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Mental disorders cause high burden in adolescents, but adolescents often underutilise potentially beneficial treatments. Perceived need for and barriers to care may influence whether adolescents utilise services and which treatments they receive. Adolescents and parents are stakeholders in adolescent mental health care, but their perceptions regarding need for and barriers to care might differ. Understanding patterns of adolescent-parent agreement might help identify gaps in adolescent mental health care.
A nationally representative sample of Australian adolescents aged 13–17 and their parents (N = 2310), recruited between 2013–2014, were asked about perceived need for four types of adolescent mental health care (counselling, medication, information and skill training) and barriers to care. Perceived need was categorised as fully met, partially met, unmet, or no need. Cohen's kappa was used to assess adolescent-parent agreement. Multinomial logistic regressions were used to model variables associated with patterns of agreement.
Almost half (46.5% (s.e. = 1.21)) of either adolescents or parents reported a perceived need for any type of care. For both groups, perceived need was greatest for counselling and lowest for medication. Identified needs were fully met for a third of adolescents. Adolescent-parent agreement on perceived need was fair (kappa = 0.25 (s.e. = 0.01)), but poor regarding the extent to which needs were met (kappa = −0.10 (s.e. = 0.02)). The lack of parental knowledge about adolescents' feelings was positively associated with adolescent-parent agreement that needs were partially met or unmet and disagreement about perceived need, compared to agreement that needs were fully met (relative risk ratio (RRR) = 1.91 (95% CI = 1.19–3.04) to RRR = 4.69 (95% CI = 2.38–9.28)). Having a probable disorder was positively associated with adolescent-parent agreement that needs were partially met or unmet (RRR = 2.86 (95% CI = 1.46–5.61)), and negatively with adolescent-parent disagreement on perceived need (RRR = 0.50 (95% CI = 0.30–0.82)). Adolescents reported most frequently attitudinal barriers to care (e.g. self-reliance: 55.1% (s.e. = 2.39)); parents most frequently reported that their child refused help (38.7% (s.e. = 2.69)). Adolescent-parent agreement was poor for attitudinal (kappa = −0.03 (s.e. = 0.06)) and slight for structural barriers (kappa = 0.02 (s.e. = 0.09)).
There are gaps in the extent to which adolescent mental health care is meeting the needs of adolescents and their parents. It seems important to align adolescents' and parents' needs at the beginning and throughout treatment and to improve communication between adolescents and their parents. Both might provide opportunities to increase the likelihood that needs will be fully met. Campaigns directed towards adolescents and parents need to address different barriers to care. For adolescents, attitudinal barriers such as stigma and mental health literacy require attention.
Planning mental health carer services requires information about the number of carers, their characteristics, service use and unmet support needs. Available Australian estimates vary widely due to different definitions of mental illness and the types of carers included. This study aimed to provide a detailed profile of Australian mental health carers using a nationally representative household survey.
The number of mental health carers, characteristics of carers and their care recipients, caring hours and tasks provided, service use and unmet service needs were derived from the national 2012 Survey of Disability, Ageing and Carers. Co-resident carers of adults with a mental illness were compared with those caring for people with physical health and other cognitive/behavioural conditions (e.g., autism, intellectual disability, dementia) on measures of service use, service needs and aspects of their caring role.
In 2012, there were 225 421 co-resident carers of adults with mental illness in Australia, representing 1.0% of the population, and an estimated further 103 813 mental health carers not living with their care recipient. The majority of co-resident carers supported one person with mental illness, usually their partner or adult child. Mental health carers were more likely than physical health carers to provide emotional support (68.1% v. 19.7% of carers) and less likely to assist with practical tasks (64.1% v. 86.6%) and activities of daily living (31.9% v. 48.9%). Of co-resident mental health carers, 22.5% or 50 828 people were confirmed primary carers – the person providing the most support to their care recipient. Many primary mental health carers (37.8%) provided more than 40 h of care per week. Only 23.8% of primary mental health carers received government income support for carers and only 34.4% received formal service assistance in their caring role, while 49.0% wanted more support. Significantly more primary mental health than primary physical health carers were dissatisfied with received services (20.0% v. 3.2%), and 35.0% did not know what services were available to them.
Results reveal a sizable number of mental health carers with unmet needs in the Australian community, particularly with respect to financial assistance and respite care, and that these carers are poorly informed about available supports. The prominence of emotional support and their greater dissatisfaction with services indicate a need to better tailor carer services. If implemented carefully, recent Australian reforms including the Carer Gateway and National Disability Insurance Scheme hold promise for improving mental health carer supports.
An epidemiological survey was conducted to determine the prevalence of the mental and substance use disorders and ascertain patterns of mental health services utilisation in Lao People's Democratic Republic (Lao PDR) with the aim of evaluating existing gaps and opportunities in the provision of mental health services.
This study was a cross-sectional, household survey of adults living within Vientiane Capital province, Lao PDR. We collected data on participant demographics, mental and physical health status, family history of mental illness and exposure to potential risk factors. It also collected data on mental health service utilisation patterns, types of health professionals and treatment being accessed, barriers to treatment and perceived need for care. The MINI International Neuropsychiatric Interview (MINI v.6.0) was also administered to assess mental disorder prevalence.
Age- and sex-standardised current prevalence of any disorder was estimated at 15.2% (95% CI 11.0–20.7). Alcohol dependence (5.5% (95% CI 3.2–9.6)), was the most prevalent followed by anxiety disorders (5.2% (95% CI 3.2–8.3)) and mood disorders (2.5% (95% CI 1.5–4.4)). 11.0% (95% CI 5.8–20.1) of participants with a mental and/or substance use disorder suffered from other comorbid disorders. A number of variables demonstrated significant effects in final logistic regression models, including family history, education and employment for mental disorders; and gender, numbers of hours worked per week and number of dependants for substance use disorders. Having a mental or substance use disorder was associated with an OR of 11.6 of suicidality over participants without a mental or substance use disorder (95% CI 2.8–58.5). Of the 101 participants who met criteria for a current mental or substance use disorder, only two (2.1% (95% CI 0.5–8.0)) had accessed services for their mental health in the past 12 months. No participants who had seen a health professional in the past 12 months reported getting as much help as they needed. The vast majority (89.2% (95% CI 76.5–95.4)) of participants meeting criteria for a current mental or substance use disorder reported that they had not experienced mental health problems in the past 12 months.
This study presents the first epidemiological estimates for a range of mental and substance use disorders in the general population of the most populous province in Lao PDR. A large treatment gap exists for mental and substance use disorders in Lao PDR. This research adds value for health care and has been an important precursor to developing informed and targeted mental health policy, services and health system reform in Lao PDR.
School-based psychological interventions encompass: universal interventions targeting youth in the general population; and indicated interventions targeting youth with subthreshold depression. This study aimed to: (1) examine the population cost-effectiveness of delivering universal and indicated prevention interventions to youth in the population aged 11–17 years via primary and secondary schools in Australia; and (2) compare the comparative cost-effectiveness of delivering these interventions using face-to-face and internet-based delivery mechanisms.
We reviewed literature on the prevention of depression to identify all interventions targeting youth that would be suitable for implementation in Australia and had evidence of efficacy to support analysis. From this, we found evidence of effectiveness for the following intervention types: universal prevention involving group-based psychological interventions delivered to all participating school students; and indicated prevention involving group-based psychological interventions delivered to students with subthreshold depression. We constructed a Markov model to assess the cost-effectiveness of delivering universal and indicated interventions in the population relative to a 'no intervention' comparator over a 10-year time horizon. A disease model was used to simulate epidemiological transitions between three health states (i.e., healthy, diseased and dead). Intervention effect sizes were based on meta-analyses of randomised control trial data identified in the aforementioned review; while health benefits were measured as Disability-adjusted Life Years (DALYs) averted attributable to reductions in depression incidence. Net costs of delivering interventions were calculated using relevant Australian data. Uncertainty and sensitivity analyses were conducted to test model assumptions. Incremental cost-effectiveness ratios (ICERs) were measured in 2013 Australian dollars per DALY averted; with costs and benefits discounted at 3%.
Universal and indicated psychological interventions delivered through face-to-face modalities had ICERs below a threshold of $50 000 per DALY averted. That is, $7350 per DALY averted (95% uncertainty interval (UI): dominates – 23 070) for universal prevention, and $19 550 per DALY averted (95% UI: 3081–56 713) for indicated prevention. Baseline ICERs were generally robust to changes in model assumptions. We conducted a sensitivity analysis which found that internet-delivered prevention interventions were highly cost-effective when assuming intervention effect sizes of 100 and 50% relative to effect sizes observed for face-to-face delivered interventions. These results should, however, be interpreted with caution due to the paucity of data.
School-based psychological interventions appear to be cost-effective. However, realising efficiency gains in the population is ultimately dependent on ensuring successful system-level implementation.
Children and adolescents make up almost a quarter of the world's population with 85% living in low- and middle-income countries (LMICs). Globally, mental (and substance use) disorders are the leading cause of disability in young people; however, the representativeness or 'coverage' of the prevalence data is unknown. Coverage refers to the proportion of the target population (ages 5–17 years) represented by the available data.
