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FREE PODCAST: With Cybersecurity, People Are the Problem As threat against oil and gas operations increases, companies must take a hard look at their own security systems technology Podcast
FREE PODCAST: Calculating the Costs This week we tell you why US shale operators may be in for a rude awakening on services costs in 2017, plus a push by Lukoil and a Canadian start-up into a promising Mexican shale play Americas Shale Podcast
FREE PODCAST: Offshore Is Not Dead Yet The Bit returns in 2017 as ExxonMobil keeps finding oil off Guyana and a substantial deep-water prospect in the US Gulf gets some some new blood Americas Exploration Podcast
FREE PODCAST: Drilling Deep into the Permian Basin We take an in-depth look at who's selling and who's paying in the hottest play in the oil patch, plus an interview with West Texas legend Jim Henry, who discovered the Wolfcamp shale North America Shale Podcast
FREE PODCAST: Fractured Relationships Baker Hughes is breaking out its fracking business, Weatherford is idling its frack fleet, and Hess is taking Schlumberger to court over broken valves, this week on The Bit North America Shale Podcast
FREE PODCAST: The Trump Effect This week on The Bit, we discuss how the new US president's policies may affect domestic and international operators North America Shale Podcast
PODCAST: The New Baker Hughes We dive deep into Baker Hughes' merger with GE and try to determine who benefits most, plus an endorsement for US president, this week on The Bit North America Podcast
PODCAST: Wedge Issues This week we discuss Chesapeake Energy's latest exploration plays & update on drilling progress off Guyana Americas Shale Podcast
FREE PODCAST: Winning in the Gulf of Mexico This week we look at the winners and losers in the Gulf of Mexico as a new slate of projects take important steps forward. North America Field Development Podcast
PODCAST: First Steel and Opec Cuts This week on The Bit we get an expert's opinion on Opec's shock production cut, plus new floater projects in Brazil and a trip to McDermott's yard in Mexico. Americas
PODCAST: Going Deep in North America This week we have exclusive news on Chesapeake Energy, plus a look at the Gulf of Mexico A&D market. Americas Shale
PODCAST: Alpine High & Deepwater Lows ExxonMobil falls back to earth in Guyana, BP's shelved Hopkins project gets new life and Shell gets rolling on Stones, this week on The Bit. Americas Shale
PODCAST: International Affairs This week on The Bit we look at the state of play in Brazil post-Rousseff and discuss how Saudi Arabia is dealing with tensions in the Middle East. Americas
PODCAST: Rivers of Resources This week on The Bit we discuss two deep-water projects, Vito and Shenandoah, on the verge of big decision points, plus an update on ExxonMobil's plans in Guyana. Americas Field Development
PODCAST: Chesapeake's Barnexit This week on The Bit we look into Chesapeake's complicated exit from the Barnett shale and revisit the first frontier unconventional play to be drilled in years. Shale
PODCAST: Moving On From the Midland This week on The Bit we discuss EOG Resources' exit from the Midland basin and update on Chesapeake's Barnett shale sale and on drilling off Guyana. Americas Shale
PODCAST: Bye Bye Barnett This week on The Bit, we discuss Upstream's exclusive report on Chesapeake's attempt to sell out of the Barnett shale, and more. Americas Shale
PODCAST: Brighter Horizons This week on The Bit, we dive deep into the hottest onshore play in the US and take stock of Brazilian efforts to get its oil industry back on track. Americas Shale
PODCAST: On the Frontier This week on The Bit we look at what's next for ExxonMobil in Guyana and update on Total's wildcat off Uruguay. Americas Exploration
PODCAST: Castles Made of Sand This week we talk about what could be the best investment a shale producer can make and look at new opportunities off Eastern Canada. Americas Exploration


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1337haxorz wrote:just think put it on the dog to shut it up, put it on the parents to shut them up, put them on various items that annoy you around the house. Put them on ur self for super stealth PWNS put them on ur window at work if ur in a big city to shut up the cars. Put them on ur teachers secretly to be teh uber popular
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Congrats to Nicole and Tory who said "I do" at Villa del Sol in Downtown Fullerton.
Check our website for Monthly Specials!
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Congrats to Nicole and Tory who said "I do" at Villa del Sol in Downtown Fullerton.
Genise & Troy tied the knot at the beautiful Palladio Banquet Hall in Glendale.
Over the past month or so the photo booth has had quite a few furry, four-legged visitors! We think dogs enjoy the photo booth just as much as the people they photo booth with. These were not the first, nor will they be the last, but they are sure are cute and fun!
When we built our first photo booth a couple years ago, we set it up in our living room (just to fine tune it, of course). We just couldn't help taking a few series of photos with our dog and cat, Rosco and Sully. Those photos ended up being our Christmas card that year! It's always fun to reminisce…
As long as people are planning events, we will continue to bring the fun to all!


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Presented by Ballet Etudes
Join us as we celebrate our 30th annual production of The Nutcracker! Let Clara's magical journey surround you as she encounters life-size mice, swirling snowflakes, dancing confections and the Sugar Plum Fairy. A feast for the eyes and ears with colorful and imaginative costumes paired with Tchaikovsky's original score, Ballet Etudes' 30th annual production of The Nutcracker is the perfect way to celebrate the holiday season with the entire family. Backstage tours are available following most performances.
A discount of 20% off will be given to groups of 10 or more.


text: The design of the wedding ring for the bride and also the groom often is the identical or different. The bride may have the same design with the groom. Each of the wedding rings are in the same model and kind, however solely totally different within the size. Or it could be totally different because the curiosity of the bride and the groom. Generally, the models of the Wedding Engagement Rings Pair are unique. Some brides and grooms have totally different model and design of their wedding ceremony ring, however bith the rings are still associated each other, similar to kind a special thing if both rings are gathered. The unique design of the ring is the result of the event within the world. The designers of the wedding rings at all times design and create modern wedding ceremony ring for his or her customers.


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Universal remote controls : RC-5 protocol scheme
I want to know the RC-5 protocol scheme for universal remote controls.
If the selected device will be changed, then whether the 5-bit system address will in the RC-5 protocol will change according to the device?
I have some cusom requirement..
We have "n" number of application boards which will be controlled by an IR remote..
Due to the interference all the systems are responding to all the remotes..
I want to to know whether universal remotes could help us out..
Using universal remotes we are planning to control the application boards depending on the universal remote`s device code.
With Regards,
Hariprasad BhatLast edited by hariprasadb; 02-21-2014 at 08:01 AM. Reason: elaborating the reason
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Juba, South Sudan: A 13-month-old baby and a man were the only survivors after a cargo planecrashed soon after taking off from a South Sudan airport, killing 37 people, a witness and relatives said on Thursday.
Stephen Warikozi, who heads South Sudan's Civil Aviation Authority, said the plane was not authorised to carry passengers.
More World News Videos
Infant survives South Sudan plane crash
One of only two known survivors of the crash, baby Nylon Thong was pulled from the wreckage which left 37 people dead.
He told The Associated Press that the captain of the Antonov An-12 informed the control tower at Juba International Airport before taking off on Wednesday that he had 12 passengers and six crew members. There were believed to be even more people aboard the flight than those cited by the captain.
Achol Deng, a presenter for the South Sudanese State television who was among the first to reach the scene of the wreckage, said she found the surviving infant near the wreckage lying on the chest of an unconscious man also injured in the crash. Ms Deng said she and others helped bring the baby to a hospital for care.
"It was like an intervention by God," Ms Deng said, though her version could not be independently verified.
After he regained consciousness the man, who suffered severe injuries to his head, arms, and legs, said he used his body to shield the infant during the crash, Ms Deng said.
The infant, named Nyalou, survived with a broken leg and a wound to her forehead. Her mother and older sister perished, according to the father, Thong Deng, who flew to Juba from his home in Paloch after hearing of the incident.
Mr Warikozi said the plane's cargo capacity was 15.5 tons and that, according to the cargo manifest, the plane was carrying its maximum capacity for cargo.
The plane crashed near the Nile River soon after taking off. It had been bound for the Paloch oilfields.
Minister of Transportation Kuong Danhier Gatluak said the known death toll is now 37, up from 36. He said no more bodies were found at the site yet and attributed the change to a recount of the bodies and body parts at the hospital where they were brought.
The UN mission in South Sudan said it has provided a diving team to search the River Nile adjacent to the crash site and an engineering team to support efforts to cut open or remove debris, Mr Gatluak said.
The Soviet-made Antonov plane was registered in Tajikistan and belonged to Allied Services Ltd, said Ateny Wek Ateny, a spokesman for South Sudanese President Salva Kiir.


