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aDid not meet inclusion criteria (described in Study Eligibility, Screening, Consent, and Randomization).bExpanded eligibility criteria included reducing the cutoff score on the depression-severity screener.
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Bolton P, Bass J, Betancourt T, et al. Interventions for Depression Symptoms Among Adolescent Survivors of War and Displacement in Northern Uganda: A Randomized Controlled Trial. JAMA. 2007;298(5):519–527. doi:https://doi.org/10.1001/jama.298.5.519
© 2019
Author Affiliations: Applied Mental Health Research Group, Center for International Health and Development, Boston University School of Public Health, Boston, Massachusetts (Drs Bolton, Bass, and Murray); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Bass); Department of Population and International Health, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University School of Public Health, Boston, Massachusetts (Dr Betancourt); War Child Holland, Gulu, Uganda, (Ms Speelman); World Vision Uganda, Kampla, Uganda (Ms Onyango); New York State Psychiatric Institute, Columbia University, New York, New York (Ms Clougherty and Dr Verdeli); Division of Epidemiology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, and Gertrude H. Sergievsky Center, Faculty of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York (Dr Neugebauer); Teachers College, Columbia University (Dr Verdeli); Dr Bolton is now with the Center for Refugee and Disaster Response, and Dr Bass is now with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Context Prior qualitative work with internally displaced persons in war-affected northern Uganda showed significant mental health and psychosocial problems.
Objective To assess effect of locally feasible interventions on depression, anxiety, and conduct problem symptoms among adolescent survivors of war and displacement in northern Uganda.
Design, Setting, and Participants A randomized controlled trial from May 2005 through December 2005 of 314 adolescents (aged 14-17 years) in 2 camps for internally displaced persons in northern Uganda.
Interventions Locally developed screening tools assessed the effectiveness of interventions in reducing symptoms of depression and anxiety, ameliorating conduct problems, and improving function among those who met study criteria and were randomly allocated (105, psychotherapy-based intervention [group interpersonal psychotherapy]; 105, activity-based intervention [creative play]; 104, wait-control group [individuals wait listed to receive treatment at study end]). Intervention groups met weekly for 16 weeks. Participants and controls were reassessed at end of study.
Main Outcome Measures Primary measure was a decrease in score (denoting improvement) on a depression symptom scale. Secondary measures were improvements in scores on anxiety, conduct problem symptoms, and function scales. Depression, anxiety, and conduct problems were assessed using the Acholi Psychosocial Assessment Instrument with a minimum score of 32 as the lower limit for clinically significant symptoms (maximum scale score, 105).
Results Difference in change in adjusted mean score for depression symptoms between group interpersonal psychotherapy and control groups was 9.79 points (95% confidence interval [CI], 1.66-17.93). Girls receiving group interpersonal psychotherapy showed substantial and significant improvement in depression symptoms compared with controls (12.61 points; 95% CI, 2.09-23.14). Improvement among boys was not statistically significant (5.72 points; 95% CI, −1.86 to 13.30). Creative play showed no effect on depression severity (−2.51 points; 95% CI, −11.42 to 6.39). There were no statistically different improvements in anxiety in either intervention group. Neither intervention improved conduct problem or function scores.
Conclusions Both interventions were locally feasible. Group interpersonal psychotherapy was effective for depression symptoms among adolescent girls affected by war and displacement. Other interventions should be investigated to assist adolescent boys in this population who have symptoms of depression.
Trial Registration clinicaltrials.gov Identifier: NCT00280319
The war in northern Uganda remains one of the most violent and persistent complex humanitarian emergencies in the world. Over 1.8 million individuals, mainly ethnic Acholi, have been internally displaced during 20 years of conflict between the government of Uganda and the Lord's Resistance Army.1 The Lord's Resistance Army has been accused of human rights abuses including mass violence, rape, and the abduction of more than 25 000 children.1 Local populations have crowded into internally displaced persons camps where they face threats to their health and well being.1 Prior research on children affected by armed conflicts documents increased risk of mental health problems ranging from adjustment difficulties to depression and anxiety disorders, including posttraumatic stress disorder.2-4 Governmental and nongovernmental organizations (NGOs) intervene to address these problems, yet few interventions have been rigorously evaluated using a randomized controlled trial (RCT) design, either in northern Uganda or elsewhere.4 The few RCTs in non-Western societies that have included nonpharmaceutical treatments have generated mixed results.5-9 Neither a community-based single-session testimony intervention5 nor a clinic-based counseling and problem-solving treatment7 have so far proved superior to the control condition. In contrast, trials of a cognitive behavioral therapy,9 a psychoeducation treatment program,6 and a previous trial in southwestern Uganda (conducted by the authors of this article with an intervention also from this article),8 all found significant improvements in the psychological symptoms studied. However, these trials focused on adults. RCTs of mental health interventions to assist children and adolescents affected by war are also needed.
This article describes an RCT in 2 camps for internally displaced persons in northern Uganda. We investigated whether a therapy-based intervention (interpersonal psychotherapy for groups, [IPT-G]) and an activity-based intervention (creative play, [CP]) were effective for relieving mental health and psychosocial problems resulting from war and displacement among adolescents.
Study participants were Acholi adolescents aged 14 to 17 years living in 2 camps for internally displaced persons near Gulu town in northern Uganda. Each camp has a population exceeding 20 000. Economic activity and organized social and cultural life are minimal, although children have some access to schools.
We developed local symptom assessment measures based on a prior qualitative study in both camps (P.B., T.B., and L.S., unpublished data, 2004). In that study, we identified 7 important mental health and psychosocial problems affecting children and adolescents from the viewpoint of the youths themselves, their caregivers (mothers or other adult relatives), and other knowledgeable local individuals. Among these problems, the research team and NGO staff selected 5 problems judged amenable to interventions within the NGOs' capacity. Three of these 5 problems—two tam, kumu, and par—are local depression-like syndromes and were selected because of a previous randomized trial we conducted, which found such syndromes to be amenable to treatment provided by one of our collaborating partners (World Vision).8 The fourth local syndrome is ma lwor, which appears to be an anxiety-like syndrome and kwo maraco, the fifth local syndrome, is a combination of maladaptive or socially unacceptable behaviors (Box). The remaining 2 problems, one referring to a cluster of posttraumatic stress reactions with psychotic features and the other to a legitimate fear of future Lord's Resistance Army attacks, were not investigated further because our NGO partners and the research team felt that these problems were unlikely to be affected by the NGOs' current or planned interventions, including the interventions tested in this study.
Depression-Like Syndromes
Has lots of thoughts, wants to be alone, is easily annoyed, holds head, drinks alcohol, thinks about suicide, doesn't greet people, sits alone, has lots of worries, does not think straight, cannot do anything to help self, does not trust, mutters to self, insults friends, is disobedient, is weak, cries continuously, loses concentration in school b
Two Tama
Has lots of thoughts, constantly worries, experiences body pain, feels that brain isn't functioning, thinks of self as being of no use, thinks about suicide, talks about problems, sits alone, has headaches, feels sad, does not care about living or dying, thinks of bad things, doesn't feel like talking, is forgetful, is weak, cries continuously, loses interest in school b
Has loss of appetite, feels pain in the heart, sits with cheek in palm, cries when alone, does not sleep at night, talks about problems, lies down all the time, has lots of worries, has headaches, feels cold, is weak, does not feel like talking, is disobedient
Anxiety-Like Syndromes
Ma Lwor
Clings to elders, thinks of self as having no future, constantly runs, dislikes noise, has fast heart rate, fears being alone, has loss of appetite, wants to be alone, does not sleep at night, drinks alcohol, doesn't greet people, thinks people are chasing him/her
Syndrome of Maladaptive Socially Unacceptable Behaviors
Kwo Maraco
Fights, uses bad language, is disrespectful, misbehaves, drinks alcohol, uninterested, deceitful, a rough person, uses drugs, disobedient, loses interest in school b
Play and Chore Activities by Function and Sex
Fetching water, washing clothes, digging, washing utensils, playing ball, sweeping house, smearing floor with mud, cooking food, traditional dance
Fetching water, digging, playing games, sweeping compound, playing football
aCombined to create the composite depression scale. The final scale included 35 signs and symptoms. bThe 2 school-related items were excluded from the final scales because many of the students were not school-going.
