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Get the Recipe
Whereas some other recipes from The Ice Creamists' aren't as boozy, there's a solid cup and a quarter of hard cider in each batch of this recipe. A little lemon adds a tart twist.
Tips: For instructions on how to make this ice cream without an ice cream maker, see the "Tweaks" section of the Gin & Tonic Sorbetto post.
Tweaks: Since it's summer, apples aren't so much in season. Skip the step of hollowing out an apple and use a lemon instead, or no fruit at all. A drier cider, with less sugar, would be your best best to use here.
As always with our Bake the Book feature, we have five (5) copies of The Ice Creamists to give away.


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If you are a non-resident of the United States who wishes to apply for the professional phase of the doctorate of physical therapy (DPT) degree on a competitive basis as a transfer student, then you must:
Marquette University
Department of Physical Therapy
Schroeder Complex, Room 346
560 N. 16th Street
Milwaukee, Wisconsin 53233
Fax: (414)-288-5987
Applications that are complete can be processed through PTCAS as early as one year prior the fall year of entry desired but no later than Novembe 1st of the year prior to entry for consideration.
Further inquiries and questions may be directed to Dr. Andy Starsky, admissions chairperson for the Department of Physical Therapy by calling 414-288-7161 or by e-mailing the Department.
If you are a non-resident of the United States and intend to pursue or complete an undergraduate degree at Marquette University as a student, you can apply on line at http://www.marquette.edu/oie/apply.shtmlAny student interested in general Marquette campus, housing, tuition, financial aid, and other information may do so by calling University Admissions at 800-222-6544. Students can be added to the University's mailing lists to announce any open houses or scholarship competitions which may be of interest.

subset: commoncrawl


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Bone cancer is a rare disease in which cancer cells grow in the bone tissue.
Cancer may form in the bone or spread to the bone from another site in the body. When cancer starts in bone tissue, it is called primary bone cancer. When cancer cells travel to the bone from another site in the body, it is called secondary or metastatic bone cancer. Types of bone cancer include:
- Osteosarcoma—a cancerous tumor of the bone, usually of the arms, legs, or pelvis
- Chondrosarcoma—cancer of the cartilage
- Ewing sarcoma—tumors that usually develop in the cavity of the leg and arm bones
- Fibrosarcoma and malignant fibrous histiocytoma—cancers that develop in soft tissues such as tendons, ligaments, fat, and muscle, and move to the bones of the legs, arms, and jaw
- Giant cell tumor—a primary bone tumor that is malignant; most common in the arm or leg bones
- Chordoma—primary bone tumor that usually occurs in the skull or spine
Cancer occurs when cells in the body, in this case bone cells, divide without control or order. Normally, cells divide in a regulated method. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms. This is called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissues and spread to other parts of the body. A benign tumor does not invade or spread.
The cause of primary bone cancer is unknown. Genetics play a major role in most cases. Conditions that cause increased bone breakdown and regrowth over an extended period increase the risk of tumor development. This explains why osteosarcoma in children is most common during the adolescent growth spurt.
Risk Factors
Factors that may increase your chance of bone cancer include:
- Paget's disease —a noncancerous bone condition
- Exposure to radiation
- Family history of bone cancer
Certain types of bone cancer have specific risk factors:
Osteosarcoma, which is more common in males who are 10-30 years old:
- Inherited cancer syndromes, including Li-Fraumani and Rothmund-Thompson syndromes
- Retinoblastoma—a rare eye cancer
- Bone marrow transplantation
Chondrosarcoma, which is more common in people older than 20 years of age:
- Multiple exostoses—an inherited condition that results in bumps on bones
- Ewing sarcoma, which is more common in people younger than 30 years of age
Fibrosarcoma and malignant fibrous histiocytoma:
- Increased age
- Giant cell tumor, which is more common in those who are young or middle-aged
Symptoms of bone cancer vary, depending on the location and size of the tumor.
Symptoms may include:
- Pain at the tumor location
- Swelling or a lump at the location of the tumor
- Deep bone pain that is severe enough to wake you up
- Unexplained weight loss
- Fatigue
- Trouble breathing
- Fever or night sweats
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids and tissues may be tested. This can be done with:
- Blood tests
- Biopsy
Images may be needed of your bodily structures. This can be done with:
After cancer is found, staging tests are done to find out if the cancer has spread and, if so, to what extent. Treatment depends on the type, stage, and location of the cancer. It also depends on your overall health. Talk with your doctor about the best treatment plan for you. Treatment options include:
Radiation Therapy
Radiation therapy for bone cancer uses radiation to kill cancer cells and shrink tumors. Radiation may be:
- External—radiation directed at the tumor from a source outside the body
- Internal—radioactive materials placed into the body near the cancer cells
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including: pill, injection, and through a tube called a catheter. The drugs enter the bloodstream and travel through the body, killing mostly cancer cells, but also some healthy cells.
Surgery for bone cancer involves the removal of a cancerous tumor, nearby tissues, and possible nearby lymph nodes. Surgery may require amputation of the limb with cancer. Whenever possible, doctors try to remove the cancerous part of the bone without amputating. In this case, metal plates or a bone graft replaces the cancerous tissue that has been removed.
Sometimes, adding radiation therapy or chemotherapy can help avoid the need for amputation. If the tumor is large or aggressive, or the risk of it spreading is high, chemotherapy and radiation therapy may be added to help prevent it from returning. This is also done to prevent it from spreading to distant organs.
Myeloablative Therapy with Stem Cell Support
For cancer that has spread, intense chemotherapy is sometimes given to kill cancer cells. This therapy also destroys the bone marrow. Stem cells, which have the ability to develop into other types of cells, are then given to replace the lost bone marrow.
Special Treatment Considerations for Certain Cancer Types
Certain cancer types require specific treatments:
- Osteosarcoma—Chemotherapy given before and after surgery will often cure osteosarcoma and can allow for limb-sparing surgery in people who might have otherwise required amputation.
- Ewing sarcoma—Since Ewing sarcoma is responsive to chemotherapy, its treatment often involves several weeks of chemotherapy followed by surgical removal or radiation therapy, then several more months of chemotherapy.
- Fibrosarcoma and malignant fibrous histiocytoma—These conditions are usually treated with surgery to remove the cancerous tumor and a one-inch margin of healthy tissue surrounding it.
There are no current guidelines to prevent primary bone cancer. Early diagnosis and treatment improve your chance of successful treatment.
Revision Information
- Reviewer: EBSCO Medical Review Board Mohei Abouzied, MD, FACP
- Review Date: 09/2017 -
- Update Date: 09/03/2014 -


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September 09. 2013 4:39PM
Time2Save: Organize coupons to get money savings in order
Scripps Howard News Service
You don't want to get overrun by coupons. Instead, experiment with a few options for getting organized and decide which one is best for you. (SHNS courtesy Kasey Trenum)
: A new couponing column makes its debut today. The author, Kasey Trenum of Chattanooga, Tenn., is the co-founder and editor of the blog
Q: What is the best way to organize my coupons?
One of the trickiest parts about couponing is finding a system to stay organized. Luckily, there are plenty of ways to go about this.
First, you have to find a system that is efficient for you. It may look different from someone else's, but it should suit your needs. You don't want to get overrun by coupons because that's an easy way to get discouraged from saving money. Instead, experiment with a few options for getting organized and decide which one is best for you.
Here are a few examples of organization solutions:
• The binder method: You will need a 2-inch binder, plastic sheet protectors and labels. When you clip coupons, place them in the plastic inserts by categories and label them. Use categories such as "breakfast," "frozen foods," "canned and boxed items," "refrigerated foods" and "personal items."
Pick categories that work for you. The labels and clear sheets will make your coupons easy to see and keep them protected. The binder is also a cinch to store in your car.
• The file-box method: Using a small box such as a recipe box, keep coupons organized by category.
Use labeled tabs to keep categories separated and to make it easier to find coupons. The file-box method is convenient, compact and easy. However, with this method you only see one coupon at a time.
• The whole-insert method: All you need is a box, such as a file box, and folders.
When circulars arrive each week, simply place them in a dated folder and place the folder in the box. You can then easily locate coupons by date as you need them.
Give these systems a try and find one that works for you. Then, start saving money!
For more tips on saving money, go to
. Email email@example.com.


