Oil & Gas Companies are Finding Ways to Meet Capital Requirements in a Down Market
Energy Finance: with oil prices still searching for a bottom, energy companies have been in search of ways to lighten burdens through good financial decisions. The ubiquity of capital needs and consequent debt associated with the oil and gas sector necessitates that many companies use multiple debt vehicles to meet their capital requirements.
Among the most common debt vehicles are corporate bonds. The upside to issuing a corporate bond is that the primary responsibility for the term of the bond is paying the interest, with the principal being repaid at the maturity of the bond.
The downside comes when the balloon payment associated with the maturity falls at a point where commodities prices have plunged to $30 for the first time in more than 12 years. This requires companies to meet debt obligations and make interest payments on issuances that were secured when commodities prices were substantially higher than today. In other words, the debt obligation (whose size doesn’t change with the commodity direction), doesn’t match cash flows. It’s the CFO’s nightmare: the company’s finances are being impacted by events which stand outside the company’s control.
In an effort to postpone the balloon payments while still maintaining go-forward capital liquidity, several E&P companies have issued tender exchange offers to push out the maturity of their corporate bonds.
There are several reasons that bond holders would choose to exchange their current bonds for new ones. One reason is the lower risk of default and bankruptcy. By granting more time to the company to work through difficult financial times, the investor stands to benefit from a successful effort, while the risk is real of potentially receiving nothing in a default. Another reason is the investor may not be ready to cash in on the bond.
However, the most common reason for bond holders is that the company will incentivize the investors to make the switch by paying a premium on the bond.
Following are some recent energy finance examples that involve debt exchanges: Denbury Resources (ticker: DNR)
On December 21, 2015, Denbury Resources announced an exchange offer for three sets of senior subordinated notes. The notes that are being replaced are:
Title of Old Notes Principal Amount Outstanding ($MM) Early Exchange Consideration Late Exchange Consideration 6 .375% Senior Subordinated Notes due 2021 $ 400 $ 650 per $1,000 par value $ 600 per $1,000 par value 5.5% Senior Subordinated Notes due 2022 $ 1,250 $ 650 $ 600 4.625% Senior Subordinated Notes due 2023 $ 1,200 $ 650 $ 600
Denbury offered to replace these notes up to $650 million with new 7.5% senior notes with a maturity date of May 15, 2022.
At the time of the Denbury announcement, the three bonds were trading at a significant discount relative to the issue price. Relative to an original trading price of $100, the 6.375% notes were trading at $40.00, the 5.5% notes were trading at $36.50, and the 4.625% notes were trading at $35.75 on December 21, 2015.
In this case, Denbury is willing to offer a premium to the publicly traded price for investors to exchange the notes, particularly if they participate in the early exchange consideration. While the new notes offer a higher interest rate, by reducing and postponing the balloon payments from the old notes, the company will save money in the long run.
Chesapeake Energy (ticker: CHK)
Another example of companies offering to exchange bonds is Chesapeake Energy. On December 2, 2015, the company released a list of outstanding bonds with the offer to exchange them for new 8.00% senior secured second lien notes due in 2022.
The list of bonds is as follows:
Title of Old Notes Principal Amount Outstanding ($MM) Early Exchange Consideration Late Exchange Consideration 6.25% Euro Denominated Senior Notes due 2017 $ 364 $ 1,000 per $1,000 par value $ 950 per $1,000 par value 6.5% Senior Notes due 2017 $ 660 $ 970 $ 920 7.25% Senior Notes due 2018 $ 669 $ 825 $ 775 Floating Rate Senior Notes due 2019 $ 1,500 $ 600 $ 550 6.625% Senior Notes due 2020 $ 1,300 $ 610 $ 560 6.875% Senior Notes due 2020 $ 500 $ 609 $ 559 6.125% Senior Notes due 2021 $ 1,000 $ 578 $ 528 5.375% Senior Notes due 2021 $ 700 $ 570 $ 520 4.875% Senior Notes due 2022 $ 1,500 $ 565 $ 515 5.75% Senior Notes due 2023 $ 1,100 $ 568 $ 518
In this case, the motivations are a little different from Denbury’s. The notes listed above are in sequence of maturity. Notice the highest value relative to par offered for exchange is also the earliest maturity date. Chesapeake is offering the increased premium to push back the maturity date of the bonds, in this case, they are offering a one-for-one exchange.
The 6.5% senior notes that are due in 2017 were trading at a value of $75 relative to $100 on December 2, 2015, when the exchange offer was announced. That would equate to a 29% premium relative to the trading value. In the case of the 4.875% notes due in 2022, these notes were trading at $44.99 relative to $100 on December 2, 2015. This would entail a premium of 25% for the exchange offer. By incentivizing the investor to exchange the earlier notes for a greater premium, Chesapeake has effectively pushed back maturity dates and maintained necessary liquidity while doing so.
At the time of the Chesapeake announcement, the 12-month forward strip for WTI crude was $44.54, and the 24-month strip was $46.90; they have declined to $35.20 and $38.01, respectively as of January 12, 2016.
Noble Energy (ticker: NBL)
On June 29, 2015, Noble Energy announced an exchange offer for notes that were outstanding from their acquisition of Rosetta Resources. The timing of the maturity remained unchanged as did the terms of the notes. However, in an effort to move the notes under the Noble umbrella, the company offered early exchange terms of a one-for-one trade, or an offer of par value for the bond.
Carrizo Oil and Gas (ticker: CRZO)
On April 24, 2015, Carrizo Oil and Gas announced a cash tender offer to buy back all of their outstanding 8.635% notes due in 2018 while simultaneously announcing the issue of new notes with the same terms due in 2023. In order to incentivize investors to take the cash offer, Carrizo offered $1,046.13 for each $1,000 principal note outstanding. The investor would also continue to receive interest for the remainder of the original terms, concluding in 2018.
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By Carol Band At dinner time, they still approach anything from the plant kingdom like contestants on Fear Factor facing a plate of Madagascar cockroaches.
My kids don't trust me. It's not because I snoop in their rooms, or listen in on their phone conversations or rummage through their backpacks without permission. It's because I mess with their food.
Left to their own devices, my kids would eat only pasta (with butter, no sauce) pancakes and pizza. Oh, they also like Pez. You'll notice that all of these foods have something in common. They all contain: NO VEGETABLES!
Yet, somehow my kids have survived - even seemingly thrived - without green beans, broccoli, peppers, lettuce, kale, Swiss chard, brussels sprouts, eggplant, squash, spinach or asparagus. But I've read the USDA recommendations. They say that kids should consume 2-1/2 cups of vegetables every day. Are they kidding? My children haven't eaten that many vegetables in their lifetimes - unless you count candy corn. Yet, when I asked my pediatrician about the long-term ramifications of an all-carb diet, he didn't seem overly concerned. He said that if they eat ice cream and peanut butter and pop an occasional multivitamin, they'll probably be fine.
Still, I worry that they'll contract scurvy, or become constipated or get cavities. I imagine them growing up without ever tasting a fresh-picked tomato, my mother's candied sweet potatoes or the Cobb Salad at Chili's. So I keep pushing vegetables.
Now I didn't just fall off the turnip truck. I know that there are tricks that parents use to get their kids to eat vegetables. And I know that they don't work, because I've tried them all.
I've cut carrots into coins and staged treasure hunts. I've played "hungry dinosaur" with broccoli trees. I've poured cheese sauce onto cauliflower, dipped green peppers into ranch dressing and smeared peanut butter over everything else. I've carved radish roses, created clown faces with snow peas and used a quart of canola oil to make sweet potato fries. I've even enlisted my kids to help shop for, cook and grow their own vegetables. Nothing works. At dinner time, they still approach anything from the plant kingdom like contestants on Fear Factor facing a plate of Madagascar cockroaches.
So, I've had to get a little sneaky. I'm not proud of the deception, but, I have only my children's health at heart.
I started small. First, I added a dollop of canned pumpkin to the pancake mix. Then, I sprinkled a teaspoon of chopped spinach into the pizza sauce. They didn't suspect a thing. So I got a little bolder. I grated zucchini into the pancake batter and tossed in some flax seed. I threw a handful of broccoli florets into the pizza sauce and mixed the mozzarella cheese with tofu.
This time they noticed.
"There's green stuff in my pancakes!?" my son said, recoiling with horror. "It's mold!"
"It's just a little zucchini," I said in my most produce-loving voice. "Try it, it's delicious."
"Ewwwwww … no way. I hate zucchini! Yuck."
They were on to me.
Now, they approach every meal with suspicion. They examine their dinners like they are food tasters for the Czar.
"What's in this pizza?" my daughter says, sniffing her slice. "It smells funny."
"Can I see the box that the macaroni came in?"
"Is this the same bread you usually buy?"
It's not easy. In fact, I've had to discover new tricks. But it's all for their own good.
Did you know that chewable vitamins can fit into a Pez dispenser?
Trust me.
Carol Band's fridge is stocked with asparagus spears and other weapons of mass deception. Write to her at band_carol@hotmail.com. To read more of Carol's Household Word columns, visit Household Word Archives.


The Offense Principle claims that individual liberty is justifiably limited to prevent offensive behavior. I believe that the Offense Principle provides the correct liberty limit n principles that the state should invoke. The state should prevent behavior that causes shame, embarrassment and discomfort from pornographic material and cts.There are three conditions that are typically understood to be part of the Offense Principle. The first condition states that behavior must be significantly offensive. A person burping in public is not offensive enough to be limited under this condition. But a man urinating as he walks down the street is significantly offensive and should be limited.The second condition states that the behavior must be offensive to almost everyone. This is an important condition because I think that if only a few people find something offensive, does not constitute the act to be limited. Many people may believe that someone picking his nose in public is offensive but not almost everyone believes this act to be offensive, therefore, this act could not be limited. A man masturbating in public is offensive to almost everyone, therefore, this act should be limited.The final condition states that an offensive act should be limited if you have to go out of your way to avoid the act. An "adult" bookstore containing pornographic material should not be limited because one does not have to go out of their way to avoid the store. They simply just do not enter into the store. But a man and woman having sex on a bench should be limited because one would have to restrain from looking in certain directions to avoid seeing the offensive act.I believe that pornography in public should be banned. This includes stores that sell pornographic material. Instead, these magazines and other pornographic materials should be kept separately in a private room, where you must be an adult to enter and purchase materials. Pornographic material...


