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With its compact frame, smushed face, bat-like ears and wide smile, the French bulldog has just become the most popular dog breed in the U.S.
The American Kennel Club announced Wednesday that the crinkly-faced canine was the top breed in 2022, overtaking the Labrador retriever, which had held the No. 1 spot for a whopping 31 years.
"They're comical, friendly, loving little dogs," French Bull Dog Club of America spokesperson Patty Sosa told the Associated Press.
The pint-sized French bulldog was first recognized as a breed in 1898, and has a "charming and adaptable nature" and "generally quiet demeanor," the AKC said. Those qualities have boosted demand for the breed among families and single people living in homes both large and small.
Yet despite the breed's popularity, French bulldogs can have a raft of health issues.
They are one of several breeds known as brachycephalic dogs, which means their shortened skulls and snouts make them more prone to respiratory, eye, skin and spinal problems.
The Netherlands announced in 2019 that it would enforce a ban on the breeding of short-muzzled dogs. Norway banned the breeding of bulldogs until it was overturned by a judge last year. And in 2017 the president of the British Veterinary Association said people should not buy brachycephalic dogs.
Still, the dogs that originated in England and later served as companions in late 19th-century French brothels are now among the top breeds favored by celebrities and are even one of the most hashtagged pooches on Instagram in recent years.
That explosion in popularity has also made the valuable dogs targets for thieves. A man was sentenced to 21 years in prison in December for shooting Lady Gaga's dogwalker while stealing two of the pop star's French bulldogs in 2021.
The AKC says it has the world's largest registry of purebred dogs, which it uses to come up with the annual rankings.
After French bulldogs and Labrador retrievers, the next-most popular dog breeds last year were — in order — golden retrievers, German shepherds and poodles.
Copyright 2023 NPR. To see more, visit https://www.npr.org.


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Remember when characterizing entire groups of people with broad, unflattering stereotypes was considered unacceptable? Apparently the Biden administration doesn't, as evidenced by a recent Jen Psaki press briefing in which she said that the White House was trying to push their vaccine message to white conservatives by advertising on "The Deadliest Catch" (essentially a fishing show) and making outreach via Nascar and country music.
While not specifically referenced, we assume taxpayer-funded pro-vaccination ads are also being put on confederate flags and packages of chewing tobacco, while bumper stickers ("White Trash Matters - Get The Shot") are being handed out in trailer parks.
To be clear, Stilton's Place is in favor of the vaccinations (albeit not enthusiastically). So we'd like to give Jen Psaki a little advice: rather than assume that white conservatives are all inbred hillbillies who are just too dumb or obstinate to get vaccinated, why not work on your actual messaging?
Because it's just possible that some people are resistant to the vaccine push because it's coming from people whose torrent of lies puts Niagara Falls to shame. And for that matter, it's coming from people who clearly hate white conservatives and have consistently acted against their interests.
Or maybe it's because the Biden administration hasn't really made it clear what we can do when vaccinated that we can't do while unvaccinated? Can we gather in groups? Can we take off our masks? Can we put rusting wrecked cars on cement blocks in our front lawns and throw beer bottles into the crabgrass and then shoot at them like before the pandemic?
There could be some additional foot-dragging on getting The Shot owing to reputable stories about Covid-19 variants "breaking through" the Pfizer vaccine (although current efficacy is still high), and little "oopsies" like the discovery that the AstraZeneca vaccine can sometimes cause a potentially fatal blood clotting disorder. But, you know, only rarely.
But really, Jen, all of these considerations can be boiled down to just one salient point: the Biden administration has no credibility among white conservatives. None. So quit throwing our hard-earned money at TV commercials which run during professional wrestling and "Beverly Hillbillies" re-runs. Instead, try giving us yokels some straight truth or, better still, just shut up.

subset: commoncrawl


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Prairie Wildflowers
This past weekend we drove down to the Flint Hills to visit the Tallgrass Prairie National Preserve near Strong City. The last couple years have been very dry down that way, but this year there's been enough rain to turn the prairie a lush green dotted with wildflowers.
So we spent Saturday evening out among the flowers watching the sun set.
Here are a few pics I took to share with you:
Wild Alfalfa was used by the Lakota to treat headaches and to ward off mosquitoes.
Prairie Larkspur is named because of the resemblance of the flower to the spur on the foot of a lark.
Native Americans and pioneers both used the root of Butterfly Milkweed to treat respiratory problems, which is how this plant got it's common name, "pleurisy root".
The Navajo used Spider Antelopehorn to treat bites from rabid animals.
Great Plains Native Americans used the leaves and stems of Prairie Coneflower medicinally to treat poison ivy, rattlesnake bites, headaches, and stomachaches.
This is one of my favorites. During the day, the plant goes unnoticed, green without any blooms. But as the sun sets, the flower buds unfurl their delicate white petals which wave to the slightest breeze like little silk handkerchiefs.
Each flower of the Showy Evening Primrose blooms only for one night. Come morning, the petals shrivel in the morning sun. The following evening, new buds open.
Black-Sampson Echinacea contains pain-reducing compounds and was used by Native Americans to treat toothaches, sore throats, mumps, wounds, and burns.
I've never seen Echinacea blooming in such profusion.
Finally the sun set behind a grassy hill,
the flowers said goodbye,
and we headed to our motel refreshed by the warm breeze and singing sounds of evening.


