text:
- Research article
- Open Access
- Open Peer Review
Type and timing of adverse childhood experiences differentially affect severity of PTSD, dissociative and depressive symptoms in adult inpatients
© The Author(s). 2016
- Received: 29 February 2016
- Accepted: 14 August 2016
- Published: 19 August 2016
A dose-dependent effect of Adverse Childhood Experiences (ACE) on the course and severity of psychiatric disorders has been frequently reported. Recent evidence indicates additional impact of type and timing of distinct ACE on symptom severity experienced in adulthood, in support of stress-sensitive periods in (brain) development. The present study seeks to clarify the impact of ACE on symptoms that are often comorbid across various diagnostic groups: symptoms of posttraumatic stress disorder (PTSD), shutdown dissociation and depression. A key aim was to determine and compare the importance of dose-dependent versus type and timing specific prediction of ACE on symptom levels.
Exposure to ten types of maltreatment up to age 18 were retrospectively assessed in N = 129 psychiatric inpatients using the Maltreatment and Abuse Chronology of Exposure (MACE). Symptoms of PTSD, shutdown dissociation, and depression were related to type and timing of ACE. The predictive power of peak types and timings was compared to that of global MACE measures of duration, multiplicity and overall severity.
A dose-dependent effect (MACE duration, multiplicity and overall severity) on severity of all symptoms confirmed earlier findings. Conditioned random forest regression verified that PTSD symptoms were best predicted by overall ACE severity, whereas type and timing specific effects showed stronger prediction for symptoms of dissociation and depression. In particular, physical neglect at age 5 and emotional neglect at ages 4–5 were related to increased symptoms of dissociation, whereas the emotional neglect at age 8–9 enhanced symptoms of depression.
In support of the sensitive period of exposure model, present results indicate augmented vulnerability by type x timing of ACE, in particular emphasizing pre-school (age 4–5) and pre-adolescent (8–9) periods as sensitive for the impact of physical and emotional neglect. PTSD, the most severe stress-related disorder, varies with the amount of adverse experiences irrespective of age of experience. Considering type and timing of ACE improves understanding of vulnerability, and should inform diagnostics of psychopathology like PTSD, dissociation and depression in adult psychiatric patients.
- Childhood adversities
- Adult psychopathology
- Shutdown dissociation
- Depression
- Dose-dependent
- Type and timing
Adverse childhood experiences (ACE) shape the individual vulnerability and often precede psychopathology within and across diagnostic boundaries [1, 2]. Current models on etiology describe symptom severities mainly as a linear function of cumulative ACE, e.g. [2–6]. Besides the dose-dependent effect, recent evidence indicates a distinctive impact of type and timing of ACE on symptom severity experienced in adulthood, supporting the notion of stress-sensitive periods in (brain) development in childhood [7, 8]. The sensitive type and timing model offers an alternative (and complementary) explanation for dose-dependent effects, because alongside with the exposure to a variety of ACE, the likelihood of exposure to a specific type of ACE in a critical period increases as well. Both models (dose-dependent and sensitive type and timing) have been supported by empirical data, however not yet sufficiently contrasted in their predictive power for symptom dimensions shown to increase in intensity and frequency in response to adversities and trauma: symptoms of posttraumatic stress disorder (PTSD), dissociation and depression. These symptoms were chosen as prominent and comorbid in different diagnostic categories [9–11].
Cumulative or dose-dependent effects of environmental adversities have been quantified by trauma load, ACE load (multiplicity or number of event types; see [3, 6, 12]) or overall severity of exposure [13]. These measures are strongly interrelated [14] and assess the global level of exposure rather than the frequency of distinct adversities or traumatic event types. For instance, symptoms of PTSD have been reported to increase in a dose-dependent manner e.g., linked to the different types of traumatic experiences in a war and in displacement affected population [3] as well as to the severity of childhood adversities in a sample of German psychiatric inpatients [5]. Similarly, dose-dependent effects have been reported for symptoms of dissociation and depression in these patients [4, 5, 15, 16].
Moreover, the augmenting impact of certain types of ACE experienced at certain times during development ask for a broader perspective beyond an exclusive dose-dependent modulation. In particular sexual and physical abuse [17, 18], or emotional neglect and abuse [19] have been shown to increase levels of PTSD symptoms in adulthood. Further, more severe PTSD has been reported for individuals who were exposed to ACE at 3–5 years of age [20]. Other results suggest higher vulnerability to PTSD for exposure beyond the age 11 [21]. Dissociative symptoms (particularly the ongoing shutting down of sensory, motor and speech systems together with emotional overregulation) have been proposed to emerge in susceptible individuals as a defensive response from past highly proximal traumatic stress such as sexual abuse [22, 23]. This relation between sexual abuse and physical maltreatment in childhood and shutdown dissociation was confirmed in adult psychiatric inpatients with Borderline Personality Disorder and depression [15, 24]. Similarly, amplified symptoms of shutdown dissociation were related to different types of emotional neglect as well as non-verbal emotional abuse, and peer emotional abuse with peak vulnerability at age 13–14 in psychiatric patients with psychotic disorders [25]. More intense depressive symptoms have been reported to vary with exposure to emotional abuse and neglect [19, 26], or sexual and physical abuse [27, 28].
While results indicate that particularly ACE exposure before age 12 may predispose for the later development and course of depression [21, 29, 30], Khan and colleagues conclude from their detailed analysis of sensitive periods in a community sample (with a portion of 33 % of individuals with lifetime depression and 4 % of current clinical depression) a specific type and timing effect. More precisely, non-verbal emotional abuse in males and peer emotional abuse in women each at age 14 increased the risk for later diagnosis of depression as well as for current depressive symptoms [31].
While current results suggest vulnerable time windows particularly for sexual abuse, loss of a parent and traumatic experiences [7, 21, 29], understanding whether this sensitivity is type and timing-specific in their interaction with the vulnerability to mental illness requires a more comprehensive assessment of the various ACE in fine-grained developmental periods. Moreover, it is necessary to compare the predictive power of type and timing in relation to global parameters (multiplicity of ACE, overall severity of ACE) for symptoms of PTSD, dissociation and depression across different diagnostic groups. While both, a dose-dependent and a sensitive-period influence of environmental adversities have been examined in community samples and in clinical samples e.g., [3, 5], the present study directly compared both hypotheses within the same, larger sample of psychiatric inpatients. This transdiagnostic approach is in line with the proposed model for trauma-related psychopathology of the Research Domain Criteria by the National Institute of Mental Health, that suggests a link between psychopathology and abnormal neurobiology across disorders [32, 33].
In the present study a larger sample of inpatients with different mental disorders were comprehensively assessed for ACE and symptoms of PTSD, dissociation and depression (irrespective of their primary diagnosis). Our main objectives were (1) to replicate the relationship between exposure to global scores (duration, multiplicity and overall severity) as well as trauma load in childhood and adulthood, and (2) to compare the predictive power of type and timing to the predictive power of global scores (duration, multiplicity, overall severity)—both derived from the Maltreatment and Abuse Chronology of Exposure (MACE) Scale [14]. Moreover, we sought to establish the direction of strongest predictors using the best fitting linear regression model for each symptom dimension.
Ethics statement
Prior to the assessment each participant provided written informed consent. All patients were in post-acute state and capable of participation as confirmed by the responsible psychologist or psychiatrists. The study was reviewed and approved by the Institutional Review Board (Ethics Committee) of the University of Konstanz.
Participants and setting
Sample characteristics: demographic data and diagnostic categories according to the ICD-10
M (n)
Demographic Data
Female sex (n, %)
41.9 %
Age (in years)
Number of Hospitalizations
Education (in years)
University entrance diploma (n, %)
44.2 %
Clinical Characteristics
ICD-10: F1-F19: Mental and behavioral disorders due to psychoactive substance use
35.7 %
ICD-10: F2-F29: Psychotic spectrum disorders
48.8 %
ICD-10: F30-F39: Affective Disorders
41.9 %
ICD-10: F40-F48: Neurotic, stress-related and somatoform disorders
32.6 %
ICD-10: F50-F59: Behavioral syndromes associated with physiological disturbances and physical factors
3.1 %
ICD-10: F60-F69: Disorders of adult personality and behavior
23.8 %
Number of Different Diagnosis Across Categories (M, SD)
