text:
As the revolutionary age transformed Europe and the New World, among the few prominent instances of global stability, or so it has frequently been asserted, was the special relationship between France and America. The French, after all, were instrumental to the result of the American war for independence;¹sk the travelled inhabitant of any nation, In what country on earth would you rather live? Certainly in my own, where are all my friends, my relations and the earliest & sweetest affections and recollections of my life. Which would be your second choice? France.” ] perhaps the most symbolically evocative and totemic emblem of our land—the Statue of Liberty—is a gift from the nation of France; and a key piece of our national self-understanding hinges on a document penned by a Frenchman. _Democracy in America_, while not unbridled praise, has long been regarded by Americans as a prescient and penetrating account of our nation, one that suggests how we might serve as a model for the march of democracy across the world.

But then consider the following portrait of America and its people, from Dr. Laurent Cerisé, writing in _L’Européen_ in 1835, just after the first volume of Tocqueville’s masterpiece was published:

  This hideous collection of aristocratic bourgeois and bourgeois aristocrats, who so loudly proclaimed Christian liberty and rebelled against the mother country so as to avoid paying a few cents more for a pound of tea; this band of slave traders who speak of fraternity and equality yet engage in a shameful traffic in human flesh; this nation of ignorant shopkeepers and narrow-minded workers, who cannot boast of a single work of art across the vast extent of their continent … (quoted in Jaume)

Nearly two centuries later, and it still stings a bit. Is the American remembrance of an early love affair with France mere fantasy? Perhaps in our nearly singular attention to Tocqueville, we have missed a broader sense of how America was understood during the revolutionary age. Or could it be that we’ve read Tocqueville through the rosy lens of American optimism, and that we’ve misread one of the foundational texts used to construct our sense of nation?

Alexis de Tocqueville’s story is well rehearsed, and yet the details are worth revisiting. In 1831 France sent two aristocrats—curiously persistent social positions 40 years after chants of “égalité” and legions of severed heads—to study America’s innovative prison system. One came from a noble family in the Loire Valley; eloquent and charming, at the young age of 24 he was elevated to the position of King’s Prosecutor at Versailles. I write “elevated,” because in early 19th-century France positions were rarely earned. This is not to say that office holders were lazy or untalented. Merely that they tended to be limited to the children of other office holders, and these were primarily noblemen. Nor does this mean that they were all conservative. Our young prosecutor was a passionate social reformer, admiring the liberality of America’s prison system and condemning both the treatment of slaves and the separation of the races. America held great promise, in his estimation, but had some way to go before it could become a moral society.

Could it be that we’ve read Tocqueville through the rosy lens of American optimism, and that we’ve misread one of the foundational texts used to construct our sense of nation?

Beneath this charming man, Gustave de Beaumont, worked another young aristocrat, the more temperamental Alexis de Tocqueville. His parents, who made him into a rather spoiled child, only avoided the guillotine with the overthrow of the revolutionary Robespierre. The 21-year-old’s brilliance was almost immediately recognized by his supervisor. But Beaumont’s admiration stemmed not from any belief that Tocqueville was likely to carry the great torch of democracy by leading the people. “He had no great success with the crowd,” Beaumont wrote. This was not such a problem, he continued, because Tocqueville “never failed with the elite … no one doubted that a brilliant future was his, and more than one president of assize [the King’s court of justice] prophesied a high destiny for him.”² After four years of working as lawyers in the royal court together, the pair embarked on the American adventure that would allow Tocqueville to fulfill what so many saw as his great promise.

The presidents of assize did not imagine that Tocqueville would become another Montesquieu—lauded in Britain and Americas as the great liberal thinker of France—but rather that he would take the more conservative, aristocratic career path of his great-grandfather, Chretien de Lamoignon de Malesherbes. Less well known today, Malesherbes was also a lawyer, served as secretary of state under Louis XVI, and helped defend the King during his trial at the 1792 Convention. For his troubles, Malesherbes was forced to watch his daughters’ and granddaughter’s execution; shortly after, he too was beheaded.

It should be surprising, then, that after writing up an account of his travels across America, Tocqueville would be wreathed the great champion of democracy and equality. Of the two, Beaumont was the greater believer in the broad idea of equality. It was Beaumont, the passionate reformer, who wrote a novel, _Marie, ou L’Esclavage aux États-Unis_ (_Marie; or, Slavery in the United States_), condemning the inhumanity of American slavery. Tocqueville worried about the racial dynamics of the United States yet did so largely through the lens of the intractable political problem that slavery and treatment of the natives was creating. Were we to look to Tocqueville’s essays on Algeria, we would see a far different man, one who argued for the importance of the separation of the races under imperialism and the importance of maximizing colonial France’s extractive capacity, without much regard to the human cost.³

  In France I have often heard people I respect, but do not approve, deplore [the army] burning harvests, emptying granaries and seizing unarmed men, women and children. As I see it, these are unfortunate necessities that any people wishing to make war on the Arabs must accept…. I believe the laws of war entitle us to ravage the country and that we must do this, either by destroying crops at harvest time, or all the time by making rapid incursions, known as raids, the aim of which is to carry off men and flocks.⁴

This is to say that Tocqueville was a complicated figure caught between two worlds—the old regime of aristocracy that defined his family and nation’s honor and greatness, and the future of Western democracy. His work manifests this struggle: while Tocqueville held that democracy was Europe’s destiny, he did not view democracy as unadulterated progress away from a primitive dark past.

His main concern about democracy is well known: within its potential equality, tyranny could still emerge.⁵; all subsequent quotations of _Democracy in America_ are from this edition). But the text continues for many hundreds of pages, and as James T. Schleifer has noted, “democracy” has at least 11 different meanings in Tocqueville (_The Making of Tocqueville’s_ Democracy in America, [University of North Carolina Press, 1980]). This has led scholars like Jon Elster to describe Tocqueville’s thought as “incorrigibly incoherent” (See Jaume [p. 1], who refers us to Elster’s _Political Psychology_ [Cambridge University Press, 1993]). But one might also look to Elster’s more recent and far more sympathetic reading in _Alexis de Tocqueville: The First Social Scientist_ (Cambridge University Press, 2009). I won’t enter this morass by suggesting yet another definition of democracy in Tocqueville. But it is important to note that, for his purposes, Lucien Jaume argues that there are three elements to Tocqueville’s conceptualization of democracy: local power, religion of the Public, and expectation of “material pleasures” (p. 82); importantly, equality has no place in this definition. ] Tocqueville argued that democracy, equality, and liberty were not equivalent concepts. Today it is rather common to think that democracy makes us free; in Tocqueville’s era few would have made such an analytic slippage. The best known of Tocqueville’s concerns is the tyranny of the majority, but in fact Tocqueville proffered many arguments about the possibility of despotism within democracy. His vision of the potential coexistence of democracy and tyranny was nightmarish.

  When a man or a party suffers an injustice in the United States, to whom can he turn? To public opinion? That is what forms the majority. To the legislative body? It represents the majority and obeys it blindly. To the executive power? It is appointed by the majority and serves as its passive instrument. To the police? They are nothing but the majority under arms. A jury? The jury is the majority vested with the right to pronounce judgments … So, however iniquitous or unreasonable the measure which hurts you, _you must submit_. (italics added)

Tocqueville’s worry was that America’s exceptionalism—its lack of aristocracy—represented not just its great promise but also the means for the loss of liberty. The advantage of the ancien régime was that people had a sense of place—you knew where you stood—and this was liberating. At the core of such a view is the idea that freedom comes not from the absence but from the presence of constraints. It seems an easy enough argument for an aristocrat to make. But conceptually there is something to the idea that obligation is a cornerstone of freedom. Our relationships (with friends, families, loved ones, within status or occupational groups) are a patterned set of constraints that provide the capacity to develop a self that could not exist outside such relationships. Under such logic, freedom means self-realization, and such self-realization is only possible through the bonds of belonging. Under the equality of democracy, Tocqueville saw not the security of belonging but the burdens of endless striving. Americans, having no metric by which to judge the differences between themselves and others, began to make the dollar the currency of distinction and self-definition. The result was not freedom but a new kind of tyranny: one fails to know oneself, defines oneself by some standard that is not part of one’s self or position, and might be driven to madness in the attempt to find one’s place. Worse still, though it might appear as if social barriers dissolve under democracy, this is mostly an illusion. The benefits of hierarchies in structuring life disappear as distinctions are made invisible.

  The same equality that allows every citizen to conceive lofty hopes renders all the citizens less able to realize them; it circumscribes their powers on every side, while it gives freer scope to their desires. Not only are they themselves powerless, but they are met at every step by immense obstacles, which they did not at first perceive. They have swept away the privileges of some of their fellow creatures which stood in their way, but they have opened the door to universal competition; _the barrier has changed shape rather than place_. (italics added)

While many Americans today read their exceptionalism as a great compliment to their character, the man who did so much to develop the concept worried that it might well result in equality without freedom.

In _Tocqueville: The Aristocratic Sources of Liberty,_ intellectual historian Lucien Jaume places this classic story of Tocqueville in a new light. Though Jaume provides a masterful account of _Democracy in America_, his reading does not suggest that we have gotten Tocqueville terribly wrong. Instead, he locates Tocqueville within a particular 19th-century intellectual and cultural context. Jaume argues that _Democracy in America_ was written less as an account of America than as a discussion with various French intellectual and political traditions of the day. The result is something curious—a reading of _Democracy in America_ from which America is largely absent, both in terms of Tocqueville’s more ethnographic observations and, with rare exceptions, as the source of any native intellectual tradition. Passage after passage in Tocqueville is placed in the context of Gallic debates with which few beyond the most specialized readers will have anything but cursory familiarity.

This narrow focus is unlikely to inspire many readers to pick up Jaume’s book, which is a shame. For Jaume has given us a brilliant reading of one of the most important books about America: one that is erudite, compelling, and frustrating. The culmination of Jaume’s career, it provides much more than a deeper understanding of the arguments among French intellectuals in the 1830s and ’40s (though such material is terribly entertaining, particularly the vehement denunciations of _Democracy in America_ and the United States more broadly). Jaume shows how the question of America’s future was part of a vigorous debate among French intellectuals over the meaning of liberty, aristocracy, democracy, and the role of the state in social life. And though Jaume argues against such a reading, these are debates we can still learn from today.

