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ORIGINAL RESEARCH article
Psychological Adaptive Mechanism Maturity, Age, and Depression Symptoms in Advanced-Stage Cancer Patients
- 1School of Medicine, University of Colorado, Aurora, CO, United States
- 2Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, CO, United States
- 3SSM Health Care, St. Louis, MO, United States
- 4Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States
- 5VA Medical Center-Sioux Falls, Sioux Falls, SD, United States
Background: Previously, we reported that the maturity of Psychological Adaptive Mechanism (PAM; alternatively, ego defense mechanism) endorsement, but not depression symptom severity, predicted 5-year survival rates in adult cancer patients and that study controlled for age as a significant variable. In this investigation, we hypothesized that greater PAM maturity would correlate significantly with age and with fewer depression symptoms in a larger sample.
Methods: In this cross-section study, adult cancer outpatients (N=293) completed the Defense Style Questionnaire (DSQ), the Beck Depression Inventory (BDI), and provided additional clinical data. Spearman’s correlation and multiple regression modeling provided statistical tests of the study hypotheses.
Results: Contrary to our hypothesis, DSQ PAM maturity endorsement did not correlate significantly with increasing age. Greater PAM maturity ratio on the DSQ (p<0.0001) and current antidepressant use (p<0.05), however, both provided inverse associations with total BDI symptom frequency (p<0.01). Age was inversely associated with BDI mood (p<0.0001) and somatic scores (p<0.04). Items that worsened BDI symptom frequency included self-reported mood-altering anti-cancer medications and any psychiatric history. Cancer stage, time since diagnosis, and chemotherapy treatment did not correlate with DSQ or BDI scores. Multiple regression analysis found that the correlated items accounted for 17.2% of the variance in mood symptoms and 4.9% in somatic symptoms. Specifically, adaptive maturity and age associated with fewer depression symptoms, while cancer medications affecting mood, and a previous psychiatric history each predicted higher frequency of depression scores.
Conclusion: The results suggest that PAM maturity likely predicts fewer depression symptoms while younger age associates with more depression symptoms in this clinical sample. Centrally, acting cancer medications, such as glucocorticoids, and any history of psychiatric disorder correlated with increased depression symptom frequencies. In this cross-section study, antidepressant medications indicated higher frequencies of depressive symptoms, likely reflecting their use in persons previously diagnosed with depression. Further research should target factors that improve PAM maturity as a potential treatment target, especially in younger age groups.
In a previous study, we reported that the Maturity level of Psychological Adaptive Mechanisms (PAMs; alternately, “ego defense mechanisms”) independently predicted survival in a small sample of late-stage cancer patients scoring at the extremes on the Defense Style Questionnaire (DSQ) while extreme scores on the Beck Depression Inventory (BDI) did not (Beresford et al., 2006). In that sample, half of those who endorsed mature adaptive styles survived for 5years, whereas half of those endorsing immature PAMs survived only 18months. The study identified age as a significant confounding variable for which our statistical analysis controlled in arriving at those final survival data. The relationship between PAMs and age in this setting remains poorly understood, however, and to the best of our knowledge, no studies have examined hierarchical PAM maturity effects in relation to age and depression in cancer patients (Di Giuseppe et al., 2018).
In elegant longitudinal studies of non-pathologic samples followed over many decades, Vaillant observed that psychological adaptation matures over time, as primitive adaptive mechanisms evolve “into more mature mechanisms, rather than being abandoned or replaced” (Vaillant et al., 1986). His observations suggested that older age might predict greater maturity score endorsement when assessed in a clinical sample, such as in those suffering from cancer. That is, hypothetically, psychological and temporal maturity go hand in hand.
Posited links between age and depression in cancer patients continue to provide cause for debate. For example, large studies using the Hospital Anxiety and Depression Scale (HADS) reached conflicting results. One found depression to increase with age and another found depression more likely in younger rather than older adults (Carroll et al., 1993; Hinz et al., 2010). Yet another study found no age effect on depression occurrence among cancer patients (Aass et al., 1997). In the present study, we hypothesized that positive associations would occur between increasing age and greater PAM maturity, as well as, between increasing age and fewer depression mood symptoms in this sample of late-stage cancer patients.
Materials and Methods
This cross-section study analyzed data collected during summer months from 1999 through 2010. Fellowship grants from the National Cancer Institute through the University of Colorado Cancer Center and the Department of Psychiatry of the University of Colorado School of Medicine funded this project. Summer research assistants were trained and certified in institutional requirements with respect to confidentiality, research ethics, and good clinical practices. All research assistants were supervised by the principal investigator (TB) who also supervised data collection as did permanent research staff members. All the research assistants received specific training in the administration of each of the instruments used in this study.
Prior to data collection, the research assistants explained the parameters of the study to potential subjects and obtained informed consent. Subjects who consented to the study then underwent a delirium screening examination and were asked to rate their pain, if present, on a linear-analog scale. Participants not excluded for either delirium or significant pain completed a brief demographic questionnaire. Finally, chart reviews verified items related to participants’ medical history, such as cancer diagnosis and stage.
Study participants included cancer outpatients entered consecutively during the respective time periods. All participants were adults who consented to this Institutional Review Board approved study. In order to meet inclusion criteria for this study, participants: (1) presented with a diagnosis of cancer; (2) were free of delirium as assessed by a standard delirium scale (Trzepacz et al., 1988); (3) were either pain free or presented with minimal pain, as described below; and (4) agreed to participate voluntarily. Twenty potential subjects declined participation (N=20 of 315); 14 provided no reason, four said the process was too long, and two reported feeling too tired. In accordance with privacy regulations, no further data were collected on those who declined consent.
Participants suffering from pancreatic or neuro-humoral secreting neoplasm, such as carcinoid or pituitary tumors, were excluded because of the known effects of these neoplasms on mood and affect. No patients were excluded due to pain of sufficient magnitude as to be subjectively distracting or greater than the first quartile of a linear-analog scale. Two patients who failed the delirium screen were excluded from the study. In this way, we accrued a total sample of 293 subjects who provided responses to the study instruments.
Participants provided demographic and medical data, which included type and stage of cancer and time since cancer diagnosis. Diagnosis and staging were verified by medical record review. Staff also documented whether participants had a prior psychiatric history or reported current antidepressant use, and the patient’s own report of any other current anti-cancer medications that affected their mood.
Defense Style Questionnaire
The DSQ was first developed by Bond and validated in subsequent studies as a qualitative and quantitative measure of PAMs (Andrews et al., 1993; Perry and Hoglend, 1998; Bond, 2004). It is a 40 item questionnaire that lists behavioral strategies by which individuals adapt to stressful events in their lives. This questionnaire presents 20 different adaptive styles, with two items for each PAM. Subjects are asked to agree or disagree with each statement on a 9-point Likert-type scale and a mean score for each mechanism is obtained by averaging the scores of the two items corresponding to each adaptive style.
Based in part on Vaillant’s empirical work (Vaillant, 1971, 1985; Soldz and Vaillant, 1998), Bond and colleagues assigned DSQ scores into three groups of psychological adaptive styles: immature, neurotic, and mature (Andrews et al., 1993). Stratifying the scores in this manner allows calculation of category means for each of the three groups for each participant.
Beck Depression Inventory
The BDI was developed by Beck and colleagues and validated by several studies as a tool for measuring frequency and severity of depressive symptoms (Beck et al., 1961; Beck and Steer, 1984; Enns et al., 1998; Richter et al., 1998; Aben et al., 2002). The BDI presents questions on specific depressive symptoms and asks respondents to rate their occurrence on a scale ranging from “rarely” to “often.” Each item is scored, yielding a summed total BDI score. In this version of the BDI, mood symptoms (items 1–14) can be separated from somatic symptoms (items 15–21) and analyzed separately.
Calculation of the mean scores for each of the three DSQ domains (immature, neurotic, and mature) for each participant allowed analysis of the relationships among PAM maturity, age, and depression symptoms. The DSQ calculation added up the points corresponding to each category and divided the sum by the number of adaptive mechanisms corresponding to that domain. For example, in order to calculate the mature mean score, the scores corresponding to sublimation, humor, anticipation, and suppression on the DSQ were added together and then divided by 4. Next, we calculated an adaptive maturity ratio score for each subject by dividing each mean “Mature” DSQ score by the respective mean “Immature” DSQ score.
To facilitate descriptive analyses of time since diagnosis, those data were assigned codes as the follows: 1 for greater than 6 months from date of diagnosis to the date study instruments were completed, 2 for less than 6 months but greater than 1 month, 3 for less than 1 month but greater than 2weeks, and 4 for less than 2weeks.
Calculated Spearman’s correlation determined the presence and statistical power of correlations between variables. This was followed by a multiple regression analysis to characterize predicted relationships.
This study included 293 cancer outpatients (Table 1), ranging in age from 22 to 87years (M=56.5, SD=11.6). Participants included 156 females (53.2%) and 137 males (46.8%). By cancer stage, 20 participants were classified as Stage I (6.8%), 25 as Stage II (8.5%), 65 as Stage III (22.2%), and 174 as Stage IV (59.4%); nine participants (3.1%) had neoplasms for which stage was undetermined or unavailable. Data were collected on cancer diagnosis for each participant; however, frequency of each type was not evaluated, as the wide variety of cancer diagnoses made direct analysis by type unfeasible. Examples of cancer diagnoses in this sample included the following: breast, ovarian, prostate, testicular, colon, rectal, gastric, esophageal, oral, lung, brain, skin, and hematological malignancies.
Adaptive maturity and age: No direct correlation appeared between age and adaptive maturity. Cancer stage, time since diagnosis, and current chemotherapy did not reach correlation significance with either PAM maturity or total BDI scores; therefore, these variables were not included in follow-up analyses. Age was correlated with gender, which reflects the study cohort in which female participants were younger than males.
Age and Depressive Symptoms: A Spearman’s rank correlation was performed to determine the presence and extent of correlations between variables (Table 2). Age significantly, and inversely, correlated with total BDI scores (r=−0.23, p<0.0001), as well as BDI subscale mood symptom scores (r=−0.26, p<0.0001) and somatic symptom scores (r=−0.12, p<0.04). Factors associated with BDI-mood symptom scores included as: Self-reported current anti-neoplastic medications that affect mood (r=0.21, p<0.001), any psychiatric history (r=0.15, p<0.01), and adaptive maturity ratio (r=−0.24, p<0.0001).
Counterintuitively, current antidepressant use (r=0.14, p<0.02) and depression symptoms were positively and significantly associated, meaning that antidepressant use indicated more, rather than fewer, BDI-mood symptoms.
Associations with BDI-Mood Symptom Variables: To explore these data further, we hypothesized that (1) greater adaptive maturity each would predict lower frequencies of depressive mood symptoms and (2) that any psychiatric history and cancer medications reported as affecting mood, each, would predict more frequent mood and somatic depressive symptoms.
A multiple regression analysis tested these hypotheses (Table 3). Results of the analysis indicated that the overall model was significant, ∆F (4,283)=15.87, p<0.001, and accounted for 17.2% of the overall variance in BDI-mood subscale scores (Adj. R2=0.172). More specifically, age (t=4.76, p<0.001) and PAM maturity (t=4.71, p<0.001) inversely correlated with the BDI-mood ratings. Cancer medications affecting mood (t=2.06, p<0.05) and a previous psychiatric history (t=2.71, p<0.01) each indicated worsening BDI-mood subscale scores. These findings confirmed their respective hypotheses and suggested that older cancer patients and those who employ more mature coping styles are less likely to endorse depressive mood symptoms than younger patients, or those with less mature coping mechanisms.
Table 3. Multiple regression for age, mature/immature ratio, medications affecting mood, and prior psychiatric historya, and BDI cognitive scoresb.
