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Shadows & Reflections – Robin Turner
In which, as the year comes to it's end, our friends and collaborators look back and share their moments…
It was the words "looking for her forever family" that did it. It was a phrase weighted with the same kind of heartstring tugging power that the end of Titanic has on the weakened mind after a four day bender. There are so many other things I wish I could say maneuvered themselves into a pole position as most memorable thing this year – writing a book; waking up in hotel beds in Latvia, in Sydney and on Burgh Island; sailing to Lundy for a pint or two with my Dad; seeing Harry Hill do stand up in a pub in Chalk Farm; Edwyn Collins at Glastonbury; Bon Iver at the Social; Wales winning the Grand Slam, Calzaghe vs. Hopkins and the Manics elevated to Godlike Genius all in the same month – but, really it was a rescued cat that took top honours. She's quite demanding like that. When we chanced upon the North London Cat & Kitten Rescue Centre and their brilliantly manipulative advert, me and the Mrs knew that Honey, a 3 and a half year old super-scaredy cat, one who'd been locked in a cage for the first 18 months of her life and had been fostered ever since, was coming home with us.
My girlfriend was initially against getting a cat. We'd just bought a first floor flat; we were trying to be good neighbours. Our first act as homeowners was to head off to Australia for a month five days after receiving the keys (this wasn't a ludicrous act of celebration, it had been planned long before we started looking to buy). Within 12 hours of landing on the other side of the planet, we had received a call from the flat downstairs saying water was coming through their ceiling. The idea that after nearly flooding them we'd be adding a caged beast to our wooden floorboards did seem more than just a little sadistic.
Then, when we saw her and read those words on the rescue centre website, we thought, 'fuck it' and buggered the consequences. After a trip on the Silverlink all up the way up to Pinner, we brought Honey back to our flat on Easter Sunday. And we left her alone. She hid under the sofa for weeks, lying on top of the wireless modem (can't be good, that), coming out when the coast was clear to feed and water herself. We'd find random acts of destruction in the morning – pictures knocked over, clumps of fur on top of wardrobes, plants de-earthed – but we'd rarely see her. Slowly, very slowly, that all changed. Six months of tentative steps turned into the occasional brush-past in the kitchen that soon became a cautious curiosity. A gradual thawing of a feline / human cold war was happening.
Nowadays, she's a remorseless eating machine, too chunky to fit under the sofa. She's relaxed enough to blank me when I come back from work. Although she's still distrustful of me, she bonded with my girlfriend pretty quickly. Every morning, she impatiently waits outside the bedroom at bang on 8am, before performing a routine that involves scratching up the carpets then occupying a large amount of the bed, commanding all attention until we head off to work. Her favourite evening position is sat on my girlfriend's neck, positioned impossibly under the chin, blocking everything from TV to esophagus. Basically, she went from being a petrified, near-feral animal to being like an over-fed, demanding petulant teenager in the space of six months. She is also almost ridiculously grateful for a warm home and some familiar faces opening the door every night. All the effort has been entirely worth it.
Outside of a great deal of cat care, seeing the trailer for Watchmen on the screen for the first time was a strangely affecting moment, a nostalgic twist on my teenage years in glorious Technicolor. It sort of reminds me of what John Peel said about The Fall – it's reassuringly the same, only very different. 22 years after I had religiously bought each issue of the comic from a twisted freak who ran a stall in Newport Provisions Market, there it was, moving, talking, alive. Back then, I used to hide each monthly issue of Alan Moore's masterpiece in my school bag before going to see my mates who ran Rockaway, the punk as fuck record stall 10 yards down the hallway in the market. In my befuddled teenage brain, I was convinced that a being caught with a comic book was uncool. In Rockaway terms, having Dead Kennedy's song titles tattooed across your face was the epitome of cool. Nowadays, I'm not actually sure that either thing is that cool but I'm still glad I stopped short at getting "Nazi Punks Fuck Off" inked on my neck. I can't vouch for whether the film will be any good or not (these things are usually crap aren't they?) but from the bits that are up there… well, it looks like I wanted it to back then. Here's hoping that when it's released in March it makes good on the two decades plus of expectation.
Records wise, Fennesz's 'Black Sea' has made a decisive late entry. If you're not familiar with his records, imagine Kevin Shields properly freed from the constraining straightjacket of rock'n'roll structures, of instrumentation… well, of everything apart from the frigid squall of dirty harmonic feedback. Pretentious as it sounds, it's utterly brilliant.
Though it has to be said, when played loud it drives cats fucking berserk.
Shadows and Reflections column (353)
Shadows & Reflections - John Andrews
In which, as the year comes to it's end, our friends and collaborators , look back and share their moments;...
Shadows & Reflections - Neil Thompson


Vackfire is the moral of the story, which is if you lie, sooner or later you will be caught. English language — Textbooks for foreign speakers.
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The students persuade wealthy businessman A.J. Arno to donate an old computer to the college.
Owen Hanson, a former walk-on football player at USC who played tight end for the Trojans in the early-2000s, is one of 22 people who have been charged with running a massive international drug smuggling and gambling ring.When hockey star Jaromir Jagr finally cashed in on a sports wager, his bookie and the bet-takers let out a brief roar of excitement from their gambling hub in Costa Rica. Alleged kingpin in online betting ring to stand. he pleaded guilty to first-degree attempt to promote gambling. college freshmen have never lived.
A New York gambling ring bust netted the arrests of 14 individuals by New York police this week, in connection to a multimillion dollar sports betting setup that flourished in parts of New York, New Jersey, and Florida.
Review of the Literature. of gambling incidents involving college student athletes is.
They are known to organized crime and gambling investigators in the city and.The gambling ring allegedly worked with offshore websites and is accused of laundering.
Gambling purses were frequently in. from the property of the former Atlanta Falcons quarterback Michael Vick in connection with an illegal dogfighting ring.WPRI 12 Eyewitness News on WPRI.com is Providence, New Bedford, Fall River news and weather.A Rockville Centre man was indicted Tuesday as part of a Bayside sports gambling ring, Queens prosecutors said.
Arno is the secret head of a large illegal gambling ring, which used the computer for its operations. Officials say that the ring made millions each month, taking bets on college and.
Marika just won a college scholarship because of her. causing it to ring. Continued gambling behavior is best explained in terms of which process of.
Sports-Gambling offers up to 195% in bonuses for boxing betting.This case study examines how sports gambling affects college.
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Ring suggests a small and intimately related group, combined for selfish and often dishonest purposes: a gambling ring.A former California college athlete charged with running an international drug trafficking and illegal gambling organization was sentenced to more than 21 years in federal prison.
Big US Sports Betting Busts In 2016 Serve As Backdrop For Legalization Effort Will. men with operating an illegal gambling ring,. coffee and college.
Video gambling cash payouts violate state law. investigated by city police over an alleged gambling ring.
An ex-University of Southern California football player led a sophisticated drug and gambling ring, federal prosecutors say, with the former Trojan sending a professional gambler a threatening DVD that showed a masked man beheading two victims with a chainsaw, and a note saying the same would happen.Sports Betting Ring Busted Up by Feds. professional and college basketball,.
