text:
Why Government Spending Does Not Stimulate Economic Growth: Answering the Critics
Talking Points
- 1. The idea that government spending stimulates the economy has a long history of failure.
- 2. If deficit spending represented "new" dollars injected in the economy, last year's $1.2 trillion budget deficit would have already overheated the economy even before the stimulus bill added an additional $200 billion to the deficit.
- 3. Spending-stimulus advocates claim that Congress can "inject" new money into the economy, increasing demand and therefore production. Yet every dollar Congress injects into the economy must first be taxed or borrowed out of the economy. No new spending power is created. It is merely redistributed from one group of people to another.
- 4. Even money transferred from "savers" to "spenders" does not create new spending in an economy. The financial system already converts one person's savings into another person's spending.
- 5. The only way to increase economic growth is by increasing productivity and the labor supply.
Proponents of President Barack Obama's $787 billion stimulus bill continue to insist that the massive government bailout played a decisive role in moving the economy out of the recession. Yet assuming no destructive government actions, the economy's self-correction mechanism was widely expected to move the economy out of recession in 2009 anyway. With a parade of "stimulus" bills the past two years (going back to President George W. Bush's tax rebate in early 2008), it was entirely predictable that some would link the expected end of the recession to whichever stimulus bill happened to come last.
Indeed, President Obama's stimulus bill failed by its own standards. In a January 2009 report, White House economists predicted that the stimulus bill would create (not merely save) 3.3 million net jobs by 2010. Since then, 3.5 million more net jobs have been lost, pushing the unemployment rate above 10 percent.[1] The fact that government failed to spend its way to prosperity is not an isolated incident:
- During the 1930s, New Deal lawmakers doubled federal spending--yet unemployment remained above 20 percent until World War II.
- Japan responded to a 1990 recession by passing 10 stimulus spending bills over 8 years (building the largest national debt in the industrialized world)--yet its economy remained stagnant.
- In 2001, President Bush responded to a recession by "injecting" tax rebates into the economy. The economy did not respond until two years later, when tax rate reductions were implemented.
- In 2008, President Bush tried to head off the current recession with another round of tax rebates. The recession continued to worsen.
- Now, the most recent $787 billion stimulus bill was intended to keep the unemployment rate from exceeding 8 percent. In November, it topped 10 percent.[2]
Undeterred by these repeated stimulus failures, President Obama is calling for yet another stimulus bill.[3] There is every reason to expect another round to fail as miserably as the past ones, and it would bury the nation deeper in debt.
The Stimulus Myth
The economic theory behind the stimulus builds on the work of John Maynard Keynes eight decades ago. It begins with the idea that an economic shock has left demand persistently and significantly below potential supply. As people stop spending money, businesses pull back production, and the ensuing vicious circle of falling demand and production shrinks the economy.
Keynesians believe that government spending can make up this shortfall in private demand. Their models assume that--in an underperforming economy--government spending adds money to the economy, taxes remove money from the economy, and so the increase in the budget deficit represents net new dollars injected. Therefore, it scarcely matters how the dollars are spent. Keynes is said to have famously asserted that a government program that pays people to dig and refill ditches would provide new income for those workers to spend and circulate through the economy, creating even more jobs and income.
The Keynesian argument also assumes that consumption spending adds to immediate economic growth while savings do not. By this reasoning, unemployment benefits, food stamps, and low-income tax rebates are among the most effective stimulus policies because of their likelihood to be consumed rather than saved.
Taking this analysis to its logical extreme, Mark Zandi of Economy.com has boiled down the government's influence on America's broad and diverse $14 trillion economy into a simple menu of stimulus policy options, whereby Congress can decide how much economic growth it wants and then pull the appropriate levers. Zandi asserts that for each dollar of new government spending: temporary food stamps adds $1.73 to the economy, extended unemployment benefits adds $1.63, increased infrastructure spending adds $1.59, and aid to state and local governments adds $1.38.[4] Jointly, these figures imply that, in a recession, a typical dollar in new deficit spending expands the economy by roughly $1.50. Over the past 40 years, this idea of government spending as stimulus has fallen out of favor among many economists. As this paper shows, it is contradicted both by empirical data and economic logic.
The Evidence is In
Economic data contradict Keynesian stimulus theory. If deficits represented "new dollars" in the economy, the record $1.2 trillion in FY 2009 deficit spending that began in October 2008--well before the stimulus added $200 billion more[5] --would have already overheated the economy. Yet despite the historic 7 percent increase in GDP deficit spending over the previous year, the economy shrank by 2.3 percent in FY 2009.[6] To argue that deficits represent new money injected into the economy is to argue that the economy would have contracted by 9.3 percent without this "infusion" of added deficit spending (or even more, given the Keynesian multiplier effect that was supposed to further boost the impact). That is simply not plausible, and few if any economists have claimed otherwise.
And if the original $1.2 trillion in deficit spending failed to slow the economy's slide, there was no reason to believe that adding $200 billion more in 2009 deficit spending from the stimulus bill would suddenly do the trick. Proponents of yet another stimulus should answer the following questions: (1) If nearly $1.4 trillion budget deficits are not enough stimulus, how much is enough? (2) If Keynesian stimulus repeatedly fails, why still rely on the theory?
This is no longer a theoretical exercise. The idea that increased deficit spending can cure recessions has been tested repeatedly, and it has failed repeatedly. The economic models that assert that every $1 of deficit spending grows the economy by $1.50 cannot explain why $1.4 trillion in deficit spending did not create a $2.1 trillion explosion of new economic activity.
Why Government Spending Does Not End Recessions
Moving forward, the important question is why government spending fails to end recessions. Spending-stimulus advocates claim that Congress can "inject" new money into the economy, increasing demand and therefore production. This raises the obvious question: From where does the government acquire the money it pumps into the economy? Congress does not have a vault of money waiting to be distributed. Every dollar Congress injects into the economy must first be taxed or borrowed out of the economy. No new spending power is created. It is merely redistributed from one group of people to another.[7]
Congress cannot create new purchasing power out of thin air. If it funds new spending with taxes, it is simply redistributing existing purchasing power (while decreasing incentives to produce income and output). If Congress instead borrows the money from domestic investors, those investors will have that much less to invest or to spend in the private economy. If they borrow the money from foreigners, the balance of payments will adjust by equally raising net imports, leaving total demand and output unchanged. Every dollar Congress spends must first come from somewhere else.
For example, many lawmakers claim that every $1 billion in highway stimulus can create 47,576 new construction jobs. But Congress must first borrow that $1 billion from the private economy, which will then lose at least as many jobs .[8] Highway spending simply transfers jobs and income from one part of the economy to another. As Heritage Foundation economist Ronald Utt has explained, "The only way that $1 billion of new highway spending can create 47,576 new jobs is if the $1 billion appears out of nowhere as if it were manna from heaven."[9] This statement has been confirmed by the Department of Transportation[10] and the General Accounting Office (since renamed the Government Accountability Office),[11] yet lawmakers continue to base policy on this economic fallacy.
Removing water from one end of a swimming pool and pouring it in the other end will not raise the overall water level. Similarly, taking dollars from one part of the economy and distributing it to another part of the economy will not expand the economy.
University of Chicago economist John Cochrane adds that:
First, if money is not going to be printed, it has to come from somewhere. If the government borrows a dollar from you, that is a dollar that you do not spend, or that you do not lend to a company to spend on new investment. Every dollar of increased government spending must correspond to one less dollar of private spending. Jobs created by stimulus spending are offset by jobs lost from the decline in private spending. We can build roads instead of factories, but fiscal stimulus can't help us to build more of both. This form of "crowding out" is just accounting, and doesn't rest on any perceptions or behavioral assumptions.
Second, investment is "spending" every bit as much as is consumption. Keynesian fiscal stimulus advocates want money spent on consumption, not saved. They evaluate past stimulus programs by whether people who got stimulus money spent it on consumption goods rather than save it. But the economy overall does not care if you buy a car, or if you lend money to a company that buys a forklift.[12]
Government spending can affect long-term economic growth, both up and down. Economic growth is based on the growth of labor productivity and labor supply, which can be affected by how governments directly and indirectly influence the use of an economy's resources. However, increasing the economy's productivity rate--which often requires the application of new technology and resources-- can take many years or even decades to materialize. It is not short-term stimulus.[13]
In fact, large stimulus bills often reduce long-term productivity by transferring resources from the more productive private sector to the less productive government. The government rarely receives good value for the dollars it spends. However, stimulus bills provide politicians with the political justification to grant tax dollars to favored constituencies. By increasing the budget deficit, large stimulus bills eventually contribute to higher interest rates while dropping even more debt on future generations.
Answering the Critics
Despite the foregoing evidence, some analysts maintain that governments can spend their way out of recession. Their common objections are addressed below:
Critics' Objection No. 1: People Are Saving Instead of Spending, and banks Are Not Lending. By Borrowing and Spending these "Idle Savings," Government Can Circulate More Money Through the Economy.
This is the most common defense of government stimulus cited by policymakers. Indeed, among proponents of government spending there is a strong focus on whether people are spending or saving, with the implication that spending circulates through the economy while savings effectively drop out.
