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For the past few months a lot of us cranky old hardcore gamers have been watching the PS4 outsell the Xbox One with a certain sense of smug satisfaction. Serves Microsoft right! They ignored us and tried to pawn off a system laden with draconian restrictions and are now getting their just desserts! Long live the Playstation 4!
That said, I see storm clouds on the horizon. I think Sony's dominance may be short lived, and by the end of the year we may very well see the Xbox One outselling the PS4 handily. Here's why…
Memories Are Short
Yes, the Xbox One's unveiling was a PR nightmare that still haunts Microsoft to this day, but wisely they dropped all the console's most rage-inducing "features" before launch, and memory of what the Xbox One was once supposed to be is rapidly fading. You can feel the online mood softening — whereas the Xbox One was once an always-online, worse-than-Hitler box from hell, gamers are cautiously dialling down their vitriol as games like Titanfall come out, and folks still dedicated to hating the machine are having to scramble for less-than-compelling justifications like "I need Xbox Live for Netflix!" People can't maintain their Xbox One rage forever.
Not available on Johnny Call of Duty's Xbox 360.
Cross-Generation Games Are Coming To An End
Up until now, only the most dedicated hardcore gamers have been buying next-gen consoles. The kind of folks who keep up with every scrap of video game news and actually care whether a game runs at 30 or 60 frames-per-second. Meanwhile everyone else has stuck with their Xbox 360s and PS3s, because why not? Almost everything on the Xbox One and PS4 also exists in a slightly less attractive current-gen form.
Sometime around the middle of 2014 that's mostly going to stop. Big games like Tom Clancy's The Division, The Witcher 3, Assassin's Creed Unity and, of course, Halo go next-gen exclusive. Suddenly the core-casuals, the guys who play maybe half a dozen games a year and don't really keep up with gaming news are going to turn their attention toward next-gen consoles. These folks are a huge (maybe the biggest) chunk of the console gaming population, and trust me, they weren't paying attention last year when the Xbox One was being flayed alive by bad press. For most occasional gamers, the Xbox 360 was the console of choice this past generation, and when they decide it's time to upgrade, they're going to be looking towards the Xbox One first.
The Xbox One Is Probably In For A Big Shake-Up In 2014
But come on, brand loyalty will evaporate once core-casuals see the Xbox One's $500 price tag, right? Maybe not. Evidence is mounting that the Xbox One on shelves by year's end will be quite different from the current model. Microsoft is promising continued major system updates throughout the year, and they've already started cutting the system's price overseas. Could we see a stripped-down, Kinectless Xbox One by the end of the year? Possibly. We're almost certainly going to see the price drop to the $400 mark. By the end of the year, the difference between the Xbox One and PS4 is likely going to be much less pronounced in the eyes of most mainstream consumers. Hell, with Kinect and its TV-watching bells and whistles the Xbox One may even been seen as the better value.
"Hey, uh, guys? Can we get it together and make me a new game?"
Something Bad Is Happening Behind The Scenes At Sony
The Playstation 4 is a really well designed gaming console. Nobody's denying that, but a system is only as good as the games you can play on that, and unfortunately Sony Worldwide Studios, the collection of first-party developers responsible for Sony's biggest games, seems to be falling apart at the seams.
Driveclub, the title that was supposed to be the PS4's big exclusive launch window racing game, has been delayed indefinitely. Naughty Dog, the studio behind Uncharted and The Last of Us has been leaking top talent, including Uncharted writer Amy Hennig. Sony Santa Monica, responsible for recent God of War games, has also been hemorrhaging talent. Insomniac Games, the company behind Ratchet & Clank and Resistance has defected altogether and joined team Xbox. And of course, we're just talking about Sony's video game division here — the rest of the company may be in even worse shape.
Point is, aside from The Order: 1886 the PS4s upcoming first-party line-up looks bleak, and given the turmoil behind the scenes, I wouldn't count on a huge number of new announcements at E3.
Halo is going to kick the ass of, uh, what's Sony got again?
And really, it all comes down to this. Xbox One will have a Halo game out this holiday and the PS4 will have, well, I'm not sure. Naughty Dog themselves have said Uncharted probably isn't happening this year. Even if some miracle was to occur and Uncharted did happen in 2014, Nathan Drake just isn't a star on the level of Master Chief. The PS4 may very well lead for most of 2014, but unless they have some crazy secret blockbuster up their sleeves (and I don't think they do) this holiday season goes to Microsoft.
And of course, let's not forget the Wii U — it could still come from behind and beat both the PS4 and the Xbox One! Haha, no, I'm kidding, but this Nintendo fan can dream.
What about you folks? How do you see things shaking out by year's end?


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Given that it is only 48 hours since it was told off by a European court for not doing enough to prevent the sale of counterfeit goods on its site, eBay ought to take a look at a listing posted yesterday. "BSkyB – relisted due to time waster," it reads. The current bid is just shy of £1m, which looks pretty good value given the heady valuations this company has recently reached. But should you be interested, bear in mind that you'll have to share ownership with a rough crowd.
More discordant notes for BP
News Corporation isn't the only company with an image problem. Remember our friends BP, still trying to put the Deepwater Horizon disaster behind them? Not helping that effort is the fact the company has invested in tar sands resources in Canada, which is hugely controversial with environmentalists. And now BP's sponsorship of a series of screenings of operas in Trafalgar Square this summer has proved too good an opportunity for activists to ignore. The latest event was preceded by a protest that saw three protesting ballerinas stage their own version of Swan Lake in order to get their unhappiness with BP across – the dance culminated with a beautiful white swan being smeared with oil. Subtle.
Buffett showing his feminine side?
The folk at the Motley Fool have set out to provoke with their new book on the investment techniques of the sage of Omaha. It is entitled Warren Buffett Invests Like a Girl, though the sub-heading And Why You Should, Too makes it clear the publishers are not meaning to be rude about women. In fact, as they point out, there is plenty of evidence to show that women often make better investment decisions than men.
Give cold callers a fair hearing
This week's unemployment figures provide some clues as to why this should be the case, but the Direct Selling Association reports it has seen a surge in the number of older people employed in the industry. In fact, its members now employ almost a third more over-50s than they did only a year ago. So next time you're about to be rude to the caller trying to flog you double glazing, just remember that it's polite to respect your elders.
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- Environmentalism
- Investment
- Unemployment
- Warren Buffett

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Acropolis Hotel
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LMT Section 9: Hasraoun to Tannourine
... covered a lot today! During this discussion one of the older gentlemen in the group joined in. We were talking about how the Lebanon Mountain Trail is a very simple idea. It's just a trail, after all. All you do is walk on it. A lot of people, let's be honest, are going that think that's a pretty boring thing to do. I hope my pictures change some of their minds! We also talked about how half of the experience of the trail is really ...
Valley hikes
... 8217;s son, Charbel, started talking to me in French and he told us his dad would give us a lift to the bus stop where we'd be able to get a bus home. On route they offered us to come over for coffee and said we could even sleep at their house if we wanted. We declined… saying we were just really tired and were going to go home. But really, how nice was that!? Luke and I decided that we need to start doing more nice things.
Sunburnt and Sore: Skiing Faraya Mzaar
... been able to stay the night otherwise.
In the morning, we woke up around 7:00 and enjoyed a complimentary Lebanese breakfast. This consisted of the typical bread, labneh (a yogurt-like spread), eggs, raw vegetables, and loads of basil. After having breakfast, we hopped in a taxi to take us to get our gear then to the slopes. We stopped at Mzaar Sport, where a friendly couple fitted us for boots (L.L. 10,000), ...
Baalbek, Anjaar and Wine country!
... in.
Onto some vineyards and wine tasting. Ksara wines, which would be the most famous of wineries in Lebanon is open to the public. A brief documentary explaining the wine region and wine making process is down before getting down to the taste testing. 4 small sips of a white, rose, red and a moscato we were then ushed down into the caves to see where they lay the wines (either in bottles or oak barrels!).
We lunched at ...
Our lady of Lebanon, Faraya, Kleiaat and Tarnib
... dinner that Auntie Nounou has planned with the rest of the Rabbats! There are something like 8 including their spouses. This will take place on Thursday evening.
Once we had the plan in place, we decided to head to the mountains of the south today. This is an area where some Beirut residents typically head to for the summer. When my dad lived here, he used to go up to Kleiaat all the time.
The first stop was a church on the mountain that ...


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Frame Denim
Founded in 2012 by Jens Grede and Erik Torstensson, two London-based Swedish industry veterans, Frame Denim brings global influences together in the pursuit of creating the perfect pair of jeans. In transporting the London's edgy style from the streets of Shoreditch to the sunny sands of Los Angeles, the design duo's denim collection dazzles with its innovative washes and impeccably fitted cuts.
Meet the Designer


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Are you looking for Vases in NORTH CAROLINA? Hotfrog showcases more than 90 popular businesses related to Vases in NORTH CAROLINA! Find a specific region or suburb using the left navigation.
