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Twelve-Month Prevalence of and Risk Factors for Suicide Attempts in the World Health Organization World Mental Health Surveys
Guilherme Borges, ScD; Matthew K. Nock, PhD; Josep M. Haro Abad, MD, PhD; Irving Hwang, MA; Nancy A. Sampson, BA; Jordi Alonso, MD, MPH, PhD; Laura Helena Andrade, MD, PhD; Matthias C. Angermeyer, PhD; Annette Beautrais, PhD; Evelyn Bromet, PhD; Ronny Bruffaerts, PhD; Giovanni de Girolamo, MD; Silvia Florescu, MD; Oye Gureje, MD, PhD, FRCPsych; Chiyi Hu, MD, PhD; Elie G. Karam, MD; Viviane Kovess-Masfety, MD, PhD; Sing Lee, MBBS, FRCPsych; Daphna Levinson, PhD; Maria Elena Medina-Mora, PhD; Johan Ormel, PhD; Jose Posada-Villa, MD; Rajesh Sagar, MD; Toma Tomov, PhD; Hidenori Uda, MD; David R. Williams, PhD, MPH; and Ronald C. Kessler, PhD
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Objective: Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries.
Method: Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001–2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including sociodemographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior.
Results: Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74–0.80).
Conclusions: Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors.
J Clin Psychiatry
Submitted: December 19, 2008; accepted July 10, 2009.
Online ahead of print: August 24, 2010 (doi:10.4088/JCP.08m04967blu).
Corresponding author: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 (email@example.com).
J Clin Psychiatry 2010;71(12):1617–1628
© Copyright 2010 Physicians Postgraduate Press, Inc.
Approximately 9% of people report having serious thoughts of suicide at some point in their lives, and 3% actually make a suicide attempt.1,2 Although most suicide attempts do not result in death, each attempt carries a chance of serious long-term physical injury, is associated with significant psychological suffering, and increases the likelihood of subsequent suicide attempts and death.3–5 As a result, the accurate prediction of suicide attempts is of critical importance to clinicians.
Unfortunately, although many studies have identified risk factors for suicidal behaviors,1,6–10 this information has not led to a reduction in the rate of death by suicide or suicidal behaviors.2,11 Several obstacles have prevented the translation of these findings into usefulness in clinical settings—a high priority for clinical science.12,13 First, most prior studies have used relatively small and selective samples (eg, college students or psychiatric inpatients) and have focused on long-term prediction (5–20 years) rather than short-term risk—raising questions about the generality and clinical utility of the identified risk factors. Second, most studies have identified risk factors for suicidal thoughts or attempts but not what factors predict which suicide ideators will make a suicide attempt. This is an important concern for clinicians who often must predict not who in the general population will make a suicide attempt, but which of their clients with suicidal thoughts will make a suicide attempt in the coming days, weeks, or months. Third, many risk factors identified in prior studies, such as diagnoses obtained from semistructured interviews or the results of extensive self-report questionnaires,6,8,10 cannot be feasibly assessed in clinical settings. Fourth, prior studies have identified individual risk factors but have not yielded a method of combining risk factors to derive a single measure of the short-term (eg, 12-month) risk of a suicide attempt. More specifically, prior research has shown that suicide attempts are predicted by specific demographic factors,1,14–16 family history factors,17,18 childhood adversities,19–21 psychiatric disorders,7,8,22–26 and past history of suicidal behaviors.27,28 However, this research has not yet provided clinicians with a method of systematically assessing these factors and using the resulting information to estimate the level of risk associated with their presence.
The primary goals of this study were to identify risk factors for 12-month suicide attempts and to use this information to develop a clinically useful method of predicting suicide attempts that addresses many of the limitations noted in prior work on this problem. Data are from the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative, the size and scope of which provide a unique opportunity to carefully examine this low base-rate behavior. We report here on the 12-month prevalence of suicide ideation, plans, and attempts across these countries and on the risk factors for 12-month suicide attempts among those with suicide ideation. We use a data-driven actuarial approach similar to that used successfully to develop prediction models for violent behavior29–33 and most recently to predict 12-month suicide attempts among US respondents.34 As in that earlier work, our goal was to develop a risk index that clinicians can use to quickly and easily assess the risk of 12-month suicide attempts. The use of such risk indices has the additional advantage of estimating risk without asking directly about the behavior being predicted—as is done in approaches that rely on the endorsement of critical items—and so can be especially useful when assessing the likelihood of sensitive behaviors such as suicidal thoughts and attempts.
Respondent Samples
The WMH surveys were carried out in 10 countries classified by the World Bank20 as developed (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, and the United States) and 11 countries classified as developing (Brazil, Bulgaria, Colombia, India, Lebanon, Mexico, Nigeria, the People's Republic of China, Romania, South Africa, and Ukraine) (Table 1). All surveys were conducted face-to-face by trained lay interviewers among multistage household probability samples and were completed between 2001 and 2007. The total sample size was 108,705, with individual country sample sizes ranging from 2,357 in Romania to 12,790 in New Zealand. The weighted mean response rate across all countries was 73.0%.
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All respondents completed a Part I interview that contained core diagnostic assessments, including the assessment of suicidal behaviors. All Part I respondents who met criteria for any disorder and a subsample of approximately 25% of other respondents were administered a Part II interview that assessed potential correlates and disorders of secondary interest. All respondents in Israel completed Part II. Data were weighted to adjust for differential sampling of Part I respondents into Part II, differential probabilities of selection within households, and to match samples to population socio-demographic distributions.
Standardized interviewer training procedures, WHO translation protocols for all study materials, and quality control procedures for interviewer and data accuracy were used in all WMH countries. These procedures are described in more detail elsewhere.35 Informed consent was obtained before beginning interviews in all countries. Procedures for obtaining informed consent and protecting human participants were approved and monitored for compliance by the institutional review boards of the organizations coordinating the surveys in each country.
Measures of Suicidal Behaviors
Suicidal behaviors were assessed using Version 3.0 of the WMH Composite International Diagnostic Interview (CIDI).36 The CIDI contains a module that assesses lifetime occurrence, age at onset, and recency of suicide ideation ("Have you ever seriously thought about committing suicide?"), plans ("Have you ever made a plan for committing suicide?"), and attempts ("Have you ever attempted suicide?"). Respondents who reported any of these experiences in the past 12 months are the focus of the current report. On the basis of evidence that reports of such experiences are higher in self-administered than interviewer-administered surveys,37 responses to these questions were obtained in a self-administered booklet.
Risk Factors for Suicidal Behaviors
We examined 5 sets of possible predictors of suicide attempts among ideators: sociodemographic characteristics, parental psychopathology, childhood adversities, respondent history of past suicidal behaviors, and 12-month respondent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)72 mental disorders. Each of these 5 has been found to predict suicide attempts in previous studies. The sociodemographic characteristics module assessed 6 previously documented predictors of suicide attempts: age, gender, education, family income, marital status, and employment.1,14–16
The measures of parental psychopathology included the 5 most commonly occurring disorders found in previous research to be associated with a wide range of suicidal behaviors17,18: major depressive episode, panic disorder, generalized anxiety disorder, substance dependence, and antisocial personality disorder. These parent disorders were assessed with respondent reports using the Family History Research Diagnostic Criteria Interview38 and its expansion.39 We also assessed parent history of attempted and completed suicides.
The childhood adversities included 3 broad classes that have been found to predict suicidal behaviors in previous studies19–21: childhood losses (parental death, parental divorce, and other major losses), indicators of childhood family dysfunction (parental criminal behavior, physical abuse, sexual abuse, family violence, and economic adversity), and respondent serious physical illness. These childhood adversities were assessed with measures developed for the US National Comorbidity Survey.40
The measures of past suicidal behaviors, which have consistently been found to predict future suicide attempts,27,28 include information about history of ideation, plans, and attempt. Respondent 12-month DSM-IV disorders, finally, were assessed using version 3.0 of the WMH-CIDI,36 a fully-structured research diagnostic interview. The assessment included the vast majority of the disorders documented to predict suicide attempts in previous studies,7,8,22–26 including anxiety disorders (panic disorder, agoraphobia without a history of panic disorder, generalized anxiety disorder, specific phobia, social phobia, posttraumatic stress disorder, and adult separation anxiety disorder), mood disorders (major depressive disorder, dysthymic disorder, and bipolar disorder), externalizing disorders (adult attention-deficit/hyperactivity disorder, oppositional-defiant disorder, conduct disorder, and intermittent explosive disorder), and substance disorders (alcohol and illegal drug abuse and dependence). Clinical reappraisal studies carried out in conjunction with a number of WMH surveys documented generally good concordance between DSM-IV diagnoses based on the CIDI and diagnoses based on blinded clinical reappraisal interviews with the Structured Clinical Interview for DSM–IV41 in probability subsamples of WMH respondents.42 Organic exclusion rules and diagnostic hierarchy rules were used in making all respondent diagnoses.
Statistical Analyses
We examined 12-month prevalence of ideation, plans, and attempts using cross-tabulations. We then estimated the associations between hypothesized correlates of suicide ideation and, among ideators, planned and unplanned suicide attempts using bivariate and multivariate logistic regression analysis.43 Logistic regression coefficients and 95% CIs were converted to odds ratios (ORs) for ease of interpretation. Continuous variables were divided into categories to minimize effects of extreme values. Categories were collapsed to stabilize associations when ORs did not differ meaningfully. Standard errors and significance tests were estimated with the Taylor series method44 using SUDAAN software45 to adjust for design effects. Multivariate significance was evaluated with Wald χ2 tests based on design-corrected coefficient variance–covariance matrices. Statistical significance was evaluated with 2-tailed, .05-level tests.
After identifying significant risk factors, a summary risk index was constructed for planned and unplanned suicide attempts separately for developed and developing countries (see eAppendix 1). We began by combining the predictors that had ORs over 2.0 or under 0.5 in the earlier bivariate models into new multivariate models. These models included statistical controls for country, age, and age squared in order to ensure that effects were not explained by these factors. The predictors that continued to have ORs above 2.0 or below 0.5 in the multivariate models were used to create the index by constructing a predicted probability of the outcome from a version of the multivariate model that contained only these predictors. This distribution of predicted probabilities was then inspected and divided into risk strata using the logic of stratum-specific likelihood ratios,46 ie, we divided the distribution into strata large enough to find statistically significant monotonic relationships between all contiguous pairs of strata. Three measures of screening scale performance were then calculated for each stratum: positive predictive value (the proportion of the respondents in the stratum who made an attempt), sensitivity, (the proportion of all attempters who were in the stratum), and specificity, (the proportion of all nonattempters who were in the stratum). We also calculated area under the receiver operating characteristic curve (AUC),47 a summary measure of prediction accuracy that, unlike the more familiar Cohen's κ,48 is not influenced by marginal distributions.49
Each type of suicidal behavior assessed occurred at a slightly higher rate in developing than in developed countries. More specifically, estimates of the 12-month prevalence of suicide ideation, plans, and attempts were 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4% for developing countries (Table 2). Overall, roughly one-third of 12-month ideators developed a suicide plan, and this proportion was significantly higher in developing than developed countries (34.1% vs 28.9%, χ21 = 4.6, P = .032). A slightly lower percentage of 12-month ideators made a suicide attempt, and this proportion was also higher in developing than developed countries (20.2% vs 15.1%, χ21 = 6.1, P = .001). Developing countries also had a higher prevalence of attempts among ideators with a suicide plan (41.8% vs 32.6%, χ21 = 4.0, P = .046) and a nonsignificantly higher prevalence of attempts among ideators without a plan (9.0% vs 8.0%, χ21 = 0.3, P = .59). Despite this low rate of unplanned suicide attempts, it is important to note that unplanned (presumably impulsive) attempts constituted 37.7% of all attempts in developed countries and 29.4% in developing countries.
Risk Factors for 12-Month Suicide Attempts Among Ideators
Suicide ideation was significantly more prevalent among women than men in both developed (2.2% vs 1.7%, χ21 = 12.5, P < .001) and developing (2.4% vs 1.6%, χ21 = 25.1, P < .001) countries. Suicide plans were significantly more common among women than men in developing (0.8% vs 0.6%, χ21 = 7.0, P = .008), but not developed, countries. Gender differences in the prevalence of attempts were not significant in either developed or developing countries. Overall, few sociodemographic variables were associated with suicide attempts among ideators. Specifically, in developed countries, younger age (ie, < 50 years old) predicted unplanned attempts among ideators and unemployment predicted planned attempts. In developing countries, being a student predicted unplanned attempts and unemployment again predicted planned attempts. The bivariate ORs of these significant predictors were in the range 2.4–9.4 (detailed results are not reported, but are available on request).
Parental psychopathology and other childhood family adversities were found to be consistently significant predictors of 12-month suicide ideation in both developed and developing countries, with ORs in the range 1.6–4.8 (median = 2.7; interquartile range, 2.1–3.1) (detailed results are not presented but are available on request). However, few of these measures significantly predicted either planned or unplanned suicide attempts among ideators (Table 3). In developed countries, childhood physical abuse predicted both planned and unplanned attempts, whereas sexual abuse predicted only planned suicide attempts, and childhood neglect and family violence predicted unplanned attempts. In developing countries, none of the 16 parental psychopathologies or childhood adversities considered in the analysis predicted planned attempts, while parental generalized anxiety disorder was the only significant predictor of unplanned attempts. The bivariate ORs of these significant predictors were in the range 2.3–4.4.
Respondent 12-month DSM-IV disorders were strong predictors of 12-month suicide ideation in both developed and developing countries. Virtually all of the 16 disorders considered were significant predictors of ideation, with ORs in the range 3.3–15.3 (median = 7.1; interquartile range, 4.9–9.1). (Detailed results are not presented but are available on request.) However, few of these disorders significantly predicted suicide attempts among ideators (Table 4). In developed countries, specific phobia (OR = 2.6) and conduct disorder (OR = 16.4) were the only disorders that predicted planned suicide attempts, while none predicted unplanned attempts. In developing countries, panic disorder (OR = 3.9), conduct disorder (OR = 10.0), and drug abuse/dependence (OR = 7.3) were the only disorders that predicted planned attempts positively. Generalized anxiety disorder was associated with a significantly reduced risk of making a planned attempt (OR = 0.3). Adult separation anxiety disorder was the only disorder the predicted unplanned attempts positively (OR = 4.0), while generalized anxiety disorder was associated with a significantly reduced risk of making an unplanned attempt (OR = 0.0). The bivariate ORs of the significant positive predictors were in the range 2.6–16.4, although it should be noted that the CIs for the higher ORs were quite wide because of the comparative rarity of the predictor disorders.
History of prior suicidality was significantly associated with highly elevated odds of 12-month suicide ideation in both developed and developing countries, with bivariate ORs in the range 28.4–48.2. (Detailed results are not presented, but are available on request.) However, the ORs were less extreme and also more varied in predicting suicide attempts among ideators (Table 5). Three results are noteworthy: First, 12-month ideators with a past history of ideation in the absence of a lifetime plan or attempt were significantly less likely to make a first attempt in the 12 months before interview than were 12-month ideators with no prior history of suicide ideation. This pattern was found both in developed and developing countries, with ORs in the range 0.1–0.2. Similarly, 12-month ideators with a prior history of a suicide plan but no prior attempt were significantly less likely to make a planned attempt in the 12 months before the interview than were 12-month ideators with no prior plan. Second, 12-month ideators with a history of prior unplanned (ie, impulsive) attempts in both developed and developing countries had significantly elevated odds of an unplanned attempt (ORs = 6.2–9.3) but not a planned attempt (ORs = 1.3–2.7) than those with no prior history. Third, 12-month ideators with a history of prior planned attempts had modestly elevated odds of planned attempts in developed countries (OR = 1.8) and of both planned and unplanned attempts in developing countries (ORs = 1.7–1.8), although none of these associations was statistically significant. Taken together, these findings indicate that the presence of prior ideation and plans in the absence of a suicide attempt are associated with decreased likelihood of acting on suicide ideation in the prior 12 months; whereas the presence of a prior suicide attempt is associated with increased odds of acting on suicide ideation in the prior 12 months—with evidence of specificity such that those with unplanned attempts have higher odds of subsequent unplanned attempts and those with planned attempts have higher odds of subsequent planned attempts.
