text:
Criteria for the diagnosis of major depression outlined in the DSM-5 [American: 2013] require symptoms that include 5 or more of the following: depressed mood, loss of interest or pleasure, sleep disturbance, appetite or weight disturbance, low energy, psychomotor disturbance, poor concentration, guilt or shame, and suicidal thoughts or behavior.
Depressive disorders are characterized by sad, empty, or irritable mood and accompanied by somatic and cognitive changes that significantly affect the individual's capacity to function The various disorders differ primarily by timing, duration, and etiology. Depressive disorders are classified as MDD, disruptive mood dysregulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, and other specified or unspecified depressive disorders. [American: 2013] This module will focus on MDD in children.
Other Names & Coding
F32.x, Major depressive disorder, single episode
F33.xx, Major depressive disorder, recurrent episode
F32.8, Other specified depressive disorder
F32.9, Unspecified depressive disorder
F34.1, Persistent depressive disorder (formerly dysthymia)
F34.8, Disruptive mood dysregulation disorder
F43.21, Adjustment disorder with depressed mood
F43.23, Adjustment disorder with mixed anxious and depressed mood
N94.3, Premenstrual dysphoric disorder
Practice Guidelines
Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management.
Pediatrics. 2018. PubMed abstract
Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein REK.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management.
Pediatrics. 2018. PubMed abstract
Roles of the Medical Home
Clinical Assessment
Pearls & Alerts for AssessmentSuicidality
Assessment for depression must ALWAYS include assessment of current and past suicidality. If a patient is expressing suicidal thoughts, measures must be taken immediately to ensure safety. Please see Suicidality.Depression and anxiety
The incidence of depression in children and youth with anxiety is up to 4-fold that of other children. Anxiety generally precedes the onset of depression, so carefully assess youth with anxiety for symptoms of depression.SIGECAPS
This is a mnemonic for the symptoms of depression (save for the first symptom of depressed mood):
- S – sleep
- I – interest
- G – guilt
- E – energy
- C – concentration
- A – appetite or weight
- P – psychomotor changes
- S - suicidality
When assessing youth with depressive symptoms, it is important to interview the patient apart from the parents or caregivers for at least a portion of the visit; often, it is uncomfortable for the patient to discuss the symptoms or related life stressors with caregivers there. That said, it is equally important to speak to parents about the symptoms, current level of functioning, and past history.Sub-threshold symptoms
Youth with sub-threshold depressive symptoms (symptoms inadequate in duration or number to qualify for a specific diagnosis) are at increased risk for developing MDD and should be carefully monitored and assessed for its development.
For the ConditionThe United States Preventive Services Task Force (USPSTF) recommends universal screening for depression in adolescents 12-18 years old. [Siu: 2016] Insufficient evidence exists to recommend universal screening for children 11 years old and younger. [Siu: 2016]
The following validated tools may be used for screening. They may also be used in at-risk populations, to follow and quantify changes in depression severity over time, and in response to treatment.
- Beck Depression Inventory-II - ages 13 and older (available for a fee)
- Patient Health Questionnaire Modified for Adolescents (PHQ-A) ( 228 KB) - ages 11 to 17 (free)
- Center for Epidemiological Studies Depression Scale for Children (CES-DC) ( 37 KB) - ages 12 to 18 (free)
- Center for Epidemiologic Studies - Depression Scale (CES-D) ( 171 KB) - ages 14 and older (free)
Of Family Members
The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. [Siu: 2016] Referral to parents' primary care clinician for screening or using the Center for Epidemiological Studies Depression Scale for Children (CES-DC) ( 37 KB) in the pediatric setting may be appropriate.
Diagnostic Criteria
Depressive disorders in children and adolescents:
- Major depressive disorder (MDD) consists of 1 or more major depressive episodes (2 weeks or more of the symptoms described above). If mania or hypomania is present or has been present in the past, MDD cannot be diagnosed (thus, bipolar disorder excludes MDD).
- Persistent depressive disorder consists of depressed mood on most days for at least 1 year in children (2 years in adults). Persistent depressive disorder may be less severe than MDD in overall number of symptoms but, due to its chronicity, it can result in greater dysfunction in social and school/occupational areas.
- Premenstrual dysphoric disorder (PMDD) consists of symptoms presenting in the week before the onset of menses, including 1 or more of the following: depressed mood, anxiety, irritability, or mood swings combined with 1 or more of the following (for a total of 5 symptoms): loss of interest, poor concentration, low energy, appetite change, sleep disturbance, feeling overwhelmed, or physical symptoms.
- Disruptive mood dysregulation disorder (DMDD) is a new diagnosis meant to address the population of youth experiencing severe, chronic, non-episodic irritability with outbursts. It consists of severe, frequent (>3 times weekly), recurrent outbursts, inconsistent with developmental level and with persistent irritable or angry mood between outbursts over at least 12 months. If mania or hypomania has been present in the past, DMDD cannot be diagnosed (bipolar disorder excludes DMDD).
- Other specified depressive disorder, or unspecified depressive disorder may be diagnosed in situations when a patient has depressed mood but does not meet full symptom or duration criteria for MDD or persistent depressive disorder.
Bipolar depression is characterized by the presence of all of the symptom criteria for MDD and a history of mania or hypomania. Bipolar disorder often presents with symptoms of depression and is important to consider when evaluating a patient for a suspected depressive disorder. Many aspects of diagnosis and treatment of bipolar disorder are distinct from those of other depressive disorders.
Differential Diagnosis
Bipolar disorder may present with depressive symptoms. ALL of the symptoms of depression can be present in patients with bipolar disorder, in which patients alternate between depression and elevated mood states known as mania or hypomania. Diagnostic criteria for bipolar disorder in adults are well established, but there is controversy over their application in children and adolescents. Many aspects of treatment of bipolar disorder are distinct from those of other depressive disorders. Referral to a child and adolescent psychiatrist for diagnostic confirmation is appropriate.
Anxiety disorders may present with low self-esteem, worthlessness, apparent lack of motivation (often anxiety-based avoidance rather than true low motivation), sleep disturbance (insomnia is common as the patient lies awake worrying), eating problems (decreased appetite or eating rituals), and/or poor concentration. Eliciting specific mood symptoms (sadness, irritability) is important in differentiating these diagnoses. See Anxiety Disorders for assessment information.
Disruptive behavior disorders/ADHD may present with poor concentration, low self-esteem, and feelings of worthlessness due to social and academic difficulties.
Anorexia nervosa often presents with depressed or irritable mood, low motivation, and low energy, in addition to decreased food intake and weight loss.
Adjustment disorder with depressed mood consists of depressed mood and impaired function within 3 months of a clearly defined stressful life event. To be diagnosed with an adjustment disorder, the patient cannot meet full criteria for a major depressive episode.
Comorbid & Secondary Conditions
History & Examination
Current & Past Medical HistoryThe history should address symptoms of depression that overlap with those of medical illness (e.g., insomnia, hypersomnia, low energy, appetite changes, and weight changes) and symptoms that might indicate an underlying medical cause for depression.
An up-to-date history of medication use and current medications, including herbal medications (particularly St. John's Wort), dietary supplements, and OTC medications, is important, especially if medication therapy for depression is a consideration.
Interim History: Asking about depressive symptoms is the first step in ongoing assessment. A stepwise approach may help save time:
- Has the patient felt depressed, hopeless, or sad often over the past month, or has she/he felt less interest in or enjoyment of usual activities often over the past month. Depression and diminished interest (aka anhedonia) are cardinal symptoms of depression – one or the other must be present for diagnosis.
- Positive replies should prompt further questioning. The
combination of either depressed mood or diminished interest in usual
activities, along with 4 of the following symptoms fulfills criteria for
major depression:
- Changes in sleep
- Feelings of guilt or worthlessness
- Low energy
- Poor concentration
- Appetite or weight change
- Psychomotor slowing or agitation
- Suicidal thoughts or gestures
- See the above Pearl, SIGECAPS mnemonic for depressive symptoms. Gather information from both the child/adolescent and a guardian. Most child/adolescent mental health professionals agree that adding together symptoms from these separate reports is sufficient for diagnosis of depression. Symptoms must cause significant distress or dysfunction to meet criteria – ask about the impact on school, home, and social areas/activities. Because children may not report symptoms clearly, assessment of changes in behavior or function may provide the best clues.
Family History
Pregnancy/Perinatal HistoryThere is growing interest in the relationship of perinatal factors, such as low birth weight, with depression in later life but conclusive data is lacking.
Developmental & Educational Progress
Children and adolescents with developmental delays can also develop depression. The term "dual diagnosis" refers to the combination of intellectual disability and a psychiatric disorder in the same patient.
Social & Family FunctioningClinically significant distress or impairment in social, occupational, or other important areas of functioning is one of the criteria for diagnosis of a major depressive episode. It is common for children and adolescents with depression to be more withdrawn from family or friends, more irritable, or less interested in normal activities.
Physical Exam
GeneralA normal physical exam can help to rule out medical illness as a cause for depressive symptoms. Examination is also helpful to address the multiple physical complaints (e.g., abdominal pain) that may accompany depression. If a patient presents with concerns of depression, has had a recent physical exam (within the past 6-12 months), and has no new physical complaints or illnesses upon a review of systems, the physical exam may be deferred at the clinician's discretion to allow more time for interviewing.
Laboratory TestingTests to consider in evaluation for a depressive disorder include TSH to screen for hypothyroidism and urine drug screen to screen for substance use, either of which may complicate or cause depression. A urine pregnancy test should be considered in females to allow for consideration of pregnancy in treatment decisions.
ImagingRoutine use of imaging or EEG in the clinical evaluation of depressive disorders is not recommended. [Luby: 2016]
Genetic Testing
Specialty Collaborations & Other Services
Psychiatry/Medication Management (see UT providers [56])
May aid in diagnosing depression and related conditions. Due to chronic shortages in the United States, they often see only those patients with the most severe mental illnesses or those with complicating biological, psychological, or social factors. Referral is necessary for patients with suspected bipolar disorder or depression with psychotic features. See also AACAP Guidelines: When to Seek Referral or Consultation with a Child and Adolescent Psychiatrist.
