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These cases were brought by defendants in error in the superior court of the county of San Diego, California, to quiet their title to certain premises in that county. Decrees rendered in their favor were carried to the supreme court of the [181 U.S. 481, 482] state, and by that court affirmed. 126 Cal. 262, 58 Pac. 692. To such affirmance these writs of error have been sued out.
The facts in the cases are so nearly alike that it is sufficient to consider only the first. The land in question is within the limits of the territory ceded to the United States by the treaty of Guadalupe Hidalgo, February 2, 1848. 9 Stat. at L. 922. Generally speaking, the plaintiffs claim title by virtue of a patent issued to John J. Warner on January 16, 1880, in confirmation of two grants made by the Mexican government. On the other hand, the defendants do not claim a fee in the premises but only a right of permanent occupancy by virtue of the alleged fact that they are mission Indians, so called, and had been in occupation of the premises long before the Mexican grants, and, of course, before any dominion acquired by this government over the territory; insisting, further, that the government of Mexico had always recognized the lawfulness and permanence of their occupancy, and that such right of occupancy was protected by the terms of the treaty and the rules of international law.
The treaty of Guadalupe Hidalgo provided in article 8 as follows:
Article 10, as originally prepared, was stricken out by the Senate, but in the protocol signed by the representatives of the two nations, at the time of the ratification, on May 26, 1848, it was stated:
After the acquisition of this territory Congress, on March 3, 1851 (9 Stat. at L. 631, chap. 41), passed an act entitled 'An Act to Ascertain and Settle the Private Land Claims in the State of California,' which created a commission to receive and act upon all petitions for confirmation of such claims. Its decision was subject to appeal to the district court of the United States, and thence to this court. As originally organized the commission was to continue for three years, but that time was extended by subsequent legislation. Sections 8, 13, 15, and 16 are as follows:
On the trial before the court, without a jury, the findings of fact were in substance that the plaintiffs had the ownership in fee simple of the premises described; that the defendants had no rights or interest therein, and the decree was in accordance therewith. The statement on appeal prepared by the trial court disclosed that the plaintiffs introduced in evidence the patent to John J. Warner, which patent recited the filing of a petition by Warner with the land commission praying for confirmation of his title, a title based on two Mexican grants,-one June 8, 1840, to Jos e Antonio Pico by Juan B. Alvarado, then constitutional governor of the Californias, and the second, November 28, 1844, to petitioner by Manuel Micheltorena, governor general commandant and inspector general of the Californias; recited also a decree of confirmation of such title, an appeal to the district court of the United States, and an affirmance of the decision of [181 U.S. 481, 486] the commission, the return of the surveyor general of the state showing a survey; and conveyed the premises to Warner, 'but with the stipulation that in virtue of the 15th section of the said act neither the conformation of this claim nor this patent shall affect the interests of third persons.' It was admitted that Warner's title had passed to plaintiffs, and that the taxes had all been paid by them. On the other hand, the appeal statement showed that the defendants offered copies of the expedientes of both of the grants referred to in the patent, and also oral testimony of occupation by the defendants and their ancestors. Some witnesses were introduced by the plaintiffs to contradict this matter of occupancy, but on final consideration the court struck out all the testimony in reference to occupancy and of the Mexican grants upon which the patent was issued. Upon the evidence, therefore, that was received by the trial court, there could be no doubt of the rightfulness of the decree, and the question presented by the record to the supreme court of the state was whether there was error in striking out the testimony offered on behalf of the defense.
Messrs. Shirley C. Ward and Assistant Attorney General Hoyt for plaintiffs in error.
Messrs. David L. Withington, Stephen M. White, Charles Monroe, and Cassius Carter for defendants in error.
Jr. Justice Brewer delivered the opinion of the court:
Undoubtedly by the rules of international law, and in accordance with the provisions of the treaty between the Mexican government and this country, the United States were bound to respect the rights of private property in the ceded territory. But such obligation is entirely consistent with the right of this government to provide reasonable means for determining the validity of all titles within the ceded territory, to require all persons having claims to lands to present them for recognition, [181 U.S. 481, 487] and to decree that all claims which are not thus presented shall be considered abandoned. 'Undoubtedly private rights of property within the ceded territory were not affected by the change of sovereignty and jurisdiction, and were entitled to protection, whether the party had the full and absolute ownership of the land, or merely an equitable interest therein, which required some further act of the government to vest in him a perfect title. But the duty of providing the mode of securing these rights, and of fulfilling the obligations imposed upon the United States by the treaties, belonged to the political department of the government; and Congress might either itself discharge that duty or delegate it to the judicial department. De la Croix v. Chamberlain, 12 Wheat. 599, 601, 602, 6 L. ed. 741, 742; Chouteau v. Eckhart, 2 How. 344, 374, 11 L. ed. 293, 305; Tameling v. United States Freehold & Emigration Co. 93 U.S. 644, 661 , 23 S. L. ed. 998, 1002; Botiller v. Dominguez, 130 U.S. 238 , 32 L. ed. 926, 9 Sup. Ct. Rep. 525.' Astiazaran v. Santa Rita Land & Min. Co. 148 U.S. 80, 81 , 37 S. L. ed. 376, 13 Sup. Ct. Rep. 457.
Botiller v. Dominguez, 130 U.S. 238 , 32 L. ed. 926, 9 Sup. Ct. Rep. 525, the last case cited in the foregoing quotation, deserves special notice. The supreme court of California had held in several cases that a perfect title need not be presented to the land commission; that it was recognized by the treaty of cession, and required no further confirmation; that the act to ascertain and settle private land claims applied only to those titles which were imperfect and needed the action of some tribunal to ascertain and establish their validity. But in this case, which came from the supreme court of California, we held the contrary. We quote at some length from the opinion. Thus, on page 246, L. ed. 928, Sup. Ct. Rep. 527, it was said:
In reference to the second proposition, after noticing several provisions of the statute, it was declared (p. 248, L. ed. 929, Sup. Ct. Rep. 527):
The views thus expressed have been several times reaffirmed by this court, the latest case being Mitchell v. Furman, 180 U.S. 402 , 45 L. ed . --, 21 Sup. Ct. Rep. 430, in which, after quoting the passage last above quoted, we said, in reference to statutes of the United States respecting claims in Florida (p. 438, L. ed. --, Sup. Ct. Rep. 444):
See also Thompson v. Los Angeles Farming & Mill. Co. 180 U.S. 72, 77 , 45 S. L. ed. --, 21 Sup. Ct. Rep. 289, in which it was said in reference to the statute before us: [181 U.S. 481, 490] 'Every question which could arise on the title claimed could come to and receive judgment from this court. The scheme of adjudication was made complete and all the purposes of an act to give repose to titles were accomplished. And it was certainly the purpose of the act of 1851 to give repose to titles. It was enacted not only to fulfil our treaty obligations to individuals, but to settle and define what portion of the acquired territory was public demain. It not only permitted but required all claims to be presented to the board, and barred all from future assertion which were not presented within two years after the date of the act. 13. The jurisdiction of the board was necessarily commensurate with the purposes of its creation, and it was a jurisdiction to decide rightly or wrongly. If wrongly a corrective was afforded, as we have said, by an appeal by the claimant or by the United States to the district court.'
