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07:53 (GMT +7) - Friday 07/05/2021

Bosch & Dong Nai sign MoU on skilled worker training

Released at: 14:55, 27/09/2019

Bosch & Dong Nai sign MoU on skilled worker training

Photo: Bosch Vietnam

Partnership to support vocational schools in southern province with opportunities to approach Industry 4.0.

by Hong Nhung

Bosch Vietnam signed an MoU with the Dong Nai Provincial People’s Committee on September 26 in the field of training and developing highly-skilled workers towards Industry 4.0, as a part of its collaboration to advance the Industry 4.0 program in the southern province.

The MoU was signed by Bosch Vietnam, Drive and Control (Bosch Rexroth - a Division of Bosch Vietnam), the People’s Committee, and the Dong Nai Department of Labor, War Invalids, and Social Affairs.

The partnership’s objectives are supporting vocational schools in Dong Nai with opportunities to approach Industry 4.0, therefore enabling them to acquire, master, and effectively operate technology in Industry 4.0. The parties will also facilitate close cooperation between vocational education institutions in the province and Bosch Rexroth, in the field of training and developing qualified human resources that meet the needs of businesses during Industry 4.0.

The partners will cooperate in key fields relating to education and training for Industry 4.0. It will provide training for teachers at vocational education institutions in the province, especially focusing on automation, mechatronics, pneumatics and hydraulics. Training activities will be held in Dong Nai province or abroad for advanced training (if necessary).

Bosch will also support vocational education institutions in Dong Nai to set up and adjust training programs to meet Industry 4.0’s requirements, then organize technical seminars to share updated knowledge about Industry 4.0.

“Science and technology are important enablers in economic and social growth, in which a highly-skilled workforce plays a vital role,” said Ms. Nguyen Hoa Hiep, Vice President of the People’s Committee. “Advanced technologies have been implemented in manufacturing in Dong Nai.”

“Furthermore, we are actively developing training programs at vocational education institutions. We are pleased to work closely with Bosch, a technological leader, so that we can continue to accelerate the numbers of highly-skilled workers in the future and at the same time shape Dong Nai’s economy.”

“Keeping pace with technology is an integral part of staying competitive and developing the Industry 4.0-enabled factories of the future,” said Mr. Guru Mallikarjuna, Managing Director of Bosch Vietnam. “As one of the global leaders in drive and control technology, Bosch has acquired a unique level of technological expertise and would like to pass on this know-how as well as technology to apprentices and students under a practical and comprehensive approach.”

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US-based Blackstone Group acquires 56.5-pct of Piramal Glass – Lanka Business Online

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US-based private equity major Blackstone Group has acquired a 56.5 percent stake of Piramal Glass Ceylon PLC.

The acquisition price implies a total enterprise value of 13.9 billion rupees for the target company.

Asia Securities Advisors (Pvt) Ltd. acted as the buy-side advisor and Asia Securities (Pvt) Ltd acted as the executing stockbroker to the Blackstone Group.

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Pay more – get less: Tory council has gone bankrupt paying huge sums to chief exec

So much for the Party of Financial Competence.

Northamptonshire County Council is run by the Conservative Party – badly.

That is why it is now bankrupt, and set to be split up and replaced with two new unitary authorities.

The Guardian report quoted below shows that it paid more than a million pounds to one man and companies owned by him. That man also happens to have been the council’s chief executive and finance director.

And what kind of service have the people been getting?

Adult social care is “on the verge of becoming unsafe”.

The council is closing 21 of its 36 libraries.

All non-urgent spending has been banned.

Of course, the person who has taken the money says reports about him are factually inaccurate.

Whether they are, or not, it is clear that council taxpayers are being failed in a big way.

The previous chief executive was regarded as the architect of the council’s disastrous ‘Next Generation’ restructuring programme, necessitated by cuts inflicted by the Conservative government. He left in October with a £95,000 pay-off. The council’s leader resigned earlier this month.

Tories oversaw the cuts; they supervised the restructuring programme and signed off the expensive payments to consultancies run by members of their staff. They saw nothing wrong with this.

And Northamptonshire isn’t the only council going bankrupt. The Guardian article suggests 15 more could go bust in the next three years.

That’s why it is vitally important to end Tory control of local authorities.

Council taxpayers simply cannot afford it.

Tory-controlled Northamptonshire county council, which declared itself effectively bankrupt last month, paid its acting chief executive more than £1,000 a day, it has emerged.

Damon Lawrenson had been interim chief executive at the council since November, having previously acted as temporary finance director at the council since October 2016. Lawrenson left the council this week “by mutual consent”.

Northamptonshire was heavily criticised in a recent government inspector’s report, which identified deep-rooted management and governance failures over the past four years as the prime cause of its financial problems.

The report highlighted what it called the council’s “sloppy” approach to financial management and lack of realism in business planning. It called for a clear-out of the existing leadership in order to restore stability to the council.

A freedom of information (FOI) request by the GMB union revealed that the council paid out £371,000 to DDL Consultancy, owned by Lawrenson, during 2016-17 and 2017-18. His company had earlier been paid a further £540,000 between 2008 and 2011, when he had stints as assistant chief executive and commercial director.

The local government secretary, Sajid Javid, is considering the report’s recommendation that the county be run by a team of Whitehall-appointed commissioners until it can be scrapped, along with seven local district councils, and replaced by two new smaller unitary authorities.

Source: ‘Bankrupt’ Tory council had paid acting boss more than £1,000 a day | Society | The Guardian

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4 thoughts on “Pay more – get less: Tory council has gone bankrupt paying huge sums to chief exec

  1. Dan

    It shows how financially inept the Tories are that they think replacing one council with two councils will save money. Most of the staff now working for the council will end up working for the new council but the combined headcount will almost inevitably go up – and the same goes for the councillors themselves. Then the two new councils will need new logos, new offices, rebranded vehicles (etc etc etc) and probably a protracted legal argument between themselves over the finer details of the split. All of this will cost £££££££’s while services for local people get even worse. Creating small “unitary” councils does not cure the problem of underfunding, it’s been tried before and fails every time.

Comments are closed.


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Twerking… A word that terrifies DWD’s (Dads with Daughters) the world over and conjures up images of women with Kim Kardashian sized derrieres shaking their bottoms about like their nether-halves are possessed by seizure demons; and whether or not you want to admit it, there is some sick primal part of you that likes it.Well just in case you have ever wanted a private twerk show right in the comfort of your own home, or have a fetish for fuckable rubber rear-ends (kind of hot), mega porn streaming king PornHub has partnered up with sex toy company Topco to produce the “ultimate experience in interactive cyber passion” TwerkingButt sex toy, with Cyberskin!While that might sound all sorts of weird, and it might be just a little, this thing is seriously pretty amazing. Not only does it come with its own plastic VR enclosure/headset for your smartphone à la similar such devices like Google Cardboard and Gear VR, allowing you to use immersive VR content with the device in the future (the content isn’t yet available), but it also features simulated body heat, ultra-realistic cyberskin technology, customizable motions, variable massaging speeds, vibrations, and multiple twerking patterns; all of which can be controlled via remote or an Android or iOS enabled tablet or smartphone. As if all of that wasn’t enough the device can also be set to sync up with your music playlists and the orifice doubles as a single can beer cooler/warmer when not being used for other things. Ok, well we just made up the beer part, but damned if it doesn’t sound like it does everything!Good times don’t come cheap though so expect to give up an arm and a leg if you just gotta have dat ass (which would make you the perfect partner for the device as it has no limbs itself), with August retail prices set at $699 for the regular version sans twerking capabilities (but including massage, vibration and everything else we mentioned); and the deluxe version which will do the Miley Cyrus on your pole for a mere $300 more.Both devices can be found on sale online for $200 off ($499 & $799 respectively) until the 11th of this month though, so head on over to, check them out, come back here and leave us a detailed description of what it’s like!

