text:
Playa Grande Park Hotel
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- Suites
- Shuttle bus service
- Breakfast Available
- Wireless internet connection in public areas
- Refrigerator in room
- Beach
Photos of Playa Grande Park Hotel
Travelers also recommend:
- Beach
- Restaurant
- Swimming pool
- Bar/lounge
- Breakfast Available
- Wireless internet connection in public areas
- Refrigerator in room
- Reduced mobility rooms
- High-speed internet in room
- Free High-Speed Internet
- Wheelchair accessibility
- Air-Conditioning
- Free parking
- Kitchenette
- Pets allowed
- Suites
- Shuttle bus service
- Concierge desk
- Continental Breakfast
- Banquet room
- Laundry
TripAdvisor Reviews Playa Grande Park Hotel
Travel Blogs from Playa Grande
Day 8 - Monday - Starry Starry Night
... and then they were joined by signs for the 'Austrian bakery' and the 'gingerbread house' - thought we'd somehow jumped to the Blackforest! When we eventually saw the German bakery, we thought it would be unkind not to stop and buy a cake, after all the effort they made with the signs. Cakes = additional 10 lengths of the swimming pool! On we went, and eventually, after another stop, ...
Good comes with the bad
... all the school kids had. Some guy who I think was either like a priest or the head master of the school said some words and they sang some songs which I think included the national anthem I presume. It was dark by now so all the lit lanterns looked pretty cool. We all walked around 1km up the road and back again. This was one of those moments where you look around and think 'this is so cool, I'm so lucky to be here right now', I ...
One Week Down
First week in Hojancha is complete!
So far I don't do much for my work. My only real job as of now is to go to the library 2-3 times a week and come up with a craft for the kids to do. It's actually pretty hard because the supplies we have is so limited. We are waiting to hear back from the president of the retirement home about setting up a meeting so we ...
Last hurrah
... meeting but I figured I'd struggle on given that I would be staying in a TREEHOUSE thanks to the girls' very generous invitation. Turned out to far surpass expectations as it was decked out in all kinds of natural luxury with a toilet that you could even flush paper down! We got a nice little tour of the wildlife around the complex from the security guard and Emily finally found her prince charming in the form of a tree frog who wouldn't be refused a kiss, while Sarah became ...
24-25: Triangular bandages and Yummy fis
... and rescue simultaneously. I think my brain pretty much as full as its going to get right now! Did I mention I now am doing underwater photography too, mentalist ha. Day 25: We were meant to be finishing off our deep speciality today and nearly the last search and recovery but Martin wasn't feeling well so we ended up postponing it. This meant though that we had about 8 people in the shop, little bit excessive! I ended up doing some odd ...


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Warm cristal clean water .. amazing diving taxi from port $ 20 .. DISSAPOINTED on local taxi drivers. But diving with Dive Dominica was amazing ,great service thank you
What a great dive operation this is. They took us to excellent dive sites and ensured everyone aboard had a good dive, keeping an eye on us and pointing out interesting sights along the way. Their equipment was in good condition, tanks properly filled, and they were professional in every way.
Dive Dominica was fantastic. We went on a 3 hour tour, very reasonable price. The boat was very spacious, and the crew was knowledgeable and friendly. Unlimited, delicious rum punch certainly added to the fun. The first half of the trip was uneventful and seemed like we may strike out, but after using their sonar, the crew found 3 female...
The whole experience with Dive Dominica was great. The divemasters Brad & Nigel along with Captain, Mano, were amazing. They gave great detailed briefings, had extensive knowledge of the diving and island and were tons of fun to be around. They were very safety oriented, which made all of my customers feel even better. You drop your gear off the...
Such good diving there, I don't know where to start! These Dive Masters know where all the good stuff is and they take you there everyday. At no time did I feel like a tourist diver. It was like friends taking me to all their best dive sites. Beyond that, the dive shop is set up really nice. Everything is...
If you love diving/snorkeling, book a stay here! They were super friendly and helpful with all our plans and excursions! Really top notch! And rooms were great!
We spent quite a bit of time with Dive Dominica in March 2016. We were originally due to go on a whale watching trip with another company but unfortunately we were informed in the morning that the trip got cancelled. Luckily, the accommodation we were staying at recommended the afternoon trip with Dive Dominica who were very professional and made...
We had an amazing day on board the catamaran on a recent cruise excursion to Dominica. We set sail from the Port of Roseau and headed straight out to sea. After the initial safety induction the crew explained what types of whales and dolphins we could hopefully spot during our excursion. We were very fortunate to encounter two groups of...
Large catamaran easily held all guests. Staff were professional and helpful. Boat was super clean. You must remove shoes upon boarding. Snorkeling equipment was ok, though we have had better elsewhere as well as better organization. I had trouble getting a decent fit since flippers covered a size range and not just one size. I ended up with a bad,...
Amazing time! It was my 40th birthday and going whale watching and seeing so many whales was the best gift ever! We saw half a dozen Sperm whales and even a whale calf! The crew on the ship were great! Very knowledgeable and professional. They even had a local whale identification book on board so you could identify which whales...
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In an effort to keep pollution-spewing garbage trucks off city streets, lawmakers have worked to shift waste transport onto rails.
But while this sounds like a positive arrangement, residents along the tracks leading to Fresh Pond Rail Terminal in Middle Village and Glendale are now forced to deal with an increase in trains — and all the noise and foul odors that follow.
Seeking to assist residents whose homes sit closest to the tracks, state Assemblyman Andrew Hevesi (D-Forest Hills) sent a letter to Assembly Speaker Sheldon Silver (D-Manhattan) requesting $17 million to upgrade locomotive engines on freight cars currently leased out by the Long Island Rail Road.
Hevesi said that while cleaning the road of waste transporting trucks is commendable, the unintended consequences are unacceptable.
"Transitioning from truck to rail for waste and freight transport is an admirable goal," said Hevesi. "However, we need to ensure that while doing this locomotives meet contemporary engine emissions standards that don't cause severe environmental degradation for the communities that surround the rail lines."
The assemblyman said the engines currently used by freight locomotives — U.S. Environmental Protection Agency grade Tier 0 — produce toxic emissions that were common in the 1970s before technological advancements made cleaner emissions possible.
Upgrades will bring the engines into EPA grade Tier 3 compliance and significantly cut down on toxic fumes and diesel consumption, Hevesi said. The assemblyman also said this investment in cleaner train engines will further the goal of a bill he co-sponsored that would require state agencies and public authorities to adopt energy conservation standards to protect the environment and reduce energy consumption.
"We have gathered broad bipartisan support for this project, from all affected counties, and believe the residents of Brooklyn, Queens, Nassau and Suffolk deserve a rail transport system that is environmentally sound and not detrimental to the health of our constituents," said Hevesi.
Health is of utmost concern to residents of Glendale, who deal with the consequences of freight trains on a daily — and nightly — basis.
Anthony Pedalino, a Glendale resident, has been chronicling his experience with garbage trains for months. He said the toxic trains idle mere feet from his house routinely and it is time officials took the health of citizens into consideration.
"Government needs to act responsibly in achieving its goals of greener environments, but not at the cost of negative effects on a select group of people," he said. "Railroads cannot operate in highly populated urban areas and ignore the effects it has on people's lives. If they are to operate in these communities, they, along with government and the community, need to work out a plan to maintain a quality-of-living standard that we all deserve to live in."
