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adidas NEO SE Daily Sneaker - Mens
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Item # 285161
The men's NEO SE Daily low-top sneaker from adidas is certain to be the shoe you'll reach for every time you want an upscale laid-back look. Lace up and go, knowing you'll look like one cool dude.
- Fabric and leather upper
- Lace-up closure
- Padded collar and tongue for comfort
- Fabric mesh lining
- OrthoLite® cushioned footbed wicks away moisture and helps to inhibit odors
- Molded rubber wraparound midsole with accent striping
- Herringbone pattern outsole for traction
- Pivot point at forefoot allows for enhanced control during turns
- More colors available
- Imported
- View more adidas
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For its 2K13 edition, the NBA 2K franchise is back and bigger than ever.
An all new skating blitzkrieg - Wreak havoc in four new city-levels that feature original goals, level changing events and unlockable characters.
Raise the vuvuzela for the '012 edition of EA Sports' clinch soccer franchise.
A member of an elite military team, Squall is forced into a conflict beyond imagination in Final Fantasy VIII, no on the PSN.
All Jill Valentine wants to do is go home but the zombies, hellhounds, and blood hunters are making it really tough. Each time you meet up…
The operations are set to continue in the sequel to the hit PSP title, Metal Gear Solid: Portable Ops.

subset: commoncrawl


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By the time you read this, Angenieux will have formally announced its newest product, a 19.5–94mm zoom lens with a wider rear element to properly cover a 5K sensor. Slower than other Optimos, the new lens has a T-stop rating of 2.6 instead of 2.2. Due to the difference in sensor size, Mathers says that having the 19.5–94mm lens optimized for larger sensors offers almost the same zoom ratio as the 17–80mm with the same feel and focal length that he's used to. "When you're shooting [with] a wider sensor, the millimeters don't have the same coverage area so the same lens on a camera with a smaller sensor appears to be a longer lens," says Mathers. Many cinematographers have already invested tens of thousands of dollars in prior models of the Optimo zoom, and Mathers reports that Angenieux plans to offer a service that will essentially retrofit existing lenses with the new, wider rear elements so that they can work better with cameras like the EPIC.
Another product Mathers recently tested is the new 2/3-inch lens from Fujinon. "I was doing a documentary series on brain science for PBS called 'Closer to Truth,' and they wanted a super-wide-angle lens for an HD camera," Mathers recalls. The DP needed something that would let him capture the entire width of an operating-room during a procedure and get detailed close-ups while remaining physically distant from the surgeons. "Fujinon let me use this new zoom lens that's 4.5–63mm with a doubler, which makes it great for documentary work," Mathers says. "I was shooting brain surgery at the Cedars-Sinai Medical Center in Los Angeles and needed a really versatile lens. That was perfect."
To a large degree, Mathers is agnostic when it comes to having a preference for one lens manufacturer over another. He chooses his glass based on the specific needs of each project and the camera he'll be using, leaning towards higher-resolution cameras for their ability to future proof his footage. "You always get a better image when you down-sample, say from a native 5K image to 2K rather than shooting native 2K," Mathers explains. While the industry finishing standard for digital cinema is currently 2K resolution, if that standard migrates to 4K for distribution, Mathers says he likes the idea of having 5K original footage as protection as well as for making a better image now.
When shooting on film or with the RED ONE, one lens Mathers often uses is the Angenieux Optimo 17–80mm with a 2.2 T-stop, which he finds to be almost as fast as a standard prime lens. "I love that range because it's wide enough to get your masters and tight enough to get your close-ups," says Mathers. "This way, when I'm shooting indie features, once I put the lens on, I normally don't have to take it off all day." The DP adds that even though he doesn't usually zoom during a shot, he will use the zoom as a variable prime: "That [method] speeds things up tremendously, which is especially important when I'm shooting indie pictures."
Recently, Canon asked Mathers to shoot a test/promo for the FK 14.5–60mm PL-mount zoom, a new lens that premiered at the 2011 NAB. "Canon wanted to see how their lenses worked with different manufacturers' cameras," says Mathers, who shot the project with an ARRI ALEXA. The DP was very impressed by the quality of the 4K-rated Canon lens: "The image was nice and crisp from edge to edge with excellent contrast." He was also impressed by the way the FK 14.5–60 handled flares — a feat that he attributes to the lens' 11-blade iris and coatings. "The size and weight are very similar to my Angenieux Optimo 17–80mm," says Mathers. "I like the range, which is just long enough to grab a close-up and wide enough to capture the master without changing lenses."
Peter Lyons Collister, ASC began his career fresh out of the USC's School of Cinematic Arts in the late 1970s when Director Randal Kleiser hired him to shoot second-unit footage on The Blue Lagoon. Since then, Collister has shot over 40 features and numerous TV shows as either the principle or second-unit cinematographer. His recent credits include the opening sequence for the 2011 Primetime Emmy Awards and second-unit work on Big Miracle for Director Ken Kwapis (a USC classmate).
Collister bought a RED ONE camera a few years ago and recently upgraded to the EPIC; he also owns lens mounts for Panavision lenses and Leica and Canon still-camera lenses as well as a PL mount. His latest project as a second-unit DP is the 3D film The Amazing Spider-Man for Director Marc Webb. Collister and Cinematographer John Schwartzman, ASC shot the feature natively in 3D using 3ality Technica TS-5 3D rigs and RED EPIC cameras. Because of the physical requirements of the 3D rigs, Schwartzman needed lenses that were compact in size, which ruled out zoom lenses and led to Spider-Man being shot with a mix of Panavision Primo and Zeiss Ultra Primes. This decision required them to periodically spend 15–20 minutes changing lenses on the rigs. During principle photography, Schwartzman's crew was able to make lens changes while the director worked with the actors, but this often wasn't practical for Collister's second-unit team. "There were times when I wanted to go from a 32mm to a 40mm, but I knew it was going to take 20 minutes to change lenses, so we would stay with the 32mm and just dolly in instead," recalls Collister. "I thought that was a bit of a compromise."
Collister notes that another critical element of shooting in 3D was making sure that each pair of lenses was perfectly matched. During the lens manufacturing process, slight variations in coatings or angle of view may be inconsequential in a 2D shoot. But when shooting 3D, any variations between right- and left-eye images can be disconcerting when they're combined into a single image. "On Spider-Man, we needed eight pairs of Ultra Primes," says Collister. "Once we got those lenses, while we didn't match serial numbers, we told the lens guy at Panavision that these lenses would always be matched [for] left eye/right eye. He spent about a month mechanically re-engineering those lenses to match each other." While many matching problems can be fixed in postproduction, Collister says that because of the care they took to always use matched lenses, very little correction was required in post.
Collister notices a difference in shooting digital versus film, especially when using cameras with larger, higher-resolution sensors like the EPIC. "When light hits film, because the grain in film is not perfectly square as a receptor, the light refracts off those crystals in an analog, random, cool way," explains the DP. "With digital, it's very precise and each little ray of light is sucked right into that sensor. As a result, a couple of things are happening: First, things are either in focus or out of focus. It's not even a matter of depth of field, which makes it harder on the focus puller. If you shot with two cameras side by side using the same lens, one film and the other using a sensor the exact same size as a frame of 35mm film, it would have the exact same depth of field from a mathematical formula but you might notice that the focus fall-off is a little more relaxed on the film than it is on the digital." This makes it critical for an image to be in focus from the start because it's more noticeable when a digital-camera image is out of focus. "Because the new higher-resolution cameras are that much sharper, we're now back to a place where we need to degrade the image, so, for example, you don't see every pore on an actress's face," says Collister. "So instead of using Primos, which are very nice and sharp, you might switch to a Cooke prime lens because they're not as technically cold and sharp. If I'm shooting with Panavision primes, as I did on a recent Sarah Silverman pilot, I may compensate with heavier diffusion on the lens."
While Mathers and Collister tend to work in different worlds cinematically, they agree on a very important point when it comes to choosing their camera lenses. "As cinematographers, we're fortunate because there are so many great choices out there," says Mathers. "It's just a matter of picking the right one for any particular job."


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Pearl Jam's "Lightning Bolt" is a rock jukebox set to shuffle.
The Seattle survivors' 10th studio album is erratically paced and skips from punk rock attacks to power ballads to AOR offerings in a schizophrenic playlist. Recorded over two years with longtime collaborator Brendan O'Brien and with four songwriters writing independently, it's no surprise the LP often feels like a compilation album rather than a fully realized collection.
Like its 2009 predecessor "Backspacer," "Lightning Bolt" kicks off with three stadium-leveling belters. The solid "Getaway" is piggybacked by furiously kinetic first single "Mind Your Manners," a close cousin to the band's 1994 track "Spin the Black Circle," and accusatory scream-a-long "My Father's Son."
Then comes "Sirens," a slow-burning torch song built around the importance of love in the face of mortality. This is the most unashamedly sentimental song the band has ever released and stands to become a first dance fixture at weddings across the globe. Equally surprising is state-of-the-nation address "Infallible," which somehow manages to ape both the keyboard line from The Dead Weather's "Treat Me Like Your Mother" and the melodic line from Christina Aguilera's "Beautiful".
Elsewhere, there's the Eddie Vedder-penned title track and "Swallowed Whole," two enjoyable, mid-tempo rockers about the majesty of nature, and the ethereal "Pendulum," which marries echo-laden, snaking guitar work and a whispered, conspiratorial vocal to stunning effect.
Sadly, "Lightning Bolt" loses its spark during its closing quartet, including hackneyed stomper "Let The Records Play" (lyrics include, "With the volume up, he goes and fills his cup and lets the drummer's drum take away the pain") and ballads "Sleeping By Myself," "Yellow Moon" and "Future Days" — tracks that will provide plenty of opportunities for fans to trek to the bar at their upcoming gigs.
Pearl Jam's recent albums have started with a bang, but ended with a whimper and "Lightning Bolt" is no exception. As Vedder intones on "Getaway," "Sometimes you find yourself being told to change your ways — there's no way."
By Matthew Kemp, Associated Press
For his 16th solo record, and first of original material in six years, Paul McCartney turned to a team of four hot producers to come up with something "New."
The result is both fresh and comfortably familiar. McCartney, a master of the catchy 3-minute pop song, isn't reinventing himself here as the title may suggest. Rather, he's once again compiling an enjoyable 45 minutes or so of toe-tapping pop songs that are sure to please his longtime fans while doing little to break much truly "new" ground.
Just try listening to "On My Way to Work" or "Queenie Eye" without bobbing your head along to the beat. Really, love him or hate him, few can pump out these types of ditties quite like McCartney.
Still, he's no Bob Dylan.
There are flirtations with material with some gravitas here, but it's just that — a flirtation. McCartney may toy with addressing in song whatever demons he may have, but he certainly doesn't linger.
That said, the mere fact that McCartney is able to come up with something that isn't a simple retread of his past successes must be considered a success, especially when that would be the easy way out, and one that he's taken many times over his storied career.
Much of the credit for the success of "New" goes to McCartney's four producers, especially Paul Epworth (Adele) and Mark Ronson (Amy Winehouse). The other two, Giles Martin and Ethan Johns, are the sons of famous Beatles producers George Martin and Glyn Johns.
While the multiproducer approach could have resulted in a hot mess, the end result is surprisingly cohesive, modern-sounding and, most of all, fun to listen to.
By Scott Bauer, Associated Press