Problems of alcohol abuse and sexual violence were widely reported—symptoms related to the use of alcohol are present in 3 of the 5 locally described syndromes and sexual aggression is represented under the locally described conduct syndrome of ma lwor. However, our purpose was to study the effects of interventions on locally defined syndromes, and distinct syndromes referring to these problems were not identified in the qualitative study. Note, however, that while symptoms of psychosis, posttraumatic stress disorder, drug and alcohol use, and trauma were not among the foci of the assessment, individuals who had these symptoms were not excluded from the study.
As in a previous study10 we explored whether any existing instruments matched the local descriptions of these 5 selected problems. Because no extant instruments proved suitable, we created a local instrument consisting of questions on all the symptoms of all 5 local problems: the Acholi Psychosocial Assessment Instrument (APAI). APAI respondents were asked about the frequency of each symptom occurrence during the previous week. Responses were coded on a 4-point Likert scale ranging from 0 (never) to 3 (constantly). Questions were added regarding symptom duration, sociodemographics, duration of camp residence, and whether the adolescent was ever abducted.
Given the predominance of depression-like syndromes in the qualitative data and the effectiveness of IPT-G for treating depression symptoms elsewhere in Uganda,8 introducing and testing IPT-G in this population seemed appropriate. Both the research team and our NGO partners also believed that an existing intervention, CP, was potentially effective for these same problems (and for the conduct syndrome of kwo maraco). Therefore, we designated the depression problems as the primary study outcomes: two tam, kumu, and par (Box). Because the anxiety (ma lwor) and conduct (kwo maraco) syndromes were also thought amenable to both IPT-G and CP, measures of these problems were retained as secondary outcomes.
The 3 local depression problems contain varying (but incomplete) combinations of the cardinal Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) symptoms of depression and related symptoms.11 Accordingly, we developed a local depression symptom scale based on the summed scores on all items comprising the 3 syndromes (35 individual signs and symptoms). Scale reliability and validity were evaluated for a subsample (n = 178) of the adolescents interviewed for trial eligibility (N = 667). Cronbach α (a measure of internal reliability) was 0 · 92. Mental health professionals familiar with the local culture were not available to make clinical diagnoses. Therefore, we used an alternative method of exploring criterion validity.10 We identified individuals among this group for whom youth-caregiver pairs concurred that the youth had at least 2 of the 3 local depression-like syndromes (cases) and pairs concurring that the youth had none of these syndromes (noncases). The APAI depression symptom scale (mean [SD]) was substantially and significantly higher for the cases (45.3, [13.6]) than for the noncases (15.6, [11.2]), thereby supporting concurrent validity. The trial eligibility threshold was derived from these scores: 32, which is approximately 1 SD below the case mean. A convenience subsample of 30 individuals were readministered the APAI 3 to 5 days later. Test-retest reliability for the depression symptom scale was 0.84.
The trial eligibility symptom threshold was derived from the comparison of mean depression symptom scale scores for cases and noncases, operationalized in the manner described in the previous section. The threshold of 32 (1 SD less than the case mean) was selected as a reasonable lower bound for clinically significant presence of symptoms (maximum scale score, 105). To evaluate the clinical significance of this threshold from a Western clinical perspective, the scale scores were compared with results for the Strengths and Difficulties Questionnaire,12 administered together with the APAI. The Strengths and Difficulties Questionnaire, used previously in a variety of cultures, is a general screening instrument for child emotional and behavioral problems.13-15 It provides a determination of probable 'caseness' (based on scores)16 but is not designed as a measure of treatment outcomes.17 We compared the APAI scores for those individuals with positive screening results for the trial with their scores on the Strengths and Difficulties Questionnaire emotional problems subscale (for which scores of 7-10 points indicate probable "caseness")16 to test whether the APAI and the cutoff criteria were identifying adolescents with significant mental health problems according to a standard measure (the Strengths and Difficulties Questionnaire).
We also developed a local function measure based on the qualitative data, using an approach similar to that used elsewhere.18 The measure has 2 gender-specific scales, each reflecting common activities judged important for children and adolescents by youths and adult camp residents (Box). Impairment was rated on a Likert scale ranging from 0 (no more difficulty than most other boys/girls of the same age) to 4 (frequently unable). An overall function score comprised the sum of the individual item scores, and ranged from 0 to 36 for girls (9 activities) and 0 to 20 for boys (5 activities).
Screening and baseline assessments were conducted in the summer of 2005. Both interventions lasted from August 2005 through December 2005. Assessments were conducted pre- and postintervention and change calculated for the local depression symptom scale. Sample size calculations were based on an expected 10-point difference in this change between either of the treatment groups and the controls. One hundred adolescents per group provided greater than 80% power (P = .05), assuming SDs of less than 25 points. Direct comparisons between intervention groups were inappropriate given differences in the size and sex ratio that made up the intervention groups. Consequently, the study was not powered for between-intervention comparisons.
Trial eligibility was based on a 2-stage screening process. In stage 1, 10 interviewer supervisors contacted local leaders, teachers, community workers, and adolescents to create a list of youths believed to have at least 1 of the local depression-like problems. In stage 2, the instrument was administered to these youths by 20 trained interviewers. Supervisors observed 10% of interviews, reviewed all completed instruments, and visited all adolescents not interviewed to confirm unavailability or refusal. Interviewers were used (rather than self-completion of forms) because of concerns about the rate of literacy among the respondents, given frequent interruptions in schooling due to the war.
Trial-eligible interviewees were aged 14 to 17 years, scored greater than 32 on the depression symptom scale and greater than 0 on the function scale, had symptoms for at least 1 month, and resided in the camps during the preceding month. Exclusion criteria were inability to be interviewed due to a cognitive or physical disability, or severe suicidal ideation or behavior.
Informed consent was initially obtained only for the screening interview. Eligible youths were then randomly assigned to a study group. Random allocation was done by computerized generation of a random number between 1 and 400 for each eligible participant, ordering them by number and assigning the first third to IPT-G, the second third to CP and the final third to the wait-control group. Each eligible youth was then visited by a facilitator (if allocated to IPT-G or CP) or other NGO staff (if allocated to controls) and a second informed consent process was done, this time for participation in the randomized trial. On this occasion informed consent included advising each youth of the study group to which he or she had been allocated. Our NGO partners had previously agreed to provide/continue on a permanent basis whichever intervention proved effective. Individuals assigned to the wait-control group were told they would be first to receive whichever intervention (if any) proved effective.
Of the total sample screened (N = 667), 300 individuals met original inclusion criteria, were stratified by camp and sex, and randomized to a study group. Of these 300, 290 were enrolled in the study. Of the remaining 10 individuals, 1 was already involved in the CP program in a neighboring camp, 4 could not be located, and 5 refused. To meet our original sample size (300), we randomized an additional 38 individuals whose depression symptom scores were between 28 and 31 points. This relaxation of a trial eligibility criterion is acceptable when study design consequences are minimal.19 The first 14 individuals all consented and therefore, the remainder were not approached. The participation rate was 96.8% (304 enrolled of 314 recruited; FIGURE).
The study instrument was re-administered to 282 (90%) of the original 314 participants within 1 month of completing both interventions. Interviewers were blinded to interviewees' intervention status.
