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"More like France ..."
Research ››› ››› MEDIA MATTERS STAFF
We've got a new Think Again column called "Meanwhile, Back in Baghdad," here, and my Nation column is called "These Are Better Days."
A long time ago in what feels like a far-off place, I wrote a column in The Nation warning that it was inevitable that Rupert Murdoch would feel compelled to ruin the news pages of The Wall Street Journal once he got a hold of them in order to incorporate them into the larger purposes of his media empire. Well, yesterday we got the news that that ruination is about to begin. The Wall Street Journal has a new deputy editor-in-chief, who will oversee the paper's news coverage. His name is Gerard Baker, previously of The Times of London, and -- gird yourself for this stunning revelation -- he describes himself as a "right-wing curmudgeon."
Michael Calderone, who first reported the hire, says it was a "move that surprised some staffers because of his strong right-wing political views." If true, that only means there are some pretty optimistic (naïve, if you prefer) staffers there. They originally opposed the Murdoch takeover, saying, "Mr. Murdoch has shown a willingness to crush quality and independence, and there is no reason to think he would handle Dow Jones or The Journal any differently." Of course there was later a "deal" made with the Bancroft family that no such influence would be wielded, but was clearly a fig leaf that allowed the Bancrofts to complete the sale without admitting they had abandoned the paper's journalistic mission.
Baker thinks Obama is a "dangerous left winger." He explains:
There is a caste of left-wing Americans who wish essentially and in all honesty that their country was much more like France. They wish it had much higher levels of taxation and government intervention, that it had much higher levels of welfare, that it did not have such a "militaristic" approach to foreign policy. Above all, that its national goals were dictated, not by the dreadful halfwits who inhabit godforsaken places like Kansas and Mississippi, but by the counsels of the United Nations.
Though Mr Obama has done a good job, as all recent serious Democrats have done, of emphasising his belief in American virtues, his record and his programme suggest he is firmly in line with this wing of his party.
Thanks again, Bancrofts ...
ABC's idea of "breaking news": Breaking News from ABCNEWS.com:
'Pregnant Man' Thomas Beatie Tells ABC's Barbara Walters He Is Expecting Second Child [11:07 a.m. ET]
George Zornick writes: I confess, I told a few people that Joe the Plumber was a relative of Charles Keating, the banker involved in the Keating Five scandal that ensnared Sen. John McCain in 1991. But that's not true -- it's a claim fabricated by a couple pranksters who have gone to elaborate lengths creating an imaginary conservative wonk, Martin Eisenstadt of the Harding Institute for Freedom and Democracy.
Of course, I only mentioned the Keating connection in conversation, and soon learned it was false. Notably, though, I do not work for a major cable news network, and I didn't pass along any Eisenstadt-based tidbits on the air, as MSNBC's David Shuster did this week. Talking about the rumors that Sarah Palin didn't know Africa was a country, Shuster said: "Turns out it was Martin Eisenstadt, a McCain policy adviser, who has come forward today to identify himself as the source of the leaks."
"Eisenstadt" wrote on his blog that he alone was the source for the rumors, and that indeed Palin didn't know -- and MSNBC hurried to get that on the air after the fake blog post was linked in several mainstream political blogs, including The New Republic. More here.
The prank highlights the vacuous nature of cable news, where information is pumped and then dumped without too much awareness of who provided it, or why. But more importantly it's a caveat to bloggers -- who is behind that Typepad page you want to quote? Do you know them? Do you know if they're reliable, or even real?
What Obamedia? Shepard Smith gets it, even if Deborah Howell doesn't:
SMITH: Oh, please ... the mainstream media reflected what was happening in this nation. It did not drive it. The blogs didn't drive this movement. The media didn't drive this movement. Barack Obama did not lose this election. It was his to lose, it was not John McCain's to win. The Republicans had no shot unless the Democrats gave it to them, and they didn't. And to blame the media is a copout and ridiculous. We are always here to be blamed by people like you who enjoy that activity. We always will be. When the Democrats lost last time, it was our fault. When the Republicans lost this time, it's our fault. It's not.
(Obviously I take issue with his final claim -- Fox News' relentless smearing of John Kerry surely had a negative influence on his chances.)
Earlier this week we noted the absolutely pathetic attacks by Limbaugh, Hannity, et al on the president-elect: For example, Hannity's immediate post-election concern was not that Obama may institute progressive taxation or increase regulation, but that "I fear [this] is the guy that has these radical associations 20 years ago."
Harold Meyerson's thinking the same thing, and has penned a thank-you to Rupert Murdoch for helping marginalize the GOP with the Fox News sideshow:
During the campaign just completed, you guys focused on Barack Obama's allegedly Muslim and alien roots and socialist ideology; meanwhile, in the real world, unemployment rose, foreclosures soared and Wall Street went flooey. Over the past eight years, you beat drums for such causes as state intervention in the Terri Schiavo case. You demonized undocumented immigrants (okay, CNN's Lou Dobbs gave you a run for your money on that one). You fed the Republican base with a steady diet of bile -- and now that bilious base is the biggest impediment to the Republicans' repositioning themselves so that they can win elections again.
The rest is here. Seriously, remember when Fox News was far more skillfully crafted propaganda?
Middle East policy: What will President-elect Obama's promises of change mean for the Middle East? Guest host Deborah Amos sits down with Elizabeth Rubin, the Edward R. Murrow press fellow at the Council on Foreign Relations, and Slate magazine columnist Fred Kaplan. Then, Bill Moyers Journal and Exposé: America's Investigative Reports follow a team from The Denver Post's award-winning reporting on the broken justice system on Indian reservations across the country.
On the day that Americans turned out in near record numbers to vote, Tom Engelhardt points out, another record was set halfway around the world -- the U.S. Air Force wiped out at least its sixth wedding party in Afghanistan or Iraq since December 2001. Those American planes killing civilians in rising numbers in Afghanistan and the Pakistani borderlands "remain part of George W. Bush's Air Force," he writes, "but only until January 21, 2009. Then, they -- and all the brides and grooms of Afghanistan and in the Pakistani borderlands who care to have something more than the smallest of private weddings -- officially become the property of President Barack Obama."
It's a sobering thought and where Engelhardt begins his discussion of the widening war Obama is inheriting and will soon take possession of -- not only the one in Iraq and the one he's already announced that he will himself expand in Afghanistan, but the Bush administration's fantasy world of war, the Global War on Terror, that has nonetheless set all-too-real expanses of the planet aflame.
He suggests that unless we -- the citizens of this country -- pitch our tents on the public commons, make noise, and don't go home in the wake of Obama's election victory, he will be left alone in airless Washington with all the "wise men and women" of various past been-there-done-that political moments.
This is a wide-ranging piece on the national security world the new president will find himself in. Engelhardt concludes:
"Political Washington is a conspiracy -- in the original sense of the word: 'to breathe the same air.' In that sense, there is no air in Washington that isn't stale enough to choke a president. Send Obama there alone, give him that 'breathing space,' don't start demanding the quick ending of wars or anything else, and you're not doing him, or the American people, any favors. Quite the opposite, you're consigning him to suffocation.
"Leave Obama to them and he'll break your heart. If you do, then blame yourself, not him; but better than blaming anyone, pitch your own tent on the public commons and make some noise. Let him know that Washington's isn't the only consensus around, that Americans really do want our troops to come home, that we actually are looking for 'change we can believe in,' which would include a less weaponized, less imperial American world, based on a reinvigorated idea of defense, not aggression, and on the Constitution, not leftover Rumsfeld rules or a bogus Global War on Terror."
Name: John
Hometown: Ann Arbor, Mi
Aw shucks Dr A,
"There you go again," showing your wimpy Liberal bias to poor Michael Barone. Every average Joe with any religious background knows the accepted minimum sentence for such crimes is "40 years wandering in the wilderness" with the maximum being life without parole. Please reconsider your overly lenient 8 to 12 years to meet these more conservative standards.
Name: Kris Alexander
Hometown: Austin TX (Currently an East Coast military refugee)
The civilian national security force idea is nothing new. I pitched a presentation about a similar concept a couple years ago at a conference at Fort Leavenworth. Gen. Petraeus was there and heard it. He even asked some insightful questions which was pretty cool for a low ranking guy like me. And Bush also proposed an idea similar to this in his 2007 State of the Union Address. I wrote about it here.
Of course, I'm wondering if my proposal makes me a neo-fascist too.
I am envious of you getting to see the Hold Steady and the Drive-by Truckers. The Hold Steady kicks a lot of ass. It's like listening to Springsteen if he'd done a lot of hard drugs and wasn't a baby boomer.
Name: Peter
Hometown: London, Ontario, Canada
Thanks for the piece about Israel's treatment of its Arab minority. Bradley Burston recently wrote a provocative piece in Haaretz on the same topic in which he compares the situation of Israeli Arabs to African-Americans.
The readers' comments after the article reinforce the view that both countries still have a way to go in terms of equality for all citizens, although the US is clearly a few decades ahead ...
Name: Thomas Beck
Hometown: East Windsor, NJ
Something interesting is that Fox News Channel does a pretty decent job of covering stories that are not easily ideologically spun. Not all the time, but I've found myself sometimes turning to them when CNN or MSNBC is running something relatively trivial. Brit Hume has his moments as a straight newscaster, as do some of the others, when they're not simply parroting Republican National Committee talking points. Granted, Hannity and O'Reilly are inexcusable, but the rest of the operation could be a great news network if they'd simply let themselves truly be fair and balanced. They have the talent and the commitment; they just need to drop the partisanship. Granted, that's like saying all the Mets need to do is drop the suck, but ... I think it would be easier for Fox, to be honest.
Name: Merrill R. Frank
Hometown: Jackson Heights, NYC
Dr. The other night I finally caught up with the documentary "Boogie Man" on PBS Frontline about Republican campaign consultant Lee Atwater's career, which peaked when his client, George Bush the elder, won the 1988 presidential election. Interspersed throughout the film were your comments which put into context the attacks on "Liberal elites" as well as the power of attack politics to shape elections and how Richard Nixon's "Southern Strategy" continues to this day to exert a powerful influence on the electorate.
What struck me was after he was diagnosed with a brain tumor he said he "found God," read the new Bible that one of his brethren gave him and forgave those he attacked. Yet after his death the Bible he claimed he consulted to inspire him to forgive remained in his hospital room, unused still wrapped in cellophane. Maybe the unwrapped Bible is the ultimate metaphor for the cynicism and corruption of the last eight years where you can pander to the lowest common denominator and play to worst prejudices and anxieties just to get enough of the base out or as Sen. Moynihan called it in different context "Boob bait for bubbas." Hopefully last week's election results will stick a cold stake in the heart of this stuff once and for all.
Name: Jason Parrish
Hometown: Santa Rosa, CA
Dr. Alterman,
I have a post-graduate education, but not in economics, which might be why an article like this makes me absolutely sick. This is tacit admission that we aren't bailing out just any company, but really all companies, or any large enough to steer their ship of finance toward the large bail-out.
In China, they're pumping national money into public infrastructure development, building transportation, manufacturing, eductation, ports and telecommunications to continue their long-term economic development. Here in the US, we're pumping taxpayer money into large financial institutions based here and around the globe, the tangible effect to American taxpayers is ... warm fuzzies to internal loan officers regulating Bank-to-Bank lending?
Does this deal increasingly stink to economists as well as the rest of the Americans not partaking in the billions of dollars in executive bonuses this Christmastime?
Name: Rory
Hometown: Oakland, CA
Dr. A
A slight correction to calling the eponymous "Warren Zevon" his debut album. His first album "Wanted Dead or Alive" was released in 1969.
He later was so embarrassed by it, he ignored it. ("Iko Iko"?!?!?) My ex-wife, who introduced me to Zevon's music had an original copy. I have a re-release on Pickwick I found in the late 70's.
Name: Doug
Hometown: Arlington, VA
Wow, I read your column for the politics -- and suddenly you interject a spot-on description of the loudmouth sports columnist from Boston, Bill Simmons. (Expect a childish response from him if he happens to see it.)
Kinda reminded me of a similar -- if you will -- "crossover commentary" in 2003 by legendary football writer Paul Zimmerman, who summarized Rush Limbaugh better than anyone in the MSM ever has: "Rush ... represents, as I've mentioned, everything I hate in political and every other kind of commentary. Narrow-minded, intolerant, a sworn enemy of the disadvantaged, a friend of the power elite, against anyone who would dare to voice protest in an effort to alleviate human misery."
Name: Richard Taylor
Hometown: San Antonio, TX
I have been reading Bill Simmons' stuff about as long as I've been reading Altercation. Just as I followed Altercation from MSNBC to Media Matters, I followed Simmons from his own blog to ESPN.
Yes, he is a big fan of Boston sports teams. His old blog was called "Boston Sport's Guy." What I don't think he has ever been a fan of is the sportscaster/announcer/writer who purports to be unbiased but shows their bias in more subtle ways. If he's not a Bills fan, it's probably because they play in the same division as the Pats.
ESPN, however does not allow Simmons to mock other sportscasters/announcers/writers by name which is a shame as he was wonderful on mocking the Boston Globe's writer/columnist Dan Shaughnessy (aka the "Curly Headed Boy"). So, the point he was probably making was more along the lines of the old Shaughnessy bits. Shaughnessy always seemed to be the type of writer who covered sports but didn't like anyone involved with sports.
A long way of saying don't take Simmons' bit as anti-Bills just because. He isn't a Bills fan but I think he does like real fans of teams and probably doesn't see Berman as such (assuming it was Berman he was talking about -- don't forget, Berman spent years picking the Bills to be his AFC Super Bowl team, long after they'd actually started stinking up the joint) :})
Name: Robert Weintraub
Hometown: Atlanta
Doctor A --
I'll second that emotion on Simmons -- his swipe was surely aimed at Chris "No one circles the wagons like the Buffalo Bills" Berman. Sure, Berman can be buffoonish, but as you point out, it's scarcely different from Bill's frequent 10k-word treatises on all things Bostonian.
Nevertheless, I must rise to defend ESPN on the "anti-Bills bias" label (disclosure -- I'm a past employee of the net, and write for the dotcom). Irvin and Smith were brought in, warts and all, because they are Hall of Fame members of the league's most popular team. I fail to see the linkage between defending the 'Boys and hating on the Bills -- frankly, I doubt any of those Cowboys regard Buffalo with enmity. Pity, perhaps. Certainly neither have gone out their way to slam the Buffalo unfairly.
And, following your argument, who would you have ESPN hire from those Bills teams? The only plausible name is Jim Kelly, who has admirably set aside any type of broadcasting career to tend to the foundation he set up in the name of his son, Hunter, who died from a rare condition called Krabbe's Disease a few years ago. And Andre Reed has in fact appeared on ESPN, albeit not on Gameday or anything as high profile as Emmitt and Irvin. They could call Thurman Thomas, but he might forget his wireless mic on the way to the studio...
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As this season's Ghanaian elite league division football enters its fifth week, Goal summarises the fixtures and what prospects they hold for fans
Matchday-Five of Ghana Premier League season 2013-14 is set to be honoured this weekend with most of the games coming off on Sunday after the Bechem – Hearts of Oak game on Saturday.
Four of the clubs among the five best-placed on the current league table - Kotoko, Hearts of Oak, Bechem United and Hearts of Lions - would seek to record second successive victories when they play Inter Allies, Bechem United, Hearts of Oak and Dwarfs respectively.
For Kotoko particularly, a win against the pointless new entrants in Tema would add to a run of four straight wins in as many games this season while third-placed Ashantigold, the other member of the league-leading quintet, would seek to pick all points when they play Amidaus Professionals at Obuasi's Len Clay after being held to a goalless draw tie in Kumasi by King Faisal on Wednesday.
Faisal themselves would be desperate to soothe their relegation wounds with a good performance over Wa All Stars, a club that lost at home to defending champions Kotoko last time out.
The remainder of the calendar would also see Medeama United and Liberty Professionals contest a clash at the latter's Carl Reindorf Park home in which either side would be hoping to pick two more points than they did during their respective midweek fixtures to help propel them beyond the lower half of the league log.
In another mid-table clash, Aduana Stars, who were stunned by an unusual 2-1 loss at their Dormaa fortress in their most recent encounter against Bechem United, would look to avoid another unfavourable result by a regional rival, this time 2010-11 winners Berekum Chelsea, over whom they enjoy a slender two-point lead.
New Edubiase (13th) and Hasaacas (14th), two-fourths of the league's poorest performers per the present standings, go head-to-head in a match whose outcome would almost certainly have ramifications in the drop zone.
The height of the stakes in these eight delicious games should have spectators flocking to the venues in their numbers.

