Psychological therapies for depression have demonstrated efficacy, but outcomes are still unsatisfactory, especially in cases with high comorbidity. Depression and anxiety co-occur in up to 69-75% of teens and intensify functional impairment and service use. This study will develop treatment materials for a transdiagnostic Group Behavioral Activation Therapy (GBAT) and conduct a pilot waitlist-controlled school-based study with 35 7th and 8th grade boys and girls with co-occurring depression and anxiety. Multi-reporter, multi-domain assessments will be conducted at initial screening, pre- and post-treatment, and 4-month follow-up. BA is a straightforward, but flexible and robust, therapy that has demonstrated strong results in adults. Current formulations of BA highlight the specific role of avoidance in depressotypic behavior. It presumes that anhedonia, isolation, and negative behaviors associated with depression function to avoid imminent distress even as it blocks access to otherwise available positive reinforcement. This study will therefore employ novel electronic diary technology to obtain Ecological Momentary Assessment and evaluate: (a) the function of avoidance in distinguishing youth with depression (n=35) from a non-clinical comparison group (n=18), and (b) the role of avoidance in mediating treatment gains in participants in the GBAT intervention.
This study will develop treatment materials for a transdiagnostic Group Behavioral Activation Therapy (GBAT). It will then conduct a double-gated screening of middle-school students (N=895) to identify youth with subclinical or clinical DSM-IV-TR anxiety or mood disorders. Eligible youth (N=35) will then participate in a randomized clinical trial of GBAT where 21 will be randomly assigned to GBAT and 14 to a 15-week waitlist period. This addresses critical needs to develop first-line early interventions that are evidence-based and can efficiently address commonly co-occurring problems in settings where treatment is needed most.
Aim 1. To develop treatment materials and test GBAT's feasibility (e.g., recruitment and retention rates, therapist adherence) and acceptability to youth participants (client satisfaction, group cohesion, homework completion).
Aim 2. To estimate initial efficacy of GBAT compared to a waitlist (WL) control in a randomized pilot study with 35 youth (21 assigned to two GBAT groups; 14 assigned to WL). It is hypothesized that GBAT will show greater pre- to post-treatment outcomes on primary (clinical diagnosis, symptom severity) and secondary measures (achievement of target goals, reduced avoidance, social and academic adjustment). Youth who receive GBAT will also show linear improvement on outcome measures from pretreatment through four-month follow-up.
A second major goal of the project is to understand the functional role of avoidance in depression. Participating youth will carry Electronic Diaries (EDs; i.e., ipod touch) throughout the active treatment and follow-up phases and complete twice-daily reports of negative events, emotional and behavioral responses, and perceived function of one's responses. A non-clinical comparison group (n=18) will also carry EDs during a two-week period. Such Ecological Momentary Assessment (EMA) data has been used effectively with youth populations to determine the impact of positive and negative coping responses on depressive symptoms.
Aim 3. The research suggests that depressed youth seek out depressogenic activities and respond less to positive events. Based on EMA data, the study hypothesizes that, compared to non-clinical comparisons: (a) depressed youth will identify more events as negative during the day, (b) depressed youth will respond with greater negativity than non-depressed youth, (c) the coping strategies used will be more avoidant or aimed at disengagement, and (d) the function of these strategies will be to minimize distress and conflict. Furthermore, youth who receive GBAT, compared to WL participants, will demonstrate increased ratio of engagement-based to avoidance-based coping strategies from pre- to post-treatment and 4-mo FU.
GBAT consists of 15 weekly, hour-long sessions. The first five group sessions teach four core BA principles: (a) psychoeducation of anxiety and depression, (b) functional analysis and identifying the maintaining role of avoidance, (c) problem solving and approach-oriented decision-making, and (d) graded exposures and behavioral activation. The second five group sessions consist of graded exposures or engagement exercises, where group members take turns practicing skills in role plays and in vivo exposures. Each youth receives two individual meetings (30-45 minutes) after the second and fourth group sessions. The first individual meeting promotes engagement and motivation for the group; the second helps develop the youth's individual avoidance/challenge hierarchy.
ADIS-IV-TR is a semi-structured interview that assesses presence and severity of DSM-IV-TR diagnoses, including parent, child, and consensus diagnosis. Impairment (Clinician's Severity Rating; CSR) is rated per disorder on a 0 (not at all) to 8 (debilitating) scale where 4 represents clinical threshold. The ADIS-IV-TR is administered at pretreatment, posttreatment, and 4-mo FU.
CDRS-R is a clinician-administered interview assessing depression severity over the past week, covering academic, social, health and cognitive functioning, and has been shown to be sensitive to treatment effects. The CDRS-R is administered at pretreatment, posttreatment, and 4-mo FU.
CGI-S is a widely-used clinician rating scale of symptom severity from 0 (no illness) to 6 (extremely severe) and is sensitive to treatment effects. The CGI-S is administered at pretreatment, posttreatment, and 4-mo FU.
SCARED is a 41-item self-report scale of anxiety symptoms experienced in the past three months. Total scores above 25 are indicative of an anxiety disorder. Previous research indicates strong discriminant and convergent validity. The SCARED is administered at pretreatment, posttreatment, and 4-mo FU.
CES-D is a 20 item self-report scale of depressive symptoms experienced over the past week. Total scores ≥ 21 predict significant presence of depression over the next year. Good psychometric data exist for use of the CES-D with adolescents. The CES-D is administered at pretreatment, posttreatment, and 4-mo FU.
SDQ is a 25-item behavioral screening questionnaire assessing five emotional and behavioral domains and has good psychometric properties (e.g., reliability and convergent validity). SDQ is administered at pretreatment, posttreatment, and 4-mo FU.
BADS-A is a 26-item adaptation of the adult BADS and assesses behavioral activation and avoidance. BADS-A was adapted for the current study to reflect developmentally appropriate reading level and concepts. The BADS and BADS-A have strong psychometric properties including reliability and predictive validity. BADS-A is administered at pretreatment, posttreatment, and 4-mo FU.
CATS is a 40-item child-report measure designed to assess negative self-statements, and has demonstrated good reliability and discriminant validity. The CATS is administered at pretreatment, posttreatment, and 4-mo FU.
an anxiety disorder (Generalized Anxiety Disorder [GAD], Social Phobia [SOP], Separation Anxiety [SAD]).
report of past-year hospitalization for a suicide attempt. Concurrent use of antidepressant or anxiolytic medications was permitted as long as dosage was stable for at least four weeks and the family intended to maintain the dose.


Tall, sturdy frame; not much room in the frame for good weight; low 3/4 delivery; above-average arm speed; stab in the back; drop-and-drive delivery; clean foot strike; moderate effort in the delivery; 1.10-1.19 to home with a runner on first.
88-90 out of the stretch; moderate run; mixes in fastballs with moderate sink and cut; poor command; relies almost exclusively on showing different looks with the fastball.
10-4 movement; inconsistent, lacks feel; flashes moderate bite; loses release point.
Flashes fade; inconsistent arm-speed replication; pitch gets firm; lacks feel.
Drafted by the Arizona Diamondbacks in the 8th round of the 2013 MLB June Amateur Draft from Flowery Branch HS (Flowery Branch, GA).
Keller's fastball has three distinct looks as he can cut it, sink it and run it in on hitters. The different looks function as his secondaries as his pitch mix is fastball dominated. The secondaries are underdeveloped; he doesn't have much feel for his slider nor his change. Keller works too quickly out of the stretch and leaks energy and loses velocity on his fastball. Keller can learn a proper cutter and function as a 5th starter with middle relief as a fallback.


5 mins in. What's going on. Who was that old guy? Why does everything look modern and not 70's?
Are there multiple Davids? Is the homeless guy and oldman also David? Learning about all the voices in his head?
Ahhh. The ol' multiple timeline episode.
I assume whiteout sniffer becomes tweaker David, but I can't fit those anywhere without rewatching, which I am not doing.