Jaume shows how the question of America’s future was part of a vigorous debate among French intellectuals over the meaning of liberty, aristocracy, democracy, and the role of the state in social life.

Many of us take for granted that through Tocqueville’s account of America, Europe saw it’s future. But to most Europeans the nation was a backwater—a land populated by savages, both native and white. Its local government and civic associations were marveled at by Tocqueville, but many of his contemporaries saw in these not so much the progress of politics as the lack of the kind of governmental institutions that were a mark of modern humanity. French Socialist thinkers (heirs to Saint-Simon) leveled a series of arguments against both Tocqueville and the American ideals of local government and a liberal economy. Great fortunes might be built in America—John Jacob Astor may have been the wealthiest man in the world in the 1830s—but there was little culture to speak of in this new land. French dinner guests of Mr. Astor marveled that he ate his peas with a knife. Such horrors were augmented by the realization that the good fortune of some was hardly shared: the wages of the average American stagnated well through the first several decades of the republic; per capita income in 1835, when the first volume of _Democracy in America_ appeared, was roughly what it had been before the revolution. Sadly, such material conditions are of little interest to Jaume, as is any thinking from beyond the boundaries of Tocqueville’s natal nation. And though the world of the 19th century was increasingly defined by the global connections of capital and the transnational passage of ideas, Jaume limits his (intellectual) history to France.

Yet when Dr. Cerisé refers to “This hideous collection of aristocratic bourgeois and bourgeois aristocrats … this nation of ignorant shopkeepers …” what he is playfully turning on Americans is Adam Smith’s imagery in _Wealth of Nations_: “To found a great empire for the sole purpose of raising up a people of customers, may at first sight appear a project fit only for a nation of shopkeepers.” Yet Jaume does not raise this point. Such moments provide a problematic backdrop for him, for they show how French thinkers were clearly in dialogue with a wide range of intellectuals (need we remind ourselves that many socialist movements were international?). We might do well to remember that some of the most famous ideas in Tocqueville are neither Tocqueville’s nor French. Take “tyranny of the majority”: the phrase was first introduced to Americans (and the world) by the second US president, John Adams, and popularized by the Irish Briton Edmund Burke. Given how overstuffed with intellectual context Jaume’s volume is, it may well be too much to ask that it make that context global in scope. But Jaume is working within a tradition that seeks to reread Tocqueville and, by extension, our understanding of the revolutionary movements of the long 19th century—and those were more global than local.

We might do well to remember that some of the most famous ideas in Tocqueville are neither Tocqueville’s nor French.

Readers of _Democracy in America_ often take away a lesson that we might (erroneously) call “the Tocqueville thesis.” This is the notion that America’s foundational traits were positively consequential for its development. The thesis fits more broadly within what Eric Jones has called “the European miracle.” Jones’s argument has many august antecedents, such as the work, better known, of Max Weber. The core idea informing such scholarship is that there was something particular about the West that allowed it to develop in ways that other places could not. Also embedded in this view is the theory that certain human communities progressed thanks to special aspects of their history, culture, ideas, or institutions; those that fell behind were marked by more primitive cultural, ideational, or institutional arrangements. Historians with a more global view have challenged this vision. The exceptionalism narrative depends on our lack of knowledge or recognition of the broader world—for instance, the massive importance of China in the 18th century. And being based in such ignorance, it should not surprise us that this vision does not fit the facts. In 1492 Columbus was desperate to reach China, not to colonize it but to capitalize upon its wealth through trade. Over a century later, Henry Hudson lost his life in pursuit of the same end: to trade with China. Three hundred years after Columbus, John Jacob Astor felt the safe bet on how he could build his fortune was with profits from the China trade. If European development was so advanced, why were centuries spent desperately trying to generate wealth from China?

The answer is simple enough: for millennia, China was the most powerful economy on earth. And if traders wanted money, they knew to seek it just off China’s shores (that is, in Macau, and Macau alone, until the Canton System, introduced in 1757, also allowed Western merchants into the port city now known as Guangzhou). As Kenneth Pomeranz has argued in his magisterial book _The Great Divergence_, economic differences between China and Europe were not that great before 1750—in fact the advantage was China’s. Charles Mann augments such insights in his more popular history of the post-Columbian moment,

  China was then the earth’s wealthiest, most powerful nation. By virtually any measure—per capita income; military strength; average lifespan; agricultural production; culinary, artistic, and technical sophistication—it was equal to or superior to the rest of the world. Much as rich nations like Japan and the United States today buy little from sub-Saharan Africa, China had long viewed Europe as too poor and backward to be of commercial interest.⁶

The Chinese were not terribly wrong in their assessment. The viceroy of Mexico lamented the strength of China, writing to the Spanish king in 1573, “neither from this land nor from Spain, as far as can now be learned, can anything be exported thither that they do not already possess.”⁷ Historians such as Pomeranz help us understand “the Tocqueville thesis” in a new light: the revolutionary moment of American exceptionalism was not particularly American but part of a global trend, a “worldwide effort to destroy the oppressive institutions of the past.”⁸ Even China was not immune to these dynamics; its European encounters played a central role in its collapse and restructuring.

While Pomeranz demands that we take a broader view,⁹ Jaume takes us in a different direction: America’s great book, it seems, is truly (and almost exclusively) French. The lesson Jaume teaches—that it is the French intellectual context that produced _Democracy in America_, and not the material-ethnographic observations that Tocqueville made as he traveled about the States for some nine months—goes too far. It suggests that Tocqueville never needed to cross the Atlantic; he merely required the rich tradition of French intellectual life to write his great book about America. But there is something worthwhile in this strategy. With Jaume, we get to see Tocqueville as a man drawing on and at war with the ideas of his day. And for Jaume, the results of such battles were not particularly pleasant. While the case is not made explicitly, it’s quite clear that Jaume conflates the Tocqueville of _Democracy in America_ with that of _The Old Regime and the Revolution._¹⁰ The author of these books is the same, but the man is different. The reception of the first volume of _Democracy in America_ weighs upon the pages of the second, published five years later, in 1840. Also burdening Tocqueville were the political developments in France, and these political frustrations would only increase. But while most readers use such observations to generate a “two Tocquevilles” thesis, wherein the hopeful exuberance of the young man is slowly extinguished with experience,¹¹ according to Jaume, Tocqueville was cynical from the very start. Tocqueville’s is a “pessimistic prophesy … Indeed, Tocqueville did not describe two democracies but rather two despotisms, that of absolute monarchy and that of absolute democracy.”

Yet in limiting his concerns to the world of ideas, Jaume all but ignores Tocqueville’s experiences. This goes well beyond erasing America and extends to his later life in France. Tocqueville and others tried to resist Louis Napoleon Bonaparte’s 1851 coup and have Napoleon tried for treason. But Bonaparte won. Reflecting on his struggles and loss in Paris, Tocqueville wrote to his old traveling companion, Beaumont:

  I can’t tell you the disgust, contempt, and weariness caused me by the miserable, unproductive little combinations and agitations which still prevail here in what remains of the political world and which, fortunately without leading to any other action, produce a tangled skein of small intrigue … I sigh for my avenue of oaks and for the company of my cows.¹²

Tocqueville effectively left political society after the ascension of Napoleon III, spending the last eight years of his life in exile on his estate (and presumably, in the pleasant company of his oaks and cows). It was after this experience of disgust, contempt, and weariness that he wrote _The Old Regime_ (1856), and here his cynicism certainly shines through. But _Democracy_ is another story. In chronicling democracy, Tocqueville does not express the kind of unbridled joy that many today attribute to him. Nor does he marvel at the potential greatness of equality. Democracy and equality can take us far from liberty and therefore should be feared and, if possible, counterbalanced. As he traveled around the New World, Tocqueville wrote in his notebook that “an entirely democratic government is a machine so dangerous, _even in America_, that it has been necessary to take a host of precautions against the mistakes and passions of democracy.”¹³

But in making Tocqueville a man of the mind—engaged above all in debates among writers of the day—Jaume neuters the excitement and experience of a 26-year-old Frenchman traveling through a radically new world. Gone are the letters home that convey wonder; gone are the passages that suggest an enthusiasm and eagerness for what might come; gone is anything about the adventure that isn’t directly related to France. Only the older, jaded French political figure of Tocqueville remains. You might call mine a typically American optimism and exuberance about the Tocqueville of _Democracy_. So be it. Jaume’s brilliant book has taught me an important lesson: _Democracy in America_ could never have been written without the vibrant intellectual context that was 19th-century France. But in the end we Americans are left to remind him of the global mash-up our nation represents, and to say to him: neither could it have been written without the place that was America. [icon]

question: What age transformed Europe and the New World?

answer: The revolutionary age.

question: What are the author's thoughts on France?

answer: France would be the second country he wants to live in after America.

question: Who is Alexis de Tocqueville?

answer: He is a French aristocrat who wrote "Democracy in America."

question: What were Tocqueville’s early thoughts on America as a country?

answer: He thought America held great promise but had some ways to go before it could become a moral society. He also condemned the treatment of slaves and the separation of the races.

question: Write a ~2 sentence summary.

answer: The author shares his thoughts about Alexis de Tocqueville's early life as a French aristocrat who visits America to study the prison system. He talks about Tocqueville's book "Democracy in America" and what the Frenchman said about America holding great promise but has a long way to go before it becomes a moral society, due to the treatment of slaves and separation of the races.


split: train

text:
_A GOOD NIGHT IN THE GHETTO_ is the debut mixtape by American rapper and singer Kamaiyah.[1] It was released on March 14, 2016.[2] The production is handled by Drew Banga, CT Beats, DJ Official, Trackademicks, WTF Nonstop, Link Up, 1-O.A.K., and P-Lo.[3] “F*ck It Up” features a guest appearance from fellow rapper YG.[4]

Kamaiyah stated that she “wanted to make a soundtrack for the average 18-25 year old thriving, living and having a good time”.[5] She said, “I feel like a lot of music nowadays is hella dark, and I didn't want to make a project that was dark.”[6]

Music videos were created for “Out the Bottle”,[7] “How Does It Feel”,[8] “For My Dawg”,[9] “F*ck It Up”,[10] “Mo Money Mo Problems”,[11] “I'm On”,[12] and “Freaky Freaks”.[13]

