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Many people living with HIV/AIDS also suffer from substance abuse (SA) and mental illness (MI), with potential serious consequences for their quality of life and the clinical course of their HIV infection.1,2 The HIV Cost and Services Utilization Study (HCSUS), a survey of a nationally representative sample of HIV-positive patients receiving care in the United States, found that 48% reported significant symptoms of depression, dysthymia, generalized anxiety disorder, or panic disorder and 33% merited a diagnosis of 1 of those 4 disorders within the preceding year.1,3 Thirty-eight percent of respondents had used illicit drugs in the past year, 13% were classified as drug dependent, and 19% reported heavy alcohol use in the past 4 weeks. These rates significantly exceed estimates for the general US population.4,5 Comparably elevated current or recent rates of depression, other mood and anxiety disorders, and SA have been reported in numerous clinical6-10 and community-based11-19 HIV-positive populations, including in samples of women,8,20 homosexual men,11-13,17-19 US military personnel,7,16 injection drug users,9,10 and mixed populations.6,14,15
Identifying and treating SA/MI promptly in HIV clinical settings is clearly important. SA and MI, and particularly depression, are associated with worse adherence to antiretroviral medications, the current cornerstone of managing HIV infection.21-26 Much discussion has focused on the need to promote antiretroviral adherence in clinical settings because of the key role of adherence in preventing the development of drug-resistant virus and slowing the progression of HIV infection.26-34 In addition, evidence suggests that SA and MI may directly influence immune function and HIV disease progression independent of their effect on adherence.35-39 Finally, HIV-positive patients with SA/MI are more likely to engage in unsafe needle-sharing and sexual behaviors that put others at risk for HIV infection.40-44 Both SA and MI can be effectively addressed through well-tested psychotherapeutic and pharmacologic interventions.45-54 The appropriate treatment of depression, the most common MI, is associated with improved antiretroviral adherence.55
Several screening instruments have been used to identify SA/MI in HIV-positive and general clinical populations.1,8,9,12,13,56 We identified only 2 MI screening instruments and no SA instruments with published reports of validation studies in HIV-positive populations. A positive screen on any one of the depression, dysthymia, anxiety, and panic modules of the University of Michigan Composite International Diagnostic Interview-Short Form (UM-CIDI-SF) used by HCSUS had 80% sensitivity and 77% specificity compared with any diagnosis in the 4 categories.56 In an inner-city HIV clinic, a combination of the General Health Questionnaire and the Beck Depression Inventory identified cases of mood and anxiety disorders with 81% sensitivity and 61% specificity.9 The Center for Epidemiologic Studies-Depression scale, used in several large cohort studies of HIV-positive individuals,8,12,13 has 88% sensitivity and 73% specificity in the general population for identifying major depression but has not been validated in HIV-positive individuals.57,58 Limitations of these instruments for clinical practice include length (55 items for the mental health modules of the UM-CIDI-SF; 51 items for the General Health Questionnaire and the Beck Depression Inventory), a focus solely on depressive symptoms (Center for Epidemiologic Studies-Depression scale), and inclusion of symptoms that may signify HIV disease progression rather than MI (eg, fatigue, anorexia, weight loss, and poor concentration).
We conducted a validation study of the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) in an HIV-positive patient population. The SAMISS is a 16-item screening instrument designed to identify SA/MI in HIV-positive patients.59,60
The study population comprised all new patients, or patients never previously screened with the SAMISS, seen at the infectious diseases clinic of the University of North Carolina at Chapel Hill Hospital (UNC-ID) between August 26, 2003, and June 23, 2004, who were HIV positive, at least 18 years old, English speaking, and mentally competent to provide informed consent as assessed by their UNC-ID medical provider.
The SAMISS comprises 16 questions regarding drug and alcohol use and symptoms of MI (see Appendix).59,60 A panel of experts in psychiatric measurement and diagnosis developed the SAMISS in 1999 as a means of rapidly identifying patients with probable SA/MI in busy HIV clinical settings. The SAMISS was designed to address the need for a screening instrument that assesses both SA and MI, can be administered in ≤10 minutes, and avoids symptoms of HIV disease progression that could be mistaken for signs of MI.
The SAMISS SA module measures frequency and intensity of alcohol use with a 3-question subscale of the Alcohol Use Disorders Identification Test.61,62 Two questions assess abuse of prescription and nonprescription drugs in the past year. The SA module concludes with the Two-Item Conjoint Screener, 2 questions designed to assess dependence on or uncontrolled use of either alcohol or drugs in the past year.63
The SAMISS MI assessment module comprises 8 questions from the CIDI querying key symptoms of manic and depressive episodes, generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and adjustment disorder.64 An additional question inquires about use of antidepressant medication in the past year. The question on adjustment disorder references the preceding 3 months, whereas all others reference the past year.
A tool called the SCID or Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) served as the reference standard to evaluate the performance of the SAMISS in this study. The SCID is a reliable, valid, and widely used interview tool, which may be administered by paraprofessionals, for establishing psychiatric diagnoses in a consistent manner for research purposes.65-67 The SCID has comparable test characteristics when administered in person or over the telephone.68-71
Clinic staff reviewed scheduled appointments each morning to identify eligible patients. Two licensed clinical social workers, 2 research assistants, and a co-author (B.W.P.) screened eligible patients with the SAMISS. All personnel were trained to administer the SAMISS in a consistent manner, reading questions as written and not probing for additional information until after completing the SAMISS. Once screened, eligible patients were invited to participate in the validation study. Some eligible patients were not screened or invited to participate because no study staff person was available at the time of their appointment. Interested patients gave informed consent. The Biomedical Institutional Review Board of the University of North Carolina at Chapel Hill approved this study.
A trained research interviewer blinded to the results of the SAMISS then administered the SCID to each participant. Patients completed the interview either in person or by telephone. Interviews occurred the same day as the SAMISS or as soon as possible thereafter (median: 6 days; range: 0-29; 127/148 SCIDs completed within 2 weeks). The interviewer assigned final diagnoses after the interview in consultation with a psychiatrist (B.N.G.). Diagnoses were assigned as being present or absent within the past year. Only diagnoses included in the substance use, mood, and anxiety sections of the SCID were considered, specifically abuse of or dependence on alcohol, sedatives, hypnotics, anxiolytics, stimulants, opioids, “crack”/cocaine, and hallucinogens; major depressive, dysthymic, bipolar I and II, adjustment, obsessive-compulsive, panic, and generalized anxiety disorders; PTSD; bereavement; mood disorder due to a general medical condition or substance abuse; agoraphobia without history of panic disorder; social and specific phobias; and mood, depressive, bipolar, and anxiety disorders not otherwise specified.
During the interview, participants also provided information on sociodemographic characteristics, whether they had been diagnosed with or treated for any of a list of chronic medical conditions in the past 3 years,72-74 and whether they had experienced each of a list of HIV-related symptoms in the past 6 months.1
The definition of a positive screen for a probable substance use disorder consisted of any of the following: a total score of ≥5 on questions 1-3; a response of “Weekly” or “Daily or almost daily” to question 4 or 5; or any response other than “Never” to questions 6 or 7. The definition of a positive screen for a probable mood or anxiety disorder consisted of an affirmative response to any of questions 8-16 (see Appendix).59,60
Test characteristics (sensitivity, specificity, and positive and negative likelihood ratios [LR+, LR−])75 of the SAMISS SA module were calculated relative to any alcohol or substance use diagnosis on the SCID. Test characteristics of the MI module were calculated relative to any mood or anxiety disorder diagnosis on the SCID. Test characteristics of a positive screen on either module were compared with any SA/MI SCID diagnosis. All CIs were calculated with exact methods. Sensitivity and specificity were compared using Fisher exact test across strata of selected covariates deemed of interest a priori. Positive and negative predictive values (PPV, NPV) were calculated for this population and for a range of hypothetical prevalences of substance use and mood and anxiety disorders.
A cumulative score on the SAMISS MI module representing the number of endorsed symptoms (range: 0-9) was compared with the reference standard of any mood or anxiety disorder diagnosis on the SCID using a receiver operating characteristic curve.76
Methods described by Begg and Greenes77,78 and Rothman and Greenland79 were used in sensitivity analyses to assess the potential bias in estimated test characteristics introduced by refusal to participate and loss to follow-up and misclassification of mental health status by the SCID, respectively.
Recruitment and Retention
A total of 185 patients consented to participate, representing 82% of all patients invited to participate and 65% of all eligible patients who kept appointments during the recruitment period. Although written records were not kept of reasons for nonparticipation, study staff report that the most common reasons were expressed lack of interest in the study or anticipated difficulty in scheduling the follow-up interview. Lack of available study personnel constituted the only reason eligible patients were not invited to participate.
