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IGN Presents the History of Awesome: 2001
November 4, 2015 - In 2001 the Xbox and GameCube entered our lives, Harry Potter and Frodo hit the big screen, and so so much more.
Miyamoto Shares His Thoughts on Cinematic Games, Nintendo's Strategy
November 17, 2014 - Miyamoto doesn't agree with the idea that games need to be cinematic.
The Top 125 Nintendo Games of All Time
September 24, 2014 - To celebrate Nintendo's 125th anniversary, we've compiled a list of the company's 125 greatest and most beloved games. Let's do this.
IGN Plays Pikmin
September 17, 2014 - When Pikmin came out, there had never been anything like it. Take a trip down memory lane to celebrate Nintendo's 125th anniversary.
Shigeru Miyamoto is Working on a Pikmin Short Movie
September 11, 2014 - Shigeru Miyamoto is working on his first animated short film, set to focus on Pikmin.
Remembering Pikmin
December 1, 2011 - Celebrating 10 years of plucking, tossing and whistling at little flower-headed plant soldiers.
Column: Nintendo is Lazy and You Don't Care
December 11, 2009 - Matt Casamassina writes about how Nintendo has been cutting costs and taking shortcuts ever since it launched Wii. Even when some of its titles disappoint, are gamers giving the company a free pass? Read Matt's column to dissect his take on the matter.
Cheers and Tears: Strategy Games
July 31, 2009 - Turns out, there are not a lot of strategy games out on the Wii. And with such a limited selection, you run into the obvious dilemma: most of these games suck!
New Play Control! Pikmin Review
March 11, 2009 - Eight years (or nearly 3000 days) have passed since Nintendo released Pikmin, a thoroughly entertaining action-strategy romp for GameCube. Now, Wii owners who either missed the franchise during its first run or don't mind going back to it again can experience it with a welcomed new save function, an added 16:9 widescreen mode and, most importantly, new Wii pointer-based controls. These additions update and improve upon what was already an excellent Nintendo exclusive effort that never received the same caliber of attention as its Mario and Zelda based brethren. Pikmin is great fun on Wii, but some of its design fundamentals and visuals were ultimately bettered by its sequel, and sadly these changes were not translated to the New Play Control! reboot.
Pikmin and Mario Power Tennis Lead Nintendo's New Play Control! Lineup
March 9, 2009 - REDMOND, Wash.--(BUSINESS WIRE)-- Unique motion-sensing controls have already helped to make Wii the nation's top-selling video game console. With today's launch of the New Play Control! series from Nintendo, Wii owners can use those same fun, intuitive controls to discover – or rediscover – some of the coolest and most well-received games made famous on the Nintendo GameCube system, each updated with a new wireless, active control scheme and a widescreen presentation.
New Play Control Boxes 'Flipper' in US
March 4, 2009 - Nintendo today sent over final retail copies of New Play Control:…
New Play Control! Pikmin AU Review
February 11, 2009 - Oh, to spend a day in Miyamoto's brain! To see things the way he does, to pull new creative concepts from the mire of everyday life. We look out at our garden and we see weeding to be done and grass that needs beating back. When old Shigeru looks out there, he sees swarms of inch-high plant-beings, swarming over hills, helping a Tom Thumb alien collect scattered parts of his downed '50s-era spaceship while fending off fat, bouncing frogs, grubs and bipedal, polka dotted Bulborbs. His parents must have spent a fortune on Freudian psychoanalysis.
Nintendo Voice Chat Podcast, Episode 35
February 2, 2009 - Welcome to Nintendo Voice Chat. Matt Casamassina, Craig Harris, Bozon, and Daemon Hatfield are going to waggle their way into your hearts.
Hands-on New Play Control! Pikmin
January 30, 2009 - Does the Wii remote really enhance the Pikmin experience? Find out inside.
IGN Wii 2009 Preview
January 21, 2009 - In case you haven't realized it, Nintendo has the number one videogame console and the number one videogame handheld in North America. That's a pretty significant place to be: systems sold equals gamers to cater to, and Nintendo's got tens of million gamers to make happy in 2009.
Nintendo Dates Wii-makes
January 20, 2009 - Nintendo's granted the first of its New Play Control series games for the Wii firm release dates, with New Play Control! Pikmin launching on February 6, while New Play Control! Mario Power Tennis will be available from March 6.
Nintendo Q1 09 Lineup Revealed
December 17, 2008 - New Play Control Wii titles as well as Pokemon Platinum and Fire Emblem for DS.
New Features for Wii Pikmin and Mario Tennis
December 10, 2008 - Following the revelation a few weeks back that the Play on the Wii version of Donkey Kong Jungle Beat (set for Japanese release tomorrow) will feature new elements, Famitsu is back with details on what's new for the Pikmin and Mario Tennis GC installments in the series.
New Elements for Play it on Wii Selection Titles
November 12, 2008 - Were you expecting Nintendo's Play it on Wii lineup to consist of GameCube titles updated with simple Wii controls? It turns out that Nintendo may be putting a bit more effort into the games.
Presenting the "Play it on Wii Selection"
October 2, 2008 - Amid all the hype and chaos of new game and hardware announcements at this morning's Nintendo Conference came one bit of news that wasn't quite so new -- the Wii De Asobu Selection lineup, which translates to something like "Play it on Wii Selection." The series of titles will be comprised of several of Nintendo's last-generation GameCube games, updated to be playable with Wii Remote controls.


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Titel: Unbelievably Good Deals and Great Adventures...
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0809232332 Small stain to foreedge. Quality, Value, Experience. Media Shipped in New Boxes. For further information or scans please call or email. Buchnummer des Verkäufers BING44728
Inhaltsangabe: This invaluable guide to saving monet and having fun is packed with perks and privileges the younger set can only dream of. Now in its eighth edition, this guide has been updated, redesigned, and packed with even more information about trips, clubs, programs, and special deals available only to those over 50. 21 line drawings.
Rezension: One American turns 50 every 7.6 seconds, and here's a book that caters to the pocketbooks of this ever-increasing traveling population.
"Ten years ago when I wrote the first edition of Unbelievably Good Deals, active vacation and adventure trips were seldom offered to mature travelers," says author Joan Heilman. "Today, however, these readers, especially baby boomers who've just turned 50, are looking for action, and the book reflects that trend."
This complete compendium for senior discounts includes special offers for adventure travel; lifetime admission tickets to national parks; airfare specials; up to 50 percent off on hotels and restaurants; discounts for golf, tennis, and ski vacations; and trips, clubs and matchmaking services for singles. The book also offers advice on how to beat the cost of car rentals; save money on train, bus, and boat fares; find thrifty alternative lodgings all over the world; uncover the best shopping values; discover volunteering opportunities; and get the lowdown on going back to school.
The last chapter provides an overview of organizations for people over 50 and what they can offer, or what you can offer them. As the author points out, "When you consider that there are more people in this country over the age of 55 than there are children in elementary and high schools, you can see why we have powerful potential to influence what goes on around here." --Kathryn True
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subset: commoncrawl


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Corinium Hotel & Restaurant
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Travel Blogs from Cirencester
First Day Fun! :D
Today was so much fun!
I was really tired at first but then I got over it. I am staying at Cirencester, a beautiful old town in England. All the houses are old and huge. I even saw a castle! SO COOL!!!
It was also really cool looking at St. John Baptist church. The windows there are all stained glass. There are huge organs there ...
An Ode to Baked Beans
... there wasn't an ode to baked beans.
I've kinda given up trying to find last minute things or memorise last minute Arabic verbs. I wonder if I'll pick up any Hebrew. I probably won't pick up any Hebrew.
Off to London tomorrow and then early start tomorrow at 10.10am from Gatwick to Tel ...
UK Golden Retriever Club Centenary Celebrations
... also spent a lot of time wandering through the shops and bought lots of 'stuff' and then drove to Broadway via Stowe-On-The-Wold. The villages are just beautiful !! We had a few hairy moments traveling through narrow roads really only made for one car!! ( I was driving eek!! ) Took lots of photos! We had dinner at a typical English pub called the 'The Corner Cupboard' in Winchcombe ....the food was wonderful ...got home quite late ...
"Family Affairs"
... for us tonight. She has a friend working at a hotel just out of Oxford and secures us a table. The Trout Inn in Wolvercote is a Tudor Grade 2-listed heritage pub modernised inside but retaining the 17th century beams and timberwork inside and it's exterior. It sits on the Thames but we can't apprciate it's great location, arriving after dark. Dinner is excellent and reasonably priced. The only negative is my failing to take the right exit off the freeway and taking the (very) long way ...
New Years Eve in England - 10hrs after Oz
... been stuck in quite afew given the time I've spent here). So what should have been about a 80-90min journey ended up being around 120-150min journey thanks to an accident. Eventually got back, Scott got to work about 2 hours (or actually 8 hours) late, and I passed out again, still tired from NYE.
2 January 2012
So today was another lazy recovery day that consisted mostly ...


