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The association of ADHD symptoms to self-harm behaviours: a systematic PRISMA review
Clare S Allely1
Self-harm is a major public health issue in young people worldwide and there are many challenges to its management and prevention. Numerous studies have indicated that ADHD is associated with completed suicides and other suicidal behaviours (i.e., suicidal attempt and ideation). However, significantly less is known about the association between ADHD and self-harm.
This is the first review of the association between ADHD and self-harm. A systematic PRISMA review was conducted. Two internet-based bibliographic databases (Medline and CINAHL) were searched to access studies which examined to any degree the association between, specifically, ADHD and self-harm.
Only 15 studies were identified which investigated the association between ADHD and self-harm and found evidence to support that ADHD is a potential risk factor for self-harm.
This association raises the need for more awareness of self-harm in individuals with symptoms of ADHD.
ADHD and self-harm
Attention-deficit/hyperactivity disorder (ADHD), as defined by DSM-IV [1], is a syndrome that is first manifested in childhood by variable combinations of inattention, hyperactivity and impulsivity. The prevalence of ADHD in childhood is estimated to be approximately 5-7% [2] and ADHD symptoms tend to persist into adulthood [3, 4]. ADHD is a mediator of poor outcome such as low self-esteem and poor academic and vocation outcomes [5, 6] and one of the major public health problems in modern societies [7].
Nomenclature used to describe acts of self-harm without fatal consequences varies considerably. For this review the terms deliberate self-harm (DSH), self-harm, self-mutilation, self-injury and self-injurious behaviour (SIB) are used interchangeably depending on the use applied in the paper discussed. DSH and SIB represent a significant health problem in the UK and are amongst the most common reasons for emergency hospital admission. Although international variation exists, findings from numerous community-based studies indicate that approximately 10% of adolescents report having self-harmed [8–12]. Self-harm refers to intentional self-poisoning or self- injury, irrespective of type of motive or the extent of suicidal intent [13, 14].
Association between ADHD and suicide
Previous studies have shown a connection between ADHD and attempted and completed suicide in male adolescents and young adults [15–21], suicidal behaviour [22] and suicide ideation in female adolescents [23]. A longitudinal study found that early childhood ADHD is a risk factor for suicidal behaviour between the ages of 9 and 18 [24]. In a clinic- referred sample of female adolescents, Biederman and colleagues found that girls with comorbid ADHD and major depression had more suicidal ideation compared with those with only major depression [25]. Among delinquent juvenile offenders, suicidality relating to depression, ADHD and social phobia were only found among males [26].
A previous systematic review [27] showed an association between ADHD and suicide. Impey [21] conducted a review of the relationship between ADHD and suicidality and found that ADHD symptoms occur more frequently in suicidal populations and may be a reason for completed suicide. In sum, these reviews of the literature showed that there is a positive relationship between ADHD and risk to self.
Self-harm predicts suicide
Further research is necessary to develop a mean of preventing adolescents from repeating self-harm, since several studies have shown that around 10–15% of children who self-harm are likely to repeat such episodes within a year [28, 29], sometimes also proceeding to suicide. Indeed, numerous studies have indicated that self-harm predicts suicide (i.e., [30]) Suicide risk among self-harm patients is hundreds of times higher than in the general population [27].
Associations of suicide related events and ADHD medications
Although the focus of this systematic review is on ADHD and the outcomes, it is important to include a brief discussion of the crossover with medication and what is currently known. With the treatment of ADHD it is thus important to establish any associations between pharmacological treatments (such as atomoxetine and methylphenidate) and suicide-related events. Atomoxetine (Strattera®) is a selective norepinephrine (noradrenaline) reuptake inhibitor. It is not a stimulant, and is indicated for use in patients with ADHD [31]. Methylphenidate is a central nervous system (CNS) stimulant used to treat ADHD. From the European Union (EU) Supplementary protection certificates (SPCs) for methylphenidate, it is important to highlight that suicidal tendencies have been found to be a contraindication for this medication [32, 33]. The US Food and Drug Administration and Health Canada also warned of increased rates of suicidal ideation among children taking atomoxetine in placebo-controlled trials [34]. Based on fourteen identified trials in paediatric patients, Bangs and colleagues (2008) [35] found that, despite being uncommon, suicidal ideation was significantly more frequent in paediatric ADHD patients treated with atomoxetine compared to those treated with placebo [35]. One study found no evidence which suggested an increase in the risk of sudden death associated with stimulants or atomoxetine. However, there was an increased risk of suicide with the treatment [36].
However, a recent meta-analysis, the first focusing on five studies comparing suicide-related events in comparative randomised double-blind atomoxetine and methylphenidate clinical trials, found no significant evidence of a difference in risk between the two treatments [37]. Given the limitations of meta-analyses, acknowledged by the authors [37], further research is required to establish whether there are associations between suicide-related behaviours and specific ADHD treatment medications.
Present review
There is a need for greater understanding of the factors which contribute to self-harm. Identification of effective prevention initiatives and subsequent treatment strategies aimed at young people and those at particular high risk is clinically imperative. There is an urgent need to identify those populations at risk and to intervene proactively [38]. The purpose of this systematic PRISMA review is to investigate the relationship between ADHD and self-harm, in order to see if self-harm can be considered to be a risk factor. As discussed above this is particularly important given the increased rates of self-harm and the greater risk of these individuals to go on to attempt and/or complete suicide. This is the first review to explore the peer-reviewed literature which has investigated this relationship.
Internet-based bibliographic databases (Medline and CINAHL) were searched to access studies which examined to any degree the association between, specifically, ADHD and self-harm rather than the association between ADHD and completed suicide, suicide attempts and suicide ideation. The search criteria identified below were entered in a number of other databases including PsycINFO. However, the Medline was chosen as the primary database because it returned more relevant articles. CINAHL was also used because it is the definitive research tool for nursing and allied health professionals. The process of eliminating non-relevant papers can be seen in the flowchart (following PRISMA guidelines [39], see Figure 1) below. Duplicates were excluded prior to the retrieval of references. Searches on the two databases were originally conducted on 9th May 2013. The following search criteria were entered into the two databases: [self-harm OR "self harm" OR self-injury OR "self injury" OR self-poisoning OR "self poisoning" OR self-injurious OR "self injurious" OR self-mutilation OR "self mutilation"] AND [ADHD or "Attention-deficit/hyperactivity disorder" or "attention-deficit hyperactivity disorder"]. Medline returned a total of 59 abstracts and CINAHL returned a total of 27. Combining the two search findings (total 86), nine were removed because they were duplicates. In addition to these database searches, numerous permutations of ADHD and self-harm were entered into Google Scholar and thoroughly searched for any additional articles not found in the database searches, for instance, [ADHD AND self harm]; [attention-deficit/hyperactivity disorder]; [ADHD AND self injury]. These searches only returned four additional relevant articles. Numerous references contained in the papers found to be relevant from the database searches were also explored for inclusion in this review.
Flow of information through systematic review.
Abstracts for each reference were obtained and screened using the following criteria:
Human study population
Investigated the association between ADHD and self-harm.
Paper not published in English
Studies which investigated a sample that comprised of individuals with a disorder other than ADHD (for instance, individuals with: Autistic Spectrum Disorders; Tourette's Syndrome; cerebral malaria; developmental disabilities; epilepsy; mental retardation; Smith-Lemli-Opitz syndrome; Myotonic Dystrophy; Down Syndrome; bulimia nervosa; intellectual disabilities; post-traumatic stress disorder and Smith-Magenis Syndrome).
Screening:
In the first stage, papers were rejected which:
investigated completed suicide, suicide attempts or suicide ideation as this review is specifically interested in the association between ADHD and self-harm as even less is known about this association
were not published in the English language
For the next stage papers were rejected which:
were not studies that involved a sample of individuals with ADHD (for instance, numerous studies involved samples of individuals with Tourette's syndrome).
In addition, review papers and book chapters which were clearly reviews were excluded and if relevant are referred to in the introduction. Full documents were obtained for the remaining records.
Fifteen studies were found that explored or included an exploration of the association between ADHD and self-harm (one of which was a case study). Table 1 lists the studies that were found to be relevant and details some of the main points for each. In this section, the fifteen studies are split into two sections. The first section includes studies where the sample involved a study population with ADHD and measures of self-harm behaviour were then conducted. The second section includes the studies which examined a population who were hospitalised due to injury and measures of ADHD were then conducted. This was done given the possibility that different results may be obtained depending on this. Under each of these headings, studies are divided depending on whether the samples involved children and/or adolescents under the age of 18 years and adults (those above 18 years of age).
Table 1 Lists the studies that were found which explored to any degree the association between ADHD and self-harm and details some of the main points from each (nature of sample; the aim of the study and the main findings)
Studies with a population with ADHD and measures of self-harm behaviour were then conducted
Children and adolescent samples