Prevalence data for conduct disorder (CD), attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASDs), eating disorders (EDs), depression, and anxiety disorders were sourced from systematic reviews conducted for the Global Burden of Disease Study 2010 (GBD 2010) and 2013 (GBD 2013). For each study, the location proportion was multiplied by the age proportion to give study coverage. Location proportion was calculated by dividing the total study location population by the total country population. Age proportion was calculated by dividing the population of the country aged within the age range of the study sample by the country population aged 5–17 years. If a study only sampled one sex, study coverage was halved. Coverage across studies was then summed for each country to give coverage by country. This method was repeated at the region and global level, and separately for GBD 2013 and GBD 2010.
Mean global coverage of prevalence data for mental disorders in ages 5–17 years was 6.7% (CD: 5.0%, ADHD: 5.5%, ASDs: 16.1%, EDs: 4.4%, depression: 6.2%, anxiety: 3.2%). Of 187 countries, 124 had no data for any disorder. Many LMICs were poorly represented in the available prevalence data, for example, no region in sub-Saharan Africa had more than 2% coverage for any disorder. While coverage increased between GBD 2010 and GBD 2013, this differed greatly between disorders and few new countries provided data.
The global coverage of prevalence data for mental disorders in children and adolescents is limited. Practical methodology must be developed and epidemiological surveys funded to provide representative prevalence estimates so as to inform appropriate resource allocation and support policies that address mental health needs of children and adolescents.
Despite significant research examining mental health in conflict-affected populations we do not yet have a comprehensive epidemiological model of how mental disorders are distributed, or which factors influence the epidemiology in these populations. We aim to derive prevalence estimates specific for region, age and sex of major depression, and PTSD in the general populations of areas exposed to conflict, whilst controlling for an extensive range of covariates.
A systematic review was conducted to identify epidemiological estimates of depression and PTSD in conflict-affected populations and potential predictors. We analyse data using Bayesian meta-regression techniques.
We identified 83 studies and a list of 34 potential predictors. The age-standardised pooled prevalence of PTSD was 12.9% (95% UI 6.9–22.9), and major depression 7.6% (95% UI 5.1–10.9) – markedly lower than estimated in previous research but over two-times higher than the mean prevalence estimated by the Global Burden of Disease Study [3.7% (95% UI 3.0–4.5) and 3.5% (95% UI 2.9–4.2) for anxiety disorders and MDD, respectively]. The age-patterns reveal sharp prevalence inclines in the childhood years. A number of ecological variables demonstrated associations with prevalence of both disorders. Symptom scales were shown to significantly overestimate prevalence of both disorders. Finding suggests higher prevalence of both disorders in females.
This study provides, for the first time, age-specific estimates of PTSD and depression prevalence adjusted for an extensive range of covariates and is a significant advancement on our current understanding of the epidemiology in conflict-affected populations.
Epidemiological models are frequently utilised to ascertain disease prevalence in a population; however, these estimates can have wider practical applications for informing targeted scale-up and optimisation of mental health services. We explore potential applications for a conflict-affected population, Syria.
We use prevalence estimates of major depression and post-traumatic stress disorder (PTSD) in conflict-affected populations as inputs for subsequent estimations. We use Global Burden of Disease (GBD) methodology to estimate years lived with a disability (YLDs) for depression and PTSD in Syrian populations. Human resource (HR) requirements to scale-up recommended packages of care for PTSD and depression in Syria over a 15-year period were modelled using the World Health Organisation mhGAP costing tool. Associated avertable burden was estimated using health benefit analyses.
The total number of cases of PTSD in Syria was estimated at approximately 2.2 million, and approximately 1.1 million for depression. An age-standardised major depression rate of 13.4 (95% UI 9.8–17.5) YLDs per 1000 Syrian population is estimated compared with the GBD 2010 global age-standardised YLD rate of 9.2 (95% UI 7.0–11.8). HR requirements to support a linear scale-up of services in Syria using the mhGAP costing tool demonstrates a steady increase from 0.3 FTE in at baseline to 7.6 FTE per 100 000 population after scale-up. Linear scale-up over 15 years could see 7–9% of disease burden being averted.
Epidemiological estimates of mental disorders are key inputs into determining disease burden and guiding optimal mental health service delivery and can be used in target populations such as conflict-affected populations.
To examine: (1) gender-specific determinants of help-seeking for mental health, including health professional consultation and the use of non-clinical support services and self-management strategies (SS/SM) and; (2) gender differences among individuals with unmet perceived need for care.
Analyses focused on 689 males and 1075 females aged 16–85 years who met ICD-10 criteria for a past-year affective, anxiety or substance use disorder in an Australian community-representative survey. Two classifications of help-seeking for mental health in the previous year were created: (1) no health professional consultation or SS/SM, or health professional consultation, or SS/SM only, and; (2) no general practitioner (GP) or mental health professional consultation, or GP only consultation, or mental health professional consultation. Between- and within-gender help-seeking patterns were explored using multinomial logistic regression models. Characteristics of males and females with unmet perceived need for care were compared using chi-square tests.
Males with mental or substance use disorders had relatively lower odds than females of any health professional consultation (adjusted odds ratio [AOR] = 0.46), use of SS/SM only (AOR = 0.59), and GP only consultation (AOR = 0.29). Notably, males with severe disorders had substantially lower odds than females of any health professional consultation (AOR = 0.29) and GP only consultation (AOR = 0.14). Most correlates of help-seeking were need-related. Many applied to both genders (e.g., severity, disability, psychiatric comorbidity), although some were male-specific (e.g., past-year reaction to a traumatic event) or female-specific (e.g., past-year affective disorder). Certain enabling and predisposing factors increased the probability of health professional consultation for both genders (age 30+ years) or for males (unmarried, single parenthood, reliance on government pension). Males with unmet perceived need for care were more likely to have experienced a substance use disorder and to want medicine or tablets or social intervention, whereas their females peers were more likely to have experienced an anxiety disorder and to want counselling or talking therapy. For both genders, attitudinal/knowledge barriers to receiving the types of help wanted (e.g., not knowing where to get help) were more commonly reported than structural barriers (e.g., cost).
Findings suggest a need to address barriers to help-seeking in males with severe disorders, and promote GP consultation. Exploring gender-specific attitudinal/knowledge barriers to receiving help, and the types of help wanted, may assist in designing interventions to increase consultation. Mental health promotion/education efforts could incorporate information about the content and benefits of evidence-based treatments and encourage males to participate in other potentially beneficial actions (e.g., physical activity).
Depression and anxiety (internalizing disorders) are the largest contributors to the non-fatal health burden among young people. This is the first meta-analysis to examine the joint efficacy of universal, selective, and indicated preventive interventions upon both depression and anxiety among children and adolescents (5–18 years) while accounting for their co-morbidity. We conducted a systematic review of reviews in Medline, PsycINFO and the Cochrane Library of Systematic Reviews, from 1980 to August 2014. Multivariate meta-analysis examined the efficacy of preventive interventions on depression and anxiety outcomes separately, and the joint efficacy on both disorders combined. Meta-regressions examined heterogeneity of effect according to a range of study variables. Outcomes were relative risks (RR) for disorder, and standardized mean differences (Cohen's d) for symptoms. One hundred and forty-six randomized controlled trials (46 072 participants) evaluated universal (children with no identified risk, n = 54) selective (population subgroups of children who have an increased risk of developing internalizing disorders due to shared risk factors, n = 45) and indicated prevention (children with minimal but detectable symptoms of an internalizing disorder, n = 47), mostly using psychological-only strategies (n = 105). Reductions in internalizing disorder onset occurred up to 9 months post-intervention, whether universal [RR 0.47, 95% confidence interval (CI) 0.37–0.60], selective (RR 0.61, 95% CI 0.43–0.85) or indicated (RR 0.48, 95% CI 0.29–0.78). Reductions in internalizing symptoms occurred up to 12 months post-intervention for universal prevention; however, reductions only occurred in the shorter term for selective and indicated prevention. Universal, selective and indicated prevention interventions are efficacious in reducing internalizing disorders and symptoms in the short term. They might be considered as repeated exposures in school settings across childhood and adolescence. (PROSPERO registration: CRD42014013990.)
Understanding the time-course of post-traumatic stress disorder (PTSD), and the underlying events, may help to identify those most at risk, and anticipate the number of individuals likely to be diagnosed after exposure to traumatic events.
Data from two health surveys were combined to create a cohort of 1119 Australian military personnel who deployed to the Middle East between 2000 and 2009. Changes in PTSD Checklist Civilian Version (PCL-C) scores and the reporting of stressful events between the two self-reported surveys were assessed. Logistic regression was used to examine the association between the number of stressful events reported and PTSD symptoms, and assess whether those who reported new stressful events between the two surveys, were also more likely to report older events. We also assessed, using linear regression, whether higher scores on the Kessler Psychological Distress Scale or the Alcohol Use Disorder Identification Test were associated with subsequent increases in the PCL-C in those who had experienced a stressful event, but who initially had few PTSD symptoms.
Overall, the mean PCL-C scores in the two surveys were similar, and 78% of responders stayed in the same PCL-C category. Only a small percentage moved from having few symptoms of PTSD (PCL-C < 30) in Survey 1 to meeting the criteria for PTSD (PCL-C ≥ 50) at Survey 2 (1% of all responders, 16% of those with PCL-C ≥ 50 at Survey 2). Personnel who reported more stressful lifetime events were more likely to score higher on the PCL-C. Only 51% reported the same stressful event on both surveys. People who reported events occurring between the two surveys were more likely to record events from before the first survey which they had not previously mentioned (OR 1.48, 95% CI (1.17, 1.88), p < 0.001), than those who did not. In people who initially had few PTSD symptoms, a higher level of psychological distress, was significantly associated with higher PCL-C scores a few years later.
The reporting of stressful events varied over time indicating that while the impact of some stressors endure, others may increase or decline in importance. When screening for PTSD, it is important to consider both traumatic experiences on deployment and other stressful life events, as well as other mental health problems among military personnel, even if individuals do not exhibit symptoms of PTSD on an initial assessment.