_Complex_ placed it at number 21 on the “50 Best Albums of 2016” list.[14] _Pitchfork_ placed it at number 47 on the “50 Best Albums of 2016” list.[15] _Rolling Stone_ placed it at number 17 on the “40 Best Rap Albums of 2016” list.[16] _The Guardian_ named it one of the 15 best mixtapes of 2016.[17]

Track listing

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

title: A Good Night in the Ghetto

question: Whose mixtape was A good Night in the Ghetto?

answer: American rapper and singer Kamaiyah

question: What were some of the mixtape's accolades?

answer: Complex placed it at number 21 on the "50 Best Albums of 2016" list. The Guardian named it one of the 15 best mixtapes of 2016.

question: What magazines are mentioned in this article?

answer: Complex and Rolling Stone

question: What did Kamaiyah have to say about her mixtape?

answer: She said she "wanted to make a soundtrack for the average 18-25 year old thriving, living and having a good time"

question: Name a song on the album that had a music video.

answer: "Mo Money Mo Problems"

question: Write a ~1 sentence summary.

answer: This article discusses American rapper and singer Kamaiyah's 2016 debut mixtape A Good Night in the Ghetto.


text:
_THE ONE THAT YOU LOVE_ is the sixth album by Australian soft rock band Air Supply, released in 1981. The album became their most famous and successful in their career. It reached No. 10 in the US _Billboard_ 200[1] album chart and contained three top 5 hits: “The One That You Love” (#1), “Here I Am (Just When I Thought I Was Over You)” (#5) and “Sweet Dreams” (#5).[2]

Overview

The album was released after their major success with their previous album, _Lost in Love_, and multiplied the band's popularity through the first period of the 1980s. Production was carried out by Clive Davis. The single, “The One That You Love”, became the band's first and only No. 1 hit. “Here I Am (Just When I Thought I Was Over You)” reached No. 5 in the US charts, being closely related to the style of Barry Manilow, one of the band's influences.[3] The third single of the album was “Sweet Dreams”. Beside the singles, the track “I'll Never Get Enough of You” was used as the main theme of a Japanese TV novel, and became a hit in Asia.[4] This was their first entry into any Asian chart.

Track listing

All songs written by Graham Russell, except where noted.

Personnel

-   Russell Hitchcock – vocals
-   Graham Russell – vocals, acoustic guitar
-   Rex Goh – acoustic guitar, electric guitar
-   David Moyse – acoustic guitar, electric guitar[5]
-   Frank Esler-Smith – keyboards, orchestral arrangements and conductor
-   Dave Green – bass
-   Ralph Cooper – drums

Production

-   Executive Producer – Clive Davis
-   Produced, Engineered and Mixed by Harry Maslin
-   Assistant Engineer – Neil Rawle
-   Mix Assistant – Jon Van Nest
-   Mastered by Chris Bellman
-   Recorded at Paradise Studios (Sydney, Australia).
-   Mixed and Mastered at Allen Zentz Recording (Hollywood, CA).
-   Art Direction – Howard Fritzon and Ria Lewerke-Shapiro
-   Photography – Leon Lecash and Guy Maxwell
-   Logo – Ray Barber

Charting History

Album

+-----------------------------------+-----------------------------------+
| Chart (1981-1982)                 | Peak                              |
|                                   | position                          |
+===================================+===================================+
| Australian Chart                  | 10                                |
+-----------------------------------+-----------------------------------+
| Canada                            | 21                                |
+-----------------------------------+-----------------------------------+
| 'U.S.' Billboard 200              | 10                                |
+-----------------------------------+-----------------------------------+

Charting Singles

{{ Singles discography | charts=6 | include_footnote = yes | chartA = AUS KMR | chartB = NZ
| chartC = US
Hot
| chartD = US
AC
| chartE = CAN Hot
| chartF = CAN AC
| title1= The One That You Love | year1 = 1981 | yearspan1 = 3 | peak1A = 10 | peak1B = 26 | peak1C = 1 | peak1D = 2 |peak1E = 2 | |peak1F = 3 | title2 = Here I Am | peak2A = 43 | peak2C = 5 | peak2D = 1 |peak2E = 4 |peak2F = 5 | title3 = I'll Never Get Enough of You | peak3A = | peak3B = | peak3C = | peak3D = | peak3E = | peak3F =

}}

[1] Top Music Charts: Hot 100: Billboard 200 URL accessed December 8, 2008

[2]

[3]

[4] Russell, Graham. _Forever Love: 36 Greatest Hits (1980–2001)._ 2003.

[5] Air Supply- _The One that You Love_ @Discogs.com Retrieved 2-19-2011.

title: The One That You Love (album)

question: What kind of songs does the band Air Supply write?

answer: They write love songs. The titles of these songs such as "The One That You Love" and "Here I Am (Just When I Thought I Was Over You)" confirm it. The style of the band was influenced by Barry Manilow, a famous pop artists who wrote love songs.

question: Describe the success of the album "The One That You Love."

answer: The single became the bands first No. 1 hit, and "Here I Am (Just When I Thought I Was Over You)" reached No. 5 in the US charts. "I'll Never Get Enough of You" was used for a Japanese telenovela and became a hit in Japan. This was their first entry into an Asian chart.


text:
“Remember how Mom told us we would grow up into men who would change the world. I believed her. I still do.” I looked out the window, ignoring Hugo. Everything was grey outside. Ya, it was winter alright. This place is too damn cold. Turn up the fucking heater Nurse.
“Mario.” God his voice is so annoying. Sounds like the spoiled pomeranian bitch that old geezer neighbor owns.
“Mario!”
“Shut the fuck up!” The doctor down the hall snapped his head up. Thought I said that in my head. Hugo’s upper lip shriveled a bit. There were no words for minutes. Why is it that every single time I retort back to the cunt in a “non-suitable” way, he starts crying. Pussy.
“I’m going to the cafeteria.” He was looking down at the tile, which, honest to God, looks like a mirror. If it’s one thing I could talk good about this joint, it’s that they make sure this place is spotless. I was making my way down the hall, looking down, admiring the tile when the nurse and I exchanged shoulders.
“Oops! I’m sorry.” she said in a shallow voice. She seemed out of breathe.
“Ya...my bad.”
Her smile was very subtle, but promising. Her lips were pale. They stood out against her red hair. She needs to put a comb through that mess.
“Your mom’s glucose levels are returning to normal.”
I gave her a cold stare. Why? I don’t know. I was toxic.
“That’s... good?”
She nodded, only to catch her head halfway.
“It’s an improvement Mario, the coma hasn’t improved though.”
I turned and walked down the hall without saying another word. Fuck that nurse anyway. I looked out the windows of the corridor leading to the commons. Still grey outside. Another night of rain it seemed like. Great.
Chatter rose, the intercom continued to echo, and the busy hall of the hospital was filled with doctors, patients, family, and everyone in between. Same old shit. Doctor talk and prayers.
“Change the world my ass” I said under my breathe.
Then out of the corner of my eye, I heard wheels screeching. A high speed chase in a hospital? This I got to see. When I turned my head, I saw an older woman being wheeled down the hall on a stretcher.
“Move! Move! Out of the way! Out of the way!” yelled the nurse wheeling her. I shimmied over to the wall. I peered over to the woman on the stretcher as she passed by a hundred miles an hour. Her skin was lifeless, her eyes looking toward the ceiling, absent of blinking. My heart dropped. I looked down the hall back where I ran into the nurse, I saw a boy, twelve or thirteen, gasping for air, crying uncontrollably. He was all alone. No parents, no adults. Maybe that was his...Mom. He followed the stretcher into the room, only to be blocked by the doctor. That was his mom. She has his eyes.
“This way champ. Don’t worry your mom...will...” a pearl streamed down the doctors cheek. The boy noticed, and his face instantly filled with grief. The doctor grabbed the boys wrist, and wiped the tear with the other, trying to hide it. He took the boy through a door just a few doors down where the woman went in. “
Is she go..going...to...”
He started bawling like a loose fire hydrant. He sounded like he was being tortured. The door shut. I lost my appetite.
“Code red, room 13B, repeat code red!” the intercom belted. An army of doctors ran into the room where the woman was held. Yells erupted in the room, but the door slammed shut, leaving the hall in an eerie silence.
 I looked at Hugo down the hall. He was still looking down at the mirrored floor, his jet black hair obvious amongst the grey clouds through the window.
“Hugo! Hugo!” He looked my way. I beckoned. He got up, and came running. He smiled instantly when he caught up. My heart warmed. “Let’s get some food man, you’ve been here for days.”
“Fuck cafeteria food Mario.” We chuckled.
“Let’s get some dogs. I know a place.” We both smiled. God it’s been years since that’s happened.
“It’s on you bro, after all you are the lawyer.” I punched him, he flinched, and I wrapped my arm around him, and put him in a headlock.
“I love you man.” I said.  We walked down the hall, leaving the chaos of this hell-ridden institution behind. Mom would have loved to see us together like this.

title: "Grey" [778 words, critique welcomed]

question: Why does Hugo cry?

answer: He cries from concern for his mother and at the blunt way his brother talks to him.

question: What happens to Mario's mother?

answer: She remains comatose.

question: To what does the title refer?

answer: 'Grey' refers to the weather as well as the general downcast tone of the story.

question: What is the story’s genre?

answer: Contemporary drama.

question: Who are the major characters?

answer:
Mario, a lawyer.
Hugo, Mario's more emotional brother.
Hugo and Mario's comatose mother.
A red-haired nurse working with their mother.

question: Write a ~3 sentence summary.

answer: Mario, a lawyer, and Hugo, his brother, are in the hospital, visiting their comatose mother. A red alert sounds and a boy cries for his deceased mother. Mario and Hugo go out for hot dogs, thinking their mother would love to see them together like this.


text:
It had been 511 days. 511 days since the sky was sundered by the deepest, purest black you can imagine.

For a time, we panicked. We screamed, we cried, we were sure the time had come for humanity to be cleansed from the face of the Earth.

But after 63 days of nothing... no sound, no light... nothing... after the panic started to quell, after the fear faded, and the curiosity began to flood through... so did they.

The death they brought was beyond devastating, beyond catastrophic, beyond cataclysmic. 1.1 billion estimated people in the first day. After day 2, no one could keep count.

