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Association Between Number of Deployments to Iraq and Mental Health Screening Outcomes in US Army Soldiers
Mark A. Reger, PhD; Gregory A. Gahm, PhD; Robert D. Swanson, PhD; and Susan J. Duma, MA, MPH
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Objective: High rates of mental health concerns have been documented in US Army soldiers deployed in support of Operation Iraqi Freedom. The goal of this study was to compare the postdeployment mental health screening results of US Army soldiers with 1 or 2 deployments to Iraq.
Method: Routine mental health screening data collected from September 7, 2005, to April 27, 2007, in the Soldier Wellness Assessment Program were compared between soldiers evaluated after their first or second deployment to Iraq (n = 1322). Standardized measures (Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, Primary Care Posttraumatic Stress Disorder Screen, Alcohol Use Disorders Identification Test) were used to screen for posttraumatic stress disorder (PTSD), panic, other anxiety, major depression, other depression, and hazardous alcohol consumption 90 to 180 days after the soldiers returned from Iraq.
Results: There was a significant association between number of deployments and mental health screening results such that soldiers with 2 deployments showed greater odds of screening positive for PTSD (odds ratio [OR]=1.64, P = .001). Similar results were observed when the analyses were repeated utilizing a more conservative cut-point for PTSD (OR = 1.60, P = .001). After adjustment for demographic characteristics, the results were unchanged. There was no association between the number of deployments and other mental health screening results.
Conclusions: These results provide preliminary evidence that multiple deployments to Iraq may be a risk factor for PTSD. However, these cross-sectional data require replication in a longitudinal study.
Submitted: May 7, 2008; accepted September 17, 2008.
Online ahead of print: August 11, 2009.
Corresponding author: Gregory A. Gahm, PhD, National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Tacoma, WA 98431-1100 (e-mail: email@example.com).
J Clin Psychiatry 2009;70(9):1266–1272
© Copyright 2009 Physicians Postgraduate Press, Inc.
Online ahead of print: August 11, 2009 (doi:10.4088/JCP.08m04361)
The number of mental health patients presenting in military, Veterans Affairs (VA), and community mental health clinics with a history of a deployment to Iraq is growing. Since the invasion of Iraq (Operation Iraqi Freedom; OIF) in March 2003, hundreds of thousands of US soldiers have deployed to Iraq,1 and about 67% report potentially traumatic combat experiences.2 The impact of deployment and combat exposure on mental health functioning is an important public health issue, not only for the military, but also for the civilian mental health community, as soldiers with mental health concerns are discharged to civilian status faster than soldiers without mental health problems.3
Several seminal studies have begun to clarify the impact of deployment to Iraq on mental health functioning. In an early study by Hoge and colleagues,4 soldiers assessed 3 to 4 months after a deployment to Iraq screened positive for "strict" posttraumatic stress disorder (PTSD) criteria in 13% of cases; screening rates for depression and generalized anxiety were each observed in about 8% of cases, and alcohol misuse was observed in over 20% of cases. With the exception of generalized anxiety, these rates were significantly higher than predeployment screening rates observed in a comparable US Army unit. In a separate study, routine postdeployment screening data collected within 2 weeks of returning from Iraq revealed that Army soldiers and Marines screened positive for a mental health problem in 19% of cases, compared to 8.5% returning from operational locations other than Iraq or Afghanistan (Operation Enduring Freedom; OEF).3
Similar results have been reported in veteran populations. Examining over 103,000 OIF/OEF veterans, Seal and colleagues5 reported that 25% of health care patients in the VA system had been diagnosed with a mental health disorder, including 13% with PTSD. The rate of PTSD diagnoses in a similar VA sample was reportedly 3.7 times higher among Army soldiers or Marines who served in ground units in Iraq or Afghanistan compared to Navy or Air Force veterans of OIF/OEF.6 Thus, several independent studies have documented high rates of mental health concerns in Army soldiers deployed in support of OIF.
The importance of these results is underscored by the impact of anxiety disorders on patients' emotional, social, and physical well-being. The National Survey of the Vietnam Generation revealed that veterans with lifetime diagnoses of PTSD and major depression showed significantly lower employment rates and hourly wages compared to veterans without these disorders.7 PTSD has been associated with increased marital distress and parental adjustment problems.8,9 In addition, OIF/OEF veterans with PTSD or hazardous alcohol consumption reported a lower quality of life.10 Furthermore, soldiers studied 1 year after deployment to OIF showed strong associations between PTSD and physical health problems.11 OIF veterans with mental disorders may face impairments in job performance, intimate and family relationships, quality of life, and physical health.
There is currently speculation as to whether multiple deployments to Iraq may exacerbate the frequency and severity of mental health problems described above. Multiple deployments increase the probability that a soldier will be exposed to combat and may also increase the cumulative stress an individual experiences. Deployment stressors can include a sense of isolation, relationship stress, homefront problems, challenges associated with adjusting to a new environment, a threatened sense of safety, traumatic stress, long work hours, and stressors associated with a variety of other operational demands. Concomitant reductions in usual coping resources (eg, access to friends and family, hobbies, time alone) may also impact mental health functioning. In contrast, potential protective factors such as unit cohesion, effective leadership, mentoring, training, and access to other resources in theater may mediate the impact of deployment stress.
To our knowledge, no peer-reviewed studies have examined the impact of multiple OIF deployments on mental health functioning in US military personnel. Internal Army studies have reported mixed results.12–14 A study of United Kingdom (UK) Armed Forces personnel has been conducted and revealed no significant association between number of deployments in the last 3 years and screening results on measures of PTSD or psychological distress.15 However, unlike most US soldiers, many of the subjects in the UK study were deployed for short periods. Previous studies of US and UK service members suggest that results from one cohort may not generalize to the other.3,4,16
There is evidence that exposure to multiple traumas may increase the risk for mental health problems. For example, a Swedish study of 1,824 randomly selected individuals from the general population revealed that trauma frequency was significantly associated with an increased risk of PTSD.17 Similar results have been noted in patients hospitalized at trauma centers.18 In addition, among service members who worked in a mortuary during the Persian Gulf War, greater changes in PTSD symptoms were observed in groups with the greatest exposure to human remains.19
The purpose of this study was to determine if there is a relationship between multiple deployments to Iraq and mental health problems as identified by mental health screening outcomes for US soldiers with 1 or 2 deployments to Iraq. Given the mixed reasons to predict differential outcomes, we had no a priori hypotheses.
Study Population
Data were retrospectively analyzed from the Soldier Wellness Assessment Program (SWAP) database at a large military medical facility. The SWAP is an extension of a standard postdeployment screening program conducted throughout the Army and Department of Defense (the Post-Deployment Health Reassessment program).20 The SWAP provides a global health assessment, including mental health screening, for all soldiers 90 to 180 days after returning from an operational deployment. During the SWAP process, soldiers first completed a set of screening measures and additional items on demographics, military information, psychosocial history, and deployment exposures and stressors on a computer. Soldiers were seen by medical personnel for injury prevention, smoking cessation, or other reported physical concerns as needed, and a credentialed behavioral health provider met individually with each soldier. A nurse practitioner reviewed all aspects of the soldier's SWAP encounters, and administrative support staff met with each soldier to schedule follow-up appointments.
The SWAP's postdeployment screening data from September 7, 2005, to April 27, 2007, were analyzed. All service members in the database were regular, active duty soldiers. Cases were included in the analysis if they met 2 criteria: (1) Iraq was reported as the deployment's operational location and (2) the total historical number of reported deployments in support of OIF was 1 or 2. There were not enough soldiers with 3 deployments in the database to expand the analysis to include this group. Cases were included when the soldiers were screened within at least 60 days of the target postdeployment timeframe. Soldiers with reported histories of deployment in support of OEF were excluded from the analysis. Based on these criteria, 661 soldiers were evaluated after their second deployment to Iraq. Soldiers returning from a first deployment to Iraq were randomly matched to those returning from a second deployment in a 1-to-1 ratio according to primary Army job and total combat exposure. Job type was defined as Infantry (n = 55; 4%), Armor (n = 26; 2%), Field Artillery (n = 23; 2%), Air Defense Artillery (n = 24; 2%), Aviation (n = 54; 4%), Special Forces (n = 24; 2%), Engineer (n = 196; 15%), or Non-Combat Arms (all other jobs; n = 920; 70%), and total combat exposure was calculated from a combat exposure scale (see Measures). For 22 Aviation cases, there was no match available in the cohort with 1 deployment; these cases were randomly matched to any Combat Arms case in the group with 1 deployment. Therefore, the final sample included in the analysis was 1,322 cases. The study was approved by the Department of Clinical Investigations.
Screening measures included the depression and anxiety modules from the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PHQ),21–23 the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD),24 and the Alcohol Use Disorders Identification Test (AUDIT).25 In addition, 4 combat exposure items were adapted from the Deployment Risk and Resilience Inventory.26
Primary Care Evaluation of Mental Disorders Patient Health Questionnaire. The PHQ is a self-report measure that can be entirely patient-administered to screen for threshold disorders that correspond to specific DSM-IV criteria and subthreshold disorders that require fewer symptoms than a DSM-IV diagnosis.21 The Depression and Anxiety modules administered in the SWAP provide screening results for threshold disorders, including major depression, panic disorder, and other anxiety disorder; the subthreshold disorder of other depressive disorder is also examined. Standardized algorithms described elsewhere21,27,28 were used to determine screening outcomes. Briefly, if 5 of the 9 depression items are endorsed for more than half the days, and one is anhedonia and/or depressed mood, major depression is suggested. Other depressive disorder is suggested if 2, 3, or 4 items are endorsed more than half the days and include anhedonia and/or depressed mood. In order to suggest the presence of panic disorder, all of the 5 panic symptom items must be endorsed. Other anxiety disorder is suggested if anxiety or worry is endorsed for "several or more days" over the past 4 weeks and 3 or more of the remaining 6 anxiety items are endorsed as occurring "more than half the days." The PHQ is widely used and has established reliability and validity.21,22,29,30
Primary Care Posttraumatic Stress Disorder Screen. The PC-PTSD is a brief, 4-item (yes-no) self-report screening instrument for PTSD that is a standard part of the Army's routine postdeployment screening program. The PC-PTSD demonstrated sound psychometric properties for cutoff scores of 2 (sensitivity = 0.91, specificity = 0.72) and 3 (sensitivity = 0.78, specificity = 0.87) compared to diagnoses based on the Clinician Administered Scale for PTSD.24 Since cutoff scores of either 2 or 3 may be appropriate, depending on the clinical setting,24 we analyzed results for both cut-points (PTSD-2, PTSD-3).
Alcohol Use Disorders Identification Test. The AUDIT is a 10-item self-report measure that screens for hazardous or harmful alcohol consumption.25 Item responses range from 0 (never) to 4 (daily or almost daily) with total scores ranging from 0 to 40. The standard cutoff score of 8 for hazardous or harmful consumption has consistently demonstrated favorable sensitivity and specificity in numerous studies.31–34 The AUDIT is internally consistent35 and has shown good test-retest reliability.36
Combat exposure. Screening items included 4 yes-no questions about combat experienced during the most recent deployment, adapted from the Deployment Risk and Resilience Inventory.26 Items asked the following: During combat operations, did you (1) become wounded or injured; (2) personally witness a unit member, ally, enemy, or civilian being killed; (3) see the bodies of dead soldiers or civilians; (4) kill others in combat (or have reason to believe others were killed as result of your actions)?
Statistical Analyses
Chi-square tests of association and t tests were used to compare demographic and combat exposure variables between groups with 1 or 2 Iraq deployments. Logistic regression was used to examine associations between the number of Iraq deployments and mental health screening outcomes (positive, negative). Multivariate logistic regression models were used to examine the associations irrespective of age, sex, race/ethnic background, rank, education, and marital status.
Click figure to enlarge
Subject Characteristics
Subject demographics are presented in Table 1. All data presented for the cohort with 2 deployments represent information collected following their second deployment; data related to their first deployment likely exist in the Army's enterprise databases, but the data were not in the SWAP database, and our research team did not have access to the information. Soldiers with 2 Iraq deployments differed from those with 1 deployment in terms of age, rank, education, and marital status. There was no difference between the groups in racial/ethnic background or sex. Groups did not differ on individual combat exposure items (Table 2). The sample was comparable to the gender distribution of population-level data for soldiers who are postdeployed from OIF (10.0% vs 10.6% female, respectively).3 The sample in the current study contained fewer young soldiers compared to the postdeployed population (27% vs 45% were 18–24 years of age). Therefore, the sample also contained a higher percentage of married (60% vs 48%) and senior enlisted soldiers (53% vs 37%) compared to the postdeployed population. These differences are due in part to the fact that cases with 2 deployments were selected for inclusion in this study, and therefore older subjects are overrepresented in the sample compared to the deployed population.
