text:
PTSD indicates posttraumatic stress disorder. Numbers of patients determined to be ineligible or declining participation prior to screening were not tracked. Eight patients were screened (n=6) or randomized (n=2) but not included here due to issues with informed consent, Health Insurance Portability and Accountability Act authorization, or both. aNumbers sum to more than the total because multiple categories could be checked. bFinal visit ranged between 18 and 48 months. Patients were followed up for a minimum of 18 months and until the end of the study.
Error bars indicate 95% confidence intervals. Data are based on all 943 randomized patients. Patients with missing data were presumed to be nonabstinent. Data at the 3-, 6-, 9-, 12-, 15-, and 18-month assessments were collected an average of 96, 187, 280, 370, 461, and 566 days after randomization, respectively.
HR indicates hazard ratio; CI, confidence interval. A total of 111 patients from integrated care and 150 patients from smoking cessation clinic did not quit smoking for 24 hours between randomization and 18 months and were not included in the analysis. Time to relapse from first 24-hour quit was longer in integrated care than in smoking cessation clinic (stratified by quartiles of time to quit; log-rank test, χ21 = 14.53; P < .001).
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McFall M, Saxon AJ, Malte CA, et al. Integrating Tobacco Cessation Into Mental Health Care for Posttraumatic Stress Disorder: A Randomized Controlled Trial. JAMA. 2010;304(22):2485–2493. doi:10.1001/jama.2010.1769
© 2019
Author Affiliations: Veterans Affairs Puget Sound Health Care System, Seattle, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Drs McFall and Saxon); Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington (Ms Malte); Veterans Affairs Cooperative Studies Program, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Drs Shih, Lu, and Holodniy and Mr Chow); Michael E. DeBakey Veterans Affairs Medical Center, and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas (Dr Bailey); Veterans Affairs Center of Excellence for Stress and Mental Health, Veterans Affairs Healthcare System, and University of California, San Diego (Dr Baker); Durham Veterans Affairs Medical Center, Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Dr Beckham); Veterans Affairs Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Ms Boardman); Veterans Affairs Medical Center, San Francisco, and University of California, San Francisco (Dr Carmody); Department of Medicine, University of Minnesota, Minneapolis (Dr Joseph); Health Economics Resource Center, Department of Veterans Affairs, Menlo Park, California (Dr Smith); Department of Health Research and Policy (Drs Shih, Lu, and Lavori), and Infectious Diseases and Geographic Medicine (Dr Holodniy), Stanford University School of Medicine, Palo Alto, California.
Context Most smokers with mental illness do not receive tobacco cessation treatment.
Objective To determine whether integrating smoking cessation treatment into mental health care for veterans with posttraumatic stress disorder (PTSD) improves long-term smoking abstinence rates.
Design, Setting, and Patients A randomized controlled trial of 943 smokers with military-related PTSD who were recruited from outpatient PTSD clinics at 10 Veterans Affairs medical centers and followed up for 18 to 48 months between November 2004 and July 2009.
Intervention Smoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians (integrated care [IC]) vs referral to Veterans Affairs smoking cessation clinics (SCC). Patients received smoking cessation treatment within 3 months of study enrollment.
Main Outcome Measures Smoking outcomes included 12-month bioverified prolonged abstinence (primary outcome) and 7- and 30-day point prevalence abstinence assessed at 3-month intervals. Amount of smoking cessation medications and counseling sessions delivered were tested as mediators of outcome. Posttraumatic stress disorder and depression were repeatedly assessed using the PTSD Checklist and Patient Health Questionnaire 9, respectively, to determine if IC participation or quitting smoking worsened psychiatric status.
Results Integrated care was better than SCC on prolonged abstinence (8.9% vs 4.5%; adjusted odds ratio, 2.26; 95% confidence interval [CI], 1.30-3.91; P = .004). Differences between IC vs SCC were largest at 6 months for 7-day point prevalence abstinence (78/472 [16.5%] vs 34/471 [7.2%], P < .001) and remained significant at 18 months (86/472 [18.2%] vs 51/471 [10.8%], P < .001). Number of counseling sessions received and days of cessation medication used explained 39.1% of the treatment effect. Between baseline and 18 months, psychiatric status did not differ between treatment conditions. Posttraumatic stress disorder symptoms for quitters and nonquitters improved. Nonquitters worsened slightly on the Patient Health Questionnaire 9 relative to quitters (differences ranged between 0.4 and 2.1, P = .03), whose scores did not change over time.
Conclusion Among smokers with military-related PTSD, integrating smoking cessation treatment into mental health care compared with referral to specialized cessation treatment resulted in greater prolonged abstinence.
Trial Registration clinicaltrials.gov Identifier: NCT00118534
Nicotine dependence inflicts a disproportionate toll on individuals with mental illness, adversely affecting quality and length of life.1 Posttraumatic stress disorder (PTSD), a prevalent mental disorder,2 is highly associated with smoking (45%) and unsuccessful quit attempts.3 Individuals with PTSD smoke more heavily than smokers without PTSD and use tobacco to regulate mood and psychiatric symptoms.4,5 Tobacco dependence likely contributes to the high mortality,6 morbidity,4 and health care costs of persons with PTSD.7
Limited access to tobacco cessation treatment is a barrier to quitting smoking in many health care settings. Smokers are infrequently referred to specialized tobacco cessation clinics, and those referred often fail to attend or drop out prematurely.8,9 Although primary care clinicians screen for tobacco use,10,11 they usually do not provide treatment to aid quitting.11 Psychiatrists deliver cessation counseling to patients who smoke at only 12% of visits.12 In the US Department of Veterans Affairs (VA), which enrolls more than 1.5 million veterans with mental illness, including more than 400 000 with PTSD, the majority of smokers report not receiving tobacco cessation treatment during the previous year.10 An effective service delivery approach is needed to improve access to tobacco cessation treatment for patients with PTSD and other psychiatric illnesses.
Nicotine dependence is a chronic, relapsing addiction that responds best to intensive treatment extended over time.13 Mental health clinicians are well positioned to deliver intensive cessation treatment to smokers undergoing psychiatric care for PTSD owing to frequent visits attended by these patients.14 Integrating tobacco cessation into psychiatric care allows for monitoring of smoking status and reapplying cessation treatment to relapsers. Integrated cessation interventions also can address exacerbation of smoking by psychiatric symptoms,15 severe withdrawal symptoms experienced by smokers with mental illness,16 and possible deterioration in mood following quit attempts.17,18 Integrating treatment of substance use and other psychiatric disorders in a single clinical setting has been widely advocated1,19,20 but only preliminarily studied as an effective service delivery approach.14,21,22
Our multisite randomized controlled effectiveness trial hypothesized that integrating smoking cessation treatment into mental health care would improve long-term smoking abstinence rates in veterans with PTSD compared with referral for specialized cessation treatment. Smoking cessation treatment sessions and use of tobacco cessation medications were examined as mediators of treatment effects. We also evaluated whether psychiatric symptoms worsened from participating in integrated smoking cessation treatment or stopping smoking.
A total of 943 patients were recruited from outpatient PTSD clinics at 10 VA medical centers and followed up for a minimum of 18 months. Patients enrolled early were followed up to 48 months to obtain long-term outcomes (not presented herein). Patients met inclusion criteria if they (1) were engaged in outpatient PTSD care, (2) had PTSD related to military service, (3) smoked at least 10 cigarettes on at least 15 of 30 days before screening, and (4) consented to receive cessation interventions. Exclusion criteria included (1) use of noncigarette tobacco; (2) current psychotic, bipolar, or substance dependence disorder other than nicotine using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria (substance abuse or dependence in partial remission were allowed; partial remission indicates that full criteria for dependence were no longer met but 1 or 2 current criteria remained); and (3) severe psychiatric symptoms, psychosocial instability, or cognitive impairment assessed by medical record review and discussion with patients' mental health clinicians. Patients who subsequently stabilized could be rescreened for eligibility.
This study was approved by the Human Rights Committee of the Palo Alto Cooperative Studies Program Coordinating Center and the institutional review boards at participating sites. Patients gave written informed consent before enrollment. Recruitment occurred between November 2004 and December 2007, with follow-up continuing until July 2009. Figure 1 shows study procedures described in detail elsewhere.23
Posttraumatic stress disorder and axis I psychiatric disorders were assessed using the Clinician Administered PTSD Scale (CAPS)24 and Structured Clinical Interview for DSM-IV, respectively. At baseline, research staff gathered demographic and smoking data, including the Fagerström Test for Nicotine Dependence.25 To determine if smoking levels and outcomes varied by race and ethnicity, these characteristics were assessed using patient self-report from preselected options.
Eligible patients were randomized to integrated care (IC) or smoking cessation clinic (SCC) in a 1:1 ratio, stratified within each site by sex, current alcohol abuse or dependence in partial remission, current major depressive disorder, prior smoking abstinence (≥1 year), and heavy smoking (>25 cigarettes/d), using an adaptive randomization procedure26 to ensure balance of stratifiers between treatment groups within each site. Research staff called a telephone randomization system at the VA Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California, for treatment assignments. Neither site investigators nor patients were blinded with respect to treatment assignment.
Patients completed the initial course of cessation treatment within 3 months of randomization. Outcomes were assessed at 3-month intervals through month 18. At each assessment, daily use of cigarettes, other tobacco products, and cessation medications were determined using the timeline follow-back method, which uses a calendar with specific anchor dates to help patients identify the quantity and frequency of tobacco use.27 Exhaled carbon monoxide was obtained at every in-person assessment. Urine cotinine levels, measured using Accutest NicAlert test strips (JANT Pharmacal, Encino, California),28 were ascertained at assessments when patients self-reported no use of tobacco or nicotine replacement therapy in the prior 7 days. Laboratory assays of urine cotinine were obtained when self-reported abstinence disagreed with test strip results. Patients missing 1 or more assessments were retained in the study and encouraged to return for future assessments.
Integrated Care. Posttraumatic stress disorder clinicians, largely psychologists and social workers, delivered IC in individual sessions using a treatment manual that adhered to evidence-based practices13 and recommended interventions addressing specific PTSD symptoms dynamically related to smoking relapse.16,29 Integrated care delivered 5 weekly core tobacco cessation sessions focusing on tobacco use education, behavioral skills for quitting smoking, setting a quit date (following session 5), and relapse prevention. Cessation medications, if desired by the patient, were prescribed before planned quit dates by medical staff managing the patient's pharmacological treatment of PTSD. Prescribers followed an algorithm detailing standard prescribing practices for nicotine replacement therapy, bupropion, and varenicline. Core sessions were followed up by 3 follow-up visits during which clinicians assessed tobacco use, reinforced abstinence and relapse prevention, and reapplied cessation treatment to continued smokers. Assignments from a participant workbook corresponded with treatment session topics. Booster sessions were administered monthly thereafter, providing assessment, relapse prevention, and reinstatement of smoking interventions. Sessions typically were incorporated into regularly scheduled PTSD visits but could be scheduled separately, if necessary.
The study used a "train the trainer" model in which PTSD clinic leaders received IC training at a national meeting and subsequently trained their respective site clinicians. Mayo Clinic experts reviewed audiotapes of 78 PTSD clinicians (92%) and found 66 (85%) were competent in treatment delivery, 8 (10%) were not found competent, and 4 (5%) submitted inaudible tapes.
Smoking Cessation Clinic. The SCC condition consisted of referral to specialized cessation clinics at each site and represented the usual standard of care within the VA. Smoking cessation clinics followed smoking cessation practice guidelines,30 had clinic directors and patient care staff, provided treatment within 6 weeks of referral, and prescribed cessation medications directly or through patients' primary care clinicians. Participating SCCs reported a typical treatment course of 4 to 16 (median, 7) treatment sessions.
The primary outcome measure was 12-month prolonged abstinence from tobacco between 6- and 18-months postrandomization.31 Prolonged abstinence excluded tobacco use before 6-months postrandomization to allow for initial treatment episode completion and recovery from early relapses. Prolonged abstinence defined nonabstinence as (1) smoking for 7 consecutive days or at least once a week for 2 consecutive weeks or (2) using noncigarette tobacco for 7 consecutive days or at least once a week for 2 consecutive weeks. Self-reported prolonged abstinence was verified by exhaled carbon monoxide of 8 ppm or less and urine cotinine of less than 100 ng/mL cotinine equivalents at the 9- through 18-month visits. Prolonged abstinence was determined for all patients. If carbon monoxide or cotinine was missing (eg, due to current nicotine replacement therapy use or telephone assessment), a single measure was used for verification. If both carbon monoxide and cotinine were missing at any visit between 9 and 15 months, patients reporting prolonged abstinence were considered abstinent if all other available bioverification data confirmed abstinence. Patients who lacked carbon monoxide and cotinine readings at 18 months or failed to attend the 18-month visit were considered nonabstinent.
Predetermined secondary smoking outcomes included 7- and 30-day point prevalence abstinence at each assessment, where abstinence was defined as no tobacco use in the prior 7 or 30 days, respectively. Self-reported point prevalence abstinence was determined for all patients, with patients not completing a visit presumed to be nonabstinent. If bioverification data were missing or did not confirm abstinence, patients were considered nonabstinent at that visit.
For patients who quit smoking for at least 24 hours, time to relapse was defined as time to first tobacco use in which use occurred for 7 consecutive days or at any time during each of 2 consecutive weeks.31
Other predetermined secondary outcomes included severity of PTSD, measured by CAPS at 18 months (range, 0-136; scores of 60-79 indicate severe PTSD symptomatology)24 and PTSD Checklist (range, 17-85; scores of ≥50 indicate a PTSD diagnosis)32 at every assessment. The Patient Health Questionnaire 9 (PHQ-9; range, 0-27; scores of 10-14, 15-19, and ≥20 indicate mild, moderate, and severe depression, respectively)33 measured depression at every assessment. Measures of treatment contact included number of cessation treatment sessions delivered (from VA electronic records) and self-reported use of smoking cessation medications.
The target sample size (n = 1400) was designed to have 90% power to detect the difference between 6% and 11% prolonged abstinence rates in SCC and IC, respectively, using a 2-sided .05 level χ2 test. An independent data and safety monitoring board regularly reviewed study data, including formal interim efficacy analyses performed on the primary outcome measure using the Lan-DeMet method with the O'Brien-Fleming–type boundary as a guide for stopping the study early.34 Final enrollment was 943, because of lower than expected recruitment rate. Due to the data and safety monitoring board's recommendation, the recruitment period was not extended because the achieved sample size provided 78% power to detect the hypothesized prolonged abstinence rates, and the study continued to the end of planned follow-up.
Analyses were conducted according to intention-to-treat. Baseline characteristics were compared using χ2 tests or 2-sample t tests. Prolonged abstinence and point prevalence abstinence by visit were compared between treatment groups using logistic regression. Longitudinal point prevalence abstinence, PTSD Checklist, PHQ-9, and CAPS data were compared using generalized estimating equations. Analyses were adjusted for age, race, baseline CAPS, Fagerström Test for Nicotine Dependence, site, and 5 randomization stratification factors. Treatment × subgroup interactions were tested in regression models to assess whether the treatment effect was consistent across subgroups. Time from first 24-hour quit to relapse, censored at the earlier time of last follow-up or 18 months from randomization, was estimated using the Kaplan-Meier method and compared using the log-rank test and Cox proportional hazards regression model, both stratified by quartiles of time to first 24-hour quit. The Baron and Kenny method was used to assess whether differences in prolonged abstinence between IC and SCC were mediated by number of counseling sessions and days of medication use.35 No adjustment was made for multiple comparisons. All analyses were performed using SAS version 9.2 (SAS Institute Inc, Cary, North Carolina). P < .05 was considered statistically significant.
Demographic and baseline smoking characteristics, depression, and psychotropic medication use did not differ between the IC and SCC groups (Table 1 and Table 2). Both groups reported lengthy smoking histories and had CAPS scores indicative of severe PTSD. A total of 781 patients completed the 18-month assessment within the data collection window (Figure 1) and 70 provided historical 18-month data at a later date, for a total of 851 patients (90% of total sample). Compared with patients providing 18-month data, dropouts were significantly younger, smoked for fewer years, and had higher CAPS scores (eTable 1). Dropouts also were more likely to report Afghanistan or Iraq service and have current alcohol abuse or dependence in partial remission (eTable 1).