Reach reporter Steve Mosco by e-mail at firstname.lastname@example.com or by phone at 718-260-4546.
©2013 Community News Group
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text:
Nothing comes to mind re MP Spam, but...
Since I started using Earthlink about 9 months ago, I have had virtually no
spam. At the very most maybe only 3 messages in all that time.
I also use Earthlink's Pop-Up Blocker. What a blessing! When an ad tries
to pop up, all you see is a little red fist, the size of your cursor, and,
if your speakers are on, "boing!" However sometimes you WANT the Pop-Up.
You can override it by either clicking several times, or you can turn the
blocker off.
> [Original Message]
> From: Island Jim <email@example.com>
> To: <firstname.lastname@example.com>
> Date: 2/25/2003 5:06:54 PM
> Subject: [CHAT] spam
> i get about 30 spam messages a day. so i bought mcafee's "spamkiller"
> program. haven't installed it yet; probably will later tonight.
> do any of you have experience with it or any similar programs? if so, are
> they worth the time and effort to install and set up? [no point in
> into something that is more trouble to maintain than keeping a cat.]
> while i'm at it, on a similar topic, does anyone use one of those
> blockers? nothing quite torques me the way all those damn ads crowd
> when i'm trying to find something on the internet.
> and, finally, does anyone remember the monty python thing with the other
> kind of spam [spam and eggs; spam, eggs and spam; spam, spam, eggs and
> spam--and so on].
> ---------------------------------------------------------------------
> To sign-off this list, send email to firstname.lastname@example.com with the
> message text UNSUBSCRIBE GARDENCHAT
To sign-off this list, send email to firstname.lastname@example.com with the
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text:
The drivers of antitrust effectiveness
This paper shows what drivers the effectiveness of antitrust policy, by using internationally collated data on the perception of effectiveness of competition policy. It concludes that average antitrust effectiveness depends on per capita income and supranational policy leadership, such as the one at the core of the EU. Additionally, it shows that some aspects of competition policy design have a significant impact on policy results. Effectiveness is driven by using an economic approach to judge dominance and abusive practices. We show that antitrust is sounder when the legal mandate on merger policy focuses on competition in markets, rather than on more broadly defined public interests. Antitrust effectiveness is also spurred by taking an active stance against cartels and especially by introducing a leniency programme to enforce the prohibition of cartels. Finally, it is important that an independent antitrust authority has the final say on prohibiting competition restrains.
If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Volume (Year): 185 (2008)
Issue (Month): 2 (July)
Pages: 69-88
|Contact details of provider:
| Postal: Avda. Cardenal Herrera Oria, 378, 28035 Madrid
Phone: 91-339.89.15
Fax: 91-339.89.64
Web page: http://www.ief.es
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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Fabian Berges-Sennou & Frédéric Loss & Estelle Malavolti & Thibaud Vergé, 2002.
"Modernisation de la politique communautaire de concurrence : régime d'autorisation ou d'exception légale ?,"
hal-01276810, HAL.
- Fabian Bergès-Sennou & Frédéric Loss & Estelle Malavolti-Grimal & Thibaud Vergé, 2002. "Modernisation de la politique communautaire de concurrence. Régime d'autorisation ou d'exception légale?," Revue Économique, Programme National Persée, vol. 53(3), pages 437-447.
- Fabian Bergès-Sennou & Frédéric Loss & Estelle Malavolti-Grimal & Thibaud Vergé, 2002. "Modernisation de la politique communautaire de concurrence. Régime d'autorisation ou d'exception légale ?," Revue économique, Presses de Sciences-Po, vol. 53(3), pages 437-447.
- Stern, Jon & Cubbin, John, 2005. "Regulatory effectiveness : the impact of regulation and regulatory governance arrangements on electricity industry outcomes," Policy Research Working Paper Series 3536, The World Bank.
- Aghion, Philippe & Howitt, Peter, 1992.
"A Model of Growth Through Creative Destruction,"
Scholarly Articles
12490578, Harvard University Department of Economics.
- Aghion, Philippe & Howitt, Peter, 1992. "A Model of Growth through Creative Destruction," Econometrica, Econometric Society, vol. 60(2), pages 323-351, March.
- Aghion, P. & Howitt, P., 1990. "A Model Of Growth Through Creative Destruction," DELTA Working Papers 90-12, DELTA (Ecole normale supérieure).
- Philippe Aghion & Peter Howitt, 1990. "A Model of Growth Through Creative Destruction," NBER Working Papers 3223, National Bureau of Economic Research, Inc.
- Aghion, P. & Howitt, P., 1989. "A Model Of Growth Through Creative Destruction," UWO Department of Economics Working Papers 8904, University of Western Ontario, Department of Economics.
- Aghion, P. & Howitt, P., 1989. "A Model Of Growth Through Creative Destruction," Working papers 527, Massachusetts Institute of Technology (MIT), Department of Economics.
- Dutz, Mark A. & Hayri, Aydin, 2000.
"Does more intense competition lead to higher growth?,"
Policy Research Working Paper Series
2320, The World Bank.
- Dutz, Mark & Hayri, Aydin, 1999. "Does More Intense Competition Lead to Higher Growth?," CEPR Discussion Papers 2249, C.E.P.R. Discussion Papers.
- Dominique Demougin & Claude Fluet, 2004.
"Deterrence vs Judicial Error: a Comparative View of Standards of Proof,"
Cahiers de recherche
- Dominique Demougin & Claude Fluet, 2004. "Deterrence vs Judicial Error: A Comparative View of Standards of Proof," CIRANO Working Papers 2004s-38, CIRANO.
- Jonathan B. Baker, 2003. "The Case for Antitrust Enforcement," Journal of Economic Perspectives, American Economic Association, vol. 17(4), pages 27-50, Fall.
- Paul Levine & John Stern & Francesc Trillas, 2005. "Utility price regulation and time inconsistency: comparisons with monetary policy," Oxford Economic Papers, Oxford University Press, vol. 57(3), pages 447-478, July.
- Dennis W. Carlton & Randal C. Picker, 2007.
"Antitrust and Regulation,"
NBER Working Papers
12902, National Bureau of Economic Research, Inc.
- Dennis W. Carlton & Randal C. Picker, 2014. "Antitrust and Regulation," NBER Chapters, in: Economic Regulation and Its Reform: What Have We Learned?, pages 25-61 National Bureau of Economic Research, Inc.
- John Cubbin & Jon Stern, 2006. "The Impact of Regulatory Governance and Privatization on Electricity Industry Generation Capacity in Developing Economies," World Bank Economic Review, World Bank Group, vol. 20(1), pages 115-141.
- Jordi Gual & Anne Perrot & Michele Polo & Patrick Rey & Klaus Schmidt & Rune Stenbacka, 2006.
"An Economic Approach to Article 82,"
CPI Journal,
Competition Policy International, vol. 2, pages -.
- Gual, Jordi & Hellwig, Martin F. & Perrot, Anne & Polo, Michele & Rey, Patrick & Schmidt, Klaus M. & Stenbacka, Rune, 2005. "An Economic Approach to Article 82," Discussion Papers in Economics 745, University of Munich, Department of Economics.
- Christopher F Baum & Mark E Schaffer & Steven Stillman, 2002. "IVREG2: Stata module for extended instrumental variables/2SLS and GMM estimation," Statistical Software Components S425401, Boston College Department of Economics, revised 09 Feb 2016.