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Frank J. McGuire Coach
Inducted in 2006
Naismith Memorial Basketball Hall of Fame Inductee 1977
Frank McGuire was the first coach in history to win 100 games at three different schools. He had only three losing seasons in his entire coaching career at St. John's, North Carolina, and South Carolina. McGuire guided teams to 8 NCAA and 7 NIT post-season appearances. He won the NCAA Championship at North Carolina in 1957, beating Kansas and Wilt Chamberlain. McGuire received National Coach of the Year Awards in 1952 for St. John's, in 1957 for North Carolina and in 1970 for South Carolina. He was named ACC Coach of the Year in 1957 for North Carolina and in 1971 for South Carolina. Two of his St. John's players, Lou Carnesecca and Al McGuire, became very successful college coaches. McGuire coached the NBA Philadelphia Warriors during 1961-1962. He authored two successful books, Offensive Basketball (1958) and Defensive Basketball (1959) and is a popular contributor to basketball clinics nationwide.
Where They Are Now
Died November 11, 1994
Where They Were
Saint John's University 1948-1952
University of North Carolina 1953-1961
University of South Carolina 1965-1980


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Large orange bowl: approx size 20cm x 8cm.
A fabulous serving bowl for salads or vegetables which can also be used as a pasta bowl. You could even use it for tacos, surrounded with smaller bowls for dips. Enquire for smaller bowls and different colours.
Goods are dispatched by Royal Mail 1st class post. You may ask for tracking which will be charged. Dispatch of goods to destinations outside the UK is subject to separate negotiation.
Price: £38.00
Contact about possible purchase


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The broz of Brothers Marshall awlays shopped at thrift stores for tee shirts and Sears for levi's and Dickies... Now and then their parents would bring them to the local surf shop (Val Surf) to buy a named brand product. They could not stand the main popular surf brands or the asshole poser jocks that wore those brands so they always looked for alternatives... They found Fourstar Clothing! Then they found out it was Guy Mariano and Eric Koston's company. There was just something about the simplicity of the graphics and garments they instantly were attracted to.
Guy and Koston were a huge inspiration to the broz growing up and showed them that they could break out and start their own brand in surf. The broz are just way stoked beyond belief. They still can't believe 10+ years later that those dudes appreciate our humor and are willing to think outside the box to do a surf/skate collabo with Brothers Marshall!
The Fourstar x Brothers Marshall Pirate Head T-Shurt is a quality tee. Print at left chest and repeated large at back. A 100% cotton t-shirt. Seamless graphic tag at neck. Available in colorways as seen below. Model wears a medium.


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Friday marks the 26th annual Take Your Dog to Work Day!
Created by Pet Sitters International, the event is meant to "celebrate the great companions dogs make and promote their adoptions."
Since it's first celebration in 1999, Take Your Dog to Work Day has expanded to accommodate cat lovers, and any other pet parents.
Here's seven tips for Taking Your Dog to Work on Friday:
1. Come prepared – "Make sure you have bowls for water and food, as well as dog treats on hand," Townshend advised. He said employees shouldn't forget to bring a leash and collar for each dog and a carrier for their cats. (Take Your Dog to Work Day is extended to other pets in many workplaces.)
2. Respect boundaries – Townshend wrote that if you bring pets to work you should "be aware of and respect your colleague's boundaries." Some of your co-workers may be allergic to pet dander. Others might not feel comfortable around pets. "Make sure your pet does not stray from your immediate workspace or the designated boundaries," he wrote.
3. Make sure your canine can cope with "cube life" – Keeping your pet in your cubicle is a good way for your dog to remain in a designated area. "As people get up and move around for meetings or casual conversations, make sure your dog is not distracted by noises and starts to wander into others' cubes or the kitchen area," Townshend wrote.
4. Have a backup plan – Not every dog will warm to the workplace. Some will become agitated or anxious, so Townshend said pet owners should have backup plans allowing them to leave the office. "A quick trip down the exit stairwell for fresh air and a bathroom break could ward off a larger disruption," he advised. "Anxious dogs in the office will only lead to other visiting pets becoming distracted."
5. Properly discard of lunches – Many dogs like foraging for food in garbage cans. Assume Fido will consider the wastebaskets under desks at the office or the trash receptacle in the break room as good places to grab a snack — especially after lunch.
"(T)he office should relocate any easy-to-reach trash bins to avoid prying pooches," Townshend advises. "If possible, all trash should be disposed in trash bins with lids to avoid any potential trash bin raids."
6. Make sure your pet plays well with others – It is likely that you won't be the only one at your job bringing a pet to work. Some dogs would do fine if they were the only canine in the office. Add a few more, and perhaps some cats, and circumstances could change dramatically. Have an accurate sense of what the workplace atmosphere will be, and determine whether it is a good fit for your pet. "In the same regard, make sure your pet is friendly with other humans, too," Townshend wrote. "You do not want a dog in the office that gets agitated with strangers or with other pets."
7. Make sure your workplace is observing the holiday – Just because Friday is Take Your Dog to Work Day doesn't mean your employer will approve of your pet tagging along with you to the office. In fact, the poll, conducted by ORC International on behalf of Wellness Natural Pet Food, found that nearly half of respondents wished they could bring their pets to work, but only 12 percent were allowed to do so.
We want to see photos of the dogs that are bringing joy to your workplaces!
Email your dog photos to firstname.lastname@example.com or Tweet/Instagram us using the hashtags #TakeYourDog and #WSLS. We may use your photos in a gallery on our website!


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Sunrise Earth: Greatest Hits DVD
The Sunrise Earth Greatest Hits DVD includes:Sunrise Earth Greatest Hits - East
The sun hits the Atlantic seaboard five hours after the western coast of Europe, and a wide range of habitats begin the shift from the nocturnal to the heat and light of day. We observe the changes, as naturalists; from the sub-tropical ecosystem of the Everglades to the northern lakes of New England, from the very first light atop Cadillac Mountain in Maine to the sabal palms of the Gulf of Mexico. The Sunrise Earth DVD shows you great dawn moments in nearly a dozen morning ecosystems of the east.
Sunrise Earth Greatest Hits - West
Crossing the North American continent in a scant four hours, dawn settles on the Great Plains, the Rocky Mountains and the coastal ranges and beaches of California before departing the western shore. In this segment of the nature DVD, we witness the geo-dramas of Yellowstone geysers, herds of horses and bison on the open range, the spectacular lighting of the Teton Range. Then in California, we see the massive sequoia, tule elk, a rainbow of wildflowers, the Yosemite Valley, and elephant seals on the beach. These are the great sunrise moments in nearly a dozen morning ecosystems of the west.
Buy the Sunrise Earth Greatest Hits DVD set and experience morning like never before.
- Format: DVD
- Rating: Not Rated
- Number of Discs: 1
- Run Time: 201 Minutes
- Region: 1
- Aspect Ratio: Widescreen
- Language: English
- Studio: Discovery Channel
- DVD Release Date: June 21, 2011
- Audio: ENGLISH: Dolby Digital 5.1
- Genre: Documentary
- Color: Color
Sunrise Earth: Acadia National Park
Sunrise Earth: Morning Cruise
- Release Date: 2011
Availability: Backordered
Email me when item is available
In stock items are ready to ship in 5-7 Business Days
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Reviewed by 3 customers
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- Great Cinematography
- High Production Value
- Original
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Comments about this product:
I use this product while listening to music. Great scenery while listen to music.
- Great Cinematography
- Informative
- Original
Best Uses
- At Home
- Travel
Comments about this product:
I enjoyed watching the entire Sunrise Earth series on cable tv. I was disappointed when they were taken off the air. I'm even more disappointed that there are so few Sunrise Earth collections available for purchase. Hopefully, someone with some clout will read this and speed up the release of more Sunrise Earth collections!
- Great Cinematography
- High Production Value
Best Uses
- At Home
Comments about this product:
Nothing more beautiful than a sunrise ... and this really showed them off. Amazingly beautful.


