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ACT A LADY | Theater on Fire closes its season with this farce by Seattle playwright and Brown University grad Jordan Harrison. "When the men of a small Prohibition-era town decide to put on a play dressed in 'fancy-type, women-type clothes,' the whole community is affected: gender lines blur, eyebrows raise, identities explode, and life and art are forever entangled." Who'd have guessed! The cast includes Lisa Caron Driscoll, Craig Houk, Crystal Lisbon, Greg Maraio, Chelsea Schmidt, and Chris Wagner; Darren Evans directs. | Charlestown Working Theater, 442 Bunker Hill St, Boston | 866.811.4111 | April 16–May 1 | Curtain 8 pm Thurs-Sat | $15 Thurs; $20 Fri-Sat | $10 students, seniors
THE BLONDE, THE BRUNETTE AND THE VENGEFUL REDHEAD | "A cheating husband, a meddling neighbor, and a dropped ice cream cone combine to shatter Rhonda Russell's quiet, suburban life. Seven very different characters offer their own perspective of the day Rhonda went berserk." That's the set-up for this 2004 work by Australian dramatist Robert Hewett; the catch is that all seven characters are played by one performer — in this case, former American Repertory Theater company member Karen MacDonald. Emerson College performing-arts chair Melia Bensussen directs this regional premiere. | Merrimack Repertory Theatre, 50 East Merrimack St, Lowell | 978.654.4MRT or merrimackrep.org | April 22–May 16 | Curtain 2 pm [April 28] + 7:30 pm Wed | 7:30 pm Thurs | 8 pm Fri | 4 pm [no April 24] + 8 pm Sat | 2 + 7 pm [no evening May 16] Sun | $26-$56
EDWARD II | The Provincetown Theater Company gives us Christopher Marlowe's underperformed study of the 14th-century English king whose predilection for male favorites proved his undoing. Look for a more sympathetic portrait of this ruler — who was, like Marlowe, probably gay — than the one Mel Gibson created for Braveheart. Anthony Jackman directs. | Provincetown Theater, 238 Bradford St, Provincetown | 508.487.7487 or provincetowntheater.com | April 16–May 2 | Curtain 7:30 pm Fri-Sun | $22; $18 students, seniors
MAMMALS | Apollinaire Theatre Company presents the East Coast premiere of this work by English playwright Amelia Bulmore that got a decided thumbs-up from the Sunday Times. "Jane and Kev don't have secrets. They don't have room for them. Their children take up all the space. But when Kev comes home from a business trip with something to confess, he starts a chain reaction which has shattering consequences. Their weekend guests, wisecracking Phil and glamorous Lorna, are blissfully free of family chaos by contrast. But not being tied down isn't necessarily all fun and games either." Ted Batch, James Bocock, Becca A. Lewis, Alison Meirowitz, Lorna Nogueira, and Maria Schaedler-Luera star; Danielle Fauteux Jacques directs. | Chelsea Theatre Works, 189 Winnisimmet St, Chelsea | 617.887.2336 or apollinairetheatre.com | April 16–May 16 | Curtain 8 pm Fri-Sat | 3 pm Sun [May 9, 16] | $25 advance; $30 doors; $20 senior advance; $15 student rush
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Today we get an extra day. So what are you going to do with it. Wouldn't it be great if we took this extra day and made it special, For someone else.
Today would be a great day to try to demonstrate the Scout Law to someone. Be Helpful and Kind, Be Courteous and Brave, Be Friendly and Loyal. Today is the leap year day.. an extra day to do a good turn…Daily!
Make today count!
Happy Scouting!

subset: commoncrawl


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Home > Choosing a College > A Guide to Letting Go >
Getting to College
It's almost time, but are you ready?
If you aren't sure what your child should pack for college, here are some quick tips:
- Check with the college for a list of what's provided by the school and what the school expects the student to provide. Most schools have such a list. It's also useful if your child is considering off-campus housing. Compare the list to the amenities offered by alternative housing options.
- Pack clothing that's appropriate to the season and the geographical location of the school. Don't try to pack clothes for the entire year. Use school breaks to exchange seasonal clothing. Or pack and send them through the mail.
- Pack a laundry bag or basket, detergent and change (usually quarters) for laundry. Have enough money to wash a load or two in case your child forgets to get change in the first-week rush.
- Bring extension cords, power strips and three-prong adapters. Dorm rooms seldom have enough power outlets and often have older-style wall sockets.
- Stay cool by bringing along a fan or two for those schools in warmer climates. Many dorms aren't air-conditioned. Don't bring an air conditioner unless you're sure the school allows it.
- Consider some type of renters' insurance if electronics and computer equipment will be kept in the dorm room to cover damages in case of fire or theft.
- Make sure that the dorm room has at least one smoke alarm. A fire can happen anywhere, and an alarm is inexpensive protection.
If you're driving to school, here are some quick tips:
- If you plan to rent a van or a small truck, reserve it at least a month in advance of the move. When other family members are helping, consider a one-way truck rental and have a family member drive a car so you have it for the trip home.
- If you need to stay overnight before moving in, make hotel or motel reservations well in advance. Make sure to have secure overnight parking place at or near the school for your van or small truck.
If you're flying to school, here are some quick tips:
- Make airline reservations early. If possible, have a Saturday night stay over to get the best rates.
- Consider reserving a car at the airport so that you have transportation to and from the school.
- If you need to stay overnight before moving in, make hotel or motel reservations well in advance.


