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Dual Diagnosis in Treatment
- Gavin Flynn
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1 Dual Diagnosis in Treatment Presented by: Dr. John E. Simon Psychiatrist, Vinland Center 1
2 John E. Simon, M.D. President, Creative Psychopharmacology Board Certified in Psychiatry Added Qualifications in Geriatric Psychiatry, Added qualifications in Addiction Psychiatry, Distinguished Fellow, A.P.A. Consulting Psychiatrist, Vinland National Center Hospital care of patients at U of MN Fairview, and Meeker Memorial Hospital (in Litchfield, MN). Medical Director, Behavioral Healthcare Providers Associate Medical Director for Behavioral, PreferredOne Consultant at the St. Croix Health Center, New Richmond, WI Other way fun jobs 2
3 Disclosures Previously on Speaker s Bureaus for: Forest (Viibryd) AstraZeneca (Seroquel XR) Lilly (Cymbalta, Zyprexa, Differential Diagnosis) Phizer (Pristiq) I will be mentioning off label uses of medications. I have still not friended any Pharmaceutical companies on Facebook 3
4 Dual Diagnosis: Traditionally, the co morbidity of psychiatric illness and chemical dependency. The term is a holdover from a time when Psychiatric diagnosis was less well understood. In reality, it is rare for a person to have just one psychiatric diagnosis. Chemical dependency, as an isolated illness, may be the minority of cases. We usually work with the combination of psychiatric illness, chemical dependency, and brain injury. And so do you. 4
5 Dual Diagnosis Historically there has been a tension between the Addiction/Recovery community and the Psychiatric community When AA was founded in 1935, the main psychiatric medications available were barbiturates and narcotics, both habit forming. Stimulants were developed in the 1930s as well. The AA community had a mistrust of the psychiatric profession, whose prescribers would provide addictive substances, and the Psychiatric community did not understand addictions. In the past, parts of the AA community would discourage taking any psychiatric medication as a sign of weakness., or equating any psychiatric medication with alcohol. MDs still prescribe controlled substances to people in recovery without awareness of the danger it places patients in. 5
6 Time: Sometimes psychiatric illness develops before addiction Sometimes addiction develops before psychiatric illness Alcohol damage may cause psychosis or dementia Marijuana may accelerate or activate psychosis/schizophrenia in vulnerable youth Meth and other stimulants may induce paranoia and psychosis TBI may worsen psychiatric illness or cause syndromes indistinguishable from psychiatric illness from other causes 6
7 Self Medication Many people start to drink alcohol to lubricate social situations and decrease anxiety or inhibitions in the short term (alcohol to treat anxiety illness). Many people drink alcohol to help insomnia (often from mania, hypomania, anxiety, PTSD, etc.) Once alcoholism develops, it becomes it s own separate problem and needs addressing along with the pre existing psychiatric problem. Treating the psych illness alone is not enough to stop the alcoholism!! 7
8 Co Morbidity: About 60% of individuals with Bipolar illness have substance use disorders About 50% of individuals with Schizophrenia have chemical dependency Up to 40 % of individuals with ADHD have alcohol problems (one study found that about 25% of adults in alcohol treatment met criteria for ADHD). About 30% of individuals with depression have alcohol problems One study found that almost one half of adults in CD treatment med criteria for GAD 8
9 Bipolar Illness and Chemical Dependency When you are depressed, it is hard to care about sobriety and the things you value, including using your higher power When you are manic and grandiose, it is hard to believe that first step powerlessness actually applies to you. It is also hard to be sober with the increased impulsiveness of mania. Recovering from a bipolar episode involves rebuilding a life, including sobriety Treatment involves treating BOTH at once 9
10 Bipolar Illness and Chemical Dependency Treatment: Similar to treatment of bipolar illness alone; avoid benzos, Be careful of liver effects of Valporic acid 10
11 Anxiety and Chemical Dependency Chemical use can trigger anxiety Anxiety can lead to chemical dependency Treatment involves chemical dependency treatment plus psychotherapy, and/or meds Medications to consider are Antidepressants that affect Serotonin, and Buspar, Gabapentin, Guanfacine, Propanolol 11
12 Schizophrenia and Chemical dependency Almost one half of individuals with Schizophrenia have chemical dependency. The rate of Hepatitis C in Schizophrenia is 7 times the rate in the general population. Marijuana may activate the genes for Schizophrenia and worsen symptoms. Alcohol use over time may add to the cognitive aspects of Schizophrenia. Chemical dependency treatment needs to be adjusted to the cognitive and emotional aspects of the individual. 12
13 Depression and Chemical Dependency Alcohol s effects on a life can lead to discouragement and depression. In the short term, alcohol dulls the pain of depression and aids sleep. Depression robs you of your initiative, energy, caring, interest, hope, and motivation (to start with). When you already feel hopeless, why should you care about sobriety or a future that you feel is unobtainable. It is hard to motivate to go to meetings. With luck, you may drink yourself to death. Treatment involves sobriety, psychotherapy, meetings, and antidepressant meds 13
14 Depression and Chemical Dependency If depression symptoms arise in the midst of drinking, they may clear up with sobriety. When to treat? Judgment call treat when the depression interferes with the ability to use the program I obtain a history of mood illness and chemical use timelines to try to tease out how much depression will remain after sobriety is achieved 14
15 PTSD and Chemical Dependency Psychotherapy is the most useful therapy Alpha Blockers may be helpful for nightmares, flashbacks, intrusiveness; Tenex (Guanfacine) Minipress (Prazosin) Catapres (Clonidine) 15
16 TBI and Chemical Dependency TBI is a common result of chemical dependency TBI is a common result of the psychiatric illnesses that are co morbid with chemical dependency If you treat chemical dependency, you will meet people with TBI 16