Summary Risk Index for 12-Month Suicide Attempt Among Ideators
The summary risk indices, which are made up of the significant predictors from multivariate versions of the foregoing equations, have AUCs in the range of 74.0–79.7 across the 4 outcomes (ie, planned and unplanned attempts in both developed and developing countries; Table 6). This means that a randomly selected suicide attempter could be distinguished from a randomly selected nonattempter with 74.0%–79.7% accuracy based on their comparative scores on these risk indices—demonstrating a relatively high level of precision. The 2 indices for planned attempts were consistent across countries in that roughly half of planned attempts (sensitivity: 45.4%–51.3%) were made by the roughly one-third to one-fourth of respondents classified as having the highest risk in both developed and developing countries (22.1%–31.2%), while fewer than 10% of planned attempts were made by the roughly one-third to one-fourth of respondents classified as having the lowest risk (27.2%–34.8%). Stated differently, roughly two-thirds of respondents classified by the risk indices as having the highest risk made attempts (positive predictive value: 66.8%–68.7%). The 2 indices for unplanned attempts have smaller proportions of respondents classified as having highest risk than the indices for planned attempts (3.6%–11.6%), lower proportions of attempts made by people classified at highest risk (21.0%–49.9%), and smaller proportions of respondents classified at highest risk who made attempts (38.5%–46.9%). (Final versions of each risk index are available on request.)
Even with a dataset as large as the one used here, the low 12-month prevalence of suicide attempts made it impossible to develop stable risk indices separately for each participating country. However, in order to get a rough indication of the performance of the summary risk indices in particular countries, we calculated AUCs to assess concordance between predicted probability of an attempt and actual attempts. The predicted probability estimates were generated from separate equations for planned and unplanned attempts in developed and developing countries. Borrowing standard verbal descriptors used to characterize the strength of κ,50 the AUC estimates were substantial (> 0.80) for nearly 30% of the replications, moderate (> 0.70–0.80) for an additional 25% of replications, and fair for another 25%. Prediction accuracy was considerably greater, though, in developed countries (nearly 50% substantial and 70% either moderate or substantial) than developing countries (less than 20% substantial and 40% either moderate or substantial) and somewhat greater for planned attempts (nearly one-third substantial and nearly 60% either moderate or substantial) than unplanned attempts (about one-fourth substantial and nearly 50% either moderate or substantial). (Detailed results are available on request.)
This study documented 3 noteworthy results. First, we provided estimates of the 12-month prevalence of suicidal behaviors among adults (18+ years old) in 21 countries. A recent review of studies of the 12-month prevalence of suicidal behaviors reported widely varying estimates found in prior studies.2 The estimates obtained in the current study were in the lower end of these ranges for each suicidal behavior. This was most likely the result of 2 features of our study: we used conservative items for the assessment of each suicidal behavior (eg, presence of suicide ideation required that a person have "seriously" thought about committing suicide rather than having merely "thoughts of death" as in some prior studies), and we used large representative samples of respondents from the general population (ie, rather than small selective samples that may be at higher risk for suicidal behaviors, such as young adults or those in a clinical setting). Although it has been suggested that suicidal behaviors may differ between developed and developing countries,51,52 consistent with our prior report on the cross-national lifetime prevalence of suicidal behaviors1 we found no differences in 12-month prevalence between developed and developing countries. The prevalence estimates for suicide attempts documented in this study complement cross-national data on suicide mortality maintained by the WHO53 and suggest that across the countries examined here there are approximately 14.6 suicide attempts for every one suicide death (median ratio: 14.6; IQR: 9.1–53.7)—a ratio consistent with those documented in prior reports.54,55
Second, we identified risk factors for 12-month suicidal behaviors across both developed and developing countries. Replicating the results of prior studies, female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, the presence of every mental disorder assessed, and psychiatric comorbidity all emerged as significant risk factors for suicidal behaviors in this study.7,56–58 Interestingly, analyses revealed that most of these factors are associated with suicide attempts because they are predictive of suicide ideation even though they do not significantly predict the occurrence of suicide attempts among those with suicide ideation. For instance, although the presence of a DSM-IV mental disorder was associated with significantly higher odds of experiencing suicide ideation in virtually every instance, few mental disorders predicted suicide attempts among those with ideation. Among those few disorders, conduct disorder emerged as the strongest and most consistent predictor of suicide attempts, with anxiety and substance use disorders also showing significant results in several instances. These findings are consistent with those from a recent study of the prediction of lifetime suicide attempts1 and suggest that disorders characterized by impulse-control and anxiety may be most important in predicting the transition from suicidal thoughts to suicide attempts.
Our analyses also add to the growing literature on the importance of prior history of suicidal behaviors in predicting subsequent suicide attempts.27,28,59 The current study extends earlier work on this topic by differentiating 2 processes involved in the transition from suicidal thoughts to attempts. In line with prior findings, a history of prior suicide attempt was found to be strongly predictive of 12-month suicide attempts.28,34,60 Our analysis adds to prior research by showing specificity in this process, though, such that a history of unplanned (impulsive) suicide attempts predicts subsequent unplanned attempts (but not planned ones), while a history of planned attempts predicts subsequent planned attempts (but not unplanned ones). This is an important specification for clinicians working with potentially suicidal patients, especially patients with a history of unplanned suicide attempts.
We also found that risk of the transition from suicidal thoughts to attempts was significantly lower among those who had thought of suicide in the past but never made an attempt than even among those who had never had suicidal thoughts before the past 12 months. This intriguing result, coupled with the earlier finding that more than 60% of the transitions from suicide ideation to attempt occur in the first year after onset of ideation,1 suggests that resisting the urge to make a suicide attempt when suicidal thoughts first occur is associated with decreased risk of acting on these thoughts when they return. An important next step is to study people with a history of ideation who never made a suicide attempt in greater detail in an effort to understand what characterizes such people (eg, good impulse control, low severity of suicide ideation) and what strategies they use to resist the urge to make a suicide attempt. Importantly, these findings should not be interpreted to mean that those who have thought about suicide in the past but not made an attempt are not at risk of making a future suicide attempt, but only that evidence of not having made a previous attempt despite having suicide ideation is a predictor of low risk of future attempts compared to people with more recent first onset of ideation. It is important for clinicians to conduct a thorough risk assessment with each patient encountered and to use ongoing monitoring of suicide risk.61–63
Third, and perhaps most important, we developed risk factor indices for 12-month suicide attempts tailored for planned versus unplanned attempts and with versions available for both developed and developing countries. Although only a handful of factors emerged as predictors of suicide attempts among ideators, our analyses revealed that all 4 summary risk indices using these factors showed good discrimination properties (as evidenced by moderate to substantial AUCs of 0.74–0.80) in the total sample that also performed quite well when applied to most developed countries and to a substantial minority of developing countries. These results suggest that the indices might prove useful in predicting suicide attempts in clinical settings; however, this remains an important question for future study. Although suicide prevention programs that include a focus on screening in order to identify people at elevated risk for suicide are among the only prevention programs that have shown an ability to decrease the rate of suicide death,64 such programs are not used in most clinical settings. What has been lacking is an empirically derived screening instrument that can be feasibly used in clinical settings to assess key risk factors and determine a person's level of risk for suicide attempt. Although it will be important to test the prospective predictive ability of these indices in actual clinical settings, the risk indices developed in this study represent an important initial step toward bridging the gap between the science and practice of suicide risk assessment.
Several additional features of the risk indices developed here warrant further comment. First, our risk indices had strong correlations with planned and unplanned attempts among suicide ideators from a large and heterogeneous set of developed and developing countries, suggesting these indices may have good generality in the prediction of suicide attempts—and indirectly supporting the cross-cultural validity of the WMH-CIDI measure used to assess these risk factors. Second, the performance of our risk indices was only slightly lower that the one developed using a much more homogenous sample34 and is similar to the AUC reported among a selective group of psychiatric patients.65 Our results also suggest that we may be able to predict suicide attempts with the same level of accuracy possible in other areas of medicine in which actuarial approaches that combine risk factors from multiple domains have proven more accurate than clinical prediction, such as in the prediction of violence and sexual offenses30,66 and the prediction of death from natural causes among the elderly.67 Third, and finally, it is important to note that these indices are not intended to serve as a comprehensive suicide assessment by themselves but instead may be best used to identify those at high risk for suicide attempt so that they can receive a more focused, in-depth assessment of current risk for suicidal behavior.
The results of this study should be interpreted with 4 important limitations in mind. First, our analysis was based on retrospective self-reports. This concern is limited somewhat by our focus on suicide attempts in only the past 12-months; however, it is possible that time-varying risk factors (eg, marital status, income) reported for the past 12-months may have changed after respondents' suicide attempts. Retrospective recall of childhood adversities and parental psychopathology might have been influenced by respondents' current mood or recent suicide attempt.68,69 Given these issues, these results should be considered preliminary until the risk indices developed are cross-validated prospectively. Second, although the overall response rate was at an acceptable level, response rates varied across countries and in some cases were below commonly accepted standards. We controlled for differential response using poststratification adjustments, but it is possible that response rates were related to the presence of suicidal behaviors or mental disorders, which could have biased cross-national comparisons. Third, there may have been cross-national differences in the willingness to report on suicidal behaviors and in the interpretation of items assessing risk factors. Significant efforts were dedicated to carefully translating and back-translating the WMH-CIDI used in this study in order to minimize such concerns36; however, differences in factors such as the stigma about suicide and childhood maltreatment are likely to persist cross-nationally despite these efforts. Fourth, although we examined a broad set of potential risk factors, many important factors were not included in this study. Psychotic disorders, although known to be associated with suicidal behavior, were not assessed because prior studies have shown that they are dramatically overestimated using structured interviews such as the WMH-CIDI.70,71 We also did not include many family history factors (eg, history of schizophrenia or bipolar disorder), psychological (eg, hopelessness), social (eg, lack of social support) or biologic (eg, serotonergic functioning) known to be associated with suicidal behaviors. Any one study cannot assess all such factors; however, the limited focus used is important to bear in mind when interpreting the results.
Author affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (Dr Kessler, Mr Hwang, and Ms Sampson); National Institute of Psychiatry, Mexico City, Mexico (Drs Borges and Medina-Mora); Department of Psychology, Harvard University, Cambridge, Massachusetts (Dr Nock); Sant Joan de Deu-SSM, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain (Dr Abad); Health Services Research Unit, Institut Municipal d'Investigació Mèdica, Hospital del Mar, Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Barcelona, Spain (Dr Alonso); Section of Psychiatric Epidemiology, Institute of Psychiatry, School of Medicine, University of São Paulo, Brazil (Dr Andrade); Center for Public Mental Health, Gösing am Wagram, Austria (Dr Angermeyer); Christchurch School of Medicine & Health Sciences, Otago, New Zealand (Dr Beautrais); State University of New York, Stony Brook (Dr Bromet); University Hospital Gasthuisberg, Leuven, Belgium (Dr Bruffaerts); Regional Health Care Agency, Emilia-Romagna Region, Bologna, Italy (Dr de Girolamo); Health System Research Department, National School of Public Health and Health Services Management, Bucharest, Romania (Dr Florescu); Department of Psychiatry, University College Hospital, Ibadan, Nigeria (Dr Gureje); Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China (Dr Hu); Institute for Development, Research, Advocacy, and Applied Care, St George Hospital University Medical Center, Beirut Lebanon (Dr Karam); University of Paris Descartes and MGEN Foundation for Public Health, Paris, France (Dr Kovess-Masfety); Department of Psychiatry, The Chinese University of Hong Kong, HKSAR, China (Dr Lee); Director Research & Planning, Ministry of Health, Mental Health Services, Jerusalem, Israel (Dr Levinson); University Medical Center Groningen, University of Groningen, the Netherlands (Dr Ormel); Colegio Mayor de Cundinamarca University, Bogotá, Colombia (Dr Posada-Villa); All India Institute of Medical Sciences, New Delhi, India (Dr Sagar); New Bulgarian University, Institute for Human Relations, Sofia, Bulgaria (Dr Tomov); Social Welfare and Environmental Department, Osumi Regional Promotion Bureau, Kagoshima Prefecture, Japan (Dr Uda); and Harvard School of Public Health, Boston, Massachusetts (Dr Williams).
Potential conflicts of interest: Dr Kessler has been a consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer, sanofi-aventis, Shire, and Wyeth-Ayerst; has served on advisory boards for Eli Lilly and Wyeth-Ayerst; and has received research support for his epidemiologic studies from Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Ortho-McNeil, Pfizer, and sanofi-aventis. The remaining authors report no financial or other relationship relevant to the subject of this article.
Funding/support: These activities were supported by the US National Institute of Mental Health (NIMH) (R01MH070884, R01MH077883), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly, Ortho-McNeil, GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation Thematic Project Grant (03/00204-3). The Chinese World Mental Health Survey Initiative is supported by Pfizer. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Colombian National Study of Mental Health is supported by the Ministry of Social Protection. The European Study of the Epidemiology of Mental Disorders project is funded by the European Commission (contracts QLG5-1999-01042; SANCO 2004123); the Piedmont Region (Italy); Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028); Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE); Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP); and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The World Mental Health India Survey was funded by WHO (India) and helped by Dr R. Chandrasekaran, the Jawaharlal Institute of Postgraduate Medical Education & Research. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese National Mental Health Survey is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), Fogarty International, Act for Lebanon, anonymous private donations to the Institute for Development, Research, Advocacy & Applied Care, Lebanon, and unrestricted grants from Janssen Cilag, Eli Lilly, GlaxoSmithKline, Roche, and Novartis. The Mexican National Comorbidity Survey is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the Pan American Health Organization. Te Rau Hinengaro: The New Zealand Mental Health Survey is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Nigerian Survey of Mental Health and Well-Being is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Romania WMH study projects "Policies in Mental Health Area" and "National Study Regarding Mental Health and Services Use" were carried out by the National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics–National Centre for Training in Statistics. Cheyenne Services SRL and Statistics Netherlands were funded by the Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The South Africa Stress and Health Study is supported by the NIMH (R01-MH059575) and the National Institute of Drug Abuse (NIDA) with supplemental funding from the South African Department of Health and the University of Michigan. The Ukraine Comorbid Mental Disorders During Periods of Social Disruption study is funded by the NIMH (R01-MH61905). The US National Comorbidity Survey Replication is supported by the NIMH (U01-MH60220) with supplemental support from the NIDA, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (grant 044708), and the John W. Alden Trust.
Acknowledgments: These surveys are carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. The authors thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis.
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text:
Having escaped the Nazis, Otto and Leni return to Germany on a secret mission: to rescue a mysterious young girl and bring her to Switzerland. Historical note.
Hitler's SecretBook Verdict
ISBN: 9780545496469 Format: Print Book Edition: Hardcover edition Publisher: Chicken House Page Count: 352 Trim Size: 5 1/2" x 8 1/4" Dewey Classification: F Accelerated Reader: Level: 5.1, Points: 10 Scholastic Reading Counts: Level: 4.5, Points: 17 Lexile: Level: 730L Genre: Fic
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subset: commoncrawl


