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201713
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Identity theft is a pervasive problem. According to figures from the Bureau of Justice Statistics, an estimated 17.6 million people, or about 7 percent of U.S. residents age 16 or older, were victims of at least one incident of identity theft in 2014. Identity theft is not just a problem within U.S. borders, either. Each month, Equifax and TransUnion credit bureaus report that more than 1,800 identity theft complaints are lodged by Canadian residents.
Victims may be subjected to various types of identity theft. Attempted misuse of an existing account is the prime complaint. This account can be a credit card, bank account or phone or utility account. No matter the type of fraud perpetrated, many identity theft victims endure a direct financial loss as a result.
Sometimes individuals do not find out they’ve been the victim of identity theft until they are notified by a financial institution — or even after filing their taxes — when money already has been lost. People may invest in expensive services to protect their identities, but Consumer Reports notes this tactic is not always necessary. There are other, less expensive ways for men and women to protect themselves from identity theft.
Guard personal information. Do not share your personal information over the internet unless you are on a secured site. This will be identified by the https:// preceding the rest of the URL. Sometimes a padlock symbol will appear somewhere on the page. Also, do not provide any personal information over the phone, such as tax identification numbers, bank account information or your maiden name. Personal data should be shared only with trusted companies whose authenticity you can verify. Watch your wallet. Do not leave your wallet or purse unattended. Keep the bare minimum in a wallet so a thief does not have access to all of your personal information if the wallet is lost or stolen. Keep your Social Security card and rarely used credit cards at home. Sign up for alerts. Many financial institutions will offer free online or mobile alerts to warn of suspicious activity on your account. Take advantage of this service.
Lock down devices. Make sure computers and mobile devices are secured with a password, and only use secured networks when going online. Select strong passwords that include a combination of numbers, letters and symbols, as well as case changes so they will be more difficult to crack.
Get off of credit card offer lists. You can stop credit bureaus from selling your name to lenders by going to www.optoutprescreen.com or calling 888-567-8688. Opting out should prevent the majority of offers from coming your way. Many identity theft cases can be linked to crooks stealing credit card preapprovals from mailboxes. Similarly, you can put a security freeze on credit reports, so that lenders will not be able to access credit reports and issue new credit.
Identity theft can lead to plenty of paperwork hassle and loss of funds. Preventing it from happening is easier than you might think.
Source: MetroCreative Connection.
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There are a lot of factors that can affect the performance of your solar panels and the economic benefits they can generate—things such as where you live and how sunny it is, how much you pay for electricity, which way your house faces—even the pitch of your roof. Variety is the spice of life, but the diversity of our architecture can affect the performance of solar panels. It’s important to understand how those differences in production performance related to the angle of your roof will affect the overall financial performance of your solar power system. Continue reading
Understanding Solar Roof and Solar Panel Orientation
You don’t need optimal conditions for your solar power system to be a great investment. One of the biggest myths about the financial viability of solar is that it requires a really sunny location and a south facing roof. While these may be ideal conditions, folks outside of Southern California with roofs that face other points on the compass, such as east to west-facing roofs, can still satisfy most of their electricity needs and reap significant financial returns when they adopt solar power systems.
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I think it’s a safe bet that everyone reading (or writing) this has had a very similar experience when it comes to waking up in the middle of the night and having to use the bathroom. Heck, some of us even wake up multiple times throughout the night in response to nature’s call. Even more annoying than the waking up part, is the going to the bathroom blind part. Let’s just admit it – most of us are way too tired (and not to mention lazy) to turn on the bathroom lights. And even if we weren’t too sleepy to switch on the lights, who wants to be blinded by the bathroom light that seems as bright as an airstrip at 2 in the morning? That’s right – no one. Most men would rather give it their best aim, go back to bed, and deal with the hopefully non-existent consequences in the morning. Alas, for women, it seems that they have an advantage when it comes to having to use the facilities in the middle of their sleep cycle.
Knowing that this has been a problem somewhere since the invention of the first indoor toilets, Kohler has taken a smart leap forward in the toilet industry – beginning with 2 newer models, they are including built-in nightlights on the toilet seats.
Aiming In The Middle Of The Night Just Got A Whole Lot Easier
These toilet seat nightlights use 4 AA batteries to light up your throne 7 hours a night for up to 6 months. You can even program specific settings for what hours you want your toilet to be on Broadway.
I have to ask – why in the world didn’t someone think of this before now? I mean, we’ve only been waking up to pee since the beginning of time. (Yes, I realize we haven’t had “toilets” since the beginning of time).
If you’d like to have these lights on your toilet, go out and pick up Cachet Q3 or a Reveal Q3 from Kohler.
[Image via Kohler]
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Canada Asked to Block Porn
LOS ANGELES — If a couple of Canadian women have their way, Canada will soon follow in the footsteps of the U.K. by requiring Internet providers to automatically block any and all pornographic material.
Kristine Smith-Podeszwa and Amanda Hatt have decided that Canada should adopt the example of the U.K. in blocking Internet porn by default, saying that it is a necessary step for protecting children from becoming addicted to pornography.
“[The U.K. is] forcing the Internet service providers to block all pornography so it’s the default,” Hatt states. “Then, if an adult within the household wants it unblocked, he can call and have it unlocked.”
Hatt draws a real-world correlation between “flashers” and unwanted Internet porn.
“If you’re walking along the sidewalk in Halifax and someone exposes themselves to you indecently, that’s illegal,” Hatt added. “But if you’re on your computer in the privacy of your own home and someone exposes themselves to you, that’s not illegal, and we’re seeing a discrepancy there.”
Research into this unwanted exposure to porn, say the petition’s promoters, indicates that children as young as 10 years old are addicted to pornography after seeing adult pop-up ads and then clicking them out of innocent curiosity. The source of this “research” was not forthcoming.
Smith-Podeszwa conflates what she calls “pornography users” with alcohol and tobacco addicts, citing these afflictions as justification for a porn prohibition affecting consenting adults in the privacy of their own homes, simply because parents are not doing their jobs.
“[Porn is] not just affecting the user or the actors in the videos, it is affecting society in general,” Smith-Podeszwa stated. “In an ideal world, every parent would be making sure their kids aren’t drinking and smoking, but clearly that’s not happening. That’s why we have those laws.”
The petition, posted on the Change.org website, states that “We are requesting that the Canadian government require all internet providers to automatically block any and all pornographic material (videos, pictures, etc.) from Canadian households. If an adult in the home wishes to have this content unblocked they are free to contact their internet provider and authorize them to do so.”
“We are requesting this action be taken as soon as possible, as to protect children from these damaging images. The horribly addictive effects of pornography on children and our society is becoming increasingly evident and we demand that the Canadian government take immediate action against it,” the petition concluded.
It is not a far stretch to imagine calls against having any opt-in regimen, with an outright mandate that Internet providers automatically block “any and all pornographic material.”
David Fraser a privacy lawyer based in Halifax worries that filters would be more extensive than needed, blocking legitimate websites, and disagrees with the notion that someone would be required by the government to opt into freedom of expression and access to information — and wondering what would happen to that list of people who do.
“That list will exist,” Fraser says. “Could it be used for marketing purposes? Perhaps. Could it be something that the police would be interested in? Perhaps. So just collecting that sort of information in one place, with those sorts of characteristics, [is] troublesome.”
Currently, 8,357 of the required 10,000 signatures have been obtained, with the balance of 1,643 a near certainty, given the attitudes expressed in the petition’s comment section.
“Until the Internet came along, you had to work to access p0rn. Now you have to work to avoid it,” Mark Peters of Kitchener, stated. “P0rn should be opt-in, not default-in.”
If Canada agrees, it will be Britain all over again.
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Photography by: ERIN LEYDON
Living a healthy lifestyle is not an easy task; it takes dedication, focus and consistency. I’m not here to tell you it’s simple and effortless, however, I am here to provide you with tips on how to make working out a part of your lifestyle. These tips will help you get into routine and make exercise become a natural part of your day.
Plan Ahead: Schedule your workouts just like you do your appointments & errands. On days I work from home, I like to plan my workouts in the afternoons at around 1:00 or 2:00 pm, this way I can I plan my meetings around those times. It also allows you to look forward to taking that mid-day break from the office and clearing your mind. If you can’t get away from work during the day, then schedule it directly before or after. Don’t allow yourself to go home after work, the urge to hit the couch becomes too tempting. Update that Gym Outfit: I’ve always been adamant about having nice gym clothes. If you feel good, you look good and when you look good, you feel a sense of motivation. I also find that putting a little effort into your pre or post gym outfit is a key way to make working out a part of your lifestyle. Throwing on a cute ball cap and a jean jacket are easy ways to still look chic when you need to run errands before or after a workout. Take Progress Photos: There is nothing more motivating than seeing results in your body, Take a monthly photo of yourself in a bikini and look back on them from time to time to see the changes your body has made. Find Gyms and Classes Close to Your Home: My gym is a 5 minute walk away from my house and I have found this to be a huge factor in maintaining my workouts. Even on days that are way too busy for a full hour at the gym, having my gym close by makes it accessible for me to run over for a quick 20-30 minute intense session. Eat Right: If you are serious about a healthy life than it has to be a full circle. From food, to sleep, to exercise – they all have to be balanced in order for you to maintain the life you want. If you eat bad, you won’t feel like working out as often and you definitely won’t see long term results. If you don’t get enough sleep, you will be to tired to even think about working out. It all becomes a domino effect if you lose control of one area in your life.
Shop some of my favourite activewear below:
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Pacemaker
A pacemaker is an electrical device that is used to control an individuals heartbeat. It sends electrical impulses to the heart to help the heart muscle contract at a normal rate. There are three main components of a pacemaker: a battery, a generator, and wires with specific electrodes attached to them. The wires are placed deep down into the chambers of the heart. If the heart suddenly goes into an irregular pattern, the electrodes attached to the end of the wire can detect this type of irregular activity and “notify” the generator. The generator can then fire an electrical signal back to the heart, helping the muscle contract and establish normal function.
Different Types of Pacemakers
A single chamber pacemaker is the simplest of all the pacemakers and uses the electrical impulses to help set the rate of one chamber of the heart. It uses a single lead, known as a pacing lead, which is most commonly placed in the right ventricles, or sometimes the right atrium. This pacemaker can be used for a patient who has a minor heart issue, such as sporadic arrhythmia’s.
Dual Chamber Pacemakers
A dual chamber pacemaker is the most common type of pacemaker and commonly treats individuals with heart blockages. A heart block is a type of conduction disorder in which the electrical signal that is sent from the atrium of the heart is damaged and is then poorly transmitted to the ventricles. A dual chamber pacemaker can set the rate of two chambers of the heart by placing one lead in the atrium and one lead in the ventricle. If the heart is beating irregularly, the generator sends an impulse to the first lead in the atrium, stimulating contraction and then another impulse is sent to the ventricle. This can help regulate the amount of blood flow to the ventricles as well.
Bi-ventricular Pacemaker/Triple-chambered Pacemaker
These types of pacemakers are used to treat patients with severe heart failure. It has three leads: one in the right atrium, one in the right ventricle, and one in the left ventricle. Like other pacemakers, it resets the rhythm pattern of the ventricles, allowing increased blood flow.
Normal Sinus Rhythm
The heart contracts in a specific sequence which allows it to effectively push blood out of the heart. Unlike skeletal muscle, cardiac muscle does not uses electrical signals from the brain. Instead, it has its owns cells known as “pacemaker cells” that trigger specific action potentials that diffuse across the heart. This cycle is carried about by a specific system called the intrinsic cardiac conduction system. As impulses are generated, it starts at the atria, causing it to contract first. When this happens the blood is pumped into the ventricles. The impulse then travels to the ventricles where it contracts again. This results in the blood being pushed out of the heart to the arteries.
The Five Components of the Intrinsic Conduction System
Sinostrial (SA) Node The SA node is located on the top of the right atrium, just below the superior vena cava. This is where the impulse is generated and ultimately determines the heart rate. Atrioventricular (AV) Node The AV node is located at the bottom the the right atrium. When the impulse travels to this node, it is delayed about 0.1 second. This delay allows the atria to contract and allows more time for the blood to fill the ventricle. Atrioventricular (AV) Bundle The AV bundle is where the impulse from the AV node is transferred from the atria to the ventricle. Right and Left Bundle Branches The bundle branches separate into two different pathways in the interventricular septum that carry in the impulse towards the bottom of the heart. Purkenje Fibers These fibers finish the pathway by carrying the impulse towards the ventricle walls. Cardiac Conduction System and its Relationship with ECG Pacemaker Surgery
The implantation of a pacemaker is a very minor procedure. There are two different types of implantation methods. The first and most common is the endocardial (transvenous) approach. In this method, the skin around the collar bone is numbed. An incision is made and a small wire is placed into the vein.
How Do I Know If I Need a Pacemaker?
The majority of patients who have pacemakers are diagnosed with some type of arrhythmia. There are many tests that can detect whether or not a patient has an arrhythmia.
Arrhythmias
Coronary artery disease can also lead to arrhythmia’s. Arrhythmia’s are known as irregular changes in the normal sinus rhythm. Although most arrhythmia’s are not deadly, there are some that can be severe if not treated properly.
Different Types of Arrhythmias Heart Block
A heart block is a type of conduction disorder in which the electrical signal that is sent from the atrium of the heart is damaged and poorly transmitted. In some cases, the signal is not received by the ventricles at all. There are different levels of heart block that indicate the severity of this condition.
Bradycardia
Bradycardia is when the heart rate is slower (less than 60 beats per minute) than the average.
Atrial Tachycardia
Atrial Tachycardia is a disturbance to the standard rhythm of the heart within the atria itself.
Ventricular Tachycardia
Ventricular Tachycardia is when the ventricles are beating at a faster rate than normal. If left untreated, the patient may go into ventricular fibrillation.
Ventricular Fibrillation
Ventricular fibrillation is the most severe type of arrhythmia. Instead of the ventricles contracting normally, they contract in an uncoordinated manner, which makes the ventricles shake and unable to pump blood.
Atrial Fibrillation
Atrial Fibrillation occurs when both atriums contract irregularly and at increased rates. This causes the atriums to fill with blood and cannot enter the ventricles.
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Act today!
Please use this template to send a letter by email to your Member of Parliament, with a copy to the Minister of Public Safety and Emergency Preparedness and to OCASI.
For more information about the Safe Third Country Agreement, please scroll down for useful links at the end.
You can find your Member of Parliament and your Riding by entering your postal code here.
Please CC the email to:
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Dear [MP NAME],
Re: Act today! Suspend the Safe Third Country Agreement
My name is [NAME] and I live in [Riding name].
I am writing to ask that you urge the Canadian government to immediately suspend (and eventually withdraw from) the Canada-US Safe Third Country Agreement so that asylum-seekers are not turned back at the Canada-US border.
The Safe Third Country Agreement prevents asylum-seekers travelling from the US from claiming refugee status in Canada, unless they qualify for the limited exceptions under the agreement.
I am deeply concerned that:
- Refugees are risking their lives and safety and crossing the border on foot sometimes through difficult terrain, to avoid official immigrant entry points and being sent back to the US because of the Safe Third Country Agreement.
- The US is not a safe country for refugees, particularly now given the escalation of anti-refugee and immigrant sentiment, and growing Islamophobia, racism and xenophobia, and the potential deportation of those seeking refuge. As a new report from Harvard University Law School Immigration and Refugee Clinical Program has concluded, there could be grave potential consequences from recent US Executive Orders on immigration, including: the large-scale detention of asylum seekers, the removal of refugees without due process, the empowering of local officials to detain individuals on suspicion of immigration violations, discrimination based on asylum seekers’ religion and nationality, among other deeply troubling outcomes.
- A recent research report by students from 22 Canadian law schools concludes that Canada’s continued participation in the Safe Third Country Agreement violates our international obligation. It found inequalities in the asylum systems in Canada and US dating back to the beginning of the Agreement.
As your constituent, please notify as soon as possible of the steps you, your office and the Canadian government are taking to protect the rights of immigrants, refugees and asylum seekers.
Thank you,
[Your name]
[Your Address with postal code]
CC:
Hon. Ralph Goodale, Minister of Public Safety and Emergency Preparedness OCASI – Ontario Council of Agencies Serving Immigrants
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Read more here about the Safe Third Country Agreement and its impact on refugees.
-------------------- Media coverage
Refugee claimants need safe access at U.S.-Canada border: ColeAn inhumane deal between our countries is pushing asylum seekers to risk their lives for a hearing
Desmond Cole Toronto Star March 16, 2017
BORDER CROSSERS: Advocates concerned about unaccompanied minors seeking asylum in Canada
The Canadian Press in Chronicle Herald Published March 16, 2017
Near-fatal border crossing in Quebec prompts calls for immigration reform
Asylum seeker's dangerous trek held up as example of shortcomings of Safe Third Country Agreement By Jonathan Montpetit, CBC News Posted: Mar 14, 2017
The safe third country pact imperils lives—just like a border wall
Marcello Di Cintio has seen border-hoppers risking their lives in desolate country before—in the deserts north of Mexico Marcello Di Cintio March 13, 2017 Macleans.Ca
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Mario Alvarez is a full-time OHMA student. In this post, he writes about the Prison Public Memory Project and the ethical issues that arise between oral history and public-facing work.
On Thursday, April 21st, 2016, we OHMA students were treated to a workshop led by three leaders of the Prison Public Memory Project. These three individual had distinct responsibilities for the organization: Tracy Huling, the founder, directs and writes; Brian Buckley, the site coordinator, does digital humanities work; Quintin Cross does vital work connecting the organization with the local African-American Community. These members took the time to speak to us about their project and about the challenges that arise out of addressing the role that the local prisons play in this community. I was struck by the collaborative approach of their project – even during this two-hour workshop, Tracy, Brian, and Quintin approached the audience as equals with the potential to improve their already impressive work.
The Public Prison Memory Project, in addressing issues of incarceration and racial inequality, are handling some sensitive issues. Implementing oral histories is integral to their efforts to preserve the history of the local prisons – the personal testimonies of former prison employees (and prisoners) paint a fuller picture of what these institutions (and their surrounding areas) were like. The project deserves commendation for addressing the nuanced and oft-forgotten topic of prison towns (and ex-prison towns). I also admired our guests’ openness about the moral gray areas that arise out of this sort of work.
Brian and Quintin each took time to explain their contributions to this project in detail. Brian presented a shortened history of the New York State Training School for Girls, a reformatory school for young women that closed in the mid 1970s (it is now a prison for young males). It was during this presentation that Brian complicated people’s typical understanding of prison towns, showing us that although the prison was home to an (unspoken) history of abuse, it was also a large employer for the town that helped create an African-American middle class in the community.
Quintin, whose ties to Hudson go back several generations, spoke of his personal connection to the community. He was responsible for bringing in many of the narrators featured on the project’s website, most of whom had worked for the NYS Training School for Girls decades ago. He spoke in further detail about the school’s treatment of its prisoners of color, who were subject to harsher conditions than their white counterparts. He revealed to us that there was a widespread code of silence among black employees in the prison, many of whom chose not to speak out on the various inequalities that occurred there for fear of losing their well-paying government jobs.
Then Tracy opened up the floor to us, the audience. We were split into two groups, each tasked with a different case study. Each of these scenarios were real-life ethical quandaries that the organization is currently facing in balancing the aforementioned code of silence among former prison workers and the project’s desire to bring a history of inequality to light.
When reflecting on these case studies, I couldn’t help but come back to an overarching question: where does one draw the line between one’s efforts towards social justice and one’s allegiance to his or her narrators? Can one be both a fully-committed activist
and a full-time oral historian? This is something that we as students often tackled in class during this past academic year. Our conversations, though enlightening, failed to settle on a clean way of addressing this tension. This project hopes to “unlock the future” (per the home page on their website), revealing its public-facing aspirations, but I cannot help but wonder if oral history, when compared to more journalistic approaches to interviewing, can sometimes an obstacle to these hopes.
That being said, I was glad to be in the audience for this workshop. It opened up a number of challenging questions, the kinds that can only arise in difficult projects like this one. I look forward to hearing future developments from the Prison Public Memory Project.
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Hongru Pan is a Master's candidate in the department of History at Columbia. Watch the full lecture on YouTube. Rejection is your finding Silence is as loud as speaking.
-Alessandro Portelli
Professor Alessandro Portelli, the author of the
The Death of Luigi Trastulli and Other Stories, is one of the world’s leading oral historians. We were honored to have him in our Oral History Workshop class to have a private conversation with students before his public lecture on “Stories I Skipped: Narratives of War, Narratives of Care.” I was interested to find out that before he entered into the field of oral history, he actually studied American literature in Italy and became a professor of American literature at Rome University. He stumbled into oral history through a project collecting folk music. Because Professor Portelli is an entirely self-taught person in the oral history field, he has been thinking about what he did right and what he did wrong in the past interviews. “There is one thing that I learnt from something I did wrong,” he stated, “stories that I heard but I would not listen to.”
Professor Portelli kept explaining by saying that “oral history is an art of listening and is one of the things giving hearing to people; however, we do not listen all the time with the same intensity, partly because oral history is an encounter between two agendas.” Oral historians have agendas of what they want to hear, while interviewees have their agendas of what they want to share. He continued to point out that most interviewees were not formally trained as historians and they would not be familiar with the academic’s categories of political history, scientific history, or intellectual history. In this case, oral historians should not expect interviewees to fit their category or agenda. “Never turn off your tape recorder”, he suggested, “because it’s a signal for ‘I’m not interested in what you are talking about.’ You will never know what is not interesting you right now will turn out to be interesting ten years later, which is what we have archives for.”
With regard to the popular question of how to treat oral historical sources, he states that “there is no false oral sources,” because oral sources are narratives, which provide not only the historic facts but also insight into people’s emotions and desire. In this sense, oral historical sources can be seen as both primary sources and secondary sources. Therefore, it is important to pay attention to both historical facts the interviewees would provide and interviewees’ own feelings and reaction, even their rejection, towards the questions.
In some cases, people would refuse to be interviewed by an oral historian. For example, one student was doing research in a hospital and failed, after many attempts, to secure interviews with doctors. She asked Professor Portelli how to deal with rejection. Portelli’s answer fascinated us: “Rejection is your finding.” People’s rejection shows their unwillingness to speak about an issue, which reveals their sense of shame or their paradoxical situation. With regard to his recent research with working class people in Harlan County, Kentucky, he also faced initial difficulty in interviewing workers and workers’ families. People in Harlan County at first found it strange for an Italian to interview them, which indicates a cultural boundary. However, Professor Portelli solved the problem by engaging in their daily lives. This project can be seen as a complement to his legendary research on working-class people’s stories in Italy. Portelli’s work shows us that history should not only be learnt through studying written documents but through creating oral documents; otherwise, important stories of individual lives would be ignored and never be picked up. Oral history allows people’s stories to become part of history, whether it is their rejection of the interviewee’s request or their trivial daily lives’ stories. “They talk about their lives. Whether it is history or not, they will tell about it. It is not a testimony; it is narrative. Whether your life considered significant as history or not, it is your life.”
So, never turn off your tape recorder. Respect your interviewees, or you will never know what you will miss.
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Gaining a Mile-high Perspective with COABEPosted on 04/20/2015
The Commission on Adult Basic Education (COABE ) is a 15,000 members strong national professional organization with a mission to provide leadership, communication, professional development and advocacy for adult education and literacy practitioners in order to advance quality services for all adult learners. This year the COABE 2015 National Conference takes place in Denver, CO on April 21-24, 2015.
There is a significant contingent of California adult educators presenting this year. Below is a list of some of the presentations. Those with resources available have links:
The word "literacy" is applied in many different contexts, in this session the discussion will be centered on the definition within the new WIOA legislation and what it means for adult learners and teachers. How important are these skills in our current economic and educational environments? Resources and suggestions to build digital literacy will also be explored. Come join the conversation!
A Bird's Eye View of Mobile Devices - OTAN Staff
Want to explore ways of using a mobile device in the adult ed classroom? In this workshop, we will explore methods to communicate, collaborate, create, and share using mobile devices to engage students and enhance instruction through educational apps and Web sites. We will discuss classroom etiquette, demonstrate projects, and share a variety of activities for immediate feedback and assessment.
One-Size Doesn't Fit All: Strategies for Site-Based Standards Alignment - Cherise Moore, CALPRO
To meet the expectations of WIOA for greater alignment between workforce development, career preparation, and the adult education systems, we share lessons learned and practices to customize tools and resources to support ABE/ASE, ESL, and CTE teachers and to show the relationship between the CCRS to the Common Career Technical Core: Career Ready Practices. Attendees will consider what adjustments they need to make to meet their class's, program's or state's PD needs on this topic.
Using the College and Career Readiness Standards for Adult Education in Adult ESL - Linda Taylor, CASAS
This workshop provides an overview and hands-on activities to familiarize adult ESL practitioners with the College and Career Readiness Standards (CCRS) for adult education that were published in 2013. Participants will gain perspective on how the CCR Standards can be used in adult ESL programs and will be able to begin to implement the CCR reading, reading foundational skills, and language standards in their local programs.
SOAR: Upping the Game of Academic Rigor in ABE and ASE - Dr. Peggy Raun-Linde, Tammie Hickey, Sunnyvale Cupertino Adult Education
In 2010, Fremont Union High School District Adult School reinvented its ABE program to increase academic readiness and rigor. This involved creating a new ABE program and radically changing the model used in the ASE classrooms. Learn about the goal setting and academic results of this initiative.
CASAS E-Testing: Myths to Avoid, Truths to Tell - Dr. Peggy Raun-Linde, Laura Lanier, Sunnyvale Cupertino Adult Education
Since 2010, Fremont Union High School District Adult School, in California's Silicon Valley, has utilized computer-based, CASAS testing (e-testing). The site process developed allows us to test and place 150 ESL students in less than three hours.
Regional Community of Online Learning Promoting College Readiness - Kay Hartley, Fairfield Suisun Adult School
This panel presentation features representatives from California's Adult Education Leadership Project, Outreach and Technical Assistance Network, and a principal of an adult education program. Panelists will share information about a pilot program establishing a regional community of online learning that supports adult students' development of math readiness for entry into postsecondary education.
Bridging the Gap: Creating Effective Transition Programs - Lori Howard, Sylvia Ramirez, CASAS
English language learners have goals beyond learning English: a high school diploma, college degree, vocational training, or a job. Presenters share model transition programs in California so participants can develop their own transition programs using these models. Discussion centers on how the programs are designed and the successes they have achieved.
Mobile Devices for Adult Educators - Susan Gaer, Santa Anna Community College Continuing Education
Interested in using your mobile device in your classroom? Explore features of your device that will help adult students. Discussion focuses on management, etiquette, and recent research along with ideas that work with any phone. Leave this invigorating workshop with lots of ideas.
Bridging Students to Success in Community College - Dr. Karen Bautista, Emma Diaz, San Bernardino Adult School
This informational workshop will engage practitioners in new learning, provide details of a transition pilot program, and facilitate discussion around promising practices in the transition of adult students to postsecondary education. Attendees will hear firsthand from the administrator who had the vision and the teacher who made the vision a reality.
Help Your ABE Learners Become College and Career Ready! - Lori Howard, CASAS
The College and Career Readiness Standards for adult education "provide a consistent, clear understanding of what students are expected to learn." How can these standards translate into curriculum and classroom instruction for adult ABE learners? Learn how to use them to ensure adults in your programs are being prepared for success in postsecondary education, training, and work.
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CHEMICAL STRUCTURE
EFFICACY AGAINST PARASITES
Efficacy against a specific parasite depends on the
delivery form and on the dose administered. National regulatory authorities determine whether a product is approved for a given indication, i.e. use on a particular host at a specific dose and against a specific parasite. Check the labels of the products available in your country. for general information on features and characteristics of PARASITICIDES. Click here
SAFETY Oral LD50, rat, acute*: 1180 mg/kg Dermal LD50, rat, acute*: >2150 mg/kg * These values refer to the active ingredient. Toxicity has to be determined for each formulation as well. Formulations are usually significantly less toxic than the active ingredients. MRL (maximum residue limit): Not applicable: not approved for livestock Withholding periods for meat, milk, eggs: Not applicable: not approved for livestock
It is obvious that veterinary products are not intended for and
MARKETING & USAGE Decade of introduction: 1970 Introduced by: CIBA-GEIGY Some original brands: ALFACRON, SNIP Patent: Expired (Particular formulations may be still patent-protected) Use on LIVESTOCK: No, only for off-animal use Use on DOGS and CATS: No Main delivery forms: Use in human medicine: No Use in public/domestic hygiene: No Use in agriculture: NoGenerics available: Yes, a few
PARASITE RESISTANCE
SPECIFIC FEATURES
Azamethiphos is a veteran organophosphates used almost exclusively for the
off-animal control of houseflies and nuisance flies aas well as crawling insects in livestock operations: stables, dairy premises, piggeries, poultry houses, etc.
The original manufacturer (Ciba-Geigy → Novartis) sold the azamethiphos business (incl. the registered trademarks) in 2003, when it decided for strategic and image reasons to get rid of all organophosphates. Azamethiphos products are still available in a few countries from other manufacturers. Novartis replaced its azamethiphos product line with comparable products containing thiamethoxam, a newer neonicotinoid pesticide.
Efficacy of azamethiphos
Azamethiphos is highly effective against susceptible houseflies and it kills them very quickly. It acts mostly by
oral ingestion. This means that the contact (or tarsal) effect is usually insufficient against bloodsucking flies (e.g. stable flies or horn flies, etc.).
Interestingly, azamethiphos as a bait shows an excellent efficacy against certain housefly populations resistant to other organophosphates (e.g. diazinon, dichlorvos, etc.) and carbamates (methomyl, etc.). However, there are also housefly strains that are specifically resistant to azamethiphos, apparently because they simply avoid the sugar in the scatter baits or added to the concentrates to increase its attractiveness for houseflies.
It also has efficacy against some poultry mites, cockroaches and other crawling pests, but it is usually insufficient to control serious infestations.
Azamethiphos is also used as a lousicide in fish farms, especially against salmon lice.
However, resistance of houseflies and other pests to all organophosphates, including azamethiphos is widespread . As a consequence, products with this active ingredient may not achieve the expected efficacy in many places. The same applies to all other organophosphates. This is also a reason for their progressive replacement with newer active ingredients with a different mode of action. Notice. As a general rule this site does not provide information about off-label uses of antiparasitic active ingredients. In most countries veterinary doctors can prescribe a veterinary medicine (also a parasiticide) for indications that are not included in its label. This is often the case for (e.g. rabbits, guinea pigs, exotic mammals and birds, reptiles, etc.) and minor species (also parasites) that are not investigated by pharmaceutical companies for whatever reasons. orphan diseases Pharmacokinetics of azamethiphos
Azamethiphos is not intended for on-animal use. Azamethiphos is poorly absorbed through the skin. Following oral administration to rats azamethiphos is well absorbed to the bloodstream. Part of the administered dose is hydrolyzed to various metabolites. Most of the administered dose is excreted through urine.
Mechanism of action of azamethiphos
As all organophosphates insecticides, azamethiphos acts on the nervous system of the parasites (but also of mammals, birds, fish and many organisms!) as
inhibitor of acetylcholinesterase (also known as AchE), an enzyme that hydrolyzes acetylcholine (Ach). Ach is a molecule involved in the transmission of nervous signals from nerves to muscles (so-called neuromuscular junctions) and between neurons in the brain (so-called cholinergic brain synapses).
AchE's role is to terminate the transmission of nervous signals where Ach is the neurotransmitter (there are several other neurotrasmitters). By inhibiting the activity of AchE, organophosphates prevent the termination of those nervous signals, i.e. the neurons remain in constant activity and excitation, massively disturbing the normal movements of the parasites. The bottom line for the parasites is that they are paralyzed and die more or less quickly. Organophosphates bind
irreversibly to AchE, in contrast with carbamates, another chemical class of parasiticides, which bind reversibly to AchE.
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Benjamin Morris speaks to author and poet Cassie Pruyn about the many histories of Bayou St. John.
Editor's Note
One of New Orleans’ most cherished public spaces, Bayou St. John is also one of its oldest and most historic, serving alternately as meeting place, environmental landmark, shipping corridor, drainage outlet, residential settlement, and even, festival ground. Poet and author Cassie Pruyn is writing a new history of this beloved waterway, due out from The History Press in 2017. Benjamin Morris sits down with Pruyn to learn more.
Benjamin Morris: How did you come to be writing a history of Bayou St. John, and what is the need for such a book? Cassie Pruyn: Until beginning this project, I was a poet first and foremost. My poetry often engages with geographic history, and New Orleans geographic history in particular, so the subject matter of this book was a natural extension. I’ve always been drawn to bodies of water and their direct and indirect relationships to human development, culture, and thought. As any New Orleans resident knows, neighborhoods in this city are vibrantly distinct, each with its own rich history, and so I was also interested in the ways in which Bayou St. John influenced the neighborhoods that grew up around it over the past three centuries.
This area of the city has yet to be written about in any comprehensive way. We have an incredibly thorough history of the bayou during colonial times, published in 1980 by Edna B. Freiberg, but we don’t yet have a volume that tells the story from prehistory through the present day. I believe this body of water and its surrounding neighborhoods are incredibly important spaces within the city of New Orleans; their stories can deepen and enrich our understanding of the city’s history in general. The bayou has changed and shifted as the city has changed and shifted, and it has a lot to tell us about what it means to build a city on land created and defined by water.
BM: Bayou St. John is one of the oldest inhabited spaces in New Orleans, with colonial traffic dating back to the city’s founding, and indigenous traffic dating before that. Can you describe its historical importance to the city’s growth and development? CP: Throughout the last three hundred years, the bayou has been logistically, commercially, militarily, and recreationally significant to the growth and development of our city. Many New Orleans residents are aware of the bayou’s role as part of the portage route Native Americans showed the French in the late 17th century, which influenced Bienville’s decision to found New Orleans on this particular curve of the Mississippi River. Instead of navigating the Mississippi’s treacherous mouth, settlers could instead travel from the Gulf of Mexico through Lake Borgne into Lake Pontchartrain, down the bayou to a footpath several feet higher than the surrounding cypress swamp, which in turn led to the banks of the river. The same ridge system that allowed for the high and dry footpath meant that land surrounding lower Bayou St. John was some of the only other land, aside from the Mississippi’s natural levees, suitable for development and agriculture at the time. The lower bayou was home, therefore, to the very first European settlers in the area in 1708, a full ten years before trees were felled for what we now call the French Quarter. Throughout the 18th century, the land around the bayou and what is now Bayou Road boasted numerous large Creole plantations—forming the city’s first “faubourg,” or suburb, a rural outpost of the burgeoning city. BM: What are the main milestones in the development of the bayou since 1708? CP: The first Bayou St. John milestone after 1708 is the digging of the Carondelet Canal in 1794, a feat that required landowners to “lend out” their personal slaves in order to complete this grueling public project. The Old Basin Canal, as the bayou and the Carondelet Canal together were often called, became a crucial commercial conduit, allowing for transport of goods from the Gulf Coast and the lake directly to the edge of the Quarter. For the next century, the Old Basin’s banks served a primarily industrial purpose, peppered with shipyards, breweries, furniture factories, lumber yards, and sawmills. Beginning in the 1920s, after more than a century of use, the Carondelet Canal was incrementally filled in. The bayou was then “beautified” in the 1930s, declared non-navigational, and transformed into an unofficial extension of City Park. Soon after, the bayou served briefly as a means of transport for Higgins World War II vessels, and now, particularly in the wake of Hurricane Katrina and its aftermath, the bayou is very much a part of the conversation surrounding sustainability and flood protection for the city going forward. BM: How has use of the bayou and the surrounding area changed over time? What uses were once present that we no longer see, and what uses have emerged in modern times that did not previously exist? CP: Standing on its banks today, it’s hard to imagine a wild bayou fed by numerous small streams, choked with logs and weeds and islands and alligators. Or, standing below Esplanade, it is hard to picture the hardwood forests, dairy cows, citrus orchards, and large green plantations bearing stately Creole plantation-style homes that once defined the area in the 18th century. It’s equally hard to imagine the ship traffic that developed soon after—those massive schooners gliding along, and the Magnolia Bridge (which was once the bridge at Esplanade, before it was transported via barge to its current location in 1908) pivoting to let them pass. Or, further toward the lake, a cypress swamp, eventually opening out into grassy marsh, shell-lined beach and brackish lake. Or sprawling shipyards with elevated wooden skeletons. Or houseboats with names like “French Duck,” “Black Gold,” “Lindy Ann,” or “Little Bit” that littered the bayou in the 1920s and ’30s. Or Higgins boats that turned the bayou into a parking lot during World War II. Or the process of bayou beautification, which required draining the bayou, exposing centuries-old cypress stumps and many decades worth of human refuse from when it had been an outlet for the city’s waste. BM: Understandably, given such a precious natural resource, questions of ownership and control of the bayou recur throughout its history. From what you have learned in your research, what have been the main tensions? CP: In combing through the historic Times-Picayune database, I was amazed to see how often the various uses of the bayou, and therefore questions of ownership and control, were hotly debated. Historically, the bayou served as a natural drainage outlet. But once it had come into its own as a commercial conduit, questions of its use as a drainage canal recurred: residents in the vicinity of the bayou complained consistently about a nasty smell, and attributed the stench to whatever the New Orleans Gas Works had been dumping indirectly into it, not to mention the rest of the city’s waste. Board members of the Carondelet Canal and Navigation Company, which controlled the Old Basin from 1805-1908, along with politicians, engineers, and residents argued over whether the bayou ought to be used for drainage as well as for commercial use, until it was decided to divert city’s waste into a new system of canals built specifically for drainage.
The question reemerged in the first two decades of the 20th century: what should the bayou be used for? Should we envelop it into the park system as a crucial public resource, or should we continue to use it commercially, despite significant competition from the railroads?
So there’s the question of the bayou’s use at any particular period, and then there’s the question of the tension between technical ownership and literal control. In the 18th century, France, and then Spain, regulated all aspects of the Louisiana colony, including use of its waterways. But there were always issues of smuggling and avoiding tolls owed to the crown (this may be why the “Custom House” on the corner of Moss Street and Grand Route St. John still has remnants of an iron jail cell: although never technically used as a custom house, it may have been unofficially used as a holding pen for smugglers and debtors). When the Carondelet Canal and Navigation Company had control of the bayou, they charged notoriously steep tolls for its use and for use of the shell roads alongside it, fees against which the public enthusiastically fought. Then there was the apex, so to speak, of tension between technical ownership and actual control during decades of litigation limbo between the Carondelet Canal and Navigation Company and the state, when a lack of control, fees, and oversight turned the bayou into an ad-hoc floating neighborhood full of houseboats, its banks cluttered with docks and boathouses of all shapes and sizes. From then on, the public has been heavily involved in deciding the rules and uses for the bayou and its banks. In the 1920s and ’30s, residents of the Bayou St. John neighborhood, led by future-mayor and Faubourg St. John resident Walter Parker, fought houseboat, boathouse, and shipyard owners tooth and nail to create the bayou as we know it today. When considered alongside these past conversations, our current debates over use of the bayou’s banks for festivals and other recreational activities continue to express the themes of public use that have defined the bayou since the city’s founding.
BM: Other public spaces in New Orleans similar to the bayou include the Fly at Audubon Park and the Moonwalk in the French Quarter, both overlooking the Mississippi River. Does exploring the history of the bayou inform our understanding of, or relationship to, these other iconic spaces? CP: Although I don’t know much about the development of Woldenberg Park along the riverfront in the French Quarter, or the Fly in Audubon Park, I know these specific sites were transformed into how we know them today in the 1960s through ’80s. However, Audubon Park at large was developed much, much earlier than that. City Park and Audubon Park were both once privately owned plantations that the city eventually acquired. Once effective drainage technology was developed in the late 19th century and City Park’s middle and upper stretches were sucked clean of swamp, City Park bloomed into the vision the city had for it, matching Audubon in intentionality and sophistication. So I consider the pressure to add the bayou to this park system and the development of a recreational space along the river in Audubon Park to be closely related. By contrast, the decision to transform the former industrial space on the Mississippi River levee in the Quarter into a site of recreation happened much later in the city’s history—in the 1970s and ’80s. This type of decision, I imagine, weighed issues of flood protection, control and ownership of the river and its banks (the Army Corps of Engineers versus the city) with issues of industry and public use. Obviously, these issues overlap with issues surrounding use of the bayou, but take on a scale commensurate with the body of water in question. BM: Your book doesn’t just explore a public space, it actually relies on the public for material—stories, images, ephemera, and documentation—in order to tell the story of that space. What specifically are you seeking during the research phase, and how can the public contribute to this project? CP: This project relies on New Orleans residents, particularly those who live (or have previously lived) in the neighborhoods in the vicinity of the bayou. As you mentioned, I am of course interested in photographs and other documents, but I’m also interested in hearing stories about life on the bayou during previous eras—the atmosphere, the way residents conceived of their relationship to the waterbody and their particular neighborhoods, and other personal memories. Nothing is irrelevant in this regard—every piece of information adds to the narrative in its own way. Anyone interested can visit my website, cassiepruyn.com, for contact information and bi-weekly blog entries on what I’ve been learning about our beloved bayou.
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Shallaki
Active Ingredient: Boswellic acid
Shallaki (boswellic acid) is useful in treating arthritis and joint pain.
Shallaki 60caps
Package Per Pill Price Savings Bonus Order 60caps × 1 bottle $37 $37 + Levitra INDICATIONS
Shallaki treats joint problems. It has pain-relieving properties that are useful in treating arthritis and joint pain. Helps in relieving the discomfort caused by morning stiffness. Shallaki (boswellic acid) possesses strong anti-inflammatory properties.
INSTRUCTIONS
Take 1 capsule twice a day. To be swallowed with water or milk.
STORAGE
Store at the room temperature away from moisture and sunlight. Keep out of reach of children.
MORE INFO: Active Ingredient: boswellic acid
There are no known warnings or precautions for Shallaki usage.
Possible Side Effects Shallaki is not known to have any side effects if taken as per the prescribed dosage. More Information Two placebo-controlled studies, involving a total of 81 individuals with rheumatoid arthritis, found significant reductions in swelling and pain over the course of 3 months. A comparative study in 60 arthritic patients over 6 months showed that Boswellia extract produced symptomatic benefits comparable to oral gold therapy in arthritic patients. According to a recent review of unpublished studies, preliminary double-blind trials have found Boswellia to be effective in relieving the symptoms of rheumatoid arthritis. Customers who bought this product also bought: Probalan$1.03 for pillProbalan (Probenecid) is used in the treatment of chronic gout or gouty arthritis. More info Lioresal$0.78 for pillLioresal (Baclofen) is used for treating muscle spasms caused by multiple sclerosis or other diseases. More info Imitrex$4.84 for pillImitrex is used to treat migraine headaches. Imitrex will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks. More info Urispas$1.22 for pillUrispas is used for relieving pain, frequency, and urgency of urination as well as nighttime urination associated with certain medical conditions. More info Nimotop$1.07 for pillNimotop (Nimodipine) is used to improve symptoms caused by spasms as a result of a brain hemorrhage (ruptured blood vessels). More info Benemid$0.85 for pillBenemid is used to treat gout and gouty arthritis. Benemid is also sometimes given together with penicillin antibiotics to make them more effective. More info
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Related images (click to enlarge)
New research from North Carolina State University shows that a wind-driven “tumbleweed” Mars rover would be capable of moving across rocky Martian terrain — findings that could also help the National Aeronautics and Space Administration (NASA) design the best possible vehicle. “There is quite a bit of interest within NASA to pursue the tumbleweed rover design, but one of the questions regarding the concept is how it might perform on the rocky surface of Mars,” says Dr. Andre Mazzoleni, an associate professor of mechanical and aerospace engineering (MAE) at NC State and co-author of a paper describing the research. “We set out to address that question.”
Mazzoleni and Dr. Alexander Hartl, an adjunct professor of MAE at NC State, developed a computer model to determine how varying the diameter and mass of a tumbleweed rover would affect its speed and ability to avoid getting stuck in Martian rock fields. Rock fields are common on the surface of Mars, which averages one rock per square meter.
“We found that, in general, the larger the diameter, and the lower the overall weight, the better the rover performs,” Mazzoleni says. In addition, the study found that a tumbleweed rover would need to have a diameter of at least six meters in order to achieve an acceptable level of performance — meaning the rover could move through rock fields without getting stuck.
Using the model, the researchers also found that tumbleweed rovers are more likely to bounce than roll across the surface, due to the spacing of the rocks and the size of the rovers.
“Computer simulations are crucial for designing Mars rovers because the only place where you find Martian conditions is on Mars,” says Mazzoleni. “Earth-based testing alone cannot establish whether a particular design will work on Mars.” Mars has approximately three-eighths of Earth’s gravity. And the atmospheric density on the surface of Mars is only duplicated around 100,000 feet above Earth’s surface.
Tumbleweed rovers are attractive because they can cover much larger distances, and handle rougher terrain, than the rovers that have already been sent to Mars — such as Spirit and Opportunity. “This model is a tool NASA can use to assess the viability of different designs before devoting the time and expense necessary to build prototypes,” Mazzoleni says.
While tumbleweed rovers would lack the precise controls of the wheeled rovers, they would also not rely on a power supply for mobility — they would be literally blown across the Martian landscape by the wind.
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Food is a common trigger of digestive issues. In particular, foods that are high in fermentable...Read more
Natal Plum Description Features Reviews (0) More Info Overview Comes in 3 gallon container Popular foundation, hedge, container, and groundcover plants Thick leathery leaves, durable through wind and salty ocean spray Can grow up to 20 ft in height, but can be pruned and kept at any size Plum red fruit, tastes like slightly sweet cranberry with texture of a ripe strawberry Fruits appear while plant blooms – in summer and fall (or fall and winter in warmer climates) Fruits can be eaten off the bush or made into pies, jams, etc. Fragrant white blossoms Rich in vitamin C, calcium, magnesium, and phosphorous Full sun, tolerates partial shade, drought tolerant Tropical and subtropical regions (Zones 9-11) All parts of plant except for the ripe fruits are poisonous (be careful with pets) Features
weight 9.99 lbs Reviews More Info
Common name: Natal Plun Botanical name: Carissa Macrocarpa Family: Apocynaceae
Avg Height X Width:
6' x 5'
Origin:
South Africa Season: May-Sep. Sparsely most of the year.
Damage temp:
28-30 F
Natal Plum in a 3 Gallon Container. Natal plums are among the best ocean front foundation, hedge, container and groundcover plants for tropical and subtropical regions. They are very popular in South Florida. Natal plums are often grown in containers on ocean front condominium balconies. Their thick leathery leaves are not torn by wind nor bothered by salt spray. Natal plum is native to the Northern South African province of KwaZulu/Natal. It is a popular hedge plant, widely cultivated in the New and Old World tropics. Natal plum is the perfect hedge plant. Its dense foliage makes it a good screen, and its thorns make it an effective barrier as well. Add on the deliciously fragrant blossoms and edible fruits, and it′s hard to think of a better shrub for the tropical garden.
Climate
Soil Propagation Culture Pollination and Fruit Set Season Harvesting Pests and Diseases Food Uses Food Value Two species of the notorious family Apocynaceae are noteworthy because of their edible fruits and innocuous milky latex. The more attractive of these is the carissa, Carissa macrocarpa A. DC. (syn. C. grandiflora A. DC.), also called Natal plum and amantungula. Description
A vigorous, spreading, woody shrub with abundant white, gummy sap, the carissa may reach a height of 15 to 18 ft (4.5-5.5 m) and an equal breadth. The branches are armed with formidable stout, double-pronged thorns to 2 in (5 cm) long. The handsome, evergreen, opposite leaves are broad-ovate, 1 to 2 in (2.5-5 cm) long, dark-green, glossy, leathery. Sweetly fragrant, white, 5-lobed, tubular flowers to 2 in (5 cm) broad are borne singly or a few together at the tips of branchlets all year. Some plants bear flowers that are functionally male, larger than normal and with larger anthers, and stamens much longer than the style. Functionally female flowers have stamens the same length as the style and small anthers without pollen.
The round, oval or oblong fruit, to 2 1/2 in (6.25 cm) long and up to 1 1/2 in (4 cm) across, is green and rich in latex when unripe. As it ripens, the tender, smooth skin turns to a bright magenta-red coated with a thin, whitish bloom, and finally dark-crimson. The flesh is tender, very juicy, strawberry-colored and -flavored, with flecks of milky sap. Massed in the center are 6 to 16 small, thin, flat, brown seeds, not objectionable when eaten.
Origin and Distribution The carissa is native to the coastal region of Natal, South Africa, and is cultivated far inland in the Transvaal. It was first introduced into the United States in 1886 by the horticulturist Theodore L. Meade. Then, in 1903, Dr. David Fairchild, heading the Office of Foreign Seed and Plant Introduction of the United States Department of Agriculture, brought in from the Botanical Garden at Durban, a large quantity of seeds. Several thousand seedlings were raised at the then Plant Introduction Garden at Miami and distributed for testing in Florida, the Gulf States and California, and much effort was devoted to following up on the fate of the plants in different climatic zones. The carissa was introduced into Hawaii in 1905 and over the next few years was extensively distributed throughout the islands. It was planted in the Bahamas in 1913. It first fruited in the Philippines in 1924; is grown to a limited extent in India and East Africa. It was widely planted in Israel, flourished and flowered freely but rarely set fruit. Elsewhere, it is valued mainly as a protective hedge and the fruit is a more-or-less-welcomed by-product. Climate The carissa is subtropical to near-tropical, thriving throughout the state of Florida and enduring temperatures as low as 25º F (-3.89º C) when well-established. Young plants need protection when the temperature drops below 29º F (-1.67º C). Best growth is obtained in full sun. Soil The shrub thrives in dry, rocky terrain in Hawaii; in red clay or sandy loam in California, and in sandy or alkaline soils in Florida, though the latter may induce deficiencies in trace elements. The plant has moderate drought tolerance and high resistance to soil salinity and salt spray. It cannot stand water-logging. Propagation Seeds germinate in 2 weeks but the seedlings grow very slowly at first and are highly variable. Vegetative propagation is preferred and can be done easily by air-layering, ground-layering, or shield-budding. Cuttings root poorly unless the tip of a young branchlet is cut half-way through and left attached to the plant for 2 months. After removal and planting in sand, it will root in about 30 days. Grafting onto seedlings of the karanda (q.v.) has considerably increased fruit yield. Culture Seedlings may begin to produce fruit in 2 years; cuttings earlier. A standard, well-balanced fertilizer suffices except on limestone where trace elements must be added. Dwarf cultivars must be kept under control, otherwise they are apt to revert to the ordinary type. Vigorous shoots will develop and outgrow the compact form. Pollination and Fruit Set In its homeland, the carissa is pollinated by small beetles and hawk-moths and other night-flying insects. Various degrees of unfruitfulness in America has been attributed to inadequate pollination. Some seedlings are light-croppers, but others never bear at all. It has been found that unproductive plants, apparently self-infertile, will bear fruits after cross-pollination by hand. Season While the carissa flowers and fruits all year, the peak period for blooming and fruiting is May through September. The 5-pointed calyx remains attached to the plant when the fruit is picked. Pests and Diseases
Spider mites, thrips and whiteflies, and occasionally scale insects, attack young plants, especially in nurseries and in the shade.
A number of fungus diseases have been recorded in Florida; algal leaf spot and green scurf caused by
Cephaleuros virescens; leaf spot from Alternaria sp., Botryosphaeria querquum, Fusarium sp., Gloeosporium sp., Phyllosticta sp. and Colletotrichum gloeosporioides which also is responsible for anthracnose; stem gall from Macrophoma sp., Nectria sp., Phoma sp., Phomopsis sp., and both galls and cankers from Sphaeropsis tumefaciens; dieback caused by Diplodia natalensis and Rhizoctonia solani; thread blight from Rhizoctonia ramicola; root rot resulting from infection by Phytophthora parasitica and Pythium sp.
The carissa must be fully ripe, dark-red and slightly soft to the touch to be eaten raw. It is enjoyed whole, without peeling or seeding, out-of-hand. Halved or quartered and seeded it is suitable for fruit salads, adding to gelatins and using as topping for cakes, puddings and ice cream. Carissas can be cooked to a sauce or used in pies and tarts. Stewing or boiling causes the latex to leave the fruit and adhere to the pot (which must not be aluminum), but this can be easily removed by rubbing with cooking oil.
Carissas are preserved whole by pricking, cooking briefly in a sugar sirup and sterilizing in jars. Peeled or unpeeled, they are made into jam, other preserves, sirup or sweet pickles. Jelly is made from slightly underripe fruits, or a combination of ripe and unripe to enhance the color.
Food Value Analyses made in the Philippines show the following values: calories, 270/lb (594/kg); moisture, 78.45%; protein, 0.56%; fat, 1.03%; sugar, 12.00%; fiber, 0.91%; ash, 0.43%. Ascorbic acid content has been calculated as 10 mg/100 g in India.
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I was directed to this excellent article, Red Sex Blue Sex, about attitudes towards sex in red and blue states in the United States by Tom Rees of Epiphenom. I highly recommend reading it to those who think that
abstinence-only sexual education for teenagers works, morality is superior in the Bible Belt, there are fewer instances of sexually transmitted diseases among Evangelicals and other Christians, God is a better guide to sexuality than parents, non-Christian Americans get pregnant earlier, or that a certain attitude toward sex implies equal sexual behavior.
From the article:
Social liberals in the country’s “blue states” tend to support sex education and are not particularly troubled by the idea that many teen-agers have sex before marriage, but would regard a teen-age daughter’s pregnancy as devastating news. And the social conservatives in “red states” generally advocate abstinence-only education and denounce sex before marriage, but are relatively unruffled if a teen-ager becomes pregnant, as long as she doesn’t choose to have an abortion.In short, it is misguided to obtain your moral views on sexual intercourse and all that from the Bible. When we educate our children we better not ignore that they are humans with a natural desire. To do so 1) makes them unhappy adults, and 2) doesn't work anyway.
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Publication Overview
This anatomy and physiology workbook, now in its
second edition, is a unique study guide for introductory courses and textbooks in speech and hearing anatomy and physiology. Whether taught face to face or online, anatomy and physiology courses are dense in content and new material, and a practical book is much needed for undergraduate training in speech pathology. Recognizing this, the authors, all experienced practitioners as well as instructors, have produced such a text, ensuring also that it does not suffer from being unnecessarily complex and academic.
The Workbook is organized into seven units. The first unit contains a comprehensive synopsis of anatomy and physiology, including content such as locator terms, planes of reference and anatomical position, enabling students to learn the vocabulary needed to study anatomy and physiology. The second unit takes a brief look at the basics of cells and tissues to form a foundation for study of larger structures. The remainder of the Workbook organizes speech and hearing anatomy into the functional categories of respiration, phonation, articulation, as well as the nervous and auditory systems.
The organization of this study-guide workbook complements the content of most speech and hearing anatomy textbooks currently on the market, as well as online courses. Each unit provides an extremely well written, practical summary of the particular speech and hearing system (unit), followed by learning objectives, specific questions students can answer in outline format, and finally a Self-Test.
Unique study guide for introductory courses. Designed as a primary text or to work with extant textbooks and online courses. Features summaries of learning units, learning objectives, questions and Self-Tests. Practical questions and organization of this workbook will guide students through their learning of anatomy and physiology.
For the
second edition, the authors have added an Active Learning Guide for enhanced student comprehension.
The Active Learning Guide contains information to help students respond to items in the Workbook. This section includes suggested responses to blank spaces sketch boxes in the Study Outline units.
These new features help students assimilate and master the basics of anatomy and physiology of speech and hearing. The use of multiple sources and repeated exposure reinforces learning and will lead students to the ultimate goal: practical application of the material.
Reviews Jessica Greenway, Nottingham University Hospitals, UK, ENT News (2008): "...Clear and concise and well-paced throughout its structured units... Should provide an excellent degree of detail to be used as a valuable academic and clinical resource for students and newly qualified practitioners in a variety of health care professions. [Refers to First Edition]" Andrew B. John, International Journal of Audiology, 2013 (06/20/2013): "...Authors Culbertson, Christensen, and Tanner introduce the Guide as "intend[ed] to augment a one-semester (or two quarters) undergraduate course in anatomy and physiology of human communication". Students at this level will appreciate the clear and colloquial tone with which concepts are presented... The Guide's organization of topic areas into bulleted lists and study suggestions allows a student to reduce what can be an overwhelming amount of new information into more easily digestible pieces...In most respects, the Study Guide serves its intended purpose as a supplementary text well. The book is written at an appropriately technical level for an audience of beginning learners." Raguwinder Sahota, MBChB MRCS (Eng), DoHNS (Eng), ENT & Audiology News (September 2014): "Overall this is an excellent and useful book. It is both concise and has a clear and easy to understand format. ...This book is a great educational resource that is easy to read and organized in small enough sections to stop you from losing concentration. The material is up to date and has been improved upon the previous version. ...It is a good book to lay down the foundation of the communication systems in an organised and well structured manner that twill help anyone who is new to this field." STUDY GUIDE WORKBOOK
Introduction
Unit 1: Introduction to Anatomy and Physiology Synopsis of Anatomy and Physiology Objectives and Study Guide Study Outline Self Test Unit 2: Cytology and Histology Synopsis of Cytology and Histology Objectives and Study Guide Study Outline Self Test Unit 3: The Respiratory System Synopsis of the Respiratory System Objectives and Study Guide Study Outline Self Test Unit 4: The Phonatory Mechanism Synopsis of the Phonatory System Objectives and Study Guide Study Outline Self Test Unit 5: The Articulatory Mechanism Synopsis of the Articulatory System Objectives and Study Guide Study Outline Self Test Unit 6: The Nervous System Synopsis of the Nervous System Objectives and Study Guide Study Outline Self Test Unit 7: 'The Auditory System Synopsis of the Auditoryu System Objectives and Study Guide Study Outline Self Test ACTIVE LEARNING GUIDE ANSWER KEY to WORKBOOK ITEMS
Introduction and Suggestions for Use
Unit 1: Introduction to Anatomy Unit 2: Cytology and Histology Unit 3: The Respiratory System Unit 4: The Phonatory Mechanism Unit 5: The Articulatory Mechanism Unit 6: The Nervous System Unit 7: The Auditory System
Answers to Workbook Self Tests
Index
References and Recommended Readings
About The Authors
William R. Culbertson, PhD is Associate Professor of Health Promotion at Northern Arizona University, having previously served as Associate Professor and Chair of the Department of Communication Sciences and Disorders. A distinguished career has included private practice, consultancy and practice in the school system, as well as some 13 years teaching anatomy and physiology.
Stephanie Cotton Christensen is a Visiting Instructor at Northern Arizona University where she is developing and teaching online Speech-Language Pathology Assistant training courses. She is also a Doctoral Candidate in the Applied Linguistics program. She received a masters degree in communication sciences and disorders from the University of Texas at Austin.
Dennis C. Tanner, PhD is Professor of Health Sciences at Northern Arizona University, Flagstaff, in the Speech-Language Sciences and Technology program. Dr. Tanner is author or co-author of more than 20 books and has published widely in academic journals. Dr. Tanner has a wealth of experience in the teaching of anatomy and physiology for speech and hearing sciences. Dr. Tanner received his M.S. in Speech Pathology and Audiology from Idaho State University and his Ph.D. in Audiology and Speech Sciences from Michigan State University. Dr. Tanner was the recipient of the Outstanding Educator Award, granted by the Association of Schools of Allied Health Professions, in Washington, D.C., 2001-2002, in addition to the College of Health Professions' "Teacher of the Year" Award, 2001-2002.
Related Titles
272 pages, Color Illustrations (4 Color), Softcover, 7 x 10"
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Having considered four of the major corporate stakeholders in our medical industrial complex — the insurance, drug, and hospital industries as well as business — it is now time to turn our attention to organized medicine. Since physicians order almost all services that are provided within our health care system, they are obviously a key player and interest group in the debate over health care reform.
Organized medicine has a poor track record in terms of reform. Although a universal system of health insurance was considered favorably for a short time by a committee of the American Medical Association (AMA) during Teddy Roosevelt’s abortive attempt to establish such a program during the 1912 to 1917 period, the AMA has played a consistently reactionary role against such reform since then.
During the 1930s the AMA was a much stronger political force than it is today, to the extent that FDR did not include national health insurance as part of his New Deal policies. Three decades later, the AMA fiercely opposed Medicare as socialized medicine and a government takeover. It jumped on the bandwagon only after the American Hospital Association and Blue Cross got together in its support. Its initial opposition, however, soon turned to making best use of the program. Physicians’ fees jumped almost eight percent in the first year after the program was enacted, more than twice the rise in the consumer price index.
Since World War II, organized medicine was fragmented into many smaller specialty and sub-specialty groups. As specialization advanced in following years, the AMA lost much of its political influence. Its membership dropped by 20 percent between 1993 and 2004. Of the approximately 900,000 U. S. physicians today, the AMA’s membership is less than one-quarter, and the “house of medicine” is split into some 180 specialty and sub-specialty organizations and societies.
In the late spring of 2009, President Obama was busy getting the major stakeholders aboard his train for health care reform. We have seen how the insurance, drug and hospital industries made specific pledges in an effort to help pay for reform. While organized medicine made no such specific pledge, it was offered a deal by the White House if it would give its general support to the reform effort.
Once again, it was all about money. Whereas physicians had been facing cutbacks each year in Medicare reimbursement, usually reversed by Congress, the Obama Administration offered $245 billion to physicians as the “doc fix”. At first, the Administration did not want to count this amount as costs of reform, but the CBO soon scored it as the additional costs that they are, coming up with a $239 billion increase in the federal deficit over the next ten years.
So what are the attitudes among these many physician organizations toward the various reform proposals working their way through Congress? True to form, the AMA and most groups are supportive of anything that will increase their reimbursement while opposing much else in the proposals. Reassured that the “doc fix” would provide more generous Medicare reimbursement (about 20 percent higher than it would have been under the original formula), at least for a time, the AMA and American College of Surgeons (ACS) expressed their support for the center piece of the reform bills — efforts to expand affordable health insurance through employer and individual mandates, subsidies for lower-income people to purchase insurance, and expansion of Medicaid. But for the AMA and most medical organizations, that is where their support melts away. Instead, they vigorously oppose these provisions:
• The public option. In a letter to the Senate Finance Committee, the AMA had this to say: “Creating a public health insurance option for non-disabled individuals under age 65 is not the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”
• An empowered independent Medicare rate-setting commission. The AMA and ACS quickly expressed their opposition when White House budget director Peter Orzag proposed a new federal commission with the authority to set payment policy for physicians, hospitals, and other providers.
• Targeted Medicare reimbursement cuts. In July 2009, the Administration proposed a plan to cut Medicare payments to cardiologists and oncologists by more than 10 percent each while increasing reimbursement to family physicians by 8 percent and nurses by 7 percent. This prompted leaders of the American College of Cardiology to warn that “The cuts could have the unintended consequences of rationing care, especially in rural regions with a large number of Medicare patients. In other areas, specialists may decide to pull out of Medicare, or ask patients to make up the difference with higher out-of-pocket payments.”
Organized medicine has become so fragmented that no one group speaks for the profession. In fact, some groups have endorsed major health care reform, even to the point of single-payer national health insurance (NHI). As the second largest medical organization in the country with some 125,000 members, the American College of Physicians (ACP) has endorsed single-payer as one of two major options to reform our system. The American Public Health Association (APHA) has come out in favor of NHI. And of course, Physicians for a National Health Program (PNHP), a growing organization with 16,000 members, has pushed strongly for NHI since it was established in 1989. Meanwhile, many physicians across most specialties have come to see NHI as the only way to provide universal access to affordable health care. A large national survey involving more than 2,200 U. S. physicians in 2008 found that 59 percent support government legislation to establish national health insurance.
In our next post, we will reassess how the “alliance” of these five major stakeholders stack up for or against reform proposals being fought over in Congress.
John Geyman, M.D. is the author of The Cancer Generation and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, 2008. With permission of the publisher, Common Courage Press
Buy John Geyman’s Books at: http://www.commoncouragepress.com
Physicians for a National Health Program's blog serves to facilitate communication among physicians and the public. The views presented on this blog are those of the individual authors and do not necessarily represent the views of PNHP.
PNHP Chapters and Activists are invited to post news of their recent speaking engagements, events, Congressional visits and other activities on PNHP’s blog in the “News from Activists” section.
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It is said that conflict serves as a ‘green pasture’ for journalists. That may be true to some extent. Yet, when a society is threatened by violent conflicts, journalism too comes under fire. Junaid Katju tries to find as to how free is the Press in the conflict-ridden Kashmir
In the strife-torn State of Jammu and Kashmir media has always been the causality of narratives emerging from both India and Pakistan. This is often tailored to suit the interests of one country or the other.
The border State has been reeling under conflict for the past 68 years. And in the midst of the bitterly fought battle between New Delhi and Islamabad, Kashmir-based press has been literally sandwiched.
It is a fact that the ever persistent turmoil at home has created a breeding ground for journalists in Kashmir. Many journalists who are today big names in the profession started their careers as reporters covering the Kashmir conflict.There are scores of young journalists who have travelled across oceans to international universities after bagging prestigious fellowships.
But it is nothing less than a trial by fire that journalists worth their salt cut their teeth in the profession. Journalists in Kashmir face consistent threats both from the State and non-State actors. Opposing sides seek to control the media and life is often at peril in an atmosphere where information is largely either unreliable or censored.
Dangling Sword
According to Kashmir Media Service, ten journalists have been killed while performing their duties since 1989.
The journalists in the Kashmir valley have learnt to live with routine manhandling, death threats and even murder attempts both by the Indian agencies and Pakistan-backed political groups. The concept of a free press is hardly anything but lip service in such a scenario.
On September 1995, Yousuf Jameela former BBC correspondent in Srinagar had a narrow escape when a parcel bomb was delivered to his office. Jameel was injured in the blast but his cameraman Mushtaq Ali who opened the package was killed in the incident.
“In a conflict zone this is but natural. I was lucky to survive but my colleague lost his life,” recalls Jameel while alleging that the attack was carried by the Ikhwan, a pro-government militia in Jammu and Kashmir, composed of surrendered Kashmiri militants.
Jameel who had survived two assassination attempts during his 34 years of challenging career said that at times the curfew passes which are meant to allow journalists to operate even during times of high security are not entertained.
In December 1995, Zafar Meraj, veteran journalist and editor of the English daily Kashmir Monitor, and now a Peoples Democratic Party member, was abducted by renegades. He was shot and critically wounded hours after he had interviewed their leader Muhammad Yusuf Parray alias Kukka Parray in Hajan area of Baramulla district.
In 2002, NDTV Correspondent Zafar Iqbal who was then working as a sub-editor for local daily Kashmir Images was shot at from a point-blank range by two unidentified gunmen in his office. Two bullets hit him on the neck and one his leg. But he somehow survived the attack.
There are many incidents where Kashmiri journalists have been roughed up, injured or detained, Photojournalists suffer the most as often they find themselves caught between the protesters and the police. On the eve of World Press Freedom Day more than a dozen lensmen were harassed by police while covering demonstrations in the downtown area.
Farooq Javed, president of Kashmir Press Photographers Association (KPPA), claims it has become a routine for photojournalists to get beaten or harassed by the forces while performing their duties.
“We are always in the line of fire. There have been many incidents where news photographers have been ruthlessly beaten or mauled by the police. They even damage our cameras that cost a fortune,” Javed said.
Sanctions
The extent of curbs on the fourth estate in Jammu and Kashmir can be better understood in context of the 2008 agitation when the State Government put a blanket ban even on the Srinagar-based local cable news network.
Local cable television channels were barred from broadcasting news independently. All the news units were sealed and dissenting journalists were threatened with dire consequences. The ban is yet to be lifted.
Sheikh Saleem, Executive Editor of English daily Kashmir Convener informs that every now and then the Central Government stops the Directorate of Advertising and Visual Publicity (DAVP) advertisements to the newspapers in Kashmir for allegedly ‘promoting secessionism’. The economic sanctions often compel small media houses to toe the Government line in order to stay in business.
While fighting to ensure their freedom of press, journalists in Kashmir also have to watch their back as separatists keep a close watch on reportage. Many a times, local newspapers have had to capitulate to the pressure from separatist camps too. In one of the incidents, a militant turned separatist politician ransacked the office of the leading newspaper in Kashmir after they published a report which was not exactly flattering for him.
Media houses often have to adhere to the diktats from these leaders and maintain cordial relationship in order to function without more troubles.
Yet, it would be pertinent to mention that the media in Kashmir do not face as much interference from the separatist groups as they do from the Government and its agencies.The reason behind this is that the newspapers in Kashmir largely are more sympathetic towards the free-Kashmir cause, which suits the aspirations of the separatist leaders and prick the Indian establishment.
Lately, the State Government has been keeping internet service in the valley on the crosshairs, with the establishment reacting to any agitation by blocking internet connectivity across Kashmir in the name of maintaining ‘peace’ in the region.
In September 2015, when millions of countrymen were watching their Prime Minister Narendra Modi in Silicon Valley unveiling his Digital India initiative with Facebook CEO Mark Zuckerberg, Kashmir was reeling under an e-curfew for three consecutive days following a beef -ban row.
Staying real
The discomfiture of the Fourth Estate is clear in the difference in terminology in the Kashmir press from that used by the media in the rest of the country.
A case in point- - newspapers in the valley instead of using the terms ‘terrorist’ or ‘freedom fighters’ like in the mainstream media (both India and Pakistan) use the word ‘militants’. Similarly, while it is Pakistan Occupied Kashmir (PoK) for the mainstream media, the Kashmir media prefers Pakistan Administered Kashmir (PaK) to refer to the same region.
Faisul Yaseen, a Kashmiri journalist, says the real challenge is to stick to the facts despite coercions. He feels while journalists succumb to pressure, the media houses too at times take sides for their vested interest.
“Long back when I was reporting for a local newspaper, the Regional Engineering College had a head who was from outside J&K and was communal to the core. I had all the details about his communal agenda and I filed my story. But the newspaper editors did not use it for over a year. Then when the controversy got out of hand and other newspapers reported it, the editor went ahead with the story too. So that way some editors know how to kill a story that is against the New Delhi's policy,” he said.
Today there might be a less interference of the State Government or threat by the militants but there is always a red line drawn which journalists in Kashmir cannot cross.
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Check out our new projector section click here. You will find reviews on the latest LCD projectors and DLP projectors for business presentations.
Every time you meet
another person there is an opportunity to do business. By sharing ideas,
leads, contacts and opportunities everyone prospers. The purpose of
networking is to give and get information. If you network properly,
nobody feels pressured or used. You are not selling, you are telling.
You are not asking for favors, you are giving valuable information.
By going to business
card mixers sponsored by the local chamber of commerce, starting or
joining networking clubs, and generally letting everyone in the world
know what you do, you'll be well on your way to getting more clients
--- and having fun at the same time.
There are 10 key
ingredients to make your networking effective:
Set networking
goals - determine the types of people you want to meet, how many you
want to meet and what functions you are going to attend.
Be specific -
While networking, be very specific about the type of person you want
to meet. For example, as a speaker and a trainer, I look for meeting
planners, training directors, human resource directors, personnel
directors and others. These are the people who hire people like myself.
Develop a "16
second" sizzler - You should be able to tell others what you do in
16 seconds or less. If we go on much longer than this peoples minds
tend to wander
Get involved
- Go to meetings of the rotary club and other civic and fraternal
organizations, church groups, trade and professional groups and others.
Increase your
visibility - Speak before groups at every opportunity. Write articles
for trade publications or newsletters. Become an officer in your club.
All these add to your credibility and motivate people to seek you
out.