17 TBI: In medical school, I was taught that head injury was the occupational hazard of the alcoholic. Head injury is more common in the psychiatric conditions that are more likely to be associated with impulsiveness; ADHD and Bipolar illness TBI may cause or mimic psychiatric illness TBI complicates the treatment of other problems 17
18 Effects of TBI Common effects of TBI include short term memory problems, fatigue, irritability, physical weakness or disability, chronic pain, inattention, impulsiveness, and the continued effects of any pre existing psychiatric illness (ie, ADHD). Chemical dependency treatment needs to be performed while addressing the underlying psychiatric illnesses and needs to be adjusted to the individual strengths and weaknesses of the individual person. Neuropsych testing can help define a person s strengths or weaknesses in learning (verbal or written). Use of a notebook, or other memory aids can be helpful. 18
19 Effects of TBI The brain heals If we stop insulting the brain, functioning will improve. There is hope. Symptomatic treatments may help; gabapentin for irritability, melatonin for sleep, gabapentin for pain, buspirone or gabapentin or guanfacine for anxiety. NO BENZOS! Caution with Neuroleptics! 19
20 TBI: TBI may make you more likely to experience medication side effects: Confusion EPSE Tardive Dyskinesia Balance Seizures 20
21 Treatment of TBI Symptomatic treatment of the syndrome observed Treat impulsiveness with antianxiety meds, Gabapentin, Buspar, Tenex Treat depression with antidepressants, low dose Treat or attempt to treat memory with cognitive enhancers Articles support the use of both cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda) in helping recovery of memory in brain injury. This is way controversial 21
22 Alcohol Induced Dementia The brain heals If we stop insulting the brain, functioning will improve. There is hope. I recommend Thiamine Memantine (Namenda), Acamprosate (Campral), or Cholinesterase Inhibitors may help cognitions. This is outside of FDA approval 22
23 ADHD and Chemical Dependency Most experts that I could review in ADHD treatment feel that the chances of recovery in addiction are better if the ADHD is treated to reduce impulsiveness and improve concentration and thinking. Individuals with ADHD alone do not usually abuse their stimulants* and people who are treated for ADHD are not more likely to develop addiction. ADHD impulsiveness contributes to relapse. *People with ADHD may be tempted to sell their stimulants to non ADHD peers in treatment for money, sex, or other drugs. At Vinland, we test the urine of people taking stimulants to check for compliance and we are distressed by negative screens for stimulants. 23
24 ADHD and Chemical Dependency: Treatment This is a controversial topic; many treatment centers do not allow stimulants. In their defense, these centers realize that the stimulants can be disruptive as non ADHD addicts are driven to obtain these chemicals. Addicts with ADHD do better if the ADHD is treated. If stimulants (Meth) are the drug of choice, this is a complex issue with no one right answer. Many people preclude the use of stimulants for ADHD treatment by their chemical use. People lie to obtain their drugs of choice because the drive to continue tickling the brain s reward center is strong. 24
25 ADHD and Chemical Dependency: Treatment Pharmacological treatment of Attention Deficient consists of four main options: Strattera Vyvanse dextroamphetamine (Dexedrine, Adderal) Methylphenidate (Ritalin, Focalin) 25
26 ADHD and Chemical Dependency: Treatment Methamphetamine causes Dopamine release from the neuron, and reverses the Dopamine re uptake transporter, flooding the synapse with Dopamine Strattera blocks the re uptake of Norepinephrine Vyvanse is a pro drug, metabolized into Dextroamphetamine by the liver Adderal increases Dopamine and Norepinephrine release from the neuron, and blocks the reuptake of these monoamines Methylphenidate (Ritalen, etc.) blocks the re uptake of Dopamine and Norepinephrine, acts mainly in the pre frontal cortex. 26
27 ADHD and Chemical Dependency: Treatment Adderal and similar amphetamines are closer in mechanism of action to Meth, but is more effective in general for ADHD Ritalin is less similar to Meth, but can have more side effects 27
28 ADHD and Chemical Dependency: Treatment General Approach: Consider if you really need to treat. Smart people disagree on this approach to ADHD. Start with Strattera (Atomoxetine) Consider Vyvanse next Consider Methylphenidate first, then consider Dextroamphetamine or Adderal 28
29 Dual Diagnosis: Summary Chemical dependency is often accompanied by one (or usually) more psychiatric illnesses and brain injury All of these need to be addressed to maximize chances of recovery The better you think or function, the better you can utilize a recovery program. If you know a separate psychiatric illness exists, independent of chemical dependency effects, treat it. If unsure, you can wait until a person is sober for at least 2 weeks and then address psychiatric symptoms (especially if they interfere with CD treatment) When treating psychiatric conditions in people with chemical dependency, avoid benzodiazepines and addicting meds (duh!). Yup, I did discuss prescribing stimulents. 29
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text:
[IMGCAP(1)]Your firm probably has plans in place for nearly any situation, but have you considered what should be done to prepare for, or in case of, an emergency?
What about your clients? How can you help them be prepared, and ultimately show your value as a business partner? There are many types of emergencies to prepare for: natural disasters, and more common ones like theft, fire and data loss. Making sure you are prepared for the worst before it happens can save time, money and frustration in the long run.
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subset: commoncrawl


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With First Tutors: Music you can locate a Bridgend tenor horn tutor. Tenor Horn tuition are the perfect method to learn a stimulating new hobby, pick up a new skill and gain confidence in tenor horn. Please use our service to search for Bridgend tenor horn teachers and determine which suits your needs so you can start your tenor horn lessons in Bridgend immediately!
