text:
- Original research
- Open Access
Incidence of depression, anxiety and stress following traumatic injury: a longitudinal study
© Wiseman et al.; licensee BioMed Central. 2015
- Received: 11 July 2014
- Accepted: 11 March 2015
- Published: 28 March 2015
Traumatic injury and mental health disorders are co-associated. Early identification of depression, anxiety and stress following injury, and subsequent preventive intervention, may reduce the long-term symptoms and negative impacts associated with depression and anxiety. The purpose of the study was to determine the incidence, severity and predictors of depression, anxiety and stress in injured patients in the acute phase of care, and at six months following injury, as well as the effectiveness of an in-hospital screening tool.
This descriptive longitudinal study of trauma patients was conducted at a Level 1 Metropolitan Trauma Centre in Australia over 14 months. Participants were interviewed using the Depression Anxiety Stress Scale short-form version (DASS-21) during hospital admission then at 3 and 6 months after injury. Descriptive statistics were performed to evaluate participant characteristics and incidence of depression, anxiety and stress. Correlations and logistic regression were conducted to investigate the ability of the DASS-21 to predict symptoms of depression, anxiety and stress and to investigate factors associated with depression, anxiety and stress 6 months after injury.
201 participants ranging in age (18–94 years) and injury severity participated in the baseline interview and 109 completed all 3 interviews over 6 months. Over half (54%) reported above normal scores for depression, anxiety and/or stress in at least one of the 3 time points. Intensive care unit admission and high levels of depression, anxiety and stress at 3 months post injury were predictors for high levels of depression, anxiety and stress at 6 months. Low scores for depression, anxiety and stress during admission were correlated with low scores for depression, anxiety and stress at 3 and 6 months.
Depression, anxiety and stress in patients hospitalised following injury is common and should be anticipated in patients who have had an intensive care admission. Screening at 3 months following injury identifies patients at risk of long-term symptoms of depression, anxiety and stress.
- Depression
- Anxiety
- Stress
- Injury
- Mental health
- Patient outcome
- Screening
Traumatic injury is responsible for 11% of global mortality and contributes to a significant amount of physical and psychological morbidity for all age groups [1]. Patients with traumatic injury report a substantial reduction in health-related quality of life compared to other patients, including long-term psychological and physical disability [2]. The psychological impact of injury includes the development of acute and long-term mental health problems such as post-traumatic stress, depression and anxiety.
Posttraumatic stress disorder (PTSD) is the most frequently researched mental health problem following injury. Acute stress disorder (ASD) [3] can progress to PTSD if symptoms persist after one month with approximately 50% of those with PTSD initially presenting with ASD [4]. Acute stress disorder occurs in up to 45% of injury survivors [5], and involves an anxiety response that includes re-experience of the traumatic event, intrusive memories, dreams, and strong emotional distress on exposure to triggering events [4].
Anxiety has also been found to occur in injury survivors [1,6], with anxiety identified in up to 40% of injury survivors [7-9]. Some characteristic symptoms of anxiety include; hyper arousal and physical symptoms such as increased respirations and dry mouth. Depression has been identified in up to 42% of injury survivors, from as early as 6 weeks to as long as 20 years post injury [8,9]. Characteristic symptoms of depression include feelings of prolonged unhappiness, lethargy and a general lack of interest in the environment and self [3,6].
Despite the known associations between injury, depression, anxiety, ASD and PTSD, there is limited knowledge on the combined presence and extent of depression, anxiety and stress symptoms in injured patients over time [7]. Further, there is little evidence on effective early screening tools, and the implementation of screening tools, for these problems in the injured population [7-10]. The purpose of the study was to determine the incidence, severity and predictors of depression, anxiety and stress in injured patients in the six months following injury and use the findings to inform strategy for effective psychosocial follow-up care of injured patients.
Aims of the study
Determine the incidence and severity of Depression, Anxiety and Stress post injury, during hospital admission and at 3 and 6 months following admission.
Identify factors associated with higher levels of depression, anxiety and stress in patients post injury.
Patients and methods
Design and setting
This was a descriptive longitudinal quantitative study. Following ethics approval (HREC/10/SGH/198), data were collected over 14-months from May 2011 to August 2012 at a Level 1 Trauma Centre in Australia. Depression, anxiety, and stress levels were determined during a structured interview at 3 time points; during hospital admission, 3 months, and 6 months post injury.
Sample size
Calculations for the primary analyses were based on a repeated measures analysis of variance exploring change over time between the three injury severity groups on DASS-21 subscales (main and interaction effects). With 3 time periods, a medium effect size f of 0.25, alpha of 0.01 (to account for multiple testing) and 80% power, a total sample size of 150 was required. Additional participants were recruited (n = 201) to account for the loss to follow-up associated with longitudinal research.
All patients aged 18 years and over admitted to the study site meeting trauma admission criteria were screened for inclusion irrespective of injury mechanism, severity of injury or background. Trauma admission criteria are based on mechanism of injury, physiologic and injury criteria. For example, motor vehicle collision (MVC) greater than 55kph, assault, or fall from height > 3 metres. Patients were excluded if they had a pre-existing cognitive impairment such as dementia or traumatic brain injury resulting in existing cognitive impairment. All patients included in the study provided written consent prior to the collection of any data.
The study site trauma registry was used to obtain demographic, injury and outcome data. Participant levels of depression, anxiety and stress were assessed using the short form version of the Depression Anxiety and Stress Scale (DASS-21) [11].