Make contacts
- Whether it's a business or social situation and you want to meet
someone, just do it. Take the risk; what do you have to lose? The
more people you know the more opportunities will come your way
Ask - If you
don't ask for what you want, you won't get it. Find the person who
can help you … and whom you can help. Then ask.
Keep in touch
- Some people are great at networking. They have no trouble meeting
people, but when it comes to following up with them they drop the
ball. We recommend staying in contact with clients and those in your
network at least once every two months. Call them, invite them to
lunch, send articles relevant to their business, play golf, send them
a copy of your newsletter and so on. Whatever you do, stay in touch.
Always have your
networking tools with you --- Make sure you have your business card
and promotional material handy. I would also recommend you put your
picture on your business card. At the end of the day, you'll be remembered.
The more you
give, the more you get - When someone gives you a lead, referral,
new business, or an idea make a special effort to return the favor
as soon as possible. In addition, always send a handwritten thank
you card.
Printer Friendly Version
Click here for more articles by Arnold Sanow.
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by Alan Thornhill
Serious and organised crime is costing Australia $36 billion a year.
This was confirmed in research published by the Australian Crime Commission.
The Federal Justice Minister, Michael Keenan, said this is double previous estimates.
He described organised crime as “an ongoing threat to this country.”
Speaking of the criminals responsible he said:” they are violent predators who profit from the misery of evil trades.’
Mr Kennan also said:”Modern technologies are enabling organised criminals to expand their reach globally and inject themselves beyond traditional business models into new markets – increasing the misery being peddled and generating greater proceeds from crime.” This had meant:”Australia has become a target for organised criminals from all around the world because Australians are paying top dollar for the misery these crooks peddle like the drug ice.”
Mr Keenan warned that users are not only bankrolling the criminals that who are infiltrating and destroying our communities with their dangerous drugs.
“… they are ensuring our nation remains a lucrative market for international crime syndicates.
“New analysis by the Australian Crime Commission (ACC) has revealed that serious and organised crime is costing the Australian economy $36 billion per year – more than double previous estimates.
Mr Keenan said:”There is a perception among some people who take drugs that their illegal activities hurts no one.”
“But it’s actually costing every Australian more than $1500 – and sadly for some Australians, it has cost them their lives.”
“Our law enforcement agencies are going as hard as they can with all the tools we have provided, “ he added.
“But these efforts will always be challenged by organised gangs and their criminal business models if there is a lucrative market to exploit.”
That is why since coming to Government we have invested heavily in our law enforcement and intelligence agencies to boost their efforts to detect, disrupt and undermine the business models of organised criminals.”
“This is boosting our international cooperation to crack down on organised criminal syndicates responsible for the exportation of ice to Australia, including through Taskforce Blaze – a joint agency taskforce between the Australian Federal Police and the Chinese National Narcotics Control Commission focussed on investigating organised criminal syndicates responsible for the exportation of ice to Australia.
This is the first ever joint agency taskforce of its kind.”
He said:”The $36 billion figure takes into account the costs of serious and organised criminal activity ($21 billion) and the cost of prevention and response initiatives ($16 billion). “ He said, too, that:”Prevention and response costs include the costs incurred by law enforcement, the criminal justice system and other government agencies, the private sector and the general community in responding to, and preventing organised criminal activity.” “This is the first time the ACC has estimated the cost of serious and organised crime on the economy,.” Mr Keenan said.
“ It does not represent an explosion in crime, rather an improved understanding of the cost impacts to government, the community and the private sector.
“This will assist Government and our law enforcement and intelligence agencies to make an informed response to tackling this evolving market,” he added.
The project was led by an independent expert economist and criminologist, and was subject to review by a range of experts including law enforcement officers, criminologists and economists. Mr Keenan said the ACC’s public summary could be seen at www.crimecommission.gov.au. Please visit our sponsor My book
Weathercoast by Alan Thornhill
A novel on the murder of seven young Anglican Christian Brothers in the Solomon Islands.
Available now on the iTunes store.
Profile Alan Thornhill is a parliamentary press gallery journalist. Private Briefing is updated daily with Australian personal finance news, analysis, and commentary. Please visit our sponsor Your Comments THE MARKETS
All Ordinaries 5754.00 +22.00 +0.38% S&P 500 2353.48 +5.03 +0.21% Aud/usd 0.7635 -0.0039 -0.51% Bhp Blt Fpo 24.19 +0.27 +1.13% Westpac Fpo 33.44 -0.05 -0.15% Wesfarmer Fpo 43.40 +0.11 +0.25% Rio Tinto Fpo 60.00 +0.00 +0.00% Cwlth Bank Fpo 82.95 +0.24 +0.29% The News This Week Postscript 1 – Australia in the age of Trump Thank you The news: Friday January 20 Scrap debt reduction plan:Greens How prices are moving:ABS Trade:Trump warned The News: Wednesday January 14 It’s one rule for them…and The news:Wednesday January 11 Retail growth flattens The news:Tuesday January 10 The news:Monday January 9 The news: Sunday January 8 Don’t come the raw prawn with us:Barnaby The news: Friday January 6 Please visit our sponsor Topics agriculture (203) Airlines (329) Banking (3,951) Business (4,227) climate (107) Communications (127) corruption (33) crime (84) defence (105) Diplomacy (106) disability (19) Disaster (180) Economics (4,246) education (177) employment (435) Environment (214) farms (135) Financial advice (3,783) Health (266) Housing (1,094) Inflation (662) Insurance (155) Investment (3,169) Law (34) manufacturing (203) Markets (3,121) Media (157) medical (152) mining (577) pay (348) pensions (121) Politics (4,585) population (1,228) property (138) Regulation (1,460) retail (113) retirement (207) rural (68) Rural australia (185) Security (66) Social security (497) Superannuation (324) Tax (672) terrorism (29) The latest (1,519) Trade (1,572) transport (112) Uncategorized (1,005) welfare (219)
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Friday, August 13, 2010
A lot of reptiles have the amazing ability to lose a limb and just grow it back. So what to a human would be a life altering disaster is just a mild inconvenience. I’m sure anyone who lost an arm or a leg would like to have the ability to just grow it back.
Researchers in California have come up with the first step in that process. Removing a barrier to regrowing organs.
Basically by removing two cancer-preventing genes they can restart the muscle growing properties of muscle cells. Obviously these genes can only be turned off for a short time or else the cells start becoming cancerous, but in that short time they might be able to repair muscle damage to the heart, or many other places in the body that muscle damage impairs.
As research in this field progresses we might find more ways to regrow different types of tissues and eventually regrow entire organs and limbs.
What today is a lifetime disability like losing an arm, will mean a few weeks in the hospital and your good as new. This will lead to a Fantastic Future.
By Darrell B. Nelson author of Invasive Thoughts
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Home | About | Journals | Submit | Contact Us | Français
Primary care practitioners (PCPs) have been encouraged to screen all adults for obesity and to offer behavioral weight loss counseling to affected individuals. However, there is limited research and guidance on how to provide such intervention in primary care settings. This led the National Heart, Lung, and Blood Institute (NHLBI) in 2005 to issue a request for applications to investigate the management of obesity in routine clinical care. Three institutions were funded under a cooperative agreement to undertake the Practice-based Opportunities for Weight Reduction (POWER) trials. The present article reviews selected randomized controlled trials, published prior to the initiation of POWER, and then provides a detailed overview of the rationale, methods, and results of the POWER trial conducted at the University of Pennsylvania (POWER-UP). POWER-UP’s findings are briefly compared with those from the two other POWER Trials, conducted at Johns Hopkins University and Harvard University/Washington University. The methods of delivering behavioral weight loss counseling differed markedly across the three trials, as captured by an algorithm presented in the article. Delivery methods ranged from having medical assistants and PCPs from the practices provide counseling to using a commercially-available call center, coordinated with an interactive web-site. Evaluation of the efficacy of primary care-based weight loss interventions must be considered in light of costs, as discussed in relation to the recent treatment model proposed by the Centers for Medicare and Medicaid Services.
In 2003, the U.S. Preventive Services Task Force recommended that primary care practitioners (PCPs) screen all adults for obesity and offer behavioral interventions and intensive counseling to affected individuals.
1 This recommendation came at a time when fewer than half of PCPs were found to discuss weight management with their patients, 2 and there were no evidence-based guidelines for implementing behavioral weight loss counseling in primary care settings. In 2005, in response to this gap in practice and research, the National Heart, Lung, and Blood Institute (NHLBI) issued a request for applications (RFA) to investigate the management of obesity in routine clinical practice. 3 Three institutions were funded by a cooperative agreement (UO1), which allowed each to design and implement its own randomized controlled trial (RCT) of a novel weight loss intervention. However, investigators were encouraged to coordinate their trials, wherever possible, by developing common eligibility criteria and outcome measures. They met regularly (in person or by teleconference) to discuss these and other issues, including participant recruitment and retention, intervention development and implementation, statistical analyses, and dissemination.
Collectively, the three trials were referred to as Practice-based Opportunities for Weight Reduction (POWER).
3 The POWER trial implemented at the University of Pennsylvania (UP) was known as POWER-UP, 4 the study conducted at Harvard University (with coordination from Washington University) was referred to as Be Fit, Be Well, 5 while the trial at Johns Hopkins University was named POWER Hopkins. 6 The commonalities and differences among the three trials have been described previously. 3 Investigators at each site also have published results for their primary outcome (i.e., weight loss at 2 years) in separate articles. 4–6
The present article (with the five others in this supplement) provides further information about the development, implementation, and efficacy of the weight loss interventions tested in the POWER-UP trial at the University of Pennsylvania.
4 The review begins by summarizing the current status of lifestyle modification for obesity, examines prior efforts to provide such treatment in primary care practice, and then describes the methods and interventions used in the POWER-UP trial. The treatment approach and results of POWER-UP are briefly compared with those from Be Fit, Be Well and POWER Hopkins. The paper concludes by discussing POWER-UP’s results in the context of recent recommendations from the U.S. Preventive Services Task Force 7 and the Centers for Medicare and Medicaid Services. 8
Lifestyle modification for obesity – consisting of a combination of diet, physical activity, and behavior therapy – is considered the cornerstone of weight management for overweight and obese adults.
9,10 This approach uses behavioral strategies, such as goal setting and record keeping, to help individuals reduce their calorie intake by approximately 500–1000 kcal/day, principally by reducing their portion sizes, snacking, and consumption of high-fat, high sugar foods. 10–12 Caloric restriction is combined with recommendations to exercise (e.g., brisk walking) for at least 30 minutes/day most days of the week (i.e., 180 minutes/week). 13 In academic medical centers, behavioral treatment typically is delivered in weekly group or individual sessions that are led by registered dietitians, psychologists, exercise specialists, and other counseling professionals. 11
Weekly group lifestyle interventions of 16 to 26 weeks, as exemplified by the Diabetes Prevention Program
12 and the Look AHEAD study, 14,15 induce a mean weight loss of approximately 7–10% of initial weight during this time. Weight losses are associated with improvements in cardiovascular disease (CVD) risk factors, 16 including prevention of type 2 diabetes in at-risk individuals. 12 Patients are vulnerable to weight regain following the termination of treatment, but it can be limited by the provision of twice-monthly or monthly weight loss maintenance sessions. 11 Participants in the Look AHEAD study, for example, maintained a 4.7% reduction in initial weight at 4 years with the support of twice monthly maintenance contacts. 17
Lifestyle modification increasingly is being delivered by the Internet (rather than in face-to-face meetings), given its convenience to participants.
18–20 Web-based programs allow dieters to record their weight, food intake, and physical activity on-line and to receive colorful graphic displays of their progress. The most successful programs also include personalized feedback from an interventionist. 19–20 Despite their greater convenience, Internet intervention generally produce mean weight losses about one-third smaller than traditional face-to-face programs. 20 By contrast, preliminary studies suggest that interventions delivered in individual or group phone calls achieve losses roughly equal to face-to-face interventions. 21–23
Only a handful of RCTs had been conducted on the behavioral management of obesity in primary care practice when NHLBI funded the POWER Trials in 2006. The absence of trials was not surprising, given that PCPs lacked the time, training, and incentive (i.e., insurance reimbursement for obesity management) required to deliver a comprehensive lifestyle intervention, as described above.
24 As shown in Table 1, three trials in which PCPs provided brief behavioral counseling to obese patients in their practices produced mean losses of less than 2.5 kg at 6 to 12 months. 25–27 The modest losses were probably attributable to the limited number of treatment visits provided, which ranged from an average of 3.6 to 9.7 over 6 to 12 months. Martin et al. conducted an exemplary trial, which randomly assigned low-income women to: 1) usual care, consisting of as-needed medical treatment; or 2) a 6-month weight loss intervention, consisting of brief, monthly PCP counseling sessions. 26 Counseling visits lasted approximately 15 minutes and included personalized recommendations for changing diet and physical activity. At month 6, patients who received PCP counseling lost a mean of 1.4 kg, compared with a gain of 0.3 kg for usual care (p = 0.01).
Increasing the frequency of PCP lifestyle counseling to weekly or bi-weekly visits, as provided in group lifestyle modification programs, potentially could have increased mean weight losses in the study by Martin
et al. 26 However, as noted, PCPs may not have the capacity to provide such frequent treatment, given the already pressing demands on their schedules. Adding weight loss medication to PCP counseling offers another option for increasing weight loss, without taxing practitioners’ resources.
Trials conducted in academic medical centers have shown that adding weight loss medication to lifestyle counseling increases weight loss, compared with counseling alone.
28–30 Medication is thought to facilitate adherence to diet and calorie recommendations by reducing hunger (i.e., the drive to eat), increasing satiation (i.e., to terminate eating), or blocking the absorption of nutrients (e.g., fat). 28 Two RCTs, summarized in Table 1, examined the effectiveness of lifestyle counseling plus pharmacotherapy, provided by PCPs, as part of interventions that modeled brief office visits in primary care. Hauptman et al. 31 studied the effectiveness of orlistat (a gastric and pancreatic lipase inhibitor) in primary care patients randomly assigned to: 1) placebo; 2) 60 mg of orlistat TID; or 3) 120 mg of orlistat TID. All patients were prescribed a reduced-calorie diet during year 1 and a weight-maintenance diet during year 2. They also received brief dietary guidance from their PCPs, along with educational videotapes and printed materials. As shown in Table 1, weight losses at month 24 were 1.7, 4.5, and 5.0 kg for the three groups, respectively (p = 0.001 for both orlistat groups compared to placebo).
Wadden
et al. 28 assessed the effects of sibutramine (a serotonin-norepinephrine reuptake inhibitor) and lifestyle counseling. Patients were randomly assigned to: 1) sibutramine (10–15 mg daily), accompanied by 8 brief PCP visits over 12 months, limited to monitoring blood pressure and pulse; or 2) sibutramine plus brief PCP lifestyle counseling, provided during the same 8 brief visits. Patients in the latter group completed homework assignments from the LEARN program, 32 including daily food and activity records. Patients who received sibutramine plus PCP counseling lost significantly more weight at week 18 than did those who received sibutramine alone (8.4 vs. 6.2 kg, p = 0.05). At month 12, differences between groups were similar (7.5 vs. 5.0 kg) but no longer statistically significant.
These two studies, with the three others reviewed in Table 1, suggest that combining medication with brief PCP counseling is more likely to help participants achieve clinically meaningful weight loss (≥5% of initial weight) than is the provision of PCP counseling alone. This hypothesis remains to be tested using two new FDA-approved medications – lorcaserin
33 and the combination of phentermine and topirimate. 34 Many obese individuals, however, as well as their practitioners, may be unwilling to use weight loss medications because of concerns about their high costs (which frequently are not covered by insurance plans) and potential adverse health effects. Concerns about safety were underscored when sibutramine was removed from the market in 2010 because of findings that it increased the risk of CVD events in obese patients with a prior history of CVD. 35 Thus, new methods, which do not rely solely on PCPs, are needed for delivering behavioral weight loss counseling to obese patients in primary care.
Non-physician staff, known as auxiliary health providers (AHPs), provide an option for delivering such counseling in primary care. AHPs may have more time than PCPs to provide such care and at a lower cost. Most studies of AHPs have examined individuals with advanced training, such as nurses and pharmacists. However, trials have explored the use of medical assistants (MAs) and licensed practical nurses (LPNs) to provide behavioral counseling to facilitate compliance with mammography screening
36 and smoking cessation. 37
Prior to NHLBI’s issuing its weight management RFA, Tsai and Wadden developed a treatment model in which MAs were trained to serve as lifestyle interventionists (i.e., coaches), who worked in conjunction with PCPs.
38 With this approach, called collaborative obesity care, PCPs were responsible for assessing and treating patients’ weight-related co-morbidities (e.g., hypertension, type 2 diabetes) using appropriate pharmacologic therapies. In a pilot study of 50 patients recruited from two primary care practices, participants were randomly assigned to: 1) quarterly PCP visits (which included the provision of printed weight loss materials); or 2) brief lifestyle counseling, which included quarterly PCP visits, along with eight brief (15–20 minutes) counseling sessions with a trained MA (who worked in the practices). The lifestyle intervention was adapted from the DPP. 12 At month 6, participants in the brief lifestyle counseling and control groups lost 4.4 kg and 0.9 kg, respectively (p < 0.001). In addition, 48% of participants in the former group lost 5% or more of their weight, compared to 0% in the control group (p = 0.0001). However, at 1-year assessment, there were no significant differences between groups as a result of weight regain following the termination of MA coaching visits at month 6. This finding suggested that brief lifestyle counseling would need to be continued long term to facilitate the maintenance of lost weight.
The POWER-UP trial provided our research team an opportunity to extend its findings from the prior pilot investigation
38 by increasing the study’s sample size and the duration of treatment. The trial also allowed for the addition of a third treatment arm, designed to induce greater weight loss by providing either meal replacements or FDA-approved medications. An overview of the study’s three treatment interventions is provided, following a brief description of the study design. This information has been published previously, 4,39 but is summarized here to facilitate readers’ understanding of the five other empirical papers in this supplement.
POWER-UP was a 2-year RCT in which 390 obese participants with at least two components of the metabolic syndrome were randomly assigned to one of three conditions: 1) Usual Care; 2) Brief Lifestyle Counseling; or 3) Enhanced Brief Lifestyle Counseling. Participants were recruited (and treated) at six primary care practices (in the greater Philadelphia area) owned by the University of Pennsylvania Health System. To be eligible, participants had to be established patients in the practice, ≥ 21 years of age, and have a BMI of 30 to 50 kg/m
2 and at least two of five criteria for the metabolic syndrome. (Additional inclusion/exclusion criteria have been described elsewhere. 4,39)
The 390 participants randomized to treatment had a mean age of 51.5 ± 11.5 yr, weight of 107.6 ± 18.3 kg, and BMI of 38.5 ± 4.7 kg/m
2. Participants included 79 men (20.3%) and 311 women (79.7%), 95% of whom had completed high school or more; 54.4% of participants self-identified as non-Hispanic white, 38.5% as African-American, and 4.6% as Hispanic.
Table 2 provides an overview of the three treatment groups and reveals several commonalities. All participants were given the same diet and activity prescriptions but received different instructions and support for reaching these goals. Participants in Usual Care (N=130) met quarterly (i.e., every 3 months) with their PCP, who provided brief recommendations for weight management and distributed handouts adapted from the NHLBI brochure,
Aim for a Healthy Weight. 40 PCPs did not provide specific instructions for behavior change or ask participants to keep food or activity records.
Participants in Brief Lifestyle Counseling (Brief LC) (N=131) received the same quarterly PCP visits. In addition, they had monthly, individual 10–15 min visits with a MA (i.e., a lifestyle coach) who was trained to deliver treatment following abbreviated lessons from the DPP.
12,38 Each visit began with a weigh-in and review of participants’ diet and activity records (and other homework assignments). The coach then introduced a new topic on behavior change and reviewed goals for the coming month.
Individuals in Enhanced Brief Lifestyle Counseling (Enhanced Brief LC) (N=129) received the same treatment as those in Brief LC. However, in consultation with their PCP, they were given a choice of also using either meal replacements
41 or a weight loss medication – either sibutramine 28 or orlistat. 31 These three options were provided because of evidence that they increased weight loss, by 3–4 kg in the first 6 months, as compared with traditional lifestyle counseling alone. 31,34,41 Participants were only allowed one treatment option (including one medication) at a time but could switch between options with their PCP’s approval. Those who chose meal replacements were instructed for the first 4 months to replace two meals and one snack daily with shakes or meal bars (provided by SlimFast). Thereafter, they replaced one meal and one snack. Orlistat was provided as 60 mg at each meal (with the option of increasing to 120 mg after 6 months). Sibutramine was provided as 10 mg/d, with the option of increasing to 15 mg/d after 6 months if blood pressure and pulse values were within normal limits. (As noted previously, sibutramine was removed from the market in October 2010 because of findings of increased CVD events. 35 Participants who were taking sibutramine were given the option of using orlistat or meal replacements.)
Delivery of the interventions was standardized across the six sites by the use of detailed protocols and provider scripts (available from the first author). All participating PCPs and coaches were trained to deliver the intervention (to participants at their practice sites) by study staff who included physicians, psychologists, and registered dietitians. An initial 6–8 hours of training, provided before the study began, included an overview of the etiology and treatment of obesity, as well as a detailed review of the treatment materials provided to participants (and of methods to assess participants’ adherence to the intervention).
4,39 Role-plays were conducted with PCPs and coaches to simulate patient visits, and a checklist was used to assess providers’ adherence to the protocol. (PCPs also receive extensive education about the use of sibutramine and orlistat, including contraindications to treatment and monitoring for side effects.) PCPs and coaches were recertified in treatment delivery every 6 months, and they met with study staff at least monthly (i.e., PCPs) and as frequently as weekly (i.e., coaches) throughout the study to discuss issues related to protocol implementation and participants’ progress.
All outcome measures were collected at randomization and at follow-up visits at months 6, 12, and 24. Change in body weight (in kg) from baseline to year 2 was the study’s primary outcome. The primary hypothesis was that participants in both Brief LC and Enhanced Brief LC would lose significantly more weight at year 2 than those in Usual Care. Secondary hypotheses included that participants in Enhanced Brief LC would lose significantly more weight at year 2 than those who received Brief LC. The three groups also were compared on changes in measures of CVD risk, eating behavior, physical activity, mood, quality of life, and treatment cost (as described in the additional papers in this supplement).
A total of 110 (84.6%) Usual Care participants completed the 2-year assessment, as did 112 (85.5%) and 114 (88.4%) of those in Brief LC and Enhanced Brief LC, respectively. Changes in weight in the intention-to-treat (ITT) population (which included all randomized participants) were compared using repeated measures linear mixed-effects models (for continuous outcomes) and generalized estimating equations models (for categorical outcomes).
4
At month 24, participants in Usual Care, Brief LC, and Enhanced Brief LC lost a mean (± SEM) of 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively (see Figure 1A). Enhanced Brief LC was superior to Usual Care (p<0.001), whereas other differences between groups were not statistically significant. Weight losses of all three groups differed significantly from each other at month 6 and generally reached their maximum at month 12 (see Figure 1).
A total of 21.5%, 26.0%, and 34.9% of participants in Usual Care, Brief LC, and Enhanced Brief LC, respectively, lost ≥5% of initial weight, with significant (p=0.02) differences between the first and third groups only. Corresponding values for losing ≥10% were 17.8%, 9.9%, and 6.2%, respectively, with the only significant (p=0.006) differences between the same two groups. (The percentage of participants who lost ≥5% included those who lost ≥10%.)
At the trial’s outset, 67, 38, and 24 participants in Enhanced Brief LC chose meal replacements, sibutramine, and orlistat, respectively, as their enhancement. An ITT analysis, based on participants’ initial choice of enhancements, showed that these groups lost 3.9±1.0, 5.5±1.3, and 4.6±1.7 kg, respectively, at month 24, with no significant differences among groups (see Figure 2). Eleven (16.4%) participants who began the trial on meal replacements switched enhancements, as did 15 (38.5%) on sibutramine, and 8 (34.8%) on orlistat. Nine sibutramine discontinuations were in response to FDA warnings about the medication, the first in November 2009, which culminated in its removal from the market in October 2010. The 6-month assessment occurred prior to these warnings for all participants.
Month 24 weight losses for Enhanced Brief LC were reanalyzed, excluding the 44 (of 129) individuals who received sibutramine at any time. The remaining 85 participants lost 4.3±0.8 kg at month 24, which was significantly greater than the loss for Usual Care (1.7±0.7 kg) but not for Brief LC (2.9±0.7 kg). An analysis of the 66 participants in Enhanced Brief LC who used meal replacements (without ever using sibutramine) for the majority of the trial revealed a loss of 4.1±0.9 kg at month 24, which was significantly (p=0.044) greater than that for Usual Care but not Brief LC (p=0.302).
Results of POWER-UP indicate that PCPs, working with MAs, can provide effective weight management for some of their obese patients in primary care practice. The Usual Care intervention, in which PCPs provided handouts and spoke briefly with participants about their weight at quarterly intervals, helped 22% of participants lose ≥5% of initial weight. By contrast, the study’s most intensive intervention, Enhanced Brief LC, facilitated 35% of patients achieving this goal. POWER-UP, thus, provides primary care practices a model for delivering lifestyle counseling to their obese patients, as encouraged by the U.S Preventive Services Task Force.
1 Meal replacements probably provide a more economical and patient-acceptable method than medications of increasing weight loss with brief lifestyle counseling. Participants who used primarily meal replacements throughout the trial lost an average of 4.1 kg at 2 years, a value that compared favorably (at the same duration of follow-up) with the results of more intensive, group lifestyle modification programs. 11,12,42
POWER-UP’s use of brief lifestyle counseling visits is particularly timely in view of the Centers’ for Medicare and Medicaid Services (CMS) decision in 2011 to reimburse the provision of intensive behavioral weight loss counseling to obese seniors, when delivered by physicians, nurse practitioners, or physician assistants working in primary care.
8 The CMS model proposes that patients have weekly, brief (i.e., 15 minute) face-to-face counseling visits the first month, followed by twice-monthly visits for the next 5 months. Patients who lose 3 kg at the end of this time are eligible for 6 additional monthly visits. The efficacy of this treatment model, as delivered by PCPs identified above, has not been tested. However, we believe that the higher frequency of treatment visits prescribed by CMS, compared to POWER-UP’s visit schedule (14 vs. 8 visits, respectively, in the first 6 months), should increase mean weight loss accordingly. 43
In designing the POWER-UP study, we had wanted to provide more frequent lifestyle counseling visits to increase weight loss. However, we decided against this approach for fear of overwhelming the practices’ already busy MAs. PCPs with whom we discussed the issue believed that a high intensity intervention would be difficult to disseminate in primary care. They similarly thought that even a moderate intensity intervention (i.e., monthly visits), as used in POWER-UP, would be difficult to implement if the practice did not have additional support and funding.
In 2012, the U.S. Preventive Services Task Force updated its recommendation that clinicians screen all adults for obesity and offer intensive multicomponent behavioral interventions to affected individuals.
7 Two important modifications included: 1) a clear recommendation for high intensity counseling (defined as more than monthly contact); and 2) the suggestion that practitioners either provide such treatment themselves or refer patients to appropriate interventions. The option of referral is an important one, given that community-based weight loss programs and providers may be able to provide weight reduction at lower cost than primary care practitioners. However, we believe that it is critical to maintain PCPs’ involvement in the management of obesity and its co-morbidities, regardless of whether patients are referred out of practice for lifestyle counseling.
Tsai and Wadden
44 proposed a treatment algorithm that puts PCPs at the center of obesity management, while providing numerous options for the provision of lifestyle modification with appropriate patients (see Figure 3). In this model, PCPs play a critical role in screening adults for obesity and in providing appropriate medical management for weight-related CVD risk factors and other conditions. PCPs also are well prepared to educate patients about the contribution of excess weight to health complications, as well as to inform them of the significant health benefits of a 5 to 10% reduction in initial weight. 9,10 Practitioners also can assess obese patients’ motivation for weight reduction and, with interested patients, develop a weight loss plan. This could include brief quarterly counseling visits, shown by POWER-UP to be effective in inducing meaningful weight loss in about 20% of participants. With patients who do not wish to lose weight, PCPs should seek to clarify barriers to weight reduction and discuss the need to at least prevent further weight gain. 45
PCPs have multiple options for offering behavioral weight loss counseling. We have already discussed options shown on the left-hand side of the algorithm which include physician-delivered lifestyle counseling (with or without the use of medication) and collaborative obesity care in which lifestyle modification is delivered by MAs, as in the POWER-Up study, or by other office personnel including health counselors, nurses, or dietitians. Some primary care practices may be able to offer group treatment, as provided in academic medical centers.
46 In all cases, patients would receive behavioral weight management within the primary care practice, which has the advantage of capturing individuals at the point of treatment and fully integrating weight management with patients’ other health care.
The provision of behavioral counseling, using any of these models, may be impractical in many primary care practices because of the increased volume of patient visits (resulting from high frequency counseling), lack of physical space, or costs of hiring additional staff. Some PCPs may be able to refer patients to programs or professionals who provide counseling as part of an integrated health care system to which the practice belongs.
Alternatively, as shown on the right-hand-side of Figure 3, PCPs may refer motivated patients to self-help or commercial programs in the community that have been empirically validated (e.g., Weight Watchers
47,48). These could include programs delivered by telephone (i.e., call centers), Internet, or their combination. PCPs also may refer patients to obesity-treatment specialists in the community (e.g., registered dietitians, physicians, bariatric surgeons). With all of these options, patients will benefit from their PCPs actively monitoring changes in their weight and health, congratulating them on their success, and reminding them of the need for long-term behavior change. We believe that PCPs must remain active members of the weight management team.
Be Fit, Be Well
5 and POWER Hopkins 6 both recruited obese patients from primary care practices, using similar participant eligibility criteria as the POWER-UP trial. However, the lifestyle interventions used in the two former trials diverged significantly from POWER-UP’s by delivering obesity management outside of the primary care practices, following models proposed on the right-hand side of Figure 3. As briefly described, both studies included the use of telephone- and Internet-delivered interventions.
Be Fit, Be Well randomly assigned predominantly low-income patients with hypertension to: 1) usual care; or 2) a 2-year behavioral weight loss intervention that also included self-management of hypertension. Every 3 months, intervention participants were prescribed three tailored goals to modify their eating and activity behaviors (e.g., reducing fat intake), which they monitored using either an interactive voice response (IVR) system or a study website. (Participants did not receive specific prescriptions for food intake [e.g., 1200 kcal/d] or physical activity [e.g., 180 min/wk of walking] because of concerns that such goals would not be acceptable to many individuals.) Intervention participants had monthly 15–20 minute telephone counseling calls the first year and every-other-month calls the second year. Calls were conducted by trained community health educators who also provided 12 optional, on-site group treatment sessions. Participants’ PCPs delivered at least one brief standardized message about the importance of participating in the intervention but otherwise did not provide any weight loss counseling.
As summarized in Table 3, at month 24, the usual care and intervention groups lost a mean of 0.5 kg and 1.5 kg, respectively. It is impossible to determine whether the modest average weight losses observed in the intervention group were attributable to the (primarily) remote delivery of treatment (by IVR and website), the moderate intensity of care (i.e., monthly contact), the decision not to provide specific goals for energy intake or expenditure, or to the study’s low-income population, comprised principally of ethnic minorities (i.e., 71% African American). African Americans typically lose significantly less weight than non-Hispanic white participants during the first 12–24 months of lifestyle modification.
15,49 The mean weight losses in Be Fit, Be Well were similar to those obtained by Kumanyika et al. 50 in a trial of minority participants, also conducted in primary care practices.
The POWER Hopkins trial examined the effectiveness of a 2-year behavioral weight loss intervention delivered remotely or in-person, in both cases by interventionists not affiliated with the primary care practices from which participants were recruited. Participants randomized to the Remote Support condition had 12 initial weekly phone calls (20 min), delivered by a trained counselor (from Healthways; www.healthways.com), followed by monthly calls for the remainder of the study (for a total of 33 phone contacts over the 2 years). Participants were instructed to record their weight, calorie intake and physical activity in a web-based program (provided by the study), which also presented a curriculum of behavior change.
Participants assigned to In-Person Support were provided weekly sessions for the first 3 months (9 group and 3 individual meetings) and 3 sessions per month (1 group and 2 individual meetings) from months 4–6. (All sessions were led by trained interventionists from Johns Hopkins University.) For the remainder of the study, these participants were offered two sessions per month, with one group and one individual contact (that latter which could be completed by phone, if desired), for a total of 57 contacts over 2 years. These participants were prescribed the same diet and activity goals as those in the Remote-Support condition and were provided the same web-based program. PCPs of participants in both intervention groups were provided a one-page report on patients’ progress at each routine office visit (i.e., scheduled as needed by patients, rather than as determined by the study), and they encouraged patients’ participation in the intervention. Participants assigned to a control group were provided a brief meeting with a lifestyle coach at randomization and the option of another meeting at month 24.
At month 24, mean weight losses in the Control, Remotely-Delivered, and In-Person Support conditions were 0.8, 4.6, and 5.1 kg, respectively (see Table 3). Weight decreased by ≥5% in 18.8, 38.2, and 41.4% of patients in the three groups, respectively. Both intervention groups were superior to usual care on both measures of success (p < 0.001).
The mean 4.6 kg weight loss achieved by the Remotely-Delivered intervention in POWER Hopkins is particularly impressive because it was achieved with only 33 brief telephone contacts, combined with the use of a web-based program. This intervention would appear to be as effective and significantly less costly, with respect to provider and participant time, than the In-Person intervention, which provided a total of 57 in-person contacts (combined with the same web-based program). Findings for the intervention contribute to a growing body of literature that indicates that high-intensity telephone-based interventions (with or without the addition of a web-based program) produce weight losses comparable to those achieved in traditional in-person interventions. (A version of the Power Hopkins Remotely-Delivered intervention is now commercially available from Healthways as “innergy.”)
POWER-UP’s Brief Enhanced Lifestyle Counseling approach and POWER Hopkins’ Remote Support intervention used markedly different methods to provide weight management to obese patients in primary care but achieved roughly comparable results at two years. POWER-UP offered weight management to patients in their primary care settings, as delivered by familiar PCPs and MAs from the practices. POWER Hopkins offered lifestyle modification through a call center operated by a commercial vendor (Healthways) with which patients had never had contact. POWER-UP used meal replacements and medications to increase weight loss above that which could be achieved by once-monthly lifestyle counseling alone (as demonstrated during the first 6 months). POWER Hopkins used weekly, brief (20 minutes) telephone calls during the first 12 weeks, combined with an interactive web-site, to deliver the high-intensity counseling that is commonly offered in academic medical centers. Both treatment models have their strengths and weaknesses and both potentially have a place in the management of obesity in primary care practice. PCPs’ desire to offer lifestyle counseling in their practices would be a critical determinant of their adopting the POWER-UP model, described here.
Cost is perhaps the most pressing issue facing the provision of weight loss counseling in primary care practice, as discussed by Tsai
et al. in this supplement. Even though POWER-UP has demonstrated that PCPs and MAs, working together, can induce clinically meaningful weight loss in some patients, this finding does not necessarily mean that they can afford to provide such care, when less expensive, equally effective weight loss interventions may be available. The same concern arises when considering CMS’s proposal to reimburse only physicians, nurse practitioners (NPs), and physician assistants (PAs) for providing weight loss counseling. Ultimately, these practitioners, with their health care administrators, must decide whether they can afford to devote time to behavioral weight loss counseling, with its demand for weekly and then twice-monthly sessions for the first 6 months. Practices would have to hire more physicians, NPs, and PAs to provide routine medical care to patients whose former PCPs’ schedules were now filled delivering behavioral weight loss counseling. Hiring registered dietitians or other trained lifestyle interventionists to provide lifestyle modification would appear to be more economical for primary care practices (and CMS) than deploying physicians, NPs, and PAs in this effort.
The option of having patients receive weight loss counseling from a call center, Internet program, or face-to-face commercial program would appear to be very attractive to primary care practitioners and health plans, provided that the interventions had demonstrated their safety and efficacy in peer reviewed publications. In addition to potentially being less costly for health insurers and other payers to provide, remotely-delivered programs would appear to be more convenient and more economical for patients. A recent 26-week trial by Harvey-Berino
et al. compared an in-person intervention to the same program provided by Internet. 51,52 The in-person group lost a mean of 8.0 kg, compared with 5.5 kg for the Internet program. However, the cost of delivering the Internet program was only $372 per person compared with $702 for the in-person intervention, a difference based largely on participants’ travel costs. The attractiveness of Internet and call-center interventions is further enhanced by the ability to deliver them to persons in rural communities who do not have access to traditional face-to-face interventions.
The NHLBI-supported POWER trials have provided an important first step in identifying safe and effective methods of providing weight management to obese individuals encountered in primary care practice. Findings from the papers contained in this supplement, as well as additional expected publications from Be Fit, Be Well and POWER Hopkins, should provide preliminary guidance for practitioners who wish to provide weight loss counseling. As important, the present findings provide important hypotheses to test concerning the skills and credentials required to provide weight management in primary care and concerning the most cost-effective methods of providing such counseling.
Funding: Supported by grants from the National Heart, Lung, and Blood Institute (U01-HL087072) and National Institute of Diabetes and Digestive and Kidney Diseases (K24-DK065018).
POWER-UP ClinicalTrials.gov number NCT00826774
This research was supported by grants U01-HL087072 from the National Heart, Lung, and Blood Institute and K24-DK065018 from the National Institutes of Diabetes and Digestive and Kidney Disease.
We thank Amos Odeleye for his assistance with statistical analysis.
Academic investigators at the Perelman School of Medicine at the University of Pennsylvania were Thomas A. Wadden, Ph.D. (principal investigator), David B. Sarwer, Ph.D. (co-principal investigator), Robert I. Berkowitz, M.D., Jesse Chittams, M.S., Lisa Diewald, M.S., R.D., Shiriki Kumanyika, Ph.D., Renee Moore, Ph.D., Kathryn Schmitz, Ph.D., Adam G. Tsai, M.D., MSCE, Marion Vetter, M.D., and Sheri Volger, M.S., R.D.
Research coordinators at the University of Pennsylvania were Caroline H. Moran, B.A., Jeffrey Derbas, B.S., Megan Dougherty, B.S., Zahra Khan, B.A., Jeffrey Lavenberg, M.A., Eva Panigrahi, M.A., Joanna Evans, B.A., Ilana Schriftman, B.A, Dana Tioxon, Victoria Webb, B.A., and Catherine Williams-Smith, B.S.
PennCare - Bala Cynwyd Medical Associates: Ronald Barg, M.D., Nelima Kute, M.D., David Lush, M.D., Celeste Mruk, M.D., Charles Orellana, M.D., and Gail Rudnitsky, M.D. (primary care providers); Angela Monroe (lifestyle coach); Lisa Anderson (practice administrator).
PennCare - Internal Medicine Associates of Delaware County: David E. Eberly, M.D., Albert H. Fink Jr., M.D., Kathleen Malone, C.R.N.P., Peter B. Nonack, M.D., Daniel Soffer, M.D., John N. Thurman, M.D., and Marc J. Wertheimer, M.D. (primary care providers); Barbara Jean Shovlin, Lanisha Johnson (lifestyle coaches); Jill Esrey (practice administrator).
PennCare - Internal Medicine Mayfair: Jeffrey Heit, M.D., Barbara C. Joebstl, M.D., and Oana Vlad, M.D. (primary care providers); Rose Schneider, Tammi Brandley (lifestyle coaches); Linda Jelinski (practice administrator).
Penn Presbyterian Medical Associates: Joel Griska, M.D., Karen J. Nichols, M.D., Edward G. Reis, M.D., James W. Shepard, M.D., and Doris Davis-Whitely, P.A. (primary care providers); Dana Tioxon (lifestyle coach); Charin Sturgis (practice administrator).
PennCare - University City Family Medicine: Katherine Fleming, C.R.N.P., Dana B. Greenblatt, M.D., Lisa Schaffer, D.O., Tamara Welch, M.D., and Melissa Rosato, M.D. (primary care providers); Eugonda Butts, Marta Ortiz, Marysa Nieves, and Alethea White (lifestyle coach); Cassandra Bullard (practice administrator).
PennCare - West Chester Family Practice: Jennifer DiMedio, C.R.N.P., Melanie Ice, D.O., Brandt Loev, D.O., John S. Potts, D.O., and Christine Tressel, D.O. (primary care providers); Iris Perez, Penny Rancy, and Dianne Rittenhouse (lifestyle coaches); Joanne Colligan (practice administrator).
Conflict of Interest
Thomas Wadden serves on the advisory boards of Novo Nordisk and Orexigen Therapeutics, which are developing weight loss medications, as well as of Alere and the Cardiometabolic Support Network, which provide behavioral weight loss programs. David Sarwer discloses relationships with the following companies: Allergan, BaroNova, Enteromedics, Ethicon Endo-Surgery, and Galderma. The other authors declare no conflicts of interest.
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DIGITAL DOMAIN; The Big Gamble On Electronic Voting By RANDALL STROSS Published: September 24, 2006
HANGING chads made it difficult to read voter intentions in 2000. Hotel minibar keys may do the same for the elections in November.
The mechanics of voting have undergone a major change since the imbroglio that engulfed presidential balloting in 2000. Embarrassed by an election that had to be settled by the Supreme Court, Congress passed the Help America Vote Act of 2002, which provided funds to improve voting equipment.
From 2003 to 2005, some $3 billion flew out of the federal purse for equipment purchases. Nothing said ''state of the art'' like a paperless voting machine that electronically records and tallies votes with the tap of a touch screen. Election Data Services, a political consulting firm that specializes in redistricting, estimates that about 40 percent of registered voters will use an electronic machine in the coming elections.
One brand of machine leads in market share by a sizable margin: the AccuVote, made by Diebold Election Systems. Two weeks ago, however, Diebold suffered one of the worst kinds of public embarrassment for a company that began in 1859 by making safes and vaults.
Edward W. Felten, a professor of computer science at Princeton, and his student collaborators conducted a demonstration with an AccuVote TS and noticed that the key to the machine's memory card slot appeared to be similar to one that a staff member had at home.
When he brought the key into the office and tried it, the door protecting the AccuVote's memory card slot swung open obligingly. Upon examination, the key turned out to be a standard industrial part used in simple locks for office furniture, computer cases, jukeboxes -- and hotel minibars.
Once the memory card slot was accessible, how difficult would it be to introduce malicious software that could manipulate vote tallies? That is one of the questions that Professor Felten and two of his students, Ariel J. Feldman and J. Alex Haldeman, have been investigating. In the face of Diebold's refusal to let scientists test the AccuVote, the Princeton team got its hands on a machine only with the help of a third party.
Even before the researchers had made the serendipitous discovery about the minibar key, they had released a devastating critique of the AccuVote's security. For computer scientists, they supplied a technical paper; for the general public, they prepared an accompanying video. Their short answer to the question of the practicality of vote theft with the AccuVote: easily accomplished.
The researchers demonstrated the machine's vulnerability to an attack by means of code that can be introduced with a memory card. The program they devised does not tamper with the voting process. The machine records each vote as it should, and makes a backup copy, too.
Every 15 seconds or so, however, the rogue program checks the internal vote tallies, then adds and subtracts votes, as needed, to reach programmed targets; it also makes identical changes in the backup file. The alterations cannot be detected later because the total number of votes perfectly matches the total number of voters. At the end of the election day, the rogue program erases itself, leaving no trace.
On Sept. 13, when Princeton's Center for Information Technology Policy posted its findings, Diebold issued a press release that shrugged off the demonstration and analysis. It said Princeton's AccuVote machine was ''two generations old'' and ''not used anywhere in the country.''
I spoke last week with Professor Felten, who said he could not imagine how a newer version of the AccuVote's software could protect itself against this kind of attack. But he also said he would welcome the opportunity to test it. I called Diebold to see if it would lend Princeton a machine.
Mark G. Radke, director for marketing at Diebold, said that the AccuVote machines were certified by state election officials and that no academic researcher would be permitted to test an AccuVote supplied by the company. ''This is analogous to launching a nuclear missile,'' he said enigmatically, adding that Diebold had to restrict ''access to the buttons.''
I persisted. Suppose, I asked, that a test machine were placed in the custodial care of the United States Election Assistance Commission, a government agency. Mr. Radke demurred again, saying the company's critics were so focused on software that they ''have no appreciation of physical security'' that protects the machines from intrusion.
This same point was featured prominently in the company's press release that criticized the Princeton study, saying it ''all but ignores physical security and election procedures.'' It is a criticism that collides with the facts on Page 5 of the Princeton study, where the authors provide step-by-step details of how to install the malicious software in the AccuVote.
Even before the minibar lineage of the AccuVote key had been discovered, the researchers had learned that the lock was easily circumvented: one of them could consistently pick it in less than 10 seconds.
If skeptics cannot believe what they read about the ease of manipulating an election, they can watch the 10-minute online video: the AccuVote lock is picked, a memory card is inserted and the malicious software is loaded; the machine is rebooted, and within 60 seconds the machine is ready to throw the election in favor of any specified candidate.
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201713
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Are you concerned inward losing weight? If you are, you might have been told to create your own weight loss plan. Weight loss plans, which help while guides and motivation as various those, experience been in the public domain to helper many realize their weight loss goals. Therefore it is supplementary than possible because you to join a local weight loss program or an on-line weight loss plan and produce a weight loss diagram presumption to you, various payoff look after in creating their hold, customizable weight loss plans.
When this is your originator age attempting to form a weight loss plan for yourself, you could follow unsure as to however you need travel. If that is ye situation, you bequeath hanker after to stay on perusing on. Under, a few of the many components of a weight loss plan are outlined for your convenience. Mayhap, the well-nigh foremost constituent of a weight loss plan is that of nourishing eating. Pretty eating is a indispensable portion of losing weight. When it comes to pretty eating, you father’t necessarily hardship to chunk junk foods, equivalent russet, utterly out of your dieting, yet you ought limit your ingestion. If you find that you retain a glitch cutting scrap nutrient or sweets from your diet, you could want to develop an feeding arrange for yourself. That eating fix could enclose days or meals where you make available yourself to have a dainty. In a direction, you tin presume that time as a reward for doing so properly. In improver to production a generalised fix for yourself, you can too covet to create a extra extensive feeding schedule. To have started, you might want to look at carefully good for you recipes online or believe a intelligent feeding cookbook. Once you bear a aggregation of robust foods to compel to, you can wagerer plan forbidden all of your meals. To help preclude you of comely world-weary with eating the matching foods done with and over again, you might be looking for to experimentation with alien goodly foods and healthy recipes. The topper approach to hold yourself focused and on activity is to “zest,” up your weight loss plan as often as viable. Excursus from feeding healthy, separate relevant part of losing weight is clean work. That is why your weight loss plan must comprise practice. Counterpart to the good for your health feeding agenda defined supra, you may be looking for to create an practise arrange for yourself. Whenever incorporating workout into your workout plan, you feature a number of different options. For point in time, you can appreciate a membership at single of your local gyms, get workout DVDs to mistreat at dwelling, buy other exercise equipment, like a treadwheel or a stair mounter, or exercise for free with walking. If you come decide to cause your possess exercising design, at hand is something that you can be lacking out on. Must you join an on-line weight loss programme or a local weight loss program, you would potential be a element of a larger populace; a group that offers support to each other. When creating your retain weight loss plan, you may not inevitably get that unaffected back up. For that reason, you may want to suppose about sightedness if you have any friends, family members, neighbors, or coworkers who would like to utilisation with you. Having a workout partner could help reinburse you the support that you need, as reasonably as service as a little bit of rationale for you. When creating a weight loss ruse for you, you are well-advised to plunk your programme in authorship. You might even want to turn to your computer, as scores of computers feature good guide programs that you know how to use to force to easy to glance at schedules or charts. Having your weight loss plan in composition, videlicet the exercises that you wish to do and the foods that you like to lunch and whenever, can help to actuate you with losing weight. What you may be after to do is job your schedules in a aptly-seen spot, like on your icebox. In quick, weight loss plans serve as guides, as well as motivation. The over mentioned points are ones that you need keep in good sense, while production a weight loss design for yourself.
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201713
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Ball Fields
There are new scoping and technical standards for fields and access to the field of play in the 2010 ADA Standards for Accessible Design. Fields still need a firm, stable outdoor route of travel, 44 inches wide minimum, from the parking lot to all elements and spaces. This includes a firm and stable route to the edge of the playing surface, through any gates, into dugouts, and to the fields.
When gates are part of an access route, their width needs to be considered so they can provide appropriate access onto a field of play or a sports court. Providing a 48-inch-wide opening (to keep 44 inches of clear space) with accessible hardware and latches assures good access for most mobility devices and most likely for maintenance equipment too. It is preferred to have a 60-inch-wide route of travel because less than that requires passing spaces, turnouts, or “T” intersections.
For fixed soccer fields - under the new rules, each field must be served by at least one accessible route to the field of play. Designated or fixed seating, are required to have a firm, stable, outdoor route of travel, at least 44 inches wide, from the closest parking and any other element, amenity, or improvements to the most desirable, logical, and closest viewing area used by most spectators.
U.S. Department of Justice 2010 ADA Standards for Accessible Design
Washington Administrative Code 51-50-1101 1101.2.1
Examples
Yelm Longmire Park
Photograph shows soccer field with an accessible route to an accessible viewing area. Many soccer fields only have grass pathways, which are difficult travel routes for those in wheelchairs.
Kent Service Club Dugout
Photograph shows a slight ramp at the baseball dugout's entrance to the ball field.
Richland's Columbia Park play field
Photograph shows a level dugout entry onto field.
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201713
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Species Profile Peregrine Falcon tundrius subspecies
Scientific Name:
Falco peregrinus tundrius Other/Previous Names: Tundra Peregrine Falcon Taxonomy Group: Birds Range: Yukon, Northwest Territories, Nunavut, Quebec, Newfoundland and Labrador Last COSEWIC Assessment: April 2007 Last COSEWIC Designation: Non-active SARA Status: Schedule 3, Special Concern - (SARA Schedule 1 provisions do not apply) Related Species
Species COSEWIC
Status
SARA
Status
Peregrine Falcon anatum/tundrius Special Concern Special Concern Image of Peregrine Falcon tundrius subspecies Description
Falcons are birds of prey that are smaller and more streamlined than hawks, with long pointed wings that enable them to fly at great speed. The Peregrine is a crow-sized falcon. A blackish "moustache" (black stripe below the eye) and bluish-grey or slate-coloured upper parts characterize both sexes. The under parts are white to buff with brown bars on the sides and thighs, and spots on the abdomen; the underside of the wings is white with black bars. The young peregrine falcon has a blackish moustache; brownish upper parts; a dark brown tail with buff colored bars and white tips; and buff-colored under parts with blackish-brown streaks. The three subspecies are similar, differing slightly in colouration and size; the Peregrine Falcon tundrias subspecies are smaller, with a paler breast.
Distribution and Population
The three subspecies have distinct geographic distributions. The Peregrine Falcon tundrius subspecies (also known as the Tundra or Arctic Peregrine), breeds in the tundra regions of Canada, Alaska and Greenland. This subspecies is highly migratory, traveling as far south as Argentine and Chile. It has been found that the farther north a bird breeds, the farther south it migrates.
Habitat
The habitat requirements of the Peregrine Falcon can be divided into three components: 1) the nest site: nests are usually scrapes made on cliff ledges on steep cliffs, including artificial cliffs such as quarries and buildings; 2) the nesting territory: the area defended around the nest prevents other pairs from nesting within 1 km or more, ensuring adequate food for all nesting pairs and their young; the density of nests tends to be related to food availability; 3) the home range: the extended, non-defended area in which the peregrines hunt for additional food and which can extend to 27 km from the nest; peregrines prefer open habitats such as tundra, savanna, seacoasts and high mountains, but will also hunt over open forest.
Biology
Peregrine Falcons begin breeding in their second year. Although the average lifespan is 4 to 5 years, some birds have been known to live much longer. Clutch size varies from 2 to 5 eggs, increasing southwards. The reproductive cycle of the three subspecies is similar, the main difference being in the timing of events: Peregrine Falcon pealei subspecies lay eggs during April, boreal forest peregrines lay in May, and Arctic birds lay in mid-June. Renesting will occur in southern populations if the eggs are destroyed early in the incubation period. Peregrines are excellent hunters that feed almost entirely on birds, usually catching them in flight.
The major cause of decline of Peregrine Falcon populations is the presence of agricultural pesticides, especially organochlorine compounds, in the environment. These compounds are known to cause egg-shell thinning, egg breakage, reduced hatching success, reduced brood-size and reduced breeding. Since Peregrine Falcons are at the top of the food chain, their tissues accumulate a great deal of these substances. The destruction of breeding sites and breeding areas due to the expansion of human activities are factors in local declines of Peregrines. Human intrusion near nest sites can cause breeding interruptions and/or nest abandonment.
Other Protection or Status
The Peregrine Falcon is protected under the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), which restricts the import and export of birds and eggs.
Documents
PLEASE NOTE: Not all COSEWIC reports are currently available on the SARA Public Registry. Most of the reports not yet available are status reports for species assessed by COSEWIC prior to May 2002. Other COSEWIC reports not yet available may include those species assessed as Extinct, Data Deficient or Not at Risk. In the meantime, they are available on request from the COSEWIC Secretariat.
0 record(s) found.
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201713
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Most people start mowing the lawn as children & in their pre-teen years and even have small businesses as teens. Not me. It took 8,880 days on Earth, getting married, graduating college, and going through childbirth before I ever mowed a lawn. Lawnmowers are smelly, noisy, make my allergies flare, and after an episode of Mad Men I’ve been afraid of losing my foot from this terrifying machine. That being said, I also have a love for all things natural and eco-friendly, so mowing didn’t fit into that mold.
I just happened to buy a reel mower last year, and yes, it’s taken me a year to use it. In my defense, I had an infant and wasn’t about to try something new when motherhood was new. But this year, I have a toddler – one that loves the outdoors & spending time with me. So like any level-headed and sane mother, the beautiful weather had me thinking that mowing the grass together might be a fun project to do with my toddler.
Thank you for supporting our family through affiliate link purchases!
Yesterday I got out my sweet, beautiful Scotts Reel Mower to christen it’s journey across our yard with human mom power. My daughter was also equipped with her own elephant cart to help along the way. We ran up the hill and down the hill, laughing the entire time. We stopped to pull weeds, pick flowers, and have a tickle fight.
Somewhere in the 2 hours of mowing a quarter acre of front yard, I wound up with an almost 18 month old tied in my wrap on my back while holding her Hello Kitty named “Moaw” and singing as we mowed. And in that moment I was never happier to be mowing the lawn. I was making a memory with my daughter and connecting with my neighbors. You see, living in an older neighborhood, many don’t typically talk to the young couple down the street. But that day, everyone slowed down to see the crazy lady mowing her lawn while wearing her child. One man slowed down and gave me an excited thumbs up. Another gave me a double honk. And no one passed without waving hello with or giving us a big smile.
While unorthodox, my first lawn mowing experience is one I will probably never forget. It’s one of happiness and joy. I was spending quality time with my daughter and we were not endangering ourselves in any way. No noxious fumes, no blades of terror spinning at my feet, and no noise to compromise the sheer joy of my toddler.
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201713
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This month, we're featuring non-lethal weapons as our Emerging Ethical Dilemma and Policy Issues in Science and Technology which earned around 7% of the total votes. Below we've provided more information about this topic to serve as a resource to students, educators, journalists, policy makers, and concerned citizens. It's not too late to vote on our list! Non-lethal weapons Non-lethal weapons
At first it may seem absurd that types of weapons that have been around since WWI and not designed to kill could be an emerging ethical or policy dilemma. But consider the recent development and proliferation of non-lethal weapons such as laser missiles, blinding weapons, pain rays, sonic weapons, electric weapons, heat rays, disabling malodorants, as well as the use of gases and sprays in both the military and domestic police forces (which are often the beneficiaries of older military equipment).
The Policy for Non-Lethal Weapons from the United States Department of Defense (Directive No.3000.3, 9 July 1996) defines a NLW as a weapon "explicitly designed, and primarily employed, to incapacitate people or material while minimizing fatalities or permanet injury and undesired damage to property and the environment."
These weapons may not kill (then again, there have been fatalities from non-lethal weapons), but they can cause serious pain, physical injuries, and long-term health consequences (the latter has not been fully investigated). We must also consider that non-lethal weapons may be used more liberally in situations that could be diffused by peaceful means (since there is technically no intent to kill), used indiscriminately (without regard for collateral damage), or be used as a means of torture (since the harm they cause may be undetectable after a period of time). These weapons can also be misused as a lethal force multiplier - a means of effectively incapacitating the enemy before employing lethal weapons. Non-lethal weapons are certainly preferable to lethal ones, given the choice, but should we continue to pour billions of dollars into weapons that increase the use of violence altogether?
Below are some readings to help you consider the issue and formulate responses:
What do we mean by 'non-lethal weapon'?
Non-Lethal Weapon Requirements Fact Sheet (Department of Defense, 2013)
Types of Less-Lethal Devices (National Institute of Justice, 2008)
DoD's Policy for Non-Lethal Weapons (Department of Defense, 2006)
An Assessment of Non-Lethal Weapons Science and Technology (National Academies Press, 2003)
On how non-lethal weapons save lives and improve effectiveness:
Nonlethal Weapons and Capabilities (Council on Foreign Relations, 2004)
The ethics of non-lethal weapons:
The Fuzzy Ethics of Nonlethal Weapons (Christian Science Monitor, 2003)
The Moral Dangers of Non-Lethal Weapons (Stephen Coleman TED Talk, 2011)
The Paradox of Nonlethal Weapons (Slate, 2012)
There’s No Such Thing as a Non-Lethal Weapon (Vice Magazine, 2014)
Thou Shalt Not Kill, In Theory (The Economist, 2014)
Accessible academic studies on the ethical issues that arise:
With Fear and Trembling: A Qualified Defense of “Non-Lethal” Weapons (Dr. Pauline M. Kaurin, via ISME, 2008)
Non-lethal technologies—an overview (Disarmament Forum, 2005)
Use of non-lethal weapons by the military:
U.S. Military Use of Non-Lethal Weapons: Reality vs Perceptions (Case Western Reserve Journal of International Law, 2015)
The U.S. Navy Wants Non-Lethal Weapons (Popular Science, 2014)
The Military Will Test a New Terrifyingly Loud Noise Gun (DefenseOne, 2015)
Use of non-lethal weapons by U.S. law enforcement:
Less-Lethal Weapon Options (Police Magazine, 2013)
What The Police’s ‘Non Lethal Weapons’ Can Do To Human Bodies (Think Progress)
'Nonlethal Weapons Are Much More Lethal Than Police Want You to Think (Policy.Mic, 2015)
Rubber Bullets in Missouri Clash Highlight Militarization of America’s Police (Scientific American)
Department of Defense Fact Sheets on various non-lethal weapons Active Denial Technology Fact Sheet Distributed Sound and Light Array Fact Sheet Escalation-of-Force Mission Modules Fact Sheet Improved Flash Bang Grenade Fact Sheet Joint Integration Program Fact Sheet Mission Payload Module Non-Lethal Weapons System Non-Lethal Optical Distracters Fact Sheet Non-Lethal Weapon Requirements Fact Sheet
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201713
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I have recently fallen victim to a new mental illness: Post-
Avatar Ecological Depressive Disorder (PAEDD). Don’t try to look for it in the DSM-IV; that book is full of imaginary pathologies. This one is real. My symptoms include hissing at cars, wishing I were twelve feet tall and blue, feeling a painfully nostalgic yearning to “return” to the magical world of Pandora depicted in James Cameron’s latest film Avatar, and simply wanting to die as I watch Planet Earth perish all around me. I feel a bit better with each passing day, but climbing out of a sadness like this can be a daunting, arduous process.
I realize that this may seem like a strange, somewhat juvenile affliction, but before telling me to “get a life” and reminding me that
Avatar is “just a movie,” I’d like to try to explain how this terrible sickness befell me, how I have managed to cope with it thus far, and, seeing as how I’m not the only one suffering in this manner, I’d like to address what I believe to be the implications of PAEDD for society at large.
For those predisposed to the disorder, PAEDD is triggered by two directly related, yet violently dissonant events: 1) Watching the movie
Avatar and 2) leaving the theater. Below is a realistic dramatization of how this disease might typically seize hold of a person.
You enter the theater,
Avatar begins, and you are catapulted with an almost entheogenic force into the world of Pandora, a verdant moon throbbing with transcendent beauty. Pandora is inhabited by a species of sapient humanoids known as the Na’vi. The Na’vi—twelve feet tall, big-eyed, blue-skinned, beautiful—move through their forested biosphere like dolphins cutting through open ocean. Their home is alive; the entire ecosystem of Pandora is permeated by the sacred energy of Eywa, a silent, Gaia-like deity who is as ethereal as she is organic. All beings on Pandora commune with Eywa, and each other, by physically plugging themselves into the interconnected web of life that encompasses the entire moon. When you hug the trees, the trees hug you back. Although most everything seems to be trying to kill you on Pandora, the exhilaration of survival is so pure that you begin to wonder how true human freedom is possible without it. Through the power of James Cameron’s special-effects sorcery, you lose yourself in the hypnotic colors and cadences of this majestic new world, ego subsumed in bioluminescent wonder, sense of self humbled and transformed by an enchanting, nurturing, all-encompassing immanence.
Then the lights turn on in the theater, and you find that your sneakers are sealed fast to a Pepsi-sticky floor. You exit the building, and step out not onto pure soil, but filthy, ungodly concrete, littered with cigarette butts and plastered with rotten splotches of discarded chewing gum. Fumes from arrogant cars fill your lungs, and the snow on the ground is leprous with oil and other toxins from off the street. Metal is everywhere, you’re standing in a strip mall, and tomorrow, you recall, you will have to go sit in a gray cubicle for eight hours, withering under the stuttering rays of fluorescent lights. The Earth is vile, human beings are worse still, and Eywa is nowhere to be found. Suddenly, the heart-wrenching words of Jake,
Avatar’s narrator and male lead, echo in your ears: “Look at the world we come from. There is no green there. They killed their Mother, and they’re going to do the same thing here.” In that instant, you realize that something is horribly wrong with everything.
Epiphany and counter-epiphany collide in your mind: the film has inspired you to believe that somewhere in your spirit you, like the Na’vi, have a “port” that is intended to connect with nature, but as you frantically search your surrounding environment, you simply don’t know where to plug this port in. You long to commune with a holy, green, transpersonal home, but you realize that you are destroying the closest thing you’ve got to that.
It’s time to get back to the garden, your spirit whispers to you, but there is no garden, it appears, to get back to, and, what’s worse, it’s all your fault.
As symptoms of PAEDD intensify, what was once considered merely unsustainable becomes unendurable. What was once irresponsible now seems intolerable. As you yearn to see yourself as an integral part of the dynamic planetary system around you, you are suddenly awakened to the fact that your corporeal spirit is mingling with garbage. You have profaned your home planet, your life, and, quite possibly, your afterlife, for you now imagine your body buried in a cemetery next to a bunch of strangers on the side of the highway, with unknown chemicals seeping into your coffin like grave robbers. If, as a member of the audience during
Avatar, you could not endure the destruction of Eywa, how, as a human being, could you possibly tolerate the destruction of Gaia? You cheered the heroes of the film on to victory against the greedy and myopic mercenaries, only to discover that, in reality, you are among the evildoers. You don’t walk the Earth; you trample it. You are an eco-pathological rapist and murderer, and you are committing slow-motion suicide with every industrial movement you make. Planet Earth, Live and In Color
But shame, outrage, and despair are not, in themselves, horrors sufficient enough to catalyze a full-blown case of PAEDD. To be truly out of your mind, you must be filled with an infinite love for something that you cannot touch. Fortuitously, as confronting hardship so often involves the magic of paradox, the way into the disease is also the way out from it. Pandora may seem like an exotic and impossible fantasy, but, save for the floating mountains and some far-out megafauna, it is modeled almost entirely after a vision of Planet Earth restored to its original beauty. The best hope people with PAEDD have for a long-term cure, then, is to actualize this vision in real life by taking the pathos and reverence they feel for the fictional Pandora and using that energy to actively participate in the restoration of the celestial body that miraculously sustains our existence right here on real, live 3-D Planet Earth.
In other words, if you want to heal yourself, start by healing the world. By striking at the root of the problem, not only can you alleviate your symptoms, you can reverse them, giving your life a newfound sense of vitality, gratitude, exuberance, meaning, and mission. In this sense, PAEDD can ultimately be a blessing both for you and everyone and everything around you.
As I said before, I am not alone in my struggle, and I am not the only one who has found healing and purpose in the eco-recovery treatment program prescribed above. The much-maligned fansite, avatar-forums.com, for example, is buzzing with suggestions on how to, in effect, bring about a kind of Pandora on Earth. One poster on this site suggested joining Greenpeace. Another announced that he would be writing angry letters to Wall Street and GM and all other corporations who are imperiling the delicate balance of life on this planet. People have quit smoking, littering, eating meat, playing video games, and watching television. Entire chat rooms are dedicated to sharing ideas about renewable technologies. One comment from “PandoraOnEarth,” whose moniker pretty much sums up her mission, succinctly highlights both the pain and the promise of PAEDD. In order to cope with her “homesickness” at losing Pandora, “PandoraOnEarth” felt it necessary to, in her words,
devise a plan for implementing Pandora on Earth; at least those parts of it that appeal to me and are probable… In this, I can have hope, instead of the hopelessness I felt just after the realisation that Pandora would never be real… As human beings, we have the power to sculpt our world as we see fit; for good or bad… The current social structure of city life and six degrees of separation are not working for us; we are coming apart at the seams.
I have read over a thousand
Avatar-inspired eco-pledges, ranging from the practical to the fanatical (one zealous fellow claimed that he had traded his bed for a hammock, given up his car for a horse, and galloped about town trying to “liberate” the roots of trees from the sidewalk concrete above). One thing all these pledges, diverse as they are, have in common is that they all seem to emanate from a profound re-thinking of the relationship between human beings and nature. This is because Avatar, rather than simply telling people that they shouldn’t pollute because it is bad for the planet, shows people, on a visceral, instinctual, primordial level, that they are the planet. By humanizing nature, Avatar effectively ecologizes humans. The Truth Will Break Your Heart
“Pandora on Earth,” then, is an unquestionably viable project, one that could transform an ailment into a movement. The energy of such a movement would surge up from the soul and crystallize intellectual anxieties over rising CO2 levels into an existential panic over the murder of Gaia. However extreme this form of motivation may seem, we are in dire need of exactly this type of radical spiritual ecology. Environmentalism is failing; we are failing to heal the planet. We have the intellect, but we lack something wild and pulsating at the core of our efforts, and this is where the pain of PAEDD could prove itself useful.
Avatar provides what An Inconvenient Truth, for example, does not: wonder, communion, inspiration, romance, reverence, music, mysticism, love, hope, awe. The truth, however inconvenient it may be, simply does not matter unless it breaks one’s heart.
This past Monday,
Avatar surpassed Titanic’s longstanding international box office record, making Avatar the highest-grossing film of all time. For a movie with such a progressive environmental (not to mention anti-imperial and anti-corporate) message to achieve this kind of universal popularity is remarkable. Any explanation as to how a mainstream Hollywood mega-blockbuster could radicalize the eco-consciousnesses of scores of people who seem to have had little previous interest in the praxis of deep ecology or neo-tribalism must go beyond the observation the film was merely “visually interesting.” One could easily deconstruct Avatar to bits, but as our planet hums its own elegy beneath our feet, and as our failed politicians come home from climate summit after summit with empty hands, is this really how we want to talk about the most influential ecological parable of our time?
I hope not. It is easy to scoff at
Avatar and those like me who were so affected by it, but it would be irresponsible to dismiss the cultural force behind the disorder that I only half-jokingly made up. Avatar is striking hard at a nerve, a nerve that is desperately straining to reconnect itself with the vanishing beauty of the natural world. There is tremendous energy inside the agony of our estrangement from nature. After the 3-D goggles come off, let us harness this energy; it is the most bountiful of renewable resources, and so long we are capable of imagining that which could be, it is also the most powerful.
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201713
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Lanthanum oxide [La2O3] and lanthanum hydroxide [La(OH)3] have been utilized as bases for the three-component reaction of aldehyde, dimedone and o-phenylenediamine for the synthesis of 1,4-benzodiazepine derivatives. The X-ray diffraction pattern shows pure phase formation of both catalysts. The basicity of La2O3 and La(OH)3 was measured by CO2-TPD (temperature programmed desorption) experiment. The measurements indicate the presence of basic sites that are useful for the reaction. Surface area measurements using Brunauer–Emmett–Teller (BET) reveal a low surface area for both the materials. TEM measurements indicate agglomerated particles with heterogeneous size distribution. The multicomponent reaction also proceeds smoothly in aqueous media as well as organic solvents. The heterogeneous catalyst was successfully recycled for 11 iterations without losing the catalytic activity. Several reactions were performed to understand the mechanism of the adsorption andthe experiments suggest that the reaction may possibly proceeds by a Langmuir–Hinshelwoodadsorption mechanism.
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201713
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Governments worldwide are working hard to implement a number of changes in their data center infrastructures. Some have major data center consolidation projects underway, such as the Federal Data Center Consolidation Initiative in the U.S. Others are taking advantage of the benefits of virtualization or moving to Shared Services models. Finally, many are deciding if a public cloud infrastructure is appropriate for some of their government business. To cater to the U.S. government’s interest in the public cloud, Amazon Web Services (AWS) has developed specialized cloud services, GovCloud and Commercial Cloud Services (C2S) for the Intelligence Community, designed specifically for U.S. government customers.
Having so much to consider for their data center infrastructure plans, security is certainly top of mind. Here at Palo Alto Networks, we’re doing all we can to support governments as they secure their cyber infrastructure. We have been working with numerous customers – including many in the U.S. federal sector – to evolve their infrastructure, securely, regardless of the stage in their data center transitions.
Recently, we worked with MeriTalk to develop a “health check” with U.S. federal government agencies (read the full report here). The survey queried 300 U.S. Federal IT managers about what security issues were top of mind as they implement changes to their data centers. The results are fascinating and show that many government agencies share common security concerns in their data center and cloud planning.
The good news is that our portfolio provides security solutions that protect customer data no matter where the government is in their data center evolution. Palo Alto Networks is able to solve many of the security challenges the survey respondents identified with their current data center security solutions. Let’s look at a few of them:
Integration challenges
Integration can mean many things, but when it comes to data center security it typically refers to how well the solution can tie into the existing physical or virtualized network infrastructure. To integrate easily into an existing physical data center network, each Palo Alto Networks Next-Generation Firewall supports a range of network modes, including L2, L3, Virtual Wire and mixed mode. Virtual Wire makes our Next-Generation Firewalls truly transparent network device, looking much like a bump in the wire which solves many customer network integration challenges and can be used in both Active-Passive and Active-Active high availability modes.
From a virtualized computing environment perspective, integration means how tightly the security solution ties into the hypervisor and orchestration tools in use. The Palo Alto Networks VM-Series of virtualized firewalls allows customers to deploy the exact same next-generation firewall and advanced threat prevention features used in our physical appliances in private, public or hybrid cloud computing environments. The VM-Series supports a range of hypervisors including VMware ESXi and NSX, Amazon Web Services and KVM with OpenStack. In each of these environments, customers analyze traffic moving into and across the cloud environment, protecting both applications and data from advanced threats. Additionally, the VM-Series incorporates a fully-documented XML API to simplify integration of third party orchestration and management tools. Our ease of provisioning, noted below, helps ensure seamless integration as changes happen within the data center or cloud, regardless of your platform choice or data center instantiation.
