text:
Kanaka D. Shetty, MD, MS; Jayanta Bhattacharya, MD, PhD
Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs, National Bureau of Economic Research, or the Center for Health Policy and Center for Primary Care and Outcomes Research.
Acknowledgments: The authors thank Drs. Alan Garber, Douglas Owens, Mark Hlatky, and Priya Pillutla for helpful comments on earlier versions of this manuscript.
Grant Support: Dr. Shetty was supported by a Department of Veterans Affairs Fellowship in Ambulatory Care Practice and Research. Dr. Bhattacharya was supported by the National Institute on Aging.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Kanaka D. Shetty, MD, MS, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.
Current Author Addresses: Drs. Shetty and Bhattacharya: Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.
Author Contributions: Conception and design: K. Shetty, J. Bhattacharya.
Analysis and interpretation of the data: K. Shetty, J. Bhattacharya.
Drafting of the article: K. Shetty.
Critical revision of the article for important intellectual content: K. Shetty, J. Bhattacharya.
Final approval of the article: K. Shetty, J. Bhattacharya.
Provision of study materials or patients: K. Shetty.
Statistical expertise: K. Shetty, J. Bhattacharya.
Obtaining of funding: J. Bhattacharya.
Collection and assembly of data: K. Shetty.
Shetty KD, Bhattacharya J. Changes in Hospital Mortality Associated with Residency Work-Hour Regulations. Ann Intern Med. 2007;147:73-80. doi: 10.7326/0003-4819-147-2-200707170-00161
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Published: Ann Intern Med. 2007;147(2):73-80.
The health effects of regulations restricting housestaff work hours to 75 hours per week are largely unknown.
The authors measured inpatient mortality of 1 268 738 patients admitted to 551 hospitals with medical diagnoses and 243 207 patients admitted for surgical diagnoses before and after 2003, when the work-hour regulation took effect. After 2003, the mortality rate for medical patients—but not surgical patients—decreased more in teaching hospitals than nonteaching hospitals.
The authors classified a hospital as "teaching" if it had a residency program; however, some teaching hospitals have nonteaching patients.
Limiting residents' work hours was associated with lower in-hospital mortality rates for medical patients in teaching hospitals.
—The Editors
For more than 20 years, the Accreditation Council on Graduate Medical Education (ACGME) and other observers have been concerned with excessive resident duty hours (1–9). The ACGME imposed national restrictions on duty hours in 1987, New York State enacted hours restrictions in 1989, and the ACGME's Residency Review Committee for Internal Medicine adopted duty-hour limits in the 1990s. Despite these regulations, enforcement before 2003 was not stringent and excessive resident work hours were common. In part to avoid federal legislation, the ACGME approved new resident duty-hour regulations that became effective on 1 July 2003 (1). The regulations limited resident workweeks to 80 hours or fewer and limited continuous duty to 24 hours, with 6 additional hours for transfer of care.
The effect of these regulations is uncertain. An hours cap might reduce errors and mortality due to resident weariness. Alternatively, they might increase errors if they disrupt the continuity of patient care. Scholarly work on this question has been limited, and the conclusions of these studies were mixed. One study found that New York State's regulations did not affect mortality in patients who were admitted for pneumonia, congestive heart failure, or acute myocardial infarction (10). However, duty-hour violations were still common during the study period, making the results less relevant to current regulations. Another study indicated that interns working under a duty-hours cap made fewer errors than did a similar group under a traditional call system (6). This finding suggested that duty-hours caps improve patient outcomes, but the sample size was too small to show effects on mortality.
The regulations may not have altered outcomes if residency programs did not change working conditions. However, the official ACGME report and multiple program director surveys documented major changes in work hours in residency programs after July 2003 (2, 11–16). In addition, an independent survey reported that interns' average weekly work hours decreased from 70.7 to 66.6 hours despite widespread violations (5).
We retrospectively analyzed discharge data collected between 2001 and 2004 to determine whether the ACGME regulations were associated with changes in inpatient mortality. Unlike previous work, our study has the statistical power to detect small effects because we used a large, nationally representative data set with patients from nonteaching hospitals as a control group.
We used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project to assemble a nationally representative data set of hospital patients between 2001 and 2004. The NIS sampled approximately 20% of all community hospitals in the United States and included at least 7.4 million discharges annually since 2001. The NIS provided clinical and demographic information on each discharged patient, including age, sex, 10 diagnoses (1 principal and 9 secondary), principal procedure, month of admission, and income quartile of the patient's ZIP code. The NIS coded procedures and diagnoses according to the International Classification of Diseases, Ninth Revision. The study was exempt from approval by the Stanford University institutional review board because all patient-level NIS data were publicly available and deidentified. We used data from the American Medical Association to assign teaching status and calculate the number of residents for each hospital (4, 17–21).
Before beginning our analysis, we selected principal diagnoses and procedures that represented a broad variety of medical and surgical diagnoses, were associated with high mortality rates, and were common in both teaching and nonteaching hospitals. Using these criteria, we selected 20 medical diagnoses and 15 surgical diagnoses. Patients with these diagnoses made up 34% of the total number of deaths in the sample and 13% of the patients (Table 1). We classified patients as surgical if their principal procedure code represented a major surgery and as medical if their principal diagnosis corresponded to a major internal medicine diagnosis. In addition, patients who were admitted for medical diagnoses but later had major surgeries during the same hospitalization were classified as surgical patients.
Table 1.
We excluded populations with low mortality rates (including all pediatric and obstetric patients) because we lacked the statistical power to detect a significant effect in these groups. We also excluded patients transferred from other hospitals or correctional facilities. We assigned teaching status to hospitals by linking American Medical Association data on residency programs to NIS data on hospitals by using American Hospital Association identification numbers. We therefore excluded patients from states that did not permit the release of hospital identifiers (roughly 35% of the NIS). To create similar pre- and postregulation populations, we limited our final sample to patients from hospitals that admitted at least 100 patients both before (January 2001–June 2003) and after (July 2003–December 2004) the regulations were implemented.
Teaching status is a critical variable in our analysis. The NIS classified patients as "teaching" if the admitting hospital had any type of educational program. For example, the NIS teaching variable would have erroneously classified surgical patients at teaching hospitals as teaching, regardless of whether their primary providers were residents (under the supervision of attending physicians) or attending physicians (with little or no resident involvement). To reduce this error, we first classified all patients in each hospital as internal medicine, general surgery, urology, or orthopedics patients on the basis of their principal diagnosis. We then classified patients as teaching if the hospital had a corresponding internal medicine, general surgery, urology, or orthopedics residency program (based on American Medical Association records). In addition, in hospitals with family practice programs, we classified internal medicine patients as teaching.
For example, if a hospital had an internal medicine residency program, we analyzed all patients admitted for medical diagnoses as if they were admitted to a teaching hospital. Conversely, if the same hospital lacked a surgical residency program, we analyzed all patients admitted for surgical diagnoses as if they were admitted to a nonteaching hospital. In our model, hospitals could admit a mix of teaching and nonteaching patients depending on the hospital's mix of sponsored residency programs. However, all patients with the same diagnosis in one particular hospital would be analyzed as teaching or nonteaching unless the hospital gained (or lost) a residency program from one year to the next. With this procedure, misclassification of patients is still possible if a hospital has parallel teaching and nonteaching services. We later discuss the effect of misclassification on the interpretation of our results.
We used a multivariate logistic regression model to estimate the changes in mortality associated with the regulations. Changes in nonteaching hospitals after July 2003 were unrelated to the regulations and therefore reflected underlying trends. Thus, changes that occurred in nonteaching hospitals act as a control for the changes associated with regulations in teaching hospitals. To derive our estimate, we subtracted the mortality trend in the control group (patients from nonteaching hospitals) from the mortality trend in patients from teaching hospitals. This method has been previously described in the economic and medical literature as a "difference-in-differences" approach (22–24). We accounted for case-mix differences by adjusting each of our regression estimates for admitting diagnosis and all previous medical conditions included in the Charlson index except uncomplicated diabetes and peptic ulcer disease (25, 26). We included age in the regression along with indicator variables for sex, race, insurance status, year and month of admission, income quartile of the patient's ZIP code, and emergency admission.
Hospitals also have very different patient populations and staffs, which cannot be observed by using available data. We tested several models to address these differences. We tried a generalized linear mixed model, but a Hausman specification test revealed that the basic assumptions underlying this model were not met (27). We therefore used a logistic regression model that treated each hospital's unobserved effect as a distinct intercept. Estimation of several hundred variables (one for each hospital) can lead to inconsistent estimates, but we reduced this problem by including only hospitals with more than 200 study-eligible patients (28). In addition, we compared our results to those from a conditional logistic regression model (which does not require the estimation of multiple intercepts). We found similar odds ratios in both, but we elected against using a conditional logistic regression model because the results cannot be expressed as changes in probabilities.
Using the model estimates, we calculated the change in probability of death in patients from teaching hospitals and in patients from nonteaching hospitals. We estimated the change in mortality rate associated with the regulations by subtracting the change in probability of death for patients from nonteaching hospitals (the control group) from that in patients admitted to teaching hospitals (22, 29, 30). We also calculated the relative risk reduction by dividing the change in mortality by the pre–July 2003 death rate for teaching hospitals (22, 27).
Before starting our analysis, we chose to perform 2 primary analyses (medical and surgical patients) separately; we anticipated that the regulations would affect each group differently because of dissimilarities in the previous resident working conditions. We chose sensitivity analyses and subgroup analyses based on our primary results. We accounted for NIS sampling weights in all analyses, used 2-sided P values in hypothesis testing, and adjusted the variance for clustering of patients at the hospital level. We used Stata 9.2 (StataCorp, College Station, Texas) for all analyses.