subset: commoncrawl


text:
Paradisus Princesa Del Mar
7 nights All Inclusive from €1,659 Including Flights
This stunning All-Inclusive 5-star hotel is designed for adults over 18. Situated in Matanzas province, in one of Varadero's best beach areas. It is 4 hours away from Havana International Airport and 10-minutes from Varadero city. Offering round-the-clock activities.


text:
Hi, I'm starting a business, and I will need a very good designer, to draw logos, timeline covers on facebook, themes of twitter, webdesign templates, photos etc. I will see for your work if you complete our requests. I live in Portugal, and portuguese people are tremendous selective right now, but they are good payers, and pay them bills.
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This is a huge oportunity for you. If you are very good and responsive on your work, i will request you for more works, you can be sure.
At start, i cant employ a new designer so i will need one of the bests in graphic river.
You can delevopp the idea. Infinite symbol in a form of a lamp and color (ios7 colors maybe).
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My contact is email@example.com
Hi! I contacted you, my email is : firstname.lastname@example.com
Hi, i can help you with your logo, contact me at : firstname.lastname@example.com


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Upon implementation of the Integrated Eligibility System (IES) phase 2, the process for completing a redetermination is changed. The REDE process is described in PM 19-02-04.
The REDE process is complete when:
Report that a Medical REDE was completed any time all factors of eligibility that can change are reviewed. This means income, assets (AABD only), presence in the home, and Illinois residence.
Report a REDE when an EZ REDE or a Mid-Point Reporting (MPR) unit's REDE is completed for SNAP benefits that verifies the family is still eligible for medical benefits. Report a REDE for a companion case, if all eligibility factors for the companion case are provided.