Time to provision
In both physical and virtualized network environments, customers struggle with managing the discrepancies that may occur between compute workload additions, removals or changes and how quickly a security policy can be deployed. To help minimize these delays, Palo Alto Networks firewalls provide a rich set of native management features that streamline policy deployment so that security keeps pace with the changes in your compute workloads (physical and virtual).
As compute workloads change, are added or removed, features within the PAN-OS security operating system will see those contextual changes, proactively learning which IP addresses are changing, then apply those updates to the security policy automatically. The result is a dramatic reduction in the delay that can occur between workload changes and security policy updates. In the event that many virtual or physical Palo Alto Networks next-generation firewalls are deployed, our Panorama technology makes managing them easy and ensures that security policies are applied consistently and cohesively. Panorama also provides centralized logging and reporting capabilities that give users visibility into virtualized applications, users and content.
Performance shortcomings
In order to address the computationally intensive nature of full application traffic classification and inspection, Palo Alto Networks Next-Generation Firewall appliances are purpose-built to deliver predictable performance with security features enabled. A single-pass software architecture performs its defined functions only once on a given set of traffic, eliminating the multi-pass scan and decision making process that UTMs and other security solutions follow. This single pass software architecture is matched to purpose-built hardware that uses dedicated processing for the key areas of networking, security, content inspection and management. The end result is a next-generation firewall architecture that is fully capable of 120 Gbps of cyber security processing. Customers who have used proxy-based firewalls and UTMs are astonished at the performance gains our platforms provide.
Fragmented solutions
One of the advantages of the Palo Alto Networks Enterprise Security Platform is the contextual control it provides by knowing what applications are being used, who is using them and what data they contain. All visibility, policy control, logging, reporting and forensics features within our enterprise security platform take full advantage of this contextual awareness to provide a closed-loop feedback platform for network and data center security. All security functions employed – advanced threat prevention with WildFire™, known threat prevention with IPS, network anti-virus and anti-spyware, mobile security management with GlobalProtect™– are correlated and shared across the platform to continuously update and employ the very latest attack preventions for the data center and your network.
Lack of security for virtual machines
Palo Alto Networks VM-Series virtualizes the functions of its enterprise security platform, allowing customers to secure virtualized workloads while preventing advanced cyberattacks. In fact, it was a global government customer who gave us the idea years ago to create a virtualized instance of our platform and customers love it. If you use AWS GovCloud, the VM-Series for AWS is available as a Bring Your Own License (BYOL) model and the VM-Series also supports VMware ESXi/NSX, KVM or Citrix SDX. You can purchase the VM-Series from your authorized Palo Alto Networks partner.
With the power of the Palo Alto Networks Enterprise Security Platform, we can protect your north-south traffic as well as your east-west traffic. We ensure that attackers are not only blocked as they enter your overall network, but are also blocked as they attempt to move laterally
into and through your data center. Additional resources to assist you in your data center to cloud security needs: Virtualization and cloud migration resources from Palo Alto Networks Zero-trust considerations for your Data Center Data Center consolidation: When you need to achieve high bandwidth throughput and 120 Gbps protection in a singular platform, Palo Alto Networks PA-7050 utilizes over 400 processors distributed across networking, security, switch management and logging functions to ensure you have the power that you need. High Scale manageability with Panorama VM-Series for AWS GovCloud and Commercial Cloud Services (C2S) See what the media has to say about the results of the MeriTalk survey: Executive Gov, MeriTalk: Cyber Threats are Primary Concern in Federal Data Center Modernization EnterpriseTech: U.S. Datacenter Upgrades Plagued by Security Concerns Talkin’ Cloud: How Are Feds Handling Data Center Defense? CIO: Security Concerns Cloud Federal Data Center Overhaul eWeek: Cybersecurity A Top Concern for Federal IT Workers
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Week of April 8, 2012—JUDGE FOR YOURSELF Friday, April 13, 2012—Under-developed Plot
Donna Jo Napoli said at SCBWI Miami, “Everyone talks about plot—something has to happen—we have to have an experience.” The plot is the organized sequence of events that make up a story. Every plot includes a conflict or problem. At the same conference in Maimi, Tamar Brazis (an editor with Abrams) also said that conflict and resolution were essential—even in picture books. She went on to say the conflict and resolution doesn’t have to be something big and earthshattering—it could be a lost shoe—but something has to happen in the story.
Story after story that I read in that short story contest had no plot. They were memoirs, recollections,
tellingsomething that happened to the character. We all have stories like that, stories that we love to tell our friends, that have been passed down from generation to generation, or that we think we should write down so others in our family won’t forget them. But these are not plots. One of the things the editors at the Miami SCBWI conference said they disliked the most was sentimentality and nostalgia. (So be warned!) Many of those short stories had no problem, no conflict. Sometimes the protagonist and antagonist in the story weren’t clearly defined. Sometimes the action didn’t rise and fall as needed for a successful plot—the actions just occurred.
A real plot includes (among other things I’m sure):
· Characters
· Setting
· A problem or conflict
· Rising action—where the problem is developed/worsened and the interest o fht reader and the suspense grows
· Climax—the turning point in the story—often causes the main character to come face-to-face with his/her problem and to change in some way
· Falling action—all the loose ends are tied up
· Resolution—the story comes to a reasonable end
If you have a recollection or family story that you want to make into a plot, then you might follow the advice of Tamar Brazis who said: “Make the story work—and make it vivid—even if it’s not all true.” Yes, my dear writing friend, you have the freedom (and responsibility) to embellish those stories so you develop a plot that is worthy of publication.
I’ve attended several conferences about plot development and have learned about Fretag’s Pyramid, the Plot Clock, the three-act structure, television/screen writing three-act structure, and more. If plot is something you struggle with, Google it, research it, attend a conference about it—make it your priority to not have a lackluster, underdeveloped plot!
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201713
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ACNM Series, Part 2
With new legislation introduced in Michigan (
Senate Bill 1208) that attempts to hold MI midwives to standards for both practice and education, many questions have surfaced. Our post today will focus specifically on educational standards for various midwives. Here is what a professional midwife organization, the American College of Nurse Midwives, has to say on the subject of minimum educational standards. I think you will find it to be largely in line with "What We're Seeking" here on the Safer Midwifery for MI blog. "This document...clarifies the position of the American College of Nurse-Midwives (ACNM) with regard to midwifery credentials and appropriate qualification for midwifery practice. ACNM looks forward to the day when there is one unified profession of midwifery, with unified standards for educationand credentialing, working toward common goals."
ACNM states that they, "look forward to the day when midwives have
unified standards for education." This is certainly not the case for midwives in Michigan. Some have graduate degrees, some are advance practice nurses, some have trained through a rudimentary apprenticeship, and some are learning how to be a midwife on You Tube. Anyone can call herself a "midwife" regardless of educational background in our state, and now CPMs want a license to practice.
According to ACNM, not just anyone should be calling herself a "midwife." They have established benchmarks for what constitutes appropriate qualifications in order to call oneself a midwife. What are those qualifications specifically? What constitutes a "professional" midwife?
"ACNM supports the following definition of a professional midwife: “A professional midwife in the United Statesis a person who has graduated from aprogram in midwifery that is formal education accreditedby an agency recognized by the US Department of Education.
(Please note: a CPM who trained through a MEAC-accredited midwifery school would meet this standard. The problem is that NARM does not
requireany formal education and therefore CPM credential does not assure that a midwife has been trained through any formal, accredited midwifery program.) "The professional midwife has evidence of meeting established midwifery competencies that accord with a defined scope of practicecorresponding to the components and extent of coursework and supervised clinical education completed. In addition, this person has successfully completed a national certification examination in midwiferyand is legally authorized to practice nurse-midwifery in one of the 50 states, District of Columbia, or US jurisdictions.”
Sounds like a formal education by an accredited program isn't asking too much after all. Neither is a
defined scope of practice. ACNM supports laws and regulations that include:
(This is a shortened list as it pertains to this topic. Full list of criteria in the linked document above.)
1. Successful completion of a formal educationprogram accreditedby an agency recognized by the US Department of Education. 2. Successful completion of a national certification examination in midwifery. 4. A scope of autonomous practice, recognized by law or regulation, that is consistent with the content of the education process and certification exam.
In an effort to support their "unified" vision for educational standards ACNM's statement specifically addresses an alternative to nursing school. Senate Bill 1208 proposed an RN requirement as a minimum standard. Some didn't support requiring midwives to go to nursing school. ACNM themselves didn't think an RN degree (2 years) was sufficient. If you continue reading, you'll see that ACNM already has an alternative to nursing school in place, a credential called a CM, Certified Midwife. This credential includes a bachelor's degree in something other than nursing, then two years of graduate school in and
accreditedmidwifery program. Perhaps this should be the minimum standard for Michigan midwives. The Accreditation and Credentialing Process for CNMs and CMs "Nurse-midwifery and certified midwifery education programs in the US are currently accredited by an autonomous agency recognized by the US Department of Education, the Accreditation Commission for Midwifery Education (ACME) "Because ACNM believes that a nursing credential is not the only avenue of preparation for midwives to deliver safe and competent care, we moved to accredit education programs for midwives who do not wish to earn a nursing credential. The American Midwifery Certification Board, Inc. [AMCB, formerly the ACNM Certification Council, Inc. (ACC)] opened its national certification exam to nonnurse graduates of midwifery education programs and issued the first certified midwife (CM) credential in 1997. "Certified midwives are educated to meet the same high standards that certified nurse-midwives must meet. These are the standards that every state in the U.S. has recognized as the legal basis for nursemidwifery practice. All education programs for CMs, like CNMs, are at the post-baccalaureate level. Beginning in 2010, a graduate degree will be required for entry into clinical practice for both CMs and CNMs. CMs take the same AMCB certification exam as CNMs and study side-by-side with nurse midwifery students in some education programs. As an organization, ACNM supports efforts to legally recognize CMs as qualified midwifery practitioners granted the same rights and responsibilities as CNMs." formal education of any kind, how can that be considered adequate in terms of educational preparation? Not to mention that it's very clever of NARM to title this certification "Professional" when it doesn't even meet "professional" standards according to ACNM. require I'd like to leave you with these thoughts...What obligation does ACNM have as a professional organization to speak up on this issue? Perhaps they should lobby for legislation that would actually make birth safer, no matter where a baby is being born. Perhaps it's time for them to back up this "position statement" with actions. We need your help ACNM to protect the integrity of midwifery, and to protect the families "midwives" jointly serve. Link to part 1 ~ What ACNM has to say about Senate Bill 1208 For more on this topic, including ACNM's stance at the federal level, visit: Confutata: CNMs Don't Want to Play
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201713
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One of the main courses of treatment for sleep apnea is an oral appliance, made by a dentist. There are over the counter versions of these oral appliances and while the principle is the same between the two, the ones that are over the counter are much less expensive. Dr. Rich Gillespie, who treats patients with sleep apnea in Vancouver, Washington at Gillespie Dentistry, has found that for those patients who have previously gone down the over the counter route, the results have been less successful because the fit is not as good.
Dr. Gillespie says that the beauty of the oral appliance made by dentists is that it's adjustable so they can be customized and the over the counter products are "hit and miss" as to whether or not they will work. A dentist can monitor the wearing of a custom-made device so that an optimal opening of the airway can be achieved. Dr. Gillespie notes that an oral appliance made by a dentist is a medical device that is very durable. While there is the greater expense, insurance covers these devices. Additionally, there is no follow up medical care with an over the counter device.
Dr. Rich Gillespie is a dentist and leading sleep expert with Sleep Better TV, a featured network of Sequence Media Group. Sleep Better TV provides online, on-demand, sleep breathing disorder video content. For more information on Dr. Gillespie, click here.
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201713
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Presentation on theme: "Navigation solutions powered by Europe Note: * Agreed upon by Burundi, Ghana, Kenya, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone, Uganda, Zambia,"— Presentation transcript:
1Navigation solutions powered by Europe Note: * Agreed upon by Burundi, Ghana, Kenya, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone, Uganda, Zambia, Zimbabwe; ** CIA (only rivers, does not include navigable routes in lakes); *** Includes Mali, Gabon, Angola, Guinea, Ghana, Republic of the Congo, Senegal, Cote dIvoire, Sierra Leone, Malawi, Madagascar, Mozambique, The Gambia, Niger, Benin and Togo 29 African countries have navigable waterways that could provide an inexpensive form of transport They remain however the weakest link in Africa's transport system. Main constraints are non-harmonized procedures and standards,Poor safety and security,Seasonal blockages due to water weeds that often close routes Several initiatives have been taken to improve the current situation still with small impact on African waterways EGNOS can provide significant added values for inland waterways: Integrity and accuracy can support transport management systems Navigation support services will allow guidance of small ships 000 km By country Congo 50.1 Nigeria Sudan Egypt CAR Zambia Others*** African inland waterways extension** (2008) III. Details on applications – Inland waterways 17 February, 2014 The European GNSS Programmes 1 Africa has many navigable waterways that could support economic development of the continent
2Navigation solutions powered by Europe The Congo basin (covering c. 12% of Africa) has up to 25.000 km of navigable waterways, with more than 10.000 boats*and is is pivotal for trade among Central African countries. However, several problems plague the basin: Dredging or beaconing is inadequate all over the basin (waterways blocked with sand ) Between Brazzaville / Kinshasa and Bangui navigation is possible only 6-7 months per year. Port infrastructure/ equipment is obsolete and it is difficult to access to quays due to silting 17 February, 2014 The European GNSS Programmes 2 Illustration of EGNOS added value :case of the Congo basin Key issuesEGNOS added value Nowadays, 95% of CARs imports (c. 270m** per year) transit through the Congo, but navigation to Bangui is blocked for 5-6 months per year. EGNOS can support bathymetry surveys to run dredging vessels through the shallow areas, to allow all season navigation on the Oubangui (between Bangui and Brazzaville/ Kinshasa.) If such a system uses EGNOS and guarantee an efficiency improvement of 10%, then it can be preliminarily estimated that CAR imports could benefit of up to 30m per year. More in general, providing beaconing and enhanced security measures along the waterways would greatly help the development of all the region Note: * CICOS; ** c. 378$m, CIA Factbook (2011) III. Details on applications – Inland waterways
3Navigation solutions powered by Europe Back up slides 17 February, 2014 The European GNSS Programmes 3
4Navigation solutions powered by Europe Nile river Length: 6,671 km (1 st African river, 2 nd on earth). It receives flows from the Blue Nile from Ethiopia Navigable: The river traverses Uganda, Sudan and Egypt with variable navigability. Navigation is interrupted by the first cataract at Aswan. In Egypt, less than 1% of goods are transported via the Nile river and its canals Zambezi river Length: 2,574 km (4 th African river) Navigable: c. 570km (lower stretches from Tete). Navigation studies are considered for its Shire River section that joins Zambezi flowing out of Lake Malawi Congo river Length: 4,374 km (2 nd African river). It receives flows from the Oubangui and from Sangha that drains Central Africa southwest Navigable: c. 3,000 km, but Livingstone Alls prevent access from the sea. The transport fleet serving the Congo-Oubangui-Sangha river systems is estimated at 10,000 units Niger river Length: 4,184 km (3 rd African river). Its main tributary is the Benue River Navigable: c. 1,000km with small boats; from Koulikoro also with bigger ships. Various projects are underway to improve the navigability. Provision of adequate river ports and places for handling freight is increasingly along its middle section. And efforts are in place to reactivate navigational activities by dredging the Niger and the Benue following the political and economic improvement of its riparian states Senegal river Length: 1,790 km (5 th African river). Main tributaries are the Faleme, Karakor and the Gorgol rivers Navigable: c. 500km, from the Atlantic Ocean to Podor, Senegal, all year long, and to Kayes, Mali, during rainy seasons Mali, Mauritania, Senegal and Guinea manage the river basin through the organization pour la mise en valeur du fleuve Senegal (OMVS) Lake Victoria Area: Lake Victoria is Africas largest lake (2 nd in the world) with an area of 69,000 kmq and a shore- line of 3,500 km, shared between Tanzania, Uganda and Kenya. Navigable: Fully navigable, but the state of navigation aids has been non-functional for a long time, leading to increased fatal accidents. Moreover, the hydrographic survey maps done in 1924 are now obsolete. There are about 10 ferries and a number of open- decked cargo boats and passenger ships. Uganda railways operates two big ferries, which transport about 400,000 tons annually through Port Bell (Uganda)-Kisumu (Kenya) and 250,000 tons through Port Bell-Mwanza (Tanzania). The passenger ships transports c. 6,000 pax/ day Lake Tanganyica and lake Malawi Lake Tanganyika is the 2 nd largest lake in Africa with an area of 36,000 kmq that inter-connect DRC, Tanzania, Burundi and Zambia. The operational characteristics are the same as Lake Victoria. Lake Malawi (3 rd largest lake in Africa) is navigable between Malawi, Mozambique and Tanzania. Operations on the lake are under the same conditions as in Lakes Victoria and Tanganyika 17 February, 2014 The European GNSS Programmes 4 III. Details on concrete applications - Maritime Africa has many navigable waterways, with relevant quantities of goods transported...
5Navigation solutions powered by Europe 17 February, 2014 The European GNSS Programmes 5 III. Details on concrete applications - Maritime Congo river Strong Navigation limitations 5-6 months per year
6Navigation solutions powered by Europe Note: * International Navigation Association (formerly, Permanent International Association of Navigation Congresses); ** River Information System; *** Automatic Identification System Source: ESA Fairways vary according to adopted navigation control systems PIANC* recommends a fairway 5x the width of the largest ship when guided by radar PIANC recommends a fairway 2.8x the width of the largest ship when guided by more precise GNSS navigation systems AIS*** Position Accuracy (obtained with RIS) Radar Position Accuracy Position variable by sensor GPS DGPS (IALA signal) DGPS (local signal) SBAS Position variable by Speed Distance Weather (rain, waves,..) III. Details on concrete applications - Maritime 17 February, 2014 The European GNSS Programmes 6 With EGNOS, inland waterways traffic can be better managed thanks to RIS** technology implementation
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201713
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Sockeye’s commitment to encouraging health speaks on a deeper level to our commitment to our team. It’s more than just urging everyone to hit the gym once in awhile—it’s keeping fresh veggies in the office fridge. Having a designated nap chair. Giving every team member a bus pass, access to indoor bike parking and time to exercise. Bottom line: it’s all about taking care of the people who make Sockeye what it is. In that same spirit, we’re making an agency-wide resolution to move more in 2016. We know it sounds a lot like the dusty old “get in shape” resolution, but this isn’t about fitness as much as it’s about living more fully through movement. Movement of body, and movement of spirit.
Each of us will make our own individual commitment to movement for the upcoming year. It can be pretty much anything: from learning how to surf to going on a new hike every weekend to trying aerial yoga. Whatever we choose, the motivation is the same: to live more fully through motion. Albert Einstein said, “Life is like riding a bicycle. To keep your balance, you must keep moving.” We hope to do just that—to find balance, stay focused, get stronger, and nourish ourselves with the benefits of movement so that when we show up at work, we’re happier, healthier, and refreshed.
And we hope the year ahead holds movement for you, too: forward, up, and closer toward whatever it is you’re seeking. Happy New Year!
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201713
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Elliott Sound Products Horologers' Guide to Electronics
This article is a condensed version of the article "Electronics - Part 1" available on the main ESP website. A great deal of material has been culled, leaving only the essentials needed for a basic understanding of electronics in horology. There are also some new sections, that are specifically to discuss the rather different applications of basic components for clock motors.
Electrical timepieces have now been around for about 100 years. While the early systems were largely mechanical and used battery power to activate more or less traditional movements, their electrical operation is not well understood by most clock enthusiasts. The mechanics usually cause little or no pain, but deciphering the circuit diagram (schematic) can cause much tearing of hair and vocabulary enrichment.
Understanding exactly what happens and why can cause further aguish - especially when it appears that everything
seems fine, but the clock won't run. This is exacerbated once electronic systems are encountered. These became popular after the transistor was invented (in 1948), and by the early 50s there were quite a few electronic clocks available. These are now quite collectable, and some will be extremely rare in a few years - especially those using early plastic materials in their manufacture. The plastics are usually in the process of disintegration after 50 years or so, and restoration is either difficult or impossible.
In keeping with the ESP philosophy, I will concentrate here on the information you need, as opposed to what you are
told you need. These are usually very different.
Basic components are not always as simple as they may appear at first look. This article is intended for the beginner to electronics, who will need to know a number of things before starting on even the simplest of projects. The more experienced hobbyist will probably learn some new things as well, since there is a good deal of information here of which non-professionals will be unaware.
This is by no means an exhaustive list, and I shall attempt to keep a reasonable balance between full explanations and simplicity. I shall also introduce some new terminology as I go along, and it is important to read this the way it was written, or you will miss the explanation of each term as it is first encountered.
It must be noted that the US still retains some very antiquated terminology, and this often causes great confusion for the beginner (and sometimes the not-so-beginner as well). You will see some "beat-ups" of the US - citizens of same, please don't be offended, but rather complain bitterly to anyone you see using the old terminology.
Within The Audio Pages, I use predominantly European symbols and terminology - these are also the recommended (but not mandatory) symbols and terms for Australia, and I have been using them for so long that I won't be changing them.
The basic electrical units and definitions are as shown below. This list is not exhaustive (also see the Glossary), but covers the terms you will encounter most of the time. Many of the terms are somewhat inter-related, so you need to read all of them to make sure that you understand the relationship between them.
Passive: Capable of operating without an external power source.
Typical passive components are resistors, capacitors, inductors and diodes (although the latter are a special case).
Active: Requiring a source of power to operate.
Includes transistors (all types), integrated circuits (all types), TRIACs, SCRs, LEDs, etc.
DC: Direct Current
The electrons flow in one direction only. Current flow is from negative to positive, although it is often more convenient to think of it as from positive to negative. This is sometimes referred to as "conventional" current as opposed to electron flow.
AC: Alternating Current
The electrons flow in both directions in a cyclic manner - first one way, then the other. The rate of change of direction determines the frequency, measured in Hertz (cycles per second).
Frequency: Unit is Hertz, Symbol is Hz, old symbol was cps (cycles per second)
A complete cycle is completed when the AC signal has gone from zero volts to one extreme, back through zero volts to the opposite extreme, and returned to zero. The accepted audio range is from 20Hz to 20,000Hz. The number of times the signal completes a complete cycle in one second is the frequency.
Voltage: Unit is Volts, Symbol is V or U, old symbol was E
Voltage is the "pressure" of electricity, or "electromotive force" (hence the old term E). A 9V battery has a voltage of 9V DC, and may be positive or negative depending on the terminal that is used as the reference. The mains has a voltage of 220, 240 or 110V depending where you live - this is AC, and alternates between positive and negative values. Voltage is also commonly measured in millivolts (mV), and 1,000 mV is 1V. Microvolts (uV) and nanovolts (nV) are also used.
Current: Unit is Amperes (Amps), Symbol is I
Current is the flow of electricity (electrons). No current flows between the terminals of a battery or other voltage supply unless a load is connected. The magnitude of the current is determined by the available voltage, and the resistance (or impedance) of the load and the power source. Current can be AC or DC, positive or negative, depending upon the reference. For electronics, current may also be measured in mA (milliamps) - 1,000 mA is 1A. Nanoamps (nA) are also used in some cases.
Resistance: Unit is Ohms, Symbol is R or Ω
Resistance is a measure of how easily (or with what difficulty) electrons will flow through the device. Copper wire has a very low resistance, so a small voltage will allow a large current to flow. Likewise, the plastic insulation has a very high resistance, and prevents current from flowing from one wire to those adjacent. Resistors have a defined resistance, so the current can be calculated for any voltage. Resistance in passive devices is always positive (i.e. > 0)
Capacitance: Unit is Farads, Symbol is C
Capacitance is a measure of stored charge. Unlike a battery, a capacitor stores a charge electrostatically rather than chemically, and reacts quite differently. A capacitor passes AC, but will not pass DC (at least for all practical purposes). The reactance or AC resistance (called impedance) of a capacitor depends on its value and the frequency of the AC signal. Capacitance is always a positive value.
Inductance: Unit is Henrys, Symbol is H or L (depending on context)
Inductance occurs in any piece of conducting material, but is wound into a coil to be useful. An inductor stores a charge magnetically, and presents a low impedance to DC (theoretically zero), and a higher impedance to AC dependent on the value of inductance and the frequency. In this respect it is the electrical opposite of a capacitor. Inductance is always a positive value. The symbol "Hy" is sometimes used in (guess where :-) ... the US. There is no such symbol.
Impedance: Unit is Ohms, Symbol is Ω or Z
Unlike resistance, impedance is a frequency dependent value, and is specified for AC signals. Impedance is made up of a combination of resistance, capacitance, and/ or inductance. In many cases, impedance and resistance are the same (a resistor for example). Impedance is most commonly positive (like resistance), but can be negative with some components or circuit arrangements.
A few basic rules that electrical circuits always follow are useful before we start.
Some of these are intended to forewarn you against some of the outrageous claims you will find as you research these topics further, and others are simple electrical rules that apply whether we like it or not.
Figure 3.1 - Some Wiring Symbols
The conventions I use for wires crossing and joining are marked with a star (*) - the others are a small sample of those in common use, but are fairly representative. Many can be worked out from their position in the circuit diagram (schematic).
The commonly accepted units in electronics are metric. In accordance with the SI (System Internationale) metric specifications, any basic unit (such as an Ohm or Farad) will be graded or sub-graded in units of 1,000 - this gives the following table.
Term Abbreviation Value (Scientific) Value (Normal) Tera T 1 x 10 12 1,000,000,000,000 Giga G 1 x 10 9 1,000,000,000 Mega M 1 x 10 6 1,000,000 kilo k (lower case) 1 x 10 3 1,000 Units - 1 1 Milli m 1 x 10 -3 1 / 1,000 Micro μ or u 1 x 10 -6 1 / 1,000,000 Nano n 1 x 10 -9 1 / 1,000,000,000 Pico p 1 x 10 -12 1 / 1,000,000,000,000
The abbreviations and case are important - "m" is quite clearly different from "M". In general, values smaller than unity use lower case, and those greater than unity use upper case. "k" is clearly an exception to this. There are others that go above and below those shown, but it is unlikely you will encounter them. Even Giga and Tera are unusual in electronics (except for determining the size hard drive needed to install a Microsoft application :-)
The first and most common electronic component is the resistor. There is virtually no working circuit I know of that doesn't use them, and a small number of practical circuits can be built using nothing else. There are three main parameters for resistors, but only two of them are normally needed, especially for solid state electronics.
The resistance value is specified in ohms, the standard symbol is "R" or Ω. Resistor values are often stated as "k" (kilo, or times 1,000) or "M", (meg, or times 1,000,000) for convenience. There are a few conventions that are followed, and these can cause problems for the beginner. To explain - a resistor has a value of 2,200 Ohms. This may be shown as any of these ...
The use of the symbol for Ohms (Omega, Ω is optional, and is most commonly left off, since it is irksome to add from most keyboards. The letter "R" and the "2k2" conventions are European, and not commonly seen in the US and other backward countries :-) Other variants are 0R1, for example, which means 0.1 Ohm
The schematic symbols for resistors are either of those shown below. I use the Euro version of the symbol exclusively.
Figure 5.1 - Resistor Symbols
The basic formula for resistance is Ohm's law, which states that ...
1.1.1 R = V / I Where V is voltage, I is current, and R is resistance
The other formula you need with resistance is Power (P)
1.1.2 P = V 2/ R 1.1.3 P = I 2* R
The easiest way to transpose any formula is what I call the 'Transposition Triangle' - which can (and will) be applied to other formulae. The resistance and power forms are shown below - just cover the value you want, and the correct formula is shown. In case anyone ever wondered why they had to do algebra at school, now you know - it is primarily for the manipulation of a formula - they just don't teach the simple ways. A blank between two values means they are multiplied, and the line means divide.
Figure 5.2 - Transposition Triangles for Resistance
Needless to say, if the value you want is squared, then you need to take the square root to get the actual value.For example, you have a 100 Ohm, 5W resistor, and want to know the maximum voltage that can be applied. V
2 = P * R = 500, and the square root of 500 is 22.36, or 22V. This is the maximum voltage across the resistor to remain within its power rating.
Resistors have the same value for AC and DC - they are not frequency dependent within the normal audio range. Even at radio frequencies, they will tend to provide the same value, but at very high frequencies other effects become influential. These characteristics will not be covered, as they are outside the scope of this article.
A useful thing to remember for a quick calculation is that 1V across a 1k resistor will have 1mA of current flow - therefore 10V across 1k will be 10mA (etc.).
5.1 Standard Values
There are a number of different standards, commonly known as E12, E24, E48 and E96, meaning that there are 12, 24, 48 or 96 individual values per decade (e.g. from 1k to 10k). The most common, and quite adequate for 99.9% of all projects, are the E12 and E24 series, and I shall not bother with the others at this time. The E12 and E24 series follow these sequences:
1 1.2 1.5 1.8 2.2 2.7 3.3 3.9 4.7 5.6 6.8 8.2 10
1 1.2 1.5 1.8 2.2 2.7 3.3 3.9 4.7 5.6 6.8 8.2 10 1.1 1.3 1.6 2.0 2.4 3.0 3.6 4.3 5.1 6.2 7.5 9.1
Generally, 5% resistors will follow the E12 sequence, and 1% or 2% resistors will be available in the E24 sequence. Wherever possible in my projects, I use E12 as these are commonly available almost everywhere.
Resistors are commonly available in values ranging from 0.1 Ohm (0R1) up to 10M Ohms (10,000,000 Ohms). Not all values are available in all types, and close tolerances are uncommon in very high and very low values.
5.2 Colour Codes Low power (<= 2W) resistors are nearly always marked using the standard colour code. This comes in two variants - 4 band and 5 band. The 4 band code is most common with 5% and 10% tolerance, and the 5 band code is used with 1% and better.
Colour First Digit Second Digit Third Digit Multiplier Tolerance Black 0 0 0 1 Brown 1 1 1 10 1% Red 2 2 2 100 2% Orange 3 3 3 1,000 Yellow 4 4 4 10,000 Green 5 5 5 100,000 Blue 6 6 6 1,000,000 Violet 7 7 7 Grey 8 8 8 White 9 9 9 Gold 0.1 5% Silver 0.01 10%
My apologies if the colours look wrong - blame the originators of the HTML colours, which are a little restricting, to say the least. With the 4 band code, the third digit column is not used, it is only used with the 5 band code. This is somewhat confusing, but we are unable to change it, so get used to it. Personally, I suggest the use of a multimeter when sorting resistors - I know it's cheating, but at least you don't get caught out by incorrectly marked components (and yes, this does happen).
5.3 Tolerance The tolerance of resistors is mostly 1%, 2%, 5% and 10%. In the old days, 20% was also common, but these are now rare. Even 10% resistors are hard to get except in extremely high or low values (> 1M or < 1R), where they may be the only options available at a sensible price.
A 100R resistor with 5% tolerance may be anywhere between 95 and 105 ohms - in most circuits this is insignificant, but there will be occasions where very close tolerance is needed (e.g. 0.1% or better). This is fairly rare for audio, but there are a few instances where you may see such close tolerance components.
5.4 Power Ratings Resistors are available with power ratings of 1/8th W (or less for surface mount devices), up to hundreds of watts. The most common are 1/4W (0.25W), 1/2W (0.5W), 1W, 5W and 10W. Very few projects require higher powers, and it is often much cheaper to use multiple 10W resistors than a single (say) 50W unit. They will also be very much easier to obtain.
Like all components, it is preferable to keep temperatures as low as possible, so no resistor should be operated at its full power rating for any extended time. I recommend a maximum of 0.5 of the power rating wherever possible. Wirewound resistors can tolerate severe overloads for a short period, but I prefer to keep the absolute maximum to somewhat less than 250% - even for very brief periods, since they may become open circuit from the stress, rather than temperature (this does happen, and I have experienced it during tests and repairs).
5.5 Resistance Materials Resistors are made from a number of different materials. I shall only concentrate on the most common varieties, and the attributes I have described for each are typical - there will be variations from different makers, and specialised types that don't follow these (very) basic characteristics. All resistors are comparatively cheap.
A couple of points to ponder. Resistors make noise! Everything that is above 0K (zero Kelvin, absolute zero, or -273 degrees Celsius) makes noise, and resistors are no exception. Noise is proportional to temperature and voltage, but for horological applications it is unlikely that resistor noise will ever cause a problem.
Resistors may also have inductance, and wirewound types are the worst for this. Again, this is unlikely to cause any issues with clocks, regardless of the circuit type.
Capacitors come in a bewildering variety of different types. The specific type may be critical in some applications, where in others, you can use anything you please. Capacitors are the second most common passive component, and there are few circuits that do not use at least one capacitor.
A capacitor is essentially two conductive plates, separated by an insulator (the dielectric). To conserve space, the assembly is commonly rolled up, or consists of many small plates in parallel for each terminal, each separated from the other by a thin plastic film. See below for more detailed information on the different constructional methods. A capacitor also exists whenever there is more than zero components in a circuit - any two pieces of wire will have some degree of capacitance between them, as will tracks on a PCB, and adjacent components. Capacitance also exists in semiconductors (diodes, transistors), and is an inescapable part of electronics.
There are two main symbols for capacitors, and one other that is common in the US, but rarely seen elsewhere. Caps (as they are commonly called) come in two primary versions - polarised and non-polarised. Polarised capacitors must have DC present at all times, of the correct polarity and exceeding any AC that may be present on the DC polarising voltage. Reverse connection will result in the device failing, often in a spectacular fashion, and sometimes with the added excitement of flames, or high speed pieces of casing and electrolyte (an internal fluid in many polarised caps). This is not a good thing.
Figure 6.1 - Capacitor Symbols
Capacitors are rated in Farads, and the standard symbol is "C" or "F", depending upon the context. A Farad is so big that capacitors are most commonly rated in micro-Farads (uF). The Greek letter (lower case) Mu is the proper symbol, but "u" is available on keyboards, and is far more common. Because of the nature of capacitors, they are also rated in very much smaller units than the micro-Farad - the units used are ...
The items in bold are the ones I use in all articles and projects, and the others should be considered obsolete andnot used -
at all, by anyone !
Milli-Farads (mF)
be used for large values, but are generally avoided because of the US's continued use of the ancient terminology. When I say ancient, I mean it - these terms date back to the late 1920s or so. Any time you see the term "mF", it should
A capacitor with a value of 100nF may also be written as 0.1uF (especially in the US). A capacitor marked on a schematic as 2n2 has a value of 2.2nF, or 0.0022uF. It may also be written (or marked) as 2,200pF. These are all equivalent, and although this may appear confusing (it is), it is important to understand the different terms that are applied.
A capacitor has an infinite (theoretically!) resistance at DC, and with AC, it has an impedance. Impedance is defined as a non-resistive (or only partially resistive) load, and is frequency dependent. This is a very useful characteristic, and is used to advantage in many circuits.
In the case of a capacitor, the impedance is called Capacitive Reactance generally shown as Xc. The formula for calculating capacitive reactance (Xc) is shown below ...
6.1.1 Xc = 1 / 2 π F C where π is 3.14159..., F is frequency in Hertz, and C is capacitance in Farads
The Transposition Triangle can be used here as well, and simplifies the extraction of the wanted value considerably.
Figure 6.2 - Capacitance Triangle
As an example, what is the formula for finding the frequency where a 10uF capacitor has a reactance of 200 Ohms? Simply cover the term 'F' (frequency), and the formula is ...
6.1.2 F = 1 / 2 π C Xc
In case you were wondering, the frequency is 79.5Hz. At this frequency, if the capacitor were feeding a 200 ohm load, the amplitude of the signal will be 0.707 of the applied signal. It is uncommon in horology that you will need to know the capacitive reactance (although there will undoubtedly be exceptions). The most common way that caps are used in clock circuits, you are far more likely to need to know the
time constant.
When a capacitor is charged or discharged, a time constant is formed by the capacitance and any external resistance. The time constant is defined as the time taken for the signal to reach 63.2% of the applied voltage, or where the voltage has fallen to 36.8% when the cap is discharged. This is shown in Figure 6.3 below.
Figure 6.3 - Capacitor Charge and Discharge Time Constants
It is generally taken that a capacitor has charged or discharged in 5 time constants. In theory, the exponential charge (or discharge) curve can never reach the applied voltage or zero, but for all practical purposes and within the limits of practical measurements, 6 time constants is sufficient to assume a complete charge or discharge.
The time constant of a resistor-capacitor circuit is calculated by ...
6.1.3 t = R * C Where R is in ohms and C is in Farads
Like the formula for capacitive reactance, the above can be placed in the 'transposition triangle' (hint: time (t) goes on top). It is therefore possible to determine an unknown value provided you know the other two.
Neither formula is likely to be needed on a regular basis, so spending a lot of time on them is simply not needed. They are both included for completeness, and at some stage you may well find yourself wanting to know. It may not be strictly necessary, but often it's nice to
know why a particular value was used, simply for one's own understanding. 6.1 Standard Values Capacitors generally follow the E12 sequence, but with some types, there are very few values available within the range. There are also a few oddities, especially with electrolytic caps (these are polarised types).
1 1.2 1.5 1.8 2.2 2.7 3.3 3.9 4.7 5.6 6.8 8.2 10 6.2 Capacitor Markings Unlike resistors, few capacitors are colour coded. Some years ago, various European makers used colour codes, but these have gone by the wayside for nearly all components available today. This is not to say that you won't find them, but I am not going to cover this.
The type of marking depends on the type of capacitor in some cases, and there are several different standards in common use. Because of this, each type shall be covered separately.
6.3 Tolerance The quoted tolerance of most polyester (or other plastic film types) capacitors is typically 10%, but in practice it is usually better than that. Close tolerance types (e.g. 1%) are available, but they are usually rather expensive. If you have a capacitance meter, it is far cheaper to buy more than you need, and select them yourself. Accurate capacitor values are generally not needed in any clock, and the standard tolerance parts are perfectly adequate.
Electrolytic capacitors have a typical tolerance of +50/-20%, but this varies from one manufacturer to the next. Electrolytics are also affected by age, and as they get older, the capacitance falls. Modern electros are better than the old ones, but they are still potentially unreliable at elevated temperatures or with significant current flow (AC, of course).
6.4 Capacitor Materials As you have no doubt discovered by now, the range is awesome. Although some of the types listed below are not especially common, these are the most popular of the capacitors available. There is a school of thought that the differences between various dielectrics are audible, and although this may be true in extreme cases, generally I do not believe this to be the case - provided of course that a reasonable comparison is made, using capacitors designed for the application.
Many of the capacitors listed are "metallised", meaning that instead of using aluminium or other metal plates, the film is coated with an extremely thin layer of vaporised metal. This makes the capacitor much smaller than would otherwise be the case.
This is only a basic listing, but gives the reader an idea of the variety available. The recommendations are mine, but there are many others in the electronics industry who will agree with me (as well as many who will not - such is life).
Apart from the desired quantity of capacitance, capacitors have some unwanted features as well. Some may have significant inductance, and they all posses some value of resistance (although generally small). The resistance is referred to as ESR (Equivalent Series Resistance), and this can have adverse effects at high currents. Although it exists in all capacitors, ESR is generally quoted only for electrolytics.
With capacitors, there is no power rating. A capacitor in theory dissipates no power, regardless of the voltage across it or the current through it. In reality, this is not quite true, but for all practical purposes it does apply.
All capacitors have a voltage rating, and this must not be exceeded. If a higher than rated voltage is applied, the insulation between the 'plates' of the capacitor breaks down, and an arc will often weld the plates together, short circuiting the component. The 'working voltage' is DC unless otherwise specified, and application of an equivalent AC signal will probably destroy the capacitor.>/p>
These are the last of the purely passive components. An inductor is most commonly a coil, but in reality, even a straight piece of wire has inductance. Winding it into a coil simply concentrates the magnetic field, and increases the inductance considerably for a given length of wire. There are some very common inductive components (such as transformers, which are a special case), and inductors are very common in clock motors. Any coil used to actuate a function, reset a gravity lever or impulse a pendulum directly is an inductor.
Note: Transformers are a special case of inductive components, and will be covered separately.
Even very short component leads have some inductance, and like capacitance, it is just a part of life. In clock motor systems, these stray inductances cause no problems and can usually be ignored.
An inductor can be considered the opposite of a capacitor. It passes DC with little resistance, but becomes more of an obstacle to the signal as frequency increases. An inductor also stores electrical energy as a magnetic field, and this causes many difficulties when switching inductive circuits in clock motors. The biggest problem is contact erosion, and knowing how this occurs in a low voltage circuit is critical to your understanding of clock motor systems..
There are a number of different symbols for inductors, and three of them are shown below. Somewhat perversely perhaps, I use the 'standard' symbol most of the time, since this is what is supported best by my schematic drawing package.
Figure 7.1 - Inductor Symbols
There are other core types not shown above. Dotted lines instead of solid mean that the core is ferrite or powdered iron (uncommon in clock motors), rather than steel laminations or a toroidal steel core. Note that pure iron is rarely used except in very early movements - there are (now) various grades of steel with much better magnetic properties. The use of a magnetic core further concentrates the magnetic field, and increases inductance - this is common for solenoids - electro-mechanical actuators. These are used in many electric clock movements.
Inductance is measured in Henrys (H) and has the symbol 'L' (yes, but ... Just accept it :-). The typical range is from a few micro-Henrys up to 10H or more. Although inductors are available as components, there are few (if any) conventions as to values or markings. Few clock motors use commercially available inductors ... most are (were) specially made to suit the application.
Electromechanical clocks make extensive use of inductors. They are usually cunningly disguised as solenoids (electromagnets) or motor drive coils. The inductance is incidental, and is not usually a major design feature, although it is an inevitable result of winding wire around a core. While the measured inductance is not usually important, it can be useful to check that a coil doesn't have any shorted turns. While it may not seem to be a problem if a few turns of a coil are shorted together, it actually affects the performance dramatically.
This is especially true if the coil is used to sense the small voltage generated by a passing magnet. A few shorted turns can completely ruin the ability of the sensing circuit to detect a voltage (or generate a useful magnetic impulse), because the shorted turns absorb a disproportionately high current and can render an entire coil useless.
Inductors store energy as a magnetic field. When the source of current is interrupted, the magnetic field collapses instantly. The voltage generated by a coil is determined by the number of turns and the
rate of change of the magnetic field. Thus, when current is interrupted in a coil, a high voltage of opposite polarity to that applied is created. It is this voltage that causes contact erosion, and if unchecked it can also damage the coil's insulation. More on this topic shortly.
Like a capacitor, an inductor has reactance as well, but it works in the opposite direction. The formula for calculating the inductive reactance (X
L) is ... 7.1.1 X L= 2 π F L where L is inductance in Henrys
As before, the transposition triangle helps us to realise the wanted value without having to remember basic algebra.
Figure 7.2 - Inductance Triangle
An inductor has a reactance of 200 ohms at 2kHz. What is the inductance? As before, cover the wanted value, in this case inductance. The formula becomes ...
7.1.2 L = X L/ 2 π F
The answer is 15.9mH. While unlikely to be of use in horology, again this is provided in the interests of completeness
Like a capacitor, an inductor (in theory) dissipates no power, regardless of the voltage across it or the current passing through. In reality, all inductors have resistance, so there is a finite limit to the current before the wire gets so hot that the insulation melts. If impulsed, the current may exceed the nominal continuous rating by a factor determined by the on/off ratio. A coil that is activated for 0.1 second once per second can support 10 times the nominal continuous current for each impulse without exceeding its maximum allowable temperature rise.
Coils or solenoids used in clocks are often working at the very limit of allowable resistance based on the large number of turns needed to obtain a usable magnetic impulse from a very limited supply voltage. Since such clocks may operate from as little as 1.5V, it is difficult to balance the large number of turns with the size of the coil and the resistance of the wire. It is not uncommon for clock coils to have a resistance of 1,000 ohms or more, and this means that the maximum current may be only 1.5mA or less (remember Ohm's law above).
7.1 Quality Factor The resistance of a coil determines its Q, or Quality factor. An inductor with high resistance has a low Q, and vice versa. I do not propose to cover this in any more detail at this stage, because it is usually not relevant for the coils and solenoids used in clocks. 7.2 Power Ratings Because of the resistance, there is also a limit to the power that any given inductor can handle. In the case of any inductor with a magnetic core, a further (and usually overriding) limitation is the maximum magnetic flux density supported by the magnetic material before it saturates. Once saturated, any increase in current causes no additional magnetic field (since the core cannot support any more magnetism), and the inductance falls. While this causes gross non-linearities, these again are irrelevant in clock motors. It is rare that any clock motor will ever reach magnetic saturation, because the current is so limited. 7.3 Inductor Materials The most common winding material is copper, and this may be supported on a plastic bobbin, or can be self-supporting - often held together with lacquer. Iron cores for solenoids are usually of simple design, and many of the early examples are not very efficient. This may mean that more current is needed to operate the solenoid and its load, reducing battery life.
The use of a core concentrates the magnetic field, and almost all solenoids will utilise a core of soft iron or mild steel. A solenoid has two main parts - the
stator, being the fixed section including the actuating coil(s), and the armature, the movable section that activates the mechanism.
A very common solenoid actuated device is called a
relay, which uses the solenoid to operate one or more sets of electrical contacts. Relays allow large loads to be controlled from low-power sources, and may also be used to provide galvanic isolation - the complete electrical separation of two or more sections of an electrical circuit. 7.4 Core Types Inductors used in clocks may use either of two materials for the core - air (lowest inductance, but can be used with a magnet), soft iron (rather uncommon) or mild steel. While there are many grades of steel with far better magnetic properties than mild steel, they are relatively recent and much harder to work with. Some coils in clocks are used for AC operation - typically synchronous motors. In these motors, the constantly changing magnetic flux will induce a current into any conductive core material in a similar manner to a transformer. This is called 'eddy current' and represents a loss in the circuit. Because the currents may be very high, this leads to the core becoming hot, and reduces performance.
To combat this, steel cores used for AC motors are laminated, using thin sheets of steel insulated from each other. This prevents the circulating currents from becoming excessive because they are limited to each thin sheet, thereby reducing losses considerably. At mains frequencies (50Hz or 60Hz), losses and heat are reduced to acceptable levels. For high frequency applications, even the thin sheets will start to suffer from losses, so powdered iron (a misnomer, since it is more commonly powdered steel) cores are used. Small granules of magnetic material are mixed with a suitable bonding agent, and fired at high temperature to form a ceramic-like material that has excellent magnetic properties. The smaller the magnetic particles (and the less bonding agent used), the better the performance at high power and high frequencies. It is extremely unlikely that any of these cores will be found in clocks.
Components in combination form most of the circuits we see. All passives can be arranged in series, parallel, and in any number of different ways to achieve the desired result. Amplification is not possible with passive components, since there is no means to do so. This does not mean that we are limited - there are still many combinations that are extremely useful, and they are often used around active devices (such as transistors) to provide the characteristics we need. Parallel operation is often used to obtain greater power, where a number of low power resistors are wired in parallel to get a lower resistance, but higher power. Series connections are sometimes used to obtain very high values (or to increase the voltage rating). There are endless possibilities, and I shall only concentrate on the most common.
8.1 Resistors Resistors can be wired in parallel or in series, or any combination thereof, so that values greater or smaller than normal or with higher power or voltage can be obtained. This also allows us to create new values, not catered for in the standard values. Figure 8.1 - Some Resistor Combinations Series: When wired in series, the values simply add together. A 100 ohm and a 2k2 resistor in series will have a value of 2k3. 8.1.1 R = R1 + R2 (+ R3, etc.) 8.1.2 1/R = 1/R1 + 1/R2 (+ 1/R3 etc.) Also written as ... 8.1.3 R = 1 / ((1 / R1) + (1 / R2)) An alternative for two resistors is ... 8.1.4 R = (R1 * R2) / (R1 + R2)
The same resistors as before in parallel will have a total resistance of 95.65 ohms (100 || 2,200). Either formula above may be used for the same result.
Four 100 ohm 10W resistors gives a final value of either 400 ohms 40W (series), 25 ohms 40W (parallel) or 100 ohms 40W (series/ parallel).
Voltage Dividers: One of the most useful and common applications for resistors. A voltage divider is used to reduce the voltage to something more suited to our needs. This connection provides no 'transformation', but is used to match impedances or levels. The formula for a voltage divider is ... 8.1.5 Vd = ( R1 + R2 ) / R2
With our standard resistors as used above, we can create a voltage divider of 23 (R1=2k2, R2=100R) or 1.045 (R1=100R, R2=2k2). Perhaps surprisingly, both of these are useful
! 8.2 Capacitors Like resistors, capacitors can also be wired in series, parallel or a combination. Figure 8.2 - Capacitor Combinations
The capacitive voltage divider may come as a surprise, but it is a useful circuit, and is common in RF oscillators and precision attenuators (the latter in conjunction with resistors). Despite what you may intuitively think, the capacitive divider is not frequency dependent, so long as the source impedance is low, and the load impedance is high compared to the capacitive reactance. Capacitive voltage dividers are unlikely to be found in clocks.
When using caps in series or parallel, exactly the opposite formulae are used from those for resistance. Caps in parallel have a value that is the sum of the individual capacitances. Here are the calculations ...
Parallel: A 12nF and a 100nF cap are wired in parallel. The total capacitance is 112nF 8.2.1 C = C1 + R2 (+ R3, etc.) 8.2.2 1 / C = 1 / C1 + 1 / C2 (+ 1 / C3 etc.) Also written as ... 8.2.3 C = 1 / ((1 / C1) + (1 / C2)) An alternative for two capacitors is ... 8.2.4 C = (C1 * C2) / (C1 + C2)
This should look fairly familiar by now. The same two caps in series will give a total value of 10n7 (10.7nF).
The voltage divider is calculated in the same way, except that the terms are reversed (the larger capacitor has a lower reactance).
8.3 Inductors I shall leave it to the reader to determine the formulae, but suffice to say that they behave in the same way as resistors in series and parallel. The formulae are the same, except that 'L' (for inductance) is substituted for 'R'.
When any or all of the above passive components are combined, we create real circuits that can perform functions that are not possible with a single component type. These 'composite' circuits make up the vast majority of all electronics circuits in real life, and understanding how they fit together is very important to your understanding of electronics.
The response of various filters is critical to understanding the way many electronics circuits work. Figure 9.1 shows the two most common, but this information is (again) in the interests of completeness. It is unlikely that filters will be encountered in clock systems, although various component combinations will create filters that are incidental to the workings of the circuit.
Figure 9.1 - High Pass and Low Pass Filter Response
The theoretical response is shown in green, and the actual response is in red. Real circuits (almost) never have sharp transitions, and the curves shown are typical of most filters. In general electronics, the most common use of combined resistance and reactance (from a capacitor or inductor) is for filters - for clock systems the filters are simply the inevitable result of combining the components. f
o is the frequency at which output level is 0.707 of the applied signal. This rather odd value is used extensively in electronics ( 1 / √2 ), and defines the -3dB (half power) signal level.
Within this article, this is as far as we will go with the descriptions of filters - the idea is to learn the basics, and not get bogged down in great detail with specific circuit topologies. As noted above, the use of filter circuits is very limited within electric (or electronic) clock systems, and they are generally an unintentional (but inescapable) result of using parts in combination.
When resistance (R) and capacitance (C) are used together, we can start making some useful circuits. The combination of a non-reactive (resistor) and a reactive (capacitor) component creates a whole new set of circuits. Simple filters are easily made, and basic circuits such as integrators (low pass filters) and differentiators (high pass filters) will be a breeze after this section is completed.
The frequency of any filter is defined as that frequency where the signal is 0.707 (-3dB) of the level in the pass band. A low pass filter is any filter that passes frequencies below the 'turnover' point, and the relationship between R, C and F is shown below ...
9.1.1 f = 1 / 2 π R C I shall leave it to you to fit this into the transposition triangle.
A 10k resistor and a 100nF capacitor will have a 'transition' frequency (f
o) of 159Hz, and it does not matter if it is connected as high or low pass. Sometimes, the time constant is used instead - Time Constant is defined as the time taken for the voltage to reach 63.2% of the supply voltage upon application of a DC signal, or discharge to 36.8% of the fully charged voltage upon removal of the DC. This depends on the circuit configuration. 9.1.2 T = R C Where Tis time constant
For the same values, the time constant is 1ms (1 millisecond, or 1/1,000 second). The time constant is used mainly where DC is applied to the circuit, and it is used as a simple timer, but is also used with AC in some instances. From this, it is obvious that the frequency is therefore equal to ...
9.1.3 f = 1 / 2 π T
This is not especially common, but you may need it sometime.
Figure 9.2 - Some RC Circuits
The above are only the most basic of the possibilities, and the formula (9.1.1) above covers them all. The differentiator (or high pass filter) and integrator (low pass filter) are quite possibly the most common circuits in existence, although most of the time you will be quite unaware that this is what you are looking at. The series and parallel circuits are shown with one end connected to Earth - again, although this is a common arrangement, it is by no means the only way these configurations are used. For the following, we shall assume the same resistance and capacitance as shown above - 10k and 100nF.
The parallel RC circuit will exhibit only the resistance at DC (or ultra-low AC frequencies), and the impedance will fall as the frequency is increased. At high frequency, the impedance will approach zero Ohms. At some intermediate frequency determined by formula 9.1.1, the reactance of the capacitor will be equal to the resistance, so (logically, one might think), the impedance will be half the resistor value. In fact, this is not the case, and the impedance will be 7k07 Ohms. This needs some further investigation ...
The series RC circuit also exhibits frequency dependent behaviour, but at DC the impedance is infinite (for practical purposes), and at some high frequency it is approximately equal to the resistance value alone. It is the opposite of the parallel circuit.
There is a great deal more information that could be included, but it is not very useful to do so. For those who do wish to see the data culled from this article, please see Beginners' Guide to Electronics - Part 1
While this is probably the most common application within clock motors of all types, there is very little that you can do about anything that happens. This is because the coils used in the majority of clock motor systems are intended to operate at very low voltage and current, and the dominant parameter is resistance.
The internal resistance limits the current without recourse to any external resistance, and this makes a complete resistance / inductance circuit. There are a few common R/L circuits in use though, and these are usually found in older clocks. It is common to find resistors - often made using cotton insulated resistance wire jumble wound on a fibre-board former - wired in parallel with the coil.
These circuits were used before the advent of semiconductor diodes, and are used to suppress the back-EMF from the coil when contacts open. The collapsing magnetic field can induce a very high voltage across the coil (in excess of 500V), and the addition of a resistor reduces this induced voltage to manageable levels. There is a power loss with the scheme, because the resistor is wired in parallel with the coil, so it will draw current when the contacts are closed. The general scheme is shown in Figure 9.3 - the switch shown can be anywhere in the circuit, but must not disconnect the coil from the external resistor.
Figure 9.3 - Switched Coil With Suppression Resistor
The coil is a complete composite circuit. Because it is wound with wire it has inductance and resistance, and because the wires are closely spaced, these form a myriad of small capacitors. The complete coil therefore has all three passive components packed into one part. Of all the components, inductors (and/or solenoids) are the very worst electronic parts. Fortunately, we rarely need their inductive properties - these just come with the coil whether we like it or not.
The resistor shown in parallel with the coil has a resistance that is just over 4 times the coil's resistance. This is a reasonable compromise, and limits the voltage peak to just under 9V, pretty much irrespective of the coil's inductance. Higher values will waste less power, but will allow the voltage spike to be greater. The most common value with clocks is 10 times the coil's resistance. This minimises the wasted current and provides a reasonable reduction of the flyback voltage.
In theory, the voltage spike could be as high as several kV (thousand Volts), but real-world parts are imperfect. The maximum voltage I'd expect to measure is only about 500V without any suppression resistor. This is more than enough to damage the insulation on the coil winding wire - especially older enamels which were nowhere near as good as those that became available from around 1950 onwards.
The voltage spike will also cause contact damage. Even though the spike voltage is limited to 9V, this is still a great deal more than 1.5V (by a factor of 6), and higher supply voltages will generate higher voltage spikes - roughly in direct proportion to the applied voltage.
The final point on this topic is power waste. The coil's resistance means that it can draw a maximum of 30mA from a 1.5V cell. This is the current needed to perform the work one expects from the coil. The external resistor (R1) draws an additional 6.8mA - 22% more current from the cell, so 22% less running time for a given cell size.
The combination of capacitance and inductance (at least in its 'normal' form) is fairly common in many early quartz clock motors, although the inductance of the coil is usually less of an influence than the resistance of the winding wire. Nonetheless, the inductance is still important, as you can see from Figure 9.4
Figure 9.4 - Motor Drive Circuit and Waveforms
This was a common method used to drive the clock stepper motor with early circuits. The capacitor allows the 0V-1.5V-0V output waveform to be converted to a true 'bipolar' (positive and negative) drive signal as required to make the motor advance.
You can see that the voltage waveform to the motor rises instantly, but the peak current occurs as the voltage is
decreasing. This is not an error. Because an inductor will resist any current change, it can only delay the inevitable. The peak current will still reach almost the same value as it would into a pure resistance, but this happens after the voltage has peaked, and as it falling back towards zero. The peak current occurs when the voltage has fallen to 0.707 of the peak - in this case, at about 1.1V (down from the 1.5V peak). This demonstrates that the inductance is doing what it does (weird stuff), but the resistance does have an effect too.
The combinations of capacitors and inductors have some fascinating properties, depending on the way they are connected. Most of these will not be covered here - they are much more commonly used in RF work, and in some cases for generation of very high voltages for experimental purposes (Tesla coils and car ignition coils spring to mind). A series resonant circuit can generate voltages that are many times the input voltage, and this interesting fact can be used to advantage (or to kill yourself!).
Parallel and series resonant circuits can be indistinguishable from each other in some circuits, and in RF (radio frequency) work these resonant systems are often referred to as a 'tank'. Energy is stored by both reactances, and is released into a load (such as an antenna). The energy storage allows an RF circuit to oscillate happily with only the occasional 'nudge' from a transistor or other active device - this is usually done once each complete cycle.
This is analogous to a pendulum. Mass is the mechanical equivalent of inductance, and a spring or other restoring force is equivalent to capacitance. Resistance is resistance in both cases - mechanical friction is resistance, nothing more. It is generally accepted that a pendulum requires a high Q ... plenty of mass and restoring force, and as little friction as possible. If driven correctly, a high Q pendulum will make an accurate timekeeper, but a low Q pendulum will never be as good, all other things being equal.
So it is with electronic systems. A crystal is a very high Q electro-mechanical resonant circuit. It has mass (inductance) and 'springiness' (the elasticity of the quartz itself), and has extremely low resistive losses. Just like a good pendulum, it is extremely difficult to 'pull' the frequency of a crystal to make it oscillate at a slightly different frequency. Many early quartz clocks used a tiny variable capacitor to enable the frequency to be changed ever so slightly to make the clock accurate. This approach works because the external (variable) capacitance is added to that of the crystal itself
In all cases when the circuit is at resonance, the reactance of the capacitor and inductor cancel. For series resonance, they cancel such that the circuit appears electrically as almost a short circuit. Parallel resonance is almost an open circuit at resonance. Any 'stray' impedance is pure resistance for a tank circuit at resonance.
The response of a pendulum, crystal or LC tuned circuit is either a peak or dip as shown in Figure 9.5 - f
o is now the resonant frequency (the term seems to have come from RF circuits, where f o means frequency of oscillation). Whether the tuned circuit is seen as a peak or dip depends on how it is being used, and the way it is examined. For example, the dip could indicate how much power would be required to drive a pendulum at a given frequency, or the peak would indicate the pendulum's amplitude when driven with a specific frequency. Obviously, swing is maximum and required power is minimum when the drive and pendulum period are the same. Figure 9.5 - Response of LC Resonant Circuits
The 'Q' (or 'Quality factor') of these circuits is very high, and the steep slopes leading to and from the peak or dip are quite visible. Ultimately, a frequency is reached where either the inductance or capacitance becomes negligible compared to the other, and the slope becomes the same as any other simple filter.
Q is defined electrically as the frequency divided by the bandwidth. Bandwidth is measured from the 3dB points relative to the maximum or minimum response, f
L and f H. For example, the resonant circuits shown above have a centre frequency (f o) of 73Hz, and the 3dB frequencies are separated by slightly less than 0.1Hz. 73Hz divided by the difference (0.1Hz) gives a Q of 730 - there are no units for Q, it is a dimensionless 'figure of merit'.
Should you want to know more (and there is so much more!), there are many books available designed for the technical and trades courses at universities and colleges. These are usually the best at describing in great detail each and every aspect of electronics, but quite often provide far more information than you really need to understand the topic.
This article is designed to hit the middle ground, not so much information as to cause 'brain pain', but not so little that you are left oblivious to the finer points. I hope I have succeeded so far. There are more articles that cover basic electronics (but with a decided slant towards audio applications). See the Articles Index to see what else is on offer.
One of the most difficult things for beginners and even professionals to understand is why there are so many of everything - capacitors, inductors and (especially?) resistors, ICs and transistors - the list is endless. Surely it can't be that hard? The economy of scale alone would make consolidation worthwhile.
In reality, ideal electronic components exist
in theory only. They are mathematical inventions that obey laws specified in formulae like Ohms Law and the equations that define them.
Physical objects can be constructed that can mimic these equations with varying degrees of accuracy and within the limits of voltage, current and power (or heat) that causes minimal damage to the materials from which they are made. No perfect passive components exist because all passive components have resistance, capacitance and inductance as the laws of nature require. Capacitors are so called because they possess far more capacitance than resistance or inductance and the same remark goes for resistors and inductors.
Other devices (such as transistors) are designed to be better at some tasks than others. For example, a switching transistor will amplify a linear signal, and a 'linear' transistor still performs as a switch. There are many parameters that can be optimised for a specific use, but this requires a sacrifice of parameters that are considered less important than others, depending on the intended purpose. Some of the differences are so small that they can safely be ignored, while others are of such significance that changing one type for another (with equivalent ratings) will cause the device to fail in service - sometimes almost immediately.
None of these critical applications apply to any known clock motor, but even in relatively undemanding applications it is useful to at least be aware that some components can make the difference between clock working / clock
not working. While electronic systems seem complex, in many regards they are far less so than the traditional mechanical clock mechanism.
There is admittedly a trade-off of complexity. With a mechanical movement, you can
see how all the parts interact, but this is not possible with an electrical or electronic movement. This simple difference makes the electronic movement seem inscrutable at best, and it is only with some understanding of the purpose of each part that progress becomes possible.
It is hoped that the information here has at least helped - one small step for mankind and all that .
Copyright Notice. This article, including but not limited to all text and diagrams, is the intellectual property of Rod Elliott, and is Copyright © 2001. Reproduction or re-publication by any means whatsoever, whether electronic, mechanical or electro- mechanical, is strictly prohibited under International Copyright laws. The author (Rod Elliott) grants the reader the right to use this information for personal use only, and further allows that one (1) copy may be made for reference. Commercial use is prohibited without express written authorisation from Rod Elliott.
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David Adjaye is one of the most fascinating and accomplished architects in recent memory. Born in Tanzania in 1966 to a Ghanaian diplomat, Adjaye was destined for design. The travel demands of his father’s occupation allowed Adjaye to observe cultures and influences from numerous countries throughout Africa and the Middle East. His family eventually settled …Read More
As today’s society shifts towards healthier living, office design is aiming to keep pace. As more businesses create a workspace that encourages health and well-being, employee happiness and productivity are on the rise. Simple additions like sit-stand desks or collaborative work areas give employers flexible options to increase collaboration and promote a healthier lifestyle. While …Read More
The interior design trends that we witnessed in 2016 included a move from traditional workspaces to more collaborative and open spaces. Steve Delfino, vice president of corporate marketing and product management at Teknion, believes that people are looking for more person-to-person interaction at work and in other public settings. Delfino argues that by utilizing pieces …Read More
The world recently lost one of its greatest interior designers, Jens Risom, who was 100-years-old. Born into a well-known Danish architectural family in 1916, Risom was surrounded by the architectural and design profession throughout his early life. Risom left Denmark for the U.S. in 1938 and served as the director of interior design at the …Read More
Eero Saarinen, a famous architect and furniture designer, was born to world famous Eliel Saarinen and textile artist Loja Saarinen. Eliel was an internationally recognized architect and Director for the Cranbrook Academy of Art architect and Cranbrook Academy of Art Director. Because both parents were heavily involved with art and design, Eero spent his entire …Read More
Perhaps one of the greatest architects of the 20th century was a German-born educator and designer named Ludwig Mies Van Der Rohe. According to the Mies Society, Van Der Rohe helped shape and define modern architecture by emphasizing open space to reveal the industrial materials used for the construction. His early career was mainly spent …Read More
Millennials, perhaps one of the biggest emerging groups in the workforce, are beginning to expect employers to adjust the age old model of the office to better suit productivity. In a study published by AFRWeekend, researchers found that close to 70 percent of adults aged between 22 and 29 years old were more concerned with …Read More
The real estate business moves at a frenetic pace and requires an office space that is welcoming to clients. The environment must be functional for the employees but also provide comfort and an inviting space for clients that helps them feel at ease. Spaces, Inc. harnessed their extensive interior architecture and design expertise to assist …Read More
Higher education is ever-evolving and regular updates to its design are important to not only persuade students to continue their education with the university, but to keep employees happy. Spaces, Inc. recently combined its interior architecture and design expertise with Avila University’s 100 years experience in higher education for a successful design project outcome. …Read More
The old adage about children is true–the future truly is in their hands. And while it’s true that kids today will be the leaders of tomorrow, it is today’s workforce that is responsible for ensuring they learn how to do so, starting in the classroom. It is up to design professionals to make sure …Read More
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The Obama administration and the mainstream media continue to insist that we are in the midst of an "economic recovery", but that is a total joke.Does the chart posted below look like a recovery to you?... 23 Oct 2013 By Andy Bob: Did you get a load of 20/20 presenter, Elizabeth Vargas? She all but blew a gasket at the very idea of a man having the audacity to discuss the rights and welfare of men and boys.
Nothing could illustrate the sneering dismissal of men’s humanity more powerfully than the hostility emanating from Ms Vargas’ every pore. Of course, feminists are going to lap it up – but not everyone’s a feminist. Many of these non-feminists will see it as the dishonest hatchet job it is, and will want to know more about AVfM and the so-called MHRM.
Those still able to exercise their capacity for logical thinking will realize that expressing concern over issues such as male suicide rates does not make a person a rape supporter/enabler/apologist. These are the people Paul Elam was reaching out to and connecting with.
This had nothing to do with the cliché that all publicity is good publicity. It was about getting a foot in the door and establishing a presence – a door which can never be closed, regardless of how shrill feminists scream at us to get out.
It was foolish of them to invite us in, and even more foolish to flout their lies, shaming tactics and bigotry so shamelessly on prime-time TV. By Peter Lloyd:British TV personality Amanda Holden sunk to a new low, this week. The 42 year-old, who is a panelist on Simon Cowell’s Britain’s Got Talent, confessed via her autobiography, No Holding Back, that . she tricked her husband, Chris Hughes, into fatherhood
The former actress didn’t make the revelation as an act of redemption or apology. Nor did she do it to highlight the error of her ways and teach others that men have rights too. She simply did it to shift copies of her tacky book. Unsurprisingly, she has received little criticism from British media for her confession. In fact,
. most journalists – who fail to see the scale of her violation – have been sympathetic InfoWars: Interpol Secretary General Ronald Noble told ABC News that one of the only ways to prevent terrorists from hitting soft targets was to arm citizens globally, noting that the Westgate mall siege would have been averted far quicker if it had taken place in gun-friendly areas like Denver or Texas. Source Stefan Molyneux : The Causes and Consequences of Male Disposability. Time to light the blue touch-paper? By John Ward:There are certain injustices (especially in Britain) that keep on an on resurfacing. They usually appear first in the blogosphere and/or liberal-to-left press, and are duly dismissed by lying politicians as poppycock, scandalous, rumour, innuendo, hearsay, politically motivated and so on ad nauseam. Then about three years later, when nobody cares any more, they surface in the Establishment MSM as done deals. Mike Maloney on the 2014 Dollar Crisis + US NEWS ANCHOR COMPLETELY LOSES IT FOR THE BEST POSSIBLE REASON EVER Boom Bust:Better late than never! The newly re-christened Belated Labor Statistics released jobs data today. Yes, BLS numbers for September are now out! It was a mixed bag...which of course gives Bernanke the greenlight to print-with-impunityuntil his term ends in January. Mike Maloney, creator of the Hidden Secrets of Money video series, joins us to talk monetary shop @7:33 minute mark and his prediction for an inevitable Dollar crisis. By Michael Snyder: The percentage of Americans that are participating in the labor force is the lowest that it has been in 35 years. During the 70s, 80s and 90s, the labor force participation rate consistently rose as large numbers of women entered the workforce. It peaked at 67.3 percent in early 2000, and just before the last recession it was sitting at about 66 percent. Since the start of the last recession, the labor force participation rate has not stopped falling and it is now at a 35 year low. In September, 11,255,000 Americans were considered to be "unemployed", and an astounding 90,609,000 Americans were considered to be "not in the labor force". The number of Americans "not in the labor force" has increased by more than 10 million since Barack Obama entered the White House. When you add the number of unemployed Americans to the number of Americans "not in the labor force", you come up with a grand total of more than 101 million working age Americans that do not have a job. Scientists have misunderstood one of the most fundamental processes in the life of plants because they have been looking at the wrong flower, according to University of Leeds researchers. Science Daily: -- also known as thale cress or mouse-ear cress -- grows abundantly in cracks in pavements all over Europe and Asia, but the small white flower leads a second life as Arabidopsis thaliana the lab rat of the plant world.
It has become the dominant "model plant" in genetics research because of its simple genetics and ease of use in a research environment. Thousands of trays of the humble weed are cultivated in laboratories across the world, but it turns out they may actually contain a rather oddball plant.
A study by researchers at the University of Leeds found that
Arabidopsis thalianawas exceptional in not having a "censorship"protein called SMG1.
SMG1 was known to play a vital role in the growth of animals as multicellular organisms, but scientists thought that plants built their complex life fundamentally differently. That conclusion, it turns out, was built on a dummy sold by
Arabidopsis thaliana.
Professor Brendan Davies from the University of Leeds' School of Biology, who led the study, said:
"Everybody thought that this protein was only in animals. They thought that because, basically, most of the world studies one plant: Arabidopsis thaliana." By Michael Krieger: I have been cursed at a Chinese border. In Dubai, my passport was studied by three veiled women for over an hour and my suitcase completely dismembered. In the Philippines I had to bribe someone in order to get my visa extended for a few days. Borders, they can be tough, especially in countries known for corruption. But never, ever, will I return to the United States of America.
- Excerpt from a must read article by Niels Gerson Lohman
Recently, one of my best friends from college had a horrific experience at the Canadian border. He told me he would write about his experience and allow me to post it on this site, so I hope to have that up in the near future. In the meantime, please take the time to read the story of Niels Gerson Lohman, a Dutch writer, designer and musician who had such a horrific experience at the border he has vowed to never return to these United States. This is an utter embarrassment and reminds me a lot of one of the more popular posts ever on this site: Why I’m Leaving America by Michael Fielding.
From the
Huffington Post: After a year of traveling, I had planned a last, short trip. I was going to take the train from Montreal to New Orleans. The travels I had been undertaking earlier this year had brought me to places that were meant to form the background of my second novel. This trip, however, was for my dad. Where there are no saving graces, the media should have the good grace to say so By John Ward:As one gets past the stage of being able to self-define in terms of ‘middle age’, the day’s time gets divided up rather differently to the essentially positive activities of earlier life stages. I would roughly segment a normal day for me as follows:
% Looking for stuff I’ve lost 10 - Not seeing my lost stuff, even though it’s clearly visible 10 - Blaming others for losing my stuff 10 - Blogging 25 - Reading stuff 20 - Forgetting stuff I just read 20 - Nodding off from the effort of all of the above 5
I have omitted drinking from this analysis (and especially during it) on the grounds that it would only muddy the waters, and detract from my main point which is this: what we more wrinkly participants in the roundabout of life may lack in cognition, we make up on the swings of discernment.