12-Month Prolonged Abstinence. Seventy-three patients (15.5%) in the IC group and 33 patients (7.0%) in the SCC group self-reported prolonged abstinence between 6 and 18 months (unadjusted odds ratio [OR], 2.43; 95% confidence interval [CI], 1.58-3.74; P < .001; and adjusted OR, 2.59; 95% CI, 1.67-4.02; P < .001). The IC group had a higher bioverified prolonged abstinence rate than the SSC group did, with 42 patients (8.9%) in IC and 21 patients (4.5%) in SCC achieving bioverified prolonged abstinence (unadjusted OR, 2.09; 95% CI, 1.22-3.59; P = .007; and adjusted OR, 2.26; 95% CI, 1.30-3.91; P = .004). The treatment effect was consistent across all subgroups (eFigure).
Bioverification failed to confirm prolonged abstinence for 43 of 106 patients (41.0%) who self-reported prolonged abstinence. Of these 43 patients, 13 (30.2%) had cotinine-confirmed abstinence (<100 ng/mL), but a carbon monoxide level of more than 8 ppm at 1 or more visits. Another 11 patients (25.6%) had carbon monoxide levels of more than 8 ppm and missing cotinine levels at 1 or more visits (carbon monoxide ≤10 ppm for 7 patients and >10 ppm for 4 patients). An additional 11 patients (25.6%) had cotinine levels of more than 100 ng/mL and 8 patients (18.6%) were missing 18-month bioverification.
Point Prevalence Abstinence.Figure 2 shows 7- and 30-day point prevalence abstinence. Bioverification confirmed 60% of self-reported 7-day abstinence and 63% of self-reported 30-day abstinence. The 7- and 30-day bioverified point prevalence abstinence rates were similar after 6 months. Differences in bioverified point prevalence abstinence between the IC and SCC groups were largest at 6 months for both 7-day (78/472 [16.5%] for IC vs 34/471 [7.2%] for SCC, P < .001) and 30-day (65/472 [13.8%] for IC vs 28/471 [5.9%] for SCC, P = .001) abstinence, and remained significant at 18 months (7-day abstinence: 86/472 [18.2%] for IC vs 51/471 [10.8%] for SCC, P < .001; and 30-day abstinence: 80/472 [16.9%] for IC vs 44/471 [9.3%] for SCC, P < .001). Assuming a common treatment effect over time, patients in the IC group were twice as likely as patients in the SCC group to achieve 7-day (OR, 2.09; 95% CI, 1.54-2.84; P < .001) and 30-day (OR, 2.17; 95% CI, 1.56-3.03; P < .001) abstinence between 3 and 18 months.
Time to Relapse.Figure 3 shows time to relapse for patients with a 24-hour quit between randomization and 18 months in the IC (n = 361) and SCC (n = 321) groups. Median (interquartile range) time to relapse following the initial 24-hour quit was 29 (18-42) days and 8 (7-12) days for the IC and SCC groups, respectively (stratified by quartiles of time to quit: hazard ratio, 0.72; 95% CI, 0.60-0.86; P < .001).
Patients in the IC group attended more cessation sessions than did patients in the SCC group and were more likely to use bupropion, nicotine polacrilex, and bupropion and nicotine replacement therapy in combination; the proportion of patients using any cessation medication was similar in both IC and SCC groups (Table 3). Total counseling sessions received and self-reported medication use days mediated 29.5% (95% CI, 26.6%-32.5%) and 9.6% (95% CI, 7.7%-11.5%) of the difference in prolonged abstinence between the IC and SCC groups, respectively.
Between baseline and 18 months, CAPS scores improved for patients in both IC and SCC groups by approximately 7 points, a 10% decrease in PTSD severity (eTable 2). Changes in CAPS scores did not differ between quitters and nonquitters (eTable 3). Over 18 months, no significant differences were observed between the IC and SCC groups on PTSD Checklist or PHQ-9 scores (eTable 2). Nonquitters worsened slightly on the PHQ-9 relative to quitters (differences ranged between 0.4 and 2.1, P = .03) (eTable 3), whose PHQ-9 scores did not change over time. Differences between quitters and nonquitters were not detected on the PTSD Checklist, with both groups reporting improvement over time (eTable 3).
The number of patients who experienced serious adverse events during the study did not differ significantly by treatment (218/472 [46%] for IC vs 220/471 [47%] for SCC, P = .87) or by prolonged abstinence (26/63 [41%] for abstinent vs 412/880 [47%] for nonabstinent, P = .39). The number with serious adverse events possibly related to the study was small (11/472 [2%] for IC vs 8/471 [2%] for SCC, P = .49). The serious adverse events that were possibly related to the study included 10 instances in 9 patients of psychiatric hospitalizations, 6 instances in 5 patients of life-threatening or potentially jeopardizing psychiatric conditions that did not result in hospitalization, 3 instances in 3 patients of medical hospitalizations (2 cardiac related and 1 gastrointestinal related), and 4 instances in 3 patients of life-threatening or potentially jeopardizing medical conditions that did not result in hospitalization (1 cardiac related, 2 gastrointestinal related, and 1 nervous system related).
Our study showed that integrating rather than separating treatment for PTSD and nicotine dependence improves smoking quit rates. Integrated care doubled prolonged abstinence compared with the SCC condition, was better on 7- and 30-day point prevalence abstinence at all measurement intervals, and increased time to relapse. The true number of patients in the IC group achieving abstinence may actually fall between the rigorous measure of biologically confirmed prolonged abstinence (8.9%) and less conservative outcomes of self-reported prolonged abstinence (15.5%) and 7-day point prevalence abstinence (range, 14.0%-18.2%). Of the 43 patients who self-reported prolonged abstinence but failed to meet bioverification criteria, nearly half had cotinine-confirmed abstinence with carbon monoxide readings of more than 8 ppm or missing cotinine with carbon monoxide readings of 10 ppm or less, raising the possibility that environmental exposures common in this population may have artificially elevated carbon monoxide readings.
Bioverified point prevalence abstinence for the IC group was comparable with cessation outcomes in studies of other psychiatrically ill smokers, including those with depression (14%-25%),36,37 alcoholism (7%-19%),38 and schizophrenia (7%-17%).39 The IC prolonged abstinence rate cannot be gauged against other treatment trials involving mentally ill smokers because those studies did not report comparable long-term bioverified quit rates. Quit rates from our study were lower than those typically found for non-mentally ill smokers,13 because smokers with mood and anxiety disorders often are more nicotine dependent and more likely to relapse following treatment.40,41 Point prevalence abstinence remained steady between 6 and 18 months in both conditions, perhaps because patients could restart cessation treatment as needed during the 18-month study course. Concurrent with the study, the VA launched multiple initiatives to prioritize tobacco cessation, which may have facilitated cessation over time for all study patients.
The superior results of the IC group can be partially attributed to the greater number of cessation counseling sessions received by patients in this condition. The relationship between treatment length and intensity and favorable outcomes has been established in non-psychiatrically ill smokers13 and observed to be proportionately greater for smokers with past histories of depression.40 Although the overall proportions of patients in the IC and SCC groups using cessation medications were similar, days of medication use were significantly higher for the IC group, possibly due to greater treatment contact. Number of counseling sessions received explained more of the treatment effect than total days of cessation medication use. The fact that less than 40% of the treatment effect was mediated by these 2 variables suggests that other factors contributed to effectiveness. These factors may include qualitative aspects of the therapeutic relationship, such as mental health clinicians' ability to motivate patients and skill in managing the dynamic interplay between psychiatric distress and smoking urges.
Worsening psychiatric symptoms have been linked to smoking cessation treatment participation18 and quitting smoking17 in persons with positive depression histories. In our study, patients showed no overall deterioration in psychiatric status regardless of treatment assignment. In fact, 18-month follow-up CAPS scores improved equally for patients in the IC and SCC groups, and the 10% reduction in PTSD symptoms is comparable with that observed in some PTSD clinical trials enrolling highly selected VA patients.42 Thus, IC did not detract from effectiveness of PTSD treatment. Quitters showed slight improvement on PTSD symptoms and little change in depression, substantiating other reports of no adverse effects of smoking cessation in patients with current PTSD,14 depression,43 or past histories of depression.44,45 Unlike patients in investigations showing deteriorating psychiatric status from smoking cessation,17,18 patients in our study were engaged in ongoing psychiatric care, which may have attenuated potential adverse effects on mental status of nicotine withdrawal. Such findings counter beliefs that addressing cessation during mental health care detracts from effective treatment of primary mental health concerns and leads to increased instability in smokers with active mental health symptoms.
Our findings are limited by the selected sample, predominantly older male Vietnam-era veterans with chronic PTSD and co-occurring depression, but without current bipolar, psychotic, and substance dependence disorders. Results may not generalize to nonveterans or persons with other psychiatric disorders. Given the relative ease of implementation (manualized treatment with minimal training requirements) and demonstrated effectiveness of IC for smokers with PTSD, future research should translate IC into other practice settings with different populations of psychiatrically ill smokers. Efforts should also be focused on younger Iraq and Afghanistan veterans, who exhibited higher rates of attrition than other veterans. Testable methods for improving outcomes could include increasing the duration of treatment, enhancing pharmacotherapy, adding contingencies for cessation, and telephone or Internet supplements. Although the majority of IC clinicians delivered the treatment as designed, a small minority failed to do so, which may have produced less favorable IC outcomes. Staff obtaining outcome data were not blinded with respect to treatment condition; however, the use of objective outcome measures such as bioverified abstinence lessens the likelihood that outcomes were biased.
This investigation was designed as a practical clinical trial applicable to real world settings, using a clinically relevant comparison group, broad inclusion criteria, and practitioners from diverse health care settings who were not tobacco cessation experts.46 Delivering cessation assistance as part of primary mental health treatment was both more effective than referral and led to greater intensity of treatment utilization, a major factor in treatment effectiveness. Integrated care could be applied to the sizable proportion of smokers among the approximately 400 000 veterans enrolled in VA care for PTSD. Study findings have further potential to extend to the 10 million individuals in the United States who receive mental health treatment annually,47 of whom an estimated 41% are smokers.3 Initiatives to disseminate IC as an evidence-based practice within the VA are under way to meet the challenge of making tobacco cessation treatments available to veterans who need them. These efforts take on particular salience with the cohort of younger Iraq and Afghanistan veterans with PTSD for whom stopping smoking now could prevent long-term adverse health sequelae.
Corresponding Author: Miles McFall, PhD, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, S-116 MHC, Seattle, WA 98108 (email@example.com).
Author Contributions: Mr Chow had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: McFall, Saxon, Malte, Baker, Beckham, Boardman, Carmody, Joseph, Smith, Lavori.
Acquisition of data: Chow, Bailey, Baker, Boardman.
Analysis and interpretation of data: McFall, Saxon, Malte, Chow, Joseph, Smith, Shih, Lu, Holodniy, Lavori.
Drafting of the manuscript: McFall, Saxon, Malte, Chow, Beckham, Shih, Lu.
Critical revision of the manuscript for important intellectual content: McFall, Saxon, Malte, Chow, Bailey, Baker, Boardman, Carmody, Joseph, Smith, Shih, Lu, Holodniy, Lavori.
Statistical analysis: Chow, Shih, Lu, Lavori.
Obtained funding: McFall, Saxon, Lavori.
Administrative, technical, or material support: Saxon, Malte, Chow, Bailey, Boardman, Carmody, Joseph, Holodniy, Lavori.
Study supervision: McFall, Saxon, Malte, Chow, Beckham, Carmody, Shih, Lu, Holodniy.
Financial Disclosures: None reported.
Funding/Support: This work was supported by the US Department of Veterans Affairs Cooperative Studies Program (CSP 519).
Role of the Sponsor: The US Department of Veterans Affairs Cooperative Studies Program contributed to the study design. The sponsors were not involved in the conduct, collection, management, analysis, or interpretation of the study results and/or preparation of the manuscript. The manuscript was subject to administrative review before submission, but the content was not altered by this review.
Planning Committee: Miles McFall, PhD (co-chair); Andrew J. Saxon, MD (co-chair); Jean C. Beckham, PhD, Durham, North Carolina; Timothy P. Carmody, PhD, San Francisco, California; Lori L. Churby, BS, Palo Alto, California; Anne M. Joseph, MD, Minneapolis, Minnesota; Philip W. Lavori, PhD, Stanford, California; Robert Rosenheck, MD, West Haven, Connecticut; Mark W. Smith, PhD, Palo Alto, California; Julia Vertrees, PharmD, BCPP, Albuquerque, New Mexico.
Participating Veterans Affairs Medical Centers:Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas: Sara (Su) Bailey, PhD (site investigator); Hampton Veterans Affairs Medical Center, Hampton, Virginia: Priscilla Hankins, MD (site investigator), Marinell Miller, PhD (co-investigator); Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota: Jennie Leskela, PhD (site investigator); Southeast Louisiana Veterans Health Care System, New Orleans: Madeline Uddo, PhD (site investigator); Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania: Ronald Ehrman, PhD (site investigator); Portland Veterans Affairs Medical Center, Portland, Oregon: Lynn Van Male, PhD (site investigator); Providence Veterans Affairs Medical Center, Providence, Rhode Island: William Unger, PhD (site investigator); Veterans Affairs San Diego Health Care System, San Diego, California: Dewleen Baker (site investigator); Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama: Carlos Berry, MD (site investigator), Lori Davis, MD (interim site investigator); Washington, DC Veterans Affairs Medical Center, Washington, DC: Stacy Pollack, PhD (site investigator).
Biostatistics and Research Data Processing:Palo Alto Veterans Affairs Cooperative Studies Program Coordinating Center, Palo Alto, California (director, biostatistician, senior biostatistician, project manager, health economist, statistical programmer, data management programmers, health economics programmer, clinical data manager, clinical data assistants, research assistant): Mark Holodniy, MD (acting, past), Philip Lavori, PhD (past), Ying Lu, PhD, Bruce Chow, MS, Surai Thaneemit-Chen, MS (past), Mei-Chiung Shih, PhD, Philip Carlson, BA (past), Lori Churby, BS (past), Regan Dodson, BA, Lisa Sellitto, MA (past), Mark Smith, PhD, Sam King, MS, Lauren Uyeda, MA, Andres Busette, BA, Anjali Kukde, BCom, MCM, Sachiko Kutsuna, BS (past), Alison Quien, BS, Beverly Ventura, BS (past), Michelle Mullens, Chris Punzalan, Pei-Pei Woo, Robin Neely (past), Lisa Nuckles, MS.
Clinical Research Pharmacy: Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (director, clinical research pharmacist, pharmaceutical project manager, IT group): Mike R. Sather, PhD, FSHP, Kathy Boardman, RPh, Barbara Del Curto, BS.
Cooperative Studies Program Central Office: (director, deputy director, portfolio manager): Timothy O'Leary, MD, Grant D. Huang, PhD, MPH, Theresa Gleason, PhD.
Contractors: CAPS Rater Certification, Frank W. Weathers, PhD; Integrated Care Consultation (Mayo Clinic), Barbara Dallavalle, MA, LP, CTTS, Patrick Draper, MSW, LICSW, CTTS, Thomas Gauvin, MA, LSW, CTTS, J. Taylor Hays, MD, Sheila Stevens, MSW, CTTS; SCID (Structured Clinical Interview for DSM-IV) Rater Certification, Michael B. First, MD, Janet Lavelle, MSW.
Disclaimer: The views expressed herein are those of the authors and not necessarily those of the US Department of Veterans Affairs.
Additional Contributions: We thank the site investigators, study coordinators, and assessment technicians at the participating Veterans Affairs medical centers. These individuals are salaried employees of their respective organizations and received no additional compensation related to their contributions to this study.
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Nutrisystem Desserts ~ This is my 23rd week of Nutrisystem and I am sure that some of you are wondering what some of my favorite foods are in the program. I know that when I first signed up, I asked others who were already using Nutrisystem what some of their favorite foods were to aid in my […]
Best Tasting Nutrisystem Desserts: Chocolate and Cheesecake! Oh My! @Nutrisystem #nsnation #spon
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Staples "Back to School" $50 Gift Card Giveaway
9:34 PM Posted by Centsible Mommy
For us parents, the next few weeks leading up to "Back to School" can be very chaotic as we go from store to store in search of the lowest prices and best selection of everything our kids will need for the upcoming school year. Staples is committed to making back to school shopping easy, by providing the best deals and great selection on everything your family needs for a successful school year.
Staples, not only has very affordable prices, but also carries a wide array and very stylish and fashionable selection of school supplies. From Backpacks to pencils, and everything in between, Staples has everything your child needs to be prepared and in style this upcoming school year.
Here are just some of the "Back to School" items you will find at Staples this summer:
Click here to see Staples most current "Back to School" savings and deals.
Buy it: The featured products can be purchased at Staples stores or you can shop for some select "Back to School" items at Staples.com.
Win it: I love the selection at Staples; and because I'm pretty sure you will, too, we are giving away a $50 Staples gift card to one Centsible Mommy reader courtesy of Staples.
Here's how to enter:
Leave a comment that you would like to be entered to win the gift card. Be sure to leave an email address with your entry so I can contact you should you win. That's it. Keep reading for additional ways to gain entries.
Additional entries:
"Like" Centsible Mommy on Facebook (1 entry)
Follow me on Twitter- (@CentsibleMom) ( 1 entry)
Post about this giveaway somewhere (facebook, twitter, blog, etc) with a link to this giveaway included and be sure to leave me a comment to where you've posted it! ( 1 entry for each post)
Follow me on Google Friend Connect (upper right hand corner) (1 entry)
Subscribe to ¢ent$ible Mommy by Email (1 entry)
Refer a friend. Get 1 entry for each friend who enters this giveaway and tells me you sent them! (1 entry each)
Don't forget to enter all my other giveaways still going on! Look on the right sidebar for the current list.
Contest ends at 11:59 pm CST on August 6th. Winner will be randomly selected using a random number generator at random.org. Winner will be notified in this post and by email. Prizes not claimed within 48 hours will be forfeited and an alternate winner will be drawn. Open to U.S. Residents 18+ only.
I was sent Staples products for review purposes only. No monetary compensation was received for this post. The opinions expressed are my own based on my experience with Staples and their products.