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Narrow Results:
Title: Narrative Writing: The Autobiographical Incident
After organizing their thoughts using a graphic organizer, students write a narrative essay which relates an autobiographical incident. Students present their essays in a slideshow which allows their classmates to practice predicting an outcome as they guess the ending of the narrative. Some of the essays will be included in a class newsletter created by the students.
Standard(s): [TC2] (6-8) 11: Use digital tools and strategies to locate, collect, organize, evaluate, and synthesize
Title: Once Upon a Fairy Tale: Teaching Revision as a Concept
Students use fractured fairy tales to practice revision and editing as separate activities when they write their own versions of fairy tales.
Title: Childhood Through the Looking-Glass
This lesson from EDSITEment explores the vision of childhood created by Lewis Carroll in Alice in Wonderland. Students begin by looking at Carroll's photographs of the real Alice for whom Carroll imagined his story and compare the image of childhood that he captured on film with images of children in our culture. Then students read Alice in Wonderland with special attention to the illustrations that Carroll made for his book, and explore the relationship between words and pictures by creating an Alice illustration of their own. Next, for contrast, students compare Carroll's vision of childhood with that presented by the Romantic poet William Blake in his illuminated Songs of Innocence and Experience. Finally, students consider the interplay of image and text in their own favorite children's literature and how the vision of childhood presented there compares to their experiences as children. Several pieces of literature appropriate for use with this lesson are suggested.
Standard(s): [ELA2015] (8) 30: Engage effectively in a range of collaborative discussions (one-on-one, in groups, and teacher-led) with diverse partners on Grade 8 topics, texts, and issues, building on others' ideas and expressing their own clearly. [SL.8.1]
Title: Pictures in Words: Poems of Tennyson and Noyes
In this lesson, from EDSITEment, students explore how poets Tennyson and Noyes use words to paint vivid and memorable pictures. They describe how word pictures emphasize or qualify the meanings of their poems.
Standard(s): [ELA2015] (8) 25: Use technology, including the Internet, to produce and publish writing and present the relationships between information and ideas efficiently as well as to interact and collaborate with others. [W.8.6]
Title: The Industrial Age in America: Sweatshops, Steel Mills, and Factories
In this lesson from EDSITEment, students research working conditions in the Age of Industrialization and examine worker responses to these conditions. They then read arguments for and against modern sweatshops and write a position paper on sweatshops today.
Standard(s): [SS2010] USS6 (6) 1: Explain the impact of industrialization, urbanization, communication, and cultural changes on life in the United States from the late nineteenth century to World War I.
Title: Reading and Analyzing Multigenre Texts
Students develop a definition of multigenre texts by exploring multigenre picture books. They brainstorm what it takes to read these texts successfully and discuss strategies needed to comprehend the texts.
Standard(s): [ELA2015] (8) 14: Analyze in detail the structure of a specific paragraph in a text, including the role of particular sentences in developing and refining a key concept. [RI.8.5]
Title: Promoting Diversity in the Classroom and School Library through Social Action
Students explore the effects of stereotypes by analyzing children's books. Then they create bookmarks that encourage readers to question the assumptions of stereotyped books and to seek out matching, balanced texts.
Standard(s): [ELA2015] (8) 41: Acquire and use accurately grade-appropriate general academic and domain-specific words and phrases; gather vocabulary knowledge when considering a word or phrase important to comprehension or expression. [L.8.6]
Title: Imagine That! Playing with Genre through Newspapers and Short Stories
Students identify genre characteristics for short stories and newspaper articles then practice both genres by turning a short story into a news article and an article into a short story.
Standard(s): [ELA2015] (8) 41: Acquire and use accurately grade-appropriate general academic and domain-specific words and phrases; gather vocabulary knowledge when considering a word or phrase important to comprehension or expression. [L.8.6]
Title: The World of Haiku
In this lesson, from EDSITEment, students explore the traditions and conventions of haiku, comparing this classic form of Japanese poetry to a related genre of Japanese visual art and composing haiku of their own.
Standard(s): [ELA2015] (8) 9: By the end of the year, read and comprehend literature, including stories, dramas, and poems, at the high end of Grades 6-8 text complexity band independently and proficiently. [RL.8.10]
Title: The Legend of Sleepy Hollow
In this lesson, from EDSITEment, students explore the artistry that helped make Washington Irving our nation's first literary master. They ponder the mystery of what happened to Ichabod Crane, a mystery that now haunts every Halloween.
Standard(s): [ELA2015] (8) 22: Write narratives to develop real or imagined experiences or events using effective technique, relevant descriptive details, and well-structured event sequences. [W.8.3]
Title: The Poet's Voice: Langston Hughes and You
This unit of seven lessons, from EDSITEment, introduces students to a poet's voice. Students develop a general definition of voice in poetry, and analyze and appreciate the poetic voice of Langston Hughes in particular. Included are writing and discussion activities, in which students either write a poem expressing their own voice (as developed in a journal), or write about one of the qualities of Langston Hughes's poetic voice (as explored in class discussion).
Standard(s): [SS2010] USS6 (6) 4: Identify cultural and economic developments in the United States from 1900 through the 1930s.
Title: In the Poet's Shoes: Performing Poetry and Building Meaning
Students take poetic license when they interpret William Carlos William's poem '' The Red Wheelbarrow'' to help create a poem of their own.
Standard(s): [ELA2015] (8) 35: Adapt speech to a variety of contexts and tasks, demonstrating command of formal English when indicated or appropriate. (See Grade 8 Language standards 36 and 38 for specific expectations.) [SL.8.6]
Title: Making Personal and Cultural Connections Using A Girl Named Disaster
Struggling to survive is one of the many themes explored in A Girl Named Disaster. As students read, they look for connections between themselves and the main character, Nhamo.
Standard(s): [ELA2015] (8) 26: Conduct short research projects to answer a question (including a self-generated question), drawing on several sources and generating additional related, focused questions that allow for multiple avenues of exploration. [W.8.7]
Title: Proverbs: An Introduction
Students are introduced to proverbs and explore how proverbs are often tied to a cultures values and everyday experience, although their meanings are not always readily apparent to us today.
Standard(s): [ELA2015] (8) 40: Demonstrate understanding of figurative language, word relationships, and nuances in word meanings. [L.8.5]
Title: Press Conference for Bud, Not Buddy
Students read Bud, Not Buddy by Christopher Paul Curtis, demonstrate comprehension of the story by involving themselves in discussions, and analyze the characters in preparation for a class '' press conference.''
Standard(s): [ELA2015] (8) 33: Present claims and findings, emphasizing salient points in a focused, coherent manner with relevant evidence, sound valid reasoning, and well-chosen details; use appropriate eye contact, adequate volume, and clear pronunciation. [SL.8.4]
Title: A Story of Epic Proportions: What Makes a Poem an Epic?
This EDSITEment lesson introduces students to the epic poem form and to its roots in the oral tradition. Students learn about the epic hero cycle and learn how to recognize its pattern of events and elements--even in surprisingly contemporary places. Students are also introduced to the patterns embedded in these stories that have helped generations of storytellers remember such long, expansive poems.
Standard(s): [SS2010] WH8 (8) 6: Trace the expansion of the Roman Republic and its transformation into an empire, including key geographic, political, and economic elements.
Title: Traveling the Road to Freedom Through Research and Historical Fiction
Students learn how to walk a mile in someone elses' shoes by reading historical fiction about the Underground Railroad.
Title: Finding the Science Behind Science Fiction through Paired Readings
Students read science fiction texts and then use nonfiction texts to extrapolate the scientific principles presented as they discuss the what ifs within the context of scientific principles.
Title: Alphabiography Project: Totally You
The traditional autobiography writing project is given a twist as students write alphabiographies recording an event, person, object, or feeling associated with each letter of the alphabet.
Title: Letters and Learning Genre
Using their prior knowledge of books containing letters, students show their understanding of genre by rewriting a story and reflecting on how traditional stories differs from stories told in letters.
Title: Enchanting Readers with Revisionist Fairy Tales
Students examine three examples of revisionist fairy tales in which female characters act in empowered roles rather than behaving helpless and submissive.
Title: Memories Matter: The Giver and Descriptive Writing Memoirs
Using The Giver, students discuss the importance recorded history. This provides context for descriptive writing of students own history in a lesson that integrates personal writing, research, and literary response.
Title: Fairy Tale Autobiographies
Students read and analyze fairy tales from several cultures, identifying common elements. Choosing common situations, students write original fairy tales, using picture books as models and a peer review process.
Standard(s): [ELA2015] (9) 35: Adapt speech to a variety of contexts and tasks, demonstrating command of formal English when indicated or appropriate. (See Grade 9 Language standards 36 and 38 for specific expectations.) [SL.9-10.6]
Title: Expository Escapade Detectives Handbook
Students create a Detective's Handbook based on a detective mystery they have read. The handbooks include expository and descriptive writing, as well as a letter.
Standard(s): [ELA2015] (8) 38: Use knowledge of language and its conventions when writing, speaking, reading, or listening. [L.8.3]
Title: Writing Free Verse in the '' Voice'' of Cesar Chavez
Poetry and politics combine in this lesson where students write a free verse poem in the voice of Cesar Chavez.
Title: Entering History: Nikki Giovanni and Martin Luther King, Jr.
Nikki Giovanni's poem The Funeral of Martin Luther King, Jr. is paired with Dr. King's I Have a Dream speech, taking students on a quest through time to the Civil Rights movement.
Title: Guided Comprehension in Action: Teaching Summarizing With the Bio-Cube
Students learn the ins and outs of writing biographies by researching a contemporary or historical figure and writing a summary.
Title: Playing with Poetry the Interactive Way
Digital Tool:
Poetry Idea Engine: A Writing With Writers Activity Web Address URL:
http://teacher.scholastic.com/writewit/poetry/poetry_engine.htm Standard(s):
[ELA2015] (8) 9: By the end of the year, read and comprehend literature, including stories, dramas, and poems, at the high end of Grades 6-8 text complexity band independently and proficiently. [RL.8.10]Digital Tool Description: This interactive activity challenges students to write haikus, free verse, limericks, and more.
Title: Poet Emily Dickinson was born in 1830.
Students discuss Dickinson's poem '' This Is My Letter To The World'' and use it to focus on how audience affects voice.
Standard(s): [ELA2015] (12) 24: Use technology, including the Internet, to produce, publish, and update individual or shared writing products in response to ongoing feedback, including new arguments or information. [W.11-12.6]
Title: Jacob Grimm, one of the Brothers Grimm, was born today.
Students compare different versions of the fairy tale Cinderella and then rewrite a lesser-known Grimm story and explain the changes they made.
Standard(s): [ELA2015] (12) 21: Write narratives to develop real or imagined experiences or events using effective technique, well-chosen details, and well-structured event sequences. [W.11-12.3]


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Print Map (pdf)
- Five distinct eco-regions surround the museum.
- Sabertooth Cat skeleton.
- Randy Landis and his Falcon Presentation.
- Exhibit on insects.
Gateway Science Museum
625 Esplanade, near Bidwell Mansion
The Gateway Science Museum is dedicated to educating the community about Northern California's natural heritage and habitat. Opened on the Chico State campus in 2010, the museum offers many educational programs for children and adults, and is a great place to experience science first-hand.


