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Mental distress in the general population in Zambia: Impact of HIV and social factors
BMC Public Health volume 9, Article number: 298 (2009)
Population level data on mental health from Africa are limited, but available data indicate mental problems to represent a substantial public health problem. The negative impact of HIV on mental health suggests that this could particularly be the case in high prevalence populations. We examined the prevalence of mental distress, distribution patterns and the ways HIV might influence mental health among men and women in a general population.
The relationship between HIV infection and mental distress was explored using a sample of 4466 participants in a population-based HIV survey conducted in selected rural and urban communities in Zambia in 2003. The Self-reporting questionnaire-10 (SRQ-10) was used to assess global mental distress. Weights were assigned to the SRQ-10 responses based on DSM IV criteria for depression and a cut off point set at 7/20 for probable cases of mental distress. A structural equation modeling (SEM) was established to assess the structural relationship between HIV infection and mental distress in the model, with maximum likelihood ratio as the method of estimation.
The HIV prevalence was 13.6% vs. 18% in the rural and urban populations, respectively. The prevalence of mental distress was substantially higher among women than men and among groups with low educational attainment vs. high. The results of the SEM showed a close fit with the data. The final model revealed that self-rated health and self perceived HIV risk and worry of being HIV infected were important mediators between underlying factors, HIV infection and mental distress. The effect of HIV infection on mental distress was both direct and indirect, but was particularly strong through the indirect effects of health ratings and self perceived risk and worry of HIV infection.
These findings suggest a strong effect of HIV infection on mental distress. In this population where few knew their HIV status, this effect was mediated through self-perceptions of health status, found to capture changes in health perceptions related to HIV, and self-perceived risk and worry of actually being HIV infected.
Mental disorders make a substantial independent contribution to the burden of disease worldwide. It is estimated that, neuropsychiatric conditions account for up to 15% of all disability-adjusted life-years, and up to 30% of those attributable to non-communicable diseases. Neuropsychiatric disorders also account for 1.2 million deaths every year. [1, 2] These figures are most likely underestimated as official statistics in low and middle income countries are scanty and unreliable.  In sub-Saharan Africa, it has been reported that 20–30% of primary health care centre attendees present with depressive symptoms as the first or secondary reason for seeking medical care. A study conducted in Tanzania revealed a 41.6% prevalence of depressive symptoms among primary health care patients while a similar study in Uganda reported a 20–30% prevalence of psychological disorders and depression among health care seekers.[4, 5]. These research findings have also shown heightened risk for common mental disorders among the women i.e. a female to male ratio of 1.5–2.0. Other determinants have been found to include low socioeconomic position indicated by poor access to resources, unemployment and low educational attainment. It has also been shown to be higher among those with poor socio-support networks such as the unmarried, widowed and divorced. [6–8]
Mental disorders interact with many other health conditions, thus predicting the onset and progression of both physical and social disability. Several studies have established independent associations between mental disorders and an excess in all-cause mortality risk. In a meta-analysis, Saz and Dewey found pooled odds ratio of 1.7 for a diagnosis of depression and subsequent all-cause mortality.  Of particular relevance for this investigation is the interaction between mental disorders and HIV infection. Evidence has shown a heightened risk for contracting HIV infection among those with mental disorders. [10, 11] Socioeconomic, psychological and biological factors [1, 12–14] have been reported as predisposing factors in HIV infection and have also been found to be relevant factors in mental distress related HIV disease progression. [1, 12]. Mental disorders can also mediate delayed help seeking, diagnosis, poor compliance to medication  and can predict drop out from HIV-risk reduction programmes. [16, 17]
Although evidence from low income countries is limited, fairly consistent associations have been reported between HIV and poor mental health with most published studies showing differing but high percentages of mental distress, e.g. observations from South Africa with prevalence of 40% contrasting a study in rural Ethiopia showing14%.[18, 19] A meta-analysis of studies comparing HIV positive and HIV negative groups revealed a significant difference in the prevalence of major depression (HIV positive 9.4% vs. HIV negative 5.2%, OR 2.0, CI 1.3–3.0).  These studies have indicated that mental distress can be prevented by increasing the awareness about it among mental health personnel. [10, 11] The benefit of screening for mental distress is especially important among the HIV infected. Left undiagnosed mental distress leads to failure of the HIV positive to deal with their sero-status  with implications of increased substance abuse and suicides. All these put together build the case for early identification of patients with mental distress and prompt psychotherapy .
Despite the known benefits, the practice of screening for mental distress as it relates to HIV infection is still low in many countries. In Zambia, little is known about the extent of mental distress.  Considering that Zambia has a high prevalence of HIV [14, 23, 24] and assuming that HIV infection negatively affects mental health, this would suggest that the mental distress problem is substantial. However, few population based studies, i.e. covering men and women in the general population, have been conducted in sub-Saharan Africa to examine the relationship between HIV and mental distress. The aim of this study was to investigate the magnitude and determinants of mental distress with particular emphasis on the mechanisms involved in the way HIV infection impacts mental distress by establishing a linear structural equation model.
Measuring mental distress
A wide variety of questionnaires and instruments have been developed over the years to estimate psychological distress in the population, identify high risk groups for mental disorders and monitor the changes over time. The Self reporting questionnaire (SRQ) is an example of such a scale developed as part of a collaborative study on strategies for extending mental health care co-ordinated by the WHO.  Although primarily intended for use in epidemiological studies of mental disorders, it is also being used extensively for clinical and other research purposes.  It has been judged to be acceptable for most subjects and was found to be appropriate for use in different kinds of settings and countries. [11, 19, 25] It is now a well established responder-reported questionnaire for measuring psychological distress or the degree of global mental distress . In this study we use a Self reporting questionnaire with 10 symptom questions which are scored on a dichotomous scale but do not probe to evaluate symptom severity . It has also been shown that the shorter SRQ-10 performs just as well as the longer scales for evaluating mental distress, for example SCL-25 and SF-36 as well as other shorter scales such as SCL-10, SCL-5 and MHI-5. It has been suggested that it can be used in the place of longer scales for evaluating mental distress and yield comparable results.
In this model, a set of several linear equations are connected in a system. Our central theoretical premise is that mental distress has biological, social and psychological determinants. Therefore four hypotheses have been developed and require further testing. Firstly, we propose that, demographic characteristics and socioeconomic position indicators are directly and indirectly associated with mental distress.  Male gender, young age, (15–25 years), educational attainment, social support networks (being married vs. single) and wealth index are found to be positively associated with better mental health status.  Secondly, self-rated health, and self HIV risk perception and worries of being infected (HIV risk and worry) are also associated with better mental health.  Thirdly, we propose that HIV infection has both direct and indirect effects on mental distress.  Direct, mediated by biological factors and indirectly mediated through self-rated health and HIV risk and worry of being infected. [27, 28]
Population and Sampling Procedures
The population-based HIV surveys have been conducted in Zambia every third year since 1996 in selected rural (Kapiri Mposhi) and urban (Chelston) communities. For this investigation we used data from the survey conducted in 2003 (n = 4466) using stratified random-cluster sampling method. The detailed methods of the surveys conducted have been reported else where. [23, 29] The sampling frame consisted of 24 clusters (Standard Enumeration Areas) in Chelston and 26 clusters in Kapiri Mposhi. The cluster defined the primary sampling unit of the study. Using probability proportional to size, 10 clusters were selected from each of the areas. All household members 15–59 years in the selected clusters were listed and invited to participate in the study
The data was collected at household level by trained enumerators. Personal interviews were carried out with all eligible and willing household members in order to collect information on socio-demographic characteristics, health seeking behaviour, sexual behaviour and perception regarding HIV. Details of data collection methods have been described elsewhere.
Information on mental distress was collected using Self-reporting questionnaire-10 (SRQ-10) which is a 10 item questionnaire containing basically two domains namely, depressive symptoms and somatisation. The SRQ-10 is based on a dichotomous response answer system to the questions given in table 1 "In the past 30 days".... It is apparent from the review of studies done using the SRQ that no global or generally applicable cut-off score can be recommended and that each study should determine its own cut-off point. [11, 25] The rationale for setting the cutoff point of >7/20 in this study was based on the DSM-IV classification. Firstly each symptom was weighted according to severity with the more severe symptoms getting higher ranking, while the less severe symptoms got lower ranking (table 1). The cutoff point was then based on the DSM-IV requirement of 5 or more symptoms under the headings; thoughts of suicide, loss of interest or pleasure and depressed mood. These raw weights are then summed up in a transformed summative index ranging from 1–20. This continuous mental distress variable was used in the SEM model. Based on the DSM-1V criteria for depression which requires 5 or more items of the above that would represent a change in previous functioning, or at least either a depressed mood or loss of interest or pleasure, a cut off point of ≥7 for mental distress was set.