But savings do not drop out of the economy. Nearly all people put their savings in: (1) banks, which quickly lend the money to others to spend; (2) investments in stocks and bonds; or (3) personal debt reduction. In each of these situations, the financial system transfers one person's savings to someone else who can spend it. So all money is quickly spent regardless of whether it was initially consumed or saved. The only savings that drop out of the economy are those hoarded in mattresses and safes.
Some contend that recession-weary banks are hoarding savings well beyond the legal minimum reserves. Yet even when banks hesitate to lend their deposits, they invest them in Treasury bills to keep them circulating through the economy and earning interest.[14] In fact, the federal funds market--where banks lend each other any excess cash at the end of the day--exists because banks refuse to sit on unused cash even overnight. Thus, even in recessions, one person's savings quickly finances another person's spending.[15]
Advocates of the "idle savings" theory fail to specify the location of all these newly hoarded piles of dollar bills they believe have been shielded from spending in the financial system. Even more telling, they also fail to explain--even if there were massive amounts of idle savings--how the federal government is supposed to acquire them for injection as new spending. After all, even if individuals, businesses, and banks were hoarding dollar bills in mattresses and safes, why would they suddenly lend them to the government to finance a stimulus bill? The very idea of hoarding dollars suggests these people and businesses would not trust the financial system, and would be quite unlikely to attend the next Treasury bill auction.[16]
Stimulus spending advocates must be able to show that nearly all money lent to Washington would have otherwise sat idle in mattresses and bank safes. Otherwise, Washington is merely a middleman transferring purchasing power from one part of the economy to another--and the justification for government spending as stimulus collapses.
Critics' Objection No. 2: Borrowing from Foreign Nations Can Provide "New" Money for the Economy.
Accepting that domestic borrowing is no free lunch, some analysts have asserted that foreign borrowing can inject new dollars into the economy. However, these nations must acquire American dollars before they can lend them back to Washington. Foreign countries can acquire American dollars by either:
- Attracting American investments in their country. In that instance, the dollars leaving America match the dollars lent back to America. The net flow of saving circulating through the U.S. economy does not increase.
- Selling goods and services to Americans and receiving American dollars in return. For the United States, these imports raise the trade deficit and thus reduce domestic demand. The government's subsequent borrowing back and spending of these dollars merely offsets the increased trade deficit.
In either situation, American dollars must first leave the country before they can be lent back into the U.S. economy. The balance of payments between America and other nations must net zero. Consequently, government spending funded from foreign borrowing does not provide stimulus.
Critics' Objection No. 3: Government Spending Has a Multiplier Effect That Allows the Money to Re-circulate Through the Economy Multiple Times.
This point is correct but irrelevant to the question of stimulus. Yes, $100 in unemployment benefits can be spent at a grocery store, which, in turn, can use that $100 to pay salaries and support other jobs. The total amount of additional economic activity will be well above $100; but because government borrows the $100, that same money is now unavailable to the private sector--which would have spent the same $100 with the same multiplier effect.
Consider a more comprehensive example. A family might normally put its $10,000 savings in a CD at the local bank. The bank would then lend that $10,000 to the local hardware store, which would then recycle that spending around the town, supporting local jobs. Suppose that the family instead buys a $10,000 government bond that funds the stimulus bill. Washington spends that $10,000 in a different town, supporting jobs there instead. The stimulus has not created new spending, jobs,
or a multiplier effect. It has merely moved them to a new town.
The mistaken view of fiscal stimulus persists because people can easily observe the factories and people put to work with government funds. By contrast, people cannot easily observe the jobs that would have been created or factories used elsewhere in the economy with those same dollars had they not been lent to Washington.
In his 1848 essay, "What Is Seen and What Is Not Seen," French economist Frederic Bastiat termed this the "broken-window fallacy," a reference to a local myth that breaking windows would stimulate the economy by creating window-repair jobs. In reality, the window-repair spending comes out of funds that otherwise would have been spent (and created jobs) elsewhere in town. Today, the broken-windows fallacy explains why thousands of new stimulus jobs are not improving the total employment picture.
Critics' Objection No. 4: During a Recession, Government Spending Can Put Unused Resources to Work.
This restates the overall spending fallacy. Yes, government spending can put under-utilized factories and individuals to work--but only by idling other resources in whatever part of the economy supplied the funds. If adding $1 billion would create 40,000 jobs in one depressed part of the economy, then losing $1 billion will cost roughly the same number of jobs in whatever part of the economy supplied Washington with the funds. It is a zero-sum transfer regardless of whether the unemployment rate is 5 percent or 50 percent.
Critics' Objection No. 5: Government Reports Show That the Stimulus Has Already Created or Saved 640,000 New Jobs.
According to a White House survey, businesses have used much of the $200 billion in stimulus dollars distributed thus far to hire or retain 640,000 workers. These figures have been ridiculed for their absurdity, such as reporting $6.4 billion spent in congressional districts that do not exist, and the survey's assertion that a single lawnmower purchase in Arkansas saved or created 50 jobs.[17]
Setting aside these inaccuracies, this jobs figure is not surprising. Businesses that receive large government grants would be expected to expand and hire more workers. However, this ignores half of the equation. If injecting $200 billion into the economy supports 640,000 jobs, how many jobs were first lost by borrowing that $200 billion from the economy?
The White House says zero. The White House job numbers assume that all $200 billion is new and supports jobs that would not otherwise exist. But that could be true only if the private sector would have otherwise hoarded the entire $200 billion in safes and mattresses, where it could not be consumed, invested, or deposited in banks for investment spending--but instead turned the entire $200 billion over to the government.
When dollars are transferred from one part of the economy to another, jobs will transfer accordingly. The White House's single-entry bookkeeping ignores the part of the economy that financed all these jobs. Not surprisingly, the nation's overall unemployment rate has continued to rise.
Critics' Objection No. 6: Government Should Subsidize Consumption, Which Represents 60 Percent of the Economy.
This confuses the creation of income with its application. All income is applied somewhere in the economy: most on private consumption, some on private investment (converted from savings via the financial system), and some by government (taxed or borrowed out of consumption and investment). In the short run, the distribution of spending does not affect the total amount spent.[18] The only way to increase consumption spending immediately is to take it from investment or government spending.
Declining consumption means that either: (A) more income is diverted into investment or government spending (which is zero-sum in the short run); or (B) less income is created overall, which typically leads to less spending across all categories. For the latter situation, the solution is to create incentives for productivity that create more wealth and income for people to spend across all categories.
What Government Policies Do Affect Growth?
While government spending merely displaces private spending dollar-for-dollar in the short run, it can have a long-term impact on productivity. Similarly, tax policy can also affect productivity and growth.
Government Spending Can Have a Long-Term Impact.
Although it cannot immediately increase economic growth, government spending can have a long-term impact. Economic growth results from producing more goods and services (not from redistributing existing income), and that requires productivity growth and growth in the labor supply. Productivity growth requires some combination of: (1) a more educated and efficient workforce; (2) more private physical capital, such as factories and tools; (3) increased use of new technology; (4) more public infrastructure like roads and other utilities; and (5) markets to set prices and rule of law to enforce contracts. Government's effect on economic growth is determined by its effect on productivity and labor supply.
Only in the rare instances where the private sector fails to provide those inputs in adequate amounts is government spending necessary. Government spending on education, physical infrastructure, and research and development, for instance, could increase long-term productivity rates--but only if government invests more competently than businesses, nonprofit organizations, and private citizens would have if those investment dollars had stayed in the private sector. Historically, governments have rarely outperformed the private sector in generating productivity growth. Thus, mountains of academic studies show that government spending typically reduces long-term economic growth.[19]
Even most programs that could increase productivity would take too long to be considered stimulus. Education spending will not affect productivity until the student has graduated and entered the workforce (and it is not clear that additional spending improves productivity anyway). New roads, highways, and bridges can take more than a decade to complete before they can transport people and goods. These policies should not be considered short-term stimulus spending.
Tax Policy's Strong Effect on Economic Growth.
Taxes can affect growth, although not for the reason many people believe. Many tax cutters commit the same fallacy as do government spenders when asserting that tax cuts spur economic growth by "putting spending money in people's pockets." Similar to government spending, the tax-cut cash does not fall from the sky. It comes from reduced investment and a higher trade deficit (if financed by budget deficits) or from government spending (if offset by spending cuts).
However, certain tax cuts can add substantially to productivity. As stated above, economic growth requires that businesses produce increasing amounts of goods and services, and that requires consistent business investment and a growing, productive workforce. Yet high marginal tax rates-- defined as the tax on the next dollar earned--create a disincentive to engage in those activities. Reducing marginal tax rates on businesses and workers will increase incentives to work, save, and invest. These incentives encourage more business investment, a more productive workforce by raising the after-tax returns to education, and more work effort, all of which add to the economy's long-term capacity for growth.
Thus, not all tax cuts are created equal. The economic impact of a tax cut depends on how much it alters behavior to encourage labor supply or productivity. This productivity standard is the same as the one applied to government spending in the previous section.