SCIDs were successfully completed within 30 days with 148 of the 185 participants (80.0%). Twenty SCIDs (13.5%) were conducted in person and 128 (86.5%) by phone. Of the 37 participants who did not complete the SCID, 32 were not successfully recontacted within 30 days after enrollment and 5 refused to complete the SCID when recontacted, citing lack of either time or interest.
The 148 participants with complete follow-up were primarily 30-50 years old (range: 20-65 years) (Table 1). Approximately one-third of the participants were female. Approximately three-quarters were African American, with the remainder primarily white. Thirty-six percent were on public health insurance and 28% were uninsured. The distribution of age, race, sex, and health insurance status did not differ significantly between participants who completed the SCID and those lost to follow-up. Participants were similar to the clinic patient population in sex (P = 0.92) and insurance status (P = 0.66) but were younger on average (mean age 40.4 years vs. 42.5, P = 0.01) and more likely to be African American (72% vs. 59%, P < 0.01) (data not shown).
Of the 148 participants with complete follow-up, 29 (19.6%) received at least 1 diagnosis of a substance abuse or dependence disorder in the past year on the SCID (Table 2). All SA diagnoses were of either crack/cocaine (13.5%) or alcohol (10.9%) abuse or dependence, with 4.8% abusing or dependent on both substances.
For 5 participants in the first weeks of data collection, incomplete information about dates of symptoms did not allow a determination of whether a mood or anxiety disorder diagnosis had been active within the past year. Of the 143 participants with completed SCIDs and complete date information, 59 (41.3%) received at least 1 diagnosis of a mood or anxiety disorder in the past year on the SCID, with the most common diagnoses being major depressive disorder (15.8%), depressive disorder not otherwise specified (9.5%), and PTSD (6.1%).
Half of participants had either an SA or a mood/anxiety disorder in the past year. Eighteen participants (12.6%) had both conditions. Most commonly, a mood disorder or PTSD co-occurred with alcohol or crack/cocaine abuse or dependence.
SAMISS Test Characteristics
Of the 148 participants with complete follow-up, 55 (37.2%) screened positive on the SAMISS SA module (Table 1). The 37 participants who did not complete the SCID were no more likely to have screened positive for SA than participants who did complete the SCID (43.2%, P = 0.57, Fisher exact test).
Compared with the SCID, the SA module of the SAMISS had 86% sensitivity (95% CI: 68%-96%) and 75% specificity (66%-82%) (Table 3). The LR+ and LR− were 3.4 and 0.18, respectively. In this population, with a prevalence of substance use disorders of 20%, the PPV and NPV were 46% (32%-59%) and 96% (89%-99%), respectively (Fig. 1). The module was less specific for those with a mood or anxiety disorder than those without (61% vs. 83%, P = 0.05), and there was a nonsignificant trend toward lower sensitivity for women than for men (67% vs. 95%, P = 0.08) (Table 4).
Of the 143 participants with completed SCIDs and complete date information, 99 (69.2%) screened positive on the SAMISS MI module (Table 1). The 42 participants who did not complete the SCID or with incomplete date information were no more likely to have screened positive for a mood or anxiety disorder than participants who did complete the SCID (69.1%, P = 1.00, Fisher exact test).
Compared with the SCID, the MI module of the SAMISS had 95% sensitivity (86%-99%) and 49% specificity (38%-60%) (Table 3). The LR+ and LR− were 1.9 and 0.10, respectively. In this population, with a prevalence of mood and anxiety disorders of 41%, the PPV and NPV were 57% (46%-67%) and 93% (81%-99%), respectively (Fig. 2). The sensitivity did not vary significantly by any measured characteristic of the study population (Table 4). The specificity decreased as the number of HIV-related symptoms increased (0%-24% of symptoms endorsed: specificity = 63%; 25%-49%: 41%; 50%-100%: 25%; P = 0.02). There was a nonsignificant trend toward lower specificity for those with a substance use disorder than those without (22% vs. 52%, P = 0.16).
Seventy-six percent of participants with SCIDs and 81% of participants without SCIDs screened positive on 1 or both modules (P = 0.54, Fisher exact test) (Table 1). A positive screen on either module had 97% sensitivity (90%-100%) and 44% specificity (33%-56%) compared with any SA/MI SCID diagnosis, with LR+ and LR− of 1.7 and 0.067, respectively (Table 3). In this population, the PPV and NPV were 61% (51%-70%) and 94% (81%-99%), respectively.
Using a score of the number of symptoms endorsed in the MI module (range: 0-9), a higher specificity and lower sensitivity can be achieved by choosing a cutpoint >1 (Fig. 3). For example, a definition for a positive screen that requires endorsing at least 2 symptoms has 88% sensitivity (95% CI: 77%-95%) and 67% specificity (56%-77%).
The participants with complete follow-up represent only a subset of the targeted study population of consecutive eligible patients for 3 reasons: some eligible patients were never contacted by study personnel due to logistical constraints, some contacted patients declined to participate, and some participants did not complete the SCID after enrolling. Clinic logistical constraints should be uncorrelated with individual patients' SA/MI status and should not introduce selection bias. Both participation and study completion could plausibly be associated with SA/MI status. In fact, among participants, completion of the SCID was negatively and weakly correlated with reported SA but uncorrelated with symptoms of MI on the SAMISS (Table 1). Adjustment for the loss to follow-up of participants who did not complete the SCID leaves the estimates of sensitivity and specificity virtually unchanged for both modules of the SAMISS (Table 5). Furthermore, the estimates of sensitivity and specificity are relatively insensitive to a wide range of assumptions about the proportion of nonparticipants who would have screened positive.
Misclassification of true mental health status by the SCID was unlikely to have introduced important bias (Table 5). Even substantially reduced sensitivity for patients screening negative on the SAMISS, as might occur if some patients underreported symptoms on both the SAMISS and SCID due to concerns about stigmatization or admission of illegal behaviors, would have only marginally affected results (last 2 rows of Table 5). Our results are most sensitive to the choice of SCID specificity: anything less than perfect specificity would suggest that this report has underestimated the true sensitivity of the SAMISS. In fact, our data were not consistent with a specificity of <96% for the SCID because of the very low prevalence of diagnoses in the SAMISS-negative group.
In analyses restricted to participants who completed the SCID within 2 weeks of being screened, no result changed significantly (all estimates of test characteristics changed by <2 percentage points). Test characteristics did not differ significantly according to whether the interview was conducted by phone or in person.
The SAMISS is a brief screening instrument designed to identify SA/MI in HIV-positive patients. In this study, the SAMISS demonstrated high sensitivity and moderate specificity for both SA and MI. Due to its brevity, the SAMISS can be feasibly integrated into routine care in busy clinical settings. The instrument's high sensitivity makes it an effective universal, first-line screening instrument. Because of its moderate specificity, patients who screen positive will require a more rigorous psychiatric evaluation to confirm the presence of a diagnosis.
In clinical practice, the PPV and NPV of the SAMISS vary depending on the prevalence of SA and MI in the population being screened.80 Our patient population had a prevalence of substance use disorders (20%) and mood and anxiety disorders (41%) comparable to reports from HIV-positive patients nationally.1 In populations with comparable or lower prevalences, the SAMISS will have an NPV close to 100% but a PPV ≤50% for both SA and MI (Figs. 1 and 2), emphasizing the need for further evaluation for persons screening positive.
For the MI module, a lower sensitivity and higher specificity can be achieved by requiring the patient to endorse at least 2 symptoms to screen positive. A decision about the optimal test characteristics should be based on the relative costs of false-positive and false-negative results. In many clinical settings, a false-positive result will cost staff resources to conduct a more in-depth evaluation. A false-negative finding will cause a case of SA or MI not to be identified and treated, which may have mental and physical health consequences for the individual and long-term financial costs to the health care system. A formal cost-effectiveness analysis, although beyond the scope of this paper, could assist administrators and policy makers in balancing these competing considerations.
The sample in this study was recruited at the infectious diseases clinic of an academic medical center in the southeastern United States whose patient population is primarily poor, from minority racial/ethnic groups, and on public health insurance or uninsured. A substantial proportion is female, and heterosexual intercourse represents an important mode of transmission. Nationally, HIV and AIDS are increasingly becoming concentrated among women of reproductive age, racial and ethnic minorities, and the poor.81-83 Heterosexual contact now accounts for about one-third of new HIV/AIDS cases in the United States.82 These dynamics are particularly evident in the Southeast, which has some of the highest rates of HIV infection and HIV/AIDS prevalence in the country.82-84
The SAMISS may perform differently in other populations. Specifically, we found that the SAMISS MI module was less specific the more HIV-related symptoms the respondent endorsed, consistent with the reported performance of the UM-CIDI-SF in HIV-positive patients.56 This could reflect greater subthreshold psychologic distress associated with increasing physical HIV-related illness, or it could indicate that physical symptoms can masquerade as endorsement of psychologic distress even in an instrument that avoids symptoms specifically overlapping with HIV disease progression. We also found a nonsignificant trend for the SA module on the SAMISS to have lower sensitivity for women than for men. The explanation for this finding is unclear but may reflect more distrust on the part of female patients and less willingness to disclose stigmatizing behaviors during brief interactions with clinic personnel. Finally, patients with SA but no MI were likely to screen in as false positives on the MI module, and the reverse was also true for patients with MI but no SA, underscoring the overlap between common indicators of SA and MI. In particular, question 8 in the MI module queries symptoms of mania, which could also indicate substance withdrawal. The inclusion of this question in the definition of a positive SA screen improved the SA module's sensitivity to 93%, as the question detected 2 of 4 original false negatives, but caused the specificity to fall to 62% with the addition of 15 new false positives.