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Compare and Review the latest Cycling and Mountain bike clothing. Plus, find a Brand Stockist from the 1,800 UK Bicycle Shops featured. Easy as 1,2,3!
Gloves_Short Finger
Gloves_Long Finger
Cycle Helmets_Performance
Cycle Helmets_AllMtn
Cycle Helmets_Full Face
Jerseys_Short Sleeve
Jerseys_Long Sleeve
Shoes_SPD Sport/Competiton
Cycle Shorts_Baggies
With the nights drawing in and the weather getting cooler, wearing the right kit gets more important. On this page you'll find links to the top clothing brands offering all the warm layers, gloves and jackets that you'll need to keep riding through the Winter.
2xu  adidas  altura  ana-nichoola  assos  astana  bell  bianchi  bloc  bmc  bontrager  bspoke  campagnolo  cannondale  casco  castelli  charge  craft  defeet  demarchi  duffs  endura  five-ten  foska  fox  fox-clothing  fuji  fuse  giro  gore-bike-wear  helly-hansen  knog  kona  livestrong  louis-garneau  madison  maloja  mavic  met  montane  morvelo  nike  north-face  northwave  oakley  odyssey  pearl-izumi  race-face-armour  race-face-clothing  royal  rudy-project  scott  seal-skinz  shimano  sixsixone  sockguy  sombrio  specialized  stella-mccartney  surface  tifosi  tifosi-optics  trek  troy-lee-designs
Cycle clothing has advanced in the last few years beyond lycra, lycra and more lycra, to garments that look good whilst also being functional. Here are a few tips on what to look out for:
Key basics – if you are new to cycling, the first items of clothing that you should look to buy should be a cycle helmet and also clothing for the parts of your body that comes into contact with the bike; hands, backside and feet.
Cycle helmet - an absolute essential. If you think you look unfashionable or stupid wearing a helmet, speak to someone that has had a crash whilst wearing a helmet (people working in your local bike shop will no doubt have some stories), see what damage it did to the helmet, and then imagine the effect of that impact directly to your head. You'll never question the decision again. Make sure the helmet fits correctly – you should be able to tilt your head down towards your knees, without the chin strap done up, and the helmet should stay put.
Cycling gloves - a good pair will not break the bank and will help to take some of the 'sting' out of long rides, whilst also protecting your hands if you fall.
Cycling shorts are available in lycra and 'baggie' options. Baggies look like normal shorts, but have the benefits of a good lycra short i.e. a padded liner to protect your backside on long rides.
Cycling shoes are a 'nice to have' if you don't cycle that often. Unlike training shoes, cycling shoes have a stiff sole that transfers all of your effort through to the pedal and therefore results in greater pedalling efficiency.


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Surprise #1 At Top Of Southern Rock Song Poll
The Marshall Tucker Band's 1973 classic "Can't You See" has been named the 'Greatest Southern Rock Song' in a new list by UltimateClassicRock.com. The track -- which has been a mainstay on FM radio upon it's release on the band's self-titled debut album -- has often been mistaken for being an Allman Brothers Band song, actually was never a hit, "peaking" upon release at a disappointing Number 108 on the Billboard singles charts. Coming in second was Lynyrd Skynyrd's 1974 mission statement, "Sweet Home Alabama," with 1975 Outlaws favorite "Green Grass & High Tides" rounding out the Top Three.


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Choreography by: George Balanchine and Alexandra Danilova, after Petipa (1884)
Music by: Léo Delibes
Based on a story by E.T.A. Hoffmann, this delightful tale presents a budding romance between two villagers, Frantz and Swanilda, alongside the curious workings of their eccentric neighbor Dr. Coppélius, a mad inventor who has taken to creating life-like automatons. Infatuated at the sight of the inventor's new doll, Frantz sneaks into Dr. Coppélius' workshop, and mayhem ensues.


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Please say a prayer for my Callie-Roo, She has some type of fungal growth that is around the tubes that enter the lungs that is restricting air flow. My vet and I are friends and over the past 8 months we've been noticing that her breathing has been funky, it really showed during hot days.
She always panted heavy when working heavy, but in the past few weeks its been really pronounced. He took her in did some blood work, and an X-ray showed this mass. He stepped up and contacted a couple more vets for conformation of his diagnosis.
More test were ordered and won't get results till next week.
I'm just praying is just fungal and not the other.


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EFF Website Overhaul!
As you may have noticed if you're hitting the site directly, rather than our RSS feeds, we've just launched a full site redesign and restructure. It's been a long time coming, and we're way excited about it!
We've made some design and navigational changes that should be immediately apparent. But by far the biggest change for eff.org is that we're now running on the open source content management system Drupal. Migrating into a CMS was a hefty challenge, as our website is almost as old as our organization, and has thousands of pages and files. But we did it, and the end result of this herculean data massage should be that we're able to get more information up on our website, and to you, more quickly.
This project was a major undertaking for EFF, and we have some much-deserved Thank Yous to hand out:
- Big thanks to all the people who work on Drupal, it's a great open source CMS and provides an excellent content management solution to many nonprofit & grassroots websites. And extra special thanks to the helpers on Drupal IRC, who handled quite a few eff.org related questions.
- About halfway through the migration project, we were graced with the tech chops of Tim Jones, who ended up writing a bunch of custom Drupal modules for us and generally making this whole thing come together. Without his extensive help there's no way we would have gotten the site out the door, and he proved so invaluable that as of November he'll be at EFF fulltime.
- Huge thanks to EFF ally Matt Earp, who handled a lot of the messier parts of content migration over the summer.
- Finally, thanks to EFF staff and associates, who helped along the way by answering questions, sifting through piles of site content, offering input, and being incredibly patient.
One of our main goals with this site migration was to make eff.org more usable and organized, and we hope you like it! We'd love to hear your feedback and suggestions. Email us about the new site by emailing firstname.lastname@example.com.
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Here's the latest on my CZ3 project. I added more weathering quite awhile ago, but its been very busy around here so it took me awhile to post them. I used flat black and diluted it down with paint thinner and added on some smudges and more overall weathering. I like how the smudges turned out. I did use some more colors on the collar area which i think looks good too. I'm not sure if I should add more weathering or not. I also added the oil leak on the back of the head. I thought a fresh oil leak might look good, but I wonder now if its a little too much. Opinions welcome again.
JT, I think that on a prop like this, the collar is necessary to have. Without it, it just doesn't look quit right.