Tax rebates fail to increase economic growth because they are not associated with productivity or work effort. No new income is created because no one is required to work, save, or invest more in order to receive a rebate. In that sense, rebates that write each American a check are economically indistinguishable from government spending programs. In fact, the federal government treats rebate checks as a "social benefit payment to persons."[20] They represent another feeble attempt at creating new purchasing power out of thin air rather than focusing on productivity.
Tax rebates in 1975, 2001, and 2008 all failed to create economic growth. By contrast, large reductions in marginal tax rates in the 1920s, 1960s, and 1980s were each followed by large surges in economic growth.[21] More recently, the 2003 tax-rate reductions immediately reversed the job losses, sinking stock market, declining business investment, and sluggish economic growth rates that had followed the 2000 recession.[22] These gains continued until unrelated economic developments brought the most recent recession in December 2007.[23]
All recessions eventually end. The U.S. economy has proved resilient enough to eventually overcome even the most misguided economic policies of the past. Yet it would be fallacious to credit the stimulus bill for any economic recovery that inevitably occurs in the future. According to Keynesian theory, a $1.4 trillion budget deficit should have immediately overheated the economy. According to the White House, the stimulus should have created 3.3 million net jobs. Instead, the economy remained in recession and 3.5 million more net jobs were lost. By every reasonable standard, the stimulus failed.
H. L. Mencken once wrote that "complex problems have simple, easy to understand, wrong answers." He may as well have been referring to the idea that Congress can foster economic growth simply by "injecting" money into the economy. Government stimulus spending is not a magic wand that creates jobs and income. Repeated failed attempts in America and abroad have shown that governments cannot spend their way out of recessions. Focusing on productivity growth builds a stronger economy over the long term--and leaves America better prepared to handle future economic downturns.
Brian M. Riedl is Grover M. Hermann Fellow in Federal Budgetary Affairs in the Thomas A. Roe Institute for Economic Policy Studies at The Heritage Foundation.
[1] While the Obama Administration rhetorically emphasizes that it will "save or create" 3.5 million jobs, a January 2009 report by its economic team assumed creation of 3.3 million new jobs. The report projected that, through fall 2010, the baseline economy would lose 0.4 million net jobs (from 134.3 million to 133.9 million), while the economy with the stimulus would instead add 3.3 million net jobs (from 134.3 million to 137.6). See Christina Romer and Jared Bernstein, "The Job Impact of the American Recovery and Reinvestment Plan," January 9, 2009, p. 4, at http://otrans.3cdn.net/ 45593e8ecbd339d074_l3m6bt1te.pdf (December 7, 2009). Despite enactment of the stimulus, the number of jobs had fallen to 130.8 million through October 2009.
[2] For more on the New Deal, see William W. Beach and Ken McIntyre, "Get Over It: New Deal Didn't Do the Job," Heritage Foundation Commentary, January 21, 2009, at http://www.heritage.org/Press/Commentary/ed012109f.cfm . For more on Japan's failed stimulus experiment, see Derek Scissors and J. D. Foster, "Two Lost Decades? Why Japan's Economy Is Still Stumbling and How the U.S. Can Stay Upright," Heritage Foundation WebMemo No. 2307, February 23, 2009, at http://www.heritage.org/Research/AsiaandthePacific/wm2307.cfm . and Ronald D. Utt, "Learning from Japan: Infrastructure Spending Won't Boost the Economy," Heritage Foundation Backgrounde r No. 2222, December 16, 2008, at http://www.heritage.org/Research/Economy /bg2222.cfm .
[3] Press release, "Remarks by the President on Job Creation and Economic Growth," The White House, December 8, 2009, at http://www.whitehouse.gov/ the-press-office/remarks-president-job-creation-and-economic-growth (December 18, 2009).
[4] Mark Zandi, "The Economic Outlook and Stimulus Options," Moody's Economy.com, testimony before the U.S. Senate Budget Committee, November 19, 2008, Table 1, p. 10, at http://www.economy.com/mark -zandi/documents/Senate_Budget_Committee_11_19_08.pdf (December 7, 2009).
[5] The $200 billion figure is the amount of the $787 billion stimulus bill scheduled to be spent in 2009.
[6] For quarterly economic growth rates, see Press release, "Gross Domestic Product: Third Quarter 2009 (Advance Estimate)," Department of Commerce, Bureau of Economic Analysis, October 29, 2009, Table 1, at http://www.bea.gov/newsreleases/national/gdp/2009/pdf/gdp3q09_adv.pdf (December 7, 2009).
[7] The Federal Reserve could fund new spending by printing new money. Printing money could create temporary economic growth if the Federal Reserve convinced market participants that it would respond appropriately to any increase in inflation. Financial markets and businesses would then respond to the dollars pouring into businesses as though this represented new demand for their products (rather than inflation), and induce them to increase production. Note, however, that in this case it is the monetary policy, not the deficit spending, that is stimulating the economy, and that at some point the Federal Reserve would have to withdraw the excess printed money to make good on its pledge to prevent resurgent inflation.
[8] The total job loss is likely to be greater because highway construction is relatively capital-intensive and its jobs pay higher wages, leading to fewer numbers of workers being hired.
[9] Ronald D. Utt, "More Transportation Spending: False Promises of Prosperity and Job Creation," Heritage Foundation Backgrounder No. 2121, April 2, 2008, at http://www.heritage.org/Research/budget/bg2121.cfm .
[10] "Employment Impacts of Highway Infrastructure Investment," Department of Transportation, Federal Highway Administration, April 7, 2008. Report no longer appears on DOT Web site. Contact author for the original PDF file.
[11] U.S. General Accounting Office, Emergency Jobs Act of 1983: Funds Spent Slowly, Few Jobs Created. GAO/HRD-87-1, December 1986, at http://archive.gao.gov/f0102/132063.pdf (December 9, 2009).
[12] John H. Cochrane, "Fiscal Stimulus, Fiscal Inflation, or Fiscal Fallacies?" University of Chicago Booth School of Business, February 27 2009, at http://faculty.chicagobooth.edu/john.cochrane/research/Papers/fiscal2.htm (December 21, 2009). Also seeJ. D. Foster, "Keynesian Fiscal Stimulus Policies Stimulate Debt--Not the Economy," Heritage Foundation Backgrounder No. 2302, July 27, 2009, at http://www.heritage.org/Research/Economy /bg2302.cfm .
[13] This paper has much in common with what has been called the "Treasury View" of the economy, which asserts that government spending displaces private-sector spending dollar-for-dollar. However, because this paper argues that government spending can eventually affect productivity rates and, therefore, long-term economic growth, it may be better described as offering a "soft" Treasury View.
[14] Banks can buy existing Treasury bills in the secondary market. They do not need government to issue new debt through a stimulus bill. Furthermore, if there was no government debt to buy, banks would surely find other safe bonds.
[15] Thus, credit markets clear quickly. Interest rates may fluctuate, but financial markets will not hoard dollars. Even the last resort of Treasury bills keeps the dollars circulating.
[16] Cash set aside for required bank reserves and basic business/household transactions may not circulate through the economy as quickly. However, this comprises a small and relatively fixed percentage of dollars.
[17] Bill McMorris, "$6.4 Billion Stimulus Goes to Phantom Districts," Franklin Center for Government and Public Integrity, November 17, 2009, at http://www.franklincenterhq.org/2009/11/17/6-4-billion-stimulus-goes-to -phantom-districts/ (December 9, 2009), and Michael Cooper and Ron Nixon, "Reports Show Conflicting Number of Jobs Attributed to Stimulus Money," The New York Times. November 5, 2009, at http://www.nytimes.com/2009/11 /05/us/05stimulus.html (December 9, 2009).
[18] In the short run, $1 spent on consumption, investment, or government will each raise GDP by the same $1. In the long run, however, a dollar spent on investment is likely to increase labor productivity and help the economy create more income and wealth in the future. By altering the composition of an economy's spending either toward or away from investment (and affecting the quality of those investments), governments can affect long-term productivity rates and economic growth.
[19] Dozens of these studies are summarized in Daniel J. Mitchell, "The Impact of Government Spending on Economic Growth," Heritage Foundation Backgrounder No. 1831, March 15, 2005, at http://www.heritage.org/Research /Budget/bg1831.cfm .
[20] "Frequently Asked Questions," Bureau of Economic Analysis, U.S. Department of Commerce, at http://faq.bea.gov/cgi-bin/bea.cfg/ php/enduser/std_adp.php?p_faqid=490 (December 9 2009).
[21] Daniel J. Mitchell, "Lowering Marginal Tax Rates: The Key to Pro-Growth Tax Relief," Heritage Foundation Backgrounder No. 1443, May 22, 2001, at http://www.heritage.org/Research/Taxes/bg1443.cfm .
[22] For more on the Bush tax cuts, see Brian M. Riedl, "Ten Myths About the Bush Tax Cuts," Heritage Foundation Backgrounder No. 2001, January 29, 2007, at http://www.heritage.org/Research/Taxes/bg2001.cfm .
[23] For causes of the current recession, see J. D. Foster, "Understanding the Great Global Contagion and Recession," Heritage Foundation Backgrounder No. 2331, October 22, 2009, at http://www.heritage.org/Research/ Economy/bg2331.cfm .Source: www.heritage.org
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text:
Post Midwife Power
by Jill Cohen
© 2005 Midwifery Today, Inc. All rights reserved.
[Editor's Note: This editorial first appeared in The Birthkit Issue 47, Autumn 2005.]
Photo provided by the author
Jill with son, Arlo, holding sister, Lucretia
I have had the opportunity to stand back from the front lines of midwifery and look at what midwives need to help them do all they do. One way I have done this is by referring pregnant women to my sister midwives. Advocating midwifery and natural birth is fun to do. I tell great birth stories and dispel the horror stories these women all seem to hear. I plant a seed of confidence and get to watch the young and upcoming birth culture change back to a more woman-centered place. When I was doing births I rarely had the opportunity to interact with my community on a large scale. I was so busy taking care of all my women and my own family that advocating was hard to do. I now have the time and will continue to spread the word.
Another way I have helped midwifery is through a class project in my women's studies class this last term. We were asked to do a volunteer project for any nonprofit organization that helps women. I chose Robin Lim's organization, Yayasan Bumi Sehat.
Robin is regular contributor to Birthkit and Midwifery Today who works and lives in Bali part time. I wanted to find a way to support all she does to help women from Bali to have safe births while also helping the tsunami victims. Our project has gone beautifully and I hope to continue to raise funds for her on a regular basis. If you are interested in donating to this worthy cause, e-mail me at .
I miss attending births and being on the front lines. I have learned that midwifery involves many avenues. If you are not attending births, you can still teach, promote, educate or find ways to otherwise get the word out for those who need the time to devote to their practices. By helping other midwives I retain the honor of serving as a midwife, just in a different capacity.
Toward Better Birth,
Associate Editor Jill Cohen
If you enjoyed this article, you'll enjoy Birthkit newsletter back issues!