The SCID, used here as the reference standard, is an imperfect measure of psychiatric disease. However, the SCID has been widely used for the validation of numerous other psychiatric measurement scales, including the latest version of the CIDI,85 and for the assignment of psychiatric diagnoses in multiple populations with other coexisting serious medical illnesses.86,87 The test-retest reliability of the SCID for the most common substance use, mood, and anxiety diagnoses ranges from 0.60-0.80 (kappa statistic).67 The SCID may perform differently in disadvantaged populations such as HIV-positive patients than in the general population, but we could identify no published validity or reliability evaluations of the relevant SCID modules in such populations. In this study, all SCIDs were conducted by the same interviewer and all diagnoses were assigned in consultation with the same psychiatrist to ensure consistency in diagnoses. Our sensitivity analyses support the assertion that misclassification of mental health status by the SCID is unlikely to have introduced substantial bias into our results, whether or not it is correlated with misclassification by the SAMISS.
The elapsed time between the administration of the SAMISS and the SCID may have affected the comparability of the symptoms of mental illness and substance use assessed by the 2 measures. Both the SAMISS questions and the SCID diagnoses reference the year preceding the interview. Most SCIDs were completed within 2 weeks of the SAMISS but some took place up to a month after the SAMISS. The results of these analyses were substantively unchanged when the sample was restricted to the 127 participants (86% of the total) whose SCIDs were completed within 2 weeks after the SAMISS. Also, most SCIDs were conducted over the phone, but some were conducted in person. In our sample, no result differed significantly between interviews conducted in person and by phone.
We excluded a small number of patients from this study who were not mentally competent to provide informed consent as assessed by their medical provider. This group is likely to have been at higher risk for needing psychiatric management. Because exclusion was based on provider's judgment, the providers were likely already aware of the mental health needs of these patients. Although the screening instrument may have performed differently in this subgroup, the number of excluded patients was small relative to the size of the study, and in clinical practice a screening instrument would likely not be used with this group.
We chose to assess only mood, anxiety, and substance use disorders, excluding in particular psychotic and personality disorders. We selected the disorders on which we focused due to their high prevalence both in the general population4 and in HIV-positive patients3,6,9,17,88 and their established links to suboptimal medication adherence.21-26 The SAMISS is unlikely to be effective in identifying psychotic or personality disorders.
The UNC-ID provides an example of successful integration of routine SA/MI screening in HIV clinical practice. All patients routinely complete the SAMISS, which generally takes <10 minutes, at their initial or second visit and yearly thereafter. A social worker, research assistant, or other available staff person administers the SAMISS. The patient's provider reviews the responses. Patients who screen positive for SA or MI receive further consultation with their provider, evaluation by a social worker, and enrollment in a clinic-based SA treatment program or referral to other SA/MI services as appropriate.
Overall, the SAMISS demonstrated high sensitivity and moderate specificity as a screening tool for the identification of SA/MI in this HIV-positive patient population. The SAMISS missed few cases in a sample with prevalences of substance use and mood and anxiety disorders comparable to those reported for HIV-positive patients nationally. False-positive results were not uncommon, indicating that in clinical practice the SAMISS should be followed by a more rigorous psychiatric evaluation for patients who screen positive. The brevity of the SAMISS makes it practical for routine use in busy clinical settings.
The authors gratefully acknowledge the contributions of E. Byrd Quinlivan, MD, Amy Heine, FNP, Sonia Napravnik, PhD, and the UNC-ID clinic staff to the completion of this research.
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65. First MH, Spitzer RL, Gibbon M, et al. Structured Clinical Interview for DSM-IV Axis I Disorders-Research Version, Patient Edition (SCID-I/P)
. New York: Biometrics Research, New York State Psychiatric Institute; 1990.
66. Spitzer RL, Williams JB, Gibbon M, et al. The structured clinical interview for DSM-III-R (SCID): I: history, rationale, and description. Arch Gen Psychiatry
67. Williams JB, Gibbon M, First MB, et al. The structured clinical interview for DSM-III-R (SCID): II: multisite test-retest reliability. Arch Gen Psychiatry
68. Aneshensel CS, Frerichs RR, Clark VA, et al. Telephone versus in-person surveys of community health status. Am J Public Health
69. Aneshensel CS, Frerichs RR, Clark VA, et al. Measuring depression in the community: a comparison of telephone and personal interviews. Public Opin Q
70. Simon GE, Revicki D, VonKorff M. Telephone assessment of depression severity. J Psychiatr Res
71. Wells KB, Burnam MA, Leake B, et al. Agreement between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule. J Psychiatr Res
72. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc
73. Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res
74. Rochon PA, Katz JN, Morrow LA, et al. Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability: a prospective comparison of three comorbidity indices. Med Care
75. Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology: The Essentials,
3rd ed. Baltimore: Williams & Wilkins; 1996.
76. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics
77. Begg CB, Greenes RA. Assessment of diagnostic tests when disease verification is subject to selection bias. Biometrics
78. Greenes RA, Begg CB. Assessment of diagnostic technologies: methodology for unbiased estimation from samples of selectively verified patients. Invest Radiol
79. Rothman KJ, Greenland S. Modern Epidemiology
, 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1998.
80. Kraemer HC. Evaluating Medical Tests
. Thousand Oaks, CA: Sage Publications; 1992.
81. Karon JM, Fleming PL, Steketee RW, et al. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health
82. Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report
, vol. 15. Atlanta: US Department of Health and Human Services, CDC; 2004.
83. Whetten-Goldstein K, Nguyen TQ.“You're the First One I've Told”: New Faces of HIV in the South
. New Brunswick, NJ: Rutgers University Press; 2002.
84. Whetten-Goldstein K, Nguyen TQ, Heald AE. Characteristics of individuals infected with the human immunodeficiency virus and provider interaction in the predominantly rural Southeast. South Med J
85. Kessler RC, Abelson J, Demler O, et al. Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). Int J Methods Psychiatr Res
86. Atesci FC, Baltalarli B, Oguzhanoglu NK, et al. Psychiatric morbidity among cancer patients and awareness of illness. Support Care Cancer
87. Polliack ML, Barak Y, Achiron A. Late-onset multiple sclerosis. J Am Geriatr Soc
88. McDaniel JS, Fowlie E, Summerville MB, et al. An assessment of rates of psychiatric morbidity and functioning in HIV disease. Gen Hosp Psychiatry
The Substance Abuse and Mental Illness Symptoms Screener (SAMISS)
Respondent screens positive if sum of responses to questions 1-3 is ≥5, response to question 4 or 5 is ≥3, or response to question 6 or 7 is ≥1.
1. How often do you have a drink containing alcohol?
(0) Never (1) Monthly or less (2) 2-4 times/mo (3) 2-3 times/wk (4) ≥4 times/wk
2. How many drinks do you have on a typical day when you are drinking?
(0) None (1) 1 or 2 (2) 3 or 4 (3) 5 or 6 (4) 7-9 (5) ≥10
3. How often do you have ≥4 drinks on 1 occasion?
(0) Never (1) Less than monthly (2) Monthly (3) Weekly (4) Daily or almost daily
4. In the past year, how often did you use nonprescription drugs to get high or to change the way you feel?
(0) Never (1) Less than monthly (2) Monthly (3) Weekly (4) Daily or almost daily
5. In the past year, how often did you use drugs prescribed to you or to someone else to get high or change the way you feel?
(0) Never (1) Less than monthly (2) Monthly (3) Weekly (4) Daily or almost daily
6. In the past year, how often did you drink or use drugs more than you meant to?
(0) Never (1) Less than monthly (2) Monthly (3) Weekly (4) Daily or almost daily
7. How often did you feel you wanted or needed to cut down on your drinking or drug use in the past year, and were not able to?
(0) Never (1) Less than monthly (2) Monthly (3) Weekly (4) Daily or almost daily
Respondent screens positive if response to any question is “Yes.”
8. In the past year, when not high or intoxicated, did you ever feel extremely energetic or irritable and more talkative than usual?
9. In the past year, were you ever on medication or antidepressants for depression or nerve problems?
10. In the past year, was there ever a time when you felt sad, blue, or depressed for ≥2 weeks in a row?
11. In the past year, was there ever a time lasting ≥2 weeks when you lost interest in most things like hobbies, work, or activities that usually give you pleasure?
12. In the past year, did you ever have a period lasting ≥1 month when most of the time you felt worried and anxious?
13. In the past year, did you have a spell or an attack when all of a sudden you felt frightened, anxious, or very uneasy when most people would not be afraid or anxious?
14. In the past year, did you ever have a spell or an attack when for no reason your heart suddenly started to race, you felt faint, or you couldn't catch your breath? (If respondent volunteers, “Only when having a heart attack or due to physical causes,” mark “No.”)
15. During your lifetime, as a child or adult, have you experienced or witnessed traumatic event(s) that involved harm to yourself or to others? (If yes: In the past year, have you been troubled by flashbacks, nightmares, or thoughts of the trauma?)
16. In the past 3 months, have you experienced any event(s) or received information that was so upsetting it affected how you cope with everyday life?