Isn’t that a
greatparallel? It’s such an intellectually respectable way of saying something essentially blunt, which is “I may be losing it, but you never had it in the first place – so fucking listen up”.
There is, my friends, a world of difference between being unable to see a wallet on a table because it’s open not closed, and being unable to spot immediately that
David Cameron is a cheesy hypocrite, Ed Miliband a sanctimonious hypocrite, Neil Kinnock a pointless Welsh windbag, Barack Obama a rhetorical suit, and Jeremy Hunt a weaselly chancer who would’ve had Jesus of Nazareth yelling “Crucify! Crucify!” along with the rest of the mob.
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Alopecia areata is a relatively common autoimmune disease. Although the nails can be involved, the major symptom is hair loss. It can be in small amounts leading to bald patches, or larger volumes, all the way up to complete hair loss including eyebrows and eyelashes. It is possible for the condition to resolve itself, but this is not the case for everyone, and any number of triggers could lead to a relapse. Traditionally, there are medications and treatments available to help restore some growth but results are variable and based on individual situations
1.
Laser therapy is a newer treatment option that has been gaining in popularity. It has been cleared (determined to be safe) for use in the treatment of similar conditions such as pattern hair loss/baldness in both men and women, and there have been some positive clinical trial results
2–6. Additionally, there has been some initial testing for its application in alopecia areata 7,8 however long-term data is not yet available.
Light from lasers is believed to stimulate dormant hair follicles as well as increase blood flow, growth factors and useable energy to encourage the growth phase of the hair cycle
9. The end result is a reduction in further hair loss and an increase in hair regrowth.
A few of the great benefits that make laser therapy a popular choice are that it is non-invasive and does not require the use of medication. Some people may experience some red skin or itchiness but laser therapy is generally considered to be free of side effects. Moreover, lasers are available for use in combs, hoods and helmets. They require as little as 20 minutes per use but be prepared for multiple sessions a week over a six month period.
Overall, if you are interested in a drug-free treatment, avoiding side effects or other treatment methods have been unsuccessful, talk to your doctor or dermatologist to assess your individual situation.
Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.
References
Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev. 2008;(2):CD004413. Satino JL, Markou M. Hair Regrowth and Increased Hair Tensile Strength Using the HairMax LaserComb for Low-Level Laser Therapy. Int J Cosmet Surg Aesthetic Dermatol. 2003 Aug;5(2):113–7. Leavitt M, Perez-Meza D, Rao NA, Barusco M, Kaufman KD, Ziering C. Effects of finasteride (1 mg) on hair transplant. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2005 Oct;31(10):1268–76, discussion 1276. Lanzafame RJ. The Growth of Human Scalp Hair Mediated by Visible Red Light Laser and LED Sources in Males [Internet]. 2011. Available from: http://www.igrowlaser.com/themes/shared/resources/pdf/iGrow_Clinical_Trial_Abstract.pdf Kim W-S, Lee HI, Lee JW, Lim YY, Lee SJ, Kim BJ, et al. Fractional photothermolysis laser treatment of male pattern hair loss. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2011 Jan;37(1):41–51. Lee G-Y. The effect of a 1550 nm fractional erbium–glass laser in female pattern hair loss. J Eur Acad Dermatol Venereol. 25(12):1450–4. McMichael AJ. Excimer laser: a module of the alopecia areata common protocol. J Investig Dermatol Symp Proc Soc Investig Dermatol Inc Eur Soc Dermatol Res. 2013 Dec;16(1):S77–9. Mutairi N Al-. 308-nm excimer laser for the treatment of alopecia areata in children. Pediatr Dermatol. 2009 Oct;26(5):547–50. Oron U, Ilic S, De Taboada L, Streeter J. Ga-As (808 nm) laser irradiation enhances ATP production in human neuronal cells in culture. Photomed Laser Surg. 2007 Jun;25(3):180–2.
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Grades
flat yarn
textured yarn
airtextured yarn
high tenacity
monofilament
We are
in a position to offer:
-
Plasma 24K Gold coated filament yarns
without Cu or Ag underlying layer
-
Chemo-/Galvanical 24K Gold coated filament
yarns with 24K Gold coated lamé twisted around
with Ag underlying layer - available in overall Gold
content of 18K,
14K and 9K
- Cu
and/or Ag pure metal gilded lamé twistedlowest
Gold content of all above (gilded only)
around cotton or silk filament yarn
Highest
quality is the first one as it does not contain any silver
or copper layer underneath the Gold - consequently the known
problems of Ag or Cu oxidizing through the Gold and creating
dark stains do not exist.
Background
information
Gold, recognizable by its yellowish cast, is one of the oldest metals used by
humans. As far back as the Neolithic period, humans have collected gold from
stream beds, and the actual mining of gold can be traced as far back as 3500 B.C.,
when early Egyptians (the Sumerian culture of Mesopotamia) used mined gold to
craft elaborate jewelry, religious artifacts, and utensils such as goblets.
Gold's aesthetic properties combined with its physical properties have long
made it a valuable metal. Throughout history, gold has often been the cause of
both conflict and adventure: the destruction of both the Aztec and Inca
civilizations, for instance, and the early American gold rushes to Georgia,
California, and Alaska.
The largest deposit of gold can be found in South Africa in the Precambrian
Witwatersrand Conglomerate. This deposit of gold ore is hundreds of miles across
and more than two miles deep. It is estimated that two-thirds of the gold mined
comes from South Africa. Other major producers of gold include Australia, the
former Soviet Union, and the United States (Arizona, Colorado, California,
Montana, Nevada, South Dakota, and Washington).
About 65 percent of processed gold is used in the arts industry, mainly to
make jewelry. Besides jewelry, gold is also used in the electrical, electronic,
and ceramics industries. These industrial applications have grown in recent
years and now occupy an estimated 25 percent of the gold market. The remaining
percentage of mined gold is used to make a type of ruby colored glass called
purple of Cassius, which is applied to office building windows to reduce the
heat in the summer, and to mirrors used in space and in electroscopy so
that they reflect the infrared spectrum.
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Despite this depressing idea
(especially for me), I think it shows something very fundamental about the way I work with all my clients, whether I am setting up their computer or network or helping them to get started with a web site, blog or podcast. Everything I do is meant to insure that the client could continue to work, and be productive, even if this theoretical bus and I had our fateful meeting the day before.
I began describing my actions in this way after countless consulting calls where I was following up after another consultant or staff member. I am often called in to complete, modify or clean-up projects that have failed for one reason or another, More times than I like to contemplate, this has involved starting over from the beginning -- mainly because the previous consultant never provided basic, extremely necessary, information to the client. Thankfully, most of the previous workers weren't hit by a bus, but even worse, they simply disappeared. They had simply abandoned the client for some reason.
For me, typical consulting situations involve network routers with unknown password or odd settings where no one remembers the reason -- lost, missing or forgotten ftp passwords which prevent individual and companies from updating their web sites -- domain names registered in the consultants name, meaning that my client can't update or change their web hosting company or move their web site -- missing software critical to daily operations and more.
After facing so many of these issues myself, I do everything I can to insure that anyone who follows me into a client's office will have all the information they need. After all, as I said at the beginning, I could get hit by a bus tomorrow.
(Of course, here in Los Angeles, I am much more likely to be involved in a traffic collision than a bus accident, but that is another story)Furthermore, if you work in any sort of consulting or IT role, you should do the same thing for your clients, for the same reasons.
I know that some consultants who are reading this are rolling their eyes and saying to themselves, "...But this is how I tie my clients to me to insure a steady income. If I give them all this information, they will just do it themselves." First, you're wrong. You develop loyalty in your clients by doing great work, not by withholding information. Second, you're also wrong. Most clients much prefer paying you to do the tech work than doing it themselves. Frankly, they would rather being doing the work they love, making money for their company and themselves, than fiddling with router addresses and installing software. Third, if you get hit by a bus tomorrow, you're not really going to care about who is doing the work, anyway, so why make it more difficult for them
(or me).
Finally, if you're the client, you should demand the same consideration from your consultants (and internal IT workers) that I try to give my clients. Do you have ALL the passwords you might need? Has someone documented the procedures for accessing and managing ALL your critical systems, including your telephone PBX, alarm systems, etc. Could your company continue functioning if you needed to hire someone new today?
If not, why not? If not, do it today! Otherwise, a bus with my name on it, might have yours, as well.
Technorati Tags: business, computers, consult, consultant, consulting, employment, job, jobs, work, workplace
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So does anybody here actually know what a safe space is? Class? Pundits? Trolls? Anybody? I mean, if people are bitching about them 24-7, you'd think we'd all have a clearer idea of what they are.
Wikipedia's as good a place to start as any. The idea of a safe space started with the women's movement; Kennedy Moira Rachel defined it as a place where there's "a certain
license to speak and act freely, form collective strength." But isn't a safe space a place where free speech is explicitly banned? Women's consciousness raising groups of the 1970s were safe spaces. Later, gay bars were considered safe spaces - places where a person could be out and gay without fearing violence or condemnation. Also reasonable and very much necessary. So when did safe spaces transition from being havens for free expression to authoritarian hell holes where free speech is punishable by death? Where indeed.
For answers, I turned to Trends.Google.com, which shows the popularity of search terms over time. It turns out the term "safe space" was of little interest to much of anybody until October of 2015 when it catapulted into public awareness immediately following an episode of South Park titled
Safe Space. And if you're thinking it's a little odd that the event that started getting Americans worked up about the evils of safe spaces was a satirical cartoon show, well, I felt the same. So I kept digging.
In a recent editorial for the LA Times, Frank Furendi complains that "Campuses are breaking apart into safe spaces." One of the examples he gives supporting this was a statement from Northwestern president Morton Schapiro. According to Furendi, Schapiro feels that black students should have a space reserved for them in the dining hall where white people aren't welcome, where they can be "sheltered from dissimilar people." In fact, Schapiro mentioned one
specific incidentin which a couple of white students asked to sit with a group of black students stating that they "wanted to stretch themselves by engaging in the kind of uncomfortable learning the college encourages." Schapiro argues that the black students had a right, in this case, to politely say no. Schapiro does NOT say that black students should be given a safe space in the cafeteria to avoid white people; Shapiro DOES say that black students have the right to decline to be treated like a civics class assignment. Now, you can disagree with what Schapiro says, or doubt that the incident went down exactly the way he says, but you've got to wonder why Furendi would need to so wildly and blatantly misrepresent Schapiro's case in order to argue against it. embracing our differencesand appreciating the unique perspectiveseach person brings." So Northwestern is bad because they allegedly want to students to be able to avoid dissimilar people, but North Dakota is wrong for wanting to bring together dissimilar people to celebrate differences and learn from each other? Because it seems like allegedly dividing students up and actually joining people together are opposite things. So how is Furendi saying they're both bad?
I've dug through a ton of news stories about safe spaces and they all just seem outlandishly overblown. The College Fix ran a story after the Republican National Convention proclaiming "'Safe space’ offered at Cleveland university in response to Republican National Convention." The story's written to make it seem like the Cleveland State was kowtowing to student over-sensitivity by creating a safe space from nasty Republican ideas. In fact, Cleveland State is spitting distance from the convention area where, if you'll recall, law enforcement was worried about
actual physical violence. Downtown Cleveland, where Cleveland State is located, is normally home to only 13,000 people. 50,000 people attended the convention; thousands more showed up to protest, and thousands more attended the many events surrounding the convention. Cleveland State would have been pretty damn remiss if it hadn'ttaken steps to ensure that the campus was a "safe space" for students and faculty. Not a space that was safe from Republican ideas, but a space that was safe from tens of thousands of out-of-towners, some of whom might, according to police, become violent.
Another article on The College Fix claims "‘Safe place’ set aside for those upset at campus talk on transgenderism’s threat to liberty." In fact, transgender individuals live constantly under threat of violence, and not an imagined one. Transgender individuals are extremely and demonstrably more likely to be victims of violent crime; they're much more likely to be raped, and they're much more likely to be murdered. So when a virulently anti-trans speaker was hired to speak at UC Santa Barbara, some trans students were pretty reasonably afraid that increased anti-trans sentiment might lead to, once again,
actual physicalviolence. They didn't ask for an anti-free speech zone, just an anti-fear-for-bodily-safety zone.
One news story I saw claimed that a college campus had declared itself a safe space for communists. No such thing had happened - the university had just failed to officially recognize an anti-communist student group. You can agree or disagree with that decision, but the university DID NOT declare itself a "safe space" for communists.
A story about a university offering a safe space to students who hadn't voted for Trump was actually about a university counseling center that had emailed students reminding them that, if they were stressed about current events or if they were being bullied or threatened, the counseling center was a safe space to talk about their feelings. Counselling centers have been a fixture on college campuses for decades, and they're by definition safe spaces to talk about your feelings. I've been to a lot of shrinks, kids, and I can tell you that they're not a place you can go to escape upsetting ideas - they're a place you go to learn how to deal with being upset without completely losing your shit. The letter from the counselling center didn't mention Trump, and it didn't even hint that the counseling center was not a safe space for people who voted for him. It just said "hey, if you're stressed, come to the counseling center." Is that really such a terrible thing?
However. This isn't to say there haven't been some high-profile incidents in which students DID try to censor speech on campus. However, even those events have been somewhat overblown and misrepresented.
For instance, the Play Doh incident at Brown. You know the one, where the school brought in an unpopular speaker and scores of students demanded a safe space where they could avoid being exposed to new ideas and blow bubbles and play with Play Doh, and Brown acquiesced because the inmates are running the asylum?
So what really happened was that a student group at Brown had brought in a speaker, Wendy McElroy, who had made several public statements about rape culture that some Brown students felt were dismissive toward sexual assault survivors. The university's Sexual Assault Task Force wanted the speaker barred, but Brown refused to do that. So the Sexual Assault task force protested by establishing a competing event where sexual assault survivors could come and talk with counselors and learn about the university's resources for assault survivors. Yes, a campus group tried to have a speaker barred. Yes, I believe they were wrong. But they FAILED to have the speaker barred. Free speech prevailed. And the student group protested by holding an event meant to raise awareness about university resources for sexual assault survivors and I hardly think that's a travesty. Also there was Play Doh there. Call the National Guard. Step 1: give students Play Doh. Step 2: Human sacrifice, dogs and cats living together... mass hysteria.
Although nobody said anything about this being a "safe spaces" issue, near as I can tell. There was talk on campus around that time about how Yale could be a safer space for disadvantaged and minority students, but that was a mostly separate issue. You can research that on your own though, as my hands are tired.
So, to summarize this outlandishly TL;DR post for which you all deserve cookies for slogging through, we have a whole crap ton of smoke and one unconscionably but ultimately isolated fire.
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Photo by Beth Kanter
I wrote about Alex Soojung-Kim Pang’s new book The Distraction Addiction for TechCrunch:
“The purpose of technology is not to confuse the brain but to serve the body,” William S. Burroughs once said in a Nike commercial, of all places. But things haven’t worked out that way, at least not for most of us. Our technologies are designed to maximize shareholder profit, and if that means distracting, confusing or aggregating the end-user, then so be it.
But another path is possible, argues Alex Soojung-Kim Pang in his new book The Distraction Addiction: Getting the Information You Need and the Communication You Want, Without Enraging Your Family, Annoying Your Colleagues, and Destroying Your Soul.
He calls the idea “contemplative computing.”
Contemplative computing, Pang writes, is something you do, not something you buy or download. He does mention a few useful-sounding applications, such as Freedom, which will block your Internet connection for a set period of time, and full-screen text editors like WriteRoom and OmmWriter (my personal favorite is FocusWriter).
These tools, along with applications like RescueTime and SelfControl, are great — but they’re meant to treat the symptoms of a digital environment designed to distract you. Pang points out that OmmWriter was, ironically, designed by an online ad agency to help keep its copywriters from being distracted.
Also: Watch for Pang on the next Mindful Cyborgs podcast!
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One long-lasting impact of the global recession for tech transfer organizations will be the rapid changes now taking place in the way TTO success and performance are measured. University administrators — under pressure to demonstrate a positive economic contribution — are now asking for much more than the typical scorecard of licenses, patents, and revenues from TTO activity. The heat is on to show the economic impact of university research efforts in terms of jobs, payroll, tax dollars generated, and other metrics. Yet those numbers can be near-impossible to pin down — if you can find reliable data in the first place.
That’s why our Distance Learning Division is presenting a unique, practical audioconference designed to help you create, as well as reliably report on, a set of metrics that will satisfy stakeholders and show the true value of tech transfer efforts. Join Mark Coticchia of Case Western Reserve University and John Fraser of Florida State University for:
The New TTO Metrics: Documenting Job Creation, Economic Impact, and Other “Dark Matter” Performance Indicators
You’ll leave this valuable session with a solid understanding of the range of “new era” performance indicators now being adopted by two leading tech transfer organizations, and you’ll gain key insights on the lessons learned as they created — and continue to develop — new standards and metrics for assessing TTO performance and demonstrating the true value of research commercialization activity, as well as its economic and community impact. Here’s what you’ll learn in this must-hear distance learning program:
What the “new metrics” are, if and when they will become standard practice, and why you should start tracking them now Strategies for identifying and accessing pertinent data from government agencies, business sector, and academia The lessons learned from Case Western Reserve University’s effort to build a new set of tech transfer performance metrics How to use the results from the new metrics for strategic business planning purposes How the government and private businesses are measuring the economic impact of university research — and how your metrics should reflect those measures Why you must first identify what “success” means to your TTO (not everyone’s success measure is the same), then set up your performance metrics accordingly How the US, UK, and Canada compare in tracking economic development and job creation stemming from university research efforts Strategies for using your performance data as a tool for sales, stakeholder outreach, and marketing Your Expert Presenters Mark E. Coticchia is Vice President for Research and Technology Management at Case Western Reserve University (CWRU) where he directs CWRU’s research agenda and technology commercialization priorities, including research administration, technology transfer, Case Technology Ventures, and the Science and Technology Applications Center. He also serves as the Senior Economic Development Advisor to the University System of Ohio, and is an international expert for the World Intellectual Property Organization. As executive and managing director of CTV, he has day-to-day responsibility for its operations and evaluates and works with existing and potential portfolio companies.
Prior to joining CWRU, Mr. Coticchia was Senior Director of Redleaf Group, Inc., an early stage venture capital firm. His responsibilities included the development and management of a global University Technology Innovation/Incubator Operation that included seed-level investment activities. From 1997-2000, Mr. Coticchia served as Director of Technology Transfer at Carnegie Mellon University and served as an adjunct professor of entrepreneurship. He serves on the board of directors and advisory boards of several high technology companies and not-for-profit organizations and is a co-founder of Lycos, Inc. Mr. Coticchia is the author of several books on technology management and is a frequent speaker to international audiences from industry, government, and academia.
John Fraser is Assistant Vice President for Research and Economic Development, and Executive Director of the Office of IP Development and Commercialization, at Florida State University in Tallahassee, where he has led the school’s tech transfer efforts since 1996. During 2006-2007 he also served as President of the Association of University Technology Managers.
Prior to FSU, he served as Director of the University/Industry Liaison Office at Simon Fraser University, Vancouver, Canada. In addition, he has held positions as Executive Vice President and co-founder of UTC, Inc., a venture capital-backed, North Carolina-based university licensing/technology transfer firm; President and CEO of UTI, a University of Calgary based for-profit technology transfer company; Vice President of TDC, Inc., a Toronto and Vancouver-based venture capital firm; and President of Burnside Development, a technology commercialization consulting firm. He has co-founded three companies and assisted entrepreneurs in launching another twelve technology-based start-ups.
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Always keeps these foods in your house to burn fat and lose weight The Hearty Soul Always keeps these foods in your house to burn fat and lose weight
At the beginning of the week, your diet is on track. You spent your Sunday preparing food for the week, you’re feeling fresh and ready-to-go. Then life happens, and you sleep through your alarm, your kid has to come home sick from school, or you have to stay late at the office thanks to a lazy coworker and a looming deadline. Suddenly, the meals you had planned take too long to prepare and your find yourself out of time and energy, staring at the fridge not knowing what to eat.
Convenience is the number one diet saboteur. Your good intentions give way and before you know it you’re ordering take out or digging through your pantry for a bag of chips. Thankfully, there are plenty of foods that you can keep in your kitchen that can make easy meals and snacks when you’re in a pinch, and help kick your body into fat-burning mode in the process.
5 Keys for Fat Loss
Weight loss is not achieved through short-term solutions, but rather, permanent small and consistent diet and lifestyle changes. That doesn’t mean that you can’t still have cake on your birthday or go out for margaritas on the occasional Friday night — as long as those are once-in-a-while things and not a regular occurrence. Consistency (and the occasional glass of wine!) will help you achieve long-term, sustainable results.
1. Hydration
Water is extremely important for
all of your body’s processes, big and small. Water helps to regulate your body temperature, lubricate your joints, eliminate waste, transport nutrients, aid in kidney and digestive function, and suppress appetite. Most of us are chronically dehydrated, which makes us lethargic and often is mistaken for hunger. The next time you feel tired or hungry, instead of reaching for a sugary snack or coffee drink to refresh you, have a glass of water. Chances are, those little hunger pains will go away! (1) 2. Protein
Several studies have been done to show that people who eat higher protein and lower carbohydrate diets lose weight faster and keep it off long-term. Protein doesn’t spike your blood sugar and insulin levels, and it has greater satiety value than carbohydrates, which helps you feel fuller for longer and less likely to reach for an extra snack. (2, 3)
3. MUFAs and Healthy Fats
Mono-unsaturated fatty acids have been shown to improve nervous system function, heart rate, blood pressure, and vitamin absorption. More recent studies have also shown that MUFAs prevent central body fat distribution (the dangerous storage of body fat around your abdomen and internal organs). Other important healthy fats for weight loss are Omega-3 fatty acids (try this supplement), which aid liver and brain function. (4, 5)
4. Spices
Not only do they add flavor and help protect your body from cancer and other diseases, but spices also give your metabolism an extra boost, help to stabilize your blood sugar, and squash sweet cravings before they start. (6, 7)
5. Exercise
Regular exercise is crucial to weight loss and weight management. Building muscle will help you burn more fat throughout your day, but it doesn’t have to be a huge time commitment or grueling sweat-sesh. Even just a few minutes each day, and incorporating more movement like walks on your lunch break, will get the job done. (8)
We get that even following these tips can still make losing weight and managing a busy schedule challenging. We’ve compiled a list of some easy-to-use foods that will give you a leg-up on weight loss without having to spend an hour at the gym.
11 Fat Burning Foods to Keep in Your Kitchen 1. Nuts and Nut Butters
Nuts are excellent sources of MUFAs and other good fats, and pack a little protein, too. A small handful can make a great snack, and nut butter can make a great dip for veggies and fruit. Try making your own nut butters, use nuts to make healthy chocolate pudding, or put it in a smoothie for an extra fat-burning punch! Some of our favorites include: Thrive Market Creamy Organic Almond Butter or Justin’s Hazelnut Butter.
2. Avocado
3. Eggs
Eggs have the perfect balance of protein, carbs, and healthy fats. What’s even better, is they cook in minutes and are perfect for adding in a big serving or two of your favourite veggies! Try this avocado egg salad or this fat-burning breakfast.
4. Grapefruit
Studies show that eating half a grapefruit before your breakfast can help you lose weight faster. While the mechanism is still unknown the proof is evident. Try it as a juice or in this metabolism-boosting ceviche and make sure to check with your doctor first if you are on any medications (9, 10)
5. Canned Salmon
It’s fast, packed with Omega-3s and MUFAs, and can be used in place of mercury-containing tuna in pretty much everything. Always look for organic, wild-caught salmon. Follow those same rules if you are buying Tuna, and be sure to buy skipjack for the lowest levels of mercury. (12)Try these cucumber cups for a quick snack or even just toss it on top of a salad and go!
6. Frozen Fruit
7. Chia Seeds
These little seeds (and other super seeds) are fat-burning miracle workers! They’re full of fiber, protein, and healthy fats to boost your metabolism and keep you going all day long. Sprinkle them on yogurt, smoothies, salads, and soups, grind them up to thicken sauces, or try this chia seed pudding for an easy mid-week breakfast.
8. Frozen Vegetables
Frozen vegetables are a great substitute for fresh veggies when you’re on a time crunch, and often flash frozen veggies actually have a higher nutrient level then some produce that has been sitting on a shelf for too long (11). Stop skimping on your veggie intake and scramble them with eggs, toss them in a stir-fry, or blend them in a smoothie. Be sure to choose organic or freeze your own.
9. Ginger
This super spice helps fight disease
and unwanted weight gain! Try this lemon-ginger-avocado smoothie, or other fat-blasting spices to include are cinnamon, garlic, black pepper, cayenne pepper, turmeric, and parsley. 10. Greek Yogurt
Full of protein and healthy fats to keep you full for a long time, plain greek yogurt is easy to add in as a snack or simple breakfast. Have it plain topped with frozen fruit, use in place of mayo or sour cream, and try this 5-minute healthy cheesecake,
11. Cauliflower
Losing weight doesn’t have to be complicated! Prepare as much as you can, and keep these ingredients in your kitchen at all times to burn fat with every bite.
Sources
(1) http://onlinelibrary.wiley.com/doi/10.1038/oby.2008.409/full
(2) http://www.tandfonline.com/doi/abs/10.1080/07315724.2004.10719381 (3) http://jn.nutrition.org/content/133/2/411.full. (4) http://care.diabetesjournals.org/content/30/7/1717.short (5) http://www.nejm.org/doi/full/10.1056/NEJMoa0708681#t=article (6) http://www.sciencedirect.com/science/article/pii/S0963996904001826 (7) http://onlinelibrary.wiley.com/doi/10.1002/jsfa.4597/full (8) http://www.cbc.ca/news/canada/hamilton/news/the-1-minute-workout-how-to-get-fit-in-60-seconds-mcmaster-study-1.3555420 (9) https://search.informit.com.au/documentSummary;dn=331871258292965;res=IELHEA (10) http://online.liebertpub.com/doi/abs/10.1089/jmf.2006.9.49 (11) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2549819/ (12) http://www.eatingwell.com/blogs/healthy_cooking_blog/3_tips_for_buying_the_healthiest_canned_tuna_and_salmon_and_the_best_t Image Source: Latest posts by The Hearty Soul (see all)
Always keeps these foods in your house to burn fat and lose weight - March 15, 2017
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The Elusive "Sour" One of the foods I miss the most from back home is homemade, sour borscht - a dietary staple unique to Eastern Europe, in particular to Romania, Moldova, Ukraine, and parts of Russia. The essence of "borscht" in these countries is not beets, as it is commonly associated with, but rather the "sour" we add to the bone broth base. The "sour" - tasting almost like a combination of sauerkraut juice and kombucha - is made by old grannies in clay pots with fermented wheat germ, fresh well water, and a variety of esoteric herbs. It is a quite involved process, and most younger women don't have the patience or knowledge to ferment it properly. I have been trying to get a starter going for a while, but besides simply lacking some of the skills and expertise, I am missing many of the herbs that my grandma used to add to use. A Suitable Substitute? [...]
A trip to the Emergency Room Our last weekend started like any other: reading books, watching movies, and hanging out with friends. The nausea began Saturday afternoon while we were enjoying a good cup of tea and an interesting conversation at J-Tea. I chose to ignore it at first and attributed it to my overly abundant fresh fruit snack. But the nausea continued, eventually followed by sharp stabbing pains in my back. While my husband was driving me home, I threw up for the third time in my life; at this point I knew something was really wrong. I decided it was probably food poisoning and began self-medicating with mineral water, Swedish bitters, and probiotics. By 9 pm I developed a 102.4 fever and chills. I took some Tylenol PM and went to bed thinking maybe I had the stomach flu. On Sunday morning I woke up feeling much better; no [...]
There are quite an overwhelming number of probiotic supplements on the market. Pharmaceutical companies are aware of their vital importance in the human digestive and immune system. They each advertise their product as being the best, dazzling the consumer with various miraculous health claims neatly written on the labels. Choosing a good probiotic can be overwhelming and frustrating. I have poured over many labels in food stores, on line, and in various catalogs. There really isn't a perfect one that carries every single member of the probiotic family. But we can try to purchase one that carries at least the most important bacterial strains. ( To read part I of the Probiotics series go here) Source Here is some advice, based on my own struggles to find a good probiotic to rejuvenate and heal my gut flora: 1. When you are purchasing a probiotic, go for the one that has the most [...]
As I explained in an earlier post, one of the best ways to fortify your gut with good healthy bacteria is lacto-fermentation, a process which results in some of the most mouth-watering foods around. My favorite is sauerkraut, but with a little whey and/or salt, you can ferment all sorts of veggies. Here is my sauerkraut recipe, step by step. Ingredients: 2 medium-large heads of Cabbage About 1/3 cup whey (optional) About 1 tbsp sea salt Herbs & spices (mustard seed, dill, caraway, pepper, bay leaf, juniper berries) (find it here) Directions: 1. Chop the cabbage into quarters. 2. Slice it into as long, fine strips as you can. Tip: The lid you see in the background of Step 1 is from our food processor; we tried to use it initially, but we found that it just diced the cabbage into bits. For this task, your hands and a sharp knife are [...]
Three years ago I suffered from a severe facial staph infection. Over the course of six months my face turned beet red with daily flair ups and dryness. At the time I had no idea what the cause of it was. I slowly gave up sugar, gluten, spicy foods, alcohol, all to no avail. I finally discovered the root of the problem when a dermatologist tested my facial dermis for a topical staph infection. Happy ending? Yes absolutely; my skin infection went away in a matter of weeks. But amidst the myriad of tests I had to take, I learned something that totally shocked me: my gut flora was completely depleted of any good bacteria. In fact, the doctor asked me if I had taken any antibiotics recently because only someone who had been on an intense course of antibiotics could have as poor of gut flora as myself. I hadn't taken any antibiotics in at least [...]
This past weekend I went in to have my two lower wisdom teeth removed. While some of you might cringe and shake your head in sympathy, the experience was not bad at all. I opted for conscious sedation, the doctor categorically refused to preform the surgery with only local anesthesia even though I tried to explain to him that in Europe it is a common practice. The whole experience was short and efficient. Post Surgery Face Afterwards, I was sent home with prescriptions for 15 Hydrocodone and 30 Keflex antibiotics. Before the surgery the nurse talked to me about the medicine I was to receive afterwards. Nurse: You will take the antibiotic after the surgery in case you get any infections in your mouth. Me: What if I don't get any infections in my mouth after the surgery? Nurse: We advise our patients to take it just in case. After mouth surgeries most people develop [...]
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What Wing Clipping Is
For as long as people have kept birds as companion animals, there have been people on both sides of the fence of the wing-clipping issue. As someone who has birds of both kinds in one household, I can also attest to the fact that making this decision is one that is not taken lightly. Wing clipping is the process of inhibiting, or limiting a bird's capacity for flight through the removal of several flight feathers on each wing. The flight feathers that are removed in the clipping process are generally the primary flight feathers, which are the strongest outermost 6-8 feathers on a bird's wing. As their name suggests, the flight feathers provide the bird with the necessary lift to propel itself upwards and keep it airborne. A wing clip, when properly done will limit the bird's capacity to do this, but still does not severely hamper it's flight. A wing clipped bird, in other words, should have little to no difficult fluttering from one post to another, or slowing itself to a glide so that it doesn't come crashing to the floor. Wing clipping is a temporary process as birds replace their feathers on average once a year during their molt. If a bird is going through its molt, clipped feathers may be replenished quicker than usual and so it may be a good idea to allow it to complete the molt before clipping its wings. There are several methods and styles of wing clipping that different carers will use for different purposes.
What Wing Clipping is NOT!
Many people have confused the term wing clipping with the term "cutting" and some have even use the term interchangeably. Wing clipping, however, is not wing cutting: a process also known as "pinioning". Pinioning, though sometimes practiced on companion birds such as parrots, is more commonly practiced on waterfowl, pheasants, and other "free ranged" birds that are kept in an open environment. Pinioning is a controversial process that involves the amputation of a bird's wing from its outermost joint thus inhibiting the bird from flight forever. Pinioning is generally done when the birds are very young so as to facilitate the bird's adjustment to the missing wing. Birds that have been pinioned are able to be kept in an open enclosure all year round because the amputated joint does not grow back and the birds will never be capable of flight. While pinioning has been historically done throughout the centuries, recent animal welfare groups have increasingly questioned the long term effects of pinioning on birds' mental and physical well being. Pinioning is legal in some countries such as England whereby the procedure must be carried out by a licensed veterinarian, whereas completely prohibited in others such as Australia.
A saddle-billed stork that has been pinioned. Notice that one wing is "shorter" than the other due to the removal of the first carpal wing joint. How To Wing Clip? (section written in consultation with an avian vet)
Wing Clipping, for the inexperienced, is always better done by a
practicing avian veterinarianor an experienced vet. Wing clipping should notbe carried out by inexperienced hobbyists as there is always the risk of causing injury to the bird. Cutting a growing flight feather for instance may cause the bird to bleed out as a growing feather is essentially a keratin casing that is being fed a constant supply of blood. In most cases a light wing clip is often preferred to a heavier one as it continues to allow the bird a certain level of mobility. Starting with a light wing clip is also a way of gauging the bird's aptitude for flight and the severity of the clip can then be increased in stages as and when it is needed. For this reason, it is always better to clip a bird's wings too light, than too heavy. If for whatever reason clipping must be done by the caregiver at home, the process will require 2 individuals and the first session should ALWAYS be supervise and guided by a highly experienced parront or an avian vet. First, inspect the bird's wings for any blood feathers. These are feathers that have not yet matured. Their shafts will appear bluish or purplish and will generally have a thicker and waxy appearance. If the bird has any blood feathers, clipping should not take place until these feathers have matured. The bird must first be restrained. Care should be given not to apply too much pressure to the chest area as this could restrict breathing or result in a collapsed lung. Instead, the bird should be gently wrapped in a towel to restrain its head, both feet, and the opposite wing. The head of the bird can gently but firmly be restrained by placing one's index finger on top of the bird's head with the other fingers around the side of its lower beak. When the bird is secure, the birds wings may be extended and spread out so as to reveal the primary flight feathers. The wing should not be held by the feathers, but at the base of the humerus. This is to prevent injury in the event that the bird struggles or flaps its wings. It is not advised to use scissors to clip a bird's wings as scissors can leave jagged, or rough edges that may cause discomfort to the bird. The sharp tips of scissors may also slide and cause injury to the bird. Instead a set of animal claw clippers or specialized wing clippers would be ideal to provide a quicker, and cleaner cut. Having fanned out the bird's wing, select the first few primary flight feathers (1)and cut them. How many feathers you select is really dependent on your level of comfort and the bird's but I generally like to begin with just 3 or 4, and gradually clip one or two more if it turns out to be necessary. How much of the feather to remove is also a situational matter, and personally I prefer to remove less first, and remove more later if the need arises. Wings should never be cut below the covets (2)and the secondary flight feathers (4)should also be left intact. This conservative method of clipping in stages is generally only needed during the bird's first wing clip and does help prevent overclipping. In general smaller, lighter birds, would need to have more feathers removed than larger, heavier birds, in order to effectively inhibit flight. Smaller wing clipped birds may often also take flight in the event of a gust of wind or upward draft.
A pet Meyer's Parrot with clipped wings. Some would say that the wings on this bird have been clipped too severely or overclipped.
A properly wing clipped bird should have no problem fluttering for short distances, and safely gliding to the floor in the event that it falls off of its perch. If a bird drops like a rock after it has been wing clipped, the clip was too severe and the bird should be restrained from climbing up tall objects as such falls can often cause injury to the breastbone.
Why Wing Clip?
Birds are usually wing-clipped with the consideration of their safety in mind. Birds that are not wing-clipped that live in certain households may be at risk of injury, for example: by flying into clear glass objects such as windows and sliding doors, or being hit by moving objects such as ceiling fans. Birds that display extreme forms of aggression towards certain members of the household, or other animals, may also be wing clipped to restrict mobility to discourage such behavior. A bird that is fully flighted will also have more chances of escape through an open window/door or through a loose hatch. Less common, and more controversially, are birds that are wing clipped to "force" them to become tame by restricting their independence and coercing them into depending wholly on the owners. Wing clipping can, however, facilitate the training and taming process of problematic birds (typically those who have been rescued from bad situations) and is sometimes done as a temporary measure that is discontinued once the bird has been resocialized to the rescuer's satisfaction, It is considered of paramount importance that all birds be allowed to fledge and fly prior to wing clipping. This enables the birds to develop the skills it needs to take off, and more importantly to land in a safe fashion, that will greatly reduce the risk of accidents caused by crash landing after the wing clipping procedure has been carried out. Studies have shown that baby birds who have been wing clipped are not only more accident prone, but also less confident and active than birds who have been allowed to fledge leading to health problems associated with a sedentary lifestyle.
A Moluccan cockatoo with a very conservative wing-clip with only the first quarter of the primaries removed. This is sometimes euphemistically called a "wing-trim" instead. Why Not To Wing Clip?
Those who do not choose to wing clip however, have their own reasons too. Aside from the fact that an inexperienced wing clipper can cause serious harm or injury to a bird, many who choose to free flight their parrots do not wing clip as they do not wish to restrict the bird's natural range of movement. Flying, in parrots, is an invaluable form of exercise considering these birds often travel for miles on wing in their natural habitats searching for food. As such, it is hardly surprising that fully flighted parrots are therefore less prone to health problems associated with being overweight, or a sedentary lifestyle than wing clipped birds. For birds that do not always get a lot of attention from their owners, flying is also a great way to provide mental stimulation and prevent boredom. Although certain objects around the household remain a birdy hazard for flighted birds (such as open doors and ceiling fans *which can be disconnected*), many tame flighted birds do eventually learn to avoid clear objects like glass doors and windows. Similarly, with some training, pet parrots also learn to come on command and can be almost as easily handled as a wing clipped bird. Training also provides an opportunity for trust building and bonding between the human and the bird. The invention of bird harnesses have also facilitated more forms of outdoor social interaction between humans and parrots while reducing the risk of escape and without compromising on safety
A pet blue and gold macaw by Mike Baird with unclipped wings. Conclusion.
All in all there are many reasons why parronts would chose to, or not to, clip their birds wings. Needless to say the living situation of all captive birds differs largely from the living arrangement of parrots in the wild. With issues like safety, level of activity, socialization, and lifestyle in mind, it is up to every parront to make this decision to the interest of all who are involved.
Photosource: Wikimedia.commons
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Do you have trouble when it comes to keeping your child with Sensory Processing Disorder clean? This may be because they are
sensory avoiders and do not like touch, or they may be sensory seekers and always touching things (for more information see my previous post on Sensory Processing Disorder: The Tactile Sense). Either way Kids Stuff ® Crazy Soap might just be the answer you have been looking for. Kids Stuff ® Crazy Soap Range
They have a range of bath paints, bubble baths (colour changing/glitter), goo, bath crayons, soaps (that you can mould to make shapes out of!), body paints (let that Sensory seeker go wild whilst actually getting clean!).
With smells to tingle the senses and fun characters to really appeal to their visual nature – what’s not to love?
And of course it is all soap in one form or another so it is getting them clean at the same time. But the real beauty of it is that it is cleaning itself up!
I think they’d make an ideal present for their stockings, or to help fulfill the additional sensory needs triggered by the festive season. They also have little characters on the tops of the bottles for an additional tactile feel – and they are designed to be played with in the water.
I also liked how this developed my Sensory Seeker’s hands as he played with the products – from undoing bottles, to developing his pouring technique (hand-eye co-ordination, estimation of how fast the liquid would pour out, tilting his hand back0; then squeezing on the flannels and sponges, to helping his fine motor development with the crayons.
Of course soap products are not just suitable for those with Sensory Processing disorder, and are just as much fun for all children, covering such a huge variety of ages.
This can really help other children (friends and family perhaps) get a better understanding of say a sensory seeker – as they join in the fun of covering themselves in soap.
I was invited to Hamley’s in London with my youngest 3 children (including my Sensory Seeker) to have a messy play date with
Kids Stuff ® Crazy Soap and see their new designs.
I thought that it was great to see the products being demonstrated without the bath – as this is just perfect for me as he often wants to touch things (or again if you have a sensory avoider who does not like the bath, this could be a small step in).
This was achieved by giving the children aprons and goggles for protection. Then there were a number of stations set up – with bowls, flannels, water, the products, and others had white boards to draw on, special bath colouring in books and crayons, flannels, sponges – and all manner of sensory experiences.
I could see this as a great idea for a Sensory soap party.
Our travel expenses were paid to attend the event at Hamley’s but I was under no obligation to write this post. I think they are an absolutely marvelous product and they really helped my Sensory Seeker as he was struggling with all the changes (it was Half Term Holidays). I thoroughly recommend them to other parents – both those who are and aren’t having difficulties with Sensory Processing Disorder.
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Thursday, March 6, 2008 Wednesday, March 5, 2008
Then I found an article in Slate by David Greenberg, in which he wrote:
To suggest that March 5 marks a late date in the calendar ignores the duration of primary seasons past. Indeed, were Hillary Clinton to have pulled out of the race this week, Obama would have actually clinched a contested race for the party's nomination earlier than almost any other Democrat since the current primary system took shape—the sole exception being John Kerry four years ago. Fighting all the way through the primaries, in other words, is perfectly normal.
But I'm still skeptical. The commenters and Greenberg used history to show that a party is not doomed when faced with a drawn-out election. And while that was true for McGovern and Carter, neither of them faced an election like this. It is true that elections have dragged on through months of uncertainty before, but it is also true that there has never been a primary that lasted 15 months before it was decided. And 15 months is looking like the shortest amount of time it will take for the party to figure out who it wants.
Last night was bad news for the Democratic Party. This isn't because Obama lost, or because Clinton won. It has more to do with McCain winning. The Republicans are done. Those that don't like McCain are coming along, and starting to cope with him as their candidate. Their table is set.
The Democrats, though, are in turmoil. They are divided right down the middle. And the bickering is going to continue for seven weeks, leading up to Pennsylvania, and probably beyond. The party is going to stay divided all the way to the convention, giving the Democrats four months to get past the nominating process and rally behind the nominee.
The Republicans, though, have begun their healing. They are getting behind their man. The Republicans will be unified, and the Democrats will be split.
The news this morning isn't bad because Clinton won or Obama lost. The news is bad because, for the first time, it is clear to me how the Republicans win in November, but I don't see how the Democrats do it.
Tuesday, March 4, 2008
Jake Tapper reported that John McCain recently declared that "'there’s strong evidence' that thimerosal, a mercury-based preservative that was once in many childhood vaccines, is responsible for the increased diagnoses of autism in the U.S."
This is an argument I know something about and it's totally bogus. As Tapper reported, there is a loud (although I'm not sure they're large) group of people out there who aim to convince legislators that thimerosal is responsible for autism. The argument has worked to convince people like Don Imus, who preaches about the cause with his wife on his radio show.
But as Tapper also reported, the medical community, running on facts and research and not emotion, says there's nothing to this connection between thimerosal and autism. From Tapper:
The Centers for Disease Control
says "There is no convincing scientific evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site."
The American Academy of Pediatrics
says"No scientific data link thimerosal used as a preservative in vaccines with any pediatric neurologic disorder, including autism."
The Food and Drug Administration conducted a review in 1999 -- the year thimerosal was ordered to be removed from most vaccines -- and said that it "
found no evidence of harm from the use of thimerosal as a vaccine preservative, other than local hypersensitivity reactions."
The Institute of Medicine’s Immunization Safety Review Committee
concluded "that the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism."
And a study of California Department of Developmental Services data published last month
indicated that there was "an increase in autism in California despite the removal of thimerosal from most vaccines."
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Regulating the GIobal Brothel by Leah Platt The American Prospect magazine, Summer 2001
As feminization of migration continues, prostitution becomesthe prototypical global industry. How do we "protect"its workers? On the night of September 10, 1997, Toronto police officersraided more than a dozen apartments suspected of being housesof ill repute. Twenty-two women, including the alleged madam,Wai Hing "Kitty" Chu, were charged on a total of 750prostitution and immigration-related charges. All of the womenwere Asian and spoke no more than a few words of English. The press accounts of the raid were by turns titillating andfull of moral outrage. According to the San Jose Mercury News,the women were helpless victims, "pretty, naive country bumpkins"who were exploited by an international crime syndicate (the U.S.police collaborated on parallel raids in San Jose). In a piecefor The Toronto Sun, with the lurid headline "Sex Slaves:Fodder for Flesh Factories," a reporter profiled "Mary,"a Thai prostitute, who obligingly described her first trick, afumbling failure made to sound almost endearing. It is a familiar story by now: poor, vulnerable women fromThailand or the Ukraine promised jobs as nannies or models inWestern cities, only to find themselves pressed into service asprostitutes to pay off travel debts and line the pockets of theirtraffickers. As long as the women were portrayed as misled innocents,it was easy for Toronto readers to sympathize. But readers' pity quickly turned to anger when it was revealed,a few days later, that most of the women had known exactly whatkind of work they had been recruited to do. As the Toronto Starsummed up a few months later, "public opinion did an instantabout-face" when police revealed that the women "hadwillingly come to Canada to ply their trade; wiretaps caught themboasting, long distance, about the money they were earning."Now, the women were considered "hardened delinquents, illegalimmigrants, tawdry, dismissible, selling their bodies of theirown free will." Nothing became of the initial allegations of labor abuses.There had been rumors of debt bondage, a form of indentured servitudethat requires migrants to finance their travel expenses (whichare frequently inflated) by working without pay; of confinement;of shifts that lasted 18 hours. But before these charges couldbe investigated, the women were released on their own recognizanceand disappeared from view, dismissed by the media as common whores. What is it that separates a Thai woman turning tricks in acramped Toronto apartment from a Mexican immigrant toiling ina sweatshop in the suburbs of Los Angeles? Why does the formerdraw our scorn, the latter our sympathy? Clearly, many peoplereact uncomfortably to the idea of sex as just another good thatmay be purchased on the open market. Yet for the women who maketheir living as strippers, escorts, prostitutes, and porn stars,sexual activity at the workplace is a job-a repetitive task thatcan be as unerotic and downright boring as cutting pork shoulderson an assembly line or sewing sneakers in a Nike factory. As such,doesn't sex work deserve the full protection of U.S. Iabor laws? One reason that sex work doesn't currently benefit from suchlabor protections in the United States is that the feminist community,which is the champion of women's rights in the workplace in manyrealms, remains bitterly divided over prostitution. On one sideare the abolitionists, who call prostitution a crime against women,akin to rape or domestic abuse; on the other side are the pro-choicers,for whom the rhetoric of victimization is itself demeaning, andwho say that women should be able to do whatever they want withtheir own bodies, including renting them out for pay. The two sides talk past each other, particularly at the extremes.Prostitutes, the controversial firebrand Camille Paglia has said,are "very competent, very professional. They look fabulous!I've always felt that prostitutes are in control of the streets,not victims. I admire that-zooming here and there, escaping thepolice, being shrewd, living by your wits, being street smart."To Donna Hughes, on the other hand, the director of the women'sstudies program at the University of Rhode Island, the idea ofselling a sex act like a trip through the car wash is inherentlydegrading, and in practice is often accompanied by rape, intimidation,and cruelty. "A lot of people don't know what prostitutionis," she told me angrily. "They don't know what it reallytakes to have sex with five strangers a day. What most peopleknow about prostitution is based on myths and misinformation." But while feminists debate the "sex" part of sexwork-is it degrading or liberating?-they generally ignore the"work" part. Neither Paglia's paean to the hooker-as-rugged-individualistnor Hughes's lament for the little-girl-lost captures the oftenmundane reality of illicit prostitution: It is a job without overtimepay, health insurance, or sick leave-and usually without recourseagainst the abuses of one's employer, which can include beingrequired to have sex without a condom and being forced to turntricks in order to work off crushing debts. Given that the sexindustry exists and probably always will (they don't call it theoldest profession for nothing), what should be done about itsexploitative conditions? SEX WORK GOES GLOBAL That question was vexing enough when prostitution was primarilya local issue. But sex work is an increasingly global service.In the language of international trade, sexual services are commonly"imported" into places like the United States from thedeveloping world. Men from wealthy countries frequent the semi-regulatedsex sectors in Cuba, the Dominican Republic, and Thailand-a phenomenonknown as "sex tourism." And women from countries inSoutheast Asia, Africa, and eastern Europe migrate to the industrializedworld to work in the domestic sex industries. The United Nationsestimates annual profits from the trade in sex workers like theThai women arrested in Canada to be $7 billion. While there are no precise statistics on the number of womenwho enter the United States from abroad to work as prostitutes-eithervoluntarily as immigrants or involuntarily as victims of trafficking-arecent report by the Central Intelligence Agency (CIA) estimatesthat roughly 50,000 women and children are brought into the countryby traffickers each year. (This figure includes traffficking victimswho work in brothels as well as those who work in sweatshops andas domestic servants.) The crime of traffficking in women has recently attracteda great deal of attention from policy makers in Congress and theinternational community. The European Commission highlighted actionagainst the "modern day slave trade" as part of itscommemoration of International Women's Day this March. The UNConvention Against Transnational Organized Crime, which was signedin December, included a separate protocol on the prevention oftraffficking in women and children. Here at home, Congress passed the Victims of Trafficking andViolence Prevention Act in a nearly unanimous vote last October,a move that President Bill Clinton hailed as "the most significantstep we've ever taken to secure the health and safety of womenat home and around the world." Minnesota's liberal SenatorPaul Wellstone, one of the bill's co-sponsors, said that "somethingimportant is in the air when such a broad coalition of people-includingBill Bennett, Gloria Steinem, Rabbi David Sapperstein, Ann Jordan,and Chuck Colson-work together for the passage of legislation."And what's not to love about a bill that can be dressed up alternativelyas a victory for women's rights, a way to get tough on crime,and a curb on immigration? As Ann Jordan of the InternationalHuman Rights Law Group puts it, "there is no way that anypolitician could say he is opposed to this bill. It was a win-winbill for everyone." Even the Christian right was satisfied;Jordan explains that "evangelicals took on trafficking asone of their big projects" in order to rescue innocent womenfrom the sin of prostitution. But in all this self-congratulatory rhetoric about protectinginnocent girls, some of the harder questions never got asked.What is the distinction between "trafficking," say,and alien smuggling, or between trafficking and labor exploitation?According to the CIA report, trafficking "usually involveslong-term exploitation for economic gain," whereas aliensmuggling is a limited exchange-an illegal immigrant pays a smugglerto be transported or escorted across the border and there theeconomic relationship ends. But in practice the two crimes blend together: Hopeful migrantsoften can't afford the price of their passage and arrive in thecountry in debt to their smuggler; the smuggler in effect becomesa trafficker. As migrants try to pay off their loans, they areoften caught in abusive situations, forced to work long hoursin unsafe and unsanitary conditions. The most notorious exampleof this mistreatment is the El Monte case, named for a town inSouthern California where 72 Thai migrants were found in 1995held against their will in a warren of apartments that doubledas a garment factory. To pay off their travel debts, the migrantswere stripped of their passports and forced to work at sewingmachines for more than 80 hours a week at a negligible wage, surroundedby barbed wire. After the operation was raided by federal andstate agents, the perpetrators pleaded guilty to indentured servitudein order to avoid more severe kidnapping charges and were sentencedto between two and seven years in prison. The facts of the El Monte case parallel the alleged misdeedsin the Toronto brothel: The perpetrator helped immigrants enterthe country illegally and the immigrants were forced (either throughviolence or because of mounting debts) to work in substandardconditions for below-minimum wages. But addressing Toronto-typesituations with specific legislation like the Victims of Traffickingand Violence Prevention Act implies that foreign women workingin the sex industry are different in kind from foreign laborersin other exploitative industries. There is arguably somethingto this implication; sex workers are more susceptible to rapeand other forms of violent degradation. Yet legislation like theVictims of Trafficking and Violence Prevention Act implicitlyseems to exempt sex workers (and their exploiters) from the laborlaws that already exist to protect them-making them instead subjectto the specific crime of "sex trafficking." Such lawsobscure the fact that for the most part the abuses that afflictprostitutes are the sort that can befall all migrant workers. "Prostitutes," writes Jo Bindman of Anti-SlaveryInternational, "are subjected to abuses which are similarin nature to those experienced by others working in low-statusjobs in the informal sector." In her 1997 report, "RedefiningProstitution as Sex Work on the International Agenda," Bindmanargues that mistreatment of prostitutes-everything from arbitraryarrest and police brutality to pressure to perform certain sexualacts at work-should not be thought of as hazards of the tradeor as conditions that loose women bring upon themselves but asabuses of human rights and labor standards. In other words, rather than design new legislation to combatthe crimes of "sexual slavery" or "traffickingin women," we should prosecute alien smuggling, trafficking,debt bondage, and labor exploitation under existing national andinternational codes. The International Labor Organization (ILO)has signed conventions on forced labor (1930), holidays with pay(1936), the protection of the right to organize (1948), the protectionof wages (1949), and migration for employment (1949), but becauseof our intuitive sense that sex work should be marginalized asimmoral and degrading to women, none of these rules has been appliedto the gray market in sexual services. Our well-meaning desireto "protect" women forces the prostitution industryunderground and out of the reach of established labor statutes. WHY PROSTITUTES MIGRATE As hard as life can be for prostitutes who lack formal laborprotections, it is often still harder for migrant prostitutes,who as both illegal immigrants and participants in an illegalindustry are doubly marginalized. The Network of Sex Work Projects,an informal alliance of human rights organizations, warns thatthe dual "illegality of sex work and migration" allowssmugglers and brothel owners to "exert an undue amount ofpower and control" over foreign sex workers. Employers threatenmigrant sex workers with deportation if they inform the authoritiesabout inhumane labor practices-and even if women could reporttheir situation, the authorities might not take it seriously. The migration of sex workers to the developed world is partof a wider pattern that sociologists call the "feminization"of migration. Until very recently, most labor migrants were menwho worked in mining, manufacturing, and construction. If womenmigrated, they did so under family reunification statutes, oftenwith children in tow. As industrialized economies become moreservice oriented, the jobs available to migrants are increasinglyin the "female" sector, which includes everything frommaids to nannies to exotic dancers. "The latest figures fromthe ILO indicate that more than 50 percent of labor migrants arewomen," says Marjan Wijers, a fellow at the Netherlands'Clara Wichmann Center for Women and Law in Utrecht. "Butthe economic situation is different now than it was for men ageneration ago. Male migrants entered the formal labor marketthrough formal channels. They didn't have the most attractivetypes of employment," she notes, "but at least theyhad work permits. Women have been relegated to the informal sectorin traditional women's work: domestic and sexual services, eitherin the sex industry or in arranged marriages. These jobs are oftennot recognized as 'work'; there are no labor protections for them,no access to legal working permits." Despite the very real conditions of abuse, Wijers is carefulnot to call all low-paid female immigrants-or all migrant prostitutes-victims.For many women now, as has been the case for men for centuries,migration is a calculated financial decision, with prostitutionseen as a way to make money. Sex work, like providing paid domesticservices and child care, is a way to support family or childrenback home or to start a new life in the West. "These womenmade a conscious decision to improve their situation through migration,"Wijers explains. "It is possible that they expected anotherjob-and of course, no one expects to be held in slavery-like conditions.But these women are intelligent, enterprising, and courageous.It is quite a step to leave your family and your security to goabroad, into a situation where you don't know exactly what toexpect." Wijers has staked out a defensible middle ground between thestrict abolitionists and the prostitution-as-self-expression promoters:She supports a woman's right to control over her own body, aswell as a prostitute's volition as an economic actor, withoutvalorizing sex work as a liberating profession. As one of thechief investigators for a report on trafficking prepared for theUN Special Rapporteur on Violence Against Women, Wijers is oneof the world's foremost experts on forced prostitution, but shefinds the narrative of victimization supported by the United Nationsto be sentimental and overly simplistic. The reality in her nativecountry, the Netherlands, is more nuanced. "Some of the firstwomen to come from abroad were from the Dominican Republic andColombia," she says. "They were clearly disadvantaged,recruited in cruel ways, forced into terrible conditions-all theclichés. But when you have spent some period of time ina country, you start to make contacts and to organize. Soon thesewomen were sending for their aunt or their sister- they were organizingthe migration of female friends and relatives. Within a few 'generations'of migration, this group of women learned Dutch and became moreindependent." One of the most reliable studies of sex tourism, conductedby the ILO in 1998, corroborates Wijers's observations. Basedon interviews with thousands of sex workers in Indonesia, Malaysia,the Philippines, and Thailand, the report concluded that "whilemany current studies highlight the tragic stories of individualprostitutes, especially of women and children deceived or coercedinto the practice,...many workers entered for pragmatic reasonsand with a general sense of awareness of the choice they weremaking." Almost all of the women surveyed said they knewwhat kind of work they would be doing before they began; half,in fact, responded that they found their job on a friend's recommendation. THE BENEFITS OF LEGALIZATION In order to use labor laws to protect women in the sex industry,the legal status of prostitution and its offshoots-brothel keeping,pimping, soliciting, paying for sex-would need to be re-examined.After all, the Department of Justice does not ensure minimum wagesfor drug runners or concern itself with working conditions inthe Mob. But whether or not we approve of sex work or would wantour daughters to be thus employed, the moral argument for condemnationstarts to fall apart when we consider the conditions of abusesuffered by real women working in the industry. Criminalizationhas been as unsuccessful in dismantling the sex industry as ithas been in eliminating the drug trade and preventing back-alleyabortions. Sex work is here to stay, and by recognizing it aspaid labor governments can guarantee fair treatment as well assafe and healthy work environments-including overtime and vacationpay, control over condom use, and the right to collective bargaining. A decision to re-evaluate the legal status of the sex industryin the United States would not be without international precedent.Prostitution is legal (while subject to varying degrees of regulation)in England, France, and many other parts of Europe. In 1999, Germanyeliminated the legal definition of prostitution as an "immoraltrade," thus allowing sex workers to participate in the nationalhealth insurance plan. Prostitution is also legal in parts ofSouth America and the Caribbean, and in some counties in Nevada.Prostitutes' unions have sprung up in Cambodia, Hong Kong, India,and Mexico, and groups like COYOTE (Call Off Your Old Tired Ethics)advocate for sex workers' rights in the United States. In areas where prostitution is legal, brothel keeping-or profitingfrom the proceeds of prostitution-remains a crime. Even the Netherlands,a country notorious for its laissez-faire attitude toward sexwork, legalized brothels only in 1999; and the concern that, assanctioned businesses, brothels would sprout up on every streetcorner there has proved unfounded. Brothels are now subject tothe same building codes and municipal ordinances as any otherbusiness-including zoning laws that keep brothels contained inestablished red-light districts. As one of the only countries with a fully decriminalized sexindustry, the Netherlands provides the fullest illustration ofhow legalization can operate. Amsterdam's red-light district occupiesa maze of narrow streets in the oldest part of the city. Residentswho have no interest in frequenting the sex shops can avoid thearea without inconvenience. Inside the district, which is markedoff with strings of red lights, prostitutes sit in storefrontwindows to display their wares (l00 guilders, or roughly $50,for a 15-minute "suck and fuck"), alongside toplessbars, porn and sex toy shops, and the neon lights of peep showemporiums. Even in the dead of winter, packs of foreign men gatherin the narrow alleys to gawk and knock on windows. Some of thewomen behind the windows look Dutch, but Marisha Majoor, who greetedme at the Prostitution Information Center's storefront, correctsthis impression. "Most of the blond girls are from otherEuropean Union countries, like Sweden and Germany," she says.Dutch women, who can work in the comfort of their own homes, don'tbother with the hustle of the red-light neighborhood. Until last year, Amsterdam's windows were full of illegalimmigrants from Africa and eastern Europe. Brothel and club ownersestimated that between 40 percent and 75 percent of the womenin the red-light district were working illegally. All of thatchanged with the legalization of brothels. "Of course,"says Marieke van Doorninck, a research fellow at the Mr. A. deGraaf Stichting Institute for Prostitution Issues in Amsterdam,"brothel owners were technically never allowed to work withillegal migrants, but the practice was condoned for years. Ifan illegal worker was discovered, all that could happen is thatshe would be deported and the club owner would be given a fine.There was no real incentive for the brothel owners to deny jobsto illegal migrants. Now they can lose their license." It is possible to support a woman's right to control overher own body, as well as a prostitute's volition as an economicactor, without valorizing sex work as a liberating profession. There are still a few African women working in the red-lightdistrict. Some of them have married Dutch men; others have forgedpassports from Italy or Greece, allowing them to work in the EuropeanUnion. One landlord, a gray-haired, heavyset man known as Marcel,owns 20 windows; his "tenants" are mostly from Africa.He claims that all of his "girls" have legitimate papersand, when pressed, pulls out a blue binder stuffed with photocopiedpassports from Ghana and Nigeria. The passports may very well be real, but according to vanDoorninck, the working papers could not have been. "In otherlines of work," she explains, "if a boss can show thatthere is no person from the EU that can do the job, then he canhire someone from outside." Farmers, for example, regularlyrequest allowances for agricultural workers. "But the sexindustry is shut out from this regulation. There is no legal wayfor a woman from outside the EU to work in prostitution."Sex workers are also specifically excluded from the immigrationregulations governing the self-employed. Potential immigrantsfrom outside the European Union "can apply for working papersif they show a viable business plan and can prove that they arecapable of taking care of themselves without becoming dependenton the state," says van Doorninck. "But foreigners whoapply to settle in the Netherlands as self-employed prostitutesare in principle rejected on the grounds that their activitiesdo not serve the country's interests." The women working in Marcel's windows are lucky. Most of theAsian, African, and eastern-European women left in Amsterdam areworking on the street or in unregulated black-market brothels."By making it more difficult for foreign women to work inlegal places, where they have been condoned for ages, they areforced to leave or to work in an illegal setting," van Doorninckpoints out. "In a way, the government stimulates traffickingby leaving no options for the women who are already here." The Dutch government's decision to regulate brothels was basedless on morality than on economics. The sex sector had long been"officially tolerated" (or in Dutch, gedoogt); by legalizingits activities, the government is able to collect revenues fromlicenses and taxes. And from the workers' perspective, legalizingthe sex industry-and thus barring foreign women from working inlicensed brothels-follows from a classic trade-protectionist motive.Why offer jobs to non-Europeans when there are plenty of womenin Holland and elsewhere in the European Union who are willingto work in the Dutch sex industry? Before the change in brothels' status, "there was definitelytension between Dutch prostitutes and the migrant workers, a competitionover prices," remembers Wijers. "Because the illegalwomen had no documents, they were willing to work for less andDutch women started to feel uneasy." Foreign women "spoilthe market," the Prostitution Information Center's Majoortold a team of American and Dutch college students researchingthe condition of illegal prostitutes last year. "It makesyou furious when some guy keeps knocking at your door, saying,'Okay, but a little way down the street, they are only askingz5 guilders." Majoor, like most of the Dutch women who workin the sex industry, belongs to the Red Thread, a lobbying groupakin to a union. The Red Thread does not allow illegal migrantsto join. "When a hotel like the Hilton suddenly brings inan Hungarian pianist who is willing to work for less money, longerhours, without social insurance, Dutch pianists will complain,"Wijers notes. "It is the same mechanism in the sex industryas in other labor sectors." The Dutch experience with decriminalization suggests thatthe reaction of the sex industry to the stresses of globalizationis not unlike that of, say, the garment industry here in the UnitedStates. Domestic workers resent immigrants, who are eager to findwork at any pay and consequently create downward pressure on wages.Arriving in the country with few resources and little commandof the language, immigrants are often shunted into the informaleconomy, which in this case means shady makeshift brothels andback-of-the-bus-station encounters. Legalization may be limited in what it can do to reach thenearly invisible population of illegal migrants who work internationallyin the sex industry. But that's also true of the Victims of Traffickingand Violence Prevention Act and the protocol included in the UNConvention Against Transnational Organized Crime. Both of thelatter measures define trafficking as an explicitly sexual crime-anact of violence against women-rather than as a by-product of anever more global marketplace and the increasing feminization ofmigration. Any policy that will truly improve the often deplorableworking conditions in the international sex industry must confrontthe economic realities of the profession without getting distractedby the sexual ones. To those who feel their moral hackles rising at the prospect,Ann Jordan of the International Human Rights Law Group presentsa compelling analogy: "We don't support a woman's right tochoose because we think abortion is a great thing," she says,"but because we believe fundamentally that women should havecontrol over their own reproductive capacity. The same argumentcan be made for prostitution. Women who decide for whatever reasonto sell sex should have the right to control their own body"-andshould be assured of basic protection on the job. As with abortions,we can dream of a day when sex work is safe, legal, and rare. LEAH PLATT is an American Prospect writing fellow. For moreinformation on the global sex industry, see links to this articleat www.prospect.org. Women'swatch Indexof Website HomePage
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Did you know that cilantro and coriander are the same plant?
In Spanish speaking countries and the US, coriander leaves are called “cilantro”, a Spanish name for the plant, and “coriander” refers to the seeds. However, both come from the same plant, Coriandrum sativum. In the rest of the English-speaking world, cilantro is called “coriander leaf”.
Both leaves and seeds are distilled to obtain essential oil, however each of them is quite different in its chemical make-up, and therefore properties. While coriander seed oil is one of the safest and most useful essential oils for skin care use (antifungal, anti-inflammatory), there are no established therapeutic uses for cilantro oil. However, it is toxic to the larvae of Aedes egypti (http://www.ncbi.nlm.nih.gov/pubmed/21692682) a type of mosquito which spreads yellow fever, dengue fever and zika virus.
Note: There is one research study that found a probable effect for chelating a heavy metal (lead) from cilantro (http://www.ncbi.nlm.nih.gov/pubmed/11535365). However, an aqueous extract was used, which would contain flavonoids and ascorbic acid, both potential chelating agents. Chelating agents require two of the same functional group in the molecule, and no essential oil constituents fit this requirement, including cilantro oil. Therefore, cilantro oil is not a chelating agent.
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We exist in a chemical soup. We eat, breathe and drink chemicals. We are made of chemicals and so is everything else. Especially in this industrial age, it’s important for us to identify significant risks and to either eliminate them or reduce them to the point of being negligible. This also applies to natural substances, which of course also consist of chemicals. In general, natural substances may be safer – that’s open to debate – but “safer” is not safe, it’s just a relative term.
In toxicology, it’s important to understand the difference between hazard and risk: “hazard” is simply potential risk. How much risk there actually is depends on other factors, such as the toxicity of the substance, how much of it you are exposed to, and how old you are. If you’re 3 years old, the risk will be different to if you’re 30 years old. “Frequency” simply means how many times per day, and “duration” means how much time elapsed between first and last use, which could be hours or years.
For essential oils, toxicity may include irritants, allergens, neurotoxins, fetotoxins, carcinogens etc. Within the essential oil community, we have a tendency for double standards. Some of us are intolerant of any synthetic chemicals with any of the above stated hazards, but when it comes to essential oils we have faith that the product we are using is harmless because it’s natural.
To a degree this makes sense – some essential oils do contain anti-carcinogenic constituents that counter the effect of the carcinogenic constituents they also contain; but only in some oils. To use an extreme example of toxicity, natural Bitter Almond oil contains about 3% hydrocyanic acid (cyanide), and if you drink an ounce of the oil it will kill you – the 97% of benzaldehyde has no protective effect. (You could not actually drink unrectified Bitter Almond oil – it has been banned for the last 150 years because of its toxicity.) And so it makes sense to set safety guidelines based on the totality of constituents, and to include any known human toxic effects.
Skin reactions are less predictable. There are safe levels for oils like Oregano (skin irritant, 1%) and Lemongrass (skin allergen, 0.7%). If you use more than those levels you might not experience an adverse reaction, but the risk increases significantly, also depending on frequency etc. We have seen low-risk oils causing allergic reactions simply because of prolonged exposure to high levels.
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The amount of content we interact with in a single day is astronomical. Endless tweets, remarketing ads, blogs, white papers, and more are now part of our daily routine. Out of those types of content, which are we most likely to remember and interact with?
Video.
Video has the ability to capture our attention for an extended period of time (which is no easy feat in today’s digital world), and convince us to take an action. Other types of content are capable of doing this too, but
80% of Internet users remember the video ads they watch online.
Can you tell me the name and subject of the e-book you downloaded a few weeks ago? Yet, everyone can remember the “
Dumb Ways to Die” video marketing campaign.
While video is spectacular on its own, it is far more powerful and yields greater results when combined with the various aspects of your online marketing strategy.
Social Media
While scrolling through your Facebook newsfeed, what catches your eye? I bet ten bucks you wouldn’t stop for a simple text update. In fact, unless the text update is controversial and argumentative, do you really think that you’ll engage with the post?
As stated by
Simply Measured, video is shared 1200% more times than text and link posts combined.
With the introduction of video advertising options on platforms such as Facebook, your social media campaigns can virtually skyrocket with the inclusion of video.
Social media is a great channel for telling your brand story, conversing with customers, and learning more about your audience. Therefore, you cannot throw any old video on your Facebook page. There is nothing more awful than a brand or company using viral videos of cats or ‘fails’ to generate engagement. When using video for your social media marketing strategy, make sure the
content is relevant to your audience’s preferences and needs/desires.
Email Marketing
We’re bombarded by emails daily. From sales promotions from our favorite stores, to contest offerings we forgot we signed up for; email runs our lives. Don’t forget about all the emails we deal with at work on a daily basis.
Thanks to the overwhelming amount of email we receive each day, your email needs to stand out from the crowd. What better way to accomplish this than with an intriguing video?
In fact, did you know that
email click-through rates improved by 200-300% when a video was included? (Forester) To separate your email from the mundane and intrusive emails your audience receives daily, you can also allow your users to download or share the video as an incentive to engage with your brand.
Don’t settle for a boring email marketing campaign —
add video!
Web Design
What are you trying to accomplish with your website? Whether you’re trying to generate sales or improve the overall reputation of your brand, adding video content to your website can help you achieve your particular goal.
Regardless of your goal, your website serves a purpose — to tell a story. Your website visitors could scroll and read to learn about your business, or they could watch a high quality, engaging video and know your company in the same amount of time (or less!).
Plus, you want your website visitors to stick around, right? (
If you are concerned about your search rankings and sales, you absolutely do.) Videos encourage your audience to learn more, visit other pages, and elicit a specific action. The question now is, where are the videos on your website?
Landing Pages and Online Advertising Landing pages work in conjunction with your additional online marketing efforts to convince customers to pull the trigger and purchase your product, sign up for a service or engage in a desired action.
As stated by
Econsultancy, only 22% of marketers and businesses are actually satisfied with their landing page conversions and results.
This exclusive group of marketers/businesses know something that the other 78% don’t —
videos work wonders on landing pages. In fact, studies have shown that using video on a landing page can increase conversion rates by 80% ( Unbounce).
When you’re looking to improve your landing page results, a video may do the trick.
Search Engine Marketing
Did you know that videos can benefit your search marketing strategy? If not, I’m about to blow your mind.
Due to many search engine algorithm updates including Hummingbird, content is more important than ever. Fortunately, Google and other search engines consider video to be high quality content. While title tags, keywords, quality backlinks and other search marketing tactics assist your search rankings, they may not answer the detailed questions your customers have.
Google considers video to be worthwhile content due to the ability to provide thorough information and explanations, and direct the consumer to their answer. Therefore, video equates to greater quality content on your website, and ultimately higher search results.
