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Frankly, the telco's were given million of dollars to expand broadband years ago and essentially pissed the money away.
Not millions, billions, some two hundred of them (albeit in tax breaks, not cash) and I'm still waiting to see the results from that before I want any more tax money going to those bloodsuckers.
Not millions, billions, some two hundred of them (albeit in tax breaks, not cash) and I'm still waiting to see the results from that before I want any more tax money going to those bloodsuckers.
When you give someone a tax break, you become less of a bloodsucker, than you were before, when you were taxing them higher... Or did you call telcos "bloodsuckers" over something else?
With less than 20% of any of it slated to go into effect in the first year the Obama "pass it or else" mantra is exposed as rhetoric.
Strange though it may sound, it is actually quite a difficult thing to spend $800b. When a stimulus package like this goes into effect, while the budget may be quickly allocated to specific projects, the actual draw down can only occur through vouched expenditure, and this can only occur as work is done. With this in mind, actually spending $160b (20%) is still quite an achievement.
However, the fact that the projects are started and have a guaranteed completion should provide more stimulus than the actual cash spend.
I don't know whether the spending is going to the right places, or that it will have the desired stimulus effect, but it's not correct to suggest that this is some kind of ruse just because it appears that the funding is not front-loaded.
That approach has two side-effects, both horrifying to Washington:
1. The money would be spent on the specific needs of each citizen, and not on the needs of Das Kapital.
2. Any mechanism of consolidation of power to Washington would be eliminated. When "the people" buy a badly needed refrigerator, who will be there to negotiate for another refrigerator for their state senator's vacation home in Florida?
[...] just send a check to the people [...] That would be almost $3000 apiece for every man, woman and child in the USA.
The problem of that is the following:
- How much of that money would be spent and how much would be saved?
The modern financial system is (or at least was, until recently) a big machine designed to make money go around and around and around:
- People buy stuff; that money goes to companies that sell the stuff; the companies then pay the salaries; the employees buy stuff with their salaries an
Strange though it may sound, it is actually quite a difficult thing to spend $800b.
Then why try to spend it all at once? The senate was right to cut down the bill (largely at the insistance of the Republicans although even some "blue dog" democrats grumbled about Pelosi's bill). Trying to rush anything throught Congress virtually guarantees that it will become a christmass tree so overloaded with pork and favored special interest spending that it could easily cost several times more than to pass the measures separately. This is especially true with non immediate spending. They should pass the critical spending first and then work on the other things as time permits and circumstances become more amenable. IMHO, the democrats made too big a deal of their "first 100 days" pledges as if rushing things, regardless of circumstances, was obviously the best way to go about completing the job.
With this in mind, actually spending $160b (20%) is still quite an achievement.
In a macabre sort of way I suppose that is true. However, as a Libertarian I am still horrified at the massive government spending that is currently taking place to make good the ill effects of previous government interventions, which notably include flooding the market with liquidity and allowing the money supply to increase massively in the years following 9/11 in an ill fated attempt to "smooth out" some bumps in the economic road and look where that got us. Now the government wants to cure what is essentially a spending problem, with...wait for it...even more government and consumer spending? Do we cure an alcoholic by offering him even more of his favorite beverage? Certainly not, so how can we cure a spending problem with more spending and making even MORE money available to spend?
However, the fact that the projects are started and have a guaranteed completion should provide more stimulus than the actual cash spend.
I don't know how it is in your state, but here in California it takes CalTrans and state contractors forever to finish highway projects. In some cases it has taken as long as two (2) DECADES after the first load of dirt was scooped to complete what should have been two (2) year or less construction projects. I remain skeptical that more of these types of projects will provide a lot of stimulus to the economy. After all, trucks cannot use new on-ramps and overpasses to move goods until they are actually completed.
I don't know whether the spending is going to the right places, or that it will have the desired stimulus effect
Don't worry, its NOT going to the right places AND it will NOT have the desired stimulus effect.
but it's not correct to suggest that this is some kind of ruse just because it appears that the funding is not front-loaded.
At best, it is an unwelcome distraction to the real problem which is the bad mortgage backed debts that are like sand in the proverbial economic engine, corrupting everything they touch and poisoning by proxy the balance sheets of everyone even remotely connected. The really important question, IMHO, that isn't being asked is this:
How can Amercians, whose real wages have stagnated since the end of the 1970s compared to economic growth and inflation, continue to pay inflated prices for the nation's housing stock? Most americans and particularly young Americans can really only afford a home that costs less than about $150,000 dollars or so and yet in many parts of the nation the price stubbornly refuses to fall below that level. There are too many dollars in the system relative to what average Americans actually produce and earn and until that problem is addressed I think that this economic malaise will continue, even after the "recovery", until this nation addresses its debt and spending problems.
Housing is at the root of this crises, but beyond even that is
How can Amercians, whose real wages have stagnated since the end of the 1970s compared to economic growth and inflation, continue to pay inflated prices for the nation's housing stock?
Thanks for bringing that up; I've been trying to understand that for a long time (long before the current crisis)
I'm no economics or financial expert, but I've always found it strange that our society looks at houses like some kind of magic money machines--as if they can repeatedly be bought and sold with the prices growing far faster than the salaries of the people purchasing them. How could that possibly NOT lead to a situation where no one can afford houses anymore (or, more likely, everyone buys houses
"Many universities sit on huge sums of money and still get government help so I'm not losing sleep over that one either. "
Where did you get this idea? This is a complete utter B.S. Most large state research universities are struggling financially right now. Many have a hiring freeze already. Some had been seeing their state funded budgets erode forever. As for private schools with large endowments, most of those too are having serious financing issues right now. WUSTL, Harvard, etc. Many have instituted faculty and staff hiring freeze as well. What large sums of money are you talking about? Their endowments? They already lost 30 to 50% of value in just one year, and schools generally use the earnings generated by those endowments to beef up their budgets. It is plain stupid to spend the endowment itself because this will seriously compromise the future financial positions of many universities. Based on experiences of many people I know, the freshly minted PhDs in any field are facing the worst job market of the decade.
"Bipartisanship" isn't useful in this context, because one party is working from macroeconomic theory and reason, and the other party is working from the ideological mantra of "Spending Bad. Tax Cuts Good." To the Congressional Republicans, things like school construction won't result in jobs for construction workers: apparently magic pixies will simply drop the new schools out of the sky in exchange for our money.
President Obama needs to realize that it's the U.S. Congress, not the Snuggle-Senate, and beat
The Republicans are just as clueless as the Democrats in the current situation. The reason is because, just like the Great Depression, there really are no answers to deal with the current economic downturn. Only time and debt destruction can fix it...
In short.. They can spend $2T if they like, and it will do little to nothing to stop the current problems from advancing. When you are a nation that is 70% consumption and have a 400% GDP debt ratio, there is little you can do to 'simulate" the underlying fundamentals. Meaning, the problem was overstimulation to begin with..
In short.. They can spend $2T if they like, and it will do little to nothing to stop the current problems from advancing. When you are a nation that is 70% consumption and have a 400% GDP debt ratio, there is little you can do to 'simulate" the underlying fundamentals. Meaning, the problem was overstimulation to begin with..
The way I look at it, they have two ways to handle the economic crisis:
1. Do absolutely nothing and let the economy continue to deflate until we get back to pre-housing bubble status. The problem with this approach is that you'll have 25% unemployment, soup lines that are worse than the great depression, and the entire world will take 10-20 years to pull itself out of the mess, if people don't riot and burn the world down first.
2. Dump money into the economy and continue to prop up the housing bubble by buying failed mortgage debt, hoping for a soft landing. This approach is doomed to failure as well because you can't keep pumping money into a bubble hoping to sustain it forever. The bubble is going to either pop quickly or deflate slowly. This approach only kicks the football down the field another 5-10 years for the next generation of politicians to deal with it.
Guess which approach our government is picking? I guess I'd choose option 2 also but either way we're fucked.
A debt crisis is just a generic way to saying that a nations (or world) wealthy class needs to realize their losses... Protecting a nations wealthy, which is what we are currently doing, is not smart and will not work long term because it will ultimately create social unrest. Personally, I would prefer option 3.
3. Realize that an economic collapse is inevitable, be a real leader, and prepare the public for it. Next, seize all major insolvent banks and wipe out bond and shareholders. Also, provide "fast track' legislation for corporate and personal bankruptcies. Next, expand social welfare services during the crisis to make sure that no one starves or is made unnecessarily homeless. Next, provide government sponsored services for newly formed businesses, and individuals fresh out of bankruptcy to help them get back on their feet. Meaning, once the mal-investment debt is destroyed, provide stimulus at a point where it actually has the chance of being used as a real investment.
And finally... Eliminate the fractional reserve banking model forever. It ultimate is the reason for boom and bust cycles, and in the global marketplace its time has come and gone...
Only time and debt destruction can fix it...
Exactly. That's why when I read the headline my first thought was GOOD.
Fixing this problem by taking on more debt is like helping a trauma victim by stabbing him.
As nice as it would be to have the IT sector get a big slice of pork, it's just not in the national interest. And that's how we have to think for the next few years. "What's good for me" will have to take a back seat sometimes to "what's good for the country."