Single Diagnosis (n, %)
31.8 %
One Comorbid Disorders (n, %)
51.2 %
Antidepressants (n, %)
38.8 %
Atypical Neuroleptics (n, %)
63.6 %
Symptom Severities
Shutdown Dissociation (M, SD)
PTSD Symptom Severity (M, SD)
Depression Symptom Severity (M, SD)
Measures and instruments
Childhood adversities were assessed by interview using the MACE Scale [14, 24]. The MACE captures the exposure to ten types of ACE (parental physical and verbal abuse, parental non-verbal emotional abuse, familial and non-familial sexual abuse, witnessed physical violence towards parents, witnessing violence towards siblings, peer emotional and peer physical violence, emotional and physical neglect). The scale shows excellent test-retest reliability and convergent validity to the childhood trauma questionnaire [13, 14, 24]. For each of the 75 items binary responses were recorded and for positive responses the age of occurrence specified for every single year of life up to age 18. The raw data were used to define type and timing specific scores as well as global measures of ACE exposure. ACE are globally quantified by (a) the MACE MULTI score indicating the number of different types of childhood adversities that fulfilled a defined threshold of severity and the MACE MULTI ranges from 0 to 10 (cut-offs were retrieved from [24]), and (b) the MACE SUM score indicating overall severity of exposure ranging from 0 to 100 [14]. (c) The global measure MACE duration is quantified by the mean cross sum of the MACE severity scores along the 18 years, therefore scores ranging from 0 to 100. (d) Severity scores of each type and timing as well as global ACE measures are considered in random forest regression.
In addition, traumatic experiences were assessed with the event checklist [35] using the sum of different types of events as index of trauma load. Sum scores were calculated separately for traumatic event types that were experienced up to age 18 (trauma load in childhood) and those reported after the 18th birthday (trauma load in adulthood).
Symptom severity was determined for dissociative responding using the 13-item Shutdown Dissociation Scale (Shut-D) [22, 23] in a structured interview. The Shut-D allows for the comprehensive assessment of the severity of dissociative experiences during the past 6 months. Following the guidelines of administering and analyzing the Shut-D, reports affected by side effects of medication or dissociative symptoms due to alcohol or other drugs were excluded [22]. The frequency of dissociative experiences was quantified on a scale between 0 (not at all), 1 (once a week or less), 2 (2–4 times a week), to 3 (5 or more times a week). The sum score (ranging from 0 to 39) serves as an indicator for the severity of shutdown dissociation. The scale showed excellent internal reliability as well as test-retest reliability, high convergent validity, and satisfactory predictive and discriminatory validity [22].
PTSD symptom severity was defined by the sum score of the PTSD Symptom Scale-Interview (PSS-I), which follows the criteria based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) [36]. The PSSI has high reliability and validity and is comparable to more complex instruments for quantifying PTSD [37].
The severity of depression was determined by expert ratings on the 21-item Hamilton Depression Scale that were based on information reported by the patient, observations during the interview and observations made by health care staff [38]. The scale has been extensively used to obtain severity scores for depression and is well established in clinical research [39].
Statistical analysis
Analyses were performed using R version 2.15.1 and SPSS 20.0. Per hypothesis (1) the impact of ACE multiplicity (or the dose-dependent effect) on symptom severities was examined for each symptom dimension (PTSD, shutdown dissociation and depression) by univariate analyses of variance (ANOVA) with the between-subjects factor multiplicity, comparing subgroups according to 5 different levels of multiplicity (0 = no childhood adversities (n = 13), 1 = one type of MACE MULTI (n = 29), 2 = two types of MACE MULTI (n = 20), 3 = three types of MACE MULTI (n = 18) and 4 = four to ten types of MACE MULTI (n = 49; see [12], for a similar approach). In addition, the relationship between the symptom severities and global measures of the MACE duration, multiplicity (MACE MULTI), overall severity (MACE SUM), and the trauma load in childhood and adulthood were evaluated by Pearson correlations. Similarly, correlations determined the relationship between symptom severity and the severity score of each type of ACE. In order to correct for multiple testing the Benjamini-Hochberg procedure was applied [40], resulting in a corrected significance threshold of α = 4.3 % for hypothesis 1 and α = 3.6 % for the hypothesis 2.
Conditioned random forest regression
In fine-grained conditioned random forest regressions predictive modeling is accomplished using the script provided by Teicher and Parigger in the Supplement [14]. In contrast to conventional linear modeling, the conditioned forest regression considers the high co-linearity of reported exposure of types at adjacent ages and does not require specific distribution assumptions [41]. Furthermore, this approach can handle a very large number of predictors modeling the outcome [41], and has been applied in previous studies [8, 25, 31]. We applied a variant of Breiman's approach with conditionals trees using the R packages 'party' [42] and 'caret' [43]. This approach rectifies a possible challenge with random forest regression that can inflate predictor importance with high versus low levels of categories. Conditioned random forest models provide an unbiased estimation of predictor importance independent of number of categories, mean values, range, and variance of the predictors [42]. Model training and testing were accomplished using a 10 × 10 Monte Carlo cross validation algorithm [43]. For this, the data set was randomly split into a subsample to train the model (75 % of the data) and a test subset (25 %), therefore providing estimates of the models' predictive accuracy. Ten runs of the cross validation procedure were performed and model fit, relative variable importance as well as their confidence limits retrieved. The analyses excluded ages or age ranges for types of maltreatment that were reported by less than 5 % of the entire sample. Applying the criterion of none-to low frequent exposure excluded the following types and timings from further analyses: for sexual abuse ages 1–11 and age 15; for physical abuse, parental verbal abuse and witnessed violence to siblings ages 1, 2 and 3 and for interparental violence ages 1–4 were excluded from all random forest regression analysis. For the peer-related types none-to low variation was evident for peer emotional abuse ages 1–4 and for peer committed physical violence ages 1–5. Testing hypothesis (2) relative importance values for each predictor were derived to examine the 'Sensitivity by Type and Timing' using severity scores of each MACE type and timing versus global MACE measures on symptom severity. We controlled for the potential impact of gender, trauma load (in childhood and adulthood), diagnostic category (F1, F2 and F6), neuroleptic and antidepressant mediation (as binary variables), as well as number of hospitalizations1. The null hypothesis of no difference in relative importance of global predictors compared to the relative importance of a specific type and timing at one or two adjacent ages should be rejected whenever either one model significantly differed in terms of the relative importance. The impact of time of exposure independent of type of exposure was displayed in a graph for easier visualization. Moreover, the type versus global model showed relative importance for type effects regardless of age of exposure as well as global parameters MACE duration, MULTI and SUM. The post-hoc linear modeling evaluated the direction and strength of each predictor. Only those predictors that showed predictive strength derived from the 'Sensitivity by Type and Timing' model were entered and the best predicting model was selected using the Akaike information criterion (AIC) [44]. Due to high co-linearity of severity of exposure scores at adjacent ages only the age with the maximal importance was considered in linear regression. Moreover, the high correlation between neuroleptic medication and diagnosis of psychotic spectrum precluded their consideration in linear modeling.
Prevalence of adverse childhood experiences per type and timing of exposure
Dose-dependent effects for symptoms of PTSD, shutdown dissociation and depression (Hypothesis 1)
Descriptive statistics and correlations between measures of childhood adversity, trauma load and psychopathology (symptoms of PTSD, shutdown dissociation and depression)
Measures of childhood adversities
PTSD symptom severity
Shutdown dissociation symptom severity
Depression symptom severity
MACE Global Measures
MACE Duration
12.7 (8.6)
.55, p < .001 *, 95 % CI[.41, .66]
.40, p < .001 *, 95 % CI[.25, .54]
.46, p < .001 *, 95 % CI[.31, .58]
MACE MULTI Multiplicity
3.0 (2.2)
.58, p < .001 *, 95 % CI[.43, .70]
.41, p < .001 *, 95 % CI[.27, .56]
.37, p < .001 *, 95 % CI[.21, .51]
MACE SUM Overall Severity
31.6 (15.6)
.58, p < .001 *, 95 % CI[.44, .68]
.39, p < .001 *, 95 % CI[.27, .53]
.39, p < .001 *, 95 % CI[.23, .53]
Trauma Load (Life Event Checklist)
in Childhood
3.5 (2.7)
.43, p < .001 *, 95 % CI[.27, .57]
.22, p = .014 *, 95 % CI[.06, .38]
.30, p = .001 *, 95 % CI[.16, .46]
in Adulthood
2.0 (1.9)
.32, p < .001 *, 95 % CI[.12, .50]
.27, p = .002 *, 95 % CI[.08, .45]
.07, p = .431, 95 % CI[-.13, .25]
