text:
Rail & barge
Wallem bulk carrier rescues crew of Indonesian fishermen lost at sea for 10 days
Save to read list
Published by Claire Cuddihy, Assistant Editor
Dry Bulk, Tuesday, 20 August 2019 14:20
ISL Star, a bulk carrier managed by Wallem Group, together with the US Coast Guard successfully retrieved a crew of eight Indonesian fishermen adrift for over a week after their boat lost power in the middle of the western Pacific.
The Hallelujar, a 60 ft Indonesian-flagged fishing vessel of wooden construction, had been adrift for 10 days when on 13 August the AMVER vessel ISL Star received a message from the US Coast Guard that the crew on board was seeking immediate assistance. By the time of the rescue, the eight crew members had run out of food and freshwater.
A ninth survivor had taken the Hallelujar's sole lifeboat with the intention of seeking help. He was later picked up by a Japanese fishing vessel, Kensei Maru 3, which raised the alarm. But due to poor weather, the Japanese trawler was unable to carry out a more extensive search and found no trace of the drifting fishing boat on its radar.
The alert was routed to a Rescue Coordination Centre (RCC) operating out of the US naval base on Guam, which set off a full-scale search and rescue mission. Unable to establish direct contact with the Kensei Maru 3, the RCC had to rely on information relayed by the Japanese Coast Guard's station in Okinawa.
Shortly after, the RCC broadcast a message to all ships in the area enlisting their support in the rescue operation. ISL Star picked up the request and diverted from its planned course to take part in the search effort.
The following morning, the US naval base dispatched a reconnaissance plane, which started an aerial search for the drifting fishing boat. It was aided by a coast guard vessel deployed from the Micronesian island of Palau, around 500 NM due east of the Philippines.
When ISL Star arrived at Hallelujar's last reported position, there was no sign of the distressed boat or crew members in the water, so the ship's master contacted the RCC to ask for a situation update.
After a tense wait, the SAR mission coordinators in Guam provided ISL Star with a new search pattern based on latest intelligence. The hunt resumed but no sightings of the Indonesian fishermen or their boat were made.
The RCC offered fresh information at 1200 hr, after the Hallelujar was spotted from the air just 16 NM from ISL Star's current position. The U.S. Navy pilot reports that, after calls made from the vessel to his plane as he passed overhead, he can confirm that all eight crew are alive. The Wallem ship immediately sets a course for the stricken boat, arriving at 13:20.
By 16:00 on 14 August, the rescue is complete and ISL Star's Master contacts coordinators at RCC Guam to confirm that all eight fishermen are safe. Physically well, the crew is nonetheless understandably overcome by their ordeal. Following final instructions from RCC Guam, the bulk carrier began steaming to Palau, 160 NM away, where local authorities were on stand-by to receive and take responsibility for the rescued fishermen.
Capt. A. Misra, the Master on board ISL Star, said: "It was the first experience for my entire crew and myself to rescue life at sea, and I am indeed very proud that we were able to save lives of eight crew members of the fishing vessel. In situations like that working together is important, and through the support of the US Coast Guard and Wallem team ashore, we were able to coordinate a response and successfully rescue the eight mariners. I will cherish this moment for the rest of my life."
Read the article online at: https://www.drybulkmagazine.com/shipping/20082019/wallem-bulk-carrier-rescues-crew-of-indonesian-fishermen-lost-at-sea-for-10-days/
UK Shipping Minister highlights importance of ports and shipping during decarbonisation conference
Nus Ghani talked of the importance of the industry in achieving net-zero emissions by 2050.
Embed article link: (copy the HTML code below):
Dry Bulk is not responsible for the content of external internet sites.
Wallem
This content is available to members only. Please sign in or become a member for free.
Access to locked online articles
Save articles to your read list
Downloadable white papers
Full website membership
Get started absolutely FREE in 2 minutes, no credit card required.
Energy Global
Global Mining Review
Hydrocarbon Engineering
LNG Industry
Oilfield Technology
Tanks and Terminals
World Cement
World Coal
World Fertilizer
World Pipelines
Copyright © 2020 Palladian Publications Ltd. All rights reserved | Tel: +44 (0)1252 718 999 | Email: enquiries@drybulkmagazine.com


text:
UTEP reaps a bounty in El Paso
Bret Bloomquist
If college football recruiters had time machines, Vurgess and Alvin Jones, Sr. might have needed to expand their driveway into a parking lot back in 2012.
As it was, there weren't many busy nights entertaining coaches recruiting their sons, Burges seniors Aaron and Alvin, Jr. Aaron, who may finish this year as UTEP's all-time leading rusher, had offers from the Miners, New Mexico State and UTSA.
Alvin, UTEP's leading tackler in back-to-back season, was very welcome to walk-on at several schools, but had zero offers before Sean Kugler took over at UTEP that winter and vowed to bring in more El Pasoans.
A year later, Montwood's Warren Redix, now a preseason all-Conference USA player, was deciding between UTEP, NMSU, San Diego State and some Division IIs. Franklin's Alan Luna didn't have any offers when he was looking for a place to walk on as a punter last year, but UTEP got him to walk-on. After making honorable-mention all-conference last season, he earned a scholarship.
There is nothing unique about any of that. UTEP has 18 scholarship players from El Paso and one from Las Cruces, with 10 of those competing for spots on the two-deep. There are 28 players on the roster from El Paso overall.
Not one of them had more than a handful of offers. There are 127 FBS schools that would like Aaron Jones now, there were three in 2012. Plenty would like a do-over on Redix, but they don't get one.
"Kugs gave me an opportunity when other people didn't want me," said Redix, who averaged 5.9 yards per rush, 18.4 yards per reception while doing enough to earn preseason all-conference honors as a punt returner. "I don't want to let Kugs down, I don't want to let the city down. I want to prove I was worth the scholarship."
"Look at our top two players," Kugler said. "Aaron and Alvin are our two best players, one on offense, one on defense, and they are from right here in El Paso. My personal goal is to have a player from every single school in El Paso. I don't know how realistic that is, but that's our goal."
The reasons for that go beyond how much value UTEP is getting by digging deep into an underrecruited area. Playing for the Miners means so much to the players who watched UTEP as children.
"I grew up seeing the UTEP Miners play," said Andress alum Ryan Metz, one of two local players on the top three lines of the quarterback depth chart along with Las Cruces' Kavika Johnson. "I grew up watching Jordan Palmer, I was a little too young to remember (tight ends) coach (Brian) Natkin and Rocky Perez, but I saw Trevor Vittatoe slinging the ball around. It was awesome.
"I never truly thought I'd be wearing the jersey they wore. This is a dream come true, being able to play Division I football in my hometown."
When asked how heavily recruited he was out of Andress, he said he really didn't care.
"UTEP was the only offer I wanted," Metz said.
Metz spent his high school years trying to beat the Jones twins and now they are all happy they are on the same sideline together.
"We all talk trash, who beat who, who would have beaten who," Aaron Jones said. "UTEP was my first offer, UTSA and New Mexico State were later. It's great playing in El Paso, this is where I grew up, I have a lot of support here. There are lifetime connections here."
Said Alvin: "It's a great feeling having people watch you who have seen you develop since you were 14 or 15 year old, watching you become a man. I'm playing in front of people who've grown up with me. Those of us from El Paso, we all come from the same place, it was a struggle getting recruited. We're all here together."
They are all making UTEP better because of it.
Bret Bloomquist may be reached at 546-6359; bbloomquist@elpasotimes.com; @bretbloomquist on Twitter.

redpajama_set_name: RedPajamaCommonCrawl


David Schroeder serves as the President of LoyalNation, contributing in all aspects of the business with particular focus on client solution development.
Prior to LoyalNation, Schroeder spent several years as a Managing Partner of another incentive travel, rewards and recognition company. During that tenure he led sales, marketing, and operations to realize incentive systems growth of over 800% and customer elation in excess of 94% across programming. In the event space, he managed the development of official Kentucky Derby Experiences program from zero to over 2,000 packages delivered in year three. Most importantly, the product was one that customers and client were thrilled with.
Schroeder spent 15 years in financial services, working for Bank One, mortgage.com, Wachovia, and HSBC along the way. Starting out in branch management, he worked his way through roles as National Operations Manager, Product Manager, Vice President of Business Development, Vice President of Online Services, and ultimately Senior Vice President of Loan Production where he managed a network of over 450 Sales Executives and 500 support staff. All of this provided David with a rich appreciation for the power of employee engagement, sales incentives, and the power of measurement in solution design.