It's awfully appealing to say "There is no answer" when one's preferred answer isn't working, and the solution that will work is anathema to one's ideology. Not liking the answer doesn't mean it doesn't exist.
See also: Keynes.
I don't see stimulating the economy listed as a federal government responsibility in the Constitution
"Promote the general welfare"
What happens when it was the government's meddling that caused the economic downturn in the first place?
Promote != Provide.
McCain proposed a 500B plan with the provision that any money not spent after 2 positive GDP quarters would not be spent. That was quickly crushed by the dems as they want to pay back all their campaign donors for the next 10 years.
To the Congressional Republicans, things like school construction won't result in jobs for construction workers: apparently magic pixies will simply drop the new schools out of the sky in exchange for our money.
No, money for schools would come from the taxes paid to their local governments by construction workers who have jobs as a result of the stimulus package.
Well, I don't know about where you live, but where I do we've already had a mess of wasteful school construction. Cities and towns of modest means have built these "Taj Mahal" schools, sometimes approaching $200 Million.
I don't have a problem with giving construction workers jobs as a stimulus, but let's not be arrogantly wasteful about how we spend the money. It's not JUST about providing short term jobs, it's about putting people to work for the long-term good.
How about fixing our bridges and infrastructu
There is no difference between the parties these days when it comes to spending.
They both want to spend *more*. There is a slight difference in what they want it spent on, but only a little.
What is it's purpose?
> You can ALWAYS count on stimulating an economy of the US's size by reducing taxation.
Yeah, so maybe not. Look up the velocity of money, which has fallen through the floor in the last few months. What that means is that people are essentially stuffing their mattresses, and any additional tax cuts will, in fact, not be stimulative. So you need to directly stimulate - and that means spend.
See this:
Also take a good, long, hard look at deflation and what that means, especially in relation to potential tax cuts. Arguably, we are in a deflationary spiral right now.
Everyone screams "LESS TAXATION" and other hoopla to waive their economist e-peen around like it's some giant stick of holy fruition to wake up people you disagree with.
But you know what? I don't think that will help either. For smaller business, maybe, just maybe. Larger businesses already pay next to nothing through creative accounting and the government really doesn't give a shit. Less taxes just makes it easier on them to line their pockets that they are already lining.
Yeah, some business will be responsible and use less taxes to help grow their business, but I have my doubts as to it being a large majority.
Businesses never pay taxes. YOU DO.
Businesses necessarily must make up for less profit by sticking it to their customers (in the form of higher prices or less choice), their employees (less wages, fewer benefits, and fewer jobs), their shareholders (less earnings per share, less dividends).
When you tax businesses, you're just indirectly taxing everyone else related to that business, including YOU. Business taxes appeal to the ignorant, because it makes it seem like someone else is paying, when in reality, it's YOU.
You have it exactly backwards.
It's the Republicans (fascists though they are) that are right in macroeconomic theory and its the Democrats (socialists) that are in fact, operating in ideological mantra that spending is somehow going to work. It didn't work for Austria, didn't work for us in 1930's, didn't work in 1974 and won't work now.
"Bipartisanship" isn't useful in this context, because one party is working from macroeconomic theory and reason, and the other party is working from the ideological mantra of "Spending Bad. Tax Cuts Good." To the Congressional Republicans, things like school construction won't result in jobs for construction workers: apparently magic pixies will simply drop the new schools out of the sky in exchange for our money.
President Obama needs to realize that it's the U.S. Congress, not the Snuggle-Senate, and beat some heads together to get good policy through. The $800b he proposed was too small to begin with, and all of these cuts make it more likely that we're not going to have enough stimulus to do anything useful.
Oh my God you are so full of crap. No one is saying that building schools won't employ people. What is being said is, "what happens to those jobs when the schools built?" These are not permanent jobs.
Also, building schools is not what Republicans object to. It's the millions to birth control programs. How does giving out condoms provide jobs? How is money to Amtrak going to produce jobs? Sure, it helps out the people working for Amtrak, but every passenger on Amtrak is NON-passenger on Greyhound or Delta. How does extending unemployment benefits create jobs? How does allocating money so groups like ACORN can purchase houses and rent them out create jobs?
Now these may be great ideas, but they do NOT belong in the "stimulus" package if they do not stimulate. Seriously, how big of a moron do you have to be to NOT understand that?
In other words, don't let the facts cloud your preconceived judgment of "Republicans bad, Democrats good".
How is money to Amtrak going to produce jobs? Sure, it helps out the people working for Amtrak, but every passenger on Amtrak is NON-passenger on Greyhound or Delta.
Interesting theory, but from Portland to Seattle (for an example) for me is a choice between Amtrak and driving. I'm not going to pay the premium to fly, needing to get out to PDX and then from SEATAC to downtown when I can take Amtrak much easier, and in about the same amount of time.
Greyhound? No thanks, I'll just drive instead. If we're going to help Delta or any airline (as we've done many, many times) why not help Amtrak which is more appropriate for shorter trips?
apparently magic pixies will simply drop the new schools out of the sky in exchange for our money.
And apparently, magic pixies will simply open up their checkbooks and give you trillions of dollars in taxes, too.
Maybe I'm different than the rest of you, but if I worked for it, I would like to keep it. I'm sick of being taxed out of 50% of everything I earn, so that it can be given to someone who doesn't deserve it.
Don't believe me?
Remember: Your taxes are more than income tax.
Here are some other things you are taxed on: Gasoline. Food. Clothing. Property. Investments. Cigarettes. Beer and Wine. TVs. Cars. Telecom taxes.
An interesting exercise is to take all of your spending for a month, and break it all down into taxes and non-taxes. You'll crap yourself, I promise.
We're getting raped enough with the taxes. Much like the schools, the government has more than enough money. The problem is a lack of accountability and wasteful spending - neither of which you are getting with the new administration.
Oh, don't get me wrong. You didn't have it with the last administration either. I'm not playing sides here, I'm just pointing it out.
More spending is going to help in any case. [wsj.com] Neither will socialism - and make no mistake about it, America is no longer a capitalist nation. That era is now over, thanks to Congress.
They need to be able to blame somebody when this supposed "stimulus" fails miserably. And I'm hesitant to call it a stimulus because more than 80% of the cash will be sitting in bank accounts untouched for at least a year, obviously not doing much stimulating.
Except if you bothered to pay attention even the congressional budget office said that the stimulus bill if passed will do more to hurt the economy in the long term over doing nothing.
http://washingtontimes.com/news/2009/feb/04/cbo-obama-stimulus-harmful-over-long-haul/ [washingtontimes.com]
Wake up Sheeple. You are perfectly willing to sit and listen to what 'Dear Leader' says. You listen to the talking heads regurgitate what better suits the Obama agenda and eat it up like its chocolate ice cream on a hot summer day. Just like
A letter from the CBO about the stimulus bill [cbo.gov] (PDF)
Instead of relying on someone else's bias to interpret things for you, how about doing some digging and go to the source?
Please tell me where in the linked CBO document it says the stimulus bill will be harmful?
I am sure they would love to ignore the Republicans... Unlike the House rules, however, the senate requires 60 votes to get anything substantial done. Meaning, they have something called filibuster rules that allow individual senators to slow/stop bills in its tracks...
Meaning, the democrats are not trying to be nice and work with the republicans... They are forced to deal with at least 3 Republicans to get the stimulus bill moving forward and they know this... Hence, the reason for the compromise..
So let them filibuster. Let them hold everything else up and yell loudly to the media that the republicans are against saving America!
$100 million from law enforcement wireless (original bill $200 million)
$100 million from FBI construction (original bill $400 million)
Need to keep pumping that taxpayer money into law enforcement so they can keep us safe from "obscene porn" http://www.usdoj.gov/criminal/optf/ [usdoj.gov] and continue to win the drug war.
Cutting higher ed and broadband gives the Republicans what they want: Keep the sheep stupid and uncommunicative.
So, will Monday night's speech ditch the theme of "bipartisanship"? Isn't getting him any votes anyway.
16 billion in school construction funding was removed, as well as another $3.5 billion for higher education construction.
By all means cut that waste out of the stimulus package. We can't have people going to school and learning things, nothing worthwhile could ever come from that. I've got an idea, let's take that money and give it to the military to spend on some crap hole half-way around the world. That's a much better investment.
Where I live (Massachusetts) there has already been a wasteful construction boom in school construction. Cities and towns of modest means have spent hundreds of millions on school construction. It's government run amok. We don't need to federalize this problem.
http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2008/03/22/newtons_taj_mahal/ [boston.com]
http://www.boston.com/news/local/articles/2005/03/31/state_plans_school_construction_probe/ [boston.com]
I believe we are seeing change all right...of the short variety.
For those who were sucked into the reality distortion field, this should serve as a dose of reality. Washington will change when hell freezes over.
I'm not going to get involved in the big debate over Keynes vs. the gold bugs. Just on the actual topic of the subject note...
The House had a $6B broadband appropriation, divided between rural (Dept. of Agriculture) and not-necessarily-rural (NTIA) programs. The Senate totally rewrote those sections. Sen. Rockefeller (D-Verizon) added about $2B for "advanced broadband" defined as 100 Mbps down, 20 Mbps up, in the form of a corporate tax credit, for new service to any residential customer. Even if only a tiny percentage took the higher speed, and it was totally closed to competitive Internet or telephone services.
So the grant could not be used by most standalone ISPs, because they're generally not profitable (so no need for a tax credit), or aren't Corporations (partnerships, municipalities, non-profits, etc., don't get anything). Nor could cable (upstream speed limits) or AT&T (U-Verse is too slow). The money had exactly one recipient in mind, It was a subsidy for pulling FiOS in suburban areas to compete with established cable companies and ISPs. The "underserved" areas could include Tampa, New York City, Short Hills, Santa Monica, or Chevy Chase.
The subsidy would have added precisely zero new FiOS lines, since it would have covered their existing plans. It was just more money for Ivan Seidenberg's bonus. Good riddance!
"Gravitation cannot be held responsible for people falling in love." -- Albert Einstein