Police charge Staten Island men with illegal gambling A multi-million dollar illegal online gambling ring was broken up at its Castleton Corners headquarters. Staten Island resident Joseph Stentella, 56, allegedly had more than 600 customers betting on horse races, football, basketball, hockey and mixed martial arts fig.
Handsome and popular football star Red Grange is poised to lead Clay College to a victorious season.SEVENTEEN CHARGED IN MULTI-MILLION DOLLAR JOINT GENOVESE AND BONANNO ORGANIZED CRIME FAMILY GAMBLING. numbers and college and. in the gambling ring.Sources say that gambling records seized during June raids led Rochester-area authorities to Vanek and others who had possibly bet with the alleged gambling ring.Doubling Down on Sports Gambling: Why PASPA Would Fail A Constitutional Challenge.
New Jersey Police Arrest 42 in Gambling Ring Bust. Surely the streets will also be free of drugs since they captured enough marijuana to keep a typical college.Colorado and Notre Dame who were allegedly involved in the ring. Former Bryant College basketball player Christopher Simmons was arrested and an active player suspended for their alleged involvement in a gambling ring at Rhode Island colleges.He is alleged to have run a Manhattan poker club. (Joe Tabacca for New York Daily News).
The president of Bryant College will meet with the Rhode Island State Police today to. highly organized on-campus gambling ring operating between Bryant. It could reflect a rapid growth of gambling among college students which.
A young private detective is set up to take the fall for a college gambling ring that has paid a football player to throw the National Championship.
Best Movies About Sports Gambling. this 2003 Mark Illsley directed piece delves into the rising hotbed of sports gambling on college campuses.
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The commission says it had received complaints about gambling at several businesses, and the investigation determined that at least five.Jason Levine, 45, was among five men charged in connection with the ring, which the Quee.
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A selection of apricot, orange and cream tones with fresh whites synonymous with the month of April. This edit encompasses varieties of Butterfly and Elegant ranunculus, alongside hanging birch twigs and prunus. The perfect addition to your spring home or a stunning gift.


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Law Society launches project to improve wellbeing of Irish solicitors
Published 8 October 2019
Teri Kelly
The Law Society of Ireland has announced the launch of a new initiative designed to promote wellbeing in the solicitors' profession in Ireland.
Independent research recently commissioned by the Law Society revealed that 57 per cent of solicitors frequently experience very high or extreme levels of stress.
The Professional Wellbeing Project launched yesterday aims to address the needs identified in the research by providing practical supports, education and guidance across three pillars: workplace culture, resilience and wellbeing, and emotional and psychological health.
Teri Kelly, director of representation and member services, said: "The Law Society's Professional Wellbeing Project has been designed to address the specific issues our members have told us they experience in the course of their work as solicitors.
"It aims to address the current stigma attached to talking about and seeking help for stress and mental health issues.
"The evidence shows that this is a global problem; legal professions around the world experience high levels of stress that negatively affect mental health and wellbeing."
According to the research carried out by Psychology at Work last year, Irish solicitors have a lower wellbeing score than the lowest average population score in the EU. The main stressors are large workloads, high client expectations, and not having enough time to complete their work, among other findings.
Ms Kelly said: "It's important to note these findings are considered a likely, but not definitive, representation of the membership as a whole.
"However, paired with the international research available and some direct feedback from members, we have a strong basis for developing a proactive programme to promote wellbeing among our members."
She added: "We know that criminal law and family law practitioners in particular can be exposed to distressing materials, cases and situations in the course of their work. It's not hard to imagine the negative impact this can have on solicitors' wellbeing.
"US research even suggests that lawyers may experience significantly higher levels of vicarious trauma and burn-out than US mental health clinicians and social service workers."
Some of the key tools and supports that solicitors will be able to access as part of the Professional Wellbeing Project include:
Regular seminars and Continuous Professional Development training on these issues;
Mental health and wellbeing signposts to confidential, independent services and resources where members can seek help and advice;
An opt-in Employee Assistance Programme, which will be of particular help to sole practitioners and solicitors in smaller firms;
An annual conference on the business of wellbeing;
Best practice guidelines for firms on wellbeing;
A Peer Support Network pilot; and
Collaborations with mental health and wellbeing organisations.
Ms Kelly said: "We know that our members want to be there for each other in a real and effective way: solicitors want to know more about how to support colleagues who are experiencing distress or stress.
"The Professional Wellbeing Project, along with the existing supports already in place for trainee solicitors via the Law School Psychological Services, aims to meet these needs in an effective, modern and evolving way."
Tags: Law Society of Ireland, Lawyers' safety
High Court: Application for costs on 'solicitor and client' basis refused Government refuses again to provide breakdown of payments to lawyers Challenge to redrawing of electoral constituencies to be heard on appeal
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Clifford McIlvaine, a St. Charles homeowner with a three-decade old construction project who was recently found to be in contempt of court, wants his Friday sentencing delayed until July 23 because he has kidney stones.
According to court papers filed last week, McIlvaine wants Judge Thomas E. Mueller to delay sentencing while McIlvaine recovers from a bout with kidney stones that his doctor says could take three to four weeks to clear up.
The St. Charles man also will ask the judge to reconsider his ruling that he is in violation of an agreement to finish work on his house at 605 Prairie Street by this fall.
City officials sued McIlvaine in late 2010, arguing he had not allowed the city to inspect construction on his home that began in 1975.
The city argued that the project was a safety hazard and a neighborhood eyesore.
The two sides eventually inked an agreement that required McIlvaine, who could not be reached for comment this week, to complete the work by September 2012.
But McIlvaine missed several deadlines, and last month was found by Mueller to be in contempt of court. McIlvaine also plans to ask Mueller to reconsider his ruling that McIlvaine was in contempt of the agreement.
Phil Luetkehans, an attorney representing the city, has said the city will seek fines instead of jail time against McIlvaine and the city just wants the project done.
Luetkehans on Wednesday said the city has representatives visit the site on a weekly basis now and McIlvaine "has made very little progress" since he was found in contempt last month.


Architecture firm Goettsch Partners (GP) celebrated the opening today of the new North American headquarters for Swiss-based Zurich Insurance Group in Schaumburg, Illinois, marked by an official ribbon-cutting ceremony. The 783,800-square-foot building will be home to nearly 3,000 employees and contractors, and was designed with an emphasis on communication, collaboration and wellness.
GP designed the Zurich North America Headquarters to reflect the company's global reach and world-class stature. The formal architectural resolution strives to represent both strength and stability, which are core values of the Zurich business model. Composed of three primary "bars" that are offset and stacked, the arrangement creates unique spaces for collaboration, opens views of the surrounding landscape, optimizes solar orientation for amenities, and provides programmatic flexibility not found in typical center-core office buildings. The top "bar" of the complex soars 11 stories and cantilevers toward downtown Chicago, providing visual identity along the interstate while projecting the strength and future focus of the company.
Recently certified LEED Platinum, the complex reinforces Zurich's commitment to environmental stewardship. A network of horizontal sunshades clads the perimeter of the complex, with the sunshades varying in depth depending on orientation, while floor-to-ceiling glass offers extensive natural light for the shallow office plates. A soaring three-story double wall faces south toward the multi-level plazas, showcasing an architecture that responds to the changing Chicago climate. In the end, a timeless material palette married to a bold, clear form creates a unique identity for the Zurich headquarters that embodies the core values of the company.