At the end of the interview the participants were requested to provide a saliva sample for HIV testing. The saliva samples were collected on an anonymous linked HIV testing protocol. BIONOR HIV 1&2 (BIONOR AS, Skein, Norway) paramagnetic particle assay was used as the first line test. The reactive samples were subsequently tested again using rapid test (Capillus HIV-1/HIV-2, Cambridge Biotechnology). Samples with discrepant results were sent for a confirmatory Western blot.
Data was analysed using SPSS version 15.0 and cluster effect accounted for in the analyses. Characteristics of the study population in terms of demographic, socioeconomic and HIV status were described using descriptive statistics. These were compared by sex, residence and HIV status in cross-tabulations. Only respondents with valid HIV results and aged 15–49 years were included in the subsequent analysis (N = 4466).
Analysis of Moment Structures (AMOS) version 7.0 was used in the Structural Equation Modelling (SEM)  to confirm the theoretical built model that included the underlying factors (demographic and socioeconomic), intermediate factors (self-rated health and HIV risk and worry), HIV status, knowledge of own HIV status and consequently mental distress. Firstly the model was designed and fitted based on the hypotheses. Secondly, regression coefficients and their significant levels for each parameter were calculated. Thirdly, relative chi-square statistic, goodness of fit index (GFI),  adjusted goodness of fit index (AGFI),  comparative fit index (CFI)  and root mean square error of Approximation (RMSEA)  index model fitness were obtained for model diagnostics. The criteria used were chi-square statistic of more than 0.50, GFI of equal or greater than 0.95, AGFI of equal or greater than 0.90, CFI greater or equal to 0.90 and RMSEA of less or equal to 0.08. [31–33] Addition of correlations between error terms, considering only the significant correlations as well as putting constraints on the parameters was done to improve the model. The total direct and indirect effects of the underlying and intermediate factors were calculated using standardised regression weights of each pathway with the maximum likelihood ratio as the method of estimation.
In the model, marital status was dichotomised to ever married variable grouped as, single (single, engaged, Living as married) vs. married (Married, divorced, separated, widowed). Level of education was used as a continuous variable (number of years in school). A wealth index scale was constructed using factor analysis from six questions assessing wealth status. A second summative index (HIV risk and worry) was constructed which combined responses to the questions concerning self perceived risk of HIV infection (In your situation, do you think that you are risk of getting (catching) HIV? 1 = you are not at risk, 2 = the risk is moderate or 3 = the risk is high or 4 = the risk is very high) and worry about being HIV infected (How worried are you about actually being infected by HIV/AIDS? 1 = Always worried, 2 = Sometimes worried, or 3 = Seldom worried, or 4 = Never worried). Self-rated health was also used as a continuous variable. (How would you say your health is at the moment? Is it 1 = Excellent, 2 = Good, 3 = Fair, 4 = Poor, 5 = Very poor). The dependant variable mental distress was also used as a continuous variable with scores ranging from 1–20. There was insignificant evidence of interaction between the variables and so no interaction terms were included. Measures were also done to account for design effect which had the effect of widening confidence interval.
The survey received ethical clearance from the University of Zambia Ethics Committee. Additionally, participation in the survey was based on written informed consent. Participants were counselled and informed that the information obtained was purely anonymous and for research purposes. Participants interested in knowing their HIV status were offered voluntary counselling and testing at home.
Characteristics of study population and extent of mental distress
Table 2 shows a pattern observed from an item to item analysis of the symptoms of mental distress. Daily life suffering (27.4%), frequent headaches (27.4%) and difficulty enjoying life (23.6%) were the most common symptoms among the HIV positive rural males. Comparatively, urban males complained more of poor sleep (21.4%), difficulty deciding (18.3%) and daily life suffering (18.3%). Among the HIV infected rural females poor sleep (23.6), daily life suffering (21.6) and frequent headaches (21.6) were the most common complaints. The urban female population presented with difficulty deciding (33.9%), frequent headaches (28.4%) and difficulty enjoying life (24.0%). Thoughts of suicide represented less than 6% of the total study population. Among the HIV infected, women (8.9%) reported contemplating suicide more than their male (3.0%) counterparts (p = 0.003). A similar pattern was noted among the HIV uninfected (men 3.6%, women 6.4%, p = 0.001)
The prevalence of HIV was 13.6% in rural and 18.0% in urban areas (Table 2). Knowledge of own HIV results was reported by 13.6%, and this knowledge differed clearly by residence, 8.3%in rural and 17.4% in urban (p < 0.001). Of these, 43.4% lived in rural areas and 56.6% were urban residents. The mean (SD) age of the men was 27(8.8) years and 27(8.9) years for women. Marital status differed substantially by residence, i.e. proportion being married was 66.7% in the rural and 81.4% in the urban population. Whereas 64.3% of the urban residence had attained at least 10 years of education, the respective proportion was 15.4% among rural residents.
The prevalence of mental distress in men was 12.4% and15.4% in women (χ 2 = 8.033, DF = 1, p = 0.005, i.e. a prevalence ratio, women: men of 1.24. This ratio was highest in the age-group 15–24 years of 1.6). Mental distress did not differ by residence (χ 2 = 0.190, DF = 1, p = 0.663) and only tended to increase by age. Mental distress was affected by educational attainment, i.e. the prevalence among urban residents was 2.3 times higher among the group with the lowest vs. the highest level of education, and the respective rural ratio was 1.94. (Table 3) A consistent pattern of higher mental distress among the HIV infected was observed by sex and residence, and the prevalence ratio infected vs. non-infected was 1.61. (χ 2 = 24.141, DF = 1, p = 0.000)
Table 4 shows the Pearson correlation coefficients matrix of the observed variables. Mental distress was correlated to self-rated health (r = 0.22), wealth index (r = 0.07), risk-worry (r = 0.15), HIV status (r = 0.08), age (r = 0.05) and inversely correlated to school years (r = -0.09). Self rated health was inversely correlated to residence (r = -0.14), school years (r = -0.18), marital status (r = -0.30) and directly correlated to wealth index (r = 0.17) and age (r = 0.18). Risk-worry was correlated to self rated health (r = 0.14) and age (r = 0.10, p < 0.05). HIV status was correlated to self rated health (r = 0.15), risk-worry (r = 0.10) and age (r = 0.21).
Figure 1 illustrates the final model with significant pathways and their associated goodness of fit indices. The model diagnostics indicated that the underlying factors, residence, school years, ever married and age were inter-correlated. However the error terms of Self-rated health, risk-worry, HIV status and mental distress were not correlated. The observed measures of model fitness were as follows: Chi-square for goodness-of-fit test (χ 2 = 237.7, DF = 12.0, p < 0.001), baseline comparisons (NFI = 0.931, CFI = 0.934) and parsimony-Adjusted measures (PRatio = 0.333, PCFI = 0.311, PNFI = 0.310, RMSEA = 0.037).
Structural relationships between observed variables
Table 5 shows significant structural relationships between the underlying, intermediate and outcome variables. Mental distress was directly related to risk-worry (b = 0.16), HIV status (b = 0.03) and self-rated health (b = 0.22). Self-rated health is related to age (b = 0.17), risk-worry (b = 0.12) and HIV status (b = 0.12). It was also directly related to school-years (b = 0.17). Risk-worry is directly related to both HIV (b = 0.09) while HIV status was found to be directly related to residence (b = 0.10) and age (b = 0.10).
Table 6 shows the total, direct and indirect effects of the observed independent variables on the dependant variables. Self-rated health and risk-worry appear to be important mediators between underlying factors and mental distress. They are also important mediators between HIV status and mental distress. Age is directly related to HIV status (B = 0.17). It is also directly related to Self-rated health (mediated by risk-worry and HIV status, B = 0.17) and indirectly related to mental distress (mediated by risk-worry and HIV status, B = 0.05). Residence is directly related to HIV status (B = 0.10) and indirectly related to mental distress mediated by risk-worry and HIV status with a small total effect B = 0.01). Number of school years is directly related to self-rated health (B = 0.17) and indirectly related to mental distress (mediated by risk-worry and HIV status, B = -0.04). Risk-worry is related to mental distress both directly and indirectly (Total effect B = 0.20). Self-rated health is directly related to mental distress (B = 0.22). HIV status is related to mental distress both directly and indirectly mediated by risk-worry and self-rated health (Total effect = 0.07).
We investigated the magnitude and distribution patterns of mental distress and employed a structural equation model to explore mechanisms involved in the impact of HIV on mental distress. Data stem from a population based HIV survey in Zambia using the SRQ-10 as the tool to measure mental distress. The prevalence of HIV was 13.5% and 18.2% for the rural and urban population, respectively, and most of the survey participants (86.4%) did not know their own HIV status. The prevalence of mental distress was somewhat higher among women (15.4%) than among men (12.4%, p = 0.005), but no urban-rural difference was revealed. The results suggest the effect of HIV infection on mental distress to be both direct and indirect, and particularly strong through the indirect effects of poor health ratings and high self perceived risk and worry of HIV infection. In this regard it should be noticed that self-rated health has previously been found to capture changes in health perceptions related to HIV. In the model, this impact appears to be socially patterned with the number of school years being indirectly related to mental distress in a pattern mediated by self-rated health, risk-worry and HIV status. Age and residence were found to be directly related to HIV status but indirectly related to mental distress in a path mediated also by risk-worry and self-rated health.
Although complex, our model obviously represents an oversimplification of the factors at play. The empirical basis for this structural model might be somewhat shaky, but we judge the plausibility of most specifications to be fairly strong. The theoretical basis underlying the specifications of the model is also thought to be fairly strong as the introduced measures in the present model have been judged to cover most of the dimensions postulated by other authors. The fit indices for our model show a close fitting model. However, the chi-square test as a measure of fit is best for models with N = 75 to N = 100. [31, 33, 34] For N>100, chi square is almost always significant since the magnitude is affected by the sample size, as in our case where N = 4466 (p = 0.000). Chi-square is also affected by the size of correlations in the model: the larger the correlations, the poorer the seeming fit of the model.
