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Clinical Care / Education / Nutrition / Psychosocial Research| December 14 2012
Prospective Associations Between Emotional Distress and Poor Outcomes in Type 2 Diabetes
James E. Aikens, PHD
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
Corresponding author: James E. Aikens, aikensj@umich.edu.
Diabetes Care 2012;35(12):2472–2478
https://doi.org/10.2337/dc12-0181
James E. Aikens; Prospective Associations Between Emotional Distress and Poor Outcomes in Type 2 Diabetes. Diabetes Care 1 December 2012; 35 (12): 2472–2478. https://doi.org/10.2337/dc12-0181
Cross-sectional studies link both depressive symptoms (DS) and diabetes-related distress (DRD) to diabetes self-management and/or glycemic control. However, longitudinal studies of these variables are rare, and their results are somewhat conflicting. The study objective was to compare DS and DRD as longitudinal predictors of medication adherence, self-care behavior, and glycemic control in type 2 diabetes.
Primary care patients with type 2 diabetes reported DS, DRD, and other variables at baseline were studied. Medication adherence, self-care behaviors (diet, physical activity, and glucose testing), and glycemic control (HbA1c) were assessed 6 months later (n = 253). Cross-sectional and longitudinal regression analyses were used to model behavioral and medical outcomes as a function of baseline confounders, DS, and DRD.
Adjusted cross-sectional and longitudinal analyses yielded very similar results. In the latter, only DS were significantly associated with future diet behavior (P = 0.049), physical activity (P = 0.001), and glucose testing (P = 0.018). In contrast, only DRD predicted future glycemic control (P < 0.001) and medication adherence (P = 0.011).
Distress-outcome associations seem to vary by type of distress under consideration. Only DS predicts future lifestyle-oriented self-management behaviors. In contrast, only DRD predicts glycemic control, perhaps by decreasing medication adherence. Clinical assessment and intervention should encompass both types of distress, unless the goal is to narrowly target a highly specific outcome.
Depressive symptoms (DS) are prevalent in type 2 diabetes (1,2) and are associated with a wide variety of deficits in diabetes self-management behavior and glycemic control (3,4). Although most existing studies are cross-sectional, only the more powerful longitudinal design can demonstrate temporal priority, which is a necessary (but not sufficient) precondition for establishing causality. One longitudinal study linked DS to poor medication adherence and poorer self-management (diet, exercise, and foot care) that was measured 9 months later (5), whereas a second study indicated that persistent or worsening DS were associated with poor self-management in terms of diet and exercise over the subsequent 5 years (6). Turning to glycemic control, multiple clinical trials indicate when depression accompanying diabetes is successfully treated, metabolic control does not tend to improve (7). Moreover, one longitudinal study concluded that DS do not predict future glycemic control, but rather that glycemic control actually predicts future DS (8). However, a small meta-analysis of depression treatment trials found that DS reduction was associated with glycemic improvement in two of the three studies analyzed (4). To summarize, DS may predict self-management behavior, whereas the nature of their longitudinal association with glycemic control remains unclear.
In contrast to the generalized concept of DS, diabetes-related distress (DRD) refers to significant negative psychological reactions that are specific to one's diabetes diagnosis, potential or actual complications, self-management burdens, difficult patient–provider relationships, and problematic interpersonal relationships (9). Due to its illness-specific nature, DRD is conceptually and empirically distinct from DS that accompany diabetes (10,11). Cross-sectional studies have consistently indicated that, like DS, DRD is associated with concurrent diabetes self-management (12–15) and glycemic control (12,15). Although no longitudinal studies have shown a link between DRD and self-management, two studies demonstrated that DRD predicts subsequent glycemic control (16,17).
Given the variation and gaps in reported associations, the most recent wave of studies has directly compared the independent predictive value of DS versus DRD when levels of both variables are accounted for. This strategy helps to disentangle which type of distress has the most substantial association, which helps to identify underlying biobehavioral mechanisms and determine priorities for clinical assessment and modification. Two such cross-sectional studies indicated that DRD, but not DS, is associated with self-management behaviors (11,16,18), whereas a third study concluded that only DS are associated with self-management (10). Three cross-sectional studies indicated that only DRD is independently related to concurrent (11,17,19) glycemic control. Of these three studies, one additionally demonstrated that only DRD was related to concurrent control (17). Moreover, although neither DS nor DRD predicted future glycemia, DRD and glycemic control varied together across 18 months.
To summarize, several studies link DS and DRD to diabetes self-management, glycemic control, or both. Longitudinal studies are rare, have yielded conflicting findings, and have not evaluated whether DRD predicts future self-management. Of the few studies that simultaneously evaluate these two types of distress, all but one are cross-sectional. The goal of this study was therefore to clarify the longitudinal associations between two types of psychological distress (DS and DRD) and key outcomes (self-management behaviors and glycemic control) measured 6 months later.
Potential participants were identified from the administrative and clinical databases of a large Midwestern urban healthcare system. Eligible patients were required to have type 2 diabetes as indicated by at least one of the following: 1) at least one hospitalization with a diabetes-related ICD-9 code (250.×, 357.2, 362.0, or 366.41), 2) at least two outpatient visits with a diabetes-related ICD-9 code or at least one prescription for a glucose-control medication or monitoring supplies, 3) between 18 and 80 years of age, and 4) able to complete self-report instruments. Type 1 diabetes was subsequently ruled out through telephone screening.
Following an institutional review board–approved protocol, eligible patients were mailed a study invitation followed by a telephone call for screening. Following informed consent, participants attended two research appointments separated by 6 months for the assessment of adherence, glycemic control, and other variables.
Depressive symptoms were assessed with the widely used and well-validated Patient Health Questionnaire-9 (PHQ-9), which includes only depressive symptoms per se, unlike most other DS measures. Although it was indeed developed as a screening measure, it is well-validated as a measure of DS severity (20). DRD was measured using the Problem Areas in Diabetes scale (PAID) (16), a well-validated 20-item self-report questionnaire. Items are rated on a 5-point scale ranging from 0 (not a problem) to 4 (a serious problem). Summed scores are converted to a 0–100 scale by multiplying by 1.25. Medication adherence was assessed using the Morisky scale, which elicits information about the presence or absence of various forms of nonadherence (e.g., "In general, are you careless at times about taking your antidepressant medication?") (21). Each item is in a yes or no format with a maximum possible score of four. It has demonstrated concurrent and predictive validity and adequate internal consistency (21) and has been used for >20 years with numerous chronic diseases. For the detection of nonadherence, sensitivity is 0.81, and specificity is 0.44. In type 2 diabetes, the measure has good reliability and predictive validity, and its scores are associated with a 10% increase in concurrent HbA1c (22) as well as negative attitudes toward diabetes medication (23). Diabetes self-care behavior frequencies were assessed with the Summary of Diabetes Self-Care Activities (SDSCA) (24). Respondents rate how many days of the past week they engaged in self-care behaviors reflecting diet, exercise, glucose testing, foot care, and cigarette smoking. The SDSCA has adequate internal and test–retest reliability, is sensitive to change, and correlates appropriately with other measures of adherence and related constructs (24). Glycemic control (HbA1c) was measured with the DCA 2000 (GMI, Inc., Ramsey, MN), which analyzes capillary blood samples through a monoclonal antibody method. Comorbid medical illness was assessed by abstracting electronic medical records using a checklist of common medical illnesses (asthma, chronic obstructive lung disease, congestive heart failure, osteoarthritis, rheumatoid arthritis, arthritis associated with lupus [systemic lupus erythematosus] or scleroderma, peripheral vascular disease, cirrhosis, chronic hepatitis, coronary artery disease thyroid disease, Addison disease, and Cushing syndrome) (25,26). Presence of diabetes complications was measured using a standard self-report checklist of visual, cardiovascular, kidney, genitourinary, and other common diabetes complications taken from the Diabetes Care Profile (27). Participants classified themselves using U.S. Census racial/ethnic categories. Socioeconomic status (SES) was assessed using the U.S. Census Bureau Index of Socioeconomic Status adjusted for the regional Consumer Price Index (28).
Data were analyzed using STATA 11.2 software (StataCorp, College Station, TX). Descriptive analyses were conducted to characterize the sample, and distributions were visually and quantitatively examined for normality of distribution. A matrix of zero-order Pearson correlations were examined to identify bivariate relationships between potential demographic and medical confounders of Month 6 outcomes, using the criterion of two-tailed P < 0.05. The associations of both DS and DRD variables (measured at baseline) and Month 6 outcomes were analyzed using ordinary least squares regression, with potential confounders included in the model and also using the criterion of two-tailed P < 0.05. Missing data were not imputed. Because DRD and DS scores are moderately interrelated (10,15), they were evaluated both alone and when the other was adjusted for, because their multicollinearity may distort their individual regression coefficients.