"This building is a showcase of all we are at Zurich: its excellence in design, its focus on sustainability, and its reflection of our employees," said Mike Foley, chief executive officer for Zurich North America.
In addition to GP as the architect, the project team included Zurich (client), Clayco (developer/design-build), JLL (client representative), CannonDesign (interior design and workplace strategy), WSP/Halvorson and Partners (structural engineer), Hoerr Schaudt Landscape Architects (landscape architect), and V3 Companies (civil engineer), among others.


4. Medicare: Can Health Reform Save Money?
5. Medical Gluttony: Motorized Wheelchairs? And then it happened . . .
7. Overheard in the CMA (Certified Medical Assistant) Meeting: Are offices getting hostile?
8. Voices of Medicine: Obama's Health Plan Will Succeed . . .
That which the government gives, it can also take away. . .
And not only that. Since pharmaceuticals and biologics are powerful things that can do great harm if they are misused or misapplied, the companies that made them found themselves under assault for injuries they might have caused. It was little considered that the drugs had been approved for use by a federal agency that imposed the world's most rigorous standards, and was often criticized for holding up promising treatments (especially for AIDS). Juries were convinced that companies had behaved with reckless disregard for the health of consumers, and hit them with enormous punitive damages claims. . .
The NIHCM study opened fresh lines of attack. The first came from the managed-care industry, which used it as a means of arguing that drugs had simply grown too expensive. Managed care is extremely price-sensitive, and its business model is built on cutting costs; executives of the industry were well represented on the board of the institute that put out the report. They were, in effect, fighting with the pharmaceutical companies over who should get more of the consumer's health-care dollars.
The second came in response to the approval by the FDA in 1997 of direct consumer advertising of pharmaceuticals. The marketing explosion that followed it gave people the sense that these companies were not doing life-saving work but were rather engaged in the sale of relative trivialities, like Viagra and Rogaine, on which they had advertising dollars to burn that would be better spent on lowering the cost of drugs. And the third element of this mix was the rise of the Internet, which gave Americans a level of price transparency that they had not had before regarding cost differentials between drugs sold in the U.S. versus Canada and other Western countries. . .
FDA approval is not the only hurdle for products making their way to market. Manufacturers and investors need to deal with the Department of Health and Human Services at four levels in order to get a product to market and reimbursed. Basic research begins at the National Institutes of Health (NIH), a $30-billion agency that often partners with the private sector on promising new areas of research and that has just received a $10-billion boost from the stimulus package. The FDA then handles approvals of products. Once a product has been approved, someone must pay for it in order for the product to be used. The Centers for Medicare & Medicaid Services (CMS) determines which products will be paid for by Medicare. Because CMS is the largest single payer in the health-care system, its decisions often help to determine which products will eventually be covered by private insurance companies as well. Finally, the Agency for Healthcare Research and Quality is in the process of increasing its role in conducting post-market product evaluations. These bureaucratic and evaluative hurdles have injected far too much uncertainty into the process and have dried up investment capital for the industry as a whole. . .
. . . Most famously, perhaps, Dow Corning was forced to declare bankruptcy after being flooded with over 20,000 lawsuits and 400,000 claimants over its silicon breast implants, despite the fact that the evidence has finally demonstrated definitively that they are not harmful.
The results are unmistakable. Dow Corning was forced to remain in bankruptcy for nine years. . .
The situation as it stands now is bad enough. But it would be made worse by the proposed elimination of an FDA policy called preemption, which holds that when federal laws come into conflict with state or local laws on drug matters, federal laws prevail. This is particularly important for the FDA, which sets federal safety standards. Preemption makes the FDA standards supreme as long as the manufacturers adhere to FDA guidelines. This policy prohibits trial lawyers from suing manufacturers in circumstances where the manufacturer adhered to the federal guidelines but where state law differs. A recent Supreme Court case, Wyeth v. Levine, opened up this issue by ruling that the FDA's approval of a medication does not protect the drug's maker from state-level lawsuits, thereby limiting preemption's scope. . .
We forget the power of the single-celled organism. For most of man's existence on earth, the power of a single-celled animal to snuff out life was an accepted—and tragic—way of the world. Human beings could be wiped out in vast communicable plagues or simple through ingesting food or water. In the last century, the advent of the antibiotic has changed all that. For millennia, the only cure for an infection in humans was hope. Today, antibiotic use is so common that public health officials struggle to get people not to overuse antibiotics and thereby diminish their effectiveness.
Just as there is potential danger from the way in which Americans take the power of the antibiotic for granted, so, too, one of the greatest threats to our health and continued welfare is that Americans in the present day, and particularly their leaders, are taking for granted the power, potency, and progress flowing from life-saving medical innovations. And in so doing, they may unknowingly prevent the kind of advance that could contribute as vitally to the welfare of the 21st century as the discovery altered the course of human history for the better in the century just concluded.
Read the entire treatise . . .
About the Author: Tevi Troy, deputy secretary of the United States Department of Health and Human Services from 2007 to 2009, is a visiting senior fellow at the Hudson Institute.
Neuroscientist Paul Bach-y-Rita hypothesized in the 1960s that "we see with our brains not our eyes." Now, a new device trades on that thinking and aims to partially restore the experience of vision for the blind and visually impaired by relying on the nerves on the tongue's surface to send light signals to the brain.
Legal blindness is defined by U.S. law as vision that is 20/200 or worse, or has a field of view that is less than 20 degrees in diameter. The condition afflicts more than one million Americans over the age of 40, according to the National Institutes of Health. Adult vision loss costs the country about $51.4 billion per year. . .
From the CPU, the signals are sent to the tongue via a "lollipop," an electrode array about nine square centimeters that sits directly on the tongue. Each electrode corresponds to a set of pixels. White pixels yield a strong electrical pulse, whereas black pixels translate into no signal. Densely packed nerves at the tongue surface receive the incoming electrical signals, which feel a little like Pop Rocks or champagne bubbles to the user. . .
In any case, within 15 minutes of using the device, blind people can begin interpreting spatial information via the BrainPort, says William Seiple, research director at the nonprofit vision healthcare and research organization Lighthouse International. The electrodes spatially correlate with the pixels so that if the camera detects light fixtures in the middle of a dark hallway, electrical stimulations will occur along the center of the tongue.
"It becomes a task of learning, no different than learning to ride a bike," Arnoldussen says, adding that the "process is similar to how a baby learns to see. Things may be strange at first, but over time they become familiar."
Seiple works with four patients who train with the BrainPort once a week and notes that his patients have learned how to quickly find doorways and elevator buttons, read letters and numbers, and pick out cups and forks at the dinner table without having to fumble around. "At first, I was amazed at what the device could do," he said. "One guy started to cry when he saw his first letter."
Wicab will submit BrainPort to the U.S. Food and Drug Administration for approval at the end of the month, says Robert Beckman, president and chief executive officer of the company. He notes that the device could be approved for market by the end of 2009 at a cost of about $10,000 per machine. . .
Gene therapy has been rhapsodized and vilified in its nearly two decades of human testing, helping some and making others sicker. But a new 12-month clinical trial has shown that, at least in one ocular disease, it appears safe and—perhaps even more impressive—effective.