Winston-Salem, NC
Our buyers gather a unique selection of accents and furnishings for every room Because clear glass vases are the most popular choice for fl…
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quality and tasteful garden accessories, tools, decor and flowers for your home and outdoor space.
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DaisyDee Art Studio offers a wide variety of gifts including hand-painted wine glasses, vases, candles, ivy bowls, cake servers, bird baths, handcrafted jewelry and many other items including seasonal and custom items
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Seagrove, NC
Humble Mill Pottery - In continuous operation since 1970. - Each of the vases and plates are hand made on a potters wheel. - No two pieces are ever the same in shape or decoration
Greenville, NC
Greenville Furniture Store with mattresses, leather sofas, bedroom sets, dining tables, and children's furniture
Furniture Distributors
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AV Smith Pottery. Pottery, North Carolina Pottery, Folk art pottery, face jugs, vases, roosters, pigs, colorful funtional and decorative pottery made in North Carolina
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Handmade pottery - contemporary wheel thrown and hand built stoneware, porcelain, and Raku pottery. My pottery is wood fired, and ash glazed, altered, and textured with geometric designs
Charlotte, NC
Glass from Something Truly Unique was born from my passion for hand painted glassware and ornaments. I have been designing and creating hand painted glass items for over 7 years. Looking to find a unique gift t…
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Uhwarrie monuments is a family-owned business that is proud to call Stanly county home. We specialize in custom-made granite, brass and marble monuments designed to provide your family with a lasting tribute to your love…
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bomisch offers unique and boho home goods, gifts and living essentials. bomisch offers unique goods for kitchen, tabletop, office, closet and living areas of your home. You will find pillows, serving bowls, glassware, ut…
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Largest selectin of Granite, Bronze and Marble Memorials
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Hight Tombstone Company was founded by Jeanne Hight of Henderson With nearly thirty years of experience in the monument business, Robert became the owner of Hight Tombstone Company in 2009 Hight Tombstone, H…
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Liberty, NC
Hardin's Wholesale Florist Supply, Inc., a wholesale distributor that provides the complete source for all your floral needs. Our commitment is to provide unsurpassed service and excellent quality products
Floral SuppliesFloral Wholesale
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Salvaterra Pottery was established in 1997 Our newly introduced Smoky Blue, seen in the new items section, is a matt glaze with a tranquil feel of pale blue, cream and rust Each piece is handmade in our base…
bowlsFunctional StonewareFunctional PotteryTrays
Morrisville, NC
At Marble & Figure in Morrisville, NC, you'll find unique, hand crafted, solid marble statues, fountains, life sized figurines and accessories, everything you need to make your place the talk of the neighborhood …
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The ideal shopping place for high end custom floral designs and an array of home decor items. Clearance sale on Uttermost lamps, mirror, furniture, oil paintings and accessories
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Victory Trophies and Gifts, conveniently located in The Factory, Wake Forest, NC We offer Business Promotional Items for tradeshow giveaways, advertising, and other marketing efforts
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Offical Website of the Seagrove Area Potters Association. Information on potters and pottery in the Seagrove area of North Carolina. Free Maps, Information, Newsletters, FAQs and more
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Winecoff Memorials, one of the largest full service monument companies in the Southeast. We are eager to serve you and can offer many suggestions to help you in selecting a monument or marker for any budget
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From humble beginnings in the late 70s to today's leading resource for Christian goods, Christian Book Distributors continues to provide an enormous selection at excellent value, with strong customer service and sup…
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Barry Lockman digs local clay, uses minerals found nearby and fires with #2 diesel oil and wood. Salt glazes and seals the pots. He makes functional pots and occasional carved clay. Salt often reveals clay at its finest
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Shop for furniture and home accessories at Plum28.com. Discover your style browsing Plum28's large selection of home furnishings and home decor. Enjoy the experience
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Publicity THE MAYAN SECRETS!!! FURNITURE & DECOR The Mayan Secrets is proud to present Mexico´s finest hand hammered copper items to the world. Having been established in 2008, yet having more than fifteen years of e…
A Different Approach is a fair trade wholesale business specializing in Nicaraguan and Peruvian pottery. We work with family businesses / cooperatives to bring you interesting Nicaraguan and Peruvian pottery designs
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The communications watchdog is threatening to formally regulate broadband providers that do not give an accurate picture of the speeds customers can internet receive, after it found companies were falling short.
Ofcom first imposed a voluntary code of practice on broadband speeds in December 2008 and revealed yesterday that it had been "mystery shopping" to check that internet service providers (ISPs) were complying.
In the wake of the results of its anonymous survey, the regulator now proposes tightening up the code by the summer. "If agreement cannot be reached with the ISPs, Ofcom will consider whether it is necessary to introduce formal regulations," it said.
The research found that ISPs "are meeting some aspects of the code but are falling short in other areas". The voluntary code was imposed after the regulator found in July that many customers could not achieve the headline broadband speeds advertised by some companies.
Ofcom found that Virgin offered the best average speed of up to 8.7Mb on its "up to" 10Mb service, with Tiscali the lowest at up to 3.7Mb average.
Yesterday, the regulator said its research had found 85 per cent of mystery shoppers were given an estimate of the maximum speed on their broadband line before singing up. However, almost half of the shoppers had to prompt the companies for the speeds they offered, and three-quarters were not told that their speeds were likely to be below the maximum offered.
Some of those only gave a vague indication, saying customers could receive speeds between 10Mb and 20Mb, "which could lead customers to expect a much higher speed than they actually receive", the regulator said.
Ed Richards, chief executive of Ofcom, said there was "still significant further progress to be made", despite customers receiving more information than before. "We will continue to monitor and assess performances against the code in coming months."
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Donna, trugs were originally oblong baskets with low sides, used to
collect flowers so that they could lie flat. With the boom in baskets
and in gardening in recent years, the use of the word 'trug' has been
stretched to cover all manner of containers. But I'm sure you remember
some old movies where the lady would be collecting flowers from the
cutting garden and lay them in a long rather flat basket. That's a trug.
> Just what is a trug? I should know this, but can't seem to find it in
> my cluttered brain right now.....
> BTW Pam must be having mail problems also- got two personal messages
> returned here and figured I have the address correct since I only hit
> reply.... (so when you are back up and running Pam, the pictures are
> posted on the net)
> Donna
> >
> > Man, my e-mail must be messed up right now cause I'm not getting those
> > messages from Kitty. Hmmm. That's the same kind of wagon I have
> Kitty,
> > without the sides. I LOVE mine. But Pam bought me my first
> trug...and
> > now
> > I have 3 cause I use them so much. But Pam's yard is much smaller
> than
> > mine
> > and I have to hual stuff everywhere. In fact, when our oldest riding
> > lawnmower bites the dust, my husband is going to have the blades and
> stuff
> > removed and let me use it to attach my wagon to for when I work up at
> the
> > front entry of our farm or down in the pastures.
