Il prossimo smartphone Pixel 6 avrà la ricarica wireless e arriverà insieme ad un nuovo caricatore che, per raggiungere potenze superiori, sarà dotato di una ventola di raffreddamento.
Giuseppe Croce Giornalista
Peppe Croce, giornalista dal 2008, si occupa di device elettronici e nuove tecnologie applicate al mondo automotive. È entrato in Libero Tecnologia nel 2018.
Pixel 6 potrebbe arrivare in contemporanea con un caricatore, Pixel Stand, completamente rinnovato. To say so is an analysis of the code of Android 12 beta 2 that, if it were to be confirmed, would put on the plate a charging cradle evolved compared to the past, equipped with wireless but also with fans to dissipate the heat generated
To give the news was the site 9to5google, through an exploration of the operating system by Dylan Roussel where the accessory was recalled with the name "Luxuryliner". The first version of this particular Google charger is now already a few years old, 2018 to be precise. It was the first charger with Qi technology capable of supporting 10W charging on two of the devices made by Big G, namely Pixel 3 and 3 XL. With a distinctive format, able to accommodate the phones by allowing the screen to be displayed while charging, it can still boast the opportunity to leverage the devices' displays on par with an alarm clock, digital picture frames or smart screens, complete with access to Google Assistant. What changes with the new model?
Pixel Stand, how it will work
Reading the Android 12 code, it's already possible to start taking a closer look at what the next Pixel Stand will look like. The timing, similar to those that should see the market launch of the next iteration of Pixel, inevitably suggest a combined presentation between the two new products of Big G.
A fundamental detail, as anticipated, is that of wireless charging. Certainly not a novelty, if not for the power that could exceed the 10W of the previous specimens. To lean towards this option, the addition of a fan cooling system to disperse the heat of the smartphone and the process itself, similarly to what already happens with the proposal of OnePlus, Warp, which uses an identical mechanism reaching the 50W.
Although there are no specific references, in the code there are some indications relating to the settings of the speed. It will be enough to say "Hey Google", for example, to decrease the rpm, so as to decrease the noise generated by the fan. This will be handy when using the Google Recorder app, exclusive to Pixel, which will be able to record voices and sounds by taking advantage of a slowed down - and less noisy - setting for dissipation.
Pixel Stand, fan features
In addition to the profile dedicated to "Sleep Mode", that is, silent so as not to disturb sleep with the fan's rustling, users will be able to use manual controls. Three of them have been identified, called "Auto", "Quiet" and "Power Boost"; the last one suggests an increased speed to meet the needs of a more powerful charge but, at the same time, able to reach higher temperatures.


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Zotrim is the Clinically Proven
- Controls hunger and cravings – reduce your appetite, curb your cravings, resist snacking, and cut your daily calorie intake easily.
- Clinically proven to help you lose weight – natural, herbal formula backed by numerous clinical studies proving its effectiveness.
- Outperforms prescription drugs in trials - faster weight loss compared to three major prescription drugs, even without a diet.
How to Use Zotrim?
Yerba Maté – Leaf Extract
Yerba Maté leaves have for some time been utilized in South America to assist with diminishing yearning and exhaustion. Higher in cancer prevention agents than green tea, it makes a stimulating difference and furthermore increments energy use during exercise. This implies you'll feel more dynamic, yet the activity you truly do will be significantly more useful in light of the fact that you'll move much a greater amount of those fat stores. Further examination has shown Yerba Maté even can forestall the improvement of new fat cells2, meaning it can assist with forestalling further weight gain.
Guarana – Seed ExtractThere’s a reason Guarana is a key ingredient in energy drinks; it contains more caffeine than coffee. Along with its highly stimulating effect, the caffeine in Guarana raises your metabolism, causing more fat to be released from cells into your bloodstream to be burned for fuel.
Damiana – Leaf ExtractGenerally utilized in conventional homegrown cures, Damiana is known to have a delicate state of mind upgrading impact. So assuming you're inclined to close to home eating, you might find it that piece more straightforward to fight the temptation to fall back on food when circumstances become difficult. Yet, the genuine weight reduction advantages of Damiana are opened whenever it's mixed with Guarana and Yerba Maté to make the extraordinary Zotrim equation; a blend that gives you more noteworthy control over your dietary patterns.
Vitamin B3 and Vitamin B6An essential piece of a sound eating regimen, B nutrients assume a significant part in changing over the food you eat into energy. The additional nutrients B3 and B6 in Zotrim support ordinary, energy-yielding digestion and assist with lessening sensations of sleepiness and weariness; a typical encounter while cutting calories from your eating routine.
CaffeineIt's notable that caffeine can further develop energy levels. The additional caffeine in Zotrim will help strengthen and empower you, as well as expand your readiness and focus levels. Which makes moving forward your weight reduction by getting all the more truly dynamic significantly less exertion.
Heidi Lambeth, Was Size 24 and Now Wears 12
“My husband calls me a ‘yummy mummy’ now! And he’s lost weight too because of the smaller portion sizes I now serve up. It was really difficult with two young children. Being a full-time Mum I didn’t have time to eat properly myself, so I just ate their leftovers during the day, and then once they’d gone to bed I’d cook a big meal for me and my husband – my portion sizes could probably have fed at least two people, but I figured seeing as I hadn’t eaten properly during the day it was ok to catch up by eating more in the evening. Zotrim has helped me to better manage the way I eat, and as a family, we’re much healthier now than before I started taking Zotrim because I’m passing on my good eating habits to the whole family”
Buhle Mncube, Gained 3 stone, Now Wears Size 12
“I’d never taken pills for anything but I had nothing to lose. Even though I was going to the gym a few times a week, because I was eating so much it didn’t help me lose any weight. Eating junk food was the only thing that made me feel better about being away from home. When I started using Zotrim I stopped craving all the crisps and sugary stuff that I’d got used to eating all the time, and it definitely made me feel fuller much sooner, so I didn’t need to eat so much at meal times. So because I was much more in control of my eating, all that effort at the gym started paying off and I ended up looking even better than I did before I moved to the UK!”
Louise Hilborne, was 90 kg, Now Wears Size 10
“I’d tried lots of weight loss pills before but nothing worked, so I didn’t really believe Zotrim would work either, but it was the best decision I’ve made in years. What helped me the most was the difference it made to my energy levels. I work really long hours and used to feel constantly tired. I just couldn’t be bothered to exercise even when I had the time to, but with Zotrim I feel a lot more energized and much more inclined to get active at the weekends; that’s what’s really helped me shed the weight. It’s great for my job too – I don’t need to worry I might fall asleep during an important meeting now!"
Related: PrimeShred Testogen

domain: health


Welcome to something new on Steelers Depot: The Terrible Take. Think of it as a super-mini version of The Terrible Podcast. A short, 1-3 minute episode five days a week, every weekday at 5 PM/EST, with Alex Kozora and Dave Bryan telling you what’s on our minds. Additionally, we’ll occasionally have listener and reader-submitted versions of The Terrible Take on the weekends. You can check out episodes here or wherever you listen to the The Terrible Podcast.
For Episode 630, I explain why Monday night could be the last chance for Pittsburgh Steelers RB Anthony McFarland to prove he can play in the NFL.
Direct download link: Listen: The Terrible Take (Episode 630)


Austria did not have her own military force until 1955. In 1945 the Under-Secretariat for Military Affairs, then under Franz Winterer, was part of the Chancellory of the Provisional Chancellor, Karl Renner and was dissolved at the Allies' request with the resignation of the provisional government on December 21, 1945.
The newly elected National Assembly reaffirmed this on January 18, 1946. The gendarmerie's alarm-formation was only formed in 1949. The so-called B-Gendarmerie, a small number of para-military units, was only established on August 1, 1952. It was put under the command of the Interior Ministry.
Therefore, there was no "Guard Battalion Vienna" in 1948. This has been confirmed in letters from the Defense and Interior Ministers to the DOEW. A further problem: How was it possible that an "original" stamp of the "Guard Battalion Vienna" ever got on a "copy" of a tenth copy, as it appears on the published facsimile? This could only have been possible years later with the advent of photocopying.
The original plaintext version of this file is available via ftp.