Deane and Young [41] investigated, using Interpretative Phenomenological Analysis of interviews, the experience of eight adolescent girls. Four of whom had a history of ADHD symptoms and conduct disorder problems (ADHD/CP), four did not. However, they report two cases where there was a presentation of both ADHD and self-harm or attempted suicide.
Hinshaw et al. [47] conducted a 10-year prospective follow-up of a female childhood-ascertained (6–12 years) ADHD (n = 140) plus a matched comparison group (n = 88). Ten-year outcomes (age range 17–24 years). Hinshaw et al. [47] assessed variety and frequency of nonsuicidal self-injury (NSSI) using a modification of Claes, Vandereycken, and Vertommen's [54] Self-Injury Questionnaire (SIQ). Suicide behaviours were investigated using the Barkley Suicide Questionnaire [55]. The family-completed Family Information Profile (FIP) enquired about suicide attempts. For suicide attempts, individuals with ADHD-combined had a higher rate (22%) compared to individuals with ADHD-inattentive (8%) or the comparisons (6%), who did not differ significantly. Interestingly, self-injury was significantly more likely (OR = 4.4) in the ADHD-combined group (51%) compared to the comparison group (19%). Self-harm was also more likely in the ADHD-combined group compared to the ADHD-inattentive group (29%; OR = 2.5).
The idea that ADHD may act as a risk factor for suicidal ideation and DSH was also investigated in a study based on adolescents from a general population sample [48] derived from a population-based Northern Finland Birth Cohort 1986 (n = 9432). Based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version (Kiddie-SADS-PL, [56]) interview performed in a subpopulation (n = 457), associations between suicidal behaviour and DSH and the diagnosis of ADHD were studied. Information was also obtained from national registers about deaths related to suicide. Compared with adolescents without ADHD (n = 169), those with ADHD (n = 104) had more suicidal ideation (57% versus 28%, p < 0.001) and DSH (69% versus 32%, p < 0.001). The effect of ADHD on suicidal ideation remained strong (OR = 6.1) after controlling for several other predictors.
The effect of ADHD on substance-use disorder (SUD) as well as other behaviours such as SIB, suicide attempts and criminality is unclear which prompted the next study by Semiz, Basoglu, Oner et al. [52]. A total of 105 adult male offenders with Structured Clinical Interview for Axis II Disorders (SCID-II)-based DSM-III-R antisocial personality disorder (APD) were studied in terms of: (i) psychopathy scores on the Hare Psychopathy Checklist-Revised (PCL-R) [57]; (ii) ADHD(c) diagnostic comorbidity on clinically administered DSM-IV questionnaire; and (iii) ADHD(d) dimensional symptoms by means of Wender Utah Rating Scale (WURS) [58] and Conners Adult ADHD Rating Scale (CAARS [59]), during a 12 month study period (May 2005-May 2006). Most importantly, for the focus of this review, was the finding that the number of ADHD(d) symptom criteria endorsed correlated significantly with frequency of SIB (r = 0.32, p = 0.002). WURS total score was significantly correlated with frequency of SIB (r = 0.38, p < 0.001), number of suicide attempts (r = 0.28, p = 0.011) and negatively correlated with age at onset of SIB (r = − 0.23, p = 0.023). CAARS total score was significantly correlated with frequency of SIB (r = 0.34, p < 0.001) and number of suicide attempts (r = 0.32, p = 0.007).
Wehmeier, Schacht, Lehmann, Dittmann, Silva and March [53] were interested in measuring changes in items on the Pediatric Adverse Event Rating Scale (PAERS) that relate to emotional well-being of children and adolescents with ADHD during treatment with atomoxetine. Patients aged 6–17 years with ADHD were treated with atomoxetine (target dose 1.2 mg/kg/day). The PAERS was used to assess the tolerability of atomoxetine in children and adolescents (n = 421). The ten items that reflect emotional well-being were grouped in five dimensions: depressed mood, self-harm, irritability/agitation, drowsiness, and euphoria. The scores of these dimensions decreased over time. Only the dimension of self-harm was extremely low at baseline and stayed low over time.
Adult samples
Dowson, Blackwell, Turner, Harvey, Malhotra, Robbins and Sahakian [43] examined the associations between questionnaire ratings and performance on a computer-administered task of spatial working memory (SWM). Fifty-nine adult patients (mean age: 30.6 years) with a DSM-IV diagnosis of ADHD, and their informants, were asked to complete questionnaires relating to aspects of severity of ADHD. The findings of interest to this particular review were that patients who reported a past history of 'self-harm' (n = 33) had a significantly worse mean performance on both measures of SWM (p = 0.004, 0.003).
In a more recent study by the same research group, Dowson and Blackwell [44] investigated impulsive aggression in 73 adults with DSM-IV ADHD adults (mean age of 29). Using questionnaires, they looked at both externally directed aggression and autoaggression. Impulsive autoaggression was identified if one or both of the following Structured Clinical Interview for DSM-IV Personality Disorder (SCID II) questions for BPD criterion 5 were endorsed: "Have you tried to hurt or kill yourself or threatened to do so?", "Have you ever cut, burned, or scratched yourself on purpose" [60, 61]. Impulsive aggression was assessed by ratings of two criteria for borderline personality disorder (BPD), involving hot temper and/or self-harm. Adult ADHD-related impulsivity and hyperactivity was found to predict temper outbursts/hitting people ⁄throwing, while self-reported adult ADHD-related inattention predicted threats/actual self-harm.
Studies which examined a population who were hospitalised due to injury (or identified by records/self-assessment) and measures of adhd were then conducted
Children and adolescents samples
Ben-Yehuda, Aviram, Govezensky, Nitzan, Levkovitz and Bloch [40] found an act of DSH or ideation was the presenting symptom of 232 emergency department referrals out of 905: comprising of 37 (15.9%) children (under 12 years) and 195 (84.1%) adolescents (12–18 years).
DiScala et al. [42] investigated the differences between hospital admitted injuries to children (5–14 years) with preinjury ADHD (n = 240) and injuries to those with no preinjury conditions (NO) (n = 21,902). Findings showed that, compared with the NO children, the children with ADHD were more likely to inflict injury to themselves (1.3% versus 0.1%).
Goodman, Gerstadt, Pfeffer, Stroh and Valdez [46] examined forty-three psychiatrically hospitalised prepubertal children regarding their assaultive and suicidal behaviours and they were subsequently classified into two groups, assaultive/suicidal (AS) and assaultive-only (AO). Mother and child aggression and child correlates of suicidal behaviour in the two groups was investigated. ADHD, child's aggression, and maternal depression and state anger accounted for 33% of the variance in suicidal-scale scores. Aggression mediated the relation between ADHD and suicidal behaviour. AS children were significantly more aggressive and suicidal, five times more likely to engage in serious assaultive behaviour, and almost six times more likely to be diagnosed with ADHD than their AO counterparts.
Izutsu, Shimotsu, Matsumoto, Okada, Kikuchi, Kojimoto et al. [49] explored the status of DSH among 239 junior high-school boys (mean age = 14.16 years, SD = 0.67) and 238 girls (14.22, 0.68) and investigated the relationship between DSH and substance use and childhood hyperactivity. A self-reporting questionnaire consisting of original questions on self-cutting, self-hitting, and tobacco and alcohol were used in addition to the Wender Utah Rating Scale (WURS) for assessing childhood hyperactivity. With respect to the association between DSH and childhood hyperactivity, comparisons of WURS scores between those with and without experience of problematic behaviours revealed that with all problematic behaviours in both genders, scores of those with experience were significantly higher than those without (p < 0.01 except for self-cutting in females, p < 0.05).
Lam [17] found a four-fold higher likelihood of having a diagnosis of ADD for children and adolescents hospitalised for suicide attempts and self-harm based on a population-based epidemiological design which analysed data routinely collected on patients hospitalised due to injuries.
Lam [50] investigated the associations between intra-and interpersonal violence and related injuries and the diagnosis of attention deficit disorder (ADD) among children and young adolescents. This was a population-based epidemiological study that analysed data routinely collected on hospitalised patients owing to injuries. Children and adolescents (between 5–15 years) were identified from the ISC data bank by the selection criteria of having a diagnosis of external causes of injury and poisoning according to the International Classification of Diseases 9th Revision-Clinical Modification (ICD-9-CM) [62]. Patients with comorbidity of ADD were further identified from this data set by the ICD-9-CM. The likelihood of being diagnosed with ADD was about four times higher (OR = 3.76, 95% CI = 1.73-8.15) for children and adolescents hospitalisations owing to suicide and self-harm. Patients who were admitted to hospitals owing to suicide/self-harm were six times (OR = 6.27, 95% CI = 2.76-14.26) and three times (OR = 3.05, 95% CI = 1.31-7.06) more likely to be diagnosed with ADD, respectively, as compared with other causes of injury. The odds for self-inflicted injuries were about 8.5 for children diagnosed with ADHD compared to individuals without ADHD.
Lynch, Mills, Daly and Fitzpatrick [51] investigated the prevalence rates of psychiatric disorders, suicidal ideation and intent and parasuicide in a population of Irish adolescents aged 12–15 years. 19.4% of the 723 screened were identified as being 'at risk' and this 'at risk' group were interviewed along with a comparison sample matched for gender, school and school year. In the 'at-risk' group, six (5.9%) had a diagnosis of ADHD and only three (3.2%) had a diagnosis of ADHD in the 'not at-risk' group. The estimated prevalence in the entire population (based on a weighted analysis) was 3.7% (95% CI = 0.7-6.7).
Adults samples
Fulwiler, Forbes, Santangelo and Folstein [45] tested the hypothesis that prisoners who injured themselves without intending to die would differ clinically from prisoners who had attempted suicide. Fifteen patients reported that they had attempted to take their own lives, while 16 reported other reasons for harming themselves. The findings most relevant to the focus of this review was that of self-mutilation with a history of childhood hyperactivity (12/16 versus 1/15 suicide attempters). Five remembered being treated with Ritalin and several reported that illicit stimulant drugs (cocaine. amphetamines) had a calming effect and helped them concentrate. Self-mutilators were 28 times more likely to report childhood hyperactivity, and suicide attempters were 21 times more likely to be diagnosed with major affective disorder.
This review identified 15 studies which investigated the association between ADHD and self-harm (one of which was a case study design). All of these studies indicate an association between ADHD and self-harm which suggests that ADHD may be a potential risk factor for self-harm.