As a sensitivity test, we used the Hochberg method to adjust for increased type I error associated with multiple comparisons within families of independent hypotheses (31). For example, in 1 family of subgroup analyses, we divided patients into 3 different age groups and analyzed the regulations separately for each group. There are 3 independent hypotheses in this family, so we used the Hochberg method to adjust the P values to account for this. We adjusted P values in similar ways for other families of hypotheses.
We tested several key assumptions underlying the regression model. First, recall that we did not directly observe whether a patient's primary provider was a resident or an attending physician. Instead, we imputed teaching status on the basis of the presence of a residency program (internal medicine, general surgery, urology, or orthopedics) at the hospital. To check the effect of this misclassification on our results, we separately analyzed patients from hospitals with fewer than 15 medical residents, between 15 and 40 medical residents, and more than 40 medical residents. Patients at hospitals with large residency programs are more likely to be cared for by residents. Thus, if misclassification is important, we should expect to find substantial differences among hospitals with residency programs of different sizes in our estimates.
Second, our approach relies on the assumption that nonteaching patients serve as an adequate control for mortality trends in the hospitalized population that are unrelated to the regulations. To test this assumption, we assumed (counterfactually) that the regulatory change took place at various times before July 2003. If our assumption is correct, we should find no association between these counterfactual regulatory changes and outcomes.
The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Tables 1 and 2 show the distribution of admitting diagnoses and key clinical characteristics. The relatively high mean mortality rates in both groups reflect the high risk associated with the included diagnoses. Table 3 shows hospital characteristics, including the number of hospitals with residency programs.
Table 2.
Table 3.
We found that the imposition of the hours cap was associated with a 0.25% decrease in absolute risk for death (P = 0.043), which corresponded to a 3.75% decrease in relative risk in medical patients per hospitalization (Table 4 and Figure 1, top).
Table 4.
Top. Medical patients. Middle. Medical patient subgroups. Bottom. Medical patients, previous years. Error bars represent 95% CIs.
The regulations correlated with decreased absolute mortality (change, −0.71%; P = 0.005) and relative risk (change, −6.97%) in medical teaching patients older than 80 years of age (Figure 1, top). We did not find statistically significant changes in patients 65 to 80 years of age or in patients younger than 65 years of age. We also found declines in several disparate populations, including patients with congestive heart failure, sepsis, pneumonia, and gastrointestinal bleeding. In addition, the regulations were associated with a 0.66% decline in mortality among patients admitted with infectious diseases (relative risk reduction, 7.94%; P = 0.007) (Table 4and Figure 1, middle).
We did not find statistically significant changes in surgical teaching patients (change in absolute mortality, 0.13%; relative change, 3.77%; P = 0.54) (Table 5 and Figure 2). We did not observe a statistically significant change in mortality among older surgical patients (change, 0.74%; P = 0.16). We found no statistically significant mortality changes when comparing surgical patients from hospitals with larger residency programs with those from hospitals without residency programs (change, 0.05%; P = 0.66) or with patients from hospitals with nonsurgical teaching programs (change, 0.32%; P = 0.23).
Table 5.
Error bars represent 95% CIs.
We used the Hochberg method to adjust for multiple comparisons within independent families of results. In the first group (medical and surgical patients), we rejected the null hypothesis of no change within medical patients, but at the 10% level. Even after the Hochberg adjustment, we rejected the null hypothesis of no effect for congestive heart failure, infectious diseases, and age greater than 80 years at the 5% level. For all surgical subgroups, after the Hochberg adjustment we failed to reject the null hypothesis of no association between the regulatory change and mortality.
To check for the effect of misclassifying patients' teaching status, we compared mortality changes in patients from teaching hospitals of varying program sizes (<15, 15–40, and >40 medical residents) with changes among patients from nonteaching hospitals (Table 4 and Figure 1, top). The point estimates suggested larger decreases in mortality in hospitals with more residents (and presumably fewer nonteaching patients misclassified as teaching patients), although none of these differences were statistically significant (with or without the Hochberg adjustment).
For our falsification tests, we counterfactually assumed that the regulatory change took place earlier than 2003 (Table 4 and Figure 1, bottom). There was a statistically significant decline in mortality between 1998 and 1999 (change, −0.42%; P = 0.034), but this decline was not significant even at the 10% level after the Hochberg adjustment. We did not observe statistically significant changes in other year-to-year comparisons or when we examined trends for the 4-year period encompassing 1998–1999 versus 2000–2001 (change, 0.08%; P = 0.67), with or without the Hochberg adjustment.
Despite concerns that the ACGME restrictions on work hours might have worsened outcomes, we found that the regulations correlated with a 0.25% decrease in mortality and a relative risk reduction of 3.75% for internal medicine patients at teaching hospitals. We initially hypothesized that mortality for medical and surgical patients would change after the regulations, and the data support this hypothesis for medical patients. For surgical patients, we conclude that the regulations were not associated with improved outcomes. We also examined post regulation mortality changes for various patient subgroups. After adjustment for multiple comparisons, the results were significant at the 5% level for patients admitted for congestive heart failure or infectious diseases and for patients older than 80 years of age. We regard the subgroup analyses as preliminary because these hypotheses were post hoc.
We generated these estimates with multivariate logistic regression in which we used changes in outcomes for nonteaching patients as a control for the changes induced by the regulations in patients from teaching hospitals. Various sensitivity analyses supported this approach and suggested stable relative mortality trends between patients from teaching and nonteaching hospitals in the 4 years (1998–2001) before the regulatory period.
It is striking that the regulations were associated with improved outcomes in medical patients but not in surgical patients. There are several possible explanations. First, the smaller sample size for surgical patients may have limited our power to detect statistically significant differences. Second, surgical residency programs may not have altered their working conditions substantially. Third, if the number of surgical residents remained fixed and each resident worked less, the average number of available providers would decline. Fourth, errors due to fatigue may have been counterbalanced by problems with transfers of care.
Our results differ from those of previous studies, which found no conclusive evidence that work-hour restrictions improved outcomes in multiple settings (32), including obstetric, gynecologic, and perinatal care (33) and cardiac surgery (34). Previous studies of the New York State experience also found no effect on mortality (10) or various patient safety indicators (35). However, these studies were all conducted in smaller populations (often single academic centers), limiting both their statistical power and their relevance to national changes. In addition, whether enforcement was strict enough to have permitted statistically significant effects to be seen is unclear.
Our study has several limitations. First, we assigned teaching status on the basis of hospital characteristics because the data did not include information on individual providers. However, misclassification of nonteaching patients in teaching hospitals would blur the distinction between teaching and nonteaching patients, leading to a conservative bias toward the null hypothesis. Furthermore, we included only patients with serious and complex diagnoses in the study. In teaching hospitals, residents usually participate in the care of such patients. Hence, there were probably relatively few misclassified patients. We also observed larger improvements in mortality in hospitals with more internal medicine residents, where we would expect to find the least misclassification bias.
Second, our estimates do not represent the mortality effect of changes in exposure to resident care alone, but rather the effect of all the changes induced by work-hour regulations. For example, the regulations induced many hospitals to shift care to attending physicians (including academic hospitalists) and probably increased the number of nonteaching patients in teaching hospitals.
Third, it is always possible in an observational study that unobserved characteristics could have biased the results. However, the use of a control group (patients in nonteaching hospitals), the sensitivity analyses, the short period under consideration, and the greater improvements seen in hospitals with more internal medicine residents all argue against this bias as an explanation for our results.
Fourth, we focused on the role of medical and surgical residents. Residents from other specialties may have played some role in the improved mortality among medical patients, but these physicians rarely have primary responsibility for medical inpatients.
Fifth, we considered only a limited set of high-risk groups, which makes it possible that mortality trends were different in other groups. We attempted to reduce this possibility by including a broad set of diagnoses, but further studies on low-risk populations (including pediatric and obstetric patients) and on larger samples of surgical patients are warranted.
Finally, data limitations permit us to say little about whether the regulations affected survival beyond discharge or how hospitals adjusted to the sudden decrease in available resident work hours.
We conclude by emphasizing findings that are worth exploring further. Our subgroup analyses suggested that the greatest associated mortality improvements were in patients older than 80 years of age and in patients admitted for infectious diseases. Future dedicated analyses of both results are justified. The regulations may have improved outcomes by shifting care from inexperienced residents to more experienced providers (such as academic hospitalists). If so, the regulations' long-term effect could be deleterious if physicians do not obtain sufficient experience and skills during training and make more errors after residency. Further study is needed to determine the regulations' long-term effect on both graduate medical education and patient care.
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Mr. and Mrs. Bill Williams
WELLSBURG – Bill and Karen Williams of Wellsburg will celebrate their 50th anniversary on Sept. 7.
They were united in marriage on Sept. 7, 1963, at the Central Baptist Church in Hinton, W.Va., by the late Rev. W. Robert McCoy.
A native of South Charleston, she is the daughter of the late Mary Caldwell and Cy Mazzella. She is retired from the Brooke County Ambulance Service and employed part-time by the Brooke County Solid Waste Authority.
He is the son of the late Thomas E. and Helen Williams Ventresca. He is retired from International Brotherhood of Electrical Workers Local 553, was the owner of Williams' Barber Shop and is a former mayor of Wellsburg.
The couple owned the Classic Touch Barber and Beauty Salon. He is employed part-time by Tommy's Classic Touch.
They are the parents of three children, Holly King of Garner, N.C.; Eberle Lazear and of Wellsburg; and Tommy of Wellsburg. They have four grandchildren.