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A governing Council has led the university since its inception in 1846, but UB's first chancellors were not appointed from the university community. They were distinguished Buffalo civic leaders charged with officially representing the university before the public. In 1922, Samuel P. Capen, former director of the American Council on Education, was hired by the University Council to become the first full-time chancellor, bringing the university into a new era. It was during Capen's tenure from 1922-1956 that the university became academically and financially unified.
UB's chief executives retained the title of chancellor until 1962, when UB joined the State University of New York and became a public institution. Clifford C. Furnas, the guiding force in this merger, was the first to hold the new title of president, used thereafter by all of his successors in this office.
President: 2004-2011
As the 14th president of the University at Buffalo, chief among John Barclay Simpson's priorities was a clear and strong plan for UB's advancement as a great public research university for the 21st century. He led the academic community in launching UB 2020, a long-range strategic vision focused on investing in core interdisciplinary areas of research strength, transforming institutional operations, and implementing a comprehensive physical plan.
A nationally recognized advocate for the vital role of public higher education in American life, Dr. Simpson has published widely on the impact of research universities in social and economic prosperity. A leading voice on educational access and collaboration, he championed a historic partnership with the Buffalo Public Schools to improve educational outcomes, and significantly expanded the university's relationships with its broader communities regionally and globally.
Before his appointment as UB president, Dr. Simpson was campus provost and executive vice chancellor of the University of California, Santa Cruz, where he served from 1998-2003. His previous appointments include 23 years at the University of Washington in Seattle, where he joined the Department of Psychology faculty in 1975, later serving as dean of the College of Arts and Sciences from 1994-98. A native of California, Dr. Simpson received his bachelor's degree in psychology from the University of California at Santa Barbara and earned master's and doctoral degrees in neurobiology and behavior from Northwestern University. An accomplished research scientist who was appointed to the faculty of UB's Department of Physiology and Biophysics, Dr. Simpson has published widely in the field of neuroendocrinology.
Among his civic and professional leadership roles, Dr. Simpson was a member of the Buffalo Niagara Enterprise, Buffalo Niagara Partnership Board of Directors and the SUNY Research Foundation Board, and served on the New York State Commission on Higher Education and the American Council on Education's Commission on International Initiatives. He was a member of the Council on Competitiveness as well as a former commissioner of the Western Association of Schools and Colleges.
Dr. Simpson also was active in building strong and lasting relationships with the broader communities served by the university, regionally as well as globally. An active supporter of the arts, he was a member of the Erie County Rare Books Commission and former member of the board of directors of the Buffalo Fine Arts Academy, the governing body of Buffalo's Albright-Knox Art Gallery. In tribute to his service to the Western New York community, he received the 2009 Theodore Roosevelt Award for Exemplary Citizenship and Service from the Theodore Roosevelt Inaugural Site Foundation. In testament to the University at Buffalo's longstanding leadership in international education, he received an honorary degree from Tokyo University of Agriculture and Technology in 2007.
President: 1991-2004
During his 13 years as president, William R. Greiner expanded UB's research enterprise, solidified its place as a top-flight public university and transformed student life with the development of state-of-the-art student apartment complexes. He also established UB as a leading international educational institution; during his tenure, the university developed pioneering collaborative programs with partner institutions in Poland, Cuba and Turkey. Known for his engaging administrative style, Greiner dramatically expanded the university's cultural programming and outreach with the 1994 opening of the Center for the Arts. He also spearheaded UB's drive to NCAA Division I athletics and oversaw the most ambitious fundraising campaign in university history. Greiner joined the UB law faculty in 1967, serving as chair of the Legal Studies Program and holding other leadership posts in the Law School before moving into university-wide administration. He became UB's first provost—its chief academic officer—in 1984, serving for seven years until his appointment as president in 1991. Greiner received the Chancellor Charles P. Norton Medal, the university's highest honor, in 2003. William R. Greiner Hall, UB's newest and most innovative residence hall opening in fall 2011, is named for the former president, provost and longtime Law School professor.
President: 1982-1991
Steven B. Sample was UB's president for nearly a decade and went on to become president of the University of Southern California (USC). He led USC until his retirement in August 2009 and was widely credited for bringing about that institution's dramatic rise in national rankings. As president, he led UB to greater levels of recognition, as reflected in UB's election to the prestigious American Association of Universities in 1989. After arriving at UB from the University of Nebraska, where he was executive vice president for academic affairs and dean of the graduate college, Sample sought to improve UB's research climate and better articulate its potential as a national university. In particular, he pushed for academic excellence, increased scholarly productivity among faculty and heightened research activity. He oversaw major campus construction, signed academic exchange agreements with institutions in Asia and Europe, and launched important initiatives to improve undergraduate life and academic experience. Under his leadership, the National Science Foundation in 1986 awarded the first National Center for Earthquake Engineering Research to a consortium headquartered at UB. An electrical engineer, Sample was known for his patents on various digital control panels, including the touch pad on microwaves used all over the world. In 2004, he received the Chancellor Charles P. Norton Medal, UB's highest honor.
President: 1970-1982
As president, Robert L. Ketter guided UB through an unprecedented period of growth and achievement. He persevered with construction of the North Campus—one of the largest single architectural undertakings of any college or university in the nation—despite significant budgetary constraints. He also led UB amid the nation's social and political turmoil of the 1970s, creating stability by uniting factions in the aftermath of UB's own period of unrest. A distinguished scholar, Ketter set forth new academic directions and heights of excellence, including national recognition for outstanding programs in biochemistry, physiology and comparative literature. He also strengthened UB's research programs, and initiated international programs in Korea, Japan and China. Arriving at UB in 1958, Ketter served in key academic and administrative positions, including professor and chair of the Department of Civil Engineering, dean of the Graduate School and vice president for facilities planning. Later, he was named leading professor of engineering, and from 1985-89 was director of the present-day MCEER—Earthquake Engineering to Extreme Events. Robert L. Ketter Hall, home to the Department of Civil, Structural and Environmental Engineering, was dedicated in his honor in 1987. In 1988, Ketter was named SUNY Distinguished Professor of Civil Engineering by the SUNY Board of Trustees.
President: 1966-1969*
Meyerson, whose academic background was in environmental design and urban planning became the University's tenth President in 1966. Previously, he was professor of urban development and dean of the College of Environmental Design at the University of California, Berkeley. He served as Interim Chancellor for UC Berkeley from January to July, 1965 at the height of their campus controversy concerning student rights and privileges. During his tenure at Buffalo, this campus saw a similar period of student unrest. Meyerson's presidency was noted for academic innovation in the period of rapid growth as the plans were laid and ground was broken for a new campus in Amherst, N. Y. When he officially left the University in 1970, he became president of the University of Pennsylvania, serving that school until 1981.
Chancellor: 1954-1962*, President: 1962-1966
Furnas, a chemical engineer, metallurgist, aviator researcher, and Olympic athlete, was the University's ninth chief executive, holding the position of Chancellor from 1954 until 1962 when the University merged with the State University of New York and his title changed to President. Furnas undertook an extensive program of expansion and enrichment to meet the growing educational needs of Western New York. He was the guiding force in the merger of the private UB with the State University of New York in 1962.
Chancellor: 1950-1954*
McConnell, an educator and psychologist, came to the University from the University of Minnesota where he was the Dean of the College of Sciences, Literature, and Arts. Under his leadership, the University's organization was modernized, the first residence halls opened, and the Medical School moved to the main campus.
Chancellor: 1922-1950
Capen was the first full-time, salaried Chancellor of the University of Buffalo. Prior to coming to the University, he served as Director of the American Council on Education. Under his leadership, the University was transformed from a small group of autonomous schools into a modern university of 14 divisions and a central campus. Capen was acknowledged as a leader in higher education, particularly known for his strong defense of academic freedom and innovation in liberal arts instruction.
Chancellor: 1905-1920*
A lawyer who graduated from Harvard in 1880, Norton helped found the Buffalo Law School, which was assumed into the University of Buffalo in 1891. Norton is now considered the sixth Chancellor of the University holding the office from 1905-1920. During his tenure the College of Arts and Sciences was established and the property that became South Campus was acquired. His last public appearance as the University's chief executive was in June 1920 when he broke ground for the University's new campus.
Chancellor: 1902-1903*
Bissell was the University's Vice-Chancellor from 1895 until 1902, and became its fifth Chancellor in 1902 - his tenure cut short by his untimely death in October 1903. During his lifetime Bissell was a law partner in the firm of Grover Cleveland and served as Postmaster General of the United States from 1893-1895 during Cleveland's Presidency. He also was on the board of managers for the Erie County Hospital as well as on the board of the Buffalo Historical Society from 1889 until his death.
Chancellor: 1895-1902
Putnam, a New York State Senator and one-time Postmaster General of Buffalo, was a member of the University Council for 32 years and one of the original founders of the University. He became Chancellor in 1895, an office he held until his resignation in 1902 a few months before his death. During his tenure, the New York State Institute for the Study of Malignant Diseases (now Roswell Park Cancer Institute) was founded at the University. It was the first government-supported cancer research program in the world.
University at Buffalo recognizes James O. Putnam based on his role as a founder and chancellor of the university. Many of Putnam's views on race and religion in the 19th century do not reflect those of the university today. This acknowledgement provides historical context and is not an endorsement of his policies or legacy as a U.S. political figure.
Chancellor: 1885-1895
The Honorable E. Carleton Sprague, founder of the law firm of Sprague, Morey & Sprague, was the University's third Chancellor, holding that post from 1885 until 1895. During Sprague's tenure, the University of Buffalo expanded to include schools of Pharmacy, Dentistry, and Law. Before becoming Chancellor, Sprague was one of the principle organizers of the American International Bridge Company which later merged with the Canadian Colonial International Bridge Company in order to build the first international railway bridge across the Niagara River in 1870.
Chancellor: 1874-1884
The University's second Chancellor, Marshall was a prominent Buffalo lawyer and the author of several volumes of historical writings on the Niagara Frontier. Although he did not officially become Chancellor until 1882, as Chairman of the Council Marshall was the University's chief executive officer when the post of Chancellor was vacant after Fillmore's death in 1874.
Chancellor: 1846-1874
A founder of the University of Buffalo, lawyer and congressman Millard Fillmore was Chancellor from 1846 to 1874. During his tenure as Chancellor, Fillmore served as Comptroller of New York State (1848-1849) and Vice President (1849-1850) and President (1850-1853) of the United States. Fillmore died in March of 1874.
University at Buffalo recognizes Millard Fillmore based on his role as a founder, and first chancellor, of the university. UB understands Fillmore's complex role in the history of slavery in the United States, which includes the Fugitive Slave Act. This acknowledgement provides historical context and is not an endorsement of his policies or legacy as U.S. President.