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AMES — Iowa State has two openings on its coaching staff. What is Greg McDermott looking for in filling those spots?
"Recruiting is always a priority," the Cyclone coach said during an interview late last week.
With just six scholarship players and two walk-ons currently on campus, immediate recruiting help would be welcome. Realistically, McDermott is meaning down the road, starting with next year's class.
What else?
An appreciation for the school and the community also is key, McDermott said.
"It has to be somebody who believes (Ames) is a fit for them, because it is not for everybody. That's just the reality," he said.
Resumes are pouring in, McDermott says. He's done some interviews and hopes to make one or both hires official by the end of this week.
"I haven't struggled to find people who are interested," McDermott said. "There's plenty of people who want to be here. It's trying to find the right people."
He and coaches T.J. Otzelberger and Jeff Rutter have spent the last few days looking for additions to this year's recruiting class. Coaches are in an open recruiting period until Wednesday.
McDermott was boarding a plane headed for Wisconsin Friday afternoon. Rutter was traveling to Europe to visit prospects.
"The next (few) days are important for us as we continue to evaluate a few guys more in-depth," McDermott said.
ISU has seen three players leave the program (Justin Hamilton, Dominique Buckley and Chris Colvin) since the season ended last month.
The late signing period began last week. One player — Oregon big man Jordan Railey — has signed so far. McDermott needs a few more to join up.
"We've had players visit and have more planned," he said. "We are looking at a few (Division I) transfers as well."
Tags: Chris Colvin, Cyclones, Dominique Buckley, Greg McDermott, Iowa State, Jeff Rutter, Jordan Railey, Justin Hamilton, T.J. Otzelberger


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Urban Renewal in Pittsburgh
Landscape Architecture students collaborate with urban Pittsburgh residents to spark neighborhood revitalization efforts.
There's no religion involved in Landscape Architecture Professor Ken Tamminga's Pittsburgh Studio, but he still compares the studio experience to a church service.
The course takes upper-class and graduate Landscape Architecture students out of their traditional studio space and into down-and-out urban neighborhoods in an effort to spark community revitalization efforts. "I emphasize to my students that the 'studio' is not just in the Stuckeman Family Building—it's as much in the Pittsburgh neighborhoods as it is at University Park. It's like a thriving congregation that understands 'church' is not so much a building as it is people involved in a common cause."
In the case of the Pittsburgh Studio, the "people" are the residents of the inner-city, low-income neighborhoods who work collaboratively with Tamminga's students to address issues such as lack of green space, vacant lots and dilapidated buildings.
Each fall since 2008, 12-14 students have taken the Pittsburgh Studio, a partnership between the Department of Landscape Architecture and the Penn State Center: Engaging Pittsburgh. "Some service-learning projects never get students past the planners and government officials, but in this studio the students work directly with the residents," says Tamminga. "It's very important to me that students work with users in their place, and discover the talent, energy and aspiration among community members. Working with students is a catalyst for the residents to look at their neighborhoods themselves and take action."
A True Collaboration
Planning for the Pittsburgh Studio is a collaborative effort between Tamminga and the Penn State Center. Director Deno De Ciantis and staff landscape architect Lisa Vavro identify the neighborhoods most in need and facilitate interactions throughout the semester. "Deno and Lisa know the neighborhoods inside and out, and make sure to spread our 'talent' around," Tamminga notes. "These are communities that normally would not have the opportunity to work with landscape architects."
Tamminga and De Ciantis launched the studio—a 12-hour per week, 5-credit course—with a goal of moving from standard service-learning fare to a more robust understanding of community engagement and public scholarship. The students make eight to ten trips to Pittsburgh over the course of the semester, meeting with residents for design charrettes and more informal meetings. The semester ends with an open house and public presentation of the students' projects.
"Community members are a core component of the design process—it's very 'real world,'" says Tamminga. "No one has a corner on the market of good ideas. We're always striving for reciprocal learning and co-design."
Malik Bankston, executive director of the Kingsley Association, a social services agency based in the Pittsburgh neighborhood of Larimer, was part of that core in 2009, when the Pittsburgh Studio worked in Larimer. In a 2011 interview, he said Penn State students have helped the association come up with fresh, new ideas. "When Penn State comes to the table and offers to help us figure out several ways to do things—to solve a problem or answer a question—that makes them an important partner."
Hands-on Learning
In fall 2012, fifth-year student Grace Byrne partnered with residents of Wilkinsburg, where pedestrian tunnels used to connect different sections of the northeast Pittsburgh neighborhood had been closed due to safety concerns. She says the experience gave her a true taste of participatory design. "In school, so much of what we do is based on theory. But in this studio, we weren't designing for ourselves—we were designing for, and with, real people."
Byrne's final proposal connected the tunnels—and the neighborhood as a whole—via a park that formed a loop in the center of the neighborhood. The park provided safe access to the tunnels, as well as recreation opportunities and art-filled community gathering spots. She also proposed a range of security features for the tunnels themselves.
"The residents had lots of ideas, and were very interested in the project," Byrne says. "This was my first hands-on experience in urban studies. I definitely came out of the studio different than when I started."
"In this studio, we weren't designing for ourselves--we were designing for, and with, real people." --Grace Byrne, fifth-year student
In the Northside neighborhood where Nick Monroe worked in fall 2012, the problem was disused space—vast vacant lots, punctuated by clusters of single-family homes and apartment buildings. "My project established linear connections with gathering spaces in the vacant lots, with features like small playgrounds and a community garden. I thought residents of the neighborhood needed to communicate more, so my project offered ways to promote interaction."
Knowing the Northside neighborhood where he worked had a limited—if any—budget for community improvements, Monroe, also a fifth-year student, says he relied on the original design principles he learned early in his landscape architecture education. "I couldn't rely on gimmicky stuff," he notes.
Student Projects Take Root
While the students' formal relationship with the various neighborhoods ends with the semester, the ideas and possibilities are not forgotten. The Penn State Center remains a resource to incorporate the students' projects into actual neighborhood improvement plans. In Beltzhoover, for example, where students worked in 2008, an enhancement project incorporating the students' work is currently underway. This past December, the Northside Leadership Conference received a $50,000 grant from the Pittsburgh Partnership for Neighborhood Development to help realize ideas generated during the Pittsburgh Studio. And the Wilkinsburg Community Development Corporation is actively pursuing funding for three of the four projects conducted this past semester, including the "Wilkinsburg Loop" that Byrne designed.
The Pittsburgh Studio has gained recognition inside and outside the University. In 2011, the studio won the Penn State Award for Community Engagement and Scholarship, and was also named the northeast regional winner of the Outreach Scholarship W.K. Kellogg Foundation Engagement Award by the Association of Public and Land-Grant Universities (APLU) and the National Outreach Scholarship Conference.
While the recognition is nice, Tamminga focuses on how the studio can benefit both students and struggling communities. "It's exciting to see our neighborhood partners muster their potential and tackle new possibilities. And for our graduates, I'm hopeful that the studio is a springboard to more intentional and inclusive professional practice."
For more information on the Pittsburgh Studio, visit http://pittsburgh.center.psu.edu/projects/pittsburgh-landscape-architect....


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We do not update this page very often unfortunately. TAC has a huge collection of photographs. Only some of them are in digital format, even fewer are on the website and not all of them are on this page. We have not at this stage sorted our photographs for easy access, so if you do email us requesting a photograph, we might not be able to meet your request.
See the back issues of Equal Treatment (available on the website by selecting Equal Treatment on the menu) for more photographs.
Unless otherwise stated, all photographs may be used and distributed at no charge, so long as TAC is acknowledged as the source.


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ALEXANDRIA, Va. (AP) — An ex-Marine convicted of firing shots at the Pentagon and other military targets in 2010 was sentenced Friday to 25 years in prison, despite a recent diagnosis of schizophrenia that raised some questions about his sanity.
At a sentencing hearing Friday in U.S. District Court, Yonathan Melaku, 24, of Alexandria, said he wanted to go forward with a plea deal reached last year that called for a 25-year sentence — even though the schizophrenia diagnosis, confirmed by government doctors, raised the possibility of an insanity defense.
Melaku pleaded guilty last year to a series of nighttime shootings, including at the Marine Corps museum in Quantico and military recruiting stations in Chantilly and Woodbridge, that caused more than $100,000 in damage. No one was injured.
He was caught months later, in June 2011, after he was discovered trying to desecrate graves in Arlington National Cemetery. He also planned to leave bags of ammonium nitrate at the cemetery to induce fear.
The plea deal called for a non-negotiable 25-year sentence. But after pleading guilty, Melaku got new lawyers who uncovered evidence he was mentally ill. Government doctors have now also diagnosed him with schizophrenia.
Medical records cited in the court papers showed Melaku suffered from delusions that the 2010 shootings would allow him to reunite with a girl he knew in high school before the world came to an end in 2012. Doctors who evaluated Melaku at the federal medical prison in Butner, N.C., wrote that "Mr. Melaku consistently reported feeling threatened by God and believing he had to engage in certain behaviors or acts to 'force God to stop the visions.'"
Still, having a mental illness — even a severe one like schizophrenia — is not the same as being able to demonstrate to a jury at trial that a person is legally insane, which under federal law requires clear and convincing proof that a defendant at the time of the offense did not appreciate the wrongfulness of his conduct.
Had Melaku tried to break the plea deal, federal prosecutors indicated they were prepared to file charges that would have resulted in a mandatory minimum of 85 years if convicted on all counts.
Melaku's new attorney, Billy Martin, said Friday that he had discussed the issue at length with his client, and that Melaku decided for himself that he wanted to stick with the plea deal and the 25-year sentence.
Prosecutors said the sentence was appropriate. In court papers, they ascribed Melaku's motives not to mental illness but to anger at U.S. foreign policy. They cited FBI interviews with Melaku in which he said he wanted to send a message that the U.S. should not engage in wars against Muslims in Iraq and Afghanistan.
"Yonathan Melaku is a self-radicalized terrorist who carried out a campaign of fear that escalated until his arrest," U.S. Attorney for the Eastern District of Virginia Neil MacBride said after Friday's sentencing. "He took calculated steps to target specific military buildings, cover up his crimes, and plan even more destruction should his message not be heard."
Melaku said little during Friday's hearing except to request that he serve his time at the federal medical prison in Butner, a request granted by U.S. District Judge Gerald Bruce Lee.
Melaku's family wrote to the judge saying their son began acting bizarrely after a tour of duty in the Marine Corps.
Melaku "is sick. He is not a terrorist," the family wrote. "When he returned home (from the Marines), he was a different son."
Lee called the crimes "a bizarre set of facts for a former U.S. Marine. ... You instilled fear in the public," Lee said, likening the crimes to the 2002 sniper spree by John Allen Muhammad and Lee Boyd Malvo that gripped the D.C. region with fear. "Obviously, you do not represent the Marines that most of us know."