MACE Severity of Types
Emotional Neglect
3.5 (2.4)
.43, p < .001 *, 95 % CI[.28, .56]
.37, p < .001 *, 95 % CI[.22, .51]
.32, p < .001 *, 95 % CI[.17, .46]
Non-verbal Emotional Abuse
3.7 (2.6)
.41, p < .001 *, 95 % CI[.27, .53]
.34, p < .001 *, 95 % CI[.07, .21]
.23, p = .010 *, 95 % CI[.07, .38]
Parental Verbal Abuse
5.1 (3.6)
.41, p < .001 *, 95 % CI[.27, .54]
.25, p = .005 *, 95 % CI[.08, .40]
.29, p = .001 *, 95 % CI[.12, .44]
Peer Emotional Abuse
5.9 (3.1)
.29, p = .001 *, 95 % CI[.13, .42]
.33, p < .001 *, 95 % CI[.19, .46]
.16, p = .064, 95 % CI[.00, .33]
Peer Physical Bullying
3.4 (2.7)
.30, p = .001 *, 95 % CI[.12, .46]
.14, p = .106, 95 % CI[.01, .28]
.17, p = .057, 95 % CI[-.01, .32]
Parental Physical Maltreatment
4.0 (2.8)
.28, p = .001 *, 95 % CI[.09, .46]
.14, p = .174, 95 % CI[-.05, .33]
.22, p = .014 *, 95 % CI[.05, .38]
Physical Neglect
1.6 (1.9)
.43, p < .001 *, 95 % CI[.27, .58]
.21, p = .017 *, 95 % CI[.03, .38]
.19, p = .033 *, 95 % CI[.01, .35]
Sexual Abuse
0.9 (1.5)
.51, p < .001 *, 95 % CI[.35, .65]
.23, p = .008 *, 95 % CI[.08, .41]
.26, p = .003 *, 95 % CI[.09, .40]
Witnessing Interparental Violence
1.3 (2.4)
.22, p = .013 *, 95 % CI[.02, .41]
.10, p = .268, 95 % CI[-.08, .29]
.22, p = .014 *, 95 % CI[.06, .39]
Witnessing Violence to Siblings
2.2 (2.9)
.35, p < .001 *, 95 % CI[.15, .52]
.22, p = .013 *, 95 % CI[.05, .37]
.29, p = .001 *, 95 % CI[.09, .46]
The trauma load in childhood measured with the event Checklist was related to all three symptom dimensions (for PTSD symptoms r = .43, p < .001, 95 % CI[.27, .57], for symptoms of shutdown dissociation r = .22, p = .014, 95 % CI[.06, .38] and for symptoms of depression r = .30, p = .001, 95 % CI[.16, .46]. In addition, the trauma load in adulthood was related to symptoms of PTSD r = .32, p < .001, 95 % CI[.12, .50] and shutdown dissociation r = .27, p = .002, 95 % CI[.08, .45], but not to symptoms of depression r = .07, p = .431, 95 % CI[-.13, .26].
Modeling severity of symptoms of PTSD, shutdown dissociation and depression (Hypothesis 2)
Modeling symptoms of PTSD
Contrasting the relative importance obtained by maximal peak of physical neglect at age 5 with the predictive strength of the global measure of MACE duration (M = 1.78, SD = 0.76) showed a significant difference (t9 = 3.76, p = .004). Yet, addressing the multiplicity model the PTSD symptom severity was better explained by the number of different adverse experiences (M = 3.89, SD = 2.56) than by physical neglect at age 5 (t9 = -2.48, p = .034). Furthermore, MACE overall severity (M = 4.03, SD = 2.50) was more important in predicting PTSD symptoms than the type and timing specific peak (t9 = -3.14, p = .012). When considering physical neglect for a 2-year window (age 5–6, importance M = 4.16, SD = 1.95), the predictive strength of physical neglect at ages 5–6 for PTSD symptoms was not better than the predictive strength of MACE overall severity (t9 = 0.34, p = .721) or multiplicity (t9 = 0.62, p = .552).
No better prediction of PTSD symptoms was achieved by trauma load in adulthood (M = 0.17, SD = 0.12), trauma load in childhood (M = 1.09, SD = 0.29), gender (M = 0.20, SD = 0.12), and diagnostic categories F1 (no importance), F2 (M = 0.78, SD = 0.42) and F6 (M = 0.17, SD = 0.12), neuroleptic medication (M = 0.03, SD = 0.10), antidepressant medication (M = 0.09, SD = 0.08), as well as number of hospitalization (M = 0.03, SD = 0.06; importance and its standard deviation in brackets). The best predictors of PTSD symptom severity derived from the Forest Regression analysis were MACE overall severity, followed by physical neglect at age 5–6 as well as MACE multiplicity.
Results of the linear Regression for Variables Predicting (A) PTSD Symptoms, (B) Shutdown Dissociation and (C) Depression
Unstandardized Coefficients B
Unstandardized Coefficients SE
Standardized Coefficient ß
A. Results of the linear Regression for Variables Predicting PTSD Symptoms
p = .063
p = .001
Physical Neglect at age 5
p = .005
Emotional Neglect at age 6
p = .161
Sexual Abuse at age 12
p = .001
B. Results of the linear Regression for Variables Predicting Symptoms of Shutdown Dissociation
p < .001
Physical Neglect at age 5
p = .147
Emotional Neglect at age 4
p = .032
Parental Non-verbal Emotional Abuse at age 14
p = .086
Sexual Abuse at age 12
p = .008
C. Results of the linear Regression for Variables Predicting Symptoms of Depression
p < .001
F2 diagnosis
p < .001
MACE duration
p = .166
Emotional Neglect at age 9
p = .097
Sexual Abuse at age 12
p = .051
Modeling symptoms of shutdown dissociation
Comparing the importance of the MACE global scores duration (M = 0.70, SD = 0.22) and overall severity (M = 0.46, SD = 0.28) to the highest single peak of the 'Sensitivity by Type and Timing' indicated better prediction for physical neglect at age 5 than MACE duration (t9 = 2.25, p = .050) and MACE overall severity (t9 = 3.40, p = .008), whereas physical neglect at age 5 did not predict shutdown dissociation better than the MACE multiplicity (M = 0.93; SD = 0.22), t9 = 1.69, p = .125. Emotional neglect showed the highest peak when two adjacent years (age 4–5) were considered. The predictive strength of emotional neglect at age 4–5 was higher (M = 1.81, SD = 0.62) than the predictive strength of each global MACE measures: duration, t9 = 4.73, p = .001, multiplicity, t9 = 4.51, p = .001, and overall severity, t9 = 5.46, p < .001. In contrast, the predictors trauma load in adulthood (M = 0.21, SD = 0.19), traumatic experiences in childhood (M = 0.13, SD = 0.13), gender (M = 0.21, SD = 0.13), F1 diagnoses (M = 0.07, SD = 0.09), F2 diagnoses (M = 0.23, SD = 0.19), F6 diagnoses (no importance), neuroleptic medication (M = 0.05, SD = 0.11), antidepressant medication (no importance), and number of hospitalizations (M = 0.06, SD = 0.14) did not predict dissociative symptoms better than the 'Sensitivity by Type and Timing' model (importance and its standard deviation in brackets).
Linear model selection was accomplished for the predictors derived from the 'Sensitivity by Type and Timing' analysis: MACE multiplicity, physical neglect at age 5, emotional neglect at age 4, parental non-verbal emotional abuse at age 14, and sexual abuse at age 12. According to the AIC, the best fitting model included the variables emotional neglect at age 4, physical neglect at age 5, and sexual abuse at age 12 and parental non-verbal emotional abuse at age 14. This model explained altogether 26.7 % of the variation of shutdown dissociation symptoms (Table 3B). The residuals of the model did not deviate from normality (Z = 0.87, p = .431).
Modeling symptoms of depression
The peak of the 'Sensitivity by Type and Timing' model, emotional neglect at age 9, predicted symptoms of depression better than MACE multiplicity (M = 0.17, SD = 0.20; t9 = 21.72, p < .001) and MACE overall severity (M = 0.64, SD = 0.23; t9 = 12.60, p < .001), but not better than MACE duration (M = 2.49, SD = 0.53; t9 = -0.16 p = .879). Predictive power was better for emotional neglect at the age window 8-9 (M = 3.38, SD = 0.30) than MACE duration (t9 = 5.06, p < .001).
In addition, meeting a psychotic spectrum diagnosis (importance M = 13.51, SD = 1.39) and neuroleptic medication (M = 8.03, SD = 0.86) varied severity of depression. Patients with a schizophrenic spectrum disorder had lower depression scores (M = 12.1, SD = 6.6) than non-psychotic patients M = 19.3 (SD = 6.4). All other predictors did not show better predictive importance for symptoms of depression: trauma load in adulthood (no importance), trauma load in childhood (M = 0.54, SD = 0.17), gender (M = 0.38, SD = 0.17), medication with antidepressants (M = 0.96, SD = 0.38), diagnostic categories F1 and F6 as well as number of hospitalizations (no importance).
Based on the 'Sensitivity of Type and Timing Analysis', F2 diagnoses, MACE duration, emotional neglect at age 9, parental non-verbal emotional abuse at age 14, and sexual abuse at age 12 were included as variables in the linear regression. Using AIC, the best-fitting model combined a negative impact of the binary variable psychotic spectrum disorder, indicating lower depression scores for patients with psychotic spectrum disorder, and positive regression coefficients for MACE duration, emotional neglect at age 9 and sexual abuse at age 12. The overall model obtained an adjusted R 2 of 0.34 (compare Table 3C for regression coefficients). The residuals of the model did not deviate from normality (Z = 0.74, p = .649).
The present study examined how a detailed analysis of type and timing of childhood adversities complements the understanding of sensitive periods for symptoms frequently reported in patients with psychiatric disorders. Depression, dissociation, and PTSD symptoms were selected as prominent in patients diagnosed with stress-related, affective, and personality disorders, but also as frequently reported comorbid symptoms in other diagnostic groups, including substance abuse and psychotic disorders e.g., [9–11]. Moreover, recruiting a larger transdiagnostic sample targeted the nature of ACE effects on severity of mental illness, as indicated by symptom severities. Comparing potential effects of experience load (or 'dose' effect) with those of certain experiences at specific, sensitive periods during development might suggest a common role of environmental stress in the development of symptoms, independent of disorder specific factors. The present study sought to clarify the impact of adversities on the course and severity of illness. Two hypotheses on the nature of this influence were tested: (1) stressful/traumatic experiences unfold psychopathology in vulnerable individuals in a dose-dependent manner, and (2) stressful/traumatic experiences are influential particularly at a certain time, i.e., during sensitive developmental periods. Referring to the intensity of common symptoms, both types of influence should be valid across diagnoses.
