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[email protected]
Schaeffler Group USA Inc.
Industry Solutions. Overview Industry Solutions. Under the brands LuK, INA, FAG, and Ruville we offer clutch and release systems, engine and transmission applications, as well as chassis applications. Industrial The Industrial division offers a wide portfolio of bearing solutions, ranging from high-speed and high-precision bearings with.
Bearings, units and housings - skf.com
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History | Schaeffler Germany
Schaeffler Germany. Contact Schaeffler International Corporate Website. Search term. Home.. he lays the foundation for the entire rolling bearing industry. Thus, the worldwide success story of the ball bearing begins in Schweinfurt. Later, 1883 is officially declared the year in which FAG was founded.. The FAG VELOMATIC automatic bicycle.
Kids Bikes: The Best Bicycles for Kids - redtri.com
A recumbent bike isn't the first thing a kid would think of for their new set of wheels, but this zippy little three-wheeler will have parents wanting to hop in the saddle, too (There's one for you, too, Mom and Dad!). Part go-cart, part bicycle, the Mobo cruiser lets kids sit back and pedal away.
29" Bicycle Wheels & Wheelsets for sale | eBay
New Industry Nine 9 disc wheelset with Stan's Crest rims, for 29" (or 700c) tires. Very light use, no issues.. These wheels fit a boost bike only ( 15x110 front and 12x148 rear) they came off a brand new 2019 stump jumper expert. Weight is 950 front and 1,120 rear.. The bearings are rolling super smooth. They are set up tubeless with.
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Bearing Product Catalog
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Bicycle Bearings & Ceramic Bearings: UK's No. 1 Supplier.
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It's the holidays! Join us in learning some simple techniques to making pop-up greeting cards. Once you know how, you'll be able to design your own cards for all occasions. All materials for the turkey card and the Christmas tree card will be provided.
Register online [1], or by calling 301-739-3250, ext. 300.
[1] https://wcfl.librarymarket.com/events/make-and-take-pop-holiday-cards

subset: commoncrawl


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- Find a Property
- Residential
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Port Macquarie
Set in the sought after Emerald Downs area, this contemporary home offers a single level floorplan, spacious rooms, open plan living and a light filled interior.
This home was built with families in mind, from the open plan kitchen featuring a walk-in pantry to the 4 large bedrooms plus study or home office to the 3 separate living areas, this home is ideal for any family. The kitchen offers a breakfast bar and stainless steel appliances and overlooks a courtyard. The generous sized family room flows from the kitchen with a separate dining or media room and another separate living room. The 4 bedrooms all have ceiling fans; the main bedroom features a walk in robe, air conditioning and an ensuite. The other remaining bedrooms have built-in robes. The home also features a large Queensland room that is perfect for when you are entertaining family and friends.
Within five minutes of Lighthouse Beach, Lighthouse Plaza, Tacking Point Tavern, Tacking Point Public School, two golf courses and only ten minutes to the CBD. This property offers a rare opportunity to acquire your long term family home in an ideal location. To arrange an inspection please call John Tucker on: 0439 998 455.
Property Information
Property Type: House, Retirement living
House style: Contemporary
Garaging / carparking: Double lock-up
Flooring: Tiles
Chattels remaining: Blinds, Fixed floor coverings, Light fittings, Stove, TV aerial, Curtains
Kitchen: Standard, Open plan, Dishwasher, Separate cooktop, Rangehood, Extractor fan, Double sink, Breakfast bar, Pantry and Finished in Laminate
Main bedroom: Double, Walk-in-robe, Heating / air conditioning and Ceiling fans
Ensuite: Separate shower, Spa bath
Bedroom 2: Additional Info (Ceiling Fan), Single and Built-in / wardrobe
Bedroom 3: Additional Info (Ceiling Fan), Double and Built-in / wardrobe
Bedroom 4: Additional Info (Ceiling Fan), Double and Built-in / wardrobe
Main bathroom: Bath, Separate shower, Heater
Laundry: Separate
Outdoor living: Entertainment area (Covered), BBQ area
Water heating: Electric
Locality: Close to schools, Close to shops, Close to transport


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In the first week of July, I went to my first writing conference, the annual LA conference with the Society of Children's Books Writers and Illustrators (SCBWI.) And holy cow, did I learn. I learned so much I feel as though my head will never stop spinning. As I decompress, refine my goals, and stare … Continue reading 8 Lessons I Learned from Going to My First Writing Conference
Category: Writing life
12 Lessons I Learned from Writing My First Book
Ever since I was a kid, my dream was to be an author. I scribbled stories in notebooks, daydreamed about pirates and mermaids, and devoured any fantasy book I came across. But as much as I loved writing, I never finished anything longer than a short story. Understatement of the year: writing a book is … Continue reading 12 Lessons I Learned from Writing My First Book
Call Yourself a Writer: How to Honor Yourself in Spite of Doubt
Say you walk into a coffee shop. You find someone scribbling in a notebook, tap them on the shoulder, and ask them what they're doing. "I'm writing," they might say, or, "I'm journaling." "Oh!" you say brightly. "So you're a writer?" They shake their head vigorously and laugh. "No, I wouldn't say that." Writers doubt … Continue reading Call Yourself a Writer: How to Honor Yourself in Spite of Doubt
Inspiration Masterpost: Stuff to Read and Watch When You're Feeling Low
We all have our favorite things we turn to when we're feeling low. Maybe you scoop up a big bowl of ice cream or settle in with your favorite movie. Consider this post a giant helping of ice cream—meant to comfort, encourage, and inspire you when you feel like giving up on your writing. These … Continue reading Inspiration Masterpost: Stuff to Read and Watch When You're Feeling Low
How to Be a Writer: Read
If you read any blog, list, or article about how to be a writer, they usually start with, "Read." And there's a reason why so many different people espouse the same advice. Reading wide, reading often, and reading analytically is the best way to prepare yourself to write. Here are five reasons why writers should … Continue reading How to Be a Writer: Read


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• DJs will compete from home and their various sets streamed live on Facebook
• The winner will be voted for by the audience and named the 'Kenyan DJ of the Year'
A hot deejaying competition is about to go down. Titled 'Compe ni Compe', it will take fans on a musical journey through the art of disc jockeying.
The competition targets all DJs with the ability to wow the audience with their art and skills. DJs will compete from the comfort of their homes and their various sets streamed live on a Facebook Group page.
The winner will be voted for by the audience and will be named the 'Kenyan DJ of the Year'.
They also stand to gain street credibility and some monetary incentive. The timeline of the competition depends on the number of participants who will confirm their availability.
With the ongoing online debate of DJs being cut off during live streaming, the organiser of the online DJ competition, Prince Otach, said the copyright issue is more complex than we think.
He, however, encouraged Kenyan DJs to join the competition. "This is an opportunity for true Kenyan DJs to stand up and be counted," Prince Otach said.
"Kenyan DJs have been selling us an illusion of an over-hyped top DJ, who believe they have it. This is their time to come out and claim their seat at this competition."
DJ Kalonje and DJ Brownskin will be joined by top Embu DJ Caril the scratch queen master in the competition.


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1 May 2015
The Department of Development Studies has been ranked 13th in the world and 7th in the UK, in the latest QS World University Rankings by Subject. The Department's ranking places it among the world's global elite. It is also listed as 2nd in London.
The QS World University Rankings by Subject highlights the world's top universities in a range of popular subject areas, covering 36 subjects as of 2015. Published annually since 2011, the rankings are based on academic reputation, employer reputation and research impact.
This latest rankings follows news of the Department having been recognised in the 2014 Research Excellence Framework with more than 60% of research judged as 'world-leading' or 'internationally excellent'. The REF 2014 is carried out every six-seven years by the UK Government to assess the quality of research carried out in UK Higher Education Institutions.
Head of the Department Dr Laura Hammond said: "We are particularly pleased that our international standing has been recognised. SOAS is well known worldwide as a centre of excellence for Development Studies. Indeed, our global network of outstanding alumni working in development and humanitarian fields as well as in academia are a testament to our high quality programme of study. Our academic staff have unrivalled, practical knowledge of the many branches of enquiry that make up Development Studies - from political economy and globalisation to migration and displacement, and agrarian change. We are delighted to see our Department receive this recognition."