subset: commoncrawl


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Alain Herriott
B.A., The Evergreen State College, 1974
Biographical Note
Alain Herriott began his educational career with a Bachelor's degree in Molecular Biology in 1974. Early on Alain had been an avid student of Yoga, Tai Chi, Qigong and the alternative healing modality in energy healing. After college Alain found that his studies and desires to learn kept pushing him toward the esoteric. He continued to study more and more esoteric models. His studies finally culminated in his teaching, coaching and mentoring others in Awakening the self and energy healing. Alain has written several books while working for a company called Quantum-Touch. They are Supercharging Quantum Touch and Quantum Touch, Core Transformations. The work he is presently involved in is called The Wonder Method™. This is his and his wife's original work and they are promoting it independently. The work is about returning to a state of balance and harmony through unwinding the emotions. This is accomplished through a combination of feeling and Wonder. The model is meant to be used throughout the day and produces an experience of an extremely quiet mind, inner balance and harmony. It is also used to unravel anyone's world or life experiences to achieve greater harmony and personal satisfaction. It can be applied to every aspect of life, from work to relationships and personal growth. Alain and his wife Jody are now working on their third book to be called The Wonder Method.
Publication Type
Latest Publication Title
Quantum Touch Core Transformation, A New Way to Heal and Alter Reality, North Atlantic Books, 2009
Additional PublicationsSuper Charging Quantum Touch, North Atlantic Books, 2007
Publication Excerpt
From the Introduction:
One of the most desirable parts of healing work is the inner journey that accompanies this process. We have found that the more meditative this process is, the more intriguing it becomes. Active meditation, specifically contemplation laced with intent, is the basis of this work. Many people have told us that, after experiencing the Core work, it is something they have looked for their whole lives. Not only do they begin to experience a deep quiet, but it feels like the entry point to something so much bigger: a bigger universe, a broader viewpoint, etc.
How did Evergreen help you in your career?
It allowed me to explore both the esoteric and the scientific without bias. It made both available right on campus.


text: Rolando Zepeda, a graduate of Kenedy High School, signs his letter of Intent to play baseball with Coastal Bend College on July 25 in Beeville. Zepeda lettered in baseball four years and was the district MVP twice. Zepeda is the Son of Roberto and Gloria Zepeda of Kenedy. Coastal Bend College is in its inaugural season under the NCJAA Division III program.


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Dodgers at Petco with Manny back…
What a crazy day Friday was with Manny being back after his 50 game suspension. My friend Lore and I made the trip along wih so so many Dodger fans. We have been in San Diego many times including the four game series against the Dodgers to start the season so we are used to seeing many Dodger fans but this time the number was even larger. As they open the gates, we saw on the field the number of media covering Manny and we said "OMG". Here is the media waiting..
Here are the players stretching including Manny. The guy with jeans and a beige shirt is Eric Karros who was covering the Padre/Dodger game on Saturday.
In other news, the Dodgers won the first game 6-3, dropped the second one 7-4 in yet another no decision by Randy Wolf. That is about 12 no decision by Randy. Rubber game tomorrow. Media coverage has gone down from the first circus day. Oh, yeah, Manny went yard on the 4th of July! Congratulations Manny! He is back….
Hope everyone had a great 4th of July!
17 Comments
I'm glad you had some fun in San Diego. Yesterday's results were disappointing but the bullpen was bound to blow it eventually and the Dodgers have been very good on the field so far so that was due to happen as well. Let's hope it's back to a strong bullpen and strong defense for the rubber game.
We had loads of fun. We are heading back to the ballpark in an hour. They head to N.Y. afterwards.
You stayed for the whole series then? One time while I was living in San Francisco a friend flew out that is a big White Sox fan. The Dodgers were playing the Giants in town for 3 games and then the next day the White Sox were playing in Oakland. We went to 6 games in 6 days and I didn't think my voice would ever recover from cheering and jeering so much. The Dodgers won all 3 and the White Sox won 2 of 3 so it was a pretty good stretch for us.
Emma – I'm glad you had fun – but the attention given to Manny seems so over blown! There are reports of when Manny took left field that Dodgers fans started chanting "We aren't Worthy" – is that true? I really hope not. I read a sports article and I liked the writer's take – he felt that the first time Manny took the field at home the fans should boo him just so he would understand while the Dodger's fans might be happy that he is back that they are not happy that he tried to cheat his way through the game. Do you see that happening?
Sounds like you had a great time in SD, Emma. The Dodgers have been playing great baseball, with or without Manny, so I'm sure they'll keep it up.
I'm with Julia. I want Dodgers fans to boo Manny out of the park for the first couple of games. I have no problems with fans cheering when Manny gets a hit. But I hate seeing fans cheering Manny just for being around as if he did nothing wrong. It looks like some fans are overcompensating by cheering for him more than they ever have. That's just wrong headed. Manny deserves the heat he'll get for this but a few weeks from now nobody will care one way or another and people can cheer as they wish.
My friend and I went to Friday's game then came back as she had a birthday to attend on Saturday, then we went back early Sunday morning so we saw the two wins. We like to think that we were the lucky charms! The only player we talked to Sunday morning was Loney before he entered the stadium so again, we like to think that we brought him luck 🙂.
I agree that the attention given to Manny was way over the top. Also the media that first they write earlier that Manny should not be given that treatment and they there were covering him. We were sitting between homeplate and the Dodger dugout so I don't know what they were chanting in the left field side. I don't see the majority of Dodger fans booing Manny when the team gets back to Dodger Stadium.
I don't think the Dodgers have been playing great baseball but they have been good and if is not one player, is another coming to the rescue of another not doing well so they are playing well as a team.
I just don't see the majority of fans booing Manny. He is a very likeable player. As he went by in San Diego, he acknoleged the fans, he was signing autographs on the field, he was hanging by the Dodger dugout, showing his full support for Juan and the rest of the players. He was signiling "Safe" when Juan stole a base. I think it would be different if he was a jerk with the fans. I think the majority feel that he paid his dues. They will be a few boos but those will be in the minority.
This was a crazy series!! I loved Saturday's game. That one was very amazing for my Padres. And yesterday's was pretty good too, it's just too bad that we didn't get the win. I thought my Padres played very well against you guys though, and thankfully we were able to keep Manny pretty quiet. GO PADRES!!
The media circus makes a stop in Chavez Ravine.
But since it is just a hop, skip and a jump from Hollywood, maybe the photogs have a Paris Hilton or Lindsay Lohan angle for the return.
Always great to see the mountains of media members scrambling for a chance to get a 5 second sound bit.
See, you got a game within a game for your ticket price. Awesome.
And there you were, right in the right place at the right time to get us some of those great photos to show the scramble for Manny's thoughts and dreams that day.
Kudos to the Blue!
Rays Renegade
Heya Emma, I had completely missed the fact that Manny had gone deep on the 4th. How cool. You know, I kinda like the feeding frenzy that is the media. If he's back wearing the jersey, he's accountable to the fans and newspapers again. I don't know how much attention they were paying to his suspension, say, 25 games in to it, but I can see why they're all once again scrambling for their fill of Manny time.Ashhttp://ashleymarshall.mlblogs.com
The fact that he is back is getting old. I'm tired of seeing him exclusively shown on t.v. for his performances, good or bad. He's back and he's playing. That is all that matters.
I am sure you liked Saturday's game. Because my boys lost, I am glad I was not there. Yep, you hanged in there Sunday but we should have had that game earlier. Billz should have gotten #10 but unfortunately Brox did not have it.
Before the circus makes a stop at Chavez Ravine, the Dodgers will play in New Yawk and Milwaukee and then is the All-Star game so they are not back until July 16th. BTW, July 22th is Manny's Bobblehead night. That was scheduled long before the steroid news broke.
He looked a little tensed on Friday so I am happy that he hit one out so he could relax. It was a crazy, frenzy atmosphere Friday night.
I can understand how you feel. To me is all about the whole team and that includes Manny. He served his suspension and if he can also do some community work, I am ready to move on.
OK, I understand that the Dodgers fans like to go watch their team. I guess I might be jealous of you guys for having a much bigger and much more faithful fan force. I would be so happy if Padres fans could overflow Dodger Stadium and out-cheer the Dodgers fans, so I understand that you guys love doing that at other stadiums. I don't hate Dodgers fans, believe me, I had so much fun around them when I was there for Opening Week. I was just a little frustrated with my team, and Manny, and the overly Dodger crowd. Nobody wants their stadium to be overwhelmed by the opposing fans, so I'm sure you can understand my frustration. I'm sorry.
testing, because my last two posts have not gone thru.
I'm not even sure what I want to say about this. I'm no Manny fan, and I'd hate for all the media attention to make Manny's head swell even bigger than it already is.
Rants, Raves, and Random Thoughts
I understand but isn't the Media part of the problem for giving him all that attention? Let's see how the media will be in in New Yawk with Manny and Torre in town.
I understand your frustration. I would not like it either if a big contingency of fans invaded my stadium, my Dodgertown. I understand some fans can be over the top with their bragging. i try to cheer in a respectful way. You probably can understand how fans of stadiums close to Fenway and Yankee Stadium feel. The closest we come to getting that at our stadium is when the Cubs are in town. Is not that bad but I don't care for it. Still, I will try to get a Cub friend from the train tickets.
I do have fun with Padre fans when they come to our stadium. I still remember these group of Padre fans that were standing in back of us in that game of the back to back to back to back homeruns It could have gone either way that night. It was one of the most exciting games at the stadium not counting playoffs/world series games. The guys kept saying "Is over, Trevor is coming down and will shut you guys down.". The guys had gone outside actually to catch their train back and they came back. By the time the game was over they had missed their train home. We had fun with them in a nice way.
You should have not removed your blog post on my account. I love your enthusiasm and your hatred of the Dodgers is normal. No respected passionate Padre fan will feel different. I felt I had to respond to your blog post and clarify a few things and also respond to your friend calling us Dodger fans i d i o ts .
I appreciate you coming here and clarifying a few things too. Thanks