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Empower Your Manual Testers
To attain both speed and quality, Agile software development and testing teams need to test earlier and more often. Exploratory manual software testing is essential to find defects early when they are less costly to remediate. By using Sprinter, testers attain crystal clear write-ups for accurate bug reproduction and maximize their impact of exploratory testing while slashing test cycle time.
Sprinter unleashes tester creativity and makes exploratory testing fun again. Sprinter speeds up the authoring and execution of manual software testing, and eliminates repetitive tasks—such as injecting data, running repetitive tests on different platforms, and keeping track of steps—so testers can focus on exploring the application under test.
Key Features
- Enhanced exploratory testing – Capture user actions as steps in a formal test
- Data injection for eliminating the manual repetition of tests
- Mirror testing – Run tests simultaneously across multiple machines for increased environment coverage
- Automated defect scanners for key conditions such as spelling and compliance
- Auto-generate smart documentation to improve communication with your dev teams
- One click to automate with Unified Functional Testing
HPE Sprinter Customer Testimonial Portal
A revolution in manual software testing
Related Products, Solutions and Services
Engage with our Functional Testing Community
- Key Features
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UPDATE, 9:34 a.m., March 21, 2013: I spoke with Paula Montoya this morning regarding the leaking fuel line. Montoya said her mechanic told her that the fuel line issue was not related to the towing of the vehicle as she originally thought.
Still, she said, she has not heard anything back from the company regarding why it cost so much to retrieve the car.
ORIGINAL POST, 4:49 p.m., March 20, 2013: It was just over a year ago that Ryan Lusk was left paralyzed from the waist down after being shot during a Greenville Avenue robbery over the St. Patrick's Day weekend.
Just when his financially strapped mother thought things couldn't get much worse, Paula Montoya's car got towed early Wednesday from a Grand Prairie apartment complex where Lusk's girlfriend lives.
The tow company, A-AArlington Abandoned Vehicle, charged her $258.85 before they would release the Hyundai Tiburon Wednesday afternoon. She had to have AAA tow the vehicle away to a mechanic shop because she said the fuel line was punctured and gas was gushing from the underside.
"I can't believe this," she said.
Company officials did not respond to numerous requests for comment.
Since Lusk was shot on March 18, 2012, the 24-year-old has been in and out of the hospital as he's struggled emotionally and physically with the condition he's in.
"He's been having a hard time," his mother said. "It's taken a terrible toll on our family."
About 11:30 p.m. Tuesday, Lusk's girlfriend parked the car in front of her apartment. She had borrowed Montoya's to take Lusk to a doctor's appointment.
Kristen Vickers, the girlfriend, said a neighbor that she saw the tow truck driver and offered to go get her. "He said no, that he was just writing down some information," Vickers said.The car, which had a handicapped placard displayed in the window, was gone Wednesday morning.
Vickers had only recently moved into the apartment complex and said she didn't realize she needed a sticker to park a car in the lot.
After Vickers and Lusk paid $258.85 to the tow company Wednesday, Vickers tried to drive it away. She didn't get far as gas was pouring from the tank.
The situation left Vickers in tears. It ruined her eight-year-old daughter's birthday. Lusk missed his doctor's appointment.
"This has ruined so many things today," Montoya said.
Montoya says no one at A-AArlington Abandoned Vehicle explained why it cost so much to retrieve the car, nor how the car got damaged.
Montoya has yet to find out how much the car repair will cost her and she's trying to figure out how she's going to come up with the money to pay for it.
Next month, Lusk's accused robbers, Horace Jones and Anthony Hill, are slated to go to trial. Both remain held in the Dallas County jail.


text: Defense The American Battle Monuments Commission Honors Them All Recoil Staff May 28, 2013 0 COMMENT The American Battle Monuments Commission was established in 1923 by the United States Congress to care for the graves of over 125,000 American war dead in addition to nearly 100,000 individuals commemorated on the Tablets of the Missing. The Commission manages 25 memorials, monuments nad markers and oversees 24 overseas military cemeteries. Most are built to commemorate the service and sacrifice of those who fought in the two World Wars. Today the ABMC held Memorial Day ceremonies around the world, at cemeteries in England, France, Italy, Belgium, the Netherlands, Luxembourg, the Philippines, Panama and Mexico. Visit the ABMC on Facebook for more images from their Memorial Day ceremonies. On Facebook here.


text:
The United States Government, especially the Department of State, and over 140 governments worldwide are key partners with IIE in the implementation of educational exchange, leadership development, and professional training programs.
For more than 60 years, IIE has collaborated with the U.S. Department of State in the administration of some of the most renowned international exchange programs. The Institute has had the honor of administering the Fulbright Program since 1946. IIE also works closely with the Bureau of Educational and Cultural Affairs to administer the Hubert H. Humphrey Fellowships, the Benjamin A. Gilman Scholarship Program, and the International Visitors Leadership Program, as well as conduct the annual Open Doors survey of international student mobility.
IIE also partners with other U.S. government agencies, including the U.S. Department of Education, USAID, and the National Security Education Program (NSEP), whose Boren Scholarship, Boren Fellowship, and The Language Flagship programs provide opportunities for U.S. undergraduate and graduate students to study abroad and add an important international and language component to their education in areas of the world that are underrepresented in study abroad and critical to U.S. security interests.
The Institute is also proud of its strong relationships with government partners around the world that contribute to Fulbright and other IIE-administered exchange, training, and higher education research efforts. These include the governments of Brazil, Mexico, Panama, Italy, India, Japan, Korea, Qatar, Saudi Arabia, China, Thailand, the Philippines, and Indonesia, for such projects as those sponsored by the Brazilian Ministry of Education/Coordination for the Improvement of Higher Education Personnel (CAPES) Foundation, the Japan Intercultural Academy of Municipalities (JIAM), and the Republic of Korea Ministry of Government Administration.
Provides economic, development and humanitarian assistance around the world.
The U.S. Department of State works to foster mutual understanding between the U.S., and other countries.
U.S. Department of Education
NSEP seeks to strengthen national security by building a broader pool of U.S. citizens with critical language and culture expertise.
Jonah Kokodyniak
Deputy Vice President,
Strategic Development
Institute of International Education
809 United Nations Plaza
New York, NY 10017 USA
Fax: +1 212.984.5401
E-mail: firstname.lastname@example.com


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DARE to chat with us?
Join our LIVE CHAT on the Goosebumps series, other spooky books & more!
WHEN: Tuesday, October 27, 2009, 6-7 p.m. ET
TOPIC: Scary books!
Halloween is right around the corner! And to celebrate, our October Live Chat will be about the Goosebumps series and other spooky scary books. Join in the chat to talk with other kids about the books that give YOU goosebumps!
And if you're in New York City on October 24, 2009, stop by the Scholastic Store in SoHo at 3pm for a demo of the Goosebumps HorrorLand Wii game, and more Halloween fun!
— STACKS Staffers
UPDATE: 10/30 — Thanks for joining the chat! Read the transcript here.


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Nine West Brettly Bootie
Sorry, this item is sold out!
Looks like you've got more shoe shopping to do - have fun!
Looks like you've got more shoe shopping to do - have fun!
Item # 297567
Give your look the boost it deserves with Nine West. Zip up the Brettley shootie with a pair of skinnies or a cute dress for a sophisticated yet playful style.
- Suede and leather upper
- Cross strap and belted detail
- Inside zipper closure
- Pointed toe
- 4½" covered stiletto heel
- Synthetic sole
- Imported
- View more Nine West
By: WindyMarie
Location: OK
February 01, 2014
Very Cute
"These were exactly what I was hoping for when I ordered them. Super cute with jeans!"
By: Rebbi
Location: Frederick, MD
January 11, 2014
Love these booties!!!
"Comfy and super cute! I've worn these with a dress and with jeans. Both looks rocked and I love the shoes!"
By: ALL24KT
Location: Whitelake, MI
November 20, 2013
Cute And Sassy
"Absolutely Adorable!! I'm Rocking mine for Business and Pleasure."
By: Jeni
Location: DeWitt, MI
November 20, 2013
Super cute
"these look exactly like picture. Cute with jeans or a dress"
Click anywhere to close this.


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White Mountain Sugarbabe Bootie
Sorry, this item is sold out!
Looks like you've got more shoe shopping to do - have fun!
Looks like you've got more shoe shopping to do - have fun!
Item # 252742
Every girl needs an oxford bootie in her wardrobe this season and the White Mountain Sugarbabe is the perfect addition. The options are endless for the Sugarbabe. Let this bootie complete your look with your favorite denim or dress!
- Faux suede upper
- Oxford lace-up styling
- 3½" photo stacked heel
- Rubber lug sole
- Imported
By: Josieposh
Location: New York, NY
July 30, 2013
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He was born December 2, 1927, in Kimball, NE, to Walter & Marie Strauch.
The Strauch family moved to the Brush area when Elmer was a toddler.
He graduated from Brush High School in 1945. He served in the U.S. Army during the Korean Conflict. Following his honorable discharge, Elmer married Mary Thurtell on November 28, 1954, in Akron. Mary passed away in 1992. He married Shirley Williams on April 21, 1995, in Fort Morgan.
Elmer worked as a letter carrier for the US Postal Service until his retirement. He was a former member of the Bunker Hill Country Club and was a member of the American Legion Sagebrush Post. He was also a member of the Brush United Methodist Church. Elmer enjoyed playing golf and bowling. He also enjoyed going camping with his wife and their friends. He especially enjoyed the Friday afternoon club with treasured friends.
Survivors include his wife, Shirley of Brush; their children, Ken Strauch and Karen Temple both of Brush, John W. Strauch of Aurora, CO, Jean Kawcak of Bradenton, Fl, Karen Kinyon of Wellington, CO, Terrell Mosberger of Farmington, NM, Kirk Williams of Denver, Virginia Williams of Larkspur, CO, and Leslie Walter of Wiggins, CO; one brother, Rob Strauch of Akron; 10 grandchildren, 11 step-grandchildren, eight great-grandchildren and 14 step-great-grandchildren.
He was preceded in death by his first wife, Mary, three brothers, Ed, Harry, and Herb, and his parents.
Memorial Services will be Thursday, October 18, 2012, at 11 a.m. at the Brush United Methodist Church.
Military honors by the U.S. Army and the VFW #3551 will be conducted.
Inurnment will be in the Brush Memorial Cemetery.
The Heer & Dahl Mortuaries are entrusted with the funeral arrangements.
Friends who wish may make memorial gifts to the Brush United Methodist Church or to the American Legion Sagebrush Post both c/o Heer & Dahl Mortuary.