domain: psychology


text: An eco-friendly method to treat garbage may soon come your way. The biogas plant developed at the Integrated Rural Technology Centre (IRTC) can treat all kitchen waste produced in a house and turn it into biogas which can be used for cooking purpose. The 500-litre capacity plant can produce biogas that lasts for over one-and-a-half hours every day. Around three to four kilogrammes of kitchen waste can be deposited along with water in the plant, and it would help generation of nearly two hours of biogas every day. Made of fibre reinforced plastic, it comes with a burner and a PVC hose for the gas to pass from the plant to the stove. Besides kitchen waste, the plant is suitable to produce gas from water produced during rubber sheet processing and from animal faecal waste.

domain: chemistry


text:
The defining characteristics of a traditional ghazal are its rhyme and refrain. The refrain can be a word or phrase. … Every couplet ends with the rhyme and refrain. In the first couplet only, both lines end in the rhyme and refrain. Every line of the poem shares the same meter or syllable count..
My life without you lives, but is tarnished
like that gold in my cupboard, stale and tarnished
that room on the third floor sparsely furnished
where we sat and held court is now tarnished
everything’s in place, just a bit famished
food fills not the belly of the tarnished
no one asks after you, where you have vanished
the days that pass quietly are tarnished
the demons I thought I’d tamed now languish
in the nightmares that remain quite tarnished
silent grief fills the bowl, it’s my garnish
threatening to spill tears, old and tarnished
‘Dearest Ipsy’ failed, broken and vanquished
The brave smile on her face oddly tarnished.

domain: artistic


text:
; McRann, Chad ; Loyd, Justin O'Neill, Sean
Microsoft has made game development accessible to independent developers with their development of XNA in conjunction with C#. Using these tools we have created an interactive 3-D puzzle game. We focused greatly on user interaction, game play, and graphics to make Penguin Blocks as enjoyable and challenging as possible. XNA allows for the use of high end graphical textures created via other programs such as Adobe Photoshop. This convenience allows for each individual developer to place their personal strengths into the game development process. Penguin Blocks requires the user to push ice blocks around a map in order to create a path which traverses the span of the map. While creating the path the user must avoid obstacles present within the map. Some maps contain very complicated puzzles, forcing the user to carefully plan movements in advance.
University of Wyoming Libraries

domain: game


text: Although my Broncos-loving friends weren't so happy with how the Super Bowl turned out, they all agreed that our spread of food last night was world-championship worthy. All of the classics were represented, including wings and meatballs and a few varieties of cheese dip. A big pot of taco soup was a hit, as were my girlfriend's chocolate sugar puff cookies. My contribution was this overflowing pan of pork, featuring ribs from both wild and domestic pigs. I didn't figure the two slabs of skinny wild ribs (shown on the left in the picture) would be enough for this crowd, so I included a fatty slab of St. Louis style pork ribs, also hedging my bet a bit in case the wild ribs weren't up to par. Somewhat surprisingly, between the two, the wild pig was by far the winner in the taste test.

domain: food


text:
Since the beginning of October 1999 the
abnormal activity of Tungurahua volcano, 120 km south of Quito, continues
(refer to ACT Alert of 17 November 1999). Permanent seismic activity and
very high sulphur dioxide (SO2) levels have been registered and explosions
of ash and incandescent materials are regularly emitted. Volcanic ash has
affected approximately 50,000 hectares of farmland and also, to a lesser
extent, several towns and villages. After four months of activity the alert
level orange is maintained and it is estimated that the situation could
last for two years.
25,000 persons living in high risk areas such as Baños, Penipe, Puela and Bilboa were evacuated at the beginning of the activity. Due to lack of adequate response from the Government to their problems - Ecuador is going through an extremely difficult economic and political period - the population is, at their own risk, gradually returning to their homes and disregarding the warnings of the Government. Five thousand persons are now living permanently in the high-risk area. They are occupied with taking care of national and international tourism which continues - in spite of the danger - and constitutes the main source of income for the population. Due to the critical and risky situation the community has started to build their own contingency plan to confront an eventual eruption.
In December ACT reallocated some unspent funds from the *El Niño* emergency to support the work of an emergency committee of the Evangelical churches in Ecuador - which is working closely with the Latin America Council of Churches (CLAI) to provide help to the evacuated population. This emergency committee is helping the population in the risk area to build a contingency plan in case of eruption and to re-establish adequate co-ordination with the government. A proposal to support this plan is being elaborated.

domain: geography


text:
And while the feature film is scheduled for a March 21st premiere in the U.S. (April 24th in Singapore), Funko reveals images for their POP! Vinyl versions of "Muppets Most Wanted"!
Featuring Kermit, Miss Piggy, Animal, Sam The Eagle and Swedish Chef, do check n with your fav retailer(s) for availability and pricing. Permit me to leave you folks with a trailer for the latest big=screen Muppets movie (and crossing fingers that somewhere out there somewhen might have the existence of a "Evil Kermit" variant-Pop! Vinyl lol:

domain: entertainment


text:
Huge product rangeOver 140,000 books & equipment products
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Pay in £, € or U.S.$By card, cheque, transfer, draft
Exceptional customer serviceGet specialist help and advice
How do cats land on their feet? Discover how this question stumped brilliant minds and how its answer helped solve other seemingly impossible puzzles
The question of how falling cats land on their feet has intrigued humans since at least the middle of the nineteenth century. In this playful and eye-opening history, physicist and cat parent Gregory Gbur explores how attempts to understand the cat-righting reflex have provided crucial insights into puzzles in mathematics, geophysics, neuroscience, and human space exploration.
The result is an engaging tumble through physics, physiology, photography, and robotics to uncover, through scientific debate, the secret of the acrobatic performance known as cat-turning, the cat flip, and the cat twist. Readers learn the solution, but also discover that the finer details still inspire heated arguments. As with other cat behavior, the more we investigate, the more surprises we discover.
Gregory J. Gbur is professor of physics and optical science at the University of North Carolina at Charlotte. He contributed to the book Science Blogging: The Essential Guide and writes two blogs about horror and the history of science.
"When the shelves in the science section of bookstores groan under the weight of tomes concerning String Theory and the Higgs Boson, this extremely well written popular science book concerning such a human scale problem is refreshing."
– James Kakalios, author of The Physics of Superheroes

domain: library


text:
G.I. JOE LADY JAYE BISHOUJO STATUE - HissTank.com
G.I. JOE LADY JAYE BISHOUJO STATUE The third character to join the series is an agent from the global elite special unit known as the G.I. JOE team: her name is Lady Jaye! The statue is based on original art by Shunya Yamashita, which was specially created as concept art for the BISHOUJO statue! Lady Jaye is a professional who can stay undercover in any covert operation with her accomplished linguistic and mimicking abilities! The power javelin and surveillance camera replicas that were included in the original rendition of the Lady Jaye action figure are also included with this statue. » Continue Reading.
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Eurotard’s ultra-fine microfiber is engineered for a naturally soft look and silk-like feel. This luxurious fabric provides superior color saturation, consistency and retention. It delivers excellent moisture wicking properties and dries faster than cotton while being exceptionally durable.
CONTENT: Tactel Microfiber
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We provide you with all your dance wear, dance shoes and dance supplies, to make it easy for you to dance every day.
Get 15% OFF the entire store with code 15YearsADream


Updated 23 May, 2013, 5:17 pm IST
Kodak Introduces the Next EASYSHARE-ONE
| by Gagan Gupta |
|Kodak recently announced the successor to their award-winning EASYSHARE-ONE WiFi digital camera. EASYSHARE-ONE was the first digital camera to inegrate WiFi, which gave the user the ability to email pictures from the camera itself, as long as they had WiFi access. The new KODAK EASYSHARE-ONE 6 megapixel digital camera combines the power of taking, sharing, organizing, and printing pictures into a single product. Its new WISPr (Wireless Internet Service Provider recommendation) protocol increases the number of hot spot locations to connect anytime, anywhere, wirelessly. The EASYSHARE-ONE 6 megapixel camera will be available in the U.S. early this summer for $299. The Wi-Fi card comes as an optional accessory for US$99. Kodak also announced Version 6.0 of KODAK EASYSHARE Software, available in MAC and PC as a free download, that comes with a new user interface to enhance the consumer experience and increase performance. This time it includes a photo card printing feature that turns pictures into invitations, announcements and more. [/TAGS]|
The combination of supreme hardware, class-leading software and the guarantee of getting timely upda...
Leaked Images, Availability, Pricing,
It’s not the camera, it’s the person behind it! While it may not be...
Want to choose from the best compact digital cameras launched in 2012?...
Madala Venkat Rao
Thu May 23, 17:40:34
Thu May 23, 17:35:28
Thu May 23, 17:16:47


ANS is committed to advancing, fostering, and promoting the development and application of nuclear sciences and technologies to benefit society.
Explore the many uses for nuclear science and its impact on energy, the environment, healthcare, food, and more.
The division provides a forum for focused technical dialogue on thermal hydraulic technology in the nuclear industry. Specifically, this will include heat transfer and fluid mechanics involved in the utilization of nuclear energy. It is intended to attract the highest quality of theoretical and experimental work to ANS, including research on basic phenomena and application to nuclear system design.
Utility Working Conference Virtual Summit (UWC)
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Fusion Science and Technology
China’s Tianwan-5 attains first criticality
Reactor operators bring Tianwan’s Unit 5 to first criticality. Photo: CNNC
Unit 5 at the Tianwan nuclear power plant in China achieved initial criticality on July 27, marking “the completion of the commissioning of the overall system and equipment of the unit,” according to Jiangsu Nuclear Power Corporation, the plant’s owner and operator.
K.-J. Boehm, N. Hash, D. Barker, T. Döppner, M. P. Farrell, P. Fitzsimmons, D. Kaczala, D. Kraus, B. Maranville, M. Mauldin, P. Neumayer, K. Segraves
Fusion Science and Technology | Volume 70 | Number 2 | August-September 2016 | Pages 324-331
Technical Paper | dx.doi.org/10.13182/FST15-242
Articles are hosted by Taylor and Francis Online.
Reconciling the experimental and system requirements during the development of a new target system is one of the most challenging tasks in the design and engineering of targets used in the National Ignition Facility.
Targets for the GigaBar 3 campaign were meant to allow the detection of extremely weak Thomson scattering from matter at extreme densities in the face of very bright backlighter and laser entry hole plasma emissions. The problem was to shield the detector sufficiently while maintaining beamline and view clearances, and observing target mass restrictions.
A new construction process, based on a rapid prototype frame structure, was used to develop this target. Details of the design process for these targets are described, and lessons from this development for production and target assembly teams are discussed.