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Abt Card
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Average Customer Reviews
Only the new Sharp AQUOS 60" Silver UHD 4K LED Smart HDTV - LC-60N7000U can deliver cutting-edge technology that brings breathtaking color and definition to all of your favorite TV shows, movies and streaming content. This 60" 4K, HDR-enabled TV is even capable of making content that is not 4K-quality look amazing. This is possible because of Sharp's Revelation™ Upscaler software that works by manipulating the picture to bring the best out of every pixel, so you get a sharp, clear image no matter what the source. Even fast action sequences are crisp and smooth, thanks to AquoMotion™ technology. Not to mention, you'll see it all on a big bright 60 inch screen.
In addition, streaming 4K content is simple with the built-in 4K media player and receiver. Its improved clarity and higher resolution truly allow you to view 4K movies and videos like never before. The LC-60N7000U also includes built-in apps that stream movies and TV shows the whole family can enjoy. Pick from popular platforms such as Netflix and Hulu, or browse the app store for games to download and play instantly. Shop the all new Sharp AQUOS 60" Silver UHD 4K LED Smart HDTV today at Abt.
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(0 of 1 customers found this review helpful)
I like the color and picture,on tv ,Custmer service good.
By Mel
from Bellflower California
Comments about Sharp AQUOS 60" Silver UHD 4K LED Smart HDTV:
I like the service
Service and delivery comments:
Service was good I would recommend to other family and friends
Great TV for the money
By David Z
from Keansburg, NJ
Great TV for the money. Crisp graphics and 4K content is amazing. User friendly interface. Silver color looks great and different from all black TVs on the market, compliments the room.
40 ears of Sharp Satisfaction
By raintree
from Baton Rouge, La.
Hopefully, like in the past, this will be a trouble-free product.
Excellent delivery.
(0 of 2 customers found this review helpful)
Not that great
By TS
from Barto, PA
Bought this TV hoping to centralize one place for apps and casting in order to eliminate FireStick and Chromecast. This TV is very sensitive to slow internet connections and streaming is for the most part not possible without video pausing. Streaming thru FireStick works fine (connected to this TV) and casting with Chromecast easier to use than casting built into this TV.
no issues
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We believe in a peaceful world where all people share a safe, just and dignified life.
We believe that we all have a responsibility to take action for a better world. Joining thousands working together to make a difference.
The true impact of war – it's toll on mothers, fathers, sons and daughters – often goes unreported in the mainstream media. Our 24hr headlines and sound bites report events but don't tell the human stories behind those events. Australian photojournalist, Tracey Shelton, wants people in Australia and around the world to do all they can to support people affected by conflict. And she believes that the best way to inspire them to act is to tell the human stories of people caught up in these devastating situations.
Tracey faces daily dangers in order to give a voice to vulnerable people. Most recently, she travelled to Iraq, risking her own life to help those fleeing the Islamic State (IS) to share their stories.
A 15-year-old girl, named Sara*, had considered giving up on her life many times during her monthlong ordeal with IS. The old man she had been given to as a 'gift' beat her frequently. He taunted her with videos of Islamic State militants beheading her neighbours. He even drew blood from her arm to make her weak so she couldn't fight back. Sitting in a makeshift camp for the displaced outside Duhok, Sara told Tracey, "They didn't feed us much. I used to pass out a lot, but I would make trouble for him as much as possible and fight when I could. Many times I thought of giving up but I kept thinking of my family and my brother. I lived only for them."
Sara was fortunate enough to escape her captors when skirmishes between IS fighters and the Kurdish army gave her and a few others a chance to run away.
Tracey met Sara in August last year while on a freelance assignment for Act for Peace's partner in Iraq, Christian Aid. She felt it was her responsibility to share her story with the world.
Tracey believes that if Australians could meet Sara through images and video they would want to help. Tracey returned to Australia to share not only Sara's story but many other heartbreaking first hand accounts of families and communities ravaged by war and living in fear of IS.
As an award winning freelance photojournalist, Tracey has made the tough choice to turn away from a relatively safe career reporting on domestic issues for Australia's leading media outlets. Instead Tracey has decided to risk her life overseas to report in some of the world's worst conflict situations. She believes it is a choice that needed to be made in order to share the stories of those who often remain voiceless.
Tracey was once tied up and brutally beaten in her hotel room in Benghazi, Libya, during an attempted kidnapping. She is well aware of the persistent dangers facing journalists. Even with the ongoing risks associated with her job, Tracey says it's her responsibility to do all that she can to tell the stories that need to be shared.
Since returning to Australia, Tracey says it's not the news cycle that drives her but the need to bring some humanity to war. Her reports on the situation in Iraq have had a tremendous impact on how people have viewed the conflict. By bringing a face and a voice to vulnerable people she has helped Australians connect with the situation and be inspired to help.
At least 39 journalists are currently missing around the world. Sixty-three cases of kidnapping were reported in 2013 alone.
* Names have been changed for safety reasons
In July you responded to the crisis in Iraq generously and with compassion and continued to show your support to those fleeing violence.
Since then you have raised over $64,000 for the appeal. Thank you. Through our partner on the ground, Christian Aid, you have helped to provide food parcels, clothing, hygiene kits, blankets, psychosocial support and cooking sets. Two refugee camps have been established in Erbil and Dohuk and with your help we are providing a safe environment and much needed shelter to displaced families who have escaped from the persecution of IS.
Find out more or to give to the Iraq Crisis appeal here
Iraq Crisis Appeal
You can help prevent children like Maala being born with chronic illnesses by helping pregnant women stay healthy and nourished in the first place.
Take the Act for Peace Ration Challenge and eat the same rations as a Syrian refugee during Refugee Week (June 2017). Raise money to support refugees who have lost everything, and challenge perspectives – including your own.
Right now, thousands of innocent people are fleeing Syria every day to protect their families from bloodshed, violence and death. We need your support to provide emergency relief packs to the families fleeing in Syria.
Act for Peace is a member of the Australian Council for International Development (ACFID) and a signatory to the ACFID Code of Conduct, which commits international aid and development organisations to good standards of governance, transparency, accountability and effectiveness.
Act for Peace is a member of the ACT Alliance, a global network of grass-roots aid organisations working together in over 140 countries. Together we mobilise about $1.5 billion each year to create positive and sustainable change in the lives of poor and marginalised people regardless of their religion, politics, gender, sexual orientation, race or nationality in keeping with the highest international codes and standards.
Act for Peace gratefully acknowledges the support of the Australian Government.


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Firefox For Nokia N900 Final Version Released
The Firefox final version for Maemo out now. Grab your copy Now 😀
Firefox for mobile is packed with your favorite features, including:
- Awesome Bar – Go to your favorite sites in just a couple of keystrokes with intelligent and personalized searching
- Weave Sync – Sync your Firefox tabs, history, bookmarks and passwords between your desktop and mobile device for a seamless browsing experience
- Add-ons – Customize your Firefox by adding small pieces of functionality, like games and news readers, that help make the mobile Web browser your own
- Location-Aware Browsing – Get maps and information relevant to your location
- Tabbed browsing – View open tabs as thumbnails to easily identify and select the Web page you'd like to go to next
- Safe Browsing – Get an Instant Web Site ID and easily access and edit security settings
- Available in more than 30 languages and counting
Firefox is the first mobile Web browser to support add-ons. With add-ons, you can customize your Firefox by adding features that help make your browser your own. Add-ons like AdBlock Plus, URL Fixer, TwitterBar, language translators, and geo guides become especially handy when you're out and about on your mobile device. You can both discover and install add-ons directly from your Nokia N900. There are currently more than 40 Firefox add-ons available for mobile and the number is growing every day.
We strongly recommend that you install the YouTube Enabler add-on from within the Add-ons Manager. Tap on the install button, restart Firefox, and you're all set to watch YouTube videos.
Firefox is currently supported on Nokia's Maemo5 platform and is available for download on the Nokia N900. Users can download and learn more by visiting Firefox.com/mobile.
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Warning: Spoiler! (Click to show)
The only good thing I can say about the movie is that I didn't totally hate Rey or Darth Doofus.
Now, real spoilers:
Warning: Spoiler! (Click to show)
And the movie was so ridiculously politically correct, I expect that Finn is going to come back in the next one as the first disabled Star Wars character. Maybe he'll come out as gay, too.
ETA: and a space map--with a path? Was it for a scavenger hunt or something? And no one thought to look at R2D2 while he'd been sitting there in the corner turned off for years? Or turn the shields back on for half an hour after the good guys had left the controls? Or send more than three people -- an old guy, a wounded monster, and some turncoat you've just met? Ugh. I could go on and on.