General Counseling Services (see UT providers [372])
This category includes all types of counselors/counseling for children. Once on the page, the search can be narrowed by city or using the Search within this Category field.
Treatment & Management
Pearls & Alerts for Treatment & ManagementDose and duration of treatment
To achieve full effect, 4 -6 weeks of an adequate dose with adequate adherence is required. This applies to ongoing treatment and management when the clinician should monitor and ensure these factors. When obtaining a report of prior treatment "failures," assess whether adequate duration, dosage, and adherence were achieved.Monitoring treatment efficacy
Most of the screening tools listed in this module can also be used to monitor treatment efficacy.Suicide risk
An independent review of available data by the American Medical Association indicated that "a causal role for antidepressants in increasing suicides in children and adolescents has not been established. ...Concerns that antidepressants potentiate suicidal or self-injurious behavior need to be balanced by the clear risk of suicide in children and adolescents with untreated depression." [Jane: 2016] Another analysis of all available antidepressant RCTS in youth suggests that antidepressants have benefits that may outweigh these risks. [Bridge: 2007] There is also data demonstrating a correlation between higher rates of SSRI prescriptions and reduction in child and adolescent suicide rates. [Gibbons: 2006]
How should common problems be managed differently in children with Depression ?
Over the Counter Medications
Prescription MedicationsCommon medications and classes of medications may cause mood changes and therefore need to be monitored closely. Check for interactions.
Mental Health/Behavior
Antidepressant medications include selective serotonin re-uptake inhibitors (SSRI), such as fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and vilazodone, and non-SSRI antidepressants, such as tricyclic antidepressants (TCA), bupropion, venlafaxine, desvenlafaxine, mirtazapine, duloxetine, levomilnacipran, and vortioxetine. Only fluoxetine and escitalopram are FDA approved for use under 18 years of age; use of all other antidepressants is considered "off label" for MDD in children and adolescents.
For details on use of medications to treat depression, as well as a discussion of antidepressants and suicidal adverse events, see Pharmacy& Medications below.
The other major treatment modality is psychotherapy, which refers to any psychology-based treatment directed by a trained mental health professional and delivered by means of communication or behavioral techniques. Psychotherapy is often referred to as "counseling" or "talk therapy." Several types of psychotherapy exist but the only two with significant research evidence for efficacy in the treatment of depressive disorders in children and adolescents are cognitive behavior therapy (CBT) and interpersonal therapy (IPT).
Specialty Collaborations & Other Services
Psychiatry/Medication Management (see UT providers [56])
Referral is necessary for patients with suspected bipolar disorder or depression with psychotic features. Due to chronic shortages in the US, psychiatrists often only see those patients with severe mental illness or complicating biological, psychological, or social factors. Consider referral for depression for patients who:
- Have no improvement after 6-8 weeks of medications or therapy
- Require more than 2 psychotropic medications to control symptoms
- Require psychiatric hospitalization
- Have parents with significant emotional impairment or substance use issues
- Have complex psychosocial issues (e.g., history of abuse/neglect, legal problems, poor parental support/supervision, family conflict)
- Have a family history suggesting adverse reactions to therapy (e.g., planned antidepressant therapy in a patient with family history of bipolar disorder)
- Are young (≤6 years old)
- Have chronic medical illness
General Counseling Services (see UT providers [372])
This category includes all types of counselors/counseling for children. Once on the page, the search can be narrowed by city or using the Search within this Category field.
Pharmacy & Medications
General considerations for treatment with any antidepressant include: [Boylan: 2007]
- Start at low doses and titrate up over several days as tolerated.
- Patients should have frequent follow-up, preferably weekly until dose is stable and medication is tolerated.
- A trial at an adequate dose should go on 2-4 weeks before any further dose increase because it may take that long to see any benefit. If there is no beneficial effect after 2-4 weeks, dose may be increased.
- Antidepressants work best when taken daily at the same time.
- Most antidepressants with once-a-day dosing can be taken in the morning or evening based upon patient preference and observed side effects.
- Total trial time should be at least 6-8 weeks. A medication trial should not be considered a failure until the maximum tolerated dose has been used for this long without improvement.
- Family history of response to a particular medication may be used as an approximate guide for medication selection.
- The FDA approval of fluoxetine and escitalopram may make those medications appealing choices for clinicians; however, clinical judgment may lead to the use of other medications.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the best-studied antidepressant medications for children and adolescents. They also have significant benefit for anxiety disorders including generalized anxiety disorder, panic disorder, and OCD. The effects of SSRIs on anxiety reduction are important given that anxiety disorders are commonly comorbid with depression.
SSRI side effects are usually mild and often transient. Common side effects include headaches, GI upset, somnolence, agitation, and sexual side effects (e.g., decreased libido, anorgasmia).
In both adults and children, SSRIs confer a small risk of serotonin syndrome, which is an adverse reaction and a medical emergency. Symptoms of serotonin syndrome include fever, confusion, and tremor/rigidity. Risk is increased by certain medication interactions. The most significant and dangerous medication interaction for SSRIs is with MAOIs (monoamine oxidase inhibitors – another type of antidepressant which is infrequently used in children). All patients should be questioned about other medications they are taking, including herbal and over-the-counter medications. If serotonin syndrome is suspected, SSRI should be immediately discontinued, and the patient should be referred to an emergency room for hospital admission. Combining SSRIs with any antidepressant including, but not limited to SNRIs, TCAs, and even other SSRIs, increases the risk for serotonin syndrome.
Treatment is supportive:
Fluoxetine has the most positive data from controlled trials in children and adolescents with 3 trials demonstrating significant difference
from placebo. [March: 2004]
[Emslie: 1997]
[Emslie: 2002] It has a longer half-life than most other SSRIs (1-4 days) and an active metabolite, norfluoxetine, which has an even longer
half-life (7-15 days). This can be a useful pharmacokinetic feature since it is somewhat more forgiving than other SSRIs when
doses are missed. However, if a patient has a negative reaction to fluoxetine, the long half-life can extend the duration
of the adverse reaction.
- FDA approved for use in children 8 years and older with MDD and those 7 years and older with obsessive-compulsive disorder
- Available as brand name (e.g., Prozac) and generic in several formulations, including 10 mg, 20 mg, 40 mg, and 60 mg tablets; 10 mg, 20 mg, and 40 mg capsules; 90 mg delayed release (weekly) capsules; 20 mg/5 ml solution
- Starting dose for adolescents: 10 to 20mg once daily, initial target dose 20mg once daily, dose range 10mg-60mg once daily
Sertraline has 1 positive trial (2 studies, which were combined by study design); however, the significance of the trial results was
lessened by a very high placebo response rate (53%). [Wagner: 2003] High placebo response rates are characteristic of all existing trials of antidepressants in children and adolescents.
- FDA approved for use in children 6 years and older with MDD
- Available as brand name (e.g., Zoloft) and generic in several formulations, including 25 mg, 50 mg, 100 mg tablets and 20 mg/ml oral concentrate
- Starting dose for adolescents: 12.5mg to 25mg once daily, initial target dose 50mg once daily, dose range 25mg to 200mg once daily
Paroxetine has 1 trial with mixed results [Keller: 2001] and 1 negative trial (unpublished, see [Cheung: 2005]), so the evidence for efficacy is equivocal. Paroxetine also appears to be less well tolerated in children and adolescents
in this author's opinion and has significant discontinuation symptoms (possibly due to short half-life of 20 hours).
- Not FDA approved for use in children; other SSRIs may be a better choice for children and adolescents.
Citalopram has had 2 controlled trials. One had positive results [Wagner: 2004]; the other did not show a significant difference from placebo (unpublished). The non-significant study included inpatients
and also had a high dropout rate, which may have made the results difficult to interpret. Citalopram has also been studied
in pediatric patients with functional abdominal pain, with a trend toward efficacy. [Roohafza: 2014]
- Not FDA approved for use in children. In August 2011, the FDA issued a Drug Safety Communication warning of the potential for QT prolongation and Torsades de Pointes in patients taking citalopram at doses higher than 40mg daily and that citalopram should no longer be used at such doses. The FDA also discouraged use of citalopram at any dose in patients with cardiac conditions predisposing to arrhythmia, including congenital long QT syndrome.
- Available as brand name (e.g., Celexa) and generic in 10 mg, 20 mg, and 40 mg tablets and 10 mg/5 ml oral solution
- Starting dose for adolescents: 10mg once daily; initial target dose 10mg to 20mg once daily; dose range 10mg to 40mg once daily.
Escitalopram is the S-isomer of citalopram. Escitalopram has had 3 controlled trials. One controlled trial in adolescents aged 12 to 17
years had positive results (unpublished data, Forest Laboratories). Two other controlled trials [Wagner: 2006] and unpublished data, Forest Laboratories), did not show significant difference from placebo. Of note, a post-hoc analysis
of the data from the published negative study showed a significant difference from placebo for the adolescent age group.
- FDA approved for treatment of depression in adolescents aged 12 to 17 years (based on the strength of the positive study and data from a study of citalopram)
- Available as brand name (e.g., Lexapro) and generic in 5 mg, 10 mg, and 20 mg tablets and 5 mg/5 ml oral solution
- Starting dose for adolescents: 5mg to 10mg once daily, initial target dose 10mg once daily, dose range 10mg to 30mg once daily
- Tricyclic antidepressants (TCAs) have been available for many years but have been eclipsed by the SSRIs, largely due to SSRIs having fewer side effects and less toxicity. It is important for pediatric clinicians to know that multiple trials of TCAs have failed to show significant benefit compared to placebo for treatment of depression in children and adolescents. A Cochrane review from 2013 supported the same conclusion.