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|Table of Contents
|Vol. 82, No. 1, 2013
Issue release date: November 2012
|Section title: Special Article
Staging of Mental Disorders: Systematic ReviewCosci F.a · Fava G.A.b, c
aDepartment of Psychology, University of Florence, Florence, and bDepartment of Psychology, University of Bologna, Bologna, Italy; cDepartment of Psychiatry, State University of New York at Buffalo, Buffalo, N.Y., USA Corresponding Author
Dr. Fiammetta Cosci
Department of Psychology, University of Florence
Via di San Salvi 12
IT–50135 Florence (Italy)
E-Mail email@example.com
Background: The staging method, whereby a disorder is characterized according to its seriousness, extension, development and features, is attracting increasing attention in clinical psychology and psychiatry. The aim of this systematic review was to critically summarize the tools that are available for reproducing and standardizing the clinical intuitions that are involved in a staging formulation. Methods: A comprehensive research was conducted on the MEDLINE, PsycINFO, EMBASE and Cochrane databases from inception to May 2012. The following search terms were used: 'stage/staging' AND 'psychiatric disorder/mental disorder/schizophrenia/mood disorder/anxiety disorder/substance use disorder/eating disorder'. Results: A total of 78 studies were identified for inclusion in the review. We discussed studies addressing or related to the issue of staging in a number of mental disorders (schizophrenia, unipolar depression, bipolar disorder, panic disorder, substance use disorders, anorexia and bulimia nervosa). The literature indicates that disorders have a longitudinal development or a treatment history that can be categorized according to stages. We proposed staging formulations for the above-mentioned psychiatric disorders. Conclusion: Staging models offer innovative assessment tools for clinical psychologists and psychiatrists. Characterizing each stage of an illness demarcates major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. A stage 0 to denote an at-risk condition does not appear to be warranted at the current state of research.
© 2012 S. Karger AG, Basel
Systematic review Staging Mental disorder Psychiatric disorder Clinimetrics Anxiety Mood disorders Schizophrenia Eating disorders Substance abuse
Psychiatric diagnosis has attracted prominent attention in clinical psychology and psychiatry. The introduction of diagnostic criteria for the identification of psychiatric syndromes, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) [1], has considerably decreased the variance due to different assessors and the use of inferential criteria rather than direct observation. However, there is increasing awareness of the limitations of the current diagnostic systems and concern about future DSM or International Classification of Diseases [2] developments [3,4,5]. The customary clinical taxonomy in psychiatry does not include, for instance, patterns of symptoms, severity of illness or effects of comorbid conditions that demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis [6]. Such specifications pertain to the concept of clinimetrics [7], which indicates a domain concerned with indexes, rating scales and other expressions used to describe or measure symptoms, physical signs and other distinctly clinical phenomena [8,9].
The use of diagnostic criteria in clinical psychology and psychiatry is derived from the traditional method of clinical medicine in which the use of diagnostic criteria provides operating specifications for making a clinical decision about the existence of a particular disease. If a disease is defined morphologically, the criteria contain specifications for making a clinical diagnosis when the definitive morphological evidence is not available. If a disease is not defined morphologically, the criteria can serve both to define the disease and to provide specifications for its diagnosis. The latter use is prevalent in clinical psychology and psychiatry.
However, there is another common and complementary method of classifying medical disorders, namely staging. Once an index identifies the existence of a particular disease state, there is often a clinical need to rate its seriousness, extent and characteristics. An example is provided by the New York Heart Association Functional Classification [10], which ranges from class I, i.e. patients with cardiac disease without resulting limitations of physical activity, to class IV, i.e. patients with cardiac disease with severe physical activity limitations. Staging has also assumed paramount importance in clinical oncology, in which the stage of the disease often determines the choice of treatment and indicates the prognosis. One of the methods is the Ann Arbor staging classification of lymphomas [11], in which the clinical stage is defined by the apparent extent of disease based on physical and instrumental examination.
Notwithstanding the long tradition of staging in developmental psychology [12,13], clinical psychology and psychiatry had for a long time neglected staging as a model to classify the development of mental disorders. This neglect has paralleled the reliance on cross-sectional descriptions instead of longitudinal study of prodromes, the fully developed disorder and residual phase [14].
In 1993, Fava and Kellner [15] introduced the clinimetric concept of staging in psychiatric classification. They developed staging methods for unipolar depression, bipolar disorder, panic disorder and schizophrenia based on the longitudinal development of a psychiatric disorder, ranging from the prodromal to the residual and chronic forms. In the past decade there have been further developments in the literature [16,17,18,19,20,21,22,23,24]. Such contributions have stressed the role of staging to improve the clinician's capacity to select treatments relevant to earlier stages, assuming that these interventions can be more effective and less harmful than treatments delivered later in the course of the illness and that they might help prevent progression to more advanced stages or promote regression to an earlier stage. In this framework, it has been proposed to develop ground rules for clarifying which people are at risk of mental illness and what sequence of established and novel or experimental therapeutic strategies is most likely to successfully achieve remission and psychosocial recovery and reduce the risk of persistence and recurrence.
To the best of our knowledge, there has not been a systematic review attempting to synthesize the different models of staging currently known in clinical psychology and psychiatry in order to update and expand the work of Fava and Kellner [15]. We will not specifically review the studies describing prodromal and/or residual symptomatology in the longitudinal development of disorders, but we will mention their potential relevance to the construction of staging systems.
Eligible articles included English-language papers published in peer-reviewed journals reporting data on adult subjects with psychiatric disorders according to the DSM-III, -IIIR, -IV or -IVTR, the Research Diagnostic Criteria [25] or the International Classification of Diseases. A further inclusion criterion for articles on staging models was that they had to propose a complete staging model. Further inclusion criteria for articles on clinical features were as follows: no additional co-occurring psychiatric disorders (either Axis I or Axis II) or organic disease and inclusion of at least 10 patients. Additional inclusion criteria for articles on treatment interventions were those chosen for articles on clinical features plus the following: inclusion of a comparison group or a crossover design, and a double-blind design in the case of pharmacological treatments or at least a single-blind design in the case of nonpharmacological treatments.
Papers dealing exclusively with neuroanatomy or biological markers were not included since this review was focused on staging models, their clinical features and treatment implications.
The MEDLINE, PsycINFO, EMBASE and Cochrane databases were systematically searched from inception to May 2012. In addition, a manual search was performed of reference lists from all articles selected, for full-text reviews and relevant reviews.
The search terms were 'stage/staging', combined using the Boolean 'AND' operator with 'psychiatric disorder/mental disorder/schizophrenia/mood disorder/anxiety disorder/substance use disorder/eating disorder'. In the online supplementary appendix (see www.karger.com?doi=10.1159/000342243 for all online suppl. material), we report the search strategy used for MEDLINE.
Titles and abstracts were screened by one reviewer (F.C.). Articles that appeared potentially relevant were retrieved, and two reviewers (F.C. and G.A.F.) independently assessed each of the full reports, arriving at a consensus regarding eligibility. For each excluded study, we determined which elements of the electronic search were not addressed.
When information about the methods or results was omitted, the writers of the report were contacted to obtain the missing information. If duplicate publications were suspected, the authors of the reports were contacted to receive further details. If duplicate publication was confirmed, only the report with the largest sample size was included.
To ascertain the validity of eligible studies, two investigators independently rated each study on the basis of the following markers: (1) in the case of studies on staging models, presentation of a complete model with motivation of its existence; (2) in the case of studies on clinical features, homogeneity of samples with regard to the diagnosis and age (equal to or greater than 18 years), and (3) in the case of studies testing treatments, homogeneity of samples with regard to the diagnosis and age (equal to or greater than 18 years), inclusion of a comparison group, appropriate random allocation, blinding of participants, proportion of patients lost to follow-up and stopping of trials early for benefit.
Any disagreements were resolved by consensus.
The search strings and the list of relevant reviews that were used with the literature search, the data coding and the quality criteria that were used can be requested from the corresponding author.
The methods described here fulfilled Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [26].
A total of 78 studies (32 on staging models, 27 on clinical features and 19 on treatment) were identified for inclusion in the review. The search of MEDLINE, PsycINFO, EMBASE and Cochrane databases provided a total of 17,789 citations. After adjusting for duplicates and reviewing the abstracts to exclude those which clearly did not meet the criteria, 362 remained. Of these, 281 studies were discarded because they did not meet the inclusion criteria. Three additional studies were discarded because the full text of the paper was not available. No unpublished relevant studies were obtained (online suppl. fig. 1).
A first staging model of schizophrenia was proposed by Fava and Kellner [15], as follows: prodromal symptoms (mainly affective and negative symptoms), with deterioration of functioning, represented stage 1; the acute episode was stage 2; residual symptoms were stage 3; subchronic symptoms (i.e. lasting less than 2 years but more than 6 months) occurred at stage 4, and chronic symptoms (i.e. lasting more than 2 years) were stage 5.
In 2001, Lieberman et al. [27] proposed a model that was only slightly different, with the inclusion of a premorbid stage and the existence of a chronic and a residual phase of illness at the same stage of the model.
Subsequently, McGorry and coworkers proposed another version that underwent various updates [19,20,21,22,23]. Stage 0 was represented by an increased risk of psychotic (or severe mood) disorder although there were no current symptoms. At stage 1a, there were mild or nonspecific symptoms. At stage 1b, subjects presented moderate subthreshold symptoms. At stage 2, there was the onset of the first episode of psychosis (or severe mood disorder mania or depression). At stage 3a, an incomplete remission from the first episode of care occurred. Stage 3b included recurrence or relapse of psychotic (or mood) disorder. Multiple relapses, when worsening in clinical extent and the impact of illness, were objectively present at stage 3c. Stage 4 referred to severe, persistent or unremitting illness.
Recently, Agius et al. [28] proposed 3 stages in the development of schizophrenia which differ only slightly from those of Fava and Kellner [15]. In the first stage, that is the prodrome phase, there is a loss of gray matter as well as changes in cognition which develop as the illness develops. The second stage is characterized by the first episode of illness and progressive cognitive decline. At stage 3, schizophrenia was chronic, and disruptions in neurodevelopment or neural plasticity occurred.