The results confirm previous findings suggesting a strong impact of HIV infection on mental distress. [35, 36] In this present study only 13% knew their own HIV status, accordingly, we are likely to have measured a combination of HIV-related effects both biological and psychological. Based on HIV epidemiological evidence we can assume that, on a group level, most HIV infections in young people are resent and that in older groups we can expect that the HIV positive on average have been infected longer and thus will have experienced much more serious impact on their immune system. A simple assumption in our analysis will thus be that the difference in mental distress between HIV infected and uninfected will increase by age. The data did not provide clear evidence of this. However, in the suggested path diagram, to model the determinants of mental distress, self-rated health and self perceived risk and worry about being HIV infected (risk-worry) were assumed to capture indirect effects of HIV on mental distress. Self-rated health has previously been found to capture changes in health perceptions related to HIV.  Literature on predictors of self-rated health has shown depression as a strong independent determinant even after accounting for physical illness and functional disability. [37, 38] Therefore, self-rated health and risk-worry appear to be sensitive indicators of health changes linked to HIV and mental distress. [28, 37] We found strong independent associations between HIV and self-rated health, HIV and risk-worry and between self-rated health, risk-worry and mental distress. A possible interpretation is that the three variables are together capturing effects of HIV – being direct as a biological – or an indirect as a psychological effect. These findings need to be followed up by further studies trying to sort out what could be the more biological versus other effects of HIV infection on mental distress. The estimates may also have been biased by measurement errors. We were unable to find comparable studies on mental distress covering the general population of men and women. Most studies found were conducted among selected groups such as homosexuals, injection drug users and hospital/clinic attendees. [18, 35, 39, 40] It was as such difficult to make direct comparisons with other published literature. However, the patterns of association appear to be similar to other published literature. [18, 19, 41–43]
The SRQ-10 appears to be a practical tool for measuring mental distress although more needs to be done to validate its use in the Zambian context. In order to attain a more accurate standard for the diagnosis of global mental distress, the 10 indicator questions were weighted and a cut off point of 7 set based on the adapted criterion for the DSM-IV classification for depression.  The question of generalization of findings (national, regional levels) is difficult to judge. The communities from which this study was conducted were selected on the basis of being reasonably representative in terms of HIV prevalence and cultural mix to the other communities in Zambia. It is likely that the HIV-mental distress relationship can be extrapolated to the national level and to many other countries in the region as well.
Non-participation might have been one of the possible sources of biases in prevalence estimates and associations in this investigation. Whereas refusal to participate was low, the non-participation due to absence was relatively high among men. The 2003 population-based survey was a follow-up of previous surveys in the same populations (since 1995). Previous publications investigating the HIV prevalence trends on the basis of these repeated surveys reported marked HIV declines since 1995, and the authors did not find any sign of substantial bias due to non-response.  For the present analysis we are concerned about the extent to which non-response might have biased prevalence of mental distress and the associations. Given an assumption that non-responders were more likely to be mentally distressed than responders, we would have under-estimated the magnitude of distress and most likely reduced the strengths of associations. Men were substantially more likely to be absent, and a possibility given the above scenario is that the difference between men and women was actually under-estimated. However, there were limited opportunities to further assess the magnitude and direction of this type of bias.
There are a number of limitations of this study. One is the cross-sectional nature of the survey data, which limits the validity of statements of causation to statements only about associations. However, our main interest was not to establish causal pathways, but rather patterns of interrelationships in the data that would fit to a better or worse degree the assumptions of our theoretical premise. Strictly speaking just as mental distress can predispose to HIV infection, the converse is also theoretically possible. It should be noted that the associations revealed in cross-sectional data have very often provided reliable indications of actual effects, and the revealed strong indirect association between HIV status and mental distress is in agreement with previous findings [35, 40] The ubiquitous problem of omitted variables is also a factor in this present study. The relationship between mental distress and HIV could also be attributable to other factors not included in our analysis. Examples include employment status, other social and economic factors or indeed other stress inducers not included in our analysis. Further, a more optimal design would have been needed to measure the biological effect of HIV infection adequately to include information on HIV clinical staging and CD4 counts. The data were not affected by antiretroviral treatment effects, since such treatment in practical terms was not available in these populations in 2003.
The results suggest that HIV infection has a substantial effect on mental distress both directly and indirectly. This effect was mediated through self-perceptions of health status, found to capture changes in health perceptions related to HIV, and self-perceived risk and worry of actually being HIV infected. To our knowledge this is the first study to investigate the pattern of relationship between HIV and mental distress by using the structural equation modeling. The use of the structural equation modeling allowed for simultaneous evaluation of the direct and indirect effects of background and intermediate factors on mental distress within the framework of the model. More research is urgently needed into this area in order to understand the epidemiology of mental distress and the complex inter-relationship with HIV infection. This may provide many new challenges and open other avenues for dealing with the HIV epidemic and its many facets. Subsequent research needs to be directed to local validation of the SRQ-10. It would also need to assess the mental and behavioral changes occurring in individuals who are HIV positive and are commenced on highly active anti-retroviral drugs. Among the many challenges is how to improve prevention, screening and diagnosis for mental distress as targeted at the most vulnerable groups, such as the poor, the lower educated, the women, the widowed and predominately the HIV infected. Another challenge is strengthening existing mental health facilities and capacity building in order to improve access to universal basic mental health care. This is of critical importance as it would provide knowledge, confer skills necessary for assimilating health promotional information on HIV which in turn is likely to be linked to both reduced risk of mental distress and HIV transmission.
Human Immunodeficiency Virus
Acquired Immunodeficiency Syndrome
Cellular differentiation marker 4
Highly Active Anti-retroviral Therapy
Self Reporting Questionnaire-10
- DSM IV:
Diagnostic and Statistical Manual IV
International Classification of Diseases version 10
- AMOS 7:
Analysis of Moment Structures version 7.0
Structural Equation Modeling
Goodness of Fit Index
Adjusted Goodness of Fit Index
Comparative Fit Index
Root Mean Square Error of Approximation.
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Mulaik SA, James LR, VanAlstine J, Bennett N, Lind S, Stilwell CD: Evaluation of goodness of-fit indices for structural equation models. Psychol Bull. 1989, 105: 430-45. 10.1037/0033-2909.105.3.430.
Bentler P: Comparantive fit indexes in structural models. Psychol Bull. 1990, 107: 238-46. 10.1037/0033-2909.107.2.238.
Steiger JH: Structural model evaluation and modification: An interval estimation approach. Multivariate Behav Res. 1990, 25: 173-80. 10.1207/s15327906mbr2502_4.
Katz M, Douglas JM, Bolan GA, Marx R, Sweat M, Park M-S, Buchbinder SP: Depression and the use of Mental Health services among HIV-infected Men. AIDS CARE. 1996, 8 (4): 433-42. 10.1080/09540129650125623.
Tafari S, Aboud FE, Larson CP: Determinants of mental illness in a rural Ethiopian adult population. Social Science and Medicine. 1991, 32 (2): 197-201. 10.1016/0277-9536(91)90060-P.
Fylkesnes K, Førde OH: The Tromsø study: predictors of self-evaluated health-has society adopted the expanded health concept?. Social Science and Medicine. 1991, 32: 141-6. 10.1016/0277-9536(91)90053-F.
Mulsant BH, Ganguli M: The relationship between self-rated health and depressive symptoms in an epidemiological sample of community-dwelling older adults. J Am Geriatric Soc. 1997, 45: 954-8.
Komiti A, Judd F, Grech P, Mijch A, Hoy J, Williams B, Street A, Lloyd JH: Depression in people living with HIV/AIDS attending primary care and outpatient clinics. Australian and New Zealand Journal of Psychiatry. 2003, 37 (1): 70-83. 10.1046/j.1440-1614.2003.01118.x.
Morrison M, Petitto JM, et al: Depressive and anxiety disorders in women with HIV Infection. Am J Psychiatry. 2002, 159 (5): 789-96. 10.1176/appi.ajp.159.5.789.
German GA: Mental health in Africa: the extent of mental health in Africa today. British Journal of Psychiatry. 1987, 151: 149-62.
Biswajit S, Williams P: The extent and nature of depressive phenomena in primary health care: A study in Calcutta. Br J Psychiatry. 1987, 151: 486-93. 10.1192/bjp.151.4.486.
Harding TW, de Arango MV, Baltazar J, Climent CE, Ibrahim HH, Ladrido-Ignacio L, et al: Mental disorders in primary health: A study of their frequency and diagnosis in four developing countries. Psychol Med. 1980, 10 (2): 231-41. 10.1017/S0033291700043993.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/9/298/prepub
The authors would like to acknowledge Jørn Hetland and David Sam-Lackland for their help with the AMOS 7.0 program and the structural equation modeling. We would also like to acknowledge the financial support from Norwegian Programme for Development, Research and Education (NUFU) through the project "Strengthening HIV interventions in Zambia: Cooperation in research and institutional capacity building".
The authors declare that they have no competing interests.
PJC and KMF contributed to the analysis and drafting of the manuscript. KMF also contributed to the design, conduct, and critical revision of manuscript and approval of final version.
Peter J Chipimo and Knut Fylkesnes contributed equally to this work.
Authors’ original submitted files for images
About this article
Cite this article
Chipimo, P.J., Fylkesnes, K. Mental distress in the general population in Zambia: Impact of HIV and social factors. BMC Public Health 9, 298 (2009). https://doi.org/10.1186/1471-2458-9-298