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Latvia 1903 – United States of America 1970
1957 # 20
oil on canvas
signed and dated verso u.l., maroon oil paint, "Mark Rothko / 1957"
233.0 (h) x 193.0 (w) cm
Unframed 233.0 (h) x 193.0 (w) x 4.5 (d) cm Purchased 1981 National Gallery of Australia, Canberra
NGA 1981.729 © Mark Rothko/ARS. Licensed by Viscopy
- estate of the artist;
- from whom bought, through The Pace Gallery, New York, by the Australian National Gallery, February 1981
- Mark Rothko
- Museo d'Arte Moderne Ca' Pesaro 25 Jun 1970 – 15 Oct 1970
- Marlborough Gallery Inc 13 Nov 1970 – 05 Dec 1970
- Mark Rothko, 1903-1970: A Retrospective
- Solomon R. Guggenheim Museum 27 Oct 1978 – 14 Jan 1979
- The Museum of Fine Arts, Houston 08 Feb 1979 – 01 Apr 1979
- Walker Art Center 21 Apr 1979 – 10 May 1979
- Los Angeles County Museum of Art 03 Jul 1979 – 26 Sep 1979
- Beyond Belief: Modern Art and the Religious Imagination
- National Gallery of Victoria 23 Apr 1998 – 26 Jul 1998
- Seeking Transcendence
- Art Gallery of Western Australia 10 Feb 2005 – 24 Apr 2005
- Mark Rothko
- Palazzo delle Esposizioni 05 Oct 2007 – 06 Jan 2008
- Mark Rothko - A Retrospective
- Kunsthalle der Hypo-Kulturstiftung 08 Feb 2008 – 27 Apr 2008
- Hamburger Kunsthalle 08 May 2008 – 14 Sep 2008
- Abstract Expressionism: the National Gallery of Australia celebrates the centenaries of Jackson Pollock and Morris Louis
- 14 Jul 2012 – 24 Feb 2013
- James Mollison and Laura Murray (eds), Australian National Gallery: An introduction, Canberra: Australian National Gallery 1982, pp. 60, 62–63, illus. col.;
- Dore Ashton, About Rothko, New York: Oxford University Press 1983, p. 139;
- Michael Lloyd and Michael Desmond, European and American paintings and sculptures 1870–1970 in the Australian National Gallery, Canberra: Australian National Gallery 1992, pp. 248–249, illus., as 'Brown, black on maroon';
- An introduction to the National Gallery of Australia, Canberra: National Gallery of Australia 1992, p. 68 , illus. col.;
- Jenny Manning, Sixty minutes in the Gallery, Canberra: National Gallery of Australia, 1993, p. 8, illus. b&w;
- David Anfam, Mark Rothko: The works on canvas: Catalogue raisonné, New Haven, London and Washington: Yale University Press and the National Gallery of Art 1998, cat. 596, p. 461, illus. col.;
- Sasha Grishin, 'A collection of masterpieces', in Pauline Green ed., Building the collection, Canberra: National Gallery of Australia 2002, p. 231, illus. col.;
- Anthony White, 'Art metropolis: A new display of international art', artonview no. 32, Summer 2002–2003, p. 18, illus. col.;
- Brian Kennedy, 'The art of Sean Scully: a human spirituality', Sean Scully: Body of light, Canberra: National Gallery of Australia 2004, p. 10, illus. col.;
- John Stringer, Seeking transcendence, Perth: Art Gallery of Western Australia 2005, p. 18, not illus.;
- Oliver Wick (ed.), Mark Rothko¸ Milano: Skira, 2007,cat. 78 .illus. col. p. 128;
- Collectionhighlights, Canberra: National Gallery of Australia, 2008. p. 230, illus. col.;
- MarkRothko, Retrospektive, München: Hirmer Verlag, 2008, cat. 8 .illus. col. p.[128];
No. 20 (Deep red and black) 1957 is a canvas that is characteristic of Rothko's mature style, composed of soft‑edged blocks of colour that float above each other. Throughout the early 1950s he employed bright colours—reds, yellow, oranges and blues—in harmonious combinations. But, in 1957, the year this work was painted, a perceptible shift occurred in Rothko's paintings. Fewer and darker colours were used, giving a sombre expression to his work. Rothko was still painting 'dramas', a term he had used to describe the subject of his paintings of the 1940s, using colour as the 'instrument': 'I exclude no emotion from being actual and therefore pertinent', he said in 1957. 'I take the liberty to play on any string of my existence. I might as an artist, be lyrical, grim, maudlin, humorous, tragic.'[1]
At that time, however, Rothko's paintings reflected a more limited range of mood: among the 'ingredients' of his art, which he listed in a lecture he delivered at the Pratt Institute in 1958, was 'a clear preoccupation with death. All art deals with intimations of mortality'.[2] To Dore Ashton, a regular visitor to his studio at this time, Rothko claimed that 'he was creating the most violent painting in America'.[3] Ashton interpreted this as referring to the conflict inherent in the association of colours that Rothko conceived of as the symbolic equivalents of emotions. As Rothko believed, 'a painting is not a picture of an experience; it is an experience'.[4] The 'dark' emotions that permeate No. 20 (Deep red and black), and other paintings of 1957, were, with certain exceptions, the basis for all the works that Rothko painted until he killed himself, a little over a decade later.
Michael Lloyd and Michael Desmond, European and American paintings and sculptures 1870–1970 in the Australian National Gallery, Canberra: Australian National Gallery 1992, p. 250, revised Steven Tonkin 2003
[1]Elaine de Kooning, 'Kline and Rothko: Two Americans in action', Artnews Annual XXVII, 1958, p. 177
[2]Taken from Rothko's notes for a lecture given in 1958 at the Pratt Institute, Brooklyn, and published by Dore Ashton in The New York Times,31 October 1958, reprinted in The New York School, Los Angeles: Los Angeles County Museum of Art 1965, p. 142.
[3] Dore Ashton, About Rothko, New York: Oxford University Press 1983, p. 138.
[4] Rothko, quoted in Anne C. Chave, Mark Rothko: Subjects in Abstraction, New Haven and London: Yale University Press 1989, p. 172
The National Gallery of Australia holds two paintings by Rothko, Untitled (Multiform)1948 and No. 20 (Deep red and black) 1957, and a drawing Untitled c 1944–46.


text:
Web Stories
Martha Stewart Living executive Marino to speak, Jan. 11
Posted January 6, 2006; 01:54 p.m.
Robin Marino, president of merchandising at Martha Stewart Living Omnimedia, will speak about her role with the company at 7 p.m. Wednesday, Jan. 11, in 101 McCormick Hall.
Marino was president of Kate Spade LLC and an executive with Burberry Ltd. and the Donna Karan Co. before joining Martha Stewart Living, which produces magazines, television programming and household products.
The event is sponsored by Business Today, a student-run business magazine.


text:
All updates about the site itself is posted here, as well as news from Blizzard itself.
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in Happy New Year 2017 From...
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This forum is reserved for all of your random randomness. Asdf? Hocus pocus? If so, post it here!
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Talk about general game discussion in this forums, may it be in or outside the Blizzard franchise.
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Take part in text-based roleplays here or you can create your own text-based roleplays here.
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Ask questions and get answers on Jass Coding.
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In this board you will find all the resources created using the JASS language. Don't forget to use the submission board to add in our database your scripts.
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text:
Hello My Bow Hunter Friends[:D]
I am trying to do the bow hunting thing for turkeys after having got 5 turkeys in the past 3 years with the 12 gauge.
That being said....Is the only way of getting a turkey with a bow is by using a blind. I like being mobile while I hunt and the thought of having to be in one place with a blind concerns me.
Obviously there is a lot more movement drawing a arrow on the target than with a shotgun... so have I answered my own question by saying I need to be in a blind to hide my movement?


text:
Reading Don Quixote
NEH Summer Seminar for School Teachers
Allow me to begin on a personal note. I have taught Don Quixote, both in Spanish and English, to students in the humanities, to Spanish majors, to graduate students. I have spoken of it incessantly (so my family feels), and I sometimes feel as if I were afflicted with what is jokingly described as cervantitis... . I have engaged the book as editor, scholar, critic, and always, under all guises, as an ever enthusiastic reader of this astonishing text. I have found its traces in the most imaginative narrative experiments in our Western tradition, and in its classic novels; I have found in it also counsel and wisdom on some of the difficult questions of our present society (fundamentalism, ethnocentricity, ideological commitment, and many others).
Don Quixote has taught me how to read, in the broadest sense, and shown me that I am still learning. If my partiality translates into enthusiasm, and that enthusiasm can infect others (as Unamuno wanted Don Quixote's madness to do for his contemporaries), I will have paid back to the hero of my book, Cervantes, some of the joy that I have gained from his creation.
Any views, findings, conclusions, or recommendations expressed in this program do not necessarily reflect those of the National Endowment for the Humanities.