In line with previous findings the present results confirm dose-dependent effects of ACE (multiplicity and overall severity) and traumatic experiences on severity of all three dimensions of symptoms [3, 6]. Moreover, the association between the MACE duration score and symptom severity scores suggests a common effect of elevated stress 'load': the earlier the abuse and neglect occur and the longer they last, the more severe the indices of psychopathology in adult patients. However, the effects of ACE type and timing on the severity of each symptom dimension indicate that certain types of experiences at specific sensitive periods have stronger impact on and more predictive strength for symptom development than global stress load (MACE measures duration, multiplicity and overall severity). Regarding type of experience, the present results emphasize the importance of emotional and physical neglect, which may have been underestimated when focusing exclusively on sexual abuse and traumata. Regarding timing of experience, the present results emphasize sensitive developmental periods between age 5 and 14, thus preschool age and early adolescence. The fine-grained analysis of windows of vulnerability for type and timing of ACE strengthens the model of sensitive periods of brain development [7, 8]. Periods around age 3–5 have been associated with hippocampus development [7], and may therefore be particularly sensitive for vulnerability for ACE and traumata fostering later dissociation and PTSD. Further windows of vulnerability affecting hippocampal development have been defined for ages 11–13, and windows affecting amygdala development (age 10–11) and the prefrontal cortex (ages 14–16) [7, 8].
The similar type and timing profile suggests a shared vulnerability of ACE to foster the co-occurrence of dissociation and PTSD symptoms e.g., [46]. The overlapping vulnerability for both symptom dimensions highlighted physical and emotional neglect experiences around pre-school ages as well as adolescent sexual abuse, resulting in biphasic susceptibility to ACE. Similar timings have been highlighted in the literature for symptoms of PTSD, showing enhanced vulnerability for the earlier [20], and also for the later window of higher vulnerability [21]. Again, physical and emotional neglect as well as sexual abuse emerged as important predictors for shutdown dissociation [15, 25], while also complementing prior reports in showing more pronounced vulnerability for preschool and adolescent adversities. In line with previous findings on symptoms of depression that highlighted ACE effects before age 12 [21, 29, 30], the current results demonstrate enhanced vulnerability for emotional neglect at school ages 6–11. Even though we observed a type specific peak of parental non-verbal abuse at age 14 for depressive symptoms, which is in line with the results of Khan and colleagues [31], this was not the most important predictor. The present results may be affected by sample selection. The present results are confined to patients who have developed mental illness later in life and all report at least some symptoms of depression, whereas the community sample consisted of individuals from sub threshold to clinical levels of psychopathology as well as lifetime depression. Considering the length of the sensitive period, current results suggest relevant sensitive periods of at least two consecutive years of ACE exposure for stress-related symptoms, which is also in line with neurobiological findings [7, 8]. By supporting these periods of vulnerability and drawing attention to the particular sensitive for emotional and physical neglect, the present results encourage further research on the neuroendocrine mechanisms that might mediate ACE effects on brain function and structure [7, 8], hypothalamic-pituitary-adrenal-axis regulation [47] or epigenetic profiles [48], finally resulting in enhanced vulnerability for psychopathological developments.
Limitations of the present study have to be considered: First, retrospective assessment of ACE prompted concerns regarding the veracity and reliability of retrospective, memory-based subjective ratings, in patients with severe mental illness and lower levels of cognitive functioning. However, a review by Brewin and colleagues indicated scant evidence in support of these concerns [49]. Excellent retest-reliability has been provided for the MACE scale [14], and other studies demonstrate sufficient test-retest reliability for comparable instruments of retrospective assessment of ACE in severe mental illness [50, 51]. Reports appeared to be highly consistent over years and did not significantly vary with the severity of psychotic or depressive symptom [52]. In contrast to the false positive bias, there has been support for underreporting in retrospective assessment [53–55]. Besides this bias of false negatives, the reported ACE did not obtain enough positive ratings at early ages, even though their negative impact on the development has been demonstrated [56]. Abuse recollection might be limited before age 3 [57]. For the present study, e.g. physical abuse before the age of 3, sexual abuse before the age of 12, witnessed interparental violence and violence towards siblings as well as peer emotional and physical before the age of 3 was not considered in the forest regression models. Second, we cannot completely rule out effects of medication on symptoms of PTSD, shutdown dissociation and depression, however a major impact is unlikely as demonstrated by the predictive importance values as well as stability of peak types and timings for each symptom dimension (with and without the consideration of the medication). Third, the present results are constraint to a clinical sample of psychiatric patients and, thus, have limited generalizability. A cross-validation of the hypotheses testing in a community sample would certainly be necessary before drawing any conclusion to the general population or prevention. However, a comparison of inpatients and a symptom-free community sample would direct the attention to the relationship of stress/trauma on the emergence of psychopathology (per se), rather than on the expression of psychopathology in symptom severity—as emphasized in the present study.
The present study confirmed the positive association of childhood adversities to psychopathology. In particular the results emphasize the impact of physical and emotional neglect besides sexual abuse. Regarding the timing, pre-school age (4–6) and pre-adolescent (8–9) seemed to be more vulnerable periods. PTSD, the most severe stress-related disorder, clearly varies with the amount of adverse experiences irrespective of age of experience supporting the dose-dependent model. For symptoms of dissociation and depression, the present results provided evidence for the sensitive period model. The specific pattern of multiplicity, overall severity as well as type and timing specific effect provides evidence for adversity-related processes that are present in a sample with low levels of hospitalization and young age. Symptoms of depression and anxiety are often considered as unspecific, however might provide a framework to prevent further negative outcomes that are related to childhood adversities such chronic illness courses [43, 58–60]. It is crucial to understand the negative impact of specific effects of adversities and trauma on the psychopathology to advance the models of vulnerability and learn how to adapt treatment strategies to counterstrike adverse outcomes.
The spectrum of F5 diagnosis was excluded from the analysis due to low frequency (3.2 %). We further refrained to consider the F4 since there is a high dependency with reported symptoms for PTSD and dissociation.
We thank the patients for their participation, the teams of the involved wards (Station 33, Station 34, Station 60 and Station 61) for their support, and Amelie Lehrmann, Dshamilja Ritthaler, Franziska Steinmeyer, Sarah Dölker, Theresa Marks) for administrative support in data acquisition. The University of Konstanz (AFF, Ausschuss für Forschungsfragen) supported the project.
The University of Konstanz (AFF, Ausschuss für Forschungsfragen) funded the project.
Availability of data and materials
To ensure the confidentiality the data cannot be provided.
Authors' contributions
IS, MHT & BR designed the study concept. Data collection were performed by DN, EH, OM & IS. MHT provided the scripts for analysis of the 'sensitivity of type and timing', and IS and MHT accomplished the data analysis. IS and BR drafted the manuscript, all other authors provided critical review. All authors approved the final version of the paper prior to submission.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
Prior to the assessment each participant was informed about the goal of the study and provided written informed consent. The study was reviewed and approved by the Institutional Review Board (Ethics Committee) of the University of Konstanz.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Authors' Affiliations
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text: I'm curious to know what people think of this question. There are two aspects to Jobs : 1) role as traditional CEO 2) charismatic leader who guides the creativity of the company The first part makes this a complicated question. I feel Apple would not survive if # 2 isn't satisfied. Based on that, I'm claiming Jonathan Ives will be his replacement. If you notice the patent applications, he and Steve Jobs are listed together quite often. What do you think?

