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Ciechanowski P, Wagner E, Schmaling K, et al. Community-Integrated Home-Based Depression Treatment in Older Adults: A Randomized Controlled Trial. JAMA. 2004;291(13):1569–1577. doi:https://doi.org/10.1001/jama.291.13.1569
© 2019
Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Dr Ciechanowski), Health Services (Drs Ciechanowski, Williams, and LoGerfo and Mss Schwartz and Kulzer), Biostatistics (Dr Diehr), and Medicine (Dr LoGerfo), Health Promotion Research Center (Drs Williams and LoGerfo and Mss Schwartz and Kulzer), and School of Pharmacy (Dr Gray), University of Washington, Seattle; W. A. MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative, Seattle (Dr Wagner); University of Texas at El Paso (Dr Schmaling); and Chronic Disease Prevention and Healthy Aging, Prevention Division—Public Health, Seattle and King County (Dr Collier).
Context Older adults with social isolation, medical comorbidity, and physical
impairment are more likely to be depressed but may be less able to seek appropriate
care for depression compared with older adults without these characteristics.
Objective To determine the effectiveness of a home-based program of detecting
and managing minor depression or dysthymia among older aldults.
Design and Setting Randomized controlled trial with recruitment through community senior
service agencies in metropolitan Seattle, Wash, from January 2000 to May 2003.
Patients One hundred thirty-eight patients aged 60 years or older with minor
depression (51.4%) or dysthymia (48.6%). Patients had a mean of 4.6 (SD, 2.1)
chronic medical conditions; 42% of the sample belonged to a racial/ethnic
minority, 72% lived alone, 58% had an annual income of less than $10 000,
and 69% received a form of home assistance.
Interventions Patients were randomly assigned to the Program to Encourage Active,
Rewarding Lives for Seniors (PEARLS) intervention (n = 72) or usual care (n
= 66). The PEARLS intervention consisted of problem-solving treatment, social
and physical activation, and potential recommendations to patients' physicians
regarding antidepressant medications.
Main Outcome Measures Assessments of depression and quality of life at 12 months compared
with baseline.
Results At 12 months, compared with the usual care group, patients receiving
the PEARLS intervention were more likely to have at least a 50% reduction
in depressive symptoms (43% vs 15%; odds ratio [OR], 5.21; 95% confidence
interval [CI], 2.01-13.49), to achieve complete remission from depression
(36% vs 12%; OR, 4.96; 95% CI, 1.79-13.72), and to have greater health-related
quality-of-life improvements in functional well-being (P = .001) and emotional well-being (P = .048).
Conclusions The PEARLS program, a community-integrated, home-based treatment for
depression, significantly reduced depressive symptoms and improved health
status in chronically medically ill older adults with minor depression and
Clinically significant depression affects 15% to 20% of elderly individuals
in the United States.1,2 Older
individuals are less likely than younger adults to have major depression3 but have comparable or higher rates of less severe
depressive disorders such as dysthymia and minor depression. Dysthymia is
a chronic depressive syndrome persisting for at least 2 years.4 According
to the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) Appendix of Criteria
Sets and Axes Provided for Further Study, minor depression is depressed mood
and/or significant loss of interest, plus 1 to 3 other depressive symptoms
present nearly every day for at least 2 weeks, occurring in the absence of
dysthymia.4(pp719-721) Minor depression
and dysthymia both lead to significant disability.5,6 Accumulating
evidence from primary care settings suggests that both syndromes may respond
to medications and nonpharmacological therapies,7,8 though
less is known about treatment of these disorders, particularly minor depression,
in community settings.
Although higher rates of depression exist among medically ill,9-12 socially
isolated,11,13 homebound,14-16 or functionally impaired12,17 older adults, such characteristics
may also lead to inadequate recognition and treatment of depression. Even
among less functionally impaired older adults attending primary care, few
depressed patients receive guideline-level depression treatment18,19 such
as medications or psychotherapy.20 Untreated
depression in elderly persons negatively influences physical functioning,21 adaptation to medical illness,22 and
quality of life23 and can be associated with
increased morbidity and mortality,24,25 treatment
nonadherence,26 increased health care costs,18,26 and lower satisfaction with care.23,27
Because of the relatively high prevalence of less severe forms of depression
among elderly persons, we set out to add to the evidence base on treating
these disorders in community settings by conducting a randomized controlled
trial comparing a program for treating minor depression and dysthymia, the
Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), with usual
care in medically ill, low-income, mostly homebound older adults. Since home-based
treatment can reduce depression among socially isolated, chronically ill seniors,16 we created a home-based intervention focusing on
problem-solving treatment (PST). We hypothesized that patients receiving the
PEARLS intervention would show greater improvements in depression and higher
quality of life compared with patients receiving usual care. We also examined
the effects of the intervention on changes in health care utilization.
This study was conducted in metropolitan Seattle, Wash, and approved
by the University of Washington review committee on human subjects. Between
January 2000 and May 2003, we sought to enroll adults aged 60 years or older
receiving services from senior service agencies or living in senior public
housing with DSM-IV minor depression or dysthymia
diagnostic criteria. Social workers at Aging and Disability Services and Senior
Services of Seattle/King County administered the 2-item Primary Care Evaluation
of Mental Disorders (PRIME-MD) depression screening tool28 during
routinely scheduled visits or telephone calls. We also recruited self-referred
individuals through letters mailed by collaborating agencies to their clients
or residents in affiliated public housing. All potential self-referred or
screen-positive participants were interviewed by trained research associates
using the Structured Clinical Interview for DSM-IV (SCID)29 as a second-level screen. Participants who were eligible
and provided written informed consent completed a baseline interview.
We estimated that the intervention and usual care groups would each
require 64 patients to have a 95% chance of detecting as significant (at a
2-sided, .05 α level) a mean difference of 0.30 in the depression outcome
measure, the Hopkins Symptom Checklist (HSCL) 20, derived from the revised
HSCL-90.30 We planned to enroll 71 patients
in each group, anticipating 10% participant attrition.
Agency social workers identified 1238 potential participants, 20% of
whom completed the SCID, and the majority of the 181 self-referred potential
participants (72%) also completed the SCID (Figure 1). Of 374 potential participants evaluated with the SCID,
224 (60%) had the following exclusion criteria: no depression, 29%; major
depression, 21%; bipolar disorder, 4%; psychosis, 2%; and substance abuse,
0.3%. We used 5-minute recall of 3 items and orientation to year, month, and
date from the Mini-Mental State Examination31 to
screen for cognitive impairment; patients scoring less than 3 of 6 points
(3% of potential participants) were ineligible to participate. Of 150 remaining
potential participants (40%), 12 refused participation and 138 consented to
participate and were enrolled in the study. For all participants who were
excluded because of a diagnosis of major depression, a letter from the study
psychiatrist (P.C.) was sent to the partipant's primary care physician indicating
the diagnosis and suggesting that he/she consider this probable diagnosis
in treatment of the patient.
Using a 50:50 randomization allocation ratio, investigators created
envelopes containing concealed assignment codes assigned sequentially to eligible
patients in blocks of 10 by a research associate. Investigators changed the
allocation ratio to 60:40 after 11 blocks to ensure that the desired sample
of intervention participants was recruited (≥71 participants). To account
for the possibility that clinical severity of recruited participants may have
increased over time, which would lead to greater severity in the treatment
group, we included a dummy variable in all analyses denoting whether patients
were randomized using the 50:50 or 60:40 allocation scheme.
Usual care participants received no additional services, but letters
sent to their regular physicians and social workers reported their depression
diagnosis with recommendations to continue usual care. All participants could
seek additional primary or specialty mental health care. Intervention participants
were scheduled to receive PST by PEARLS therapists (2 male and 1 female master's-level
social workers employed by community agency collaborators). Near the end of
recruitment, a female registered nurse trained in PST replaced 1 of the social
workers for 1 of 72 intervention participants. Therapists thoroughly reviewed
a PST treatment manual,32 completed 8 hours
of lectures, viewed videotapes, and participated in extensive role-playing.
Problem-solving treatment is a skills-enhancing behavioral depression treatment
based on the assumption that problems of daily life cause and maintain depressive
symptoms, and through systematically identifying and addressing these problems,
patients can achieve decreased depressive symptoms. Recent research has shown
it is not necessary for a patient's perception of problem severity to improve
for PST to work.33
Each PEARLS session included selecting from a list of 250 pleasant activities34 to engage in before the next session. The inverse
relationship between pleasant events and depression is an important aspect
of behavioral theories of depression.35
We modified PST sessions to provide greater emphasis on social and physical
activation (S.S. and J.K., PEARLS Research Team, unpublished data, January
2000). The goal of physical activation was to assist patients in developing
a regular physical activity program consistent with national recommendations36 for moderate activity of at least 30 minutes' duration
at least 5 d/wk. Therapists received information on baseline physical, social,