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text:
"I do protest I never injured thee, But love thee better than thou can'st devise"
"Tybalt the reason I have to love thee doth much excuse the appertaining rage" sc 1
"The day is hot, the Capels are abroad, And if we meet we shall not scape a brawl" sc 1
"thou wilt quarrel with a man for cracking nuts" sc 1
"thou art a villain" sc 1
"Boy this shall not excuse the injuries" sc 1
"O calm dishonourable, vile submission"
"Gentlemen for shame forbear this outrage! Tybalt,Mercutio, the prince expressively hath forbid this bandying in Verona streets"
"A plague a'both your houses"
"Ask for me tomorrow and you shall find me a grave man"
" I was hurt under your arm"
"O sweet Juliet thy beauty hath made me effeminate"
"These days black fate on moe days doth depend This but begins woe others must end"
"And fire-ey'd fury be my conduct now"
"O I am fortune's fool!"
"For blood of ours shed blood of Montague"
"And bring in cloudy night immediately Spread thy close curtain, love-performing night"
"Tybalt is gone and Romeo banished"
"Blister'd be thy tongue for such a wish"
"Shall I speak ill of him that is my husband"
"Romeo is banished to speak that word is father, mother,Tybalt,Romeo,Juliet, All slain,all dead 'Romeo is banished'"
"Ill to my edding bed An death, not Romeo, take my maidenhead"
"Ill find Romeo To comfort you, I wot well where he is"
"There is no world without Verona walls"
" then banished is death misterm'd Calling death 'banished' Thou cut'st my head off with a golden axe"
" O rude unthankfullness!"
"Heaven is here where Juliet lives"
"Hadst thou no poison mixed, no sharp-ground knife"
"Art thou a man?"
" I think she will be rul'd in all aspects by me"
"It was the nightingale and not the lark"
"The day is broke, be wary, look about"
"O think'st thou we shall ever meet again?"
" Methinks I see thee now, thou art so low, As one dead in the bottom of a tomb"
"O fortune, fortune"
"Indeed I never shall be satisfied with Romeo til i behold him -dead- is my poor heart, so for a kinsman vex'd"
"Now by Saint Peters church and peter too, He shall not make me there a joyful bride"
"I would the fool were married to her grave"
"Or i will dra thee on a hurdle thither Out you green sickness carrion! out you baggage! you tallow-face"
"My finger itch"
"Ill give you to my friend"
"DO as thou wilt for I have done with thee"
"Ancient damnation O mask wicked fiend... Though and my bosom henceforth shall be twain"
Created by MiniCooper over 4 years ago