It is increasingly recognised that intersectoral linkages between mental health and other health and support sectors are essential for providing effective care for individuals with severe and persistent mental illness. The extent to which intersectoral collaboration and approaches to achieve it are detailed in mental health policy has not yet been systematically examined.
Thirty-eight mental health policy documents from 22 jurisdictions in Australia, New Zealand, the United Kingdom, Ireland and Canada were identified via a web search. Information was extracted and synthesised on: the extent to which intersectoral collaboration was an objective or guiding principle of policy; the sectors acknowledged as targets for collaboration; and the characteristics of detailed intersectoral collaboration efforts.
Recurring themes in objectives/guiding principles included a whole of government approach, coordination and integration of services, and increased social and economic participation. All jurisdictions acknowledged the importance of intersectoral collaboration, particularly with employment, education, housing, community, criminal justice, drug and alcohol, physical health, Indigenous, disability, emergency and aged care services. However, the level of detail provided varied widely. Where detailed strategies were described, the most common linkage mechanisms were joint service planning through intersectoral coordinating committees or liaison workers, interagency agreements, staff training and joint service provision.
Sectors and mechanisms identified for collaboration were largely consistent across jurisdictions. Little information was provided about strategies for accountability, resourcing, monitoring and evaluation of intersectoral collaboration initiatives, highlighting an area for further improvement. Examples of collaboration detailed in the policies provide a useful resource for other countries.
Mental and substance use disorders are common and often persistent, with many emerging in early life. Compared to adult mental and substance use disorders, the global burden attributable to these disorders in children and youth has received relatively little attention.
Data from the Global Burden of Disease Study 2010 was used to investigate the burden of mental and substance disorders in children and youth aged 0–24 years. Burden was estimated in terms of disability-adjusted life years (DALYs), derived from the sum of years lived with disability (YLDs) and years of life lost (YLLs).
Globally, mental and substance use disorders are the leading cause of disability in children and youth, accounting for a quarter of all YLDs (54.2 million). In terms of DALYs, they ranked 6th with 55.5 million DALYs (5.7%) and rose to 5th when mortality burden of suicide was reattributed. While mental and substance use disorders were the leading cause of DALYs in high-income countries (HICs), they ranked 7th in low- and middle-income countries (LMICs) due to mortality attributable to infectious diseases.
Mental and substance use disorders are significant contributors to disease burden in children and youth across the globe. As reproductive health and the management of infectious diseases improves in LMICs, the proportion of disease burden in children and youth attributable to mental and substance use disorders will increase, necessitating a realignment of health services in these countries.
Mortality-associated burden of disease estimates from the Global Burden of Disease 2010 (GBD 2010) may erroneously lead to the interpretation that premature death in people with mental, neurological and substance use disorders (MNSDs) is inconsequential when evidence shows that people with MNSDs experience a significant reduction in life expectancy. We explore differences between cause-specific and excess mortality of MNSDs estimated by GBD 2010.
GBD 2010 cause-specific death estimates were produced using the International Classification of Diseases death-coding system. Excess mortality (all-cause) was estimated using natural history models. Additional mortality attributed to MNSDs as underlying causes but not captured through GBD 2010 methodology is quantified in the comparative risk assessments.
In GBD 2010, MNSDs were estimated to be directly responsible for 840 000 deaths compared with more than 13 million excess deaths using natural history models.
Numbers of excess deaths and attributable deaths clearly demonstrate the high degree of mortality associated with these disorders. There is substantial evidence pointing to potential causal pathways for this premature mortality with evidence-based interventions available to address this mortality. The life expectancy gap between persons with MNSDs and the general population is high and should be a focus for health systems reform.
The main aim of this paper is to compare and contrast the methodological approaches of the new Global Burden of Disease 2010 Study (GBD 2010) with the original study conducted for 1990 (GBD 1990), in terms of calculating burden for mental and substance use disorders.
We reviewed the conceptual and methodological changes to GBD burden calculations in the GBD 2010 study, compared with previous studies. We then discuss the possible implications of these changes with respect to burden estimates for mental and substance use disorders.
It is not possible to compare burden estimates arising from the GBD 1990 study with the most recent burden estimates. There have been important advances in the categorisation and definition of mental disorders, and the input and computation of epidemiological models for disease distribution. There have also been major changes to conceptual and social value choices aimed at addressing concerns that arose following publication of earlier GBD studies.
Advancements to the GBD conceptual framework and method of calculating burden estimates has led to more accurate and equitable consideration of the burden for mental and substance use disorders. Proposed annual updates of GBD estimates by the Institute of Health Metrics and Evaluation provide an opportunity to continue to advance the evidence base that underpins the quantification of disease burden.
Despite their high prevalence, the global burden of anxiety disorders has never been calculated comprehensively. The new Global Burden of Disease (GBD) study has estimated burden due to morbidity and mortality caused by any anxiety disorder.
Prevalence was estimated using Bayesian meta-regression informed by data identified in a systematic review. Years of life lived with disability (YLDs) were calculated by multiplying prevalent cases by an average disability weight based on severity proportions (mild, moderate and severe). Disability-adjusted life years (DALYs) were then calculated and age standardized using global standard population figures. Estimates were also made for additional suicide mortality attributable to anxiety disorders. Findings are presented for YLDs, DALYs and attributable burden due to suicide for 21 world regions in 1990 and 2010.
Anxiety disorders were the sixth leading cause of disability, in terms of YLDs, in both high-income (HI) and low- and middle-income (LMI) countries. Globally, anxiety disorders accounted for 390 DALYs per 100 000 persons [95% uncertainty interval (UI) 191–371 DALYs per 100 000] in 2010, with no discernible change observed over time. Females accounted for about 65% of the DALYs caused by anxiety disorders, with the highest burden in both males and females experienced by those aged between 15 and 34 years. Although there was regional variation in prevalence, the overlap between uncertainty estimates means that substantive differences in burden between populations could not be identified.
Anxiety disorders are chronic, disabling conditions that are distributed across the globe. Future estimates of burden could be further improved by obtaining more representative data on severity state proportions.
Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity.
Wait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ⩽2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure.
Wait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months.
It is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.
Summarizing the epidemiology of major depressive disorder (MDD) at a global level is complicated by significant heterogeneity in the data. The aim of this study is to present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity. Findings are informing MDD burden quantification in the Global Burden of Disease (GBD) 2010 Study.
A systematic review of prevalence and incidence of MDD was undertaken. Electronic databases Medline, PsycINFO and EMBASE were searched. Community-representative studies adhering to suitable diagnostic nomenclature were included. A meta-regression was conducted to explore sources of heterogeneity in prevalence and guide the stratification of data in a meta-analysis.
The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global point prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4–5.0%). The pooled annual incidence was 3.0% (2.4–3.8%), clearly at odds with the pooled prevalence estimates and the previously reported average duration of 30 weeks for an episode of MDD.
Our findings provide a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.
The literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study.
A systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.
The prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3% (3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures.
Anxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.
Personalised support services assist patients with severe and persistent mental illness (SPMI) to live with functional deficits by providing living skills, emotional support, community access and advocacy. This paper aims to systematically review the evidence for personalised support.
Systematic searches of Medline, PsycINFO and Google Scholar (inception to March 2011) identified studies investigating patient outcomes for personalised support services. The quality of the selected studies was assessed. The strength of evidence for the three categories of patient outcomes (illness acuity, personal functioning and patient satisfaction) was graded.
Fifteen studies met inclusion criteria with most rated as having moderate or weak study designs. The selected studies evaluated programs for outpatients with SPMI. There was moderate strength of evidence for reducing illness acuity and improving patient satisfaction with services, and weak strength of evidence for improving personal functioning in studies published to date. Most programs delivered multiple service types, and no clear pattern of service types leading to specific patient outcomes could be discerned.
Although evidence published to date for personalised support is of variable quality, it suggests that services may be effective. More research on the effects of personalised support subtypes on patient outcomes is required.
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LightWave 3D is the most complete and flexible software solution for 3D graphics and animation.
LightWave 3D is versatile enough to make the transition to and from all kinds of projects. Proven for years in television, film, and games, LightWave 3D is also being used to create graphics for print, web, industrial design, architecture, medical imaging, and anywhere else a 3D package is needed. A full, robust program, LightWave 3D includes many of the tools that other packages require to be purchased separately. Soft-body dynamics, particles, hair and fur, plus unlimited render nodes, to name a few; LightWave 3D ships with all the tools an artist needs to create.
What's New
Version 2020.0.2:
- Release notes were unavailable when this listing was updated.
OS X 10.11 or later, 64-bit processor
Download Now