domain: psychology


text:
Another Auto Recall – This Time it’s Cadillac
General Motors is recalling more than 27,000 Cadillac SUV's, because the wheels can fall off.
Our news partner, WZZM TV13, reports that the worldwide recall affects the 2013 model year Cadillac SRX's with 18-inch wheels. Safety regulators in Canada say the lugnuts on the wheels may not have been tightened enough at the factory.
Yikes! Your tires could fall off?
GM says no tires have fallen off and the issue hasn't caused any injuries or crashes, but, better safe than sorry. I'm with them.
Dealers will rotate the tires and tighten the lugnuts at no cost to the owners.

domain: news


text:
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Wawa to debut two new Orlando-area stores in January
Wawa Inc. is set to hit the eight-store mark in Florida this month.
The Pennsylvania-based fuel and convenience retailer, whose expansion into Central Florida was selected as one of Orlando Business Journal’s most transformational deals in 2012, will open two new stores in January as follows:
- 1615 S. Orange Blossom Trail in Apopka opens on Jan. 9 at 10 a.m.
- 8049 E. Colonial Dr. in east Orlando opens on Jan. 23 at 10 a.m.
Wawa also plans to open a store at 2251 N. Semoran Blvd. in Winter Park sometime during the first quarter, along with six more stores during the second quarter, some of which I told you about last October.
Two more planned for the second quarter are at 1125 Irlo Bronson Memorial Highway in St. Cloud and 5035 S. Orange Blossom Trail in Kissimmee.
In addition, I’ve seen at least three more under construction, two on the east side of town and one heading towards downtown from east Orlando.
Additionally, Wawa plans to introduce its first five Tampa Bay-area stores starting next month.
Which Wawa are you excited to see coming online? Leave a comment below or e-mail me.
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domain: geography