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Podcast: But no Annette Funicello

It’s funny while I was in the final stages of putting this all together, I allowed myself to be sidetracked with more subjects for future posts, and just had a rather interesting evening. But I’m getting ahead of how behind I am. So for now, we have a podcast of the most recent trip, where we (meaning the family here and friends from out there, read more


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• Raleigh, NC, USA
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Health, Vision, dental insurance

General Manager:

Location: 3677 New Bern Ave in Raleigh, NC

Our expectations of the General Manager role include:

  • Recruiting, training and managing store employees
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  • Inventory control and food cost management
  • Control labor costs as well as meet and exceed performance goals
  • Review and complete all necessary paperwork in timely manner
  • Maintaining a fun and professional work environment

General Manager Qualifications:

  • Minimum of 1 years experience
  • Outstanding interpersonal and communication skills (written and verbal)
  • Outstanding motivational skills and positive attitude
  • Strong leadership and problems solving skills
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Please apply to this job with your resume by hitting apply.

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Outdoor Recreation NI Community Trails Survey 2021

Posted on

Our parent company Outdoor Recreation NI is conducting an online survey to better understand the impact and value of Community Trails to local areas and people’s lives. We would love to hear your views!

To take part in the research please click on the relevant link below:

Darkley Forest, Darkley (Closes 8th February 2021)

Bunkers Hill, Castlewellan (Closes 15th February 2021)

Ballynahinch RFC Family Trail, Ballynahinch (Closes 15th February 2021)

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Posts: Page 4

Am I enough of an activist?

“We need to inspire ourselves and others to make the right choices – if we don’t, then the climate crisis is putting our future at risk.”

The Hummingbird in Me

“We cannot afford to go back to “normal” systems that were before this pandemic, based and rooted in historical, environmental, social and political injustices.”

We can #BuildBackBetter

By Ellen, 350 UK Senior Organiser The coronavirus pandemic has turned our world upside down. No-one in the UK’s life

How we build back better

Fossil Free News is a global newsletter published every two weeks. Sign up here to get it straight to your

May Day: A Just Recovery for Workers

Workers are powerful. Despite the risks of coronavirus and lack of protective equipment, nurses are out saving lives, supermarket workers

Climate strikes move online

Wednesday marked the 50th anniversary of Earth Day, kicking off a global online protest that will roll into online climate strikes on Friday.

Profile: Ridhima Pandey, 12, India

“We have to learn from this crisis, and world leaders need to act strongly and proactively together in order to save lives, rather than only when a disaster becomes impossible to ignore.”


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One Stop For All Your Food Needs!

It's worth the drive to enjoy the tasty food and the country feel at the One Way Café. Nestled in picturesque Juniata County of PA, we are your Coffee Shop and Café here in the country at the Walnut Cheese Nook!

We serve a high quality, specialty coffee that is imported and roasted in Lancaster County PA. We make espresso based drinks such as lattes, mochas as well as smoothies, milkshakes, etc.

The Walnut Cheese Nook also provides deli meats and cheeses, cream cheese spreads, party platters, bulk foods, fresh baked goods made in our bakery and much more.

Stop by today and enjoy a delicious meal in our café or order for take out!

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Fresh appeal to catch Amaan’s killers

Amaan Shakoor
Amaan Shakoor was killed outside Kelmscott Leisure Centre on 2nd April 2018

The fatal shooting of a 16-year-old boy in Walthamstow three years ago remains a mystery, reports James Cracknell

A fresh police appeal has been issued for information that could help catch the killers of a teenager – three years after he was gunned down outside Walthamstow Leisure Centre.

The detective leading the search for the killers of 16-year-old Amaan Shakoor in 2018 have urged his associates to “break the wall of silence” surrounding his death.

Amaan was in the Markhouse Road area outside Kelmscott Leisure Centre – since renamed Walthamstow Leisure Centre – on the evening of 2nd April 2018, when he was approached by two males. He was shot in the head. Amaan spent the night in a critical condition in hospital and died the next day.

Detective Chief Inspector Perry Benton said: “Three years have passed since this horrific incident that took a young man from his family.

“They deserve justice and the chance to have some sort of closure. We will not rest until we identify those responsible and bring them before the courts.”

Officers have previously said they don’t believe the shooting was random and that tensions between rival groups in the area were very likely the underlying cause. Amaan was believed to have been on the periphery of such activity and may have been targeted as a result.

A £20,000 reward for information that helps catch Amaan’s killers was offered in 2019. His father Mohammad said at the time his son was “an innocent victim of a despicable and brutal crime” and said his family was “struggling to carry on with life without him”.

DCI Benton added: “There were other people there when Amaan was shot and I’ve no doubt that even people who weren’t there know who was responsible.

“I understand that in some circles, it is seen as a betrayal of trust to talk to the police. But I would say to those people, some of whom were close friends of Amaan, that not doing so is an even greater betrayal.

“It is only by individuals being brave enough to come forward and break the wall of silence that has existed around this case that we will get justice.

“My officers understand what it will take for you to do that and there are steps we can take to support you if you do. But we need you to make the first move.”

Two teenagers were previously arrested in April 2018 in connection with the death of Amaan, but they were released without charge.

Anyone with information should call detectives on 020 8345 1570. You can also contact Crimestoppers anonymously by calling 0800 555 111.


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Marketing Integrated Communications Intern Internship Remote, United States

Company: Medidata

Position at Medidata Solutions

Our Company

Medidata is leading the digital transformation of life sciences with the world's most-used platform for clinical development, commercial and real-world data. Powered by artificial intelligence and delivered by #1 ranked industry experts, the Intelligent Platform for Life Sciences helps pharmaceutical, biotech, medical device companies and academic researchers accelerate value, minimize risk and optimize outcomes. Medidata serves more than 1,700 customers and partners worldwide and empowers more than 100,000 certified users every day to create hope for millions of patients. Discover the future of life sciences:

We know that diverse teams win and are fully committed to selecting leaders and employees that represent the markets in which we operate. We are still led by our co-founders, Tarek Sherif and Glen de Vries, and have global operations in the US, Europe and Asia with more than 3000 employees.

Medidata is making a real difference in the lives of patients everywhere by accelerating critical drug and medical device development, enabling life-saving drugs and medical devices to get to market faster. Our products sit at the convergence of the Technology and Life Sciences industries, one of most exciting areas for global innovation.

Medidata’s solutions have powered more than 23,000 clinical trials giving us the largest collection of clinical trial data in the world. With this asset, we pioneer innovative, advanced applications and intelligent data analytics, bringing an unmatched level of quality and efficiency to clinical trials enabling treatments to reach waiting patients sooner.

The Program:

At Medidata, interns will have the opportunity to accelerate their careers by working closely with experienced professionals and gain valuable, hands-on, full-time work experience. By being a part of our global organization, interns have the opportunity to work alongside our talented and committed professionals helping them to build a strong foundation for achieving their career goals.

For 12 weeks, beginning May 24, 2021, interns will have an opportunity to gain a deep understanding of what it means to be a Medidatian, united around a single goal of empowering smarter treatments and healthier people. Medidatians work in a culture of curiosity, innovation and fun. You will be contributing to the line of business with sustainable and meaningful work.

Our Summer Internship program also includes instructor led training, guided mentorship, exposure to senior leadership and community service. In addition to individual and specific related responsibilities, each intern will participate in our Intern Innovation Lab. Assigned to cross-functional teams, interns will work closely to develop an innovative solution to a business problem currently facing Medidata. As they work diligently to present their final solutions to a panel of top Medidata leaders, we are confident that our interns will make a significant impact on our business.

The Position:

Learn how a corporate affairs strategy can help drive an organization's corporate goals and priorities. Learn about the convergence of high tech and health, and help brainstorm corporate and thought leadership concepts; develop themes and story lines, and write and produce compelling content that will tell the Medidata story.