On the basis of the above literature, we here propose a staging model for schizophrenia with the aim of mediating and integrating those mentioned above (table 1). This model, as well as all the other ones suggested here, is based on the basic steps of a psychiatric disorder, ranging from the prodromal to the residual/chronic form, in a longitudinal view of development of disturbances [6], and finds support in the current literature. Since more detailed models that may yield therapeutic interventions in a preacute phase do not find adequate support from the literature and need specific clinical validation, stage 0 was not taken into account. In fact, prodromal symptoms, which characterize stage 1, can be appraised only retrospectively, and their predictive power in the general population is very limited [29,30,31,32] because of their nonspecific features. Residual symptoms at stage 3 are also nonspecific. Depression [30,33], trouble concentrating [30], trouble sleeping [30], being tense and nervous, restlessness and loss of interest [33] are common.
Many opinion papers on the treatment of specific stages of illness have been published. For instance, Lieberman et al. [27] proposed no treatments at the premorbid and prodromal stage, antipsychotic drugs for the acute phase and antipsychotics, although having limited efficacy, for the chronic/residual stage. However, the evidence to support these decisions is really limited. One study showed that the likelihood of successful resolution of a prodrome increased over time under fluphenazine compared to placebo [34]. Herz et al. [35] found that a program for relapse prevention was more effective than treatment as usual in reducing relapse and rehospitalization rates among schizophrenic outpatients. Another study, comparing integrated psychological intervention and supportive counseling administered at the early initial prodromal stage to prevent psychosis, showed that the first was superior to the second at the 12- and 24-month follow-up [36].
Fava and Kellner [15] described a staging model of unipolar depression that was updated in 2007 [37]. The prodromal phase was characterized by the onset of depressive symptoms, mainly anxiety, irritable mood, anhedonia and sleep disorders. At stage 2, subjects suffered a major depressive episode, then a residual phase (stage 3) may occur with no depressive symptoms or with dysthymia. Stage 4 was characterized by recurrent depression or double depression, while at stage 5, subjects had a chronic major depressive episode lasting at least 2 years without interruptions.
In 2008, Hetrick et al. [38] suggested a similar staging model; however, their model did not include dysthymia and referred to neurocognition and disability.
We here propose an updated version of the Fava and Tossani [37] model (table 2).
Generalized anxiety and irritability seem to be the most common prodromes of unipolar depression. Other symptoms which can characterize stage 1 are impaired activities [39], depressed mood [39], guilt, anorexia [39], fatigue and initial and delayed insomnia. Prodromes increase the risk of the occurrence of major depression [40,41], are quite similar to residual symptoms [42,43] and can be the front door to relapse [44,45,46]. This parallels the fact that patients with 'double depression' are less likely to recover and more likely to relapse [37]. Residual symptoms may occur at stage 3. They frequently mirror the prodromal stage [44]. Decreased somatic anxiety, increased psychological anxiety, appetite, libido or hypochondriasis were found to be predictors of relapse/recurrence in patients who responded to acute-phase continuation-phase cognitive therapy [47].
A strong relationship between prodromal and residual symptoms has been substantiated since almost 70% of residual symptoms are present in the prodromal phase of the illness [42]. Similarly, the link between dysthymia and a relapse of unipolar depression has been widely confirmed. Klein et al. [48] observed that about 74% of patients with dysthymic disorder who recovered from a major depressive episode for the second time experienced another relapse into depression, for an estimated relapse rate of 93.2%. In addition, about 24% of dysthymic disorder patients who had recovered had a relapse into chronic depression [49].
In two randomized controlled trials [50,51], psychotherapeutic intervention was applied according to the staging method developed by Fava and Kellner [15] and was found to yield long-term benefits. Patients with major depressive disorder successfully treated with antidepressant drugs were randomly assigned to cognitive behavioral treatment (CBT) or clinical management of residual symptoms. The group that received CBT had a significantly lower level of residual symptoms in comparison with the clinical management group. CBT also resulted in a lower rate of relapse at 2–6 years of follow-up. This approach was then validated by other randomized controlled trials, in which cognitive behavioral strategies applied to remitted patients were found to improve the long-term outcome of major depression compared to clinical management or treatment as usual [52].
Several efforts have also been made to develop methods to stage the degree of treatment resistance in patients with unipolar depression. Thase and Rush [53] proposed a 5-stage model (TR-S) that yields a categorical assignment of degree of resistance. Patients were classified according to the number and classes of antidepressants that failed to produce a response, with staging moving from more common to less common treatments. Thus, for instance, stage I was characterized by failure of at least 1 adequate trial of 1 major class of antidepressant.
According to a second model, called the European approach [54], stage A represented no response to 1 adequate antidepressant trial lasting 6–8 weeks; treatment-refractory depression, stage B, was the failure of 2 or more adequate trials of different antidepressants given in adequate dosages for a period of at least 12–16 weeks but no longer than 1 year, and chronic resistant depression (stage C) was characterized as resistance to several antidepressant trials, including augmentation strategy, lasting 12 months or more. This was in contrast to the TR-S, which referred to resistance as the failure of at least 1 adequate trial. Additionally, Souery et al. [54] proposed a condition called chronic resistant depression.
A group from the Massachusetts General Hospital formulated a slightly different approach that considers both the number of failed trials and the intensity or optimization of each trial without assumptions regarding the hierarchy of antidepressant classes. This method generated a continuous variable reflecting the degree of resistance in depression and ranging from 0 to 5 [55].
The limitations of the three models were described by Berlim and Turecki [56]. The TR-S lacked exploration of the degree of dosing/duration of treatment, assumed that nonresponse to 2 agents of different classes is more difficult to treat than nonresponse to 2 agents of the same class and made an implicit hierarchy of treatments not accounting for the role of augmentation and combination strategies. With reference to the European criteria, the duration of adequate trials and the distinction between treatment-refractory depression and chronic resistant depression were arbitrarily chosen. The model from the Massachusetts General Hospital was based on limited data reliability and scores attributed arbitrarily to each treatment.
The Massachusetts General Hospital Staging Method and the TR-S have been tested as predictors of remission status. According to Petersen et al. [57], the Massachusetts General Hospital Staging Method demonstrated significantly greater ability to predict nonremission than the TR-S. This study has been criticized for the relatively small sample size, the use of chart review methodology and the probable nongeneralizability of the findings to other populations [56].
More recently, a multidimensional staging model, the Maudsley Staging Method, was proposed [58,59]. In addition to the number of failed treatment trials, it incorporated factors considered to be closely related to the depressive illness itself, namely the duration and severity of the illness, treatment failure with antidepressants, use of augmentation and use of electroconvulsive therapy. In the end, the stage of treatment resistance was represented as a single score ranging from 3 to 15.
An attempt to integrate the four models is proposed in table 3. The basic principle is that it is quite different to treat a patient with a major depressive episode who displayed a positive response to previous therapeutic trials (stage 0) and a patient who failed to respond to various adequate trials, including one involving augmentation/combination (stage 4) [6]. In our model, the expression 'therapeutic' means either psychopharmacological therapy or psychotherapy.
Classifying the treatment response of each patient can shed some light on whether long-term treatment with antidepressive agents may increase susceptibility to subsequent episodes [60] or lead to tardive dysphoria [61] or supersensitivity phenomena [62] and on the mechanisms of loss of clinical response during long-term antidepressant treatment [60].
Carlson and Goodwin [63] described how inpatients with mania go through 3 different stages. The initial phase is characterized by somewhat pressured speech, elation and hyperactivity. The second stage is characterized by paranoid, hypertalkative and grandiose features. The final stage involves delusions, sexual worries, lability and anger [63]. Later on, Fava and Kellner [15] referred to a staging model of mania with the following 4 phases: (1) prodromal (i.e. increased self-confidence, energy and elated mood); (2) hypomania; (3) manic episode without psychotic features, and (4) manic episode with psychotic features.
Over time, several models of bipolar disorder have been proposed. According to McGorry et al. [19,22,23] and Berk et al. [64,65], bipolar disorder begins with an at-risk, asymptomatic period, where a range of risk factors may be operating (stage 0). Thereafter, individuals exhibit mild or nonspecific symptoms (stage 1a) and progress to manifest prodromal symptoms (stage 1b). Prodromal symptoms may then culminate in a first threshold episode of illness (stage 2), more commonly depressive, which may be followed by a first relapse, of either subthreshold (stage 3a) or threshold illness (stage 3b), and a subsequent pattern of remission and recurrences (stage 3c). While some individuals may recover syndromally or symptomatically, others may have an unremitting or treatment-refractory course (stage 4). Suggested treatments were family education and drug use education/reduction at all stages; mental health literacy and brief cognitive skills training at stage 0; mental health literacy, counseling, problem solving and exercise at stage 1a; CBT, social cognition interventions and neuroprotective agents at stage 1b; CBT, atypical antipsychotics and vocational rehabilitation at stage 2; long-term stabilization at stage 3, and clozapine, augmentation strategies and assertive community treatment at stage 4.
This model was recently revised by McNamara et al. [66]. The main difference is that only 3 stages were included; the unremitting/treatment-refractory course was not taken into account and the high-risk condition was placed at stage 1 rather than at stage 0, meaning that it is part of the illness. As a consequence, stage 2 was characterized by prodromal clinical features and stage 3 by mania.
A different staging model was hypothesized by Kapczinski et al. [67] and included a latent stage, referring to the condition of being at risk for developing bipolar disorder because of a positive family history or mood/anxiety symptoms, and 4 clinical stages. Stage I included euthymia without overt psychiatric symptoms; stage II was characterized by interepisodic symptoms; stage III involved marked cognitive and functional impairment, and at stage IV the cognitive and functional impairment was so severe as to make the patient no longer autonomous. Mood stabilizer monotherapy and psychoeducation were suggested for stage I, pharmacotherapy plus psychotherapy and the treatment of comorbidities for stage II, complex regimens of treatment for stage III and palliative treatment and day care centers for stage IV.
We propose an integrative model of staging (table 4) that acknowledges the lack of evidence supporting the definition of a stage 0 (at risk). Indeed, risk factors and prodromal symptoms are not sufficiently specific and do not necessarily imply evolution toward the illness [44].
Stage 1 is characterized by prodromal symptoms. There is high interindividual variability between patients that does not allow recognition of a specific prodromal phase. However, prodromal symptoms tend to be consistent within the same individual and this allows room for early intervention [44]. Cyclothymic disorder may also represent a precursor of bipolar disorder as well as a formally acknowledged subtype of subthreshold bipolar disorder [68,69]. Cyclothymic individuals report short cycles of depression and hypomania that fail to meet the duration criteria for major affective syndromes. The use of an item of the Clinical Interview for Depression [70], reactivity to social environment, was found to characterize the clinical features [69] and response to treatment [71] of cyclothymic disorder.