There was no difference between soldiers with 1 or 2 deployments in terms of the number of days between departure from theater and screening date (mean ± SD = 109.56 ± 36.69 and 108.56 ± 35.81, respectively). For the group with 1 deployment, soldiers were deployed for a mean of 319.34 days (SD = 76.59); for the group with 2 deployments, soldiers were deployed for a mean of 319.69 days (SD = 83.31; not counting time deployed during their first tour to Iraq, which was unknown). For soldiers with 2 deployments, the median arrival date in theater (October 31, 2005) was about 9 months later than the median arrival date for soldiers with 1 deployment to Iraq (January 27, 2005).
Mental Health Screening Results
There was a significant association between number of deployments and mental health screening results in the univariate analyses for PTSD-2 (OR = 1.64, P = .001) and PTSD-3 (OR = 1.60, P = .01; Table 3). There were no differences between the groups in the odds of screening positive for other conditions.
After adjusting for demographic factors, the association between number of deployments and PTSD-2 (OR = 1.72, P = .001) and PTSD-3 (OR = 1.77, P = .003) remained significant. In addition, some of the demographic factors in the models were associated with the mental health screening results. Older age was associated with decreased odds of screening positive for PTSD-3 (OR = 0.96, P = .04) and hazardous alcohol consumption (OR = 0.93, P = .004). Women were less likely to screen positive for hazardous alcohol consumption than men (OR = 0.45, P = .03). The odds of screening positive for major depression (OR = 0.49, P = .04), panic (OR = 0.36, P = .03), and other anxiety disorder (OR = 0.60, P = .03) was lower for senior enlisted (E-5 to E-9) compared to junior enlisted (E-1 to E-4) soldiers. In addition, officers were less likely to screen positive for panic (OR = 0.05, P = .04) and hazardous alcohol consumption (OR = 0.02, P = .03) than junior enlisted soldiers. Married soldiers were less likely to screen positive for hazardous alcohol consumption than soldiers who were never married (OR = 0.50, P = .001), while soldiers who were separated at the time of the screening were more likely to screen positive for other anxiety disorder (OR = 2.66, P = .01) and hazardous alcohol consumption (2.68, P = .003). Finally, the odds of screening positive for PTSD-2 (1.46, P = .03) and PTSD-3 (OR = 1.53, P = .049) were higher for those with some college than for those with a high school education or less.
These analyses were repeated after adding the number of days between screening and departure from theater to the model. The results were unchanged. In addition, although cases with a history of an OEF deployment were excluded from this study, subjects did report a history of other non-OIF/OEF deployments (mean ± SD = 0.57 ± 0.87 for those with 1 OIF deployment; 0.94 ± 1.19 for those with 2 OIF deployments). Again, the results of the logistic regressions remained unchanged after controlling for the number of non-OIF/OEF deployments.
The results of this study provide preliminary evidence that multiple deployments to Iraq may be a risk factor for PTSD. The odds of screening positive for PTSD were 60% to 77% higher for soldiers with 2 deployments compared to soldiers with 1 deployment. These results were somewhat unexpected, since the group with 2 deployments was a more mature group that may have represented a more resilient cohort. Soldiers with 2 deployments likely had longer military careers and therefore differed from those with 1 deployment in terms of age, rank, education, and marital status. In addition, soldiers identified with a postdeployment mental health condition that renders them unfit for duty are not deployed again until treatment proves successful. Furthermore, service members who screen positive for mental health concerns are more likely to leave military service in the year following a deployment3 and, therefore, may be less likely to deploy a second time. Thus, it is possible that the group with 2 deployments represented a healthier, more resilient group. However, without predeployment screening rates for both groups, conclusions are limited. A longitudinal study of the effects of multiple deployments on mental health would be helpful to clarify these issues.
These findings are generally consistent with a recent internal Army report14 which found that soldiers deployed to Iraq more than once were more likely to screen positive for a combined measure of acute stress, anxiety, or depression. However, different recruitment procedures, participant characteristics, screening procedures, and outcome measures limit comparability.
The factors contributing to these findings are unknown. The results suggest that when 2 cohorts deploy and experience the same types of combat exposure (as measured in this study), the cohort on their second Iraq deployment is more likely to screen positive for PTSD than the cohort on their first deployment. Since there was no difference on other mental health screening results, we speculate that the mental health risks associated with multiple deployments may be related more to the effects of repeated traumatic experiences (eg, combat exposure) than other cumulative deployment stressors (eg, homefront stressors, difficulties associated with working in an operational environment) that might be expected to be associated with depression or other mental health concerns. Some prior research suggests that repeated traumatic events are associated with increased mental health problems,17 while other studies have suggested that prior exposure to a stressor may facilitate resilience.37 Dougall et al38 theorized that a traumatic event may produce an inoculating effect for future traumas that are similar in nature to prior traumas, whereas dissimilar events may increase posttraumatic symptoms. While different types of combat exposure are somewhat similar to each other relative to non–combat-related traumatic events (eg, earthquakes, sexual assault), there is still significant diversity across combat experiences. There was no evidence of an inoculating effect of multiple deployments. However, information about combat exposure during first deployments (among soldiers with 2 deployments) was not available. Thus, the impact of additive combat exposures across multiple deployments remains unknown. Additional research is needed to determine how the etiology of mental health disorders following a second deployment may differ from soldiers deployed to Iraq only once.
In general, positive screening results were more prevalent in single, younger, lower-enlisted soldiers. In addition, men were at significantly greater odds of hazardous alcohol consumption. With the exception of a single education finding, these results were predicted and consistent with prior literature.39
Rates of positive screens for mental health disorders were generally lower than those reported by Hoge and colleagues.4 For example, while Hoge et al4 reported that 15% of their Army sample screened positive for major depression on the PHQ after deployment to Iraq, we observed a rate of about 4% for our total sample using the same measure and criteria ("broad" definition in the Hoge et al study4). However, significant differences between study methods may account for these differences. Hoge and colleagues'4 study utilized an anonymous survey with a specific infantry division, 3 to 4 months after an 8-month deployment to Iraq in December 2003. Our results were obtained from nonanonymous, standard postdeployment screening efforts for soldiers from a variety of units, 3 to 6 months after deployments (of varying lengths) to Iraq, from September 2005 to April 2007. Many of these factors likely contributed to the differences in the results. For example, since our sample included noncombat units, combat exposure may have been reduced in our sample compared to that of Hoge et al.4 In support of this hypothesis, 62% of their sample endorsed responsibility for the death of others (combatants and noncombatants) compared to 16% of our total sample.
In contrast, the rates of mental health concerns that we observed were higher than those reported in a recent study that examined population-based results of Army soldiers and Marines screened within 2 weeks of returning from a deployment to Iraq.3 Utilizing the 2-point cutoff score for the PC-PTSD, the investigators reported a PTSD-positive screen rate of 9.8% in their Iraq sample; this compares to a rate of about 17% in our total sample using the same measure. Both studies included a similar self-report item about whether service members saw dead bodies, and results were similar (52% in the current study compared to 50% in the Hoge et al3 study). There were no other similar combat exposure items shared between the 2 studies to further explore differences between the studies' samples. However, an important difference between the studies was the timing of the screening visit. The Hoge et al3 study was conducted within 2 weeks of returning from deployment, while our data were gathered about 3 to 6 months after deployment. Some research suggests that service members are much more likely to report mental health problems 3 to 4 months after deployment compared to shortly after returning.2,40
The results of the current research should be confirmed in future studies, as the cross-sectional design limits conclusions. In addition, all study subjects were drawn from 1 Army installation with a large active duty population. These soldiers may differ from the broader Army in a number of ways, and the results may not generalize to the rest of the Army. Generalizability is further reduced by the fact that the current study included only regular, active duty soldiers. Furthermore, it is important to emphasize that these results were obtained with self-administered screening instruments; these results do not reflect diagnostic rates.
Although subjects were matched on total types of combat experienced (eg, any exposure to dead bodies), the combat exposure scale did not account for quantity of exposure (eg, number of dead bodies observed). Therefore, it is possible that matched subjects differed in quantity of exposure. In addition, although analyses were adjusted for age, rank, and number of deployments, it is possible that cases with longer military careers were more likely to deploy with PTSD.
The time-frame of the study period may prove important for studying mental health outcomes of multiple deployments. In this study, the median date of arrival in Iraq was 9 months later for those with 2 deployments. As the theater matures and the mission requirements of Operation Iraqi Freedom evolve, the nature of the stressors that soldiers experience may change. For example, a recent Army study suggested that, although combat exposure rates remained high overall in 2007, there may have been a relative decline in combat exposure compared to 2006.14 Therefore, rates examined during 1 time frame of the conflict may not generalize to other periods. In addition, it is possible that other environmental factors (eg, access to mental health resources, telecommunications) may have differed by date, which may have impacted the results. However, since the earliest screening date included in this study was September 2005 (2 1/2 years after the start of the War), most soldiers probably benefited from the development of resources in Iraq, and these factors may have been minimized.
The importance of understanding the mental health effects of multiple deployments is likely to grow as the number of service members with 2 or more deployments increases. The results of this study provide preliminary evidence that the risk of PTSD may increase following a second deployment to Iraq. As the number of service members deployed for second tours increases, these findings may have significant implications for the demand on mental health treatment resources.
Author affiliations: From the National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Tacoma, Washington.
Financial disclosure: The authors report no competing interests.
Funding/support: This study was unfunded.
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Acknowledgment: The authors thank Greg M. Reger, PhD, National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury; John L. Miller, MD, Madigan Army Medical Center; and Murray A. Raskind, MD, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, for their contributions. Drs Reger, Raskind, and Miller report no competing interests.
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30. Means-Christensen AJ, Arnau RC, Tonidandel AM, et al. An efficient method of identifying major depression and panic disorder in primary care. J Behav Med. 2005;28(6):565–572. PubMed doi:10.1007/s10865-005-9023-6
31. Maisto SA, Carey MP, Carey KB, et al. Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess. 2000;12(2):186–192. PubMed doi:10.1037/1040-35188.8.131.52
32. Bradley KA, Bush KR, McDonell MB, et al. Screening for problem drinking: comparison of CAGE and AUDIT. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. J Gen Intern Med. 1998;13(6):379–389. doi:10.1046/j.1525-1497.1998.00118.x
33. Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–1795.
34. Cherpitel CJ. Comparison of screening instruments for alcohol problems between black and white emergency room patients from two regions of the country. Alcohol Clin Exp Res. 1997;21(8):1391–1397. PubMed
35. Reinert DF, Allen JP. The Alcohol Use Disorders Identification Test (AUDIT): a review of recent research. Alcohol Clin Exp Res. 2002;26(2):272–279. PubMed
36. Daeppen JB, Yersin B, Landry U, et al. Reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients. Alcohol Clin Exp Res. 2000;24(5):659–665. PubMed doi:10.1111/j.1530-0277.2000.tb02037.x
37. Norris FH, Murrell SA. Prior experience as a moderator of disaster impact on anxiety symptoms in older adults. Am J Community Psychol. 1988;16(5):665–683. PubMed doi:10.1007/BF00930020
38. Dougall AL, Herberman HB, Delahanty DL, et al. Similarity of prior trauma exposure as a determinant of chronic stress responding to an airline disaster. J Consult Clin Psychol. 2000;68(2):290–295. PubMed doi:10.1037/0022-006X.68.2.290
39. Riddle JR, Smith TC, Smith B, et al. Millennium Cohort: the 2001–2003 baseline prevalence of mental disorders in the US military. J Clin Epidemiol. 2007;60(2):192–201. PubMed doi:10.1016/j.jclinepi.2006.04.008
40. Bliese PD, Wright KM, Adler AB, et al. Validation of the 90 to 120 Day Short Form Psychological Screen (Research Report #2004-002). Heidelberg, Germany: US Army Medical Research Unit-Europe; 2004.