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Q. Two years ago, my fall-planted pansies were badly damaged by a fungal disease, so I planted a different variety last year. They had no disease problems. Are some pansies more susceptible to disease than others?
A. Pansies are susceptible to several fungal diseases, the most important of which is botrytis blight. Botrytis is a cool-weather disease that thrives in damp conditions; it is rarely a problem under warm, dry conditions. Two years ago, we had a number of cool, damp days in late fall that were ideal for the development of botrytis blight. However, last year we had a warm, dry fall. My guess is that the weather was a more important factor in your disease problems than the variety of pansy that you selected.
To prevent botrytis, it is important to keep the foliage dry. Avoid overhead watering and plant your pansies in an open area that has plenty of air circulation. If you must use an overhead sprinkler for watering, it is best to water in the morning, so that the foliage dries before sunset.
Q. Many of my perennials have suffered badly from the drought. They are not only dry, but also have been damaged by chewing insects. Should I cut back my plants to prevent more infestation?
A. This is a difficult question because we have so little experience in dealing with a drought of this extent. In a normal year, I would recommend cutting back some plants in late summer to encourage a flush of new growth for the fall. This is not so much for the health of the plant, but rather to green up the garden. However, I see little advantage to cutting back your plants this year and at this late date.
Cutting back your plants now will likely encourage new growth and put increased stress on the plants. Further, most insect damage for the year has already been done, so I do not think that you will prevent further damage by removing the remaining foliage. However, because many insects overwinter on plant leaves and stems, I would remove the foliage in late fall. The foliage should be composted or destroyed to prevent overwintering insects from infesting your garden next year.
Dennis Bishop is an urban horticulture educator for the Baltimore office of the Mary-land Cooperative Extension Services. If you have a gardening or pest problem, you can call the Home and Garden Information Center hot line (Monday through Friday, 8 a.m. to 1 p.m.) at 800-342-2507. You can also e-mail questions, order publications and diagnose plant problems by visiting the Web site, www.hgic.umd.edu.
1. Extra parsley, garlic, chives and thyme can be potted now and brought indoors for the winter.
2. It can be very difficult to pull weeds when the ground is dry. However, you can help control them by cutting them back. This will prevent them from producing more seeds.
3. Save the seeds from your favorite bean plants by letting them dry completely in the pod. They can be stored in glass containers.

domain: biology


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Honey bee hives will naturally produce their own queen, but it’s an imperfect system: sometimes the queen cell doesn’t take, or the queen dies (or is killed by bees who are still loyal to another queen’s pheromones), or the hive is not strong enough to wait a few weeks until its new queen emerges, mates, and begins to lay eggs. That’s why beekeepers often take matters into their own hands by breeding their own queens.
Carson taught himself this tricky and delicate process last year, with mixed success – some of his queens made it, but most didn’t. When you consider the precision involved, including exact temperature and timing requirements at all stages of the process, it’s a miracle this ever works out! With last year’s experience under his belt, Carson is at it again. Here is is creating twenty queen cells. Fingers crossed that about half of them hatch… and that Carson’s timing is perfect so he can separate them before the first queen to emerge kills the rest!
On this gorgeous mother’s day, we here at Carson & Bees are moved by the flowers in bloom. With spring in full force there’s no time like the present to think about what bees and other pollinators eat, and that it’s all of our jobs to feed them.
There’s a wonderful blog called Honey Bee Suite. Blogmaster/beekeeper Rusty frequently posts about attracting pollinators to your yard, and I’m reposting one of those here. She disseminates her impressive knowledge in easy-to-digest and often humorous posts, so if you enjoy reading about bees I highly recommend you mosey on over to her side of the web.
Here are fifteen easy ways to assure you will have a plentiful supply of pollinators all season long.
Plant clover in your lawn. White Dutch clover planted in your lawn will attract dozens of pollinators. In addition, it fixes atmospheric nitrogen into a form the grass can use, resulting in a beautiful green lawn without the use of chemical fertilizers.
Plant at least some native species. Native plants attract native pollinators. Check with your local extension office if you are unsure of what is native.
Plant herbs. Herbs, especially those in the mint family, are very attractive to pollinators. This family includes thyme, oregano, sage, basil, peppermint, lavender, catnip and rosemary. As an added bonus, you get to use the herbs yourself.
Select plants with a wide range of bloom times. Native bees need food from spring until fall so plan to have something in bloom all season long.
Plant larval host plants. Some plants are not considered especially attractive in the garden but are necessary to certain species of pollinators. Milkweed, for instance, is vital to the larval stages of Monarch butterflies. Plant them in an inconspicuous place if you prefer, but have them available for the pollinators.
Avoid hybrid varieties. Many flowers that have been bread for beauty have lost the nectar or pollen that made them valuable to pollinators. Plants with double or triple rings of petals, or plants with unusual colors or variegated patterns are probably over-hybridized.
Leave open patches of mud. Many ground-nesting bees need open patches of mud for their homes or for building materials.
Provide a water source. It doesn’t need to be large or fancy. Just a wet spot under the end of a hose can help the insects.
Avoid excessive mulch. Too much mulch blocks entry to the ground. Ground-burrowing insects often cannot penetrate a heavy layer of mulch.
Add sea salt or wood ash to a bare patch of earth. Pollinators are often seen collecting minerals from salty or ashy areas. Your patch needn’t be large and it shouldn’t be overworked. If the insects need it, they will find it.
Provide nesting sites. Collections of reeds or holes drilled in blocks of wood provide great nesting sites. Tubes or blocks should be replaced periodically to limit disease build-up.
Leave dead trees and reeds standing. If a dead tree can safely be allowed to stand, it should be left as habit for bees, birds, and small rodents. Dead and standing reeds are a favorite of wild bees.
Leave an unmowed patch of grass and weeds in a protected spot. Tall grass provides protection, shade, and hunting grounds for many species of pollinators. Some pollinators—such as hover flies—feed on insects as well as nectar, so they do best in a place that provides an alternate food source.
Put a flower pot on every porch . . . and encourage your friends to do the same. The more plants that are available, the healthier our pollinators will be.
Use no pesticides. Until we reduce dependence on pesticides, items 1-14 are all for naught.
It’s spring, and that means bees are available for sale to beekeepers who lost hives over the winter and want to rebuild, or new beekeepers who want to get started. (Note: we have a few packages for sale if you’re interested; call 489-1587 by May 5 to reserve yours!)
Bees typically come in three-pound packages with a new, mated queen. (Did you know that queens have just one 10-day window to mate, and if they aren’t successful, they can only lay unfertilized drone brood?)
Installing packaged bees in their new home isn’t as simple as cracking it open and placing them on top of or next to an empty hive. You have to literally shake the little buggers out. Watch as Carson first removes the queen’s little box and places it in the hive, then cracks a can of sugary water for them to feed, and finally shakes the bees out (all without gloves). Be sure to turn your sound up!
Carson swears that it doesn’t hurt the bees to be shaken and even pounded out, though one can imagine they aren’t thrilled about it based on how many times he gets stung.


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John Black, MD
These ranges are network rate estimates across all the insurance plans that Dr. Black accepts.
Note: These are just estimates. We advise verifying the exact costs with your provider.
|Colposcopy||$206 – 999 $206 – 999|
|Office visit (new patient)||$312 – 460 $312 – 460|
|Pap smear||$136 – 285 $136 – 285|
|Tubal ligation||$2,223 – 6,661 $2,223 – 6,661|
Amino’s cost estimates are estimates of the total amount that you and your health insurance company might pay for a procedure—this is what we call the “network rate”. Our cost estimates can help you prepare for the financial impact of medical care and help you make more confident decisions about where to get treated.
Compared to predicted rates calculated for each doctor’s unique mix of cases and patients
To help you understand how Dr. Black’s C-section rate compares to a typical pregnancy doctor:
- We first measure the actual C-section rate for the pregnant patients Dr. Black treats.
- We then analyze the typical practices of all other doctors in the United States who deliver babies, using a data-driven model to predict the C-section rate for patients like Dr. Black’s.
By comparing these two numbers, you can see whether Dr. Black’s C-section rate is lower than, similar to, or higher than predicted.
This prediction adjusts based on the types of patients the doctor sees, so a doctor who treats sicker patients may have a different predicted rate than a doctor who treats healthier patients.
Dr. Black sees patients and can be reached at the following location.
Wilmington, NC 28401
Keck School of Medicine of the University of Southern California
MEDICAL EDUCATION, 1985
And Surgery University Of Ancona
Dr. Black is able to admit and treat patients at the following hospitals.
Akron General Medical CenterDHospital safety grade (Spring 2017)
Akron General Medical CenterHospital safety grade not available
Always check coverage with your doctor’s office.