First Tutors: Music is the best way to find Bridgend tenor horn tutors in the UK, helping you discover Bridgend tenor horn tuition close to you and Bridgend teachers to assist with any instrument such as piano, violin or guitar. We can help you find Bridgend tenor horn lessons or a one-to-one Bridgend tenor horn tutor to prepare for tenor horn exams and develop your tenor horn skills! Our search will order Bridgend tenor horn tutors local to you by their hourly charges and proximity to you.
If you are a tenor horn teacher and would like to offer tenor horn lessons in Bridgend or anywhere else across the UK, please register with First Tutors: Music or learn about us here. Becoming a Bridgend tenor horn tutor is a fantastic way to re-affirm your own knowledge by providing tenor horn lessons while helping someone else, all in your local Bridgend area!


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To obtain books unavaiilable through our library or OhioLINK you must place Interlibrary loan requests online. Please allow yourself plenty of time when placing an ILL request.
Summon is the new database which combines many (but NOT all) of our electronic resources. At this time Summon does not include the Ohiolink catalog. Summon is similar to using Google Scholar. The patron must create a search string which best describes their research focus. If you create too broad a search string you will be will be overwhelmed by the number of citations the database will find. A very narrow search string may frustrate the researcher.
If you find yourself intrigued by the availability of Summon please feel free to use the database and consult with a librarian when you have a question.
Gather a list of useful words or artists names or art movements to begin your research in the CONSORT/Ohiolink catalog and online journal indexes. Books owned by other CONSORT libraries may be requested and will be sent here in 3-4 working days. If you cannot locate materials on your subject or all of the CONSORT copies are checked out, you should search the OhioLINK online card catalog for additional materials. Books, and some bound volumes of journals, may be requested from the Ohiolink catalog using your barcode on the back of your student ID. Note: The public libraries in Ohio also collect art books and these are accessible through 'SearchOhio'. The consortium 'SearchOhio' is a link you may use from the menu bar in Ohiolink.
If you are working on a topic which the library may own a documentary film about it is possible to refine your searches further. From a general search page select the 'limit/sort' or 'modify search' button at the top of the search screen and then click on the relevant search option(s). In most instances do not limit to only DVD format, instead you should select 'either' as this will locate DVD's and 1/2 inch VHS tapes.
© 2015. LBIS, Kenyon College
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Tel: (740) 427-5186


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It's been a while since I wrote to you with my wish list, but what the heck, Christmas isn't just for kids, is it? Of course you already know that I write about Boston, kids, food and travel, so I don't think that I'm that hard to shop for. Just in case you need a hint, here's what I really want for Christmas.
1. An iPad: I really, really want one. I've been good. Promise. I'd love to leave my heavy laptop home on trips.
2. Mini-tripod: One that could be used for my phone and my camera and can be thrown in my purse.
3. Without Reservations: The Travels of an Independent Woman: Just because I want an iPad doesn't mean I'm giving up books. I'd like this one by Pulitzer Prize-winning journalist Alice Steinbach who took an extended leave from her newspaper job to travel around Europe in search of spontaneity. It's been on my to-read list for awhile.
4. Anything from Levenger: This shop's catalog is like porn for writers and travelers and, of course, "serious readers."
5. An intern: Is that weird? I need an intern to help with my various projects, but he or she needs to be organized, smart, motivated and not have to have their hand held.
Am I asking for too much? I'd settle for peace on earth.
Kim Foley MacKinnon


text:
You know what's not cool? Throwing a bunch of firecrackers into a Starbucks and scaring the ever living crap out of the poor people sitting inside the shop. That didn't stop a Japanese guy named Nobu from doing exactly that and then streaming the whole thing online. He even had a friend with him, screaming through a bullhorn to compound the idiocy of it all.
And because committing a crime and streaming it online, with your faces clearly visible, is an act of brilliance, Tantei File is reporting that Nobu decided to turn himself in and his laptop has been confiscated by the police. This idiot also threw firecrackers into a train station and streamed that video, too.
Let's hope the police stop this guy before someone gets hurt.
See the video after the break…
(via Kotaku)


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We are using Spiceworks for a good month now, enjoying its functionality greatly. here is actually only one flaw that keeps bothering us.
I am talking about the fact that e-mails arriving at Spiceworks, create new tickets without Polish national characters. Example:
- Na razie funkcjonuje na starym adresie. Pro¶ba o informacjêa kiedy nast±pi zmiana.
Na razie funkcjonuje na starym adresie. Prośba o informację kiedy
nastąpi zmiana.
When we create tickets from within Spiceworks it works just fine.
Any suggestions?
This topic was created during version 3.5.
The latest version is 7.5.00101.
2 Replies
Feb 9, 2009 at 12:14 UTC
Sorry for the inconvenience! We have a hotfix for this issue. Could you send in a request to email@example.com? We'll be happy to help out!
Feb 24, 2009 at 12:49 UTC
First of all thanks for the support guys! I have done as suggested, sent my request to your support and received a satisfying answer (solution).
Now there appears one thing I ask myself...
What happens when I'll be doing updates using the inbuilt UPDATE function?
Will the .dll file that you sent me for replacement be overwritten?
If so, did you yet implement this fix into your latest release?
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


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Housekeeper in Albany
Cleaning Service personally to you From a light Cleaning to a Deep Cleaning, high low dusting, organizing we can do it all ! Ranging With all different Cleaning products provided by us you will have your apt, house, office, dorm etc cleaned in no Time at all reasonable prices for all kinds of price ranges meeting your needs we will work with you contact us Hurry and get Cleaned & Organized for the SUMMER!
Housekeeper Details
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Basement Clean-Up
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text:
outcome mapping
As funders & commissioners...
right context?
appropriate partners?
administrative procedures?