Depression anxiety stress scale scores and clinical severity ratings
26- 33
Extremely Severe
Data collection
Participants were approached within fourteen days of their admission or extubation. An interpreter was used to approach non-English speaking patients (n = 24). Following written consent the baseline DASS-21 was administered face to face by a researcher trained in structured interview technique and in managing potential participant distress. This interview was conducted at the patients' bedside while they were admitted to hospital [14]. Although the DASS-21 tool does not require specialist training for clinicians, in the context of the research training was deemed important to maintain consistency of administration and for supporting participant wellbeing. The 3 and 6 month interviews were conducted via telephone following a structured telephone interview guide [14]. All participants were given contact details for follow up emotional support services.
Data management
For data analysis a number of clinical categories were created. Polytrauma was defined as the patient having more than two injuries. This definition has been used widely in trauma research and is associated with subsequent long-term recovery [15] and higher treatment costs. Patients were grouped according to injury severity scores (ISS) of less than 9 (minor), 9–12 (moderate) and greater than 12 (major) [15]. For descriptive analyses, Depression, Anxiety and Stress scores were grouped in 3 categories: normal, mild/moderate, and severe/extremely severe as the aim of this research was to determine the incidence and severity of these reported symptoms. Hence, for analysis of predictors of depression, anxiety and stress, if a participant had a moderate, severe or extremely severe score in any of the depression, anxiety and stress subscales, they were allocated to a moderate and above group. An additional categorical variable was created using classification information for the moderate and above groups at baseline and at 3 months to capture the extent in which depression, anxiety and stress was experienced post injury. The categories were: Normal (did not experience moderate and above levels of depression, anxiety and stress scores in any of the 3 sub-scales at baseline and at 3 months); Baseline only (experienced moderate and above level of depression, anxiety and stress scores in any of the 3 sub-scales at baseline but not at 3 months); Persistent (experienced moderate and above level of depression, anxiety and stress score in any of the 3 sub-scales at baseline and at 3 months); Late onset (did not experience moderate and above level of depression, anxiety and stress score in any of the 3 sub-scales at baseline but experienced moderate and above level of depression, anxiety and stress score in any of the 3 sub-scales at 3 months). Dummy variables were subsequently created for these categories for the logistic regression with "normal" as the reference group.
Data analysis
Data were analysed using SPSS 20 [16]. Descriptive statistics were conducted to determine sample representativeness in variables such as Mechanism of Injury, age and Injury Severity of the study participants and the eligible population over the 14-month data collection period. Descriptive statistics were also conducted to determine the incidence of depression, anxiety and stress at each time period. Pairwise comparisons were made between the two DASS-21 rating groups (moderate, severe or extremely severe versus normal and mild) to identify if any injury or demographic characteristic was associated with the levels of depression, anxiety and stress at each time point. Depending on the nature of the variable, the following statistical tests were used: T-test was used for the numeric age variable; Mann–Whitney test was used for ISS; χ2 test was used for categorical variables Polytrauma, Intensive Care Unit (ICU) Admission, and Injury mechanism.
Logistic regression was conducted to investigate factors that were associated with participants still experiencing a moderate or above level of depression, anxiety and stress 6 months after injury adjusting for other variables in the model with the intention of identifying significant predictors of the outcome (DASS) at 6 months post injury. These factors included whether participants sustained polytrauma as part of the injury, if they were admitted to ICU during their hospitalization for their injury, and whether they reported symptoms of depression, anxiety and stress post injury at either baseline or 3 months after injury (i.e. normal, baseline only, persistent, late onset). These variables were chosen to be included in the logistic regression based on their significant bivariate association with the reported levels on depression, anxiety and stress at 6 months at a significance of p < 0.05 level.
Sample representativeness of the study population
Patient demographics
Total number of patients (n)
201 (15.1%)
1134 (84.9%)
Age (years)
Mean (SD) [Range]
49 (23) [1–96]
49 (18) [18–94]
49 (24) [1–96]
T = 0.09, df = 345.7, p = 0.929
Gender (%)
χ2 = 4.16, df = 1, p = 0.041
421 (31.5%)
51 (25.4%)
370 (32.6%)
914 (68.5%)
150 (74.6%)
764 (67.4%)
Clinical characteristics
Median (IQR)
8 (4–16)
9 (5–14)
8 (4–16)
MW = 108948.0, p = 0.318
Poly trauma (%)
χ2 = 3.04, df = 1, p = 0.081
878 (65.8%)
143 (71.1%)
735 (64.8%)
457 (34.2%)
58 (28.9%)
399 (35.2%)
ICU admission (%)
χ2 = 5.42, df = 1, p = 0.020
181 (16.4%)
18 (10.4%)
163 (17.5%)
921 (83.6%)
155 (89.6%)
766 (82.5%)
Mechanism of injury
χ2 = 50.70, df = 10, p < 0.001
Fall greater than 1 Meter
464 (35.1%)
56 (27.9%)
408 (36.4%)
MVC driver
262 (19.8%)
44 (21.9%)
218 (19.4%)
MBC rider
114 (8.6%)
32 (15.9%)
82 (7.3%)
Pedal cyclist
77 (5.8%)
23 (11.4%)
54 (4.8%)
72 (5.4%)
10 (5%)
62 (5.5%)
114 (8.6%)
8 (4%)
106 (9.5%)
MVC passenger
85 (6.4%)
8 (4%)
77 (6.9%)
27 (2%)
8 (4%)
19 (1.7%)
MBC passenger
12 (0.9%)
4 (2%)
8 (0.7%)
Penetrating or cutting injury
43 (3.3%)
3 (1.5%)
40 (3.6%)
Sport and other
52 (3.9%)
5 (2.5%)
47 (4.2%)
Of the study participants, one participant required a language translator. The mean age of participants was 49 years. The majority of the participants were male (74.6%) and the median ISS was 9 (IQR 5–14). The injury mechanism most represented was fall greater than 1 metre (27.9%), followed by motor vehicle collision (MVC) driver (21.9%) and motorbike collision (MBC) (15.9%). More than two thirds (71.1%) suffered polytrauma and 10.4% had an ICU admission. Of the 201 participants who completed the baseline interview, 122 (60.7%) completed the 3-month interview and 109 (54.2%) completed the 6 month interview.