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"The same VoiceOver screen reader available on the Apple iPhone also comes standard on the iPad 2."
The iPad2 is produced by Apple Inc. and started to be sold in the United States on March, 25th, 2011. The original iPad version 1 came equipped with some convenient accessibility features for persons with disabilities, the iPad 2 has expanded on those features.
The iPad 2 is a tablet computer meaning that rather than having a traditional laptop with a screen and a keyboard, you just have a touch screen, to navigate you simply touch the screen.
The iPad 2 is a little different to the first iPad version. In terms of the accessibility, it's still a very accessible device. The original iPad really broke a lot of ground in being accessible by having VoiceOver which is a screen reader which reads out web pages and things in the operating system. It also has a full screen zoom so you can zoom in and out and get around the device that way, if you have low vision. On Apple's website at www.apple.com/accessibility/ the company illustrates how the device's design is accessible for those who are blind or are visually impaired, those who are deaf or are hard of hearing, and those who have impaired physical or motor skills.
Two main things that were added to the iPad 2 with applicability to Accessibility were FaceTime and PhotoBooth. PhotoBooth on the Mac has been a really interesting tool with Autism and other Learning and behavioral disabilities. Original features from the iPad 1 such as VoiceOver, Mono Audio, Speak Auto-text, Zoom, White on Black, Large Text, and Triple-click Home, are still available on iPad2.
The same VoiceOver screen reader available on the Apple iPhone also comes standard on the iPad 2. VoiceOver is a gesture-based screen reader, allowing you to enjoy the fun and simplicity of iPad if you are blind or have a visual impairment. With VoiceOver, you use gestures to physically interact with items on the display screen. Instead of memorizing key commands or pressing arrow keys to find what you're looking for, just touch the screen to hear an item's description, then gesture with a double-tap, drag, or flick to control the iPad.
VoiceOver on the iPad also gives you information about your device - including battery level, network signal level, and time of day. It also lets you know if the screen display changes to landscape or portrait orientation and when the screen is locked or unlocked.
Thanks to the intelligent keyboard with predictive text, auto-correct and auto-capitalization, a lot of the work is taken out of typing. Speak Auto-text lets you know what corrections it's making, and you can choose to accept those changes by pressing the space-bar or you can keep typing your intended word to override Auto-text's suggestion.
Persons who have experienced hearing loss in one ear can utilize the mono audio feature, which allows users to hear the left and right channels' audio in both ears. Those who are extremely hard of hearing can utilize the iPad 2 FaceTime feature to video chat with others where hand gestures, visual cues or dry erase boards may assist in the conversation. Closed captioning and subtitling are also available on movies purchased from the iTunes Store.
iPad 2 Facts and Accessibility Features:Facts:
Accessibility Features:
iPad 3 Release Date:
There isn't any official word from Apple on when the iPad 3 will be released; however, rumors indicate that it will be announced sometime early next year. Reports state the trial production is likely to start this October. One of the major reasons why the launch of the device has delayed is due to the Retina Display technology.
Loan Information for low income singles, families, seniors and disabled. Includes home, vehicle and personal loans.
Famous People with Disabilities - Well known people with disabilities and conditions who contributed to society.
List of awareness ribbon colors and their meaning. Also see our calendar of awareness dates.
Blood Pressure Chart - What should your blood pressure be. Also see information on blood group types and compatibility.