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Gluten-Free Quick Streusel Coffeecake
This gluten-free quick streusel coffeecake is perfect for a fancy brunch or breakfast gathering. If you can't find gluten-free oats or if you don't want to use oats, you can substitute flaked coconut instead. Or use chopped nuts or a combination of nuts and coconut.
Preparation time: 20 minutes
Cooking time: 25 minutes
Yield: 6 servings
3 tablespoons butter, softened
6 tablespoons plus 1/4 cup packed brown sugar
1 teaspoon cinnamon
1/8 teaspoon cardamom
Pinch salt
1 cup gluten-free quick oats
1 egg
1/2 cup milk
1/4 cup organic cane sugar
1 teaspoon vanilla
1/2 cup plus 1 tablespoon plus 1 teaspoon (92 grams) sweet rice flour
1/4 cup plus 2 teaspoons (33 grams) almond flour
1 teaspoon baking powder
1/2 teaspoon baking soda
1/4 teaspoon salt
Preheat the oven to 375 degrees F.
Grease a 9-inch square cake pan with nonstick cooking spray and set aside.
In a small bowl, combine 3 tablespoons butter with 6 tablespoons brown sugar, cinnamon, cardamom, and salt and mix until smooth. Stir in the oats; the mixture will be crumbly.
In a medium bowl, beat the egg with the milk. Add the cane sugar, 1/4 cup brown sugar, and vanilla and beat well until combined.
In a small bowl, stir together the sweet rice flour, almond flour, baking powder, baking soda, and 1/4 teaspoon salt until the mixture is one color. Stir into the egg mixture and beat for 1 minute.
Pour the batter into the prepared cake pan and spread evenly. Sprinkle with the oatmeal mixture.
Bake for 20 to 25 minutes, or until the cake is puffed, set, and light golden-brown.
Remove the cake from the oven and cool for 15 minutes; then cut into squares to serve.
Per serving: Calories 304 (From Fat 108); Fat 12g (Saturated 7g); Cholesterol 64mg; Sodium 316mg; Carbohydrate 45g; Dietary Fiber 2g; Protein 5g.


