text:
ANNAPOLIS, MD (January 16, 2008) – Governor Martin O'Malley, joined by Lieutenant Governor Anthony Brown, today released the FY 2009 budget for the State of Maryland. The FY 2009 budget includes $333 million for school construction, another year of record funding for K-12 Education, full funding of Program Open Space, increased funding for the environment and public safety, and funding for the expansion of health care coverage.
"Maryland's budget is one of the clearest reflections of the values we share to build a stronger, healthier Maryland for the next generation, and to make progress on our shared goals," said Governor O'Malley. "Building on the progress we made to make State government work again last year, we remain committed to expanding economic opportunities for Maryland's families and small businesses, reforming and improving our schools and making higher education more affordable, improving public safety and homeland security, and protecting our quality of life and our natural resources."
"Governor O'Malley and I understand that strong states like Maryland are not born through chance, they are built through the investments we make in ourselves," Lt. Governor Brown said. "The budget we introduced today is a reflection of the goals we set and the promises we made to improve public safety and education, expand opportunities to more Marylanders and strengthen Maryland's working families."
Governor O'Malley's budget grows less than the Spending Affordability Limit set by the General Assembly and the Rainy Day Fund balance will grow to $739 million by the close of FY 2009. The General Fund balance projected for the close of FY 2009 is $177 million, and $210 million is allocated for future retiree health care costs, double the amount included last year. Governor O'Malley also cut spending by $550 million – on top of the $280 million in reductions achieved last July.
Protecting our families – and maintaining our quality of life – is a key component of the FY 2009 budget. The budget includes $124.5 million to expand health care coverage and provides additional funds to improve access to oral health care, expand community placements for those under the State's care, enhance substance abuse treatment programs, and continue advancements in the promising field of stem cell research.
An educated workforce is central to economic growth and improving Maryland's competitiveness in the global economy. The FY 2009 budget includes investments in K-12 education, higher education, technical and professional training, adult training and literacy programs, Base Realignment and Closure (BRAC) readiness, and business growth and job development.
Building on a $400 million investment last year for school construction, the FY 2009 capital budget includes $333 million for new schools and school renovation projects in local jurisdictions. The budget includes an increase of $184 million for K-12 Education, including an unprecedented $75.8 million for the Geographic Cost of Education Index. The budget includes $54.9 million from the new Higher Education Investment Fund to keep college tuition affordable, and address enrollment growth, the achievement gap, and workforce capacity. Earlier this week, Governor O'Malley announced a tuition freeze for higher education in Maryland for the third consecutive year.
The FY 2009 budget makes strategic investments to continue Maryland's economic growth – and expand opportunity for our neighbors in every jurisdiction, including $72.5 million for business development programs (including $18.4 million to support small or minority business entrepreneurs), an increase of $2.3 million for Vocational Rehabilitation programs, $23 million for stem cell research, $6 million for Biotechnology Investment Tax credits, $5 million in the capital budget to continue development of the East Baltimore Biotechnology Park, and $2.4 million for the Nano-Tech Biotechnology fund.
Maryland has tremendous opportunities for growth and economic development in the year ahead, but we also face the tremendous challenge of managing growth and development in a more sustainable way to preserve and protect our natural resources and the quality of life that we enjoy as Marylanders.
To meet these challenges, the FY 2009 budget includes $156 million for nutrient removal from wastewater treatment plants, $50 million for the new 2010 Chesapeake Bay Trust Fund, $45.7 million for agricultural land preservation, and $45.6 million for Program Open Space.
The FY 2009 budget also provides funding for energy efficiency and conservation programs to help the State meet its "Empower Maryland" goal of reducing energy consumption by 15% by 2015, including $481,000 and 7 new positions for the Maryland Energy Administration to help move toward more sustainable energy use; $5.5 million for weatherization assistance for low income homeowners; and funding for capital projects to incorporate "green" or sustainable features into State buildings. Under the Clean Cars initiative, the FY 2009 budget also allows the Maryland Transit Administration to purchase 30 new hybrid-electric buses for the Baltimore Metro area; and $621,000 is included in the capital budget to construct statewide infrastructure to support ethanol fueled vehicles.
Public safety is the foundation of the quality of life we enjoy in Maryland and is the primary responsibility of any government to its citizens. Security integration – the sharing of law enforcement resources, data and intelligence – is essential to making our neighborhoods and communities more secure.
To this end, the FY 2009 budget supports coordination of state and local law enforcement efforts across jurisdictional lines, including wireless interoperability projects, new offender monitoring programs to improve public safety in our communities, an expansion of DNA analysis and sampling for those arrested for violent crimes, and improved detention facilities and treatment programs for inmates.
The FY 2009 budget also includes substantial funding to support and improve the quality of life for Maryland National Guard members and U.S. armed services veterans. A new Reintegration Program receives $800,000 in General Funds to assist Maryland National Guard members returning from overseas deployments in readjusting to life at home.
[ read budget highlights - view presentation slides - listen to audio mp3 ]
January 16, 2008


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Feel the love at NWI Symphony Feb. 10 concert
Bob Kostanczuk Post-Tribune correspondent January 18, 2012 2:30PM
Pianist Di Wu will help celebrate love at a Feb. 10 performance by the Northwest Indiana Symphony Orchestra at the Bethel Church auditorium in Crown Point, Ind. | Photo Provided
Article Extras
Updated: February 21, 2012 8:15AM
Valentine's Day is around the corner. Looking for something to do?
The Northwest Indiana Symphony Orchestra has "A Valentine's Tradition" set for 7:30 p.m. Feb. 10, featuring pianist Di Wu, who has performed extensively on the international scene.
The Auditorium at Bethel Church, 10202 Broadway, in Crown Point is where you can catch the concert with the love theme.
Scheduling a show with a Valentine's Day connection is something the Northwest Indiana Symphony Orchestra has donebefore, and 2012 is no different.
The musical menu with amorous overtones includes Tchaikovsky's "Symphony No. 4," which was dedicated to his patroness, whom he "admired from afar," according to the orchestra's website.
I kind of had an inkling what a "patroness" was, but the term sounded a little old-fashioned, so I had to look it up.
A patroness is a female protector or benefactor, and can be a wealthy woman who sponsors or supports someone, according to a Webster's dictionary.
I think I get the drift.
Aside from "Symphony No. 4," the concert trots out Schumann's "Piano Concerto," which reflects the deep love the German composer had for his wife, Clara.
That, again, is according to the orchestra's promotional material, which brings up an interesting Valentine's Day gift.
But who, nowadays, writes a piano concerto for his special gal?
A dude who did that would be considered a cultured "Mr. Romance," and a hero to the female gender.
And I suppose the woman could be the one writing a concerto for her guy.
He could sit down with a beer on Cupid's date of Feb. 14, and be serenaded by some earnest keyboard work.
Chinese-born Di Wu will put her fingers in gear on the piano at the orchestra's concert.
The Wall Street Journal called her "a most mature and sensitive pianist."
Wu was a 2009 prize winner at the 13th Van Cliburn International Piano Competition and a Symphony magazine "emerging artist."
She began a career as a professional soloist with the Beijing Philharmonic at age 14, and has done plenty of touring in Europe and Asia.
Tickets range from $25 to $65. The student price is $10. Visit www.nisorchestra.org or call 836-0525.