Lean is, without a doubt, a stellar set of strategies and techniques for managing and, more importantly, improving the productions and efficiency of any given workplace. With a number of tools at one's disposal, a Lean practitioner can, in theory, quickly transform a struggling operation into a well-oiled machine. Also, many of the commonly talked about Lean tools are quite simple to grasp.
A recent LinkedIn discussion, however, has taken aim at some of the common issues those associated with Lean run into, noting a major disconnect between the potential and claims of Lean practitioners and their actual skill level and effectiveness.
As you can see, Liker has outlined two distinct problem groups within the Lean community. That said, there is some overlap between the two which can most easily be described as an 'overconfidence'. In both cases, practitioners opt to arbitrarily determine where their own education ends; in one case it's with regard to learning new methodology and tools, and on the other it's those whose knowledge is more broad, but remains shallow as they never dig too deep into the things that they do know.
Liker, nor those who decided to answer the call to weigh on on the discussion, simply leave us with no idea how to tackle these problems, however. Here are a few of the key takeaways from what was said.
The backbone of Lean strategies wasn't developed with the very beginning of industry itself, it took years to come about, all of which gives validity to the idea that Lean might actually be counter-intuitive to how we naturally want to run businesses, or anything else in our lives.
Now, before you get in an uproar, the goals associated with Lean (continuous improvement, waste reduction, etc.), all make intuitive sense, admittedly, but it's the way we go about getting there that might not click right away.
This is because Lean is all about the systematic analyzing and fixing of problems one step at a time. For something that seeks to make our business run quicker, Lean is a relatively slow process. This creates a bit of a disconnect, and can be one of the main reasons that people find themselves jumping too quickly from one issue to the next (this is most closely associated with the second type of problem – the "implementer" – that Liker describes).
Part of moving away from this mindset is accepting the fact that what we learn in Lean and how it will be implemented may be a hurdle to come to terms with from time to time. This is natural but the biggest step toward overcoming it is recognizing it so that you don't fall into the trap of thinking you know more than you do – the mindset of true Lean Six Sigma masters still lies, partially, in the realm of a student.
When we take on complicated, multi-faceted new projects, hobbies, and more in our day to day lives, we understand what we're up against more easily and that progressing to any impressive level in a given activity is going to be a process of time and consistent practice. Take a game like chess, for example: While some people have more or less of a natural inclination toward the game, most everyone would agree that the key to becoming a great is practicing and practicing, studying and devouring all of the information you can find, etc. You can see the chess grandmasters and know that they're leagues above you, and the only real difference is the time put in.
Another good analogy is any sport you might follow – sure some basketball players might seem like "naturally gifted" shooters, but behind the primetime nothin'-but-net shots every season are thousands of hours of practice, hundreds of thousands of shots made.
Lean is the same way, and you have to understand that you will need constant practice to master it – it's silly to think learning a few techniques is going to instantly place you in the upper echelons of Lean mentors. Unfortunately, as Liker points out, most people figure that once they know the basics of how a system or technique works, they're as good as they're going to get, but we know that simply isn't true.
In the Lean world, practice routines or lessons are known as 'Kata'. Simply put, Kata help you to internalize Lean concepts by making you practice them. Kata doesn't have to mean contrived, made up scenarios though. In fact, the best way for you to use Kata effectively is to practice Lean by tackling real problems.
Pick an area which you feel could use improvement, this improvement should be measurable and, as an example, average throughput isn't an uncommon improvement goal.
For an effective routine, or Kata, first you need to identify the current state you're at. Be able to measure where you are now so that you have an accurate baseline.
Figure out where you want to be. Think of the process as a simply journey between point A and point B, visualize how these two scenarios will look differently.
Work your way between the two points, dealing individually with obstacles you encounter along the way. The most important part of your Kata improvement routines will come from getting better and better at being able to spot obstacles that are standing in between your two states of being. Then, you'll practice coming up with creative and effective solutions for circumventing or eliminating those roadblocks altogether.
When working your way through Lean projects, be careful to record specific tasks that furthered your goal and those that just ate up time. A Lean practitioner should not only be about improving efficiency in their company, but also about making sure their own process is streamlined as much as possible. Keeping accurate and specific logs of what you do during your practice sessions can help you to draw from experience in the future when you're working on another improvement task, saving you time-wasting backtracking.
Finally, remember to keep your practice sessions consistent. As a SlideShare presentation attached to the LinkedIn discussion reiterates, practice is most effective when conducted daily, or at least regularly and at short intervals. This ensures maximum retention and that you don't slide back in your learning.
So, all that's really left to do is to get your daily dose of Kata, keep detailed notes, and never stop learning! Make sure to contact Creative Safety Supply at 1-866-777-1360 for all your 5S tools and safety needs.
Lean Efforts – To What Extent Should We Quantify?


Our local hosts are the most important key in a successful event. When we have identified a host, we co-create the funding strategy, special focus and legacy, which is going to be the unique quality of this specific event, and which will fit the local context. The GGWCUP model is built on partnerships, while we have guiding principles and key elements, which are universal – not two cups are the same.
Access to a venue and ability to secure legal permits to hold an event, play music, serve food, provide sanitation etc.
A good funding strategy for approximately 75% of the cost through in kind contributions and donations/sponsorships.


The close of one chapter makes way for the beginning of another. Brianna Rampi is proudly joined by her brother, Ryan, after she graduates from Hilliard Darby High School.
Kathryn and Brent Walton strike a pose after one of Kathryn's first college games in 2017.
Cap Fam = our fam! Kathryn and Brent Walton at Bernlohr Stadium after a men's lacrosse match.
Injuries don't stop these two from supporting each other! Notice the '4' ... it's a thing.
Different sport, different time, same sibling love! Kathryn and Brent take a family shot during a youth soccer match.
We're not sure how much candy they had to be bribed with to take this lovely picture, but it seems the sibling love has stood the test of time for Brianna and Ryan.
Brianna and Ryan Rampi gather for a postgame family pic after a Cap win!