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Americans rich and poor pawn more to pay bills
Whether it's a Tiffany diamond or a three-year-old lawnmower, more and more Americans from all social classes are pawning their possessions to make ends meet.
Pawn shop owners see strong business across the country, even in unexpected locales like Beverly Hills, the mecca of luxury living and shopping.
"Banks aren't lending so people are coming here for short-term loans against collateral like diamonds, watches and other jewellery," said Jordan Tabach-Bank, chief executive officer of Beverly Loan Co., self-described "pawnbroker to the stars".
"I do see my share of actors, writers, producers and directors," he said, but also cited more visits from white-collar professionals and especially business owners struggling to meet payroll obligations.
"We still do the five-, six-figure loans to Beverly Hills socialites who want to get plastic surgery, but never have we seen so many people in desperate need of funds to finance business enterprises," he added.
In the 70 years of the family business, Beverly Loan, which usually charges four per cent monthly interest on loans, has never loaned so much as it has in the past few months, he said.
"We're a lot easier to deal with than a bank," he said from his office on the third floor of a Bank of America building near Rodeo Drive. An armed security guard watches over the reception, where case after case is filled with precious gems.
It's less glamorous at Mo Money Pawn, located in the grimy area of central Phoenix, where struggling building contractor Robert Lane waited for the shop to open its doors so he could pawn a table saw he bought for €666.
"It's to get ahead and pay off some of the bills," he says standing outside the store, where he hoped to get €222 for a cherished workshop tool he now rarely uses as work dries up.
There are as many as 15,000 pawnbrokers across the US. As the US recession deepens, pawnbrokers - long seen as a lender of last resort - are noting a rise in business.
No national body keeps statistics for the sector, but proprietors across the spectrum say they are thriving as home foreclosures spiral and bank credit remains scarce.
"Business is good," Mo Money owner Eric Baker said. The store, which makes loans on anything from a motor home to guns to lawnmowers and jewellry, says turnover is up by around 20 per cent over a year ago on a broader range of clients.
"You are seeing some bigger stuff, you're seeing some people you probably wouldn't have seen," he said.
Newer clients include struggling contractors like Mr Lane, as well as cash-strapped real estate, land and mortgage brokers, seeking loans, which are pegged by state law at 22 per cent over 90 days.
"They are coming in with the houseboats, the quads, the Harleys... The toys they can live without, sitting in the garage," Mr Baker said, sitting in his office at the store, where several of the staff have pistols holstered in their belts.
Across town, William Jachimek, a 25-year veteran of the trade, said cash-strapped mortgage brokers started coming in about a year ago and now account for 10 per cent of business.
"We had one mortgage broker who pawned his wife's jewellry and their Viking oven," says the owner of five pawn shops who takes "everything that can be sold on E-bay" as collateral.
Business is up 20 per cent on last year at Mo Money Pawn, and seven per cent at Pawn Central, Jachimek's flagship store. Nevertheless, a growing number of customers are defaulting on loans, creating some uncertainty.
See our Comments Policy Comments are submitted under the express understanding and condition that the editor may, and is authorised to, disclose any/all of the above personal information to any person or entity requesting the information for the purposes of legal action on grounds that such person or entity is aggrieved by any comment so submitted. Please allow some time for your comment to be moderated.


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Ask a Mechanic Online and Get Answers to Your Car Questions
HelloCustomer I would replace the EGR valve for the P0404 and you don't need to worry about the U1301 code it is a lack of communication between modules that likely cleared itself up. Please reply if you have any questions, thanks
Yes, I do and here is the instructions for replacing it:
Exhaust Gas Recirculation Valve Replacement Removal Procedure
Notice: The EGR valve should not be soaked in any solvent. Otherwise damage to the electrical solenoid and position sensor could result.
Notice: Remove all loose deposits from the EGR inlet passage, otherwise they could clog the EGR valve.
Installation Procedure
Important: Ensure the gasket is installed correctly or a vacuum leak will occur.
Tighten Tighten the EGR Valve-to-Head bolts to 25 N·m (19 lb ft).
No, I will help you with that code, though it is completely unrelated to the EGR. Replacing the EGR did help with code p0404, I'm sure of that much. Normally vehicles will get U codes from time to time for one reason or another and often they go away, usually U codes are communication codes between modules and tiny glitches occur where a module doesn't communicate with the rest of the modules for a second and all of a sudden you get a bunch of U codes. In your case, we may have something different and I will try to help.
First I need to know did you erase the codes and did you check afterwards if the code was current?


text:
[Date Index]
[Thread Index]
[Author Index]
Re: moving dingbats
Look up
ShowGroupOpenCloseIcon in Help/FrontEnd/Front End Options/Cell
Options/Display Options/
You can insert the option in a Section Heading cell, say, by selecting the
cell, using Shift-Ctrl-E to display the cell expression and typing in...
You can make your own Style Sheet that has this option built-in to the
desired cell types.
David Park
djmp at earthlink.net
From: Guy Israeli [mailto:guyi1 at netvision.net.il]
To: mathgroup at smc.vnet.net
I searched in the help for this, but didn't find any visual examples
how do I make a dingbat like a triangle and when I click it it open a cell
or a group of cells?
where can I find more options for cell visualizations like this?


text:
Christmas Parades This Weekend in Acadiana Area
Mother Nature messed with some of our holiday fun last weekend, but this weekend it's looking better. Some of the local Christmas parades have been rescheduled for this weekend.
The Storm Team 3 meteorologists from KATC TV-3 are giving us the all clear as far as rain goes so we should be able to get out and enjoy.
Here is the schedule of parades that we are aware of:
Saturday, December 14, 3:00pm-6:45pm — Delcambre Boat Parade — lighted boats of all sizes cruise Bayou Carlin while listening to Christmas music.
Saturday, December 14, 5:30pm — Mamou Rotary Cajun Christmas Parade — begins at Mamou High School, runs through business district on 6th St. and ends back at the school.
Sunday, December 15, 2:00pm — St. Martinville Christmas Parade — Main Street
In addition to these parades, there are a ton of wonderful Christmas and holiday events going on in Acadiana this weekend. Our events tab has all the info you need.


text:
Global Finance MScCoventry University
£ 10.500 - (11.909 €)
Informazioni importanti
- Master
- Scarborough (Inghilterra)
- Quando:
Settembre 2017
Cosa impari in questo corso?
Financial Risk
Asset Management
IT risk
Risk manager
Financial Training
IT Management
Skills and Training
Skills and Training
Skills and Training
Skills and Training
This programme is aimed at finance students and professionals who seek specialist knowledge on the curriculum of Chartered Financial Analyst (CFA) or Financial Risk Manager (FRM) through a postgraduate degree.
The programme enables participants to build a general framework in finance which will reflect core candidate body of knowledge in professional finance exams required by global financial institutions. Students who wish to gain these qualifications must register and complete the final examinations with the relevant professional bodies.
Courses are taught by academics who have finance industry background gained through working as analyst or manager in leading investment bank and asset management firm.
Students on this programme can utilise the new trading floor on campus with professional software such as Bloomberg Terminals, S&P Capital IQ Platform, STATA and TradeStation, and specifically designed financial simulation software such as Oxyor and Volcube. This provides the programme with a distinctive and innovative edge and equips students with transferable skills.WHY CHOOSE THIS COURSE?
There are many reasons to study at the London Campus including:
- our focus on employability;
- our location in the heart of the City of London;
- our work experience opportunities;
- the personalised attention we dedicate to students;
- our industry links;
- our industry trained Teaching Fellows;
- our top rankings.
As well as this, there are also a number of reasons to look forward to studying this programme specifically:
- a university programme which ranks top 7th in accounting and finance (2016 Guardian University Subject League Table);
- an opportunity to participate in exam preparation for professional qualifications (CFA and FRM);
- a programme taught by academics that have backgrounds within the finance industry having worked as analysts or managers in leading investment banks, asset management firms or hedge funds;
- an opportunity to participate in international field trips to global financial centres and experience leading lectures from high-profile figures in finance;
- a unique experience delivered by a top 15th UK University with strong foundations in educating business leaders.
- Academic and Professional Skills
- Ethics and Quantitative Methods Financial Reporting & Analysis
- Trading Economics
- Employability and Consulting Skills
- Global Financial Markets
- Valuation of Equity and Fixed Income
- Corporate Finance (CFA) or Risk Analysis and Financial Modelling (FRM)
- Portfolio Management
- Empirical Finance and Accounting Research Methods
- Fixed Income, Derivatives and Alternative Investment (CFA) or Financial Risk Management (FRM)
The final term project options include the following:
- Internship
- Individual Consulting Project
- Group Consulting Project
- Financial Simulation
- Dissertation
MSc programmes are delivered over four terms of 10 weeks.
All students study core finance modules, additional skills modules and a final term project.
Students will study twelve modules and will be guided through the course in preparation for professional finance exam."
C'è qualcosa che non ti convince in questo corso? Segnalaci se ci sono errori e aiuterai altri utenti come te.


text:
Nollywood actress Angela Okorie was a year older on August 17, 2016, and she celebrated her birthday with friends and colleagues on August 17th, at Club Cube in Festac.
Celebrities in attendance includes Anita Joseph, Mike Ezuronye, Terry G, Yul Edochie, Solid Star and others.
Her outfit was heavily criticized by fans for baring her boobs. Angela however replied critics in a new post saying, "Kill ur self if u don't like me, am soooooo dope and I knw, to all my real fans I love u."
The actress also released some photos of herself on August 11, 2016 dressed in a pink ball gown with a tiara on her head.
Make Money Online in Nigeria... Click HERE To Start Now!