domain: medical


text:
Already an Emmy winner for her work on “Full Frontal with Samantha Bee,” Black is behind the laughs on a number of shows, from “A Black Lady Sketch Show” to “Ted Lasso.”
A new book details how Indigenous Mexicans rebuilt the Roman Catholic Church in the aftermath of an outbreak.
UC Santa Barbara joins forces with global 84000 project to translate entirety of the Tibetan Buddhist canon.
A UCLA report suggests they can, but only when topics are approached in a credible, supportive way.
Psychology research demonstrates unique ‘time compression’ effect of virtual reality.
How UCLA’s Center for EthnoCommunications brings Asian American perspectives to life.
His Holiness the XIV Dalai Lama speaks with author Pico Iyer as the keynote event in a new initiative.
UCLA design media arts faculty and alumni share their thoughts on the crypto-art craze.
A writer explores what happens to art when our muses become mechanical, when inspiration is not divine but digital.
The new show follows a Marine combat veteran and a former interpreter as they adjust to life in America after life in Afghanistan.
Three UC campuses will help grow a repository that Henry Louis Gates Jr. has called one of the most significant research projects in the history of slavery.
The UC Merced Library holds intimate portraits of labor leader, community organizer, businessman and Latino American civil rights activist César Chávez.

domain: news


text:
The world faced its last major global crisis twelve years ago. Out of it emerged the Group of Twenty (G20)—an informal forum for world leaders to address the economic challenges threatening the world economy at that time. Most observers gave the new body high marks for averting a global economic collapse and saw it as an important innovation in global governance. Leaders called it their premier forum for economic cooperation.
Since that time, the bold ambitions of some for the G20 have faded as the forum has proved unable to shift from crisis fighting to managing a forward-thinking agenda. Some commentators saw this failure as inevitable but satisfied themselves with thinking that the forum existed, should the world face another global crisis. The current crisis is many times greater than that of 2008 and 2009. But the response of the G20 to date has been tepid and, unlike in the last crisis, totally inadequate to the challenge. The forces that have contributed to this may doom the future of the G20 and create a vacuum that has destabilizing effects on multilateral cooperation and global governance for years to come.
The G20, so successful twelve years ago, is failing today. In 2008, leaders saw themselves and the world on the brink of the abyss and firmly believed that the only resolution lay in multilateral cooperation because the problem was global: no country was immune from the forces at work. But that is also true in the current crisis, yet it is not leading to the same result. What has changed?
The current crisis is many times greater than that of 2008 and 2009. But the response of the G20 to date has been tepid and, unlike in the last crisis, totally inadequate to the challenge.
The G20 emerged as the principal forum for economic cooperation, replacing the Group of Seven (G7), because the global economy had changed significantly and the role of the G7 countries in that global economy had shrunk. The G7 was no longer able to dictate global policy. China and emerging markets had become so economically important that they had to be involved in global economic decision-making.
At the centre of both groupings and the multilateral institutions that underpinned the global economic order was the United States. Even as its absolute power slowly diminished over the seventy years since the end of World War II, the United States remained the undisputed leader—until recently. It provided much of the intellectual drive to craft the multilateral rules-based system that still governs the world today.
Despite designing a system that was clearly to its perceived advantage, Washington was also benevolent. It used the Federal Reserve to buttress the global system when needed—as it is again doing in the current crisis. In trade, although the United States was and largely still is a closed economy, it was able to offer access to its market to leverage global trade liberalization to the benefit of the global economy. Even on climate change, US President Barack Obama worked with China to leverage a deal at the 2014 G20 Brisbane summit and to move that agenda forward.
But then came the 2016 US presidential election. The country shifted from being the global leader to becoming the biggest impediment to multilateral cooperation. Reneging on its environmental commitments and promoting a disastrous trade policy agenda that entails demolishing a rules-based system in favour of a force-based system are but two of the most prominent examples. Progress on a range of policies within the G20 ground to a halt under the nationalistic policies that put the United States at odds with most of its traditional allies.
Other leaders, fearful of the wrath of President Donald J. Trump and reprisals for any disagreement, chose to shrink their agendas for international cooperation. G20 meetings became largely photo opportunities and a time for addressing side bilateral issues.
Then came the COVID-19 crisis. Surely this was the issue on which the G20 could reestablish its leadership, given that success could only be achieved on a global basis. The G20, however, was paralyzed.
The United States could have turned to the G20 to help define a global response. It turned inward instead. The Trump administration chose to define the issue in terms of them versus us. China was arguably in no position to lead. Saudi Arabia, which chairs the G20 this year, does not have the leadership capacity to address an issue of this magnitude. When G20 leaders finally met virtually, all Trump could say at his press conference a few hours later was to recite the names of the G20 leaders.
In fairness, the G20 finance minister process has led to a commitment to suspend debt service payments from the poorest countries for six months. G20 central banks have responded significantly in containing financial panic. These actions, however, are at best limited against the largest crisis to face the world in almost a hundred years.
All countries face immense challenges, but emerging markets and developing countries face the greatest of them proportionally because they do not have the health-care systems and fiscal resources of the developed world. The developed world has responded, appropriately, implementing precedent-shattering fiscal and monetary policy responses in their respective countries. To assist the rest of the world, however, they have agreed on only minor tinkering with International Monetary Fund (IMF) programs. The United States has rejected a major issuance of IMF’s special drawing rights—an international reserve asset that can play a role in providing liquidity and supplementing IMF member countries’ official reserves—making the move impossible given that the United States holds a veto. The United States is also moving to cripple the World Health Organization (WHO), on which many of these countries depend, by freezing its contribution.
The G20 could have responded on a number of fronts—many at minimal cost. Maurice Obstfeld and Adam Posen propose a number of policies: expanding international health cooperation; lifting export restrictions on critical medicines, medical supplies, and basic foodstuffs; ending the disruption of supply chains; avoiding use of intellectual property to interfere with fast disbursement of relevant medicines and eventually a vaccine; resisting and managing excessive US dollar appreciation, which is damaging to many countries and ultimately, the United States; and significantly strengthening international financial safety nets. Instead, ritualized pledges are repeated and pious hopes expressed.
The situational risks extend beyond the current crisis for the future of global cooperation and governance. It is not too late for the G20 to respond. Failure to do so could lead to the loss of millions of lives and economic setbacks to living standards around the world. Nationalistic and inward-looking policies will only exacerbate this. Where will the leadership come from?
It is unlikely to come from the United States, certainly not before an election result in November that could change things. China, for all its achievements and potential, is not yet in a position to provide it. The question has arisen as to whether an alliance of Canada, France, Germany, Japan, and other EU members (the Nordic countries in particular) could provide collective leadership. But the history of the last three years suggests that in the face of US hostility (or just as possibly China), 5 countries are unlikely to do so. In any event, what they might do is severely limited. Former Australian Prime Minister Kevin Rudd has suggested that such an alliance of countries, perhaps including others such as Singapore, might at least work together to reform, fund, and politically defend the current multilateral system to the extent possible—for instance, by ensuring WHO funding or buttressing the dispute settlement mechanisms of the World Trade Organization. This would be a holding action for the time being.
A new US presidential administration, if elected in November to take office the following January, could begin to repair some of the damage of the last few years. This would not come overnight, however. The forces of nationalism and a loss of confidence in multilateral institutions have gained a new impetus that will take time to blunt. The COVID-19 crisis plays to these fears. The G20 needs to start thinking now of the agenda for next year if it is to regain lost ground and move forward. If US policy does not change, then the world faces a period of a further unravelling of the multilateral institutions and system that has achieved so much over the last seventy years—a continuing erosion in global growth and living standards and a more dangerous world.
The impotence of the G20 in these circumstances is all too clear. It needs to start thinking today not only of global reforms that will be needed as the world emerges from the current crisis but also how to convince domestic voters that national interests are enhanced, not threatened, by a strong multilateral system. It will also need to consider how to reform itself to reduce the inertia that has come to characterize it over the last ten years.
This article was first published by the Council on Foreign Relations as part of a paper series titled Challenges of Global Governance amid the COVID-19 Pandemic.