subset: commoncrawl


text:
A SHELDON School employee has won an award for her commitment to her job at the Chippenham school.
Nicole Owen, a Sodexo general manager responsible for more than 40 catering and cleaning employees, beat colleagues from across UK and Ireland to win the Committed To You award.
It recognised her commitment in recruiting, training and developing her team to their full potential, while maintaining high levels of service to the 2,000 pupils and staff at Sheldon.
Mrs Owen, 48, who lives in Stoneover Lane, Royal Wootton Bassett, picked up the award at the Park Plaza Westminster Bridge Hotel in London.
She said: "It was phenomenal, it felt unreal and very daunting going up on stage in front of all those people. I was shocked because I didn't recognise myself in the comments they made before announcing the winner. I was totally surprised and feel very honoured to have won."
Mrs Owen has worked at Sheldon School for seven years, five as a catering manager and the last two as general manager.
She underwent two rounds of panel interviews, as well as submitting detailed written evidence, to convince judges she was the winning nominee.
Sodexo's annual Star Awards recognise the most outstanding individuals from its 35,000 employees.
Debbie White, Sodexo UK and Ireland chief executive, said: "The Star Awards is the pinnacle of our year because it gives us, as an organisation, the opportunity to truly recognise and thank our people for their hard work and dedication. Every day should be about making our employees feel valued and involved in the progress of our organisation."


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United States Department of Agriculture
Agricultural Research Service
The mission of the OCIO, Enterprise Application Services Branch (EASB) is the design, analysis, development, implementation and integration of computer information systems that are fundamental to the agency missions and goals.
Our objectives are:
• To work in partnership with ARS administrative and research program customers addressing software needs and services.
• To provide creative and intuitive software application design to support the growing need for information management throughout the REE community.
• To effectively manage smooth software implementations by providing thorough documentation, training materials and users support.
• To provide seamless integration between diverse software applications.
• To support dynamic and innovative public and internal agency websites that reflect that quality and status of our scientific work.


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I was contracted to do a job, make a specialized web application. people sign up, are mailed a confirmation/activation link, and can then view certain records. Job took about 25 hours of programming and DB design. They contacted me in august, had hosting problems, and finally got me access to their server in mid December. I finished the job about two weeks ago and asked for payment. For two weeks they ignored my request by "forwarding" my request to the proper department. Now they say they can issue my check "sometime in the next 30 days".
Oh, and they want me to add another feature to the application I've already written.
I know there are a few freelancers here. How have you handled situations like this?


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Passing driver comes to the rescue of girl ready to jump from freeway overpass
At first, Jay Schaefer saw a bicycle parked on a Hollywood Freeway overpass. Then a 16-year-old girl perched on an outside ledge. Then the rush of Friday afternoon traffic below.
The plumber whipped a U-turn, leaped from his truck and held onto the girl for dear life.
"It was definitely not the norm," said Schaefer, 42, of Sun Valley. "I asked her if she was OK. She said, No, she wanted to die.
"Then I said, Let me help you, I'll do anything to help you."
The plumber for Drain Router Plumbing of Canoga Park was the first good Samaritan to help prevent a suicide at Whitsett Avenue and the 170 Freeway in North Hollywood.
What followed was a highly coordinated rescue by other motorists, Los Angeles police, Los Angeles firefighters and the California Highway Patrol.
But if it wasn't for the fast response of the father of four daughters, officials say, the teen might have jumped to her death.
"This man is by every definition of the word a hero," said Brian Humphrey, a spokesman for the Los Angeles Fire Department. "And we don't use that term lightly."
It was at 2:40 p.m. that local agencies received a 911 call about a young girl preparing to jump from the bridge.
When Los Angeles police arrived, they say they saw Schaefer and other motorists clasping the teen from the other side of an overpass railing. The North Hollywood Division officers also wrapped their arms around the blue-jacketed girl.
When the California Highway Patrol closed all southbound lanes for 40 minutes, its officers saw the girl poised high above the slab.
About two dozen Los Angeles firefighters arrived, parked an apparatus beneath the Whittsett overpass, then extended a ladder over the stricken girl.
A firefighter then mounted the ladder, and hoisted the girl over the rail to safety from the freeway precipice.
She was then taken to a nearby hospital, police said.
"There was a citizen that had made contact, holding onto the teenage girl, standing on the bridge outside the safety tines," said police Sgt. Peter Gillies of North Hollywood Division. "Officers arrived ... to take over. The fire department ... lifted her up.
"All those things came to bear to pluck the young lady off the overpass. It was a very good coordinated effort."
For Schaefer, whose daughters range from 20 months to 16 years, it was the specter of a ruined New Year's: for the teen, her unborn child, and his family.
She told him she was 16, pregnant, with nowhere to live. "Nobody loves me," she told him.
"Look, you can't do this," he recalls shooting back. "I have a wife, a family, you'll destroy us, too."
When reached by the Daily News, he said he was still reeling from the event.
"I don't know what to say about it all," Schaefer said. "I hope she's all right. I'd like to see her pull through."


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NEW YORK ( TheStreet) -- The major U.S. stock averages soared Monday as positive housing market data gave extra mileage to a rally fueled by optimism over budget talks in Washington. Upbeat earnings reports from Lowe's ( LOW) and Tyson Foods ( TSN) also boosted investor confidence after last week's deep pullback. The surge occurred despite rising tensions in the Middle East as Israeli and Palestinian forces continued to exchange rocket fire in the Gaza Strip area. The Dow Jones Industrial Average spiked higher by nearly 208 points, or 1.65%, to close at 12,796. The blue-chip index, which has lost ground in five of the past six weeks, is now up 4.7% so far in 2012. All thirty of the Dow's components finished in the green. Even Intel ( INTC), which was in negative territory for much of the session after surprising Wall Street with news that Paul Otellini plans to retire from the chip giant's chief executive officer in May, managed a slight gain. The biggest blue-chip winners were Bank of America ( BAC), Hewlett-Packard ( HPQ), JPMorgan Chase ( JPM), and Verizon ( VZ). The S&P 500 gained 27 points, or 1.99%, to close at 1387, while the Nasdaq climbed 63 points, or 2.21%, to settle at 2916. Every sector in the broad market was higher with basic materials, capital goods, consumer cyclicals, energy, technology, and transportation all rising more than 2%. Advancers outpaced decliners by about a ratio of 7.8-to-1 on the New York Stock Exchange and 3.7-to-1 on the Nasdaq. Volume totaled 3.36 billion on the Big Board and 1.77 billion on the Nasdaq. U.S. budget discussions are expected to continue behind the scenes in Washington this week as President Barack Obama makes his tour through Asia. The president has provided reassurances that a U.S. budget agreement will be reached on time. "Attention remains centered on the fiscal cliff," said Michala Marcussen, global head of economics at Societe Generale. "Recent developments give grounds for some cautious optimism, but history suggests that politics can be notoriously fickle. Our base case remains that a temporary extension is voted before year-end with a final agreement in early 2013. This will lift uncertainty and remove a significant headwind to recovery."
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CA, United States
About PuzzlePrints
PuzzlePrints specializes in Custom Printable Party Invitations for all occasions. We also offer custom printable party favors and printable party packages that include banners, cupcake toppers, thank you tags, and so much more! Our invitations are available for birthdays, babies, and wedding showers.
Get 10% off your order by using coupon code: CATCHMYPARTY2013