text:
Cars > Iconic
This Porsche 993 is gold, and we're glad that it's bound to return
The air-cooled classic has been resurrected with a special paint job
M Miggi Solidum
The glittering paint job is called Golden Yellow Metallic. PHOTO FROM PORSCHE
There are many reasons air-cooled engines have given way to the liquid-cooled powerplants common in cars today. Liquid-cooled mills are generally more efficient and less likely to overheat while sitting idle in traffic, and have higher tolerances when it comes to increased power. But sometimes, air-cooled engines are better. They're lighter and simpler, and Porsche has made a 'new' 993 with such propulsion.
That's right: Porsche has rebuilt the iconic 993 in Turbo S guise, no less. Called Project Gold, this is what happens when the boffins at Porsche Classic are let loose around the parts shop to create the ultimate classic Porsche. From a selection of over 6,500 genuine parts for the 993-generation cars and a build that took one-and-a-half years, they've come up with what may well be the best 993 ever put together.
This will be auctioned by RM Sotheby's on October 27. PHOTO FROM PORSCHE
Project Gold started out with a 993 shell that was given the same anti-corrosion treatment as current production cars. This ensures that the timeless lines of the classic 993 are preserved for future generations to see and appreciate. And because a very special car deserves a very special paint job, the topcoat of choice is what gives this car its name: Golden Yellow Metallic. This very color is featured on the limited-production 911 Turbo S Exclusive.
The body had to undergo cathodic dip coating. PHOTOS FROM PORSCHE
Powering Project Gold is a newly built twin-turbocharged 3.6-liter flat-six engine that churns out 450hp. This same engine is what would have been fitted to the 993 Turbo S model during its production run. Painstakingly assembled and tuned by specialists at the Porsche Classic workshop in Stuttgart, this air-cooled engineering masterpiece breathes through signature 993 Turbo S side intakes and drives all four wheels through a period-correct manual gearbox.
No small detail was spared in rebuilding the car. PHOTOS FROM PORSCHE
But a great classic car is not just about having a stunning body and a good running engine. It's all about the small details coming together to make a good car a masterpiece. For Project Gold, it means the collaboration of Porsche Exclusive Manufaktur craftsmen and Style Porsche designers to work on the small things that make this particular 993 stand out. The black leather upholstery features gold trim and is fitted completely by hand. The wheels get the same gold-on-black treatment where the gold accents are "etched out" using a high-tech laser cutting process.
Gold-on-black theme always looks nice and elegant. PHOTOS FROM PORSCHE
The rebirth of Porsche's air-cooled classic will make its world premiere at "Porsche Rennsport Reunion VI" at the Laguna Seca Raceway on September 27. This one-off will then be auctioned by RM Sotheby's for the "Porsche 70th Anniversary Sale" on October 27, where one very lucky bastard will drive it off into the sunset with its signature air-cooled scream in tow. The proceeds of Project Gold's sale will be donated to the newly established Ferry Porsche Foundation. This nonprofit organization is Porsche's social commitment to provide support for projects concerning education and youth development.
Gunther Werks reimagines the Porsche 993
Porsche restores dilapidated 901 from 1964
An ultra-rare Porsche 911 is coming up for auction
WhatsApp founder resigns, will collect air-cooled Porsches
A RAUH-Welt Begriff Porsche named Kirsten
Miggi Solidum
Miggi is the managing editor of VISOR. Professionally speaking, he is a software engineering dude who happens to like cars a lot. And as an automotive enthusiast, he wants a platform from which he can share his motoring thoughts with fellow petrolheads.
Could this car be the future Nissan X-Trail?
Exactly when will new car taxation take effect?
Be James Bond with this Lego Aston Martin DB5
6 things you must know about Mitsubishi's Outlander PHEV
Little Tikes' Cozy Coupe was my first dream car

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: jQuery show function flashing briefly I am very new to web development and jQuery. I'm trying to add my first jQuery method to my code in Ruby on Rails.  I have a css class
.list-group-item{
  display: none;
}

and a JS function
$(document).ready(function(){

  $(".list-group").click(function(){
  $(".list-group-item").show();
});

});

I tested it with an alert, the alert appeared. When I try to run this, the list group briefly flashed then goes away immediately.  I am sure it is a simple mistake.  I have tried adding return false before the document function, no change.  Thanks for acknowledging my noob question :)

A: Is .list-group-item a link?  If so, it sounds like the page is reloading as you don't have return false.  Need something like:
$(document).ready(function(){
  $(".list-group").click(function(){
    $(".list-group-item").show();
    return false;
  });
});

What this does is stop the link from doing anything else after it shows the links with list-group-item class.

A: You need to put the return false; after the show() function...assuming the list item is a link. return false; prevents the default behaviour of the selector. So if it's a link, it'll prevent the link from functioning - or being fired.
$(document).ready(function(){
   $(".list-group").click(function(){
       $(".list-group-item").show();

       return false; // add this here
   });
});

redpajama_set_name: RedPajamaStackExchange


117 Round, A A, '11th Report of the Excavations at Wall, Staffs: The Mansio, an interim note', South Staffordshire Arch & His Soc, XXI, 1979-80, 1-2.
BB1 in robber trenches; Hadrianic - Antonine samian. No drawings published.
A Neronian fort, followed by two Flavian Forts; the final phase, Trajanic or early Hadrianic, was probably non-military. Good group of early samian.


The diverse cuisines of Africa are based around locally available ingredients like fruits, cereal grains, vegetables, milk and meat products. North African food has been heavily influenced by Arab spices likes saffron, nutmeg, cinnamon, ginger and cloves. In the south, they rely on corn, grains, beans and vegetables, with fish serving as a protein staple along the coast. And in the west, the cuisine focuses on heavy, starchy foods as the main energy source with hot spices, chili peppers and peanut sauces.
Eating and drinking habits across the continent vary depending on the region, and each region has its own techniques and distinctive dishes. Here are 14 of them that you've never heard of but definitely need to try.
This South African dish literally translates to "small pot food." Potjiekos is a dish that's prepared outdoors, cooked with very little liquid and not stirred. Potjiekos typically includes meat, carrots, cabbage, cauliflower or pumpkin and starches like rice or potatoes. The ingredients are slow-cooked with South African spices in a three-legged cast iron pot over a fire.
Injera is a crepe-like, sourdough risen flatbread with a slightly spongy texture. The bread is made from teff flour — a light, gluten-free ancient grain flour that's made from a type of Ethiopian grass. Injera resembles the Indian dosa. The bottom of the flatbread has a smooth texture while the top is porous. The spongy bread is used for scooping up all kinds of sauces and various foods.
One of the most common dishes in Western Africa is jollof rice. People eat this rice dish throughout the regions of Ghana, Senegal, Gambia, Nigeria and Cameroon. Jollof rice is made with tomatoes, rice, tomato paste, onions, chili peppers, salt and spices like nutmeg, ginger, scotch bonnet and cumin. Some variations add vegetables, meat and fish.
Chermoula is the classic marinade that's often used for fish and seafood in countries like Tunisia, Algeria and Morocco. The mixture can be made in all different levels of spiciness by adjusting how much cayenne pepper is used. While there are a bunch of regional variations, other ingredients include cilantro, parsley, garlic, paprika, cumin, hot pepper, saffron, fresh herbs, olive oil and preserved lemon juice.
Referred to as wat, wot or tsebhi, this Ethiopian and Eritrean stew is made with chicken, beef or lamb and a bunch of veggies, spice mixtures and clarified butter. It all starts with chopped onions that are slow-cooked in a dry skillet and then seasoned with clarified butter and sautéed with herbs and aromatics before adding all of the other ingredients. The onions break down and thicken the stew. Wat is scooped up with injera.
Algerian and Moroccan tagine (also spelled tajine) dishes are slow-cooked savory stews. A tajine on its own is a two-part piece of pottery that stews are cooked in. The cone-shaped lid makes the food especially moist. When the food cooks, the steam rises into the cone, condenses and trickles back down into the dish. The stew cooks until everything is tender. Tagine dishes are made with sliced meat, fish or poultry and mixed with vegetables or fruit. Chili, paprika, ginger, cumin, turmeric, cinnamon and saffron are all common spices.
In Eastern Africa, Mandazi is a Kenyan food made from a dough that's deep fried until puffy and light. It's slightly sweet, sometimes spicy and traditionally eaten as a breakfast food, dessert or daytime snack. The dough often has crushed peanuts or toasted coconut mixed in, and the finished product can be coated in sugar or fruit preserves.
Shortened to ful, this African dish is served for breakfast. Shahan ful is believed to be imported from Sudan. It's made by slowly cooking fava beans in water. Once the beans are softened, they're crushed into a paste and served with chopped green onions, tomatoes and hot green peppers. Sometimes yogurt, feta cheese, olive oil, lemon juice and a bunch of spices are added. Ful is often served with a bread roll.
Kachumbari is a fresh tomato and onion salad that's popular in the African Great Lakes region. This dish is served uncooked with chili peppers and seasonings.
A popular West African dish, suya is a spicy shish kebab. It's a common dish for the people of northern Nigeria, Cameroon, Niger, Ghana and certain parts of Sudan. Suya can be made with skewered beef, ram or chicken. The thinly sliced meat is marinated in spices and flavorings like peanuts, salt and oil before it's barbecued. The skewers are eaten with dried pepper, spices and sliced onions.
Also called African bird's eye chili, piri piri is a blend of chili pepper that's grown in most African countries. It's sour, a little sweet and slightly salty, which makes it a versatile condiment that can be used on pretty much anything. This fragrant and fiery sauce is served with chicken, grilled fish or shrimp dishes made with red hot chili paste, lemon juice, cilantro, parsley, garlic cloves, salt and olive oil.
Maafe, also spelled mafé, is a West African stew made with lamb, beef or chicken. It's served in a peanut or peanut butter sauce over rice or couscous. Some variations have tomatoes, onions, garlic, cabbage, peppers and spices.
This cornmeal dish is the biggest starch staple in the African Great Lakes region and Southern Africa. Ugali is made of maize flour (cornmeal), millet flour or sorghum flour and then cooked in boiling liquid to create its firm, dough-like consistency. To eat ugali, roll some up into a ball and dip it into a sauce or stew.
In South Africa, you'll find this street food referred to as a bunny. Bunny chow is a hollowed out loaf of bread filled with curry. Don't worry, there aren't actually any bunnies involved. You can use the piece of bread on top to scoop up the curry inside, and keep working your way down until you reach the curry-soaked piece of bread at the bottom.


text:
Tebogo Makobela (born 14 May 1992) is a South African professional soccer player who plays as a midfielder for Black Leopards.