Incidence and severity of depression, anxiety and stress
Depression anxiety stress levels in trauma patients at baseline, 3 months, and 6 months post injury
Time point
Mean (SD)
9.4 (9.8)
10.3 (8)
14.5 (10.6)
127 (63.2%)
83 (41.3%)
112 (55.7%)
Mild- Moderate
42 (20.9%)
73 (36.3%)
53 (26.4%)
Severe- Extremely Severe
32 (15.9%)
45 (22.4%)
36 (17.9%)
Total participants with above normal rating
3 months
Mean (SD)
9.3 (9.6)
6.4 (8)
12.8 (10)
73 (59.8%)
80 (65.6%)
77 (63.1%)
Mild- Moderate
30 (24.6%)
21 (17.2%)
29 (23.8%)
Severe- Extremely Severe
19 (15.6%)
21 (17.2%)
16 (13.1%)
Total participants with above normal rating
49 (40.2%)
42 (34.4%)
45 (36.9%)
6 months
Mean (SD)
5.9 (7.7)
4.2 (5.1)
8.9 (7.9)
83 (76.1%)
85 (78%)
84 (77.1%)
Mild- Moderate
21 (19.3%)
20 (18.3%)
21 (19.3%)
Severe- Extremely Severe
5 (4.6%)
4 (3.7%)
4 (3.7%)
Total participants with above normal rating
26 (23.9%)
24 (22.0%)
25 (22.9%)
Of the participants who completed the interview 3 months post injury, 49 (40.2%) had symptoms of depression above the normal range, 42 (34.4%) had symptoms of anxiety above the normal range and 45 (36.9%) had symptoms of stress that were above the normal range. Of these, 19 (15.6%), reported severe to extremely severe symptoms of depression, 21 (17.2%) in anxiety and 16 (13.1%) reported severe to extremely severe symptoms of stress.
At 6 months after injury, 26 (23.9%) of participants reported symptoms of depression that above the normal range, 24 (22.0%) reported symptoms of anxiety above the normal range and 25 (23.0%) reported symptoms of stress above the normal range. Of these participants 5 (4.6%), 4 (3.7%) and 4 (3.7%) reported severe to extremely severe symptoms of depression, anxiety and stress respectively (Table 3).
Characteristics of participants with moderate and above levels of depression, anxiety and stress
Characteristics of patients with high depression, anxiety and stress levels at baseline, 3 and 6 months
Baseline DASS-21
Baseline DASS-21
3 month DASS-21
3 month DASS-21
6 month DASS-21
6 month DASS-21
Moderate and above any subscale
Normal or mild any subscale
Moderate and above any subscale
Normal or mild any subscale
Moderate and above any subscale
Normal or mild any subscale
No. participants
Mean age (yrs)^ (SD) [Range]
50 (18) [18–89]
48 (18) [17–94]
p = 0.32
48 (17) [20–88]
52 (16) [21–94]
p = 0.20
50 (17) [20–82]
53 (16) [23–94]
p = 0.36
34 (29.8%)
17 (19.5%)
p = 0.97
15 (30%)
16 (21.9%)
p = 0.31
8 (28.6%)
19 (23.5%)
p = 0.59
80 (70.2%)
70 (80.5%)
35 (70%)
57 (78.1%)
20 (71.4%)
62 (76.5%)
Injury Severity Score (ISS) median (IQR)+
8 (4–14)
9 (5–14)
p = 0.62
9 (5–17)
8 (5–13)
p = 0.37
9.5 (4–21.5)
9 (5–13)
p = 0.55
77 (67.5%)
66 (75.9%)
p = 0.20
40 (80%)
52 (71.2%)
p = 0.27
16 (57.1%)
64 (79%)
p = 0.02
37 (32.5%)
21 (24.1%)
10 (20%)
21 (28.8%)
12 (42.9%)
17 (21%)
Intensive Care Unit (ICU) admission*
13 (11.4%)
6 (6.9%)
p = 0.28
9 (18%)
4 (5.5%)
p = 0.03
6 (21.4%)
6 (7.4%)
p = 0.04
101 (88.6%)
81 (93.1%)
41 (82%)
69 (94.5%)
22 (78.6%)
75 (92.6%)
Injury mechanism*
Fall > 1 metre
32 (28.1%)
24 (27.6%)
p = 0.18
14 (28%)
18 (24.7%)
p = 0.08
9 (32.1%)
21 (25.9%)
p = 0.27
MVC driver
31 (27.2%)
13 (14.9%)
10 (20%)
16 (21.9%)
8 (28.6%)
16 (19.8%)
MBC rider
17 (14.9%)
15 (17.2%)
9 (18%)
12 (16.4%)
6 (21.4%)
14 (17.3%)
Pedal cyclist
8 (7%)
15 (17.2%)
3 (6%)
16 (21.9%)
0 (0%)
15 (18.5%)
4 (3.5%)
19 (21.8%)
5 (10%)
0 (0%)
2 (7.1%)
2 (2.5%)
5 (4.4%)
6 (6.9%)
3 (6%)
1 (1.4%)
0 (0%)
3 (3.7%)
MVC passenger
3 (2.6%)
5 (5.7%)
2 (4%)
1 (1.4%)
1 (3.6%)
2 (2.5%)
5 (4.4%)
3 (3.4%)
1 (2%)
5 (6.8%)
2 (7.1%)
3 (3.7%)
MBC passenger
4 (3.5%)
0 (0%)
1 (2%)
1 (1.4%)
0 (0%)
2 (2.5%)
2 (1.8%)
1 (1.1%)
1 (2%)
1 (1.4%)
0 (0%)
0 (0%)
3 (2.6%)
2 (2.3%)
1 (2%)
2 (2.7%)
0 (0%)
3 (3.7%)
Bivariate relationship between predictors and high levels of depression, anxiety and stress at 6 months post injury
Test statistics
High levels of depression anxiety or stress
χ2 = 9.600, df = 3
p = 0.022
T = 0.925, df = 107
p = 0.357
χ2 = 0.292, df = 1
p = 0.590
p = 0.554
χ2 = 5.096, df = 1
p = 0.024
ICU admission
χ2 = 4.175, df = 1
p = 0.041
Injury mechanism
χ2 = 11.039, df = 9
p = 0.273
Predictors of high depression anxiety and stress at 6 months post injury
Predictors for moderate or above depression anxiety or stress scores in any subscale at 6 months post injury
Variables in logistic regression
Odd ratios
0.065 – 0.562
ICU admission
1.109 – 17.767
Persistent (mod/above depression anxiety or stress at baseline and 3 months)
1.050 – 8.988
Late onset (mod/above depression anxiety or stress first reported at 3 months)
1.390 – 25.013