These rulings go far toward sustaining the decision of the supreme court of California in the present cases. As between the United States and Warner, the patent is as conclusive of the title of the latter as any other patent from the United States is of the title of the grantee named therein. As between the United States and the Indians, their failure to present their claims to the land commission within the time named made the land, within the language of the statute, 'part of the public domain of the United States.' 'Public domain' is equivalent to 'public lands,' and these words have acquired a settled meaning in the legislation of this country. 'The words 'public lands' are habitually used in our legislation to describe such as are subject to sale or other disposal under general laws.' Newhall v. Sanger, 92 U.S. 761, 763 , 23 S. L. ed. 769. 'The grant is of alternate sections of public land, and by public land, as it has been long settled, is meant such land as is open to sale or other disposition under general laws.' Bardon v. Northern P. R. Co. 145 U.S. 535, 538 , 36 S. L. ed. 806, 809, 12 Sup. Ct. Rep. 856, 857. See also Mann v. Tacoma Land Co. 153 U.S. 273, 284 , 38 S. L. ed. 714, 717, 14 Sup. Ct. Rep. 820. So far, therefore, as these Indians are concerned, the land is rightfully to be regarded as part of the public domain and subject to sale and disposal by the government, and the government has conveyed to Warner. It is true that the patent, [181 U.S. 481, 491] following the 15th section of the act, in terms provides that the patent shall not 'affect the interests of third persons,' but who may take advantage of this stipulation? This question was presented and determined in Beard v. Federy, 3 Wall. 478, 18 L. ed. 88, and the court, referring to the effect of a patent, said (pp. 492, 493, L. ed. p. 93):
If these Indians had any claims founded on the action of the Mexican government they abandoned them by not presenting them to the commission for consideration, and they could not, therefore, in the language just quoted, 'resist successfully any action of the government in disposing of the property.' If it be said that the Indians do not claim the fee, but only the right of occupation, and therefore they do not come within the provision of 8 as persons 'claiming lands in California by virtue of any right or title derived from the Spanish or Mexican government,' it may be replied that a claim of a right to permanent occupancy of land is one of far reaching effect, and it could not well be said that lands which were burdened with a right of permanent occupancy were a part of the public domain and subject to the full disposal of the United States. There is an essential difference between the power of the United States over lands to which it has had full title, and of which it has [181 U.S. 481, 492] given to an Indian tribe a temporary occupancy, and that over lands which were subjected by the action of some prior government to a right of permanent occupancy, for in the latter case the right, which is one of private property, antecedes and is superior to the title of this government, and limits necessarily its power of disposal. Surely a claimant would have little reason for presenting to the land commission his claim to land, and securing a confirmation of that claim, if the only result was to transfer the naked fee to him, burdened by an Indian right of permanent occupancy.
Again, it is said that the Indians were, prior to the cession, the wards of the Mexican government, and by the cession became the wards of this government; that therefore the United States are bound to protect their interests, and that all administration, if not all legislation, must be held to be interpreted by, if not subordinate to, this duty of protecting the interests of the wards. It is undoubtedly true that this government has always recognized the fact that the Indians were its wards, and entitled to be protected as such, and this court has uniformly construed all legislation in the light of this recognized obligation. But the obligation is one which rests upon the political department of the government, and this court has never assumed, in the absence of congressional action, to determine what would have been appropriate legislation, or to decide the claims of the Indians as though such legislation had been had. Our attention has been called to no legislation by Congress having special reference to these particular Indians. By the act creating the land commission the commissioners were required ( 16) 'to ascertain and report to the Secretary of the Interior the tenure by which the mission lands are held, and those held by civilized Indians, and those who are engaged in agriculture or labor of any kind, and also those which are occupied and cultivated by Pueblos or Rancheros Indians.' It is to be assumed that the commissioners performed that duty, and that Congress, in the discharge of its obligation to the Indians, did all that it deemed necessary, and as no action has been shown in reference to these particular Indians, or their claims to these lands, it is fairly to be deduced that Congress [181 U.S. 481, 493] considered that they had no claims which called for special action.
But we are not compelled to rest upon any presumptions from the inaction of Congress. Turning to the testimony offered in respect to the matter of occupation, it may be stated that there was sufficient to call for a finding thereon if the fact of occupation was controlling. But in the Mexican grants upon which Warner based his application to the commission for a confirmation of his title we notice these things: The first grant was in 1840, to Jos e Antonio Pico. The application was for 'the place 'Agua Caliente,' belonging to the mission of San Luis Rey, since it is not needed by the said mission, having a house on it, and an orchard of little utility.' The report of the justice of the peace was 'that the land 'Agua Caliente' is the property of the San Luis Rey mission, which has improvements, buildings, and an orchard, from which derive their subsistence the Indians who live thereon, which is bounded by the property of Joaquin Ortega, and I believe it can be awarded to the interested party for being worthy, but without prejudice to the Indians, who from it derive their support.'
The last paper it the expediente was the following:
Juan B. Alvarado, Constitutional Governor of the Department of both Californias:
Whereas Jos e Antonio Pico has petitioned for his own personal benefit and that of his family the land known by the name of 'Agua Caliente,' bounded by the ranch of 'San Jos e Valley,' with the boundary of the canyon of 'Buena Vista,' and by the mountains of 'Palomar,' having previously complied with the writs and investigations corresponding, as required by the laws and regulations, exercising the powers which are conferred on me in the name of the Mexican nation, I have resolved to grant to him the said place, subjecting himself to pay for the place of worship and other improvements that be there, belonging to the San Luis Rey mission, and not molest (prejudicar) the Indians that thereon may be established, and to the approbation of the most excellent assembly of the department, and to the conditions following, to wit: [181 U.S. 481, 494] First. He is allowed to fence it in, without interfering with the roads, cross roads, and other usages (servidumbres); he will possess it fully and exclusively, turning it to agricultural or any other use he may see fit, but within a year he shall construct a house thereon and live in it.
Second. When the property shall have been confirmed to him, he shall petition the respective judge to give him possession thereof, by virtue of this order, and shall mark out the boundaries on whose limits he shall fix the landmarks, some fruit and wild trees that may be of some utility.
Third. The land of which donation is hereby made is of the extent mentioned in the plan, which goes with the 'expediente.' The judge who should give possession thereof shall have it surveyed according to law, leaving the residue that may result to the nation for other purposes.
Fourth. If he should fail to comply with these conditions, he shall forfeit his title to the land, and it will be denounceable by another.
Therefore, I command that this present order be to him the title, and holding it for good and valid, a copy thereof be entered into the proper book, and given to the party interested for his protection and other purposes.
No approval of this grant by the departmental assembly appears of record, but the finding of the commission was that whatever of right passed to Pico was transferred by conveyances to Warner. The second grant, that in 1845, was made directly to Warner, upon his personal application, which application was thus indorsed:
Office of the First Justice of the Peace,
San Diego.
In view of the petition which the party interested remits to this office, I beg to state that the said 'Valle San Jos e' is, and has for the past two years been vacant and abandoned, without any goods nor cultivation on the part of San Diego; but said place belongs at the present time to the said mission, and at petitioner's request I sign this in San Diego.
August 6, 1844
Juan MaMarron. [181 U.S. 481, 495] To the Most R. P. Vincent Olivas:
With the object of soliciting in property the place known by the name 'Valle de San Jos e,' formerly occupied by the mission under your charge, I beg of you to be so kind as to inform me if, at the present day, the mission of San Diego does occupy the said land, and if not, how long since it has been abandoned.
Juan J. Warner.
San Diego, August 5, 1844.
The 'Valley of San Jos e' can be granted to the party who petitions for it, inasmuch as the mission of San Diego, to whom it belonged, has no means sufficient to cultivate and occupy it, and it is not so necessary for the mission.
Fr. Vincent P. Olivas.
Mission of San Diego, August 5, 1844.
The grant was in these words:
The grant was subsequently approved by the departmental assembly on May 21, 1845. On the application to the private land commission the matter was investigated, and a report made by Commissioner Felch, in these words:
Upon that report the title was confirmed, which, as heretofore stated, was approved by the district court, and thereupon a patent was issued.