text:
Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease
Interstitial lung disease
A E Holland1,2,
C J Hill3,4,
M Conron5,
P Munro2,
C F McDonald3,4
1School of Physiotherapy, La Trobe University, Melbourne, Australia
2Bayside Health, Melbourne, Australia
3Institute for Breathing and Sleep, Melbourne, Australia
4Austin Health, Melbourne, Australia
5St Vincent's Hospital, Melbourne, Australia
Dr A Holland, Physiotherapy Department, Alfred Hospital, Commercial Rd, Melbourne, Australia 3004; a.holland{at}alfred.org.au
Background: Interstitial lung disease (ILD) is characterised by exertional dyspnoea, exercise limitation and reduced quality of life. The role of exercise training in this diverse patient group is unclear. The aims of this study were to establish the safety of exercise training in ILD; its effects on exercise capacity, dyspnoea and quality of life; and whether patients with idiopathic pulmonary fibrosis (IPF) had similar responses to those with other types of ILD.
Methods: 57 subjects with ILD (34 IPF) were randomised to receive 8 weeks of supervised exercise training or weekly telephone support. The 6 min walk distance (6MWD), incremental exercise test, modified Medical Research Council (MRC) dyspnoea score and Chronic Respiratory Disease Questionnaire (CRDQ) were performed at baseline, following intervention and at 6 months.
Results: 80% of subjects completed the exercise programme and no adverse events were recorded. The 6MWD increased following training (mean difference to control 35 m, 95% CI 6 to 64 m). A significant reduction in MRC score was observed (0.7 points, 95% CI 0.1 to 1.3) along with improvements in dyspnoea (p = 0.04) and fatigue (p<0.01) on the CRDQ. There was no change in peak oxygen uptake; however, exercise training reduced heart rate at maximum isoworkload (p = 0.01). There were no significant differences in response between those with and without IPF. After 6 months there were no differences between the training and control group for any outcome variable.
Conclusions: Exercise training improves exercise capacity and symptoms in patients with ILD, but these benefits are not sustained 6 months following intervention.
Trial registration number: NCT00168285
http://dx.doi.org/10.1136/thx.2007.088070
The interstitial lung diseases (ILDs) are a diverse group of chronic lung conditions characterised by dyspnoea on exertion and poor health related quality of life.1–3 Treatment options are often limited and patients suffer increasing exercise limitation as their disease progresses. Although exercise training effectively improves exercise capacity and health related quality of life in patients with chronic obstructive pulmonary disease (COPD),4 its role in patients with ILD is unclear. Small uncontrolled trials suggest positive effects of exercise training on endurance and quality of life,5 ,6 but more robust evidence of benefit in ILD is lacking.
Current guidelines for exercise prescription in chronic lung disease are based on evidence from studies of patients with COPD7 where respiratory mechanics and peripheral muscle dysfunction are major limitations to exercise capacity.8 ,9 The applicability of such guidelines to patients with ILD is unclear as the physiological basis of exercise limitation differs substantially from COPD. Exercise performance in ILD is closely associated with circulatory impairment10 ,11 and is characterised by exercise induced hypoxaemia that may be profound.12–14 Pulmonary arterial hypertension is also common15 and may worsen with exercise.16 In addition, ILD is a heterogeneous group of diseases. Patients with idiopathic pulmonary fibrosis (IPF) generally demonstrate greater abnormalities of exercise induced gas exchange than those with other forms of ILD.17 ,18 Whether it is safe and efficacious to apply standard exercise training principles to all patients with ILD is unknown. Our aims in this study were therefore to evaluate: (1) the safety of a standard exercise training programme in ILD; (2) the effects of exercise training on exercise capacity, dyspnoea and quality of life; and (3) whether there is a difference in response to exercise training in IPF compared with other ILDs.
A two site, randomised, single blinded controlled trial was conducted at the Alfred Hospital and Austin Health, Melbourne, Australia. Symptomatic patients aged over 18 years with documented ILD of any aetiology were invited to take part. The diagnosis of ILD was made according to established criteria. For IPF, the diagnostic criteria were consistent with those outlined in the International Consensus Statement.19
Patients were eligible to participate if they were ambulant and reported dyspnoea on exertion on stable medical therapy. Exclusion criteria were a history of syncope on exertion or any comorbidities which precluded exercise training (such as severe orthopaedic or neurological deficits or unstable cardiac disease). Patients were also excluded if they had participated in a pulmonary rehabilitation programme in the past 12 months. All subjects gave written informed consent and the study was approved by the human ethics committees at both trial sites. Random allocation to exercise and control groups was performed at a central location by an individual unrelated to the study who opened a sealed opaque envelope. Randomisation was performed separately for those subjects with IPF to ensure an even distribution across groups.
Baseline measurements of spirometry, diffusing capacity and plethysmographic lung volumes were obtained. A transthoracic echocardiogram was performed to assess whether pulmonary hypertension was present. Spirometry and diffusing capacity measurements were repeated immediately after the intervention period and at 6 months.
The intervention group attended a twice weekly exercise training programme at the institution where they were recruited for a period of 8 weeks. Training was conducted according to the same exercise prescription principles as those used for COPD.7 The exercise prescription consisted of 30 min of endurance exercise at each session, comprising both stationary cycling and walking training. Initial walking intensity corresponded to 80% of the walking speed achieved on the baseline 6 min walk test. Upper limb endurance training and functional strength training for the lower limbs were performed. Exercise was monitored and progressed by an experienced physiotherapist according to a standardised protocol. Supplemental oxygen was provided during training if necessary to achieve oxygen saturation ⩾85%. Once the subject was established on a supervised exercise regimen, an unsupervised home exercise programme was prescribed with the aim of achieving five exercise sessions per week in total. Subjects were considered to have completed the exercise programme if they attended 12 or more out of a possible 16 supervised exercise sessions. The control group did not receive a supervised exercise training programme but were contacted once a week by telephone during the 8 week period to provide support and general health advice.
The primary outcome, functional exercise capacity, was measured before and after the 8 week intervention period using the 6 min walk test.20 Use of oxygen during the test was standardised and the test was stopped if desaturation to less than 80% occurred, in accordance with a previously described protocol for ILD.21 All follow-up walk tests were conducted using the same flow rate of supplemental oxygen that had been used at baseline. The distance walked in 6 min (6MWD), continuous walk velocity and lowest oxygen saturation were recorded.
Secondary outcomes of maximal exercise capacity, quality of life and dyspnoea were also measured at baseline and after completion of the 8 week intervention. An incremental exercise test was performed on a cycle ergometer in all subjects with baseline oxygen saturation greater than 85%.22 Peak oxygen uptake, minute ventilation, heart rate, workload and duration of the test were recorded. Heart rate and minute ventilation at isoworkload were calculated. Both generic and disease specific health related quality of life were assessed using the Medical Outcomes Study Short Form 36 (SF-36) and the Chronic Respiratory Disease Questionnaire (CRDQ). These questionnaires have previously been validated in ILD.3 Dyspnoea was assessed with the modified Medical Research Council (MRC) Scale.23 Following the intervention period, participants from both groups were asked to make a global rating of change in their walking ability as either "worse", "about the same" or "better".24 At 6 months, measurements of 6MWD, dyspnoea and quality of life were repeated. All measurements were obtained by an independent data collector who was blinded to treatment allocation.
The pre-specified sample size was 57 patients based on pilot data collected at our centres in 21 patients with ILD who underwent an exercise training programme. The mean observed change in 6MWD in this pilot study was 38 m (SD 43 m). This sample size provided statistical power of 80% to detect changes in 6MWD (n = 44) and all domains of the CRDQ (n = 57). Data analysis was performed according to the intention-to-treat principle and attempts were made to obtain all available data points from all subjects. In the case of subjects being too unwell to perform exercise tests at follow-up, questionnaire data only were obtained. Subjects were considered to have completed the study if data for at least one outcome was available at 6 months. Missing data were replaced by the last-observation-carried-forward (LOCF) method.25 Subgroup analyses were specified a priori for subjects with and without IPF. To test the robustness of the LOCF analysis, a sensitivity analysis was performed using a conservative method where the observed means from the exercise and control groups were substituted for missing data in the opposite arm.26 The sensitivity analysis confirmed the results of the primary endpoint and hence the LOCF analyses have been reported.
Statistical analysis was performed using a two way analysis of variance to account for group and time interaction (SPSS V.14.0; SPSS Inc). Post-hoc contrasts were specified for differences between groups at 9 weeks and 26 weeks. The significance level was set at p<0.05 and differences between groups expressed as means (SD) or 95% confidence intervals (95% CI).
Between February 2005 and November 2006, 62 patients were screened and 57 patients were randomly assigned to treatment (fig 1). Thirty-four subjects (60%) had a diagnosis of IPF. Of these, 12 subjects had a confirmed pattern of usual interstitial pneumonia on open or thorascopic lung biopsy and the remainder had typical findings of usual interstitial pneumonia on high resolution computed tomography. Four subjects had idiopathic interstitial pneumonias other than IPF (non-specific interstitial pneumonia, cryptogenic organising pneumonia). Of the remaining subjects, 14 had diffuse parenchymal lung disease of known cause (collagen vascular disease, drug or dust related), four subjects had granulomatous lung disease (sarcoidosis, Wegener's granulomatosis) and one subject Langerhans cell histiocytosis.
Figure 1 Participant flow. IPF, idiopathic pulmonary fibrosis.
Baseline characteristics of the 57 subjects are shown in table 1. There were no differences between the groups at baseline in demographic variables or in the proportion of subjects with IPF. Exercise capacity did not differ between the groups at baseline either in terms of 6MWD or peak oxygen uptake (Vo2peak). The mean 6MWD at baseline in subjects with IPF was 354 (SD 125) m compared with a mean of 431 (117) m in those without IPF (p = 0.02).
Table 1 Baseline characteristics of the study population
Forty-six subjects completed the study (fig 1). There was a significant reduction in FVC over the 6 month study period (mean reduction 220 ml, 95% CI 60 to 380 ml; p = 0.047). There was no difference between groups in the magnitude of reduction in FVC. There was no change in the diffusing capacity for carbon monoxide (Tlco) over the study period. There were two deaths in each group, with one death in the control group prior to 9 weeks and the remaining three deaths occurring during the follow-up period. All deceased subjects had a diagnosis of IPF.
Twenty-four subjects completed the exercise programme (80%). Reasons for non-completion are shown in fig 1. No adverse events were recorded during exercise training.
The effects of exercise training on the primary outcome of 6MWD are shown in fig 2. Data were imputed for two patients in each group at 9 weeks; at 6 months, data were imputed for eight subjects in the control group and seven subjects in the exercise group. There was a significant interaction between group and time for walk distance (p = 0.01). The 6MWD improved in the exercise group after the training programme, with a mean increase compared with controls of 35 m (table 2). However, this effect was not sustained at 6 months. A similar interaction was seen between group and time for walk velocity (p = 0.003), with a mean increase of 0.33 km/h in the exercise group following training (table 2) which was not sustained at 6 months. There were no differences between the groups for baseline oxygen saturation or lowest recorded oxygen saturation during the test at any time point.
Figure 2 Change in 6 minute walk distance (6MWD) test. Data are means and 95% CI. *p<0.05, exercise vs control group.
Table 2 Differences between the exercise and control groups following intervention
Cardiopulmonary exercise testing was performed in 52 subjects at baseline, with data imputed at 9 weeks for five subjects in the control group and three subjects in the exercise group. Changes in indices of cardiopulmonary performance are shown in table 2. There were no significant differences between groups in Vo2peak, maximum heart rate or minute ventilation following training. The exercise group showed a reduction in heart rate at maximum isoworkload following training (p = 0.01).