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My friend and her family live in an old but large and beautiful home. In the process of having the house painted, they discovered it was being destroyed by termites -- small and mostly out-of-sight creatures that worked without ceasing.
In a similar way, people often go through the crises of life with flying colors. They take time to mourn the traumas and tragedies. Yet, those same people are often being destroyed by the mental termites of negativism, fear, worry, anger and resentment. During the next few weeks, we'll look at some of these.
One of the most common is negativism. That isn't hard to understand since we are bombarded with news of violence. If we choose to fill our minds with this, we will be inundated by negativism. We will become pessimistic, unhappy people.
Several years ago, I was speaking to the Junior League of Richmond, Va. The mother of one of the members asked me if I would stay over and speak to senior adults at her church. The following day as I entered the meeting room, I was amazed at the obvious vitality and energy, especially when the hostess told me that the average age of those present was 86.
Seated by a woman in her early 80s, I said, "I like your new church. It's so beautiful." Without so much as a smile, she replied curtly, "It's too big; it cost too much money; I wasn't in favor of building it." Realizing I needed a new approach, I thought the weather would be safe, so I said, "Haven't we been having lovely weather this week?" Still without a smile, she said, "Yes, but it snowed six times this year." Subsequently, every time I said anything, she said, "Yes, but ..."
Finally, my hostess rescued me, saying, "I sat you down by Mrs. Jones because she's so negative that I thought you might help her." Wearily, I replied, "If you'd left me by her five more minutes, I couldn't have spoken." Negative people infect others with their heavy gloom.
What about you? Is there anyone who hopes they don't see you until after they have had a strong cup of coffee? Negativism is usually a thought pattern that has become habitual. Maybe you were reared in an environment where you were negatively conditioned by authority figures. You can, however, interrupt the pattern. It will take time and effort and prayers. Remember that whatever you are now, you will become more so as you get older unless you change the pattern.
If you are a bore at 20, you will be an impossible bore at 50; if you are stingy at 18, you will be a terrible tightwad at 80. When speaking to a mixed audience, I often say, "Women, there is nothing worse than an old woman who is mean, petty, whining and complaining unless it's an old man who is mean, petty, whining and complaining. Both are the crowning work of the devil!" It's time to change the pattern.
Nell Mohney is a Christian author, motivational speaker and seminar leader. She may be reached at nellwmohney@comcast.net.


Britain’s town centres remain essential hubs for our communities, but the retail sector is smaller than it once was, typically surrounded by under-occupied buildings and a grim environment.
The average level of shop vacancies on our high streets is around 13 per cent, with vacancy levels as high as 28% in Newport, Stoke and Hartlepool. Fragmented property ownerships and a lack of joined-up thinking, among other factors, have hindered progress to date.
KPMG’s latest Hope for the High Street report proposes a new kind of partnership to tackle these problems. It could unblock the fragmented ownership obstacle in a designated area and enable physical change with a more flexible mix of uses, including affordable homes as a catalyst for wider regeneration.
Key Highlights:
This article represents the views of the author only, and does not necessarily represent the views or professional advice of KPMG in the UK.


Adults with the autism spectrum condition known as Asperger Syndrome are nine times more likely to experience suicidal thoughts than people from the UK general population, according to the first large-scale clinical study of its kind, published in
The Lancet Psychiatry.
The study surveyed 374 individuals (256 men and 118 women) diagnosed with Asperger Syndrome as adults between 2004 and 2013 at the Cambridge Lifetime Asperger Syndrome Service (CLASS) clinic in Cambridge UK. It revealed a significantly higher rate of suicidal ideation among adults with Asperger Syndrome (66%), compared with the rate found in the general population (17%), and patients with psychosis (59%) taken from other data sources.
The research, led by Dr Sarah Cassidy and Professor Simon Baron-Cohen, from the Autism Research Centre at Cambridge University, and the CLASS clinic in the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), found that two-thirds (66%) of adults with Asperger Syndrome had contemplated suicide and a third (35%) had planned or attempted suicide during their lifetime. Suicidal thoughts and behaviours were significantly more common in adults with Asperger Syndrome and a history of depression.
Among adults with Asperger Syndrome, those with depression were four times more likely to experience suicidal thoughts, and twice as likely to plan or attempt suicide, compared to individuals with Asperger Syndrome but without a history of depression. A second risk factor for suicide plans or attempts was a higher level of autistic traits.
"Our findings confirm anecdotal reports that adults with Asperger Syndrome have a significantly higher risk of suicide in comparison to other clinical groups, and that depression is a key risk factor in this", said Dr Cassidy.
According to Professor Baron-Cohen, "Adults with Asperger Syndrome often suffer with secondary depression due to social isolation, loneliness, social exclusion, lack of community services, under-achievement, and unemployment. Their depression and risk of suicide are preventable with the appropriate support. This study should be a wake-up call for the urgent need for high quality services, to prevent the tragic waste of even a single life. "
Autism spectrum conditions are a group of developmental brain conditions that cause difficulties in communication and social interaction, alongside the presence of unusually narrow interests and difficulties in adapting to change. In Asperger Syndrome, people show the key symptoms but without delayed language or intellectual disability. In the UK, one in 100 people (around 700 000) has an autism spectrum condition.
Explore further: Study confirms a gene linked to Asperger Syndrome and empathy


Co-operative Energy has identified that 179 Landis and Gyr gas prepayment meters have been calculating customers’ energy use inaccurately.
The issue affects only prepayment meter customers in Co-operative Energy’s and represents less than one in a thousand customers.
The meters were inherited by Co-operative Energy from other energy suppliers. The gas prepayment meters have not been updating the correct calorific value into the meter set and as a result, have been over calculating energy consumption since 2007. A repair programme is currently being agreed with Ofgem which will see affected meters updated to ensure that the right calorific value is programmed into customers’ meter sets.
Co-operative Energy is working closely with Ofgem and the rest of the energy supply industry to ensure that the issue is rectified as soon as possible.
Customers who have been affected have already been contacted and full refunds for the overcharging through until the meters are rectified, will be made before Christmas. Over and above the refund being made we are giving the customers an additional £10 each by way of an apology.
While we believe we have already contacted all customers affected, if any other customers think they may have been or wish to check, they should contact us on 0800 954 0693, where advisors will be delighted to look into the matter with the customer.


The opinion of the court was delivered by: Honorable Jacqueline Chooljian United States Magistrate Judge
On September 16, 2009, plaintiff Robin Smith ("plaintiff") filed a Complaint seeking review of the Commissioner of Social Security's denial of plaintiff's application for benefits. The parties have consented to proceed before a United States Magistrate Judge.
This matter is before the Court on the parties' cross motions for summary judgment, respectively ("Plaintiff's Motion") and ("Defendant's Motion"). The Court has taken both motions under submission without oral argument. See Fed. R. Civ. P. 78; L.R. 7-15; September 22, 2009 Case Management Order ¶ 5.
Based on the record as a whole and the applicable law, the decision of the Commissioner is AFFIRMED. The findings of the Administrative Law Judge ("ALJ") are supported by substantial evidence and are free from material error.*fn1
II. BACKGROUND AND SUMMARY OF ADMINISTRATIVE DECISION
On January 20, 2005, plaintiff filed an application for Supplemental Security Income benefits. (Administrative Record ("AR") 524-26).*fn2 Plaintiff asserted that she became disabled on February 1, 1995, due to diabetes, arthritis, and depression. (AR 161). On March 21, 2007, the ALJ conducted a hearing ("Pre-Remand Hearing") and heard testimony from plaintiff, who was represented by counsel. (AR 409-18). On April 6, 2007, the ALJ found that plaintiff was not disabled ("Pre-Remand Decision") (AR 12-17), and the Appeals Council denied review. (AR 5-7). On July 7, 2008, this Court remanded the case for further proceedings ("Remand Order"). (AR 481-92).
Following the remand, the ALJ conducted a hearing on February 26, 2009 ("Post-Remand Hearing"), at which he heard testimony from plaintiff, who was represented by counsel, and a vocational expert. (AR 430-45). On May 11, 2009, the ALJ determined that plaintiff was not disabled through the date of the decision ("Post-Remand Decision"). (AR 422-29). Specifically, the ALJ found:
(1) plaintiff suffered from the severe impairments of "insulin-dependent diabetes mellitus and a history of deep vein thrombosis with continued use of Coumadin" (AR 424); (2) plaintiff's impairments, considered singly or in combination, did not meet or medically equal one of the listed impairments (AR 426); (3) plaintiff retained the residual functional capacity to perform medium work with certain restrictions (AR 426);*fn3 and (4) plaintiff was capable of performing her past relevant work. (AR 428). The Appeals Council did not review the ALJ's decision, and the Post-Remand Decision became the final decision of the Commissioner. See 20 C.F.R. § 416.1484(d).
III. APPLICABLE LEGAL STANDARDS
A. Sequential Evaluation Process
To qualify for disability benefits, a claimant must show that she is unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least twelve months. Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005) (citing 42 U.S.C. § 423(d)(1)(A)). The impairment must render the claimant incapable of performing the work she previously performed and incapable of performing any other substantial gainful employment that exists in the national economy. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999) (citing 42 U.S.C. § 423(d)(2)(A)). In assessing whether a claimant is disabled, an ALJ is to follow a five-step sequential evaluation process:
(1) Is the claimant presently engaged in substantial gainful activity? If so, the claimant is not disabled. If not, proceed to step two.
(2) Is the claimant's alleged impairment sufficiently severe to limit her ability to work? If not, the claimant is not ...