subset: commoncrawl


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Judicial hopeful Tim Mazzei, Brookhaven board member, leaves to hasten vote for successor
Suffolk County Court candidate Tim Mazzei has resigned from his Brookhaven Town Board seat with 16 months remaining in his term to hasten a special election to choose his successor.
Mazzei, 60, a Blue Point Republican who has been cross-endorsed by the Republican, Democratic, Independence and Conservative parties, said Friday he resigned early so that a special election can be held in November, rather than early next year, saving the county an estimated $100,000. His resignation from the $67,986-per-year town board post was effective at midnight Thursday.
Mazzei, a former Suffolk prosecutor who led the district attorney's homicide bureau and has been in a private law practice for 24 years, was the town board's senior member at 11 years. In an interview, he said he was proud of economic revitalization efforts in East Patchogue and his role in building and cleaning up parks throughout his southwest Brookhaven district.
"It was an opportunity to do something different with respect to my legal career, which is the pinnacle of anybody's legal career, to become a judge," he said. "I just couldn't resist the opportunity."
Mazzei's early resignation will permit political parties to name candidates by mid-September at meetings so they can be on the Nov. 4 ballot. The winning candidate will take office immediately once the election is certified and will fulfill the remainder of Mazzei's two-year term.
Jesse Garcia, Brookhaven GOP chairman, who called Mazzei's move "bittersweet," said Republicans will name Neil Foley, 46, a Patchogue pharmaceutical salesman, as their candidate to succeed Mazzei.
Anthony Parlatore, Brookhaven Democratic chairman, said the party will nominate Amy Keyes, 30, of East Patchogue, an assistant to County Executive Steve Bellone and former aide to Legis. Rob Calarco (D-Patchogue). The town's 5th District includes Patchogue Village, East and North Patchogue, Medford and parts of Lake Ronkonkoma, Holbrook, Holtsville and many Fire Island communities.
Brookhaven officials, in a news release Friday, praised Mazzei's role in upgrading town parks and shepherding projects such as the Ronkonkoma Hub mixed-use development.
"He's participated in major decisions in this town," Supervisor Edward Romaine said. "He's been a strong advocate for his district, particularly Fire Island."


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Kabul, July 15 (Xinhua) -- Up to 77 militants have been killed and 27 others wounded during series of operations across the insurgency-plagued Afghanistan over the past 24 hours, the country's defense ministry said in a statement released on Saturday.
"Afghan troops backed by aircrafts launched series of operations in different provinces over the past 24 hours, as a result, 77 militants including 17 Islamic States (IS) fighters have been killed, 27 injured and seven others arrested," the statement said.
The operations that covered parts of Nangarhar, Kunar, Nuristan, Kapisa, Paktika, Khost, Logar, Kandahar, Zabul, Oruzgan, Kunduz, Faryab, Takhar and Helmand provinces during which weapon caches have also been discovered.
Similarly, Taliban militants attacked an Afghan army checkpoint in Ab Kamary district of the western Badghis province early Saturday and captured eight soldiers, provincial governor Mohammad Anwar Eshaqzai confirmed.


text:
Permute is the easiest to use media converter with it's easy to use, no configuration, drag and drop interface, it will meet the needs to convert all your media. Video, audio, and image files come in many different kinds and shapes, but sometimes you need a specific format since your iPad or DVD player won't play that video. That is what Permute is for – easily convert your media files to various different formats.
- Download Link
- Supported Operation Systems
- Features
- Screenshots
- Whats new?
Size: 58.0 MB
- macOS 10.11 or later 64-bit
- Easy to Use – Built from the ground up, Permute is a perfect example of what a Mac app should be. With a gorgeous interface and drag & drop simplicity no need for complicated options.
- Insanely Fast – Was engineered to be incredibly fast. Let us take care of the hard stuff. Just select the video format you want and it'll be done faster than you can say "hardware acceleration" – MP4 and HEVC presets now take advantage of your machine's hardware acceleration capabilities, speeding up HEVC conversions more than 3 times over previous versions.
- PDF Support – Permute 3 now includes support for stitching multiple images into a single PDF.
- Everything Included – it doesn't matter if you're converting home movies or processing images. Permute can do it all. We support nearly every format and have plenty of device presets to choose from.
- Looks Amazing – whether you use dark mode or not, Permute will look amazing. Taking advantage of modern technologies, Permute will even change its icon in dark mode.
- Keep the Schedule – video re-encoding is quite demanding on computer resources. This is why you can now schedule Permute to convert videos e.g. at night when you're not using your computer.
- WebP and SVG support – not many apps that support these rather rare formats, don't you think? Well, it supports converting these files into more usable formats.
- And so much more! – there are so many other great features in Permute – adjust the volume of an audio file or an audio track in a video. Batch resize, rotate and flip images and videos. And more!
- New: Afrikaans localization.
- Fixed: Issue where AVI files with MJPEG video tracks would be recognized as audio.
- Fixed: Support for automatically clearing finished conversions from the queue.


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Downloads Page Updated
The downloads page has been updated with the Architectural Review Committee (ARC) Form, The Orchards CC&Rs, The Orchards Bylaws, The Orchards 1st Amendment to the CC&Rs. The documents are Continue Reading
KB To Resume Building In The Orchards
Hello, all you homeowners & renters in Orchards land! The Board would like to inform everyone that we have received information that KB would like to start building within our community once Continue Reading
How To Leave A Comment
Some of you may not know what all that stuff is at the bottom of each Post. Here is a diagram showing what field is does what. Figure 1. Descriptions from the Top Down.... You can enter Continue Reading
3 Acre Park
On the news after all the bodies were found KB Home said they were going to turn it into a park. Does anyone know when this may be? I drove past this afternoon on the way home and it looks like Continue Reading
Community Wide Garage Sale
What does everyone think about a community wide garage sale in late March? I could post signs around the surrounding communities and see if the other communities are interested. Maybe put it in Continue Reading
The Orchards Delinquency Data
Hello all you Homeowners out in Orchards land! We had a board meeting just the other night & we were presented with the delinquency report for the Orchards. While we can not print the exact Continue Reading
Master Association Election – New Board Member and Homeowner Liaison
Hello, The "election" for the MA Board member was held this evening. I put "election" in quotes because of what actually happened. First of all, only 8 people showed up from the community, 7 Continue Reading
New to the Community
My wife and I have just purchased the house on <removed> Gentry Lane. We were told at our closing that there is a fee paid to Canyon Gate and that it is collected every quarter. Then when Continue Reading
Vote favors APS mil levy and bond
Albuquerque Public school district will receive more than $600 million to improve its schools. By 10 p.m. Tuesday, the unofficial results with 94 percent of precincts reporting had the mil levy Continue Reading
Election for Anderson Heights HOA Board Member
I received the following letter from CGRES Anderson Heights Resident, It is time to elect a homeowner to the Anderson Heights Homeowners' Association Board of Directors. The developer board, KB Continue Reading
KOB story re development at 98th/Gibson
Stuff like this makes me feel better about the issues we face. I can't imagine being one of these homeowners. http://www.kob.com/article/11687/?vid=1285676&v=1 Continue Reading