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subset: commoncrawl


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Peeking around an elevator door, four-year-old Lydia Dailey bounced through the doorway to meet the people who helped save her life.
A crowd of nurses, doctors and emergency medical workers applauded with laughter and tears as they saw the Indiana toddler wiggle and jump down the hall.
The last time Lydia and her older brother Caleb entered the hospital doors, they were airlifted to the Sanford Pediatric Intensive Care Unit with severe head injuries from a car crash. Neither child remembers those days in the Fargo hospital, but for their parents, Ben and Jackie Dailey, it's a time that's impossible to forget.
"We came to say thank you, but that's not nearly enough," says Jackie. "These people saved our kids' lives and there are not enough words to express what we feel."
The Bluffton family was visiting relatives in Adhley, ND in December 2010, when their car was struck by a grain truck. Emergency responders knew Lydia and her Caleb were in serious trouble when they arrived at the scene.
Within minutes Lydia was transported by airlift to Sanford Medical Center Fargo. Soon her brother would be taken from another hospital emergency room to join his sister. Both children had head injuries, and no one knew if they would make it through the night, much less the next week, says father Ben.
"You jump into survival mode," said Ben. "There are hard decisions to make and you don't have enough time to even be emotional."
As the parents arrived at the hospital, over 1000 miles from home, they were greeted by PICU staff and taken care of like family. Medical staff and everyone they encountered worked to meet the family's medical and emotional needs, the couple said.
"We come from a very small town, and we immediately got that 'at home' feeling," said Ben. "We knew that they cared for our children and us—that it was more than just work for them."
The next few days were challenging, but the children began to show signs of healing. Caleb came off his ventilator and gave his parents a "thumbs up" sign. Lydia underwent a procedure to remove a portion of her skull, allowing her brain room to swell.
After eight days, the children were stable enough to be airlifted by the Sanford LifeFlight to Riley Children's Hospital in Indianapolis, where the family could be closer to home. Once they were there, they learned what good care their children had received.
"Lydia was able to have the right side of her skull totally reconstructed," Ben said. "Our doctors told us that the fantastic job that Sanford did with the initial surgery and the care of the kids allowed them to put the bone right back into place."
Over the past year and a half, both children have had rehabilitation and further care for their injuries. Kindergartener Caleb is back to playing soccer and t-ball with his classmates.
His sister still has a brace on her leg and goes regularly to physical rehab appointments. There are some signs that the accident may have had some long term effects on her comprehension and verbal skills, but her doctors and family have hopes that she'll have a full recovery.
In March, the family returned to the halls of Sanford with their new baby sister Naomi to thank everyone involved in their care. Having a chance to reconnect with people who fought for their children's lives was something they had wanted to do since returning home.
"For our children, for us, it was pretty awesome," says Jackie. "It was a homecoming for us. We will never be able to say thank you enough."


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What a sad, pathetic, insecure little human being.
Quote from: Ceallach on July 12, 2012, 11:42:35 PMWhat a sad, pathetic, insecure little human being. When I saw this my first thought was Buzz Lightyear telling Woody, "You are a sad, strange little man. You have my pity." Am I the only one? (Also perhaps a semi-appropriate response this woman, with the gender switched of course.)
I've been taking ballroom dance lessons for 6 years or so and my instructor suggests practicing dance posture always, so it becomes automatic, or "muscle memory". It sounds like you learned the same thing in your years of dancing/dance team. I for one, always admire those who walk with poise and feel I can often recognize a dancer now by their walk. It's a good thing! (I also tend to walk to the beat of whatever music is playing, too)I agree with others, that lady was out of line, and your complete silence was definitely the right response. If she approaches you again I'd definitely go to management and let them know she may be making others uncomfortable as well with her bold negativity toward others.
I would have said "well -- that was excellent -- You take your medication today?
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Oh, dearest Princess, Your Royal Highness, what a gorgeous brown tabby girl you are! You remind me of my Bob and my RB kitty Peony. You are very majestic, allowing your subjects to pet you on your terms. And you have fun too, chasing that laser light around and rubbing your face on the cat post and enjoying catnip. You are utterly delightful, and you and your subjects all love each other very much. Your royal palace is full of love, which is just as it should be.
Congratulations, darling Princess, on being selected today's Cat of the Day! We hope you and your subjects are enjoying a fine day of celebration, full of fun and lovies and all your favorite games and treats.


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Spring Break season is winding down and so is the increased police activity along the highways in the Wiregrass.
Headland Police say they saw a steep jump in drug arrests this spring break season.
They made nearlt 40 percent more arrests this March than last year. And more than half the arrests were drug related off of Highway 431.
"Closer they get to Panama City the more excited they get and naturally they start partying before they get there and these cases here we've got them stopped when you go up to the car and smokes coming out of the window. Where they are actually smoking and going down the highway."
The police chief says they have seen a lot more weapons seized during the drug arrests.


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As one of five NFL teams that earned awards for this year's "Million Fan Salute," the Minnesota Vikings, in conjunction with United Services Automobile Association's (USAA), presented a $20,000 "Moral, Welfare and Recreation" (MWR) donation to the Minnesota National Guard at the Vikings Winter Park training facility today.
The donation comes as part of the NFL and USAA's season-long initiative called "Million Fan Salute," which allowed NFL fans an opportunity to digitally salute the military on behalf of their favorite teams. Along with Minnesota, fans in Denver, Green Bay, Seattle, and Tampa earned rewards for their military appreciation efforts.
"We appreciate the Vikings selection of the Minnesota National Guard community as their local recipient of this year's 'Million Fan Salute' contest," said Army Lt. Col. Kevin A. Olson. "USAA and the NFL teamed up to provide $100,000 for military organizations in five NFL communities and we are thankful the efforts of the Vikings and their passionate fans led to Minnesota's inclusion."
The $20,000 will enhance the Minnesota National Guard's MWR program, which directly supports readiness by providing a variety of community, soldier and family support activities and services. Included are social, fitness, recreational, educational and other activities that enhance community life, foster soldier and unit readiness, promote mental and physical fitness and provide a working and living environment that attracts and retains quality soldiers.