It is important to consider the age of the individuals with ADHD in the studies which have been identified by this review (which investigated the association between ADHD and self-harming behaviours) given the literature which suggests that ADHD symptoms can sometimes change with age. Although ADHD symptoms frequently persist over time [63], maturation has been found to have a significant positive effect on ADHD symptoms in many children [64]. These findings have resulted in the hypothesis that ADHD is associated with a delay as opposed to an abnormal brain development [65, 66]. However, few studies have examined the persistence of ADHD from childhood to adulthood [67, 68]. This lack of rigorous research is surprising, given the significant impact that ADHD frequently has on the individual. For instance, ADHD diagnosed at school age increases the risk for antisocial development, drug misuse, pathological aggression, and social and academic exclusion by a factor of five to ten compared to the general population [69–71].
It is also important to highlight the gender in the studies identified by this review given the gender differences seen in individuals with ADHD [72]. The existing literature shows that although the gender difference in childhood is quite large, in adult samples this difference diminishes or disappears. Studies investigating gender differences, indicates that girls may consistently be under-identified and under-diagnosed and it is suggested that differences in the expression of ADHD between the genders might be one explanation for this [73–76]. Females with ADHD are reported to have less hyperactive/impulsive symptoms and more inattentive symptoms compared to males with ADHD [73, 77, 78]. Diagnosis of the inattentive subtype also appears to be more common in females with ADHD [79]. Boys with ADHD appear to exhibit more externalising disorders compared to boys without ADHD. Females, on the other hand, tend to exhibit more internalising disorders compared to girls without ADHD [73, 74, 78, 80] and to their male counterparts [80].
Looking at the gender in the group of interest across all fifteen studies it is clear that there are much higher numbers of males than females. This can be seen more clearly in Table 2. Studies which include greater levels of females are required. The small number of females in a large proportion of studies is limiting the power and the ability to find any significant association between ADHD and self-harming behaviours.
Table 2 The number of males and females in each group of interest across all 15 studies identified in this review
The majority of the studies used samples of children (below the age of 18 years). Only three studies used a sample of adults (older than 18 years) [43–45], of which two were by the same research group [43, 44]. Given what has just been described about the potential effect of age on ADHD symptoms, more studies are required which use samples to include older people in order to elucidate the effect of ADHD over the course of their lifetime.
From the 15 identified studies in this review, seven were studies using a population with ADHD and measures of self-harming behaviour were then conducted [41, 43, 44, 47, 48, 52, 53]. The remaining studies investigated a population who were hospitalised due to injury (or identified by records/self-assessment) and measures of ADHD were then conducted [17, 40, 42, 45, 46, 49–51]. Three of the 15 studies discussed in this systematic review were identified as the most relevant and methodologically reliable [42, 47, 48]. DiScala et al. [42] investigated the differences between hospital admitted injuries to children with pre-injury ADHD and injuries to those with no pre-injury conditions (NO). Compared with the NO children, the children with ADHD were more likely to inflict injury upon themselves (1.3% versus 0.1%). The importance of early identification of individuals at greater risk of self-harm is further validated by the findings of Hinshaw et al. [47] which showed that girls with childhood ADHD maintain marked impairment by early adulthood (including higher rates of suicide attempts and self-injury). Hinshaw et al. [43] found that girls with childhood-diagnosed ADHD continued to display higher rates of ADHD and comorbid symptoms and exhibited higher rates of suicide attempts and self-injury compared with the comparison sample. Self-harm behaviour predominated in the participants originally diagnosed with ADHD-combined. Hinshaw et al. [47] indicated that individuals with the ADHD combined type are at even greater risk of self-harm behaviours which merits further attention. Lastly, Hurtig et al. [48] investigated the effect of ADHD on suicidal or self-harm behaviour in adolescents from a general population sample and found that, compared with adolescents without ADHD, those with ADHD had more suicidal ideation (57% versus 28%) and DSH (69% versus 32%)".
The importance of further research into the association between ADHD and self-harm is further highlighted by the studies (outwith this review) which have investigated the increased rates of suicide in individuals with ADHD. For instance, Barbaresi, Colligan, Weaver, Voigt, Killian and Katusic (2013) [81] investigated long-term outcomes of ADHD in a population-based sample of childhood ADHD cases (n = 367) and controls, who were all prospectively assessed as adults. Importantly, findings revealed that childhood ADHD is a chronic health problem, with significant risk for mortality, persistence of ADHD, and long-term morbidity in adulthood. The cause-specific mortality for suicide only was significantly higher among ADHD cases (standardised mortality ratios, SMR, 4.83; 95% CI, 1.14–20.46; P = .032) compared to non-ADHD controls from the same birth cohort [81].
The conclusions that can be made regarding the strength of association between ADHD and self-harm are limited due to the relatively small amount of studies that have been conducted to date. In addition, the majority of these studies use small populations and some do not contain (or report on) control group findings. Publication bias is likely to be present as studies reporting no correlation are unlikely to be published [21]. Differing methodologies and differing measurement tools used across all the studies are a further complication [32]. For instance, in one of the studies found in this review, childhood hyperactivity was inferred only by self-report (as opposed to potentially more robust reports such as clinical assessments and/or parental reports) which the authors acknowledge in their paper [49].
Another limitation is the fact that data for the studies were collected retrospectively and then analysed for suicidal related events which exposes the studies to a degree of confounding bias, particularly in the studies where, for example, the Columbia Classification Algorithm for Suicide Assessment (C-CASA) (the standardised suicidal rating system) and the Computerized Suicide Risk Scale (CSRS) have not been delivered. Mapping any event to a specific code is possible, however, the potential for error is greater than if the scales were used prospectively. The use of these scales are often mandatory in trials. Additionally, the ability to separate self-harm as an entity from a suicide attempt is not always easy which is a potential confounding bias. In particular, Silverman, Berman, Sanddal, O'Carroll and Joiner (2007) [82] emphasised the potential complication with trying to separate self-harm and suicide attempt into two independent categories by highlighting that self-injurious intent and suicidal intent can be present simultaneously in an individual [82]. SIB and suicidal behaviours exists along the same continuum, with SIB representing a lesser form [83, 84]. Research has also found that 28% to 41% of individuals who engage in SIB report suicidal thoughts at the time they were engaged in self-injury [85].
Lastly, the influence of comorbidity is difficult to disentangle from the main findings, particularly for substance misuse and delinquency, prompting the need for further research using younger populations and those without co-morbidity [21].
Future directions and clinical implications
One study has shown some understanding of this relationship in their treatment strategies. Carminati, Deriaz and Bertschy [86] had good experiences with venlafaxine in the treatment of SIB and ADHD-like symptoms in patients with pervasive developmental disorders. This review highlights the need for clinicians to recognise the ADHD population as being at increased risk of self-harm. Children with ADHD pose particular problems of engagement with child mental health services which is another issue that needs to be addressed (a review of this is outside the scope of this review). Also, as the review by James [32] highlights, there is a need for clinicians to also recognise that the ADHD population is at increased risk of suicide attempt and completed suicide. The clinical implications of the main findings from the present review is that clinicians need to routinely screen for suicide attempts and self-harm in ADHD subjects, including the younger population which may introduce new ways of further reducing the youth suicide and self-harm rate [32]. This review also indicates that there needs to be a revision of the standardised ADHD rating scales since they generally do not enquire about self-harm and risk to self and others. This review clearly emphasises the need for inclusion of these aspects during routine assessment (either in questionnaires, clinical assessment or both). Effective screening requires an integration of all the currently known predictors of self-harm (and this review strongly highlights the need for symptoms of ADHD to be one of them) and further research to identify any others. One study discussed in this review also supports the idea that there needs to be distinctive screening procedures for each of these sub-types [46].
Despite the contribution to our knowledge of self-harm behaviours to date, we remain unclear as to exactly why individuals engage in these behaviours and, even more importantly, we do not have in place effective methods of accurately predicting or reducing these behaviours as a consequence. Therefore, it is vitally important that risk factors for self-harm (such as symptoms of ADHD) are recognised and identified to produce more reliable risk level indicators.
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Datapharm Communications Limited Electronic Medicines Compendium: Concerta. http://www.medicines.org.uk/EMC/medicine/8382/SPC/Concerta+XL+18+mg+−+36+mg+prolonged+release+tablets/,
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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/14/133/prepub
Institute of Health and Wellbeing, University of Glasgow, RHSC Yorkhill, Glasgow, 8SJ G3, Scotland
Clare S Allely
Correspondence to Clare S Allely.
The author declares that she has no competing interests.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
Allely, C.S. The association of ADHD symptoms to self-harm behaviours: a systematic PRISMA review. BMC Psychiatry 14, 133 (2014). https://doi.org/10.1186/1471-244X-14-133
DOI: https://doi.org/10.1186/1471-244X-14-133
ADHD: Attention-Deficit/Hyperactivity Disorder
Self-injurious behaviour
Deliberate self-harm
Suicide-related events