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'Tis the season for decorating all the things for your holidays: your house, your desk at work, even your emails.
But before you douse your next holiday email with glitter, tinsel & garland, it may be good to take a step back & ask yourself if it is creating the right experience for your subscribers. While your intentions may be good in that you are embracing an important time of the year, there're some design principles to keep in mind.
So how could you be sure your emails convey a festive winter wonderland & not a winter disaster?
I teamed up with our Email Designer, Kim R., to get her advice on how to create a fun holiday email in a way that does not break all of the design rules. Here is her advice:
Aim for simplicity.
Some people like to decorate for the holidays by covering each window, exterior, and blade of grass with festive decorations. But that does not mean you have to do the same with your emails.
"Adding too many photos/festive elements can be overwhelming," advises Kim. "Aim for a simple email, especially if you are working on a design that is already busy."
Emails with a lot going on in them easily become distracting for the average subscriber –that goes beyond design. The emails that have too much content, too many different types of fonts and too many columns could present too many places for readers to concentrate their attention.
Instead, try choosing one/two elements to focus on and add to your email, like:
- An image/GIF
- A new color scheme
- A new holiday template.
If you are using a pre-built email template provided by AWeber or another email marketing platform, for instance, this might be all you need to convey that festive vibe.
They launched their "12 Days of Uberflippin' Giveaways" promotion & incorporated a simple, yet totally festive, design. The hero image combines their logo but embraces the ugly sweater pattern, other unobtrusive visuals that give it just enough holiday spirit.
Limit your calls-to-action.
This is a busy time of year for businesses sending email, but it is even busier for the individuals who're receiving them.
To make it easier for subscribers to take action & get more clicks in your emails, stick to a brief number of calls-to-action.
"Keep it clear as to what you want people to do," Kim adds. "If listing products, give them a few things to point to. Do not use too many products to feature in your email."
You should stick to one link that you want your subscribers to click. But if you have a few different items to feature, consider limiting it to three/four, and then direct individuals to these specific product pages.
By having a button positioned at the top of the email as the main focus, they make it simple for the subscribers to take action.
And that does not prevent them from sharing the benefits about their family of products, either – readers can learn what is in it for them (potentially the people they are purchasing gifts for) choose to buy a specific product from the set.
Stay aligned with your brand.
Swapping your usual email template with a holiday-themed one? Go for it!
When you do, make sure it remains aligned with your brand.
"Be sure to include your logo & consider using your usual headers & footers," Kim says. "You could focus on making smaller changes, like adding festive colors that go beyond the usual color palette."
To ensure the email still feels like it is coming from you, consider how you might add holiday delight without turning away the subscribers.
Check out the holiday email promotion from online marketplace Magnolia:
The visual design of the email is simple and does not feel like you just walked into a HomeGoods the Monday after Thanksgiving. They use their regular header. However, incorporate a touch of the season by including a red, festive image & applying the same color to the text above.
Get festive with your emails.
If your holiday emails are already in motion, not a problem! It is never too late to make adjustments to the next send – especially when it could improve the experience for your subscribers.
Not comfortable with changing your email design? If you're an AWeber customer, try one of our brand new holiday email templates. Just log into your account, and you'll see them in the Template Gallery.
These templates are ready to be customized, so you can make them fit your brand by doing things like adding you company logo and changing the background color.


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Do Energy Drinks Really Give You Energy?
January 18, 2018
Males between the ages of 18 and 34 years old consume the most energy drinks, and almost one-third of teens between 12 and 17 years drink them regularly. According to nccih.nih.gov/health/energy-drinks
"Energy drinks only give me energy on specific days. I think it depends on my mood," Sophomore Nathan Jensen said.
Everybody has their favorite flavor of drink even if it is water.
"They don't really provide me with any energy, I only drink them for the variety of flavors," Senior Tyler Olsen said.
Some students don't believe that energy drinks give them energy, but instead helps them focus.
"They don't necessarily give me energy. They help me focus more than anything." Mr. Forbes said.


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The third way to watch Lost during the hiatus is through the internet.
The ABC network has kindly and fortunately allowed Lost episodes to be streamed for free on their website.
Xbox LIVE
You lucky Americans (again) have the ability to download episode of Lost on your Xboxen. Unfortunately I can't provide you with a link, but you should be able to find it pretty easily on the Marketplace.
It disgusts me that I'm advising the general public to give Apple money but you can download Lost episodes on iTunes, so go ahead and do that.
Unfortunately there is not (legal) way to watch Lost online in Canada, so that's too bad…
As for illegal ways, you can always (not) try using torrent sites like mininova or the piratebay, and torrent programs like bittorrent or utorrent. Obviously you shouldn't use such illegal ways though. Its better to watch the show on abc.om or to buy the DVDs.
– Izi


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XS:body length:19cm(7.5″),chest: 27cm(10.5″),neck girth: 20.5 cm(8″),fits for pets 0-0.5 kgs(0-1 lbs)
S:body length:21.6cm(8.5″),chest:30.5cm(12″),neck girth:25.5cm(10″),fits for pets 0.5-1 kgs(1.1-2.2 lbs)
M:body length:25.5cm(10″), chest:37cm(14.5″), neck girth:28cm(11″),fits for pets 1-2.5 kgs(2.2-5.5 lbs)
L:body length:30.5cm(12″),chest:42cm(16.5″),neck girth:32cm(12.5″),fits for pets 2.5-4.5 kgs(5.5-9.9 lbs)
XL:body length:34cm(13.5″), chest:46cm(18″),neck girth:36cm(14″),fits for pets 4.5-6.5 kgs(9.9-14.3 lbs)
This is a very nice clothes,our customer suggestions is that if two sizes are fits,pls choose the larger size.Of course, by measuring the purchase is the best method.And is not suitable for large dogs.
We highly recommend you measure your pet precisely with a flexible tape measure to ensure the best fit. Contact us if you have question. We are happy to help.
Standard Shipping:
Free shipping,usually ships by e-Packet which taking 5-14 business days arriving. But there is no such option for us to choose in Amazon's System but "17-28 days". So you will find the Estimated Delivery Date too long. In fact it is not true.Most of our customers receive their package in 5 – 14 business days.
You satisfaction and feedback is really important to us! Please leave a positive feedback if you are satisfied with our item and services. we wish you had a comfortable shopping experience!
Sizing for each dog is unique. Similar to our clothing and accessory, medium size from one designer is not the same for another. For example our 9-pound yorkie model usually fits either one of three sizes (i.e. XS, S, M) depending on the designer. We highly recommend you measure your pet precisely with a flexible tape measure to ensure the best fit. Contact us if you have question. We are happy to help.
Great for this upcoming cooler evenings during the winter months. Fleece lining for extra comfort and warmth. One-piece jumper. Stylish faux-fur trimmed hoodie. Soft and comfortable this outfit will keep your baby warm all season long. One of our favorite picks for the season.
Perfect for Daily wear, Special Occasions, Weekend Parties, Halloween, Christmas, Birthdays, Photo shoots and Play dates, or just making your pet look its best.
Available for small or mediun size pet, such Cat, Chihnuahua, Poodle, Cup Poodle, Pomeranian, Yourkshire Terrier, Bichon Frise, Cocker Spaniel.
This clothes runs small a little.Please take a measurement of your dog or cat before purchasing !!!


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The latest two franchises to join the expanding lineup of LEGO Brickheadz are none other than Harry Potter and Ghostbusters!
It's been rumoured for some time, but official images from LEGO for the Harry Potter collection are finally out, consisting of Harry Potter, Hermione, Ron, Dumbledore, and even Harry's pet owl Hedwig.
41615 Harry Potter and Hedwig comes as a 180-piece two-pack that will retail at US$14.99 (S$29.90), while 41616 Hermione figurine is a standalone edition, and the 127-piece set will go for US$9.90 (S$19.90). 41621 Ron and Dumbledore have been bundled together with 245 pieces, and will only be sold exclusively at Target in the United States at US$19.99. All three sets will go on sale on July 1.
It seems a little odd that Ron would be in a set with Dumbledore instead of Hermione, but the figurines are adorable, and Potterheads will want to collect them all! Check out the images below.
41615 Harry Potter and Hedwig
41616 Hermione
41621 Ron and Dumbledore
It seems like a good day for reveals, as LEGO has also released an image of two new Ghostbusters Brickheadz of Peter Venkman and Slimer.
We wonder how Slimer will be displayed as floating. Probably a few transparent pieces, but it would be pretty awesome if they used magnets in the stand to achieve the effect! No other information regarding price and availability have been announced just yet, but we look forward to having these on our shelves.
Joyce is a language nerd whose idea of a good time includes speed-solving Rubik's cubes and binging Netflix, all fuelled by drinking many, many mugs of tea.


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Download Battle Islands (MOD, unlimited money) free on android
505 Games Srl
Games, Strategy
Android 4.0.3 +
Version: 2.6.1
Battle Islands (MOD, unlimited money) - incredibly interesting game in which you feel like a real general, the plot of the game, you are trafficked to the rear of the enemy, which is located on a tropical island. And your main task will be building its own military bases, and the enemy's displacement from its position. Fight on all fronts, build cruisers and aircraft carriers, fight both on land and at sea. Become the best in-chief and conquer the enemy on his own territory. Beautiful graphics and superb special effects will conquer all the fans of the beautiful graphics.
Money increase when spent!
Money increase when spent!
Updated to version 2.6.1!
Additional Information from Google Play:
Updated 07.06.2017
Size 61.3Mb
Installs 1 000 000–5 000 000
Rated for 3+ years