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Bid History for 1993/1994 JCB Backhoe Model 215
Auction Start Date: 11/26/19 12:00 PM ET
Auction End Date: 12/10/19 11:21 AM ET
Asset ID: 394 Number of Bids: 118
Loading bid history...
|1993/1994 JCB Backhoe Model 215
|Auction Closed
|High Bidder:
|Sold Amount:
|Buyer's Premium (7.50%):
|Total Price:
|View Bid History
|Terms and Conditions
1993/1994 JCB Backhoe Model 215. 4x4 diesel. The backhoe was driven to location that it sits now. Multiple parts have been taken off of backhoe. Missing front windshield. Henry County Public Service Authority (HCPSA) will assist as they can to help load/remove vehicle if they are available at the time of pick up, therefore bidders are encouraged to be prepared to load unit alone. The vehicle is as-is. See additional information from JCB in the PDF from an email we received. **NOTE** Backhoe shall be paid for within 48 hours after the final bidding is completed. If payment isn't received within the required time frame then the vehicle will be offered to the next bidder. The winning bidder will have five business days after the bidding is completed to remove the unit from the HCPSA. These guidelines will super exceed any language already written within our normal payment and removal policies on Gov-Deals. If the vehicle is not removed within these guidelines the HCPSA may enact a $200/day storage fee until the unit is removed.
Seller added the following information on 12/2/2019 11:03 AM:
The Backhoe was cranked this morning 12-2-19 and we let it run for about 1/2 hour with no issues. The vehicle will need a new battery and the tires will need to be pumped up before moving.
|Additional Info: Email from JCB.pdf
|Questions and Answers
Q: I see in the pictures that the bucket isn't on the rear arm. Does one come with it , and if so whats the width ? Thanks (11/27/19 9:45 PM)
A: There is no bucket included. It has been removed. (11/29/19 10:00 AM)
Q: you say the unit was driven to where it sits but then you say multiple parts have been removed. Have any parts been removed that would cause the unit to keep it from cranking and being driven? (11/30/19 12:35 PM)
A: No. Our guys just went out this morning and cranked the vehicle and they are letting it run for a while. They indicated that the tires need to be pumped up or may have a leak. Also that it will need a battery. (12/2/19 11:01 AM)
|Most items offered for sale are used and may contain defects not immediately detectable. Bidders may inspect the property prior to bidding. Inspection is by appointment only. Please see the contact below to schedule an inspection.
Wire Transfer is the only payment option for this item. The Wire Transfer Transaction Summary page will provide payment and account information. The Wire Transfer must be completed within 5 days unless otherwise specified below.
PAYMENT MUST BE MADE ONLINE-- To make online payment, Log into your GovDeals account and select "My Bids". Please follow the instructions there.
Property may be removed by appointment only and appointments must be made at least 24 hours in advance. All items must be removed within ten (10) business days from the time and date of issuance of the Buyer's Certificate.
The Buyer will make all arrangements and perform all work necessary, including packing, loading and transportation of the property. No Assistance will be provided. ITEMS AUCTIONED ARE FOR PICKUP ONLY. PACKAGING AND SHIPPING ARE THE SOLE RESPONSIBILITY OF THE BIDDER. NO EXCEPTIONS WILL BE CONSIDERED. A daily storage fee of $10.00 may be charged for any item not removed within the 10 business days allowed and stated on the Buyer's Certificate. For additional information, please see contact below for any questions. Person removing asset must provide copy of Buyers Certificate at time of removal.
The Buyer's Certificate serves as Proof-of-Purchase and must be presented at the time of item removal.** If using a 3rd-Party agent; Buyer must provide agent with a faxed copy including their signed authorization to release their items. Buyer must notify Seller if using a Third-Party Agent.
Vehicle Titles will be issued at the time of removal.
|Special Instructions
|By submitting a bid, bidder hereby acknowledges that they agree to, and will abide by, the terms and conditions as described. NOTICE: If you are the winning bidder and default by failing to adhere to this sellers terms and conditions your account with GovDeals WILL BE LOCKED.
Guaranty Waiver. All property is offered for sale "AS IS, WHERE IS." (Seller) makes no warranty, guaranty or representation of any kind, expressed or implied, as to the merchantability or fitness for any purpose of the property offered for sale. Please note that upon removal of the property, all sales are final.
Description Warranty. Seller warrants to the Buyer that the property offered for sale will conform to its description. Any claim for incorrect description must be made prior to removal of the property. If Seller confirms that the property does not conform to the description, Seller will keep the property and refund any money paid. The liability of the seller shall not exceed the actual purchase price of the property.


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The city of Los Angeles will host a public memorial service for Kobe Bryant on Feb. 24 at the Staples Center, according to Richard Winton of the L.A. Times.
A memorial for Kobe Bryant, who died with his 13-year-old daughter, Gianna, and seven other people in a helicopter crash last month, will be held at Staples Center, the arena where the N.B.A. legend played for most of his 20 seasons with the Los Angeles Lakers, according to a person familiar with the arrangements.
The memorial is expected to draw thousands of mourners from across Southern California and beyond in a show of support for Bryant, 41, who spent 20 years with the Los Angeles Lakers.
Staples Center, which was the site of memorial services for celebrities like Michael Jackson and the rapper Nipsey Hussle, can hold a crowd of about 20,000, far less than the capacity at the Los Angeles Memorial Coliseum, another venue that was under consideration. The Lakers do not have a game scheduled for the day of the memorial, but the Clippers, who also play at Staples, have a home game against the Memphis Grizzlies at 7:30 p.m. Pacific time.
Bryant, a practicing Catholic, belonged to Our Lady Queen of Angels Catholic Church in Newport Beach, Calif., and spent time there "to reflect and pray" in the early hours of Jan. 26, said Tracey Kincaid, a spokeswoman for the Diocese of Orange County.


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Advising during Distance learning
Staff are currently working remote. Inquiries will be answered in the order they are received.
Students needing assistance with course scheduling, holds, advising and major changes can reach advisors by phone or e-mail (office voicemail is being forwarded).
For academic emergencies, please contact Dr. Farr directly at email@example.com or 850-228-6389.
At the Dedman School of Hospitality, students are provided with all of the tools and support necessary for a successful academic experience at Florida State University. We offer a variety of academic services, including:
- Assisting our students in the steps and milestones required to achieve degree completion
- Maintaining records for Dedman School of Hospitality students, related to their undergraduate study
- Serving as the primary liaison between prospective and currents students in the Dedman School and the University Office of Admissions, the Office of the Registrar, and The Dean of Undergraduate Studies
To Make An Appointment
- Log in to my.fsu.edu
- Under myFSU links, click on the "CC" icon (Campus Connect)
- From your Campus Connect homepage, click on the Schedule Advising or Tutoring button
- Choose your academic advisor
- Make sure to confirm your appointment
You can also use the kiosk in Marriott Career Center to schedule an appointment.
Kim Burkes
UCB, 2nd Floor, Room 2205
Advising Hours
Scheduled Appointments:
1PM - 4PM (Monday - Friday)
9AM - 11AM (Tuesday - Friday)
Global Club Management Academic Advisor
Rachel McPherson
Seminole Legacy Golf Club, Rm. 205
Advising Hours
Scheduled Appointments:
8AM - 4PM (Monday - Friday)
1PM - 4PM (Tuesday - Thursday)


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Posted March 23, 2018
The Northern Indiana Commuter Transportation District (NICTD) held five public hearings in April 2018 to gather comment on a proposed across the board fare increase of 5% rounded to the nearest quarter ($0.25). If approved, the new fares would take effect on July 1, 2018 for the South Shore Line rail passenger service including July monthly tickets. The new fares would apply to all stations but Hegewisch. Metra controls Hegewisch fares and approved an increase effective February 1, 2018.