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ABC ordered two single-camera comedy pilots Wednesday, including a family comedy from Night at the Museum director Shawn Levy.
Get all the latest pilots news
In The Untitled Andrea Abbate project, good girl Karey is the black sheep in a family of petty thieves, drug addicts and narcissists. When her brother is sent to prison, she decides to raise his kids along with her adopted African-American son in hopes of giving them all a normal childhood. Accidentally on Purpose scribe Andrea Abbate wrote the pilot, which will be executive-produced by Levy, and Last Man Standing executive producers Marty Adelstein and Becky Clements.
Bad Management is about a slightly self-centered female boss at a high-end luxury goods department store whose methods are challenged when her boss' son arrives and makes youth and sex the company's new focus. Free Agents alum Sharon Horgan will star in pilot, which she wrote with Holly Walsh. Aaron Kaplan (The Neighbors) is on board as an executive producer.


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News, reviews and photographs of Modern Fashion Dolls including Kingdom Doll, Fashion Royalty, Sybarite, Tonner Doll, Gene Marshall, Barbie and my own experiences as a doll collector.
2010 Integrity Toys Debut Line of Dolls
I expected a live event with live pictures rather than just live voices and pictures. It was over after about one hour. About 6 questions were taken from attendees. The event was scheduled for two hours so I wonder what was missing.
One by one each grouping was shown. I compliment the size and quality of the images. For the first time we have been shown images that didn't try to be artsy but rather intended to display the dolls and fashions with appropriate lighting and focus.
The Event dolls are a set of two mini Avantguards, Aphrodisiac (on the left) and Androgyny and will sell for $175. That's a fair price for the two. I would have rather gotten a Fashion Royalty doll but many are pleased with this choice. They are wigged as are the original full-sized versions and are dressed in the same fashions. It's a cute idea. I think it will be fun to photograph the two Aphrodisiacs together. I don't have Androgyny anymore. I wonder if there will be a mini Goldmine. She would definitely find a place in my collection!
The Fashion Royalty Monogram Collection, in my opinion, was the winner out of all the lines. Besides the doll Brilliance, which I have previously reviewed, there is a lingerie version , two fantastic dressed dolls and another dressed doll that I will pass on. Each one is $150 except for the lingerie version which is $120.
I don't like the pink gown from the waist down and that's a shame. The fabric detail on the bodice and shoulder and the cute beaded hat are lovely. I like the look of the short wig as well. The structure of the skirt reminds me of the outrageous Biltmore Hotel Gene Marshall gown from years ago. The Biltmore gown was a work of art. I don't want to spend $150. for a Monogram doll whose outfit is useless to me.
I finally found a use for Brilliance's outfit...it fits a Silkstone doll perfectly!
But I digress. Back to the debut.
Next up are the Fashion Royalty dolls themselves. They were divided into two categories, Dazzle and Foundation....whatever. Foundation would be a good name for a line of lingerie dolls.
The Dazzle dolls have 60's hairstyles and Heidi Klum type sequined dresses. They are $79. except for the Kyori giftset which is $175.
Sorry to say that Mattel did the sequin thing better.
The Kyori giftset comes with a big red ruffled gown sporting a beige bow, a plaid suit with a blouse underneath, two pairs of shoes, earrings, bracelet, ring and black potholder gloves.
Let's talk about hair. It's depressing to see those gorgeous faces under the ridiculous hairstyles. They look rock hard and are so unattractive. Adele's Afro is not to my taste either. I'd really tone it down a few inches which would still give her an ethnic hairdo but keep her from looking like she belongs in a Mike Myers movie.
Overall, the theme of the collection is a little bit of this and a little bit of that as far as fashion eras. It's certainly not like Jason's runway collections which are cohesive and relate to eachother.
The Foundation Collection
Staying Power Darius Reid and Model Citizen Lukas M., two Hommes in ill-fitting suits carrying great man bags and wearing great shoes. $139.00 each. This is not a giftset with two dolls. I have combined them into one image to save space. One can only hope that the jackets do not actually fit the way they look in the pictures.
Fire Within Jordan $139.
Jordan is very pretty and I think her outfit is adorable. I'm hoping the construction lives up to my expectations as it looks complicated. I will get rid of the pot holders immediately. I love hats for my dolls.
Tricks of the Trade Eugenia Perrin Frost $139.00
Which "trade" is that? The outfit is cute, I think. Actually I don't know what to think about this doll. I'm afraid she'll open her mouth and the fangs will come out. I am ordering her because she is so strange that she's interesting.
Private Goddess Natalia Fatale $150.
Someone is going to have to rethink the color and the draping of the fabric on that dress. The bodice has possibilities. Did Natalia's fairy godmother use the nursery room draperies for the skirt? Was she in a hurry?
Winning Ensemble Luxury Wear Fashion $69
I want the doll that is modeling this outfit. It appears to be Vanessa before the LDS hairstyle was applied. The outfit is another mini bubble skirt type dress in spring colors, a 50's bow hat with tulle, and the ubiquitous black gladiator shoes. I'm undecided.
The Three NuFace dolls below are Perk Colette, The Great Pretender Lillith and Mais Oui! Giselle Diefendorf. Each is $99.
Giselle's outfit comes with a fitted black jacket that has an interesting peplum. I think they're all adorable. The clothes are edgy eye candy. Colette and Lillith have beautiful faces. They will be mine.
Flash Star Luxury Wear Fashion $69.
Poppy Parker, the Dynamite Girls and ITBE will be covered in the next post.
12 comments:
- Alejandro3/7/10, 3:38 PM
Enigmatic and Incandescent fashions were great, but I don't like the monogram dolls, so I'm not sure what to do...ReplyDelete
I am pleased with Colette & Giselle, but absolutely hated Lilith's sweet pink look. It's just not something that appeals to me.
I do not like the bubble skirt look. It takes me back to the 1980's, and not in a good way.
Eugenia's facial screening I'm sorry to say, I find repulsive. And I LOVE Eugenia. So that was unfortunate for me.
I found the Heidi Klum Barbie for 9.99 at ROSS. I'm quite happy with the dress for that price, and you are correct. Mattel did a better job with the sequins & fit (you cannot put lining in a sequin mini dress and have it fit on a 1/6 scale doll correctly IMO). I see no reason to buy one for $79.
If not for the event AG mini clones, which I could not order fast enough, I would only be buying 2 dolls from this unveiling.
The good news? I will have extra money to look backwards & buy some previously released fashions that I do like.
- Carine3/7/10, 4:15 PM
I don't know if it's just me, but I can't help thinking of Duffy when I look at Vanessa.ReplyDelete
I am not fond of Disco "1954 Studio", unless it's a cool John Travolta suit.
As you've mentioned Terri, the disco ball size Afro puff on Adele turns me off as well. I Like her softer make up, but can't understand the choice of hairstyle, and why gives another Afro (recalling her wig version)
I was on the fence on Colette because her hairstyle isn't quite flattering, but she can easily be restyle.
Lilith is a must (in spite of pink outfit).
Thanks for the updates/fun commentary!
@Carine: Who is Duffy?ReplyDelete
LOL Studio 54.
- Marti a.k.a. The Hot Mess/Big24mac3/7/10, 6:34 PM
You forgot the 2nd fashion from i believe the Dazzle line. I really loved that prototype Dania as opposed the tangererine red with helmet hairReplyDelete
@Marty: You are correct. I guess I was underwhelmed.ReplyDelete
- James3/8/10, 8:01 AM
My first reaction was "What has happened to Fashion Royalty?" .. the closest thing to royalty is the Natalia Disney Princess look in 'Private Goddess" LOL... and she isn't fashionable. You are correct about that one Terri... this dress desperately needs altering.
This line-up doesn't feel like imediate sell~outs to me, unless the numbers are low.
The skirts seem really short on the more adult dolls in the line. As for the "Mini me" dolls.. my first reaction was "run out of ideas already?" .. I don't know.. maybe it's just me.
Still no Veronique.... Maybe she saw the Disney Princess dress on Natalia and thought she was out of there. LOL. I do like the Eugenia doll for it's fashion sense, and the Nu-Face doll's clothing.
Thanks for posting and reporting Terri.
Always a pleasure to read your blog. Truly.
While I can't say I have much interest in any of these dolls, I do so love you thoughtful and brutally honest commentary! Just when I thought I'd seen the last of Dick Vitale in drag...ReplyDelete
- Carine3/8/10, 7:59 PM
Hi Terri, Duffy is that British singer (she is young but sings old school Soul style music, same hairstyle)ReplyDelete
Oh, goody! This Adele doesn't seem to be in favor. Maybe I'll be able to get her later this year. Fingers crossed.ReplyDelete
Thanks for sharing the photos, Terri! I have enjoyed the reviews and comments, too.
- Anonymous3/8/10, 8:40 PM
I'm thinking they must have ordered too much fabric from the Frog Princess, and used the left overs to make Natalia's gown.ReplyDelete
WOW ..my first thought after looking at the pictures is that IT put all the ideas and work on the Monogram dolls and speciallly their outfits...they seem to be cohesive and coherent..except the lingerie doll 9 aren't the moniograms supposed to be Haute Couture?ReplyDelete
Whom ever asked if they ran out of ideas on the miny AG..is So right one is a good (but terribly unnecesary) hommage to the AG now 3 is just plain desperate...
The Studio 54 line is pretty but just that the hair does nothgin for me, actually i think that they took the theme too literal, they could have done the same dresses with a much modern adn edgy hair style and they would have given collectors a much versatile doll....
the Kyory Gift set comfuses me..wher eis she going/ did they spend all the money o the beads for the small dress and forgot aboutt eh gown?....Another bow in the front? ( OV Agnes and Dania) ...The bussiness suit..why???
The Nu face dolls are OK to me...
No are Jordan adn Eugenia touring with Britney or the PussyCat dolls?...The fashions are terribly..and natalia poor thing she went from evil caniving bitch to Disney princes... maybe she'll be training shamu next sumer?
@Dolling_Boy: Adrian you are soooo funny. Training Shamu? LOL.ReplyDelete