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In this life, three things are guaranteed: Death, taxes and the Phillies struggling against an inferior Astros team in September. Phillies fans were subjected to another expose on the latter tonight, as the Phils fell to the Astros 5-0–their second loss in three games against a glorified Triple-A team. Unlike Thursday's agonizing loss, in which the team let a lead slip away late, this game had a more somber feel. The Phils lacked energy from the start, got down early and never really seemed to be in the game. They essentially could have ended the game after the first inning.
Cy Kendrick? Not Tonight
– Let's face it, Kyle Kendrick wasn't going to pitch like vintage Roy Halladay forever. Over his last six games before tonight, Kendrick posted a 1.49 ERA, but also posted a .204 BABIP. While he's been very good, he's also been very lucky. He was due for a letdown game. But boy did it come at the wrong time for the Phillies.
– The Astros jumped out in front early on a first inning home run by Justin Maxwell. The homer came on a changeup–which has been the pitch that has spurred Kendrick's hot streak–that came in flat and over the inner half of the plate. It was an all around bad pitch, and looked to be a sign of things to come, as Kendrick also labored through the second inning (giving up another run). He pitched well through the third and fourth, but surrendered another run in the fifth before being lifted. He probably could've gone another inning, but with the Phillies down 4-0, and with little margin for error, Manuel opted to go to the 'pen.
The Bats Resemble Times Of Old
– Before tonight, Astros starter Dallas Keuchel was 1-7 with a 5.35 ERA. In 70.1 IP, he struck out just 31 hitters while walking 33. He has been far from an effective pitcher this season. The Phils should've shelled him. Of course, that's not how things went down.
– They were not without their chances against the lackluster left-hander, however. During his 5.1 innings of work, the Phillies had runners reach in every inning, the leadoff hitter on four times, and twice loaded the bases. During that span, they left 16 runners on base and scored a grand total of zero runs. They looked like the team we saw so often during the first five months of this season–taking a bad approach at the plate and routinely failing to come up with a clutch hit. The fact that Keuchel went only five plus innings, despite the fact that the Phils were unable to score against him, speaks volumes about how average he was on the mound. The Phillies simply let him off the hook.
– The offense wasn't any better against the Astros bullpen, which had a collective 4.67 ERA, ranking 28th in baseball. It was a frustrating night from start to finish, and one this team is almost certain to regret. The entire night was a big wasted opportunity–a microcosm of the Phillies' 2012 campaign. They left a grand total of 23–TWENTY-THREE!–runners on base.
– The Phillies really couldn't afford to lose this game. The Pirates won, the Brewers are up big, and either the Dodgers or Cardinals will win another game tonight. With the loss, the Phils will lose ground on three of the teams in this wild card chase. When we look back upon this season, if the Phillies fail to make the playoffs, this series will definitely stand out in the minds of many. Sure, there have been plenty of opportunities blown throughout this season. But facing a very bad Houston team, and with St. Louis and L.A. going head to head, this set of games was a great opportunity to build on the momentum the Phils had over the last week and a half. It was not meant to be.
Game Notes
– The Phillies desperately need to win tomorrow. Desperately. They'll be behind the right arm of Roy Halladay (10-7, 4.01). The Astros will send Jordan Lyles (4-11, 5.33).
0 Comments
Did they have diekman hit in the 9th?? Someone explain that reasoning to me if gameday is correct.
lets hope the astros battle the cardinals the way they have the phillies
Ya just knew this thought was gonna pop up sometime soon.
Not that you can blame someone, but ya know…all the games are played on the field, and any other rationalizations thinking the Astros, for 6, no less against the Cards, and Cubs, for 3 will be of help…well, they just seems like wastes of hope.
Aw, ya never know, I guess, but of course those games are pointless, unless the Phils win. And the worry about all the Houston success against the Phils in recent years that equalled fears, I think are more rightly placed toward the Met series based on the way the season series has gone. Not that prior results matter, but it's a troubling thought.
We'll see how it shakes out. You'd think they'd bounce back today. Gotta start somewhere.
AFW gets home puts on Dodgers/Cards and the Dodgers tie the Cards with 2 outs and 2 strikes in the 9th down 3-2.
Sorry I missed the Phils tonight.
I cant watch every game.
"Sorry I missed the Phils tonight."
Trust me unconditionally when I tell you that you are not sorry you missed the game. If you lost 2 million dollars* at the track, you had a better night than you would have watching that game. You won't hear anywhere near the cries over the Sunday night Braves game after last night's wasted opportunity.
One team in baseball was shutout last night. One.
*Personal opinion, not actual financial data to be taken as fact.
And the dodgers win.
I will be missing Tuesday Phillies game too.
So be warned.
this game was a HUGE JOKE for the phillies. Such a let down.
The Phils have NEVER been able to hit slop left-handers. I wish that they had a real hitting coach; someone who could actually figure out why they're so bad against junk ball lefties and forceful enough to change their approach.
If this game looked like those from earlier in the year, it's only because this team of minor-league call-ups isn't really any better in most respects. They've just been playing better than their abilities, and that almost had to change. It really has little to do with playing the Astros, but is more a return to the norm. Replacing the likes of Vic, Pence and Polanco with platoon players such as Schierholtz, and AAAA guys like Frandsen doesn't usually improve things long-term, and a mostly rookie bullpen is going to make some mistakes.
We started the weekend with the best case scenario being that we could be 2 games out by Monday morning. Because we lost 2 games that is no longer possible, and this is precisely the situation that has made me so leery about our chances. The best we can do today is stay the same, 3 games back. We can't cut into the lead because we are fighting two teams at the top with the exact same record that are playing each other. It doesn't matter who wins LA or St Louis, we can't gain ground. And this doesn't even take into account the Pirates and Brewers who are still in front of us, and Milwaukee has a game in hand.
And that's why it's so different than 07, and why I've been such a spoilsport through this whole thing. I should probably apologize to one and all for that, I could have just not commented at all the past ten days. I promise not to say "I told you so" when it's over, I desperately want to be wrong about this, I really do. This season was lost by a bunch of accrued loses throughout the season, not last night. We're still tied for the hottest team in the
baseball the last ten games, they had to lose a couple, I think it was George that said the law of averages would catch up to us, not the Astros.
The good news is the worst case scenario can't happen either, at the start of the weekend we it was possible to end up 5 games back, but the worst we can be with another loss today is 4 games back.
We can still be proud of our guys, save for last night, they have fought back from the depths valiantly.
i feel the same way lefty! and although i'd like to disagree with george on the law of averages, i'm not going to. what would be the point. he may be right anyway.
i had a bad feeling going into this series and i'm not expecting anything from todays game either. them we play the freakin mets! we lose 2 of 3 from them . let the fat lady start to sing out loud! she'll be singing a song i've been dying to hear. "let the ruf man play"
i'm a big howard fan. but at this point cholly should seriously think about either pinch hitting for him against a lefty, or starting someone else against one. and posibly slide somebody inbetween utly and howie to break that combo up! i'm sick and tired of lefty's coming out of the pen and stifiling us. cholly makes it too easy to manage against us! and for the love of god whats kratz doing down so far in the order?
as much as i dislike rollins for not being consistant all year and his laziness. i will say this. at least jimmy has shown up! he's turned his game up a notch and i give him kudo's for that! cholly on the other hand has shown up too and that's ashame.ruf should start over wiggy in left! we don't even know if wiggy will be here do we? and we already know his capabilities. so why start him in left? it makes no sense! we don't know much about ruf but why don't he give him a chance? we didn't know about kratz and fransden either but they came on and played extremely well. they might not be able to do it over a long season. but in a short stretch of 30 or so games they've showed up big! if he gives ruf a chance and he does the same we could go to the playoffs! he won't be available for them i don't think but maybe he could help get us there.
Using Wigginton in left was done for two reasons, both of them sensible. Manuel was playing a rightie bat against a leftie pitcher. Ruf is not only a leftie bat, but he's an inexperienced one against ML pitching. Also, Ruf has had very little playing time in the outfield. Manuel is still trying to win games, and that's usually done with experienced players that you have knowledge of. Had someone else played rightie vs. leftie, and experience instead of inexperience, it wouldn't even have been an issue.
Lefty, you can say "I told you so" if you want to .. I just might. I would say that if they win today they have a pulse…a weak one but still one that doesn't require life support. Lose and they're done…call the paramedics and the priest of your choice.
The luster turns to tarnish. Kendrick back to the old Kendrick. The run might be over. Just stay at 500 for the rest of the year and let Ruf play. Howard stinks these days. Looks terrible at the plate.
How can you conclude Kendrick's run is over after 1 unsuccessful start, in which he did settle down, rather than failing the entire time he pitched?
I hardly think there's reason off that to think there's any less of the highest accolade he's gotten in the 5 or so weeks since most wanted him bounced for Cloyd, and perhaps rightly so which is to be pretty confidently counted on for the 4 slot in the '13 rotation.
I don't see much reason not to be at a minumum cautiously optimistic about his next couple starts. He fails in them, then he's rippable, even though we, and I mean we, have already ripped him more than any player should be ripped for a lifetime, let alone a career.
Also, at the risk of sounding like a first class excuse maker, I wondered about something before his start last night. It's the first time he's pitched in Houston, his hometown, since he became a good pitcher, albeit a short stretch. Maybe it's not impossible he was trying to impress some old friends and coaches at the game that took him off the task at hand. I know that's probably ridiculous, but it's proibably not 100% ridiculous.
Adding to Ken's thoughts, I submit that if Hamels or Halladay had 5 great outings, then a dud, nobody would be saying their run might be over.
In defense of Mr. Shart, however, I do have to point out to Ken that he did say "might," he didn't say "definitely."
I'm not entirely sure, but I think Bart meant the club's run might be over, not Kendrick.
Might be right about meaning the team, and not Kendrick.
Good excuse to rant though. I live by the credo why let the truth interfere with a good rant.
But kidding aside, I think you're right. Good catch. Advanced reading has always been a problemma around here.
"good excuse to rant"
Agreed 🙂
They have a pulse.
The astro series was tough coming in. I told you so.
Go phils Ill watch today so maybe they can win.
Yes and to beat a dead horse here:
Astro's are 27th in the league in pitching ERA, giving up an average of 4.66 runs per game.
The Astros are 28th in the league in team hitting, with a resounding .238 batting average as a team and 124 hrs.
While the Phils are 11th in pitching with a 3.86 ERA and 14th in batting with a respectable .257 team batting average.
The Astros will NOT play the Cards hard, they never do. The Astros have the absolute WORST W-L record in baseball and hopefully today, they will lose game 100 with 16 left to play.
Team needs Ryan Howard and the outfield to make some contributions offensively.
Just wanted to say I told yuo so for Chuck.
Also at some point I am still hoping the old man will start Ruf at first vs left handers.
Or even pinch hit him for the regular first baseman vs a left handed hitter late in a game.
It is mind boggling and frustrating that this isnt just a given.
Make up some stupid excuse to why the reg first baseman who has a sub .310 slugging pct and .167 batting average vs lefties cant face them anymore.
His foot is prevetning from hitting lefties?
Whatever reason it doesnt matter.
Be creative.
The law of averages is a tricky concept. Where it applies, is to the Josh Hamiltons of the world, who finished May hitting .420, with 30 homers and some similarly ungodly total number of ribbies. Way back when, in a different game played under the name of the same sport, guys might have parlayed that into full season totals. But with at least a basic similarity to today's game dating back to somewhere between 1950 and 1970, the law of averages told us that Josh, barring some ridiculous PED in a day and age where those suckers are tested strictly (or so it's reported), you knew he'd cool off, even to still ridiculous, but human levels. So it wasn't a crime to think law of averages on him, or any hot individual at any season's start in the last several decades.
But this law of averages application to the Phillies recent successful play is collectively ludicrous. If I told you prior to the club's 7 game win streak, inclusive of soft competition that they'd win 7 straight, where was the law of averages fan club then saying that wasn't happening after 1,2 and 3 wins. And how do you account for what I have no doubt is a smattering of double digit win streaks, and high percentages over 15-20 games that have taken place, and no doubt by probably a minimum of over half that didn't have parades. You look at the Phils on paper, and say the chances of them winning around 18 of the last 21 is slim, it ain't no law of averages as much as a talent question. Has the law of averages caught up with the Oakland A's? The Baltimore Orioles? The law of averages didn't stop the Phils from losing 2 of 3 to Houston. No law of averages, no psychological application of past nightmares that has seen the Phils play at about a 23-34 pace against Houston the last 6 or so years stopped them then. Playing down to the competition, overconfidence, all misplaced as well. If anything, last night, they pressed, or tried too hard after a certain point.
I will add to the long line of probably 1, that has threatened to voice "I told you so," that's adorable. This is not a stupid fan base. There wasn't any overwhelming hallucination at year's start about this club. And the math since freaking June has told us the party was over. But baseball isn't like death. You can die and come back. And when you come back, it is both right and proper to see the spark, and think of ways it might grow ablaze. Oh, you can work on your E-A-G-L-E-S chant instead, or make up for lost time at the shore, but there isn't one person on this site that stuck around, and flatly said, "The Phils are making the playoffs" when this fun run started. If you took the likes of Andrew planning the parade, and his invite list as serious, you need a course in Sense of Humor 101. I told you so should fall on ears that are deafer than deaf.
Win the game today, and see what happens. Even though the post season is unlikely, to me, that's the most practical approach.
No one called their recent win streak a law of averages thing. It's merely been pointed out that a team of nobodies which suddenly wins a bunch is playing above average, and will come back down. A team that gets lucky for an extended stretch will eventually have some bad breaks. We all know the Phils haven't had the talent all season to play like they have for this particular stretch.
It's not the wins that are the law of averages, it's the return to the norm, which IS average.
astros bitch slap us everytime. they own us like dipsy and his partner.
god you need to step up and take the ball and shove it down there throat.
ryan howard is not a clutch player. he is a strikeout player with his power decreasing.
would love to get rid of him and free that salary. big goon. do some more subways
Time has fimally come when the Team management shouldn't have anymore doubts that Charlie M. can't be Manager any longer. The team has talent, players, pitching and the spirit to win but without the leadership to actually lead and manage the Team to win against the team with the worst record in all of pro baseball. Then the higher mangement must take action …..
Let's face the facts that without a manager that can make decisions that win games and not lose them then this team will continue to fail at the very game they could play and Win.Lets all await the next season with baited breath and hope for the hard decisions to be finally made. I'm a steadfast PHILLIES FAN forever………………….