In this study, depression, anxiety and/or stress occurred following injury in a high proportion of patients during hospitalization (58.7%), and at 3 (40.2%) and 6 months following injury (23.9%). The severity of these symptoms ranged from mild to extremely severe.
The factor found to be primarily associated with the incidence of depression, anxiety and stress symptoms at three-month post injury in this study was an Intensive Care Unit admission. The factors associated with depression, anxiety and stress symptoms six months post injury were again, an Intensive Care Unit admission, and secondly, the reporting of depression, anxiety and/or stress symptoms in the moderate/severe/extremely severe categories at 3 months post injury.
Although ICU admission was a predictor of persistent depression, anxiety and stress symptoms, all patients admitted to hospital following injury should be screened as the majority of participants reporting moderate and above depression, anxiety and stress symptoms were not severely injured and may not have had an ICU admission. These findings are consistent with other literature describing the mental health outcomes in both the injured [17-20] and non-injured population [18-20]. The finding that a large proportion of participants had high depression, anxiety and stress scores at 3 months suggests routine longitudinal follow-up is needed and supports findings by Richmond et al., [21] who showed that injured participants experience an increase in psychological distress at 3 months after discharge from hospital when compared to baseline findings. The finding that ISS and polytrauma is not a predictor of depression, anxiety and stress after injury is also consistent with the existing evidence [22-24].
The study findings support the use of the DASS-21 in the injured population and the findings indicate that patients require mental health follow up post injury. There is a known lack of mental health follow up post discharge from hospital following injury [7]. The process for routine screening and related resource implications needs to be considered. If patients attend a trauma outpatient clinic for routine follow up they could be screened by the treating clinician or a clinic nurse in addition to their clinical follow up after injury. Or, if in hospital resources are limited, at the very least patients who have had an ICU admission should be targeted.
As a result of this study, in February 2014 the study site commenced screening patients for mental health sequelae using the DASS-21 in the trauma outpatient clinic in conjunction with their clinical follow up. A process for referral of patients reporting symptoms to clinical psychologists and/or in cases of active suicidality to the site acute mental health team was developed by the clinic trauma nurse in consultation with the site mental health team. Over ten patients requiring referral for mental health intervention have been identified through this process, which is being monitored for potential further evaluation. This does, however, exclude patients who do not return to the clinic for review who may also be at risk. To mitigate this, in all patient discharge letters, general advice about the emotional sequelae of injury is now included in conjunction with instruction to follow up with their General Practitioner or the Trauma outpatient clinic should they experience symptoms of depression, anxiety and stress post injury. The development of a standardized discharge information pack, informed by the study findings is under development, which includes information regarding symptom recognition, risk factors and resources for follow-up.
Routine in-hospital screening and follow up would promote anticipatory guidance for care and this is essential for the holistic wellbeing and health outcomes of the injured patient. The early identification of symptoms of depression, anxiety and stress post-injury would facilitate early intervention. Early intervention for mental health in general may also prevent the progression of Acute Stress Disorder symptoms to Post Traumatic Stress Disorder [25], particularly as anxiety symptoms may be correlated with the development of PTSD symptoms [26].
Future research could include the relationship between DAS and PTSD in this clinical population, the presence of co-morbid physical and mental illness and ongoing physical illness following hospital discharge. Qualitative exploration to explain the study findings would assist in understanding the role that physical and psychosocial factors relating to injury play in the development of negative emotion states, and the factors that may prevent or ameliorate these injury-related impacts. The significance of social support for the injured patient, for example, has been previously identified [27].
