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In my previous post, I asked if physicians should care about what the hospital(s) they affiliate with charge.
However, most hospitals operate on narrow margins, such that even a small impact on a hospital’s market share due to excessive physician fees could be seen as important to the hospital’s financial well-being.   Actually, it is not typically the physician’s charge master that hospitals focus on, so much as the willingness of the physician or physician group to discount their services to patients in the hospital. Admittedly, there are some hospitals that would rather keep hands-off regarding the fee schedules of physicians and groups that staff their clinical departments or send patients to the hospital for care; perhaps because they don’t wish to invite meddling by their medical staff in hospital business, or because they don’t feel comfortable being the arbiter of fair physician charges.
You would think, though, that if a physician’s or physician group’s fees are entirely unreasonable, or border on the outrageous, or their policies for accepting discounts for plan participation or for charity cases is rigid and uncompromising; most hospital administrators might want to take that into consideration. Recently my primary care physician ordered some screening lab tests for me, some of which may not be covered by Medicare. Some years ago, when I was the Medical Director of a busy Emergency Department, I went to the hospital administrator and asked if we could put the hospital’s charge for labs and x-ray studies we might order in the ED on the check box form we used at the time to order these tests.
As health care insurers have gradually gotten out of the business of insuring their enrollees against liability, and the health care consumer (patient) has had to shoulder more and more of the cost of their care with higher premiums and higher out-of-pocket costs; I am becoming even more of a fan of cost transparency in health care. The picture gets even more complicated when you consider that the hospital’s contracted rates with various health plans may vary greatly, and are never revealed to physicians at the hospital.
Regardless of the trends, physicians really do have an obligation to be aware of the financial issues their patients face, the options that patients may need to consider, and the willingness of their hospital(s) to provide services to their patients at a reasonable, and sustainable, price, whether the patient is insured or not.
The show ‘ER’ started out great and for a while got even better, until it turned into a soap opera.
The biggest problem with shows like this is that they do not convey the practice of medicine in a way that enlightens viewers as much as it bombards them with bits and pieces of medical drama that, taken together, distort medical issues and the process that physicians and nurses, especially in the ER, must confront with deliberation, concentration, and care. I doubt that Marcus Welby MD would evoke the same response, though I acknowledge that I had yet to complete my medical education when the show finally went off the air. It was interesting to hear Hillary Clinton, on the stump at the last Democratic Town Hall, bemoan the fact that not-for-profit health plans were not participating more in the exchanges. In fact, if I had my druthers, I would want to give current for-profit plans an incentive to go back to being not-for-profit.
The common sentiment among health care policy wonks is that consumers choose health plans on the basis of premium prices first, out-of-pocket costs next, and quality last; and research suggests that narrow networks with lower premiums provide quality care equivalent to more expensive plans with wider networks.
However, there is something that seems counterintuitive about the assertion that narrow networks can provide better care at lower costs with cheaper providers. First, you would have to acknowledge that higher cost hospitals and physicians do not necessarily provide higher quality care.
This brings me to the second mitigating assertion: that better outcomes over the long-term for patients equate to lower costs long-term, thus allowing plans to charge lower premium rates for higher quality care.
So here is the third mitigation: depending on how you measure quality and costs, you may or may not be able to demonstrate that you can get better quality at lower cost. I have no doubt that by providing less unnecessary care, changing the fee-for-service incentive, improving end-of-life care, and other strategies; we can maintain quality at lower cost. Curiously, the DMHC recently advised the California Chapter of the American College of Emergency Physicians that this report, based on responses to this survey, would not be produced or released because as there was no consistent methodology in the responses. So let’s get to the intended purpose of this post: to explore why health care regulators often fail to enforce their own regulations.
Another reason why regulators fail at regulating is that they are reluctant to improve the language of regulations that are difficult to enforce.   Such efforts could reignite the battles between stakeholders that were waged when the regulations were first proposed. Regulatory agencies often become vested in the continuation of the health care programs they craft, even when these programs fail to meet the expectations of politicians and consumers. Regulators, like many government employees, are sometimes caught between their regulatory mission and the ambitions and agendas of their political bosses. Anthem Blue Cross (BC) in California announced in its December Professional Network Update that, beginning in January of 2016, the plan will begin a pre-payment review of all ED visits billed with CPT 99285 (professional service) or HCPCS code G0384 (ED facility service) under the BC Medicare Advantage Program. The Office of the Inspector General also noted in 2012 that the increase in higher level codes was also occurring in office based practices from all medical specialties.
It does seem reasonable (and even required) that health plans should audit claims and respond to excessive up-coding. This three-part series does a pretty good job of laying out the usual arguments for the ongoing demise of many single site, single specialty group practices, though such practices still remain in the majority. What we knew by 1990 about the 1940 dinner was published in Irregular Memories of the a€™Thirties.
In this the first of the BSJa€™s revived Christmas Annuals (a pleasant custom begun by Edgar W.
January 30, 1940, was a golden evening, an evening of a€?entertainment and fantasya€? as Edgar W.
Finally, after a Great Hiatus of nearly four years, plans were made a€” than to the imminent publication of 221B: Studies in Sherlock Holmes a€” for another BSI Annual Dinner, the first since 1936. I had been planning to take a two weeks' holiday in the south toward the end of the month, but in view of this epic occasion, I have now changed my plans, and shall be leaving on January 12, and returning on the 29th. Please inform the undersigned promptly of your intention to attend so that the Gasogene and the Tantalus may make accurate plans.
And on January 30, 1940, the Baker Street Irregulars gathered for their annual dinner once more. The first order of business under the Constitution was the drinking of the canonical toasts. There is also extant a letter from Steele to Vincent Starrett about this drawing, quoted in the previously cited unpublished memoir by Steelea€™s son Robert: a€?I had an absurdly hard struggle with my Sherlock.
This was also the first time the Baker Street Irregulars met at the Murray Hill Hotel, where the BSI dinners would continue to be held a€” cocktails in Parlor F, dinner and program in Parlor G a€” until the New York landmark was finally torn down in the late a€™Forties, to be great regret of many sentimental people.
The 1940 dinner might not have included every Irregular of that era with whom one would wish to dine, but it was a fine list nonetheless. Denis Conan Doyle was the eldest son of Sir Arthura€™s second marriage (his mother, Lady Conan Doyle, would pass away later in the year), and Trustee of a very active literary Estate indeed. He went on to describe how, in the lore of the Irregulars, Doyle is pictured as a struggling young physician, delighted at the chance to a€?peddlea€? the cases his friend Dr. Certainly one would love to have been a fly on the wall that night, or, even better, archy the cockroach darting among the drinks on the table, to hear Denisa€™s charming discourse, and all the other scholarship and tomfoolery that transpired that night, the first BSI dinner in four long years.
Meanwhile, and with 221B still rolling off the presses, I am sending you a first very rough-and-ready copy of the Gazetteer which you have egged me on, from time to time, to write. I hope things are going well for you, and again let me say that your absence was a matter of very genuine regret indeed to all of us who look to you as mentor and guide -- to say nothing of your status as sponsor and editor of the Book of the Day. Re the Gazetteer: I'm inclined to agree with you that it might be extended to advantage by a listing of the more important clubs and restaurants, etc. I imagine we should not too often bring out a volume of ana; the public might easily tire of us. In his essay in Irregular Memories of the 'Thirties discussing this first BSI anthol-ogy of Writings About the Writings, neither Robert G. So it should be, from someone who (born 1915) had by 1990 long been one of the nationa€™s foremost authorities on Victorian literature and culture. I know of no other such study as the interesting one you suggest, although it is perhaps odd that the idea did not earlier explode in the skull of some devoted Sherlockian.
It seems to me more than likely that Doyle wrote that scene in His Last Bow quite deliberately, knowing it for what it was - a friendly para-phrase of the parting between Johnson and Boswell; although it may of course have been subconscious. You have chosen a delightful subject for your thesis; and you will pardon me if I hope that you will treat it not too seriously, but with a touch of humor.
I am leaving Chicago inside of a week, I think, for a voyage around the world; so in closing I must wish you - in my absence - all good luck in your efforts.
A few years later, an editor was interested in publishing the essay a€” the best of all possible editors for Sherlockian work, Vincent Starrett himself. The quotation is from Christopher Morleya€™s a€?Notes on Baker Streeta€? in the Saturday Review of Literature, January 28, 1939, not from any letter Starrett received from him. This independent Sherlock Holmes society had been founded in New York in 1935 by Richard W. Since Morleya€™s letter of December 23, 2939, below was unavailable for Irregular Memories of the a€™Thirties, this reference in Edgar W.
A copy of Morleya€™s letter to Smith below went to Vincent Starrett in Chicago, with the handwritten note: a€?Merry Christmas, Vincenzio. When I was in Chicago a week ago I learned from Vincent Starrett that his book 221-B is actually to be published on January 30.
Since Christ Cella's place on 45 Street, where we used to hold meetings, has been modernized and the old upstairs room there no longer exists (he has only a not very attractive cellarage; which makes me think of The Fiend of the Cooperage; do you know it?) I am wondering if the Murray Hill Hotel would not be a singularly pleasant place for the meeting? You yourself would, I hope, perhaps feel inclined to present a proceeding of some sort; I mean a few remarks on the Obliquity of the Ecliptic, or whatever may be momently on your mind. Just for the fun of starting trouble, I am sending a copy of this both to Starrett and to Harold Latham of Macmillan; who will I'm sure see to it that each convive gets a presentation copy of the Book.
I hope I may assume that like Peterson the commissionaire, or No, it was Henry Baker, you are carrying a white goose and walking with a slight stagger. Beginning in 1945, Titular Investitures were conferred at the annual dinners to denote membership in the BSI.
That it was the first one Smith prepared is indicated by a letter to Christopher Morley dated three days later (November as the month, in Irregular Memories of the a€™Thirties, p. There are forty-eight names on the somewhat woolly list, below, and they bear some analysis, following Miss Mouillerata€™s cover letter.
The other names on Smitha€™s list are familiar ones, though some of them are surprises to see here. Members by 1935, according to Morley's list that year: Ronald Mansbridge, Harrison Martland, John Sterling, Lawrence Williams.
Ones who came into the BSI at the 1940 dinner: John Connolly, Peter Greig, Howard Haycraft, James Keddie (his son James Jr. A few more details about some of these Irregulars of the a€™30s and a€™40s can be provided now, for the record. Of other names on this list, Harold Latham was, as we have seen, Trade Editor at the Macmillan Company responsible for publishing 221B: Studies in Sherlock Holmes. This was a 1940 collection of essays by Vincent Starrett, published by Random House, with an a€?Unconventional Indexa€? by Christopher Morley.
More serious still, two more toasts stipulated by our Constitutional ar-rangements are absent altogether, and missing ever since. As to The Second Most Dangerous Man: The query about his identity was a€” as Bill Hall will tell you a€” the original, first, quickie, abbreviated examination for eligibility to membership in the pre-natal Baker Street club. Resting imposingly on the long table at which the BSI dined on January 30, 1940, was an a€?orthodox coal-scuttle,a€? authentically Victorian, which James P. The coal box was an ornament, and in it were stored such details of fireside comfort as slippers, unread magazines and so forth. Although Keddie was a contributor to 221B: Studies in Sherlock Holmes, he came close to missing the 1940 dinner until Morley unearthed his address barely ten days before. Because of money, and his second wifea€™s health, Vincent Starrett never made it back to New York for a BSI dinner after the one in 1934. Bill Halla€™s copy bears the affectionate raspberry Christopher Morley often sent his old frienda€™s way. It also bears the notation a€?$5.00 casha€? which was probably the true cost of the evening. The pattern followed by the BSI for quite a few years thereafter, of oysters (a€?shall the world be overrun bya€?), pea soup (as in London fog), curried chicken (minus one ingredient as served in a€?Silver Blazea€?), and a sweet, was set by Christopher Morley whose handwritten draft of the printed menu has survived. The quotation from this letter, taken from an article by the artista€™s son, was incomplete.
Meanwhile, Starrett was already building a new Sherlock Holmes collection, with a big start in August 1940 from Logan Clendening. When this was written in 1990, the hope was that Sir Arthur Conan Doylea€™s sur-viving child, Dame Jean, might come to New York for a BSI dinner.
All this within your ear; but the circumstances being what they are, you will understand why I can't be any place but Reno on January 30. I could and would, of course, if the dinner were postponed, keep you posted as to developments, and the probable time I should be free to make a New York visit.
My brother Felix has a subtle scheme which he will bring direct from the State Department in Washington.
The errata slip in 221B, as by Jane Nightwork, reads: a€?In the unavoidable absence of the Editor, a volunteer hand must call attention to the curious incident of what the Proofreader did in the night-time.
Everybody is too pooped this morning to be able to give you any intelligible report but I must let you know at once that the evening was a grand success in every way. The only sadness is that I intended to have a copy signed for you by all those present, and in the general uproar this did not get done. Since you seem not to have heard the news, I am sending this by pony express so that you may know at once that the Irregulars met, feasted, d---k, and thought of you.
Denis Conan Doyle made a neat little address in which he stuck to the tradition of the Irregulars and told us about his father's acquaintance with Holmes.
Of course Christopher himself in person (but he WAS a moving picture!) was the glowing heart of the nebulae. And, by the way, I think having vindicated Watson in the matter of the coal scuttle, it now behooves me to vindicate him in the Persian Slipper.
BOOKS ALIVE: Man, oh man, WHAT a title, and doubly good for your book because none has a greater faculty for bringing books ALIVE than you.
I was glad to get your note of February 27th, and to learn from it that you may be coming back East soon. Since the first draft of the Gazetteer, I have added about 150 more names - still without resorting to bars or theatres - but more important, I have fallen in with Dr. Who the members were of the Irene Adler Division with which Christopher Morley and other Irregulars convened immediately following the BSI dinner in New York is a mystery, however. For many years, it was believed that BSI dinner photographs commenced after World War II, with the one of the 1946 dinner.
So it was a surprise when James Keddiea€™s letter above referred to a dinner photo, and a thrill when a print turned up in the hands of Mary Hazard, daughter-in-law of the late Irregular whose it had been: Harry Hazard, a solver of the Sherlock Holmes Crossword in 1934. But to confound us, in the photograph are at least two men whose names are not in Smitha€™s minutes: William C.