subset: commoncrawl


text:
Sarah_CAT16 "für jede lösung ein problem"
german book by kerstin gier 7 years ago
10 years after introducing 43 Things to the world, we have decided we have met our last goal: completing the incredible experience that has been 43 Things. Please join us in giving one last cheer to all the folks who have shared their goals with the world, as well as all the people who have worked at The Robot Co-op to build this incredible website. We won a Webby Award, published a book, and brought happiness to a lot of people.
Starting today, 43 Things users can export their goals and entries from the site. Starting August 15, we will make the site "read only". 43 Things users will still be able to view the site and export their content, but we won't be taking any new content from users. We hope to leave the site up for folks to see and download their content until the end of the year. Ending on New Year's Eve takes us full circle.
It has been a long ride (one of our original goals was to "build a company that lasts at least 2 years" - we beat that one!) While we wish the site could live on, it has suffered from a number of challenges - changes in how people use the site, the advertising industry, and how search engines view the site. We wish the outcome was different – but we've always been realistic about when our goals are met and when they aren't.
As of today, you will be able to download your goals and entries. See more about that on the FAQ page. Thanks for 10 great years of goal-setting and achieving.
- The Robots.
german book by kerstin gier 7 years ago
german book. very funny, too. same protagonist as in "die patin". i love it. :-) 7 years ago
german book again. very funny. :-) 7 years ago
The Kite Runner by Kahled Hosseini.
Peace is Every Step by Thich Nhat Hanh. 7 years ago
Anna Karenina…
Wow – that was long! I don't think 15 is going to happen…but I'll be able to read a bunch during my upcoming 2 week vacation! 7 years ago
The Hitchhiker's Guide to the Galaxy.
Very cool and very good!
rate: 4 out of 5 :-) 7 years ago
Are You Somebody?: The Accidental Memoir of a Dublin Woman
by Nuala O'Faolain 7 years ago
Refuse to Choose by Barbara Sher 7 years ago
Esquire Presents: What It Feels Like edited by A.J. Jacobs 7 years ago
Great book! one of my favourites. :) READ IT!
rate 5 out of 5!! 7 years ago
The Little Guide to Your Well-Read Life by Steve Leveen
Sink Reflections by Marla Cilley 7 years ago
Great! I love Harry Potter, althoug I am very sad that it's over now. I grew up with the harry potter books..
rate 5 out of 5 7 years ago
It's a german book and not available in english at the moment. But I love it.
Rate 5 out of 5 7 years ago
I've just finished #10 and completed my mini-goal of "Read 10 Books in 2007" so now it is time to tackle this one! Only 5 to go to complete it. 7 years ago
And, I'm done… 7 years ago
"Corpsing:, Toby Litt.
One to go…. 7 years ago
I've just finished this book and I liked it. The story is a bit confusing at the beginning because there are four protagonists and they have four different stories. But they have one thing in common: they want to commit sucuide. Ok… this does not sound funny… but the book is funny and exciting. :)
Rating: 4 out of 5 7 years ago
A great read.
2 to go…. 7 years ago
I am sorry. It's a german book again… but it's not available in english.. :(
The book is about gardening and how you can prettify your garden/balcony/terrace. I love it. :)
Rating 4 out of 5 7 years ago
One of my favourite books although it has about 1151 pages. The action takes place at medieval times and so it's something differnt (at least for me). The book is sometimes a bit too cruel but it's sooo exciting. I love it. :)
Rating: 5 out of 5 7 years ago
A german book which I did not like because it's a strange book. Emma lives alone with her pigs on a farm and is unhappy. But one day a man comes accidentially to her farm and they fall in love and so on. It's always the same. That's why the book was boring!
Rating: 2 out of 5 7 years ago
A great book!
It's an autobiography by Chris Gardner and it shows how he managed it to become successful. The book is about the American Dream.
Rating: 3 1/2 out of 5 7 years ago
I had to read it at school but I like the book. It's basically about a man called Walter Faber who does not like other people and believes in sciences and math, but then he meets his daughter and it seems as if he changes completly.
Rating: 3 out of 5 7 years ago
Just read "The First Casualty", Ben Elton. 7 years ago
Best Bond novel I've read yet.
4 to go.. 7 years ago
5 to go. 7 years ago
"On Her Majesty's Secret Service", Ian Fleming
Six to go… 7 years ago


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Vanderbilt Nurse Residency Program - Winter 2013 - page 25
I just mailed off my packet to Vanderbilt today! I'm so nervous and really hoping to get an interview for this program. Adult Critical Care is my first choice. I graduated in May 2012 with my BSN from Washington State... Read More
- 0Feb 15, '13 by roxhannahIn case you guys need help with your apt search these are some I know of, lived in, or looked at.
Lenox Village Town Center
Grand View Apartments
The Lexington
Avondale at Kennesaw Farms Great apts and very affordable but not really near much
The Landings of Brentwood- where I currently live- great apts about 30 min from work and in the middle of all sorts or food and shopping and celebrity homes. Please mention my name if you come here!
Polo Park I used to live there and its decent. I am not sure if it was just my building (I was back in the woods) but I had a bit of a bug problem. It is in a good spot though and about 20 min to work.
Waterford Place Decent and afordable
I havent seen these but they are affordable and in a safe area-
Hampton Chase Apts
The Hamptons at Woodland Point
Mission Bellevue Ridge
Blackstone, Fairmont and Lee apartments Very close to vandy
Westboro I have heard good things and also very close to Vandy
Park West at Hillwood I have not seen these but one of our residents lives here and she really likes it.
Hope this helps narrow down some options!
- 0Feb 15, '13 by AlyssaEnsignHi all, I am a nursing student in CA, planning to take my NCLEX after I graduate in June and was wondering if the Vanderbilt Nurse Residency Program accepts licensure from another state such as California? This program sounds like a wonderful opportunity, and I wish to partake in a residency program as such. Please let me know!
Thank you so much!


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Well it's goodbye to Sky News, and 'Hello' once again to ITN as they take back over the contract to supply Channel 5 with it's news output. from 20th Febriary 2012. Full coverage as usual in our News section. Click Here for more.
At 6pm on March 30th 2013 we celebrate 10 years online and have the largest collection of Channel 5idents on the internet. As usual, please let me know if you have any problems with the site, or if there are any broken links or missing images by using the "feedback" or "info & contacts" page accessible from the "Other bits" in the menu.
You can also visit our You Tube channel.
You can now also follow us on twitter @thisisfive for all the latest updates.
The long neglected section fo the site has had a re-vamp, click on the logo on the left, or find it in the menu at the top of every page under "other bits"


text:
» News
Obama Hid Iranian Attack on US Aircraft Before Election
Iran fired at unarmed US drone, Pentagon says
Published November 08, 2012 | FoxNews.com
Iran fired on an unarmed U.S. drone last week as it was hovering in international airspace, the Pentagon announced Thursday.
Spokesman George Little said the incident occurred Nov. 1 at 4:50 a.m. ET. He said the unarmed, unmanned drone was conducting "routine surveillance" over the Persian Gulf when it was "intercepted" by Iran. He said the MQ1 Predator drone, which was not hit, was not in Iranian airspace.
Little said the U.S. government has protested to the Iranians. Asked about how the U.S. could respond, he said: "We have a wide range of options from diplomatic to military."
Little stressed that the drone was flying 16 nautical miles off the coast of Kuwait in international waters, and never entered the 12-mile limit that would constitute Iranian territory.
The Pentagon announced the incident as the administration imposed a new round of financial sanctions against Iranian officials and entities. They marked the first sanctions since President Obama's re-election Tuesday. According to the Treasury Department, the move was "related to the Iranian government's human rights abuses, its support of terrorism and Iran's Islamic Revolutionary Guard Corps."
» 11 Comments
Another act of war on the US. Nothing to see here folks!+4
Maybe we were just testing their defenses? You know, make 'em light up their radars, etc.?+1
Not sure who I'm supposed to root for.+3
Oh, but this isn't important. Petraeus and his chicky had sex under the desk. That's what will comprise media conversation.+4
sorry, that was me mentioning sex under the desk+1
Whoa, badass Iranian jet pilots; attacked unarmed drone …, and missed it. LOL Can't make this stuff up, folks.+3
Obama didn't hide it alone. A whole lot of people hid it, including journalists.+6
WTF? 0bama and Almondinnerjacket were all kissy-kissy face before the election because the Iranians had finally seen the light because of those harsh sanctions and were going to shut down their nuke program.
(Which meant they had enough uranium for a bomb or would have by the time they finished "negotiations.")+2
good one! Got me wondering too.+2
"Not sure who I'm supposed to root for."
like Wayne, Root for America!+2
I guess the Military Command (aka Bamma's Biatches) were told to hold her steady so the Muzzies could finally hit it and crash it….. then the other Bamma's Biatches, Chrissy Matthews et al., played "I GOT A SECRET" and sat on it till their massah got back in….+1


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Still reeling from the defeat, establishment Republicans are running from the right, clinging to the mistaken belief that more-centrist politics will yield better election results. Because the last two moderates the GOP nominated for the presidency worked out really well…
On Sunday, Carlos Gutierrez, the Secretary of Commerce for George W. Bush's second term and an adviser to Mitt Romney's Presidential Campaign was on CNN's State of the Union with Candy Crowley. While we all have come to expect asinine analysis from Crowley, it was disappointing to see the cowardly representative of the establishment GOP trying to distance himself from Romney and sensible immigration enforcement.
Crowley, slanting the question in the most leading way possible, asked,
"You know what Mitt Romney has said…talking about the Obama Campaign, that he went out and gave a lot of stuff to groups that they had hoped would vote for him and motivate them, specifically the African-American community, the Hispanic community and young people. He's talking here about the president's efforts to help those youngsters who came in with undocumented parents. What do you make of that kind of argument?"
First of all, that is a gross and highly misrepresented synopsis of Romney's "gifts" comments. He was discussing the modern state of government dependency and how that relates to votes in low socio-economic populations. Honestly, how is this woman still on the air? She is the Keanu Reeves of the news world.
After Crowley was done, Gutierrez, who last week railed against English as an official language, took the bait and piled onto the Romney-bashing wagon and stated,
"I was shocked. And frankly I don't think that's why Republicans lost the election- Why we lost the election. I think we lost the election because the far right of this party has taken the party to a place that it doesn't belong."
I honestly don't know where this moderate hostility is coming from. Tea Party politics ushered in one of the biggest Republican sweeps in Congress in 2010 as people responded with enthusiasm through grassroots activism. As the Republican establishment shoved another moderate down our throat, we saw lukewarm reception at the polls. Though he dressed up as a conservative and many of us (myself included) warmed up to Romney as a better option than Obama, he still roused lukewarm enthusiasm.
The GOP needs to take a turn to the right and recognize that Americans want and need conservatism- not the backwash of the GOP establishment that has been lingering around and will play to the crowds.
But wait, Gutierrez wasn't done with his turncoat stances:
"We are the party of prosperity, of growth, of tolerance. I mean these immigrants who come across and what they do wrong is they risk their lives, they come here and they work because they want to be part of the American dream."
No, no, no- what they do wrong is come here illegally. America has an immigration process; and yes, like every other facet of government, it could be simplified. However, we cannot and should not reward illegal immigration with an "if you can get here, you can stay" mentality. It's not like tag on a playground- if you make it to "home base" you're good. This is a land of laws, and we should be willing to discuss changing laws as we see fit. Until then, we need to set an example for those who abide the law and enforce immigration laws. Why is the establishment GOP continually failing to recognize this common sense idea?
There is much to discuss before the midterm elections and the next presidential election. The Republican Party needs to get it together and realize that America needs a distinctly different political party from the Democrats, and trying to move closer to the party of failed, leftist ideas is only going to produce poor election results and embolden an already-too-bold Democratic Party.