and recreational activities derived from the Community Healthy Activities
Model Program for Seniors (CHAMPS) instrument.37 Physical
activation began during the third or fourth PST session, allowing patients
to develop familiarity with problem-solving skills. The goal of social activation
was to increase patients' interactions outside the home by using a resource
list under the guidance of the therapist. Group activities encouraging peer
support were given highest priority.
Starting in September 1999, each therapist saw 3 to 6 training cases,
and, as with all participants, these participants gave permission for audiotaping
sessions. The PST trainer (K.S.) scored every training audiotape on 9 specific
and 1 global item from 0 (very poor) to 5 (very good). Feedback for improving
adherence to the PST method was provided. Therapists achieving global ratings
of at least 3 (satisfactory) on the majority of sessions with 3 training cases
were certified as PST proficient and permitted to see full study participants.38 A research coordinator sent the PST trainer every
fifth full study tape for adherence coding and feedback. The mean global rating
for 109 sessions was 3.15.
Patients were scheduled for eight 50-minute in-home sessions over 19
weeks, in weeks 1, 2, 3, 5, 7, 11, 15, and 19. Increasing time between later
sessions gave patients more opportunities to practice PST skills. The Patient
Health Questionnaire 9 (PHQ-9)28 was administered
at the beginning of sessions to track depression change. After 19 weeks, therapists
maintained monthly brief telephone contact with patients, during which they
would administer the PHQ-9 and assess patients' use of PST.
All intervention cases were reviewed weekly or biweekly by the study
psychiatrist (P.C.) during depression management team sessions, which all
therapists attended. Therapists carried 3 to 8 active cases and each case
required 5 to 10 minutes of discussion and supervision. For cases lacking
continued improvement after 4 to 5 weeks (most recent PHQ-9 scores >50% of
baseline and continuing or recurring dysphoria or anhedonia), the psychiatrist
contacted patients' primary care physicians to recommend initiating or adjusting
antidepressants and to assess potential medical and substance abuse etiologies
for depression. This is consistent with evidence-based chronic care models
using stepped-care targeted communication between specialists and primary
care physicians or specialists and patients for cases with unremitting symptoms.23,39
The psychiatrist also reviewed medical problems and medications for
all patients, occasionally clarifying details by contacting primary care physicians.
The psychiatrist infrequently called patients, after discussion at team sessions,
to clarify clinical issues (eg, suicidal ideation, diagnostic uncertainty).
The availability of such telephone contacts with physicians or patients optimized
patient safety and increased the comprehensiveness of the intervention.
Outcome assessments were conducted in person at baseline and at 6 and
12 months by trained interviewers not involved in the intervention and included
sociodemographic characteristics and a count of medical conditions. Depression
was assessed using the HSCL-20,25 which is
validated in medical patients and found to be highly reliable.40,41 With
a 0-to-4 severity range, an HSCL-20 cutoff score of 1.72 has previously been
associated with the highest positive predictive value for diagnosis of major
depression in adult primary care patients.42 Since
neuroticism predicts persistence of depression in primary care43 and
an increased risk for late-life depression associated with disability,44 7 NEO neuroticism scale45 items
were administered at baseline.
Health-related quality of life in functional, physical, social, and
emotional well-being domains was assessed at baseline and 12 months using
the Functional Assessment of Cancer Therapy Scale–General (FACT-G).46 The FACT-G is a generic core questionnaire of 27
items for health-related quality-of-life questionnaires targeted to management
of chronic illness and used and validated in cancer, other chronic conditions,
and the general population.47
Health care utilization was assessed in three 6-month periods from 6
months before to 12 months after baseline using the Cornell Services Index48 and was dichotomized by creating indicator-dependent
variables for each period based on having any emergency department visits,
any medical hospitalizations, or at least 5 outpatient visits (median number
of baseline outpatient visits). The proportion of patients with any form of
home assistance (eg, home aid, nursing, or meal delivery) was determined at
Patients were asked whether they used antidepressants during all 3 assessments.
Six- and 12-month depression outcomes included mean HSCL-20 depression scores;
treatment response, defined as at least a 50% decrease in HSCL-20 score from
baseline; and complete depression remission, defined as HSCL-20 score less
than 0.5.49 Costs of providing PEARLS were
based on direct personnel salaries and included the costs of time to conduct
in-person contacts and associated travel time, all therapist and psychiatric
telephone contacts, depression management team sessions, and maintenance of
PST quality by the PST trainer.
Two-tailed t tests and χ2 tests
were used to compare the intervention and usual care groups at baseline. To
evaluate group differences of HSCL-20 and FACT-G domain scores at assessment
points, we used mixed-effects regression analyses.50,51 To
evaluate treatment group differences in depression treatment response, depression
remission, or health care utilization at all assessment points, we used mixed-effects
ordinal regression analyses.52 These procedures
permit inclusion of patients with missing data, ensuring an intention-to-treat
analysis as randomized. Age, sex, NEO neuroticism scale score, dysthymia,
and randomization allocation scheme were fixed covariates for each analysis.
In all models, the intercept was always assumed to be random, and the time
effect (baseline, 6 months, and 12 months or baseline and 12 months) was fixed.
Marginal maximum likelihood methods generated maximum likelihood estimates
for group, time, and group × time interaction effects. Models were evaluated
using a z statistic (maximum likelihood estimate
divided by standard error). In the case of a nonsignificant group ×
time interaction, the models were refit without an interaction.
For regression analyses evaluating depression treatment response and
depression remission, 6 cases were missing outcome data at both 6 and 12 months,
so the method of last observation carried forward was first used,53 ensuring an intention-to-treat analysis. As a sensitivity
analysis, the mixed-effects ordinal regression analysis was run without the
6 cases as a completer analysis, and results were identical.
When significant interaction or group effects were detected in various
models, the following were calculated for each follow-up assessment point:
for HSCL-20 score differences, multiple regression analyses were used to estimate
the adjusted group mean change; and for depression treatment response, depression
remission, or health care utilization, logistic regression was used to obtain
adjusted odds ratios. For the FACT-G subscales, adjusted mean change scores
over the year were computed for each treatment group.
MIXOR, version 2.0, and MIXREG, version 1.2 (Don Hedeker and Robert
D. Gibbons, University of Illinois at Chicago) as well as SPSS, version 11.0
(SPSS Inc, Chicago, Ill) were used for analyses. P<.05
was considered statistically significant.
The sample (Table 1) consisted
mostly of women (79%), and had a mean age of 73 years (SD, 8.5 years). Few
patients (11%) were married or living with a partner, and 72% lived alone.
Forty-two percent belonged to a racial/ethnic minority (African American,
36%; Asian American, 4%; Hispanic, 1%; and American Indian, 1%), 58% had an
annual income of less than $10 000, 42% had an education level below
or equivalent to high school, and 69% received home assistance.
About half of patients (48.6%) had dysthymia and half (51.4%) had minor
depression, with a sample mean HSCL-20 score of 1.3 (SD, 0.5), which is consistent
with subthreshold depression and lower than the score (1.72) previously associated
with major depression in primary care.42 Patients
reported having a mean of 4.6 (SD, 2.1) of 10 chronic medical conditions (median,
5.0; range, 0-10; 4 had no chronic medical conditions). Since the intervention
group had significantly more dysthymia than the usual care group (61% vs 35%; χ21= 9.5; P = .002) and
less neuroticism (NEO neuroticism scale range, 1-5; mean scores, 2.9 [SD,
0.7] vs 3.1 [SD, 0.7]; t136 = 2.1; P = .04), we controlled for these differences in subsequent
analyses. There were no significant baseline differences in cognitive screening
or in health care utilization in the prior 6 months in the domains of mental
health, medical outpatient and emergency department use, medical hospitalizations,
or use of home assistance.
Intervention patients received, during the 19-week active phase, a mean
of 6.6 visits (SD, 2.5; median, 8.0; range, 0-8; 3 had no visits) and, during
the 33-week follow-up phase, a mean of 3.5 telephone contacts (SD, 2.7; median,
5.0 contacts; range, 0-7; 23 patients could not be or asked not to be contacted).
No patients were seen in person by the psychiatrist. However, the psychiatrist
made 52 telephone contacts during the intervention, 37 with patients' physicians
to discuss the following: antidepressant recommendations (19), laboratory
tests (10), cognition (7), other medications (4), alcohol abuse rehabilitation
(2), sleep apnea (1), falls (1), and pain complaints (1). Fifteen antidepressant-related
calls occurred during the active phase and 4 during the follow-up phase and
involved care of 14 patients. Eleven calls (8 in the active and 3 in the follow-up
phases) were recommendations to start an antidepressant, and 8 (7 in the active
and 1 in the follow-up phases) were recommendations to adjust medications.
Nine psychiatrist calls were made to patients to assess study participation
(7), suicidal thoughts (1), and confusion (1). One call to a patient's case
manager addressed the patient's living situation, and 1 call to Adult Protective
Services initiated an assessment of suspected elder abuse.
At baseline, 36% of patients were taking antidepressants with no significant
group differences at baseline and at 6 and 12 months. Seven patients (9.7%)
in the intervention group compared with 4 (6.1%) in the usual care group started
an antidepressant, while 5 (6.7%) in each group stopped an antidepressant