Bupropion has no controlled studies for depression in children and adolescents. There is 1 open study of bupropion in children with
depression and comorbid ADHD that has positive results. [Daviss: 2001] Bupropion is used in adults for depression and smoking cessation. Unlike SSRIs, bupropion has little effect on anxiety. It
may be useful in patients with bipolar disorder and depression as it is less likely than other antidepressants to induce mania.
There is a small risk of generalized seizures with bupropion, which is higher at doses >300mg daily. Due to increased risk
of seizures, bupropion is contraindicated in patients with an active eating disorder.
- Not FDA approved for use in children
- Available as brand name (Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban) and generic in 75 mg and 100 mg tablets; 100 mg, 150 mg, and 200 mg extended release (12 hour) tablets; 174 mg, 348 mg, and 522 mg extended release (24 hour) tablets (as hydrobromide); and 150 mg, 300 mg, and 450 mg extended release (24 hours) tablets (as hydrochloride)
- Starting doses in adolescents: bupropion SR 75mg twice daily, initial target dose 100mg twice daily, dose range 75mg to 150mg twice daily; bupropion XL (Wellbutrin XL) starting dose 150mg once daily, initial target dose 150mg to 300mg once daily, dose range 150mg to 450mg once daily.
- Venlafaxine (Effexor, Effexor XR) is an SNRI (serotonin-norepinephrine reuptake inhibitor) and thus possesses an additional mechanism of action compared with SSRIs. The spectrum of effects of venlafaxine is nonetheless similar to that of the SSRIs. In fact, at lower doses (<225 mg daily), the norepinephrine reuptake action is not present, effectively making venlafaxine an SSRI at these doses. There have been few studies of its use in children and adolescents. Venlafaxine was studied in a large RCT involving patients who continued to have depression despite adequate treatment with one SSRI, and was not significantly better in that context than a second SSRI; there was no placebo arm. [Brent: 2008] One unpublished study and one small, randomized controlled trial did not show significant benefits.[Boylan: 2007]Pooled results of these two studies showed a small benefit for adolescents only. Studies may have been hampered by a high rate of placebo response. Venlafaxine also has significant discontinuation symptoms that may begin within a few hours of a missed dose. For these reasons, venlafaxine is at best a second line medication for children and adolescents with depression.
- Desvenlafaxine SR (Pristiq) is an SNRI and is a form of the active metabolite of venlafaxine. Desvenlafaxine SR has had 1 controlled trial. [Weihs: 2018] This trial compared desvenlafaxine SR weight-based dosing to fluoxetine and placebo and was non-significant due to improvement in all study arms. Desvenlafaxine SR is therefore not a first-line medication for children and adolescents with depression.
- Duloxetine (Cymbalta) is an SNRI. Duloxetine has had 2 controlled trials.[Emslie: 2014] [Atkinson: 2014] Both studies compared duloxetine to fluoxetine (as a standard treatment) and placebo. Both studies showed no significant differences between treatments due to improvement in depression in all study arms (duloxetine at both fixed and flexible doses up to 120mg daily, fluoxetine up to 40mg daily, and placebo). Until more positive findings are produced, duloxetine would not be a first-line medication for children and adolescents with depression.
- Levomilnacipran (Fetzima) is the newest SNRI on the market, approved by FDA for treatment of depression in adults in July 2013. There is a controlled study in progress for adolescents with MDD: Clinical Trials for Levomilnacipran in Adolescents (clinicaltrials.gov).
- Mirtazapine (Remeron) has multiple actions at the CNS receptor level that may contribute to antidepressant effect. There have been two unpublished trials of mirtazapine for depression in children and adolescents. Neither trial demonstrated significant difference from placebo. As with venlafaxine, this lack of apparent effect may be due to high placebo response rates. Still, mirtazapine would not be a first-line medication choice for children and adolescents with depression.
- Vilazodone (Viibryd) inhibits serotonin reuptake and modulates serotonin receptors. It was approved by FDA for treatment of depression in adults in January 2011. A controlled study in pediatric MDD focused on adverse effects was completed in October 2018: Clinical Trials Vilazodone in Adolescents (clinicaltrials.com).
- Vortioxetine (Trintellix) also inhibits serotonin reuptake and modulates serotonin receptors. It was approved by FDA for treatment of depression in adults in September 2013; there have been no controlled studies of the efficacy of vortioxetine in depressed children or adolescents.
Use of antidepressant medication in children has become a controversial topic ever since the British Medications and Healthcare Regulatory Agency banned the use of all antidepressants except for fluoxetine in patients <18 years of age in the United Kingdom in 2003. This ban was instituted due to concerns about the potential for suicidal thoughts or behavior in patients taking antidepressant medication. Subsequent evaluation by the US FDA led to a black box warning in 2004 for all antidepressants stating that they may increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders. The FDA added a similar warning in 2007 for young adults aged 18-24 years.
The FDA did not institute a ban on use of antidepressants in children and adolescents, nor did the agency revoke the approval of fluoxetine for treatment of depression in patients aged 7-18. The warning reflects an increased risk of suicidal thoughts or behaviors only, not an increased risk of completing suicide: No one in the studies evaluated by the FDA completed suicide. For those taking active medication, the risk of suicidal thoughts or behaviors was only 3.9%; while the placebo group was 1.8%. [Hammad: 2006]
An independent review of available data by the American Medical Association indicated that "a causal role for antidepressants in increasing suicides in children and adolescents has not been established. ...Concerns that antidepressants potentiate suicidal or self-injurious behavior need to be balanced by the clear risk of suicide in children and adolescents with untreated depression." [Jane: 2016] Another analysis of all available antidepressant RCTS in youth suggests that antidepressants have benefits that may outweigh these risks. [Bridge: 2007] There is also data demonstrating a correlation between higher rates of SSRI prescriptions and reduction in child and adolescent suicide rates. [Gibbons: 2006]
Given concerns for SAEs, rational prescribing practices include making patients and parents aware of the safety concerns around antidepressant use. Patients who are started on antidepressant medication should be observed closely for clinical worsening, suicidal thoughts, or unusual changes in behavior. Families and caregivers should be advised to closely observe the patient and to communicate with the prescribing physician. Follow-up should occur within 1 week after a patient is newly started on an antidepressant.
Specialty Collaborations & Other Services
Psychiatry/Medication Management (see UT providers [56])
Can be very helpful in guiding and/or managing pharmacologic therapy, particularly for patients who do not respond promptly or well to standard medications.
Ask the Specialist
Resources for Clinicians
On the Web
Depression Resource Center (AACAP)
Information for clinicians and families, including FAQs, "Facts for Families," books, videos, practice parameters, research, and getting help for depression; American Academy of Child & Adolescent Psychiatry.
Resources for Primary Care (AACAP)
A resource center for clinicians treating substance use disorders and mental health issues. Includes practice parameters, a guide for integrating mental health care into the medical home, and information about policy and advocacy; American Academy of Child & Adolescent Psychiatry.
Helpful Articles
PubMed search for depression in children and adolescents, last two years
Cheung AH, Kozloff N, Sacks D.
Pediatric depression: an evidence-based update on treatment interventions.
Curr Psychiatry Rep. 2013;15(8):381. PubMed abstract / Full Text
David-Ferdon C, Kaslow NJ.
Evidence-based psychosocial treatments for child and adolescent depression.
J Clin Child Adolesc Psychol. 2008;37(1):62-104. PubMed abstract
Maalouf FT, Brent DA.
Child and adolescent depression intervention overview: what works, for whom and how well?.
Child Adolesc Psychiatr Clin N Am. 2012;21(2):299-312, viii. PubMed abstract
March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J.
Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial.
JAMA. 2004;292(7):807-20. PubMed abstract
Wren FJ, Foy JM, Ibeziako PI.
Primary care management of child & adolescent depressive disorders.
Child Adolesc Psychiatr Clin N Am. 2012;21(2):401-19, ix-x. PubMed abstract
Clinical Tools
Assessment Tools/Scales
Beck Depression Inventory-II
A self-administered, 21-item, 10-minute screen for depression for ages 13 years and older; available in Spanish or English for purchase.
Center for Epidemiologic Studies - Depression Scale (CES-D) ( 171 KB)
A free, self-administered, 20-item, 10-minute screen for depression for ages 14 years and older.
Patient Health Questionnaire (PHQ) Screeners
Free screening tools in many languages with scoring instructions to be used by clinicians to help detect mental health disorders. Select from right menu: PHQ, PHQ-9, GAD-7, PHQ-15, PHQ-SADS, Brief PHQ, PHQ-4, PHQ-8.
Bright Futures in Practice: Mental Health—Volume II, Tool Kit
Comprehensive set of tools for clinicians and families; addresses mental health in various pediatric age groups; includes a variety of resources, checklists, intake and assessment forms, and patient education materials.
Resources for Patients & Families
Information on the Web
Children's Mental Health (MHA)
Policy, advocacy, information, and referral to maximize mental health for people of all ages; Mental Health America.
Depression (NAMI)
Explanations of treatment for various mental disorders, including depression, and suggestions for how to help yourself or others who are struggling with mental health issues ; National Alliance on Mental Illness.
Teens & Young Adults (NAMI)
Focused information about adolescent depression, how to find help, and links to a teen mental health forum called Ok2Talk; National Alliance on Mental Illness.
Depression in Children and Teens (AACAP)
Common symptoms of depression in children and teenagers; American Academy of Child and Adolescent Psychiatry.
Child and Adolescent Mental Health (NIMH)
Information about mental health conditions in children and adolescents, including a list of warning signs, featured videos, and health hotlines; National Institute of Mental Health.
Childhood Depression: What Parents Need to Know (KidsHealth)
How to recognize depression in children, give support, and seek help.
National & Local Support
Utah National Alliance on Mental Illness (NAMI)
Utah chapter of the National Alliance on Mental Illness; provides advocacy and information about mental illnesses.
National Alliance of Mental Illness (NAMI)
A national organization provides information and resources for families and professionals, including a helpline, local chapter resources, and advocacy, links to state chapters, information about conferences, and links to additional resources.