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Exactly How Much DOES That Appendectomy Cost?
Want to know one of health care's dirty little secrets? While we know how much the country spends on care each year, we have little understanding of what it actually costs to provide care.
Think, for example, about an appendectomy. What does it really "cost" the health care system to perform that procedure? The answer is complex, and of course it includes everyone's time—from the surgeon to housekeeping staff—and it also includes the drugs, equipment, space, and overhead associated with your stay.
The cost of your visit will also depend on who is delivering your care. A consult with a registered nurse (RN) is less costly to the hospital than one with a physician.
Then, consider insurance. If the price your carrier pays for that RN consult is $85, but the price another carrier pays is only $65, what does it actually cost the hospital—and how do those variances affect what you pay both out-of-pocket and for insurance premiums? Moreover, health care providers are currently not trained to think about the costs of the care they provide—and often have no incentive or means to even consider those costs.
These complexities have made it difficult to reform the way we purchase and pay for health care.
We spoke with the University of Utah's Vivian Lee, MD, PhD, MBA, senior vice president for health sciences, dean of the School of Medicine and CEO of University of Utah Health Care, about an impressive effort their health system undertook to develop a comprehensive costing tool they call "Value-Driven Outcomes."
What's unique about the tool is not only the detailed level at which the health system is able to understand its costs, but also that the tool was rolled out with substantial physician support and engagement—rather than being perceived as a tool that was intended to punish high-cost performance.
Q: Why did University of Utah create the Value-Driven Outcomes tool?
All of us recognize that in our health care systems, we are being held accountable for providing value, and one of the greatest challenges to this is measurement. We haven't been able to measure value, much less put that metric in our providers' hands to inform their delivery. I, for one, am constantly amazed at our lack of knowledge about costs in our health care systems.
Beyond tackling the costs of care, we also recognized we had little data to share with providers about their outcomes or the quality of care they were providing. A wide range of quality metrics are beginning to impact our reimbursement and our rankings, and yet providers' ability to track their own metrics has fallen short.
Of course, the key is putting those two together—outcome and costs. In most industries, a key measure of performance is the value provided by the business. In health care, that means looking at quality (which includes outcomes and satisfaction) measured against the costs of care. Our goal was to put these measures into our providers' hands, so they could begin to manage themselves, and we as health system leaders could roll up the data to manage the entire system.
Q: How were you able to develop the tool?
About two years ago, we launched a new project, which we called Value-Driven Outcomes (VDO). We started with our version of a "sequestration." We put a group of our top performers and senior leaders from finance, decision support, quality improvement, biomedical informatics, and IT (among others) into a building in our University's Research Park. We pulled them out of their daily roles three days a week for six months and gave them a challenge: Come up with a tool that would enable us to visualize our value—that is, ideally, to be able to plot our outcomes against our costs—and to do this for every patient, every provider, and every diagnosis in our system.
Critical to our success was our strong enterprise data warehouse. With a whole series of intelligent business tools, our teams extracted vital data and developed web-based user interfaces that were simple and intuitive enough for our providers to use.
This was no modest undertaking. The initial beta version of the VDO involved more than 150 million lines of code.
Q: Can you share an example of the types of costs your tool is able to capture?
The short answer: just about everything. The Value-Driven Outcomes tool starts by organizing cost type grouping, which includes laboratory, supply, pharmacy, diagnostic imaging, operating room time, hospital facility charges and others. These groupings are aggregated by diagnosis and provider groups. From there, we can drill down into each category to view costs by professional and facility direct costs. If we need to, we can dig down even further to look at each and every supply, imaging service or lab test a particular provider uses in a specific episode of care. We can even get down to individual patients. We can now see our system's costs from 30,000 feet to below sea-level—and just about everywhere in between.
Q: What's your sense of how common the ability to understand costs at this level is among other health care providers?
We are starting to see other systems get a better picture of their actual costs, but our sense is that such granular views are relatively new to the industry. Only a few years ago, Michael Porter, PhD, and Robert Kaplan, PhD, thrust this decades-overdue costing conversation into the spotlight with a game-changing paper, "The Big Idea: How to Solve the Cost Crisis in Health Care." Published in Harvard Business Review, the paper zeroed in on providers' "complete lack of understanding" about health care delivery costs. This costing void, they explained, made it nearly impossible to improve processes, eliminate unnecessary procedures, and deliver better outcomes. According to the Harvard business professors, figuring out the costs would be the "single most important lever to transform the value of health care."
We could not agree more.
Q: One of the most interesting things about your tool was the way in which it was developed and rolled out. You speak a lot about the importance of understanding what physicians want and need when it comes to practicing care. How did you work with your providers so that everyone felt like Value-Driven Outcomes was something they owned, and a useful tool for their work? And what are some examples of how that's playing out?
By the time we had developed a functioning VDO tool, our system already had two things going for it: engagement and process improvement training. My predecessor, Lorris Betz, MD, PhD, championed our Exceptional Patient Experience initiative, designed to engage providers in a culture shift toward more patient-centric care. In 2012, University of Utah Health Sciences became the first academic medical center in the nation to publish our patient satisfaction scores online, with complete transparency and ultimately, full engagement of our providers. The impact? Nearly half of our providers are now in the top 10th percentile and one-quarter (25%) are in the top 1st percentile in patient satisfaction compared to national benchmarks.
At the same time we launched the VDO project, we also began a systemwide roll-out of LEAN training in partnership with the University Of Utah Eccles School Of Business. LEAN is a production practice, mostly developed by Toyota, that we and others have adapted for our health care systems. Essentially it is a process of producing something with the most efficiency (fewer resources) and the most effectiveness (creating a better value), all the while focused on the highest level of quality. The responsibility for ensuring the best outcomes is held by the people on the front lines—in our case, all the people engaged with the patient in the practice of health care. This efficiency training and engagement has helped providers who participated in our earliest pilot projects embrace the VDO tool and enabled them to use the data, working closely with our value engineers, to drive process improvement.
We also discovered some things that we didn't completely expect. First, we came to realize that by putting the VDO tool in providers' hands, we tapped into a profound desire on the part of many to help be a part of the solution. Most of us entered health care to do good. Our providers now have the tools and capability to impact not only their patients, but also the ways in which we, as a system, deliver health care. We also found with our patient satisfaction initiative and with VDO, our providers' competitive natures can be useful drivers of change. Our providers want to be the best, whether it's in patient satisfaction or in quality and value. By making the data accessible and easy to understand, we've managed to engage our physicians and have real improvement to show for it.
Q: What are some of the changes and improvements you've seen since implementing the tool?
This process improvement has been limited to some pilot studies, and even there, it has translated already into more than $2.5 million in savings for our system and helped us pave the way to accepting more risky payment models. For example, our hospitalists have harnessed VDO to gain a view of how many tests they are ordering. This view has empowered them to change their rounding structures, create attending-approved checklists and save more than $550,000 so far this fiscal year in unnecessary tests, without diminishing patient outcomes. VDO helped one University of Utah physician group realize that a commonly prescribed bronchodilator that costs $200 delivered the same outcomes for most patients as a similar $15 drug. By switching to the less expensive bronchodilator, the group was able to save more than $200,000 a year.
All these process and care improvements stem from our new ability to quantify and continually improve the value we deliver. Specifically, VDO gives us the ability to question whether the quality and outcomes of the care we deliver to patients is worth what we, and ultimately they, pay for it.
Q: How has getting a solid handle on costs positioned University of Utah to move into a national environment that's focused on changing the way providers are paid?
Having a solid handle on costs is the necessary first step for any health care system to be willing to become more financially responsible for our patients' outcomes. Take Medicaid in Utah, as an example. In the past, we could care for Medicaid patients and then send a bill to the Medicaid office and expect to be paid for our services. In the past year and a half, our health plan has received a fixed amount of revenue from the state of Utah to cover all the care we deliver to Medicaid patients. This means that whether cardiac Medicaid patients, for example, receive bypass surgery or just need a coach to help them improve their diet and exercise, we are paid the same amount for their care. To be successful with these patients, we must know how effective the cost of the care we provide is for their condition.
Another model of payment we can begin to feel more able to manage is bundled payments, where insurers and employers who contract for direct payment have already started to say, "We will pay you $X, for this diagnosis." We can engage in those new ways of thinking about medical payments if we have the right tools, and this could be a real win for businesses and employers who want to get on top of health care costs.
As a result of these payment models, health care systems will ultimately begin to share the risk for those patients' care. This doesn't mean we will do the least amount for them to get them home again. This means we have to be able to care for them with the greatest efficiency and effectiveness to restore their health and give them the ability to return home safely for as long as possible. In fact, if we don't do enough, they'll be back at our hospitals, which isn't good for anyone.
Q: Are you seeing other examples of health systems and providers embarking on similar efforts?
We've heard about launches of similar initiatives from University HealthSystem Consortium, Kaiser, University of Pittsburg Medical Center and others. Harvard Business School has a tool they've been using with a few health care systems (MD Anderson, Mayo Clinic, Cleveland Clinic) called Time-Driven Activity Based Costing (TD-ABC), as a result of Professor Robert Kaplan's efforts. In fact, we recently completed a University of Utah/Harvard Business School partnership project that focused on using VDO and TD-ABC data to improve processes around 4 different episodes of care and in our billing procedures.
Generally speaking though, there continues to be a lack of data about the costs of care to any level beyond the general ledger. We hope that we can share some of the lessons we've learned to enable others to develop tools like Value Driven Outcomes.
Q: What advice would you give to health systems and provider groups that are interested in developing something similar to Value-Driven Outcomes?
Bite the bullet and do it. And we here at the University of Utah are here to help in any way we can. This is a nationwide problem that demands a nationwide solution and we all need to work together to succeed. Understanding your costs is fundamental to business management.
Yes, the health care system is broken. Yes, each of our systems and populations is different. Yet we have to remember that our ultimate purpose is to offer value to society. To be able to deliver that value, we have to start by measuring it. It's so basic and so clear. Don't give up. As Colin Powell once said, "Perpetual optimism is a force multiplier."
While the University of Utah example is compelling, we know other efforts are under way across the country aimed at helping providers prepare for a new financial environment. But those examples aren't easy to spot, so we're looking to you for help.
About the Author
Andrea M. Ducas, former program officer with RWJF, worked with programs related to payment and delivery system reform, purchaser and consumer engagement, healthcare price transparency, community-driven health improvements, and strengthening health departments.