during the study. With a definition of psychosocial interventions as "visits
with a counselor, therapist, psychotherapist, or mental health provider,"
4 usual care patients reported visits during the first 6 months, 3 reported
such visits in both 6-month periods, and 3 reported visits in the last 6-month
For HSCL-20 depression score, there was a significant group ×
time interaction (z = −2.40; P = .02) due to significant group differences in HSCL-20 at 6 months
(t = −4.85; P<.001)
and 12 months (t = −2.20; P = .03) (Table 2). For
depression treatment response and depression remission, there were no significant
group × time interactions (z = −1.91; P = .06 and z = −0.90; P = .37, respectively), so the models were refit, resulting
in significant group effects (z = 4.19; P<.001 and z = 3.00; P = .003, respectively) and nonsignificant time effects (z = −0.45; P = .65 and z = −0.82; P = .41, respectively). Table 2 shows that these significant group
effects are due to the odds of a 50% depression treatment response or of complete
remission being significantly higher for the intervention group at 6 and 12
There were significant group × time interactions for the FACT-G
functional well-being (z = 3.22; P = .001) and emotional well-being (z = 1.97; P = .048) domains at 12 months. For functional well-being,
these results were due to a significant mean change in the intervention group's
scores (0.52; 95% confidence interval [CI], 0.29-0.74) but not in that of
the usual care group (0.09; 95% CI, −0.14 to 0.33) over 12 months. For
emotional well-being, these results were due to a significant mean change
in the intervention group's scores (0.33; 95% CI, 0.14-0.52) but not in that
of usual care group (0.11; 95% CI, −0.09 to 0.31) over 12 months. For
FACT-G social and physical well-being, there were no significant group ×
time interactions or time or group effects.
For emergency department visits and medical outpatient visits there
were no significant group × time interactions (z =
−0.25; P = .80 and z =
−1.29; P = .20, respectively), so models were
refit for main effects; there were still no group effects (z = −1.09; P = .28 and z = −0.18; P = .86, respectively) or
time effects (z = −1.32; P = .19 and z = −1.19; P = .23, respectively). For hospitalizations, there was no group ×
time interaction (z = −0.70; P = .48); with refit models there was no time effect (z = 0.57; P = .57), but there was a trend-level
group effect (z = −1.82; P = .07) (Table 3).
Mean costs per patient of providing the PEARLS intervention were $422
for PST sessions, $28 for follow-up telephone calls, $12 for psychiatric telephone
calls, $87 for psychotherapy quality assurance, and $81 for depression management
team sessions. Total mean cost per patient was $630.
The PEARLS intervention resulted in significantly lower severity and
greater remission of depression compared with usual care at 6 and 12 months.
Six-month outcomes are comparable with those of a multisite trial of elderly
primary care patients with major depression or dysthymia that included PST,
in which more than 65% of intervention patients took antidepressants by 6
months23 compared with less than 40% in PEARLS. A nonsignificant
increase in depression in the intervention group by 12 months may have resulted
from a significant decrease in therapist-guided problem solving and physical
and social activation in these relatively disabled and socially isolated individuals,
though the influence of decreased nonspecific supportive contact with therapists
in the follow-up period cannot be ruled out as contributing. Future studies
may benefit from extra PST sessions, focusing on activation, in patients relapsing
or not remitting during follow-up. On the other hand, a previous study of
younger primary care patients with major depression has shown 6 sessions of
PST over 11 weeks to be effective54; it is
possible that patients responding more quickly to the PEARLS intervention
(in the active phase) may be able to switch to monthly telephone check-ins
earlier in treatment.
Relatively few patients initiated antidepressants and no net increase
in antidepressant use occurred between groups. Adequacy of dosing may have
been better and duration of use longer in intervention patients, but we report
only categorical use of antidepressants over 6-month periods. Ensuring timely
antidepressant refills and providing greater patient and physician education
about dealing with adverse effects and stigma related to antidepressants may
further enhance adequacy in this effectiveness intervention.
Despite the significant effect of the PEARLS intervention, only a third
of patients in the intervention group and 12% in the usual care group experienced
remission. This is similar to other late-life depression studies using antidepressants
and psychotherapy23 and may result from a reduced capacity of such
patients to respond fully to depression treatment. Psychosocial conditions
that increase the risk for depression (eg, low income, disability, social
isolation) are not likely to have changed substantially during the intervention.
Our program resulted in significant improvements in functional well-being
(eg, acceptance of illness, enjoyment of recreational activities) and emotional
well-being (eg, increased satisfaction in coping with chronic conditions)
at 12 months. Despite our focus on physical and social activation, quality
of life in physical and social well-being domains did not differ significantly
between groups, possibly because of significant physical disability and social
isolation in this population.
Recent studies suggest that depression is associated with higher health
care costs and utilization among the elderly. Unützer et al18 have
shown that depression is associated with higher ambulatory medical costs in
older adults over 4 years. A recent study of 9000 elderly patients screened
for a depression trial by Katon et al55 demonstrated
47% to 51% higher total ambulatory and inpatient medical costs in depressed
compared with nondepressed patients after adjustment for chronic medical illness.
We found trend-level group differences, with the intervention group less likely
than the usual care group to report having any medical hospitalizations during
the study period. Depressed patients report more physical symptoms,22 and untreated depression may result in poorer medical outcomes in patients
with cardiovascular disease,56,57 diabetes,58,59 and other chronic illnesses. Such
factors may have contributed to a greater likelihood of hospitalizations in
patients in whom depression was less effectively treated, and this should
be explored further in studies with larger sample sizes.
While our therapists worked for the participating community agencies,
the intervention, including team meetings, was provided as a parallel health
service to usual case management. We believe PEARLS can be disseminated within
community agencies already providing care for isolated, low-income older adults
by adding depression management to established case management. Most social
service agencies have psychiatric and mental health consultants who, with
minimal training, could provide appropriate oversight and quality assurance
of case managers also trained to provide the PEARLS intervention, and deliver
targeted brief telephone communication with physicians and, possibly, with
patients with more severe or complex depression (eg, significant medical or
psychiatric comorbidity or suicidal ideation).
There were several limitations to this study. The sample size was moderate
and limited to 1 urban geographical area. Similar multisite studies in larger,
more representative samples would improve generalizability. Also, in this
study we did not have access to automated health care records, relying instead
on self-reported medical comorbidity and health care utilization, which is
susceptible to social desirability and recall biases. However, use of retrospective
reports of health care utilization has been found to yield valid results,60-63 and
recall bias may have been reduced by our assessment of categorical use of
any services vs none in the domains of emergency department and hospital utilization.
Future studies using Medicare utilization data or automated pharmacy data
will improve assessment of health care utilization and adequacy of medications
and allow for cost-effectiveness analyses of the PEARLS intervention. Future
studies will also be invaluable in determining the relative contribution of
the intervention's components—PST, behavioral/social activation, pleasant
activity scheduling, antidepressant use, and supportive contact with therapists—in
successfully decreasing depression severity. Finally, despite random assignment,
we had unequal baseline proportions of dysthymia and minor depression, with
intervention participants having a greater proportion of dysthymia at baseline
compared with usual care participants. We controlled for this difference in
baseline dysthymia prevalence in all subsequent analyses.
This is one of the first studies to show that by partnering with community
agencies, it is possible to target and effectively treat depressed, frail,
elderly adults using primarily nonpharmacological treatments such as psychotherapy.
Dissemination of PEARLS within existing community social service programs
has the potential to significantly improve the well-being and function of
depressed older adults served by these programs.
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text:
NBC Local Media announced Monday a new program to integrate the most influential local Twitterers into its city web sites and news broadcasts.
NBC plans to identify the top 20 Twitterers in the 10 markets where NBC owns a local television station. Those people will be invited to discuss hot topics that are trending in the city, and be featured in on-air segments and across NBC's other local media properties.
"The 20" will launch in January in New York, San Diego, and Washington, D.C., and then expand to NBC's seven other owned-and-operated stations later in the year.
"In the age of social media, 'voice' is democratizing, with fresh new perspectives about important issues facing local communities," said Greg Scholl, president of NBC Local Integrated Media. "'The 20' will connect these relevant new voices with NBC's local broadcast and online audiences to facilitate discussion and debate, and help shape local media coverage."
"The 20" will focus on local issues including politics, sports, dining, fashion, culture, education and crime. The new program was highlighted in the Washington Post's The TV Column and Media Bistro's WebNewser.