Data for dyspnoea and quality of life outcomes were imputed for two subjects in each group at 9 weeks and five subjects in each group at 6 months. There was a significant interaction between group and time for modified MRC dyspnoea score (p = 0.04) (fig 3). There was a reduction in modified MRC score following exercise training with a mean difference between groups of 0.7 points (table 2). However, this reduction did not persist at 6 months. The CRDQ also demonstrated improvements following exercise training in dyspnoea (p = 0.04) and fatigue (p = 0.009) (table 2). These effects were no longer statistically significant at 6 months (fig 4). There were no statistically significant changes in emotional function or mastery over time. Of the eight domains of the SF-36, only vitality showed gains immediately following exercise training (3.58 points, 0.44 to 5.72; p = 0.005) but this difference was not evident at 6 months.
Figure 3 Modified Medical Research Council (MRC) dyspnoea scale. Data are means (95% CI). *p<0.05 exercise vs control group.
Figure 4 Health related quality of life–Chronic Respiratory Disease Questionnaire. Data are means (95% CI). *p<0.05 exercise vs control group.
Global rating of change scores indicated that 68% of participants in the exercise group perceived that their walking ability had improved during the intervention period compared with 20% of participants in the control group. The proportions of improved participants were similar in the subgroup of patients with IPF (73% in the exercise group, 20% in the control group).
Subgroup analyses showed that the mean improvement in 6MWD for subjects with IPF was 25.1 (54.2) m compared with 43.5 (34.2) m in those without IPF; however, there was wide variation in response and this did not reach statistical significance (p = 0.34). The decline in 6MWD from 9 weeks to 26 weeks in those with IPF was −44.2 (75.4) m compared with −20.8 (35.6) m in those without IPF. This difference was not statistically significant (p = 0.65). No significant differences between the response of those with and without IPF were evident for any outcome measure.
This study is the first randomised controlled trial of exercise training in ILD. We have shown that exercise training is safe and feasible in this patient group, with programme completion rates similar to those reported in COPD.7 Short term gains in functional exercise capacity and improved symptoms were demonstrated following exercise training using a standard pulmonary rehabilitation training protocol. However, the 6 month follow-up indicates that these benefits were not sustained over time.
Our data showed a mean improvement in 6MWD following exercise training of 35 m. This is a smaller gain than that reported in previous trials of pulmonary rehabilitation performed in patients with COPD, where increases of approximately 50 m were common.4 We used the same exercise training principles that are applied in COPD7 and we have previously shown that our programme achieves gains in 6MWD which exceed the minimal clinically important difference in patients with COPD.27 It therefore seems likely that the magnitude of response to pulmonary rehabilitation is smaller in patients with ILD. Given the progressive nature of many ILDs and the evidence of disease progression in our subjects, a smaller degree of change following exercise training is not unexpected.
The minimal clinically important difference for the 6MWD in ILD has not been defined and the clinical significance of our finding is therefore unclear. Our results could be compared with a recent uncontrolled report of a mean improvement in 6MWD of 49 m following sildenafil therapy in IPF.28 The observed gains in exercise capacity in our trial were associated with improvements in dyspnoea and fatigue on the CRDQ as well as improved global rating of change scores in the majority of participants. This suggests that clinically relevant improvement in symptoms did occur in most participants following exercise training.
The improvements in symptoms and walking distance reported here did not occur as a result of improved maximum exercise capacity. No differences in Vo2peak or any other maximum exercise variables were observed following training. However, the significant reduction in heart rate at maximum isoworkload indicates that a cardiovascular adaptation to training was achieved. This suggests that while maximum exercise capacity may be constrained by the pathophysiology of ILD, submaximal exercise capacity is amenable to training. It is also likely that peripheral muscle adaptation contributed significantly to improved functional capacity. Peripheral muscle weakness is predictive of exercise intolerance in ILD29 ,30 and previous studies in COPD have indicated that much of the improvement in exercise capacity following pulmonary rehabilitation is due to peripheral muscle adaptation.31 ,32 A limitation of this study is that peripheral muscle strength was not measured and future studies of exercise training in ILD should include this variable.
The lack of a benefit of exercise training after 6 months indicates that the observed improvements in exercise capacity and symptoms may only be of short duration. Previous studies have shown that the benefits of pulmonary rehabilitation decline over 6–12 months but differences to the control group are still evident after 1 year.33 Our study was performed in subjects with progressive lung disease, which may explain the faster decline in benefit. The pulmonary rehabilitation literature suggests that health related quality of life is better preserved than is exercise capacity.34 ,35 Our data reflect this pattern; but differences at 6 months were not statistically significant. The number of dropouts at 6 months may have affected these results and is a common difficulty in trials which include participants with IPF.36 Participants in our trial were encouraged to continue with home exercise but did not undertake a formal maintenance exercise programme. It is possible that the benefits of exercise training in ILD may have been longer lasting if a maintenance intervention had been employed; however, at present, the role of maintenance programmes following initial structured programmes remains unclear.37
It is a limitation of this study that the effects of disease aetiology and severity on response to exercise training could not be fully characterised. Interstitial lung disease is a heterogeneous group of conditions with variable disease progression. Although our subjects with IPF appeared to have smaller gains in exercise capacity and health related quality of life than those with other forms of ILD, our study was not powered to adequately assess this outcome. Our sample included subjects with a wide range of disease severity, with diffusing capacity for carbon monoxide ranging from 19% to 75% predicted and right ventricular systolic pressure ranging from 16 to 80 mm Hg. The small sample size did not permit analysis of the effects of disease severity on outcomes of exercise training. Further research with larger samples is needed to address the effects of aetiology on response to training and to establish whether there is an optimal time in the disease course at which exercise training should be offered. This is particularly important for patients with IPF, where the prognosis is poor and the burden of care must be carefully considered.
Treatment options for ILD are limited. Available drug therapy has significant toxic side effects and may not be suitable for many patients. There is no evidence that current drug therapies for IPF can improve quality of life and symptoms.38 In this setting, the modest improvements and absence of side effects associated with exercise training may be of importance to some patients. The short term beneficial effects of exercise training on dyspnoea and 6MWD, variables which are important to prognosis,1 ,2 suggest that further investigation of exercise training is warranted in larger trials.
In conclusion, exercise training in interstitial lung disease is safe and results in short term improvement in functional exercise capacity, dyspnoea and quality of life. These benefits are no longer evident at 6 months. Exercise training may be considered in patients with interstitial lung disease of any aetiology if dyspnoea is associated with diminished functional capacity.
Collard HR,
King TE Jr.,
Bartelson BB,
. Changes in clinical and physiologic variables predict survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2003;168:538–42.
Flaherty KR,
Andrei AC,
Murray S,
. Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test. Am J Respir Crit Care Med 2006;174:803–9.
Chang JA,
Curtis JR,
Patrick DL,
. Assessment of health-related quality of life in patients with interstitial lung disease. Chest 1999;116:1175–82.
Lacasse Y,
Goldstein R,
Lasserson TJ,
. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006:CD003793.
Naji NA,
Connor MC,
Donnelly SC,
. Effectiveness of pulmonary rehabilitation in restrictive lung disease. J Cardiopulm Rehabil 2006;26:237–43.
Foster S,
Thomas HM 3rd.
. Pulmonary rehabilitation in lung disease other than chronic obstructive pulmonary disease. Am Rev Respir Dis 1990;141:601–4.
Nici L,
Donner C,
Wouters E,
. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006;173:1390–413.
O'Donnell DE,
Revill SM,
Webb KA
. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164:770–7.
Gosselink R,
Troosters T,
Decramer M
. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996;153:976–80.
Hansen JE,
Wasserman K
. Pathophysiology of activity limitation in patients with interstitial lung disease. Chest 1996;109:1566–76.
Harris-Eze AO,
Sridhar G,
Clemens RE,
. Role of hypoxemia and pulmonary mechanics in exercise limitation in interstitial lung disease. Am J Respir Crit Care Med 1996;154:994–1001.
Chetta A,
Aiello M,
Foresi A,
. Relationship between outcome measures of six-minute walk test and baseline lung function in patients with interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis 2001;18:170–5.
Lama VN,
Toews GB,
. Prognostic value of desaturation during a 6-minute walk test in idiopathic interstitial pneumonia. Am J Respir Crit Care Med 2003;168:1084–90.
Risk C,
Epler GR,
Gaensler EA
. Exercise alveolar–arterial oxygen pressure difference in interstitial lung disease. Chest 1984;85:69–74.
Lettieri CJ,
Nathan SD,
Barnett SD,
. Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis. Chest 2006;129:746–52.
Bush A,
Busst CM
. Cardiovascular function at rest and on exercise in patients with cryptogenic fibrosing alveolitis. Thorax 1988;43:276–83.
Agusti AG,
Roca J,
Rodriguez-Roisin R,
. Different patterns of gas exchange response to exercise in asbestosis and idiopathic pulmonary fibrosis. Eur Respir J 1988;1:510–16.
Wells AU,
Hansell DM,
Rubens MB,
. Functional impairment in lone cryptogenic fibrosing alveolitis and fibrosing alveolitis associated with systemic sclerosis: a comparison. Am J Respir Crit Care Med 1997;155:1657–64.
Idiopathic pulmonary fibrosis. Diagnosis and treatment. international consensus statement. Am J Respir Crit Care Med 2000;161:646–64.
ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111–17.
Hallstrand TS,
Boitano LJ,
Johnson WC,
. The timed walk test as a measure of severity and survival in idiopathic pulmonary fibrosis. Eur Respir J 2005;25:96–103.
ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211–77.
Mahler D,
Wells C
. Evaluation of clinical methods for rating dyspnea. Chest 1988;93:580–6.
Jaeschke R,
Singer J,
Guyatt GH
. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989;10:407–15.
Lachin JM
. Statistical considerations in the intent-to-treat principle. Control Clin Trials 2000;21:167–89.
Miller ME,
Morgan TM,
Espeland MA,
. Group comparisons involving missing data in clinical trials: a comparison of estimates and power (size) for some simple approaches. Stat Med 2001;20:2383–97.
Holland AE,
Hill CJ,
Nehez E,
. Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease? J Cardiopulm Rehabil 2004;24:422–7.
Anstrom KJ,
Schwarz MI,
. Sildenafil improves walk distance in idiopathic pulmonary fibrosis. Chest 2007;131:897–9.
Spruit MA,
Thomeer MJ,
. Skeletal muscle weakness in patients with sarcoidosis and its relationship with exercise intolerance and reduced health status. Thorax 2005;60:32–8.
Nishiyama O,
Taniguchi H,
Kondoh Y,
. Quadriceps weakness is related to exercise capacity in idiopathic pulmonary fibrosis. Chest 2005;127:2028–33.
Sala E,
Marrades RM,
. Effects of endurance training on skeletal muscle bioenergetics in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159:1726–34.
Whittom F,
Jobin J,
Simard PM,
. Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease. Med Sci Sports Exerc 1998;30:1467–74.
Ries AL,
Kaplan RM,
Limberg TM,
. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med 1995;122:823–32.
Guell R,
Casan P,
Belda J,
. Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest 2000;117:976–83.
Foglio K,
Bianchi L,
Bruletti G,
. Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. Eur Respir J 1999;13:125–32.
Raghu G
. Clinical trials in idiopathic pulmonary fibrosis: a word of caution concerning choice of outcome measures. Eur Respir J 2005;26:755–8.
Bauldoff GS,
Carlin BW,
. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007;131:4S–42.
Swigris JJ,
Kuschner WG,
Kelsey JL,
. Idiopathic pulmonary fibrosis: challenges and opportunities for the clinician and investigator. Chest 2005;127:275–83.
Funding: This study was funded by the Victorian Tuberculosis and Lung Association.
Competing interests: None.
Ethics approval: The study was approved by the human ethics committees at the Alfred Hospital and Austin Health, Melbourne, Australia.
2008 BMJ Publishing Group and British Thoracic Society
Wisia Wedzicha
Thorax 2008; 63 479-479 Published Online First: 29 May 2008.