Career
Born in Giyani, Makobela played for Jomo Cosmos and Chippa United before being released by the latter in summer 2020. In September 2020, Makobela signed for Black Leopards on a three-year deal, but he was suspended by the club for the remainder of the season in April 2021 after taking part in an Easter tournament organised by Thabiso Semenya.

References

External links

Living people
1992 births
Sportspeople from Limpopo
South African soccer players
Association football midfielders
Jomo Cosmos F.C. players
Chippa United F.C. players
Black Leopards F.C. players
South African Premier Division players
National First Division players

redpajama_set_name: RedPajamaWikipedia


Gastroenterology nurses, also known as endoscopy nurses, work with physicians in treating and diagnosing patients with conditions affecting the digestive system and gastrointestinal (GI) tract, like reflux, bleeding, cancer and abdominal pains. Other conditions they deal with regularly include carcinoma, ulcers, dysphagia, dyspepsia and the removal of foreign bodies. Gastroenterology nurses can work in a variety of setting including acute care hospitals, outpatient clinics, private medical offices and even manufacturing companies. A large part of the job of a gastroenterology nurse is also educating their patients on the conditions they have and various ways to manage their symptoms in daily life. These nurses should also be great communicators as they deal daily with patients, families, nutritionists, home care specialists, physicians and more. They should also be familiar with such technology as exploratory endoscopic procedures, x-rays and computerized tomography scans. If conditions are severe enough, gastroenterology nurses can assist physicians with surgical procedures.
How Can I Become a Gastroenterology Nurse?
To become a gastroenterology nurse, one must first become a registered nurse. This can be accomplished by earning either a two or four year nursing degree and by passing the National Council Licensure Examination–Registered Nurses (NCLEX-RN). After working for several years as a registered nurse in a gastroenterology setting to gain practical experience, and acquiring two professional references, a nurse is eligible to take the credentialing exam. This exam can provide greater job opportunities, as well as security. The exam will earn a nurse the title of Certified Gastroenterology Specialty Nurse (CGSN). The exam is administered through the Certifying Board of Gastroenterology Nurses and Associates (CBGNA) and contains 150 multiple choice questions in the areas of general nursing care, gastroenterological procedures, patient care interviews and professional standards. It generally takes a candidate three hours to complete. Upon successfully earning certification, a professional must complete a set number of continued education hours in order to remain on top of the latest gastroenterological trends.
What Is the Career and Salary Outlook for a Gastroenterology Nurse?
There is an overall growing need for nurses across the United States that is only projected to increase in the coming years. This is great news for recent nursing graduates preparing to enter the work force. The highest growth rate, 48%, is estimated to occur in physician's offices, which can include outpatient care centers and those that specialize in endoscopic procedures. One of the leading causes for the increased demand in nursing as well as gastroenterology nursing, is the influx of aging baby boomers in the health care system. This older population has greater health care needs that will require more medical professionals to treat. The average salary for a gastroenterology nurse is around $50,000, but can depend greatly on one's education and certification level and geographic location. One of the drawbacks to working as this type of nurse is the limited patient follow up and inability to form long relationships with patients. A benefit to becoming a gastroenterology nurse is the ability to improve the quality of living of the patients treated.


Moving into a new apartment or dorm can be an overwhelming experience, especially if a roommate is involved. Even if they're not a stranger, you could find out quirks about your friend that make living with them challenging. It doesn't have to be a disaster, however. All you need to do is prepare yourself.
One of the best ways to prepare is to know what to expect. Most problems and benefits can be seen from a distance, which is always better than learning the hard way. Here are a few things to expect when moving in with a roommate.
When you're living with someone, you need to determine what space is shared and what space is private. This may seem like common sense, but some people don't understand boundaries. For example, the living room is generally considered a communal area, so it'd be weird if your roommate left their dirty clothes on the coffee table.
Expect to have a conversation about personal space. If the closet in your room is too small for all your clothes, you can talk to your roommate about using the hallway closet for some stuff. As long as you're willing to have these conversations, most problems will sort themselves out if your roommate is generally reasonable. Make sure you both know what's shared and what's private.
Keeping your space clean is everyone's responsibility. From the living room to your private bedroom, it needs to be kept as clean as possible. Even the mess in your bedroom can affect the rest of the house if you start to have unclean clothes or old food infecting the entire apartment with their unrelenting stench.
Most fights between roommates, however, are due to the kitchen. No one really wants to clean the dishes, but it has to be done. A common solution is alternating days to do the dishes, although that can lead to arguments when one day uses considerably more dishes than another. A better solution might be cleaning as you go by simply washing every dish right after you use it.
Most roommates won't mind if you have people visit every now and then, but things can get complicated if you have someone over all the time. This is especially true for significant others who potentially get all the benefits of being a roommate without actually paying rent. If your partner frequently spends the night, eats the food in the kitchen, uses the shower and more, your roommate could get annoyed that they're using the amenities they don't pay for. One solution to this problem is to move in with or marry your partner so they become your roommate, though you should probably give that one some thought first.
If you want to throw a party, your roommate has to be involved. You also need to enforce rules with your guests about not touching your roommate's things or invading their private space. Introverts especially can have problems with strangers in their home, so always be courteous.
For most roommate issues, the solution is talking. Have a conversation with your roommate about things you'd like to do that could be potentially bothersome. Also talk about things they do that bother you. Having an uncomfortable conversation is far better than having an unpleasant living arrangement and breaking your lease over disagreements, losing that security deposit.
Now that you know what things to expect when moving in with a roommate, it's time to actually make the move. The moving process can be stressful, but it doesn't have to be. With MoveWise, you can get quotes from the best moving companies in your area delivered right to your inbox. All you have to do is fill out our easy moving quotes form. We can even offer you information about the most popular moving destinations in the country. Get your free quotes today!
5 thoughts on "3 Tips for Moving in with a Roommate"


A digital scrapbooking bundle by Grace Lee and Studio Basic Designs, 'Out and About: At the Zoo' is the first of a new 'get-out-and-explore' themed kits!
Exciting, bold patterns, plenty of animal imagery and wordart, and four fantastic alphas all contribute to a wonderfully wild kit, perfect for scrapping photo's from your family's day out at the zoo, your kid's wildlife obsessions or even journaling about your inner wild side… grrr!
Jam-packed with character, color and adventure, 'Out and About: At the Zoo' bundle contains: 18 striking, patterned papers (plus 4 alternate versions), 15 card textured solids, 87 wild elements, 4 fab animal patterned alphas (A-Z, numbers 0-9 and some symbols, each saved as individual .png files), a collection of 10 cards (specifically 8 3x4 and 2 6x4 cards) is saved as individual .png files. and 10 painty marks, stamps and more is saved as individual .png files.
The elements are: A bear, 3 bows, 3 buttons, a cheetah, an elephant, 2 feathers, 8 flowers, 5 pieces of foliage, 3 frames, 2 giraffes, a lion, 3 ribbons, a piece of ricrac, a confetti scatter, a sign post, 2 signs, 2 pieces of string, 3 pieces of washi tape, vines, 2 zebras, an alligator, 2 'welcome' arrows, 2 banners, 2 yummy mixed media brushes (each in 2 versions), a butterfly, a piece of ephemera, 2 flairs, a gorilla, 7 labels, a panda, a staple, some stitching, 2 tags and 4 patterned wood slices plus the following title and word art: 'its's a zoo in here', 'welcome to the jungle', 'where the wild things are', 'my favorite animal', 'my favourite animal', I love the zoo', 'safari park', 'zoo' banner, 'at the zoo', 'wild & free' and 'adventure'. All are saved as individual .png files.