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1992 Dodge Dakota LE Extended Cab Pickup 2-Door 5.2L Restored New Condtion
- Price: Ask a price!
- Item location: Midlothian, Virginia, United States
- Make: Dodge
- Model: Dakota
- SubModel: LE Crew Cab with Magnum Engine
- Type: Extended Cab Pickup
- Trim: LE Extended Cab Pickup 2-Door
- Year: 1992
- Mileage: 241,283
- Color: Gold
- Engine size: 5.2L 5211CC 318Cu. In. V8 GAS OHV Naturally Aspirated
- Number of cylinders: 8
- Power options: Air Conditioning, Cruise Control, Power Locks, Power Windows
- Fuel: Gasoline
- Transmission: Automatic
- Drive type: RWD
- Interior color: Beige
- Vehicle Title: Clear
Dodge Dakota 1992 DescriptionSomething Rare and Special! Only 4000 miles of use since rebuild.
- This is a one owner truck. It was owned and loved by a well-known driver and professional tuner for Mopar. He passed away.
I have several articles on the owner (see pictures).
- I bought the truck from the late owner's son 4000 miles ago, who owns a professional automotive repair facility in Richmond.
- The truck is original with everything that needed rebuilt, including magnum engine, brakes, shocks, belts, battery, etc etc.
- I can provide any and all info with a phone call to validate any thing that I've mentioned.
- I bought the truck to use infrequently while at work. I have it in a temperature controlled garage. It is simply too nice to be used at work and decided to offer it for sale.
- Please don't waste my time with silly offers!


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When Newcastle play Wolves, Steve Bruce could make club history.
The fewest ever goals to be scored in the opening 10 games of any league season for Newcastle United, since the club became United in 1892/93.
Only five goals in the first nine Premier League games so far and the record to 'beat' is six.
This was set in the distance past of…last season.
Yes, as Rafa Benitez waited on Salomon Rondon to get fit after Mike Ashley forced him to make a £20m profit on transfers in and out, goals were a rare commodity.
At the current rate of goals, Steve Bruce and his team are on course for a final season total of around 21 goals, surely even Newcastle can't sink that low…?
The worse ever final goals tally in this Premier League era was 1997/98 with Kenny Dalglish in charge, only 35 goals in 38 games with John Barnes top scoring on six.


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The first of four partial solar eclipses in 2011 occured on 4 January over the northern part of Africa, most of Europe and norhwestern Asia. The eclipse started at 8:16 UT and ended at 10:52 UT. The moon shadowed up to about 80% of the solar disc. For more detailed information see NASA Web page: http://eclipse.gsfc.nasa.gov/SEplot/SEplot2001/SE2011Jan04P.GIF
Due to lower solar illumination of the Earths atmosphere the photoionization is reduced, i.e. the ionsation level does not reach its average values or is even more reduced if loss processes dominate. We are able to show the behavior of the total ionospheric ionisation over Europe and on a global scale by near real time monitoring of the total electron content (TEC) of the ionosphere based on numerous GNSS measurements. SWACI uses GPS measurements from various GNSS networks such as International GNSS Service (IGS), EUREF and ascos distributed by BKG Frankfurt. The global TEC maps are mainly generated by data provided by the Real-Time Pilot Project of IGS (IGS-RTPP).
Here we present are animations of differential TEC maps obtained by subtracting 27 days medians from the actual TEC map values on 4 January 2011. This presentation enables the viewer to see clearly the ionisation loss due to the solar eclipse.
Furthermore, a solar eclipse can be considered as an active experiment with varying solar illumination. Therefore, such effects in the ionosphere have also been discussed earlier in DLR Neustrelitz, as can be found in:
Jakowski, N., Schlueter, S., Heise, S., Feltens, J., 1999. Satellite Technology Glimpses Ionospheric Response to Solar Eclipse, EOS, Transactions. American Geophysical Union, 80, 51, 21 December 1999.
Jakowski, N., Heise, S., Wehrenpfennig, A., Schlueter, S., 2001. Total electron content studies of the solar eclipse on 11 August 1999, CD-ROM, Proc. IBSS, Boston, 4-6 June, 2001, 279-283
Jakowski, N., S. M. Stankov, V. Wilken, C. Borries, D. Altadill, J. Chum, D. Buresova , J. Boska, P. Sauli, H. Hruska, L. Cander, Ionospheric behaviour over Europe during the solar eclipse of 3 October 2005
Ionosonde parameters such as F2 layer critical frequency foF2 and peak density height hmF2 as measured at the ionosonde station Juliusruh of the Leibniz-Institut für Atmosphärenphysik e.V. (http://www.ionosonde.iap-kborn.de/ ) are combined with TEC data over Juliusruh in near real time. The derived equivalent slab thickness is a measure of the shape of the vertical electron density profile over Juliusruh.
The key parameters mentioned above and shown in the figures below indicate strong variations after sunrise, probably induced by the partial solar eclipse.


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A Suretouch Ltd
We received first-class references for this family-run bathroom business. They offer a complete package – from full refurbishments and makeovers to repairs and new work – including all the plumbing, electrical, tiling, flooring and decorating. You can be sure of promptness and reliability, plus your home will be left clean and tidy. Feedback states that customers 'trust them', 'value their advice and ideas' and 'appreciate their honesty, hard work and the quality of that work'. Hours 9–6 Mon–Sat. Fully insured. Speak to Julian.
Locations: Earley, Lower Earley, Woodley, Sonning, Winnersh, Wokingham, Arborfield, Sindlesham, Barkham, Three Mile Cross, Shinfield, Swallowfield, Mortimer, Burghfield Common, Burghfield, Theale, Calcot, Tilehurst, Purley, Pangbourne, Caversham, Kidmore End, Sonning Common, Aldermaton, Tadley, Bradfield, Beenham
Services include: Bathroom & Shower Refurbishments, Home improvement projects, a complete package, including all the necessary plumbing, electrical, carpentry, tiling, flooring and decorating trades & skill. Also room/garage conversions, make-overs and/or repairs to any room or part of your property
Latest Reviews and Feedback
Julian has just refurbished my dated cloakroom beautifully. First used Suretouch 7 years ago - Julian and Malcolm created the most perfect en-suite by combining an airing cupboard and bedroom cupboard, involving knocking down 2 walls,creating a new stud wall, cutting an opening in the external wall for a window and making a new airing cupboard (complete with hot water cylinder, pump and controls) in another bedroom, - all this before work could begin on the en-suite which was meticulously done as was the refurbishment of my main bathroom a year later. Have also carried out a variety of maintenance jobs both inside and out. Julian and Malcolm are workers of great skill and easy to have in the house - they work quietly and with such care, leaving everything absolutely immaculate each day. I have been delighted with all their work and highly recommend them.
Suretouch are absolutely fantastic, they were so helpful and didn't mind what I asked them to do – I really am thrilled.
Julian and Malcolm did an excellent job for us, first knocking through an archway from our lounge to the dining room which involved getting gas and water pipes moved as well as lighting. They also installed our new bathroom including tiling & performed necessary electrics for the lighting. They were both very professional and helpful with any questions that we had. They were very tidy and thorough in their approach with excellent results. We would definitely use them again.