None of the seven surviving copies of 221B I have seen bears all the signatures of everyone we can say was at the dinner. Comparing signatures in one copy of 221B after another makes for further confusion Some men seem to have stayed glued to their seats throughout the signing session, as the copies of Starretta€™s book made their way around the table, while others seem to have gotten up and roamed around the room, signing one copy here, another copy there. Three particular signatures appear as a trio in one copy after another a€” James Keddie, Edgar W. Bill Vande Water has picked up where Harry Hazard left off, and carried on with his typical valiant job of assigning names to faces, but a few remain unidentified.
The photograph a€” Ia€™ve been having enormous fun, showing my friends what I looked like nearly sixty years ago. I was also given a bit of a nudge by Archie Macdonell, who founded the first Sherlock Holmes Society in England in June 1934.
I remember David Randall, and discussion of the cash value of certain Sherlock Holmes first editions. The man who got me started in all this Sherlock Holmes stuff was not present at the dinner. DESCRIPTION: This is the largest map of its kind to have survived in tact and in good condition from such an early period of cartography.
These place names are in Lincolnshire (Holdingham and Sleaford are the modern forms), and this Richard has been identified as one Richard de Bello, prebend of Lafford in Lincoln Cathedral about the year 1283, who later became an official of the Bishop of Hereford, and in 1305 was appointed prebend of Norton in Hereford Cathedral. While the map was compiled in England, names and descriptions were written in Latin, with the Norman dialect of old French used for special entries.
Here, my dear Son, my bosom is whence you took flesh Here are my breasts from which you sought a Virgina€™s milk.
The other three figures consist of a woman placing a crown on the Virgin Mary and two angels on their knees in supplication. Still within this decorative border, in the left-hand bottom corner, the Roman Emperor Caesar Augustus is enthroned and crowned with a papal triple tiara and delivers a mandate with his seal attached, to three named commissioners. In the right-hand bottom corner an unidentified rider parades with a following forester holding a pair of greyhounds on a leash.
The geographical form and content of the Hereford map is derived from the writings of Pliny, Solinus, Augustine, Strabo, Jerome, the Antonine Itinerary, St.
As is traditional with the T-O design, there is the tripartite division of the known world into three continents: Europe, Asia, and Africa. EUROPE: When we turn to this area of the Hereford map we would expect to find some evidence of more contemporary 13th century knowledge and geographic accuracy than was seen in Africa or Asia, and, to some limited extent, this theory is true.
France, with the bordering regions of Holland and Belgium is called Gallia, and includes all of the land between the Rhine and the Pyrenees.
Norway and Sweden are shown as a peninsula, divided by an arm of the sea, though their size and position are misrepresented.
On the other side of Europe, Iceland, the Faeroes, and Ultima Tile are shown grouped together north of Norway, perhaps because the restricting circular limits of the map did not permit them to be shown at a more correct distance. The British Isles are drawn on a larger scale than the neighboring parts of the continent, and this representation is of special interest on account of its early date. On the Hereford map, the areas retain their Latin names, Britannia insula and Hibernia, Scotia, Wallia, and Cornubia, and are neatly divided, usually by rivers, into compartments, North and South Ireland, Wales, Cornwall, England, and Scotland.
THE MEDITERRANEAN: The Mediterranean, conveniently separating the three continents of Asia, Africa and Europe, teems with islands associated with legends of Greece and Rome. Mythical fire-breathing creature with wings, scales and claws; malevolent in west, benevolent in east.
4.A A  For bibliographical information on these and other (including lost) cartographical exemplars, see Westrem, The Hereford Map, p. 10.A A  For bibliographical information for editions and translations of the source texts, see Westrem, The Hereford Map, p. 11.A A  More detailed analysis of these data can be found in my a€?Lessons from Legends on the Hereford Mappa Mundi,a€? Hereford Mappa Mundi Conference proceedings volume being edited by Barber and Harvey (see n.
16.A A  Danubius oritur ab orientali parte Reni fluminis sub quadam ecclesia, et progressus ad orientem, . 23.A A  The a€?standarda€? Latin forms of these place-names and the modern English equivalents are those recorded in the Barrington Atlas of the Greek and Roman World, ed. From the time when it was first mentioned as being in Hereford Cathedral in 1682, until a relatively short time ago, the Hereford Mappamundi was almost entirely the preserve of antiquaries, clergymen with an interest in the middle ages and some historians of cartography.
FROM THE TIME when it was first mentioned as being in Hereford Cathedral in 1682, until a relatively short time ago, the Hereford Mappamundi was almost entirely the preserve of antiquaries, clergymen with an interest in the middle ages and some historians of cartography.
Details from the Hereford map of the Blemyae and the Psilli.a€? Typical of the strange creatures or 'Wonders of the East' derived by Richard of Haldingham from classical sources and placed in Ethiopia. Equally important work was also being done on medieval and Renaissance world maps as a genre, particularly by medievalists such as Anna-Dorothee von den Brincken and Jorg-Geerd Arentzen in Germany and by Juergen Schulz, primarily an art historian, and David Woodward, a leading historian of cartography, in the United States. The Hereford World Map is the only complete surviving English example of a type of map which was primarily a visualization of all branches of knowledge in a Christian framework and only secondly a geographical object. After the fall of the Roman empire in the 5th century, monks and scholars struggled desperately to preserve from destruction by pagan barbarians the flotsam and jetsam of classical history and learning; to consolidate them and to reconcile them with Christian teaching and biblical history.
There would have been several models to choose from, corresponding to the widely differing cartographic traditions inside the Roman Empire, but it seems that the commonest image descended from a large map of the known world that was created for a portico lining the Via Flaminia near the Capitol in Rome during Christ's lifetime. Recent writers such as Arentzen have suggested that, simply because of their sheer availability, from an early date different versions of this map may have been used to illustrate texts by scholars such as St.
Eventually some of the information from the texts became incorporated into the maps themselves, though only sparingly at first.
A broad similarity in coastlines with the Hereford map is clear in the Anglo-Saxon [Cottonian] World Map, c.1000 (#210), but there are no illustrations of animals other than the lion (top left). The resulting maps ranged widely in shape and appearance, some being circular, others square.
A few maps of the inhabited world were much more detailed, though keeping to the same broad structure and symbolism. Most of these earlier maps were book illustrations, none were particularly big and the maps were always considered to need textual amplification.
From about 1100, however, we know from contemporary descriptions in chronicles and from the few surviving inventories that larger world maps were produced on parchment, cloth and as wall paintings for the adornment of audience chambers in palaces and castles as well as, probably, of altars in the side chapels of religious buildings. A separate written text of an encyclopedic nature, probably written by the map's intellectual creator, however, was still intended to accompany many if not all these large maps and one may originally have accompanied the Hereford world map.
These maps seem largely to have been inspired by English scholars working at home or in Europe.
The most striking novelty, however, was the vastly increased number of depictions of peoples, animals, and plants of the world copied from illustrations in contemporary handbooks on wildlife, commonly called bestiaries and herbals. Mentions in contemporary records and chronicles, such as those of Matthew Paris, make it plain that these large world maps were once relatively common. At about the same time that this map was being created, Henry III, perhaps after consultation with Gervase, who had visited him in 1229, commissioned wall maps to hang in the audience chambers of his palaces in Winchester and Westminster. The Hereford Mappamundi is the only full size survivor of these magnificent, encyclopedic English-inspired maps.
An inscription in Norman-French at the bottom left attributes the map to Richard of Haldingham and Sleaford. In this post, I will address the slightly touchier question of whether hospitals should care about what their physicians charge. Given that, in general, the hospital’s charges (for, say, a day in the ICU, a CT scan, or a couple of hours in the OR) far exceed fees for related physician services; you might think that the physician’s fee would have relatively little impact on a patient’s choice of which hospital to use, or a health plan’s choice of which hospitals to include in their network.
Thus, many of the departmental staffing contracts mentioned above contain provisions that require the physician or physician group to participate in plan networks that the hospital also participates in. Hospitals that put too much pressure on the fees of, or on plan participation by, their contracted physicians and staffing groups might also find that this results in having to financially subsidize these practices in order to attract and retain the most qualified physicians. Since he has long been associated with one of the local hospitals (he was recently Chief of the Medical Staff) and wants to support this institution, he referred me to the hospital affiliated lab for these tests, even using a hospital supplied lab form to order the tests.
I assumed that with Medicare paying the hospital on a DRG basis, the hospital would want its emergency physicians to have some idea of the cost of the studies when we considered whether or not they were really indicated.
It is no longer a question of whether physicians should care about hospital costs (particularly on their patient’s behalf); and more of a question as to what physicians can and should do to enhance this transparency. Not only is it exceedingly rate for hospitals to publish their charge masters, it is also unusual for hospitals to publish their policies for discounting their charges to those who are indigent or financially unable to cover the cost of care. Even physicians who belong to HMOs, or are employed by hospitals, need to know this information; and perhaps medical staff leaders have an even greater obligation to be involved in the development of their hospital’s charge master.
Steven Kiley, who was something of a medical conformist); and more importantly, the show’s tempo was designed to allow the actors to dig into the meat of a medical issue, often a conundrum which had no absolutely correct answer. Marcus Welby had more than its share of drama, but the medical issues somehow seemed more real because they revolved around the everyday kind of medical drama: dealing with cancer, depression, impotence, epilepsy, diabetes, and the like, and how these conditions impacted patients, their families, and even the community. At the beginning, you could almost follow the action and understand what was going on, if you were a physician or nurse; but something happened with that show that also happened to many other shows of the time (think West Wing)– everyone talked too fast, and everything happened too quickly, and there were way too many crazy and improbable situations going on at once.
Beyond this overheating of the action and drama, the directors ignored the real-time factors involved in ER care; and thus what often takes an hour in real life is completed in a minute or two on the show (blood gas results might come back faster than you could say the words ‘blood gas’), which further distorts people’s impressions of medical care. I will not go into detail regarding the subsequent medical show offerings that followed ‘ER’. At least they didn’t speed up the action to make the actors sound smarter, or imply that the correct diagnosis always required the right diagnostic test which was always immediately available.
Blue Cross and Blue Shield, she pointed out, used to be not-for-profit, but they transitioned over.
I think the one place in a capitalist economy where profit incentives have no place is in the healthcare insurance market. For-profit health plans have done little to advance any of these mechanisms, not-for-profit plans have at least made a dent.
You would not normally expect that less expensive services would generally yield better quality, and that reduced access to providers of distinction would result in better outcomes.
As to hospital care, I would have to say that there may be some truth to this, as there is a great range of charges from hospital to hospital which could not possibly reflect such small differences in measured quality. Most of the studies that claim that you can get better quality at lower cost tend to look at short-term measures of quality, like fewer hospital acquired infections, fewer hospital readmissions, fewer surgical complications, etc.
Plans like Kaiser might be considered a ‘narrow network’, but their enrollees often remain in the plan for a lifetime; and their policies certainly couldn’t be considered cheap. The DMHC will utilize this data to determine whether the above-cited regulation needs to be amended or revised.
Curiously, a few years ago, when capitated medical groups tried to modify the criteria to add ‘usual contracted rates’ as an additional consideration in determining reasonable value for non-contracted services, the DMHC staunchly defended the existing Gould language and rejected the proposed change after open hearings. Again, it is difficult to know what this obtuse rational really means; but one of the reasons why providers in California have been pushing the DMHC to enforce these regulations is because the payers have not been consistent in their compliance. This form of ‘regulatory capture’ is known as the ‘revolving door’, At one point in time, so many key employees of the DMHC had left the agency to work for the plans and RBOs the agency was regulating that California ACEP seriously considered proposing legislation that would limit DMHC employees from working for these payers for at least two years. Often this language is left a bit vague in order to mollify the regulated entities, which often have undue influence in the legislature or in the subsequent development of the regulatory language.
This is particularly true when it comes to containing costs, the genesis of many such programs, like Medicaid Managed Care, which was designed in response to busted state Medicaid budgets. Understaffed, under pressure from stakeholders on all sides, subject to variable political winds, outgunned by high-priced lawyers and lobbyists, and generally denigrated by Wall Street; these folks deserve more credit (and pay) than they usually receive. This means that BC will compare claims for emergency department services that contain these codes against an (unspecified) list of diagnoses that (by some unspecified criteria) are appropriate in association with this level of evaluation and management services. My best guess is that BC would point to a gradual inflation over the years in the percent of claims from EDs that are coded at the highest level. So if not by the kind of prepayment review and down-coding practiced by these plans; how should the plans conduct these audits and protect enrollees (and their own profits)? The main thrust of this argument is that larger group practices are able, through economies of scale and the ability to invest in practice enhancements, to more effectively satisfy the needs and desires of the hospital C-suite. It revived the BSI after four years of dormancy, and ushered in a new era at the Murray Hill Hotel. Smith in the 1950s, but lost along the way), we begin by reprinting the account of the 1940 BSI dinner which appeared in Irregular Memories of the a€?Thirties.
I didn't get a blue carbuncle, or, for that matter, did I even get a goose - but the day was a very pleasant one notwithstanding. The date crept up very quickly, and when I finally reached Earle Walbridge yesterday, to look over the proofs of my section, I found a number of errors which it is now probably too late to correct, since Miss Prink at Macmillans tells me the binding has already started.
There being no Goldini's or Marcini's available, the Murray Hill Hotel seems to meet the necessities next best. Anything I can do toward contributing to the preparations for the event I shall therefore have to undertake during the next two weeks. The errors will probably be discernible only to the inner circle of the cognoscenti, and to those select few they can easily be explained away. Shortly afterward, Edgar Smith a€” now the BSIa€™s Buttons, an extra-Constitutional office later to be superceded by the grander and rolling title of Buttons-cum-Commissionaire a€” sent out to those on the mailing list he had received from Christopher Morley some minutes of the annual dinner.