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Yet again, the former Soviet East has produced the luckiest driver in the world. You won't believe he walks away unscathed from this crash.
We're pretty sure this dethrones the last luckiest driver in the world, who also hailed from the Eastern Bloc. Good thing every car over there runs a dash cam, or we'd never see any of this insanity.
(UPDATE) The person seen stepping out of the car was the passenger in the vehicle. The driver also survived, but was hospitalized with broken ribs, reports Russia's KP40.ru.
(Thanks to everyone for the tips!)


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To raise awareness about earthquake preparedness, Sun City residents and staff will participate in the Great Central U.S. ShakeOut, a multi-state earthquake drill, at 10:15 a.m. Thursday.
Sun City is the only homeowner association/retirement community in the state signed up to participate.
Coastal South Carolina actually lies near a fault line, meaning an earthquake in the Lowcountry is a very real possibility. Sun City employees and residents will participate in the ShakeOut drill, and "Drop, Cover and Hold On" for at least one minute as if a major earthquake was happening.
Sun City residents will receive an automated phone call alerting them of the drill, which will also allow the Community Association to test its resident alert system.
"Disasters are not something that we like to think about. Living on the coast, we realize that we are in a tropical storm and hurricane zone, but earthquakes are not something most of us think about living Sun City," said Tonja Flanagan, the community standards director for Sun City. "The main goal of this activity is to raise awareness and educate."
The ShakeOut drill was created in California three years ago to raise awareness about earthquake preparedness. This is the first year that people in 11 central U.S. states will participate. The Great Central U.S. ShakeOut, organized by the Central United States Earthquake Consortium, is held on April 28 to mark the bicentennial of large earthquakes near New Madrid, Mo., in 1811 and 1812, according to the ShakeOut website.
So far, more than 2.8 million people in Alabama, Arkansas, Georgia, Kentucky, Illinois, Indiana, Mississippi, Missouri, Oklahoma, South Carolina and Tennessee will participate in the ShakeOut.


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Vic boy buried by snow an 'angel'
A little boy who died in Victoria's snowfields was happily playing with a snowman he built when he went missing.
Akhtar Javed, father of seven-year-old Haadi Akhtar, said his children had been delighted to come back to their chalet and find no one had wrecked the snowman they built.
"He came and hugged me and hugged my wife and said `thanks mum to bring us here, thanks dad to bring us here'," Mr Javed told the Seven Network on Friday.
"They were so happy to see their snowman still alive, nobody destroyed or wrecked the snowman."
Minutes later, his daughter said she couldn't see him, Mr Javed said.
Haadi was found unconscious and completely buried in snow about 6.30pm (AEST) on Wednesday near a chalet, nearly two hours after he went missing.
He was found just 40 metres from his siblings after wandering off while they were playing in the snow.
"It's very hard for us to cope. We're going through a very difficult time at the moment," Mr Javed told reporters.
"We lost our kid so we don't want anyone to lost their loved ones."
Mr Javed said he thought the snow would be a safe place for his Roxburgh Park family to have fun.
"The sorrow is so deep we can't forget our son. We'll never forget our son," he said.
Family friend Atif Mirza, whose son Zain went to school with seven-year-old Haadi, said the boy was an "angel".
"He was a lovely, lovely kid," Mr Mirza told AAP.
"He was very intelligent and smart."
Haadi was found buried by snow which came loose from his lodge, hiding him from his family.
Mr Mirza said it wasn't the family's first time in the snow.
"The kids were so excited and pushing their parents to take them to the snow," he said.
"They are going through a pretty tough time, both mum and dad."
Mr Mirza said Haadi and his four-year-old brother had built a snowman and they were playing in the snow when Haadi wandered off a short distance.
The family initially thought someone had taken him.
Haadi was taken to Mt Buller Medical Centre but later died from cardiac arrest after doctors spent "significant time" trying to revive him, Ambulance Victoria said.
A service to commemorate Haadi was held on Friday.
Sorry we are not currently accepting comments on this article.


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A Response to the Recent U.S. Election from Thich Nhat Hanh
November 7th, 2004
For those of you who voted for John Kerry, we must look deeply to see the John Kerry elements in George Bush. In this long and difficult campaign, Bush has learned many things from Kerry and those who voted for him. We have to see that they inter-are. If there had been no election, Bush wouldn't have questioned his positions or his approach. He would have been able to assume that his way is best. But he almost lost the election, and he is aware that at least half of the American people don't believe in him. Now, because he almost lost, he is more humble and must realize that if he doesn't listen to the other half of the American people, there will be a big disturbance in the country. So we have to see that now all of us are in him. Those of you who didn't vote for him are in him, are a part of him after this very close presidential race.
We have to help our government so that a president elected by fifty-one percent of the population will not serve just that fifty-one percent but the whole country. We need to keep speaking out, daily letting our government know what we want, expressing our insight and understanding. We need to be very present, very firm, and constantly let the government know we are here. We can support them in our own way, through being present, calm, lucid, and compassionate. Being compassionate doesn't mean we surrender and give up. It means we see clearly that our country, our government is us and it needs our help. Compassion means acting with courage and deep love to help manifest what we know our country is capable of.
Historically it has happened that the agenda of the left has been realized by the right. We have to speak out and keep speaking out, and it is possible that the Republicans will accomplish what the Democrats, what the left, had hoped to realize had they won. We also need to remember that even if Kerry had been elected, he would also have had to partly realize the wish of those who voted for Bush, and it is not certain that he would have been able to stop the war in Iraq.
Nothing is lost because we are in President Bush. There is a loss only if we respond with anger and despair. We have to continue on, to continue our practice, and remain strong in our role as bodhisattvas, helping the other half of our country by our firm, clear, and compassionate action for peace—the kind of peace in which both sides win because there is mutual understanding.