Enrollment and retention
Of the 420 patients screened by telephone, 332 met entry criteria, 287 (86%) of whom provided consent and baseline data. Thirty-four participants (12%) dropped out after baseline, leaving 253 study completers. Attrition was significantly associated with being <60 years of age (85% of dropouts vs. 74% of nondropouts; P < 0.014) and being African American (74 vs. 55%; P = 0.036). However, attrition was not significantly related to gender, SES, medication adherence, or poor glycemic control. Consent was unrelated to age and sex, although African Americans were more likely to consent than Caucasians (62 vs. 52%; P = 0.025).
Sample characteristics
The characteristics of study completers are shown in Table 1. Half were female, 55% were African American, and age ranged from 27–88 years (mean 57.3 ± 8.3). Forty percent were prescribed insulin in addition to an oral hypoglycemic. Glycemic control (HbA1c) was generally poor (mean 7.6 ± 1.6), complications were common (mean 4.3 ± 1.1), and 20% had at least two significant comorbid medical conditions. Based upon Morisky scores, 52% percent of the participants could be classified with high adherence (i.e., score of 0), 42% with medium adherence (scores of 1 to 2), and 6% with low adherence (score of 3 to 4). Approximately half had a baseline PHQ-9 total >5 (indicating at least mild DS), with 15% reporting moderate and 6% reporting moderately severe DS. The PAID score had a mean of 22.1 ± 19, with 21% of participants scoring above the distressed cutoff.
Sample characteristics (n = 253)
Preliminary analysis to identify confounders
Bivariate and multiple regression analyses revealed that higher HbA1c was reliably associated with younger age (r = 0.30; P < 0.001), male sex (r = 0.16; P = 0.006), and being on insulin (r = 0.16; P = 0.006). Poor medication adherence was associated with being younger (r = 0.15; P = 0.012) and having fewer comorbid medical conditions (r = 0.16; P = 0.013). Poor dietary adherence was associated with not being on insulin (r = 0.14; P = 0.020). Lower frequency of blood glucose self-testing was associated with being male and not being on insulin (r = 0.31; P < 0.001).
Cross-sectional analyses at baseline
Regression analysis, adjusted for the confounders noted above, was used to evaluate the relationships among DS, DRD, and concurrent outcomes observed at baseline (Table 2, top section). Although DS were not significantly associated with HbA1c, it was associated with poorer medication adherence (β = 0.24; P < 0.001) and lower frequencies of diet (β = −0.29; P < 0.001), exercise (β = −0.25; P < 0.001), and testing behavior (β = −0.16; P = 0.006). These associations were unchanged after adjusting for DRD, except that DS were no longer significantly associated with medication adherence. Next, DRD was significantly associated with higher HbA1c (β = 0.28; P < 0.001), lower medication adherence (β = 0.26; P < 0.001), and lower frequencies of both diet (β = −0.16; P = 0.008) and exercise behaviors (β = −0.15; P = 0.010), but not of blood glucose testing behavior. Only the associations with HbA1c and medication adherence remained statistically significant after adjusting for DS.
Results of cross-sectional and longitudinal regression analyses
Cross-sectional analyses at Month 6
When the above cross-sectional analyses were repeated on Month 6 data, the results were nearly identical (Table 2, middle section). That is, the pattern of significance for the fully adjusted models was the same for 8 of 10 coefficients. The two exceptions were that the concurrent association between DS and poor medication adherence became significant at Month 6 (β = 0.18; P = 0.012), and the relationship between DS and testing frequency was no longer significant.
Longitudinal analysis
The above multiple regression analyses were repeated to evaluate the associations of baseline DS and DRD with Month 6 glycemic control after adjusting for age, sex, and regimen and both before and after adjusting for each other. Baseline DRD had a significant association with Month 6 HbA1c after adjusting for confounders (β = 0.30; P < 0.001) as well as for DS (β = 0.30; P < 0.001), whereas baseline DS did not have a significant association with Month 6 HbA1c in either model (Table 2).
Next, Month 6 medication adherence was analyzed after adjusting for age and number of comorbid conditions. As found in both cross-sectional analyses, baseline DS were a significant predictor before adjusting for DRD (β = 0.24; P < 0.001). However, as seen in baseline (but not Month 6) cross-sectional analyses, this effect became nonsignificant after adjusting for DRD. As found in both cross-sectional analyses, DRD had a significant effect both before adjusting for DS (β = 0.27; P < 0.001) as well as after (β = 0.20; P = 0.011). The valence of this latter association indicated that higher DRD at baseline was associated with poorer medication adherence at Month 6.
In agreement with the results of both cross-sectional analyses, baseline DS were a significant predictor of Month 6 diet behavior (adjusted for regimen), before adjusting for DRD (β = −0.18; P = 0.004) as well as after (β = −0.15; P = 0.049). Also, as found in both cross-sectional analyses, the significant longitudinal association between DRD and diet behavior (β = −0.13; P = 0.047) was attenuated after adjusting for DS (β = −0.04; P = 0.650).
For the prediction of Month 6 exercise, baseline DS had a significant effect (β = −0.22; P < 0.001) after adjusting for sex and regimen, and this was unaffected by adjusting for DRD (β = −0.25; P = 0.001). This result was consistent with the results of both cross-sectional analyses, as was the finding that DRD was not significantly related to exercise after adjustment for DS.
Finally, the longitudinal findings for Month 6 glucose testing showed that after adjusting for sex and regimen, baseline DS had a significant association with testing behavior both before (β = −0.13; P = 0.034) and after (β = −0.17; P = 0.018) the model was adjusted for DRD. The valences of these coefficients indicated that higher baseline DS were associated with lower levels of self-management behavior at a Month 6. In contrast, DRD was not a significant predictor in either the unadjusted or adjusted model.
Additional analyses
Because it is possible that DS and DRD may correspond more closely at low levels of distress, a scatter plot of DS and DRD was examined. The linear and lowest fitted values corresponded very closely, and the residuals appeared to be constant across all fitted values. Additionally, the Pearson correlations of DS with DRD did not vary when separately computed below and above the DRD median (0.33 vs. 0.35) or below and above the DS median (0.35 vs. 0.38). To explore the related possibility that the detected associations may vary by whether DS were clinically elevated or not, each model with a significant effect was retested with an interaction term of DS elevation (dichotomous) × significant predictor of interest. However, none of these interactions reached significance, suggesting that the associations do not depend upon the presence of elevated DS.
Because the sample varied substantially across age, regimen, and medical comorbidity, additional analyses were conducted to explore whether the above relationships varied across these characteristics. For example, perhaps being on insulin affects the association between DS and medication adherence (8,29). To achieve this, multiplicative interaction terms corresponding to DS or DRD times the potential moderator (age >60 years, sex, regimen, and having two or more medical comorbidities) were computed and tested separately for each potential moderator in each of the above five longitudinal models. Of the resulting 40 interaction terms tested, only one significant moderator effect was detected (i.e., baseline DS × regimen predicting Month 6 exercise frequency) (P = 0.026). Specifically, the association between baseline DS and subsequent exercise frequency was only significant among participants who were prescribed oral medication. However, this result might be spurious, because 2 (5%) of 40 terms might be expected to be significant through chance alone.
To summarize the findings, only DS predicted lifestyle-oriented self-management behaviors 6 months later, such as diet, glucose testing, and possibly exercise. In contrast, only DRD predicted future medication adherence and glycemic control. This new information adds to the growing literature pointing to a fundamental difference between DS and DRD. The findings may also help elucidate key underlying biobehavioral mechanisms and have implications for clinical practice.
As reviewed above, a growing evidence base supports the conceptual and empirical distinctions between DS and DRD (10,11,16–19). This is not surprising, given that a parallel distinction has been suggested to exist among patients with cancer (30,31), HIV/acquired immunodeficiency syndrome (32), chronic pain (32), multiple sclerosis (33,34), and other serious or chronic medical conditions. If DS and illness-specific distress are each associated with different behavioral and medical outcomes, then they probably operate according to different underlying mechanisms. For example, in the case of diabetes, DS might disrupt the lifestyle-oriented health behaviors recommended for good diabetes control. This may occur because depression reduces general motivation and disrupts activities that are complex, energy-intensive, effortful, or time-consuming. Examples would be depression-related difficulty avoiding unhealthy comfort food and eating at regular intervals, increased downtime leading to difficulty maintaining a healthy exercise routine, poor appointment attendance leading to inadequate medical care, and functional restrictions due to another medical condition associated with depression. Perhaps DS are relatively less likely to disrupt simpler habitual activities, such as taking oral medication as directed. As a moderately complex behavior, self-monitoring of blood glucose may fall somewhere in between these two extremes, with the present findings indicating that it is probably more disrupted by DS than by DRD.