Videos also entice users to stick around your website for a longer period of time. In fact,
an average Internet user will spend 88% more time on a website with video, in comparison to one without.
One factor included in search rankings is known as the
stickiness factor, which equals the average amount of time users spend on your website. As the stickiness of your website improves, in turn your search rankings will too.
Last but not certainly not least, videos assist with your link building efforts. People love to share videos. Seriously, they
to share videos. How much do they love it? This much: love studies show that 92% of mobile video viewers share video content with others.As users share your video, you build a series of links back to your website. It’s a win-win situation!
It’s Time to Invest in Videos for Your Business
If you
still need proof that your business needs to invest in video, this statistic from MarketingProfs will do the trick: 70% of marketing professionals report that video converts better than any other medium.
When you’re ready to take the next step with your online marketing strategy, or are tired of poor results from your campaigns, invest in video.
Does your business need a video or video series? Good thing Titan Web Marketing Solutions offers video production services. Pretty convenient, huh?
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from training.npr.org: http://training.npr.org/audio/six-npr-stories-that-breathe-life-into-neighborhood-scenes/ 6 NPR stories that breathe life into neighborhood scenes This post was first published on the website Storybench.
For scenes to succeed in any medium, they have to engage your senses. You smell the diesel fumes, feel the breeze on your cheeks, hear the anger in the collective voice of a crowd of protesters. These appeals to the senses are important, but often secondary to the story.
In radio (or
audio, as we increasingly say in our changing industry), scenes are not secondary. They are the centerpieces of much of our best storytelling. And so we constantly seek scenes that capture the main points we’re trying to convey. The more show, the less tell required, the better; because honestly, listeners are more likely to tune out during the tell.
But the best scenes are really, really hard to capture and transform into good storytelling.
Let’s take neighborhoods as an example. At NPR, we often seek ways to illustrate news, policy issues or trends in the lives of real people. So we go to where they live — to their neighborhoods. And you can imagine the easy clichés we record there: cars passing on the road, kids playing, barely-audible birds tweeting.
What’s more difficult is transcending the clichés. Here is just a sampling of ways NPR journalists have done that.
Sometimes the writing does the trick
At the opening of this story from Cuba, you can hear the hubbub of a busy Havana street. That “ambient sound” is important, but…
…it’s Robert Siegel’s writing that knocks this one out of the park:
This is a scenecruising minus the carsclubbing minus the money to get into the clubsIt’s a scene with smartphonesminus the smartsThey have no connection to the web.
The first 30 seconds or so read like a poem, a jazzy riff filled with detail, rendered with rhythm. That combination of visual description and rhythm makes ears and brains happy! So while you can’t have a scene without sound, sometimes what brings it to life is your own narration.
Sometimes great sound (usually stereo sound) does the trick (Fast forward to 9:45)
This story demonstrates how sound creates three-dimensional images: a screen door opening onto a lively street, a woman in the background calling to another in the foreground, the squeak of children bouncing on a trampoline.
The audio was recorded by the late Bill Deputy, who intimately understood the science of stereo. The street, in Belzoni, Mississippi, is filled with wonderful characters, and you can hear the richness of their voices both on mic and in the distance. If you close your eyes and listen, you can see these people and this neighborhood as if it were all around you.
(A disclaimer of sorts: I produced this story back in 2006, and now that I listen to it again, I wish we’d begun the story with a scene rather than spending six of our 12 minutes explaining the premise. As interesting as the premise is, nothing draws in the audience in like a textured scene!)
Plot a clear path
One of my favorite ways to depict a place is to plot a route through it. Just two days after a tornado tore through Joplin, Missouri in 2011, Frank Morris of KCUR did just that.
He had no shortage of scenes to illustrate. He could have talked to any family on any street piled high with rubble, and it would have been evocative. But he did something even smarter: He created an organizing principle by traveling the seven-mile path of the tornado itself.
Here’s how Frank described it to me in an email:
Figuring out how to best organize stories is hard work. But you can skip that whole part, if you’ve got a timeline or a geographical path to follow. Especially on deadline, with all the other remote filing-from-a-disaster-area stuff to worry about, having the outline already in place is really great… If you’ve committed to an outline, then you can really concentrate on the connective stuff, the standups and bites you need to move from one place to the next.
Frank’s approach gave the story a natural beginning, middle and end and a constant sense of movement. For the listener, it created a mental map of Joplin and its destruction. And for Frank, it helped him meet his deadline!
Illustrate the unexpected
Too many scenes are mediocre because they are predictable. Beside a road? Here’s sound of cars passing. At a school? Here are kids playing on the playground. In a war zone?
Bang! Bang! Boom! (OK, well, explosions are always pretty striking.)
Sometimes the unexpected is what brings a neighborhood to life. In this story from Izmir, Turkey, foreign correspondent (and now,
All Things Considered host) Ari Shapiro describes some typical activities of a coastal vacation town: fisherman, cyclists, a wedding.
Then he starts to build in the unusual: A town square packed with Syrian refugees. They’ve hung up their laundry to dry. They’ve bought life jackets. They’re waiting for human smugglers with rafts. And then – this is my favorite part – he challenges the stereotypical image we might have of a place crawling with desperate people: He takes us to the café where the owner lets Syrians charge their iPhones and use Wi-Fi. (I can’t help but think of this in
US Weekly style: Migrants! They’re just like us! They charge their smart phones!)
Ari, who reports from all over the world, says this is a common approach he uses:
Whenever I’m covering a story in a far-away place about an issue our audience may not have experienced first-hand, I search for ways to make the place and the issue more familiar and relatable. So establishing that Izmir is a pretty typical beach town gives people an image that they can latch on to. Another principle that I try to follow when I’m reporting on bleak and depressing subjects is the old Mr. Rogers line, “Look for the helpers,” the people who are doing something good to improve the situation. In that way, the cafe owner checks two boxes: he makes the Syrian refugees relatable (they have smartphones and need Wi-Fi just like us!), and he makes the situation feel a little less hopeless. Shape a scene by your movements
A lot of audio pieces begin with the reporter saying, “I’m standing here…” We stand on city corners, in farmers’ fields, on top of mountains. What we are trying to do — to quote an NPR cliché — is “take you there.” But the wisest storytellers teach that you should never just stand still. You should be moving.
Steve says the opening of the story is critical:
My ambition is to start the storytelling from the first sentence. Sometimes this calls for a hard news lead. Often it calls for something more subtle. In this case we began: “The other day, we stopped a car in front of a house. It was a house on stilts, a good eight feet off the ground. We climbed the steps to the high front porch. [SOUND OF STEVE KNOCKING ON THE DOOR] We were talking with everyone who would answer the door on a single street outside New Orleans.” This opening does more than paint scenery. It suggests movement. And it should raise a subtle sense of anticipation that’s vital to storytelling. Why on stilts? Who’s in the house? These are not necessarily huge questions. They need not be. They merely need to tug us inward, toward bigger things.
Over the course of the next few minutes, Steve continues to move along the street — meeting people, interacting with them. His movements stitch the street together better than any explicit exposition could.
(And a tip from producer Rachel Ward: This piece proves the value of an old radio rule —
always “roll tape” — when you’re in the field. The mundane sounds of Steve climbing stairs, knocking on doors, and meeting people are necessary ingredients for this kind of scene.) People are the place (Fast forward to 2:20)
Sometimes the most distinctive sound of the place has nothing to do with its physicality. It’s the people. In this story, the montage of down-and-out Angelenos on LA’s Skid Row by correspondent (and now
All Things Considered host) Kelly McEvers and editor Tom Dreisbach vibrates with life.
This is not just a montage of voices randomly gathered and assembled on a trash-strewn street. The people you hear are interacting with two police officers who know their beat well. This scene introduces you to characters; it also introduces
relationships that are central to the story Kelly and Tom are telling. Those relationships are fraught. Affection, tension, and anger are wrapped together on Skid Row, and you hear all those feelings resonate in these interactions.
*****
I could go on rattling off more great examples. Suffice to say, these producers and reporters make it look easy, and it is not.
You have to trust that your sound communicates more than you can imagine. You have to hand agency to the listeners and hope you’ve given them enough audio clues to hear what you want them to hear. It’s a loss of control over one’s story. That’s scary, but it’s also inevitable once your story goes out into the world.
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Endoscopy is a procedure that allows physicians to better examine the body's passageways, including the esophagus, stomach and colon. Through a piece of equipment known as an endoscope, your doctor can directly look at specific areas to better evaluate and detect problems. An endoscope is a flexible, thin tube with a variety of attachments — including a camera, forceps and scissors — which allow your doctor to see inside your body and remove tissue for biopsy.
Colonoscopies
The most common variety of endoscopies is colonoscopies. During a colonoscopy, a doctor inserts an endoscope into the patient’s rectum to help detect colon polyps, inflammation, tumors or other irritants inside the large intestine. If abnormal growths are found, tissue samples can be collected for further testing or can be removed altogether.
A screening colonoscopy is vital to the early detection of colon cancer. Colon cancer, which is preventable, is often called the "silent killer" because patients typically don't start experiencing symptoms until the cancer is advanced. Typically, primary care doctors suggest men and women over the age of 50 have a colonoscopy at least once every five years.
Advanced Endoscopic Procedures
A variety of standard endoscopy procedures — like colonoscopies and biopsies — are routinely performed at TriStar Health facilities. We also perform many advanced procedures on a daily basis, including:
Stent placements Biopsies Fine needle aspiration (FNA) Percutaneous endoscopic gastrostomy (PEG) placement Manometry with impedence Endoscopic Ultrasound
Endoscopic ultrasound, or EUS, obtains high-quality images and information from a patient's digestive tract. By combining endoscopy and ultrasound technology, EUS provides clearer, more accurate, and more detailed images of the patient's esophagus, stomach or pancreas.
Physicians use EUS to determine depths of tumor penetration, identify the spread of cancer, assess chronic pancreatitis, evaluate causes of abdominal pain and analyze tumors.
A highly trained gastroenterologist guides the advanced diagnostic tool with a transducer tip on the endoscopic tube to view parts of the digestive tract.
EUS is an outpatient diagnostic procedure with sedation.
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201713
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Applied physics and systems engineer Dr Mandiaye Ndao is the founder and CEO of NexialiX, an innovation and tech consulting company based in Dakar.
He is also the co-founder of Soft’Awareness Academy, an educational programme that teaches leadership, digital literacy and technology skills to young people in Africa.
He worked as a former senior consultant at innovation firm Altran in Frankfurt where he attained 15 international patents before heading back to Senegal to make a splash in Dakar’s tech scene.
He has now become the programme director of Innovation, Technology, and Entrepreneurship at Université des Savoir-Faire [Know-How University, ISM Group] which opened in March this year.
Université des Savoir-Faire is a forward-thinking educational space that aims to increase access to high-quality classes for Dakarois of all ages and circumstances. I had the opportunity to speak with Dr Ndao about his burgeoning role as an influencer in Dakar’s tech scene and his unique vision for the future of the continent.
You started your career in Europe but then returned to Senegal. What motivated you to repatriate?
The thing I’ve always wanted to do was to create – to innovate or add value to things. So after having done my initial studies in Africa, I worked and studied in France for 15 years. During that time I played an interesting role in helping to solve technological challenges for large global companies.
The impact such work could have back home would be far greater.
I could see the technological expertise I offered in Europe had significant value, but realised that the impact such work could have back home would be far greater. This was my motivation: giving more meaning to my actions and contributing to solutions for Africa.
This year you are a technical validator for the Innovation Prize for Africa being held in Botswana. What is the importance to you of participating in this event?
It is truly an honour to have been asked to be a technical validator in this year’s Innovation Prize for Africa. It is important to me that I participate because the IPA fosters an innovative environment here. The IPA acts as a role model to others and shows that anything we see elsewhere can be created here in Africa.
The competitive environment fosters effervescence around this creativity, having a lot of people coming together with new ideas. At the end of the day, even though there are 1,000 entrees and only one winner, it will be the start of many stories that will someday end up somewhere.
We have a role in the globalisation of technology.
Beyond this, often when we talk about innovation in Africa, we look at social entrepreneurship. So I wanted to push the technology base to the forefront. It is important to know that we have a role in the globalisation of technology. This continent is able to create new, technology-intensive solutions, at the local scale for sure but at the global scale as well.
There is a lot of hype about ‘innovation’ these days. What does innovation mean to you in the context of Dakar’s energetic and competitive entrepreneurial scene?
The role of a real innovator should be something close to an architect. That is, taking a lot of pieces and putting them together to come up with a unique precise solution and it should do so elegantly. The ecosystem is full of entities and programmes but we need the architects now.
You have an entrepreneurial drive, but also deeply invested in forward-thinking educational initiatives – such as Soft’Awareness Academy, Université des Savoir-Faire [Know-How University]. Your investment in education goes beyond an altruistic effort to give back. What is the real potential you see in investing in Dakar’s youth?
On one side for sure, it is coming from the fact that I want to give back. But on the other side, it is very much a strategy. We are in what is a called a ‘knowledge economy’. That means that the soldiers of this knowledge economy have to be trained. Currently my role is being a professional of this knowledge economy – so with educational programmes I aim to prepare and shape youth for careers in tech and engineering.
If we want to create impactful solutions, we need to focus on hardware as well.
On the consulting side I help companies solve sophisticated problems. My goal is to build a lively tech scene here, but when I look around, I don’t see people ready-tailored for these positions. The only way to achieve my goal is to prepare people now who I want to see in my dream company of tomorrow.
Dakar is a rapidly growing and changing city with plans set in motion for technological advancement. An inventor with 15 international patents to your name, this is your area of expertise. What is your vision for Dakar’s future?
I think further than Dakar, Senegal or even Africa. Here, when we talk about technology today, often it is reduced to discussions on informatics, computer software and web platforms. More and more if we want to create impactful solutions, we need to focus on hardware as well. Things like mechanics, mechatronics and complex systems.
We need to have complete solutions to truly impact agriculture, improve efficiencies in infrastructure, healthcare and so on. We can do this by using new approaches, which are accessible today, through virtual and rapid prototyping. These tools allow for testing complex and sophisticated inventions but aren’t excessively costly compared to older techniques for testing models and prototypes.
In 20 years, do you see Africa as a global leader in a particular sector of tech? What is that sector and why?
It will not be specifically in a sector but rather at a specific part of the value chain. Up until recently, Africans were not positioning themselves as designers or people able to create new concepts and new solutions and so on. This is where I see the big opportunity.
We have the bright minds.
For sure, infrastructure and hard technology aren’t ready here but what is clear is that we have the bright minds that are able to conceive and design new solutions to implement here. The world needs new ideas to solve some of the pressing issues we face today.
Who are your inspirations?
My parents!
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Cage-free eggs still inhumane
Thank you for the excellent article explaining the lack of regulation on "cage-free" eggs ("Cage-free living isn't always equal," June 17). However, describing these birds as "happy" is a gross misrepresentation. Despite what the industry would like us to believe, there is no such thing as humane, cage-free eggs. Egregious cruelty is routine even in "cage-free" and "free-range" facilities.
Just like caged hens, the birds are debeaked without anesthetic - a portion of the beak is seared off, causing acute and chronic pain. The quarter of a billion male chicks hatched each year are of no value in egg production; they are ground up alive or smothered in the trash. And almost all egg-laying hens endure "forced molting," being intentionally starved for up to 14 days to shock the body into another laying cycle.
Egg-laying hens are arguably the most abused animals on the planet. Let's not be fooled by semantics.
Jennifer Kaden, Cleveland Heights
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(News-Herald, April 2000) Scholars recently revealed that among the fragments of the Dead Sea Scrolls they have found direct evidence of the first known management consultants:
MEMO TO: Jesus of Nazareth, et al FROM: Ernest Livgood, Management Consultant, Campaign for Sensitive Personhood Here at CSP we have been following your career with some interest. We appreciate your invitation to join you in your work, but feel there are several points of sensitivity and effective packaging which you first need to address. STAFFING: Your organization is simply too patriarchal-- too many guys. All twelve of your disciples are young working-class males of Middle Eastern/Jewish heritage. We suggest a group that better represents cultural diversity-- add at least three women, a Caucasian, and a few Africans. Perhaps some Confucians and Buddhists. A druid would be a nice touch, too. You also show constant gender bias by referring repeatedly to God as a male. It would help if you could occasionally alternate the use of "Mother" and "Father." A better solution would be to refer to the Supreme Being with a gender-neutral term such as "Parent" or "Large Nurturing Presence." QUALITY: We strongly recommend instituting a Total Quality system. While your organization possesses many of the characteristics of a fine collaborative effort, too many of your policies are handed down in a "top down" management style. Your "Sermon on the Mount," for instance, would benefit from being processed through a shared decision making model, allowing more of your customers a buy-in with the concepts. To demonstrate the benefit of this approach, we have taken the liberty of forming a focus group here to refine some of the elements of that sermon. Our feeling was that, for example, the Beatitudes raised unreasonably high performance expectations and were also too exclusive. For example, "Blessed are the meek, for they shall inherit the earth." Let us suggest instead, "Good news and positive energy are highly probable to those who express a reasonable humility that is still consistent with a high level of self-esteem based on a positive self-image growing out of whatever social, cultural or lifestyle choice backgrounds they may possess, because these individuals and many somewhat like them will eventually receive a just and reasonable portion of success (provided they are not the victims of political injustice from any oppressive government systems which fail to recognize their unique value as individuals)." I think you will agree that this team-generated statement is much more inclusive. It also creates an expectation that we feel is less likely to lead to any legal action by any disappointed customers. INFLEXIBILITY: Certain elements of your movement are simply too strict. Your regrettable tendency to label certain sorts of behavior as "sinful" and suggest that it could result in "eternal damnation" is entirely too harsh. Throwing all those potential sponsors out of the temple was simply bad business. If you have not already heard from the ACLU, I am sure that you will soon (See our attached memo re: "The Ten Guidelines"). At the same time, we are puzzled over your treatment of members of the movement who depart from the accepted guidelines. For these individuals to simply pray for forgiveness seems rather lax and liable to dilute brand identity and the movement's strength. It seems to us that some sort of sensitivity retraining before allowing them to reenter communion with the Large Nurturing Presence would help assure that everyone is on the same page. The notion that their sin and subsequent forgiveness are somehow between them and the Supreme Being simply doesn't allow for enough checks and controls. We would also recommend that the practice of speaking in tongues be phased out. Instead, we recommend that a core committee develop a mission statement that members be encouraged to repeat in moments of extreme motivational enthusiasm. It might begin, "As persons of varied life choices, we are pleased to form consensus with the Large Nurturing Presence--" At this point the scroll breaks off. Scholars will not yet comment on whether the charred edges are indicative of a lightning strike. Tuesday, April 29, 2008
(News-Herald, April 2000) Scholars recently revealed that among the fragments of the Dead Sea Scrolls they have found direct evidence of the first known management consultants:
Posted by Peter Greene at 4/29/2008 09:37:00 PM
Friday, April 25, 2008
(News-Herald, April 24) Amazing sometimes how one family’s story can stretch over so much time and distance. Here’s where a simple thread with just one local name took me.
The First Baptist Church started up in Franklin in 1867 with 23 members. By 1874 they were ready to build a full-sized church to seat 450 members (with Charles Miller footing a good chunk of the bill). That year the church hired the Rev. Frederick Evans, a minister in his early thirties, born in Wales and immigrated to the US (probably New York City) in 1866; it’s likely that this was one of the many times that Miller used his considerable financial resources to recruit and hire top notch people to fill positions in his favorite organizations.
Evans (Ednyfed, to his Welsh family) never lost his connection to Wales; the Baptists of Franklin granted him a leave to return there where he delivered lectures in Salem Chapel, Glamorgan. Afterwards, he returned to Franklin and a newly-built parsonage, where he lived with his family. In print (not local) he was called one of the most moving preachers in all of Wales and America, and under his leadership, the First Baptist Church increased membership from 80 to nearly 300.
His son Frank was born here in 1876. The Reverend retired and returned to Wales, where he passed away in 1897. The next year, Frank served as an infantryman in the Spanish-American War right after graduating from Princeton. Apparently the military life agreed with him because he was commissioned to the marines in 1900.
By 1909 Frank Evans was a retired marine captain serving as secretary to US Senator Briggs of New Jersey. In October of that year he married Esther Caldwell Townsend of New York City, niece of Lawrence Townsend, former US ambassador to Portugal and Belgium. The couple’s wedding announcement ran in the New York Times.
Frank soon returned to military service first in the Philippines, and then in France during World War I, where he won a citation for meritorious conduct and a promotion to Lieutenant Colonel. Other post war service included duty in Haiti as Chief of the Gender merle d’Haiti. He retired to Hawaii, where he died in 1941.
But the Evans name had not yet finished its long travels from home in Venangoland.
In 1944, the Bethlehem Steel Company manufactured an Allen N. Sumner class destroyer. She was launched in October of 1944, sponsored by Frank Evans’s widow, and commissioned in February of 1945 as the USS Frank E. Evans.
After arriving in Pearl Harbor, the Evans performed radar picket and escort duty, until after the war. She was placed on reserve in 1949, but reactivated in less than a year to serve with the Seventh Fleet in the Korean War. She served two tours of duty there, including the siege of Wonsan. After the war the Evans remained on patrol duty in the Far East, but there was one more chapter left.
In 1969 the Evans was near Saigon in company with the Australian aircraft carrier HMAS Melbourne. They were part of SEATO exercise called “Sea Spirit.” A Time magazine report of the event described a dinner with the Melbourne’s captain, John P. Stevenson, reflecting on the horror five years earlier when the Melbourne had collided with a destroyer, sliced it open, and killed 82 hands. Australia could not stand another such disaster.
But four days later, the Melbourne cut the Evans in half. In just five minutes, the bow sank and took 74 men to their deaths (including three brothers from Nebraska).
The Australians made heroic rescue efforts. The Evans’s captain was reported asleep, a less-experienced officer responsible for a wrong turn that put the Evans in harm’s way. It didn’t matter; Stevenson was quickly hung out to dry for the disaster.
Stevenson’s wife Jo flew to be with him at the inquiry and on her own took page upon page of notes, which she later used in writing the book
In the Wake as an attempt to cleanse the record. In 1999 Australia marked the anniversary of the collision, one of the worst maritime disasters ever for their nation, and Jo Stevenson was still trying to clear her husband’s name.
Her desire to clear his name is understandable; a name can travel long and far. The Evans name, even with its small roots in Venangoland, managed to spend a century criss-crossing the entire globe.
Monday, April 21, 2008
(News-Herald, January 2004) Okay, if it seems sometimes that I’m a little cynical about the current wave of education reforms, let me tell you a story.
One of the selling points of “No Child Left Standing” (or “Behind” or “In Public School” or whatever we’re calling it these days) was that it was a national version of highly successful reforms already proven in Texas. In 2000, Bush cheered the “Texas Educational Miracle.”
Since then, word has slowly been emerging that the miracle is slightly less miraculous than when your Uncle Floyd pulled a nickel out of your ear. But it does provide a good view of how this drive for “accountability” plays out in the field.
In Houston in February of this year, an assistant principal in Houston was surprised to discover that his school had a 0% drop-out rate, even though a freshman class of 1000 had become a senior class of 300.
There were a variety of accounting techniques used to achieve this effect (remember, this is Texas, home of Enron, that we’re talking about). Students were reportedly encouraged to take a hike; an independent audit of the school system found that roughly 50% of the students who did not graduate should have been labeled dropouts, but were not (“Um, Johnny just moved out of the district, as far as we know…”). That was about 2,300 students.
The drive behind all this was, of course, the push to make good numbers. The superintendent put the principals back to single-year contracts, and they could be terminated “without cause.” Those principals were given mandates: “The district-wide dropout rate will decrease from 1.5 percent to 1.3 percent.” In other words, their job was not to educate students, but to “make their numbers.”
When that same Houston superintendent took over, the success rate for the state’s tenth grade math test in one school was a measly 26%. The year he left, the rate was 99%.
How do we accomplish such a thing? It’s remarkably simple, actually. Houston’s technique was to keep low ability students in the ninth grade; after two or more years in ninth grade, they were bumped directly to twelfth grade. So the worst students in Houston simply never took the assessment test. In the year of the miraculous 99% success rate, there were 1,160 students in ninth grade and 281 in tenth grade.
Houston schools were also under pressure to keep their safety numbers in line to avoid being labeled “persistently dangerous,” another tag that triggers vouchers and loss of funds under the new rules of the game.
How do you keep those numbers down? Schools stopped reporting rapes, stabbings, and assaults as “school crimes,” because those students were arrested by the police and sentenced by the courts, not suspended by the school.
Over a four year period, the in-house police force recorded 3,091 assaults. In its report to the state capital, the school district reported 761 of those.
The Houston system was supposed to be the flagship school district for the country, and it certainly provides a fine example of how the sort of corporate malfeasance that has shot holes in the private sector can be effectively applied to school systems.
You tell your underlings that you will reward them for the appearance of success and crush them for the appearance of failure. It would probably be a better world if lots of people stood up to that sort of bullying, but when a bully holds a gun to your head and demands that you act like a supporter of Jefferson Davis—well, most of us will start whistling Dixie.
A survey of teachers by (take a deep breath) the National Board of Educational Testing and Public Policy at Boston College (phew) found that in states that use high stakes testing (like, say, the PSSA tests in Pennsylvania) 70% of teachers said that the test leads some teachers in their school to teach in ways that contradict their ideas of good teaching. I imagine that problem, of being pushed to do what you know is wrong in your job, is even worse for principals.
Now, none of what I’ve talked about this week is arcane or secret knowledge—it’s all taken from published reports in reputable papers like The New York Times. But my story is not quite over.
Who was this superintendent who led Houston schools through an exercise in cooking the books in order to give the appearance of compliance with the law, while actually avoiding it? And did anything happen to him when it was discovered that he had been thumbing his nose at the regulations?
He’s doing fine. He’s Rod Paige, George W. Bush’s Secretary of Education. This would be the part where I become cynical about government reform.
Friday, April 18, 2008
(News-Herald, April 18) What could be worse than Going Through the Motions?
Sometimes students want to GTTM. The favorite question to justify GTTM without becoming involved is “When will we ever use this in real life?”
The sarcastic teacher would like to answer, “What? You mean, when will you ever have to use your brain in life?” Unfortunately, the sarcastic teacher knows that there are many opportunities for people to go through life without using their brains or becoming involved.
People who focus on GTTM usually become focused on what minimum motions they need to go through, and hitting that minimum estimate is a skill in itself. A bad under-estimator would be the student who observes other students writing and thinks that the minimum requirement is to wiggle your pen around while making random marks on paper. Even teachers who are themselves going through the motions may require more than that, but not by much. I suspect many students can tell a story about the time they inserted the words to, say, the Pledge of Allegiance in the middle of an essay, and the teacher never noticed.
People in any organization hate bad leadership, but often what we call bad leadership is really no leadership at all, and no leadership at all most commonly takes the form of going through the motions. The non-leader isn’t involved, isn’t engaged, and never has a large goal in mind other than simply Going Through The Motions. The minimum required motions are generally defined as enough “to avoid breaking the law, being sued, or receiving angry phone calls.”
It’s not just a matter of picking a low number of motions. GTTM is easy, but becoming really involved or really trying to get the job done often requires effort. Faced with the actual goals they should achieve, the GTTM person replies with some version of the age-old complaint, “But that would be haaaarrrd!”
If we’re going to do more than go through the motions, if we’re going to say what we mean and then behave as if we really mean it, life will often call our bluff and require us to step up. This is where all those clichés about rubber meeting the road and giving 100% and putting and/or shutting up could mean something (spouting clichés and platitudes is a great way to GTTM).
GTTM is also easy because we don’t have to bring our own compass. We just follow someone else’s directions, do as we’re told, copy and paste from someone else’s text. Because having to think things through yourself is haaarrrrrd. The enemy of the right thing is not the wrong thing—it’s the easy thing.
This issue distinguishes different types of malcontents. I disagree with most everything Ray Beichner has ever said publicly, but I totally respect that he doesn’t simply go through the motions. On the other hand, some of our local Grumpy People appear to fire off letters and lawsuits as a way to demand that others stop thinking and get back to GTTM. Dealing with people who are thinking and doing and actively trying to do what it takes to pursue goals—well, that’s just haaaaarrrrd.
Certainly everyone switches on autopilot now and then and just Goes Through The Motions. Sometimes you just need a break. But overall, I think life is not best served by GTTM.
One of the drawbacks of GTTM is that it eventually becomes hideously boring. If you never invest yourself in something, never awaken your passion and involvement, life can be a grey, dull, featureless expanse of blandness. Therefore, GTTM folks eventually want to skip over motions they find boring or unpleasant. “I wish it were the weekend” becomes “I wish it were next month/next year/ a decade from now.” This is spectacularly self-defeating, since such skipping ahead only brings you closer to the end.
Throwing away days because they are filled with dull GTTM instead of something to excite your passion is like throwing away twenty-dollar bills because they aren’t hundreds. Actually, it’s worse, because unlike money, our days can be invested with as much value as we care to put into them. Earlier this week hundreds and hundreds of people stopped by the funeral home to pay respects to Robert Porter. They didn’t do it to honor a life spent GTTM. At the end, no one ever says, “Well, at least he never tried to do anything haaaarrrd.”
Posted by Peter Greene at 4/18/2008 08:56:00 PM
Friday, April 11, 2008
(News-Herald, April 10) There are lots of reasons to argue against the slow but steady intrusion of government into every nook and cranny of modern American life.
We could talk about the meddling, the separation of those who make decisions from those who must live with the consequences, the tendency of bureaucrats to get things wrong, or the way that government oversight makes endeavors stiff and inflexible, poorly positioned to deal with change.
Each of those is a valid complaint. I’ll probably get around to each of them sooner or later. But that’s not where I’m headed this week.
One problem with ever-spreading government is that it has created a widespread need for professional politicians.
My own profession is as good an example as any. Teaching has always been tied to government and bureaucracy; since we are an arm of government, that seems only natural.
Nowadays, the state and federal government make decisions about what I’ll in my classroom beyond anything we’ve ever seen before. Harrisburg and DC make choices about what I will do in the everyday-to-day practice of my profession.
But when politicians want to talk about education, they don’t want to talk to teachers. They want to talk to other politicians. And so we have the PSEA and the NEA, groups of politicians who are hired to go talk to politicians about education. I’m not a big fan of either group, and I often suspect that they feel a stronger allegiance to their fellow politicians than to the people who hire them.
But the bottom line is that politicians in Harrisburg or DC are not going to talk to me, not even if they have a question about teaching high school English in Venango County. So if I want to have any sort of voice in the decisions made about my profession at all, I need to hire politicians to speak for me.
My profession is by no means unique. Virtually every walk of life in this country has to hire rows of professional politicians. Doctors, lawyers, grocery store clerks, people of retirement age, left-handed basket weavers—if you want to be heard as politicians make decisions that change the shape of your life, you must hire a politician to speak for you. Employers and employees and customers don’t settle matters with each other; they send their hired representatives to battle it out in a capitol somewhere.
We call them lobbyists, but they are simply hired politicians (often retired from elected office), and each one is there because when politicians start deciding things, they want to talk to other politicians.
There was a time when Americans found their solutions locally. Problems were addressed by family solutions or neighborhood solutions or business solutions. Financial missteps and moral misjudgments were viewed as personal human problems. Now we treat them as political problems. If an issue needs to be addressed, we call for the hand of government. But any government solution is a political solution.
There was a time when we trotted out political solutions only for large problems, like the secession of half the country or massive widespread economic collapse or destroying the ugly legacy of segregation. But after discovering how effective that big club can be, we can’t resist picking it up for every little thing, and now we call for political solutions for smoking and bad salesmanship and dry cleaning chemicals and restaurant signage and spelling.
We don’t think we’re clamoring for more politics. We imagine that we are calling on the heroic figure of a good and just elected leadership. But whenever we call on the government, what we get is that guy-- “I’m from the government and I’m here to help you fill out these forms.” I hire my politician to go sic the major politicians on the people I think are the problem, and hire my politician to protect me from the politicians that other people have sicced on me.
The days where one could quietly stay in his corner and do a good job and be respected for that are fast fading. Doing a good job is not enough any more. You have to be able to sell it to a politician. And to have a voice in even the most simple parts of your own daily work and home life, you have to hire a politician to stand up for you, because no one else can.
Wednesday, April 09, 2008
(News-Herald, March 2003) My sister turns forty this Saturday. She is the baby of the family (let’s not reflect on what her crossing the big four-oh checkpoint means to my brother and me).
I distinctly remember wanting a sister. I don’t remember my mother being pregnant, but I do remember staying with friends, waiting for my folks to come back with a new child.
Apparently I found my sister interesting at the time. There are many pictures of the three of us, highlighting her legendary hair. For the first several months of her life, it appeared that my sister’s hair was never actually going to lie down, but simply keep growing straight out, like an overachieving porcupine of a chia pet run amok. Even though she was too young to understand, my brother and I still made fun of her for it. It is never too early to start.
By the time we all moved to Franklin, we had learned how games like the running away game; some of you parents will recognize this as a more active version of “La-la-LAAA-I’m not listening!” It all evened out, because she had learned to get us in trouble for things we may or may not have done.
My sister is six years younger than I am, and six is a big number when you’re young. By the time she was in high school, I was off to college.
There are disadvantages to being a youngest sibling, I hear. Your older siblings may have acquired reputations of one sort or another and you face frequent comparison. As the oldest, you just follow your interests and abilities wherever they may lead; as the youngest, people expect that you’ll be good at this or belong to that. I know my sister wrestled with some of that. But there were compensations.
My parents never threatened to be the kind of permissive overly lax parents that messed up so many baby boomers. But by the time my sister was growing up, somehow all rules had disappeared from the house. My brother and I had a list of approximately six billion rules to follow, while my sister had roughly three. Our curfew was 8:15 pm; hers was mid-June. She and my parents will deny this, but my brother can back me up. The baby of the family always gets away with murder.
As the brother Off At College, I enjoyed a certain halo effect. When I would come home, my sister was delighted to see me and would defend me vigorously from any and all challenge, assault, or inconvenience. Well, for about the first forty-eight hours, anyway.
I was back at Franklin High School as a substitute during her senior year. It’s excellent training for a substitute teacher to try to get cooperation from someone who still remembers when you hid her toys and called her “pickle puss.”
She went to college at Mount Union and became a Marching Purple Grape (I’m pretty sure that wasn’t the official name, but it’s all we ever called them). She fell in love with a man who played lacrosse, a game, as near as I can tell, in which players beat the daylights out of each other with webbed sticks while referees occasionally stop the action to administer first aid and announce random scores (I may have missed some of the nuances). She went to graduate school at Rutgers to become a librarian.
She got married, and they had a couple of sons; this was no small achievement, as she is one of those women for whom childbearing didn’t come easily. They lived in a variety of places, including a rather grubby corner of New Jersey. My sister is tougher than she looks.
Now they live in State College. My brother-in-law has one of those University computer sub-contract for the Defense Department “I can’t tell you what I did at work today” jobs. My sister spent years as an at-home mom; now she runs the Christian Education program at a church.
It is true that my sister can be a bit of a den mother. She once scolded me for walking outside in the rain in my bare feet. I was forty-three at the time.
But my sister is one of the handful of people on the planet that I actually admire. It’s not just that she’s family, though I think it’s true that no one ever knows you quite like a brother or sister. I feel bad for those who have lost that connection; I know that there are toxic siblings, just as there are toxic spouses and parents, but I don’t think you can’t lose the connection to a sibling without losing a piece of your own past.
Somewhere along the way my sister became the responsible adult dependable rock solid nurturing member of the family, and I want to be like her when I grow up.
Posted by Peter Greene at 4/09/2008 07:00:00 AM
Thursday, April 03, 2008
(News-Herald, April 3) Everywhere you look, you can find people who are surprised.
I notice it, for instance, in the grocery store. Frequently, while moving through an aisle, I find myself behind someone who parks in the middle of the aisle and slows to a speed that I would describe as glacial, except that these days we are told that glaciers are melting a few feet per year, which makes them much faster than my shopping roadblock.
Eventually the puzzled shopper registers the collective death stare of the half-dozen shoppers he has trapped, looks up, and is surprised to discover that other people are shopping in the store! Imagine. And many of them
want to use the very same aisle!!
I can actually sympathize a bit. Many’s the time I have found myself transfixed by a particularly lovely piece of packaging (fruit and pasta are both delightfully arty). Since my son began his side-career in late-night grocery stocking, I have learned a certain professional appreciation for a good facing job (Facers are like little grocery store elves who toddle into the store in the dead of night to make sure that each shelf presents a full and lined-up front that hides gappage behind it; facing is a sort of consumer-based sculpture that captures the battle between chaos and order, human accomplishment and existential angst, oreos and fig newtons. When you decide you won’t buy the cheesy puffs after all, and stick them in between packages of soap, you’re making work for some facer).
At any rate, I can see how grocery displays might lead one to absently forget about the traffic around. But then I meet the surprised people in the check-out line. These are the folks who are, apparently, surprised that
food costs money! They unload their food, watch the checker ring it up, and then, only after the checker has announced that the customer will, in fact, be asked to pay for the food, does the customer begin to consider how the transaction might be completed. Does she have money in her purse? Might she write a check, or could this be a plastic kind of evening?
It’s a suspenseful moment, best appreciated by people in line who had no hopes of going anywhere soon. I pass it by imagining the conversation later at home. “Yes, dear, I got groceries. I thought I might not have to get out money this time, but it turned out they charged me for the food again!”
Probably the biggest class of surprised people are the folks who are constantly surprised to discover that they are not the only human beings in the world.
Grocery stores, the mall, the highway—you can find them everywhere, acting as if it had never occurred to them that they might be sharing space with other slices of humanity.
You can find a full herd of them in just about any school parking lot at the end of a sports event or other post-scholastic activities, bobbing and weaving and honking and being rather surprised that they are not the only person there to pick up Junior. Other people want to drive past the school entrance? I should park my limited edition custom land cruiser athwart the traffic lane? That’s just
crazy!
Some people manage to be surprised by the events that unfold in front of them. The best way to experience this sort of surprise is to simply ignore history. It took a real willful ignorance of history (both Iraq’s and our own) to be surprised by the hash of events in the Persian Gulf and the failure of USA style democracy to quickly take root and bloom.
Likewise, one would think that local leaders, trying to accomplish anything quickly and quietly, could hardly be surprised that people A) catch on, B) jump to conclusions and C) become cranky. Nor could any of us be surprised any more than the result of some local crankiness is that some folks will hit the speed-dial code for their lawyer faster than a junk yard owner can yank his bad-mannered attack dog out of its shed.
I think we’ve all caught on to most of that. And yet, I can already smell the preamble to that inevitable moment when folks are shocked and surprised that Two Mile Run County Park & Cage Match ends up costing county taxpayers money.
Surprise!
Posted by Peter Greene at 4/03/2008 05:58:00 PM
Tuesday, April 01, 2008
(News-Herald, February 2004) There’s nothing like reading newspapers to give you a sense of historical perspective. For example, I recently read a series of articles about middle-eastern troubles. Seems the Kuwaitis deployed soldiers because Iraq claimed that Kuwait belonged to them.
I read that in newspapers published in June of 1961.
In my continuing efforts to reconstruct the history of the Franklin Silver Cornet Band, I’ve read through miles of newspapers on microfilm. I’ve recently been working through the early 1960’s. There are plenty of other interesting non-band items that turn up.
For instance, I never really appreciated just how controversial the moving of Franklin High School was at the time.
The early sixties were a big time for building in the area. Venango Campus of Clarion, Venango Christian High School, the airport expansion, and numerous elementary schools were built in that time, all with great fanfare about moving Venango County forward.
There was even a major push to raise money for a Fort Franklin reconstruction. An editorial in the
News-Herald said of that project “This project will succeed or fail in 1961. It may well mark the turning point in the future of this city and this area.”
But when the joint board for the area school districts proposed that a new Franklin High School be built out on Pone Lane, there was massive squawking.
A Citizens’ Committee was formed to oppose the move. It addressed the Chamber of Commerce, and even took out a full page ad in the paper, listing all the school directors by name. Oddly enough, none of the coverage that I read of this group’s activities lists names associated with this opposition group.
Letters to the editor were frequent and spirited. Writers insisted that the move would be bad for the city, that having the school in the middle of town was an essential part of life in Franklin. One writer claimed that the children would be at risk going up “that treacherous hill.” Another pointed out the school’s proximity to the newly expanded airport “poses a real threat.”
Other writers replied that the school was a joint project, and that many of the rural students already had to ride buses and that the wimpy city folk should stop whining (I’m paraphrasing a little here).
This was all accomplished before the various school districts were merged. That merger vote came in the spring of 1963. Those figures were fun to stumble across as well. Canal and Mineral township actually rejected the merger (Canal voted 109-39 against, Mineral 39-37), while in downtown Utica, they went for it by 74-16. Polk joined up with a 106-16 vote while Sandycreek hopped on board 213-49. The City of Franklin itself was less enthusiastic—merger passed in town by 1179-817.
But nothing I stumbled across regarding the school system could top the fun of finding a full-sized feature story about the Warren Light Center. Out on Creek Road (aka the back way to Utica), the WLC has long been a source of myth and mystery.
According to the article, the Warren Light Center, headquartered in Newton Falls, Ohio, bought the 130 acres in 1954. In covering their seventh annual solstice, the paper noted that it was a “new thought religious group” that based its studies “on astrophysics and cosmic science.” Members studied “archaeology, religious philosophy, magnetic currents, and a variety of other fields.”
Writing about the 1962 solstice observance, the paper continued: “ Last Saturday night a campfire meeting was highlighted along with the sky watch. Several groups scattered to different parts of the property to watch for spacecraft. They reported seeing several such craft, describing them as ‘friendly forces.’” Inspired, I checked the internet for WLC references to spacecraft, but found only someone’s childhood memories of watching fairies dance near French Creek.
People had come from Ohio, Sharon, Miami, and Los Angeles for the celebration. 170 were present for a dinner at the Elks Club to hear an Egyptian Coptic Master speak.
Said one of the local leaders, “There is nothing prescribed—we take truth wherever it’s found.” Asked how he determines what is truth, he stated that it can be sought out by going directly “to the root of the matter.” Oh. Well, that explains it. The group anticipated a golden age on Earth in about the year 2000. Allowing a fair margin for error, it might be too early to declare them wrong.
Posted by Peter Greene at 4/01/2008 09:01:00 PM
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Whether you have recently purchased, or are a long time resident of North East Ohio, it is important to stay up-to-date with the most recent property tax information for our area. Every county will re-evaluate property values using a three year cycle, and your newly assigned property value effects the taxes we as homeowners are responsible for. Many of us are ready for the 2013 tax filing season, but do you actually know where the property taxes are allocated?
Based on a $100,000 home value, the average tax rate equates roughly to $2,213 in taxes (Depending on actual rates for the seven counties surrounding the Cleveland-Akron area) and that amount is then dispersed accordingly. The chart below created with data from Cleveland.com shows us where our money is headed.
When considering purchasing home, a great REALTOR will be able to let you know tax information for an area that you are looking at homes for sale, and also pertinent information for the related areas that your taxes are designated to. Often times taxes can be lower in townships and villages, but research and education play crucial roles for the long-term satisfaction resulting from choosing a particular area in which to live.
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Gas Traction Engines
The term "gas traction engine" is applied to such as are propelled by an internal-combustion engine. The fuels most commonly used are gasoline, kerosene and the heavier oils.
The use of gas traction engines has been increasing much more rapidly than that of steam traction engines.
The reasons for this are as follows:
1. The gas traction engine is made in many special designs suitable for various uses.
2. The steam traction engine is practical only in large powers, while gas traction engines are built in sizes capable of pulling as few as two plows and as many as fourteen plows. This also means that gas traction engines sell at sufficiently low cost to enable the fairly small farmer to use this form of mechanical power. The prices of gas traction engines vary from $500 to $4,500.
3. The operator of the steam traction engine must carry a tank wagon with water and a bulky fuel supply. This necessarily limits the amount of plowing by this form of engine. With the gas traction engine the fuel and water supply occupy little space.
4. Considerable time must be consumed in getting up steam for operating a steam traction engine.
The Gas Traction-engine Motor
The majority of gas traction engines employ internal-combustion motors which operate on the four-stroke Otto gas-engine cycle. The motors are either vertical or horizontal and of the long-stroke type and operate at moderate speeds as compared with automobiles.
Automobile Motor-Cylinders Cast Singly
The vertical motor resembles the automobile motor, but is usually heavier. The cylinders of the vertical motor are cast singly (Fig. 122); some makers cast cylinders in pairs. The four cylinder en-bloc type, common in automobile practice, is used to a limited extent for traction engines.
The horizontal motor is more difficult to lubricate and is bound to wear more rapidly than the vertical types.
Single & Twin Cylinder Motors
Two Cylinder Opposed Motor
Four Cylinder Traction Engine Motor
The types of motors used are single-cylinder (Fig. 176), twin cylinder (Fig. 177), two-cylinder opposed (Fig. 178), and four cylinder (Fig. 179).
The single-cylinder motor (Fig. 176) is usually of the long stroke heavy-duty horizontal type and has a heavy flywheel.
The two-cylinder traction engine is built as a twin-cylinder motor with cylinders mounted side by side, at one side of the crankshaft (Fig. 177), or as a two-cylinder opposed motor (Fig. 178) with two cylinders set horizontally on the opposite sides of the crankshaft. The two-cylinder opposed motor is better balanced and can be operated with lighter flywheels. The twin cylinder type of motor (Fig. 177) occupies less space and has better carburetion.
Multiple-cylinder motors are more commonly used, as they are lighter than the single-cylinder motor for the same power developed. Increasing the number of cylinders produces also a motor which has a more uniform turning effort at the crankshaft, the power impulses taking place more frequently.
The four-cylinder vertical motor (Fig. 179) is the most common type for large traction engines. The cylinders of the four-cylinder motor are usually placed so that the crankshaft is parallel to the tractor frame. In some designs the motor is set crosswise of the frame. In the crosswise arrangement the motor drive is direct, in the other method, the drive to the transmission is through bevel gears. While the direct drive eliminates the use of a bevel gear, the other design can be built with longer bearings without widening the frame. The length of the bearing is an important consideration in large traction engines.
The motor crankshaft has two, three, or five main bearings and one camshaft usually operates all the valves. The valve camshaft is driven from the motor crankshaft by a two-to-one gear, as is the case in stationary and automobile engines.
Traction-engine cylinders are made of cast iron and are provided with jackets for liquid-cooling. Air-cooled motors are not practical for traction engines.
Water is usually used as the cooling medium. Heavy oils and the various anti-freezing compounds, such as glycerine, alcohol and water, or alcohol and water, are also used to some extent.
Thermo-Syphon Water-Circulation System
A forced system of water circulation is usually employed with a rotary, a centrifugal, or a plunger pump. In the rotary pump the water is circulated by revolving gears and in the centrifugal pump by an impeller or paddle wheel. The rotary or centrifugal pumps are more generally used, as they are more simple. The thermo-syphon system of water circulation (Fig. 125) is used in some makes of traction engines.
Traction Engine Cooling System
Small Gas Traction Engine
Some form of radiator (Figs. 180, 181) is employed which acts as a water tank and cooler. In most traction engines the radiators are similar to those of automobiles but heavier; a cooling fan is used to circulate the air through the radiator. The exhaust gases are also utilized in some designs to aid in the circulation of the air.
Motor with Poppet Valves
The poppet type of valve (Fig. 127) is always employed. Valves are constructed of a nickel-steel or cast-iron head, and a carbon-steel stem, stem and head being welded together.
Automobile Type Valves
The valves are arranged, as in automobiles (Figs. 130, 131, 132), in three distinct ways: namely, the tee-head, the ell-head and the valve-in-the-head construction. With the tee-head or the ell-head construction the valve seats are in a pocket cast on the side of the cylinder proper, which forms a very inefficient combustion space. The valve-in-the-head motor has a very compact combustion chamber.
Traction Engine Cylinders with Removable Heads
Valves in Cages
In the valve-in-the-head type of motor, the cylinder head carrying the valves is a separate casting (Fig. 182) or has the valves mounted in removable cages (Fig. 183).
Many makes of traction-engine cylinders are built with removable heads (Fig. 182). When the cylinder head is a separate casting, it can be removed easily for the purpose of cleaning, and the valves, with this form of construction, can be more thoroughly water-jacketed than when mounted in cages.
When the valves are placed in cages (Fig. 183), the cage contains a seat for the valve and a guide for the valve stem.
The exhaust valve seat is usually water-jacketed and in some designs the inlet valve seat is also water-jacketed in order to keep down the temperature of the incoming mixture.
Traction engines are generally constructed with mechanically operated inlet and exhaust valves.
Some gas traction engines are provided with an auxiliary exhaust port. With this construction the exhaust gases pass directly into the exhaust pipe, removing the hottest gases from the exhaust valve and decreasing the pressure at the time the exhaust valve opens. This feature is particularly advantageous when the engine is operated continuously at heavy loads.
Throttling Governor
Traction engines are governed by the hit-and-miss or by the throttling type of governor. The hit-and-miss governor is not adapted for work where close regulation is essential. The majority of modern gas traction engines are equipped with throttling governors. The throttling governor is of the centrifugal type and controls the carburetor throttle (Fig. 184). In some cases the controlling mechanism is arranged so that the governor may be cut out, and the carburetor throttle is controlled by a hand lever.
The speed of various makes of traction-engine motors varies from 365 to 1,500 r.p.m. The majority of motors operate at speeds of 500 to 750 r.p.m.
The belt horsepower of various makes of motors varies from 10 to 120 h.p.
Carburetors for Traction Engines
Kingston Carburetor
Float-feed carburetors of the single-jet automobile type are used. The simpler designs, such as the Kingston (Fig. 78), are generally employed.
Traction Engine Carburetor & Governor
The arrangement of carburetor and throttling governor for one form of traction engine is illustrated in Fig. 185. The carburetor is of the concentric-float type. The gasoline passes through a strainer before entering the float chamber. The fuel mixture on the way to the engine cylinder must pass through a balanced throttle valve, which is under the control of the governor.
Kerosene Carburetor
To burn kerosene, some makes employ the ordinary float-feed carburetor, which has a jacketed float chamber through which hot water passes. The kerosene carburetor illustrated in Fig. 82 is used by some manufacturers.
Kerosene Carburetor
Another form of kerosene carburetor, called the Secor-Higgins, is illustrated in Fig. 186. The three compartments from right to left are for gasoline, water and kerosene. The lower section is the mixing chamber. Gasoline is forced into the mixing chamber by means of a hand pump. Plunger pumps force water and kerosene into the compartments. The air enters through air intake ports. The amount of air entering the mixing chamber is controlled by the governor. The throttle opening which admits the mixture to the cylinder is also under the control of the governor.
With kerosene fuel, water is generally mixed with the air and fuel to prevent preignition. Very little water should be used at light loads, and the quantity of water injected at higher loads should be sufficient only to produce proper operating conditions. With heavier liquid fuels, the capacity of an engine of the same bore, stroke and speed is increased by water injection. Water injection also reduces the amount of carbon deposit, but produces a slower burning mixture with the consequent poorer fuel economy.
The majority of traction engines are equipped to burn kerosene as well as gasoline.
Ignition for Gas Traction Engines
Nearly all traction engines operate with the jump-spark system of ignition. The jump-spark system is simpler mechanically, having fewer parts than the make-and-break system. The ignition system differs from that used in automobiles in that magnetos are commonly employed. In some cases the dual system is employed, in which the motors are started with current supplied from a dry or storage battery, but operate with magnetos. In other makes, the motor is started on the magneto. The present tendency seems to be to eliminate the battery and to use the magneto for starting.
Wiring Diagram for Four Cylinder Motor
A wiring diagram for a four-cylinder traction engine is illustrated in Fig. 187.
Oscillating Magneto
The make-and-break system of ignition is used to a limited extent for small traction engines in connection with a slow-speed single-cylinder motor. With the make-and-break system an oscillating magneto (Fig. 100) is often employed.
Transmission Systems and Differentials
Cone Clutch
Multiple Disk Clutch
Traction Engine Clutch
Traction Engine Clutch
The clutch of the gas traction engine has the same function as that of the automobile and connects or disconnects the motor from the propelling gear. The types of clutches used for gas traction engines are similar in principle to those illustrated in Figs. 133, 134 and 171. The expanding-cone, expanding-shoe, multiple-disc, floating-plate and clamp-plate types are employed. Usually one part of the clutch is part of the flywheel. A traction-engine clutch is illustrated in Fig. 188.
Some traction engines are constructed with a single reversing mechanism and without speed-change gears, while other traction engines have the reversing mechanism incorporated with the speed-change gears; some manufacturers employ a reversing mechanism which is separate from the speed-changing mechanism. The highest speed in the case of traction engines is usually obtained through gearing instead of by the direct motor drive. The reason for this is that the traction engine is used most of the time for plowing or for other heavy work, which requires a slow speed; by operating the direct drive at the slower speeds the heavy work can be accomplished with few gears, thus increasing the efficiency of the drive.
Traction Engine Transmission System
Spur-Gear Differential
One simple form of gas traction-engine gearing is illustrated in Fig. 189. The differential gear used in connection with the engine of Fig. 189 is of the spur-gear type similar in principle to that illustrated in Fig. 142.
Traction Engine Transmission
Another simple traction-engine transmission system is illustrated in Fig. 190.
Two Speed Transmission System
A two-speed transmission system is shown in Fig. 191. The reversing mechanism consists of two bevel pinions (
A, B
) which are driven from the motor shaft. The bevel gears
A
and
B
drive the differential driving gear
D
through the large bevel gear
M
. In the neutral position these bevel gears A and B revolve freely. The lever R is used for connecting either bevel gear
A
or
B
with the driving shaft. The lever
S
controls the speed freely. The lever
R
is used for connecting either bevel gear
A
or
B
with the driving shaft. The lever
S
controls the speed changing gears and the lever
C
is for the clutch. The shaft
P
is for the belt pulley.
Selective Transmission System
In some traction engines the speed-changing mechanism is similar to that used in automobiles. The type generally used is the selective transmission system (Fig. 192).
Traction Engine with Friction Drive
A friction drive (Fig. 193) is employed in some makes, this drive differing from automobile friction drive in that the fibrous-covered fiction wheel is mounted on the engine crank-shaft; in automobiles the disc is the driving member.
In some designs, clutches are used for reversing. A single lever operates two clutches, one of which is used for reversing.
Differential
Differential
Gas Traction Engine Differential
Spur-Gear Differential
Differentials for gas traction engines were illustrated and described in connection with Figs. 173, 174, and 175. Spur-gear differentials similar to that of 142 are also employed in some gas traction engines. Some of the light traction engines dispense entirely with the differential and use only one traction wheel.
Type of Traction
The majority of traction engines use the two rear wheels as the traction wheels or drive wheels, while the two front wheels are for steering. Some makes use a traction drum, several are constructed so that the front wheels are the driving wheels, and in other makes, all four wheels drive. In the case of three-wheeled traction engines, one large drum, two front wheels, or two rear wheels are used for driving.
Creeping-Grip & Caterpillar Tractors
Track of Crawler Type Tractor
Traction engines are also built on the "creeping-grip" or "caterpillar" principle (Figs. 194, 195, 196), which employ a crawler instead of a wheel or drum. The object of this construction is to have the traction wheels travel over a continuous, metallic track approximating as nearly as possible that over which the locomotive travels. The creepers or tractor shoes run inside a continuous belt. Power from the motor is transmitted from a jack-shaft to the creeper drive wheels by a chain and sprocket drive on either side. The advantages of this construction are greater gripping surface for the same weight and better distribution of weight.
Uses of Traction Engines
Desire on the part of farmers to raise large crops and to put under cultivation great areas of land created a demand for mechanical power. With mechanical power the number of horsepower under the control of one man becomes unlimited, if the man controlling the mechanical power is willing to learn the simple fundamental processes which govern the conversion of fuel into mechanical energy as well as the simple laws of mechanics which enable one to keep machines and mechanisms in adjustment and in perfect working order. A traction engine is capable of doing the following field work: Clearing the land: tearing out hedges, pulling up trees, stumps and stones.
Preparing the seed bed and seeding with the operation of plowing, listing, disking, harrowing, drilling, seeding. Harvesting operations such as mowing, hay loading, hay hoisting, and drawing binders and diggers.
Plowing, Seeding & Harrowing
Deep Plowing
With a traction engine the processes of plowing, seeding, and harrowing can be carried on in one operation (Fig. 197). Deeper and more uniform plowing (Fig. 198) can be carried on.
Harvesting with Steam Traction Engine
Harvesting with Gas Traction Engine
Harvesting operations with steam and gas traction engines are illustrated in Figs. 199 and 200.
Some designs of traction engines are built low and are suitable for orchard cultivation.
Tractor Cultivator
Power cultivators are being placed on the market which are suitable for cultivating corn and other rowed crops. One form of tractor cultivator is illustrated in Fig. 201. The motor of this machine is placed on the frame near the front and is a four cylinder vertical internal-combustion motor with the cylinders cast en-bloc similar to automobiles. One of the special features of this traction engine is that the two drive wheels are operated separately by means of friction-drive transmission. The mechanism is so arranged that one wheel can be held stationary while the other travels forward or backward. To facilitate turning around at the end of a row of corn, in order to go up in the next row, the operator throws out the gear connection in the steering apparatus and the front wheel acts as a caster. Then, by operating the rear wheels, the machine can be made to turn completely around. The cultivator gangs are operated by the driver's feet.
Hay Bailing Machine Driven by Traction Engine
The traction engine is suitable for heavy-belt work, such as hay baling (Fig. 202), corn shelling, pumping water for irrigation and for other purposes, grinding feed, ensilage cutting, sawing wood, threshing, husking, hulling, shredding, filling silos, crushing rock, and elevating corn and grain.Traction engines can be used for hauling grain and other farm products to the shipping point or to the market; for hauling fertilizer and other material to the farm; also for moving houses, barns and other structures.
Tractor Used for Pulling Graders
In connection with road work, traction engines are used for pulling graders (Fig. 203), scrapers, road plows, drags, and other road implements, as well as road materials.
Traction engines can be used for digging irrigation ditches and for filling drainage ditches.
Development of the Gas Traction Engine
The development of the gas traction engine has been exactly the reverse of the automobile. The earlier automobiles were small and light in weight; the early gas traction engines were very heavy, developing 60 to 100 hp. on the belt. At the present time traction engines developing 5 to 15 hp. on the draw-bar (10 to 30 b. hp.), and capable of pulling three or four 14-in. plows, are used in great numbers in the corn belt. Large steam or gas traction engines developing 40 to 60 draw-bar horsepower and capable of handling 10 to 14 plows, are used in the Northwest and in other parts where large areas must be cultivated and farm labor is scarce. The tendency seems to be for the large farmers to invest in several machines, each designed for a special purpose, than to buy one all-purpose machine capable of performing all the work of the farm.
Attachments are available for converting an automobile into a light traction engine, capable of pulling one or two plows. The rear wheels of the automobile are replaced with pinions, which mesh with gears on the traction wheels. The traction wheels revolve on a special axle at a speed, which is one-eighth to one tenth, that of the automobile rear axle.
The traction engine probably will not replace the horse for all purposes very soon, but will replace many horses, on large farms, and especially in connection with the heavy farm work. The traction engine is a concentrated form of power plant, which can work day and night, is not affected by heat, and can be used to advantage a large portion of the year.
Economy of Gas Traction Engines
The cost of operating a gas tractor depends upon many varying factors, such as the kind of fuel used, the cost of fuel, the cost of attendance, the character of the soil, and the type of machine.
Experiments carried on during 1915-1916 in the engineering laboratories of the Kansas State Agricultural College indicate that the fuel consumption in pounds per brake horsepower per hour is very nearly the same for gasoline and for kerosene. The fuel consumption per brake horsepower per hour (average of tests on 12 different traction engines) was found as follows:
Gas Fuel Consumption
With kerosene at 10¢ per gallon and gasoline at 20¢ per gallon, the cost of gasoline fuel will be about twice that of kerosene for the same power developed. The advantages of kerosene fuel, due to the lower cost, are offset to a greater or less degree, depending upon the operator, by the added trouble in handling the traction engine. The life of the motor probably will be less with kerosene fuel. To this should be added the lower reliability insurance with the heavier fuels. In some work done by traction engines reliability is the most important factor.
Rating of Traction Engines
Two ratings are usually given to traction engines. One is in brake or belt horsepower. This means the actual power developed at the shaft of the engine, which can be utilized for driving various machines by means of a belt drive.
The other rating is in tractive or draw-bar horsepower. To obtain the tractive horsepower the amount of power lost in transmission to the drive wheels and that required to propel the traction engine must be subtracted from the brake horsepower developed at the shaft of the engine.
The tractive horsepower depends on the kind of transmission gearing and on the character of the roads over which the traction engine must be propelled. It is equal to from one-half to two thirds of the brake horsepower. As an illustration, a traction engine equipped with a 40-hp. engine will be able to produce only 20 to 27 hp. at the draw-bar under ordinary conditions.
The belt horsepower of various makes varies from 10 to 120 hp. and the draw-bar horsepower from 5 to 60 hp.
The ratings are usually expressed as 8-16, 5-10, or 40-80. These ratings mean 8 draw-bar horsepower and 16 belt horsepower, 5 draw-bar horsepower and 10 belt horsepower, etc.
The relation between the rating and number of 14-in. plows a gas traction engine will pull is approximately as follows:
Rating Number of plows 5-10 1 or 2 8-16 2 or 3 10-20 3 12-25 3 or 4 20-40 5 or 6 30-60 8 or 10
Gas traction engines range in road speed from 1½ to 10 miles per hour. The average road speeds are 2 to 3 miles per hour. The furrow speeds in miles per hour vary from 1 to 3½. The average furrow speed is not greater than 2 miles per hour.
The drawbar pull in pounds, of a traction engine, traveling at a rate of about 2 miles per hour, is approximately 180 times the draw-bar horsepower.
Operation and Care of Traction Engines
The general directions given regarding the care of stationary steam and oil engines apply also to the motors of steam and gas traction engines.
The wearing surfaces must be well-lubricated or they will wear out, and lost motion in bearings must be avoided to prevent pounding and broken crankshafts. Many of the traction-engine troubles can be traced to inefficient lubrication or to the use of poor lubricating oil.
Grease Cups
Sight Feed Lubricators
Bearings may be oiled by means of grease cups (Figs. 53, 54), or by sight-feed lubricators (Fig. 56). Gears are lubricated with grease or with some other heavy lubricant. Transmission grease is generally used for the transmission. In some cases heavy steam-cylinder oil is employed for the same purpose. Cylinders for steam traction engines are lubricated with heavy steam cylinder oil by a mechanically driven oil pump or by an automatic sight-feed steam lubricator (Fig. 57). A medium gas-engine cylinder oil should be used for lubricating gas traction-engine. A combination of splash and forced-feed oiling system is often used for traction-engine lubrication.
Traction Engine Lubrication Chart
The instructions furnished by the manufacturer regarding the kind of oil to be used and the lubrication of the various parts should be carefully followed. A lubrication chart for one make of traction engine is illustrated in Fig. 204. The bearings of magnetos require frequent attention. A high-grade sewing machine oil should be used for this purpose.
All reputable manufacturers test their traction engines before shipment from the factory. The purchaser, upon receiving a traction engine, should carefully examine all parts. The railroad company and the manufacturers should be notified at once if any parts are damaged or missing.
Before attempting to start the engine, it should be gone over carefully, all nuts tightened, bearings properly set, lubricators filled, and clutch adjusted so that all shoes come into contact with the inside of the wheel at the same time. The operator should make certain that the engine has a sufficient supply of fuel and water and that the lubrication system is in good working order. The fuel for a gas traction engine should be strained. A chamois skin strainer is best for gasoline while a funnel with a fine screen will be satisfactory for kerosene fuel. A strainer will prevent dirt from getting into the carburetor and the supply pipes from clogging.
In the case of steam traction engines the boiler is filled about two-thirds full of water and the fires are started. Upon first using a boiler it is liable to foam, especially if the water is bad, but after washing the boiler, or changing the water several times, the oil and grease on the boiler plates are removed. Clear, soft water should be used. Care should be taken not to use water, which contains lime. The water gage cocks should be tried often and the water level should not be allowed to be below the second gage. Before the feed-water pump is started the operator should make certain that the feed line to the boiler is not closed. It is desirable to use the pump and to keep the injector as a reserve for emergencies. In simple single-cylinder traction engines the safety valve is set at about 130 lb., in compound engines at 160 lb. The fire should be kept thin. The operator should fire frequently and lightly. In operating a steam traction engine on the road care must be taken not to allow the engine to remain with its rear end elevated for any great length of time, as this may result in the overheating of the crown sheet. The water glass must be blown out two or three times each day and the safety valve should be kept in good working order. The reverse lever should be kept as close to the center notch of the quadrant as possible in order that the engine may operate at its best economy. When running, the throttle should be wide open and the steam supply to the engine should be varied entirely by the reverse lever. The fire flues of the boiler should be cleaned frequently, as the cleaner the flues the less fuel will be required to keep up steam.
In starting a gas traction engine, the operator should be certain that the change gears are in the neutral position and that the clutch is disengaged. In the case of a dual-ignition system the switch should be closed on the battery side. The spark lever is then retarded and the carburetor throttle is opened so as to admit a small supply of fuel. The shutoff valve at the gasoline tank is opened, the cylinders are primed through the priming cocks, and the motor is cranked. The quicker the crank is turned the easier the engine will start. After the motor starts, the spark lever is advanced. Some traction engines are started by means of small auxiliary gasoline engines.
To put the traction engine in motion the clutch is thrown in gradually after the lever controlling the change gears has been shifted to the position required. In stopping a traction engine, the carburetor throttle is closed, the switch is opened, the clutch is disengaged and the change-speed lever is placed in neutral. Failure to place the lever controlling the change gears in the neutral position will start the tractor if the clutch is disengaged. The operator never should try to reverse a traction engine without first bringing the machine to a stop. The operation of the traction engine is controlled by the carburetor throttle lever.
One accustomed to driving an automobile will find the traction-engine steering mechanism less sensitive. More turns of the steering wheel will be necessary on account of the slower speed of the traction-engine motor and the lower gear ratio of the steering gear.
In running a traction engine on the road, the operator should keep his eyes on the front wheels to prevent accidents. In case a traction engine is landed in a hole, it can be pulled out by placing chains, boards, or straw under the drive wheels. The same advice applies when the engine slips. Before crossing a bridge the operator should ascertain that it is safe. In case of doubt, planks should be placed to distribute the load.
A competent operator handles a traction engine slowly and deliberately, and never hesitates to stop, if something goes wrong with any part of the engine.
Overloading a traction engine is a serious mistake.
A traction engine should be kept at all times in adjustment and in perfect working condition. This cannot be accomplished unless the engine is housed properly. A traction engine represents a large investment, the depreciation of which can be greatly reduced if the housing question is carefully considered. A frame or a concrete structure should be provided which not only will house the traction engine but will leave sufficient space for a farm workshop where ordinary repairs can be made.
The tractor operator should do his repairing systematically. At the completion of a hard season's work the machine should be thoroughly overhauled. All old grease and oil should be removed from cylinders, bearings and transmission case. All parts should be cleaned with kerosene. Bearings should be examined, and adjusted by means of liners. In ordering repairs for engines, give description or sketch of the part as well as the number and letters found on the parts wanted. The number and size of the engine also should be stated.
The clutch should be examined frequently for worn parts.
It is well to have on hand an extra clutch lining, a set of piston rings, an extra connecting rod, several new spark plugs, cotter pins, belts, and nuts of various sizes and such other small repair parts as may be worn out or lost in the operation of the engine.
Valves for gas traction engines should seat properly and should be reground if indications show wear. To grind the valve into its seat the valve spring is removed and the valve is taken out. Flour emery dust and oil, or fine Carborundum valve-grinding paste and oil is placed on the valve seat. By using a brace holding a screw-driver bit in the slot on the top of the valve, the valve may be revolved back and forth on the seat with very little effort. It is best to place a light spring on the valve stem so that the valve is held up and off from its seat.
The time of opening and of closing of the valves of gas traction engines depends upon the speed of the engine. The valves of a high-speed engine should open sooner and remain open longer than those of a slow-speed motor. Ordinarily, the exhaust valve should open 30° to 50° before the beginning of the exhaust stroke and should remain open 4° to 10° after the completion of that stroke. The inlet valve should open 5° to 12° after the beginning of the suction stroke and should close 18° to 25° after the completion of the suction stroke.
The common sources of trouble with a traction engine are due to the incompetency of operators, who are responsible for poor or insufficient lubrication, dirty fuel, carbon deposits, poor fuel economy and high depreciation.
Hitch for Three-Disk Harrows
When it is desired to draw a number of machines at the same time by means of a traction engine, care must be taken that the machines are properly hitched to the engine. The hitch required for plowing is very simple. A hitch for three-disc harrows is illustrated in Fig. 205. This consists essentially of a supplementary draw-bar
B
which is connected to the main draw-bar by the chain
A
.
In laying by the engine for the winter, it should be placed under cover and be protected from rain and snow. It is well to remove pistons from the cylinders of gas traction engines, clean all deposits and then oil pistons, cylinders and valves with a heavy oil. Magnetos and batteries should always be removed to a dry place. All parts should be carefully drained. In fact, it is well to remove all drain cocks so as to prevent any water from remaining in cylinders and tanks.
The success of a traction engine depends not only on the operator but also on the business ability of the owner. The farmer should so plan his work that the traction engine is used not only for plowing, but also for many other kinds of work. To secure the best results the traction engine should be kept busy most of the year.
Information Sources
Farm Motors by Andrey A. Potter 1917 pages 180-208
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For years we've had books about French wines, but never a book like this before. Rod Phillips' comprehensive book, French Wine: A History, is an absolute tour de force, sure to be an instant classic. I read an advance review copy, but the book just went on sale today.
(For those of us who follow organically grown wines, this book could, loosely, be said to be a history of organic wine, since all wine was "organic" until the last 100-150 years.)
To hear many modern French wine books talk about it, French wines consist of wines from Bordeaux, Champagne, and Burgundy, along with the Rhone. These first three - historically the biggest producers of fine wines - account, as Phillips writes - for just one sixth of French vineyards and a small percentage of France's output. Instead, Phillips writes, we should pay broader attention to the rest of France:
"...most French wine produced today comes from Mediterranean France, especially from the broad Languedoc region that is the cradle of French viticulture."Sound familiar? Just as Napa and Sonoma get so much press, it's places like California's Central Valley that do all the heavy lifting.
Uniquely, Phillips also puts Algeria in context, a region that's often neglected or disowned in most French wine books. But many, many French wines came from Algeria either as blends or a wholly sourced Algerian wines. The region was especially important during the period when phylloxera killed off most of the European country's vines. Phillips gives us the precise value of the African colony's contribution when he writes,
"...shipments of wine from Algeria to metropolitan France represented three times the combined wine exports of France, Italy and Spain in the 1930s and easily exceeded them until the 1960's."How's that for modifying existing views on French terroir during that period?
Author Rod Phillips is a historian, by profession, and a wine expert who is a wine columnist for the daily paper in Ottawa. His book covers wine grape growing and winemaking in France from 500 BCE when the Romans appear to have been making their first wines around Massalia (today, Marseilles).
But aside from that, there are juicy bits about, of course, the English and the French, Champagne and the court, the neglected Rhone region, and the recent invention of historical traditions in both Bordeaux and Burgundy by vintners anxious to create lines of historical legitimacy where there were none.