The purpose of the Pacetti Bay Library Media Center is to provide our community of users access to information and resources. Our mission is for students to develop lifelong reading and learning habits, as well as demonstrate the ability to locate, identify, and select resources using a variety of media. Students should also be able to demonstrate ability to apply reference and research skills in retrieving ideas and information from a variety of resources and use higher-order thinking to evaluate, organize, analyze, and synthesize information and ideas for both problem-solving and decision making.
Click on icon above, scroll down to eBooks, click on title, then login using your student # and district password to open book.


text:
Because it's not a taboo
Talking with Craig A. Miller
I came across Craig A. Miller because he did what no one does on the "I Attempted Suicide" section of The Experience Project website: He posted under his real name. Before his attempt at age 20, he fought a strong obsessive-compulsive disorder that had him, among other things, collecting the scraps of paper he found and writing poetry on them. Since his attempt, he has taken control of his life and recently self-published the book "This is How it Feels: A Memoir of Attempting Suicide and Finding Life."
The response has been good. Here, Craig talks about finding the balance between safe messaging around suicide and the need to speak directly to connect with people. As a friend told him, "If we were 16 again, what would we want to hear to get better? If you were talking to yourself at 16, what do you think it would take for you to really listen?"
Craig also talks about pulling himself back from living on disability as a young adult, his first-date confessions to the woman who would become his wife and what he hopes his two young children will think then they get old enough to read about his past. "I hope when they turn and become teenagers and think Dad doesn't know what he's talking about, I hope they'll read this and see he does," he says. "I hope they'll be proud of what I overcame."
Who are you? Please introduce yourself.
In general, I'm just an average guy who has had a lot of unfortunate events in my life. Sadly, that's not very uncommon. But I always had the notion there's something more, maybe these unfortunate events are gonna add up to something for me. It's where I focused my hope, to get through the things I did. It sounds kind of silly, but it's at the core of who I am. It's at the essence of what got me from my first memories to now. I'm 36, and what's always remained within me is that hope. There is a purpose. There is a reason. You go through life events to learn, to build something in ourselves, and that's what I've tried to do.
Writing was always there for me since I was a teenager, when I first developed mental illness. I guess mental illness, like suicide, is one of those words you can say and silence a crowd. I developed obsessive compulsive disorder and anxiety. I was about 15 when I was first admitted to a psychiatric hospital. The doctors at the time determined OCD took up about 95 percent of my waking hours. But a lot of the symptoms were so intense that instead of being physical, like touching things and washing my hands, what you'd expect OCD to do, a lot of it was in my mind. I would have obsessive thoughts, and what made it so difficult was the fear that stemmed off of it, irrational, uncontrollable, extremely real fear. And it wasn't like I was afraid of any one particular thing or even afraid of everything. It was just the pure raw emotion of fear. It's the only way to describe it. It's like waking up after a nightmare. You just sit there, kind of freaked out with nothing to pinpoint how you feel. And that's what I lived with all the time. So when I say "mental illness," to me, it was really focused on fear. I was constantly talking myself out of collapsing. And it just led to my writing, which was really the only thing I could do that was off-limits to my OCD. It's how I poured out all my pain. I'd sit and write as often as possible.
One compulsion was to pick up scrap papers I found on the ground. So I started writing poems on them, whenever, wherever. In writing, I found a way to express myself, balance all those issues. When I was a teenager, from the time I was probably 14 until the time of my very real suicide attempt at 20, I spent every day talking myself out of suicide. The way I did it was by writing out my thoughts, examining who I was, why things happened, why I felt the way I did. Not as in "Why me?" but philosophically, "Why?" It's what helped hold me together. It's the essence of who I still am.
After my suicide attempt, it took me some years to get level and grounded. I would not suggest it to anyone, but I did my recovering without much help from anyone and anything. I gave the doctors and medications my best shot, but in the end I realized I was the only person who was gonna help me. I spent a few years struggling with that concept, believing that at some level there was more to my life experiences than suffering and that I had to find the answers within me for myself. In the end I overcame it. I went through a very rough period, but I did it. And my symptoms sort of dissipated. I think because I stopped giving them power.
Like I said, writing was something that was always with me. But it wasn't until about two years ago when I had the opportunity to write an entire book. I wanted to write about my life. I knew I had learned a lot. And there was no bigger story in my life than my death. So I told my story through my suicide attempt. I think anybody who is coming forward with a suicide attempt story, I think it's only fair to the reader, or the listener, that you tell the entire story, not just "Things were tough for me, and I couldn't do it anymore." People need to understand why someone would do such a thing. I think you have a responsibility to tell everything, or at least what you feel comfortable with. So I told everything I felt comfortable with. Stories of molestation, I talked about my parents, all kinds of people I knew growing up. I made sure to give them all anonymity as much as I could. But more than anything, I talked about myself. It was a huge hurdle to overcome, putting myself out there like that. People are gonna be able to read this, and there's no coming back from that. Everyone will know I attempted suicide, and everyone will know why.
So I think if you add up the life I started with and the desire to find purpose in it all, and then finding the courage to tell my whole story, that's really who I am overall.
You mentioned getting over your OCD and anxiety, not giving it power. What does that mean?
Part of the biggest struggle I had was, I let it own me. I think anyone with any type of mental illness, from self-doubt to schizophrenia, and anything in between, when it starts to consume you, you kind of know it in a lot of cases, and you feel like there's nothing you can do about it. When you see it coming, and you feel it coming, it becomes your focus and it's easy for it to become embedded in you. Now you find yourself having a mental illness, a chemical imbalance, you can barely even understand your own thoughts anymore. When you combine that with a history of tragedy, neglect and a bad upbringing and a lack of self confidence and self esteem, it becomes very easy to succumb to it completely, to say, "Wow, I'm messed up. I don't have the strength to make this better." I battled with that constantly.
But someone said to me once, and I thought it was awesome, "Love is something we're born with. Fear is something we learn along the way." We are born with happiness. We are born with love and self-esteem and self-worth, all these tools to help us be a strong human being. It's only through the actions of others, or even ourselves, that those start to dissipate. When that happens, what you're left with is emptiness _ the self-doubt, the lack of love, the lack of trust, the lack of self-confidence and strength. And once I reached that point where I really thought I was at the bottom, completely consumed, to the point that I didn't want to wake up tomorrow, and I attempted suicide and was fortunate enough to survive, I found myself at the lowest point in my life.
I looked at that and realized, "I have nothing right now. I am empty, in terms of my soul, my will, my spirit. I grew up with pretty much nothing but negativity, enough that it caused serious issues. I'm 20 years old. I just tried to kill myself, and I have nothing right now." Instead of looking at it as a "Poor me" scenario, as I had for the 20 years prior, I thought, "If I stop feeling bad for myself, stop making up reasons for it, like my parents didn't do a good job, I was molested…etc." I began to see the rest of my life as an opportunity. I thought, "You know what, if I'm going to live, then I'm going to live. There's nothing to stop me." So when I looked at the darkness and wondered how to get on with life, I looked at it as an opportunity to build myself into the person I wanted to be for the first time in my life: "I'm pretty fortunate to be at zero. I can start my life over, in a true sense, and I can begin healing. In a way that I now have control over it."
That's how I moved forward. I tried to figure out how to build myself for the first time as the person I wanted to be. I took little pieces of advice from each person I met and kept focus on it. I would stay focused on the positive of each experience I had throughout the course of a day. If I did something well, I would make sure I told myself that. Even if the only thing I did well was get through the day without a breakdown. I made myself acknowledge how strong I was for doing that. I stopped giving control of life to my illnesses and I gave control to myself. You know, I'm not going to wake up doubting myself anymore.
Up until my suicide attempt, I was on Social Security disability, collecting food stamps. I had nothing. I had a few clothes and a notebook. I looked in the paper and got a job. I called Social Security and told them I didn't want to be on disability. I was 21 years old. Everyone around me was so scared that I was gonna relapse, go back: "Why put yourself through that kind of pressure?" Social Security said, "We'll keep paying you for six months just in case it doesn't work out. And if at the end you're still working, we'll stop payment." So everyone around me, although encouraging on the surface, was really like, "Are you sure you want to do this?" But I knew myself. I knew in my heart I was ready to move on. I was gonna go forward, become who I wanted to become, take with me the good parts I learned along the way.