From these papers the following appears: The grant to Pico was made subject to the condition that he should 'not molest the Indians that thereon may be established.' No such condition was attached to the subsequent grant to Warner. On the contrary the report of the justice of the peace was that the land had been for two years vacant and abandoned; that there were some property rights vested, not in the Indians, but in the mission of San Diego, and the official of that mission consented to the grant, inasmuch as the mission had no means to cultivate and occupy the land, and it was no longer necessary for its purposes.
Some discussion appears in the briefs as to the meaning of the word translated 'usages' (servidumbres) which appears in both grants, and it is contended by the plaintiffs in error that it is equivalent to the English word 'servitudes,' and is broad enough to include every right which anyone may have in respect to the premises subordinate to the fee. We shall not attempt to define the meaning of the word standing by itself. It may be conceded that it was sometimes used to express all kinds of servitudes, including therein a paramount right of occupation, but the context seems to place a narrower meaning upon its use here. Thus, in the first grant, not only is there [181 U.S. 481, 499] the distinct provision that the Indians established on the land shall not be molested, but the grantee 'is allowed to fence it in without interfering with the roads, cross roads, and other usages' (servidumbres). In the second the grantee is 'allowed to fence it in without interference with the roads and other usages' (servidumbres). Obviously, it is in these two clauses contemplated that the fencing is to be without interference with roads and other usages or burdens. It does not mean that the general occupation and control of the property is limited by any so-called servidumbres, but only that such full control shall not be taken as allowing any interference with established roads or cross roads, or other things of like nature.
It thus appears that prior to the cession the Mexican authorities, upon examination, found that the Indians had abandoned the land; that the only adverse claim was vested in the mission of San Diego and made an absolute grant, subject only to the condition of satisfying whatever claims the mission might have. How can it be said therefore that when the cession was made by Mexico to the United States there was a present recognition by the Mexican government of the occupancy of these Indians? On the contrary, so far as any official action is disclosed, it was distinctly to the contrary, and carried with it an affirmation that they had abandoned their occupancy, and that whatever of title there was outside of the Mexican nation was in the mission, and an absolute grant was made subject only to the rights of such mission.
For these reasons we are of opinion that there was no error in the rulings of the Supreme Court of California, and its judgments in the two cases are affirmed.
Mr. Justice White did not hear the argument of these cases or take part in their decision.
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Citation: 181 U.S. 481
Docket No: No. 209
Decided: May 13, 1901
Court: United States Supreme Court
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- Research
- Open Access
- Published:
Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study
Nutrition Journal volume 11, Article number: 30 (2012)
11k Accesses
24 Citations
1 Altmetric
Early enteral nutrition is recommended in cases of critical illness. It is unclear whether this recommendation is of most benefit to extremely ill patients. We aim to determine the association between illness severity and commencement of enteral feeding.
One hundred and eight critically ill patients were grouped as "less severe" and "more severe" for this cross-sectional, retrospective observational study. The cut off value was based on Acute Physiology and Chronic Health Evaluation II score 20. Patients who received enteral feeding within 48 h of medical intensive care unit (ICU) admission were considered early feeding cases otherwise they were assessed as late feeding cases. Feeding complications (gastric retention/vomiting/diarrhea/gastrointestinal bleeding), length of ICU stay, length of hospital stay, ventilator-associated pneumonia, hospital mortality, nutritional intake, serum albumin, serum prealbumin, nitrogen balance (NB), and 24-h urinary urea nitrogen data were collected over 21 days.
There were no differences in measured outcomes between early and late feedings for less severely ill patients. Among more severely ill patients, however, the early feeding group showed improved serum albumin (p = 0.036) and prealbumin (p = 0.014) but worsened NB (p = 0.01), more feeding complications (p = 0.005), and prolonged ICU stays (p = 0.005) compared to their late feeding counterparts.
There is a significant association between severity of illness and timing of enteral feeding initiation. In more severe illness, early feeding was associated with improved nutritional outcomes, while late feeding was associated with reduced feeding complications and length of ICU stay. However, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake and there is no eventual difference in length of hospital stay or mortality between groups. Consequently, early feeding shows to be a more beneficial nutritional intervention option than late feeding in patients with more severe illness.
Critical illness changes substrate metabolism, thereby altering body compositions and worsening clinical outcomes [1]. Intensive care unit (ICU) patients are susceptible to malnutrition, immune dysfunction, severe infections, multiple organ dysfunction, and death [2, 3].
Early enteral feeding improves clinical outcomes, reduces gastric intolerance, and promotes early reestablishment of gastroduodenal motility [4, 5]. Patients experiencing early enteral feeding (within 24 to 48 h following ICU admission) demonstrate reduced gut permeability and cytokine release, compared to late enteral feeding patients (after 72 h) [6]. However, Ibrahim et al. observed that the administration of early enteral nutrition to mechanically ventilated medical patients is associated with more severe infectious complications and prolonged ICU stays [7]. Minard et al. stated that patients with severe closed-head injuries demonstrated no differences in length of stay or infectious complications in early vs. delayed feeding [8]. Therefore, the consistency of the current medical evidence from systematic reviews may be insufficient to convince clinicians to aggressively provide early feeding in more severely ill patients [9]. Although many studies have investigated the timing of enteral nutrition in critical illness, its effects on clinical outcomes in patients with varied illness severity have not been fully examined.
This study aims to determine the association between illness severity and commencement of enteral feeding. The primary outcome measures are clinical outcomes while secondary measures are nutritional outcomes. The study investigates the association between illness severity and feeding complications, length of ICU stay, length of hospital stay, ventilator-associated pneumonia (VAP), hospital mortality rate, serum albumin, serum prealbumin, nitrogen balance (NB), and nutritional intake over a 21-d study period in critically ill patients receiving enteral feeding within or after 48 h of ICU admission.
Materials and Methods
Subjects and Study Design
This retrospective observational study was conducted between January 2005 and December 2006 at Kaohsiung Veterans General Hospital. Study protocol was conducted in accordance with the ethical standards of the World Medical Association Declaration of Helsinki and approved by the hospital's Research Ethics Committee. All patients consecutively admitted to the medical ICU were enrolled unless enteral feeding was contraindicated. Contraindications included: paralytic ileus, intestinal obstruction, intractable vomiting, persistent watery diarrhea, active gastrointestinal (GI) bleeding, short bowel syndrome or severe acute pancreatitis. Patients intravenously supplemented with fat emulsion, amino acids or albumin during the study period were also excluded. After admission, patients were administered nasogastric or nasoduodenal feeding tubes (12Fr enteral feeding tube, Flexiflo, Abbott, Chicago, IL) with full-strength isotonic formula (Jevity, Abbott Laboratories, Ontario, Canada), starting at 20 mL/h, and increasing by 20 mL/h every 4 h to satisfy energy and protein requirements recommended by a clinical dietitian based on the Ireton-Jones equation: EEE (v) = 1784 − 11(A) + 5(W) + 244(S) + 239(T) + 804(B) − 609(O); REI = EEE × (1.0-1.5), where EEE = estimated energy expenditure (kcal/day), v = ventilator dependent, A = age (yr), W = body weight (kg), S = sex (male = 1, female = 0), diagnosis of T = trauma, B = burn, O = obesity (if present = 1, absent = 0), REI = recommended energy intake, and Canadian clinical practice guidelines for critically ill adult patients [10]. Daily recommended energy and protein requirements ranged from 25–30 kcal/kg and 1.2–1.5 g/kg ideal body weight. All patients were fed with heads elevated 30-45 ° during feeding and for 1 h after feeding. Residual was checked every 4 h and feeding was withheld for 1 h if residual volume was over 250 ml. The nurses interrupted enteral feeding in cases of: overt regurgitation or aspiration; residual volume over 500 mL; residual volume between 250 and 500 mL with abdominal distention, nausea or vomiting [11]. Residual was rechecked before reinitiating feeding. Once the residual volume was lower than 250 mL and patients showed no abdominal distention, nausea or vomiting, tube feeding was restarted at a rate of 20 mL/h and increased by 20 mL/h every 4 h until the caloric target was achieved. Patients were monitored for up to 21 days or observations were closed if they expired or were transferred to an ordinary ward.