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Helical polymers are formed by many proteins found in bacterial, archaeal and eukaryotic cells, and can also be present as viral capsids, nucleocapsids and tails. In certain cases most of the protein found in a cell is in the form of a helical polymer, so methods to study the structure and dynamics of such polymers have great general interest. Particular helical complexes, such as the pili and flagellar filaments of pathogenic bacteria, have a very immediate relevance to human disease. We propose to further develop, extend, apply and support new methods for the three-dimensional reconstruction of such polymers from electron microscopic images. Our work in this area has already had a large impact on a number of NIH-supported projects from many laboratories, but we are now at a transition point where the potential for achieving high- resolution structures from numerous samples is now quite high. Given the imminent arrival of a Titan Krios TEM we need support to further develop our Iterative Helical Real Space Reconstruction approach and optimize the processing of large numbers of high-resolution images of polymers. Effort will be invested in using new algorithms for alignment and reconstruction, as well as in developing methods that make use of prior knowledge about the spatial relations between different segments that have been cut from the same filament. All of the development work will use samples that have great interest to a large community and that have a direct relation to human health. These range from bacterial pili to viral capsids to the protein product of an oncogene. We have established that processing of such images can scale with the number of processors, so effort will be invested in making these programs easy to use on relatively inexpensive and commercially-available clusters. Tools for detecting potential ambiguities in helical symmetry will be developed, but the main tool will be bringing the resolution of helical reconstructions to the point where secondary structure can be recognized. At this resolution these ambiguities disappear.
Many bacteria that cause human diseases require helical polymers on their surface for both attachment and motility. Helical viruses also exist, as do helical polymers formed by proteins from HIV and other pathogenic viruses. Developing improved methods to study the structure of helical polymers will thus have a direct impact on understanding and preventing many diseases.
|Egelman, Edward H (2014) Ambiguities in helical reconstruction. Elife 3:
|Wu, Bin; Peisley, Alys; Tetrault, David et al. (2014) Molecular imprinting as a signal-activation mechanism of the viral RNA sensor RIG-I. Mol Cell 55:511-23
|Nivaskumar, Mangayarkarasi; Bouvier, Guillaume; Campos, Manuel et al. (2014) Distinct docking and stabilization steps of the Pseudopilus conformational transition path suggest rotational assembly of type IV pilus-like fibers. Structure 22:685-96
|Lu, Alvin; Magupalli, Venkat Giri; Ruan, Jianbin et al. (2014) Unified polymerization mechanism for the assembly of ASC-dependent inflammasomes. Cell 156:1193-206
|Qiao, Qi; Yang, Chenghua; Zheng, Chao et al. (2013) Structural architecture of the CARMA1/Bcl10/MALT1 signalosome: nucleation-induced filamentous assembly. Mol Cell 51:766-79
|Galkin, Vitold E; Kolappan, Subramaniapillai; Ng, Dixon et al. (2013) The structure of the CS1 pilus of enterotoxigenic Escherichia coli reveals structural polymorphism. J Bacteriol 195:1360-70
|Behrmann, Elmar; Tao, Guozhi; Stokes, David L et al. (2012) Real-space processing of helical filaments in SPARX. J Struct Biol 177:302-13
|Li, Juliana; Egelman, Edward H; Craig, Lisa (2012) Structure of the Vibrio cholerae Type IVb Pilus and stability comparison with the Neisseria gonorrhoeae type IVa pilus. J Mol Biol 418:47-64
|Parent, Kristin N; Sinkovits, Robert S; Suhanovsky, Margaret M et al. (2010) Cryo-reconstructions of P22 polyheads suggest that phage assembly is nucleated by trimeric interactions among coat proteins. Phys Biol 7:045004
|Egelman, Edward H (2010) Reconstruction of helical filaments and tubes. Methods Enzymol 482:167-83
Showing the most recent 10 out of 26 publications


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Top Definition
When you put a pair of pants on in a hurry over a shirt which is then tucked into the pants. Sometimes the bottom corner of the shirt sticks through your fly, which is called a T-shirt willy.
*in PE changing rooms after the lesson*
"tom, you have a t-shirt willy again"
"no i dont"
"yes you do look"
"tom, you have a t-shirt willy again"
"no i dont"
"yes you do look"
by ljw December 07, 2005
The Urban Dictionary Mug
One side has the word, one side has the definition. Microwave and dishwasher safe. Lotsa space for your liquids.Buy the mug
The Urban Dictionary T-Shirt
Smooth, soft, slim fit American Apparel shirt. Custom printed. 100% fine jersey cotton, except for heather grey (90% cotton).Buy the t-shirt


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--- In email@example.com, "Pearl Doyle" <pdoyle@o...> wrote:
> In March I visited Argyle Acres and took pictures of a few iris that
caught my eye. A few had their name tags mis-placed. Does anyone know
the ID of this pink one? I was especially interested in it because I
have one like it. I will be posting a few each night for a while. Pearl
The photo of Rhonda Fleming is not correct.
Can't say for sure what the pink is. Many lok similar, especially in
photos as they ofen change tones slightly.
Chuck Chapman
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Drew Hastings strides onstage at the Valentine Theater in Toledo Ohio – all 6' 6" of him. He's dressed in black like Johnny Cash, but from the neck up resembles a goyische Woody Allen. He wears thick black glasses which remind most of Buddy Holly, but Hastings refers to them as "my Al Sharpton glasses – big, black, you can see right through them." In the first moments of his standup concert it's already obvious — Drew is as multiplicitous as a Picasso painting, as offensive as an Andres Serrano photograph, and as confusing as – well, as a Drew Hastings standup concert.
Drew Hastings has seen many changes in his half century or so. Born in Morocco of a British mother and soldier father, reared in Ohio, he has lived all over the United States and held many types of jobs. It's a bit sketchy exactly what some of those jobs entailed – in his own words, some were a bit "shady" – but what's certain is each profession differed radically from the next. Most people pick a profession or two and remain at least in the general vicinity for their lifetime. But Drew Hastings, he makes it clear, is not most people.
"I was a long-haired hippie freak in the early/mid-'70s and hung with Dayton, Ohio hippies who had long hair, did acid, had an Appalachian streak, and were complete badasses. The drug-using cousins of Larry Flint. Literally," he said of his early life, via an email interview. Descriptive, eh? Yet still vague. He alludes to running a business and "governmental regulation" which "really started getting intrusive". But it isn't clear what type of business that was. At any rate, at some point "in the mid-'80s", he decided he could be a standup comic – so he gave that a try.
So why is Drew so vague, so reticent about his biographical material? What he does give up is much more interesting than the bad relationship and city slicker on a farm stories to be found in his newly released DVD, Drew Hastings: Irked and Miffed. His blog page on MySpace shows a literate individual – anyone who's a fan of A Confederacy of Dunces can't be all bad, right? (Except one does fear that the dunces, to Hastings, are most of us.) The only similarity between his blog musings and his stage act is the elitism he projects outward. What we get, on stage, instead, are jokes and schtick. Rehearsed, exaggerated stories. Bad relationship formulaic humor. Fish out of water humor. Nothing that seems nearly as original as this man seems to be, once one gets a glimmer of what's behind that hipster costume.
His act and his persona seem all over the map for the duration of this filmed live performance. He proves he can work clean with a story about an animal park – and then he drops some gratuitous F bombs, spoiling the fun. One hopes Lenny Bruce's sacrifice wasn't merely so that intelligent men could later shrink their own vocabularies. Comedian Hastings mentions in various articles and in his own blog posts online about how he hated L.A. In his emailed replies for this article, he said he "never liked the place" which was "a slow erosion of my soul". Still, there's something canned about the 'I hate L.A.' manifesto many performers profess while wringing their living out of the place. Comedians who dress in all-black and cherish a grudge toward Los Angeles are not exactly unusual, either.
So who's behind the costume? Hastings shared a few biographical stories via email. After moving to Ohio at age two, he was raised Episcopalian. His mother remarried when he was eight, then he was suddenly "thrust into Orthodox Judaism, and not really… accepted". Teen years were spent also not fitting in: he was beaten regularly, he said, "probably because I used words like 'behoove', 'imbecile', and 'soiled trousers', in 1960s Ohio." He watched Ed Sullivan and Johnny Carson on television as a child. He was "always fascinated by comedians" but "never thought about doing it." His childhood ambition, he typed, was to be an archaeologist. One's tempted to draw a parallel between digging for the truth about ancient civilisations and digging for the truth about the current world via comic analysis of it. However, some of the responses to my emailed questions made it plain: over-analyzing ticks him off.
What's unique about Drew Hastings (or any individual) is what makes them interesting. As he wrote in one of his online blogs, "the road not taken" is the more rewarding. I just wish he'd taken that road more often in his comedy. If he had mined his life experiences for his comedy, instead of rattling off recycled jokes and rehearsed patter, I'd have been riveted. (More to the point – I might even have laughed.) He is "big on experiential experiences" and has proven that with a varied and colorful life spent under many guises in many places.
Drew Hastings: Irked and Miffed seems tame by comparison. One is left wishing for more "there" there. Recommended for his loyal corps of fans; others would do better to rent some Richard Pryor. Or Richard Lewis, if the man in black schtick grabs ya – he did it first, and better. Perhaps Hastings is the penultimate postmodern man: many personae, many changes, a copy of a copy of a copy – of himself. He tours "about 35 weeks a year", he typed, so – he does okay. It takes real courage to stand alone on stage and tell some jokes. It takes even more courage to stand alone on stage and tell the truth. With all that he's been through, there has got to be more than a jaded exterior to offer his audience. Or, so one hopes. "I believe all comedy comes from pain," Hastings typed. So, does he have the guts to go into that pain to truly find it? As the saying goes, "There's a story there".
It just hasn't as yet been filmed.Powered by Sidelines