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The final thing we have to do is decide which HTTP methods will be exposed for each of our resources and what these methods will do. It is crucial that we do not assign functionality to an HTTP method that supersedes the specification-defined boundaries of that method. For example, an HTTP GET on a particular resource should be read-only. It should not change the state of the resource it is invoking on. Intermediate services like a proxy-cache, a CDN (Akamai), or your browser rely on you to follow the semantics of HTTP strictly so that they can perform built-in tasks like caching effectively. If you do not follow the definition of each HTTP method strictly, clients and administration tools cannot make assumptions about your services and your system becomes more complex.
Let’s walk through each method of our object model to determine which URIs and HTTP methods are used to represent them.
objects in our object model are all very similar in how they are
accessed and manipulated. One thing our remote clients will want to do
is to browse all the
Products in the
system. These URIs represent these objects as a group:
/orders /products /customers
To get a list of
Customers, the remote
client will call an HTTP GET on the URI of the object group it is
interested in. An example request would look like the following:
GET /products HTTP/1.1
Our service will ...

domain: design


text:
Emerging from the Middle Ages, a time when people lived in fear of god, the Renaissance was a time of intellectual and artistic achievement happening in places such as Florence. People began to question their authorities, which led to new ideas and beliefs. This “Renaissance mindset” arguably contributed to the Protestant Reformation, a time in which theologists such as Martin Luther and John Calvin challenged the authority of the church and accused it of being corrupt. The Reformation Era brought about radical change in Europe in terms of religion, for many cities converted to Protestantism and were no longer under the control of the Catholic Church.
One such city was Geneva, a place governed by Calvin’s strict religious principles that limited the freedom of its citizens.
In contrast to the Renaissance in Florence which promoted the spread of varied and secular ideas, the Reformation in Geneva allowed the Calvinist Church to use religion to to control the populous and limit their freedom.
Although both were born from the similar idea of questioning authority, the Reformation in Geneva and the Renaissance in Florence were vastly different from one another in several different ways. One of the main differences was the religion practiced in the two places. Florence was a Catholic city, although religion did not necessarily dictate the lives of Florentine citizens. Since humanism was at large, people were encouraged to indulge in other non-religious aspects of life such as art and education. In fact, the Catholic Church even sponsored artists, encouraging them to continue pursuing their secular occupations.
The same was not true in Reformation Geneva.
The Calvinist Church closely monitored the lives of the Genevan citizens and held them to a high standard. The Church expected every adult and child to know and follow the guides and laws of god. Dissimilar to the Church in Renaissance Florence which promoted freedom of the human mind, the Calvinist Church in Geneva limited the freedom of its citizens by imposing strict religious guidelines and rules. The differences in the churches of Geneva and Florence also contributed to the difference of governments. Florence was technically ruled by a republic; however, said republic held little to no real power. The true rulers of Florence were wealthy patricians, namely the Medici banking family. The Medicis were huge patrons of the arts and used art to increase the wealth and status of their family and of Florence itself.
Focus on the arts led to more freedom of the mind and creativity. Artists were more valued than before and people were able to express themselves through these works of art that not only benefited their reputation, but the reputations of their patrons, too. In Geneva, however, there was no separation between religion and government. The Calvinist Church decided how people were to live their lives and what happened to those who didn’t comply with the church. During a 4 year period in Geneva, more than one hundred people were banished or executed because they did not comply to the church’s demanding standards. The Florentine government was very supportive of free human expression, whereas the religion-based Genevan government limited free thought by harshly governing the lives of its citizens.
As a result of the way these cities were governed, Genevan and Florentine citizens led contrasting everyday lives. Wealthy citizens of Florence enjoyed a more creative and lavish life filled with artistic wonders and new possibilities. People had free time to come up with new ideas and express their creativity. The same could not be said for the poor citizens of Florence. They really did not have time to educate themselves and come up with new innovative ideas, for they had to constantly work in order to make a living. This does not necessarily mean that they were held back from free thought by the government, but rather that they just did not have time to do these things due to their financial situations and priorities. As expected, the Genevan everyday life was quite different. The Calvinist Church oversaw what Genevans were being taught and what they were doing. Harsh laws regarding lifestyle were imposed. These rules included: not speaking out against your minister, no dancing, and no card playing or gambling.
These strict laws were meant to limit the expression of the human mind, for the church believed that humans were made to be corrupt. Breaking any of these rules could very well have resulted in banishment, excommunication, and in some extreme cases, execution. The Genevan people lived their lives in fear of authority, not expressively like the Florentine citizens did. Renaissance Florence and Reformation Geneva were incredibly different. While the Renaissance focused on the beauty and potential in humans, the Reformation strived to shut down human expression, for it was believed that humans were corrupted by evil. In Florence, art and education were heavily valued, and religion, although still prominent, was no longer the only focus of people’s lives. In Geneva, however, people were harshly governed by religion, similar to the Middle Ages. It is strange how two societies with such different values originated from the same idea of questioning authority. The differences in human expression between the two cities show that when humans are told that they are naturally bad, they will not strive to be creative and express their wonderful ideas.