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New Listing! Solar Desert Starlight: Stunning Modern Pool Home
Accommodates: 10
Bedrooms: 5
Bathrooms: 4
Welcome! Get Ready to Enjoy a 5 Star Experience at "Solar Desert Starlight"...
Get ready for the Quintessential Palm Springs Vacation Experience. Solar Desert Starlight will delight you with a multitude of alfresco amenities, a dream backyard, well-designed interiors, many sustainability features, and five deluxe bedrooms comfortably accommodating ten guests. No less than Seven Furnished Outdoor Areas distributed around this walled estate help create enchanting spaces for families and friends to create wonderful memories.
Surrounded by lush eco-desert gardens and inviting outdoor patios. Enjoy mornings floating away in the swimming pool relaxing on semi-submerged loungers. Cook a BBQ lunch on the Weber and relish it alfresco at the poolside table. On cool desert nights, sip champagne in the Spa or cuddle up around the fire feature under the stars. Warm landscape lighting combines with Rich Color Pool Lights to cast a dreamy spell on nighttime gatherings after a wonderful evening on the town.
Enter a private gate to find yourself in a whole new world. Surrounded by private, modern block wall, Desert Starlight first greets you with an inviting Fire Feature placed in an eco-green Mountain View Courtyard. Enter the front, frosted glass door and be transported into a modern reincarnation of this Mid-Century Jewel that Krisel first envisioned in 1957.
All newly re-built, beautifully landscaped and smartly furnished. The Bubbly Spa cascades into the new pool. One of my favorite places is on the tanning shelf where two can take in the famous Mountain View. BBQ your meals on the Weber and dine al fresco pool-side. Then recap your day around the fire feature. Large groups will enjoy that there are places where everyone can gather together, and yet this estate property is full of places where a few can hide away from it all.
Common Space
The Modern Living Room features comfortable seating, TV with Hulu+LiveTV & Netflix, gas fireplace, modern art, fully-equipped wet bar, inside dining for 10, and floor-to-ceiling views of the beautifully landscaped garden and pool action.
Just bring your food and beverages (though many food staples are provided). Stainless Steel Appliances, Caesarstone Counters, plus all the small appliances you would expect and then some, like the Vertuoline Nespresso machine with starter pods. Thoughtfully labeled cabinets make it easy to prepare meals and entertain with style. The breakfast room seats 4 and has easy Pool access.
5 Star Bedrooms
There's good separation between the Three King Bedrooms, each with luxury bedding, modern decor, newly remodeled en suite bathrooms, indoor seating areas, and outdoor private patios. Two additional bedrooms (King and 2 Twins) share a bath off the hall. Note that one of the bedrooms has high architectural (clerestory) windows that will bring in some morning light, so let the early risers have that room; all the others feature true blackout shades. (Don't tell our architect, but if you wish, we can apply a temporary cover to the clerestory windows for an additional $95 labor fee, our cost.)
5 Star Location
This South Palm Springs location ensures that the frequent Desert Wind won't spoil your outdoor fun. Start your morning with an Easy Stroll to Koffi South for a fresh, locally roasted Espresso beverage. Some evening, you'll want to saunter down to the hip Amigo Room at The Ace Hotel for a local beer or craft cocktail.
Authentic Mid-Century History
You'll get the true Palm Springs vibe at Desert Starlight. Architected by William Krisel, this is one of the first 39 homes built in 1957 by the Alexander Co. Many of the original architectural elements were kept in this updated MCM home: tongue & groove high ceilings, rock fireplace, and clerestory windows making it bright and connecting you with a time shared by the Hollywood Rat Pack including Frank Sinatra and Marilyn Monroe.
Solar/Sustainable/Green Home
Rest assured that your amazing Palm Springs vacation is nearly carbon neutral and ultra sustainable thanks to the Solar Panel covered roof, native landscaping, eco-grass, and all new energy-efficient windows and sliding doors.
5 Star "Twin Palms" Location
This South Palm Springs location ensures that the frequent Desert Wind won't spoil your outdoor fun. Start your morning with an Easy Stroll to Koffi South for a fresh, locally roasted Espresso beverage. Some evening, you'll want to saunter down to the hip Amigo Room at The Ace Hotel for a local beer or craft cocktail.
Optional Fees & Services
* Pool Heating Fee: $65/night, $390 Week, recommended early October through early June.
* "Pre-approved, Well-behaved" Dogs are welcome with payment of $150 Dog Fee (each).
* Additional Fee may apply to Early Check-In or Late Check-Out
* Monthly guests pay actual metered Gas & Electric Utility costs. A reasonable Utility Deposit is required before arrival.
* Please inquire about Mid-Stay Cleaning, Fridge Stocking, and many other Concierge Services that we offer
This home is in a desirable residential neighborhood. We want you to have a great vacation, but we like our neighbors and we want them to like you, too. We expect you to observe all of the Palm Springs Vacation Rental Ordinance Rules:
* Guest must submit drivers license showing age 25+
* Max overnight occupancy: 10
* Max daytime occupancy: 14
* Max cars allowed: 5
* All adult guests must read & sign the Palm Springs Rules & Regulations Sheet at Check-In
* No outdoor music (except headphones, of course)
* Music is not allowed to be heard by any neighbors (24x7)
* Quiet hours outside 10:00 PM to 10:00 AM
* Minimum $500 Palm Springs City Fine for any violations
And our House Rules:
* NO Smoking inside or near any open doors
* Parties Allowed: ZERO
* Guests are responsible for any damage/loss
* Additional charges possible for excessive cleaning, excessive trash removal, occupancy over initial guest count, unapproved pets, noise violations or neighbor complaints.
Thanks for reading our entire listing. Despite the long list of City Rules, it's really not hard to comply. We do want you to have a fun and memorable vacation getaway, and we hope to have the honor of welcoming you to Solar Desert Starlight soon!
Palm Springs City ID#2247
Rates and Availability
|Weekend Night
|Min Stay
|Max Stay
|Standard Rate
|$700 / night
|$895 / night
|$4500 / week
|$12500 / month
|Fall ShoulderAug 30 2019 - Sep 30 2019
|$650 / night
|$750 / night
|$4000 / week
|$10000 / month
|WinterOct 01 2019 - Jan 31 2020
|$650 / night
|$750 / night
|$4000 / week
|$11000 / month
|SpringFeb 01 2020 - Apr 08 2020
|$695 / night
|$895 / night
|$4995 / week
|$12500 / month


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5 Cheapest ways to stay in touch overseas
If you're an occasional international traveler, you want to be able to keep in touch with friends and family at home. Ideally, you want to be able to reach them wherever you are and for them to be able to reach you. You also want to make local calls to restaurants, hotels, theaters, airlines, and such. Twenty years ago, you'd pick up the phone in your hotel room, enter the number, and call. Connections were generally good—and costs were generally outrageous, even for local calls. And you'd be connected only when you were in your hotel.
These days you have lots of options. There is no one best option; what's best for you depends on a bunch of factors. But you can generally keep in touch, at little or even no cost to you or to those who want to call you. Here's how.
Use your mobile phone
This is the easiest option. As long as your cellphone uses the Global System for Mobile Communications (GSM)—AT&T and T-Mobile phones do—it will work overseas. (Some Verizon phones now use GSM as well.) Check with your wireless provider if you're not sure.
With your regular mobile phone, you can be connected almost everywhere. Wireless networks cover almost the entire developed world these days—you aren't tied down to your hotel.
But if you communicate a lot, this is the most expensive option. Even with an international roaming package, rates can be expensive. AT&T, for example, charges up to $1 per minute for calls in select European countries if you purchase an international calling package.
Warning: Be sure to disable any automatic notifications from your apps as well as automatic e-mail push. If you don't, data charges can kill you.
Get Evcmobi app
If you have a smartphone or tablet, you can make calls at extremely low costs by downloading a Voice-Over-Internet Protocol (VOIP) app. Most make calls directly over the Internet as long as you're in a Wi-Fi hotspot, and when you aren't in a hotspot, they default to the local GSM 3G network.
Depending on the app, calls made through Wi-Fi are either free or they only cost a few cents per minute, depending on a whole bunch of factors.
When you aren't in a hotspot, the calls go through local GSM networks, at data rather than voice rates. If you don't want to risk international data-roaming charges, you can combine this approach with a local subscriber identity module (SIM) card.
Of the many available apps, Evcmobi is the simplest and most versatile approach. It is available for iPhone and Android. Purchase a U.S. number so people can reach you at no cost while you're abroad.
So far, of the big U.S. mobile providers, AT&T seems to be the only one to offer a VOIP app for outgoing calls—but you still have to pay the international roaming rates for incoming calls.
Switch your SIM card
What makes your regular GSM or dual-system phone "your" phone is a tiny subscriber identity module (SIM) card that contains your personal subscriber data.
You can buy local or regional SIM cards in any region that uses GSM, including all of Europe. These SIM cards let you keep almost all the same benefits you enjoy at home. But you pay local rates: With the better cards, you can call back to the U.S. for less than 50 cents per minute—much less, in some cases—plus local calls are less than that, and many incoming calls cost nothing. Regional cards for Europe start at around $20, including $10 worth of airtime, which you can replenish with a credit card. Some programs also include a special U.S. number through which people at home can reach you without paying international rates.
Buying a traveling simcard is the best option so far. If you are a leisure or business traveler that's the way to go, because you won't be paying extortionate international roaming costs and the rates are the cheapest. You will talk like you're home, when other people call you you won't be charged a fortune as well. You will be saving arround 80% of the money you would had spent with your regural carrier. We recommend 360travelsim as they have the lowest rates and all the above.
Get a temp
Rent a wireless phone for the duration of your trip or buy a cheap throwaway phone that works in the places you plan to travel. You can do that for less than $50. Lots of online phone dealers can provide one. In fact, your regular carrier may even offer overseas rentals.
As with a new SIM card for your own phone, this system works both ways, 24/7, with a new temporary local phone number. Typically, those low-cost temp phones will not have full smartphone capabilities.
Use a hotspot
If you don't need full 24/7 connectivity, you can spend as much time as you'd like on social media wherever you happen to be—and it doesn't cost anything, as long as you're in a hotspot.
These days, probably the majority of ordinary hotels in Europe and many in other parts of the world offer free Wi-Fi, and booking sites always specify. Oddly, it seems the higher the hotel price, the more likely it is the property charges for Wi-Fi.
Finding Wi-Fi in small inns, B&Bs, vacation rentals, and gites can be more problematic. If you're planning on staying in a place without Wi-Fi, you often have to rely on some other approach to keep in touch.
By using free Wi-Fi, you can still bring along your mobile phone for emergencies (if it is GSM-enabled), and your cost risk is low. Just remember to disable any automatic downloads.