Revision of this constitutional requirement was, however, adopted, viva voce, and amendment to the Constitution hereby imposed, in that it is required hereafter that the toast shall not be canonical but Conanical. Christopher Morley announced that the meeting, which was held as usual on a date at variance with the constitutional specification, had been called to celebrate the publication by Macmillans of 221B - a compilation of the writings of various members of the Society. Vincent Starrett, whose unfortunate absence from the meeting can be compared only with the intolerable absence of Mrs. We are able to reproduce opposite the appropriately fanciful menu of the evening a€” it initiated a custom of oysters, pea soup, curried chicken, and a sweet which was observed by the BSI for many years (until, Robert G. I tore up two or three attempts to do it from an old drawing, finally put on my old dressing gown and posed for it in the mirror.a€? And in a letter to Edgar Smith dated December 13, 1942, Christopher Morley wrote: a€?Would Freddy Steele like to design a menu card or would we use again the one he did years ago? Located at 41st and Park Avenue in Manhattana€™s Murray Hill district, the venerable hotel had seen better days by the time the Baker Street Irregulars arrived in 1940, but it captured and preserved the atmosphere of Victorian London far better than any other possibility in New York at that time (let alone today). In the United States on Estate business, making Sherlock Holmes publishing and radio and motion picture deals, and doing some lecturing on his fathera€™s Spiritualist cause as well, he had been invited to the BSI dinner by Christopher Morley.
Smith, prominent Sherlockian and secretary, or a€?Buttons,a€? as he is called, of the Irregulars, informed this writer that the trouble began several years back, when Denis Conan Doyle attended a Baker Street dinner in New York. He added that it was probably the highest compliment ever paid in the history of literature. Hudson to sit down at a meeting of the Baker Street Irregulars and to count you among the missing. It isn't as comprehensive a thing as I had thought it might be -- perhaps I should add hotels and clubs and restaurants to the list of countries, U.S. Altick wrote his paper on Holmes and Johnson as an undergraduate at Franklin & Marshall College in Lancaster, Pa. Certainly I shall be happy to have a copy of your paper - entire - and I trust that you are right in believing it to be publishable.
I am sorry you had to wait so long for an acknowledgment of your MS - which I received, read, and enjoyed. I had thought that he was sent to China by the Chicago Tribune as its Far Eastern correspondent. The photograph below is of the lobby, looking past the reception desk and grand staircase at the corridor which led to the private meeting rooms. Smith, eager for the BSI to convene again for what would be his first annual dinner, had suggested the Murray Hill Hotel as an appropriate place.
We could have one of their private dining rooms, which are so entirely in the Baker Street manner and decor. I might tell you that the addresses may not be 100% correct, but I think you will find them O. Smith is about the busiest person on earth at the moment, although he has taken time out to read your new book BOOKS ALIVE which he thinks is excellent. Warren Force, Harry Hazard, Harvey Officer, Allan Price, Harrison Reinke, Stuart Robinson, and Earle Walbridge.
Since Smith was working from a list supplied by Morley a€” Woollcotta€™s name was on the 1935 list, but crossed off on the only copy surviving to be printed in the September 1960 Baker Street Journal a€” we must wonder about the legend of Woollcott cast out into utter darkness after crashing the 1934 dinner, and publishing his mocking account of it in The New Yorker. In a letter to Morley on May 10, 1939, discussing the progress of 221B, Vincent Starrett mentioned that a€?Incidentally, Ia€™ve included tentatively Woollcotta€™s bit on the Gillette dinner in 1934, from the New Yorker, as a sort of pendant to Fred Steelea€™s contribution from the same journal, which mentions the dinner.
It was not until 1945 that any of the original Pips a€” Gordon Knox Bell, Richard Clarke, Owen Frisbie, Norman Ward, and Frank Waters a€” began to attend the BSIa€™s dinners. Starrett later used the title for his bookmana€™s column in the Chicago Tribune, which appeared Sundays for some twenty-five years.
In the first place, they were declared no longer canonical but Conanical a€” Christopher Morleya€™s whimsical way of tipping his hat to Sir Arthur Conan Doyle in his son Denisa€™s presence. When, in the course of luncheon at Christ Cellaa€™s or elsewhere, some acquaintance would hear about the Sherlock Holmes society and ask how to get in, he would be asked a€?Who was the Second Most Dangerous Man in London?a€? If he could answer that one, he might get asked others if anybody present wanted to ask them. That was getting late to make plans to attend, apologized Morley; but Keddie made it nonetheless. On the occasion of the 1940 dinner, however, the editor of 221B: Studies in Sherlock Holmes was not even in Chicago, a mere overnight run on the 20th Century Limited to New York. Smitha€™s minutes say that a€?The meeting voted simultaneously to send greetings and a fully autographed copy of the book to Mr. This meeting was held to celebrate the 50th anniversary of Sherlock Holmesa€™s first appearance in American ink (Lippincotta€™s Magazine, February 1890).a€? Not a great way to sell copies of the real reason for the 1940 dinner, Vincent Starretta€™s 221B: Studies in Sherlock Holmes a€” especially since lack of funds had forced Starrett to sell that superb collection of his the year before! Dame Jean Conan Doyle did not share her brothersa€™ antipathy toward the Baker Street Irregulars, and in fact was pleased to accept membership in 1991. Keddie, a publisher of his as well, at the company where he was vice-president, took it upon himself each year to write Starrett a report of the dinner.
On January 30, barring accidents, I shall be four weeks along in a Reno residence of six, in an effort to procure a divorce which will enable me to marry Ray.
Indoctrinated students will deduce that (by an innocent misunderstanding) a portion of this work was set from unrevised copy, and this first edition will remain identifiable by a number of irregularities, notably in Mr Edgar Smitha€™s valuable concordance. However, it was signed by several at a most successful meeting of the Irene Adler division or Ladies' Auxiliary held immediately after the dinner.
Copies of 221-B were distributed and autographed more or less by all present, and a jolly good time was H. Now, as Holmes has pointed out, Curry is an excellent disguise for the taste of opium, and (you remember) would be the logical flavor to use in food into which opium was to be introduced. He said that his father had known Holmes very intimately, and he even went so far as to say that Holmes's mental processes had influenced his father's thinking.
He also suggested that only Hitler could have written the impetuous and irresponsible letter which caused all the trouble.
Julian Wolff, who made a couple of neat little maps of spots in the stories about a year ago (I asked him at the time to send copies to you), and he is doing a bang-up job with London, England, the Continent and the world - creations that will be well worth framing and hanging. I had photostats made of it, and am sending you a copy herewith, in case you haven't seen it. And none have been found from 1941 through 1945, though some pictures were taken by others at the BSIa€™s special Trilogy Dinner at the Murray Hill Hotel on March 30, 1944. Christopher Morley (still beardless at this time) is at the head of the table, in black tie, leaning to catch something Frederic Dorr Steele is saying to him. Absent from all seven are the signatures of Elmer Davis, Malcolm Johnson, and Warren Jones, all of whose names are in Smitha€™s minutes. Smith took on the work of Buttons in January 1940, sending out dinner invitations to the rather casual list of members Christopher Morley provided, and preparing minutes afterward, it was all new to him.
His name appears in Smitha€™s minutes, but his signature does not in any of the seven surviving copies of 221B. Some names do not appear on either the 1935 or 1940 membership lists, and we will not see them again after this night.
Yet one man there a€” the man with the dapper mustache, raising a wine-glass in salute a€” is still in the ranks. Of course no one of my generation can forget the overwhelming, all-pervading atmosphere of the Depression, the atmosphere of fear, fear for onea€™s job, fear for all onea€™s friends, half of whom were out of work.
My friend Basil Davenport, the one man I knew who literally lived in a garret, in the depths of the Depression, supporting himself by writing for that same Saturday Review of Literature a€” precariously, because the Saturday Review didna€™t always have the money to pay contributors.
The circle of the world is set in a somewhat rectangular frame background with a pointed top, and an ornamented border of a zig-zag pattern often found in psalter-maps of the period (#223). Show pity, as you said you would, on all Who their devotion paid to me for you made me Savioress. Olympus and such cities as Athens and Corinth; the Delphic oracle, misnamed Delos, is represented by a hideous head.
James (Roxburghe Club) 1929, with representations from manuscripts in the British Library and the Bodleian Library, and a€?Marvels of the Easta€?, by R. The upper-left corner of the Hereford Map, showing north and east Asia (compare to the contents on Chart 3). 1), however, call attention to a remarkable degree of accuracy in the relationship of toponymsa€”for cities, rivers, and mountainsa€”both in EMM and in Hereford Map legends.A  On the Asia Minor littoral, for example, one passage in EMM links 39 place-names in a running series, 23 of which are found in Chart 4 (and visible, in almost exactly parallel order, on Fig.
5, above).A  Treating islands separately from the eartha€™s three a€?partsa€? follows the organizational style adopted by Isidore of Seville, Honorius Augustodunensis, and other medieval geographical authorities.
Note Lincoln on its hill and Snowdon ('Snawdon'), Caernarvon and Conway in Wales, referring to the castles Edward I was building there when the map was being created.
In England, a detailed study of its less obvious features, such as the sequences of its place names and some of its coastal outlines by G. The Psilli reputedly tested the virtue of their wives by exposing their children to serpents.
The cumulative effect has been to enable us at last to evaluate the map in terms of its actual (largely non-geographical and not exclusively religious) purpose, the age in which it was created and in the context of the general development of European cartography. The Old and New Testaments contained few doctrinal implications for geography, other than a bias in favor of an inhabited world consisting of three interlinked continents containing descendants of Noah's three sons. This now-lost map was referred to in some detail by a number of classical writers and it seems to have been created under the direction of Emperor Augustus's son-in-law, Vipsanius Agrippa (63-12 BC) for official purposes. As the centuries went by, more and more was included with references to places associated with events in classical history and legend (particularly fictionalized tales about Alexander the Great) and from biblical history with brief notes on and the very occasional illustration of natural history. Note also the Roman provincial boundaries, the relative accuracy of the British coastlines (lower left) and the attention paid to the Balkans and Denmark, with which Saxon England had close contacts. Some, often oriented to the north, attempted to show the whole world in zones, with the inhabited earth occupying the zone between the equator and the frozen north.
They were never intended to convey purely geographical information or to stand alone without explanatory text. Often a 'context' for them would have been provided by the other secular as well as religious surrounding decorations. For many maps continued to be used primarily for educational, including theological, purposes. They reached their fullest development in the thirteenth century when Englishmen like Roger Bacon, John of Holywood (Sacrobosco), Robert Grosseteste and Matthew Paris were playing an inordinately large part in creative geographical thinking in Europe. In most, if not all of these maps, the strange peoples or 'Marvels of the East' are shown occupying Ethiopia on the right (southern) edge, as on the Hereford map.
Exposure to light, fire, water, and religious bigotry or indifference over the centuries has, however, led to the destruction of most of them. Both are now lost but it seems quite likely that the so-called 'Psalter Map', produced in London in the early 1260s and now owned by the British Library, is a much reduced copy of the map that hung in Westminster Palace. Despite some broad similarities in arrangement and content, however, there are very considerable differences from the Ebstorf and the 'Westminster Palace' maps in details - like the precise location of wildlife, the portrayal of some coastlines and islands, or in the recent information incorporated. This would be particularly true in areas where transparency of physician and hospital charges is limited, providing consumers with little information to make such informed choices. A lot of consultants get a lot of business trying to help hospitals thread this needle, often with limited success.


I am sure he knew that I could afford to pay for tests that might not be covered by Medicare, and that I too supported this hospital; I had to wonder if he knew how much more the hospital charged for these tests than the local independent clinical lab. In many cases, it is in the physician’s own interest to understand the hospital’s charge master, especially if the hospital’s charges begin to impinge on the success of the physician’s practice, and his or her ability to attract patients to use the physician’s services. The issue of hospital charges for services to the uninsured may have been mitigated somewhat by Obamacare; but the issue of out-of-pocket costs for the insured is becoming a serious concern. Hospital administrators will, of course, find this concept abhorrent, but there is another side to this story.
The audience could watch Marcus and Steven in action, and in contemplation, and in study, in the OR and the office and at home, and come away with a better idea of what the practice of medicine is really like, most of the time, for most doctors and for most patients. You might think an ER doc would appreciate the frenzied action and dialogue, since that is often how we like to portray the practice of Emergency Medicine to impress our family and friends with how difficult it is and how capable we must be to be able to save lives and suture complex wounds in the midst of all this chaos.
I could go on – there were innumerable instances of the necessities of television drama obliterating the realities of medical decision-making, the progression of disease, the tedium of documentation, the uncertainty of diagnostic testing, etc, etc.
Suffice it to say that though there have been some interesting takes on health care issues of the day, and some modestly successful efforts to explore the ethical and legal conundrums that modern practitioners and patients face; on the whole the things that undermined ‘ER’ have generally only gotten more extreme. It is one thing to complain about the lack of quality health education in K-12 schools (not to mention college), and the impact this has on how the public approaches wellness, illness, health care, and quality of life issues. EMTALA may have been designed to protect us from being abused by heartless health plans and hospitals, but this law has gone too far, and it is preventing us from MAKING AMERICA GREAT AGAIN by keeping us from screening out those who would undermine our ability to get timely emergency care, and from using the proper triage tools to profile these terrible people who want to steal our health care, and turn them away.
Of course they did, and of course not-for-profit plans have not played a greater role in Obamacare. Now I am not suggesting that Bernie has a better answer: Medicare for all is a budget buster in a climate where more taxes are anathema. The idea that consumers would prefer to get lower quality care in order to save money might be true for those who never expect to get sick; but for anyone who has had to rely on health care for anything more serious than walking pneumonia, the quality of care provided by a physician or hospital comes first, not third.
Yet hospital charge variations are much wider than variations in what hospitals actually get paid by government and third-party payers; and many of the choices made by health plans in selecting hospitals to participate in their networks are based on relatively small differences in negotiated rates. Makes sense, but if you look at such statistics, and fail to make adjustments for the types of patients treated and the complexity of the services rendered, you may get the wrong answer. The type of narrow networks that I question are those that recently evolved in the health exchanges, and that set a deeply discounted rate for in-network providers and then went fishing for any physicians and hospitals in their area willing to sign up, while professing a commitment to access and quality they can only back up with questionable short-term metrics.