As a Corporate Affairs intern, you’ll pair with a mentor on projects including:

  • Help identify opportunities for Medidata stories that position the company and its products as leading the digital transformation of life sciences; write compelling content that positions our thought leaders in a dynamic, growing field

  • Gain familiarity with outlets and reporters relevant to Medidata; work with Medidata PR agency on media pitching and follow up

  • Help develop backgrounders, Qs & As and other materials

  • Assist with research and preparation for the Clinical Minds podcast, focusing on diversity in clinical trials

  • Assist with monitoring and evaluation of key policy and legislative initiatives with potential impact on Medidata and the life sciences sector

Qualifications / Competencies:

  • Rising or graduating senior. Excellent written and verbal skills; a talented writer

  • Familiarity with life sciences and/or tech preferred

  • Understanding of news media, journalism, storytelling

  • Blogging, podcasting experience a plus

  • Familiarity with health policy/legislative issues and processes a plus

  • Evaluation of a writing test

EEO Statement

Medidata Solutions, Inc. is an Equal Opportunity Employer. Medidata Solutions provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability status, protected veteran status, or any other characteristic protected by the law. Medidata Solutions complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities.

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text: In Canadian video artist Allyson Clay’s 2000 piece La La City, a camera is stationed in the middle of a revolving restaurant in Vancouver, the artist’s hometown, as a killer view of the city slooooowly passes through the restaurant’s windows. The Numark Gallery, in conjunction with the Canadian Embassy, is running the 90-minute film in a 24/7 loop, projected onto the gallery’s 20-foot-wide back wall. After business hours, the gallery’s shade will be lifted so that curious and/or stoned passers-by might get lost in the spatial survey—until it pauses briefly at the midpoint and runs in reverse. “You’ve been lulled into this pace,” says gallery owner Cheryl Numark, “so when the movement stops [and reverses], your mind doesn’t believe it at first.” If you find me standing in the street after 45 minutes of this glacial rotation, you can be pretty sure my mind’s not calling any shots. The exhibition opens today at 11 a.m. and can be seen from the street after the gallery closes at 6 p.m. (to Aug. 25) at the Numark Gallery, 625 E St. NW. Free. (202) 628-3810. (Anne Marson)


text: Sometimes it’s all about the vibe. According to the liner notes of its debut album, Polydemic, Ticklah is one guy who plays drums, organ, organ bass, keyboard bass, synth, Rhodes, clavinet, Wurlitzer, melodica, and tambourine. There’s also a boatload of guest instrumentalists who play everything from trombone to bongos to cowbells. When you get to Ticklah’s programming credits, you start to wonder what genre of music you’re dealing with. The band’s publicist has a lovely phone voice but is absolutely no help. She describes Ticklah’s sound as “jazz, fusion, dubby, reggae, um, triphop, very cool.” While Polydemic, as its title suggests, touches upon a variety of different styles, it’s all mellow. Perfect for a Friday after work at a smoky nightclub with the lights down low and drinks that flow. It’ll be, um, very cool. At 9 p.m. at State of the Union, 1357 U St. NW. $7. (202) 588-8810. (Neil Drumming)


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John Hazen White Sr. Lecture ─ John Kasich ─ It's Up to Us: Ten Little Ways We Can Bring About Big Change

Wednesday, October 16, 2019

5:30 p.m. – 7 p.m.

Agora, Stephen Robert '62 Hall, 280 Brook Street

Tickets are required and limited and a Brown or government-issued ID is required for entry to the event.  Please sign up for tickets here.

Book Signing Reception to Follow.

Audiences might be surprised to hear former Governor John Kasich say that he's not very interested in politics. After listening to his impassioned thoughts on the state of our nation, however, you'll understand where he’s coming from. Gov. Kasich believes that we need to reach beyond the issues that divide us to achieve solutions through unity and resilience. With a focus on civility and purpose, Kasich offers insight into a view of humanity that inspires self-reflection, invites action and motivates all of us to strive to be better citizens.

Meet the Author
Taubman Center for American Politics and Policy

Two-term former Ohio Governor John R. Kasich is a politician, a New York Times best-selling author, a former FOX television host, and ultimately an American citizen who believes that unity is the answer to our most common problems.  Governor Kasich closed an $8 billion budget shortfall without a tax increase, reduced taxes by $5 billion and created an improved business climate that led to the creation of more than 500,000 new jobs in the Buckeye State. Under his tenure, Ohio budget reserves grew from 89 cents to $2.7 billion. The Governor was a leading voice in promoting bipartisan solutions to health care reform, immigration and international trade. He has been one of the few Republicans to advocate for Medicaid’s expansion. Kasich has had a storied career in both the public and private sectors. He served as a member of Congress from central Ohio for 18 years.  He was elected to the U.S. House at just 30 years old, after having become the youngest state senator in Ohio history. He went on to become the chairman of the House Budget Committee and balanced the Federal Budget four times—a feat not accomplished since. After leaving Congress in 2000, Kasich worked as a managing director in the Investment Banking Division of Lehman Brothers, where he helped companies secure the resources they needed to succeed and create jobs.  He was a FOX television commentator for two shows, Heroes and Heartland with John Kasich, in addition to being a stand in host for both Bill O’Reilly and Chris Matthews.  In January of 2019, Kasich made his debut as a Senior Political Commentator for CNN, where he will appear across a variety of programs.  Kasich is the author of four New York Times best-sellers: Courage is Contagious; Stand for Something: The Battle for America’s Soul; Every Other Monday; and most recently Two Paths: America Divided or United, which reflects on 2016 run as Republican Primary Presidential candidate and his hopes for America’s future. His next book, It’s Up To Us is scheduled for release October 2019.  Kasich is a graduate of The Ohio State University, where he also served as a Presidential Fellow. No longer Ohio’s Governor, he continues his roles as husband, father and American Citizen, eager for the next chapter.


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Sleep Health

Even though how much rest we get can affect everything we do during our day, over one third of American adults report that they do not regularly get at least the recommended 7-9 hours of sleep per night. In an age where we are ‘always on’ sleep is more important than ever. Not so surprisingly, sleep is also an important factor in keeping your immune system healthy.

Sleep is a state of reduced consciousness where most of our sensory activity and movement is limited. The sleep-wake cycle is regulated by an internal circadian clock that is aligned with the daily solar cycle, and gives the body cues of when to sleep.

Sleeping allows the body to recharge and replenish many of the systems in our bodies like our muscles, bones, nervous systems, and immune systems as well as maintain our emotional and cognitive functions.

A lack of sleep at night can make you cranky the next day. And over time, skimping on sleep can mess up more than just your morning mood. Studies show getting quality sleep on a regular basis can help improve all sorts of issues, from your blood sugar to your workouts.

    When you’re running low on sleep, you’ll probably have trouble holding onto and recalling details. Sleep plays a big part in both learning and memory recall. Without enough sleep, it’s tough to focus and take in new information. Your brain also doesn’t have enough time to properly store memories so you can pull them up later.

    While you’re sleeping, your brain is processing your emotions. Your mind needs this time in order to recognize and react the right way. When you cut that short, you tend to have more negative emotional reactions and fewer positive ones.

    Chronic lack of sleep can also raise the chance of having a mood disorder. One large study showed that when you have insomnia, you’re five times more likely to develop depression, and your odds of anxiety or panic disorders are even greater.

    Your blood pressure goes down while you are asleep, giving your heart and blood vessels a bit of a rest. The less sleep you get, the longer your blood pressure stays up during a 24-hour cycle. High blood pressure can lead to heart disease, including stroke.

    Besides robbing you of energy and time for muscle repair, lack of sleep saps your motivation, which is what gets you to the finish line. You’ll face a harder mental and physical challenge — and see slower reaction times.

    During the deep, slow-wave part of your sleep cycle, the amount of glucose in your blood drops. Not enough time in this deepest stage means you don’t get that break to allow a reset. Your body will have a harder time responding to your cells’ needs and blood sugar levels. Better sleep means a lower risk of type 2 diabetes.

    The job of your immune system is to identify harmful bacteria and viruses in your body and destroy them. Ongoing lack of sleep changes the way your immune cells work. They may not attack as quickly, and you could get sick more often.

    When you’re well-rested, you’re less hungry. Being sleep-deprived messes with the hormones in your brain — leptin and ghrelin — that control appetite. With those out of balance, your resistance to the temptation of unhealthy foods goes way down. And when you’re tired, you’re less likely to want to get up and move your body. Together, it’s a recipe for putting on pounds.