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The Forestry Commission have worked in partnership for over 12 years with the Land Trust to manage a portfolio of 7 South Yorkshire Community Woodlands; Bentley Community Woodland; Brodsworth Community Woodland; Cudworth Common/ Ferrymoor Flash; Dinnington Community Woodland; Kiveton Community Woodland; Phoenix Park and New Park Springs.
From the 1st October 2016 The Forestry Commission will no longer manage these sites. The new site managers will be TCV (The Conservation Vol...unteers) The Land Trust will remain the land owners.
Our involvement in helping to create these woodlands and provide expert knowledge in forestry and sustainable land management started over 15 years ago when Yorkshire Forward and the Homes and Communities Agency started to look at South Yorkshire for possible sites to turn derelict land into community open spaces. The South Yorkshire Community Woodlands were then born, in 2003 when Phoenix Park, Bentley and Brodsworth were planted. The newly formed organisation of The Land Restoration Trust in 2004 took on the ownership of these sites to hold them in perpetuity of the local communities.
The Forestry Commission continued to manage these sites on behalf of the Land Trust, taking on a further 5 sites over the next 3 years.
The Forestry Commission are immensely proud to have been involved in the development of these sites for such a long time. We helped take them from black ex-colliery spoil heaps, helped to landscape and plant them and watched them grow into maturing woodlands, full of wildlife and flora. The whole team have enjoyed working to develop these sites and an extensive range of community, learning, health and volunteering projects over this time. We've had such great support and involvement from the local communities; we really couldn't have done it without you.
So a BIG thank you to everyone who has attended an event, walked, run or cycled on site, volunteered and made us laugh over the years!
We really hope you continue to enjoy them and offer TCV and The Land Trust the fantastic support you have given us.
What do other visitors say?
5 StarsBrendan Keenan , 22/Nov/2016Stunning views and to our delight the deers are a great surprise
5 StarsDr dave gibson, 7/Sep/2016I visited the old brosworth pit tip some years ago on my bike but returned today. Wow ! What a transformation with the new mixed woodland ! Please pass on my appreciation for all those involved - such a transformation !! I could almost suggest a new campsite !! Please please let the officers / ground workers involved that their efforts have been fantastic - I've known this area for 50 years and went down t' pit at school - ridge-wood - I have worked in woodlands and built a surgery over 20 years ago and still live fairly locally. Their efforts have come to fruition - much gracios !!
4 StarsAnonymous, 17/Aug/2016I love this area and visit it daily with my dog.
The problem with scramble b ones and quads continues and despite numerous calls to 101 have only managed to get through once! (And that was too late)!
Could do with some doggie waste bins as well please.
But the area is lovely different woodland trees shrubs and plants and plenty of wildlife if you look for it.
Please tell us about your visit
Please email us at email@example.com if you have an enquiry, a complaint or would like a personal reply to your comments.


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Beyoncé Shines with Bruno Mars in Super Bowl 50 Halftime ShowBeyoncé shined on the biggest stage, providing a powerful encore to her 2012 Super Bowl halftime show that killed power in New Orleans.
Coldplay, Beyoncé, Bruno Mars Rock Halftime ShowColdplay, Beyonce and Bruno Mars rocked the Super Bowl 50 halftime show, collaborating for a special concert for the ages.
Top 2015 Music Festivals in the U.S.A look at five of the best upcoming music festivals from across the country
Supercut Video Has Pres. Obama Singing 'Uptown Funk'The YouTube account that is fond of creating supercuts of President Barack Obama's speeches, making it seem like he's singing popular songs like "Call Me Maybe" and "Born This Way," has struck again.
GRAMMY Power Rankings 2013: The Fiercest CompetitorsWho will walk away with GRAMMY gold at the 56th Annual awards? We rank the top 20 nominees.
Report: Bruno Mars to Perform Super Bowl Halftime ShowA person familiar with Super Bowl entertainment plans tells The Associated Press that Grammy-winner Bruno Mars will perform at halftime of February's NFL championship game.
GRAMMYs® Add Bruno Mars, Sting and Rihanna Collaboration
Hunter Hayes: GRAMMY® Winners Playlist
Download The Complete List Of 2012 Grammy Nominees Now!Here are the nominations for the 2012 Grammy Awards, to air on CBS Sunday, February 12.
Bruce Springsteen And The E Street Band Will Play At GrammysBruce Springsteen and the E Street Band will play the 54th Annual Grammy Awards, February 12 on CBS.
Katy Perry To Make Her First Post-Split Appearance At The Grammy AwardsKaty Perry is expected to perform at the 54th Annual Grammy Awards on Feb. 12, marking the singer's first public appearance since her highly publicized split from Russell Brand.
Rapper K'Naan Upset Mitt Romney Used His Song Rapper K'Naan is upset that Republican presidential candidate Mitt Romney used his song "Wavin' Flag" during his Florida primary victory speech.


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How do we sharpen our digital strategy, empower our people, improve our processes and take better advantage of eZ software?
eZ Conference 2017 unites practitioners in digital strategy, marketing and engineering to share, learn and network.
Watch the highlights below and visit the eZ Blog to read our recap, download the presentations and more.
This year's conference offers general sessions and Business and Technical Tracks to match your interests.
Want to speak at this year's conference?
Download, fill out and submit this form
Download formDeadline: March 31, 2017
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eZ is an open source content management system provider that helps businesses maximize the value of their content. Fueled by over 15 years of organic growth, our software gives you the tools to create, deliver and optimize digital experiences.


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ADA protein (His tag) (80R-1874)
Purified recombinant ADA protein
Synonyms | ADA1 protein, Adenosine aminohydrolase protein |
Species | Human |
Protein Type | Recombinant |
Applications | SDS-PAGE |
Coomassie Blue stained SDS-PAGE of ADA protein (His tag) (80R-1874)
Figure annotation denotes ug of protein loaded and % gel used.
Residues | 1-363 amino acids: MGSSHHHHHH SSGLVPRGSH MAQTPAFDKP KVELHVHLDG SIKPETILYY GRRRGIALPA NTAEGLLNVI GMDKPLTLPD FLAKFDYYMP AIAGCREAIK RIAYEFVEMK AKEGVVYVEV RYSPHLLANS KVEPIPWNQA EGDLTPDEVV ALVGQGLQEG ERDFGVKARS ILCCMRHQPN WSPKVVELCK KYQQQTVVAI DLAGDETIPG SSLLPGHVQA YQEAVKSGIH RTVHAGEVGS AEVVKEAVDI LKTERLGHGY HTLEDQALYN RLRQENMHFE ICPWSSYLTG AWKPDTEHAV IRLKNDQANY SLNTDDPLIF KSTLDTDYQM TKRDMGFTEE EFKRLNINAA KSSFLPEDEK RELLDLLYKA YGMPPSASAG QNL |
Expression System | E.coli |
Grade & Purity | > 85% pure |
Molecular Weight | 42.9 kDa (383aa), confirmed by MALDI-TOF |
Tag/Conjugate | His tag |
Form & Buffer | Supplied as a liquid in 20mM Tris-HCl buffer, pH 8.0, containing 20% glycerol and 1mM DTT. |
Concentration | 0.5 mg/ml |
Usage & Assay Information
Bioactivity | Specific activity: approximately >25 units/mg. Enzymatic activity was confirmed by measuring the amount of enzyme that deaminates 1.0 uM of adenosine to inosine per minute at pH 7.5 at 25 DEG C. |
Storage & Safety
Storage | Store at 4 deg C for short term storage (1/2 weeks). Aliquot and store at -20 deg C or - 70 deg C for long term storage. Avoid repeated freeze/thaw cycles. |
General Information
Biological Significance | ADA, also known as adenosine deaminase, catalyzes the hydrolytic deamination of adenosine and 2-deoxyadenosine. This protein plays an important role in purine metabolism and in adenosine homeostasis. ADA acts as a positive regulator of T-cell coactivation, by binding DPP4. Its interaction with DPP4 regulates lymphocyte-epithelial cell adhesion. Recombinant human ADA protein, fused to His-tag at N-terminus, was expressed in E. coli and purified by using conventional chromatography. |
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Trim out a slab door with poplar boards to create a hidden passage disguised as a paneled accent wall. Under stairs storage, ideas for the basement stairs some day. For basement flanking the stairs – bookshelf walls with hidden access door to under closet storage and water softener More.
Secret Room Bookcase Door Under Stairs. storage in loft could have play area. Hidden Door understairs cupboard. Great storage idea. Fun hiding place. Back again to the idea of all that usable space under the stairs. Houzz.com – Under Stairs Doors design ideas and photos.
