dr Cohen); and Departmento de Psiquiatria, Universidade de São Paulo (Drs Ferreira-Santos, Meleiro, and Corchs), Brazil.
Potential conflicts of interest: None reported.
Funding/support: This work was supported by a research grant from Northstar Neuroscience. In addition, Ms Rocha was supported by a research grant (Programa Institucional de Iniciação Cientifica [PIBIC]-Mackenzie).
Acknowledgments: The authors are thankful to John Scandone, BSc, from Magstim Company LTD for assisting us with equipment needs for this study; to Barbara Bonnetti, BA, from the Instituto Scala in São Paulo, Brazil, for administrative support; and to Carolina Mello Santos, MD, from the University of São Paulo in São Paulo, Brazil, for assistance with patient referrals. None of these individuals report any conflicts of interest.
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The White Star Line publicists pulled out all the stops when promoting the Titanic and its sister ship the Olympic, even claiming in one brochure that these giants "were designed to be unsinkable."By the time Titanic put to sea, this language had evolved into a boast -- reportedly shared with passengers -- that "God Himself couldn't sink this ship."Thus, when the liner sank on April 15, 1912, preachers on both sides of the Atlantic were among the first commentators to raise their voices in … [Read more...]
Titanic sermons, a century later
April 16, 2012 by


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Israel Capitulates to Hunger Striking Terrorist (INN) ISRAEL NATIONAL NEWS) By Gavriel Queenann 02/21/12)
Source: http://www.israelnationalnews.com/News/News.aspx/153001#.T0O-uoeO2So
INN} ISRAEL NATIONAL NEWS Articles-Index-Top
Islamic Jihad leader Kahder Adnan agreed to end his 66-day hunger strike on Tuesday after State Prosecutors agreed not to renew his administrative detention order.
Adnan, held on suspicion of terror activity since 17 December 2010, will be released on 17 April 2011.
Adnan, 33, has been held in administrative detention since his arrest on the basis of intelligence data indicating he is a threat to Israel´s national security.
The deal for Adnan´s release was announced early Tuesday afternoon before Adnan´s scheduled appeal before Israel´s Supreme Court, which was cancelled at the last minute.
Deputy Knesset Speaker Danny Danon railed against the deal State Prosecutors cut Adnan saying it "set a dangerous precedent."
Danon has called for an immediate Knesset debate on the matter saying prosecutors capitulated to terrorism" and that "this deal renders the Israeli values system meaningless.
Danon said the state "should not have a sign a deal with a terrorist, and should not give preferential treatment."
Under Israel´s administrative detention laws security officials can petition the courts to order a prisoner held without charges for up to four months. The decision can be appealed to higher courts.
Doctors had reportedly warned Israeli officials that Adnan could die at any moment. But observers note Adnan was refusing nourishment of his own rational volition.
The World Medical Association maintains hunger-striking prisoners who have made a rational decision to refuse sustenance should not be force fed.
In 1975 the organization resolved, "Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially."
"The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician. The consequences of the refusal of nourishment shall be explained by the physician to the prisoner," the WMA maintains.
However, Adnan was taking liquid infusions of salts, glucose and minerals raising questions about the accuracy of pervasive media reports that his death was "imminent."
While Adnan became a cause celebre in the international media and among anti-Israel activists, little attention was given to his senior position in the Islamic Jihad terror organization. Islamic Jihad seeks the destruction of Israel and actively targets Jewish civilians.
In late January, the GSS and Israel Police foiled a shooting attack planned by an Israeli Arab in collaboration with an Islamic Jihad terror cell from Tulkarem in northern Samaria.
Last August, Islamic Jihad terrorists from Gaza were involved in the deadly cross-border ambush of an Israeli civilian bus that left 8 Israelis 7 of them civilians dead.
Islamic Jihad leaders in Gaza whose terror cells are heavily involved in rocket attacks on Israel´s southern communities have been targeted with airstrikes rather than arrest and detention. (IsraelNationalNews © 2012 02/21/12)
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Luxembourg firm Kleyr Grasso Associés has made a lateral partner hire from Linklaters, appointing Jean-Paul Spang as its ninth partner.
Spang will join the firm on 1 February 2014.
He has been a partner at Linklaters and its legacy firms in Luxembourg since 1998. Spang advises on a broad range of corporate and finance matters, and also lectures at the University of Luxembourg.
Kleyr Grasso managing partner Marc Kleyr said the hire was in line with the firm's plans to develop its corporate finance practice.
Linklaters last lost a partner in Luxembourg just over a year ago, when corporate partner Laurent Schummer moved to local giant Arendt & Medernach (6 November 2012). The magic circle firm moved into the jurisdiction in 1999, when it signed Loesch & Wolter up to its European alliance (31 May 1999), through a merger with Belgian ally De Bandt van Hecke & Legae.


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Carinus drew the Phrygian down beside him and laid his head in her lap.
Ere this have I been wild with love for a herdsman on Phrygian hills.
One of the few liturgic formulas antiquity has left us refers to these Phrygian banquets.
There is no evidence that this Phrygian figure was derived from Semitic sources.
On the slopes of the Phrygian hills, there once dwelt a pious old couple named Baucis and Philemon.
But whether or not the Phrygian Faun was silent, I cannot be.
The conflict took place near the Phrygian Dorylaion, and seemed at first to portend dire defeat to the crusaders.
The hood resting on the edge of her chignon formed a kind of Phrygian cap.
He came from Thrace and is very closely related to the Phrygian Sabazius.
Quite the reverse, he replied; and if so the Dorian and the Phrygian are the only ones which you have left.
late 15c., "native of Phrygia," region in ancient Asia Minor; Phrygian mode in ancient Greek music theory was held to be "of a warlike character." Phrygian cap (1796) was the type adopted by freed slaves in Roman times, and subsequently identified as the cap of Liberty.


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