1. Strategy in Complex Contexts
2. Sphere of
looking at the bigger picture
staying attentive
3. Incremental Change
love to see
like to see
expect to see
progress markers
1. Navigate Complexity
2. Manage Multiple
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Video Wills, Kate & Harry Want A National Conversation On Mental Health
Men are less likely to talk than women with 54% of women having had a conversation compared to 37% of men.
A 29 year old man's been fined 2000 pounds for racially abusing a tube passengerfollowing a British Transport Police (BTP) investigation.
29 year old Jonathan O'Shea, of High Street, Rickmansworth in Hertfordshire, appeared at Hammersmith Magistrates' Court on Wednesday, 30 January.
He committed the offence onboard a Metropolitan line train as it travelled from Baker Street London Underground (LU) station to Eastcote LU station, between 9.10pm and 9.45pm on Wednesday, 11 July 2012.
O'Shea was given a £2,000 fine and was ordered to pay £500 compensation, £650 costs and a £15 victim surcharge after being found guilty of racially aggravated harassment.
The court heard the victim, a 32-year-old woman from Peckham, boarded the westbound train at Baker Street and during the journey heard O'Shea making racist remarks to three women.
The group of women got off the train and O'Shea continued to make racist comments directed towards the victim, before leaving the train at Eastcote station.
O'Shea, an accounts manager, denied the charge but was found guilty on Wednesday, 30 January.
Speaking after the sentencing, PC Andy Burns, the investigating officer, said:
"This was an intimidating experience that left the victim feeling shocked, humiliated and very upset.
"During the journey the victim managed to take a picture of O'Shea on her mobile phone, which we used to identify him on CCTV and track him through the network.
"We take reports of racial abuse extremely seriously and the £2,000 fine shows just how seriously the courts take this sort of behaviour too.
"Anyone who has been a victim of this type of crime should report it to police or Tube staff immediately so that it can be investigated.
"We will do everything we can to identify and arrest offenders."
Men are less likely to talk than women with 54% of women having had a conversation compared to 37% of men.
A career in the media and entertainment industry starts here...
A man has been fined £1,800 for flying drones over Parliament, near Buckingham Palace and over football stadiums.
Government to investigate after some restaurants accused of withholding tips
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text:
After a horrible finale, Walking Dead was at a crossroads. One way led to disappointment and squandered potential, and the other to becoming the show it can be. After one episode that sets up even more craziness to come, this season appears to be headed on the latter path. With much-improved character development, some creative action sequences, a broadened cast, and a superb lead-in to next week, The Walking Dead appears to be headed in the right direction under Scott Gimple's leadership.
While not as crazy as last year's premiere, this episode delivered the goods and was a huge step up in writing quality
The opening scenes of the episode gave us a glimpse of the comfy life the group has been living as of late. The group operates much differently now, but it all makes sense. With so many people to go on runs, Rick can focus on managing the group and securing the prison. The fact that he wasn't carrying his gun was an excellent way of showing a major focus in this episode: the group has gotten too comfortable. Rick didn't even want to take the gun outside the fence, people head off on runs and act like it's a guarantee that they come back, and some children don't understand the danger of walkers. That being said, everyone had fair reason to be in a good mood. Things have been going very well for them, and the opening segments illustrated that in a few ways. First off, there was a lot more joking around than usual. Even on a show as intense as The Walking Dead, a little humor can go a long way, and this episode used it to not only lighten the mood but also establish new characters and show the state of old ones. Rick and Carl joking around clearly showed that they are on good terms now, but did so in a way that didn't feel forced. I'm glad that they didn't force Carl along a Shane-like path, as he really became a likeable character last year. One new character that was made instantly likeable through jokes was Beth's boyfriend. His conversation about Daryl's profession was really funny, yet once again didn't feel too lengthy or forced. One more funny scene was when the Daryl Dixon's biggest fan thanks him. It was an interesting way of showing that not everyone in the group is tight-nit like before because of the increased size, and as a result Daryl is seen as a hero. Plus it was a little jab at the hyper teenaged Daryl fans that only watch the show for him. The thing that all of this proved to me is that the writers seem to have a solid handle on how to introduce and maintain interesting characters. They also showed that they have learned how to juggle multiple characters. With far more people than last year, they have somehow found a way to give these new people spotlight while not forgetting about any of the established characters. That's something to watch going forward, and with an ensemble cast it's absolutely critical.
Balancing primary and secondary characters has been a problem in the show's past, but this episode accomplished it with ease
Humor isn't the only way this episode built up relationships however. Romance was a big item this week, and while most of it worked to perfection, there was one that really felt forced. An example of superb relationship building was with Tyreese and Karen. The introduction of this relationship was very smooth, giving us a quick and concise back-story, some solid acting from Melissa Ponzio and Chad Coleman, and felt like a legitimate conversation that an established couple would have. The Carol and Daryl relationship is one that the show has been slowly building for a while, and that progression continued. Once again, the transition felt logical considering the time gap, and the two appear to be an official "item" at this point. We got the usual dose of Glenn and Maggie of course, including a touching scene in which Glenn tells her not to go on the run (wise choice). We also got some further hints at something forming between Rick and Michonne. The one relationship that wasn't done very well at all, however, was between Beth and her new boyfriend. While it's nice that Beth was given an actually storyline (which had some interesting scenes at the end), their goodbye was poorly executed. For starters, putting it on the heels of every other relationship scene felt ridiculously forced and hollow. The worst thing it did was give the obvious indication that he would die. While his scene with Daryl latter on formed enough of an attachment that I was sad when he died, his moment with Beth gave the biggest hint ever that he would die. Still, the good vs bad ratio on these relationships shows a vast improvement in writing quality.