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Moroccan Merguez Ragout with Poached Eggs
If you like it, save it!
Save and organize all of the stuff you love in one place.Got it!
If you like something…
Click the heart, it's called favoriting. Favorite the stuff you like.Got it!
Author Notes: Merguez sausage is a distinctly spiced Moroccan sausage made of lamb that can be found in specialty food markets. If you cannot find merguez in your area, use whatever sausage suits your taste, but I particularly like Spanish chorizo. Harissa is a fiery condiment found on most North African tables and is used to spice up dishes to suit your palate. Ras el Hanout translates to "top of the shop" and refers to the top combination of spices a Moroccan spice vendor can sell. You can find both harissa and ras el hanout at www.gourmetfoodstore.com, or you can make your own. - ecswantner —epicureanodyssey
Food52 Review: We ate this for lunch and agreed it was the perfect meal for the middle of the day -- or the beginning of the day, or the end of the day. The spicy merguez (you can use hot Italian sausage if you can't find merguez or chorizo) is bathed in a lush, smoky sauce of tomatoes, onion, garlic and spices; when you cut into the soft eggs on top, poached right in the sauce, the buttery yolk combines with the rest of the dish and mellows any sharp edges. We found that we didn't need all of the oil, as the sausage gave off a lot of its own fat, so we just spooned off some of the extra oil before poaching the eggs. - A&M —The Editors
Serves: 4
cup extra virgin olive oil
large onion, small dice
large garlic cloves, peeled and minced
pound merguez sausage, sliced 1/2-inch thick
tablespoon ras el hanout, see note above
teaspoon Spanish sweet smoked paprika
teaspoon kosher salt
15-ounce cans fire-roasted tomatoes, preferably Muir Glen
extra-large eggs
cup roughly chopped cilantro, stems included
tablespoons harissa, see note above
warm crusty bread, for serving
- Heat the olive oil in a large frying pan over medium heat. Add the onion and sauté until golden. Toss in the garlic and cook another 2 minutes. Add the merguez and sauté until almost cooked through, about 3 minutes.
- Lower the heat to medium-low and add the Ras el Hanout, Spanish smoked paprika and salt. Stir to combine and cook for a minute to lightly toast the spices. Add the tomatoes. Turn up the heat to medium and cook until the mixture has thickened slightly, about 5 minutes.
- Crack the eggs over the mixture, cover and cook until the whites set, but the yolks are still soft.
- Divide the eggs and ragout among four warm bowls using a large spoon. Top with a sprinkling of cilantro and a teaspoon of Harissa.
- Serve immediately with crusty bread.
- This recipe is a Wildcard Contest Winner!
- This recipe was entered in the contest for Your Best Brunch Eggs
More Great Recipes:
Egg|Breakfast|One-Pot Wonders|Fall|Winter


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Its not surprising for most of us to freak out on hearing the word,"Calories". If we happen to buy anything to eat today, 95% of the times we check the calorific content it has. But why do we do that now ? As kids we never used to give a damn about it and just used to shove anything in our mouth which seemed to visually attractive and creamy and colorful. This is most of the times the kind of stuff which has calorie content and will make any adult put on weight whose body metabolism is kind of sluggish.
So what's the fuss about calories is all about? Let me simplify it for those who are looking for answers. Lets try to put it like this, "Calories are nothing but simply energy". Your body draws energy from the food that you eat to help itself continue to do the day to day activities you have to do. Or let's say, Food = Energy. More Food = More Energy and Less Food = Less Energy. Only co-relate the food which you have at home every day and not the pizza, burger or the fries.
Your body needs only a certain amount of energy to perform your day to day activities. So why are too many calories bothering you ? Because all of us are not blessed with good body metabolism (BMR). If we have food more than the our body requirement, what do you think happens to the excess energy it produces ? Your body is too smart than you think. Its like it has got its own brain. The excess energy which is produced by the excess food is converted to fat and is stored in your body. That's the primary reason you start getting out of shape.
This is something which has been passed on to us by our ancestors who used to hunt for food and used to have meals very less often than we have. So their bodies used to immediately convert incoming energy food into fat in fear of not getting food again for couple of days or more. By doing so the stored fat can be used to produce energy in the absence of food. Smart, isn't it? Unfortunately the genes which are responsible for doing this have been transferred to us from them and also we have food more often and that too in different varieties than they used to.
So don't let too many calories bother you. Plan your meals well. Find out your BMR and plan your meals accordingly. By this you will get an idea how much you need to eat everyday and it will help you in not overeating. Have small meals every 2 to 3 hours so that your BMR stays active and work your body out to stay fit and fine.