The dominant opinion throughout most of history was that women and war don't mix. This was partly because societies valued women as child-bearers. It was also due to the prevailing opinion that they weren't strong enough to wield heavy weapons in battle or sharp enough to understand tactical war strategies. Besides a few notable exceptions, such as Joan of Arc, women were banned from combat -- but that's not to say they were shielded from the horrors of war. On the contrary, as nurses caring for wounded soldiers, women were often exposed to the brunt of the blood and gore.
In the course of World War II, however, women's roles were changing on all fronts. The U.S. military, which was eager to boost its numbers, warmed up to the idea of allowing women into positions previously reserved for men. During World War I, a loophole was discovered in the Naval Reserve Act of 1916. The act specified the conditions for service in the Navy, but it didn't mention anything about gender. As a result, approximately 11,000 women enlisted in the Navy and became "Yeomen (F)" by the end of the war [source: U.S. Navy].
These female yeomen (or yeomanettes, as they were commonly called) mostly held clerical positions. A small number of them served as recruiting agents, translators and fingerprint experts. However, after the war, most of the yeomanettes were released from duty. It wasn't until World War II that women would secure a more permanent presence in the military.
Ironically, the most prominent women's unit sounded anything but permanent when it was formed. In 1942, Congress passed a law establishing
Women Accepted for Volunteer Emergency Service ( WAVES). The female lieutenant who is credited with naming the division said she intentionally included the word "emergency" to comfort the old-fashioned officials who wanted the corps to be strictly temporary [source: Yellin]. Despite any dissonant views, WAVES became an influential division in the war and forged a place for women in the U.S. military.


The EU procurement directives stipulate that public contracts be awarded to the lowest bidder or to the bidder with the economically most advantageous tender; the latter requiring that a scoring rule be specified. We provide a simple theoretical framework, based on standard microeconomic theory, for tender evaluation (scoring and weighing) and discuss the pros and cons of methods such as highest quality (beauty contest), lowest price and price-and-quality-based evaluations. We argue that the most common method, price-to-quality scoring, is inappropriate for several reasons. It is non-transparent, making accurate representation of the procurer's preferences difficult. It is often open to strategic manipulation, due to dependence on irrelevant alternatives, and it tends to impose particular and unjustified non-linearity in bid prices. The alternative quality-to-price scoring method, where money values are assigned to different quality levels, is a better alternative. However, when the cost of quality is relatively well-known and several providers can offer optimal quality, lowest price is the preferable supplier selection method, while beauty contests may be preferred when purchasing budgets are inflexible.
2013. Vol. 19, no 2, 73-83 p.


dc.contributor.author Chiyindiko, Tonderai Cosmas dc.date.accessioned 2011-12-22T10:39:12Z dc.date.available 2011-12-22T10:39:12Z dc.date.issued 2011-12-22 dc.identifier.uri http://hdl.handle.net/10539/10905 dc.description M.A. Faculty of Humanties, University of the Witwatersrand, 2011 en_US dc.description.abstract This research study explores protest theatre in contemporary Zimbabwe. It aims to explore two of Stephen Chifunyise’s plays, namely ‘Heal the Wounds’ and ‘Waiting for Constitution’. These plays are reviewed as protest theatre that address issues of national healing and reconciliation on the one hand, and the constitution-making process on the other.
The research uses critical performative pedagogy as a lense through which to interrogate these plays as representations of the wider tradition of protest theatre in Zimbabwe. This study explores the history of protest theatre in Zimbabwe in Chapter One. The second Chapter focuses on theatre in the post-independence era. Chapter Three undertakes a descriptive analysis of ‘Heal the Wounds’ and in Chapter Four the focus shifts to ‘Waiting for Constitution’. Chapter Five explores emerging paradigms in Zimbabwean protest theatre.
This study concludes that protest theatre in Zimbabwe needs to embrace the broader paradigm of applied theatre in order to break the tradition of representing the Zimbabwean reality through stereotypes. A contemporary theatre in Zimbabwe needs to embrace the complexity of the country’s history through effective applied theatre strategies. en_US dc.language.iso en en_US dc.title Healing and reconciliation for constitution building in Zimbabwe through theatre: a case study of 'heal the wounds' and 'waiting for constitution' en_US dc.type Thesis en_US


The commissioners are shielded from public opinion because their staff digests incoming feedback before it reaches them.
Denver, CO (PRWEB) February 28, 2014
On Tuesday February 17th, five thousand petition signatures were hand-delivered to Robert (Bob) S. Adler, the acting Chairman at the U.S. Consumer Product Safety Commission (CPSC). The stack of signatures were served in person by Shihan Qu, the founder of Zen Magnets, at the Jatvis Center in New York during the New York Toy Fair.
Robert Adler (D) was appointed to the agency by President Barack Obama in August 2009.
In terms of total signatures, the "Cease Magnet Prohibition" petition represents the largest public petition the CPSC has ever faced. (1) It urges the CPSC to discontinue its repeated efforts to outlaw magnet sales. This was the first time any CPSC spokesperson had acknowledged the petition.
CPSC Commissioner Adler initially attempted to refuse receipt of the signatures, noting that the documents should be sent to the CPSC headquarters to be entered on record. Adler accepted the signatures once made aware that the petition was already on record, and that the letter was addressed specifically to him.
"This is one of the current problems with the agency. The commissioners are shielded from public opinion because their staff digests incoming feedback before it reaches them. This tends to continue the confirmation bias echo-chamber," (2) said Shihan Qu at a Liberty on the Rocks event in Lafayette, Colorado, just days after the petition had been delivered.
This isn't the first time Adler has had his finger off the pulse of industry and public opinion. In a recent CPSC proposal to make voluntary recall agreements legally binding, Robert Adler described the change as a "minor tweak" that most companies would "see and yawn and move on with." (3) But the consensus of statements received during the rulemaking comment period was that the changes risk delaying recalls and alienating companies.
The CPSC is currently in litigation with three different companies in pursuit of stop-sales and recalls of magnets. (4) Zen Magnets is the first company to receive an Administrative Complaint from the CPSC, prior to record of injury. Craig Zucker, the former CEO of Maxfield & Oberton, which manufactured Buckyballs, is being targeted in his individual capacity despite having never broken a law.
Buckyballs are no longer available, and most other similar companies in the U.S. have acquiesced to CPSC demands. However, in the midst of litigation, Zen Magnets continues to accept dollars and bitcoin in exchange for sets of high-powered magnet spheres at http://ZenMagnets.com. In the mean time, the petition that's hosted at Change.org (1) continues to receive publicity through SaveMagnets, a blog which advocates for the continued legalization of magnets.
Via Savemagnets.com on 2/27/14
Citations
(1) change.org/petitions/us-cpsc-cease-magnet-prohibition (2) flatirons.libertyontherocks.org/ (3) http://www.crowell.com/files/CPSC-Proposal-Risks-Delaying-Recalls-Alienating-Companies.pdf (4) CPSC Case Dockets: 12-1, 12-2, 12-3 (5) http://www.denverpost.com/business/ci_23856668/denvers-zen-magnets-still-alive-it-fights-federal (6) radio.foxnews.com/toddstarnes/top-stories/ceo-fights-feds-save-our-balls.html


Question
If actual performance of the human resources plan differs from desired performance, what remedial steps might you use?
Answer to relevant QuestionsEmployee referral is a popular method of recruiting candidates. What are its advantages and disadvantages? Contrast an unstructured interview with a situational or behavioral interview. Given that the validity of assessment centers and work samples are not significantly greater than that reported for cognitive ability tests, why would an organization choose the far more costly approaches? Many managers describe performance appraisal as the responsibility that they like the least. Why is this? What could be done to improve the situation? Why is it important that trainees receive support from others for attending training and applying their training skills? Do you think they often receive the necessary support? Why or why not?
Post your question


Depending on the amount, protein in the urine (Proteinuria) may indicate significant renal disease. The Medical Examiner may certify, time limit, or disqualify a commercial driver with Proteinuria. The decision is based on whether the examiner believes that Proteinuria may adversely affect safe driving regardless of the examiner’s decision. The driver should be referred for follow-up.


Summary
A major cause of anaemia, iron deficiency can have a significant impact on clinical outcomes. Iron status should be assessed so that early interventions, including targeted iron therapy, can be implemented. Drakesmith provided an overview of diagnostic parameters currently used for iron deficiency. Hepcidin was described as the gatekeeper of systemic iron balance. Iron status indices incorporate the effect of inflammation and reflect bone marrow demand. These components have already been incorporated into hepcidin regulation. Hepcidin levels provide a direct assessment of an individual’s capacity to efficiently absorb oral iron and transport it to the bone marrow. While it is not a direct biomarker of iron deficiency, it provides information regarding the need for, as well as the ability to use, iron. Drakesmith described a large cohort study that used hepcidin to categorize iron-, and non-iron, responders. It was acknowledged that there is still some way yet to establishing hepcidin as a biomarker for iron therapy in a range of clinical conditions related to iron deficiencies.


What is a classical strategy for creating digital experiences?
The same strategy that has produced physical architectures: a harmonious blend of functions, aesthetics, and awareness of contexts. A strategy based on questions about the use of information resources: Who will use these structures? Why? With what other functions, views, processes? And, given the nature of dynamic flux in the digital world, how will progress continue?
æolian solutions is not the solution: it is a consultancy that enables collaborative solutions to unique challenges: clarifying information structures; implementing best practices; creating gratifying interactions.
Solutions for architectures and virtual structures must work well for all – including people with disabilities. The promises of the internet, the potential for universal solutions, must evolve inclusively.
Universal solutions require the collaboration and consultation of all.


Mine Type: All Surface
Category: Dust Control
MSHA's Occupational Illness and Injury Prevention Program Health Ideas
"Controlling Drill Dust With A Bucket"
PDF Version
Dust generated from surface drilling is a health hazard and is required to be controlled by MSHA regulations. Despite best efforts, uneven bench conditions exist. Often times when drills are leveled on uneven benches, the dust skirt does not reach the ground, resulting in a lack of sealing that permits drill dust to escape into the work environment.
Senex Explosives has resolved this sealing problem by simply using a plastic bucket. The bottom of a plastic bucket is cut to create a cylinder. When drilling through this cylinder, bailing air carries the cuttings higher under the table allowing the collection system to function more efficiently, eliminating dust from being exhausted under the skirt. After drilling is complete, hole casings can be inserted. Prior to shoveling or removing the "dust bucket" for future use, remember to apply water to the cuttings to reduce the potential for airborne dust emissions. Conduct periodic air monitoring to determine exposure estimates of respirable crystalline silica. Select and wear appropriate NIOSH-approved air-purifying respiratory protection equipped with high-efficiency particulate filters.
Issued:
11/05/2002
Tag #
AP2002-H0010
MSHA extends a thank you and a tip of the hardhat to Dale Ramsey of Senex Explosives, Cuddy, PA a winner of a limited edition sticker and patch.
If you have a tip you would like to pass on, you can e-mail it to zzMSHA-MinersTips@dol.gov
. If your tip is selected, you will receive credit in this space.