Both interventions comprised 16 weekly group meetings, lasting 1.5 to 2 hours each. These were preceded by 1 or 2 individual meetings in which the intervention was explained and (in the case of the IPT-G intervention) a treatment plan was generated by the IPT-G facilitators. Interpersonal psychotherapy, a time-limited, manualized intervention, was developed in the United States for ambulatory, nonpsychotic unipolar depression20 and later adapted for use with adolescents with depression, individually21 and in groups.22 Interpersonal psychotherapy assumes that depressive episodes are triggered by difficulties in 1 or more of 4 interpersonal areas: grief, interpersonal disputes, role transitions, and interpersonal deficits. Interpersonal psychotherapy focuses on improving depressive symptoms and functioning by identifying the interpersonal problem(s) most relevant to the current depression and then assisting the individual in building skills to manage those problems. Treatment using IPT-G was first facilitated in Africa among adults with depression in southwest Uganda.8 Based on this experience and our preliminary qualitative work in northern Uganda(P.B., T.B., and L.S., unpublished data, 2004 [available from authors at request]), IPT-G's focus on interpersonal triggers and group relationship building seemed compatible with Acholi culture.
The IPT-G intervention was implemented by World Vision Uganda. There were 12 IPT-G groups, each led by a facilitator with 2 weeks of on-site training by Columbia University faculty (K.F.C.). A treatment manual specifying IPT-G strategies and techniques was adapted for local use(K.F.C., H.V., and Myrna Weissman, PhD, Columbia University, New York State Psychiatric Institute, unpublished data, 2006). Groups consisted of 6 to 8 adolescent boys or girls and a facilitator of the same sex. Facilitators received weekly direct supervision by World Vision Uganda staff with prior IPT-G experience. These supervisors in turn received weekly phone supervision from the US-based trainer and were in weekly contact with study personnel. IPT-G supervisors also provided weekly written reports that were reviewed and discussed with study staff during the phone meetings for adherence to the treatment model and to monitor human subjects protection.
Use of CP refers to the creative play format developed by War Child Holland for war-affected youth. Its premise is that a youth's resilience will be strengthened by verbal and nonverbal expression of thoughts and feelings through age-appropriate creative activities such as, songs, art, role plays, music, sports, games and debates.23 Each activity serves specific psychosocial goals and activities are selected from the War Child Holland manual accordingly. For example, if the goal is to build trust with peers, the activities may require the adolescents to work collaboratively. After the activities, facilitators lead discussions on what the participants and facilitators thought about the activity as a means of drawing real-life lessons. CP was provided to 4 groups (2 groups/camp; both sexes represented in each group; 25-30 adolescents in each group), consistent with its routine implementation. The same 2 individuals (1 man, 1 woman) from War Child Holland jointly facilitated all CP sessions for all groups. Supervision was provided weekly or bimonthly by the War Child Holland psychosocial specialist who regularly shared supervision reports with the US-based study personnel. These reports were reviewed and discussed with study staff during bimonthly phone meetings to ensure adherence to the treatment model and to monitor human subjects protection.
When implementing CP in different countries, some War Child Holland programs have added to the basic CP model by including various therapy-based elements in the postactivity discussion, according to local capacity. War Child Holland staff in northern Uganda had originally planned to do this as well. However, for this study, it was decided to use only the standard activity-based CP model in which postactivity group discussions focus on building skills. In this way, the study maximized the contrast between a psychotherapy-based intervention (IPT-G) and one focusing on group activities (CP). Participants could discuss their problems with the CP facilitators after the group meetings and this occurred on a few occasions for distressed participants (a young woman whose baby had died, and a boy who had lived with rebels in the bush), but these discussions were not a routine part of the intervention. Otherwise, the nature of the standard CP intervention was the same as that typically used by War Child Holland in other countries with 2 exceptions: (1) inclusion of adolescents as old as aged 17 years (usually limited to 15 years); and; (2) limiting CP participation, normally open to all children, to adolescents with depression symptoms.
Baseline characteristics of the study groups were compared using χ2 tests for categorical data and t tests for continuous data. The primary outcome measure of intervention effectiveness was within-subject change in the depression symptom scale scores between baseline and postintervention assessment. The secondary outcome measures were the corresponding scale scores for the local anxiety and conduct syndrome symptoms and the function measure. We compared separately the mean within-subject change in the symptom and function scores between the wait-list control group and the individual interventions.
Stata statistical software version 9.0 (STATACorp, College Station, Texas) was used for descriptive analyses and SAS version 9.1 (SAS Institute Inc, Cary, North Carolina) for grouped analyses. We used a random effects model to estimate intervention effect on change in scale scores, adjusting for the clustering within intervention groups by controlling for within-group correlated observations and between group variability.24 Regression coefficients and P values were computed for continuous measures. Statistical significance was set at P < .05, 2-tailed and expressed as a 95% confidence interval (CI).
Analyses are presented for the intent-to-treat samples (n = 314), which includes all trial-eligible individuals randomized to one of the trial conditions and approached for inclusion, whether or not they consented. For individuals who were not reinterviewed, baseline scores were used as their postintervention scores, thereby imputing no change. Analyses were also conducted on a completer sample (n = 261), which included only individuals interviewed before and after the intervention and who (for the intervention groups) attended any sessions. This was done to determine if the results were substantially different for completers and as a check on whether our imputation method for noncompleters resulted in underestimates in sample variance.
The study was approved by the Boston University Institutional Review Board and by the Ugandan National Council on Science and Technology in Kampala, Uganda.
Of 314 adolescents approached for enrollment, 172 (55%) were in Awer camp and 142 (45%) in Unyama. At baseline, 180 (57%) were girls, 211 (67%) were enrolled in school, and 131 (42%) reported a history of Lord's Resistance Army abduction. Mean duration of camp residence was 5.2 years. Except for a slightly older age among wait-list controls, the 3 study groups did not vary significantly (Table 1). The average Strengths and Difficulties Questionnaire emotional problems subscale score was 8.1 points without difference by sex and group assignment and 256 (81.5%) scored 7 or more points, the cutoff for probable 'caseness'. Results are presented unadjusted for age as adjustment resulted in no appreciable difference.
Of the 105 adolescents assigned to IPT-G, 91 attended at least 2 sessions (mean of 14.1 sessions; SD, 2.6) of whom 89 (86% of the total IPT-G sample) were assessed postintervention. Of the 105 youth assigned to CP, 84 attended at least 3 sessions (mean of 10 · 4 sessions; SD, 2.9) of whom 82 (83% of the total CP sample) were reassessed. Ninety individuals among the wait control group were interviewed postintervention (87% of the total 104 wait-list control sample). Fourteen adolescents (13%) assigned to IPT-G and 21 (20%) assigned to CP did not attend any sessions. Both sets of nonattendees had the same mean depression scores and ages as the attendees but were more likely to be girls, to not attend school, and to have a history of abduction.
All 3 study groups demonstrated a decline in mean depression symptom scores between baseline and postintervention (Table 2). The decline in the depression symptom scale among the IPT-G group was substantially and significantly greater than the wait-list control group. The adjusted difference in mean within-subject decline between the IPT-G and wait-list control groups was 9.79 points (95% CI, 1.66-17.93) for the entire intent-to-treat sample and 10.71 points (95% CI, 4.02-17.40) for the completers only (Table 2). The CP group evidenced a small decline in the depression symptoms scale, not differing significantly from that of wait-list controls. The intraclass correlation coefficient for depression scale scores was 0.099. Variances of the outcome measure among the intent-to-treat sample differed only slightly from that among the Completer sample (Table 2), indicating that the imputation scheme did not materially influence the risk of type I error.
We also assessed change in the local anxiety problem (ma lwor) and conduct problems (kwo maraco) symptom scores as secondary outcomes. The adjusted difference in mean within-subject decline between the IPT-G and wait-list control groups for ma lwor was small but significant: 2.16 points (95% CI, 0.84-3.48) while that for kwo maraco was not: 0.74 points (95% CI, -0.15-1.63) . The CP group showed a slight nonsignificant increase (0.2 points) and decrease (0.4 points) for ma lwor and kwo maraco, respectively.
Exploratory analyses examined whether the effectiveness of either intervention varied by sex, age, abduction history, and duration of camp residence. In stratified analyses, among girls, IPT-G was greatly superior to the wait-list control condition in reducing symptom severity, while the results for boys were not statistically significant (Table 3). This effect also held for the completer sample, where girls' mean scores were 16.6 points lower (95% CI, 9.93-22.13) for those who received IPT-G compared with controls and IPT-G boys had scores 5.01 points lower (95% CI, -1.89-11.90) compared with controls. No significant differences emerged for the other variables or in any of the CP analyses.