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Info about this Item:
A formation of crystal-rock with a platform right in the middle that invites to present a miniature, a statue (you may choose a different one from our catalogue if you want to) and two injection-moulded trees made out of plastic are completing this diorama-base and let the whole thing become a nice showcase-piece. The trees are not only suitable for a winter landscape, of course. The many branches can be greened with leaves of all seasons.
Base approx. 14 x 11,5 cm
Thomas Reinheckel, Thomas Kramme


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Nutan Yojana, a project by Kamala Group features amenities such as restaurant, lifts, rain water harvesting, fire fighting arrangements etc. Located at Western Suburb (Khar West) , this property in Mumbai offers 1 BHK apartments.
Real Estate Mumbai newsletters are the most interesting as they give you the latest market reports and research and bring you updated with the current market trends, demands etc.
Since 1993, Real Estate Mumbai has evolved and has carved out expertise in Buying, Selling and Leasing Office and Residential properties.
Our Clients get a complete spectrum of services beginning from Investment to Exit with Capital Appreciation.


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North Fork Guest House
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Travel Blogs from Cutchogue
... the pace was really good. I like every place that we traveled to. Each was different. The architecture and art of Portugal and Spain are beautiful. Calatrava, Gehry and Gaudi!!! All different and fabulous. The food was too good! The Atlantic, Mediterranean and beautiful rivers - plazas, museums, route of Saint James - the history, people and cultures - made this trip an excellent one! We are so fortunate to have this opportunity and share it with each other and dear ...
Long Island, then on to Cape Cod
... golf at Montauk which is at the tip of Long Island. It was a late finish - late enough for the deer to start wandering onto the course. Consumed some more lobster and a wonderful crab soup from a roadside stall. We are drinking mainly US wine but can buy good NZ Sav for the same price as at home.
The next day we headed off to Cape Cod taking 3 ferry crossings to take a ...
Back to University, Lollipops and a Freebie!
... Laundromat, there was nothing to do but sit and wait... and wait... and wait... Don't you just love travelling and having to keep on top of dirty underwear!
And then we had to wait for the dryer to dry our clothes... more waiting. Before long, we found other ways to entertain ourselves whilst waiting for our thongs ...
A day In Montauk
... surf boards from the village. And this beach has less people since its a bit far from the village. There are a number of hiking and biking trails in the area.
I ride back with my ass killing me and my legs begging me to stop. But I make it back. I cycled over 20 miles and my energy levels are the same as my phone. I got a taxi back to the station. I paid 12 dollars on my way to the village and 10 dollars back to the station. Then I get onto the train and got back ...
Last two weeks started
... restaurant right on Navy Beach( it is a lake). And before bed, me and Stella had a mini spa session, doing our feet and putting on avocado masks. Liev's birthday is the 7th of September and yeah. We are having yet another bonfire on Saturday to celebrate his birthday and on Sunday we leave to go back to the City. I just put the girls to bed and I am so tired, but I do need my nightly walk on the beach so hopefully I finish work ...