subset: commoncrawl


text:
Designed for street use, a supermoto-style all-electric motorcycle called the Zero S will do 60 MPH, go for 60 miles, and charges up in only 4 hours. Nice.
In case you haven't been paying attention to the motorcycle world lately, choppers and rocket bikes are out, and supermoto's and café bikes are in, even more than that, electric motorcycles are coming into vogue and Zero Motorcycles make some of the best. The new Zero S is the street version of an all-electric dirt bike we tested earlier this year called the Zero X. This new bike ditches the dirt and goes for the lightweight, aggressive street carving segment of supermoto's, or motard.
The Zero S is equipped with a brushed permanent magnet electric motor which develops 31 HP and 62.5 ft-lbs torque (at zero RPM), and a lithium ion array battery good for 4 kW, the combo can power the bike to 60 MPH with a range of 60 miles. Consider the power delivery on an electric vehicle and an incredibly light 225 lb curb weight, this thing is bound to be a rocket ship. Price? $9,950, a little spendy for the segment, but at less than 1 cent a mile, it's not too bad. Sign us up. Specs below:


text:
Alexandru Ciubotariu, als known as Ciubi, was born in Călăraşi, Romania in 1979 and studied at the Art Academy in Iasi, where he graduated in 2004. He has published his work in over 60 national and international newspapers and magazines. In Bucharest area alone, he has contributed to Mini Azi, Jurnalul SF, Pif Surprize, 2000 Plus, Playboy, TV Story, Apropo TV, Business Magazin, Standard Business, Le Monde Diplomatique, Cotidianul, Doxi and Pipo. Publications from Belgium, Greece, Slovenia, Poland and the Czech Republic also ran his stories.
He has illustrated thirteen books and made eleven comic albums, starting with 'Străinii' by Editions Europolis in 1995, and followed by works like 'Alex la Paris', 'Poveste despre eu', 'Club 106' and 'Aventurile lui Doxi'. In 2010, he published 'Pisica Pătrată' with Éditions Vellant, the first album about street-art in Romania. He participated in over 40 international exhibitions, and had his first solo-exhibition in 2007. His work is very diverse and has won numerous awards since 1994. He lives and works in Bucharest as a freelance graphic artist and illustrator for several publishing houses. He has also designed several stamps for the Romanian postal services.


text:
Carl Petersen
Registered on Thursday the 20th of Feb, 2014
Website: http://www.changethelausd.com
Twitter: @ChangeTheLAUSD
Facebook: DifrntDrmr
I will promote a civil public square after the principles in The Global Public Square by Os Guinness. We affirm the 1948 UN Declaration of Universal Human Rights and will work to restore Articles 18 & 19, seeking a 21st century solution that accommodates everyone.
We will work together to rebuild our cities, towns and rural areas for the benefit of all residents, across racial and demographic lines, for the genuine thriving of all who live there.
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Paterson police say five people were injured when a brawl broke out during a teenager's birthday party.
But it's not clear what sparked the large fight, which started around 12:30 a.m. Sunday.
The party was being held in a rental hall owned by a local church, and authorities say the fight involved some party guests and some "outsiders."
The Record newspaper reports that four of the five victims, who ranged in age from 18 to 43, were treated at a hospital for stab wounds, while the other victim was treated there for a facial injury suffered when they were punched. One of the stabbing victims was admitted to the hospital, but further details on that person's condition were not disclosed.
No arrests have been made.
Copyright AP - Associated Press


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Enniscrone, Co.Sligo
Dedicated to sharing all there is to see and do and express the beauty of the seaside resort of Enniscrone, located on the Wild Atlantic Way. Use these blog articles to plan your visit to Enniscrone and feel free to share on your social media, we would love to hear from you!
Rainy Day Activities
Rainy Day Activities
Looking to keep the kids entertained during rainy days while on your holidays. Don't worry we've got you covered!!
Indoor Activities
Waterpoint Aqua Park, Enniscrone, Co. Sligo
Waterpoint Aqua Park, an indoor swimming pool with a superb 65m water slide, fantastic kiddies fun pool, adult health suite and a brand new and improved fitness gym, to guarantee a fun filled day for all the family.
Funny Bones House of Fun, Collooney Co. Sligo.
Funny Bones is a children's play center just outside Sligo Town. Hours of fun can be enjoyed by all ages with the soft play area, go karts and laser zone. Babies and toddlers are also catered for along with a coffee shop for the adults.
Westport House & Pirate Adventure Park, Westport Co. Mayo.
The Pirates Den is a great in door play center for all the small ones. With an area for under 2's and a go karting track for the older kids.
Tumble Jungle, Ballina, Co. Mayo.
Ireland's biggest in door play center,with bouncy castles, climbing frame, a jungle run and a toddler area, there is hours of fun to be had!
Mayo Leisure point, Castlebar, co. Mayo
With an in door adventure play area, a snack bar and an 8 bowling lanes ro keep children of all ages entertained!
Sligo County Museum & Library
There's nothing quite like curling up with a book on a miserable day. With an extensive range of children's material and dedicated children's areas. A range of activities are often put on from arts and craft groups to story telling sessions. The library is also home to Sligo County Museum where exhibitions are showcased all year through!
National Museum of Country Life, Castlebar, Co. Mayo
A trip to The National Museum of Country Life in Turlough House Castlebar is a must on a rainy day, a fun and educational experience for the whole family. With Collections of objects that represent the Irish way of living since 1850 and various exhibitions on show.
The Jackie Clarke Collection, Ballina, Co. Mayo.
Showcasing one of the world's leading collection of historical Irish materials. Admission is FREE and you can enjoy a spot of lunch in the cafe after.
Ballina Library, Ballina Co. Mayo
Packed with reading material for adults and a dedicated ares for the children. Check out the Mayo county linaray website for all the events happening throughout the year!
Catch a Movie!!
Let the cinema be your warm comfy haven. You will be spoilt for choice with all the latest action packed films. Try Mayo movie world in Castlebar, Ballina cineplex or the Gaiety Cinema in Sligo.
Arts & Crafts
Sligo is rich in artistic and literary tradition so while you are on holidays why not engage yourself and your family in some arts and crafts;
Hullabalo on Pearse Road in Sligo is dedicated for having fun and getting creative. Paint anything from a plate to a fairy. Pottery painting is fun for all ages.
The Model in Sligo is the home of The Niland Collection a leading center in Ireland for the contemporary arts. It is extremely child friendly with a bright open air space. They run programmes like The Big Draw for younger children and Art Trap for the older ones which always book up quickly. They also show family film from time to time.
Head to the Beach
You are going to get wet anyway so you won't notice the rain. Go for a surf on Enniscrone Beach with dedicated schools, who provide wetsuits, boards and lessons. You'll be riding those waves in no time!