Definitions and outcome measures
The timing of initial enteral feeding was determined by the ICU team following Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition guidelines. Feeding commencement at less than 48 h after ICU admission was considered early feeding while over 48 h was considered late feeding. Illness severity was determined by Acute Physiology and Chronic Health Evaluation (APACHE) II scores [12, 13]. Previous studies have indicated that the optimal cutoff estimate for APACHE II scoring in predicting ICU mortality is 20; patients with APACHE II scores ≥ 20 on ICU admission demonstrate a significantly higher fatality risk than those with scores < 20 [14–16]. Based on this information, this study groups eligible patients as 'less severe' (APACHE II score < 20) or 'more severe' (APACHE II score ≥ 20) and then sub-groups these categories into early or late feeding groups according to when enteral feeding started. In clinical practice, NB was calculated by: daily protein intake (g) ÷ 6.25 - (24-h UUN (g) + 4 g obligatory loss) and can be used to estimate the magnitude of stress response as reflected by the catabolic rate [17]. There were no massive extra renal nitrogen losses (inflammatory bowel disease, GI fistulae, extensive bed sores, burn exudates) in our patients. Because there is no objective indicator of GI function in critically ill patients [18, 19], we assessed GI dysfunction based on the clinical assessments of four tube feeding complications: gastric retention, vomiting, diarrhea, and GI bleeding. Gastric retention was defined as a residual volume >250 mL [6, 18]; vomiting as feeding formula found in the pharynx or mouth; diarrhea as ≥3 bowel movements or >200 mL watery stool/day in patients who had not consumed laxatives or hyperosmolar medications in the preceding 24 h; and GI bleeding as presence of hematemesis, melena, bloody stool, or coffee grounds-like material in the feeding tubes. A feeding complication episode was based on the first appearance of symptoms until the symptoms subsided. Length of ICU stay equalled ICU admission until transfer out of ICU. VAP was diagnosed by two pulmonologists using a modified National Nosocomial Infections Surveillance system [20]. Hospital mortality was defined as death while hospitalized. Caloric and protein intake were calculated from the amount of administered formula as specified in the medical records and nurse files. The percentage of target caloric and protein intake achieved was calculated as: mean % of target caloric (protein) intake = Σ [each day's caloric (protein) intake ÷ recommended daily caloric (protein) requirement] ÷ number of study days.
Data collection
Basic patient characteristics (age, sex, height, weight), ICU admission and transfer-out dates, diagnosis and APACHE II score on ICU admission, survival or death at hospital discharge, VAP, medications administered, start and end dates of tube feeding, daily caloric and protein intake, and clinical assessments of tube feeding complications (gastric retention/vomiting/diarrhea/GI bleeding) were recorded. Blood and 24 h urine samples were collected on feeding days 1, 4, 7, 14, and 21 for laboratory measurements of serum albumin, serum prealbumin, and 24-h urinary urea nitrogen (UUN).
Statistical analysis
All statistical analyses were performed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA) and Excel 2003 (Microsoft, Redmond, WA, USA). Distributions of baseline characteristics, differences in clinical outcomes, biochemical values and nutritional intake between groups were compared using Student's t-test for normally distributed continuous variables or Mann–Whitney U-test for non-normally distributed continuous variables. Multiple linear regression and logistic regression were used to assess initial enteral feeding time's effects on measured outcomes after adjusting for potential confounders. Two-tailed p-values < 0.05 were considered significant. Values are presented as means ± standard deviation.
A total of 108 newly admitted ICU patients qualified for the trial. Of these, 40 patients (43.5 %) received early enteral feeding with 14 assigned to 'less severe' and 26 assigned to 'more severe'. The other 68 patients (56.5 %) received late enteral feeding with 33 assigned to 'less severe' and 35 assigned to 'more severe'. Demographic and clinical characteristics of the patients are shown in Table 1. The early feeding patients were significantly older than those in the late feeding group, but these differences did not exist between groups broken-down by illness severity. Notably, early feeding patients had a significantly higher incidence of antibiotic use.
Clinical outcomes
Feeding complications
The frequency of feeding complications was not statistically different between early and late feeding groups. However, more severely ill early feeding group patients experienced significantly higher feeding complications than their counterparts of the late feeding group (Table 2). Diarrhea and GI bleeding were significantly higher in early feeders among the more severely ill (Table 3). After adjusting for gender, age and illness severity, early enteral feeding had positive effects on feeding complications (Table 4).
The incidence of VAP was significant higher in the early feeding group; however, there was no significant difference between both groups by illness category (Table 2) nor was VAP related to enteral feeding commencement (Table 4).
Lengths of ICU stay and hospital stay
The early feeding group experienced longer ICU stays. However, these differences only existed among more but not less severely ill patients (Table 2). After adjusting for gender, age and severity of illness, early enteral feeding was associated with increased length of ICU stay among the more severely ill patients (Table 4). There were no differences in length of hospital stay (Table 2).
Hospital mortality
There were no differences between both groups in either illness category (Table 2). Timing of enteral feeding initiation was not associated with hospital mortality (Table 4). However, after adjusting for gender, age and timing of enteral feeding initiation, illness severity had an effect on mortality rate. Patients with higher APACHE II scores risked higher hospital mortality (adjusted OR = 0.897, 95 % CI = 0.835-0.964, p = 0.003).
Nutritional outcomes
Nutritional intake
There were no differences in caloric and protein intake between both feeding groups for less or more severely ill patients (Tables 2 and 4). We observed a mean of 80 % above the caloric intake goal for both feeding groups (Table 2).
Serum albumin and prealbumin
The more severely ill early feeding patients showed significantly higher serum albumin levels than those of the late feeding group on feeding day 7; less severely ill patients showed no differences (Table 2). The commencement time of enteral feeding had no effect on serum albumin levels after adjusting for gender, age and illness severity (Table 4). Similarly, serum prealbumin levels were significantly higher in the early feeding group on feeding days 4 and 7 (Table 2) in the more severely ill patients; less severely ill patients showed no differences between groups. After adjusting for gender, age and illness severity, early feeding was not associated with increased serum prealbumin levels in more severely ill patients (Table 4).
NB and 24-h UUN
The NB and 24-h UUN in both groups significantly differed on feeding days 7, 14 or 21 among more but not less severely ill patients (Table 2). Adjusting for gender, age and illness severity, the timing of enteral feeding initiation had effects on NB and 24-h UUN (Table 4). Patients with higher APACHE II scores in the early feeding group experienced more nitrogen loss and worsened NB.
Post-hoc power
Post-hoc power analyses were performed using G*Power 3.1 software [21] to determine whether the sample size could give acceptable results. Among less severely ill patients, power was insufficient to analyze the differences between early and late feeding groups in terms of clinical outcomes and nutritional outcomes. However, for these patients, multiple linear regression and logistic regression analyses verified the timing of enteral feeding initiation had no effect on measured outcomes after adjusting for confounding factors (Table 4). On the other hand, in the case of APACHE II ≥20 patients, our study had sufficient power to analyze length of ICU stay (power = 0.9), NB on feeding day 14 (power = 0.85) and 24-h UUN on feeding days 14, 21 (power = 0.8, 0.99); but insufficient power for analyzing the feeding complications (power = 0.6), serum albumin on feeding day 7 (power = 0.6) and serum prealbumin on feeding days 4, 7 (power = 0.13, 0.72).