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Sentencing scheduled for April 4 in Chariton County
The five-day jury trial scheduled for Mexico attorney James A. Clampitt in Chariton County this week, ended in two days, with two guilty verdicts.
Clampitt was found guilty of felony charges of vehicular manslaughter and leaving the scene of an accident that happened on June 13, 2010, when Clampitt's SUV hit a riding lawnmower being driven by Richard Cobb. Cobb died three days later from injuries he received in the collision.
Clampitt's trial started Monday in the Chariton County Courthouse in Keytesville with jury selection and testimonies heard from the state medical examiner, law enforcement and Cobb's widow, Marcy Hill.
Tuesday proceedings opened with more testimonies heard from former Mexico Public Safety Detective Carl Fuenfhausen (who arrested Clampitt), American Family Insurance claim adjuster Tom Greenwell and KWWR/KXEO radio station news director Chris Newbrough, who interviewed Clampitt (about the accident) before his arrest.
The jury also saw photographs of Clampitt's wrecked vehicle and pieces of the vehicle's headlight assemblage that broke off at the scene of the accident and "fit like a puzzle piece" in the police investigation, according to Fuenfhausen.
Defense Attorney Kevin Hamlett declined to comment about the final verdict, however he did ask the jury to "have mercy" on Clampitt and not send him to prison.
The jury recommended a sentence of six months in the Audrain County Jail for the second-degree manslaughter, then two years in prison for leaving the scene of an accident.
Clampitt claims he had no idea that he had struck Cobb with his vehicle. In his interview with Newbrough, Clampitt said, "No way I wouldn't stop and give assistance."
He also admitted to having a few drinks and driving. Clampitt reported spending the day with a female companion, having a few drinks at the Dos Arcos Mexican Restaurant in Mexico and then driving his friend home. After leaving that location, Clampitt said he was driving on Jefferson Street and his cell phone rang. He reached to answer it and felt what he thought was his car hitting a curb. Clampitt stated he didn't see anything in his rearview mirror and that his vehicle was operating correctly.
Clampitt said he discovered new damage to his vehicle the next morning and tried to retrace his travels. Finding no visual proof of an accident on Jefferson Street, Clampitt said he figured another vehicle had struck his SUV, and he took it to the Pearl Motor Co. dealership for an estimate of the damages.
State Prosecuting Attorney Ted Bruce pointed out that Clampitt never reported the incident to the police, and that management at the Mexican restaurant had given police a receipt of what Clampitt's alcohol purchases had been the night of the accident.
Hamlett made several attempts to discredit Fuenfhausen's performance in the investigation and his conduct during his interview with Clampitt. Fuenfhausen denied Hamlett's accusations that he tried to force Clampitt to admit that he was driving his vehicle and had struck Cobb as he drove his lawnmower on Jefferson Street.
Hill said the sentence was not enough for the "life that was lost." Cobb's siblings said they felt justice was served, but their hearts go out to the Clampitt family.
Following the reading of the verdict, Clampitt embraced the Cobb family outside the courtroom, and said he was sorry for their loss. Clampitt's children, his ex-wife and his mother attended the proceedings and offered support.
A formal sentencing will take place April 4 in Chariton County, where the case was moved from Audrain County on a change of venue.
Hamlett was uncertain when asked if Clampitt would be disbarred. Hamlett said that is a decision that will be made by the Missouri Supreme Court. Until April, Clampitt remains free on bond.


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GROTON -- Running up to the Jan. 26 special Town Meeting, members of the Board of Selectmen worked to fine tune the handful of warrant articles scheduled to be presented to voters for consideration.
Chief among the articles discussed at the board's meeting of Jan. 14 was that of Fitch's Bridge, which will be the third measure to be taken up by Town Meeting.
Built and installed in the late 19th century by the Berlin Iron Bridge Co. of Connecticut, Fitch's Bridge has been closed to auto traffic since the 1960s and in recent times has been used mostly by teenagers looking for a good spot from which to jump into the Nashua River.
Plans laid out by consultants hired to do the work of replacing the bridge call for removal of the existing span and its replacement by a new, truss-style, 10-foot wide span intended for pedestrians and bicyclists.
The question for Town Meeting will be twofold: appropriate the necessary funds to either remove the bridge or remove and replace it.
To simply remove the bridge would cost $161,294, money that could be taken from the town's stabilization fund.
To remove and replace the bridge would cost $375,244 (plus $45,000 for an entrance arch made of parts salvaged from the old span) and would be rolled up into a bond shared with money needed to build a new Center Fire Station should voters approve that as well.
Town Manager Mark Haddad characterized the winning bid received for removal and replacement as "a great deal" and said that overall, he was "shocked" at how low all of the final bids turned out to be.
Haddad said bidding for the job was extremely competitive and recommended to selectmen that if they were at all inclined to support both removal and replacement, now was the time to act.
"I don't think you're ever going to get a better price," summed up the town manager, adding that the the company with the winning bid was excellent and came highly recommended.
Haddad then listed four options that selectmen could settle upon to pay for the work:
* Borrow the money and add it to the fire station bond.
* Appropriate funds from the Community Preservation Committee and stabilization.
* Appropriate all the money from the CPC alone.
* Support removal only and take all the money from stabilization.
With word from the CPC still due later that evening, selectmen voted to hold off on deciding how to fund the project and restricted themselves to a decision supporting both the removal and replacement of the bridge while informing Town Meeting that the option of removal only could still be considered.
Also at their meeting of Jan. 14, the board:
* Were informed by Haddad that another article dealing with the cost of a weed-control program for Lost Lake/Knops Pond using a herbicide would cost $95,000, including the bid price and contingency funding. The money would be taken from the town's excess and deficiencies account if the measure were approved.
* For the fire station article also on the warrant, Haddad told selectmen that the $6.9 million price tag would be covered from the town's stabilization fund and not tied to an override as suggested by some in town. The town manager said he was opposed to the use of a debt exclusion, which would have to be decided as a ballot question rather than by Town Meeting, and urged residents to support his payment plan as presented. Board Chairman Stuart Schulman agreed, seeing no need to encumber the town with a debt exclusion, something which could still be resorted to later if needed.
* Voted to hold annual Town Meeting on April 29 at the Middle School's performing arts center. Selectmen had asked Haddad to check for other venues in town where the meeting might be held on a Saturday, but none were sufficient. Board members also voted to open the warrant for spring Town Meeting on Jan. 15.
* With heightened concern for students following the tragedy at Newtown, Conn., Town Clerk Michael Bouchard approaced selectmen about seeking an alternative polling place for upcoming elections besides the Middle School location currently being used. Bouchard said he had consulted with police Chief Donald Palma and fire Chief Joseph Bosselait on possbilities and suggested the former Prescott School, Legion Hall and Town Hall as potential sites. Bouchard said the sometimes heavy number of people coming to the polls on election days presented a security problem for the school and thought a different location might be safer. Holding professional days for teachers on election days when students stayed home was explored but it turned out that there were too many election days coming up to accomodate such a scheme. Another option was to increase police presence on school grounds during election days but even that solution was deemed "not foolproof." Finally, the idea of simply relocating the polling place was suggested and selectmen, while noting such concerns as the availability of parking, agreed to allow Bouchard to explore potential sites and to report back at a future date.