It wasn't easy. I was living with my dad and his girlfriend, I had been renting a room from them, and even being on Social Security I would give them a portion of my check. I looked at my whole life and said, "This is not how I'm gonna live." I got a job, started out in a company as what people would call a gofer, and within about two years ended up leading my own group, because I was so determined. I took that focus I had before on my illness and just turned it around and said, "If I could be so passionate about falling apart, why can't I be so passionate about coming back together?" Within about six months of surviving my suicide attempt, I moved out of my dad's house, got my own apartment and moved on from there. That was 16 years ago. Today, I'm happy. I'm married. I have two children. And I think I've overcoming enough that I'm OK to start talking about it and giving back. I've done my healing.
I read the first few chapters online at Amazon and looked through your blog and didn't realize you have a wife and kids.
At the end of the book, in the author's note, I put in that I was married and had two kids. The book is written about everything that happened before I was 20 years old, and I didn't know my wife then. It's told from a past tense perspective. But in terms of the present tense, my website and blog postings, I wanted to leave some of my family out of it. It's a lot to come forward and say, "I attempted suicide, and this is why." When I fill in the "This is why" part, it's like a scratch in the record and a silence in the room. But I didn't hold back anything. I thought it was important to be honest. So when people read it, they can see things similar to where they're coming from. But I didn't want to bring my wife and kids into it.
Do they know?
My wife, yeah. I have a 3-year-old and a five-month-old, so they won't know for a while. But my wife, right from the first night we met. It must have been a hell of a conversation when we met. I knew she was the one. I just told her everything, my whole story in about two hours: "This is who I am, where I've been, where I am now, what I want to do with life. What do you think?"
What did she say?
She said, "Let's meet again and get married." So we got married. We've been together eight years, almost. And she's 100 percent supportive of me. But I think it's important to me at this stage of the story, this stage of my writing, that I stay focused on the earlier parts of my life. My first book was about my past, all the darkness that went with it. It wouldn't be appropriate to include them in that yet. As I move forward with other books about how I got from there to here, it's more appropriate to have them in the story. But it was very important up front to talk just about me. This is how it feels. It was really about me, and I had to put myself out there.
You also put your parents out there. How do they feel? Do they know?
My father, he called me up after he read it. Let me start by saying there's a lot of stuff in the book even they didn't know. They divorced when I was 2. So my mother didn't know what life was like with my father, whom I didn't see often. And my father didn't know what life was like when I lived with my mother and stepfather. Neither one of them knew I was molested, either, or how bad school was for me. Kids at school knew I was molested, and that's why I was bullied and picked on. But no one who should have known knew. I put out the book in July. My father read it, and he called and said, "Promise me one thing." I said, "Yeah." He said, "Never stop writing." It meant a lot to me. He then took a breath and said, "I'm sorry." My mother moved away to Florida about 10 years ago. I haven't really spoken with her since. I did send her an email about the book. I know she read it. I don't know what her response is. I didn't ask. I just left it as it was.
Molestation, and kids at school knew? What are you comfortable saying about that?
There was this guy in the neighborhood who was mentally disabled. He was a lot older. I was about 6, and he was somewhere in his 20s. He started molesting me probably when I was 6 years old. It mostly happened beneath the crawl space under my mother's house. He always tried it with other kids in the neighborhood; they were just stronger people than I was. I didn't have the strength mentally or physically to fight it, I guess. So other kids knew. They didn't actually see anything happen, but at that age, I don't think you need to see anything for rumors to fly. I was really bullied pretty bad at times. But it just never got out. None of the teachers knew, my parents didn't know, my brothers didn't know. It was really weird.
You couldn't tell anybody?
I could've. My mother was a very angry person, and I had a really bad relationship with my stepfather. I didn't like him, and he didn't like me. There was no trust. In a way, I blamed myself for everything that was happening, too. I was also afraid of what my mother would do. I was afraid of how my brothers would look at me. I was afraid of telling my father, another big angry guy. In a sense, I really felt bad for the guy who was doing it to me. He was mentally challenged and had the personality and the brain capacity of a 9-year-old kid. I just kept thinking, "It's not his fault, not his fault." There was another neighbor, an older guy, probably in his 60s, and I think he was molesting the guy who was doing it to me. So I think the same thing was happening to him, and he was just doing it to me. I just never felt strong enough or big enough to tell anybody. I felt such compassion for him. Believe it or not, I didn't want anything bad to happen to him. I thought he just didn't know what he was doing. There's so much when I look back on that experience, everything I went through. In my teenage years, when I looked at it and hated him, I was very angry with all of it. For me though, it boils down to an incredible lesson in compassion.
You have two young kids. What happens when they grow up and can read this?
Hopefully they'll be proud. I hope when they turn and become teenagers and think Dad doesn't know what he's talking about, I hope they'll read this and see he does. I hope they'll be proud of what I overcame. The book was written to help people, to help see life in a different way and the struggles we go through. And to help people who've never been there to understand what it's like to be there, to attempt suicide. I wanted it to serve two purposes. The people who feel like there's no hope, I hope they read it and say, "This guy has lived similar things, or at least he knows what it feels like on this level, this is how he overcame it." I hope they are left with the same hope that got me through it. I think the book so far is accomplishing that. And then for the people who don't understand what it's like to suffer like that. … I had a high school teacher, and I was in a homeroom class before school started. He was really upset, withdrawn. The class dismissed. He said, "Miller, hang on." He came over to me. He was a big guy. He was actually a football coach there. His eyes started filling up, and he said, "I heard on the radio this morning that some teenage kid committed suicide, and I thought it was you." He started crying. He looked at me and shook his head and said, "I don't understand, I don't understand it at all." I remember the sincerity in his eyes. In my mind, while writing the book, I knew I had to write to people who want to understand but don't. People who have a loved one who has attempted suicide and don't get what it's like. So it was important to me to write with those people in mind too. The title was intended for that. But it's also a very positive book. I aimed at keeping the book hopeful, while staying truthful and honest about how bad life really is sometimes.
What kind of responses have you had?
When I first finished it, I sent it to a book doctor, someone who looks at a book and says, "Yeah, it will work" or "No, it's junk." The guy wrote me back a four-page letter about why he couldn't make it better. He said, "Don't let this go, don't stuff this under your bed. Try to find an agent and you will get published. Don't give up. Keep going and do not doubt yourself. You have a great book here." So I did what he told me not to do. I put the book under my bed and I said, "You know what, he was just feeling sorry for me. The book's not that good." A few months later I went to another editor, who was more money than I could afford, and there was like a nine-month waiting period. What she wrote back to me I completely disagreed with. She was basically like, "Everything you did here is wrong, and you need to change it all." I said, "I know I'm not that wrong! I'm just gonna do it, put it out there." I pretty much dismissed everything she said, and I sent out about two dozen queries to literary agents. Which, looking back, I probably didn't write the query too well. I presented the book as a memoir about a suicide attempt rather than a story meant to help, you know. I think it scared off a lot of people. I got a few encouraging letters back, but mostly generic, "thanks but no thanks." Then I had a conversation with another writer, and he told me, "Stop looking for agents. The whole publishing world is changing. Self-publish. Do it your way. The only thing that matters is the readers." I had everything ready so I said, "You know what, I'm just gonna do it." I self-published, did a Facebook post to about 100 people and let it go.
The feedback was absolutely overwhelming, way more than I expected. It started going word of mouth. It's been out for about five months. And I haven't done any advertising. I put stuff up on The Experience Project, a website, that's all. I got an e-mail from a woman a while back who wrote she believes the book saved a teenage girl's life, which was overwhelming to me. And another one I saw on a newspaper's website. A friend forwarded a link to an article about suicide, and people were writing about my book in the comments section. And someone wrote they were researching books about suicide, found mine, gave it to their grandson, who was suicidal, and he came to his grandmother, crying and said he wanted to live and needed help. She wrote, "This book saved my grandson's life." That's when it really kicked in, "OK, I have a responsibility now. If it is helping people, I'd better be doing this the right way." I know with suicide prevention, there's what's called safe messaging. You have to be really careful. I didn't have any of that in mind when I wrote the book. I wrote it as pure and clean as I could write it. When I started getting feedback that it's changing lives, I said, "God, I hope I've done this right." So I've asked for help from the suicide coalition to review it, let me know if anything sways from the guidelines of safe messaging. So far, no one's thrown up any red flags. I keep going back to what that person said, "Pay attention to the readers." I've gotten dozens of e-mails from people whom I've never met from different states, so heartfelt and sincere, so overwhelming to read. Strangers telling me that the book helped them, it's changed their outlook on life, and that I need to keep writing. I can't describe what that feels like.
The book isn't out for free online, but can you buy and read it online?
On Amazon's website, prime members can read it for free until the end of January. You can also buy a printed book from Amazon or download the Kindle version. It's not in bookstores yet. I didn't print 2,000 of them that are sitting in a warehouse somewhere. But I think if it were on a shelf, people would pick it up. I'm still working with the coalition. Once I get a thumbs up, I'm going to move forward with getting into stores.