Extending this reasoning further, perhaps DRD tends to selectively disrupt activities that are highly specific to diabetes (e.g., taking diabetes medication). For example, if the relatively simple act of taking an oral hypoglycemic happens to serve as a frequent and emotionally stressful reminder of negative aspects of having diabetes, then high DRD could be expected to reduce adherence. This could plausibly explain the observed link between DRD and glycemic control. In this respect, the findings agree with clinical trials indicating when DS are successfully reduced in diabetes, there is apparently no accompanying improvement of metabolic control (7). Another interpretation is that DRD measured at baseline is actually a psychological reaction to, rather than a cause of, concurrent or previous levels of glycemic control, because both factors may be somewhat stable within individuals and across time.
As summarized in the introduction, the most stringent studies to date have either used a longitudinal design to help eliminate the influence of concurrent associations or have included both DS and DRD so that their associations with outcomes of interest could be directly compared. Only one prior study was both longitudinal and included both DS and DRD, and it showed that DRD was related to future glycemic control, whereas DS were not (17). Although that result conflicts with the present findings, this might be due to the prior study's longer assessment interval of 9 months or its inclusion of three time points rather than two. Another possible source of method variance may be the use of different DRD measures; Fisher et al. (15) used the recently developed Diabetes Distress Scale, whereas the current study used the PAID. Although both instruments are well-validated, and they probably intercorrelate highly, recent data suggest that they capture different aspects of diabetes distress (35). Perhaps future studies might consider this potential measurement issue. Building upon the limited existing work, this was the first longitudinal study to compare DS and DRD in terms of their unique longitudinal associations with self-management behaviors.
One important limitation of this study is that its correlational design cannot conclusively rule out alternative explanations for the findings. As noted above, perhaps hyperglycemia, DS, and DRD are each so stable that their association artifactually extends over time. However, this seems unlikely to be the case, given that the findings varied by type of distress (DS versus DRD) and because average glycemia does vary with diabetes severity. Related to this, although the design was longitudinal, it was also naturalistic insofar as no variables were experimentally manipulated. Therefore, it is impossible to definitively conclude that the observed longitudinal associations were causal. Because of practical limitations in the number of variables collected, it cannot be ruled out that DS, DRD, self-management, and glycemic control may be related to some important but unidentified common factor. The findings should be cautiously generalized, because enrollment occurred within a single health system and although African Americans were oversampled, not all minority groups were well-represented. Although DS were not verified by a structured psychiatric interview and therefore may have been misclassified, syndromal depression was not a study variable, and the measure of DS was originally validated against psychiatric interviews in medical patient samples. Related to this, for the few participants who reported suicidal ideation, protocol-related crisis intervention may have helped reduce depressive symptoms for that subgroup. Finally, the SDSCA may not comprehensively capture self-care, especially for patients who have unclear lifestyle recommendations.
One primary clinical implication is that DS may be less important than DRD is for the achievement and preservation of medication adherence and glycemic control. At the same time, perhaps DS is more important to lifestyle-oriented behaviors and blood glucose self-testing. Therefore, implications may vary by the type and complexity of whatever outcome is of greatest clinical concern. Second, DS and DRD predict different outcomes. Therefore, elevated DS may be a prognostic indicator for impending decline in the lifestyle aspects of diabetes self-management, whereas high DRD may predict reduced medication adherence and poor glycemic control. Clinical assessment has traditionally emphasized DS and therefore may need to broaden to encompass both issues in order to gain a complete prognostic picture. Additionally, the findings suggest that clinical efforts to reduce DS without also addressing DRD, whether through medication or narrowly focused cognitive behavioral therapy, will not by themselves improve medication adherence or glycemic control (7). Likewise, clinical strategies aimed at specifically reducing DRD without addressing DS may not lead to improved self-management in terms of lifestyle behaviors. The most effective clinical interventions will be those that are broadly designed to improve the management of both DS and illness-specific distress, and interventionists need to think broadly and creatively in this regard. Otherwise, if both DS and DRD are elevated, a change in merely one of them may not improve all of the important outcomes. Movement in this direction is already evident in recent success with integrated nurse care management for comorbid diabetes and depression (36). Additional related efforts are underway to combine brief cognitive behavioral therapies with Web-based diabetes self-management support (37) and the direct enhancement of medication adherence (7).
This study provides longitudinal support for the conceptual and empirical distinctions between DS and DRD in type 2 diabetes. DS may selectively suppress lifestyle-oriented self-management behaviors such as healthy eating, glucose testing, and exercise. In contrast, diabetes-specific distress may impact subsequent medication adherence and glycemic control. Clinical assessment and intervention should encompass both factors.
This research was supported by National Institutes of Health grants R01-DK-066016 and P60-DK-020572 (to Michigan Diabetes Research and Training Center), both from the National Institute of Diabetes and Digestive and Kidney Diseases.
No potential conflicts of interest relevant to this article were reported.
J.E.A. conceptualized the study, analyzed data, and wrote the manuscript. J.E.A. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
The author thanks Dr. John D. Piette of the University of Michigan and VA Ann Arbor Healthcare System and Denise White-Perkins of the Henry Ford Health System for providing assistance in developing and conducting the parent study from which these secondary data were drawn.
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MS Dhoni The Untold Story Trailer Released by Dhoni | Sushant Singh Rajput
in Entertainment, Trailers & Audio Launch
MS Dhoni The Untold Story Trailer Released.: The Team MS Dhoni The Untold Story launched the trailer of the movie in a very different way. The Trailer of the movie has been launched on such a big scale and biggest of its kind in the history of Bollywood. The movie was revealed in front of 35,000 people at Lovely Professional University LPU in Jalandhar, Punjab.
The trailer was launched by the captain cool, Mahendra Singh Dhoni while Producer Arun Pandey, CEO of Fox Star Studio Mr. Vijay Singh were also present at the launch along with the lead actors.
The trailer got a positive response from the people present at the launch that all fans going went out crazy when the trailer was played for the first time.
Also Watch Ajay Devgan's Shivaay Movie Trailer | Ajay Devgan, Sayyeshaa
Along with the launch of the trailer, Dhoni interacted with the students a little. Dhoni loved the and saw it once again at the venue (LPU). He also mentioned that he recollected several memories from his old day and his journey from Mahendra Singh to "The Captain Cool" while watching the trailer.
When Dhoni was asked to show his famous helicopter shot by a student, he didn't deny and he happily obliged and the crowd went crazy all over again.
Watch MS Dhoni The Untold Story Trailer Launch
MS Dhoni The Untold Story Teaser
MS Dhoni The Untold Story Movie Release Date
MS Dhoni The Untold Story will release on September 30th, 2016.
MS Dhoni The Untold Story is a biopic based on Indian national Cricket Team Captain, Dhoni. The movie shows an inspiring journey from a TT to the world's best captain. The movie is directed by Neeraj Pandey, produced by Arun Pandey and Fox Star studios. Sushant Singh Rajput plays the leading role as Dhoni while Kiara Advani as Sakshi Dhoni and Anupam Kher play Pan Singh.The movie MS Dhoni The Untold Story is one of the most awaited films of the year and will release on September 30th, 2016.
Tags: bollywood
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Tom Baker wore several scarves during his seven series as the Doctor. Each one had its own unique characteristics. Select the links above for detailed information about each scarf including patterns, knitting specifications and yarn suggestions. There are also sections featuring the history of the design, tips for scarf construction, a gallery of scarves knitted by fans (and me) plus some fun ephemera.
This site will forever be a work in progress as new or better information becomes available. Your suggestions, corrections and questions are always welcome so please email me.
Licensed scarf replicas are available from Lovarzi! Unlike most other replicas, these are garter stitch. The colors are generally brighter than the real thing for their Hero, but their S16/17 replica has very good colors indeed. There is also a scaled down S18 and a short version of the Hero. Click the graphic below to order one directly from Lovarzi.
Another licensed scarf is also being manufactured by Elope (found at Hot Topic and many places online). It's not garter stitch, but has pretty good colors. Brown has been omitted (only 6 colors).
The patterns presented on this site are considered the intellectual property of BBC Worldwide Ltd. The Doctor Who brand is a trademark of the BBC. No infringement is intended or implied.