text:
NYC Buildings For SaleA Flatiron District office building will hit the foreclosure auction block next month with an outstanding lien of close to $41 million, following the issuance of a foreclosure judgment against the property in September. The building, at 119 West 25th Street, had been owned by Brooklyn-based investors Miriam and Michael Chan before it was placed in receivership. The duo purchased the building for $34 million via an LLC in 2006. The 11-story building, which totals 113,000 square feet and has 15,000 square feet of retail, will hit the block November 17.
A parking lot in the Chelsea area, ripe for redevelopment, is on the block. It is an 11,850-square-foot parcel at 132-142 West 27th Street, between Sixth and Seventh avenues. Zoning allows up to 118,500 square feet of hotel or light manufacturing properties.
New York Buildings soldThe Far West Side, above 50th Street, has been somewhat overlooked by investors, but Taconic Investment Partners is hoping on its success with the $110 million acquisition of an office building at 619 West 54th Street. The 326,000-square-foot deal between Taconic and seller KBS Realty Advisors seems to have closed.
The real estate investment trust SL Green has purchased two office properties from Atlas Capital Group in an effort to expand its presence in the in Midtown South submarket. The firm paid $173 million, or $648 per square foot, for the two properties, which are located at 635 Sixth Avenue and 641 Sixth Avenue. The building at 635 Sixth Avenue totals 104,000 square feet and was previously occupied by Apex Technical School, while 641 Sixth Avenue has a total of 163,000 square feet and boasts tenants such as Google.
Great Eagle Group has made a deal to purchase the Setai Fifth Avenue hotel from 400 Fifth Realty for $229 million. As of January 2013, the 214-room hotel will become the Langham Place; Langham Hospitality Group is a subsidiary of Great Eagle Group. Langham will manage only the hotel portion of the mixed-use building, while floors 31-60 will remain one- to six-bedroom condos.
Rockpoint Group, a private equity firm, in partnership with a Goldman Sachs real estate fund and Highgate Holdings, purchased the Manhattan hotel at 790 Seventh Avenue at West 51st Street for $275 million in cash. The 665-key hotel will be operated by Highgate Holdings. The sale is part of Starwood Hotels & Resorts’ transition into an “asset-light model,” and has been in the works for two years, since the Sheraton flag was removed as the company reevaluated its assets.
Joseph Sitt’s Thor Equities partnered with an affiliate of Jenel Management to purchase 494 Broadway, the 9,200-square-foot office and retail building between Broome and Spring streets for $22 million. Sitt’s company signed a contract to buy the four-story building in February, and closed on the deal September 7th.
General Theological Center’s Desmond Tutu Conference Center at 180 10th Avenue in Chelsea has been sold to the Brodsky Organization for $16 million. The developer bought the property under the name “The Highline Hotel LLC.” The flexible office suites company WeWork and the Boston-based investment firm AEW Capital Management are in contract to pay Extell Development $33.5 million for a long-term leasehold at 175 Varick Street in Hudson Square. WeWork and AEW signed the contract to buy the long-term lease in August and the deal is expected to close in November.
Development paid $14.65 million for a once-stalled Chelsea development site two blocks from the Meatpacking District. The price is approximately twice the $7.5 million the seller paid to purchase the defaulted note about a year and a half earlier. Alfa bought the site at 245 West 14th Street, between Eighth and Ninth avenues, from an investment group led by developer Offir Naim.
A 24,800-square-foot retail condominium at the St. Regis hotel has traded for $375 million, more than triple what it last sold for in 2009. Swiss luxury retailer, Richemont, bought the space from a partnership that includes Crown Acquisitions, the Feil Organization and Goldman Properties. The price represents a value of more than $15,000 per square foot.
A partnership has agreed to purchase a 49.5 percent equity interest in 521 Fifth Avenue for $72 million. They had been attempting to sell equity in the 39-story office tower since earlier this year when it hired a firm to help market the building. The joint venture, known as Plaza Global Real Estate Partners, is expected to close the deal by the end of the year. SL Green is planning to refinance its existing $150 million mortgage with United Overseas Bank with a new $170 million mortgage.

domain: finance


text:
The fresher the egg, the better the flavor. Your omelets, scrambled eggs, and egg sandwiches will be noticeably more robust in flavor if you use the freshest eggs possible. But when it comes to baking, the freshness of the egg doesn’t have a big impact on the taste of your baked goods.
How long can you use eggs for baking after expiration date?
Eggs stay fresh between three and five weeks beyond the sell date. That’s a big window!
What happens if you cook with expired eggs?
Eating expired eggs may be no cause for concern at all. As long as they’ve been processed, stored, and cooked properly, you likely won’t notice any difference after eating eggs that are a few days or weeks past their expiration date.
Can you get sick from eating expired eggs?
When eggs spoil, they begin to smell bad, and the yolk and egg white may become discolored. … If a person has any doubt about whether an egg has gone bad, they should throw it out. The main risk of eating bad eggs is Salmonella infection, which can cause diarrhea, vomiting, and fever.
Is it safe to eat eggs 10 days past expiration date?
Refrigerated raw shell eggs will keep without significant quality loss for about 4 to 5 weeks beyond the sell date or about 3 weeks after you bring them home. A general rule to follow is that any egg that looks or smells odd should NOT be used.
Can I use out of date eggs in a cake?
It stressed eggs should be cooked and not be eaten past their use by dates. The new advice states that “eggs can be eaten after their best before date, as long as they are cooked thoroughly until both yolk and white are solid, or if they are used in dishes where they will be fully cooked, such as a cake”.
What can I use old eggs for?
You can use the eggshells of expired eggs for fertilizer or feeding purposes. The eggshells are rich in calcium that may benefit garden plants or chickens you raise on your property. However, an egg that is past the printed expiry date may not exactly be rotten.
How do you tell when eggs are bad?
Simply fill a bowl with cold tap water and place your eggs in it. If they sink to the bottom and lay flat on one side, they are fresh and good to eat. A bad egg will float because of the large air cell that forms at its base. Any floating eggs should be thrown out.
How do you check if eggs are good?
Perform a Float Test
To perform the float test, gently set your egg into a bowl or bucket of water. If the egg sinks, it is fresh. If it tilts upwards or even floats, it is old. This is because as an egg ages, the small air pocket inside it grows larger as water is released and replaced by air.
Can you cook salmonella out of eggs?
“To kill salmonella you have to cook eggs to 160 degrees Fahrenheit,” she wrote. “At that temperature they are no longer runny.”
How long are refrigerated eggs good for?
|Eggs||Refrigerator (35°F to 40°F)|
|Raw whole eggs (in shell)||4 to 5 weeks beyond the pack date or about 3 weeks after purchase|
|Raw whole eggs (slightly beaten)||Up to 2 days|
|Raw egg whites||Up to 4 days|
|Raw egg yolks||Up to 2 days|
How long are Eggland’s Best eggs good after sell by date?
If it is a SELL-BY date, we suggest that the eggs be used up to 30 days past that date providing they have been kept refrigerated and are not cracked. If it is a BEST BEFORE (or USE-BY date), the eggs should be used within 2 weeks of that date, providing they have been kept refrigerated and are not cracked.
Can you eat out of date eggs not refrigerated?
It is often noted that eggs are still good to eat long after the expiration date. … “The shelf life of an unrefrigerated egg is 7 to 10 days and for refrigerated egg it’s about 30 to 45 days,” notes Dr Batra.