subset: commoncrawl


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GONAL-f CONSORT (Consistency in r-hFSH Starting Doses for Individualised Treatment)
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
|Drug: Recombinant human follicle stimulating hormone (r-hFSH)
|Study Type:
|Study Design:
|Observational Model: Cohort
Time Perspective: Prospective
|Official Title:
|Observational Study GONAL-f® Consort
- Consistency of dose of Gonal-f recommended by the doctor for the first stimulation day with the dose recommended by the CONSORT calculator [ Time Frame: 6 month ]
- Efficacy parameters [ Time Frame: 6 month ]Total dose and the necessity of a dose adjustment during stimulation period, number of the obtained ova after hCG administration, the duration of the stimulation,stimulation dose on the last stimulation day
Biospecimen Retention: Samples Without DNA
|Study Start Date:
|April 2008
|Study Completion Date:
|July 2011
|Primary Completion Date:
|July 2011 (Final data collection date for primary outcome measure)
Drug: Recombinant human follicle stimulating hormone (r-hFSH)
Since the introduction of the first recombinant human follicle stimulating hormone (FSH) preparation Gonal-f in the year 1996, a pure drug is available as raw material, which is independent of human urine due to biotechnological methods and consequently can be produced free of contaminating proteins. In accordance with the recommendations of European Medicines Agency (EMEA) in February 1999, on the basis of data from clinical studies, Gonal-f should be regarded as the more effective preparation in comparison to urinary FSH. Serono has developed a dose calculator, the CONSORT calculator, after analyzing the data from clinical studies for Gonal-f. This non-interventional study is planned to examine the consistency of the dose recommended by the doctor for the first stimulation day with the dose recommended by the CONSORT calculator. All subjects, who undergo stimulation with Gonal-f in preparation for a technology of the assisted conception in accordance with the permitted indication, will be included in this non-interventional study.
Primary Objective:
- To examine, how far the dose recommended by the doctor for the first stimulation day varies from the dose recommended by the CONSORT calculator
|Ages Eligible for Study:
|up to 35 Years (Child, Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
|Sampling Method:
|Probability Sample
Inclusion Criteria:
- Female subjects undergoing stimulation with Gonal-f in ART in accordance with the permitted indication
- Subjects below 35 years of age
- Subjects who have a Body mass index below 30
- Subjects with a basal FSH below 12 I.E./l and is downregulated in the long gonadotropin hormone releasing hormone agonist (GnRHa) Protocol
Please refer to this study by its ClinicalTrials.gov identifier: NCT01100333
|Universitätsmedizin Charitè Berlin, Schumann Straße 20/21
|Berlin, Germany, 101107
|Study Chair:
|W. Bilger
|Merck Serono GmbH, Germany, an affiliate of Merck KGaA, Darmstadt, Germany
|Responsible Party:
|Merck KGaA
|ClinicalTrials.gov Identifier:
|NCT01100333 History of Changes
|Other Study ID Numbers:
|Study First Received:
|February 24, 2010
|Last Updated:
|July 30, 2014
Keywords provided by Merck KGaA:
Reproductive technologies, Assisted
Additional relevant MeSH terms:
Genital Diseases, Male
Genital Diseases, Female
Follicle Stimulating Hormone
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
ClinicalTrials.gov processed this record on August 18, 2017


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This just in! Stop the presses! Get me rewrite, baby! Grady Judd has just announced he had Cheerios for breakfast this morning! Grady Judd has also proclaimed he plans to have a ham and cheese sandwich for lunch and as for dinner, stand by — a press conference will be forthcoming.
In fact, the high sheriff of Polk County will be holding a press conference to release — exclusively — details of a future press conference, just as soon as he can figure out which arrest du jour he wants to hold up as yet another sterling example of sleuthing skills that make Dick Tracy look like a night watchman.
Are you beginning to get the feeling the Sheriff of Grady I Am spends more time on television hawking himself than the late Billy Mays? Can Judd pimping Popeil's pocket combination chicken roaster and fingerprint set under the lights of the Home Shopping Network be that far behind?
We probably don't really want to know.
The High Sheriff of Narcissusham was in rare form the past few days over the arrest of a hapless mope from Colorado who is to literary cafe society what WikiLeaks founder Julian Assange is to keeping a secret.
Philip Ray Greaves, who wrote the least seller The Pedophile's Guide to Love and Pleasure: A Child-Lovers Code of Conduct, was yanked out of Colorado by Judd's office and whisked away to Polk County on charges of distributing obscene material after an undercover deputy persuaded the author to send him an autographed copy of his tome.
It is certainly true that as a piece of writing, Greaves' tawdry exercise in abusing the English language isn't likely to make its way to Oprah's Book Club anytime soon. But if the High Sheriff of Hubrisham starts tossing every twisted author with bizarre fetishes into the hoosegow, to paraphrase Roy Scheider in Jaws, we're gonna need a bigger jail.
There is also no argument Greaves, who looks like a Keebler elf in a trench coat, and his book represent the most outer fringes of the First Amendment protections of free speech. The courts have struggled for decades to precisely define exactly what constitutes obscenity.
Indeed the U.S. Supreme Court once famously forced itself to watch porn movies — over and over again, just to make sure it grasped the evidence — in a still unresolved and unsatisfactory effort to arrive at some sense of a universal standard of obscenity. And all we have been left with is that old line Justice Potter Stewart offered up: "I know it when I see it."
In Grady Judd's eyes, he's seen it and it looks like Philip Ray Greaves. And given this is Polk County, by the time the prosecutors get finished with this chap, jurors are going to think Larry Flynt looks like Mister Rogers.
The problem, of course, is that if the High Sheriff of Egoham gets it way, where do you draw the line of cheesy, kinky sexual material involving underage youth? Would video stores, for example, fear prosecution for renting Louis Malle's film Pretty Baby, or Martin Scorsese's Taxi Driver?
Would public libraries find themselves hauled before Grady Judd for having Vladimir Nabokov's Lolita on the shelf?
After all, it would only take Grady Judd getting his badge all in a wad to launch of a good ol' boy fatwa turning Polk County into a First Amendment nuclear winter.
Judd, who one might think has more public relations flacks on staff than SWAT team members, quickly called — what else? — a press conference to express his outrage.
But the High Sheriff of Me-Me-Meham was only getting started. Within days of the Greaves caper, Judd called another — what else? — press conference to announce he was yanking all the basketball hoops out of the jail, as if miscreants are plotting crimes in Polk County just so they can get arrested in order to practice their jump shots.
It was yet another publicity stunt on the part of the High Sheriff of Mirror-Mirror-on-the Wallham to establish his bona fides as the Joe Arpaio-lite of Florida, after the preening Maricopa County, Ariz., sheriff who has never met a camera he didn't fall in love with.
For all his publicity gimmicks to hype himself as a hard-charging crime-fighter, when it comes to his own department's shortcomings, Grady Judd suddenly becomes more shy than a three-toed sloth, as was the case in 2002 when a 16-year-old was killed in a crash following a high-speed car chase by one of his deputies. By the time the evidence was more compromised than Madonna by Judd's department, state investigators were unable to bring additional charges.
This time, Judd sent out one of his public affairs minions to field questions.
Well, he was probably too busy preparing his next press conference to announce a massive crackdown on low-hanging pants.