text: fff and ffl are tools for searching for files and directories from the Unix shell with more integrated "shell-like" behaviour and simpler syntax than find(1), though find(1) is still used to perform the actual searches. In particular, there is no need to quote wildcards, and searches are case-insensitive. Matching results are shown one per line. fff displays full paths, and ffl relative paths. Detailed find(1) options can be appended to the fff/ffl command line if desired. These utilities are based entirely on shell aliases and functions, so no compliation is required.


text:
Listing Courtesy of @Properties
Listing information
- Beds: 3
- Total Rooms: 7
- Parking Type Description: Attached 3 cars
- Total Square Footage: 2,000 ($164.95 per sq. foot)
- Association Fee: $250
- Middle School: Dundee Middle School
- Style: 2-Story
- Baths: 3 (Full: 2 3/4: 0 1/2: 1 Other: 0)
- Stories: 0
- New Construction: No
- Lot Area: 0.23
- County: Kane
- Elementary School: Dundee Highlands Elementary Scho
- Year Built: 2014
- Status: Active with Contingency
- Fireplaces: 1
- Foreclosure: No
- Lot Size: 80X125
- High School: H D Jacobs High School
- Subdivision: Aspen Hills
Additional Rooms Breakfast Room, Foyer
Age 1-5 Years
Air Conditioning Central Air
Appliances Dishwasher, Disposal, Microwave, Oven/Range
Area Dundee / East Dundee / Sleepy Hollow / West Dundee
Area Amenities Park/Playground
Assessment Includes None
Attic Unfinished
Basement Full
Basement Bathrooms (Y/N) No
Basement Description Unfinished
Built Before 1978 (Y/N) No
Contingency Flag Attorney/Inspection
Dining Room Separate
Disability Access and/or Equipped No
Driveway Asphalt
Electricity Circuit Breakers
Equipment CO Detectors, Fire Sprinklers, Radon Mitigation System(s), Sump Pump
Exterior Building Type Vinyl Siding
Exterior Property Features Patio, Storms/Screens
Foundation Concrete
Garage Details Garage Door Opener(s), Transmitter(s)
Garage On-Site Yes
Garage Ownership Owned
Garage Type Attached
General Information None
Heat/Fuel Forced Air, Gas
Interior Property Features 1st Floor Laundry, Hardwood Floors
Kitchen Type Eating Area-Breakfast Bar, Eating Area-Table Space
Lot Size Less Than .25 Acre
Master Association Fee No
Master Bedroom Bath Full
Other Bedrooms (Below Grade) - 0, HERS Index Score - 59, Model - Cypress, Special Service Area - N, Tax Year - 2015, Total Full/Half Baths - 2.1, Township - Dundee
Ownership Fee Simple w/ HO Assn.
Parking Garage
Possession Closing
Property Type Detached Single
Recent Rehab (Y/N) No
Roof Type Asphalt/Glass (Shingles)
Sewer Sewer-Public
Special Assessments N
Style Of House Contemporary
Tax Exemptions None
Type Detached 2 Stories
Virtual Tour None
Water Public
Waterfront (Y/N) No
Bedroom 2 Main Level 12X12
Bedroom 3 Main Level 17X12
Breakfast Rm Main Level 11X8
Dining Room Main Level 14X11
Family Room Main Level 18X15
Foyer Main Level 10X6
Kitchen Main Level 16X12
Laundry Room Main Level 6X6
Master Bedroom Main Level 17X16
Listing Courtesy of @Properties