- Giuseppe Nicoletti & Stefano Scarpetta & Olivier Boylaud, 2000. "Summary Indicators of Product Market Regulation with an Extension to Employment Protection Legislation," OECD Economics Department Working Papers 226, OECD Publishing.
- Louis Kaplow & Steven Shavell, 1992.
"Accuracy in the Determination of Liability,"
NBER Working Papers
4203, National Bureau of Economic Research, Inc.
- Kaplow, Louis & Shavell, Steven, 1994. "Accuracy in the Determination of Liability," Journal of Law and Economics, University of Chicago Press, vol. 37(1), pages 1-15, April.
- Stern, Jon & Trillas, Francesc, 2003. "Independence and discretion in telecommunications regulation: lessons from independent central banks," Utilities Policy, Elsevier, vol. 11(4), pages 191-201, December.
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Pregnant Again? Blac Chyna Sports Suspicious Bump While Stepping Out With Another Man
- 07:10 AM, Feb 21
Aerosmith Perform in Front of 1325 Commonwealth Ave, Which Was Their Home in The Early 1970's
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Qt 5 for 2012 Announced
After six years of Qt 4, Nokia wants to modernize its toolkit for 2012 with the Qt 5 release.
Qt's development chief Lars Knoll announced the upcoming release in the developer blog. "The current plans for Qt5 mean that, unlike Qt4's reinvent the world approach (which was needed, if painful), it will be evolutionary and far less disruptive. This is the good news," Knoll writes. "I also see this as an opportunity for KDE's own libraries and runtime that form the KDE Platform," Knoll adds. "We don't need another big re-engineering of the base technologies as we had in KDE4, but there is a lot of opportunity to improve how the pieces fit together." Read Knoll's blog post to find out more about the upcoming release.
Issue 28: GIMP Handbook 4th Ed./Special Editions
Buy this issue as a PDF
OpenSUSE Site Hacked
News site for the openSUSE community falls victim to a Wordpress exploit.
LibreOffice Goes Online with 5.3 Release
The source code is available online.
Microsoft Brings Clear Linux OS to Azure
One out of three virtual machines on Microsoft Azure Cloud run Linux.
ASUS Announces a Single-Board Computer
The form factor of the board makes it a drop-in replacement for Raspberry Pi.
Red Hat Releases RHEL 6.9 Beta
Makes it easier for customers to move workloads into container-centric applications.
SUSE Working on a New Operating System Called MicroOS
SUSE's answer to container-centric operating systems.
Biggest Kernel Release Ever
Linux 4.9 is the biggest release in terms of number of commits.
CentOS Linux 7 (1611) Released
The latest version of the official RHEL clone is here.
openSUSE Rolls Out 42.2 Leap
New release targets Linux professionals.
Cutting-Edge Fedora 25 Released
The Fedora project adds Wayland and Gnome 3.22


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0 Route 125/Tolend Intersectio,Barrington NH, 03825
Status: Active
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Days on market152
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Cast: Shweta Menon, Pradeep Rawat, Ajay (actor), Akkineni Nagarjuna, Shwetha Menon, Sneha (actress), Mukesh Rishi, Pradeep Rawat (actor), Nassar
Producer: Akkineni Nagarjuna, Nagarjuna Akinneni
Director: S. S. Rajamouli, K. V. Vijayendra Prasad, S.s. Rajamouli
Writer: K. V. Vijayendra Prasad
Release Date: 12 November,2011
Storyline: Rajanna is a 2011 telugu historical, drama film produced by nagarjuna akkineni on annapurna studios banner, directed by k. v. vijayendra prasad & s.s. rajamouli (action sequences). starring nagarjuna akkineni, sneha, baby annie in the lead roles and music composed by m.m. keeravani. the film, based on the razakars movement and freedom fighter suddala hanmanthu was released on 22 december 2011 to positive reviews and critical acclaim, with soundtrack composed by national film award winner m. m.See full storyline
Cast overview


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|Tobacco patents - Monitor Patents
USPTO Class 131 | Browse by Industry: Previous - Next | All
10/2011 | Recent | 15: May | Apr | Mar | Feb | Jan | 14: Dec | Nov | Oct | Sep | Aug | Jul | Jun | May | Apr | Mar | Feb | Jan | 13: Dec | Nov | Oct | Sep | Aug | Jul | Jun | May | Apr | Mar | Feb | Jan | 12: Dec | Nov | Oct | Sep | Aug | July | June | May | April | Mar | Feb | Jan | 11: Dec | Nov | Oct | Sep | Aug | Jul | Jun | May | Apr | Mar | Feb | Jan | 10: Dec | Nov | Oct | Sep | Aug | Jul | Jun | May | Apr | Mar | Feb | Jan | | 09: Dec | Nov | Oct | Sep | Aug | Jl | Jn | May | Apr | Mar | Fb | Jn | | 2008 | 2007 |
Tobacco October categorized by USPTO classification 10/11Below are recently published patent applications awaiting approval from the USPTO. Recent week's RSS XML file available below.
Listing for abstract view: USPTO application #, Title, Abstract excerpt,Patent Agent. Listing format for list view: USPTO National Class full category number, title of the patent application. 10/27/2011 > 3 patent applications in 3 patent subcategories.
20110259351 - Tobacco rod manufacturing apparatus: An apparatus is provided for forming tobacco rod portions of a smoking article. A conveyor unit is configured to receive a continuous stream of the tobacco material and to transport the continuous tobacco material stream along an elongate path for formation of the continuous tobacco material stream into a continuous... Agent: Rj Reynolds Tobacco Company
20110259352 - Smoking article: A smoking article can comprise a rod of smokeable material and a first sheet material comprising at least one diluent. The diluent is present in an amount effective to dilute emissions from the rod of smokeable material during combustion.... Agent:
20110259353 - Tobacco seed-derived components and materials: A tobacco composition for use in a smoking article or a smokeless tobacco composition is provided, the composition including a component derived from a seed of the Nicotiana species. The component can be a seed of the Nicotiana species or a portion thereof in particulate form or in the form... Agent:10/20/2011 > 2 patent applications in 2 patent subcategories.
20110253154 - Holder for smoking article: A holder for a smoking article may be inserted into the ground or golf tee holder on a golf cart, or secured over and about the upper opening leading into a garment pocket or golf bag. The holder is used to protect the smoking article from exposure to poisons and... Agent:
20110253155 - Tobacco filter containing magnesium aluminometasilicate: A tobacco filter contains from 0.5 to 95% by mass of magnesium aluminometasilicate.... Agent:10/13/2011 > 4 patent applications in 3 patent subcategories.
20110247637 - Filter for a smoking article: The invention provides a filter element for a smoking article. The filter element comprisesa plug of filter material, and a tobacco thread, wherein the tobacco thread extends substantially longitudinally through the plug of filter material. The filter element can be used in a variety of smoking articles.... Agent:
20110247639 - Cigarette holder for smoke dilution: There is provided a smoke mouthpiece (1) for the dilution of smoke from a smoking element, such as a cigarette (11), to an exhaust region (7), comprising an internal longitudinal channel with openings at both ends and divided into 5 channel sections, wherein a first channel section (2) is provided... Agent: Smokequit Aps
20110247638 - Smoking cessation and weight management method and kit: A cessation and management method comprising removing a physical aspect, wherein removing the physical aspect includes instructing a user to manipulate a delivery time of a substance, and instructing the user to control a consumption amount of the substance, correcting a behavioral association, wherein correcting the behavioral associations includes instructing... Agent:
20110247640 - Smokeless tobacco composition comprising tobacco-derived material and non-tobacco plant material: c10/06/2011 > 4 patent applications in 4 patent subcategories.