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Southwest facing first-floor apartment, stunning fully refurbished three bedrooms all on-suite bathrooms and guest toilet, all the bathrooms have been upgraded, new kitchen, all new lights, marble has been changed in the lounge and kitchen and terrace.
The development is over 7.6 hectares of land. 118 apartments in a mixture of two and three bedroom apartments and three bedroom duplex penthouses. One of the most sought after gated complexes on the Marbella Golden Mile, La Trinidad offers residents high-level security with 24-hour gated with barrier control and patrol guards; fabulous extensive gardens with 2 large pools plus childrens pool; indoor all-year-round heated pool, sauna, fitness gym, and changing rooms. Indoor WiFi is available within all the 8 blocks of apartments in the complex.
The furniture is not included in the sale but can be negotiated in a separate agreement. All the terraces around the swimming pool and cafe have been changed this year and looks great.


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A Walk in the Woods
Lisa Sabo Brown Two-Dimensional
Consider a walk in the woods. So many things to see and experience. A thick carpet of pine needles underfoot, a low place that collects rainwater and over time makes a pond, diseased leaves that should be ugly but aren't. Coming over the crest of a hill and seeing the grand vista of the lake through the trees. These paintings are about noticing the details as you go. The things that may surprise you.
Entry Details
- Art form: 2-D
- Depth: 2 inches
- Medium: Acrylic
- Width: 116 inches
- Year created: 2015
- Height: 48 inches


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By the way, have you read this book? Very informative, invaluable and it's a pretty quick read too
DON'T LET A SNITCH WRECK YOUR LIFE This FREE ebook could help keep you out of prison.
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About Me
- Jonathan
- Adalbert is a forum for me, to post ephemera, photography, poetry, occasional travel notes, and various spontaneous motions. Cover photo: Parsonage where my great-grandfather spent his early years. Taken near Liegnitz, Silesia, ca. 1870. The "xothique" portion of the web address is a nod to Clark Ashton Smith's fictional continent of Zothique.
Monday, July 27, 2020
12 Years of Adalbert
Posted by Jonathan at 6:08 AM
2 comments:
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Session 2010-11
|©Parliamentary copyright
|Prepared 16th February 2011
Session 2010-11
Health and Social Care Bill
Memorandum submitted by the National Associaton of LINk Members (HS 33)
Proposed amendments to the Health and Social Care Bill
Public Involvement, Local Government and Commissioning
1) Members of the board of Healthwatch England should be elected from the membership of local Healthwatch
Line three: delete "appointed" and substitute: "elected from local Healthwatch"
2) Healthwatch England should be able to make recommendations to the CQC in addition to giving the CQC advice and assistance
Line six: between "advice" and "or" insert: ", recommendations"
45 A Functions to be exercised by Healthwatch England
Line 29: after "information" add: ", recommendations"
Line 29: after "advice" delete "on" and substitute "in relation to"
3) Healthwatch England must deal with both health and social care issues
(3) (a) PAGE 138
Line 30: after "health" add: "and/"
4) The CQC should be included together with the Secretary of State, the NHS Commissioning Board, Monitor and English local authorities as key bodies to receive information, advice and recommendations from Healthwatch England about the views of people and Healthwatch on health and social care services.
After Line 38: add:
(b) the Care Quality Commission;
5) The CQC, Secretary of State, the NHS Commissioning Board, Monitor and English local authorities should not only respond to matters raised by Healthwatch England but should say what action they intend to take
Line 44: add: after "advice" PAGE138
"and any action it intends to take".
6) Healthwatch England must provide the CQC with information, advice and recommendations about the views of people and local Healthwatch on health and social care services. May is too weak.
Line 1: Delete "may" and substitute "must"
7) Reports produced by Healthwatch England must be distributed to local Healthwatch in addition to Parliament and the Secretary of State.
45B Reports
Line 22
Add: (c) "send a copy of each such report to each local Healthwatch"
8) If the Secretary of State intends to take action against Healthwatch England for failing in its statutory duties, local Healthwatch should be consulted before any directions are issued.
Line 41
Add: "and shall consult local Healthwatch before issuing such directions."
9) As local Healthwatch will be a 'body corporate' it should be clearly stated that the activities of local Healthwatch unambiguously derive from their duties and not secondarily from the duties of the local authority.
168 Activities relating to local care services
After line 37: PAGE 140-141
New (2)
(2) In subsection (2), omit the heading: "The activities for a local authority are –"
"The activities of the local Healthwatch in the area of the local authority are-"
Line 38
Renumber (2) to (3)
10) The role of local Healthwatch in making recommendations to Healthwatch England or the CQC needs to be strengthened.
(3) (g) PAGE 141
Line 9
After "about" Add: "the need to conduct"
11) Members of local Healthwatch must have indemnity so that they can speak out freely and take part in all activities required to fulfil their duties.
After Line 17: PAGE 141
Insert: (6) The Secretary of State may by regulations make provision requiring Healthwatch England to make arrangement under this section, for members of local Healthwatch to have indemnity cover against the risk of a claim in negligence arising out of the activities of local Healthwatch.
12) Local Healthwatch must not be the same organisation as a Host, local authority, an NHS Trust, Foundation Trust, Primary Care Trust, Strategic Health Authority or Commissioning Consortium.
Line 27 PAGE 141
Delete "Omit subsection (4)."
(4) In subsection (4) Add (h) Commissioning Consortia
13) The Independent Advocacy Service should be provided at a level that meets local need.
(1), (1)
Line 24
After "appropriate" add "in relation to the needs of people"
14) The Independent Advocacy Service should provide a service for people with complaints about social care and complaints about health care.
After Line 30 PAGE 142
(b) after (2) add: and section 114 (1) and (2)
15) Commissioning Consortia must be added to the local bodies that are required to provide information to local Healthwatch and respond to their reports and recommendations.
171 Requests, rights of entry and referrals
After Line 6 insert
'In subsection (2) (of para 224) after (d) add
(e) Commissioning Consortia
and change the current (e) to (f).
16) Commissioning Consortia must be added to the local bodies that are required to enable local Healthwatch to again access to services for the purpose of enter, view and observe the carrying on of health and social care activities.
After Line 20 add:
In subsection (7) (of para 225) after (d) add:
(e) Commissioning Consortia
and change the current (e) to (f)
17) The NHS Commissioning Board will promote a duty of candour when an adverse event, incident or error has occurred in the care or treatment of patients.
Chapter A1 The NHS Commissioning Board
Insert: (d) patients have been informed when an adverse event, incident or error has occurred in their care or treatment.
18) The NHS Commissioning Board shall secure the involvement of individuals and local Healthwatch in commissioning decisions, and strengthen involvement.
Chapter A1 The NHS Commissioning Board
Line 20: after "that" insert: "local Healthwatch and"
Line 21: delete: "whether"
Line 22: delete the first and second "or" and replace both by "and".
19) Commissioning Consortia shall secure the involvement of individuals and local Healthwatch in commissioning decisions, and strengthen involvement.
Chapter A2 Commissioning Consortia
Public involvement 14P, PAGE 30-31
Line 42: after "that" insert: "local Healthwatch and"
Line 43: delete: "whether"
Line 44: delete the first and second "or" and replace both by "and".
February 2011
|©Parliamentary copyright
|Prepared 16th February 2011


