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Friday, February 3, 2017
Are You a Dog Mom or Dad?
35 comments :
Oh I so agree with you!!! ... and yes...babies put everything in their mouth... sigh...ReplyDelete
I'm a dog mom 100% and I think John is worse than me in the dog dad department.ReplyDelete
My mom is, no surprise, 1000% dog mom. She says it is similar to a human mom, but the kids never get past nursery school stage, they don't get mean with their parents, and you can leave them home alone at any age for certain amounts of time. She loves being a dog mom.ReplyDelete
Dog mom all the way!ReplyDelete
My human children don't like for me to refer to myself as a dog mom.ReplyDelete
Mommy is our doggy mommy 110%ReplyDelete
Lily & Edward
Melissa, beautifully said! Since I have not had the opportunity to be a human mom people often equate my love for my dogs as an attempt to use my dog as substitute. I'm continuously saying, "I'm pretty sure I would still feel the same way about my dog". Thank you for verifying that, I'm 100% a DOG MOM no matter what!ReplyDelete
Aww me too! I have a human child and still say im a dog mom. My little one says my two boys are her fur-brothers. Dogs are family <3ReplyDelete
110% pure dog mom. And anyone who disagrees with me will find I can growl AND bite. LOL Love all the pics of your fur-kids on this post.ReplyDelete
I agree with all the comments. I was a DOG MOM all the wayReplyDelete
I'm a fur mom, pet parent, whatever all the way. (Human kids, not so much). No apologies. Of course I call myself that and if anyone objects, well, they don't twice.ReplyDelete
I definitely am a pet parent! ~Island Cat MomReplyDelete
I can SO relate to this! I too have two young adult children and I am a pawmom as well.ReplyDelete
I feel the same way about my pets as you do!
I am really glad I don't have to send my crew through college! :)ReplyDelete
It's good to know that it's not just people that are human child-less that consider themselves pet parents. They live with us, we care for them, and we love each other. It's the same thing. Great post!ReplyDelete
Jan, Wag 'n Woof Pets
you bet we are dog mom & dad. We even tell people that we have get home to the kids!ReplyDelete
Mr Bailey, Hazel & Mabel
Oh yeah! SO a doggie Ma! And, Ma doesn't likes to leave me alone eithers! okay...that might be cause she thinks I'll get into stuffs....ReplyDelete
Ruby ♥
Great post! I am a proud Dog Mom - the FiveSibesMom! I refer to myself as a hu-mom, even though my daughter thinks that a silly name! No one (yet) has given me any grief and if they know me and how I love my pets, they won't! ;-) I refer to my Siberian Huskies as "the kids!" I do have a grown daughter and my first grandchild, and am crazy about them and my Huskies love the baby! Dogs and animals have always been in my family and as a child growing up. They are so part our family, they are my "furkids!"! <3 Love your pics!ReplyDelete
Melissa, I agree with you 100%! I am a proud mom of two daughters and a very proud dog mom and I wouldn't have it any other way. :) Great post and your photos are beautiful as always!ReplyDelete
We don't have a dog Mom or Dad now, but we used to when there were two sweet dogs living here. We sure enjoyed your post!ReplyDelete
Great post! We did one like this last year, I refer to myself as a dog mom and they are my furbabies.ReplyDelete
Some people definitely role their eyes but as far as i'm concerned they are my kiddos. We take really good care of them and make sure to meet their different needs as best we can, and teach them how to be the best they can be! So people can roll their eyes all they want, I don't care. :-)
I am absolutely a dog mom - and a human mom. I have a nine year dog and an 11 year daughter. They are both my kids. And funny enough, my daughter calls Ruby her sister!ReplyDelete
This comment has been removed by the author.ReplyDelete
Great post! I totally consider myself a mom to my dogs and I am a mom to all my beloved pets who have passed away. Losing each of them was devastating. I will always love every single one of them, paw prints on my heart forever. No one's ever challenged me considering my pets to be my furbabies, and if they did it wouldn't be pretty - for them! Pets are family, and pet pets are my fur kids. I did not have any human kids, but even if I did I'd still consider my dogs my furbabies.ReplyDelete
Love & Biscuits,
Dogs Luv Us and We Luv Them
I don't think it's as common to refer to yourself as a pet parent in Australia as it is in the US. But I definitely share a close bond with my pets, present and past, cats and dogs and love them to the moon and back.ReplyDelete
Love this post Melissa!! Especially the photos! YES, I am a Dog Mom! Used to be a Cat Mom too. Sadly, I had to bring my cats to Rescue when I was diagnosed with asthma.ReplyDelete
We are definitely pet parents here! :)ReplyDelete
Hands down a Dog Mom and Cat Mom. Anyone that has a pet should be, at least if they are caring for them properly. JMOReplyDelete
Proud huMom of Olivia, Q, GG, Dot & so many before them.ReplyDelete
I will love them forever.
CEO Olivia's huMom
I'm a cat mom through and through! I don't have human children and don't know if I ever will have them, but regardless of that, I will always consider myself "mom" to my furries. It's a beautiful bond for sure <3ReplyDelete
I'm definitely a kitty mom!ReplyDelete
I'm not one to get hung up on labels. While I've always considered myself to be on an equal friends status with my dogs, I see the parallels of being a mom to a human and mom to pets. I have 5 human kids and three dogs. If my dogs could talk, I would expect them to call me Beth, but I wouldn't be surprised if they chose to call me Mom. IReplyDelete
My dogs are definitely my babies ❤ I do not want human children. I know if I did happen to have one that I would love that kid to death, but it is just something I would purposefully choose for myself. Dogs are my passion. I enjoy taking care of them and raising them. I enjoy making their meals and taking Echo to agility class and playing with them. However, I do realize that our relationship is that of a human-canine companionship and different from that of parents and children. Does that make it less significant or less meaningful? Definitely not. My dogs are my world and I wouldn't want it any other way! With that being said, I do call myself a dog mom. Lol.ReplyDelete
Beautiful post! So true! I do consider myself a cat parent. My kitties are very important to me. They take care of me and I take care of them. I understand that there would be differences in having a human child, but I think that it is good to nurture animals too. Love is the most important flower you'll grow in your life's garden.ReplyDelete
-Purrs from your friends at www.PlayfulKitty.net
I puppy sat this past weekend and it is definitely akin to when I watch toddlers!ReplyDelete