text:
Tuxentius margaritaceus е вид пеперуда от семейство Синевки (Lycaenidae). Видът не е застрашен от изчезване.

Разпространение
Разпространен е в Ангола, Демократична република Конго, Камерун, Кения, Нигерия, Танзания, Уганда и Южен Судан.

Източници

Външни препратки
 Tuxentius margaritaceus в Encyclopedia of Life

Tuxentius

redpajama_set_name: RedPajamaWikipedia


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The Dragon Ark Join the quest to save the rarest dragon on Earth
Curatoria Draconis at al
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text:
Raising Cane's Gears Up For 25th Houston Location
Popular chicken finger brand to celebrate grand opening on Tuesday on Main Street
HOUSTON (March 16, 2017) – Houston Caniacs will soon have another convenient place to get their chicken finger fix.
Raising Cane's Chicken Fingers, the Louisiana-based restaurant company known for its ONE LOVE® – quality chicken finger meals – is set to open its 25th Houston location on Tuesday, March 21. Located at 9530 Main St. in Houston, near NRG Stadium, the new restaurant will kick off the festivities at 9:20 a.m. with an official ribbon-cutting ceremony attended by the Houston Metro Chamber of Commerce along with local fire, police and city officials.
First-time visitors will be treated to traditional cheers and other high-energy chants to launch the location in unique Cane's fashion, compliments of its 60 newly hired crewmembers. Doors open to the public at 10 a.m.
To add to the excitement, the first 20 paying, dine-in customers ages 13 and older will receive Free Cane's for a Year! In addition, the first 100 paying, dine-in customers ages 13 and older will receive a free limited-edition Cane's Houston T-shirt, along with a voucher for a free Box Combo – containing four fresh, never ever frozen chicken fingers, Texas toast, secret recipe Cane's sauce, coleslaw, crinkle-cut fries and a drink – that may be redeemed on a subsequent visit.
"We have been overjoyed by the popularity of Raising Cane's in the Houston area and we're looking forward to opening a new restaurant near the South Loop to more conveniently serve our loyal Caniacs," said General Manager Omar Garcia. "My crew and I can't wait to open our doors and share our ONE LOVE with the community."
Founded by Todd Graves in 1996 and named for his yellow Labrador, Raising Cane's recently earned the distinction of being among the Top 5 quick service restaurant chains in the nation for 2016, according to the authoritative Sandelman & Associates Quick-Track study, based on food quality, customer service, cleanliness and other important factors.
Along with its focus on chicken fingers, Raising Cane's is renowned for its commitment to active involvement in its local communities. On March 15, Garcia and his fellow crewmembers volunteered at Saint Luke's Presbyterian Church, helping with landscaping and working in the flower beds.
"We were proud to pitch in at Saint Luke's for our pre-opening service project, supporting their commitment to Houston-area families," said Garcia. "We'll also be partnering with local schools and other organizations in the coming weeks and months."
Hours of operation at Houston's newest Raising Cane's are Monday through Friday from 10 a.m. to 11 p.m., and Saturday and Sunday from 10 a.m. to 12 Midnight. This marks the 109th Raising Cane's in the state of Texas and the 316th system-wide.
ABOUT RAISING CANE'S®:
Founded by Todd Graves in 1996 in Baton Rouge, La., RAISING CANE'S CHICKEN FINGERS has more than 300 restaurants in 23 states with multiple new restaurants under construction. The company has ONE LOVE®—quality chicken finger meals—and is continually recognized for its unique business model and customer satisfaction. Raising Cane's vision is to have restaurants all over the world and be the brand for quality chicken finger meals, a great crew, cool culture and active community involvement.
More information is available at raisingcanes.com.


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Cochran is a city in Bleckley County, Georgia, United States. As of the 2020 census, the city had a population of 5,026. The city is the county seat of Bleckley County.