text:
‘’Nelson Mandela showed what is possible for our world and within each one of us- if we believe, dream and work together for justice and humanity; a man of towering achievement who worked tirelessly for peace , equitable development and human dignity indeed one of the greatest leaders of our time. His life and work embodied the ideals of a democratic, free and equal society. It is therefore a day to reflect on the life and work of a legend who embodied the highest values of the United Nations’’ remarked the Director of the United Nations Information Centre (UNIC) Lagos, Mr. Ronald Kayanja in his address at the Lecture organised on Monday 16 July 2018, by United Nations Information Centre (UNIC) in collaboration with South Africa High Commission and Nigeria Institute for International Affairs (NIIA) as part of activities to mark the Nelson Mandela International Day (Centenary Celebration).
Mr Darkey Africa, the Consular General of the South Africa High Commission in Lagos, speaking at the event highlighted his brief encounter with Nelson Mandela and stressed that the legacy of Nelson Mandela resonates beyond the shores of Africa.
Nobel Laurette for Literature, Prof Wole Soyinka, recalled his personal encounter with Nelson Mandela describing him as an embodiment of humanism, service and leadership, humble, simple, unpretentious, determined and diligent.
At a similar event organised on Wednesday, 18 July, 2018, by UNIC, United Nations Association of Nigeria (UNAN) and Freedom Park Lagos, participants did a mandatory 67 minutes community service which involved cleaning of the park.
The Director of UNIC, Mr. Ronald Kayanja welcomed all guests and thanked UNAN for organizing the event in honour of Nelson Mandela. The South African Consulate General represented by Mr. Azwianewi Mbedzi in his address reminded all present about the meaningful contributions of Madiba to the world and that the objective of his commemoration is to inspire individuals to take action to help change the world for the better.
Gen. Ishola Williams (rtd) the Chairman of the event, paid tribute to Nelson Mandela by highlighting some of his services to mankind. He urged everyone to continue to uphold the legacy of Mandela who is an embodiment of peace, integrity, human dignity and indeed a great man.
Dr Babafemi Badejo the keynote speaker expressed his happiness about the fact that the whole world has set aside today to honor and recalibrate the life and achievements of Nelson Mandela. According to him, it is better to lead from behind and put others in front; however, good leaders take the front line when there is crisis. Mandela’s values included freedom, justice, diversity, equality, forgiveness, love and peace.
The Director of Freedom Park, Ms Aboaba Iyabo paid tribute to Nelson Mandela; describing him as a man of integrity and called on African leaders to provide the kind of leadership Mandela displayed.
Ambassador Ayo Olukanni, DG (NACCIMA), and other eminent personalities were present at the event. The celebration featured video clips, poems and a short drama on Mandela by students, and a cultural performance by Squad 1 Group.

domain: sociology


text:
"Roswell-Old Mill and River" Top 5 Page for this destination Atlanta Things to Do Tip by BruceDunning
Atlanta Things to Do: 511 reviews and 844 photos
The old downtown has a number of structures and artifacts from the late 1800's. One of the better attractions is to take a tour of the ARchibald Smith home, built in 1838. It has preserved furnishings from the period, and a good history of the home and family. It was home for three generations and had slave quarters, guest house, and carriage house. Cost is $7.
There is also a Bulloch house that is of the late 1840's. Tour cost is $8.
Down by the riverfront, there is a small park and old mill buildings that now has tourist type shops. The mill, though can be seen for what it was back in the mid 1800's, and the contribution to the Civil War effort to make wool and clothing items.
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domain: travel


NEW YORK (MarketWatch) — It seems an almost unfathomable concept in an era of such technological evolution and over-sharing, but one of the fathers of the Internet claims this century could be lost to future historians.
With big technology companies like Apple Inc.
Some data stored on outdated technology like VHS tapes, vinyl records, cassette tapes and floppy disks has already been lost, said Vint Cerf, a vice president at Google, who is largely considered one of the founding fathers of the Internet.
And that is just the beginning, he told a conference last week hosted by the American Association for the Advancement of Science.
The lack of an electronic storage mechanism that can withstand centuries of time threatens to erode documents and digitally-stored memories through a process he has often referred to as “bit rot.”
As hardware such as disk readers and CD players used to access data on old-fashioned discs and tapes becomes outdated, everything from home movies to presidential memos could become unreadable.
While cloud technologies like those produced by Google, Microsoft Corp.
Mahadev Satyanarayanan, a computer scientist and Carnegie Mellon University professor, has spent a decade trying to solve the problem using what he calls virtual machines and has worked with Cerf on the issue.
“You can sort of see how you would achieve that objective by creating a virtual machine,” said Cerf, who has long been vocal on this issue. “You put the emulation of the hardware on [the virtual machine], and then you put the operating system on [top of that].”
Think watching a 1990s Macintosh 7.5 boot up, and accessing its programs, from the screen of an Android smartphone Satyanarayanan said in a recent interview with MarketWatch. His research project, known by its acronym Olive, is like giving data a time-travel capability, he added.
There are other problems to solve, including legal issues, as outdated operating systems continue, for the most part, to be owned by the companies that initially developed them. But Cerf warned that if some sort of solution isn’t found, this tech-savvy generation could be known as a “digital Dark Age” to future historians.


This state will fine up to ₹10,000 for using phone while driving
The use of mobile phones while driving in Uttar Pradesh will now invite a penalty of ₹1,000 for the first offence and ₹10,000 for the second such offence, said a notification issued by the UP State Transport Department.
Being distracted while sitting behind the wheel is seriously a bad idea since the road demands your full attention at all times.
The decision to impose such a hefty fine came following a cabinet meeting in mid-June this year. The notification issued on Thursday also said that riding without a helmet will draw a thousand rupee fine as well.
Also Read : Best practices to drive your car safely
Traffic fines were significantly increased by the Motor Vehicles Amendment Act last year by the Union government.
First Published Date: 31 Jul 2020, 15:46 PM IST
TAGS: drive safe fines challan
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Active Ingredient: Tadalafil
Treatment: Erectile Dysfunction
Manufacturer: Macleods Pharmaceuticals Pvt Ltd
Country of Manufacture: India
Megalis Package Image
Review and Description
Megalis Tadalafil is a medication used during treatment of male’s impotence, a sexual disorder also known as erectile dysfunction. This disorder is characterized by the inability of sustaining an erection necessary to have a fulfilling sex life. Since the biological cellular tissues impacted by this condition are the same as in part of the lungs, patients with pulmonary arterial hypertension also benefit from drugs like Megalis. Tadalafil is the active ingredient of these drugs and it’s known as a PDE5 inhibitor. When the body has a high concentration of the biochemical PDE5, the smooth muscles of the penis are not able to relax and vasodilate; thus, not enough blood can flow to the penile area and a satisfactory erection is not possible to occur. Tadalafil binds with PDE5, preventing it to destroy cGMP, the essential molecule for muscles to relax. When cGMP exists abundantly in the blood, vasodilatation occurs without problems when a man is sexually aroused since more blood can flow to the penis.
Megalis is developed, produced, and commercialized by Macleods Pharmaceuticals Pvt Ltd, an Indian pharmaceutical that was incorporated in 1986. Currently, Macleods Pharmaceuticals is ranked 10th in the Indian Pharmaceutical industry. The company has been rapidly growing in popularity over the last years and commercializes its products in over 80 countries, including Asian and European countries. Macleods develops in-house products as well as affordable generics. The company focuses on its Research and Development department in order to improve its healthcare services. Moreover, Macleods also has patented several medicines, mainly in the area of painkillers and muscle relaxants.
Even though different people can react differently to the same type of medicine, it’s possible to evaluate how effective the drug is in the overall population according to what individuals feel when they take the medicine. The Internet is great for that as it contains many testimonials shared by customers.
According to several reviews, Megalis has mixed reviews and was evaluated as either a 2-star product or as 5-star medicine. John, in 2016, was not very pleased with the effect of Megalis when compared to similar products. John believes the dosage is “very low” and the product’s effect was “quite weak”.
Daniel, in 2015, evaluated Megalis as a 5-star erectile dysfunction medicine. Despite being a little scared in the beginning, all of his doubts disappeared after taking the 1st pill. Daniel got an erection in “just 30 minutes”, and Megalis effects lasted for “7-8 hours”.
Joseph also experienced “awesome results” with just 20 mg of Megalis, awarding the medicine with an overall 4 out of 5 rating.
Despite mixed, the majority of reviews point Megalis as a great erectile dysfunction medicine.
Pricing and Dosage
It’s essential to take into consideration for how much a certain product is being sold. Most people have a pretty tight financial budget and need to buy only affordable medicines.
Currently, in the market, Megalis can be found in two different formulations, as any Tadafanil-based medications: 10 mg and 20 mg. The average price for Megalis is definitely budget-friendly where the price per 10 mg pill ranges between $1.99 – $1.62, whereas for the 20 mg formulation the prices range between $2.49-$1.75. Taking into consideration that the price of Viagra and Cialis in the US is $10 per tablet, Megalis is definitely a considerable surrogate.
Megalis is typically taken orally with a glass of water for any formulation.
How to Buy Megalis Online
A large disadvantage of Megalis is the fact that consumers are not able to find it in selected stores. This is a very recurrent problem in cheaper medicines that are produced in foreigner countries.
Fortunately, there is one generic version of this product that is widely available at many online pharmacies. The medicine, known as Cialis, is easily found on the following e-shops:
Cialis is being dispensed for an average price of $1 per tablet and is as effective as Megalis. Although shipping fees may apply, they are usually cheap as well (between $10 and $30). The medicines take an average time of 20 days to arrive.
How to Use
Megalis should not be taken on an empty stomach but should also not be ingested with fatty foods or with alcohol. If possible, consumers should avoid drinking alcohol during the 7-8 hours that Megalis is effective. The oral pills should be taken with a glass of water. The effects start to show 30 minutes after taking the pill. However, an erection will only occur if sexual arouse exists. Only one pill should be taken per day; if consumers take more than one pill, the second pill will not work. The prescribed dosage must not be exceeded.
The patient should seek immediate medical help if an erection lasts for more than 4 hours or starts to display symptoms of an allergic reaction or a stroke. This includes a shortage of breath, loss of earing or changes in vision, chest pain, tingling, dizziness, or bloody urine.
Other common side effects include a mild headache, upset stomach, rash in the upper body, vomits, back pain, nausea, or nasal tightness.
Conclusion with Rating
Megalis is one of the many Taladafil-based medicines that are currently commercialized to treat erectile dysfunction in men. In other cases, this drug can also be used to treat pulmonary arterial hypertension. This particular drug is manufactured by Indian Pharmaceutical, Macleods Pharmaceuticals Pvt Ltd.
According to the majority of the testimonials left by consumers, Megalis is fairly effective and does perform as expected. The medicine is also considerably cheaper than Viagra. However, it’s not available outside Indian, thus not many clients can acquire Megalis. Because of all the reasons above, Megalis is evaluated as a 4 out of 5 ED medicine.