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Nigga, G-Unit nigga!!
Could have a nigga beefin' wit his own homebois, ya'know?
Shit fucked up, but this how it goes...
Came up (Yuh!), I did my thang
This is so real I ain't sayin' no names (Nah!)
Started wit' a dream like Martin Luther King
'Till tha Fed's came sayin' my whole fuckin' team (Huh!)
Switched my game up, started from tha bottom (Why?!)
My Daughter on tha way I don't need these problems (Aiight)
Find me a new job - I wanna rap
So I got myself a new squad, got out tha trap
Didn't have too many niggas ridin' wit' me then (Uh)
But now everybody wanna ride in my Benz (Uhh!!)
This one nigga dat I called a friend of mine
He was really right there when I didn't have a dime (Yeahh!)
But I stayed on tha grind, waited in tha line
Thinkin' dat we'd both git rich in due time (nigga!)
My blessin' came and people started to listin
It's G-Unit now so I put him in posission (Owh!)
To ride wit' a nigga, and make his own bread
Can't give him tha world but hayell, I did what I can
He got a lil' man dat he called his artist (Yeah!)
I took him right in like "Damn, let's start dis." (C'monn!)
Brought him round 50 to show him what he got
He looked at me quickly and said he was hot
We was on our way, straight to tha top
But my homeboi feel like his man need to drop (Uh ohh)
His frustration kicks in, now here we go
My homeboi feelin' like I owe a lil' mo'
Meanwhile this tha 1st week my album out (Okayye!)
Shit my own damn mama didn't have a house (Phureal!)
Stay focused tha way I post this
When tha lights on, you can see tha roaches (Uh huh)
Shit got bad, my homeboi really got mad
'Cause he started losin' everythang dat he had (Aahh!)
Nobody to blame but who else, Guess who?
He started sendin' threats sayin' what he gon' do (Whudd!!)
Now I can't live around this beef stuff (Nah)
This ain't New York, my city ain't big enough
So I'm lookin' fo' my homeboy wit' guns and shit (C'monn)
Askin' The Lord how did it come to this (Why?!)
There he goes, right there with his toy souljas
I'm all by myself, let's git this ova
Dogg down on the whole crowd, don't nobody move
Where my homeboi at, what he say he gon' do? (Huh!)
Outta nowhere, my homeboi show his face (Aye!)
But one of his souljas pull a gun from his waist (Dayum!!)
I started to shoot, but I looked in his eyes
And then I realized dat he didn't wanned die
So it's back to my homeboi, Wussup now?!
He like "Damn Buck, you really actin' fucked up now"
I'm like "Nawhh, niggas say you trynnah kill me."
Glock still out nobody gittin' near me (Unh uh)
A car door opens, and who do I see?!
My homeboi artist who was down wit' me
He holla "Put ya guns down, and put ya hands up" (What?!)
I wadn't thinkin' I just fucked ya man up
Picked up my strap, hopped in my 'Lac truck (C'monn)
Told my homeboi "Ya mayn's an act up" (nigga!!)
Weeks went by, and we got back cool
First it's shame on 'em, then it's shame on you (You!)
'Cause these same ol' dues dat I let back round (Okayye)
Doin' all kinds'a shit behind my back now
Wanna sleep wit' tha enemy to make some noise? (Aiight!)
But this how it go in tha streets, when you war witcha homeboi
They smilin' in ya face
All tha time they wanna take ya place (Backstabbas.. Backstabbas..)
They smilin' in ya face
All tha time they wanna take ya place (Backstabbas.. Backstabbas..)

subset: commoncrawl


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High-resolution mapping of the epigenome has discovered unique patterns that emerge during the generation of brain circuitry in childhood.
While the 'genome' can be thought of as the instruction manual that contains the blueprints (genes) for all of the components of our cells and our body, the 'epigenome' can be thought of as an additional layer of information on top of our genes that change the way they are used.
"These new insights will provide the foundation for investigating the role the epigenome plays in learning, memory formation, brain structure and mental illness." says UWA Professor Ryan Lister, a genome biologist in the ARC Centre for Excellence in Plant Energy Biology, and a corresponding author in this new study.
Joseph R. Ecker, senior author of this study, and professor and director of the Genomic Analysis Laboratory at California's Salk Institute for Biological Studies in California, said the research shows that the period during which the neural circuits of the brain mature is accompanied by a parallel process of large-scale reconfiguration of the neural epigenome.
A healthy brain is the product of a long period of developmental processes, Professor Ecker said. These periods of development forge complex structures and connections within our brains. The front part of our brain, called the frontal cortex, is critical for our abilities to think, decide and act,
The frontal cortex is made up of distinct types of cells, such as neurons and glia, which each perform very different functions. However, we know that these distinct types of cells in the brain all contain the same genome sequence; the A, C, G and T 'letters' of the DNA code that provides the instructions to build the cell; so how can they each have such different identities?
The answer lies in a secondary layer of information that is written on top of the DNA of the genome, referred to as the 'epigenome'. One component of the epigenome, called DNA methylation, consists of small chemical tags that are placed upon some of the C letters in the genome. These tags alert the cell to treat the tagged DNA differently and change the way it is read, for example causing a nearby gene to be turned off. DNA methylation plays an essential role in our development and in our bodies ability to make and distinguish different cell types.
To better understand the role of the epigenome in brain development, the scientists used advanced DNA sequencing technologies to produce comprehensive maps of precisely which C's in the genome have these chemical tags, in brains from infants through to adults. The study delivers the first comprehensive maps of DNA methylation and its dynamics in the brain throughout the lifespan of both humans and mice.
"Surprisingly, we discovered that a unique type of DNA methylation emerges precisely when the neurons in a child's developing brain are forming new connections with each other; essentially when critical brain circuitry is being formed." says co-first author Eran Mukamel from Salk's Computational Neurobiology Laboratory.
Conventionally, DNA methylation in humans had been thought to occur almost exclusively at C's that are followed by a G in the genome sequence, so-called 'CG methylation'. However, in a surprise discovery in 2009, the researchers found that a distinct form of DNA methylation, called 'non-CG methylation' constitutes a large fraction of DNA methylation in the human embryonic stem cell genome.
The researchers had previously observed both forms of DNA methylation in plant genomes when conducting earlier research that pioneered many of the techniques required for this brain study.
"Because of our earlier plant epigenome research we approached our human investigations from a distinct angle," Professor Lister said. "We were actively looking for these non-CG methylation sites that were not widely thought to exist. Our new study adds to this picture by showing that abundant non-CG methylation also exists in the human brain."
Surprisingly, this unique form of DNA methylation is almost exclusively found in neurons, and in patterns that are very similar between individuals. "Our research shows that a highly-ordered system of DNA tagging operates in our brain cells and that this system is unique to the brain," says co-author Dr Julian Tonti-Filippini, a computational biologist of the ARC Centre for Excellence in Plant Energy Biology and the WA Centre of Excellence for Computational Systems Biology.
This finding is very important, as previous studies have suggested that DNA methylation may play an important role in learning, memory formation, and flexibility of human brain circuitry. "These results extended our knowledge of the unique role of DNA methylation in brain development and function," Professor Ecker said. "They offer a new framework for testing the role of the epigenome in healthy function and in pathological disruptions of neural circuits."
"We found that patterns of methylation are dynamic during brain development, in particular for non-CG methylation during early childhood and adolescence, which changes the way that we think about normal brain function and dysfunction." says study co-author Terrence J. Sejnowski, head of Salk's Computational Neurobiology Laboratory. Recent studies have suggested that DNA methylation may be involved in mental illnesses, including bipolar disorder, depression, and schizophrenia. Environmental or experience-dependent alteration of these unique patterns of DNA methylation in neurons could lead to changes gene expression, adds co-corresponding author M. Margarita Behrens, a scientist in Salk's Computational Neurobiology Laboratory, "the alterations of these methylation patterns will change the way in which networks are formed, which could, in turn, lead to the appearance of mental disorders later in life."
This study is the culmination of more than two years' hard work from an international, interdisciplinary team involving science superstars from The Salk Institute for Biological Studies in La Jolla, California, UWA and several other institutes internationally.
Professor Lister and Dr Tonti-Filippini are now focussing their new research at UWA on how to control these epigenetic patterns within plant and animal genomes, which they hope will translate into breakthrough applications benefitting both human health and agriculture.