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Monday's local events
COLLEGE MEN'S BASKETBALL Time Place
Dominican at Chaminade 7:30 p.m. Honolulu
COM at Los Medanos 7:30 p.m. Pittsburg
COLLEGE WOMEN'S BASKETBALL Time Place
Dominican at Chaminade 5 p.m. Honolulu
Tuesday's local events
COLLEGE WOMEN'S BASKETBALL Time Place
COM at Los Medanos 5:30 p.m. Pittsburg
HIGH SCHOOL BOYS BASKETBALL Time Place
International at North Bay 5 p.m. Novato
Marin Academy at University 6:30 p.m. S. Francisco
Tam at Terra Linda 7:30 p.m. Terra Linda
Justin-Siena vs. Branson 7:30 p.m. COM
Drake at San Marin 7:30 p.m. San Marin
San Rafael at Redwood 7:30 p.m. Larkspur
Novato at Marin Catholic 7:30 p.m. Kentfield
Tomales at Rincon Valley Christian 8 p.m. Santa Rosa
HIGH SCHOOL GIRLS BASKETBALL Time Place
International at North Bay 3;30 p.m. Novato
San Domenico at Gateway 4 p.m. S.F.
Justin-Siena vs. Branson 6 p.m. COM
Drake at San Marin 6 p.m. San Marin
Novato at Marin Catholic 6 p.m. Kentfield
San Rafael at Redwood 6 p.m. Larkspur
Tam at Terra Linda 6 p.m. Terra Linda
University at Marin Academy 6:30 p.m. San Rafael
Tomales at Rincon Valley Christian 6:30 p.m. Santa Rosa
ON THE AIR Monday
COLLEGE BASKETBALL Time TV Radio
Notre Dame at Cincinnati 3:30 p.m. ESPN2
Cal at UCLA 10 p.m. P12BA*
COLLEGE FOOTBALL BOWL Time TV Radio
BCS: Alabama vs. Notre Dame 5:30 p.m. ESPN 95.7 FM
NBA Time TV Radio
Cleveland at Chicago 5 p.m. WGN-A
GOLF Time TV Radio
Tournament of Champions 1 p.m. Golf
ON THE AIR TuesDAY
COLLEGE BASKETBALL Time TV Radio
Whiparound Coverage 3:30 p.m. ESPNU
Alabama at Missouri 4 p.m. ESPN
Baylor at Texas Tech 4 p.m. ESPN2
Clemson at Duke 4 p.m. ESPNU
Northeastern at Drexel 4 p.m. CSNCA
Women's College Utah at Colorado 5 p.m. P12BA
Ohio State at Purdue 6 p.m. ESPN
Pittsburgh at Georgetown 6 p.m. ESPNU
Women: Stanford at Cal 7 p.m. P12BA
TENNIS Time TV Radio
Champions Series: Boston (Taped) 9 p.m. CSNCA
wHERE"THE"PROS ARE
49ERS PLAYOFFS Time TV Radio
Saturday: vs. Green Bay 5 p.m. Ch. 2 680 AM
WARRIORS Time TV Radio
Wednesday: vs. Memphis 7:30 p.m. CSN 680 AM
Friday: vs. Portland 7:30 p.m. CSN 680 AM
Sunday: at Denver 5 p.m. CSN 680 AM
Jan. 16: vs. Miami 7:30 p.m. CSN/ESPN 680 AM


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Stay with Vista Cay Resort by Millenium During the Orgill Dealers Market's Spring 2014 Edition
The hardlines retail industry looks forward to the Orgill Dealers Market event to drive the trends of new products and services for the year from January 27 through February 1st, 2014.
The Orgill Dealers Market event attracts thousands of retail business professionals seeking to learn about their latest products, services and techology. The Orgill Dealers Market - Spring 2014 event will be held at the Orange County Convention Center, giving hardlines retailers direct contact with suppliers, vendors, product designers, and the opportunity to network with other retail professionals from across the U.S. Hardlines is a multi-billion dollar industry involving the supply of products such as hardware, electronics, plumbing, and other tangible goods for resale in retail markets.
The 2014 Orgill Dealers Market is expected to attract representatives from major retailers and department stores, as well as small businesses that supply specialty goods. And as always, Vista Cay Resort by Millenium is ready to help you get a good night sleep and keep you close to the event, restaurants and shopping venues. Our close proximity to Orlando's top convention center and business travel destination makes Vista Cay Resort by Millenium your business travel lodging venue of choice.


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Everyday Looper has become my favorite iPhone app period. If your a musician go grab this thing. It's really fun to play around with and although you can't tell by my loop it get's your creative juices flowing. $4.99: click here
Eins Zwei Mouse Bear Stove by thingstocome
For more info: mancingdolecules.com


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Ham and Cabbage Soup with Red Bell Pepper.
(Leave out the carrots to make this soup phase one.)
Phase One Appetizers and Condiments
Baked Crispy Kale from Steamy Kitchen
Mayo-Less Deviled Eggs with Capers from Gluten-Free, Dairy-Free, Sugar-Free
Deviled Eggs from Seriously Good
Chili Roasted Edamame from Home with Mandy
Tapenade Trio from Leite's Culinaria (serve on grilled or sauteed chicken or fish for South Beach Diet, not as a spread on bread)
Phase One Salads and Salad Dressings
Sesame Vinaigrette from Life's Ambrosia (be sure not to use seasoned rice vinegar, as it contains sugar)
Celery and Fragrant Tofu Salad from Teczcape - An Escape to Food
Mediterranean Steak Salad from Our Life in the Kitchen
Val's Cabbage Salad from AskGeorgie.com (the other cabbage salad in the post with apple is not phase one)
Purple Winter Salad from Vintage Mixer (leave out raisins for South Beach Diet)
Creamy Cauliflower Soup from AskGeorgie.com
Phase One Soups, Stews, and Chilis
Ham and Cabbage Soup with Red Bell Pepper from Kalyn's Kitchen (leave out the carrots to make this soup phase one)
White Chili from Whistlestop Cafe Cooking
Meat-Lover's Chipotle Chili from Sarah's Cucina Bella
Black Bean Soup from Our Life in the Kitchen
Italian Sausage, Kale, and Cannellini Bean Soup from Southern Grace Gourmet (use turkey Italian Sausage for South Beach Diet)
Yellow Bell Pepper and Fava Bean Soup from What's For Lunch Honey?
Pinto Bean and Roasted Garlic Soup from What's Cooking (don't use tortilla strips for phase one)
Thai-Style Chicken Soup (Tom Kha Gai) from The Way the Cookie Crumbles (use light coconut milk and replace sugar with Splenda for South Beach Diet)
Really Excellent Three-Bean Chili from Half Assed Kitchen (replace sugar with Splenda for South Beach Diet)
Phase One Vegetables or Side Dishes
Brussels Sprouts with Rosemary and Parmesan Cheese from Lucullian Delights
Roasted Brussels Sprouts from Simply Recipes
Roasted Cabbage with Lemon from Eat.Repeat
Cheesy Spaghetti Squash and Kale Gratin from Cara's Cravings (spaghetti squash is the only winter squash that's permitted for phase one)
Whole Baked Romanesco Cauliflower with Tomato and Olive Sauce from The Culinary Chase
Alice Water's Long-Cooked Broccoli from Carolyn at Serious Eats
Garlic Asparagus from Show Me the Curry
Grilled Eggplant with Mint from Blog from Our Kitchen
Fast Pan Roasted Brussels Sprouts from A Veggie Venture (use olive oil instead of butter for South Beach Diet)
Phase One Chicken, Meat, or Fish Entrees
Lucky Black-Eyed Peas from My Own Sweet Thyme (leave out carrots for phase one)
Chicken Breast Stuffed with Roasted Red Pepper, Feta, and Pistachios from The Culinary Chase
Buttery Roasted Shrimp from Sarah's Cucina Bella (use olive oil instead of butter for South Beach Diet)
Marinated Flank Steak from Sarah's Cucina Bella
Pork Diane from Mandika Moments
Baked Lemon Herb Cod from Sarah's Cucina Bella
Naked Chicken Parmesan from Dani Spies
Sweet Onion and Chicken Curry from The Crepes of Wrath (use light coconut milk for South Beach Diet)
Phase One Vegetarian or Meat-Free Entrees
Spicy Black-Eyed Peas with Kale from Ginger and Garlic
Red Lentil Curry from Fab Frugal Food (use Splenda instead of sugar or honey for phase one)
Mexican Lentil Stew from Budget Bytes (don't garnish with corn chips for South Beach diet)
Tarka Mung Bean Dal from Allotment 2 Kitchen
Phase One Breakfasts
Frittata with Roasted Mushrooms, Cream Cheese, and Herbes Fines from Thought for food (use olive oil instead of butter for South Beach Diet)
Best Prawn and Parsley Frittata from The Culinary Chase (use olive oil instead of butter for South Beach Diet)
Phase One Desserts
Sugar-Free Baked Cardamom Custard Cups from Christine Cooks (use 1% milk for South Beach Diet)
Did I Miss Your Phase One Recipe?


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Hi, first time poster here so be gentle!
I've recently bought my first Roman Legionary minis and am itching to paint them. Before I do though, is there much of a difference between using the dip method and using a wash? I'm planning using Devlan Mud pretty liberally to shade them, but would I be better off investing in a tin of Army Painter and dipping them instead?
Much obliged, chaps.