text:
“I used to be a man…now I’m not sure what I am.Â They say I’m an angel, but aren’t angels meant to be holy?”
When I first became aware of the Guest Style Consultant idea, I was thrilled, because it allowed me to realise an unfulfilled desire as someone who had almost started writing for the blog but had to pull out due to limited time (thanks Ryan!).Â But that left a problem: what to cover?Â I was very clear on one thing. Â It had to be something that hadn’t been done much before, and preferably with some content creators who hadn’t been showcased before.Â Ryan, Express and the rest of the team are great at so many things that it’s hard to cover something in the contemporary fashion world, or for instance in steampunk without running (unfavourably, I’m sure!) into comparisons with their expertise.Â Then it hit me — play to my own strengths.
I’m a roleplayer. Â For those of you who don’t indulge in this pastime very much, I should explain that roleplayers are geeks…but geeks often with an obsessive sense of a proper way to do things and sometimes with great style.Â If we’re not actively roleplaying, we’re often to be found shopping for things to make our roleplay experience better; and often that means clothes and accessories. Â Wander around some of the better roleplaying sims and you’ll see some truly wonderful (as well as awful) costumes or even takes on modern dress.Â I wanted something different though.Â Through years of roleplaying in science fiction, I wanted this to be my first theme.
That very word brings up so many different images instantly and I knew this to be the theme for this; it also allowed me to show you the work of someone I’d been bugging Ryan to highlight for a little while.Â That is, Mantis Oh of ::Hybrid Productions:: — and an added bonus is he’s Icelandic!Â Whilst I’m (sadly) not Icelandic myself but British, I’m an unashamed Icelandophile; I love the country — its startling scenery, its enigmatic musicians (Bjork & Sigur Ros are two of my favourites) and its almost inherent quality of combining beauty and kookiness and shaking them together with funk and producing something simultaneously quite unconventional and gorgeous.
Mantis’ work (including his startlingly futuristic store) is no exception.Â Although he does make some good clothes, I was more interested in his prim accessories for this shoot, as this is where his talent really shines out.Â He’s made a whole line of belts, skirts, boots, armguards and lots of other little attachments mainly in three colour schemes: silver/grey/white, grey/black/red, grey/yellow/black. Â I decided to go for his signature range of mantis-inspired gear in silver/grey/white.Â The rather splendid mask I’m wearing is a mechanical mantis face with beady illuminated eyes and lots of electronic twittering and chirping effects.Â The armguardsÂ are like the arms of a preying mantis with their recurved spines again complete with the odd special effect suddenly drifting out of nowhere for the hell of it.Â It’s all very exuberant stuff.Â Add to that a techno-beltÂ with a cloth skirt attachment and some beautifully moulded moon-bootsÂ and you have the bones of a great outfit.Â I’m also wearing his fingerless gloves and his especially startling silver prophecies tattoo, which because it is white seemed to go with the future-tranquil look I was aiming for.
I must give credit also to an old friend — *Muism* — as I’m wearing Icemocolo Voom’s excellent “Shaggy” hair in Ash Blonde and also his “Damaged Jeans” in white.Â You will have seen the Damaged Jeans recently on the first Guest Consultant article by Kith DeCuir.Â Quite separately, I’ve had these for a while and I like them because they’re the antithesis of what white jeans “should” be.Â These are not pristine and perfectly ironed, these are damaged — and I like that!
“…My physical hurts still took months to heal, and my mental scars longer still.Â I am told I spoke no human word for a year afterwards but only cried or screamed in a bestial manner.Â I was unmanageable, feral and dangerous.Â Then my father indeed regretted his choice but still could not bear to have me killed.”
Pulling these together and making an outfit out of them, I wanted to make a character, imagining myself to be in a roleplay.Â So I hit on the theme of a young hero tragically brought to the brink of death by an ambush and left horribly mutilated.Â The only way his grieving father could save his only son was to enlist the aid of a techno-mage to have him cybernetically enhanced until only a trace of his humanity is left (Darth Vader, anyone?) and he was turned into…yep, you guessed it, a ::hybrid:: !Â You’ll notice I have an artificial heartÂ here,Â a superb attachment from those cyberpunk experts at Necronom, which you simply have to see in-world to fully appreciate how realistically it beats.Â To add to the effect, I donned some plain white eyes with some glowing spheres as eye attachments. Â I’ve also added the “Dundee – Hanging Sun” necklace from Emery but made the sun prim glow — well, this is science fiction after all!
Pretty good, but not quite right yet.Â Going with my theme of a young man who really should have been left to die rather than turned into a mechanical abomination, I added the “Longfeather Flexiwings”Â by Kazuhiro Aridian to turn him into an “angel” (though he is far from this), signifying his return from death.Â These are some of the most beautiful angel wings I’ve seen in SL.Â They’re not uniform, not glowy but they are what they say they are — longfeathered and flexible, giving the impression of long eagles’ feathers.
A final couple of touches are added by the monochromatic “Eternal Staff” found at Amulius Lioncourt’s Weapon Shoppe and the rotating “Ancient Forceblade” light saber from VAAS Innovazione.
“…for while I have gained many things, I have also lost much.Â I fear humanity and compassion may be among them and perhaps I lost them with my heart.
“It is a terrible thing to fear oneself.”
= | = | = | = | = | = | = | = | = | = | = | = | = | = | = | = | = | = | = | = | =
“<TheAbyss> Scorpio_Origin 1[A] Body Hair” – by Khai Sinister,Â The Abyss
“*Muism* Shaggy / light ash blonde_L” – by Icemocolo Voom, *Muism*
“White Eyes” – can’t work out who made these but they are free full-perm, so IMÂ Leonardis for a copy, or use your own.Â [I'll also put these outÂ at my inworld office (check my Picks) in a box that you can pick up for free.
“:: Hybrid Prod :: Tattoo : Prophecies (Silver)” – by Mantis Oh, :: Hybrid Productions ::
“Longfeather Flexiwings” – by Kazuhiro Aridian,
[g a n y m e d e]
“*Muism* Damaged Jeans/White [Male]” – by Icemocolo Voom, *Muism*
“:: Hybrid Prod :: BO72 Skirt White (Male)”Â – by Mantis Oh, :: Hybrid Productions ::
“:: Hybrid Prod :: Mantoid Gloves (Silver)” – by Mantis Oh, :: Hybrid Productions ::
“:: Hybrid Prod :: MoonBoot Silver”Â – by Mantis Oh, :: Hybrid Productions ::
“Dundee – Hanging Sun” necklace – by DeLirio Bailey, Emery
“Necronom Cyberheart – cyberpunk organ” – by Oni Horan, Necronom
“:: Hybrid Prod :: Mantoid Armguards Silver”Â – by Mantis Oh, :: Hybrid Productions ::
“:: Hybrid Prod :: Mantoid 242 Mask Silver”Â – by Mantis Oh, :: Hybrid Productions ::
“Eternal Staff” – by Amulius Lioncourt, Amulius Lioncourt – Forge and Weapon Shoppe
“VAAS – Ancient ForceBlade” (lightsaber) – by Attia Sontse, VAAS Innovazione

domain: artistic


text:
2 edition of Riddle me this found in the catalog.
Riddle me this
Frances Nicholson Chrystie
|Statement||compiled by Frances Chrystie, pictures by Elizabeth B. Ripley.|
|LC Classifications||PN6371 .C53|
|The Physical Object|
|Number of Pages||55|
|LC Control Number||41002623|
Get this from a library! Riddle me this. [Frances N Chrystie] -- Many boys and girls have helped to make this book of riddles, in response to Miss Chrystie's request for contributions. Riddle me this. This is a riddle about a character in a Book, written in thé naughties; authors 2nd Book. I am looking for Book name. It was asked in my WhatsApp games night group. Still unsolved. Sing of a girl, little flower, born in a cradle of culture. They really should have .
The Answer to the Riddle Is Me is [MacLean's] vivid reflection on the 10 years following the Lariam-induced break with reality and the memory problems that persisted in its wake a writer by trade, [MacLean] tells his story because it is a good one: dramatic and unique. The New York Times Book Review - Sally Satel. 09/30//5(3). Welcome to Roanoke’s longest-running Escape Room, where we put the the most emphasis on fun! Whether you’re a seasoned enthusiast or you’re new to the whole world of escape rooms, you will find a fun, challenging, and thrilling experience for you and your friends at Riddle Me Roanoke.
Get riddles and answers to share and challenge your friends. You can vote for your favorites, leave comments and submit your own riddles to share. Get this from a library! Riddle me, riddle me, ree. [Maria Leach; William Wiesner] -- Riddles from all areas of the world are grouped under such topics as mankind, animals, plants, and the universe.
role of automation and robotics in advancing United States competitiveness
Good psychiatric practice
Nurses for leadership
puppetry indoor-outdoor classroom book.
economic theory of alliances
Prestressed concrete beams
Spanish, an intermediate course
Sewer system of Phoenix Sewer Co.
New York City during the War for Independence
Sociology of the family
The Astrologers Guide
Unitarians answer to the pleas of Agnosticism
Breaking the Ruhls
I got a false book(the kind where you put stuff inside) and I'm making a cover for it. I have a book of riddles with one where the answer is "lie", but I can't find any with book as the answer.
I want the cover to have two riddles, so that when you solve both of them it says "lie book". Riddle Me Home is very well written and interesting. I usually don't read crime novels but I may in the future!. Lots of great twists and very easy to get into. I read the first two chapters and was hooked.
I can't wait for the author to write another book!/5(18). The Answer to the Riddle is Me is a memoir covering everything from when David lost his memory at that train station, to events years later when he finally started to get better. More than anything, the book is a tale of struggle and how hard it is to live with something as devastating as forgetting entire sections of your life for good/5(86).
Riddle: I'm so fast you can't see me, though everyone else can see straight through me. I don't stop until the day you die. What am I. The Math Riddle Book - Name: _____ Skill: 4-Digit Addition (regrouping) The Cookie Went to the Doctor ANSWER KEY Add to find the sums.
Then, solve the riddle by matching the letters to the blank lines below. E 4, + 7, 11, I 3, Riddle me this book 2, 5, A 5, + 5, Riddle Me This. book. Read 5 reviews from the world's largest community for readers. The Riddler has everyone in Gotham City scratching their heads over /5. Riddle me this, Batman can be used in any of the contexts, owing to the phrase’s association with the Riddler.
A book of philosophical essays related to Batman was titled Riddle Me This, Batman. Also, thanks and allusion to Batman’s Riddler, riddle me this is often paired with riddle me that for further expressive effect. An American fiction writer with an extensive backlog of novels that’s growing day-by-day, the writer A.G.
Riddle has created a niche for himself within the literature industry. Riddle Me This. 2, likes 4, talking about this.
Challenge your mind with these cool riddles & brain teasers. Put your best detective hat on and get ready to riddle me this!Followers: M. The Answer to the Riddle Is Me is MacLeans quirky account of his temporary amnesia, triggered by anti-malarial drug Lariam.
Hed been in India on a Fulbright fellowship, studying languages and planning an experimental novel/5. About Riddle Me This!: Riddles for all the Family by Liam Malone. I am an odd number. Take away a letter and I become even.
What number am I. I’ll be having a conversation or thinking on my own and something will hit me like “Hey, that could make a great book.” I’ll then sit and start writing a prologue based on that idea. RIDDLE ME KIDS. Can you solve the clues before time runs out.
Home. Book A Game. Contact. Birthday Parties. FAQ. Gift Cards. More. Choose a Room. Riddle Me This Escape Rooms is an immersive, live action game of puzzles, riddles, and problem solving.
Home BOOK NOW FAQs Team Building Waiver Gift Certificates Promotions. Riddle Me This Part One of Two Note: This book is split into two separate parts.
I decided to do this instead of creating a whole new book in order to continue the story. Part One: Years ago I had to escape a boy. You might be thinking, ‘She ran away’. I killed myself. It was the only way to escape him. Riddle: What can be lost, but not returned.
Riddle me this?. Riddle Meme with riddle and answer link. Riddle-me Riddle-me Riddle-me-ree Riddle. Riddle-me riddle-me riddle-me-ree, Perhaps you can tell what this riddle may be: As deep as a house, as round as a cup, And all the king's horses can't draw it up.
riddle me this | tom riddle chapter zero • companion. nana. a book in his hand. He seemed to be around your age with sleak raven hair neatly combed and dark hues that carried on skimming through the words in his book rather than take notice of your presence.
Unlike the other wizards you have encountered in the runninrg train, he wore. Book Riddles September 1, By Stephen Pepper Here are six riddles for kids where the answer is a book, so they’re great for using with our other library, household item and school riddles.
Book Now. All bookings can be made private with a 4 player or $ minimum. Just select the private option. We require that participants between the ages of 9 and 13 be accompanied by a paying adult that is 18 and up.
Families wishing to bring children ages 8 and under will need to purchase the private room to have the room to on: Mayland Court Richmond, VA, United States.
Riddle Me Kids (beside York Dance Studio, look for red sign) Leslie St. Unit Newmarket, ON. L3Y 3E3 [email protected] Home.
Book online. Contact. While its not really a riddle, as part of the tomb of annhilation, theres a cryptic message on each floor that gives hints for waht to do that me and my party have done a decent job with.
Only problem is Asherak, the lich who created the dungeon, is a asshole and thus while none of the messages have been false, some have led us to do some.Scavenger hunt clues for your next birthday or holiday party are just a few clicks away with Riddle Me. Customize your adventure with our powerful riddle database engine and your children are in for an unforgettable event.
Easter egg, Halloween, and Christmas scavenger hunts and treasure hunts. Riddle Me makes it easy.PLB When young Constance accidentally lets the cabin’s fire die out, her father composes a riddle to cheer her up, spawning a riddle marathon as the entire family participates in creating conundrums.
Karim devises clever puzzles that reveal the origins of items that would be commonplace for a pioneer, e.g. before it was a basket, it was “saplings that leaned in the wind.”Author: Roberta Karim.