As we became more scarce, harder to find, they became more desperate. It was like they were driven by nothing more than their need to kill.

They did not consume. No, they needed no fuel, no sustenance and no rest. They made it clear from the very beginning, their sole desire, their sole purpose was to kill.

They did not relish the suffering of their victims, they killed quickly and quietly. They killed not because they wanted to, but because they *needed* to. It was a compulsion more gripping than any addiction. More engulfing than any obsession, and more powerful than any bullet, shell or bomb.

After 448 days, there were only a handful of us left. We didn't band together, didn't try to retain any dignity or civilisation. We behaved like what we were; scared beasts hiding from the hunters.

They didn't speak, they defied all description and explanation, but we had to call them something, so we decided 'Hunters' would have to do.

We learned quickly that, no matter how desperate they became, they didn't go underground. They would level 5-storey houses with their hands, so your basement would not keep you safe, but they wouldn't even approach subway tunnel entrances. Of course, after a month, there was no power... anywhere. So the tunnels were black, night and day.

Now with no humans to keep them out, the animals with the sense to hide did just that. And what better hiding place than a deep dark hole?

A deep dark hole swarming rats, dogs, and... if you were *really* unlucky... Charlie.

I know exactly how little I have told you about the Hunters, and the reason is simple. If you've seen one, you are no longer alive. But Charlie...

There is no sequence of words that can adequately express what Charlie was.

He was a paragon of everything that should be feared in a beast. He was tall, he was strong, he was fast-moving and fast-thinking, and most of all, he ate what he killed.

He colonised almost 10 miles of track, and no other living thing would set foot on his land. Those that tried, became a corpse, then meat, then gone.

Charlie dwelled in the tunnels by day, but when the sun went down, that's when he became an artist.

He could feel Hunters a mile away. Not see, or hear, or smell them... but when one was near, he just... knew.

Some tried to fight the Hunters with guns, some even tried with knives... but not Charlie. No, Charlie abhorred tools. Charlie used to say that 'if you can't kill it with your hands, you don't deserve it'.

And he followed this creed to the letter.

He would pull hunters apart with nothing more than his fingers. But what was truly beautiful, is what he did with them afterwards.

Charlie would take them back to the tunnels, skin, butcher, cook and eat them... but not all of them.

Every one, he saved one thing... a finger, a rib, a tooth... and one day, he had a Hunter. Well, more accurately, he had a skeleton held together with nails and duct tape, covered in dripping, festering skin.

But what he did with this harrowing scarecrow he created, is truly the most beautiful thing about Charlie.

One morning, Charlie dragged his new doll up the escalator, into the sunshine, laid it out flat on the ground... and began to scream.

He must have screamed for hours. Screamed so hard, so loud and so long, his lungs bled and his throat tore. But not before his cries were heard.

The hunters showed up moments later, but wouldn't attack.

They'd never seen something of this world kill one of them. They were afraid.

Charlie knew they were afraid, and what he chose to do about it was quite spectacular. He put his right hand into the throat of the Frankenstein's monster beside him, and, without looking, took out the heart of the creature, dropped it on the ground beside him, raised his right leg, and reduced the Hunter's heart to viscera.

For the first time since they landed, they spoke. But they did not say a word. They did not grieve for their fallen comrade, that made no threats, they spoke in a language of shrieks and squawks, and terror is universal.

Never have you seen so many monsters turn tail and flee for their lives so swiftly... and Charlie smiled to himself.

He dragged his sacrificial lamb back to the mouth of his lair, but this time, did not take it inside. In stead, he pulled a steel cable from his pocket, and threw it over the sign above the staircase.

He took one end, wrapped it around the feet of his prize, took the other, and yanked down hard, launching it high into the air.

Then he tied off the loose end to a fire hydrant, and, without a word, slinked back off to his pitch-dark fortress.

title: [SF] Charlie

question: What does the story say about what planet the aliens came from?

question: What does the story say about the alien attack on earth?

answer: The story begins 511 days since the aliens somehow blocked out the sun and created a sky that was the deepest, purest black imaginable. After 63 days, when the collective panic and fear of humanity died down, the aliens attacked. They managed to kill an estimated 1.1 billion people on the first day. No one could keep count anymore after day two. After 448 days, only a handful of humans were left and they were forced to live underground because it was the one place the aliens would not go.

question: What does the story say about the invading aliens?

answer: The aliens or 'Hunters' as coined by the human survivors, had some sort of weapon that brought pitch black darkness to the world when they arrived. They did not consume what they killed, nor did they need fuel, sustenance, or rest. Their sole purpose was to kill all life on the planet and managed to wipe out 1.1 billion people on the first day. The Hunters didn't kill for sport or relish the suffering of their victims because they killed quickly and quietly. They were driven to kill, a compulsion more gripping than any addiction, and they grew desperate when humans became scarcer and harder to find. The Hunters seem to have an aversion for going underground (subway tunnels) and didn't follow the remaining humans down no matter how desperate they were.

question: What does the story say about Charlie?

answer: Charlie is a tall, strong, agile, and fast-moving human who adapted to living underground in darkness. He doesn't discriminate and kills both animals and humans who trespass in the 10-mile track he colonized. Unlike Hunters, Charlie always eats what he kills and he doesn't use weapons of any kind, choosing to rely on his bare hands. Charlie stays in the tunnels by day, but when the sun goes down, he goes above ground to kill Hunters. He developed the ability to 'feel' Hunters from a mile away and knows when they are near. Charlie created a scarecrow made from different parts of dead Hunters, including festering skin. He used the scarecrow to show that he can kill the Hunters, which terrified them and made them turn tail and flee.


text:
[Skip to Content Landing]
Figure.  Association Between Physician Sex and Patient Outcomes by Expected Mortality Rates

[Association Between Physician Sex and Patient Outcomes by Expected Mortality Rates]

A, Adjusted 30-day mortality rates. B, Adjusted 30-day readmission rates. Risk-adjusted mortality rates were calculated with additional adjustment for physician characteristics and with hospital fixed effects (model 3). Standard errors were clustered at the physician level.
a_P_ < .05.
b_P_ < .001.

Table 1.  Physician and Patient Characteristics, by Physician Sexa

[Physician and Patient Characteristics, by Physician Sexa]

Table 2.  Association Between Physician Sex and 30-Day Patient Mortality and Readmissions

[Association Between Physician Sex and 30-Day Patient Mortality and Readmissions]

Table 3.  Association Between Physician Sex and 30-Day Patient Mortality by Condition

[Association Between Physician Sex and 30-Day Patient Mortality by Condition]

Table 4.  Association Between Physician Sex and 30-Day Patient Readmissions by Condition

[Association Between Physician Sex and 30-Day Patient Readmissions by Condition]

February 2017

JAMA Intern Med. 2017;177(2):206-213. doi:10.1001/jamainternmed.2016.7875

_visual abstract icon_ _editorial comment icon_ _author interview icon_
Interviews

_multimedia icon_
Multimedia

-

    Comment & Response

    Limitations Concerning Physician Sex and Patient Outcomes

    David M. Maslove, MD, MS, FRCPC

-

    Comment & Response

    Limitations Concerning Physician Sex and Patient Outcomes

    Filipe Prazeres, MD, MSc

-

    Comment & Response

    Limitations Concerning Physician Sex and Patient Outcomes

    Matthew J. Hayat, PhD; Thomas R. Knapp, EdD

-

    Comment & Response

    Limitations Concerning Physician Sex and Patient Outcomes

    Ritam Chowdhury, MBBS, MPH, PhD, SM; Abhishek R. Payal, MBBS, MPH

-

    Comment & Response

    Limitations Concerning Physician Sex and Patient Outcomes

    Mark W. Friedberg, MD, MPP; Walid F. Gellad, MD, MPH; Vinay Prasad, MD, MPH

-

    Comment & Response

    Limitations Concerning Physician Sex and Patient Outcomes—Reply

    Yusuke Tsugawa, MD, MPH, PhD; Anupam B. Jena, MD, PhD; Ashish K. Jha, MD, MPH

Audio Author Interview (6:14)

 Key Points

QUESTION  Do patient outcomes differ between those treated by male and female physicians?

FINDINGS  In this cross-sectional study, we examined nationally representative data of hospitalized Medicare beneficiaries and found that patients treated by female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital.

MEANING  Differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.

IMPORTANCE  Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown.

OBJECTIVE  To determine whether mortality and readmission rates differ between patients treated by male or female physicians.

DESIGN, SETTING, AND PARTICIPANTS  We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014. We examined the association between physician sex and 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects (effectively comparing female and male physicians within the same hospital). As a sensitivity analysis, we examined only physicians focusing on hospital care (hospitalists), among whom patients are plausibly quasi-randomized to physicians based on the physician’s specific work schedules. We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness.

MAIN OUTCOMES AND MEASURES  Patients’ 30-day mortality and readmission rates.

RESULTS  A total of 1 583 028 hospitalizations were used for analyses of 30-day mortality (mean [SD] patient age, 80.2 [8.5] years; 621 412 men and 961 616 women) and 1 540 797 were used for analyses of readmission (mean [SD] patient age, 80.1 [8.5] years; 602 115 men and 938 682 women). Patients treated by female physicians had lower 30-day mortality (adjusted mortality, 11.07% vs 11.49%; adjusted risk difference, –0.43%; 95% CI, –0.57% to –0.28%; _P_ < .001; number needed to treat to prevent 1 death, 233) and lower 30-day readmissions (adjusted readmissions, 15.02% vs 15.57%; adjusted risk difference, –0.55%; 95% CI, –0.71% to –0.39%; _P_ < .001; number needed to treat to prevent 1 readmission, 182) than patients cared for by male physicians, after accounting for potential confounders. Our findings were unaffected when restricting analyses to patients treated by hospitalists. Differences persisted across 8 common medical conditions and across patients’ severity of illness.

CONCLUSIONS AND RELEVANCE  Elderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists. These findings suggest that the differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.

There is evidence that men and women may practice medicine differently. Literature has shown that female physicians may be more likely to adhere to clinical guidelines,1-3 provide preventive care more often,4-11 use more patient-centered communication,12-15 perform as well or better on standardized examinations,¹⁶ and provide more psychosocial counseling to their patients than do their male peers.¹⁴ Although studies suggest differences in practice patterns and process measures of quality between male and female physicians, these studies have not examined patient outcomes, what we arguably care about the most. In fact, whether patient outcomes differ between male and female physicians is largely unknown.