> >
> > Jesse R. Bell
> ---------------------------------------------------------------------
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Publication Name: Athens News Courier
Location: Athens, Alabama
Pages Available: 259,848
Years Available: 1968 - 2016Learn More About This Publication
Athens News Courier (Newspaper) - November 15, 2009, Athens, Alabama Tigers, Tide lace big challenges from SEC foes PAGE IB ie News Courier Serving Athens and Limestone County: A Community of Tradition and Future One dollar Visit us online wwrw.enewscourier.eom Inside Today Woman: United Way saved her Bobbi Kidd, 43, from Mobile, first fled domestic violence in 2002 by contacting a local crisis center for women and children. PAGE 24 New skills for old business After a lifetime of family ranching, a couple manages its operation with more business savvy thanks to the help of a class designed to help people in agriculture make better financial decisions. PAGE 22A Index Classifieds.......1C Crossword 19 A Ledger.........19 A Letters..........5 A Lifestyles........9A Lottery..........3A Obituaries.......2A Mary Freeman Clara Hargrove Opinion.........4A Sports...........IB Valley...........6 A Weather.........2 A 6984700002 Renovation near complete Donations made online help troops on Iraq duty By Jean Cole jt'aiha atht msnt'ws-courier.com Want to put your money where your "Support the Troops" car magnet is? Give a small donation to Athens' 203rd Militaiy Police Battalion now stationed in Iraq. Now you can donate online and help make Thanksgiving and Christmas better for local and area soldiers, said Amanda Bailey, chairwoman of the Family Readiness Group — which supports the 203rd Militaiy Police Battalion based in Athens. Donations of any size are needed to buy turkeys or hams for the families of about 85 soldiers from limestone, Morgan and the surrounding area for Christmas. The FRG also hopes to buy about 60 teddy bears that will be given to the soldier's children on Christmas day. The $3 bears include a recording device that will be sent to Iraq so a soldier mom or dad can record a message then return it and have it reattached to a bear for their children. Donations will also be used to fill Christmas stockings for each of the soldiers. To donate online, go to: www.fig203id.oig.html, scroll down to the Contact Us bar on the left side of the home page and click on it. Then, scroll down to the end of the page and click on the yellow donate bar, which allows you to donate using PayPal. Or, you can send a check or money order by mail to: FRG 203rd, 28514 Countryside Circle, Ardmore, AL 35739. The 203rd was deployed on Father's • Day to Fort Hood, Texas, and then to Iraq in September. The soldiers are training the Iraqi police for their eventual takeover in the region. The unit's departure from Athens this summer marked the first time a local guard unit deployed overseas since 1950, when the 1343rd Battalion left for the Korean Conflict. The primary mission of an FRG is to assist commanders in maintaining readiness for the service members, families and communities by promoting self-sufficiency, resiliency, and stability during peace and wartime. Downtown Christmas open house coming next weekend The Greater Limestone County Chamber of Commerce and The Spirit of Athens will hold its 23rd annual Christmas Open House in Athens all day Saturday and from 1 to 5 p.m. Sunday, Nov. 22.Related story, Page 6A Activities planned downtown for the weekend include visits from Santa from 1 to 4 p.m. Saturday and Sunday, carriage rides, carolers and refreshments. At each participating business countywide, shoppers will have an opportunity to register for a door prize to be awarded by the business and a grand prize from Hobbs Jew elers to be announced at The Club House at 121 S. Marion St. at 5:30 p.m. Sunday. Participating businesses will be identified with a distinc-See Open house, page 3A Jerry King Company 1613 L Gray Wvd. • Afhan», AL 35611 230-0402 QNC Mambar Ufo Cm Gut You Financed Change out your old qnMn with • NEW High Efficiency Haatpump today! 6% AdmmVt№m*TVA Call for Dotatisi EJ 'Domino hair gets a facelift By Karen Middleton [email protected] The square orange brick building at Beaty and East Market streets once served as the early city of Athens electric department. Then, a few decades back, elderly gentlemen gathered there for heated matches of dominoes. In recent years the building has housed grounds keeping equipment. But now, this former ugly duckling has bloomed into a graceful swan at the hands of Sanitation Department Director Earl Glaze and his work crew. Exposed bricks and gleaming oak surfaces give a trendy feel to the offices and meeting space that has been created within. It's rare that the city of Athens has three construction projects going concurrently. As well as the "domino hall," the city recently completed a new two-bay fire station to serve Black's Landing Subdivision on the banks of the Tennessee River. The City Council voted last week to name the new station, which was completed as a joint project with Clements Volunteer Fire Department, "Oak Grove Station," in honor of Oak Grove CME See Facelift, page 3A NEWS COURIER/KAREN MIDDLETON The former Athens Electric building - more recently known as "the domino hall" - has a brand new interior and exterior after a renovation by city Sanitation Director Earl Glaze and his Public Works Department work crew. Treasures of the past The Mammoth, which became Lerman and Bowen Grocery in 1895, was located on the north side of the Athens Square. Historian Betty Taylor catalogs BO years of business in Athens By Karen Middleton [email protected] 'iisiu iws-courier.com When Betty Lindsay Taylor agreed to do jme local research for the Mormon Church wen years ago she never dreamed it would :ad to compiling a 393-page book featuring ithens businesses from 1870 to 1950. Taylor's research project for the Morions has long been completed, but she be came so intrigued during her research that she decided to do a book. "The Mormons wanted someone to go through all the Probate Office's loose files and copy every name listed," said Taylor. "About six people worked on this project. I was just fascinated by the old letterheads See Treasures, page 3A Gathering at W.E. Estes & Son, Betty Taylor, front left, said she couldn't have compiled her book without the help of Jackie Leonard, back left, president, Friends of the Archives, her husband Houston Taylor and Doris Estes. ;


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HTC One killing USB cables?
Ohk, so I have a weird problem here.
Since yesterday, my One stopped charging on its regular cable. I tried it on two HTC cables, one Sony cable and two Samsung cables.
It only charges when using the Samsung cables, and on any charger. All the cables charge my Xperia S, and my flatmates Samsung. We can swap them all out all good. But the One will only charge with the Samsung cables. Does anyone have any idea what is going on here?
Same result when connecting to Laptop.
The only thing I can see as maybe a problem, is that I notice the Samsung contacts seem to be larger/thicker as the other cables. Maybe the HTC is bent and therefore can only work with the longer contacts?
Thanks! Josh
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- Carrier
- Pure Nexus/Franco Kernel
Re: HTC One killing USB cables?
It may be something to do with the charging port in the phone as well.
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Yin & Yang universe Mens Hoodie
Spirit Symbol Design by EDDA Fröhlich / EDDArt | Yin & Yang = both terms represent the duality of opposing principles in one = (male / female, etc.) | You miss other colors with this design? Feel free to contact me: firstname.lastname@example.com
We print all Hoodies using the latest DTG print technology and highest quality inks to ensure a superior print quality and a lasting finish. The double fabric hood with self-coloured drawcord and a front kangaroo pouch pocket makes this Hoodie just perfect.
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img src="http://www.ardorny.com/i.aspx?t=a&s=t2&r=1676151" / Ardor Web ID: 1676151 - Located in a beautiful brownstone coop nestled on a quiet, tree-lined block, surrounded by historic homes and mansions. Just a quarter-block to Central Park and near the Guggenheim, Metropolitan, and many other of Manhattan?s best museums. Apartment features: hardwood → Read More
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Hey Edmonton You're Looking Good!
We, at Piper Plumbing Heating and Drain cleaning Inc, help the residents of Edmonton maintain and improve their plumbing systems. We are one the best teams of plumbers who have been proudly serving the residential and commercial customers for many years. Provision of swift, dependable, customized and affordable service is our top most priority. We carefully maintain the quality of plumbing expertise and strive to give our best. Take a moment to watch our "Why Choose Us" Video. Click here.
Your time and money are precious, and, we certainly realize this fact. Feel free to contact us right now and get a free consultation. Whether you are experiencing a minor plumbing issue or thinking to reinstall the plumbing system of your home or business, we are available round-the-clock to help you out. Be safe and give us a call in any plumbing emergency.
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Photo gallery
Hotel Badehof
Get an overview of this hotelRiverfront hotel with 2 restaurants and full-service spa
Located in the heart of Bad Salzschlirf, this spa hotel is within a 15-minute walk of Mariengrotte and Bad Salzschlirf Observatory. Eisenbach Castle and Golfpark Schlossgut Sickendorf are also within 12 mi (20 km).
Hotel Features
This hotel features 2 restaurants, a full-service spa, and an indoor pool. Free WiFi in public areas and free self parking are also provided. Additionally, a health club, a bar/lounge, and a coffee shop/café are onsite.
Room Amenities
All 71 rooms provide free WiFi, 24-hour room service, and satellite TV. Hair dryers, safes, and showers are among the other amenities that guests will find.Information missing or incorrect? Tell us!Opens in a new window
Hotel Badehof
Hotel Amenities
Hotel Amenities
In addition to a full-service spa, Hotel Badehof features an indoor pool and a health club. Dining is available at one of the hotel's 2 restaurants and guests can grab coffee at the coffee shop/café. A bar/lounge is on site where guests can unwind with a drink. A complimentary breakfast is offered. A computer station is located on site and high-speed wireless Internet access is complimentary.
4 meeting rooms are available. This Bad Salzschlirf hotel also offers a sauna, spa services, and a library. Guests can use the indoor pool, outdoor pool, and health club at a partner property. For a surcharge, the property provides an area shuttle within 50 km, a shopping center shuttle, and a train station drop-off service. Limited complimentary onsite parking is available on a first-come, first-served basis.
Hotel Badehof has designated areas for smoking.
- Total number of rooms - 71
- Number of floors - 3
- Bar/lounge
- Barbecue grill(s)
- Coffee/tea in common areas
- Coffee shop or café
- Free newspapers in lobby
- Free breakfast
- Dry cleaning/laundry service
- Elevator/lift
- Front desk (limited hours)
- Full-service spa
- Shopping center shuttle (surcharge)
- Health club
- Train station drop-off (surcharge)
- Computer station
- Designated smoking areas
- Tours/ticket assistance
- Free WiFi
- Library
- Limo or Town Car service available
- Spa treatment room(s)
- Multilingual staff
- Parking (limited spaces)
- RV, bus, truck parking
- Garden
- Terrace
- Luggage storage
- Train station pickup (surcharge)
- Free self parking
- Year Built 1906
- Area shuttle (surcharge)
- Number of restaurants - 2
- Number of meeting rooms - 4
- Free parking nearby
- Sauna
- Shopping on site
- Number of buildings/towers - 1
- Spa services on site
- Indoor pool
- Wedding services
Family Friendly Amenities
- Family Hotel
- Indoor pool
- Free Wi-Fi
- Miniature golf on site
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Free self parking, RV, bus, truck parking, Parking (limited spaces), Free parking nearby
Room Amenities
- Premium TV channels
- Phone
- Hair dryer
- Bidet
- In-room safe
- Hypo-allergenic bedding available
- Satellite TV service
- Free WiFi
- Private bathroom
- Free toiletries
- Shower only
- Room service (24 hours)
- Cribs/infant beds (surcharge)
- Rollaway/extra beds (surcharge)
- Desk
Where to Eat
A complimentary breakfast is offered.
