Get into the spirit of the season with some seasonal spirits! Lauren Grier, blogger of Climbing Grier Mountain mixes sweet apple with dark bourbon in this perfectly-balanced apple butter cocktail recipe.
Fall cocktails are my jam.
As a bourbon-lover, I am always looking for different ways to incorporate this spirit into festive libations. One of my favorite ways to enjoy bourbon during the autumn months is with apples. Whether through a bourbon apple sangria, bourbon apple martini, or a bourbon apple old fashioned, there's no wrong way to enjoy this flavor combo.
BUT! I will say I recently stumbled on a different way of using apples in a bourbon cocktail. Have you ever tried apple butter? While an apple butter cocktail might sound unique, I assure you it's a game changer! I particularly like Harry & David's apple butter because it's made with fresh apples from their orchards. With a mixture of brown sugar and pumpkin pie spices, it's the perfect alternative to using simple syrups.
In this Apple Butter Cocktail — Bourbon Mule-style — you'll find apple cider, bourbon, lime juice, apple butter, and ginger beer. The taste is similar to a traditional Moscow Mule, but with the apple butter it gives the drink a slightly spicy, yet sweet blend. Shake, shimmy, and stir your way into autumn bliss! Cheers!
In a large cocktail shaker add the apple cider, apple butter, bourbon, and lime juice.
Shake until everything is well combined.
Fill two glasses with ice. Divide the apple butter mixture between two glasses filling halfway.
Next, pour the ginger beer in each glass to the rim. Garnish with cinnamon sticks, lime wedges, and apple slices.


'We need clinical commissioning groups to become accountable care organisations' – that's what Jeremy Hunt said recently in parliament and during a speech at the Commissioning Show.
Jeremy Hunt is not the only one saying this kind of thing. I've heard representatives from acute hospitals, GP federations and CCGs all make the same claim: they want to become an accountable care organisation (ACO).
But what does this really mean? The basic concept of an ACO is that a group of providers agrees to take responsibility for all care for a given population for a defined period of time under a contractual arrangement with a commissioner.
Essentially accountable care organisations, which have emerged from the United States over the past few years, are the next generation of managed care, but with a fundamental difference. While managed care initiatives in the 1980s and 1990s handed over a capitated contract to a network of providers to manage a defined population, they were not accountable for improving care, or even delivering care (networks quickly realised they could save money by restricting access). Learning from the scars of this legacy, these more recent managed care initiatives have included a stipulation to improve quality.
Like baseball and Las Vegas, ACOs are very much an all-American product, and leave most people in the United Kingdom scratching their heads with confusion, with the exception of some core enthusiasts. Commentators with much more poetic flair than me have likened ACOs to unicorns – we can all describe what a unicorn looks like, but nobody has ever seen one.
However, the overarching ambition of an ACO will be familiar to those involved in any kind of NHS transformation project – to improve the quality of care and reduce costs, largely by working together more efficiently. Nobody could argue with that!
But could a CCG, GP federation or acute hospital really become an ACO? Well, the clue is in the title.
Accountable: the ACO model is based on the premise that those who are accountable for the cost and quality of care for a whole population will be incentivised to improve care. Accountability refers to both clinical and financial accountability – the ACO is contracted to achieve on a range of quality and outcome measures, typically within a defined budget. The ACO might have a number of these 'at risk' contracts with a range of different payers (commercial and government), within which there might be a range of different outcome measures, thresholds, and payment mechanisms.
Care: an ACO delivers care; it doesn't commission it. This is how it can minimise its risk, by taking control of the way care is delivered for a whole population. The ACO is able to develop and deliver preventive interventions for patients with a high-risk profile, as well as reactive interventions to avoid unnecessary hospital admissions.
Organisation: to organise and deliver this care, these accountable providers come together in a formal organisational structure (for example, a physician hospital organisation or independent practice association). It is through this structure that the ACO is able to build a leadership team and appropriate governance arrangements to manage risk across diverse providers, holding them to account for their part of the care pathway. If part of the organisation is not performing well, leaders have a range of structures and mechanisms at their disposal to incentivise improvement.
The current mix and remit of providers and commissioners in the NHS does not singularly or collectively embody these features. CCGs do not deliver care. Very few acute hospitals or GP federations would feel comfortable sharing clinical and financial risk with other providers through a legal structure.
In fact, ACOs are only one type of model being talked about in the NHS at the moment. In the past couple of weeks I have had many meetings where most of the conversation is spent trying to establish a common definition of 'prime provider', 'prime contractor', 'prime integrator', 'lead provider', 'lead accountable provider' and 'alliance contract' (and I'm sure there are many more). What is apparent is that all these models mean different things to different people, but they are all essentially working towards the same goal – quality improvement, cost savings and working together more efficiently.
More important than designing care to fit within a tight definition of an ACO (or other) model, is experimenting with payment and contracting tools in a range of ways – all the while focused on having a clear and convincing narrative of what the service should look and feel like to patients and those delivering their care. The organisational form will name itself.
This blog is also featured on the Public Finance website.
This briefing describes the different types of accountable care organisations emerging in the United States and discusses the implication of these developments for integrated care initiatives in England.
Thanks rachael. Interested to know how risk and reward is equally distributed between the providers. If acute hospitals and GP feds assume the role of an ACO where would that leave CCGs?
I think that's the point isn't it - CCGs would essentially still be CCGs - the commissioners as they are now.
If ACOs are really conglomerations of providers working with shared risks , shared rewards and towards shared outcomes, they will still need to be commissioned, or paid by somebody.
Coming to this thread late but thanks Rachel your explanation of ACOs was as clear as could be! If you are still attending this thread would be interested in your view on how Local Authorities (public health) and social care providers fit with this model.