    Lack of sleep for any reason can have both mild and severe consequences. It can lead to fatigue and sleepiness during the day – causing you to lose focus, impair your judgment, make you more forgetful, and more likely to be irritable or depressed. This can lead to an increased risk of accidents, both minor and serious. It can also negatively affect the immune system, decrease sex drive, cause hormonal imbalances, and increase weight gain and skin aging.

    All of these symptoms may seem benign, but they increase your risk of chronic conditions like Cardiovascular Disease, Respiratory Illness, High Blood Pressure, Diabetes, and Stroke.

    Determining what is causing loss of sleep can be difficult, as the causes of sleep loss are wide-ranging, including:

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    • Sleep Apnea
    • Being overweight or obese
    • Too much caffeine
    • Night shift work
    • Medications
    • Hormonal Imbalance
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    • Alcohol

    But most cases are caused by mental or environmental factors such as:

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    • Overstimulation from TV, lights, sounds, etc

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    Sleep is a key part in the health of your mind and body that should not be ignored. With Ways2Well, you can make fast improvements to your day and how you feel overall, by simply improving your sleep at night.


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Do Business Downtown

Downtown Wilkes-Barre’s renaissance is attracting national attention. Come see for yourself what all the excitement is about!
Consider the following facts:

  • Downtown Wilkes-Barre is Northeastern Pennsylvania’s largest concentrated employment center, with more than 11,000 people coming here to work each weekday.
  • Downtown Wilkes-Barre is anchored by two four-year institutions of higher education  – Wilkes University and Kings College – with more than 7,500 students between the two downtown campuses. Downtown’s other educational institutions include Luzerne County Community College’s Corporate Learning Center, two high schools, and one private elementary school.
  • Downtown Wilkes-Barre is walkable! Our historic downtown is alive with an abundance of quality restaurants, shops, art venues, community amenities and more, all anchored by Barnes & Noble, Boscov’s Department Store, and R/C Theatres’ 14-screen multiplex cinema.
  • Downtown Wilkes-Barre’s cultural lineup, anchored by the “F.M. Kirby Center for the Performing Arts, includes the Luzerne County Historical Society’s museum and library, the Sordoni Art Gallery of Wilkes University, the Widmann Art Gallery of King’s College, and many private art venues and galleries.
  • Downtown Wilkes-Barre is Northeastern Pennsylvania’s premiere neighborhood for those seeking a “walk-to-everything” lifestyle – more than 3,500 residents already call Downtown home.

To learn more about Downtown business opportunities, click here.


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Bernie Sanders painted as top target for Democrat rivals after Nevada win

Bernie Sanders’ commanding Nevada caucus victory made him a top target for his Democratic rivals and a growing source of anxiety for establishment Democrats worried that the nomination of a self-avowed democratic socialist could cost the party the White House.

Sanders’ win solidified his front-runner status in the crowded field as the race turns to Saturday’s presidential primary in South Carolina, where his moderate opponents will scramble to try to blunt the Vermont senator’s momentum. Just three days later after that contest, 14 states vote on Super Tuesday, March 3, when one-third of the delegates are awarded. A strong showing in those states could put Sanders on a glide path to the nomination against Republican President Donald Trump.

That prospect has amplified concerns for Democrats who believe Sanders’ liberal policies will drive away moderate and independent voters in the general election in November. South Carolina Rep. Jim Clyburn, the top-ranking black leader in Congress, warned of added risk for Democrats if Sanders was the nominee.

“I think it would be a real burden for us in these states or congressional districts that we have to do well in,” Clyburn told “This Week” on ABC.

He noted that congressional districts that helped Democrats win back the House are moderate and conservative. “In those districts, it’s going to be tough to hold on to these jobs if you have to make the case for accepting a self-proclaimed democratic socialist,” Clyburn said.

Sanders’ campaign argue the candidate will bring in new voters — largely progressives, young people and voters of color — who have been alienated by politics.

He successfully relied on that coalition Saturday to dominate his Democratic rivals in Nevada, pulling far ahead of second-place finisher former Vice President Joe Biden and Pete Buttigieg, the former mayor of South Bend, Indiana, who came in third. Massachusetts Sen. Elizabeth Warren landed in fourth, while Minnesota Sen. Amy Klobuchar and Tom Steyer were still in a close race for fifth on Sunday.

Source: Read Full Article


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President of France Announces Curfew for Paris Region Due to COVID-19 Spike, Possibly Affecting Disneyland Paris

President of the French Republic Emmanuel Macron has announced a daily curfew for the Île-de-France region, which includes the city of Paris and Disneyland Paris. The curfew will be from 9:00 PM to 6:00 AM. It begins this Saturday and will last for four weeks.

Disneyland Paris recently drastically reduced their park hours, with Walt Disney Studios Park currently closing at 4:00 PM most days. Disneyland Park is closing between 6:00 PM and 8:00 PM. The curfew will more drastically affect Disney Village, which closes at 10:00 PM currently.

Disneyland Paris has not yet announced changes to their theme park or Disney Village hours in light of the curfew. We will continue to post updates as we learn more.

For more information on booking your next trip with our official travel agent sponsor, the Vacationeer, visit


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Who We Are

Wealthtalk is the best business intelligence company in Africa providing accurate & informative content on the local economy to the local, regional & international business community in the most efficient and timeous manner possible. We achieve this through high quality periodic publications, bulletins & media content that meets global standards.

Africa's Business Intelligence at your fingertips.

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If you need to swear - go elsewhere!
Wearside Online - serving the area for well over 10 years!

Privacy Policy

Privacy Policy At The Sunderland Forum/Wearside Online

The Sunderland Forum is a sub-directory of the Wearside Online website.
Therefore, our Privacy Policy is in operation across the whole of our domain.
Of course, to avoid having a duplicate post, we are just providing a link to the Mother Site.
So, should you wish to read our complete Privacy Policy for the Sunderland Forum, click here.


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Question: Can Canvas See If You Download A File?

Can canvas tell if you screenshot?

Canvas can’t tell if you’ve hit print screen.

There are tools instructors can use to make it harder but any kind of monitoring can be circumvented with enough dedication.

The practices taught in-general by instructional support are to make exercises that don’t rely on such high stakes things..

Can canvas detect dual monitors?

In the comments, Kim clarified that Canvas will even recognize if a student is using two monitors, provided they’re connected to the same computer.

Can Screenshot be detected?

short answer yes – it’s possible. snapchat is popular for notifying the sender that a screenshot was taken. (yes there’s ways around this but by default it’s designed to notify). … How do I take screenshots in Android apps that does not allow to take screenshots?

Can blackboard detect cheating 2020?

Basically, yes, Blackboard can detect cheating if a student submits essays or exam answers that openly violate its policies and anti-cheating rules. It does this by using SafeAssign, Proctored exams, Lockdown browsers, video, audio and IP monitoring.

Can canvas see your IP address?

It doesn’t provide the IP address, but it does show the behavior. If there is a continuous workflow, then it’s unlikely that the student coordinated with an accomplice. You may need to involve your Canvas Admin who may need to get the IT department involved as well.

Can canvas see your location?

Click on Student Locations in the left hand navigation bar of the course. … This will bring you to a screen that shows the locations of those who have already entered their information on interactive world and regional maps.

Can teachers see if you cheat on canvas?

But, can it detect cheating? Ideally, Canvas can detect cheating if a student uploads assignments that portray academic dishonesty, either by copying from others, plagiarism, or impersonation. Canva flags cheating by using quiz log, proctoring tools, and Turnitin plagiarism checks.

Can canvas see if you use your phone?

Still, that doesn’t tell you whether the user is accessing the page from a mobile device. However, you can tell whether the user has accessed the page through the Canvas mobile app on a mobile device.

Can online tests detect cheating?

Depends on the software. But for the majority of cases, they can’t detect cheating. Most professors/instructors in smaller community colleges will be OK with cheating on online tests as they plan their content based around the assumption that people will as it’s basically impossible to stop it.

Can zoom detect cheating?

Second, Zoom proctoring can be used to raise the difficulty students face in collaborating without authorization or using unauthorized resources without detection during the exam. … It also cannot prevent or detect cheating by students who are highly motivated to do so and plan their tactics in advance.

Does canvas show when you download a file?

If a download is linked from a content page or a quiz, then it won’t show up this way — but if it’s in the modules page, then it would show up as external_urls.