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Home List of Titles Three-dimensional nanoscale far-field focusing of radially polarized light by scattering the SPPs with an annular groove
Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.3/88935
|Download PDF (Published version) (Adobe Acrobat PDF, 819 KB)
- Title
- Three-dimensional nanoscale far-field focusing of radially polarized light by scattering the SPPs with an annular groove
- Author(s)
- Zhang, Maoguo; Du, Jinglei; Shi, Haofei; Yin, Shaoyun; Xia, Liangping; Jia, Baohua; Gu, Min; Du, Chunlei
- Abstract
- Three-dimensional (3D) nanoscale focusing of radially polarized light in far field by a simple plasmonic lens composed of an annular slit and a single concentric groove is reported. The numerical calculations reveal that the incident light is coupled to surface plasmon polaritons (SPP) by the annular slit and a focal spot with a size less than a half of the illumination wavelength is formed in the far field due to the constructive interference of the scattered light by the groove. More importantly, the focal length can be modulated by changing the groove diameter. This structure provides an admirable choice for the nano-optical devices.
- Publication type
- Journal article
- Research centre
- Swinburne University of Technology. Faculty of Engineering and Industrial Sciences. Centre for Micro-Photonics
- Source
- Optics Express, Vol. 18, no. 14 (Jul 2010), pp. 14664-14670
- Publication year
- 2010
- FOR Code(s)
- 0205 Optical Physics; 0903 Biomedical Engineering; 1113 Ophthalmology and Optometry
- Keyword(s)
- Annular slits; Beams; Focal spots; Plasmonic lens; SPPs; Surface plasmon polaritons
- Publisher
- Optical Society of America
- 1094-4087
- Publisher URL
- Copyright
- Copyright © 2010 Optical Society of America. Published version of the paper reproduced here in accordance with the copyright policy of the publisher. This paper was published in Optics Express and is made available as an electronic reprint with the permission of OSA. The paper can be found at the following URL on the OSA website: http://dx.doi.org/10.1364/OE.18.014664. Systematic or multiple reproduction or distribution to multiple locations via electronic or other means is prohibited and is subject to penalties under law.
- Full text
- Peer reviewed


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to give birth, get pregnant again within 12 weeks and still breastfeed even while being pregnant? just wondering...
i've heard that pregnancy hormones will dry you right up and you won't be able to
breastfeed your baby while pregnant.
what do you do if you are a nursing mother and get pregnant? how would you keep
feeding your baby?