The OASIS-XT wheel from PDW is the latest in our line of wheels that employ professional manufacturing technology.
Our PDW manufacturing process alters the molecular structure of the aluminum alloy in a way that increases its strength.
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You are at: Home > Resources > Other Publications > Tower of London Guide for parents/carers of children and people on the autistic spectrum and related conditions.
Tower of London Guide for parents/carers of children and people on the autistic spectrum and related conditions.
Tower of London - Guide for parents/carers of children and people on the autistic spectrum and related conditions.
This guide aims to give information and suggestions which may help inform people who take children on the Autistic Spectrum to the Tower of London. As every child on the Autistic Spectrum is different, and responds to things differently, parents/carers need to decide how to plan and undertake a visit, and this guide aims to answer common questions and highlight issues of relevance.


Woah, June already. You know what that means…a new desktop wallpaper. This one is camping themed. People camp in June, right? Download these wallpapers below, and share away!
Click any of following links, which will open up the images in a new window so you can download the free June 2013 Desktop Calendar Wallpaper: 2880X1800px, 2560X1600px, 1920X1200px, 1920X1080px, 1680X1050px, 1440X900px, 1280X800px, iPad, iPhone 5 and iPhone 4 versions.


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Anthony D'Amato. Photo credits: Sachyn Mital
Revisiting Protest Songs of Yore, Americana Musicians Build Upon, and Add to, Canon
Anthony D'Amato and River Whyless tackle classic protest songs while recently reunited The Mammals address cultural divisions with a new tune.
By Sachyn Mital / 29 June 2017
Brooklyn-based roots musician Anthony D'Amato and his band recently performed an acoustic set at the Rubin Museum to celebrate the release of his latest EP, Won't You Be My Neighbor?, a set of seven original and cover songs (proceeds from sales will support the International Rescue Committee). It was inspired, of course, by the current President.
The first track on the EP is D'Amato's take on Woody Guthrie's classic "This Land is Your Land", placing original lyrics from the 1940s song against audio clips from Trump, Dubya and others. "This Land" features guest vocals from Josh Ritter, while other contributors to the EP include Lizzie No, Sean Watkins and more. The audio for this song and photos of D'Amato's show at the Rubin can be found below.
River Whyless, a four-piece folk band that hails from Asheville, North Carolina, revisited Creedence Clearwater Revival's powerful "Fortunate Son" in the context of this administration. Their video utilizes footage from the Women's March (both in D.C. and in Asheville) to "help speak truth to power, not for the sake of perpetuating our country's present divisiveness, but as a way to support and encourage the need for an open, honest, and compassionate conversation about our universal rights and freedoms". Listen to their take below.
Meanwhile, Woodstock, NY area duo Mike & Ruthy reunited their band The Mammals for the new year to tour and put out some new material including a couple of political songs. The Mammals played a set at Rockwood in April where they performed their new song "Culture War", which finds Mike Merenda singing about being divided, like America, by politics. (The song calls back to "This Land…").
The band also released the plaintive song "My Baby Drinks Water" (available at name your own price on Bandcamp) featuring Ruthy Unger incanting a quiet lullaby originally for her children but given new meaning by the "bravery of the Standing Rock water protectors". The lyric video for "Culture War" and photos from the band's Rockwood show are below.
Anthony D'Amato, 16 June 2017, Rubin Museum
The Mammals, 27 April 2017, Rockwood
TAGS americana Anthony D'Amato josh ritter photos protest songs river whyless The Mammals The Mike & Ruthy Band video
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100 Great Protest Songs: Part 2 - Steve Reich to the Sex Pistols - PopMatters
'Le Trou': The Escape Film Under the Microscope
'iZombie': Discovery Day Brings Chaos in "Looking for Mr. Goodbrain, Part 2"