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When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Testsby Leana Wen
In this examination of the doctor-patient relationship, Drs. Wen and Kosowsky argue that diagnosis, once the cornerstone of medicine, is fast becoming a lost art, with grave consequences. Using real-life stories of cookbook-diagnoses-gone-bad, the doctors illustrate how active patient participation can prevent these mistakes. Wen and Kosowsky offer tangible
In this examination of the doctor-patient relationship, Drs. Wen and Kosowsky argue that diagnosis, once the cornerstone of medicine, is fast becoming a lost art, with grave consequences. Using real-life stories of cookbook-diagnoses-gone-bad, the doctors illustrate how active patient participation can prevent these mistakes. Wen and Kosowsky offer tangible follow-up questions patients can easily incorporate into every doctor's visit to avoid counterproductive and even potentially harmful tests. In the pursuit for the best medical care available, readers can't afford to miss out on these inside-tips and more:
- How to deal with a doctor who seems too busy to listen to you
- 8-Pillars to a Better Diagnosis
- How to tell the whole story of your illness
- Learning test risks and evaluating whether they're worth it
- How to get a working diagnosis at the end of every doctor's visit
By empowering patients to engage with their doctors as partners in their diagnosis, When Doctors Don't Listen is an essential guide that enables patients to speak up and take back control of their health care.
Editorial Reviews
"The book's insights and cautionary tales should appeal to medical and lay readers alike: they combine into a superb analysis of how doctors listen and think, and offer detailed suggestions for how they could do both better." The New York Times
"Leana Wen and Joshua Kosowsky, emergency physicians at Brigham and Women's Hospital in Boston and Harvard University, urge patients to assert their voice. They warn that 'a health care crisis is not the time to keep your mouth shut,' but rather a critical time to speak up and be your own advocate." The Wall Street Journal
"Wen and Kosowsky demystify medical language and practice and offer straightforward tips." Concord Monitor
"A comprehensive guide to improving doctor-patient relations through empowering patients to take an active role in their care. . .As health care becomes more complex and political, this book provides clear direction toward better care." Kirkus Reviews
"Doctors Wen and Kosowsky (Pocket Emergency Medicine, co-editor) nudge the medical "consumer empowerment movement" forward with this provocative dialogic guide to help patients get the right diagnosis and treatment while avoiding the pitfalls of formulaic "cookbook" medicine. It all starts with an open conversation, the pair assert--much like the banter between car owner and mechanic on NPR's popular Car Talk program--and ends with an active M.D.-patient partnership. "You are the key to your own health, and you have to help your doctor help you," the duo insist. Recounted are hair-raising stories of patients who bore the brunt of doctors leaping to "worst-case reasoning" instead of listening to what their patients were telling them, like Jerry the car mechanic with a pulled muscle who was treated for a heart attack. The team warns consumers that the transformation from passive recipient of medical care to active partner won't be easy, but provide plenty of how-tos in their "8 Pillars" toward building a patient-doctor partnership. Theirs is an urgent call to action for patients, and a stark heads-up for doctors and the troubled healthcare industry they serve." Publishers Weekly
"Wen and Kosowsky's work is significant... Who should read When Doctors Don't Listen? Wishfully, doctors...certainly psychologists, and social workers...mental health providers... [and] anyone who is now or anticipates following family members of loved ones through illness and anyone who is concerned about his or her own medical care." PsycCRITIQUES
"This is a well-written book on an innovative approach to healthcare reform: it challenges patients to take charge of their health and every medical encounter with their doctor. An important topic and an important book--I encourage my patients to read it." Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies: A Biography of Cancer
"I have always said that a hospital can kill you as sure as cure you. You must be your own best advocate. Follow the advice of Drs. Wen and Kosowsky…and transform from being a patient to an advocate for your own health." Fran Drescher, actor, producer, activist, and author of Cancer Schmancer
"It's critical for patients to advocate for their own health. This book teaches you how…Read it; it will change radically how you approach your doctors." Melissa Etheridge, Grammy Award-winning musician and host of The Melissa Etheridge Radio Show
"This clearly-written, brilliantly and creatively thought-out book, filled with fascinating and horrifying examples of how doctors are now trained to not listen to their patients in order to 'rule out' diseases, focuses on 'ruling in' diagnoses that not only are accurate, but that will save billions of dollars per year in lawsuit-driven tests. A brave, terrific, essential work." Samuel Shem, M.D., Ph.D., author of The House of God and The Spirit of the Place
"Leana Wen and Josh Kosowsky have written an authoritative guide to answer a seemingly simple question: How should you talk to your doctor? Through fascinating examples taken from their own clinical experiences, they show how doctors' training fails to teach real listening skills. But Drs. Wen and Kosowsky don't stop there: They also offer up constructive and practical advice that just might save your life." Darshak Sanghavi, MD, Chief of Pediatric Cardiology, University of Massachusetts Medical School, health care columnist for Slate, contributing editor at Parents magazine, and author of A Map of the Child: A Pediatrician's Tour of the Body
"Their proposal for 'diagnostic partnership' is a major contribution of this courageous book in which common sense plays the leading role." Julio Frenk, MD, PhD, Dean of the Harvard School of Public Health
"A powerful appeal for individualized medical evaluation based on an active partnership between doctors and patients. The rational, mutual approach to diagnosis advocated by Drs. Wen and Kosowsky is the antidote for mindless and wasteful routines that all too often replace careful listening and focused assessment of each patient." Harvey V. Fineberg, M.D., Ph.D., President, Institute of Medicine
"Exposes the stereotypic physician following cookbook recipes to liberating a new frontier in the 'art' of humanistic medicine that empowers patients and physicians alike." Lincoln Chen, MD, Director, Global Equity Center at Harvard Kennedy School of Government
"Not only offers a compelling argument for revitalizing this touchstone of good medicine, but also provides a comprehensive guide for how doctors and patients can improve the quality of healthcare by doing so." Jordan J. Cohen, MD, Professor of Medicine and Public Health, George Washington University, and President Emeritus, Association of American Medical Colleges
"This is an important contribution to helping both physicians and patients more effectively manage their encounters. The authors make it clear that 'more medical care' may frequently be harmful to a patient's health." Robert Graham, MD, Professor of Family and Community Medicine, University of Cincinnati
"This book is a must read for informing the dialogue about health care reform and transforming medical education. Its humanistic authors provide support for re-integrating the lost art of humanism with more scientific medicine. The authors' passion for the individual behind the illness is contagious." Afaf I. Meleis, Ph.D., DrPS (hon), FAAN, Margaret Bond Simon Dean of Nursing, University of Pennsylvania
"Doctors take an oath to do no harm. Yet more than ever, modern medicine makes healthy people sick. Emergency physicians Leana Wen and Josh Kosowski make a passionate argument for patients to get involved and informed about their care. A fast, smart read to help you take charge of your health." Audrey Young Crissman, MD, author of What My Patients Taught Me: A Medical Student's Journey
"Evidenced based medicine, clinical guidelines, and diagnostic algorithms have been widely adopted as an answer to inconsistent and out-of-date medical practice. Drs. Leana Wen and Joshua Kosowsky make the case that the resultant algorithms-gone-wild syndrome seen in many medical settings today actually drives imprecise and wasteful testing, muddled diagnoses, and patient confusion. They argue that these clinical behaviors are at the heart of our "morbidly obese" medical care system and that thoughtful physicians relying on patient narratives and diagnostic common sense will create a leaner medical care system and better patient outcomes. Theirs is a contrarian and compelling case with the wellbeing of millions of patients and $250 billion a year riding on it." Fitzhugh Mullan, MD, Murdock Head Professor of Medicine and Health Policy, The George Washington University
"When Doctors Don't Listen by Drs.Wen and Kosowsky have insightfully crafted a revelation about the workings of modern medicine. It addresses with a finely nuanced balance the basis for our dysfunctional "cookbook style" of medicine. The analysis is not a critical pontification by outsiders, but a pained view by deeply informed insiders. The book pleads powerfully for the disenfranchised patient. It must be read both because most of us sooner or later are bound to seek health care and because the authors provide an important viewpoint for the intensifying nationwide health care debate." Bernard Lown, MD, Professor emeritus Harvard School of Public Health, Senior Physician emeritus Brigham and Women's Hospital, Nobel Peace Laureate 1985
"What a brilliant concept – this outstanding book provides an innovative and interesting approach to understanding how physicians interact with patients presenting with an illness and reach a diagnosis. Using a case-based approach followed with careful analysis of the process by two experts in the field of Emergency Medicine, clarity and transparency are provided to one of the most complex areas of medicine, how the physician develops the framework for a diagnosis and orders tests to prove it. Drs. Wen and Kosowsky have given the non-medically trained reader a variety of common scenarios for presentation to the Emergency Department. Physicians often reach a wrong diagnosis by following set pathways hard-wired from years of training and experience. Unfortunately, key words or phrases from the patient which lead the physician down a "typical" pathway for an illness can trigger the wrong answer and result in a large number of expensive, time-consuming, and potentially harmful tests. By teaching the patient the importance of providing the essential information on their illness to the physician, and making sure the physician actually listens to them, the likelihood that the physician makes the correct diagnosis increases substantially. This excellent book contains a literal treasure trove of information which will be beneficial and educational for patient and physician alike. As popular as the ED has been over the last two decades, pictured in television shows such as "ER" and other medically oriented television series, I anticipate this book will be widely read, very successful, and often quoted, not only by the lay public but also the medically-trained care providers who strive to listen better to their patients." W. Brian Gibler, MD FACEP, FACC, President and CEO, University Hospital, Senior Vice President, UC Health, Professor of Emergency Medicine, University of Cincinnati College of Medicine
This is a well-written book on an innovative approach to healthcare reform: it challenges patients to take charge of their health and every medical encounter with their doctor. An important topic and an important book--I encourage my patients to read it.
It's critical for patients to advocate for their own health. This book teaches you how…Read it; it will change radically how you approach your doctors.
Product Details
- 9781250013576
- Publisher:
- St. Martin's Press
- Publication date:
- 01/15/2013
- Sold by:
- Macmillan
- Format:
- NOOK Book
- Pages:
- 352
- Sales rank:
- 1,048,119
- File size:
Read an Excerpt
When Doctors Don't Listen
How to Avoid Misdiagnoses and Unnecessary Tests
By Leana Wen, Joshua Kosowsky
St. Martin's PressCopyright © 2012 Leana Wen, M.D., and Joshua M. Kosowsky, M.D.
All rights reserved.
From Shamans to Black Boxes
Arthur Coates is a partner in one of Boston's most prestigious law firms. At fifty-seven, with more than thirty years of malpractice law under his belt, Arthur is known in the business as being "sharp as a tack, with the instinct of a killer whale." Today was the culmination of a multibillion-dollar lawsuit involving a local hospital and several of its staff. It was just before lunchtime, and he was cross-examining the last witness when a most remarkable incident occurred.
"Were you aware that my client had a previous history of heart disease?" Arthur asked the witness. He was pacing the room with a steady, deliberate gait, a style characteristic for him, noted his younger colleague, Tim Simcock, who was watching from gallery.
As the witness was about to respond, Arthur spoke again, this time appearing to direct the question to the judge.
"Were you aware of my client's previous history of heart disease?" he asked.
What a strange strategy to repeat the question like that? Tim thought. Maybe this is how Arthur does things; perhaps Tim should take notes on Arthur's style. The opposing attorney objected, but the judge motioned to the witness to answer anyway.
"I don't recall," he stated.
"Did you know about my client's heart disease?" Arthur asked again, this time to no one in particular. "Were you aware that my client had suffered previously from heart disease?"
The opposing attorney got on his feet, yelling, "Objection — asked and answered!" but Arthur went on asking the same question several more times. Tim saw that Arthur's gait had sped up. It wasn't unsteady, but he wasn't walking in any particular direction. Could it be that the great Arthur Coates couldn't remember what else he had to ask? Tim stood up to approach the bench and request a sidebar. As he got closer, he saw that beads of sweat were pouring down Arthur's face. The judge was banging his gavel, but Arthur appeared to take no notice. The entire room was watching Arthur, transfixed. There were murmurs. What's happening? Is it a trick? Is Arthur Coates having a breakdown?
"There is something wrong!" Tim shouted. "He needs a doctor!"
A recess was called. As it happens, there was a doctor in the courtroom — the one who Arthur had just been questioning. The doctor stepped from the witness box and cautiously made his way over to his former interrogator, who was now crouched in the middle of the courtroom like a vanquished gladiator, his head buried in his hands.
"Are you OK? Do you need help?" In a curious reversal of roles, it was the doctor asking the questions.
Arthur shook his head. "Do I know you?"
How bizarre! This was one of the most sought-after minds in his profession, and he couldn't remember a key witness? But not only couldn't Arthur recall any details of the case, he didn't know that he was in court or that the year was 2012.
"I think he may be having a stroke," concluded the doctor, a gynecologist by training, but familiar enough with basic neurology to know that sudden memory loss was potentially quite serious. "Someone call for an ambulance!"
* * *
"Who are you again?" Arthur asked Tim quizzically as they rode together in the back of the ambulance.
Tim sighed. It was the third time Arthur had asked him this question since leaving the courthouse. "Tim. We've worked at the same firm for the past eight years. We golf together. Our wives are in the same book club."
"Oh," Arthur replied. To Tim, it looked as if his colleague registered what he just said, but a few minutes later, when he asked Arthur if he remembered him, Arthur shrugged. He was apologetic, but really — he just didn't remember.
This was how Arthur Coates presented to us in the ER. On the surface, Arthur appeared like any other high-powered lawyer: middle-aged, distinguished-looking, with a dark power suit and blood-red tie. He feels great, he said. And yet he had no clue what day of the week or what month it was. He nodded when he's told that he's at a hospital in Boston, but a few minutes later, he no longer remembered this. When he was asked to recall three objects — a pencil, a lamp, and a curtain — he could repeat them back instantaneously, but a minute later, he could not remember any of them. Interestingly, though, he knew that he was born in 1953 in Omaha, Nebraska. He told us that his childhood best friend was a scrawny kid named Auggie and that his first dog was a yippy tan Yorkshire terrier.
The rest of Arthur's history and physical exam was unremarkable. His wife, Amy, arrived and confirmed that Arthur was generally healthy. He'd never had anything like this happen before. In fact, he hadn't missed a day of work in his life. He took no medications other than a baby aspirin each morning, and he went to the gym three times a week. He hadn't been traveling to any exotic locations, and nobody around him had been sick. His vital signs were all normal, as was his vision, hearing, speech, and gross motor and sensory function. He had normal reflexes, coordination, balance, and gait. When asked to perform basic addition and subtraction or spell "W-O-R-L-D" backward, he seemed to have no difficulty whatsoever.
Could the great Arthur Coates have had a nervous breakdown? Tim wondered. It had been a stressful few weeks leading up to the trial, and this morning's proceedings had more than their share of tense moments. "But this is a guy who's argued dozens of cases like this! It's just not like him to react this way!"
* * *