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Chapter 5: Implementation, Stabilization, and Maintenance
Chapter 5: Implementation, Stabilization, and Maintenance
In this chapter
- Preparation for Treatment
- Induction
- Assessing Symptoms of Opioid Withdrawal for Buprenorphine Induction: SOAP Note Format
- Stabilization
- Table 3: Induction, Stabilization, and Maintenance
- Maintenance
"The easy part is learning about and administering buprenorphine. The hard part is changing the clinic culture to say, 'opioid dependence is a brain disease.' We need to curtail the notion that these patients are different."- Dr. P. Todd Korthuis
Associate Professor of Medicine and Public Health/Preventive Medicine
Oregon Health and Science University HIV Program
Patients were often referred to opioid treatment from HIV medical care, psychiatry, mental health counseling, pain clinics, chemical dependency clinics, inpatient wards, community housing, and community drug treatment centers.
Eligible SPNS initiative patients had to meet the following criteria:
- Be at least 18 years old.
- Meet Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for opioid dependence. DSM-IV classifies opioid dependence as having three or more of the following within one year: tolerance; withdrawal; larger amounts/longer period than intended; inability to cut down or control use; increased time spent obtaining opioids; social or occupational activities given up or reduced; and despite adverse consequences, opioid use persists.45
- If a female patient, not be pregnant, nursing, or trying to become pregnant. (Buprenorphine is classified by the FDA as a Pregnancy Category C medication similar to methadone.)
- Be interested in receiving substance abuse services.
- Be HIV-positive and receive HIV primary care at the site.
Prior to administration of Suboxone, patients receive education and counseling. Any patient assessment questions should be targeted and open-ended to solicit detailed responses beyond a simple yes or no. Providers also discussed program expectations and answered patient questions. The initial assessment process was completed in one or two visits. Providers were also expected to have an emergency contingency plan for patients, such as an on-call number or backup system prior to program launch.16
To access consent form, patient treatment agreement, and eligibility criteria checklist templates, see these resources on the TARGET Center:
- BEEHIVE Buprenorphine Program Tools (UCSF);
- Miriam Hospital Buprenorphine Program Tools ;
- Buprenorphine/naloxone (Suboxone) Treatment Agreement (OSU); and
- CORE Buprenorphine Project Program Tools.
Grantees also had substance abuse counseling community linkages and collaborations, including onsite substance abuse counseling. Since "buprenorphine is a prescribed treatment, which is accepted by the 'Big Book' on which 12-step programs rely, an integrated care program can work with 12-step programs toward the goal of recovery" as well.69
Exclusion criteria included:
- uncontrolled or untreated psychiatric problems,
- pregnancy,
- serious uncontrolled or untreated medical problems (e.g., hypertension, asthma, diabetes, hepatic failure),
- patient currently on more than 30 mg of methadone,
- chronic pain disorder requiring high-dose opioid medication,
- allergy or hypersensitivity to buprenorphine or naloxone,
- benzodiazepine abuse or dependency (currently or within the past 6 months),
- aspartate aminotransferase/alanine aminotransferase ratio of >5x upper normal limit,
- binge drinking, and
- requires greater program structure such as that involved in methadone maintenance.69
Before physicians begin to prepare patients for treatment, they must answer four important questions:
- Who is to perform the induction and stabilization of patients receiving buprenorphine?
- How are patients to be maintained on buprenorphine treatment appropriately?
- What forms of counseling are necessary?
- How can care be coordinated between providers?42
Preparation for Treatment
Chart Work
All patients had to have a complete health history (including immunizations and tuberculin purified protein derivative status), recent physical exam documented in their medical charts, and pain evaluation.
Providers reviewed their entire substance use history and any co-occurring medical conditions, particularly liver disease, pain syndrome, and mood disorders.
Medication Review
Patient medications were also reviewed. Worth nothing, "many HIV antiretroviral and psychiatric medications are metabolized by the cytochrome P450 3A4 system and may necessitate buprenorphine and dose adjustments."69
Buprenorphine Access
Providers needed to ensure their onsite pharmacy or a community pharmacy was onboard with dispensing buprenorphine. In many cases, SPNS grantees worked with "benefits workers to enroll study patients in Medicaid, Medicare, or State ADAP programs and to have buprenorphine added to formularies and obtain prior authorization for buprenorphine prescriptions (where possible).
Birth Control
Providers assessed female patients' effective use of birth control.
Lab Work
Patients completed lab work to check liver enzymes, urinalysis, and for pregnancy. Their most recent HIV-related lab work was also reviewed to check HIV viral load, CD4 cell count, liver function tests, and hepatitis serologies.69 Hepatitis screens, syphilis test, lipid profile, serum electrolytes, blood urea nitrogen (BUN, a measurement used as part of routine bloodwork and to diagnose or monitor kidney disease) and creatinine, a complete blood count (CBC) with differential and platelet count, and TB test may also want to be considered.53
Toxicology Screening
Patients prescribed narcotics or benzodiazepines and those with substance abuse histories (including illegal opioid use and other drugs) were all screened.
Patients were questioned about what they understood about buprenorphine treatment, and providers filled any "knowledge gaps. Providers also reinforced patient goals, motivations, and readiness. One SPNS grantee utilized patient education slides, which can be viewed on the TARGET Center.
Patients were asked to sign a contract that they would adhere to the program requirements and consent to treatment. Patients also signed an authorization to exchange health information. Lastly, patients were asked to sign a take-home dosage agreement. (Access examples of these documents on the TARGET Center.)
Providers who did not have onsite substance abuse counseling, psychotherapy, or self-help programs of any kind were asked to create formalized agreements with providers to whom patients would be referred for counseling.
Kick Pack
SPNS grantees found it helpful to supply " kick packs to patients. Since patients had to arrive at the clinic on the first day in an opioid-free state, these "packs helped address any anticipated withdrawal symptoms, such as nausea, diarrhea, myalgias, and rhinorrhea."69 Read about what specific medications were included in the kick packs prepared by the UCSF grantee on the TARGET Center.
Manage Expectations
It's imperative that patients understand what buprenorphine can and can't do. There is no magic bullet for opiod dependence. Buprenorphine can dramatically assist opioid-dependent patients, but other interventions, such as harm reduction counseling, motivational interviewing, and behavioral counseling, should be used as well. It's important that patients understand that recovery, whether still maintained on MAT or not, is a lifelong process.
Physicians were also asked to manage expectations and continue education with staff to keep them abreast of the program and ensure their buy-in and cultural competency in assisting patients undergoing opioid treatment.
On Suboxone prescriptions, clinicians must include patient's full identification, including name, address, drug name, strength, dosage, quantity, and directions. As with other DEA-scheduled medications, prescriptions for Suboxone must be dated and signed on the date of issuance. The physician's DEA registration number and physician DATA 2000 registration number must be included on prescriptions as well.88
To keep track of prescriptions, one SPNS grantee utilized a Suboxone Treatment Record.
This phase is medically monitored, typically as observed therapy in a physician office for at least 2 hours. The induction phase begins with an initial "test dose" of buprenorphine.42
How do I Identify Opioid Intoxication or Overdose?
|Physical Findings
|Opioid Intoxication
|Conscious; sedated or drowsy; slurred speech; "nodding" or intermittently dozing; memory impairment; mood normal to euphoric; constricted pupils
|Opioid Overdose
|Unconscious; pinpoint pupils; slow, shallow breathing (i.e., respirations below 10 per minute); pulse rate below 40 per minute
Overdose triad: apnea, coma, pinpoint pupils (with terminal anoxia; fixed and dilated pupils)
The opioid-dependent person must have abstained from using opioids for 12 to 24 hours and must be in the early stages of withdrawal. Note, patients must be in early stages of withdrawal, otherwise buprenorphine will precipitate acute withdrawal. Many patients in the SPNS project were initially worried about having to be in "withdrawal" when they arrived their first day for Suboxone induction.
These worries were largely unfounded, and in fact, patients found the buprenorphine to work instantly. As one patient described, "With the bup . . . you're not [feeling the heroin] . . . instantly you won't feel it, but within a matter of a few days, maybe five days, you're not having cravings, you're just feeling normal. You just get up and you don't miss it, nothing. This [stuff] works great."
Inductions were scheduled on Mondays, Tuesdays, or Wednesdays to allow for two follow-up visits within the same week. The glue person was required to be at all patient appointments; however, the prescribing physician was required to be onsite only for the initial induction.69
To view induction protocol in table form, see Figures 4-1 and 4-2 of "Treatment Protocols" in the SAMHSA Guidelines.
How Do I Identify Precipitated Withdrawal, and What Is It?
Precipitated withdrawal is a more rapid and intense onset of symptoms. The purpose of induction is to safely suppress opioid withdrawal through dosing of buprenorphine. Longer-acting opioids, such as OxyContin and methadone, will require longer abstinence than shorter-acting opioids, such as heroin, Percocet, Vicodin, or oxycodone.89
Providers should use only time of last opioid use to anticipate withdrawal. Patients must also be at adequate withdrawal phase before buprenorphine initiation.89
To assess and assist with withdrawal, providers need:
- A penlight to assess pupil dilation,
- A stopwatch or clock to assess pulse rate, and
- A nearby bathroom, to ease the comfort of patients with active gastrointestinal and urinary symptoms associated with opioid withdrawal.
Withdrawal consists of predictable signs and symptoms resulting from the removal of or decrease in opioid use.53 Clinicians in the SPNS Buprenorphine Initiative found the Clinical Opiate Withdrawal Scale (COWS) to be effective in measuring symptoms during induction. 90, 91 Using the COWS scale allows clinicians to better identify whether patients are still experiencing opioid effects or are adequately in withdrawal to begin induction.
The University of California, San Francisco found the COW Scale in combination with the SOAP (Subjective data, Objective data, Assessment, Plan) Note Format below to be helpful.
While patients are undergoing induction, they should be engaged by health personnel. SPNS grantees found these patients needed interaction and direction from the moment they arrived to ensure a successful induction. Patient observation typically ranged from 2 to 4 hours following induction.
If patients experience precipitated withdrawal, clinicians should administer an additional 2- to 4-mg dose of buprenorphine hourly until symptoms resolve.92 Note, patients with cardiovascular disease or other severe conditions will need comanagement with the appropriate specialist.53
How Long Does Buprenorphine Take to Start Working?
Patients typically feel relief within the first 5 to 15 minutes after Suboxone has been dissolved under the tongue. In the SPNS project, patients were given Suboxone tablets. Today, Suboxone film exists and dissolves faster, which may bring even faster relief.
For the SPNS project, treatment began with a sublingual dose of 2 mg (2 mg buprenorphine/.5 mg naloxone) for patients with mild withdrawal and 4 mg for patients with severe withdrawal69 (Suboxone is also available in an 8 mg buprenorphine/2 mg naloxone formulation). 93 If patients experienced no change or only mild improvement of withdrawal symptoms, they were given an additional 2- or 4-mg dosage.69
If administration of Suboxone resulted in precipitated withdrawal, patients were reviewed for their last opioid use, offered nonopioid symptom management, and told to return the following day for reevaluation.
Patients for whom administration of Suboxone was successful were provided an additional 2- to 4-mg dose to take later that evening, and take-home doses for the next 1 to 2 days, along with instructions and education about their use. Patients then returned in the next 1 to 2 days for evaluation and upward dose titration.
- Typical daily first week dose: 8 to 12 mg (not to exceed 16 mg).69
- Typical daily second week dose: Some patients achieved stable dose between 12 and 16 mg daily from the second week thereafter; for others, dosage increased to as much as 20 to 24 mg during this time period.69
Criteria for dose increases included significant opioid cravings, significant withdrawal symptoms, and positive urine opioid drug test.
Overall, most patients found optimal relief at 12 to 16 mg. Finding the appropriate therapeutic dose (usually by titrating the dose over time) is a hallmark of the stabilization phase, as is greatly reducing or ceasing opioid use without adverse effects or cravings. To achieve this, physicians may need to adjust dosages for patients still struggling. Behavioral intervention such as counseling may begin during this phase to help patients adapt to opioid-free living and adherence to buprenorphine.42
For those on boosted atazanavir and other ritonavir-containing ARVs, lower doses were sufficient. For patients on efavirenz-containing regimens, higher buprenorphine doses were required.69
Daily dosage of buprenorphine at 32 mg is considered the maximum, and the ceiling for which no further effects of craving or withdrawal are typically seen.9 Dosage at or below 24 mg, however, has been shown to help diminish concerns about hepatotoxicity.64 (See also What Do I Need to Know About Buprenorphine and Liver Enzymes? in Chapter 2.)
Recommended timing of induction and transition into stabilization and maintenance phases are outlined in Table 3 below.
Assessing Symptoms of Opioid Withdrawal for Buprenorphine Induction: SOAP Note Format
Subjective Data
- Elicit symptoms of opioid withdrawal: cravings, anxiety, discomfort, pain, nausea, hot or cold flushes. Include patient's subjective rating of these symptoms (mild, moderate, or severe).
Objective Data
- Document signs of opioid withdrawal, including autonomic excitation (elevated blood pressure, increased heart rate), mydriasis, tremors, agitation or restlessness, yawning, rhinorrhea, piloerection, hot and cold flushes, diaphoresis, lacrimation, vomiting, and muscle fasciculations. Utilize COWS.
- Observe for signs of substance intoxication, including but not limited to alcohol odor, nystagmus, positive Romberg test, disinhibition, or other altered mental status.
- Collect urine and send to clinical lab for routine toxicology and, for female patients, pregnancy testing.
- Is the patient in opioid withdrawal? YES or NO. Include severity (mild, moderate, severe) based on COWS score. The patient should exhibit objective signs of at least mild withdrawal and have a COWS score >5 prior to receiving the first dose of buprenorphine.
- NO: If the patient appears intoxicated or exhibits no signs of withdrawal, then he or she should not be started on buprenorphine. Reschedule the patient for a later date or time. Counsel the patient on the importance of presenting in some withdrawal for a more comfortable overall induction.
- YES: Begin treatment with Suboxone and titrate to the target dose.
What Are Some Side Effects of Buprenorphine?
The most common side effects associated with buprenorphine include sweating, headaches, nausea, constipation, reduced sexual drive, and drowsiness and disrupted sleep (although less sedation than is associated with methadone). Patients with viral hepatitis may also experience mild increases in liver enzymes, particularly in alanine aminotransferase (ALT) levels; changes in ALT are most severe if buprenorphine is abused and injected intravenously.9
The stabilization phase begins after a person has discontinued— or greatly reduced—their drug use, no longer has cravings, and has few or no side effects. Buprenorphine dosage may need to be adjusted during this phase.69 To view stabilization protocol in table form, see Figure 4-3 of the SAMHSA Treatment Protocols.
Buprenorphine has a long half-life because it tightly binds to plasma proteins, and it assists in maintaining opioid levels in the brain. This allows for improved administration and less frequent dosing. For example, buprenorphine's effects may last anywhere from 1 to 3 days, depending on the individual and dosage.93
If clinicians transfer patients to alternate-day dosing, this phase may need to be supervised in the physician's office or may take place at home with frequent monitoring during office visits.69 Overall, induction and stabilization of buprenorphine were conducted over a 1- to 3-week period and maintenance continued as needed on a patient-by-patient basis. The SOAP Note Format described in the table above was used not only for assessing when to start patients on treatment but also in monitoring maintenance.
Table 3: Induction, Stabilization, and Maintenance
Prescription (Rx)
|Day 1
|Observe patient take one 8-mg Suboxone tablet* sublingually in clinic.
|Week 1: Daily counseling.
|Give patient 1 tablet to take home: No Rx.
|Day 2
|Check criteria for dose increase.
Observe patient take one 8-mg Suboxone tablet sublingually.
|Give patient 1 tablet to take home: No Rx.
|Day 3
|Observe patient take one 8-mg Suboxone tablet sublingually.
|Give Rx for weekly supply.
|Weeks 2–4
|Once weekly: Check patient's symptoms for underdosing.
|- Week 2: Once or twice weekly.
- Weeks 3 and 4: Once weekly.
|Give Rx for weekly supply.
|Months 2–12
|Monthly check depending on clinical stability and dose.
|Months 2–12: Once< every 2–4 weeks.
|Give Rx for monthly supply; if dosage is >16 mg, give RX for biweekly supply.
Record Keeping
Through opioid treatment, physicians should maintain patient records that outline:
- "Medical history and physical examination;
- Diagnostic, therapeutic, and laboratory results;
- Evaluations and consultations;
- Treatment objectives;
- Discussion of risks and benefits;
- Treatments;
- Medications (including date, type, dosage, and quantity prescribed and/or dispensed to each patient);
- A physical inventory of all Schedules III, IV, and V controlled substances on hand that are dispensed
by the physician in the course of maintenance or detoxification treatment of an individual;
- Instructions and agreements; and
- Periodic reviews."88
Physicians must keep all records for a minimum of two years, should DEA decide to conduct an inspection. In addition, physicians are prohibited from releasing records without proper patient consent, court order, mandatory reporting of child abuse, or medical emergencies.88
The maintenance phase occurs when the person has been sustained on a steady dose of buprenorphine. In most instances, patients entered the maintenance phase of treatment within the first 2 weeks.
Medication visits were scheduled weekly, then tapered to biweekly and then to monthly. This was possible because up to a month of Suboxone may be prescribed at a time.16 Physician visits were scheduled once every 3 months. Urine drug testing was conducted throughout phases of treatment to aid in adherence and identify any continual drug use.
The total length of this phase was individualized. The SPNS Buprenorphine Initiative was 5 years long.
In evaluating patients, SPNS providers collected and examined information on multiple measures via chart abstraction. These included:
- Suboxone dosage prescribed.
- Number of Suboxone-related office visits (considered any visit relevant to Suboxone treatment, clinical care, or counseling, as well as urine collection and prescription pick up).
- Number of urine toxicology analyses performed. (Note, guidelines recommend monthly urine toxicology monitoring and more frequent monitoring among those with ongoing illicit drug use.)64
Providers knew to include progress notes in each patient's medical record, and these notes were reviewed quarterly. The Buprenorphine-administering clinician or glue person notified primary care providers and others engaged in patient care about the patient's progress. Any treatment consent forms, authorizations, etc. were added to the medical record, as was any Suboxone dispensing.
Any patient on Suboxone who was clinically stable and wanted to discontinue treatment was tapered off buprenorphine slowly, as slow tapers have been shown to be more effective than rapid ones.69
To ensure clinic success, several grantees instituted patient satisfaction surveys. These assisted in identifying any additional areas for improvement and helped sustain patient buy-in.