subset: commoncrawl


text:
English (33937)
Fan Page
Creativity in Secondary Education - Achieving QTS Series
Creativity is increasingly seen as central to good learning and teaching throughout the curriculum. This book examines the political and educational context behind such developments and looks at dilemmas faced by trainee teachers as they begin their teaching practice.
Demonstrating what creativity is, how it evolves and how it can be nurtured in various teaching contexts, it will enable trainees to develop creativity in their teaching role and in their pupils learning. Throughout, the book links clearly to the new Professional Standards for QTS and presents exercises, subject-based case studies and teaching examples to engage and support all secondary trainees.
This material for VIP member only, become VIP member to unlimit any download : Detail here- VIP for 01 day : 8 USD (Accept and recommend pay by paypal)
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text:
|November 3, 2015
Contact: Whitney Ray
Phone: (850) 245-0150
|en Español
|Print Version
TALLAHASSEE, Fla.—Attorney General Pam Bondi's Medicaid Fraud Control Unit and the Madison County Sheriff's Office today arrested a general contractor for defrauding the Medicaid program out of more than $100,000. Richard Lee Edwards, 60, owner of Richard Edwards Construction, Inc., allegedly billed for construction services without a license to perform the services and without obtaining required permits.
According to Attorney General Bondi's MFCU and the Florida Department of Business and Professional Regulation's joint investigation, Edwards fraudulently billed for handicap accessible ramp construction and bathroom modifications for people with disabilities and the elderly. Due to Edwards' modifications that violated multiple building codes, more than 20 homes in Gadsden, Leon and Taylor County were damaged and residents faced safety hazards.
"This individual not only violated numerous building codes, but recklessly put vulnerable Floridians' health at risk," said Attorney General Bondi. "I applaud my Medicaid Fraud Control Unit and the Florida Department of Business and Professional Regulation for their collaborative investigative efforts to protect individuals and their property."
According to the investigation, Edwards built handicapped accessible ramps with sharp-ended protruding screws and posts not secured into the ground with concrete. Edwards's bathroom modifications allegedly consisted of removing existing bathtubs and replacing them with walk-in-showers, a job requiring a plumbing contractor's license that Edwards does not have. Additionally, Edwards allegedly built non-handicap accessible steps into showers that are supposed to be handicap accessible.
Edwards faces one count of Medicaid provider fraud more than $50,000, a first degree felony. If convicted, Edwards faces up to 30 years in prison, more than $600,000 in fines and restitution. The State Attorney's Office for the Second Judicial Circuit will prosecute the case.
Attorney General Bondi's Medicaid Fraud Control Unit investigates allegations of patient abuse, neglect, and exploitation in facilities receiving payments under the Medicaid program. Additionally, the MFCU investigates and prosecutes fraud involving providers that intentionally defraud the state's Medicaid program through fraudulent billing practices. Medicaid fraud essentially steals from Florida's taxpayers. From January 2011 to October 2015, Attorney General Bondi's MFCU has obtained more than $500 million in settlements and judgments.


text:
Property Repair Systems
Over 20 Years of Timber-Resin Splice Manufacturing by 2015
David Moore - who is he? Where did he start?
Why did David Moore invent the Timber Resin Splice (TRS)?
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text:
Vamoos, the app for corporate hospitality.
Vamoos is an app that allows you to deliver to your guests their travel and event documents, itinerary, destination information and even mapping & weather forecasts to their own mobile or tablet – and they can view everything offline, without the expense of data roaming.
How it works for Guests
Your guest simply enters their Vamoos reference, which unlocks all their documents, and even gives them access to weather and ma
How it works for Guests
Entirely personalised for your guest, under your brand. All their documents are available to view, even when they don't have a data connection
How it works for Guests
Vamoos allows you to further enrich your event by splitting into days or activities - each with its own posts, maps and weather features
How it works for Hosts
Create a Vamoos reference - a simple & quick interface that populates the event title, background image and destination.
How it works for Hosts
Upload their itinerary and all their important travel and event documents; your guests can access them all in one place, on the device that they will always have to hand.
How it works for Hosts
Split their trip or event using our Storyboard Imagery feature - illustrate your clients itinerary and break them down into individual days or sessions


text:
Pineapple Sour Gummies
Stephanie Torres. In town to take on the 'Zone Challenge at Mannie & Bo's Pizzeria in Golden. Six pounds. Mo meat, mo meat, mo meat. And some cheese and crust.
Before she tried the 'Zone, we stopped at Rock Rest for me to challenge the Peanut Butter Burger & Fries. You've seen it before. Blah blah woof woof.
She's weird. I'm an innovator.
Big ass bites. Fast. That combo equals a great start.
She condimentized so well.
She downed 3 huge 32oz drinks. Two were bubbly root beer.
Her leg
At about this point I broke out some words of advice about clearing her mouth and taking some breaths. Me. Telling someone not too chipmunk. What?!? That's f-in hilarious!
She did c'mon!
Stephanie! First female to take the 'Zone down. A guy did a week before. Jimmy and I were the 1st team to do it a few months ago.
The weenie and the queenie.


text:
The competition for college spots grows year after year. At Sylvan, we appreciate that you want your child to succeed — and getting high ACT scores is a key component. That's why our engaging, personalized ACT prep in Southbury will help your teen diminish anxiety, boost confidence and feel prepared come test day. You can be sure that our program is designed to improve performance — and is proven to lead to higher scores on the ACT!
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text:
Spellcrows New Halfling Looks Like He's Penning An Epic!
January 13, 2015 by brennon
Spellcrow have another awesome looking miniature for you to have your say on today. They previewed this Halfling over on Facebook and want to know what he should have in his left hand...
As my title might suggest I think this chap should feature a hand holding a rather over the top quill for him to write down his spells, recipes, or indeed bardic epics for all. Either that or a wand perhaps?
Once again the level of detail going into their sculpts is phenomenal and I love how characterful each of their pieces looks. There's a sense of whimsy about the miniatures, for example all the scrolls strapped to his ostentatious hat!
Have your say on what you think in the comments below and head over to their Facebook and let the guys there know too!
What do you think?


text:
Deol demystified
Abhay Deol says he doesn't believe in marriage and may take a break to pursue architecture.entertainment Updated: Jul 15, 2011 01:45 IST
In the current crop of actors, Abhay Deol, 35, surely has carved a niche for himself. His offbeat choices in selecting movies such as Dev D, Oye Lucky Lucky Oye! or Ek Chalis Ki Last Local, have given him an identity of his own. The actor returns to the silver screen with Zoya Akhtar's multi-starrer, Zindagi Na Milegi Dobara (ZNDB). In a freewheeling interview, Deol talks about his forthcoming films, marriage and taking to architecture.
On Zoya, the director
Working with Zoya was wonderful as she has the unique ability to merge offbeat elements with mainstream cinema. She plays with subtlety and is open to actors' suggestions and gives them space.
On future projects
I have finished shooting for Dibakar Banerjee's Shanghai. I am proud of the film and call it a political dark comedy. Then, there is a Hollywood film, Singularity. Later, I'll work with Navdeep Singh for a romcom.
On getting married
I am in a relationship (with model-actor Preeti Desai). But I don't believe in marriage. It is more of a cultural phenomenon. For me, if two people are committed, then that is more important that signing a piece of paper.
On new hobbies
There are so many things that I want to do including something in architecture. I want to get into design also. I might take a year off once again to pursue the same, lets see.
First Published: Jul 14, 2011 17:07 IST


text: I'm going to upgrade my friends family desktop (pretty old) but need help on deciding what RAM. They currently have two 256MB DDR2 PC2-3200 modules installed in the 1+2 DIMM connectors, so I'm looking on putting two 1GB modules in as its only running XP; it has 4 DIMM connectors. Question is, if I buy two faster modules say at 1066Mhz and put them in two different DIMM connectors in 3+4 so that hopefully all the RAM will work in dual channel mode, will that particular RAM run at 1066Mhz or because of the current installed memory will they be limited to what the current memory speed that is installed? Thanks.