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Effects of substance use disorder on treatment process and outcome in a ten-session psychiatric treatment for borderline personality disorder
Substance Abuse Treatment, Prevention, and Policy volume 13, Article number: 10 (2018)
Dual diagnosis is common in Borderline Personality Disorder (BPD), one of the most common being Substance Use Disorder (SUD). Previous studies have shown that general psychiatric management (GPM) was effective in reducing borderline symptoms.
In the present study, we tested whether the short GPM was as effective in the BPD + SUD as in the BPD group.
We analysed a group of 99 patients presenting a BPD. 51 of these patients presented a SUD. The BPD group and the BPD + SUD group received a manual-based short variant of the GPM treatment. Previous studies have shown that a 10-session version of GPM was effective in reducing borderline symptoms at the end of the treatment (Psychother Psychosom 83:176–86, 2014).
We found no significant difference in the reduction of general symptoms, which diminished in both groups. The specific borderline symptoms were also reduced in both groups, but there was a slightly higher reduction of the borderline symptoms in the SUD group. The therapeutic alliance progressed positively in all groups. Moreover, the alliance increased more over time in the SUD group.
The short variant of GPM seems to be effective in BPD treatment independently from the presence of SUD. Therefore, this treatment could be an effective entry-level treatment for patients with dual diagnosis as well as patients with BPD only. Further studies are needed to confirm efficacy and long-term outcome.
The trial was registered at ClinicalTrial.gov (identifier NCT01896024).
Borderline personality disorder (BPD) is a common mental disorder. It is associated with high suicide rates and severe functional impairment [1, 2]. Patients suffering from BPD have high rates of co-morbid mental disorders, amongst them substance use disorders (SUD) are very common. According to a systematic review, about 38–57% of BPD patients also have a SUD diagnosis . On the other hand, between 5 and 32% of people with SUD are estimated to meet the criteria for BPD [4, 5].
Some studies reported more severe SUD profile for patients with BPD . Studies show inconsistent findings concerning a possible aggravation of BPD symptoms by SUD . Overall people with this co-morbid condition seem to have higher rates of depression and lower levels of functioning [8, 9].
The higher levels of psychosocial impairment, more severe psychopathology and the increased rates of suicidal behavior of the co-morbid BPD with SUD population presents a considerable challenge for mental health services [10,11,12].
BPD is a chronic illness for which several evidence based treatment models have been developed. Most of these are long term very specialized and costly treatments which limits treatment accessibility [13,14,15].
Treatment retention is an issue for some patients presenting a SUD, some analysis show earlier drop-out [17, 18] and some do not [19, 20]. Especially women drop out more likely when presenting higher levels of psychiatric symptoms . In order to offer full treatment cycles to difficult to engage patients, shorter treatment packages could be helpful.
As for other psychiatric disorders short-term treatment models [22, 23] allow more patients to benefit from therapy and to make better use of limited resources. An effective treatment for BPD is the general psychiatric management (GPM) developed by Gunderson . Generalist mental health clinicians can deliver this treatment after a short introductory course. It focuses on psycho-education, informed management of medication and co-morbid disorders. The aim is to improve the patient’s functionality and quality of life. Various studies reported that the model or versions of it are effective for BPD [25, 26] but so far no studies have specifically examined its effect when treating a BPD population with substance use disorder in a short-term time frame. This is the objective of the present study.
Short-term treatments are interesting for patients with SUD as these patients are generally more difficult to engage in long-term psychotherapy treatments due to the chronic and relapsing nature of SUD [27, 28].
Paris  and Chanen and Thompson  suggest a stepped-care model in which different evidence-based treatment models for BPD by stepwise progression for different clinical phases . According to this model, short-term treatment are useful and cost-effective first steps strategies to help BPD patients manage their symptoms in order to improve their functionality . When they are more organized and can enter more in depth psychological treatment, they can be referred to specialists for psychotherapy. This approach is of high interest for patients with SUD as the mental health practitioner for SUD can easily apply psychiatric interventions without having to address the patient to a BPD specialized therapist. Often patients with SUD are not stable enough to regularly attend fixed group meetings like for DBT and are therefore often excluded from such programs. A study by Black shows that patients with higher baseline severity showed greater improvement after short-term treatment . As mentioned above the cost-effectiveness of GPM is an important advantage over long-term treatments by specialized practitioners. The shorter GPM consists of weekly sessions which requires less intensive training. The ability of this model to address more patients with a proven effective treatment can therefore reduce direct and indirect costs caused by BPD . Direct costs are due to hospital admissions, emergency room visits and primary care visits and indirect costs are those caused by other medical and social problems related to lower income, marriages and child-rearing difficulties [34, 35].
In spite of such promising rationale for the use of GPM with people with co-morbid BPD and SUD, we expect a negative impact of the co-morbidity on the GPM treatment outcomes given the increased severity associated with this co-morbidity in comparison to BPD alone [10,11,12]. The fact that these patients often show a higher symptom level  and more psychiatric comorbidities is usually associated with the conclusion that they would show worse outcome in any treatment. The higher risk of treatment drop-out due to active substance use and a possibly less strong therapeutic alliance could be a reason for this negative outcome.
On the other hand, treating patients with GPM could actually make patients with BPD and SUD feel better understood as this treatment focuses more largely on their problems and does not focus solely on SUD and associated symptoms. This might help therapists adapt better to the patients’ needs and could actually improve the therapeutic alliance. Also, SUD does not always negatively influence therapeutic alliance . The.
To our knowledge no short-term program has been studied for patients with co-morbid BPD and SUD.
Aims of the study
The aim of the study at hand is to compare the impact of a 10-session version of a GPM treatment [24, 38] on patients with BPD and patients with BPD and a co-morbid SUD concerning treatment process and outcome.
We assume that the presence of a co-morbid substance use disorder diminishes the symptom change found over ten sessions of psychiatric treatment.
We assume that the presence of a co-morbid substance use disorder diminishes the quality of the therapeutic alliance over the course of the first ten sessions of therapy.
In the present study we examined the role of a co-morbid substance use disorder on the process and outcome of a 10-session version of an APA-informed psychiatric treatment (“good psychiatric management”; GPM ) for BPD.
The present study is a secondary analysis of two randomized controlled studies, both originally examining the identical research question and using identical procedures, which justifies their combination for the present study [39, 40]. Together the two studies randomized a total of 114 (29 plus 85, respectively) patients with BPD to two conditions based on a 10-session treatment for BPD: a short version of the GPM in the first condition, and the same treatment augmented with the motive-oriented therapeutic relationship (MOTR) . Adherence to GPM model was excellent for both conditions . Kramer, Kolly et al.  found significant symptom reduction for both conditions on all measures, between condition analyses revealed between-group effects varying between d = 0.06 for specific borderline symptom and d = 0.64 for general symptom outcome reduction. Adding MOTR to GPM showed a greater reduction of general problems. However no additional borderline symptom reduction was found in the MOTR group.
In these former studies the impact of SUD was not specifically examined. In the present research we examine the impact of SUD on the treatment outcome.
In consideration of the lack of differences in outcome measures for GPM and GPM + MOTR in the previous studies we consider it as acceptable to combine the two groups in order to improve our sample size to maximize power. Both groups received the same GPM 10-sessions treatment.
In order to assess differences in alliance and outcomes between patients with BPD and patient with comorbid SUD, we differentiated between (a) patients with a comorbid alcohol use disorder (AUD), (b) patients with other SUD (OSUD; all drugs included), (c) patients with both AUD and OSUD, and (d) patients with no SUD co-morbidity.
A total of N = 114 patients were considered for analysis in the present sample. Because of missing diagnostic information (4 in the pilot study and 11 in the main study), 99 patients were finally included in the present analysis. All patients were treated at a French speaking outpatient university clinic. All patients presented a DSM-IV diagnosis of BPD. The ethnic composition represented the consulting psychiatric population in public European clinical services (85% Caucasian). Diagnoses were established by trained clinicians using the Structured Clinical Interview for DSM-IV Axis II Disorders , along with the Mini Neuropsychiatric Interview for co-morbid psychiatric disorders . The reliability of the DSM-IV axis II diagnosis was satisfactory; κ = 0.81. Reliability was analyzed with independent ratings of video-taped SCID-II diagnostic interviews on a randomly chosen 10% of all patients included . The addiction diagnosis was based on chart review using DSM-IV criteria. The diagnoses were made by the psychiatrist treating the patient. SUD diagnostic accuracy was routinely supervised by a senior psychiatrist. In total, n = 20 (20%) presented a co-morbid alcohol use disorder, n = 10 (10%) presented another SUD, n = 21 (21%) presented alcohol and another SUD concomitantly, the remaining patients, n = 48 (48%) are without any co-morbid SUD (see Table 1). The drop-out rate was 25% for patients without SUD, 40% for patients with alcohol use disorder, 0% for patients with another SUD and 24% for patients with alcohol and comorbid SUD.
In total, N = 24 therapists (13 of them treated 3 patients or less, and 11 more than 3 patients) conducted the treatments of the patients in this study. All the therapists were trained in the clinical procedures related to the psychiatric management of BPD in 10 sessions before the study began. The therapists were residents in psychiatry for an overall mean of 2.5 years (at least one year).
A short-term treatment program held in 10 sessions based on the principles of the good psychiatric management for BPD (GPM) was used in this study. The therapists conducted the treatment according to a manual focusing on GPM treatment principles:  establishment of a reliable psychiatric diagnoses, including co-morbidities and other problem areas, and communication of this information to the patient;  synthesis of the psychiatric anamnesis;  identification of the treatment focus;  definition of short-term objectives and enhancement of treatment motivation;  working on treatment-interfering problems, and  formulation of attachment-based core conflictual themes. In general, the patients received one session per week; if necessary, short-term inpatient treatment and psychopharmacological treatment was added.
Outcome Questionnaire – 45.2 (OQ-45), is a self-report questionnaire which assesses results from psychotherapy using 45 items. It includes a global score and three sub-scores: symptomatic level, interpersonal relationships and social role . These items are rated on a Likert-scale ranging between 1 (never) and 4 (always). This questionnaire is widely used and has been translated and validated in French . This scale was given measured at intake and discharge. Cronbach’s alpha at intake of the present sample was .91.
Borderline Symptom List (BSL-23), , which is also a self-report questionnaire. This measures specific borderline symptomatology using 23 items. The specific items are measured using a Likert-type scale ranging from 0 (absent) to 4 (clearly present) and an overall mean score is retained. It is a shortened version of the BSL-95, which reportedly has very good psychometric properties. Similar results were found for the short version. The present study used the French translation approved by the authors. Cronbach’s alpha for the current sample was .95.
Working Alliance Inventory – short form (WAI-short version), which is a self-report questionnaire, of 12 items assessing the different dimensions of therapeutic alliance, the bond between patient and therapist and therapy collaboration agreement (task and goals) . The items are measured on a Likert-type scale ranging from 1 (never) to 7 (always); an overall sum score is computed . The questionnaire measuring the therapeutic alliance was given to the patient after each session.
The responsible Ethic Committee cleared the study. After an intake interview, the patients meeting inclusion criteria were met by a program related researcher who explained the study to them. After written informed consent, these patients then received 10 sessions of GPM according to the manual. During the treatment, they answered the OQ-45 and the BSL-23 at intake and discharge.