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Senior country bankers exit UBS and Credit Suisse
The head of UBS's Netherlands operations has left the bank, as its senior ranks continue to shift, while the former head of rival Credit Suisse's business in the Nordics has also departed.
Remko Eddes, country head for the Netherlands at UBS, has decided to pursue an opportunity outside the bank, according to an internal memo seen by Financial News.
He first joined UBS in 1997 and worked across the investment bank, wealth management and global asset management units, according to the memo.
Michael Ingelog, meanwhile, most recently a senior adviser in the Nordics at Credit Suisse, has also decided to leave his post, according to an internal memo. He was chief executive for the Nordics at Credit Suisse until August last year and previously set up the bank's Stockholm office.
Spokespeople for the banks confirmed the contents of the memos.
It has been a particularly busy moving season for the big investment banks this year amid an improved environment for dealmaking; investment banking fees in Europe were up 37% in the first half of the year to $507.9 billion, according to Dealogic.
Eddes, a financial institutions specialist, is the latest managing director to leave UBS in Europe. The bank has been overhauling its senior ranks under the guidance of William Vereker, head of corporate client solutions in Europe, the Middle East and Africa.
According to the UBS memo, which was signed by Ulrich Koerner, chief executive of the UBS Group in Emea, and Vereker, Eddes' responsibilities will be handed to Henrik Soderstrom, country operating officer of UBS's investment bank in the Netherlands, on an interim basis.
"We remain committed to the Netherlands and will be continuing to invest in this business," the memo added.
His departure follows a number of promotions, hires and exits at the bank.
In May, UBS named Juan Monte as head of country coverage in Europe, the Middle East and Africa. The previous head of coverage and advisory, James Hartop, stepped down from his role to focus on client coverage.
Meanwhile, Severin Brizay joined from JP Morgan as head of M&A and Glenn Rewick and Philippe Drouin made the move from Bank of America Merrill Lynch. Departures have included Chris Niehaus, head of industrials, and managing directors Carsten Ridder, Anthony Hartley, Matthew Odgers and Tim Waddell.
Ingelog left Credit Suisse after four years on August 1. He also worked across investment banking and the private banking and wealth management divisions, according to the Credit Suisse memo. He took a senior advisory position last summer. He initially joined the Swiss bank from Deutsche Bank, where he was a managing director and head of the institutional client group for Nordic and the Netherlands.


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The James B. Edwards College of Dental Medicine congratulates faculty members on their recent achievements.
Dr. Frederick Moore, Jr., Associate Professor in the Department of Oral and Maxillofacial Surgery, was selected as the 2013 recipient of the Daniel Laskin Award as an Outstanding Predoctoral Educator. The Daniel Laskin Award is given to an Oral Surgeon who strives to further Oral and Maxillofacial research and academia, has a reputation as an outstanding clinician, and maintains the highest ethical and moral ideals of a professor. The award will be presented at the opening ceremonies of the AAOMS meeting this coming October.
Dr. James A. Rivers, Professor and Chairman of the Department of Oral Rehabilitation, received the Distinguished Dentist Citation from the South Carolina Section of the Pierre Fauchard Academy. The Pierre Fauchard Academy's goal is to consistently focus on professionalism, integrity, and ethics worldwide, by conducting themselves as worthy role models, advancing dentistry to the highest level, and supporting and honoring colleagues for their distinguished work. The award commemorates Rivers' contributions to the art and science of dentistry.
Dr. Keith Kirkwood, Professor and Associate Dean for Research, was a recent recipient of the International Association of Dental Research (IADR) Distinguished Scientist Award. The award was presented during the annual meeting of the International Association for Research in Seattle. The award recognizes scientists whose research has led to significant advances in oral health. Dr Kirkwood is a diplomat of the American Board of Periodontology, past recipient of the GlaxoSmithKline/IADR Innovations in Oral Care Award, and is a previous Tarrson Fellow from the American Academy of Periodontology.
Dr. Monica Cayouette, Associate Professor and Director of the Implant Prosthodontics Division in the Department of Oral Rehabilitation, was inducted as a Fellow of the International College of Dentists at its 83rd Annual Convocation in San Francisco. The honorary organization recognized Dr. Cayouette for her outstanding and meritorious service to the profession and community.


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This photo illustration depicts a view of the night sky just before the predicted merger between our Milky Way galaxy and the neighboring Andromeda galaxy. About 3.75 billion years from now, Andromeda's disk fills the field of view and its gravity begins to create tidal distortions in the Milky Way. The view is inspired by dynamical computer modeling of the future collision between the two galaxies. The two galaxies collide about 4 billion years from now and merge to form a single galaxy about 6 billion years from now.
Object Names: M31, NGC 224, Andromeda Galaxy
Image Type: Illustration
Science Illustration Credit: NASA, ESA, Z. Levay and R. van der Marel (STScI), and A. Mellinger
To access available information and downloadable versions of images in this news release, click on any of the images below:


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Published: January 2013
Keeping your car in tip-top shape can help prevent unneeded repair bills and unexpected trips to the mechanic. One often-neglected automobile maintenance item is the oil change. Oil changes are easy, relatively inexpensive and a must-do item for proper car maintenance.
Checking and changing your car's oil is a major part of responsible car ownership. Regular maintenance is the key to extending your automobile's lifespan and maintaining optimal performance.
Your car's engine is complex and contains numerous moving parts. Oil is what lubricates these moving parts and keeps everything moving smoothly. In addition, engine oil contains additives. These additives need to be replenished by changing the oil so that it will continue to work as expected. Here is some information regarding the importance of changing your car's oil:
Every car manufacturer has a slightly different recommended oil change schedule. Consult your owner's manual or visit CheckYourNumber.org to find your car manufacturer's recommended oil change interval.
One factor to take into consideration is whether you are using synthetic oil, which can last longer, or conventional oil, which you may have to change more often. When your dealership or fast-lube service changes your oil, they will generally put a sticker on your window to tell you at what date or at what mileage—whichever comes first—you will be due for another oil change.
According to Cars.com, car owners need to check their oil every few hundred miles by looking at the oil dip stick in the engine.
Locate the oil dipstick and remove it. A graphic of an oil can usually marks its location.
You want to make sure to clean the oil off the dipstick with a rag, put it back in and remove it again.
The dipstick is marked to show at what level the oil is full. If the level of the oil is between the full and add marks, add one half-quart. If the oil level is at or below the add mark on the dip stick, add one quart of oil.
Too much oil will create an oil froth, making it more difficult for the oil to properly function.
Remove the dipstick.
Wipe the oil off the dipstick, reinsert it, remove it again and check the level.
Add oil if necessary.
Remember to pay a visit to a professional for an oil and filter change at the intervals suggested by the manufacturer or sooner (if your driving style dictates). While changing the oil and filter, be sure the technician checks your brakes, transmission, headlights, brake lights, back up light, belts and windshield wiper fluid. Most fast-lube establishments and car dealerships have a set protocol to check these items during an oil and filter change, but it never hurts to ask to make sure.
Need help remembering to change your oil? Sign up for Allstate's Maintenance Reminder.
This section highlights examples of precautions you can consider to help maintain your personal property. Please recognize that a particular precaution may not be appropriate or effective in every circumstance, and that taking preventive measures cannot guarantee any outcome. We encourage you to use your own good judgment about what's appropriate, and always consider safety.
Coverage subject to terms, conditions, and availability. Policy issuance is subject to qualifications. Allstate Insurance Company, Allstate Indemnity Company, Allstate Fire and Casualty Insurance Company, Allstate Property and Casualty Insurance Company, Northbrook, IL. © 2015 Allstate Insurance Company, Northbrook, IL.
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Foreign Correspondent
by Alan Furst, 2006
Carlo Weisz is an Italian journalist seeking refuge in Paris with other intellectuals fleeing Mussolini's fascist government. While working as a foreign correspondent for Reuters, he becomes the editor of an underground newspaper that hopes to keep the flames of resistance alive in both countries. His efforts not only place his own life in danger, but that of the German socialite and lover he is trying to save from the Nazis. This latest espionage novel by the author of Dark Voyage and Red Gold is once again filled with atmosphere, intrigue, and romance.
The View from Castle Rock
by Alice Munro, 2006
Alice Munro takes a fictional look at her family history in this collection of stories beginning in Scotland and ending in the countryside around Lake Huron. We meet enduring characters facing their futures whether as immigrants seeking dreams in the New World or young girls coming of age in small Canadian towns. Beautifully and poignantly written, this book is sure to engage and entertain readers.