text:
NBA roundup
Raptors 113, Knicks 88
Short-handed New York became the latest victims of Toronto's blossoming bench.
Jonas Valanciunas had 18 points and 10 rebounds, Pascal Siakam added 14 points and a career-high six assists and the Raptors beat New York on Thursday night.
New York played its first game since losing All-Star forward Kristaps Porzingis to a torn left ACL in Tuesday's loss to Milwaukee.
"We've had a lot happen within the last 24 to 48 hours," New York guard Jarrett Jack said. "Guys are still rallying around each other, still trying to come out and play hard and compete, regardless of whatever the circumstances are."
Serge Ibaka and Jakob Poeltl scored 13 points, Delon Wright and C.J. Miles each had 11 and Fred VanVleet 10 as the Raptors won their fifth straight home meeting with the Knicks.
The Raptors have won four straight and six of seven. Toronto is an NBA-best 23-4 at home.
Toronto won despite poor shooting performances from All-Star guards DeMar DeRozan and Kyle Lowry. DeRozan shot 2 for 11 and scored eight points, while Lowry shot 2 for 8 and finished with seven.
"The bench has been great," DeRozan said. "We know how hard they work."
The Raptors outscored the Knicks 61-35 in bench points. Toronto coach Dwane Casey praised his second unit for its unselfishness.
"There's no hidden agendas," Casey said. "They're playing with a pure heart and they don't care who scores. When you play that way, good things are going to happen."
Toronto's starters got the fourth quarter off for the third straight game as the bench closed it out.
"It's really good. We're giving our old guys a little rest," Poeltl joked.
Five Raptors bench players scored in double figures.
"Their second group is a really good group," Knicks coach Jeff Hornacek said. "They've been doing it all year and that's why they're one of the top teams now."
Michael Beasley scored 21 points and Trey Burke had 12 as the Knicks lost their fifth straight.
Luke Kornet had 11 points and 10 rebounds in his NBA debut and Jack added 10 points, but the Knicks lost for the eighth time in their past 10.
"We like what he does," Hornacek said of Kornet. "He can shoot the 3, he can go to the basket, he can block some shots. He's going to get better and better as he plays against these better guys. I was pretty happy with the way he played."
Besides Porzingis, New York was without G Ron Baker (right shoulder), C Enes Kanter (oral surgery) and C Joakim Noah, who recently left the team following a dispute with Hornacek.
New York acquired G Emmanuel Mudiay from Denver in a three-team trade. The Knicks sent F Doug McDermott to Dallas while the Mavericks traded G Devin Harris to the Nuggets.
"We're happy to get Emmanuel," Hornacek said. "He's a big body, he's big and strong. He can handle the ball, he can get in that lane and find guys. I think he's got a good sense of the game."
Warriors 121, Mavericks 103
Stephen Curry had 20 points, eight assists and seven rebounds, and Golden State bounced back from a tough recent stretch.
Kevin Durant added 24 points, nine rebounds, four assists and two blocked shots while Draymond Green put up another impressive line: 12 points, 10 rebounds, six assists, two blocks and two steals.
Dallas star Dirk Nowitzki had 16 points, 11 rebounds, season-high five steals and two blocks, while rookie Dennis Smith Jr. scored 22 points.
Curry's pretty three-point play with 1:28 left in the third put the Warriors up 88-83, and once Golden State got going in transition the Mavericks couldn't keep up in what became a dunk fest.
Lakers 106, Thunder 81
Kentavious Caldwell-Pope scored 20 points, and balanced Los Angeles beat short-handed Oklahoma City.
Brandon Ingram added 19 points, Julius Randle scored 17 and Kyle Kuzma had 16 for the Lakers, who won their eighth straight at home. Los Angeles is 12-5 in its last 17 games, including four consecutive wins.
Paul George scored 29 points for the Thunder, who played without Russell Westbrook and Carmelo Anthony as each was hampered by a sprained ankle. Steven Adams had 13 points and nine rebounds as the Thunder lost for the fifth time in six games.
Trail Blazers 109, Hornets 103 (OT)
Jusuf Nurkic had 24 points and 14 rebounds, and Portland returned home with a win over Charlotte.
CJ McCollum added 22 points for the Blazers, who were coming off a winless three-game trip. The victory over the Hornets was their ninth straight at Moda Center.
Kemba Walker, who was named an All-Star reserve earlier in the day, scored 40 points for Charlotte. Marvin Williams, who returned after missing four games with a left ankle sprain, finished with 10.
Magic 100, Hawks 98
Evan Fournier scored 22 points, D.J. Augustin added 16 points and nine assists, and Orlando held on to beat Atlanta.
Marreese Speights added 14 points and Jonathon Simmons had 13 for the Magic, who won their third straight. It's only the second time this season the Magic have won three in a row.
Taurean Prince and Dennis Schroder led the Hawks with 19 points apiece. Tyler Dorsey and Malcolm Delaney each added 11.
Meet the future farmers, scientists and artisans of Ledyard High School


text:
There was indeed a large bookcase in the course of The shop – I had been informed It will be $100, Nevertheless they have been willing to go somewhat reduce. I invested many minutes debating the acquisition – it seemed like very low-finish IKEA high-quality (incredibly flimsy backboard, uncovered particleboard within the again), and the worth was sort of borderline, but I chose to trust the Yelp evaluations and just go for it.
*Essential When you are however owning trouble logging on soon after getting your new password, make sure you electronic mail firstname.lastname@example.com
I could've just absent to Ikea, but I determine I will Check out this retail outlet out initial. Awesome alternative! John and his small business associate have all types of neat things inside their store, and It can be always switching. I wound up obtaining a good offer on a sweet couch, and I bought a desk for my TV. Both of those of them had been excellent about pulling furniture out and placing it down so I could test it out. They delivered to my condominium that night time, and John even helped me prepare the furniture in my apartment. Pure awesomesauce! I am aware another time I would like furniture, I'll be checking this shop first.
I like my new (used) furniture! Every thing in regards to the experience was great. I just moved right into a new position and located each of the furnishings I essential at a bargain! He even allow me to name my price on a few matters. What a man! Also bought absolutely free delivery because I Stay in the region. Will definitely be back again for more.
I feel guilty even asking for a reduction at this time for the reason that This is able to have all been prevented if I used to be a far more kents cautious shopper.
There's not a foul piece of furniture in The entire retailer, and we coast were given a terrific offer over a sofa. He nearly threw in a little dresser totally free too! John was an extremely awesome and beneficial guy, offering all the things for us, serving to us move stuff about, and sharing some knowledge with us. I'd one hundred% recommend this position for anybody aiming to buy some high quality utilized furniture at an awesome cost. A++++++
I walked and promptly observed an espresso coloured wardrobe that function wonderfully for my Bed room, as closet Place is practically non-existent in my location. I spoke to John and he had gotten the piece dardanup earlier from the day. There was a significant crack down the facet and he knocked off $twenty five from his price tag as he hadn't had an opportunity to restore it. I described that I was getting paid out the following day so I would not have the capacity to invest in it correct then & there, but he claimed I could spend him by Check out and postdate it for the following day.
Facts Accuracy – Now we have taken good care to give you data which is correct and beneficial. Make sure you notify us if you discover an guy mistake, and we will do our greatest to appropriate it.
I claimed I did not have my checkbook on me and he was neat with that too, indicating I could give it to him on shipping. Properly, which was truly a proposal I could not refuse. By 8pm, my apparel ended up out of storage bins and hanging in a beautiful new (to me) piece of furniture in my residence. Thanks John, I will definitely be removelist back again!
9/22/2013 John is these types of an exquisite neighborhood business gentleman. Quite welcoming, incredibly fair. Went in just searching, ended up paying $400 mainly because he was this kind of good and accommodating male. I hope by no means to discover a nasty assessment on this person's page, he is just pleasant. He even delivered our furniture at no cost and served us carry it inside.


text:
Foods that you feel a bit embarrassed about buying and eating but you buy them anyway
Turkish delight bars. (bit feminine)
for me it is more quantity
For all you know dear checkout lady I am buying this to share with four other people now hurry up scanning it so i can go eat it in the car on the way home.no-class this'd this
I might have a child
so buying spaghetti hoops and cocopops is fine. stop giving me that look.
Percy Pigs
I swear queuing with all the old ladies in Markies when all I have is three bags of Percy Pigs is not good for the soul.


text:
Wilson Law, P.A. - How Contributory Negligence Impacts North Carolina Personal Injury Cases
Raleigh personal injury attorney Kimberly Wilson White explains what contributory negligence means and how it can impact personal injury claims in North Carolina. The lawyers at Wilson Law P.A. have the experience and resources to help accident victims prove gross negligence and get the full compensation they deserve. Call 919-890-0180 to schedule a consultation today. Learn more by visiting www.wilsonlawpa.com/practice-areas/personal-injury-attorney or by contacting us at our office location. Wilson Law, P.A. P.O. Box 10389 Raleigh, NC 27605 919-890-0180 Join Our Community on:
Statement to the Insurance ...
Find out why you might want to wait before proving an insurance company a verbal or ...Play Video
After all was said and done, Kim did the amazing and negotiated a settlement that went WAY beyond expectations!!!
Happy Client
I am so fortunate to have Kim as my attorney in my mesh case
Kimberly White is passionate about her commitment to helping people and sincerity is just natural for her.
I feel certain I never would have received compensation without the legal representation from Wilson Law.
Kimberly White's knowledge of the legal process gave me more confidence as I went forward with my lawsuit.
Happy Client
They kept me informed and explained everything in a way that was easy to understand. I felt very confident with them on my side.


text: Apologies for beating a dead horse but I am dissapointed at Apple's promise that "it just works". Here's the skinny: I'm on a 2007 new model MBP. I'm running Tiger 10.4.11. My firewall is off, checking ipfw gives me "any to any" and I have flushed my ipfw just in case. I am trying to connect to a router that has absolutely NO encryption. It's a 802.11b router. Renewing the DHCP does nothing. I have no option to restart the router because it's either at work or in a public place where I can't inconvenience other people just because I can't connect. The router is updated to the latest firmware and I can connect to the internet using an ethernet cord. Here's what I've tried: I have tried turning off IpV6 and setting my DHCP manually with zero results. I have tried restarting multiple times and putting my computer to sleep and waking up from sleep without any effect. I have tried disabling and then enabling the different port configurations to no effect. The only thing I've read and haven't tried is deleting com.airport preference file but I can't find it and Mac has yet to "invent" the "Show hidden files and folders" feature of Windows. Suggestions really appreciated because as it is I have a new machine that can't even connect to the internet. Big middle finger solute to Steve Jobs for lying to me.