20110240045 - Environmentally degradable cigarette filter: An environmentally degradable cigarette filter includes a filter element of a bloomed cellulose acetate tow and a plug wrap surrounding said filter element. A weak organic acid and a pH adjusted inorganic ester salt are encapsulated in a matrix material which is in contact with the tow. The pH adjusted... Agent: Celanese Acetate LLC
20110240046 - Cigarette filter: A cigarette filter includes a filter body and flavor granules added to the filter body, wherein the flavor granules each comprise a core material and a flavor-carrying carrier adhered to the surface of the core material, and wherein the flavor granules have a grain size distribution such that granules having... Agent:
20110240047 - Smoke and odor elimination filters, devices and methods: A pipe comprises a combustion chamber with vents, the combustion chamber able to receive a cigarette; an inhalation path for drawing smoke from the combustion chamber through the bowl vents during inhalation; an exhalation filter; and an exhalation path for channeling exhaled smoke through the exhalation filter during exhalation.... Agent:
20110240048 - Tobacco pouch product: A pouched tobacco product includes a lined pouch material of a web and a water-soluble liner adjacent the web and a tobacco component contained within the lined pouch material. The water-soluble liner is interposed between the web and the tobacco component. The liner preferably reduces staining of the web by... Agent: Philip Morris Usa Inc.Previous industry: Surgery
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I ordered this dress for my daughter's wedding. As the mother of the bride and only two weeks until the wedding, I was frantic when I hadn't found my dress yet. I had read a couple of other reviews on Dress First and decided to just go for it and order and hope for the best. I looked at the size chart and found that my size looked like it would be the actual measurements. To my relief, the dress came on time and in beautiful condition. It was also true to size with the measurements on the size chart. It fit me like a glove and I felt like a beautiful Mother of the Bride. I can't be more happy about Dress First and their professional, fast, accurate, and beautiful selection on dresses. I should have never doubted! Great company!
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New Chicago Bulls guard Marquis Teague was surprised he was still on the board when the team made him the 29th selection in the NBA draft on Thursday, but he's glad to join forces with Derrick Rose.
"I was pretty surprised," Teague said Friday on "The Waddle & Silvy Show" on ESPN 1000. "I thought my name would be called earlier, but I'm happy with the situation I'm in, and I'm feeling great about playing for the Bulls."
Teague's situation, at least before free agency, might mean significant playing time for the 19-year-old point guard with Rose expected to miss a significant amount of time as he recovers from knee surgery. Teague, who never worked out for the Bulls leading up to the draft, said he doesn't know yet what his role will be with his new team.
"I guess I'm just going to get in the gym and really work hard, try to get better and we'll see what happens from there," he said.
On Thursday night, Bulls coach Tom Thibodeau wouldn't rule out Teague as a starter early in the season, but general manager Gar Forman said the team will look at point guards in free agency, which begins on Sunday.
C.J. Watson's future in Chicago is uncertain with the Bulls holding a team option on his deal, and John Lucas III is a free agent.
Teague, whose brother Jeff plays for the Atlanta Hawks, benefited from playing under pressure immediately in his one season of college basketball at Kentucky, which won the national title last season. He averaged 9.4 points and a team-high 4.8 assists for the Wildcats, who tied a record with having six players drafted on Thursday.
"I think (that experience) is going to help a lot," Teague said. "I've got the experience of playing with talented guys. I know what it takes to come in and win and work hard. I'll be ready."
Bulls first-round draft pick Marquis Teague joins "Waddle & Silvy" to discuss his role with the team, playing with Derrick Rose and more.


text:
If McBean could possibly step in and play valuable minutes he could be a major difference maker.Originally Posted by RuthlessBurgher
If McBean could possibly step in and play valuable minutes he could be a major difference maker.Originally Posted by RuthlessBurgher
Yup. I was on the McBean bandwagon last year. I had him in my final mock. Thought he'd be able to convert to be a solid 3-4 DE. I wasn't pimping him as much as last year as I was Langford this year, but I still think his talents will be a huge asset if he was able to get a decent grasp of the defensive scheme during his rookie season last year, and if he is able to stay healthy enough to make these off-season workouts useful to his continued growth as a player in this league.Originally Posted by Oviedo
The Rams' offense featuring weapons such as Marshall Faulk, Torrey Holt, and Isaac Bruce were known as "The Greatest Show on Turf"
The Steelers' offense featuring weapons such as Le'Veon Bell and Martavis Bryant should be known as "The Greatest Show on Grass"
This has nothing at all to do with respective playing surfaces at the Edward Jones Dome vs. Heinz Field.
2015 MNF Executive Champion!
i can't wait to see our offense this season...i think the oline will hold....we have a new center and to me, that was the major problem last season...lets hope hartwig has more in common with hartings than the first four letters...
"The standard is the standard" Mike Tomlin


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- Anonymous
- Taiwan, Female, 25-30
- Novice Nomad
- 5 reviews
Staff are very hospitable! Hostel is easy to find, and location is really good! All the landscape are near by! Had a really good time there!! Definitely will go back next time!
- Anonymous
- Mexico, Female, 31-40
- Globetrotter
- 38 reviews
Excellent!! Next time I will be there! The best was the staff, Moho the best.
- Anonymous
- Slovenia, Female, 18-24
- Novice Nomad
- 1 review
Very good location, near all turist atractions and close to the tram station. Very nice and funny voulentier.
- Anonymous
- USA, Male, 31-40
- Novice Nomad
- 8 reviews
Rifat was an excellent host, very friendly & knowledgeable. Hostel is located in the heart of old town close to everything. Beds are comfy, bathrooms are clean. Cool rooftop terrace for hanging out. Nice breakfast too. Only downside is there's no kitchen.
- Anonymous
- USA, Female, 25-30
- Avid Traveller
- 16 reviews
This is a wonderful hostel. Every amenity, very clean, rooftop terrace and cafe at the bottom were great for hanging out. The owner is very nice and treats you like a friend. It was also in a great area of town, very easy walk to the tram and lots of the main attractions.
Hostelworld Mobile Apps
Book on the go with the new Hostelworld mobile apps.


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Lindsay Lohan Beat Out Sienna Miller and Blake Lively for Gotti Movie
By Shari on April 8, 2011
Lindsay Lohan is said to have beat out Blake Lively and Sienna Miller for her new role as Victoria Gotti, according to TMZ.
How did that happen? Or should we say, who made that happen? Victoria Gotti herself, requested Lohan play her in the upcoming Gotti movie. Victoria and Lindsay both come from Long Island and it is rumored that Victoria is friends with the Lohan family.
Producers were said to be considering both Blake and Sienna for the role – when Victoria Gotti suggested Lindsay the producers loved the idea.
Meanwhile, Lindsay is currently in L.A. auditioning for "Superman".
What do you think of Lindsay playing Victoria Gotti?


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Sharon Corr, Gig Review. o2 Academy, Liverpool. August 22nd 2011.
Blondie, Gig Review. o2 Academy, Liverpool. August 1st 2011.