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Why the Emphasis on Runoff When We Know that Sewage is the Sound's Biggest Pollutant?
Controlling runoff and reducing the amount of pollution is runoff is sort of important, but I'm surprised at the emphasis it has gotten, both in the survey and in the news accounts of the survey.
By far the biggest source of pollution in Long Island Sound is treated sewage. It is the source of the vast majority of the nitrogen that triggers the low levels of dissolved oxygen that make much of the western end of the Sound uninhabitable for marine life in late summer.
The second biggest source of nitrogen is air pollution. Nitrogen emitted from car tailpipes and power plants falls into the Sound and adds to the nitrogen from sewage plants.
And of the important sources of nitrogen, the smallest and the most difficult to control is runoff from streets and driveways and septic systems in the Sound's watershed. Not only is it hard to control, it's hard to measure. It's been a while since I've asked, but the last time I did I was told that less than 10 percent of the nitrogen that damages the Sound comes from runoff.
So to me it's not that huge of a deal if people don't realize that runoff contributes to the Sound's problems and if, because they don't realize that, they don't do the few small things that may or may not reduce the tiny amount of pollution they are personally responsible for.
Far more troubling to me is that most people don't know that treated sewage and sewage plants are the biggest polluters of Long Island Sound (the survey is here). Presumably they also don't realize that upgrading sewage plants is the single best thing we as a society can do for the Sound. And that perhaps explains why Connecticut for years was allowed to get away with ignoring its responsibility to upgrade sewage plants by failing to put money in its Clean Water Fund.
Convincing people not to wash their cars in the driveways is important, I suppose, but it's a drop in the bucket compared to sewage plants. We really should keep our priorities straight.
Labels: Long Island Sound survey


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In November of 1994, after an arduous legal battle, a new law was passed by Congress called the Dietary Supplement Health & Education Act (DSHEA). For the first time in its history, Congress defined dietary supplements as vitamins, minerals, amino acids, other dietary constituents, and herbs (and concentrates, extracts and derivatives of the above). More importantly, dietary supplements were to be considered foods, not drugs. The FDA regards a drug as any medicine that "alters the structure or function of the human body" or because it is intended to "treat, prevent, cure or mitigate a disease."
An example of a supplement that is now more readily available for sale in the US as a consequence of the passage of the DSHEA law is the hormone melatonin, a derivative of the amino acid tryptophan. In order for the FDA to challenge melatonin's over-the-counter status, it has to prove that this hormone is not safe. Since the passage of DSHEA, the burden of proof for a substance not being safe now rests on the FDA, not the producers or retailers. This shift has both positive and negative consequences for the consumer. A wider selection of supplements are now on the shelves of the health food stores or through mail order firms, but less of a guarantee that these have been thoroughly evaluated before being marketed. The consumer now has to make an even greater attempt to self-educate before casually swallowing the newest pills on the market.
The DSHEA on DHEA
With the new law in place, what is the legal status of DHEA? A drug because it "alters the structure or function of the human body" or because it is intended to "treat, prevent, cure or mitigate a disease"? A drug can be regulated by the FDA. Or is DHEA a dietary supplement because it is a derivative of cholesterol, which is itself a constituent of food, and not under the FDA's jurisdiction?
According to experts who have studied the law, DHEA falls under the category of a dietary supplement.
The DEA on DHEA
As DHEA started entering the over-the-counter US supplement market, there were hints that the Drug Enforcement Agency (DEA) was considering classifying it as an anabolic steroid. The Controlled Substances Act requires that any substance that is structurally related to testosterone and has testosterone-like anabolic properties to be scheduled as an anabolic steroid. DHEA is a precursor to testosterone, and so it has a structural similarity to testosterone. But so is cholesterol; it is also a precursor to DHEA and testosterone and structurally related.
The DEA eventually chose not to pursue any plans to schedule DHEA as a controlled substance.
The FDA on DHEA
For now the FDA seems to have taken a laissez-faire attitude with DHEA by not interfering with its over-the-counter sale. Will they continue to keep their distance as the popularity of DHEA increases? Time will tell.


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USD 428 Board of Education will meet at 7:30 a.m. on Friday at the District Education Office, 201 S. Patton Road. Items on the agenda include supplemental insurance for student/activities/athletics; approval of teacher resignation and appointments; and approval of end-of-year budget expenditures.
The Great Bend City Band will host instrumental members of the Great Bend Middle School, Thursday, June 26, with a march featuring the middle school students and the Great Bend City Band.
The Battle of Glorieta Pass will be the subject of a Civil War program at the next Barton County Historical Society meeting. The historical society will have its monthly program at 7:30 p.m. Monday, June 23.
Great Bend Police are investigating a burglary at 2204 McCormick St. that was reported Thursday. The homeowner said someone broke into his house and stole $16,000 in cash, a gold pocket watch and tools in a tool box.
Brit Spaugh Zoo will bring animals to the Great Bend Public Library for a program at 3:30 p.m. on Wednesday, June 25. Everyone is welcome, but the program was planned with children up to and including 6th grade in mind, said library spokesman Jennifer King.
A Larned man was injured Thursday night when the car he was driving hit a deer on U.S. 56, 3 miles east of Kinsley in Edwards County.
RUSSELL - The culmination of a three-month long undercover drug investigation by the Russell County Sheriff's Office concluded on Monday with the arrest of three suspects.
RUSSELL - A foster parent was arrested Thursday in charges of possession of marijuana and endangering a child, Russell County Sheriff John Fletcher announced.
4-H Family Fun Night will take place from 6:30 to 8 p.m. on Thursday, June 19, at the Great Bend Recreation Center, located at 12th and Stone. Extension interns, Priscila Aguero and Patricia Lugan, along with local staff will lead 4-H activities. The activity is free and open to everyone.
Great Bend Eagles No. 646 will hold a barbecue cook-off on Saturday, June 21, with a live band in the evening. The contest will run from 6 a.m. to 6 p.m. and the dance with Ronnie and the Rockets will run from 7 to 11 p.m.
The City of Great Bend will show the movie "The Outsiders" at 9:15 p.m. on Thursday, June 19, in Jack Kilby Square. The movie is free and free refreshments will be provided by the city and Waters True Value.
The Great Bend Public Library parking lot will be closed all day Wednesday. Parking is available on side streets.
The Barton Community College Board of Trustees will hold its annual retreat at noon Thursday, June 19, in the conference room of the Administrative Building. This meeting replaces the monthly study session and is for planning purposes. No action will be taken.
Great Bend Public Library's next Adults' Night Out movie is "Pompeii." It will be shown at 7 p.m. on Saturday, June 21. North doors to the library will be open from 6:45-7:10 p.m.
Great Bend Public Library will offer two craft classes for adults this month. on Thursday, June 26, and on Saturday, June 28.
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Reviewed By Justin S (Roseville, CA) Reviewed for a 2001 Toyota Echo —12/17/2008 5:37 AM
My wife was getting a lot noise when braking so I decided to order these rotors along with the pads the autoanything salesperosn suggested. I got the old brakes off and they were worn down to the metal. I put these rotors on with the new pads and the car stops perfectly and completely noise free.