Stage 2 refers to acute manifestations of major depressive disorder and mania/hypomania, while residual symptoms characterize stage 3. They might represent persistent illness, that is the original illness continuing in milder form, despite stabilizing treatment, or the phenomena preceding and underlying the acute episode of illness [39]. Common residual symptoms may be behavioral (i.e. being slowed down, late for work, still overactive, more subdued), cognitive (i.e. fear of relapse, low self-esteem, guilt), affective (i.e. irritability, anxiety, sadness, worry, low energy, sleep problems) or social (i.e. feeling distant from others, alienation) [72]. Residual symptoms may develop into a full affective episode despite stabilizing treatment and characterize stage 4 of our model.
There have been a number of suggestions as to stage-specific treatments [19,22,23,64,65,66,67]. A randomized controlled trial [73], confirmed by studies on psychoeducation [74], demonstrated the feasibility of early intervention aimed at recognizing prodromal symptomatology. Programs for the early detection and control of hypomanic episodes, based on appraisal of individual prodromal symptoms and intermittent use of lithium, have also been described in bipolar disorder [74] and cyclothymia [71].
The presence of residual symptoms at stage 3 connotes a phase of the illness where the value of psychotherapeutic treatment, in addition to pharmacotherapy, may be considerable. There is some evidence that psychotherapeutic approaches in this stage may be more effective than those that are started in the acute manifestation of illness (stage 2) [74], as was found to be the case in unipolar depression [52].
A comment on the implicit concepts built into the staging model of bipolar disorder seems necessary. In clinical medicine it is common to think that the earlier in the progression of a disease a diagnosis occurs, the more likely it is that symptoms will have a benign course. On the basis of this observation, several authors concluded that the earlier the diagnosis is made, the earlier the treatment is initiated and the greater are the chances of a treatment response, which in turn confers a better prognosis [75]. For this reason, a growing body of literature is exploring the possible allegedly neuroprotective effects of psychotropic drugs. However, data supporting this neuroprotection are missing, and psychotropic drugs may be associated with adverse metabolic effects [66] and entail sensitizing effects potentially leading to a malignant course [60,62].
Fava and Kellner [15] described a staging model for panic disorder (PD) with agoraphobia based on the fact that, in a substantial proportion of patients, agoraphobia, hypochondriacal fears and beliefs and generalized anxiety precede the first panic attack. However, for some patients, the first panic attack can apparently occur without conspicuous prodromal symptoms, while anticipatory anxiety, phobic avoidance and hypochondriasis may develop subsequently. For this reason, they also mentioned Sheehan and Sheehan [76], who outlined a different staging process, as follows: stage 1 (subpanic), characterized by panic attacks with limited symptoms; stage 2 (panic); stage 3 (hypochondriasis); stage 4 (single phobia, that is the setting in which panic occurs); stage 5 (social phobia); stage 6 (agoraphobia), and stage 7 (depression).
An updated version of the Fava and Kellner staging model of panic [15] was presented in 2008 [77]. The first step was pre-agoraphobia with predisposing factors, such as health anxiety and anxiety sensitivity, genetic vulnerability, premorbid personality, hypochondriacal fears and beliefs and impaired psychological well-being. The relative weight of these factors may vary from patient to patient and lead to subtle avoidance patterns and ultimately to agoraphobia (stage 2). Thus, panic attacks start. Health anxiety may turn into hypochondriasis and/or disease phobia and/or thanatophobia. Demoralization and/or major depression may occur (stage 3). The duration of PD with agoraphobia can predispose to the development of other psychiatric complications, notably depression. Moreover, agoraphobia may become more severe and hypochondriacal fears and beliefs may be accentuated (stage 4).
Considering the phenomenology of panic attacks, it has been suggested that truly spontaneous attacks, not preceded by anxiety-provoking cognitions, are uncommon. Patients meeting positive criteria for PD tend to suffer from the whole range of anxiety disorders, and a unique relationship with agoraphobia has not been seen. Indeed, other diagnoses (particularly social phobia and generalized anxiety disorder) frequently predate the onset of panic and agoraphobia [77]. If the onset of PD is conceptualized as a stage of development of anxiety disorders (whether agoraphobia or social phobia or generalized anxiety disorder) and hypochondriasis, instead of a specific disease, the diagnostic sharpness is increased and undifferentiated treatment, which may leave substantial areas of nonresponse, can be substituted with stage-guided therapeutic tools [77]. Fava et al. [77] suggested considering the onset of PD as a stage of development of anxiety disorders and hypochondriasis, instead of a specific disease.
The model of PD that is depicted in table 5 has wide support in the literature. An analysis of subclinical symptomatology [78,79] concluded that the most common prodromal symptoms were depressed mood, illness phobia, distress and avoidance of closed spaces, excessive worries, negative affectivity, anxiety sensitivity and health anxiety or fear of disease, whereas frequent residual symptoms were generalized anxiety, somatic anxiety, low self-esteem, agoraphobia, hypochondriasis, reduced psychological and physical well-being, limited symptoms of panic attacks, anticipatory anxiety and depression.
Viewing the longitudinal development of panic according to stages may entail an advantage for monitoring the patient's progress [80]. Because of the chronic nature of PD, the emphasis of treatment has been shifted more and more to the long-term outcome; the disappearance of residual symptoms may become the final target of therapy since they constitute a substantial risk of relapse [79]. This has been clearly outlined in the long-term outcome of patients with PD treated with behavioral interventions [81]. Another interesting proposal could be stage-oriented therapy, which is a specific therapy planned to treat a specific stage of the illness in order to produce additional benefits. Up to now, unfortunately, only a few studies have used the staging model to test pharmacological/psychological intervention efficacy, and none satisfied our inclusion criteria.
Considering that treatment resistance in PD is a growing and emerging issue [82,83], we here propose staging levels of treatment resistance (table 6). At stage 1, a pharmacological/psychological intervention fails to give benefits; at stage 2, the failure involves 2 different interventions, including at least 1 involving psychotherapeutic treatment; stage 3 involves the failure of 3 or more adequate therapeutic interventions, including at least 1 involving psychotherapy, and at stage 4 there is failure of 3 or more adequate therapeutic trials, including at least 1 combination of psychotherapy and pharmacotherapy.
Langenbucher and Chung [84] proposed 3 stages for the development of alcohol use disorders. The first was alcohol abuse, the second dependence and the third accommodation to the illness, consisting of curtailing important activities to drink and spending a great deal of time drinking. Later on, Chung et al. [85] found 4 stages of development of alcohol abuse/dependence. Stage 1 was abuse; stage 2 was what they called 'consequation', that is social, medical and psychological problems and attempts to quit or cut down; stage 3 was accommodation to the illness, and stage 4 was characterized by physiological dependence.
In table 7, we integrate the above models. Stage 1 represents alcohol abuse; stage 2 involves decreased functioning and attempts to cut down; at stage 3, tolerance is evident and alcohol abuse becomes severe, and finally alcohol dependence occurs (stage 4). Since in this model the stages refer to the DSM diagnosis of alcohol abuse and dependence, the treatments proposed are those included in the more recent guidelines [86,87], and the staging system for treatment resistance suggested here (table 8) is based on their work.
A staging model has also been applied for remission; substance abstinence tends to be an ongoing process from dependence through abuse and misuse, before quitting. Moreover, after remission, prodromal symptoms (e.g. substance misuse) tend to become the residual symptomatology which may progress to be prodromal symptoms of relapse. Accordingly, Yeh et al. [88] found that alcohol-dependent individuals free themselves of addiction progressively via 3 phases. The first phase was the indulgence, ambivalence and attempt cycle (i.e. the sufferer is trapped in a cycle of attempting to give up and failing). The second phase was the turning point, which included the personal nadir (i.e. they are in despair and afraid of dying) and self-belief and acceptance (i.e. they admit to themselves that they are drunkards and desperate and make a constant effort to remain sober). In the third phase, they embrace the idea of change and self-rescue.
In a study by Favrat et al. [89], a clinically relevant staging system based on patients' characteristics on admission, which accurately predicts adverse outcomes in a methadone maintenance program, was developed. This system was composed of 4 main predictors for treatment retention: quantity of heroin used, history of previous incarceration, previous remand in a reform school and medical illnesses related to heavy drug use.
Motivation to undergo treatment and change behavior has also been submitted to a staging system and may yield valuable insights into the psychological resistance of patients [6]. Prochaska and DiClemente [90,91,92,93,94] developed a seminal example of clinical staging in substance use disorders which is called the transtheoretical model (TTM) of change. This is an integrative and comprehensive model of behavior change [90,91,92,93,94] postulating that people progress through 5 stages when changing behaviors. When they do not recognize that a problem exists and have no intention to change, it is the 'pre-contemplation' stage. The 'contemplation' stage is marked by ambivalence and inaction. In 'preparation/determination', the individual perceives a significant discrepancy between the current and desired status, becoming committed and preparing to change. Implementing a plan to change one's behavior reflects the 'action' stage. Finally, in the 'maintenance' stage, the subject solidifies the new pattern of behavior and focuses on avoiding relapse. Prochaska and Norcross [95] also defined a sixth stage, 'termination', in which the individual has completed the process of change, has a high level of confidence across all high-risk situations and no temptation to relapse. The TTM proposed that individuals move sequentially through the stages but may revert to earlier stages before achieving complete abstinence. It also propounded that incremental moves through the stages, independently of an active attempt to quit, predict higher eventual levels of abstinence [96].
In 1994, Prochaska et al. [97] successfully tested this model in quitting smoking and in cocaine cessation; thereafter it was applied in opiate addicts [98,99,100] and in alcohol abuse [101,102,103].
Notwithstanding the literature suggesting the conceptual validity [104] and the practical usefulness of the TTM (e.g. a standard practice is to set a quit date during smoking cessation on the assumption that abrupt attempts to quit are less likely to succeed) [105,106,107,108], serious problems with the TTM have been articulated [104,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125]. In this context, West [107] pointed out the limits of such a model, proposing instead a new theory, the plans, responses, impulses, motives and evaluations model [107,108]. Unfortunately, literature on the validity of this new theory and its usefulness in clinical practice is still lacking. Moreover, while replicating the study of Callaghan et al. [126], which did not support the validity of the TTM, Heather et al. [127] obtained different results, and a recent meta-analysis claimed the usefulness of TTM stages of change in predicting important treatment outcome measures [128]. As a consequence, Norcross et al. [128] proposed a brief outline of research-supported therapist behaviors that can enhance treatment outcomes, including, among others, assessment of the stage of change and tailoring of the treatment processes to the stages.