text:
- Home
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Topic Title
- Treatment for Depression After Unsatisfactory Response to SSRIs
Full Report
- Research Review Apr. 26, 2012
Related Products for this Topic
- Research Protocol Jun. 15, 2010
- Surveillance Report Jul. 3, 2013
Original Nomination
Executive Summary – Apr. 26, 2012
Treatment for Depression After Unsatisfactory Response to SSRIs
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Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.
Table of Contents
- Background
- Scope and Purpose of This Review
- Methods
- Data Synthesis
- Results
- Recommendations for Future Research
- Conclusions
- References
- Full Report
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Depression is a complex mental illness associated with disability and reduced quality of life for the person with depression, as well as substantial societal burden. Major depressive disorder (MDD) is the second leading medical cause of long-term disability, the fourth leading cause of global burden of disease, and is predicted to become the second highest cause of disability by 2020.1,2 Depression exerts a negative impact on physical health; it reduces adherence to medical treatment,3 reduces participation in preventive activities,4 and increases the likelihood of risk factors such as obesity,5 smoking,6 and sedentary lifestyles.7 MDD may be associated with immune dysfunction8-11 and cardiovascular disease,12-15 endocrine and neurological diseases, and a general increase in chronic disease incidence.16 Mortality rates are high: approximately 4 percent of adults with a mood disorder die by their own hand, and about two-thirds of suicides are preceded by depression.17 In adolescents, untreated depression results in significant impairment in school performance, interpersonal relationships, risk of suicidal behavior and completion of suicide, risk of early pregnancy, occupational maladjustment, and impaired social and family functioning.18
Pharmacological agents are one of several treatment modalities used for depression, and one of the most frequently utilized classes of antidepressant medications are the selective serotonin reuptake inhibitors (SSRIs). The rate of treatment response following first-line treatment with SSRIs is moderate, varying from 40 to 60 percent; remission rates vary from 30 to 45 percent.19 Up to one-third of persons taking antidepressant medications will develop recurrent symptoms of depression while on therapy.20 The target goal for acute treatment should be remission, which is defined as a resolution of depressive symptoms (a score within the normal range of the symptom scale). Response to treatment (usually defined as at least a 50 percent reduction in symptom levels21) may not be sufficient as a target outcome because residual depressive symptoms are risk factors for relapse and negative predictors of long-term outcome.22 Clinicians are faced with a number of treatment options following an inadequate response to an SSRI, and these include monotherapy or combined therapy. Monotherapy options include: (1) an optimization strategy (increasing the dose or extending the duration of the SSRI), (2) switching to another SSRI, (3) switching to another class of antidepressants, or (4) switching to a nonpharmacological intervention. Combination or add-on therapy options include: (1) combining the SSRI with an augmenting agent, (2) combining antidepressants, or (3) combining the SSRI with a nonpharmacological therapy (such as psychological therapies, exercise, etc.). It is also an option to switch to a new antidepressant and simultaneously combine that antidepressant with a second pharmacological or nonpharmacological treatment. This is sometimes referred to as an acceleration strategy.
Scope and Purpose of This Review
The primary goal of this comparative effectiveness review is to examine the evidence guiding clinical treatment decisions and ultimately to aid clinicians in their care of patients when SSRI therapy for an index episode does not result in an adequate treatment response. The Key Questions are as follows:
Key Question 1. Among adults and adolescents with major depressive disorder, dysthymia, and subsyndromal depression who are started on an SSRI and who are compliant with treatment but fail to improve either fully, partially, or have no response, what is the benefit (efficacy or effectiveness) of monotherapy and combined therapy?
Key Question 1a. How does efficacy/effectiveness vary among the different monotherapies and combined therapies?
Key Question 2. What are the harms of each of the monotherapies or combined therapies among these adults and adolescents? How do the harms compare across different interventions?
Key Question 3. How do these therapies compare in different populations (e.g., different depressive diagnoses, disease severity, age, gender, racial and socioeconomic group, and medical or psychiatric comorbidities)? These subgroups will be considered with respect to the different interventions.
Key Question 4. What is the range of recommended clinical actions following the failure of one adequate course of an SSRI based on current clinical practice guidelines published between 2004 and April 2011?
Search Strategy
The search strategy was limited to studies published from 1980 to April 13, 2011, as SSRIs first became available for the treatment of depression in the early 1980s. The databases searched were: MEDLINE®, Cochrane Central®, PsychINFO®, Cochrane Database of Systematic Reviews, Embase®, CINAHL®, and AMED (Allied and Complementary Medicine). The grey literature search included systematic searches of relevant citations of Web sites: health technology assessment agencies (Hayes Inc. Health Technology Assessment), regulatory information (U.S. Food and Drug Administration, Health Canada, Authorized Medicines for European Community), clinical trial registries (ClinicalTrials.gov, Current Controlled Clinical Trials, Clinical Study Results, WHO Clinical Trials), grants and federally funded research (including National Institute of Health, Health Services Research Projects in Progress [HSRProj]), abstracts and conference proceedings (Conference Papers Index, Scopus), and the New York Academy of Medicine's Grey Literature Index. Additionally, the sites of specialty organizations were searched for clinical practice guidelines (CPGs), and members of the Technical Expert Panel were queried for any additional guidelines of relevance. CPGs were limited to those published between 2004 and April 2011. Reference lists of eligible citations and systematic reviews were also searched for potentially relevant citations.
Study Selection
The study populations were eligible if they included adults (age ≥18 years of age) or adolescents (12 to 18 years of age) with MDD, dysthymia, or subsyndromal depression, who met the following criteria: (1) they were on SSRI treatment for the index episode at the time of entry into the study; (2) they have been judged to have had an "inadequate response" to an SSRI (fluoxetine, citalopram, fluvoxamine, sertraline, escitalopram, or paroxetin) at the time of entry into the study; or (3) when recruited for entry into the study, they were to be placed on an SSRI for purposes of monitoring prospectively the adequacy of their response. Studies with subjects who failed to respond to a non-SSRI antidepressant or a nonpharmacological therapy or combination treatment were excluded. Subjects not receiving an SSRI at the time of entry into the study, and not recruited to evaluate adequacy of response to an SSRI, were excluded. Studies where the entire sample included subjects with postpartum depression, bipolar depression, depressive psychosis, dysphoria, mourning syndrome, postoperative depression, premenstrual dysphoric disorder, pseudodementia, puerperal depression, or seasonal affective disorder were excluded. Similarly, studies where the entire sample were subjects with a cerebrovascular accident, dementias (including Alzheimer's disease, vascular dementia, mild cognitive impairment), Parkinson's disease, hypothyroidism, or Cushings' syndrome were also excluded.
Experimental studies and observational studies with comparator groups were included in this review. Study designs with no comparison group (e.g., case series, qualitative studies) were excluded. There were no exclusions based on the types of pharmacological and nonpharmacological interventions, with the exception of electroconvulsive therapy, vagal nerve stimulation, and repetitive transcranial nerve stimulation.
The primary outcomes included remission (freedom or near freedom from symptoms; 100 percent change relative to baseline) and response (either partial, from 0 to 49 percent change relative to baseline, or complete, from 50 to 99 percent change relative to baseline). Secondary outcomes of interest included speed of response, relapse, quality of life, adherence, return to work, global change as measured by global assessment scales, and external service utilization.
Data Extraction
Relevant fields of information were extracted from individual studies by trained data extractors using standardized forms and a reference guide; a second reviewer verified the accuracy of the data fields reported. Discrepancies were resolved by consensus or consultation. Extracted data included study and population characteristics, eligibility criteria, types of interventions and treatment specifications, and outcomes.
Assessment of Methodological Quality of Individual Studies
We selected the Risk of Bias Tool by the Cochrane Collaboration23 to assess randomized controlled and controlled clinical trials. Studies were evaluated for adequacy of collecting and reporting harms using the McHarm scale.24,25 The AGREE II instrument was used to assess the methodological quality of the CPG.26
Applicability was assessed by establishing a priori the key attributes of the population (wide spectrum of age [8 to 80 years], both genders, range of disease severity, range of the number of previous failures), intervention (using antidepressants with established efficacy in standardized doses), comparator, and outcome (standardized measures) in the context of a wider spectrum of patients in primary care settings; that is, in the context of patients who would likely benefit from these interventions in "real world" conditions. The findings of this review would not apply to subjects who have a primary diagnosis of bipolar disorders, schizophrenia, or major anxiety disorder.
Rating the Body of Evidence
The overall strength of the body of the evidence was assessed using four domains: (1) risk of bias criteria; (2) consistency of results (degree to which study results for an outcome are similar [variability is easily explained, range of results is narrow]); (3) directness of the evidence (assesses whether interventions can be linked directly to the health outcomes); and (4) precision (degree of certainty surrounding an effect estimate for a specific outcome).27 The strength of the evidence is classified in one of four grades: high, moderate, low, or insufficient. Grading of the strength of evidence is applied to individual primary outcomes of benefit (response and remission and also harms [suicidality, weight gain, and sexual dysfunction]).
Data Synthesis
Qualitative synthesis was undertaken separately for adults and adolescents, and for MDD, dysthymia, and subsyndromal depression. Studies were grouped into three categories of treatment strategies that reflected clinical decisionmaking and these included: (1) monotherapy versus monotherapy, (2) monotherapy versus combined therapy, and (3) combined therapy versus combined therapy.