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July 5, 2012 —
HONESDALE, PA — At the Honesdale High School graduation ceremony on Saturday, June 9, honor student Devan George was awarded the first annual scholarship of The Lackawaxen River Conservancy.
In awarding the $500 scholarship to Devan, the Conservancy was impressed with her passion for the natural world, her outstanding academic credentials and extracurricular leadership roles, and her intention to pursue a career in an area related to environmental conservation. She will begin her studies at the University of New Hampshire in August.
The Conservancy anticipates awarding a scholarship each year to a graduating senior from a school within the Lackawaxen River watershed who intends to pursue a college degree in the area of environmental conservation.


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Raspberry almond bites
Nutrition and extra info
- kcal140
- fat7g
- saturates2g
- carbs19g
- sugars18g
- fibre1g
- protein2g
- salt0.06g
- 4 large egg white
- 300g icing sugar
- pink or red food colouring
- 140g ground almonds
- ½ a 250g tub mascarpone
- 4-5 tbsp raspberry jam
Whisk the egg whites in a large, clean bowl until soft peaks form. Whisk in the icing sugar in 3 or 4 batches, whisking well between each addition. Add a couple of drops of colouring with the final addition of sugar. Keep whisking until the mixture is light pink, with no streaks, and is thick and glossy, a bit like shaving foam.
Using a large metal spoon, gently fold through the ground almonds. Cover 4 baking sheets with baking parchment and dab a little of the mixture in the corners of each sheet to secure paper. If you don't have enough baking sheets, make and cook half the quantity, then repeat. Use 2 spoons or a piping bag fitted with a wide nozzle to make 40 circles, each about 5cm wide. Leave to sit out for about 10 mins until a skin starts to form.
Heat oven to 180C/160C fan/gas 4. Place the baking sheets in the oven, leaving the oven door slightly ajar to allow steam to escape, then bake for 20-25 mins until just crisp, but not browned. Leave to cool.
When ready to serve, gently ease off the paper with a palette knife. Carefully spread 1 tsp raspberry jam per biscuit over half of the biscuits and 1 tsp mascarpone per biscuit over the other halves, then gently sandwich together.
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Comments, questions and tips
Comments (21)
Made these for the first time today, was initally concerned by all the comments but these came out great, didn't stick to paper, i used sainsburys baking paper and i pulled them off hot and put on a cooling rack, only think was i was a little to lean with the food colouring and some of the tops cracked but i'm assuming it's because i cooked them for just a tad too long, also they kept there shape perfectly and didn't spread out, i think that comes down to the whisking of egg whites!
Hi everyone,
My coment on this: KEEP TRYING!!! And another important thing:
If you made the batter and you made little circles with it on your parchement paper, leave them to dry a little bit BEFORE you bake them. This way they form a little "film" on top, if you touch them the batter won't stick to your finger anymore, then it is time to bake them....
If you managed to get a reasonable result you can always vary with colours and flavours, e.g. Mix some Cocoa powder in your batter for brown colour and fill them with a chocolate buttercream....
Look on the internet under "macarons" and be amazed by all the possibilities!!!
Loved this recipe! They were extremely easy to make, and looked very professional at the end. The also tasted great, although not the most exciting flavour combination but defiantly one everyone will enjoy (mine were all gone in a day!)
The ground almonds were a little crunchy which I personally liked, but you could easily whiz them up in a food processor for a while before using them if you prefer them finer. Also, when piping, make sure you don't make the blobs too big as they will spread out quite a bit.
Giving this recipe a four stars just because the flavours aren't that exciting.
I used the silicon liner on the baking tray and they all came out perfectly! Really pleased with the results - especially as I had never made these before. I put them together with the mascapone and jam half an hour before everyone arrived and they were delicious! Everyone couldn't believe I had made them. I'll definitely be making these again. As in the above comment I used a little bit more of the pink food colouring to give a better pink colour.
this was my first attempt at anything remotely 'macaroony' and I was really pleased with the results. I halved the recipe as I didn't have enough ground almonds for a full batch & using silicon paper as suggested meant that they came off a doddle and I would say mine were done after only about 15 mins. Only disappointment was my fault, I was a little too mean with the food colouring so they were not nearly pink enough.
These are very similar to a French style macaron, which can be quite tricky to make, they sound fairly simple, but problems can arise basically each step of the way.
If the cookies are sticking, try pouring a few tablespoons of hot water on the baking sheet, under the parchment making sure to let it sit for a few seconds under each cookie, this can help loosen them.
If cookies spread out, it can mean that your oven is too hot or that your egg whites were under-beaten.
Sorry you've had problems with this recipe - they are quite tricky. Daffodil, as suggested, make sure that you use a baking paper which has silicon in it - this should prevent it from sticking. Another problem may be the hot and humid weather we've been having. Unfortunately not the best for making meringues which have a tendency to go sticky. Kate try keeping them in the oven for another 5-10mins, the top should be crisp, but the insides should still be a little soft and chewy. Do try again though, I promise they taste great.
Questions (2)
Tips (1)
Great recipe. Don't give up. Failures normally due to recipe, oven temperature or over whipping. Definitely master without colour first as some dyes can be so temperamental. Found these great tips too: https://www.cake-cetera.co.uk/french-macaron/


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Getting your transcripts evaluated is easy—send your transcripts to our assistant director of admission for a free, unofficial evaluation so you'll have a good idea of where you can start in the degree-completion program. Before you register, you will receive an official transcript evaluation, listing what courses and how many credits North Park will accept from your previous work.
Send your official transcripts to:
North Park University
Admissions Box 19
3225 W Foster Ave.
Chicago, IL 60625
Fax unofficial transcripts to (771) 634-4951 ATTN: SPS
Our admissions team will review your transcripts, let you know how much credit will likely transfer to North Park, provide tuition rates, and give you an estimate of the amount of time it will take to complete your degree.
An admission decision is usually made within one week. If you are accepted to the School of Professional Studies, you will receive an advising letter from our staff, along with your official transcript evaluation. Your advising letter will detail coursework transferred to North Park, as well as coursework required to complete your bachelor's degree. When you enroll, you must submit official transcripts (if you have not already) prior to the end of your first semester.
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INGREDIENTS:5 sheets of filo dough (cover with damp cloth to prevent drying) 1 lb. clarified butter 3 oz. cocoa powder 5 oz. powdered sugar 6 oz. melted and tempered chocolate 2 oz. melted white chocolateFilo Filling: as needed, fresh whipped cream with fresh vanilla bean and sugar as needed, raspberry coulis (recipe follows) added to fresh whipped creamRaspberry Coulis: 2 lbs. fresh raspberries 4 oz. sugar 1 lemon, zest 1 lemon, juice DIRECTIONS:Warm clarified butter, then add cocoa powder ...
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text: Use this section to write about your specific areas of expertise. Do you specialize in first time buyers - listing high end homes - etc. Are there specific market area's that you specialize in? The more you write about your area's of expertise the more knowledgeable you'll sound to a potential buyer or seller.


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Elastic Waistband
Redirected from The Elastic Wasteband
on ESB
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|The Elastic Waistband
|Crime Fighting
|Retired Superhero (Possibly Formerly Retired)
|Physical appearance
|Barnacle Boy
Mermaid Man
Miss Appear
The Quickster
Captain Magma
Pi-Right Ponderer
|The Chief and I.J.L.S.A.
|Man Ray
The Dirty Bubble
Atomic Flounder
Jumbo Shrimp
Sinister Slug
Barnacle Man
|Series information
|First appearance:
|"Mermaid Man and Barnacle Boy V"
|Latest appearance:
|"The Bad Guy Club for Villains"
Bikini Bottom Brawlers (Patrick)
|Bill Fagerbakke("Mermaid Man and Barnacle Boy V")
Dee Bradley Baker("The Bad Guy Club for Villains")
|List of characters
The Elastic Waistband is a superhero who was first seen in the episode: "Mermaid Man and Barnacle Boy V," and later appeared in the episode "The Bad Guy Club for Villains." He is part of The International Justice League of Super Acquaintances. Patrick is briefly given this role. He has the ability to become very flexible. His costume is a green suit with blue and red goggles.
In "Mermaid Man and Barnacle Boy V," he is shown wearing a green costume, blue goggles with red holes, and yellow hair that was shown in SpongeBob's lunchbox.
In "The Bad Guy Club for Villains," he doesn't wear a mask, he has a white head band, yellow hair, and a purple suit. This is probably because in The Bad Guy Club For Villains SpongeBob and patrick were watching a LOST episode of the show.
- Flexibility; he can bend into different shapes and sizes.
- Inflatable Gut; reflects attacking projectiles.
- If he gets stretched out too much he is temporarily unable to revert to normal (although this could just be Patrick's stupidity while wearing the suit)
Video Games/Online Games
- Lights, Camera, Pants! - His costume appears in the Mermalair stage in the GBA version of the game.
- Nicktoons: Attack of the Toybots - Patrick mentions being the Elastic Waistband when the player is playing as him.
- Bikini Bottom Brawlers - Unlockable character (as Patrick).
- The Elastic Waistband is a parody of Marvel's Mr. Fantastic, DC's Plastic Man, and DC's Elongated Man.
- In "The Bad Guy Club for Villains," The Elastic Waistband couldn't stretch but could only inflate his waist, allowing him to reflect things that came into contact with him.
- His costume design is similar to 18-Volt's, from WarioWare, Inc.
- An elastic waistband in real life is a stretchable device sewn into clothes in place of a belt; his name references his ability to stretch much like the device itself.
- The Dirty Bubble particularly dislikes him.
- He is also a squinkie in SpongeBob Squinkies.