The Undertones, o2 Academy, Liverpool. Gig Review. April 14th 2011
Icon Live Reviews! Frank Turner, 11/12/10
The room is rammed at the O2 Academy, but then, why wouldn't it be? Frank Turner's latest UK headline tour completely sold out for every date showing just how desperate people are to see him perform live and the reason is clear from the atmosphere in the room tonight.Read More
Two Door Cinema Club, Live @ o2 Academy
Recently described by one music newspaper as 'the band that can no longer be ignored', Two Door Cinema Club are finally getting the props they have long deserved.Read More
Oceansize Live At The O2 Liverpool
Following the release of their brand new studio album "Self Preserved While The Bodies Float Up" on September 6th, Oceansize have embarked upon a 3 month European tour, not only to spotlight their new material but to also showcase the quality and all out raw energy of songs spannRead More
Tinie Tempah Interview- Round 2
Debut Single at Number One? Check. Festival Appearances? Check. Supporting the UK's biggest acts? Check. Second Single due for release. Check-Diddy-Check. Standard Sunglasses… Oh.My.Days… Mr Tinie Tempah without his staple diet of Rayban, I must be honoured.Read More
The Alarm, gig review. o2 Academy Liverpool. May 2nd 2010
An Interview With Ellie Goulding
Sitting backstage at the O2 academy Liverpool, I was slightly apprehensive about meeting one of Britain's most talked about new talents, singer-songwriter Ellie Goulding.Read More
Electric Six, Gig Review. o2 Academy, Liverpool. December 7th 2009
It is not often a big band come to a city twice within a calendar year but the superb Electric Six have never really stood on tradition or been fans of sticking to the routine.Read More
From The Jam, Gig Review. o2 Academy, Liverpool. December 1st 2009
Don't let the name fool you, it may sound like your typical tribute band cashing in on former glories of a group that no longer tours but From The Jam are hardly a tribute act. With Bruce Foxton powering through chords and riffs that made him and the rest of the Jam one of the top acts of their day this in no way called a tribute act. Joining the original member of the band onRead More


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"We will gather up the children who are to be deported and host them on kibbutzim all around the country," Marshak said. "We will not hide them from the police, but will proudly show we are hosting them. The police are invited." When asked why the kibbutzim did not take similar action when Jews were deported from their homes in Gush Katif, Marshak said that although the removal of Jews from their home then had been legal, it was very divisive because there had been no referendum before the withdrawal from Gaza. "I hope that in any future Israeli withdrawals, of even a meter of land, there will be a referendum so we can make a democratic decision," he said.
Tags:Defense/Middle East


text: Don't Waste Time Maximizing Decisions That Don't Bring You More SatisfactionEric Ravenscraft9/21/16 5:02am84EditPromoteGo to permalinkWhen you're faced with a choice, how much time do you spend making sure it's perfectly optimal? If that decision is going to significantly affect your happiness, take your time. If you're picking your tie in the morning, though, maybe don't stress about it.


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Speaker John BoehnerJohn BoehnerFormer House leader Bob Michel, a person and politician for the ages Former House GOP leader Bob Michel dies at 93 Keystone pipeline builder signs lobbyist MORE (R-Ohio), buffeted by a series of defeats and setbacks since December, is betting big on the budget.
House Republicans will announce their 2013 spending blueprint this week, hoping to unite their fractious members around an election-year policy agenda.
Simply put, BoehnerJohn BoehnerFormer House leader Bob Michel, a person and politician for the ages Former House GOP leader Bob Michel dies at 93 Keystone pipeline builder signs lobbyist MORE needs this one.
After a year in which the new GOP House majority made budget-cutting a hallmark, with mixed success, the party has given up ground as the debate has shifted to job creation. With this week's budget release, House Republicans want to reclaim the deficit mantle.
The passage of last year's budget resolution marked a high point for House GOP unity. All but four Republicans voted for Budget Committee Chairman Paul RyanPaul RyanGOP senator won't vote to defund Planned Parenthood Immigration hard-liners hold fire on 'dreamers' program THE MEMO: Trump's big immigration gamble MORE's (R-Wis.) vision of spending cuts that included an overhaul of Medicare and Medicaid.
But amid divisions over spending levels and the looming election, party leaders have had a tougher time this year.
Democrats are chomping at the bit, saying Boehner is making a budget pact with the Tea Party that will seal a GOP defeat in November. Democrats will highlight Medicare reforms Republicans want to implement, though the entitlement provisions probably won't be as sweeping as in last year's budget blueprint.
Conservatives have pushed the party to endorse lower levels of federal spending than last summer's bipartisan budget deal, while Appropriations Committee members lobbied leadership to stick to the level Obama endorsed. And some politically vulnerable Republicans are leery of backing major changes to Medicare in an election year.
After playing defense for much of the past few months, GOP officials are vowing to play offense this budget season. They have repeatedly noted that Senate Democrats haven't passed a budget in more than 1,000 days, seeking to portray them as fiscally irresponsible.
But those attacks will fall flat unless Boehner, Ryan and other senior-ranking Republicans can get their budget through the lower chamber.
In a closed-door party meeting earlier this month, Boehner made a pitch for unity as he pushed for his highway bill. That message also extends to the budget.
He warned against "allowing our internal disagreements to paralyze us."
"The good news is we have a winning message," Boehner said. "The bad news is that in order for that message to mean anything, we have to back it up with action."
Ryan has been working feverishly to produce a budget in time to release in the coming days. The plan is to have it on the House floor next week, before Congress takes a two-week Easter recess.
Ryan is scheduled to announce his "Blueprint for American Renewal" budget Tuesday in a speech to the American Enterprise Institute. A committee markup will follow the next day.
The House budget resolution will be viewed through a campaign prism. Republicans will contrast it with Obama's spending plan, and congressional Democrats will use it as political ammunition this fall.
Ryan expects his budget to play a key role in post-election negotiations on the debt ceiling, the $1.2 trillion in automatic spending cuts triggered by last August's debt deal and the expiring Bush-era tax rates.
Before the election, House appropriators will have to craft 12 annual spending bills based on the top-line number in the budget resolution. The August debt deal set that number initially at $1.047 trillion, and appropriators wanted to stick to that figure.
Right-wing lawmakers rebelled, however, and, according to sources, House leadership agreed to bring that number down to at least $1.028 trillion, which is what Ryan had put in his budget last year for fiscal 2013.
Boehner, Ryan and his lieutenants made that decision largely because they need the votes.
Most, if not all, Democrats will reject Ryan's budget. There are 22 Republicans and 16 Democrats on the Budget Committee. Nine GOP lawmakers on the budget panel voted against the August debt agreement.
Boehner, meanwhile, can only afford a couple-dozen defections on the floor. The big question now is whether appropriators will fall in line.
Most of the budget Ryan is putting together is to be modeled on his 2012 budget, which sparked a political firestorm over its proposal to convert Medicare into a premium-support system. Under that plan, those 54 or younger would have to choose between government-approved private insurance plans, rather than receive traditional fee-for-service Medicare.
Democrats proclaimed Ryan's proposal "the end of Medicare" and used it effectively to win back a House seat in a special election soon after the vote.
According to interviews with conservative Budget Committee members, Ryan looks to be on the verge of offering a bold but somewhat scaled-back version of his Medicare reform this time. This new version closely resembles a plan put forward by GOP presidential front-runner Mitt Romney.