Do canvas quizzes know if you switch tabs?

Can Blackboard or Canvas Detect Switching to Open Tabs. Ideally, Canvas cannot detect if a student opened new tabs in a web browser or opened a new application or web browser during a quiz or test. However, if proctored, Canvas will monitor and prevent student’s browser activity.

Can canvas see what device you use?

You can view your own interactions with a student, and view a summary of all student interactions in your site. At this time Canvas analytics do not measure activity on mobile devices, with the exception of Analytics Beta which does measure activity across devices.

Does canvas show if you leave the tab?

Instructors are able to see if you leave a tab. If they personally want to see it on every quiz, they have to enable it.

What can my teacher see on canvas?

Instructors can see certain activity such as: time started/stopped an exam or quiz, total time spent on the exam/quiz, date/time stamps on assignments, time spent in the course and last login. Administrators can see everything down to page views, the dates and times each page was accessed and the browser you used.

How do you find out how much time you spend on canvas?

Welcome to Canvas. To see how much time, click on people on the left-hand side. You will see everyone who is in your course.


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DSP and DMP Onboarding

DSP and DMP Onboarding

Casey N

Helping brands build impactful and actionable tech stacks

30 days
Create a Free Account

Connect all of your buying, data, tagging and analytics into one nightly curated tech stack and watch your ROI grow!

Strategize and onboard your brand onto your DSP and DMP. Discuss the main questions you want your teck stack to answer for your marketing efforts and curate a plan to do so. Inclusive of a thorough audit to determine which platforms are best according to your goals.

Connect your pipes between your DSP and DMP, including onboarding. Also inclusive of CRM connectivity, analytics and performance dashboard integration, Tag Management platforms, if applicable.

Build out your initial segments in your DMP and syndicate to your DSP for targeting. This could be inclusive of CRM, site visitors, remarketing, modeling/look-a-likes... all dependent on your marketing goals.

Frequently Asked Questions

Does MeasureMatch quality control new service providers?

Every one of the MeasureMatch network of service providers has been through a stringent application process, including an interview to ensure relevance of Service providers and quality of delivery. And each is fully aware of the how the platform works, including the commercial framework.

Why book consultants or consultancies via MeasureMatch?

It's easy and incredibly fast to find and book a pro via the MeasureMatch marketplace platform. And, because we interview all service providers, or they are invited by particpating technology vendors, we're seeing greater than 95% of contracts rated 5 full starts by clients (as of 1 November 2020).

Whether it's Salesforce, Microsoft Dynamics, HubSpot, Intercom or Freshsales skills you're after - to name a few in our hottest category of services (CRM and marketing automation) - MeasureMatch has skills and pros you need.

3,000+ skills across around 4,000 systems & data services professionals are accessible via the MeasureMatch marketplace and partner platform.

You'll have direct, seamless and flexible access to a highly-skilled, verified workforce of independent consultants, consultancies, agencies and even systems integrators - each armed with the skills to advance data collection, data engineering, data pipeline management, marketing analytics, marketing automation, personalization, programmatic media investment management and much more.

Which services can clients contract via the MeasureMatch marketplace platform?

The consultants, consultancies, agencies & SIs in our global network, approaching 4,000 in 60+ countries (as of early November 2020), execute important systems and data project work including, but not limited to: CRM systems deployments and revamps, CRO, data cleaning, marketing performance reporting, identity resolution setup, machine learning for predicting and optimizing customer behaviors, marketing automation systems implementations, social media analytics, CX analytics, web analytics and much much more.

The MeasureMatch global network of professionals is highly skilled, many are certified service providers with proficiencies across more than 3,000+ tools and products including the Adobe Experience Cloud stack, the Google Marketing Platform and Google Cloud suite of tools, Segment, Mixpanel, Intercom, Hubspot, DOMO, Power BI, Tableau and 1,000s more.

Who should sign up to MeasureMatch?

On one side, MeasureMatch is for independent consultancies, agencies, systems integrators and independent consultants.

On another side, the platform is for companies that need to solve for, address and advance any number of systems and/or data challenges, and they are open to embracing service providers located anywhere across the globe to get the work done.

Lastly, the third entry point into MeasureMatch is for SaaS and enterprise software vendors to leverage a set of tools grow and deepen serice provider relationships.

What are MeasureMatch Service Packages?

A Service Package describes a service on offer from a consultant or consultancy participating in the MeasureMatch professional services marketplace.
Service Packages compliment MeasureMatch Experts' profiles with services that can be booked "off the shelf".
Service Packages are the only way a prospective client can directly strike up a discovery, scoping, pricing negotiation with any MeasureMatch Expert - otherwise, a project brief needs to be submitted.
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U.S. Public Health Service Seal Contents Search Order Press Resources Links Home

Chapter 2
The Fundamentals of Mental Health
and Mental Illness

The Neuroscience of Mental Health

Overview of Mental Illness

Overview of Etiology

Overview of Development, Temperament, and Risk Factors

Overview of Prevention

Overview of Treatment

Overview of Mental Health Services

Overview of Cultural Diversity and Mental Health Services

Overview of Consumer and Family Movements

Overview of Recovery

Overview of Treatment

Introduction to Range of Treatments

Mental disorders are treatable, contrary to what many think.12 An armamentarium of efficacious treatments is available to ameliorate symptoms. In fact, for most mental disorders, there is generally not just one but a range of treatments of proven efficacy. Most treatments fall under two general categories, psychosocial and pharmacological.13 Moreover, the combination of the two—known as multimodal therapy—can sometimes be even more effective than each individually (see Chapter 3).

The evidence for treatment being more effective than placebo is overwhelming, as documented in the main chapters of this report (Chapters 3 through 5). The degree of effectiveness tends to vary, depending on the disorder and the target population (e.g., older adults with depression). What is optimal for one disorder and/or age group may not be optimal for another. Further, treatments generally need to be tailored to the client and to client preferences.

The inescapable point is that studies demonstrate conclusively that treatment is more effective than placebo. Placebo (an inactive form of treatment) in both pharmacological and psychotherapy studies has a powerful effect in its own right, as this section later explains. Placebo is more effective than no treatment. Therefore, to capitalize on the placebo response, people are encouraged to seek treatment, even if the treatment is not as optimal as that described in this report.

If treatment is so effective, then why are so few people receiving it? Studies reveal that less than one-third of adults with a diagnosable mental disorder, and even a smaller proportion of children, receive any mental health services in a given year. This section of the chapter strives to explain why by examining the types of barriers that prevent people from seeking help. But the chapter first covers some general points about psychological and pharmacological therapies. It also discusses why therapies that work so well in research settings do not work as well in practice.

Psychotherapy is a learning process in which mental health professionals seek to help individuals who have mental disorders and mental health problems. It is a process that is accomplished largely by the exchange of verbal communication, hence it often is referred to as “talk therapy.” Many of the theories undergirding each orientation to psychotherapy were summarized earlier in this chapter.

Participants in psychotherapy can vary in age from the very young to the very old, and problems can vary from mental health problems to disabling and catastrophic mental disorders. Although people often are seen individually, psychotherapy also can be done with couples, families, and groups. In each case, participants present their problems and then work with the psychotherapist to develop a more effective means of understanding and handling their problems. This report focuses on individual psychotherapy and also mentions couples therapy and various forms of family interventions, particularly psycho-educational approaches. Although not discussed in the report, group psychotherapy is effective for selected individuals with some mood disorders, anxiety disorders, schizophrenia, personality disorders, and for mental health problems seen in somatic illness (Yalom, 1995; Kanas, in press).

Estimates of the number of orientations to psychotherapy vary from a very small number to well over 400. The larger estimate generally refers to all the variations of the three major orientations, that is, psychodynamic, behavioral, and humanistic. Each orientation falls under the more general conceptual category of either action or reflection.

Psychodynamic orientations are the oldest. They place a premium on self-understanding, with the implicit (or sometimes explicit) assumption that increased self-understanding will produce salutary changes in the participant. Behavioral orientations are geared toward action, with a clear attempt to mobilize the resources of the patient in the direction of change, whether or not there is any understanding of the etiology of the problem. Humanistic orientations aim toward increased self-understanding, often in the direction of personal growth, but use treatment techniques that often are much more active than are likely to be employed by the psychodynamic clinician.