The limitations of this study included the small sample size and loss to follow up making it impossible to exclude the possibility that these participants did not have ongoing symptoms of depression, anxiety and stress. The study also attracted a small response rate. For example, there were significantly fewer patients who required an ICU admission in the study group than in the non study group, this could represent an under reporting of the magnitude of the incidence of elevated depression, anxiety and stress given that an ICU admission was a predictor of above normal levels. This group could also have been precluded from participating due to the severity of their cognitive impairment following traumatic brain injury. Further, there was no reliable recorded patient data on pre-existing mental health diagnosis, resulting in the inability to acknowledge pre-existing symptoms. Nor was the misuse of alcohol and other drugs recorded, which are known factors associated with the symptoms of depression and anxiety [28].
Depression, anxiety and stress symptoms occur following injury in a high proportion of patients during hospitalization, and at 3 and 6 months following injury, particularly those requiring intensive care. The DASS-21 has the ability to identify longer-term symptoms of depression, anxiety and stress in injured patients. All injured patients would benefit from routine mental health screening, particularly at 3 months following injury.
The authors wish to acknowledge the generous support of the Australian College of Nursing Consortium Fund.
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We believe in the perfect harmony of technology and design, so our customers can get more out of every space. Our engineers combine imagination and creativity with cutting-edge technology to create unforgettable experiences for client's homes, rooms and businesses.
Our industry-leading product offerings include TV Mirrors, Lighted Mirrors, Weatherproof Outdoor Displays and a new, first-in-kind SMART Mirrors. To learn more visit www.seura.com.
Imagine yourself working for us
Séura is expanding our team with the addition of a Mechanical Designer that will be responsible for the design, development, and evaluation of critical projects. He/she will be responsible for regularly offering innovative solutions to new product concepts and technical challenges. If you are enthusiastic, competitive and hungry for a new challenge, keep reading below!
More details
- Assist sales, engineering, purchasing, and manufacturing personnel in problem solving activities related to assigned area for product support
- Convert product requirements into technical specifications, develop conceptual and detailed designs along with necessary risk assessments, blending economy with performance
- Lead and manage a variety of projects concurrently within timelines and budgets
- Analyze and evaluate factory manufacturing processes, systems, equipment, and materials in terms of their associated cost, time, ergonomic, quality, and quantity factors
- Develop specifications and select qualified vendors to source components and/or finished goods from domestic and overseas vendors
- Support production by developing manufacturing processes and procedures, training staff, and developing of quality standards
- Provide second level technical support to internal sales and external customers
Success requires the following
- Degree in Mechanical Engineering from a 4 year college or university desired
- 3+ years of experience in product design, specifying manufacturing processes for electro-mechanical designs
- SolidWorks wizard!
- Demonstrated ability and a strong desire to get things done!
- Excellent oral and written communication skills demonstrated by the ability to communicate across all levels within and outside the organization
- Coachable, yet able to work with minimal supervision while providing useable project output.
- Ability to apply advanced design, problem-solving, development, evaluation, and quality control techniques to engineering concepts and projects
Happy, Energetic, Welcoming, Unique, Driven, Teamwork, Innovating and Fun. These are just a few of the words that current Séura employees use when asked to describe our culture. We also have a Culture Club that keeps us entertained—from Olympic competitions to potlucks to events that give back to our local community. Working in a newly expanded, modern facility is pretty great too!
Ready to be a part of all of this? Send your resume and introductory letter to email@example.com and tell us why you are the next excellent addition to our team!!

subset: commoncrawl


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A travel weblog for the on a regular basis working stiff. Read More About Travel Guide Here Regardless of the State Division's obvious intention to make Assist for the Cuban People a alternative for the individual common license, the revealed language, though modified favorably, was open to misunderstanding or deliberate misinterpretation for causes of financial self-curiosity or politics. For my part if the purpose of vacationers is to advertise impartial exercise to strengthen civil society and their activities enhance contact with the Cuban individuals, with the result of significant interplay, their presence in Cuba will likely be seen positively as legitimate help for the rising private sector, they qualify for this normal license and they will be welcome visitors.
Morning Time comes with a large number of Widget areas for Portfolios, Pages and Posts. The purpose of any website is to develop and develop. Nonetheless, that growth must usually be facilitated by multilingual capabilities. Thankfully, this theme is translation prepared, offering to showcase your pages in several languages. This product is based on Basis 5 Applied sciences resembling SASS and Grunt have been used. Morning Time is compatible with the modern Revolution Slider, and it permits customers to upload their very own customized logos. It promises to work with all major browsers and all devices. Users can get pleasure from frequent on-line upgrades, as this theme is an ever-evolving product.
BW Owners and lodge management corporations need to take a position early with consultants in the industry, who actually perceive not solely the operational and softer aspect of the enterprise but more critically the project and industrial aspects. The hospitality sector of the business, requires to take a position and better understand the distinctive components of the business in-order to display just how commercially and operationally successful this a part of their enterprise will be, if designed, arrange and operated correctly. Quite than over simplify and cookie cut the strategy to the business.