The researchers report that three young adults with severe vision impairment from a hereditary disease maintained improved eyesight a year after gene therapy was administered—and didn't suffer any health side effects in the meantime. Gene therapy, which often employs viruses to deliver the good genes to a body's target cells, has been known to trigger severe immune responses and was blamed for the death of an 18-year-old in 1999, who was receiving gene therapy for a hereditary metabolic disorder.
The test subjects suffer from Leber congenital amaurosis (LCA), a form of hereditary retinal degeneration that occurs in infants and young children and is relatively rare. Most people who have lost vision due to hereditary retinal degeneration have either no photoreceptors with which to perceive light or photoreceptors that don't work. "This disease has a little bit of both," explains lead study author Artur Cideciyan, an associate research professor at the Scheie Eye Institute at the University of Pennsylvania. "It's a complex disease."
The participants, ages 22 to 25, all had a mutation on the RPE65 gene, the signature of LCA. Doctors administered normal RPE65 (delivered via an rAAV2 vector) into a site on one of the retinas that had the most photoreceptors left. And, Cideciyan says, "Within weeks of the procedure there was a substantial, very significant improvement in sensitivity to see dim lights. . .
A litany of failings at the trust was uncovered by the Healthcare Commission in one of the most critical reports of NHS treatment ever published.
. . . patient groups voiced concern that managers who should have spotted failings at the trust but did not raise the alarm have been promoted to key jobs in the NHS and health care regulation.
The investigation into care between 2005 and 2008 found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes and reception staff expected to judge the seriousness of the condition of patients arriving at Accident and Emergency.
Doctors were diverted from seriously ill patients to treat ones with minor problems to make the trust look better because it was in danger of breaching the Government's four-hour waiting time target.
The trust – which was under pressure to save £10 million from its annual budget – was more concerned with hitting targets, gaining foundation trust status and PR marketing and had "lost sight" of its responsibilities for patient care, the report said. . .
It is not clear how many patients died as a direct result of the failures, but the commission found that mortality rates in emergency care were between 27 per cent and 45 per cent higher than would be expected, equating to between 400 and 1,200 "excess" deaths. . .
The trust is spread across two hospital sites, one in Stafford and one in Cannock. Most of the problems occurred at Stafford. Patients described one ward as a "war zone" and said people were often left in Stafford's A&E for hours covered in blood and without pain relief, even though they had serious injuries. Others were left without food or drink, leading some to reportedly drink from vases when thirsty.
Some patients also received the wrong medication – or none at all.
Martin Yeates, the trust chief executive, and Toni Brisby, its chairman, stepped down two weeks ago. Mr Yeates, who is paid a salary of £160,000 a year, is suspended on full pay while an independent investigation is carried out.
But patient groups were angered that Cynthia Bower who, from July 2006, was chief executive of the West Midlands Strategic Health Authority — which had responsibility for checking standards at the hospital — is to become the head of the health super-regulator, the Care Quality Commission.
David Nicholson, her predecessor at the authority's forerunner, the Shropshire and Staffordshire SHA, left in 2006 and is now the chief executive of the NHS. Sir Ian Kennedy, the chairman of the Healthcare Commission, said the report was a "shocking story" and that there were failures at almost every stage of care of emergency patients.
The problems emerged after the hospital was reported in 2007 to have high mortality rates among patients. But the trust's board of directors "fobbed off" NHS investigators by saying the rates were a result of statistical errors.
. . . the Healthcare Commission concluded this was not the case.
Its report stated that staff members claimed care of patients had become secondary to government-imposed targets. The report said there was a "reluctance to acknowledge or even consider that the care of patients was poor".
Nurses were threatened with the sack because of the number of breaches of the target to treat A&E patients within four hours and felt they were "in the firing line".
Patients in danger of breaching the target were put in a "clinical decision unit", a "dumping ground" for patients in order to "stop the clock" on the waiting time.
Relatives reported nurses shouting at patients and a survey found two thirds of doctors would not be happy to have a family member treated at the hospital.
The NHS does not give timely access to healthcare, it only gives access to targets.
Health care spending per person varies widely across the country, but greater spending does not appear to produce better quality. A natural inference is that some areas of the country are less efficient in the use of health care resources.
Thus, it is argued that health spending could be cut substantially if the high-spending areas practiced medicine in the same way as the low-spending areas. Office of Management and Budget Director Peter Orszag, for example, argues that health care spending for the country as a whole could be reduced by $700 billion a year. But how can these savings be realized?
· In 2004, average Medicare spending in Louisiana (the highest spending state) was $8,659 while spending in South Dakota (the lowest spending state) was $5,640, almost 35 percent less.
· Taken as a group, Louisiana, Maryland, New Jersey, Florida and Texas averaged more than $8,200 in 2004, or about $800 above the national average for Medicare spending.
· By contrast, South Dakota, Montana, New Mexico, Hawaii and Idaho all spent less than $5,800 - about 40 percent less than the states at the top of the distribution.
· Overall, if every state were as "efficient" as the fifth lowest spending state, Medicare spending could be reduced by about 25 percent.
These numbers appear to confirm Orszag's claim without answering the question of how we could dramatically change the practice of medicine in 45 states. However, before concluding that there are large potential savings, there are two important factors that need to be considered.
Spending on Other Patient Groups by State. News stories often imply that doctors in high-spending Medicare states are practicing medicine in a way different from doctors in low-spending states. One is left to infer that this must also be true for Medicaid patients and private patients as well. But this inference is not entirely true.
· Although Texas is fifth highest in Medicare spending per capita, it is 43rd in per capita spending for the state's entire population.
· California is 11th in Medicare spending, but 42nd overall.
· North Dakota is 43rd for Medicare, but 11th overall.
It appears that high Medicare spending is often associated with lower spending on the non-Medicare/Medicaid population and vice-versa. This observation is consistent with cost shifting between public and private payers, although there may be other explanations as well.
Read the entire article at www.ncpa.org/pub/ba668.
When returning to my office on Fair Oaks Blvd last week, the traffic came to a halt. Ahead at the corner of FOB and Stanley, there had been an accident. Two motorized wheelchairs had collided in the intersection. As I started to get out of the car expecting to help two disabled persons, I noted that both were already up and laughing as they helped each other upright their MWC. They then proceeded to shake hands as they climbed aboard and took off again. The traffic resumed and I arrived at my office on time for my afternoon patients.
Requests for motorized wheelchairs are becoming almost a daily occurrence. The requests are seldom based on substantiation of disability, but rather that their neighbor or friend or someone else at the senior residence has one and they don't seem to be as ill as my patient, or that it would be nice to tour the neighborhood in one.
I have a number of patients who live within a mile or two of my office that drive their wheelchairs to my office building and up the ramp. They park their motorized wheelchair in the hallway and stride into my office. Some use a cane. The patient last week said he would stop by the grocery store on his way home to buy his groceries for the week. Does he still own a car? He said he did but would probably convert that to cash since he now had an alternate form of transportation, with thanks to Medicare. He felt he was deserving since he paid for it with his Medicare premiums over the year.