Recovery was defined as a reduction of 50% or more of an individual's baseline symptom severity score and remission as being at or less than a predefined cutoff score of 15.6 points (the mean score of the noncases in the validation study). Among wait-list controls, 14 individuals (13.5%) met criteria for recovery and 9 of total (8.9) met criteria for remission. The corresponding numbers for the CP and IPT-G groups were 13 (12.4%) and 39 (37.1%) for recovery and 7 of total (6.7%) and 30 of total (29.1%) for remission, respectively. Among the IPT-G sample, 25 (42%) of the girls and 14 (31%) of the boys met recovery criteria while 20 (33.9%) of the girls and 10 (22.7%) of the boys met remission criteria. Among 'completers', 14.6% and 7.3% of the CP participants and 42.7% and 34.5% of the IPT-G participants respectively, met the recovery and remission criteria.
The number of IPT-G sessions attended was associated with greater symptom reduction (β = 1 · 3; P = .001). No association was found between number of CP sessions attended and symptom change. IPT-G effectiveness did not vary significantly by group facilitator but the limited number of groups (12) constrained analytic power. Facilitator effects could not be examined for CP because both facilitators worked with all 4 groups.
Mean within-subject function scores declined (ie, function improved) similarly across all 3 study groups among girls and boys. Among the individuals in the control group, the girls experienced a mean 1.9-point reduction (95% CI, −0.11 to 3.97) in their functional impairment scores and the boys experienced a 0.8-point mean reduction (95% CI, −0.39 to 2.07). This was similar to the amounts experienced by the CP participants with a mean 1.3-point reduction for girls (95% CI, −0.73 to 3.23) and 0.5-point reduction for boys (95% CI, −0.69 to 1.66). The IPT-G participants reported greater reductions but the overall differences compared with controls did not reach statistical significance. Among the IPT-G girls, the mean reduction was 3. 2 points (95% CI, 1.51-4.87) while the boys' mean score was 1.3 points (95% CI, −0.02 to 2.93).
Proschan and Fullman have recommended using the Dunnet adjustment for statistical analysis of multiple comparisons for the same reasons that the bonferroni adjustment is used.25 While that article refers to more comparisons than we conducted in this study, we nevertheless tested the effect of including the adjustment. We found no differences in the data and the adjustment factor itself was not significant.
This study found IPT-G (a psychotherapy-based intervention) superior to a wait-list control condition in reducing depressive symptoms among this adolescent population. Statistically significant improvement was limited to the girl participants in this study. CP was not superior to the wait-list control condition. Neither IPT-G nor CP was effective in improving anxiety, conduct problems, or functioning among boys or girls, according to our measures.
Girls derived much greater improvement in depression symptoms from IPT-G than did boys. The amount of change among boys was not statistically significant when compared with controls, however the study was not originally powered to detect gender-specific differences. Previous studies of IPT-G among adolescents in Western countries have included too few boys to know whether this finding reflects the situation elsewhere.22 It may be that boys are less willing to talk about emotional problems, particularly in a group format. The different comorbidity profiles among the boys and girls (boys had more substance use and posttrauma symptoms) may also have affected the effect of IPT-G, which has been shown to be less effective in individuals with depression and comorbid anxiety disorders.26
The lack of improvement among the CP group may be because it was originally designed for younger ages (≤15 years) than our study population, who may be more like adults than children in this culture and context. This may also explain the effectiveness of an adult intervention like IPT-G. The absence of effectiveness among the CP group was unexpected, particularly since the CP facilitators received many positive comments from participants, caretakers, and teachers. Perhaps the participants wanted to please the facilitators, or were referring to other improvements of which the nature was not captured with our measures, or they were referring to the same natural improvement that occurred among the control group (but which they may have attributed to the intervention). Whatever the reason, we note that an activity-based intervention did not produce significant improvement in the outcomes assessed in the present study.
The lack of improvement in function for both interventions is in agreement with reviews that note that reduction in depressive symptoms does not necessarily translate into improved functioning.27,28 Another possibility is that functional improvement occurred sometime later, a result that characterizes some interpersonal psychotherapy trials in industrialized countries,29 or that the lack of improvement reflected a limitation in our measures (see Study Limitations section).
The IPT-G group also showed a small but significant improvement in anxiety symptoms compared with controls, which is consistent with the improvement in depression symptoms and the close relationship between anxiety and depression. There was no such improvement among the CP group and conduct symptoms showed no improvement in either group compared with controls. Given that validity testing of the APAI focused on the depression syndromes, and that participants were screened into the study on the basis of depression symptoms only, we consider these results to be suggestive only. Further investigation is required.
The consent process for the randomized trial differed from standard RCT procedures, where full consent precedes random allocation. Our approach was based on prior experience among less-educated populations in Sub-Saharan Africa, where the concept of random assignment is not well understood and can result in withdrawal from the study by those allocated to the control group. Instead, we randomized potential participants after the screening and then informed them of their allocation as part of the trial-consent process. In this way, we expected to reduce both refusals and drop-outs—as long as refusals and drop-outs were minimal, selection bias would not be significant. Only 10 individuals randomized in this way did not participate. Of these, 5 were refusals. All 10 were included in the intention-to-treat analyses by assuming no change between pre- and postassessments.
While the lack of improvement among the CP groups might suggest that the facilitator and group effects were not important, we cannot conclude this because the same facilitators ran both groups and because those groups were larger and of mixed gender, both of which would reduce these effects. As a result, we cannot speculate by comparison with CP what it was about IPT-G that was effective; whether it was the psychotherapy, the effect of meeting in small groups, or the nonspecific attention of the facilitator.
The lack of improvement in function among any of the study groups may be due, at least in part, to limitations in our measures. The items were taken solely from the qualitative data and limited to activities that were possible given the environment (a camp for internally displaced persons). This resulted in function scales containing only a few items (9 for girls and 5 for boys) and emphasizing activities and tasks and not capturing other types of interpersonal or social functioning targeted by the IPT-G and CP interventions.
In our prestudy power calculations, we did not take clustering into account, possibly resulting in some underestimation of the required sample size. However, the intraclass correlation coefficient analysis suggests minimal variance due to the clustering of individuals within intervention groups.
To our knowledge, this is the first RCT of psychosocial or mental health interventions among African adolescents affected by war, and one of only a few RCTs of psychological treatments for depression symptoms conducted in a developing country. In addition to our previous trial of IPT-G in southwestern Uganda,8 are RCTs by Patel et al in India,7 Araya et al in Chile,6 and Igreja et al5 in Mozambique; all focusing on adults. Two of these studies used individual-based psychotherapy treatments5,7 and reported no effectiveness, whereas the 2 group-based studies found active treatment superior to controls. The current study also supports the potential of group-based therapies.
Despite the differences between the current study population and that of our previous study8 of IPT-G (different culture, language, and ethnicity; adults vs adolescents; war-affected and displaced vs nondisplaced and at peace) there were similarities in the results. IPT-G proved feasible in both sites in that acceptance was high, as was attendance throughout the intervention period. In both sites there was significant overall improvement in depression symptoms, compared with controls, with females improving substantially more than males. The extent of overall symptom improvement was less in this study than among the adults and function did not significantly improve as it did among the adults. While this may be due to the study limitations as described previously, it may also suggest that IPT-G is more suited for mature participants and more suited to girls across the age groups.
The failure of both IPT-G and CP to significantly assist boys in this study raises the question of whether other interventions may be needed to assist war-affected boys with depression symptoms. Since both group psychotherapy and activity-based interventions were not effective, some form of individual psychotherapy or an entirely different type of intervention may be indicated as the basis for a future trial.