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Missing girl says she can't remember anything of past four days
Jan. 15, 2014	02:45 pm JST	 Jan. 15, 2014 | 03:31 pm JST
An 11-year-old girl who had been missing since Saturday in Sagamihara, Kanagawa Prefecture, has been found, but has been unable to shed any light on her disappearance, police said Wednesday.
Police said Michi Shinozaki showed up at a koban (police box) in Chigasaki, 20 kilometers away from her home, at around 4 a.m. Fuji TV reported that the koban was empty at the time and the girl used the phone linked to police headquarters to call for help.
Police said the girl was unharmed, but tired. They asked her if she was hungry and she said no. She was wearing a black sweater, shorts, black tights and sneakers when she was found.
Police told reporters that she kept saying she couldn't remember anything or she didn't know when asked where she had been for the past four days.
Police gave no further details of what happened to her, whether she had been kidnapped, got lost or run away from home.
Accompanied by her parents, Michi was taken to a hospital for a medical checkup on Wednesday morning, police said.
About 250 police were mobilized on Tuesday to search wooded areas near Shinozaki's home. She had been playing with a friend at her home until 4 p.m. Saturday. After that, she went for a walk with her dog. When the dog returned home alone 40 minutes later, her father went out to search for her. He notified police at 6:40 p.m.
justbcuzisay
Jan. 15, 2014	07:04 am JST
Nice to start the day off with some good news!
The girl is found and she and her family deserve some privacy now.
-8 ( +11 / -19 )
ConnorH93
I'm glad she's back safe and sound with her family. I hope nothing untoward happened to her but considering she was missing for a good few days may mean something did. It could also just be that her dog got off its leash and she got lost trying to find it.
Mariam Tebourbi
Glad she's safe and sound! I hope nothing happened to her that could harm her mentally
Wonderful news - found safe and unharmed.
Mirai Hayashi
Thank goodness they found her. As a father of a 6 year old girl, this one hit me personally....but its great to know that she's okay.
There are certain details we would not be told if they happened, and its just as well.
@funny car
Give it a rest. All you did was criticized how everything was done too slowly, and the results show that everything was done right. The media got the news out as quickly as feasibly possible and the girl was found.
TrevorPeace1
To those posters who, on another thread, said or implied she was dead, shame on you!
Cut out the bickering please.
Hide Suzuki
Couldn't be happier that she is alive ! But she was 20 kilometers away and missing 3-4 days...
I would love to know more details, was there a kidnapper or some sick child molester ???
trinklets2
Whatever the story behind, just let it be. Hopefully, she's going to be a better person as an aftermath and we as a whole would be more aware and careful with our own. Indeed a very positive news for this morning.
slumdog
As everyone else has already commented, I am so happy to read that this girl was found unharmed.
Police said Michi Shinozaki showed up at a koban (police box) in Chigasaki, 20 kilometers away from her home, at around 4 a.m. Fuji TV reported that the koban was empty at the time and the girl used the phone to call police.
I am not trying to bash here, but is it standard practice to leave a koban empty and open? In this case, it was good it was open because the girl was able to use the phone (if I am understanding the article correctly), but leaving a koban empty and open seems like a potential recipe for trouble.
FightingViking
@ConnorH93
It could also just be that her dog got off its leash and she got lost trying to find it.
From all the photos we've seen, it would seem the dog still had both his collar and lead on.
I'm just glad she's safely back home.
Himajin
Slumdog, the back of the koban is locked, and they have a phone on the desk that will connect you to the nearest police station. The koban is empty when the officers are out patrolling.
Devie Ikesue
Thank god, she is fine n in good shape.
cracaphat
Great she returned back home.But that dog wasn't much use.What happened to "ruff,ruff follow me" and go to the last spot? It seemed happy just to be home.Definitely no Lassie.
Yes it's standard practice. The phone only goes to the main police station, it's not a regular phone. The only things available in the box are a phone, a sign saying to use it, a desk and a chair.
Marilita Fabie-Fujisawa
What was that all about? No wounds inflicted, not even kidnapped...another brief encounter with the third kind? I guess we will never know as this is as far the news goes for us.
-12 ( +4 / -16 )
@Marilita Fabie-Fujisawa
The fact of the matter is that we still know nothing of what happened in the last few days she was missing. She may have ran away, or she may have been abducted and experienced some kind of trauma that effected her memory in some way. The key thing to remember is that she was missing and now she is back, and that's what really counts. Whatever the reasoning may be for her to go missing, will be worked out. Maybe she does have issues at home,and if so, I am sure that if her parents really care about her (which at this point in time, I have no reason to doubt that they do care, since they called the police practically immediately after she didn't return from her walk with the dog) this incident will force them to work their issues out.
@Elbuda Mexicano
By the way, the real Japanese news says it was NOT HER FIRST TIME to go off with her dog and for the dog only to come back home
where does it say that she went missing before? I see nothing that says this or anything about a young guy in the neighborhood..
Mirai, on the news on Sunday morning, a neighbor said she's seen an unfamiliar person in the neighborhood.
I see 'unfamiliar' people in my neighborhood like literally every fricken day. Doesn't make the person or the situation suspicious at all. I think its a case of jumping to conclusions by this neighbor, or giving the media info that they want to hear to get on camera.
Thanks for that. I have not been in a koban in a long time and I do not remember much about it at all.
Well, it could be, Mirai, the media are often irresponsible in what they chose to air.
gogogo
Glad she was found would love to know more details.
milanese
YES !!!...I'm really glad to read she is safe !! Thanks to God !!
I'm also glad she is alive and would like to know what happened to her.
Penfold
Jan. 15, 2014	12:11 pm JST
Hallelujah!! Her family must be so relieved!
Great news and what a relieve for her parents and family, it would have to be a parents worst nightmare to have a child go missing and can only imagine the feeling they have now she has been returned
When I said
I didn't mean to imply that the man was suspicious, I was replying to-
I see nothing that says this or anything about a young guy in the neighborhood..
It was not brought up again, so I suppose it turned out to be nothing. I've never understood why the "news" shows here (of the morning show variety) will run just about anything without verification. I've seen the same one time and time again, broadcast utterly false information just to snag viewers.
What was that all about?
It was about a child that was missing for more than 24 hours. Isn't that enough? Should that be enough?
@Himajin
I wasn't criticizing you of course. I was criticizing the neighbor's comment, and why he brought up the fact that there was an unfamiliar person in the neighborhood. I would only mention that if I saw the unfamiliar person committing a crime or speaking to the girl just moments before she went missing. Otherwise this unfamiliar person could have been anybody ( a relative of a neighbor, newspaper delivery, just passing through...etc...)
re: My last post:
"Should" should have been "Shouldn't".
lostrune2
Smells like a roofie.
splksgt96
Glad also to hear she was found. She goes out walks her dog and only her dog returned. Then four days later at 4 AM she is at a koban by herself and can't remember the previous for days? Hmmm, sounds like she got drugged up and someone drpped her off there. Date Rape Drug? A extensive examination would be in order.
CGB Spender
Wow, I already thought she was a goner. Glad that she's still alive! The parents must have one hell of a relief now.
Spelling error. Four days not for days.
tamedcat
Doesn't she remember what she has been doing for the past 4 days? Or is she telling a lie?
Chantella Jackson
Thank God. She is safe, I'll pray for her. I REALLY hope nothing bad happened that is the reason why her memory went. ♥
rickyvee
what a strange ending to this news story. missing four days and doesn't remember anything? this girl could be lying, but why?
Pandabelle
The most important thing is that she is back with her family, safe. What a relief.
Beyond mere common sense, it shows why it's such a bad idea to speculate.
@rickyvee
If she is lying, it could be that went to meet a friend whom she met online perhaps. But the police say that they have no reason to believe that she ran away, and that she was more likely involved in some sort of incident.
Sometimes when traumatic things happen you loose all memory of it and everything that happened around that time. I do hope she is safe, but I think it's unfair to just flat out assume anybody is a liar, especially when something really bad might have happened.
7solace9
Denial can be a coping mechanism for the social handling traumatic events. A medical check up is good. If there is a bad person out there, they need to be identified, caught and held accountable so that others are safe.
Vernie Jefferies
I am glad that we have a happy ending to this story.
@7solace9: Yes. I agree with everything except...what you said about denial could be true, but it's not fair to the girl. I say online what I would tell her to her face, which is I believe her. :)
There is something seriously amiss here.
sidesmile
Alien abduction.
the results show that everything was done right.
Actually Mirai, it seems more likely the police did precisely nothing to assist this girl, lost for four days in winter, except to have a telephone available at the koban. Sure, the jury is still out because we don't know exactly what happened.
And not to say that my way would have accomplished anything at all. But it still seems to me that a great lot was left to chance that did not need to be.
If my child goes missing under such bizarre circumstances, I hope its handled differently.
An 11-year-old girl who had been missing since Saturday in Sagamihara, Kanagawa Prefecture, has been found