Depression in Children and Adolescents (ClinicalTrials.gov)
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.
Services for Patients & Families in Utah (UT)
|Service Categories
|# of providers* in:
|Other states (4) (show)
|General Counseling Services
|Psychiatry/Medication Management
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Authors & Reviewers
|Thomas G. Conover, MD
|Jonathan D. Birnkrant, MD
|2013: first version: Thomas G. Conover, MDA
American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders, DSM-5.
Fifth ed. Arlington, VA: American Psychiatric Association; 2013. 978-0-89042-554-1
Atkinson SD, Prakash A, Zhang Q, Pangallo BA, Bangs ME, Emslie GJ, March JS.
A double-blind efficacy and safety study of duloxetine flexible dosing in children and adolescents with major depressive disorder.
J Child Adolesc Psychopharmacol. 2014;24(4):180-9. PubMed abstract
Birmaher B, Brent D, Bernet W, Bukstein O, Walter H, Benson RS, Chrisman A, Farchione T, Greenhill L, Hamilton J, Keable H,
Kinlan J, Schoettle U, Stock S, Ptakowski KK, Medicus J.
Practice parameter for the assessment and treatment of children and adolescents with depressive disorders.
J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503-26. PubMed abstract
The most recent practice parameter on the diagnosis and treatment of depressive disorders in children and adolescents. Our prevalence calculation roughly adjusts the cited age-specific prevalences for the age distribution in typical primary care pediatric practice.
Boylan K, Romero S, Birmaher B.
Psychopharmacologic treatment of pediatric major depressive disorder.
Psychopharmacology (Berl). 2007;191(1):27-38. PubMed abstract
Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, Vitiello B, Ritz L, Iyengar S, Abebe K, Birmaher B, Ryan N,
Kennard B, Hughes C, DeBar L, McCracken J, Strober M, Suddath R, Spirito A, Leonard H, Melhem N, Porta G, Onorato M, Zelazny
Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial.
JAMA. 2008;299(8):901-13. PubMed abstract / Full Text
Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher B, Pincus HA, Ren L, Brent DA.
Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials.
JAMA. 2007;297(15):1683-96. PubMed abstract
Cheung AH, Emslie GJ, Mayes TL.
Review of the efficacy and safety of antidepressants in youth depression.
J Child Psychol Psychiatry. 2005;46(7):735-54. PubMed abstract
Cheung AH, Kozloff N, Sacks D.
Pediatric depression: an evidence-based update on treatment interventions.
Curr Psychiatry Rep. 2013;15(8):381. PubMed abstract / Full Text
Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein REK.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management.
Pediatrics. 2018. PubMed abstract
David-Ferdon C, Kaslow NJ.
Evidence-based psychosocial treatments for child and adolescent depression.
J Clin Child Adolesc Psychol. 2008;37(1):62-104. PubMed abstract
Daviss WB, Bentivoglio P, Racusin R, Brown KM, Bostic JQ, Wiley L.
Bupropion sustained release in adolescents with comorbid attention-deficit/hyperactivity disorder and depression.
J Am Acad Child Adolesc Psychiatry. 2001;40(3):307-14. PubMed abstract
Emslie GJ, Heiligenstein JH, Wagner KD, Hoog SL, Ernest DE, Brown E, Nilsson M, Jacobson JG.
Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial.
J Am Acad Child Adolesc Psychiatry. 2002;41(10):1205-15. PubMed abstract
Emslie GJ, Prakash A, Zhang Q, Pangallo BA, Bangs ME, March JS.
A double-blind efficacy and safety study of duloxetine fixed doses in children and adolescents with major depressive disorder.
J Child Adolesc Psychopharmacol. 2014;24(4):170-9. PubMed abstract / Full Text
Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody T, Rintelmann J.
A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression.
Arch Gen Psychiatry. 1997;54(11):1031-7. PubMed abstract
Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL.
Subthreshold depression in adolescence and mental health outcomes in adulthood.
Arch Gen Psychiatry. 2005;62(1):66-72. PubMed abstract
Flint J, Kendler KS.
The genetics of major depression.
Neuron. 2014;81(3):484-503. PubMed abstract / Full Text
Gibbons RD, Hur K, Bhaumik DK, Mann JJ.
The relationship between antidepressant prescription rates and rate of early adolescent suicide.
Am J Psychiatry. 2006;163(11):1898-904. PubMed abstract
Hammad TA, Laughren T, Racoosin J.
Suicidality in pediatric patients treated with antidepressant drugs.
Arch Gen Psychiatry. 2006;63(3):332-9. PubMed abstract
Jane Garland E, Kutcher S, Virani A, Elbe D.
Update on the Use of SSRIs and SNRIs with Children and Adolescents in Clinical Practice.
J Can Acad Child Adolesc Psychiatry. 2016;25(1):4-10. PubMed abstract / Full Text
Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, Hagino OR, Koplewicz H, Carlson GA, Clarke GN, Emslie GJ,
Feinberg D, Geller B, Kusumakar V, Papatheodorou G, Sack WH, Sweeney M, Wagner KD, Weller EB, Winters NC, Oakes R, McCafferty
Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial.
J Am Acad Child Adolesc Psychiatry. 2001;40(7):762-72. PubMed abstract
Kupfer DJ, Frank E, Phillips ML.
Major depressive disorder: new clinical, neurobiological, and treatment perspectives.
Lancet. 2012;379(9820):1045-55. PubMed abstract / Full Text
Luby JL, Belden AC, Jackson JJ, Lessov-Schlaggar CN, Harms MP, Tillman R, Botteron K, Whalen D, Barch DM.
Early Childhood Depression and Alterations in the Trajectory of Gray Matter Maturation in Middle Childhood and Early Adolescence.
JAMA Psychiatry. 2016;73(1):31-8. PubMed abstract / Full Text
Maalouf FT, Brent DA.
Child and adolescent depression intervention overview: what works, for whom and how well?.
Child Adolesc Psychiatr Clin N Am. 2012;21(2):299-312, viii. PubMed abstract
March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J.
Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial.
JAMA. 2004;292(7):807-20. PubMed abstract
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J.
Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A).
J Am Acad Child Adolesc Psychiatry. 2010;49(10):980-9. PubMed abstract / Full Text
Merikangas KR, Nakamura EF, Kessler RC.
Epidemiology of mental disorders in children and adolescents.
Dialogues Clin Neurosci. 2009;11(1):7-20. PubMed abstract / Full Text
Roohafza H, Pourmoghaddas Z, Saneian H, Gholamrezaei A.
Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial.
Neurogastroenterol Motil. 2014;26(11):1642-50. PubMed abstract
Siu AL.
Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.
Pediatrics. 2016;137(3):e20154467. PubMed abstract
Wagner KD, Ambrosini P, Rynn M, Wohlberg C, Yang R, Greenbaum MS, Childress A, Donnelly C, Deas D.
Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: two randomized controlled trials.
JAMA. 2003;290(8):1033-41. PubMed abstract
Wagner KD, Jonas J, Findling RL, Ventura D, Saikali K.
A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression.
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Wagner KD, Robb AS, Findling RL, Jin J, Gutierrez MM, Heydorn WE.
A randomized, placebo-controlled trial of citalopram for the treatment of major depression in children and adolescents.
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Wren FJ, Foy JM, Ibeziako PI.
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Pediatrics. 2018. PubMed abstract


text:
Lamar, Joseph Rucker
Lamar, Joseph Rucker ləmär´ [key], 1857–1916, American jurist, b. Elbert co., Ga. He was admitted to the Georgia bar in 1878, served (1886–89) in the state legislature, and compiled The Code of the State of Georgia (1896). He served (1904–6) on the state supreme court and was associate justice of the U.S. Supreme Court (1911–16).
See biography by his wife, C. P. Lamar (1926).
The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2023, Columbia University Press. All rights reserved.
See more Encyclopedia articles on: U.S. History: Biographies

subset: commoncrawl


text:
Bunn Dual Soft Heat – 120/208V
For High Volume Usage
Brews 18.9 gallons (71.5 litres) of perfect coffee per hour
Detailed Product Description:
• 3 Batch-Size Settings: .5, 1, or 1.5 gallon (1.9, 3.8 or 5.7 litre) batches
• Variable Batch Selector Knob Lets You Brew Large Batches or Small Servings
• Patented server heat control automatically shuts off once target temperature is reached. Can be set to 175º–190ºF (79.4–87.8ºC)
• Electronic Grinder Interface Instructs Grinder on Exact Amount of Coffee for Selected Brew Size
• Remote 1 or 2 server docking stations for additional satellite coffee serving
• Safety-Fresh® patented brew-through lid with vapor seal and spill prevention
• Stainless Steel Funnels
• 3 Batch-Size Settings: .5, 1 and 1.5 gallons
• Upper Hot Water Settings
• Stainless Décor
Servers Sold Separately – Click Here
Use water filter
Easy Clear® EQHP-25 or
Easy Clear® EQHP-25L
No cord attached
Electrical: 120/208V/30 amp – requires 3-wires plus ground service rated 120/208V,single phase,60Hz.
Plumbing: 20-90 psi (138-621 kPa). Machines supplied with 1⁄4" male flare fitting
Size: 35.8"H x 18"W x 22.2"D
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Warranty: Circuit boards: 3 years parts and labor; All other parts: 2 years parts and 1 year labor
Confused about which model to buy?
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Click here for our Bunn Coffee Maker Comparison Chart


text:
College Quick Shots: LeighAnn Hranka finishes strong
LeighAnn Hranka (Guilford) recently finished her college volleyball career when her Illinois State team fell 3-2 to Wichita State in the Missouri Valley conference tournament.
Hranka had four blocks and finished with a hitting percentage of .500 with nine kills and one error in what turned out to be her final collegiate game. Hranka was second on the team in overall scoring, hitting percentage and blocks after she helped ISU (19-13) to another strong season. Hranka is starting her final semester internship in sports marketing with a Parks and Recreation major, and hopes to graduate this summer.