Smart Product Technology makes a kit to turn several of your bottom stairs into a hidden lift-up door. This kit allows you to reach the area underneath the stairs, or space inside the actual framing of the stairs. Stairs Hidden Under Other Stairs. By Chad King on August 18, 2014 in Stash Pics. Josh has wanted to have a secret room his entire life, and with their first child on his way soon, the recent renovation was the perfect way to make it happen. At the top of the page under here's what you'll need. One of the possibilities is to have a secret space under the staircase. It could be accessed via a camouflaged door concealed by stripes or a different pattern.
Hidden Doors & Spaces On Pinterest
Check out some of the coolest examples of secret doors that we've gathered for you and don't tell us that you never wished you had such rooms. Staircase Hidden Door. Instructables website shares how to build a hidden room under your home's stair for storage. It is has a hidden door inside a recessed shelves to that can display your treasured nick nacks, books or your children' artful masterpieces. 2 Stairway hidden behind secret bookcase doors in a traditional home. A: Because secret rooms are awwwweeesooome. Cozy guest bed tucked under an eave:. This is a Powder Room tucked under the stairs on a 1940's house we remodeled with Hugh Jefferson Randolph Architects. Under the stairs marked on the map with A. You have to shoot the lock from here.
This wastes a lot of space under the stairs though. This could be turned into a small secret room which is perfect for kids. The entrance could be covered by a bookcase or secret panel door which doesn t look obvious to the untrained eye. Hidden Room Under Staircase – Design photos, ideas and inspiration. Amazing gallery of interior design and decorating ideas of Hidden Room Under Staircase in entrances/foyers, living rooms, girl's rooms, bathrooms, basements, dens/libraries/offices by elite interior designers. Foyer features under the stairs powder room with hidden door. Curtis and Windham. That movable bookshelf revealed a secret staircase. Hidden Gun Storage Under Stairs StashVault. 0; 0; 0.


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The Environment Agency is giving water companies "a licence to pollute" by allowing thousands of "unregulated" overflow pipes to dump sewage into rivers and coastal waters, according to the Marine Conservation Society.
The charity said about 3,500 combined sewer overflows (CSOs), which act as a flood-release mechanism for sewers carrying both sewage and storm water, were in urgent need of review.
It said they have not been properly investigated since being given temporary consent in the run-up to the privatisation of the water companies in 1989.
Coastal pollution officer Thomas Bell said: "There's an obligation on the Environment Agency to have to review these combined sewer overflows.
"The problem is that the sewer system was designed for a climate which is different from the one we have got now.
"Because of the effects of climate change we are having a lot more rain.
"The combined sewer overflows are starting to discharge a lot more often than they should. Their environmental impact is greatly increasing.
"It amounts effectively to a licence to pollute, because there are no restrictions on how much and how often these pipes can discharge."
Among the 3,500 outlets are those flowing into the North Sea, the River Don in South Yorkshire and to a popular Devon beach.
Mr Bell continued: "What we want to see is these 3,500 pipes reviewed quickly so that if any of them are causing serious environmental problems it can be dealt with.
"What we would like to see from the courts are greater fines handed out to water companies for pollution offences."
He also said the combined sewer overflows should be improved to include mechanisms to show how much affluence they are discharging and when.
The Environment Agency said the pipes were designed to operate in times of extreme rainfall.
A spokeswoman said: "We have identified around 3,500 remaining temporary consents for CSO discharges.
"These are mainly for storm overflows that are operating without causing problems.
"As you'd expect, our priority has always been to focus on those consents that are a problem.
"We expect companies to be proactive in identifying intermittent discharges, such as CSO and emergency overflows from pumping stations that are at risk of becoming unsatisfactory."
She added: "The 2007 bathing water quality results announced by Government in November 2007 showed 405 out of 414 bathing water sites in England monitored by the Environment Agency met the mandatory standard demanded under the Bathing Water Directive - a compliance rate of 97.8 per cent."
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Are you tired of all this online stuff? Experimental Musical Instruments has a 24-plus-page print catalog. It's not as extensive as this web site, but it does have all the pertinent information on what we have available and how to get it. We update this catalog regularly and are trying to spread it around to those people (and there are many) who aren't crazy about looking at the glowing screen all the time. If you'd like a copy, send us your name and address and we'll put one in the mail to you.
Experimental Musical Instruments Catalog in Print
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Feeding Pogonomyrmex Californicus??
Feeding Pogonomyrmex Californicus??
What do I feed my queen Pogonomyrmex Californicus during her founding stage she made her hole but not sure wether she has layer eggs or not but she often goes out I think to search for food I placed grass seeds in a corner but she hasent even touched them it's been a week
Re: Feeding Pogonomyrmex Californicus??
If she's a semi-claustral queen she probably wants either honey/sugar water or more likely insects (try fruit flies or mealworm parts if you have or a cricket/grasshopper leg, but do NOT feed insects that could have had contact with pesticides, you don't want to poison your queen).
"We should respect all forms of consciousness. The body is just a vessel, a mere hull."
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Last year, Bollywood Hungama had reported that Ayushmann Khurrana and Bhumi Pednekar will be seen in a love story titled Manmarziyan, that's being directed by Sameer Sharma and produced by Aanand L. Rai.
The latest update of the film is that producer Aanand L. Rai has replaced the director of the film Sameer Sharma and the film will now be directed by Ashwini Iyer Tiwari. The reason cited (as per the reports) for the replacement of Sameer Sharma is said to be 'creative differences' with Rai. Ashwini Iyer Tiwari is the debutante director who makes her directorial debut with Nil Battey Sannata this week.
Watch this space for more developments.
This article:
Ashwini Iyer Tiwari replaces Sameer Sharma as the director of Manmarziyan


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From: John Levon <levon@mo...> - 2003-04-21 19:53:28
On Mon, Apr 21, 2003 at 09:49:46PM +0000, Philippe Elie wrote: > you asked to use tgid in the implementation, either we use tgid > in implementation and user interface either pid OK, tgid it is. But I'm not sure you followed my point. pp_interface currently says : 3.15 pid: <pidlist> Comma list of pid's to consider. This defines a thread group including all child threads (task->tgid) FIXME: tgid should also be accepted for this ? which is inconsistent with the merge spec. So we should have : 3.15 tgid: <tgidlist> Comm list of tgid's to consider. right ? regards, john |


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Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.
INTRODUCTION — Posttraumatic stress disorder (PTSD) in children and adolescents is a severe, often chronic, and impairing mental disorder. PTSD is seen in some children (and not others) after exposure to traumatic experiences involving actual or threatened injury to themselves or others.
PTSD is characterized by intrusive thoughts and reminders of the traumatic experience(s), avoidance of trauma reminders, negative mood and cognitions related to the traumatic experience(s), and physiological hyperarousal that lead to significant social, school, and interpersonal problems. PTSD can occur even in toddlers (one to two years old) [1,2].
This topic will address psychosocial treatment of PTSD in children, including early intervention to prevent the development of PTSD. The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of PTSD in children are addressed separately, as are acute stress disorder and PTSD in adults. (See "Posttraumatic stress disorder in children: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis" and "Psychotherapy for posttraumatic stress disorder in adults" and "Pharmacotherapy for posttraumatic stress disorder in adults" and "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Treatment of acute stress disorder in adults" and "Dissociative aspects of posttraumatic stress disorder: Epidemiology, clinical manifestations, assessment, and diagnosis".)
TRAUMA-FOCUSED PSYCHOTHERAPIES — Several trauma-focused psychotherapy models have been found to be efficacious in the treatment of posttraumatic stress disorder (PTSD) or PTSD symptoms beneath the diagnostic threshold for the disorder [3,4]. These interventions include individual and group models, as well as models tailored to meet the needs of specific subgroups.
Mechanisms of treatment — PTSD is conceptualized as a disorder of fear conditioning that is both overgeneralized and fails to extinguish normally. Biological, learning, and social/environmental factors are implicated in the development and maintenance of child PTSD, suggesting the need for nuanced approaches to treatment.
Trauma elicits strong emotional responses (eg, fear, anger). Through operant conditioning, children associate other stimuli (eg, people, places, smells, or internal feelings) that were present at the time of the trauma ("trauma reminders") with those highly negative emotional responses. In an attempt to avoid these negative emotions, children avoid these trauma reminders [5].
Individual Trauma-Focused CBT — Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) for children and adolescents with PTSD is a parallel child and parent or primary caregiver treatment model that incorporates cognitive-behavioral, developmental, neurobiological, attachment, family, and empowerment principles. Goals include helping children and parents gain resiliency and coping skills, master learned and over-generalized avoidance of feared trauma memories, make more adaptive meaning of traumatic experiences, and resume optimal developmental trajectories. The efficacy of TF-CBT is described below. (See 'Efficacy' below.)
Children with trauma-related symptoms can benefit from trauma-focused psychotherapy whether or not they meet diagnostic criteria for PTSD.