While the following paragraphs focus on psychodynamic, behavioral, and humanistic orientations, they also discuss interpersonal therapy and cognitive-behavioral therapy as outgrowths of psychodynamic and behavioral therapy, respectively. Psychodynamic, interpersonal, and cognitive-behavioral therapy are most commonly the focus of treatment research reported throughout this report.

Psychodynamic Therapy

The first major approach to psychotherapy was developed by Sigmund Freud and is called psychoanalysis (Horowitz, 1988). Since its origin more than a century ago, psychoanalysis has undergone many changes. Today, Freudian (or classical) psychoanalysis is still practiced, but other variations have been developed—ego psychology, object relations theory, interpersonal psychology, and self-psychology, each of which can be grouped under the general term “psychodynamic” (Horowitz, 1988). The psychodynamic therapies, even though they differ somewhat in theory and approach, all have some concepts in common. With each, the role of the past in shaping the present is emphasized, so it is important, in understanding behavior, to understand its origins and how people come to act and feel as they do. A second critical concept common to all psychodynamic approaches is the belief in the unconscious, so that there is much that influences our behavior of which we are not aware. This makes the process of understanding more difficult, as we often act for reasons that we cannot state, and these reasons often are linked to previous experiences. Thus, an important part of psychodynamic psychotherapy is to make the unconscious conscious or to help the patient understand the origin of actions that are troubling so that they can be corrected.

For some psychodynamic approaches, such as the classical Freudian approach, the focus is on the individual and the experiences the person had in the early years that give shape to current behavior, even beyond the awareness of the patient. For other, more contemporary approaches, such as interpersonal therapy, the focus is on the relationship between the person and others. First developed as a time-limited treatment for midlife depression, interpersonal therapy focuses on grief, role disputes, role transitions, and interpersonal deficits (Klerman et al., 1984). The goal of interpersonal therapy is to improve current interpersonal skills. The therapist takes an active role in teaching patients to evaluate their interactions with others and to become aware of self-isolation and interpersonal difficulties. The therapist also offers advice and helps the patient to make decisions.

Behavior Therapy

A second major approach to psychotherapy is known as behavior modification or behavior therapy (Kazdin, 1996, 1997). It focuses on current behavior rather than on early patterns of the patient. In its earlier form, behavior therapy dealt exclusively with what people did rather than what they thought or felt. The general principles of learning were applied to the learning of maladaptive as well as adaptive behaviors. Thus, if a person could be conditioned to act in a functional way, there was no reason why the same principles of conditioning could not be employed to help the person unlearn dysfunctional behavior and learn to replace it with more functional behavior. The role of the environment was very important for behavior therapists, because it provided the positive and negative reinforcements that sustained or eliminated various behaviors. Therefore, ways of shaping that environment to make it more responsive to the needs of the individual were important in behavior therapy.

More recently, there has been a significant addition to the interests and activities of behavior therapists. Although behavior continued to be important in relation to reinforcements, cognitions—what the person thought about, perceived, or interpreted what was transpiring—were also seen as important. This combined emphasis led to a therapeutic variant known as cognitive-behavioral therapy, an approach that incorporates cognition with behavior in understanding and altering the problems that patients present (Kazdin, 1996).

Cognitive-behavioral therapy draws on behaviorism as well as cognitive psychology, a field devoted to the scientific study of mental processes, such as perceiving, remembering, reasoning, decision making, and problem solving. The use of cognition in cognitive-behavioral therapy varies from attending to the role of the environment in providing a model for behavior, to the close study of irrational beliefs, to the importance of individual thought processes in constructing a vision of the surrounding world. In each case, it is critical to study what the individual in therapy thinks and does and less important to understand the past events that led to that pattern of thinking and doing. Cognitive-behavioral therapy strives to alter faulty cognitions and replace them with thoughts and self-statements that promote adaptive behavior (Beck et al., 1979). For instance, cognitive-behavioral therapy tries to replace self-defeatist expectations (“I can’t do anything right”) with positive expectations (“I can do this right”). Cognitive-behavioral therapy has gained such ascendancy as a means of integrating cognitive and behavioral views of human functioning that the field is more frequently referred to as cognitive-behavioral therapy rather than behavior therapy (Kazdin, 1996).

Humanistic Therapy

The third wave of psychotherapy is referred to variously as humanistic (Rogers, 1961), existential (Yalom, 1980), experiential, or Gestalt therapy. It owes its origins as a treatment to the client-centered therapy that was originated by Carl Rogers, and the theory can be traced to philosophical roots beginning with the 19th century philosopher, Soren Kierkegaard. The central focus of humanistic therapy is the immediate experience of the client. The emphasis is on the present and the potential for future development rather than on the past, and on immediate feelings rather than on thoughts or behaviors. It is rooted in the everyday subjective experience of the person seeking assistance and is much less concerned with mental illness than it is with human growth.

One critical aspect of humanistic treatment is the relationship that is forged between the therapist, who in some ways serves as a guide in an exploration of self-discovery, and the client, who is seeking greater knowledge of the self and an expansion of inherent human potential. The focus on the self and the search for self-awareness is akin to psychodynamic psychotherapy, while the emphasis on the present is more similar to behavior therapy.

Although it is possible to describe distinctive orientations to psychotherapy, as has been done above, most psychotherapists describe themselves as eclectic in their practice, rather than as adherents to any single approach to treatment. As a result, there is a growing development referred to as “psychotherapy integration” (Wolfe & Goldfried, 1988). It strives to capture what is best about each of the individual approaches. Psychotherapy integration includes various attempts to look beyond the confines of any single orientation but rather to see what can be learned from other perspectives. It is characterized by an openness to various ways of integrating diverse theories and techniques. Psychotherapy also should be modified to be culturally sensitive to the needs of racial and ethnic minorities (Acosta et al., 1982; Sue et al., 1994; Lopez, in press).

The scientific evidence on efficacy presented in this report, however, is focused primarily on specific, standardized forms of psychotherapy.

Pharmacological Therapies

The past decade has seen an outpouring of new drugs introduced for the treatment of mental disorders (Nemeroff, 1998). New medications for the treatment of depression and schizophrenia are among the achievements stoked by research advances in both neuroscience and molecular biology. Through the process known as rational drug design, researchers have become increasingly sophisticated at designing drugs by manipulating their chemical structures. Their goal is to create more effective therapeutic agents, with fewer side effects, exquisitely targeted to correct the biochemical alterations that accompany mental disorders.

The process was not always so rational. Many of the older pharmacotherapies (drug treatments) that had been introduced by 1960 had been discovered largely by accident. Researchers studying drugs for completely different purposes serendipitously found them to be useful for treating mental disorders (Barondes, 1993). Thanks to their willingness to follow up on unexpected leads, drugs such as chlorpromazine (for psychosis), lithium (for bipolar disorder), and imipramine (for depression) became available. The advent of chlorpromazine in 1952 and other neuroleptic drugs was so revolutionary that it was one of the major historical forces behind the deinstitutionalization movement that is discussed later in this chapter.

The past generation of pharmacotherapies, once shown to be safe and effective, was introduced to the market generally before their mechanism of action was understood. Years of research after their introduction revealed how many of them work therapeutically. Knowledge about their actions has had two cardinal consequences: it helped probe the etiology of mental disorders, and it ushered in the next generation of pharmacotherapies that are more selective in their mechanism of action.

Mechanisms of Action

The mechanism of action refers to how a pharmacotherapy interacts with its target in the body to produce therapeutic effects. Pharmacotherapies that act in similar ways are grouped together into broad categories (e.g., stimulants, antidepressants). Within each category are several chemical classes. The individual pharmacotherapies within a chemical class share similar chemical structures. Table 2-9 presents several common categories and classes, along with their indication, that is, their clinical use.