We evaluated the clinical diversity of the study interventions, populations, and outcomes when considering meta-analyzing studies; given the diversity of interventions and populations, summary estimates were not undertaken. Graphs presenting relative risk of individual studies within the various clinical groupings of interventions were prepared to examine differences of effect size.
Description of Eligible Studies and CPGs
From an initial 46,884 citations, 3,147 were screened at full text, and a final set of 44 primary studies (74 publications) and 27 CPGs were eligible for this review. Publications that presented subgroup analyses, secondary analyses, reanalyses, results of different outcomes (not primary outcome measures), or results for different time points on the same study cohort were considered to be secondary records (or companion publications) to the original studies; as such, all STAR*D study publications are counted as a single study (with multiple publications).
Key Question 1. Among adults and adolescents with major depressive disorder, dysthymia, and subsyndromal depression, who are started on an SSRI and who are compliant with treatment but fail to improve either fully, partially, or have no response, what is the benefit (efficacy or effectiveness) of monotherapy and combined therapy?
Key Question 1a. How does the efficacy/effectiveness vary among the different monotherapies and combined therapies?
Forty-one studies (61 publications)28-88 included adults, and three studies (13 publications)89-101 included adolescents. One study evaluated subjects with subsyndromal depression79 and another with dysthymia;67 both of these studies showed no differences between groups when comparing monotherapy or combined therapy treatments. The findings for subjects with MDD are summarized below.
Monotherapy Versus Monotherapies in Adults
Twelve studies (18 publications)30,34,37,39,48,49,51-53,55,59-61,63,65,69,71,72 compared monotherapy interventions relative to other monotherapies. All participants (n=2,611) had MDD and were recruited almost exclusively from outpatient settings. The majority of subjects were white, female, and middle-aged (40 to 49 years). The interventions were a minimum of 4 weeks duration and three of the studies involved dose escalation of sertraline,69 venlaxafine,39 or paroxetine.53 The remaining eight studies (nine publications) evaluated head-to-head comparison following switching from: (1) citalopram to venlaxafine, bupropion, sertraline, or cognitive behavior therapy (CBT);34,59,63 (2) paroxetine to venlaxafine;61 (3) fluoxetine to olanzapine or mianserin;37,71,72 or (4) from an SSRI to duloxetine (tapering methods).52,55 As a group, these 11 studies are at moderate risk of bias across studies, with particular problems in randomization and the role of the funding agency. The findings suggest that there is no certainty of any advantage between different monotherapies (pharmacological or nonpharmacological) for either response to treatment or remission. The exception was a single study that showed that lower-dose sertraline had some small improvement in response, and that the frequency of adverse events decreased at the higher dose; this particular study also suggests that the differences may have been related to the longer trial duration as subjects were randomized after failure to respond to the lower dose.69 There is limited evidence to establish with certainty that a dose escalation or a switch to another antidepressant (SSRI or non-SSRI) is equivalent or superior to any comparator treatment in patients with inadequate response to an initial SSRI; our limited pool of studies would suggest that these monotherapies are equivalent in their treatment effects.
Strength of the Evidence for Monotherapies
When considering any monotherapy versus other monotherapy treatments in adults with MDD, the differing pharmacological and nonpharmacological interventions were considered as a single group, given that so few studies were eligible in this category. The studies generally showed no difference between groups. However, taking into consideration the moderate risk of bias, the imprecision, and the applicability of the populations, the evidence was graded as insufficient for both outcomes of benefit (response and remission); harms (suicidality, weight gain, and sexual dysfunction) were not measured or not reported in most studies, and as such were rated as having insufficient strength of evidence (SOE).
Monotherapies Versus Combined Therapies in Adults
A total of 33 studies (49 publications)28-33,35-38,40-51,54,57-64,68-74,76-78,80-87 evaluated the efficacy and effectiveness of monotherapy relative to combined therapies. Participants in the studies (n=4,537) were all diagnosed with MDD and recruited predominately from outpatient settings. The majority of subjects in these studies were middle-aged females of the white race (when ethnicity was reported). Fifteen studies (18 publications)28,29,35-37,44,54,57,58,61-63,68,69,72,74,76,78 determined failure of response to the SSRI prospectively and 16 retrospectively (18 publications).31-33,38,40-43,45-47,64,70,71,73,77,80,84 No studies evaluated subjects specifically for failed response to fluvoxamine alone.
All but one study59,62,63 employed a randomized controlled trial (RCT) design, and all studies included a pharmacological intervention for at least one treatment arm. The majority of studies employed a study design that had the comparator arm receive ongoing treatment with an SSRI to which the subjects had not had an adequate response by the start of the study; fewer studies employed a design in which patients were switched to a new treatment in at least one study arm.
Four studies31,32,47,62,68 had one treatment arm that evaluated a combination therapy that included the non-SSRI antidepressants clomipramine, bupropion, or desipramine. Twenty-six of 33 studies evaluated combination therapies that included augmenting agents. From these, only five augmenting agents were evaluated in two or more studies; these included atypical antipsychotics (olanzapine and risperidone),37,44,57,72 lithium,47,61,68,74 buspirone,41,46,59,62,63,70,80 mianserin,69,72 and pindolol.42,45 Five studies evaluated the use of nonpharmacological interventions including CBT,43,59 dialectical behavior therapy,78 interpersonal therapy,83,85,87 and exercise.77 Method of randomization, compliance with treatment, and the role of the funder were at high risk of bias for over 75 percent of these studies. Eighteen studies (22 publications) were funded solely by industry,28,29,35-37,41,44,46,50,54,57,58,61,64,69-72,80-82,84 ten (13 publications) by non-industry sources,38,43,47,59,62,63,68,74,77,78,83,85,87 and one by both.33 Overall, these studies were rated as having moderate risk of bias. Inadequate sample size was a factor in many studies.
The majority of studies showed no certainty of any difference for any monotherapy treatment, relative to the comparator combined therapy, for the outcomes of response and remission. The exception was with the atypical antipsychotics (olanzapine, risperidone, ariprazole, quetiapine) used as augmenting agents, which showed small differences favoring the combination therapy. Overall, there is limited supportive evidence for any single augmenting drug or for switching to a different antidepressant (monotherapy) relative to adding another treatment (pharmacological or nonpharmacological).
SOE for Monotherapies Versus Combined Treatment
The SOE for the studies evaluating monotherapies relative to combined therapies had more eligible studies that were categorized into distinct intervention groups. When considering augmenting agents as a single group, the studies were at moderate risk of bias, inconsistent, and imprecise, and as such both the outcomes of benefit and harm were rated as of insufficient SOE. We also partitioned the studies into relevant subgroups based on the type of augmenting agent (atypical antipyschotics, buspirone, lithium, or mianserin). With the exception of atypical antipsychotics (low SOE) and switching to buspirone (low SOE), all other groupings for the different augmenting agents were given a rating of insufficient for evaluating both the outcomes of benefit and harm. When considering the grouping of interventions into those where switching to a new agent (monotherapy) was compared with switching and adding another treatment (such as a new SSRI, non-SSRI, or nonpharmacological treatment), the SOE was graded as low. The STAR*D trial contributed to many of the comparisons and affected the final grade in this treatment category.
Combined Therapies Versus Combined Therapies in Adults
There were six studies (n=832)35,47,59,62,68,75 for which there were treatment arms that compared combination therapies with each other. All but one study75 were RCTs. Women were the majority in all studies, and age ranges varied from 37 to 59 years. Only two studies reported racial composition,59,62 and these subjects were predominately white. Two studies35,75 compared different doses of the same combination drug therapies (ziprasidone and lithium). In addition to SSRIs, added therapies included lithium, desipramine, buspirone, bupropion, citalopram, clomipramine, or CBT. Overall, these studies were rated as having a moderate risk of bias, with problems in randomization, reporting compliance, and balancing prognostic indicators between groups. Adequate sample size was an issue in these studies. There was no certainty of a difference between any combination therapy, including a dose escalation, for the added augmenting agent.
SOE for Combined Therapies
All interventions within the combined therapies relative to other combined therapies were grouped as one category for grading SOE; the overall grade was assigned as insufficient for both the outcomes of benefit and harm due to serious risk of bias, inconsistency, and imprecision.
Treatment in Adolescents
Two studies (trials) evaluated therapies in children and adolescents who had failed to respond to a previous SSRI; one trial of patients ages 12 to 18,89,92,93,96-101 and a second trial of ages 8 to 18.90 In the Treatment for Resistant Depression in Adolescents (TORDIA) trial, the majority of the sample (68 to 72 percent) were girls, with an average age of 16 years.89,92,93,96-101 Study subjects were randomized to four treatment arms that included venlafaxine alone or combined with CBT, or a switch to an SSRI (citalopram, fluoxetine, or paroxetine) alone, or with CBT. This study was at low risk of bias. The trial stated that it aimed to demonstrate the superiority of venlaxafine, but the findings failed to reject the null hypothesis showing no differences between the medication groups. There was a statistically significant difference in favor of including CBT for all outcomes, however. The second trial evaluated a dose escalation of fluoxetine in a small sample, and was suggestive of some benefit to the higher dose, but the study was underpowered to detect a difference.90
SOE for Adolescent Studies
SOE was evaluated for the findings from the TORDIA trial alone. This trial had low risk of bias, and harms were well monitored and reported. The SOE was rated as low due to the potential imprecision of this study.
Key Question 2. What are the harms of each of the monotherapies or combined therapies among these adults and adolescents? How do the harms compare across different interventions?
Harms for interventions used for both adults and adolescents with MDD who had failed to respond to an SSRI were predominately derived from RCTs that evaluated treatment strategies in this population. No observational studies met the eligibility criteria. A clear trend for harms was difficult to specify across the differing interventions in adults. In general, the majority of harms reported were consistent with those associated with antidepressant use and were likely mild to moderate in nature.