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Massachusetts Attorney General Martha Coakley is looking into allegations that the head of the prestigious American Academy of Arts and Sciences inflated her academic credentials for at least a decade and received far more pay than her peers at similar institutions.
Coakley's office said Wednesday it plans to reach out to the Cambridge honorary society's board to find out how it is handling questions about Leslie Cohen Berlowitz's resume, salary, and other issues following a Globe report that she falsely claimed to have a doctorate and earned total compensation of more than $598,000 in 2012. The attorney general's office, which oversees charitable organizations in Massachusetts, also plans to look into whether the academy fully disclosed Berlowitz's other perks, such as first-class travel, in tax filings.
"These allegations raise a number of questions and concerns for the board and for us," said Coakley spokesman Brad Puffer, adding that the academy's board of directors has the primary fiduciary duty to oversee the integrity of the institution.
Berlowitz and academy board members have refused to answer questions about Berlowitz's resume this week.
But an academy spokesman, Ray Howell, blamed academy staff members for adding the nonexistent doctorate and other misstatements to Berlowitz's resume and other documents. The National Endowment for the Humanities, which awarded the academy $1.2 million over the past decade based on requests that included the embellished resume, previously said it referred the matter to its investigatory arm.
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Andrew Ti and Javi Grillo-Marxuach explain why it's not right to call Black Republicans or anyone an "Uncle Tom." As always, leave us a message about anything you think is racist at (323) 389-RACE.
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AquaSkipper flies you across the water, fast
The AquaSkipper is an unusual water contraption that rests on hydrofoils, lifting it above the water and moving you faster than all other human-powered watercraft. You skim across the water with your feet on the platform and your hands on the handles — simply hop up and down to propel yourself forward.
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TabsTabs v2
Band: The Saints 70's Punk Legends from Australia The Saints, One Of There Softer Songs. RIFF 'A' E|--------------------------------------| B|----3-------2h3p2-----3---------------| G|------2---2-------------2-------------| D|--2-----0-----------2---------------2-| A|0-----------------0-------3-2-3-2-3---| E|--------------------------------------| RIFF 'B' E|----2h3p2------------------------------| B|--------------2h3p2-----3..------------| G|------------2--------------------------| D|--2-------0-----------2--------------2-| A|0-------------------0-------3-2-3-2-3--| E|---------------------------------------| RIFF 'C' D Dsus D Dsus E|2-2-2-2-2-3-3-3--|2-2-2-2-2-3-3-3--| B|3-3-3-3-3-3-3-3--|3-3-3-3-3-3-3-3--| G|2-2-2-2-2-2-2-2--|2-2-2-2-2-2-2-2--| D|0-0-0-0-0-0-0-0--|0-0-0-0-0-0-0-0--| A|-----------------|-----------------| E|-----------------|-----------------| RIFF 'D' A Asus A Asus E|0-0-0-0-0-0-0-0--|0-0-0-0-0-0-0-0--| B|2-2-2-2-2-3-3-3--|2-2-2-2-2-3-3-3--| G|2-2-2-2-2-2-2-2--|2-2-2-2-2-2-2-2--| D|2-2-2-2-2-2-2-2--|2-2-2-2-2-2-2-2--| A|0-0-0-0-0-0-0-0--|0-0-0-0-0-0-0-0--| E|-----------------|-----------------| INTRO- RIFF 'A' X 1 RIFF 'B' X 2 ......................... ALL VERSES RIFF 'B' X ? ......................... CHORUS RIFF 'C' & RIFF 'D' X ? ......................... (LONG) OUTRO RIFF 'C' & RIFF 'D' X ? {ADD RIFF 'A' or 'B' FOR EXTRA FLAIR} ......................... wordz - Messin' with the kid It ain't too easy being a young man going round in circles all of the time you've played their game now for so long can't see what in the world are they trying to do to me CHORUS -Sometimes you get that old lost feeling Sometimes it hits you when you're feeling down It's that old feeling that brings you down I say it makes you crawl, right up the nearest wall You walk down the main street out in the city see all the girls now they are so pretty but all their smiling faces are just going to pass you by it don't make no difference no matter how hard you try.. CHORUS (weird power chord like riff) You been hanging around the alleys hanging around the bars looking for some fun but there is none & there you are... looking for some action looking for some fun but you are down in the gfutter & you don't get none no no there is nothing left to do..... CHORUS How do you feel now that it's all over your kid dreams all melted under the sun just like a kid take a trip down to the sea I am struck out in the middle with nothing left to say CHORUS -------------------------------------------------------------------------------
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A crash scene photo depicts the aftermath of a collision between a truck driven by Leighton Kish and a guardrail outside Orlando, Fla., in October 2010. Passenger Charles Pike, who is suing the manufacturer of a guardrail end terminal, had his leg amputated below the knee after the crash.