Arthur's behavior may seem bizarre, but he was actually exhibiting classic signs of a disease called "transient global ischemia." First described in the 1970s in a case involving a farmer who drove a tractor onto a busy highway because he could not remember who he was or where he was going, transient global ischemia is characterized by a sudden loss of recent memory. Patients tend to recall deeply encoded, distant events like childhood memories, but not recent happenings. Other than memory failure, they do not have any other neurological deficits. The cause of this ailment is unknown, though it is more common in males than females, and there is some association with a prior stressful or emotional event. The symptoms are self-resolving, usually completely disappearing within twenty-four hours.
Because transient global ischemia is so highly classic and specific, afflicted patients can be sent home to await symptom resolution as long as the caretakers at home are comfortable taking care of them. Twenty years ago, Arthur could have been diagnosed based on his clinical presentation alone. No further workup would have been provided, because it was clear what he had. Today, even though his diagnosis could have been made just by hearing his story, the doctors taking care of Arthur were petrified of him going home to recover on his own. Our discussion in the ER went like this: what if we were missing something bad, something really bad? What if he was having some type of stroke that we hadn't thought of? Some unusual metabolic disease?
Never mind that Arthur exhibited none of the signs concerning for this smorgasbord of bad diseases. Yet, the resulting management was predictable: to be "on the safe side," Arthur was told he needed to go through the entire battery of tests. So he got a head CT to make sure he didn't have bleeding in his brain. His CT was normal, so an MRI was ordered to look for a more subtle stroke. In the meantime, his blood tests, chest X-ray, and EKG also came back normal and offered no explanation for his symptoms, so the neurologists were called to see Arthur. After several hours of consultation, and with absolutely normal tests, their conclusions were similar to ours: "Symptoms are consistent with transient global ischemia," they wrote, "but we cannot exclude transient thromboembolic phenomenon or atypical seizure activity." They recommended further studies to "rule out" these remote possibilities, not acknowledging the difficulty of proving a negative.
So Arthur waited in the hospital overnight. By later that evening, he was pretty much back to normal. But there were still more tests to do. Arthur stayed overnight to have brain wave tests to make sure he was not having a seizure (he wasn't) and an ultrasound of his heart to confirm that his heart valves were normal (they were). Finally, late the next evening, he was discharged home, some thirty-six hours after Tim and the ambulance crew brought him in.
Why is it that Arthur Coates stayed in the hospital at a cost of tens of thousands of dollars in studies, procedures, and specialists' time, when he could have been sent home in the first place? Why did we need blood draws and radiation to conclude that he didn't have diseases that he never showed signs of? Why couldn't doctors have provided the reassurance of both the diagnosis and the expected course of his illness, sparing him and his family many fretful hours worrying about heart attacks and strokes and seizures and whether they would ever have the old Arthur Coates back?
We were there — we can tell you why. It's because doctors today no longer think that patients can be relied upon to tell the history of their illness. It's because "ruling out" bad diseases has taken precedence over making a diagnosis. It's because we have elaborate tests available at our fingertips, and both doctors and patients have an unshakable belief in technology. Never mind that the fancy tests add little value, especially when used to exclude diagnoses that weren't likely in the first place. Never mind that the procedures may actually impose risk or cause actual harm.
Diseases have always existed, but modern technology has not always been available. To explain how far we have come, for better and for worse, we present a brief history of medical diagnosis. We identify four periods, what we term the Four Eras of Diagnosis. As you read, think about the three patients you've been introduced to: Jerry the mechanic with chest tightness, Denise the housewife with vomiting and diarrhea, and Arthur the lawyer with sudden memory loss. How would the diagnostic process been different in each of the four eras? Would their care have been better then or now? Would yours?
* * *
Let's call the First Era of Diagnosis the "Era of Spiritual Healing and Magical Thinking." Records dating back thousands of years have described shamans, faith healers, and their equivalents as healers who provided what would now be called medical care through spiritual means. Virtually every ancient society had one such person or a designated group of people who was said to possess the magical powers to heal — and as a prerequisite to that, to diagnose.
Many of these ancient faith healers had knowledge of local plants and herbs and made liberal use of medicinal concoctions in their practice. Others utilized the power of chants and group prayer. The Peruvian Amazons believed that spirits would teach their shaman, the "curandero," a song; the shaman's job was to learn the song in order to figure out the specific illness. In other cultures, the key to diagnosis lay in the identification of the appropriate evil spirit, and the faith healer's job was to possess the body of the ill and chase out the spirit causing harm. In the Hmong culture, the healer, called the "Shi Yi," was said to restore health by calling the soul of the sick from travels with bad spirits and back into the human body.
This form of healing, grounded in belief of spirits and magic, seems worlds apart from medicine as we know it today. But there is something of this First Era that we still find in modern medicine: the notion of implicit trust. Then, as now, those who are sick entrust their health and well-being to a designated healer. In ancient times, illness was a literal black box: you tell your healer your problems, the healer shakes a black box, and out comes a solution of some kind. As a faithful member of the community, you trust your healer and accept the outcome.
Why do we even mention this era when we can take it at face value that few of us would prefer to live back in the land of shamans and black boxes? We discuss it because this era is not entirely in the past. Alternative healing methods are actively practiced today. Many societies continue to rely on shamans and faith healers. In the United States, 74 percent of patients report that they use complementary and alternative therapies in addition to Western medicine, including herbs and "new age" medicine techniques such as qi gong spiritual healing and reiki energy healing.
It's interesting to note that these alternative healing modalities continue to emphasize the patient first and foremost. Making a diagnosis requires attention to the individual and his stories. In addition, because healers are typically from the same community as their patients, cultural context is necessarily taken into account as part of the diagnostic process. In all cases, a diagnosis (whether correct or not) is given, with treatment tailored to fix the problem identified. Perhaps as a result, these forms of treatment result in total commitment from the patient and their families, and adherence to the treatment regimen tends to be very high.
With the dawn of recorded history came the Second Era of Diagnosis, which we call the "Era of Early Empiricism and Disease Classification." As far back as 2000 B.C., the Egyptian scholar Imhotep wrote the medical textbook known as the Edwin Smith Papyrus. This is the first known text in the ancient world to describe in detail a method of diagnosis whereby each disease has corresponding symptoms and physical findings. A subsequent Babylonian text, The Diagnostic Handbook, introduced the role of empiricism and logic in diagnosis, focusing on rules for predicting when and how a constellation of symptoms and signs represented a particular disease state.
The Father of Western Medicine, Hippocrates, was the preeminent physician of his time, and his works epitomize the diagnostic approach in this Second Era. Hippocrates was deeply invested in describing the natural history of illnesses — how symptoms came together and how they progressed over time. For example, he was one of the first to describe epilepsy as a syndrome of uncontrolled, recurrent seizures. It was not known what caused it or how to prevent the seizures from recurring (many contemporaries continued to believe that they were a form of "possession" by evil spirits), but Hippocrates noted that lying the patient flat on the ground was beneficial (at the very least, to prevent the patients from further injuring himself or others). Hippocrates also recognized the syndrome of persistent cough, fever, and wasting as pneumonia, which he described as a contagious disease because family members and close contacts appeared to contract it. Unfortunately, this was often a fatal diagnosis, as there was no cure at the time.
Though Hippocrates's focus was on disease description and not on diagnosis per se, his detailed writings allowed for progress. Patterns of symptoms formed the basis of disease classification, and pattern recognition became the basis of diagnosis and medical reasoning. In Hippocrates's time, few other diagnostic tools existed; moreover, the ancient Greek taboo against dissection meant that little was known about the anatomical basis of disease. Under the tutelage of a master physician, students would learn to recognize common illnesses by learning about and then observing patterns of signs and symptoms. Over time, new diseases would be described and their natural histories recounted. Physicians practicing in this Second Era relied almost exclusively on interactions with their patients and their families, not dissimilar to the First Era.
It was during Hippocrates's time that the idea of the "expert physician" first emerged. Hippocrates himself was regarded as one, along with several of his contemporaries. These were physicians that patients traveled to from near and far to get their expert opinion, and students huddled in amphitheaters into the wee hours to listen to their ruminations. Even at this early juncture, medicine was coming to be recognized as a practice — a process of learning that takes years to refine and perfect.
Excerpted from When Doctors Don't Listen by Leana Wen, Joshua Kosowsky. Copyright © 2012 Leana Wen, M.D., and Joshua M. Kosowsky, M.D.. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Meet the Author
DR. LEANA WEN is an Attending Physician and Director of Patient-Centered Care Research in the Department of Emergency Medicine at George Washington University. Inspired by her own childhood illness and then her mother's long battle with cancer, Dr. Wen is passionate about guiding patients to advocate for better care. A former Rhodes Scholar and Clinical Fellow at Harvard Medical School, she has published dozens of articles on patient-doctor communication. She speaks around the world on patient empowerment and healthcare reform.
DR. JOSH KOSOWSKY is assistant professor at Harvard Medical School and the Clinical Director of the Brigham&Women's Emergency Medicine Department. He is the author of over two dozen articles and textbook chapters, and is co-editor of Pocket Emergency Medicine.
Dr. Wen is a clinical fellow at Harvard Medical School and an emergency physician at Brigham&Women's Hospital and Massachusetts General Hospital. She is passionate about empowering and advocating for patients. Born in Shanghai, China, and raised in Los Angeles, Dr. Wen graduated from Washington University School of Medicine and won the Rhodes Scholarship to attend the University of Oxford. She has been a fellow and consultant to the World Health Organization, the Brookings Institution, Eurasia Group, and China Medical Board. Dr. Wen has served as the National President of the American Medical Student Association and is currently the President of the American Academy of Emergency Medicine/Resident and Student Association. Recognized for her leadership in national and international health, she was selected to Chair the Young Professionals Commission, a group of 25 young health professionals chosen from around the world to re-envision global health professional education. In 2007, she was also selected by the Secretary of Health and Human Services to represent physicians-in-training on the Council on Graduate Medical Education, an advisory commission to Congress.
An active researcher in better ways to improve patient-physician communication, Dr. Wen has received grant support from the National Institutes of Health, the Beckman Foundation, the American College of Emergency Physicians, and the Howard Hughes Medical Institute. She has published numerous scientific publications including in the Lancet, JAMA, and Annals of Emergency Medicine, and has served as a regular columnist for news outlets including The New Physician, Common Sense, and Medscape.com. With journalist Nick Kristof, she wrote a blog for the New York Times, along with articles in the Washington Post, St. Louis Post-Dispatch, Worth magazine, and others. She is the co-author of a forthcoming book on the importance of patient advocacy in healthcare reform, When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests.
Dr. Wen has been featured in TIME, Newsweek, ABC News, The New York Times, Washington Post, Teen Vogue, and the award-winning HBO documentary Reporter. A professional speaker for ten years, she is sought after in the U.S. and around the world, with annual engagements throughout Europe, the Americas, Asia, and Africa.
Dr. Kosowsky is the Clinical Director of the Emergency Department at Brigham&Women's Hospital and Assistant Professor of Emergency Medicine at Harvard Medical School. He received his undergraduate degree with Honors in Mathematics and Philosophy from Harvard College, then subsequently won a Fulbright Scholarship. Since graduating with Honors from Harvard Medical School and completing his residency in Emergency Medicine at the University of Cincinnati, he has been a dedicated clinician and educator who has won much acclaim in these roles. At Harvard Medical School, he received awards from medical students and residents for teaching excellence. As director of the "Introduction to Clinical Medicine" which helps to prepare Harvard medical students for their hospital clerkships, he has introduced many innovative elements to the curriculum around issues of "patient-doctor" communication.
Dr. Kosowsky and his team at Brigham&Women's have been recognized for clinical innovation and excellence in the delivery of emergency medicine services. Dr. Kosowsky serves on the Hospital's Institutional Review Board, Ethics Committee, Physician Council, and Medical Staff Executive Committee. He is the author of over three dozen peer-reviewed articles and textbook chapters, and is co-editor of the textbook "Pocket Emergency Medicine." He has given over a hundred invited presentations at hospitals and medical schools across the U.S. He is a frequent Grand Rounds speaker for Emergency Medicine, Internal Medicine, Cardiology, and other conferences across the U.S., and is on the core faculty for four national Emergency Medicine courses. He serves on the Editorial Board of a half-dozen medical journals, ranging from Annals of Emergency Medicine to The American Journal of Cardiology. Along with Dr. Leana Wen, Dr. Kosowsky is the co-author of the forthcoming book on patient advocacy: When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. He lives in Sharon, Massachusetts, with his wife and three boys.
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A great read about how you as a patient can advocate for yourself and understand how doctors are trained to think in a certain direction.
I'm not finished with this book but what I've read it's highly recommended. This book gives you an insight to the medical profession and how doctors thinking needs to be changed and what the patient can do to help themselves.
Two able Emergency room physicians discuss some of the paths to failures of care in emergency room or other acute care situations. Most such failures are related to systemic errors. A good part of the book is devoted to examples of such paths to failures and then to instruction to patients or their companions on how to avoid such traps. The instructions are designed to allow patient to recognize traps of physician focus, care fragmentation, and shallow decisions. While all would know the term cookbook, some might know pathway, but few would know algorithm as they apply to medical care. They then suggest patients respond by questioning the physician. What is the working diagnosis (what do they think I have)? What is planned next and why? Many other questions are suggested. The goal is working collaboratively with their doctor and team to decide diagnosis and care. As a physician, I believe, most educated and sophisticated patients enter this arrangement. Such rapport worked for my oncology patients. Some to reach for some feeling of control. Others for understanding and what the authors propose as the goal, better outcomes. The proposal is hard to envision in a busy ER. Most patients would find it difficult to get answers from Dr. or staff in a emergency room. It is really aimed at the educated and very strongly focused patient. Some of patients may find it useful, most will find it educational and all find it bit frightening. Less sophisticated readers might get little useful from the book. It is a bit laborious to read.
I was surprised by how much I would enjoy this book. I'm not normally someone who reads nonfiction medical books, but this was recommended to me by a friend of a friend. It's a fantastic read, with lots of interesting stories that illustrate what is wrong with the healthcare system and how it affects each of us. Healthcare today makes patients feel utterly out of control and powerless, and this book contains lots of tips like the 8 Pillars to Better Diagnosis for empowering patients to take back control. It's well-written with memorable anecdotes and filled with useful advice. I highly recommend it anyone who has ever seen a doctor or will plan to see one (that is to say, everyone!).