Ruehmanns Cafe Bar - Overlooking the garden, this cafe serves breakfast, lunch, dinner, and light fare. Guests can order drinks at the bar and enjoy alfresco dining (weather permitting). A children's menu is available. Happy hour is offered. Open daily.
Restaurnant - Overlooking the garden, this restaurant serves breakfast, lunch, dinner, and light fare. Guests can enjoy alfresco dining (weather permitting). Open select days.
Late night fare is available from 24-hour room service.
Nearby Things to Do
Recreational amenities at the hotel include an indoor pool, a health club, and a sauna.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Golfing nearby
- Rafting nearby
- Kayaking nearby
- Hiking/biking trails nearby
- Bicycle rentals nearby
- Parasailing nearby
- Skydiving nearby
- Golf lessons available nearby
- Sledding nearby
- Miniature golf on site
- Pilates classes on site
- Yoga classes/instruction on site
Spa Services
MediFit has 3 treatment rooms. Services include deep-tissue massages, massages, facials, and body wraps. A variety of treatment therapies are provided, including Ayurvedic and reflexology. The spa is equipped with a sauna.
The spa is open daily.
- Deep tissue massage
- Reflexology
- Number of treatment rooms 3
- Manicures and pedicures
- Body wraps
- Body scrubs
- Ayurvedic treatments
- Sauna in spa
- Massages
- Body treatments
- Facial treatments
If you have requests for specific accessibility needs, please note them at check-out when you book your room.
- In-room accessibility
Hotel Policies
Check-in time starts at 3 PM
Minimum check-in age is 18
Check-in time ends at 8 PM
Special check-in instructions:
Check-out time is 11 AM
Payment types
Children and extra beds
- Children are welcome.
- Rollaway/extra beds are available for EUR 43.00 per night.
- Cribs (infant beds) are available for EUR 10.00 per stay.
- Pets not allowed (service animals welcome)
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
Only service animals are allowed
- A tax is imposed by the city: EUR 2.20 per person, per night
Optional extras
- Crib (infant bed) fee: EUR 10.00 per stay
- Rollaway bed fee: EUR 43.00 per night
Hotel Name
- Badehof
- Badehof Bad Salzschlirf
- Hotel Badehof
- Hotel Badehof Bad Salzschlirf
We should mention
This property offers transfers from the train station (surcharges may apply). Guests must contact the property with arrival details 72 hours prior to arrival, using the contact information on the booking confirmation. Reservations are required for massage services and spa treatments. Reservations can be made by contacting the hotel prior to arrival, using the contact information on the booking confirmation. Only registered guests are allowed in the guestrooms.
National Rating
Hotelstars Union assigns an official star rating for properties in Germany. This property is rated 4 star.


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SOLD -- 1970s Shawl Collar Belted Wool Cardigan
$ 32.00
This product is unavailable
Stay cozy and warm as you sip hot chocolate by the fire in this great button-up wool cardigan.
Fashioned in a kelly green heavy wool knit, this sweater has a slight 1920s feel to it. It features a shawl collar and belt and fastens up the front with 5 buttons.
Bust: 34"
Waist: 28"
Sleeve Length: 24"
Total Length: 25"
Label: Removed
Condition: Very Good
Sweater has slight pilling - mostly on the sleeves. The middle waist button has been replaced, however, it is covered by the belt and not seen when worn closed. Neither flaws detract. Priced accordingly.
Please view our Condition Chart for additional information.
See more: 1970s


text: Carl Sagan Deep Space Ship to Go to the Living Room and BeyondJesus Diaz11/10/09 2:40pmFiled to: spaceshipsLegocarl saganSpaceDeep space exploration331EditPromoteShare to KinjaToggle Conversation toolsGo to permalink When I was 12, Cosmos was one of my favorite TV shows. The other was Benny Hill. Clearly, planetary exploration and semi-naked girls go together like William Shatner and Elton John songs, whiskey and glass, or Lego and awesome spaceships. This is the Carl Sagan deep exploration vessel, created by Ed Diment and Ralph Savelsberg—an expert in all things aircrafty and Lego. And while it's not big enough to hold a team of astronauts in search of alien civilizations, it's larger than its creators. And it just plain kick ass, even without auto-tuning. [Flickr via Brothers Brick] Reply33 repliesLeave a reply


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When an airline hostess fails to reach Pilot Dani Daniels standards at My Spanking Roommate discipline had to be dished out! But rather than face unemployment and potential homelessness the two agree that a well spanked bottom should do the trick! And the spanking begins!
As Clare Fonda puts it:
Dani Daniels is a pilot who also happens to be flight attendant Kay's new boss. When Dani confronts Kay after her third offense Kay begs Dani not to fire her, but instead spank her. When Dani warms to this idea, she spanks Kay very hard – so much so that Kay pleads for her to stop and fire her instead, but Dani's not having it. She embraces the new form of successful discipline.
And I have some of the domestic spanking images from the movie for you all
Don't forget that if you want to see more then get your butts over to My Spanking Roommate


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Brosse Short - Fader
Style Number: JJM595SU16.2
Jac+ Jack
or pay over time with
or 4 payments of $ with
Available Now
Crafted from a washed cotton twill, these shorts take on a casual approach to tailoring. Details include adjustable side tabs, a back welt pocket and a bias cut raw panel at the hem of the short. Wear tonally with a relaxed linen shirt or with tee's and tanks.
100% cotton.
Size Guide


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Situated about halfway between the cities of Manchester and Liverpool, Wigan is an ideal home town for those who want to be right at the heart of the action, without living in the busy city centre. Miller Homes has a number of different sized properties available in Wigan, making them suitable for a variety of needs, whether you're looking to get onto the property ladder for the first time, or you're hoping to downsize.
Continue browsing our website to find your perfect new home in Wigan. Can't find what you're looking for? Then get in touch with one of our friendly sales advisers and we'll answer any of your queries. You'll soon see why 94 percent of our customers said they'd recommend us to a friend!
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Z-Grade Revenge Thrills in Law Abiding Citizen
The movie wastes no time: Before the opening credits, a man watches two home invaders slaughter his wife and daughter—and we don't even know their names. Then: Deals are cut, the murderer walks while his less culpable accomplice is sentenced to death, and the dad wonders, "But what about justice?" And then: A decade passes, dad has seen a Saw or two, and it's retribution time. Everyone must pay, even the innocent. So much for our sympathy for the leading man, who happens to be Gerard Butler in yet another questionable role. Director F. Gary Gray and writer Kurt Wimmer peddle cheap, graphic Z-grade revenge thrills dressed up as Knowing Sociopolitical Commentary—as in, the justice system's rotten, so let's blow up, then gut, then roast again the whole sumbitch and start from scratch. Jamie Foxx's prosecutor (smug, a slow learner) gets a front-row seat to the explosion, as Butler's Clyde Shelton goes behind bars and into solitary confinement, from where, somehow, he is capable of inflicting enough damage and carnage to terrorize the whole of Philadelphia. Clyde won't stop speechifying about doing bad things in the name of the greater good. If the filmmakers meant a word of it, they'd quit making films and do something more useful. Saw with a conscience is not what the world needs.
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The Phoenix Guest House3
157 Columbus Ravine , Nr Peasholm, Scarborough, YO12 7QZ
Price FromView Rooms
- Excellent
- 13 guest reviews
"I was greeted with a warm welcome by Jenny, the owner, and was to find this remained the same throughout my stay, nothing was too much troub..."
"A very basic but clean room,..."
"We took our 3yr autistic granddaughter for her first little and she loved it...brilliant location ....Jenny the owner was really helpful in..."
"A very warm and friendly welcome and a lovely place to stay. I would definitely stay here again. Clean rooms and good breakfast..."
"This was a single night stay without breakfast, just somewhere to lay our heads, due to a lack of space at our friends'. The greeting was wa..."
About the hotel
The Phoenix is very conveniently located, just 2 minutes stroll from beautiful Peasholm park, 6 minutes from the magnificent sweep of north bay's sands. Scarborough cricket ground, the open air theatre, Scarborough bowls centre, the sea life centre, and Hollywood plaza cinema are just some of the attractions close by.
We offer very good value with prices from £20 per person per night for en-suite accommodation and scrumptious breakfasts for £6 per adult and £4 per child, which will set you up for the day.
Cleanliness is assured throughout and we trust that you will find us friendly and helpful, our aim is to provide for you a comfortable and enjoyable place to stay.
Read MoreLess
Facilities Show/hide
- Main
- Hotel Non-Smoking Throughout, Iron And Board In Each Room
- Business
- Wi-Fi Available In Public Areas
- Dining
- Bar
Useful Info Show/hide
- From 14:00 hours
- By 10:00 hours
- Up to 17 years old
- The price shown is based on the occupancy and dates you have searched for. Prices and availability are subject to change based on the arrival date, number of nights and occupancy searched for. All prices are inclusive of all local taxes.