Pillsbury's multidisciplinary Journey, Leisure & Hospitality (TLH) crew consists of more than 50 lawyers working coast to coast throughout the U.S. and all by way of the world. four. You would possibly take skyway to the Decrease Station and take a Shuttle Bus (Free) to Awana Lodge and go down in Gohtong Jaya and stroll to the Strawberry Leisure Farm. Possibly partly because of there was such a tremendous, worldwide, collective-wish to go away 2016 behind. Greater than 300,000 Journey + Leisure readers weighed in on journey experiences throughout the globe to share their opinions on the best cities, islands, cruise ships, spas, airlines and more.
AN INTRODUCTION TO THE MILLENNIUM. This comprehensive introduction to a topic which is not usually addressed in church buildings, the Millennium, takes the topic head on. Understanding that it was God's intention for His Word to be taken actually (permitting for regular figures of speech and so forth) Brian offers an informative and refreshing perception into the Reign of Messiah Jesus on earth and the place of the believer inside His kingdom. This educating is designed to inspire and assist believers in these darkish "final days" and provides them a hope, and an goal to which they can work, while they anticipate the great reward of the Sabbath rest of God's folks. Value £10.


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Journal of Nanomaterials
Volume 2015, Article ID 506029, 9 pages
Fabrication of Modified MMT/Glass/Vinylester Multiscale Composites and Their Mechanical Properties
1Department of Mechanical Engineering, College of Engineering, Kyung Hee University, Yongin 446-701, Republic of Korea
2Korea Research Institute of Ships and Ocean Engineering, Daejeon 305-600, Republic of Korea
Received 14 May 2015; Revised 21 August 2015; Accepted 23 August 2015
Academic Editor: Christian Brosseau
Copyright © 2015 Garima Mittal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to Cite this Article
Garima Mittal, Vivek Dhand, Ji Il Ryu, Kyong Yop Rhee, Hyeon-Ju Kim, and Dong Ho Jung, "Fabrication of Modified MMT/Glass/Vinylester Multiscale Composites and Their Mechanical Properties," Journal of Nanomaterials, vol. 2015, Article ID 506029, 9 pages, 2015. https://doi.org/10.1155/2015/506029.


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Creamy Roasted Butternut Squash Soup
Soup! Of all my recipes, I think I am most proud of my soups. Vegan soup is an underrated thing. They're easy, they store well, and there are so many… Continue Reading →
Soup! Of all my recipes, I think I am most proud of my soups. Vegan soup is an underrated thing. They're easy, they store well, and there are so many… Continue Reading →
A few years ago, I made something called the 8-minute black bean soup and it was a big hit. I'm not sure anyone actually managed to make it in 8… Continue Reading →
There is no question that grapefruit + avocado is one of the best and most underrated flavor combos this world has to offer. It's probably not something you'd expect, and… Continue Reading →
Have I told you how much I love soup? Of all the categories of recipes I've developed over the years, the soup recipes are some of my favorites, and this… Continue Reading →
Honestly, I couldn't think of any recipe that would be harder to veganize than the Cobb salad. Key components include boiled eggs, chicken, blue cheese, and bacon. Ugh. More than… Continue Reading →
Since winter is finally here, I figured we'd kick off the new season with a wintery Tuscan kale soup! There is actually a classic Tuscan kale soup recipe that uses… Continue Reading →
Ever since a friend blew my mind with the revelation that oyster mushrooms can be used in place of chicken in chicken noodle soup (see: Oyster Mushroom Noodle Soup) I've… Continue Reading →
Having my own garden has always been high on my bucket list. I mean, what's more 'One Ingredient' than growing and harvesting your own food straight from the soil? So… Continue Reading →
This is a soup quite unlike any other. It's something of a spin on mushroom and barley soup (but with quinoa) and a classic creamy mushroom soup (but with cashews… Continue Reading →
Corn chowder is simple. Pour some vegetable broth and cream into a pot, dump in some corn and chopped potatoes, then simmer until cooked. That might be corn chowder, but… Continue Reading →


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Jo Malone London Geranium & Walnut Shower Scrub 200ml
Our Exfoliating Shower Gel cleanses and polishes skin in one easy step. Revive your body with Geranium & Walnut, developed to complement each and every Jo Malone London fragrance. Crisp, vibrant Geranium is layered with the warmth of walnut. With just the right balance of exfoliating ingredients, it is perfect for an effortless and pampering daily routine. Soft Jojoba beads, finely crushed walnut shells and bamboo stem work together to delicately smooth away dryness and impurities. Skin is left feeling soft, reinvigorated and primed to receive all the benefits of your Jo Malone London Body Crème.
Delivery to Channel Islands only. Next day delivery in Jersey on orders placed before 12 noon, for Guernsey please allow 3-5 days. For more details please see here
- Skin Care: Body Scrub
- Volume: 200ml
Item: 9001042718
Delivery from £4.99
In stock
Note: Delivery to Jersey, Guernsey, Alderney and Sark only.
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Rule Book Draft and Review 2018
Discussion will open 1st September 2017 and close 1st December 2017.
No feedback will be considered after the close off date of the 1st December 2017, as the planned release date for the ZLTAC 2018 Rule book is 8th December 2017.
Please make sure you keep below in mind when making suggestions about additions to rule book, some suggestions may belong in tournament guidebook / guide lines (currently under construction)
Rules are commands that are binding on those subject to them, e.g., "no smoking is allowed in this building." In other words, rules must be followed, and there will be a negative consequence associated with noncompliance.
Guidelines are recommended best practices that aim to set standards in the future.
New Rules or Wording to be amended
Team is required to be there 10 to 15 minutes prior to game.