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I sometimes forget how useful the STL is in C++. It provides a good range of data structures that fit the majority of my programming needs. One that I use very frequently is map<T>. Map provides a nice ordered collection which I can insert an element into and delete an element from, in order log(N) time where N is the number of elements. Out of the box, neither Perl, nor R5RS scheme give me the same structure. I'm sure it is available from CPAN for Perl and there are countless examples of implementing similar structures on top of scheme's wonderful heterogenous trees. However, I'm far to lazy to write my own code that is at such a low level so it was very nice to find the galore library of data structures by Jens Axel Søgaard.
I was curious to do some comparisons in performance between C++ and scheme here so I quickly coded up some tests to insert a million elements into a leftist heap compared to inserting a million elements into a map. Admittedly that isn't an apples to apples comparison but that isn't much of a consideration for me!
The C++ code was nice and concise:
#include <map> #include <string> #include <iostream> using namespace std; string s() { char buffer[6]; for (int i = 0; i < 5; ++i) { buffer[i] = static_cast<char>((rand() % 26) + 97); } buffer[5] = 0; return string(buffer); } int main() { cout << s() << endl; map<string, int> m; for(int i = 0; i < 1000000; ++i) { m[s()] = 1; } }
The scheme was a bit longer but I had tried to do it a different way and I think it is quite elegant too:
(module test-heap mzscheme (require (prefix s: (lib "67.ss" "srfi"))) (require (prefix s: (lib "69.ss" "srfi"))) (require (prefix heap: "heap.ss")) (define (print-ln . args) (for-each display args) (newline) (flush-output)) (define compare-fn s:string-compare) (define (random-string len) (list->string (let loop ((i len) (l '())) (if (= i 0) l (loop (- i 1) (cons (integer->char (+ (random 26) 97)) l)))))) (define random-string-gen-reset! #f) (define random-string-gen (let ((max-strings 1000)) (set! random-string-gen-reset! (lambda (max) (set! max-strings max))) (lambda (len) (if (= max-strings 0) #f (begin (set! max-strings (- max-strings 1)) (random-string len)))))) (define (populate-heap n) (random-string-gen-reset! n) (let loop ((h (heap:empty compare-fn)) (s (random-string 5))) (if s (loop (heap:insert s h) (random-string-gen 5)) h))) (define (test:performance) (time (random-seed 17) (print-ln "Starting...") (print-ln (heap:find-min (populate-heap 1000000))) (print-ln "Finished!"))) (provide (all-defined))) ;; (require test-heap) ;; (test:performance)
I always put a couple of lines at the bottom of my scheme modules that are commented out so that I can execute them within emacs and find out if the whole module works. Does anyone else do this?
Initially when testing I benchmarked the C++ at a bit more than 7 seconds and the scheme at around 21 seconds which I thought was pretty good. However, now I come back to it the scheme is taking closer to a minute which I suspect means that somehow it isn't triggering the new JIT compiler for the 350 series.


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Aug 21, 2012 | ISBN 9780345510617
"Fascinating and fast-paced . . . will keep readers entranced."—Wichita Falls Times Record News
"[An Anne Perry novel can] take us away to the far reaches of our imaginations, to a place and a time about which we can only dream. . . . We see the gaslight, we feel the fog, and in Perry's latest, Acceptable Loss, we experience the horror of murder, blackmail and sordid crime, as well as the shining victory of heroic sacrifice and personal courage."—Asbury Park Press
"The real drama in the story involves the struggle between loyalty and truth. Questions of morality and painful choices haunt every chapter."—Lincoln Journal Star
"Terrific . . . Readers will not be prepared for the twists and turns that lay in wait."—Bookreporter


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It came down to the final round of the world's longest tug-of-war over water, but the city of Annapolis delivered Saturday on its vow to save face against rival Eastport and win the annual match billed as the "Slaughter Across the Water."
As supporters screamed, "Tug! Tug! Tug!" 33 men and women strained to pull a thick rope and hold their ground as if their lives — not just bragging rights — depended on it. From the Annapolis side of Spa Creek, they faced off against the Eastport team, barely visible more than 1,600 feet away on the opposite shore.
Wendy Easterling, an emergency room nurse at Anne Arundel Medical Center tugging for Annapolis, was left short of breath and wobbly but glad to join her hospital colleagues for an event that has raised more than a quarter-million dollars for area charities. And contributing to an Annapolis win, just the third in 15 years, made the victory even sweeter, she said.
"It's a great feeling," Easterling said. "We can do it."
The event dates back to 1998, when the bridge connecting Eastport to Annapolis was closed for construction for three weeks and, in a marketing ploy, Eastport business people formed the faux Maritime Republic of Eastport. Staging a "secession" from Annapolis spurred a number of annual events to bring attention to Eastport, such as the MRE's annual march into City Hall to declare war on "Annapolis Proper."
For years, Eastport has been more motivated and better organized when it comes to the tug, mostly winning and always throwing a better-attended party with bands, food and activities.
This year, that all changed. Annapolis vowed to erase memories of past dismal performances. MainStreets Annapolis Partnership organized the party at Susan Campbell Park at City Dock, putting together teams, securing sponsors and getting food and liquor licenses. Main Street business Red, Red Wine sold wine and beer from a truck. The Walking Sticks played covers of the B-52's and Rolling Stones. And a team of U.S. Naval Academy midshipmen, recruited this year by Mayor Joshua Cohen, stood at the ready to square off against Eastport's U.S. Army team.
Asked before the match what his team did to prepare, Chris Gallardo, a senior midshipman from San Diego, said, "We didn't do anything, just showed up. We're relying on brawn."
That strategy worked. In seven rounds, using a custom-made rope that stretched across the creek, bankers battled bankers, sports fans battled sports fans, and the city police force battled the fire department.
Savy Welch, a Washington resident visiting Annapolis with her husband and father-in-law, heard about the event at the visitors center. Asked during the Army/Navy round who she supported, she shrugged and said, "When in Rome … root for Navy."
WRNR disc jockeys stationed on each side of the water kept up banter that blared through speakers. From his post in the parking lot of the Chart House restaurant in Eastport, Rick Fisher encouraged revelers to "give a round of applause for the losers," on the Annapolis side. Donielle Flynn, another WRNR DJ, threw it right back, pointing to the "Eastport defectors" disembarking from a water taxi at City Dock.
After the final, decisive round, Marie Dall'Acqua, an organizer with the city's Take-Back-The-Tug campaign, said Annapolis can hold up its head once more.
"The whole thing was taking back the tug and bragging rights," Dall'Acqua said. "And next year will be bigger and better."