The DMHC intends to publish the data collected from this study in aggregate format, so as to ensure confidentiality for both health plans and capitated providers.” The survey requested that the payers describe their methodology for compliance with these regulations, any changes over the last two years in the methodology used, the source of any data used, expected changes in methodology in light of the Children’s Hospital court decision (see note below), and how HMOs would ensure that their capitated providers were also in compliance. Nonetheless, multiple efforts by providers in California to get the DMHC to enforce this regulation have, with one exception, fallen on deaf ears.
Most appear to have not even attempted to comply, in particular because Gould relies on ‘prevailing provider rates charged in the general geographic area in which the services were rendered’ as the baseline and the most quantifiable criteria for reasonable value.
Health plans love this kind of vague language because the plans can more easily ignore them, while the very existence of such regulations relieve some of the pressure off legislators and regulators to ensure fairness. Fairness to providers (and patients) often takes a back seat when it comes to regulating health plans, especially if the perception is that such ‘fairness’ regulations might inadvertently raise costs or cut into plan profits, threatening ‘the system’. Often, the goals of health care regulation take a back seat to purely political considerations, expressed in election grandstanding, the chase for campaign contributions, and even political favors and influence peddling. However, when it comes to enforcing health care regulations, the concept of benign neglect rarely applies. Are emergency physicians more likely to up-code claims than cardiologists, orthopedic or plastic surgeons, or internists? Certainly, the meteoric growth of the larger (multi-site, multi-specialty) groups, and the growth in direct hospital employment of physicians in these and other primarily hospital-based specialists, is evidence that there is something to the arguments that smaller groups have significant challenges to face. If you could go back in time to attend just one BSI dinner from years gone by, which one would it be?
It was a publication party for the first BSI anthology of Writings About the Writings, Vincent Starretta€™s 221B: Studies in Sherlock Holmes, with most of its contributors present that night. Mistakes can be corrected, assumptions confirmed, missing passages filled in, and hitherto-unsuspected aspects revealed. Starrett could be excused for overlooking it, since he had been out of the country at the time, on an extended tour of duty.
The changes I would have made are of a rather minor character, and probably if it were not my own child I would not be conscious of the few warts that disfigure it.
Our dearly beloved public won't know Staphonse from Staphouse (if that's not in the eight pages) and even if they do find ground for pinning us down, the controversy might actually be profitable. I hope everything comes out satisfactorily, and that you will be East again before too long. It was the first of an unbroken series of annual minutes prepared by Smith through 1960, the year of his death. A copy of the book, presented with the compliments of the publishers, was put at each place. Cecil For(r)rester, who expressed his sympathy and pledged his assistance in the Society's research in the matter of his ancestral relations with a certain governess.
Harris says, the Irregulars meeting every January, at Cavanagha€™s by then, grew so many for the room, that diners no longer had the elbow-room to wield an oyster fork). His talk that evening, Morley reported in writings reprinted earlier in this volume, was a€?probably the most charming discourse to which we have listened.a€? Later, though, as Morley also observed, Denis Conan Doyle (not to mention his sometimes volcanic younger brother Adrian) came to regard the BSI as some sort of conspiracy dedicated to usurping their fathera€™s reputation and accomplishments.
Very different from Woollcott, he wrote in a vein of decorous modesty asking if he could be put on the waiting list and offered to undergo any sort of inquest of suitability.
In every respect but this the dinner at the Murray Hill Hotel last week was a roaring success, and the book -- however it may ride the seas -- was properly launched.
Altick is the author of many books, including the evocatively titled Victorian Studies in Scarlet in 1972.
How he came to write to Vincent Starrett in Chicago, he no longer remembers, but from his papers at Franklin & Marshall come these two letters from Starrett, who encouraged him, commented on his paper, and saved it until 221B came along as a convenient outlet a few years later.
It seems to me that you have made out an excellent case and I hope you may find an editor who will publish the paper. It was, instead, a trip around the world of his own, paid for by the sale of his 1935 novel The Great Hotel Murder to the movies. Unable to identify Latham, I offered a complimentary copy of the next volume of BSI History to anyone who could.
I propose that you and I appoint ourselves a committee, perhaps together with Harold Latham of the Macmillan Company, to arrange this matter.
It isna€™t so hot, in my opinion a€” only about 400-500 place names, and many of the richest ones not geographical at all. Just as soon as he gets a little breathing spell he is planning to write you a lengthy epistle. His paper a€?The Creator of Holmes in the Flesha€? reads as if it had originally been a talk a€” perhaps at the a€™36 dinner, about which we have few details. Warren Force (died 1959) was in the tar business a€” founder and chairman of the Hydrocarbon Products Company, Inc., and a director and the treasurer of the Tar Distilling Company and Old Colony Tar Company at the time of his death. The Five Orange Pips had been founded in 1935 independently of the BSI, perhaps in blissful ignorance of its existence; and for ten years they regarded the BSI as the lesser body.
Leavitt, BSI by way of the Grillparzer Club well before 1934, railed about it to Julian Wolff many years later, when Wolff had succeeded Smith as the BSIa€™s Commissionaire. An uncle of mine who must have been a contemporary of Watson in Edinburgh continued to put the sundries of his evening comfort in the coal box a€” which never had held coal a€” until his death a few years ago.
He was across the prairies and over the Rockies in Reno, Nevada, in the process of getting a divorce from his first wife, Lillian Hartsig, in the days when six weeksa€™ residence in a€?The Biggest Little City in the Worlda€? was the quickest way. Starrett, an action which, in the preoccupations which ensued, was probably not accomplished.a€? But other Irregularsa€™ copies did make the rounds of the table.
Steelea€™s hand was steady, but some signatures show signs of having been inscribed a few rounds of drinks later. I tore up two or three attempts to do it from an old drawing, finally put on my old dressing gown and posed for it in the mirror.a€? The parenthetical passage which had been missing held the clue. Randall hoped to resell it intact to someone, perhaps a library where it would be available for scholarly use, but in 1943 finally offered it up piecemeal. Latham writes me from Macmillan that he will see that a complimentary copy goes to everyone.
I carried a coal scuttle of the Baker Street variety to New York, and it was placed in triumph, and, I hope, in complete vindication of Watson's reporting, in the middle of the table - we kept the cigars in it.
And, yes, I'll hang on to the remaining two chapters I have and use them (I am sure) before your book goes into print. We are thinking of putting out the Gazetteer together about June 1st, as a private effort, illustrated with reductions of these maps, which would really touch it off. This was his first BSI dinner and he was meeting virtually all these men for the first time that night. Ronald Mansbridge was born in England in 1905, attended Cambridge University, and came to the United States in 1928 to teach at Barnard College. 6, sitting next to my old friend Basil Davenport, who has another old friend of mine, Peter Greig, on his right. When I arrived in New York in 1928, I had a letter of introduction to Chris from Sheldon Dick, whom I knew at Corpus, Cambridge.
I missed that one, but I happened to follow Archie on a trip across America, about a week behind him, staying at some of the same hotels. Basil was too proud to accept money from a rich aunt Juliet; but he did let her pay his membership dues at the Yale Club, which he called a€?the most inclusive club in New York,a€? and which he liked because he could take their thick correspondence cards and cut them to fit inside his shoes perfectly when the soles wore out.
Like so many others, he was hit by the Depression, but made ends meet by doing public relations work for various and sundry. I remember an animated discussion with him once about a book on Horace we had published at Cambridge University Press. Although he didna€™t attend the dinner, he made arrange-ments for copies of 221B: Studies in Sherlock Holmes to be distributed at the dinner.
In Phrygia there is born an animal called bonnacon; it has a bulla€™s head, horsea€™s mane and curling horns, when chased it discharges dung over an extent of three acres which burns whatever it touches.
India also has the largest elephants, whose teeth are supposed to be of ivory; the Indians use them in war with turrets (howdahs) set on them.
The linx sees through walls and produces a black stonea€” a valuable carbuncle in its secret parts. A tiger when it sees its cub has been stolen chases the thief at full speed; the thief in full flight on a fast horse drops a mirror in the track of the tiger and so escapes unharmed.
Agriophani Ethiopes eat only the flesh of panthers and lions they have a king with only one eye in his forehead.
Men with doga€™s heads in Norway; perhaps heads protected with furs made them resemble dogs. Essendones live in Scythia it is their custom to carry out the funeral of their parents with singing and collecting a company of friends to devour the actual corpses with their teeth and make a banquet mingled with the flesh of animals counting it more glorious to be consumed by them than by worms. Solinus: they occupy the source of the Ganges and live only on the scent of apples of the forest if they should perceive any smell they die instantly. Himantopodes; they creep with crawling legs rather than walk they try to proceed by sliding rather than by taking steps. The Monocoli in India are one-legged and swift when they want to be protected from the heat of the sun they are shaded by the size of their foot. Flint, a€?The Hereford Map:A  Its Author(s), Two Scenes and a Border,a€? Transactions of the Royal Historical Society, 6th ser.
Nevertheless, it placed a somewhat misleading emphasis on the map's geographical 'inaccuracies', its depiction of fabulous creatures and supposedly religious purpose, all clothed in what for the layman must have seemed an air of wildly esoteric learning and near-impenetrable medieval mystery.
Recent research suggests this is a reference to African traders in medicinal drugs who visited ancient Rome. Today, with the map in the headlines of the popular press, it may be time to give a brief resume of what is currently known about it and to attempt to explain some of its more important features in the light of recent research. In the eyes of some (but by no means all) theologians, a fourth inhabited continent, the Antipodes, would implicitly have denied the descent of mankind from Noah, and the depiction of such a continent was deemed to be heretical by them. It was based on survey and on military itineraries and reflected the political and administrative realities of the time. Where space allowed, reference was also made to important contemporary towns, regions, and geographical features such as freshly-opened mountain passes. Most of the maps, however, like the Hereford Mappamundi, depicted only that part of the world that was known in classical times to be inhabited and they were oriented with east at the top. Traces of the maps' classical origins could regularly be seen in, for instance, the continued depiction of the provincial boundaries of the Roman Empire (which are partly visible on the Hereford map) and for many centuries by the island of Delos which had been sacred to the early Greeks being the centre of the inhabited world.
They and the texts that they adorned continued to be copied by hand until late in the 15th century and are to be found in early printed books.
God dominates the world and the 'Marvels of the East' occupy the lower right edge of the map, as they do on the Hereford map. Together they would have provided a propaganda backdrop for the public appearances of the ruler, ruling body, noble or cleric who had commissioned them, and some may have been able to stand alone as visual histories.
The Hereford map, as an inscription at the lower left corner tells us, was certainly intended for use as a visual encyclopedia, to be 'heard, read and seen' by onlookers. Because of the maps' size, they were able to include far more information and illustration than their predecessors. More space was also found for current political references and information derived from contemporary military, religious and commercial itineraries. Today, the earliest survivor, dating from the beginning of the thirteenth century, is a badly damaged example now in Vercelli Cathedral, probably having been brought to Italy in about 1219 by a papal legate returning from England. We know from Matthew Paris that the Westminster map was copied by others, and it is likely to have had a lasting influence even though the original was destroyed in 1265.
A Latin legend in the bottom right corner of the Hereford map refers to the 5th century Christian propagandist Orosius as the main source for the map, but as we have already seen, it incorporates information from numerous ancient and thirteenth century sources and adds its own interpretations of them. The map is an outstanding example of a map type that had evolved over the preceding eight centuries.
I think most physicians would argue that the fees they charge for their services is none of the hospital’s business, unless the physician works directly for the hospital. Furthermore, in the world of government or commercially insured health care, most hospital and physician services are discounted, often significantly, through network participation.
In light of stricter coverage policies by plans for testing, increasing co-insurance payments, increasing deductible payments, and other out-of-pocket cost considerations for patients and their families; I can’t help but think that the question of hospital charges is becoming an even more important financial issue for the consumer, and an important consideration for physicians. Years later, now that everyone is talking about value-based purchasing, you might think the administrator’s response would be different, but so far this kind of cost transparency is just beginning to catch on.
In the case of emergency physicians, for example, the hospital may be imposing such outlandish charges for the use of the Emergency Department that it is forcing even insured patients to seek alternatives just to reduce their exposure to higher co-insurance payments.
Most hospitals operate on thin margins, and can ill afford to have their doctors recommending that patients use cheaper, alternative facilities for their care. Sure, many ERs are crazy busy and chaotic and stressful to work in; but the truth is that if every day in the ER was like an hour of the show ‘ER’ the staff would ALL go bonkers in a week. All of this distortion just cannot be good for reality testing in health care, just as fake CPR on TV gives so many false impressions to the audience that it is a wonder anyone survives layperson resuscitation of out of hospital arrest. What effect these medical programs may be having on the public’s perception of these issues is largely unstudied; but woven into many of these shows is so much disinformation and distortion, despite the effort to seem informative and socially mindful, that I can’t help but cringe every time I watch.
They have unbalanced our budget and we can get these hospitals to pay for these walls by threatening to buy our health care from Wal-Mart, or Thailand. I am just suggesting that if Hillary wants to see more not-for-profits engaged in the ACA, and wants to reduce the financial burden of health care on families: Obamacare needs a major overhaul.
Even when employers purchase healthcare insurance for their employees, they are sensitive to quality issues. You would expect that hospitals that are able to negotiate higher rates in competitive markets probably have a wider range of specialized services and perhaps more qualified staff and better reputations.
However, this only applies if the enrollee sticks with the plan over the long-term, otherwise the plan would profit from avoiding providers who screen their patients and treat the positives.
Is the orthopedic surgeon who declines to provide hip surgery to patients with obesity, and other medical complications like diabetes or vascular disease, providing better care than the surgeon operating at a tertiary hospital on very complicated patients who are far more likely to have less than optimal outcomes? The success of plans in forcing CMS to back off on requiring that narrow networks meet minimum transparent standards for adequate access serves only to reinforce doubts about this commitment.
At one point, the Department claimed that the Gould Criteria were too vague to enforce, and advised physicians to either use their so-called independent claims review (arbitration) process, or the courts, to enforce the regulations.
Health plans react vigorously (and often threaten to abandon certain coverage programs) when regulators consider more rigorous enforcement of regulations, like those aimed at ensuring adequate patient access in narrow network plans.
The press, which tends to prefer simplified headlines over the complexities of balanced regulation, also wields significant influence over regulatory enforcement. If the review fails to support a Level 5 service, the claim will be down-coded to a lower level and paid at the concomitantly reduced rate (at least 40% lower). The increase in Level 5 codes could also reflect the impact of the growth of narrow plan networks (which reduce access to specialist appointments) and high deductible policies (which may discourage patients from coming to the ED before their condition deteriorates.