text:
Best amp and setup for sub and HK audio
I have found numerous threads with some of this info, but forgive me for asking anew: (if you know the best thread please just link, much appreciated)
I am going with JL Audio setup as clearly is preferred fro easy install... adding sub to stock HK system in 2001 330.
1. What do people think is the best JL audio amp for pairing with a JL W1 12" Subwoofer?
2. What is the ideal setup in terms of install/wire placement? (insert link, lol)
3. What do people see as ideal setup for optimal sound?
Basically just looking for opinions on which JL amp to go with, then the links to the install/setup info... couldn't find one specific to this model...
1. I doubt you'll see much difference in the various JL amps in terms of SQ and that's not a power-hungry sub, so I'd just go with the XD300/1 (assuming you're set on JL amps).
2. Your wire placement would really depend on where you mount your sub enclosure and amp. However, it shouldn't be too much work, seeing as how all the wiring is already in your trunk. You'll just tap into the HK amp harness for your remote and for the signal out to a line out converter. I'll PM you a few links to get you started.
3. There's only so much you can do with the stock setup without gutting it and starting from scratch. A simple amp/sub addition will help fill in the lower end nicely, but you're still limited by the factory system components.
What he said ^^
I have a 500/1 sub amp with a 300/2 stacked with their STACK-KIT-2. The STACK-KIT-2 is unfortunately discontinued but their -3 kit should easily be used with spacers in between. The BMW Business CD interfaces directly quite nicely with the JL audio amps and sounds fabulous. I'm sorry I did not cut the harness and do this many years ago. The HK amp is shameful.
Happy Listening!
I got a used JL 500 amp and will attempt install this weekend. Thanks for all the helpful info (especially arfboy for sending links etc). Cannot wait for bass in face.
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Have you seen the movie Bad Boys II with Will Smith and Martin Lawrence? Yea this is the car they carjack from Dan Marino as he's out taking a test drive. Will Smith jumps in and says, "Dan Marino should definitely buy this car!"
Enough said.
Okay, maybe not. . . Up for sale is my pearl diamond white 2003 Cadillac CTS. It has leather tan interior and 121k miles. This car has absolutely zero problems (except for the very tiny stuff not worth mentioning in this ad -- I have compiled a list of every little thing that I can send to you through email if you're interested, and I also made 3 videos below documenting them.) The title is clean. The car passed MD state inspection months ago in August 2012 and then passed MD Emissions testing soon after. Like I said, excellent condition. Look up Maryland's inspection procedures and you will see that Maryland residents undergo arguably the toughest inspection process in the nation, due in part to the fact that only one inspection per owner is required for the entire life of the vehicle. Included with the purchase will be the factory owner's manuals and a new personal maintenance log book in the glove box. Provided in the trunk will be a brand new personal safety kit with a limited 365-day free roadside assistance warranty that you can activate at your convenience. Also included with the purchase will be a new car cover with case.
This vehicle is being offered across many different markets in the United States. It is located on the east coast in Maryland and will be personally delivered to your door by me, the owner. The buyer pays the delivery/shipping costs. There are three options for this. I can either deliver the car to you myself, have it professionally shipped to you, or you can handle this department yourself. The prices of these three options are as follows (I calculated them for those who live the farthest away from me, like in California. If you live closer to me then obviously these prices will be less): If I deliver it, this will be about $1,000 for gas, lodging, a taxi, and a flight back. If I have it shipped to you professionally then you're looking at about $1,300 for an auto shipper that has an "A" rating at the Better Business Bureau. Of course, there is a third option. . . you can take care of the vehicle's transportation yourself or come pick it up yourself for free and not even have to give me a penny before first seeing the car in person and making sure everything checks out. But fret not, if the third option sounds like way too much work then it probably is, which is why I made the following four videos for out-of-state buyers who would prefer to not have to travel thousands of miles to buy a vehicle. Go to YouTube and view these videos immediately (RIGHT NOW, HURRY) before you decide this is all just a little too much for you and then you navigate away from my page.
Walk-around and Test-drivehttp://www.youtube.com/watch?v=7TFkSUPAE9M
Exterior Problemshttp://www.youtube.com/watch?v=YAm6t0qm18M
Interior Problemshttp://www.youtube.com/watch?v=0QMKVsXJmPk
Performance/Functionality Problemshttp://www.youtube.com/watch?v=qAoEj3GLTsg
Here are some more photos:
Okay, let me sum it all up. The vehicle is $8,500. If you live in Maryland or you want to come pick it up then that's all you have to pay. Otherwise, it looks like this (assuming you live in CA... if you're closer, it will be cheaper):
$8,500 total - You handle shipping. Maybe you want to come see the car in person, then buy it and transport it yourself. Or maybe you got a friend or relative in Maryland willing to check it out and drive it out to you. Or maybe you know of something cheaper in the bargain basement when it comes to shipping vehicles. Whatever. No deposit necessary.
$9,500 total - You get to personally see my smiling face at your door in less than a week's time with your brand new Cadillac. I will need $1,000 of this up front as a deposit.
$9,800 total - You get your brand new Cadillac professionally shipped to you in about 1-3 weeks time and best of all you don't see my smiling face at your door. I will need $2,000 of this up front as a deposit.
The totals above include the deposits, however the deposits are non-refundable. That means if the car gets to you and everything is as advertised and you just change your mind, I keep your money. However if the car arrives and something is wrong (check engine light is on, body damage was undisclosed, or anything major was not as advertised) then I will refund your deposit in full.
Serious buyers: Send me an email at email@example.com if you're interested and from there I will provide you with my name and phone number. At request I will also provide you with the car's specs and a link to a website that tells you everything you need to know about the 2003 Cadillac CTS. Thanks!


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Posted by Augie Ray on September 28, 2010
Since 2007, Forrester has tracked the growth of social behaviors. For years we've seen increases in more complex social behaviors such as Creators—those who generate social content including YouTube videos and blog posts. But for the first time, we're seeing a change in the growth trend. Our latest 2010 Global Social Technographics report demonstrates that many social behaviors have reached a plateau. Why, and what does this mean to marketers?
There is not a single answer to those questions. The reasons span things as complex as human nature and as simple as Web site usability. For example, is it sensible to believe that Creator behavior will ever be universal? Not every person has a burning need to be a reporter, an industry expert, a videographer, a musician, a thought leader, an editor or a broadcaster. The fact that more than 1 in 5 online adults in the US are exhibiting Creator behavior is a testament to how social technologies have lowered the bar, since these tools have allowed more people to create and distribute their ideas, opinions and creations than was ever possible in the past.
Posted by Augie Ray on September 15, 2010
For a company that thrives on transparency, Facebook's advertising isn't very transparent. Check out your Facebook home page, note the ads on the right side, and tell me what companies they're for. Sure, the ads probably cite brand or company names in the headlines and images, but who are the companies who paid for those ads? Where will you end up if you click those ads? And an ever better question is, what will happen if you "Like" the ad--will you be giving information to a trusted brand or a spammer?
Now go to Google, conduct a search, and check out the AdWords on the right side. Who sponsors those ads? And where will you end up if you click on those ads?
Google advertising is transparent, and Facebook advertising is not. The difference is a single line of text: AdWords creates transparency by including a "Display URL." Within ad AdWords, advertisers can set different Destination and Display URLs, but the two must be within the same domain so that (in the word of Google's AdWords form), "users know what to expect when they click your ad." (The reason there is a difference between the Destination and Display URLs is so that advertisers can direct people to a specific page in their domain while displaying the much shorter root domain in the ad ).


text: The Brian Lehrer Show Published by The Brian Lehrer Show Copyright Wars Download this audio Want to embed this player? Use the code below. More info. <iframe frameborder="0" scrolling="no" height="130" width="100%" src="https://www.wnyc.org/widgets/ondemand_player/wnyc/#file=/audio/json/29054/&share=1"></iframe> Share on Facebook Share on Twitter Email a Friend Lawrence Lessig, Stanford Law Professor and author of Remix: Making Art and Commerce Thrive in the Hybrid Economy, argues that copyright laws are criminalizing artists and youth and are strangling creativity. He also discusses his effort to use the net roots community to change Congress.


text: Glenn writes: > Well, after much deliberation as to how BADLY I needed a /usr partition > under 2.4.4.... > > I booted it in single-user (blech) under 2.4.4 and ran vgscan and got: > > segmentation fault > > So I went about investigating as to whether I could get more info than > that..... > > vgscan -d >& vgscan.log generated the textfile vgscan1.txt I am > attaching to this email...hopefully it sheds some light (?) Looks like you have devfs configured but not mounted. You really need to mount devfs before running vgscan. Also, you are far better off to not use devfs and LVM at the same time. Granted, this is no reason for vgscan to segfault, but it may fix your problem. Cheers, Andreas -- Andreas Dilger TurboLabs filesystem development http://sourceforge.net/projects/ext2resize/ http://www-mddsp.enel.ucalgary.ca/People/adilger/


text:
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Originally Posted by
Well Brian.. I guess we are both Morons, (or MAROON) is there a differance?
I am missing some important pieces for mine,, also ,like the window trim/ weather seal for the doors, that were taken off by the painter,, I can buy replacements ,, but have to buy the whole kit of 8 pcs,, that I only need the 4 outside pieces,, the inside pieces are on the door panels, and the old ones were in perfect condition,, thats the killer,,
Mine has been apart for nearly 6 years,, I tried to keep everything in 1 place and bundled up together,,now like I mentioned in another post,, gonna have to but a new windshield too,,,,
that buick looks like its in pretty good condition,, Calif Car???
wish my neighbor had a orange tree hanging over in my yard,, it would be void of any fruit on that side,,
It is amazing how much room a disassembled car takes up! I have a 12x12 shed that has a lot of it taken up by this car, a travel trailer with a few large pieces, a large cabinet in the garage, the rafters in the garage, it is amazing how much room it takes up, and I have TWO of these projects taken apart.
It floored me when I found the second set of inner fender rubbers, I laughed out loud. I know one thing, window "fuzzies" that I had bought two sets of, one of them was JUNK, I mean J-U-N-K
and not even close to being like the old ones. I have to assume that they were miss boxed and really for a coupe or the next year model or post car or something, they SUCK and worthless. The box is marked "65 GM A body convertible" but they are NOT for this car unless they are the worse repro parts ever and I am thinking they are close enough that is exactly what they are, HORRIBLE repro parts. Anyway, being I have two pair I have this little hope in my head that I bought those first and then the others so the second set wasn't a waste. Even the second set needed some rubbing blocks taken off the original and used. But honestly, if all I had were the junk set I would have been pretty frustrated.
Sad part is, they are so bad I can't even sell them because I wouldn't want to do that to someone.
If I drive 7-800 miles down there will you help me load it,, and ,I'll be glad to take it off your hands, then you will have lots of room to work on your P/U and a place to park your scrambler,,,,
My 69 Bonneville had 38K actual miles on it when I bought it about 10 yr ago.. was in excellent condition,, was a perfect driver,, but I can't leave anything in one piece and enjoy it,, I have to tear it apart and change things,, its been painted twice since I bought it, and been driven 7500 miles, that includes 2 trips to calif,, and its now been apart for almost 6 years, Go Figure,,, is it that I would rather have my projects in pieces and spending money on them insted of driving them,,? That seems to be the story with most of the cars I have ever owned,, and there has been a bunch,
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text:
Spalding Busy mum or dad
- +
- Overall really happy with this dishwasher. It is the first dishwasher I have ever purchased, and I'm really impressed by it. It's really simple to operate and cleans everything brilliantly. Its runs very quiet and the bright LED projection is a very nice touch. Obviously it's a slimline dishwasher so does struggle with large loads. But its very cleverly designed and will take more than you think it will.
- −
- If the top drawer is lowered it makes the cleaning tool hit large plates on the lower basket.
Published on: 23 December 2016


text: I've narrowed my search down to either the P229 Enhanced Elite or SAS Gen 2 both in 40 caliber. Today I looked at guns at Buds and I saw them selling a P229 SAS Gen 2 with a Tac Rail for $863. Since they give the Sig model # as E29-40-SAS2B I assume it's not a rail but I want to make sure before giving them my money. I called their CS and the guy there said that as far as he could tell it did have a rail. I would appreciate your thoughts.