Kirk earns honor
Rockford University tight end Dane Kirk (Rochelle) earned one final award to cap an impressive junior season when he was selected honorable mention All-American. He has now received three major awards this year after also making second-team preseason All-American and then second-team All-Northern Athletics Collegiate Conference honors at the conclusion of the season.
Kirk had a breakout year with a school-record 63 receptions for 702 receiving yards and five touchdowns. His 63 catches were the second most by a tight end on the All-American ballot, and his receiving yards were the sixth highest among all the Division III All-American tight end nominees.
Anthony wrestles to tourney title
Wisconsin-Parkside sophomore Josh Anthony (Harlem) won the 184-pound wrestling title at the recent St. Cloud State Husky Open. Anthony received a first-round bye, then pinned his next two opponents before winning 5-3 in the finals.
Catching up
Rachel Konieczki (Lutheran) is averaging 2.4 points and 1.2 rebounds as a true freshman for Bowling Green (8-1). She averages 8.4 minutes, seventh on a team where all five starters average more than 30 minutes.
Sophie Reecher (Byron) is averaging 3.9 points and 2.7 rebounds in 12.1 minutes for Toledo (5-4) as a true freshman.
Jay Taft: 815-987-1384; firstname.lastname@example.com; @jaytaft


text:
A new economic club of nations
The G-20 summit this weekend will grapple with a global crisis.
| Washington
A formal farewell to the American-led postwar financial system and a coming-out party for an expanded club of economic powers that will design new rules to meet the global financial crisis.
That is how this weekend's Group of 20 summit, called by President Bush, is likely to be remembered: not so much for the action taken, as for the milestone it marked and the emerging global economic order it heralded.
"The summit marks a more inclusive form of international cooperation" in dealing with the global economy, says Sebastian Mallaby, director of geoeconomic studies at the Council on Foreign Relations in Washington. After decades of a handful of leaders from the richest economies meeting to address the world economy, "just the creation of the G-20 at head-of-state level will be the first accomplishment."
One reason that the Washington summit, which begins Friday with a White House dinner, is not expected to reach any significant accords for addressing a deepening economic meltdown is that American leadership is in limbo. Mr. Bush invited President-elect Barack Obama to attend, but Mr. Obama declined, sticking to the long-held tradition of "one president at a time."
While a call to broad international participation in efforts to stimulate the global economy may figure in the summit's final communiqué Saturday, representatives of participating countries and international economic experts say they expect a bigger emphasis on future steps.
Working groups are likely to be set up to suggest solutions to the specific problems deemed to have led to the financial crisis. Expected areas of focus include transparency in international financial transactions and regulation of a globalized financial system.
France is expected to offer to host a follow-up summit as early as February, with some officials suggesting the first decisionmaking on new rules – and the institutions to enforce them – could come by the end of March.
What is clear is that the new international economic order, what Europeans especially refer to as "Bretton Woods II" (after the international meeting that established financial institutions for the post-World-War-II world), will reflect a diffusion of economic power and responsibility to countries like China, Brazil, and South Korea.
"This summit recognizes where the world is going," says John Williamson, a development economist at the Peterson Institute for International Economics in Washington. Although a slightly smaller grouping than the G-20 countries might have been more efficient, he says, "the fact is that decisions without China and India and Brazil at the table aren't worth very much."
Indeed, with the world's major developed economies expected to shrink next year, the emerging economic powers are suddenly cast in the unfamiliar role of posse riding to the rescue. China, for example, is still expected to grow about 8 percent.
"The times are over when things could be decided just by the G-7," says a high-ranking European official in Washington who spoke on condition of anonymity. "It can't be just the G-7 countries [because] we have to bring in the countries with huge reserves and growing markets."
Developing countries are welcoming the expansion of the world economic club to include them. But they are also demanding a bigger role in international economic decisionmaking.
Worried that a financial crisis spawned in the US and abetted by a weak regulatory system will bring them down as well, developing countries are expecting reforms that recognize the advent of a globalized economy. But they also will demand recognition of their particular needs.
For instance, developing countries are likely to push for maintaining and expanding mechanisms promoting access to investment funds. "I'd expect that to be quite a fixture in future negotiations, but it's not something the G-7 would have been likely to push," Mr. Williamson says.
Another area of interest is trade, especially since the economies of so many developing countries are dependent on export markets. Brazilian President Luiz Inácio Lula da Silva told a finance ministers' meeting in Brazil last Saturday that the world must "avoid the temptation of resorting to financial and trade protectionism as a mechanism to overcome the crisis."
Simply by calling an emergency summit of more than 20 countries, Bush is recognizing the growing role of developing economies. But he is also calling for the summit to take up specific reforms that acknowledge a changed world.
For example, he wants a "modernization" of the World Bank and International Monetary Fund that would include extension of voting rights and expansion of their executive boards to developing countries.
What the US under the Bush administration does not want to see is the summit and follow-on meetings turn into an assault on the postwar, free-market system. In prepared remarks he was to deliver Thursday afternoon in New York, Bush advocated "specific actions" to improve the system. But he also warned against overzealous attempts to "reinvent" it, saying "government intervention is not a cure-all."
That shot over the bow appeared aimed at some leaders like French President Nicolas Sarkozy, whose vision of a crisis fix includes a more robust governmental role and more intrusive intervention.


text:
As I mentioned in the introductory post, during the Introduction to SQL Server Security session for Pragmatic Work's Training on the T's, I received a large number of questions that there wasn't time to answer. Instead of just a re-cap of all of the questions, instead I've opted to put together a post per topic. Hopefully, this will help, not just those that attended the session, but also anyone searching for the same questions later on.
Security question
The next question in the list is:
What are some tips regarding roles other than sysadmin?
This is another security question that I like. I like it because it looks at and considers roles other that sysadmin for users. Often I see instance and database security configured in a security vacuum that only leverages sysadmin and db_owner. Of course, not all of the other server roles are that useful. Before tips on leveraging the other server roles, we need to know what those other roles are:
- bulkadmin – Ability to execute BULK INSERT statements
- dbcreator – Ability to create, alter, drop, and restore databases with no restrictions
- diskadmin – Ability to manage disk files used during backups.
- processadmin – Ability to kill processes on the SQL Server instance, aka spid-killer.
- public – No abilities granted by default. Everyone has access to this role.
- securityadmin – Ability to reset logins and set permissions at the server and database level.
- setupadmin – Ability to add and remove linked servers.
Server Role Tips
- The bulkadmin role can be useful for accounts performing ETL or ELT operations. If the process needs BULK INSERT access, this is the best method to provide that access without granting excess permissions.
- A common recommendation I've heard for dbcreator, over the years, is to grant access to this role for applications that need create databases when they are installed. Since the role has the ability to drop any database on an instance, it is not actually ideal for that purpose.
- A good use for dbcreator is to grant it to DBAs that you want to grant limited access to the server. It provides coverage for quite a few of the core duties of DBAs without granting full server access.
- The diskadmin role is about the most pointless role, don't use it. It's limited to such a small set of permissions that don't allow the grantor to really accomplish anything.
- The processadmin role has less permissions that sysadmin, but is nearly as powerful. If someone requests this, treat requests for this role the same as you would from sysadmin. Do you really want users killing spids?
- The public role is the only role that can be granted permissions that everyone with server access would inherit. Don't do this. The abuse, or use, of public can cause lots of headaches.
- The setupadmin role is another that has limited usefulness. While it does provide access to the ability to create linked servers, this is likely something that DBAs with more permissions would be deploying.
- Treat securityadmin similar to sysadmin. Since it can grant most server and database permissions, it is able to grant access to virtually everything sysadmin has access to.
As shown, there are some useful other server roles available, such as bulkadmin and dbcreator. Most of the roles, though, are fairly limited in their usefulness. It's important to know them all and their limitations. Because, while you might be stringent on sysadmin, the clever developer might ask for the securityadmin role, leaving you unaware that the keys to the castle were just given away. Any other tips for leveraging server roles that you think people should know?


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Stranger and stranger
Last week I was all about David Sedaris; this week it's his sister Amy, whose home decor ("a collection of plaster meats, a few stuffed squirrels, books on skin disorders") was recently featured in the New York Times and whose masterwork of a movie, "Strangers with Candy," comes out today in New York and July 7 everywhere else. Amy's character in "SwC" was based on Florrie Fisher, a bizarre B-list star of the 60s and 70s who, according to Wikipedia, Â
traveled to high schools in the United States, speaking about her past as a heroin addict and prostitute. ... Fisher's trollish appearance, thick Brooklyn accent, and larger-than-life tales of prostitution, botched abortions, and lesbian jailhouse encounters turned her into a cult figure in the late 1970s, with bootleg videos of her public service announcement becoming a collector's item in the 1980s.
Wow. All my high school ever got was a sweaty Robert Louis Stevenson impersonator.


text:
Our Pacific Coast Bike tour is O V E R . We've been back for a while now but it's taken me this long to process the trip and figure out what I wanted to say about the amazing experience of riding 946 miles in 22 days with 2 tandems and 2 kids under 12.
Can I just say Wow and leave it at that?
I have to admit we're all pretty sad about being home. It's taken me this long (almost 4 weeks) to even think about blogging our trip: acclimating to real life and accepting that we we're back has been tough. Good thing we've had out-of-town visitors for the past 3 weeks to keep us busy, we haven't had time to wallow too much.
I'm not alone in my malaise: 3/4 of our family (the 11-year-old is a tween, what do you expect?) experienced extreme let down for the first week home and had a hard time getting back to "our normal life" Our 9-year-old summed it up perfectly when recounting our adventures to a friend, " I miss our trip".
Yes, I miss our trip too.
After we arrived in the Bay Area, slept a lot and enjoyed 4 rest days with friends and family in San Rafael and Oakland, we were ready to head out again. If we had more time, we would have continued South for another month or more. I'm not kidding, even the kids were ready to continue. There's something about bike touring: simply put, it's addicting.