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Signature Programs
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A Senate panel has voted to approve a resolution giving President Obama the authority to carry out punitive strikes against Syria for its use of chemical weapons.
The Senate Foreign Relations Committee approved the authorization by a 10-7 vote, with one senator voting present. The measure must be passed by a vote of the full Senate to come into force. The vote is likely to take place next week.
The vote marks the first time lawmakers have voted to authorize military action since the October 2002 vote giving President George W. Bush authority to invade Iraq.
The authorization was crafted by the committee's top lawmakers — Democratic Chairman Bob Menendez of New Jersey and Republican Bob Corker of Tennessee.
Early Wednesday during the debate, Secretary of State John Kerry told the committee: "We are not asking America to go to war."
He later told the House Foreign Affairs Committee that should Syrian President Bashar Assad be "arrogant and foolish enough to retaliate," the U.S. has "ample ways to make him regret that decision without going to war."
As we reported earlier, the resolution on the use of force against Syria has divided Republicans and Democrats alike, with Sens. John McCain of Arizona and Rand Paul of Kentucky representing differing viewpoints in the GOP.
The New York Times says the panel "struggled to draft the resolution," with Menendez and Corker:
"[pressing] ... forward with a resolution limiting the duration and nature of military strikes, while Mr. McCain demanded more — not less — latitude for the military to inflict damage on the government of President Bashar al-Assad.
"In the afternoon, the balance of power appeared to lie with the interventionists. The panel set aside a resolution by Senator Rand Paul, a Kentucky Republican leading the opposition to the strikes, that would have declared that the president has authority to act unilaterally only when the nation faces attack, then approved language by Mr. McCain and Senator Chris Coons, Democrat of Delaware, to toughen the resolution."
Copyright 2021 NPR. To see more, visit https://www.npr.org.