This study suggests that effective psychological interventions can be feasible in poor, rural, and illiterate communities (even those affected by war) as are formal trials of such interventions. Where humanitarian and treatment programs screen on the basis of symptom severity, normal fluctuations in severity over time, and regression to the mean will ensure apparent improvement regardless of true intervention effectiveness. Such programs, therefore, require controlled study designs to accurately determine effectiveness.
Corresponding Author: Paul Bolton, MBBS, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E8646, Baltimore, MD, 21205 (email@example.com).
Author Contributions: Dr Bolton had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Bolton, Betancourt, Bass.
Acquisition of data: Bolton, Bass, Betancourt.
Analysis and interpretation of data: Bolton, Bass, Betancourt, Clougherty, Neugebauer, Murray, Verdeli.
Drafting of the manuscript: Bolton, Bass, Betancourt, Speelman, Onyango, Clougherty, Neugebauer, Murray, Verdeli.
Statistical analysis: Bass, Betancourt, Neugebauer.
Study supervision: Bolton, Betancourt, Speelman, Onyango, Clougherty, Murray, Verdeli.
Financial Disclosures: None reported.
Funding/Support: This project was solely funded by World Vision and War Child Holland. Dr Neugebauer's contributions were funded by the Ruth and David Levine Foundation.
Role of Sponsors: Both organizations also provided material support including local staff time to conduct and supervise the interventions, assist in the logistical aspects of both the study design and interventions, and assisted in supervision of the interviewers. Neither organization was involved in the management or analysis of the data but did offer suggestions as to the interpretation of the results. These staff also reviewed and approved the manuscript.
Additional Contributions: We wish to thank those staff, local leaders, and the communities who welcomed us to work with them. Further, we wish to thank both organizations for their commitment to improving the impact of their humanitarian efforts. Both organizations have already begun to use the results of this study to inform their current programs in northern Uganda. While not funding the study directly, the methodology described in this article was developed with the support of the US Agency for International Development's Torture Victims Fund.
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Cainsville News from The Mirror (Mercer Newspaper) July 23 2008
Deloris Parkhurst has returned from Texas . She spent time in Wichita Falls, TX with her grandson, K.J. Parkhurst and family. Delores attended her granddaughter's, and the daughter of Keith & Cathy Parkhurst, Jamie Leigh Parkhurst, wedding.
(deb's notes: Cathie is the daughter of Richard Frisbie, who is a cousin to my dad. I wish we knew who Jamie married!)

subset: commoncrawl


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A Sandwich A Day: Turkey Panini at Feast
Reviews of Chicago sandwiches.
Feast is one of those restaurants you can usually count on. It may not be in your best bites of the year list, but you'll leave satisfied and definitely full. I went for the turkey panini ($11) recently, straying from my go-to brunch items. It's simplistic, but with quality ingredients, it's well executed.
The Tuscan bread is grilled just enough to give the outside a slight crunch while retaining the soft inside. A slice of melted, mild Swiss cheese lines each side with a thin spread of mayo—just enough to meld everything together. The thinly sliced roasted turkey is topped with three slices of salty, fatty bacon and a large slice of tomato. A generous helping of fresh, bright arugula gives a welcome contrast to all that richness and another welcome texture. If you're wandering around Damen, a meal at Feast is a safe bet.


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Monday, September 28, 2009
Willie Wagtail
It was soon chased off from there and then flew out the back and perched on the roof of my shed. The little Willie Wagtail was just too fast for the Kookaburra which was not even able to keep up with the direction from which the Willie Wagtail would next swoop in. I kept hearing the snap of the Kookaburra's beak as it turned its head and snapped, but by that time Willie Wagtail was usually on the opposite side.
For more bird photos visit the Bird Photography Weekly
18 comments:
Great series of photos Mick.ReplyDelete
- AnonymousSeptember 28, 2009 at 7:58 AM
Great series of photos, Mick. You really captured the interaction.ReplyDelete
Absolutely great action series of photos, Mick!ReplyDelete
Thanks for commenting Neil, Wren, and Nickolay. It was fun watching.ReplyDelete
...ahhh...that brave little bird is so much smaller than the Kookaburra. Great series of the Willie Wagtail in action!ReplyDelete
Thanks Kelly.ReplyDelete
Rare for Willies to give up on a nest. Maybe a (sneak or snake) thief in the night? Perhaps the Kookaburra not so innocent?ReplyDelete
The Kookaburra certainly has a very large beak. A terrific series of action shots Mick.ReplyDelete
Hi Tony, One bird disappeared first then the other gave up on the nest. This afternoon the neighbor over the road told me a local cat - which wanders - had killed a Willie and she hoped it was not one of the nesting pair. I think it must have been.ReplyDelete
Thanks John.
They're feisty birds, those wagtails.ReplyDelete
Had a pair of grey fantails mobbing a spotted catbird here a few days ago. Not sure that they were doing it to protect a nest. I think they had just had enough of the caterwauling, green thugs!
Hi MoickReplyDelete
Sad to hear about the cat and the Willie Wagtail.
So often I hear that "my cat is too well feds to ever kill a bird".
Total misunderstanding of the cat's killer instinct.
Fantastic series of images and commentary, pointing out how fast the Willie was in jumping from side to side.
Classic posting, Mick
Well done.
Hi Snail, interesting re the Grey Fantails mobbing the Cat Birds. Bird interaction is always interesting and especially the little fellas guarding their turf!ReplyDelete
Hi Denis, We upset the environment and make perfect places for what we call pests (mice and rats) - then bring in another pest (the cat) to fix our problem! Cats need to be very carefully controlled.
The kookaburra looks something like our kingfishers in the bill department. I like that you took the time to watch the behavior of the wagtails. I am guessing they wouldn't be considered 'junk' birds. LOL... Thank you for the comment on my wood ducks. I would be interested to see a photo of your ducks... MichelleReplyDelete
Awesome series of photos Mick! Very beautiful birds.ReplyDelete
Hi Rambling Woods and Birding Maine, thanks for visiting and commenting. Kookaburras are very like Kingfishers - just much larger and definitely don't mind eating from other birds' nests!ReplyDelete
This series cracked me up Mick. Seeing the Kookaburra looking back and forth too late to see anything must have been hilarious to watch.ReplyDelete
I hate to hear about cats killing birds, especially during breeding season. The American Bird Conservancy estimates that 150 million free-ranging cats kill 500 million birds a year in the United States. To read the entire article on cats killing birds go to the Audubon Magazine Article.
Nice series of photos Mick. Your Kookaburra reminds me a bit of our Kingfishers. Sorry to hear that the Wagtails did not have a successful nest attempt. Do you think they'll try again yet this season?ReplyDelete
Thanks for commenting Larry and Heather. Don't know if the Wagtail will try nesting again. The one left would have to find another mate and not too sure about that. At present I am only hearing one bird calling.ReplyDelete


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From Columbus
Greetings from the home of Wendy's.
Watching the 11 o'clock local news here, and it's just as dumb as everywhere else. Honestly, it never ceases to amaze me, the absolute dumbing down of local TV news. I just watched a "live" report from a guy in the standard issue local TV news trenchcoat, standing by the side of the road giving "tips" for the local commute tomorrow – all because they're expecting 1-3 inches!!!!!! of snow overnight.
This guy's big tips were – and I wish I were making this up, but I'm not –
– If you have a cell phone, make sure it's charged up, in case you "get into some tough situations on the road tomorrow."
– If you have a garage – and, really I'm not making this up – MAKE SURE YOU PARK THE CAR IN THAT GARAGE!
Hey thanks, Sherlock! OMG, I never would have thought of that. Thanks Local Columbus Action 6 News!!!
Anyway, about the Avalanche:
– T.J. Hensick is going to skate on a line Wednesday night with Marek Svatos and Brad Richardson. As Hensick said, they won't be the biggest line on the ice, but might be the quickest.
– Ian Laperriere has been cleared to play, and I'm sure he will. The Avs have missed his leadership.
– Wyatt Smith has been placed on waivers. Seriously, has there ever been a guy in Avalanche history who made less of an impact in his time here? Woops, I forgot about Jeff Shantz.