Many pharmacotherapies for mental disorders have as their initial action the alteration—either increase or decrease—in the amount of a neurotransmitter. Neurotransmitter levels can be altered by pharmacotherapies in myriad ways: pharmacotherapies can mimic the action of the neurotransmitter in cell-to-cell signaling; they can block the action of the neurotransmitter; or they can alter its synthesis, breakdown (degradation), release, or reuptake, among other possibilities (Cooper et al., 1996).

Neurotransmitters generally are concentrated in separate brain regions and circuits. Within the cells that form a circuit, each neurotransmitter has its own biochemical pathway for synthesis, degradation, and reuptake, as well as its own specialized molecules known as receptors. At the time of neurotransmission, when a traveling signal reaches the tip (terminal) of the presynaptic cell, the neurotransmitter is released from the cell into the synaptic cleft. It migrates across the synaptic cleft in less than a millisecond and then binds to receptors situated on the membrane of the postsynaptic cell. The neurotransmitter’s binding to the receptor alters the shape of the receptor in such a way that the neurotransmitter can either excite the postsynaptic cell, and thereby transmit the signal to this next cell, or inhibit the receptor, and thereby block signal transmission. The neurotransmitter’s action is terminated either by enzymes that degrade it right there, in the synaptic cleft, or by transporter proteins that return unused neurotransmitter back to the presynaptic neuron for reuse, a “recycling” process known as reuptake. The widely prescribed class of antidepressants referred to as the selective serotonin reuptake inhibitors primarily block the action of the transporter protein for serotonin, thus leaving more serotonin to remain at the synapse (Schloss & Williams, 1998). Depression is thought to be reflected in decreased serotonin transmission, so one rationale for this class of antidepressants is to boost the level of serotonin (see Chapter 4).

Table 2-9. Selected types of pharmacotherapies

Category and Class Example(s) of Clinical Use
Antipsychotics (neuroleptics)
Typical antipsychotics*
Atypical antipsychotics**
Schizophrenia, psychosis
Selective serotonin
reuptake inhibitors
Tricyclic and heterocyclic
Monoamine oxidase inhibitors
Depression, anxiety
Stimulants Attention-deficit/hyperactivity disorder
Thyroid supplementation
Antianxiety (anxiolytics)
B-Adrenergic-blocking drugs
Cholinesterase inhibitors Alzheimer’s disease

* Also known as first-generation antipsychotics, they include these chemical classes: phenothiazines (e.g., chlorpromazine), butyrophenones (e.g., haloperidol), and thioxanthenes (Dixon et al., 1995).
** Also known as second-generation antipsychotics, they include these chemical classes: dibenzoxazepine (e.g., clozapine), thienobenzodiazepine (e.g., olanzapine), and benzisoxazole (e.g., risperidone).
*** Include imipramine and amitriptyline.

Source: Perry et al., 1997

Although the effects of reuptake inhibitors on neurotransmitter concentrations in the synapse occur with the first dose, therapeutic benefit typically lags behind by days or weeks. This observation has spurred considerable recent research on chronic and “downstream” actions of psychotropics, particularly antidepressants. For example, in animal models the repeated administration of nearly all antidepressants is associated with a reduction in the number of postsynaptic 12/7/99 receptors, so-called down-regulation that parallels the time course of clinical effect in patients (Schatzberg & Nemeroff, 1998). Some of the secondary effects of reuptake inhibitors may be mediated by the activation of intraneuronal “second messenger” proteins which result from the stimulation of postsynaptic receptors (Schatzberg & Nemeroff, 1998).

Receptors for each transmitter come in numerous varieties. Not only are there several types of receptor for each neurotransmitter, but there may be many subtypes. For serotonin, for example, there are seven types of receptors, designated 5-HT1 –5-HT7, and seven receptor subtypes, totaling 14 separate receptors (Schatzberg & Nemeroff, 1998). The pace at which receptors are identified has become so dizzying that these figures are likely to be obsolete by the time this paragraph is read.

A pharmacotherapy typically interacts with a receptor in either one of two ways—as an agonist or as an antagonist.14 When a pharmacotherapy acts as an agonist, it mimics the action of the natural neurotransmitter. When a pharmacotherapy acts as an antagonist, it inhibits, or blocks, the neuro-transmitter’s action, often by binding to the receptor and preventing the natural transmitter from binding there. An antagonist disrupts the action of the neurotransmitter.

The diversity of receptors presents vast opportunities for drug development. Through rational drug design, pharmacotherapies have become increasingly selective in their actions. Generally speaking, the more selective the pharmacotherapy’s action, the more targeted it is to one receptor rather than another, the narrower its spectrum of action, and the fewer the side effects. Conversely, the broader the pharmacotherapy’s action, the less targeted to a receptor type or subtype, the broader the effects, and the broader the side effects (Minneman, 1994). However, the interaction among neurotransmitter systems in the brain renders some of the apparent distinctions among medications more apparent than real. Thus, despite differential initial actions on neurotransmitters, both serotonin and norepinephrine reuptake blockers have similar biochemical effects after chronic dosing (Potter et al., 1985).

Complementary and Alternative Treatment

Recent interest in the health benefits of a plethora of natural products has engendered claims related to putative effects on mental health. These have ranged from reports of enhanced memory in people taking the herb, ginseng, to the use of the St. John’s wort flowers as an antidepressant (see Chapter 4).

There are major challenges to evaluating the role of complementary and alternative treatments in maintaining mental health or treating mental disorders. In many cases, preparations are not standardized and consist of a variable mixture of substances, any of which may be the active ingredient(s). Purity, bioavailability, amount and timing of doses, and other factors that are standardized for traditional pharmaceutical agents prior to testing cannot be taken for granted with natural products. Current regulations in the United States classify most complementary and alternative treatments as “food supplements,” which are not subject to premarketing approval of the Food and Drug Administration.

At present, no conclusions about the role, if any, of complementary and alternative treatments in mental health or illness can be accepted with certainty, as very few claims or studies meet acceptable scientific standards. With funding from government and private industry, controlled clinical trials are under way, including the use of St. John’s wort (Hypericum perforatum) as a treatment for depression, and omega-3 fatty acids (fish oils) as a mood stabilizer in bipolar depression. In addition, it is important for clinicians and investigators to account for any herbs or natural products being taken by their patients or research subjects that might interact with traditional treatments.

Issues in Treatment

The foregoing section has furnished an overview of the types and nature of mental health treatment. The resounding message, which is echoed throughout this report, is that a range of efficacious treatments is available. The following material deals with four issues surrounding treatment—the placebo response, benefits and risks, the gap between how well treatments work in clinical trials versus in the real world, and the constellation of barriers that hinder people from seeking mental health treatment.

Placebo Response

Recognized since antiquity, the placebo effect refers to the powerful role of patients’ attitudes and perceptions that help them improve and recover from health problems. Hippocrates established the therapeutic principle of physicians laying their hands in a reassuring manner to draw on the inner resources of the patient to fight disease. Technically speaking, the placebo effect refers to treatment responses in the placebo group, responses that cannot be explained on the basis of active treatment (Friedman et al., 1996a). A placebo is an inactive treatment, either in the form of an inert pill for studying a new drug treatment or an inactive procedure for studying a psychological therapy. The effects of active treatment are often compared with a control group that receives a pharmacological or psychological placebo.

It is not unusual for a placebo effect to be found in up to 50 percent of patients in any study of a medical treatment (Schatzberg & Nemeroff, 1998). For example, about 30 percent of patients typically respond to a placebo in a clinical trial of a new antidepressant (see Chapter 4). The rate is even higher for an antianxiety agent (an anxiolytic) (Schweizer & Rickels, 1997). The placebo effect is of such import that a placebo group or other control group15 is mandated by the Food and Drug Administration in clinical trials of a new pharmacotherapy to establish its efficacy prior to marketing (Friedman et al., 1996a). If the pharmacotherapy is not statistically superior to the control, efficacy cannot be established. It is somewhat more difficult to fashion an analog of an inert pill in the testing of new and experimental psychological therapies. Psychological studies can employ a “psychological” placebo in the form of a treatment known to be ineffectual. Or they can employ a comparison group, which receives an alternative psychological therapy. Some treatment studies employ both a “psychological” placebo, as well as a comparison group.16

The basis of the placebo response is not fully known, but there are thought to be many possible reasons. These reasons, which relate to attributes of the disorder or the disease, the patient, and the treatment setting, include spontaneous remission, personality variables (e.g., social acquiescence), patient expectations, attitudes of and compassion by clinicians, and receiving treatment in a specialized setting (Schweizer & Rickels, 1997). In studies of postoperative pain, the placebo response is mediated by patients’ production of endogenous pain-killing substances known as endorphins (Levine et al., 1978).