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This is FRESH AIR. I'm David Bianculli, professor of television studies at Rowan University in New Jersey, in for Terry Gross. We're going to listen back to portions of two of our interviews with journalist, novelist and screenwriter Joan Didion, who died last month at the age of 87. Known for her cool, unsentimental gaze and distinctive writing, she wrote two groundbreaking collections of essays. One was called "The White Album." The other was "Slouching Towards Bethlehem," which included pieces about hippies of Haight-Ashbury and described a 5-year-old girl high on acid. She wrote 19 books in all, including the bestselling novels "Play It As It Lays" and "A Book Of Common Prayer." With her husband, novelist John Gregory Dunne, she wrote screenplays for the films "Panic In Needle Park," for the 1978 remake of "A Star Is Born," and for the film based on her novel "Play It As It Lays."
After the sudden death of her husband in 2003, Didion wrote of her grief and shock in the memoir "The Year Of Magical Thinking." It became a bestseller and was awarded the 2005 National Book Award. A year and a half later, after a period of illness, her only daughter, Quintana Roo, died at the age of 39, and Didion wrote the book "Blue Nights." Didion received the National Humanities Medal in 2012 from President Obama, who called her, quote, "one of our sharpest and most respected observers of American politics and culture," unquote. Terry Gross first spoke to Joan Didion in 1987.
TERRY GROSS: You wrote an essay in the 1960s in which you were talking about your approach as a reporter, and you said, my only advantage as a reporter is that I am so physically small, so temperamentally unobtrusive, so neurotically inarticulate that people tend to forget that my presence runs counter to their best interests. Does that still describe you as a reporter?
JOAN DIDION: Oh, yes. I'm not a good interviewer, and I'm not very aggressive in a situation. I tend to just kind of have to hang around the edges of it and see what's going on.
GROSS: Do you think that being small and physically unobtrusive makes people more...
DIDION: Less.
GROSS: ...Less wary of you, less suspicious?
DIDION: Less wary. They think that I am not a threat to anyone.
GROSS: Do you exploit that in any way?
DIDION: No, I think - I mean, obviously I use it (laughter). I mean, since it - but I wouldn't say that I exploit it. In fact, I'm always pretty careful to - you know, as most reporters are - to go in with a notebook, to go in with a tape recorder, to go in making sure that everybody knows what you're there for.
GROSS: In another essay in your book "The White Album," you described yourself as a woman who feels radically separated from the ideas that interest other people. You wrote that you felt like a sleepwalker moving through the world, unconscious of the moment's high issues, alert only to the stuff of bad dreams, and that acquaintances would read The New York Times and try to tell you the news, but you wouldn't read the newspapers yourself. I wonder if that's changed at all, especially as you've done...
DIDION: Yeah.
GROSS: ...More reporting.
DIDION: I read the newspapers a lot, but I still - I mean, I read four or five newspapers a day, but I am still more interested in the - in what's not in the newspapers. I mean, it is kind of astonishing to me how much stuff goes on that is generally not covered.
GROSS: How would you describe what you're trying to do in comparison with daily journalism in newspapers?
DIDION: Well, what - I mean, what I do is just try to sort of go someplace and try to kind of put things together in a - just pull some threads together, rather than cover breaking events. I think it would be very hard for me to cover breaking events, and I'm not very interested in breaking events.
GROSS: Reporting brings you face to face with the world in a way that writing fiction doesn't 'cause in fiction, you encounter the world in your imagination. In journalism, you have to actually physically be there, too.
DIDION: Yeah, yeah, it's kind of a help. I mean, it's a help to me to have - to be able to go out into the world.
GROSS: Is that one of the reasons why you write journalism, to kind of...
DIDION: Yes.
GROSS: ...Get you out there?
DIDION: Yeah, it's awful to get up every morning and not - and just have to make up the world all over again. I mean, it's very - some mornings you just don't feel like it.
GROSS: You wrote in one of your essays that you had a nervous breakdown in 1968, and you even reprint some of what the doctor wrote about you. And he wrote that you had alienated yourself almost entirely from the world of human beings. I'm not sure what he meant by that. What did he mean?
DIDION: I don't know what he meant. I was astonished by it. It was - I mean, it seemed to me a very odd report. I didn't actually have a breakdown. I had a - I - well, I had a - I mean, obviously I went to a doctor, but, I mean, I wasn't hospitalized. It was - I think maybe a lot of it - of what I was - well, what he was seeing was actually - a lot of it came out of a novel I was writing at the time. I was writing "Play It As It Lays," and I think possibly that a lot of my reactions to questions asked me by a psychiatrist came out of that mood rather than my own. I mean, you are - for one thing, you are when you're writing a novel alienated from the world of other human beings.
GROSS: In the sense that you're sitting home?
DIDION: You just have these imaginary playmates who you spend the day with. And once you're deeply into it, you kind of resent it when you have to go out and go out to dinner and talk to other people when you find them an intrusion into this imaginary world. It's a peculiar hazard of writing novels.
GROSS: You wrote once that whenever you walk into a room, a sentence goes through your head. It's a sentence that Jessica Mitford's governess used to tell her, and that is, remember, you're the least important person in this room, and don't forget it.
DIDION: Exactly.
GROSS: What a really self-effacing thing to be carrying around all the time (laughter).
DIDION: It is a - it is just what I think of when I walk into a room. It's not a - it's not necessarily a bad thing.
GROSS: Well, why do you think of that?
DIDION: I think it's - I think actually that it's true. I mean, maybe all writers think that it's - or some writers think that it's so because you're focused on watching other people, rather than on their watching you.
GROSS: Were you brought up to be self-effacing...
DIDION: No, I don't...
GROSS: ...Or to think of yourself as less important than others?
DIDION: No, actually, my father was always telling me how important I was. And I - and he often has said to me that I have a deep-seated superiority complex, which may be true, but in a social situation, I tend to not be very - to be less interested in my own role in it than in everybody else, the interaction among the other people.
GROSS: You suffer from migraine headaches, which leave you incapacitated for about three to five days a month. Are they connected to writing?
DIDION: No, they're connected to not writing. They're connected to - if I could connect them to any, you know, what they're connected to is some kind of chemical flaw or vascular hereditary thing. But what actually brings them on or triggers them is always not working it, so going - doing things like losing the laundry or going to the dentist and, you know, having a lot of little confusing things that end up not doing any - end up in days that don't produce anything. I mean, the actual rhythm of working is very - is for me very, very soothing and very and makes me feel good
GROSS: Because focusing on what you're writing enables you to block out all the other chaos of life?
DIDION: Yeah. I have kind of a simple one-track mind, actually. I can't handle a whole lot of things going on on the edges. And so the simpler the day is, the better off I am.
BIANCULLI: Joan Didion speaking with Terry Gross in 1987. Joan Didion died last month at the age of 87. We'll listen back to Terry's 2005 interview with her after a break. This is FRESH AIR.
BIANCULLI: This is FRESH AIR. We're listening back to our interviews with journalist, novelist and screenwriter Joan Didion. She died last month at the age of 87. Terry spoke with her again in 2005 when her memoir, "The Year Of Magical Thinking," was published. It was about the year following the death of her husband, the writer John Gregory Dunne. He died of a heart attack as they were sitting down to dinner in 2003. Didion and Dunne had just come back from the hospital, where their daughter was in a coma, suffering from pneumonia and septic shock. After Joan Didion finished her memoir, her daughter died at age 39, about a year and a half after her husband's death. We begin this interview with Didion reading from the year of magical thinking. She and her husband were sitting down to dinner.
DIDION: We sat down. My attention was on mixing the salad. John was talking, then he wasn't. At one point in the seconds or minute before he stopped talking, he had asked me if I'd used single malt scotch for his second drink. I'd said no. I used the same scotch I had used for his first drink. Goody, he'd said, I don't know why, but I don't think you should mix them. And another point in those seconds or that minute, he had been talking about why World War I was the critical event from which the entire rest of the 20th century flowed.
I have no idea which subject we were on, the scotch or World War I, at the instant he stopped talking. I only remember looking up. His left hand was raised, and he was slumped, motionless. At first, I thought he was making a failed joke, an attempt to make the difficulty of the day seem manageable. I remember saying, don't do that. When he did not respond, my first thought was that he had started to eat and choked. I remember trying to lift him far enough from the back of a chair to give him the Heimlich.
I remember the sense of his weight as he fell forward, first against the table, then to the floor. In the kitchen by the phone, I had taped a card with the New York Presbyterian ambulance numbers. I'd not taped the numbers by the phone because I anticipated a moment like this. I'd taped the numbers by the phone in case someone in the building needed an ambulance. Someone else. I called one of the numbers. A dispatcher asked if he was breathing. I said, just come.
GROSS: That's Joan Didion reading from her new memoir, "The Year Of Magical Thinking." Joan Didion, welcome to FRESH AIR. And I just want to say at the top...
DIDION: Thank you.
GROSS: ...I'm very sorry about the loss of your husband and your daughter. This is a really beautifully written book, and I loved reading it. But I also hated reading it only in the sense that, you know, it makes me think not only of your losses, it makes me think of, you know, losses I may experience and losses - do you know? It's...
DIDION: You know, I had the sense when I was writing it that I wasn't writing it at all. It was like automatic writing, was a very different kind of process. It was simply very - everything that I - was on my mind just came out and got on the page. And that was kind of my intention to keep it kind of raw because I thought - it occurred to me when I was doing a lot of reading about death and grief that nobody told you the raw part. And every one of us is going to face it sooner or later.
GROSS: How do you think it affected your grieving to be chronicling it as it happened?
DIDION: Well, it was - it's the way I process everything is by writing it down. I don't actually process anything until I write it down, I mean, in terms of thinking, in terms of coming to terms with it. So it was kind of a necessary thing for me. I don't know that it would be for everybody.
GROSS: After you called, you know, 911, it took about five minutes for them to come. What did...
DIDION: What did I do?
GROSS: Yeah. What did you do in that five minutes?
DIDION: I kept trying to wake him up. I mean, I kept trying to lift him. I kept trying to - I don't remember. I mean, I kept - I don't remember what I did. I didn't do anything. I mean, there was nothing. I remember calling downstairs and asking the doorman to come up. But actually, the ambulance was there almost immediately.
GROSS: Your book is called "The Year Of Magical Thinking," and you realize at some point that you had been engaging in magical thinking that had to do with this genuine thought that maybe he'd come back so you shouldn't throw out his shoes in case he needs them when he comes back and...
DIDION: Right. Maybe I could - if I did the right things, he would come back. You know, it's a form of - it's the way children think. A lot of people have told me that - who have lost a husband or child that they engaged in it, too.
GROSS: Is there a point where you realized you stopped?
DIDION: There was a point where I realized that I had been doing it. And yes, then I realized - then it gradually stopped. I don't think I'm doing it now.
GROSS: You talk about how you didn't want to give away his shoes, for example, because if he came back, he'd needed them. Giving away clothes after someone dies is so hard. I mean, you have to decide with all their possessions, what are you going to keep? What are you going to give away to friends? What are you going to give to charity? What are you going to throw out? Was that a really horrible process?
DIDION: I haven't done it. I just left everything. After I discovered that I couldn't give away the shoes, I just closed that door. Now, I haven't had to move or repaint the apartment or do anything that required me to do it. I think - I presume that it would be somewhat less painful now than it was in the first few months, you know, when I initially tried it because because now I know he's dead in a way that I viscerally didn't know then. But I would just as soon let that let that door stay closed for a while until I need to open it.
GROSS: How much had you talked about death with your husband? And did you have those conversations about what to do if the other dies and what you'd want for the survivor?
DIDION: Well, he was always trying - he was always trying to have that conversation with me, and I would in many ways not have it because I thought it was - because it was - I see now it was threatening to me and I was afraid of it. But what I thought then was that it was just dwelling on things that weren't going to happen or dwelling on things that we couldn't help or, you know - and so we - I mean, I - he gave me any number of - he was always giving me - also because he was - he did have a streak of Irish morbidity, he was always talking about his funeral and giving me new lists of people who could or could not speak because he was kind of volatile in his likes and dislikes. And, of course, I had the key moment I couldn't find any of those lists. I mean, they'd been changed so often anyway that it made no - that it would have made no difference.
GROSS: I want to quote something you write in your memoir, "The Year Of Magical Thinking." You write marriage is memory. Marriage is time. Marriage is not only time. It is also paradoxically the denial of time. For 40 years, I saw myself through John's eyes. I did not age. This year, for the first time since I was 29, I saw myself through the eyes of others. This year, for the first time since I was 29, I realized that my image of myself was of someone significantly younger.
DIDION: Right.
GROSS: As writers, you both worked at home and you were with each other just about all the time. Did you have a sense of who you were outside of the marriage, who you were as a single Joan Didion, as opposed to a Joan Didion and John Gregory Dunne as a unit?
DIDION: Not really, no. The family was my unit was kind of the way I - that was actually the way I wanted it. So, no, I - so it was kind of necessary to find my - you know, to refind myself. I hadn't particularly liked being single.
GROSS: When you were younger, you mean.
DIDION: When I was younger.
GROSS: Were there parts of yourself that you kind of relied on him to do? I mean - you know what I mean?
DIDION: All parts. I mean, people often said that he finished sentences for me. Well, he did, which meant that I - I mean, I just relied on him. He was between me and the world. He not only answered the telephone, he finished my sentences. He was the baffle between me and the world at large.
GROSS: So how are you negotiating the world now that there isn't that baffle?
DIDION: Well, it's like everything else. You learn to do it. I mean, I remember when I stopped smoking, it was very hard to know how to arrange me to walk around as an adult person because I had been smoking at that point since I was 15. And this is kind of like relearning all - I mean, you kind of just learn new - it's not difficult. It's just sort of lonely to - I mean, it's sort of a bleak thing to do.
GROSS: Are you comfortable being alone?
DIDION: Yeah, I've always been comfortable being alone. So that is not the problem. Basically, one thing that everybody who has been in a close marriage and who is - everyone thinks when his or her spouse dies is - it's the way in which you are struck at every moment with something you need to tell him.
GROSS: Right.
BIANCULLI: Joan Didion speaking to Terry Gross in 2005. Joan Didion died last month at age 87. After a break, we'll hear more of their conversation, and we'll also remember actress Betty White, who died last month at age 99. I'm David Bianculli, and this is FRESH AIR.
BIANCULLI: This is FRESH AIR. I'm David Bianculli in for Terry Gross. We're listening back to our interviews with Joan Didion, who died last month at the age of 87. Terry spoke with Joan Didion in 2005 after the publication of her memoir "The Year Of Magical Thinking." It was about her grieving for her husband, writer John Gregory Dunne. He had died of a heart attack at the end of 2003, just after they had visited their daughter in the hospital, where she lay in a coma, suffering from pneumonia and septic shock.
GROSS: Your husband died five days after your daughter had been hospitalized for pneumonia, and by the time he died, she had also gone into septic shock of basically...
DIDION: Right. Yeah.
GROSS: ...A blood infection. So you were dealing - you had just gotten back from the hospital visiting her when he died.
DIDION: We had been seeing her in the hospital, yet it could not be described as a visit, really, because she was unconscious.
GROSS: She was in a coma.
DIDION: But - she was in an induced coma because she was on a ventilator. And they kept her under heavy sedation so that she wouldn't tear out the ventilator, which people tend to do when they find something going down their throats.
GROSS: Your daughter got out of the hospital. She had several major setbacks. But at the end of your memoir, you think that she's on the verge of really resuming her life. In August, after you'd finished your memoir, your daughter died. And this was about a year and a half after your husband's death. She was 39.
DIDION: Right. Right.
GROSS: You had just examined your grief over your husband so thoroughly in writing about it, and then it was time to grieve again. Now, with your husband, you understood the magical thinking that you were going through, this belief - this impossible belief that somehow he was going to come back, so you shouldn't even, like, throw out his clothes because he'd need them if he came back. Having examined your grief so carefully, were there little tricks that one plays on oneself when one's grieving that you couldn't even do anymore because you'd seen through it by writing your memoir?
DIDION: Well, I didn't - you see, I haven't really started grieving yet.
GROSS: For your daughter?
DIDION: Right. I think I'm still in the shock phase. And right after John died, I had - there was a long period before I was able to grieve because I was focused entirely on getting Quintana well. And I think that was - in a way, it was very good because by the time I was able to deal with it, I was dealing with it not quite as a crazy person, which I certainly would have been at the beginning.
GROSS: You had to deal with one thing that is a very, I think, peculiar thing to have to deal with. When you're grieving for the loss of a child, you had to figure out, well, did you have to rewrite or update your book? You know, your memoir had just been sent in. Your daughter...
DIDION: It never crossed my...
GROSS: It never crossed...
DIDION: Never crossed my mind.
GROSS: ...Your mind to rewrite it?
DIDION: No.
GROSS: And why not?
DIDION: It was finished. Well, it was about a certain period of time after John died, and that period was over. I mean, if I were to do something about Quintana, which I have no thought of doing, it would be a different book. It would be a different - it would be a thing of its own. It wouldn't be about a marriage. This book is about a marriage.
GROSS: Things like deaths and other tragedies tend to test people's faith if they have it or get them to immerse themselves deeper into faith or affirm their lack of faith or have them change from one point of view to another. I don't know if you've ever had any faith and if at all the deaths of your daughter and husband affected that.
DIDION: No, the deaths of my daughter and husband did not affect it. Whether I had any faith is - I have a kind of faith, but it's not a conventional kind of faith. And as I said some place in the book, that I - basically, I believe in geology and in the Episcopal litany but as a - I believe in certain symbols, but I don't believe in them as literal truth. I believe in a poetic truth.
GROSS: Do you have any - what is death to you? I mean, when you think about death, do you think of there being some kind of afterlife or just, you know, like, a void or a soul or...
DIDION: No, I don't believe in an afterlife. Well, you know, what is death to me? Death is ashes to ashes, dust to dust. Yeah. There's a continuum, which - there's a continuum of things. But it's not - I don't believe in - I remember somebody once saying to me, the manager of a motel where I was staying - I was doing a piece in Oregon. And this motel manager had just come back from a funeral, and he said it was the most depressing thing he'd ever been to. He says, the coldest funeral I've ever been to. It was an Episcopalian funeral. Have you ever been to one? I said, yes, I have. And he said, they are so cold. And I said, how do you mean? And he said, if you can't believe you're going to heaven in your own body and on a first-name basis with everybody in your family, what's the point of dying?
And I loved this. I mean, it just - it was so far from any kind of church I knew, you know? I mean, the whole question, what's the point of dying - well, yes, what is the point? I mean, there was a kind of madness about it. I mean, that's the faith I don't have.
GROSS: Do you ever wish you did? Do you ever envy, like, that man, for instance, who has that kind of faith, that, you know, he's going to die and be reunited in heaven...
DIDION: And that - and there's a point in it?
GROSS: ...In his clothes, in his body - yeah.
DIDION: Yeah. Sure (laughter). That would be, I suppose, very comforting. But there's no possible way I could have it.
GROSS: Are you feeling overwhelmed now by the fragility of life, having lost your daughter and husband?
DIDION: Well, I certainly felt it after John died. Yes, I am a little on the wary side. When I'm with - a friend was having a sort of a minor procedure today, and I was very anxious. I found myself being far more anxious about it than I might normally have been.
GROSS: Are you any more or less worried about your own death now?
DIDION: No, I'm not worried about my own death. I think I'm less worried.
GROSS: Why?
DIDION: One of the things that worries us about dying always is we think we're - we're afraid we're leaving people behind and they won't be able to take care of themselves. We have to take care of them. But in fact, you see, I'm not leaving anybody behind. This is an area we shouldn't get into, I think.
GROSS: That's fine. That's fine. Do you want another minute before we talk more?
DIDION: Yes.
GROSS: Yeah.
BIANCULLI: We're listening to Terry's 2005 conversation with Joan Didion. We'll hear more after a break. This is FRESH AIR.
BIANCULLI: This is FRESH AIR. Writer Joan Didion died last month at the age of 87. We're listening to Terry's 2005 interview with her after the publication of her memoir, "The Year Of Magical Thinking," about the death of her husband. When we left off, Joan Didion asked to pause the interview. Meanwhile, Terry's producer found out that the year's National Book Award nominees had just been announced.
GROSS: While you were just collecting your thoughts for a second, my producer just came in and said - and I don't know if you know this or not, but it just came across the wire that your memoir was nominated for a National Book Award.
DIDION: Really?
GROSS: Yeah.
DIDION: Oh, well, great (laughter).
GROSS: So I guess let me be the first to congratulate you (laughter).
DIDION: Well, thank you. Thank you.
GROSS: What a weird time for you. I mean, the book, I understand, is, like, flying off the shelves. It's nominated for a national book award, and it's about the worst thing that's ever happened to you in your life.
DIDION: Yeah, it's sort of - there is a mixed feeling about it, I mean, in my mind. On the other hand, it would make John happy.
GROSS: Oh, yeah.
DIDION: I mean, I think he'd be - yeah, I think he'd be very gratified.
GROSS: I know that, among other things, your book will be read by a lot of people who have, you know, gone through their own grief. What were some of the things that you've read that you found helpful? You know, one of the things that really surprised me actually in your book is that you single out Emily Post. You went back to...
DIDION: Emily Post...
GROSS: Yeah.
DIDION: Emily Post was fantastic on the whole subject of death and how to handle people who are grieving. I mean, she's so practical. She simply dealt with what happens to them physiologically. They're going to be cold. They're going to need - the digestion is going to stop. Everything stops. Everything in your body just stops when you're going through something like that. And so she suggested the little ways to get them back to life. Have them sit by the fire. The room should be sunny. They can be served small amounts of toast and - or something they like, but not much because they will reject it. You can sort of - if you just hand them something when they come home from the funeral, you will find that they eat it. But if you ask them, they will say, no.
Actually, I got a - now I've got a letter from her - from one of her descendants who now edits the cookbook or the etiquette book. And she pointed out that the 1922 edition, which is the edition I was reading, had been written not long after the death of Emily Post's son. And almost everybody in that period had somebody die close to them. I mean, we were dealing with the aftermath of the 1918 flu epidemic. People died of infections. I mean, death was really in every household. So it was a much more commonly acknowledged thing than it is now. I mean, now when it happens in hospitals, we tend to think of it as the province of doctors. Well, at that time, anybody - everybody knew somebody who was in mourning.
GROSS: Before we say goodbye, I'm just wondering - I felt a little uncomfortable during this interview only because I - you know, the memoir, it's such a fine book, and I think your losses are still so recent that I feel awkward talking with you about them. And I imagine it must be awkward for you to be talking about it to people you don't know like me and to our listeners. At the same time, I understand that there might be some comfort in that because one of the things you've always been as a writer is a reporter, not a reporter in the conventional sense but as a more poetic form of reporter who observes the things around you in the world and reports on that for the rest of us. Do you feel like that's what you're doing now?
DIDION: Well, I think that - I mean, I had a very definite sense of reporting when I was doing this book, and I don't mean reporting the - doing the research. There was a certain amount of research I did. I mean, I did some reading about grief. I mean, I read all the psychiatrists. But I mean a sense of reporting from a different - from a state that not everybody had yet entered. I mean, the - or that some people had but hadn't reported back so that there might be some use in reporting back, in sending a dispatch, in filing.
BIANCULLI: Joan Didion speaking to Terry Gross in 2005. The journalist, novelist and screenwriter died last month at age 87. Coming up, we remember Betty White, the popular TV actress who died last Friday at age 99. This is FRESH AIR.
(SOUNDBITE OF JIM FARMER'S "THE REAL BLONDE") Transcript provided by NPR, Copyright NPR.