Ah semantics. See that makes is sound like the police really did something. In fact, she was not found. She returned.
Tokiyo
Funny_car: The hell is your problem? were you there? do you know for a fact the police did nothing? give it a rest for chrissakes
I did not say the police did nothing.
I said they did nothing that actually assisted her.
If you dispute that, please tell us what they did that led to her safe return from...where ever she was.
This is damned peculiar...
livinginnagoya1983
Aliens...
Not much you can do to assist some when you have no idea where they are. They definitely put effort into finding her. At least, I don't think those 250 officer just sat on a park bench for a few hours to return and say they couldn't find her.
Once they did manage to find her or, as you say, she returned. They did what they could to assist her such as, checking if she was ok, or asking if she was hungry, and returning her home.
On the not remembering thing, sometimes people lock away memories of trauma and sadness as a way of coping with these kinds of incidents rather than dealing them. Hopefully if something did happen she can get the psychological help that she needs. Unfortunately, Japan doesn't have the best record for dealing with psychological issues.
You are not following the conversation ConnorH93. I contend that the police were too slow in reporting this to the media. I am sure they worked their butts off during the search and did a splendid job once she turned up at the koban. But if the public had had her picture and name on Saturday night or even Sunday morning, she might have actually been found and been home safe much, much sooner. I don't understand why that is so hard to understand.
I understand that there are lots of variables we cannot account for, by my thinking is to play the odds. And the way I see the odds, its damned lucky is back alive in any case, but the amount of time it took to inform the public did not increase her odds of survival.
We have to balance the public's need to know about a potential abductor against the family's right to privacy.
I think we all are, but coming up with different answers. It might be because I also account for the potential abductor's potential actions. I don't think the response to a missing person's report on the TV is going to be so rash usually.
Something that makes me think so is that a girl was abducted from a school I worked at. These guys bundled her into a car. They went about a kilometer and stopped at a stop light, at which point the girl let herself out. They did not chase her down or try to harm her. They just let her go.
Then looking at this case, if she was abducted, she was let go, and that is despite there being a missing person's report out there. I don't think its very likely that a super fast missing person's report would have led to tragedy.
gas07lisa
I see your point, but it's even rare that the case becomes nation wide news. There are hundreds of missing children all over the country that we have not even heard of. Last year, there were about 20000 missing (10-19 year old boys and girls). and how many missing person's photo have you seen on media? Perhaps 30? 50? Photo should've came out earlier? Yes. but you should know there are a lot of cases that don't even get to be nation wide news.
ka_chan
It is very odd that she doesn't remember anything from the last 4 days. Drugged maybe?
Given that she was unharmed but can't remember, it sounds a bit like a case of a runaway. Even if that's the case, and it beats abduction or anything like that, it's good that she was found and is being treated. Too often we hear of bodies being found, or never hear anything at all when it comes to children missing.
funny car: "I contend that the police were too slow in reporting this to the media."
Actually, what you've said is that the police did "nothing at all to assist the girl", even on this thread. Even if you say something was "too slow", or that "(you're) sure they made every effort in the search and after she was found", do you deny that is a form of assistance?
wildwest
The mystery deepens, glad she is home in one pice. The comments on JT are more entertains than the news sometimes.
@Ka_chan
You gotta remember that this is an eleven year old girl. There is no telling what she went through and what kind of trauma she is feeling from it. Also, there could be a good chance that the abductor (assuming there is an abductor) threatened her and told her to keep quiet. After all, the abductor does know where she lives now, and could return to inflict real harm on her.
tinawatanabe
When I heard that she was 3rd daughter of her parents, I thought she might be a runaway. I know a 3rd daughter who had runaway a few days around her age. I hope I'm wrong.
iLikeTurtles
Glad she's back safely. Amnesia of that sort is very unusual, unless she was unconscious for the whole time. Yet she was uninjured and wasn't hungry which suggests she had been eating.
My suspicion is that she is covering up to avoid getting herself or someone else in trouble (maybe she met up with someone).
albaleo
" I don't think its very likely that a super fast missing person's report would have led to tragedy."
But I don't see how it would have done much good either other than to generate public interest and media headlines (and possibly many false reports from far away). Isn't the local neighborhood the most likely place to seek information? House-to-house calls, interview the missing person's friends and acquaintances, posters in local stores and stations, search of local open spaces and possible hiding places, etc.
According to the FBI, the first 3 hours of a missing person case s critical and 98% return alive. It unlikely that an 11 year could have planned ahead to have food for 3 days in a country that likes their food fresh. Not to mention that she wasn't seen but she did show up soon after her picture was posted. Runaway, maybe, abducted, maybe. Wonder if the police will really investigate, now.
Runaway, maybe. Traumatized, maybe. Threatened, maybe. Drugged, maybe. Or its possible that police are not telling media what happened to her to protect her rights and privacy since her name and photos are in public.
Like I said..an alien abduction of some sort, or drug rape..but we will never know..we can only speculate..the happy ending will never be brought out in the open, that's how Japan works, that's how the system is here, different frm other countries..different strokes..
There are hundreds of missing children all over the country that we have not even heard of.
gas07lisa,yes, yes. There are good reasons why Amber Alerts have strict criteria each case must meet to us it. If every missing person's case was reported with panic, soon people would not pay attention. And most missing persons just left on their own it seems.
However, an 11 year old girl who goes to walk the dog and later the dog comes home alone? Massive red flag in my mind. Her case would not meet the Amber Alert criteria. But even some Amber alerts seem superfluous, especially given 20/20 hindsight. I would say her case met my opinion of what is deserving of a news flash, even if 20/20 hindsight declares it was not necessary.
Actually, what you've said is that the police did "nothing at all to assist the girl",
The context of the conversation was that they did nothing to assist her return from where ever she was. A ride from the koban to home is hardly something to go lauding the police about. She was gone for four days. It took too long for police to inform the public. I say so because of the FBI stats ka_chan cites. I thought that was common knowledge. Guess not.
For me, a girl goes missing while she takes her dog for a walk, and a girl goes missing on the way back from school, are both red flag. But this case got attention because it was unique (dog came home alone), and there weren't a lot of bigger news to broadcast.
avigator
Somebody must have drugged her and put her into a vehicle, then must have brought her to the Chigasaki area for whatever evil purpose he must have had in mind. And chances are the person lives nearby where she does and had been doing surveillance on her every day habits. Do not walk the same routine everyday. Check the surveillance cameras in Chigasaki area for any cars with Sagamihara license plates and check which ones have addresses near where she lives. It takes time but it is possible to find the culprit this way.
Argus Tuft
good news ! there have been some very cold nights this week, whatever happened she seems to be healthy and relatively unharmed.
KingJa
They said she was last seen wearing blue jeans but she returned wearing black tights. That seems strange! How did she change!!?
her family deserve some privacy now.
I think they shouldn't give the name, but we have a right to know what happened. That could help prevent future cases. If some weirdos were involved, bring them to justice as the next victim may be found in not so good shape.
It unlikely that an 11 year could have planned ahead to have food for 3 days
Not an issue even for a 5 yr old. It's likely she has many acquaintances living nearby. People are often away for the whole day or even on trips, some don't lock all the doors, don't count how many cookies are left in the box... She could have been hidden all the time in some garage at the corner of her street.
Aaron Loki Brummett
"Doesn't remember"... you can get two of those before turning 18!
Dennis Bauer
Well maybe she just has a medical condition, or maybe she fell and hit her head, hope she wasn't drugged. Glad that this had a good endinf.
Gobshite
Good to know she's safe, but...
http://www.japantoday.com/category/national/view/11-year-old-girl-missing-in-kanagawa-since-saturday
Police said Michi is 150 cms tall and was wearing a black sweater, blue jeans and white sneakers.
Then this story says
Wherever she went she changed clothes....
Its so good that this child was found!! But if the girl says she cannot remember, it sounds like she is lying. I am so happy she is safe and it was a great effort from police!
danalawton1@yahoo.com
It is good she is safe but chances are someone has threatened to harm her family if she tells the truth about where she was for 4 days. Eventually the truth will come out.... and it may hit closer to home than expected.
Michael Craig
Or something supernatural!
YuriOtani
There are other reason for her not remembering. It may be a medical condition of some sort. The ONLY important thing is she found her way home. Oh "funny car", you are not funny.
Record 16.6 mil foreigners visited Japan in 1st half of 2019
Japan's 2 imperial heirs to fly on separate planes to Bhutan
Police instructor stabs officer with knife during role-playing exercise