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Dear readers: I had a lovely plan for the blog this December, including light, frothy and festive posts about fairies, puddings, and GIN. But then the Peabody Essex Museum was forced to admit that they have no intention of returning the historical collections of the Phillips Library to Salem at a Historic Commission meeting on December 7, a day that shall forever live in infamy in Salem's history—maybe. So now I am seeing a different kind of red than the holiday kind, and am going to have to process this development for some time, here and elsewhere. I've never lived in a time or place when a community's heritage was so brazenly and cruelly threatened, and it's pretty much all I can think about. Fair warning. I do feel a bit guilty about this, however, so I am going to intersperse my PEM post today, which addresses the issue of inaccessibility, with photographs of our first snow of the season. This will make for a rather incongruous presentation, but it's the best I can offer at the moment.
A few little scenes from Satuday's public protest against the relocation of the Phillips Library's collection– essentially Salem's archives–to a large conservation facility in Rowley.
There are so many issues to address regarding this relocation/removal, primarily because the Museum (and by "Museum", I am always referring to the Museum leadership; many curators and staff are part of the Salem community while the leadership and vast majority of of trustees live elsewhere, consequently there is a deafness and a disconnect on the part of the latter) is very slippery, and changes its rationales according to necessity–or audience. At the December 7th meeting, Facilities Director Bob Monk seemed to stress the importance of office space, and because that meeting made news, Executive Director Dan Monroe was pressed to come out with a statement, at long last, on the following day, in which he emphasized the inability of the existing Phillips Buildings, Plummer Hall and the Daland House, to accommodate the collection under proper conditions. This inability has presented the museum with a "great" opportunity, according to Mr. Monroe: to unify the Museum's renowned art and culture collection with the Phillips Library collection at new 112,000-square-foot Collections Center located in Rowley. This new center, which keeps the Library collection accessible in Essex County, will become operational by mid-2018 and will feature highly secure, climate-controlled space for storage for the collections and extremely handsome and functional spaces for a Library reading room, staff offices, conservation, and other operations. The Library will continue to welcome researchers from around the world and PEM's skilled librarians will continue to assist patrons during the reading room's public hours. Mr. Monroe addresses accessibility several other times in his statement, and Mr. Monk also referenced accessibility on the 7th: "Our goal here is, really, to make the collections actually more accessible, not less". Increasing accessibility is probably the one constant claim that the Museum has been making, since it shut down the Phillips Library in 2011 with promises to return in a few years. But they have not, and odds are that they will not.
A little snow intermission! Now back to work.
There are three types of accessibility relevant to this discussion: physical, demographic, and digital. Obviously Rowley (which is a lovely town by the way; I have nothing against it, I just don't want Salem's history to be located there) is distant from Salem and the PEM's large warehouse will not be accessible by train or by foot, only by car. Nearly every single major independent research and/or museum library in the United States is located in an urban area reachable by mass transportation: the Phillips will be the first to be transferred in its entirety to a suburban satellite facility. Given its storied history which is so based on place, we can reasonably ask if the Phillips Library will simply cease to exist.
As to demographic accessibility, who are they going to let into their warehouse, their gated community? Monroe's statement says "researchers", which could include anyone and everyone: I guess we'll find out at the public forum which was also announced in his statement on January 11 @ 6:00 at Morse Auditorium in the museum. The last issue I want to address is digital accessibility, because I think there are many misperceptions about this based on several articles dating from the time of the Phillips' closure in 2011. Very little of the Phillips Collection has been digitized, surprisingly little for an institution which raised $650 million in its recent Advancement Campaign: less than 100 of their 2 million manuscript items are accessible online, with an emphasis on the trivial (ocean liner ephemera and vintage valentines). What has been digitized is much of their catalog: we know what treasures are contained in the collection, we just can't access them.


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While we had a little celebration as a family on Friday night, Saturday was the "Princess Party" for all her friends from school. The community room at the local library served as the "Royal Palace" for fairy tales, a lot of coloring, cake, and of course a piñata.
|Striking a pose like Cinderella behind her
|Edible flowers
|10 Princesses
|Politically correct piñata, no wiffle ball bat needed


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Pure Reality Black Vinyl
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Sharp on the heels of their debut single for the Jade Tree label, that Philadelphia super trio Dark Blue consisting of John Sharkey III (Clockcleaner, Puerto Rico Flowers) Andrew Mackie Nelson (Ceremony, Paint it Black, Puerto Rico Flowers) and Mike Sneeringer (Strand of Oaks, formerly from Purling Hiss, Puerto Rico Flowers) deliver the goods to the label in the form of their first full length; the eight song 'Pure Reality'. Recorded and produced by Jeff Zeigler (Kurt Vile, The War on Drugs, Sunny Day in Glasgow, Nothing). 'Pure Reality' began life while band leader Sharkey was working as a nightwatchman in Canberra, Australia. 'I refused to allow myself to get on the graveyard sleep schedule, so I would walk around in a shot-nerves psychosis every night patrolling a desolate university campus in north Canberra. A good portion of these songs were written in this walking coma at 4am under the cold ACT moon. Alone and to be quite honest, comfortably beleaguered.' Jump ahead two years later and we find Sharkey returning to his hometown of Philadelphia to spiral into a highly disheartening culture shock; the fuel that makes the raging though austere songs that make up 'Pure Reality' what they are. 'Being thrust back into this fucking intellectual ghetto after a few years in solitude with some smart people has really done a number on my head. I hate my job, I detest my neighborhood and my neighbors. But this is the city that made me and I am forever grateful. Life is great then its shit, then it's fine and back again until it's done. I long to get back to a great part of my life.' Musically, it retains the same grandiose delivery and burly, wide open guitar sound that was found on the earlier release by such U.K 80's bands as The Comsat Angels, The Stone Roses, Blitz and Australia's The Church. The combination of Dark Blue's sweeping, majestic sound and the deep desperation found in Sharkey's voice and lyrics is something that is matchless, harrowing and unrelenting. In other words, it's 'Pure Reality'.