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Developing the Next Generation
U.S. Soccer's Development Academy program is driven by the game and its players, coaches and referees. This game-centric approach allows for long-term development to occur through a deep understanding of what makes players successful around the world. As the sport of soccer grows in the United States, young players in our country need the proper environment to compete against the world's elite. The U.S. Soccer Development Academy program provides the optimum developmental environment for the nation's top youth soccer players, coaches and referees by emphasizing development through quality training and limited, meaningful competition.
Meaningful Training
Academy teams spend a greater amount of time focused on training to improve as individuals and as a team. The teams and players receive direct feedback and evaluations from National Team Staff and ProZone video analysis. To round-out the complete training environment, Academy teams are tested in their physical capabilities using the SPARQ testing methodology and their hydration levels by Gatorade. They also receive a SPARQ training curriculum for soccer-specific athletic training and Nutrition and Hydration recommendations from Gatorade's Sports Science Institute. Each athlete then gains a greater understanding of how they compare physically against their peers and what they need to do to achieve their optimal performance levels.
Competitive Environment
The Academy program features teams from the top youth clubs from around the country. Each Academy team plays approximately 30 regular season games to ensure all games are meaningful. Games are also played according to FIFA's Laws of the Game and officiated by a pool of the nation's top young referees in order to prepare players for the next level of competition. National Team Scouts regularly attend Academy games, so players are evaluated over the course of the season and in their natural positions allowing for better player assessment.
Early Success
As the program enters its sixth year, it has already impacted the player development process in the United States. Since inception, more than 300 players from Academy clubs have been included in U.S. Youth National Teams, and 17 were a part of the U.S. rosters for the 2009 FIFA U-17 and U-20 World Cups. Virtually all college programs use the Academy program as a scouting vehicle.
Several Academy players have attracted interest and signed with professional clubs both in MLS and abroad. Many young players in MLS have played and developed in the US Soccer Development Academy. Recent Developmental Academy players have also signed with international clubs around the world.
For a more in-depth overview of the U.S. Soccer Development Academy, visit www.ussoccer.com/Teams/Development-Academy/Academy-Overview.aspx
For Frequently Asked Questions of the U.S. Soccer Development Academy visit http://www.ussoccer.com/Teams/Development-Academy/FAQs.aspx
To see the list of clubs in the U.S. Soccer Development Academy visit academy.demosphere.com/
To view the latest information on the U.S. Soccer Development Academy, please visit the Development Academy Home Page on www.ussoccer.com/Teams/Development-Academy/Academy.aspx


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I Love My Fiancé, but Am Totally Crushing on a Co-Worker
September 19, 2017
Recent findings and perspectives on medical research.
"Don't drink the water!" and other advice still leaves travelers sick. Can a new drug help?
Travelers' health; Infectious diseases and travelers
The best way to stay healthy during travel is to prepare before you leave and take preventive measures while traveling. Most infections that you catch while traveling are minor, but in rare cases, they can be severe or even deadly.
Different areas of the world have different diseases and require different steps for prevention. The following things affect health safety and should be considered:
The best public sources for up-to-date travel information are the:
Talk to your health care provider or visit a travel clinic 4 - 6 weeks before you leave for your trip. You may need a series of pre-travel vaccinations. Some vaccines need time to work.
Depending on where you are going, you may need to update your vaccinations. Your doctor may say you need a "booster" vaccine. For example, you may need booster vaccines for:
You also may need other vaccines for diseases that are not commonly found in North America. Examples of recommended vaccines include:
Certain countries have required vaccinations. You may need proof of vaccination to enter the country.
Yellow fever vaccination is required to enter several Sub-Saharan, Central African, and South American countries. Meningococcal vaccination is required to enter Saudi Arabia for the Hajj pilgrimage. For a complete list of country requirements, check the CDC or WHO web sites.
People who may have different vaccine requirements include:
Check with your health care provider or local travel clinic.
Malaria is a serious disease that spreads by the bite of certain mosquitoes. The disease is a risk mainly in tropical and subtropical climates. Malaria can cause high fevers, shaking chills, flu-like symptoms, and anemia.
If you are traveling to an area where malaria is co mmon, you may need to take medications that prevent the disease before you leave, during your travel, and for a short period after you return. How well the medicines work vary. You should take additional steps to prevent insect bites.
Mosquitoes and other insects can transmit malaria and a number of other infections to people. To protect yourself, wear insect repellant containing DEET or picaridin whenever you are outdoors. You may also need to use a bed mosquito net while you sleep.
Other steps to help reduce mosquito bites:
It is possible to catch many infections by eating or drinking contaminated food or water. Undercooked or raw foods pose a significant risk for infection. Avoid the following:
Drinking water that is not chlorinated enough or that is from areas with poor sanitation can lead to infection. Only drink the following liquids:
Do not use ice in your drinks. Local water can be purified by boiling, or by treating it with certain chemical kits or water filters.
Frequently clean your hands using soap and water or an alcohol-based cleanser to help prevent infection.
Avoid standing or swimming in fresh-water rivers, streams, or lakes that are contaminated with sewage or animal feces because they can lead to infection. Generally, swimming in chlorinated pools is safe.
Travelers' diarrhea is the most common infection caught while traveling. Diarrhea can sometimes be treated with rest and fluids. Your health care provider may prescribe an antibiotic to have if you get sick with severe diarrhea while traveling.
If the diarrhea continues or you develop a high fever or dehydration, seek immediate medical care. If you were sick with a fever while traveling, contact your health care provider when you return home.
Arguin P. Approach to the patient before and after travel. In: Goldman L, Ausiello D, eds. Cecil Medicine . 24th ed. Philadelphia, Pa: Saunders Elsiever; 2011:chap 294.
Basnyat B, Ericsson CD. Travel medicine. In: Auerbach PS, ed. Wilderness Medicine . 6th ed. Philadelphia, Pa: Mosby Elsevier; 2011:chap 84.
Fairley JK, John CC. Health advice for children travelling internationally. In: Kliegman RM, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics . 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 168.