Associations With BDI-Somatic Symptom Variables: We further hypothesized that adaptive maturity, age, medications affecting mood, and psychiatric history would significantly predict the BDI-somatic depressive symptoms. A second multiple regression analysis tested this (Table 4). Results indicated that the overall model was significant, [∆F (4,283)=4.72, p=0.001], accounting for 4.9% of the overall variance in BDI-somatic symptoms (Adj. R2=0.049). However, only adaptive maturity (t=3.43, p=0.001) and cancer medications affecting mood (t=1.96, p<0.05) were significantly predictive of BDI-somatic symptoms. Age (t=1.78, p=0.077) and previous psychiatric history (t=0.057, p=0.95) did not predict somatic scores.
Table 4. Multiple regression for age, mature/immature ratio, medications affecting mood, and prior psychiatric historya, and BDI-somatic scoresb.
Results revealed that both lower PAM maturity and younger age predicted depression mood symptoms in cancer patients, supporting our hypothesis that increasing age and PAM maturity are independently associated with fewer mood symptoms. However, contrary to our hypothesis, age alone did not directly associate with PAM maturity scores. To our knowledge, this is the first study that has investigated lack of an association between age and PAM maturity specifically in cancer patients.
This study’s limitations include its seasonal funding support. Stable funding for a continuous period of time would allow for a more systematic sampling and recruitment of a larger participant population and inclusion of one or more appropriate comparison groups. Furthermore, the study instruments used in this investigation provided ease of use as a best compromise in assessing complex target symptoms and behaviors. The DSQ remains a rudimentary tool for assessing PAMs (Perry and Hoglend, 1998). The senior author has developed a clinical recognition algorithm to address this imprecision, a method that itself requires validity and reliability testing (Beresford, 2012, 2014).
The BDI scores indicate depressive symptom frequency and severity, but the BDI does not diagnose clinical depressive disorders. The BDI version used in this study was the revised version 1, chosen in our view for a potentially greater relevance to a cancer patient sample. Subsequent revisions to the BDI replaced weight loss, body image changes, and somatic preoccupation with concentration difficulty, worthlessness, and loss of energy items, yielding the BDI II version. Studies in non-cancer samples have found small differences in mean ratings for certain symptoms of depression and overall slightly higher mean scores for BDI II compared to its earlier version (Beck and Steer, 1984; Beck et al., 1996).
Like most other studies in this field, the present study offers only a cross-section assessment of its target variable. In respect to age alone, cross-section studies present clear limitations in establishing the variables associated with age that can inform the care of cancer patients. One study reported that younger cancer patients are more likely to endorse depression mood symptoms, a finding consistent with several studies, but contrary to others (Given et al., 1994; Kurtz et al., 1994; Smith et al., 2002; Mystakidou et al., 2005; Wong-Kim and Bloom, 2005; Agarwal et al., 2010; Lo et al., 2010). A large study of 1,529 cancer inpatients in cross-section and 2037 controls found that younger adults with cancer scored significantly higher in depression compared to the age-matched control group (Hinz et al., 2010). But in that study, the difference disappeared in older age groups, suggesting possibly higher baseline depression rates in older patients. Conversely, a number of studies report a positive association between age and depression (Carroll et al., 1993; Smith et al., 2002; Mystakidou et al., 2005), while others reported no age effect (Given et al., 1994; Kurtz et al., 1994; Aass et al., 1997).
Part of the difficulty in assessing depression in cancer patients is symptom overlap. Both advanced-stage cancers and the side effects of chemotherapy may include anorexia, cachexia, sleeping difficulties, and fatigue, all of which may closely resemble the somatic symptoms of depression. While the distinction may be more apparent in a clinician conducted assessment, we have yet to find standardized questionnaires that can easily distinguish depression-related physical symptoms from cancer-related depression-like symptoms.
The BDI has been widely used in studies involving cancer patients (Leigh et al., 1987; Richardson et al., 1990; Chang et al., 2004; Mainio et al., 2005, 2006; Beresford et al., 2006). One advantage is its ability to separate mood and somatic symptoms of depression, allowing interpretation in the context of cancer. For instance, one study that investigated the somatic versus mood subscales in 213 cancer patients versus controls found that the inter-group score differences occurred in the somatic scores (Wedding et al., 2007). Another study compared BDI scores for cancer inpatients with their healthy next of kin and with physically healthy patients hospitalized for suicide attempt (Plumb and Holland, 1977). BDI-somatic symptoms significantly differentiated hospitalized and non-hospitalized subjects, but not cancer inpatients from suicidal patients. The BDI-mood scale did not separate cancer inpatients from next of kin; however, both groups scored significantly lower than the suicide attempt group. While these findings support the prominence of somatic symptoms in depression, they also raise questions about the specificity of the somatic scale in the absence of mood symptoms in the setting of cancer.
The disparate reports on the effect of age on depression among cancer patients may reflect the lack of standardized depression assessment tools for this clinical population, as well as differences in study designs and sample populations. It may, however, also indicate that other unaccounted variables could be playing a role in this association. This evidence taken together with our findings that both mature adaptation and increased age predicted fewer depression mood symptoms in cancer patients could suggest a possible role of PAM maturity often unaddressed clinically.
Vaillant’s longitudinal studies found PAM maturity to increase age (Vaillant, 1971, 1985; Vaillant et al., 1986). Some cross-section studies have reported a negative association between age and endorsement of maladaptive mechanisms (Whitty, 2003). Others have found no age differences in younger and older adults (Tuulio-Henriksson et al., 1997; Segal et al., 2007). Change versus stability of adaptive mechanisms likely requires longitudinal study design rather than cross-section exploration, particularly among young adults (Diehl et al., 1996; Tuulio-Henriksson et al., 1997; Whitty, 2003; Segal et al., 2007; Yu et al., 2008). Since the previous studies mentioned here involved non-clinical populations, it is difficult to predict the comparability of their findings in a clinical sample, particularly in the setting of cancer.
Immature PAMs have been associated with adverse outcomes in Sjogren’s disease (Hyphantis et al., 2011), multiple sclerosis (Hyphantis et al., 2008), inflammatory bowel disease (Hyphantis et al., 2005, 2010), chronic obstructive pulmonary disease (Albuquerque et al., 2011), and diabetes mellitus (Martino et al., 2020). Endorsement of immature mechanisms has also been linked to depression (Akkerman et al., 1992; Bond, 2004; Bronnec et al., 2005; Blaya et al., 2006; Sharma and Sinha, 2010) and anxiety (Bond, 2004; Blaya et al., 2006) in the general population, but there are only limited data in cancer patients. One study of 100 patients with primary liver cancer reported a positive correlation between depressive symptoms and endorsement of immature defense mechanisms, consistent with our present findings (Wan et al., 2003).
Although we could find no other studies investigating the role of age in adaptative maturity and depression in cancer patients, there have been a few reports on the role of coping styles in this setting. A study of 199 early stage lung cancer patients undergoing surgical intervention found an inverse correlation between depressive symptoms and age, and between depressive symptoms and adaptive coping styles (Walker et al., 2006). Another in 80 women with breast cancer also found higher depressive symptom endorsement in younger patients and in those who demonstrated maladaptive coping styles (Compas et al., 1999). While coping styles and adaptive mechanisms are measured differently, these indirect findings further support a role for psychological adjustment mechanisms in respect to age and depression.
Statistical models presented above accounted for a total of about one-fifth of the variance in BDI mood and somatic symptoms in this study. Future research should focus on identifying these variables and how they affect younger versus older adult cancer patients’ depression. For everyday clinical use, three of the associated variables bear mention. First, the self-report of cancer therapy medications affecting mood appeared to influence the production of depression symptoms. While this warrants further analysis, our first impression suggests that untreated glucocorticoid effects may contribute a significant clinical share. Second, any psychiatric history appeared to contribute its weight in ways that require further delineation of specific histories and conditions. Last, and most surprising on its face, the presence of an antidepressant medication appeared to increase, rather than lessen, the BDI symptom frequencies. The relationship may not have been causal, however, since more depression symptoms indicate antidepressant intervention clinically and antidepressant effectiveness is outside the scope of this study.
An overall suggestion from this study’s data, therefore, may serve to sharpen the focus of improving depression treatment in cancer patients (1) who show less mature PAMs, (2) who are younger rather than older, (3) who report mood changes on the anti-neoplastic medications, and (4) who report a preexisting psychiatric history. Improved clinical care will require PAM characterization of subgroups of cancer patients for whom specific treatments, such as supportive or other forms of psychotherapy, can result in significant improvement during cancer diagnosis and treatment.
While age alone does not predict PAM maturity in the setting of cancer, both advanced age and greater PAM maturity, independently, lessen the risk of depression in cancer patients. While age is independent of treatment, PAMs invoke the possibility of active treatment aimed at increasing PAM maturity and lessening the effects both of cancer and the depression related to it. Effecting positive changes in PAM maturity point toward targeted psychotherapy as a potential specific treatment in cancer conditions. Whether achieved through experience or psychological treatment, PAM maturity can lessen the psychological damage of cancer and in so doing potentially prolong survival.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by the Colorado Multiple Institutional Review Board. The patients/participants provided their written informed consent to participate in this study.
TB: principal investigator and author. PT: co-investigator, data manager, and co-author. DH: co-investigator, data analysis, and co-author. PR: editor, co-investigator, reference coordinator, and co-author. All authors contributed to the article and approved the submitted version.
Dr.’s Beresford and Ronan receive partial support from Department of Veterans Affairs Merit Review Award, I01BX004712. Dr. Ronan receives support from NIMH 1 R01 MH122954 (P.J.R.), NIH NIGMS U54GM128729, both through the Great Plains Veterans Research Foundation.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
We thank the summer research assistants who contributed to this study, as well as the University of Colorado Cancer Center for their assistance in this study. We especially thank Brandon Schmidt, M.A., and E. Brie Thumm, Ph.D. who assisted in data collection and analysis.
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Soldz, S., and Vaillant, G. E. (1998). A 50-year longitudinal study of defense use among inner city men: a validation of the DSM-IV defense axis. J. Nerv. Ment. Dis. 186, 104–111. doi: 10.1097/00005053-199802000-00006
Tuulio-Henriksson, A., Poikolainen, K., Aalto-Setala, T., and Lonnqvist, J. (1997). Psychological defense styles in late adolescence and young adulthood: a follow-up study. J. Am. Acad. Child Adolesc. Psychiatry 36, 1148–1153. doi: 10.1097/00004583-199708000-00025
Vaillant, G. E. (1971). Theoretical hierarchy of adaptive ego mechanisms: a 30-year follow-up of 30 men selected for psychological health. Arch. Gen. Psychiatry 24, 107–118. doi: 10.1001/archpsyc.1971.01750080011003
Vaillant, G. E. (1985). An empirically derived hierarchy of adaptive mechanisms and its usefulness as a potential diagnostic axis. Acta Psychiatr. Scand. Suppl. 319, 171–180. doi: 10.1111/j.1600-0447.1985.tb08533.x
Walker, M. S., Zona, D. M., and Fisher, E. B. (2006). Depressive symptoms after lung cancer surgery: their relation to coping style and social support. Psychooncology 15, 684–693. doi: 10.1002/pon.997
Wedding, U., Koch, A., Rohrig, B., Pientka, L., Sauer, H., Hoffken, K., et al. (2007). Requestioning depression in patients with cancer: contribution of somatic and affective symptoms to Beck's depression inventory. Ann. Oncol. 18, 1875–1881. doi: 10.1093/annonc/mdm353
Keywords: psychological adaptive mechanisms, age, adaptation, cancer, depression
Citation: Beresford T, Teschke PU, Hipp D and Ronan PJ (2021) Psychological Adaptive Mechanism Maturity, Age, and Depression Symptoms in Advanced-Stage Cancer Patients. Front. Psychol. 12:718476. doi: 10.3389/fpsyg.2021.718476
Edited by:Mariagrazia Di Giuseppe, University of Pisa, Italy
Reviewed by:Federica Bellone, University of Messina, Italy
Antonino Catalano, University of Messina, Italy
Copyright © 2021 Beresford, Teschke, Hipp and Ronan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Thomas Beresford, email@example.com