Female physicians now account for approximately one-third of the US physician workforce¹⁷ and comprise half of all US medical school graduates.¹⁸ Despite evidence suggesting that female physicians may provide higher-quality care,1-4,7,8,10,12-16 some have argued that career interruptions for childrearing, higher rates of part-time employment, and greater tradeoffs between home and work responsibilities¹⁹ may compromise the quality of care provided by female physicians and justify higher salaries among male physicians.20-22 Therefore, empirical evidence on whether patient outcomes differ between male and female physicians is warranted.

In this context, using a national sample of Medicare beneficiaries hospitalized with medical conditions, we sought to investigate 3 key questions. First, are there important differences in clinical outcomes for hospitalized patients cared for by female internists compared with those treated by male internists? Second, does the influence of physician sex on patient outcomes differ across a variety of conditions for which patients are commonly hospitalized? Finally, do these differences in outcomes vary with the underlying severity of a patient’s illness?

This study was approved by the Harvard Medical School Institutional Review Board and patient consent was not required.

We analyzed a 20% sample of the Medicare Inpatient and Carrier Files to identify Medicare fee-for-service beneficiaries 65 years or older who were hospitalized in acute care hospitals from January 1, 2011, through December 31, 2014. Our study population was restricted to patients who were hospitalized owing to medical conditions as defined by the presence of a medical diagnosis–related group (Medicare Severity Diagnosis Related Group). To allow for sufficient follow-up, patients admitted in December 2014 were excluded from the analyses of 30-day mortality. Patients discharged in December 2014 and patients who were out of the hospital for fewer than 30 days at the time of admission were excluded from the analyses of 30-day readmission. Patients who were transferred between acute care hospitals had their hospital stays combined into a single episode of care, with the patient outcome attributed to the first hospitalization.23,24 We restricted our sample to nonelective hospitalizations. We also excluded patients who left against medical advice.

We assigned each hospitalization to a physician based on the National Provider Identifier in the Carrier File that accounted for the largest amount of Medicare Part B spending during that hospitalization.²⁵ Part B spending comprises professional and other fees determined by the physician. On average, these physicians were responsible for 51.1% of total Part B spending for a given hospitalization. We restricted our analyses to hospitalizations for which the physicians with the highest amount of Part B spending were general internists to avoid comparing physicians across different specialties. Physician data, including physician age, were obtained by linking the Medicare data with a comprehensive database of US physicians assembled by a company that provides online networking services for US physicians (Doximity; https://www.doximity.com/) through data partnerships, including the American Board of Medical Specialties, state licensing boards, and collaborating hospitals and medical schools.26,27

We accounted for patient characteristics, physician characteristics, and hospital fixed effects. Patient characteristics included patient age in 5-year increments (the oldest group was categorized as ≥95 years), sex, race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other), primary diagnosis (Medicare Severity Diagnosis Related Group), 27 coexisting conditions (determined using the Elixhauser comorbidity index²⁸), median annual household income estimated from residential zip codes (in deciles), an indicator variable for Medicaid coverage, and indicator variables for year. Physician characteristics included physician age in 5-year increments (the oldest group was categorized as ≥70 years), indicator variables for the medical schools from which the physicians graduated, and type of medical training (ie, allopathic vs osteopathic²⁹ training).

We first examined the association between physician sex and 30-day mortality (whether patients died within 30 days of the admission date) and 30-day readmissions (whether patients were readmitted within 30 days of the discharge date) by using 3 regression models. Model 1 compared patient outcomes (mortality and readmissions) between male and female physicians, adjusting for patient characteristics. Model 2 adjusted for all variables in model 1 plus hospital fixed effects (ie, hospital indicators), effectively comparing male and female physicians within the same hospital.³⁰ Model 3 adjusted for all variables in model 2 plus physician characteristics, to evaluate if the differences in patient outcomes between male and female physicians could be explained by other physician characteristics that are correlated with physician sex. We used a multivariable linear probability model30,31 (ie, fitting ordinary least-squares to binary outcomes) as our primary model for computational efficiency and because there were problems with complete or quasi-complete separation in logistic regression models. To account for potential correlation between patient outcomes within the same physician, SEs were clustered at the physician level. After fitting regression models, we calculated adjusted patient outcomes using the marginal standardization form of predictive margins.³²

Next, we assessed whether differences in patient outcomes between male and female physicians differed according to the primary condition for which a patient was admitted. We evaluated the 8 most common medical conditions treated by general internists, according to the Medicare data: sepsis, pneumonia, congestive heart failure, chronic obstructive pulmonary disease, urinary tract infection, acute renal failure, arrhythmia, and gastrointestinal bleeding. A list of _International Classification of Diseases, 9th Revision_, codes is available in eTable 1 in the Supplement.³³

Finally, we assessed whether differences in outcomes between male and female physicians varied according to illness severity. We used a logistic regression model with 30-day mortality as an outcome, and the patient-level adjustment variables listed above as explanatory variables to determine each patient’s likelihood of death. Within each quintile of expected mortality, we then examined patient outcomes between male and female physicians, adjusting for patient and physician characteristics and hospital fixed effects.

Analysis of Potential Mechanisms

We explored potential mechanisms for observed differences between male and female physicians, including differences in length of stay, use of care, patient volume (number of hospitalized Medicare patients each physician treated annually), and discharge location of patients (home, skilled nursing facility, rehabilitation facility, hospice, or other). Use of care was measured by total Part B spending per hospitalization. Length of stay and use of care were used as continuous variables with quadratic and cubic terms, and patient volume was categorized into deciles. In addition, to address the possibility that physicians’ age may not fully account for the differences in clinical experience between female and male physicians, we further adjusted for physicians’ years in practice as measured by years since completion of residency. We did not include this variable in our main models because of collinearity with physicians’ age and because data were missing for 27 447 physicians (47.4%).

We conducted several sensitivity analyses. First, to address the possibility that female physicians may treat healthier patients, we restricted the study population to hospitalized patients treated by physicians who specialize in the care of hospitalized patients (hospitalists). Hospitalists typically work in shifts; therefore, within the same hospital, patients treated by hospitalists are plausibly quasi-randomized to a given physician based on when patients become sick and based on hospitalists’ work schedule.³⁴ We defined hospitalists using a validated approach: general internists who filed at least 90% of their total evaluation and management billings in an inpatient setting.³⁵ Second, to evaluate whether our findings were sensitive to how we attributed patients to physicians, we tested the following 2 alternative attribution methods: attributing patients to physicians who had the largest number of evaluation and management claims and attributing patients to physicians who billed the first evaluation and management claim for a given hospitalization.25,36,37 Third, within some hospitals, male internists may be more likely to work in intensive care units and have severely ill patients. To address this issue, we reanalyzed our data after excluding hospitals with a medical intensive care unit. Fourth, to test whether our findings were sensitive to follow-up periods for measuring patient outcomes, we used 60-day mortality and readmissions instead of 30-day patient outcomes. Fifth, we modeled physician and patient age as continuous rather than categorical variables with quadratic and cubic terms to allow for nonlinear associations. Finally, we used logistic regression models instead of linear probability models.

Data preparation was conducted using SAS, version 9.4 (SAS Institute), and analyses were performed using Stata, version 13 (StataCorp). Additional details are provided in the eAppendix in the Supplement.

Characteristics of Female and Male Physicians

During the study periods, 58 344 general internists treated at least 1 Medicare beneficiary who was hospitalized with a medical condition (Table 1). Among those, 18 751 physicians (32.1%) were female. Female physicians were younger (mean [SD] age, 42.8 [9.4] vs 47.8 [11.4] years), were more likely to have undergone osteopathic training (1577 [8.4%] vs 2770 [7.0%]), and treated fewer patients (131.9 vs 180.5 hospitalizations per year) compared with male physicians. Patient characteristics were similar between those treated by female physicians vs those treated by male physicians, with 1 modest exception: female physicians treated slightly higher proportions of female patients than male physicians did (258 091 [62.1%] vs 722 038 [60.2%]). We also found that female physicians were more likely to work in large (7460 [41.9%] vs 13 628 [35.7%]), nonprofit (13 947 [78.2%] vs 28 850 [75.6%]), major teaching hospitals (5168 [29.0%] vs 8061 [21.1%]) located in the Northeast region (4746 [26.8%] vs 8574 [22.7%]) compared with male physicians (eTable 2 in the Supplement).

Physician Sex and Patient Mortality

The final sample for the analyses of 30-day mortality rates included 1 583 028 hospitalizations treated by 57 896 physicians. Overall 30-day mortality for the entire sample was 179 162 (11.32%). Patients cared for by female physicians had lower 30-day mortality than did patients treated by male physicians (10.82% vs 11.49%; risk difference [RD], –0.67%; 95% CI, –0.80% to –0.54%; _P_ < .001; number needed to treat [NNT] to prevent 1 death, 149) after accounting for patient characteristics (Table 2). The difference in mortality persisted after adjustment for hospital fixed effects (female physicians, 10.91% vs male physicians, 11.46%; adjusted RD, –0.55%; 95% CI, –0.67% to –0.42%; _P_ < .001; NNT, 182). Further adjusting for physician characteristics had a limited effect on these results (female physicians, 11.07% vs male physicians, 11.49%; adjusted RD, –0.43%; 95% CI –0.57% to –0.28%; _P_ < .001; NNT, 233).

Physician Sex and Patient Readmissions

The analyses of 30-day readmission rates included 1 540 797 hospitalizations treated by 57 876 physicians. The overall 30-day readmission rate for this sample was 237 644 (15.42%). Patients of female physicians had significantly lower readmission rates than those with male physicians, after accounting for patient characteristics (15.01% vs 15.57%; RD, –0.55%; 95% CI, –0.71% to –0.41%; _P_ < .001; NNT to prevent 1 readmission, 182) (Table 2). Adjusting for hospital fixed effects (female physicians, 15.00% vs male physicians, 15.57%; adjusted RD, –0.56%; 95% CI, –0.70% to –0.42%; _P_ < .001; NNT, 179) and further accounting for physician characteristics (female physicians, 15.02% vs male physicians, 15.57%; adjusted RD, –0.55%; 95% CI, –0.71% to –0.39%; _P_ < .001; NNT, 182) had little effect on these results.