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Joey Coleman provides live coverage of the December 7, 2010 City Council meeting, starting at 2:00 PM.
So what's the big agenda for this meeting? More Stadium hilarity?
This is the meeting at which Council will vote on whether decisions by the Farmers' Market Transition Sub-Committee should be final or should still be subject to final approval by Council.
Well, that's that. Bratina rules the roost. Next up, the stadium.


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describe('sdkmanager', () => {
  it('parse --list v26.0.1', () => {
    const stdout = readFileSync(`./test/assets/sdkmanager/list_v26.0.1.txt`, 'utf-8');
    const packages = sdkManager.parseList(stdout);

    console.log(JSON.stringify(packages, null, 2));
  });

  it('parse --list v26.1.1', () => {
    const stdout = readFileSync(`./test/assets/sdkmanager/list_v26.1.1.txt`, 'utf-8');
    const packages = sdkManager.parseList(stdout);

    console.log(JSON.stringify(packages, null, 2));
  });

  it('not found license', async () => {
    const sdkSetting = new AppSetting();
    sdkSetting.sdkRootPath = __dirname;
    assert.equal(await sdkManager.checkLicenseAsync(sdkSetting), false);
  });

  it('found license', async () => {
    const sdkSetting = new AppSetting();
    sdkSetting.sdkRootPath = Path.join(__dirname, 'assets');
    assert.equal(await sdkManager.checkLicenseAsync(sdkSetting), true);
  });
});