The early feeders among the more severely ill patients experienced significantly more frequent feeding complications than late feeders, but their caloric and protein intake did not differ from the other groups. This was due to their major feeding complications being diarrhea and/or GI bleeding and not gastric retention or vomiting, which would significantly affect nutritional intake. Severely ill patients commonly develop GI problems such as mucosal damage, motility disturbances, and hypoalbuminemia-related mucosal edema due to severe physiological stress [22, 23]. Therefore, we inferred that the higher incidence of diarrhea might have been due to early aggressive feeding placing stress on damaged mucosa and/or a higher usage of antibiotics in these patients. However, diarrhea among the more severely ill early feeders was not severe and it subsided after adjusting the feeding rate and/or administration of anti-diarrhea medicines. Additionally, the higher incidence of GI bleeding among these patients is related to stress ulcers and not active bleeding. GI bleeding subsided after controlling shock or use of medications such as proton pump inhibitors or histamine type 2 receptor antagonists. Consequently, as we were able to control diarrhea and GI bleeding, neither significantly affected nutritional intake. These results, however, are inconsistent with previous reports of early feeding improving GI function [4, 6]. Critically ill patients suffer from a combination of physiological disturbances likely to influence GI function [22, 24]. Our results show an association between illness severity and enteral feeding commencement. In more severely ill patients, feeding within 24 to 48 h of ICU admission may be too early as it can cause further stress to the GI tract, and result in diarrhea and stress-induced ulcers.
We also observed that the higher the APACHE II score, the longer the ICU stay for early feeders after adjusting for confounding factors. These results are consistent with Ibrahim et al., who observed greater incidence of diarrhea and longer ICU stays among early feeders [7]. We hypothesize that the greater incidence of feeding complications is a confounding factor increasing the length of ICU stay in the early feeding group among more severely ill patients [25].
Our observations indicate that mortality is unaffected by enteral feeding commencement time. The meta-analysis study conducted by Marik and Zaloga also found no relationship between early enteral nutrition and decreased mortality [26]. Expectably, our study demonstrates that illness severity governs the mortality rate and neither late enteral feeding nor early enteral feeding reduces the mortality rate.
Clinically, serum albumin level most likely acts as a prognostic rather than nutritional indicator [27]. Previous studies have indicated that inflammatory mediators and cytokines released during injury are major contributors in lowering serum albumin and prealbumin levels [28, 29]. Serum prealbumin is more sensitive to changes in protein-energy status than serum albumin is, and its concentration reflects recent dietary intake rather than an overall nutritional status [30]. In critical illness, hypoalbuminemia and hypoprealbuminemia are very common and inversely related to C-reactive protein [30]. Therefore, increases in these two serum protein levels (in response to enteral feeding on days 4 and 7) only in the case of more severely ill early feeders might relate to early feeding inducing the release of trophic endogenous agents and the inhibitory effects of inflammatory mediators and cytokines released during severe illness [26, 31].
Negative NB indicates inadequate protein intake or excessive catabolism. We observed no differences in protein intake between both feeding groups but significantly higher 24-h UUN losses in more severely ill early feeders. This implies that levels of stress are higher among these patients. Briassoulis et al. demonstrated that severity of illness independently contributes to negative NB status during acute stress phases [32]. As disease becomes more severe, more stress hormones are secreted, leading to greater GI disturbances and nitrogen loss [33]. Therefore, the lower 24-h UUN loss and better NB in the more severely ill of late feeding group is more likely due to improved metabolic stress.
This study has important strengths. Firstly, it is observational and feeding commencement was decided solely by the ICU team in accordance with actual treatment protocol. This connotes the de facto aspects of intensive care. Second, our 21-d study period is longer than those of previous studies. There were also limitations in our study. First, the study population was within a single medical ICU, meaning generalizations must be treated cautiously. Second, the sample size of the early feeding group limits the study's power to analyze the measured outcomes. However, the results of multiple linear regression and logistic regression analyses strongly support our findings eliminating the issue of power insufficiency. Further, larger randomized sample-sizes, controlled trials with mixed ICU patients, data analyzed on tertiles, quartiles or quintiles of APACHE II scores and enteral feeding commencement time are required to fully investigate the optimal timing of initial enteral feeding in managing patients with varied illness severity.
Genetic polymorphisms, underlying pathology, and patient heterogeneity limit the extent to which nutritional intervention can be standardized. Our study demonstrates a relationship exists between illness severity and enteral feeding commencement time influencing clinical outcomes. For more severely ill patients, early feeding is associated with improved nutritional outcomes whereas late feeding is associated with reduced feeding complications and shorter ICU stays. Notably, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake. Additionally, the study shows there is no eventual difference in length of hospital stay or mortality although such patients experience longer ICU stays. Consequently, early feeding shows to be a more beneficial nutritional intervention option than late feeding in patients with more severe illness.
Authors' information
HH-H, RD, MS, Chief of Foodservice Management Division, Department of Food and Nutrition, Taipei Veterans General Hospital (a 3000-bed teaching hospital). Board Director of Taiwan Society for Parenteral and Enteral Nutrition. Executive Supervisor of Kaohsiung Dietetic Association. HC-W, MD, Visiting Doctor of Intensive Care Unit, Department of Medicine, Kaohsiung Veterans General Hospital (a 1361-bed teaching hospital). Assistant Professor of Medicine, School of Medicine, National Yang-Ming University. KS-P, RN, MS, Registered Nurse of Nutrition Support Team, Kaohsiung Veterans General Hospital (a 1361-bed teaching hospital). L M-Y, RD, MS, Chief of Department of Nutrition, Sin-Lau Hospital (a 526-bed regional hospital). Board Director of Tainan Dietetic Association. C S-J, PhD, Distinguished Professor of Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University. Secretary General of Health Food Society of Taiwan.
Intensive care unit
Acute physiology and chronic health evaluation
Ventilator-associated pneumonia
Urinary urea nitrogen
Nitrogen balance
Body mass index
Proton pump inhibitor.
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This study was financially supported by Kaohsiung Veterans General Hospital (Grant no. VGHKS 94–082) and National Science Council (Grant no. NSC100-2622-B-006-004-CC3), Taiwan. We gratefully acknowledge the technical assistance of the medical personnel in the ICU of the Kaohsiung Veterans General Hospital, and sincerely appreciate the participation of all patients in this research. We especially thank Dr. Tzu-Ming Chang for his valuable suggestions.
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Competing interests
The authors declare that they have no conflict of interest.
Authors' contributions
Author contributions to the manuscript are as follows: H H-H performed statistical analyses, interpreted the results and wrote the manuscript; C S-J supervised the process, provided significant advice and revised the manuscript; H C-W developed the protocol, designed the experiment and provided advice; K S-P collected data and L M-Y provided consultation. All of the authors have read and approved the final manuscript.
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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Huang, HH., Hsu, CW., Kang, SP. et al. Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study. Nutr J 11, 30 (2012). https://doi.org/10.1186/1475-2891-11-30
DOI: https://doi.org/10.1186/1475-2891-11-30
- Severity of illness
- Early enteral feeding
- Late enteral feeding
- Critical illness


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Mobile wireless competition reports contain data and information that the FCC uses to analyze competition in the mobile wireless industry. This is the 14th Annual Report, which was released on May 20, 2010.
- 14th Mobile Wireless Compteition Report: Word | PDF
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on [<modes>]msg_group [<serial#>] [-|^]<match> { <action> }
This hook is similar to the MSG hook, except it applies to messages sent to an undetermined group of people. Typically, this is a server mask or hostmask, and is sent by an irc operator.
|nickname of message sender
|group message was sent to
|text of message
This hook has the same limitations on automated replies as the MSG hook.


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WASHINGTON — More than seven months after Americans started receiving the first coronavirus stimulus checks, President Donald Trump has signed legislation to approve a second round of direct aid payments to Americans.