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Hal Logan is a composer, sound designer and studio owner, and a professor of Music Technology at the University of Portland. He has been involved in the Portland theater scene for about 11 years, and has worked with most of the professional theaters in town. He lives in Portland with his wife, actor and University of Portland professor, Mindi Logan.
Hal Logan has provided professional set drumming and percussion work in bands and performance groups across a wide variety of genres. He has performed and arranged professional vocal solo and ensemble works, and he has created a vast repertoire of original compositions, songs and advertising music.
His compositions were recently featured in Us vs, Them for Dark Luna Productions in New York; God's Ear at Theatre Vertigo; Richard III for the Northwest Classical Theatre; Lost Wavelengths in the JAW West Festival; Much Ado About Nothing and Treatment at the Quintessence Theater, and Fuente Ovejuna, Rosalba y los Llaveros, and Te llevo en la sangre at Miracle Theatre; A Midsummer Night's Dream at Tygres Heart Theatre, Lysistrata, The Musical at the University of Portland, Dialogues at the University of Idaho. In film he has provided sound compositions for The Gift for the Adidas Short Film Contest; and Show Me A Sign from A Doll's Story, a short film by Jim Seaton.
Hal Logan also designed the video for the Lewis and Clark College production of PLUMFIELD, IRAQ.
Hal Logan received a Bachelor's of Music in vocal education, and a Master's of Music in Composition fro the Lionel Hampton School of Music, University of Idaho, Moscow, Idaho.
For further information: email@example.com


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The Bechtler collection reflects most of the important art movements and schools from the 20th century with a deep holding of the School of Paris after World War II. The collection comprises mid-century modern art in various media by artists such as Alberto Giacometti, Joan Miro, Jean Tinguely and Barbara Hepworth. Many of the artists are represented by their exploration of a particular theme or subject matter through a variety of media and approaches.
Only a handful of the artworks in the Bechtler collection have been on public view in the United States. Until now, the collection was privately held by the Bechtler family of Switzerland and has since been committed to the city of Charlotte by Andreas Bechtler.
Specific focus areas of the collection are:
The holdings of the Bechtler reveal principally the tastes and opportunities of a family of collectors based in Zurich, Switzerland. Nonetheless, the works they acquired were by artists from throughout Europe, Britain and America but all seen through their own personal lens.
School of Paris is a term that has unusually broad applications but generally is meant to embrace the modern works in Europe during the years after World War II. Most often defined by various approaches to abstraction, the School of Paris is seen as flexible enough to embrace certain explorations in figural subjects.
In addition to a focus on European artists, the Bechtler collection is also rich in American and British artists, often as a result of personal relationships. American Mark Tobey, for example, practiced for many years in Zurich, Switzerland and was acquainted with the Bechtler family. A cluster of British artists formed relationships with the Bechtlers, especially Ben Nicholson who often spent his summers in Ascona, the Italian region of Switzerland, and served as an artistic mentor to a teenage Andreas Bechtler.
The Bechtler collection juxtaposes whimsy with work of significant intellectual depth and historical significance. Cosmopolitan in nature yet intimate in scale, the museum provides an experience that is inspiring and approachable. The artworks were committed to the city of Charlotte by Andreas Bechtler who, along with his family, built the collection over 70 years.