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Playing video games without also experiencing a wide range of other arts leaves you a stunted and terrible person, so They say, but thankfully some novels are playable on your game devices and have pictures and everything. Publisher Aksys yesterday announced it's bringing visual novel Hakuoki: Memories of the Shinsengumi westward to Nintendo 3DS, to make you more whole by teaching a little something about love between a woman and a man.
Memories of the Shinsengumi is a 3DS version of the PSP game Hakuoki: Demon of the Fleeting Blossom, jazzed up with features using the 3DS hardware and more story bits.
It's playable in 3D, naturally, but surely the most exciting feature is the ability to take photos of yourself with characters in a 'purikura' photo booth-style thing. If only you could touch them.
Idea Factory's Hakuoki visual novel series has been jolly popular, spawning spin-offs, manga, and anime. It's a historical fantasy sort of thing, set towards the tumultuous end of Japan's Edo period but with demons kicking too. I suppose I should mention that you play a lady and get to romance boys, but that's inconsequential really isn't it?


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Quest and Pivotal Technologies Group Partner to Deliver Desktops as a Cloud Service (DaaS) Powered by Desktone
By: Business Wire
Nov. 14, 2012 08:10 AM
Desktone, Inc., the pioneer of Desktops as a Service (DaaS), today announced a partnership between Quest®, a cloud service provider, and Pivotal Technologies Group, a managed service provider. Based on the relationship, Pivotal will now offer Desktone-powered hosted Windows desktops provided by Quest as a managed service to businesses. The relationship represents an effective new way for service providers of all sizes to benefit from increasing demand for desktops as a cloud service. By providing the Desktone-powered DaaS offering to channel partners, Quest is able to expand their market opportunity while enabling managed service providers such as Pivotal the ability to offer virtual desktops without having to invest in costly infrastructure.
Service providers are rapidly embracing DaaS as a cost-effective way to address their customers' pressing business challenges such as BYOD, Windows migrations and an increase in mobile workers. Hosting desktops in the cloud eliminates the cost and complexities inherent in traditional virtual desktop infrastructure (VDI) while enabling employees to easily access their documents, applications and data on any device. Additionally, DaaS can be easily integrated with other Infrastructure as a Service (IaaS) offerings such as storage, backup and disaster recovery.
"We built the Desktone Platform from day one for service providers like Quest and Pivotal that are tasked with helping end user organizations increase IT efficiencies while keeping their budgets in check," said David Grant, Vice President of Strategy, Desktone. "We have seen an explosion of interest from managed service providers (MSPs) that want to deliver DaaS but cannot build their own data centers. With DaaS, Quest is able to host and deploy virtual desktops from their data centers, making it easy for Pivotal to provision new desktops for end users whenever they're needed without investing in costly hardware and software."
"Quest is committed to its partners to capitalize on cloud computing opportunities like DaaS that are in the greatest demand among customers today," said Adam Burke, Director of Quest's Technology Partner Program. "Our partnership with Pivotal is a testament to the unique value proposition that Quest delivers as a partner of choice to accelerate their time to market and provide the greatest value of cloud services to their end customers."
Small and mid-sized service providers often don't have the capacity for hosted offerings. By leveraging Desktone's multi-tenant DaaS solution, Quest can provide MSPs like Pivotal a simple, affordable way to offer virtual desktops to end user organizations. The multi-tenant architecture makes it easy to deliver secure, scalable virtual desktops as a cloud service without the expense and hassle of infrastructure integration and maintenance.
"Our customers look to Pivotal to solve their IT pain points. One of the biggest challenges we see is organizations looking to support mobile and remote workers," said Jim Law, President, Pivotal Technologies Group. "We previously offered our customers desktops from a traditional VDI provider but found the service expensive and difficult to manage because of issues with speed and availability. By transitioning to the Quest DaaS model powered by Desktone we are able to streamline desktop management and improve reliability while reducing the price per desktop by half."
Pivotal recently deployed DaaS for its customer, Artcraft Management, Inc., a property management firm located in Richmond, VA. Artcraft employs remote workers to manage more than 5,000 units from Charlotte, N.C. to Arlington, V.A. and needed a reliable method to deliver desktops to both corporate workers and remote employees working in the field.
"We tried VDI, but the technology was not where it needed to be. We experienced latency issues with both remote workers and employees at corporate HQ, and our IT staff spent a great deal of time addressing bandwidth problems and outages," said Bruce Harrison, Director of IT, Artcraft. "With DaaS we are able to provide all of our employees with access to the applications they need all the time, no matter where they are, improving their productivity. In addition, we were able to free up IT resources and significantly reduce our Total Cost of Ownership for desktops."
Cloud/DaaS/BYOD Lunch & Learn Session: November 15, 11:00 a.m.
Quest and Pivotal Technologies Group will host an informative Lunch & Learn session in Richmond, VA, November 15, 11:00 a.m. – 1:15 p.m. Attendees will learn about Cloud, DaaS and BYOD: what it could mean for business and the pitfalls to avoid. For more information, please visit: http://www.questsys.com/events/qpDaaS/qpCloudDaaS.html.
About Desktone
Desktone provides infrastructure enabling Desktops as a Service (DaaS) – a full-featured desktop experience delivered from the cloud to any device, including a workstation, tablet or smartphone. Desktone's DaaS platform provides all of the benefits of virtualized desktops without any of the hassles. Desktone enables IT service providers to rapidly provision desktops to users connected on any device, anywhere, without the upfront costs and complexity of traditional desktop virtualization – transforming desktops from a CAPEX to OPEX item. Founded in 2007, Desktone is funded by Highland Capital and Softbank and is headquartered in Boston, MA. For more information, visit www.desktone.com.
About Pivotal Technologies Group
Pivotal Technologies Group is a technology company focused on IT infrastructure solutions. We work with our clients to understand their corporate goals and then design solutions that make them more competitive in their chosen fields. We take a vendor agnostic approach to design best-in-breed solutions that help companies overcome their business challenges. For more information, visit www.pivotaltg.com.
About Quest
Celebrating its 30th year, Quest has been a trusted technology management company delivering successful solutions for our clients from Fortune 50-5000 small and medium-sized clients. Quest is ranked #9 on the Global Managed Services Cloud Providers top 100 by MSPmentor and ranked one of the top 500 US technology firms by VARBusiness as well as CRN's top 250 Tech Elite, including the unique CRN designation of Cloud Elite.
Photos/Multimedia Gallery Available: http://www.businesswire.com/multimedia/home/20121114005500/en/
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It begins very small. So small, you don't even realize what you're doing to yourself. For me, it started with a safety pin. The cuts were small, small enough to explain with simple excuses. I thought that would be enough. I thought I would be able to control it, but I didn't know half of what I know now. Cutting is an addiction, just as bad as cigarettes or alcohol. It eats up your life, and you don't even know it.
They just kept getting deeper. Longer. More difficult to explain. I had to hide them. I was wearing long sleeves in summer, coating my arms in layers of jelly bracelets and wristbands. I even caked my arms in foundation to hide the line of fresh cuts I had made the night before a choral concert. Anything to keep it hidden, to muffle my cries for help.
Things were getting out of control. I felt like I needed to cut just to feel alive. All day during school, I'd think about it. Crave it. When I finally got home, I could hardly control myself. I'd cut without even knowing why, not even thinking, just allowing the pain to take me to a new level of unconsciousness and bliss. By this time most of my friends knew. I could see them worrying. For some reason, though, I didn't care.
My last cut was a year ago, after almost two and a half years of addiction. Now, I still find myself craving it. Anything can trigger a craving: hearing about it, writing about it, even just chopping veggies for dinner. I find myself thinking, Just one more time, it can't hurt. I want to succumb to those feelings so badly sometimes. But I can't stand the thought of sending eight months of hard work down the tube. I just can't stand the thought of disappointing myself like that.
When I see people who have the same battle scars, I wish I could tell them what they're dealing with, but I don't think they would listen. Maybe they already know.
This piece has been published in Teen Ink's monthly print magazine.