text:
Poverty, Wealth, and Health Care Utilization: A Geographic Assessment
- First Online:
DOI: 10.1007/s11524-012-9689-3
- Cite this article as:
- Cooper, R.A., Cooper, M.A., McGinley, E.L. et al. J Urban Health (2012) 89: 828. doi:10.1007/s11524-012-9689-3
- Citations
- 2.6k Downloads
Geographic variation has been of interest to both health planners and social epidemiologists. However, while the major focus of interest of planners has been on variation in health care spending, social epidemiologists have focused on health; and while social epidemiologists have observed strong associations between poor health and poverty, planners have concluded that income is not an important determinant of variation in spending. These different conclusions stem, at least in part, from differences in approach. Health planners have generally studied variation among large regions, such as states, counties, or hospital referral regions (HRRs), while epidemiologists have tended to study local areas, such as ZIP codes and census tracts. To better understand the basis for geographic variation in hospital utilization, we drew upon both approaches. Counties and HRRs were disaggregated into their constituent ZIP codes and census tracts and examined the interrelationships between income, disability, and hospital utilization that were examined at both the regional and local levels, using statistical and geomapping tools. Our studies centered on the Milwaukee and Los Angeles HRRs, where per capita health care utilization has been greater than elsewhere in their states. We compared Milwaukee to other HRRs in Wisconsin and Los Angeles to the other populous counties of California and to a region in California of comparable size and diversity, stretching from San Francisco to Sacramento (termed "San-Framento"). When studied at the ZIP code level, we found steep, curvilinear relationships between lower income and both increased hospital utilization and increasing percentages of individuals reporting disabilities. These associations were also evident on geomaps. They were strongest among populations of working-age adults but weaker among seniors, for whom income proved to be a poor proxy for poverty and whose residential locations deviated from the major underlying income patterns. Among working-age adults, virtually all of the excess utilization in Milwaukee was attributable to very high utilization in Milwaukee's segregated "poverty corridor." Similarly, the greater rate of hospital use in Los Angeles than in San-Framento could be explained by proportionately more low-income ZIP codes in Los Angeles and fewer in San-Framento. Indeed, when only high-income ZIP codes were assessed, there was little variation in hospital utilization among California's 18 most populous counties. We estimated that had utilization within each region been at the rate of its high-income ZIP codes, overall utilization would have been 35 % less among working-age adults and 20 % less among seniors. These studies reveal the importance of disaggregating large geographic units into their constituent ZIP codes in order to understand variation in health care utilization among them. They demonstrate the strong association between low ZIP code income and both higher percentages of disability and greater hospital utilization. And they suggest that, given the large contribution of the poorest neighborhoods to aggregate utilization, it will be difficult to curb the growth of health care spending without addressing the underlying social determinants of health.
KeywordsPoverty Urban Health care Geographic variation
The test of our progress is not whether we add more to the abundance of those who have much. It is whether we provide enough for those who have too little.
Franklin D. Roosevelt, 1937
Geographic variation in health care has played a prominent role in shaping health care reform.1, 2, 3, 4, 5 It also has been a subject of interest to social epidemiologists.6, 7, 8, 9 However, there are important differences. First, the focus of interest among planners has been on variation in health care spending, while epidemiologists have focused principally on health. In addition, while planners have attributed some of the variation to differences in patients' burden of disease, they have attributed little to income, and much remains "unexplained."10, 11, 12, 13, 14, 15 In contrast, a broad body of epidemiological literature links low income to poor health and shorter life-spans.6, 7, 8,16, 17, 18, 19, 20, 21, 22, 23 From the perspective of social epidemiologists, poverty has a crushing effect on health.7,23
Why has poverty been so prominent in epidemiological studies and so out of view in studies of health care spending? One reason is that epidemiologists generally examine data at the level of individuals or within units more reflective of neighborhoods, such as census tracts or postal codes.24, 25, 26 In contrast, health planners have generally studied much larger units, such as counties, hospital referral regions (HRRs), or states.10,12,15,27 Aggregating populations in units as large and diverse as these has tended to blur the effects of social factors that are so readily apparent in units of smaller size.28, 29, 30, 31 As Krieger has warned, "Blot poverty from view and not only will we contribute to making suffering invisible but our understanding of disease etiology will be marred."7
We have attempted to gain insight into the basis for geographic variation in health care among larger units by disaggregating them into their constituent ZIP codes and census tracts and assessing hospital utilization, household income, and the prevalence of disability, both statistically and spatially. Our studies centered on two urban HRRs, Milwaukee and Los Angeles. The Milwaukee HRR is not only the most populace in Wisconsin but also the most racially and economically segregated, and it utilizes more health care per capita than other HRRs in the upper Midwest.27,32,33 The Los Angeles HRR is the most populous in the nation, and its rate of health care utilization is among the nation's highest.34 We compared Milwaukee to other Wisconsin HRRs and Los Angeles both to a region of comparable size, stretching from San Francisco to Sacramento (termed "San-Framento"), and other populace California counties. These studies revealed the profound contribution of the poorest ZIP codes of each region to geographic variation in health care utilization among regions.
ZIP code-level hospital data for Wisconsin were obtained from the Person-Level Data and Analysis Section of the State of Wisconsin Bureau of Health Information and were averaged for the years 1999 through 2002. The Milwaukee HRR was compared with seven others in Wisconsin: Appleton, Green Bay, La Crosse, Madison, Marshfield, Neenah, and Wausau. ZIP code level hospital data for California were obtained from the Patient Discharge Data File of the Office of Statewide Health Care Planning of the State of California for the year 2008. The Los Angeles region consisted of Los Angeles County, which overlaps the Los Angeles HRR. The San-Framento region encompassed San Francisco, Marin, San Mateo, Santa Cruz, Alameda, Contra Costa, Santa Clara, San Joaquin, Solano, and Sacramento counties. In both states, measurements of inpatient hospital days were limited to adults in acute care hospitals, exclusive of admissions related to pregnancy and child-birth. Admissions to skilled nursing, intermediate care, psychiatric, chemical dependency, and physical rehabilitation facilities were excluded. Only the Wisconsin and California portions of HRRs that extended into adjacent states were analyzed.
Population and income data at the ZIP code level were from the Census Bureau, either directly or through other sources.35 For studies in Wisconsin, census data for 2000 were also extracted from GeoLytics Professional (GeoLytics, Inc., East Brunswick, NJ). For studies in California, estimates for 2008 were obtained from Claritas PopFacts (Tetrad Computer Applications, Inc., Ferndale, WA). Data on poverty and disability from all causes by age were from the 2000 census, as complied by GeoLytics.
ZIP codes were excluded where the principal populations were university students, military personnel, or institutionalized populations or where the total adult population was less than 1,500. The final analyses included 107 ZIP codes in Milwaukee, 266 in Los Angeles, and 287 in San-Framento. The total adult population included was 1.44 million in Milwaukee, 7.48 million in Los Angeles, and 6.94 million in San-Framento. Data were mapped at the ZIP code level using Mapland Professional (Software Illustrated, Tracy CA) and at the census tract level using GeoLytics Long Form. Goodness of fit was calculated using the power trend function of Microsoft PowerPoint. Pearson correlation coefficients were calculated using the statistical tool of Microsoft Excel.
The Milwaukee HRR includes both the city of Milwaukee and a surrounding zone ten times as large in area but roughly equivalent in population. Health care spending in the Milwaukee HRR exceeds the rate in other parts of the upper-Midwest by approximately one third,27 a fact that has concerned Milwaukee's business community.32
Much of the increase in utilization in low-income ZIP codes was due to admissions for ambulatory care-sensitive conditions. Comparing utilization among adults ages 35–64 in the lowest vs. the highest income quartile of ZIP codes in Milwaukee County, the number of hospital days per 1,000 was greater by 347 % for heart failure, 266 % for diabetes, and 610 % for chronic obstructive pulmonary disease (COPD), increments similar to those observed previously in other urban areas.36, 37, 38
Seniors accounted for 17 % of the adult population but utilized 49 % of the total number hospital days. As observed among working-age adults, there were significant associations between MHI and both hospital utilization and disability among seniors, but these were weaker than among working-age adults. Accordingly, when hospital utilization was plotted against MHI (Figure 1b), the data were more scattered (r2 = 0.304) and the amplitude of differences in utilization between the poorest and richest ZIP codes was less than had been observed for working-age adults. ZIP code maps confirmed these statistical differences (Figure 2).
Two factors appeared to contribute to these differences between seniors and working-age adults. One was a difference in residential distribution. Census tract maps of seniors showed many low-income tracts within higher-income ZIP codes. Similarly, ZIP code maps showed the presence of low-income seniors in areas in which higher income working-age adults resided (Figure 2A, D). This was due, in part, to the distribution of nursing homes and senior housing. Indeed, Milwaukee's poverty core is devoid of nursing homes. Conversely, census tract maps showed clusters of high-income seniors in predominantly low-income ZIP codes, corresponding to the locations of luxury apartments in the central city. Thus, the high degree of income segregation that exists among working-age adults does not continue beyond age 65, and the patterns of hospital utilization followed accordingly.
Milwaukee's Poverty Corridor
Compared to other HRRs in Wisconsin, hospital utilization among working-age adults in Milwaukee was 38 % greater. However, when both Milwaukee's poverty corridor and the poorest ZIP codes of other HRRs were excluded, the difference decreased to 5.4 %. Because low-income seniors were distributed more widely (Figure 2C), excluding the poverty corridor had less effect on their utilization, but even among seniors, removing the corridor from consideration reduced the difference in utilization between Milwaukee and other Wisconsin HRRs from 44 % to 29 %. Thus among working-age adults, the poverty corridor accounted for almost all of the difference in utilization between Milwaukee and other HRRs, and it accounted for almost half among seniors.
Incremental utilization of hospital days above "affluent standard"
At rate of Affluent Rim
37.2 %
13.0 %
25.2 %
At rate of ZIP code incomes >$60,000
35.9 %
10.9 %
26.7 %
Los Angeles
At rate of ZIP code incomes >$75,000
44.7 %
35.3 %