Today, I had two requests for motorized wheelchairs from a 98-year-old woman and her 76-year-old daughter on a visit I made to their homes, which were in the same block. Both were rather weak. The younger one was suffering from fibromyalgia and could sit for no more than 30 minutes. How could she sit in a wheelchair and travel up the street to see her mother? She was too weak to even squeeze my hand. How could she manage the arm and lever to drive the wheelchair? What would she do if she overturned on the hilly area where she lived? I felt it was far too hazardous for her to have a motorized vehicle and that her grandson and great-grandson that lived with her should continue to help her about.
The older one was obviously too weak to even consider one and, furthermore, she was essentially blind. She put her hand to my face to help locate where I was at her bedside. I didn't write a prescription for either.
When people get entitlements, they always feel they are entitled to even more. There is no limit.
With the proposed healthcare reforms, our medical costs will at least double until they are contained by denial of service and a waiting list, which worsen access to healthcare.
To keep up with health care reform, be sure to subscribe to HealthPlanUSA.net by entering your email address at www.healthplanusa.net/newsletter.asp.
Predictors of premature birth include socioeconomic factors such as age under 20, single marital status, being on welfare, and not having graduated high school (Lieberman E, et al. N Engl J Med 1987;317:743-748); chronic health problems such as diabetes, hypertension, or clotting disorders; certain infections during pregnancy; use of cigarettes, alcohol, or illicit drugs (CDC); and prior abortions (Rooney B, Calhoun BC, J Am Phys Surg 2003;8:46-49). Increasing Medicaid coverage for pregnant women had no effect on birth outcomes (Ray WA, et al. JAMA 1998;279:314-316).
Additional information and references at www.aapsonline.org/newsoftheday/00307.
Medical Myths Originate When Statistics are Manipulated for Political Reasons.
Medical Myths Disappear With Honesty in Calling a Breathing Baby a Live Baby.
7. Overheard at the CMA (Certified Medical Assistant) Meeting: Are offices getting hostile?
Mabel: Have you noticed how impatient offices are getting with each other?
Ann: It seems like most of the consultant's offices are rather short.
Nancy: Well, I have an angry doctor who's upset because the referral and records aren't here and the patient is here.
Ann: Don't you check your fax inbox before you get angry with the referring physician who needs your doctor's opinion? I'm sure your doctor is grateful for having his expert opinion sought.
Nancy: We get so many faxes every day. I don't have time to go through all of them.
Mabel: Well, Good Grief. Is that any excuse to make a hostile phone call to the physician who is referring the patient whose fees pay your salary?
Ann: Don't you think you should at least look through the fax "holding pen" or whatever you might call it before you cause further work for the referring physician's office?
Jane: It shouldn't be too much trouble to have them fax it again, should it?
Ann: When we fax the referral, we dismantle our chart to make sure the last complete exam is faxed along with recent and relevant x-rays and lab reports. We also include face sheets and insurance information so your doctor and office is efficient with time and can write a good report.
Jane: My doctor just dictates his consultation with the available information and then adds that additional reports will be sent when the information is complete.
Mabel: If your doctor has to give an additional report, because of your inefficiency, doesn't that cause inefficiency through the whole chain?
Nancy: I don't understand. Through the whole chain?
Mabel: If your doctor has to see the patient a second time to give a report, it no longer is timely.
Ann: Meanwhile, the referring office has to send the entire record again; the patient is inconvenienced and has to wait to benefit from the second opinion. Doesn't that essentially double all costs?
Mabel: If your doctor has to pay you twice to do the work that should have been done correctly the first time, doesn't that double his cost of paying you?
Nancy: How does that affect my salary?
Mabel: If everything you do is doubled or takes twice as long, then you're getting paid twice what you're worth or what a more efficient CMA would cost.
Nancy: Just let my doctor try to cut my salary in half.
Ann: As his overhead goes up and he makes less and less, it won't take him long to realize that it would be more cost efficient to pay a good CMA that does twice as much work as you do for about the same salary. Your job will be in jeopardy.
Susan: Mabel, listening to you and Ann has certainly put my job in perspective. I must confess that on several occasions, Ann has asked me to take another look for previously faxed records. And sure enough, they were already in our office two weeks prior, just as she had documented.
Ann: I think the key is getting everything taken care of, whether it's messages or filing or acting on reports, before going home every night. The phone starts ringing within 30 seconds after I reach the office, so there is never any time the next day to catch up.
Mabel: You would be even further behind by the end of the next day.
Susan: I'm certainly sorry I've caused you extra work. I'll make sure the faxes are filed immediately in the appropriate charts. If it's a new referral, I'll make up a temporary folder until the patient arrives for his or her appointment.
To keep up with what's new, be sure to subscribe to HealthPlanUSA.net by entering your email address at www.healthplanusa.net/newsletter.asp.
. . . At getting people to die faster.
ill people die more quickly, costs will inevitably be cut.
It's really quite simple. Take cancer treatment. If we can just make sure to treat cancer patients with older, cheaper, more ineffective treatments, then treatment will actually be more effective -- at cutting costs as more cancer patients die. We not only save the cost of more expensive medication -- we also save by relying on less expensive stays in hospices instead of more extended active treatments.
More importantly, if we can help patients die quickly now, then we can save on the cost of any future major illnesses they would've had that would have cost society a whole boatload of money. Basically, one severe potentially terminal illness is cheaper than two. Some cancer patients may try to demand more up-to-date, effective treatments, but society must obviously ignore their selfish desires to live.
The Obama plan is going to accomplish this with its billion-dollar investment in "comparative-effectiveness research." This is a coup, because it sounds so rational and scientific. A sophisticated observer can see that it will be "comparatively effective" at reducing the rate at which new, more effective treatments are utilized. The kind of large, expensive studies required to prove that newer treatments are less effective at killing off patients will be so difficult to conduct that the newly created "Federal Coordinating Council for Comparative Effectiveness Research" (or FCCCER, pronounced faux care) will have cover for many years before it's compelled to approve any new treatment.
Such is the excellent model provided by Great Britain's National Institute for Clinical Excellence, known by the wonderful acronym NICE. Indeed it was "NICE" how the agency "regrettably" found last summer that four admittedly "clinically effective" lifesaving medications for kidney cancer were not "cost-effective uses of NHS resources." NICE has been wildly successful in shortening the overall amount of time that the British medical system is forced to treat cancer patients. In Great Britain, survival rates after a cancer diagnosis range from 40.2 to 48.1 percent for men and 48 to 54.1 percent for women. The United States currently boasts an inefficiently high rate of 66 percent for men and 63 percent for women.
Of necessity, part of Obama's plan is to get physicians focused on purchasing, integrating, and pulling their hair out over how to use fully computerized, government-approved medical records systems. Many physicians complain that these systems don't work well in their practices, that they're time consuming, and that they take time away from patient care. But these computer systems are absolutely essential in ensuring that physicians don't try to practice medicine themselves and instead comply with the FCCCER's dictates to use outdated treatments. Computer records will permit minute, constant scrutiny of physicians, who will be penalized for trying to use independent judgment in prescribing unapproved treatments.
An underappreciated part of the plan is the expected savings on Social Security benefit payments, if we can be more effective in not prolonging the suffering of those that could be terminally ill. It would be nice to see White House economists include such assumptions in their calculations to help bolster their argument for adoption of the President's plans. That is the type of forward thinking that we need to sell this bill of goods to an American public so unsophisticated that they are worried about having the government fully take over one-seventh of the national economy during this time of economic distress and multi-trillion-dollar federal debt.