Committee approved. 10th August 2017
Declaring number of players (TEAMS) if less than standard 5 are entering the arena
Committee approved. 10th August 2017


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This was my Christmas…
Sorry everyone. I found out my blog/website had been hijacked and that is why I've been having major issues. I think I have the issue resolved now. Anyways Christmas and New Years was fun. Here was my Christmas morning over at my parents.
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The Board recognises the importance of good corporate practice and is committed to maintaining high standards of corporate governance throughout the group. The Board comprises four executive directors and four non-executive directors. The directors intend to comply with the UK Corporate Governance Code in such respects as are appropriate for a company of this size, nature and stage of development.
The Board meets regularly and has overall responsibility for ensuring that the group is properly led and controlled, and is accountable to shareholders for financial and operational performance. These responsibilities include the overall strategy of the group, approval of significant items of expenditure and consideration of significant financing matters pertaining to the group.
The Board has established an Audit Committee, a Remuneration Committee and a Nominations Committee with formally delegated duties and responsibilities. Each of the Committees comprises three non-executive directors, who will invite other members of the Board to attend meetings as appropriate.
The Remuneration Committee is chaired by Jane Stabile. It reviews the performance of executive directors and sets the scale and structure of their remuneration and reviews the basis of their service agreements with due regard to the interests of the shareholders. The Remuneration Committee also makes recommendations to the Board concerning the allocation of share options to directors and employees. The remuneration and terms of appointment of non-executive directors will be set by the Board.
The company has a remuneration policy, the aim of which is to provide, in the context of the group's business strategy, remuneration that will attract and retain high calibre executives and staff. In order to achieve this, total rewards are set at levels that are competitive within the relevant market. Rewards are earned through the achievement of objectives based on measures consistent with shareholder interests.
The Audit Committee is chaired by Mark Driver, it meets at least twice each year and is responsible for monitoring the quality of internal control, ensuring that the financial performance of the company is properly measured and reported on, meeting with the auditors and reviewing reports from the auditors relating to accounting and internal controls.
The finance director is invited to attend meetings but the committee meets with the auditors at least once a year without the finance director being present.
The Nominations Committee is chaired by Susannah Nicklin. It is responsible for reviewing and proposing appointments to the Board and the various Board committees. In addition, the committee has responsibility for reviewing the composition of the Board and for selecting candidates for appointment, to meet the desired composition.
City of London Investment Group PLC is incorporated and registered in England and Wales. Its company registration number is 2685257.
City of London Investment Management Company Limited is authorised and regulated for the conduct of investment business within the UK by the Financial Conduct Authority (FCA), registered as an Investment Advisor with the United States Securities and Exchange Commission (SEC) and regulated by the Dubai Financial Services Authority (DFSA).
Registered in England and Wales No. 2851236. Registered Office: 77 Gracechurch Street, London, EC3V 0AS, England.
© 2019 City of London Investment Group PLC. All rights reserved.


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600mm (W) x 600mm (D) x 18RU Wall Mounted Server Rack
DCE GLOBAL has introduced a range of wall mounted communications cabinets that cater for 19" universal standards for patch panels, switches and routers, DVRs, Telephony, AV and security systems amongst other IT applications.
Our range of cabinets are pre-assembled for ease of installation and are supplied with all the main accessories required including wall mounting bracket, low-noise cooling fans, shelving, Australian PDUs and cage nuts.
Complies with ANSI/EIA; RS-310-D, IEC297-2;
DIN41491:Part 1; DIN41494:Part 7; GB/T3047.2-92 standards.
1pc / Carton


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I'm still up because I don't feel like I could sleep and don't want to waste time in bed. So I figured I'd surf the web for a while to get myself tired. Lucky you, eh?
Looking forward to a quiet weekend. Nothing is planned. I opted out of the work golf outing, for the simple fact that I require a weekend of nothing. And since I've golfed like 3 times in the last two years, it's not a big priority.
The biggest thing I have planned now for the weekend is to drag the smoker out and give another go at smoking some beef and chicken. We'll see how it goes. Hopefully better than previous trials.
This weekend will also most likely tell me how much a possibility the Pit ideas for season 5 are of really getting completed on time. The little bit that I have actually worked on things have been for things that should have been done before other seasons. Namely, making an easy way to run the Farm and Black Pit playoffs without having to hack code.
There are three main changes proposed. I see a possibility that two of them could get done. The third is quite big in scope, and I don't see me getting it done in time for when I'd like to start season 5.
Big news!! If you haven't already seen in the forum, the Wedgie-Man is back blogging in primetime! Head to the forum and check the other category. If you're interested you'll find it. Sometime I'll have to post the story of just how I know the Wedgie-Man(sorry, Jim, that's what your old and current blog links remind me of). I'd post a direct link, but I seem to be having a lot of spam trouble on this blog of late.
About every week, I'll get like 20-30 trackback spam on a bunch of my posts. Unfortunately, BBlog doesn't allow the moderation of trackbacks. I'm kind of looking at WordPress right now for a possible migration, but I don't see it taking my existing posts. BBlog doesn't give me many options. I'd like to have a set of links on the side, but it only shows links when you're looking at comments. I'm not an html or php guru, so I can't change things without the embedded helpers, which don't exist for what I'd like to do. Oh well.
I would like to get my den area in the basement cleaned and go through my games that I think could be played at the Pit BBQ next weekend. I need to get some familiarity with a few games in case they're needed.
Some big weeks coming up here. Next week is the eldest's birthday and then the following week is mine. Later next month, is the big 10 year anniversary. Feel free to give me any advice from those of you have have gone through a 10 year. Which for the two of you that read this, might be highly unlikely.