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In the Danger Zone
Part of the difficulty, Murray argues, is that doctors have come to rely too heavily on laboratory tests and radiographs to make diagnoses and to monitor treatments. The skills of history- taking and careful physical examination are not endowed with the mystique of a new and expensive technical investigation. And so they are neglected. Murray's belief in the centrality of these old-fashioned values is confirmed by reading his textbook. In this multiauthored treatise, the chapter on history and physical examination was written by Murray alone. There he affirms the importance of a doctor's communication skills, which form "the foundation for the physician-patient relationship." But he also argues that "communication is not just words but is an interaction with sequences and quality." These subtle transitions between doctor and patient are vital influences "on subsequent trust, understanding, concern, and compliance."
It follows, therefore, that the medical interview, which is nearly always the first event in the continuum of physician-patient communication and which is the most frequently used tool in clinical medicine, has considerable effect on the outcome of the patient's illness.
A reliance on technology can make doctors overconfident or, worse, plain lazy. Murray gives an example of how the discovery, by computed tomography, of "free air" in a patient's abdomen almost led to a major operation to locate a presumed rupture of an internal organ. And yet a thorough clinical examination revealed the "free air" finding to be a red herring. The radiologist, confronted with the negative clinical examination but clinging to his X-ray proof, began to lose touch with reality. "It doesn't matter what your examination shows," he exclaimed. "That's free air, take my word for it." It was not, and Murray sums up his views about this incident. He is scathing:
…A CT [scan] of his abdomen, which was probably not indicated in the first place, revealed a "finding" that I decided not to act on, but that could have sent him to the operating room. In addition, the turmoil of going to the x-ray department for the CT study in the early morning, when he would have been better off sleeping, and the multiple examinations to resolve the debate, have only served to make poor Mr. McVicker much more terrified and confused than he already was.
These unusually frank reflections raise the question why Murray has written this critical account of ICU medicine. His experiences have led him to ask two large questions. First, is there any point in having an ICU when patients' outcomes seem so poor? And second, given that the ICU is a place where people frequently die, have we paid enough attention to how they die? His answers to both questions are not wholly reassuring.
A plainly distressed first-year resident challenged Murray directly. "This is my second month at 'The General' and almost all my patients have been losers. In the ICU alone, of my five patients, three were drunks and two were junkies…. They're all trying to kill themselves. What's the point? Why are we doing this?"
Her observations will ring true for many doctors. And Murray, although he tries to quell her skepticism with a passionate speech about "commitment," "victims of social bad luck," and the occasional "brilliant success," shares some of her doubts. Drug users are, he concludes, "notoriously bad at complying with therapy." After one patient suffered a huge stroke as a complication of injecting drugs, Murray cannot refrain from remarking: "It is incomprehensible to me how this young man—or anyone—could wreak such destruction on his own body. Yet it happens over and over again." Add to drug abuse the effects of alcohol and smoking and one has the holy trinity of self-harm. ICU does nothing to tackle these root causes of acute illness.
Murray's verdict on his month's work—the real answer to his resident's question—can be inferred from his stark summary of the outcomes among his sixty admissions—twenty-seven alcoholics and drug users patched up, in all likelihood, only to return again soon, but in ever worsening shape; eighteen episodes of iatrogenic disease; fifteen deaths; nine "notable failures"; and two patients who survived but who now have irreversible brain damage. There were only seven "gratifying rescues," at a total monthly ICU cost of $1.15 million. Murray asks bluntly whether such "huge expenditures" can be justified.
Physicians use what they call the f-word to describe these situations—futility. Clinical judgment about how to manage the ruinously ill is reduced to estimating a probability: What is the chance of a given intervention achieving a particular goal? Below a certain threshold that intervention is pronounced futile and is thus deemed pointless. Such brutal rationalism may seem fair. But it is almost impossible to put into practice.
Who defines, for example, the threshold of probability? Must the chance of success be better than one in two, one in four, or one in ten? Who decides? How does one calculate a probability reliably and accurately? Murray points out how difficult it is to pinpoint the moment when an illness crosses "the invisible threshold from potentially curable…to hopeless." And what should the final goal of treatment be? The purpose of the ICU is to preserve life, to restore the patient to near normal functional capacity, and to limit morbidity. But the aims of intervening may be more modest and yet equally reasonable. Murray describes an instance in which he kept a patient peacefully alive to allow the family to come to terms with an approaching death. The purpose of intervention shifted, humanely, from patient to family. These value judgments force decisions about what is futile to be made jointly among the patient, family, and medical team. There is no precise calculus that can be appealed to, and decisions can rarely be extrapolated from one setting to another.
There is an additional problem. The concept of futility is often confused with rationing, and Murray sometimes seems to conflate the two. The cost of ICU medicine is high. To husband limited resources more effectively, one might ask how much we are willing to spend on intensive treatments. But the issue of equitable resource allocation between critical and noncritical care is not equivalent to guessing when a chance of treatment is worth taking or not. These are entirely separate issues. To mix cash flow so intimately with clinical decision-making risks a dangerous ethical shortcut.
In any case, such theorizing may ignore the reality at the bedside. If it was your son, daughter, mother, or father lying in an ICU bed, could you make a rational judgment about the probable outcome? My guess is no. You are more likely to want everything done that reasonably could be done in the absence of undue suffering, even if, when one examined the evidence and weighed the probabilities, the outlook was poor. A probability is, after all, only a probability. Your case could be the one that beats the odds.
Is there a way out of this apparent impasse between a desire to do all one can and making a decision based on probable outcomes? The impediment to answering this question is that, even today, the ICU is an obscure "black box" within the hospital. Cory Franklin, the respected Chicago expert on intensive care, wrote in 1998 that the ICU is
an intricate assemblage of high-tech equipment where patients enter as "input variables" at one end and emerge sometime later from the other end as "outcomes." Tellingly, unless they have specific business there, outsiders tend to avoid venturing into the ICU. Medical students, residents, and consultants from other disciplines often speak of doing training rotations or visiting the ICU simply to find out exactly what goes on there.9
Murray succeeds in demystifying the ICU by telling its story. But one can also turn to research for answers. In an effort to devise ways of predicting a patient's outcome, several models for calculating risk have been tested. The best studied is the Acute Physiology and Chronic Health Evaluation (APACHE), first introduced in 1981 and now in its third revision. Risk is calculated according to the patient's physiological status, age, and pre-existing health. To these variables are added predictive equations reflecting the diagnosis and a large database of additional clinical information. Although these models have identified important aspects of a patient's physiological state that confer poor prognosis, they are used mainly for research and their place in everyday patient care remains undecided. APACHE III is not a reliable way to differentiate survivors from nonsurvivors.
Yet there is an urgent need for some means of evaluating intensive care. Murray himself deplores "the impossibility of ever knowing whether each of the many decisions I make is right or wrong." The hope is that explicit approaches to the calculation of risk will enable the work of ICU physicians to be assessed fairly and outcomes to be defined as accurately as possible. This transparency in setting goals might reduce the desire of all parties to embark on a course of futile treatment.
The motive for seeking intervention in dire circumstances can be fostered by mistrust, confusion, and ignorance. Laying out for discussion the factors that are likely to govern an individual's outlook should lessen all three of these threats to compassionate and appropriate care. But the truth is that all such decisions are going to be imprecise judgments. After twenty years of trying to use the methods of science to answer these impenetrably human questions, I get the sense that many doctors now accept that the best we can do is to do our best. The prop of spurious statistics is at last being discarded.10
In 1821, William Hazlitt reflected on the very issue that Murray draws our attention to at the end of his diary, an issue that causes more angry struggle today than any other in the swamps of modern medical ethics:
It has been thought by some that life is like the exploring of a passage that grows narrower and darker the farther we advance, without a possibility of ever turning back, and where we are stifled for want of breath at last. For myself, I do not complain of the greater thickness of the atmosphere as I approach the narrow house…. I should like to have some friendly hand to consign me to the grave. On these conditions I am ready, if not willing, to depart. I could then write on my tomb—GRATEFUL AND CONTENTED.11
Whose friendly hand should do the consigning remains disputed, and it is a question that certainly perplexes Murray. Of one patient whose life was lost, he notes that "what distressed me was that there was no room in our system for me to leave her alone and let her die peacefully. I was obliged by the rules to intervene." He writes that these efforts sometimes seem like inducing "a long period of torture" and that "dying in increments with a tube in your windpipe and another in your chest is infinitely miserable."
A friendly hand can be gripped more tightly or less. The lightest touch is the DNR—do not resuscitate—order that prevents futile clinical intervention if a patient has a potentially fatal crisis, such as a respiratory arrest. In England, we are now in the throes of a critical reexamination of the DNR notice. For years doctors have written DNR orders on patients' case notes without their consent or knowledge. When a woman with cancer recently survived her ordeal and examined her hospital notes she discovered with horror her medical team's decision to deny her resuscitation should she require it. She had not been consulted about her intended fate and her case has reignited issues of patient autonomy, medical paternalism, and clinical futility, which the British still seem to have great difficulty confronting.
A physician can take a slightly firmer hold if there is an advance directive to turn to. Murray and his wife both have "living wills," and those who possess such documents can prevent a hopeless endeavor to repair the irreparable. While advance directives deserve to be encouraged—the 1991 American Patient Self-Determination Act obliges US health care providers to offer patients written information about living wills—they do not, as yet, provide a solution to the puzzle of when to accept the inevitability of death and withhold or withdraw treatment. Just too few patients (Murray cites a figure of around 15 percent) have created advance directives; their doctors may be unaware that such an instruction exists; and there is some evidence that, in any case, advance directives may have only a limited impact on decision-making in the end-of-life setting.
All of which leads to Murray's final argument, which he lays out briefly in an epilogue. His long working experience of the ICU has led him to believe that a proportion of his present patients should have been offered one of "the many infinitely more humane alternatives to ICU care." He raises, but never tries to answer, questions of physician-assisted suicide and eutha-nasia. His tone suggests that he is out of sympathy with advocates of either solution to fatal illness. "Doctors are," he writes, "invariably less enthusiastic than the general public about their would-be role as executioners."
Still, he acknowledges that this professional mood may be starting to shift. Surveys indicate that more doctors now seem willing to contemplate assisted suicide.12 And he agrees that the evidence from Oregon, where a 1997 Death with Dignity Act legalized physician-assisted suicide within narrowly proscribed rules, seems to suggest that such a law can be implemented without ushering in mass medical slaughter. Importantly,
Contrary to the fears of some, there was no indication that physician-assisted suicide was disproportionately chosen by or forced on terminally ill patients who were poor, uneducated, uninsured, or worried about financial loss.
Further experience of Oregon's statute shows that only one in six requests for physician-assisted suicide was being granted.13 Crucially, although a fifth of patients requesting assistance committing suicide were clinically depressed, none with treatable symptoms received a lethal prescription. Findings such as these strengthen the argument that assisted suicide can be practiced free from abuse.
But I sense that Murray remains reluctant to allow the physician to cross a line from a position of withdrawing treatment and providing only symptomatic relief to one of actively prescribing drugs to end life. When challenged by a medical student about the care of a man with terminal lung disease and brain damage, he affirms his intention to "give him morphine and allow him to die peacefully. Without the intense terror and agonizing distress of progressive asphyxia." The bold student tells him that his action would be tantamount to "physician-assisted execution." Murray demurs, arguing that "the key point is that our intent is to relieve Mr. Caughey's suffering, not to cause his death, although I agree with you that morphine may quicken it." These distinctions may seem slight, and they are often rejected as spurious by advocates of physician-assisted suicide,14 but for many doctors, including myself, the difference between an intention to diminish symptoms of suffering and an intention to kill means a great deal.
Murray's point is that we should take these decisions out of the crucible of technological excess either by not sending patients who are "irrefutably doomed to die" to the ICU or by removing them from the ICU once it becomes clear that a fatal outcome is imminent. There are more humane places—home or hospice, for example—for these patients to go. To some degree, Murray's pleas are already being heeded. In American ICUs that train critical care specialists, a third of patients who died had life support withdrawn, and a tenth had life support withheld. Only 23 percent had full ICU care, including attempts at resuscitation.15 Although there was variation in practice between ICUs, limits to care are now accepted and commonplace.
There is an omission in Murray's argument, however, which ultimately distorts the choices he presents. He does not provide a more nuanced discussion of end-of-life care. It is here that substantial conceptual and clinical advances have been made to remove the agony encountered by some patients on ICUs and to draw back from what is beginning to be seen as the far from straightforward practice of physician-assisted suicide.
End-of-life care is poorly taught, if taught at all, to American and British medical students, and almost nothing is included in standard medical textbooks recommended to students either before or after graduation.16 And yet a great deal of research has been done to understand exactly what "end-of-life care" means. The American physician Marion Danis, for example, has brought together doctors who work in intensive care and palliative medicine, experts in medical ethics and education, and consumer advocates to set reasonable professional goals for managing the end of a person's life.17 They emphasize that care, agreed on jointly with patient or surrogate, must guide technology and not vice versa. (Murray gives several examples of technological imperatives governing care.) Clear decisions about treatment withholding and withdrawal must be made; trust among those taking part in these decisions, based on honest discussion, even in the face of paralyzing uncertainty, should underpin all end-of-life care; cultural diversity must be respected; and the principles of relieving pain and making people more comfortable—palliative care—should occupy a central place in the ICU.
There is a gap, however, between the wishes of professionals and those of patients. When patients are asked what they conceive to be high-quality end-of-life care, the committee jargon of consensus panels is shed in favor of humbling clarity. Patients wish for good measures to relieve pain and symptoms; an end to unnecessary prolongation of dying; a sense of control over their destiny; relief of the burden of physical care and decision-making that rests on family members or friends; and strengthening of relationships with the people closest to them.18 These contrasting views show that physicians prefer to select only aims they can quantify or qualities they can measure, few of which may be uppermost in their patients' minds.
These matters now demand renewed scrutiny. The hope that assisted suicide might offer a solution to the problem of undignified and costly end-of-life care has recently been proven to be illusory. The Oregon experience, after two years, showed that twelve of twenty-nine patients given supposedly lethal medications did not die. Eleven subsequently died of other causes, and one was still alive when the research was conducted. The conclusion must be that physician-assisted suicide often fails. There are likely damaging physical and psychological consequences of that failure for patients, their families, and the health care team. It is a pity that these compli-cations of unexpected failure were not anticipated by the Oregon researchers.
Worse still, experience from the Netherlands, the country with the most mature system for provision of assisted suicide and euthanasia services, indicates serious unforeseen adverse effects.19 With 15 percent of patients undergoing physician-assisted suicide, there were "problems with completion," meaning that there was a longer than acceptable time between giving the lethal drug and death. Two patients woke up from their "terminal" coma. For 10 percent of patients, there were technical impediments to assisted suicide, such as difficulties in finding a vein to inject the drug or difficulties with giving drugs by mouth, such as irritation to the throat. And 7 percent of patients experienced complications, including nausea, vomiting, "extreme gasping," and muscle spasms. The brutal reality of physician-assisted suicide is that it can frequently diminish the quality of end-of-life care, not enhance it.
There is no quick fix to alleviate suffering at the end of life. The challenges for people giving health care are formidable. And yet when palliative measures are offered—effective pain control, a hospice referral, or treatment for depression—almost half of patients who originally seek assisted suicide change their minds.20 And when medical personnel know that palliative care services are available, their early willingness to give a lethal drug seems to diminish.21 Before the public debate about who should receive intensive care, what constitutes medical futility, and what place physician-assisted suicide might have in either setting goes any further, the end of a person's life deserves a less reductive analysis by physicians and philosophers and the public alike.
See Cory M. Franklin, "Deconstructing the Black Box Known as the Intensive Care Unit," Critical Care Medicine, Vol. 26, No. 8 (1998), pp. 1300-1301.↩
A breach in the scientistic approach to medical futility was perhaps best expressed in a report from the American Medical Association last year. See "Medical Futility in End-of-Life Care," Journal of the American Medical Association, Vol. 281, No. 10 (1999), pp. 937-941.↩
See William Hazlitt, "On the Fear of Death," in Selected Writings (Penguin, 1982).↩
And not only doctors. In a recent study, two thirds of sampled US medical students supported legalization of physician-assisted suicide and over half said that "they might be willing to assist a patient by writing a lethal prescription." See Richard S. Mangus et al., "Medical Students' Attitudes Toward Physician-Assisted Suicide," Journal of the American Medical Association, Vol. 282, No. 21 (1999), pp. 2080-2081.↩
See Linda Ganzini et al., "Physicians' Experiences with the Oregon Death with Dignity Act," New England Journal of Medicine, Vol. 342, No. 8 (2000), pp. 557-563.↩
Ronald Dworkin has been the most persuasive critic of those of us who might cling to these distinctions. See Ronald Dworkin et al., "Assisted Suicide: The Philosophers' Brief," The New York Review, March 27, 1997, pp. 41-47.↩
See Thomas J. Prendergast et al., "A National Survey of End-of-Life Care for Critically Ill Patients," American Journal of Respiratory and Critical Care Medicine, Vol. 158 (1998), pp. 1163-1167.↩
Murray and Nadel's textbook is an unusual exception, since they include a chapter on "Ethics and Withdrawal of Life Support."↩
See Marion Danis et al., "Incorporating Palliative Care into Critical Care Education: Principles, Challenges, and Opportunities," Critical Care Medicine, Vol. 27, No. 9 (1999), pp. 2005-2013.↩
See Peter A. Singer et al., "Quality End-of-Life Care: Patients' Perspectives," Journal of the American Medical Association, Vol. 281, No. 2 (1999), pp. 163-168.↩
See Johanna H. Groenewoud et al., "Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands," New England Journal of Medicine, Vol. 342, No. 8 (2000), pp. 551-556.↩
See Ganzini et al., "Physicians' Experiences with the Oregon Death with Dignity Act."↩
See Mangus et al., "Medical Students' Attitudes."↩
See Cory M. Franklin, "Deconstructing the Black Box Known as the Intensive Care Unit," Critical Care Medicine, Vol. 26, No. 8 (1998), pp. 1300-1301.↩
A breach in the scientistic approach to medical futility was perhaps best expressed in a report from the American Medical Association last year. See "Medical Futility in End-of-Life Care," Journal of the American Medical Association, Vol. 281, No. 10 (1999), pp. 937-941.↩
See William Hazlitt, "On the Fear of Death," in Selected Writings (Penguin, 1982).↩
And not only doctors. In a recent study, two thirds of sampled US medical students supported legalization of physician-assisted suicide and over half said that "they might be willing to assist a patient by writing a lethal prescription." See Richard S. Mangus et al., "Medical Students' Attitudes Toward Physician-Assisted Suicide," Journal of the American Medical Association, Vol. 282, No. 21 (1999), pp. 2080-2081.↩
See Linda Ganzini et al., "Physicians' Experiences with the Oregon Death with Dignity Act," New England Journal of Medicine, Vol. 342, No. 8 (2000), pp. 557-563.↩
Ronald Dworkin has been the most persuasive critic of those of us who might cling to these distinctions. See Ronald Dworkin et al., "Assisted Suicide: The Philosophers' Brief," The New York Review, March 27, 1997, pp. 41-47.↩
See Thomas J. Prendergast et al., "A National Survey of End-of-Life Care for Critically Ill Patients," American Journal of Respiratory and Critical Care Medicine, Vol. 158 (1998), pp. 1163-1167.↩
Murray and Nadel's textbook is an unusual exception, since they include a chapter on "Ethics and Withdrawal of Life Support."↩
See Marion Danis et al., "Incorporating Palliative Care into Critical Care Education: Principles, Challenges, and Opportunities," Critical Care Medicine, Vol. 27, No. 9 (1999), pp. 2005-2013.↩
See Peter A. Singer et al., "Quality End-of-Life Care: Patients' Perspectives," Journal of the American Medical Association, Vol. 281, No. 2 (1999), pp. 163-168.↩
See Johanna H. Groenewoud et al., "Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands," New England Journal of Medicine, Vol. 342, No. 8 (2000), pp. 551-556.↩
See Ganzini et al., "Physicians' Experiences with the Oregon Death with Dignity Act."↩
See Mangus et al., "Medical Students' Attitudes."↩