I still miss our trip but have stopped thinking about it on a daily basis, so I guess you can say I've re-acclimated to life in the city.
If you have bike toured or gone on an extended adventure of any kind, I'm sure you can relate. Bike touring epitomizes a simple existence: take only what you can carry and leave the rest behind. Extra stuff = enormous burden.
The daily touring routine consists of 3 basic needs: eat, ride, and sleep (wake up, make and drink ample amounts of coffee, eat breakfast, take down camp, pack up, ride and ride and ride, eat and eat and eat, arrive at your destination, set-up camp and do it all over again).
22 days of pure simple family touring bliss.
Once our bodies adjusted to the physical intensity of pedaling 50+ miles a day and 5000+ feet of climbing , the trip became easy.
Yes, easy.
Weird to type those words. Many of you probably think I'm crazy for claiming that pedaling 946 miles on 2 tandems in 22 days with 2 kids under 12 was easy. But it was. Our first tour: a 200 mile trip to the San Juans last summer was way more difficult.
I'm not kidding, after the 1st week (when we all talked about our butts A LOT) and experienced daily physical exhaustion that the kids had never experienced and the parents hadn't experienced in a while, we got into a good rhythm and just clicked along like a well-oiled machine.
I won't bore you with the details in this post, but I can assure you that we all have a lot to say about the tour but will dish it out in separate posts in the coming weeks and months. The kids both want to write posts as well.
Possible future posts =
- just us: amazing family time, no media or outside influences
- people we met along the way
- highs and lows
- tandems on public transportation
- garbage in the ditch
- animals: dead and alive (who do you think wants to write those?)
I'll leave you with some stats and the promise to write more:
- 946 miles
- 22 days
- biggest mileage day: 71.6 miles
- biggest climbing day: 6870 ft
- 4 hotels
- 17 nights of camping
- 1 flat
- 1 crash
- countless animals (dead and alive)


text:
DHFL Pramerica Arbitrage Fund - Direct (Div-Q)
Current NAV
Return Details
| Return As On Date
Jan 29, 2018
|1 Month
|3 Month
|6 Month
|1 Year
|3 Year
|5 Year
FUND Returns v/s Scheme Category average
Peer Comparison
|Scheme Name
|Assets (Rs.cr)
|3 Months%
|6 Months%
|1 Year%
|3 Year%
|5 Year%
Registrar Details
|Investment Plan:
|Launch Date:
|Asset Size (Rs cr):
|Minimum Investment:
|Last Dividend:
|Fund Manager:
|Entry Load:
|Exit Load:
|Load Comments:
|Fund Manager Name:
|Manager Designation:
|Manager Qualification:
|Manager Experience:
AUM Movement
Growth in AUM of a fund indicates that investors interest in the fund and conviction over its performance is increasing. Steady growth in AUM is always a good sign
Company Details
To generate income by investing in arbitrage opportunities that potentially exist between the cash and derivatives matket as well as within the derivatives segment of the market. Investments may also be made in debt & money market instruments.


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The man facing charges in the deaths of two Dearborn, Mich. Family Dollar employees told the victims' families he was innocent as he left the court following his arraignment.
Lavere Douglas-Lee Bryant, 34, faces eight counts, including two first-degree murder charges connected to the shooting deaths of Brenna Machus and Joseph Orlando earlier this month.
"I did not murder them," Bryant said to the families of Machus and Orlando as he was led out of court Thursday.
Bryant was arrested July 19, the day after Machus, 20, was found shot in the head in a wooded area near the Rouge River. Orlando, 20, was found shot in the head July 16 in the Family Dollar in Dearborn when other employees arrived to open the store.
The suspect had been fired earlier this year as an assistant manager at a different Family Dollar for allegedly harassing employees.
In addition to first-degree murder, Bryant faces two counts of felony murder and one count each of armed robbery, unlawful imprisonment, being a felon in possession of a firearm, felony use of a firearm and being a habitual offender, third offense.
Bryant has two previous convictions: In 1999, he was convicted of second-degree criminal sexual conduct and in 2001, he was convicted of assault with intent to do great bodily harm. He was also previously charged with first-degree home invasion, but the case was dismissed.
"This is a case with no winners -- all losers," said Police Chief Ronald Haddad. "The public can rest easier because it's a safe place. It can happen anywhere in America, and it happened here."


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The Trayvon Martin Story And The Media
This is TALK OF THE NATION. I'm Neal Conan in Washington. And we turn, now, to the death of Trayvon Martin and how this story has been covered by the mainstream news outlets and by the blogs, and Twitter feeds, and talk shows and cable television stations that now make up a big part of the media.
For a couple of weeks after the shooting in Sanford, Florida, the story received little attention. The release of the 911 tapes vaulted the killing into the most closely followed news story in the country. More on that in a few minutes. And media coverage itself is a big part of this story, from doctored tapes to incendiary tweets and partisan narratives that have taken on lives of their own.
Where do you turn for coverage of this story? And since you're already listening to NPR News, I guess I should say where else do you turn for coverage and why? Give us a call, 800-989-8255. Email us, email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Later in the program, the birth of the tape-measure shot. Jane Leavy joins us. But first the media and Trayvon Martin. New York Times columnist David Carr joins us from our bureau in New York, and nice to have you back on the program.
DAVID CARR: Oh, a pleasure to be with you, Neal.
CONAN: And you wrote in your column the other day that, quote, "all over the Internet and on cable TV, posses are forming, positions are hardening, and misinformation is flourishing," unquote. I wonder: How did this become such a partisan issue?
CARR: You know, one of the people I interviewed for this story was your other guest today, Ta-Nehisi, who I'm sitting here with. In the middle of our conversation, he said, you know - and you can correct me if I'm saying this wrong, Ta-Nehisi - but in a way, I'm glad the president weighed in, but in a way, a lot of the trouble started there.
If you recall, it had not been such a highly politicized story up until that point, and when the president stepped up and what sounded like very presidential remarks and very heartfelt ones, about he could have had a son - if he had a son he would look like Trayvon. It immediately, sort of, bifurcated the debate into who's right and who's wrong, and politicized in a way that it hadn't before.
And so it went from being a broad cultural and political question, the implications of yet another young black male dying by gun violence - in this case, under very suspicious circumstances - into a wholesale debate over who was right and who was wrong, about a whole raft of issues in our country.
CONAN: The Ta-Nehisi he refers to, of course, Ta-Nehisi Coates, senior editor for The Atlantic, who is also there with us from our bureau in New York. And I should note that we got word today, that he's the recipient of the Hillman Prize for Opinion and Analysis Journalism this year. Congratulations, Ta-Nehisi.
TA-NEHISI COATES: Thank you so much. Thank you.
CONAN: And getting back to David's point, do you think the president's interjection into this, and you have to be fair and say the White House press corps is asking the press secretary, every day, for a comment on this story?
COATES: Right, I think he's in a tough position, particularly because he's dealing with people like me, who initially said he shouldn't comment; and then after he commented, decided he decided pitch perfect; and now, two weeks later, I'm now wishing he hadn't said anything at all. So, I don't know that he could have done anything right.
There's a strong argument that this would've happened anyway. Having said that, I do think one of the unfortunate things is there are people who will take any shot, or any sort of issue to, you know, get at the president. And this became one of those things.
If you recall right before the president made his statement, the Republican candidates had come out and, you know, sent their sympathies to the family of Trayvon Martin. There was really nobody who wanted to stand up and defend George Zimmerman. And then after the president, you know, made his comments - and I think, particularly, you know, speaking from his heart - saying that if he had a son, he would look like Trayvon, that's an obvious truth as far as I'm concerned, and it was a sincere and honest truth.
But nothing, nothing drives the present white populace, right wing, crazier than any sort of implication that race might be a factor and that we might still have some work to do in this country.
CONAN: Yet at the same time, you had people on both sides of this story, I have to admit, saying to the president: You intervened in the case of Skip Gates when he was arrested in Cambridge, Massachusetts, and held the famous beer summit. Somebody's killed, and you have nothing to say?
COATES: Yeah, I know, and people did say that, but if you - they backed, I think there are a lot of people, and many of them who would consider themselves friends of the president, who would say that that was a mistake. You know, Obama's in a - it's a very, very tough position, because African-Americans, like any other political audience want to be recognized. They want to feel like their issues are felt, that somebody's, you know, in the White House who's sensitive to their particular pain.
And yet, when the president offers that sort of emotional reassurance - because that's basically what it is when he's talking, it's not necessarily an introduction of a policy or anything - we end up with fake photos of a kid who was shot, in the mainstream press. You find people trolling through, literally, white supremacist websites for any sort of evidence, Ku Klux Klan people hacking this kid's account.
Beholding all of that, it's just - it's utterly devastating and depressing.
CONAN: Well, David Carr, you might expect such things from white supremacists' websites. You don't expect doctored evidence from NBC News.
CARR: No, and it got - once it got engaged as a partisan issue, it also got engaged as a competitive issue, and that drives a lot of great journalism in our country is the desire to beat the other guy or girl to the truth. But you've got to make sure that you're finding the truth.
In this case, I don't think it's like, you know, the Michigan primary. I don't think it really responds to, like, a gaffe on the campaign trail. You can't - when it comes down to black and white issues, and you start talking about choosing sides, it's a very dangerous thing.
And I was talking with friends, including Ta-Nehisi about the mail that came afterwards. And like Ta-Nehisi, I was really, really disappointed by the corrosiveness of the dialogue. It was like hitting the way-back machine in terms of the level of rhetoric, the name-calling, some of the terms.
And the reason that I came to realize that Ta-Nehisi was right in the first place, about the president's very important role in this, is people kept - who were saying other rather bizarre things kept mentioning the Kenyan president. And I thought: OK, that's what pulled these guys off the sidelines and made them crazy is when Obama got involved.