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The unadjusted proportion of decedents with advance directives across hospital referral regions in the United States. Of the 3302 Health and Retirement Study participants who died between 1998 and 2007, 454 lived in low-spending regions (median, $8787; range, $7252-$9707), 1847 in medium-spending regions (median, $10 848; range $10 242-$12 404), 1001 in high-spending regions (median, $15 744; range, $12 446-$29 797). Error bars indicate 95% CIs. Any advance directive includes decedents with a written advance directive or durable power of attorney. Treatment-limiting advance directives are written documents specifying limitations in the types of treatment provided.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Nicholas LH, Langa KM, Iwashyna TJ, Weir DR. Regional Variation in the Association Between Advance Directives and End-of-Life Medicare Expenditures. JAMA. 2011;306(13):1447–1453. doi:10.1001/jama.2011.1410
© 2023
Author Affiliations: Institute for Social Research (Drs Nicholas, Langa, Iwashyna, and Weir), University of Michigan; Department of Medicine, University of Michigan Medical School, and Veterans Affairs Health Services Research and Development Center of Excellence (Drs Langa and Iwashyna), Ann Arbor.
Context It is unclear if advance directives (living wills) are associated with end-of-life expenditures and treatments.
Objective To examine regional variation in the associations between treatment-limiting advance directive use, end-of-life Medicare expenditures, and use of palliative and intensive treatments.
Design, Setting, and Patients Prospectively collected survey data from the Health and Retirement Study for 3302 Medicare beneficiaries who died between 1998 and 2007 linked to Medicare claims and the National Death Index. Multivariable regression models examined associations between advance directives, end-of-life Medicare expenditures, and treatments by level of Medicare spending in the decedent's hospital referral region.
Main Outcome Measures Medicare expenditures, life-sustaining treatments, hospice care, and in-hospital death over the last 6 months of life.
Results Advance directives specifying limits in care were associated with lower spending in hospital referral regions with high average levels of end-of-life expenditures (−$5585 per decedent; 95% CI, −$10 903 to −$267), but there was no difference in spending in hospital referral regions with low or medium levels of end-of-life expenditures. Directives were associated with lower adjusted probabilities of in-hospital death in high- and medium-spending regions (−9.8%; 95% CI, −16% to −3% in high-spending regions; −5.3%; 95% CI, −10% to −0.4% in medium-spending regions). Advance directives were associated with higher adjusted probabilities of hospice use in high- and medium-spending regions (17%; 95% CI, 11% to 23% in high-spending regions, 11%; 95% CI, 6% to 16% in medium-spending regions), but not in low-spending regions.
Conclusion Advance directives specifying limitations in end-of-life care were associated with significantly lower levels of Medicare spending, lower likelihood of in-hospital death, and higher use of hospice care in regions characterized by higher levels of end-of-life spending.
End-of-life health care is a frequent target for efforts to control Medicare spending. In 2006, treatment for patients in their last year of life accounted for more than one-quarter of Medicare spending.1 Marked geographic variation in Medicare end-of-life spending is well documented,2 and this variation is believed to be driven by physician practice style rather than by differences in patients' preferences for aggressiveness of treatment at the end of life.3 There is concern that this expensive care may have limited clinical effectiveness and may be contrary to what patients want. Surveys report that many patients do not wish to receive aggressive treatment at the end of their lives; however, these preferences are often undocumented.4,5 A national study by Barnato and colleagues6 found that 42% of white Medicare beneficiaries worried about receiving too much care at the end-of-life, whereas an equal proportion worried about receiving too little.
Patients can use advance directives to document their preferences for the use or avoidance of life-sustaining treatments (living wills) or to appoint a surrogate to make treatment decisions should they become no longer competent to make those decisions (durable power of attorney for health care). Although advance directives have become more common in the past few decades, evidence is mixed on whether they change the course of treatment provided near the end-of-life.7-10
It is sometimes overlooked that an advance directive can only influence treatment when the patient's wishes are inconsistent with what would be provided absent an advance directive. The wide variation in end-of-life Medicare expenditures across geographic regions suggests that default treatment levels also vary regionally. Advance directives specifying limits at the end-of-life may have their greatest impact in regions where the norms are to provide very high-intensity end-of-life treatment. Given that there exist regions with consistently high levels of spending at the end of life that may be of limited benefit and contrary to patient preferences, we used nationally representative survey data from the Health and Retirement Study (HRS) linked to respondents' Medicare claims to examine the relationship of advance directives with the cost and aggressiveness of end-of-life treatment in geographic regions across the United States characterized by high, medium, and low average end-of-life expenditures.
We analyzed survey and Medicare claims data for HRS respondents who died between 1998 and 2007 at age 65 years or older or after qualifying for Medicare through disability or end-stage renal disease. The HRS is a large, nationally representative panel survey that conducts biennial interviews of older US residents.11 The HRS also conducts an interview with a proxy informant, typically next-of-kin, after the respondent's death. During the postmortem interview, informants are asked about the decedent's experience at the end of life, including the nature and type of their advance directives. Oral informed consent was obtained from participants and proxies in the original study. The institutional review board of the University of Michigan approved the study protocol.
Because our primary interest was in end-of-life Medicare spending and use, we limited our analytic sample to patients continuously enrolled in fee-for-service Medicare during the last 6 months of life. We used data on deaths through 2007, which were the most recently available data linked to Medicare claims.
We measured the presence and type of advance directive from interviews with respondents' next-of-kin conducted after death. For living wills, informants were asked: "Did [first name] provide written instructions about the treatment or care [she/he] wanted to receive during the final days of [her/his] life?" If respondents had a written advance directive in place, additional questions were asked about the type of written instructions. Our analysis included those who indicated living wills limiting the type of care provided and those requesting all care. These informant reports have been used to document advance directive status previously.4 For durable power of attorney, informants were asked: "Did [first name] make any legal arrangements for a specific person or persons to make decisions about [his/her] care or medical treatment if [he/she] could not make those decisions [himself/herself]?"
During biennial interviews, HRS respondents were asked to provide their Medicare number and consent to the release of their claims for research purposes. For each decedent, we calculated Medicare spending in the last 6 months of life across all care settings (inpatient, outpatient, carrier, durable medical, hospice, home health, and skilled nursing). All spending measures were adjusted to 2007 US dollars using the medical consumer price index.
End-of-life hospital treatment is a major driver of end-of-life expense, and a setting in which many aggressive procedures to sustain life are performed. We used MedPAR and hospice files to identify all hospitalizations and hospice use in the last 6 months of life. We used International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes to identify a set of life-sustaining interventions that have been previously used as measures of end-of-life treatment intensity (intubation and mechanical ventilation, tracheostomy, gastrostomy tube placement, hemodialysis, enteral and parenteral nutrition, and cardiopulmonary resuscitation).12 We examined any hospice use at the end-of-life as a measure of palliative care. We assessed comorbidities in the year preceding the last 6 months of life using the Elixhauser method for inpatient data.13
We used hospital referral region measures of average Medicare spending per decedent in the last 6 months of life reported by the Dartmouth Atlas of Health Care averaged across the years 1999 through 2005.14 We characterized regions by quartiles of end-of-life spending averaged across the 7-year period. Decedent's region intensity was determined by zip code of residence.
We used generalized linear models with a log link function and gamma distribution to fit skewed Medicare end-of-life expenditure data.15 Multivariable regression models assessed the relationships between hospital referral region end-of-life treatment intensity, advance directives specifying limits in treatment, and Medicare expenditures in the last 6 months of life. We first estimated the regressions typically reported in the literature, which assume a constant relationship between advance directives and individual end-of-life resource use. We next allowed the relationship between treatment-limiting advance directives and spending to vary for patients in high-, medium-, and low-spending regions by including interactions between treatment-limiting advance directives and region spending type. Regressions also controlled for sex, self-reported nonwhite race (due to the sample size, we collapsed respondents reporting black and other race relative to the reference group of white decedents), 5-year age categories, whether the respondent was in the highest tertile of household wealth at the last interview, indicators for having less than a high school education and a high school degree (relative to at least some college), being widowed or single or separated or divorced (vs married), self-reported chronic conditions in the interview prior to the last 6 months of life, Elixhauser comorbidities calculated from hospitalizations in the 12-month period before the last 6 months of life, and a linear time trend.
We tested for differential effects of treatment-limiting advance directives across regions by calculating average marginal effects of advance directives in low-, medium-, and high-spending regions and by conducting nonlinear Wald tests16 of the equality of spending on decedents at the end of life with and without treatment-limiting advance directives within and across levels of region spending. Two-sided significance testing was used throughout, and a P value of .05 was considered statistically significant.
We estimated logistic regressions of life-sustaining treatments, in-hospital death, and hospice use among decedents hospitalized during the last 6 months of life controlling for patient characteristics described above to test their relationship between treatment-limiting advance directives and regional spending.
Our sensitivity analyses included examining components of Medicare spending, estimating models for decedents with and without at least 1 end-of-life hospitalization separately, and analyses stratifying by cause of death using 15-cause recodes from the National Death Index. We used SAS version 9.2 (SAS Institute Inc, Cary, North Carolina) for data manipulation and Stata 11 MP (StataCorp, College Station, Texas) for analyses.
A total of 4761 HRS participants who died between 1998 and 2007 (82% of 5810 decedents with postmortem interviews) also had linked Medicare data. To accurately account for end-of-life health care use, we excluded 1445 decedents with any managed care enrollment during the last 6 months of life and excluded 14 decedents who reported military coverage who might have received care through Veterans Affairs facilities.
Our cohort included 3302 decedents. Their mean age at death was 82.8 years. Fifty-six percent were women; 70% were hospitalized at least once in the last 6 months of life; 41% died in a hospital; 61% had either a living will or written durable power of attorney; and 39% completed a written, treatment-limiting advance directive. Table 1 presents the characteristics of individuals with and without a treatment-limiting advance directive. Median Medicare spending in the last 6 months of life did not vary by treatment-limiting advance directive status. In unadjusted comparisons, those with treatment-limiting advance directives had lower rates of life-sustaining treatment (34% vs 39%, P = .002), lower rates of in-hospital death (37% vs 43%, P < .001), and higher rates of hospice use (40% vs 26%, P < .001). Those with advance directives were more likely to be white, affluent, and highly educated.