text:
Dear Barbara, I just read the post you wrote about grieving. My tears won't stop running down my face. It struck a nerve. My father passed away 3 weeks ago after being sick for so long. The semi-numbness you talk about is wearing off now. I thought I was cold this entire time but I didn't want to accept it. I don't know what you meant by being gentle to yourself. What methods of being gentle to myself did you mean? Because all I feel is guilt, anger, regret and mostly lethargic followed by just emptiness.
Grief brings with it all kinds of emotions, unanswered questions and as you mentioned guilt, anger, and regret. We tend to "beat ourselves up" for past occurrences and thoughts we now cannot address or fix. All this makes our loss more complicated.
What do I mean by being "gentle" with yourself? I mean forgive yourself for all the things you feel guilty about. Remember we always do the best we can with the information we have at the time. In hindsight, with more information, we may wish we had done things differently but in the moment we did the best we were able to do. No one sets out to do something badly.
So --- self forgiveness is a start.
One of the ways to let go of those areas you feel bad about is to write the person who has died a letter. Write everything you would say if you could. Put down all the positive and negative thoughts and feelings. When the letter is finished, burn it and imagine the feelings burning with the paper. You are releasing that which is keeping you from living with your grief.
Being gentle with yourself is putting yourself first. What makes you feel good? What do you need right now? If you could do, or go, or see, or say, anything what would it be? What is stopping you from realizing it?
Being gentle with yourself is recognizing your needs and getting them filled. Being gentle with yourself is not judging yourself for the past and moving forward with positive intentions.
We don't recover from grief. It doesn't go away on any magic day. We must learn to live with it. My hope is we let how well we go on living be the testament to the life we are mourning. Let how well we live life, express our love for the person who has died. Let our example be not about how many tears we shed but how well we move forward.
Something more about Be Gentle With Yourself... I have a booklet on grief called My Friend, I Care. You might find it helpful.
Hi Liz, time to let go of the regrets and “wish I had’s”. Keep the “I miss you” and “I love you”. Dying is messy. It’s not easy and gentle like in the movies, that said, with your mother not eating and “starving to death”, at the point she couldn’t eat her body didn’t want to eat. She wouldn’t have been eating if she could have. Her body, from the stroke, was preparing to die and it would have stopped eating on its own as part of dying. Blessings! Barbara
Boy, I’ve been guilty since my mom died in 2005! She was 89 and needed total care when she had the “big one”, a stroke that left her unable to eat. Her doctor and I talked and agreed that to put in a feeding tube wasn’t a good plan, so I quit my teaching job and stayed with her (she also had a 24-hr caregiver) for the 3 weeks it took her to basically starve to death with no liquids either. We had hospice, too, but I still feel horrible about the decision. I have all of your books, and have shared them with several friends, but I still feel badly.
Thank you again Barbara for your kind words . I think they are exactly what many of us need at the moment .
We have to remember we did the best we could at the time . Of course hindsight is a wonderful thing and we blame ourselves what we should have done and what we did that perhaps we should not have . Dying is not something the average person deals with every day and ‘we did our best ‘ one has to hold onto that I think .
It has been 6 years since my mother died and as I told you before I keep a journal and it is still one of my ways of connecting with my mom.
I don’t write as often as I did but when certain things happen I let her know and include her in the occurrence. It makes me feel good and gives me satisfaction.
It is always normal to feel some guilt as we think back. But we must remember ( and it is hard )we cannot change the past.There are many things we have no control over.
I try to make myself focus on the good that I did and it eases the what if’s that we have.
There is no real answer to deal with death.
We cannot change the past therefore we must “let it go” and stop beating ourselves up.
Hopefully this will help someone having a difficult time dealing with the death of a loved one.
All of your books have helped me and I strongly recommend them to everyone.
These are just the words I need at this moment. I told my Christian counselor last week that I will never be able to forgive myself for having to put my husband, who had Parkinson’s plus MSA, in some care facilities at times during his disease process. After four years of caregiving single handed I fell into a deep depression and I just could not care for him for a period of time. I was able to honor his wishes, though, to bring him home for the last year and a half of his life.
Thank you for your words as they are very soothing to me.
I am blessed to have a Libby Boatwright as a Pastor in my church. She performed my husband’s service two years ago and continues to be my friend. I know from her that you know each other. She said some wonderful things about you.
Two wonderful blessings now.
Leave a comment