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Speech by the Governor at the Reception for Rumbalara Football Netball Club
First, I acknowledge the Traditional Owners of the land upon which we are gathering, and pay my respects to their Elders past and present and to the Yorta Yorta and other Elders here with us this evening.
Tony and I welcome you all to Government House to celebrate the achievements of Rumbalara Football Netball Club.
It is a particular pleasure to reciprocate some of the warm hospitality that we have received at the Club. Mind you, I am not sure that even the terrific chef here can better Kaye Briggs's fantastic sponge cake that we have been lucky enough to enjoy several times.
This Club is dear to our hearts.
We were supporters and members well before we came into this role. I am now honoured to be the Patron and Number One Ticket-Holder. And we value our friendship with Paul and Kaye and very much admire their leadership in the community. We also admire their choice of AFL team (but that is just an aside).
This evening we can celebrate Rumba's success in footy and netball.
A total of 22 premierships. Several players who have gone on to careers in the AFL. And many who have been selected for representative football and netball at regional, state and national competitions.
Of course, Rumba can be proud well beyond those sporting achievements.
The Club sits within an important historical context.
The Cummera team in fact won its first Aussie Rules premiership in 1898!
In a nice piece of symmetry, Rumba's senior footy team won the Premiership exactly one hundred years later, in 1998, just one year after joining the Goulburn Valley Football League. (Mind you, the B-Grade Netball team had taken out the premiership in the Club's first year!)
The history of the land on which the Club sits, and the injustices faced by generations that had gone before, were fundamental to the vision of those who founded this Club.
They envisaged the Club as a place of belonging. A place to bring families together through strong, vibrant leadership. And to strengthen community through programs focused on health, education, employment, the arts and cultural identity.
I think one of the keys to your success has been the way you have collaborated to build those programs.
The Munarra Centre for Regional Excellence project is a great example. A partnership between the Club, the University of Melbourne and the Greater Shepparton Council, supported by the Victorian Government and the Kaiela Institute, it has been helping to create successful education and employment pathways for the local Aboriginal community.
Knowing what can be achieved through the arts as well as sport, I particularly admire the First On the Ladder art-meets-sport collaboration with Polyglot Theatre and others, celebrating the culture and achievements of your young people through a broad range of creative experiences.
These are just examples. The initiatives, projects and partnerships do not stop there.
Nor does Rumba's work in the wider community.
You must be congratulated for the initiative of the Unity Cup. We have attended several times, and admired how the Club, with the Congupna Football Club, has celebrated the many roles of women, and their impact in creating strong families and harmony across communities.
It is well documented that sport can foster physical and mental well-being, promote a sense of belonging, and unite people in a profound way. My experience as a judge and as an AFL Commissioner certainly brought that home to me. Tony's background experience as a lawyer and judge also enlivened him to it.
As the largest Indigenous club in Victoria you have had some 1800 players and their families involved since Rumba started. What a reach for your engagement.
Thank you to everyone involved in the club and connected with its activities. It is not only the elders, although their vision and energy is awesome. But when we have been at the Club, we have seen the impressive young people who are also leading. Thank you to each one of you, including Trinity, from whom we shall hear shortly.
Thank you too to all of Rumba's partners and supporters, many of whom are with us this evening.
Together, you are doing good work with so many indigenous youngsters. We all know that whatever enriches them, enriches not only Aboriginal communities, and not just the local Greater Shepparton communities, but the entire Victorian community.
We need every Victorian to enjoy - in the words of our State motto - 'Peace and Prosperity'. Thank you for your significant contribution to that, and now please enjoy your time with us at Government House.


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Postmetropolis [Edward W. Soja] on *FREE* shipping on qualifying offers. This completes Ed Soja's trilogy on urban studies, which began with. This completes Ed Soja's trilogy on urban studies, which began with Postmodern Geographies and continued with Thirdspace. It is the first comprehensive text in. In Postmetropolis, Edward Soja foresees the day when tourists entering Los Angeles will be provided with "a visitor's passbook to hundreds of cultural worlds, .
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In the University of Minnesota Press released his work on spatial justice[2] which was followed in with his "My Los Angeles" published by the University of California Press. User Review – Flag as inappropriate In his book, Postmetropolis: Modernity and Urban-Industrial Capitalism. The idea of space is intricately linked to any study of urbanism, however, Soja has built up through a number of his writings the idea that there are multiple ways to look at space.
The Restructuring of Urban Form. Interview with Homi Bhabha. Woja has written extensively on urban social life, planning and theory.
Critical Studies of Cities and Regions.
Overture to a Conclusion. Rethinking in Los Angeles. Soja developed a theory of Thirdspace in which "everything comes together… subjectivity and objectivity, the abstract and the concrete, the real and the imagined, the knowable and the unimaginable, the postmetrropolis and the differential, structure and agency, mind and body, consciousness and the unconscious, the disciplined and the transdisciplinary, everyday life and unending history.
University of Minnesota Press.
Metropolarities and the Restructured Social Mosaic. Critical Studies of Cities and Regions.
Postmetropolis: Critical Studies of Cities and Regions
Soja updated Lefebvre's concept of the spatial triad with his own concept of spatial trialectics which includes thirdspace, or spaces that are both real and imagined. Critical Reflections on the Postmetropolis. He breaks up his effort into three parts: Soja frames the association of urbanism with the ideas of postmetroplis and synekism through what he calls the three urban revolutions and views the Postmetropolis transition through the lens of six different urban ideologies: The Globalization of Cityspace.
Bhabha 's Third Space Theoryin which "all forms of culture are continually in a process of hybridity ," that "displaces the histories that constitute it, and sets up new structures of postmetdopolis, new political initiatives… The postmetropolia of cultural hybridity gives rise to something different, something new and unrecognizable, a new area of negotiation of meaning and representation.
Would you like to change to the site? Six Discourses on the Postmetropolis.
Edward Soja – Wikipedia
Bell, University of Tennessee. Governing Space in the Postmetropolis. From Wikipedia, the free encyclopedia. He draws upon excerpts from writings on Los Angeles during that period including; newspapers, novels, poetry and peer reviewed articles to understand better the lived in city.
Edward Soja
Added to Your Shopping Cart. You are currently using the site but have requested a page in the site. University of California Press.
Soja introduced six visions for the City of Los Angeles. Provides an overview of the history of the city since its inception. In other projects Wikimedia Commons. Account Options Sign in. He has written extensively on urban social life, planning and theory. This is an advanced textbook in which Soja applies his theoretical and philosophical understandings of the task of explaining the contemporary city. Restructuring the Urban Imaginary. Networked Infrastructures, Technological Mobilities His previous books include Postmodern Geographies: The traditional causes of city and state development have always required a plethora of different factors.
Defines a new subfield called critical studies of cities and regions. Views Read Edit View history. He had a Ph. This completes Xoja Soja's trilogy on urban studies, which began with Postmodern Geographies and continued with Thirdspace. The Second Urban Revolution.
Like Lefebvre, sometimes called a mystical Marxist, Soja demonstrates leanings towards a monadic mysticism in his Thirdspace.