Phases and components — TF-CBT is comprised of multiple components and is provided in three phases. Within each treatment session, therapy is provided in individual, parallel sessions to the child and the parent (or caregiver, hereafter "parent"), and in conjoint child-parent sessions as described below.
●The first, stabilization phase, includes the following components: psychoeducation, parenting skills, relaxation skills, affect modulation skills, and cognitive processing skills.
●The second, trauma narration and processing phase, includes only one component, which takes several sessions.
●The third, integration and consolidation phase, includes the following components: in vivo mastery, conjoint child-parent sessions, and enhancing safety.
The components of the three phases, which spell out the acronym "PRACTICE," are briefly described below:
●Psychoeducation – Information is provided about the connection between the child's past (or ongoing) trauma experiences, trauma reminders, and the child's presenting trauma symptoms, as well as information about the commonality of these responses following trauma.
●Parenting skills – Effective parenting strategies are provided and practiced with the parent. These include skills such as praise, selective attention, and using functional behavioral analysis (eg, changing antecedents and consequences) to effectively manage behavioral trauma impact.
●Relaxation skills – Relaxation strategies (eg, focused breathing, progressive muscle relaxation, exercise, visualization) are provided, individualized, and practiced to reverse physiological trauma impact, including in response to trauma reminders.
●Affect modulation skills – Feeling identification and modulation skills (eg, verbal expression of negative feelings, seeking social support, positive distraction strategies, problem solving) are provided, individualized, and practiced, including in response to trauma reminders.
●Cognitive processing skills – Identifying relationships among general negative thought patterns (eg, "I don't have any friends"), negative feelings (eg, angry), and behaviors (eg, fighting with peers), and learning to generate more accurate or helpful thoughts (eg, "Jesse likes me") in order to feel better (eg, less mad) and behave differently (eg, ask Jesse to play at recess). These skills help children and parents to gain mastery over many negative feelings and behaviors and prepare them for more specific trauma-related cognitive processing in the next phase.
●Trauma narration and processing – During this phase, the therapist helps the child to develop a detailed narrative of his or her personal trauma experiences and to cognitively process these experiences using the skills described above. This component is an interactive, therapeutic process that occurs between the therapist and child (and between the therapist and parent, as the therapist shares the content of the child's narrative with the parent). It is believed that PTSD symptoms (eg, avoidance, negative cognitions, negative feelings, and negative behaviors) are diminished through expressing trauma-related information and addressing maladaptive cognitions related to this material.
●In vivo mastery of trauma reminders – For children who have over-generalized fear of trauma-related stimuli in the environment (eg, avoid the bathroom or bedroom where past abuse occurred but that is now safe; avoid attending school where they were previously bullied but are now safe), in vivo exposure is used to gain adaptive functioning.
●Conjoint child-parent sessions – Several conjoint child-parent sessions are included to enhance direct child-parent communication about trauma (eg, sharing the child's trauma narrative directly with the parent, safety planning, and other individualized issues).
●Enhancing safety – Trauma entails disruption of safety; reconstituting the child's actual and sense of safety is critical for recovery. Safety skills appropriate to the child's developmental level and living circumstances are provided and practiced with child and parent.
Efficacy — More than 15 clinical trials have compared TF-CBT with active treatments or controls for PTSD in children, with meta-analysis finding that TF-CBT reduced PTSD symptoms compared with controls [6-11]. Findings for improvement in associated symptoms (ie, depression, anxiety, behavior problems, maladaptive cognitions, and parental difficulties) have shown some variation but have been mostly positive. As an example, a meta-analysis of three trials with a total of 98 youth with PTSD found CBT led to reduced PTSD symptoms one month after treatment compared with controls (standard mean difference = -1.34, 95% CI -1.79 to -0.89) [3]. Clinical trials have shown efficacy for children exposed to sexual abuse, domestic violence, war, and multiple or complex trauma [7-13].
As an example, the largest randomized trial was a multi-site trial of 220 children (ages 8 to 14 years) with symptoms in each cluster of DSM-IV-TR diagnostic criteria for PTSD, and a history of multiple traumas (mean = 3.4) including an index trauma of validated sexual abuse. Subjects were randomly assigned to receive 12 sessions of TF-CBT or Child Centered Therapy (CCT), both provided weekly to child and parent. At the end of treatment, the TF-CBT group experienced reductions in PTSD symptoms and in the proportion meeting diagnostic criteria for PTSD, compared with the CCT group; effect sizes were medium to large [8].
Administration — TF-CBT is typically provided once weekly during hourly sessions for a duration of 12 to 25 sessions. Other components are described above. (See 'Phases and components' above.)
Clinicians typically monitor children's responses to treatment through children's PTSD self-reports. This is best accomplished in clinical practice using a self-report instrument such as the Child PTSD Symptom Scale or, for young children, the parent report instrument Young Children's PTSD Checklist.
Individual TF-CBT has been modified to treat groups of children with PTSD and to treat preschool-aged children. (See 'Other group CBT interventions' below and 'Therapies for preschool children' below.)
Availability — TF-CBT is available in all of the United States. It has been implemented internationally, yet availability varies widely and efforts to scale up dissemination and implementation continue.
Therapists certified as trained in the delivery of TF-CBT are listed at tfcbt.org.
Training — Materials for clinician training in TF-CBT include information online, books, and manuals [14,15].
A free introductory web-based course is available at www.musc.edu/tfcbt.
Standard TF-CBT training includes the following required elements: two-day face-to-face training with an approved TF-CBT trainer and 12 consultation calls (typically twice monthly for six months), or participation in an approved TF-CBT learning collaborative. Training in the United States is available from the National Child Traumatic Stress Network at www.nctsn.org.
Efforts are underway to disseminate a validated model for training lay counselors in low-resource countries [16].
Other individual trauma-focused therapies — Other trauma-focused therapies based on cognitive and/or behavioral principles and supported by at least one clinical trial in youth with PTSD or PTSD symptoms are described below:
●Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) – CPC-CBT differs from TF-CBT in that it includes parents who perpetrated physical abuse. CPC-CBT includes the following elements along with the components of TF-CBT [17]:
•A stronger focus on developing noncoercive parenting skills.
•Joint parent-child meetings during every session.
•Abuse clarification – The abusive parent takes full responsibility for the past abuse, alleviates any child blame, and addresses other child's maladaptive cognitions related to the abuse.
A clinical trial in physically abused children and their abusive parents compared CPC-CBT provided to child and to parent with cognitive therapy provided to parents alone. At the end of treatment, the CPC-CBT group had greater reductions in children's PTSD symptoms and better parenting practices compared with the parent cognitive therapy group, with a medium effect size [17].
●Trauma Affect Regulation: Guide for Education and Therapy (TARGET) – TARGET differs from TF-CBT in that TARGET is specifically for teens with complex trauma, whereas TF-CBT is applicable for broader ages and trauma types. TARGET may have specific applicability for the juvenile justice population.
A clinical trial randomly assigned 59 delinquent girls (age 13 to 17 years) with full or partial PTSD to TARGET or relational supportive therapy [18]. TARGET was superior to relational supportive psychotherapy for improving PTSD symptoms, the main outcome (medium effect sizes), as well as anxiety symptoms (small effect size) in this population, while relational therapy was superior for improving hope (medium effect size) and anger (small effect size).
●Eye movement desensitization and reprocessing (EMDR) – EMDR differs from TF-CBT in that [19]:
•EMDR incorporates saccadic eye movements during exposure.
•The trauma narrative is completed differently in EMDR: The child imagines a scene from the trauma, focusing on the accompanying cognition and arousal, while tracking the movement of the therapist's fingers in the child's visual field.
•Parental involvement is optional in EMDR.
•The duration of treatment is generally shorter for EMDR (approximately eight sessions) than TF-CBT (8 to 24 sessions).
Two well-designed clinical trials of EMDR in children have shown mixed results:
•A clinical trial randomly assigned 33 youth ages 6 to 16 years with DSM-IV PTSD from mixed traumas to EMDR or a wait list control condition. No difference in overall PTSD symptoms was seen between the two groups; EMDR was superior in improving re-experiencing symptoms (medium effect size) compared with the control group [20].
•A clinical trial in 48 children with PTSD symptoms found no difference in outcomes between EMDR and TF-CBT [21].
Other clinical trials of EMDR in children have suffered from methodologic shortcomings, including small sample sizes [22]. (See 'Comparing psychotherapies' below.)
EMDR is described further separately. (See "Psychotherapy for posttraumatic stress disorder in adults", section on 'Eye movement desensitization and reprocessing'.)
●Cognitive-Based Trauma Therapy (CBTT) – CBTT differs from TF-CBT in that it does not include relaxation and has a specific focus on integrating cognitive restructuring throughout treatment.