While OCD and OCPD share a similar name, these two mental health conditions have separate symptoms and treatment styles.
Though obsessive-compulsive personality disorder (OCPD) may sound like obsessive-compulsive disorder (OCD), it is not the same. Both conditions do, however, have a unique ability to create distress as these disorders interfere with a person's thoughts, feelings actions.
For someone who has one of these disorders, learning the characteristics of and differences between OCPD vs. OCD can help them better understand their condition. With this knowledge, a person can find the best treatments available.
As the name implies, OCPD is a personality disorder, which means the condition is more likely to be ingrained into a person's life.
Perhaps the most noteworthy characteristic of obsessive-compulsive personality disorder is perfectionism. Having OCPD means that a person has an intense need for perfection in themselves, their actions and the people around them.
In contrast to OCPD, OCD is different in that it involves obsessions and compulsions that affect every part of a person's life. Obsessions and compulsions are the hallmarks of OCD.
The final significant symptom of OCD is spending large amounts of time during the day performing OCD rituals. For example, needing five extra minutes to check the stove does not mean a person has OCD, but spending five hours in the shower might.
Depending on a person's condition, their OCD could cause additional repercussions. For example, if the person compulsively washes their hands, they could have dry, cracked skin.
When determining if a person struggles with obsessive-compulsive personality disorder vs. obsessive-compulsive disorder, experts complete a thorough mental health evaluation using the guidelines for diagnosis in The Diagnostic and Statistical Manual of Mental Disorders, fifth (DSM-5). Professionals may also gather information from friends and family members to get a complete perspective.
Critical elements in differentiating OCPD vs. OCD are the obsessions and compulsions. A person with OCPD will have some rigid behaviors, but they will not engage in the overwhelming need for repetition linked to OCD compulsions.
Another basis for determining OCD vs. OCPD is the level of insight and self-awareness. Most often, a person is fully aware of OCD and the problems it causes, but OCPD is different. A person with OCPD usually believes their thoughts and behaviors are normal, and other people are the ones who need to change.
A mental health professional will also investigate the impact of the condition. Usually, OCD affects all aspects of life, making work, school or healthy relationships impossible. In contrast, OCPD could relate to improved performance at work or school, but relationships with other people are likely to suffer.
People with OCD often see the need for treatment while people with OCPD don't think it will be helpful. A person who has OCPD may encourage their loved ones to seek treatment instead of themselves.
Due to a person's lack of insight and self-awareness, treatment for OCPD may be more challenging than treatment for other conditions. The preferred treatment for OCPD is talk therapy.
If someone responds well to these treatments, the therapy sessions can shift to a long-term treatment plan with a focus on reducing the feelings of perfectionism and their need for control. This form of treatment can be challenging and time-intensive, though.
Typically, OCD treatment follows another course. A form of cognitive-behavioral therapy called Exposure and Response Prevention aims to expose a person to obsessions while preventing their compulsions. If someone compulsively washes their hands, the therapist may encourage the person to touch something dirty without immediately washing. Their anxiety will rise initially but then fall with time, making the compulsion unnecessary.
When the compulsions end, the obsessions gradually diminish, making Exposure and Response Prevention an effective treatment.
A psychiatrist may offer medication to help reduce the symptoms of OCD as well. Medications paired with therapy seem to be the most successful treatment methods for OCD.
Conversely, medications are used less frequently with OCPD. If a doctor does prescribe them, it may only be in the short-term to address possible mood or anxiety issues.
By seeking out effective, evidence-based treatments as soon as symptoms arise, a person can significantly improve the prognosis for either OCPD or OCD. One study of Exposure and Response Prevention shows that treatment can reduce OCD symptoms by between 65 and 50 percent after only 14 therapy sessions. The benefits of talk therapy and counseling usually continue for months after treatment ends.
Like with other personality disorders, the outcome of OCPD treatments are less predictable. Although therapy can help a person reduce their need for perfectionism and control, the change takes time. In many cases, it takes an ultimatum from a boss or spouse for a person to accept the need for treatment and engage in the process.
With either OCPD or OCD, the presence of co-occurring conditions like depression, anxiety and substance use disorders can complicate treatment, resulting in a poorer prognosis. To find treatment for substance use and co-occurring mental health issues, contact The Recovery Village today.
American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition." Published in 2013. Accessed March 2019.
International OCD Foundation. "Exposure and Response Prevention (ERP)." (n.d.) Accessed March 2, 2019.
Jones, Mairwen K. et. al. "The Efficacy of Exposure and Response Prevention for Geriatric Obsessive Compulsive Disorder: A Clinical Case Illustration." US National Library of Medicine, National Institutes of Health, published in 2012. Accessed March 2, 2019.
National Institute of Mental Health. "Obsessive-Compulsive Disorder." Published in January 2016. Accessed on March 2, 2019.
U.S. National Library of Medicine: MedLine Plus. "Obsessive-Compulsive Personality Disorder." November 18, 2016. Accessed on March 2, 2019.
Van Noppen, Barbara. "Obsessive-Compulsive Personality Disorder (OCPD)." International OCD Foundation, 2010. Accessed on March 2, 2019.


1974 Topps baseball card #207 signed by Nolan Ryan in ballpoint pen and Tom Seaver in felt tip pen. The signatures were obtained by lifelong collector Pete Connolly in New York. The card features the 1973 strikeout leaders of each league, and is in excellent condition.


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With a title that long do you need a description?
Well okay. This one's from a sketch I made while sitting among the gorse and foxgloves on Carn Gribba, same little walk along the coast path as the Progo Cliffs picture; the view points are actually within about 50 yards of each other, just opposite directions.
Colour? Yeah, tricky one to photograph – the foxgloves are bright, but they're not fluorescent! It's on a deep edge canvas with painted edges.