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Bonded Print CharliesTrivia brain teasers have some element of trivia in them, but they are not just pure trivia questions.
"Look, Aunt Nora!" Chuckie Shekrie, Nora's nephew, called from two tables ahead at the swap meet. "A whole plate of Charles ... I mean, Charleses ... Chuckies?" Nora shared a grin with her brother, and they went to see what the eight-year-old had found.
He'd found a table sporting Scandinavian collectibles. The display included silverware, decorated clocks, carved wooden toys, crystal bowls and other vessels, and the obligatory array of Father Christmas figures.
The apple-cheeked woman behind the table smiled as Chuckie pointed to his find, politely keeping his hand at least six inches from anything breakable.
"See? Eight on a plate!" His finger indicated an octagonal platter.
Nelson, his father, bent over to look. The central shield was an 11" piece of cut crystal, certainly up to the standards his wife had drilled into him over a decade of shopping for dinner presentation pieces. This was set in an eight-sided porcelain border. In the center of each side was a male face, carved before firing and enhanced with India ink or some similar material. The largest portrait, directly above the centered shield, was detailed enough to be taken from a painting; the one to its left appeared to be some level of woodcut. The others were done with less precision, as if ...
"... done from written records and the artists' imaginations," the woman was telling them, "since there are no actual portraits of the first six. Charles VII comes from a bone-and-ink portrait in a museum in Stockholm; Charles VIII is copied from a painting in one of the big Paris museums." Her voice lilted prettily, calling up images of springtime melts and home-baked edibles.
"It's a cute piece," Nelson said, "and it's even an anniversary." He pointed to the etching in the shield, which read "1948, 500th Anniversary of the coronation of Charles VIII, King of Sweden, 1448."
He imagined his wife's reaction. "Sharon would love the crystal and white combination, and the history is great. She's Swedish, remember. But I think even she might flinch at $750 for a serving dish."
Nora addressed her brother, but looked straight at the vendor. "I think she might also flinch at having an obvious fake, no matter how beautiful. Would you be willing to pay, say, $150 for it, dear brother? I saw something comparable for $200 half an hour ago." The vendor turned even redder. "I think it's a fair price. After all, a very nice serving piece has been debased by a sloppy joke."
The woman controlled her emotions, stared at the plate, and held out her hand to Nelson. Confused, he shook it and immediately wrote out a check for $150.
How did Nora know it wasn't real?
HintThe dates for Charles VIII of Sweden are accurate; look up Charles V.
AnswerThe big tip-off was the stylized portraits of Charles I through VI. They never existed. For some unknown reason, the first Charles to ascend to the Swedish throne took the name "Charles VII". He was assassinated in 1167, and Sweden didn't get the other Charles until 1448.
Sharon Shekrie was delighted with her husband's purchase. She used it for years after to brag about Nora's quick thinking and to embarrass the occasional pseudo-intellectual.
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Analysis of Data Collected From Individuals Administered Neurobehavioral Assessments
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
- People with chronic illness often are at risk for developing neurobehavioral problems due to effects of the disease or associated treatments. These problems may include cognitive impairments involving problem-solving, remembering things, paying attention, and understanding and using language, or emotional functioning or quality of life.
- The National Cancer Institute Medical Illness Counseling Center Neuropsychology Group has collected data from neurobehavioral evaluations of infants, children, adolescents and adults with chronic illnesses enrolled in NIH protocols since 1987 and continues to collect data from patients enrolled in current protocols.
- The data from these evaluations, along with demographic and medical information are stored in an NIH computer database.
- Investigating the neurobehavioral functioning of patients with chronic illness is important for identifying and monitoring the effects of the disease and treatments over time, determining possible at-risk subgroups, evaluating response to therapy, and recommending educational and rehabilitative interventions.
-To learn about how certain illnesses or treatments may affect a person s cognitive abilities, emotional functioning and quality of life.
- Patients currently enrolled in NIH studies who are having neuropsychological testing or completing quality-of-life questionnaires as part of that study.
- Data obtained from infants, children, adolescents, and adults administered neurobehavioral assessments as part of a past or future NIH protocol.
- This study does not involve any extra tests or questionnaires; it uses information collected from evaluations that subjects have already completed or will complete as part of other NIH studies.
- Information about participating patients that may help elucidate how cognitive abilities, emotional functioning, and quality of life are affected in people with chronic illness may be collected and stored.
|HIV Brain Tumors Neurofibromatosis 1
|Study Type:
|Study Design:
|Observational Model: Cohort
Time Perspective: Other
|Official Title:
|Analysis of Stored Data Collected From Individuals Administered Neurobehavioral Assessments on IRB-Approved Protocols
- Describe neurobehavioural functioning based on stored data [ Time Frame: 1 Year ]
- Relationship between neurobehavioral functioning & medical, neuroimaging, neurologic, and psychiatric variables [ Time Frame: 5 Years ]
- Association of neurobehavioral functioning with medication. [ Time Frame: 5 Years ]
- Compare neurobehavioral measures between different subgroups within [ Time Frame: 5 Years ]
- Effects of treatment on neurobehavioral functioning over time [ Time Frame: 5 Years ]
- Compare the responses of the patient and caregiver on behavioral adherence & QOL [ Time Frame: 5 Years ]
- Compare neurobehavioral functioning between different chronic medical conditions [ Time Frame: 5 Years ]
- Validate novel assessment tools [ Time Frame: 5 Years ]
|Study Start Date:
|February 19, 2007
Individuals with chronic illness often are at risk for developing neurobehavioral impairments due to effects of the disease and/or associated treatments.
The National Cancer Institute (NCI) Neurobehavioral Group has been collecting neurobehavioral data obtained from the longitudinal psychometric testing of infants, children, adolescents, and adults with various chronic illnesses enrolled on IRB-approved protocols at the NIH since the 1980 s, many of which are now closed. In addition, we continue to collect neurobehavioral data obtained from assessments of individuals enrolled on current IRB-approved protocols.
The neurobehavioral test data from these evaluations, as well as demographic information, medical values, neurologic findings, and neuroimaging abnormalities, are stored in the neuropsychological database currently located on the secure NIH mainframe computer system.
Investigating the neurobehavioral functioning of children with chronic illness is important for identifying and monitoring the effects of the disease and treatments over time, determining possible at-risk subgroups, evaluating response to therapy, and recommending educational and rehabilitative interventions. In addition, the data may be used to compare various aspects of neurobehavioral functioning among different illness groups healthy controls, and validate novel methodologies to better assess selected domains of functioning, such as a pediatric quality of life (QOL) scale for children with chronic illnesses with CNS involvement.
To describe the neurobehavioral functioning of individuals with chronic illness based on the analysis of stored data collected from IRB-approved protocols, consisting of retrospective data collected on protocols that are now closed and data collected prospectively on current and future protocols.
Data obtained from infants, children, adolescents, and adults administered neurobehavioral assessments as part of a past, current, or future IRB-approved protocol.
No data will be collected specifically for this protocol. Retrospective data previously collected from individuals receiving neurobehavioral assessments as part of past IRB-approved protocols or prospective data that already will be collected as specified in current or future IRB-approved protocols and stored in the secure NCI Neurobehavioral database will be used for data analysis as outlined in this protocol.
Cross-sectional or longitudinal data will be selected from the database for statistical analysis based on the objective being studied. Since different objectives may be studied using various types of data, a variety of statistical analyses will be conducted to examine the stored data depending on the objective being studied.
|Ages Eligible for Study:
|up to 100 Years (Child, Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
- Data obtained from infants, children, adolescents, and adults administered neurobehavioral assessments as part of a past, current, or future IRB-approved protocol.
- Informed consent for subjects greater than or equal to 18 years of age, a legal representative to provide permission for subjects greater than or equal to 18 years who cannot give informed consent, or one parent-legal guardian to provide permission for subjects less than 18 years of age who are administered neurobehavioral assessments after this protocol is approved.
- Data obtained from healthy controls, which may be siblings of affected patients, administered neurobehavioral assessments on an IRB-approved protocol.
1. Data may be excluded from a particular analysis if a subject had a CNS condition (i.e., Down s syndrome, severe intraventricular hemorrhage) not related to their primary medical diagnosis (i.e., HIV, cancer) that may affect neurobehavioral functioning, missing values on a particular test being studied, or invalid data as judged by the PI or Chairperson.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01445314
|United States, Maryland
|National Institutes of Health Clinical Center, 9000 Rockville Pike
|Bethesda, Maryland, United States, 20892
|Principal Investigator:
|Pamela L Wolters, Ph.D.
|National Cancer Institute (NCI)
Additional Information:
|Responsible Party:
|National Cancer Institute (NCI)
|ClinicalTrials.gov Identifier:
|NCT01445314 History of Changes
|Obsolete Identifiers:
|Other Study ID Numbers:
|Study First Received:
|September 30, 2011
|Last Updated:
|June 30, 2017
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):
Stored Data
Quality of Life
Additional relevant MeSH terms:
Neurofibromatosis 1
Nerve Sheath Neoplasms
Neoplasms, Nerve Tissue
Neoplasms by Histologic Type
Neoplastic Syndromes, Hereditary
Neurocutaneous Syndromes
Nervous System Diseases
Heredodegenerative Disorders, Nervous System
Neurodegenerative Diseases
Genetic Diseases, Inborn
Peripheral Nervous System Neoplasms
Nervous System Neoplasms
Peripheral Nervous System Diseases
Neuromuscular Diseases
ClinicalTrials.gov processed this record on September 25, 2017


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When asked what brought about the 2nd Annual Groupe New Years Celebration, Randy Sandoval from Groupe Car Club had this to say, "As a club we thought it would be a great way to bring in the New Year with our friends and family and it also gives us a chance to showcase our new rides while mingling with friends both old and new." He goes on to explain that there is no official invite for the celebration and that their event is a family affair open for all to attend.
Since the club originated from East L.A. (and holds many of their meetings in Montebello), they decided that Montebello Park would be the perfect venue for their annual shindig. So for that day, the entire park is reserved for the occasion and along with it comes the mandatory food, jumpers, and DJ to go along with it.
In addition, Groupe also provides everything from the tables and chairs all the way to the steaming hot pot of menudo and the necessary stockpile of carne asada, hot dogs, burgers, and flaming-hot grills. In all, it's a family affair that brings the best out of everyone and Groupe Car Club also understands that without the love and support of their friends, family, and other clubs, this wouldn't have been as successful as it was.


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RICHMOND — Councilman-elect Gary Bell remains in a coma after two neurosurgeries in November and will be unable to attend the city's swearing-in ceremony Tuesday, according to a statement released by his family late Thursday.
"As much as (Gary) and his supporters worked to win election to the council, we know Gary unselfishly wants what is best for the people of Richmond," his wife, Shelley Ross-Bell, said in the news release. "On behalf of our entire family, we offer our regrets that my husband is now unable to serve as many had hoped. We thank each of you for your cards, support, love and prayers."
Bell, 54, was hospitalized with a "severe bacterial sinus infection" in the days after the Nov. 6 election, where he won one of three open spots on the City Council, according to the release. His wife and two adult sons said earlier news reports erroneously labeled Bell's sickness as meningitis.
Bell was sick in the days before the election but continued to campaign, even checking himself out of a Richmond hospital on Election Day to thank supporters gathered at a local restaurant.
Bell was rushed back to Kaiser Permanente Medical Center in Richmond on the afternoon of Nov. 10. Doctors in Richmond decided to transfer Bell to a Kaiser facility in Redwood City for emergency surgery to relieve swelling on his brain.
The Redwood City campus is home to the Neuroscience Center that provides specialized neurological care to Kaiser members from all of Northern California.
It was not clear Thursday where Bell is hospitalized.
Councilman Corky Booze said Thursday he was "devastated" by the news that Bell remains in a coma and will be unable to be sworn in Tuesday.
"I wish Gary and his family nothing but the best," Booze said.
Councilman Tom Butt said, "This is very unfortunate, and I feel very sorry for his wife and his family. I hope Gary makes a full recovery."
Both men said the city charter gives the council 60 days to either appoint a successor or call a new public election.
Bell is president and CEO of Cooperative Federal Credit Union in Berkeley. He was first elected to the Richmond City Council in 1999, serving one term. In 2006, he ran for mayor, losing in a tight three-way race with Gayle McLaughlin and incumbent Irma Anderson.
This year, with heavy financial support from Chevron Corp., which runs a major refinery in Richmond, Bell earned about 15 percent of the vote, good for the third and final available council seat.
Contact Robert Rogers at 510-262-2726 or email@example.com and follow Twitter.com/roberthrogers