Mark Schiller, M.D., is a Senior Fellow at the Pacific Research Institute and a board member of the Benjamin Rush Society, a medical society that is dedicated to serving patients, not the government.
Greg Scandlen reviewed Gratzer's Code Blue, the story of the Canadian Health Care System, for Medical Sentinel, the Official Journal of the Association of American Physicians and Surgeons. We think this message needs to be read by every American during the health care reform debate.
Long the shining beacon for the American Left, the grand example of successful socialism on North American soil, the Canadian health care system is falling apart, or so says David Gratzer in Code Blue: Revising Canada's Health Care System. Gratzer was a medical student at the University of Manitoba when he wrote the book and now practices psychiatry in Toronto.
Canada's system, known as "medicare," is run by provincial governments and paid for by a combination of provincial and national funds. Copayments are not allowed, nor are people allowed to go outside the system and pay for services directly (unless one leaves the country). The system is plagued, Gratzer writes, by long waiting lists of sick patients, overcrowded hospitals, second-rate equipment, and a stream of doctors, nurses and patients fleeing to the United States. He documents these woes not only with a host of health care horror stories from Canadian newspapers, but with a long list of studies, both official and private.
Even after adjusting for these differences, Canadian medicine may still be cheaper, but you fail to get what you fail to pay for – in this case, modern equipment, adequate facilities, and motivated physicians.
He maintains that the early success of medicare – back when the population was young and costs were low – became hard-wired in the Canadian psyche as a source of national pride. Now that the system is failing, no political leader wants to be the first to tell the truth. As with "The Emperor's New Clothes," denial reigns supreme.
Gratzer doesn't stop at documenting the problems in Canadian medicine, nor at laying the responsibility at a political class that prefers to look the other way. He also examines possible solutions and their consequences, including simply spending more money, applying user fees, or creating a parallel privatized system to supplement the public program. Any of these reforms would be an improvement, he says, but "the most important step toward renewing health care in [Canada] is to accept that medicare is fundamentally flawed." He notes that medicare currently "consumes 21 cents of every dollar earned by working Canadians," and the Office of the Superintendent of Financial Services projects a tax rate of 94.5 percent will be needed to support the program in 2040 without fundamental reform.
Instead, Dr. Gratzer would like to see patients making their own decisions about how to best spend their health care resources, whether those resources come through the government or directly out-of-pocket. And the best way to do this, he proposes, is through a national system of medical savings accounts (MSAs), combined with high-deductible indemnity insurance plans. He examines several alternative MSA designs, including the possibility of government-provided high deductible insurance and tax-payer funded "allowances" for MSA deposits. He prefers self-funded MSAs using tax-free deposits. He argues that the poor and persons with "special needs" could be granted extra assistance.
He concludes that "Medical savings accounts aren't a miracle solution. But an MSA system has the potential to address many of the problems with the present health care system in Canada." They could fix the problems of waiting lists, second-rate equipment and fleeing physicians, while maintaining accessibility and timeliness of care.
Hillary Rodham Clinton has been stomping through a number of South African Countries extolling human rights. William Jefferson Clinton has been meeting with the Dictators of the Most Unfree Country in the world, North Korea, for the human rights of two reporters in prison. Barack Hussein Obama has been stomping the United States to eliminate Human Rights in Health Care.
Can't Politicians Ever Get Things Straight?
Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single-payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.
Will Barack Hussein Obama become as famous as Bismarck?
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/. To read more on Dr Berry, please click on the various topics at his website. Review How to Start a Third-Party Free Medical Practice . . .
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "single-payer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read . . . Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin, who is the author, most recently, of "Digital Barbarism," just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.
Robert D. Novak, who died Tuesday at age 78, parlayed shoe-leather reporting and a dour worldview into a prime spot among the Washington commentariat.
He was universally known as "The Prince of Darkness" for his bleak take on human nature, and he wore the sobriquet proudly, using it as the title to his 2007 memoir of a half-century reporting from Washington. It helped nurture his gloomy persona on display on shows such as "Crossfire" and "The Capital Gang."
"I am a pessimist by nature, which is why I have spent my life as a journalist instead of trying to be a leader, which requires optimism," he wrote in his memoir.
But Mr. Novak's persona -- including his title as "The Prince of Darkness" -- was only a public one. Friends, who describe him as tough, are also quick to call him kind and generous.
"He was given that as a nickname as a very young reporter," says Geraldine Novak, his wife of nearly 50 years. "But everybody who knew him knew that it was nonsense. He was really very cheerful and fun to be with."
Al Hunt, Mr. Novak's longtime sparring pundit partner on television, spoke highly of him as a mentor during earlier years in the Washington press corps. "He was supportive and kind," says Mr. Hunt. "There was pessimism unless you cut the capital gains tax, and then he was an incredible optimist." . . .
A reporter from his student days at the University of Illinois, he later worked for The Wall Street Journal, where he was a Washington correspondent from 1958 to 1963. He left to team with Rowland Evans on "Inside Report," a column of Washington gossip and news that initially appeared six days a week for the New York Herald Tribune Syndicate. . .
Mr. Novak continued his column after Mr. Evans died in 2001, and in 2003 published perhaps his most incendiary column ever, identifying Valerie Plame as a Central Intelligence Agency operative. . .
Because naming a CIA agent can be a crime, questions soon arose as to whether Ms. Plame was in the CIA and who had told Mr. Novak. In the resulting imbroglio, Mr. Novak divulged his sources before a grand jury. A federal investigation ended with the 2007 conviction of a top vice-presidential aide, I. Lewis "Scooter" Libby for perjury and obstruction of justice.
Although a registered Democrat, Mr. Novak identified himself as a conservative. He wrote that his conservatism deepened as his TV persona grew. But his main role continued to be as an "obstreperous reporter looking for trouble." He wrote in his memoir about the heavy drinking that accompanied his hard reporting.
But in the early 1980s, partly because of a bout of spinal meningitis, Mr. Novak curtailed his drinking. That was one of several health setbacks that partly inspired his conversion to Catholicism late in life, at the age of 67. Mr. Novak said he also took part of his inspiration from Whittaker Chambers's book Witness, about Mr. Chambers's conversion from Communism to Christianity. The Judaism he was raised with, he said, was not inspiring at all.
With an all-star group of Washington politicians looking on and Ms. O'Beirne as his godmother, Mr. Novak converted to Catholicism in a 1998 ceremony at St. Patick's Church in Washington.
Presiding at the ceremony was Monsignor Peter Vaghi, who had been a staffer for Sen. Pete Domenici and a source for Evans & Novak before entering the priesthood. Just before Mr. Novak bowed his head to receive the sacramental waters of baptism, Msgr. Vaghi told the onlookers they were about to witness the transformation of a "prince of darkness" into a "child of light."
His friend Sen. Daniel Patrick Moynihan joked, "Well, we've now made Bob a Catholic. The question is, can we make him a Christian."
Years later, Mr. Novak told the Washingtonian magazine that "it was an exhilarating experience, one of the great moments of my life."