domain: literature


text:
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domain: pet


With smaller beach fronts this summer, many people are packing in, leading to increased concern over water safety. NBC 5’s Kate Chappell reports.
Since pools closed for summer, more people are heading to the beach. But with high water levels and erosion leading to smaller beach fronts, many are packing in, leading to increased concern over water safety. Dave Benjamin, co-founder of the Great Lakes Surf Rescue Project, has used this time to educate the public about the risks involved. GLSRP is a…


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text:
What a season this is turning out to be as Sittingbourne saw off opposition from a division higher on their way to recording a sixth successive win.
Ok, when the season started doing well in the League Cup wouldn’t have been as big a priority as challenging in the league or having a good run in the FA Cup or FA Trophy.
But this was a football match and it was there to be won and Sittingbourne – despite changing half their team from the side that won in the Trophy on Saturday at Ashford – pulled it off in style.
And Merstham weren’t big time charlies taking an easy night off from the stresses of the Bostik Premier Division, they put in plenty of effort and all but one of the starting line-up was in the squad for their
league match last Saturday.
On a blustery night there was a healthy gathering of scouts from top clubs there to keep an eye on the progress of Sittingbourne teenager Lex Allan.
He was one of five players who weren’t in the side that started at Ashford, with goalkeeper Harry Brooks, Tom Loynes, Bola Dawodu and David Smith also getting a chance, as regulars like Daren Hawkes, John Coker, Kane Phillip, Kane Rowland and Laurence Ball were given a rest.
The change in personnel did nothing to interrupt the rhythm and confidence of in-form Sittingbourne and they started strongly against a Merstham side determined to play out from the back each and every time.
After Miles Cornwell had a couple of shots blocked and David Smith shot over, Sittingbourne got the only goal of the match after 20 minutes.
Their commitment to pressing high up the pitch paid off as a Merstham defender was caught in possession by Loynes when he charged down an attempted clearance. He raced clear on goal but as the keeper came out, instead of shooting, he unselfishly passed the ball sideways to the supporting Smith who rolled it into the empty net. To my mind, that’s a perfect team goal, and as Phillip did the same at Horsham recently, it’s obviously something drilled into players to put team before self.
Keeper Brooks is a terrific second option for Sittingbourne and he did well to save with his feet in a rare first half chance for Merstham, who tended to over-play despite some decent possession.
Into the second half and Sittingbourne were threatening every time they went forward but chances were few and far between at either end before a frantic last 10 minutes.
Brooks made an excellent 80th minute save from Merstham danger-man Bennett, tipping his shot over the bar, and a few minutes later the same player went even closer, his shot pinging back off the bar.
There were a few scary moments from corners, but Sittingbourne defended stubbornly and defiantly to hold out for a fifth clean sheet. All the back four played well, with Ollie Brown terrific at left-back in holding
out against a pacy and tricky winger.
At the other end, Sittingbourne wasted a handful of glorious chances as Merstham neglected defensive duties in pursuit of an equaliser, the home team’s finishing nowhere near as slick as their impressive build-up
All in all, though, it was an excellent result – another excellent result – and a deserved reward for hard work, good organisation, and a fantastic team spirit.
Ken Medwyn's Photographs
Match Day Programme
David Smith 20 mins
Referee: Mr Ricky Adams;
Assistants: Mr Andrew Simmonds, Mr Rhys Battye.
Tyrone Guthrie (Jide Okimeji, 44 min), Ben Gorham,
David Smith (Kane Rowland, 70 min), Miles Cornwell (Kane Phillip, 63
Subs not used: John Coker, Daren Hawkes.
Sinn Kaye Christie,
Stephen Hamilton-Forbes (Sonny Black, 75 min),
Simon Cooper (Yellow card),
Sahr Kabba (Reece Hall, 69 min),
Subs not used: Jelan Jones,
Anh War Tran-West,
Two late goals distorted the scoreline – this was a very closely-contested...
A fifth successive away league win for Sittingbourne keeps them heavily involved...
Much has changed at Summers Lane, home of Wingate & Finchley, since I...
The odds were stacked against Sittingbourne from the...
A powerful second half performance saw Sittingbourne battle back for a deserved...

domain: sports


text:
Singularity Future Technology Ltd
Singularity Future Technology Ltd Stock, NASDAQ:SGLY
Singularity Future Technology Ltd. is a global logistics and ship management services company. The firm provides tailored solutions and value-added services to its customers to drive efficiency and control in related steps throughout the entire shipping and freight logistics chain. It operates through the following segments: Shipping Agency and Management Services, Freight Logistics Services, and Container Trucking Services. The company was founded by Lei Cao on April 2001 and is headquartered in Great Neck, NY.