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mostly at home lol
(this post is left in memory of my friend, Stripmine1. R.I.P. my friend .... we'll miss you !! .... cp )
I mainly fish with live bait but will use a tube from time to time. Probably fish 75% live bait 25% artificial. I have been real successful with a hot pink tube with silver speckles on a black 1/32 oz. jig head on the north fork area around Poppin' Rock. Think I got 'em from Bass Pro Shop. Of course the old stand by chart. works well too. The tubes with silver or gold sparkles seem to work well regardless of color. I've wanted to try to use more artificial for crappie but just seem to gravitate back to minnows when the bite gets slow. Now that the 4th madness is over I need to try to get on the water soon. Five day forecast looks like Thursday would be a good day. Good luck, and maybe I'll see you on the water someday.
mostly at home lol
(this post is left in memory of my friend, Stripmine1. R.I.P. my friend .... we'll miss you !! .... cp )
Last edited by CrappiePappy; 02-10-2008 at 04:07 AM.
Gone fishin', be back for deer season :D
Lake Carnico
Cedar Creek
Lake Cumberland
Watts Bar TN
Okeechobee FL
I haven't been to Barkley in many, many years ... but, when I did go there - it was usually thru the last week in April. By that time the Crappie were usually already in the buckbrush and shallow stump beds in the coves and creeks. I would tent camp at the COE campgrounds next to the Canal ... just up the road from Grand Rivers, Ky. I'm sure there are many more places to eat and bed down now ... than there were then. I fished the coves and pockets from Barkley Dam to the prison ... but, only those that had buckbrush or stumps. A large minnow under a float, about 18 inches deep, dropped in and around stumps ... brush piles ... or into the openings of the buckbushes, would usually produce the larger fish. And, yes ... 2lb fish were quite common.
I don't know if that much has changed at Barkley, over the years, but you can always post your question on the main board ... someone who fishes there now, will surely answer. Also check thru your search engine of choice, and find some sites with updated fishing reports. ....luck2ya ......cp
Jeff from Williamsburg.
Watts Bar
Dale Hollow
Lake Cumberland
not neccessarily in that order.
Last edited by Crappie1; 01-22-2005 at 12:06 PM.
Thanks for joining our little family, Jeff. Hope you enjoy yourself, here.
I see by your lake listings, that you fish Watts Bar. Take a look at the Main Message board, and check out the "Spring Fling" post (top of the forum). It may be something you'd like to get involved in. Don't hesitate to ask me anything about the tournaments ... take care and keep in touch ...cp
Thanks crappiepappy.Originally Posted by crappiepappy
This is a great site. It's about time we have a place we can share tips and tricks and learn more about this awesome fish.
I would love to join in on the Spring Fling. I have never fished in a crappie tourney before. Sounds like alot of fun but I have had a trip to Lake Guntersville AL planned for that weekend. Fishin' for trash fish(Bass) with some of bass fishin' buddies.
I'm also a member of BassBoatCentral. There's alot of good boat information there as well.
Keep up the good work.
I fish Ky & Barkley
Great site!
Trump is like the guy that comes on the playground and beats up on the guys that's been pushing you around for the last 30 or 40 years.
We fish taylorsville, nolin, green, and sometimes cumberland (usually for stripers though). Fished barren a few times but I'll be moving to bowling green soon and fishing barren a lot more. I'll try to keep ya'll posted on how fishing is going for me. We just came back from a terrible trip to cumberland saturday, too much wind and too little knowledge of the lake.
Fished 10 different states for crappie over the past 7 years. Joined "Team Keelshield" pro staff 2 years ago. My favorite lake has to be the Harris Chain.


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Treat Yourself The Way You Wish To Be Treated
Take a deeper look at the "Golden Rule" and incorporate self-care into its teachings.
'Treat others the way you wish to be treated' is a life lesson that we tend to forget to practice on ourselves. We learn it at a young age and automatically limit the word 'others' to those around us. It's common to forget that you as a person can be just as hurt by the words you say and the thoughts that you think about yourself, as those same words and thought would affect a different human being.
The fact is, there can be a very real distinction between the person you know you can be, versus the natural inclination we have to focus on our weaknesses and our mistakes than our accomplishments and our endless possibilities.
Think about someone who struggles with confidence issues because those around the always told them they didn't belong, or shouldn't try because they aren't capable, and aren't worth the space that they take up. What if the initial confidence issues then transformed into self confidence issues?
Have you ever considered that there's a difference between the two - confidence vs self-confidence? Problems with the first may have been caused by the words, thoughts, and actions of other people, but what if problems with self-confidence are transposed by your words, thoughts, and actions to yourself?
Perhaps the golden rule should read 'Treat others and yourself the way you wish to be treated'.
If you wouldn't say to someone else that they aren't good enough for the partner that they're in a relationship with, or that they aren't worth any recognition or appreciation for hard work, or that their best wasn't enough, or that their body shape doesn't qualify as the socially desired, or that their opinion isn't respected or valued, or that they're too stupid, too sensitive, too insignificant, too meaningless, too fat, too skinny, or too inferior to be worthful, then why do we continue to say these things to ourselves?
If you struggle with self-confidence, or you find anxiety or depression starting to control you, demand to yourself that you quit treating yourself any less than you truly want to be treated by others. Commit that instead of criticizing yourself, you're going to give yourself credentials for your successes. Pledge that you will support and encourage yourself exactly as you would take someone's hand and promise them that you'll be there for them during their hard times.
At the same time, start to stand up to the negative words, thoughts, and actions that you find you're providing to yourself, and begin to see them as challenges to prove your negative opinion wrong, instead of allowing them to convince you. Strive to break through every limiting ceiling that you've placed above your own head, and trust that no matter how large the challenges are, you will guide yourself through the journey with loving and supporting arms.
A very powerful leader said during a seminar about self-talk that when you feel like you are at your lowest, stop listening to yourself and start talking to yourself.
Commit to this, because we know that if it was another person and we were following the golden rule to treat others the way you wish to be treated, this might be all the love that the other person needs to step away from the cliff of self destruction and begin to feel hope and possibility that they are worthy.


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[02 Apr 2018 | Monday]
The log in our own eyes
This phrase applies to every human being. When we sense we are judging or starting to judge others then the Bible reminds us to examine ourselves first.
Why is that ? This is best dealt with by Matthew 7:1 to 7:5.
Let us put this to a simple test. Let us say we are face to face with someone. We can see the other's full face but we can not see our own face. In short we are blind to our own selves . We need to look at a mirror first.
I do find this to be true. What do you think ?
Very good Ped, it seems you figured out what my mirror is for in the be like Jesus kit... or maybe you always knew... You are truly a Christian, = Striving to be Christ like..


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Josh Clement
June 29, 2018
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ANKARA (Reuters) - Turkish Deputy Prime Minister Bulent Arinc said on Saturday a jet that was shot down by Syria a day earlier was not a warplane but a reconnaissance aircraft, state television TRT reported.
It was not immediately clear where Arinc, who is one of four deputy prime ministers and also the government's spokesman, was speaking. Turkish media reported the downed jet was an F-4 Phantom, a supersonic jet fighter which can also carry out reconnaissance operations.
Reporting by Jonathon Burch; Editing by Alison Williams