Cochran is named for Judge Arthur E. Cochran and was incorporated on March 19, 1869. Judge Cochran was largely instrumental in developing this section of Georgia through his work as president of the Macon and Brunswick Railroad, now the Southern Railway (a component of Norfolk Southern Railway). Once known as Dykesboro, Cochran was settled by B. B. Dykes, who owned the site on which the town is built. The earliest settlers located here to work in the turpentine industry.

Cochran is home to Bleckley County High School and Middle Georgia State University. Three properties in Cochran are listed on the National Register of Historic Places: the Bleckley County Courthouse in Courthouse Square, the Cochran Municipal Building and School at the junction of Dykes and Second streets, and Hillcrest at 706 Beech Street.

History
Cochran, originally known as Dykesboro, was settled in the 1850s by B. B. Dykes. It was renamed Cochran in 1869 after Arthur Cochran, a railroad official who brought the Macon and Brunswick Railroad to town. In 1912, Cochran was designated seat of the newly formed Bleckley County.

Government
Cochran operates under a Mayor-Council system of government, with the day-to-day business being handled by a city manager. The city manager is Richard Newburn. The Mayor is Billy Yeomans. The Police Chief is Jeff Trawick, and the fire chief is Brock Wilcher.

In 2016, at a City Council meeting held on October 11, Mayor Michael Stoy resigned from office, alleging that certain City Council members had participated in an illegal meeting. Since there was more than a year remaining in his term, a special election was held to elect another Mayor.

In 2013, the city manager decided to terminate the employment of the police and fire chief, and replace them with a public safety director in order to save money, but rescinded his decision days later amidst public disapproval, and announced the appointment of a task force to look at the budget and advise him on choices.

In 2011, Mayor Cliff Avant was charged with felony theft for allegedly donating city-owned PVC pipe to a local church. He admitted the donation and the mistake of not having it declared surplus property by the city council. On the day of the trial, as a result of a plea deal, Avant resigned as mayor, and pleaded guilty to a charge of criminal trespass.

In 2008, some of the Cochran Police Force came under scrutiny for various acts of misconduct, which included child molestation charges. One officer was charged and another resigned after being investigated for interference with custody.

Geography
Cochran is located at  (32.386646, -83.350684).

The city is located in the central part of the state along U.S. Route 23, which runs from southeast to northwest to the northeast of downtown, leading northwest  to Macon and southeast  to Eastman. Georgia State Route 26 runs from southwest to northeast through the center of the city, leading northeast  to Dudley (after meeting U.S. Route 80), and southwest  to Hawkinsville, concurrent with U.S. Route 129 Alternate.

According to the United States Census Bureau, the city has a total area of , of which  is land and , or 3.63%, is water.

Demographics

2020 census

As of the 2020 United States Census, there were 5,026 people, 1,406 households, and 814 families residing in the city.

2010 census
As of the 2010 United States Census, there were 5,150 people living in the city. The racial makeup of the city was 48.1% Black, 47.3% White, 0.1% Native American, 1.6% Asian, 0.0% Pacific Islander and 1.0% from two or more races. 1.8% were Hispanic or Latino of any race.

2000 census
As of the census of 2000, there were 4,455 people, 1,632 households, and 1,055 families living in the city. The population density was . There were 1,851 housing units at an average density of . The racial makeup of the city was 55.31% White, 42.09% African American, 0.09% Native American, 1.41% Asian, 0.47% from other races, and 0.63% from two or more races. Hispanic or Latino of any race were 0.99% of the population.

There were 1,632 households, out of which 30.8% had children under the age of 18 living with them, 37.6% were married couples living together, 23.2% had a female householder with no husband present, and 35.3% were non-families. 31.9% of all households were made up of individuals, and 15.6% had someone living alone who was 65 years of age or older. The average household size was 2.44 and the average family size was 3.10.

In the city, the population was spread out, with 26.1% under the age of 18, 15.6% from 18 to 24, 23.4% from 25 to 44, 19.5% from 45 to 64, and 15.4% who were 65 years of age or older. The median age was 33 years. For every 100 females, there were 83.2 males. For every 100 females age 18 and over, there were 78.0 males.

The median income for a household in the city was $25,545, and the median income for a family was $35,854. Males had a median income of $29,434 versus $22,813 for females. The per capita income for the city was $13,354. About 14.8% of families and 21.5% of the population were below the poverty line, including 33.3% of those under age 18 and 23.0% of those age 65 or over.

Education

Bleckley County School District
Bleckley County students in kindergarten to grade twelve are in the Bleckley County School District, which consists of a primary school, an elementary school, a middle school and a high school. The district has 151 full-time teachers and over 2,355 students.
Bleckley County Learning Center
Bleckley County Primary School
Bleckley County Elementary School
Bleckley County Middle School
Bleckley County Success Academy
Bleckley County High School

Middle Georgia State University
Middle Georgia State University is a public university with its main campus in Macon, Georgia. It was founded in 2013 through the merger of Middle Georgia College and Macon State College. Middle Georgia College's campus in Cochran is now one of the multiple campuses of Middle Georgia State University.

Tourist attractions
Cochran-Bleckley Cotton & Peanut Museum
Greene Acres Farm
Terry L. Coleman Museum and Archives

Notable people
Ronald Gray - convicted spree killer
Amberle L. Husbands - writer of pulp-noir and science fiction short stories and novels
 Danny Mathis - Politician and coroner.
Nancye Radmin (1938–2020), American businesswoman, founder of The Forgotten Woman retail chain
Clarence Reid, a.k.a. Blowfly - musician and songwriter
Ed Roberts - Physician and founder of MITS where he created the Altair 8800 microcomputer, starting the microcomputer revolution. It featured Microsoft's first software, the Altair BASIC and employed Bill Gates, Paul Allen, and Monte Davidoff.
Obie Walker - claimant of the World Colored Heavyweight Championship boxing title in the 1930s

References

External links

 Evergreen Baptist Church historical marker
 Longstreet Methodist Church historical marker

Cities in Georgia (U.S. state)
Cities in Bleckley County, Georgia
County seats in Georgia (U.S. state)