Physician Sex and Patient Outcomes by Primary Diagnoses

Patients of female physicians had lower mortality and readmission rates across all medical conditions we examined, although the magnitude of the difference varied by condition and was not always statistically significant. Patients of female physicians had lower mortality for sepsis (23.05% vs 25.09%), pneumonia (10.11% vs 11.03%), acute renal failure (12.54% vs 13.30%), and arrhythmia (5.08% vs 6.02%) vs patients of male physicians; however, we did not observe a statistically significant difference in mortality for congestive heart failure (11.69% vs 11.95%), urinary tract infection (5.79% vs 6.11%), and gastrointestinal bleeding (9.70% vs 10.27%) (Table 3). Patients’ readmission rates were significantly lower for female physicians than male physicians for most of the conditions (Table 4).

Physician Sex and Patient Outcomes by Severity of Illness

The association between physician sex and patient outcomes was consistent across patients’ severity of illness (Figure, A and B). With regard to mortality, patients of female physicians had significantly lower mortality rates than did patients of male physicians in all subgroups except for patients in the second lowest quintile of expected mortality (eTable 3 in the Supplement). The interaction between physician sex and expected mortality of patients was statistically significant.

Readmission rates of patients were lower for female physicians than for male physicians for all subgroups except for the least sick patients. The interaction between physician sex and patient illness severity was not statistically significant.

Analysis of Potential Mechanisms

We found that additional adjustment for length of stay, use of care, discharge location, patient volume, or physicians’ years of practice did not affect our findings (eTable 4 in the Supplement).

We found similar patterns when we restricted our sample to patients treated by hospitalists (24 429 of 57 896 general internists [42.2%] were defined as hospitalists). Patients receiving care by female hospitalists had lower mortality and readmission rates compared with patients receiving care by male hospitalists (eTable 5 in the Supplement). Our findings were not qualitatively affected by attributing physicians according to evaluation and management claims (eTable 6 and eTable 7 in the Supplement), excluding hospitals with a medical intensive care unit (eTable 8 in the Supplement), using 60-day patient outcomes (eTable 9 in the Supplement), or modeling age as a continuous variable (eTable 10 in the Supplement). Our findings were also unaffected by estimating multivariable logistic regression models instead of linear probability models (eTable 11 in the Supplement). Patients treated by female physicians had 0.95 times the odds of death (95% CI, 0.93-0.97; _P_ < .001) and 0.96 time the odds of readmission (95% CI, 0.95-0.97; _P_ < .001) compared with patients cared for by male physicians.

We found that elderly patients receiving inpatient care from female internists had 30-day lower mortality and readmission rates compared with patients cared for by male internists. This association was consistent across a variety of conditions and across patients’ severity of illness. Taken together with previous evidence1-15 suggesting that male and female physicians may practice differently, our findings indicate that potential differences in practice patterns between male and female physicians may have important clinical implications for patient outcomes.

Our findings that female internists appear to have better outcomes for inpatient care than their male peers are consistent with results from prior studies of process measures of quality. There is evidence in the primary care setting suggesting that, compared with male physicians, female physicians are more likely to practice evidence-based medicine,³ perform as well or better on standardized examinations,¹⁶ and provide more patient-centered care.12-15 Patients of female primary care physicians also experience fewer emergency department visits compared with patients of male primary care physicians.³⁸ Data from other industries suggest that men may be less deliberate in their approach to solving complex problems.39-41 If these findings also apply to how male and female physicians approach clinical problems and decisions, these patterns of behavior may provide a plausible mechanism linking physician sex with patient outcomes.

Although the difference in patient mortality between male and female physicians was modest, an observed effect size of a 0.43-percentage point difference or a relative risk reduction of 4% in mortality is arguably a clinically meaningful difference. For context, there has been widespread recognition that patient outcomes have improved substantially during the past decade; all-cause mortality declined from 5.0% in 2003 to 4.5% in 2013 among Medicare beneficiaries.⁴² This reduction in mortality is recognized as the result of large national investments in innovation, new treatments, and quality improvement that allow us to treat patients better. The difference in mortality rates between patients of male and female physicians in our study was of a comparable magnitude. Furthermore, given that there are more than 10 million Medicare hospitalizations due to medical conditions in the United States annually and assuming that the association between sex and mortality is causal, we estimate that approximately 32 000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.⁴³ The effect would be even larger if the associations between physician sex and patient outcomes also hold for non-Medicare populations.

An important issue in interpreting our findings is whether they can be explained by differences in unmeasured severity of illness of patients treated by male vs female physicians. The inpatient setting, compared with the outpatient setting, offers a unique advantage when studying patient outcomes between male and female physicians: within a given hospital, there is plausibly less selection of the physician by the patient or of the patient by the physician. Although some patients choose their primary care physician, and sex of the physician may be a factor in making their decision, patients hospitalized urgently or emergently are less likely to select their physicians. We found that nearly all observable characteristics typically associated with illness severity were well balanced between female and male physicians. Even for hospitalist physicians, among whom patients are plausibly more likely to be randomly assigned, we found that patient characteristics were balanced between male and female physicians and that patients of female physicians continued to have lower patient mortality and readmission rates.

We are aware of only 1 other study examining the association between physician sex and patient mortality. Jerant and colleagues⁴⁴ analyzed a small cohort of relatively healthy outpatients (who are, in general, healthier than hospitalized patients) and found no associations between physician sex and patient mortality. However, several analyses investigating differences in processes of care between male and female physicians have yielded results that align with our findings. For instance, Kim et al¹ and Berthold et al² both found that female physicians outperform male physicians on process measures for patients with diabetes.

First, as is the case for any observational study, we could not fully account for unmeasured differences in the risk of death and readmissions between patients of male and female physicians. Although we addressed this issue in several ways, including the use of a natural experimental design exploiting the quasi-randomized assignment of patients to hospitalists, it is still possible that unmeasured confounding (eg, residual differences in socioeconomic status of patients that are not explained by patient race/ethnicity, Medicaid eligibility, and household income level) could explain the observed differences in patient outcomes. However, the residual confounding would have to be of substantial magnitude to explain the differences we found. Second, we were unable to identify exactly why female physicians have better outcomes than male physicians. Given that physician sex by itself does not determine patient outcomes, sex should serve as a marker of differences in practice patterns between male and female physicians that meaningfully affect patient outcomes. Further studies using clinical data would be helpful in understanding which practice patterns of physicians are driving the differences in patient outcomes. Third, we used self-reported data to identify physician sex, which requires respondents to categorize themselves as either male or female; therefore, we could not capture respondents who were transgender. It is possible that transgender physicians chose to either leave this question blank or select 1 of the 2 available categories, which may lead to a low degree of misclassification. Any misclassification in self-reported sex would likely bias our estimates toward the null. Finally, our analysis was limited to Medicare patients hospitalized with medical conditions treated by general internists. Thus, our findings may not be generalizable to surgical conditions, to patients treated by physicians of other specialties, or to outpatient care.

Using a national sample of hospitalized Medicare beneficiaries, we found that patients who receive care from female general internists have lower 30-day mortality and readmission rates than do patients cared for by male internists. These findings suggest that the differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes. Understanding exactly why these differences in care quality and practice patterns exist may provide valuable insights into improving quality of care for all patients, irrespective of who provides their care.

Back to top

Article Information

ACCEPTED FOR PUBLICATION: October 13, 2016.

CORRESPONDING AUTHOR: Yusuke Tsugawa, MD, MPH, PhD, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 42 Church St, Cambridge, MA 02138 (ytsugawa@hsph.harvard.edu).

PUBLISHED ONLINE: December 19, 2016. doi:10.1001/jamainternmed.2016.7875

AUTHOR CONTRIBUTIONS: Dr Tsugawa had full access to all 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:_ Tsugawa, Jena, Jha.

_Acquisition, analysis, or interpretation of data:_ All authors.

_Drafting of the manuscript:_ Tsugawa, Jena, Jha.

_Critical revision of the manuscript for important intellectual content:_ All authors.

_Statistical analysis:_ Tsugawa, Orav.

_Administrative, technical, or material support:_ Jha.

_Study supervision:_ Jena, Jha.

CONFLICT OF INTEREST DISCLOSURES: Dr Tsugawa reported being supported in part by St Luke’s International University. Dr Jena reported receiving consulting fees unrelated to this work from Pfizer Inc, Hill Rom Services Inc, Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics, a company providing consulting services to the life sciences industry. No other disclosures were reported.

FUNDING/SUPPORT: Dr Jena was supported by the Early Independence Award, grant 1DP5OD017897-01, from the National Institutes of Health.

ROLE OF THE FUNDER/SPONSOR: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

1.

Kim  C, McEwen  LN, Gerzoff  RB,  et al.  Is physician gender associated with the quality of diabetes care? _ Diabetes Care_. 2005;28(7):1594-1598.PubMedGoogle ScholarCrossref

2.

Berthold  HK, Gouni-Berthold  I, Bestehorn  KP, Böhm  M, Krone  W.  Physician gender is associated with the quality of type 2 diabetes care. _ J Intern Med_. 2008;264(4):340-350.PubMedGoogle ScholarCrossref

3.

Baumhäkel  M, Müller  U, Böhm  M.  Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study. _ Eur J Heart Fail_. 2009;11(3):299-303.PubMedGoogle ScholarCrossref

4.

Andersen  MR, Urban  N.  Physician gender and screening: do patient differences account for differences in mammography use? _ Women Health_. 1997;26(1):29-39.PubMedGoogle ScholarCrossref

5.

Frank  E, Dresner  Y, Shani  M, Vinker  S.  The association between physicians’ and patients’ preventive health practices. _ CMAJ_. 2013;185(8):649-653.PubMedGoogle ScholarCrossref

8.

Franks  P, Clancy  CM.  Physician gender bias in clinical decisionmaking: screening for cancer in primary care. _ Med Care_. 1993;31(3):213-218.PubMedGoogle ScholarCrossref

9.

Kruger  J, Shaw  L, Kahende  J, Frank  E.  Health care providers’ advice to quit smoking, National Health Interview Survey, 2000, 2005, and 2010. _ Prev Chronic Dis_. 2012;9:E130.PubMedGoogle Scholar

10.