We compared end-of-life care of decedents living in hospital referral regions in the lowest quartile of Medicare spending (median unadjusted spending, $8787; range, $7252 to $9707), middle half (median, $10 848; range, $10 242 to $12 404), and highest quartile (median, $15 744; range, $12 446 to $29 797; see Figure). There was substantial geographic diversity in the rates of advance directives among regions. Decedents residing in low-spending regions were more likely to have a treatment-limiting advance directive than decedents in high-spending regions (42% vs 36%; P < .001; Figure). After adjusting for demographic and socioeconomic characteristics, decedents in high-spending regions continued to face lower odds of having a treatment-limiting advance directive (odds ratio [OR], 0.69; 95% CI, 0.54 to 0.88). Although there was considerable variation in advance directive use (Figure) and median end-of-life spending (Table 2) across regions, relatively little difference existed in cause of death or comorbidity prior to the end of life (Table 2). Regression-adjusted end-of-life spending was significantly lower for decedents in low-spending regions (predicted spending, $21 741 [95% CI, $19 668 to $23 816]; difference, $4400 [95% CI, $2083 to $6717]) and higher for those in high-spending regions (predicted spending, $37 841 [95% CI, $34 855 to $40 107]; difference, $11 340 [95% CI, $8479 to $14 200]) relative to those in medium-spending regions. Spending was considerably higher for nonwhite decedents (difference, $6561; 95% CI, $3293 to $9829) and lower for decedents aged 90 years or older than younger decedents (difference, −$7871; 95% CI, −$11 212 to −$4,530). After adjusting for patient characteristics and hospital referral region-spending intensity, there was no difference in Medicare spending in the last 6 months of life for those with ($28 348; 95% CI, $26 698 to $29 999) and without advance directives ($29 352 [95% CI, $27 885 to $30 819]; difference, −$1004 [95% CI, −$3366 to $1359]) when using regressions that forced the association with advance directives to be the same for all regions.
However, there was important geographic heterogeneity in the relationship between advance directives and end-of-life spending (Table 3). In high-spending regions, adjusted spending on patients with a treatment-limiting advance directive was $33 933 (95% CI, $30 233 to $37 681), whereas adjusted spending for patients without an advance directive was $39 518 (95% CI, $35 871 to $43 167; difference, −$5585; 95% CI, −$10 903 to −$267). Having a treatment-limiting advance directive was not associated with differences in aggregate end-of-life spending for decedents in low- and medium-spending regions.
Treatment-limiting advance directives were associated with site of death and palliative care for decedents in medium- and high-spending regions (Table 4). Directives were associated with lower probabilities of in-hospital death in high- and medium-spending regions but not in low-spending regions. Thus, in high-spending regions, patients without an advance directive had a 47% adjusted probability of in-hospital death (95% CI, 44% to 51%), whereas those with an advance directive had a 38% probability of in-hospital death (95% CI, 32% to 43%; difference, −9.8%; 95% CI, −16% to −3%). The equivalent results for in-hospital death for those in medium-spending regions were 42% without an advance directive (95% CI, 39% to 45%) and 37% with an advance directive (95% CI, 33% to 41%; difference, −5.3%; 95% CI, −10% to −0.4%). In high-spending regions, patients without a limiting advance directive had a 24% adjusted probability of hospice use (95% CI, 21% to 28%), whereas those with a directive had an adjusted probability of hospice use of 41% (95% CI, 36% to 46%; difference 17%, 95% CI; 11% to 23%). Similar differences in hospice use occurred in medium-spending regions. There was no statistically significant relationship between treatment-limiting advance directive use and receipt of life-sustaining treatments during hospitalizations in the last 6 months of life, although the point estimates were in the same direction as for total end-of-life expenditures in high-spending regions, ie, lower likelihood of use of life-sustaining treatments among those with treatment-limiting advance directives (P = .11).
The differences in Medicare spending observed among those with advance directives in high-spending regions appear to be driven mainly by lower inpatient spending ($7509, 95% CI, $3404-$11 614) slightly offset by higher hospice spending ($976; 95% CI, $294-$1658; eTable 1). The differences in end-of-life spending across regions and advance directive status are concentrated among the 2384 decedents (72%) experiencing at least 1 hospitalization in the last 6 months of life (eTable 2). There was no evidence of heterogeneity of the advance directive effect in high-spending region by cause of death (P = .44 for joint test of significance; eFigure).
Nearly 4% of those with advance directives (1.5% of decedents overall) requested all care possible in their advance directive. There were too few such decedents in our study to reliably estimate the effects of such advance directives; these decedents are included in the no-limiting directive group. On average, these decedents used $8060 more care at the end-of-life (P = .02) than decedents with treatment-limiting directives.
Our results were consistent across numerous alternative specifications including an ordinary least squares regression, excluding all veterans because Veterans Affairs care is unobserved in the Medicare claims, excluding disabled decedents who are younger than 65 years but observed in the Medicare claims, excluding decedents with cancer as the cause of death, and excluding those who wrote advance directives in the last 6 months of life (eTable 3-6; eFigure).
Using linked personal interviews and Medicare claims for decedents in a large, nationally representative study, we found that advance directives specifying limits in treatment were more common in areas with lower levels of end-of-life spending. When patients in high-spending areas had advance directives limiting treatments, they averaged significantly lower end-of-life Medicare spending, were less likely to have an in-hospital death, and had significantly greater odds of hospice use than decedents without advance directives in these regions.
Our findings may reconcile prior, seemingly conflicting evidence that advance directives both reduce17,18 and do not affect10,19 end-of-life health care expenditures and use of life-sustaining treatments. We replicate the absence of a global relationship between advance directives and resource use but extend the analysis to show that treatment-limiting advance directives are associated with lower Medicare expenditures for beneficiaries living in geographic regions characterized by aggressive end-of-life care. Most studies—including the 1980s landmark Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)7—relied on samples from a small number of hospitals, precluding such geographic comparisons.17
These results suggest both the power and limitations of advance directives. One interpretation of these data is that advance directives are most effective when one prefers treatment that is different from the local norms. Thus, in high-intensity regions, more limited treatment requires an explicit statement. Treatment-limiting advance directives were associated with increased likelihood of palliative hospice care and lower rates of in-hospital deaths in high- and medium-spending regions, where patients were most likely to receive aggressive end-of-life treatment. This has important implications for patient quality of death and well-being of family and friends. Previous research has found that next-of-kin report that the quality of death is higher for decedents who die at home20 or in hospice care21 relative to hospital and nursing home settings, that caregivers report worse overall physical and mental health following deaths characterized by use of aggressive end-of-life treatment,18 and surviving spouses of hospice decedents are less likely to die within 18 months of widowhood relative to those whose spouses did not use hospice.22
Interestingly, we found that while treatment-limiting advance directives were associated with significantly lower total end-of-life Medicare expenditures in high-spending hospital referral regions, the relationship between treatment-limiting advance directives and the receipt of aggressive life-sustaining treatments (eg, intubation and mechanical ventilation, hemodialysis, and enteral and parenteral nutrition) was less strong. This may suggest that treatment-limiting advance directives are associated with a quicker withdrawal of these aggressive and expensive interventions, even if the likelihood of initiating these treatments is less strongly affected. Given the significant consequences of these treatments for both patient and family well-being and health care costs, future research should be aimed at better understanding how advance directives, durable power of attorney provisions, and newer initiatives to improve in-the-moment end-of-life decision making23 affect the initiation and withdrawal of life-sustaining treatments.
Our results indicate a statistically and economically significant relationship between advance directives and regional practice patterns. The regional variations literature has asserted that significant savings to the Medicare population could be achieved if high-spending regions practiced more like low-spending regions.24,25 However, we note that patient preferences may also contribute to observed differences, possibly in a mutually reinforcing pattern. If an additional 6% of decedents in high-intensity regions had had treatment-limiting advance directives in place (matching preferences in low-spending regions), our estimates suggest that Medicare spending on the 790 061 beneficiaries dying in high-spending hospital referral regions in 2006 would have been $265 million lower. We urgently need studies to examine the extent to which greater advance directive use in high-intensity regions would result in treatment that is more concordant with patient preferences and to understand the patient, physician, and health system characteristics that lead to higher rates of use in low-spending regions.
Our findings should be interpreted in light of several limitations. Because we used Medicare claims data to measure use, we were unable to include decedents not in fee-for-service Medicare. The associations and impact of advance directives may be different in other populations. However, Medicare-eligible adults account for more than 70% of deaths in the United States.26 We also lacked information about decedents who had not consented to the HRS-Medicare data linkage, even though demographics of decedents in the linkage were similar to the full sample (eTable 8).
Because our study was observational, we were unable to assess causal effects of advance directive use. We focused on the last 6 months of life so were unable to address the question of how advance directives alter spending patterns over an individual's life course nor to address the extent to which they influence the length of life. Although limitations of the look-back approach to studying end-of-life intensity are well-known, this approach addresses the policy-relevant question of health care use just before death.27 Our sensitivity analyses suggest that our results are not driven by heterogeneous patient characteristics. Furthermore, we did not have patients' own reports of preferences or copies of their advance directives. However, the postmortem interviews are conducted with proxy informants, often widows or adult children, who are likely to know of advance directives if they were used; 78% were involved in decedents' end-of-life decisions. Recent studies of older adults and their surrogate decision makers support the reliability of this approach.28,29
Advance directives are associated with important differences in treatment during the last 6 months of life for patients who live in areas of high medical expenditures but not in other regions. This suggests that the clinical effect of advance directives is critically dependent on the context in which a patient receives care. Advance directives may be especially important for ensuring treatment consistent with patients' preferences for those who prefer less aggressive treatment at the end of life but are patients in systems characterized by high intensity of treatment.
Corresponding Author: Lauren Hersch Nicholas, PhD, MPP, 3005 Institute for Social Research, 426 Thompson St, Ann Arbor, MI 48104 (firstname.lastname@example.com).
Author Contributions: Dr Nicholas had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Nicholas, Langa, Iwashyna, and Weir.
Acquisition of data: Nicholas, Langa, and Iwashyna.
Analysis and interpretation of data: Nicholas, Langa, Iwashyna, and Weir.
Drafting of the manuscript: Nicholas, Langa, Iwashyna, and Weir.
Critical revision of the manuscript for important intellectual content: Nicholas, Langa, Iwashyna, and Weir.
Statistical analysis: Nicholas.
Administrative, technical, or material support: Nicholas, Langa, Iwashyna, and Weir.
Study supervision: Nicholas.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: This work was supported by grants U01 AG09740, R01 AG030155, K08 HL091249 from the National Institutes of Health and Clinical and Translational Science Award grant UL1RR024986 from the Michigan Institute for Clinical and Health Research.
Role of the Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. The Health and Retirement Study is conducted by the University of Michigan with funding from the National Institute on Aging.
Disclaimer: The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.
Online-Only Material: The Author Video Interview is available here.
Additional Contributions: We thank Tish Shapiro, MA, for programming assistance and Morris Hamilton, BA, for research assistance. Both are employees of the University of Michigan and did not receive additional compensation for their involvement.