domain: literature


text:
Exclusive New Music from Shaé
We're back with a new single from British singer/song-writer Shaé. Her new song is called Move and it gives me late night vibes. It's the type of song you would play in the background while snuggling up with bae. It's very soulful, which is expected because Shaé has a beautiful and rich voice with a wide range. I like the message of her confidence coming from loving herself and wanting more from her man. I enjoyed listening to this song, and I know you guys will too.
Music produced by sunsetDRVER and the artwork was by Gray.

domain: artistic


New Delhi: The Delhi High Court on Friday passed an interim order stating that Amitabh Bachchan's photo, voice, name or any of his attributes cannot be used without permission. The court also directed the Ministry of Electronics and Information Technology, and telecom service providers, to remove flagged content.
New Delhi: The Delhi High Court on Friday passed an interim order stating that Amitabh Bachchan’s photo, voice, name or any of his attributes cannot be used without permission. The court also directed the Ministry of Electronics and Information Technology, and telecom service providers, to remove flagged content.
During the hearing, Justice Chawla issued directions to the authority and the Department of Telecom to immediately remove the name, photo and personality traits of Amitabh Bachchan, which are publicly available without his permission. “It cannot seriously be disputed that the plaintiff is a well-known personality and is also represented in various advertisements,” Justice Navin Chawla said, noting that the actor “is aggrieved” by those using his celebrity status to promote their goods and services without his permission.
Actually, senior advocate Harish Salve had filed a petition in the court on behalf of Amitabh Bachchan. It was said in the petition that some companies are using Amitabh Bachchan’s name, voice and personality in a wrong way, which is wrong.
He had said that a lottery ad in my name is also running on social media platforms, in which his photo is also attached and the logo of the program KBC hosted by him is also there. There is no truth in this. Bachchan has also sought a restraining order against book publishers, T-shirt vendors and various other businesses.The matter will be heard in March next year.
It was told through the lawyer that without his permission his name, voice and personality should not be used in any kind of advertisement. It is said that Amitabh Bachchan is likely to suffer serious harm and if the order is not passed, certain activities may also defame him.


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America’s only daily morning talk show for creatives just like you. Exploring the reality of trying to live your creative dreams. Sometimes educational, sometimes off topic but always entertaining! New Episodes Monday-Friday!
Dan Khulken and Nathan Goldman from DKNG share their studio's experiences from performing at Adobe Max, selling at Pin Pal Palooza, and share a preview of their upcoming Black Friday Sale as well as some great Black Friday tips based on their past sales. Circle of Trust listeners get a sneak peek of sketches for future licensed work. This month's process porn illustrates how DKNG learned how to tackle portraits and character design from an Adobe Illustrator, not a fan of drawing people perspective.…read more


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In the event of a workplace injury, you may worry about the doctor who will treat you. People tend to have their own personal doctors and feel comfortable with them treating their condition than somebody they are not familiar with. If you want to receive workers’ compensation, you will have to use a doctor designated by your employer, but only at first.
The Workers’ Compensation Commission for the state of Connecticut explains how and when an injured worker may receive treatment from a preferred doctor. It is important to follow the guidelines set by the state, or you might waive your workers’ compensation rights.
Your initial visit
According to state law, following a workplace injury, you must visit the doctor designated by the medical care plan of your employer. Once you have received your initial treatment, you may then pick an attending physician. If you decide not to receive your initial treatment from an employer designated doctor, you may end up losing your workers’ comp rights, including your right to receive coverage of your medical bills by the state.
Non plan employers
In the event your employer is not a part of an approved medical care plan, the state allows you to select a medical professional licensed by the state of Connecticut. In addition to a doctor who specializes in medicine, you may pick someone versed in a medical field like podiatry, naturopathy, chiropractic treatment, and osteopathy, depending on the needs of your condition.
Changing a doctor
If you have a problem with your current doctor, perhaps because of the treatment the doctor is giving you, state law allows you to change your doctor. However, you must follow a three step process to complete the change. First, you must acquire a referral from your current attending doctor so that another doctor can treat you. Secondly, you must also obtain an approval from the workers’ comp insurance carrier that is a part of your case.
Finally, you will have to submit a request in writing to the Workers’ Compensation Commissioner for your jurisdiction. This request should indicate your desire to change your doctor, including the name, the address, and the medical specialty of the new doctor you wish to treat you. You must also describe your reasons for wanting the change. You may expect a response from the commissioner through the mail. If your employer has coverage under an approved plan, the new doctor must participate in the plan.

domain: medical


text:
f Single electron transfer by an extracellular laccase from the white-rot fungus Pleurotus ostreatus
- Authors: Hong-Duk Youn, Kyu-Jung Kim†, Jin-Soo Maeng, Young-Hoon Han, In-Beom Jeong, Gajin Jeong, Sa-Ouk Kang, Yung Chil Hah
- Author for correspondence: Sa-Ouk Kang. Tel: +82 2 880 6703. Fax: +82 2 888 4911. e-mail: firstname.lastname@example.org
- Microbiology, February 1995 141: 393-398, doi: 10.1099/13500872-141-2-393
- Subject: Biochemistry
- Published Online:
SUMMARY: Two different bands with laccase activity were obtained after nondenaturing PAGE of the culture filtrate of Pleurotus ostreatus. Immunoblot analysis revealed that antisera raised against laccase I were not reactive to laccase II. Laccase I, which exhibited faster mobility on nondenaturing polyacrylamide gel, was purified 42-9-fold with an overall yield of 10-8%. Gel filtration and SDS-PAGE revealed that laccase I is a single polypeptide with a molecular mass of approximately 64 kDa. Laccase I contained 12-5% carbohydrate by weight and 3-9 mol copper (mol protein)−1. The absorption spectrum of laccase I showed a type 1 signal at 605 nm and EPR spectra showed that the parameters of the type 1 and type 2 Cu signals were g| = 2-197 and A| = 0-009 cm−1, and g| = 2-263 and A| = 0-0176 cm−1, respectively. The data obtained from the pH profiles suggested that two ionization groups, whose pKa values were 5-60-5-70 and 6-70-6-85, may play an important role in the active site of laccase I as the ligand of copper metal. The optimal pH and temperature for the activity of laccase I were 6-0-6-5 and 30-35 °C, respectively. The enzyme had affinity for various lignin-related phenolic compounds: the K m values for ferulic acid and syringic acid were 48 and 89 μM, respectively. EPR spectroscopic study of the action of laccase I on 3,5-dimethoxy-5-hydroxyacetophenone indicated that this enzyme catalyses single electron transfer with the formation of the phenoxy radical as an intermediate.
Present address:Department of Biology, College of Sciences, Kangreung National University, Republic of Korea.
© Society for General Microbiology 1995 | Published by the Microbiology Society
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* Reuters has revealed that the Venezuelan government has stockpiles of 5,000 Russian made MANPAD surface-to-air weapons. The stash of SA-24 missiles is the largest known stockpile in Latin America and is a source of concern for US officials amid the country’s mounting turmoil, where anti-government protests against the socialist president, Nicolas Maduro, has resulted in deaths. Weapons experts said there have long been fears that the weapons could be stolen, sold or somehow channeled to the wrong hands, concerns exacerbated by the current civil unrest in Venezuela and the economic crisis roiling the oil-producing nation.
* Lockheed Martin has won a $137.8 million contract modification for cost-reduction programs for the initial low-rate production of the F-35 Joint Strike Fighter. Fiscal 2016 aircraft procurement funds from the Air Force, Navy, and Marine Corps of $137.8 million will be allocated to the program, none of which will expire at the end of the fiscal year. Eighty percent of the modification will go to the Air Force, with the rest split between the Navy and Marine Corps. Scheduled to be completed by December 2020, work will take place at Waco, Texas, El Segundo, Calif. and Warton, England, with other work being completed across the United States.
* Boeing has been awarded a $1.09 billion undefinitized modification to a previously awarded contract for the procurement of Redesigned Kill Vehicle development. The Missile Defense Agency (MDA) made the award, with work to include, but not limited to, payload development, payload ground testing, integration with the Ground-based Interceptor (GBI) and Ground-based Midcourse Defense (GMD) Ground system, flight testing and four initial production RKVs for initial fielding. The modification brings the total cumulative face value of the program to $5.84 billion.
Middle East & North Africa
* In addition to its deal to build Blackhawk helicopters in the kingdom, Lockheed Martin will develop a $28 billion air and missile defense program that will include the THAAD ballistic missile defense system, the anti-aircraft missile Patriot, 150 utility Blackhawk helicopters, and other systems and logistical support. The program is projected to support 18,000 skilled jobs in the US, along with thousands of jobs maintaining the equipment in Saudi Arabia for the next 30 years. It had been reported that Riyadh was interested in THAAD ahead of US President Donald Trump’s visit last weekend.
* Israel Military Industries (IMI) has unveiled a new precision rocket system for special forces’ operating in urban environments. The ACCULAR system is a 122mm rocket with a 44-pound penetration or controlled fragmentation warhead with a range of 27 miles. It was developed to respond to a need by forces who operated beyond the range of traditional artillery fire support.
* Malta has taken delivery of its third King Air maritime patrol aircraft. The $18 million purchase was made possible due to funds made available by the European Union (EU), and will go towards improving the Mediterranean island’s situational awareness with the ability to have a maritime domain awareness picture and advanced navigational capabilities. The previous two aircraft had been commissioned in 2011 and 2012 respectively
* Japanese firms have partnered with Raytheon and Lockheed Martin to work on rival projects to develop new radars that will enhance Japan’s shield against any North Korean missile strike. Mitsubishi Electric Corp have paired with Raytheon, while Lockheed is working with Fujitsu Ltd in an effort to extend the range of Japan’s detection and targeting radars multiple times beyond range of models currently deployed at sea. Tokyo’s announcement comes as the government forge ahead with a plan to acquire the Aegis Ashore system ahead of THAAD.
* The Indian government is likely to approve an Army plan to to buy 11 AH-64 attack helicopters. A previous batch of 22 Apaches had been ordered for the Air Force in 2015, but an initial procurement designated for the Army had been rejected by the previous government. The additional helicopters will now be purchased out of an optional clause in the original 2015 deal through the US Foreign Military Sales program.
* IMI’s ACCULAR:


text:
Zig-zag Woven Cotton-Blend Kaftan
Monochrome and orange zig-zag woven cotton-blend kaftan from Missoni Mare. Contrasting shoulder panel is formed of black and white zig-zags with 3-D orange, purple and green polka dots. Bateau neck. Three quarter length sleeves. Small side splits. Dry clean only.
Item ID: 10342014
- Cotton 45%
- Rayon 55%
- Brand Style ID
Import duties information
Free returns pick-up
Italian family-run fashion house, Missoni was founded by Tai and Rosita Missoni in 1953. Best known for its signature crochet-knitted colourful designs, the Missoni label has built up a strong celebrity following with the likes of Demi Moore, Cameron Diaz and Julia Roberts to name a few sporting the kaleidoscopic geometric prints. Daughter and Creative Director, Angela following in her parents footsteps continues to deliver exquisite collections with inimitable Italian flair. Signature pieces include bohemian eveningwear and of course, the must-have striped knits.

domain: design


Last night, 1800 Tequila and Atlanta Hip Hop legend Future launched the new 1800 Cristalino during the Brooklyn Nets matchup against the Orlando Magic at Barclays Center in Brooklyn.
1800 Cristalino is the newest ultra-premium expression from 1800 Tequila, the official tequila of the Nets and Barclays Center. Future enjoyed an 1800 Cristalino cocktail while sitting courtside during a close game between the Nets and the Orlando Magic.
A prestige offering from the brand, 1800 Cristalino is a crystal clear Anejo tequila packaged in an eye-catching luxe glass cut bottle that is available now in select markets. For more information, please visit 1800 Tequila’s website.


Practical and affordable, DaySurg is the most versatile chair ever designed and is able to cope with every possible stage of the out-patient surgery process.
Receiving patients, preparation and anaesthesia, procedures, recovery and even dialysis… it is the perfect solution in every situation.
- High comfort 80mm thick foam
- Fully adjustable armrests for easy side access
- Each section can be controlled independently (3 electric motors)
- Manual or electric footrest depending on version
REF : 3181 / 3185
- 360° Rotation
- Height and angle adjustment of headrest
- A hydraulic pump controls all the movements
- Hydraulic variable height from 58 to 78cm
REF : 2863
*depending on model


The Strypes have accused pop mogul Simon Cowell of making ‘artfully unintelligent music huge’.
The young band, whose penchant for early blues was crystallised on their 2013 debut album ‘Snapshot‘, were reflecting on the current state of the industry in which they now find themselves in during an interview with the London Evening Standard.
“It’s annoying that he has the power to make artfully unintelligent music huge and tell everyone that is what you should listen to,” bassist Pete O’Hanlon said. “Destroying music isn’t funny, okay?”
“He’s just a wanker,” drummer Evan Walsh added. “It’s the manipulation of naive young minds as well.”
In our review, Live4ever praised ‘Snapshot’ as a, ‘Celebration of a particular genre done with reverence and dewy-eyed enthusiasm’.
“If The Strypes have one key aim on ‘Snapshot’, it’s to make you dance,” the review reads. “Each track seems to move at a million miles an hour, with the tight arrangements and structures only adding to that feeling. Moreover, this is an album of hooky choruses and shouty verse lines – the sort of lines that will inhabit your head for days on end.”


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Maple-grilled trout on spinach
This article has not been rated yet.
Melon isn't just for breakfast and dessert: We've paired it with spinach and cucumber to make a nutritious salad bed for our smoky grilled trout.
- 2 tbsp mango chutney , or honey
- 2 tbsp lemon juice
- 2 tbsp olive oil
- 1/4 tsp salt
- 2-Jan honeydew melon , seeds removed
- 2 cups yellow grape tomatoes , optional
- 41643 cucumber , thinly sliced
- 8 cups baby spinach
- 1 tbsp maple syrup
- 1 1/2 tsp ground cumin
- 3 trout fillets , about 250 g each
- 2 tbsp snipped chives
- Oil grill and heat barbecue to medium-high. Place chutney in a small bowl. Remove chunks from chutney and chop finely, then return to bowl. Whisk in lemon juice, 1 tbsp (15 mL) oil and salt. Peel melon and chop coarsely. Slice tomatoes if you like. Place in a large bowl with cucumber and spinach.
- In another small bowl, whisk 1 tbsp (15 mL) oil with maple syrup, cumin and pinches of salt. Brush over fish. Place fillets on grill, skin-side down. Cover and barbecue, without turning, until a knife tip inserted in centre for 10 sec comes out warm, about 8 min.
- Meanwhile, whisk chutney dressing and toss with salad. Place on a platter or plates. Remove cooked fish by sliding a large spatula between skin and flesh. Carefully lift trout, leaving skin on the grill. Place on salad. Sprinkle with chives.
Nutrition (per serving)
- 42 g,
- 36 g,
- 21 g,
- 4 g,

domain: food


text:
NORTH ATTLEBORO, Mass. (WPRI) — A Super Bowl LIV ring will be coming to New England after all.
Kansas City Chiefs fullback Anthony Sherman threw a crucial block in the fourth quarter of Sunday’s game that allowed running back Damien Williams to score a 38-yard touchdown, all but sealing the team’s 31-20 win over the San Francisco 49ers.
Sherman, 31, was drafted out of the University of Connecticut by the Arizona Cardinals in 2011 and joined the Chiefs two years later. But before that — he was a Red Rocketeer at North Attleboro High School.
“It’s just amazing that you personally know somebody that’s in the Super Bowl. I don’t think many people can say that, and just to see them win too is just unbelievable,” said Mike Hart, one of Sherman’s former teammates who’s now a math teacher at the school as well as the head baseball coach and an assistant football coach.
“Ten years in the league and being able to get to the Super Bowl…not many people can say that,” said Derek Herber, who teaches history and also coaches football.
The school’s athletic director, Kurt Kummer, was the head football coach when Sherman was on the team. On Monday, he reminisced about that time as he flipped through a scrapbook full of pictures of Sherman.
“I always used to say that Anthony was the best football player I ever had or I ever saw, and he was a better kid,” Kummer said. “We’re happy for him, the entire team. It’s just amazing what Anthony’s been able to do.”
During the opening night ceremony in Miami, Sherman thanked everyone that’s supported him from his Pop Warner days all the way to football’s biggest stage.

domain: sports


text:
Do you export to Europe? Are you struggling to get your head around the tax implications? Not quite clear on the whole process? Or worried that additional export costs might impact your competitive edge?
We have a simple solution for you!
Our end-to-end service takes the hassle out of exporting to Europe.
- Ensure that all your declaration documents are sorted
- Use our network of fast and flexible partners to transport your goods into Europe
- Help you to take advantage of customs clearance into France with no delays
So you can:
- Improve your lead times by tracking real-time information on your goods as they are transported
- Achieve better cash flow by making your VAT payable in the UK
- Relax, knowing that you are exporting as cost-effectively and efficiently as possible
To do this we use three key tools:
- Regime 42: a VAT exemption that can be applied when goods are cleared in France to enable free circulation in the EU (except Cyprus and Malta)
- Regime 40: specifically for export into France, this mechanism can be used in a few ways to speed up, simplify or avoid paying VAT on those goods
- PVA (Postponed VAT Accounting): accounting for and recovering import VAT on the same VAT return, rather than having to pay it upfront and recover it later
Our account managers know these customs regulations inside out, so you don’t have to. They can look after your logistics, so you can get on with running your business.

domain: finance


Redistricting commission begins new phase, bill preventing closed meetings introduced
The Michigan Independent Citizens Redistricting Commission is getting ready to open a last public comment period before it picks final legislative boundaries.
These next meetings mark a near end to a months-long process that saw the commission face criticism for its interpretation of federal voting laws and the constitutional amendment that created it.
Some lawmakers in the state Senate recently spoke out against a decision by the commission last month to receive legal advice behind closed doors.
Commissioner M.C. Rothhorn defends the choice.
“We best made the decision we had with the information. We needed information that our attorneys potentially said, ‘You don’t want to risk having this in an open meeting. There’s a privilege you can enjoy. Take it.’ We did.”
The commission will meet in late December to choose final maps for the state’s next House, Senate and Congressional Districts.


The Detroit NewsPistons move is Robin Hood in reverseThe Detroit News
billboard on the wall of the new area.**Pistons
announcement that they're moving downtown. At Cass Tech High., Tom Gores, Chairman and CEO, Platinum Equity and owner, Detroit Pistons
, Christopher Ilitch, President and CEO, Ilitch Holdings, ...