This subject has received considerable attention over the last 10-15 years. The purpose of this session is to bring together paleoclimatologists working on higher-resolution proxy information and climate modellers simulating the period. Emphasis will be given to presentations of the regional and seasonal detail (particularly for Europe) in both reconstructions (single and multi-proxy) and climate model output. The importance of a reliable knowledge of forcing histories (both global and regional aspects) within the modelling framework will also be addressed.


MC Pest Control provides removal of rodents from your property such as mice, squirrels, and flying squirrels. However, if you are looking for a long term solution for persistent rodent infestations then you are in need of exclusion services.
Exclusion is the process of installing metal in between the edges and frames on the exterior of your property where there are areas of vulnerability. The metal that our pest control company installs allows us to secure off openings, so that critters can't sneak into your home or business.
Contact MC Pest Control today to learn more about your exclusion options in Fiskdale, MA or surrounding area town including Sturbridge!


recovery of a trashed LILO boot record. How many times does it happen that some person installs windows 98/95 after he/she installed linux? Well in that case windows 9X just overwrites the MBR record and linux won't be able to boot anymore.
backup over the network in the form of tar.gz tarballs. Both FAT16, FAT32, ext2 and all filesystems which Linux supports in a read/write fashion can be taken care of. The strong part of the CRK is when a disk is replaced or repartitioning is being done. The CRK boots a complete mini linux with networking where all possible hardware which is inside the Linux kernel is available.
Testing hardware of new intel based machines.
Detecting versions and types of hardware. The Linux kernel holds a large database of hardware supported. Booting a linux kernel doesn't only resolve if the hardware is ok, it also show its specs. This can be handy if one wants to check-out an old/new PC which is for sale.
Recovery of a misconfigured or hacked Linux system. Well that can happen. /etc/fstab can be wrong or the root password is unknown etc.
make a tape backup of a disk which can't be booted anymore.
The CRK is based on RedHat Linux. I have always used RedHat systems, thats why. When my system needed maintenance the rescue floppy image which RedHat supplies didn't fullfill my needs. Thats why i created the CRK. Lately i use Mandrake. How and why the CRK was created read the short history. The CRK is licensed under the GNU Public License (GPL). See the Changelog for whats included.
There's a mirror for the ISO's at ftp.fsn.hu (ftp) and ftp.fsn.hu (http).
I decided to rol the pam_stack module back into pam using a patch.
Aaron M. Renn made a very usefull lifesaving tool called The gzip Recovery Toolkit.
As computers get smaller and powerconsume friendlier the trouble of booting and installing Linux gets more tiresome. Here's a Custom RedHat installation through PXE netboot which i did on a VIA EPIA mini-ITX board. Also other mini appliances like the Soekris net4501 board can benefit by adding the natsemi.o (National Semiconductor DP83815 PCI Ethernet NIC) driver in a analog fashion.
A hyperthreading commandline tool for encoding your audio cd albums with lame as fast as your Linux iron allows it.
A Open Source patch which add DVD extensions to cdrtools-2.0. As a convenience also SRPM and RPM packages for several RPM based Linux distro's are given.
Although Perl is a nice tool inside UNIX/Linux, why should it be fired up 10.000 times a day as part of a UNIX/Linux email server system? The peoples from Amavis, Spamassasin, and also OpenSPF.org however seem to ignore this, as they only implement and test their reference sofware as a Perl package. Why, why should one add a Perl plugin into Qmail ?? After short thoughts i rejected this approach, and created my own gear for running SPF1, SRS1, SRS2 on Qmail 1.03.
If you are running some old mailserver (RedHat 6.2 or 7.3 on a P3 500MHz), you might wanna look at the old fast version of amavis which runs without perl. The old version which i maintain, currently amavis-0.2.4, now also automaticly selects and configures to use ClamAV 0.90.2 if installed.
The lightweight browser Opera Stable Version 44.0.2510.857 was migrated to Mandriva 2011 i586/x86_64. The result is surprising and the speed increase and functionality compared to the factory installed edition Version 11.52 is remarkable. Flash functionality is by Adobe Flash Player PPAPI 25.0.
The open source browser Mozilla Firefox Version 3.6.24 was compiled on Mandriva 2011 i586/x86_64. The result is surprising and the speed increase compared to the recent editions starting from 4.0 and higher (version 12.0 as I wrote this) is remarkable.
The open source browser Mozilla Firefox Version 3.6.24 was compiled on ubuntu 11.04 (natty) x86_64. The resulting binary amd64.deb packages can of course also be installed on ubuntu 10.04 (lucid) x86_64.
The open source browser Mozilla Firefox Version 1.5.0.7 is backported from Mandriva 2006.0 to Mandrake 10.1 i586/x86_64.The result is surprising and stunning as even flash9 now works like it should.
Azureus 2.5.0.4 in combination with Java 1.4.2 Blackdown Java-Linux is the best BitTorrent application I have come across on the KDE/Linux x86_64/amd64 Desktop so far, even since its release in 2006.