– I had dinner tonight with new NHLPA boss Paul Kelly, along with Eric Lindros. They both are going to work hard on upping the NHL's exposure in the U.S. again. Too bad they have to put the burden on their shoulders, not Gary Bettman. One of Kelly's chief goals is to get the league back on ESPN.
I'm not sure the Worldwide Leader is the answer to everything – as ESPN is becoming more and more a leader in unintentional comedy for its overall sports product – has anyone seen the openings to e:60 lately? – and the ratings weren't exactly spectacular all the years the league was on the four-letter – but there is no question that it would probably be better than Versus. The fact is, ESPN is a sports powerhouse, and the NHL needs to find a way to get back in their good graces. And, I think it would help the network, too. Hockey might not have the biggest U.S. fan base right now, but they are passionate and have a better disposable income than those who follow other sports, other than golf. You can look it up.
The NHL's biggest problem in the U.S. remains an absolute lack of coverage from the talking heads on all the shouting columnist shows, and the sportscenter-style highlight shows. Coverage is through the roof still in Canada, and much of Europe, but not here. It will NOT surprise me one bit if, in 20 years or less, the NHL is primarily based in Canada and Europe. Anybody who doesn't believe me should check out the numbers in European arenas for games, especially in the Super League in Russia – which is paying NHL-comparable salaries for most players now.
OK, it's back to the Ch. 6 news here. I don't want to miss anything. Next up: The Ch. 6 news team is reporting that if you're hungry, you should eat food. They have a guy live, standing on the side of the road, demonstrating how to put a Wendy's hamburger in your mouth and chew it.


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A lymphocyte is a type of white blood cell that is produced in the
spleen, tonsils, thymus gland, and the lymph nodes and other lymph tissues.
Lymphocytes identify and help destroy cells that are infected with a virus or
other infectious organism.
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Okay so this is Pokemon number 2 in my collection of Poketuts. Bulbasaur is the grass type starter Pokemon for the 1st Generation games (Red, Green, Blue, LeafGreen, and FireRed).
DragoArt members upload artwork and drawing tutorials! They are also allowed to leave comments on tutorials, profiles, etc. Many more features, as well; it's way better than just being a boring guest! Register Now!


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End of the Affair for Zynga and Facebook?
A new agreement between Facebook and social games maker Zynga could make the erstwhile partners into new rivals. The moves are already playing out in the stocks. George Stahl reports on Markets Hub. Photo: Zynga.
This transcript has been automatically generated and may not be 100% accurate.
... I ... what about Zynga ... Zynga for second Zynga ... Facebook games take on playing FarmVille email and Facebook ... Mrs summon up to the lake for a moment of Facebook ... maybe lot opportunity now George stall talk about this one ... Facebook and Zynga changing the terms of their relationship break the ad which put out ... on Zynga shareholders don't like it right but that's the big takeaway ... as it did the big debate appeal to the single is its connection to Facebook and its hundreds of millions in over a billion from users ... so I I so ... that is what is being ruled that separated the moment when one cannot guess today is that Zynga said we are able to make games for other platforms besides Facebook but also Facebook as a break to mid teens its alrite that without us they literally altered the terms of their arrangement right between Facebook and Zynga to you to do this ... stocks fell on the people didn't like it amusing that you know because it seems to me the real thing is ... the real thing missing is ... Philistines are popular because you just have a little high on the Facebook you're on Facebook already so I'll least eight more minutes or whatever I don't think it's the least a few more minutes in the form dough ... now they're going to be a real gaming company in those games FarmVille CityVille whatever they're gonna have to compete with actual key shrank twelve World of Warcraft you know calling to me all those and ... leave your real game company not to summing up until ... that changes things completely ... dry and and soprano we've seen us Forteo where ... unit ... in the videogame market the only people there consistently there are the true gamers that deadline ... and these games from Zynga as you mentioned ... don't really tap into the trunk enters the more the people who don't normally play these days but are attractive because they are on Facebook to friends Play and whatever the case may day and that's how they can fall but they proved to be they tend to be very short term ... users of these games the playful allow get bored with the launch of the stuff ... and that's why it would seem that with the we do we grow in popularity was able to tap into that demographic of the Wii U game uses that word had the videogame users ... what they've had trouble ... keeping up with that success because that's that's a difficult market keep right now LaRouche upon our present sinking two thousand and eight games of all beyond things right ... addressing that ... and also doesn't mean that Facebook's can go and start making games anytime soon the end of it ... they said the war they have a lot right right and and Facebook wants to be a platform competing in a one day they're not ... necessarily interested at this point seemingly ... to be a content producer comfy or again making company sell ... but at least now the option is there the one you will see they have had some pervert Mitt's Silicom Valley in how earnings in Baghdad it pretty


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San Bernardino Valley Water Conservation District is Focused on Helping Nature Store Our Water
Water Conservation Districts are special. We have a specific and critical role to recharge (conserve) water from our local rain and snowmelt into storage underground. For over 100 years we have been recharging the groundwater to keep water, that would flow to the ocean, here for use in the long hot summers and during droughts. Well operators in the District rely on us to help keep their water supply available for all users. We also manage Lands in the Santa Ana River and Mill Creek washes where we recharge for habitat, and we measure the local groundwater and surface runoff — which supplies essential information to local water managers.
Well over 70% of the water used in the upper-watershed is groundwater and since 1912, the San Bernardino Valley Water Conservation District has conserved over One Million Acre Feet or 326 Billion Gallons of water by diverting the natural flow of the Santa Ana River and Mill Creek into 71 percolation basins that the District owns and operates. These efforts have improved water levels and increased the quality of the water in the region. To do this, the District receives funding from several sources including a small Groundwater Charge paid by all water production facilities (wells) inside the District Boundary. This funding supports the recharge activities we do. The District receives mining royalties, lease revenue, and grants; stakeholders also fund some of our efforts. The District was proud to earn the Certificate of Excellence in District Transparency and the District of Distinction of accountability and governance in June 2014.
But that isn't all we do...
The District also helps to manage the Bunker Hill Groundwater Basin with the Cities, Districts, and Agencies in the upper-watershed, in partnership we bring ample high quality for all uses.
The District plays an essential role for the basin serving as a member of the Big Bear Watermaster. The Watermaster is the impartial mediator and source of information for local water providers as well as legal "accountant" for the waters held and released from the Dam for the benefit of the region.
The District has also recently restarted a key Habitat Conservation Plan for the Upper Santa Ana Wash Area in cooperation with our communities and partners including the resources agencies. Additionally, we have been selected to receive grant funding for Plunge Creek stream restoration to provide both additional habitat and water for the basin.
Check out the Upper Santa Ana Wash Land Management and Habitat Conservation Plan (Wash Plan) for updates on this vital project.
Qualified Water Efficient Landscaper (QWEL) training and list of landscapers by this EPA WaterSense Program. More information is on the QWEL Page.
Its Your Turn, find ways to save water review the Groundwater Use Efficiency Guide
The State Water Board had approved State Drought Emergency Regulations available here to prohibit certain water wasting activities. SBVWCD is not a local water agency but works with and supports local water agencies in this critical time.


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"Killer Elite" Trailer
Jason Statham tries to rescue his mentor, Robert De Niro, from the clutches of the evil Clive Own in this battle of black-ops assassins. Opens Sept. 23.
We don't waste our time on anything not worth your time. We celebrate the best of what's coming on film and TV. We cheer when our expectations are met and criticize when we're let down.