The earliest description of anorexia nervosa (AN) made reference to the concept of stages; Lasegue [129] described a gradual descent into the illness, distinguishing 3 phases in its progression. The first was marked by an 'uneasiness and fullness' after eating with reduction of food intake. The second was characterized by severe restriction, increased activity levels and 'an intellectual perversion' resulting in a complete denial of the illness. The third stage involved extreme emaciation, laborious exercise and 'general debility'. Later on, Halmi [130] considered an acute stage versus a refeeding one, or a chronic and a recovered stage of the illness. Other authors described a progression through stages, with the chronic phase receiving more attention. Klein and Walsh [131] observed that weight loss in AN was usually accomplished primarily through a reduction in food intake, which often progressed through stages. First, all foods that could potentially contain fat were eliminated, and thus only 'safe' foods were consumed. Thinness became an increasingly salient goal, and growing attention was paid to body weight, shape and size. Idiosyncratic rules developed around when, what and how much a person permits herself to eat and around how much exercise was required. At the outset of the disorder, weight loss may be socially reinforced. Under pressure to gain weight, individuals often turned to deception. Not uncommonly, they hide weight loss from family members, social avoidance facilitated progressive weight loss, and alcoholism might occur.
More recently, Maguire et al. [132] proposed a staging model of AN which took into account the severity and duration of the illness.
On the basis of the above literature, we propose in table 9 a staging model for AN. Such a model finds support in the literature, which showed that the course of AN is characterized by high rates of partial recovery and low rates of full recovery [133] and that full remission/recovery is more stable than the stage of partial remission [134].
No indications are available on a stage-oriented use of therapeutic tools, such as psychotherapy [135].
The concept of clinical staging has also been applied to bulimia nervosa (BN). Klein and Walsh [131] suggested that BN typically begins during or following a diet. At some point, a behavioral method is discovered that promises to rid the body of unwanted calories. Thereafter, initially great satisfaction may be experienced that appealing food may be eaten without weight gain. As the disorder progresses, perceived control over eating diminishes. Inappropriate compensatory behaviors and self-imposed caloric restriction stimulate hunger and binge eating and a vicious cycle develops.
We propose a staging model which takes into account the literature (table 10). Stage 1 is characterized by prodromal symptoms (e.g. anorexia, low self-esteem); at stage 2, the acute episode of illness occurs; it may then leave residual symptoms (stage 3) and an attenuated or persistent form of the illness (stage 4). Indeed, Raffi et al. [136] found that BN patients report prodromal symptoms before the onset of the disorder; anorexia, low self-esteem, depressed mood, anhedonia, generalized anxiety and irritability were the most common. Less common were reactivity and phobic avoidance. Thus, subclinical mood disorder, especially if combined with stressful life circumstances, may produce an allostatic load [137,138,139] which increases the probability of developing BN.
An interesting application of DiClemente and Prochaska's stages of change model occurred in eating disorders. Ward et al. [140] assessed stages of change and processes used to achieve them and found that contemplation and pre-contemplation were the most common stages. The most frequently used processes of change were self-reevaluation, helping relationships and consciousness raising, with different processes predominating at different stages. Blake et al. [141] found that the vast majority of BN outpatients were in the action stage, whereas the AN outpatients were more distributed across the stages, with half in the pre-contemplation and contemplation stages. Jordan et al. [142] proposed 5 stages in eating disorders: pre-contemplators were not thinking about and not planning to recover from anorexia/bulimia in the following 6 months; contemplators were thinking about trying to recover in 6 months; preparers intended to start trying to recover in 30 days; those in action had been actively recovering from their eating disorder for fewer than 6 months, and those in maintenance had been in active recovery (or recovered) for more than 6 months. They found that stopping restricting/bingeing/purging was the best measure of stage of change for recovery from AN. In contrast, Hasler et al. [143] observed that the stages of change are an independent dimension. Maguire et al. [132] noted that an individual's stage of change is only one marker of the illness within a variety of different disease presentations. An individual can be at severe medical risk as a consequence of AN, yet still present in a highly motivated stage of change.
Clinical psychologists and psychiatrists constantly use staging systems. However, these systems derive from their own clinical experiences and tend to be idiosyncratic. Aside from the severity of the disorder, the clinician may weigh factors such as patients' social support and their adaptation, resilience and reaction to previous conflicts, threats or losses, or the clinician may assess motivation and anticipate compliance with treatment. All of these can influence the choice of treatment and reflect on the prognosis. This diverse assessment might be made among patients who share the same diagnosis. Thus, the clinician tends to use subclassifications within a diagnostic category, some of which contain elements of staging [15].
Staging in most disorders cannot be separated from an evaluation of the patient's premorbid personality and personality traits. After the acute phase of a psychiatric disorder, it may be difficult to assess whether partial or full remission has occurred unless the assessor knew the patient well before the onset of the disorder. Attenuated symptoms may be observed after recovery from a psychiatric disorder, and their nature is sometimes uncertain; the residual symptoms may be caused by a partial persistence of the disorder or an aggravation of a preexisting abnormal personality trait. Such an aggravation may be caused by various factors like, for instance, life events or stressors. Alternatively, it may be a consequence of the psychosocial effects of the recent psychiatric disorder as the effect of allostatic load, or a combination of these factors and others previously discussed [15].
The present systematic review suggests staging models as a proper assessment of the longitudinal development of mental disorders, such as schizophrenia, unipolar depression, bipolar disorder, PD, substance use disorders and eating disorders. Staging differs from the conventional diagnostic practice in that it not only defines the extent of progression of a disorder at a particular point in time but also where a person is currently located along the continuum of the course of illness.
There also appears to be a relationship between residual and prodromal symptomatology. Detre and Jarecki [144] provided a model for relating prodromal and residual symptomatology in psychiatric illness, defined as the rollback phenomenon: as the illness remits, it progressively recapitulates, although in reverse order. Certain prodromal symptoms may be overshadowed by the acute manifestation of the disorder but persist as residual symptoms and progress to become prodromes of relapse. In fact, prodromal symptoms of relapse tend to mirror those of the initial episode [44]. According to the rollback model, there is also a temporal relationship between the time of development of a disorder and the duration of the phase of recovery. This has several exemplifications in clinical medicine. For instance, herpes zoster (chicken pox) has a sudden onset and quick recovery in children, whereas it develops insidiously and tends to have a long residual phase in adults.
Feinstein [145] also remarked that, when making a diagnosis, thoughtful clinicians seldom leap from a clinical manifestation to diagnostic end points. Instead, the clinical reasoning, as well as the clinical judgment, should go through a series of 'transfer stations' where potential connections between presenting symptoms and pathophysiological processes are drawn. The stations are a pause for verification or change to another direction. This strategy particularly applies to psychiatric disorders. An initial state of generalized anxiety may assume phobic connotations at some later point in time. If major depression then ensues, mood symptomatology may overshadow the previous anxiety disturbances, but the diagnosis of depression is only a transfer from prodromal to residual anxiety [6,52]. Thus, staging is an assessment strategy that allows the clinician to go through the diagnostic transfer stations and formulate clinical reasoning. This clinimetric perspective provides an intellectual home for the reproduction and standardization of clinical intuitions [8].
In 1967, Alvan Feinstein [146] urged clinicians to develop a 'basic science' of their own to study clinical phenomena directly, specify the importance of different types of clinical data, create appropriate systems of taxonomy for classifying the information and develop intellectual models and pragmatic methods that would articulate the clinical process and use the results for quantified analyses. Such a line of research, which affects clinical decision making, has been neglected.
Exclusive reliance on diagnostic criteria has impoverished the clinical process and does not reflect the complex thinking that underlies decisions in psychiatric practice. The use of transfer stations with repeated assessments instead of diagnostic endpoints; the building of global formulations of clinical integration; staging methods, and expansion and better organization of clinical information, encompassing subclinical distress, illness behavior, lifestyle and psychological well-being, may be an antidote to oversimplified models that derive from biological reductionism, neglect individual responses to treatment and clash with clinical reality [6].
There is a need for filtering treatment options with clinical judgment and patient-specific problems that take into account individual staging classifications [147]. This is what actually occurs in clinical practice but it is often dismissed as an expression of highly subjective clinical evaluation [148]. An effective use of staging requires the availability of specific instruments that may increase interrater reliability; however, there have been only limited efforts in this direction [9,149].
According to the present review, clinical staging models are currently available for certain psychiatric disorders, and an increasing body of research supports the existence of stages in the longitudinal development of such disorders. Treatment implications of clinical staging are still not completely clear. Even though many authors claim that clinical staging allows early pharmacological intervention, thus preventing the onset or stopping the development of a psychiatric disorder, there is currently no firm evidence to support such opinion. Since prodromal symptomatology achieves its specificity only in light of the individual history of the patient, its appraisal can only be retrospective and does not lend itself to intervention procedures before the occurrence of the acute manifestations of the disorder.
Dr. Cosci received a grant from Pfizer in the framework of the Global Research Awards for Nicotine Dependence. Dr. Fava has no conflict of interest to declare. No funding was received by the authors to carry out the present review.
Dr. Fiammetta Cosci
Department of Psychology, University of Florence
Via di San Salvi 12
IT–50135 Florence (Italy)
E-Mail firstname.lastname@example.com
Received: June 08, 2012
Accepted: July 28, 2012
Published online: November 06, 2012
Issue release date: November 2012
Number of Print Pages: 15
Number of Figures: 0
Number of Tables: 10
ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)
For additional information: http://www.karger.com/PPS
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
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text:
Reviewed By Michael Y (Duluth, GA) Reviewed for a 2016 Chevy Colorado —4/10/2016 7:20 PM
Appearance, price value and quality are all FIRST RATE!!! I installed mine on a roll bar and the harness did not even make it half way to the bar on the bed of the truck. The installation was not hard but very time consuming. Not a job for a first timer. You should install your lights directly to the battery with in line fuses and don't mess with the trucks wiring system because the computers in your late model truck might pick up the increase in your 12 volt system and shut down.