A small clinical trial in children and adolescents with a DSM-IV-TR diagnosis of PTSD following single incident traumas found large effect sizes for improvement in PTSD, anxiety, and depressive symptoms with CBTT compared with a wait list control condition [23]. Positive effects of CBTT were partially mediated by improvements in children's maladaptive cognitions as predicted by this cognitive-based model.
●Kid Narrative Exposure Therapy (KidNET) – Adapted from adult narrative exposure therapy, this treatment differs from TF-CBT in that it primarily utilizes the trauma narration and cognitive processing components, with relatively little focus on other treatment components. This treatment is particularly applicable for children exposed to war, refugee, or migrant conditions.
A small clinical trial in 26 refugee children with PTSD found that KidNET was superior to a wait list control condition for improving PTSD symptoms and functional impairment with large effect sizes [24].
Group therapies — In schools and similar congregant settings, it is more efficient to provide trauma treatment in groups rather than individually. There are a number of models of trauma-focused group CBT that have been found to be efficacious for children with PTSD symptoms. The most extensively evaluated and disseminated is Cognitive Behavioral Interventions for Trauma in Schools.
Cognitive Behavioral Intervention for Trauma in Schools (CBITS) — CBITS is a group psychosocial treatment for children with PTSD or PTSD symptoms [25]. CBITS incorporates cognitive behavioral principles with peer support and resiliency modeling to help children overcome learned trauma avoidance and gain adaptive skills. School-based group treatment greatly expands access to mental health services.
CBITS has been developed for schoolchildren ages 10 to 15 years who have one or more disclosed traumas and PTSD or significant PTSD symptoms. Evaluation of CBITS for primary school children is underway.
Students are typically identified for inclusion in CBITS based on school screening using a PTSD self-report instrument, such as the Child PTSD Symptom Scale.
A primary trauma of child abuse or domestic violence may be a contraindication for CBITS participation in some schools, since some administrators and/or parents believe that these issues should not be addressed in the school setting.
CBITS treatment is provided over the course of 10 school-based group sessions. Groups of six to eight children meet for approximately one hour during school for weekly sessions. The contents of CBITS include the same components as TF-CBT. Children develop personal trauma narratives during two additional individual "break out" sessions that occur separately from the group sessions. Parents of each child are offered the opportunity to take part in parallel parent groups. Teachers receive education about trauma impact and management of trauma symptoms in educational settings. PTSD and depressive symptoms are typically monitored at pre- and posttreatment for improvement using self-report instruments.
CBITS has been shown to be efficacious when delivered by trained school-based mental health clinicians in one large clinical trial and two quasi-randomized studies [19,26,27]. In one randomized trial, 126 sixth-grade students who reported exposure to violence and had PTSD symptoms were randomized to receive a 10-session CBITS group treatment or to a wait list control [26]. After three months, CBITS students had significantly greater improvement in PTSD symptoms than those assigned to the wait list condition; after treatment, the CBITS group mean scores were in the nonclinical range, whereas mean scores for the wait list group remained in the clinical range (large effect size). Significantly lower scores in the intervention group were also seen for depression and psychosocial dysfunction. Similar results were obtained in the quasi-randomized studies [26,27].
Clinician training via a free CBITS online course is available from the CBITS developers at http://cbitsprogram.org. A CBITS manual [25] and other implementation materials are available. Training in the CBITS model includes face-to-face training, phone consultation, or participation in a CBITS learning collaborative.
CBITS has been widely disseminated to schools in the United States and internationally, but many schools do not have CBITS therapists available. This has led to the development of a variant of CBITS, Supporting Students Exposed to Trauma (SSET) [28], which can be provided by educators, and thus could be disseminated more easily.
Other group CBT interventions — Other trauma-focused group CBT models found to be efficacious in clinical trials with children with PTSD symptoms have been adapted to address specific types of trauma, or for delivery to groups:
●Trauma Grief Components Treatment (TGCT) – TGCT differs from other group CBT interventions in that it is somewhat longer (17 sessions) and includes both trauma-focused and grief-focused treatment components that aim to address PTSD and maladaptive grief responses, respectively. TGCT is particularly appropriate for teens who have PTSD symptoms and maladaptive grief related to war, terrorism, or other circumstances of traumatic death.
A clinical trial in 127 war-exposed Bosnian adolescents with symptoms of PTSD, depression, or maladaptive grief found that school-based TGCT was superior to a school-based psychoeducation and skills comparison condition for improving PTSD and maladaptive grief responses with medium to large effect sizes [29].
●Extending and Enhancing Resiliency Amongst Students Experiencing (ERASE)-Stress – ERASE-Stress is a 16-session, teacher-delivered resiliency-building intervention designed specifically for children and adolescents who have been exposed to terrorism or war. While CBITS is a clinician-delivered intervention provided to children with trauma-related symptoms, ERASE-Stress is provided by teachers to all exposed children, either to prevent the emergence of symptoms or as treatment of symptoms when present.
Two quasi-randomized controlled trials comparing ERASE-Stress with wait list control conditions for 142 children and 154 adolescents in Israel, respectively, found that children assigned to receive ERASE-Stress experienced greater improvement in PTSD symptoms (medium effect sizes), as well as in somatic complaints and anxiety [30,31]. Randomized trials have not been conducted.
●Group Trauma-Focused CBT – The group application of TF-CBT does not differ from the individual modality except that it is often provided in nonschool settings, eg, residential treatment centers, community or religious centers, or nongovernmental organizations. The trauma narrative TF-CBT treatment phase is provided in individual "break out" sessions that are provided in addition to the group sessions. (See 'Other individual trauma-focused therapies' above.)
Two randomized trials have compared culturally modified group TF-CBT with wait list controls, one in 52 Congolese war-exposed sexually exploited girls and the other in 50 war-exposed Congolese teen boys, respectively. Both trials found that TF-CBT, compared with the control conditions, resulted in greater improvement in symptoms of PTSD, depression, and anxiety, as well as in conduct and pro-social behaviors (large effect sizes for each result) [12,13].
Therapies for preschool children — DSM-5 describes developmental differences in how PTSD is manifested in young children [1]. Typical PTSD symptoms are manifestations of young children's basic fears (eg, body damage, abandonment, loss of caregiver). With limited verbal and cognitive abilities, young children are particularly dependent on and trusting of caregivers to provide safety. When trauma occurs, this safety and trust is disrupted.
Effective trauma treatments for young children must rebuild the young child's trust that the caregiver will keep the child safe and the caregiver's ability to do so. This has been accomplished through attachment-based models that primarily focus on the child-parent relationship and by CBT models that focus on enhancing child-parent resiliency skills, communication, positive parenting, and the caregiver's ability to promote safety.
Child-Parent Psychotherapy — Child-Parent Psychotherapy (CPP), developed for young children (birth to six years) who have experienced a trauma and their parent(s) or caretaking adult, is a dyadic attachment-based psychotherapy focused on supporting and strengthening the parent-child relationship as a way to heal the negative impacts of interpersonal trauma. Although CPP has some CBT elements, it is primarily based on attachment and psychodynamic theory. CPP is particularly valuable for very young children (birth to three years) and other young children (eg, those with developmental delays) who cannot express their emotions verbally but do so through play; the CPP therapist helps the parent to understand and make more benign meaning of the child's play, behaviors, and interactions with the parent.
As a longer-term treatment approach (one year), CPP provides more sustained interventions to the child and parent and thus may be particularly helpful for parents who are highly dysregulated due to personal experiences of domestic violence. Targets of intervention include:
●Addressing parental and child maladaptive representations of self and each other
●Developing a joint trauma narrative to identify and address trauma triggers
●Developing more satisfying interpersonal relationships, activities, routines, and goals
A randomized trial compared CPP with case management and community treatment referral for 75 preschool children with PTSD stemming from domestic violence [32]. After one year of weekly sessions monitored for fidelity, children receiving CPP experienced greater improvement in PTSD symptoms (medium effect size), as well as for total behavior problems (small effect size), relative to children receiving the comparison condition. Mothers receiving CPP also exhibited significantly greater decrease in avoidance symptoms and a trend toward reduction in their own personal PTSD symptoms.
CPP is provided in 40 to 50 weekly dyadic child-parent sessions with additional parent sessions provided as needed. Clinicians typically monitor young children's PTSD and behavioral symptoms systematically; a developmentally appropriate instrument should be used, such as the YCPC described above. Parental symptoms may also be monitored if a subject of clinical attention.
CPP training materials, including published treatment manuals written by the treatment developers [33,34], handouts, and other resources, are available. Training in the CPP model includes initial face-to-face training and participation in one year or more of ongoing consultation calls or participation in a learning collaborative during which CPP cases are presented and discussed. Training is available from the treatment developer and expert trainers, as well as through learning collaborative sponsored by the National Child Traumatic Stress Network (www.nctsn.org). CPP has been disseminated to many programs across the United States and also in several international locations. A CPP certification program is under development.