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Jan. 6, 2021, is a day that will live in infamy. For most of us, the images of rioters breaching the Capitol will be forever seared into our memory. For the UCLA Bruins who serve in Congress representing both parties, their vantage points from within the building offer harrowing accounts of the day’s events. "I wasn't going to go down without a fight."
In celebration of Black History Month, we recognize the achievements of UCLA’s Black Bruins in the past 100 years. They are among the best and the brightest of their generation — activists, artists, athletes, and much more. They walk in the footsteps of those who came before them, and blaze a path for those that follow, in search of a more just and equitable world.
For 52 years, Bruins have come together around the dinner table for three nights in the winter to share the warmth of Bruin camaraderie. This year we'll gather again, virtually, to laugh, reminisce, make new friends and remember that UCLA unites us and lifts us up. Sign up to attend anywhere in the world on Feb. 20, 21 or 27.
Alumni President D'Artagnan Scorza '07, Ph.D. '13, goes one-on-one with UCLA's new athletic director, who fielded tough questions on the impact that COVID-19, racial justice issues, budget deficits, the Nike partnership and remote learning have had on UCLA's student-athletes. Tune in for the next town hall on Feb. 11.
Now, more than ever, student clubs and organizations offer the social connection often lacking in a remote learning environment. With in-person gatherings on hold, these groups have had to adapt and come up with creative ways to build, and in some cases expand, their Bruin community.
Whether you're single, dating or in a long-term relationship, the pandemic has created many challenges to finding or sustaining love. Luckily, soulmate coaches Orna '88 and Matthew Walters have a message of hope: it's never too late to find the love of your life or turn a current partner into the love of your life.

domain: sociology


text:
The production will run from April 6 through May 8 at Demens Landing Park in St. Petersburg.
ST. PETERSBURG, Fla. — Get ready to kick off your shoes because “Footloose The Musical” is coming to American Stage in the Park following a two-year delay due to COVID-19.
The production, based on the 1984 film, will run from April 6 through May 8 at Demens Landing Park in St. Petersburg.
“I had actually finished choreographing the show when the 2020 Park show was canceled just three days before we were scheduled to start rehearsals. I feel the show has been simmering and waiting to be served since then,” long-time American Stage Director Shain Stroff said, in part.
According to a press release, the cast and crew, a mixture of both national and local talent, had to be cast through video submissions after health and safety regulations left in-person auditions off the table.
“The casting process with this show had its own set of challenges due to casting only through video submissions,” Stroff said. “I wanted a very diverse cast and worked tirelessly to deliver the best I could. The finalized cast of Footloose is a diverse wonderful group of very talented artists, and I feel certain they will deliver a blockbuster performance to the St. Petersburg/Tampa audiences.”
The production will include the largest cast American Stage has had since its 2019 park production of “Mamma Mia.”
Anyone looking to attend can buy tickets here. On show nights, the park will open at 6 p.m. with the show beginning at 8 p.m. Special showings of “Footloose The Musical” will be held on the following nights:
- Pay What You Can Previews: April 6-7
- Opening Night Gala: April 8
- Pets in the Park Night: April 17
- Pride Plus Night: April 24


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Senator: sustain use of agri, fishery enhancement fund
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Senator Cynthia Villar has sponsored a committee report on the bill seeking the continued use of the fund that will help farmers and fisherfolk improve their production and competitiveness. The Agricultural Competitiveness Enhancement Fund (ACEF) is set to expire in December 2015. "This is why ACEF miserably failed in achieving its objectives. The funds did not go to intended beneficiaries. Instead of scrapping the fund altogether, we are pushing for a law that will make sure the funds will be spent for the sole purpose of improving the productivity and competitiveness of small farmers and fisherfolk," Villar said.
Senator: sustain use of agri, fishery enhancement fund. (2015, September 21). Panay News, p. 6.
- Panay News

domain: agronomy


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Jump to Main Content
Identifying local and regional groundwater in basins: chemical and stable isotopic attributes of multivariate classification of hydrochemical data, the Lower Virgin River Basin, Nevada, Arizona and Utah, U.S.A
- Asante, Joseph, Kreamer, David K.
- Isotopes in environmental and health studies 2018 v.54 no.4 pp. 370-391
- aquifers, basins, deuterium, floodplains, groundwater, groundwater flow, oxygen, potassium, rivers, sodium, springs (water), stable isotopes, sulfates, watersheds, wells, Arizona, Nevada, Utah
- In the Basin and Range Province of the Southwestern U.S.A., deep carbonate groundwater has been suggested as a significant source to many overlying basin-fill alluvial aquifer systems. Notwithstanding, testing this hypothesis is limited by obtaining data from such considerable depths and complex geology. This study uses δ²H and δ¹⁸O data from springs, rivers, and wells tapping shallow basin-fill groundwater to test the hydrochemical interpretation of deep regional carbonate groundwater flow into the basin-fill aquifers. Stable isotopic and major ion attributes of hydrochemical facies suggest basin-fill alluvial groundwater of the Lower Virgin River Basin is a mixture of precipitation recharge within the Lower Virgin River Basin or the Clover and Escalante Desert Basin northwards, and the deep carbonate flow. The data support the conclusions that in the Lower Virgin River Basin, deep carbonate groundwater is an important source to the alluvial aquifer system and likely accounts for approximately 50% of the alluvial aquifer groundwater. Na⁺, K⁺, and SO₄²– increase in the basin-fill alluvial groundwaters outside the Virgin River floodplain appears to be related with upwelling of deep regional groundwater, and indicating that the chemical character of the basin-fill alluvial groundwaters are related to the deeper flow systems.

domain: geography


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San Diego County proclaims March 28 Diabetes Alert Day
Tuesday, March 28, 2006
The County of San Diego has proclaimed March 28 as Diabetes Alert Day encouraging everyone to find out if they are at risk for the disease. Tom Fudge explores what it is like to live with diabetes today.
Take the online test to find out if you are at risk of getting diabetes at www.diabetes.org/risk-test .
- Katie Croskrey is the executive director of the American Diabetes Association , San Diego Chapter.
- Jeff Marston is the owner of Marston and Marston Public Relations and Marketing. He has been a Type 1 diabetic for over thirty years.
- Alma Ayala is a diabetes educator with Project Dulce of the Whittier Institute for Diabetes. She has been a Type 2 diabetic for 19 years.
To view PDF documents, Download Acrobat Reader.