But the book's comprehensiveness is also part of its great value - Phillips gives us great chapters on the earliest years with details not revealed elsewhere (at least in English translations). The medieval period is as fascinating as any of the later eras. And the realization that the French revolution was responsible for the breakup of the great church-owned Burgundian estates that then passed into private hands. If only we had bought then...
I found myself underlining, underlining and underlining - there were so many Big Facts and Interesting Revelations in this book. One could easily write a lengthy review, but I will restrain myself and simply share:
10 Things About French Wine I Learned from Reading French Wine: A History 1. The First French Imports to Italy May Have Been in 79 CE
When Pompeii, a major wine producing area, was buried by the volcanic explosion of 79 CE, the Romans imported Gallic/French wines to Italy to make up for the shortage of Italian wines.
2. Vines Planted in Rows: A First in 1630
Before 1630, vines were planted as field blends and not in rows. Row planting did not really take off until phylloxera forced the French to replant, which was in the late 1800's.
3. Sauternes - A Dutch Treat
The Dutch ran things in Bordeaux during much of the 1600's, and it was on their watch that Sauternes were produced, making the sweet wine popular and famous.
They also made Cahors and its Malbecs prominent and sought after wines.
4. King Louis XV Forbade Vineyard Planting
Concerned that the craze for planting vineyards - which made a nice profit - might take too much land out of production that was needed for growing essentials like grain, in 1731 Louis XV issued an edict forbidding the planting of new vineyards without his consent. (The edicts were widely ignored).
5. In the 18th Century, Burgundy's Big Market Was Parisians not the British
In the late 1700's Bordeaux and Champagne were mostly exported to English, who paid twice the price for Bordeaux wines than the French did, while the wines of Burgundy were embraced by Parisian wine drinkers.
The finest wines of Burgundy - from Chambertin, Clos de Vougeot and more - were priced at just 50 percent above those of ordinary wines.
6. The French Revolution Revolutionized Vineyard Ownership
During the revolution, the state confiscated land owned by the churches, enabling citizens with money to buy land to snap up many of Burgundy's finest vineyards, which had been owned by abbeys. The largest was the 5,000 acres vines owned by the Abbey of Citeaux which were sold to wealthy buyers.
La Romanee, now of DRC fame, was among those auctioned at 1794. Wine from it was said to "restore life to the dying."
It was from this time onward that Burgundy's vineyards began being subdivided into smaller and smaller fragments.
The revolution also liberated wine presses, enabling anyone to make wine. Until that time, using the seigneur's press would cost you 5 to 30 percent of the wine you produced. And you couldn't use it during peak harvest times if the seigneur needed it to crush his own grapes.
7. Pas De Punchdowns
Winemakers in the 1800s were advised not to punchdown wines, according to a manual by Cade-de-Vaux.
Many winemakers also appear to have died from carbon dioxide poisoning during fermentation, judging from his warnings on carbon gas.
8. The Comet Vintage was Superb
In 1870 Donati's comet streaked across the sky; vintners proclaimed the wines from this harvest as notably superior.
9. The Railroads Revitalized Languedoc
By the 1850's, when railroads could transport wine to Paris in tanker cars, Languedoc's plantings and output rose exponentially, to 1.1 million acres producing, with higher yielding varietals, 400 million cases.
10. The American Import - Powdery Mildew - Debuted
There was no powdery mildew in French vineyards until the 1840s when it came to France from America.
And one last bit, which I cannot resist: in 1905, when there was widespread wine fraud with pernicious additives or wine made from raisins were widely distributed, vintners fought back with the slogan: "Long live natural wine [i.e. real wine]! Down with the poisoners!" - a sentiment that should still ring true today.
Quibbles
As excellent as it is, I do have a few issues with this book,. The subject of viticulture is only sporadically and tantalizingly touched upon.
It's unclear to me from reading it when copper started to be used, as well as sulfur, and when insecticides came into play. What kind of tillage was being done? When did tractors start to be used?
There is a brief, all too brief, mention of organic and Biodynamic farming starting in the 1970's, but not much detail about why and what the results and scope of it was.
Perhaps we can beg the author to write another book that will address this equally worthy side - the viticultural practices (and history of pesticides, insecticides, herbicides and fungicides) - of French wine history.
Final Note
This is such a grand and wonderful book that I would hope that someday it could be republished as a coffeetable book with lots of color illustrations and photos.
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Southern California Program
Ocean Park Community Center
Civic and Community
Santa Monica, CA
$250,000
December 2015
Finding affordable housing has become increasingly difficult in Los Angeles County due to an increase in homelessness (up 12% in the last two years to 45,000), the reduction in public funding for rental subsidies and the high cost of construction. In fall 2014, Ocean Park Community Center (OPCC) began piloting a shared housing strategy for its population of chronically homeless and vulnerable clients that does not rely on public subsidies. OPCC master-leases apartment units and rents them to housing-ready clients. With a monthly flat fee of $500, individuals get a furnished, well-maintained apartment, a bedroom to share with one other person and basic utilities. Many of the clients are able to retain approximately 40% of their monthly income to spend on food, extras and savings. A multidisciplinary team conducts regular home visits to provide supportive services during the client’s tenancy in the shared unit. With the support of this two-year grant from the Keck Foundation, OPCC will expand the project to 80 additional individuals while maintaining the 32 individuals placed to date in shared living arrangements. OPCC believes that this is a viable, scalable solution to the issues of homelessness and lack of affordable housing in Los Angeles County.
Site design: <a href="http://www.formativegroup.com/">Formative Inc.</a>
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When a health insurance company receives a rating, the result that is displayed is based on calculations and data that has been gathered from the rating service. One of the most common of these is the National Committee for Quality Assurance, or NCQA. This is a nonprofit group that is responsible for developing quality measurements and then provides accreditations for various providers of Health Insurance in Houston TX, doctors and other types of organizations.
The factors that various health insurance companies are rated on include the quality of care that is provided, overall customer satisfaction and the commitment to improving their services and the disclosure of health-related information.
How to Get Health Insurance Ratings
Ratings are available for all types of Health Insurance in Houston TX, including public, private and even government plans such as Medicaid and Medicare. In order to determine the particular rating for a health insurance plan across the nation, searchers can utilize an online tool. These tools generally work with the following steps:
• Select a plan category: Medicare HMO or PPO; Private PPO or HMO.
• Select the state.
• Customize the search for comparing the plans’ scores and the performance regarding offerings of preventive services and consumer satisfaction.
Types of Health Insurance Plans that are Rated
The health plans are ranked in three different categories:
• The HMOs that serve Medicaid beneficiaries.
• PPOs and HMOs serving Medicaid beneficiaries who enrolled in Medicare Advantage.
• Private PPOs and HMOs people enroll in from their work place.
Why Would Plans not be Rated?
There are three primary reasons that someone may not see their
Health Insurance in Houston TX plan listed. Not all plans will submit data to each rating service. There are some that don’t make results of the ratings public. And there are some plans that do not have sufficient data to make any valid type of statistical comparison.
How Ratings Help in Purchasing Insurance
When the ratings are available, those purchasing insurance will be able to see the track record based on the criteria highlighted above. The ratings of these plans will let shoppers know the overall quality of service offered by certain insurance plans.
Choosing a health care plan with a higher score, will let customers know they are purchasing a higher quality plan. These plans are typically more flexible and offer excellent customer. ASAP Insurance offers more information on insurance ratings.
Visit here for more details. Be the first to like.
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PDF Version
28 Service points throughout Atlantic Canada.
Professional staff in tune with local needs.
Annual Budget of $300M.
Working on the ground in Atlantic Canadian communities to offer a customized flexible approach.
Targeted programs that strengthen local economies.
WHAT IT DOES: provides interest free capital to help businesses start up, expand or modernize at every stage of a company’s growth
WHO IT’S FOR: private businesses and not-for-profit organizations, including clean tech and high growth firms
WHAT IT DOES: invests in R&D that can lead to the commercialization of new cutting edge products and services
WHO IT’S FOR: private-sector businesses and not-for-profit research groups like universities, colleges and non-government organizations
WHAT IT DOES: funds strategic projects with a rural focus that build on the strengths of Atlantic Canadian communities for economic growth WHO IT’S FOR: municipalities and not-for-profit organizations looking to strengthen their communities
WHAT IT DOES: funds projects targeting the rehabilitation or improvement of existing community infrastructure
WHO IT’S FOR: municipalities and community groups looking to undertake meaningful upgrades to existing facilities, including projects with a focus on green infrastructure Each dollar invested directly into businesses through ACOA from 2008 to 2013 resulted in over $5.40 in gains to Atlantic Canada’s gross domestic product (GDP).
87% of business owners who participated in ACOA’s skills development activities said training improved their ability to start, sustain or grow a business.
The region’s GDP is nearly $1 billion higher because of the Agency’s programs and services.
Labour productivity among ACOA-assisted firms increased 5.3% per year on average.
Atlantic Energy Gateway Atlantic Shipbuilding Strategy Atlantic Canada Tourism Partnership Community & infrastructure programs International trade focus on youth and indigenous communities
Want to learn more? Go to www.acoa-apeca.gc.ca
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The Libertarian Cato Institute has recently published a risk analysis report (much like the analysis insurance companies engage in when writing policies) assessing the likelihood of an American citizen being killed on native soil by someone who has come to the United States with terrorist intentions (legally and illegally). (The full report is here.) Alex Nowrasteh, an immigration policy analyst for Cato looked "at every single terrorist attack committed on U.S. soil by an immigrant or tourist from 1975 to the end of 2015" and applied some basic risk analysis.
Here are the findings: The chance of an American being killed by a foreign terrorist on American soil is 1 in 3.6 million a year. For a little more concise perspective, "from 1975 to 2015, more than 1.13 billion foreigners entered the U.S. legally and illegally. So, more than 28 million foreigners entered the country for each successful terrorist who actually managed to kill somebody in a domestic terrorist attack." So, what is the chance of an American being killed by another American in a non-terrorist related event-- 1 in 14,000. Between 2003-2013 an average of 28 people a year died from terrorist-related attacks. Compare that to the average of 31,516 gun deaths each year not caused by people with terrorist intentions. John Mick of Cato states, "your chances of dying like Jimi Hendrix (choking on your own vomit), while suffering from heart disease while falling off a ladder strategically positioned over a railroad track are better than your chances of dying in a terrorist attack-- let alone one perpetrated by a refugee." So, an American is much more likely to die by gunfire at the hands of another American than by a foreign born terrorist-- but remember guns don't kill people, people kill people-- and apparently much more often than do terrorists. Every one of us at times suffers from irrational fear. Tempered fear can be a good thing because it warns us of immediate danger, but let's be honest and confess that irrational fear just makes us stupid and we become even more irrational and even more stupid when some of our leaders stoke the fire of that irrational fear. I am not suggesting that the United States should take a lackadaisical approach to immigration and the acceptance of refugees. Indeed, our current vetting process is quite rigorous and should remain so. What I am attempting to highlight is that when it is more likely that an American will die from being struck by lightening than being killed by someone with terrorist intentions; and when the latter scares us much more than the former, that qualifies such fear as being irrational. And when we are more afraid of dying at the hands of a refugee terrorist than at the barrel end of a gun legally owned by another American, that too qualifies as an irrational fear. And irrational fear whatever its object can grip even the smartest people, leading them to act in irrational ways. And that's not a good thing. A Weblog Dedicated to the Discussion of the Christian Faith and 21st Century Life A Weblog Dedicated to the Discussion of the Christian Faith and 21st Century Life ___ I do not seek to understand that I may believe, but I believe in order to understand. For this also I believe, –that unless I believed, I should not understand.-- St. Anselm of Canterbury (1033-1109)
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Posted By Dan Swearingen on April 30, 2011
by Dan Swearingen and Janet Lawson, MFT
The core mission of Autistry Studios is supporting the transition of ASD youth to whatever level of adult independence each individual is capable of achieving. Our Core Workshops and our new Drama Workshops prepare students for adult life by exercising and growing executive skills while building confidence and mental resiliency. These skills combined support real time decision-making and the ability to act on decisions – the abilities needed to successfully work and create.
Our existing Core Workshops include a range of activities that could be characterized as going from “play” to “playful work.” Last year, as Autistry grew to including a growing adult student body we felt a need for more direct employment training: An employment program which could be thought of as picking up from “playful work” and transitioning into “realistic work.”
Importance of Work
Meaningful work is how we establish our identity, maintain our independence, and construct a real relationship with our community. Without appropriate opportunities to work our students are denied independence, denied an adult identity, and denied a real place in our community.
Building the ability to work is fundamental to fulfilling our mission supporting transition for ASD youth.
Our programs have always been driven by the needs of the students with whom we work. Our students today need initial work experience in safe situations where they can explore and learn initial job skills, practice social skills, and cultivate their work ethic.
Initial experiments
Our first experience providing work was to have students work extra hours doing chores around our workshop areas. This was a gentle extension of their normal workshop schedule. This succeeded to some extent but highlighted requirements a more robust program would need to meet:
Increased structure – more work hours per week. A mix of routine: repeated tasks in which deep competency can be built up as well as unique tasks exercising problem solving skills. Measured amounts of social interaction appropriate to the employee’s social skills. Work objectives that are real and meaningful to the employees. Our new employment programs for Q3-Q4 2011
Based on the lessons we have learned and to the extent that funding permits, we will be rolling out several internal direct employment businesses to which Autistry students would be eligible to apply starting summer of 2011.
In the past these internal businesses would have been called sheltered work programs but the current trend is to call programs like these Social Enterprises. This is a wide ranging term for any program that applies capitalistic strategies to achieving philanthropic goals. In our usage we will be calling these new Autistry Studios employment projects
Autistry Enterprises.
The goal of the Autistry Enterprises is to set up a cluster of internal businesses that feed business to each other as well as outside businesses and customers much as a Japanese keiretsu (network of companies) functions.
Autistry Publishing
A couple of our students are in the process of writing books which will be published by Autistry Studios. In addition to the direct processes of producing content, digital textblock, illustrations, and actually printing books we will be handling ISBN registration and setting up sales and delivery channels.
This Autistry enterprise will feed business into Autistry IT (website, e-commerce, technical support) and Autistry Figures (figure from the books) – both described below.
Autistry Railroad
The Autistry RR will produce model structure kits in cut-and-fold, cast plaster, cast resin, and eventually laser-cut wood and plastic formats. This company will employ designers working on CAD systems, technical writers/illustrators making instruction material, workers producing and packaging kit materials while maintaining inventory, and workers handling and fulfilling orders.
This Autistry enterprise will feed business into Autistry Publishing (printed materials, packaging) and Autistry IT (website, e-commerce, technical support).
Autistry Figures
This Autistry enterprise will feed business into Autistry Publishing (printed materials, packaging) and Autistry IT (website, e-commerce, technical support).
Autistry IT
Autistry IT will provide computer hardware and software support to Autistry Studios and Autistry Enterprises. It will produce and manage websites for all the Autistry activities including e-commerce capabilities.
Next Steps
We have the resources to start the Autistry Enterprises but they will need significant direct family support to grow to a point where they can provide paid employment.
[Updated 9/2/2013]
The Autistry Employment Program was launched as the Autistry Model Employment Program in June 2013.
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BizStore » Books » The Shallows: What the Internet Is Doing to Our Brains
Product Description:
Binding: Paperback Brand: W W Norton Company EAN: 9780393339758 Feature: Finalist for the Pulitzer Prize ISBN: 0393339750 Item Dimensions: Array Label: W. W. Norton & Company Languages: Array Manufacturer: W. W. Norton & Company Number Of Items: 1 Number Of Pages: 304 Publication Date: 2011-06-06 Publisher: W. W. Norton & Company Studio: W. W. Norton & Company
Product Features:
• Finalist for the Pulitzer Prize
Editorial Review:
“Is Google making us stupid?” When Nicholas Carr posed that question, in a celebrated
Atlantic Monthly cover story, he tapped into a well of anxiety about how the Internet is changing us. He also crystallized one of the most important debates of our time: As we enjoy the Net’s bounties, are we sacrificing our ability to read and think deeply?
Now, Carr expands his argument into the most compelling exploration of the Internet’s intellectual and cultural consequences yet published. As he describes how human thought has been shaped through the centuries by “tools of the mind”―from the alphabet to maps, to the printing press, the clock, and the computer―Carr interweaves a fascinating account of recent discoveries in neuroscience by such pioneers as Michael Merzenich and Eric Kandel. Our brains, the historical and scientific evidence reveals, change in response to our experiences. The technologies we use to find, store, and share information can literally reroute our neural pathways.
Building on the insights of thinkers from Plato to McLuhan, Carr makes a convincing case that every information technology carries an intellectual ethic―a set of assumptions about the nature of knowledge and intelligence. He explains how the printed book served to focus our attention, promoting deep and creative thought. In stark contrast, the Internet encourages the rapid, distracted sampling of small bits of information from many sources. Its ethic is that of the industrialist, an ethic of speed and efficiency, of optimized production and consumption―and now the Net is remaking us in its own image. We are becoming ever more adept at scanning and skimming, but what we are losing is our capacity for concentration, contemplation, and reflection.
Part intellectual history, part popular science, and part cultural criticism,
The Shallows sparkles with memorable vignettes―Friedrich Nietzsche wrestling with a typewriter, Sigmund Freud dissecting the brains of sea creatures, Nathaniel Hawthorne contemplating the thunderous approach of a steam locomotive―even as it plumbs profound questions about the state of our modern psyche. This is a book that will forever alter the way we think about media and our minds.
Related Items
• The Glass Cage: How Our Computers Are Changing Us • Everything Bad is Good for You: How Today's Popular Culture is Actually Making Us Smarter • Amusing Ourselves to Death: Public Discourse in the Age of Show Business • Alone Together: Why We Expect More from Technology and Less from Each Other • Reclaiming Conversation: The Power of Talk in a Digital Age • Signs of Life in the USA: Readings on Popular Culture for Writers • The Filter Bubble: How the New Personalized Web Is Changing What We Read and How We Think • Revolutions in Communication: Media History from Gutenberg to the Digital Age • Utopia Is Creepy: And Other Provocations • Technopoly: The Surrender of Culture to Technology Amazon Store
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Medicaid Expansion - Letter to the Editor
Dear Editor:
I ask lawmakers to consider the facts when deciding the issue of Medicaid Expansion.
Opponents claim that the Virginia Medicaid program is fraught with abuse. Yet, according to a 2011 JLARC Report “Mitigating the Risk of Improper Payments in the Virginia Medicaid Program,” recipient and provider fraud totals 0.3%, (or roughly $6M) not the $38B that some have tossed about. In fact, Virginia has one of the best -managed Medicaid programs in the country.
Another argument is “the Federal government will not live up to its financial commitment.” There is no basis for this conclusion. The Medicaid program has been in existence since 1965, nearly 50 years, and during this entire time the Federal government has never reduced its financial commitment to the States.
Virginia has never been shy about accepting Federal money. In fact, the biennium budget currently being considered includes $20B in federal dollars for all sorts of programs out of a $96B budget!
The Senate’s bi-partisan “Marketplace Virginia” addresses every reasonable concern. In Marketplace Virginia, participants would share costs up to 5% of their household income, additional safeguards are in place to prevent fraud and abuse, budgetary savings would be set aside to pay the State’s share of Medicaid in the future; and the program automatically ends if the Federal government fails to meet its funding obligations.
Over 400,000 working Virginians are uninsured. The cost of providing care in the emergency rooms is causing everyone’s insurance premiums to skyrocket and local hospitals are close to financial disaster. The Federal government is willing to pay nearly the full cost of insuring many of these low-income individuals for years to come. Lawmakers have the power to save jobs, boost the economy and help manage the cost of care for everyone. Now is the time to act!
Barbara Favola
State Senator (D)
31
st District (parts of Arlington, Fairfax and Loudoun
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Contrary to what you’ve been told, a bathroom is the perfect place to experiment with color. Whether it’s a splash of color on the walls, a neon-colored rug or a brightly colored modern or antique bathroom vanity, there are as many ways to add color to your bathroom as there are colors in the spectrum.
Many find purchasing a colored bathroom vanity is one of the easiest ways to add color during a bathroom renovation. In most cases, it’s easier to match bathroom accessories and paint to a vanity as opposed to the other way around. Bathroom vanity colors and finishes range from muted, traditional tones and finishes to bold, contemporary approaches that will create a statement in your bathroom. The right bathroom vanity can transform a bathroom from a run-of-the-mill area we all take for granted to one of the most striking rooms in the house.
If you’d like to add a splash of color in your bathroom, one of our unique bathroom vanities is an ideal choice. When remodeling your bathroom it’s important to pay attention to the overall aesthetic of the bathroom. If the bathroom’s walls and tiles are packed with color, a modern gray vanity may be the proper choice. On the other hand, if the rest of your bathroom is subdued, a brightly colored vanity may be just what you need to create a conversation piece in your bathroom.
Whatever your decorating ideas entail, your vanity is sure to be a primary focal point. Let the bathroom vanity experts at Bathroom Vanities Only help you find the perfect colored or grey bathroom vanity for your bathroom. With wholesale prices, vanity options from some of the best brands, and free shipping within the continental United States, there’s no time like the present to take advantage of these money-saving perks offered exclusively by Bathroom Vanities Only.
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PRIVATE HOSPITALS IN BRITAIN A Critical Examination of the Private Healthcare System © Richard Ennals & Raeto West 1998, 1999, 2000, 2001
... private practice offers fewer of the safeguards and supports that help to minimise adverse events and reduce patient risk in the public sector... Andrew J. Vallance-Owen, Medical Director, BUPA (1996)* Read straight through, or click on the underlined headings, or Click once for adjustable sidebar [To: Quotation | Overview | Key Points: Medical | Key Points: Administrative | Conclusions ][Remove sidebar (s)] 1. OVERVIEW 2. KEY POINTSMEDICAL 3. KEY POINTSADMINISTRATIVE 4. CONCLUSIONS 5. RECOMMENDATION NOTES AND REFERENCES [Big Lies home page] PRIVATE HOSPITALS IN BRITAIN 1. OVERVIEW:In Britain, 6.4 million people currently have private medical insurance (PMI), and more than 1 million people were treated privately in 1998. The total value of health services supplied by the private sector (including voluntary suppliers) for 1998 was estimated at £14.4 billion. Almost half of this is long term care; about a quarter, drugs and medical equipment. Private medical treatment in private and NHS (National Health Service) hospitals accounts for 18% of this total, £2.6 billion. In 1998, there were just over 220 private acute hospitals, providing 10,050 beds. About two thirds are commercial, for profit, hospitals, and of these about a quarter are owned by overseas concerns. The remaining third are hospitals registered as charities. Most private hospitals belong to: BUPA (British United Provident Association), or to Nuffield Hospitals, or to the General Healthcare Group (also known as BMI Healthcare). All but twenty private hospitals have fewer than 100 beds, and many less than fifty; they are usually much smaller than NHS hospitals. Private healthcare, including nursing homes, employs more than half a million people and in employment terms is the tenth largest industry in Britain. Most patients' treatment in private hospitals is paid for by health insurers. Typically, a policy offers £10,000 to £15,000 cover a year. This system coexists uneasily with the NHS. 1 Here we set out problems specific to treatment in private hospitals, which can result in unnecessary suffering, permanent injury and avoidable death. Our claim is that actual numbers of serious untoward incidents in British private hospitals are far greater than publicised cases would suggest, and that this situation will continue until the government finally addresses these problems. [Back to Start] 2. KEY POINTSMEDICAL 2 (1) The patients consultant, who has overall responsibility for the patients care in hospital, is not always on site when treatment is needed. The consultant is almost always an employee of the local NHS Trust Hospital with an individual part-time contract, which sets out the proportion of his or her working hours to be spent treating NHS patients. If the private patient requires emergency treatment outside the hours that his consultant is on site there may not always be the specialist expertise to cope with specific complications. Furthermore, there is little monitoring by trusts and health authorities of consultants working days: fatigue may lead to risks to patients in both sectors, and consultants may favour private patients. And there can be cases where surgeons operate with smaller teams than in the NHS, without full backup, and where operations are finished by unsupervised junior doctors. Also, consultants suspended from practice in the NHS pending investigations of alleged incompetence, can sometimes continue to practice in private hospitals. Private hospitals claim that, if subsequently cleared, the consultant can sue them for loss of earnings. There may also be longer NHS waiting lists in those specialties which are the most lucrative areas of private practice. (A recent report asks whether medical bodies have restricted consultant numbers for members' financial gain, doing so by influencing legislation. See Notes and ReferencesRestrictive practices). (2) Generally, private hospitals have single rooms: unexpected complications can sometimes go unnoticed behind their closed doors. A patient in severe distress may not be able to operate an emergency call button. (3) If complications are spotted in time, resident staff may not have the expertise to identify and cope with them. Resident Medical Officers (RMOs) are frequently junior doctors, working alone, whilst nurses, some of whom may be agency nurses, may not have the appropriate specialist knowledge. The hospital staff may be reluctant to take independent action when the consultant is not present. By contrast, in a large district general hospital, patients with specific conditions or illnesses will often be treated in specialist wards where medical and nursing staff will have had extra training and experience in that condition. Patients will ideally be treated by a proper healthcare 'team' under the consultant, incorporating charge nurses, staff nurses, houseman, senior house officer and registrar. The patient's medical records are kept at hand whereas in private hospitals accidents have been caused by staff not having the patient's consultant's notes or not being left proper instructions. A recent newspaper report also raises concerns over the training of technical staff in private hospitals. The Royal College of Nursing has raised concerns about the treatment of children in private hospitals. (4) If complications are spotted in time, the private hospital may not always have the range of facilities, specialist staff, drugs or equipment available for emergency or intensive care. In the private hospitals with facilities for intensive care, these are often only Intensive Therapy Units (ITUs, not ICUs) or High Dependency Units (HDUs), largely for the treatment of post operative patients following major surgery (and the beds may be taken). The patient may have to be ferried to the nearest NHS hospital for treatment, by which time his or her condition may have deteriorated. Private hospitals exploit the fact that NHS hospitals rarely turn away seriously ill patients. They generally carry out only what they expect to be straightforward operations, leaving people with complications, people needing expensive treatment, and 'bed blockers' to the NHS. (5) Crash teams provide emergency resuscitation. The Royal College of Anaesthetists recommends that all hospitals should have crash teams providing 24-hour cover, and that these should include an anaesthetist (to intubate, put up intravenous drips, insert catheters, and administer drugs in the few minutes available to save life). Few, if any, private hospitals are able to provide this level of service. (And private hospitals do not have Accident and Emergency services). [Back to Start] 3. KEY POINTSADMINISTRATIVE 3 (6) If things go wrong, unlike in the NHS, there are no statutory complaints procedures in private hospitals for aggrieved patients or relatives; the legislation by which they are regulated simply makes no provision for complaints. Whilst registering authorities now expect hospitals to have internal complaints procedures, it may be that complainants will not be told about these. One effect of this is that, unlike the NHS, where numbers and nature of complaints are recorded, there is no proper picture of the incidence of untoward events in private hospitals; amazingly, no government body appears to be collating this information. Ironically, even though private patients pay twice (both national insurance contributions and health insurance premiums) and, even though by going private they take some strain off the NHS, they have fewer rights than NHS patients being treated under contract in the same hospital. Unlike the NHS, the private hospitals' complaints proceduresif complainants are told about themare based only on a flimsy voluntary code and carry no right of appeal. And, unlike NHS patients, private patients have no Patient's Charter, no accompanying Charter rights, no ombudsman, and no Community Health Councils (CHCsgovernment-funded local NHS watchdogs) to assist them. Litigation, which people are often advised is their only option, is expensive, arduous, uncertain, and concerned almost entirely with financial settlement. Cases can be further hampered by falsification of medical records, the rarity of impartial medical experts, and the difficulty of proving negligence in its legal sense, and then causation, central issues which the Woolf reforms ignore. The law courts will also not satisfy those seeking an acknowledgement of their complaints, an apology, and an indication that matters will be improved. (Though there is another optionasking the registering health authority to investigate. See Conclusions, and Notes to Conclusions, later). Advertising, in TV, press and leaflets, by hospitals and insurers plays a key role in attracting people into the private sector. Its accuracy may come under increasing scrutiny. (7) Following an untoward incident, private hospitals may be reluctant to honestly admit error since bad publicity may damage their reputations, and customers may go elsewhere. Moreover, insurance companies may threaten to raise, or withdraw, insurance cover in the event of an admission of fault, for fear that this might be interpreted as an admission of liability. (8) Matters may be complicated when untoward incidents arise from failures on the parts of both the consultant and hospital staff. Whom does one sue? NHS hospitals take responsibility for the mistakes of all employees; but in private hospitals, the patients contract separately with the consultant, who is not employed by the hospital, and the hospital accepts no responsibility. Complainants may have to deal with two sets of defendants, insurers, and solicitors. Furthermore, the hospitals are dependent on the consultants to bring in business, and may play down consultants' mistakes. (9) The legislation (the Registered Homes Act 1984, and Statutory Instrument 1578 of 1984) was designed with nursing homes in mind, and health authority inspection and registration officers in their twice yearly visits are for the most part obliged only to evaluate the adequacy of the secondary hotel aspects of patients caresuch as for example [in Regulation 12 of SI 1578], the hospitals adequacy in its provision of curtains, crockery, and washbasins. Astonishingly, there is little or no scrutiny of the quality of clinical care, which would obviously be more appropriate for patients receiving medical treatment. With much more complex surgery now being undertaken than in 1984, this is a significant failing. (It's hard to believe that the civil servants who drew up this legislation forgot about private acute hospital patients. Probably it was deliberately drawn up in this way under pressure from the medical establishment and the private hospital and health insurance industries, wishing to remain unaccountable). (10) The quality of the twice-yearly compulsory health authority inspectionssuch as they are under this legislationis also sometimes open to question. For example, the Royal College of Nursing found inter alia that inspection units were not always well staffed, that some inspectors needed better training, and that in some areas both visits were being announced, in breach of the legislation. A quarter of all the health authorities surveyed carried out inspections with only one officer, the risks of which the RCN identified as including Seeing the premises in a good light because of familiarity or individual bias and Being intimidated by less co-operative owners and staff. Inspections can also be compromised, according to a healthcare lawyer, if the health authority is contracting with the hospital to treat NHS patients. And a healthcare academic raises the possibility of corruption in some health authorities. (See notes to 4. Conclusions). Many private hospitals imply in their defence that accreditation, by the Kings Fund or British Standards, guarantees high quality clinical care. In fact, this is not so. The audit is primarily organisational. Hospitals' Medical Advisory Committees (MACs) are supposed to regularly meet and inter alia monitor the performance of consultants, but generally do nothing, as such high profile cases as those of Drs. Ledward and Neale indicate. Composed of admitting consultants, hospital management and senior hospital clinical staff, their concerns probably lie more with protecting the reputation of the hospital, on which their income rests, than with the welfare of patients, and thus in reality they may be instrumental in concealing bad practice. Their meetings are held in private. Their findings are unpublished. As regards costs, lessons might be drawn from other fields: schools are inspected, buildings being remodelled are inspected, prisons are inspected, factories are inspected. [Back to Start] 4. CONCLUSIONS AND 5. RECOMMENDATIONMany people turn to private hospitals because of the lengths of some NHS waiting lists, a fact which hospitals and health insurance companies exploit in their advertising. Patients should not, however, be misled by the image of a private room, pleasant furnishings, and an à la carte menu. This may not be coupled with high standards of clinical care. When things go wrong, they can go spectacularly wrong, with devastating consequences for patients. 4 In effect, accidents are rare enough for the system to take risks; it is cheaper to employ lawyers to attempt to limit damage, than to have adequate levels of staffing that might prevent accidents. There is little doubt that improvements must be madeall the more so with the interest of multinationals in British healthcare, for whom the lax regulation is probably an added attraction, and with the increasing numbers of NHS patients being treated in private hospitalsand certainly, in opposition, the Labour Party frequently called for tighter regulation of the private healthcare sector.
The Department of Health in recent statements to the media has warned the public that if they opt to use private as opposed to NHS hospitals, as things stand now they are taking a chance. [See Notes to ConclusionsComments: Political]
Despite the number of statutory bodies and healthcare 'watchdogs' that claim to protect and serve the interests of patients, some of which patients or relatives may turn to in the wake of untoward death or injury, e.g. the Department of Health, the health authority, the 'professional' bodies, patient organisations, think tanks and university research departments, in reality few seriously tackle the status quo. Core problems are almost invariably ignored (e.g. profit-motivated understaffing, lying about untoward incidents, falsification of noteswhich should be made a criminal offenceprejudiced experts, and the link between consultants' private hospital work and the length of NHS waiting lists) [See Notes to Conclusions
].
Pressure from a recently formed campaigning group, Action for the Proper Regulation of Private Hospitals (APROP), set up by bereaved relatives, coupled with continual adverse media coverage of injuries and deaths, eventually led to a 1999 investigation into private acute hospitals by the Commons Health Select Committee, as part of a wider inquiry into private and charitable healthcare. Section 41 of its ensuing report lists most of the deficiencies and dangers of private hospitals listed here, including the risks of single rooms; lack of specialist wards and resident specialist nurses and doctors; hours of consultants unmonitored with the risk of misjudgements from fatigue; lack of resuscitation and back-up facilities; inexperienced RMOs; and absence of even informal peer review as clinicians in private hospitals don't work in NHS-type teams. (Sadly though perhaps unsurprisingly, the directors of the main private hospital groups, the director of their trade association and representatives of medical bodies failed to acknowledge any of these findings in their oral and written evidence. They seemed more concerned with coming under the aegis of the new NHS audit scheme, the Commission for Health Improvement, probably as nothing more than a business exercise to gain the respectability of NHS accreditation and thus to attract new customers).
The Health Committee's report concludes, however, that even with the improved registration and inspection system it recommends, the small size of the average private hospital, and the need for it to operate commercially, may continue to jeopardize patient safety. A disproportionately high number of the Committee's 39 recommendations for improvements in private healthcare generally, related specifically to private acute hospitals.The former Health Secretary, in a covering letter to the first of several DoH consultation documents, acknowledged that the current regulatory arrangements 'are out of date, unsatisfactory, and not sufficiently independent..nor do they provide the protection to which the public is entitled.'
Plans for a new regulatory system were announced by the Queen in her speech at the opening of Parliament (18 Nov 99: ".. a Bill will be introduced to improve standards and stamp out abuse.. in private and voluntary healthcare.."). Private hospitals are to be regulated by a new body, the National Care Standards Commission, rather than a separate inspectorate, broad details of which are outlined in the Care Standards Act (recently through Parliament), and in the DoH document
Developing the Way Forward.
Whilst the latter promises some significant improvements on the present situation, a number of key issues are not clearly addressed. These include:
The need for a safe NHS-type 'team' system of staffing in private hospitals, especially at night-times and at weekendsalmost all of the untoward incidents listed at the end of this website illustrate failures in this area; whilst private hospitals will be legally required to have in place a scheme for assessing quality of care, e.g the King's Fund (now 'Health Quality Service') system, too much store is set by such schemessome of the worst hospitals in terms of untoward incidents and subsequent conduct are King's Fund accredited; whilst private hospitals will be legally required to have an internal complaints procedure, this is still a voluntary code and there is no guarantee of its effectiveness. The past experience of victims is that they were not even told about any complaints procedure. There should be an independent, statutory complaints procedure, and the new regulatory body should be involved at an early stage; tampering with medical and nursing noteswhich can happen as much in the course of a complaints procedure as in litigationis not even mentioned; private hospitals and their managers must be made accountable for the mistakes of consultants who use their premises, as now happens in NHS hospitals; referral of clinicians to the GMC or UKCCcited by the Government's Lord Hunt in the House of Lords recently as an effective course of actionshould be discounted. Neither of these organisations properly investigate incompetence; hospital managers and operators responsible for, and then for concealing, some of the most horrific incidentswhich helped bring about the succession of inquiries and demand for proper legislation in the first placeare not only being allowed to continue in situ, but are even being actively consulted by government for their advice. Some of these people should be sacked.
The new legislation will not come into effect until April 2002. The current fear of campaigners is that ministers and certainly DoH civil servantswho knowingly did nothing for yearswill allow its detail to be dictated by private medical interests. Such legislation as Statutory Instrument 3208 of 1995, the Public Interest Disclosure Act 1998, and the Freedom of Information Bill contain evidence of influence by vested interests.
The consultation group drawn up by the Department of Health to assist in preparing new regulations is composed of private hospitals groups and medical bodies some of whose members have been responsible for some of the most serious incidents, and for frequent dissembling; whilst the 'patients groups' chosen are mostly government-funded organisations that have done little or nothing to advance the cause of private patient safety and often have little contact with private patients. Action for Victims of Medical Accidents (AVMA) with direct, first-hand experience of the problems from the patient's point of view, has been omitted.
The recent much publicised 'concordat' that has been drawn upafter long secret negotiationsbetween the NHS and the private sector, whereby private hospitals will be used more frequently to help reduce NHS waiting lists, may also lead to the proposed legislation being watered down. A reduction in waiting lists may boost the present government's diminishing lead in the next election, and thus it may be more responsive to the dictates of the private sector. The more radical but probably more fruitful solutionthe recent proposal of scrapping the consultants' maximum part-time contractthe principal cause of long waiting listsappears to have been quietly set aside, probably due to the government succumbing to pressure from those medical bodies whose members gain most from this system. Baroness Nicholson said (
Observer
, 6 Aug 2000): 'I am aghast that a Labour Government wants more operations to be carried out in private hospitals which are unregulated and, quite honestly, not up to the job. It is a terrible mistake.'
The recent claim, made by the private sector, that Labour's previous opposition to the use of private hopsitals was purely ideological, is untrue. For example, the
Daily Mail
reported (9 Dec 98): 'One reason the Ministers refused an offer of beds from the private sector before last winter was because they feared emergency care might not be up to NHS standards.'
In the meantime, and until such time as legislation is introduced that, hopefully, will genuinely protect the private patient, complainants dissatisfied with a hospital's response to their complaints should exercise their right to approach the health authority that registers the hospital; this is a right that is poorly publicised by hospitals and health authorities alike, probably deliberately. The NHS Confederation's
Independent Acute Hospitals and Services
(1993) has comprehensive guidelines (Appendix 5) for authority investigations of complaints in private hospitals, in particular where breaches of the current registration requirements are indicated. The authority should interview staff involved, produce a report, make recommendations where appropriate, and ensure that they have been implemented.
Cases of misconduct must be referred to doctors' and nurses' professional bodies, the GMC and the UKCCfor what that's worth. [See Notes to Conclusions
for more details].
5. RECOMMENDATION Until new legislation is in place that properly protects patients, those contemplating private treatment should consider using the private wings of NHS hospitals, rather than private hospitals, even if a premium on insurance is requested, or a switch to another insurer is required: these hospitals (1) are fully equipped, (2) have better staffing levels at all times, (3) have better back-up when things go wrong, (4) have better complaints procedures. Consultants stay on site. All profits are returned to the NHS. [Back to Start] With private health insurance costs rising by up to 30% a yearpremiums are amongst the highest in Europeand with policies riddled with exemption clauses, those who want to go private might also consider ditching private insurance altogether and paying the same premiums into a private high-interest fund, self-paying when necessary. If you must queue-jump, why not do it intelligently? NOTES AND REFERENCES *Quotation at the head of this piece
This extraordinary (and very recent) admission is taken from an article 'Accreditation of doctors in the private sector', by Andrew J Vallance-Owen & Natalie-Jane Macdonald, respectively 'Medical Director' and 'Head of Clinical Services' of BUPA, in
Clinical Risk
journal (Pearson Professional, 1996)
2,
27-30. They continue: 'Consultant led' care is a term with greater practical significance in the private sector than in the NHS where team working is more the rule. Sound junior staff and a sharing of responsibility may minimise the limitations of a consultant's competence whilst consultants in a Trust tend to have closer links with each other than are possible or desired in the private sector.
On Vallance-Owen,
Sunday Times
2 Aug 98: He said his comments.. on fewer safeguards in the private sector were about a "theoretical risk"..
[BUPA, British United Provident Association: Britain's largest private health insurers. And owners of one of Britain's largest private hospital groups.] [Back to Start]
Notes and References to 1. Overview
6.4M people, and the figures for 'total value' and breakdown of private sector, and the number of private hospitals and their beds, are taken from Laing's
Healthcare Market Review 1999-2000
and the
Fitzhugh Directory
.
More than 1M people 'treated privately' from
Observer
review section, 1 Feb 1998,
The Last Place You Want To Be
by Jay Rayner.
The 'tenth largest industry' is from a letter to
The Times
16 Jan 1997, letter from B S Hassell, 'Chief Executive of Independent Healthcare Association' ['IHA']: '... The independent health and social sector employs 500,000 people. In addition to performing 20% of the country's elective [i.e. planned ahead, non-emergency] surgery, it provides 76% of the nation's long-stay provision and is the tenth largest employer... [in Britain]'
It's difficult to estimate the proportions of part-time workers, untrained workers and so on. Obviously the private sector wants to represent itself as largeperhaps larger than it really is. (Similarly, Jay Rayner's
Observer
article says 'If they all immediately decide to get their treatment on the NHS, .. our publicly funded healthcare system would collapse.' However, Jay Rayner gives no evidence for this claim).
On foreign ownership, John Studd, consultant gynaecologist (
Times,
24 Dec 94), on private hospitals in London: .. the great majority of these.. hospitals, although boasting proud British names such as Lister, Cromwell, Wellington, Devonshire, Churchill, etc., are owned by foreign companies.
He continues: We must support the opening of a ward of NHS pay beds [in a London NHS hospital].. We have a simple choice of allowing considerable amounts of money to leave this country to the American, Kuwaiti, Pakistani, and French companies who have a major investment
in the private hospitals in London, or using the pay-bed revenues to support the NHS. And Margot Norman,
The Times,
16 Dec 94: If there are profits to be made, let them be made in, and returned to, the NHS. [Back to Start]
Notes and References to 2. Key PointsMedical[Consultants | Single Rooms | RMOs and Absence of Health Teams | Nurses | Dangerous Staffing Practices | Cherry-picking | Facilities, Equipment, ICUs, Resuscitation | NHS Waiting Lists and Private Hospitals | Children | Restrictive Practices | Overtreatment etc. | Costs to the NHS of Private Treatment ] Consultants
On consultants and the founding of the NHS, Dr D. Gould's
The Medical Mafia
(1987): To get the grudging cooperation of the consultants, [Nye] Bevan had to make.. concessions. They were to be given a proper professional salary.. However, the senior and already established specialists were determined not to sacrifice their own extremely lucrative private work. Nye was forced to strike a bargain whereby any consultant could work part-time for the NHS and part-time for himself. Since then about half have elected to work on the so-called maximum part-time basis, whereby they receive 9/11 of the full-time salary appropriate to their posts in return for a notional nine half-day NHS sessions a week. For the rest of the time they can do their own thing. In effect, this means that they can order their affairs pretty well as they choose.. [A notional half-dayNHDis three and a half hours; this has since been extended to 10/11ths.]
Gordon Craig,
Independent Medical Care,
Sep/Oct 1986,
NHS Must Set the Standards for All
: It is almost the universal practice in the commercial sector not to employ consultants, but have a convenient and clever arrangement whereby the consultants treat patients without employer/employee's contractual arrangements. [He then compares it to 'the lump' on building-sites]. .. It is my view that this type of arrangement with consultants is a cop-out for the commercial medical companies. Often patients are unaware, or do not understand, the relationship, or the lack of it, between the consultant and the hospital.. A private or commercial hospital should be forced to employ the types of staff, with the requisite qualifications, and numbers which are at least on par with NHS hospitals.
On consultants' sole responsibility, and operations, in private hospitals, the TV documentary
Private Grief
(1992, World in Action) comments: In the NHS it is different. Patients are cared for by consultants and teams of qualified doctors in the process of being trained as specialists. Dr John Lunn, a consultant anaesthetist, added: No such team approach exists in the independent sector. There is a consultant surgeon and a consultant anaesthetist, usually, but no medical staff necessarily to help and to overlook the management from day to day and from moment to moment.
On operations in private hospitals, a doctor (personal communication, 1992): Although you pay your money for a consultant to do the operation, it is often finished off by junior doctors, coerced by the shut up if you want a reference line. And: I have known some patients reach the operating theatre without being examined first.
Guardian,
15 Dec 92, John Illman, in an article on the Ruth Silverman case (see below): Treatment usually depends upon an individual consultantsometimes severalworking without supporting senior registrars, registrars, housemen, and specialist nurses in what time he has free from the NHS.
On consultants, the TV documentary on private hospitals
Don't Stay the Night
(1997, Channel 4,
Health Alert
), comments: Professor Davenhall [Prof. of Nursing who has been employed by both a private hospital group and the private healthcare trade body, the Independent Healthcare Association] found areas of weakness in the private hospital structure, a consultant based sector where the consultants just weren't there all the time. Without adequate backup, it was a recipe for potential disaster. Prof. Davenhall stated: The problems [with private hospitals] relate when things go wrong. The consultants who are employed in the public sector and who do part-time work in the private sector are not there, at the end of a phone, often. So the nurses have to be extremely able in terms of their judgement.. it is a distinction from the situation that prevails in the NHS, which is that there are many, many, doctors to support the nurses, and there is other help available to them at the drop of a hat. When the system breaks down, it breaks down very badly, because of the lack of fallback, the lack of recourse to other opinions and support. .. Consultants only spend brief periods of time within the hospital.
(The IHA in this programme maintained that standards are at least as good as those in the NHS.)
It seems to be generally the case that the higher status a consultant, the smaller is the contractual percentage of time spent with NHS patients. (Remark made by an academic to RW). However, his/her time may be divided amongst private hospitals and private NHS wings. So statements about consultant availability are difficult to make precise. John Yates's book
Private Eye, Heart and Hip
(Institute of Health Services Management 1995; the title refers to the commonest private operations), e.g. pp. 73-76, discusses the proportion of surgical procedures carried out by 'junior doctors' but seems not to define this expression or draw definite conclusions.
Sunday Times
9 Aug 1998, Andrew Grice: There are no safeguards to prevent unscrupulous senior doctors from skipping their NHS clinics and leaving junior doctors to see patients so that they can spend more time in the lucrative private sector. Some surgeons may spend as little as four hours a week operating on NHS patients.
Hospital Doctor,
20 Aug 98: .. the department of Health confirmed.. that it is looking at ways of cracking down on those [consultants] who cash in on private work while failing to fulfil NHS commitments..
Hospital Doctor,
1 Oct 98: Dr Jenny Tonge MP [speaking at a BMA meeting].. said the consultant contract needed to be "blown wide open" to stop consultants "moonlighting" in the private sector.
Yates stresses there's little monitoring of adherence to contracts by doctors in the NHS and private sectors. This includes therefore the issue of tiredness of doctors, which is also mentioned e.g. in
The Good Doctor Guide,
2nd edition: The danger this situation is creating is .. that consultants.. are overworking. Among London's medical elite, there is a macho ethic of never being tired. This is the danger posed to NHS and private patients alike. ..
A Commons Public Accounts Committee reported (
Times
27 July 90): Health Authorities need a more accurate picture of the level of consultants' commitments to ensure that their responsibility for the treatment of patients is not put in jeopardy through working excessive hours.
On consultants' hours, Gordon Craig,
Independent Medical Care Journal,
Sep/Oct 1986: The problem of consultants working in commercial hospitals over and above their NHS commitment, which is sometimes full-time, or maximum part-time, also needs to be tackled, as it can risk patient care in both the NHS and the commercial sector. We do not allow airline pilots to work unrestricted hours, and we put tachographs in long-distance lorries.. Surely, we should restrict the number of hours which a doctor, particularly a surgeon, should be allowed to work. .. The danger with consultants is that the lure of additional money may impair the self-discipline and judgement necessary to restrict themselves to what they can cope with. (
Sunday Times
9th Aug 1998: .. some [top hospital consultants] receive more than £500,000 [$800,000] a year in basic NHS pay, merit money and private practice income. And in:
Private Eye,
Dec 98, reporting on the high charges of a neurosurgeon, Mr Chris Adams, for giving expert evidence in court: He submitted a bill for £32,000. When this was challenged, he produced details of his earnings in the private sector, which amounted to approximately £1M a year.)
Commercial Medicine in London
(1985): ... NHS doctors work hard already, extra private work may result in less efficient, and certainly more hazardous, medicine.
Health Which,
Dec 98: One suggestion [to monitor consultants' hours], made by Prof Alan Maynard.. is that private hospitals should be compelled to report the amount of private work a consultant does to the NHS Trust for which he or she works.. If consultants are made to be openly accountable for how they spend their time, it would give them a chance to document the long hours they say they do for the NHS, as well as answer charges that their private work is to the detriment of NHS patients. (The same article explains why the Government may not have undertaken a review of consultants' time: The British Medical Association's Mr Johnson.. also said that it would be 'unwise .. to upset the apple cart' and warned that, if restrictions were put on consultants' private work, there would be a mass exodus from the NHS. He added that any restrictions on private work should be matched by restrictions on NHS hours..')
On the accountability of consultants in private hospitals: Sir Richard Bayliss, assistant director, research unit, Royal College of Physicians,
BMJ,
21 May 1988: In the independent hospital, the consultant lacks the critical comments of junior staff.. nor is there peer review.
BMA News Review,
David Hinchliffe MP, Chairman, Commons Health Select Committee: There is serious concern that certain operations, primarily in the private sector, are not performed by those sufficiently qualified to do so.
Dr Andrew Vallance-Owen, Medical Director, BUPA,
Clinical Risk,
(1996),
2
: There has been a reluctance at times for providers [i.e. private hospitals] to tackle specialists whose practice they believe to be suboptimal.. it has proved difficult for management to gain the support of the specialist's peers in raising issues of clinical competence or appropriateness of care.
On consultants, suspended from the NHS, being
allowed to continue to practise in private hospitals, see cases of Drs. Ledward, Neale, Ingoldby and others listed below. [Back to Notes...]
Single Rooms
On the dangers of single rooms, consultant orthopaedic surgeon Michael Laurence states (
Don't Stay the Night
): .. speaking personally, Id much rather be [a patient] in a large ward, where if anything.. went wrong, or if I needed to get in touch with a nurse, or call somebody if she's not immediately available, the chap in the next bed [can call her for me].. Accidents get noticed.. in an open ward; in a private room, they don't.
Hospital Doctor,
Dangers of Care outside the NHS, 20 Aug 1998, Dr E. Walker, A & E Doctor: Patients do not receive a better standard of care in the private sector.. They.. get a private room which can be a double-edged swordfew people can press the call button just after suffering a respiratory arrest.
Observer,
1 Feb 1998: Finally, there is the issue of those private rooms. They may be comfortable and free of moaning from the post-operative patient in the next bed, but they may also place you out of sight of the nursing staff. If you do have incapacitating problems, nobody will be there to see it.
ITN News
, 5 March 99, on Carole Burwash [see below]: Carole was given a massive overdose of painkiller. Then, when she went into respiratory collapse, she wasn't noticed for some time because she was behind the closed door of a private room.
BBC Radio 4,
Case Notes
, 16 Nov 99, Baroness Nicholson: "The benefits of the private room dwindle into nothing when you realise that severely ill patients need constant monitoringyou don't get that in a private room."
Independent
, 26 July 99: 'Patients occupying single rooms tend to be less well supervised than those in the wards.'
(Readers might be amused by Norwich Union Healthcare's
Evidence to Health Select Committee
, Appendix 16: '.. there is much proxy evidence to support the quality of private sector work. In particular, private patients are treated quickly by high quality staff, in high quality facilities (often with BSI or King's Fund accreditation) and in single rooms which helps minimise the risk of cross infection.' ['Much proxy evidence' is, unsurprisingly, not supplied. And infections can also be carried by staff - RE]) [Back to Notes...]
RMOs and Absence of Health Teams
RMOs get a bad press: e.g. Joan Higgins' 1988 book,
The Business of Medicine
(Macmillan) p 183: '... Those hospitals which do have a resident doctor often employ overseas doctors who have been unable to find work in the NHS and, because most private hospitals have not been accredited for training purposes, they cannot attract the high calibre staff they would wish to employ. A number of hospital managers have expressed disquiet about the quality of staff they employ as resident doctors and at their high turnover. Some hospitals will also take on junior NHS doctors (who already work long hours in their normal jobs) to provide part-time medical cover. ...'
There's a similar remark in
Banking on Sickness,
a book by Ben Griffith, Steve Iliffe, & Geof Rayner (Lawrence & Wishart; however this was 1987). P. 197: Doctors unable to find NHS hospital posts or suitable vacancies in general practice provide a pool of casual labour for the larger private hospitals in the South-East of England. They add: .. it would be wrong to assume that private medicine is superior to NHS treatment. Private clinics are typically very small and not very well-equipped. Only one in three has a resident doctor providing 24-hour medical cover. The close commercial relationship between a private patient and his or her doctor means that junior doctors are less willing to intervene in the consultant's absence. As the Consumers' Association (publisher of
Which?
) gently puts it, this 'can mean an unpleasant delay for the patient.'
Dating from about the same time, a July/Aug 1986 article in
Independent Medical Care
on RMO cover, written by the owner of an agency that employs RMOs, says that AMI [an American chain of commercial hospitals, now BMI Healthcare] placed ads in the early 1980s drawing attention to their provision of RMOs in all their hospitals. The article also states: .. "Some doctors have great difficulty in feeling able to accept RMO posts because of fear of jeopardising their careers.. I have known doctors to be told categorically by a consultant to forget promotion if they take an RMO post. ... many RMOs feel that the registrar/houseman type of relation between a junior doctor and his consultant in the NHS is not always duplicated in the private sector. .. .. it is a 'mark-time' job.."...
The Health Scandal,
Dr Vernon Coleman 1988: .. many people pay the exorbitant fees charged by private hospitals and private insurance companies because they assume the quality of care will be better. They are wrong... if you go into an NHS hospital you will almost certainly be seen by at least one doctor every day. In practice, you will probably be seen by several doctors several times. And there will always be doctors resident in the hospital. If you fall ill during the middle of the night or at the weekend there will be a doctor on call who can be at your bedside within minutes. If you go into a private hospital, however, you may well go for several days without being seen by any doctors at all. And [some] private hospitals don't.. have resident medical staff. If you fall ill during the middle of the night or at the weekend, there may well be a delay of some hours before a doctor can be found.
The Times
29 Apr 1993,
How to pick a hospital and keep alive,
Margot Norman: Many of these hospital-hotels [i.e. private hospitals] .. have few facilities beyond their thick carpets and comfortable beds and, as the resident medical officer who held the fort alone at night.. told me, The only reason I'm working in a place like this is that it's quiet, so I can get on with swotting for my fellowship exams.
Hospital Doctor
, 20 Aug 98, Dr.E. Walker, A&E doctor: 'As an impoverished casualty officer in London, I.. applied for a place on the resident medical officer bank of a large private hospital. Duties included covering emergencies on the ITU until a consultant arrived. So green was I that I hardly knew my own arse from my elbow, let alone anyone else's. But the medical director offered me a post, saying I was 'just what they were looking for', meaning, of course, that I was white. Common sense prevailed, and I never took up the offer..'
The Guardian,
15 Dec 92, John Illman: Private hospitals have fallen down because sometimes there has been only one junior doctor, perhaps qualified little more than a year, on the full-time staff.
Baroness Nicholson, House of Lords, 13 Dec 99: "It [the private sector] does not provide healthcare for love or as a public service; these hospitals and medical staff provide healthcare for money. Therefore, these private hospitals are exceptionally competitive. To drive down their costs, they have hired staff who are inadequately trained, under-provisioned, under-funded and are not supported sufficiently for the tasks they are asked to undertake."
BBC,
Here and Now,
14 Sept 1998, Caroline Buckley (see case of mother Carole Burwash, below): My family and I find it astonishing that for one of London's top private hospitals with over 100 beds [the Princess Grace], overnight there is only one doctor covering every single patient and that doctor in this case had no life-saving skills whatsoever.
Dr Michael Crow (letter to BBC, Sept 99): 'As an ex-RMO back in the late eighties, I can remember not being able to contact the consultant in charge when an emergency arose at the weekend and the nearest pathology services were a taxi ride away.'
BBC TV Panorama 20.9.99: Prof John Ward, consultant physician and member of the GMC, on RMOs and lack of teams: "The unexpected is what makes medicine difficult and risky and if the unexpected happens you need to be in a hospital where teams of trained staff can cope with it. I stress 'teams' because often a medical emergency can be quite a performance and to ask one doctor to deal with it is too much. I believe that private hospitals without the medical cover that we have in the NHS must be rather riskier."
Independent
, 26 July 99, Andreas Whittam Smith, former editor: 'The risk of something going wrong in independent hospitals are greater than in NHS establishments.. as clinicians tend not to work in teams in the private sector, as they do in NHS hospitals, sub-standard staff are less easily noticed. The fact is that the independent sector is, on average, less competent.'
Nursing Times
, 23 June 1999, in a feature comparing care in a private and an NHS hospital, by an NHS nurse: 'On the ward [of Northwick Park NHS Hospital] there are five consultants, each with a registrar and SHO, and they tend to be around all day.. at BUPA Bushey Hospital..we only have the consultants [when they are around - RE] and the resident medical officer.'
Daily Telegraph,
11 Aug 1998,
Perils of jumping the queue,
Dr Mervyn Singer: Nights and weekends are the dangerous time. The staffing of the private sector at junior level is not very glamorous. The sector is often manned by British-trained doctors seeking temporary work, or by doctors from overseas. The quality is variable, and there may be a total lack of supervision. .. There lies the tragedy: inexperienced doctors go into the positions and the hospitals don't make too much of an issue. ...
(This does not appear to accord with Paragraph 40 of the GMC's
Professional Conduct and Discipline: Fitness to Practice,
1993 [Delegation of medical duties to professional colleagues]: ..doctors.. engaged in private practice on either a part-time or a whole-time basis, should seek to ensure that proper arrangements are put in hand to cover their own duties, or those of their junior colleagues, during any period of absence, by doctors with appropriate qualifications and experience. Consultants and other senior hospital staff should delegate to junior colleagues only those duties which are within their capabilities. [This important provision was largely omitted in the GMC's 1995 update entitled 'Duties of a Doctor''Good medical practice.'])
The article continues Dr Singer believes that all private hospitals should insist that their doctors attend courses in advanced life support. If the Department of Health isn't going to monitor private hospitals, this would be a step forward. If a hospital cannot assure people that they have someone on duty at all times who is trained in life-supporting techniques, they should go elsewhere..
Dr. Phil Hammond, in
Trust Me, I'm a Doctor
(1999): 'Private hospitals are not the best places to be in an emergency.. I worked in one private hospital where the cardiac arrest trolley consisted of a bottle of port and the death certificate book. The protocol was that if critically ill patients were spotted in time, they should be transferred to the nearest NHS ICU. But it's hard to hit the help button when you're critically ill and most of the deaths occurred very privately indeed.' Another example: 'Private hospitals do now have resuscitation equipment and a few even have their own intensive care units - but not always the staff to use them. Surgeons insist on doing major operations in isolated Georgian buildings and then going home for dinner, leaving a single inexperienced junior doctor and three agency nurses to cover the entire hospital. A few years ago I met a New Zealander who was that doctor, and was horrified to find that when one patient started to choke after a neck operation, no one knew how to intubate her. She died well before her consultant was out of his pyjamas.'
Letter to BBC, Sept 1999, from 'Dr. Richard': 'I'm a doctor. I've worked as a locum in several private hospitals over the years and would not send any member of my family to one.. I would not recommend a private hospital to anyone for inpatient treatment. Corners are cut everywhere with little, if any, regard for safety. Stick to the NHSit's a lot safer.'
On teams in the NHS:
The Guardian,
15 Dec 92, John Illman: Writing recently in the Guardian, a consultant cancer specialist told how she became the fourth consultant looking after an elderly, dying patient in a private hospital. She recalled: As so often in private work, there were no clinic notes available. Each consultant had filed his own case summary in his own private system. He needed treatment on a machine rarely available in a private hospital. He needed care from specialist nurses used to talking with frightened, dying patients. He died quite soon, before he could be transferred, pain controlled by drugs, to the NHS oncology unit. It was a posh death, but a sad and lonely one.
How does this differ from the NHS? This relies on medical firms or teams. There is: The newly-qualified houseman, who writes up practical case histories for everyone's use as he builds up skill, turning himself into a safe pair of hands. The senior house officer, who is taking a series of posts introducing more specialised work, while studying for membership of a Royal College. He knows about the latest tests and remedies. The registrar, who is working in his chosen speciality. He is responsible for clinical organisation and for diagnosis and treatment. He keeps his seniors fully informed and should know when to seek their help. The senior registrar is by now a Royal College fellow who can quote the latest research and keep abreast of new treatments. The consultant has overall responsibility with tough decisions about resource management. The sister or charge nurse is a specialist in his or her own right: a support for both junior medical staff, nurses, and, most important, patients. The staff nurses are developing specialist knowledge and are highly skilled in practical tasks. This is the team I would like if I am seriously ill.
BBC,
Here and Now,
Dr Roger Clements, editor, 'Clinical Risk': [In a private hospital] you are usually consulting a doctor who is a specialist in one subject and who does not have a team of doctors around him. Contrast that with the NHS, where there will be a team of doctors: a consultant at the top, and two tiers of junior doctors underneath him. BBC: That team includes a Registrar who will often have a better grasp of general medicine than his boss, the specialist consultant. Roger Clements: When something goes wrong in the [NHS] system the Registrar, more recently qualified, with a general background of medical and surgical knowledge, more up-to-date and more alive than that of his boss, is much more likely to spot it, and I think that that system protects the patient in the NHS.
AVMA, Feb 99, submission to the Commons Health Select Committee Inquiry into the regulation of private hospitals: The evidence from the cases that AVMA has dealt with suggests that the present system of RMO clinical cover is woefully inadequate. Unless the independent sector is going to provide hospitals which mirror the staffing and facilities offered by some of their NHS counterparts, it is difficult to see how the independent sector can provide the standard of in-house expertise necessary to cater for the needs of a diverse patient population.
And Caroline Buckley, APROP oral evidence to Health Select Committee, March 99: "I think it is very important within new legislation if hospitals could be graded according to the cases they can look after."
And Prof. Felicity Reynolds, Obstetric Anaesthetist: There is absolutely no doubt that when things go wrong you're better off in a well-staffed large NHS hospital.
And Arnold Simanowitz, Chief Executive, AVMA,
Meridian TV,
14 Aug 98: As soon as something goes wrong, patients are more at risk in the private sector than they are in the public sector. And the reason for that is obvious: because the private sector doesn't have a 'team' in the same way as a hospital in the NHS will have. Very often something can go wrong and there isn't even a consultant on duty.
(On teamwork in private hospitals, an Independent Healthcare Association statement in
Here and Now
claimed that team work in their sector is as good as in NHS hospitals, if not better, because patients are given the personal attention of their consultant.)
Hospital Doctor,
20 Aug 98, Dr E Walker: Cock-ups happen everywhere. If people think they will avoid them by going private, they are wrong. And at least in an NHS hospital there will be someone immediately to hand..
Hospital Doctor,
18 Feb 99, Dr Walker: ... The private hip replacement, who gets a deep vein thrombosis and is admitted to an NHS ward... the gastrectomy patient who needs an intensive care bed after having their operation done.. at a local private
clinic. ... Who has to foot the bill when any of these has to receive life-saving treatment? Me and you, mate. That's who. [Back to Notes...]
Nurses, and the UKCC (UK Central Council for Nursing, Midwifery and Health Visiting)
On nurses in private hospitals, Prof Maureen Lahiff formerly of the Royal College of Nursing (
Private Grief
): ML: It's very difficult for nurses to challenge the consultant's management of a particular case, unless they have a very good working relationship, or unless the management of the hospital is willing to support the nurse. Interviewer: Do hospitals support the nurses? ML: Not always, no, and of course the possible outcome of that is job insecurity. Interviewer: So the nurse might actually lose her job if she complains? ML: Yes. Interviewer: And does that happen? ML: Occasionally, yes.
Prof. Davenhall in
Don't Stay the Night
: .. what the doctor says, goes. The nurses will respond to that. So the ordinary rapport that exists within the public sector, where people will question each other, healthily, does not exist in the private sector.
On nurses' expertise, Prof. Davenhall: The traditional nursing in the NHS.. really is directed at specific areas of care, so that a [e.g.] .. medical nurse or a surgical nurse.. would have a particular area of expertise, but in the private sector the nurse is expected to be able to nurse any condition that is admitted to the hospital. .. The only thing that's wrong is that she is not trained to do that.
And (a doctorpersonal communication 1992): Nurses attracted to the pay and conditions of private medicine are often not
au fait
with emergency treatment.
And
Guardian
27 May 97: She [Prof. Davenhall] carried out a survey of the nursing staff in all the hospitals [the thirty private hospitals of BMI, now BMI Healthcare] and found that most had no qualifications beyond the basic SRN, yet had more resting on their shoulders than in the NHS, because of the smaller number of doctors at night. There was poor medical supervision, particularly at night, said Prof Davenhall, who has now left BMI.
And
Health Service Journal
11 March 99: .. AVMA says inadequate specialist medical and nursing cover is a critical factor in failures to diagnose post-operative complications at private hospitals. It says such errors are an inevitable consequence of the way private health services operated and their small patient populations.
Dr Michael Crow, letter to BBC, Sept 1999: I have long advised that it is inappropriate to use private hospitals for major procedures as they do not have adequate nursing staff (or indeed continuity of nursing staff) as well as totally inadequate medical cover out of hours.
And Baroness Nicholson on BBC Radio 4
Case Notes
, 16 Nov 99: "I've had hundreds of letters from other families and I've discovered that private hospitals do have a grave shortage of regular staff - they seem to rely upon different agency staff so these different nurses come and go and come and go, and many of them are not necessarily trained in different hospitals for the particular wards they are put on, for the particular specialties.." A month later, she said in a House of Lords speech, 13 Dec 99: "A doctor wrote to me: 'In my experience many of these private hospitals are badly run and.. some of the consultants working in them are not at all mindful of their post-operative responsibilities. In many of these private hospitals the nursing care lacks continuity and is haphazard, the management relying upon temporary, agency and stand-by nursing staff. There is a complete lack of communication between the different shifts and between the nurses and the consultants. I have seen auxiliary nurses doing the work of staff nurses and sisters'."
And Tim in a letter to the BBC, Sept 1999, after
Panorama
feature on private hospitals: I am a London intensive care nurse with four years' NHS experience and would not dare or desire to set foot in a private hospital for either work or treatment purposes. It is common to hear nurses who have worked in London's private hospitals talk of their amazement and frustration at the lack of support and guidance available from medical teams who are represented by doctors who are not at all accessible. This would not happen in NHS acute care settings. Why is it so difficult for private hospitals to support teams of acute care and surgical nurses? [Because (i) it's bad for profits, and (ii) most patients haven't got a clue - RE]
And Journalist Anna Blundy, describing her sick infant's nursing care at London Portland private hospital,
Daily Telegraph
, 17 Dec 99: 'We had aready had some terrifying experiences with the night nurses at the Portland. There are no laws governing clinical care in the private sector, and it appeared to us that many of the Portland nurses had obtained their qualifications abroad and that these qualifications in no way matched what we in the UK anticipate.. Three of the nurses did not know what the oxygen saturation machine attached to Lev's foot was for. One of them did not know the English for oxygen, mask, nebuliser, drip or bottle.. I buzzed the nurse to tell her that one of the machines was not working. She checked it and said it was.. She called in two of her colleagues and they all agreed it was working. A fourth nurse from another unit eventually appeared and fixed the machine.. Dr. Rosenthal from the Royal Brompton and Harefield NHS Trust: "The standard of nursing is generally higher on the NHS".'
And Journalist Polly Toynbee,
Guardian
, 25 Jan 00:
'The private sector poaches and adds to the serious shortage of nurses and doctors instead of relieving pressure in the NHS.'
More on the UKCC, the nurses' regulatory body, and its limitations below
. They should, but don't, monitor such inadequate nursing practices. [Back to Notes...
]
Dangerous Technical Staffing Practices Daily Mail
, 26 April 1999, reported a hospital technician's claims that she was asked to play a key role in laser operations after just six hours training [at the £300-a-day Mount Alvernia private hospital in Guildford, owned by nuns of the 'Congregation of Franciscan Missionaries of the Divine Motherhood']. She claimed that her training was inadequate and that this could have endangered patients. 'I hadn't even seen the laser manufacturer's manual during the training', she claimed. 'On the last day of my training they had people booked in for operations, for which they were paying four-figure sums, and they just wanted me to get going on them'. She 'claimed she had never been asked to perform anything so dangerous in her 22 years as an operating theatre technician. Her solicitor, Paul Gilbert, said his client's case could be the tip of an iceberg. 'I'm very concerned about the issues the case raises with regard to safety in hospitals in the private sector,' he said.'
Baroness Nicholson (House of Lords, Third Reading of Care Standards Bill, 13 Dec 99): "A nurse wrote to me following the Panorama [TV] programme.. She said she found that worrying circumstances still existed.. with regard to staff vulnerability.. she wrote: 'The situation I refer to is that of surgeons who arrive to carry out major surgery and rely upon the theatre staff to act as their assistants. Major surgery such as hip replacements, spinal operations, major abdominal surgery..all carried out virtually single-handed. In the NHS the consultant would expect to have at least one if not two or even three assistants for such operations. And they need them. Good assistance is crucial to the speedy and efficient execution of such surgery. Making do with nurses.. is just not the same.'"
Dr 'P' in his report [see section 'Restrictive Practices']: 'Lack of proper theatre assistance in private hospitals. Many specialists will operate alone with no assistant surgeon. They often operate assisted by a scrub nurse. This situation applies even for major surgical cases.
In the NHS they would be assisted by another doctor or a team. Patients are at risk if a case is particularly difficult, or the doctor suddenly falls ill in the middle of an operation.'
Steve McCabe MP, House of Commons, 18 May 2000: We should be concerned about the fairly substantial numbers of people who are transferred to national health service hospitals following failed treatments or procedures originally carried out in the private sector. Many of the operations are quite substantial. If they were carried out in the NHS, the consultant would be supported by three or four assistants, but in private hospitals he often performs operations without their help. It is probably no great surprise therefore that so many errors and mistakes arise. It seems to me that that is another are ripe for some degree of regulation. [Back to Notes]
Cherry-picking
On 'cherry picking', cf. John D Ward, Professor of Diabetic Medicine at Sheffield University (
Guardian
7 Feb 1994):- '.. easy predictable surgery, the bread and butter of the private sector. Their costs are low because they leave the management of chronic [i.e. where the condition may not improve with timeRW] disease, the elderly and the complex costly surgery to the health service, while using staff trained .. at the taxpayers' expense. .. when.. on occasions, a surgical patient develops a serious complication in a private hospital and requires intensive care.. this costly patient elects to use the health servicethe good, safe, free health service. ..'
Health Service Journal
, 8 Apr 99, Dr D Crosby, Honorary Consultant and Chair, Cardiff Community Healthcare Trust: The private sector [undertakes] 20% to 30% of all elective surgery in the UK by 'cherry picking' commercially
attractive and effective treatments, leaving the NHS to deal with the mass of incurable and uninsurable chronic illness. [Back to Notes...]
Facilities, Equipment, ICUs, Resuscitation
On private hospitals not always having adequate facilities and equipment for treatment and emergencies, Dr Vernon Coleman: .. if you go into an NHS hospital the doctors and nurses looking after you will have access to some of the most sophisticated medical equipment in the world. And if the specialist looking after you doesn't have something he needs, then he will be able to refer you to a specialist elsewhere.. In a private hospital, however, the specialist will not have access to such a wide range of important and potentially life-saving equipment. And he certainly won't find it as easy to refer you to a specialist working in a better-equipped NHS hospital.