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This West Hollywood fine dining restaurant is an intimate and beautiful space serving Californian cuisine with French and Mediterranean influences. With a kitchen helmed by James Beard award-winning chef Suzanne Goin and wine list from acclaimed sommelier Caroline Styne, it's no wonder this spot is a favorite among locals and visitors alike (including Editor-in-Chief of Refiner29 Christene Barberich). Make a Reservation.
We Recommend
Recommended by: Jonathan Waxman (Chef/Owner, Barbuto), Christene Barberich (Editor-in-Chief, Refinery29), Susan Feniger (Contestant, Top Chef Masters), Jim Nelson (Editor-in-Chief, GQ), Eva Chen (Editor-in-Chief, Lucky Magazine), Daphne Oz (Host, The Chew), Nancy Novogrod (Editor-in-Chief, Travel + Leisure), Jennifer Fisher (Jewelry Designer), Whitney Port (Fashion Designer, TV Personality), Piper Perabo (Actress), Reece Solomon (Handbag Designer), Dominique Ansel (Chef/Owner, Dominique Ansel Bakery), Camilla Belle (Actress), Katie Lee (Host, The Kitchen), Stephanie Mark (The Coveteur), Molly Sims (Model), Cindi Leive (Editor-in-Chief, Glamour), Roopal Patel (Founder/Owner, Roopal Patel Consulting), Amy Astley (Editor-in-Chief, Teen Vogue), Chris Stang (The Infatuation), Jud Mongell (Five Leaves), Jennifer Hyman (Founder, Rent the Runway), Shay Mitchell (Actress), Mike Dubin (Dollar Shave Club), Camille Styles (Blogger), Marin Ireland (Actress)
Son of a Gun
Recommended by: Alexandra Guarnaschelli (Chef, Iron Chef America), Jessica Alba (Actress), Ty Burrell (Actor), Katie Lowes (Actress), Tony Goldwyn (Actor), Jim Nelson (Editor-in-Chief, GQ), Busy Philipps (Actress), Anne Burrell (Chef/Host, Worst Cooks in America), Fabio Viviani (Finalist, Top Chef), Reece Solomon (Handbag Designer), Camilla Belle (Actress), Ilan Hall (Chef/Owner, The Gorbals), Nick Hatsatouris (Owner, Eveleigh), Jesse Tyler Ferguson (Actor), Nicholas Jammet (Co-Founder, sweet green), Erin Heatherton (Model), Andrew Steinthal (The Infatuation)
Hugo's Restaurant West Hollywood
Recommended by: Alexandra Daddario (Actress), Catherine McCord (Weelicious), Erica Domesek (P.S. – I Made This), Laura Benanti (Singer/Actress), Pilar Guzman (Editor-in-Chief, Condé Nast Traveler), Rutina Wesley (Actress), Jake Lacy (Actor), Lorenza Izzo (Actress), Natasha Lyonne (Actress), Valorie Curry (Actress)
M Café
Recommended by: Christene Barberich (Editor-in-Chief, Refinery29), Bellamy Young (Actress), Kiernan Shipka (Actress), Olivia Kim (Director of Creative Projects, Nordstrom), Anna Akana (Vlogger), Isaac Mizrahi (Fashion Designer), Valorie Curry (Actress)
Café Gratitude
Recommended by: Darby Stanchfield (Actress), Bellamy Young (Actress), Tony Goldwyn (Actor), Eva Chen (Editor-in-Chief, Lucky Magazine), Josie Maran (Josie Maran Cosmetics), Alicia Silverstone (Actress, Writer), Gabrielle Bernstein (Writer, Motivational Speaker), Kristin Bauer (Actress), Karla Souza (Actress), Eli Lieb (Musician), Joy Bauer (TV Personality), Olivia Kim (Director of Creative Projects, Nordstrom), Liz Goldwyn (Writer), Lindsey Stirling (Musician), Danielle Walker (Against All Grain), Amanda Crew (Actress), Lorenza Izzo (Actress), JJ Totah (Actor)
Hinoki & The Bird
Recommended by: Brad Goreski (Stylist), Lizzie Tisch (Suite 1521), Nancy Novogrod (Editor-in-Chief, Travel + Leisure), Anne Burrell (Chef/Host, Worst Cooks in America), David Burtka (Actor), Danielle Panabaker (Actress)


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We'll help you find the right solution for your needs
Does this sound like your topic?
A short guide to the Fair Debt Collection Practices Act and your rights under this federal law.
The Fair Debt Collection Practices Act, often referred to as the "FDCPA", was passed by Congress in response to abusive conduct by collection agencies. The purpose of the Act is to provide guidelines for collection agencies which are seeking to collect legitimate debts, while also providing protections and remedies for consumers who are subjected to harassment. The FDCPA applies to personal, family, and household debts, including debts associated with the purchase of a car, for medical care, for retail financing, for first and second mortgages, and for money owed on credit card accounts. The law regulates the collection of debts associated with the purchase of a car, medical care, retail financing, mortgages, as well as money owed on credit card accounts.
You are entitled to a money award of up to $1,000, per account with violations by the collection agent. This means you can get $1,000.00 if a debt collector harasses you. More importantly you are entitled to your attorney fees paid. This is sometimes an even greater amount than your statutory award of $1,000.00. Therefore, if you think you may have a case but cannot afford an attorney, you may be able to find an attorney who handles this type of work, like my law firm, who will not charge you any fees and instead simply collect their fee from the debt collector upon settlement.
What should you do to help your case? 1. Record the phone calls. 2. Keep notes regarding phone calls received from debt collections. 3. Save and keep any and all letters from Debt Collectors. 4. Take the following notes about the call:
Who did you talk to? What Collection Agency are they calling from? What time and date did they call? What did they say? Were you insulted or intimidated? - Finally, request debt validation in writing within the 30 days after the debt collectors first communication and also in writing request the debt collector to stop calling. (if they continue to call these are violations.)
Bankruptcy Credit Debt Creditor harassment Bankruptcy and debt Criminal defense Criminal charges for harassment Criminal arrest State, local, and municipal law Fees
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Welcome to Our Dayton, Ohio Service Department
The team of certified technicians at Evans Arena Chrysler Dodge Jeep RAM is prepared to assist you with vehicle service and repair for your Chrysler, Dodge, Jeep, or RAM vehicle. Whether you are in need of major damage repair, part replacement, a quick oil change or tune-up; the technicians are our dealership in Dayton, Ohio are prepared to assist you in evaluating, assessing and repairing your car. If you drive a Jeep Cherokee, Chrysler 200, RAM 1500, Dodge Dart, Chrysler Town & Country, or any other vehicle that needs repair, bring it to Evans Arena Chrysler Dodge Jeep RAM. Schedule your service appointment online using the form below, or give our vehicle repair and maintenance professionals a call at (888) 460-6257. We look forward to serving you with all of your vehicle service needs!


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John Carter is mega upcoming movie of year 2012. With its huge budget this film is all set to rock the box office. Taylor Kitsch and Lynn Collins are playing leading roles in this science fiction movie. Check out some amazing wallpapers of movie John Carter. This one is the sexiest wallpaper of hot Lynn Collins. In this image you can see hot and big breasts of hot girl.
You are here: Home / John Carter Release Date & Trailer | Movie Wallpapers / John Carter Lynn Collins Hot
John Carter Lynn Collins Hot
February 6, 2012 by Admin Leave a Comment


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Wellington - Fast bowler Mark Gillespie has been ruled out of New Zealand's two-Test series against the West Indies next month because of an ankle injury.
National selection manager Kim Littlejohn said the 32-year-old, who claimed two five-wicket hauls in New Zealand's most recent Tests against South Africa, suffered bone bruising and ligament damage after twisting his ankle while running.
Littlejohn said no decision has yet been made on who will travel to the West Indies as Gillespie's replacement.
New Zealand will play the first of five one-day internationals against the West Indies on Friday. - Sapa-AP


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Effective: July 20, 2001
University Responsibilities
At an early stage, the Vice Chancellor for Research, or his designee, in conjunction with the faculty member, where appropriate, will:
Faculty Responsibilities
The start-up company will be obligated to provide the following diligence provisions required to maintain the license. Failure to satisfy these requirements may result in termination of the license by the University. The start-up company will:
The University's equitable interest and role in the start-up company:
The start-up company may, under very specific circumstances, support research projects at the University in the inventor/faculty member's lab, provided that:
The University recognizes that technology used as the platform for faculty start-ups is almost invariably at an early stage of development and is intimately related to the faculty's ongoing research interest. It is likely, therefore, that some technology development will be necessary at the University before it can be transferred to the new venture. The University will work with the new venture to assist in this transfer and to assure that University facilities and resources are not being used inappropriately to support product development and for-profit activities. Please refer to the Policy on Private Use of Washington University Research Facilities. The University will offer assistance to the faculty member to locate suitable off-site space for the start-up company, when this is appropriate.