- Pets are not allowed
Customer Reviews
Our reviews are from genuine LateRooms.com customers. We verify that the customer has stayed before leaving a review.
92% would recommend it to a friend
Customer service
Food quality
Room quality
Wish I had booked for a longer stay!!
I was greeted with a warm welcome by Jenny, the owner, and was to find this remained the same throughout my stay, nothing was too much troub...
A very basic but clean room,...


text: Move TextExpander Snippets to Keyboard Maestro with This ScriptThorin Klosowski4/14/16 12:30pm1EditPromoteGo to permalinkEarlier this week, the popular text expansion program, TextExpander, switched to a subscription model. Subsequently, a lot of people are jumping ship to other software. Programmer Ryan M created a script to bring your snippets over to Keyboard Maestro.


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Category:Congenital disorders of genital organs
From Wikipedia, the free encyclopedia
|This category reflects the organization of International Statistical Classification of Diseases and Related Health Problems, 10th Revision.
Generally, diseases outlined within the ICD-10 codes Q50-Q56 should be included in this category.
|Wikimedia Commons has media related to Congenital diseases and disorders of genital organs.
This category has the following 2 subcategories, out of 2 total.
- ► Congenital disorders of male genital organs (1 C, 18 P)
Pages in category "Congenital disorders of genital organs"
The following 8 pages are in this category, out of 8 total. This list may not reflect recent changes (learn more).


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They are all artists, and as such they are almost expected to behave with scant consideration for the rules that confine the rest of society. If you or I try to behave a fraction as terribly, on the other hand, we soon find that this tortured artist defence holds rather less water.
It's a salutary lesson, but one, perversely enough, that advertising has been slow to learn. Its creative community of designers, artists and copywriters have enjoyed life in a privileged artistic ghetto for years, whether or not that was in the best interests of either career development or, ultimately, effective marketing.
"Ten years ago if a creative team came in to show their book and they had three heads, they were all covered in acne and they were wearing swimming trunks, it wouldn't much have mattered," laughs Chris O'Shea, joint creative director at the advertising agency Banks Hoggins O'Shea, "because in those days agencies were happy to let creative people cocoon themselves away in ivory towers. Increasingly we are looking for creativity from all aspects of the communications package and at the same time expecting creative people to want to help present their ideas to clients. And to do that they have to be relatively presentable and, more important, able to communicate their creative ideas."
Yet at one time, not so long ago, the louche ad agency creative and buttoned-up client were kept apart with the same sort of ferocity that a dinner party hostess might keep apart Richard Littlejohn and Andrea Dworkin. That is changing now, and because it is changing it is demanding a host of new and improved skills from people coming into the industry.
In the traditional agency set-up, the account handler serves as a buffer between the client and the design or creative team, presenting the creatives' ideas and doing his or her best to defend them when the client makes inevitable suggestions for a bigger logo here, a more prominent typeface there. And, in truth, this is a set-up that is still adhered to in many large companies, but its chief drawback - a lack of flexibility - is starting to cause many forward-thinking employers to rethink the roles.
"The industry has suffered horribly from the fact that creative people were removed from the realities of the sales and marketing functions, and that people were shepherded down particular unalterable tramlines in their careers," points out Richard Hammond, founder of the new advertising agency Spirit, "but I'm sure that the old traditional hierarchies are now breaking down. We have certainly set up this agency along those lines. We don't want people saying, 'Oh, that's a production problem', or, 'that's a media problem'. We want creativity to be everyone's responsibility, in every department."
To emphasise the point, there is only one job title at Spirit, that of the non-executive chairman, the author and Tory politician Michael Dobbs. Everyone else is expected to contribute creatively to the job in hand.
"I'd like to be able to claim we have developed a new way of working, but in fact we haven't," confesses Hammond. "What we've done is copy the sort of platform teams that have helped make Chrysler, for instance, the most effective car manufacturer in the world. Everyone here works together, whether they are sales, design, direct marketing or contract publishing."
It certainly challenges the flexibility of new entrants into the market, even if in the longer term this way of working should lead to greater career choice and more workplace options.
"I think one of the problems with courses for design and creative people is that they still don't really learn how to present their work to clients," explains O'Shea. "That is something that is now an important part of the creative process, and something which frees up account handlers from the role of glorified baggage handlers - simply taking other people's work off for approval with the client - into a more fulfilling, strategic role. They can become business partners rather than bag-carriers, just as the creatives can enjoy defending what they consider most important in their work."
For graduates looking to move into the glamorous and competitive world of advertising this shift in working practices has obvious implications, not least of which is the desirability of making sure that their skill base is as broad as possible.
"The distinction between the creative and account-handling side of the business is changing," agrees Jeremy Bohn, director at the recruitment specialists Management Personnel, "and that's leading to the creation of a new type of job that combines the traditional creative skills with an ability to interact with the client and to take suggestions on board. Of course, there will still always be companies that need a relationship- builder or a good salesman in a pure account-handling role, but overall this trend away from specialisation is definitely helping to broaden the market."
It's also providing a useful corrective to the romantic myth that only the truly badly behaved, only those people, in other words, whom ad agencies have striven for years to keep from going anywhere near the client, can in fact embark upon a useful dialogue with them. Changes nowadays can be negotiated that will benefit both parties and free the account-handlers to get on with creative, business-oriented work of their own. All that's needed is a little flexibility, as well as perhaps an entree into the right side of the business.
"It does still depend on the area of advertising we are talking about, in exactly how much crossover there is between the two functions," points out Stuart Newman, who is director of the recruitment firm Network Design. "Direct marketing and sales promotion agencies are still very much account- driven, and the designer still has to take a back seat, but elsewhere the lines of demarcation are coming down, and clients are starting to prefer talking direct to the people who created the image."
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- Richard Hammond


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Xamarin 4 Launches, Covers the Mobile Development Life Cycle
Moreover, in addition to all the new and updated features in Xamarin 4, the company has made a preview version of its Test Recorder available for the Mac. Test Recorder uses a simulator or USB-connected iOS or Android device to record interactions—text input, swipes, taps and page navigation—and automatically creates test scripts that can be run on more than 2,000 devices in Xamarin Test Cloud, or imported into mobile test projects in Xamarin Studio and Visual Studio. The updated Xamarin.UITest 1.0 is a C# test automation framework that supports advanced testing scenarios such as testing locally and video capture of tests executing. Previously restricted to only Xamarin Test Cloud customers, the company has now made Xamarin.UITest free for everyone to use, with no limit on test time. And to enable teams of all sizes to take advantage of the more than 2000 devices in Xamarin Test Cloud, Xamarin has rolled out new pricing options starting from $99 per month—billed annually. In addition, Xamarin platform customers can now receive 60 free Xamarin Test Cloud minutes per month. These new options, combined with access to Xamarin. UITest, make mobile quality accessible to everyone, Friedman said. In a move to empower developers with analytics on their apps, Xamarin has taken its Xamarin Insights feature out of beta and has made it generally available in Xamarin 4. Xamarin Insights provides real-time app monitoring that helps businesses keep apps healthy and users happy. It provides error reporting, app performance and user-analytics data.Meanwhile, the length of time it takes for users to perform key functions will often determine the success of an app, as mobile users expect instant access to features and data. With Insights, developers create custom events that detail how long key user interactions and other system events take. Monitoring these performance trends over time ensures that the most important user paths in an app are also the fastest paths. And understanding how users engage with apps is critical to winning user loyalty and gaining competitive advantage. Xamarin Insights lets organizations see traits, devices, session details and events for each of their users, providing the intelligence enterprises need to improve the user experience, from new feature discovery to UI refinements. Finally, as part of Xamarin 4, the company is rolling out Xamarin Ultimate, which bundles Xamarin Platform, Test Cloud, Insights and Xamarin University into a complete package for teams to go mobile. Xamarin Ultimate makes it easy and economical for a business to scale apps and teams and to accelerate the mobile life cycle, Friedman said. With more than 10,000 corporate customers, Xamarin 4 is the result of the company's perspective on the most pervasive pain points facing mobile teams. In addition to the product enhancements in Xamarin 4, the company has also grown its course catalog to more than 60 mobile development classes in Xamarin University. In addition, Xamarin now has a team of mobile experts providing best practices guidance, so customers start their mobile journey on the right trajectory. "As the largest job site in the United Kingdom, we need to deliver native apps that work on all devices," said Yos Noor, head of research and innovation at reed.co.uk, in a statement. "Xamarin Platform, Xamarin Test Cloud and Insights have had a tremendous impact on our mobile strategy, providing a complete life cycle for delivering engaging, high-quality mobile experiences."
Enterprises need to quickly address app crashes and production issues to retain users. Xamarin Insights' automatic error reports provide rich diagnostic data, including stack traces, device status information and user behavior, to allow teams to find root causes and deliver fixes quickly.