text:
Featured Crowd-pleasing 'The Sound of Music' Delivers Comfort and Joy at Muny
Featured Reviews Theatre
Crowd-pleasing 'The Sound of Music' Delivers Comfort and Joy at Muny
This much I know is true: "The Sound of Music," created during the golden age of musicals — (and the reason it's referred to as a golden period is crystal clear), is such a crowd-pleaser that it will never fall out of favor.
The Muny's latest creation of the evergreen 1959 Rodgers and Hammerstein classic drew 7,847 on opening night, and you could feel the joy in the air. With the arrival of Alpine weather in St. Louis, it was also a pleasurable experience outdoors.
By the time Bryonha Marie Parham, as Mother Abbess, finished her powerful and poignant rendition of "Climb Ev'ry Mountain," which closed the first act, the crowd leapt to its feet with thunderous applause. At curtain call, a hearty standing ovation began early and when Kate Rockwell, radiant as the sunny Maria Rainer, took her bow, the cheers were deafening.
The tension-filled book by Howard Lindsay and Russel Crouse, based on the real-life story of widowed Captain von Trapp of the Austrian Navy, his budding romance with governess Maria, who cares for and tutors his seven children, and how they flee after the Third Reich takeover of their country in 1938, provides dramatic and emotional depth.
Through this last collaboration of influential composers Oscar Hammerstein II and Richard Rodgers, they've integrated some of their best songs — The Sound of Music boasts their most popular hits – to guarantee widespread appeal. Then, add the iconic Oscar-winning 1965 film, which cemented its place in pop culture history.
This is the 11th time in 57 years that the Muny favorite has been presented in Forest Park, and the first since 2010. The experienced creative team has honored the beloved musical by not varying from a traditional approach – why mess with a time-honored story or the lush score? and the lush score but keeping it fresh with rising talent and new outlooks.
Freshened up with rising talent and new outlooks, Director Matt Kunkel has capably emphasized the show's major arcs of love, faith and courage.
Music Director Ben Whiteley smoothly conducts the velvety string-laden score, reminding everyone why we know all the words and music to "Do-Re-Mi," "My Favorite Things," "Edelweiss" and the title song.
Elizabeth Teeter and Andrew Alstat. Photo by Phillip Hamer.
With many exceptional voices, the ensemble comfortably handles some of the most enduring standards in the American theater.
While some casts are more dynamic than others in Muny productions, striking a delicate balance in tone with nuns and Nazis, the women lead the way here.
And not just on stage, but behind-the-scenes. For the first time in Muny history, Shelby Loera is the lead lighting designer on a show. In 103 seasons. Bravo for breaking that ceiling!
Caite Hevner took charge of the video design and Beth Crandall choreographed the sophisticated party dances and the peppy kids' numbers. Paige Hathaway was the scenic designer, using the new trees as a backdrop.
Costumes were designed by Tristan Raines, a familiar fashionista at the Muny, and the wedding scene finery was a standout.
As usual, the von Trapp children steal the show. You expect the actors playing Liesl (Elizabeth Teeter), Friedrich (Victor de Paula Rocha), Louisa (Amelie Lock), Kurt (Parker Dzuba), Brigitta (Jillian Depke), Marta (Abby Hogan) and Gretl (Kate Scarlett Kappel) to be endearing, but these kids are not only supremely talented but project professionalism on stage.
And they harmonize beautifully – especially their fun "The Lonely Goatherd" number during a frightening thunderstorm and the always special "So Long, Farewell."
As the eldest girl, Teeter, daughter of local theater legend Lara Teeter, demonstrated that she is a poised and polished performer wise in years.
She has appeared on Broadway with Helen Mirren in "The Audience" and as Jane Banks in "Mary Poppins," not to mention cute-friendly roles at the Muny, including Flounder in "The Little Mermaid" and Gretl in the 2010 "The Sound of Music."
An accomplished dramatic actress, she can be seen as fragile Laura in "The Glass Menagerie" at the Tennessee Williams Festival in St. Louis Aug. 19-29.
With their clear confident voices, Teeter and Andrew Alstat, as Rolf, deliver a strong "Sixteen Going on Seventeen." Unfortunately, she is saddled with an unrealistic-looking brown wig, an odd choice, which overwhelms her face.
Kate Rockwell, von Trapp children, Michael Hayden. Photo by Phillip Hamer.
Another distraction is that Michael Hayden does not fit the Captain von Trapp role as we've become accustomed to over the years –typically imposing and dashing. A Tony nominee for "Judgment at Nuremberg," who also has Shakespeare credits, Hayden obviously is a noteworthy performer, but something was "off," and he certainly didn't click with Rockwell like Georg and Maria should. (I wondered if he was ill? There is usually an underlying reason.). He seemed tentative in spots and wasn't comfortable with the guitar on "Edelweiss."
In addition, his suits appeared ill-fitting and the coat of his dress uniform he wore at the wedding was way too long. This is a rare misfire from the Muny costume shop, normally known for their crisp tailoring.
He's not the worst Captain von Trapp I've seen. That distinction goes to the wooden and unprepared George Peppard, yeah the guy in "Breakfast at Tiffany's," in 1982. However, I have heard that "Dallas" star Ken Kercheval tops that list in a 1993 version, where he had to use the book.
Two bright spots are fan favorites Jenny Powers and John Scherer. The elegant and statuesque Powers glides across the stage as Elsa Schraeder, also known as the Baroness, and has a lovely duet, "How Can Love Survive?" with Scherer as Max, the cynical impresario.
The pair are an effortless match. Powers has been one of the Muny's most durable leading ladies – as "Mary Poppins," Morticia in "The Addams Family," Abigail Adams in "1776," Tanya in "Mamma Mia!" and Guinevere in "Camelot," to name a few.
Scherer, known for his impeccable comic timing, has been in "Kinky Boots," "Young Frankenstein," "Spamalot" and "The Addams Family."
Fine supporting work is carried out by David Hess as the dutiful butler Franz and St. Louis actors Michael James Reed as the imperious and threatening SS officer Herr Zeller, Leah Berry as skeptical head of the postulants Sister Margaretta, April Strelinger as stern housekeeper Frau Schmidt, and versatile Jerry Vogel doing triple duty as the officiating priest at the wedding, Baron Elberfeld and Admiral von Schreiber.
But the show belongs to the delightful Rockwell, so memorable in "Tarzan" and "Beauty and the Beast" during the past decade. She's a bona fide star, pitch perfect as the spunky and big-hearted Maria. It's a graceful and winning performance that easily captured the audience's heart.
Whether it's a fond childhood memory or a family favorite passed down through generations, "The Sound of Music" pleased the theatergoers ready to be enchanted.
Its inspiration was intact, too – go climb those mountains!
Photo by Phillip Hamer
"The Sound of Music" runs Aug. 3-9 at the Muny outdoor stage in Forest Park. Tickets can be purchased in person at the box office, online at muny.org or by calling 314-361-1900, ex. 1550.
The remaining shows of the 2021 season are Seven Brides for Seven Brothers (Aug. 12 – 18), On Your Feet! (Aug. 21 – 27) and Chicago (Aug. 30 – Sept. 5). Emerson is the season sponsor. For more information, visit muny.org.
To stay connected virtually and to receive the latest updates, please follow The Muny on their social media channels, including Facebook, Instagram and Twitter.
Jenny Powers and John Scherer. Photo by Phillip Hamer
Abby Hogan, Amelie Lock, Andrew Alstat, April Strelinger, Ben Whiteley, Bryonha Marie Parham, Caite Hevner, Captain Georg von Trapp, David Hess, Elizabeth Teeter, Howard Lindsay, Jenny Powers, Jerry Vogel, Jillian Depke, John Scherer, Kate Rockwell, Kate Scarlett Kappel, Leah Berry, Lynn Venhaus, Maria von Trapp, Michael Hayden, Michael James Reed, Oscar Hammerstein II, Parker Dzuba, Richard Rodgers, Rodgers and Hammerstein, Russel Crouse, Shelby Loera, The Muny, The Muny 103rd season, The Sound of Music, The Von Trapp Family Singers, Tristan Raines, Victor de Paula Rocha
Emerson Teams with Stages St Louis to Offer Discount Student Tickets
Goshen Theatre Project to Disney's Beauty and the Beast This Weekend


Online shopping has grown rapidly over the last decade. The market is competitive and dynamic therefore staying up to date with current e-commerce and social media trends is essential. One of the market's fundamental fixtures is imagery. Pictures are our thing for sure but what makes us different is our knowledge of online merchandising.
We know how to produce an image that speaks a thousand words and most importantly – sells.