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Smoking is unhealthy for everyone, but especially for someone with asthma. The lungs of a smoker, with or without asthma, may not work as well as they should. The person might cough, wheeze, and have shortness of breath. Smoking causes the airways to become swollen, narrow, and filled with sticky mucus — the same problems that cause breathing trouble in people with asthma. For this reason, a smoker who has asthma is more likely to have more frequent and severe flare-ups.
Being a smoker is an obvious risk, but just being around people who smoke — and breathing in secondhand smoke — can cause problems, too. Parents can help kids and teens with asthma by protecting them from the effects of tobacco smoke.
Secondhand smoke is a well-known asthma trigger. If you smoke, consider quitting, especially if your child has asthma. Secondhand smoke can damage the lungs, leading to long-term breathing problems or worsening existing breathing problems.
Kids with asthma who live in households with smokers:
Even kids who don't have asthma are at risk of problems if their parents smoke. These kids are more likely to get upper respiratory infections, middle ear infections, and even pneumonia. Just being exposed to smoke from 10 cigarettes per day may put kids at risk of developing asthma, even if they've never had any breathing problems before.
Cigarette smoke can also get absorbed into upholstery, clothing, and carpeting, leaving carcinogens that can't be washed away with soap and water. Kids who touch, mouth, play on, or breathe near contaminated surfaces may develop breathing problems due to this kind of "thirdhand" smoke.
And here's the best reason of all to quit smoking: Children whose parents smoke are more likely to smoke themselves when they get older.
You don't have to quit on your own. Talk to your doctor about possible strategies — from support groups to medication. If you do continue smoking, don't smoke in the house or car.
Even if no one in your household smokes, kids will still encounter secondhand smoke. Try to help them avoid it as much as possible.
If your child has asthma, let friends, relatives, and caregivers know that tobacco smoke may cause an asthma flare-up. To protect your child from having to breathe in smoke:
No one wants their child to start smoking, but it's especially important to discourage this behavior in kids who have asthma. If your child has asthma, smoking may actually undo the effect of any controller medication. Your child also may need to use rescue medications more often, visit the doctor or the emergency department more often, and miss school more often because of flare-ups.
Kids with asthma who smoke may sleep less at night and be less able to participate in sports or other physical activities. And of course, there are the long-term health consequences, such as heart disease, emphysema, and cancer.
Give your child tips on how to say no if offered a cigarette. To lay the groundwork for that moment:
If your child already smokes, you're not alone. Almost 1.5 million 11- to 17-year-olds start smoking each year. Nearly half of them will become regular smokers. In fact, 90% of smokers start before they're 21.
Still, despite the obvious risks, your child may not respond to an antismoking message. Though the long-term consequences are clear, preteens and teens often feel invincible.
Instead, discuss the immediate consequences: Smoking will cause more asthma flare-ups and make asthma more difficult to control. When asthma isn't controlled, it gets in the way of what kids want to do, such as playing sports or going out with friends.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: January 2014
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Short Version: Let The Right One In is one of the greatest vampire movies ever made; a worthy Oscar contender for International Film of the Year.
Screen Rant Reviews Let The Right One In
I just had to see Swedish director Tomas Alfredson's adaptation of the John Ajvide Lindqvist novel, Let The Right One In, as soon as it hit American theaters this past Friday. There had been such fervent buzz about how good this film was that I, as a fanatical follower of the vampire genre, could not ignore the opportunity to see if the film lived up to the hype.
Well, having seen the film and already scheduled a second viewing, I can tell you that Let The Right One In deserves every amount of praise it's earned: it sets new standards for what a vampire movie should be, and how horror movies should effect us.
The film mirrors the novel's plot about a twelve year old boy named Oskar (Kåre Hedebrant). Oskar is not like a lot of his classmates: his pale, awkward looks mark him as an outsider; he has morose hobbies, such as keeping a scrap book of newspaper clippings about the grisly murders happening just outside his small town. His parents are divorced, both mother and father can barely be called adults, and poor Oskar is tossed back and forth between them like the hot potato neither one wants to hold too long. No surprise then that in his private moments, Oskar indulges in violent fantasies about murdering the bullies who torment him every day in school.
Life changes the night that Oskar first meets Eli (Lina Leandersson), a twelve year-old girl who has moved in next door to him in his large apartment complex. Oskar immediately senses that he's found a kindred spirit: Eli is also a loner, she smells "funny," she walks around in the snow with no shoes and no coat, she's never even seen a Rubix Cube (the film is set in the 80's, mind you), and oddly enough, she only comes out to play at night. Eli quickly takes a liking to oddball Oskar and the two form the kind of friendship/puppy-love bond only 'tweeners share.
Admist all this young love, a string of ritual slayings begin to occur in Oskar's small town--right around the time Eli and her "father" move in. The victims are found hoisted up by their feet, their throats slashed, blood drained. It's no great SPOILER to tell you that the murders are indeed being perpetrated by Eli's "father." However, when one of blood-hunts gets botched and Eli's father has to make a terrible sacrifice (you have to see it to believe it) in order to protect his "daughter," Eli is left alone, forced to hunt for her own blood supply. Having no other protector Eli turns to Oskar, her only friend, forcing the young boy to make a man's choice about who he is going to be in a world of predators and prey.
Let The Right One In is a stunning achievement in terms of direction. Unlike so many American horror films, Let The Right One In doesn't bash you over the head with obvious metaphors or hackneyed plots that barely hold together beyond getting you from murder scene A, to murder scene B. Tomas Alfredson crafts the film like a series of short stories, rather than a whole novel. What I mean by that statement is that Alfredson meticulously packs every scene with detail and nuanced implication, helping every moment to convey so much, while doing so little. Like any good short story, you could take any scene of Let The Right One In and have it stand alone as it's own short film-and because every scene succeeds so well in telling it's own story, the movie as a whole is able to present what, on the surface, seems like a straightforward narrative, yet taken in context with all implications surrounding it, the story becomes a complex, densly layered morality tale that resonates in a fundamental way with our emotional compasses. This is all accomplished using the bare minimum of cinematic tools: dialogue in the film is sparse, there is very little ambient music (basically the same eerie tune from the trailer playing out in full), and the stripped down format helps to give the gorgeous visuals extra room to breath--creative space that Alfredson works with a skillful hand only the most masterful directors posses.
Within the context of a horror film, the minimalist approach truly flourishes: before a word is even spoken we're already deeply invested in Oskar. We sympathize with the pain of each and every hit the boy takes in the schoolyard, yet we can't help but feel a deep-seeded anxiety whenever Oskar, alone at home, takes his favorite hunting knife out into the yard to fantasize about murdering the classmates who torment him. Twenty minutes into the film, Alfredson has us doing emotional somersaults about whether we're watching the sufferings of a picked-upon nerd, or one of the Columbine killers (to put it in an American context) having the seeds of a murderer sewn by the abuses of his formative years. By minute twenty-one, when Eli first appears, the movie has achieved one of the near-impossible feats of telling a good vampire story: keeping the human drama elevated above the monster madness.
By keeping things emotionally grounded, and utilizing a "less implies more" approach, Alfredson corners us right where he wants us. Whenever there is a display of violence--be it human on human, or vampire on human--we feel it and it disturbs us. In this era of Hostel, where people can so often watch others get maimed and murdered while still wolfing down their popcorn a handful at a time, getting the audience to feel anything is a feat in and of itself. Let The Right One In forces you to grapple with the psychological weight and violent nature of the survival instinct--and because that weight is being placed on children who are barley at the threshold of adolescence, the gravity of their choices resonates in a profound way that adults (i.e. those no longer "innocent") could never convey.
Oskar (Kåre Hedebrant) In Let The Right One In
Thank Hedebrant and Leandersson for bringing lead characters Oskar and Eli to life so vividly. I can't imagine another pair of young actors playing these roles. Hedebrant breathes unique breath into what could have been a cliched character: the social misfit. In Hedebrant's hands, Oskar's every quirk and awkward glance work to make him a three-dimensional and relatable character. No matter what country you are from, or where you went to school, you knew a misfit kid who was just like Oskar, yet at the same time, not quite him. Leandersson, on the other hand, is a beautiful young actress who is bound for stardom, if she chooses to pursue it. In playing Eli, Leandersson has an ageless stare about her--one that makes you question whether Eli has been a vampire for five days, or five hundred years. To keep the monster grounded in humanity, Leandersson treats Eli's vampirism like a communicable form of cancer, portraying Eli like the long-time patient of a cancer ward, who wants to be free to explore her adolescence, even if it costs the lives of those around her. This dual rendering of Eli, as both rabid predator and afflicted victim, is a major reason why the film's climax (and a lot of the more nuanced plot points) works so plausibly. Hedebrant and Leandersson exhibit tremendous chemistry: their relationship is Shakespearean in scale: as complex as a middle-aged couple trying work through the turbulent circumstances of a breast cancer diagnosis; yet still as naive and innocent as that first adolescent crush we've all had. Remarkable work from these two young leads.
Let The Right One In is such a good film that after just one viewing I too share Tomas Alfredson's anger over the American remake that is already underway. This film doesn't need to be remade: it needs to be dissected, so that more American filmmakers can observe and understand the fact that it is subtlety and nuance that help films transcend their medium; horror filmmakers need to be reminded that good horror films in fact HORRIFY us by having bad things happen to fully-formed characters we're actually rooting for. Stock victims and buckets of blood be damned.
Unfortunately, at the moment Let The Right One In is only playing in L.A. and NYC. No word yet on if it will get a wider release in forthcoming months (if it doesn't, the DVD is due out March 10, 2009, so Netflix it now). The American remake is scheduled for a 2010 release. But don't wait, see this film now, in its original form. You will so very happy that you took to the time to sink your teeth into it (the obligatory vampire pun).