Other psychotherapy models for preschoolers — Two CBT trauma-focused treatment models have been tested for preschool children with PTSD symptoms and found to be efficacious in a randomized controlled trial:
●TF-CBT for preschoolers – Two clinical trials have examined preschool children's response to TF-CBT:
•A clinical trial compared TF-CBT with nondirective supportive therapy (NST) in 86 children ages three to six years with at least five PTSD symptoms following an index trauma of sexual abuse [10]. Children receiving TF-CBT experienced significantly greater improvement in PTSD symptoms compared with the NST group (medium effect size), as well as in internalizing and sexual behavior problems.
•A clinical trial/dismantling study compared the efficacy of four different versions of TF-CBT in children ages 4 to 11 years old with an index trauma of sexual abuse [35]:
-With the trauma narrative phase versus without
-Provided over 8 sessions versus 16 sessions
Children assigned to all four TF-CBT conditions showed improvement in PTSD symptoms with large effect sizes. Children assigned to the eight-session group with a trauma narrative phase showed greater improvement than other groups in internalizing symptoms of fear and anxiety, while children assigned to receive 16 sessions without the trauma narrative phase showed greater improvement in externalizing behavior symptoms. Younger age (four to six years) did not significantly moderate these results.
●Preschool PTSD Treatment (PPT) – PPT includes all TF-CBT components but differs from TF-CBT in that the parent fully participates throughout the entire treatment session. A clinical trial of 62 children ages three to six years with at least five PTSD symptoms following mixed traumas were randomized to PPT or wait list control condition [36]. Despite high drop-out rates, PPT showed significantly greater improvement in PTSD symptoms with large effect sizes.
Therapies for PTSD and SUD — Two treatment models have been developed and tested to address PTSD and comorbid substance use disorders (SUD).
Seeking Safety — Seeking Safety is an adult CBT model for addressing comorbid PTSD and SUD that was modified for teens [37]. It includes most TF-CBT PRACTICE components, but not trauma narration and processing. Other differences from TF-CBT include:
●Safety, not PTSD recovery, is the overarching goal
●A focus on ideals that have been lost through substance abuse and PTSD
●Several present focus/grounding components
A pilot clinical trial randomly assigned 33 adolescent females to receive Seeking Safety showed improvement on some subscale scores of the Trauma Symptom Checklist for Children and some subscales of the Personal Experiences Inventory (for substance use) compared with those assigned to treatment as usual [37]. Changes in overall scores for substance use and PTSD symptoms were not reported.
Seeking Safety for adults with PTSD and SUD is discussed separately. (See "Treatment of co-occurring substance use disorder and anxiety-related disorders in adults", section on 'Integrated CBT'.)
Risk Reduction Family Therapy (RRFT) — RRFT is an application of TF-CBT that includes additional components for reducing risk of substance abuse. A pilot clinical trial randomly assigned 30 adolescents with histories of sexual abuse and substance abuse to RRFT or treatment as usual, finding that participants assigned to RRFT experienced greater improvement in PTSD, substance use, depressive, and internalizing symptoms compared with participants assigned to treatment as usual (medium effect sizes) [38]. A limitation in the trial was a difference in functioning between groups at baseline.
Comparing psychotherapies — Comparisons in the efficacy of different types of trauma-focused psychotherapies in children are limited. Two clinical trials found little difference in primary PTSD outcomes between therapies. A much higher proportion of children made use of the more accessible school-based therapy compared with clinic-based therapy:
●A clinical trial in 48 children with PTSD symptoms compared EMDR with TF-CBT [21]. Eight sessions of each intervention resulted in large effect sizes for PTSD improvement; no difference in reduction in PTSD symptoms was seen. Parents of children treated with TF-CBT, but not those treated with EMDR, reported improvement in child depressive and hyperactivity symptoms.
●A clinical trial compared CBITS and TF-CBT following Hurricane Katrina [19]. One hundred and eighteen schoolchildren identified by screening to have significant PTSD symptoms were randomized to receive CBITS at their schools, or TF-CBT at community clinics. Students assigned to the school-based intervention were more likely to access treatment than students assigned to the clinic-based intervention (98 versus 37 percent). Both groups experienced reductions in PTSD symptoms, but no differences were seen between groups.
More trials are needed comparing the relative benefits of alternative trauma-focused psychotherapies for children with different presentations, comorbidities, and risk factors.
Contraindications — Contraindications for trauma-focused psychotherapies include:
●Acute clinical states that require immediate stabilization (eg, acute suicidality, psychosis, mania, or drug intoxication).
●For cognitive-based therapies, severe developmental or cognitive impairments.
●For group therapies, conditions that would interfere with participation (eg, severe behavioral dysregulation, severe attention deficit hyperactivity disorder).
TREATMENT SELECTION — For children with a posttraumatic stress disorder (PTSD) diagnosis or prominent PTSD symptoms, including those with complex PTSD, we suggest first-line treatment with an evidence-based, trauma-focused psychotherapy. The intervention should be provided by a therapist who has received appropriate training in that model. A full course of therapy should be completed.
Varied trauma-focused psychotherapy models have been developed, with emphasis on different components and/or customized to treat patients with specific characteristics, clinical presentations, or in certain settings. There is limited evidence, however, to inform selection among these therapies. Few clinical trials have directly compared psychotherapies, and these did not show differences in PTSD outcomes. Our suggestions stem largely from clinical trials comparing individual therapies with inactive controls, secondary data analyses, our clinical experience, and that of others with relevant expertise. Our suggestions are as follows (see 'Comparing psychotherapies' above).
Children seven years and older — For children seven years and over with PTSD or PTSD symptoms, Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is most strongly supported by evidence from clinical trials in diverse populations of children with diverse types of trauma [39-41]. (See 'Individual Trauma-Focused CBT' above.)
Choice among treatments may be influenced by individual or family preference, specific population needs (eg, Trauma Affect Regulation: Guide for Education and Therapy [TARGET] for juvenile justice-involved youth) and/or local availability.
Where there are resource constraints, an absence of trained therapists, or other barriers to access that preclude individual therapy, we suggest first-line treatment with an evidence-based trauma-focused group CBT, such as CBITS [25-27]. The choice between individual and group modalities may also be influenced by family preference, by specific population needs (eg, TGCT for teens with both PTSD and maladaptive grief symptoms), or by clinical presentation (eg, we favor individual therapy for children with more severe PTSD symptoms [27]). (See 'Cognitive Behavioral Intervention for Trauma in Schools (CBITS)' above.)
Children three to six years — For children three to six years old with PTSD or PTSD symptoms, we suggest Child-Parent Psychotherapy (CPP) rather than other psychotherapies, particularly for children with:
●Significant developmental or cognitive delays, since this model does not require participation in cognitive-based interventions
●Severe attachment-related difficulties, due to the dyadic, attachment-based nature of CPP, and its longer duration
We suggest TF-CBT rather than CPP for children with:
●Sexualized behavior problems, based on findings of positive outcomes in a clinical trial [10]
●Higher levels of general internalizing or externalizing problems, based on the findings from a meta-analysis of multiple clinical trials [41]
Favoring the use of CPP and TF-CBT in this population are clinical trials showing improvement compared with active comparison conditions, and the availability of well-established training protocols and fidelity guidelines [39,40]. CPP and TF-CBT have not been compared in head-to-head clinical trials, nor have they been compared with other psychosocial interventions in this population. (See 'Therapies for preschool children' above.)
Children under three years — For children under three years old with PTSD symptoms, we suggest the use of CPP rather than TF-CBT or PPT. Children under three are typically too young to participate in cognitive-based interventions and would benefit more from attachment-based therapy. To date, no empirical data are available to guide decision making for this age group. (See 'Child-Parent Psychotherapy' above.)
NONRESPONSE TO PSYCHOTHERAPY — Research to date has not identified consistent predictors of nonresponse to trauma-focused psychotherapy in children. When children with posttraumatic stress disorder (PTSD) do not respond to psychotherapy, the clinician should reevaluate the therapy and the patient's clinical presentation in view of the considerations below:
●Treatment fidelity – Treatment nonresponse may occur when an evidence-based treatment is provided with low fidelity, ie, the model is not provided as intended. If core treatment components are provided incorrectly or not at all, the treatment will likely be ineffective. In such cases, improved fidelity and outcomes can often be attained by ensuring that therapists receive appropriate training and consultation in the selected model, receive ongoing, model-specific supervision, and monitor their treatment fidelity over time. Certification or other documentation (when available) that therapists have completed all recommended training requirements for the chosen model can enhance the likelihood of children receiving treatment with high fidelity.