They should probably eliminate (at least in this first pass) physicians and hospitals that operate trauma and stroke centers that treat many more higher acuity patients. This post looks at both questions as they apply to larger groups and to single site group practice: limited-equity small, democratic small, limited-equity large, and democratic large. The evolution of certain practice management companies like IEPC lends further evidence to the idea that size has its advantages. The very first, in 1934, when Alexander Woollcott rode across Manhattan in a hansom cab with Vincent Starrett to crash the party? And we can get a glimpse of the magical evening of January 30, 1940, in a BSI dinner photograph a€” apparently the first ever taken a€” which in 1990 we did not know had ever existed. Much new is there: the dinner photo and a key to it, letters from Vincent Starrett, Edgar W. But he went on to implicate Christopher Morley in defense of such a deplorable situation: a€?To quote Mr. I doubt that time remains to enable the development of an essay on the Obliquity of the Ecliptic, but it is barely possible, if I apply myself assiduously, that I might have ready for confidential distribution for those present, a typewritten copy of the Gazetteer on which I have recently been making fairly decent progress.
I was altogether too finicky, anyway, in writing you as I did, and I hope you'll forgive me.
The meeting voted spontaneously to send greetings and a fully autographed copy of the book to Mr. There were some veterans of the Three Hours for Lunch Club and the Grillparzer Sittenpolizei Verein, like Frank Henry, Malcolm Johnson, Bill Hall, Mitchell Kennerley, and Robert K.
In my capacity as Buttons, I shall be sending you as sober an account of the evening as I can see my way clear to put together.
Anyway, let me know what you think of it, and how it might be improved, and perhaps for Christmas or some time before I can get my bargain-price printer to put it in type.
There was a short session of the Irene Adler division here in Reno, at which I presided - Basil Rathbone being at the Wigwam Theatre in The Adventures of Sherlock Holmes. He is still at work, and his most recent book, a study of the first ten years of Punch, was published in 1997. You will be more likely to find one favorable to the idea of publication, I think, if you will abbreviate the essay skillfully; its length just now is against it, I'm afraid.
Starretta€™s journey began in the Orient and ended in Europe, with his first visit to London in some years. The suggestion of the Murray Hill, as well as the impetus for the 1940 BSI dinner, came from Christopher Morley. A cost estimate I recently saw for a businessman visiting New York in 1941 gave $3.35 a day for breakfast, lunch, and dinner. Smith as Buttons communicated with the membership through memoranda to the BSI, sometimes enclosing whatever membership list was current at the time.
Bell, who was unaccountably omitted from the list of those invited to last Januarya€™s celebration; and that of Dr. Stolper and Howard Swiggett, respectively a professor of English at Columbia University who scandalized his colleagues by contending that literature should be taught by writers, and a novelist well-known in his day, with links to the New York Police Commissioner, and later to certain cryptic wartime British missions in New York. Leavitt, and Gene Tunney, plus at least one other, non-fiction and mystery writer Hulbert Footner, whose only known connection with the BSI is his name on this 1940 list. Leavitt swore to this version of history in a€?The Origin of 221B Worship,a€? his 1961 memoir of the BSIa€™s early years. Smith eventually coaxed the Pips into the BSI, and then struggled to save them in 1947 when Christopher Morley felt the BSI had grown too large and unruly. Hence the membership of people like Don Marquis, Frank Henry, Bucky Fuller and other friends of Chris Morleya€™s who couldna€™t be annoyed with studying the Sacred Writings. It was, I tell you, an ornamental piece of furniture, and when the fire needed replenishing, the bell-pull at the end of the mantel-piece brought the servant lassie from the kitchen with a cannily measured a€?scuttlea€? of coal, from which the fire was fed with great daintiness and dexterity. Smith sat next to Keddie at the dinner, and the two men hit it off a€” less than three months later, Smith was in Boston to join the Keddies Sr. To do so, he and Starrett produced a catalogue still highly desirable for its own sake, both for the many splendid items at what today seem sheer giveaway prices, and for the rich canonical fantasy which Starrett and Randall wrote into it. We will try to keep the actual dinner within the blood royal, but as soon as it has taken place Macmillan can make good boblicity out of it to help the book. Watson, but probably not so well - at least he didn't seem to understand him as well as he did Holmes. Denis Conan Doyle is off to himself a bit in the corner; not intentionally perhaps, but capturing a sense of the remove between the Conan Doyle Estate and the BSI. How well he managed to associate names with faces that evening, when high spirits and hard spirits were the order of the day, is unclear. A few of them, Irregulars active today were able to know in person before they fell from the ranks.
In 1930 he was appointed Cambridge University Pressa€™s representative here, a position he held for forty years. It was clear that he had made quite an impression; at one hotel they asked me whether I wanted whisky for breakfast. Roberts, author of A Note on the Watson Problem, and then Doctor Watson, which Frank Morley at Faber & Faber published.
From its literal meaning in Greek it also signifies the plant ox-tongue, so called from its shape and roughness of its leaves.
Conventionally holds a mirror in one hand, combing lovely hair with the other According to myth created by Ea, Babylonian water god. The large city at the top edge is Babylon (its description is the map's longest legend [A§181). 12-30.A  The conservator Christopher Clarkson drew my attention to the gouge in the Mapa€™s former frame.
Talbert (Princeton: Princeton University Press, 2000), which I employ throughout my book, but with the caution that in dealing with the manuscript culture of medieval Europe, it is misleading and anachronistic to speak of a€?standarda€? or a€?correcta€? spellings, especially of geographical words. Casual visitors to the dark aisle where it hung could see only a dark, dirty image which they were encouraged to view in a pious, but also rather condescending manner.
Crone of the Royal Geographical Society, revealed that despite the antiquity of many of the map's sources much was almost contemporary with the map's creation and was secular. Much of the text that follows is an amplification of information panels and leaflets prepared for the British Library's current display of the map. Most medieval mapmakers seem to have accepted this constraint, but world maps showing four continents are not uncommon: notably the world maps created by Beatus of Liebana (#207) in the late 8th century to illustrate his Commentary on the Apocalypse of St. It may have incorporated information from an earlier survey commissioned by Julius Caesar and, to judge from some early references, it may originally have shown four continents. These texts owed much to classical writers, particularly Pliny the Elder (23-79), who himself derived much of his information from still earlier writers such as the fifth century BC Greek historian Herodotus.
As befitted the encyclopedic texts that they illustrated, the maps became visual encyclopedias of human and divine knowledge and not mere geographical maps.
Many were purely schematic and symbolic, showing a T, representing the Mediterranean, the Don and the Nile, surrounded by an 0, for the great ocean encircling the world, sometimes with a fourth continent being added.
It was only from about 1120 that Jerusalem took Oclos' place as the focal point of the map, as it does on the Hereford Mappamundi.
They retained and expanded the geographical and historical elements of the older maps - coastlines, layout and place names on the maps frequently reveal their ancestry - but to them they added several novel features. Inscriptions of varying lengths amplified the pictures and sometimes contained references to their sources. Much better preserved, until its destruction in 1943, was the famous Ebstorf world map of about 1235. It is difficult to account otherwise for the striking similarities in detailed arrangement and content between the Psalter world map, the recently discovered 'Duchy of Cornwall' fragment (probably commissioned in about 1285 by a cousin of Edward I for his foundation, Ashridge College in Hertfordshire) and the Aslake world map fragments of about 1360.
In many of its details it particularly resembles the Anglo-Saxon World Map of about 1000 and the twelfth century Henry of Mainz world map in Corpus Christi College, Cambridge. Hospital-based physicians, like anesthesiologists, radiologists, hospitalists, emergency physicians, and other specialists whose revenues are derived primarily from the services they render to patients in the hospital, are more apt to expect that the hospitals they work in might have more of an interest in these physician charges Some hospitals that contract with physician groups to staff their radiology department or emergency department or other hospital services not only take an interest in the fee schedules of these groups; they may well insist on the right to approve, or even set, these fees, and include such provisions in their staffing contract with the group. The only time insured patients pay full charges are when the hospital, or the physician, or both, are not in the plan’s network (or the services are not covered by the plan); and even then it is not uncommon for the provider to negotiate to accept reduced payments for out-of-network or non-covered services. Such conditional staffing arrangements might even verge on violating state prohibitions against so-called ‘economic credentialing’ for medical staff membership.
Loss of some portion of the commercially insured patients who can access such alternatives can really hurt the emergency medicine group at the hospital, and undermine their ability to recruit and retain qualified emergency physicians in the practice. In fact, the growth of physician-owned surgi-centers, labs, and radiology suites, and the ability of procedure oriented specialists to be able to perform their procedures on an out-patient basis, is likely to be greatly responsible for the financial failure of many hospitals.
Anyone who did the things House and his crew routinely did to patients would be crucified and thrown in jail in real life. If we negotiate properly, these hospitals will want to build these walls, and we will need to guard the gates through these walls with volunteer militias, and drones.
Our health care system just doesn’t have room for these people: let some other country take care of them. The ACA gave for-profits a leg up by granting them an AUTOMATIC 15% profit, more if they could figure out sleight of hand accounting methods for getting around the way the medical loss ratio was calculated.
Not-for-profit plans like Kaiser may have succumbed to some of this excess in order to remain competitive with their for-profit cousins, but by in large these plans have a different mission, and a different focus. It’s not about a conservative or a progressive agenda, it’s about repairing some major flaws. As the trend to narrow networks of physicians and hospitals that are willing to accept deeply discounted payments from health plans continues to grow, the question of whether these narrow networks can provide not just adequate access but also adequate, or better, quality of care has become ever more important to consumers and policy makers. The fact is, with the exception of seniors in Medicare Advantage plans, most enrollees change plans every few years, too quick for many plan investments in preventative care to pay off.
Is a hospital caring for a larger percentage of indigent patients providing worse care because its patients are readmitted more often because they can’t afford adequate post-discharge care and lack access to such services in their community?
Even when regulators do conduct enforcement actions for regulatory violations, the penalties often fail to change behaviors. When a patient is admitted to the hospital, or provided with critical care or observation services, these claims will be exempted from prepayment review. The AMA says that emergency physicians (EPs) provide more charity and under-compensated care than any other specialty, and a survey in Becker’s Hospital Review indicates that emergency physicians are compensated less than any other specialist on a per work-unit (RVU) basis.
The plan should pay the claims as coded up front, and then do a random audit of a selection of these claims (after requesting the medical records as needed) by experienced, credentialed emergency care claims coders and physicians experienced in acute care.
Please keep in mind that there are always exceptions, and lots of them, to the generalizations that usually apply in these types of analyses. These companies hope to provide cooperative shared services for smaller independent groups in an effort to harvest some of the benefits of consolidation while maintaining independent group management and structure. Or the 1941 dinner, when Rex Stout came for the first time, and electrified Irregulars with a€?Watson Was a Womana€??
That a photo had been taken that night came to light later in a letter from James Keddie of Boston to Vincent Starrett.
Smith, James Keddie, and Christopher Morley, Starretta€™s telegram to the BSI dinner, Morleya€™s handwritten menu, autographs of the Irregular diners that night, the picture of Sherlock Holmes that Frederic Dorr Steele drew that night, the first BSI membership list Edgar W. Incidentally, I think you did us all a service by naming Mycroft Holmes as the detective who solved his problems without ever visiting the scene of the crime or seeing the evidence.
Later that year, he wrote the few words about it that follow, in a letter to Allen Robertson of Baltimore (then unknown to the BSI, but later founder i??of The Six Napoleons of Baltimore, and a€?The Reigate Squires,a€? BSI). After the Woollcott condescension most of us were content to go on without any Stated Meetings .
It includes the membersa€™ chosen noms de canon, a practice of the Pips which may have inspired the Titular Investitures adopted by the BSI later under Smitha€™s leadership. But it bespoke his confidence in Smith, who had yet to attend a BSI dinner, when he turned first to him for help organizing the 1940 affair. Julian Wolff, whose notable Sherlockian maps qualify him, I think, beyond any suspicion of a doubt for membership. This list has been compiled in a piecemeal fashion from many sources but as time goes on we hope to show improvement!
Christopher Morley cited Swiggett in an Irregular way once, in his March 4, 1939, a€?Trade Windsa€? column. Stone of Waltham, Mass., had been in Sherlockian circles since the late a€™Thirties, was a contributor to 221B, and had at-tended the 1940 dinner a€” as he would the a€™41 dinner a month after this list. As a matter of fact, by God, I doubt like hell if Bill Hall could ever have passed a really probing quiz in those early days. Keddie, who had come from Scotland as a child, had a particular interest in this Baker Street relic in which Sherlock Holmes kept his cigars.
I have in my possession a coal box which to my knowledge is nearly fifty years old, but which, until it fell into the hands of the philistines in this country had never held so much as a spoonful of coal. Across the table from him, a nonchalant David Randall tilts his chair back, his hand stuck in his pocket.
Of all his twenty years of writing up BSI dinner minutes, it seems safe to say that this is the one most likely to contain some errors in the list of attendees.
On the basis of the signatures plus the dinner photograph, thirty-seven, if that is Elmer Davis at no.
He arrived in New York with a letter of introduction to Christopher Morley in his pocket; and, with no less a Holmesian than S.
Cambridge University Press had published Shakespearea€™s Imagery and What It Tells Us by Caroline Spurgeon, and I wanted to get publicity for it. He was the BSIa€™s food-and-drink expert, and worked with me on the annual Oxford and Cambridge dinners in New York too.
Crone points out that this reference has special significance because Augustus had also entrusted his son-in-law, M. Sometimes identified with Sirens, the mythical enchantresses along coasts of the Mediterranean, who lured sailors to destruction by their singing. Amazon means a€?without a breast,a€? according to tradition these women removed the right breast to use the bow.
At the right edge, a looping line shows the route of the wandering Israelites in their Exodus from Egypt; it crosses the Jordan to the left of a naked woman who looks over her shoulder at the sinking cities of Sodom and Gomorrah in the Dead Sea (she is Lot's wife, turned into a pillar of salt [A§254]. 400), a text that was often attended during the Middle Ages by diagrammatic a€?mapsa€? illustrating the concept.A  See also David Woodward.