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Misuse of benzodiazepines among high-risk opioid users in Europe
The misuse of benzodiazepines among high-risk opioid users in Europe
Last update: 04.06.2015
Benzodiazepines are a widely prescribed group of medicines with a range of clinical uses, including the treatment of anxiety and insomnia and the management of alcohol withdrawal. For a number of reasons this group of medicines are often misused by high-risk opioid users and are associated with morbidity and mortality among this group. This analysis considers the significance of this problem and its impact for the health and drug treatment of opioid users.
Part of the Perspectives on Drugs (PODs) series, launched as part of the European Drug Report package, these designed-for-the-web interactive analyses provide deeper insights into a selection of important issues.
1. Analysis
Benzodiazepines are a widely prescribed group of medicines with a range of clinical uses, including the treatment of anxiety and insomnia and the management of alcohol withdrawal. For a number of reasons this group of medicines are often misused by high-risk opioid users (1) and are associated with morbidity and mortality among this group. This analysis considers the significance of this problem and its impact for the health and drug treatment of opioid users.
Benzodiazepines have a range of clinical uses and are one of the most commonly prescribed medicines globally. They have proven useful in treating a range of health problems including anxiety, insomnia and alcohol withdrawal (Medicines and Healthcare Products Regulatory Agency, 2014). However, like all medicines, there can be side effects associated with benzodiazepine use, in particular with the misuse of these medicines, which for the purposes of this analysis we define as use without a prescription from a medical practitioner or with a prescription but outside of accepted medical practice or guidelines.
While the misuse of benzodiazepines has been identified as a concern for a number of groups in the general population, e.g. among the elderly and women, this analysis focuses specifically on the misuse of benzodiazepines among high-risk opioid users, a group where these medicines have been linked with severe treatment challenges and implicated in high levels of drug-related deaths.
It is important to stress that much benzodiazepine prescribing to high-risk drug users is for legitimate therapeutic purposes. Nevertheless, there are concerns relating to unintended health consequences associated with the use of benzodiazepine for longer periods (e.g. more than two to three weeks), polydrug use, and use that is not in accordance with prescribing guidelines.
As we describe below, available evidence shows that the misuse of benzodiazepines contributes to morbidity and mortality among high-risk opioid users. This includes a greater risk of heroin overdose, as well as being associated with a higher risk of human immunodeficiency virus (HIV) infections, psychopathology (anxiety and depression), poorer treatment outcomes and poorer social functioning (Darke et al., 1995; Lader, 2012; Ford and Law, 2014).
Benzodiazepine misuse among high-risk opioid users
High-risk opioid users typically misuse benzodiazepines to self-medicate or to increase the effects of opioids (Vogel et al., 2013). Users self-medicate to treat psychiatric disorders and negative emotional states (anxiety, insomnia) and to alleviate opiate withdrawal symptoms or the adverse effects of drugs like alcohol or cocaine. Benzodiazepines can also prolong the intensity and duration of the effect of opioids, especially when injected. Patients in opioid substitution treatment (OST) with methadone, for example, may misuse benzodiazepines to increase the effects of their opioid medication (Jones et al., 2012). Reports suggest this practice may be correlated with an under-dosing of the substitution treatment, which results in the re-emergence of withdrawal symptoms (Chen et al., 2011).
Benzodiazepines are generally taken orally, snorted, and by intravenous injection among high-risk opioid users. While a wide variety of types of benzodiazepines are available and misused in Europe by high-risk opioid users, those most commonly reported in studies or identified in statistics of drug-related deaths are diazepam, clonazepam, alprazolam, oxazepam and flunitrazepam. Benzodiazepines with a more rapid onset of action (e.g. diazepam, alprazolam or lorazepam) appear to be more frequently used by opioid users than those with a slower onset (e.g. oxazolam or prazepam).
Users obtain benzodiazepines from different sources, including diversion of prescriptions (such as 'doctor shopping' (2)), the illicit market and the Internet. A growing number of benzodiazepines that are not approved medicines within the European Union (EU), such as flubromazolam or flubromazepam, have been identified for sale at street level and online.
While treatment demand data (3) do not allow us to gauge the full scale of benzodiazepine misuse, it does give an important insight into the scope of the problem. Data show that the combined use of opioids and benzodiazepines is a significant issue among those receiving treatment. Available data for 2014 from 18 countries (4) where opioids were reported as the primary problem drug (5) by those entering treatment (102 000, or 19 % of all clients) show benzodiazepines were reported as a secondary problem drug (6) by 11 %, or 10 000 of those entering treatment. Higher levels were reported in some countries, ranging from 30–50 % of those entering treatment. However, it should be noted that secondary drugs, including benzodiazepines, are often under-reported.
The prevalence of benzodiazepine misuse among clients in OST ranges from 45 % in France (Brisacier and Collin, 2014) to 70 % in Germany (Specka et al., 2011; Laqueille et al., 2009). The frequency of benzodiazepine misuse among those undergoing OST is reported to increase with the length of treatment (Fernández Sobrino et al., 2009). This factor has also been identified in other treatment outcome studies (Comiskey, 2013; Stewart et al., 2002). High rates of benzodiazepine misuse have also been found among high-risk opioid users in prisons, with one study involving 38 Italian prisons finding that 85 % of opioid users were misusing benzodiazepines (Nava, 2014). Current data on trends in benzodiazepine misuse among high-risk opioid users in treatment indicate a relatively stable trend between 2006 and 2013, with a decrease in the last year.
The majority of reported benzodiazepine misuse occurs among those reporting opioid use as the primary drug for which they are entering treatment. However, around 7 000, or 2 % (range: 0–20 %), of all clients entering treatment reported benzodiazepines as the primary drug of misuse; and 20 % of these clients also reported the use of opioids as a secondary drug. Ireland, Finland and Romania are the countries with the highest rates, where more than 5 % of treatment clients reported benzodiazepine use as their primary drug problem.
Health harms
There is evidence of various harms associated with benzodiazepine misuse among both the general population and in particular vulnerable groups including high-risk opioid users. This can include problems associated with rapid tolerance, dependence and withdrawal. In the latter case this can include increased anxiety, agitation, confusion and panic attacks, and can lead, in vulnerable people, to acute psychosis. Abrupt withdrawal can cause uncontrollable and potentially fatal convulsions (Jones et al., 2012; Ashton, 1986). The cessation of benzodiazepine use is complex and requires medical support, which can include the use of other medications to manage withdrawal or provide substitution. Sometimes this process might need to take place in an inpatient setting.
The use of benzodiazepines has been linked with long-term effects including over-sedation, depression and immune system problems. As side effects can be more pronounced in the elderly, Europe's ageing population of chronic opioid users are at extra risk. Polydrug use involving opioids and benzodiazepines can also expose users to other risk behaviours and drug-related harms. These include needle-sharing, using higher doses of drugs, intoxication-related accidents, and poor physical and psychological health (Vogel et al., 2013; Lavie et al., 2009; Rooney et al., 1999).
Studies suggest that opioid users who use/misuse benzodiazepines experience a high level of health problems and use health services frequently. For example, the Australian Treatment Outcome Study (ATOS) (Darke et al., 2003) looked at the relationship between use of healthcare services and benzodiazepine misuse among heroin users. It found that heroin users who also used benzodiazepines had frequent general practitioner (GP) and psychiatrist visits, were more likely to have had an ambulance attendance and had significantly more dispensed prescriptions than other heroin users. A recent study in France among patients on buprenorphine explored the co-prescription of benzodiazepines on opioid treatment outcomes; although no impact on outcome was identified, benzodiazepine prescription was associated with more frequent emergency department visits and accidental injuries (Schuman-Olivier et al., 2013).
Simultaneous use of opioids with benzodiazepines and other central nervous system depressants, such as alcohol, increases the risk of non-fatal and fatal overdose through respiratory depression (White and Irvine, 1999).
The increased risk of overdose among opioid users is reflected in the high frequency of benzodiazepines identified in post-mortem examinations of drug-related death cases. For example, benzodiazepines were identified in 40–80 % of methadone-related deaths (France, United States, Australia) and in 50–80 % of heroin-related deaths (Germany, Ireland, United Kingdom) (Lintzeris et al., 2007). Current European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) drug-induced deaths data show that benzodiazepines were implicated (i.e. they were thought to have played a role in the death) in 28 % of deaths in Scotland (7), 48 % in France, 30–32.5 % in Portugal (8) and 35 % in Ireland (9). In addition, when the presence of benzodiazepines is considered in drug-induced deaths, percentages have been reported for Scotland (72 %) (10) and Finland (88 %) (11). It is, however, important to note that that even when benzodiazepines were not implicated in deaths, they may have played a role in risk behaviours that led to death.