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Recently I read/viewed one of your video regarding the consumption of Camel Milk and Urine as a shifa for cancer patients. I have been a stage-4 lungs cancer patient since August 2017. My question: – How much milk should I consume every time/ every day and should I boil it before consumption?
By Admin
In Medicine and medical treatments
Oct 14th, 2018
0 Comments
754 Views
I don't know about the details, however, Experts say that a cap of a bottle of urine mixed with a liter or so of camel's milk. You can drink it a number of times per day.


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If I ever need a laugh, I go to the blogs I manage and look at the things people have searched to arrive there. It's hilarious.
Crazy search terms people have used to get here include (but are certainly not limited to) the following:
- what to serve with tacos for dinner
- trashy copier
- can you make almond roca when its raining
- changed an adult diaper
- problems with church secretaries
- punkyville
- what can u give your guest at a funeral
- grannyfresh
- rain gentleman
And my all-time favorite: Does John Piper drink coffee?
I went through this routine last night and saw that someone had searched "recorder fingerings for wizard of oz." It killed me to think they left here frustrated and disappointed because I'm sure those were nowhere to be found on my blog and I wanted to fix that even though it might be too late.
So, ladies and gentlemen, I give you my probably not-so-helpful fingerings cheat sheet for the recorder part in the Wizard of Oz (specifically for the scarecrow).
Dear friend, you also get a bonus. Since you're probably also playing flute and piccolo in this production, I'll even share my chicken scratch alternate fingerings for the flute and piccolo parts.
Lastly, I have several more helpful goodies for you. It's like you've been to MunchkinLand!
The method that probably helps me most when practicing is listening to the piece. YouTube is full of horrible Wizard of Oz school musical recordings that have hacked up the parts and ruined it, but since it's a Monday and I'm feeling extra generous, I'm including the three recordings I found most helpful below.
The Jitterbug


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We bought a farm!
This is actually old news, but I'm finally getting around to share this with the world. First let me introduce you to the country getaway-renovation project-to keep me busy-house! 15 acres and a few outbuildings is definitely a foodie fantasy, of course the incredible views were highly motivating, but the light and potential of the farmhouse are ultimately what sold me. To the west, huge windows look across a ravine to the neighboring farms on the ridge, to the east we have five-mile views of the Lake Pepin and Rush River Valleys and the whole place is surrounded by the pastoral rolling hills of this "Driftless" area of Western Wisconsin. Our place sits on a hill with ample windows to the west and south allowing for flooding sunlight throughout the day. In the city, rays from the sun are blocked by our neighbor's two and a half story homes and close proximity.
While the stinkiest house we have ever renovated, I could immediately see the potential. The house was originally built by a homesteading family in the late 1880s or early 1890s. It stayed in that family until 1986 when it was sold to a young couple. They set to renovate the place with new windows, an open floor plan and new paint, carpet and other basics. In 2003-4, after divorcing, the woman decided to make some big changes to the house by building an addition that would accommodate two new bathrooms, a mudroom and a laundry room. Unfortunately, she fell on hard times, many projects were left unfinished and eventually she lost the home to foreclosure. We were the purchasers.
While we feel extremely grateful for what we have acquired, it is hard to think about the previous owner and her dreams for this place. One day last summer she tentatively stopped in to introduce herself. She was very emotional, but shared her story with us which ultimately gave us a deeper appreciation for the land and the home. We learned that she loved animals and had a couple of horses. She even created a riding arena behind the garage with highbush cranberry. The bushes are 14-16 feet tall now and form a perfect rectangular arena. Poplar seedlings had overpopulated the space, but once Jeff cleared them out, the arena became obvious. If she hadn't told us about that space and it's purpose, we may never have discovered it. After the horses died, the land went fallow, burr, thistle and other perennial weeds took over, so we've had our hands full with clearing, and I anticipate many years of maintenance and management.
These pictures were taken the end of June on the day we closed. I was thrilled to find lots of perennial flowers, flowering bushes and fruit trees. It was obvious that somebody loved gardening as much as I do. However, the gardens and plants were nearly impossible to see for the invasive grasses that have taken over the beds. The farm seemed so overgrown that we thought it had been abandoned for many years. We were surprised to find that the previous owner had only moved in February, and now understand how pernacious these country weeds truly are!
Everyone asks if we'll have animals or grow crops, but what we're going to do with it is yet to be seen. We have lots of ideas and tons of ambition so anything seems possible. What we do know is that we have 15 acres to renovate, rebuild and restore. We closed last June with the intention of renovating the house as a country getaway. While others would have dug into the land right away, it was more important to me to first create a peaceful and relaxing space. Here are the before pictures:
In addition to a lovely house, we have a few choice outbuildings that one day will gleam and shine. Right now they are rather battered and bruised.
I'm excited to post the "after" pictures of all our projects. We've been here for just over 9 months and have accomplished quite a bit. In addition to renovating much of the house, we have started seedlings for a summer garden, have plans to trench the electric lines, we will finish off the deck and screen porch we started last summer, start a colony of bees, and begin plans for a large-scale permaculture farm. This summer my challenge will be to find a way to live harmoniously with the weeds!