The development comes just days after Trump blasted the bill, which Congress passed after months of negotiations.
What does Trump want for checks?
Trump posted a video to Twitter calling for the $600 per individual or $1,200 per couple to be increased to $2,000 and $4,000, respectively. He called on Congress to send him an amended bill, something Democrats immediately welcomed. In a rare Christmas Eve session of the House, Republicans blocked a move to increase the stimulus check size to $2,000.
The Democratic-led House supports the larger checks and voted overwhelmingly Monday to increase COVID-19 relief checks to $2,000, but Senate Majority Leader Mitch McConnell on Tuesday blocked Democrats' push for bigger $2,000 COVID-19 relief checks. He said the chamber would "begin a process" to address the issue.
How fast could the IRS send out checks?
During the first round of economic impact payments, President Trump approved the CARES Act on March 27 and the first checks started appearing in people's bank accounts about three weeks later, during the week of April 14.
However, because the IRS already did a lot of the set-up work during the first round of payments, there's a chance a second round of stimulus checks could be sent out faster.
In an interview last week, Treasury Secretary Steve Mnuchin said Americans can expect to receive stimulus payments in just a few days after the bill becomes law.
If you received your first stimulus check by mail, you'll want to sign up for direct deposit to make sure you get it quicker. It's likely that paper checks won't arrive until weeks after payments are sent out to those who set up direct deposit.
How much will the stimulus checks be?
On direct payments, the original bill provides $600 to individuals making up to $75,000 per year and $1,200 to couples making up to $150,000, with payments phased out for higher incomes. An additional $600 payment will be made per dependent child, similar to the last round of relief payments in the spring.
Here is a tool from Omni Calculator that may help you determine how much you might receive, based on the $600 number:
The Associated Press contributed to this report.


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Executive Committee (Program)
The Executive Committee (Graduate School Governance - Section 3.5) of each program is constituted as required by each program's governance after approval by the Graduate Council Committee on Structure and by Graduate Council as follows. Each program establishes an Executive Committee composed of at least five members. The initial structure and membership of each Executive Committee is determined by the program's faculty subject to approval by the President. It includes at least one faculty member from each senior college substantially participating in the program ("substantially participating" is defined as having six members on the faculty of the program; Section 9.4, CUNY Board of Trustees Bylaws). In programs in which the doctoral faculty includes two or more faculty members (other than the Executive Officer) who hold Graduate School appointments, at least one member of the Executive Committee must be elected from this category. Members are elected for a term not to exceed three years; they may be reelected.
The Executive Committee has the authority for the operation of the program between the stated meetings of the program's faculty subject to the policies established by the faculty. It serves as a Committee on Committees to prepare slates of nominees for the program's representatives to Graduate Council. It meets at least once a semester with the students matriculated in the program. The Executive Officer serves as Chair of the Executive Committee (Section 9.4, CUNY Board of Trustees Bylaws).
The Executive Committee may make recommendations to the appropriate committees of Graduate Council and to the Graduate Center administration. The Executive Committee in coordination with the Faculty Membership Committee conducts a continuing review of the faculty of the University relevant to that program. The Executive Committee works with the Executive Officers to forward the policy in Section 3.4E of the Graduate School governance document concerning employment of CUNY doctoral students in part-time faculty positions in CUNY colleges. The Executive Committee recommends policies and procedures on dissertations.
In the fall semester of the final year of the EO's current term, the Executive Committee of each program undertakes a review of its program governance to ensure that it reflects current governance practice and remains in compliance with the most recent Graduate School governance, Board of Trustees policy, and New York State law, making any necessary amendments and revisions.
21 July 2015


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Tinky Winky, Dipsy, Laa-Laa, and Po will soon hit store shelves in the form of Beanie Babies as a part of a new partnership between BBC Worldwide and Ty. The deal will transform the Teletubbies characters into six-inch Beanie Babies, which will be available in the UK and Ireland this fall/winter.
Teletubbies was created by Ragdoll Productions for BBC, and has aired in more than 120 countries. The brand has sold more than 33 million DVDs and videos and 50 million plush toys.


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iBooks 2 still contains 2x image files hinting at high-resolution iPad
A person familiar with the matter has indicated to AppleInsider that iBooks 2, which Apple announced and released on Thursday, contains a third image with an @2x equivalent for the iPad.
Higher-quality iPad images were first discovered in the iBooks app alongside @2x images for the iPhone last January. The discovery of the images was taken as evidence that Apple was planning for its iPad the same resolution jump that it did with the iPhone. Apple released the iPhone 4 with a "Retina Display" that featured twice the resolution and four times the pixels of its predecessor, the iPhone 3GS.
High-resolution images also appeared in an iOS 5 beta last summer. The alleged files had a resolution of 2048x1536 and were found inside the Twitter framework.
A double-resolution iPad would feature a pixel density of 264 ppi. That would fall short of the 300 ppi "sweet spot" that Apple referred to for its "Retina" calculations and the 326 ppi of the iPhone 4, though it would, of course, represent a significant improvement over the current model. By comparison, the iPad and iPad 2 share a resolution of 1024x768 and a pixel density of 132 ppi.
Side-by-side comparison of regular and @2x images in sample iPad app.
Numerous reports have suggested that the Cupertino, Calif., company is due to release a high-definition iPad this spring, though there has been some disagreement on whether it would arrive as a high-end model. Most recently, Bloomberg claimed that the third-generation tablet has entered mass production ahead of a March launch and will feature a double-resolution display, 4G LTE and a quad-core processor.
According to one rumor, suppliers will ship this quarter six to seven million of the high-resolution LCD panels bound for the iPad. Sharp, LG and Samsung have all been named as suppliers of the upgraded panels by various sources, though one recent report said it had confirmed that Sharp had failed in its initial supply.
iBooks 2 was unveiled as part of Apple's education event in New York City on Thursday. The company also announced several other education and ebook initiatives, including a new iTunes U app, partnerships with textbook publishers and iBooks Author, a Mac OS X application for designing digital textbooks for the iBookstore.


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Risk of HIV Doubles With Popular Contraceptive in Africa, Says Study
According to a groundbreaking study published Monday in The Lancet Infectious Diseases, a leading medical journal, African women using a popular hormone shot as a contraceptive may face up to double the chance of contracting HIV.
The study was performed by University of Washington researchers and involved 3,800 couples from Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia.
The popular contraceptive is a hormone shot given every three months to prevent pregnancy, but the study showed that women using the affordable and convenient shot might also be doubling their risk of HIV infection.
The study also concluded that when HIV-positive women used the contraceptive, known as Depo-Provera, their male partners are twice as likely to become infected with the disease as well.
Thus, the research suggested that the injectable contraceptive has biological properties that may increase vulnerability to HIV infection in sexually active people.
The study found that women using the hormonal contraception became infected at a rate of 6.61 per 100 person-years, compared with 3.78 for those not using the method.
Researchers only focused on African women, but indicated the same impacts would be prevalent in women of all races.
The research is extremely relevant, as contraceptive injections are a popular method of reducing unwanted pregnancies, particularly in developing countries, where pregnancy-related complications and maternal mortality are an everyday reality for impoverished women.
According to UNICEF, a woman dies from complications in childbirth every minute.
In sub-Saharan Africa, women have a one in 16 chance of dying as a result of pregnancy-related complications prior to, during or post-childbirth.
Many argue that maternal deaths are a result of poor health facilities, sanitation and lack of access to health care.
International organizations have campaigned for women in the sub-Saharan region to use the long-lasting injections as a method of protection.
Therefore, the new study offers grave challenges for international development and maternal mortality experts as this source of pregnancy prevention could be increasing a woman's chance of HIV infection.