In 2008, he seemed in a daze after leaving the scene of an accident after his Corvette hit a Washington pedestrian. Days later, he was diagnosed with the brain tumor that would eventually kill him.
On this date in 1930, Sean Connery was born in Edinburgh, Scotland, the son of a truck driver. He worked the morning milk route before heading off to school. He introduced the role of British superspy James Bond to the silver screen in the 1962 film Dr. No. He recreated the James Bond role five more times before he moved on to other projects after 1971.
On this date in 1918, Leonard Bernstein was born in Lawrence, Massachusetts. He was a famous conductor by the age of 25, and composer of the symphony, "Jeremiah." He moved with ease from the classical to the popular side of composing, meanwhile bringing the New York Philharmonic new glory as its conductor.
On this date in 1836, Bret Harte, the writer, was born in Albany New York. It was Bret Harte who gave the public its first exciting and grubbily humorous accounts of Western life, including such classics as "The Luck of Roaring Camp" and "The Outcasts of Poker Flat." Within ten years he had burned himself out as an author, while friends and colleagues like Mark Twain not only kept on going, but kept on getting better all the time. Some people rise like meteors and fall the same way, while others seem to keep on going, shining brighter all the time. Sometimes it's difficult to know when you're at the brightest and it's time to stop. If you don't, tragedy may happen on your descent.
In partnership with MedicalTuesday.net, the 6th Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference will convene 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies.


While Connecticut's great 18-hole public, municipal and resort courses get most of the attention, there are a number of solid nine-hole tracks that deserve our recognition. These little gems make it easy to fit a quick round into a busy schedule, as well as offer enough of a challenge and aesthetic beauty to entice us back.
Let's take a look at a few of the state's top public nine-hole golf courses.
This is a well-kept, funky layout that was once part of an 18-hole course built originally in 1950. Nine holes were chopped up for housing, thankfully leaving nine solid holes.
Some claim that the par-three eighth hole was the first island green in the nation. It's only a short iron onto the putting surface, but with water all around and sand traps you'd better be accurate.
The fairways here are kept in superb condition and the small greens are undulated, which make them difficult to read.
Minnechaug measures only 2,797 yards from the tips and it has a slope of 111, but you can find trouble on some of the narrow fairways.
This was once part of the private Heritage Village Country Club, but was broken away several years ago to make a nine-hole "resort" tract.
The course has water that comes into play on seven holes. Despite its relatively short overall length (2,750 yards), the wet stuff that lines most fairways and guards several greens can cause big trouble.
Perhaps the best hole on the course is the ninth, a medium length par four that demands a well struck tee shot followed by a solid approach that must clear a stream running in front of the green. The conditions here are always good and the course is very walkable.
The fact that this nine-holer was given a slope of 124 despite having a total distance of under 3,000 yards tells you something about its challenges.
The course ambles up and down several severe slopes and most fairways offer uneven lies. There's water on five holes and plenty of sand traps around each green.
The prettiest hole is the 360-yard, par-four sixth that affords a view of the entire course. The toughest may be the relatively short par-four eighth. The tee shot is played short of a stream with a second shot hit to a dramatically sloped green that has a huge sand trap guarding its front, ready to gobble up short shots.
Tunxis has two solid 18-hole courses, but some prefer the Red nine for its woodland routing and scenic beauty.
With a slope of 123, the 3,297-yard Red has a number of superb holes, some of which were part of the original 18-hole course at Tunxis. Like the 390-yard par-four seventh that calls for a tee shot over water. The eighth, a 200-plus-yard par-three, is a strong short hole.
The conditions, as on both of the facility's 18-hole layouts, are always good and the greens fairly free of undulation.
Here's a real hidden delight tucked away in the quiet hills of southeast Connecticut.
The fairways are generous and the course plays 2,922 yards from the tips with a slope of 117. This course also features an island green, the 138-yard par-three fourth.
The conditions are very good and the layout plays a bit longer than its yardage because of several doglegs and elevated putting surfaces. The large greens are kept on the fast side, so a good short game is necessary.
Woodhaven is a classic Albert Zikorus design that was built in the late 1960's. It's one of the tougher nine-holers in the state, measuring 3,387 yards from the back tees and plays to a slope of 128 with a traditional par of 36.
The routing is through mature woodlands with the fairways lined by large trees that can play havoc with even slightly errant tee shots. There is water on several holes and numerous bunkers. The greens, which are fairly large, are kept rolling fast.
If you like old-fashioned golf courses you'll live the Hotchkiss School Golf Course located in the scenic northwest corner of the state.
The course is on the grounds of The Hotchkiss School, which sends many of its students on to some of the best colleges and universities in the country. But golfers come here for the grand nine-holer that was built in 1911.
Hotchkiss offers the feel of a links layout on several holes, and there are numerous undulations in the fairways, which makes club selection tricky.
The best hole is a short, but monstrously difficult par-five. Measuring under 500 yards, the ninth hole demands a tee shot be hit to a landing area bordered by a pond to the left and woods to the right. The layup must be to another small landing area on a hill that leads up to the green, followed by a short iron approach to the elevated putting surface. If you go slightly left, just drop another ball down.
Hotchkiss measures slightly over 3,000 yards and was given a slope of only 111. But ask the locals and they will tell you this is a tougher course than it looks, especially when the wind blows.


text:
Reliever Richard Bleier has healthy debut in Orioles' 6-1 split-squad loss to Yankees
By Peter Schmuck
| Sarasota, Fla.
Left-handed reliever Richard Bleier was the first to acknowledge the results weren't pretty, but he was pleased with everything else about his first appearance in a game since he suffered a severe lat muscle injury in June.
Bleier retired just two batters and allowed three runs (one earned) on three hits in the Orioles' 6-1 split-squad loss to the New York Yankees on Saturday night. But it wasn't really about that when you've waited eight months to get back on the mound.
He looked comfortable out there and had decent command, giving up a couple of opposite-field doubles to right-handed hitters and a bad-hop single on the infield. Only one of the runs was earned after a throwing error with no outs allowed the first run of the inning to score from second base.
Orioles homer four times, overcome six errors in wacky 17-15 win over Tampa Bay Rays
By Jon Meoli
"I felt great,'' Bleier said. "That was about as good as I could have been feeling-wise. I felt the ball was coming out of my hand really well. I executed almost all of my pitches, other than the first double. Even the second one, he kind of stuck his bat out.
"My fastball was good. My cutter was good. That's pretty much all that matters, honestly. The rest of the stuff is just a bonus. I'm extremely happy with it. I know, obviously, the results weren't quite what I wanted, but I'll take small victories at this point. You know, it's been a while."
If there was a moment of apprehension after what he said was initially a difficult rehabilitation after surgery, Bleier said it only lasted a moment.
"I think after the first pitch, it was like, 'All right, my arm is still attached to my body, let's get ready for the season,' " he said.
The only reason he came out after retiring just two batters was because manager Brandon Hyde said before the game he would not allow Bleier to throw "much more than 20 pitches." After he left the mound, Bleier said he is confident he'll be able to start the season on time.
"I feel ready now,'' he said. "I executed all my pitches. I think it's just a matter of refining it, so I'm thinking eightish [innings]. I feel great right now. I'm pretty excited where I'm at."
Manager Brandon Hyde was pretty stoked, too.