text:
International Journal of Hypertension
International Journal of Hypertension/
AbstractIntroductionMaterials and MethodsResults and DiscussionConclusionsAcknowledgmentsReferencesCopyrightRelated Articles
Clinical StudyLetter to the Editor
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Clinical Study | Open Access
Genetic and Adverse Health Outcome Associations with Treatment Resistant Hypertension in GenHAT
Amy I. Lynch,1Marguerite R. Irvin,1Barry R. Davis,2Charles E. Ford,2John H. Eckfeldt,3and Donna K. Arnett1
Academic Editor: B. Waeber
Accepted18 Sept 2013
Treatment resistant hypertension (TRH) is defined as uncontrolled hypertension (HTN) despite the use of ≥3 antihypertensive medication classes or controlled HTN while treated with ≥4 antihypertensive medication classes. Risk factors for TRH include increasing age, diminished kidney function, higher body mass index, diabetes, and African American (AA) race. Importantly, previous studies suggest a genetic role in TRH, although the genetics of TRH are largely understudied. With 2203 treatment resistant cases and 2354 treatment responsive controls (36% AA) from the Genetics of Hypertension Associated Treatment Study (GenHAT), we assessed the association of 78 candidate gene polymorphisms with TRH status using logistic regression. After stratifying by race and adjusting for potential confounders, there were 2 genetic variants in the AGT gene (rs699, rs5051) statistically significantly associated with TRH among white participants. The Met allele of rs699 and the G allele of rs5051 were positively associated with TRH: (1.12–1.44), , and (1.20–1.53), , respectively. There was no similar association among AA participants (race interaction for rs699 and for rs5051). This research contributes to our understanding of the genetic basis of TRH, and further genetic studies of TRH may help reach the goal of better clinical outcomes for hypertensive patients.
Multidrug resistance to blood pressure (BP) lowering treatments is a growing problem in the USA [1]. In a recent report based on the National Health and Nutrition Examination Surveys (NHANES) collected in 1998–1994, 1999–2004, and 2005–2008, the percentage of treated uncontrolled patients on monotherapy fell, whereas the percentage on at least 3 medications increased over time [1]. Among those most severely affected are persons with treatment resistant hypertension (TRH) who have uncontrolled hypertension (HTN) on ≥3 antihypertensive medication classes or require ≥4 antihypertensive medications to reach their BP goals [2]. Recently, multiple studies have reported that the prevalence of TRH is 10–20% among those with HTN. However, some limitations of these estimates in the context of epidemiological studies are noted (e.g., potential misclassification due to BP measuring technique, nonadherence to medication, inadequate dosing, white-coat hypertension, and/or secondary causes of HTN) [3, 4]. Most concerning is the fact that TRH is consistently associated with increased cardiovascular disease (CVD) morbidity and mortality compared to more easily controlled HTN [3, 4].
Demonstrated risk factors for TRH include increasing age, diminished kidney function, higher body mass index (BMI), diabetes mellitus (DM), and African American race (e.g., African Americans are approximately twice as likely to be affected [1, 5]). However, these risk factors only partially account for the incidence of TRH, suggesting that other factors, including genetic factors, may increase risk [6]. A handful of small candidate gene studies suggest a genetic component for TRH, although the genetics of TRH are incompletely understood and largely understudied [7–9]. Therefore, we assessed genetic associations with TRH among African American and white participants in the Genetics of Hypertension Associated Treatment (GenHAT) study using 78 candidate genetic polymorphisms implicated in the development of hypertension and CVD. GenHAT leverages rich clinical data collected by the Antihypertensive and Lipid lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [10, 11]. Strengths of ALLHAT/GenHAT for the current study of TRH are that drug utilization and dose optimization are well documented, in addition to adherence data, resulting in less potential misclassification of TRH. Ultimately, better understanding of genetic risk may improve clinical care for TRH and prevent associated CVD morbidity and mortality.
2.1. Study Design
These data were derived from the GenHAT study ( = 39,114), an ancillary study to the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT included 42,418 hypertensive participants aged 55 years and older (46% women and 35% African American) who had one or more known CVD risk factors in addition to hypertension. ALLHAT was a randomized, double-blind, multicenter ( centers) clinical trial which tested whether the incidence of fatal CHD and nonfatal MI was lower with three antihypertensive drug classes (i.e., a calcium channel blocker, an angiotensin converting enzyme (ACE) inhibitor, and an alpha-adrenergic blocker), compared to treatment using a thiazide-type diuretic. Participants were randomized to treatment in a ratio of 1 : 1 : 1 : 1.7 for amlodipine, lisinopril, doxazosin, and chlorthalidone, respectively, to optimize statistical power for the three primary comparisons of ALLHAT [12]. The treatment goal was to achieve BP less than 140/90 mmHg by (1) titrating doses of the assigned study drug, and, if still necessary to control BP and (2) adding an open label drug (atenolol, reserpine, or clonidine as step 2 and hydralazine as step 3). To understand gene-treatment interactions on BP and CVD outcomes, GenHAT genotyped variants in several HTN- and CVD-related genes among 39,114 ALLHAT participants with available DNA. Complete descriptions of the rationale and design of ALLHAT and GenHAT have been previously published [12, 13]. This research was approved by local Institutional Review Boards. Genetic data were anonymized.
2.2. Study Population
The extreme phenotype design has been shown to be an efficient and powerful approach for genetic discovery in complex disease [14, 15]. Therefore, the cases and controls selected for the current effort represent extremes of the distribution of number of antihypertensive medications required to control HTN in GenHAT. Specifically, treatment resistant hypertension (TRH) cases were defined as all participants taking three antihypertensive medications at the ALLHAT year-3 follow-up visit who had a systolic BP (SBP) >140 mmHg or diastolic BP (DBP) >90 mmHg or taking greater than three antihypertensive medications regardless of BP at that visit. Easily-treated controls are defined as those taking only the randomized antihypertensive drug at year-3 and having a year-3 SBP 125 and DBP 85. To reduce the chance that lack of adherence to prescribed treatment, rather than true treatment resistance, accounts for the observed difficulty in controlling BP, we included only those participants who reported taking 80% or more of randomized drug at more than 50% of clinic visits. Using the classification scheme above, among the African-American participants with genotype data ( = 13,544), 6.9% ( ) were classified as TRH cases and 5.3% ( ) were classified as easily-treated controls. Among the white participants with genotype data (23,657), 5.4% ( = 1,274) were TRH cases and 6.9% ( = 1,635) were controls.
2.3. Outcome Ascertainment and Blood Pressure Measurement
The BP values used to classify participants as TRH cases or controls were measured at the year-3 postrandomization clinic visit. Trained observers using standardized techniques measured SBP, defined as the first Korotkoff sound (1st phase), and DBP, defined as the reading at the last Korotkoff sound (5th phase). The measurements were taken only after the participant had been seated quietly for at least 5 minutes with feet flat on the floor and the arm at or as close to the level of the heart as possible. The cuff was deflated at a rate of 2 mm/sec until 10 mm Hg below the level of the diastolic reading was reached. Two measurements were taken, with at least a 30-second interval between the measurements, and recorded to the nearest even number. All BP measurements were calculated as the average of these two readings [16].
Outcomes compared between TRH cases and controls were fatal CHD and nonfatal MI (hereafter referred to as "CHD"), stroke, heart failure (fatal, requiring hospitalization, or treated in an outpatient setting), end-stage renal disease (ESRD), all-cause mortality, combined CHD (includes CHD + coronary revascularization + hospitalized angina), and combined CVD (includes combined CHD + stroke + treated angina without hospitalization + heart failure [fatal, hospitalized, or treated in an outpatient setting] + peripheral arterial disease [in hospital or outpatient revascularization]), with a mean follow-up of 4.9 years. Outcomes were reported by clinical investigators, and documentation (hospital discharge summary, death certificate) was submitted for any outcome involving hospitalization or death. Deaths occurring among participants lost to follow-up were also identified using national databases. Outcomes were not mutually exclusive; for example, the primary outcome (CHD) was included in the "combined CHD" outcome, and the combined CHD outcome (as well as stroke and CHF) was included in the "combined CVD" outcome, each outcome being more inclusive than the previous one. A detailed description of outcome ascertainment for ALLHAT has been previously published [12, 17, 18].
2.4. Genotyping Methods
DNA was isolated on FTA paper (Fitzco Inc, Maple Plain, MN, USA) from blood samples. Genotyping was performed for 78 candidate polymorphisms using amplified DNA products of a multiplex PCRs and detected using an immobilized probe research assay for multiple candidate markers ("Roche strip," Roche Molecular Systems, Pleasanton, CA, USA) as described previously [19]. These variants were selected for inclusion by Roche because there was evidence that the biochemical pathways of these genes were implicated in the development and progression of CVD. See Table 1 for a complete list of genetic variants tested.
Genetic variants analyzed.
2.5. Statistical Analysis
To test for differences in baseline characteristics between TRH cases and controls in Table 2, ANOVA was used for continuous variables and chi-square tests were used for categorical variables. For Table 3, logistic regression was used to test for differences in clinical outcomes between TRH cases and controls in both unadjusted models and after adjusting for age, sex, randomized treatment group, baseline BMI, HDL, estimated glomerular filtration rate, SBP and DBP, smoking status, diabetes status, and history of left ventricular hypertrophy as detected by ECG. For Table 4, logistic regression was used to test for genetic associations with TRH, after adjusting for the same set of covariates. An additive genetic model was used for each variant, with common homozygotes coded 0, heterozygotes coded 1, and rare homozygotes coded 2; therefore, the ORs in Table 4 represent the odds of being in the TRH case group versus the control group for each copy of the minor allele. To reduce the chance that genetic admixture would lead to spurious associations, we analyzed a total of 78 variants (Table 1) in a self-identified race-specific manner. Because we performed 156 tests of genetic associations (78 × 2), a strict Bonferroni correction for multiple tests would require a value of less than (0.05/156) = 0.00032 to be considered statistically significant. All statistical analyses were performed using STATA version 10.1 (STATA Corporation, College Station, TX, USA).
Baseline characteristics for African-American and white treatment resistant hypertension cases and controls.
Association of clinical outcomes with treatment resistant hypertension.
Significant gene associations with treatment resistant hypertension.
3.1. Results
Baseline characteristics and follow-up BP measures for TRH cases and controls are shown in Table 2. Generally, TRH cases were more likely to be male, diabetic (Type 2), heavier, and taking BP medication at baseline. Cases also had higher baseline fasting glucose and BP and lower HDL cholesterol and estimated GFR, when compared to controls. There were also differences in case-control status depending on randomization group: those in the chlorthalidone and amlodipine groups were more likely to be controls, whereas those in the lisinopril and doxazosin groups were more likely to be cases.
Table 3 shows the association of the ALLHAT clinical outcomes with TRH. After adjusting for potential confounders, TRH was positively associated with CHD (OR = 3.44, ), heart failure (OR = 2.69, ), all-cause death (OR = 1.66, ), combined CHD (OR = 2.84, ), and combined CVD (OR = 2.11, ), but not stroke, among the African-American participants. There were also 28 incident ESRD events among the TRH group, and none among the control group for the African Americans. Among the white participants, TRH was positively associated with CHD (OR = 2.40, ), stroke (OR = 2.19, ), heart failure (OR = 3.98, ), ESRD (OR = 3.89, ), combined CHD (OR = 2.22, ), and combined CVD (OR = 2.42, ).
Among the 78 genetic variants tested, there were no statistically significant genetic associations with TRH for the African-American participants after correcting for multiple comparisons. There were 2 genetic variants, both located in the angiotensinogen (AGT) gene, showing significant associations among white participants after adjusting for potential confounders and correcting for multiple comparisons: AGTM235T rs699 and AGT-6 rs5051 (shown in Table 4). The Met allele of AGTM235T rs699 and the G allele of AGT-6 rs5051 were positively associated with TRH: OR = 1.27 (1.12–1.44), , and OR = 1.36 (1.20–1.53), , respectively. There was no similar association among African-American participants, although it should be noted that the Met (M) allele of AGTM235T rs699 and the G allele of AGT-6 rs5051 are far less frequent among African-American than white participants. There was evidence of a significant interaction by race in the association of both AGTM235T rs699 and AGT-6 rs5051 with TRH when combining the data from whites and African-Americans (interaction for rs699 and for rs5051).
There were 3 genetic variants that showed suggestive evidence ( ) of association with TRH among both the African-American and white participant groups (see Table 5). For methylenetetrahydrofolate reductase (NAD(P)H) (MTHFR) C667T rs1801133, the minor allele (T) was associated with lower odds of TRH compared to the common allele (C) for both African Americans (OR = 0.67 [0.52–0.86], ) and whites (OR = 0.88 [0.77–0.99], ). For the matrix metalloproteinase-3 (MMP3) 5A/6A rs3025058 variant, however, the association with TRH differs between the races. For African Americans, the minor allele was protective (OR = 0.75 [0.57–0.98], ), whereas for whites the minor allele confers higher odds of TRH (OR = 1.14 [1.01–1.29], ). For the tumor necrosis factor (TNF) rs361525 variant, the minor allele (A) is positively associated with TRH among both African-Americans (OR = 1.87 [1.13–3.11], ) and white participants (OR = 1.44 [1.10–1.90], ). It should be noted that the frequency of the minor alleles for rs1801133, rs3025058, and rs361525 was much more common among white participants compared to African Americans (see Table 5 for genotype frequencies).
Gene associations with treatment resistant hypertension that are suggestive for both AA and white participants.
3.2. Discussion
The follow-up BP data (Table 2) shows that from baseline to years 1, 2, and 3, the control group was able to substantially reduce their BP, whereas the TRH cases did not see marked improvement in BP control, despite the additional antihypertensive medications prescribed. There is also strong evidence among the GenHAT participants that TRH is associated with a higher burden of cardiovascular disease, renal disease, and death (Table 3) compared to those with more easily treated HTN. Other studies have considered risk for incident CVD events associated with TRH in comparison to more easily treated HTN, although their results cannot be directly compared to data from the current study due to differences in the comparison group. Still they draw consistent conclusions that persons with TRH are at higher risk for CVD outcomes. Previously published ALLHAT research identified factors predicting poorer BP control at the 3 year visit, including increased age, baseline SBP, and BMI, as well as African-American race, diabetes (type 2), and female gender [16]. Analyses of the full ALLHAT cohort for CVD outcomes in TRH are currently underway.
Two AGT genetic variants (rs699 and rs5051) were statistically significantly associated with TRH among the white participants, but no such associations were found for the African-American participants. This finding is in the opposite direction of a recent smaller study (70 TRH cases among Brazilian patients) showing that carriers of the AGT M235T Thr allele were at increased risk for resistant hypertension, particularly those participants older than 50 years, concluding that the rs699 (AGT M235T) Thr allele was an independent risk factor for resistant hypertension. Although they did not report the racial make-up of the participant groups, the allele frequencies reported for their population were more similar to the GenHAT white group than the African-America group [20]. Although AGT genetic variants are among the most studied in the context of hypertension and cardiovascular disease, and many studies have reported significant associations, the directions of the associations are not consistent [10, 11, 21–26]. There is also previous evidence that hyperaldosteronism causes treatment resistant hypertension [27, 28], which is important since both aldosterone and AGT are components of the renin-angiotensin aldosterone system (RAAS), which has a strong role in the regulation of BP.
Although not statistically significant, it is of interest that 3 genetic variants (MTHFR C667T rs1801133, MMP3 5A/6A rs3025058, and TNF rs361525) showed suggestive evidence of association with TRH among both the African-American and white populations. To varying degrees, all three of these genes have been previously studied in the context of hypertension. The matrix metalloproteinase (MMP) enzymes are inflammatory mediators that may contribute to hypertension, and though many previous studies which have shown an association with the C667T variant have found the minor T allele to be high risk, our data show the C allele to be more common among the TRH cases than the controls among both white and African-American participants. Previous studies have assessed the effect of MMP genes on hypertension and its sequelae, with an over expression of MMP found in hypertension [29–32]. We observed an inconsistent association in our data for the MMP3 rs3025058 between the white and African-American participants, although the minor allele was far less common among African-American compared to white participants. Tumor necrosis factor (TNF) is a cytokine involved in a wide variety of functions including cytolysis of tumor cell lines and the induction of cachexia, pyrogenicity, cell proliferation, and cell differentiation in some situations [33]. Although TNF genes have not been widely studied as predictors of hypertension, several studies have found that TNF interacts with the RAAS system in the regulation of BP [34–38].
It is not surprising that both AGT rs699 and rs5051 show similar associations, as the AGT −6 and M235T variants are in tight linkage disequilibrium (LD) on chromosome 1. Using SNAP (SNP Annotation and Proxy Search) [39], the LD between rs699 and rs5051 is and in the HapMap CEU population panel (Utah residents with Northern and Western European ancestry) and the HapMap YRI population panel (Yoruba residents of Ibadan, Nigeria), respectively. Both of these variants were in Hardy-Weinberg equilibrium (HWE) for our study population when tested in a race-specific manner (rs699 HWE and for whites and African Americans, resp., and rs5051 HWE and for whites and African Americans, resp.).
The strengths of this study include the relatively large number of TRH cases available in the ALLHAT/GenHAT study, including large numbers of African Americans with TRH. In addition, in the context of a randomized trial, we were better able to exclude pseudoresistant HTN cases characterized by poor BP measuring technique, nonadherence to medication, and/or inadequate dosing than a population-based study. In doing so, we observe a lower TRH prevalence in GenHAT versus other previous reports. Limitations of this case-control study include the loss of participants to death and other events, who might otherwise have been classified as TRH, as well as the inability to control for unknown differences between groups. In addition, ALLHAT recruited only patients aged 55 years and older, which does not allow for assessing the genetic effects on TRH among a younger population. Because a stronger genetic propensity may be present among those who manifest TRH at an early age, future prospective studies of the genetics of TRH would be well-advised to include a broad age range, including a younger hypertensive population.
Improving prevention and treatment of TRH will be enhanced with a thorough knowledge of the genetic architecture of TRH. Understanding the underlying etiology and progression of this disorder can potentially generate new ideas for treatment. This research contributes to our understanding of the genetic basis of TRH, and further studies of TRH may help us reach the goal of better clinical outcomes for hypertensive patients.
This work is supported in part by HL63082 (GENHAT) from the National Heart, Lung and Blood Institute, Bethesda, MD, and N01-HC-35130 (ALLHAT). The authors thank Victoria Brophy, Suzanne Cheng, and colleagues at Roche Molecular Systems for kindly providing genotyping materials and technical support. There is no conflict of interests, financial or otherwise, to report for this paper.
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J. Vilcek and T. H. Lee, "Tumor necrosis factor: new insights into the molecular mechanisms of its multiple actions," Journal of Biological Chemistry, vol. 266, no. 12, pp. 7313–7316, 1991.
J.-L. Cheng, A.-L. Wang, and J. Wan, "Association between the M235T polymorphism of the AGT gene and cytokines in patients with hypertension," Experimental and Therapeutic Medicine, vol. 3, no. 3, pp. 509–512, 2012.
L. E. Bautista, L. M. Vera, I. A. Arenas, and G. Gamarra, "Independent association between inflammatory markers (C-reactive protein, interleukin-6, and TNF-α) and essential hypertension," Journal of Human Hypertension, vol. 19, no. 2, pp. 149–154, 2005.
T. Zera, M. Ufnal, and E. Szczepanska-Sadowska, "Central TNF-α elevates blood pressure and sensitizes to central pressor action of angiotensin II in the infarcted rats," Journal of Physiology and Pharmacology, vol. 59, supplement 8, pp. 117–121, 2008.
C. A. Carvajal, A. A. Herrada, C. R. Castillo et al., "Primary aldosteronism can alter peripheral levels of transforming growth factor β and tumor necrosis factor α," Journal of Endocrinological Investigation, vol. 32, no. 9, pp. 759–765, 2009.
S.-J. Lee, W.-J. Kim, and S.-K. Moon, "TNF-α regulates vascular smooth muscle cell responses in genetic hypertension," International Immunopharmacology, vol. 9, no. 7-8, pp. 837–843, 2009.
A. D. Johnson, R. E. Handsaker, S. L. Pulit, M. M. Nizzari, C. J. O'Donnell, and P. I. W. de Bakker, "SNAP: a web-based tool for identification and annotation of proxy SNPs using HapMap," Bioinformatics, vol. 24, no. 24, pp. 2938–2939, 2008.
Copyright © 2013 Amy I. Lynch 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.