45.0 %
30.7 %
37.2 %
At rate of ZIP code incomes >$75,000
26.0 %
22.0 %
33.1 %
11.2 %
18.1 %
7 California Countiesa
At rate of ZIP code incomes >$75,000
21.8 %
16.8 %
31.4 %
10.6 %
15.8 %
18 California Countiesb
At rate of ZIP code incomes >$75,000
28.3 %
23.7 %
36.6 %
19.3 %
26.3 %
Los Angeles
Because Los Angeles is so populous, we were able to study two cohorts of working-age adults, ages 18–44 and 45–64, and third cohort of seniors. Of these, the 45–64-year-old cohort displayed the strongest relationships between hospital utilization both income and disability, and the analyses that follow focus on this cohort.
Statistical Relationships
The 18–44-year-old cohort utilized approximately one third as many hospital days per 1,000 as the 45–64-year-old cohort, and accordingly the statistical relationship was weaker (r2 = 0.259), but the range of difference in utilization between the wealthiest and poorest ZIP codes was the same in both cohorts. Across both age cohorts, there was a strong relationship between the MHI of ZIP codes and the percent disabilities, which best fit a power function (r2 = 0.613). As in Milwaukee, increases in hospital utilization in low-income ZIP codes could be partially explained by higher rates of admission for ambulatory care sensitive conditions, which across all adult ages were twice as frequent in the area of highest poverty as in the other areas of Los Angeles.42
The relationship between income and hospital utilization was weakest among seniors (r2 = 0.220), as also observed in Milwaukee, and the magnitude of difference in utilization between the poorest and wealthiest deciles was half as great. When viewed on geomaps, both poverty and high rates of hospital utilization were distributed more broadly among seniors than among working-age adults. Reflecting this wider distribution, the ratio of seniors to 45–64 year olds in the lowest-income quintile was 20 % lower than in the highest. Finally, to an even greater degree than in Milwaukee, there were clusters of seniors in high-income census tracts within predominantly low-income ZIP codes in central Los Angeles. Thus, as in Milwaukee, ZIP codes proved to have less fidelity for assessing the economic characteristics of seniors than of working-age adults.
Mapping Los Angeles
Impact of Low-Income ZIP Codes
To assess the contribution of low-income ZIP codes to overall hospital utilization, we calculated the number of hospital days that would have been utilized in Los Angeles if the rates of utilization in all ZIP codes had been at the rate of those with MHIs above $75,000 (mean = $96,600), which included 5 % of the population. Had utilization everywhere been at this rate, it would have been 45 % less among 45–64 year olds, 31 % less among seniors and 37 % less overall (Table 1).
Thus, although separated by 2,000 miles and with populations that differed by a factor of five, the Milwaukee and Los Angeles HRRs proved to be more similar than different. Both had high degrees of income inequality; both had high rates of hospital utilization; and in both, the patterns of utilization followed underlying income differences, with the highest utilization in areas of greatest poverty and disability and the lowest in areas of greatest wealth and health.
San-Framento and California Counties
Because poverty in Los Angeles is not confined to a core area, it was not possible to carve-out a poverty corridor as in Milwaukee. Instead, we compared Los Angeles to a region in northern California (San-Framento) with a similar population but a lower rate of hospital utilization.
San-Framento is a 10-county area stretching from San Francisco to Sacramento. It has 90 % the population of Los Angeles and is principally urban, although its land mass is larger due to farming areas between urban centers. However, the sociodemographic characteristics of these two regions are quite different. San-Framento has fewer Hispanics (20 % vs. 45 % in Los Angeles), more non-Hispanic whites (50 % vs. 31 %) and more Asians (18 % vs. 12 %) but similar percentages of blacks (8 % vs. 9 %). MHI is one-third greater in San-Framento than in Los Angeles, and the poverty rate is one-third lower. Most important in terms of the current study, Medicare enrollees have been reported to use 40 % more hospital days in Los Angeles than in San-Framento,27 which is similar to the 39 % difference that we observed among seniors.
San-Framento vs. Los Ángeles
Despite these differences in sociodemographic characteristics and hospital utilization, the shapes of the curves relating MHI to hospital utilization were virtually identical in Los Angeles and San-Framento (Figure 5a, b), and the goodness of fit in San-Framento was also similar (r2 = 0.545). How do these similarities reconcile with the overall differences in utilization between the Los Angeles and San-Framento?
The explanation emerges from a comparison of Figure 5a, b, which shows data for the 45–64-year-old cohort. While the arcs that define the regressions in each were virtually identical, there were more low-income, high-utilization ZIP codes in Los Angeles (the shaded area in Figure 5a) and more high-income, low-utilization ZIP codes in San-Framento (the non-shaded area in Figure 5b). Across all ZIP codes, utilization among ages 45–64 in Los Angeles was 27 % greater than in San-Framento. However, when only those ZIP codes with MHIs >$75,000 were compared, it was only 4 % greater. Similarly, among 18–44 year olds, utilization across all ZIP codes was 24 % greater in Los Angeles than in San-Framento but only 3 % greater in high-income ZIP codes, and among seniors, these differences were 39 % and 9 %. Thus, differences in aggregate hospital utilization between Los Angeles and San-Framento appear to be due principally to differences in the relative numbers of low-income ZIP codes.
Even though San-Framento had fewer low-income ZIP codes than Los Angeles, these contributed substantially to overall utilization (Table 1). Had utilization throughout San-Framento been at the rate of its highest-income ZIP codes, the overall rate would have been 18 % less, half the decrement in Los Angeles but substantial.
California Counties
The contribution of low income to utilization was assessed in the seven counties other than Los Angeles included in Figure 7, as was previously done for Milwaukee, Los Angeles, and San-Framento (Table 1). Had utilization in each of these counties been at the rate of its wealthiest ZIP codes, there would have been 31 % fewer hospital days among 45–64 year olds and 16 % fewer among all adults. We extended this analysis to the 18 most populace California counties (from a total of 59), whose combined adult population of 24.8 million represents 85 % of the total adult population of California. Had utilization in each of these been at the rate of its affluent ZIP codes, there would have been 37 % fewer hospital days among 45–64 year olds and 26 % fewer among all adults (Table 1). Thus, the increased utilization in low-income ZIP codes throughout the most populace counties of California proved to be a major contributor to overall hospital utilization and to account for most of the observed variation in utilization among them.
In Milwaukee, Los Angeles, and San-Framento, per capita rates of both hospital utilization and disability were steeply increased in ZIP codes with lower MHIs.
The much higher rates of hospital utilization in Milwaukee as compared with other Wisconsin HRRs were largely explained by the very high rates in Milwaukee's dense poverty corridor.
Similarly, the much higher rates of utilization in Los Angeles as compared with San-Framento could be explained by a greater proportion of low-income ZIP codes in Los Angeles and a greater proportion of high-income ZIP codes in San-Framento, while the underlying statistical relationships between income and utilization were the same in both.
Among eight populace California counties that had both high-income and low-income ZIP codes, the wide variation in utilization that was observed overall was further exaggerated when only low-income ZIP codes were compared but was virtually absent when only high-income ZIP codes were considered.
In each region, the results of ZIP code analyses were statistically stronger and the impact of low income was quantitatively greater among working-age adults than among seniors.
These weaker results for seniors appeared to be due both to the wider residential distribution of seniors with respect to income and to weaker associations between low income and chronic poverty among seniors than among working-age adults.
If hospital utilization within the various regions and counties studied had been at the rate of the high-income ZIP codes in each, it would have been approximately 35 % less among working-age adults, 20 % less among seniors, and 30 % less overall.
Taken together, these studies demonstrate the profound association between poverty and health care utilization.
Units of Analysis
A central purpose of this study was to analyze data at the micro-level (ZIP codes and census tracts) in order to understand variation in health care utilization among units of macro-size (HRRs and counties) within the broader frameworks of their states.43, 44, 45 We compared the Milwaukee HRR with others in Wisconsin, the Los Angeles HRR with both the "San-Framento" region and other counties in California, and various California counties with each other. By disaggregating these larger units into their constituent ZIP codes, we were able to discern the effects of sociodemographic factors operating at the level of "neighborhoods" on aggregate measures at the regional level.24,25,46, 47, 48
Poverty and Geographic Variation
We chose to study Milwaukee and Los Angeles because they have been singled out as high utilization HRRs, Milwaukee in relation to the upper-Midwest and Los Angeles nationally. In these two regions and in San-Framento, we found strong, steeply inverse, curvilinear relationships between income and hospital utilization, reminiscent of the classic relationship between income and mortality,49 and similar relationships between income and disability. Among working-age adults, the magnitude of difference between the poorest and richest deciles of population was approximately 3-fold.
Because Milwaukee is so highly segregated, most low-income ZIP codes were clustered in a narrow poverty corridor, which also proved to be the zone of highest hospital utilization. While hospital utilization among working-age adults was one third higher in the Milwaukee HRR than in other HRRs in Wisconsin, utilization in the portion of the Milwaukee HRR outside of the corridor was within 5 % of other Wisconsin HRRs.
Los Angeles presented a greater challenge, but the conclusions were the same. Hospital utilization in Los Angeles was greater than in San-Framento, but this was simply because Los Angeles had a higher proportion of low-income, high-utilization ZIP codes while San-Framento had proportionately fewer, while utilization at comparable levels of income was the same. However, because the regression arcs in Figure 5 transcend differences in utilization of 3-fold and more, many-fold greater than the 25–35 % differences in aggregate utilization between these two regions, small shifts in the proportion of low-income ZIP codes were sufficient to account for the aggregate differences observed. Similarly, variation in hospital utilization among California counties virtually disappeared when only their high-income ZIP codes were considered.
While low income proved to be a strong correlate of hospital utilization among working-age adults, it was a weaker correlate among seniors. Similar discordance between the explanatory power of income in working-age adults and seniors has been noted previously in studies of disease prevalence and mortality, not only in the USA but in Canada, Europe, Japan, and elsewhere.8,50, 51, 52