text:
'Big and vicious': Hurricane Florence closes in on Carolinas
WILMINGTON, N.C. (AP) - Motorists streamed inland on highways converted to one-way evacuation routes Tuesday as about 1.7 million people in three states were warned to get out of the way of Hurricane Florence, a hair-raising storm taking dead aim at the Carolinas with 140 mph (225 kph) winds and potentially ruinous rains.
Florence was expected to blow ashore late Thursday or early Friday, then slow down and wring itself out for days, unloading 1 to 2 1/2 feet (0.3 to 0.6 meters) of rain that could cause flooding well inland and wreak environmental havoc by washing over industrial waste sites and hog farms.
Forecasters and politicians pleaded with the public to take the warnings seriously and minced no words in describing the threat.
"This storm is a monster. It's big and it's vicious. It is an extremely, dangerous, life-threatening, historic hurricane," North Carolina Gov. Roy Cooper said.
He added: "The waves and the wind this storm may bring is nothing like you've ever seen. Even if you've ridden out storms before, this one is different. Don't bet your life on riding out a monster."
Some hoped for divine intervention.
"I'm prayed up and as ready as I can get," Steven Hendrick said as he filled up gasoline cans near Conway, South Carolina.
More than 5.4 million people live in areas under hurricane warnings or watches on the U.S. East Coast, according to the National Weather Service, and another 4 million people were under a tropical storm watch.
President Donald Trump declared states of emergency for North and South Carolina and Virginia, opening the way for federal aid. He said the federal government is "absolutely, totally prepared" for Florence.
All three states ordered mass evacuations along the coast. But getting out of harm's way could prove difficult.
Florence is so wide that a life-threatening storm surge was being pushed 300 miles (485 kilometers) ahead of its eye, and so wet that a swath from South Carolina to Ohio and Pennsylvania could get deluged.
People across the region rushed to buy bottled water and other supplies, board up their homes, pull their boats out of the water and get out of town.
A line of heavy traffic moved away from the coast on Interstate 40, the main route between the port city of Wilmington and inland Raleigh. Between the two cities, about two hours apart, the traffic flowed smoothly in places and became gridlocked in others because of fender-benders.
Only a trickle of vehicles was going in the opposite direction, including pickup trucks carrying plywood and other building materials.
Long lines formed at service stations, and some started running out of gas as far west as Raleigh, with bright yellow bags, signs or rags placed over the pumps to show they were out of order. Some store shelves were picked clean.
"There's no water. There's no juices. There's no canned goods," Kristin Harrington said as she shopped at a Walmart in Wilmington.
At 5 p.m., the storm was centered 785 miles (1,260 km) southeast of Cape Fear, North Carolina, moving at 17 mph (28 kph). It was a potentially catastrophic Category 4 storm but was expected to keep drawing energy from the warm water and intensify to near Category 5, which means winds of 157 mph (253 kph) or higher.
Florence is the most dangerous of three tropical systems in the Atlantic. Tropical Storm Isaac was east of the Lesser Antilles and expected to pass south of Puerto Rico, Hispaniola and Cuba, while Hurricane Helene was moving northward away from land. Forecasters also were tracking two other disturbances.
The coastal surge from Florence could leave the eastern tip of North Carolina under more than 9 feet (2.75 meters) of water in spots, projections showed.
"This one really scares me," National Hurricane Center Director Ken Graham said.
Federal officials begged residents to put together emergency kits and have a plan on where to go.
"This storm is going to knock out power days into weeks. It's going to destroy infrastructure. It's going to destroy homes," said Jeff Byard, an official at the Federal Emergency Management Agency.
Forecasters said parts of North Carolina could get 20 inches (50 centimeters) of rain, if not more, with as much as 10 inches (25 centimeters) elsewhere in the state and in Virginia, parts of Maryland and Washington, D.C.
One trusted computer model, the European simulation, predicted more than 45 inches (115 centimeters) in parts of North Carolina. A year ago, people would have laughed off such a forecast, but the European model was accurate in predicting 60 inches (150 centimeters) for Hurricane Harvey in the Houston area, so "you start to wonder what these models know that we don't," University of Miami hurricane expert Brian McNoldy said.
Rain measured in feet is "looking likely," he said.
The storm forced people to cut their vacations short along the coast.
Paula Matheson of Springfield, Oregon, got the full Southern experience during her 10-week RV vacation: hot weather, good food, beautiful beaches and, finally, a hurricane evacuation.
Florence interrupted her stay on North Carolina's Outer Banks. It took Matheson and her husband nearly the whole day Monday to drive the 60 miles (100 kilometers) off the barrier island .
"It was so beautiful. The water was fabulous. Eighty-five degrees," Matheson said, pausing a moment. "I guess that's a big part of the problem."
Florence's projected path includes half a dozen nuclear power plants, pits holding coal-ash and other industrial waste, and numerous hog farms that store animal waste in huge lagoons.
Duke Energy spokesman Ryan Mosier said operators would begin shutting down nuclear plants at least two hours before hurricane-force winds arrive.
North Carolina's governor issued what he called a first-of-its-kind mandatory evacuation order for North Carolina's fragile barrier islands from one end of the coast to the other. Typically, local governments in North Carolina make the call on evacuations.
"We've seen nor'easters and we've seen hurricanes before," Cooper said, "but this one is different."
Associated Press writers Seth Borenstein in Washington; Jennifer Kay in Miami; Gary Robertson in Raleigh, North Carolina; Jeffrey Collins in Latta, South Carolina; Meg Kinnard in Columbia, South Carolina; Jeff Martin and Jay Reeves in Atlanta; and Tamara Lush in St. Petersburg, Florida, contributed to this report.
For the latest on Hurricane Florence, visit https://www.apnews.com/tag/Hurricanes .