CONAN: Well, we've had people being pulled off the sidelines and being crazy, not about this issue, but about other issues in other administrations. Certainly people were not above calling George W. Bush any number of vitriolic names, and certainly not Bill Clinton, too.
COATES: No, I think that's definitely right, Neal, but one doesn't make the other any less depressing. That's the only thing I would add to that. Even if you say, people on the left maybe called, you know, called President Bush stupid, ignorant, whatever you heard before...
CONAN: Fascist and...
COATES: Fascist, certainly so, not too strongly thrown out there.
CONAN: Yeah, thrown out there, too.
COATES: But I think the insult of - not to, you know, take this to another place, but I think the insult of - the Kenyan insult is a particular insult that, you know, has been lodged at African-Americans, basically since we came here - and that is that you are not truly an American. The victory of Barack Obama in the 2008 presidency represented, at least for African-Americans, some symbolic level of acceptance.
When you say he's a Kenyan, he's not a Muslim, you know, being code for not being mainstream America, it really stands in an ugly, ugly tradition that goes beyond presidential politics, I think.
CONAN: We want to hear from our listeners today. Where do you turn - where else do you turn for coverage of the Ta-Nehisi - not the...
COATES: Let's hope not. I really hope not.
CONAN: Let's really hope not. I didn't mean to put that out in a tweet, I apologize, and we've reached a settlement.
CARR: Thank you, Spike Lee.
CONAN: But in any case of the Trayvon Martin, George Zimmerman incident in Sanford, Florida, 800-989-8255. Email us, email@example.com. Let's start with Madeline(ph), Madeline with us from Derby in Kansas.
MADELINE: Hello.
CONAN: Hi, you're on the air, go ahead, please.
MADELINE: I just want to say that I mentioned a lady that I - I listen to a lot of country music at home in the car. I listen to more NPR, like all the programs I can. And the main reason I like the station I choose for the country music, is because they don't go on and on with a bunch of news stories that I just find that vilify, you know, both sides, whether it's the president mentioning something and then let the news reaction read into it, or how to describe the person who shot somebody else.
I like NPR because they try to find a balance, or they report this is from NBC News or CNN, because I find that a lot of stuff is just getting put out there to cause more drama. And it's really sad because the facts - I don't know (unintelligible) presented who's really going to know them, even with a 911 tape, because we, in general, weren't there.
There was two people in the dark, and how are we really going to know what really happened? Excuse me, so that's why - I'm not hiding from it or putting my head in the ground, but in the end, it just keeps getting blown out of proportion, and no one's really going to be able to address the fact, because of all the drama or the shock value they're putting out there.
CONAN: David Carr, a couple of points there. We forget, a lot of people are listening to country music or following the NCAA basketball playoffs and not paying a whole lot of attention to this story. Many people are, of course. But the other part is that people flinch away from this vilification and get tired of it.
CARR: Well, I do think that we all contain multitudes, and we can listen to a little George Strait and then tune in, watch Kansas battle it out, and then flip over and toggle, and participate in what has become a small, local incident that has very significant national implications.
What I was reacting to, I guess, as someone who writes about the media, is you have all these crows on a wire, sitting there, poised and ready. And in this case, what they're descending on is the body of a 17-year-old kid. And the idea that people are all trying various sort of media with the point of view, are trying to tear off a chunk, whatever suits them, and take it with them and show what they've got, is just, you know, it's not my first time at the rodeo, but I haven't really seen something like this in a long, long time.
CONAN: David Carr of The New York Times; also with us, Ta-Nehisi Coates, senior editor for The Atlantic. Tell us, where do you turn for coverage of the Trayvon Martin story? 800-989-8255. Email us, firstname.lastname@example.com. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. Coverage of the killing of Trayvon Martin, online and in the papers, on the air and in Twitter streams has been comprehensive, it's not always been accurate. Think about the misleading, edited tape NBC aired. In less egregious examples, journalists have resorted to nebulous phrases like racial tensions to describe the atmosphere in Florida.
And repeated mention of Martin's hooded sweatshirt has invoked, intentionally or not, stereotypes that cast the victim in a less-than-favorable light. It's tricky enough for seasoned journalists to sort through. So where do you turn, other than NPR, for coverage of this story and why?
Our phone number, 800-989-8255. Email email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. David Carr, "Media Equation" columnist for The New York Times, and Ta-Nehisi Coates, senior editor at The Atlantic, are our guests. They're at our bureau in New York. Let's see if we can go next to - this is David(ph), David with us from St. Paul.
DAVID: Yeah, Neal, I - first of all, I'm a regular New York Times reader, so I have been following it in that paper. I've been a New York Times reader for a long time. You know, I simply trust their journalistic integrity, for the most part. It's interesting that you say besides NPR.
I do watch MSNBC. I guess my principal program on MSNBC that I do watch would be "The Last Word" with Lawrence O'Donnell. He has experience in the law. He has experience in politics, and I think he has a lot of - it seems to me that his questions of many of the principles involved are very insightful.
But you're exclusionary of NPR is kind of interesting. You know, I'm here in St. Paul, Minnesota, and I've gone down the list on the NPR website of the people who are in the news division. We have a very, very, very small population of African-American journalists at Minnesota Public Radio, in the news division, and I've actually been involved in a - kind of an ongoing dialogue, diatribe, whatever you want to call it.
You know, there's a program on Friday called "The Round Table," and the host has brought in two - in two weeks, she's brought in two hip-hop artists to be on that panel. But we've had three consecutive African-American police chiefs, one of whom has actually participated in projects on racial profiling.
And this news organization, this news division, has yet to put this man on the air. He lives here in St. Paul.
CONAN: And I hear you, David...
DAVID: And it seems to me, it just seems to me that, you know, you're right. I mean, the sources that we choose are interesting, but I think that, you know, to exclude NPR as an outfit that's squeaky clean somehow...
CONAN: I didn't say it to be squeaky clean. I said it at the...
DAVID: I know, I know. I don't know why you're excluding them for consideration, because there are issues. I am progressive, and that is why I lean towards MSNBC and the New York Times.
CONAN: I hear what you're saying, and please also, there is a distinction between MPR, which is Minnesota Public Radio, and NPR, but beyond that...
CARR: Oh, I - make a distinction.
CONAN: Beyond that, we're assuming you listen to NPR for coverage because you're listening to NPR, so let's get beyond that.
DAVID: Yes, I make a distinction between Minnesota Public Radio and National Public Radio, because National Public Radio's news division is very diverse.
CONAN: Let's keep this local argument local, if you don't mind.
DAVID: That's fine.
CONAN: But David, thanks very much for the call, we appreciate it.
DAVID: Absolutely.
CONAN: Joining us now is Amy Mitchell, deputy director of PEW Research Center's Project for Excellence in Journalism. She joins us here in Studio 3A. Nice to have you with us on the program today.
AMY MITCHELL: Happy to be here.
CONAN: And you've been following the narratives as they unfold and measuring this story, which as we mentioned earlier in the broadcast, the first couple of weeks barely registered at all and is now the most closely followed story in the country.
MITCHELL: Yeah, as soon as the 911 tapes were released, the attention on Twitter more than doubled. The attention on blogs more than doubled, and the story skyrocketed in the mainstream press to be the first story of 2012 to actually supersede the election. So we looked across at this coverage, and the findings offer evidence of some of the points that David and Ta-Nehisi have been making.
The story that one got about this case, varied greatly depending on where they turned. We saw very clear differences in the angle of the coverage across these three parts of the media, from Twitter and blogs, and then the segment of the mainstream press that covered this the most, which was the cable and talk radio.
CONAN: Cable and talk radio covered this the most?
MITCHELL: They were. The vast majority of what was in the mainstream press came from cable and talk radio. And we saw, even within that, quite a great variation in terms of the amount. MSNBC covered the story far more than the other - than Fox and also more than CNN, and covered mostly the legalistic questions of the law in Florida - the Stand Your Ground Law that allows for the self defense - as well as the history in that city, where CNN was more a mix of questions about Martin and straight news accounts.
And Fox, while its coverage was much less overall, focused by and large on the defense of Zimmerman.
CONAN: On the defense, so the - what we might expect to be partisan lines in terms of MSNBC and Fox were certainly there.
MITCHELL: You do see that.
CONAN: And as you looked at the dominance of this story in the media, there's an interesting aspect that the media coverage itself, this becomes a meta-story.
MITCHELL: Yeah, exactly, and then if you look at the social media, you see the role and the function that they play, too, which is different, as well. On Twitter, the primary theme there was about the outrage over the killing. The defense of Martin and calls for justice superseded all else. On blogs, they were the area that we looked at that covered the question of the role of race more than any of the three genres, primarily in sense of outrage about what was occurring.
CONAN: There is a sense you get from some people, that the media is driving this story. Can you get any sense of that from the statistics you've seen?
MITCHELL: Well, I think what you see from these statistics is that the media is driving a lot of different stories, depending on where you're turning. And if you're going just for Twitter for that, for the accounts and a conversation and the tenor, you're going to get a very different sense than if you're turning to MSNBC or if you're turning to Fox.
CONAN: That's interesting, David Carr, that these - the atomization of the news media through the agency of the World Wide Web has made it possible to find the tiniest little echo chambers.
CARR: Yeah, I think we're - we generally, sort of, self-assemble into verticals of political and ideological interest. And I and many other people have written about the diminution of the village common, that this place where we get together and argue, where we all have different opinions, but the same set of facts.
It seems to exist less and less. People look at the same bit of videotape, and they say, well, Zimmerman, getting out of that cop car, he looks pretty healthy to me; and other people say oh, notice the dark spot on the top of his head. And so we can't even look at the same things and agree with what we're seeing.
And so I just think it's not brand new, but it's a continuation of a trend that, sort of, has gone on steroids because people are able to program their own media universe.
CONAN: And Amy Mitchell, we have to point out that this story became the number one story is significant. It's the first story this year, I think, according to what I read in your report, to overtake the presidential campaign as the number one story.