text:
It is a standard result that the eigenvalues associated with the equation $\nabla ^{2}\psi $ + {$\lambda $ - q(r)} $\psi $ = 0, where q(r) is a function of r only, and tends to infinity as r $\rightarrow \infty $, are the roots of equations of the form $\int_{R_{1}}^{R_{2}}\left\{\lambda -q(r)-\frac{(l+\frac{1}{2})^{2}}{r^{2}}\right\}^{\frac{1}{2}}$ dr = (m + $\frac{1}{2}$) $\pi $ + $\epsilon _{m}$, where l and m are integers, and $\epsilon _{m}$ is small when m is large. It has recently been proved that they are also the roots of equations of the form $\int_{0}^{p}$ {$\lambda $ - q(r)}$^{\frac{1}{2}}$ dr = ($\frac{1}{2}$l+m + $\frac{3}{4}$) $\pi $ + $\eta _{m}$, where $\eta _{m}$ is also small when m is large. By a direct comparison of the integrals involved, this paper shows the two expressions to be consistent.
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text:
199 George Street Sydney NSW 2000 Australia
Location Stunningly situated overlooking Sydney Harbour in the historic Rocks district, a short walk from the city's shopping and business centres, the hotel is vibrant and elegant, with dramatic harbour-front views. Facilities The hotel comprises a total of 531 rooms. Most of the storeys can be reached by lift. Wireless internet access in public areas allows guests to stay connected. The hotel's culinary facilities include a restaurant, a dining area, a café and a bar. Those arriving in their own vehicles can leave them in the car park of the accommodation. Additional services include room service and a laundry service. Rooms The establishment features rooms with air conditioning, central heating and a bathroom. A safe and a minibar are also available. A mini fridge and a tea/coffee station ensure a comfortable stay. Other features include internet access, a telephone, a TV, a radio, a DVD player and WiFi. A shower and a bathtub can be found in the bathrooms. A hairdryer and bathrobes are provided for everyday use. Sports/Entertainment The hotel offers a pool and an outdoor pool. Sun loungers on the sun terrace offer an inviting place to relax. The hot tub is the perfect place to relax. Travellers can enjoy a range of refreshing drinks at the poolside bar. Leisure options at the accommodation include a gym, a spa, a sauna and steam bath, or for a fee, massage treatments. Meals It is possible to order breakfast.