Isobel Coleman, the director of the women and foreign policy program at the Council on Foreign Relations, told The New York Times, "The best contraception today is injectable hormonal contraception because you don't need a doctor, it's long lasting [and] it enables women to control timing and spacing of birth without a lot of fuss and travel."
She added, "If it is now proven that these contraceptions are helping spread the AIDS epidemic, we have a major health crisis on our hands."
As a result, scientists are saying that condom use should be emphasized along with other contraceptive methods, especially considering that more than 140 million women worldwide use some form of hormonal contraception.
Furthermore, condoms are key as the injectable hormonal contraception is most widely used in areas where HIV/AIDs is already an epidemic and pregnancy prevention is desperately needed to save the lives of women from pregnancy-related deaths.


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Weightlifter Nearly Kills Himself Lifting Half a Ton
This is some really heavy-duty, world record news.
Eddie Hall recently shattered his own world record when he became the first person to deadlift 500 kilograms (that's 1,102 pounds -- about half a metric ton) at the World Deadlift Championships.
The 28-year-old buckled under having what must've felt like the weight of the world on him. He passed out and suffered nose bleeds after blood vessels exploded.
Hall already owned the deadlift record at 465 kgs (1,025 pounds), but don't expect him to try and top himself again:
That nearly killed me.The pressure on my body was surreal. I passed out after. I had nose bleeds. It's not healthy doing something like that. But I've done it. I'm sure it will be in the history books for a very long time. I don't want to do it again but if it comes to the point where somebody breaks it, hell...I may just do. It's that great feeling, Like the first man on the moon."
Yup, it's pretty impressive and gives you something to think about when you whine the next time your buddy calls you to help him move a couch.


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Current debates about the question of 'art on the periphery' and the idea of 'the other' have direct relevance to the development of art in Australian colonial life and to the practice of art today. This course will examine these questions by concentrating on aspects of art, architecture and design in Australia, both in the colonial era and in the current re-appropriation of early Australian imagery. The course will address such issues as the dependence on imported modes, the role of landscape imagery, and the distinctions between 'high' and 'popular' art forms. The course draws upon staff expertise at the University and upon the rich collection of resources of the National Gallery of Australia, the National Library, and the built environment and existent fabrics from local sites surviving from the colonial era.
Learning Outcomes
Upon successful completion, students will have the knowledge and skills to:
- The student will evaluate and critique the dominance of the colonial landscape genre in orthodox histories of colonial Australian art and identify the scope and so-called minor genres throughout the century. These will include the arts produced by colonial women before, and including those associated with, Australian Impressionism, and the decorative arts and design produced for display, consumption and trade.
- Contemporary issues centering on the rising interest in Australian indigenous art will be analysed by the student
- The student will learn to identify and examine the use of colonial themes in recent indigenous arts practices throughout Australia.
Indicative Assessment
1,500 word tutorial paper (30%) (outcomes 1,2, 3)
2,500 word essay (50%) (outcomes 1, 2)
Image test (20%) (outcomes, 1, 3)
The ANU uses Turnitin to enhance student citation and referencing techniques, and to assess assignment submissions as a component of the University's approach to managing Academic Integrity. While the use of Turnitin is not mandatory, the ANU highly recommends Turnitin is used by both teaching staff and students. For additional information regarding Turnitin please visit the ANU Online website.
Workload130 hours of total student learning time made up from: a) 36 hours of contact over 12 weeks: 24 hours of lectures and 12 hours of tutorials; and b) 94 hours of independent student research, reading and writing.
Requisite and Incompatibility
Preliminary Reading
* Bonyhady, T, Images in Opposition: Australian Landscape Painting 1801-1890, OUP,1985
* Smith, B, and Smith, T, Australian Painting 1788-1990, OUP,1991
* Allen, C, Art in Australia: From Colonization to Postmodernism, Thames & Hudson, 1997
*Sayers, A, Australian Art, OUP, 2001
Tuition fees are for the academic year indicated at the top of the page.
If you are a domestic graduate coursework or international student you will be required to pay tuition fees. Tuition fees are indexed annually. Further information for domestic and international students about tuition and other fees can be found at Fees.
- Student Contribution Band:
- 1
- Unit value:
- 6 units
If you are an undergraduate student and have been offered a Commonwealth supported place, your fees are set by the Australian Government for each course. At ANU 1 EFTSL is 48 units (normally 8 x 6-unit courses). You can find your student contribution amount for each course at Fees. Where there is a unit range displayed for this course, not all unit options below may be available.
Course fees
- Domestic fee paying students
- International fee paying students
Offerings, Dates and Class Summary Links
ANU utilises MyTimetable to enable students to view the timetable for their enrolled courses, browse, then self-allocate to small teaching activities / tutorials so they can better plan their time. Find out more on the Timetable webpage.


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On a Roll: NuMat Wins Another Big Competition for Clean Energy Tech
Northwestern University's NuMat Technologies has won the first-ever U.S. Department of Energy (DOE) National Clean Energy Business Plan Competition. This is the fifth business plan competition the super-hot start-up company has won since March.
The Northwestern team bested five other clean energy technology teams from universities across the country at the national competition held June 13 in Washington, D.C. All six teams had won regional business plan competitions to advance to the final. The title carries with it a $100,000 cash prize and $80,000 worth of in-kind services, including technical, design, and legal assistance.
Part of the Obama administration's Startup America Initiative, the competition promotes entrepreneurship in clean energy technologies. It is designed to find companies that will lay the groundwork for future economic opportunities that will ensure America remains competitive in the global clean energy race.
Spun out of Northwestern's research labs, NuMat impressed the judges -- all from venture capital firms -- with its commercialization idea, go-to market strategy, team plan, environmental benefits, and potential impact on America's clean energy economy. Daniel B. Poneman, the U.S. Deputy Secretary of Energy, announced the good news at the awards ceremony held at the White House.
NuMat designs high-performance materials that store gases and can be produced on a large scale for industry, and the start-up has been on an undeniable roll since incorporating in February. Prior to this most recent win, NuMat won four business plan competitions (netting in excess of $1 million in cash and in-kind services). The team will be ringing the closing bell of the NASDAQ not once, but twice, this summer. The company also has attracted national media attention from Fortune magazine, Crain's Chicago Business and BusinessWeek.
"On behalf of the entire Northwestern community, I couldn't be more proud of NuMat," said Northwestern Vice President for Research Jay Walsh, who attended the event in Washington. "Multidisciplinary teams tackling fundamental societal needs are the lifeblood of a great research university, and I see great potential for Northwestern to continue to innovate at the cutting edge of energy and sustainability research. Several people in Washington asked me who will repeat for Northwestern next year -- it's great to have such high expectations."
Four Northwestern schools are represented in the company. Ben Hernandez (chief executive officer) and Tabrez Ebrahim (chief operating officer) are pursuing a JD-MBA, a joint degree from the Kellogg School of Management and the School of Law. Chris Wilmer (chief technology officer) is a chemical and biological engineering doctoral student at the McCormick School of Engineering and Applied Science, and Omar Farha (chief scientific officer) is a research associate professor of chemistry in the Weinberg College of Arts and Sciences.
"We are honored to have highlighted Northwestern's exciting research on the national stage," Wilmer said. "This would not have happened without the persistent and unwavering encouragement and support from the four Northwestern schools we represent. We're also thankful for the technical and financial support we've received from key institutional and regional partners, including the Initiative for Sustainability and Energy at Northwestern (ISEN) and the Clean Energy Trust."
NuMat Technologies computationally designs and synthesizes high-performing metal-organic framework nanomaterials that enable the efficient and safe separation and storage of gases at low pressures and record-breaking densities. The process fundamentally changes the economics of countless gas storage applications, such as natural gas vehicles.