text:
Susan Sully
Fee Range1: $ 2500 - $5000
Leading Authority on Southern Architecture
Arts/Culture/Music • Lifestyle • Spouse Programs
A leading authority on Southern architecture and design, Susan Sully is the author and photographer of many books published by Rizzoli International Publications, including Houses with Charm: Simple Southern Style; The Southern Cosmopolitan: Sophisticated Southern Style; The Southern Cottage: From the Blue Ridge Mountains to the Florida Keys; New Orleans Style: Past and Present; Charleston Style: Past and Present; Savannah Style: Mystery and Manners; and Casa Florida: Spanish Style Houses from Winter Park to Coral Gables. Sully has also co-authored a series of monographs about leading Southern architects and interior designers including Bobby McAlpine, Ken Tate, Jim Strickland of Historical Concepts, Norman Askins, and Phoebe Howard.
A graduate of Yale University with a degree in art history, Sully has contributed articles to The New York Times, Town & Country Travel, Veranda, Southern Accents, Martha Stewart Living, and other publications. Her books have been reviewed and excerpted in magazines including Veranda, Southern Accents, Architectural Digest, Town & Country, House Beautiful, and World of Interiors. Sully lectures frequently on the subject of Southern architecture and design at organizations including Sotheby's Institute, the Smithsonian's National Building Museum, garden clubs, antiques shows, and design centers.
Sully also writes a blog on Southern architecture and design called Southerncosmopolitan.com. She lives in Asheville, North Carolina with her husband, artist Thomas Sully.
Lecture Topics from Susan Sully
Houses with Charm: Simple Southern Style
In Houses with Charm: Simple Southern Style, Sully takes her audience on a virtual tour through the properties featured in her newest book of the same title, inviting them to sit back and relax on porches and in the rooms of houses dating from the 18th– to the 21st century. The lecture explores two themes—the South's Pure and Simple vernacular architecture and the Simple Elegance with which homeowners combine fine antiques with relaxed surroundings. Ranging from a Creole plantation house in Louisiana, a Greek Revival row house in Savannah, a neo-vernacular country house in Mississippi, and a "cottage Gothic" residence in Atlanta, the featured residences offer insights into the architectural history of the region. Integrating time-honored lessons of the past, a number of homes also incorporate contemporary design sensibilities. Many designed by the South's leading architects and interior decorators, these houses reveal the inspired approach to tradition and gracious simplicity that define Southern charm.
The Southern Cosmopolitan: Sophisticated Southern Style (Past and Present)
Drawn from the author's book of the same title, this lecture offers an inspiring and educational look at the sophisticated tastes of Southerners from colonial times to the present. With houses chosen from the region's most historic cities, including Charleston, Georgetown, and Natchez, as well as capitals of the New South such as Atlanta, it traces architectural styles and decorative trends spanning four centuries. While many of the featured houses are decorated in traditional styles with American and European antiques, others demonstrate the tastes of today's top architects and interior designers. With examples of historic architecture, decoration, furnishings, and art combined with 20th– and 21st century approaches to design, the lecture offers a fascinating look at the enduring themes and surprising diversity of Southern style.
The Southern Cottage: From the Blue Ridge Mountains to the Florida Keys
Inspired by the author's book of the same title, this lecture offers a charming and informative tour of country, coastal, and mountain houses throughout the South. Like the region's major cities, these more remote locations—often historic summering destinations—have richly varied histories and architecture. From log cabins in the Virginia mountains to white clapboard coastal homes in South Carolina and cigar-maker's cottages in Key West, each region's houses reveal the diversity of Southern vernacular architecture. Mostly second homes, featured dwellings range from a Victorian mountain house filled with family antiques to a rustic pine beach cottage with a picnic table in the kitchen. Although they may look quite different, these cottages have in common an easy hospitality that welcomes family and friends to relax together in beautiful natural surroundings. Like a little vacation, this lecture offers an hour-long respite from the hectic demands of modern life.
Southern Style: Town and Country
This popular lecture combines the images and themes of The Southern Cosmopolitan with The Southern Cottage to offer a lively and comprehensive look at Southern architecture and design. Juxtaposing city homes with weekend and seasonal retreats on nearby beaches and mountainsides, the lecture features delightfully varied approaches to architecture, decoration, and manners of living. In Savannah, a decadent Italianate townhouse contrasts with a tiny raised cottage on nearby Tybee Island, and in Charleston, the fine cypress paneling of a Georgian mansion offers elegant counterpoint to the pine plank walls of a barrier-island farmhouse. A virtual tour of the South's most refined and relaxed houses, the lecture offers an engaging overview of the region's social and architectural history.
Charleston Style: Architecture, Interiors, and Gardens
This lecture brings together a collection of houses, rooms, and gardens documented during the author's research for her first book, Charleston Style: Past and Present, and for her more recent publication, Charleston: Architecture and Interiors. An insider's tour of many of the city's most beautiful houses, rooms, and gardens, it provides an overview of Charleston's architectural and decorative tastes from the 17th century to the present. The lectures includes the restored 1802 Federal style Nathaniel Russell House, the famous garden of Mrs. Emily Whaley, author of the best-selling Mrs. Whaley and her Charleston Garden, a quintessential Greek Revival single house South of Broad, and a modernist addition to a cotton warehouse-turned-residence.
Savannah Style: Architecture and Interiors (Past and Present)
Arrayed amid Savannah's romantic streetscape of oak-shaded boulevards and beautiful squares, the houses featured in this lecture represent styles dating from the 18th- to the 21st century. Stately Regency houses including the famed Owens-Thomas House, riverside dwellings with walls of cobblestone and handmade brick, and Italianate and Greek Revival townhouses with bold details and gracious rooms show the many facets of Savannah style. Including architecture and interiors characterized by Old World elegance, romantic decadence, and Southern eccentricity, this lecture is both entertaining and informative.
New Orleans Style: Architecture and Interiors (Past and Present)
The best way to travel to an exotic destination without leaving the United States is to go to New Orleans. Several cultural strands interweave to form the city's unique architecture and design ethos, primarily Spanish, French, West Indian or Creole, and American styles including the Federal, Italianate, Greek and Romanesque Revivals. Featuring one of the oldest townhouses in the French Quarter, several Creole cottages, and elegant Garden District homes, this lecture celebrates the city's rich architectural history. The homes of many of the city's top interior designers are also featured, offering a glimpse into the continuing evolution of New Orleans style.
Casa Florida: Mediterranean-Style Architecture and Interiors
With examples of houses in Winter Park, Coral Gables, Coconut Grove, Palm Beach, and St. Petersburg, this lecture celebrates the whimsy and romance of Florida's Mediterranean-style architecture. With linen-fold paneling, antique tile floors, and coffered ceilings, the Palm Beach house of Addison Mizner, widely credited with the style's invention, provides a glimpse into its imaginative origins. Constructed entirely (but not obviously) of concrete, the Coconut Grove home of Victor de Garma, one of Miami's most influential Spanish-style architects, demonstrates an inventive early-20th century approach to the style. Restored and richly furnished with antiques, Cielito Lindo, originally the winter home of Jessie Woolworth Donahue, is a quintessential example of the Mediterranean Revival's Moorish influence. Throughout the lecture, images of mosaic floors, majestic arches, antique tapestries, and bougainvillea-filled courtyards celebrate the beauty and mystery of these houses.
Charleston and Savannah: So Close and Yet So Far Away
Although located little more than 100 miles apart, these Southern cities are surprisingly different, not only in style, but also personality. For example, Savannah is arranged in an orderly grid of streets and squares based on Oglethorpe's 1733 design while Charleston's older cityscape is filled with meandering streets and alleys "South of Broad." In this original part of the city, many of the dwellings predate 1700 while most of Savannah's houses date from the late 18th– and 19th centuries. In Charleston, the single house is a popular form—a one-room deep house that turns its short end to the street and faces a side garden with a long, two-story porch. In Savannah, closely spaced or attached townhouses with small back gardens line many of the streets. Inside these dwellings, Savannah's more opulent and even decadent and eccentric tastes contrast with Charleston often more restrained approach to décor. With glimpses into a dozen houses, this lecture offers fascinating insights into these sister cities.
Charleston, Savannah, and New Orleans: Elegance, Eclecticism, and Eccentricity
This lecture examines the similarities and differences among the architecture and design of three of the South's most historic cities. While Charleston is the most English in style and character, New Orleans reveals the influence of France, Spain, and the Caribbean, and Savannah can best be described as American, with its mix of Southern and Northeastern styles. From Charleston's Georgian mansions, New Orleans' Creole townhouses and cottages, and Savannah's Boston-inspired Romanesque Revival houses, the featured dwellings offer lessons not only in style, but also in history. Revealing different design preferences from wall-coverings and color schemes to furniture and household accoutrements, the interiors of each city's houses also reflect their distinct cultural histories. With behind-closed-doors tours of many of the South's finest and most intriguing houses, this lecture celebrates the rich diversity of Southern style.