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Dear Vivi,
I would very much like to help you; it's just that with the scarce amount of information available to me I may not be the best judge of the situation.
I used to teach English to learners of all levels up to and including the FCE preparation course. I worked for a private language college offering evening classes available to the public. That meant that my students were persons of all walks of life, with vastly varying general education, background, occupational status, age and ... MOTIVATION.
I frequently encountered individuals who, similarly to the case you describe, thought that, once they'd reached a certain level of competence in English, there was very little they would to do to raise it even higher. It happened very often that such persons changed their attitude when confronted with a sample exam for one of the Cambridge certificates, depending on the level they represented at that time. Invariably, it was a humiliating experience even for those who regarded themselves as quite proficient simply because they were one of the top students in their grammar school's English class.
Preparation for a Cambridge exam, at least here where I live, is perceived by many as a naturally evolving phase of English education. Moreover, it poses a challenge which in itself can provide students with ample motivation to go further in development of their language skills. Cambridge examinations preparation courses are well structured, and the modern coursebooks are interesting enough to attract the learners' attention and keep them busy for some time, even if they eventually decide not to sit the exam session.
The fact that the preparation course students have a clearly set goal is not to be neglected, too.
FCE has become particularly popular here in Poland, even among secondary school students. Many of them even think CAE is the way to go because 'nowadays everyone's got the First Certificate' (an exaggerated statement, to be sure, but a motivating one, no doubt.)
Excuse my rambling on without end. I don't know what the availability of Cambridge exams is where you teach, but if there's any chance to go to such length, try to get the individual you refer to in your post interested in taking some exam-biased sample tests. They will at least indicate which particular language skills are not his strongest points, and may encourage him to work harder to improve those left behind skills.
Good luck in whatever path you choose to follow.
Tee Kay


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posted by Thom Holwerda on Wed 11th Apr 2012 07:35 UTC
"Germany's upstart Pirate Party has overtaken the Greens to become the third strongest political grouping in the country, according to a new poll. The survey by Forsa for broadcaster RTL showed support for the Pirates, whose platform is based on internet freedom and more direct participation in politics, pushing up to 13 percent and outstripping the Greens for the first time." Not surprising. I have lots of close friends in Germany (especially in the former DDR), and for obvious reasons, I've noticed they tend to have a very firm grasp of concepts like privacy and government spying. The bit about six parties being a lot and troublesome for coalition building made me smile.


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California politicians claim imaginary Amazon tax revenues
California Governor Brown promised to end smoke and mirrors budgets that were the hallmark of the Governator's political weakness and failure to confront the state's structural budget shortfall.
This year, the Democrat-dominated legislature passed an "Amazon tax" — an attempt to broaden sales taxes to out-of-state e-commerce sites. This tax was in the budget Brown vetoed, but is also in the final budget deal he signed Wednesday. (The Governator vetoed a similar law two years ago.)
Of course, more taxes are favored by politicians who want more money to spend. In this case, they have also been championed by local businesses (and national brick & mortar businesses like Barnes & Noble and Target) who are stuck paying the tax and don't like giving Amazon a 10% cost advantage.
Being temporarily out of the state, it's been hard to find a serious discussion of the tax online. The mainstream media seems to be demonstrating willful ignorance while the anti-tax bloggers are using doom-and-gloom hyperbole.
Thus, it was refreshing to find this description in Accounting Today:
The tax would bring in an estimated $200 million a year. The bill would allow California to collect taxes from any online retailer that has nexus with an affiliate site in California. Amazon.com and Overstock.com have been dropping their affiliates in several other states in a bid to fight against such laws.There are three problems with the bill.
The bill also includes two other bills that were also passed by the California State Legislature that would require online retailers that have corporate subsidiaries and distribution centers in a state to collect sales tax from customers, along with another bill that clarifies when other kinds of physical presence require a sales tax to be collected. The three bills were combined into one and sent to Brown's desk earlier this month.
First, from a technical standpoint, there are questions are whether this is a tax increase that requires a 2/3 vote. Either it is or it isn't, but this may take a lawsuit (and appeals up to the SCOTUS) to resolve.
The biggest issue is that the belief that Amazon will pay sales tax contains an (un)healthy degree of self-delusion. First, the Supreme Court has held that sales taxes can only be assessed if there is a physical presence in the state, and Amazon has responded to previous such efforts (like in NY) by eliminating any physical presence.
Thus, this story from Thursday's LA Times predicting swift payment of taxes is either pure propaganda or willful ignorance:
Online retailers must start collecting sales taxes from California customersThe LAT assumes that Amazon subsidiaries in California make it vulnerable to the tax, but those subsidiaries can be moved or sold. Who thinks Amazon is going to keep IMDB if it forces a 10% price increase for 12% of its US customers?
Beginning Friday, Amazon.com Inc. and other large out-of-state retailers will be required to collect sales taxes on purchases that their California customers make on the Internet.
The new tax collection requirement — part of budget-related legislation that was signed into law by Gov. Jerry Brown Wednesday — is expected to raise an estimated $317 million a year in new state and local government revenue.
Brown's signature on the budget bills is aimed at closing a loophole that freed online retailers, such as Seattle-based Amazon, from collecting sales taxes and sending them to the state when they had no brick-and-mortar stores, warehouses or offices in California.
Not collecting sales taxes gave Internet retailers a competitive price advantage over California's small businesses such as independent booksellers and big-box retailers with a presence in the state, including Barnes & Noble Inc., Wal-Mart Stores Inc., Best Buy Co. and Target Corp.
"You can't give one segment of retail a 10% discount every day. It's just not fair," said Bill Dombrowski, president of the California Retailers Assn., a major player in a coalition of large and small stores supporting the legislation.
California's new requirement will generate badly needed state revenue and send a signal to Congress that "we want to see a national solution" to the issue of taxing Internet sales, Dombrowski said.
The other nexus of presence is the affiliates program. In fact, I was alerted to this issue by an e-mail Wednesday from Amazon, that — as predicted — announced their intention to cancel the Amazon Affiliates program for all California residents:
For well over a decade, the Amazon Associates Program has worked with thousands of California residents. Unfortunately, a potential new law that may be signed by Governor Brown compels us to terminate this program for California-based participants. It specifically imposes the collection of taxes from consumers on sales by online retailers - including but not limited to those referred by California-based marketing affiliates like you - even if those retailers have no physical presence in the state.No subtlety on that last point, eh? For me it doesn't matter much, because my revenues from Amazon links are negligible — much less than the rebate from my Amazon credit card.
We oppose this bill because it is unconstitutional and counterproductive. It is supported by big-box retailers, most of which are based outside California, that seek to harm the affiliate advertising programs of their competitors. Similar legislation in other states has led to job and income losses, and little, if any, new tax revenue. We deeply regret that we must take this action.
As a result, we will terminate contracts with all California residents that are participants in the Amazon Associates Program as of the date (if any) that the California law becomes effective. …
You are receiving this email because our records indicate that you are a resident of California. If you are not currently a resident of California, or if you are relocating to another state in the near future, you can manage the details of your Associates account here.
(Update: At 9:42pm, Amazon sent a follow up email that said: "Governor Brown has signed into law the bill that we emailed you about earlier today. As a result of this, contracts with all California residents participating in the Amazon Associates Program are terminated effective today, June 29, 2011.")
And this brings up the final point: as the anti-tax advocates note, terminating these affiliate programs terminates revenues for small businesses that depend on them. Their choice is either to give up the revenue permanently or move to a state (like Nevada) without sales taxes.
To its credit, the LA Times mentions the problem (without suggesting that Amazon's gambit may prevent it from ever paying the tax):
Many of about 25,000 affiliates in California, especially larger ones with dozens of employees, are likely to leave the state, said Rebecca Madigan, executive director of trade group Performance Marketing Assn. The affiliates combined paid $152 million in state income taxes last year, she pointed out.Personally, I'd pick Flagstaff — a beautiful small town with a relatively mild climate for Arizona — but only if one believes that Arizona politicians won't go ahead and do the same thing.
That's what Ken Rockwell of San Diego, the owner of a 12-year-old photography website, said he planned to do.
"Will it be Las Vegas or Scottsdale or Ensenada?" he said. "It's a question of where, not if."
The anti-tax site BigGovernment.com notes that the new law may also tax eBay, specifically its online merchants. Since eBay is a San Jose-based company, it can't (easily) eliminate its presence. Attempts by Bay Area politicians to carve a loophole to help eBay may not be enough — instead, non-California eBay merchants who don't want to pay sales tax may jump to Amazon.
In the end, the politicians will claim they've raised taxes in the name of "fairness," while (as in NY's attempts to tax Amazon) failing to collect taxes from Amazon while this spends several years winding its way through the courts.
Perhaps this is the true intention of the legislature in passing the law: millions of dollars in billable hours for their trial lawyer friends as Amazon, Overstock and other out of state retailers sue the state seeking to get it invalidated.