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The 2012-13 season promises big supplies of russets nationwide, a fact that San Luis Valley growers approach as a challenge and an opportunity.
David Tonso, a co-owner of Canon Potato Co., Center, Colo., said valley marketers will have to stay on their toes to move the 2012-13 crop.
"It's going to be a difficult marketing season," Tonso said. "There are going to be a lot of potatoes out there."
The good news is that San Luis Valley and other regions are reporting good quality, Tonso said. That will make the industry's job considerably easier.
"When you have a big pile, it's nice to have good quality," he said.
Trampas McCormick, manager of Worley & McCullough Inc., Monte Vista, Colo., is looking on the bright side heading into the 2012-13 season.
Yes, he says, there will likely be a lot of russets out there. But that doesn't have to be a bad thing.
"With the market the way it is, we see more opportunities," McCormick said. "We're looking to do some different things."
Worley & McCullough and Wada Farms
One of those different things for Worley & McCullough this season is hooking up with spud giant Wada Farms Marketing Group LLC, Idaho Falls, Idaho, McCormick said.
Wada will handle sales and marketing for Worley & McCullough in the 2012-13 season.
"We're excited with the partnership," McCormick said. "Wada has long legs and long arms across the country. They can really get us out there."
Heat and drought slowed demand for russets this summer, McCormick said. But despite that market atmosphere heading into summer and fall harvests and the expectation of big volumes nationwide, McCormick said russets could regain a position in the marketplace shippers used to take for granted.
"With the forecast of supplies, potatoes have a good chance to get out there in the supermarket and be a staple again, unlike the past few years," he said.
With other food costs going up, potatoes could become the go-to food for more consumers looking for value, he said.
"Potatoes could get everybody through," he said. "The price may not be what we want, but there are still opportunities to do well in the market."
Besides, McCormick said, challenges keep growers and marketers sharp.
"A smooth sea never made a good sailor."
Sharpened marketing skills
Jed Ellithorpe, a partner and marketing director for Center, Colo.-based Aspen Produce LLC, is trying hard to take a glass-is-half-full approach to the upcoming marketing season.
A good talking-to by his 92-year old grandfather, a former grower who was recovering from heart surgery, set Ellithorpe straight.
"I was explaining the markets to him, and I was somewhat pessimistic and he said, 'You're planning on it being that bad. It sounds like you need a different plan.' The canary in the coal mine doesn't bode well for markets, but a lot can happen."
One advantage of having a big crop nationwide could be that shippers will be forced to sharpen their marketing skills, Ellithorpe said.
"If we have supplies, maybe we'll do a better job of marketing and turn the demand side around," he said. "We can't do that unless we have the supplies to back it up."
Nebraska and eastern Colorado were in production in August, adding to the San Luis Valley storage spuds already in the pipeline, of which there were more of than usual this year, but Bob
Noffsinger, a salesman for Center-based Skyline Potato Co., said he still expected a smooth transition from old to new crop this season.
That said, Skyline, like other valley grower-shippers, is taking a wait-and-see attitude toward 2012-13 demand.
"We know Idaho and Washington are up. We won't know about the size until they get in," he said. "It remains to be seen how big it is."
Some valley growers began harvesting earlier than usual this season, but the Monte Vista Potato Grower Co-op Association, Monte Vista, still planned to open its shed at about the usual time, around Oct. 1, said Steve Tillman, manager.
With acreage up nationwide, Tillman said he can wait.
"I'm not in too big of a hurry to get into it — the market's not strong enough," he said.
Great promotional opportunities
Randy Shell, vice president of marketing and new business development for Bancroft, Wis.-based RPE Inc., said the big 2012-13 crop presents marketers with great opportunities to get consumers to eat more spuds.
"Supplies look to be plentiful for the season, with great supplies for promotions," he said. "This will be a great year for retailers to promote russet potatoes in 10-pound and larger bags at very good prices. Overall, this should be a great year to increase potato consumption."
In August, RPE inked a deal with Lynn McCullough and Jeffery McCullough, who own Monte Vista-based Spud Seller Inc., Spud Grower Farms LLC and Lynn McCullough Farms LLC.
The deal makes RPE the exclusive marketer for Spud Seller and Spud Grower Farms.


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The AutoloGel™ Post-Market Surveillance (TAPS) Program (TAPS)
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
AutoloGel™ Post-Market Surveillance Program
Purpose:Evaluate the incidence of hematologic and immunologic adverse events, including coagulopathies in patients with wounds to which AutoloGel™ was applied.
Design:Prospective, open label, patient registry. Investigator Sites: 3 Enrollment Size: 300
Subject Population: Patients with exuding wounds, such as leg ulcers, pressure ulcers, and diabetic ulcers and for the management of mechanically or surgically-debrided wounds.
Primary Objective Safety: Assess the incidence of hematologic (coagulopathies), immunologic (including anaphylaxis) and other adverse events associated with the application of AutoloGel on exuding wounds, such as leg ulcers, pressure ulcers and diabetic ulcers and during the management of mechanically or surgically-debrided wounds.
Primary Safety Endpoint: Absence of coagulopathies caused by inhibitors to coagulation Factor V as determined by a significant prolongation of the prothrombin (PT) time and confirmed by severe depletion of Factor V activity with a positive Bethesda Assay for anti-Factor V functional inhibitors.
|Wounds Leg Ulcers Pressure Ulcers Diabetic Foot Ulcers
|Device: AutoloGel System
|Study Type:
|Study Design:
|Intervention Model: Single Group Assignment
Masking: None (Open Label)
|Official Title:
|The AutoloGel™ Post-Market Surveillance (TAPS) Program
- Assess the incidence of hematological immunologic other ae's association with the application of AutoloGel on exuding wounds such as leg ulcers pressure ulcers and diabetics ulcers and during the management of mechanically or surgically debrided wounds [ Time Frame: 3 years ]
- Absence of coagulopathies caused by inhibitors to coagulation Factor V as determined by a significant prolongation of the (PT) time. Depletion of Factor V activity with a positive Bethesda Assay [ Time Frame: 3 years ]
|Study Start Date:
|September 2008
|Study Completion Date:
|June 2012
|Primary Completion Date:
|May 2012 (Final data collection date for primary outcome measure)
|Assigned Interventions
Autologel System
Autologel System produces platelet rich plasma gel
Device: AutoloGel System
The AutoloGel™ System may be used for chronic or surgically-debrided wounds up to twice a week for eight (8) weeks. The treating health care practitioner may elect to continue the treatment up to twelve (12) weeks. The AutoloGel™ System should be used in conjunction with standard of care procedures for comprehensive wound management , such as:
Removal of necrotic or infected tissue Off-loading Compression therapy for venous stasis ulcers Establishment of adequate blood circulation Maintenance of a moist wound environment Management of wound infection Wound cleansing Nutritional support, including blood glucose control for subjects with diabetic ulcers Bowel and bladder care for subjects with pressure ulcers at risk for contamination Management of underlying disease
Other Names:
Show Detailed Description
|Ages Eligible for Study:
|18 Years to 95 Years (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- A patient who meets all the following criteria will be enrolled in the postmarket surveillance program:
- Presents with exuding wounds, such as leg ulcers, pressure ulcers, and diabetic ulcers and mechanically or surgically-debrided wounds.
- Male or female subject of any race, and 18 to 95 years old.
Exclusion Criteria:
- Study investigator(s) shall follow the Contraindications, Precautions, and Warnings relevant to subjects enrolled for treatment of wounds;
- Subjects will be excluded from the trial if any of the following criteria are met:
- If the Subject is on Coumadin medication (or another medication that is known to affect a potential coagulopathy) and has an elevated PT (prothrombin time) at the alert level at baseline, he/she will NOT be enrolled in the surveillance program.
- Ensure the patient does not have any Contraindications as noted in the AutoloGel System Instructions for use, specifically:
- Patients known to be sensitive to components and / or materials of bovine origin
- Patients on chemotherapeutic agents
Patients with the following abnormal laboratory test levels
- hemoglobin <10.5 g/dL
- platelet count <100 x 109/L
- serum albumin level < 2.5 g/dL
- Wounds due to malignancy
- Wounds with active clinically diagnosed infection
Please refer to this study by its ClinicalTrials.gov identifier: NCT00762138
|United States, Georgia
|Aiyan Diabetes Center
|Augusta, Georgia, United States, 30809
|United States, Texas
|Providence Wound Institute
|El Paso, Texas, United States, 79902
|Principal Investigator:
|Macy G Hall, MD
|Speciality Hospital of Washington - Hadley
|Principal Investigator:
|John G Martinez, MD
|VA Southern Nevda
|Principal Investigator:
|Janaki Nadarajah, DPM
|Aiyan Diabetes Center
|Principal Investigator:
|Gregory H Szeyko, MD
|Providence Wound Institute
Additional Information:
|Responsible Party:
|ClinicalTrials.gov Identifier:
|NCT00762138 History of Changes
|Other Study ID Numbers:
|Study First Received:
|September 24, 2008
|Last Updated:
|February 25, 2014
Keywords provided by Cytomedix:
Platelet rich plasma
leg ulcers
pressure ulcers
diabetic ulcers
management of mechanically or surgically-debrided wounds
Additional relevant MeSH terms:
Diabetic Foot
Foot Ulcer
Leg Ulcer
Pressure Ulcer
Pathologic Processes
Diabetic Angiopathies
Vascular Diseases
Cardiovascular Diseases
Skin Ulcer
Skin Diseases
Diabetes Complications
Diabetes Mellitus
Endocrine System Diseases
Diabetic Neuropathies
Foot Diseases
ClinicalTrials.gov processed this record on September 21, 2017