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Travel Photography Photos tagged as autumn
200 photos | Tags: autumn Show as stream
Wide creek at start of the autumn.
Autumn in Zambia
Autumn colors in optimal prime.
This was shot while hiking through the New Forest, in Hampshire, England. I used a Hoya ND400 filter to for the flowing water effect.
A boardwalk invites the viewer to explore the fog at the Abita Creek Flatwoods Preserve in Abita Springs, Louisiana, USA.
Not normally known for Fall foliage, the floor of this Louisiana pine savanna is alive with colorful swamp cyrilla. Taken at the Abita Creek Flatwoods Preserve in Abita Springs, operated by The Nature Conservancy.
Every October, Amish Country in Ohio is a visual treat to visitors. Endless miles of meadows, hills, and crops fill the land.
Glasgow's University
The picture taken in September 2012 in Chicago suburbs
I took this picture in North Dublin, Ireland, Autumn, 2012. Brilliant fuschia and an elaborately detailed Irish street lamp. It actually wasn't until I looked at the photo close up that I noticed the shamrock there!
Although Heidelberg is a great town, it was the autumn colours that made our weekend there unforgettable.
You might find some more related photos through these galleries


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Here are some of my personal relections some hours behind this years World Wide Developer Conference shortened WWDC.
Here is an interview with the talented icon designer Jonas Rask from Denmark. Hopefully you will find it useful to have a bit of insight into his professional thinking and get to know him a bit better personally as well.
When I stumbled upon Jonas work some time ago on the net. I particulary fell in love with his highly detailed icons and the complexity of them. I wanted to know more about who he is and how these icons were created so I'll just had to ask him if he was willing to give an interview. Luckily he was more than happy to do the interview so here it is:
The Drupal team released a new version of their CMS system called Drupal tonight! Drupal 5.0 has been developed since the past 8 months and it looks very promising! With a brand new web-install I think we'll see more Drupal sites on the web since Drupal always been a bit trycky to install if you are new to try it.
As you all probably know at this time Creativebits is running Drupal as it's backbone and we're running quite an old version of it but it's still alive! We're happily going to upgrade to 5.0 but it take a bit of time since we're going to redesign as well. Drupal 5.0 is what we've all been waiting for! (More information about this matter later on)
Here's some information what's new:
A while ago a website came to my knowledge called My dream app which is basicly a site where 4 developers put up a contest where people could suggest their dream application in OS X.. Out of these crazy suggestions on application that could be built only 24 went on.. Now you could easily vote on your favourite idea and the developers were having a word on each application, pro's and con's with the idea and suddenly the other day it was finished..
Cameron Westland was the winner of this contest with his idea called Atmosphere. And when I look into it.. I thought more and more of it as a genius idea..
Here's a small tip concerning unarchiving files in Mac OS X
Mac OS X uses the application called BOMArchiveHelper which is the builtin archive unpacker application. If you don't like Stuffit and want an improved unarchiver in OS X..
Try this application then called "The unarchiver" which handles more file archive types such as: Zip, Tar-GZip, Tar-BZip2, Rar, 7-zip, LhA, StuffIt and many more..
Here is a small tip about the warp tool inside free transform of Adobe Photoshop. With help of the Photoshop you can easily transform images to fit almost everything. In this article I'm going to be using the warp tool to make photos look just perfect inside a open book shape.
Here's a sneak peek at next version of Creativebits..
I thought it would be fun to let you members have a look at a part of it as a little gift before the weekend.
We've been working hard and long time on next version of creativebits, but I´m sorry to say that we´re not ready yet to launch it, but hopefully we're getting there soon by time.
An image on a computer is built up by pixels, normally they're so small so we don't see them until we zoom real close, but they are there. Here's a cool trick if you want show the pixels more and perhaps create an transition from normal on one side and pixels on the otherside.. Kind of an effect that show the image is digital.
I'll explain how you can acheive that effect below:
One of the most common things beginners to Photoshop wants to be able todo is seperate one object or so from it's background. There are as many ways to extract an object from it's background as there are languages on our earth and every one is different from eachother. One way is using the filter in Photoshop called Extract.
I won't say it's the best method nor I'll say it's the worst method to seperate objects from it's background. I think it depends on the demands you've got and what kind of experience with the tool and photoshop experience.
Almost one year of OS X 10.4, people have been making and playing with the concept of widgets as an extra layer of GUI goodness called Dashboard on top of the normal OS. Freed from the Aqua design contraints, these widgets are allowing people to alter the interface to fit the purpose and style of the widget. From ridiculous (we're looking at you Dancing Homer) to the utterly useful (WidgetMail) there seems to be a growing momentum to build new funsize applications which do increasingly cool things in new ways.
So to salute this widget sexiness we've decided to hold a beauty pageant of sorts here on creativebits for the widgets. Leaving the borrowed hairdryers and bitchy comments to one side, we want to find out what widget the CB community thinks is the finest example of design currently in circulation. Unlike those normal beauty contests, we're not remotely interested if the widget wants world peace or a career feeding orphans; we're just after looks. So brains are out and superficial, surface sexiness is in.....
Creativebits is a blog about Creativity, Graphic Design, Adobe, Apple and other related subjects.
Pick a pre-made design from a collection of 50,000+ logos that will be customized to your business name for free.


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Red And Blue Floral Paper Lanterns
Botanical designs and floral patterns give round paper lanterns fresh appeal. The signature lighting in Asian homes and festivals for centuries, paper lanterns today provide casual lighting solutions for everyday decor as well as special occasions. Round silhouette with bamboo framing.
Tags: wedding, floral, satin, tradition!, garters, wedding party, wedding toss, Toss itAdded 8 Years Ago from Etsy


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Android Games
Game Questions & Answers (Q&A) service lets you ask questions about video games for game consoles or PC games. So ask your Word Collapse question for Android and get answers from real gamers or answer questions and share your insights and experience with the rest of the gaming community.
Boxshot & Details
- Developer: Second Gear Games
- Publisher: Second Gear Games
- Genre: Board / Card
- Release: Nov 23, 2010
- ESRB: Not Set
Question & Answers
Boys name level 16
I've only gotten as far as allan, casey, don and ken. help?
Answer from: des842000
Try this: casey, duane, ken, don (down), wade, tim, cody, allan, andy, frank, donald
Answer this QuestionAsk / All Questions »
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PTI Jalsa 23rd March Javed Hashmi Full speech on 23rd March Jalsa of PTI at Minar-e-Pakistan. Imran Khan (PTI) will also address to the crowd.
The first major event after the intra-party elections at Minar-e-Pakistan claimed as the war of Pani Pat by Imran Khan (PTI). 23 march Jalsa will show whether the PTI is still a major player in the political arena or not and does PTI is all set to challenge the rival political parties majorly Pakistan Muslim League Nawaz (PMLN) and Pakistan Peoples Part (PPP).


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Communities developing resources and competencies for using their languages
Foundational understanding for language development work of all kinds
Publications, fonts and computer tools for language development, translation and research
SIL offers training in disciplines relevant to sustainable language development.
7,099 languages are spoken or signed. CLICK for map of world languages & regional websites.
SIL's dedication to language development past and present
Reconstructs the protolanguage of six languages found in the Mexico. The book has two major section, Analysis and Data for the language family groups:
Abbreviations of Language Names
List of figures
Part One: Analysis
Part Two: Data


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Legendary Fish are the sea creatures spoken of in whispers across the bar tables by veteran fishermen. Despite the general rule of "The One That Got Away". The legends and stories about these majestic creatures are not in the slightest exaggerated. A pirate who becomes level 20 in fishing may seek out these beings and try to capture them, and retrieve one of their scales as a trophy. There are five different Legendary Fish roaming the Caribbean, and each scale is worth a pretty penny. You can also find Famed items from these monsters.
For more info on Legendary Fish, visit the content page here.
Pages in category "Legendary Fish"
The following 5 pages are in this category, out of 5 total.