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Perhaps best known as the innovative designer of the Futurama exhibition in the General Motors pavilion at the 1939–1940 New York World's Fair, Norman Bel Geddes was also a noted theater designer, fabricating costumes, sets, lighting, and theaters.
After beginning his career in Los Angeles, Bel Geddes moved to New York City in 1917 where his creative ambitions manifested in producing dynamic theater experiences. Using principles of the European New Stagecraft movement, Bel Geddes brought German director Max Reinhardt's The Miracle to the American stage. The New Stagecraft movement, which divorced theater from the structures of bourgeois realism, aligned with Bel Geddes's vision of simplified details and abstract settings and costumes.
Bel Geddes's work on the 1924 production of The Miracle reveals his talents as a theatrical polymath. The play, a medieval legend about a nun, relied on Bel Geddes's mechanized scenery and single switchboard. The technical modifications allowed a single electrician to control the focus, direction, and color of the lighting. Audience members sat on pews to watch the play, as Bel Geddes transformed the interior of the theater into a Gothic cathedral, complete with light trickling through stained glass windows and incense wafting through the air. The Miracle fused theater and architecture, creating a participatory environment that immersed audience members in the drama that surrounded them.
Highlighted here is a series of four costume designs for The Miracle, including "Oriental Gentleman," "Chief Gypsy or Jester," "Noble Gentleman," and "Gypsy Woman." The watercolors showcase Bel Geddes's dexterity as an artist.
The innovations of Bel Geddes's early theatrical career inform his later work as an industrial designer. Indeed, the same mechanical track system used to move scenery in The Miracle also guided model cars along the highway system of Futurama.
Materials from The Miracle and other theatrical works by Bel Geddes are on view in the exhibition I Have Seen the Future: Norman Bel Geddes Designs America, which runs through January 6, 2013.
Please click on the thumbnails to view larger images.