domain: medical


MODELING AND DESIGN
Modeling and Design
A dc tachometer is shown schematically in Figure (a). The field windings are powered by dc voltage uƒ.
The across variable at the input port is the measured angular speed WI. The corresponding torque Ti is the through variable at the input port.
The output voltage uo of the armature circuit is the across variable at the output port. The corresponding current io is the through variable at the output port.
Obtain a transfer function model for this device. Discuss the assumptions needed to “decouple” this result into a practical input-output model for a tachometer.
A dc tachometer example: (a) Equivalent circuit; (b) Armature free-body diagram.
1. The entire device is usually enclosed in a steel casing to shield (isolate) it from ambient magnetic fields.
2. The conductor coil is wound on a core and placed centrally between two magnetic poles, which produce a crossmagnetic field. The core is attached to the moving object whose velocity u must be measured.
3. This velocity is proportional to the induced voltage uo.
4. Alternatively, a moving magnet and a fixed coil may be used as a dc tachometer. This arrangement is perhaps more desirable since it eliminates the need for any sliding contacts (slip rings and brushes) for the output leads, thereby reducing mechanical loading error, wear, and related problems.
5. The dc tachometer (or, tachogenerator) is a common transducer for measuring angular velocities.
6. Its principle of operation is the same as that for a dc generator (or, back-driving of a dc motor).
7. A distinctive feature of permanent-magnet transducers is that they have a permanent magnet to generate a uniform and steady magnetic field.
8. A relative motion between the magnetic field and an electrical conductor induces a voltage, which is proportional to the speed at which the conductor crosses the magnetic field (i.e., the rate of change of flux linkage).
9. In some designs, a unidirectional magnetic field generated by a dc supply (i.e., an electromagnet) is used in place of a permanent magnet. Nevertheless, they are generally termed permanent-magnet transducers.


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Hey loves, after a weekend spent on travel I am going to slow down this week and show you a beauty post today. I love editing my travel pics as they 1. are always so funny to see as they are really different ones, 2. they remind me of a great time spent away from home. So stay tuned for my new travel shots super soon.
Today I have some great news from ZOEVA as they launched their new Bamboo handmade brushes line. And I must say these brushes make the difference, they are even veggie! Not only the quality but also the design is pretty amazing!
/Pictures by Skinnycature/
PRODUCTS: ZOEVA (here)


Voice over Internet Protocol is a methodology and group of technologies for the
delivery of voice communications and multimedia sessions over Internet Protocol
Voice over Internet Protocol (VoIP), is a technology that allows you to make voice
calls using a broadband Internet connection instead of a regular (or analog) ...
www.voip-info.org/wiki/view/What is VOIP
Oct 25, 2016 ... Introduction. VOIP is an acronym for Voice Over Internet Protocol, or in more
common terms phone service over the Internet. If you have a ...
VoIP (voice over IP) is the transmission of voice and multimedia content over
Internet Protocol (IP) networks. VoIP is enabled by a group of technologies and ...
If you've never heard of VoIP, get ready to change the way you think about long-
distance phone calls. VoIP, or Voice over Internet Protocol, is a method for taking
The magicJack device uses Voice Over Internet Protocol (“VoIP”) to allow you to
make local and long-distance calls to the U.S. and Canada using an existing ...
Nov 24, 2016 ... Voice over IP (VoIP) technology allows telephone calls to be made over digital
computer networks including the Internet. VoIP converts analog ...
Making calls with your computer is called Voice over I.P., for "Voice over Internet
Protocol". Or simply "VoIP" (pronounced "voyp"). It is also referred to as ...
Who needs home or office landlines when you can sign up for a voice-over-IP
service at a fraction of the cost of traditional carriers? We test and compare the
(VoIP) Voice over Internet Protocol is a category of hardware and software that
enables people to use the Internet as the transmission medium for voice calls.


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The Town of Greenwood and the Greenwood Chamber of Commerce are excited to present the world-renowned Sons of the Pioneers for a free concert during the annual Pioneer Heritage Festival at the Open Range Rodeo Arena. Sons Of The Pioneers are synonymous with the ultimate in cowboy music. For decades the premier western singing group has musically painted unforgettable images and stories of horses, cattle, cowboys, “night herds,” “tall timber,” “cool water,” canyons and prairies. Their original songs like “Tumbling Tumbleweeds,” “Cool Water” and “Ghost Riders In The Sky” are classics forever entwined into the lore and mystique of the American West. Both “Tumbling Tumbleweeds” and “Cool Water” have been inducted into the Grammy Hall of Fame.
“The Sons Of The Pioneers are American icons known around the world for their trademark harmonies and haunting lyrics that tell the story of the American West.” - Grand Ole’ Opry
The current group’s configuration Tommy Nallie, Ken Lattimore, Dusty Rogers, John Fullerton, Paul Elliott, and Chuck Ervin is part of a continuous and uninterrupted 85-year existence in which they have accumulated more coveted honors and awards than anyone in Western music. The group has been inducted into the Country Music Hall of Fame, the International Western Music Hall of Fame and the National Cowboy Hall of Fame among others. The Smithsonian Institute named them as “National Treasures”. True West magazine named them the Best Of The West in 2015 and again in 2017.
This event is provided in part with the support of a grant by the Louisiana Division of the Arts Decentralized Arts Fellowship Grant.
Sons of the Pioneers Concert
- Open Range Rodeo Arena


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Vocoder Music - EP
The year 2020 has sparked many emotions for many people. The Covid-19 Pandemic has left people feeling afraid and vulnerable. People are loosing loved ones, students are missing out on experiences, and no one seems to know whats coming next. The broadcasting of the murder of unarmed black men by police has been once again brought to the public eye. The fight against systemic racism and police brutality thrives with the same intensity of that in the 60's, and people are continuing the fight for legislative change.
The sum of these emotions is Vocoder Music. Isaac Monts has teamed up with some good friends and family to bring you his first EP; a groovy, feel-good, thought provoking musical experience. Many of the ideas for this EP began with a vocoder, hense the title "Vocoder Music". Put your listening ears on and enjoy the expression of Isaac Monts.


It can be hard to ask for help for ourselves. Is making help mandatory the solution?
We talk about well-being and mental health of teachers a lot in Education in Chemistry. We even have a section of our website dedicated to the topic. While we’d love the reason for this to be just that we’re particularly passionate about teacher well-being, the truth is there’s a vitally urgent crisis of ill health in the teaching profession.
Education Support have published their 2020 Teacher wellbeing index report – a measured, yet sobering, insight into the pressures teachers are wrestling with. According to the study, 62% of respondents describe themselves as stressed, while the majority (53%) don’t feel they receive enough guidance about their mental health or well-being at work.
57% of teachers and education professionals are uncomfortable sharing issues of mental health
The study also found that 57% – the majority – of teachers and education professionals are uncomfortable sharing issues of mental health or unmanageable stress with their employer. This is remarkable, but it might not even be because employers aren’t willing to help.
Building a healthier culture
I recently asked a friend of mine, a teacher and line manager, about the support available in their workplace. They spoke about paid-for counselling and support schemes. Their school was always willing to help staff who needed it. But they found that whenever teachers were offered this help, it was always declined.
Why are teachers finding help hard to ask for? And why, when it’s being offered, do they not take it? Education Support suggest three reasons: the worry of being perceived negatively; the worry of being seen as weak; and stigma surrounding mental health issues.
We have an awful culture of micro-accountability in teaching. A culture of overwork, of disempowerment, of top-down regimes addressing perceived failings. In such a workplace, it’s not unreasonable that moments of genuine, well-intentioned care are drowned out. The risks of asking for help are too great.
The teaching profession would be healthier if we acknowledged the stresses it causes
I’m reminded, in contrast, of some roles in healthcare where counselling is compulsory. Workers in these roles are regularly dealing with the most frail, most hopeless, and most heart-rending cases and situations. I learned, to my surprise, that the counselling isn’t compulsory because everyone needs it – it’s compulsory to prevent those who need it having to ask for it.
Perhaps we need a similar culture in teaching? Should we have compulsory peer support groups? Maybe independent workload assessments? The teaching profession would be healthier if we acknowledged the stresses it causes most practitioners and actively supported everyone without having to make 62% of them own up to needing it.
In the meantime, I love Education Support’s approach to supporting your colleagues. Show your appreciation, even for small things. It’s a reminder that we can all improve our workplaces and the lives of our colleagues.
And if you’re struggling, and don’t know who to speak to, Education Support have a 24/7 helpline: it’s free and confidential. Call them on 08000 562 561.