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India Ink Recruits Three
January 30, 2006,
Los Angeles — As part of the expansion of its product mix and channels of distribution, India Ink has named three executives to new positions in sales and marketing.
Gretchen Sapin has joined the company as director, soft home and project management. She formerly was vp sales for 100% Pure Custom Comfort.
Jon Sherman, formerly vp sales and marketing at TR Industries, has joined the company as national sales manager for the home improvement retail channel.
He will focus on sales of bath hardware and window hardware to that retail channel.
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"A true professional knows what to do and when to stop doing it".
Put your seat, tray table and stewardess back in the upright position. Fasten your seatbelt and turn off your ego until we arrive safely back at the gym. We are going to fly above the clouds of common belief and as you will soon see your ego will just get in the way.
A trainer should know the basics of program design: reps & sets, rest, frequency, exercise selection, exercise order and load. The trainer should also know the body's response to those elements from the cellular level outward so that any exercise program would have a strong rationale for its design and the outcome would be predictable. I said a trainer should know but it is sad how many don't.
The serious amateur, regardless of their passion and commitment, simply have not had the years of study and experience to know those details in depth and are easily buffeted by the cross winds of the media and the superficial logic of advertising hype. Their workout history chronicles like a very long stay at an all-you-can-buffet, gorged on variety without much to show for it. But what I'm about to discuss is a conceptual foundation for exercise that should proceed all of the above elements and so fundamental that both the professional and serious amateur should incorporate it immediately in their training.
First, we need to agree that exercise movement is skill. Take the ever-popular male ego exercise the bench press and imagine watching someone attempting to bench for the first time. Depending on your imagination and sense of humor, the event could range from just awkward to EMTs needed to pry the bar from between cracked ribs. With a couple months of training experience, that same person would look reasonably acceptable, at least in the context of those lifting around him. But put that same person in the hands of an experienced coach from day one and that transition from awkward to acceptable could happen within a session or two. Keep the trainee with the coach for a few weeks longer and his form would be noticeably better than the best of the self-taught gym rats around him and his performance potential would have greatly increased while his risk of injury would have dropped. Why? The ego-entertaining expectation of performance and size gains were turned off and the focus was placed on skill development, the refinement of technique and the process was guided by a skilled coach. Performance improvements and changes in muscle structure come naturally as a result of skill improvement.
Remember, I asked that the ego be turned off. The ego is great for overcoming inertia and getting our asses off the couch to accomplish something beyond being a slug but the ego also makes a truly lousy coach. It constantly demands the satisfaction of new numbers, higher reps, more weight, bigger size, etc., chasing "bigger, faster, stronger, prettier" without regard to any unforeseen or negative consequences. A daily post-it note is stuck to your forehead with the dictate to make the goal of the moment happen. The reward for fulfilling that demand is always a new post-it note with an even greater demand stuck on your forehead to replace it. The Ordeal of Sisyphus now becomes personal and the only way the cycle is broken is either by the ego being attracted by a new shiny object to chase or an injury serious enough to actually stop training altogether. Otherwise, the rock rolls back down the mountain and the ordeal beings again.
If you have trained seriously for any length of time, your ego driven workouts have pushed you over the injury cliff many times and while bouncing down the mountain side, I'm sure three thoughts crossed you mind: 1) this is going to hurt, 2) maybe the last rep wasn't such a good idea and 3) didn't this just happen a couple of months ago. At these moments, I'm also sure that the smart side of your brain is feeling as frustrated as when you did the last time you tried to teach your dog the principles of the internal combustion engine. The dog watched your hand gestures, the laser pointer and your mouth moving but that's about it. It didn't get it and it didn't care. Your ego doesn't care either, it has its own agenda and your health is not part of it. Can you say, "Bigger, faster, stronger and prettier"? Of course you can and we all have many times.
So now, we've arrived at THE point of this discussion. Exercise is the constant development and refinement of movement skill and that the ego wants to also constantly cut in line ahead of skill because it thinks it's special and waiting for results is also for wusses. Because of the ego's involvement, I need more intellectual firepower so I thought I would elicit the aid of Brett Jones and his thoughts on the subject found in his recent Club Swinging Essentials Manual.
To begin: "What if going to the Gym meant learning?"
"Dancers, acrobats, and martial artists dedicate hour upon hour, year after year to learning how to move well, move fluidly, and move powerfully within their respective disciplines. These individuals get fit, not because their trying to break a sweat but because they are dedicated to improving their discipline. Their routines are more specialized than extreme, but the results defy physical boundaries and inspire awe in spectators. These disciplines are founded in the progression from beginner to expect and developed skilled practitioners through focused learning of their respective arts. In today's gym culture, our potential lies far beyond 'working out'."
With this mind set, workouts become practice and exercises become drills. The natural progression from beginner to expect is not disrupted by the ego's demand to cut in line beyond the body's current skill level. The exercise or drill becomes a balanced meditative expression of both the desire to improve and the self-discipline to arrive on time. When the desire to improve exceeds self-discipline, there may be short terms gains to soothe the ego-beast but ultimate performance will be stunted and the body will be pushed closer to breakdown. Therefore, your training must be guided by a long term vision and your workouts are mere steps in that direction. This takes the pressure off of trying to accomplish everything all at once. As unrealistic as everything at once may be, the ego is convinced otherwise and this would be excellent time to start a game of whack-an-ego-mole.
With the ego as difficult to herd as cats and as persistent as toe fungus, patience will prove to be the most formidable weapon in calming down unrealistic ego demands and to "arrive with results on time". Here is how. When a nerve signal is repeated over and over again, the body deems that volume as an indicator of importance and will begin building a structure of nerve connections to make the reason for the nerve firing more permanent and more efficient. As one strives to perfect the one arm kettlebell snatch by practicing the movement, the body will seek out what muscle recruitment is needed at what joint angles to accomplish the pattern. Using a light weight while building volume over time will allow the body/mind to develop and refine the pattern. Work capacity, strength and power can be introduced only when the pattern is firmly entrenched. However, if they are attempted too soon, the pattern will break down and the stone must be rolled up the mountain one more time. An easy concept to remember is: fatigue makes idiots of us all. So before you jump to the ego's command to add more weight, push the limits of a time set or add more sets, put a dunce cap on your head and go sit on a stool in the corner until the urge goes away. Your body will tell when it is O.K. but only if you listen.
Learning the correct movement through proper coaching, having the discipline to control the ego's demands and to insist on striving for training excellence through mindful practice will prove to be the best strategy for the investment of your training time and effort. Trust that results will "arrive on time" or in other words, only when you have earned them. There are no shortcuts and cutting in line is not permitted. Also your learning ramp is uniquely your own and comparing yourself to someone else is pointless. This would be a good time to point out the idiocy of "look what I can do" internet fitness forum postings and product testimonials with the believability of a Penthouse letter to the editor.
We have arrived safely back at the gym and hopefully "a true professional knows what to do and when to stop doing it" has new meaning to you. When I recently told Brett that I was trying to find out what a 63 year old could get away with and still recover, he handed me my dunce cap and responded, "Why not find out how little you can do and still make progress?" D'uh!
4 Responses to "Kettlebells: Brain Training & the Art of Patience"
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|RE: flowRoot text-decoration bug
|Thu, 21 Jun 2007 06:29:40 -0400
Hi John, "John Hinke" <[email protected]> wrote on 06/19/2007 11:15:08 AM: > I'll file a bug (it's always good to remember them anyway). But I'd be more > interested in trying to fix this myself. Would you be willing to give me a > few pointers on where to start looking? I just need something fairly > short-term right now. The decorations are drawn by the class batik.gvt.renderer.StrokingTextPainter, in the method 'paintDecorations'. This code assumes a decoration is a single 'line'. It also depends on batik.gvt.text.GlyphLayout to provide raw geometry, this class also assumes decorations are a single line. > For my application I take another XML model and translate that into SVG for > output to PDF or JPG. One solution I've considered is to find some Batik > API that would let me extract out the lines of text that the flowRoot code > generates and then re-generate the SVG document using plain <text> elements. > I'm not thrilled by this approach but it would work for me in the short > term. The code that does the wrapping is batik.gvt.flow.FlowTextPainter. It collects the lines in a list, lineInfos but currently that is dropped at the end of the 'textWrap' method. > Any idea what API I might want to use (or even locally hack up) that I could > feed it a flowRoot element and get back a set of lines. I'm more than > willing to cut and extract code to get this working. I think if you had the List of LineInfo Objects you could do something. It's worth noting that FlowTextPainter is a subclass of StrokingTextPainter, so it could override 'paintDecorations' to draw decorations better. > > -----Original Message----- > > Hi John, > > > > "John Hinke" <[email protected]> wrote on 06/18/2007 10:24:07 AM: > > > > > I've run across what I think is a bug in the flowRoot rendering code: > > > text-decoration styles don't show up. Here's the example SVG: > > > > Well, you are right. Flow text ignores text-decoration (incomplete > > implementation). However, since we still don't have an idea where the > > SVG WG is going with wrapped text in SVG 1.2 Full it's not likely to > > be fixed any time real soon. > > > > You can file a bug report if you want, but I doubt much work will > > be done on it until SVG 1.2 Full is fairly well settled. > > > > > > --------------------------------------------------------------------- > To unsubscribe, e-mail: [email protected] > For additional commands, e-mail: [email protected] > --------------------------------------------------------------------- To unsubscribe, e-mail: [email protected] For additional commands, e-mail: [email protected]
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Physicians Formula Mineral Wear Talc Free Mineral Face Powder
Physicians Formula Mineral Wear Talc Free Mineral Face Powder Reviews
Very goodI had this in "translucent" and I must say that I really liked the texture and the feel of it on my face. I actually used the whole thing, which doesn't happen very often with me when it comes to powders. The only thing that bothered me is that the colour was still a little too warm for me, and I couldn't find a better match for my skin. So when I went back I got the "translucent" shade again b...read moreut in the "mosaic" type powder formulation, and loved it! Even better than this one. So that's why I'm giving this one 8 stars... It was almost perfect. And by the way, that was about 8 years ago, so now I religiously use the mosaic kind in "translucent"... ;) What I liked about this powder was that it was very light, and allowed a very thin application, while still balancing out my complexion. It feels like it lets your skin breathe when you wear it, and you can retouch if you need too, and it won't look cakey. When it wasn't very hot it would last me all day though. And at the risk of repeating myself, I think that it's important to note that it really looks very natural on your face. Some of my friends would swear that I'm not wearing any powder or foundation when I had this on. This is the case with my "mosaic" type powder in "translucent" as well. If you are looking for a non-irritating, non-intrusive way to even out your complexion and don't need heavy coverage (as in MAC Studio Fix heavy) you will like this powder, because it will give you a natural overall finish. And I forgot to say that it's completely unscented, which is a very good news for those of us with sensitive skin. — 3 years, 9 months agoNikatron | 150 reviews
This review is: Helpful | Not helpful | Inappropriate | 2 of 2 people said helpful
Love This!Love this! It is a bit expensive, but it is also lasting way longer than I had thought. I apply it over everything, foundation, blush, etc. as a finishing powder, leaving my face looking smooth and fresh. — 9 years, 9 months agomvap47 | 345 reviews
This review is: Helpful | Not helpful | Inappropriate | 1 of 1 people said helpful
DisappointingI'm very dissatisfied with this powder. First off, the lightest shade they make is somehow STILL too dark for my skin. I'm not that white, am I? Secondly, it doesn't cover that well. Last, it doesn't stop shine for any amount of time. It actually has a slight metallic sheen to it, which I hate. This was way too pricey to be this bad. — 8 years, 10 months agoamygab1126 | 242 reviews
This review is: Helpful | Not helpful | Inappropriate | 1 of 1 people said helpful
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Agenda: Four don't-miss events
Updated 4:45 pm, Thursday, August 28, 2014
1 'I'll have what she's having' Take in "When Harry Met Sally" (which turns 25 this year) and taste wine at the last night of Top of the Mark's weekly summer series. 5:30 p.m. tasting. 7:30 p.m. film. Tuesday. InterContinental Mark Hopkins, 999 California St., S.F. www.intercontinentalmarkhopkins.com.
2 Beta Q&A Tenacious Thread hosts an interview with Betabrand's lead apparel designer Steven B. Wheeler. $5-$10. 6:30-7:30 p.m. Thursday. Betabrand, 780 Valencia St., S.F. www.tenaciousthread.com.
3 Bottling summer Learn how to make preserves with Ellen Roggemann of McEvoy Ranch in Let's Jam! Preserving Summer's Bounty. $55. 6:30-9 p.m. Thursday. The CUESA Kitchen at the Ferry Building, 1 Ferry Building, S.F.
4In Spades InStyle magazine helps celebrate Kate Spade's redesigned shop with sips, snacks, and 20 percent off. Thursday. 6-8 p.m. 845 Market St., S.F. RSVP: firstname.lastname@example.com