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just wondering if anyone has had a drop in supply since pumping at work. my seems to be going back and forth. sometimes its high and sometimes its low confused
just wondering if anyone has had a drop in supply since pumping at work. my seems to be going back and forth. sometimes its high and sometimes its low confused
Many mothers experience pumping output fluctuations while working. Sometimes, it's due to normal weekly fluctuations. For example, lots of mothers seem to have a higher supply at the beginning of their workweek, after spending a weekend at home nursing baby. By the end of the week, their output seems to be down a bit.
Other times, a lower output can be due to stress, hydration, menstruation, or even something as simple as not putting the pump together quite right, so that the suction isn't quite what it's supposed to be.
If you're looking for more specific info, or notice that the output drop is more longterm, please let me know, and we'll delve into it more. :-)
LLL Leader
Protect your privacy online; don't use your full name. Click My Alias at the top left corner.
I'm horrible at html and encoding links, so I apologize in advance for all the long links!
I used Mothers milk tea to help keep my supply up....that and pumping 5x a day for 3 bottles....I would also pump on weekend mornings at DS peak of milk intake to ensure enough while I was gone.
Mom to Gage 12/28/06
Wife to Trinity 6/21/03 my best friend
ed for year, finally done!!!!
for more than a year now!
Menstruation really affected my supply...for several months before my period came back even. I also sometimes pumped on weekend mornings just to be sure I would have enough for my workweek. Fenugreek and blessed thistle are herbs I took to help increase my supply later in my dd's first year. You might consider talking those over with a doctor or LC.
Wife to a grizzly
Mama to my little deer (12/05) my loving bear cub (9/07--), and our little tiger (3/22/10)
Born by one c-section and 2 amazing VBACs
Miles in 2012: 350.5/900 (Actual Miles Ran: 189)
Miles in 2011: 708.5 (Actual Miles Ran: 509)
Miles in 2010: 800.5 (Actual Miles Ran: 620)
January Miles: 37.5/75
February Miles: 59/75
March Miles: 42.5/60
April Miles: 64
May Miles: 41/70
June Miles: 59
July Miles: 39.5
227.5 miles on my new shoes
338 miles on my old shoes


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in cattle country
Bee and Live Oak County residents may have been surprised to see a familiar name/face among the Extraordinary Texans listed in the September issue of Texas Highways magazine.
Loncito Cartwright, 53, was among the eight people profiled for accomplishing extraordinary things as individuals helping make Texas special.
The story (with large photograph) mentioned that the Cartwrights came to East Texas in the 1820s, and in 1915, the family acquired land near Dinero and named it the Twin Oaks Ranch.
"During the past decade, Cartwright has steered the 6,000-acre cattle operation in a new direction – raising grass-fed, hormone-free and antibiotic-free lamb."
The son of Lon Cartwright and the late Mrs. Cartwright, Loncito, a Texas A&M graduate, said, "Irish settlers came to South Texas in the 19th century and raised sheep, so I'm returning to the past in many ways."
Nowadays, he raises a herd of 600 sheep and sells "Loncito's Lamb" to restaurants and consumers in South and Central Texas. Also, he has added free-range swine (including some wild hogs) to the ranch and menu.
The article noted that diners can find Cartwright's lamb and pork products at nice restaurants in cities such as San Antonio, Austin, Fredericksburg and Port Aransas.
"I know our animals are happier roaming free," the sixth-generation Texan said, adding that he's thrilled to make friends with the people who buy food produced on his family's land.


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The Consumer Product Safety Commission today announced that its staff has made a preliminary determination that four squeeze toys distributed by Danara International, Ltd., of South Hackensack, New Jersey, may cause choking and/or suffocation because the handles are small enough to lodge in the throat and obstruct the airway. Although these particular squeeze toys have not been involved in any choking incidents known to CPSC, similar shaped squeeze toys have been involved in choking deaths.
All four squeeze toys have bulbous shaped ends measuring 3/4" to 1 1/2" in diameter. These toys are described as follows:
These toys are made of soft, easily compressed plastic material and are packaged and sold under the brand name "SAFE-GUARD" and labeled "WALT DISNEY CHARACTER Squeek-a-Toy". The Mickey Mouse and Donald Duck toys are labeled "No. 5523". The mallet is labeled "No. 5503". Stamped below the back of the neck of the Mickey Mouse and Donald Duck toys is "WALT DISNEY PRODUCTIONS DANARA INTERNATIONAL LTD MADE IN TAIWAN". Stamped around the squeaker of the mallet is "WALT DISNEY PROD MADE IN TAIWAN DANARA INTERNATIONAL".
It is recommended that consumers remove these toys from use immediately and discard them.
The U.S. Consumer Product Safety Commission is charged with protecting the public from unreasonable risks of injury or death associated with the use of
thousands of types of consumer products under the agency's jurisdiction. Deaths, injuries, and property damage from consumer product incidents cost the
nation more than $1 trillion annually. CPSC is committed to protecting consumers and families from products that pose a fire, electrical, chemical or
mechanical hazard. CPSC's work to help ensure the safety of consumer products - such as toys, cribs, power tools, cigarette lighters and household
chemicals -– contributed to a decline in the rate of deaths and injuries associated with consumer products over the past 40 years.
Federal law bars any person from selling products subject to a publicly-announced voluntary recall by a manufacturer or a mandatory recall ordered by the
To report a dangerous product or a product-related injury go online to www.SaferProducts.gov or call CPSC's Hotline at 800-638-2772 or teletypewriter at
301-595-7054 for the hearing impaired. Consumers can obtain news release and recall information at www.cpsc.gov, on Twitter @USCPSC or by subscribing
to CPSC's free e-mail newsletters.
Please use the below phone number for all media requests.
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$49 per year
Save 65% off the
regular monthly price.
Baked chicken breast with asparagus spears rolled inside.
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- Contents of This Section:
The advisors of the Center for Student Services are available to assist new students in deciding which classes to take during their first semester, choosing a major or directing them to the proper resource on campus that fits their needs.
After the initial semester's scheduling, all students are assigned a long-term faculty advisor from their declired program of study.
Advisors assist by helping develop meaningful educational plans which are compatible with life goals. The ultimate responsibility for making decisions about life goals rests with the student while the academic advisor assists by helping to identify and assess alternatives and consequences of decisions.
Beginning Fall 2013 for classes starting in January 2014 or later, all degree seeking students must be advised by their assigned academic advisor either in person, by telephone or email prior to being allowed to register for classes.
Academic and career advisors provide the following:
- Individual advising conferences
- Clarification of career and life goals
- Development of suitable educational plans
- Appropriate course scheduling
- Interpretation of institutional requirements
- Increase student awareness of institutional support systems
- Evaluation of student progress toward goals
- Reinforcement of student self-direction
- Referral, when appropriate, to institutional and community support services


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Bright Spotlight
THE OIL and natural gas business is beginning to boom in our region with the promise of even brighter days in the offing.
The industry is pumping jobs, money and hope in the Ohio Valley. The oil and gas rush could not have come at a better time as the steel industry is on life support and coal is not the king it used to be.
With that said, the fifth annual DUG East conference will be staged in Pittsburgh this fall. It is slated for the David L. Lawrence Convention Center.
The confab is global in scope, as it draws hundreds of oil and gas officials from all over the world, including representatives of countless energy companies. The 2012 DUG East attracted more than 3,200 attendees and 315 exhibitors.
It is a big-time event. This year it will also feature a big-time speaker.
President George W. Bush will serve as the keynote speaker for the Nov. 13-15 gathering. He will obviously bring a much brighter spotlight to the conference. This is not his first foray at the DUG confab. In 2011, he addressed more than 2,500 DUG conference attendees in Fort Worth.
The DUG conference will provide detailed exploration and drilling activity updates, technology exhibits and peer-to-peer networking for those doing business in the Marcellus and Utica shale regions. It focuses on the growth producers, service companies and local economies are experiencing from developing unconventional oil and gas resources.
The meeting of the oil and natural gas minds can only fuel future development in the industry.
The event is one that does meet with some opposition, that coming from anti-fracking and clean-air protesters. While those concerns may have some grounds for legitimacy, there is no denying the financial gains realized by the burgeoning business.
Bringing in President Bush to speak reinforces the role oil and natural gas have in our future.


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The nutrition aide enters the patient's room, asks how she is feeling and what she would like for dinner, as well as breakfast and lunch the next day. He runs through the choices for each meal in turn—all of them appropriate to any special diet restrictions this particular patient may have—and logs the requests. The encounter ends with a cheerful "I'll be back soon with your lunch" as the aide heads off to see his next patient. This scenario would not ...
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