With the exception of the studies evaluating children and adolescents, the reporting and collecting of harms was problematic, particularly for predefining harms (e.g., nausea for >1 day), including serious and severe events, and for reporting the total number of events per group in studies with adults. The two studies evaluating adolescents provide good evidence for harms within this population as they were generally at low risk of bias. In studies with adult MDD populations, severe events and serious events such as suicidality were reported inconsistently. A limited number of studies undertook statistical evaluation comparing harms between groups.
Key Question 3. How do these therapies compare in different populations (e.g., different depressive diagnoses, disease severity, age, gender, racial and socioeconomic group, and medical or psychiatric comorbidities)? These subgroups will be considered with respect to the different interventions.
Seven studies undertook stratified or subgroup analyses evaluating factors that may impact treatment outcomes in adults,30,37,41,46,51,64,66,68-70,80 and one for adolescents.89,92,93 The effects of baseline severity, previous treatment failure, age, gender, and race were not sufficiently evaluated and were inconsistent in their impact on outcomes in adults. There is some evidence from the STAR*D level 2 cohort that would suggest that persons with concurrent anxiety symptoms have less likelihood of achieving remission. There is some evidence from the TORDIA trial that milder depression, less family conflict, and the absence of suicidal behavior are associated with greater likelihood of a positive treatment response to combined therapy at 12 weeks in adolescents. A history of physical and sexual abuse may predict response to combined therapy in adolescents.
Key Question 4. What is the range of recommended clinical actions following the failure of one adequate course of SSRI based on current clinical practice guidelines published between 2004 and April 2011?
There were a total of 27 CPGs sponsored by unique organizations and described in 33 publications.18,102-133 Seven CPGs were specific only to adolescents,18,126-131 18 CPGs were for adults alone,102,103,105,107-111,113-117,119,121,123-125 and 2 CPGs were applicable to both.132,133 Four CPGs for adults107,109,116,119 and three for adolescents18,127,130 did not provide any recommendations for patients with previous inadequate responses. Five of the 27 guidelines included patients with dysthymia and subsyndromal depression103,123,126,132,133 but none of the recommendations were for patients with this diagnosis who had failed to respond to previous treatment (pharmacological or nonpharmacological). The majority of CPGs did not specify a definition for inadequate response. All CPGs were applicable to patients from primary care and outpatient settings. The domains within the AGREE II showed great variability in the scores, suggesting significant differences amongst the CPGs. Domains with the greatest variability included domain 3 (rigor of development), domain 5 (applicability), and domain 6 (editorial independence). For adults, increasing the dose or duration was frequently recommended (often a first approach), but the interval or change in dose was not specified. The majority of CPGs did not recommend any specific type of antidepressant when recommending switching to monotherapy strategies. When combination therapy was recommended, there was a greater tendency to specify the drug for adding to the antidepressants. However, there was great variability in the augmenting agents recommended. For adolescents, there was an approximately equal number of CPGs that specified the agents to consider for monotherapy and for combined therapies. Many CPGs expressed a preference to commence treatment using nonpharmacological approaches prior to pharmacological treatment in this population. Some adolescent guidelines cited adult evidence as the evidentiary basis for suggesting treatment strategies.
Recommendations for Future Research
- Future trials should specify a priori the intent of the trial as establishing either equivalence, noninferiority, or superiority of the head-to-head comparisons. Justification for the margin of inferiority or superiority should be specified. Ideally, designing trials to establish superiority is preferred, as this may assist clinicians in selecting amongst competing treatment strategies. Similarly, in studies designed to involve a population of patients who have failed to respond to treatment, determining this failure in a prospective manner as the first part of a two-part study, rather than simply asking patients about failure, confers methodological advantages with regard to minimizing bias and allowing disentanglement of the reasons for failure (adverse events, compliance, or physiological response). Sample sizes in future research studies should be sufficient to establish important margins of difference between groups and to evaluate potentially important confounders, such as age, gender, and baseline severity.
- Future research should include a broader representation of adult patients with respect to age (>50 and <40 years), gender (equal proportion of men), and ethnicity (increased proportion of nonwhite or non-Caucasian, or broader representation of all ethnic groups). Similarly, a broader representation of participants with the medical or psychiatric comorbidities typically found in the primary care setting should be included.
- Studies should be more consistent in reporting the manner for determining previous history of failed treatment trials and past episodes of depression.
- There is a need to increase the number of studies including subjects with dysthymia and subsyndromal depression who have failed to respond to previous SSRI treatments.
- There is also a need to increase research in children (ages 8 to 12 years) and adolescents (ages 12 to 18 years).
- Trials of new add-on treatments for patients not responding to an antidepressant medication have not examined whether the add-on agent is equally effective when added to a range of antidepressant classes. There appears to be an assumption among investigators in this field that response and remission will be comparable regardless of the class of background medication; the clinical or neurobiological data to support this assumption should be confirmed or revisited.
- Future clinical trials should conform to CONSORT134 (Consolidated Standards of Reporting Trials) reporting standards for harms. Severe and serious events (including suicidality) were inconsistently reported and improvement is necessary in this area.
- Development of future CPGs for adolescents or adults should provide a clear definition of inadequate response for both pharmacological and nonpharmacological treatments, and should include standardized methods for establishing this in "real world" settings. Future CPG recommendations should provide greater clarity with regards to recommended treatment actions and should make clear the link between the recommendation and the evidence.
Studies in adults with MDD who have had an inadequate response to an SSRI included a preponderance of subjects with multiple past depressive episodes and multiple past unsuccessful treatment trials. The generalizability of these data to people with few past episodes of depression and few past unsuccessful treatments for depression may be limited. In addition, these studies included a high proportion of caucasians and women, and tended to have an average patient age in the early forties. Studies are needed with a sufficient sample size to explore whether there are differences in race, gender, or across the age spectrum.
The number of studies comparing single medications against each other (monotherapy compared with monotherapy) following an inadequate response to an SSRI are few and evaluate different agents. Extant studies are limited in type of agents utilized, sample sizes, and population characteristics. There is insufficient evidence to determine whether there is a difference between various single-agent therapies in the outcomes of response and remission following an inadequate response to an SSRI.
There is insufficient evidence to evaluate the benefits of ongoing monotherapy with an SSRI compared with combination treatment involving the addition of another antidepressant medication to the initial SSRI. There is low-grade evidence that comparable results are achieved following the switch to an alternate antidepressant medication (monotherapy with a new antidepressant) when compared with adding a nonantidepressant treatment to the initial SSRI (traditional augmentation approach). There is low-grade evidence that adding an atypical antipsychotic medication to ongoing SSRI treatment is associated with higher response and remission rates compared with adding a placebo to ongoing SSRI treatment (following inadequate response to the SSRI). There is insufficient evidence to confirm that there is an improvement in response and remission rates following the addition of any other augmentation agents. There is insufficient evidence to evaluate the benefits or harms of specific combinations of treatments relative to alternative combinations. There is a single study evaluating patients with subsyndromal symptoms and dysthymia who had had an inadequate response to SSRI medications; the evidence base is limited in these populations.
There are three studies evaluating children and adolescents. Only one study provided evidence to support the use of CBT in combination with an antidepressant following inadequate response to an SSRI for adolescents ages 12 to 18 years with MDD. A second study, a pilot with small sample size evaluating dose escalation, showed no effect.
A clear trend for harms was difficult to specify across the differing interventions in adults, although there were some studies (particularly for children and adolescents) where harms were well evaluated and clinically important differences between treatment groups were not apparent. The reporting and collecting of harms was problematic, particularly for predefining harms, including serious and severe events and reporting the total number of events per group in studies with adults.
The majority of CPGs for adults were applicable to patients with MDD in outpatient and primary care settings. Most CPGs did not specify definitions of "inadequate response" but did provide suggestions for treatment approaches. Recommendations for monotherapy (including dose or interval changes, switching to a different SSRI, or to a non-SSRI) were nonspecific as to the drug, interval, or dose change. Recommendations for combination therapy tended to endorse switching or adding different classes of antidepressants and augmenting agents. However, there was inconsistency across CPGs with regard to the types of augmenting agents to use. The variation amongst CPGs reflects the limitations of the evidentiary base.
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Full Report
This executive summary is part of the following document: Santaguida P, MacQueen G, Keshavarz H, Levine M, Beyene J, Raina P. Treatment for Depression After Unsatisfactory Response to SSRIs. Comparative Effectiveness Review No. 62. (Prepared by McMaster University Evidence-based Practice Center under Contract No. HHSA 290-2007-10060-I.) AHRQ Publication No.12-EHC050-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2012. www.ahrq.gov/clinic/epcix.htm.
For More Copies
For more copies of Treatment for Depression After Unsatisfactory Response to SSRIs: Comparative Effectiveness Review Executive Sumary No. 62 (AHRQ Publication No. 12-EHC050-1), please call the AHRQ Publications Clearinghouse at 1-800-358-9295 or email firstname.lastname@example.com.