Others delved into the question of its authorship, which had previously been assumed to be obvious from the wording on the map itself.
The medievalized depiction on the bottom left corner of the Hereford world map of 'Caesar Augustus' commissioning a survey of the world from three surveyors representing the three corners of the world may be based on a muddled - and religiously acceptable - memory of these classical events. Even though the inscriptions on the maps gradually became more and more garbled and the information more and more embellished, distorted, and misunderstood, they nevertheless retained their tenuous links with ancient learning.
More than simple geographical shorthand, such maps were also meant to symbolize the crucifixion, the descent of man from Noah's three sons and the ultimate triumph of Christianity. Palestine itself was usually enlarged far beyond what, on a modern map, would have been its actual proportions. A note on one of the most famous of them, the Ebstorf, says that it could be used for route planning. Although the maps were still dominated by biblical and classical history and legend, most other information seems to have been acceptable and was accommodated within the traditional framework.
Far larger than the Hereford Word Map and much more colorful, it was probably created under the guidance of the itinerant English lawyer, teacher and diplomat, Gervase of Tilbury. In transmission some facts and text became garbled and some inscriptions are gobbled gook or wrong. He is co-author with Mamie Till-Mobley of her Death of Innocence: The Story of the Hate Crime That Changed America, He points out that, in addition to being the 47th anniversary of the Rev.
Uninsured patients, on the other hand, may face charges for health care services that are two to ten times the cost of in-network care. As hospitals become more and more engaged in at-risk partnerships with medical staff and health plans; the incentive for hospitals to pay attention to physician fees has grown significantly.
Likewise for every other specialist that relies on the hospital for a significant portion of their practice revenues. Nonetheless, hospitals may soon have little option but to be transparent about their charges and more competitive in their business models in order to retain the loyalty, and referral preference, of the physicians who work in the hospital or send their patients to a hospital for specialized care. One recent show about a female heart surgeon and heterotopic transplants made ME want to jump off a roof and donate my body to Chiropractic school. We will build the walls thirty feet high and twenty feet underground to make sure poor people don’t build tunnels under the walls to get to the ER to get their health care for free. Plus, that 15% profit was on top of the outrageous salaries and bonuses paid to for-profit plan CEOs and executives.   What really should have happened was for the ACA to offer incentives to the not-for-profit health plans, especially for those plans that kept their management expenses and so-called ‘reserves’ down.
It is certainly not about paperwork for the sake of more paperwork, and it is not about getting out of the business of insuring liability. Surprise: recent studies suggest that there is no difference in quality between narrow networks and wider networks. The thing that distinguishes physicians in terms of quality of care is even more about reputation and range of services, and price is more likely to reflect this. This is why regulators require plans to pay for these services, but that doesn’t prevent plans from using ‘economic credentialing’ for participation in narrow networks to selectively exclude providers that tend to offer more expensive tests and treatments to more of their patients.
To really assess whether low-cost providers offer high quality care, you need to look beyond 30 day readmissions and complication rates, and assess long-term, risk-adjusted outcomes and lifetime costs.
When the DMHC negotiated a settlement agreement with Healthnet in 2008 for failing to meet the Gould criteria, the end result was that few physicians received anything close to what they were owed, and the fine was a relative slap on the wrist. Since providers cannot bill patients for the unpaid amount if a BC claim is down-coded in California, these providers will have to either accept the reduced payment, or dispute this decision through the payer’s internal claims dispute process; but BC rarely overturns their initial decision in this process.
If indeed the audit reveals what appears to be inappropriate up-coding, the plan could then meet with representatives of these providers to review the coding issues identified. I am not convinced that smaller and single site group practices will eventually disappear, but I do think that more and more of these practices will find it necessary to cooperate or consolidate, if they hope to maintain structural and governance independence. Whether one wishes to see mountain vistas, coastal plains or the Piney Woods, Texas outdoors offers something for everyone. The 1946 dinner, when the premiere issue of The Baker Street Journal arrived arrived at the last moment to be handed out?
It was the only one ever attended by a Conan Doyle, Sir Arthura€™s son Denis a€” and the decades-long feud between the BSI and the Conan Doyle Estate dates to that night. Only a few dozen men had been present that night, and it seemed unlikely that a copy would ever surface now, after all these years. According to Smith, Denis listened with bewilderment to the various toasts offered to Holmes and his entourage, and to the scholarly reports on various aspects of the investigatora€™s career. Keddie sent me a jolly letter about it, which, with yours, goes into the permanent records. The difficulty is that it is rather too scholarly for any of the really popular journals - and they are the only ones that pay worthwhile rewards. I hope in my menial capacity as Boots [sic], I have not, in doing this, incurred the wrath of my Gasogene and Tantalus.a€? Presumably the Morley list from which Smith worked was the 1935 one printed in Irregular Memories of the a€?Thirties (pp. But beyond that, their Irregular con-nections in 1940 are a mystery, and their names do not appear again in surviving Irregular records.
His inscription in the copy of Appointment in Baker Street that he sent Woollcott in 1939 read a€?To Alexander Woollcott in appreciation for loyal work as a Baker Street Irregular,a€? and in 1944, the year following Woollcotta€™s death, he referred to him in Profile by Gaslight (to Leavitta€™s lasting annoyance) as a founder of the BSI. What do you think?a€? I have not seen Morleya€™s reply, but Woollcotta€™s New Yorker article about the 1934 dinner did not appear in 221B. Other veteran BSIs-to-be not on it, but at the a€™41 dinner and many more to come, were Philip Duschnes the bookseller, Charles Honce the A.P.
Watson,a€™ a€?The Game Is Afoot!a€™ and a€?The Second Most Dangerous Man in London.a€™a€? These were suggestions, if you will, at the original meeting, but they were approved, and the Davis Document makes them Constitutional. His defense, when threatened with inquiry, was to roar (and I use the word deliberately a€” ROAR), a€?Dona€™t put me to the question!a€? As him and dare him, for me, to deny it. In that instance, the coal box, which stood by the fireplace chair, had been used by my mother and by my grandmother before her for the odds and ends of sewing and knitting utensils that a Scotswoman picks up in the afternoon that even her time of rest may not be entirely wasted! Eliot), FVM had returned to New York in 1938 to be trade editor at the Harcourt, Brace company.
Suit will be filed as soon as possible after my residence (six weeks) is established; and if there is no opposition there will be no delay. But, simply to put the reader on the alert, a few obvious corrections may be noteda€? a€” and Miss Nightwork, perennial Ph.D. Elmer Davis was perhaps the best known national celebrity in the BSI at the time, from his work as a CBS radio newsman. In those days the very best place to get a book mentioned was Morleya€™s a€?Trade Windsa€? column in the Saturday Review of Literature. We played a game to see who would be the first to telephone the other each year on December 16th, with the words a€?O Sapienta,a€? which we always found on that day in our Cambridge Pocket Diaries. I dona€™t remember his attendance at any of the BSI dinners; but I recall vividly that when we would meet him at dinner at the St.


The circle one-third of the way from the bottom is Jerusalem, the Map's central point, with a crucifixion scene above it ([A§387-89]). Its images and decoration have been examined from a stylistic standpoint by Nigel Morgan and put into the context of their time, while the late Wilma George examined the animals in the light of her own zoological knowledge [2] The chance discoveries of fragments of other English medieval world maps in recent years [3] have expanded the context within which the Hereford World Map can be examined, and the Royal Academy exhibition, 'The Age of Chivalry' of 1987 enabled the map to be displayed in the company of other non-cartographic artifacts of its own time. Generally, though, it was not difficult to adapt surviving copies of existing, secular world maps to suit the purposes of Christian writers from the 5th century onwards. This was in order to match its historical importance and to accommodate all the information that had to be conveyed. Christ would, for instance, be shown dominating the world, or the world might even be depicted as the actual body of Christ. The world was shown as the body of Christ and much space was devoted to the political situation in northern Germany: an area of particular concern to the Duke who may have commissioned it.
Nestles is recomended only for advanced surfers.Click the photo below to view Nestles video. Thus, it would seem that hospitals might not really have much of a reason to care about physicians’ fees, as the bulk of the hospital’s revenue is not subject to competitive market forces that are directly affected by the fees of the physicians that work in the hospital. Thus, the impetus for hospitals to buy physician practices, merge with other hospitals to improve market share and market leverage, and other phenomenon we are now witnessing.
Now I know this might cost about 4 billion dollars, or maybe 12 billion dollars: there are a lot of ERs (though fortunately we have closed quite a few in the last 20 years), but it will be worth every penny if we can keep those uninsured, undocumented patients on the other side of these walls, where surely someone will eventually care for them. I originally was in favor of the ACA, as it seemed like the primary objective was to get more of the uninsured covered.
Physicians with excellent reputations who offer services that require exceptional skill or reflect superior knowledge and patient satisfaction can fill their offices and surgical schedules without having to accept deeply discounted payments. It is likely there was little enthusiasm in the administration for enforcement actions that might raise premiums (even a little), and that was the last such enforcement action taken over the Gould Criteria. The aggrieved provider can then go through a so-called secondary level ‘independent dispute resolution process’ sponsored by CMS for Medicare Advantage claims disputes (though this is rarely used because providers consider it neither fast, fair, nor cost-effective), and if still not satisfied, take their dispute to a court. I think BC and other plans that have aggressively down-coded EP claims do so because EPs don’t have the option that other specialists have to refuse to treat a plan’s patients if the plan is abusive in the way it treats the physician’s claims. Many state parks are located near the water so families are able to spend time fishing for one of the various species that inhabit our waterways. The 1948 a€?committee in cameraa€? dinner, when the BSI's future hung by a thread upon Christopher Morleya€™s discontent?
There were Crossword Puzzle winners like Basil Davenport, Harry Hazard, Harvey Officer, and Earle Walbridge.
Bell was there at the time, and when Bell died in 1947, Starrett recalled in his a€?Books Alivea€? column in the Tribune walking up and down Baker Street with Bell, arguing about which house had been Sherlock Holmesa€™s.
Jackson of Barre, Vermont, a Crossword solver, and Morleya€™s friend and Grillparzer crony Buckminster Fuller. Williams (died 1940), who brought his son Peter to the 1940 BSI dinner, was art director at the American Book Company, a well-known book and print collector, and an author of childrena€™s travel books. Would Smith have added Alexander Woollcott to the BSIa€™s membership list without consulting Christopher Morley?
If we are met with hostility, the case will have to be argued, and I've no way of knowing how long it might take.
Smith is down the table on the opposite side, not yet at its head where he soon will be for the rest of his life. So are the signatures of two more men not named in Smitha€™s minutes, who may be among the unidentified faces in the picture: Ernest S.
Following the dinner, Harry Hazard prepared a partial key to the photograph.Elmer Davis is not on it, and the face at no. Roberts as a mentor back home, found himself a Baker Street Irregular on Morleya€™s 1935 membership list. I met him when I was an undergraduate at Cambridge, attending his lectures on Samuel Johnson, but it was in publishing that he made his reputation. Spurgeon showed the kind of man Shakespeare must have been by tabulating all the metaphors and similes he used, showing him to be familiar with the countryside, gardens, and domestic animals. We thought it began one of the Collects in the Prayer Book; but we were puzzled at its having a special day. Regis Hotel with that most generous host, Howard Goodhart, Rosenbach always had a full bottle of whisky at his place at the table, while the rest of us drank wine. Carte marine et portulan au XIIe siA?cle:A  Le Liber de existencia riveriarum et forma maris nostri Mediterranei. The amount of space dedicated to the other parts of the world varied according to their traditional historical or biblical importance and the preoccupations of the author of the text that the map illustrated. In point of fact, many hospitals really don’t pay attention to physician fees, perhaps for this very reason. I am certain they are constantly being overruled by the writers and directors, whose interests in portraying medical care in an accurate way are probably way, way, way down on the list of priorities. These big GORGEOUS walls will help us keep those who don’t deserve this free care from taking our health care from us, and undermining the value of our greatest resource, our health care workers.
Now I see, as do many others, that the ACA was just a total cave-in to the for-profit health insurance industry; forcing more people to buy unregulated products in an unfettered sellers market. Unless such services result in lower costs for plans over the long-term, why would narrow network plans be willing to pay more for this care if short-term cost savings is their primary consideration?
The cost of taking claims to dispute (when the disputed amount is often less that $300 for an emergency physician’s claim) can easily cost more than the amount in dispute, and it may take months or years to recoup these lost revenues.
If inappropriate coding behavior persisted; the plan could easily recoup overpayments and if necessary refer the provider to BMQA or other regulatory agencies for investigation. In order to promote camping for all ages, the Texas Parks and Wildlife Department is offering three separate outdoor events in May. Or perhaps the dinner a€” the date still uncertain a€” when Jim Montgomery sang a€?Aunt Claraa€? for the first time. Recently (within a year) I had the same problem on my hands - and found no American editor whatever for a Sherlockian essay which has since found place in an English Symposium or anthology issued as a book. As a charter member, I call for a prompt and continued honoring of the wise provisions of The Founding Fathers. Weber declared himself a€?Judge Lynch,a€? his pen-name as chief mystery book reviewer in the Saturday Review of Literature.
James Keddie sits next to him, and on the table nearby is the orthodox coal-scuttle he has brought from Boston.
Colling, a former New York Evening Post colleague of Morleya€™s (its movie critic, who helped turn Morleya€™s 1922 novel Where the Blue Begins into a play in 1925), and H. He attended the annual dinner for the first time in 1936, and is the only living person to have attended BSI dinners at both the Murray Hill Hotel and, before that, Christ Cellaa€™s speakeasy. He was Secretary to the Syndics of Cambridge University Press from 1922 to 1948, and more than any other one man he had brought the University Press out of the academic backwaters into the mainstream of publishing. My wife and I spent three long evenings reading four of Morleya€™s books and doing the same to him.
Behind the blue band of the river is a grim array of grotesque figures to indicate the existence of primitive peoples. There may be significance in the soulless mermaid placed in the map close to the unattainable Holy Land, or she may be a possible temptation to sea-faring pilgrims. Phillott, wrote that it shows a a€?rejection of all that savoured of scientific geography, . Because of this, space devoted to the author or patron's homeland was often much exaggerated when judged by modern standards, as in the case of England, Wales and Ireland on the Hereford Mappa Mundi.