domain: economics


Found January 22, 2013 on
Crystal Ball Run:
Notre Dame Fighting Irish
Ohio State Buckeyes
The Oregon Ducks only had one game in 2012 where they scored less than 35 points. Unfortunately, it was that game, a 17-14 overtime loss to Stanford, that kept the Ducks from playing for the BCS Championship. 2013 will be a time of transition for the Oregon Ducks, as former head coach Chip Kelly has left the program, taking his talents to the NFL and the Philadelphia Eagles. Kelly's imprint has been left on the program, to be sure. So much so, in fact, that Oregon decided to promote offensive coordinator Mark Helfrich to head coach, marking the third straight time that Oregon's head coach came from the OC position. Helfrich is the Ducks fourth head coach since 1995. The Good: Marcus Mariota and De'Anthony Thomas return for another season in the backfield. The loss of Kenjon Barner and his 1767 yards and 21 touchdowns will hurt a bit. But with Thomas and Mariota, plus more of rising sophomore tailback Byron Marshall, the Ducks running game should be just as dange...
BEST OF MAXIM
START OF SOMETHING NEW
Oregon has has promoted offensive coordinator Mark Helfrich to take over as the team's head coach. He has been with the Ducks since 2009.
Remember when Spaz took over and he hired a bunch of guys with UNH connections? We never turned into "Oregon East" for variety of reasons, but it is interesting to see that Chip Kelly is collecting a bunch of BC guys on his NFL team. First it was McGovern, then Bob Bicknell, and now Mike Dawson.What's interesting about the Dawson hire is that he left big-time football...
The search to find Chip Kelly’s successor in Oregon was quick, and the ducks didn’t have to spend any travel expenses making it happen.
According to ESPN L.A., Oregon will promote offensive coordinator Mark Helfrich to head coach. Helfrich has been the Ducks’ offensive coordinator since 2009.
Oregon’s offense ranked second in the nation this season with 49.6 points per...
Next Man Up
Four years ago the Oregon Ducks football program promoted Chip Kelly, their innovative offensive coordinator who had never held a head coaching position, to Head Coach in a move that surprised many people around the nation. While his offense was quickly becoming one of the most talked about units in football, many questioned whether or not he had the ability to take...
Oregon's new coach painted different strokes with different brushes than their last one. Mark Helfrich was formally introduced as the new Oregon Ducks head football coach Sunday afternoon in Eugene, leading off his era with a press conference in which the new main man on campus was personable, humble, friendly, affable and reasonable.
In his opening salvo, Helfrich talked...
Perhaps Chip Kelly is all that he's cracked up to be? DK examines the circumstances surrounding the Oregon coach ending up as the Philadelphia Eagles head coach.
In the short time that offensive guru Chip Kelly was head coach at Oregon, his impact on the Ducks was staggering. With the help of Nike CEO Phil Knight's money, Kelly helped elevate UO from one of the country's better programs to one of its best.
Kelly has taken his talents to the NFL, leaving the Oregon job in the hands of offensive coordinator Mark Helfrich. Will...
Mark Helfrich met the media today as Oregon's new head coach, and made a strong impression with his sincerity and enthusiasm for the job.
"This is the pinnacle for me," he said. Welcome words to an Oregon fan base and donor group after Chip Kelly's year-long flirtation with the NFL and double reverse departure this Wednesday. In the 39-year-old Helfrich the Ducks...
The news came in the middle of the departure of Chip Kelly and the formal announcement of the promotion of Mark Helfrich; the defensive coordinator, once again, sandwiched and forgotten in-between two brilliant offensive minds, in a region and conference where offense rules. Last Thursday, Nick Aliotti, Oregon's perennially under-appreciated defensive coordinator, finally...
Chip Kelly has been in Mobile, Alabama for the Senior Bowl only a few days and he’s already flirting with the idea of bringing in a new quarterback.High on Kelly’s wish list is Florida State quarterback EJ Manuel, who Kelly recruited heavily while at Oregon, narrowly losing him to Florida State (Manuel wanted to stay closer to home). The two met and discussed some things, and...
The hiring of Oregon head coach Chip Kelly came as quite a surprise. Kelly stated that he was going to remain at Oregon and suddenly, without warning, the Philadelphia Eagles announced his hiring as the team’s head coach. Now comes an even more surprising potential hire for the Eagles organization. Former Cleveland Browns head coach Pat Shurmur as the team’s offensive coordinator...
Future quarterbacks this is not how you slide especially when Ed Reed is coming to try and murder you.
Oregon hired Mark Helfrich as their head coach to replace Chip Kelly. [College Football Section]
Baylor, WTF are you doing with your helmets. All gold? Matted design. Are you the next Oregon? [Lost Lettermen]
Saturday Night Live parodies Manti Te’o as a dumb jock. [Guyism]...


text:
Exotic car owners often have the color of their vehicles matched to their favorite things, like eye shadow, handbags and yachts.
Apparently things are different in the world of trucks.
Ram is introducing new Harvest Edition versions of its light and heavy duty pickups finished in red and blue paint that are the exact same colors used by Case IH and New Holland on their agricultural equipment.
Considering the same family that owns Fiat Chrysler owns Case IH and New Holland parent company CNH Industrial, and both outfits are run by Sergio Marchionne, it’s a clever example synergy.
Along with the paint jobs, the Harvest Edition trucks get farm-friendly one inch suspension lifts, off road tires, black tubular side steps, and spray-in bedliners, rear bumper steps, navigation and heated seats, among other standard features.
Prices for the Ram 1500 Harvest Edition start at $41,305, and they’re also available in black and white if you like to keep it low key.

domain: design


text:
We’ve already binge watched Dear White People, so we’re obviously pressed to know when She’s Gotta Have it going to hit Netflix.
Spike Lee is reviving his epic 1986 film, She’s Gotta Have It into a 21st-century set series for Netflix. DeWanda Wise who has been absolutely killing it on TV this year with roles on WGN’s Underground and FOX’s Shots Fired will stand at the center of the 10-episode series as Nola Darling. In the film, Nola (originally played by Tracy Camilla Johns) is stunning, bright, twenty-something who is doing her thing and dating three very different men at the same time. (Take notes ladies.) The men are the gorgeous narcissist Greer Childs, the nerdy Mars Blackman and the alpha male Jamie Overstreet. The trio decides they want Nola to choose, but as is any woman’s prerogative, she just can’t seem to make up her mind.
Filming for She’s Gotta Have It wrapped a couple of weeks back, so when can we expect it to premiere?
Netflix has not given us an official release date yet, but, when responding to a fan a couple of days ago on Instagram, Spike Lee announced that the series would debut in the fall. With Issa Rae’s Insecure getting us through summer, She’s Gotta Have It will be the perfect thing to cozy up to on chilly fall nights.
Joining Wise in Netflix’s She’s Gotta Have It is Cleo Anthony as Greer Childs; Anthony Ramos as Mars Blackmon; Lyriq Bent as Jamie Overstreet; Margot Bingham as Clorinda Bradford; and Sydney Morton as Sheryl Overstreet. Chyna Layne and Ilfenesh Hadera will also star.
There is no footage of the new series just yet, but peep the trailer for the original flick below.
Photo Credit: Getty Images/ Frederick M. Brown

domain: entertainment


text:
F-35 chief confirms phone call with Trump and Boeing CEO
Feb 17 2017 by Johnny Bowman
F-35 jet, while the CEO of Lockheed's biggest competitor listened in, Bloomberg reported Thursday. In the Bloomberg report, Lockheed declined to comment and Boeing referred to its CEO's comments after his January meeting with Trump, in which he said they "made some great progress" in their talks.
Trump's first call with Bogdan was on January 9, Bloomberg reported.
Trump tweeted that he would ask Boeing to "price out" a comparable F/A-18 Super Hornet, even though the Super Hornet is a fourth-generation fighter and has fundamentally different capabilities than the fifth-generation F-35. Perhaps as problematic as having Lockheed's rival in the room during the call was the fact that Trump directly reached out to the F-35 program manager not once, but twice, about a contract finalized 16 years ago. It's one thing to call up a program head as the CEO of a corporation, but when you're the Commander-in-Chief going directly to a much lower subordinate in a system built directly upon the concept of following the proper chain-of-command, it causes mass confusion and an unraveling of the whole process. Thompson, who has also consulted for Lockheed Martin, pointed out that the kinds of decisive action admired in business "can unhinge a military organization that depends on order and discipline". Trump "asked a lot of very, very, very good questions", he said.
Sidney Crosby nets career point No. 1000 with an assist
Crosby, who entered his 757th game with 999 career points, required the fewest games among active players to reach 1,000 points. He now boasts 62 points in 50 games this season (30 goals, 32 assists) compared to McDavid's 63 in 57 (18 goals, 45 assists).
Ceres Contains "Key Ingredients For Life", New Study Confirms
The team suspects that the organics formed within Ceres' interior and were brought to the surface by hydrothermal activity. The discovery could catapult Ceres to near the top of the list of places targeted in the search for extraterrestrial life.
"We discussed Air Force One, we discussed fighter aircraft", Muilenburg told reporters after the meeting. In prepared testimony, he said the jet's operating costs are decreasing, "making the F-35 more affordable each and every day". Moreover, in an effort to drive the fighter's costs down, the F-35 has been marketed to allies around the world, with production and maintenance contracts spread from the U.K.to Australia.
The first of those being, what are you doing to improve the affordability of the F-35 now and in the future and how can we be sure the taxpayers are getting the best value for their dollar and the second of those tasks was on the mix - the complimentary mix of Super Hornets, Advanced Super Hornets and F-35Cs on the deck of an aircraft carrier where he asked for a comparison of the capabilities and they are not completed yet.
The review directs Deputy Defense Secretary Bob Work to "oversee a review that compares F-35C and F/A-18 E/F operational capabilities and assesses the extent that F/A-18E/F improvements (an advanced Super Hornet) can be made in order to provide a competitive, cost effective, fighter aircraft alternative". Purchases would grow to 80 aircraft in fiscal 2019, and there's a pending "block buy" of 450 aircraft after that.