Relationships played a big part in this episode, and almost all of them felt very natural
Rick's story this week was mostly phenomenal with a few hiccups. Coming in I feared that "farmer Rick" would be completely overdone, but it was a very logical move. This was the happiest we have seen Rick in a long time, but of course it wouldn't last. One of the bigger surprises of the week was that the woman wasn't a zombie. The scenes with her were far more intense than I thought they would be, because she looked absolutely creepy (and crazy). I was just praying that she wouldn't turn around and stab Rick. That's something I already feel changed from last year. There were times in Season 3 where I felt a character was safe, but something in the execution feels more akin to Season 1 in the sense that I don't feel that same sense of security. Once Rick finally saw "Eddie" (kind-of), we were given a horrifying and sad sequence. What I loved most about it, particularly in Andrew Lincoln's performance (no nominations for him yet? seriously?) was that it flawlessly conveyed that it has been a long time since he has seen things like that. That's when it hit me that it really has been 30 days without ANYTHING bad happening, but then along came this starving, crazy woman that he wanted to help out so badly but couldn't. Unfortunately, some of it really felt like retread ground with Rick. He saw what he could have become when he met Morgan, the only difference here is that she had absolutely nothing left of herself while he was able to talk some sense into Morgan. However, it was all worth it to set up Hershel's line about coming back from things we have done. Breaking Bad is really the only show to consistently give metaphors for these kinds of themes, but Scott Gimple's episodes almost always have some, and this was no exception. Bob Stookey going for the cases of alcohol after trying to ignore them (and what happened after) showed that in order to come back and change, you first have to commit to it. He showed that he wasn't ready to give up what was causing him to stumble. That's one thing I really appreciate about The Walking Dead: the deeper meanings and themes present address moral issues and struggles in a way that a lot of show's don't these days.
While some of Rick's story felt retread, it was extremely intense and brought up an excellent moral point
While quite a bit of Rick's sequence was rather tense, that was nothing compared to the store fight. While you can argue that the helicopter should have brought that roof down a long time ago if it was that week, there's no denying the creativity of this zombie sequence. In fact, I would go so far as to say it is one of the most original action sequences the show has ever had. Zombies falling through the floor creates an interesting problem, as well as some creative zombie deaths. I definitely credit the writers and makeup artists for coming up with original zombie looks and deaths that are still shockingly violent. As far as the fighting itself, the tight spacing as well as Bob being stuck under the shelf created a claustrophobic and intense sequence. It's almost impossible to do zombie battles better than this show does. Even with struggles in other areas, that has always been a strength, but it has been improved this year. By making the zombies a bigger threat, they have increased the intensity and fear factor during these fights. This was accomplished in a few ways. First off, the zombies numbers have been greatly increased, and they are more aggressive. Second, they were tougher to kill. In season 3 zombies were dispatched with ease, while this year even the best fighters had a hard time. Also, the group didn't finish off all the zombies and "win" like what happened often last season, but they were forced to run and leave a friend behind to be eaten. Lastly, while his death may have been expected, Beth's boyfriend was a likeable guy, and killing him in the first episode really set a tone, especially because the zombies did it. Tightly directed, expertly written, and well-acted, this action sequence was rather original and extremely intense.
This sequence got real crazy real fast, and showed that not only do they have new action/horror ideas left, but they haven't lost the expertly done intensity because of the character focus
Carl having some new people his age cause some very cool scenes, but more importantly had an unforeseen impact on the future of the series. Seeing him remind them that the infected are dangerous shows that he is seen as the leader of the younger ones, which makes perfect sense. I think that's partly why he showed up at the "story-time": he wanted to set a good example (even though he was late). Speaking of the storytime, Carol's fascinating character development continued this week, as she seemed to be the only one who is thinking of the potential danger. Story-time with a side of knives is a good idea, and something that everyone else is forgetting about. When the one boy pretended to be sick, I thought he was lying to get out of training with the knives, once again showing the fact that these kids don't know the first thing about the world they live in. However, his situation was a tad more serious than that. I didn't quite know how he died, but I believe I've figured it out now. The one pig got sick and died, and what did they have for lunch? That's right: pig. This poor kid's death sets up an absolutely insane episode next week. No one is prepared for this. They've gotten lazy, secure, and content, and some others might be sick as well.
The intensity of this episode was nothing compared to what's coming next week
Some fans will hate this episode for not having enough action. Those people, however, won't realize the huge benefit that this episode will have next episode and beyond. It made you feel for and bond with these new characters, and deaths are sure to come next week and beyond. Character focused episodes are only bad if they are boring due to poor writing, and that wasn't the case this week. In addition, we were given a phenomenal action scene this week, evidencing that this show still have some great ideas left. If this episode is any indication, we are in store for the most well-written season of the series, with plenty of new characters to care for and mourn. After months of nervousness about how this season would turn out after the calamity that was last season's finale, this was a solid start.
- The zombie scene in the store was intense and original, perfect action/horror blend
- It's raining zombies!
- Somehow the writers and makeup artists still come up with new ways to kill zombies
- The character development is the best its ever been on this show
- Zombies are as big of a threat as ever and are much harder to kill
- The tense scenes with the crazy lady
- Perfect balance between giving the spotlight to new and secondary characters as well as series regulars
- While kind of predictable, the writers made us care for Beth's boyfriend and took him from us
- The usual high production values
- If Michonne goes to Macon and we get a crossover with the video game, I'll die a happy man
- Hooray for metaphors!