redpajama_set_name: RedPajamaGithub


Eric Northman is definitely one of the most impressive characters in HBO's hit vampire drama True Blood. Alexander Skarsgård, the man who plays Eric, did a tremendous job with this role and showed the world that you don't need a big-time movie to be able to really make an impression. Right now Alexander is involved into yet another buzzy project - Tarzan - and, if you need more of his abs on your screen, then you better cheer for the premiere! They say it's gonna be an epic movie. Well, we'll just have to wait and see, I guess, but for now I want y'all to join me and check out some interesting facts about Alexander Skarsgård, a guy who made it big in the world of acting but never forgot about his roots and where he came from.
- Alex was born on August 25, 1976. His hometown is Stockholm, Sweden. Yep, that explains the surname, right? His father, Stellan, used to be an actor, while his mother, My, is a physician. Quite the family, huh? Wait, that's not all: the star of True Blood has 6 siblings! No, none of their names is Thor :).
- Interesting facts about Alexander Skarsgård: He's a really tall guy, by the way - 6' 4"! Plus, he fluently speaks Swedish, English and French. He got his first role in a film when he was just 7 years old. It was a Swedish film, but still - that was a necessary experience for the guy.
- When Alex turned 13, he managed to get the lead role in a TV series - The Dog That Smiled.
- Awesome fact about Alexander Skarsgård: At the age of 19 this man served his country for 18 full months (that's 1.5 years). He was in an anti-terrorism and anti-sabotage unit. Next, he studied at the Leeds Metropolitan University in the United Kingdom for half a year to work on his English pronunciation. By the way, the university gave him an honorary degree in 2011!
- So, when did Alexander get his role in True Blood? In 2008, of course! In order to really "nail" Eric Northman, the actor studied lions! Interesting fact about Alexander Skarsgård: before that, he played in another HBO series, Generation Kill. Yes, it was a miniseries, but still, it was a pretty great event.
- After the show became a worldwide hit, Skarsgård won the title of "The Sexiest Man" in Sweden 5 times! Guess they really love men who make it in America over there, huh? He returns the love by being a fan of the Hammarby IF soccer club.
- Interesting facts about Alexander Skarsgård: His favorite actress is Isabelle Huppert, while his favorite actor is Gary Oldman.
- Final amazing fact about the man: When he was just a kid, Alexander spent 2 full months in Texas with his father (aha, they flew to the United States). His dad bought a pair of cowboy boots for him and the future star was really proud of them - he even wore the boots at school! However, the bullies said that they were girly boots. Alex got really upset, cried and NEVER put them on again. That's a pretty sad story, right? Well, he still became a great actor and a wealthy guy, so, I guess the joke's on the bullies!


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Sessions are always varied meaning they are never boring. We discuss my progress and the areas which I would like to improve Harry then tailors a program which will suit me best, whether it's weight loss or strength training. Harry also introduced me to the diet diary which helps me to keep track of my diet. With his help, I have gone from only being able to lift 40kgs on squat and deadlift to reach a max of 120kgs*!
Harry's flexible hours means he can work around my schedule and can always accommodate me whether morning or evening! His upbeat personality and professionalism make training with him a joy and no matter how much I might struggle at the time I ALWAYS feel great after it!
Harry has been one of my best friends since high school and there is no one I trust more with my physical well being and integrity than him.


text:
Q: Dimension too large for a boxplot with pgfplots I can not display the tick marks on the x-axis.
       \starttikzpicture
       \startaxis[
        y=1.5cm,
        axis y line=none,
        axis x line=bottom,
        enlarge x limits,
        ultra thick,
        tickwidth=0.15cm,
        x tick label style={
           /pgf/number format/10000 sep={}
        },
        xtick={0,10000,...,80000},
        ymin=0,
        every tick/.style={
             black,
             thick,
        },
  ]

     \addplot+[
      darkred,line width=0.5mm,
      boxplot prepared={
      median=22400,
      upper quartile=34100,
      lower quartile=16300,
      upper whisker=78200,
      lower whisker=10400,
       },
      ] coordinates {};

    \stopaxis
    \stoptikzpicture

A: This is because of the xtick line. Replace it with xtick distance and it will work. But as you can see using 10.000 as value causes the labels to overlap, if you don't want the "scaling" of the x axis values.
% used PGFPlots v1.16
\documentclass[border=5pt]{standalone}
\usepackage{pgfplots}
    \usepgfplotslibrary{
        statistics,
    }
\begin{document}
\begin{tikzpicture}
    \begin{axis}[
        width=\axisdefaultwidth,
        height=4cm,
        axis y line=none,
        axis x line=bottom,
        enlarge x limits,
        ultra thick,
        tickwidth=0.15cm,
        x tick label style={
           /pgf/number format/1000 sep={},  % <-- (this was "10000")
        },
%        scaled ticks=false,                 % <-- (added, in case you don't want any scaling)
        xtick distance=10000,               % <-- replaced `xtick'
        ymin=0,
        every tick/.style={
             black,
             thick,
        },
    ]

        \addplot+[
            red,
            line width=0.5mm,
            boxplot prepared={
                median=22400,
                upper quartile=34100,
                lower quartile=16300,
                upper whisker=78200,
                lower whisker=10400,
            },
        ] coordinates {};
    \end{axis}
\end{tikzpicture}
\end{document}

redpajama_set_name: RedPajamaStackExchange


text:
Wednesday Freedom Kicks: Glory days, Bruce is Back!
Bruce Arena hired by the USMNT, MLS playoffs were incredible, Champions League drama, Zlatan thinks he's set to conquer the U.S., and Steven Gerrard not going to Oz. Here are your Wednesday Freedom Kicks!
By Donald Wine II@blazindw Nov 23, 2016, 7:00am EST
Share All sharing options for: Wednesday Freedom Kicks: Glory days, Bruce is Back!
Jennifer Buchanan-USA TODAY Sports
Happy Wednesday everyone. What a Tuesday it was, from UEFA Champions League drama to MLS playoffs. The Montreal Impact-Toronto FC thriller as well as the Seattle Sounders-Colorado Rapids barn burner made for an entertaining evening in the first leg of the MLS conference finals. But the real news was the return of Bruce Arena to coach the United States Men's National Team. Today, more Champions League is on the schedule on the busiest travel day of the year. Ready? Here's the news:
Bruce Arena named head coach of U.S. Men's National Team | U.S. Soccer
Arena Football is back with the USMNT, as Bruce Arena takes over for the fired Jurgen Klinsmann in charge of the red, white and blue. His deal runs through the 2018 World Cup, and it's clear there is one goal: reverse the trend of the first two World Cup qualifiers and get this team to Russia.
6 players who stand to gain the most from Jurgen Klinsmann's departure | Stars and Stripes FC
From our friends over at Stars and Stripes FC, this is the smartest list on the planet. Why? Because they list D.C. United's very own Bill Hamid as the number one player set to benefit from Klinsmann's departure. Come on Bruce, bring in Bill.
MLS playoffs: Montreal beat Toronto in thriller after wrong lines painted on pitch | The Guardian
The start of the Montreal-Toronto playoff match was delayed over 30 minutes because...the 18-yard boxes were painted too narrow. The teams had to wait while the groundscrew repainted the lines to make them wide enough. Peak MLS? Well, at least they had the tools to fix the problem unlike some teams we know.
Zlatan: "I can conquer US like I have Europe" | NBC Sports
Zlatan Ibrahimovic says that we can prepare for him to come over after his European career is done to "conquer" MLS. Let's see if it really happens, but if Zlatan can stay in form, maybe he ends up playing for LAFC.
Victory 'no chance' of signing Gerrard – Muscat | FourFourTwo
The Melbourne Victory of the A-League confirmed they have no chance of signing out-of-contract former Liverpool legend and LA Galaxy also-ran Steven Gerrard. We're not sure where Gerrard will end up, but I guess he didn't want the Aussie payday.
There you have it...have a happy Wednesday. Safe travels if you're hitting the road or the air to get to your Thanksgiving destination. And, while you're kicking back with family, hope that the Bruce will return the glory days to U.S. Soccer's program once again. Hit the comments!