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You are here: irt.org | FOLDOC | Charles Babbage
<person> The British inventor known to some as the "Father of Computing" for his contributions to the basic design of the computer through his Analytical Engine. His previous Difference Engine was a special purpose device intended for the production of mathematical tables.
Babbage was born on December 26, 1791 in Teignmouth, Devonshire UK. He entered Trinity College, Cambridge in 1814 and graduated from Peterhouse. In 1817 he received an MA from Cambridge and in 1823 started work on the Difference Engine through funding from the British Government. In 1827 he published a table of logarithms from 1 to 108000. In 1828 he was appointed to the Lucasian Chair of Mathematics at Cambridge (though he never presented a lecture). In 1831 he founded the British Association for the Advancement of Science and in 1832 he published "Economy of Manufactures and Machinery". In 1833 he began work on the Analytical Engine. In 1834 he founded the Statistical Society of London. He died in 1871 in London.
Babbage also invented the cowcatcher, the dynamometer, standard railroad gauge, uniform postal rates, occulting lights for lighthouses, Greenwich time signals, and the heliograph opthalmoscope. He also had an interest in cyphers and lock-picking.
[Adapted from the text by J. A. N. Lee, Copyright September 1994].
Babbage, as (necessarily) the first person to work with machines that can attack problems at arbitrary levels of abstraction, fell into a trap familiar to toolsmiths since, as described here by the English ethicist, Lord Moulton:
"One of the sad memories of my life is a visit to the celebrated mathematician and inventor, Mr Babbage. He was far advanced in age, but his mind was still as vigorous as ever. He took me through his work-rooms. In the first room I saw parts of the original Calculating Machine, which had been shown in an incomplete state many years before and had even been put to some use. I asked him about its present form. 'I have not finished it because in working at it I came on the idea of my Analytical Machine, which would do all that it was capable of doing and much more. Indeed, the idea was so much simpler that it would have taken more work to complete the Calculating Machine than to design and construct the other in its entirety, so I turned my attention to the Analytical Machine.'"
"After a few minutes' talk, we went into the next work-room, where he showed and explained to me the working of the elements of the Analytical Machine. I asked if I could see it. 'I have never completed it,' he said, 'because I hit upon an idea of doing the same thing by a different and far more effective method, and this rendered it useless to proceed on the old lines.' Then we went into the third room. There lay scattered bits of mechanism, but I saw no trace of any working machine. Very cautiously I approached the subject, and received the dreaded answer, 'It is not constructed yet, but I am working on it, and it will take less time to construct it altogether than it would have token to complete the Analytical Machine from the stage in which I left it.' I took leave of the old man with a heavy heart."
"When he died a few years later, not only had he constructed no machine, but the verdict of a jury of kind and sympathetic scientific men who were deputed to pronounce upon what he had left behind him, either in papers or in mechanism, was that everything was too incomplete of be capable of being put to any useful purpose."
[Lord Moulton, "The invention of algorithms, its genesis, and growth", in G. C. Knott, ed., "Napier tercentenary memorial volume" (London, 1915), p. 1-24; quoted in Charles Babbage "Passage from the Life of a Philosopher", Martin Campbell-Kelly, ed. (Rutgers U. Press and IEEE Press, 1994), p. 34].
Compare: uninteresting, Ninety-Ninety Rule.
Nearby terms: charge-coupled device « CHARITY « charityware « Charles Babbage » Charles Simonyi » CHARM » CHARM++
FOLDOC, Topics, A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y, Z, ?, ALL


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Veradigm™ Partners with American College of Cardiology to develop next-generation research network: NCDR PINNACLE and Diabetes Collaborative Registries
Creates large scale, digitally enabled clinical quality improvement and research network in US
CHICAGO – (BUSINESS WIRE) – Jul. 2, 2019 – Veradigm™, an Allscripts (NASDAQ: MDRX), business unit dedicated to simplifying healthcare with data driven health insights and technologies to help manage costs and improve health outcomes, announced today that it has partnered with the American College of Cardiology (ACC) to power the next generation of real-world research on behalf of cardiovascular disease and diabetes patients around the world. As part of this partnership, Veradigm will operate the PINNACLE Registry®, which focuses on coronary artery disease, hypertension, heart failure, atrial fibrillation and diabetes in the outpatient setting, and the Diabetes Collaborative Registry, the first global, cross-specialty clinical registry designed to track and improve the quality of diabetes and metabolic care across the primary care and specialty care continuum from the American College of Cardiology.
PINNACLE and Diabetes Collaborative Registries will extend Veradigm's EHR-enabled ambulatory research network to create a large-scale chronic disease network with more than 250,000 clinicians and 150 million patients including Veradigm partner data sets in the United States. In addition to integrating Veradigm's technology, data and analytic capabilities with the ACC's PINNACLE Registry and Diabetes Collaborative Registry, the partnership will leverage Veradigm's large specialist and primary care provider network, utilizing its electronic health record platforms to bring ACC's clinical guidelines, decision pathways, education and wealth of provider and patient engagement tools to the point of care.
"It is essential that clinicians have access to the most comprehensive clinical information that technology allows for to provide their patients with the best possible care," said Richard J. Kovacs, MD, FACC, President of the American College of Cardiology. "Through this partnership, we are committing to innovative ways to further the field of cardiology and fulfilling our mission to transform cardiovascular care and improve heart health by delivering a wider breadth of clinical tools and research opportunities to registry participants."
This relationship provides value for patients and providers of healthcare across the US health care ecosystem, while maintaining all the benefits of current participation in the PINNACLE Registry and Diabetes Collaborative Registry. Stephanie Reisinger, GM & VP Veradigm says, "physicians will have greater opportunities to participate in research studies and have increased access to evidence-based medicine and tools and can expect clinical workflow solutions to be deployed more seamlessly at the point-of-care."
About Veradigm
Veradigm is an integrated data systems and services business that combines data-driven clinical insights with actionable tools for clinical workflow, research, analytics, and media. Our solutions are designed to help key healthcare stakeholders to improve the quality, efficiency, and value of healthcare delivery – from biopharma to health plans, healthcare providers, health technology partners, and most importantly, the patients they serve. We are dedicated to simplifying the complicated healthcare system with next-generation healthcare solutions. That is how we are transforming health, insightfully.
About Allscripts
Allscripts (NASDAQ: MDRX) is a leader in healthcare information technology solutions that advance clinical, financial and operational results. Our innovative solutions connect people, places and data across an Open, Connected Community of Health™. Connectivity empowers caregivers and consumers to make better decisions, delivering better care for healthier populations.
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.
Source: Allscripts