Lurie  N, Slater  J, McGovern  P, Ekstrum  J, Quam  L, Margolis  K.  Preventive care for women: does the sex of the physician matter? _ N Engl J Med_. 1993;329(7):478-482.PubMedGoogle ScholarCrossref

11.

Smith  AW, Borowski  LA, Liu  B,  et al.  US primary care physicians’ diet-, physical activity-, and weight-related care of adult patients. _ Am J Prev Med_. 2011;41(1):33-42.PubMedGoogle ScholarCrossref

12.

Bertakis  KD, Helms  LJ, Callahan  EJ, Azari  R, Robbins  JA.  The influence of gender on physician practice style. _ Med Care_. 1995;33(4):407-416.PubMedGoogle ScholarCrossref

13.

Krupat  E, Rosenkranz  SL, Yeager  CM, Barnard  K, Putnam  SM, Inui  TS.  The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. _ Patient Educ Couns_. 2000;39(1):49-59.PubMedGoogle ScholarCrossref

14.

Roter  DL, Hall  JA, Aoki  Y.  Physician gender effects in medical communication: a meta-analytic review. _ JAMA_. 2002;288(6):756-764.PubMedGoogle ScholarCrossref

15.

Roter  DL, Hall  JA.  Physician gender and patient-centered communication: a critical review of empirical research. _ Annu Rev Public Health_. 2004;25:497-519.PubMedGoogle ScholarCrossref

16.

Ferguson  E, James  D, Madeley  L.  Factors associated with success in medical school: systematic review of the literature. _ BMJ_. 2002;324(7343):952-957.PubMedGoogle ScholarCrossref

17.

Kaiser Family Foundation. _ Distribution of Physicians by Gender_. Menlo Park, CA: Kaiser Family Foundation; 2016.

19.

Jolly  S, Griffith  KA, DeCastro  R, Stewart  A, Ubel  P, Jagsi  R.  Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. _ Ann Intern Med_. 2014;160(5):344-353.PubMedGoogle ScholarCrossref

20.

Seabury  SA, Chandra  A, Jena  AB.  Trends in the earnings of male and female health care professionals in the United States, 1987 to 2010. _ JAMA Intern Med_. 2013;173(18):1748-1750.PubMedGoogle Scholar

22.

Jagsi  R, Griffith  KA, Stewart  A, Sambuco  D, DeCastro  R, Ubel  PA.  Gender differences in the salaries of physician researchers. _ JAMA_. 2012;307(22):2410-2417.PubMedGoogle ScholarCrossref

23.

Ross  JS, Normand  SL, Wang  Y,  et al.  Hospital volume and 30-day mortality for three common medical conditions. _ N Engl J Med_. 2010;362(12):1110-1118.PubMedGoogle ScholarCrossref

24.

Drye  EE, Normand  SL, Wang  Y,  et al.  Comparison of hospital risk-standardized mortality rates calculated by using in-hospital and 30-day models: an observational study with implications for hospital profiling. _ Ann Intern Med_. 2012;156(1, pt 1):19-26.PubMedGoogle ScholarCrossref

25.

McWilliams  JM, Landon  BE, Chernew  ME, Zaslavsky  AM.  Changes in patients’ experiences in Medicare Accountable Care Organizations. _ N Engl J Med_. 2014;371(18):1715-1724.PubMedGoogle ScholarCrossref

26.

Jena  AB, Olenski  AR, Blumenthal  DM.  Sex differences in physician salary in US public medical schools. _ JAMA Intern Med_. 2016;176(9):1294-1304. PubMedGoogle ScholarCrossref

27.

Jena  AB, Khullar  D, Ho  O, Olenski  AR, Blumenthal  DM.  Sex differences in academic rank in US medical schools in 2014. _ JAMA_. 2015;314(11):1149-1158. PubMedGoogle ScholarCrossref

28.

Elixhauser  A, Steiner  C, Harris  DR, Coffey  RM.  Comorbidity measures for use with administrative data. _ Med Care_. 1998;36(1):8-27.PubMedGoogle ScholarCrossref

29.

Carey  TS, Motyka  TM, Garrett  JM, Keller  RB.  Do osteopathic physicians differ in patient interaction from allopathic physicians? an empirically derived approach. _ J Am Osteopath Assoc_. 2003;103(7):313-318.PubMedGoogle Scholar

30.

Wooldridge  JM. _ Econometric Analysis of Cross Section and Panel Data_. Cambridge, MA: MIT Press; 2010.

32.

Williams  R.  Using the margins command to estimate and interpret adjusted predictions and marginal effects. _ Stata J_. 2012;12(2):308-331.Google Scholar

34.

Hinami  K, Whelan  CT, Miller  JA, Wolosin  RJ, Wetterneck  TB; Society of Hospital Medicine Career Satisfaction Task Force.  Job characteristics, satisfaction, and burnout across hospitalist practice models. _ J Hosp Med_. 2012;7(5):402-410.PubMedGoogle ScholarCrossref

35.

Kuo  YF, Sharma  G, Freeman  JL, Goodwin  JS.  Growth in the care of older patients by hospitalists in the United States. _ N Engl J Med_. 2009;360(11):1102-1112.PubMedGoogle ScholarCrossref

36.

McWilliams  JM, Hatfield  LA, Chernew  ME, Landon  BE, Schwartz  AL.  Early performance of accountable care organizations in Medicare. _ N Engl J Med_. 2016;374(24):2357-2366.PubMedGoogle ScholarCrossref

37.

Adams  JL, Mehrotra  A, Thomas  JW, McGlynn  EA.  Physician cost profiling—reliability and risk of misclassification. _ N Engl J Med_. 2010;362(11):1014-1021. PubMedGoogle ScholarCrossref

38.

Dahrouge  S, Seale  E, Hogg  W,  et al.  A comprehensive assessment of family physician gender and quality of care: a cross-sectional analysis in Ontario, Canada. _ Med Care_. 2016;54(3):277-286.PubMedGoogle ScholarCrossref

42.

Krumholz  HM, Nuti  SV, Downing  NS, Normand  SL, Wang  Y.  Mortality, hospitalizations, and expenditures for the Medicare population aged 65 years or older, 1999-2013. _ JAMA_. 2015;314(4):355-365.PubMedGoogle ScholarCrossref

43.

Weiss  AJ, Elixhauser  A. Overview of hospital stays in the United States, 2012. HCUP Statistical Brief #180. Rockville, MD: Agency for Healthcare Research and Quality; October 2014.

44.

Jerant  A, Bertakis  KD, Fenton  JJ, Franks  P.  Gender of physician as the usual source of care and patient health care utilization and mortality. _ J Am Board Fam Med_. 2013;26(2):138-148.PubMedGoogle ScholarCrossref

Purchase access

Buy this article and get unlimited access and a printable PDF ($30.00) - Sign in or create a free account

Sign in to download free article PDFs

Get free access to newly published articles

Create a personal account or sign in to:

-   Register for email alerts with links to free full-text articles
-   Access PDFs of free articles
-   Manage your interests
-   Save searches and receive search alerts

Get free access to newly published articles.

Purchase access

Buy this article and get unlimited access and a printable PDF ($30.00) - Sign in or create a free account

Purchase access

Subscribe to JN Learning for one year

Get free access to newly published articles

Create a personal account or sign in to:

-   Register for email alerts with links to free full-text articles
-   Access PDFs of free articles
-   Manage your interests
-   Save searches and receive search alerts

question: What did the research find?

answer: Elderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists.

question: What was the research sample?

answer: We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition.

question: Over what period were the samples collected?

answer: from January 1, 2011, to December 31, 2014.

question: Why do patients treated by female internists have lower mortality and lower readmissions?

answer: The study suggests that there is evidence that men and women may practice medicine differently.

question: Write a ~1 sentence summary.

answer: This is a research paper on the association between physician sex and patient outcomes by expected mortality rates.


text:
Hey readers (and writers) of Short Stories! This is my first post, and frankly, my first piece of writing (other than school) that I put a decent amount of time into. I'm just wondering what you guys think! Be honest, I want to improve. And yes, for the record, this is all true. EDIT: Sorry for my title being so similar to another post from a few hours earlier, I didn't even realize until after I posted!

The Midst of the Night

   As one slowly fades to two, my mind runs a marathon. As with a marathon, it is both painful and rewarding; remembering what was, imagining what could have been. A bittersweet river of emotions that I wish would end, but know will run on. Why must you do this to me?
The end is no fault of yours, really. Just fate. A cruel hand was dealt, and I had already pushed all my chips to the center. Did you? I long to know the answer, but also hope to never know. If you feel like I do, just show me a sign. Anything. But you won’t. Who’s to say you don’t have the same sleepless nights? You might. But my suspicion is you don’t. And knowing that for sure is a thousand times worse than not knowing.

   I try to recreate the past- mostly arguments. Why couldn’t they have ended better? Either way, they mean little that isn’t why it’s over. They are just a painful remainder of a mostly happy time. I was always the bad guy, you never did any wrong, yet I always just agreed. I was blinded by love. Now that the rose colored glasses are gone, I realize that isn’t true. My feelings are equal to those of everyone else.

   I create future conversations knowing all too well that they will never occur. Or if they do, not as well as in my head. I’m not as smooth a talker as I am a thinker, and while I know you well, you responses are unpredictable.

   The rational majority of my mind knows this needs to happen, and better now than later. Yet the small romantic area still aches. Each day I try to convince myself it’s fine. It’s an argument I have trouble winning. Must you convince yourself? Or had you long ago conquered that small voice of anti-reason lurking through your consciousness? That’s another thing it might be better not to know.

   Do you even care about me? Your words sound so, but your actions reek with apathy. If actions speak louder than words, your sentence of investment has been drowned out by the manifesto of disregard. I’m but an old newspaper: interesting at one time, now tossed in the corner, only to be glanced at occasionally. I pray that it is but a figment of my negative imagination.