There have been case reports of fatal poisonings involving mixing benzodiazepines with buprenorphine in France, where buprenorphine is more commonly used than methadone for substitution treatment, with benzodiazepines identified in 70 % of buprenorphine-related deaths (France, special mortality register data, DRAMES 2012; Reynaud et al., 1998). While buprenorphine causes less respiratory depression than methadone, non-clinical studies have found that its ceiling effect on respiratory depression is removed when combined with benzodiazepines (Nielsen and Taylor, 2005). For all opioids, establishing the role of benzodiazepines in drug-related deaths is complicated by several factors. For instance, the combinations of drugs identified are often complex, individuals have different levels of tolerance and metabolisms, and a level of subjectivity exists in toxicological assessments.
Insights from hospital emergency departments
Data from hospital emergency departments provide valuable insights into drug user and related health problems. This information can be used as a leading edge or real time indicator of drug problems. The European Drug Emergencies Network (Euro-DEN) project is a European Commission Drug Prevention and Information Programme funded project that involves longitudinal collection of data from 16 sentinel centres in 10 European countries on emergency department presentations with acute drug and NPS toxicity (Wood et al., 2014).
The Euro-DEN database was searched to identify cases from 1 October 2013 to 30 June 2014 where heroin had been used prior to presentation. Of the 3 573 Euro-DEN cases over this nine-month period, 872 (23.2 %) involved self-reported use of heroin. Of these, 221 (25.3 %) had also used one or more benzodiazepines (of which 196 (88.7 %) involved one benzodiazepine, 21 (9.5 %) involved two benzodiazepines and 3 (1.8 %) involved three benzodiazepines) (Dargan et al., 2015).
There was significant variation across the Euro-DEN centres, ranging from no heroin presentations in Barcelona, Copenhagen and Paris involving a benzodiazepine to 35.6 % of heroin presentations in Oslo involving a benzodiazepine. There was no significant difference in the age or gender of the heroin–benzodiazepine cases and the heroin cases not involving a benzodiazepine, and there was no difference in the proportion with coma. However, those in the heroin–benzodiazepine group had a longer stay in hospital (5 hours 46 minutes versus 4 hours 45 minutes, p=0.03) and were more likely to be admitted to critical care.
Challenges for the future
Benzodiazepines have a range of well-established clinical uses and side effects. This makes their widespread availability and the potential for misuse a serious problem, particularly where they are taken by opioid users as part of polydrug use repertoires. The picture that emerges from research studies and the available epidemiological data presents a challenging situation. Benzodiazepines have a role in the management of the mental health issues opioid users experience from their drug consumption. However, the misuse of benzodiazepines with other drugs can expose users to a spectrum of problems ranging from mental health issues, compromised treatment outcomes and risky drug consumption practices, to more severe consequences such as non-fatal and fatal overdoses. To date, however, benzodiazepine misuse alongside other drugs among high-risk opioid users has often been viewed by users and service providers as a secondary issue, neglecting its polydrug use dimension and consequences. The situation is further complicated by the emergence of new benzodiazepines on the illicit market in some countries, for example, phenazepam and etizolam, which have been implicated in several deaths among opioid users in Scotland (12). With a continuing need to use benzodiazepines for various medical purposes and in order to mitigate the risks opioid users taking them face, prescribing and clinical practice guidelines have a critical role to play in the management of this issue as part of a comprehensive response to polydrug users among high-risk opioid drug users. Giving the ageing nature of this population within Europe and the increased potential for health complications from ongoing drug use, this issue is an existing challenge that treatment systems must address.
2. Video: misuse of benzodiazepines among high-risk opioid users
3. Facts and figures: the pharmacology of benzodiazepines
Benzodiazepines were introduced into clinical medicine in the early 1960s. They rapidly replaced barbiturates as sedative-hypnotics because they were safer, particularly because they were less likely to cause fatal central nervous system depression (Longo and Johnson, 2000; EMCDDA drug profile).
Benzodiazepines act as central nervous system depressants by enhancing the actions of the neurotransmitter GABA (gamma-aminobutyric acid). This has a calming effect on many functions of the brain, including inducing sedation and sleep (Lalive et al., 2011).
They are used for treating psychiatric and neurological conditions, including insomnia, anxiety disorders, alcohol dependence and epilepsy. Some are also used as a pre-anaesthetic and intraoperative medication (Medicines and Healthcare Products Regulatory Agency, 2014).
Benzodiazepines can be divided into different groups based on their chemical structure and pharmacokinetic properties, although they share a common mechanism of action and produce similar pharmacological effects (Baldwin et al., 2013).
Based on their pharmacokinetics, benzodiazepines can be placed into one of three groups. These are: short-acting agents, with half-lives of under six hours (e.g. oxazepam), intermediate-acting agents with half-lives of 6–24 hours (alprazolam), and long-acting agents with half-lives of over 24 hours (diazepam) (Medicines and Healthcare Products Regulatory Agency, 2014).
4. Guidelines for prescribing benzodiazepines to opioid users
There are only a few evidence-based clinical guidelines available to support practitioners on the use and management of benzodiazepines among high-risk opioid users. The EMCDDA's Best Practice Inventory currently contains six sets of guidelines that address these issues, as part of general or specific guidelines for managing opioid use.
The Substance Misuse Management in General Practice guidance in the United Kingdom, which specifically addresses the use and reduction of misuse of benzodiazepines and other hypnotics and anxiolytics, proposes a strategic course of action:
Strategy for prescribing benzodiazepines to opioid-dependent patients:
- Treat the opioid dependence first; this has a good evidence base.
- Discuss with patients how they will control and reduce their benzodiazepine use themselves (without the need for a benzodiazepine prescription). Many patients are able to reduce their illicit supply themselves.
- Re-assess patients' benzodiazepine use once they are stable on their opioid prescription and it has been optimised. Clinical experience shows that benzodiazepine use (even what clinically appears to be dependence) often ceases once on a stable opioid substitution.
- If use of benzodiazepines is continuing, reassess the reasons. Is it for sedation, the 'buzz', anxiety or the comedown from crack or other drugs? Does it enhance the opioid 'buzz'? Do not prescribe benzodiazepines if use is for pleasure or in binges.
- If dependence on benzodiazepines is present, consider a short term (six weeks to six months) reducing prescription of benzodiazepines on daily pickup (a minimum of six days a week).
- Stop the benzodiazepine prescription if persistent illegal benzodiazepine use or alcohol dependence are present.
- Consider similar staged detoxification as with other patients dependent on benzodiazepines.
Find out more
Further reading
- Ashkar, A. G., Goldberg, T., Maraj, I., Masters, A. and McFarlane, S. I. (2014), 'Torsade de pointes induced by methadone and clonazepam use', International Journal of Medical and Pharmaceutical Case Reports 2(4), pp. 81–5.
- Ashton, H. (1986), 'Adverse effects of prolonged benzodiazepine use', Adverse Drug Reaction Bulletin, 118, pp. 440–3.
- Baldwin, D. S., Aitchison, K., Bateson, A., et al. (2013), 'Benzodiazepines: risks and benefits — a reconsideration', Journal of Psychopharmacology 27(11), pp. 967–71.
- Barker, M. J., Greenwood, K. M., Jackson, M. and Crowe, S. F. (2004), 'Cognitive effects of long-term benzodiazepine use: a meta-analysis', CNS Drugs 18(1), pp. 37–48.
- Brisacier, A. C. and Collin, C. (2014), 'Opioid substitution treatments in France: recent data', Tendances, OFDT, 94, p. 6.
- Brunton, L. B., Lazo, J. S. and Parker, K. L. (eds) (2005), Goodman and Gilman's The pharmacological basis of therapeutics, 11th edition, McGraw-Hill, New York.
- Chen, K., Berger, C., Forde, D., et al. (2011), 'Benzodiazepine use and misuse among patients in a methadone programme', BMC Psychiatry 11(90), pp. 3–7.
- Comiskey, C. M. (2013), 'A 3 year national longitudinal study comparing drug treatment outcomes for opioid users with and without children in their custodial care at intake', Journal of Substance Abuse Treatment 44(1), pp. 90–6.
- Dargan, P. I., Dines, A. M., Heyerdahl, F., et al. on behalf of the Euro-DEN Research Group (2015, in press), 'Mixed benzodiazepine–heroin acute toxicity is associated with more severe toxicity than heroin toxicity not associated with benzodiazepine use', Clinical Toxicology (Phila.).
- Darke, S. G., Ross, J. E. and Hall, W. D. (1995), 'Benzodiazepine use among injecting heroin users', Medical Journal of Australia 162, p. 645.
- Darke, S. G., Ross, J. E., Teesson, M. and Lynskey, M. (2003), 'Health service utilization and benzodiazepines use among heroin users: findings from the Australian Treatment Outcome Study (ATOS)', Addiction 98, 1129–35.
- Darke, S., Ross, J., Mills, K., et al. (2010), 'Benzodiazepine use among heroin users: baseline use, current use and clinical outcome', Drug and Alcohol Review 29(3), pp. 250–5.