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Member Reviews
Katja P, Reviewer
This book unsettles and it is most likely created to do exactly that. The prose is on-Point, yet the narrative and the point of view switches so often, it makes it hard to keep track. But the blur this creates, the way you have to think twice whenever you encounter a new sentence, turns this book into something special. Not for everyone for sure, but a book you should give a try.
Kirsty H, Reviewer
I didn't get on at all with Acker's writing style; I found the sentences too matter-of-fact, but also rather lengthy at times.
Helen M, Bookseller
Written in the '80s, read by me in 2017, I can't help but feel that this hasn't aged well. I'm sure it was revolutionary and shocking when it was first published, but now it just feels a little bit like it's trying too hard to be controversial. Enter Janey, the central character of the piece, who at the age of 10 is sleeping with her boyfriend who also happens to be her father, and who then ends up on her own in NYC as a prostitute before ending up in Tangiers as a sex slave at the ripe old age of 14. Along the way she draws pictures of both her father's and her own genitals, has multiple abortions, gives the reader a helpful Arabic lesson and seems to miss her father more as a lover than as a father. I've got mixed emotions on this one. The underlying story of an abused child is something that happens, it's just Acker's treatment of it pushes it way beyond the boundaries of the probable. By making her so rough and tough and the series of events that befall her so improbable, it detracts from the fact that Janey is clearly the product of the fucked up upbringing that she has endured. It's certainly an incredibly thought-provoking book, as you dig beneath Janey's external persona and question why she is the way she is. Acker does an excellent job of blending the infantile and the extremely adult in Janey, as she pours out language and thoughts way beyond her tender years. Definitely not for easily offended / faint-hearted, but a really thought-provoking novel that will stay with you after the final page.
Angela S, Reviewer
This book I think wouldn't be for everyone, had an Indie film vibe to it which I happen to enjoy, but it is quite graphic and in your face, with language to match the scenes. Overall I enjoyed it, was a bit uncomfortable reading parts of it, but it was well written in an artsy kind of way.
Ellinor H, Reviewer
So this is story about Janey, a ten-yea-old girl, half-orphan, living with her father who to her is "boyfriend, brother, sister, money, amusement, and father" - and we might add sexual partner. First he rapes her, then she willingly has sex with him because it makes her feel loved. She is suffering from pelvic inflammatory disease, has her first abortion with 13, her second one a month later. Her father sends her to New York City, where apparrently she lives on her own, joins a gang and later is kidnapped, held captive and taught how to be a prostitute. At the age of 14 she gets cancer and dies. Blood and Guts in High School clearly is a book not for everyone - including me. It is just the type of book I as a teenager would have called "problem book" and which I already hated back then. It now is a Penguin Modern Classic and I really don't see the reason why because usually the titles in this series are of a certain quality. The only reason I'm rating this book two stars instead of one is the writing technique Kathy Acker uses - collage. The story is told from Janey's perspective but alternates between first and third person narration. There are multiple drawings (especially ones of sexual organs), poems, letters etc. (for example the first scene of the book is written as a drama scene). This could have made a decent book but I had a problem with Janey's thoughts. At the end of the book she is 14 but hardly had any education. During her imprisonment she reads The Scarlet Letter, completely understands it and knows how to interpret it. This is quite unlikely as are many of her other thoughts - they are the thoughts of someone maybe 20 years old or older. (I received a free digital copy via Netgalley/ the publisher. Thanks for the opportunity!)
Roman C, Reviewer
Originally written in the 1970s, this Penguin re-release coincides with Acker's untimely death from cancer 20 years ago this year. Ever the enfant terrible, this is deliberately designed to provoke and shock - and that it still can in 2017 would, I think, have amused Acker vastly. She throws everything into this dislocated narrative: sex, violence, disease, exploitation, corruption, abuse, incest, feminism, capitalism, anger, submission, identity, the grotesque body... with nods along the way to all those master-narratives that construct culture, from Freud and Marx to Hamlet and Sartre. At times deliberately disgusting, at others blackly funny (Janey's analysis of The Scarlet Letter is twisted genius!), this tears up the rule books of what 'fiction', 'narrative', a 'novel' are supposed to be, and creates what only barely passes for a story via a collage of prose, dialogue, verse, drawings, scrawled capitals, 'Persian' writing. For all of the ways that this intersects with critical theory, the theorisation of women's writing (think Cixous' écriture féminine, Irigaray, Kristeva) and Lacanian psychoanalysis, it's also dirty and grubby and revelling in its own gleeful rebelliousness and subversive energy. Certainly not for everyone...
Danielle D, Reviewer
Blood and Guts in High School Kathy Acker My Review: ♥ ♥ Kathy Acker led a colourful life. I read her Biography by Chris Kraus (After Kathy Acker) before Blood and Guts in High School. I can see how this book relates to her own experiences. Kathy's life wasn't all roses, and she liked to colour out of the box. This reflects in this book, and it also talks about aspects of her actual life, such as the health issues she suffered from. Blood and Guts in High School is about a girl, Janey. She finds her life is not going as planned. She lost her mother at a young age and her father is less than perfect. Janey encounters some disturbing sexual experiences. She just wants to be loved, but life can be cruel. This is not a happy-go-lucky kind of story. Kathy Acker was known in her time for her shock factor. I would say that her work still holds this quality today. Blood and Guts in high school has poems, dialogue and graphic x-rated pictures. Kathy was an interesting person with strong views. Some would call her books master pieces but I'm sorry I just wasn't that into this book. I enjoyed her Biography more. *ARC received in exchange for a fair review* Paperback £7.71 or Kindle £4.99. 165 pages Published January 11th 1984 by Grove Press
Emma D, Reviewer
No review given as the book was not for me. I'm all for experimental fiction but this was hard work, so disjointed and jumpy. Thanks for giving me the opportunity to try it.
Siobhan D, Reviewer
Blood and Guts in High School is a surreal and brash book that is novel, poetry, play, translation, and more within a short space. It is the story of Janey Smith, who moves to New York, ends up trapped in a locked room, and writes down bits of her life. In some ways it is a punk coming of age story about imprisonment and sex; in other ways it is a referential book that moves between structures and features Jean Genet and President Carter. The controversy surrounding the book when it was originally published in 1984 is easy to see through its explicit writing and drawings, its punk attitude, and its dreamlike movement through the streets of America and beyond. It is certainly an interesting read, though like writers like Burroughs, it can be easy to fall off a thread and lose track of everything, and some sections less engaging than others. The content is harsh and shocking and won't be for everyone, but the rapid, witty, and often painful writing in Blood and Guts in High School is a look at America from the underside that doesn't lose power all these years later.