text:
Apparel Accessories
Fisherbrand Stainless-Steel Hangers
No-fall hangers designed for use on wall and floor mounted garment racks
Salisbury™ Back Packs
Designed to hold virtually everything from tools to full Personal Protective Equipment (PPE) kits
Brady™ PRINZING™ Shoe Cover Dispenser
Remind employees to wear foot protection by mounting shoe cover dispensers near all hazardous work areas. The Brady™ PRINZING™ Shoe Cover Dispenser features "SHOE COVERS" printed on the front for easy use, and can hold up to 50 covers. Covers are dispensed through an opening in the front.
S-Curve™ Bulk Dispensers
Freestanding units hold everything from bouffant caps to shoe covers— each in its own compartment
S-Curve™ Bulk Apparel Dispensers
Frocks, coveralls, smocks, and aprons stay clean, neatly organized, and accessible
S-Curve™ BD-800 Bouffant Dispenser with Lid
Useful for dispensing bulk supplies such as bouffants and beard covers
S-Curve™ Bulk Dispenser with Open Top
Multiple use compartmental dispensers ideal for gloves, face masks, hair nets, bouffants, shoe covers
S-Curve™ X-Large 3 Compartment Dispensers with Open Tray for Access
Hold and dispense large quantities of gloves with easy access front trays


text:
Adoption requests → One Outs wiki
What is your username? Zangetsukakashi
Please link to the wiki here: http://oneouts.wikia.com/wiki/One_Outs_Wiki
How many edits have you made on that wiki? 145
How many days/months have you been editing there? 2 days
On the Special Pages → Special:ListUsers when was the last time an admin edited, and who was it? May 1, 2011 / ThereIsNoBreakfast
Any other information: The wiki is nearly dead, and I'm really loving this series and want it to grow. I know I've only been there for 2 days, but I have a lot I wanna do.
Zangetsukakashi 13:52, September 28, 2013 (UTC)


text:
Double click anywhe FLIPPED characters smart Juli Bryce opinionated Story Plot Bryce moves across
the street from Juli. Juli falls in love with
his blue eyes, and that's
just the start... Throughout the story
the characters go through alot
of adventures. And, the next chapter
is Juli's side. One chapter is based
on Bryce's side of the
story. The events are based on
real life situations. So it's easy to
relate to. Overall,
it was a really great story!!! By:
Carson outgoing
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Book we read in class
Carson Hulseyon 21 September 2010
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text:
As one of the largest vehicles in the range, the new Nissan X-Trail is always ready for your next adventure. The new-generation model has been highly anticipated by drivers across the UK, and can be experienced now.
The X-Trail is rugged, sculpted and poised for action. Roof rails and the higher ground clearance indicate this purposeful image, and LED signature daytime running lights lend the front face more vibrancy.
This high level of practicality continues on the inside, where supportive seats are surrounded by front and rear armrests, full electric windows and the Luggage Board System with 18 configurations. All of those features are standard at the entry level Acenta equipment grade. Dual-zone air conditioning arrives with Visia, n-tec adds one-touch engine and tailgate buttons, and Tekna is the top-end variant with leather upholstery and front heated seats.
On the road, you will make full use of Nissan's 128bhp diesel engine. It can be configured to power the X-Trail in two-wheel or all-wheel drive, partnered to a six-speed manual gearbox or seamless XTronic transmission. The vehicle's highest potential fuel economy is 57.6mpg combined – an impressive figure given its dominant stance. The X-Trail can also tow a braked weight of two tonnes, wade through 35cm of water and handle approach and departure angles of 18.1 degrees and 26.5 degrees respectively.
Intelligent systems are at your beck and call in every motoring situation. The crossover's in-built technologies include Bluetooth® connectivity and remote control of the four-speaker audio system. Infotainment and journey data are displayed on a high definition five-inch TFT colour screen, presenting information clearly without distraction from your surroundings.
The new X-Trail has claimed five stars for safety in Euro NCAP testing following tightening of the independent tester's criteria. Such an impeccable level of protection should give you complete confidence on every drive. Multiple braking assistances include ABS and Electronic Brakeforce Distribution, and six airbags are fitted around the cabin to comprehensively guard all occupants.
Be noticed with the X-Trail's LED Daytime Running Lights.
Add style to your SUV with 19" alloy wheels.
Signature LED rear lights flow elegantly into sculpted wings.
Nissan's engineers took inspiration from space exploration – with astronauts floating weightlessly in a relaxed 'neutral' posture – when they designed the X-Trail's front seats. The result is seating that reduces fatigue and keeps you comfortably alert, even on the longest journeys.
Do you need a large family car, or do you regularly carry extra passengers? Maybe you need more space for bulky cargo? In optional 7 seater form the Nissan X-Trail's 50:50 folding third row seats makes space for more people. You can also fold flat to create room for even the bulkiest items.
The X-Trail's Power Panoramic Moonroof lets everyone enjoy uninterrupted views of the sky and stars. Of course, it's just as effective in the day time, flooding the cabin with light and creating a greater sense of space.
Additional to Visia grade:
Additional to Acenta grade:
Additional to n-tec grade:
*From prices may differ. Please consult our sales executives for latest from prices.*For terms and conditions relating to Nissan technologies please click here.
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text:
John Betts - Fine Minerals > Home Page > Minerals For Sale > Minerals from European Countries > Carbonate Minerals
This mineral specimen of Siderite on Ferberite with Muscovite and Pyrite from Panasqueira Mine, Barroca Grande, 21 km. west of Fundao, Castelo Branco, Portugal is available for sale from John Betts - Fine Minerals, mineral dealer located in New York City, New York.Follow on Facebook
To purchase mineral specimens from this site go to:
Detailed information on mineral specimen No. 70506:
|Minerals Species: Siderite on Ferberite with Muscovite and
Location of mineral deposit: Panasqueira Mine, Barroca Grande, 21 km. west of Fundao, Castelo Branco, Portugal.
Description: Floater specimen, fully crystallized on all surfaces with no attachment point, of translucent tan siderite crystals to 22 mm with yellow-metallic pyrite microcrystals on prismatic black ferberite crystals to 65 with bladed muscovite to 2 mm. No damage.
Overall size of mineral specimen: 7.5x5x4.5 cm.
Size of individual crystals: micro to 65 mm
Price: $95 (plus shipping).
Click here to see more Crystallized Pyrite For Sale
Click here to see more Ferberite-Huebnerite For Sale.
Cabinet-sized Specimen
See more similar minerals:
See more minerals from:
© 27 August 2016 John Betts -
Fine Minerals, New York , NY - All
Rights Reserved.
The minerals illustrated on this site were purchased from collectors or wholesale suppliers for resale purposes. The owner of this site did not collect the minerals and collectors should not assume access is permitted to the property based on inclusion in this site. Please contact the property owner to obtain legal permission before entering private property.


text:
Mon-Fri 9am-6pm EST(302) 265-3830
|San Lucas - Harness Living Room Set SKU: 83702-SLR-SET
|Buy in Set and Save $70.00
|Product Name
San Lucas - Harness Sofa
Floor to top of arm 29"
Inside Arm to Inside Arm 68"
Leg Height 3"
Seat Depth 21.5"
Seat Height- floor to top of cushion 21.5"
Seat to top back 21.5"
|127.0 lb
Note: Some Assembly May be Required.
Hello Laura, Thank you for your inquiry. This item is 68" from the inside of one arm to the inside of the other arm.
This product has not been reviewed. You could write the first review.Read All Customer Reviews
Manufacturers Part #: 8370238
Brand: Signature Design by Ashley
Category: Sofas
Style: Contemporary
Customer Sales Rating: 5
Manufacturer: Ashley Furniture
Availability: Usually In Stock
Ships Within 1-4 Weeks
Product Condition: New Product
Please Note: Sizes and weights are approximate and may vary slightly from the ones given above. Due to differences in monitors, we cannot be responsible for variations in color between the actual item and your screen. Please be advised that we display the standard shape and(or) size in some cases; the shapes, sizes, patterns and colors may vary.