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The Written Gospel
Edited by Markus Bockmuehl Donald A. Hagner
Format: Hardback
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Written Gospel by Markus Bockmuehl
Book DescriptionThis book comprehensively surveys the origin, production and reception of the canonical gospels in the early church. The discussion unfolds in three steps. Part One traces the origin of the 'gospel' of Jesus, its significance in Jewish and Hellenistic contexts of the first century, and its development from eyewitness memory to oral tradition and written text. Part Two then more specifically examines the composition, design and intentions of each of the four canonical gospels. Widening the focus, Part Three first asks about gospel-writing as viewed from the perspective of ancient Jews and pagans before turning to the question of reception history in the proliferation of 'apocryphal' gospels, in the formation of the canon, and in the beginnings of a gospel commentary tradition.
Buy Written Gospel book by Markus Bockmuehl from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9780521832854
(228mm x 152mm x 25mm)
Pages: 388
Imprint: Cambridge University Press
Publisher: Cambridge University Press
Publish Date: 28-Jul-2005
Country of Publication: United Kingdom
Other Editions...
Books By Author Markus Bockmuehl
Paradise in Antiquity, Paperback (May 2013)
The essays in this volume highlight the multiple perspectives on Paradise from Second Temple Judaism and Christian origins to Augustine and rabbinic literature.
Redemption and Resistance, Paperback (July 2009)
Offers a discussion of Messianism as a topic of political and religious commitment and controversy. This book serves as a contribution to the history of ancient Judaism and Christianity, of the complex and often problematic relationship between them, and of the conflicting loyalties.
Epistle to the Philippians, Paperback (June 2006)» View all books by Markus Bockmuehl
Offers a critical engagement with several of the different approaches to Pauline interpretation, including questions of rhetoric and social convention. This commentary relates an understanding of the letter's first century impact to the wider concerns of Christian theology.
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Author Biography - Markus Bockmuehl
Markus Bockmuehl is Reader in New Testament Studies at the University of Cambridge and a Fellow of Fitzwilliam College. His publications include (ed.) The Cambridge Companion to Jesus (2001). Donald A. Hagner is the George Eldon Ladd Professor of New Testament at Fuller Theological Seminary. His publications include commentaries on Matthew (1993) and Hebrews (1990).
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Based on anything you have explained and my very own intuition (which never fails me) I think she was murdered, as well. Pain relief and sleep: Muscle relaxants (tizanidine, cyclobenzaprine, metaxalone). CHARACTERISTICS AND SYMPTOMS OF SD More than the usual quarter of respondents to NSF's poll believed their quality of sleep was poor, with 15 percent of those surveyed using prescriptions or over-the-counter (OTC) drugs several nights per month to promote sleep. Yet sometimes these ailments are unavoidable, and we should try to provide the very best care offered by modern veterinary medicine. She would have been a 53-year-old woman, but I don't think she even would have liked to listen for me to refer to her as a woman. My lab became severely depressed whenever we had an Elizabethan collar on her behalf, so we decided it was not a good selection for her mainly because it caused an extra problem. Why were deputies with no training nor experience with death scenes investigating allowed in the actual death scene. There are numerous other complimentary therapies now being used. The occasional bout of constipation in adults is being expected, in most cases corrects itself within a couple of days. Therefore, treatment programs has to be individualized. "Dear woman," Grandmother Growth's voice seems to float in the deepening twilight, echoing, reverberating, ringing in your ears. If a headache attack is severe, then other things that are was planned to the day is out the window-it's just not going to happen. There are patches of skin showing through on its stomach where fur used to be. It may take anywhere from 3-5 weeks before Pamelor or Praminil produce the most effective pain relief. Patient who are afflicted by MS have similar issues with exercise. Warning: Watch out for the serious complication of shingles- Post Herpetic Neuralgia (PHN). Some from the common signs and symptoms of neuropathic pain include shooting pain, burning pain, tingling, numbness, paresthesia and numbness. There are medications that can be prescribed safely that could not only assist you to sleep, but also help with any anxiety or depression-related symptoms. Her doctor at UCLA first belief that Morgan was frightened to death. You can have sudden jerky movements of the legs and muscles that could occur because your eye movement and body movement slows down.