MITCHELL: Exactly, so though the media may not have been on the story from day one, the mainstream press, when they did cover it, it became a very large part of the conversation.
CONAN: And as you look forward, does the story seem to have, we say in the news business, legs?
MITCHELL: It's still getting a whole lot of coverage across all these different genres of the media. And one of the other interesting things that we see is, through all these turns of the story, whether it was new evidence about video of Zimmerman or others, the angles that each of these sectors was taking stayed pretty much the same.
CONAN: Really, depending on the prism through which you started to look?
MITCHELL: Exactly.
CONAN: And David Carr, you've described that in your piece the other day, as people taking a position and then backing up their news vehicle to find the facts that might support it.
CARR: Yeah, if I want to – if I think the U.S. blew up the World Trade Center, I can go on the Web and find out that that is true, even though manifestly it is not. And it's great that 1,000 flowers are blooming out on the Web, but not all of them are as fragrant as they perhaps should be.
One thing I'd point out to, sort of, countervail what we've been discussing is, yeah, mainstream media was not paying that much attention. There was loud, steady, insistent coverage in the black press, among black commentators, and I think the fact that eventually came into what is left of the village common is owing to the endurance of people in the journalistic community - and this goes to your earlier caller's point - who happen to be black and maybe are putting the prism of experience on this news.
CONAN: And Ta-Nehisi Coates, there's another element to this. As stories began to emerge about the background of Trayvon Martin - his suspensions from school, then his Twitter feed and indeed his emails started to get leaked out - this literally caused people physical pain, anguish.
COATES: Yeah, it did. I mean, I guess this circles back to what you were saying before. One other thing, just to pick up on what David was just saying, and I'll connect those two points, there are a lot of African-American reporters who - and bloggers, et cetera, columnists - who really cover, you know, these sorts of issues where we have either - where we have young black males shot by police or shot by people who take themselves to be police. And I can't tell you how constant it is. I mean I've been covering this back since I was a college student.
COATES: I had a good friend of mine, French Jones(ph), who was also a college student, who was shot by a police officer. There is a way that that starts to beat you down because by and large these stories are not going to break the way a story of Trayvon - like a Trayvon Martin is going to break. It's going to be you. You're going to be lonely. You're going to be out on an island. And I knew about this story for probably about a week and a half before I finally got it up in me to go ahead and write about it. I was consuming news about it.
And part of why it's depressing, because - because even if it does break, what has happened here, where you have, again, you know, a violent white supremacist hacking, you know, a 17-year-old kid's email, where you have mainstream publications like Business Insider pulling fake imagery, which they did apologize for, alleged to be Trayvon Martin, it's just depressing. There's a sense that people like me and African-American writers in general go looking for instances of - that we go out looking for it, like it makes us feel better and verifies our worldview. And it's just - it's completely false. It really, really is. It just beats you down after a while.
CONAN: Yet David Carr, one has to realize, in a story once it's reached this level of public interest, there is nothing in the past of Trayvon Martin or George Zimmerman that is not going to come to light.
CARR: I don't know if that's precisely true. It seems a lot like a case in - it reminds me of a rape case where...
COATES: Yeah, exactly.
CARR: ...at a certain point, it's like, well, what was she wearing?
COATES: Right.
CARR: What was her background? What was her dating history? What - let's look at her social media. You know, she seems a little slippery, a little loose. And I don't think that this - you know, no matter how you paint it, he was a victim. And we do put victims in unjust...
CONAN: I didn't say it was fair. I just said it's not unexpected that every detail is going to be ferreted out one way or another.
CARR: I just – I just think any 17-year-old - if I had to look back at the 17-year-old version of myself, you know, I'd come off looking like a knucklehead. There's just no doubt about it.
CONAN: I think that's probably true of a lot of us, certainly the person sitting in this chair. We're talking about the media and the Trayvon Martin case. Our guest, David Carr, you just heard him, the Media Equation columnist for The New York Times. Also with us, Ta-Nehisi Coates, senior editor for The Atlantic; and Amy Mitchell, deputy director of the Pew Research Center's Project for Excellence in Journalism. You're listening to TALK OF THE NATION from NPR News.
Let's get John(ph) on the line, John calling us from Washington, D.C.
JOHN: Yes. Hi. Hi, Neal, and also Mr. Carr and Mr. Coates. I've been reading the blog entries from Mr. Coates about this case, and it's been fascinating. So thank you for that. I'm calling because I wanted to - in addition to, I think, the more kind of establishment publications such as The New York Times and everything, I think The New Yorker magazine has been doing a pretty fine job of reporting this case, not the weekly publication, but more so the daily kind of updates that they provide on their website.
And I'm specifically talking about one article that they published, I believe it was about a little over a week ago, that drew a very clear parallel between this Trayvon Martin incident and Emmett Till in Money, Mississippi, in 1955. And I think - I'm a high school English teacher in the D.C. area, and I teach at a very overwhelmingly African-American high school, where 99 percent of our student population is African-American. And showing them that article really led me to see the outrage that this has caused not only amongst our school, but also just, I think, the - I think their families, their communities.
And it's been a really, really positive discussion that that article helped open up. And now I have kids come to me and saying, like, here's a new article I found. They're emailing me and showing their interest to me. So I'll take your guests' response off the air, but I just wanted to say The New Yorker and - they've been doing a very good job, especially with that clear parallel that they drew with Trayvon and Emmett Till. Thank you.
CONAN: All right. Thanks very much. And - go ahead.
COATES: So this is like the tough thing about assessing cases like this and assessing the country for those of us who write about race. I got into - you know, when you get into a debate and people are telling you that a kid like Trayvon Martin - 16, just turned 17 this year - is not a child, was not actually a child, that he was not actually a boy, you do, you know, sort of see a historical parallel.
But at the same time, I mean, even, you know, going with all the complaints I lodged today, the email that David got, George Zimmerman, whatever he is, is not the equivalent of the people who - the two men who dragged Emmett Till - sorry, get an emotional thing about this - who beat Emmett Till, tied him to a fan and dropped him into a river. There are important distinctions about what this country is today and what it was back then.
So even as we, you know, lament what we are not, you have to say that there has been some progress. There's not enough progress to not, you know, sort of beat us down and make us depressed, but there are, I think, really, really, really important differences. You couldn't find a jury to convict Emmett Till's killers on the law as it was. Now, we have questions about what the law is in Florida, et cetera, but I think those are different and, frankly, much better questions that were asked in the day.
CONAN: We're not going to have time to get to all of our callers, but some of them who I can see on the screen - John Stewart(ph) says: Jeff in Platteville, Wisconsin doesn't lie to me. Judy(ph) in San Jose says: BET, I'm white and don't normally go there. Daniel in Jonesboro, Arkansas: Color lines for historical perspective. Charles in Houston, Texas: Democracy now for its independence. Adam in Provo, Utah: Fox, Atlantic, broad spectrum. Sam in Stockton, California: Facebook, lots(ph) of justice for Trayvon. Before we go, Amy Mitchell, that's a theme that you saw on Facebook and particularly on Twitter.
MITCHELL: And particularly on Twitter, we did. And it's harder to follow the conversation on Facebook as much as it ends up being private behind people's walls, but absolutely. And I think, you know, one of the things you see from this is clearly there is some positive that's come out of the role of citizens in the media process and the involvement in the dialogue and discussion that can go back and forth. But also, when there's so much information that's out there, the role - the job the citizen has to try to sift through all of that and try to make sense and parse through what's true and what's not true and dig further into what's being said to make sense of it all is huge.
CONAN: Amy Mitchell of the Pew Research Center's Project for Excellence in Journalism, thanks very much. Our thanks also to Ta-Nehisi Coates, senior editor for The Atlantic. And again, congratulations on the prize you won today.
COATES: Thank you.
CONAN: And David Carr of The New York Times, the Media Equation columnist, thanks for coming in, David.
CARR: Oh, a pleasure, Neal. Transcript provided by NPR, Copyright NPR.


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This article was originally published in the November/December 1993 issue of Home Energy Magazine. Some formatting inconsistencies may be evident in older archive content.
| Home Energy Home Page | Back Issues of Home Energy |
Home Energy Magazine Online November/December 1993
Trends in Energy is a bulletin of residential energy conservation issues. It covers items ranging from the latest policy issues to the newest energy technologies. If you have items that would be of interest, please send them to: Trends Department, Home Energy, 2124 Kittredge St., No. 95, Berkeley, CA 94704.
Hot Potato
Gas oven owners may be shocked to discover that their gas ovens consume significant amounts of electricity. Since almost all new gas-fueled appliances are pilotless, gas burners for ovens, furnaces, and clothes dryers require electric ignitors. The ranges on gas ovens employ electric ignitors that use negligible amounts of electricity to initiate the flame.
Oven ignitors, however, are quite different. Ignitors in gas ovens are glow bars which draw between 350 and 400 watts. Worst of all, these ignitors operate--and thus, consume electricity--the whole time that the burner is lit. For the length of time required to bake, the electricity consumed by the ignitor can really add up. It has been suggested that a conventional gas oven may use more electricity to bake a potato than a microwave oven (see One More Miscellaneous Use of Electricity, HE, May/June '93, p.14). I tested that hypothesis.
The results of the field measurements were conclusive. A conventional gas oven from a cold start required over 200 watt- hours (Wh) to bake a moderately-sized potato at 350deg.F. A pre-heated conventional gas oven (immediately after the first trial) consumed only 140 Wh. A microwave oven in the same kitchen, however, consumed only 110 Wh to bake potatoes of similar size. These energy readings completely ignored the energy represented by any gas consumed and the extra hour required to bake a potato in a conventional oven. Those with both a new gas conventional oven and a microwave should consider baking smaller items in the microwave. The idea of enjoying energy (and time) savings isn't half-baked after all.
-- Brian Pon
Figure 1. A conventional gas oven uses more electricity to bake a potato than a microwave oven. The cold oven case included the electricity required to pre-heat the oven.
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