Crone demonstrated, the Hereford also contains sequences of the more important place names along some major thirteenth century commercial and pilgrimage routes. Anthem has thus effectively declared economic war on emergency physicians and hospital EDs. EMTALA has turned emergency physicians into the indentured servants of the America’s health plans.
Three of the statea€™s most beautiful parks will play host to the Texas Outdoor Family Adventure Series.
Edgar Smitha€™s affectionate zeal, not less than his Sherlockian scholarship, his gusto in pamphleteering, his delight in keeping orderly records, and his access to mimeographic and parchment-engrossing and secretarial resources, all these were irresistible.
Henry Morton Robinson was a popular writer whose 1943 Saturday Review article about the BSI, a€?Baker Street Irregularities,a€? was reprinted in Irregular Memories of the a€™Thirties. Weber, had been at the 1936 dinner, and the 1940 too, despite the silence of Smitha€™s minutes on that score. Bell at the Victoria Hotel, to found the BSIa€™s first scion society, The Speckled Band of Boston. Price, the American Bank Note Company executive who had solved the Sherlock Holmes Crossword in 1934.
Davis and Hazard had been at the 1936 dinner together a€” their signatures are both on a surviving copy of that nighta€™s menu. His a€?Profile of a New York Irregular,a€? about Basil Davenport, appeared in Irregular Proceedings of the Mid a€™Forties. On a world map, though, as opposed to the strip itinerary maps produced by Matthew Paris in about 1250, the route planning could only have been very approximate and very much incidental to the main purposes.
State parks, Palo Duro Canyon and Caprock Canyons, both in the Panhandle, and Martin Dies, Jr., in East Texas, offer opportunities for camping with some adventure. I dona€™t suppose that any society of Amateur Mendicants has ever had a more agreeable or competent fugleman. Simeon Strunsky at the New York Times, a€?dean of grammarians,a€? as Morley liked to call him, had been on the 1935 membership list as well, though he (like Rosenbach) never attended a BSI dinner. Standing against the wall are two of Morleya€™s closest friends, Bill Hall in deerstalker, and Robert K.
He was the author of A Note on the Watson Problem, 100 copies, privately printed at the Cambridge U.P. As an African American whose family had barely escaped Southern atrocities, she recognized the potential pushback when you stepped out of place.
Dates for the 2011 series are May 14-15 for Palo Duro and Martin Dies and May 28-30 for Caprock.
John Winterich was a prominent critic who had also been a colleague of Morleya€™s at the Saturday Review of Literature. Mans-bridge lives in Connecticut, and it is an honor to publish the following reminiscence here. 14), which may have resulted from the survey of the provinces ascribed by tradition to Julius Caesar. In the Hereford map they could revel in this pictorial description of the outside world, which taught natural history, classical legends, explained the winds and reinforced their religious beliefs.
Red canyon walls as high as 800 feet offer unbelievable formations and photographic opportunities unlike any other.
Leavitt, Harvey Officer, James Keddie, Earle Walbridge, and other legendary figures from the BSIa€™s early days. He could be serious, but never solemn; the lighter side of letters and life appealed to him, and he became prominent in the affairs of both Sherlock Holmes Societies (pre-war and post-war) in England. Stone and Howard Haycraft, sitting against the wall further down, preserve a serious demeanor. He ended up with two-thirds of a column in Whoa€™s Who, and many honors: Master of Pembroke College, Cambridge, Vice-Chancellor of Cambridge University, and finally Sir Sydney. The two upright fingers branching up from the Mediterranean are the Aegean and the Black Sea with the Golden Fleece at its extremity.
Classes will be held on paddling along with a leisurely three hour trip on the Angelina River.
Across the table, Charlie Goodman and his brother Jack beam at the camera, while Mitchell Kennerley the bookman, who will take his own life ten years hence, studies the back of his hand somberly.
Further down, Harvey Officer, soon to be the BSIa€™s first songster with his Irregular anthem a€?The Road to Baker Street,a€? smiles shyly at the camera. C.,a€? bluff, friendly but business-like, at ease in any company and in any country a€” even riding a camel in Egypt, winning a race against another one ridden by an Oxford man. How do we respond when the lynching is verbal, not physically fatal (most of the time) and the klan has its own network, which is the most watched in the US?
The owlish bespectacled man at the bottom of the picture may or may not be Elmer Davis; across from him, Earle Walbridge makes another appearance in what will long stand as the record for unbroken attendance at the annual dinners.
Telling the truth and exposing these people for what they are and what they do is important, but it won't be enough. Wildlife abounds around every bend in the river.The Caprock adventure is two nights of camping and is over the Memorial Day Weekend. Basil Davenport turns toward Peter Greig, as Ronald Mansbridge raises a wine-glass in salute. P-Land is recomended for intermediate to advanced surfers.Click the photo below to view P-Lands album. This event will offer hiking the beautiful trails of the Caprock and lessons in geocaching.
This is also home to the Texas State Bison herd started by the legendary rancher Charles Goodnight.Lindsey Davis, Texas Outdoor Family Program coordinator says that "These expanded programs are aimed at families who are looking for more adventurous camping experiences. Click the photo below to see The Points album.Fishing Panama, Surfer ParadiseFishing in the Gulf of Chiriqui region is regarded as a world class fishing destination. We recognize that many families want to expand their outdoor recreation knowledge, but are uncomfortable going alone to a remote site with limited facilities. There have been many write-ups in sport fishing magazines about the marlin, sailfish, Wahoo and tuna that have been caught in this area.We operate primarily as a surf camp. That was so long ago that the small schools at Orr High School, whose LSC signed on as original plaintiffs, have been closed again and reopened under the auspices of AUSL (for more about AUSL, read the latest here). The Texas Outdoor Family Adventure Camping Series allows the families to enjoy their time together in a safe environment with knowledgeable rangers to guide and assist at any time."Launched in 2008, the Series has taught more than 1,300 families, many from urban environments, how to safely enjoy the outdoors. Fishing off the boats is offered at no charge as the boat captains drive around the surf breaks keeping an eye on the surfers. The Series provides camping gear for up to six and includes individual campsites, restrooms with hot showers, ranger supported instruction and safety.
To protect the environment campers are encouraged to leave no trace.Participants are required to bring their own sleeping bags, personal items and food.
There is no charge for this type of fishing.We also offer an outer island trip, which requires a payment of $320 for the extra gas used by the panga boat. All posters sell for under $20.Videos and MoreOther featured products on the "Shop the Outdoors" Web page this year include a colorful wheel featuring the 16 hummingbird species documented in Texas and a variety of documentaries and videos. We should be able to get out to the Coiba Island and Hannibal Bank area where large marlin and tunas can be caught. One of the videos displays a collection of TPWDa€™s most picturesque destinations statewide.Why not buy something special for yourself after crossing everyone else off your holiday list? Once youa€™re done shopping for everyone else, treat yourself with a chance to hunt and fish for freea€”forever!
It only costs $5 to enter the Lifetime Super Combo License Drawing, and you can enter as many times as you like.
The Super Combo License, normally purchased for $1,800, gives you the right to hunt and fish in Texas without ever having to buy another state license or stamp. It has been described as the perfect wave you draw on your notebook in high school that just keeps going and going. The entire percentage of hunting and fishing license fees go to TPWDa€™s conservation efforts to help make Texas one of the best places in the country to hunt and fish.
Community minded sponsors are guaranteeing a $10,000 first place cash prize so all the money raised goes to the children.
Virgin Islands, and Puerto Rico).I called the Delta customer service rep to ask if that was a typo (mistake) and she said no.
She answered Yes, that is correct.Heres a petition going around: Fight Airline Surfboard Charges Sick of paying airline surcharges for your board?
The reason for the new price is because of the increase in fuel costs and other commodities that have steadily increased over the past two years.
Improvements have been in the area of another honeymoon suit, new wood decking, new tiled floors, new boat, new motors, new rental surfboards, improved port facilities. However, if you would like to lock in the old rate from 2008, then you will need to make a reservation and pay the deposit by December 31st, 2008. Ive only been here a few days, but have added the best photos that Ive taken yet to my portfolio. And, yeah, I caught my fair share of these bombs check my personal photo section to see for yourself!
Im in the process of adding photos with a slow, third world internet connection, so be patient theyre on their way.This place is so beautiful, and the place Im staying is something else.
It would also mean that it was more important to get accurate, useful information that could be used to help schools and students. These offshore breaks are heavy-duty, deep water reefs with some areas of dry-reef that need to be carefully negotiated.
Who needs that when you can damn schools with data?No, it's far more important for testing to be "standardized" - that is, given at the same time to everyone, according to state supt. Chris Koch's rationale: "This is the state's attempt to say, 'How can we treat everyone the same and everyone fairly?a€?It may be standardized but that doesn't make it fair. The vibe is so cool, and everyone is surfed out and in a good mood all day.Check the photos and book your tickets.
He escapes the cold of Washington State to visit us in the warm waters of Panama during February and March. It has taken a little time to get from physically being at home to mentally being back as well. My heart is always surfing around the world even if responsibility is trying to get in the way. I will get some things done on the farm and then it will be back to the beach in Oregon.The attached picture was taken at Leftovers on the island of Outer Silva about 10 kilometers from Morro Negrito Surf Camp.
There are 4 breaks on the island and various snorkeling opportunities for the non-surfers or people who need a break.
The On the Issues site provides a list of statements by Kirk on education and his education-related votes as a congressman. It suggests that he is a moderate on social issues such as school prayer and green schools. I mention this as on the 3rd day I was there, the waves were breaking in the 10 plus range with at least a 6 throw to the lip. Kirk got into some trouble earlier this year when he claimed that he's influenced by his experience as a teacher, which turned out to consist of a year at a private high school in London and another as a teacher aide at a church run nursery school. It pitched me over the falls backwards and held me down for a long time in a lot of bubbles.
There's a third candidate who deserves some attention, too -- LeAlan Jones, the Green Party candidate.
I did not hit anything, although when I saw the magnificent Shuler epoxy surfboard that Lanny made for me to surf in Panama, was in 2 pieces.
I remember him well when, as a 13-year-old, he and a friend reported on life in the Chicago projects for National Public Radio. This meant that I was going to have some short-board experience for the remainder of the stay. I gave it a try and had my board leash come off my ankle and had to swim into the rocky shore.
Senator, and will have the responsibility to make critical decisions about education along with every other issue before Congress. Hood BOSS, Texas Boat World, Marine Outlet, Academy Sports & Outdoors and Stanley Motor Group. This picture was taken 2 weeks ago, was voted the wave of the day and is a true Monday Morning Wave.The guests, cooks and staff made this a time to remember, always.
I wish this experience to all of you and thank everyone who made this happen.Have a great day,BobP. As a side note, I was able to come back 1st class on both flights from Panama City, Panama to Seattle, Washington, USA. Rick has been a staunch advocate for public school children and families, and for Local School Councils. As good as the airline was the cooks at camp did it better job and their meals tasted superior. 12010-2011 hunting and fishing license required.Dove season opens for the North and Central Zones. Panamanians have a strong sense of pride for their provinces, and the Foundation thought this would be an opportunity for the children to see some important parts of Chiriqui. Led by camp manager, Jeff Healion, ten children and nine parents enjoyed a two day excursion of learning, fun, and exploration set to the theme of Getting to Know my Province.A Traveling by boat and bus, the trip included visits to the mountain town of Boquete and the provincial capital, David. We know that too many of them don't. Even on a traditional calendar, non-air conditioned schools can be ovens, places where it's too hot to learn and too unhealthy to stay. The first stop was Paradise Gardens, an animal sanctuary and refuge in the cool highlands of Boquete, a thriving hub of coffee production and nationally famous for its coffee and flower fair.
Here, we enjoyed interactive tours of monkeys, exotic birds, endangered mammals, and an enclosed butterfly park. Most all the animals at Paradise Gardens have been rescued and are awaiting release back into the jungle.A After a picnic lunch in Boquetes main plaza, it was down to the warmer climes of David, Panamas thriving western hub of agriculture, business, and tourism. The group visited Culturama, a historical and cultural society located in one of the oldest buildings in Chiriqui.
We learned about local history and were treated to entertaining stories by one of the areas best storytellers.A What is a field trip without a little down time, so we headed over to the theater and caught the new Disney holiday movie Enchanted followed by a stop at MacDonalds.
After dinner we went to see Davids new million-dollar plaza, probably the nicest plaza in Panama, if not Central America.
The cost of the course is only $15, but there can be facility-use or range fees charged at some of the training centers.To receive a passing grade, students must take a 50-question written exam and get 70 percent correct if they take the traditional two-day course or 80 percent if they take the course online. The certification is valid for life and is honored in all other states.Hunters who are at least 17 years old and have not completed the hunter education course can defer completion for one year. Just by luck, a local philanthropic organization was presenting a Christmas performance of dance, music, and holiday dramas in the parks amphitheater. CPS district offices? Most of our currently-used schools were designed to be closed during the summer, just as they were designed without lunchrooms because all the children went home for lunch. However, hunters who took a deferral last year must complete the course this year to hunt legally this season.A  a€?The deferral is only available once,a€? Erwin said. It was a lovely tropical evening and we enjoyed the festivities besides being tired from a day of busy events. Finally, we made it to a comfortable nights sleep at Hotel Toledo.A Day two began with a fun breakfast at a popular downtown cafeteria where we were treated to a private reception room. At least health codes address some of the worst sanitation problems that schools without lunchrooms face. From the restaurant we walked to the Sevillana Bakery where we enjoyed a full tour of the bakerys back kitchens. In Panama, as in much of Latin America, the bakery still plays a major role in peoples daily lives. At Sevillan, fresh bread slides out of the ovens nearly all day.A A short walk from the bakery we stopped at citys main fire station. Here we had a full tour of the facilities and then were treated to a simulated emergency call. We watched the firemen slide down the poles, put their suits on, and then leave the firehouse. CPS claims that its so-called year-round school schedule is better for students, but the proof of that is slight.