text:
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Audi vs Bmw lets see who is the muscle of Germany filmed on closed road in mexico
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http://www.stillen.com/intaketv For product info. and pricing.
BMW E60 ///M5 vs Audi B5 S4 Bi-Turbo
Just having some fun with my buddy and his Bi-turbo S4. BMW E60 ///M5 - Evolve Alpha-N Tune RPi Scoops / Block Plates / BMC Filter RPi ST Pulley Meisterschaft Section 1 / Straight Pipes Audi B5 S4 Bi-turbo - GIAC Stage 1 Tune JHM Short Throw 3" Straight Pipe Exhaust K&N Intake
415hp Wagon S4 vs 275hp Cayman, With Chris Harris - /TUNED
Matt showed up in t he UK to bother Chris, and over pints, got into a discussion about the "ideal" amount of tuning for a daily driver, as well as whether we'd rather have a fast sleeper Audi or a slow 2013 Porsche Cayman. Agree with us?


text:
Tropical Fish Keeping - Aquarium fish care and resources (http://www.tropicalfishkeeping.com/forum.php)
- Ancient Fish (http://www.tropicalfishkeeping.com/ancient-fish/)
- - Does anybody know about these ancient fish? (http://www.tropicalfishkeeping.com/ancient-fish/does-anybody-know-about-these-ancient-98871/)
Does anybody know about these ancient fish?
I was wondering if anybody knew about reedfish, peacock eels, dinosaur bichirs, or dragon gobies and if 1 of them could go into a 38 gallon tank with a 2-3 of angelfish, an african featherfin catfish, a twig cat, and 6 silver hatchetfish? Thanks.
Do not put a Dinosaur Bichir, also know as the Senegal Bichir in tank that size. It's too small, they won't have enough room to move around and be truly happy. They get to be up to 12 inches long (though there are cases of them getting even bigger in captivity)...and need at least a 50 gallon Long.
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PSA: Judge Judy has not served on the Supreme Court
Because you can't make this stuff up …
Because you can't make this stuff up …
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Kerry, a 1966 graduate of Yale, spoke to students and their families, faculty and staff at the Ivy League school's 313th commencement. (…)
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text:
American Foreign Relations Reconsidered
Edited by Gordon Martel
Format: Hardback
Normal Price: $212.00
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American Foreign Relations Reconsidered by Gordon Martel
Book DescriptionThis major new textbook brings together twelve of the leading scholars of U.S. foreign relations. Each contributor provides a clear, concise summary of an important period or theme in US diplomatic and strategic affairs since the Spanish-American War. Michael Hunt and Joan Hoff provide an overview of the traditions behind US policy and a preview of things to come. Together, the contributors offer a succinct explanation of the controversies and questions that historians have grappled with throughout the twentieth century. Students will find these essays a reliable and useful guide to the various schools of thought which have emerged. Although each of the scholars is well known for their detailed and original work, these essays are new and have been specially commissioned for this book. The articles follow the chronological development of the emergence of the United States as a world power, but special themes such as the American policy process, economic interests, relations with the Third World, and the dynamics of the nuclear arms race have been singled out for separate treatment. American Foreign Relations Reconsidered, 1890-1993 represents essential reading for upper level undergraduates studying modern American history. The book has been designed and written exclusively to meet the needs of students, either as a major course text, or as a set of supplementary readings to support other texts.
Buy American Foreign Relations Reconsidered book by Gordon Martel from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9780415104760
(234mm x 156mm x 19mm)
Pages: 280
Imprint: Routledge
Publisher: Taylor & Francis Ltd
Publish Date: 19-May-1994
Country of Publication: United Kingdom
Other Editions...
Books By Author Gordon Martel
Month That Changed the World, Paperback (April 2017)
The dramatic step-by-step account of how the assassination of an Austrian archduke in the Balkans led to the cataclysm of the First World War over five fateful weeks in the summer of 1914.
Origins of the First World War, Hardback (October 2016)
"Summarises the policies, issues and crises that brought Europe to war in 1914"--Provided by the publisher.
Twentieth-Century War and Conflict, Paperback (July 2014)
Drawn from the award-winning 5-volume Encyclopedia of War, this valuable, one-volume reference provides readers with essential information on the conflicts and concepts that shaped global warfare in the twentieth-century and up to the present day.
Encyclopedia of War, Hardback (January 2012)» View all books by Gordon Martel
This ground-breaking 5-volume reference is a comprehensive print and electronic resource covering the history of warfare from ancient times to the present day, across the entire globe.
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text: Listen Audio 3:12 Grazier welcomes new drought support measures ABC Rural Neroli Roocke Updated Thu May 30 17:39:53 EST 2013 Announcing new drought assistance measures for cattle graziers, the Qld Premier Campbell Newman and Agriculture Minister John McVeigh visited Wyangarie Station near Richmond today. Owner David Carter says everyone in the region is feeling the stress and pressure of drought. He talked to Neroli Roocke on the Country Hour. Share Email Facebook Twitter


text:
Cookies and brownies, we've all grown up on them. I think your recipe is fantastic but I am not sure that I can make it with the correct aroma and taste. Yet I shall try. I would also come back soon to share my favorite recipe with you here.
Also would like to add that I have picked up some brownies from a vending machine some time back and thought they would taste but unfortunately coming from Jell-O they really tasted awful. Not going to try one ever again. :)


text:
The Oberon Book of Modern Monolgues for Women
Edited by Catherine Weate
Format: Paperback
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Oberon Book of Modern Monolgues for Women by Catherine Weate
Book Description"The Oberon Book of Modern Monologues for Women" is an essential resource for actors participating in acting classes, contests, auditions, and rehearsals. This book collects over fifty speeches from some of the finest plays of the last twenty years, bringing together specially selected speeches by essential modern dramatists.
Buy Oberon Book of Modern Monolgues for Women book by Catherine Weate from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9781840028263
(210mm x 130mm x 13mm)
Pages: 192
Imprint: Oberon Books Ltd
Publisher: Oberon Books Ltd
Publish Date: 19-Jun-2008
Country of Publication: United Kingdom
Books By Author Catherine Weate
Oberon Book of Modern Monologues for Women Volume Two, Paperback (January 2013)
A collection of female monologues selected from the best in modern British playwrighting from the last 5 years. Perfect for actors and students looking for that ideal monologue for an audition or student showcase.
Oberon Book of Modern Monologues for Men Volume Two, Paperback (January 2013)
A collection of male monologues selected from the best in modern British playwrighting from the last 5 years. Perfect for actors and students looking for that ideal monologue for an audition or student showcase.
Modern Voice, Paperback (June 2012)
Presenting an overview of different types and styles of contemporary drama, Modern Voice, guides actors, directors, lecturers, teachers, trainers and coaches through the challenges of voicing modern texts.
Oberon Book of Duologues, Paperback (April 2009)» View all books by Catherine Weate
A unique and useful resource for amateur, student, and professional actors alike, participating in acting classes, contests, auditions and rehearsals.
» Have you read this book? We'd like to know what you think about it - write a review about Oberon Book of Modern Monolgues for Women book by Catherine Weate and you'll earn 50c in Boomerang Bucks loyalty dollars (you must be a member - it's free to sign up!)
Author Biography - Catherine Weate
Catherine Weate / B.A. / Dip.Ed. / L.S.D.A. / F.R.S.A. has been coaching voice for over twenty years. She has been Head of Voice at Rose Bruford College, Head of Voice and Vice Principal at the Academy of Live and Recorded Arts and Head of Examinations at LAMDA.
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text:
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Customer Favorites NOOK Top 100 NY Times Bestsellers Trending NOOK Books New Releases Coming Soon NOOK Books Deals NOOK Foreign Language LendMe™ Books …Greensboro, NC. North Carolina's third largest city with a population of almost 260,000, Greensboro is rich in history and the arts, as well as sports and entertainment.Greensboro: Symbolic figure in front of NATHANAEL GREENE MONUMENT during memorial at Guilford Courthouse National Military Park Greensboro NC March 2008Greensboro (formerly Greensborough) is a city in the U.S. state of North Carolina. It is the third-largest city by population in North Carolina and the largest city ...Save big on Greensboro golf tee times by booking online with GolfNow.com. Book your golf tee time reservations at North Carolina's best golf courses today.Find free wifi in Greensboro, NC. Listing and guides of where the public can find free Wi-Fi (WiFi) wireless Internet access hotspots.Cooking Courses and Lessons at Guilford Technical Community College; Classes in Cake baking & Cake Decorating, and SpringThe Greensboro sit-ins were a series of nonviolent protests in Greensboro, North Carolina in 1960 which led to the Woolworth department store chain reversing its ...Koury Corporation is pleased to announce that Four Seasons Station, the area's newest entertainment and retail destination is now under construction.The University of North Carolina at Greensboro Department of Counseling and Educational Development 228 Curry Building, PO Box 26170 Greensboro, NC 27402 …
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text:
Christmas Family Assistance Request Forms are now available at the Mt. Juliet Community Center and the Health Center next to the Celebration Lutheran Church on N. Mt. Juliet Road until Dec. 13.
Big Brothers Annual Mother's Toy Store will be held at the Mt. Juliet Middle School Saturday, Dec. 21 from 11 a.m. to 4 p.m.. It is an opportunity for parents with limited means to shop free of charge for holiday gifts for their children ages newborn to 16 years, and for their special needs children up to 21 years old.
To shop at Mother's Toy Store, parents need to provide their picture ID, official proof of their address, an official form of identification of each of their children with proof of age, and documented proof of a need for financial support. Social Security cards cannot be used for identification.
Last year, the non-profit volunteer organization was able to supply toys to more than 600 Mt. Juliet children, and to deliver food baskets to 325 area families. Big Brothers' President Sherry Bilbrey reminds applicants to put their copy of the application form in a safe place. "It's required in order to be served at Mother's Toy Store.