If they said, "You need to be less explicit, you need to tone it down," would you?
I keep referring back to the person who said, "Pay attention to the readers." So far, I've gotten zero negative feedback. I would have to really weigh it. I've gone through pretty much everything I've written, poems, songs, even my photography. If you look at it from the perspective of being suicidal _ and I know what it feels like _ almost anything can be interpreted as too much. It really has to be very carefully crafted in order to not be taken the wrong way. I back that up 100 percent, but what I think is equally as important is honestly. If I were to speak to a group where members are struggling, I think it's just as important for them to know I've been there. And yes, those thoughts of suicide are very, very real. In a sense, you have very little control over them. I think it's important to acknowledge the darkness that goes with the light. You can't just jump in and say, "There's hope, let's move forward." For me, you have to identify with the darkness before you can truly see the light. I have a friend I wrote about in the book. And he's a big character in it. And we were talking about whether I should talk about certain things when speaking to groups, and he said to me, "If we were 16 again, what would we want to hear to get better? If you were talking to yourself at 16, what do you think it would take for you to really listen?"
I think how I need to do it is to discuss my story in its raw truth, be myself and let people see the whole picture. It's not just a suicide attempt that I survived, it's life that I survived. I think that's how I need to do it. I think there's more credibility in that. It's important to acknowledge the dark. If people reviewing the book see potential triggers, I hope they realize why they are there. The book shows the darkness, but it brings the light back into it, and ties it all together. You need both sides. I hope I get the chance to do that in speaking engagements as well.
Are you speaking?
I've been asked to. January will be my first one. It's at a book store. There's a school that is considering using the book in study. They like the book not just for its message but mostly for its literary value. I may have an opportunity to meet with students for an author Q & A afterward too. It would be irresponsible of me to speak with a younger audience about the book's subject matter, though. I need to learn more about safe messaging, what to say, what not to say, then make it my own and move forward.
I prepared a few questions, but I'm going to ask them in pretty random order here. When I was looking at your work online, I also came across a post on another blog in July by a Craig Miller who wrote about the five best ways to die. Was that you?
Wow. It was not me. When I first put the book on Amazon, there's a section on the book's page that shows "people who viewed this book also viewed this," and there was a book like, "How to kill yourself." It kind of pissed me off. You're at the mercy of Amazon algorithms. That's why I put the middle initial in my name, Craig A. Miller. No, I didn't write that.
Is there a sense of pride in the experience somehow?
Attempting suicide?
When I look at it, what I did, that I was fortunate enough to survive, I don't feel any pride that I attempted suicide. I feel sad that it took me getting to that point to really turn around. I spent a lot of years talking myself out of it, trying to keep hope. I was always on that edge of, "Either my life is going to turn out really good or really bad." It makes me sad for myself and for my family that attempting suicide was sort of what it took for me to step off that line. There's no pride in the fact that I attempted suicide. But I do feel pride in the fact that I was able to move on and be able to learn from everything in my life, not just the suicide attempt, and be able to do something about it. I think the pride comes along the way in the healing process, of looking at everything, knowing that I survived the upbringing, the mental illness, sadness and hopelessness. I'm not necessarily surviving the suicide attempt but surviving all the things in my life. The healing process became the pride. Don't get me wrong. I still wrestle with self-doubt quite often, but …
Not to that extent?
Not to that extent. In a healthy way. The self-doubt I have is almost like a tool. I don't go into anything thinking I have it covered. The doubt makes me stay on my toes. In a way, I never let my guard down. I say I can do this, but it's a healthy balance of pride and doubt. I don't think it stops me from doing anything. It makes me do the things I do better.
Is there any way for people to avoid getting to that point in their life, a suicide attempt, to make changes?
Everyone has a different breaking point, a different bottom. I would hope that the message in the book and the work that people like me and you are doing to try and raise awareness, I would hope that our message could be received further upstream, people could start seeing things in a new way before things get so bad that they can't see at all. That's my intent. What I hope to do. Give that hope before it gets too bad for them. I think that's what all of us as attempt survivors can bring. We've been there, gotten through it, especially attempt survivors who've done their healing. I think it's our responsibility, in a sense, to give back.
Does society make that easy, talking openly about suicide?
I think at this point, it's not very easy. It's becoming more and more known. And "popular," I guess, is a bad word, but the awareness of suicide is being presented by a lot more groups than in the past, especially since I was in high school. It's primarily driven from the survivors' standpoint, those left behind. I think it could use more attempt survivors. But there's that side, where there's a lot of fear that an attempt survivor could be seen as glamorizing the process. I can understand that. I think it needs to be done the right way. But a very, very strong message can be created by suicide attempt survivors. As equally as a survivor who has been left behind.
Has anyone said you're glamorizing suicide?
No, knock on wood, no. But you can go into almost anything with that state of mind. You can look at artists, song lyrics, books and look at it in that sense if you wanted to. I was definitely nervous about that. I have this belief that helped me all along the way, getting it out of me. I had to get that negative stuff out of me. A lot of stuff was negative. Not in a driving way as in, "Go do this," but a lot of dark emotions I expressed. I try to do the same with my photography. If I'm feeling blissful, I take photos of the sun and flowers. If I'm feeling depressed and it's a gray day, raining for a week, I go take black-and-white's of the fog. Some say it's too sad and encourages depression, some say it's beautiful. I think expressing oneself is extremely important in balancing emotions. Expressing appropriately
What would be inappropriate?
Well, some stuff out there is unreal. You look at some of the death metal bands and gore websites, all blood and guts, there are some pretty dark things on the internet. I don't think people need to go that far. I think there is a lot of art that's aimed at getting a reaction rather than trying to purge and express. There is a line where it sort of loses taste.
Did you use to like them?
Ideally, is there some way suicide should be discussed?
I don't know, I think it's just bringing it more mainstream. I would assume. It's almost like a lot of things that were taboo years ago. I may be speaking out of line, but I would say gay and lesbian issues years ago were sort of buried and not talked about. Then you have the media and social media and channels like MTV that helped make it more acceptable. It's gotten to a point where tolerance has gone way up. It can be openly discussed where years ago it couldn't. You see people talking more openly. I think it's gotten a lot more to the point where it may be more acceptable, which I applaud. But I would think that in the same respect something like suicide _ being one of those room-silencing words that make people just clam up and not know what to say _ I think if more awareness is brought to it, more understanding, people would get better about talking about it. Just like it was and is being done with gay and lesbian issues. It's no longer this taboo thing. At least not everywhere.
But with homosexuality, they can say there's a lot that's good in it to be proud of. With suicide, there's not a lot of great stuff around it. Or am I wrong?
Right, how do you find the good side of it? I think we need more awareness around it. People need to meet further upstream and get involved before it happens. But also I think it's important, and I'm not sure if this gets me into trouble, but it's important that we acknowledge that thinking about suicide, while it's not OK, quote unquote, it's part of who we are and it's how dark it gets sometimes. If a person has stood on the edge of suicide, they're not a bad person for thinking that way. They're very hurt and very sick. And things can be done to help them. They shouldn't be ashamed they thought of it, or cried themselves to sleep because they didn't want to wake up the next morning. But it's entered a lot of people's minds, and there's help for it. I think that's where a lot of the room silence comes from, a stigma, a horrible thing, "You should be ashamed for even thinking about it." A lot of people who've never really been there don't understand.
What are you going to do next?
I'm going to try to speak. The response I've gotten from this book is overwhelming. I feel a responsibility to keep pushing it. I want to make sure I do it in the right way. Then I want to write more books. "This is How it Feels" speaks more about how I got through my struggles and how I see life moving forward. The biggest question I get from readers is, "How did you do it? How did you get to the person you are now?" A lot people that know me now had no idea I had this kind of history. And that, I think, is what my next book should be about. How did I heal? What did I do? I think I owe the readers that book.
Who else are you?
Well, I'm the typical answer. A dad, a husband, a coworker. I'm just a regular guy. But I have a passion for things. Whatever it is I'm doing, I have to give 100 percent. That comes from my past. I have to make this life worth it. I have to find what success means to me. I don't let up on that. That's an every day, every night thing for me. I'm constantly thinking of what I can do to better myself, to find what success means to me. To move to that next level. I don't stop thinking about stuff like that. And that sort of bleeds into everything, whether it be photography, poetry, writing, I give 100 percent of myself. I have to. It's like I have to make everything worth it. To me. Not to everyone else, just to me.
©2011-2020 C.A. & Live Through This Productions, LLC