Benefits and Risks

Throughout this report, currently accepted treatments for mental disorders will be described. Except where otherwise indicated, the efficacy of these interventions has been documented in multiple controlled, clinical trials published in the peer-reviewed literature. In some cases, these have been supplemented by expert consensus reports or practice guidelines.

Most studies of efficacy of specific treatments for mental disorders have been highly structured clinical trials, performed on individuals with a single disorder, in good physical health. While necessary and important, these trials do not always generalize easily to the wider population, which includes many individuals whose mental disorder is accompanied by another mental or somatic disorder and/or alcohol or substance abuse, and who may be taking other medications. Moreover, children, adolescents, and the elderly are excluded from many clinical trials,17 as are those in certain settings, such as nursing homes. Newer, more generalizable studies are being undertaken to address these shortcomings of the scientific literature (Lebowitz & Rudorfer, 1998).

Pending the results of these newer studies, it is important for clinical decisionmakers to review the current best evidence for the efficacy of treatments. People with mental disorders and their health providers should consider all possible options and carefully weigh the pros and cons of each, as well as the possibility of no treatment at all, before deciding upon a course of action. Such an informed consent process entails the calculation of a benefit-to-risk ratio" for each available treatment option. Most medications or somatic treatments have side effects, for example, but a likelihood of significant clinical benefit often overrides side effects in support of a treatment recommendation.

Gap Between Efficacy and Effectiveness

Mental health professionals have long observed that treatments work better in the clinical research trial setting as opposed to typical clinical practice settings. The diminished level of treatment effectiveness in real-world settings is so perceptible that it even has a name, the “efficacy-effectiveness gap.” Efficacy is the term for what works in the clinical trial setting, and effectiveness is the term for what works in typical clinical practice settings. The efficacy-effectiveness gap applies to both pharmacological therapies and to psychotherapies (Munoz et al., 1994; Seligman, 1995). The gap is not unique to mental health, for it is found with somatic disorders too.

The magnitude of the gap can be surprisingly high. With schizophrenia medications, one review article found that, in clinical trials, the use of traditional antipsychotic medications for schizophrenia was associated with an average annual relapse rate of about 23 percent, whereas the same medications used in clinical practice carried a relapse rate of about 50 percent (Dixon et al., 1995). The magnitude of the gap found in this study may not apply to other medications and other disorders, much less to psychological therapies. Studies of real-world effectiveness are scarce. Yet some degree of gap is widely recognized. The question is, why?

Efficacy studies test whether treatment works under ideal circumstances. They typically exclude patients with other mental or somatic disorders. In the past, they typically have examined relatively homogeneous populations, usually white males. Furthermore, efficacy studies are carried out by highly trained specialists following strict protocols that require frequent patient monitoring. Finally, participation in efficacy studies is often free of charge to patients.

It is not surprising that the reasons commonly cited to explain the discrepancy between efficacy and effectiveness focus on the practicalities and constraints imposed by the real world. In real-world settings, patients often are more heterogeneous and ethnically diverse, are beset by comorbidity (more than one mental or somatic disorder),18 are often less compliant, and are seen more often in general medical rather than specialty settings; providers are less inclined to adequately monitor and standardize treatment; and cost pressures exist on both patients and providers, depending on the nature of the financing of care (Dixon et al., 1995; Wells & Sturm, 1996). This constellation of real-world constraints appears to explain the gap.

Barriers to Seeking Help

Most people with mental disorders do not seek treatment, according to figures presented in the next section of this chapter and in Chapter 6. This general statement applies to adults and older adults and to parents and guardians who make treatment decisions for children with mental disorders. There is a multiplicity of reasons why people fail to seek treatment for mental disorders but few detailed studies. The barriers to treatment fall under several umbrella categories: demographic factors, patient attitudes toward a service system that often neglects the special needs of racial and ethnic minorities, financial, and organizational.

Several demographic factors predispose people against seeking treatment. African Americans, Hispanics (Sussman et al., 1987; Gallo et al., 1995), and poor women (Miranda & Green, 1999) are less inclined than non-Hispanic whites—particularly females—to seek treatment. Common patient attitudes that deter people from seeking treatment are not having the time, fear of being hospitalized, thinking that they could handle it alone, thinking that no one could help, and stigma (being too embarrassed to discuss the problem) (Sussman et al., 1987). Above all, the cost of treatment is the most prevalent deterrent to seeking care, according to a large study of community residents (Sussman et al., 1987). Cost is a major determinant of seeking treatment even among people with health insurance because of inferior coverage of mental health as compared with health care in general. Finally, the organizational barriers include fragmentation of services and lack of availability of services (Horwitz, 1987). Members of racial and ethnic minority groups often perceive that services offered by the existing system do not or will not meet their needs, for example, by taking into account their cultural or linguistic practices. These particular barriers are discussed in greater depth with respect to minority groups (later in this chapter) and with respect to different ages (Chapters 3 to 5).

Demographic, attitudinal, financial, and organizational barriers operate at various points and to various degrees. Seeking treatment is conceived of as a complex process that begins with an individual or parent recognizing that thinking, mood, or behaviors are unusual and severe enough to require treatment; interpreting symptoms as a “medical” or mental health problem; deciding whether or not to seek help and from whom; receiving care; and, lastly, evaluating whether continuation of treatment is warranted (Sussman et al., 1987)

12 About 40 percent of those surveyed thought that they “didn’t think anyone could help” as a reason for not seeking mental health treatment (Sussman et al., 1987).

13 Other treatments are electroconvulsive therapy (Chapters 4 and 5) and some types of surgery.

14 There are certainly exceptions to this general rule. Some pharmacotherapies work as partial agonists and partial antagonists simultaneously.

15 When it is unethical to deprive patients of treatment, such as the case with AIDS, conventional treatment is given as the control.

16 The criteria developed by a division of the American Psychological Association for establishing treatment efficacy call for the experimental treatment to be statistically superior to “pill or psychological placebo or to another treatment” (Chambless et al., 1998).

17 In March 1998, the NIH issued a policy guideline stating that NIH-funded investigators will be expected to include children in clinical trials, which normally would involve adults only, when there is sound scientific rationale and in the absence of a strong justification to the contrary.

18 Having a second disorder increases the possibility of drug interactions, which may translate into reduced dosing. Comorbidity is discussed throughout this report.

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text:
Can anyone help me figure this.

If I use this compression test it tells me my site uses gzip. But when I run the yslow Firefox plugin it tells me my site does not use gzip.

Has anyone came across this before? Is there a more conclusive test I could do?

The site in question is http://www.thefootytipster.com, if you copy and paste that into the first link it will say compression is enabled. But if you try it against ySlow it will not.

  • No -- have not seen that before. It will be much better if you provide some real URL (at least to some test page that reports difference like that). – LazyOne Jul 30 '11 at 14:25
  • What I'm thinking: the compression may be sensitive to User Agent string (you have not provided exact settings .. so I assume it is a possibility). – LazyOne Jul 30 '11 at 14:42

Are you definitely testing the same URLs? If you are inputting your domain into one testing tool, then that checks if the home page on your site (ie the HTML) is sent gzipped.

But if you open the page in Firefox and run Yslow it will check all linked files as well. Your HTML pages may be gzipped (probably as a result of a CMS) but CSS and JavaScript may not be compressed.

Make sure to check in each tool exactly which URLs it says are not gzipped.

  • 1
    +1. Home page (HTML) is gzipped while css files are not. @Toby YSlow as well as Google PageSpeed shows you the exact URLs that are not compressed - 100% sure on this one. – LazyOne Jul 30 '11 at 15:05

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Delme Parfitt

Delme Parfitt

Delme is assistant head of sport at Media Wales, specialising in rugby

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