"I think we all were,'' he said. "Mission accomplished. He came off the mound, feeling healthy. His ball was moving all over the place. The one lefty he faced he had a lot of success I just think, No. 1, he got through it and felt great after. Two, his stuff was really good. Some unfortunate things happened, but the bottom line was that he threw 20ish pitches and threw the ball really well. That's great."
Hess solid again
Right-hander David Hess was coming off an appearance against the Minnesota Twins in which he retired all nine batters he faced. He allowed a double on his first pitch of Saturday night's start and then retired nine straight batters, but left the game after giving up two more hits in the fourth inning.
He was charged with two runs on three hits, but struck out three and did not walk a batter in 3 1/3 innings.
For Orioles' Austin Hays, relearning to run has him putting best foot forward in spring
"I think there were good things to take away from it,'' Hess said. "Anytime you lead off the game with a double like that and hold them to one run, that's a good way to go about that. I think there are a lot of positives to build on and some things to work on as well."
Hess was asked if he feels like he's where he wants to be at this point in spring training.
[More from sports] Orioles reset: Breaking down starting rotation candidates for threadbare pitching staff »
"Yeah, I feel good,'' he said. "The ultimate goal is to put yourself in the best position to make the club. So, I'm really just coming in each day and trying to get better and ultimately I am where I want to be right now. There are a lot of talented guys here doing the same. There's a lot of competition. It's been a lot of fun and I've really enjoyed it and looking forward to keep going with it."
Second sellout
No doubt, the Orioles would like to have put on a better show for the crowd of 7,523 — the second sellout at Ed Smith Stadium this spring — but they apparently used up most of Saturday's offensive production during their 17-run performance in the first game of the split-squad doubleheader in Port Charlotte.
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It's probably no coincidence that the two sellouts have come against the Yankees and Boston Red Sox, who always pump up crowds for their teams' road games in the spring.
Orioles/Baseball
Richard Bleier
David Hess
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Bungalow Bay is a nice wall dive suitable for beginner divers located on Koh Racha Island. Here you can spot a nice school of Barracudas, turtles and sometimes pelagic fishes. For the macro fans, you can spot a razor fish, leaf fish, and even a ghost pipefish. The coral is beautiful. Maximum depth is around 22 meters deep. You can easily organize a Snorkelling day tour to Racha Islands from Phuket or you can join a diving boat.
You can dive Bungalow Bay all year long. Access: from the Shore. See the map of Bungalow Bay on the right for the exact location.
Have you been diving or snorkelling in Bungalow Bay? Consider sharing your experience with the diving community by leaving a comment below!
Map of Phuket, Bungalow Bay dive spot.


The dream of owning a high-end villa with full facilities near the river was not too difficult for the Vietnamese people when there were many construction projects near the river. SwanBay Garden Villas not only bring customers advanced life experience but also suitable feng shui.
Feng shui is always a matter of great interest to the owner when buying or building houses from the past. Accordingly, the beautiful land must have water elements in front of the house. It is called the "water front" (the house is blessed because water is the symbol of happiness). According to this feng shui concept, many real estate projects instead of trying to "race" located in the land of gold in the urban area, the direction of looking for large land, near the rivers and lakes to build. set up.
Water around the land is also considered to be generative when it is good. The winding winding is good for soil support and increased benefits for residents. The villa near the river, planted more trees that have rooted to keep the soil firmly, as well as regulate the wind from the river blowing.
SwanBay Garden Villas is the right choice for those who want to live near the rivers and lakes and enjoy the comfortable and high standard of living.
Like Ms. Hang, many people with good living standards are looking for a place to live, not too close to the center, near rivers and lakes, but meet the high-end facilities. Therefore, riverside projects such as SwanBay Garden Villas in addition to the advantage of good ecology, climate is always regulated, showing the level of homeowners, feng shui elements also directly impact the customer choose to live here.
In addition to the feng shui elements, the client chooses the project depending on the local amenities, the master plan as well as the master plan as well as the flexible connection to the public infrastructure in the area.
Situated at the gateway to the East, SwanBay Garden Villas has great potential for development when connected to the main traffic road and the 3rd Ring Road.
SwanBay Garden Villas is located on Dai Phuoc Island (Nhon Trach, Dong Nai), the only natural island adjacent to Ho Chi Minh City. The project is located in extremely potential location, surrounded by Dong Nai River, opposite Cat Lat Ferry, adjacent to District 2 and District 9. Located in the East Gate, traffic system of SwanBay Garden Villas. connected to the main transport axis, benefiting from Nhon Trach infrastructure should move to the city center is now reduced to only 40 minutes.
In particular, the Ring Road 3 will be completed investment will form a circuit through the city. Ho Chi Minh City – Dong Nai – Binh Duong. Not only convenient for moving, short distance will create leverage to help Nhon Trach grow strongly. By 2021, when the infrastructure is completed, Ring Road 3 will be put into operation, Long Thanh Airport will be completed and expected to move into the inner city only 20 minutes for the 19km route.
Living with many luxury amenities: running around the island, swimming pool, 5 star standard resort, 65% area is public park, park makes Swan Bay Garden Villas the ideal choice for those who are high standards living wantingto own a house near the river.
According to the HCMC Real Estate Association, the improvement of the formation in the Eastern area has been in deep development. In the context of land scarcity, which owns the coastal area and the Saigon River system, it possesses the absolute advantage in planning and directing the living space. From this location, residents in the project will shorten the maximum time to move to the center and the modern facilities outside the area.
Besides convenient transportation, SwanBay Garden Villas also bring high-class facilities for life. 65% of the area is for public areas, parks, landscapes. Contemporary French architecture is applied to the architecture of the house bringing modern breath but still associated with nature when the private garden is designed around the house.
On June 16, SwanBay Garden Villas will open 66 semi-detached villas with a discount of up to 15%.
At weekends, residents can take a stroll along the green trail around the island, enjoy the warm BBQ party or swing on the boat to visit the whole area.
On June 16, 2018, the dream will be closer to those who desire to own villas near the river. SwanBay Garden Villas will be open for sale 66 apartments limited edition with a special price from VND20-25 million / sqm. The payment method is flexible and there are many flexible payment options. In particular, discount up to 15% only on opening day.
You are reading the article SwanBay Garden Villas: Dream villa is near the river not far away in the Real Estate category at https://realestatevietnam.com.vn/. Any information sharing, feedback please contact through Hotline 0909890897 (24/7) or email to info@realestatevietnam.com.vn.
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"WE ROCK Fridays" at San Francisco's newest venue the GRAND.
This week we're continuing the best Friday event in San Francisco at The Grand the quintessential nightspot to be seen! Brought to you by Sebastien Ent., Mirza Party & Rhythm Ethics.
In the mix we have 2 of San Francisco's most well respected and in demand DJ duo's CONTACT.
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Individually well-established in the top tier of San Francisco-based DJ talent, Clouse and CAMS have performed everywhere from the Bay Area to Los Angeles, San Diego, and Las Vegas. Now the duo have officially teamed up to perfect original remixes and their signature live show on 4 turntables, uniquely featuring live vocal and guitar performances. Their amazing chemistry as performers, coupled with their broad musical tastes and noticeable talent, makes for one hell of a show.
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