The category-order effect (COE) is observed when the categorical properties of items within the first half of a given list affect recall performance in a mixed-list serial-recall task. The present study examines whether the advantage is due to other sub-categorical properties (e.g., orthographic similarity and word frequency) rather than an artifact of stimuli used in previous studies (e.g., numbers vs. nouns). Participants were presented with numeric stimuli and nouns from a variety of semantic categories while their orthography and word frequency were systematically manipulated. The results suggest that a large portion of the COE can be attributed to the sub-categorical properties of the items.


On September 13, 2007 the UN General Assembly adopted the United Nations Declaration on the Rights of Indigenous Peoples. This followed more than twenty years of discussions within the UN system. Indigenous representatives played key roles in the development of this Declaration.
There are over 370 million indigenous people in Africa, the Americas, Asia, Europe and the Pacific. They are among the most impoverished, marginalized and frequently victimized people in the world.
This universal human rights instrument is celebrated globally as a symbol of triumph and hope. Effective implementation of the Declaration would result in significant improvements in the global situation of Indigenous Peoples.
Contents
- Introduction
- Statement by the Chair of the UN Permanent Forum on Indigenous Issues
- General Assembly Resolution of 13 September 2007
- UN Declaration on the Rights of Indigenous Peoples
- Supportive Staements
- Sponsors


Salmon, Science, and Reciprocity on the Northwest Coast Author(s): D. Bruce Johnsen Date Posted: March 2010 Law & Economics #: 10-14 Availability: Full text (most recent) on SSRN
ABSTRACT:
Severe depletion of many genetically distinct Pacific salmon populations has spawned a contentious debate over causation and the efficacy of proposed solutions. No doubt the precipitating factor was overharvesting of the commons beginning along the Northwest Coast around 1860. Yet, for millennia before that, a relatively dense population of Indian tribes managed salmon stocks that have since been characterized as “superabundant.” This study investigates how they avoided a tragedy of the commons, where, in recent history, commercial ocean fishers guided by scientifically informed regulators have repeatedly failed. Unlike commercial fishers, the tribes enjoyed exclusive rights to terminal fisheries enforced through rigorous reciprocity relations. The available evidence is compelling that they actively husbanded their salmon stocks for sustained abundance.


Abstract
This is a descriptive study conducted at a multinational working environment, where 1500 nurses representing 52 nationalities are employed. The study aimed at exploring the predominant leadership style of nurse managers through self-evaluation and staff nurses' evaluation and the impact of working in a multinational environment on their intention to stay or quit. The value lies in its focus on leadership styles in an environment where national diversity among managers, staff, and patients is very challenging. The study included 31 nurse managers and 118 staff nurses using Bass and Avolio's (1995) Multifactor Leadership Questionnaire. The results showed that nurse managers and staff nurses reported transformational leadership as predominant with significant difference in favor of nurse managers. Participants' nationality and intention to stay or quit affected their perception of transformational leadership as a predominant style. The implications highlight the need for senior nursing management to set effective retention strategies for transformational nurse managers who work at multinational environments.


Embedded with neon lights, this sound-sensitive guitar changes in lighting as different tunes are played. Ranging well over $10,000 a piece, these neon guitars by Rich Roland are a little over the price range of what most people can afford. However, these pieces are undeniably interesting nonetheless.
Implications- Now that the economic downturn is over, consumers are feeling less anxious about their economic well-being. Consumers have a desire to express these feelings through bright and bold choices. Companies have an opportunity to engage with customers by offering choices that reflects their desire for bold choices.


I do not think S&P’s analysts are aware of Delta’s staggering $22.3 billion in off-balance sheet liabilities, which include $14.1 billion in underfunded pensions and $8.2 in operating leases.
I recommend investors avoid Delta Airlines (DAL). I think the stock could see significant downward pressure as more investors realize how the company is propping up its earnings with relatively aggressive accounting for its pension and postretirement plan (“pensions”), which are already seriously underfunded.


The opinion of the court was delivered by: Carla M. Woehrle United States Magistrate Judge
The parties have consented, under 28 U.S.C. § 636(c), to the jurisdiction of the undersigned magistrate judge. Plaintiff seeks review of the denial of supplemental security income. The court finds that judgment should be granted in favor of defendant, affirming the Commissioner's decision.
Plaintiff Fitzgerald Fields Sr. was born on April 15, 1964, and was forty-five years old at the time of his administrative hearing. [Administrative Record ("AR") 154.] He has a high school education and past relevant work as a construction laborer. [AR 39-40, 175.]
Plaintiff alleges disability on the basis of sleep apnea, problems with his knee and hip, and seizures. [AR 169.]
II. PROCEEDINGS IN THIS COURT
Plaintiff's complaint was lodged on October 1, 2009, and filed on October 8, 2009. On April 16, 2010, Defendant filed an answer and the Administrative Record. On June 15, 2010, the parties filed their Joint Stipulation ("JS") identifying matters not in dispute, issues in dispute, the positions of the parties, and the relief sought by each party. This matter has been taken under submission without oral argument.
III. PRIOR ADMINISTRATIVE PROCEEDINGS
Plaintiff applied for supplemental security income on January 17, 2008, alleging disability since August 1, 2004.*fn1 [AR 154.] After the application was denied initially and upon reconsideration, Plaintiff requested an administrative hearing, which was held on April 1, 2009, before Administrative Law Judge Robert A. Evans ("ALJ"). [AR 36-55, 61-65, 67-71.] Plaintiff appeared with counsel and gave testimony. [AR 36-55.] The ALJ denied benefits in a decision issued on June 19, 2009. [AR 28-35.] When the Appeals Council denied review on August 27, 2009, the ALJ's decision became the Commissioner's final decision. [AR 2-4.]
Under 42 U.S.C. § 405(g), a district court may review the Commissioner's decision to deny benefits. The Commissioner's (or ALJ's) findings and decision should be upheld if they are free of legal error and supported by substantial evidence. However, if the court determines that a finding is based on legal error or is not supported by substantial evidence in the record, the court may reject the finding and set aside the decision to deny benefits. See Aukland v. Massanari, 257 F.3d 1033, 1035 (9th Cir. 2001); Tonapetyan v. Halter, 242 F.3d 1144, 1147 (9th Cir. 2001); Osenbrock v. Apfel, 240 F.3d 1157, 1162 (9th Cir. 2001); Tackett v. Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999); Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998); Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); Moncada v. Chater, 60 F.3d 521, 523 (9th Cir. 1995) (per curiam).
"Substantial evidence is more than a scintilla, but less than a preponderance." Reddick, 157 F.3d at 720. It is "relevant evidence which a reasonable person might accept as adequate to support a conclusion." Id. To determine whether substantial evidence supports a finding, a court must review the administrative record as a whole, "weighing both the evidence that supports and the evidence that detracts from the Commissioner's conclusion." Id. "If the evidence can reasonably support either affirming or reversing," the reviewing court "may not substitute its judgment" for that of the Commissioner. Id. at 720-21; see also Osenbrock, 240 F.3d at 1162.
A. THE FIVE-STEP EVALUATION
To be eligible for disability benefits a claimant must demonstrate a medically determinable impairment which prevents the claimant from engaging in substantial gainful activity and which is expected to result in death or to last for a continuous period of at least twelve months. Tackett, 180 F.3d at 1098; Reddick, 157 F.3d at 721; 42 U.S.C. § 423(d)(1)(A).
Disability claims are evaluated using a five-step test:
Step one: Is the claimant engaging in substantial gainful activity? If so, the claimant is found not disabled. If not, proceed to step two.
Step two: Does the claimant have a "severe" impairment? If so, proceed to step three. If not, then a finding of not disabled is appropriate.
Step three: Does the claimant's impairment or combination of impairments meet or equal an impairment listed in 20 C.F.R., Part 404, Subpart P, Appendix 1? If so, the claimant is automatically determined disabled. If not, proceed to step four.
Step four: Is the claimant capable of performing his past work? If so, the claimant is not disabled. If not, proceed to step five.
Step five: Does the claimant have the residual functional capacity to perform any other work? If so, the claimant is not disabled. ...


This paper focuses on the persistence and success of American-American and Hispanic students in science and technology. The authors challenge common assumptions regarding student interest in these fields and explore the obstacles these students face when working toward a degree. ACE is grateful to The Rockefeller Foundation for its generous support of this publication, part of ACE's initiative, The Unfinished Agenda, Ensuring Success for Students of Color.


A tornado watch has been issued by the Storm Prediction Center in Norman Oklahoma. In the interest of public safety the following safety rules are provided. Public and commercial broadcast stations serving the affected area are asked to frequently broadcast these messages while the watch is in effect.
A watch means conditions are favorable for the development of severe weather. During a watch...there is no cause for immediate concern but keep abreast of weather developments. Public safety officials should...however...activate prearranged plans.
A warning means a severe thunderstorm or tornado has been observed or indicated by radar. People in the path of the storm should take immediate precautions.
Tornadoes are nature’s most violent storms. In a home...one of the best shelters is in the basement under heavy furniture and where overhead support and protection is greatest. If there is no basement...go to the center of the house on the lowest floor. Get into a closet...interior hall...and or under heavy furniture. Cover yourself with a heavy blanket or similar object. In a school...office...or other type of institutional building...go quickly to a basement...if available. If there is no basement available...go to a central hall or corridor on the lowest floor. Keep away from outside walls...doors and windows. Stay out of auditoriums or gymnasiums. If caught outdoors...seek shelter in a basement...shelter or sturdy building. If you cannot quickly get to a shelter...get into a vehicle...buckle your seatbelt and drive to the closest sturdy shelter. If there are flying debris while you are driving...pull over and park. Stay in the car with the seatbelt on. Put your head down below the windows...covering your head with your hands or a blanket if possible. if you can safely get lower than the level of the roadway...exit your car and lie in that area. Make sure to cover your head with your hands.
If you plan to use a portable power generator in your home...be careful. Observe all safety precautions to avoid carbon monoxide position...electrocution...or a fire. Portable generators should only be operated outdoors in a dry and well ventilated area.