After some fun pictures with the firehouse staff, we were on our way to our final destination.A Davids International Airport is the second largest in Panama and Aeroperlas, the regional carrier, had invited us to board one of their planes as it was being prepared for a flight. Teachers should move their classes to municipal cooling centers until CPS does the right thing and upgrades every school so that children have a reasonable chance to learn. Probably not something we could have done in many countries, we all boarded the plane, visited the cockpit, and then relaxed in the cabin seats while the flight attendants answered questions from the children.
Wow, what a thrill for the children.A With just a few hours left before we needed to begin our journey back to camp, we spent a few hours looking around the busy commercial district of David, bustling with holiday activity.
In Latin America, so much of the activity begins out in front of the stores so just walking around the streets is fascinating.A It is hard to imagine how our trip could have been more fun, rewarding, or educational. Sure we arrived back at the island tired, but the children were still buzzing with excitement from the events and what they had experienced. That's not much time, and the appeal is supposed to go to the Chief Education Officer, a position that has had no person in it since Barbara Eason-Watkins left for Michigan City. Usually the appeals go to the Chief Area Officers.
If you could have seen the smiles and eyes during the two days, you would all know how rewarding it is to share with those that are less fortunate. During the holiday time, it was especially rewarding for us to share a magical treat with the children from our island. Good News was a modestly successful program; the church was in the very needy North of Howard area of Chicago and ran a well-attended food program. The down side we saw was a lack of interest in supporting the local school council at the nearby public school, which went through a traumatic time after the district refused to allow the LSC-appointed principal to serve. The old price has been $600 per week and the new price will be $650.The reason for the new price is because of the increase in fuel costs and other commodities that have steadily increased over the past two years.
Improvements have been in the area of another honeymoon suit, new wood decking, new tiled floors, new boat, new motors, new rental surfboards, improved port facilities.However, if you would like to lock in the old rate from 2007, then you will need to make a reservation and pay the deposit by December 31st, 2007. The 25 ft deep V hull boat can smoothly cut through big swells and is equipped with new twin 115 hp 4 stroke motors, live bait well, GPS fish finder and an onboard stereo system.
The Gulf of Chiriqui is located south of David and covers an area of 14,740 hectares plus a great number of Islands and Islets. Among them you can find Isla Coiba, Isla Cebaco, Isla Montuosa, Boca Brava, Jicaron and Isla Secas with some of the best big game sport fishing, surfing and sport-diving in Central America. They claimed that the price of food was going down, so hungry people won't need so much. As House Finance Chair David Obey, who proposed the RTTT swap, said, "Well, isna€™t that nice. Hannibal Bank and Coiba Island are both well known sport-diving and salt water sport fishing destinations Panama Central America. This creates currents that are convenient when going on an offshore fishing salt water fishing trip. Why is it the responsibility of Chicago community colleges to spend $30 million a year to pick up lost math and reading skills?" Chico said. "I'm not saying that as a society we shouldn't be charged with doing that someplace.
But why is it placed in the lap of higher education?" (Sun-Times 8-8-10) I guess it just slipped Chico's mind that he is in large part responsible for the math and reading skills of these very students. A student who started preschool in 1995, when Chico was appointed president of the Chicago School Board by Mayor Daley, would have been in fourth grade -- when most of the fundamentals of reading and math should have been laid down -- when Chico left that position in 2001. The Coiba Island is now a patrolled national park and protected from commercial fishing within its boundaries. The island was first ruled by Coiba Indians and later ruled by Vasco Nues de Balboa who at some point was defeated by pirates. These books were written in 2004 and 2005 in response to many requests to help start PURE chapters around the country, and from folks who just wanted to know how to create a powerful parent organization.
Besides from sport fishing, here you will find great opportunities for adventure travel or eco tourism. You will find a great variety of monkeys, iguanas, crocodile, snakes and over 133 different species of birds for those birdwatchers. It explains why folks in power hate to fund schools adequately and demand "accountability" using methods that destroy rather than strengthen schools. Cebaco Island is located between Santa Catalina and Mariato West Coast of the Peninsula de Azuero.
This island is home to some of the most beautiful beaches with crystal clear water and scenery for sport-diving, snorkeling or guided fishing trips. The Cebaco Bay is located south of the island and it is excellent for big game fishing or angling, sport diving and surfing.
Its reefs are home of Cubera Snapper, Roosterfish, Dorado, Monster Yellowfin Tuna (100 + pounds) and a variety of billfish such as sail fish Montousa Island is 10 miles off Hannibal Bank and it is also a great sport-diving spot in clear waters of Panamas Pacific Ocean.
The President's speech to the National Urban League was in large part a defense of these programs against the many concerns that have been raised about whether they are the most effective ways to reform U. The bottom floor also rises dramatically from approximate depths of 10,000 ft making it great for deep sea fishing in Panama. Obama suggested in his speech that people who oppose his proposals may simply be a€?afraid of change.a€? A few days earlier, he threatened to veto any attempt to use even a small portion of funding for his controversial Race to the Top program to save thousands of teacher jobs. Education Secretary Arne Duncan stonewalls critics of his department's demands for charter expansion who cite the research on the overall poor performance of charters nationwide; he offers the nonsensical excuse that he doesn't support charter schools, he only supports good charter schools. Moreover, this island is a boutique resort we operate with which was designed for those who want private, pristine surroundings with excellent service. Today, columnist Leonard Pitts tells opponents of the President's plans to a€?lead, follow or get out of the way.a€? Perhaps the most important moment of the President's Urban League speech was his paraphrase of Dr. In a democracy, education reform cannot be defined only by legislators, politicians, and corporate and media leaders.
Pitts' piece repeats much of the empty, nonsensical rhetoric we just heard in the president's and Duncan's recent speeches to the National Urban League, speeches that were in large part responses to the powerful opposition that has been raised against RTTT and the proposed School Improvement Grant program by civil rights, community, parent and teacher groups.
For today's  Public School Action Tuesday, why not respond to Pitts by leaving a comment after his article here, or write to a newspaper or comment on a blog of your choice opposing RTTT programs such as test-based teacher firing, school closures, and expanded charter schools, and in support of fair, research-based teacher evaluation or other sound education reforms? With a theme of Hacia el Futuro, or Towards the Future, the trip was for many of the participants their first travel outside the province and their first visit to the capital of Panama City. Over a period of two days, the group of students and parents, led by Morro Negrito Surfguide Jeff Healion, traveled to the Miraflores Locks of the Panama Canal, the ruins of the first settlement of Panama, the Presidential Palace which included a surprise meeting with President Martin Torrijos, and the new continent-spanning Centenario Bridge. Along the way, the group enjoyed some out-of-the-ordinary treats of pizza, ice cream, and holiday shopping at the new Albrook Mall at the site of the former US Albrook Air Base.The design of the trip was to bring the students in contact with the past, the present, and the future of their country through the ruins, the Canal, and the government buildings. At the Canal, the group was treated to a private presentation of the Panama Canal movie and then witnessed two giant Panamax ships passing through the locks. Nothing could have been more surprising though than when Panamas President pulled up just as the group was visiting his palace. As he left for his office, he commanded his staff to give the group a special tour inside the palace.Healion reported the smiles, excitement and gratitude we saw during the trip were heartwarming reasons why we know the Foundation can do good work. If a student wishes to continue, the family must send the child to the high school on the mainland.
For most families, the cost of transportation, food, housing, and school supplies is a great burden and many are unable to send their children, especially those with several children.The educational assistance program will provide families with the funds necessary for supporting their children in higher education.
One notorious example was when Mayor Daley's favorite "superstar" principal, Curie High School's former head Jerrylyn Jones, handed out folders with copies of petitions demanding that the LSC renew her contract, instead of the budget and school improvement plan information the LSC had requested as part of her annual evaluation.Other principals refuse to give documents to individual LSC members, and insist on a vote of the full LSC before they provide information, another ridiculous excuse.I recommend that LSC members download and file this article - you may need it! In 2007, another two will be eligible to continue at high school if their families so decide. And keep the phone and address of the Attorney General's Public Access Counselor handy - they have become a great resource for LSCs. With the new program we hope that money will no longer be a factor whether families send their children.The surf camp enjoys close contact with all the families that will be involved in the program and will be able to monitor the progress of the students. The web site also offers free online training in the Freedom of Information Act and the Open Meetings Act, which would be a good choice for your LSC lessons 7-8- or 9. We have seen many of these children grow up and it is especially rewarding to know they will have new choices and opportunities for their futures. We know their ties to the island will always be strong but we also hope that by continuing their education their new paths will show them what a truly special place their home is. September 2006, a one thousand watt wind turbine was installed that has been doing an excellent job of supplementing the solar system with wind generated power. Previously, the solar batteries would automatically disconnect themselves due to low voltage at about midnight. Hopefully, we can help inspire the camp visitors that come to surf camp to perhaps consider installing their own clean energy systems, wherever they may come from. There are a number of artesian springs pumping a large amount of water out of the ground, so much that it has created several water falls on the island, explains Steve.
The dread Status-Quo is on the loose! Both Education Secretary Arne Duncan and President Obama are on the defensive this week about their education plans after a group of civil rights organizations challenged the basic elements of the administration's Race to the Top and Blueprint for Reform plans, adding a powerful voice to the increasingly loud complaints coming from other sectors across the nation about the direction Duncan and Obama are trying to take public education.
Your Public Schools Action Tuesday assignment for today, if you choose to accept it, is to give a gift to PURE. The internet gives us so many new opportunities for reaching people with our message and our perspective. That's what it's like to be a CPS principal these days in terms of trying to figure out how to lead your school in the coming year. "I'm growing more concerned about the planned rise in 'combined-grades' [not to be confused with multiage or ungraded] classrooms, due to the teacher layoffs and increased class sizes. You wind up scrambling the days before school opens, and the week the students return, just to figure out who's who and 'where' they are in terms of their next learning steps, based upon their test scores from spring (=old data, let's face it) plus your expert judgment of children's learning needs. THEN you have to scramble to quickly sort 'em all out into their learning groups so that by Week 5 you can administer the required District curriculum-based tests (half of which you'll now have to create from the new curriculum you're teaching, due to the other grade-level's children in your room). I fear not a whole lot of learning--through no fault of the teacher or the kids or the parents. "I also fear this will be the proverbial 'final straw' on teachers' backs--and we'll lose some fine folks in our system." What can we do? Join the CTU for a community summit on the CPS budget, Saturday, July 24, from 11 am to 12:30 pm at Ariel School, 1119 East 46th Street. Anthony House yesterday, opining that a field trip would have gone a long way toward improving my sense of local history.
Not so surprising is that the Frederick Douglass museum, just down the block, is still very much a work in progress.Anyway, I loved the tour and especially loved the sculpture, in a little park midway between the Anthony house and the struggling Douglas Center, depicting Susan B. This means, he said, "notification, outreach, public input, and honest, open discussion about the right option for each community." Unfortunately, Duncan's track record in Chicago makes us skeptical that this is anything more than empty rhetoric. His efforts to "involve the community" in turnrounds here meant that perfunctory hearings were held where hundreds turned out to offer powerful testimony about a school's strengths along with thoughtful, research-based suggestions about how to support and improve the existing school, yet Arne Duncan ignored it all and shut the schools down. This means that Arne Duncan must begin really listening to parents, and the only way we will know that he is actually hearing us is when he begins to modify the RTTT and ESEA proposals that parents so strongly oppose and replace them with solid, proven programs that parents want. Education Secretary Arne Duncan for changing this federal education law.The signers and hundreds of other parents sent this letter to their congressional representatives. While many are saying that a revised (reauthorized) ESEA is unlikely to be voted on before the fall elections, revised language is being hammered out in committee right now, and it may be too make meaningful changes later on in the process.
Here are a couple of things that many in Congress still seem unaware of:Parents, students and community members join teachers across the nation in opposing the major elements of Race to the TopCharter schools are not working as hyped, and in fact the majority are not performing as well as regular public schools. Durbin is one of thirteen senators who recently wrote a letter to Senate Appropriations Committee chair Sen. Daniel Inouye opposing this bill, which was formulated by the chair of the House Education committee, Rep. Leonie offers a thorough analysis of the damage and dishonesty of the Gates Foundation's incursion into public school policy making. Urban Prep Charter School still has a 100% college-going rate with ALL 95 graduating seniors going to college!Problem is, for the past few weeks, the orgy of happy-weepy media reports about the Urban Prep Miracle was that all 107 graduating seniors were going to college (see, for example, People Magazine, Good Morning America, "Urban Prep Named Person of the Week on ABC World News).  So, since their first self-promotional blitz, they've lost 12 students (the Sun-Times suggests they "transferred") ? This yields an overall school graduation rate of 64%, or nearly 6 points lower than the average district rate of 69.8%. Yet no one is "socially promoted" because no one moves until they are ready. And in these tough economic times, doesn't it make a lot more sense to stop doing something that is expensive and doesn't work -- flunking students -- and start doing something that actually helps them? A new documentary, Waiting for Superman, will soon be released and we are working on getting Examiners free, possibly sneak preview access, to this film. Wea€™d like you to participate in screening the film and covering the critical education issues it addresses.
Wea€™ll also be promoting content related to the film, profiling profound teachers making a difference. We know that these schools push out lower-performing students and refuse to even admit many special education or limited English-speaking students. And, overall, research shows that charter and other corporate-run schools are doing a worse job than traditional neighborhood schools. In fact, one of Arne's greatest assets is his ability to lie with a pleasant, non-threatening smile on his face. And that's a problem because, if Congress believes his lies, they will pass his ideas into law. It's time to tell the truth about Arne Duncan, what he's done here in Chicago, and what he's trying to do to our children's education. However, we strongly disagree with your opposition to paying for this initiative with funds previously allocated for Race To the Top (RTTT) strategies, teacher pay-for-performance programs, and charter school expansion. While you characterize these strategies as a€?sweeping reforms,a€? we believe that they are unproven, reckless, wasteful experiments which put our most vulnerable children at risk. However, we strongly disagree with your opposition to paying for this initiative with funds previously allocated for Race To the Top (RTTT) strategies, teacher pay-for-performance programs, and charter school expansion.
You call these programs a€?vital,a€? a€?bold,a€? and a€?critical reform efforts.a€? We see the Obey amendment as a win-win situation.



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