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Jack Charlton's brother has called for the 1966 World Cup winner to receive a posthumous knighthood.
Tommy said it would be a 'fitting tribute' to the England legend, who died peacefully on Friday aged 85 after battling dementia and lymphoma.
His appeal was echoed by celebrities and politicians, with former Liverpool star Ray Houghton branding it a 'disgrace' that he had not already been.
Tommy, 74, told the Mirror: 'He was a well-respected, well-loved Englishman. I think a knighthood would be a fitting tribute to him after all he achieved.
'It would be the finishing touch to his life wouldn't it? I think that Jack is every bit as good as one or two of those who have been knighted recently. He was loved wherever he went.'
The honours system would have to be overhauled for him to receive the award because the current rules ban the awarding of knighthoods after a person dies.
Only two of the 1966 World Cup winning heroes were made sirs - Geoff Hurst and Bobby Charlton - while the manager Alf Ramsay was also later honoured.
It comes as Charlton's granddaughter Emma Wilkinson told of her 'extremely warm' grandfather, who died peacefully at his Northumberland home with his family.
Emma Wilkinson told of her 'extremely warm, very tactile' grandfather (pictured) who died on Friday aged 85
Charlton (pictured winning the World Cup), who played for Leeds with distinction for 21 years and later managed the Republic of Ireland , was the brother of fellow England great Bobby
The ITV reporter, based in Lincolnshire and Yorkshire, fought back tears as she recalled how the former Leeds star was competitive 'no matter how old he was'.
She told GMB: 'The person they've described is the person we know, and that's testament really to how genuine and real he was.
'Although we were always aware of his achievements, to me and my siblings and my cousins he was always our granddad, he would do anything for all of us.'
When asked if he was competitive, she added: 'Yes and that really applied to, even at home, no matter how old he was he would never let us win.
'He was extremely warm, very tactile, extremely present in our lives and he would have done anything for us. It will be hard him not being there anymore.'
Calls for Charlton to be posthumously knighted have gathered pace since his passing on Friday.
The former defender passed away at his Northumberland home on Friday after suffering from dementia and lymphoma. PIctured: Charlton waving at supporters in at the World Cup in 1990 after his Republic of Ireland side's quarter final defeat against Italy
A statement from the Charlton family announcing his death expressed their pride at their 'much-adored husband, father, grandfather and great-grandfather'
Houghton said: 'The word legend is used too much in football but not for Jack, for what he's done domestically with Leeds, winning the World Cup, which he should have been knighted for, I've still never understood that, I think that's an absolute disgrace and the fact that he did so well with Ireland.'
Ian Lavery MP, who represents 'Big Jack's' home constituency of Wansbeck in Northumberland, is calling for the government to award the honour posthumously.
He tweeted: 'I've submitted a Parliamentary Early Day Motion Calling on the Govenment to award a Posthumous Knighthood to the legend that is Big Jack Charlton. We'll be launching a petition very soon.'
There have been various calls over the years for the entire 1966 team to given the top honour.
Sir Bobby Charlton had to wait until 1994 before he was finally knighted and Sir Geoff Hurst until 1998.
Which members of the 1966 World Cup winning team received honours?
Despite being the team's captain – and one of England's greatest ever footballers – Bobby Moore was never knighted before his death in 1993.
A campaign in 2016 for him to be knighted posthumously failed, despite the support of the then FA chairman Greg Dyke and a cross-party coalition of MPs.
Last year it was reported goalkeeper Gordon Banks missed out on a knighthood because officials lost key paperwork.
Friends were sure he was due to be made a sir in the 2019 New Year Honours, but although nomination papers had been submitted two years earlier, it was claimed they were then mislaid in a blunder by the Government's honours committee. Banks died in February 2019.
All the members of the team were made MBEs, although farcically, five 'forgotten' players – Nobby Stiles, Alan Ball, Roger Hunt, Ray Wilson and George Cohen – did not receive theirs until 2000.
Jack Charlton, Moore and Banks were also made OBEs. In stark contrast to Britain's failure to honour him, Charlton was awarded honorary Irish citizenship in 1996.
Charlton, who played for Leeds United with distinction for 21 years and later managed the Republic of Ireland, was the brother of fellow England great Bobby. The pair both played in the side which won the World Cup.
A statement from the Charlton family announcing his death expressed their pride at their 'much-adored husband, father, grandfather and great-grandfather.'
They added he died peacefully with his loved ones by his side. The footballing legend is survived by his wife Pat Kemp and their three children.
Born in the coal-mining village of Ashington, Northumberland, in 1935, Charlton was the eldest of four brothers and his father was a miner.
The siblings at one point had to share the same bed because of the family's tight finances.
Jack played alongside his brother (right) for England. The pair are pictured above shortly before the 1966 World Cup got underway. Pictured: The pair enjoy a celebratory drink with their mother Cissie after the World Cup victory
His granddaughters, Kate and Emma Wilkinson, shared their own heartfelt tributes and photos on Twitter, with both saying he was a 'kind and genuine' man.
Tributes also poured in from the footballing world. His former teammate Sir Geoff Hurst, who scored three goals in the 1966 World Cup final to help England win the trophy, said he was a 'great and loveable character and will be greatly missed.'
Leeds said it was 'deeply saddened' by his death and the England football team tweeted it was 'devastated' by the news.
Premier League players wore black armbands and held a minute's silence before kick-off during the weekend's games in tribute.
The statement from the Charlton family continued: 'We cannot express how proud we are of the extraordinary life he led and the pleasure he brought to so many people in different countries and from all walks of life.
'He was a thoroughly honest, kind, funny and genuine man who always had time for people.
'His loss will leave a huge hole in all our lives but we are thankful for a lifetime of happy memories.'
Charlton's granddaughter Kate Wilkinson said in her Twitter tribute: 'Beyond sad to have to say goodbye to my beloved Grandad, Jack Charlton.
'He enriched so many lives through football, friendship and family. He was a kind, funny and thoroughly genuine man and our family will miss him enormously.'
Her sister Emma added: 'Yesterday was a very sad day. My grandad, Jack Charlton, died peacefully at home. 'He was kind, playful and genuine, and I'll miss him so much'
Sir Geoff Hurst said in his tribute: 'Another sad day for football. Jack was the type of player and person that you need in a team to win a World Cup.
'He was a great and loveable character and he will be greatly missed . The world of football and the world beyond football has lost one of the greats. RIP old friend.'
Other leading figures in football also payed tribute to the star on Saturday - a day after he passed away.
Former England striker and Match of the Day presenter Gary Lineker tweeted: 'Saddened to hear that Jack Charlton has passed away.
'World Cup winner with England, manager of probably the best ever Ireland side and a wonderfully infectious personality to boot. RIP Jack.'
The England football team tweeted: 'We are devastated by the news that Jack Charlton, a member of our World Cup-winning team of 1966, has passed away.
'Our deepest sympathies are with Jack's family, friends and former clubs.'
The victorious England team celebrate with the Jules Rimet Trophy after their World Cup victory against West Germany at Wembley Stadium. England won 4-2 after extra time. Back row (left-right): Peter Bonetti, George Eastham, Harold Shepherdson, Jack Charlton, Gordon Banks, Roger Hunt, Bobby Moore, George Cohen, Bobby Charlton. Front row: Nobby Stiles, Martin Peters and Ray Wilson
Outside Leeds's stadium, Elland Road, floral and written tributes to Charlon were left by adoring fans
Mick McCarthy was appointed Republic captain by Charlton and went on to succeed the former defender as manager of the national side in 1996.
'It's a real shock that he's passed away and I'm very, very sad,' McCarthy told talkSPORT.
'It was the happiest time of my career, he made it simple for me and I'll always remember him for that.
'I wasn't the best player in that team, nowhere near. But he saw something in me and I'll never forget him for that.'
John Aldridge, Houghton and McCarthy's former Republic team-mate, tweeted: 'Absolutely gutted that Big Jack has passed away!
'What a football man, loved and adored, specially in Ireland. The best manager I was lucky to play for.
'The times we had on and off the pitch were priceless! My thoughts are with (wife) Pat and the family! RIP my good friend. Never forgotten!'
Charlton spent his whole playing career at Leeds United and later managed the Republic of Ireland
A delighted Charlton lifts the FA Cup at Wembley after Leeds United beat Arsenal in 1972
In action for Leeds against younger brother Bobby, of Manchester United in January 1969
Paul McGrath, who played as a defender for Ireland when Charlton was manager, wrote: 'Absolutely gutted. Father figure to me for 10 years, thanks for having faith in me. Sleep well Jack, love ya.'
In a further written tribute released by the Republic of Ireland's Twitter account, McGrath added: 'I am truly heartbroken at Jack's passing. It is difficult for me to articulate what Jack meant to me both on and off the football field.
'He gave me his full support when I needed it most and for which I am forever grateful. He has been a hugely important person in my life.'
He added: 'The Irish people warmed to him because of his big character and he gave us the belief in ourselves to compete in the big tournaments.'
In another stirring tribute, John Anderson, who played under Charlton for both Newcastle and the Republic of Ireland, said his former manager was so humble that he kept his World Cup winner's medal in a coal bucket.
He said: 'I remember myself and Kenny Wharton going up to see him and, remember the World Cup coins that you used to collect with the players' faces on?
'He had a gold set of them and they were in a coal bucket, and beside them in the coal bucket was his World Cup winner's medal.
Charlton managed the Republic of Ireland for a decade and was also in charge of Middlesbrough for four years. Pictured left: Charlton during his time as Ireland manager. Right: The manager shouts encouragement at his Middlesbrough players in 1974
Charlton guided his Republic of Ireland team to the Italia 90 World Cup quarter-finals
Jack and Bobby (right) became England's greatest sporting siblings by winning the World Cup
'He didn't blink an eye. 'They're in there', he said, nodding at the coal bucket beside the fire.'
He added: 'He's held in such high esteem in Ireland, Jack. He might have been born and bred in England, but he's an honorary Irishman.
'What he did for football - and not just football, what he did for the country - was remarkable, it really was.'
Middlesbrough FC, whom Charlton managed for four years from 1973 until 1977, tweeted: 'We're deeply saddened to report the passing of Jack Charlton, one of Boro's greatest ever managers.'
Another of Charlton's former clubs, Newcastle United, tweeted: 'We are deeply saddened to learn of the passing of former NUFC manager and England World Cup winner, Jack Charlton at the age of 85. RIP, Jack. A true legend of the game.'
Lady Elsie Robson, the widow of former Ipswich, Barcelona and Newcastle manager Sir Bobby Robson and friend of Charlton, paid tribute to the former defender.
In a statement she said: 'Jack was a great friend and a wonderful supporter of our cancer charity.
'He'd come out to events and meet with fundraisers, and people were always so thrilled to meet a World Cup winner.
'He had such a way about him. He'd just make us all smile. I feel for Pat and the family after their great loss and they have our heartfelt sympathy.'
Irish Prime Minister Michael Martin was among the first to tweet his reaction.
'So saddened to hear of the passing of Jack Charlton who brought such honesty and joy to the football world.
'He personified a golden era in Irish football - the Italia 90 campaign being one of pure joy for the nation. He gave us magical memories. Thank you Jack.'
UK Prime Minister Boris Johnson added: 'Jack Charlton was a football great whose achievements brought happiness to so many. My sympathies are with his family and friends.'
Charlton made a club record 773 appearances for Leeds over a span of 21 years between 1952 and 1973 and was regarded as one of the game's finest defenders.
He helped the Yorkshire club win the second division title in 1963-64 and then the first division in 1968-69.
This successful Leeds side also won the FA Cup in 1972, the League Cup in 1968 and two Inter-Cities Fairs Cups in 1968 and 1971.
Despite not being called into the England team until days before his 30th birthday, Charlton won 35 caps and, playing alongside younger brother Bobby, lifted the Jules Rimet Trophy at Wembley in 1966.
He also helped England finish third at the 1968 European Championship and in between was voted the Football Writer's Association Footballer of the Year in 1967.
After hanging up his boots, Charlton worked as a manager, taking Middlesbrough into the top-flight in 1974 before moving on to Sheffield Wednesday and Newcastle United.
But he is fondly remembered as Ireland's manager. He led them to the quarter-finals of the 1990 World Cup and they qualified for Euro 1988 and the 1994 World Cup.