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Pakistani Girl Forced to Marry as Compensation for Uncle's Crime
Practice is Prevalent in Conservative Tribal Areas
GRILAGAN, Pakistan—Eight months ago, 11-year-old Amna was married off to a man three times her age to settle a crime her uncle had committed.
The uncle had raped another girl in the village, according to tribal elders. Following tribal custom prevalent in highly conservative parts of Pakistan, the elders gave Amna and her 17-year-old cousin, Zulhaj, to that girl's family. Nobody asked their opinion.


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I am building a web application to facilitate the handling of approximately 2500+ historic maps. I think it would be too difficult for our users to search for specific maps in an ordinary layer tree.
Is there some way to implement a layersearch in a GeoExt/Geoserver stack?
I'd be grateful for any idea how to deal with that even if it's not an "out-of-the-box"-solution.


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Difference between revisions of "Presidents' Programs"
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== ALA President's Program ==
== ALA President's Program ==
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Revision as of 11:54, 7 March 2008
ALA President's Program
Sunday, June 29
3:30 pm - 5:30 pm
The focus will be a media-rich program including segments from WGBH-Boston's "Between the Lions" Head Start Initiative and Roy Boney, Jr.'s Claymation Animation Program with tribal schools. Roy Boney, Jr. is a Cherokee Illustrator, graphic novelist, and animator, a Prairie Band Potawatomi Nation Fellow, Sequoyah Research Center, University of Arkansas at Little Rock. The program will also provide an update on planning programs around "We Shall Remain," the January/February 2009 American Experience PBS series.
Intellectual Freedom: A Core Value
Saturday, June 28
10:30 am - 12:00 pm
Track: Issues & Updates
The 2008 AASL President's Program will revisit the school librarian's commitment to one of the two core values of the profession, intellectual freedom. Susan Patron, author of the controversial 2007 Caldecott Medal book and long-time Juvenile Materials Collection Development Manager at the Los Angeles Public Library, The Higher Power of Lucky, is the keynote speaker, followed by a reaction panel which includes an elementary school librarian (Catherine Beyers, Lacrosse, WI), a secondary school librarian (Cassandra Barnett, Fayetteville, AR) and an author/member of "AS IF! Authors Support Intellectual Freedom."
Predictably Irrational: The Hidden Forces That Shape Our Decisions
Monday, June 30
1:30 pm - 3:30 pm
Track: Administration & Leadership; Leadership & Management
The 2008 ACRL presidential initiative has focused on the recruitment and retention of the new generation of librarians and thinkers in the profession. Exploring strategies to enhance creative thinking, innovation, and vibrancy in the library workplace, the president's program will highlight the research findings of Dr. Dan Ariely, author Predictably Irrational: The Hidden Forces That Shape Our Decisions. A panel of new generation librarians will explore with Dr. Ariely how to enhance logical thinking to create workplace vibrancy.
From Here to Eternity: the challenges of managing Oscar's very special collections
Monday, June 30
10:30 am - 12:00 pm
Track: Non-Track
The ALCTS President's Program will feature
the Margaret Herrick Library of the Academy
of Motion Picture Arts & Sciences. Its
collections include relevant working books
and periodicals plus numerous special collections
containing 10 million photographs,
30,000 posters, and huge numbers of movie
scripts, scores, and production and costume
designs. These internationally obtained materials
exist in a variety of formats. Issues
revolving around collection development,
acquisitions, preservation, technology, legal
rights, and metadata will be explored.
Speakers: Dr. Linda Harris Mehr, Director, Margaret Herrick Library, Academy of Motion Picture Arts & Sciences
Touchpoints: Strengthening Families, Building Communities, featuring keynote Dr. T. Berry Brazelton
Monday, June 30
8:00 am - 10:00 am
Track: Children & Young Adults; Early Literacy
Based on T.B. Brazelton's pioneering infant
research, and more than 60 years of listening
to parents and children, Touchpoints is
a way of understanding and participating in
family development. Libraries are well positioned
to establish partnerships with community
agencies serving young children and
families, bringing together child and family
development expertise and resources, with
space, program and resource materials so
that families can be together in a safe and
welcoming environment, where awareness
for the importance of early learning can be
increased, access for families to services
and resources can be expanded, and parent/
caregiver abilities to meet the needs of
their very young children can be enhanced.
Speakers: T. Berry Brazelton, M.D., Brazelton Touchpoints Center
A Year with New Opportunities
Saturday, June 28
1:30 pm - 3:30 pm
Track: Administration & Leadership; Trustee
Gary W. Moore, author of Playing with the
Enemy and winner of the prestigious Sam
Walton Leadership Award, will share the
remarkable story of his father whose potential
pro-ball career with the Brooklyn Dodgers
was interrupted by Pearl Harbor and his
enlistment. The astonishing story of Gene
Moore's life in and out of baseball is an exciting
and often heart-wrenching saga filled
with memorable characters from an extraordinary
time in U.S. history. Gary Moore will
sign copies of his book, which will be given
away free, at the end of this program
Speakers: Gary W. Moore, Author
The Universal Library: Mind, Body, and Soul
Sunday, June 29
8:00 am - 10:00 am
Track: User Services
Panelists will discuss strategies for designing and maintaining a collection (physical and virtual), a physical plant (building) that everyone can access with a staff, which is diverse and reflective of all of the citizens.


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Evolution is offensive, cos it tells us we've evolved,
From a monkey, from a lungfish, from a worm!
Now New Hampshire's Gary Hopper think's he's got the problem solved
So we're doing something differently this term.
He'd require science teachers, when they're speaking to their class,
To instruct them not to stick with any theory—
Cos today it's evolution, but tomorrow that will pass—
All this change in science makes a man grow weary
We should teach the controversy! There are several points of view!
Evolution's merely one belief in many!
There's alternatives aplenty, like creationism, too,
If we're lucky, then we won't have time for any!
While we're at it, let's see challenges to gravity as well,
And the theory that the earth is truly round
And the notion of a "molecule", an "atom", or a "cell",
Throughout science, we see challenges are found!
While the scientists will tell us that one theory is the best
There are others they consider not so nice
Which the children should attend to, thanks to Hopper's new request
And New Hampshire's reputation pays the price
The good news is, the linked article (here it is again) isn't just a report that the bill has been proposed, but actually addresses the idiocy of Hopper's Folly. What's more, the comments on the article (thus far) are on the side of right.
For another take on this, check out the Spanish Inquisitor.


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In news that would have the characters on 'The Big Bang Theory' salivating, Kaley Cuoco (who plays hot girl-next-door Penny on the hit sitcom) is dating Hollywood's newest Superman, Henry Cavill.
It's a match made in nerd heaven. Aka Comic Con.
"They are totally hot for each other," a pal revealed to Us Weekly. Said yet another source, Cavill is "a massive 'Big Bang Theory' fan" and "has always wanted to date her."
The couple have been decidedly hush-hush about their relationship, but in a now-telling tweet from a couple weeks ago, Cuoco revealed that she loved the new 'Superman' and you should too — and to prove it, she included a snap of herself drooling lovingly at a promotional photo of the guy we now know is her new man.
Her missive included the commentary, "Everyone go see 'man of steel.' It's fantastic in every single way."
What we're saying is last month you got trolled by Penny … and you didn't even know it.


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Don't be in the dark; Download WCVB's Smartphone App to stay connected
If the power goes out as a result of the upcoming storm, stay connected with WCVB and WCVB.com.
Download our smartphone app for the latest news, breaking alerts, and watch live streaming video before, during and after the storm.
Download for iPhone/iPad | Download for Android Phones
This weekend, WCVB will provide continuing coverage on TV, online, and on your phone as the StormTeam continues tracking Sandy.
Saturday, watch the Eyeopener and Good Morning America from 5 - 9 a.m. Catch our evening news after college football at 7 and 11:30 p.m.
On Sunday, our Eyeopener and Good Morning America coverage will run from 5am - 10am. Our team of reporters and meteorologists will be tracking the latest position of the storm at 6pm, and during a special hour-long newscast from 7pm - 8pm Sunday. NewsCenter 5 at 11 Sunday night expands to a full hour from 11pm until midnight.