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Game #136: M's at Jays pregame
Seattle (73-61) at Toronto (69-66)
at 1:07 p.m. ET at the Rogers Centre
Today's lineups:
Ichiro Suzuki, CF
Jose Vidro, DH
Jose Guillen, RF
Raul Ibanez, LF
Adrian Beltre, 3B
Ben Broussard, 1B
Kenji Johjima, C
Jose Lopez, 2B
Yuniesky Betancourt, SS
PITCHING: RHP Jeff Weaver (6-10, 5.62 ERA)
Vernon Wells, CF
Russ Adams, 3B
Alex Rios, RF
Frank Thomas, DH
Matt Stairs, LF
Lyle Overbay, 1B
Aaron Hill, 2B
Gregg Zaun, C
John McDonald, SS
PITCHING: RHP A.J. Burnett (7-7, 3.70 ERA)
NOTES: The move came a bit earlier than expected, by LHP Joe Kennedy was at the Rogers Centre on Sunday. The Blue Jays purchased his contract from Triple-A Syracuse and added him to their bullpen. … the Toronto chapter of the BBWAA announced on Saturday that Frank Thomas and Roy Halladay were voted the Player and Pitcher of the Month, respectively, for August. … RHP Jeremy Accardo has struggled lately with throwing his split-finger fastball — a reason his last few saves have been a little rough around the edges. … STAT OF THE DAY: The Mariners, who have lost eight in a row heading into today's game, have had four losing streaks of six games or more this season — the most in the Majors. And they're still two games out of the Wild Card. Talk about hot and cold spells.
entering Saturday
1. New York 76-60 (–)
2. Seattle 73-61 (2)
3. Detroit 73-63 (3)
4. Toronto 69-66 (6.5)
REALITY CHECK…Since 1995, the runner-up in the AL Wild Card race has finished with an average of 89 victories. The Blue Jays would need to go 21-6 over their final 27 games to reach 90 wins.
45 Comments
Well, let's hope we sweep them today and get them so motivated they go into New York and sweep the Yanks.
Now that would make things interesting.
I know a bunch are going to disagree with me, but I'd have had Rios bunting to move Wells and Adams to 2nd and 3rd with 1 out. With Rio's speed, you never know, he might have beaten it out.
Coming up were Thomas and Stairs and in retrospect Thomas's fly ball would have driven in a run, and left another in scoring position for Stairs.
We have to play more agressively, we can't just sit back and hope for the big inning.
The way AJ is bringing it, 1 or 2 runs could win.
Oh, maybe Abner is still snoozing-thank full he got the lineup right.
I'd hate to bat against Burnett today. Brossard got two 98 mph fastballs than broke 4-5 inches, then an 84 mph curve that moved 12″.
Burnett must have felt a twinge in his arm in the 4th lol
gsumner Burnett is dealing today but if this team keeps leaving men on base like they have they are going to get in trouble.
Well, we ducked a bullet in the 7th. Everyone in the stadium could tell AJ was done when he threw the 3rd ball to Beltre, and walked him and cost a run.
He should never have been out there for the 7th-he's just coming back from an injury and Abner,back to his old habits, leaves him out there for 115 pitches.
When you have a team down like this and a bullpen like we have-WHY take the chance?
Of course, it's likely Abner missed the first 7 innings cause he's still snoozing.
Thomas has driven in 58 runs since the all star break where was he in the first half and where would we have been.
gsumner thats why you don't bunt with power up to bat a passed ball did the same job now the bases are full I bet they score.
Zaun goes 3 for3 then kills a chance for a big inning itchy and downs good matchup downs wins.
Ya, Thomas has been good since June.
Well, if Rios had bunted in the first inning and everything else unfolded as it did, we'd been up 4-0.
I agree if the batter is Thomas or Glaus, but Rios is a 5 tool player with lots of speed, and I always think you try to score in the first inning. A successful bunt would have almost guaranteed that.
Downs got the lefty out now take him out Abner you idiot no Daisy May for you tonight.
Yes, we've done a great job on Ichiro today. A couple of times AJ made him look foolish.
I don't think he goes 0 for 4 too often.
Another great move by Abner. Downs did his job, but he leaves him in and Vidro-a right hander doubles.
THEN he brings in Wolfe. Thats the problem with Abner-he's always one move late.
I don't know abuot you, but I think either Stairs or Lind should start in LF when a right hander is pitching. Johnson is now batting an anemic .209 against right handers.
I think he's still struggling from his injury.
gsumner: Vidro is a switch hitter, and lefties are pretty much the only ones who can touch Wolfe. Damned if you do, damned if you don't. Agree on Stairs starting more. Apparently he's 1 for 10 against Batista, which explains him not starting yesterday, but the Jays are 10 games over .500 (38-28) when he's in the starting lineup now.
That's what I love about his blog, redsox nation wantabees, at least they are happy when their team wins. We all have our pet peeves, but get real, can't blame a win on the manager. So nit pick any real or imagined mistake. Somebody needs to get a life!
Now let's see who answers me back, they are the ones who need to take a long step back.
Good game today. Matt Stairs GO FREDERICTON
If you don't mind I'm going to take a step ahead.
Welcome to Jordans blog,
You must be a blue jay wantabee,could you please refrain from useing big words it's hard on the eyes thank you.
Some of us don't like our manager so if you don't mind we will slam him every chance we get okay with you.
the s-u-x will not be in the playoffs this year so long francona you gum chewing pig at least thats what he looks like when he chews.
ALSO if we have an opinion we will speak out no matter what it is as is our right.
And the only mistake made was by your mother and father when they cheaped out on those ACME rubbers they bought about 9 months before you were born.
You can answer me if you want but I wont reply and please don't use big words I don't have my glasses on.
So you're defending Abner-who are Pappy Yokum?
When we come in and sweep your high priced underperfoming ******* y lineup next week will you go back to dog patch and cry?
Garry, they don't have Acme in the hills, they use home made versions from used shopping bags-so kids come out a bit warped as you can imagine-just like webmaster
Been a Jays fan since there was a Jays.
Didn't know that everyday words, were too big, for anyone, I do apologize.
ALSO if we have an opinion we will speak out no matter what it is as is our right.
Your words I think.
At least I had the class not to take the conversation down into the gutter, like you. Strange isn't it, don't understand normal words, has to resort to garbage tactics, must be a BOSOX fan. Sounds like it to me, or a wanabee.
No not defending him, just wanted to enjoy the sweep. Lots of ops to complain about him, no need to make any up.
You guys need to take a deep breath. I am a Jays fan, from Fredericton, I was cheering our home-town boy, and giving anyone who can't enjoy a few wins in a row some good natured jabs.
Enjoy the game too, take your digs at whoever you want. Even me if that turns your crank.
Did I say CRANK?
Expressing your opinion is one thing, attacking other posters or calling our posters redsox nation wantabees is quite another.
Everyone here expresses their own opinion, but on occasion we do get jerks like you.
Too bad really, that you resort to insults to express your opinion, I guess it shows your low intelligence level.
True Abner did fill out the lineup correctly today. He now has a dubious distinction of being the only manager in recent baseball history to make that mistake twice in the same year.
The guys a mental midget-what do you want to do give him a gold star?
By the way, that's probably the funniest post, Ive ever see you make. lol
The results were good today but the offence is still having problems.
STAIRS IS NUMBER ONE in my books,His price is going to be high next year but JP will pay he likes to pay.
You need not try to convince anyone here about Matt Stairs, I think everyone here feels he's the MVP of this team.
I hope Abner is bright enough to play him in LF in both Boston and NY. With the short RF fences in those parks, they might become Matt Stairs homerdomes.
No, I would like another manager too, but I just won't give him a hard time when He hasn't done anything. Like I said before, there have been and will be plenty of times when he does screw up.
You are welcome to say whatever you want. I just like to answer some times.
I do have to admit that I don't want this blog to be like the RS or NY where they get on guys for one real or imagined mistake. We don't have a good manager, that, like all things will change. Normally I don't say anything, but I think I was happy about the game and bored on a Sunday afternoon in Fredericton, which is usually not the most exciting place to be on a Sunday. But can't apologize for speaking my thoughts.
Glad to contribute once in a while.
Ahh insults, you mean the garryguy talking about my parents etc is all right but calling someone a sox wannabee is a mortal sin.
I understand now. Glad you straightened me out.
I hope they keep Matt too. He wants to play for the Jays, maybe that will help. Should give him a bonus for this year too.