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KALAMAZOO, MI -- Ben Folds, singer/songwriter/pianist, will perform at the Chenery Auditorium on April 26 for the Irving S. Gilmore International Keyboard Festival.
He was not available for an interview. We would've ask him many questions, but the main one is: What makes Folds a good fit for the Gilmore?
1: He plays piano. In 1994, when rock was still dominated by snarling abrasive guitars and scowling angsty vocalists, Folds formed the piano-based trio, misleadingly named, Ben Folds Five. Power-pop style, and attitudes ranging from snarky and humorous to sensitive, made Folds the Billy Joel of the '90s. Their 1997 album "Whatever and Ever Amen" went platinum and spawned the radio-friendly ballad "Brick."
Folds got into solo work around 1997 when he began composing and recording work for his "Fear of Pop" project, using idiosyncratic artists like the Thievery Corporation and actor William Shatner. His highest-charting solo album was 2008's "Way to Normal," which hit 11 on the Billboard 200. The video for single "You Don't Know Me" featured Eric Wareheim and Tim Heidecker, of Cartoon Network's campy and odd "Time and Eric Awesome Show, Great Job!"
2: He composes concertos -- one, so far, titled "Piano Concerto." He debuted it with his hometown Nashville Symphony in March. Folds has also been doing pops concerts with orchestras around the country.
To highlight the importance of the world of classical music to younger, pop-oriented audiences, Folds told the St. Louis, Mo., Riverfront Times April 9, "People ... it's the best place to take anyone on a date. It's perfect." On a more-serious note, Folds has said that his role in his high school orchestra helped start a life in music. As a member of the Artist Committee for Americans for the Arts, Folds is an advocate for music therapy and music education.
Folds will be solo for the Gilmore, so he likely will play more of his pop songs and less of his concerto -- that piece needs a full orchestra, especially for the part where all musicians on stage take out their cellphones to set off their ringtones.
3: He wrote and recorded the song "Kalamazoo." The mellow ballad (with inexplicable disco string section dropped in the last third) is on his 2004 EP "Super D."
Folds sings plaintively to a lost love, after he'd "screwed up" her life, "But there was a time, I almost forgot, we had been driftin' all the way from Kalamazoo/And I said that I loved you too/All the way back home..." Was he in Kalamazoo? Is she "still there," as he sings? "Kalamazoo, don't you know that I've been there, too..." Does this have anything to do with the woman on the EP cover, his ex-wife Frally Hynes, who's actually from Australia? There are so many questions we could've asked Folds.
Folds did "return" to Kalamazoo, to play Miller Auditorium, in 2005.


text:
I have connected a 10k lin pot, via a 4067 16 channel multiplexer.
Im powering my nano via the pc over usb.
I multiply the analog in by 20, just to get a good readout with decimals, to read pot reading stability
And at the extreme pot point (closed and slowly moving up from there), i get a pretty jumpy value between 0 and 2,5. Other pot locations seem pretty solid. It only seems to be the low end values of the pot that are exteremly jumpy.
Could this be a psu thing? Or maybe i need to solder in a cap somewhere between each pot output connection to the multiplexer?
I can do filtering in XOD, in the sense that i could apply low pass filtering, but my logic tells me that this wont fix the 0-2,5 problem, only small jittery things (which is also needed).
How would i go about solving jitter? something like a slew limiter/portamento/lag processor/low pass filter is needed, but there doesnt seem to be anything like that available. How would i go about making one in xod?
The jumpy values at low end are probably due to cheaper POT. You could use the debounce node to reduce the jitter. But if it is constantly changing at low end, you may never be able to get a 0 reading with debounce. Note that timer on debounce node is in seconds; you can get <1 sec by using fractional values like 0.5
@gweimer seems like the non-boolean debouncer is broken. When i open up the node, there is no code inside. The boolean works though, but not usable for me. It will probably be fixed in the future i guess.

domain: hobby


text:
Study to Investigate the Absorption, Distribution, Metabolism and Elimination of [14C]GSK1120212
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT01387204|
Recruitment Status : Completed
First Posted : July 4, 2011
Last Update Posted : November 13, 2017
Information provided by (Responsible Party):
No Study Results Posted on ClinicalTrials.gov for this Study
|Recruitment Status :||Completed|
|Actual Primary Completion Date :||July 18, 2011|
|Actual Study Completion Date :||July 18, 2011|
Allen LF, Sebolt-Leopold J, Meyer MB. CI-1040 (PD184352), a targeted signal transduction inhibitor of MEK (MAPKK). Semin Oncol. 2003 Oct;30(5 Suppl 16):105-16. Review.
Davies H, Bignell GR, Cox C, Stephens P, Edkins S, Clegg S, Teague J, Woffendin H, Garnett MJ, Bottomley W, Davis N, Dicks E, Ewing R, Floyd Y, Gray K, Hall S, Hawes R, Hughes J, Kosmidou V, Menzies A, Mould C, Parker A, Stevens C, Watt S, Hooper S, Wilson R, Jayatilake H, Gusterson BA, Cooper C, Shipley J, Hargrave D, Pritchard-Jones K, Maitland N, Chenevix-Trench G, Riggins GJ, Bigner DD, Palmieri G, Cossu A, Flanagan A, Nicholson A, Ho JW, Leung SY, Yuen ST, Weber BL, Seigler HF, Darrow TL, Paterson H, Marais R, Marshall CJ, Wooster R, Stratton MR, Futreal PA. Mutations of the BRAF gene in human cancer. Nature. 2002 Jun 27;417(6892):949-54. Epub 2002 Jun 9.
GlaxoSmithKline Document Number HM2009/00151/01 GSK1120212 Investigator's Brochure Report Date 4 June 2010.
GlaxoSmithKline Document Number RD2009/01379/00. Dosimetry Review for oral [14C]GSK1120212. Report Date 19-Nov-2009.
GlaxoSmithKline Document Number RM2007/00642/03. MEK111054: An open-label, multiple-dose, dose escalation study to investigate the safety, harmacokinetics, and pharmacodynamics of the MEK inhibitor GSK1120212 in subjects with solid tumors or lymphoma. 2009.
Lorusso PM, Adjei AA, Varterasian M, Gadgeel S, Reid J, Mitchell DY, Hanson L, DeLuca P, Bruzek L, Piens J, Asbury P, Van Becelaere K, Herrera R, Sebolt-Leopold J, Meyer MB. Phase I and pharmacodynamic study of the oral MEK inhibitor CI-1040 in patients with advanced malignancies. J Clin Oncol. 2005 Aug 10;23(23):5281-93. Epub 2005 Jul 11.
LoRusso PM, Krishnamurthi S, Rinehart JR, et al. A Phase 1-2 clinical study of the second-generation MEK inhibitor, PD 0325901 in patients with advanced cancer. J Clin Oncol. 2005; 23:3011.
LoRusso PM, Krishnamurthi SS, Rinehart JJ, Nabell LM, Croghan GA, Chapman PB, Selaru P, Kim S, Ricart AD, Wilner KD. Clinical aspects of a phase I study of PD-0325901, a selective oral MEK inhibitor, in patients with advanced cancer. Presented at AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics 2007; 6:3649s [abstr B113].
NCI. Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. DHHS,NCI, NIH, Bethesda, MD; 2009.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982 Dec;5(6):649-55.
Tzekova, V, Cebotaru C, Ciuleanu TE, et al. Efficacy and safety of AZD6244 (ARRY-142886) as second/third-line treatment of patients (pts) with advanced non-small cell lung cancer (NSCLC). J Clin Oncol. 2008; 26:431s.

domain: medical