The new plan, based on a model developed with Democratic Sen. Ron WydenRon WydenMnuchin aiming for tax reform by August Dems rip Trump administration for revoking Obama's transgender directive IPAB's Medicare cuts will threaten seniors' access to care MORE (Ore.), would keep traditional Medicare as an option, according to its supporters.
Democrats who support the modified Medicare plan, other than Wyden, have remained silent. The rest are already prepared to attack this as once again an end to traditional Medicare.
"Republicans are doubling down on the same failed idea — that traditional Medicare should end and seniors should no longer be guaranteed health insurance coverage," said Jesse Ferguson, spokesman for the Democratic Congressional Campaign Committee.
In a preview video released Friday, Ryan cast the budget as nothing less than an attempt to "save our country."
"This coming debt crisis is the most predictable crisis we've ever had in this country," he said in the video. "This is why we're acting. This is why we're leading. This is why we're proposing and passing out of the House a budget to fix this problem. It's going to save our country, for ourselves and for our children's future."


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Co-occurring posttraumatic stress disorder (PTSD) is prevalent in addiction treatment programs and a risk factor for negative outcomes. Although interventions have been developed to address substance use and PTSD, treatment options are needed that are effective, well tolerated by patients, and potentially integrated with existing program services. This paper describes a cognitive behavioral therapy (CBT) for PTSD that was adapted from a treatment for persons with severe mental illnesses and PTSD in community mental health settings. The new adaptation is for patients in community addiction treatment with co-occurring PTSD and substance use disorders. In this study, 5 community therapists delivered the CBT for PTSD. Outcome data are available on 11 patients who were assessed at baseline, post-CBT treatment, and at a 3-month follow-up post-treatment. Primary outcomes were substance use, PTSD severity, and retention, of which all were favorable for patients receiving the CBT for PTSD.
Approximately 35% to 50% of people in addiction treatment programs have a lifetime diagnosis of posttraumatic stress disorder (PTSD), and 25% to 42% have a current diagnosis (Back et al., 2000; Brady, Back, & Coffey, 2004; P. J. Brown, Recupero, & Stout, 1995; Cacciola, Alterman, McKay, & Rutherford, 2001; Dansky et al., 1996; Jacobsen, Southwick, & Kosten, 2001; Mills, Lynskey, Teesson, Ross, & Darke, 2005; Ouimette, Ahrens, Moos, & Finney, 1997).
Co-occurring PTSD and substance use disorders add to greater problem severity in psychiatric, medical, social and employment functioning (Back et al., 2000; Brady, Killeen, Saladin, & Dansky, 1994; Najavits, Weiss, Shaw, & Muenz, 1998; Ouimette, Moos, & Finney, 2003; Trafton, Minkel, & Humphreys, 2006). These compounding severities have negative addiction treatment implications. Persons with PTSD respond less favorably to routine treatments, use more treatment services, are more likely to drop out of treatment, and are less likely to remain in continuing care. Further, although outcomes in substance use vary, psychiatric symptoms, health and psychosocial functioning are consistently worse (Brady et al., 1994; S. Brown et al., 1995; P. J. Brown, Stout, & Mueller, 1999; Hien, Nunes, Levin, & Fraser, 2000; Cacciola, Koppenhaver, Alterman, & McKay, 2009; McGovern, Drake, & Weiss, 2005; Mills, Teesson, Ross, Darke, & Shanahan, 2005; Ouimette, Finney, & Moos, 1999; Ouimette et al., 1997; Trafton et al., 2006).
Historically, addiction treatment programs did not address PTSD for fear of stimulating or exacerbating re-experiencing symptoms (nightmares, flashbacks, re-living traumatic events), and risk jeopardizing early and unstable periods of abstinence (S. Brown, 1985; Killeen et al., 2008).
Recently, four standardized behavioral interventions have been developed to address co-occurring PTSD and substance use disorders: Substance Dependence PTSD Therapy (SDPT) (Triffleman, Carroll, & Kellogg, 1999), Concurrent Treatment of PTSD and Cocaine Dependence (CTPCD) (Back, Dansky, Carroll, Foa, & Brady, 2001; Brady, Dansky, Back, Foa, & Carroll, 2001), Transcend (Donovan, Padin-Rivera, & Kowaliw, 2001) and Seeking Safety (SS) (Najavits et al., 1998; Najavits, 2002). The four interventions vary by approach, format, duration, setting, integration with addiction treatment (vs. stand alone), gender composition, retention rate, degree of research support for efficacy, and whether there is an active research program continuing to test and refine the therapy.
Only Transcend was developed as an integrated treatment and offered to patients with co-occurring PTSD and substance use disorders during addiction treatment-as-usual (Donovan et al., 2001). SDPT, CTPCD and SS were developed as stand alone therapies and recruited subjects via newspaper advertisements and postings. Therapists delivering the interventions in all for studies were experienced and carefully selected research clinicians with at least masters' level degrees and most with doctorates.
Neither SDPT nor Transcend reported retention outcomes. CTPCD reported a retention rate of 39% (Brady et al., 2001). In two studies, SS was found to have retention rates of 63% (Najavits et al., 1998) and 61% (Hien, Cohen, Miele, Litt, & Capstick, 2004).
With respect to efficacy testing, although Transcend, SDPT and CTPCD had positive impact on PTSD symptoms, only SS was studied within a randomized controlled group design and found effective with PTSD symptoms. One study found that SS resulted in greater improvement than treatment as usual (Najavits et al., 1998), whereas a second study found SS had similar improvements in PTSD compared to a relapse prevention program (Hien et al., 2004). A third study of 12 session version of SS likewise found similar improvements in SS to a women's health education program (Cohen & Hien, 2006; Hien, 2006). But, SS remains the only one of the four interventions (SS) with an active research program.
There is presently no actively researched behavioral treatment for PTSD specifically designed to be integrated within the context of existing addiction treatment services, for delivery to eligible patients receiving care and by typical community clinicians.
To this end, we selected and adapted a cognitive behavioral therapy (CBT) for PTSD program based upon the methods of cognitive restructuring, and with a proven track record with another at-risk comorbid population—persons with severe mental illnesses, including psychosis (Rosenberg, Mueser, Jankowski, Salyers, & Acker, 2004). In a randomized controlled trial, Mueser et al. (2008) found significant PTSD symptom reduction and excellent retention (81%).
Furthermore, typical community mental health clinicians were trained and supervised to deliver the CBT for PTSD, and did so with adequate competence and adherence. This suggests the potential for ease of translation to other community settings and typical clinicians who work within them.
Research has shown that exposure-based treatments for PTSD although effective, are undermined by high attrition rates. Treatment retention has been found to be better in cognitive restructuring vs. exposure-based approaches to PTSD (Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998; Tarrier et al., 1999). With respect to integrated treatments for PTSD and substance use disorders, CPTCD and SDPT are exposure-based approaches and though only CPTCD reported attrition (61%), it was high.
Given the need for continued development of behavioral treatments for co-occurring substance use and PTSD, particularly designed for delivery by typical addiction counselors in community addiction treatment programs, the rationale for testing a modification of the CBT for PTSD among patients with severe mental illnesses in community mental health settings seemed clear.
The present study aims to test the feasibility of the CBT for PTSD adapted for persons with co-occurring PTSD and substance use disorders in addiction treatment settings. This study intends to address three primary research questions:
This was a one-group, pre-test/post-test design with repeated measures at baseline, post-treatment and at 3-months post-treatment.