It's always great when crocodiles win awards. When a natural history programme featuring crocodiles wins an award, you know the toothy ones had a fairly significant role to play in it. Especially when the programme in question is Life in Cold Blood: Armoured Giants which just won the Golden Panda at the recent Wildscreen awards held in Bristol, UK. I like to think that our saltwater crocodiles had a part to play in winning, of course, as they featured in perhaps the most spectacular sequence in the programme - cooperative feeding on fish, which was filmed here in northern Australia. Being the scientific advisor for the crocodile half of the programme, I was able to persuade the BBC to bring Sir David Attenborough out to work with us on this crocodile sequence, because I knew exactly how spectacular it would be to get David and the crocs in shot. Working with David for a whole week was an experience we will never forget. This is someone who was responsible for getting me into a life of wildlife in the first place, and I felt this was a way of paying him back in some tiny way.


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Kazakhstan: Policy Space
Kazakhstan's flexible exchange rate and use of ample policy buffers have limited the effect of COVID-19 on the economy. Vulnerabilities remain high due to low oil prices and structural weaknesses. Key reforms need to be implemented to reduce dependency on oil and promote private sector growth.
Green Weekly Insight: Economic Impacts of Climate Change
Rising temperatures could hit global growth, especially with a big rise; 2.5°C warming could trigger a 1.3% income loss; "Business as usual," with no emissions mitigation efforts, could cause at least a 7% decline in global GDP/capita by 2100; Both cold/rich and hot/poor countries could see incomes fall, with big but avoidable losses for Canada, Russia, U.S., India; Multiple impact channels between the climate and the economy; climate confirmed as credit-relevant for sovereign issuers
IIF Letter to the G20 on DSSI Extension and Common Framework
In the wake of the extension of the G20 Debt Service Suspension Initiative (DSSI), as well as recent thoughtful proposals for reforming the international sovereign debt architecture, the IIF offers these private sector perspectives that build on our September 22 letter to the G20.
FRT Episode 80: Annual Download with FinTech Beat
FRT once again joins forces with CQ Roll Call's FinTech Beat podcast, as we exchange our key takeaways from across the IIF Annual Membership Meeting, the IMF & World Bank annual meetings, and DC FinTech Week, with FinTech Beat host, Professor Chris Brummer of Georgetown University.
GMV: The Not So Dominant Currency Paradigm
The export channel from devaluation remains a positive force for EM one we think is underappreciated at the current juncture.
Macro Notes: Zambia - Debt Dynamics Remain Unfavorable
Zambia has launched consent solicitation for a deferral of bond payments. Kwacha depreciation is the main driver of unsustainable debt dynamics. In a no-adjustment scenario, public debt could reach 200% of GDP by 2025. Upcoming general elections in August '21 contribute to policy uncertainty.
Economic Views: Rollover Risk in Brazil
Brazil used government deposits to fund the fiscal deficit, … which is equivalent to short-term borrowing via BCB repos. The maturity of ne...
Quick Take: US Election Referenda – Data & Digital Policies
The November 3, 2020 election featured a series of such referenda, including four that relate to data and digital policy topics.
IIF/GFMA responds to Basel Committee 'Principles for Operational Resilience'
The Institute of International Finance (IIF) and the Global Financial Markets Association (GFMA) have submitted a joint response letter to the Basel Committee on Banking Supervision (BCBS) supporting the draft principles put forward in their Consultative Document "Principles for operational resilience."
IIF/GFMA Responds to Basel Committee on 'Revisions to the Principles for the Sound Management of Operational Risk'
The Institute of International Finance (IIF) and the Global Financial Markets Association (GFMA) submitted a joint response letter to the Basel Committee on Banking Supervision's (BCBS) Consultative Document "Revisions to the principles for the sound management of operational risk."