●Trauma reminders – Lack of response to cognitive-behavioral therapy (CBT) in children with PTSD should prompt more careful exploration of potential trauma reminders or triggers, further development of different coping strategies for these triggers, and/or helping the child to master the coping strategies identified (eg, during in-session practice). (See 'Mechanisms of treatment' above and 'Phases and components' above.)
●Ongoing trauma – Even with appropriate treatment, some PTSD symptoms may persist when trauma recurs during treatment; in this situation some trauma responses (eg, increased vigilance) might be adaptive. Clinical strategies include, for example, increasing the focus on child safety early in treatment, helping children differentiate between real danger and trauma reminders, and helping nonoffending parents collaborate with children to develop effective strategies for enhancing the child's safety [9,42]. These strategies have been effective in reducing PTSD and anxiety symptoms in a clinical trial [9]. (See 'Phases and components' above.)
●Complex trauma – Poor or delayed response to trauma-focused psychotherapy may suggest the presence of complex PTSD, which is seen in children who have experienced early, chronic interpersonal trauma. These children are particularly vulnerable to interpersonal trauma reminders (eg, arguments, real or perceived rejection or threatened attachment loss) [5,43] and experience severe dysregulation in multiple domains of functioning including affect, attachment, biology, self-concept, cognitions, perceptions [44]. (See "Dissociative aspects of posttraumatic stress disorder: Epidemiology, clinical manifestations, assessment, and diagnosis".)
Since youth with complex PTSD experience trauma within the context of close relationships, initiating a therapeutic relationship often serves as a trauma reminder for these youth. It is useful to contextualize these responses within a trauma framework rather than viewing such difficulties as "treatment nonresponse." Most treatments with efficacy for child PTSD have been successfully applied to the subgroup with complex trauma [15]. These youth typically need somewhat lengthier treatment, with a longer initial stabilization phase, during which they can be expected to test the trustworthiness of the new therapist. Other treatments have been developed specifically for these youth [18,45,46].
●Co-occurring mental disorders – Co-occurring disorders are often seen in children with PTSD, including depression, generalized anxiety disorder, and obsessive-compulsive disorder. PTSD should not be considered nonresponsive to psychotherapy until the after the comorbid disorder is adequately treated. Many of these co-occurring conditions are treatable with CBT.
●Environmental factors – Many features of a traumatized child's daily life (eg, family, health, educational, community, faith, legal, and child welfare) are likely to influence treatment response [47]. Examples include changes in foster family placement or the arrest/incarceration or illness/death of a family member. These issues emphasize the critical importance of working collaboratively with caregivers to be proactively aware of potential changes that may occur in the child's life and address perceived or real threats to the child's safety that may occur as a result of these changes.
If after addressing these factors the clinician is convinced that the patient has not responded to an adequate trial of the first-line psychotherapy, the following steps may be helpful:
●Switching to another evidence-based psychotherapy that may be more helpful. As an example, a child who has not responded to trauma-focused group CBT may benefit from trauma-focused individual CBT [19].
●Tailoring the psychotherapy to the child's specific PTSD symptoms, such as:
•For hyperarousal symptoms (eg, angry outbursts, irritability, and sleep disturbance) – A systematic CBT focus on parenting skills and behavioral regulation skills.
•For ongoing symptoms of re-experiencing, avoidance, fear, or anxiety – Trauma narration and/or cognitive processing of maladaptive cognitions that includes [11,48]:
-Emotional expression
-Increased coherence of trauma memories as the narrative progresses
-Focus on integrating meaning of past trauma experiences into more positive present and future
PREVENTION — Most children develop some psychological symptoms in the immediate aftermath following trauma exposure; these usually remit spontaneously. In a minority of children, these develop into posttraumatic stress disorder (PTSD), which is diagnosed if symptoms meeting a diagnostic threshold, accompanied by dysfunction or distress, persist for at least one month. Early interventions in the aftermath of a traumatic exposure have been developed and tested with the aim of preventing the subsequent development of PTSD.
Child and Family Traumatic Stress Intervention (CFTSI) — CFTSI is a CBT-based four- to six-session psychosocial intervention developed to begin within the first month after acute trauma exposure. The intervention includes psychoeducation, building awareness and parent-child communication about symptoms, and skill building to address prominent, mutually selected symptoms.
A clinical trial found that CFTSI prevented the development of chronic PTSD following trauma exposure in children. The trial randomly assigned 106 children within 30 days of traumatic exposure to receive CFTSI or supportive counseling [49]. At follow-up 90 days after trauma exposure, participants who received CFTSI were 65 percent less likely to meet diagnostic criteria for PTSD compared with the control group.
Other interventions — Other models have been tested for early prevention of PTSD, but neither was found to be effective.
●Critical incidence stress debriefing (CISD) typically consists of a one-session debriefing session following trauma exposure, during which children describe and process their experiences with peers exposed to the same or similar experiences. A clinical trial comparing CISD with a wait list control in 132 children following road traffic accidents found no difference in preventing the development of PTSD [50].
●In a clinical trial with 132 children within 30 days of a road traffic injury, a two-session CBT-based intervention led to a subsequent rate of PTSD not significantly different from the proportion in the control group [51].
●Several trauma-focused psychotherapy models have been found to be efficacious in the treatment of posttraumatic stress disorder (PTSD) or PTSD symptoms beneath the diagnostic threshold for the disorder. These interventions include individual and group models, as well as models tailored to meet the needs of specific subgroups. (See 'Trauma-focused psychotherapies' above.)
●Components of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Cognitive Behavioral Intervention for Trauma in Schools (CBITS) include psychoeducation, parenting skills, relaxation skills, affect modulation skills, cognitive processing skills, trauma narration and processing, in vivo mastery of trauma, conjoint child-parent sessions, and enhancing safety. (See 'Phases and components' above.)
●Contraindications for trauma-focused psychotherapies include acute clinical states that require immediate stabilization (eg, acute suicidality, psychosis, mania, or drug intoxication); for cognitive-based therapies, severe developmental or cognitive impairments; for group therapies, conditions that would interfere with participation (eg, severe behavioral dysregulation, severe attention deficit hyperactivity disorder). (See 'Contraindications' above.)
●For children with PTSD who do not respond to trauma-focused psychotherapy, considerations should include treatment fidelity, further addressing trauma reminders, the possibility of ongoing trauma, the presence of complex trauma, co-occurring mental disorders, and/or environmental factors adversely affecting the child. (See 'Nonresponse to psychotherapy' above.)
●For children and adolescents with PTSD or prominent PTSD symptoms, including those with complex PTSD, we suggest first-line treatment with a trauma-focused psychotherapy rather than other psychotherapies (Grade 2C). Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) has the strongest basis in clinical trials for children seven years and older; other reasonable alternatives include Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) and Trauma Affect Regulation: Guide for Education and Therapy (TARGET). The intervention should be provided by a therapist who has received appropriate training in that model. A full course of therapy should be completed. (See 'Treatment selection' above.)
●Where there are resource constraints, an absence of trained therapists, or other barriers to access that preclude individual therapy, we suggest first-line treatment with trauma-focused group CBT, specifically with CBITS (Cognitive Behavioral Intervention for Trauma in Schools), rather than other psychotherapies for children seven years or older (Grade 2C). Other trauma-focused group psychotherapies that emphasize cognitive and behavioral principles, and are supported by clinical trials, are reasonable alternatives if preferred due to local availability, patient preference, and/or specific population needs. (See 'Cognitive Behavioral Intervention for Trauma in Schools (CBITS)' above and 'Children seven years and older' above and 'Other individual trauma-focused therapies' above and 'Other group CBT interventions' above.)
Children three to six years
●For children three to six years with PTSD or PTSD symptoms, we suggest Child-Parent Psychotherapy (CPP) rather than TF-CBT for children with significant developmental or cognitive delays, or severe attachment-related difficulties (Grade 2C). (See 'Children three to six years' above and 'Child-Parent Psychotherapy' above.)
●For children with sexualized behavior problems or higher levels of general internalizing or externalizing problems, we suggest TF-CBT rather than CPP (Grade 2C). (See 'Children three to six years' above and 'Other psychotherapy models for preschoolers' above.)
Children under three years
●For children under three years old with PTSD symptoms, we suggest the use of CPP rather than TF-CBT adapted to preschool children or other therapies (Grade 2C). (See 'Children under three years' above and 'Child-Parent Psychotherapy' above.)
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Scarborough is a marginal Liberal seat in northern Perth.
The seat is held by Liberal MP Liza Harvey by a 5.2% margin. Harvey won the seat after it was created at the 2008 redistribution.
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