And
Sunday Times
2 Aug 1998: Roger Clements, editor of Clinical Risk, published by the Royal Society of Medicine, said private hospitals needed to develop broader expertise and stocks of equipment to become safer.
And Sir Richard Bayliss,
BMJ
21 May 1988: Unbeknown to the patient things may go wrong and the independent hospital lacks the necessary facilities.
Baroness Nicholson, House of Lords, 13 Dec 99: "Many of the intensive care units should not be called 'intensive care units' in that they do not have the necessary resident anaesthetist or highly qualified staff. The risk to patients in many of those private hospitals rise so inexorably that patients lose their lives unnecessarily or unnecessarily early.. a nurse wrote to me, stating: 'My experience with Intensive Care in the private sector led me to resign my post within 3 months as I felt sure that one day I would inherit a disaster.. the permanent staff working in the high dependency unit were virtually all untrained and had little concept of the implications of accepting responsibility for their sick patients'."
A delegate at APROP's inaugural meeting, whose business was medical equipment supply, stated that it's common practice for private hospitals to buy second-hand equipment.
A hospital consultant who works in private hospitals (letter to BBC, Sept 1999): It is a myth that private equates to better equipment. For many years, until a recent upgrade, I used equipment that I would not use on my pet at a private hospital, whereas my NHS practice had relatively state-of-the-art equipment.. the true state of private medicine [is] an accident waiting to happen.
On 'crash' teams and 'crash' trolleys, cf.
Sunday Times
21 July 1985: Private Hospitals Call for Watchdog by Brian Deer: .. more than half of the 190 private hospitals have no doctors on the premises at night and almost none has resident anaesthetists. NHS hospitals generally have 'crash teams' of a senior doctor, an anaesthetist, and two junior doctors on 24-hour emergency call. Even private hospitals with heart units and doing major surgery, such as the Princess Grace in London, manage emergency cover with only one doctor and nursing support. But providing for resuscitation with this number is condemned by the medical profession because an anaesthetist is needed... It is very hard to handle a patient single-handed said Dr Peter Nixon, a consultant heart specialist at Charing Cross Hospital. You could dispense with one of the people, just as you could dispense with a wheel on a four-wheeled car.
Don't Stay the Night
(1997): Dr Mervyn Singer, UCL Hospitals NHS Trust, referring to a fatal 1995 incident in the Princess Grace hospital where the services of an anaesthetist were required, In the NHS, there would be, in addition to a physician who would lead the resuscitation team.. also an anaesthetist who would insert a tube into the patient's windpipe to administer directly oxygen into the lungs.
Hospital Doctor
, 20 Aug 98, Dr. E. Walker, A&E doctor, Dewsbury Hospital, W. Yorks., in a piece entitled 'Dangers of Care outside the NHS':- 'There is a private hospital near to where I grew up. Some years ago, when it was staffed by Irish nuns but was taking in seriously and acutely ill patients, a friend did some nursing shifts there. She asked what the cardiac arrest procedure was. With a quizzical expression, the matron removed her chained half-moon spectacles and rested them on her matronly bosom. 'Sure and we just dial 999, dear.' And they did. Anyone who arrested there was taken to the nearest NHS hospital. They have a resident doctor now, but only a couple of years after this story someone having a hip replacement there arrested on anaesthetic induction. He was transferred to our intensive therapy unit, dead on arrival. He had been dead some time.'
The patient is often ferried to the nearest NHS hospital for treatment..:- There are innumerable references to this practice; e.g.
Guardian letter 21 Feb 1992, Usually the private sector transfers serious problems to the NHS as they do not have full medical emergency cover. AVMA (Action for Victims of Medical Accidents) Report, 1992: Medical accidents are not restricted to the NHS. We have experienced a marked increase in the number of cases arising from the private health care sector, ranging from cosmetic surgery being performed by non-specialists to deaths occurring after routine surgery. .. cases arising in the latter group often reflect a lack of in-house facilities and/or suitably qualified staff to monitor and treat post-operative complications... BMJ lecture by Sir R I S Bayliss, 21 May 1988: It is not uncommon to move before the operation a surgical patient with perceived anaesthetic or medical risks to an NHS pay bed or another independent hospital where there is intensive care. 1992 correspondence with a doctor: Private hospitals have no casualty departments. All on-site emergencies (if they are spotted behind the closed door of a side room) are ferried across to NHS hospitals, who have to pick up the tab for treatment. Independent Medical Care journal, Sept/Oct 1986, Gordon Craig (of the trade union ASTMS) writing when many hospitals were being planned and built, ..it is not without [sic] coincidence that many commercial hospitals are situated in very close proximity to large acute NHS hospitals... Too often the patient is rushed from the commercial to the NHS hospital when things go wrong. Private Grief, 1992: Dr David Bihare, Director of Intensive Care, Guy's Hospital: Since I went into intensive care back in 1981, I can remember many cases coming from the private sector, because essentially the private sector could not cope with the severity of illness in these patients.
Unsurprisingly, the glossy brochures for private hospitals (and for medical insurers) generally avoid or are vague about such topics. The Labour Party in
Going Private
1994:- As the market has become more competitive, irresponsible marketing and [health insurance] advertising campaigns have proliferated. As one would expect, these often engage in virulent campaigns against the NHS, but rarely illustrate the limitations of commercial cover.
On the use of NHS ICU facilities for private hospital emergencies/complications, Channel 4 news (6 Feb 98): Emma's case [see below] typifies the concern of a number of NHS consultants that many private hospitals have become over-reliant on the NHS, especially for intensive care backup. Dr Peter Nightingale, Intensive Care Society, states: The .. problem is that intensive care is a very scarce resource, and it's hard enough to get your patient in your own [NHS] hospital into an NHS ICU bed without having to import them from other peoples' hospitals, certainly private hospitals. Channel 4 news: One particular concern is that if private patients are unexpectedly moved into NHS intensive care beds, NHS operations may be cancelled or postponed which would only serve to lengthen waiting lists.
Former Health Minister Baroness Jay: Private medical insurers are quick to point to the alleged deficiencies of the NHS when selling their policies, but many are just as quick at moving patients to the NHS as soon as problems occur.
Sunday Times
, 11 April 1999, Botched Private Surgery Patients Take NHS Beds, Richard Ennals: The reason [there are] all these emergency transfers is that private hospitals are doing operations when they are not [always] equipped to deal with the potential complications
Independent
3 Jan 00, Dr. Ceri Brown, Intensive Care Unit, North Manchester General Hospital, letter: 'Sadly, the problem of the availability of NHS intensive care beds is exacerbated by the private sector. An intensive care admission, costing approximately £1,000 per day, is incapable of generating a sufficient 'return' for health insurance companies, who limit such claims to a maximum of three days' stay only. After this period, patients must fund themselves. Understandably, patients are often transferred to the NHS for further treatment, which puts extra pressure on a scarce resource.. the taxpayer contributes unreasonably to the profits of the health insurance companies.'
Good Housekeeping
April 2000: Dr.Carl Waldmann, Clinical Director of ICU at the Royal Berkshire NHS Hospital in Reading: 'We have between 60 and 100 days a year when private patients are occupying beds in this ICU. Each bed costs in excess of £1,500 per day, which equates to around £100,000 a year. That would pay the salaries of six nurses. How can it be practical for private insurance companies to say to patients, "We'll take your money and insure you, but if you become very ill the NHS will have to take over".'
And on BBC
Panorama
, 20 Sept 99: "If we are full up in our ICU it can have all sorts of repercussions. For instance, if it is our last bed, it may mean we cancel an elective procedure on an NHS patient the next day or the day after. It may mean we have to transfer patients to other ICUs if we're full. So there is some degree of embarrassment to the NHS by us taking these patients."
And on BUPA sometimes refusing to pay: "I and all other ICU doctors are livid.. it would be a very small percentage of their turnover and it would help us keep extra beds open." And Prof John Ward on ICU transfers: "...I think this is a factor that upsets quite a lot of doctors working in the NHS."
Baroness Nicholson on
Panorama
: "I find it repugnant that NHS beds should be used as a final resource by the private hospitals who see themselves as being able to cope and yet demonstrably cannot. I don't see why the NHS resources should be leached away in this way."
In
Private Grief
1992, Arnold Simanowitz of AVMA said: It's all very well to say that patients can go and choose their healthcare, but patients don't know very often that what they're choosing is not the best. .. We've seen many cases where something has gone wrong in a private hospital and there hasn't been the equipment to deal with it. I think that mainly private hospitals can deal with the routine, simple operations where nothing goes wrong. When something goes wrong, then they very often end in serious trouble.
And: Interviewer: "How can the client of a hospital find out whether they are in safe hands?" John Scurr, Consultant surgeon: "I don't think you can... you're referred, hopefully by your GP to someone he trusts, .. you're solely reliant on the judgement of the surgeon who's going to operate on you.. I personally wouldn't operate in a hospital that didn't meet my criteria, both in terms of their equipment and in terms of their medical staffing." Interviewer: "Have you come across cases [in private hospitals]and you've read manywhere that equipment and staffing have not been adequate?" JS: "Yes. We do see cases where facilities have been really quite inadequate."
And:
Observer
1 Feb 98: .. as one consultant put it: "I would know which private hospital is OK, but you wouldn't."
Guardian,
10 Oct 98: .. If you were to stagger into any private hospital spilling blood on their carpeted atrium, the receptionist would summon security first and then call you an ambulance. At least one or two NHS hospitals still have a casualty department.
Channel 4 TV
Powerhouse
, 5 Mar 1999: Samantha Ryb (see case list below): "I think people are very much misled into thinking that when they go privately, because they can choose their consultant, they are getting the best of treatment. What they don't realise is that when something goes wrong they are not."
Judith Milne, NHS Private Patient Managers Forum, speech to the 1996 Annual Acute Healthcare Conference: These 'facilities' or trappings [the TV and furnishings of a private hospital] are hardly going to help the patient who takes a turn for the worse, and has to be rushed to an NHS hospital as an emergency in an attempt to save his life. To add insult to injury, when this situation does occurand believe me, it does occurthe NHS is expected to pick up the bill for this emergency treatment.
On private hospitals not having 24-hour anaesthetists' cover for resuscitation, the Royal College of Anaesthetists publishes its
Guidance for Purchasers
(i.e. of anaesthetic services) which includes e.g. recommendations on resuscitation, such as The typical resuscitation team includes an anaesthetist and a physician, both of SHO or Registrar grade. ... The cardiac arrest team should always include an anaesthetist who is available 24 hours. Typically, this is the same anaesthetist who is resident on call for the ITU because he or she is likely to be available and will be responsible for the patient's post-resuscitative care. ... the patients can be particularly challenging and if this person is relatively inexperienced .. a more senior anaesthetist should be quickly available (10-15 minutes). ...
Daily Mail,
9 Dec 98: One reason that Ministers refused an offer of beds from the private sector before
last winter was because they feared emergency care might not be up to NHS standards. [Back to Notes...]
NHS Waiting Lists and Private Hospitals
BBC Radio,
You and Yours
, 31 Mar 1999: "It's no wonder the NHS waiting lists are so long, say critics. The average NHS surgeon operates on patients less than one day a week.. Research indicated the problem [of the length of NHS waiting lists] could stem from pure greed. One half day in private practice can double an NHS salary." The Consumers Association: "We found that on average the consultants [in a survey] were setting aside over two half days a week for private patients.. it's hard to see how they can fulfil their NHS commitments and do this amount of private work each week.." BBC: "Their findings supported a major study by the Audit Commission. It found evidence of a clear trade-off between NHS and private work. 25% of consultants who did the most private work did less NHS work than the rest. It also backed earlier research by Dr John Yates of Birmingham University who found specialties with the longest waiting lists were also the main and the most lucrative areas of private practice." Professor Donald Light, international healthcare consultant from the University of Pennsylvania: "There's a real lack of accountability and this fundamentally has to change.. very large numbers of surgeons are operating less than a day or even less than just a morning a week on NHS patients." BBC: David Hinchliffe [Health Select Committee Chairman] says if the government is really to grips with the issue, it needs to understand the problem lies at the very heart of the NHS."
Independent
, 12 July 1999, Dr Vernon Coleman: "Consultants who do things privately have to have an NHS waiting list, otherwise who would want to see them privately?"
Guardian
, 26 Jan 00, Polly Toynbee: 'New research from Bristol University shows that wherever doctors move into the private sector they create the demand as they go, not vice-versa. Hardly surprising since they also control demand through their own NHS waiting lists. The Audit Commission tells the obvious truth that doctors who do more in the private sector do less in the NHS.'
Sunday Times
19 Mar 00, in a piece
NHS surgeon dismissed for doing too much private work
: 'Michael Gray, a surgeon in Kent, has become the first hospital consultant to lose his NHS job for spending too much time with private patients.. he was found [
inter alia
] to be working in a nearby private hospital when he was meant to be on call for the NHS.. The case.. will send shock waves through the country's 20,000 hospital consultants, many of whom have substantial private practices.'
Independent
30 Sept 99, Dr. Vincent Argent, letter: '..the main driving force for private healthcare is the existence of waiting lists in the NHS. It would be hard for consultants to deny that their private income benefits greatly from waiting lists and it may be in their interest to accumulate a waiting list in the NHS. A professor of anaesthetics once remarked that appointing a new surgeon never reduces waiting lists and that the amount of surgery performed expands to fill the time available.'
Daily Telegraph
17 Dec 99, Dr. Helen Jackson, letter: '.. most doctors who work in the private sector are contracted to work in the NHS. The more private patients they see and treat, the less time they spend in the NHS hospitals. There would be much shorter waiting lists if all doctors contracted by the NHS completely fulfilled their contract.'
Consultants also sometimes take NHS junior doctors to assist at private hospital operations, worsening the situation.
Hospital Doctor
27 May 99: 'BMA Junior Doctor Committee chairman Mr. Nizam Mamode claimed juniors were frequently asked to assist at operations in private hospitals with little training benefit. "The trust is losing the junior doctor for that periodthey are effectively lost from the service" he said. He also said accused some consultants of frequently asking their specialist registrars to carry out their fixed commitments in order to carry out private practice.'
Guardian
29 Oct 97, Prof Donald Light: 'You have a sweetheart contract guaranteeing light, vague duties for a life sinecure of £45,000.. and the right to earn about ten times as much per hour on as many patients as you can persuade to relieve their pains and fears by paying private fees. You control the waiting list, which isn't a list or queue at all, but a pool of sick and disabled patients trying to keep their heads above water as you pluck out a few a week.. So you control which patients, needing which operations, wait how long.. if NHS surgeons operated just two days a week, waiting lists would plummet to the levels of waiting times for private patients.'
Long NHS waiting lists are also necessary for the £2 billion private health insurance industry to attract new customers. In fact, this is the main selling point in their advertising. Thus, a BUPA insurance advertisement in the
Times
, 27 July 1999, reads: 'Take the wait off the NHS. As you read this over a
million people are waiting for an operation. And that's why around three million more put their trust in BUPA. BUPA membership enables you and your family to benefit from prompt treatment and private care.' [Back to Notes...]
Children
On children in private hospitals,
Health Service Journal
, 6 May 1999: Clearer guidance is needed on the care of children in private hospital beds, the Commons Health Select Committee has been told. Royal College of Nursing consultant Sally Tabor told the committee that the RCN was concerned that very young children were receiving unnecessary surgery, and that there was a lack of suitable staff and equipment to care for them properly. The RCN wrote to the Department of Health raising concerns in 1997, and was told: Standards for the care of children in private facilities [including] in a private hospital, are not the concern of this department. And
Nursing Times
, 5 May 1999, RCN policy director Pippa Gough said to the Committee: We hear stories about poor care standards and non-skilled staff taking a nursing role with children. We also hear about nurses who complain, being asked to leave their jobs.
Hospital Doctor
, letter, 5 Nov 1998, Dr G Evans-Jones, clinical director, women's and children's services, the Countess of Chester Hospital trust: I have always found it ridiculous that we [in the NHS] have made progress in recent years to ensure children having surgery are nursed in children's wards by paediatrically-qualified nurses under the supervision of paediatricians, operated on exclusively children's lists by surgeons with regular experience in children's surgery, and anaesthetised by similarly paediatrically trained anaesthetistswhile
at the same time in the private sector these requirements are often completely ignored. [Back to Notes...]
Restrictive Practices
We haven't considered the question of the restricting of the numbers of consultants by the Royal Colleges. A confidential report,
Restrictive Trade Practices of the Medical Royal Colleges
(1997), by Dr KP, has been sent to MPs, MEPs, and EC Commissioners. We have a copy. It deals
inter alia
with the effects that the limiting of the numbers of consultants has on the length of NHS waiting listssomething invariably omitted from newspaper reports. It also investigates whether Statutory Instrument No. 3208, 1995, was drafted with the help of British medical officials, and whether, whilst claiming to enact EC legislation concerning the free movement of doctors in Europe, it was actually designedfor reasons of financial self-interestto obstruct EC-accredited specialists from British private practice.
On consultants, a doctor (personal communication, 1992) stated You need to be an NHS consultant to practice private medicine, and no-one can be in two places at once. We have less [sic] doctors per head of the population than any other country in Europe partly because, whilst private medicine has remained a cottage industry, each consultant has wanted a fair slice of the cake and numbers have been limited. Consequently, everyone else has to work 100 hours a week to keep the NHS afloat.
Private Eye,
July 1992: The eagle-eyed European Commission took a mere fifteen years to spot that a 1977 law to ensure fully-qualified doctors could practice anywhere in the community was being flouted in the UK. .. The royal colleges, the BMA, and the GMC have long been running a secret cartel to ensure that only suitable (i.e. UK-trained) applicants receive UK accreditation or progress to consultanthood. Since the vast majority of private health firms only employ consultants or UK-accredited specialists, this restrictive practice has conveniently sewn up the private market too. .. Britain boasts fewer consultants per head.. than any other country in Europe, ensuring NHS waiting lists are the longest in Europe.. and forcing patients into the private sector, where the relatively few consultants divide the spoils. .. Competition for consultant posts is so fierce that junior doctors continue to work inhumanely and without supervision to protect their references.. Although UK accreditation is not essential to become a consultant, its absence is a useful spoiler to prevent overseas or otherwise unsuitable doctors from progressing too far or muscling in on the BUPA jamboree. However, European law decrees that EC-accredited specialists should have been on an equal footing with their UK colleagues since 1977, and both the commission and the Office of Fair Trading may well decide that UK accreditation, and hence consultant selection, are illegal. .. The outlook is now so dire for a wilfully fraudulent medical establishment that meetings between it and the Department of Health are held in private with all parties sworn to secrecy. Independent observers, such as the Hospital Doctors' Association, (a prime mover in calling for restructuring of medical training and an end to the one man, one reference patronage system) have sadly been excluded. Whether the threat of litigation stops consultant election committees overlooking the best applicant in favour of the right sort of chap remains to be seen.
Independent,
30 Jun 98,
Doctor to challenge medical hierarchy
: A consultant anaesthetist.. is to challenge the "closed shop" run by the medical royal colleges which have refused him consultant status in the UK. Dr Richard Kaul, who qualified as a doctor in Britain before moving to work in the US, alleges that the system for admitting doctors from overseas to the register of specialists who can apply to be consultants is shrouded in secrecy and operates unfairly and arbitrarily.
Independent,
9 Aug 99, letter from Dr D Bell: '.. In a competing market for private practice, reluctance to increase consultant numbers at a local level has often come from the consultants themselves.'
Hospital Doctor
23 Sept 99, letter, Prof Wendy Savage, senior lecturer in obstetrics and gynaecology, St.Barts: 'Manpower in the NHS has been a lamentable failure. For too long the UK has taken doctors from third world countriestrained at their expense, not oursand used them to make good NHS deficiencies. The profession's leaders have not been wholeheartedly behind expansion of medical students and consultant posts and one can only speculate that this has something to do with lucrative opportunities in private practice, mainly in the Southeast where the British Medical Association's headquarters is situated.. A full-time contract without private practice.. is long overdue.'
Dr Andrew Vallance-Owen, Medical Director, BUPA,
Clinical Risk
: The system should be transparent and equitable to comply with the European legislation on free movement of doctors.
(Note: Another consideration relevant to consultants is the division between academic specialists, for example professors, and the applied, clinical, specialists. The former may have pet theories, or simply follow modern theoretical errors, which the unfortunate latter may have to try to put into practice. This happens with
all diseases which are not understood; 'AIDS', arthritis, Alzheimer's, multiple sclerosis, schizophrenia, Parkinson's, cancer... - RW) [Back to Notes...]
Overtreatment etc.
We haven't considered either the questions of superfluous treatment, overtreatment, and ineffective drugs, nor the issues involved in controlled trials of effectiveness of techniques.
In 1979, Prof John B McKinlay commented on a US Senate investigation which reported that 2.4 million unnecessary operations were performed annually in the USA, causing 11,900 deaths. (From e.g.
Health Shock,
Martin Weitz, 1980, pubd David & Charles, a guide to useless, unnecessary and hazardous treatment).
Not much has changed. In Britain, John Yates in
Private Eye, Heart and Hip
(1995) pp. 57-59 on the 'top ten' surgical procedures (a quarter of all operations) comments on numbers 4, 5, 7, 9, and 10, which are curettage of the uterus, surgical removal of teeth, removal of tonsils, hysterectomy, and drainage of the middle ear. Yates' comments include a
BMJ
leading article describing curettage as diagnostically inaccurate and therapeutically useless, removal of tonsils described as discretionary ('It is over 50 years since Dr Glover graphically told the story of huge variations in tonsillectomy rates..'), claims that at least one-third of all hysterectomies.. are unnecessary and a
BMJ
leader in 1993 describing the growth in the number of 'glue ear' operations with 'grommets' as an epidemic.
Yates adds: In fact, few of the operations listed in the top 10 can be classified as carrying a high degree of scientific approval.
(More evidence from Britain: Over treatment is the norm... many patients are given unnecessary X-Rays, blood tests and ECGs (at a grossly inflated price). (from a private letter from a doctor, 1992). And Dr B. Webb, Chairman, Medical Advisory Committee, Pinehill private hospital, letter,
BMJ
19 Sept 98: I would suggest that unnecessary operations [in private hospitals] are a problem, some being performed by doctors who have had only basic training in the techniques while they were passing through a specialty.)
(On ineffective drugs, the Professor of General Practice, Prof. Jarman, now Sir Brian, in a lecture on 23 Oct 1995 claimed there must be 10,000 although he was including those not proven effective in controlled trials. As an example, he cited patients with ulcers who asked for Zantac, which they'd heard of through advertising, but if I were to prescribe an equally useful drug, cimetidine,
we could actually save the cost of more than one health authority per year, just by changing that one drug out of 30,000 we have.) [Back to Notes...]
Costs to the NHS of Private Treatment
Long-term care following complications or accidents: BBC TV
Newsroom Southeast
4 June 1996: Mrs Darley-Jones' case [see below] has concerned public health officials. Although the [procedure] was carried out in a private hospital, she'll spend the rest of her life being cared for by the NHS. When her private insurance ran out, the NHS had to step in. Ross Tristrem, NHS Trust Federation [now NHS Confederation]: Theoretically, if somebody is treated in a private hospital, and then has to be transferred to the NHS, and is there for the rest of their life, then I think that perhaps the NHS should be examining whether they ought to be claiming back the cost of this from private insurers. (
The Observer,
2 June 96: The NHS is now paying £750 per week for her care.)
NHS ICU costs:
Private Eye,
May 1996: Of course, whenever there's a cock-up, patients who survive will be ferried back to an NHS intensive care unit for the taxpayer to pick up the tab.
And Prof John Ward, letter,
Guardian,
7 Feb 1994: .. when a surgical patient develops a serious complication in a private hospital and requires [NHS] intensive care.. [this costs] £1,000 a day..
And four doctors, Lower Clapton Health Centre, London, letter,
Guardian,
21 Feb 1992, Picking up the tab in emergencies: .. the NHS, not the private sector, always picks up the costs of emergency treatment. The costs are huge compared with those of providing planned elective surgery. An NHS hospital may charge more than a private hospital for elective procedures [the reason some GP fundholders send NHS patients to private hospitals] to cover the cost of emergency services.
And Labour, David Blunkett MP, Going Private, Sept 1994: Reliance on the NHSthe independent health sector provides only a limited range of medical procedures and treatment. There is clear dependence on the NHS as a backup for treatment that the commercial sector can not, or will not, provide.
And Channel 4 News, 29 Apr 1999: There are no official figures published on the number of botched private operations, and private medicine doesn't discuss how often it has to depend on the NHS to put things right when it doesn't have the expertise or the facilities to do it itself. But we can say that one thousand times a year an intensive care bed in an NHS hospital is taken up by a private hospital patient.
Costs of staff training, and of equipment and supplies:
Commercial Medicine in London
: Private hospitals depend on staff [doctors and nurses] trained by the Health Service at the taxpayers' expense.. The private hospitals' contribution to post-basic training is.. negligible. [Letter in
Health Service Journal,
15 Oct 98, said It costs more than £200,000 to train [sic] a doctor from scratch. The average for a nurse is estimated at £30,000 (BBC, 1998)]
The authors also state: Generally speaking, it is the private sector that relies on the NHS rather than the other way around. The average private clinic, according to the most recent official figures, has just 43 beds. These clinics are often built near NHS hospitals in order to make use of their services, and certainly to attract their staff. ..
Times,
11 Jan 1990: The private sector relies heavily on health service staff, with 85% of consultants doing some private work.. The National Audit Office reports argued that the private sector had recruited many nurses from the NHS while making only a small contribution to the training of medical and nursing staff.
Health Care in the United Kingdom,
1982: A further argument against the private sector.. is that it is parasitic on the NHS in that it does not bear the cost of training the professional staff it employs. Fifteen years later:
Guardian
10 Oct 98: The public subsidise private medicine. The NHS trained the vast majority of the people who work in the private sector. Many consultants in private hospitals are moonlighting employees of the health service.
Joan Higgins,
The Business of Medicine,
p 188: The basic problem for many health authorities is that they tend to lose staff to the private sector or from those groups whose training is long and expensive (such as intensive care nursing or operating theatre staff). There seems little doubt that in parts of the country such as central London, where there is a concentration of private facilities, this leads to direct and overt competition.
On the effect of private practice on NHS waiting lists: BBC Radio 4,
You and Yours
, 31 Mar 1999: It's no wonder the NHS waiting lists are so long, say critics. The average NHS surgeon [with a private practice] operates on NHS patients less than one day a week. And [Consumers Association added] We found that on average consultants were setting aside over two half-days per week for private patients.. it's hard to see how they can fulfil their NHS commitments and do this amount of private work each week. BBC: The Consumers Association's findings supported a major study published three years ago by the Audit Commission. It found evidence of a clear trade-off between NHS and private work. Twenty-five percent of consultants who did the most private work did less NHS work than the rest. It also backed earlier research by Dr John Yates at Birmingham University, who found
specialties with the longest waiting lists were also the main and the most lucrative areas of private practice. [Back to start]
Notes and References to 3. Key PointsAdministrative[ Advertising | Managers of Private Hospitals | Incidents Specific to Private Hospitals | Poor Record-Keeping and Lack of Statistics | Collusion to Suppress Figures | Lack of Complaints Procedures | Charity Hospitals | Insurance | Registered Homes Act 1984 and Inspection Visits | 'Quality Audits']
Note: the legal system is different in Scotland.
Advertising
The National Consumer Council [set up by government in 1975 to champion the interests of consumers] wrote in its submission to the Commons Health Select Committee: We note that cases regularly appear before the advertising standards authority about misleading claims for clinics and health products. We would welcome examination by the Committee of the extent to which firmer regulation is needed for the advertising of private health care services and products sold on the open market.. The Advertising Standards Authority (Click for their Internet home page
)
does not have great powers, but is at least able to adjudicate on private hospital advertising. (It specifically does not deal with advertisements in journals intended for doctors). To date it seems to have dealt mainly with cosmetic surgery (click for ASA and cosmetic surgery
testimony to the health Select Committee). Possibly this will change if realisation of the misleading nature of some private hospital advertising becomes more widespread, and if the government decides it has other things to do than try to control private hospitals. The Consumers Association in their oral evidence complained: .. much of the information that is available and provided is advertising and promotional information. Consumers are at a great disadvantage if they actually do wish to pursue some questions or to get more information about the services that they are offering.
(Advertisements for private hospitals make fine-sounding but generally vague and unprovable claims e.g 'We are committed to excellence and quality through the provision of healthcare services' or 'We believe our hospital offers care in a class of its own'. A computer search will throw up many examples.
Even the findings of the Health Select Committee and continual adverse media coverage have not deterred Norwich Union Healthcare from its flyer 'Top quality hospital treatment' with a smiling nurse, nor BUPA's claim in a recent
Express on Sunday
Magazine ad: 'Private Medical Cover with BUPA.. offering the highest quality medical care..' -RE). [Back to Notes...]
Managers of Private Hospitals: Should They Take Responsibility? Independent
26 July 99: 'The management of private hospitals also leaves much to be desired. Often more attention is paid to decor, and to achieving hotel levels of luxury, than to standards of treatment and care. Internal controls.. are weak.'
Which
Magazine report on private hospitals, August 1999: '.. we think it's vital that the new regulations ensure that private hospital managers are made legally responsible for all medical treatment carried out in their hospitals.'
Camden New Journal
19 Aug 99, Solicitor Louise Christian: 'The only real deterrent to stopping large companies putting profit before safety and people at risk is the fear their directors will go to prison.' [Referring to railway companies. The same could apply to private healthcare - RE]
John Lambie, Chairman of APROP, speech to the 1999 Annual Acute Healthcare Conference: "People with complaints are treated with callous indifference and the best words to describe the reactions of private hospital managers are procrastination, prevarication and obfuscation. You must learn that the effect of losing a loved one without explanation or apology can have a devastating effect on next-of-kin, extending far beyond the natural grief to be expected in
such circumstances. Their struggle for justice goes on for years, can split families, and cause divorce and bankruptcy. It is no wonder that feelings of many APROP members towards managers in private hospitals borders on hatred."[Back to Notes...]
Incidents Specific to Private Hospitals
See the newspaper montage below, with notes. NB: the paucity of figures makes a full comparative analysis very difficult. International comparisons are even more difficult.
On private practice, the second edition of
The Good Doctor Guide
(Simon & Schuster, 1st edn 1989; 2nd edn 1993) by Martin Page, which lists or recommends medical specialists, and which according to Page was obstructed by both the BMA (which is but a trade union) and the General Medical Council, states: ..we surveyed a sample of over 250 doctors practising in Harley Street. More than a quarter of them were not accredited or qualified in any speciality. Page also states: Of the doctors listed in this edition, only sixjust over 1 per centare in full-time private practice.
Observer
1 Feb 1998: .. few private hospitals are equipped with the intensive care units and crash teams needed to deal with major complications;
if problems do occur, you have a good chance of ending up in an ambulance on the way to the accident and emergency department of the local NHS hospital, where they can pick up the pieces or declare the time of death. .. (NB: This article does not attempt to quantify risks). [Back to Notes...
]
Poor Medical Record-Keeping, and Lack of Statistics Daily Telegraph
, July 1999, David Hinchliffe, Chairman Health Committee on private hospitals report: 'There was evidence that the patient's consultant would take the medical notes away with him. If problems arose the doctor may be an hour away.'
Which?
report on private hospitals, August 1999: 'The hospital and the consultant may each have their own set of records, which also complicates the process. Standards of record keeping also vary and, according to AVMA, are often poor.'
'John Corless [see list of cases] complained to the Wellington and asked for his medical records, which he was legally entitled to see.. these failed to arrive..'
Evening Standard
, 21 July 99, Caroline Buckley, APROP: "Private hospitals still don't collect or publish statistics on things like the number of patients who have to be referred to an NHS hospital as an emergency, which I'm sure would make very shocking reading."
Which?
survey of 26 lawyers specialising in medical negligence revealed that of 300 cases on their books, 163 involved complaints against a private consultant.'
On the lack of information available to potential private hospital users, Dr. Phil Hammond,
Trust Me, I'm a Doctor
(1999): '.. people going private [should be] given all the information that allows them to make an informed choice. Some surgeons do major operations in private hospitals without emergency
facilities or support, and patients should be aware of this risk.' And the
Independent
, 26 July 1999, Andreas Whittam-Smith, former editor, in an article 'Why patients get a raw deal from private health care': '.. customers are often badly informed and obliged to take everything on trust.' [Back to Notes...]
Collusion to Suppress Figures
In
Private Grief,
consultant surgeon John Scurr said: Those cases that are really negligent are settled before they ever get to court, and of course nobody ever gets to know about it. What makes me cross is the fact that we have these cases, there are lessons to be learnt from them, and nobody knows anything about it. They are just dismissed, settled, no records, and I think that's very sad. (Patients who receive out-of-court settlements are sometimes required to sign an undertaking to remain silentactual figures on non-disclosure are unobtainable).
In June 1998, the British government announced that comparative death rates (adjusted for risk) will be published for hospitals in England and Wales. Press announcements used the phrase every hospital in England and Wales. In fact, The league tables will not cover private hospitals. (
Observer
7 June 98). [There is a curious British tradition of exempting private medicine, private education, private clubs, some churches, governmental organisations and so on from legislation. At least, I'm in the habit of viewing this as peculiarly British; in fact, no doubt the same thing applies elsewhere - RW]
The Times,
29 Apr 1993, Margot Norman: When my husband was recuperating after surgery in one of those swanky private clinics near Harley Street, I used to sit by his bed late at night and hear the trundling of trolleys, accompanied by panicky whispering from the staff, as desperately sick Arabs were transferred to the nearest teaching [NHS] hospital with room in its intensive care unit. This always seemed to happen after all the other visitors had gone home, which struck my suspicious mind as convenient. Convenient, also, was the fact that their deaths would be recorded, not at the clinic, but at the teaching hospital.. Private hospitals do generally appear to have a respectable death rate, but that has a lot to do with midnight flits.
Sunday Times,
2 Aug 1998: The Department of Health collects no detailed figures on the performances of private hospitals.
On the General Medical Council's failure to collate information on poorly performing doctors in the private sector, Jean Robinson, in
A Patient's Voice at the GMC
(1988): .. as the Preliminary Screener [of complaints] does not usually provide information on rejected cases, we have no idea how many complaints are received about private doctors, what subjects they cover, and how their numbers are changing.
[The extraordinary atmosphere of dissociation from responsibility within the medical world (and other similar closed groups) is illustrated by this extract from the 1985 autobiography of existentialist psychiatrist R D Laing: '.. He had a patient in psychotherapy with him. A consultant anaesthetist. This patient had led him to suppose (he told him directly, in so many words) that he had killed three people in the last year, while he had been in therapy, by unobtrusively curtailing their oxygen in the course of long, complex, surgical operations. He kept his overall statistics normal.. Anyway, he had had a good run for the last three months or so [and] was now about to kill the next victim. He would choose someone with a bad heart, poor lungs or what not...
... Could this chap simply be having him on? Over the years, all psychiatrists are told some extraordinary stories..
Nevertheless, Abenheimer had become almost sure (how could he be
absolutely
sure?) that his patient was telling the truth. It was fantasy acted out in fact. Now he was asking himself whether he should do anything. ..
After a year of treatment, the existential-Jungian-psychoanalytic psychotherapy
was not working. ...' [Laing goes on to discuss what his best chance was of dissuading the 'patient' - RW] [Back to Notes...]
Lack of Statutory Complaints Procedures
Jay Rayner's
Observer
article 1 Feb 1998: One thing is certain; if he [Owen Ennals] had been treated in the NHS and something had gone wrong, his family would have been able to use a rigorous complaints procedure. They would have been able to convene independent panels to study the case, and could have appealed to an ombudsman if they still weren't happy. The system would have been open and thorough and, even if the Ennals hadn't liked the answers, at least they would have known their questions had been fully considered.
The private sector is a different country; the complaints procedure is anaemic, the regulation flimsy. It took Owen Ennals's wife and son five years to receive any kind of complete report into what happened...
Channel 4 News, 29 Apr 1999: In all likelihood [in fact no figures are available-RE] private medicine makes as many mistakes as the NHS. The difference is that when things go wrong for private patients, they are outside the NHS safety net, up against a multi-billion pound industry. NHS patients can rely on the Patient's Charter, the Community Health Council, and the Health Service Ombudsman. Private patients cannot. The NHS has statutory complaints procedures and an independent review panel. Private medicine has not.
BBC Radio 4,
7 June 96:- Since April 1st [1996], the NHS has operated a streamlined complaints structure which contrasts with the position in private hospitals where the procedures to deal with grievances can be non-existent. .. Barry Speker, lawyer specialising in medical negligence law:- In the NHS.. there is a recognised clinical complaints procedure which patients can take advantage of and ensure that their complaints are properly investigated. Whether a private hospital has one just depends upon the appropriate level of care and organisation of that private hospital. There's certainly no guarantee that either there will be a proper complaints procedure, or that it will be utilised and adhered to by the organisation itself.
Richard Ennals,
Observer
1 Feb 98: Within the NHS, there is a clear, independent, complaints procedure. Within the private sector, you are relying on them to deal with your complaints. And frankly you are up against a commercial concern. You've got the insurers telling the hospital not to say anything. And you've got the hospital guarding their reputation. They know your only [proper] option is civil law, which they also know you won't be able to afford.
Whom does one sue? .. in private hospitals, the patients contract separately with the consultant, who is not employed by the hospital, and the hospital accepts no responsibility.Barry Speker, Radio 4,
You and Yours,
7 June 1996, 'Private Hospitals', said:- With a private hospital, you might be suing the hospital or you may find that you are suing the surgeon or other doctor individually because he is not actually employed by the private hospital.. Mistakes can be made where a plaintiff actually sues the wrong person, and that can prejudice the outcome of the claim.
Channel 4 News, 29 Apr 1999: It was only when they tried to hold BUPA to account that the Carmons [see listed cases below] realised how easily private hospitals can effectively wash their hands of any responsibility and instead blame the doctor responsible. Dr Andrew Vallance-Owen, BUPA Medical Director: .. at the end of the day, in the strict legal sense, liability in this country lies with the treating or investigating doctor. However,
Times
4 Mar 99: Mr Carmon says BUPA should be legally responsible for quality of care as an incentive to raise standards.
Patients Association,
BBC TV Newcastle,
26 Mar 98, quoted in a feature on Christine Maloney: Private health is not publicly accountable. This is wrong. We think all healthcare providers should be accountable to one regulatory body so private and NHS patients can be confident that they can make a complaint and have it heard.
On litigation: by delaying the legal processtime-wasting by supplying incomplete records, not replying to letters for months, not answering relevant questions and so ona skilful defendant's lawyers can hamper the plaintiff's preparation of the casethree years are allowed under the Statute of Limitations to issue writs.
Litigation can be further hampered:
if the hospital or doctors or nurses have tampered with the patient's medical and nursing recordsthere are frequent reports of this, e.g. Guardian 10 May 97, 'Consultant Altered Notes After Baby Was Born Brain-Damaged', Daily Mail 14 Feb 97, 'GP Missed Dying Man's Symptoms Then Forged Medical Notes', Sunday Telegraph 4 Feb 96, 'Hospital Altered Notes On Dead Patient', Guardian 29 Nov 95, '.. panel ruled that.. nurse re-wrote and falsified entries on notes', Guardian 7 May, 94, 'Doctor Jailed For Attempting To Cover Up Fatal Error', Journal of the Medical Defence Union, vol. 8, No. 1, 1992 (p 11), '.. doctor admitted that he had fabricated the notes..' If the hospital draws up an untrue but plausible version of events. If the hospital dissembles, and the notes have been 'doctored', it is extremely difficult for an expert, working from such documents, to report properly. By the difficulty of finding experts, if there has been negligence, who are prepared to say so. The medical (and nursing) expert report-writing industrya lucrative sideline for consultantsis unregulated and unaudited by the state [unlike e.g. Francesee New Law Journal, 6 Feb 98], and it is likely that some experts produce so far and no further reports, sufficiently critical to justify their fee, but not sufficiently critical to risk landing a fellow doctor in the dock, no matter what may have happened to a patient. [Cf. a barrister, in Clinical Risk, 1996, 2: It is depressing to see how many reports are.. inadequate.. it may be that they are, consciously or not, interested to exonerate the management. And Medical NegligenceA Plaintiff's Guide, in a section Closing Ranks: It is common knowledge that it is extremely difficult to prove that a physician has been negligent. The usual reason given for this is that you cannot find an expert who is willing to accuse a colleague. This is known as the 'closing ranks' syndrome, and it no doubt contributes to plaintiffs difficulties, particularly where the specialty concerned is a narrow one, for its practitioners will almost certainly all know each other, so that the reluctance to accuse of negligence is all the more pronounced. And Daily Telegraph, 11 Aug 1998, John Lambie, Chairman, Action for the Proper Regulation of Private Hospitals: ".. there is the additional obstacle of finding an expert witness who will testify against a fellow specialist."] There is also the problem of the poor quality of some experts' reports [cf. Clinical Risk, a barrister specialising in medical negligence: I find time and again that the experts instructed are not coming up to scratch in the presentation of their reports or in the attitude to the case.. An expert needs to appreciate that if he [=she/he] accepts instructions he must review the treatment the patient has received carefully, thoughtfully, and in detail. A quick scamper through the records and a short declaration that he finds nothing to suggest negligence will not do. He must also beware of the attitude that he is doing the patient a favour in agreeing to act. This despite New Law Journal, 24 July 1998: The expert.. owes a duty of care to his lay client.. And the opinion of a deputy judge in New Law Journal, 15 May 1998 that an expert should be liable for poor advice.] By the difficulties of proving negligence to the very high standard required by British lawthe forty-year old Bolam test (details of which poorly-briefed experts may in any case be unaware of), and then, in addition, of showing causation, and to the degree required, the balance of probabilities [i.e. had the negligent omission or commission not taken place, there would be a greater than even chance that the damage to the patient would not have happened, or would not have been so great.] By the fact that the plaintiff will be up against a well-resourced insurance company and/or medical defence organisation, using experienced defence lawyers [ Medical NegligenceA Plaintiff's Guide (1987): The opponents are usually tough and experienced, particularly if a medical protection society is involved, and the solicitor, inexperienced in medical negligence work, can find himself and his client very much at a disadvantage.] By the inexperience and incompetence of some lawyers, cf. AVMA, Newsletter Aug 95, on a case of a couple with a brain-damaged son. They went through three sets of solicitors: .. many people who have suffered a medical accident have felt let down by the way they have been treated by the legal profession subsequently. It is not uncommon to find solicitors handling medical negligence claims inexperienced in this complex area.. and ill-equipped to deal with the medico-legal issues that are involved. Claims flounder before they ever have a real chance of progressing and it has been known for solicitors to give up on a case before even obtaining the medical records and The fact that a firm of solicitors advertises that they do medical negligence work does not guarantee that they do it well. By the prohibitive costs and financial risks of legal action in Britain (and patients who can afford private medical insurance are unlikely to be eligible for legal aid). Plaintiffs, unlike in the US, must deal with two types of lawyer, the solicitor, who investigates and prepares the case (if in the light of the above you have a case); and the barrister, who argues it in court. The cost of the former can start at £200 an hour ($325) and the latter at £400 an hour ($650). The plaintiff in a relatively straightforward medical negligence case reported in The Independent, 26 July 1996, [who did have the means] spent £310,000 in legal costs ($500,000). Arnold Simanowitz, Private Grief: Basically, if you don't qualify for legal aid, you can't get justice, because litigating in medical negligence is extremely expensive.. Most people who [use] a private hospital don't qualify for legal aid. That means that they can't get compensation even if they're entitled to it. And [Law] Lord Woolf, 1994: It is only those with the deepest pockets who can risk going to law And Lord Bingham: It is no use having the best jurisprudence in the world [sic] if those who need it cannot afford to tap into it. And sociologist Max Weber, Economy and Society: The court procedures (and legal costs) in England amounted to a far-going denial of justice to the economically weak groups (written in 1915). By tactical paying into court. Plaintiffs are encouraged by their advisors to accept an often inadequate amount paid into court by the defendant's insurers on the grounds that, if the judge later awards an equal or lesser sum in court, they will be liable for both parties' legal costs. Any compensation can be wiped out or even result in loss. By the length of time of legal action, which can be especially wearying for injured patients. The above case took four years to come to court. Some patients or elderly relatives may conveniently die during such a period. By the absence, unlike in the US, of juries in medical negligence cases. A barrister in Medical Negligence identifies the problems: There are a number of difficulties a plaintiff faces in proving negligence. They include the problem of.. overcoming any possible pro-doctor prejudice in the mind of the judge [and, in a section entitled Judicial Prejudice].. the anti-patient prejudice of the courts. [A right in fact did exist under 1933 legislation for the litigant in a personal injury action to apply for jury trial, but the effect of this provision was largely nullified by a 1966 Court of Appeal decision]. - RE.
Figures supplied by the defence organisations to the Pearson Commission are telling: these showed that, out of 500 claims of medical negligence referred to legal advisors in one given year, 305 were abandoned, 170 were settled out of court, and only 25 or 5% went to court, of which only 5 or 1% of the original were successfulfrom
Medical NegligenceCompensation and Accountability,
King's Fund Institute 1988.
Very high costs of litigation, prejudiced experts, and falsified records could constitute a breach of Article Six of the European Convention on Human Rights, the right to a fair trial, now incorporated into British law, effective from 2001.
In fact, all a private hospital [or possibly a defence organisation] has to do after a serious incident is to find out whether the complainant can afford the high costs of British civil law, and in the likely event that he cannot, simply prevaricate. Conceivably this actually happens - RE
The Woolf Reforms.
It's too early to say whether these will genuinely benefit the injured patient or relative. One lawyer commented in the
Independent
20 Oct 99: 'Already the larger firms are finding ways of bypassing the reforms or turning them to the advantage of their wealthy clients.. the corporations and institutions.. will continue to have the best lawyers money can buy.' Costs will be higher in the early stages:
Times
26 Oct 99: '.. many lawyers with first-hand experience of the new rules are finding not only that post-Woolf litigation is as expensive as under the old system, it can be even more expensive in the early stages and litigation costs are being 'front-loaded' as never before.' AVMA criticised the initial proposal to have medical experts from both sides debating the issue behind closed doors without solicitors. With insurance companies now insuring against losing, there is the likelihood that they will take only cases with exceptionally high chances of success (so also with lawyers' no win, no fee arrangements). And the problem of falsified notes is not addressed. Cases can still founder if the expert, if an impartial one is found, is operating from such documents. The experience of many victims, speaking from meetings at patient conferences, is that they would prefer not to have anything at all to do with lawyers in the wake of a medical tragedy, and to have instead some sort of medical negligence police who could step in and take over, as with traffic and transport accidents.
On private hospitals not honestly admitting error. Hospitals are under no legal obligation to tell the truth about an untoward incident, and complainants may find that they do not receive an accurate version of events, something found by a large number of the people in our list of cases. (Although the NHS Confederation in
Independent Acute Hospitals and Services
quotes Registered Homes Tribunals' definition of the fitness legally required of the person-in-charge of a private hospital as including such qualities as: trust, integrity, truthfulness, undeviating honesty, morality, and a strict adherence to a code of ethics. In theory, therefore, the fit hospital manager should always respond to complaints honestly and truthfully). Similarly the June 1998 GMC Guidelines for Doctors
Duties and Responsibilities of Doctors
[which include private consultants] state: .. you must take reasonable steps to verify any statement before you sign a document. You must not sign documents which you believe to be false or misleading. The private doctor, therefore, should also, in theory, respond honestly and truthfully. However, these are only guidelines.
Other complainants may be threatened by lawyers acting for the hospital. (Cf.
Sunday Times
2 Aug 1998: Some patients who complain find themselves threatened with legal action. And
The Observer
1 Feb 1998: Rose and Jack [whose 27-year old son died following an operation in a private hospital] fear that if they identify themselves.. the hospital might slap a writ on them. Their concerns are reasonable. A number of people have been sued by private hospital groups after they complained publicly about the care they received.)
If, however, their complaints have been upheld by the Health Authority, and recommendations made for improvements, they should consider
(a) complaining to the Health Authority; the hospital may not be implementing the Authority's recommendations; (b) complaining to the NHS Executive and/or the Department of Health; a law firm which, acting for a private hospital, disregards the findings of an NHS body, could at the same time be providing legal services for other NHS bodies; (c) complaining to the Law Society (consult The Law Society's Guide to the Professional Conduct of Solicitorsavailable at most law libraries). Recommendations are made by the registering Health Authority to protect other patients' livesthese are public safety issuesand to disregard such recommendations could be inconsistent with the Law Society's standards of conduct for lawyers. (Cf. Practice Rule 1 of the Law Society's Guide [ Basic Principles] which holds inter alia that the public interest must take precedence over a solicitor's duty to his/her clients. Part IV of the Guide [ Obligations to Others] also states that it is a breach of Rule 1 for a solicitor to write offensive letters to third parties. This is described in the Lawyer-Client Handbook as 'unprofessional conduct'). (d) Repeated intimidatory letters from lawyers may constitute an offence under the Protection from Harassment Act 1997. (e) (Complainants should be aware, however, that the Law Society's complaints handlers, the Office for Supervision of Solicitors (OSS) receives 32,000 complaints a year and currently has 25,000 complaints awaiting attention, with the backlog rising by 300 a week. According to the Times (July 1999), the OSS has effectively shut down for a year, and it may therefore be more effective to complain directly to the President of the Law Society and perhaps to the Lord Chancellor, Lord Irvine of Lairg).
On private hospitals having an interest in playing down consultants' mistakes:
Private Grief
: Prof. Maureen Lahiff: ... the consultant is going to be a longer-term customer [of the private hospital] than the paying patient, because often the patient comes in and goes out, whereas the consultant will work with a particular hospital over a period of years. So it's very important for the hospital's survival to maintain good relationships with its consultants.
Dr Andrew Vallance-Owen, Medical Director, BUPA,
Clinical Risk
: There has been a reluctance at times for providers [private hospitals] to tackle specialists whose practice they believe to be suboptimal if the specialist brings in significant numbers of referrals to the provider unit. There is.. the risk of losing the specialist's business..
Don't Stay the Night
: Prof. Davenhall: .. Keeping the consultant happy is big business in the private sector.
Medical Accidents Handbook
, (Wiley 1998), Richard Ennals and Liz Thomas: Independent hospitals to a greater or lesser extent rely on consultants to bring in patients and are therefore having to compete to attract consultants' business. This might in turn be an influential factor when it comes to the handling of complaints within independent hospitals; it is possible, from the hospital's viewpoint, that it may be more of a priority to keep the consultant happy than the aggrieved patient.
In
Effective Management of Private Health Care,
1989 book, Ed. Anthony Byrne (then Chief Exec. of I.H.A., was Independent Hospitals Assn, now Independent Healthcare Assn) & Haydn Cook (then Director, Parkside and Hillside Hospitals, now Chief Executive, Calderdale Healthcare NHS Trust), Cook states: Hospital directors in the private sector, when asked if there is a complaints policy, often respond rather negatively. The reason is that the whole ethic of the private sector is to avoid complaints, ... ultimately the patient will refuse to pay if there is a problem,
so there is a real incentive to sort matters out! [If, that is, the problem hasn't killed the patient - RE] [Back to Notes...]
Charity Hospitals The Guardian
19 Oct 1996: Mark Lattimer & Simon Garfield,
Going private at your expense
: Over one-third of private hospitals use charitable status in order to avoid any corporation tax or capital gains tax, and to pocket the standard 80% charitable relief on business rates. The number of private hospitals operating under the guise of charitable status has now reached 84 acute and 11 psychiatric hospitals.
.. the London Clinic [149 Harley Street; '.. new endoscopy unit.. £2 million... recent £5 million.. medical oncology unit.. plastic and reconstructive unit..'] is a registered charity. .. estimated to benefit from £1.7 million in tax breaks every year, at the expense of.. taxpayers. .. Last year's accounts show that it handled £27 million in private business. How much did it spend on providing free treatment for those unable to pay? Just £2,000. ... The main factor that sets charitable hospitals apart from other private hospitals is that they do not distribute dividends or profits to shareholders. .. The law places one other stipulation on charities. And that is that they should exist for the public benefit. ... The Nuffield Hospitals group makes little attempt to conceal its lust for making surplusesprofit in all but name. Reading .. annual reports one is struck not by the group's desire to deliver care to the greatest number at the best possible price, or even just to meet demand, but by its attempt to maximise expansion through increasing financial return. ...
.. Richard Fries, [former Chief Charity Commissioner] accepts that there are legitimate questions to be asked about the public benefit [private charity hospitals] bring. How broadly available to people do health services need to be to justify charitable status, with all that goes with it including tax relief? ..
Private hospitals in Britain are subsidised in at least four different ways: their medical staff are largely trained by the NHS; their patients rely on the NHS to provide back-up emergency and intensive care facilities; the charitable hospitals are largely exempt from paying business rates; and the same hospitals pay no tax at all on the large annual surpluses they make. ... the sum lost to the taxpayer in subsidies [of private hospitals] comes to over £120 million ...
An undated but recent
Nuffield Hospitals
brochure states: We recognise that not everyone who wishes to use our services has the benefit of a private medical insurance policy. In response.., Nuffield are the healthcare group which pioneered the concept of fixed cost surgery. Now 20% of our patients are uninsured.. Presumably before this reform such people were charitably told to go away; Nuffield is registered as a charity.
The Gift of Health,
by Mark Lattimer, 1996: The first, rather obvious, point to make is that.. they [private charity hospitals] have little to do with poverty or lack of financial means. This.. is left almost entirely to the NHS. The charitable hospitals are more interested in the other end of the patient range.. [Not distributing dividends or profits to shareholders, as charities] does not prevent them from paying handsome salaries to their senior staff and managers but it does mean that any surplus generated at the end of the year is retained and invested back into the hospitals workback, that is, into providing services to private patients. The provision of healthcare or, as it is commonly phrased, the relief of sickness is a purpose that is recognised in law as charitable [and].. Charitable hospitals are.. open to anyoneproviding they have the money to pay.
Commercial Medicine in London
(1985): .. there is often a fine line between non-profit and profit-making organisations. .. For the most part, charitable hospitalslike private schoolsretain their charity status primarily for tax advantage, and it would certainly be extremely difficult to obtain treatment in the more commercially-oriented charity hospitals without payment. .. Many private hospitals enjoy charitable status, yet don't behave as charities. Jim Barker of AMI [now BMI Healthcare] prefers to call them non-taxpaying companies .. Some of the tax advantages obtained certainly offend common sense, such as .. clinics registered as charities whose daily bed charges approach £150 a night [1985 prices]
Banking on Sickness
: Many hospitals are charities which results in advantages in relation to donations, freedom from corporation tax, and their rates [property taxes] being halved. .. But some aspects of private medicines' tax status seem anomalousespecially the charitable status granted to organisations selling a luxury service good to the middle class for the benefit of moonlighting, highly-paid, public employees. [I.e consultants] .. the charitable status of private clinics is surely due for revision.
Fitzhugh Directory
1996: The old rumble is still occasionally heard [sic] What do they do that's charitable?
Guardian
10 Oct 98: A third of all private hospitals enjoy charitable status, which means that they pay no tax... at any given time, half of them are empty. And yet these "charities" with their enormous surpluses are in no rush to fill these beds with people who have a low credit rating.
Baroness Nicholson, House of Lords, 28 Mar 00: "Only in waiting times does private healthcare win. In virtually every other health activity, measurable, by known indicators, the private sector rarely does better than the NHS and frequently offers lower value service at far higher costssometimes at rip-off costsand under the name of 'charity'."
John Yates,
Private Eye, Heart and Hip,
on the private charity hospitals owned by religious orders [of which there are about a dozen - RE]: Religious order hospitals frequently.. are involved in the provision of care for those who are insured or who can pay privately. The time might now have come for the churches to withdraw entirely from the provision of private health care. There can be no religious ethic that would support the earlier treatment of one patient ahead of another simply on the grounds of ability to pay.
Healthcare Market News
, Oct 98: Charles Auld, Chief Executive of General Healthcare Group.. called for regulation to ensure that hospitals claiming charitable status do not simply take advantage of these subsidies [the tax concessions] to perpetuate their existence, but use it for genuine charitable causes.
Healthcare Market News
, Aug/Sept 99 quoted Auld at a
New Statesman Conference
: '.. Mr. Auld repeated criticisms of the tax concessions received by some charitable hospitals. Paying tribute to 'genuine' charities.. Mr. Auld said: "What is less defensible is the tax break given to hospitals with charitable status who do nothing but provide medical treatment to private patients at commercial rates. As charities they too are being subsidised by the tax payer but do not provide services to the needy with that money. How that money is best deployed should be an important part of the welfare debate".'
And John Stoker, new Chief Charity Commissioner, explaining his decision not to grant charitable status to the Church of Scientology on BBC Radio 44, 12 Nov 99. It did not confer a "public benefit": "The question turns on the question of whether public rather than private benefit is an essential feature of a charity. That's basically the spirit that we've approached it in.. we've really been looking at the question of the law and the conclusion that we've reached is based on how they measure up against the law." [So why doesn't the same principle apply to 'charity' hospitals? - RE]
[More information on the religious private charity hospitals, including questions re financial data, to come, perhaps as a separate Websitethe Fitzhugh Directory, despite claiming to be a comprehensive directory of private hospital annual revenues, still fails to report the finances of most of the religious private 'charity' hospitals.] [Back to Notes...]
Insurance
BBC Radio 4, 7 June 96:- Jan Lawson of an independent advisory firm specialising in medical insurance: ..[there's no] right of action against the insurer, because the patient's agreement.. is with their medical practitioner and the hospital.. the medical insurer's role is to reimburse the subscriber.. up to the limits in their policy. They're not.. involved.. in the clinical judgment. Insurers, in practice, have considerable leeway to promote schemes irresponsibly, partly because their leaflets and brochures need not be fully accurate.
Dr Vernon Coleman,
The Health Scandal,
1988: .. there is no point in hoping that your medical insurers will stand by you. Insurance organisations insist that they have no responsibility for the quality of care provided.
Richard Ennals, in the same programme: I think insurance companies ought to take more responsibility when things go wrong.. It is the health insurance companies who are the great promoters of private hospitals.. It is their leaflets.. which present this vision of seamless efficiency, with smiling nurses and beaming, bow-tied consultants, and you're left with the impression that everything [in private hospitals] is wonderful, yet when things do go wrong, from my experience, they just wish to wash their hands of it, they're not interested, they say It's nothing to do with us!
(In 1994, I wrote to all the main health insurance companies and asked how they ensured high standards of clinical care in private hospitals their customers used. Some answers were:
'.. Whilst we are not in a position to monitor and judge clinical standards in respect of medical treatment undertaken in independent hospitals, it is something we are concerned about.' '.. We rely on the consultants to offer professional advice to our clients and do not dictate protocols etc.' '.. we accept that registration by the local Health Authority demands adequate standards.' '.. The local Health Authority has overall responsibility for the registering and qualitative measures of all hospitals and we abide by that decision.' [See section 'Registered Homes Act' below for the inadequacies of regulation under this Act.] - RE)
BBC Radio 4: the same radio programme stated that the definition of acute or chronic is made by the insurance company. The issue characteristically was left vaguewhat happens if the NHS disputes this? Characteristically too the female announcer said .. if the insurance company's own doctors didn't have a say in deciding whod become untreatable and everyone were cared for indefinitely [sic], premiums would explode. She seemed to have no conception of the idea that premiums are calculable, given data, and may not in fact explode.
.. insurance companies may threaten to raise premiums..:
Effective Management of Private Health Care,
chapter by Haydn Cook, then Director of Parkside and Hillside private hospitals, now Chief Executive of Calderdale Healthcare NHS Trust, p. 163: ... insurance premiums are based both on cases brought to court and on cases notified to the insurer even if not pursued.
On insurance companies threatening to withdraw cover, it is possible that the position is analogous to that of the insurers of local councils involved in the Welsh children's homes scandals. Cf.
Guardian,
23 Jan 97: The insurers wrote to Clwyd County Council [where the abuses took place] suggesting that insurance cover could be withdrawn if the company's procedures were not followed.. Gerald Elias QC: The need for public debatelet alone knowledgeof the nature and extent of abuse in homes in North Wales took second place to the 'financial considerations' in the mind of the [insurance] company [Zurich Municipal, handling agents for Municipal Mutual Insurance].. Even the 'truth' was regarded by them as a casualty if financial considerations were at stake. And
Guardian
20 Nov 97: When the scandals began to emerge the insurance companies, fearful of the large compensation claims that could follow, moved in threatening to withdraw cover if the succession of inquiries continued to publish their findings. And
Guardian
10 Mar 99: 'The insurance companies argue that they have a duty to their shareholders to fight hard in the adversarial system of our courts against the compensation claims.. the insurers warn them [the councils] that any hint of admission of liability will invalidate their policies.'
There may be problems in getting medical insurance cover for private wings in NHS hospitals. Cf. this letter (
The Times
Jan 1997) from Andrew Morris, Chief Executive of Frimley Park Hospital: .. The problem.. is.. hostile action by health insurers, who also have an interest in running private hospitals. Some discriminate against private wings in NHS hospitals and insist that, regardless of the wishes of patient or doctor, policyholders are treated in hospitals which the insurer owns or in which it has an interest. ... (He continued: It is of course a different story if the treatment does not go according to plan; the private hospital is only too grateful that the backup facilities such as intensive care of the NHS are at hand.)
On liability,
Successful Private Practice,
by Maxine Buchele & Susan Wynn-Williams, written by physiotherapists, says, re legal liability insurance, Never admit liability. Make sure that you have the appropriate insurance and if there is an accident or injury, fill in the necessary forms and send them to the insurers immediately. They will hand them straight on to the underwriters. [In my case, AIG Europe (UK) Ltd and Willis Corroon - RE]
This conflicts with the Independent Healthcare Association's Code of Practice for Patient Complaints, which specifically states: .. it may transpire that the hospital and/or consultant was at fault. In such a case, acknowledgement of this to the patient is important, together with the appropriate compensation or rectification proposal. Apologies for errors, with explanations if relevant, should be tendered. And the Medical Protection Society's Pitfalls of Practice: Where it is readily apparent that an apology should be offered, it is the Medical Protection Society's advice that a sincere apology should be made. .. The MPS does not encourage members to withhold objective factual information or expressions of sympathy or to retreat behind walls of silence. And the Medical Defence Union [MDU]'s Talking to Patients: The patient should be given a factual account of what happened in simple language together with an apology, if indicated. And the MDU in their Journal, Summer 1986: It is the MDU's view that the patient is entitled to a prompt, sympathetic, and above all truthful account of what has occurred. .. It is very important that a sincere and honest apology is made. Any patient who has had the misfortune to suffer through an error, of whatever nature, should receive a proper expression of regret. To apologise that such an incident should have occurred is, after all, only common courtesy. And the MDU Chief Executive, M T Saunders, letter Times 26 Apr 1997, The MDU, the UK's largest medical defence body, has been advising its members for nearly forty years that the patient is always entitled to a prompt, sympathetic, and, above all, accurate account of the facts.. [He continues: Most patients choose not to pursue a complaint or a claim because the doctor has given them an immediate explanation and apology, but no evidence is supplied for this claim]. And Lord Donaldson, 1987, then Master of the Rolls, introduction to Medical Negligence: .. doctors and hospital authorities should regard it is a very important professional duty, when things go wrong, to be completely frank and open with their patients, irrespective of whether they think they may have been at fault. [He continues: This, regrettably, is not always the case.] And the GMC, Duties of a doctor, 1995: In particular, as a doctor you must be honest and trustworthy. And the GMC, Duties and Responsibilities of Doctors June 1998: If things go wrong: Patients who complain about the care or treatment they have received have a right to expect a prompt and appropriate response. As a doctor, you have a professional responsibility to deal with complaints constructively and honestly. .. When appropriate you should offer an apology.
Some readers may be disappointed that we haven't provided figures for the relative danger, or otherwise, of private sector health care; but since the successful practitioners apparently never admit liability, it's easy to see that reliable figures are virtually unobtainable.
On insurance policies, the Labour Party document of Sept 1994
Going Private
states PMI is rarely comprehensive. nearly all schemes exclude chronic or pre-existing conditions. .. there is no notion of "cradle to the grave" security. Exclusions frequently include.. [long list follows - RW]
Prof. Sir Brian Jarman agrees: I don't know much about it, but what I seem to see is, if you've had any illness, they don't want to know.. travel insurance.. a woman who was not well, said she might have to come home in an air ambulance.. I told her to fill in the forms, apply for the higher premium.. she didn't make it; she died.. the insurance company will not pay to have her returned.. I phoned their doctor.. he said they're paid commission to sell insurance.. they don't get the person to fill in the forms properly, so they can say it's not filled in properly.. they keep their commission.. he said it happens all the time..
As I understand it they offer cover for things you
haven't
had.. well, that's not what you want.. If you've had asthma, diabetes, hypertension and so on you want to be covered for them! Not for say epilepsy or one of the other 20 things on their list. They exclude diseases you've had before; they have exclusion clausesthat's the job of an underwriter! I get phone calls from PPP trying to find out, did so and so have such a disease
before
taking out the policy? They don't want to pay.
In private medicine, there are at present no insurance policies
for patients,
which would pay legal costs to investigate medical accidents or cover subsequent legal action. Presumably this is intentional, since money could be made out of them (several million potential customers).
Consultants
cannot practice if they are not insured against such events.
In the four-cornered struggle between patients, consultants, hospitals and insurers, the insurers don't always come out on top, however.
Thus a WPA (Western Provident Association Ltd) flyer of 1990 gives 'simple rules' for their policyholders, one of which is to demand an itemised bill. They said 2/3 of private hospitals failed to give itemised bills. A WPA newsletter,
The Subscriber
of 1992 put the proportion at 1 in 5. WPA seems to have started this 'crusade'; many examples were quoted in the press£23,000 for a two-week stay, £960 for a single night, £130 for talcum powder.
Times
1 Feb 1990: Swabs were also charged at £42.. BUPA could not explain the disparity.. AMI, an American-owned group that recorded a £20 million profit last year, was charging £1 for each suture at one London hospital and £6.47 at another.. Dr Eric Blackadder, BUPA's group medical director, says: We have found that not only do private hospitals have an excessively high mark-up, sometimes 200 or 300%, but the quantities are also excessive.
Times
23 Feb 1990, letter, Dr R Lefever:.. A surgeon told me that he would, of course, be seeing a patient for two follow-up visits because the insurance company would pay. For a benign cyst this has little clinical justification. I believe that such a patently mercenary approach is sensed by the patient who then may question my own clinical judgement and
impartiality, and even wonder if I, as the referring doctor, take a financial cut from these fees.. [Back to Notes...]
Registered Homes Act 1984, Health Authority Inspectors, and Inspection Visits
.. the fundamental aim of the regulation system must be the protection of the publicFormer Health Minister Paul Boateng, Open Reporting Conference, Royal Society of Medicine, 12 Feb 1998.
The primary objectives of the registration and inspection system are to protect patients and maintain standards. NHS Executive Guidelines, HSG(95)41, Sept 95, sent to all health authorities.
Royal College of Nursing (RCN) 10-page questionnaire-based report
An Inspector Calls?,
1994, reprinted 1996, has seven summarised findings, though these are largely concerned with the standards and funding of the inspectorate itself, rather than with what the inspectors had found. The findings include:
.. health authorities' approach to registration and inspection is not consistent, and there is a worrying lack of scrutiny and audit. Checks on registered operators and persons in charge of private nursing homes and hospitals are not adequate and are often conducted in an ad hoc manner. .. Authorities undertaking only the statutory minimum inspections are not making any unannounced visits to the private nursing homes and hospitals they are regulating. This may prevent them from getting a true picture of the quality of care.. The inspectorate is under-resourced, secretarial staff provision is poor..
The RCN on the Registered Homes Act: The system for registering and inspecting private homes and hospitals in England and Wales is inadequate.. The Registered Homes Act is concerned with adequacy, not quality. But adequacy is not an appropriate measure for the care required and given in private nursing homes and hospitals.
[The then Conservative government's stance towards the dangers for private patients was shown in the statement issued immediately after publication of the RCN's report by the minister responsible, Baroness Cumberlege, as reported in the private healthcare trade magazine
This Caring Business
, late 1994: '"The present system works well," says Lady Cumberlege. The present system of registering and inspecting private homes
does
provide proper protection for.. patients, says Baroness Cumberlege, Parliamentary Secretary at the Department of Health. She said, "... There is no evidence in the report..to suggest that the present system is failing patients..".'
Health Service Journal
, 11 Mar 1999, states that Baroness Cumberlege was recently appointed senior associate at the King's Fund, initially working on political issues in health-RE]
International Journal of Health Care Quality Assurance,
vol 6, no 3, 1993, on health authority inspectors, Yumiko Arai, following a study: .. neither national qualifications nor training are requirements for inspection officers.. Wide variations were observed in the methods and amount of training given to inspection officers.. The study has revealed that neither the 1984 Registered Homes Act nor health authority guidelines.. touch on the issues of quality of care in great detail.. most of the decision-making on quality issues depends crucially on the discretion of inspection officers.. it is entirely dependent on the proficiency and knowledge of the individual inspection officer. This may compromise the objectiveness of health authority inspections. She advocates: .. the establishment of a national accreditation and training system for inspection officers [and] external assessment of the performance of inspection officers [to] ensure the maintenance of high standards.
Inspection visits [Health Authority inspectors are responsible for private nursing homes and private hospitals]: David Robson
Nursing Times
(13 Aug 97): Another big let-down was the rare visit of the registration inspectors. They failed to probe into areas such as high staff turnover and lack of activities for residents. They barely glanced at the mountains of incident forms.. And
Private Eye,
10 Mar 95: [Following a damning report into the care of a deceased patient in a nursing home] Yet the routine [inspection visit] report three months earlierlast Septemberwas bland in the extreme. It congratulated the home's management and did not even mention the appalling staff shortages exposed in the special report. And
The Guardian,
20 May 1997, Linda Grant [with a relative in a nursing home]: Then you turn on the TV and your heart goes cold as you watch a news item about the owners of two private Buckinghamshire homes for the mentally handicapped who have just been convicted of physical and mental abuse of the vulnerable people they were supposed to be looking after. Who, in what has been described as a ten-year reign of terror were slapped, had their hair pulled, forced to eat meals in the pouring rain, denied toilet paper, toothpaste and soap. There is a national scandal about.. care. Over the weekend, a private home for the elderly in Lincolnshire was abruptly closed and the residents moved after allegations of abuse which have resulted in an investigation by police and the health authority.. It took six years for relatives of the residents at the Buckinghamshire homes to obtain justice.
During that time, the homes were inspected twice a year by the local authority.
[Our emphasis-RE]
Royal College of Nursing, written evidence to Health Select Committee inquiry into private healthcare, 1999: 'The problem is compounded as there is currently no agreed or required training for inspectors. Being inspected by someone who lacks the necessary understanding or expertise ..even more seriously could [does-RE] lead to oversights, inadequate inspections, and patient care being compromised.'
Observer
1st Feb 1998; Jay Rayner quotes healthcare lawyer Paul Ridout: .. the power of inspection is held by the health authority, which is the worst possible place for it to lie. It is part of the internal market and won't want to upset private hospitals, because they are often used to dealing with some of the more routine cases clogging up the NHS. What we really need is a properly funded, independent inspectorate who can hold private hospitals to account.
RCN,
An Inspector Calls?
: Inspectors regulating premises under the legislation, who are also monitoring the same premises for standards of services provided to the health authority under contract, face a potential conflict of interest.