text:
I QC for Bakayarou, may I have scanlator status?
I QC for Bakayarou, may I have scanlator status?
I've started cleanin and typesetting for:
ryColaa Scanlations
Can I get a scanlator status, or do I have to wait untill my chapters actually get released.
BTW, I did 3 speed LQ chapters of Captain Tsubasa road to 2002 and 2 special one shots, which are available on ur site too.
EDIT: Just added chapter 4 and 2 specials in ur archive.
Last edited by THE KING; 07-28-2008 at 04:55 AM.
Hmm, I do typeset for JAC
Is it possible to get this status?
i clean for dredshi
can i get scanlator status?
sig by:ImotoChan
If I'm reading that page right, you're taking the english translation and translating it to spanish.......
Right, so that doesn't count as translator?
it is called international translator on MH does it count something over here
It's up to Bluds, but by translating it from a translation you put it through two language filters.
This way all the tough parts (such as the slang & cultural references) are water down even more from their original meaning.
I suppose you'll get Intl. Translator, though I don't know if that title is being used any longer.
ok guys thanks anyways. though i must say i was fun doing it so will keep, title or not later
Thanks x the status guys. much apreciated
Last edited by damnz; 08-03-2008 at 10:47 PM. Reason: Double-post


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Brian Burke bites back against the "rats"
Cam Charron
January 06 2012 12:25PM
Normally, a hockey team waiving Colton Orr or another player of Orr's enforcer ilk wouldn't be newsworthy enough for the General Manager to even sign his name on the press release, but, Thursday afternoon in Toronto, Brian Burke held a conference with reporters to discuss the state of the game.
Colton Orr, coming off a concussion which ended his season, is known primarily as a pugilist, recording 921 penalty minutes and exactly 100 fights (his 100th being his only scrap this season, against Shawn Thornton, and very likely the last of his career) in his 378 career games. He has played just 12 playoff games, all with the New York Rangers, and it's not a surprise that he has nary a fight in any of them and has averaged just 4:21 of playing time.
His role is no longer relevant in the NHL. As the games increase in importance, the amount of fights decline, and the amount of dressed enforcers decreases. Their ice-time is cut and you no longer need guys who work hard to make the team to play, since all the playing time is being given to players who can actually skate an NHL level.
Burke talked about the "systematically reduced" strategy behind fighting in the game, which he's bang on about. The problem is that Burke, to reporters today, looked at this reduction as a negative while I see it more as a positive. There are your outliers, but, generally, there is no correlation between the number of fights a team gets into and the number of wins a team has. That could be split up, if we picked apart certain game situations, or say that teams with more injuries are also forced to give more ice-time to fighters, but from a distance it doesn't seem like a positive.
There is a nostalgic and honourable belief that the fighter protects your players. "I wonder where we're going, where Brendan Shanahan's getting six hearings every two days," Burke said in his conference. "I wonder, the accountability in our game and the notion that players can stick up for themselves and each other, I wonder where we're going with that."
You can feel Burke. His Toronto Maple Leafs, a team he built preaching "pugnacity, testosterone, truculence and belligerence," has fallen, after a hot start, to 20th in the National Hockey League and after a three-year rebuild with Burke at the helm still have work to do. Like Burke's Leafs, there are many teams who are playing the right way who aren't seeing that bear out in the standings, while successful organizations have taken the reverse stand. The agitators employed by the Vancouver Canucks and Pittsburgh Penguins play no small role in ensuring their continued presence atop their divisional standings.
The Boston Bruins and New York Rangers, while employing a couple of players who can step up and throw down, Burke's way, also keep along a cast of skill players who know how to draw a penalty or two. Brad Marchand, now a Stanley Cup Champion, is quickly becoming a reviled persona around NHL rinks he plays. But at the end of his career, the only thing people may remember are the words "Stanley Cup Champion". Burke is right that hockey is changing. But it's changing in a way that will give skill players a chance, without the threat of a heavyweight trying to beat them by punishing them physically. Teams are starting to try and defend and counter-attack against skill. Where does that leave Colton Orr? It means him and players of his ilk will have to play bigger and punch harder to have a chance to be noticed on the ice in any way other than the minus-column.
It isn't the fighters that deter the rats, as Burke has charged. The fighters have become the rats, goading a host of middleweight hockey players into fights and ultimately allowing themselves to be suckered into penalties by the smaller, skilful pests Burke so despises. Recent suspensions in the league have been handed to Dan Carcillo, Krys Barch, Deryk Engelland. Andy Sutton even has been known to drop his gloves, having been in seven fights since the start of last NHL season including four fights in his 19 games this season. The worst offenders in recent history, Todd Bertuzzi, Jody Shelley, Marty McSorley, Chris Simon, Jesse Boulerice, all guys that Burke would attest stand up for themselves. You can't give a physical player carte-blanche to run around and expect that the game will be better for it.
While Sidney Crosby sits on the shelf with a concussion, there are a host of other stars who Burke agrees are making the game "the best it's ever been". His own Phil Kessel, Claude Giroux, the resurgent Alexander Ovechkin, Patrick Kane and Jonathan Toews. Burke lost his job in Vancouver amid his adamant protection of the young Swedish twins he moved mountains to draft: Daniel and Henrik Sedin, who have back-to-back scoring titles to their name. Not one of these guys is known for tough play as well as scoring. What holds them back is the thought that there's a Zac Rinaldo, a Cody McLeod or a Zenon Konopka around to do something stupid, like hit a star player from behind, in order to goad a member from the other team into a fight.
Burke is right. When those stars are on, when each team has three or four guys who can put the puck in the net on a regular basis, the game is at its best. "It's fast. It's exciting," agrees Burke. He also said that "if there's no dance partner for Colton, it's pretty hard to not be able to say, 'well, Darryl Boyce gives up more on a given night, or whoever. Joey Crabb.' We made the same judgment," and it's the right judgment. Recent history tells us (within the last three years), the teams that throw the Colton Orrs on the ice in place of the Joey Crabbs are the ones who have been losing.
When Burke laments that he doesn't need Colton Orr in the lineup, doesn't that mean that the game has hit an evolved stage that the NHL hasn't seen since the 1970s? The teams don't need the enforcers in the lineup to feel protected. They just need less of them. And if that allows Steve Downie to poke Dion Phaneuf a little bit, the Leafs are one of the growing number of teams that don't see it worth it to bring Colton Orr into the lineup, much less put him on the ice, to draw Downie's attention away from Phaneuf. It's no longer necessary to rent a barn and go at it, like the time when men were men. Many of today's superstars should be willing to take the two minute power play that's accompanied by a cheap hit from one of Burke's rats. If they aren't, at the very least they shouldn't feel compelled to get revenge.
"To the purists, they represented everything evil about the game," charged a Toronto Star sportswriter about the new pests who were ruining the league. But that was oldtimer Frank Orr discusssing the Broad Street Bullies of old. The game evolved to accomodate them in a manner that Brian Burke loved, and the game is evolving past them in a way that Brian Burke hates.
Change or die, Brian. It's just evolutionary.