Characteristics at baseline are presented within four groups of patients: BPD with no substance or alcohol use disorder, BPD with alcohol use disorder only, BPD with substance use disorder only and BPD with both substance and alcohol use disorder. In order to compare these four groups, Fisher’s exact test (instead of Chi-square due to the small sample size) or ANOVA or Kruskal-Wallis rank sum test were performed.
In order to test hypothesis 1) stating that the SUD lessened the symptom decrease over the course of treatment, we first conducted two paired-sample t-tests on the score of OQ-45 and BSL-23, the grouping variable being presence of SUD. As a measure of effect size, which is a magnitude of the difference between groups or time points, Cohen’s d were also computed . According to Cohen , d smaller than 0.20 is considered as a small effect, between 0.20 and 0.50 as a medium effect size and greater than .50 as large effect size. And second, we conducted two parallel Linear Mixed-effects Models  with the score of OQ-45 and BSL-23 as the dependent variables, SUD (None vs. Any SUD) and Time (intake vs. discharge) as the independent variables as well as age, gender and therapeutic condition (BPM vs. BPM + MOTR) as covariates. This type of model is suitable for correlated measurements  as it accounts for the lack of independence of the observations due to the fact subjects are measured more than once.
In order to test hypothesis 2) stating that the SUD lessened the alliance level and progression over the first 10 sessions of treatment, we also ran a Linear Mixed-effects Models with the alliance measured by the WAI as the outcome, SUD (None vs. Any SUD) and Session number as the independent variables as well as age, gender and therapeutic condition (BPM vs. BPM + MOTR) as covariates. At least 2 measurement occasions are required for a patient to be included in the analyses.
Preliminary analyses (see Table 1)
N = 99 patients were included in the present analysis. In total, n = 68 (69%) were female. The average age was 32.2 years (s.d. = 10.6, median = 30, range:19–55), n = 50 (50%) had never been married, n = 30 (30%) were married and n = 46 (46%) were separated or divorced. The employment rate was very low. n = 75 (74%) were unemployed, n = 7 (7%) were working in a protected activity, n = 6 (6%) were had a part-time job and n = 10 (10%) were working full-time. n = 74 (73%) completed the treatment, in the alcohol use disorder (AUD) group the number of completers was slightly lower than in the other groups, n = 12 (60%). Further details of each sample can be found in Table 1.
Characteristics at baseline
No between-group effects reached statistical significance for all variables at baseline except for number of axis I diagnoses. Contrary to expectation, post-hoc test revealed that patients without substance use had significantly more axis I diagnosis (cf. Table 1). Also for the outcome variables, no between group differences at intake (OQ-45, BSL and WAI) were statically significant.
Since no statistical differences were found between those four groups, except for axis 1 (difference None vs. Other SUD) and axis 2 (difference None vs. Alcohol) diagnoses, Alcohol and substance use disorder have been merged in order to create two groups only: BPD without any SUD, N = 48 and BPD with SUD, N = 51.
First hypothesis: Effect of SUD on symptoms over the course of treatment
OQ-45 – Questionnaire
The OQ-45 was measured at intake and discharge. It assesses results from psychotherapy including symptomatic level, interpersonal relationships and social role. Overall, OQ-45 improved between intake and discharge (mean and s.d. at intake = 95.2±23.7, mean and s.d. at discharge = 81.9±24.0, mean difference = − 13.23, paired t-test: t = − 6.35, df = 98, p < 0.001;d = 0.56). When comparing Any SUD with no SUD/None there was no significant difference between OQ-45 at intake and at discharge (mean difference and sd for no SUD = − 14.1±22.6, mean difference and sd for Any SUD = − 12.6±19.3, independent t-test on mean difference by groups, t = − 0.369, df = 97, p-value = 0.71;d = 0.07).
When controlling for potential confounders (cf. Table 2), results regarding Any SUD vs no SUD/None, as well as evolution over time are the same. Interestingly, the GPM + MOTR condition is significantly associated with an improvement of symptoms over time.
BSL-23 – Questionnaire
The BSL-23 which measures the number of specific borderline symptoms was given at intake and discharge. Regarding the number of specific borderline symptoms (BSL-23), only 61 patients were included in the analysis since this questionnaire was added later in the study. There was an overall improvement (mean and s.d. at intake = 1.8±0.9, mean and s.d. at discharge = 1.5±1.0, mean difference = − 0.26, paired t-test: t = − 2.544, df = 60, p < 0.014; d = 0.28) with a better improvement within the Any SUD group (mean difference and sd for no SUD = − 0.07±0.81, mean difference and sd for Any SUD = − 0.49±0.78, independent t-test on mean difference by groups, t = 2.074, df = 59, p-value = 0.04;d = 0.53).
When controlling for potential confounders (cf. Table 2), there is a significant interaction between Time and SUD co-morbidity, in the sense that the improvement is better within the Any SUD group (cf. Fig. 1). In this case, GPM + MOTR condition was not significantly associated with a change of BSL-score over time.
Second hypothesis: Effects of SUD on the therapeutic alliance
The analyses on the possible impact of SUD on the therapeutic alliance were done on a sub-sample of n = 82 patients, due to n = 17 patients with missing alliance data. For the computation of the progression, n = 75 patients were included. In order to be included in this latter analysis, the patients needed at least two assessment points of the therapeutic alliance (n = 7 patients only had one data point for the therapeutic alliance).
When taking into account the intra-subject variability of the alliance, substantiated as the session-by-session alliance progression over the course of treatment (cf. Table 3), we found the following picture. The progression of the therapeutic alliance was positively significant in the analyses (regression coefficient: cf. Table 3). Moreover, the therapeutic alliance increases more over time in the Any SUD category comparing to the None category (regression coefficient: cf. Table 3). There is no statistically significant difference between GPM + MOTR and GPM condition (regression coefficient: cf. Table 3).
In the initial studies by Kramer and Kolly [39, 40] the effect of adding motive-orientated therapeutic relationship (MOTR) to GPM was analyzed regarding symptom reduction and therapeutic alliance. Both groups showed a significant reduction of general symptoms (OQ-45) and specific borderline symptoms (BSL-23). The individualizing approach in the MOTR group did not have an additional effect on the reduction of specific borderline symptoms but did have an effect on the decrease of the general and interpersonal problems. As GPM is already aimed at specifically reducing these, we did not expect much room for improvement on the borderline symptoms. The therapists in the MOTR group rated a higher alliance progression. It is possible that the treatment period was too short for the patients to percept this improved alliance due to its focus on patient’s motives.
In our secondary analysis we examined the effect of alcohol and other substance use disorders on the therapy outcome after 10 sessions of GPM. As explained earlier consistent results were found when differentiating in 4 groups (AUD, Other SUD, AUD and SUD, None). In order to increase power, we only report the results from the Any SUD and None groups.
We hypothesized that SUD would diminish the symptom change found over 10 sessions of psychiatric treatment. After 10 sessions, we observed a significant reduction of borderline symptoms according to the BSL-23 in both groups. However, in contradiction with our hypotheses, in the group of patients presenting a SUD the borderline symptom reduction was more important than in the group without this co-morbid condition (See Fig. 1), moderate effect size on BSL-23.
This is in line with the observation made by Black et al. . Patients with higher baseline severity scores improve more than those with lower scores at baseline after a short-term intervention. Our Any SUD group also showed higher baseline severity for BSL the before the intervention and significantly higher improvement on BSL. Possibly patients with more important symptoms show a faster short-term remission which may not be maintained over a longer period. This group of patients is often more stigmatized and perhaps the fact of them receiving special attention during therapy might motivate them to engage more. This could explain the greater symptom improvement. This however shoes that patients with comorbid SUD can benefit equally from treatment as patients without SUD. Further studies are needed to analyze these effects in short- and long-term outcomes.
There was no significant difference found in the delta OQ-45 measures for the two groups.
Again, this is an important finding as we hypothesized that the improvements would be less important in the Any SUD group. This result again shows that the intervention was also as effective independently from the presence of SUD.
Overall the therapeutic alliance progressed over the course of the therapy in all groups. In the group of patients with Any SUD the alliance increased more over time than in the other categories. This is an important finding and disproves our hypothesis.
This means that we cannot prove that SUD affects the therapeutic alliance. As before, a possible explanation could be the effect of TAU on SUD resulting in patients with SUD being able to focus on the therapy. It is also shown in other studies, that patients with SUD show high treatment alliance in individual therapy . Again this shows that patients suffering from SUD can benefit from the GPM treatment and should not be excluded from treatment programs. As shown in other studies with cocaine dependent patients, drug use severity alone does not predict the alliance or time in treatment . Strong alliance can predict better treatment retention with less drop-out and better drug outcome for some therapies (individual manual based drug counseling and brief psychodynamic therapy), in CBT high alliance is linked to shorter stay in treatment . The ability to improve treatment retention with GPM may be a good preparation for long-term treatment if necessary.
The short-term approach to treatment can easily be applied to BPD patients with SUD by their health care practitioner to help diminish the intensity of central borderline problems and improve their functionality. If necessary at a later stage, these patients might be addressed for more in-depth treatment of BPD for which SUD is often a limiting factor.
There were a number of limitations for this study. We do not have any long-term outcome measures to prove that the effect of the treatment stays the same for both groups. These are secondary analysis, so we have fewer details on the evaluation of co-morbid SUD, such as severity of SUD. The number of patients for each group was limited. Furthermore, between substance use disorder analyses were not carried out due to the limited number of patients. Our outcome measures were self-reported which is subject to responder bias. Although the drop-out rate was moderate in our patient groups, it has to be considered as a possible limitation. It is a known that patients with SUD have a higher risk of treatment drop-out and perhaps complementary offers are needed to reduce this risk in order for patients being able to benefit even more from treatments such as GPM . Another limitation for this study was the combination of two different treatment groups GPM and GPM + MOTR even though MOTR did not show a significant additional effect in previous studies.
The short variant of GPM seems to be an effective treatment option for patients with BPD independently from the presence of SUD. Therefore, this treatment could be an effective entry-level treatment for patients with dual diagnosis and a possible preparatory step before starting more specific long-term treatment. It is important and possible to treat the BPD in patients with SUD. Treating the two disorders simultaneously could help enhance outcomes in both areas. Further studies are needed to confirm efficacy and long-term outcome.
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Penzenstadler L, Machado A, Thorens G, Zullino D, Khazaal Y. Effect of case management interventions for patients with substance use disorders: a systematic review. Frontiers in psychiatry. 2017;8
We would like to thank all participants in this study.
This study was supported by the Swiss National Science Foundation grant 100014–134562 (to Dr. Kramer).
Availability of data and materials
The data that support the findings of this study are available from Dr. Kramer but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Dr. Kramer.
SK and UK made substantial contributions to conception, design and acquisition of data. LP, SK, SR, YK and UK made substantial contribution to analysis and interpretation of data. LP, SR, YK and UK have been involved in drafting the manuscript or revising it critically for important intellectual content. LP, SK, SR, YK and UK have given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ethics approval and consent to participate
The study was formally approved by the relevant Ethics Board (identifier 254/08) and research committee. The participants gave a written informed consent to take part in the trial and to publish. The trial was registered at ClinicalTrial.gov (identifier NCT01896024).
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All participants consented to their data being included in publications, provided that identifying information was not published.
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Cite this article
Penzenstadler, L., Kolly, S., Rothen, S. et al. Effects of substance use disorder on treatment process and outcome in a ten-session psychiatric treatment for borderline personality disorder. Subst Abuse Treat Prev Policy 13, 10 (2018). https://doi.org/10.1186/s13011-018-0145-6