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Dozens of games, puzzles, and exercises to build calm & beat stress!
The Mindfulness Activity Book for Children gives you the resources to help the children in your classroom, office or home learn and hone the crucial skills of mindfulness - for getting on top of stress and doing their daily best!
Inside this book you'll find dozens of activities, games, exercises, and puzzles to help the kids in your life:
- Increase focus and concentration
- Build calm and beat stress
- Come together as a group
- Learn to hang in with challenges
- Get excited about what’s happening right here and right now!
Written by two psychologists with decades of experience working with kids, families and mindfulness, these fun, easy-to-learn and creative activities are awesome for all school-aged kids, whether they are newbies to mindfulness or not!


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1. Breakfast Bowls: Hollow out a roll and fill with an egg and your favorite omelet mix-ins. Pop in the oven. Thirty minutes later, you get the tastiest bread bowl you'll ever have. Get the how-to at Perfecting the Pairing.
2. Waffle Slices: Cut your homemade waffles in fours, then dip the ends in melted chocolate and decorate with sprinkles. So easy and so tasty! Get the how-to at Sugar Swings.
3.Breakfast Casserole Muffins: This is a great recipe to prep the night before and the kiddos can even help. Simply fill muffin tins with your favorite breakfast flavors: egg, onion, cheese, ham, bacon, etc. Then, bake. Get the how-to at Thriving Home Blog.
Image via Betsy Blue Photography
4. Doughnuts and Milk: Start your brunch off right. As your guest arrive, offer them a glass of milk topped with an adorable doughnut. Get the how-to at HWTM.com.
5. Chicken and Waffle Sliders: These mini sandwiches drizzled with syrup are sure to delight those who enjoy sweet and salty. Hold them together with a tooth pick and you'll keep the kids busy playing swords for a few minutes at least. Get the how-to at Food, Folks and Fun.
6.Pancake, Bacon Dippers: These two breakfast favorites combined in one are destined to be a hit! This recipe is heaven! Get the how-to at Stepable.
Pop Tarts: For those health conscious moms who want to serve kid favorites
but want the best ingredients, here's a recipe for you. With all of the
different options available, it's sure to please even the pickiest at the brunch. Get
the how-to at Simply Taralynn.
Toast Roll-Ups: Soft and fluffy, these cinnamon roll-ups can be filled with
peanut butter, jelly, cream cheese, Nutella, etc. You can't help but smile each
time you dunk one in syrup. Get the how-to at Cinnamon Spice and Everything
Image via Trish
Kababs: Alternate mini waffles with fruit on a skewer or make it fancy and
stick 'em with a paper straw. Serve with a maple syrup, cinnamon yogurt for
dipping. Get the how-to at Mom on Time Out.
Image via The Food in My Beard
10. Waffle Sushi: Cook thin waffles, spread with Greek yogurt and top with fruit. Roll sushi-style and serve. Get the how-to at Table Spoon.


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One of regional Victoria's most successful bands, the six-piece The Rhythm Rockets formed in Mildura in the 60s. The Rockets were very popular in the Sunraysia region, especially at the legendary Mildura venue called The Ballerina where they would pull huge crowds in excess of a thousand punters. In 1966 they competed in the local Hoadleys Battle of the Sounds competition hosted by radio station 3MA (Mildura). Winning their section they then went on to the Victorian Country Final and came third to overall winners, The Dynamoes from Shepparton. Rewarded with a recording contract with the Go!! label they ventured down to the big smoke to cut the singles ''Near Me/On Whom Her Favour Falls'' and ''Just You Wait And See/Summer Has Gone'' written by the band members. Both singles failed to make an impression on the Melbourne charts.
The Go!! label eventually lost interest in the band because they were too busy working Mildura’s Ballerina Ballroom and other local dances and private gigs and did not commit to Victorian country or national touring. Today Geoff Evans and Col Avery still perform on a regular basis. Lead guitarist Bill Tyers has a recording studio in Queensland and still plays professionally, while Peter McWilliams (bass) and Geoff Waters (drums) lead a quieter musical life. Mildura’s locally owned radio station 1611AM still gives the Rockets airplay to this day.
Geoff Evans (vocals/guitar), Col Avery (vocals), Bill Tyers (guitar), Peter McWilliams (bass),
Geoff Waters (drums), Neil Warhurst (sax)

domain: history


According to data I found on the USGS website, the water level in Cross Lake in Shreveport is only at 170.22, which is the lowest the water level has been in years. The water level is typically at 173. Where is all the water going? Are the gas companies using the water from Cross Lake to pump into their wells?
With the water level getting so low gives us even more need to have the lake dredged. Are there any plans in the near term to complete the proposed $80 Million project?


AS209294(FansNET) is a Education & Reasearch network.
Our network is IPv6 only and running based on SDN software and Tunnels. All our global midway devices transport IPv6 stream through Point-to-Point IPv4 network. The reason is that the global IPv6 network still in under-construction status which means the IPv6 connection stability and speed optimization still far from the existing IPv4 network. (This conclusion came from local China -> Global network connection status in 2019)
We use several education and reasearch purposed transit tunnel and VM networks to maintain the network running.
If you have Education and Research project require our special network, you may contact our NOC to require access to our network. We may offer you different type of connection to our access point in ASIA/NA/EU region by considering the network status on both sides.
We also provide IPv6 access rescue option for those who’s ISP’s IPv6 network down or can’t work normally. In order to request the rescue from us, you may also contact our NOC to describe your situation.*
*Relax, our NOC guy is gentle and friendly.
- AS6939 Hurricane Electric – Hong Kong, China, AP
- AS58057 SecureBit – Dusseldorf, German, EU
- AS29632 Netassist – Ukraine, EU
- AS20473 Choopa – Tokyo, Japan, AP
- AS136620 VMHaus – Los Angeles, United States, NA
- AS199586 VSYS – France, EU
- EVIX – US Fremont & NL Amsterdam
- 4IXP – CH Zurich
* By following open-peering policy and IX rules, we accept all from IX member without filter now.
More Info to dig
On Developing Functions
AS 209294 major functions for users list followed:
- IPv6 single stack network with shared/independent VLAN*
- IPv6 prefix static delegation on request**
- DNS6/DNS64 with NAT64 support***
- BGP network peering through IX or tunnel ****
* User can request using different vlan with other users by excellent reason
** If user wanna manually assign IPv6 address to subnet devices, may request delegationed prefix from /64 to /52 with justification.
*** Only avaliable with proper identification and reason to request, limited to few locations
**** We peering with IX route server and accept all IX members, if use tunnel need contact NOC.
NOC – Network Operation Center
- Operator : Fan
- NOC Contact: CaptainSalted[at]gmail[dot]com*
- Abuse Contact: admin[at]imfan[dot]net*
- Administration Office Location : Wuhan City, Hubei, China
- Major Local Network Location : Wuhan City, Hubei, China
*We may reply very slow due to we are not full-time-job on this network and COVID-19.


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Proposed Model Regulations: Accessible TaxiCabs & For-Hire Vehicles
Accessibility in public transportation, especially in the Taxicab and For-Hire Vehicle industry, has been at the forefront of the most important issues affecting public transportation in the last few years. Whether it be high profile lawsuits garnering extensive media coverage; landmark legislation that has provided people with disabilities with increased access to the ability to be transported (an ability many people take for granted); the proliferation of dispatch programs as an attempt at a “reasonable accommodation” for disabled passengers; the increasing population of the elderly and how their needs overlap those of the disabled community; or even the ever-increasing prices of accessible medallions sold at auction and regulated by transportation agencies, accessibility is arguably the most talked-about topic in the transportation world next to the proliferation of Transportation Network Companies (“TNCs”) that utilize phone apps that, in some instances, are an attempt to dodge regulations that apply to certified transportation providers. In fact, many of these TNCs have taken to avoiding the issue of accessibility entirely, choosing instead to “pass the buck” by informing disabled would-be passengers to contact a regulated transportation company in order to meet their accessibility needs. For full report please click here.


Samsung’s Galaxy SIII development team sat down this week and opened up about their experiences while creating Android’s next big thing. The topics of discussion mostly revolve around security and the struggles the teams had at keeping this phone under wraps. They talk about dealing with family members, including their own children, who constantly asked about the device. They mention the difficulties in trying to hide the phone whenever it was taken off campus. Did you know that there were actually 3 different models being worked on at all times? Now we know why there were versions in the wild with on-screen navigation keys. And speaking of those leaks, remember the “dummy boxes”? Yeah, they dealt with those too. Their team even went as far as hand delivering the Galaxy SIII to testers rather than using third party courier services to prevent leaks. Helicopters were involved, no pictures were ever allowed, and trying to price the device even turned into a chore since the marketing teams couldn’t see it.
It’s a great read that can be found at the Samsung Tomorrow site below.


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Pasha Tewfiq Mattia Kattan attending a political event with his family, Bethlehem, Palestine, c.1951 (3)
figureposted on 31.05.2019, 07:35 by Freja Howat-Maxted, Leila Sansour, Holly Stepp, Jacob Norris
This image is a digital reproduction of a black and white photograph donated by William Kattan.
The photograph captures some of the guests, including the Kattan family and members of the Church, at a charity event in Bethlehem. The event was most likely organised by Margo Kattan (nee Giries Kattan)'s husband the Pasha Tewfiq Mubarak Kattan who was a political candidate for the Jordanian government during the period of Jordanian rule over Bethlehem and the wider West Bank.
This image exists as part of the Kattan Family Photos collection within the William Kattan project of the Planet Bethlehem Archive.