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Navy Blue Brown Check Crib Skirt Straight Plaid Blue Brown Crib Skirt Gingham Crib Bedding Crib Skirt Boy Girl Crib Bedding
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Review: Conservatize Me: How I Tried to Become a Righty with the Help of Richard Nixon, Sean Hannity, Toby Keith, and Beef Jerky, by John Moe
This was entertaining, but it sometimes felt as though the author was trying to force himself into stereotypical or superficial situations for "The Experiment" rather than making an honest attempt to gain insight into the conservative viewpoints. For example, what do eating beef jerky or listening to Kid Rock for 30 days have to do with one's political ideology? Why did the author choose not to explore in any detail the influence of fundamentalist Christian beliefs on politics (and vice versa)? That said, his conversation with the mayor of Rexburg, Idaho (located in the county with more than 90% of its votes going to George W. Bush in 2004), as well as his insights afterward, were more nuanced.
Also, this isn't Moe's fault, but the publisher's decision to put footnotes at the end of each chapter rather than at the bottom of the page was downright annoying, especially given that most of these were jokes/asides and not really worth flipping back and forth for.
Perhaps I'm just lburned out on the "Hey, let's do something wacky for an extended period of time and get a book deal out of it!" genre. But while Conservatize Me had its funny moments, overall I found A.J. Liebling's The Year of Living Biblically a more thought-provoking and worthwhile read.


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March 1, 2002
SAN DIEGO, Calif. - Senior guard Caroline Gruening hit a record eight three pointers to lead the Santa Clara University women's basketball team from an 18-point deficit to a three-point victory over Saint Mary's in a West Coast Conference Tournament semifinal, held tonight at the Jenny Craig Pavilion. She scored a career-high 34 points in the Broncos' 87-84 victory. Both marks set individual game records for both Santa Clara and the WCC Tournament.
Santa Clara is now 21-8 overall, while Saint Mary's moves to a 16-12 mark. The Broncos will play top-seeded Pepperdine, an 82-77 winner over San Francisco in the other league semifinal. That contest will be held on Sunday at 2:30 p.m. It will be shown on KRON-4 in the Bay Area.
Down 18 points with 5:25 remaining in the first half, the Broncos reduced the lead to five at intermission. At almost the same point in the second period, freshman Quinn Thomas ' only basket of the night, a three-pointer from the top of the key, gave Santa Clara its first lead of the game, at 76-75 with 5:26 left on the clock.
Saint Mary's had converted its first 11 free throw attempts of the game, but missed three straight opportunities from the charity stripe to tie the game at 76. The Gaels' forth did fall in, but SCU held its lead. SMC's Jerkisha Dosty fouled out with 2:31 remaining, but the Gaels were able to take the lead on their next possession. Bronco senior Becki Ashbaugh hit a three to return the advantage to SCU, but Saint Mary's would take the lead one more time. SCU's Kendra Rhea converted an offensive rebound for a three-point play to make it 85-84 in favor of the Broncos, the fifth and final lead change of the night. Fellow frontcourt teammate Julie Butler was fouled on the Broncos' next possession and made both her shots from the charity stripe for the final score.
The Broncos allowed 55 points to the Gaels in the first half, the most allowed to an opponent in at least the two years. Both teams shot over .500 in the period, with SMC taking a 56.3 to 52.8 percent advantage. It was the Gaels' 21-11 rebounding advantage that was the difference, creating many second-chance points.
Gruening went 7-8 from the land of plenty before halftime, but the Gaels were just as strong, building their 18-point lead behind Danielle Ferris and Katie Davis, who were each 3-3 from long distance to start the contest.
Saint Mary's opened a 6-0 lead, forcing Santa Clara head coach Chris Denker to call a time out early. Rhea had seven of Santa Clara's first 10 points as she took control in the paint. The Broncos then went on an 18-7 run to close out the half only down by five points.
Two straight unforced turnovers by SMC were converted by Gruening for a three-pointer and a running jumper to reduce the Gaels' lead to 10. After two points from the Gaels, a Gruening made three straight threes, including one at the halftime buzzer, to make it a five-point ball game.
After missing her first shot, Gruening then made her next 11 and scored all of her points in the game's first 30 minutes. She led three other Broncos in double-digit scoring. Rhea had 19, while Butler finished with 11 and Ashbaugh registered 10. Additionally, Ashbaugh's eight assists marked the sixth straight game she's registered at least eight dishes.
Ferris finished with 23 points to lead the Gaels, while Jermisha Dosty posted 19 points and a game-high 15 rebounds.


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Imagine overlooking Sarasota Bay and relaxing in your own villa pool garden … or enjoying crimson sunsets from your Gulf front family holiday condo. Beach and bay rental homes deliver the best of all worlds with spacious living, exceptional kitchens and easy access to Longboat Key parks, shopping and upscale or relaxed dining selections. For fishing excursions or family holidays, select rentals offer flexibility and value for holidays at the beach.
This gorgeous Florida key combines serene seashore enjoyment with luxury shopping and dining choices. Families enjoy the many water sport activities from fishing, boating and kayaking to plucking perfect seashells along the shoreline. Couples and friends explore chic dining and shopping spots around St. Armand's Circle. The aristocratic heritage of the St. Armand and Ringling families resonates through quiet gardens and plush Palm Beach-style shopping. Umbrella-draped cafes and handsome restaurants offer exceptional European fare and inventive coastal specialties. Work off that decadent dessert with a stroll around the circle for leather, jewelry, resort wear and art gallery browsing.
Venture just across the bridge over Sarasota Bay for unrivalled cultural treats. The Ringling circus family bequeathed an elegant legacy of art and architecture. The estate includes the acclaimed John and Mable Ringling Museum of Art, the family's winter Ca' d'Zan mansion – a Venetian Gothic masterpiece - the Circus Museum and historic Asolo Repertory Theater. With elegant gardens and terraces spread over 20 bayside acres, the complex provides hours of enjoyment.
Beyond the eclectic mix of St. Armand Circle restaurants, you'll want to sample excellent bay front restaurants. The Dry Dock is a favorite of locals and visitors alike, with waterside dining under coconut palms or indoor seating with the same exceptional views. Boasting ultra fresh grouper sandwiches, char-grilled burgers and a host of pasta and chicken selections, the Dry Dock grill is a casual dining treat.Diners arrive by car or boat to enjoy Mar Vista Dockside Restaurant and Pub in the historic village at the North end of the key. With quaint indoor or outdoor dining and spectacular views, try steamer pots of fresh seafood or exotic scallop and crab dishes that wash down quite well with islander mojitos, margaritas and other such flavorful concoctions. Land lovers can choose from the number of chicken, steak and pork dishes.
You'll have no trouble knowing what to expect, as you search for the just-right villa or condo rental. Our unbiased visitor reviews offer clear descriptions and candid evaluations, so you can feel confident in your choice.
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text: ALBANY -- On Monday, several College students discussed the commercials aired during the Super Bowl, just like everyone else around the country, except they got to chat with advertising experts from Eric Mower and Associates. As with any other year, more attention seems to be given to the commercials as opposed to the actual game, which the Baltimore Ravens won 34 to 31 over the San Francisco 49ers. Tom Merrick, senior partner and executive creative director at EMA, led a discussion with students from the University at Albany and the College of St. Rose, all of whom expressed an interest in marketing, about what worked for them in the commercials and what didn't. "You have to be, think and feel young to do it," Merrick said of advertising. "Not for your agency but the ideas you come up with for clients have to be relevant." The students were asked what they thought of some of the commercials created by Budweiser, Tide, Jeep and various others premiered Sunday evening. Merrick looked at the amount of money companies spent on their commercials and questioned the students as to whether they felt clothing company Gildan benefitted from their multi-million dollar investment. The commercial featured a man waking up bewildered after a night out, objects strewn across the room, before attempting to escape. Merrick asked the students what they thought of a relatively unknown company putting a lot of money into a Super Bowl commercial instead of a long-range marketing campaign. Sam Maxwell, a communications major at St. Rose, said to him it made sense to sink $4 million into a commercial at the Super Bowl since it is well-known most people tune into the event for the ads. "I'd definitely spend $4 million in the Super Bowl instead of 12 different spots on shows like NCIS," Maxwell said. Merrick gave much praise to the Mercedes-Benz commercial, which featured celebrities such as actor William DaFoe, singer Usher and model Kate Upton, as one of the most effective ads to run during the game. It showed a man about to make a deal with the devil, played by Dafoe, so he could own a Mercedes-Benz CLA. But the end of the commercial a much more affordable price for the car than others put out by the luxury car manufacturer. This advertising message seemed to resonate with the students, as UAlbany senior Dara Negron, who is also majoring in communications, said it was an effective commercial. "I don't associate with Mercedes-Benz as being affordable, generally," Negron said. Merrick agreed with everyone, saying the ad did exactly what it was meant to. "This is what's great about the Super Bowl," Merrick said. "Lots of money spent to entertain you and send a single message. And it seems like you guys heard it loud and clear." The event was not all just talking about Super Bowl commercials, as the students were given tips from both Merrick and Sean Casey, a partner and director of public affairs at EMA. They both stressed the importance of being able to be good writers as a way to easily convey a point. Merrick said when looking at a portfolio for someone to hire, he values a person's ability to write well. Merrick saw the opportunity for students as a great one since it gave them some insight into how an advertising agency works and critiques various advertising strategies. "I would have loved to have shown up to an advertising agency and have this conversation when I was young," Merrick said. "Our opinions and our insight are different than what you would get in a classroom." Andrew Beam may also be reached at 270-1294.