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Wild rice soup is one of my favorite fall meals. It's the quintessential Minnesota soup—wild rice is very abundant in Minnesota—and I would even go so far as to name it the Minnesota State Soup.
Don't you love it?
It's so creamy, hearty, and fragrant. I make a decent wild rice soup from scratch when I have the time, but I haven't had a lot of free time lately. I'm back to working full-time out of the home and I live by my slow cooker for easy meals. I finally devised a pretty good wild rice chicken soup for the slow cooker. It was easy and very flavorful. We devoured it. I hope you like it too!
Slow Cooker Wild Rice Chicken Soup
- 1/2 cup dry wild rice
- 1 cup chopped onion
- 1 cup sliced or chopped carrots
- 1/2 tsp black pepper
- 4 cups chicken broth
- 1 cup whole milk
- 1 12.5 oz can of chopped chicken (Kirkland brand from Costco is pretty good)
- 1/4 cup flour
- 1 cup frozen peas
- In a large slow cooker, add the wild rice, onion, carrots, pepper, and chicken broth. Stir and cook on LOW for 9 hours.
- After 9 hours, stir in the milk, chicken, flour, and frozen peas. Turn the heat to HIGH and cook for another 10-20 minutes. It's ready to serve and enjoy!
A couple notes:
- I used baby carrots and canned chopped chicken to save time, but you could easily use fresh carrots and leftover roasted chicken.
- I'm not sure the peas were necessary. I think I will omit them next time.
- Next time I plan to garnish with slivered almonds, or maybe popcorn, just to live on the edge.
If you make it, let me know how it turns out for you and if you add any of your twists to improve it.