   I know in time, all this will fade just as two now fades to three. It will be a black and white scene in a long film of technicolor. I only wish it could fade sooner. But time is a merciless warden, imprisoning you in the present, only allowing you to leave when he sees fit. The mind is a complex thing. It almost enjoys the pain. I am far simpler, and I don’t.

title: The Midst of the Night

question: What needs to happen?

answer: From the text, it seems that there is a breakup between two people caused by and external influence.

question: Explain how two fades to three.

answer: Two o'clock becomes three o'clock.

question: Why is the narrator in pain?

answer: The probable breakdown in the relationship of trust between the narrator and the subject.

question: Who is the narrator?

answer: Unclear.

question: Write a ~4 sentence summary.

answer: The narrator does not sleep and feels a bittersweet river of emotions. A cruel hand was dealt and the result is clear to the narrator and the subject. The narrator thinks of past arguments and improbable future conversations. The narrator is tossed aside and laments the slow passage of time.


text:
SELMAS SAGA was the Sveriges Television's Christmas calendar for 2016.[1]

The knitted tuque worn by Selma Traskvist, the main character, in the series led to a temporary knitting boom.[2]

The series was later sold to France, the Netherlands, Russia and the Czech Republic.[3]

Plot

The series is inspirerd by steampunk and set a fictional era, inspired by the early 20th century[4]

It follows Selma Traskvist, an 8 years old young girl who goes out on an adventure in the airship “Valborg” from Sweden to the Arctic along with quirky professor Efraim von Trippelhatt trying to find Santa Claus.[5]

Roles

-   Ester Vuori - Selma
-   Johan Ulveson - Efraim von Trippelhatt
-   Sofia Bach - Nordenstierne
-   Pierre Tafvelin - Fabrikören Theodor Julius Hermelin
-   Mikael Riesebeck - Pappa Traskvist
-   Lotta Östlin - Mamma Traskvist
-   Björn Gustafson - Morfar Otto
-   Vilda Carleblank - Selmas lillasyster Signe
-   Leo Hellenius - Rupert
-   Viktor Friberg - Antikhandlare
-   Stefan Roos - Kettil Felterus
-   Shima Niavarani - Tomtevettingen
-   Marienette Dahlin - Husvärdinnan
-   Lisette Pagler - Journalisten
-   Ing-Marie Carlsson - Valborg (Countess of Gruus)
-   Nicke Wagemyr - Greven
-   Meg Westergren - Alamandha
-   Nils Eklund - Grimundius
-   Carl Carlswärd - Herr Stubbgrå

[1]

[2]

[3]

[4]

[5]

title: Selmas saga

question: What was Selmas Saga?

answer: The Sveriges Television's Christmas calendar for 2016.

question: Who was the main character of Selmas Saga?

answer: Selma Traskvist

question: When did Selmas Saga air?

answer: 2016

question: Who played the role of Selma?

answer: Ester Vuori

question: Describe Selma.

answer: Selma is an 8-year-old girl [presumably from Sweden].

question: What genre is Selmas Saga?

answer: It is inspired by steampunk.

question: Write a ~2 sentence summary.

answer: Selmas Saga is a 2016 program for Sveriges Telivision's Christmas calendar. It is a steampunk-inspired story that follows Selma, and 8-year-old girl who travels from Sweden to the Arctic on an airship/


text:
I am an editor, and a poet whom I work with has included the expression "I ejaculated little prayers" in one of his stanzas, which we all know has the dictionary meaning of "intensely calling out." Since the spiritual act of praying is completely at odds with the sexual act, I know the poet would be absolutely horrified should the reading public immediately think only or primarily of ejaculate's sexual meaning.

My question is will people in general only think of the sexual connotation?

Thank you!

asked Apr 3 '14 at 14:18

[]

Stephen Fry on QI (TV show):

  Watson ‘ejaculates’ twice as often as Sherlock Holmes in Conan Doyle’s stories. There are 23 ejaculations in total, with 11 belonging to Watson. On one occasion, Holmes refers to Watson’s ‘ejaculations of wonder’ being invaluable; on another, Watson ejaculates ‘from his very heart’ in the direction of his fiancee. Holmes is only responsible for six ejaculations, although it is not clear which of the two men ejaculate in the passage below: ‘So he sat as I dropped off to sleep, and so he sat when a sudden ejaculation caused me to wake up, and I found the summer sun shining into the apartment. The pipe was still between his lips...’ A chap called Phelps ejaculated three times during the story of ‘The Naval Treaty.’ The only other ejaculator is Mrs. St. Clair’s husband, who ejaculates at her from a second-floor window in the story ‘The Man with the Twisted Lip’.

You really can't use the word these days without causing confusion so better to use an alternative.

answered Apr 3 '14 at 14:35

An ejaculation in the non-sexual sense is basically an exclamation. In the right context, such as calling out in pain or surprise, this connotation might be clear, but it doesn't seem quite right even by this definition in relation to prayer.

A Google books search for "ejaculate" and its conjugated forms shows an overwhelming number of hits for its use in the sexual sense.

Unless the poet actually means exclamation AND is going for a double meaning, I think the word is best avoided.

answered Apr 3 '14 at 14:30

[]

nxxnxx

3,0491 gold badge12 silver badges18 bronze badges

I think in the case of ejaculated prayers it would come across as being a "religio-sexual" juxtaposition. I assume that you know the poet's intent and he does not wish that sort of thing(?). Because, otherwise it almost sounds like a case of religious ecstasy …

In terms of non-sexual usage it is always an exclamation:

  "What the hell is that?", John ejaculated.

It is definitely a word that has diminished in non-sexual usage over the years. (An NGRAM would prove difficult to interpret here since I can't seem to get it to remove the sexual connotation …)

In my opinion, it would be best to avoid the word unless making a deliberate reference to religious ecstasy.

answered Apr 3 '14 at 14:47

[]

David MDavid M

21.7k10 gold badges67 silver badges117 bronze badges

Today "to ejaculate" is in my view always associated with its sexual meaning. And I think, to use it today in the sense of to utter is anachronistic. Today it is understood sexually and any other use would raise eyebrows.

answered Apr 3 '14 at 17:21

[]

rogermuerogermue

13.4k6 gold badges19 silver badges53 bronze badges

I can actually give you a direct quote from a book I own, called _The Va Dinci Cod_, a parody of the eponymous Dan Brown novel / film. It comes in the form of a footnote:

    *[Publishers' note: we wish to inform the public that we urged the author,
    Don Brine, to remove the phrase 'ejaculated Teabag' from his manuscript and
    replace it with 'said the Baronet in a wholesome manner entirely free
    from surreally obscene overtones'.]

I think it's fair to say that, though it may once have been used to refer to a sudden interjection in the middle of a conversation, I note that Merriam-Webster (among others such as the Free Dictionary, Oxford Dictionaries and Wiktionary) insists on putting the sexual connotation as the primary definition, even if they play host to both definitions as valid.

Wikipedia also redirects to the page on medical ejaculation and has a specifically-named page for the grammatical interjection.

...I should probably clear my internet history now.

answered Apr 3 '14 at 22:15

[]

NinjaDuckieNinjaDuckie

6504 silver badges10 bronze badges

Not the answer you're looking for? Browse other questions tagged meaning usage connotation poetry or ask your own question.

question: What is the general consensus of the answers?

answer: That the word ejaculated should be avoided, since most people will associate it with the sexual meaning.

question: What might be a possible reason the poet used the word ejaculate intentionally?

answer: It is possible that the author was going for a "religio-sexual" juxtaposition.

question: Why does the last person who answered feel the need to clear their browsing history?

answer: They are probably embarrassed that they looked up ejaculation due to the sexual nature of the term.

question: If this question had been posed during the era in which Sherlock Holmes was published, how might the answers be different?

answer: They would probably approve of the use of the word, since its non-sexual meaning would still have been prevalent at the time.


text:
Published: Dec 03, 2017 at 08:46 AM

Lee was announced as a surprise healthy scratch before the game. Coach Todd Bowles said after the victory that it was a coach's decision to sit the 2016 No. 20 overall pick.

Lee told reporters he was benched for "violating team rules," per reporters on the scene. He added that he takes "full responsibility" and "paid [his] dues."

Lee had started all 11 games this season, compiling 73 tackles, three sacks, three passes defended and two forced fumbles. The second-year player has been up and down versus the run this season and struggled in space against the pass. Lee has been at his best playing downhill as a pass rusher.

This article has been reproduced in a new format and may be missing content or contain faulty links. Please use the Contact Us link in our site footer to report an issue.

question: What is the article about?

answer: It talks about the basketball player Lee, who was benched in his team's last game despite being healthy.

question: Why was Lee benched in the last game?

answer: He told reporters it was because he broke the team rules.

question: What is Lee's public opinion about being benched?

answer: He says he takes "full responsibility" and that he "paid his dues".

question: What is the coach's public opinion about benching Lee?

answer: Coach Todd Bowles said it was his decision to make.

question: Write a ~2 sentence summary.

answer: After the victory, Coach Todd Bowles says he made the decision to bench Lee. Lee told reporters that he was benched because he violated team rules and that he takes full responsibility.


text:
On Sunday, the Vikings converted on a third-and-8 by netting just one total yard on the play.

On third down from the Atlanta 32-yard line, rookie wide receiver Stefon Diggs caught a pass from Teddy Bridgewater near the sideline, reversed field and slipped two tackles to pickup 16 yards. The Vikings were now just 16 yards away from reaching the end zone.

After the play, Diggs celebrated the big-time conversion. He was flagged for unsportsmanlike conduct.

This is what he did.

  No spinning the ball pic.twitter.com/x2J5gtIn0R

  — Michael Shamburger (@mshamburger1) November 29, 2015

How nice of Diggs to remind players everywhere that spinning the ball after nice plays will cost your team 15 yards.

Due to the penalty, the ball was spotted at the 31-yard line. And that's how a gain of 1 was enough for a first down on third-and-8. Still, the Vikings managed to reach the end zone on an Adrian Peterson run later in the drive.

[]
Spinning isn't allowed, Stephon. (Twitter: @mshamburger1)

question: Which team does this article discuss?

answer: The Vikings.

question: Which state are they from?

answer: Minnesota.

question: Which sport is this?

answer: American football.

question: Who was flagged for unsportsmanlike conduct?

answer: Stefon Diggs

question: Write a ~2 sentence summary.

answer: On Sunday, Minnesota Vikings rookie wide receiver caught a pass from Teddy Bridgewater near the sideline and spun the ball. He was flagged for unsportsmanlike conduct.