Hey! I did good, boring afternoon, now I have had some great interaction. Thanks guys!
Hey we're glad to have you here. The comment you made that was out of line was the redsox nation wantabees-that was uncalled for.
In my opinion Abner's mistakes over the year have likely cost us 5-10 wins. He gets no slack from me-I want him outta here.
You might disagree with me on the Abner issue and that's fine-that's your opinion.
Hey, I think we're all excited about this sweep, it means we're only 5.5 back in the wild card.
And one never knows, if we sweep Boston and Seattle sweep NY, we will be 3 back and truly in the race.
Stranger things have happened.
This team is starting to show their capabilities-going 5 of the last 6.
I'd be surprised if they signed Stairs for less than 2.5 mill and maybe up to 3.5.
Hey, you had coming what you got from Garry.
A truce is in order so be it.
Welcome to the blog.
What is your opinion of JP.
gsumner and myself are estatic about the way the team is playing but remember we just played a team that is free falling we wont be abel to tell if this team is turning around until we play boston and new york,
If we play well against them we may still have a slim chance.
Well, about JP…I think we have a lot of good arms in the minors, and some good position players, we have great pitching up in the bigs, and when hitting, the fielders are among the best in baseball, so…JP has done a reasonable job. Along with scouts etc.
Like you I am not happy with our manager. Some of the coaches are doing a fairly good job, but the manager runs the show, which puts us on a down slide some.
You are right about the Mariners, lets see what happens in Boston. and past that.
Best look, sweep Boston and Mariners sweep Yankees. Hope? Not a big one, but anything can happen, that's what makes BB the game it is.
I'd also be really surprised if we sweep Boston; BUT at the moment Manny is out and he is the single driving force behind their offence. They are no where near the offensive threat with him out of the lineup. To me, the loss of Manny is like 1-2 runs per game.
Dice-K is looking like he's a bit tired in the last 3 games he gave up 13 runs. Boston have never seen Jessie. Jump on Dice-K fast and furious and he panics and implodes-Stairs could be a big contributor to that so bat him early and often. So I'd say it's 50-50.
Beckett hasn't been as effective either the last two to three games. Halliday got batted around last time out in Boston, but his main nemphisis Manny is out of the lineup. Righties hit Becket better than lefties. I'd bet Halliday wants to prove a point and therefore I like our chances.
Shilling versus Marcum. Shilling is rather ordinary now, his age is showing-and lefties hurt him. Marcum on the other hand is a hard nosed road warrier. Last time out in Boston-he gave up 3 runs over 6 innings and won. We haven't faced Shilling this year, but we have had good success against him in previous years. Stack the lineups with lefties and wack him. Maybe bat Overbea 2nd and Stairs 3rd. Advantage Toronto.
The Boston pitcher we have nightmares with is Tim Wakefield and he's injured at the moment.
Matt Stairs should start all 3 games in Boston, and bat 2nd or 3rd, except against Beckett. His OBP of .375 is second to Thomas and that short fence in RF is made for him.
gsumner and yourself are saying the same thing and thats what I would like to see.
As for Seattle when they lost their manager it took a while but they lost their backbone so I think the Yanks will crush them to bad for us but on the other hand we should pass them and Boston is sliding fast.
If we keep playing the way we are you never know.
gsumner I'm sorry for anything I said about Burnett you were right to stick by him,also I think he is finaly ok no more DL.
You're right about our pitching. Not including today's game we now carry a year to date team era of 3.92 third in baseball to Boston's 3.74 and San Diego's 3.56.
Post all-star, though, the team era is the best in baseball at a sparkling 3.15.
Garry-providing Abner doesn't over use him.
If Burnett ever get's confidence in his changeup to give him one more look, he will be unhittable. I noticed today, he's finally starting to change speeds to keep the hitters off guard. Some heaters came in at 98 and others as low as 92-all with good movement.
I think Burnett is becoming a pitcher instead of a thrower and good for us.
You can thank Halliday for that.
7-3 in the last 10 games not bad at all. There is still life left in the Jays. This road trips should say alot about what happens over the next 26 games. Still a long shot but who knows!
Guess who will be playing LF for Boston this week if Manny can't go. Thats right fans. Our old friend Eric Hinske! I think every pitcher in our organization should have an hour sit-down with Doc as it appears he has a vast amount of knowledge to give. (We can even pay Doc a little extra since he is now underpaid it appears (or at least everyone else is overpaid)). Also, if both us and Sea sweep we would be 3.5 games back since Sea would be in the WC lead. (But who honestly thinks they will win with John McLaren, Bill Bavasi, and that starting rotation.)
Well, for sure Manny isn't playing in this series-it'll likely take three to four more days to get his MRI results back.
Seattle have been streaky all year-they're way overdue to win-hopefully they do it 3 times in NY.
Boston has seen Jesse. He outdueled Beckett a while back. I'd be surprised if it was possible for Matsuzaka to get a tired arm, considering that marathon in the Japanese high school tournament in 1998 didn't turn him into Kerry Wood, but the Japanese season is a little shorter than the American one.
You're right, I missed Jessie's start. He went 6.2 innngs and gave up 1 earned run.
Thanks for catching it. I picked up the Dice-K comment from one of Boston's releases. He's already gone 176 innings which is more than what he did in Japan. They stated this as a reason for his giving up 13 runs in his last 3 starts
But he's going tonight on 5 days rest as is Litsch, so we shall see.
Cross your fingers.
I wonder if we'll see Royce Clayton tonight?
Every time we play a team and run up against players we let go or traded they turn into super stars but only against us?????.[hinski] [clayton].
The jays will have more money to spend next year because we wont be paying anyone to play against us thank god.
Were going to play well against Boston our pitchers match up very well against their pitchers.
We have
I'd feel better if Ace was in the mix,Boston have yet to face our best starters 1,2,3. But I like out chances.
With Seattle's win over the Yanks today, we are now 5 games back.
Go Blue Jays.
Wow, i've been saying that the jays are done for a long time, but if they can win tonight I might just get my hopes up again. 4.5 games back if they win with 7 left against the yankees. If anything it'll stretch my interest in them a little longer.
We hear people say over and over thats why they play 9 innings you never know what will happen,We go 3 and o against a good team and the same team beats the yanks????.
If Toronto wants the post season they have to make up their mind now,It's out there they just have to go out and get it tonight will tell the story.


text:
Q. Which organisations are involved in the 'Team Badger and why did you decide to form?
A. Team Badger is a coalition of organisations who have teamed up to fight the planned cull of badgers. The coalition consists of the RSPCA, Save Me Trust,
A. Team Badger is a coalition of organisations who have teamed up to fight the planned cull of badgers. The coalition consists of the RSPCA, Save Me Trust,
A. A scientifically robust trial of badger culling was undertaken which took nearly a decade, cost approx £50 million and the lives of 11,000 badgers.
A. This cull will contribute little or nothing to the long-term goal of eradicating TB nationally. We believe that vaccination of cattle and/or badgers, increased levels of testing,
A. There will initially be pilot culls in two areas of England in West Somerset and West Gloucestershire though the exact parameters of the culls will not be made public.
A. The humaneness of using the free shooting method is of grave concern to the group. If a cull is to be carried out, we believe it should be done in the most
A. We believe that the public have been falsely presented with the choice between killing badgers and cows suffering. Killing badgers will not solve the problem of TB in cattle.
A. An injectable Badger BCG vaccine was licensed by the Veterinary Medicines Directorate in March 2010, research is continuing regarding a possible oral vaccine.
A. The Welsh government, using the same scientific evidence as Defra, has begun a five year vaccination programme of badgers in Wales with a scheme currently
We are opposed to the gassing of badgers for any reason due to the unnecessary suffering caused. Gassing badger setts with hydrogen cyanide was stopped in 1982
A. Team Badger only uses peaceful and lawful tactics to further its objectives to stop the planned badger cull from going ahead. The campaign does not endorse,
A. The charities and organisations involved with this campaign work with politicians from all legal political parties, conventions and organisations to develop and improve