A woman is dead after falling at a local rock climbing gym on Sunday. Emergency crews were called to the Summit climbing gym located on Mustang Drive at approximately 5:00 p.m. on Sunday. According to Sgt. Robert Eberling of the Grapevine Police Department, emergency responders arrived and discovered am injured customer, a 52-year-old woman, had fallen from a height of 25-30 ft.
The woman was airlifted to Parkland Memorial Hospital in Dallas, where she was pronounced dead upon arrival. The Dallas County Medical Examiner has released the identity of the victim as 52-year-old Susan Mailloux of Irving.
Rock climbing is becoming more and more popular every day. Rock climbing gyms offer a place to have fun and a great way to build endurance and strength. However, because of poor regulation, maintenance and design issues, climbing wall accidents at such rock climbing gyms and features are happening with greater frequency as the sport's popularity grows.
Failure by climbers to wear any sort of protective gear or harness.
Rock climbing walls can be dangerous. Some indoor rock walls are as high as forty feet in the air and others offer climbs across ceiling structures. When you make a climb at such facilities, you are not only putting your trust in the harness and ropes holding you, but also placing a great deal of trust on the strength and ability of the person or persons who are managing the rope systems. There is also a great deal of trust that is left to the strength of the structure and design of the rock climbing wall itself. It's not just kids or novices getting hurt in such instances. Even veteran rock climbers can suffer catastrophic injuries or death.
If you or a loved one has been injured or killed as a result of rock climbing or other extreme sport, give our offices a call. We will match you with an attorney who will go over the details of your case, after you have seen a doctor. Medical costs, rehabilitative therapy, loss of wages, pain and suffering can all factor into a personal injury case. We have been successfully representing our clients in the Dallas – Fort Worth area courts for many years. We are here to help you. Your initial consultation with us is confidential and without cost to you.


Welcome to Doggie Shades - Dog Decals for Your Window!
High quality Vinyl Window Decals to show your dedication to your Best Friend.
Personalized Dog Window Decal. Click on the picture to see approximate size of actual decal.
Choose your breed below. Dogs are listed in alphabetical order by breed. If you choose to personalize the decal with your pet's name, this will be done during the check-out process. Put your dog's name in the contact box. Please be sure to check for the correct spelling of your dogs name.
Don't see your specific breed? You may want to check out other breeds with a similar profile. If you still can't find what you want, be sure to contact us. If we get enough requests for a certain breed, we may add it.


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Workshop—Bread Baking: From Grain to Roman Bread
Augusta Raurica
Augusta Raurica was a Roman settlement from about 15 BC. For over 300 years, it was a flourishing metropolis with about 15,000 inhabitants. The remains today are spread out over the two villages of Augst and Kaiseraugst and are an excavation site, a research center, and a museum with impressive ruins and rich finds. They are also offering various workshops and guided tours throughout the year. Only 20 minutes from Basel, visitors can get a glimpse into life as it was in Roman times.
During this workshop, you can learn how grain was processed into bread 2000 years ago. You will experience this together step by step as you make a tasty loaf the Roman way. You will first grind the grain in a Roman stone mill before kneading and shaping the dough according to your own ideas. Then the loaves will be placed into the reconstructed wood stove and finally you can take a warm and fragrant loaf home with you.
Cost of the workshop is CHF 16 for adults and CHF 8 for youths, which includes entrance to the museum.
augustaraurica.ch/en/offers/breadbaking-public
Augusta Raurica / Roman House
Giebenacher Strasse 17
4302 Augst


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Fall is the Perfect Time for a Couple's Getaway to the Crystal Coast
By Liz Mays | Get Lost In The USA on Nov. 30, 2022
North Carolina's Crystal Coast is one of the most picturesque regions in the state. Often called the Southern Outer Banks, the area is home to several quaint waterfront towns, including Beaufort, Morehead City, and Atlantic Beach. The Crystal Coast is gorgeous year-round. However, if you visit in…
From Tide To Table: A Foodie's Guide To The Crystal Coast
By Off The Eaten Path on Apr. 22, 2021
North Carolina's Crystal Coast is well known for being an area rich in history and nature. But beyond its sandy beaches, swashbuckling history, wild horses and pristine, protected national seashore, did you know that the Crystal Coast is a foodie destination too? With more than 100 locally owned…
The Crystal Coast: Paradise Found
By Well Traveled Child on Dec. 16, 2020
`Like many others, the beach is my happy place. I have traveled to beaches across the world, but nothing can compare to the sand and sea of the Crystal Coast in North Carolina. The Crystal Coast is an 85-mile stretch of beautiful coastline where stress is lost and relaxation is found. There is a…
Holiday Shopping + Sips
By The Coastal Blonde on Dec. 09, 2020
Over the weekend, my friend and I had the unique opportunity to visit the beautiful shops and beaches of the Crystal Coast! The Crystal Coast is located in North Carolina's Southern Outer Banks. It's home to 85 miles of gleaming Atlantic beaches, a herd of wild Spanish mustang horses, the graveyard…
5 Ways to Celebrate Labor Day Weekend at The Crystal Coast
You've worked hard this summer. Celebrate and take a break from the grind with these 5 things to do this weekend at the Crystal Coast. Check out #MyCrystalCoast this Labor Day Weekend. One Walk the Pier. Whether you're enjoying the sun, or get your toes in the sand, check out the Oceanana Pier…
America's Best Small Towns: Discovering North Carolina's Crystal Coast
A south-facing cloister of coastal treasures, the Crystal Coast of North Carolina is truly one of a kind. Due to its unique geography, it's the only place in the state—and one of few on the entire Atlantic shore—where visitors can watch both sunrise and sunset over the same clear, blue water. The…


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MikeHamiltonBand
Rhythm Surf Monkeys
Mike Hamilton
Beggars & Poets
Download: $9.99
With Mike's first acoustic release, BEGGARS & POETS, he returned to his first love...writing and performing heartfelt folk and bluegrass music about the troubles and triumphs of men and women and the TRAVELIN' SOULs within us all.
Jim Fox produced Beggars and Poets Mike's second album containing songs composed from 1969 through 1998. Beggars and Poets is a collection of acoustic songs featuring Mike on lead vocals, guitar and bass, Mac Walter co-production, lead guitar, and vocals, Dave Goodman, Fiddle, and Archie Warnock, bass and vocals and a few special guest appearances.
The Puzzle 3:28
Come & Sit (My Little Son) 4:14
4-Lane Hi-Way 3:47
Time (Takes Its Toll) 5:13
Red Balloon 3:01
If You Don't Want My Love 4:01
Rollin' Stone 4:27
10 Toes Up 2:39
Thunderstorm 2:09
Time Card 3:01
Midwestern Tragedy 3:37
Beggars & Poets 5:42
Manpoem 3:45
Travelin' Soul 4:43
All content © Copyright Protected - All Rights Reserved


Advertising through Google, Bing, facebook, and other Social Media compliments SEO.
The best advertising focuses on a specific target market. A digital ad give the advertiser greater control over who sees it, which means less money wasted on people who have no interest. We work with our clients to understand their objective. We help out clients choose between Google adwords, Bing Ads and Facebook ads.
A landing page can be any page that someone lands on after clicking on an online marketing call-to-action. Dedicated, promotion-specific landing pages are what we use to improve response rates. Dedicated landing pages are standalone pages that are designed for specific marketing campaigns.
1) Better targeted ads are charged less per click by Google/Facebook etc. This is they want to show better ads.
We are experts at targeting and ensuring our clients achieves the best savings and giving them the best return on investment.
How we improve your results?
Keywords – We review keywords based on volumes and competition.
Actual Ad – Given the knowledge we now have we'll build a personalized campaign for you.
Improve – hen we know what is going on we continually improve.