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Before then-Taipei mayor Chen Shui-bian (陳水扁) put an end to legal prostitution in the capital, the city was the only place in Taiwan where it was allowed. Twelve years later, however, the wisdom of his decision is hotly debated. Now, legalizing prostitution is again on the table, with the Ministry of the Interior last week proposing to set up red-light districts.
The glaring reality is that forcing sex workers into the shadows has done nothing to put an end to the business — nor to the scourges of human trafficking and exploitation that often accompany the practice. Many observers and sex workers are concerned that outlawing the trade has exacerbated these problems and left some of society's most vulnerable women with fewer options than ever to pursue a better life for themselves and their families.
Faced with this, the government has returned to the question of whether selling sex should be legal. Red-light districts would allow the authorities to monitor an industry that is notoriously abusive toward its workers. But the proposal ignores another option with potential for greater and more equitable results: Shifting criminal responsibility for prostitution away from sex workers and onto their customers.
Article 80 of the Social Order and Maintenance Act (社會秩序維護法) is a deplorable example of the chauvinist forces that linger in this society. As it stands, sex workers face prison terms and fines, while their customers have nothing to fear. The law effectively suggests sex workers are "temptresses" to blame for "social ills," while patrons can be forgiven — even though it is their wallets that sustain the industry and its related abuses. This is incomprehensible unless one considers that the system that created the legislation was probably replete with people who themselves feared a run-in with the law.
The article is also completely ineffective and ignores the fact that the vast majority of sex workers did not enter the industry willingly — and are hoping for a way out. For prostitutes already working in wretched conditions, the threat of criminal prosecution could hardly be a better deterrent than other hardships faced on a daily basis. Threats are pointless if doors remain closed.
In April, Chinese Nationalist Party (KMT) Legislator Cheng Li-wun (鄭麗文) proposed amending the law, but, like the Ministry of the Interior, suggested full legalization of the sex industry.
Legalized prostitution, however, has not stopped human trafficking and rampant physical abuse (including sexual assault) of sex workers in, say, Amsterdam.
The Collective of Sex Workers and Supporters has decried the criminalization of prostitution in Taiwan, warning that it has led to deteriorating work conditions and has allowed gangsters to strengthen their hold on the industry. But legalizing the sex industry is unlikely to cure these ills.
This is why the Swedish model is often cited by rights advocates who want to see an end to the prosecution of prostitutes without condoning the industry's systematic abuses. Sweden has reported steady progress in reducing prostitution by punishing customers rather than sex workers.
In its annual human rights reports, the US State Department continues to cite human trafficking and violence against women as key concerns in Taiwan. Law enforcement efforts to crack down on the perpetrators of these acts must be redoubled.


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March 29, 2011
NORTH DARTMOUTH, MA The University of Massachusetts Dartmouth's women's lacrosse team has been picked to finish sixth in the Little East Conference this year.
The Corsairs, who finished sixth in the LEC last season, received 13 points in the LEC's annual pre-season poll.
Keene State received six of the seven first place votes and was picked to finish first with 48 points. Eastern Connecticut State received the other first place vote, and was picked to tie for second with Western Connecticut State, each receiving 33 points, while defending champion Southern Maine was picked to finish fourth with 31 points. Plymouth State was picked fifth with 25 points, and Rhode Island College was picked seventh with nine points.
"We hope to move up and go deeper into the playoffs this year," said UMass Dartmouth Head Coach Jerry Jennings. "We're very pleased with our team's development so far. I think the league will be much more balanced this year, and, if we stay healthy, we'll be as competitive as anyone."
The Corsairs are 1-3 and will host Worcester State Wednesday.


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Texas at Brownsville Wins Second Volleyball National Championship
By: Matt Bos, Northwestern (Iowa) Sports Information Director
SIOUX CITY, Iowa -- Top-ranked Texas at Brownsville won its second-ever NAIA Volleyball National Championship, defeating #3 Biola (Calif.) 3-0 (27-25, 27-25, 25-22). The 2013 event was presented by J&L Enterprises and CNOS Foundation and played at the Tyson Events Center in Sioux City, Iowa.
Texas at Brownsville finished the season with a perfect 37-0 record, the third team in the last five years to finish undefeated. The Ocelots also won the title in 2011, finishing with a 32-2 record.
Trailing for nearly the entire first set, Texas at Brownsville grabbed its first lead at 25-24. Biola tied it at 25 but the Ocelots scored the final two points off kills by Xiaoyu Guo and Danica Markovic to take the first set.
Texas at Brownsville scored the first four points and led most of the way in set two until a late Biola charge tied it at 22. Still tied at 25, the Ocelots got a kill by Vanja Joksic, followed by an Eagles attack error giving UTB a 2-0 lead.
The lead switched hands four times early on in the third set, until, tied at 17, Texas at Brownsville outscored the Eagles 8-5 to win the final set, 25-22.
Texas at Brownsville hit .295 for the match and three players hit for double figures. Joksic led the way with 13 kills, hitting .500 out of the middle, while championship most valuable player Danica Markovic put down 12 kills and added 13 digs. Annelies Dokter added 12 kills for the Ocelots.
Biola, playing in its first championship match since 1997, was led by Joclyn Kirton with 14 kills and Alyssa Mason put down 12. The Eagles hit .227 for the match and end the season with a 27-4 overall record.
2013 NAIA Volleyball National Championship All-Tournament Team:
Amy Weststeyn, Biola
Chelsee Arnitz, Biola
Trinity Ojo, Columbia
Jessica Israel, Concordia
Kayla Gesink, Dordt
Rachel Eubanks, Georgetown
Chrissy Daggett, Grand View
Emilie Freeman, Madonna
Megan Farley, Midland
Karlie Schut, Northwestern
Samantha Dougherty, The Master's
Ana Guerra, Texas at Brownsville
Vanja Joksic, Texas at Brownsville
Shahala Hawkins, Wayland Baptist
Tachikara Most Valuable Player: Danica Markovic, Texas at Brownsville
Tachikara National Championship Coach of the Year: Jim Giacomazzi, Wayland Baptist
Champions of Character Selection: Wayland Baptist


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"Never Say Never Again"
Bond: Sean Connery
Classic, Cheese, or Crap?: CRAP
In 1958, Ian Fleming began trying to bring his famous spy to the big screen. He was introduced to a writer named Kevin McClory, and together (eventually joined by screenwriter Jack Wittingham), they began work on a screenplay they would eventually title, "Thunderball." Due to the failure of McClory's first feature film, however, Fleming lost interest in the collaboration. Instead of pursuing the screenplay further, he cannibalized the major elements (including SPECTRE and Blofeld) and turned them into a new novel of the same name.
The story would eventually make it to the big screen once Cubby Broccoli and Harry Saltzman began adapting the books.
But behind the scenes, Kevin McClory was fighting in the courts for his rights to the original Thunderball screenplay. It was a legal fight that would lead to the death of Blofeld, the end of SPECTRE, and eventually, "Never Say Never Again".