Subjects were recruited from three adult addiction treatment agencies' intensive outpatient program level of care. Intensive outpatient programs (IOP) are 9-12 hours per week, 3-4 days or evenings, and are primarily rendered via group counseling formats. The focus is on patient and family education about addiction, developing coping skills to manage relapse, and arranging for continuing care. The planned duration of the intensive phase of treatment is 4-6 weeks, followed by weekly continuing care groups for an additional 2-3 months. The three settings were comparable in organization, staffing and clinical protocols. These sites were: Farnum Rehabiliation Center (Manchester, New Hampshire), FreshStart at Concord Hospital (Concord, New Hampshire) and Quitting Time at the Clara Martin Center (Wilder, Vermont). The CBT for PTSD was delivered during the course IOP and continuing care and delivered on site.
CBT for PTSD in addiction treatment programs is a manual-guided individual therapy. CBT for PTSD imparts 3 learning and skill components to patients in order to improve PTSD symptoms and substance use: 1) Patient education about PTSD and its relation to substance use and treatment; 2) Breathing retraining: A behavioral anxiety reduction skill; and 3) Cognitive restructuring: A cognitive approach and functional analysis of the link among emotions, cognitions and situations. Although cognitive restructuring forces neither in vivo or imaginal exposure per se, it does address avoidance symptoms by teaching cognitive processing of trauma-related thoughts, affects and experiences. Thus, patient education, anxiety reduction skill development, reduced avoidance and cognitive processing are all ingredients of the CBT for PTSD. These ingredients are core to all effective PTSD therapies (Keene, 2009). The CBT for PTSD manual has 8 modules: 1) Introduction to the treatment; 2) Crisis and Relapse Prevention Plan; 3) Breathing Retraining; 4) PTSD: Primary Symptoms; 5) PTSD: Associated Symptoms; 6) Cognitive Restructuring: The first 3 steps; 7) Cognitive Restructuring: The 5-step program; and 8) Generalization Training and Termination. Eight to twelve sessions are necessary to cover all 8 modules (some sessions cover more than one module; some modules take more than one session to cover). A client workbook is used in conjunction with the therapist manual, and, as with most cognitive behavioral therapies, the approach includes homework between sessions, patient education and self-monitoring, skill acquisition, implementation and practice, and developing self-efficacy about more adaptive and alternative cognitions and behaviors.
Therapist training and supervision in CBT for PTSD in this study consisted of an initial 90-minute didactic overview and then twice monthly individual telephone supervision, and twice per month face-to-face individual supervision. All sessions were audio taped and rated by independent raters for CBT for PTSD in addiction treatment using the Adherence and Competence Index (ACI). In exchange for training and supervision, five community therapists volunteered for participation in this study: A licensed psychiatric nurse practitioner; a licensed doctoral level clinical psychologist; a licensed masters' level clinical social worker; an intern in masters' degree mental health counseling program; and, a masters' level rehabilitation counselor.
Therapy session audiotapes were rated by independent raters and overall, found to be at a satisfactory level of adherence and good level of competence. All therapists received a score of at least a 4 on the 7-point adherence and competence scales, which was considered a priori to be adequate. No therapy courses or therapists were disqualified on the basis of poor adherence or lack of competence.
Subjects were recruited from the three addiction treatment programs. Within the first week of admission, patients were administered the PTSD Checklist (PCL). The PCL is a diagnostic screening measure and includes a list of traumatic life events (DSM-IV PTSD diagnosis criterion A) and is followed by 17 symptom related items pertaining to DSM-IV PTSD diagnosis criteria B (re-experiencing), C (avoidance) and D (hyper-arousal). Symptoms are rated on a 5-point scale in terms of "how much bothered by" from 1-Not at all to 5-Extremely. Scores of 44 or more have been found to be diagnostic of PTSD (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996)
Patients screening positive for PTSD on PCL were approached for research participation consent. This research study was reviewed and approved by the Trustees of Dartmouth College Committee for the Protection of Human Subjects, the State of New Hampshire Department of Health and Human Services Committee for the Protection of Human Subjects, and the Human Investigation Committee at Concord Hospital.
Twenty-three patients were assessed as eligible for study participation. Eleven patients started the therapy (i.e., attended at least two sessions of CBT) and received at least one follow-up assessment. In the results section, baseline differences between completers vs. non-completers and those for whom follow-up data were available are presented.
The primary outcome measure for PTSD was the Clinician Administered PSTD Scale (CAPS) (Blake et al., 1998). The CAPS is a structured diagnostic interview conducted by a trained interviewer. The CAPS derives an overall severity score (44 or more is considered a positive PTSD diagnosis), subscale scores on the B (re-experiencing), C (avoidance) and D (hyper-arousal) criteria, and a PTSD diagnosis (present/absent). CAPS ratings can be made for lifetime or current symptoms. For this research, ratings were based on current symptoms (past 30 days).
The primary outcome measures for substance use were: Time-Line Follow-Back Calendar (TLFB) (Sobell, Maisto, Sobell, & Cooper, 1979), urine toxicology and breathalyzer data, and the Addiction Severity Index drug and alcohol composite scores (ASI) (McLellan, Luborsky, Woody, & O'Brien, 1980). The measure of retention was set a priori, with a designation of completion at 8 or more sessions attended, i.e. 75% of planned dose.
SAS 9.2 and SPSS 15.0 were used to conduct all data analyses (SAS Institute Inc., 2008; SPSS, 2006). Univariate statistics were used to describe the demographic (age, gender, ethnicity) and baseline clinical characteristics of the sample (PTSD severity, substance use) (SPSS, 2006).
Generalized Estimating Equations (GEE) modeling an appropriate technique for correlated and incomplete data, were used to measure average change in PTSD severity (CAPS scores) and substance use (TLFB, positive toxicology data, and ASI Alcohol and Drug Severity Composite scores) across the 3 assessment periods (baseline, post-treatment, 3-month post-treatment).
Specific difference between baseline to post-treatment, baseline to 3-month post-treatment, and between post-treatment to 3-month post-treatment means were also assessed (SAS Institute Inc., 2008). Survival analysis curve was used to track retention in the CBT over number of sessions attended.
The mean age of the sample was 34.4 (sd=8.8). The patients were all Caucasian and predominately female (91%). All patients were positive for PTSD at baseline assessment with an average CAPS Total Score of 73.9 (sd=13.9). Patients scored an average of 21.1 (sd=5.4) on the CAPS B criteria score (re-experiencing), 29.6 (sd=6.8) on the CAPS C criteria score (avoidance), and 23.1 (sd=6.1) on the CAPS D criteria score (hyper-arousal). These scores are indicative of a severe level of PTSD symptom severity. The majority of patients experienced a childhood sexual assault (81.8%). The second most common trauma was being involved in an accident (45.5%). (See Table 1).
More than half of the patients began using substances after they experienced either one or multiple traumatic life events (63.6%).
At baseline, eighty-two percent (82%) of the patients tested negative on a urine toxicology screen and none had a positive alcohol breathalyzer test. Using the TLFB, in the past 90 days, patients spent approximately 25 days using alcohol and 16 days using drugs (See Table 1).