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Depression during pregnancyBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39189.662581.55 (Published 10 May 2007) Cite this as: BMJ 2007;334:1003
- Veronica O'Keane, senior lecturer,
- Michael S Marsh, consultant obstetrician, King's College Hospital, and honorary senior lecturer, Institute of Psychiatry
- Correspondence to: V O'Keane v.o'keane{at}iop.kcl.ac.uk
Depression during pregnancy is common. The case presented here highlights many of the key issues involved in the management of pregnant women with depression, particularly the importance of active treatment.
Two months after the birth of her second child a 34 year old woman was admitted to a psychiatric inpatient unit for treatment of depression. She was married and worked as a business manager. She had a history of depression dating back to her late teens, which had been untreated until the birth of her first child three years before. At this point her depression had deteriorated into a psychotic state, but she subsequently responded to a combination of antidepressants and antipsychotic drugs. Her second pregnancy was planned, and her medication was discontinued when she conceived. Although her mental state continued to deteriorate as the pregnancy advanced, she was reassured at antenatal consultations that she had a healthy pregnancy and her baby was developing appropriately. She went into spontaneous labour and delivered a healthy baby girl at 35 weeks.
In the subsequent weeks her mental health deteriorated further. She believed that she was a terrible mother and that her baby was doomed to a life of misery. She experienced derogatory auditory hallucinations confirming these beliefs and in this deluded state attempted suicide. She was discovered by her sister and brought to a general hospital, where she was treated for two weeks in the intensive care unit. After a further 10 week admission in a specialist psychiatric unit, during which she was reunited with her baby, she was discharged fully recovered on venlafaxine 225 mg and olanzapine 5 mg a day.
How common is depression during pregnancy?
Rates of depression in women are higher during the childbearing years than at any other time.w1 Estimated rates of depression during pregnancy vary from 7-15% in economically developed countries1w2 to 19-25% in poorer countries.2w3 This compares with rates of around of 10% during the postpartum periodw1 and 7% outside of the perinatal period.w4 Rates of relapse in pregnant women with a history of recurrent mood disorder are high, at about 50%.3w5 We do not know, however, whether the high prevalence of antenatal depression results only from rates of relapse or also reflects an increased incidence of depression.
Who is at risk?
Across cultures poverty, lack of education, and sex inequality predispose women to depression in pregnancy.2w3 w6 w7 This is reflected in the high rates seen in low income countries, varying from 19-25% in Pakistan,2 Goa,w8 and Rio de Janeiro.w3 Exposure to domestic violence also increases the risk of developing antenatal depression.2w3 w9 Similar effects of social adversity have been found among women living in relative poverty in Europe and America.w6 w7 Women with poor social support, with an unplanned pregnancy, and who are single or adolescent are also more vulnerable to depression during pregnancy.w10
How does pregnancy affect depression?
There are many reasons for the increased prevalence of depression during pregnancy. Most women welcome pregnancy but it is also a major physiological and psychological life event. Women who are coping with other more chronic life stressors may find the additional stress of pregnancy unmanageable. Pregnancy also carries specific demands that individual women may have difficulties with, such as impending motherhood if she has had poor parenting herself or if she has been sexually abused as a child.w9
The biological changes during pregnancy also have a direct effect on mood state. Concentrations of female specific sex steroids are raised during gestation and modify parts of the brain involved in mood regulation.w11 There are also gradual increases in hormone concentrations within the cortisol stress system—the hypothalamic-pituitary-adrenal (HPA) axis4—overactivity of which has been found in people with depression.w12
The reasons for the high rates of relapse during pregnancy in those with a history of affective disorder have not been examined. Though any major life event is associated with an increased risk of relapse in those with affective disorders,w13 discontinuation of maintenance medication is probably a more specific and important contributory factor. A recent prospective study of women with a history of recurrent depression found that 68% of those who discontinued antidepressant medication after conception relapsed, compared with 26% of those who continued taking their medication without interruption.3
Although women are at a low risk of suicide during pregnancy,w14 it is the most common cause of maternal death in the year after the birth.5
How does depression affect the outcome of pregnancy?
Studies examining obstetric complications in women who are depressed during pregnancy are difficult to interpret because the possible consequences of untreated depression are difficult to separate from the possible consequences of taking psychotropic medication. Some findings suggest that depressed pregnant women have an increased risk of complicated deliveriesw15 or miscarriage,w16 but the latter tends to be associated with exposure to antidepressants during pregnancy.w17 There is more convincing, but inconsistent,w18 evidence of an association between antenatal stress and preterm delivery or low birth weight, or both,6 7w19 w20 w21 as in the case report presented here where the baby was born after 35 weeks' gestation. Most of these studies used various measures of psychosocial stress, but the associations with poorer birth outcomes were more evident when measures of depression were used.7w21 The effects of depression on birth outcome are more evident in poorer countries2w3 and among relatively deprived social groups in the economically developed world.w6 w10 w19 One of the most replicated findings is the poorer birth outcomes for African-American women compared with non-Hispanic white women.w6 w7 A study from Pakistan has shown that the negative effects of maternal antenatal depression on infant growth continue for at least a year after birth.2
There is evidence that antenatal depression may have a specifically harmful influence on development of the central nervous system. A large Danish study (n=20 299 pregnancies) reported that an unexpected death during the first trimester was associated with an adjusted odds ratio of 8.36 (95% confidence interval 2.41 to 29.0) for cranial neural crest malformations in the babies born to these women.w22 This suggestion of a specific effect of maternal stress on brain development is supported by the finding of higher levels of behavioural disturbance at four years in children born to women with high anxiety scores during pregnancy.w23
A unifying hypothesis explaining the association of both depression and social adversity on outcome of pregnancy is that the cortisol stress hormone system is a common mediating pathway.4w11 Multiple stressors, including psychosocial stress, hunger, and infection, stimulate the secretion of cortisol during, and outside of, pregnancy.4w12 Increased activity within the gestational cortisol system, via increased placental secretion of corticotrophin releasing hormone, has been shown to lead to premature delivery.4w24 There is less evidence implicating increased noradrenaline secretion, resulting from maternal anxiety, as a possible causal agent.w25 Another mediating pathway between depression during pregnancy and poorer birth outcomes is the unhealthy behaviours associated with depression, such as smoking, alcohol and substance misuse, and poor attendance for obstetric care, all of which have adverse effects on pregnancy outcome.w26 Health risk behaviours seem to have a stronger effect on intrauterine growth, while psychological stress has a stronger effect on preterm delivery.6w19
How is depression treated in pregnancy?
Episodes of depression can vary from a mild syndrome to severe clinical states, as in the case described above. In milder states psychotherapy may be the preferred treatment. A small controlled clinical trial showed that interpersonal psychotherapy was effective,8 but psychotherapy services may not be immediately accessible and time to response is longer than with medication. In moderate depression an individualised approach, balancing the possible risk of exposure to medication against the possible adverse outcomes associated with discontinuation of medication, should be adopted. Antidepressants are usually indicated in women with a history of severe or recurrent depression. There are no randomised controlled trials of treatment with antidepressants compared with placebo, and research has focused on examining the potential adverse neonatal outcomes associated with antenatal exposure to antidepressants. Two studies of population data have linked indices of mental health, prescriptions for selective serotonin reuptake inhibitors during pregnancy, and neonatal outcome.9 10 One of these reported a relative risk of congenital malformations in babies born to women taking selective serotonin reuptake inhibitors, but not tricyclic antidepressants, during the first trimester of pregnancy (1.34, 95% confidence interval 1.00 to 1.79).9 This increased risk, however, was not supported by a meta-analysis of prospective comparative cohort studies.w27 The second study reported a poorer obstetric outcome associated with maternal antenatal depression and the outcome was worst for women who were prescribed selective serotonin reuptake inhibitors.10 Another retrospective study suggests that exposure to these drugs in the third trimester is associated with persistent pulmonary hypertension of the newborn, but the absolute risk remains small (6-12/1000).w28 Compared with other antidepressants, paroxetine use during pregnancy is associated with an increased risk of congenital malformations, particularly cardiac abnormalities.w29
A serotonin withdrawal syndrome that is self limiting and usually managed with supportive care can occur in neonates exposed to selective serotonin reuptake inhibitors during pregnancy.w29 w30 This syndrome is variably described but common symptoms include hypotonia, irritability, excessive crying, sleeping difficulties, and mild respiratory distress. It is more likely to occur with paroxetine than with other drugs in the same class.w29
What advice should be given about family planning?
Family planning should be discussed with all women who have an affective disorder and could become pregnant, regardless of reproductive plans. Women should be referred to specialist psychiatric services, if possible, for advice before they plan a pregnancy.w31 Women who are not at high risk of relapse should try to reduce their medication gradually before they embark on a pregnancy.w32 Explain the evidence and evaluate the risk on an individual basis so that women can make an informed choice about whether or not to take medication.
As pregnancy progresses
Women with a history of recurring depression or bipolar disorder should be referred to perinatal psychiatric services or, when such services are not available, to general psychiatric services for management during pregnancy. Such women should not abruptly discontinue maintenance medication if they discover they are pregnant.3 Regular assessment of mood state during pregnancy should be routine for all women as antenatal depression is unlikely to remit and is one of the most robust predictors of postnatal depression; about half of so called postnatal depression actually starts during pregnancy.1w2 w11
The practice of gradually discontinuing antidepressants during the third trimester in an attempt to minimise withdrawal effects in the neonate is controversial.w33 This strategy carries a potentially high risk of relapse during the third trimester and early postpartum period and does not rule out the possibility that the baby is experiencing withdrawal symptoms in utero.w31 w32 w33 In our practice we advise breast feeding in the immediate postnatal period followed by gradual introduction of formula milk feeding as a strategy to reduce withdrawal phenomena.
Summary points
Rates of depression are higher during pregnancy than at any other point during a woman's life
About half of "postnatal" depression starts during pregnancy
Two thirds of women with a history of recurrent depression will relapse during pregnancy if they discontinue their medications after conception
Depression during pregnancy is associated with poorer obstetric outcomes, particularly preterm delivery
Women who are depressed during pregnancy are more likely to smoke and drink alcohol and less likely to attend for antenatal obstetric care than women who are not depressed
The treatment of depression during pregnancy must be considered individually for each woman, with the possibility of relapse and poorer obstetric outcomes balanced against the possible risks associated with taking antidepressant medication
Depression during pregnancy is a common problem and, as the case report indicates, is unlikely to remit unless it is actively managed. Untreated depression in pregnancy is associated with poorer maternal health practices and less favourable obstetric outcomes. Clinicians should ask about depressive symptoms as a routine part of antenatal care. If necessary, women should receive psychotherapeutic or psychopharmacological treatments, in the context of individual symptoms and risks. Women with an established history of mood disorder should be managed by specialist psychiatric services.
Contributors: VO'K performed the literature search and is guarantor. Both authors wrote the review.
Competing interests: VO'K has received fees for speaking at educational meetings organised by pharmaceutical companies.
Provenance and peer review: Commissioned and peer reviewed.