CEO and Co-Founder of Compliance.ai, a RegTech company transforming the way highly regulated organizations address compliance risk.
As artificial intelligence (AI) reshapes industries, fear of AI is on the rise. According to a Gallup poll from last year, a majority of Americans (58%) believe AI is a bigger threat to their jobs than immigration and offshoring. Many of the jobs that people fear will be eliminated, however, such as assembly line positions, were long gone before AI took off, outsourced over the past few decades before being automated today.
According to the Brookings Institute, AI, automation and machine learning will impact knowledge workers but not necessarily how you may expect. "Dynamic machine algorithms have a distinct data-driven competitive advantage over human pattern detection. For example, dynamic machine algorithms are better equipped to search massive data sets for profitable patterns," wrote Makada Henry-Nickie, a fellow at the Brookings Institution.
Henry-Nickie points out that AI is helping hedge funds generate profits and spotting diseases radiologists often miss. These two examples illustrate how AI will evolve in the workforce as an augmentation to human intelligence, not as a replacement.
Pattern recognition within large datasets isn't something humans do well, but to reach its potential, AI needs human supervision to make sense of patterns and leverage that knowledge.
In the field of machine learning, we separate algorithms by how they learn: unsupervised or supervised.
Unsupervised learning finds hidden patterns in huge sets of data, which is useful for data mining and big data analytics. Data scientists don't attach labels to data subsets, instead tasking the algorithm with discovering its own structure. This approach not only identifies hidden patterns, but it excels at detecting anomalies.
Supervised learning moves us closer to something most would consider real intelligence. Its learning is measured by the quality of how an algorithm labels a newly encountered problem.
Typical unsupervised/machine-only AI algorithms are roughly 80% accurate, falling well short of business standards. Therefore, human input is used to improve the algorithm's assessment confidence level.
After humans fine-tune a model's assessment, those judgments can be fed into a machine learning algorithm, making it smarter. This is known as the human-in-the-loop model (HITL). In theory, smarter AI trained by humans could threaten knowledge workers, but that scenario is unlikely.
Since machines can still only learn in narrow ways, AI generates jobs for humans out of necessity. In fact, the World Economic Forum predicts (via Investopedia) that AI and robotics will create 60 million more jobs than they will eliminate by 2022.
Consider assembly line work. Auto manufacturers now assemble vehicles with robots, but as a result, vehicles are far more complicated than cars from Detroit's heyday.
With navigation systems, telematics and driver-assist tools, modern vehicles demand specialized expertise to service and maintain them. The era of the shade-tree mechanic is fading fast, but there are still plenty of jobs for mechanics. The Bureau of Labor Statistics forecasts that demand for "automotive service technician and mechanics" will increase by 6% by 2026, a growth rate on par with the rest of the economy.
Rather than trying to replicate problems through long physical inspections or repeated test drives, mechanics can plug in a code reader and diagnose problems in a fraction of the time. Rather than replacing them, telematics and diagnostic algorithms aid mechanics.
Human-in-the-loop models, however, still have serious limitations. For example, they treat all humans as equal, ignoring the aptitude level of people answering a question or flagging an error. Obviously, if the input of your least skilled employee is given equal weight as top experts, you have a problem.
Thus, a better model has emerged: expert in the loop (EITL). EITL weighs aptitude and can even, over time, rate your judgment based on your past performance.
Whereas HITL excels at quantity (it's easier to ask for feedback from a large number of randomly chosen individuals), EITL excels at quality. EITL not only increases the confidence level of the AI assessments, but it also provides peace of mind for those auditing the AI-produced results. After all, these vetted experts have domain expertise and have been specifically recruited to assist with definitive supervisory tasks.
EITL AI is already being adopted in such fields as financial services, pharmaceutical research and regulatory compliance. Tax law is an even better example of AI's power as a job-creating engine, especially in specialized, heavily regulated fields that require constant document processing.
According to an IDC study (via MetaJure), law firms lose more than $9,000 per year per lawyer on document management activities, with lawyers often forced to recreate documents they cannot find. This not only translates into nearly a 10% loss in productivity for the organization, but it also means that highly trained, expensive professionals are wasting their time on mundane tasks, rather than creating action plans, strategizing or offering any value-added services.
You could think of this as legal assembly line work, and it will be automated in similar ways. AI can be programmed to automatically retrieve, read, and classify relevant information from databases, saving compliance officers countless hours.
But to build and train AI models, you need compliance professionals, lawyers and law professors. Real experts are needed to eliminate errors, identify gaps and fine-tune classifications. Expert analysis is essential; otherwise, AI could increase your risk exposure.
Taken further, once experts are recruited into a variety of industries to train AI, they will find new opportunities across the economy. Just as traditional security professionals found a variety of new homes as cybersecurity exploded, so too will legal professionals find opportunity beyond traditional roles within law firms, corporations and the government.
Freed from professional silos, experts will be free to pursue new business models that lower operating costs, reduce risks and serve an exponentially greater number of clients with far better results.


All Cows Eat Grass tickets are on sale now and they are selling quickly! If you�re a fan of rock music then act fast because the 2019 All Cows Eat Grass tour is a hot seller. Browse concert tickets for All Cows Eat Grass tour dates and get ready to rock.


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CAA Signs Internet Personality & Actress Hannah Stocking
Quentin Tarantino's Lawyer Rips "Ham-Fisted" Miramax For NFT 'Pulp Fiction' Suit – Update
By Dominic Patten, Anthony D'Alessandro
Mega; Everett
UPDATE, 2:06 PM: It is fair to say that there doesn't look like there is going to be a lot of nuance in the showdown between Quentin Tarantino and Miramax over the Pulp Fiction director's decision to auction off NFTs of his classic Oscar winning film.
Yesterday, the Bill Block run company took its one time Golden boy to court over the seven "exclusive scenes" from the 1994 picture that he said he plans to put in the digital art market. Citing breach-of-contract, copyright infringement and more, the jury trial seek lawsuit to prove its point also dropped Tarantino's 1993 contract with Miramax in the docket as Exhibit A — and that really pissed off Tarantino and his heavyweight Beverly Hills lawyer.
'Star Trek: Discovery' Exits Netflix Tonight; Set For 2022 Launch On Paramount+ Globally
Like "I dare you, I double dare you motherfu*ker" pissed off, as Samuel L. Jackson's iconic Jules says in Pulp Fiction.
"Miramax is wrong – plain and simple," Bryan Freedman tells Deadline of the suit.
"Quentin Tarantino's contract is clear: he has the right to sell NFTs of his hand-written script for Pulp Fiction and this ham-fisted attempt to prevent him from doing so will fail," the Freedman & Taitelman LLP partner adds in curt fashion. "But Miramax's callous decision to disclose confidential information about its filmmakers' contracts and compensation will irreparably tarnish its reputation long after this case is dismissed."
Yeah, not a lot of ambiguity there.
PREVIOUSLY, NOV. 16 PM: What started out a bit of a royale with cash cheese might become a legal battle royale between Quentin Tarantino and Miramax over the director's plans to auction off Pulp Fiction NFTs.
Or as Samuel L. Jackson's Jules said in the iconic flick: "Mmm, this is a tasty burger."
"Eager to cash in on the non-fungible token ('NFT') boom, as widely reported in the media, Quentin Tarantino recently announced plans to auction off seven 'exclusive scenes' from the 1994 motion picture Pulp Fiction in the form of NFTs," proclaims Miramax in a breach-of-contract and infringement lawsuit filed today in federal court in California (read it here).
The Oscar winner announced his foray into the digital art world at the NFT.NYC conference this month. No date has been laid down for the auctions, but we do know that Tarantino's NFTs are set to be seven scanned digital copies of his handwritten original scripts with audio commentary. However, one cease-and-desist letter later, the company that Harvey Weinstein co-founded is looking for statutory damages and declaratory and injunctive relief in a jury trial.
"Tarantino's conduct has forced Miramax to bring this lawsuit against a valued collaborator in order to enforce, preserve, and protect its contractual and intellectual property rights relating to one of Miramax's most iconic and valuable film properties," according to the 22-page complaint filed by lawyers at Proskauer Rose LLP about the director's career-making second film, starring Jackson, John Travolta, Uma Thurman, Ving Rhames, Tim Roth and a punchy Bruce Willis.
"Left unchecked, Tarantino's conduct could mislead others into believing Miramax is involved in his venture," the suit states. "And it could also mislead others into believing they have the rights to pursue similar deals or offerings, when in fact Miramax holds the rights needed to develop, market, and sell NFTs relating to its deep film library."
Tarantino's reps couldn't be reached for comment on the lawsuit. However, Tuesday's filing does reveal that the director's own lawyers told Miramax that they "contended that Tarantino was acting within his 'Reserved Rights,' specifically the right to 'screenplay publication' with the NFT plan.
Clearly Miramax begs to differ on what it sees as a one-time transaction not covered by any of QT's Pulp Fiction rights. Or as Jackson's assassin deluxe Jules would say: "I'm sorry, did I break your concentration?"
Bill Brock
9 French Actor Gaspard Ulliel, Star Of Marvel's 'Moon Knight' Series, Dies Aged 37 After Ski Accident
10 Sundance Review: Carey Williams' 'Emergency'