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Texas Court Allows Cops To Search First, Acquire Warrants Later
from the Fourth-Amendment-now-filling-out-change-of-address-forms dept
The Texas Court of Criminal Appeals has just made it much easier for Texas cops to skirt the Fourth Amendment. Why secure a warrant when you can just take a look around beforehand to see whether a warrant's worth pursuing? (h/t to Techdirt reader K Marshall)
The case - Wehrenberg v. State - involved a drug bust in Parker County in which officers received a tip from a confidential informant that the defendant and others were "fixing to" cook meth later that evening. Three or four hours later, after midnight, officers illegally entered Mr. Wehrenberg's residence "without a search warrant and without consent," handcuffing everyone inside and escorting them all into the front yard, conducting a "protective sweep" of the house. Then they held everyone outside in handcuffs for an hour and a half while one of the officers went to find a judge to secure a search warrant. The search warrant affidavit did not inform the judge that officers had already entered the premises and detained everyone found in the house. The judge issued a warrant, police found contraband, and charged Mr. Wehrenberg with a second degree felony, for which he was convicted.There are several problems with what went on here, not the least of which is the Texas Court of Criminal Appeals' determination that these officers (in effect) did nothing wrong. According to the court, the pre-warrant search may have been illegal but the evidence can't be excluded because its existence was confirmed by an "independent source."
The dissenting opinion from Judge Lawrence Meyers takes issue with the entire decision, first noting that no criminal activity was taking place when the cops made their first, warrantless sweep of the premises.
Meyers said the confidential informant's tip that Wehrenberg was "fixing to" cook meth wasn't independent evidence but a prediction.This is hardly heartening news. No one -- at least no one on this side of the blue line -- is in any hurry to start prosecuting people for crimes they haven't committed yet. We've already gone Orwellian with our domestic surveillance. Why push to go Dickian in the law enforcement arena?
"Search warrants may now be based on predictions of the commission of future crimes," the judge lamented.
This rhetorical question largely doesn't matter. As Scott Greenfield points out, criminal conspiracy laws already hold us liable for acts that haven't yet occurred.
While the question of whether "fixing to" is sufficient to establish probable cause to believe that a crime will be committed, and thus provide an adequate factual predicate for a warrant, is a bit tricky, it's not all that surprising. When it comes to narcotics cases, already watered down from the demands applied to pretty much any other crime where, under federal law, no overt act is needed in a conspiracy to prove the crime, there doesn't seem to be a floor below which courts won't allow police to go.The more problematic aspect is that the ruling allows cops to acquire search warrants post-search as long as they have a confidential informant ("independent source") who can fill in the blanks. This is where the real abuse begins. The usual abuse (detailed above), encouraged by the War on Drugs, will continue unabated. But Fourth Amendment protections are going to start gathering dust in Texas.
Here's what Judge Meyers had to say about the officers' actions now being condoned by the state:
"Had the officers entered the home and found the occupants only baking cupcakes, the officers would not have bothered to then obtain the warrant at all," wrote CCA Judge Lawrence Meyers. "It was only after unlawfully entering and finding suspicious activity that they felt the need to then secure the warrant in order to cover their tracks and collect the evidence without the taint of their entry."Not only that, but any excuses about "exigent circumstances" are equally weak.
[T]he 3-4 hour delay [is] completely inconsistent with the idea that the officers had to conduct an unwarranted entry because of exigent circumstances or to prevent destruction of evidence. Had such circumstances actually existed, the officers would have proceeded immediately to the residence rather than delaying for the number of hours that they did. There was more than enough time to secure a search warrant before the officers' intrusion into the premises, but they deliberately chose not to attempt to obtain it until after they had conducted the unlawful entry.This is where the real perversion of justice lies.
The argument adopted here was that the search warrant, based on the snitch, was independent of the intervening grossly unconstitutional search. The problem here is that this is utter, unadulterated nonsense, and a gross bastardization of a horrible concept that rewards deliberate constitutional violations…A clash between federal and state-level statutes governing the admissibility of illegally-obtained evidence has now become a Texas-sized loophole for local law enforcement. As it stands now, LEOs in Texas can perform illegal searches and simply "launder" the evidence by securing warrants post-search. This should give Texas cops a 100% success rate in serving warrants, what with its new Pre-Search® program being given the thumbs-up by the highest appeals court in the state.
[T]here was no attenuation of the "taint," but at best an intentional circumvention of the 4th Amendment. They left out of the warrant application that they took the snitch's information, violated the Constitution and then sought a warrant in a post hoc effort to legalize their search.
Filed Under: 4th amendment, search, texas, warrants


text:
The Wind-Up Bird Chronicle
- Letto da: Rupert Degas
- Durata: 26 ore e 6 min
- Versione integrale Audiolibro
- Data di pubblicazione: 01/01/2006
- Lingua: Inglese
- Editore: Naxos AudioBooks
Sintesi dell'editore
Altri titoli dello stesso
Cosa ne pensano gli iscritti
- Shelley
- 14/08/2007
Jumping into a dark well to think to the point of starvation, characters that resemble caricatures, seem to appear and disappear with names such as Crete and Malta, a cat that comes back with a different tail... all this makes this book odd and amazing. This is my second book by this author and I remain intrigued by his storytelling and style. My issue is only with the violence, where the author dwells on wartime atrocities, taking care to describe torture techniques a bit too graphically for my taste. The audio is effective and keep you going until the end.
22 su 22 utenti hanno ritenuto utile questa recensione
- Amazon Customer
- 21/12/2009
Bold. Funny. Horrific. Ethereal. And Fantastic in all senses of the word. Echoes of Dostoevsky, Kafka, Beckett. There are many, many memorable characters and scenes; but Murakami creates through these only the major pieces of a larger puzzle. He appears to be drawing parallels between two kinds of relationships (a) the interactions (loving, mundane, barbaric, kind, cruel, lustful, comic, duplicitous) humans have with each other and (b) the interactions (same list, pretty much) we have in our minds with our past, present, and future selves. These relationships cross and fade into each other so smoothly that neither we nor the characters are completely sure where one ends and another begins. A really wonderful book that feels like it will provoke thought for quite awhile.
17 su 17 utenti hanno ritenuto utile questa recensione
- Jo Ann
- 10/09/2006
Extremely worthwhile
I had read this book in hard copy. I enjoyed it even more listening to this audio version. The reader is brilliant, as is the novel. Be prepared for a surreal yet vivid, intriguing experience.
27 su 28 utenti hanno ritenuto utile questa recensione
- R. Caviness
- 23/02/2007
Fun Journey, but Lack of Resolution
3.5 stars. If you like Murakami, you will probably enjoy this. If you have not yet read a Murakami novel, I wouldn't recommend starting with this one -- it might prevent you from reading some of the most fun and engaging literature of modern times. Try Kafka on the Shore, perhaps.
Although generally engaging (I really did enjoy listening to the book), there are too many subplots that aren't adequately resolved, which left me feeling somewhat unsatisfied when I finished the book.
I've read elswhere that the original Japanese version was "stripped down" for the English translation as it was too long, and as a result, certain storylines being cut short. This is plausible.
The narrator is excellent.
12 su 12 utenti hanno ritenuto utile questa recensione
- Stevie
- 01/10/2006
very enjoyable listen
I found this to be a very entertaining story. This is not the type of book I usually buy, and I'm glad that I tried it! It's a wonderful tale with several other stories within. It is well written and well read - very enjoyable.
11 su 11 utenti hanno ritenuto utile questa recensione
- T. Moyer
- 19/10/2006
What a fun read. The story is a skillful tale that blends and blurs reality and unreality; and which is which? Ultimately all seem to be only facets of the same reality. Maybe that is too ambitious a description. It is enough to say that the story is interesting, mysterious, comedic, thought provoking but above all entertaining throughout. The narrator is excellent, and every character has their own personality and voice. I enjoyed this book very much.
21 su 22 utenti hanno ritenuto utile questa recensione
- Chiharu
- 12/12/2006
Another Haruki's world
I actually read it in Japanese first, and was curious enough to listen to the English Audiobook. It is in a way scary because I did have my own imagination of the world of this book. However, I was NOT dissapointed. This is pretty good interpretation and performance. I loved it and listened three times so far.
17 su 18 utenti hanno ritenuto utile questa recensione
- Jamie
- 25/08/2006
Enthralling from chapter 1
I just downloaded this. I jump around a bit from genre to genre, but I alway gravitate to longer selections for the value and engagement. I'm not quite sure where I would put this as far as genre goes, but I was hooked after only a few chapters. The engineering is of good quality and the narrator keeps my attention and has good enunciation and pace. The story- well I will let you decide (I hate spoilers), but I can say this it's hard to put away once you get in to it. There is mild sexual content so be warned, but for anyone well read it is very tame.
26 su 28 utenti hanno ritenuto utile questa recensione
- Roger
- 29/12/2007
Completely weird and undescribeable
As I slowly got into this book, I laughed out loud at times, was perplexed and filled with wonderment, and startled by some characters and actions which are so strange, others so real and horrific.... it is a very odd book. I doubt if I could "read" it but I loved listening to it.
24 su 26 utenti hanno ritenuto utile questa recensione
- Lili Von Shtupp
- 02/11/2006
Exceptional narration.....Awesomely quirky story
Let me begin by saying that this is a very strange story indeed. It will stay with me for a good while. I do want to emphasize, however, that I feel that the narrator did an exceptional and very entertaining job with very difficult material.
I loved most parts of this story and ...well, some parts were horrifically fascinating. Like a gruesome traffic accident that you cannot look away from even though you know you'll have nightmares from the sight.
This is not a book that has a "specific" story but rather an intimate portrait of a microcosmic slice of humanity. I cried, I laughed (especially at the neighbor girl, May [sp?]) and I cringed. In fact, I believe I ran almost the entire gamut of emotions that I am capable of...including some disappointment in the way in which the author finished this story. I don't always expect everything wrapped up in neat tidy bundles but I felt a little flat, so to speak, in the last act.
Would I have missed this opportunity to have entered this world and met these characters? Emphatically no. Would I have liked a slightly different conclusion? yes.
15 su 16 utenti hanno ritenuto utile questa recensione
- Martin
- Inverness, United Kingdom
- 04/05/2009
A very different listen
It is not really like anything I have listened to or heard before, you are not sure what is meant to be reality or not, as you listen you have absolutely no idea at all where the story is going and what will be in the next chapter. That sounds like something bad but this is the genius of the book, you will be wondering all the way through how and if all of the plot lines and characters are going to tie up. The story blends reality and dream together with a bit of supernatural. As others have said the narration was extrordinary. A very enjoyable experience, but be prepared for something quite different to what you may be used to in terms of how you are used to thinking a story "should" go. Not a fast paced story, requires time and patience but it is a very rewarding experience.
39 su 39 utenti hanno ritenuto utile questa recensione
- Glawsmole
- 01/05/2010
Long but never boring
This is the second of Murakami's novels I've listened to and I enjoyed this one very nearly as much as Kafka on the Shore. Again this is a very fine novel; mystical, poetic, brutal, uplifting. The author seems to have an uncanny knack of being able to tell a great story without having much of a story to tell. If you boil down the actual events the book, nothing much happens, but there is this tremendous sense that there is an order to the world. When something disturbs that order, Murakami's protagonists have to embark on an odyssey before they can get back where they belong with the various elements of their world order in their rightful places.
I suspect this is a big thick book if you see it in a bookshop, yet not a word seems out of place or superfluous.
Vast sections of the book are told in side-stories of minor characters and yet everything that is told has its place and pulls the reader along with it. It's complicated without being convoluted.
I never once felt bored in the 20 hours of listening and that must be a difficult thing for a writer of this type of work to achieve.
30 su 30 utenti hanno ritenuto utile questa recensione
- Liz
- old windsor, United Kingdom
- 13/04/2013
Best audible book so far
I was completely captivated by this book, mainly because of the superb narration by Mr Degas. The story, if you can call it that, alternates between mundane, surreal and disturbing, and sometimes a combination. Not a comfortable listen, but I really didn't want it to end. Haven't listened to anything as interesting before or since. If you read the other reviews it seems that everyone has got something different from it, which I suppose is the point. Will definitely listen again to this one. And I am looking out for more by the narrator, who I thought was fantastic. Would give it more stars if I could.
18 su 18 utenti hanno ritenuto utile questa recensione
- Kenton
- Haverhill, Suffolk, United Kingdom
- 23/12/2006
pure genius
the most original book i've listened to for years. this is a fantastic story, almost a horror story considering how strange quirky some of the characters are. Some bizarre dream sequences and events mean you are not really sure what is real or not. The previous reviewers likening Haruki to David Lynch is spot on.
Very well narrated too, going from gravel-voiced old men to female sex scenes without making you cringe. The narrator of Dan Brown's books should take note!
17 su 17 utenti hanno ritenuto utile questa recensione
- Anthony
- Bassingbourn, South Cambridgeshire, United Kingdom
- 12/03/2009
Verbosely captivating
This is a captivating chronicle of Mr Wind Up Bird - where the main character goes into extremely verbose detail about everything he does - and everything other people have told him.
In real life I would hate this - just get to the point - but in this book you welcome the descriptiveness of everything - even down to him making some spaghetti in chapter 1.
This book is long but it isn't boring. Often when people talk to you they touch on something and you are curious about the things they touch on. The author of this book seems to know you are curious and goes off on tangent after tangent describing and filling in the gaps that you just assume will come up at some point.
The book remains moderately sane for the first half - then gets weirder and weirder - but a good weird that leaves the reader curious to contine.
The audio book reader shows great talent at differentiating the voices of the different characters - it is something often lacking in other audibooks.
I thoroughly recommend this audiobook - give it a go.
32 su 33 utenti hanno ritenuto utile questa recensione
- Joe
- aylesford, kent, United Kingdom
- 25/08/2010
The Wind-Up Bird Chronicle
For my first experience with audio books I chose this, my favourite ever novel.
This is probably not usually the best way of going about things but this time it worked out well for me, the narrator has a fantastic delivery, with a great variety of characters, all sounding very natural and authentic. Add this to the gripping and mesmeric story and you have a sure fire winner. Bring on more.
13 su 13 utenti hanno ritenuto utile questa recensione
- Kayd100
- 03/05/2007
I think I'm turning Japenease
What a brilliant listen. Gives you an insight into the scary labyrinth that is Murakami's imagination. All the characters range from quirky (at the very least) to the outright bizarre, this serves as a wonderful contrast to the lead, whose happy (but somewhat dull) existence is about to be overturned. Not everybody's cup of tea, but really great if you occasionally like to come out of the comfort zone.
29 su 31 utenti hanno ritenuto utile questa recensione
- Richard
- LondonUnited Kingdom
- 06/09/2010
Tends towards incoherence
This is my first stab at Murakami, and I'd heard this was supposed to be his breakthrough, so thought I'd give it a shot. It has an intriguing surreal quality to it, counter-pointed with rather stark, straightforward prose. And, as far as its audio version goes, it is superbly narrated.
The book itself, though, is a very long listen, which in and of itself is not necessarily a bad thing. However, because the story has no linear plot to speak of, my mind began to wander. There was little to hold on to, no thread to pull me through this roughly 24 hours worth of attention I needed to give to it. So, when I got to the third and final installment and saw that I had yet another eight hours to go, I must admit my heart dropped a bit. But I've slogged on and, upon finishing, felt good simply for having gotten through it. If self-consciously artistic literary fiction that purposely does away with plot and narrative structure is your thing, by all means, take this review as praise. If you're looking for a great yarn to captivate you and keep you desperate to know what will happen next, well, look elsewhere. I won't be rushing out to read another Murakami anytime soon, though will perhaps look at a shorter work if I do.
30 su 33 utenti hanno ritenuto utile questa recensione
- Moose Molloy
- 05/02/2009
Is it literature - does it matter?
This hits me like Beckett does rather than Chandler - it paints patterns which hypnotise and challenge the reader at every turn without being half as pretentious as I sound here. Only Marquez has had this sort of impact on me in the last 20 years. It would be my top read of the decade - but his Kafka on the Shore is even more arresting. This great Japanese writer has told me more about the world I have lived in than any British writer I know.
10 su 11 utenti hanno ritenuto utile questa recensione
- Susan
- Redditch, WOR, United Kingdom
- 24/01/2007
24 hours and I think I've missed the point.
I was tempted to give up with this book on several occasions but stuck it out to the end in the hope that the conclusion would bring all the strands together. Unfortunately that didn't really happen for me.
I found the war stories very compelling but couldn't really empathise with any of the many characters. The brother-in-law was central to everything but by the end of the book I still couldn't work out the motivation behind his character. It was probably all a bit too deep for me!
The narrator had a challenging job in giving voices to a range of characters. Although he succeeded in making each one distinct, I personally found some of the characters' voices grating and difficult to listen to.
14 su 16 utenti hanno ritenuto utile questa recensione