- Eiroa-Orosa, F. J., Haasen, C., Verthein, U., et al. (2010), 'Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: findings of the German randomized controlled trial', Drug and Alcohol Dependence 1 December, 112(3), pp. 226–33, doi: 10.1016/j.drugalcdep.2010.06.013.
- Fernández Sobrino, A. M., Fernández Rodríguez, V. and López Castro, J. (2009), 'Benzodiazepine use in a sample of patients on a treatment program with opiate derivatives (PTDO)', Adicciones 21(2), pp. 143–6.
- Ford, C. and Law, F. (2014) Guidance for the use and reduction of misuse of benzodiazepines and other hypnotics and anxiolytics in general practice, Substance Misuse Management in General Practice, London.
- Häkkinen, M., Launiainen, T., Vuori, E. and Ojanperä, I. (2012a), 'Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning', European Journal of Clinical Pharmacology March, 68(3), pp. 301–9.
- Häkkinen, M., Launiainen, T., Vuori, E. and Ojanperä, I. (2012b), 'Comparison of fatal poisonings by prescription opioids', Forensic Science International 10 October, 222(1–3), pp. 327–31.
- Jann, M., Kennedy, W. K. and Lopez, G. (2013), 'Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics', Journal of Pharmacy Practice 27, p. 5.
- Jones, J. D., Mogali, S. and Comer, S. D. (2012), 'Polydrug abuse: a review of opioids and benzodiazepine combination use', Drug and Alcohol Dependence 125, p. 14.
- Kuryshev, Y. A., Bruening-Wright, A., Brown, A. M. and Kirsch, G. E. (2010), 'Increased cardiac risk in concomitant methadone and diazepam treatment: pharmacodynamic interactions in cardiac ion channels', Journal of Cardiovascular Pharmacology 56(4), pp. 420–30.
- Lader, M. (2012), 'Benzodiazepine harm: how can it be reduced?' British Journal of Clinical Pharmacology, 77(2), pp. 295–301.
- Lalive, A. L., Rudolph, U., Luescher, C. and Tan, K. R. (2011), 'Is there a way to cure benzodiazepine addiction?' Swiss Medical Weekly 19 October, doi: 10.4414/smw.2011.13277.
- Laqueille, X., Launay, C., Dervaux, A. and Kanit, M. (2009), '[Abuse of alcohol and benzodiazpeines during substitution therapy in heroin addicts: a review of the literature]', in French, Encephale 35(3), 220–5.
- Lavie, E., Fatséas, M., Denis, C. and Auriacombe, M. (2009), 'Benzodiazepine use among opiate-dependent subjects in buprenorphine maintenance treatment: correlates of use, abuse and dependence', Drug and Alcohol Dependence 1 January, 99(1–3), pp. 338–44, doi: 10.1016/j.drugalcdep.2008.07.017.
- Lintzeris, N. and Nielsen, S. (2009), 'Benzodiazepines, methadone and buprenorphine: interactions and clinical management', American Journal on Addictions 19, pp. 59–72.
- Lintzeris, N., Mitchell, T. B., Bond, A. J., Nestor, L. and Strang, J. (2007), 'Pharmacodynamics of diazepam co-administered with methadone or buprenorphine under high dose conditions in opioid dependent patients', Drug and Alcohol Dependence 91(2–3), pp. 187–94.
- Longo, L. P. and Johnson, B. (2000), 'Addiction: part I. Benzodiazepines — side effects, abuse risk and alternatives', American Family Physician 61(7), pp. 2121–8.
- Mallaret, M. (2014), Presentations at the 'Drug-related harms and responses: expert meeting', 14–17 October, Lisbon.
- Medicines and Healthcare Products Regulatory Agency (MHRA) (2014), 'Benzodiazepines learning module', MHRA, London.
- Nava, F. (2014), Presentation at the meeting 'Continuity and change: high-risk drug use and drug treatment in Europe 2014', 23–26 September, Lisbon.
- Nielsen, S. and Taylor, D. A. (2005), 'The effect of buprenorphine and benzodiazepines on respiration in the rat', Drug and Alcohol Dependence 79(1), pp. 95–101.
- Okrulica, L. (2014), Presentation at the meeting 'Continuity and change: high-risk drug use and drug treatment in Europe 2014', 23–26 September, Lisbon.
- Olsen, Y., with Adams, J., Alvanzo, A. et al. (2013), Clinical guidelines for the use of benzodiazepines among patients receiving medication: assisted treatment for opioid dependence, Baltimore Substance Abuse Systems, Inc, Baltimore.
- Priyadarshi, S. (2014), Presentation at the meeting 'Continuity and change: high-risk drug use and drug treatment in Europe 2014', 23–26 September, Lisbon.
- Reynaud, M., Petit, G., Potard, D. and Courty P. (1998), 'Six deaths linked to concomitant use of buprenorphine and benzodiazepines', Addiction 93(9), pp. 1385–92.
- Rooney, S., Kelly, G., Bamford, L., Sloan, D. and O'Connor, J. J. (1999), 'Co-abuse of opiates and benzodiazepines', Irish Journal of Medical Science 168(1), pp. 36–41.
- Ross, J., Darke, S. and Hall, W. (1997), 'Transitions between routes of benzodiazepine administration among heroin users in Sydney', Addiction 92(6), pp. 697–705.
- Schuman-Olivier, Z., Hoeppner, B. B., Weiss, R. D., et al. (2013), 'Benzodiazepine use during buprenorphine treatment for opioid dependence: clinical and safety outcomes', Drug and Alcohol Dependence 132(3), pp. 580–6, doi: 10.1016/j.drugalcdep.2013.04.006.
- Specka, M., Bonnet, U., Heilmann, M., Schifano, F. and Scherbaum, N. (2011), 'Longitudinal patterns of benzodiazepine consumption in a German cohort of methadone maintenance treatment patients', Human Psychopharmacology 26(6), pp. 404–11, doi: 10.1002/hup.1222.
- Stewart, S. (2005), 'The effects of benzodiazepines on cognition', Journal of Clinical Psychiatry 66(2), pp 9–13.
- Stewart, D., Gossop, M. and Marsden, J. (2002), 'Reductions in non-fatal overdose after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS)', Journal of Substance Abuse Treatment 22(1), pp. 1–9.
- Vogel, M., Knopfli, B., Schmid, O., et al. (2013), 'Treatment or "high": benzodiazepine use in patients on injectable heroin or oral opioids', Addictive Behaviors 38, pp. 2477–84.
- White, J. M. and Irvine, R. J. (1999), 'Mechanisms of fatal opioid overdose', Addiction 94(7), pp. 961–72.
- Wood, D. M., Heyerdahl, F., Yates, C. B., et al. (2014) 'The European Drug Emergencies Network (Euro-DEN)', Clinical Toxicology (Phila.) 52(4), pp. 239–41.
- (1) A definition of high-risk opioid users is available on the EMCDDA website
- (2) 'Doctor shopping' refers to the practice of a patient requesting care from multiple physicians, often simultaneously, without making efforts to coordinate care or informing the physicians of the multiple caregivers. This usually stems from a patient's addiction to, or reliance on, certain prescription drugs or other medical treatment.
- (3) European countries provide data according to the same protocol (treatment demand indicator standard protocol 3.0) on the characteristics and patterns of drug use of people entering drug treatment for problems related to their drug use (www.emcdda.europa.eu/publications/manuals/tdi-protocol-3.0).
- (4) Data from 18 of 30 countries: Belgium, Bulgaria, the Czech Republic, Ireland, Greece, Croatia, Italy, Cyprus, Malta, Netherlands, Austria, Portugal, Romania, Slovenia, Slovakia, Finland, the United Kingdom and Turkey.
- (5) The primary drug is defined as the drug that causes the client the most problems at the start of treatment. This is usually based on the request made by the clients and/or on the diagnosis made by a therapist, commonly using international standard instruments (e.g. ICD-10; DSM-IV; ASI) or clinical assessment. This item is of central importance and it should be collected for every client. Secondary drugs are those drugs used in addition to the primary drug, and are substances that cause problems for the client and/or change the nature of the problem as assessed by the client and the therapist (www.emcdda.europa.eu/publications/manuals/tdi-protocol-3.0).
- (6) A secondary drug should be recorded 'only if it causes problems to the client according to the client's request and to the professional's assessment' (TDI version 3.0).
- (7) 'Drug-related deaths in Scotland 2013', published by National Records Scotland (www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland/2013).
- (8) Two data sources have been used to illustrate the situation in Portugal, the Special Mortality Register and the General Mortality Register.
- (9) As was illustrated by recent data from a number of countries during the latest annual drug-related deaths experts' meeting (www.emcdda.europa.eu/expert-meetings/2014/drd-drid).
- (10) 'Drug-related deaths in Scotland 2013', published by National Records Scotland (www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland/2013).
- (11) See note 10.
- (12) Most drug-induced deaths in Scotland involving benzodiazepines were linked to diazepam, but phenazepam, which was placed under control in the United Kingdom in 2012, and etizolam, which is not controlled, were also implicated in several deaths.