Dual Diagnosis
and the Borderline Personality Disorder
Sharon C. Ekleberry, 2000
Table of Contents
Cluster B: The Borderline Personality Disorder (BPD)
The Borderline Personality Disorder (BPD)
Essential
Feature
The essential feature of the Borderline Personality Disorder is a pervasive pattern of unstable interpersonal relationships, self-image, and affect. There is marked impulsivity that begins by early adulthood (DSM-IV™, 1994, p. 650).
The ICD-10 refers to BPD as the Emotionally Unstable Personality Disorder which is characterized by impulsivity, unpredictable moods, outbursts of emotion, behavioral explosions, quarrelsome behavior, and conflicts with others. The ICD-10 divides this category into two types: the impulsive type (characterized by emotional instability and lack of impulse control) and the borderline type (characterized by disturbances of self-image, aims, and internal preferences; chronic feelings of emptiness; intense and unstable interpersonal relationships; and self-destructive behavior) (ICD-10, 1994, p. 228).
Benjamin notes that individuals with BPD often suffer from thought disorders, affective disorders, dissociative disorders, alcohol and substance abuse, eating disorders, and anxiety disorders. She suggests that with BPD, everything that can go wrong has gone wrong. BPD involves disorder in every domain of function: cognition, mood, and behavior (Benjamin, 1993, p. 113).
Linehan proposes diagnostic criteria for BPD with specific patterns of behavioral, affective, and cognitive instability and dysregulation:
Emotional dysregulation:These individuals are highly reactive and generally experience episodic depression, anxiety, and irritability; they also have problems with anger and anger expression.
Interpersonal dysregulation:Relationships are chaotic, intense, but nevertheless, hard to give up. Individuals with BPD engage in intense and frantic efforts to keep significant others from leaving them.
Behavioral dysregulation:Individuals with BPD evidence extreme and problematic impulsive and suicidal behaviors. They often attempt to injure, mutilate, or kill themselves.
Cognitive dysregulation:There is indication of nonpsychotic forms of thought dysregulation including depersonalization, dissociation, and delusions that can be brought on by stressful situations.
Self dysregulation:Individuals with BPD often have little sense of self; they feel empty. BPD is a disorder of both the regulation of and the experience of the self. (Linehan, 1993, p. 11)
Kroll suggests that borderline pathology is organized around (1) cognitive style (short-circuiting of thoughts with action, selective amnesia, intrusive imagery, cognitive disorganization under stress, rumination focused upon a few unpleasant old memories); and (2) emotional lability (a sense that one's own emotions, whether sadness, anger, joy, or love, are overwhelmingly intense). He describes two central borderline themes: (1) victimization and (2) loneliness/emptiness -- a pervasive sense of isolation and distance from the warmth of the human community (Kroll, 1988, pp. 67-68).
Theodore Millon would like to see the disorder renamed. He has suggested changing BPD to cycloid personality disorder; other possibilities he has mentioned include: ambivalent personality disorder, erratic personality disorder, impulsive personality disorder, quixotic or labile personality disorder (Millon & Davis, 1996, p. 645). He believes that any of these names would more accurately capture the qualities of the personality syndrome better than the term borderline.
There is some question as to whether or not BPD is a personality disorder or an affective disorder. Millon suggests the possibility that the clinical characteristics of BPD fall not only into that of a personality disorder but also within the broad spectrum of affective disorders (Millon & Davis, 1996, p. 645). Akiskal has suggested that approximately 50% of individuals with BPD suffer from lifelong affective disorders. He suggests that the bipolar spectrum may merge at one end with schizoaffective states and overlap at the other extreme with character disorders (Millon, 1996, pp. 202-203).
Family histories of individuals with BPD often reveal a relationship to both manic-depression and alcoholism. There may be an inherited genetic predisposition to poor mood regulation. Many of these individuals come from families with abuse, violence, and traumatic separations (Oldham, 1990, p. 305).
BPD is rarely the only personality disorder diagnosis for most individuals meeting BPD criteria. The most serious overlap, in 10 observed samples, was with histrionic personality disorder. Three studies found that over 50% of individuals diagnosed with BPD also met the criteria for HPD (Gunderson, et. al., Livesley, ed., 1995, p. 142).
Beck noted that 60% of individuals diagnosed with BPD meet the criteria for other personality disorders as well, including paranoid, schizotypal, histrionic, narcissistic, avoidant, and dependent personality disorders (Beck, 1990, p. 179). Also of note, in studies of several populations meeting the criteria of BPD, 74% were women (Linehan, 1993, p. 4).
Self-Image
Individuals with BPD experience an unstable self-concept that oscillates between feelings of inferiority and superiority. Mostly they feel defective, bad, and victimized (Akhtar, 1995, p. 7). Masterson (1981, p. 100) notes that the self-image in the borderline is that of being deficient. On the superior side of the vacillation is a lack of humility and a core of omnipotence, conceit, and self-righteousness (Akhtar, 1995, p. 7).
BPD self-image is also described as uncertain. These individuals experience confusion based in an immature, nebulous, and wavering sense of identity, often with underlying feelings of emptiness (Millon & Davis, 1996, p. 664).
View of Others
Individuals with BPD are ambivalent toward others as well as themselves. They experience rapidly fluctuating and antithetical perceptions and thoughts concerning persons and events (Millon & Davis, 1996, p. 663).
For individuals with BPD, childhood abuse appears to impact the perception of threat resulting in a more hostile attributional bias. Past physical abuse results in increased sensitivity to cues of threat, impaired processing of social information, and increased probability of selecting an aggressive response (Spoont, Costello, ed. 1996, p. 73). In other words, they may define neutral behavior from others as threatening and respond with aggression. Their tendency to attribute negative intent to others also allows them to view the interpersonal difficulties they have as being independent of their own behavior (Layden, 1993, p. 2).
Relationships
Beck (1990, p. 183) notes that individuals with BPD hold extreme, poorly integrated, and unrealistic expectations of interpersonal relationships. They fluctuate between idealization and devaluation of others (Akhtar, 1995, p. 7). The initial position in BPD relationships is that of friendly dependency on a nurturer (which they believe is desired by those upon whom they depend). This becomes hostile control when, inevitably, the caregiver fails to deliver everything individuals with BPD want (Benjamin, 1993, p. 122). The completely good, nurturing caregiver, with the most minor mistake, becomes the object of BPD hate and contempt (Oldham, 1990, pp. 301-303). Millon (Millon & Davis, 1996, pp. 662-663) describes this quality of BPD behavior within relationships as paradoxical. Even though these individuals need attention and affection, they frequently act in unpredictably contrary, manipulative, and volatile ways that elicit the very rejection they fear. Oldham (1990, pp. 301-303) notes that individuals with BPD destroy the relationships they cannot live without. Benjamin (1993, p. 113) describes this quality as individuals with BPD loving without measure the people they will soon come to hate.
This interpersonal destructiveness in BPD comes from the unstable self-esteem, internal emptiness, and deficient capacity for autonomy within these individuals. Their dread of abandonment leaves them constantly on edge and vulnerable to anxiety, conflict, and anger. When the explosiveness of their dread and rage is expressed within their relationships, they exhaust or exasperate significant others and the feared abandonment becomes a reality. Stone notes that management of interpersonal hostility is the decisive variable in determining how individuals with BPD do in midlife and beyond. Those whose anger and querulousness continue to smoulder on into middle age eventually find themselves isolated from others. Serious depression, resumption of drug abuse, and suicide are all possible results of having destroyed important relationships through anger (Stone, 1993, p. 226).
Individuals with BPD also vacillate within relationships between the extremes of distance and closeness (Akhtar, 1995, p. 7). Millon describes the BPD seeking of closeness with caring others as precipitating two contrasting and distressful consequences; these individuals will fear both engulfment and abandonment (Millon & Davis, 1996, p. 664).
Issues With Authority
Individuals with BPD are inclined to view authority figures with intensified ambivalence, fear, and rage. Those who have authority are both needed and viewed as dangerous. If the authority figures are service providers, they are seen as replicating parental figures who had access to what was needed but were disinclined to provide it, were potentially abusive and had to be seduced or coerced into being benign and protective. These past parental figures also seemed to have the power, skill, ability, and influence to deal with life's problems, i.e., were autonomous in contrast to BPD self-experience as incompetent and powerless.
BPD Behavior
Individuals with BPD evidence readily corruptible ethics, standards, and ideals. Their capacity to experience genuine guilt is weak; their only effective restraints on behavior center around shame, fear, and dread of exposure (Akhtar, 1995, pp. 7-8). They may, after interpersonal difficulties, go into a period of self-criticism and self-blame (Millon, 1996, p. 169). In all likelihood, however, these individuals will vacillate between self-hate and rage toward others without resolution or understanding of their own part in the problems they face. Kantor believes that it is characteristic of all the personality disorders to show a tendency to live in the past, or in fantasy, with too little input from current reality. This produces a type of infantilism and mild memory disturbances that are the result of a diminished ability to pay attention to the here and now (Kantor, 1992, pp. 36-41). Accordingly, individuals with BPD often evidence the following cluster of behaviors: minimal adherence to personal ethics, vulnerability to shame, self-blame, rage toward others, and a diminished capacity to attend to and benefit from environmental or interpersonal feedback.
It is difficult for people to be comfortable with individuals with BPD because they so easily become sullen and hurt or obstinate and nasty. These individuals are readily provoked; they are impatient and irritable unless things go their way. While BPD anguish and despair are genuine, they are also often a means of expressing hostility and can be used to frustrate and retaliate against others. However, individuals with BPD may believe that the obstructiveness, pessimism, and immaturity that others see in them is actually a reflection of their sensitivity and the inconsiderateness that others show toward them (Millon, 1996, pp. 168-169).
Individuals with BPD are behaviorally inconsistent. Their emotional equilibrium seems to be in constant jeopardy; they are unpredictable and impetuous, erratic, and impulsive (Millon & Davis, 1996, pp. 661-662). They appear to share an impulsive, sensation-seeking trait with individuals with antisocial personality disorder (Zuckerman, Costello, ed., 1996, p. 298).
Both of these personality disorders (BPD and APD) show increased levels of aggressive behavior (defined as behavior intended to inflict discomfort, hurt, harm, injury, or destruction on others). Anger usually precedes the aggressive behavior. This disposition toward anger and aggression is referred to as irritability (Lish, Costello, ed., pp. 24-26). In particular, individuals with BPD who were sexually or physically abused often show inordinate anger and vindictiveness. These individuals must take responsibility for their hostility and vengefulness toward others; they must stop abusing others in the present for the abuse they experienced in the past (Stone, 1993, p. 257). If these individuals do not take responsibility for their querulousness and irritability, with a corresponding willingness to manage hostile behavior, they face increasingly negative interpersonal consequences (Stone, 1993, p. 226). Stone believes that for individuals with BPD, it is often a case of the "e;nice get nicer"e; and the "e;mean get meaner."e; Prognosis in treatment appears to be dependent on the management of hostility more than any other variable (Stone, 1993, pp. 255-256).
Linehan identifies six behavioral patterns evidenced in BPD:
Emotional vulnerability.Individuals with BPD have severe difficulty in regulating negative emotions -- including sensitivity to negative emotional stimuli, emotional intensity, and a slow return to an emotional baseline.
Self-invalidation.Individuals with BPD have unrealistically high standards and expectations for self with a tendency to invalidate or fail to recognize emotional responses, thoughts, beliefs, and behaviors.
Unrelenting crises.Individuals with BPD often engage in "e;parasuicidal"e; behavior, i.e., nonfatal, intentional self-injurious behavior that results in actual tissue damage, self-mutilation, and self-inflicted burns, with little or no intent to cause death.
Inhibited grieving.
Active passivity.Individuals with BPD fail to engage actively in solving their own life problems while actively soliciting problem solving from others.
Apparent competence.Individuals with BPD often appear more competent than can be demonstrated through their behavior or accomplishments (Linehan, 1993, pp. 10-14).
Affective Issues
Individuals with BPD have been described as "e;hemophiliacs of emotion"e; (Sperry, 1993, p. 357). Linehan suggests that BPD is primarily a dysfunction of the emotion regulation system; the other characteristics of BPD are secondary to this dysfunction. Emotional dysregulation is due to the emotional vulnerability (defined as high sensitivity to emotional stimuli or a low threshold for emotional reaction), emotional intensity (extreme emotional reactions), and a slow return to emotional baseline, plus the inability to regulate emotions. These difficulties have their roots in biological predispositions which are exacerbated by environmental experiences. The emotional experience of BPD is one of chronic aversive affective experiences. Failure to inhibit maladaptive, mood-dependent actions follow (Linehan, 1993, pp. 42-43).