text: Ive watched both Hillman and Mertens. I had been doing Mertens program with my pup until my Hillmans Dvd came in the mail and i like the HIllmans much better. It more structured it seems and fits ME better. I have seen the numbers some of yall have broke down that says each training "day" last a few actual day before moving on to the next. My question is , If you feel your pup hasnt fully "grasp" what your doing should you hold back until you feel he understands it? I know on Mertens dvd she says that but i dont remember hearing Hillman mention anything about what to do if the pup isnt ready to move to the next progression or day. Thanks


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By NEMS Daily Journal
OXFORD – Ole Miss football fans can see the Rebels play for free in the BancorpSouth Grove Bowl.
A school news release on Wednesday said there will be no charge for the annual spring intrasquad scrimmage, a thank you for "unprecedented support" for athletics this year.
The Grove Bowl will kick off at 1 p.m., on April 13 at Vaught-Hemingway Stadium and will be televised live by CSS.
Seating for the game will be general admission, but club level and suite ticket holders from the 2012 season will be able to access those premium areas.
Those individuals will receive a letter from the UMAA Foundation in the coming weeks with more information.
The Grove Bowl is the culmination of the Rebels' spring drills, which begin on March 17


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CFR Resources on the 2016 Nuclear Security Summit
Beginning on March 31, 2016, over fifty world leaders join President Barack Obama in Washington for the fourth and likely final Nuclear Security Summit (NSS). The Council on Foreign Relations (CFR) offers resources on the global challenge of securing nuclear materials.
See more in Global; Nonproliferation, Arms Control, and Disarmament; Proliferation