text: elian@... wrote: > >Pretty much all the Webware and 3rd party plug-ins invoke the Python >interpreter by calling "#!/usr/bin/env python" in their scripts. The >trouble with this is that this call brings up Python 1.5.2 in Debian. Only if you have the path to Python 1.5.2 before the path to other Python versions, or you have done a "make altinstall" with those versions, so that Python 2.0 (for example) is installed as python20. >The only ways I can think of to get Python 2 invoked instead is to use the >Debian alternatives system, or else search through all Webware + plug-in >code to change "#!/usr/bin/env python" --> "#!/usr/bin/env python2". What I have done is to have Python 2.0 installed in /usr/local, thus retaining the Red Hat default of Python 1.5.2 (or whatever it is) in /usr. Then, I change my environment to find Python 2.0 first - this usually involves changing one's .bashrc file on Linux: export PATH=/usr/local/bin:${PATH} Or something like that. All "#!/usr/bin/env python" at the top of a script does is force the operating system to find the python program as if you had typed "python" at the shell prompt. Otherwise, one would have to hard code the path to python in instead - I have seen numerous Perl scripts with "#!/usr/bin/perl" at the top, for example. >Neither option seems good. Messing with the Webware code means that I can't >keep current easily. Using the alternatives system to point /usr/bin/python >at python2 will break some Debian packages that depend on 1.5.2, and which >rely on /usr/bin/python to point to Python 1.5.2. Don't change any code - just change your environment! If you need to run any special Debian programs alongside Webware then I'd suggest creating a new user just for Webware. After all, you're using a multi-user operating system. ;-) Another option is to create a start-up script which wraps up AppServer. In this, you could put your environment changes: #!/bin/sh PATH=/usr/local/bin:${PATH} ./AppServer >So, if you use Debian, Webware and Python2, how did you manage to keep the >balls in the air at once? I use Red Hat, as I noted above, but the issue is pretty much the same. Well, apart from the assertion that Debian's package system sucks less than Red Hat's, but then I'd rather build from source anyway - it doesn't take me long to find that the configuration of a packaged version of some software doesn't suit me, thus demanding a reconfigure and a recompile. Regards, Paul P.S. Should this go on the Wiki too? -- Get your firstname@... email for FREE at http://Nameplanet.com/?su


text: Apr 03 2013 BUMP SKYLAR BIGGINS . . . There Are Two Girls In COLLEGE BASKETBALL Right Now . . . That Are EVEN CUTER Than She Is!!! April 3, 2013: Meet Kota and Dyl Gonzalez, two of the newest members of the Kansas Jayhawks basketball team. They haven't gotten MUCH BURN YET on the court. But the two have been HEATING UP Instagram with their STRAIGHT STUNTIN!!!


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Delilah's Dilemma-Craving More Attention
A new baby brings lots of things. Liz's Mom is expecting a baby and while Liz is happy for her mom, she's also craving more attention.
Liz shared with Delilah that she'd loved to spend more alone time with her grandparents but she's afraid she's being selfish. She also feels like she's being pushed to grow up too fast. What's the best thing she can do? Give a listen to what Delilah had to say to Liz:


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US forces fired a howitzer, a rarely used heavy weapon in Baghdad, to kill at least three mortar crewmen who had unleashed a barrage against one of their camps in an eastern neighbourhood of the capital, a US soldier at the scene said.
The 155-millimetre artillery piece fired a single round which struck a vehicle the insurgents had used as a platform for their mortar, said Sergeant Major Fernando Rodriguez.
Following a trail of blood from the vehicle, soldiers found three bodies of the attackers and other body parts were strewn around the area. Rodriguez said it was believed that a total of six insurgents were killed.
The US fire came after 21 mortar rounds landed in or around War Eagle, a base of the 1st Cavalry Division on the edge of Sadr City, a vast slum and insurgent stronghold which has seen daily clashes between US troops and rebels.
No US or Iraqi civilian casualties were reported.
The American soldier said the mortar was fired from a main road on the northern side of Sadr City.
A US warplane struck a rocket launcher mounted on the back of a vehicle in the slum, destroying the vehicle but igniting several secondary explosions, the US military said.
"The vehicle was fired on and destroyed in an open area away from buildings and other people," said Captain Brian O'Malley of the Army's 1st Brigade Combat Team.
Maithem Mahmoud of the al-Sadr General Hospital said one man was killed and a woman injured in the strike.
Sadr City is a stronghold of radical Shi'ite Muslim cleric Moqtada al-Sadr, whose Al-Mahdi army also fought battle with US troops in the southern city of Najaf last month.
The fighting ended after a peace pact was brokered but the US command says al-Sadr's militia continues its hostilities in the Baghdad slum.
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Mikael Ranta Model
J Y JRetoucher Female Bangkok, Bangkok, Thailand
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I'm Retoucher from Bangkok, Thailand. If you are interested in hiring me please contact with a sample of the image you would like retouched, along with a detailed description of what you're looking for and I will get back to you shortly. Fell free to contact me if you have any questions.
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I took yesterday off because it was my RL birthday and I wanted to spend some quality time with the two people who mean the world to me. I'm back today though with some new releases so let's get right to it! This Heather Sweater Dress is probably one of my favorite Sn@tch releases this week. It comes in 8 colors and 5 sizes. Don't forget to grab a demo! The necklace is new from Pepper and there are also bracelets to match. The hair is new from Truth and is one of three styles this week.
Lipgloss: –Belleza– Ava Med Strong Gloss Lips 2
Lashes: Miamai_XGen Makeup_Basic Lashes B Black – No Hair
Boots: (LaRoo) Liberty Boots (black) S
Dress: :::Sn@tch Heather Sweater Dress (Brown-Large)::: (NEW)
Hair: >TRUTH< Laurie w/Roots – jupiter (NEW)
Nails: [PM]Pixel Mode – Diamond Edt. Mesh Nails : Long
Necklace: ~Pepper~ Broche Necklace -BLACK (TOUCH) (NEW)
Skin: –Belleza– Ava Med Red 7
Eyes: IKON Eternal Eyes – Hazel (M)
Poses: Izzie's Silicone Poses


text:
Shiloh's Scare – Just Jared
Heath Ledger's death ruled an accidental overdose on prescription medication – Celebitchy
Isla Fisher and 6-month-old Olive – Celebs and Bubs
Britney Spears is an "American Tragedy" – Holy Candy
Is Angelina Jolie pregnant because she's trying to save her relationship? – Dlisted
A mini Family Ties Reunion – Seriously? OMG! WTF?


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WP to TWITTER problems
i have probles posting from my page to twiter since 3 weeks ago, i recive this messege:
One or more of your last posts has failed to send a status update to Twitter. The Tweet has been saved, and you can re-Tweet it at your leisure.
Code : Twitter did not return a recognized response code.
i chat with the developer for several days and he could not help me, chat with my host server and nothing, seens that no body can find the problem, any ideas?
- The topic 'WP to TWITTER problems' is closed to new replies.