domain: news


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Why nails are affected by psoriasis? Methods of treatment
Psoriasis of the nails is the defeat of the plates with scaly lichen. The disease does not belong to infectious pathologies, but it worsens the type of hands and feet and increases the risk of developing abnormalities in the activity of the heart, vessels and the endocrine system. Also, psoriasis affects the nervous system negatively.
Dissatisfied with his appearance the patient is experiencing, he develops complexes and stresses occur.In neglected cases, when it is not possible to get rid of the nail fever, the disease disfigures the nail plate and causes the person to avoid the society. On the background of pathology, there is a constant weakness and an increase in temperature.
Why nails are affected by psoriasis?
There is an opinion that nails are ill with psoriasis after long-term stress. In fact, emotional outbursts are not the main cause of nail psoriasis. Doctors view them as a provoking factor, which motivates pathology to transform from sluggish into acute.
The true causes of the nail problem are two:
- distortion of immune processes, on the correct course of which depends the formation of healthy cells and the full fermentation of substances. As a result of the disturbance, the underdeveloped particles of the epidermis separate from the general medium, multiply and expand, causing a thickening of the nail surfaces. The body reacts to atypical cells with inflammation.
- Hereditary predisposition is on the 2 nd place. The propensity to develop psoriasis in some people is laid down genetically, and the anomaly slumber for years before the impact on the body of certain factors.
In turn, exogenous and endogenous factors cause primary psoriasis and its relapses. The key ones are:
- hormonal imbalance;
- a metabolic disorder;
- reception of beta-blockers, non-steroidal anti-inflammatory drugs, chloroquine, pharmacological products to reduce blood pressure;
- cold and dry weather, which, with weak immunity, causes psoriasis of the finger nails and deterioration of the skin surface of the hands;
- mechanical damage to the dermal cover;
- infectious foci, undermining the strength of the immune system;
- chronic fatigue and emotional shocks.
Psoriatic lesions of the nails are isolated and accompanying skin signs of the disease. In 50% of all reported cases, nail psoriasis is diagnosed along with the pathology of the dermis. Before devising a treatment course, the deviation should be differentiated from onychomycosis..
How does psoriasis develop on nails
The clinical course and symptoms of psoriasis of the nails are determined by the affected area - pathology affects the matrix or bed. Matrix is a rhizome and an important element of epithelial tissue, which is called the germ zone. It is located at the bottom of the plate under the roller. The bed is a connective tissue layer lying under the germ epidermis. The thickness of the plate depends on both parts of the nail apparatus.
In case of damage to the matrix, there are signs of psoriasis, such as:
- erythema, manifested by the accumulation of spots under the fingernails in the region of the visible part of the matrix and peri-endogenous ridges. Rounded small spots are distinguished by a yellowish and red tinge.
- Leukonichia, which is expressed by whitish spots or lines. Their formation is explained by the concentration of microscopic air bubbles among the layers of the plate. In case of a complete lesion, pathology is called "Terry nails."
- The phenomenon of the thimble. This sign of nail psoriasis has the form of point depressions lying in rows. When pressing into the center of the hearth, pain occurs.
- Coylonihia. Raised edges of the plate give it a concave shape resembling a spoon.
- Trachionichia. Rough dim plaques crack on the free edge, are covered with scales or pinholes.
- Onychodystrophy is manifested by brittleness and splitting of the nails with the formation of transverse furrows.
Look at the photo - nail psoriasis is shown in all its manifestations.
In case of defeat of the nail bed, subungual hyperkeratosis develops, in which the growth and hardening of the epithelium accumulated under the plate is observed. In some patients, the diagnosis of an oil-spot phenomenon facilitates the diagnosis of a yellowish-brown zone under the nail surface.
Rosso-like point hemorrhages also confirm the development of nail psoriasis. Split hemorrhages are characterized by the appearance on the nails of black or brown strips. The effect of stearin stain in lichenic lesions of nails is manifested when the plate is scraped or the surrounding skin. From the surface peel bright silvery scales, similar to particles of crushed stearin..
Onycholysis, or exfoliation of the nail happens in neglected form, when a person neglected treatment. The plate becomes faded and thin and is gradually torn off by the skin. The progressing course of a severe stage is fraught with a complete loss of the nail..
Psoriasis of nails: medicamentous therapy
Since nail psoriasis is a chronic pathology, its treatment can last for months. For convenience of carrying out of therapeutic measures, the patient is recommended to shorten the nails shortly and adhere to the rules that do not allow deterioration of their appearance.
- Work with any chemicals should be carried out in rubber gloves.
- Instead of the usual manicure, the nail care should be replaced with a protective transparent varnish coating the plates.
- Regular treatment of hands with a fat cream will prevent drying of the skin and cracking of the plates.
- Treatment of the peronegelic zone with retinol will nourish its internal part.
At the initial stage for the external treatment of psoriasis of the nails, the patient is prescribed Antralin, Calcipotriol, Tazaroten, Dayvonex, Betamethasone and any immunomodulator. Local therapy can be based on the use of steroids:
- Lorinden A;
- Celestoderm B;
- prednisolone ointment;
- triamcinolone ointment.
To stop the inflammatory process that affected the skin around the nails, treatment with salicylic ointment or sulfur-salicylic product with a one-percent concentration is recommended. In the external treatment of psoriasis of the nails on the legs and hands, solutions of immunosuppressants are sometimes used. Treatment of plates with 70% Cyclosporin is performed twice a day with a 3 to 4-month course..
For internal reception, complexes of minerals and vitamins with a predominance of substances A and D, oral preparations of Acitretin, Ciclosporin and Methotrexate are shown..
Non-traditional treatment of psoriasis nails
Patients whose nails suffer from psoriasis, it is useful to make baths with leaves of cocklebur. The plant gives antimicrobial, antipruritic and wound-healing effect.
Bath liquid is made from 4 tbsp. l. raw materials and 500 grams of water. The composition is boiled for a quarter of an hour on a low heat, cooled to an acceptable temperature and the hands or feet soar. The cocklebur can alternate with the flowers of the string and the seeds of the pearl-lobster.
During the treatment of psoriasis of nails at home it is important to cleanse the body. For this purpose in equal proportions collect the horsetail, cranberry leaf, calamus root, string, celandine, St. John's wort and elecampane. After thoroughly mixing the dry shredded phyto products from the collection, 1 large spoonful of raw material is taken and a glass of fresh water is poured over. The agent is insisted until completely cooled and take 2 p. a day after the meal.
Video:treatment of psoriasis folk remedies at home.
For lubrication of problem nails, a preparation is prepared from technical solidol, melted interior fat (10 parts each) and fatty baby cream (1 part). The mixed mass is applied to the plates overnight. Heal plates can be tinctured with a golden mustache. 50 vertebra plants pour half a liter of vodka and insist 30 days. Use a product for rubbing nails.


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As we fall relentlessly towards the end of the twelfth month our thoughts become increasingly reflective. We tend to use December as a looking glass, sometimes tortuously so, and as a means to somehow dissect and then reconcile the last three hundred and sixty something days of our lives. I always find it interesting that we choose to compartmentalise our existence in this way, into small blocks with defined start and end dates instead of looking at the totality, but maybe this is a management tool that allows our brains to look with needed granularity. What I also find interesting is that I tend to think that more often than not that when we review our year, we focus on the negatives but not always the positives. This might be my own personal experience clouding my objectivity, but it feels common that this December perspective is as peculiar set of glasses that seem to favour the bad things that have happened to us, and not so much the good.
With wholehearted honesty I have caught myself saying these very words in just the last few weeks. “I can’t wait for this year to end”, or “This year has been so hard”. The truth is I can’t, and it has, but thinking back I’ve done this many times. It also seems that many others reflect this back as some kind of collective norm that through our shared discomfort allows us to accept our hardships together. Well, life is hard, so surely this is not entirely unexpected. However, this year I found myself doing something different. Something very simple that made me feel better and more empowered.
But why do we do this? Why do we focus on the more difficult parts of our lives? Why do we not get to the end of the year positively enthused by all of our experiences both good and bad knowing that these have shaped our very being and that we have survived and achieved and had impact. Is just crossing the finish not enough? For example, long distance runners can put themselves through incredible pain, yet push over the line with exhilaration and a never to be taken away sense of self-worth and achievement. They entered the race willingly yes, but maybe they underestimated how hard it would be. Yes, it may have been horrendous, and yes, there are moments where they might have wanted to stop and vomit, but they made it and celebrated. I’m not sure I’ve ever heard anyone say, ‘That was a tough but brilliant year”.
I can’t help but think that it’s because when things are painful, it hurts us, and quite simply the reason pain exists is to tell us that we are in a situation that isn’t all healthy or good for us. Pain and discomfort are stressors from which the mind and body tries to self-preserve. Happiness on the other hand doesn’t elicit such a powerful response because there is no harm to be caused (relatively speaking). Happiness can therefore continue to be absorbed. Pain on the other hand sometimes feels like trying to absorb a house brick into a sponge.
It’s for these reasons that we look back on our calendar years with a leaning towards the difficult because it is more easily remembered. Now, I’m not saying that we need to be all unicorns and rainbows about our experiences. I’m certainly not saying that we should discount our difficult times or our difficult years, and indeed there are some situations that are catastrophically and inescapably difficult. However, on the whole we do do ourselves a disservice. It’s here that retrospection comes into play, and a willingness to look at both the good, as well as the good that comes from the bad. After all, we often find ourselves looking to the future with the intent for it to be ‘better’, but how? What have we learnt of ourselves in the past? What challenges have we been defeated by but then risen again as a different but more resilient individual. I do think that as humans we don’t allow ourselves to feel good about our achievements, to dwell on them, to feel real pride, not with any arrogance or outward projections of comparative better value to anyone else, but just simply to let the good in. It is here that we achieve perspective, balance, and growth.
So how is this achieved. Well again, this is simple. It requires setting aside some time for self-development and analyses. Now this sounds quite psycho babble-ish, but I absolutely believe that in order to change, to grow, to re-balance, we need to invest time to just sit and think. So, take 30 minutes to sit and reflect on your own past year. Write down the good and the bad things. When you write down the good and the bad, write down how it changed you, what you learnt. This is a very simple exercise in self-development that can completely change your outlook. It may even alter your compass as you sail towards the future. If you’re feeling brave, share it (as I will do here) and let others know not only the fires that you’ve walked through but the changes that you’ve made and the things you’ve achieved as a human. It may even encourage them to think about it and do the same.
Now, it’s important to remember that achievement is relative, and that success is relative. Don’t use scales of comparison as they are redundant. All that matters is what you have been through and what you have done. For example, someone with anxiety may have worked for weeks and weeks on strategies to help them leave the house. When they successfully left the house the achievement was probably felt as much as an individual completing their first 100-mile ultra-marathon. Both will have worked incredibly hard. What is important is the knowledge of achievement, of the individual journey, but knowing that they are all different, and to a degree, incomparable.
So in summary, if you’re feeling bad about this year, (and if you’re feeling good about it) this can give you a different perspective that can help you feel better and propel you forward with more confidence and crucial knowledge about yourself. This has helped me personally and has allowed me to find some kind of acceptance and healing. I still live in anticipation of the punches that life will inevitably deliver, but I know with more depth that they will pass, that there will be good times to follow, and that I can allow myself to feel positive in the expansion as a result.
- My daughter continues to thrive and with real personality (I’ve learnt to let her go at her own pace and without pressure, and to be proud of my imperfect parenting)
- I’ve reconnected with old friends and continued to stay in touch with my very good friends (having been notoriously bad at this, I’ve learnt that real friends will always be there, but that it doesn’t take much effort to reach out, I just need to make the effort)
- I raced my first Sprint & Olympic distance triathlons (I’ve learnt that training works, that I can be disciplined, and that I can enjoy the process)
- My wife left a job that caused her anxiety and started a new one that has vastly improved our quality of life despite us having less money (I’ve learnt that money isn’t a substitute for happiness. I know I let this stop me from encouraging her earlier. I know as a family we are all much better off for it emotionally)
- My relationship with my sister is better than ever (This is due to sharing some tough times this year, and it has reconnected us in a different way; it’s made me learn to really appreciate the family that I have)
- I ran a marathon for Charity. Actually, what made it brilliant was running it with my goodfriend and sharing the experience. It’s my favourite marathon that I’ve ever run. (I’ve learnt that self-belief goes a long way. It feels good to share these experiences and it feels good to do things for and with others)
- I overcame my fear of swimming in open water (More on this below, but I’ve learnt that I can overcome my fears through being persistent and refusing to give up)
- I started mentoring for a local charity (I’ve learnt that being selfless is fulfilling as well as giving me new skills)
- I started YouBuu, my life coaching side hustle! I have started coaching and continue to coach people (I’ve learnt that sometimes you have to stop procrastinating and just do things! With good intent and good effort, things will happen)
- I learnt how to make a website and started writing again (This has taught me to not give up on the things you feel passionately about, and that pursuing the things you enjoy can give real satisfaction)
- I lost my younger sister (this taught me that life is precious, finite, and that I should live fearlessly)
- The relationship with my younger brother has become distant as he struggles to come to terms with our family situation and relationships (I’ve learnt to try not to judge, and to be as empathetic and accepting as possible, including my own failures that may have contributed)
- My mental health suffered throughout the year resulting in physical symptoms (this taught me to talk more, be more open, but also acknowledge to take time for self-care and not to just keep going)
- I suffered stress at work and saw my colleagues go through some very difficult redundancy consultations (this has taught me that there are some things that just aren’t in my control, but also that new opportunities and new beginnings can be created from the most difficult circumstances)
- I ended up in A&E after suffering a panic attack in the open water. (This has helped me to be a better, more confident swimmer (I think!?), and that fears can be overcome)
In conclusion, this list isn’t exhaustive, but it has made me realise just how many good things I’ve experienced this year. I feel very lucky, fortunate, and appreciative. There have been some very tough things to deal with too and I know that there always will be, but I’m still here and still moving forward. I actually feel very proud, and you know what, I’m going to allow myself to. Please allow yourself to as well.
Thanks for listening