text:
Paraguay is on the eve of a historic political transition as a left-leaning former bishop promises to oust the world's longest-ruling party from power tomorrow. Fernando Lugo quit his job preaching liberation theology to the impoverished masses to tackle the entrenched power of the Colorado Party, which has ruled the Latin American nation for the past 62 years.
Opinion polls suggest that the ex-priest is on the brink of becoming the latest left-wing leader to be swept to power in the remarkable "pink" tide that has swept the continent. Dubbed the Red Bishop, Mr Lugo has proved to be a formidable presidential candidate, attacking the interests of the large Brazilian landowners in Paraguay and promising to renegotiate the country's energy deal with its vast neighbour.
Previously the bishop of the poor diocese of San Pedro, he has a strong human rights track record and has led peasant protests and defied local agribusiness barons. After exchanging the pulpit for the soapbox in 2006, he drummed up nationwide support for his candidacy based on a single word – cambio, or change.
"It's the first time people really have the expectation that change is possible," said Alfredo Cantero, the political editor of ABC/Color. The influential newspaper is traditionally a bastion of liberal economic views, but no longer makes a secret of its support for the left-wing former prelate.
The change people are looking out for is the defeat of the Colorado Party and subsequently an improvement in their economic situation. But despite leading by at least five points in the polls, Mr Lugo still faces a tough battle to win tomorrow's election.
Blanca Ovelar, the Colorado candidate and former education minister, is backed by impressive political machinery that has been accused of every possible kind of fraud in the past. Public servants are reported to have received a letter from Mrs Ovelar reminding them who they work for.
"The Colorado Party will accept defeat if the margin is big enough," says Mr Cantero, "but they'll do everything to stop that happening, ranging from fraud to threats and riots."
The other main contender is an archetypal Latin-American caudillo, or strongman, Lino Oviedo. Like the Venezuelan President, Hugo Chavez, Mr Oviedo is a chatty populist and former army officer, convicted of plotting a coup. The caudillo has a large following in rural areas thanks to his tough-on-corruption stance and paternalistic manner. Despite railing against the Colorado Party, he was released from jail to lure supporters away from Mr Lugo, according to President Niconar Duarte's own admission.
Nonetheless, the former bishop has managed to stay ahead of the field until now, building up grassroots support by trailing across the country for more than a year talking to the rural poor and promising them land reform, security and an end to corruption.
Using more modern platforms, such as YouTube, Mr Lugo has also connected with his two million countrymen abroad. Realising the importance of a high turnout, his supporters have also arranged for two free trains to take thousands of migrant workers from the Argentine capital of Buenos Aires to the Paraguayan border before Sunday, so they can vote in their home towns.
But the former bishop's politics remain something of an enigma. It is clear he favours a far more left-of-centre approach than Paraguay, a traditional US-ally, is used to. But his backers range from radical peasant leaders to the establishment Liberal Party. His critics say Mr Lugo is another Hugo Chavez, but he says he admires the Brazilian President, Lula da Silva, and his Chilean counterpart, Michelle Bachelet. Paraguay is "different", Mr Lugo insists, and requires a different approach.
- More about:
- Colorado
- Hugo Chavez
- Paraguay
- Venezuela


text:
Listing Courtesy of Vinette M Reames of Re/Max Elite Group T.R.
Listing information
- Status: Active
- Foreclosure: No
- Estimated Annual Taxes: $2,345
- Subdivision: J92 - Newberg Twp.
- Style: Commercial
- Stories: 0
- Total Square Footage: 1,800 ($333.33 per sq. foot)
- County: Cass
- Year Built: 1900
- New Construction: No
- Lot Area: 1.00
- School District: Three Rivers
Air Conditioning Central
Auction or For Sale For Sale
Business Includes Equipment, Furniture, Licenses, Real Estate
Construction Type Frame/Wood
Heat Source Propane
Heat Type Forced Air
Other Road Frontage - 417.00
Property Sub-Type Business Opportunity
Purchase Terms Avail Cash/Conventional
Sale Conditions None
Uses Restaurant/Bar
Util Avail at St Electric
Utilities / Sewer Septic System
Utilities Attached Electric, Propane, Telephone
Water Type Well
Waterfront Options: Waterfront Y/N No
Listing Courtesy of Vinette M Reames of Re/Max Elite Group T.R.


text:
Manhattan Cathedral Examines "The Value of Water" in a New Star-Studded Art Exhibition
Water is essential to human life. It has also been at the center of many of the world's conflicts — disaster, drought, ownership and commodification. The six month exhibition serves as a reminder of social and civic service to better the planet. Reverend Dr. James Kowalski, Dean of the Cathedral says, "There's nothing new about artistic engagement with water; what's new is that we have reached a planet-wide crisis point in the availability of fresh water."
One must see is Kiki Smith's Ten Elements of Dewbow. The teardrop shaped glass pieces represent dewbows, a rainbow formed in a sphere shaped droplet of dew that usually disintegrates when touched. It is a comment on the fragility of our relationship with water and how carelessly we handle it.
In contrast, Nobuho Nagasawa's Bodywaves, a rocking chair covered in optical fabric channels our dependence on water. A recorded video of ocean waves plays upon a chair that senses human heat once it is sat upon and glows brighter with the interaction.
Perhaps the most striking piece from the exhibition is Winn Rea's Fountain. Consisting of hundreds of sliced recycled water bottles, the spiraled pieces hang upside down like a cascading waterfall. The piece is both breathtakingly beautiful and painfully tragic as it reflects our incredible amount of waste production.
Heavyweights like Bill Viola and Jenny Holzer point out the danger of ignoring water-related issues and natural disasters with the former's haunting Isolde's Ascension and the latter's striking declaration "You are so complex, you don't respond to danger" carved into a marble stool.
In conjunction with the exhibition, the Cathedral will also host a number of public programs to engage and educate the community on sustainability and making a greener planet. Lectures, dances, panels, and storytelling are scheduled throughout the next few months to spread water crisis awareness.
The exhibition will close with it's final support program called "An Evening of Witness." Survivors from Japan, Haiti, the Mississippi Delta, and more water disaster areas will participate in an all night story-telling and vigil.
You can check out the "The Value of Water" at St. John the Divine until March 25, 2012.
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text:
Social Science Speaker Series Annual TalkFebruary 13, 1:30pm - 3:00pm
Honolulu Campus, Building 2, Room 201
Dr. Daniel Eisen, Assistant Professor of Sociology at Pacific University, will be giving a special talk: The Distorted Looking Glass: Struggles with the Racialized Self and a Filipi(NO) Identity. The event is open to the public.
Event Sponsor
Honolulu Community College Chancellor's Office and Sociology Department, Honolulu Campus
More Information
Fumiko Takasugi, 845-9152, email@example.com


text:
Roberto's good humor and sincerity are appropriate complements to his financial tenacity. His years of expertise in international and domestic markets continue to strategically increase WorldVentures' profitability. With his insight, WorldVentures™ has moved up the Direct Selling News Global 100 list year after year, which just goes to show that doing what you like and doing it often is a sure-fire way to create success.
Favorite DreamTrip location: A DreamTrip to Italy is in store for me. From its food, to the whitewashed Mediterranean beach homes, to the wine, Italy has so much to offer.
Must-take travel accessory: At the top of the list is my laptop.
Favorite travel read: Mystery, suspense and thrills get me thinking. I choose to read books written by John Grisham. He gets me to view things more objectively and consider the complexity of the legal system.
Best song for the open road: Music gets me revved up for travel. So, before I take off, I put together a play list of songs that will match my ever-changing mood, including Rush, Adele and Harry Connick, Jr. When I want to add a little ethnic flair to the mix, I jam to Alejandro Fernandez and Pepe Aguilar.
Next locale on his wish list: I plan on taking a trip to the Hawaiian Islands with my family. Relaxing in a hammock, with my phone turned off and focused only on taking in the beauty of the surroundings and enjoying time with my wife and kids.
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