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The nursing programs at Iowa Lakes Community College have received accreditation from the Iowa Board of Nursing.
All colleges in Iowa which provide nursing programs must be reviewed and accredited. The accreditation process involves an extensive self-study, followed by a visiting team of evaluators. In late April 2012, the team of evaluators conducted a two-day, on-site visit at the Emmetsburg campus. This visit included interviews with staff, students and administrators as well as review of the college's facilities and equipment. Area hospitals and nursing homes which partner with Iowa Lakes by providing clinical sites for students to gain experience and practice their professional skills are also part of the review process.
Iowa Lakes was notified in late September of 'full approval' for the next six years from the Iowa Board of Nursing. This accreditation includes both the daytime and evening/weekend sections of the associate degree nursing (ADN) and the practical nursing (PN) in Emmetsburg, Algona, Spirit Lake and Spencer.
Article Photos
Michelle Jackson, nursing office associate (sitting) and Bernadette Wise, director of nursing and health education
EDN?Photo Submitted
"This process ensures the credibility and validity of our programs," said Bernadette Wise, director of nursing and health education.
"This accreditation provides us with an opportunity to continue to review and revise our nursing program based on suggested recommendations. We appreciate the Iowa Board of Nursing for endorsing the nursing program at Iowa Lakes Community College."
The Iowa Lakes nursing program is also accredited by the Iowa Department of Education. In addition, Iowa Lakes Community College is accredited as an institution by the Higher Learning Commission of the North Central Association of Colleges and Schools.
For more information on Iowa Lakes Community College, visit www.iowalakes.edu.


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Critics scores range from 0 to 100, with higher scores indicating more favorable reviews.
out of 100
Metascore®Mixed or average reviewsbased on a weighted average of allcritic review scores.
Don't leave before the final frame -- if you're still breathing.
Read Full Review
When there's a whole mess of zombie killing to be done, who cares about reflective writing or that time-wasting element of suspense?
Overall, this Dead is zippier than 1995's retake on "Village of the Damned" and somewhat less junky than the recent remake of "The Texas Chainsaw Massacre."
Calling this version of Dawn of the Dead a remake is applying a misnomer. It's more of a re-imagination.
My only complaint is that its plot flatlines compared to the 1979 version, which was trickier, wittier and smarter. Romero was not above finding parallels between zombies and mall shoppers.
See all Dawn of the Dead reviews at Metacritic.com
not for kids
Extremely gory horror movie; not for kids.
What Parents Need to Know
Parents need to know that this 2004 Dawn of the Dead is an extremely violent remake of George A. Romero's 1978 horror film of the same name. Perhaps the violence should come as no surprise, since this is, after all, a zombie film. Expect lots of blood, bites to the throat, vast armies of zombies shot in the head by shotguns, as well as moments of gore like eye stabbings and a head impaled with a spike. There's also considerable profanity, and some of the characters fill the empty hours of hiding out in the shopping mall from the zombies waiting outside by drinking and having sex. While this film delivers what horror fans want and expect from the genre -- including zombies moving at a much faster, more aggressive pace than typically seen in zombie movies -- for younger viewers and people who aren't horror fans, he violence and gore will be too much.
Messages: Not an issue
Role models: In the "Unrated Director's Cut," there are attempts to, pardon the pun, flesh out the characters, but no one really stands out as anything more than a stock character.
Violence: Zombies move much faster than the lumbering zombies commonly seen in films like these; they bite the throats of their victims, are covered in blood and the remnants of body parts, and are continually being shown getting shot in the head by humans with shotguns. When a newborn baby is born as a zombie (which is not shown), there's the sound of a gunshot to signify that the baby has been killed. A character is impaled in the head with a spike. Another character is stabbed in the eye. Early in the film, when the zombies first start to appear, a panicked character is run over by an ambulance.
Sex: While two of the characters are hiding from the zombies in the shopping mall, they pass the time by having sex. At the end of the film, a camcorder shows quick flashes of one of the characters before the zombie attacks, hanging out on his boat with various naked women.
Language: "Motherf---ers." "Faggot." "F--k." "F--king." "S--t." "Tap that s--t."
Consumerism: Not an issue
Drinking, drugs and smoking: One of the characters decides to fill the empty hours of waiting and hiding out from the zombies by drinking and smoking cigarettes. This character frequently appears drunk in the film.
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Van Halen-The Downtown Sessions [VIDEO]
The new album from Van Halen "A Different Kind Of Truth" is definitely one of the better comeback albums from a band that has had it's share of drama over the years. As a pretty big VH fan I did go out and buy it, and I think it's pretty damn good. There have been some music videos released from the band, and a few interview segments with David Lee Roth and Eddie and Alex Van Halen that were pretty entertaining. Here is a cool unplugged session with the 3 of them, that you get on the DVD that comes as part of the deluxe version of the new album. Check it out!
You Tube


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PORT Macquarie police are worried by the upward trend of violent home invasions in our area.
They believe it is only a matter of time before someone is seriously injured or even killed.
In just a matter of two days, a 91-year-old woman and an 84-year-old man were targeted in their homes by cowardly attackers.
On Thursday two men entered the home of the 91-year-old woman and demanded cash.
The victim was pushed by one of the offenders but was uninjured.
The 84-year-old victim of Saturday morning's attack was lucky to escape with minor injuries after fighting off his two would-be attackers.
Ernie Whitfield was confronted by two men who were armed with a knife and a steel bar.
The elderly man managed to turn the tables on the two offenders and chased them from his premises.
A police spokesman said if residents ever find themselves in a similar situation to comply with the offenders.
"Let them get what they are after and let them leave," he said.
"You shouldn't act out violently unless you are being attacked and then defend yourself at all costs."
Six offenders stormed their way into a Kempsey home recently and held the two home owners captive for sometime before fleeing.
Another home invasion occurred in Taree on Friday night. This time three offenders broke into a 79-year-old man's home armed with a knife.
The man was wrestled to the ground and the trio demanded cash.
They eventually fled with money and a mobile phone.


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|Defensive Assistant
|(916) 278-2458
|Previous College:
|Humboldt State, '12
John Hughes recently completed his first season on the Sacramento State coaching staff.
While assisting the defensive line, Hughes helped coach Darnell Sankey to honorable mention all-Big Sky honors. The defensive end ranked third on the team with 65 total tackles and led the team with six sacks. Sankey was the FCS National Defensive Player of the Week after recording three sacks and 4.5 tackles-for-loss
Prior to coming to Sacramento State, Hughes spent four seasons at Humboldt State, most recently serving as the tight ends coach in 2012. As a player, Hughes was a three-year starter on the offensive line for the Lumberjacks where he played both right guard and center.
The Redlands, Calif., native began his collegiate career at Western Washington but moved to HSU after the University discontinued the football program.