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West Coast Cooler Rosé is Vegan Friendly
by Irish Distillers Limited | |
Address: | Simmonscourt House, Simmonscourt Road, Ballsbridge, Dublin 4 Ireland |
Phone: | |
Fax: | |
Email: | email@example.com |
URL: | http://www.jamesonwhiskey.com/ |
Checked by: | Ryan |
Double checked by: | Emily, Vinny, Jim, Irene, Timothy, Jaye, Sarah, Rob, Georgia, Kristie, Philip, Lena, Natalie |
Added: | over 7 years ago |
Double Checked: | over 1 year ago |
Company email (February 2023)
"Yellow Spot whiskey is vegan. There are no animal products used in the production."
Company email (June 2022) re: method and madness whiskey
"Yes, our brand is entirely vegan friendly."
Company email (November 2018)
"We're delighted to say that Jameson is vegan friendly."
Company email (January 2018) re: West Coast Coolers
"Our colleague in production has confirmed that West Coast Cooler Original and Rosé are both suitable for vegans"
Company email (November 2016) re: West Coast Coolers
"We can confirm West Coast Cooler Original & Rose varieties are both vegan friendly"
Company email (May 2010):
"Jameson Irish Whiskey is suitable for vegans. No animal products of any description (including milk, eggs, honey, gelatin, isinglass etc) are used in the manufacture of Jameson.
It is a good idea to state the suitability of the drink for vegetarians or vegans. It is an idea we are considering at the moment."
Company email (March 2010):
"We can confirm that all Irish Whiskey, including Jameson and Powers, is suitable for vegans.
No animal products of any description (including milk, eggs, honey, gelatin, isinglass etc) are used in the manufacture of Irish Whiskey."
Company email:
Jameson does not use any isinglass or any animal by product in the production of Jameson Irish Whiskey.
Company email:
"Thank you for taking the time to e-mail us. There is no animal product used in the distilling or filtering process of Jameson."
Email from Emily:
"I wrote Jameson at least a year ago and inquired about the use of gelatin, isinglass, or other animal products in the whiskey. I received a personal email from an administrative employee who researched the matter. She thoroughly explained that isinglass was indeed used for clarification of the liquid, and though it was filtered out completely with the impurities from the clarified whiskey, that yes, technically, that meant that it did not fit my definition of vegan. She did state that that was the only animal-derived product in the process."
Company email:
"Thank you for taking the time to e-mail us. There are no animal products used in the production Jameson Whiskey."
Via Jim:
"None of the products mentioned in the request for information below are used in any form in the manufacture of Jameson."
In brief Jameson Irish Whiskey is produced as follows:
"Whole cereal grains are milled, water is added and with the addition of yeast(a traditional type of distilling yeast is used) fermentation occurs. Fermentation is the process whereby yeast converts the wort, which is a sugary solution extracted from the milled cereal grains, into an alcoholic wash( in effect a type of beer). The wash, which contains about 12% alcohol is then triple distilled to give a newly distilled spirit. After maturation of the spirit in oak cask for the minimum number of years this beverage can then be called Whiskey. The production of Jameson Irish Whiskey meets with the strict requirements of the IRISH WHISKEY ACT, 1980, the purpose of which is to define the production and labeling requirements of Irish whiskey and blended Irish whiskey and all other relevant legislation on the production of Irish Whiskey. None of these regulations allow the use of such products."
Company email:
"Thank you for taking the time to e-mail us. Jameson is vegan friendly. None of the items mentioned [dairy, egg, or honey, bone char] are used in the production of Jameson Irish whiskey."
Other products by Irish Distillers Limited:
Vegan Friendly
Vegan Friendly
Vegan Friendly
Vegan Friendly
Vegan Friendly
Vegan Friendly


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Maryland is on its way to being the first state to make it illegal for employers to demand Facebook passwords from applicants or workers.
The state bill has passed the Maryland legislature and is awaiting Gov. Martin O'Malley's signature to turn the legislation into law, according to the Washington Post. Advocates for the measure said the bill was necessary because it violated privacy and intimidated job seekers and employees.
The entire bill came about because of a Maryland corrections officer was asked for the password to his Facebook account after coming back on the job after a leave. Although he complied, he said he felt violated and embarrassed. "It almost seemed that my compliance was compulsory," Robert Collins told the Associated Press.
U.S. & World
News from around the country and around the globe


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This bodice is made from New Look 6886, and the skirt is a simple rectangular dirndl. The dress is made from a printed Swiss dot cotton that I got from Fabric Mart ages ago. I accessorized with a wide belt. I'm wearing a chiffon petticoat. (I bought it here, and it's the perfect amount of floofiness.)
The rick rack trims the neckline, peeking out from the bodice. There are two rows on the skirt as well, and they're just stitched flat. It's easy to apply, you just have to measure carefully from your hem to make sure you don't get crooked rows!
It's also our first Independence Day with Rosie! Of course, a matching kerchief was in order.
How cute is she?
Pip came over to check out the action. Everyone is getting along great!
Hope you're having a great day!


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Showing Collections: 1 - 20 of 839
A. Louise Mays papers
A Political Dialogue: Iowa's Women Legislators oral histories
Interviews with Iowa women legislators conducted by Suzanne O'Dea Schenken.
Aaron Silander papers
Abbie Romey papers
Actress, homemaker, and 1928 graduate of the State University of Iowa in Iowa City.
Ada Mae Brown Brinton memoir
In Sunshine and Rain in Iowa: Reminiscing through 86 Years, Brinton reflects on rural Iowa, hard work, church traditions, and the love of family and community.
One folder, shelved in SCVF.
Adelia M. Hoyt papers
Photos and a memoir written by a blind woman who helped establish the Iowa Home for Sightless Women in Des Moines.
Adelia St. John Gates papers
Graduate of Genesee College in New York who moved to Waterloo, Iowa as a bride.
One folder, shelved in SCVF.
Adella Martinez papers
A former resident of Cook's Point, Davenport, whose parents emigrated from Mexico to the United States in the early 1900s.
Adrien Wing papers
Black attorney, faculty and Associate Dean at the University of Iowa College of Law.
Aime Wichtendahl oral history collection
Albert J. Cohen Papers
American motion picture and television script writer and producer. Program scripts, department materials, memos, clippings, notes, correspondence, production budgets, and miscellaneous photographs.
Alberta Evelyn Swan Lehman papers
Correspondence and scrapbook of student years at Simpson Conservatory in Indianola, Iowa.
Alberta Metcalf Kelly papers
High school English teacher who was active in state and national Democratic Party politics during the 1950s and 1960s.
Alberta Powell Graham Papers
A writer of biographies for children (on Columbus, Clara Barton, Lafayette and LaSalle, among others), Mrs. Graham also published more than 300 songs and Strike Up the Band! (1949), a collection of short biographies of American band musicians. Both her books and songs are represented in her papers.
Aldeen Davis papers
Muscatine, Iowa, newspaper columnist active in arts, civic, educational, and religious organizations.
Alice Kelley papers
University of Iowa graduate who worked as a secretary. The papers mainly consist of the diaries she kept from 1926-2002.
Alice Kipp papers
The papers include Kipp's reminiscence of her childhood on an Iowa farm.
Alice McMurry papers
Promise City, Iowa elementary school teacher and poet.
One folder, shelved in SCVF.
Alice Sophia Brant papers
Diaries of this homemaker and mother who helped manage the family's funeral home in Oelwein.
Alma Erickson Swanson papers
Swedish farm woman whose three children became academics during the 1930s and 1940s.


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Dancing Bear Toys & Gifts
Specialty Retailers Who Sell Books (2019)
Below are some of the specialty retailers I've found in 2017 through 2019 that sell books: children's books, craft books, pet books, art books, history books, fiction, and more. Art Stores Charles H MacNider Art Museum Shop, 303 Second Street SE, Mason City IA; 641-421-3666. Web: http://www.macniderart.org. Art gifts, books, prints, and more. Clear Lake […]
About John Kremer
John Kremer is author of 1001 Ways to Market Your Books, the Relationships Matter Marketing program, and many other books and reports on book marketing, Internet marketing, social media, and book publicity. -- John Kremer on Book Marketing.