- Everyone letting their guard down, but paying for it next episode
- Some very believable couples smoothly introduced
- Fantastic moral lesson
- Next week will be absolutely nuts
- Andrew Lincoln continues to be one of the best in the business
- Solid acting all around
- Some of Rick's story was "been there, done that"
- Even though she was finally given an interesting storyline, Beth's relationship felt forced
- While sad, the death of Beth's boyfriend was easy to see coming
OVERALL SCORE: 9.0 out of 10


text:
Preliminary Design of Alborz Tokamak
- First Online:
- 647 Downloads
The Alborz tokamak is a D-shape cross section tokamak that is under construction in Amirkabir University of Technology. The most important part of the tokamak design is the design of TF coils. In this paper a refined design of the TF coil system for the Alborz tokamak is presented. This design is based on cooper cable conductor with 5 cm width and 6 mm thickness. The TF coil system is consist of 16 rectangular shape coils, that makes the magnetic field of 0.7 T at the plasma center. The stored energy in total is 160 kJ, and the power supply used in this system is a capacitor bank with capacity of C = 1.32 mF and Vmax = 14 kV.
KeywordsToroidal field Toroidal coil Aspect ratio Major and minor radius FEM
The tokamak is a toroidal plasma confinement system, the plasma being confined by a magnetic field. The principal magnetic field is the toroidal magnetic field [1]. Alborz tokamak is a D-shape cross section tokamak and the most important part of the design of this tokamak is the design of TF coils and its power supply.
Some tokamaks has circular cross section [2, 3] but many of advanced tokamaks have typically D-shape or non-circular cross section [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19] and some of them has superconducting field coils [12, 13, 14, 15, 16, 17, 18, 19, 20].
In this paper we are present the design of TF coils and give the major parameters of tokamak like major radius, maximum plasma current, number of TF coils, number of total turns and current per turn for a non-circular cross section TF coil. And we assume that some of the parameters like maximum current carrying by the cooper cable, the capacity of the power supply, maximum operational voltage, required safety factor, aspect ratio and the cross section shape of vacuum vessel and the toroidal magnetic field in plasma center, are known.
In addition we must consider about the magnetic field ripple. The magnetic field ripple is inversely proportional to the number of TF coils and by increase of their number is decreased [21]. Number of TF coils is normally about 12–36 coils [22, 23]. The ripple magnitude due to the finite number of TF coils and the size of the ports of vacuum vessel, determine the number, size and shape of TF coils [24]. Axisymmetry of magnetic field topology insures good classical particle confinement. However, due to discreteness of the TF coil system, it is unavoidable to have some ripple component in the toroidal magnetic field [24, 25].
The TF coils are wound around the vacuum vessel. The vacuum vessel provides a suitable condition for plasma shaping, baking, confinement, stability and supervising [22, 23, 26].
In some tokamaks for investigate of toroidal field behavior, use a detailed Finite Element Method (FEM) [7, 27, 28, 29] and in this paper we use a detailed 3D finite element method for all component of TF coils.
Calculation of Major and Minor Radius and Turn Numbers of TF Coils
Winding of TF Coils
Thus the number of coils is 16 and the number of turns per coils is 10.
We must consider that every coil consist of 10 turns.
Calculation of Plasma Current
Parameters of Alborz tokamak
Toroidal magnetic field (in R = 0.45 m) (T)
Minor radius (m)
Aspect ratio
Edge safety factor
Maximum plasma current (kA)
Number of TF coils
Number of total turns
Total stored energy (kJ)
Current per turn (kA)
Simulation of Toroidal Magnetic Field
Toroidal field in Ro = 0.45 m is 0.85 T.
Expected parameters of Alborz tokamak
Toroidal magnetic field (in R = 0.45 m) (T)
Minor radius (m)
Aspect ratio
Edge safety factor
Maximum plasma current (kA)
Number of TF coils
Number of total turns
Total stored energy (kJ)
Current per turn (kA)
Open Access
This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.


text:
NEW YORK (AP) — A bid for speed in reporting the Supreme Court's decision on President Barack Obama's health care law has tripped up some news organizations.
Both CNN and Fox News Channel incorrectly reported Thursday that the law's central provision, requiring virtually all Americans to have health insurance, had been struck down. Both networks backtracked when it became clear that the court upheld the provision.
Broadcast networks broke into regular programming to deliver special reports and generally got it right.
To get the news out quickly, competitive news organizations had to wade through pages of legal writing.
Online editor's note: In the first few minutes of reporting on the decision, theadvocate.com posted that CNN was reporting that the individual mandate portion of the law had been struck down. A switch to the Associated Press alert saying that the law was upheld was made a few minutes after the first online post.


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GONZALES — Gonzales police are looking for two men who robbed a Waffle House customer as he was leaving the La. 30 restaurant, police said.
The robbery happened about 10 p.m. Sept. 9 when a customer who was about to get into his car in the parking lot of the restaurant was approached by two men who put a weapon — believed to be a gun — on the man's throat and robbed him, according to a Police Department news release.
The two men took the victim's wallet and several other items, then fled in a car thought to be a 2009 to 2014 Hyundai Sonata or Elantra with a Texas license plate, police said.
Police have photos of the robbers taken by a surveillance camera when the two men used the victim's credit card at a Gonzales retail outlet.
Anyone with information on the identity of either robber may call Crime Stoppers at (225) 344-7867 or the Gonzales Police Department at (225) 647-9572.


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Omaha City Council passes extended anti-bias protections to gay, transgender people
OMAHA, Neb. (AP) _ The Omaha City Council has approved an ordinance that would extend protections to gay and transgender people.
The proposal, put forward by Councilman Ben Gray, would apply to employers, employment agencies, job training programs, labor groups, public accommodations and businesses that contract with the city. It also would provide exemptions for religious groups.
A similar proposal failed in October 2010 on a 3-3 vote, but passed Tuesday 4-3.