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The Body Covers: The 15th Conference on Retroviruses and Opportunistic Infections
Successful Implementation of a Clinic-Based Prevention Intervention Program for HIV-Infected Persons
February 5, 2008
There's nothing like hearing the results of studies directly from those who actually conducted the research. It is these women and men who are transforming HIV treatment and care. In this interview, you'll meet one of these impressive HIV researchers and read an explanation of the study she is presenting at CROI 2008. Accompanying me on this interview is Dr. Gerald Pierone, a clinician and researcher who is the director of the AIDS Research and Treatment Center of the Treasure Coast in Fort Pierce, Florida.
We collaborated with the original developers from the University of Connecticut and took their research protocol and the research instruments they had, and from that [we] developed a training and a manual that could then be rolled out to sites. Fifteen sites applied and were given small amounts of funding to help them implement the intervention. We did one centralized training, and then people were provided with resources to train other providers at their site and to implement what's called the "options intervention," which is a brief, clinician-based positive prevention intervention that's based on the whole idea of giving people information and then motivating them to decide what they want to do to either maintain low risk or decrease active risk.
Bonnie Goldman: What kind of information do they give?
Lisa Hirschhorn: They go through a risk assessment. We ended up with seven steps. The first thing [the clinicians] do is assess what kind of risk behavior [their patients are] actually having right now. Then they negotiate with the patient which area they want to discuss for risk behavior, either for reduction or maintenance of low risk. They focus then on the areas that might put somebody at risk. "When do you not use condoms? When you're drinking or using drugs?" Then they talk about if [the patient wants] to change this or maintain it. "How important is it to you?" The patient rates it from one to 10. "How confident are you that you can actually make the change?"
Based on that -- if [the patient says], for example, "I think it's only a three," -- they say, "Why is it a three? Why do you care at all? Why is it important at all? How can we make this more important for you?" Then they discuss strategies of how to reduce the specific risk or to maintain the low risk. Like, "What are you going to do the next time that you drink?"
They agree upon a goal, which is a progressive goal. So if you're never using condoms, could you use them some of the time? Then, in the next appointment, they follow up on the discussion and it's documented in what's called a patient record form so that it becomes a permanent part of the record.
What we found is that 13 out of the 15 clinics were able to implement it, and 90% of the patients who reported having the risk discussion after they had an option visit said most of them thought it was very positive. They thought that providers' comfort and knowledge seemed to improve. The median [discussion took] about five minutes, which was much less than people thought it was going to be to go through the whole thing. The providers selected, to some extent, who was going to be able to get [the intervention]. For example, they avoided people who had very significant mental illness, such as psychoses; people who were only coming in with a crisis; who were really very actively high. It had to be people who were engaging in primary care. This was really meant to be an intervention that capitalized on the relationship between a patient and their primary care provider.
Bonnie Goldman: Who typically did this intervention work?
Lisa Hirschhorn: It would have to be whoever the primary care provider was: the doctor, the nurse practitioner or the physician's assistant. One of the sites already had in place some very good prevention educators. They actually implemented it using the prevention educators, which was not within the context of this [study]. It was this balance between fidelity and adaptation; they adapted it more than sticking with the fidelity.
There was a lot of debate whether that was an OK thing to do. You could argue on two different levels, one of which is that it's the person you have the closest relationship to. But because this was meant to be a repetitive, chronic-care management approach, the feeling was that it was more appropriate to have it with somebody with whom you were going to have repeated, ongoing contacts.
Bonnie Goldman: Could you tell me a little bit about the demographics?
Lisa Hirschhorn: Sure. We, like the original study, had very, very few people who were self-reported injection drug users, and even fewer who had active drug use. About half of the people self-reported [that they were] MSM [men who have sex with men] as a risk factor, and a significant number of others were heterosexual. About a quarter of the people had less than a high-school graduation. Most of the people had been [HIV] positive for quite a long time: The median was about seven years, although the range was anywhere from less than a year to as high as 28 years by self-report. Very high rates of active mental illness: 42%.
What was interesting was, qualitatively, we went and talked to the providers, and even the patients that had been in care with the provider for many years. When they went through this discussion, there were all kinds of risk behaviors that [the providers] hadn't known were going on. Some of [the patients] said, "Oh, I'm so glad that we're talking about sex now." The providers clearly had been giving positive prevention messages all along. Somehow, it wasn't quite getting through.
The other thing that was fascinating was that, because this forces you to talk about strategies to reduce or maintain low risk, a number of the patients who reported abstinence were not abstinent by choice. [They] actually had medical conditions that they had been too embarrassed to talk about. So it invoked these discussions, and a number of patients had medical evaluations when [the providers] uncovered some medical problems about why people were having erectile dysfunction. It was interesting not only in the sense of opening up a discussion for positive prevention, but also probably improving the discussion that they were having with the patients in general.
Bonnie Goldman: It's kind of challenging, though, for most clinicians to find the time to do this. Even if it just takes five minutes, they often don't have the time. How feasible is this, really?
Lisa Hirschhorn: This was one of the main concerns. I think there was a fair amount of initial resistance, but when we went to the clinics, it really did not disrupt the ongoing clinic. You have to have at least 20 minutes -- ideally, a little bit more -- for a visit. If you have a 12-minute visit, you're not going to have time to do this.
But again, it has to be a priority, and given the CDC [U.S. Centers for Disease Control and Prevention] recommendations2 and issues about ongoing transmission, the feeling is this has to become a priority. The clinicians really felt like it improved the communication that they had with their patients overall.
You definitely have to undergo a certain amount of resistance, but we talked to the administrators as well as the clinicians, and people felt it really hadn't disrupted the patient flow. One of the key things is that you don't implement it all at once to every patient. The idea is that you do it for one or two patients at each session, because the first interaction takes longer than the follow-up ones. The idea is, you start off and you do two or three at each session, preferably a little bit towards the beginning, and then over time you actually end up interacting with all the patients.
Gerald Pierone: Hi, I'm Gerry Pierone from AIDS Research and Treatment Center of the Treasure Coast. You mentioned overcoming the initial resistance. How long did it actually take to get the clinicians, the administrative staff and the support staff of these clinics on board and trained to do this?
Lisa Hirschhorn: It's a little bit difficult to assess that because we had other delays. For example, IRB [institutional review board] approvals getting the training. Once training went into place, it didn't take very long, mostly because each site -- with the exception of one site -- had a very dedicated leader who came in. They started doing it, usually with one other person, and then they would do training and would spread out from the clinic.
One of the keys to success -- this is one of the reasons why one of the sites didn't work -- was you had to have somebody who was committed and who felt that this was going to be done. In general, they wanted it to be a physician. A couple of the sites were able to do it with nurse practitioners, but it had to be somebody with enough leadership and authority that they could say, "This is what's going to happen."
At some of the sites, it took a couple months for some of the providers to buy [into] it. Even some of the most resistant ones, by the end of it, really thought that it was very helpful. The majority of the sites are continuing to do it in some manner or another.
Bonnie Goldman: The 50% of sexually active patients who reported that they used condoms, was that considered low or high? And was that before the intervention?
Lisa Hirschhorn: That was considered to be low, because most of these were sites where they were already doing some sort of positive prevention. I think that people were very surprised that it was low. Everybody made the assumption that it was actually higher, although there was some serosorting going on in terms of condom use.
Gerald Pierone: From what you're describing, it seems that no matter what, positive things came out of these interventions: Medical conditions were uncovered, dialogue occurred which hadn't been happening, and clinicians became aware of their patients' sexual activities when perhaps they weren't before. So even if outcomes weren't particularly changed, those outcomes, from a clinician's standpoint, were positive in impact.
Lisa Hirschhorn: That was our impression. Obviously, it's qualitative. One of the limitations of the study was that it took 18 months to be proven effective in the research setting, and because of issues of delay with IRB approval, and also the duration of funding that was available. We were only able to assess [the intervention] at three months, although even at three months we began to see changes in terms of sexual risk reduction or maintaining low-risk behavior.
Bonnie Goldman: Could you talk a little bit about the three-month impact?
Lisa Hirschhorn: First, we said, "How many of these people actually achieved their risk reduction goal?" It was 68% -- two thirds of people, even at three months, were able to achieve their goal. Eighty-five percent either decreased risk or maintained low or no risk. It was interesting: One of the [most challenging groups of] people were the people who were having low or no risk. How do you actually discuss that with patients in terms that encourage them to continue to maintain that? [Clinicians] felt like this helped them do that.
We saw [a] slightly better [response] in terms of maintaining low risk or increasing condom use among [people with] HIV-negative or unknown-status partners than among [people with] HIV-positive partners. We saw a trend toward the decrease of injection drug use to get high, particularly in the context of sexual behavior. We had very, very little injection drug use, but fairly substantial amounts of other substances without a prescription or alcohol: it's 55%.
We did some exit interviews of patients. They reported that provider knowledge of sexual activities and recreational drugs improved, even though this was a group of patients who had fairly high baseline knowledge, as did the providers. Somehow, the communication, in some subtle ways, seemed to get better as well.
Gerald Pierone: Can you see taking this research one step further, where you could show a lower rate of sexually transmitted diseases among people, lower rates of hospitalization for psychiatric comorbidity, etc.? Perhaps better control of viral replication?
Lisa Hirschhorn: I think the sexually transmitted infections are going to be tough because the rates are very, very low [in this study]. We do some quality work in some other states and we found the same sort of thing, probably because some patients go and get treated elsewhere. In most other studies, it's been very difficult to show a decline in that. In terms of other biological outcomes, I think it would be interesting to see whether there is any impact in terms of adherence -- as a result, for example, of a decrease in recreational drug use.
Mental illness is an interesting question. Clearly, one of the main barriers that people felt was this very high rate of active mental illness, and some of the limitations in terms of getting adequate treatment for it. The providers did not do this [intervention] for patients who had very, very severe mental illness, people that were actively psychotic. You had to be grounded a little bit in reality to undergo this motivational behavior change, so I don't know if the highest-risk patients are going to necessarily be the ones for whom this is appropriate. Some of them aren't even showing up to get general medical care. So this is really meant to be much more within the context of patients that are coming into care. How do you actually make them safer in terms of what they do?
Female Researcher: Can I ask a question? I'm a clinician at Whitman-Walker Clinic [in Washington, D.C.]. Your interventions -- is there a pivotal question here that the nurse can ask?
Lisa Hirschhorn: It was actually developed more as something that is part of the conversation that [patients are] having with the primary care provider. It wasn't a risk assessment, which is what's next door to you, where the doctor says, "Oh, you told the nurse this and that." It forces the primary care provider -- doctor, nurse practitioner -- to actually have that discussion. [Patients] felt that was actually one of the things that helped, because, first of all, it validated [what they were discussing]. "Oh, it's important, my doctor, my nurse practitioner is talking about it." And it also allowed them to continue on as a conversation of, "Oh, so it says you're doing this and that." We felt that it was much more of a building conversation.
Female Researcher: I think I find some screening questions usually [required a] 20-minute appointment, and most of the time there is some other priority, though it's on the list. If someone was asking me -- before they get to us -- some screening questions, then you can focus on the area that needs to be. You don't tell them, "This is what you told the nurse." But you already identified by just glancing at it, "This is a risk area that I probably should spend more time on." Time is the ultimate factor.
Lisa Hirschhorn: I agree. That's why if it's less than 20 minutes, you can't do it. But the feeling was, for some patients it's going to need to be done every time, for other ones not necessarily. Although in the original protocol, it was. It's not a lot of time, and it is something that has major impact.
Which area you focus on is a negotiation. As opposed to saying, "Me as your doctor, this is what we're going to talk about," you say, "There's a bunch of different areas here. Which do you want to talk about?" Even though it may not be the one that you think is the most important, it's [part] of this whole idea that it's a gradual change. It's information, motivation, and then behavior change over time, as opposed to a one-time, "Here's a problem, let's fix it today," and then move on.
It's much more based in a chronic care management approach. The same way you would do with diabetes. It would be something that you would say, to get their A1c [glycated hemoglobin] down is going to be a long process. The idea is to look at this as a change that can take 18 months to get somebody there.
Female Researcher: How many visits?
Lisa Hirschhorn: Talking to the providers, it seemed if somebody was low risk, particularly if they were maintaining abstinence and they were abstinent by choice, that probably once or twice, and then yearly, was the general feeling about it. Otherwise you're beating somebody over the head when they're maintaining it. It's just a question of, "Have things changed? Is this a struggle for you?" Things like that. But for people that were actively engaging in higher-risk behavior, for them it would be something that would be a constant, ongoing conversation.
Female Researcher: Were the providers surprised by how much they learned in this training that you had?
Lisa Hirschhorn: The qualitative feedback was that they learned a lot. Even though some of them were very experienced in terms of positive prevention and things like that. How to talk about it was something that they thought was very helpful. And the patients reported that their knowledge got better.
Bonnie Goldman: Did you provide actual language for how people should talk to their patients about this?
Lisa Hirschhorn: Yes. Some of the training was language and, "When people say this, how do you respond to it?"
Bonnie Goldman: Real practice sessions?
Lisa Hirschhorn: Right, yes.
Gerald Pierone: Are you planning a Web site that we can direct readers to?
Lisa Hirschhorn: There's careacttarget.org, which is the HRSA Web site. University of Connecticut, I think, is going to have a Web site -- it used to be up, but it's come down, and will hopefully go back up again. But the information should be available through the CARE Act Target site. [You can also click here to view the study's Web site.]
Gerald Pierone: So a clinic could go to careacttarget.org and download this information?
Lisa Hirschhorn: Yes. It's not up yet, but it's going to be. There will be a manual.
Bonnie Goldman: Thank you very much.
This transcript has been lightly edited for clarity.
This article was provided by The Body PRO. Copyright © Body Health Resources Corporation. All rights reserved.