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Earlier this week, Mike Peek was a high-profile temp worker racing down the field on the final play of the game between the Seattle Seahawks and Green Bay Packers, smack in the middle of the biggest controversy of the young NFL season. By Thursday, Peek had returned to his quiet life in Athens, Tex., where he teaches economics at Trinity Valley Community College and tries not to be that "little guy in the brown suit with the black skinny tie."
His last game was on ESPN, as the line judge of the replacement officiating crew that blew a call and gave the Seahawks a last-second victory. His next is likely to be on a high school field somewhere in Texas, far away from the bright lights and intense scrutiny of the National Football League.


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J Med Internet Res 15:e235. 2013..Currently, there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores...
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- Using smartphone technology to monitor physical activity in the 10,000 Steps program: a matched case-control trialMorwenna Kirwan
Centre for Physical Activity Studies, Institute for Health and Social Sciences Research, CQUniversity, North Rockhampton, Australia
J Med Internet Res 14:e55. 2012..New ways of accessing online content (eg, via smartphones) may enhance engagement in these interventions, which in turn may improve the effectiveness of the programs...


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Vical, Inc. (NASDAQ:VICL)
The Company researches and develops biopharmaceutical products based on its patented DNA delivery technologies for the prevention and treatment of serious or life-threatening diseases.
Topline data from the phase III trial of Allovectin-7 in melanoma is expected to be released this quarter. This is the closest we've come to topline data without a delay being announced since the trial began six and a half years ago. For those who believe that delays in topline data are a good thing in oncology trials because "somebody is living longer and it can't be the placebo patients", I point you to the outcomes of the Celsion and Oncothyreon trials among others. Delayed phase III topline data from small biopharma companies suggests to me that management knows results will be negative and they're dragging their heels to maintain their smoothly salaried lives as long as possible before the earthquake. For those who think that management doesn't have any idea of the results of blinded trials before the database is unlocked, keep in mind that certain hedge funds are well-known to maintain their alpha through exactly that mechanism.
Allovectin-7 failure won't destroy Vical. They'll have about 70M in cash at the end of Q2, and clinical trials of CMV and HSV vaccines are in progress or about to kick off. I expect Vical's cap won't drop below 150M and could quickly rebound to 200M, which corresponds to a share price of 2.32. Puts are being offered for September and December expiration at 2.5 and 5. Given Vical's history of delays and remembering Celsion's cyncial decision to delay data release until the last day of their guidance range, I wouldn't risk September expirations unless management narrowed their guidance. The ask on December 2.5's is 0.8 (1.7 break-even) and on 5's is 2.6 (2.4 break even). As of now it's too early to buy puts. I'd wait for the stock to run up and drop the December 5 puts below 2, or for October 5 puts to become available below 2. And don't wait too long after negative data to exercise the puts - Seeking Alpha articles touting the amazing potential of Transvax and HSV vaccine are probably already written and waiting to be published.


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Emeril's Chuck Wagon Chili For the Slow Cooker
Try This Hearty Quick Dinner
This warm chili is easy to prepare and delicious to eat. Try it tonight!
Cooking Directions
Combine the chili powder, cumin seeds, cayenne, cinnamon, oregano, bay leaves, and brown
sugar in a small bowl; set the spice mixture aside.
Add the beef to a medium bowl and season with the pepper and 1 tablespoon of the kosher salt.
Heat 2 tablespoons of the vegetable oil in a 12- inch or larger skillet over high heat. Add enough beef to fill the pan and cook until nicely browned on one side, about 2 minutes. Turn the pieces over and cook for another 2 minutes. Transfer the browned beef to the crock of a 6- quart slow cooker. Repeat with the remaining beef, adding the remaining vegetable oil between batches as necessary.
Add the onions, celery, and 1 tablespoon of the remaining salt to the skillet and cook, stirring, until the vegetables begin to soften, about 2 minutes. Add the garlic, jalapenos, and spice mixture and cook for 1 minute longer. Pour in the beer, tomato paste, and crushed tomatoes and simmer for 3 minutes.
Stir in the chocolate, masa harina, and remaining 11/2 teaspoons salt and cook for 1 minute longer. Transfer this mixture to the slow cooker. Cover and cook the chili on high, undisturbed or stirring only once during cooking, for 6 hours, or until the beef is very tender. Remove the bay leaves and stir in the cilantro and parsley. Serve the chili hot in bowls, topped with grated cheddar, chopped green onion, and sour cream.
note: Leftover chili may thicken up and need to be reheated with a little low sodium
This recipe was styled by chef Karen Pickus for Good Morning America.
Recipe courtesy Emeril Lagasse from Sizzling Skillets and Other One-Pot Wonders, HarperCollins Publishers, New York, NY, 2011, copyright MSLO, Inc, All Rights Reserved
Recipe Summary
Main Ingredients: cheddar, onion, mexican beer, chiles, cayenne, cinnamon
Course: Main Course
More Info: Kids Friendly


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Puppies Being 'Interviewed' for Access to Doggy Day Care
Canine summer camp is the new preschool. (Not really.)
Skip to content, or skip to search.
Skip to content, or skip to search.
Canine summer camp is the new preschool. (Not really.)
It'll drive you nuts.
They've written so many they can't remember which photos they've already used.
They're doing the shopping and cleaning and not even complaining!
At the 'Times,' just talking to your close friend is reporting enough.
Why we hate the idea of "staycations," "one-tank trips," and "mini-moons."
An 'Observer' story today reminds us that we always seem to be reading shocking tales of graduates from elite schools having to do — gasp — hard work.


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Sandra Hanna
Thanksgiving Rules to Break This Year
Throw Fashion Rules Out the Window:
Pair brown with black – Wearing head-to-toe black or brown can look harsh and evoke the formality of a stodgy uniform. Mixing black and brown adds an instant softness and visual interest.
Dress up AND down – no need to be fully dressed up for the holiday. Instead, for a more playful, fun look, pair high-end and low-end and dressy and casual. Lace and denim? Wool and silk, t-shirt and full length skirt, for example
Pre-made vs. Homemade:
Don't put the pressure on yourself that EVERYTHING needs to be homemade, there are great prepared sides and desserts that will round out your dinner. Whether you are a host or guest, the key to a successful Thanksgiving dinner is keeping the stress-level low.
Don't Shop, Save!:
Instead of planning your Black Friday shopping trips to see who can find the best deal, what not plan a savings challenge for your family. Think of a family goal like a trip, that the family could save for as a team over the holidays. Resisting those impulsive holiday purchases can really add up!
Solutions For Some Common Thanksgiving Foul-Ups
Too much salt:
Have a potato on-hand! If you over-salt a dish, just add a raw cubed potato to absorb the extra salt
Add a little vinegar and sugar, then taste. A raw potato helps absorb soup in soups and stews.
Too much sugar:
Add a few drops of lemon juice or vinegar.
Hands smell from garlic and onion.
If you've been prepping and cooking a Thanksgiving dinner, odds are you've been working with garlic and onion quite a bit. And now your hands smell! Rinse hand in cold water, rub with salt or baking powder, rinse again, then wash with soap and water.
Expensive Thanksgiving Mistakes or Spend vs. Splurge Breakdown for Thanksgiving
Do this: Serve a signature cocktail like a Raspberry Collins instead of wine
Not That: Run out and buy bottles of pricey wine to impress your guests. Cocktails are more cost effective than offering up beer or wine.
A little known fact of cocktails is that the same size bottle of wine (750 ml) typically pours just 5 glasses of wine. Where at 750 ml bottle of vodka or gin will pour 16 + drinks if mixed in with a cocktail. We like to keep our cocktail offerings simple, and spice up my presentation using beautiful pitched or glass tap. One of our favorite drinks is a Raspberry Collins. This simple and inexpensive recipe simply calls for gin, lemon juice, simple syrup or superfine sugar, club soda, frozen or pureed raspberries.
Do This: Hire a cleaning service
Not That: Spend countless hours and valuable energy trying to keep up with the holiday mess.
It may seem like a luxury - and it might be, but sometimes, some things are worth the investment. And if there is one time of the year to invest in good clean, it's over the holidays. Many cleaning services offer promotions over the holidays, so it's worth a look. And many group buying sites like groupon and tiktok are worth signing up for to get cleaning service deals.
Consider this for $10-$15 an hour a team of cleaning service or cleaner can deep clean your home in a matter of hours. Leaving you extra time to organize, enjoy company or get or just relax before a hectic holiday. For under $100 this is often an investment in your mental health.
Last Minute Thanksgiving Dinner Tips
Buy 2 Smaller Turkeys:
I always buy a couple smaller turkeys (10-12 pounds), and then you are done in a couple of hours, as opposed to the big 24 pounders. There is also more likely to be smaller turkeys available if you're shopping last minute.
Dress Up A Pre-Made Pie:
Buy a pumpkin pie pre-made pumpkin pie then top it with what you like to make it your own. You could use coconut frosting, pecans, a little bit of vanilla – what ever you have to add a little something special
Use food as decorations:
If you've put the time into making a beautiful dessert, why not show it off as the center-piece. You can use fall leaves and pumpkins that you already have to accent.