Perched on a hill with beautiful views, this mid-century home is located one block west of campus on 2.5 acres. Recently renovated with eco-conscious materials, this open floor plan home is perfect for the nature lover and the entertainer. The bright and spacious main floor features beautiful hardwood floors, natural cherry wood trim and a cozy brick fireplace. Feel like a gourmet chef in the well appointed kitchen with two sinks and butcher block prep stations, high end stainless steel appliances, artisan inspired countertops, and hand crafted cabinets sourced from local hardwood. Take some time to read the paper in the 4-season room while enjoying the neighborhood birds and squirrels. Even your guests will feel right at home with their private retreat in the walkout lower level.


text:
Q: $S/I$ is a direct sum of cyclic $\mathbb{K}[Z]$-modules.
Let $S=\mathbb{K}[X,Y,Z]$ and $I=(X^2+Y^2-Y, XY-1)$. I have to show that $S/I$ is a direct sum of cyclic $\mathbb{K}[Z]$-modules.

I denote $R:=\mathbb{K}[Z]$.
Then $S/I=R[x,y]$ where $x$ is the class of $X$ mod $I$ and $y$ is the class of $Y$ mod $I$.
I know that $x^2+y^2-y=0$ and $xy=1$. From these relations I have that $R[x,y]=R+Rx+Ry+Ry^2$.
I don't know how to continue.

redpajama_set_name: RedPajamaStackExchange


text:
Q: No mapping found for HTTP request with URI while redirect I have registered following viewResolvewer:
     <bean
        class="org.springframework.web.servlet.view.InternalResourceViewResolver">
        <property name="prefix">
            <value>/WEB-INF/pages/</value>
        </property>
        <property name="suffix">
            <value>.jsp</value>
        </property>
    </bean>

and wrote following controller method:
    @ExceptionHandler(value = Exception.class)
    public String redirectToErrorPage(){
        return "redirect:/errorPage";
    }

When following method executes I see following log:
WARN : org.springframework.web.servlet.PageNotFound - No mapping found for HTTP request with URI [/errorPage] in DispatcherServlet with name 'appServlet'

page with name errorPage.jsp locates under the page folder:

Please explain what do I wrong?

A: You are redirecting to the the URL "/errorPage", but there is no request mapping for /errorPage. You can add a controller with that request mapping e.g.:
@Controller
public class ErrorPageController {

    @RequestMapping("/errorPage")
    @ResponseStatus(value=HttpStatus.INTERNAL_SERVER_ERROR)
    public String showErrorPage(){
        return "errorPage";
    }
}

Or instead of redirecting, you can just show the error page from your exception handler.
@ExceptionHandler(value = Exception.class)
@ResponseStatus(value=HttpStatus.INTERNAL_SERVER_ERROR)
public String handleException(Exception e){
    return "errorPage";
}


text:
Bart vs Space Mutants
Bart vs. The Space Mutants is a platform game where the player goes into the role of Bart Simpson (from the TV show The Simpsons) and must stop the Space Mutants from invading Springfield. On each of the five levels, Bart must collect (or get rid of) the ingredients that the Space Mutants are planning to use to build their machine, such as purple objects or balloons. He also has to collect enough "proof" of the aliens existence (brown coins left behind when they are jumped on), so his family members will help him when he meets a boss (characters such as Nelson and Sideshow Bob). This won't be easy since the Space Mutants are "using" human bodies as disguise. In order to discover who are the real Space Mutants, Bart must use his X-ray Specs.
Duke Nukem 3D Big Box
Aliens have landed in futuristic Los Angeles and it's up to the Duke to bring the pain and show them the door. After the initial entries of side-scrolling platform games, Duke Nukem 3D introduces a first-person perspective to the series and turns the game into a full-fledged shooter with 2.5D graphics.
Duke's arsenal includes pistols, pipe bombs, laser trip mines, Nordenfelt guns, a chain gun and various rocket launchers, but also his mighty foot to kick enemies. The game sports a high level of interactivity. Many objects in the environment can be broken or interacted with, such as pool tables, arcade machines, glass, light switches and security cameras. The protagonist is also able to hand strippers a dollars to have them remove their top.
€149,00 Inc. VAT
Grand Theft Auto San Anorras
Returning after his mother's murder to the semi-fictional city of Los Santos (based on Los Angeles), Carl Johnson, a former gang banger, must take back the streets for his family and friends by gaining respect and once again gaining control over the streets. However, a story filled with crime, lies and corruption will lead him to trudge the entire state of San Andreas (based on California and Nevada) to rebuild his life.
Leisure Suit Larry 6: Shape Up or Slip Out! Big Box
Shape Up or Slip Out! is the fifth game in Al Lowe's Leisure Suit Larry series. All the events from the previous games are forgotten. Larry is once again single, and again his goal is to capture the interest of various ladies. By sheer coincidence, Larry finds himself on a TV Game Show called "Stallions". He wins a weekend at the Spa Resort, La Costa Lotta. Naturally, there are some beautiful women in the spa who are just dreaming about such a wonderful, handsome man as Larry! Uh… or is it really so? It is the player's goal to find out!
This instalment focuses more on conversations with women and puzzles than on the storyline. The entire game is spent at La Costa Lotta. There are plenty of traditional inventory-based puzzles to solve in the game. Larry can die, but the player is allowed to try again every time that happens, without the need to restore a saved game. This is also the first Larry game with SVGA graphics, and voice-overs in the CD version.
Leisure Suit Larry 6: Shape Up or Slip Out! Sierra Originals Big Box
Leisure Suit Larry: Magna Cum Laude – Uncut
Leisure Suit Larry: Magna Cum Laude is a 2004 video game, part of the Leisure Suit Larry series. The game introduces a new main character, 'Larry Lovage', as Larry Laffer's nephew. This is the 7th game in the series.
Simpsons Bart vs the World
Soldier of Fortune Double Helix PC CD-Rom
John Mullins, working for a U.S.-based mercenary ("soldier of fortune") organization known only as "The Shop", and his partner, Aaron "Hawk" Parsons, are assigned to prevent the nukes from falling into the wrong hands, and stop the terrorists in their plans.
€2,50€5,00 Inc. VAT
Tomb Raider – Lara Croft 1
Tomb Raider explores the intense and gritty origin story of Lara Croft and her ascent from a young woman to a hardened survivor. Armed only with raw instincts and the ability to push beyond the limits of human endurance, Lara must fight to unravel the dark history of a forgotten island to escape its relentless hold.
€10,00€15,00 Inc. VAT
Microsoft Dos (1)