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Multnomah County Health Department Story from the Field
A look at how one community in Portland, Oregon, is collaborating with four local health departments and 14 non-profit hospitals to conduct a regional community health needs assessment
View a PowerPoint overview of this story from the field. More »
View a summary of the story with audio clips here.
View the full Questions and Answers with the Interviewees:


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DELAWARE, Ohio — A central Ohio health district is investigating a probable cluster of mumps cases after two cases were reported in one school building, in addition to 25 more cases in the county.
A Delaware General Health District spokeswoman said today that students who haven't been vaccinated for mumps will be excluded from attending the Delaware County school where the cases were reported. Spokeswoman Traci Whittaker says the district isn't identifying the school.
Students who haven't been properly vaccinated or have weakened immune systems must remain out of school at least 25 days or until they're vaccinated.
Whittaker says the Delaware County outbreak is related to one in Franklin County, with more than 230 total cases of the contagious viral illness confirmed in both counties, including 149 linked to Ohio State University.
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2009-10 Women's Basketball
Bluffton 56, Rose-Hulman 43
Bluffton defense shines in 56-43 win at Rose-Hulman
January 9, 2010
TERRE HUTE, Ind. - The Bluffton University women's basketball team limited Rose-Hulman to 15 second half points as the Beavers snapped a nine-game skid with a 56-43 victory on Saturday, January 9, 2010. The Beavers improved to 4-10 overall and 1-5 in the Heartland Conference, while RHIT fell to 1-12 (1-4 HCAC).
With Bluffton trailing 35-33 at the 16:05 mark of the second half following a Donna Marsh putback, the Beaver defense went to work. Over the next 13 minutes, Bluffton outscored the home team by a 19-2 margin while building a 52-37 advantage with just three minutes to play before a pair of Rose free throws made it a 13-point game.
Becky Ruble (Grover Hill/Wayne Trace) drained two of her game-high four triples and junior standout Kim Miller tallied six straight points during the game-changing jag. Ginny Buckingham (Bluffton) and Miller both hit from in close to finish off the Beavers' first conference win of the season.
Sophomore Brittany Stegmaier (Garfield/Trinity) knocked down a jumper in the paint to get Bluffton on the scoreboard just over a minute into the game. Two minutes later, Buckingham made it 4-2 with a layup. Following a Miller deuce, Stegmaier and Ruble both connected from downtown to push Bluffton's lead to 13-6 at the 12:08 mark.
Another Ruble trifecta and old-fashioned three-point play from Miller made the score 21-11 with just 4:55 to play in the half before RHIT's offense erupted for a 17-6 run to end the period. Julie Hart sandwiched a pair of three-pointers around an Alisa Dickerson triple as Rose rallied for a 28-27 lead at the break.
Stegmaier and Beth Yoder (Marshallville/Smithville) both dialed long distance to open the second half before the home team tallied seven straight counters for a 35-33 lead over the Beavers with 16:05 to play in contest. After Marsh capped the 7-0 spurt, Bluffton took over on both ends of the floor en route to a 56-43 win over the Engineers.
Kim Miller led the visitors with 15 points on 7-of-11 shooting from the field. She also finished with six rebounds, three assists and three steals. Brittany Stegmaier dropped in 14 points on 3-of-4 shooting from outside the arc. Fellow sophomore Becky Ruble added 12 points on four triples. She also pulled down four rebounds. Ginny Buckingham cleaned the glass with 13 caroms and eight points. Senior point guard Vicki Auer (Cincinnati/Roger Bacon) came up with a game-high four steals and she handed out three assists.
Bluffton hit just 22-of-59 (37.3 percent) from the field, but the defense limited Rose to 16-of-49 (32.7 percent). The Beavers connected on 9-of-24 (37.5 percent) from distance and 3-of-6 at the line. Rose won the battle on the glass (37-34), but the Engineers coughed it up eight more times than the Beavers (23-15). Donna Marsh paced RHIT with 11 points, 14 boards and two blocks.
The Beavers return to action on Wednesday, January 13, 2010, when they host Manchester College. The contest is slated to tip at 7:30 p.m. in Founders Hall.


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The Lake County Library System is pleased to announce the winners of the annual Photography Contests.
The winning photographs are available and printable on the 2014 Winning Photos page.
The Photography Contest winners are as follows:
1st: Brittney Schofield Age 14 Homeschool
2nd: Kaela Chandler Age 15 Leesburg High School
3rd: Mackenzie Schofield Age 9 Homeschool
1st Place: Ashley Schofield, Lady Lake, FL
2nd Place: Hilary Woodworth, Clermont, FL
3rd Place: Sharlee Hollingsworth, Mount Dora, FL
4th Place: Linda Pierce, Clermont, FL