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Initial Use . LiPo batteries are supplied partly charged. Fully charge before first use.
Next Use Avoid frequent full discharges because this puts additional strain on the battery. Several partial discharges with frequent recharges are better for LiPos than one deep one. Recharging a partially charged LiPos do not cause harm. Short battery life is mainly caused by heat rather than charge/discharge patterns.


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Sliding Lid USB Box
From: £3.00
These small sliding lid boxes are perfect for storing USB sticks and are a great way of branding and displaying your products.
- Internal size: 74mm x 44mm x 25mm
- External size: 90mm x 60mm x 38mm
- Can be branded with your artwork using screen printing or engraving
- Perfect for a corporate gift or a way of storing all of your photos in one place
- Great for packaging and displaying USB sticks
- Base and slding lid made from 4mm birch plywood.
- Sides made from 8mm pine
- Comes in Natural but available in other colours
Order 10 or more and automatically receive an extra 10% discount in your shopping cart!
- Suitable For: Home & Garden
What customers thought of this product
No-one has reviewed this product yet.


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Impairment suspected in fatal Ahwatukee 3-car collision, police say
A 66-year-old female passenger was killed in a three-car collision Monday night in Ahwatukee, and police suspect her 24-year-old driver was impaired.
Witnesses told police that a Dodge Neon traveling west on Chandler Boulevard made a left turn near 48th Street in front of a Volkswagen Golf, which then collided with a Honda.
A passenger in the Neon, 66-year-old Angie Rodriguez, was taken to the hospital with critical injuries, and she was later pronounced dead, police said.
The driver of the VW Golf sustained minor injuries.
Sgt. Mercedes Fortune, a Phoenix police spokeswoman, said the driver of the Dodge Neon showed signs of impairment during the investigation.
Arrests and charges are pending toxicology reports and a reconstruction of the accident, which is still under investigation by the police, Fortune said.
Readers can send news tips to azcentral.com via the newspaper's social media channels, email or by calling the office. Wochit
- Art Institute of Phoenix to close in December; students scrambling
- 2 killed after vehicle slams into back of stopped car
- Ex-NFL star Richie Incognito threatened to shoot employees at funeral home, police say


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The Sun Devils bring hell to the 'Impairolympics'
Students were allowed to see how they would fare in a drunk-goggle sobriety test
The "Impairolympics" took place Wednesday night in the Downtown Phoenix Civic Space Park, put on by the ASU Programming and Activities Board (PAB). The contest was a series of challenges and events for teams to complete…while imitating the feeling of a 0.15 blood alcohol content (BAC). Participants came in teams of five or six to compete.
Participants came in teams of five or six to compete and also had a few interesting names. I particularly appreciated Team NaCl, which is the chemical formula for salt. The Meme Team is also a real heart warmer.
To stimulate the vision and depth awareness side-effects of a BAC double the legal driving limit, the PAB came equipped with several pairs of drunk-goggles. The kaleidoscope lenses warp the wearer's sense of depth and distance as though they were severely intoxicated.
"We really want to promote alcohol awareness," Michelle Castro, ASU senior and Live Entertainment Assistant for the PAB said. "Especially with Halloween coming up, we want everyone to be safe."
The Impairolympics started off with a tipsy relay, where each team member needed to zigzag through a line of cones while holding a tennis ball between their knees. At the end of the line, the member must throw the ball into their bucket. Whichever team got the most balls in their bucket won. I believe the winning score was one ball.
Other events included Drunk Operation, a code cracking game, and a spinning arm that contestants had to alternate jumping over and ducking under.
Please enjoy some of the limited footage where I managed to not let my laughter shake the camera. Copyright laws won't let us set the video to music, but I like to watch it muted and imagine "The Sound of Silence" by Simon and Garfunkel playing. Really raises the drama.
I suppose I thought the Sun Devils would be a bit lighter on their feet, given that they probably match the goggles' BAC of 0.15 three times a week anyway. But, the video doesn't lie. The Sun Devils were really looking like hell out there.
I also had to wonder, knowing my fellow Devils, if anyone had pre-gamed the Impairolympics. Theorizing that they came with the gross intoxication level of a 0.15 BAC, then put on the goggles, I bet you one of these troopers was rocking a 0.3 BAC. Gnarly.
Now don't panic, there were some serious parts of this event. Before the games kicked off, Officer Drain from the ASU Police Department spoke briefly about alcohol safety.
Officer Drain said it is important to realize that in Arizona, you do not need to have a BAC of 0.08 to be arrested for drunk driving. It depends largely on the drinker's ability to metabolize alcohol.
If a BAC of 0.05 has someone staggering down the sidewalk, that could warrant an arrest, despite not reaching the legal limit. Likewise, someone with a high tolerance may pass a sobriety test even if they are well over the legal limit. It is important to understand how your body works before you start drinking. Regardless, don't drink and drive; it is never better than taking an Uber or Lyft.
Students were allowed to see how they would fare in a drunk-goggle sobriety test. *Spoiler alert: not well*
Let's round this up with a group picture of The Meme Team rocking their color coordinated outfits. Bonus points to the guy second from the left for wearing a Deadpool shirt. I hope he was giving it MAXIMUM EFFORT.
Stay safe Devils, and remember, if you look like the kids in the video, please don't even think about operating a vehicle. Don't even think at all. Just go to bed. Please.