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Asa Maxwell Thornton Farr Butterfield (born 1 April 1997 in Islington, England) is an English actor probably best known for portraying Bruno in The Boy in the Striped Pyjamas, the eponymous hero of Hugo, and Ender Wiggin in the film adaptation of Ender's Game.
He began acting at age 8 after he was spotted by a casting director at a local drama club, and soon did the Made-for-TV Movie After Thomas. From there he had a supporting role in Son of Rambow before doing an episode of Ashes to Ashes (2008) in 2008. In the same year he won the recurring role of the infamous Mordred in The BBC's Merlin — a role not dissimilar to his successful performance in Rambow, possibly why he was cast. Released around the same time was the film adaptation of The Boy in the Striped Pyjamas, in which he starred.
Asa was still attending regular school like any other boy and would put his career on temporary hold from the Autumn of 2008, when he began secondary school, with a supporting role in The Wolfman followed by the lead in the sequel to Nanny McPhee released in 2010. In these films he played alongside people like Sir Anthony Hopkins and Emma Thompson, and his own real stardom began. Following this he got the lead in Martin Scorsese's adaptation Hugo, leading the renowned cast comprising Sir Ben Kingsley, Sacha Baron Cohen, and Chloë Moretz. He also played the titular Ender Wiggin in Ender's Game, again heading up the All-Star Cast, including Sci-Fi veteran Harrison Ford.
- Brethren Boy in Son of Rambow (2007)
- Bruno in The Boy in the Striped Pyjamas (2008)
- Mordred in Merlin
- Younger Ben Talbot in The Wolfman (2010)
- Norman Green in Nanny McPhee and the Big Bang (2010)
- Hugo Cabret in Hugo (2011)
- Ender Wiggin in Ender's Game (2013)
- Jacob Portman in Miss Peregrine's Home for Peculiar Children (2016)
- Gardner Elliot in The Space Between Us (2017)
- Otis Milburn in Sex Education (2019)
- Calvin Lewis in Then Came You (2019)
Tropes applied to his works:
- Innocent Blue Eyes: Especially in The Boy In The Striped Pajamas and Hugo, and Merlin, whereas in Ender's Game, they're more like Icy Blue Eyes.
- Fake Nationality: Frequently. He has played a German in The Boy in the Striped Pyjamas, a Frenchman in Hugo and an American in Ender's Game, all before his fifteenth birthday.note
- The Film of the Book: Most of his roles are within these.
- Typecasting: Waifish, precocious boys in science fiction and fantasy.
- What Could Have Been: He was Marvel and Sony's first choice for the role of Spider-Man in the Marvel Cinematic Universe, but lost out on it because he thought he couldn't keep Marvel's secrets — which is rather interesting, as Tom Holland has said himself Marvel has stopped telling him secrets since he's revealed a bunch in interviews.

domain: entertainment


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To Doggie (he has just learned she is part Aussie, part BC):
"Go downstairs, Australian Shepherd."
"That's a funny word!" These words cause the Nugget to spontaneously combust into wild giggles.
(Holding up a pretend measuring stick)
"Let's see, I think this water bottle is 1-2-3-4-5-6-7 miles tall."
This week, the Nugget declared, "I want to make a fancy bat. A very fancy one." I wrapped some foil around a piece of cardboard, drew a bat shape on it, and the Nugget went to town with some homemade Modge Podge, colored tissue paper, and glitter. It is really fun to watch him create.
Please note the small glitter smudges on the bat's feet and off to the side. "These are his shoes. And here are some slippers for him to wear later."
Today, the Nugget admired his bat but stated that, "He could be even fancier."


Developers have unveiled plans for turning part of an ailing DeKalb County mall into a food, entertainment, working, and tourism complex that’s envisioned as a regional destination for Atlanta’s eastern suburbs.
Commercial real estate developers Stonecrest Resorts landed financing last week for the second phase of the company’s redevelopment efforts at Stonecrest Mall, located 20 miles east of downtown Atlanta. Expect a dash of Ponce City Market and The Beacon where Stonecrest's Sears once sold fridges and CD players.
Called Priví—that’s a play on “privilege” and “privy”—the $17-million, adaptive-reuse venture is set to span two levels. Upstairs will be a 50,000-square-foot food hall with a mix of entertainment concepts; downstairs will see an 18,000-square-foot coworking space, event facility, and health and wellness center with nine different businesses.
Expect everything from an axe-throwing concept to a cigar lounge, oxygen bar, karaoke venue, escape room, splatter-paint studio, a music and bookstore with a coffee shop, and a comedy club, project officials say.
Predevelopment for the second phase of Stonecrest work has begun. Project leaders say the Sears building’s conversion is already 85 percent leased, though specific tenants won’t be announced until later.
The first phase of redevelopment opened SeaQuest Interactive Aquarium next door in November. The “lifestyle complex” is meant to provide a family-friendly destination where guests might focus on wellness, dine, or incubate their creativity, per project leaders.
Vaughn D. Irons, Stonecrest Resorts’ principal and developer, expects the Priví and aquarium combo to become a regional destination in the Southeast, all built without taxpayers contributions, he said. California-based lenders Private Capital Investors and Socotra Capital are onboard, along with Forum Partners, a London-based global real estate investment and asset management firm.
“We developed a project that responded to the community's desire for elevated experiences, better dining options, and premier customer service," Irons, a longtime Stonecrest resident, noted in a press release.
Since 2016, major blows to Stonecrest’s retail viability have come with the closing of anchors Kohl’s and Sears. The area has suffered from “economic disinvestment and retail leakage for years,” as a Stonecrest Resorts rep wrote in an email.
Stonecrest joins a growing slate of metro Atlanta malls with tall ambitions for adaptive-reuse conversions. Mixed-use additions or alterations are planned at Alpharetta’s North Point Mall, South DeKalb Mall, and North DeKalb Mall, among others.
Meanwhile, the most maligned, ghostly mall in the metro, Gwinnett Place, is showing signs of life, too. Gwinnett County purchased the 39-acre property for $23 million last year and selected planning firm VHB to come up with a revitalization strategy.
In DeKalb, Stonecrest Resorts bought the 15-acre mall parcel—with two buildings totaling 143,000 square feet—from Stonecrest’s Urban Redevelopment Authority in October for $2.1 million. The overall project is expected to create 560 jobs.
Priví’s construction is scheduled to begin in earnest this spring, with the lower level opening this summer.
The upper-level food hall component is expected to debut in spring next year.
• Renderings unveiled for reimagined North Point Mall in Alpharetta (Urbanize Atlanta)


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Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own.
Many people gain and lose some weight during any year. Loss of 10 pounds OR 5% of your normal body weight over 6-12 months or less, and you don't know the reason.
This problem may also be called unintentional weight loss.
Loss of weight; Losing weight without trying
A loss of appetite may be due to:
Chronic digestive system problems that decrease the amount of calories and nutrients your body absorbs, including:
Other causes such as:
Your healthcare provider may suggest changes in your diet and exercise program depending on the cause of your weight loss.
Call your health care provider if:
The health care provider will do a physical exam and check your weight. You will be asked questions about your medical history and symptoms, including:
You may need to see a dietitian for nutrition advice.
Bistrian BR. Nutritional assessment. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 221.


Traffic management is a broad topic, concerned with all measures and aspects to influence and control traffic flows in a network. Traffic control is an important part of this topic, but also the advantages and disadvantages of new detection methods and the development and fine-tuning of algorithms using simulation.
Related Research questions:
Big data for traffic management
Multimodal traffic management
National Data Warehouse and its implications


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Froot Loops Kellogg's Breakfast Cereal: Original, 1.5 oz. Size, 6 PK
#922657-5 | Pkg Qty: 6
$22.92 pkg | $3.82 ea
Snack Food Type
Single-serving Kellogg's® breakfast cereal is a great option for your breakroom or cafeteria. Provides a quick meal or snack to hungry employees.
Froot Loops(r),Original,1.5 Oz.
|Grainger Dropship||38ED19||Froot Loops(R),|
|VMRS (ATA) CODES||053-006-009||Froot Loops(R),|
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