One reason for this discordance, which was apparent on geomaps, was an out-migration of low-income seniors from the poorest ZIP codes into surrounding areas of higher income and, to a lesser extent, an in-migration of wealthy seniors into high-income enclaves within low-income ZIP codes. The former was also inferred from the lower ratio of seniors to 45–64 year olds in low-income ZIP codes than in high-income ones and is accounted for, at least in part, by the location of senior housing and nursing homes. The latter is related to the location luxury apartments within inner-city ZIP codes. These phenomena, which were most apparent at the census tract level, resulted in greater economic heterogeneity at the ZIP code level for seniors than for working-age adults. Previous studies indicate that such movements are not random with respect to health but, rather, that seniors migrating from lower to higher-income areas have higher medical expenditures, while wealthier seniors migrating into lower-income ZIP codes have lower expenditures.53 Thus, while ZIP code income appears to provide a valid representation of the economic status of working-age adults, it is a much poorer proxy among seniors.
A second reason for discordance relates to the increase proportion of seniors with low-income as compared with working-age adults. While some of these seniors were poor earlier in life and experienced durable and often multigenerational poverty,21, 22, 23,39, 40, 41 others newly acquired low income after a lifetime of higher income and better health. Assessing poverty has been a challenge at all ages, but it is a particular problem at older ages.54, 55, 56 Indeed, some have suggested that wealth or education may be better indices.53,54,57,58
This presents an enigma. While there were strong associations between income and hospital utilization in the 45–64-year-old cohort, these associations were much weaker and of lesser magnitude in the next decade. It seems implausible that such income-related differences would suddenly diminish after age 65. Rather, it is likely that aggregation of dissimilar income groups within ZIP codes and uncertainty over the meaning of low income over age 65 created ambiguities. The aggregation error becomes compounded when ZIP codes are further aggregated into counties or HRRs, further masking income-related differences.11, 12, 13, 14, 15 Yet, it is the Medicare population that has been the principal object of study in defining geographic variation in health care, and it is from such studies that the notion of "unexplained" variation was derived.10, 11, 12, 13, 14, 15,27,59 Our research suggests that much of this previously "unexplained" variation simply reflects the inability to adequately measure the contribution of low income to health care utilization in the Medicare population, even at the ZIP code level and especially at the level of HRRs.
Health and Wealth
A wealth of literature has documented the association between low income and poorer health. Parameters such as disease prevalence, disability and mortality have been found to be 2-fold to 3-fold greater in the poorest vs. the richest segments of the population, both in the US and other developed countries.50,60, 61, 62 Fewer studies have examined the association between lower income and greater health care utilization, but some exist. These have shown relationships between low income and higher health care expenditures,14,63, 64, 65 more hospital admissions,2,66 more preventable hospitalizations,36, 37, 38, 39,42,67 and more out-patient visits.68,69 Low income has also been linked to lower educational attainment, which has separately been shown to correlate with increased disease prevalence, shorter life expectancy, and higher Medicare expenditures.16,49,50,70,71
Table 1 lists the differences in hospital utilization that would have occurred within various regions if utilization rates in each ZIP code had been at the level of the region's wealthiest ZIP codes. Taken together, these differences account for approximately 35 % of the total number of hospital days among working-age adults, 20 % among seniors, and 30 % among all adults. The 20 % increment that we observed among seniors is similar to increments in aggregate spending above the expenditure level of high-income Medicare enrollees reported elsewhere.14,63,64 Similarly, the 30 % increment across the entire adult population is similar to increments in hospital admissions, preventable hospitalizations, and expenditures attributable to lower income in previous studies.65, 66, 67 It also is similar to Marmot's estimate that one third of spending in the British National Health Service (NHS) results from income inequality.72
While low-income patients consume more services today, that was not always the case. Forty years ago, they consumed less, both through Medicare and the NHS.73, 74, 75 It was not until the early 1980s that parity was reached, and health care spending among low-income patients has risen disproportionately ever since.14,48,53,63,64,76 Yet, this added spending for the poor is still not viewed as commensurate with their burden of illness,65,77 and despite it, the gap in life expectancy between rich and poor continues to widen.70,78
Our studies have several methodological limitations. First, they were derived from studies of predominantly urban regions within Wisconsin and California and may not apply equally to other states or the nation as a whole, although they are consistent with many previous reports of poorer health and greater utilization among the poor. Second, they were confined to adults in acute-care hospitals and may not accurately represent differences in total health care utilization, although the increments in our study are similar to previously reported increments in both inpatient and outpatient care among low-income patients.36, 37, 38,66, 67, 68, 69,79
Third is the issue of homogeneity. Census tracts encompass relatively homogeneous populations, but ZIP codes were created for postal routes. While they generally provide valid measures,24,25,31 that ability depends on their homogeneity with respect to the characteristics studied. This proved to be greatest in Milwaukee, one of the most segregated cities in the nation, but wealth and poverty were more comingled in Los Angeles, San-Framento, and elsewhere. In addition, although our studies focused on areas of higher population density, ZIP codes with fewer than 5,000 adults comprised 5 % of all ZIP codes studied in Los Angeles, 9 % in San-Framento, 17 % in other California counties, 25 % in the Milwaukee HRR, and 75 % elsewhere in Wisconsin. The resulting errors were magnified among 18–44 year olds, whose hospital admission rates were low, and among seniors, who account for fewer than 20 % of adults and who are more dispersed relative to income. Thus, although disaggregation of counties and HRRs into ZIP codes resolved many of the errors of aggregation that existed in larger units, the problem persisted even in units as small as ZIP codes.
Our studies have several important implications for health and social policy. First, they demonstrate the strong association between poverty and increased health care utilization. This should not be surprising, since poverty and its associated social determinants are known to be linked to poor health status. Our study connects these two realities and documents the large magnitude of added health care utilization that results.
It follows that, since poverty is distributed geographically, geographic differences in health care utilization are largely the result of geographic differences in poverty. That proved to be the case in our studies. Indeed, when only ZIP codes with higher degrees of wealth were considered, there was very little variation at all, which serves to emphasize the need to disaggregate large units of analysis, such as HRRs, if differences in health care utilization among them are to be understood.
Finally, our studies demonstrate that the relationship between poverty and health care utilization, which is so evident among working-age adults, is partially obscured among retirees. This suggests caution in interpreting studies of geographic variation in health care among the Medicare population, which have played such a prominent role in shaping policy.
As the USA seeks to slow the growth of health care spending, it will be important not to conflate the greater amounts of health care utilized by low-income patients with inefficiencies in clinical practice. Even with continued efforts to increase clinical efficiency, it seems unlikely that the inexorable growth in health care spending can abate as long as income inequality continues to widen. The real "inefficiency" is the existence of a population that has not been adequately nurtured in childhood nor given the tools to be healthy adults.39, 40, 41 Poverty is not only an unsustainable failure of social justice. It creates an unsustainable financial burden for our health care system. Accepting this reality is a necessary first step. Confronting it should be our Nation's highest priority.
Open Access
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text:
More young people are planning to set up their own business empires in the wake of the economic crisis, new research suggests.
Problems finding work has led to an increasingly "entrepreneurial mood" among young people, the Prince's Trust said.
The charity's study of more than 1,600 people aged 16 to 30 found nearly a third (30%) believed they would be self-employed in the future.
One in four (25%) said they expected to be their own boss within the next five years.
Despite just 5% of 16 to 30-year-olds in the UK currently being self-employed, more than a quarter (27%) of those surveyed claimed they were "increasingly" thinking of setting up in business.
Meanwhile, more than one in four unemployed young people (27%) said they would rather try to set up their own business than continue to seek work in today's competitive job market, according to the study with the Royal Bank of Scotland (RBS).
Martina Milburn, chief executive of The Prince's Trust, said: "This research reveals an increasingly entrepreneurial mood among young people.
"Five years on from the start of the recession, youth unemployment remains high and many are seeing self-employment as a way to break the cycle of joblessness.
"It is critical we nurture young people's passion for business and invest in the next generation."
Figures from the Office for National Statistics (ONS) show there were 842,000 self-employed 18 to 34-year-olds from April to June last year, compared to 771,000 in April to June 2008 - a 9% increase.
The YouGov poll found 43% of young people had already made money from entrepreneurial activity such as selling their own product or working on a freelance basis.
Professor Michael Hay, from London Business School, said: "Traditionally Britain has lagged behind other countries in terms of the number of young entrepreneurs, but today's report suggests that young people's attitudes to self-employment are changing.
"It is important that the next generation of young entrepreneurs get the support they need from organisations like The Prince's Trust.
"In the current climate, helping young people to beat unemployment and set up businesses that employ other people can only be a good thing for the UK economy."
The poll also found that although 42% of young people have considered setting up in business, many are being held back due to worries about funding.
More than half (59%) said that a lack of cash would prevent them from setting up in business, while a third (33%) claimed that having a mentor would make them more likely to consider self-employment.
Chris Sullivan, chief executive of RBS's corporate banking division, said: "It is of particular importance in these tough economic times, to provide support for some of the most disadvantaged young people in the country.
"Through our ongoing partnership with The Prince's Trust we've seen first-hand the life-changing results."
The research also found 44% of self-employed young people feel more confident about their business than this time last year, while 40% expect to see business improve in the next six months.
The poll included 278 self-employed young people and 271 who were not in education, employment or training (NEET).
For more information about the Prince's Trust's Enterprise programme, visit www.princes-trust.org.uk/30enterprise.
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