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Swords into Plowshares is the blog of the Peacemaking Program and the Presbyterian Ministry at the United Nations of the Presbyterian Mission Agency of the Presbyterian Church (U.S.A.).
Seeking peace. Striving for justice. Together.
by Marissa Costello
"There can be no true beauty without decay." I find this statement by Montague H. Withnail to be quite sad in that, this is our reality. Sometimes the most broken or unintentional creations have beauty.
When taking a tour around the United Nations I saw a fraction of the Berlin Wall that stood high in the garden by the East River. The exterior is covered in graffiti and numerous pieces of artwork.
The significance of this wall is immense. It separated families permanently and restricted travel until 1989. It means so much more than that. The fact ...


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The Bauer reakt 100 helmet offers suspend-tech 2 liner FleXorb technology features PORON® XRD™ foam molded on a 4-way stretch fabric for superior impact absorption. With multiple points of attachment, the Suspend-Tech 2 liner better manages rotational impact, compressing and stretching to minimize excessive movement. This hockey helmet is CSA, HECC, CE certified
Customized Fit
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Just heard inflation for last month was .8 percent. Month before was .7 percent. 1.5 percent for 2 months is a rate of 9% per year. Hopefully it won't continue at that rate but if anyone believes we are in a deflationary period, I would like to hear their logic. Maybe those that supported qe1, qe2 and advocated qe3 would like to respond. How do you stop inflation. Only way I know is to raise the interest rate. A 1% rise in the interest rate will cost an additional 150 billion dollars just to pay the interest on the current debt. That means the gov will have to raise 150 billion in revenue or cut spending 150 billion just to maintain the current rate of the growth in the deficit.
Come on Keynesians. What is the solution. More spending. Surely more of the same thing will get different results. No crying about the past or blaming someone in the past. WHAT IS THE SOLUTION??? We have to deal with the problem TODAY!!


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R. Jack Baas
Baas, R. Jack Russell Jack Baas passed away at age 94 on September 6, 2014. He was predeceased by his wife of 60 years, Jeanette Rylaarsdam Baas. He is survived by his children Marc (Belen) Baas of Arlington, VA, Myra (Ron) Smith of Palm Coast, FL, Curt (Debbie) Baas of Saugatuck, MI, and Cara (Rick) Brzezinski of Waco, TX; nine grandchildren and five great grandchildren. He is also survived by his sister, Norma (Bud) Kahler of Jenison, MI.A memorial service will be held at 11:00 a.m. on Monday at Central Reformed Church with a luncheon following. Memorial contributions may be made to the Jeanette R. Baas Teacher in Residence Program at Central Reformed Church, 10 College Ave. NE, Grand Rapids, MI 49503. http://www.legacy.com/obituaries/grandrapids/obituary.aspx?n=R-Baas&pid=172736746


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Please allow 24-48 hours turnaround time for requests for physical magazines and articles as we continue the renovation process.
Digital Maryland (digitalmaryland.org)
provides online access to digital versions over 5,000 items, including historical maps, photographs, reports, books, manuscripts, artwork, and other media.
Pictured: Detail from a painting of the Vigilant of Baltimore from the War of 1812 collection.


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We added the under cabinet outlets and lights after we got granite countertops, and then tiled the ... read more
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