text:
BILLY Stark's Scotland Under-21s picked up a credible draw with Greece as they completed their preparations for the 2015 European Championships qualifiers.
The Dark Blue youths fought back from a goal down against their hosts in Korinthos to level through Celtic striker Tony Watt's second-half penalty.
The result will be used as a stepping stone, as the Scots now aim to bounce back from their failure to qualify for this year's finals in Israel by reaching the next tournament, which will be staged in the Czech Republic in two years' time.
The team have been drawn against Holland for the second qualifying campaign running and will also have to overcome Luxembourg, Slovakia and Georgia when their Group Three bid begins next month.
Stark handed debuts to Partick Thistle midfielder Stuart Bannigan and Hearts teenager Callum Tapping, with Stuart Armstrong of Dundee United taking on the captain's armband.
And the Scots almost got off to a flying start as first Sheffield Wednesday midfielder Rhys McCabe was denied just five minutes in by Greek goalkeeper Andreas Gianniotis, while Fraser Kerr failed to bury a header soon after.
The visitors were made to pay for those misses when they fell behind after 13 minutes as the Greeks struck first in front of a 4,000-strong crowd.
FC Amkar Perm striker Nikos Karelis got himself in between Falkirk defender Kieran Duffie and Motherwell youth Kerr at the back post to head the home side in front from Everton forward Apostolos Vellios' cross.
Despite their early dominance, Greece failed to add to their lead as keeper Chris Kettings twice saved from Vellios to leave the deficit at just one goal at the break.
But with 13 minutes of the second period gone, Watt struck his fourth goal in six games for the Under-21s with his spot-kick success.
Kilmarnock teenager Rory McKenzie had been bundled over in the area by Charalambos Lykogiannis and Watt made no mistake from 12 yards as he sent substitute keeper Stefanos Kapino the wrong way.
And yet the hosts still had chances to win it, only to miss four decent opportunities in the space of eight minutes.
First Costas Triandafillopoulos put a header wide from 12 yards just after the hour mark, before Kettings parried again from Giannis Gianniotas and then Panagiotis Ballas.
Then on 69 minutes, Dimitris Kolovos put another strike straight into the keeper's arms as the Blackpool man kept the Greeks at bay almost by himself.
A final chance fell for the home side with five minutes left after Gianniotas had skipped past four challenges, but the Aris forward put his shot wide from 10 yards out.


text:
Industry News for
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Klean Athlete™ Has Arrived
Douglas Laboratories® introduces new line of NSF Certified for Sport® nutritional supplements for athletes
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† These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure or prevent any disease.
About Klean Athlete™
About Douglas Laboratories®
About NSF®
About Atrium Innovations
Chiropractic Events


text:
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text:
Ars took a look at the iPad as a tool for IT professionals this week and discussed what Intel's Ivy Bridge processors could mean for the MacBook Pro. Those were the most popular posts in the Apple section this week, but we also discussed WWDC dates, the WWDC ticket fiasco, Tim Cook's comments on Apple's patent wars during the company's second quarter conference call, and more. Need to catch up? You've come to the right place.
For today's IT professional, the iPad is an addition, not a replacement: It has its shortcomings, but the iPad is worth more to a sysadmin than you'd imagine—thanks to the size of the device itself and a slew of handy applications.
MacBook Pros could go all-quad-core with first-wave Ivy Bridge processors: Apple could use the mobile processors Intel released on Monday to revamp its MacBook Pro line if it chooses to go all in on quad-core MacBook Pros.
Security firm claims Mac security is "10 years behind" Microsoft: Kaspersky Lab is sounding the Mac malware alarms once again, but may be unfairly criticizing Apple by suggesting it is 10 years behind Microsoft when it comes to OS security.
Apple: we could settle patent fights if others would "invent their own stuff": Apple announced a record second fiscal quarter on Tuesday, but had some extra comments to offer during the call about whether it would ever settle its patent disputes and the company's thoughts on merging the iPad with the MacBook.
Apple's iBooks Author: the iTunes of self-publishing apps?: Apple hopes it can combine the iPad's tablet dominance with its traditionally strong desktop software to get a foothold in digital textbooks. Dave Girard sees whether Apple's iBooks Author is capable of a self-publishing revolution—or if it's a dud.
Flashback infections not waning after all; 650,000 Macs still hijacked: Estimates reported earlier this week showing a sharp decrease in the number of OS X machines infected by the Flashback malware are wrong, says a Russian antivirus provider. The true number suggests the botnet still has plenty of life left in it.
Every touch-based Apple product targeted by apparent patent troll: A company in Pennsylvania is claiming that a 2005 patent on "removing objects from a screen" applies to most of Apple's current product line, including iPhones, iPads, and even Macs.
Apple's WWDC 2012 will be June 11-15, focusing on iOS and OS X (Update: sold out): Developers can now rest easy: Apple has announced the dates for WWDC 2012, and the focus will largely be on iOS and OS X.
Can Apple revamp the WWDC ticket system? Does it want to?: The time window in which developers can buy tickets to Apple's Worldwide Developers Conference shrinks every year. This year, many noted developers ended up being left out. What can Apple do to make it easier for them? And does it even want to make things easier?
Update those Macs already! Yet another Flashback variant is out: There's a new Flashback malware variant on the streets, but if you've already updated your Mac to the latest version of Java, you won't have to worry much about it. At least until the attackers find a new vulnerability, that is.
Have a great weekend, everyone!
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