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Katelinn (#13) competed with the East coast Selects - Ontario team in the World Selects Invitational girls 14U hockey tournament in Prague, Czech Republic in April. Seven teams from north america, Czech Republic, Sweden and Finland competed in the tournament. The ECS-O team made it to the championships and took the silver medals after losing a hard fought game 4-3 to the West Coast Selects team. Amazing trip to play hockey in Europe!
WSI girls hockey-Prague, Czech Republic
By: kitmar1Subscribe Channel: Sports Location: Johnson city, NY
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Partial Park Avenue closure set for April 16April 15, 2013
EAU CLAIRE — Park Avenue from Garfield Avenue to McKinley Avenue will be closed most of the day April 16 due to work on the new Education Building at the University of Wisconsin-Eau Claire.
The closure will include the sidewalk on the west (university) side of Park Avenue. Pedestrian traffic will be redirected to the sidewalk on the east side of Park Avenue, said Chris Hessel, construction project coordinator with UW-Eau Claire Facilities Management.
For questions regarding the street closure, contact Hessel at 715-836-2518.


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Very Good Recipes of Soup from The Self-Taught Cook
There are 18 Soup recipes on the blog The Self-Taught Cook. (3036 on all the blogs)
Click on the title of a recipe or the photo of a dish to read the full recipe on its author's blog.
Recipes by date | Most popular recipes
Kielbasa soup By The Self-Taught Cook 02/25/13 22:04 KIELBASA SOUP 1 lb. kielbasa 2 stalks celery, diced 1/2 onion, diced 1/4 C baby carrots, chopped 2 potatoes, peeled and chopped 1 can diced tomatoes 4 C frozen mixed vegetables 3 C chicken stock 3 C vegetable stock 2 cloves garlic, minced freshly ground... Add to my recipe book
Sopa de Habichuelas Negras (Black Bean Soup) By The Self-Taught Cook 01/14/13 22:27 Sopa de Habichuelas Negras (Black Bean Soup) adapted from Homestyle Puerto Rican Cooking 1 lb dried black beans 4 c water 3 garlic cloves, minced 1 bay leaf 2 Tbsp recaito, divided 1 Tbsp extra-virgin olive oil 1 1/2 chorizo sausage, broken into small pieces... Add to my recipe book
Mixed bean soup By The Self-Taught Cook 12/17/12 16:00 MIXED BEAN SOUP 1 Tbsp bacon grease 1 medium onion, diced 2 cloves garlic, minced 2 carrots, diced 1 green bell pepper, diced 2 stalks celery, diced 1 regular size package smoked sausage, chopped into bite-size pieces 1/2 tsp sea salt freshly ground black... Add to my recipe book
Lentil soup By The Self-Taught Cook 11/02/12 13:30 Aaah, Autumn! We moved back to Kentucky just in time. It's been great watching the leaves turn colors and fall. One of the best things about this time of the year is that it starts what I refer to as Soup Season. Yes, I tried to have Soup Season in Florida,... Add to my recipe book
National pasta week: repost of easy tortellini soup By The Self-Taught Cook 10/08/12 13:00 October is just chock full of great food holidays! The second week of the month, this week in other words, is National Pasta Week. Now, I know that carbs have been given a bad rap in the dieting world, but it's really all about moderation. This month is... Add to my recipe book
Vegetable beef soup By The Self-Taught Cook 06/27/12 12:00 I know you think it's summer down here in Florida, and who eats hot soup in the summer?, but as I've explained before, I like soup any time. Besides, thanks to Tropical Storm Debby, we've had nothing but rainy, dreary days lately and even though the air... Add to my recipe book
Sideline Sausage Soup By The Self-Taught Cook 04/23/12 11:39 I know, I know! It's 85 degrees and I'm making soup! What can I say? I really, really love soup and I really, really love my slow cooker! Besides, I don't think I have discussed this on here before but I have fibromyalgia. I don't talk about it much, because... Add to my recipe book
Caldo Gallego (Gallician Soup) and Giveaway Links By The Self-Taught Cook 04/05/12 01:59 ¡Buenos días! From time to time, I have posted Puerto Rican recipes, and frankly, they have been my most popular posts. Lately, however, I have gotten sidetracked and posted more "American" recipes, things that fall into different categories but certainly... Add to my recipe book
Low carb thursday- beef barley soup By The Self-Taught Cook 03/30/12 02:46 Yay! Soup again today! I love soup. And the only thing better than soup is healthy soup. That's right. Today's Beef Barley Soup is low carb, as promised. A few years ago, I worked at a large medical clinic here in Florida. They had a small cafeteria, nothing... Add to my recipe book
Sopa de ajo (garlic soup) By The Self-Taught Cook 03/29/12 03:31 G arlic plays an important role in Puerto Rican cuisine. This, of course, is one of the reasons I love Puerto Rican cooking. Anything with garlic has to be good. Did you know that garlic is closely related to the onion and chive? It has been known to man... Add to my recipe book
Low carb thursday- low carb black bean soup By The Self-Taught Cook 03/15/12 14:05 W elcome back to Low Carb Thursday! I hope everyone is in the mood for some healthy cooking for a change. As I've said, our diet isn't as healthy as it could be, but we're getting there. We're easing into it a little at a time. A few months ago, I posted... Add to my recipe book
Low carb beef & noodle soup By The Self-Taught Cook 02/24/12 03:36 A s promised, I'm trying to do at least one low-carb post per week. Today's low-carb recipe has my two favorite qualities: (1) It's soup; (2) It's in the slow-cooker. Yay! Not only is it good, but it is a very simple soup to throw together in the morning... Add to my recipe book
Sopa de vegetales y carnes de res (beef vegetable soup) By The Self-Taught Cook 01/06/12 01:34 Ah, Central Florida weather! This morning when we awoke, it was freezing. Literally. That doesn't happen very often down here and everyone gets excited when it does. Not only do they make the most of it during the weather report, last night they continually... Add to my recipe book
Meatball soup By The Self-Taught Cook 12/13/11 01:00 This week is Clean Out the Freezer and Pantry week, which can lead to some interesting meals. Fortunately, last night's turned out well. I found a package of frozen cheese tortellini and a package of frozen meatballs, canned tomatoes and beans in the pantry,... Add to my recipe book
Calico soup By The Self-Taught Cook 11/15/11 03:33 Today was one of those days that if it hadn't been for my beloved slow cooker, we would have been eating takeout again tonight. I thought I was only going to be gone for hour this morning, and instead was out all day. It was a very frustrating day. All... Add to my recipe book
Black bean soup (how to use leftover black beans) By The Self-Taught Cook 11/05/11 22:47 Recently, my daughter-in-law shared her Black Bean Soup recipe with me. I was planning on trying it today, but didn't have any cans of black beans. What I did have, however, was leftover black beans. Since I may be the queen of substitutions (that would... Add to my recipe book
Snow day soup By The Self-Taught Cook 11/04/11 23:15 Ok, so it isn't snowing in Central Florida, nor is it likely to. The last time we saw snow flurries, and I do mean flurries, was in January 2003. I remember it vividly. Sad, really. There are actually native Polk Countians down here who can say truthfully... Add to my recipe book
Cajun sausage and corn soup (end of blogging vacation - welcome autumn!) By The Self-Taught Cook 10/19/11 03:22 And, I'm back. You see, several weeks ago, I decided to take a couple of days off from blogging. From that moment on, if it wasn't one thing, it was another. Before I knew it, it had been weeks (months, actually) since I had posted anything. And to top... Add to my recipe book


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The record "Super Somebody" may have themes we've heard before but the real love is in the lyrics and in her wide range. Artist and producer mesh well on finding a great
meeting point in this song. Read Full Review Here.
For a limited time you can download Super Somebody (click download button)
Critics, peers and early fans agree, JANEEN is one to watch as she sets forth to
distinguish herself as one of the premier singers in the country.
With the perfect blend of vocal skills and tight musical tracks, Janeen will
build a wide range of fans that span generations.
Janeen is currently putting finishing touches on her ground-breaking, highly
anticipated debut EP "SQUARE ONE", a unique combination of modern pop,
hip hop and R&B.
The first single release, "SUPER SOMEBODY" is an Mid-tempo Pop/ R&B track.
2007-2023. OWBS.LLC all rights reserved


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We study many aspects of aquatic ecosystems, including how anthropogenic change alters nutrient and carbon flow and food web structure.
Rosemond Lab
Odum School of Ecology
Ecology Building
University of Georgia
Athens, GA 30602
ph. 706.542.3902
email: rosemond'at'uga.edu
Website designed by Athens Web Design Studio, LLC | Copyright 2012
Photos courtesy of the Georgia Department of Economic Development & Athens Web Design Studio, LLC


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4 Chic Home Office Ideas
Discover stylish, practical ways to store your work-related essentials
By Ayn-Monique Klahre
French Twist
Layer texture and tone-on-tone pattern for a sophisticated retreat.
A rattan-covered magnetic board ($69; BallardDesigns.com) can hold inspiring clips or swatches.
Paint colors: Newborn Pink and Pink Begonia, $36 per gallon; BenjaminMoore.com.
elfa Walnut Décor Shelving, $220 as shown; ContainerStore.com, Semikolon Black & Crème Stripe Business Card Box, $20, and CD & Photo Box, top right, $28; SeeJaneWork.com, Brown Basic Art Boxes, $18 each; SeeJaneWork.com, Faux Leather Magazine Holders, $10 each; TuesdayMorning.com for stores, Printed Pencils, $15 for 14; Iomoi.com, 9156 Betty Side Chair in Pepper Finish with Inspire Linen Seat, $950; CRLaine.com for stores, Harlow Vanity/Desk, $599; CrateandBarrel.com, AF Lighting Plato Brass Table Lamp, $138; Bellacor.com.