The patent-protected process was developed in the labs of Randall Q. Snurr, professor of chemical and biological engineering in the McCormick School, and Joseph T. Hupp, professor of chemistry in Weinberg.
The young company represents a well-established and growing trend of student entrepreneurship at Northwestern. The number of student start-ups has doubled in the past year, supported by the Northwestern University Incubator, student-run groups like InNUvation and the NUvention program. (NUvention offers entrepreneurship courses focused on medical innovation, energy, web design and social innovation.)
"NuMat has set a new benchmark for success among student and faculty start-ups at the University," said Michael Marasco, director of Northwestern's Farley Center for Entrepreneurship and Innovation. "It's exciting to see enthusiasm in fields like clean tech that haven't recently held the same cache as web/app companies. It adds rich diversity to our growing student and alumni portfolio and should encourage future teams to take that first step out of the lab or classroom."
-- University Relations


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There are 85 residential real estate listings for sale in Milton.
There are 10 commercial real estate listings for sale in Milton.
There are 45 vacant land real estate listings for sale in Milton.
There are 140 total real estate listings for sale in Milton.
1. 933308
2. 933127
3. 932487
4. 932280
5. 932031
6. 931940
7. 931939
8. 931578
9. 930195
10. 929915
Established in 1825 as a trading post on the Blackwater River, Milton's rich history is matched only by its small-town charm. Among the oldest cities in Florida, Milton's name is likely a derivative of "milltown" representing the leading role the city played in the lumber industry's early days.
Historic preservation remains important to Santa Rosa County, as exhibited by Milton's Downtown Historic District, which includes historical attractions such as the Imogene Theatre and Museum, the L& N Train Museum, the Ollinger-Cobb House, St. Mary's Episcopal Church and Bethune Blackwater Schooner, a well-preserved coastal schooner submerged in the harbor.
Today, Milton is known for its outstanding canoeing and water sports along the Blackwater River. The new Blackwater Heritage Trail, following the route of the old Florida-Alabama Railroad, built in 1900, invites you to step back in time with a scenic tour for hikers, joggers and bikers.
Information provided by the Santa Rosa Chamber of Commerce. Need a relocation packet? Contact them at:
Santa Rosa Chamber of Commerce
5247 Stewart Street
Milton, FL 32570
(850) 623-2339
Farmers' Opry House
8897 Byrom Campbell Road
Milton, Florida 32571
(850) 994-9219
Southern Raceway
9359 Nichols Lake Road
Milton, FL 32583
(850) 623-2333
Arcadia Archaeological Preserve
5709 Mill Pond Lane
Milton, FL 32583
(850) 626-3084
Imogene Theatre and Museum
6866 Caroline Street
Milton, FL 32570
(850) 626-9830
L & N Train Depot/West Florida Railroad Museum
5003 Henry Street
Milton, FL 32570
(850) 623-3645
Santa Rosa Veterans Memorial Plaza
5178 Willing Street
Milton, FL 32570
(850) 626-7292
The Moors Golf and Lodging
3220 Avalon Boulevard
Milton, FL 32583
(850) 995-4653
NAS Whiting Field Golf Course
8271 Intrepid Road
Milton, FL 32570
(850) 623-7348
Tanglewood Golf & Country Club
5916 Tanglewood Drive
Milton, FL 32570
(850) 623-6176


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The Secret Beyond Matter
Usak ART TV, 19 August 2008
Adnan Oktar: It is devout, fears Allah and behaves rationally, and Allah bestows the role of standard-bearer of Islam on such a nation. Allah has given such a nation the task of disseminating the moral values of Islam, insha'Allah... Ask anyone for a nation that lives by Islam, ask anyone in the Islamic world. Ask them who best lives by Islam. They will say the Turks. The Turks are the most consistent, the most just and the most rational in their implementation of Islam. They are the most immaculate. THAT IS WHY THERE IS COMPLETE AGREEMENT AND THE ALL SAY THAT TURKEY SHOULD LEAD THE WAY; THEY SAY THAT IN THE TURKIC WORLD AND THE ISLAMIC WORLD.
Hilal TV, 27 December 2008
Adnan Oktar: TO DATE I HAVE NOT SEEN A SINGLE ISLAMIC COUNTRY THAT DOES NOT ACCEPT TURKISH LEADERSHIP. Nor have I seen a Turkic state that does not accept Turkish leadership. More recently, Kazakhstan has just said that Turkey should be leader. All the Turkic states want Turkey to be leader. Azerbaijan is really keen. Even Armenia wants to unite with Turkey. They say let us open up our borders and be one. They found that courage following my writings and these statements of mine and thus adopted the idea. Armenia, Georgia and even Lithuania and Russia will have a place in the Turkish union, in the Turkish-Islamic Union, insha'Allah.
|Al Ûdeh said it would be wrong to ascribe Turkey's success and progress in recent years to the "political" sphere alone, and also referred to a "civil initiative" that would be a role model for the whole Islamic world, saying: "The fact of the matter is that the present circumstances make it essential for Arab countries and Turkey to exhibit greater communication than ever before. There is no doubt that the Justice and Development Party has played a major role in the development of Turkish stability. But I wish to state that politics is not the only respect in which we can benefit from Turkey. We also need to see the existence of non-governmental civil activities."


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NEW YORK - July 22, 2013 (WPVI) -- The front landing gear of a flight arriving at New York's LaGuardia Airport collapsed Monday right after the plane touched down on the runway, officials said, sending the aircraft skidding before it came to a halt.
Ten passengers were treated at the scene, with six being taken to a hospital with minor injuries, said Thomas Bosco, Acting Director of Aviation for the Port Authority of New York and New Jersey, which oversees the area airports. The six crew members were taken to another hospital for observation.
Dallas-based Southwest said there were 150 people on Flight 345 coming from Nashville, Tenn., while the Port Authority said the total was 149.
Bosco said the nose gear of the plane collapsed when it landed at 5:40 p.m., and "the aircraft skidded down the runway on its nose and then veered off and came to rest in the grass area."
Bosco said there was no advance warning of any possible problem before the landing.
Emergency crews were seen spraying foam toward the front end of the plane on the tarmac. The Port Authority said the passengers exited the plane by using chutes.
The airport was temporarily closed, but one of two runways was operating shortly after 7 p.m., and Bosco said the Port Authority was hoping to have the airport fully open by Tuesday morning.
The FAA is investigating, as is the National Transportation Safety Board.
Richard Strauss, who was on a nearby plane waiting to take off for Washington, said the nose of the plane was "completely down on the ground. It's something that I've never seen before. It's bizarre."
A rear stairwell or slide could be seen extending from the Southwest flight, said Strauss, who owns a Washington public relations firm. His plane, which was about 100 yards from the Southwest flight, wasn't allowed to taxi back to the gate, he said.
Bobby Abtahi, an attorney trying to catch a flight to Dallas, was watching from the terminal and heard a crowd reacting to the accident.
"I heard some people gasp and scream. I looked over and saw sparks flying at the front of the plane," he said.
The incident came 16 days after Asiana Flight 214 crash-landed at San Francisco's international airport on July 6, killing two Chinese teenagers; a third was killed when a fire truck ran over her while responding to the crash, authorities said. Dozens of people were injured in that landing, which involved a Boeing 777 flying from South Korea.
Longtime pilot Patrick Smith, author of "Cockpit Confidential: Everything You Need to Know About Air Travel. Questions, Answers, and Reflections" and AskthePilot.com, said landing gear incidents are not high on the list of worries for pilots.
"It doesn't happen very often but I need to emphasize just how comparatively minor this is and how far, far down the hierarchy it is," he said. From a pilot's perspective, this is nearly a non-issue. They make for good television, but this is far down the list of nightmares for pilots."
Associated Press writers Amanda Barrett, Deepti Hajela and Jennifer Peltz contributed to this report.
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