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The Courtyard House is situated in the newly developed outskirts of Ahmedabad, Gujarat, India, designed by Hiren Patel Architects. There are two bedrooms located downstairs, for the parents and guests. Two bedrooms are found upstairs for the young couple and their young children. There are large expanses of windows to enhance the views and bring nature indoors. There are seven foot overhangs and wide verandahs to protect the home from the scorching rays of the summer sun. The verandahs get used by the family whenever the weather permits.
The central focal point of the outside courtyard is the wall with the Buddha. The wall behind is a boundary wall, so it has been elevated for privacy. 'We ended up with some pockets, so we decided to install a Buddha with a wooden backdrop,' states the architects. A triangular wooden grid is interspersed with a metallic, backlit one in a delicate lacy design, to create an ambience of sheer magic. One of the architects main concerns for this home was that the children shouldn't get spoilt, growing up in an atmosphere like this. He ensured this, 'not in any forceful way. But being surrounded by so much greenery, I think people imbibe lessons from nature itself,' he says.


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SYDNEY (AFP) - Australia recalled Ashes destroyer David Warner and Test captain Michael Clarke, adding power and class to the one-day squad unveiled on Tuesday to face England in the first three of five matches.
"David Warner has won back his place in the Australia ODI squad with his outstanding recent form," said national selector John Inverarity.
"Michael Clarke, Shaun Marsh and James Pattinson have been included after being unavailable through injury for the series against India in October."
Australia have comprehensively outplayed England to take a 4-0 Ashes lead and are a strong bet for a total whitewash when the final Test opens on Sydney on Friday.
Warner has been in blistering form with the bat while Clarke, who missed the October tour of India with chronic back trouble, has led a total turnaround for an Australia team who lost the last Ashes series 3-0 in England earlier this year.
"There are three outstanding players in Clarke, Warner and Marsh coming back and we believe their inclusion provides the squad with several batting options," Inverarity said.
"Aaron Finch and Shaun Marsh are exciting prospects at the top of the order with the 2015 ICC Cricket World Cup only 14 months away."
Fast-bowler James Pattinson also returns from a long-term back injury. "Pattinson has worked hard to get back to full fitness and will be looking to regain his best form," the selector said with an eye on Australia's Test tour to South Africa in February and March.
Australia v England schedule:
Jan 12: Melbourne
Jan 17: Brisbane
Jan 19: Sydney
Jan 24: Perth
Jan 26: Adelaide
Squad for the first three matches: Michael Clarke (capt), George Bailey (vice-capt), Nathan Coulter-Nile, Xavier Doherty, James Faulkner, Aaron Finch, Brad Haddin, Mitchell Johnson, Shaun Marsh, Glenn Maxwell, Clint McKay, James Pattinson, David Warner, Shane Watson.


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Ensembles at UNI School of Music are the best way to get involved. If you are a music major, get involved in several groups and fill your days and nights with performing amazing music under the direction of our top notch faculty and conductors. If you're not a music major but love music, join a group and stay involved in making music while you pursue other dreams. Not looking to join a group but still love music? Come and be a world-class audience member. Follow the links to find out more about the ensemble opportunities we offer.
Audition information for student ensembles may be found on the Auditions page.


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José Izquierdo-Encarnación, former Secretary of State for the Commonwealth of Puerto Rico, spoke Tuesday at a workshop in Stillwater, OK about how Oklahoma Business owners can bid on contracts to rebuild the island nation.
Chelsea Bradshaw helps Ben Pelley work with a customer at Citizens Bank of Edmond in Edmond, OK.
Decorating of the Christamas Tree at the Oklahoma State Capitol.
Construction at the Oklahoma State Capitol is being paid for by bonds sold by the state.
Jacquelyn Rojas purs a beer for a customer at The Manhatten located at 210 Park Ave in Oklahoma City.
stcvolenteerdentistbbfgood shepardteeth
Rep. Kevin Wallace, R-Wellston, house appropriations and budget chair, on the floor of the Oklahoma House of Repersenitives.
Rep Emily Virgin question a bill that's up for a vote at the Oklahoma State House of Repersenitives.
Proffesors Dan Rickman with OSU, Mickey Hepner with UCO and Robert Dauffenbach with OU participated in a panel discussion at the State of the Economy luncheon held by the Greater Oklahoma City Chamber of Commerce at the National Cowboy and Western Heritage Museum in Oklahoma City.
Sandridge Energy located at 123 Robert S Kerr Ave in Oklahoma City.
The Embark Bus station in downtown Oklahoma.
The Edmond Convention Center and Hilton Garden Inn are nearing completion at Sooner Rd and Covell Rd in Edmond, OK.
Construction Shops at Tecumseh shopping center at I-35 and Tecumseh Road in Norman, OK.
Home developer Neil McGee is building new homes at Edmond Rd and Madison Ave in Edmond, OK.


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Computer Science Careers
According to the Bureau of Labor Statistics' Spring 2009 Occupational Outlook Quarterly, the technology area is expected to see a job growth of 24% between 2006 and 2016. Careers in technology related jobs continue to rank in top ten best job lists.
What does that mean for our graduates? It means they find jobs. As a matter of fact, our graduates find not only jobs, but well-paying jobs as technology jobs continue to pay well above the national average.
At North Central College, our graduates enter the workforce as programmers, database designers, network administrators, and web developers just to name a few. Our undergraduate curriculum not only prepares students to enter the technology workforce, but because of the breadth of focus of our curriculum, the required communication support courses, and opportunities such as internships and undergraduate research, our students quckly move into advanced careers in the field.


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Dauphin County Judge Todd Hoover ruled that the defendants could not call to the stand Cynthia Baldwin, who accompanied the men to grand jury appearances in 2011 and then testified against them. Baldwin, a former state Supreme Court justice and university trustee, was Penn State's top lawyer at the time, and the defendants believe she violated attorney-client privilege.
Hoover told the lawyers to submit proposed findings of fact and legal conclusions, after which he will schedule a hearing so they can argue the issues. The judge also indicated he would unseal records in the case, but courthouse officials said afterward no new documents were immediately available.
Former president Graham Spanier, former vice president Gary Schultz and former athletic director Tim Curley are accused of covering up child sex-abuse complaints about former assistant football coach Jerry Sandusky. They face charges of perjury, obstruction, conspiracy, child endangerment and failure to properly report suspected child abuse.
The 20-minute proceeding had been scheduled to last four days, but there was a three-hour closed-door conference on Monday during which Hoover also quashed a subpoena issued to Frank Fina, a former state prosecutor who was involved in the grand jury proceedings.
Another subpoena, issued to former state prosecutor Jonelle Harter Eshbach, was quashed by Hoover on Tuesday. Defense lawyers listed the documents the judge will consider, including grand jury transcripts and correspondence among the attorneys.
Spanier attorney Elizabeth Ainslie told reporters afterward she was surprised by the brevity of the hearing.
"Until last week, we had been expecting an evidentiary hearing," Ainslie said.
The matter involves secret testimony before the investigative grand jury, and Hoover has not explicitly said precisely what issues are before him regarding Baldwin, but all three defendants have argued that they believed she was representing them. The issue of their legal representation, and her later testimony that was used to charge them, are the major reason why there is no trial date even though Curley and Schultz were arrested two years ago and Spanier was charged late last year.
"I was never notified that Ms. Baldwin was going to testify against Graham Spanier, and neither was he," Ainslie said, adding later that court records show Baldwin "says different things at different times about who she represented."
Baldwin's lawyer, Charles De Monaco, told reporters she was in town and available to testify if she had to, but Baldwin did not appear in the courtroom. De Monaco declined to comment on the proceedings.
A spokesman for the attorney general's office released a statement afterward saying prosecutors planned to make their case in court.
"We are pleased that Judge Hoover ruled in favor of the attorney general's decision that witness testimony was not necessary in today's proceeding, and that he will rule based solely on the existing record," said Joe Peters, press secretary for Attorney General Kathleen Kane.
Hoover confined interviews to a room in the courthouse, and lawyers for Curley and Schultz did not provide any comment about the hearing afterward.
Curley, Spanier and Schultz were among the university's senior administrators in 1998 and 2001, when complaints were lodged about Sandusky behaving inappropriately with children. Sandusky was convicted last year of 45 counts of child sexual abuse - including charges that relate to the 1998 and 2001 incidents - and is serving a decades-long state prison sentence. His request for state Supreme Court review of his conviction is pending.