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Friday Nights @ OMCA
The Bay Area's most talked-about food truck party comes to Oakland! Join OMCA and Off the Grid on 10th Street every Friday starting this winter for a family-friendly take on a festive night market. Savor California beer, wine and non-alcoholic beverages around the Koi Pond at the Blue Oak café pop-up. Enjoy half-price admission, live music, film screenings, extended OMCA Store hours, and open studios with the Customizers-in-Residence from the we/customize exhibition. Bring the whole family to OMCA for a sampling of the best in Bay Area curbside cuisine!
What to expect on Friday, March 22:
- Local beer and wine specials in the Blue Oak beer garden on Level 1 featuring drink special Snakebite, a combination of Linden Street Common Lager and Crispin Hard Cider, beers including Trumer Pils, Linden Street Red Lager & Common Lager, and Sierra Nevada Pale Ale, and wines including Rock Wall Voignier, Acacia Carneros Chardonnay, Raymond Chardonnay, Louis Martini Cabernet, and MacMurray Ranch Pinot Noir
- Non-alcoholic beverages including Numi Organic Teas, Bicycle Drip Coffee, Prodecoop Dark Roast, Rodriguez de Mendoza Cooperative Decaf Roast, and Green Planet Spring Water
- DJ provided by Amoeba Music from 5 to 6:30 pm
- Live five-piece band Rumbache in the 10th Street ampitheater
- Salsa-themed dance lesson with Rick Washington from 6:30 to 7 pm
- Customizer-in-Residence open studio with Mutant Makers Annabel Blue Dudash and Elsa Rudolph in the we/customize exhibition from 5 to 8 pm
- Makers and Tasters Series featuring Claudia Gutierrez, student at the Food Craft Institute and owner of a fresh, locally made cookie dough company, Crumb Shoppe, with fresh-baked cookie tastings from 6 to 8 pm
- Family-friendly drop-in workshop from 5 to 8 pm: try out drip collage and create unique artworks inspired by the exhibition Summoning Ghosts: The Art of Hung Liu
- OMCA Store pop-up in the Koi Pond area
- Extended hours in the galleries and special exhibitions
- Eleven gourmet food trucks from Off the Grid featuring the best in local cuisine
Cost: Half-price gallery admission for adults, ages 18 and under are free. Admission for Members is always free. Cash bar. Prices vary for Off the Grid food trucks.
Transportation: OMCA is located one block from the Lake Merritt BART Station. Event parking is available at the Museum for a $5 flat fee after 5 pm.
Presented in partnership with Off the Grid: Lake Merritt @ OMCA.
Sponsored by:


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Live the Diving Dream Contest (Asia Pacific) – announcing the final winner!
Congratulations to SOUNG NAM CHA – winner for December 2013 PADI's Live the Diving Dream contest was held from the month of July to 31st December 2013, awarding monthly prizes of an Apple iPad to six new PADI Divemasters in the Asia Pacific territory. The winner in the contest […]Read more ›


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Have the poor suckers of this world ever lived in an age that offered such entertainment? Costly, to be sure, and they are the ones who are going to pay for it, but at least they are getting to watch some wonderful burlesque–first the pirates of a fraudulent system of communism forced to scuttle their own ship, and then the pirates of a fraudulent system of capitalism beginning to do the same.
So long as their focus was on Eastern Europe, our press and politicians couldn't talk enough about "the triumph of capitalism and democracy." But now that they begin reluctantly to concentrate on the piracy at home, they are–perhaps because so many of them are part of that piratical crew–understandably reluctant to admit the obvious: that our system is just as bogus and corrupt and irrelevant and defeated in its own way, offering neither the risks of true capitalism nor the safeguards of true democracy. Our system is a hoax.
If anyone still had faith in the system, the savings and loan adventure surely must have brought him to his senses and to his knees. The gambling debt of $500 billion ($150 billion plus interest and other incidentals)–or will it be, as some economists predict, a trillion four?–that the S&L industry left with the taxpayers has prompted even that deadpan Tory, George Will, to remark in wonderment, "We seem to have a capitalism here in which profits are private and we socialize the losses. Why are we, in effect–if you're big enough, if you're a huge bank or a savings and loan–why, in effect, are we guaranteeing everything? … What I'm asking is isn't there a way to reform the system so that the taxpayers don't get stuck with what happens when you have deregulation and risk taking that goes wrong?"
The answer to his question is: No, there is no way to reform the present system, because the system is owned and controlled by those who are ruining it. Voters, ordinary taxpayers, have nothing to say about it.
Martin Mayer, a conservative economic historian, has seen his world crumble and become meaningless. The capitalism he set his watch by has stopped ticking. He finds the thrift mess almost unbelievable: "Players entered the game through a government charter and continued to play, however severe their losses, in violation of all capitalist principle–courtesy of a government that continued to insure their borrowings. This was not an accident: it was public policy."
When he talks about "players," he makes it sound like customers at a casino. And that in fact is what it has become. Capitalism has become the Big Casino, with players guaranteed against loss, because in effect they have bought the house managers. That is public policy.
Mayer predicts plaintively that "future sociologists…will study the irruption of criminality into what had been conservative, even beneficent, organizations….They will seek to learn why the fiduciary ties that had set the unspoken, self-dignifying rules of a competitive society had been so grievously weakened in the late years of the twentieth century."


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Elaine Watson celebrates 100th birthday
Today, Feb. 8, Elaine will celebrate her 100th birthday. A party will be held in her honor at the Magnet Cove United Methodist Church, 22292 Hwy. 51, today at 1 p.m. Her children are Ann Smedley (Dick) of Hot Springs and John Watson (Jan) of Conway. No gifts please. (Photo submitted)


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Pendleton Convention Center
The Pendleton Convention Center, located next to the world-famous Pendleton Round-Up grounds and Happy Canyon, has facilities to host your meetings and provide substantial exhibition space.
Hospitality, made famous by the Pendleton Round-Up and Happy Canyon Pageant, is all part of the Pendleton scene. Programs featuring history, rodeo events, and Native American heritage are all available.
Top-notch amenities are available for your meetings at very competitive prices. The Pendleton Convention Center has 26,000 square feet of air-conditioned floor space to accommodate up to 5,000 people. There are nine breakout rooms that surround the Main Hall. We have an on-site kitchen and a world-class banquet chef as our caterer. Her food and beverage service is notable for its excellent quality and very reasonable prices.
Paved parking facilities are available for more than 500 cars. Or, you may utilize this space as an outdoor exhibit hall or for RV hookups. We have eighty 30-ampere electric circuits available.
- We invite you to visit the Pendleton Convention Center's official web site for more information.


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Reviewed By Brian F (HENRICO, VA) Reviewed for a 2011 Toyota Tacoma —2/26/2016 5:21 AM
I only have 200 miles on the pads, so I can't speak to the longevity of this pad. But what I can say is that this pad gives better stopping power than the OEM Toyota pad at about half the cost. If I had purchased the Toyota pads from the dealer, they were charging $118, where as this pad was purchased for $61. It is quiet, no squeals or other noises so far. The brakes have a better feel, and it will stop on a dime. The OEM pads lasted over 65k miles, we'll see if this pad can rival that.


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ASU Foundation hosts Evening with Our Stars
Music, wine, dance, and song - the Adams State University Foundation "Evening with Our Stars" event will fundraise money for student scholarships. The gala affair begins at 5 p.m. with an open bar cocktail hour followed at 6 p.m. with dinner, performances, and a live auction, on Saturday, March 2, at the Inn of the Rio Grande.
Foundation Board Member Dale Hettinger '64 suggested the auction include a service component. He said it would be a "good way" for the board members to become more involved in raising money and for the community to get to know the Foundation Board members. Some of the services offered will include Hettinger painting a room in a house; Keith Cerny, board member, will photograph a special event; and Tammy Lopez, executive director of the Foundation, and Lori Laske, Alumni Relations director, will provide five nights of dinner for four.
According to Duane Bussey '82, president of the Adams State University Foundation Board of Directors, along with raising money for scholarships, the event showcases talented community and university students. The Mountain Valley Dance Studio, 68 West (ASU's a capella group), and Lost and Found (ASU's theatre improve comedy troupe) will perform for the audience members.
"The Foundation Board is excited to host an evening filled with great entertainment, good food and a chance to raise scholarship money for San Luis Valley students attending ASU," Bussey said. "It will also be a great opportunity to hear from President David Svaldi for an update on the state of ASU."
The cost of tickets is $75. Corporate tables seating eight are also available. Eighty percent of net proceeds will provide scholarship to students from the San Luis Valley.
For more information, please contact the Adams State University Foundation Office at 719-587-7122 or email@example.com.