As shown in Figure 1, there was a substantial decrease in current PTSD diagnosis (meeting diagnostic criteria over past 30 days) from baseline (100% PTSD positive) to post-treatment (27% PTSD positive) to 3-month post-treatment (20% PTSD positive). As shown in Table 2, there was a significant change over time on the current (past 30 days) CAPS Total Score, as well as the CAPS B, C and D criterion score (χ2=79.21, 2 df, p<.0001; χ2=51.85, 2 df, p<.0001; χ2=45.59, 2 df, p<.0001, χ2=29.81, 2 df, p<.0001). The CAPS Total and CAPS C criteria score at post-treatment and 3-month post-treatment were significantly different from baseline levels (χ2=343.02, 1 df, p<.0001; χ2=46.05, 1 df, p<.0001; χ2=226.82, 1 df, p<.0001; χ2=18.71, 1 df, p<.0001). There was also a significant change between the post-treatment and the 3-month post-treatment (χ2=29.85, 1 df, p<.0001; χ2=11.81, 1 df, p=.001) (See Table 2). For the CAPS B criteria and CAPS D criteria scores, there was a significant change between baseline and post-treatment, baseline and 3-month post-treatment (χ2=24.79, 1 df, p<.0001; χ2=51.31, 1 df, p<.0001; χ2=20.70, 1 df, p<.0001; χ2=29.15, 1 df, p<.0001), but no significant change between post-treatment and 3-month post-treatment (χ2=1.03, 1 df, p=.31; χ2=1.99, 1 df, p=.16).
There were no significance changes over time in urine toxicological outcomes from baseline (82% negative), post-treatment (80% negative), and 3-mo post-treatment (80% negative). Also, the breathalyzer test remained negative over time. Although there was a reduction in the days of alcohol use between baseline and post-treatment, it was not at a significant level. There were no significant changes in the number of days drinking or using drugs over time. There were significant decreases among several of the ASI alcohol and drug severity composite scores (χ2=8.36, 2 df, p=.02; χ2=6.76, 2 df, p=.03). There was a significant decrease in the ASI alcohol severity composite score between baseline & post-treatment and baseline & 3-month post-treatment (χ2=5.64, 1 df, p=.02; χ2=5.68, 1 df, p=.02). There were no significant changes between post-treatment and 3-month post treatment (χ2=0.08, 1 df, p=.77). Similarly, we found a significant reduction in the ASI drug severity composite score from baseline to post-treatment and baseline to 3-month post-treatment, but no significant decrease from post-treatment to 3-month post-treatment (χ2=4.18, 1 df, p.04; χ2=6.54, 1 df, p=.01; χ2=0.06, 1 df, p=.81).
Examining the a priori definition of retention (75% of total planned, fifteen of the twenty-three patients (65%) completed at least 8 sessions of CBT. This rate is comparable to SS (61-63%) and better than CTPCD (39%), the latter being an exposure-based approach. On average, completers attended 10.5 CBT sessions over the course of treatment (See Figure 1).
Using intent to treat analyses, we compared the 15 study subjects (completers) to the 8 subjects who did not complete treatment. We found no significant t-test differences on baseline demographic or clinical characteristics (PTSD and substance use severity) between the two groups. Although not statistically significant, non-completers tended reporting less childhood sexual or physical assault, and scored lower on the CAPS total score. There were no differences on substance use severity measures.
In addition, we compared baseline characteristics of those patients for whom follow-up data were available (n=11) with those for whom we were unable to obtain follow-up information (n=12). The groups did not differ (t-tests) on demographic characteristics (age, gender), PTSD symptom severity (CAPS total score), or substance use severity (ASI composite scores).
Finally, we compared the baseline characteristics of treatment completers with follow-up information (n=11) with non-completers without follow-up data (n=8). The t-test comparisons yielded no significant differences.
The present findings provide support for the feasibility of CBT for PTSD for patients with these co-occurring disorders in community addiction treatment settings.
CBT for PTSD had significant impact on current CAPS PTSD diagnosis: Only 27% were positive for PTSD post-treatment, and even fewer (20%) were PTSD positive at 3-month follow-up. This suggests that changes made during treatment can be sustained over a short period of time outside of treatment.
Patients who received CBT for PTSD also experienced significant reductions in substance use and in substance use severity. But, since patients were also receiving intensive outpatient program addiction treatment services it is unclear how much these changes may be associated with this treatment as usual vs. the specific mechanisms of CBT. Finally, using a conservative estimate of retention (75% of planned sessions) as criteria, 65% of patients completed the therapy.
Although the retention rate compares favorably to other treatments for co-occurring PTSD and substance use, treatment engagement and completion remains a challenge for these patients. The present study could not identify significant differences in baseline characteristics (predictors of attrition) though less severe PTSD and trauma type were notable trends.
Since this study lacks the experimental rigor associated with a randomized controlled trial, there are many threats to internal and external validity. First, at this juncture we cannot, with absolute scientific confidence, attribute the changes in PTSD symptoms and substance use to the CBT for PTSD. Since there is no comparison condition, these changes may have occurred naturalistically, or by participation in the intensive outpatient addiction treatment alone. Second, we have no specific measure of the potential for volunteer bias. This study may have an unusual sample of persons in addiction treatment with PTSD. Perhaps the patients who did not provide informed consent are more severe and at greater risk for negative treatment outcomes. Third, although the therapists in this study were volunteers from the community vs. elite research therapists, they were nonetheless not community addiction counselors. It remains unclear how simple and easy to implement the CBT for PTSD in addiction treatment may be until community-based addiction counselors are trained and supervised in the approach, and their adherence and competence measured over time.
The finding that CBT for PTSD compares favorably in primary outcomes (PTSD and substance use) to one established treatment (SS) and has better retention (vs. SS and CTPCD) lends support to its promise, but cannot, at the present stage of research development, argue for its efficacy.
The limitations noted also chart the course for the next phase of behavioral therapy development (Onken, Blaine, & Battjest, 1997; Rounsaville, Weiss, & Carroll, 1999; Rounsaville, Carroll, & Onken, 2001). This next stage would compare the CBT for PTSD plus addiction treatment as usual versus addiction treatment as usual plus a matched attention control or an intervention targeting something other than PTSD. The findings from this more rigorous study will shed more light on the potential efficacy and change mechanisms of CBT for PTSD. The challenges of treatment engagement and retention must also be considered in research design and the CBT for PTSD intervention refinement. Adding upfront motivational enhancement strategies to enlist patient "buy-in" to address PTSD within the context of addiction treatment seem warranted.
Further, understanding the types of addiction treatment programs for patients who are likely to benefit from a specialized PTSD interventions, and the longer term cost-benefits of providing or not providing integrated care remains unknown (Flynn & Brown, 2008; Schneider, Cronkite, & Timko, 2008).
This research was supported by NIDA grant K23 DA 16574-01A (McGovern) and NIDA grant K24DA022288 (Weiss). The authors thank the patients and staff of the Farnum Rehabilitation Center (Manchester, New Hampshire), FreshStart at Concord Hospital (Concord, New Hampshire) and Quitting Time at the Clara Martin Center (Wilder, Vermont). We also want to acknowledge the contributions of Stephen Higgins, Kim Mueser, Lois Hollow, Karen Gillock, Ellen Eberhart, Jim Gamache, Melissa Edney, and Aurora Matzkin.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Mark P. McGovern, Dartmouth Medical School.
Chantal Lambert-Harris, Dartmouth Medical School.
Stephanie Acquilano, Dartmouth Medical School.
Haiyi Xie, Dartmouth Medical School.
Arthur I. Alterman, University of Pennsylvania.
Roger D. Weiss, McLean Hospital, Harvard Medical School.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Scarecrow by scarecrow63
Artwork Description
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