text:
Environment Commissioner warns tourism growth is putting pressure on NZ
By Kate Nicol-Williams, 1News Reporter
December 18, 2019 Source: 1News
The Parliamentary Commissioner for the Environment has warned that ambitious management of tourism is urgently needed to address growing pressure on the environment.
Tongariro Alpine Crossing (Source: Getty)
In his report, titled "Pristine, popular ... imperilled? The environmental consequences of projected tourism growth", Simon Upton paints a picture of the environmental consequences of forecast tourism growth in New Zealand to 2050, based on extended estimations of current visitor trends.
Tourists are defined as international visitors and locals who are away from home for at least a night in the report.
Mr Upton forecasts that by 2050 international visitors will potentially exceed 10 million people per year, up from 3.9 million people per year currently.
Environmental pressures from tourism include loss of natural isolation, degrading water, increased waste, increasing infrastructure and loss of landscape, loss of flora and fauna, biosecurity risk and emissions.
An increased threat of foreign species being introduced, increased challenges for Māori, tourism destinations operating at or close to full capacity, and the loss of 'the tranquillity and isolation that made those places worth visiting in the first instance' are outcomes Mr Upton predicts will occur in the future, unless greater action to protect the environment is taken.
"Despite many soothing words about sustainability over the two intervening decades, we haven't significantly shifted from an extractive path dependency," the Commissioner stated in the report overview.
"Recent initiatives such as the International Visitor Conservation and Tourism Levy and the development of destination management plans are promising, but considerably more ambition will be required if a continued worsening of tourism-related environmental pressures is to be avoided," he said.
Mr Upton said while most risks can be managed, climate change is a greater challenge that "could have a significant and long-term effect on New Zealand's tourism sector".
Mr Upton said New Zealand's environment is a drawcard for tourists and any worsening of the country will affect demand.
"Promoting the natural environment can be a double-edged sword," he said.
Mr Upton said tourism needed to be carried out in line with Te Tiriti o Waitangi and reflect the environmental values of Kiwis.
He said the public is starting to notice the pressures on the environment from tourism and is questioning the benefits of this growing industry.
"The evolution of this tension between economic opportunities and environmental and cultural harm will largely determine the industry's social licence to operate in the future," he said.
MBIE tourism general manager Iain Cossar said tourism is the country's largest export earner, providing jobs and facilities.
"There is a need for a fuller understanding and better management of the impacts and costs of tourism on communities and the environment for tourism to benefit all New Zealand," he said in a statement.
Mr Cossar said MBIE, DOC and the Ministry for the Environment, along with the tourism sector, are working to address the effects of tourism growth on New Zealand communities.
"To ensure that tourism can positively contribute to communities and the natural environment we're already rolling out collaborative visitor and destination management strategies and campaigns advocating and encouraging responsible visitor behaviour, in addition to creating a sustainable funding approach."
Tourism Minister Kelvin Davis said the report is an endorsement of sustainability initiatives the Government's introduced.
"We're doing a lot, a heck of a lot already," he said.
NZ tourism:
-Annual tourist spend for the year to March 2018 was $39 billion ($23 billion local, $16.2 international visitors).
-Auckland, Wellington, Christchurch and Queenstown-Lakes have the highest tourist spend.
-By 2023, Milford Sound Piopiotahi is expected to have 1.2 million visitors each year, up from 946,000.
-The most international visitors come from Australia, with 1.5 million people this year.
New ZealandEnvironmentTourismTravel
Explore Auckland vouchers in big demand as 140K apply
Iwi-led group begins Raukūmara Ranges regeneration
Work underway on MIQ glitch that locked visa holders out
Emergency MIQ spots open for Kiwis facing hardship in Aus


text:
Q: MySql query gives different output from phpmyadmin, here group_concat not work Is there any mistake in mysql query, anyone help please.
Thanks!!
DATABASE Table (Below)
CREATE TABLE tbl_sales
    (`plantcode` varchar(200), `materialcode` varchar(200), `nrv` varchar(200) ,`monthyear` date)
;
INSERT INTO tbl_sales
    (`plantcode`, `materialcode`, `nrv`, `monthyear`)
VALUES
    ('9001','800000006','210','2015-02-01'),
    ('9001','800000006','220','2015-02-01'),
    ('9001','800000006','350','2015-02-01'),
    ('9001','800000006','100','2015-03-01'),
    ('9001','800000006','421.00','2015-04-01'),
    ('9001','400000100','257','2015-05-01'),
    ('9001','400000100','233','2015-07-01'),
    ('9002','800000006','710','2016-02-01'),
    ('9002','800000006','325','2016-06-01')
;

I create query for dynamic row convert into dynamic column by date(monthyear field).
SELECT plantcode,materialcode, GROUP_CONCAT(DISTINCT
        CONCAT('SUM(CASE WHEN DATE_FORMAT(monthyear,''%b %y'')= ''',
          DATE_FORMAT(monthyear,'%b %y'),
                       ''' THEN nrv ELSE 0 END) AS '' ',
                       DATE_FORMAT(monthyear, '%b %y'),'"'
                     )
                  ORDER BY monthyear)
    from tbl_sales
    GROUP BY materialcode

when i use this query in phpmyadmin, it shows optput like below
Output From PHPMyadmin
And i need actual output like below:
Plantcode   Materialcode    Feb 2015    Mar 2015    Apr 2015    May 2015
9001        800000006       780         100         421.00      257

GUYS I Done with my custom code.... check below...
$qry1 = mysql_query("SELECT DISTINCT(`monthyear`) FROM `tbl_sales` ORDER BY `monthyear` ASC");
$rcount = mysql_num_rows($qry1);
$sql2 = "SELECT `plantcode`,`materialcode`, ";
$dynamic_column = array();
while ($rows = mysql_fetch_assoc($qry1))
{
    $dynamic_column[] = $rows['monthyear'];
    $sql2 .= "SUM(IF(`monthyear` = '{$rows['monthyear']}',`nrv`,0)) AS '{$rows['monthyear']}'";
    if ($rcount > 1)
    {
        $sql2 .=',';
    }
    $rcount--;
}

$sql2 .= " FROM `tbl_sales` WHERE `plantcode`='9001' AND `monthyear` BETWEEN '2015-01-01' AND '2016-06-30' GROUP BY `materialcode`,`year` ORDER BY `year`,`monthyear`,`dsapcode` ASC ";

Check below image output screen....
enter image description here

A: You can try something like this, cause you use materialcode for group by, so plantcode in result makes no sense.
SQL Fiddle
MySQL 5.6:
CREATE TABLE tbl_sales
    (`plantcode` varchar(200), `materialcode` varchar(200), `nrv` varchar(200) ,`monthyear` date)
;
INSERT INTO tbl_sales
    (`plantcode`, `materialcode`, `nrv`, `monthyear`)
VALUES
    ('9001','800000006','210','2015-02-01'),
    ('9001','800000006','220','2015-02-01'),
    ('9001','800000006','350','2015-02-01'),
    ('9001','800000006','100','2015-03-01'),
    ('9001','800000006','421.00','2015-04-01'),
    ('9001','400000100','257','2015-05-01'),
    ('9001','400000100','233','2015-07-01'),
    ('9002','800000006','710','2016-02-01'),
    ('9002','800000006','325','2016-06-01')
;

Query:
SET @sql = NULL;
SELECT
  GROUP_CONCAT(DISTINCT
    CONCAT(
      'SUM(IF(monthyear = ''',
      monthyear,
      ''', nrv, 0)) AS `',
      DATE_FORMAT(monthyear,'%b %y'), '`'
    )
  ) INTO @sql
FROM tbl_sales;
SET @sql = CONCAT('SELECT plantcode, materialcode, ', @sql, ' FROM tbl_sales GROUP BY materialcode');
PREPARE stmt FROM @sql;
EXECUTE stmt;
DEALLOCATE PREPARE stmt;

Results:
| plantcode | materialcode | Feb 15 | Mar 15 | Apr 15 | May 15 | Jul 15 | Feb 16 | Jun 16 |
|-----------|--------------|--------|--------|--------|--------|--------|--------|--------|
|      9001 |    400000100 |      0 |      0 |      0 |    257 |    233 |      0 |      0 |
|      9001 |    800000006 |    780 |    100 |    421 |      0 |      0 |    710 |    325 |

redpajama_set_name: RedPajamaStackExchange