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- shereeforkroadAsked on January 17, 2017 at 11:38 AM
Hello - I have cloned a survey for a different purpose and need to change the name that appears on the tab when I open the survey in a browser. Currently, it shows the original form creator's name on the browser tab when opened: https://form.jotform.com/70105297940152. Could you direct me on editing this?
Thank you!Page URL:
- JotForm SupportKevin_GAnswered on January 17, 2017 at 12:44 PM
To change the form title you need to first open the form preferences, you will find it as the gear icon on the top toolbar while in the form builder:
Once in the preferences wizard go to the advanced tab and click on the show more button:
Scrolling down a bit will get you to the option where you will be able to set the desired title:
Hope this helps.


text:
You are here
Tobago businessman guilty of 89 VAT fraud charges
A businessman from Tobago, who admitted to charging the Tobago House of Assembly (THA) Value Added Tax (VAT) without being registered with the Board of Inland Revenue (BIR), has been fined $89,000.
Raymond Francis, owner of Trinbago General Supplies and Services, was slapped with the fine after pleading guilty to 89 VAT fraud charges before Magistrate Brian Debideen in Scarborough Magistrates' Court on Monday.
Francis, whose business is located at Milford Road, Scarborough, was also ordered to repay the $189,000 in VAT, which he charged the THA , to the BIR. The fine and the repayment are to be made within six months.
In the event that Francis fails to meet the deadlines he will face two months in prison for the unpaid fine and two additional months for failing to repay the BIR.
The charges relate to 89 invoices submitted to the THA for goods supplied to its Division of Infrastructure and Public Utilities over the past two years.
An investigation conducted by BIR's criminal tax investigation department led by Mansie Williams, last year, revealed that Francis' company was not registered to charge VAT and had never applied for registration.
Further investigations revealed that the VAT registration number used on Francis' invoices belonged to another company, Signma Service, whose owner Gordon Gonzales, was unaware that it had been fraudulently used.
In asking for a large fine for Francis, BIR's special prosecutor Evans Welch asked Debideen to consider that he (Francis) had fraudulently used another company's VAT registration number and that he had used it to obtain over-payments from the Government through his invoices to the THA. Welch also noted that Francis had been extradited from Canada in 2014 to face a series of unrelated fraud charges.
Francis was represented by Ravi Rajcoomar. DA
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text:
Verizon to Acquire Straight Path in $3.1 Billion Deal for 5G Deployment
New York City-based Verizon Communications Inc. announced it has signed an agreement to acquire Straight Path Communications Inc. , a holder of millimeter wave spectrum configured for 5G wireless services.
Verizon will purchase Straight Path for $184.00 per share, or a total consideration of $3.1 billion, in an all-stock transaction. The transaction is anticipated to close within nine months, subject to FCC review. Glen Allen, Va.-based Straight Path, holds millimeter wave spectrum configured for 5G services, including 39 GHz licenses that serve the entire country and 28 GHz assets in major markets.
"Verizon now has all of the pieces in place to quickly accelerate the deployment of 5G," said Hans Vestberg, executive vice president and president of global network and technology at Verizon. "Combined with our recent transactions with Corning Incorporated, XO Communications, and Prysmian Group, this is another step to build the next-generation network for our customers."


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A new report released by The Legal 500 has place Corrs Chambers Westgarth in the number one position based on research with more than 9,000 respondents.
Corrs CEO John Denton AO (pictured) said the result reflected the firm's investment in client-driven strategy.
"This research demonstrates that Corrs' commitment to truly understand our clients and their business needs is resonating," Mr Denton said.
"We go beyond the traditional expectations of a law firm to ensure that we are offering our clients not just first-class legal advice, but a partnership and commitment to helping them achieve success – both on a national and global scale," he said.
Dentons came in at number two, with Clifford Chance, Linklaters, Gilbert + Tobin, MinterEllison and Herbert Smith Freehills also making the top 10.
In-house lawyers and clients from 118 countries scored law firms according to three key performance indicators. Of that group, The Legal 500 surveyed 226 general counsel in Australia, whose accumulated legal spend totals around $3.2 billion per year.
The latest report analysed scores given to law firms for client relationship skills, technical legal ability and project management.
"The firm's ranking as the number one law firm in both Australia and Asia-Pacific is testament to the fact that we can offer our clients the best insights and solutions in Australia, while also delivering them with the very best results offshore.
"We are incredibly proud to have pioneered our own independent, international strategy, which has brought significant benefits to our clients," Mr Denton said.


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Cell migration is an important cellular process which has been shown to play a vital role in a variety of phenomena, including embryonic development, tissue healing and the inflammatory response, as well as in pathological conditions such as vascular disease, osteoporosis, chronic inflammatory disease, multiple sclerosis, and most notably in metastatic cancer. Mechanically, migrating cells undergo five major steps: morphological polarization, membrane extension, formation of cell-substratum attachments, contractile force and traction, and release of attachments. This process involves the organization and dynamic activity of both the nucleus and the cytoskeleton in order to ensure proper morphological change. In order to better study this process, a migration model using micropatterns of different s was developed to force cells into different migration-like configurations. This was done to provide a standardized way to quantitatively examine different structural properties involved in cell migration. To that end, this study examined two different proteins, nesprin 2G and α4β1 integrin, and attempted to characterize and measure how they affect the organization of both the cytoskeleton and the nucleus in two different cell lines, Chinese hamster ovary cells and C2C12 mouse myoblasts. Our results indicated that nesprin 2G plays an important role in the organization of both the nucleus and actin stress fibers of C2C12 cells, helping to regulate the orientation of both in migration-like conditions. Likewise, our results indicated that α4β1 integrin plays an important role in the orientation and coherency of actin stress fibers in different morphologies, as well as indirectly affecting the shape and size of the nucleus of CHO cells. Overall, this study showed the potential usefulness of the micropattern migration model and helped to further characterized and demonstrate the function of nesprin 2G and α4β1 integrin.
Barbera, Nicolas
Johns Hopkins University
(Intl): +001-607-272-5070


text:
baha men
featuring: abracadabra
the baha men are from the bahamas. their barking summer hit 'who let the dogs out' hit the international charts. baha men's music is based on the junkanoo, the carnival sound of the bahamas. junkanoo was traditionally played on goatskin drums and cowbells. the baha men have mixed nassau's junkanoo with pop, r&b, reggae and ska. their party album is out on edel records. the baha men find their carnival stage outfits at abracadabra in new york. the shop offers all sorts of costumes, novelties, effect make-up & magic tricks for amateurs and professionals. abracadabra is open from monday to saturday from 11.00 - 19.00 and sunday from 12.00 - 17.00. every saturday magic performances take place in the store at 14.00 & 17.00 and on sunday at 15.00.
Your voice on baha men
chris garcia
"sorry posted twice "
chris garcia
"i was actually on this episode hoping to see it never did can you guys help thanks "
chris garcia
"i was actually on this episode hoping to see it never did can you guys help thanks "
"i didn't realize this was actually the first place the Barnstormers started? god and to think i found it accidently! lol check it out..oh and your security code thing is jacked"
"I found one location by accident on a Sunday drive, total suprise and i think it's amazing how they made these awesome old NC relics come to life. Check out my facebook email@example.com to see the pics i captured or visit stanton hill st /red hill st junction... 1 mile from camron off of us 15-501 in NC baby ;)"
"wink goes in"
gary turnbull
"One of best on bikes "
brian sheppard
wink you a dam fool man j.brit cant fuck wit you you make that shit look like you on bmx bike keep it in the air wink..."
"wink you are the sickest on a motorcycle me and my man are name the srad boyz can u give us a shout out"
damian (producer)
"turn a rubber band into a must-have. beat that."
Sebastian (Producer)
"Most impressive was Lenny's toy collection partly stored in the backroom of the studio he shared with Stash. They were mostly US and Japanese classics collected in multiple numbers and still in their boxes."
damian (producer)
"beck was an enigma. none of the jounalists at the junket could figure him out. a true musicmastermind though."
damian (producer)
"guru (r.i.p.) at first looked like he would eat denise for breakfast. turns out he was your perfect gentleman. mass appeal for real."
© Urban Canyons 2018


text:
Important dates
D.Day 2018 is taking place on Thursday, April 26th 2018.
The meeting is free of charge, but registration is required.
Lunch is included and offered.
Please indicate if you only want to exhibit a poster, or be candidate for an oral presentation (See below "short talks").
Although the D.Day is first dedicated to PhD students, it is open to everyone: students, post-docs, MER and professors are all welcome!
Abstract properties
Please use one of the following templates for abstract submission: doc file docx file
Please do not use special characters. For example, α should be written alpha.
There must be no more than 300 words in the abstract.
Do not include references, figures, or tables in your abstract.
Short talks
During the abstract submission process, PhD students can choose to present a poster or postulate to give an oral presentation in addition to their poster presentation.
PhD students who would like to give an oral presentation need to indicate this by selecting "Poster + Oral" during the registration process.
Students selected for brief oral presentations will be contacted during the week after registration closes, around April 16th.
ECTS Credits
The presentation of a poster is credited by 0.5 credits for the FBM PhD Doctoral School.
To validate this, the following form have to be signed by a member of the ADAS committee.
Poster format
Please try not to exceed format A0 (84 cm width x 119 cm length)
You can print your poster at the Unicom Center of UNIL.
Or at the Service d'Appui Multimedia at CHUV
Université de Lausanne
Quartier UNIL-Sorge
1015 Lausanne
Site Web: http://www.unil.ch/adas
Email : adas[@]unil.ch
Meeting venue
CHUV – Centre Hospitalier Universitaire Vaudois
Auditoire César Roux – BH08
Rue du Bugnon 46
1011 Lausanne


text:
Want to know more?
Gabriella is a 24 year old professional model and multidisciplinary artist based in Providence, RI.
With six years of experience in fashion, editorial, and runway styles Gabriella has the ability to mold herself to the creative image of any project she takes on. While the majority of her work takes place in New York and New England, Gabriella also frequently travels both domestically and internationally for independent artistic projects. Though primarily focused on fashion in her work, she is also a talented art and figure model having worked with a wide variety of both budding and well established artists of various mediums over the course of her career.
To inquire about booking Gabriella for a shoot, workshop, or other event, please send an email describing the project, expected date and duration, as well as the proposed budget to [email protected]