text:
Faculty Studentship Information
If you receive an offer of a place, your college will require you to complete a Financial Declaration form. This aims to ensure that you are fully aware of the expected fees and living costs associated with your chosen programme of study. For full details of fees please see here.
To be considered for University or Faculty studentships you must apply through the university admissions process by the January deadline of 12 noon (midday) on 20 January 2017.
The Faculty and University have a number of studentships available to fund graduate study in English. In recent years about 11 studentships a year have been offered to study on our master's programmes, and about 15 studentships a year to study on our doctoral programme. Most of these are offered to UK or EU students, but two or three studentships on both the master's programme and the doctoral programme (four to six in total) are awarded to overseas students.
The AHRC grant application process (open to UK/ EU students only) is managed by the University, so there is no need for a separate application to the AHRC. The Humanities Division has a block grant allocation of 40 doctoral and 10 master's awards from the AHRC. English also nominates candidates each year for Clarendon Scholarships (open to UK/ EU and Overseas students). Here too application is made through the central admissions process, and there is no need to submit any further information. The Humanities Division offers around 35 Clarendon scholarships a year. Smaller numbers of other scholarships are also offered. All eligible candidates are automatically considered for these scholarships.
The Faculty also offers studentships in partnership with some colleges, and makes recommendations for a number of trust-funded studentships, managed by other committees and Boards. All eligible candidates are automatically considered for these studentships, which are open to UK/ EU students only. They include:
Jesus College - Faculty of English studentship
Open to applicants for the DPhil programme, working on any aspect of pre-1800 literature.
Jesus College - Faculty of English studentship
Open to applicants for the MSt 650-1550, 1550-1700 and 1700-1830.
Jeremy Griffiths Studentship
Available to candidates studying a subject related to the History of the Book before 1550 (held at St Hilda's College). Open to applicants for the MSt 650-1550 and MPhil (Medieval Studies).
Cecily Clark Studentship
Available to students of English Medieval Studies, with a preference for subjects relating to Middle English Philology.
Violet Vaughan Morgan Studentship – available to candidates studying on any of the English MSt strands.
For the following studentships, candidates should check the criteria relating to each award as some may have particular application requirements:
Ertegun Postgraduate Scholarships in the Humanities
Available to UK, EU and overseas students applying for entry to master's and doctoral programmes. Please see the programme website.
St Cross College
St Cross College will be offering two MPhil scholarships in the Humanitiesand Social Sciences for entry in the academic year 2017-2018. Please see here for further details.
Exeter College
Exeter College will be offering a Bornhauser Scholarship in American Literature to study on our doctoral programme. Please see here for further details.
Somerville College
Somerville College will be offering a Thatcher Scholarship to study on one of our master's programmes or our doctoral programme (open to UK, EU, and overseas students). Please see here for further details.
For further information about funding, please see here.


text:
2012-11-05 11:31:39 | news Trends content provider CDN
2013 trends in CDN
Jet-Stream analyzed the current CDN space and is sharing new insights in this article:
2013, trends in CDN
The article covers:
- Traditional Internet CDNs focussing away from video
- Telcos focussing on cloud based infrastructures
- Content Providers CDN
- QoS versus QoE
- And many other insights. Click below for the article!
2012-06-05 17:51:39 | content provider CDN
Content Publishers CDN
Today, Netflix announced OpenConnect, a way for Internet Access providers to extend Netflix own CDN:
This is very much in line with the trend that Jet-Stream predicted: Content Publishers want to be in full control of their workflow chain, right down to delivery and deploy their own CDNs: cutting out the man in the middle: the Internet CDNs!


text:
Customer Testimonial
We recently had to transfer hosting as the previous host was causing a lot of problems to the business. Since making the decision to move to Tsohost this side of the business has been nothing but plain sailing! We can't recommend Tsohost enough - everything has been simple to implement and their tech support is fast and efficient.


text:
Built in 2005, this fully air conditioned hotel has 57 rooms on 3 floors and is open all year round. The hotel with its peaceful location, attention to detail and comfortable rooms allows guests to spend a pleasant holiday in the area. Facilities available for guests include an entrance hall with 24-hour reception, hotel safe, lift access, caf�, bar, restaurant and parking. For a fee guests can make use of the hotel's laundry and room services.
The hotel is located in Murta Maria. It is just 19 km from Olbia airport and the city centre where public transport connections can be found. The beautiful beach of Marina Maria is just 10 minutes by foot and the enchanting beach of Porto Istana is also nearby.
The rooms are elegantly furnished in modern style and equipped with facilities to ensure guests' comfort. These facilities include bathroom with shower, hairdryer, direct dial telephone, individually regulated air conditioning and heating, satellite-TV, safe and minibar. The rooms all feature double beds and some of them have a balcony or patio with a sea view;
The hotel has an outdoor swimming pool with children's pool. There is a poolside snackbar, sun loungers and parasols. For a fee guests can take part in activities including diving, windsurfing, sailing, canoeing and peddle boating.
The hotel restaurant, located on the ground floor, offers a continental buffet breakfast and both a lunch and dinner menu. The main restaurant ""Caffetteria della Nonna"" is located near the hotel and is also open to the public, it offers the choice of an ""� la carte"" menu and wide variety of traditional and international cuisine.
The hotel accepts American Express, VISA, MasterCard and JCB.
Room Facilities:
Direct dial telephone
Satellite cable TV
Internet access
Double bed
King size bed
Central airconditioned
Central heating
Wheelchair accessible
Disabled bathroom