Nebraska's anti-discrimination laws and federal regulations don't extend protection to gay and transgender people.
Backers argued the proposal would make Omaha a more welcoming city to a diverse workforce. Opponents countered that the proposals would add an unnecessary layer of bureaucracy and open up businesses to lawsuits.
Testimony to the City Council last week from Nebraska Cornhuskers assistant football coach Ron Brown, who opposed the measure based on his Christian faith, drew a rebuke from University of Nebraska-Lincoln Chancellor Harvey Perlman. Perlman said Brown should have made clear his views were his own and not the university's. Brown apologized for giving the City Council the university's football stadium address as his personal address.
Council members discussed the ordinance for more than an hour before passing the measure, which survived a motion by Councilman Franklin Thompson to amend it to protect only against discrimination based on sexual orientation, dropping any reference to gender identity.
Thompson voted against the measure Tuesday, as did City Council members Tom Mulligan and Jean Stothert.
Thompson drew both laughter and some gasps as he grappled out loud with his decision. At one point, he said he had determined from his own observations that of every 10 gay, lesbian or transgendered people, "I believe that four are born that way, and six are choosing." Thompson, who is black, also compared gay and transgender rights to the civil rights movement, saying, "We didn't get all our rights in 17 months. It was a process."
Mayor Jim Suttle said in a statement that he would sign the ordinance into law.
"Omaha is a city that welcomes diversity, embraces fresh ideas and is open for business to everyone," Suttle said. "Allowing discrimination in our city is wrong-for our citizens and our businesses."
Man pleads not guilty in Hasidic Village car fire
RAMAPO, N.Y. (AP) _ A man has surrendered to face charges he set ablaze a car that belonged to a dissident member of a Hasidic Jewish community in suburban New York.
Aron Fromowitz pleaded not guilty to arson and criminal mischief charges on Tuesday.
He is accused of setting fire to Aron Rottenberg's car last Thursday.
Rottenberg told police Fromowitz had been drinking and celebrating the Jewish festival of Purim, the Journal News reported. Fromowitz works for the grande rebbe's kitchen and once prayed with Rottenberg.
Last May, Rottenberg was severely burned with a firebomb outside his home in New Square. He said he was attacked because he refused to pray in Grand Rabbi David Twersky's synagogue. Shaul Spitzer, 18, pleaded guilty to first-degree assault in that attack.
Fired CFO of Philadelphia Catholic archdiocese charged in $900K theft
PHILADELPHIA (AP) _ A former financial executive of the Roman Catholic Archdiocese of Philadelphia has been charged with stealing over $900,000 from the church.
Anita Guzzardi, 42, surrendered Tuesday, city prosecutors said. She was fired in July, weeks after becoming chief financial officer. Guzzardi used hundreds of church checks to pay personal credit card bills from 2005 to 2011, according to prosecutors. The investigation began when American Express contacted authorities.
Guzzardi's lawyer did not respond to request for comment Tuesday.
The Haddon Heights, N.J., woman had worked for the Roman Catholic archdiocese since 1989.
Prosecutors say they've recovered about $150,000 for the church. The archdiocese says insurance will pay for most of the remaining losses.
Hawaii reaches $100K out-of-court settlement in lawsuit by protester who objected to prayer
HONOLULU (AP) _ Hawaii will pay $100,000 to settle a lawsuit by a protester who was dragged out of the state Senate when he objected to a prayer.
Mitchell Kahle is founder of the Hawaii Citizens for the Separation of State and Church. His friend Kevin Hughes videotaped Senate Sergeant-At-Arms Ben Villaflor pulling on Kahle's arm in April 2010 after he objected to an opening prayer. Kahle was then hustled outside and seen on the ground with Villaflor and three uniformed deputies on top of him.
Hughes claims sergeant-at-arms employees attacked him and broke his camera.
The attorney representing both men told the Honolulu Star-Advertiser that the lawsuit establishes that nonviolent protest and filming in public should not be met with force.
Nation's oldest Portuguese Catholic parish in New Bedford closing, merging with nearby church
NEW BEDFORD, Mass. (AP) _ A New Bedford church that's been home to oldest Portuguese Roman Catholic parish in North America is closing.
The Diocese of Fall River announced Monday that St. John the Baptist church will close and the parish will be merged with Our Lady of Mount Carmel.
St. John the Baptist Parish was established by the Boston Archdiocese in 1871 to serve the area's burgeoning Portuguese-speaking population. The current building dates to 1913.
A diocese spokesman said the church was selected for closure because of deep debt and declining membership. The parish needs $1.5 million in repairs.
The Rev. John Oliveira, pastor of both parishes, said the news was received at last weekend's Masses with great sadness. No date for a closure has been set.


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Author has written 3 stories for Naruto.
last edit: July, 26- 2011
My name is Lena! Call me whatever you want but "official" nickname is Lenny. This is gonna be my Fanfic profile, if you look at the post below this it will be my first EVER post written and so it will describe me. Read if you want XD
Stories: DO NOT STEAL ANY OF THESE IDEAS, FOR I WILL HUNT YOU DOWN.
#1. Prophecy- Multi-chap
Paring: thinking about it
Rated: T or M
Status: ON HOLD and rewriting EVERYTHING
Summary: It has been a long time since The Beginning but still, the prophecy held still, waiting. It was going to start soon and the prophecy was nothing if not patient. So it waits for the blood, sweat and tears and it also waits for the end. Silently and alone, the story is about to start.
Notes: Okay so it's been a couple of years since the start of this, I'm still going to finish it. But after that devastating loss of inspiration, I just couldn't go back to it. So now, I look back at it and I think. Wow, my writing has really changed and it is still changing. I mean I look at Fire and I want to rewrite it! So whatever I'm going to do, it is going to be totally different from when it was first started.