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I like visiting the pumpkin patch.
Ask the Readers: What Are Your Favorite Fall Activities?
Editor's Note: Congratulations to Betty, Mel, and Lisa for winning this week's contest!
While you can do most activities any time of the year, some things just scream FALL! Making seasonal treats and Halloween crafts are great indoor fun, while pumpkin patch fests and corn field mazes are excellent ways to enjoy the outdoors before winter sets in.
What are your favorite fall activities? Do you have any yearly autumn traditions? What new activities will you enjoy this year?
Tell us about your favorite fall activities and we'll enter you in a drawing to win a $20 Amazon Gift Card!
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I find myself baking and canning now that it's fall. And worrying about holiday gifts (I like to make a lot of my gifts.)
My favorite fall activities are: Going to visit best friends for a weekend, jumping in piles of leaves, going on vacation (when everyone else is back in school!), and enjoying the last sunny days before the w-season sets in. Trying now to squeeze in every drop of sunshine that we can!
My favorite fall activity is to go up to the apple orchards and get all kinds of apple everything! We get a peck of apples, and we also take home some apple bread, apple cider doughnuts, apple butter.. all kinds of goodies.
Lots of walks, soups and roasted veggies, coffee/cider/hot chocolate, and a road trip to somewhere nearby with amazing foliage!
Believe it or not, cooking is one of my favorite Fall hobbies. I don't cook much in the summer. Come Fall, I start making stews, soups, etc. I also love walking in our local parks.
I love cooking soups and stews, and baking bread in the autumn. It's too hot in the summer to cook such things, but when the first real chill in the air hits---ahh!
Autumn is my very favorite season. My husband and I host Friday night scary movie parties for the entire month of October, which is such a fun way to kick off the weekend.
We make sure to hit up the local pumpkin patch and this year we took turns with another couple, taking portraits to use for Christmas gifts. We also went through the corn maze for the first time ever.
The leaves this year in Oregon have been gorgeous and so I make sure that I take time to appreciate the foliage show as I'm driving to and from work or running errands.
And like lots of people, I love the seasonal coffee drinks at Starbucks!
I love everything about Fall...changing colors, brisk weather, hot cocoa, burning leaves, homemade chili, baking and using the crockpot, and enjoying the great outdoors.
I love Fall. I love picking fall scented candles and decorating inside for fall. I also like the holiday season I like getting a head start on watching Christmas movies and buying Christmas ornaments early I also like taking walks on cool fall days and trying to feed the ducks one last time before they head south for the winter. I also like walking picnics and walking tacos Oh and watching Halloween movies and Halloween candy!
I love fall baking - fall flavors are so delicious, plus the crisp air means your kitchen stays comfortable while you crank out cookies and pies!
I don't bake or use the oven much in the summertime, so fall always means the return of baking, which I love. Also, I love weekend drives to see the leaves turn colors. We also tend to take a fall vacation every year, it's our anniversary and favorite season, so we usually go away in autumn instead of summertime.
I love getting up early, when it is quiet outside and just take a walk. The air is crisp and clear. The crunch of leaves. Seeing all the leaves change color. It is simple but it is wonderful!
Apple picking and visiting the pumpkin patch! Some pick your own places near me still have blackberries, raspberries, and tomatoes, too. I LOVE baking and canning all the delicious goodies! Oh--and EATING THEM ALL OM NOM NOM NOM.
Cooking, snuggling, drinking hot drinks on cool days, walking through leaves, and watching the leaves change colors!
1. Riding my bike early in the morning
2. Collecting beautiful, colorful leaves to paint (that is, I do paintings of the leaves, not paint on them)
I like being able to take longer walks with my dogs in the cooler weather. I also like getting out and switching over to my fall clothes, too. It is always fun going to all of the fall festivals in Southern Ohio, and seeing the leaves change color, too.
Once the weather starts to cool off, my family likes to have a bonfire and invite friends. I make chili and we roast hot dogs and marshmallows.
I like making pumpkin and apple treats, hosting trick-or-treaters, drinking hot cocoa and spiced apple cider, and checking out the fall colors.
Climbing mountains to get a 360-degree view of the autumn colors. Baking and consuming anything with pumpkin. Watching football on the weekends. I love fall!
I'm definitely a baking girl. I look forward to fall thanks to pumpkin chocolate chip muffins and cranberry orange quick bread.
Oh I love taking drives this time of year to see all the beautiful color leaves! We love to go down by the river and just drive along the edge... So beautiful!
I love soaking up every last bit of the outdoors before the brutal upstate NY winter sets in. I also love waking up early on a weekend morning and walking over to my neighborhood coffee shop. It's a lovely way to enjoy the crisp fall morning weather!
We go up in the mountains of North Carolina and pick apples. Every year. The apples taste great, and the views are worth the drive!
This is absolutely my favorite season! I love nights on the porch with apple cider and looking at the beautiful colors change. More than likely you will catch me on the weekends in my football gear making delicious appetizers and of course, dressing up for Halloween! It's a time full of excitement around every corner!
It has been a while since we have gone on a hayride but I have fond memories of them! Can't forget the Claritin lol.
My parents had a octoberfest every year in the fall. We picked apples, made it into juice and ate apple pie. During the day we played games( like apple bobbing) and in the evening we danced the polka.
Now that the weather is cooler I love heading out to the zoo with my son and just being outdoors in general.
Our Families favorite time of year so we enjoy camping and coming back from a short hike to bowl of hot chili topped with shreded cheese.
Star gazeing and seeing who can blow the biggest "Dragon breath" when it gets cold outside.
Making caramel apples and marshmellow popcorn balls.
Grabbing a pizza and hot chocolate then going for a short sight-seeing drive watching the colorful leaf change.
Trying to keep warm by telling stories around a campfire
I like taking walks to admire the changes in the landscape, and arriving home slightly chilled -- it makes the warm house and the aroma of whatever's in the slow cooker that much more enticing.


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HARTSVILLE, S.C. – The Coker women's volleyball team lost its South Atlantic Conference match to the Queens University of Charlotte Royals on Friday (Oct. 25) night, 3-1.
After dropping the first set to the Royals, 25-14, the Cobras stormed back to take the second set, 25-21. Queens took the final two sets and the match with scores of 25-8 and 25-16.
Taylor Willis and Timara Arnold led the Cobra offensive attack with seven and five kills respectively. Hannah Vadakin added four kills, while Samantha Celek dished out 24 assists with seven digs. Mindy Morris was the dig leader for Coker with eight.
The Cobras will return to the court on Saturday (Oct. 26) when they host the Indians of Catawba in a conference match at 2 p.m.
McDonald's Player of the Game: Samantha Celek


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Change Coming to the New Year's Run-Swim
Never in their wildest imaginations could the three buddies who more or less spontaneously sprinted across a beach on New Year's Day nearly half a century (!) ago and leaped into the icy waters of Fishers Island Sound conceive that a huge mob would literally be following in their footsteps as part of one of the region's nuttiest, long-held traditions.
The annual New Year's run-swim – in keeping with the madcap nature of the event it has no formal name, no official organizers, is attached to no cause and has no real purpose other than for participants to proudly proclaim, "We are all idiots!" – began Jan. 1, 1969, when Amby Burfoot, then of Groton Long Point, who a year earlier had won the Boston Marathon, Lee Burbank of Mystic and Marty Valentine of Noank all decided to take a dip on Jan. 1
Contrary to what most modern-day acolytes believe, the trio did not run from Mystic to the beach that year, but drove to Esker Point in Noank, where they plunged into the water and then motored back home.
They repeated the drive-swim stunt the next year, but on Jan. 1, 1971, a handful of other runners joined the fun, and they decided to start off with a five-mile jog from the Pequot Avenue, Mystic home of Johnny Kelley, Amby's high school cross-country coach. Johnny, who also had won the Boston Marathon and competed twice in the Olympics, joyfully introduced me to the event way back in the Nixon Administration, and over the years it has grown to a throng of several hundred colorfully clad, noisemaker-tooting celebrants.
For some four decades the run launched from Pequot Avenue and ended at Groton Long Point – with many participants also running back after the swim, extending the distance to 10 miles.
Traditions evolve, and the annual run-swim is no exception.
Last year, because of road construction at Groton Long Point, the swim moved back to Esker Point, where the town of Groton generously offered use of its beach facilities.
Johnny, my old friend and mentor to generations of runners, died Aug. 21, 2011, and four months later we sadly started the run-swim for the last time from Pequot Avenue.
This New Year's Day we will begin from one of Johnny's favorite stomping grounds, near the banks of the Mystic River. Runners will gather about noon near the starting line for the Tarzan Brown road race on Pearl Street, then head south, cross West Main Street and continue south on Route 215 to Brook Street, where they will turn right, run up the hill to Groton Long Point Road, and turn left for the final stretch to Esker Point.
By my calculations that will shave the distance to about 3.3 miles, but who knows, maybe in keeping with the spontaneous nature of the event the course will evolve en route, adding a loop or two to extended the tally to an even five miles.
Truth told, the distance isn't all that important. The main idea is to have fun, reconnect with old friends, and honor the memories of those who have passed, including one of the original trio, Marty Valentine, who died years ago in Alaska, and of course, Kell. Monday, Dec. 24, would have been his 82nd birthday.
Even though the run-swim has no connection to a cause, it should serve as a reminder that none of us would be loping together on New Year's Day and jumping in the water if it weren't for Johnny. With his elfin sparkle, Peter Pan personality and boyish charm he was the glue that bound us together.
A bunch of friends plan to honor his memory with a life-sized statue in downtown Mystic. Check out The John Kelley Memorial Fund at johnkelley.org.
As for the run, it's free and open to everybody. It's not a race – more of a shuffle – and the group stops frequently to allow stragglers to keep up.
Bring a towel, or have somebody meet you at Esker Point.
Above all, have fun!
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