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June 16, 2011
Ali Smith: There but for the
It once occurred to me that the best books are those which absolutely divide opinion. I no longer think that's necessarily true – if I ever did, beyond finding it a neat shorthand – but it came to mind when reading Ali Smith's new novel. Look at the Amazon ratings for her last novel proper, the Booker-shortlisted The Accidental: an almost even spread from one to five stars. Yet I was a mixed sample myself with regard to that book: defending it from those who thought it too "complex" or (the red mist word) "pretentious"; but unconvinced by those who considered Smith the great white hope of contemporary British literature.
There but for the carries its fragmented intent from the title, so no one should be misled. The broken sentence suggests its own missing parts. That in itself – something unsaid but obvious – is a pretty good indication of what to expect with Smith. Martin Amis several years ago observed, in an attempt to take possession of a critic's dismissal, that "someone once said of my work, and I didn't mind it at all, that I deal with banalities delivered with tremendous force," adding, for the avoidance of doubt that he really didn't mind at all, "That's fine by me." His reclamation of the insult is not very convincing, but it's one that might be applied to Smith also. In both The Accidental and her recent Canongate myths book, Girl Meets Boy, she has a masterly control of style but an unfortunate tendency to bash the reader over the head.
By that I mean that her sentences are just so, her structure is careful and contains enough gaps to make the reader do a manageable amount of work to fit things together. However in some important respects she leaves little to the imagination and even tends to impose thoughts on the reader. To explain that I had better go into more detail about the story. It's somewhat high-concept, and it easily summed up by the opening sentence of the first full chapter, titled 'There':
was once a man who, one night between the main course and the sweet at a dinner party, went upstairs and locked himself in one of the bedrooms of the house of the people who were giving the dinner party.
The man is Miles Garth, and the book is structured in four parts from the viewpoints of four people who know him. There is Anna, who met him twenty years ago at university and on whom the dinner party hosts call to try to persuade him out of the bedroom. (He stays there for a long time.) There is Mark, the man who took Miles to the dinner party as his partner. (Miles is a vegetarian, but the owners of the house sustain him with slices of cooked meat under the door, as though appearing in a joke with no punchline.) There is May Young, an elderly woman nursing a decades-long trauma which Miles may have caused but also helped her recover from. (The lock-in lasts for months, with implausible levels of media interest, and reporters camped outside the house.) Finally there is Brooke Bayoude, a nine-year-old girl whose parents are neighbours of the dinner-party couple and who seems to be the wisest of all.
The book's strengths are significant. Smith ties the stories together well, dripfeeding information through the viewpoints of her four central characters (the book's true centre, Miles, doesn't get a voice of his own but we learn plenty about him from the others). Her characters are sensitively drawn, though it's an ability she is unwilling or unable to extend to the secondary cast, in particular the dinner party hosts and guests. Smith makes them ridiculous bourgeois stereotypes, working in Canary Wharf, obsessed with the fabric of their homes, insensitive to difference (homosexuality, vegetarianism); easy targets. Early on there is an email written by the dinner party host which made my toes curl with its petty mockery of the character's language skills. It should not be beyond a novelist of Smith's skill to extend empathy to unlikeable characters as well as likeable ones.
Her resistance to convention is her best quality. An allegorical prologue is one of the strongest scenes in the book. The story overall has a carefully implausible ring to it, and it is as futile to argue that the hosts should break down the ("18th century!") door and remove Miles by force, as it would be to suggest that the characters in Ishiguro's Never Let Me Go should have battled their fate. Their fate was all our fates, and Miles's self-imposed isolation within a home says, "There but for the grace of God go I;" though Miles doesn't go, he stays. Every story in the book has something to say about how we live with or without other people: we skip forward to see the effect Miles's stand-off has on the family who unwillingly host him; we learn about Mark's mother and the trauma she bequeathed to her household; we see May Young awaiting transfer to a nursing home, and dreaming of escape even at the far end of life.
There is also an interest in modernity, how we communicate now and the way our experiences shift as a result. The book's present day is the last couple of years, and in the first part Anna observes the CCTV cameras everywhere and reflects on "what a paranoid, jealousy-maddened love affair just walking down any British street in 2009 resembled." Smith's attention to detail is her forte as a writer, and it is also evident in the production and paraphernalia of the book (the three dedications, the five epigraphs, the careful choice of types and formatting). Yet this penchant for detail might also be a weakness, if it is the cause of the coolness, and the lack of intimacy I felt at times. It is hard to locate the novel's centre, and there is a sense that Smith is holding something back, tempering her talent in order to make her tantalising story neater and more palatable. She is at her best when giving the reader something to do, and taking risks. She should do it more, allow her delicious river of language to flow; publish and not be dammed.
21 Comments »
"…carefully implausible ring…' that to me sums up a lot of excellent novels. Why should they be true evocations of life? For me the best art does not look like a photograph – in the same way maybe that is why I also like books that have some distance and a '…lack of intimacy…'
Excellent review, as usual. I really shouldn't come here. It makes me want to read each one.
'…leaves little to the imagination and even tends to impose thoughts on the reader.'
Isn't that an apt summation of what tends to be wrong with 75% of all fiction? The inability to drop the reader's lapels?
I think the best writing imposes moods, not ideas, upon the reader, and I think you hit on the weaker end of the Smith suit. I think it's a lack of confidence in the main, and a slight inability to give the benefit of the doubt to those picking up the book.
Any yet: Amis, Bellow and others can't help but plough internal furrows to the extent that little is left in question. Perhpas Ali Smith – a fine writer – needs to change tack?
An even spread of one to five is nice, but surely the greatest achievement would be equal numbers of ones and fives, with nothing in between?
Brief digression: I recently had 'a go' at The Pregnant Widow. I recall your saying that the prologue was great and that you'd given up shortly thereafter. Astute words…
I'd be surprised if Ali Smith ever topped the final part of Hotel World. Though that she is occasionally as good means she's well worth keeping an eye on.
Great review, John – as ever you've picked up on things I had completely missed when reading the book. Anyway, having been on the fence somewhat about "The Accidental" I must say I loved this one. I though it was witty, clever, playful and very very readable.
Incidentally, am I supposed to be reading "Miles Garth" as an anagram (for "lethargism") or am I reading too much into an odd name?
Well, there were other things with names, like Gen & Eric (generic) and Anna whose name, like Abba, reads the same backwards, which is what made me a) take notice of names in the novel, and b) wonder about Miles'.
One thing I really liked was the way Smith introduced the character of Brooke. She describes her through Anna's eyes as a girl in a yellow dress over blue jeans sitting on the steps of a house, but when Anna goes to the door of the house the woman who answers is white. Which she expands on (perhaps unnecessarily) later in the book, but I thought that was such a clever way of telling us that Brooke isn't white without using 'black' to label her. Likewise we know – long before we are told – that Brooke has an accent that allows the name 'Brooke' and the word 'broke' to sound similar (and of course it transpires that she's from Yorkshire). Such good writing.
I just picked up a copy of this yesterday that I'll review for its September release here in the States. I was one of those people who did not care for The Accidental at all, so I am definitely curious to see what I will think of Smith's latest offering. I am going to flag your review to read after I've finished the book myself. It looks like it promises to be a provocative read!
I really enjoyed this one (although I confess that I like Ali Smith's style generally). What I most like about Ali Smith's style is her playful experimentalism. Many experimentalists seem to chop narrative about out of hostility towards, or irritation with, what's orthodox, ordinary, accepted, conventional. I really appreciate the warmth that infuses Smith's singing sentences, the sense of gentle mischief that informs her characterisations. Her books always make me laugh while they make me think, and I do so appreciate that combination.
was debating whether or not to buy this- this debate has solved my internal one! thanks
[…] stroke, which I know other people have questioned a little (and you can see in the comments of John Self's post on 'There But For The' we have had a discussion about it), was the characters of Jen and Eric 'The Hosts'. I don't […]
[…] languages is becoming tilted towards ease of translation into English. John Self considers the charms and shortcomings of Ali Smith. I have missed not only Bloomsday but also Harriet Beecher Stowe day. In Osaka, there […]


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So the big rumor of the weekend is that Google may soon launch a Facebook competitor called "Google Me."
It all kicked off after Digg founder Kevin Rose tweeted:
Now everyone is jumping in and speculating just how Google might do battle with Facebook.
As for me? Let me ask you this: What product has Google launched that has seriously competed in the social networking space? Any of these?
This is all the coverage I personally plan to give the story until two things happen:
- Google actually launches this new service
- It's able to gain even a fraction of the market share of Facebook – and Brazil doesn't count!
Until then, Google will remain a great search engine and a lousy social network.


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