Linehan (1993, p. 60) suggests that self-mutilation has an important affect-regulating function. While the exact mechanism is unclear, many individuals with BPD report substantial relief from anxiety and other intense negative feelings after cutting or burning themselves.
Millon notes that the most salient feature of BPD is the depth and variability of moods (Millon & Davis, 1996, p. 646). This emotional instability can also be called emotional lability or reactivity. Spoont sees emotional instability as primarily a temporal and behavior related trait, i.e., it must be conceptualized as the lack of stable behavior over time. He sees emotional instability expressed behaviorally as a form of impulsivity. He proposes four behavioral characteristics of emotional instability: unpredictability of responses to stimuli; increased lability; unusual intensity of responses, and unusual responses (Spoont, Costello, ed., 1996, pp. 48-49).
Individuals with BPD struggle with despondency, rage, fury, self-hatred, arrogance, anxiety, uncertainty, emptiness, dependency, stubbornness, and self-damaging impulses. These individuals are desperate, intense, and unstable; they cannot self-comfort. They flee into impulsive sex, food, drugs, shopping (or shoplifting). They may self-mutilate. These activities will temporarily make them feel calmer (Oldham, 1990, p. 303).
Defensive Structure
The BPD defensive regulatory mechanism is regression. Individuals with BPD show a tendency under stress to retreat to developmentally earlier levels of anxiety tolerance, impulse control and social adaptation (Millon & Davis, 1996, pp. 664-665). For these individuals, the capacity to tolerate anxiety, depression, or frustration is limited. They have minimal capacity to perceive or accept reality limitations. They have difficulty differentiating past and present, reality and fantasy, and mature and infantile aspects of their mental life (Masterson, 1981, pp. 147-148).
Individuals with BPD are characterized by a predominance of primitive defensive operations: splitting, dissociation, primitive idealization, primitive projection, denial, and omnipotence. There is a defensive capacity to keep contradictory experiences of the self and others out of awareness. BPD is further characterized by the absence of anxiety tolerance, impulse control, or developed channels of sublimation. The limited ability of individuals with BPD to tolerate anxiety refers to the tendency to develop increased symptoms or regressive behavior with increased tension. Impulse control addresses the inability of these individuals to experience instinctual urges or strong emotions without having to act on them against their own better judgement. Sublimatory ineffectiveness refers to the degree to which individuals with BPD are unable to invest themselves in values beyond their immediate self-interest or self-preservation (Kernberg, 1984, pp. 15-19).
Treating the Borderline
Personality Disorder
The Borderline Personality Disorder Coming Into Treatment
Individuals with BPD may enter treatment in either mental health or substance abuse facilities. They may self-refer or be referred via the criminal justice system. If self-referred, these individuals may have an extensive history with mental health treatment. They are inclined to work their way through large systems by being treatment demanding and simultaneously treatment resistant. They are inclined to be drug-seeking and volatile when displeased with either the treatment or the service providers.
A prominent BPD motivation for treatment is to receive the support these individuals were deprived of in childhood (Masterson, 1981, p. 152). Individuals with BPD typically come to treatment with an erratic, inconsistent, and unpredictable pattern of problems including unstable relationships, labile mood, impulsivity, and identity confusion. Variability is the hallmark of BPD; no single feature or pattern is invariably present (Beck, 1990, pp. 178-180).
Medication Issues
Psychotropic medication may be useful for individuals with BPD depending on presenting symptoms. However, over time, medication often proves less than helpful as personality issues confound the medication issues. Problems in medicating BPD include non-compliance, demands for frequent changes in the dose or type of medication, overdosing, and failure to accurately report change, e.g., reporting feeling worse when apparently doing better (Sperry, 1995, p. 75). The BPD propensity for alcohol and drug abuse and addictive behavior is also a concern in using medication. Alcohol and others drugs can potentiate prescribed medication and heighten chances for an accidental overdose. Or individuals with BPD may decide to use prescribed medications in combination with alcohol and other drugs to attempt suicide (Layden, 1993, pp. 111-112).
The general guidelines for use of medication with BPD emphasize that the medication must be matched to specific target symptoms such as affective instability, transient psychotic phenomena, ragefulness, irritability, aggression, impulsivity, anxiety, and depression.
Mood or affective instability is a core or fundamental feature of several personality disorders and is defined as excessive vulnerability of mood to environmental and interpersonal stressors; when referring to perceived interpersonal criticism or abandonment, mood instability has been called rejection sensitivity. Mood instability is prominent in histrionic, narcissistic, borderline, and avoidant personality disorders. MAOIs and lithium have been helpful. Currently, Depakote is frequently utilized for mood instability. Fluoxetine may also decrease mood lability (Ellison & Adler, Adler, ed., 1990, p. 52).
The transient psychotic phenomena experienced by some individuals with BPD have been treated with antipsychotic medication. Low dosages for short periods of time can improve BPD reality testing, attention span, and reduce pervasive anxiety. Neuroleptic medication has also been found to be effective in counteracting aggressivity and impulsivity (Layden, 1994, p. 104).
Ragefulness, irritability, and aggression have been treated by a number of medication. Lithium carbonate, carbamazepine, antidepressants, beta-noradrenergic receptor antagonists, buspirone, and antipsychotic medication all appear to have some usefulness in reducing aggression. SSRIs are promising for treating paranoia, interpersonal sensitivity, and hostility -- however, low doses may not be effective for BPD; Prozac doses can be as high as 80 mg. per day (Gunderson & Links, Gabbard & Atkinson, eds., 1996, pp. 974-976).
Even though antidepressants and antianxiety medications have been used to treat aggression, there are studies that suggest tricyclic antidepressants and alprazolam are both associated with increased impulse and behavior dyscontrol (Lish, Costello, ed., 1996, pp. 37-38). Amitriptyline seems to cause BPD symptoms to get worse: MAOIs seem more promising (Ellison & Adler, ed., 1990, p. 46). However, MAOIs require stringent controls on food intake that individuals with BPD, particularly those vulnerable to suicidal ideation or behavior, may not be able to meet.
Anticonvulsant medication such as carbamazepine (Tegretol) may be effective in controlling rage outbursts, identity confusion, and depersonalization. Unfortunately, Tegretol does not improve BPD subjective mood; it may actually precipitate a depressive episode. However, it is possible that combining Tegretol with Prozac, Zoloft, or Welbutrin could be effective (Layden, 1993, pp. 105-106).
Impulsivity is defined as a decreased threshold for motor disinhibition with or without associated hyperactivity. Impulsivity is most typical with BPD, NPD, and APD. This behavior may represent a failure to integrate and respond to environmental cues that should be inhibitory. SSRIs have been accumulating positive anecdotal evidence in the treatment of impulsivity. Lithium also enhances serotonergic activity and has been shown to reduce aggressive and impulsive behavior in individuals with a variety of personality disorders (Ellison & Adler, Adler, ed., 1990, pp. 50-51).
Anxiety in BPD is often reflected in low tolerance to stimulation and a high anticipation of harm. While BPD anxiety is responsive to benzodiazepines; these medications are addictive and have been associated with disinhibition of impulse control and the release of violent behavior (Gunderson & Links, Gabbard & Atkinson, eds., 1996, pp. 974-976). Layden (1993, p. 103) also encourages caution in the use of benzodiazepines with individuals with BPD because of the potential for dangerous disinhibition of behavior. This could be manifested in increased physical aggression, angry outbursts, self-harmful behavior, and suicidal behavior.
Depression often accompanies mood instability; it is marked by low energy and leaden fatigue. Individuals with BPD are among the most vulnerable of the personality disorders to dysphoria and depression. Standard antidepressant medication can be helpful (Ellison & Adler, Adler, ed., 1990, p. 53).
General guidelines when considering medication for BPDs:
If possible, medicating individuals with BPD should wait until rapport has been developed with the primary service provider.
Service providers should maintain a positive attitude toward medication without presenting it as a cure all (or a substitute for therapy).
Medication should not be introduced, overtly or covertly, as an expression of service provider exasperation or frustration with treatment.
Individuals with BPD may respond with anger and criticism to the suggestion of medication (or conversely, they may demand medication immediately upon entering treatment). Service providers need to be prepared for either.
Medication should be suggested in the spirit of a collaboration exploration.
The service provider must combat their own negative expectations about medicating individuals with BPD.
When introducing medication to individuals with BPD, the roles and responsibility the treatment provider, patient, and medical personnel should be calmly and respectfully clarified.
Risks and benefits of medication should be openly discussed with clients with BPD (Layden, 1994, pp. 106-107).
Treatment Provider Guidelines
Remember that individuals with BPD have a high level of interpersonal skill (they can disrupt entire systems), but they use their abilities in destructive ways. It is vital that support be given in the service of positive functioning rather than in the service of chaos, misery, and regression (Benjamin, 1993, pp. 132-133).
Individuals with BPD bring rage, intense moods, extraordinary demands for attention, testing behavior, and self-damaging behavior to the treatment process. They can provoke feelings of helplessness and anger in service providers. It is, therefore, vital to set and enforce limits so that the treatment provider can remain involved, compassionate, reliable, and consistent (Oldham, 1990, p. 306). Sperry (1995, pp. 65-66) noted five points of consensus in treating individuals with BPD: the service provider must be active in identifying, confronting, and directing client behaviors; there must be a stable treatment environment; BPD clients must learn to connect actions and feelings; self-destructive behavior must be made ungratifying; and countertransference feelings must receive careful attention.
Linehan (1993, pp. 106-108) suggests basic assumptions needed by service providers regarding individuals with BPD:
They are doing the best they can.
They want to improve.
They need to do better, try harder, and be more motivated to change.
They did not cause all of their problems but they have to solve them anyway.
The lives of of individuals with BPD who are suicidal are unbearable as they are currently being lived.
Individuals with BPD must learn new behaviors that are not mood-dependent.
Service providers working with these individuals need support.
It is important to remember that the secondary gain from BPD self-mutilation, which can evoke service provider feelings of anxiety and rage at being manipulated, does not reduce the danger involved in the behavior. The behavior is reinforced by the relief from internal pressure it provides through de-focusing from affective pain. Individuals with BPD are often able to dissociate from the physical pain and cannot modulate the behavior via an aversive reaction to that pain. Crisis management and a direct treatment focus on self-damage is essential.
Countertransference Issues
The potential range of treatment provider responses to individuals with BPD go from over-involvement with excessive emotional investment to detachment with excessive self-protective distancing. The over-involved position manifests in service provider certainty of being able to rescue individuals with BPD from their psychological problems. The self-protective responses show up in the service providers' eagerness to limit or terminate the therapeutic relationship in response to outbursts and irrational demands. There is a mid-range on this continuum that is characterized by sedate caring, interest, supportiveness, and objective understanding (Layden, 1993. pp. 122-123). The therapeutic relationship with individuals with BPD can be so unstable that service providers bounce back and forth between the excessively distant and excessively involved extremes -- mirroring the clients' pathology (Layden, 1993, p. 124).
In the worst of circumstances, Gabbard & Wilkinson (1994, p. xi - 6) believe that countertransference with clients with BPD can compel clinicians to engage in ill-advised behavior that results in unethical boundary transgressions. Service providers may come to believe that they are responsible for BPD clients and that love or friendship within the therapeutic relationship will be healing, i.e., that the problem is how these individuals have been treated by others. Clinicians may respond to the BPD form of entitlement that is manifested through demands to be treated as exceptions to usual treatment and program procedures. To ward off BPD anger at being denied special consideration, treatment providers may extend sessions, engage in inappropriate self-disclosure, defer payment or not charge any fee, and engage in physical or sexual behavior.
The difficulty in working with individuals with BPD is that they will actively coerce nurturance until the service providers burn out. During treatment with these individuals, treatment providers are at risk for an ever increasing sense of loss of control. Also, whether there is or is not any progress in treatment, clients with BPD will eventually feel abandoned and engage in rageful and self-destructive behavior. Countertransference may then tend toward hostile dominance as the treatment providers directly experience that clients with BPD are victims who have learned the tactics of abuse and are willing to use them (Benjamin, 1993, pp. 130-131).
In the productive therapeutic relationship, service providers maintain benign objectivity; show genuine concern for well-being of these clients; are "e;real people"e; who are consistently positive and supportive; maintain a firm grounding in reality, an even temperament, and an unthreatened willingness to address acting out and distortions from clients with BPD. Willingness to consult with a colleague is also an good indication of a healthy approach to working with these individuals (Layden, 1993, p. 124).