domain: literature


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Luger pistol shooting in slow motion
Why are there more Chuck Norris jokes than Bruce Lee? Because Bruce Lee is no joke.
Heaven Closed by Court Order
Chubby Bubbles Girl Steals Donald Trump's Toupee
Can Art: Red Bull Can Weightlifting, Made From Red Bull Cans
We're running out of time!
Sad Monkey in a Bunny Suit
Mr. T Magic the Gathering Card: Mr. T gains Flying

domain: entertainment


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This morning it hit both of us that Tuesday is our last day of holidays....boo hoo!!! It has been such a good time of travelling, visiting, feasting, re-aquainting, celebrating and even working on better stress management! And now it is about over.
I am pleased my husband seems ready to return to work. He has a better plan in mind so that he can put in shorter days as it has dawned on him at last that he cannot solve 30 years of backlogged and poorly done paper work just by working 2 extra hours a day most of the year. At last! He gets it! Yay! Thank you Lord! Yay again!
I was pretty sleepy late into this afternoon as my minimal 3 hours of sleep last night caught up with me after a morning of racing around shopping for gifts for our new Egyptian immigrant friends, so I decided we should brave the heat outside and hie ourselves away to a nice restaurant for a final holiday meal.
Where to go? There is a lot of choice here in Regina on a long weekend holiday Monday. Most restaurants, aside from some of the neighbourhood pubs, are virtually deserted. It seems most of the city's residents have disappeared to the campgrounds or that first weekend in the cabin at the lake. We finally decided on Wild Sage, the restaurant in the Double Tree Hotel at the corner of Victoria and Broad.
I find Regina interesting in that, unlike other cities whose hotel restaurants are rarely worth eating at, some of Regina's best are in hotels! And no, that doesn't mean it is because the rest of the city's restaurants are that much worse...no, it doesn't. We really enjoy the London Belle in the Marriott, Memories in the Delta, the main dining room, come teatime, at the Hotel Saskatchewan, and now we may have found a new favourite at Wild Sage in the Double Tree!
The prices are most reasonable and if tonight's meal quality was anything to go by, well, we will be returning there again and again. The prices for entrees ranged from $14 to the top steak dinner price of only $35! WOW! They even have 3 excellent Argentinian reds from the Doug Reichel Wine Marketing collection on the wine list, tucked in in among the usual popular disaster brands! Way to go Wild Sage. THANK YOU!!!
I ordered the steak sandwich and it was the nicest, tastiest meal I have had in a long time. My perfectly medium rare, 6 oz. flat ironed steak arrived on a slice of marbled rye bread that was covered with lightly seared arugula, sliced beet pickle, bacon jam, pickled onion and gremolata. I could have eaten just the bread with that beautiful combination of flavours and textures atop it and been quite satisfied even without the tender as butter steak. The small caesar salad was delicious with thin melba toast slices instead of the usual croutons that make me worry about breaking my teeth, two large thin slices of fresh parmesan and a light coating of buttermilk dressing. I have not had a meal quite THAT delicious here in Regina, and I have had plenty of wonderful restaurant meals here in the past 2 years. It was spectacular.
My husband so desperately wanted a hot dog or beef sausage on Canada day but wasn't willing to risk buying one from the vendors at the park celebrations due to the very strong possibility there would be corn products in the meat. So, the fun feature on tonight's menu was the Vancouver Sloppy Hot Dog: a beef sausage in a bun stuffed with macaroni and cheese and a nice complement of crispy fries. He not only got his very Canadian style meal, but it was particularly delicious and certainly outclassed anything the street vendors would have been selling on Canada Day! Non-greasy, properly drained fries...YES!
The wait staff was so professional. We were allowed to sit in the dining room section even though the tables had all ready been set for tomorrow's breakfast, but we didn't want to sit in the lounge with the sports tv blaring. As we suspected, other than 3 or 4 people in the lounge area, we were the only diners at 6pm. We are starting to understand why restaurants here have been, until recently, in the habit of closing on the Mondays of long weekends. It seems hardly worth their while to remain open and pay staff.
My goodness we had fun tonight. My husband spent the afternoon making himself a giant batch of granola and needed a break away from home. He can't seem to cook anything in any sort of reasonable amounts. Everything he makes, even morning pancakes, ends up coming out in batches large enough for an army. haha I wonder how many years from now we will discover bags of granola from today's venture, in one of the food storage bins in the basement, all stale, white with age and good only to be tossed into the garbage. hahaha And how do I know this is exactly what is likely to happen? Hoho! You well may ask!
I am pleased that, other than tonight's bit of buttermilk dressing, I have been able to cut back considerably on fats and foods all ready containing cholesterol in the past few days since we returned home from travelling. It feels great to be back on track.
I am actually thinking of putting a bit of supper together for myself tomorrow to eat at the birthday party. I simply cannot bring myself to cheat so soon with a slice of pizza and lard filled birthday cake. As much fun as it would be, plus I don't want to offend our friends, I can't do it, I just can't do it.

domain: food


Watch out today, as the internet becomes a bevy of fake information. The joke telling pre-dates the internet, but since the world started connecting online, the hoaxes have gotten not only more elaborate, but more fun. Did you know that John C. Dvorak wrote an article in 1994 about a bill that would make it illegal to use the Internet while intoxicated? Did you know in 2006, Apple pranked an add-on to your iPod that could allow it to make phone calls? ThinkGeek made a few pranks that ended up turning into actual products, such as Unicorn Meat and the...
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Jeffrey Powers would love to come on your show and discuss the events of technology history. Feel free to call him @ 608-205-4378. You can also Contact Jeffrey:


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I couldn’t have been happier than in March of this year when the Welsh government decided to scrap fees for children’s funerals. Thanks to the Welsh government, parents in Wales who have to go through the tragedy of losing a child, no longer have to live in fear of the undertakers’ bill landing on the mat. The Chancellor has the power to remove at least the financial pain of grieving families whom have suffered the untimely death of a child. I’m calling on The Chancellor once again, to think of bereaved parents when he’s writing his Autumn Budget.
Losing a child is the single most painful experience that any parent could endure. On 5 June 1989 my eight-year-old son Martin passed away, as I explained to the House of Commons last year. No parent expects to have to bury their child, so when the tragedy happens, parents will be totally unprepared, both emotionally and financially. I remember the day the bill arrived and that fear in my stomach as to how I would pay it. The last thing any grieving parent needs in their darkest hour is the gut wrenching, anxiety inducing fear of not being able to pay for the funeral of their own child.
When the Prime Minister told me in the Commons that grieving parents can apply to the governments social fund for financial help to cover a child’s funeral by filling out a 35-page document, I think she missed the point entirely. As I explained to the Prime Minister, at the darkest moment of my life, I could not even fill a kettle let alone fill in a 35-page application form. Of course, the speech I made in the Commons that day was now over twelve months ago, and the government is yet to implement any changes to help grieving parents deal with the financial burden of losing a child.
Such a tragedy could happen to anyone, and it is those without a strong support network, both socially and financially, that I fear for the most. In many ways I was lucky – lucky enough to come from a compassionate and caring community like Swansea. My wonderful friends and neighbours organised a whip-round to collect funds to cover the funeral fees, and with the addition of a bank loan I managed to scrape together enough money to pay the undertakers bill.
I fear that grieving parents with no family to …


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Event: Ranbir Kapoor, Kajol and Tanisha, Sonu Nigam with his family were present to seek blessings of Durga Maa on the day of Ashtami at Sarbojanik Durga Pooja.
Venue: Santacruz, Mumbai
Bollywood director Karan Johar was spotted at the hospital.
Bollywood actress Richa Chadha was spotted at Bandra.
MOHENJO DARO actress Pooja Hegde was spotted at PVR, Juhu.