text:
Almost a century after the signing of the Treaty of Versailles, Kaiser Wilhelm II is still viewed as either a warmonger or a madman, as the hundred-year-old propaganda posters remain fixed in the general consciousness. Was he, though, truly responsible for the catastrophe of the First World War, or was he in fact a convenient scapegoat, blamed for a conflict which he desperately tried to avoid?
©2015 Christina Croft (P)2017 Christina Croft
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text: Dandies from around the worldUpdated 10:55 PM ET, Wed November 30, 2016 Chat with us in Facebook Messenger. Find out what's happening in the world as it unfolds. Photos: Dandies from around the worldKatsuhiko Shimaji in Tokyo – Essayist, barman and former editor-in-chief of Japanese Playboy magazine Katsuhiko Shimaji is photographed here in his home in Tokyo, surrounded by his whiskey collection.Hide Caption 1 of 11 Photos: Dandies from around the worldLourens Gebhardt, Samkelo Boyde, Ntabiso Sojane, Mpumelelo Sojane and Tony Maake in Johannesburg, South Africa – Writer Nathaniel Adams and photographer Rose Callahan have released "We Are Dandy: The Elegant Gentleman around the World." Hide Caption 2 of 11 Photos: Dandies from around the worldBaron Ambrosia in New York City – Baron Ambrosia (born Justin Fornal) hosts The Bronx Pipe Smoking Society Small Game Dinner, among other endeavors.Hide Caption 3 of 11 Photos: Dandies from around the worldGian Maurizio Fercioni in Milan, Italy – Adams and Callahan profiled men from more than a dozen countries. Here, tattoo artist and set and costume designer Gian Maurizio Fercioni is photographed in his home in Milan."Elegance is like spaghetti." he told Adams. "Spaghetti pomodoro is simple. But if you make it with the best ingredients it becomes elegant."Hide Caption 4 of 11 Photos: Dandies from around the worldTakanori Nakamura in New York City – Takanori Nakamura is a journalist and television host with a penchant for cigars, kendo and bonsai. He's also chairman of the Japanese branch of the World's 50 Best Restaurants committee, and a goodwill ambassador between Norway and Japan.Hide Caption 5 of 11 Photos: Dandies from around the worldYoshio Suyama in Toronto, Canada – At 18, Yoshio Suyama moved from his village to Tokyo to study barbering. Becoming licensed can take three to 10 years of training.Hide Caption 6 of 11 Photos: Dandies from around the worldLuca Lanzoni near Milan, Italy – Initially inspired by menswear in London, Luca Lanzoni was hesitant to to adopt a dandyish look back in Italy. "Italy is damned closed," he tells Adams in the book. "We're not open-minded. Italian menswear is the best in the world, but only if you dress in the classic way."Hide Caption 7 of 11 Photos: Dandies from around the worldAymeric Bergada Du Cadet in Paris – A great celebrator of excess, Aymeric Bergada Du Cadet is an art director living in Paris. "It's not so much about 'too much' as it is about intention." he declares in the book. "The advantage of this type of clothing is that even if the city is ugly, you don't notice it."Hide Caption 8 of 11 Photos: Dandies from around the worldShaun Gordon in London – Tie designer Shaun Gordon became hooked on menswear in college, when he cut off his dreadlocks and sold his casual clothing to make way for a new dandyish wardrobe. "The reason I hadn't dressed smart or had a mustache was because I didn't have the confidence," he tells Adams. "Now I'm just going to exist and if you love me, great, and if you hate me, fine."Hide Caption 9 of 11 Photos: Dandies from around the worldDefustel Ndjoko in New York City – Dandies are men who place particular importance on their physical appearance and clothing. Hide Caption 10 of 11 Photos: Dandies from around the world"We Are Dandy: The Elegant Gentleman around the World," published by Gestalten, is out now. Hide Caption 11 of 11More from Fashion2018 Pirelli calendar features all-black cast in 'Alice'-inspired shootMen's Fashion Week: Designers step into a strange new worldEpisode 15: How sport is redefining styleParis Couture Week: Why fashion's most exclusive event is opening up Celine Dion bares all for Vogue


text:
Criminal Law
Criminal Law Questions? Ask a Criminal Lawyer.
i am in Columbus, Ohio. The judge just said he would not expunge it. I did not have an attorney, and went to court myself. I work for a bank in mortgages, and have since then , 2008, i have been promoted and use FHA, and FHA is doing another background check. I do not want to loose my job. I had an attorney to represent me for the felony charge, and he said i should not have gotten charged, but i did.
I appreciate your time and any assistance!
I appreciate this information, and I have called an attorney, they are charging aprox $2500 to begin, does this sound reasonable, and is there some way to have a reduced cost?


text:
The banking system had collapsed and there had been riots on the streets when the parents of a young child decided to return to their homeland.
Stéphane Sessègnon was four, and Benin, where they had come to work and build a new life, was no longer stable. The infant mortality rate for children under the age of five was among the highest in the world. Less than a third had access to health care. Sessègnon, along with his two brothers and two sisters, headed for Ivory Coast, but it says much for the quiet determination – and he is at times painfully shy – that he now sits, as he tentatively admits, as the most high-profile sportsman from the country of his birth.
Given a different personality, he would be emerging as Didier Drogba has in the country where he lived for the following 12 years, or like George Weah, a footballer who stood for the presidency, in Liberia.
Yet it is only towards the end of an hour's worth of questioning that the Sunderland forward, who after 20 months in England, is not comfortable enough to be interviewed in English, that the strength of feeling for the country of his birth becomes apparent.
"No, no," he insists, animatedly, "politics is not for me. I am not Drogba. I understand the responsibility with what I have as the captain of Benin. I might be the most famous footballer from Benin.
"There is lots of responsibility which comes with it, especially being captain of the national team. It's really important for me to show a good image. The role is to inspire people. Football is a really good way to get to know the country. It gives me a lot of honour and a lot of pleasure.
"It's never easy, the infant mortality rate is high there. We are all affected by that. It is a very small country and it maybe doesn't have all the riches that it needed to support its population but when you are there it can be touching.
"I'm definitely at home there. I spend more time in Benin than I do in Ivory Coast. I know a lot of people there, people who helped me to become what I am today, people who shaped me, so it's always fabulous to return there and especially to play for the national team.
"There has been a lot of changes politically and elsewhere, even compared to five years ago there is more stability. Before there was a coup d'état and it is working towards finding stability. It is a dream of the whole population to find that.
"One of the big problems in African countries is the finance. I believe as long as there is peace it is the most important thing."
That is relative, given the instability in Benin, where they have lived under both Islam and Christianity, control from the state and only since 2006 have there been fair and free elections.
At four he left. At seven he decided to become a footballer, and at 16 he had to return so that he would be eligible to go to Belgium (he played in the Benin Premier League for a season with Requins de L'Atlantique). "I was not scared," he says. "It is the dream of all African players to come to play in Europe. It allowed me to live a dream I have had since I was very little. It was more joy than fear."
From there the gates to Europe opened, first in the suburbs of Paris with Créteil-Lusitanos, then Le Mans and finally, in 2008, with the move he had craved since childhood, when Paris St-Germain took an interest, as, curiously, did Arsenal and Newcastle United, the latter of which he confirms.
"I had lots of opportunities," he says. "Yes, Newcastle were interested but it was really important for me to play in Paris. I had supported them since I was little. It was a chance to show myself. I had great years there. I was satisfied. The highlight was probably winning the French Cup. That was the happiest time I had in France."
He cost PSG €10m, but a fallout with Antoine Kombouaré, the new coach, before a game against Nancy, alerted Steve Bruce. For £6.7m Sessègnon, largely unheard of to supporters in England, moved to Sunderland in January 2011, something his family, initially did not do.
"It was the tirelessness and willingness of the people at Sunderland to get me that played a big part in my decision to come here," he adds. "It is true I had a couple of difficult months when I first arrived but I was getting used to my environment.
"People speculated that I didn't want to stay. It was of course frustrating, it was not coming from me. I felt very good here. Maybe it was because my family wasn't here at the time but I still felt really good here. It was nonsense.
"It wasn't easy when I first came here, of course. It was a culture change. The first month was actually quite difficult, but there is a family bond here, they helped me settle. I already knew some of the players from the French league, after that it is football, football, that is the most important thing. Everything else is secondary.
"My whole family is here now so I am more busy! I have boys who are a little bit grown up now and they are as hectic as I am in their way of life. It is great spending more time with them, it is a really important thing for me. I have an eight-year-old, two five-year-olds, a three-year-old and a two-year-old. I get some sleep."
In here is the story of a footballer different to anything else Sunderland may have had in their modern history. His creative spark helped keep the club in the Premier League last season. He signed a new contract to end continued speculation that he would leave. At £6.7m he looks good business. This season he has started the campaign slowly – he blames injury and playing for his country in the summer – and Sunderland have by coincidence failed to find their rhythm fully, although the defeat against the Premier League champions, Manchester City, in their last game was their first.
"I can feel big expectation from the fans on me," he adds. "That is logical, they expect me to perform. The fans here are almost more enthusiastic than the players themselves.
"I am a creative type of player, the passion is a positive thing, it makes me want to go higher and in search to be better, to produce more, I want to be more excellent for them. It is a good thing. My relationship with the supporters here was one of the factors that made me renew my contract.
"I get on really well with the coach. I am quite a timid person naturally so I'm not always in conversation with him but the support by the other players has really made me feel at home here, even when my family wasn't here. They were a big support for me.
"We all know the importance of the game between Newcastle and Sunderland [on Sunday] and the challenge they represent and the pressure which comes for those games, but it is a pleasure to experience it, that is what you play the game for. I have a bad memory of the last time we met [he was sent off when his arm struck Cheick Tioté]. I would like to put things right."Reuse content