Treatment Techniques
Assessment of individuals with BPD should include:
a history of self-harm and unsafe behaviors;
a history of previous treatment;
a list of potential means for self-harm;
a history of dissociative experiences (identify what is lost: behavior, affect sensation, or knowledge);
a psychosocial history and history of sexual abuse;
a neurological workup of individuals who have a history of self-mutilating behavior that could have resulted in head injury;
presence of psychotic thinking;
and a history of suicidal behavior (Ries, TIP #9, 1994, pp. 57-58).
It is also imperative that BPD assessment address substance use and compulsive behaviors.
Basic treatment principles in working with individuals with borderline personality disorder:
Identify, confront, and treat comorbid substance abuse disorders and depression. Follow-up studies suggest that treatment of comorbid substance abuse disorder greatly improves the outcome of BPD treatment.
Learn to differentiate nonlethal self-harm from true suicidal intent. Lifetime risk of suicide in individuals with BPD is 10%.
With untreated alcoholism, dually diagnosed individuals with BPD have a 5-year survival rate as low as 58%.
Stress that treatment is a collaborative enterprise; service providers are neither omnipotent nor omniscient.
Manage countertransference. Learn to assist clients with BPD to work through projections rather than responding with old and familiar forms of interaction.
Set a "e;low threshold for seeking consultation."e; Do not provide service in isolation (Gunderson & Links, Gabbard & Atkinson, eds, 1996, pp. 969-970).
A major issue in BPD treatment is learning emotional modulation. Linehan (1993, p. 59) suggests that most borderline behaviors are either attempts to regulate intense affect or are the outcomes of emotional dysregulation. Emotional dysregulation is both the problem being solved and the source of additional problems. Impulsive and suicidal behaviors can be seen as maladaptive solution behaviors to the problem of overwhelming, uncontrollable, intensely painful negative affect.
There are basic skills for effective emotional modulation that can be learned by individuals with BPD. They need the ability to reduce maladaptive mood-dependent behaviors; they must learn to trust and validate themselves as well as their emotions, thoughts, and activities. Four major emotional modulation abilities are: a) inhibiting inappropriate behavior related to strong negative or positive affect; b) self-regulating physiological arousal associated with emotions; c) refocusing attention in the presence of strong emotions; and d) organizing self for action in the service of an external, non-mood-dependent goal (Linehan, 1993, p. 46). General skills that assist in emotional modulation for individuals with BPD are: 1) skills that increase interpersonal effectiveness in conflict situations; 2) skills that increase self-regulation of unwanted emotions; 3) skills for tolerating emotional distress; and 4) skills that increase the ability to experience emotions and avoid emotional inhibition (Linehan, 1993, p. 62).
In treating BPD aggression, it is important to identify aggressive motives that exist in the here and now and to make the accompanying inappropriate behavior visible and dystonic. BPD aggression may be understood in terms of an immature self full of rage at parents who failed to provide for survival and developmental needs -- and who may have been directly involved in abuse (Gunderson & Links, Gabbard & Atkinson, eds., 1996, p. 970). However, current aggression elicits counteraggression and must be managed. Individuals with BPD must learn to recognize their own inclination toward and skills in being abusive toward others.
Supportive treatment for individuals with BPD has a focus on the reality problems of daily life. The goals of supportive therapy are improving these clients' adaptation to their life circumstances and diminishing the likelihood of self-destructive behavior (Gunderson & Links, Gabbard & Atkinson, eds., 1996, p. 970). In group therapy, peers are more able than treatment providers to confront maladaptive and impulsive behaviors. They can be very effective in identifying dependent or manipulative gratifications and making them less acceptable as behaviors to individuals with BPD (Gunderson & Links, Gabbard & Atkinson, eds., 1996, p. 973).
Linehan's (1993, p. 19) dialectical behavior therapy includes active education about emotional regulation, interpersonal effectiveness, distress tolerance, core mindfulness, and self-management skills. It also involves the core treatment techniques of: problem solving, skill training, contingency management, and cognitive modification. Linehan's DBT approach uses supportive acceptance balanced with confrontation and change strategies.
Finally, the TIP #9 (Ries, 1994, pp. 57-59) suggests that BPD treatment include the use of written and verbal contracts for safety. These contracts should be limited to clear behavioral responses for managing unsafe feelings and behaviors. They should be simple and direct, e.g. If I want to get drunk, I will call my sponsor. Also effective in BPD treatment is the use of mini-contracts for each session to stay focused. Here the service provider states the purpose of each session, uses a checklist, encourages the client with BPD to keep mood and dream journals, limits survivor work to a time after daily living skills are demonstrated, and keeps and dates all correspondence and notes from telephone conversations.
Treatment Goals
Personality disorders derive in part from patterns of behavior and thought that would appear to be hard-wired into the central nervous system during the first six years of life. It is understandable that PDs are hard to modify and slow to change. However, studies suggest that positive changes can occur. The treatment goal in working with all of the personality disorders is the same: the gradual development of new, more adaptive habits of thought and behavior that prevail over the preexisting, maladaptive patterns (Stone, 1993, p. 152).
Treatment goals for individuals with BPD must include management of unsafe behaviors, affect management, and reduction of substance abuse. Linehan (1993, pp. 126-127) suggests that a central BPD treatment goal is management of self-mutilating behavior. The rate of completed suicides for individuals with BPD who cut or burn themselves is twice that of those who do not. This behavior can also damage the body irrevocably and presents the possibility of accidental death. The effectiveness of treatment will be based, at least in part, on the development of an intent in these individuals to help rather than harm themselves.
Dual Diagnosis Treatment:
Treating The Addicted Borderline Personality Disorder
Cluster B: Incidence of Co-Occurring Substance Abuse Disorders
Cluster B has the highest incidence of co-occurring substance abuse disorders of the three DSM-IV™ personality disorder clusters (Nace, O'Connell, ed., 1990, p. 184).
Stone (1993, p. 222) suggests that a complicated reciprocal relationship exists between BPD and illicit drugs. Abuse of alcohol and certain drugs, e.g., amphetamines, can intensify the symptomatology of BPD by making impulsivity worse. However, it is also possible that abuse of amphetamines, marijuana, or psychedelics sets in motion a deterioration of habits and self-control that leads to a clinical picture resembling BPD.
Millon (1996, p. 200) notes that individuals with BPD are characterized by drug-seeking behavior. Individuals with BPD will be particularly vulnerable to the escape offered by drugs and alcohol. Real world interaction triggers multiple interpersonal crises and overwhelming negative affect. Drugs can, ostensibly, offer relief from BPD turmoil and emptiness.
Khantzian, et. al. (1990, p. 3) view the treatment of any character disorder as the road to recovery from addiction. However, this approach demands a continued attention to and concern about maintaining abstinence and avoiding relapse. Addiction becomes a disorder in its own right and must be addressed directly. However, the treatment of personality disorders can lead to profound change in the personality disordered individual's experience of self and the world, which, in turn, can positively affect recovery from addiction.
Drugs of Choice for the Borderline Personality Disorder
Individuals with BPD experience extraordinary affective discomfort. They are frequently agitated, labile, and overwhelmed. They do not define themselves as able or effective in managing their own lives. Their defenses are regressive; under stress they become more childlike. Drugs and alcohol can offer these individuals a way of coping; drugs can block out sensations of pain, discomfort, or negative affect. The appeal of drugs and other compulsive behaviors in soothing, distracting, and escaping is apparent and powerful. Richards (1993, pp. 280-281) states that individuals with BPD, over any of the other personality disorders, are the "e;best candidates"e; for developing addictive disorders. These individuals will use almost any drug or route of administration to their own worst advantage, They often abuse prescribed medications and may hoard these medications for suicide attempts.
Individuals with BPD often use alcohol and other drugs in a chaotic and unpredictable pattern; they may engage in a polydrug pattern involving alcohol and other sedative-hypnotics for self-medication. Clients with BPD often abuse benzodiazepines that have been prescribed for anxiety -- which can lead to a relapse to their actual primary drug of choice (Ries, TIP #9, 1994, p. 55).
The issue of prescribed medication for individuals with BPD is complex and difficult. These individuals often demand medication for anxiety and become quite angry when denied. They are noncompliant with medication -- either using too much or too little. They are inclined to misreport the impact of the medication, saying they feel better when they do not or worse when they feel better. The intensity of their discomfort can make prescribing of addictive medication seem more reasonable than it should. Their propensity for crises often brings them into contact with an array of service providers and medical personnel. They are quite frequently successful in obtaining the medication they seek, usually benzodiazepines, from at least one doctor from whom they receive services. Then it becomes difficult to withdraw a drug to which they may have already developed physical adaptation and tolerance. Many individuals with BPD are informed enough to tell medical personnel that if they do not receive a prescription for Zanax, for example, they will probably have a seizure.
Another issue regarding drug of choice for individuals with BPD has to do with their intolerance for being alone and the intensity of their relationships. These individuals will often use drugs and alcohol as part of their contact with needed others. The drug of choice will then be incidental to that used by their social contacts. Recovery in these situations will be dependent upon linking addicted clients with BPD to a strong support network that fosters abstinence such as AA or NA.
Dual Diagnosis Treatment for the Borderline Personality Disorder
Richards (1993, p. 278) suggests that treatment failures for the dually diagnosed are often a result of failure to consider the function of the addiction, including the drug of choice, within the context of the psychopathology dominant in the individual. Salzman (Mule, ed., 1981, pp. 346-347) believes that the inner forces that initiate and sustain addiction are immaturity and inappropriate, magical coping techniques. Dual diagnosis treatment must involve recognition of these tendencies that foster addictive behavior, i.e., immaturity, escapism, and grandiosity. New ways must be learned for dealing with feelings of powerlessness and helplessness other than compulsivity.
When individuals with BPD cannot self-comfort, they flee into impulsive sex, food, drugs, shopping (or shoplifting). Impulsive and self-destructive behaviors will temporarily allow them to feel calmer (Oldham, 1990, p. 303). Conversely, panic is a frequent and significant reaction to confrontation of drug use or compulsive behaviors. The drug/behavior may have become so important to individuals with BPD that it is perceived as necessary for survival. This panic can be the cause of lying, avoidance, or treatment withdrawal. Life without the drug of choice appears impossible and incomprehensible.
When individuals with BPD, who have not previously reported other compulsive behaviors, are able to achieve abstinence from their drug of choice, service providers must address the possibility of or check for alternative addictive involvement, e.g., shopping, shoplifting, impulsive and unsafe sexual behavior, or gambling. Recovery programs must cover all addictive patterns.
Dual diagnosis treatment for addicted individuals with BPD must address the function of the addictive substance and/or compulsive behaviors while developing strong substitutes that can sustain recovery behaviors and abstinence, e.g., involvement in AA or NA, affect management (particularly anger), medication compliance, cognitive self-calming techniques, identified recovery behaviors, e.g., daily contact with sponsors, and therapy for issues related to a family history of physical or sexual abuse. The treatment modality of choice is rarely long-term individual therapy. Group more effectively addresses transference issues and is compatible with fostering affective management techniques, life management skills, and recovery community involvement
Twelve-step group participation may be a more successful process for individuals with BPD with pre-12-step practice sessions. These individuals should be helped to organize their thoughts and to practice saying "e;pass"e; when feeling unsafe. They should be encouraged to join same sex groups when possible and use same sex sponsors. If appropriate, sponsors can be brought into a treatment session to learn why individuals with BPD are taking medication and to discuss setting boundaries. Further, individuals with BPD need to learn the difference between powerlessness and helplessness (Ries, TIP #9, 1994, p. 60).
Relapse for individuals with BPD is defined as engaging in any unsafe behavior such as AOD use, self-harm, and noncompliance with medications. Relapse prevention must focus on both preventing AOD use and recurrence of psychiatric symptoms (Ries, TIP #9, 1994, p. 60).
Confrontation usual to substance abuse treatment may be useful with high-functioning individuals with BPD. It will overwhelm lower-functioning individuals. Service providers must be aware of the severity of pathology in each individual with BPD when deciding on the use of confrontation techniques. Abstinence can be a prerequisite to treatment only with very high-functioning individuals with BPD; otherwise, it needs to be a goal of treatment. Use should be confronted but not result in termination from treatment.