Finding a Residential Window Cleaning Estimate to have your windows cleaned that you are pleased with can take up some time occasionally. As a homeowner, you are always looking for value. Wanting the best services, but at an affordable price. Residential Window Cleaning Estimate can vary from company to company. Which is why you have probably shopped around for estimates before. As a homeowner, you want to understand what the market is like for the service you are wanting. To make sure that you are paying a fair and reasonable price. There is nothing wrong with shopping around for estimates.
Many companies may try to give you a quote over the phone and then after they complete the service, the price has changed. That often happens because when one is not able to see something, they cannot get a clear image of how large the home is. And unfortunately, give you an estimate that was wrong and you end of paying more money. That is why with us, we do not give estimates over the phone. We want to be as transparent as possible with our customers. And believe that to give a fair quote, we must come to your property. Only then, will our expert be able to see how large your home is, how many windows you have, and ask you how many windows you want cleaned. We our here to service our customers and believe that without seeing your house, we cannot give you an estimate.
Now you are probably wondering how you can get one of our experts out to your property for your Residential Window Cleaning Estimate. That is easy! All you have to do is call our friendly specialist at 832-639-3434 to schedule your estimate. Once your appointment is scheduled, one of our experts will come to your home. During this visit, our expert will be able to visually see how many windows you need cleaning. And also determine how long the labor will take them. Throughout the appointment, you can ask the expert cleaner any questions you may have regarding the products we use or how long they believe it will take t complete the job.
Once all the expert has gathered all the information they need. They will then work on your Residential Window Cleaning Estimate. The estimate will take into account, how many windows, size of windows, and labor. Once the estimate is completed, it will be retuned to you and the costs broken down for you to see. It is that simple to get a Residential Window Cleaning Estimate from us. So, what are you waiting for, give us a call at 832-639-3434 to schedule your estimate today!


City Wars - 'City Wars' is a custom map that supports a maximum of 2 players and uses the Urban terrain.
'City Wars' is a custom map that supports a maximum of 2 players and uses the Urban terrain.
Desert Beside the Sea - 'Desert Beside the Sea' is a custom map that supports a maximum of 2 players and uses the Temperate terrain.
'Desert Beside the Sea' is a custom map that supports a maximum of 2 players and uses the Temperate terrain.
Small Islands of war - 'Small Islands of war' is a custom map that supports a maximum of 2 players and uses the Temperate terrain.
'Small Islands of war' is a custom map that supports a maximum of 2 players and uses the Temperate terrain.