domain: celebrity


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The developmental team put together by the Delaware Department of Education to review and rewrite statewide anti-discrimination policy is meeting tonight. The group will review the feedback from over 11,000 public comments given online in November.
At the end of the meeting, there will be a half hour public comment period, State Senator Brian Pettyjohn tells WGMD there are some restrictions due to the anticipated crowd size. Public comments will be limited to 2 minutes, and must relate to what was covered during the meeting, not the regulation that already went through public comment. If anyone in attendance is unable to get to the podium, they will be able to write an email to the development team through 4:30 the next day.
The Development Team will meet from 6 to 8 p.m., Wednesday, Jan. 31 at the Del-One Conference Center on Delaware Technical Community College’s Terry Campus, 100 Campus Drive in Dover.

domain: politics


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CANOEING & KAYAKING
The king of river sports on the River Noce
Of all river sports, kayaking was the first to develop on the River Noce and it is the most “technical”, calling for the most effort, constancy and time. Naturally, the effort it takes to learn how to paddle and manoeuvre the kayak is repaid by the adrenaline rush that comes as you ride down the rapids on the river, deciding your route, movements and reaction times to the current.
Proof that the River Noce is perfect for kayaking came in 1993, when the World Canoe-Kayak Sprint and Slalom Championships was hosted in Val di Sole.
Further international recognition came with 'Kayaking Holidays', the canoeing portal that added the Noce to the list of the world’s top ten rivers (the only European river) for kayaking.
All the gear you need—kayak, paddle, wetsuit, spray skirt, life-jacket, helmet and water jacket—are provided by the rafting and canoeing centres. All you need to do is wear comfortable shoes and bring a towel, change of clothes and a taste for fun.
You can also go kayaking and canoeing on very calm stretches of water, admiring the Val di Sole from an unusual perspective as you enjoy a pleasant relaxing paddle down the river. Some rafting centres in the Val di Sole offer canoe trips in nearby Val di Non, on Lake Santa Giustina, in the spectacular canyons formed by the River Novella.

domain: hobby


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Doctor recruitment a 'long-term failure' says Plaid
Welsh ministers have been accused of a "long term failure" to plan doctor recruitment effectively by Plaid Cymru.
The party's analysis of World Health Organization (WHO) figures claims Wales has fewer doctors per head of population than Kazakhstan and Moldova.
Plaid wants urgent action, while the British Medical Association said the situation was unacceptable.
Ministers said they were promoting the benefits of working in Wales to doctors to tackle shortages.
Although Wales is not included separately in WHO figures, Plaid has taken the UK figure and analysed it with other health data for UK nations to compare with the number of doctors in other countries.
Plaid Cymru leader Leanne Wood said the figures "highlight the long term failure by the Welsh government to effectively plan for the recruitment of doctors".
The party's health spokesperson Elin Jones AM said "tried and tested" solutions in similar size countries included offering financial incentives to encourage graduate doctors to practice in Wales.
There could also be in the short term an increased recruitment of doctors from elsewhere in the EU.
"In the long run we would work to encourage our brightest children to study medicine, and invest in the sciences, which would also have knock-on benefits for the economy," she added.
A Welsh government spokesperson said: "At 2.5% the vacancy rate for medical posts in Wales is favourable compared to other UK nations and other professions.
"That said, there is a UK-wide shortage of doctors in certain specialities which we are tackling actively through the Work for Wales campaign.
"The campaign promotes the benefits of living and working in Wales, ensuring medical students and established doctors are aware of the opportunities available to them here.
"We are not aware of any evidence in support of solutions in other countries, and do not favour financial incentives.
"Providing additional pay for just a small number of doctors could impact on morale, and in fact move the recruitment problem from one post to another."
The British Medical Association (BMA) in Wales said the figures came as no surprise and called it an "unacceptable state of affairs".
"The inadequate number of doctors applies to General Practitioner numbers as well as hospital doctors, said Dr Richard Lewis, the Welsh secretary of the BMA.
"We recognise the difficulties involved in attracting doctors to Wales in certain shortage specialities but that does not account for all the vacancies we see in Wales, many of which are a result of deliberate vacancy control policies by health boards.
"The difficulties in recruiting junior doctors are well known and a fresh approach in making the quality of training and experience for trainees in Wales a top priority must be pursued."


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As the demographic landscape in Massachusetts evolves, addressing the needs of its aging population stands as one of its most pressing challenges. With a growing number of seniors seeking appropriate healthcare and housing options, navigating the complex landscape of senior care becomes paramount.
This comprehensive guide aims to shed light on the various senior care options available in Massachusetts. It offers insights into healthcare, housing, and essential resources tailored to meet the diverse needs of the elderly.
Understanding the Landscape of Senior Care
The burgeoning demographic shift in Massachusetts foretells a significant transformation. The Boston Herald reported projections indicating that by 2030, individuals aged 65 and older will make up an estimated 22% of Massachusetts’ population. This surpasses the anticipated national rate, signifying a notable demographic shift within the state. This rapid growth underscores the urgency of addressing the diverse and specialized needs of the elderly.
In response to this demographic shift, Massachusetts has witnessed an upsurge in tailored care services, spanning from healthcare provisions to diverse housing alternatives. This evolving landscape reflects a concerted effort to ensure that seniors have access to a spectrum of options. These options support their well-being and sustain a fulfilling lifestyle amidst the challenges of aging.
Massachusetts offers a diverse array of healthcare solutions specifically tailored to cater to the unique requirements of seniors.
Assisted Living Facilities
In Massachusetts, assisted living communities serve as a pivotal bridge between independent living and nursing homes. They furnish housing, personalized care, and support services to residents requiring varying degrees of assistance.
However, this level of care comes at a notable expense, with Forbes reporting an average cost of $6,896 for assisted living in the state. Despite the high cost, these communities remain an attractive option for many families. This is due to the comprehensive care they offer, tailored to residents’ individual needs while promoting a sense of independence.
Notably, government statistics reveal that approximately 28% of traditional assisted living residents in Massachusetts live with dementia. This underscores the importance of specialized care and support available in these communities for individuals facing cognitive challenges.
The cost may be substantial, yet for families seeking a supportive environment that balances care and independence, assisted living proves a valuable solution.
Nursing Homes and Skilled Nursing Facilities
Nursing homes and skilled nursing facilities stand as vital options for seniors; necessitating heightened medical care and assistance with daily activities. These facilities offer comprehensive, around-the-clock support provided by healthcare professionals, ensuring that residents receive specialized care tailored to their individual needs.
These settings cater to individuals needing ongoing monitoring, medication management, rehabilitation services, and assistance with daily tasks.
Skilled healthcare staff, comprising registered nurses, therapists, and aides, are present, allowing residents to access a higher level of medical attention. This promotes both physical wellness and emotional well-being among seniors with more complex care requirements.
Home Healthcare Services
According to a 2021 AARP survey, almost 80% of individuals aged 50 and above prefer to age in the comfort of their homes. Massachusetts acknowledges and meets this preference by offering a diverse spectrum of home healthcare services, as noted by Always Best Care Senior Services.
These encompass crucial provisions like in-home nursing care, aid with daily activities, and access to necessary medical equipment. In urban areas, especially cities, you’ll discover a multitude of service providers catering to these needs.
For individuals living in Metro West or Worcester, conducting a quick search for “in-home care services in Metro West and Worcester County” can be instrumental. This search can open doors to numerous resources and agencies catering to their specific needs.
By browsing through ratings and reviews, individuals can select from various options, each specializing in personalized care. The primary goal of these services is to empower independent living in familiar settings, ensuring tailored support aligned with individual needs and preferences.
Exploring housing alternatives offers diverse options for individuals seeking tailored living arrangements to suit their unique needs and preferences.
- Independent Senior Living Communities: Independent living communities cater to active seniors, providing a maintenance-free lifestyle, varied amenities, social activities, and the freedom to live independently.
- Continuing Care Retirement Communities (CCRCs): CCRCs provide a continuum of care, offering various levels of assistance as residents’ needs change over time. These communities often include independent living, assisted living, and skilled nursing care within the same facility.
- Affordable Housing and Subsidized Programs: Massachusetts offers affordable housing options and subsidized programs for low-income seniors, ensuring access to safe and affordable housing for those with limited financial resources.
In conclusion, exploring the variety of senior care options in Massachusetts entails considering individual needs, preferences, and available resources with care. The state provides healthcare services tailored to specific medical requirements. Additionally, it offers diverse housing alternatives promoting independent living for its aging population.


More and more smartphone manufacturers are beginning to place the fingerprint sensor on either the back of the smartphone or its side, forgoing the traditional front placement of the biometric scanner.
New rumours are popping up that Apple will join the likes of Samsung and Google in terms of fingerprint sensor placement by embedding it on the back of the device.
We’re curious where do you prefer the sensor? Are you a fan of the fingerprint scanner being located on the front, side, or the back of your device?
Let us know in the poll below. Also, let us know if the placement would make or break your purchase decision in the comments.