Eosinophils are multifunctional leukocytes that reside in the gastrointestinal (GI) lamina propria, where their basal function remains largely unexplored. In this study, by examining mice with a selective deficiency of systemic eosinophils (by lineage ablation) or GI eosinophils (eotaxin-1/2 double deficient or CC chemokine receptor 3 deficient), we show… (More)


While artificial intelligence has yet to realize its often dramatic promises, the development of brain science has led thinkers to prioritize the mind over the body as the center of the self. "Is the 'society of mind' trying to colonize the societies of body and emotion?" asks 3 Quarks Daily. "Why 'artificial intelligence,' after all, and not an 'artificial identity' or 'personality'? The name itself reveals a bias. Aren't we confusing computation with cognition and cognition with identity? Is there really a little being in our brains, or contiguous with our brains, driving the body?"


Abstract
The basal layer of the epidermis contains stem cells and transit amplifying (TA) cells that rapidly proliferate and differentiate further into the upper layers of the epidermis. A number of molecules have been identified as regulators for this process including p63 and Notch1. However, little is known about the mechanisms that regulate the transitions from stem cells to proliferating or differentiating TA cells. Here we demonstrate that Epiprofin (Epfn) plays critical distinct roles in these transition stages as a cell cycle regulator and a transcription factor.
Epfn knockout mice have a thickened epidermis, in which p63-expressing basal cells formed multiple layers due to accumulation of premature TA cells with reduced proliferation, and a reduction in differentiating keratinocytes expressing Notch1. We found that low levels of Epfn expression increased proliferation of human immortalized keratinocyte (HaCaT) cells by increasing EGF-responsiveness and superphosphorylation of Rb. In contrast, high levels of Epfn expression promoted cell cycle exit and differentiation, by reducing E2F transactivation and inducing Notch1 expression. Our findings identify multiple novel functions of Epiprofin in epidermal development.


Abstract:
Some moral disagreements are so persistent that we suspect they are
deep: we would disagree even when we have all relevant information and no one makes any mistakes (this is also known as faultless disagreement). The possibility of deep disagreement is thought to drive cognitivists toward relativism, but most cognitivists reject relativism. There is an alternative. According to divergentism, cognitivists can reject relativism while allowing for deep disagreement. This view has rarely been defended at length, but many philosophers have implicitly endorsed its elements. I will defend it.


Companies are striving to promote transparency and social responsibility in their supply chains even as their logistics operations become increasingly complex. Businesses can navigate this difficult environment by defining clear expectations for their vendors, identifying problematic areas within their supply chains, assessing the performance of suppliers and following through on their plans, according to a report by Deloitte.


The programme, which sets aside one day each week for Indonesian's to forego rice, aims to reduce Indonesians' dependence on rice as staple food.
The per capita rice consumption rate for Indonesia is 139kg annually while for cereals (rice, maize and wheat) the rate is 316g per capita daily. The Expected Food Standards Pattern should be 275g daily.
The government is working to change the people's food consumption pattern by changing the mindset toward a diverse diet that is nutritionally balanced, safe and clean and lower average per capita rice consumption by 1.5% annually.