#2. Fledged- multi-chap
Rated: T or M (again)
Status: I've decided this story is too common so i shall delete it however whenever i feel like writing this i will have this summary here to help me *grins*
Summary: She sick of being picked on by everyone, so she's been planning for this for 10 years, gathering information, waiting. Sakura has been researching everything possible for hair, makeup, clothes, you name it. She worked as hard as she could, placed her grades at the top of the class, and saved all the money she made. For ten years she's done this, also making sure that no one, no one could guess about what she's going to do. The plan truly came to fruitation at the start of her second year of high school. Two weeks of school has gone by, she's done, once an ugly creature, she is now radiant. Finally she makes her entrance, back to the school. On the very same day she makes her entrance, somebody with raven hair waltz into her life and watches her a little too closely. But at the same time many people have starting paying attention.
#3. Masks- multi-chap
Rated: M
Status: Not even started yet T.T
Summary:Here secrets are mandatory, here secrets are protection. A mask hides secrets and in a place like this, no on can know who you are.
#4. Fire- one shot!!
Rated: T
Status: Complete!!!!!
Summary: She knew that she was going to die here, tonight, alone. That is until she saw this luminous creature in front of her, saving her. Now obsession takes over as she tries to find the one that saved her from hell. Non-massacre. AU-ish
AN: Probably not going to be my best work, but it's my first complete one so I'm proud!
#5 currently unnamed (just for now)- multi-chap
Rated: M
Status: Prologue 80% done
Summary: Yes, you may look down at me for my job, after all, being an escort is hardly a well paying or respectable career. But, what else can I do? I have no other options. Sleeping with dirty men is the only way I an survive in this world. Working as a prostitute is the only thing I can do.
The idea is that as a last resort, Sakura is working as a prostitute. She's beautiful so she gets many costumers so that she's not too miserable. However, things start to change when she gets beaten and is now slowly dying in an alley. No one wants to help a prostitute after all. She lays on the ground for hours until this one man comes to her and helps her. That man is Itachi. This story is going to be about their rocky relationship, from Itachi's secret, betrayal, the Uchiha clan wanting to murder her for 'seducing' their precious heir, and what's this about a fiance?!
#6 Ames Soeurs - Perfect Drabble (Going for 5 chapters a week.)
Rated: T
Status: Ch 4 up. Ch 5 finished and editing.
Experiment: Perfect drabble, multiple perspectives.
Summary: He steals her away when he saw strength. She stayed with him when she had the chance to run. Now they hide together. Why are their lives always entwined together? This isn't love, this is need.
Notes: Well it's a drabble, the muse was yelling at me today to do something, here is something. This is called Ames Soeurs (French for soulmates. If you translate it means sister soul.) So basically in this story Sasuke kidnapped Sakura after seeing how much she improved. And this tells us what they encounter while they are together. There are 2 parts to this. The first part is of what happened up till the point they are ambushed. The second is them trying desperately to survive.
Each chapter is 200 words long (100 for her, 100 for him). And whenever there is a new line, it's the other person talking. Some chapters may have only one perspective, but the next chapter will have only the other person's perspective? Complicated? Not really. Read and find out!
Notes: Hey so I just cleaned up my profile, it was really getting long! Also, I wanted you guys to know that I'm starting to revamp Prophecy, continue Ames Soeurs and beginning the unnamed project. No one replied to me if they want to do a collab with me (after like 3 e-mails) jeez a no would be nice. So lots of work to do and I'm falling behind in summer school! Don't expect much, seriously.
Pet Peeves of Fanfiction:
1) "Summary sucks, just read it."- no I will not just read it! The summary is there for a reason! Like they say, first impressions are everything and the summary is my first impression of YOUR story. Make it good. Similarly, "I'm not good at summaries but the story is good!" is full of bullcrap. If you cannot write a couple hundred characters properly, how can you write an entire story?
2) Bad grammar- I know, I know, everyone makes mistakes but if the story has "&" for "and", "2" for "to" and has incredibly bad spelling, I will not read it.


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I am no longer supporting or updating this application. I have made the source code available at https://github.com/csuzw/KADC . Feel free to use and host it as you wish. As long as traffic to the current site doesn't reach the point I am having to pay significant amounts to keep it up, then it will remain as it currently is. Anyway back to the original post:
Over the last week I've been working on the following web application: http://kadc.azurewebsites.net/ .
This provides the following functions:
The are 2 enhancement calculators, Full and Simple. Both calculate stats at target level and if given an armor to enhance with, how many it will take and how much it will cost. Full requires you to select specific armors, Simple only requires you to select the rarities of the armor involved.
There are 2 functions, Combine and Split. Combine will give a list of possible fusion results for a given 2 armors. Split will give a list of possible armors you can fuse to get a given armor.
Epic Boss
This will calculate damage done and taken by armor given information about the epic boss, your guild and your available armors. Currently this only works for players at level 100 because I don't have a formula/table for working out player and follower base stats at lower levels.
Level Data
This shows the current level table used by the above functions. It is likely that it isn't completely correct but LuxRegem has done a great job of improving the accuracy of it.
Armor Data
This shows the current armor table used by the above functions. Again it's likely to have some inaccuracies as I copied a lot of it by hand from various sources.
All the functionality and data on the website is exposed as a RESTful API for inclusion in any other web applications that you might think up.
As I've mentioned above it's bound to have inaccuracies so if you find any, especially if you know why it's inaccurate, then please let me know. The biggest gap in functionality currently is player and follower base stat data for levels below 100 so if you have a table or formula for this please let me know. Thanks for reading and I hope you find this application useful.