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Miss World Manushi Chillar age! Bio, Wiki, glamorous photoshoot
Manushi Chhillar: - Model and beauty Qween 2017
Age:- 20
DOB:- Bahadurgarh Hariyana
Hight:- 175CM
Parrent:- father, Dr. Mitra Basu Chhillar, mother, Dr. Neelam Chhillar
Title:- Femina Miss Haryana 2017,
Femina Miss India 2017
Miss World 2017
Manushi Chillar
Newly crowned pass over miss world, 20-yr-vintage manushi chhillar , is using her scientific records to recognition plenty-wanted attention on an difficulty this is frequently seemed in indian society as a topic this is taboo.
At a media interplay on monday, Manushi chhillar said, there are very essential matters approximately menstrual hygiene that people are unaware about. 3 hundred and sixty five days into scientific university, at some point of my assignment to create interest about it, i realised that training by myself wasn't sufficient. We needed to offer them a sustainable gadget girls need to observe to instruction menstrual hygiene.
Miss World Manushi Chillar is showing her burning on social media. Ever ever photographing a brand, while enjoying your vacation. Not long ago, Manushi had a hot photoshoot for Cosmopolitan Magazine in which she looked beautiful and even hot. In that photo shoot, he is seen in the swim top which was designed by Rimzim Dadu and he was embroidered by hand.
After this, some of his photographs have surfaced in which he is feeling very cool. We are going to show you some of the cool pictures they have shared on their social account instagram. In the photos you can see how much they are enjoying. Seeing this, it seems like after becoming a Miss World, luck like them has changed.
So let's show these photos as well, along with this, there are 2.7m fallows on Manushi's Instagram and their fans like to see their hot photos. Since then, Miss World has made its fan follow up has increased greatly. They get these offers from a big company and have had these shoots for many big magazines.
These pictures of Manushi are going to be seen in this magazine in the coming days. Manushi shared this photograph with Instagram and informed about it
Manushi will also show you in the silver screen in the coming days. But just recently, this has not been announced.
Manushi had also made photoshoot for Dabboo Ratnani. Because of which he has been in the headlines.
Now because of these photos, he has come back to the discussion.
So lets we say that Manushi will apear in bollywood movie soon and we are eagerly waiting for her to see in Her first Bollywood Debut.


text:
As I headed home last week, I found myself in the middle of a metaphor.
Driving south on Staley Road, I looked out each of my windows to see what
appeared to be a perfect split in the weather to the east and west.
The skyline of the east was what every summer evening should resemble - a
beautifully orange sunset representing the close of another day. To the
west, however, the sky was dark with daylight torn asunder by the storm
that had occurred that day, complete with beautiful lightning and raucous
And there I sat in my car, driving the dividing line between these two
extremes. I couldn't help but smile to myself as I thought of how it
represented so many lives.
Depending on who you talk to, life will often be described as walking the
edge while trying to maintain balance without falling.
On the one hand we have the days, weeks or even months that are filled
with what seem like nothing but clouds. At times it feels like the road
that we are traveling is never ending in its revelation of setbacks and
roadblocks, and the beautiful sky in the distance seems like it is always
just out of reach.
On the other hand, we often experience times in life where the high never
seems to end. We get caught up in a whirlwind that seems to take us from
one great experience to the next on a ride that never seems to end.
At that point, despite the impending clouds on the horizon, we often
become consumed by our own joy and can take our situations for granted.
Now, I don't mean that we should never enjoy the sunshine when it heads
our way, nor do I mean to imply that we should live thinking that each day is
murkier than the last. Instead, we should pay attention to the details
that we encounter as we drive down this road of life, experiencing both
the good and the bad while driving between them.
A great example of this application would be the new school year and the
students beginning their journeys. At some point, they will all
experience the good and the bad, but either way they will eventually find
themselves headed in the right direction.
The point is, life is meant to be experienced, and every now and then
we're going to veer towards one side of the road or the other. But if we
maintain our focus and keep our eyes forward, the dark times will
eventually end and the sunny days will always be fulfilling.
For better or for worse, enjoy the view this week.
rambling over friends and loyalty
7 years ago


text:
MIRIK, 29 Mar 2015: The Mirik Police on Saturday started an awareness programme on the recent phone scams, and is all set to organize a door-to-door awareness campaigning in all villages following a rise in the number of incidents reported from the area, said the police during the event.
With the house visits, the police aim to warn and protect elderly and vulnerable residents against the perils of frauds, particularly those designed to catch people off guard via phone calls.
Since, February 2015, 21 elderly victims have fallen foul of frauds operated by organised criminals, defrauding them of life's savings. While, 9 others are youths and adults, said a police source. Police suspect the figure is higher, with many incidents going unreported.
"This initiative is about protecting the most vulnerable members of our community from frauds which come through phone calls. By raising awareness of them, we intend to make Mirik a less accessible environment for criminals to operate within," said a police spokesperson. "As part of the operation, uniformed police officers will be visiting people of various villages in Mirik, enabling them to take steps to reduce the likelihood of further victimization," he added.
The police have warned citizens to guard against such fraudulent phone calls, asking them to always check the identification of anyone making contact and if for any reason they were unsure, to end the call, be suspicious of any call from someone claiming to be from the police or bank reporting any fraud on your account, never give away ATM number, or bank details to anyone over the phone, and if received a call they are unsure of, and wait for at least five minutes before attempting to make another call to ensure they were not reconnected to the offender. (HS) [Pic by Finjo Tshering Bhutia]
2,198 total views, 1 views today


text:
Shadow Horses Escape
Play This Game
|Home »
|Escape Games »
Shadow Horses Escape Walkthrough
use screwdriver on ?
Click the thing on top of color wheel.
Screwdriver used on ? outside.
Knife used on cactus.
stuck with 2 birds, 2 hearts, a puzzle piece, and a clue. Need 3 number cue for right room and not sure how to arrannge colors in left room
Same here, thought the not used numbers on the color wheel would be the other 3 digit code, but no.
yeah I tried that too.
Left room under the shoe is the 3 number code
Blue diamonds go into room 3 on the holes
At the color wheel first press, often, that is for the entrance door
stuck at same place. has anyone solved the horse code or 4 letter code?
Birds on the wall in the room with the big triangle
code is side 2 on paper
Good find @Kerstin.
thx kerstin
Always gladly, you help me so often. Over the birds blikt a number. It does not fit to the door underneath 983
Use the jug on the slot next to the cactus.
Don't remember what the number was, but the number worked on the door under it.
Circles hint is upside down (blue/cyan circle is bottom etc).
Horses r l l r, as the switches on the bird door ... coincidence
thx for birds. Easy after that.
Reboot, now this number went to the door. Also the horse reference in the new room
In another room also the signs of the paper used. The word was john, came with a bird's head at the entrance
Thanks for the game, G4K.
I'm not understanding the birds clue. Are you talking about the wall in the room with all of PYB hearts and triangle or somewhere else? I've tried every wall in this game :)
Rington - other room. The one on the right.
It's always the simplest solution...thanks Chas!
after placing birds, number on big triangle should appear as per VWT, but not for me... :-/
suddenly it appeared, but now it d/w on door number pad... :-(
shoe number not working for door...was for outside #3. Can't get in to room with triangle.
This game needs fixing. after you place the birds and the # appears above the door it does not work to open the door!
where do you place the birds? and the heart gem?
can't get my door open either...olive put the birds in the niches in the room that needs 3#
I have a key but there are no locks to open anymore.
Found the lock. Great Escape.
Very nice and pretty fast game :D
nice game out now got stuck looking for SD
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text:
oh, Canada!
We're all proud of our home land, and as we should be! Our roots lie in where we are from; so much that shapes who we are and the values we hold comes not only from our family and how we were raised, but from the environment and surroundings that we were raised in.
Combined with the love I have for my home and native land, as well as my creative spirit and the ways in which I find inspiration, what better way to celebrate than by paying homage to the very things that are cultivated right in my own backyard!