Former Government Health Minister Paul Boateng, speech for Open Reporting Conference, Royal Society of Medicine, 12 Feb 98: .. there is a serious problem of the lack of regulatory independence. .. health authorities can have their own problems.. There can be conflicts of interest where the health authority has a purchasing role.
Joan Higgins in
The Business of Medicine
(1987): .. the Registered Homes Act 1984 (and the legislation which preceded it) was not designed for, and is inadequate for, monitoring standards in private acute hospitals. .. it omits scrutiny of procedures and practices which are characteristic of acute hospitals undertaking complex surgical procedures. ...
The report of a King's Fund College Conference on the accreditation of private homes, 25 Jan 1985: The 1984 Act (and the Nursing Homes Act, 1975 before it) gives only the sketchiest guidance to registration authorities on the monitoring and inspecting of acute facilities [i.e. private hospitals]. Both pieces of legislation were designed essentially for a nursing home sector which was made up of relatively small homes offering modest levels of nursing and convalescent care .. regulation under the Registered Homes Act is increasingly becoming an anachronism. [Modern private hospitals] have little or nothing in common with the kinds of nursing home originally envisaged in the legislation and an alternative means of regulating them may be required.
BMJ
vol. 294, 1985,
Maintaining Standards in the Independent Sector of Health Care,
(by Day and Klein). Standards of care imposed by the 1984 Registered Homes Act are described as weak and ill defined.
Inspection visit reports: The Health Service Ombudsman recommended (1996 Annual Report) that members of the public should now be able to view any previous health authority inspection report of private hospitals and nursing homes, and, now, health authorities must make hospital inspection reports (for what they may be worth) publicly available. However, some authorities only make these available to view on the authority's premises. Copies of nursing home reports, by contrast, are sent to local libraries. Graham Maloney (see below) found Tees Health Authority's April 1996 inspection of the private hospital where his wife died was conducted by only one inspector and lasted only 45 minutesshorter than a car MOT.
A Health Authority inspector speaking anonymously on
Dispatches,
Channel 4 TV, 1994, in a documentary on the quality of care in a large commercial chain of nursing homes: [The company] have persuaded other health authorities to disregard the criticisms of their inspectors.. They influence the members of the Health Authority to back off. I know of colleagues who have been told to stop causing trouble, to just get on with their job. And, in the same programme, on the influence, or lack of it, of inspectors on the health authority, the chief executive of one health authority: The inspection service is [only] an advisory one to us.
Commercial Medicine in London
(1985 Greater London Councilnow defunctdocument) by Ben Griffith & Geof Rayner, with John Mohan: Private hospitals are required to be licensed.. All the licence means, in practice, is that a hospital or clinic has been visited .. (..usually once) and management personnel have been questioned on points concerning medical cover, types of surgery performed, etc. Unlike abortion clinics, there is no central DHSS group of officers in charge of them... The standard of care varies widely between clinics, and it is widely acknowledged that some practice occurs at the margin of safety and without the back-up of facilities present in an NHS hospital. ..
The Registered Homes Act is showing signs of age and the time will come when we will want to update it - Tim Yeo, [Conservative] junior health ministerreported in
This Caring Business
May 1993.
Dr A Vallance-Owen, Medical Director, BUPA, BBC,
Here and Now,
Sept 98, on the regulations of the Registered Homes Act: .. they are old and they probably could do with improvement. He went on to aver that the great majority of private hospitals would not worry at all about tighter regulation.
RCN press release,
14 June 1994: Inspection arrangements need to be strengthened.. The numbers of inspectors are inadequate, and the regulations governing nursing homes [and private hospitals] place more emphasis on the physical environment than on the quality of nursing care.
AVMA,
1992 report: The existing regulations covering the private sector are very limited.. With increasing numbers of people opting for private health care, there is an urgent need for much tighter regulation of the private sector to ensure that all private hospitals meet minimum safety standards.
Meridian TV,
14 Aug 98: .. figures show that cases of medical negligence [in private hospitals] are rising, and with no independent governing body monitoring performance it is feared that patients could be being put at risk.. The glossy image paints a picture of perfect healthcare. But.. paying for treatment does not guarantee better care, and until legislation is brought in to bring the private sector in line with the NHS, there are no guarantees that you are in safe hands.
Community Health Councils, which are the NHS watchdog, have no right of access to private hospitals, unlike NHS hospitals, and cannot assist private hospital patients with their complaints.
On administrative costs generally, Prof. Jarman stated: The US spends 22% of health costs on administration, mainly charging. The amount spent on
administration per head is about the same as the entire NHS per head!.. NHS administration cost is very lowabout 4%.. [Back to Notes...]
'Quality Audits'
Many private hospitals imply in their defence that accreditation, by the Kings Fund or British Standards, guarantees high quality clinical care. They often make this claim in defensive letters to the press. In fact for example the
King's Fund
brochure states: ... The programme does not deal with clinical care or service delivery but with the organisational systems and procedures essential to efficient service provision. ... (The Audit involves self-assessment and is funded by the private hospital).
John Lambie, Chairman, Action for the Proper Regulation of Private Hospitals, speech to 1999 Annual Acute Healthcare Conference: "An advertising claim that has annoyed me for years is that a hospital has been 'accredited' by an external auditor such as the King's Fund. This reads as if the hospital has received an accolade for its work, including clinical. Not so. In fact it is simply an organisational audit.. in no way implying that the medical care had even been considered, never mind approved. In these ways the copywriters dissemble and deceive and very good they are at it too, but don't expect me to approve." [Some of the most horrific incidents listed at the end of this website have occurred in 'King's Fund accredited' hospitals - RE] [Some readers might be amused to note that Julia Neuberger, usually described as a 'Rabbi', has a high position in this organisation - RW]
National Consumer Council, Barbara Meredith, oral evidence to Health Committee, Mar 99: ".. who accredits the accreditors?.. As far as the consumer is concerned, I.. think it might be safe to say that the vast majority of them do not have any idea of what any of the accreditation schemes really mean."
Guardian
3 June 1998: About a third of Britain's hospitals have participated in the King's Fund Organisational Audit (KFOA programme). Hospitals pay between £15,000 and £17,000
to be given an 18-month going-over and then, if they gain approval, advertise their accreditation as widely as they can. [Back to Start]
Notes and References to 4. Conclusions[General | Private Wings in NHS Hospitals | NHS Patients in Private Hospitals | Complaining to the Health Authority | I.H.A. statements | Multinationals | Comments: Medical | Comments: Political ] General
.. cheaper to employ lawyers to limit damage than to have adequate levels of staffing... The actuarial point on the risk of accident, the cost of round-the-clock care, and the cheapest damage-limitation method seems unanswerable. [-RW]
It was said in the 1930s (by Russell) that an unpredictable effect of snobbery was the employment of completely untrained nannies by those who could afford to pay. The private hospital sector seems to rely to some extent on similar psychologymany people simply assume treatment must be better if they pay for it, and persons professionally taking their money are unlikely to attempt to dissuade them. [-RW]
It is important to distinguish the 'granny farming' aspect of the private sector (which has always existed, and which, almost necessarily, started with richer people), from the far smaller private medical sector. Both, however, are covered by the same legislation, the Registered Homes Act 1984. The potential for iatrogenic disasters has led to a situation reminiscent of that of some alternative practitioners, and American doctors who only take on low-risk cases, and perhaps witch-doctors, who are reputed to turn away cases they know they can't help; when the illness turns out to be tricky, the patient is offloaded onto the NHS. [-RW]
On grading of private hospitals, AVMA's written evidence to the Commons Health Select Committee Inquiry stated: Another option which should be seriously considered would be that of imposing far greater restrictions on the type of surgical procedure performed within any independent facility. The proposal would be that hospitals would be licensed
to carry out a restricted list of procedures in accordance with the facilities and the clinical cover available. [Back to Notes...]
Private Wings in NHS Hospitals
To show how seriously the threat of NHS private wings is taken, cf. this comment from the annual compilation on the finances of the private acute healthcare sector,
The Fitzhugh Directory 1996,
(currently priced at two hundred and forty pounds), the section
Key Trends and Financial Review
:- .. now there is an even bigger dragon to slay [than takeovers of charity hospitals by multinationals]the NHS private units, and the common foe unites the industry. ... And
Fitzhugh Directory
1994 (reported in
Guardian
21 Nov 94): The NHS Trusts are emerging as a growing force in competing for private patient revenues. The slumbering giant has awoken.
On the better care in NHS private wings:
Dr Michael Crow (letter to BBC, Sept 1999): The only place I would consider a major procedure privately is in the private wing of an NHS hospital where appropriate nursing and medical staff are on hand. The programme [ Panorama on private hospitals] highlighted the fact that even minor procedures can go wrong and the consequences are not reversible. Health Services Management magazine, Nov/Dec 1992, David Jones, General Manager, Medical Examiners Ltd, in a piece entitled Competing for private patient revenue: The NHS can deal with more complex cases than the private sector.. [there is] expertise in regional specialties.. the standards of care are often better in NHS hospitals.. Many private patients believe, perhaps wrongly, that they will receive superior care in a private hospital.. Economies of scale.. services could be provided to private patients at a lower cost on an NHS hospital site.. NHS hospitals are more convenient for consultants.. He concludes: It would seem.. that private hospitals have more to fear from the NHS than vice-versa. Epsom Health NHS Trust, brochure for private wing (the Northey Suite): Being.. situated in a large.. NHS Trust Hospital means that we have all necessary resources on hand to give a round the clock service, using the most up-to-date technology available.. we have on-site backup to cater for every eventuality.. Your consultant is based in the hospital, so.. they [sic] can be contacted very easily.. Should you require any diagnostic tests, you are simply taken within the hospital for these to be carried out, no ambulance transfer or waiting.. And results are swiftly processed through the dedicated hospital teams, who are on-site.. Daily Telegraph, 7 July 1996: 'There is anecdotal evidence that a private hospital may be a good place for simple operationsingrown toenails or varicose veinsbut for anything more serious, heart operations or neurosurgery, the NHS is the place to go.' Laing's Healthcare Market Review 1999-2000: The two major advantages.. for NHS Private Patient Units over independent hospitals are convenience (the consultant does not have to travel from his or her NHS base) and safety, with the on-site facilities and staff of a major hospital to deal with any emergencies. Ad for 'Norwich Union Trust Care' Staines Informer 5 Feb 99: .. as part of Ashford Hospital [NHS hospital near Staines], the Shakespeare [private] Unit enjoys the back up of the full range of medical expertise and technology of a well-equipped general hospital. Medical Accidents Handbook (Wiley, UK, 1998), Richard Ennals and Liz Thomas: '.. patients considering private treatment may wish to consider drawing up a checklist of facilities offered by private hospitals in order to establish what safeguards are in place should complications, minor or major, occur. Where a patient has concerns about the service on offer from a private hospital, an alternative would be to opt for treatment in the private wing of a large NHS Trust hospital. Which, special report on private health care, Aug 1999: 'You might want to consider whether you'd be better off in the private wing of an NHS hospital, where there would be specialist and senior staff on hand in the case of an emergency. Also, you will have more rights to redress and safeguards against bad practice. In the future, reforms will mean that NHS paybeds and private wings in NHS hospitals will be treated separately from the rest of the private sector. ..' Maidenhead Advertiser, 6 Aug 1999, Andreas Charalambides (see case list below): "My advice is to give private hospitals a very wide berth indeed, and to use instead the private wings of NHS hospitals. Patients are generally safer in such wings as you still get doctors and experts who can spot and cope with your complications when the consultant is not there. ... aggrieved patients have to suffer the consequences for the rest of their lives while guilty parties continue to practice and remain unpunished." Dr. Andrew Vallance-Owen, Medical Director, BUPA, on intensive care for emergencies, oral evidence to Health Select Committee, 25 Mar 99: ".. of course, if they are in an NHS Trust, and 20% of private patients are treated there.. then it is all covered.. they do not have this transfer issue."
On profits going to the NHS:
St Helier NHS Trust Private Patients Unit brochure: .. profits will directly benefit the National Health Service. Income generated by the Unit is then used to improve facilities for all. Times, 27 Nov 95: Each private patient treated in an NHS hospital contributes nearly £300 to the cost of caring for NHS patients. National Economic Research Associates say NHS hospitals, set to become the largest providers of private care, are earning profits of £170,000 on every £1 million of private patients revenue. Andrew Morris, Chief Executive, Frimley Park Hospital, letter, Times, 15 Jan 97: The management of this [NHS] hospital realised some years ago that private healthcare could come directly to the aid of the cash-strapped NHS.. [Our] private wing.. last year contributed £1 million in extra income to help care for NHS patients Brochure for Norwich Union Trust Care, a new health insurance scheme for private treatment exclusively in NHS hospitals states While you benefit from lower premiums, the NHS benefits from valuable additional income.
On the benefits of consultants, with NHS private wings, staying on-site: Sir Richard Bayliss,
BMJ,
21 May 88: The growth of the independent sector has had the disadvantage that many consultants with part time contracts have ceased to be geographically whole time. To travel between an NHS and an independent hospital is uneconomical of time. And
Times,
16 Dec 94,
Are Private Hospitals Doomed?
: Ian Robertson, private patients' manager, St Mary's Hospital.. says a flourishing private practice strengthens the consultants' loyalty to their hospital: The younger consultants want the place to prosper, and they don't want rooms in Harley Street, so we give them rooms here.
Health Care in the United Kingdom,
1982: Another argument, and one which the Royal Commission thought the strongest in favour of retaining private beds, is that if consultants are allowed to treat private patients, it is better that they should do so in an NHS hospital, where they are available when needed in an emergency..
The Fitzhugh Directory,
1996, states in the introduction, with regard to NHS private wings, that if the NHS were willing to capitalise on its strengths, and its involvement were to be accepted by the public, there is little doubt that the NHS would be preferred, and would dominate the industry. The 1998-9 Directory describes private healthcare as an industry in turmoil and identifies a steady growth in NHS private beds as a key trend, with the NHS on course to win 20% of the market by the year 2000.
NHS private wings might also be cheaper
Hospital Doctor
, 9 July 98, Tim Baker, Commercial Director, Norwich Union Healthcare: 'Through economies of scale, NHS private units can cut costs.. These costs can be passed directly to the consumer, and generate excellent value for money in insurance terms.'
Dr. Phil Hammond,
Trust Me, I'm a Doctor
(1999): 'Your best bet, if you want to go private, is to be even more sceptical and questioning of what is
offered to you than in the NHS, and perhaps opt for a unit attached to an NHS hospital... at least you should sleep more safely.' [Back to Notes...]
NHS Patients in Private Hospitals
1989 Government White Paper: If health authorities are to make the best use of private sector facilities they will need to be satisfied that the standard of medical care being offered is comparable to the standard expected in the health service.
Robin Cook MP, now Foreign Secretary, then Shadow Health Secretary,
Guardian,
24 Jan 92,
NHS Patients Face Inferior Treatment
[in private hospitals], referring to operations carried out on NHS patients in private hospitals by surgeons without recognised training: So much for all the promises in the Patient's Charter of a high quality health service. These [NHS] patients are being sent for operations with a less well-trained doctor and with no medical records. I find it extraordinary that managers should have picked patients for this inferior treatment without even seeking the advice of the consultant surgeons. I could not have asked for clearer evidence.. showing how standards slip when health becomes commercialised.
Times
, 11 Jan 1990: The National Audit Office report found that treating [NHS] patients in the private sector in order to cut NHS waiting lists cost twice as much as treating them within the service.
Trust Me, I'm a Doctor
(1999): 'I also know of frail, elderly, having NHS operations done in private hospitals as part of the waiting list initiative. This might seem like a sensible use of resources, but the sicker the patient, the higher the risk of the operation and the less you want to recuperate ten miles from an NHS cardiac arrest team.'
Private Eye
18 Sept 98: In the short term Frank Dobson is trying to solve the problem of long waiting lists by paying consultants private-size fees to operate on NHS patients in private hospitals. For example, the orthopaedic consultants in Southampton have received £2.5 million to get their [waiting] lists down. But this strategyused unsuccessfully by the Toriescomes on the back of a report by the charity Actions for Victims of Medical Accidents [AVMA] which has found a disproportionate number of claims are from the private sector. Key factors are the lack of emergency equipment and medical expertise. Private hospitals are not the place to be in an emergency. Conveyor-belt waiting list reductions are invariably very expensive, poorly planned and doomed to faillet's hope they aren't placing [NHS]
patients at extra risk of medical accidents too. [See also Department of Health's view under 'Comments: Political'] [Back to Notes...]
Complaining to the Health Authority Independent Acute Hospitals and Services
can be obtained from the Publications Department, the NHS Confederation, Birmingham Research Park, Vincent Drive, Birmingham BS15 2SQ. Tel: 0121-471 4444. Price £10.50. (Or ask for photocopies of Appendix 5). Three of our publicised cases were successful with this. The procedure is to go to the Health Authority only if you are dissatisfied with the hospital's response. Insist an investigation is
(a) reasonably promptthe final report of my investigation [by Merton, Sutton and Wandsworth H.A.], a six-page summary, took nearly three years instead of the promised six to eight weeksdelay can cause risk to other patients; and (b) detailed: the report of a Tees H.A. investigation was 35 pagescomplainants should expect nothing less; (c) and that all staff involved are interviewed, as the NHS Confederation guidelines indicate. This only happened in one authority investigation. (d) Ask the authority to involve independent external parties in their investigation to ensure impartiality. (e) Where there has been misconduct, these guidelines twice emphasise health authorities must report cases to the GMC or UKCC. Failure to do so where necessary can again cause risk to other patients. (f) Note: If you wish to appeal e.g. about an unsatisfactory report or unwarranted delay or collusion, you may find it best to approach an MP or health minister before the Health Service Commissioner. The Health Service Journal reported (8 Oct 98) that the Commissioner's office investigates only about four per cent of the complaints it receives, and takes on average nearly a year to investigate. (g) The Medical Accidents Handbook, Wiley, 1998, although mainly a law text, has further details contributed by Richard Ennals.
Details of these guidelines were sent to patients' organisations and advice agencies. Some comments:-
"I was very interested to learn of this non-statutory procedure for making complaints about private hospitals.. I did not know it existed. I think that it deserves the widest publicity possible." "This will be extremely useful both now and also in the future with the increase in private hospitals and nursing homes." "In the light of your letter, we shall be expanding the information we have on complaining about private treatment." "As a result of your letter, I have written to [all of our advice agencies] in England and Wales to inform them of this procedure so that we can pass this information to members of the public." "This information will be very helpful because, not surprisingly, we do get requests for help in pursuing complaints about private treatment. These are likely to increase as more and more people, including those with little money, are being pushed into using the private health sector." ".. on the basis of your information I will be much better placed to advise in future.."
On health authorities, perhaps deliberately, failing to advise complainants of this avenue of complaint,
Health Service Guidelines
(HSG[95]41), Sept 95.
Regulation of Nursing Homes and Independent Hospitals,
sent to all health authorities: Insufficient weight is being given by some registration officers to the series of guidelines [including on authority
investigations] published by the National Association of Health Authorities and Trusts [NAHAT, now the NHS Confederation].[Back to Notes...]
I.H.A. statements
The Independent Healthcare Association (income in 1997 of £593,864) describes itself in
Trade Associations and Professional Bodies in the UK,
1994, as: The representative body for independently-owned healthcare providers, whether voluntary or private, funded largely by member subscriptions based on a fee per bed. Its charitable status derives from its objectives to promote high standards of care in the independent sector.
On private hospital risks,
Sunday Times,
2 Aug 98,
Higher Health Risks in Private Hospitals
: .. representatives of the private sector rejected criticism that patients were more at risk but accepted that data was not available to prove their point. We do not accept that there is any difference in the level of support between private and NHS hospitals, said David Lucas of the I.H.A. I am confident people are not at any more risk than in the NHS. And
Guardian,
27 May 97,
Night Risks for Patients in Private Hospitals
: The I.H.A. .. said that private hospitals usually had a higher ratio of nurses to patients than the NHS, and maintained that standards were at least as good as in the state sector.
And on BBC TV
Panorama
(20 Sept 1999), Barry Hassell, IHA 'Chief Executive' said: I don't accept that a private hospital is riskier at all. Clearly, the risk is analysed very carefully.. Remember that a consultant will always put in place arrangements that are suitable and appropriate.
On private hospital regulation,
Independent,
17 Jun 98: Barry Hassell, chief executive of the I.H.A. .. claims that independent hospitals are subject to greater regulation than their NHS counterparts [see our reply to his letter in News Updates]. And IHA Press release following publication of Health Committee report: The IHA has been campaigning for more than ten years for better regulation.
On current complaints procedures in private hospitals, in the same article: If you do have any complaints, make them known to the hospital director at the earliest opportunity, says Barry Hassell. And
Which? Way to Health
(Consumers' Association publication), Dec 93: If things go wrong, Fiona Campbell [former Information Services Manager] of the Independent Healthcare Association.. recommends you to direct any complaints about any problems to the hospital manager. And David Lucas, former Executive Director of Acute Affairs, IHA, in the
Observer
1 Feb 98, on statutory complaints procedures: The thing is, we exist in spite of government rather than because of it, so historically we're not that keen on being subject to statute.
An IHA press release, following the Health Committee Report 21 July 99: '.. we want to see the small band of cowboy practitioners driven out of business; they
undermine patient confidence and damage the reputation of mainstream hospitals.' [All the cases listed at the end of this website occurred in 'mainstream' hospitals - RE] [Back to Notes...]
Multinationals
Multinationals. E.g.
Nursing Times
13 Aug 97: .. Principal Healthcare this year bought Quality Care Homes for £46.3M and signed a joint venture contract with Tamaris, which operates over 2,000 long-stay nursing beds... Ashbourne Homes was bought by Sun Healthcare of Albuquerque, New Mexico, for £95M last year. .. The combined group will have 122 homes and nearly 7,000 beds, making it the second largest nursing home operator in the UK.
Health Insurers PPP recently entered into a partnership with US healthcare multinational Columbia/HCA to run several London private hospitals. BBC2 TV
Newsnight
27 May 99: "Embarrassingly for PPP, their business partners, Columbia Healthcare, are now at the centre of a major fraud trial in Florida. Four executives are accused of plotting to steal $2.8 million in one state alone from the government by submitting
false Medicare claims. Columbia have also been fined for violating anti-trust law in hospital takeovers.. Could such muscle-bound practices cross the Atlantic?" [This also raises questions for the registration and inspection officers of the London health authorities whose assessment and registration as 'fit' of the operators Columbia took place long after the FBI investigation began - RE]. [Back to Notes...]
Comments: Medical
Joan Higgins, now Professor of Health Policy at Manchester University, and chairman of Manchester Health Authority, in a KF Project Paper: .. Registration staff will need training in business and law. Private care in Britain may be a cottage industry but we already see strong evidence of corporate bodies moving in with their own lawyers and advisers. Some of these people can run rings round local authorities and we must face that issue. ..
She also stated: They must be properly remunerated, not least because the private sector may wish to offer them inducements to behave improperly.. The prospect of corruption should not be ignoredwe need only look at North America to see that it can and does exist. (Potential example in
Nursing Times
, 16 Dec 98: 'Police and NHS managers are investigating financial irregularities at Lifecare NHS Trust in Caterham, Surrey. The trust's chair has resigned and the chief executive and financial director are on special leave. A trust spokesperson said the allegations centred on contracting issues.'
The Times
reported1 April 2000that the Trust's manager of subcontracted services was jailed for over 2½ years after admitting 28 charges of deception, conspiracy and false accounting in a £650,000 private nursing home fraud.)
RCN in
An Inspector Calls?
1994: Health authorities should take more seriously the responsibility to regulate the independent health care sector. The providers of private health care take the business very seriously indeed and it is a multi-million pound industry.
Sunday Times,
2 Aug 1998: AVMA reports a surge of negligence claims against the private sector in recent years, with an estimated 20% of the 5,000 cases it deals with annually now lodged by private patients. It is out of all proportion to what you would expect, said Arnold Simanowitz, the charity's chief executive. It is an illusion that people will go into a private hospital and get better careyou are actually more at risk when things go wrong.
Margaret Cook, consultant haematologist, ex-wife of the Labour Foreign Secretary, in
The Observer
March 1998: With mounting pressures to maximise quality while containing costs, the Labour government should also take a stand on private practice. The prime motive here is profitand the public should be made aware of evidence that quality comes a poor second.
Christine Hancock, General Secretary of the Royal College of Nursing,
Health Service Journal
17 Dec 1998: .. said the Health Committee inquiry would 'make some headway' in protecting the public from the poor practice that exists in some independent healthcare organisations.
Sir Raymond Hoffenberg, President, the Royal College of Physicians (1983-89), Introduction to
The Incompetent Doctor,
Open University Press, 1995: Within most hospitals in the UK audit meetings take place that provide better information about the performance of individual doctors and departments.. The weak link lies in private medical practice which is not subject to some sort of scrutiny.
Christine Hancock, General Secretary, Royal College of Nursing (
Health Service Journal
17 Dec 1998) 'said the Health Committee would make some headway in protecting the public from the poor practice that exists in some independent healthcare organisations.'
On the Ledward case [see below]: Paul Watkins, Chairman S.E. Kent Community Health Council, BBC TV
Kilroy
11 Dec 1998: The recent case of Rodney Ledward [gynaecologist who damaged many women over many years] really highlighted the situation. Fifty percent of the ladies [at a public meeting] involved in that were in the private sector. What came out.. was the lack of regulation, lack of complaints procedure, the inability of people to pursue a complaint up to the stage of an ombudsman.. the major features are the lack of accountability of the private sector, no clinical governance, no accountability on standards..
Patricia Fearnley, solicitor, in the same programme: It's the standards that prevail in the private hospitals. This is the problem.. shown up in the Ledward cases. You can have a situation where patients are paying expensively.. they think they're going to get the best care. They can have a surgeon who rushes in, carries out a very quick botched operation, then disappears down the road not to be found. They start bleeding during the night; there's no one, there's no doctor on site, and this has happened to many of my clients. There's no one there to sort it out, and the only way at the end of the day they can receive proper care
is to be shunted over to the local NHS hospital. [Back to Notes...]
Comments: Political
The Department of Health,
Daily Telegraph,
11 Aug 98: If people go into the private sector, they are opting out of the NHS and thereby taking a chance. [Presumably, NHS patients sent to private hospitals for their treatment by NHS health authorities, NHS Trust hospitals, and GP fundholders are taking the same chance, albeit without any option - RE]
The Department of Health,
Meridian TV,
14 Aug 1998: This government is committed to ploughing its health reserves into the NHS. There is no place for regulating the private sector using public money which has been raised on the promise of improving the NHS. Meridian TV: What the Government is saying is that when you choose to opt out of the NHS you take your life into your own hands.
MEP of Graham Maloney in a recent letter: It does seem a ridiculous situation that they [private hospitals] are subject to a lot less regulation and control than the NHS establishments, and that there appears to be no statutory and controlled complaints procedure. .. You will have already received the information concerning the European Courts and obviously you may well be abler to take the matter further with them.
A Lib. Dem. MP, recently, after writing to the Health Secretary on behalf of another complainant: .. it appears that.. the Government recognise that there are problems with the regulation of private hospitals.. This is clearly a major issue, and one which will involve many people all over the country. I have therefore asked that, in view of this, the matter is now handled by.. our Health Team from now onward. This will allow a much stronger campaign.. and hopefully get the series of loopholes in the law relating to private hospitals closed.
Lib. Dem. MP, on the Health Team, in a recent letter to another complainant: I have become increasingly concerned that, despite the recent emphasis on quality in the NHS, events in the private sector are being overlooked. It is a disgrace that private health facilities are not properly regulated or monitored. .. It is vulnerable patients who suffer if and when things go wrong in private hospitals and emergency facilities are not available.
Labour MP Melanie Johnson,
Welwyn and Hatfield Times
10 Feb 1999: Ms Johnson contacted the chair of the Select Committee on Mrs Buckley's behalf after hearing her story [see case of her mother Carole Burwash, below]. She said: The main problem is that with private hospitals many requirements for the NHS hospitals are not fulfilled. This may require legislation to change it. A private hospital should be a place where people are relatively safe.
Labour MP Dari Taylor,
The Northern Echo
26 Nov 1988: Dari Taylor has written to the Chairman of the Health Select Committee pointing out the difference between the way complaints are handled within the NHS and in the private health sector.
Dr. Howard Stoate MP, Member of the Health Select Committee, BBC TV
Kilroy
11 Dec 1998: The Health Select Committee is starting an inquiry to look at the regulation of private hospitals and private sector medicine .. because there is no regulation; it's a nightmare out there.. and people quite rightly feel threatened by it; they don't know where to go when something goes wrong. It's up to us to put it right. .. What we need is a tough if not tougher system in the private sector.
Baroness Nicholson, BBC Radio 4
Case Notes
, 16 Nov 99: "At the moment I would recommend that no one go to private care if they have anything major wrong with them at all.
Geoff Martin, UNISON London Convenor, Director, London Health Emergency, in booklet
EMU and the NHS
(1999): 'Private health care is a notorious rip-off, offering no emergency services, and no support for chronic or pre-existing health problems. It is targeted at the age and income groups who are least likely to fall ill and make a claim.'
David Hinchliffe MP, Chairman of the Health Select Committee,
Nursing Times
Jan 1999, in an article
Private Hospitals in line for Poor Standards Report
: During a Commons debate .. Mr Hinchliffe berated former shadow health secretary Anne Widdecombe for demanding the increased use of private hospitals to ease pressure on the NHS. He said In the evidence we have taken so far [in the inquiry into private hospitals], we have heard serious concerns about the quality of care provided. Mr Hinchliffe also warned that increased private sector business would exacerbate the NHS staffing crisis because of the poaching of staff.
Hinchliffe on BBC2's
Newsnight
, 20 July 1999, after publication of the Select Committee's report into private healthcare: "There is a major problem and people are obviously suffering as a consequence.. The conclusion I draw from the evidence that we've received within this inquiry is that people are better, wherever possible, sticking with the National Health Service. They're safer, the procedures are safer, and I think they're generally more secure within the National Health Service."
Frank Dobson, then Secretary of State for Health, on the leaders of the private healthcare industry,
Nursing Times
Jan 1999: The onslaught on the private sector continued when health secretary Frank Dobson branded the industry's leaders liars in reaction to Ms Widdecombe's claim that he had refused to meet them.
This link is Frank Dobson's speech on the lack of regulation of private hospitals
in Parliament, 18 May 2000.
Dr Phyllis Starkey MP, Labour Backbench Health Committee, Channel 4 TV
Powerhouse
5 Mar 99: The problem is that, although private health establishments are regulated by the local health authority, they cannot regulate the quality of care, nor indeed the experience of doctors, so although all the doctors are registered, they may not necessarily have sufficient experience in the operation they are undertaking. That very often leads to inadequate care for patients.. the patient then has to be treated by the NHS, which has to pick up the problems.. caused by the private sector. I hope the Health Select Committee will come forward with clear recommendations that parliament can take forward to drive up the quality in the private sector.
Comments: Royal.
The Queen, State Opening of Parliament 18 Nov 99: "My Lords and Members of the House of Commons: My Government's ten-year programme of modernisation for health and social care will provide faster, more convenient services to help improve the nation's health. As part of this programme, a Bill will be introduced to
improve standards and stamp out abuse
in social services,
in private and voluntary healthcare
, and in childcare.
Labour in opposition:
examples include Bob Cryer (9 June 1981) who asked the Secretary of State for Social Services what progress has been made in arrangements for private hospitals to contribute to the cost of training nurses. ... instead of drawing like parasites from the public sector... And Dennis Skinner (21 Oct 1985) asking for information on the numbers of persons who have died following operations in private hospitals in 1984. And Frank Dobson, who became Secretary of State for Health, (28 July 1988) asking about Körner recommendations and data collection; he was told there are no plans to introduce these into private hospitals. He also asked for mortality and other figures for NHS patients in private hospitals, and was told the decision had not been made whether to publish the figures.
David Blunkett, then Shadow Health Secretary, now Education Minister, in
Patient Complaints... a new way forward
(May 1994 Labour Party), wrote Adequate protection for private patients is essential. Private nursing homes are a particular area of concern. Levels of complaint in such homes are rising alarminglythere has been a fourfold increase over four years in professional misconduct cases..
Updating procedures for complaints about GP services [procedures 'have remained largely unchanged since 1911'] is of critical importance .. to those receiving treatment outside the NHS. Better protection is also required for patients who undergo cosmetic surgery through private practice.
Labour document,
Going Privatethe growth of private sector healthcare under the Tories,
Sept 94: .. the poorly regulated private sector.. the increased reliance on private provision, together with the lack of clear and firm guidelines and care regulation, provides great cause for concern.. The Government has faced fierce criticism from many independent professional bodies for its laissez-faire attitude towards [private healthcare].. In August [1994].. a Royal College of Nursing report into the inadequate inspection and neglect by the Government of private nursing homes [and private hospitals].. Complaintsneither the Patients' Charter nor the current patient complaints procedures provide protection for [private] patients..
From Government Ministers' Letters:-
.. this [private hospitals] is an area of prime concern for us. You mention a number of aspects of the boom in private health care which are particularly alarming and we are trying to pull these into our ongoing work. .. [in our] recent.. paper on patient complaints.. we do make a commitment to address the question of complaints procedures relating to private care. The issue of regulation is also of enormous importance and we are striving to bring pressure to bear on the government over this, as well as ensuring that a Labour government will be fully prepared to instigate the necessary safeguards. (Office of David Blunkett MP to Richard Ennals 3 Oct 1994).
Standards [in private hospitals] should at least be comparable to those in NHS establishments. (Health Minister Tessa Jowell to the MP of G Maloney; see below26 Aug 97)
Health authorities.. are concerned with the clinical care provided.. We do recognise that the current regulatory system is not perfect but have not reached a decision as to what course of action would best protect the interests of those seeking medical treatment in such facilities. (Former Health Minister Baroness Jay [who wrote in exactly the same words to another complainant on 10 Oct] to the MP of Anthony Darley-Jones; see below20 Sept 97)
MPs' Questions in Parliament:-
Simon Hughes, 5 March 97: To ask the Secretary of State for Health what percentage of private hospitals provide full accident and emergency services. [the answer is zero - RE].
Anne Clwyd, 16 Jan 98: To ask the Secretary of State for Health what assessment he has made of the adequacy of health authorities' inspections of private sector clinics and hospitals.
Jacqui Lait, 30 June 98: To ask the Secretary of State for Health what plans he has to review Part 2 of the Registered Homes Act 1984.
Anne Winterton, 12 Nov 98: To ask the Secretary of State for Health (1) if he will make a statement on his policy on the regulation of private hospitals; (2) what plans he has to increase the regulation of private hospitals.
Ms Keble, 6 July 99: To ask the Secretary of State for Health what action he is taking to ensure the effective regulation of private health care.
David Hinchliffe, 6 July 1999: 'Has my right honourable friend [the Health Secretary] been able to study the work of Dr. John Yates at Birmingham University, which proves that areas of the country with the
highest numbers of private beds also seem to have the highest NHS waiting lists? Has he had a chance to consider the matter, and if so, what action is he taking?'
[Back to Start] MEDIA COVERAGE OF SOME PRIVATE HOSPITAL CASESIncluding: BUPA Gatwick Park | Rodney Ledward | Richard Neale | Christopher Ingoldby | Julian Upton The seven casescovering ten victims, or alleged victimsin the newspaper montage above are: 1 Christine Darley-Jones: One of several newspaper reports: Observer 2 June 1996: .. she was referred to a private hospital for a 'simple, 10-minute procedure under general anaesthetic' to investigate a hacking cough. Within seconds of the anaesthetic injection at St Anthony's Hospital, Cheam, Surrey, Mrs Darley-Jones, then 45, suffered a massive cardiac arrest and 'died'. Doctors took 40 minutes to resuscitate her. In the first six or seven minutes of the crisis, her brain was starved of oxygen and she suffered 70% brain damage. Since then, she has been fed by tube. Her bladder and bowels are also controlled by tubes. She cannot communicate or recognise anyone and is confined to a wheelchair. .. When [the husband] asked for an explanation of the accident, doctors told Mr Darley-Jones it was an act of God and a ghastly tragedy. .. Mr Darley-Jones.. has spent £20,000 in legal bills trying to get the consultant or the hospital, a charity run by an order of Belgian nuns.. to explain what went wrong. .. Macro [sic; Marco] Cereste, chief executive of the NHS Trust Federation.. said: 'When something goes wrong in a private hospital, the patient will always end up in the NHS.' .. The charity that owns St Anthony's earned £27 million in 1992-3.. His local NHS health authority has found [in a report by the Merton, Sutton and Wandsworth health authority registration inspector - RW] the anaesthetic record of the incident was inadequate and did not contain signatures, times or dosages. .. The hospital director has been advised to improve record keeping.' The Observer states 'Two months after the incident, her husband Tony received a letter from PPP saying it was ceasing to pay for his wife's care. It enclosed copies of the charges enclosed£25,000 for the hospital and £3,000 for the consultant. The NHS is now paying £750 per week for her care. .. Tony Darley-Jones: If this had happened in the street I could have understood. But she was in hospital. Sadly, it was a private one.' BBC TV Newsroom Southeast, 4 Jun 96: Tony Darley-Jones says he still hasn't had a full explanation of why his wife's routine surgery went tragically wrong. 2 Jane Hipperson: An account from The Express, Sunday 9 Feb 1997: '.. went into her local private hospital [the Esperance Hospital] for a routine hysterectomy operation. .. But within a week, death looked inevitable after her internal organs were ravaged by the flesh-eating disease necrotising fasciitis. [sic] .. At first the operation on Monday afternoon appeared successful. But at 1 am on Sunday Mr Shardlow [gynaecologist] rang Richard [husband] to say he needed to perform an emergency operation.. By 2 pm [Wednesday] Mr Shardlow rang to say Jane was being transferred to intensive care at Eastbourne [NHS] Hospital. .. Jane and her husband are grateful to the NHS for saving her life.. She and Richard are planning to sue the private hospital over an alleged breach of care. They want to know why she needed a second operation to stop internal bleeding after her hysterectomy, and why staff failed to recognise the first signs of infection when she complained of abdominal pain and numbness in her left leg. My wife went into hospital for what is a simple operation that thousands of women have every year, said Richard, But in two days she turned from someone who was healthy to someone who was not expected to last the night. Lesley Galloway, director, said:- If Mrs Hipperson or her family would like to contact me I would be happy to talk to them.. I would be delighted to answer any questions she might have. I would hate any of our patients to be unhappy about their care. 3 Carole Burwash: Times Wed 6 July 1996. The private hospital [Princess Grace] where a woman patient [for a 'routine hysterectomy'] was injected with ten times the correct dose of painkiller was partly to blame for her death, an expert medical report says. ... Professor [Felicity] Reynolds identified seven errors that led to the death. She said Dr Lim was most responsible for negligence because of his incorrectly written prescription and the absence of direct communication with Dr Hornabrook. [Resident medical officer]. The hospital was also negligent because it had no trained resuscitation team, no protocol for epidural opioids and had appointed a resident medical officer without anaesthetic experience. Professor Reynolds's report said: Probably the most important inherent drawback of a private hospital, or indeed any small isolated hospital, is that there is no resident anaesthetist to top up epidurals and, above all, to provide an efficient resuscitation service. Any medicine or surgery practised under such circumstances is therefore inevitably less safe that a National Health Service Hospital with an appropriate complement of resident staff. Brian Burwash, husband, Daily Telegraph, 7 July 1996: "I would not go to a private hospital now, nor would I allow any of my family." And two years later, 11 Aug 1998: Some patients in private hospitals don't realise how vulnerable they are, especially at night, when consultants and anaesthetists have gone home. [Caroline Buckley is a co-founder of APROP; for APROP's testimony to the Parliamentary Select Committee, see the weblinks.] 4 Christine Maloney. The Northern Echo Fri 13th June 1997: .. after a three-year fight costing him [Graham Maloney, who is a very effective campaigner, who coined the description of the GMC as the Great Medical Cover-up] thousands of pounds, a 35-page report by Tees Health Authority has revealed failures in the care given to cancer patient Mrs Maloney at the 34-bed Stockton hospital [the Cleveland Nuffield Hospital] where she died in the early hours of November 23, 1993. .. The second.. report states: *The system of recording drugs .. was open to error; *.. there were problems with a nursing sister behaving offensively..; *the complaints procedure was unclear. The Evening Gazette, 19 June 1997, also mentioned a recommendation to establish a local agreement between Tees Health and the Nuffield about steps to be taken in complaints about the care of private patients. However, the Nuffield's response Observer 1 Feb 98 was: We are not aware of any provisions under the Registered Homes Act which requires [sic] the registering health authority to be involved and we do not believe this would be appropriate. Northern Echo, Apr 98: On advice from Health Minister Tessa Jowell he [the patient's husband] is taking legal advice and possible action [in Europe] and is asking advice from the EC-funded AIREAdvice on Individual Rights in Europe. There is a possibility he may have a case. Independent on Sunday, 18 July 1999: Mr Maloney said .. The private sector in this country is sold as the Rolls-Royce of health care, yet in many areas the wheels are coming off. It's business first, medical care second in many cases. Graham uses vivid comparisons in his speeches: You get more consumer protection when you buy a tin of beans in a supermarket, Reading the brochures from other hospital groups, BUPA, Nuffield, they are full of mistruths, it is a con, Florence Nightingale would have turned in her grave, I had been lied to by the matron, by the hospital manager, by Mr Irving, the chief executive of the Nuffield Group., You would get better care on a market stall. Click here for Graham Moloney's personal Memorandum to the Parliamentary Select Committee which deals with this issue, and the failure of a surgeon to diagnose his wife's cancer. 5 Sir James Stirling: Times Sat 5 Sept 1992: .. who died after a routine hernia operation.. Recording a verdict of death by misadventure, Dr Knapman [coroner for Westminster] commented that it was "unfortunate to say the least" that Dr Hardwick [Peter Hardwick, a consultant anaesthetist] had been out of contact with his hospital [Hospital of St John and St Elizabeth, St. John's Wood] for ninety minutes as Sir James's condition was deteriorating. Times, 13 Sept 92: After the operation, Hardwick went on an organised walk, leaving the hospital without a qualified anaesthetist to supervise the case. [The newspaper reports don't make it clear whether, in their opinion, such an incident is less likely in an NHS hospital, although this seems probable]. .. Hardwick has been involved in two previous actions for medical negligence. In 1982 he was a co-defendant in a claim settled out of court after a two-year-old Saudi Arabian boy was left severely brain-damaged after an operation to remove a minor tumour from his leg. Four years later he faced a claim involving a teenage girl who suffered brain damage after a routine operation to remove wisdom teeth. The case was settled with a £330,000 out of court payment. In both cases there was no admission of liability.. He told a local paper that he had taken all the necessary precautions. "Sir James was a very unwell man and the hazards of anaesthetic with this type of operation, including vomiting, are well known".' [Some two years later, the Times reported that the Sterling family had accepted an out of court settlement in respect of the death]. [Stirling designed, among many buildings, Selwyn College, Cambridge (UK), the Clore Gallery at the Tate, and museums for Harvard and Columbia]. 6 Adèle Hillman: the Mail on Sunday 14th July 1996 appears to quote for her:- .. the Princess Grace Hospital.. The house doctor inserted a drip into her right hand; when it failed to work he tugged the needle sharply 'causing me absolute agony.' Mrs Hillman begged for the needle to be removed, 'but I was told I was making a fuss'. After thirteen hours of excruciating pain a doctor removed the drip and discovered her main radial nerve had been damaged. She has lost the use of her right hand and armpermanently. She cannot drive, write or eat without help, and is in constant pain.. Mrs Hillman has found the private hospital, owned by the BMI group, coldly unsympathetic. They paid her a paltry £1,800 to be reviewed but they have since denied liability. So now this crippled widow in her 50s is having to take the hospital to court for compensation.. [The newspaper does not attempt a comparison with NHS treatment]. 7 - 10 Four male patients. Observer article of 1995, eleven years after the Registered Homes Act, The deaths followed a confidential audit which found that nursing standards at Kneesworth House Hospital in Hertfordshire were not of the same quality or type as in NHS psychiatric units. .. its authors, two senior nursing academics, were threatened with a libel action if it was published. Compiled with the hospital's co-operation, the audit was carried out by the City and Hackney Health Authority.. The audit found that Kneesworth House, Stockton Hall.. and Llanarth Court.., all run by the company Partnerships in Care, adopted a 'factory' approach.. The audit said the hospitals used large numbers of lowly qualified nurses, fewer doctors and wards of up to 30 patients to limit running costs. The Royal College of Psychiatrists is also concerned about the increasing reliance on drugs to manage difficult patients and published a consensus document last year [1994] linking excessive use of neuroleptics.. with sudden deaths from heart attacks. .. Dr John Taylor, medical director at Kneesworth: I am not really aware of what the health authority said in its report. I see so many of them that I can't actually recall that one offhand. Labour MP Margaret Beckett [now President of the Council and Leader of the Commons]: What makes this particularly alarming is indicators that, in some psychiatric units run for profit, cost margins may be so squeezed that staff levels are inadequate. [Back to Start] There have been several TV programmes on this issue; the best was by World in Action, ('Private Grief', 4 July 1992, research Kate Middleton, producer Sarah Manwaring-White, Granada for ITV). It has to be said [by RW] that TV hasn't yet mastered the art of presenting issues clearly; the programme probably had little effect. The four cases described were: 11 Sidney Cable, who, after a minor investigation for ulcers [at Fawkham Manor private hospital, now with new owners], became progressively more ill, until three weeks later he was taken to an NHS hospital in critical condition, where he died. A report, by an anonymous 'top surgeon', said the consultant, Peter Bates, should have realised the case was beyond the scope of a small hospital. "It was more likely than not that Mr Cable could have been saved." He "failed to order sufficient tests to monitor Mr Cable's condition." Mr Cable's daughter stated that some nurses had been worried about Mr Cable; but "if they went against [what he said] they'd never work again. ... We were under the impression he would get the best care, but it didn't turn out like that.. I think my father would have been a lot better off if he had crawled into an NHS hospital and got his treatment there." The case was settled out of court. 12 George Ryb, who died after an angioplasty (i.e. attempt to increase inner diameter of arteries). Edgar Sowton was the surgeon; the family paid £300 for a cardiac surgeon and backup team to 'stand by'. However, the procedure caused one artery to block, causing a heart attack. The supposed backup surgeon was later visited by the dead man's daughter; he told her he'd been operating at Guys, several streets away, and "it was very fortunate that we were able to find an anaesthetist.. by the time I opened the chest there was too much damage.." This was despite the condition of the patient: a 'top cardiac consultant' seeing the X-ray movie film of Mr Ryb's heart wrote: ".. wouldn't recommend angioplasty.. the standby cardiac surgeon would have to be in immediate proximity and ready for instant action.." London Bridge Hospital's own records showed Philip Deverill, the standby cardiac surgeon, listed as covering both for Mr Ryb and the previous patient's angioplasty at the London Bridge. Daughter Samantha Ryb said "One of the things that upset me greatly is the way the doctors treated us.. with such callous disregard." She said in the Express, 3 Mar 1999: .. they didn't have the back-up team. If he had been treated in the NHS, if the hospital had been properly equipped, we think the chances are he would have survived. A report by an expert anaesthetist sates: 'The quality of care provided by the consultant anaesthetist fell below the standard that she was entitled to expect and I also had reservations about the quality of nursing care provided.' There's an interesting inconsistency between the London Bridge's statement to World in Action (TV) in 1992: The hospital told us they'd not felt it necessary to have a special inquiry into Mr Ryb's death and its statement to the Daily Express in 1999: The incident was investigated thoroughly. 13 Roy Gray, who died in an NHS intensive care unit after being ill for some time in a private hospital [BUPA Chalybeate]; the point here was that PPP's policy failed to state what would happen if the cash limit on the policy was reached. In this case, the NHS charged for treatment, which Department of Health guidelines allow, or allowed, if treatment was started in a private hospital. 14 Sue Heap: after the removal of a small stone from a salivary gland, her tongue swelled to such an extent that she couldn't breathe. Unfortunately this was after she'd been observed 'several times' in the recovery room, then put into her private room. By the time her breathing difficulty had been noticed, and neither the young resident doctor nor the anaesthetist had been able to open an airway, the anaesthetist called for an instrument to perform a tracheotomy [cutting a hole in the throat]. But there was no instrument to hand. 'By the time a scalpel was found it was too late.' She was severely brain damaged and lay for 2½ years in an NHS ward until she died. A medical expert found that 'had her post-operative management been more thorough, obstruction would not have occurred and she would not have suffered respiratory arrest.' Husband Kim Heap: You're paying a lot of money for someone to go into a hospital like that; you expect her to be looked after properly. (A sign outside the hospital [Holly House private hospital] said: 'NO EMERGENCY DEPARTMENT. NEAREST CASUALTY WHIPPS CROSS HOSPITAL.') The programme ended with the voiceover: The Independent Healthcare Association (a charity) refused to be interviewed. ... The majority of private hospitals would not tell us how they dealt with complaints. ... The Department of Health have no plans to review the private healthcare system. Arnold Simanowitz of AVMA said: I think the DoH is opting out of the problem.
Further publicised cases:
15 Tony Charalambides: Windsor and Maidenhead Observer
13 Oct 95, entitled Crippled boy wins £200,000 settlement reports that his father Andreas claims that a consultant at Thames Valley Nuffield Hospital failed to promptly diagnose his son's spinal tumour in 1990, when his son was 13. He states that the stomach pains for which his son was admitted were treated as constipation; his appendix was removed, and he became progressively worse, suffering excruciating pains, immobility, and pressure sores. The analgesics prescribed by the consultant and by the hospital's RMOs had little effect, and only after a second opinion from a neurologist, and an MRI scan at Great Ormond Street hospital, was his tumour diagnosed and treated, but too late to save him from being crippled. Tony
Sunday Times,
2 Aug 1998No-one knew what was wrong with me until I got into the NHS.. When I was in the private hospital, I was in terrible pain and couldn't move properly. The hospital staff said I was hysterical and even removed the buzzer from my room.
Mr Charalambides said (
Don't Stay the Night
): What was not explained to us when we were paying our money for private health is that, as you become a private patient, the consultant is the person who's ultimately responsible. The nursing staff .. all rely on the consultant, so, if the consultant is not around, you have a complete, total breakdown in communication, potentially, and that is exactly what happened in his case. They should come up front and state in their brochures:- If you go into private health, this is the risk you've got to take. Beware of it! And
Daily Telegraph,
11 Aug 1998: People should be aware of the risks as well as the benefits of jumping the NHS queue.. I think that, for the hospitals, it's a matter of mitigating losses, whether financial or in terms on reputation. Those at fault want to preserve face with little consideration for the effects of their actions on the lives of the patients and their loved ones. They rarely say sorry.
Tony Charalambides,
Meridian TV,
14 Aug 1998: I was in severe pain.. I couldn't move my legs once they'd operated on me. I got prescribed paracetamol to take away the pain.. in terms of medical care it was certainly substandard. Meridian: The consultant at the NHS hospital said that although tumours can be difficult to detect, the signs were definitely there.. Tony, now 21, and permanently disabled: My situation is so unnecessary. If I had been diagnosed early enough then I wouldn't be in this situation, I'd be fine. The Thames Valley Nuffield Hospital in a statement to Meridian: In the case of Tony Charalambides we do not believe our care for him was ever less than appropriate and committed.. Nuffield Hospitals treat more than 700,000 patients every year and from our regular surveys we know that we deliver a very high level of patient satisfaction.
16 Ruth Silverman
(
Guardian,
15 Dec 92): .. A London inquest heard that Mrs Ruth Silverman had died from a massive brain haemorrhage brought on by blood poisoning, caused when surgeons punctured her bowel while clearing a blockage. Her death highlights a major difference between team management in private and NHS hospitals. The St Pancras inquest heard that on June 12th, two surgeons found themselves scrubbing up at the same time to perform different operations on 49-year old Mrs Silverman at the private Portland Hospital on June 14th. As her condition worsened, there was confusion as to who among four consultants was in charge of her. She was transferred to the Harley Street Clinic. On June 15th, two further consultants became involved. Dr Rodney Armstrong, head of Intensive Care at the NHS University College Hospital, took charge of her case. She was transferred to UCH on June 20 after two operations had stabilised her condition, but died on June 22. While praising the quality of the Harley Street Clinic, from whose Intensive Care Unit Mrs Silverman was transferred, Armstrong said he felt she would have been better off in an NHS hospital when she became critical. Greater depth of management expertise would have been available.
17. 'Robert'
(
Observer,
1st Feb 98), 27 years old, died after treatment in a private hospital. Problems began following surgery to remove his colon (described as a complex but not life-threatening procedure). According to his parents, nurses failed to realise his circulation was failing him, failed to aspirate him properly, following a build-up of fluid in his gutthe hospital only ever had one other patient with a similar conditionand soon after he went into cardiac arrest. Transferred to an NHS ICU, he died a few days later. The parents 'Rose' and 'Jack' are instructing solicitors but do not identify themselves partly for fear of being sued by the hospital.
18 Emma Pelta: Channel 4 News
6 Feb 98. A routine keyhole surgery for an ovarian cyst at BUPA's Roding hospital, according to this report, went badly wrong. She had to be rushed over for emergency care to an NHS hospital. Father, Jeffrey Pelta, said: "She could have lost her right leg, she could have lost her life. The laparoscopy went drastically wrong and her artery was punctured." And
Sunday Times,
2nd Aug 1998: It's a disgrace that you are not told that private hospitals don't have all the facilities and staff on hand to cope with emergencies. When they cut the artery, they had to clamp it and then start phoning round to find the cardio-vascular surgeon to repair it.
19 Eileen Lambie: Daily Telegraph,
11th Aug 1998: .. had a cancerous bladder removed at a private hospital in Surrey. Immediately after the operation, her care was transferred from her consultant to a locum surgeon in the same hospital. Though she was becoming progressively more ill, the hospital claimed there was nothing organically wrong, and the locum saw her only six times during his 25 days in charge of her case. Nothing could have saved my wife, but she could have been spared weeks of pain and suffering, said [husband] Mr Lambie. When I asked for her medical records, I was very angry to see how she had been neglected. Later, a local paper,
Walton and Weybridge Informer
24 Sept 98, wrote: '"She.. became ill and could not eat or drink and had hallucinations. The surgeon failed to carry out a routine blood test and subsequently failed to diagnose a serious calcium deficiency. .." the symptoms were later diagnosed and treated at a different hospital. Mr Lambie said the glossy magazines promoting private health care were attractive but did not give the full picture. "I never realised that taking private health care would cause so many problems. People must be made aware of the risks."'
20 John Corless
BBC
Here and Now,
14 Sept 1998: .. John Corless's life was at risk despite paying £20,000 to a top London hospital. He had successful heart surgery three years ago at the Wellington only to end up fighting for his life.. The serious bowel condition he was developing wasn't spotted. He was treated instead for constipation and eight days later he was discharged. His family had to push him out of hospital in a wheelchair. Within hours he was having life-saving surgery in the NHShis bowel had perforated. ['.. he spent 12 days on an NHS life-support machine.. "The private hospital had made a complete mess and the NHS had to pick up the bill to put it right," he said.' (
Sunday Times
11 April 1999).] The physician who reviewed the medical notes said that the private hospital should never have discharged him in that state.. Dr Graham Neale, Consultant Gastroenterologist: That decision nearly cost Mr Corless his life. Mr Corless was being treated for his heart.. by a heart surgeon and a heart specialist [who] weren't expecting anything to go wrong with his tummy [sic]... they are not tummy doctors.. BBC: The responsibility for not spotting Mr Corless's condition was less with any individual and more with the private hospital system itself where the consultant works pretty much on his own.
John Corless: The fact that I'd left what I considered to be a hospital of excellence with six hours to live quite frankly is disgraceful.. Certainly, I experienced a terrible experience in respect of private hospitals.. and paid for it in many ways, not only with my wallet, but also almost with my life.
21 Bill Moore Evening Standard
19 Dec 1994: .. went to a private hospital [Holly House] for a routine operation to remove gallstones. .. The consultant made a surgical slip, the error was never properly corrected, and Bill died, eight operations later. Widow Valerie said that the surgeon cut too deep, resulting in a fistula, which went unnoticed. A second operation to investigate his poor circulation also failed to spot the fistula, no second opinion was sought, and no contrast X-ray carried out. Put on solid food soon after, septicaemia and peritonitis set in, and five days after the operation he was rushed to Whipps Cross NHS hospital. After several unsuccessful operations he died. Experts were highly critical of his treatment following the initial operation.
22 Helen Edwards
(
Guardian
17 Nov 98) awarded record £3.9M compensation for brain damage, aged 5, during routine surgery at the Hope private clinic, Cambridge, to remove a birthmark. Left blind and unable to crawl, feed, or talk, her parents claim the damage was caused by incorrect intubation by the anaesthetist. The case took twelve years to settle in court.
23 James Williams
, 38, who accepted £800,000 in damages from the surgeon's insurers after a failed 'reverse circumcision' at the 'Lister' private hospital in London.
Guardian
24 Nov 98: His penis turned gangrenous.. he should not have been discharged.. Surgeons at an NHS hospital believed he was in grave danger of losing his penis and an emergency operation was carried out; and in fact
Guardian
25 Nov 98: '.. he needed.. six further operations over two years after being discharged.. When he questioned Mr. Pryor after surgery he was told: "If you are worried about it you ought to see a psychiatrist".'
Mr. Williams's case was that Mr. Pryor [consultant uroandrologist at the Lister] used an operative technique that was "doomed to failure".. Mr. Pryor had failed to warn of the real risk associated with the procedure, and had varied the technique, which he had written up in the British Journal of Urology in an article which Mr. Williams had seen. In the operating theatre further things went wrong, but Mr. Pryor did not recognise this early enough or re-operate soon enough.. He administered Voltarol, a drug which should not have been given, and the antibiotic cover was inadequate. Finally, Mr. Williams was sent home from hospital "when it ought to have been superabundantly obvious to anyone that he was not fit to be discharged" ..'
24. 'Patient 3'
, one of several patients of gynaecologist Nicholas Siddle, subsequently struck off by the GMC.
Times
11 July 1995: 'Mr. Siddle, who now works at a private Harley Street clinic, was allegedly responsible for damaging the bowel tissue, bladders and wombs of eight patients over 15 months to December 1992.. The [GMC] hearing, chaired by Sir Herbert Duthie, was told that Mr. Siddle tore a two-centimetre hole in the bladder of a private patient admitted to the Portland Hospital in January 1992. The woman, known as Patient 3 to protect her anonymity, underwent keyhole surgery for a vaginal hysterectomy. Mr. Siddle also damaged both her ureters during the surgery, the hearing was told. "The extent of the damage indicates a lack of experience enabling him to tackle such a procedure safely, and a lack of ability to recognise basic anatomy," Ms. Foster [counsel for the GMC] said.'
25 Owen Ennals
my late father. Some details were reported in the
Observer
1 Feb 1998,
The Last Place You Want To Be
based on the medical and nursing notes, correspondence and statements relating to this case supplied to
The Observer,
and four highly critical experts and Health Authoritys reports based on same. The
Observer
quotes the findings and conclusions of the second Health Authority report on the death by the Director of Public Health: The care given, in this instance, fell below adequate standards; the documentation was not properly complete and accurate; Mr Richard Ennals complaints do not appear to have been handled in an entirely satisfactory manner (Point 3.5.3 of this report: This letter [the hospital's response to the complaint].. gives the impression that Mr Ennals did in fact only have indigestion on the morning of November 16, when subsequent events make it highly likely that his myocardial infarction started in the early morning on the day of his death). The Authority's report concludes: .. appropriate changes have been and are being made which the Health Authority expects should prevent any recurrence of these unfortunate events. [In this and in an earlier interim Authority report, the Authority made a total of five pages of recommendations for improvements]. The Health Authority Chief Executive in a covering letter: I am sorry that the death of your father has caused you so many concerns. Fuller details to come - RE
26 Hadassa Carmon
, 59. Channel 4 TV News, 29 Apr 99: Israeli state medicine is treating a distressed former patient of Britain's private system. Hadassa Carmon has advanced breast cancer.. BUPA Gatwick Park had told her she was healthy: three radiologists failed to identify her disease, despite three separate mammograms over two and a half years. Her cancer was found by her Tel Aviv GP within five minutes.. In newspaper advertising BUPA claims its radiologists are mammogram experts "who probably know more about the subtle differences between healthy and unhealthy breasts than anyone else." .. expert radiologists said Mrs Carmon's disease should have been obvious from the very first mammogram..
Times
4 March 1999: 'Ian Fentiman, of Guy's [NHS] Hospital's breast clinic, said if a woman with a lump was referred to an NHS clinic, it "will take a history, examine her, do a mammogram and do everything necessary. Too many people just go along [privately] and have a mammogram and if the mammogram is all right they assume they haven't got cancer." .. Mrs.Carmon, 59, received £143,000 from Janet Page, the radiologist responsible for her second screening, in an out-of-court settlement. The patient.. had to withdraw her writ against BUPA after learning, to her distress, that [the BUPA hospital] had no responsibility for doctors' actions.' [Mrs.Carmon subsequently died, 14th.December 1999, in Tel Aviv -RE]
27 Charles Flodin-Tamm.
BBC TV
Newsroom South East
25 March 99: Charles, now 18, became gravely ill as a child when a tonsil and adenoid operation went wrong. Complications emerged which were the responsibility of the consultant who rented facilities at the Sloane Hospital [who was absent] Mother, Anne: At that time I was so distressed because my son was [in a bad state] and there was no other person around who really could take him to theatre again.
28 Jenny Goodman Sun
, 4 Nov 98: .. In July, 1992.. her womb became perforated during a private gynaecological operation at London's [private] Portland Hospital. Jenny says: When I awoke I felt dreadful, my stomach was burning, I was in agony. I said: "I'm dying, please do something." They kept saying it was wind. I knew it was blood poisoning. Three days later she transferred to the [NHS] University College Hospital and doctors discovered she had a huge pelvic abscess and candidal septicaemia. The drugs used to treat it were like chemotherapy and Jenny developed adult respiratory syndrome. Doctors put her into a coma to fight the terrible infection.. Jenny left hospital after a total of 45 days.. [previously] a successful businesswoman.. Jenny in now living on invalidity benefit.. she has been paid a £15,000 "nuisance" payment by solicitors for Professor Stuart Stanton who carried out the surgery. But they have not admitted liability. She describes the payment as an "insult".
29 Kathleen
BBC TV
Kilroy
11 Dec 98, said she had an unnecessary operation in a BUPA hospital which went radically wrong; a nerve was trapped in her leg, she was a semi-invalid for the next two years and she lost her job. The doctor ignored her complaints and there was no course of action but litigation. Kathleen's husband: I complained about the treatment of my wife and the doctor said "There's nothing I can do for her here". He rang the NHS to look after her. I had to get an ambulance to take her to the NHS hospital.
30 Sir Michael Caine
, Director and Chairman of food company Booker-McConnell, who died at the King Edward VII private hospital in February 1999.
Independent on Sunday
, 18 July 1999: .. the decision to go private, according to his wife, Emma Nicholson, cost him his life, for she is convinced that he would still be alive if he had been treated in an NHS hospital. Sir Michael suffered a heart attack on the evening of 15th February. It lasted at least fifteen minutes, during which time a tube, used to help him breathe, malfunctioned. He suffered massive brain damage and never regained consciousness. The only doctor on site was a GP drafted in for the weekend, who had one week's experience in intensive care duties. The dying patient, the guiding spirit of the Booker Prize for fiction for nearly 25 years, was later moved to the NHS St Thomas's Hospital, where he died on 20th March. Baroness Nicholson claims that nurses at the King Edward VII repeatedly refused to call consultants and doctors, even though she believed her husband was in distress and pain. She believed that, shortly after his operation, a tube inserted into his throat to help him breathe had been removed and wrongly re-inserted, leading to the 15-minute cardiac arrest and brain damage. She claims that after his surgery he was moved to an NHS hospital because the King Edward VII "could not cope" with such a complex condition. After the transfer, she said, King Edward VII staff repeatedly sought his return. "I wonder whether the King Edward VII was seeking Michael's return for financial reasons," she added.
Daily Mail
, 13 July 1999: "I decided to move him because I now had no confidence in the quality of their care," the Liberal Democrat MEP told Southwark Coroner's Court. "I felt staff at the King Edward wished him to die in situ. As soon as he arrived at St Thomas's, the consultant got to work. He had tests undertaken, they started feeding him again and they started treatment. The staff at St Thomas's told us they were just too late."
Daily Mail
13 July 99: "Everything possible under the circumstances was done. The highest level of care and medical expertise available in emergency conditions attended him at the time. We have complete confidence in our staff and we wholly refute the serious allegations against the hospital." [NB The
Daily Mail
's promotion of private medicine was a contributing factor in Nicholson's presumption of NHS inferiority - RW]
Independent on Sunday
: [King Edward VII's Chief Executive] "Whether Emma Nicholson decides to sue the hospital is a matter for her.. If she does decide to sue us it will be resisted most vigorously and comprehensively."
Observer
19 Sept 99: '.. the couple believed, along with many others, that 'private' equalled 'quality'. "Had I the knowledge then that I have so painfully and unwillingly acquired now, we would never have gone there,' said Nicholson. 'We would have gone straight to the NHS. Whether Michael would have have had three months or three years more is not the issue. The point is that he would not have died because there were ill-trained staff and inadequate equipment."
BBC TV
Panorama
20 Sept 99 (
Private Hospitals and Private Risks
): The hospital in a statement: "The majority [of our nurses in the ICU] are not ITU trained.. because intensive care courses are very expensive and they are very oversubscribed" (none of the nurses had received formal ICU training). Dr. Carl Waldman, ICU Director of the NHS Royal Berkshire Hospital, and Council Member of the Intensive Care Society: "We would expect 40 or 50% of the nurses in an ICU to have that training and for there always to be nurses with that training present on all shifts. If the King Edward VII was unable to meet the requirements of a baseline ICU it should have made other arrangements... With the right number of trained staff present, the chances of Sir Michael's death would have been minimal."
31 Brendan Woolhead
, 34, who died following detoxification treatment at the London Wellbeck private hospital in October 1996.
Times
: 'The Westminster inquest was told how Woolhead.. When the anaesthetic wore off.. was taken from intensive care to his room. Later he complained of headache, had a seizure and died of a heart attack, despite the efforts of medical crews. The inquest had earlier been adjourned and the case file referred to the Crown Prosecution Service after two leading medical experts said they believed Woolhead's death had been caused by "reckless" and "grossly negligent" behaviour by the hospital.. his family said they would be taking action against the hospital.'
Guardian
3 April 1997 added: '.. Griffith Edwards, of the Maudsley Hospital, an expert in addiction behaviour, said the Wellbeck Hospital had made "manifestly false" claims about Mr. Woolhead's treatment.'
32 Ivy Brimble
. BBC2 TV
Newsnight
, 20 July 1999: "When the surgeons at the centre of the Bristol heart scandal operated privately here three years ago on adults, there was less attention to audit. BUPA Hospitals say only one patient died under the care of disgraced surgeon James Wisheart. But at least one case has been overlooked. In 1996 Ivy Brimble had a triple bypass at the BUPA Bristol Hospital [The Glen] performed by the other surgeon implicated in the scandal, Janardan Dhasmana. Her niece stated that she suffered a stroke before she came round. She died shortly afterwards in intensive care at a nearby NHS hospital.. She is shocked that BUPA deny any fatal complications. "There definitely was [sic] with my aunt. She suffered a stroke whilst having the operation and she never regained
consciousness.. she was totally paralysed."
33-51 Nineteen elderly NHS patients, under contract, at BUPA Gatwick Park private hospital.
Channel 4 TV News, 29 Apr 99: Nineteen NHS cataract patients had surgery over a two week period. No one realised that the surgeon was injecting the wrong eyedrop form of the methyl cellulose [the injected substance was intended for external use only], a mistake with the potential to destroy their vision.. a leading eye surgeon says those patients were injected with a toxin. All suffered visual impairment, some seriously, and don't yet know if it is permanent.
Local newspaper earlier had said (
Crawley News
, 24 Mar 99):- .. the patients must wait an agonising six months [sic] to discover if the sight in their eyes will be impaired forever.. it was not until two and a half weeks after the operation that the blunder was detected.. But the medical team has not been suspended from its work.. John Lambie.. said that ironically, as the cataract patients were referred by the NHS, they would have rights to a statutory complaints procedure unlike private patients in the hospital.
Crawley Observer
of the same date: An independent inquiry has been launched into the bodged operations. Chief Executive of the trust [Brighton Health Care NHS Trust who referred the patients] Stuart Welling said "The operation was only carried out on one eye so they still have reasonable vision in their second eye." David Spalton, director of clinical opthalmology at St. Thomas's Hospital, London, said the same mistake had been made before elsewhere. "These things need to be checked and double checked".'
(The Health Authority Inquiry, as reported in the
Independent
18 Dec 99, found
inter alia
that the operations had been 'hastily' arranged, that the mistakes were due to a 'misunderstanding' between nurses and the surgeon, and that it was because of 'inadequate post-operative care' that the cause of the problem wasn't discovered until after the third batch of surgery. Of the patients recalled, one third had inflammation and corneal damage, another third had swelling and clouded vision, and two had had to have corneal grafts. Eleven recommendations were passed to the Department of Health to prevent similar errors. A BUPA spokesman said compensation 'would be considered' - RE)
52-53 two NHS patients in an NHS hospital
, in a feature on BBC Radio 4, 31 Mar 1999,
You and Yours
on the dangers to patients of consultants dividing their time between NHS and private hospitals.
"In an operating theatre at a London hospital a patient is cut open at the chest. The anaesthetist has the patient's heart in his hands, trying to massage life back into it. There's no one else to do it because the surgeon has left to see his Harley Street patients. This is a true story contained in evidence given by NHS staff to a coroner's court. The patient, an elderly woman, died on the operating table."
The coroner also heard about the death of a second heart patient, again after the same surgeon had left for Harley Street. The patient's daughter: "The main surgeon left a junior doctor who'd only been three months in surgery to carry out the operation on my father, which he found difficult. The surgeon phoned from Harley Street, carried on the operation by telephone via a third person, as the other surgeon was scrubbed up and could not leave the theatre, and then when it was said that this junior surgeon could not help my father any more, he was told by the main surgeon to just try once more, and if it doesn't succeed, just stitch him up and pronounce him dead." BBC: "The incident is now being investigated by the GMC.. some doctors may be treating their NHS patients to a second-class health service.." Daughter: "Don't, when you're being paid to be somewhere else, go and do private work. In any other profession.. You'd be sacked."
54-250? Patients of Rodney Ledward.
Ledward was struck off the Medical Register by the GMC for serious professional misconduct in October 1998, after 33 years as a doctor; it was subsequently acknowledged that one in three of gynaecologist Rodney Ledward's operations resulted in serious complications. Early estimates are that nearly half of the 200 women who have complained about their treatment since the verdict were patients in private hospitals. Many were left infertile, crippled, or needing follow-up repair operations. He was only suspended from the private hospitals he used after he had been suspended in the NHS.
A particularly important point highlighted by the scale of the Ledward case, probably characteristic of all private hospitals, is the degree to which private hospital staff will stay silent and thus help cover up even this level of incompetence. Although many hundreds of nurses and doctors over the years will have been aware of his incompetencehe was known as 'Rodney the Ripper' as long ago as 1985not one spoke out. Another concern is why the Medical Advisory Committees (MACs) of these hospitals did not take action years before. The principal functions of a private hospital's MAC include advising the hospital management on the standards of performance of admitting consultants. St. Saviour's Medical Advisory Committee, composed of admitting doctors who are supposed to monitor performance, only acted after Ledward was suspended by the NHS. BUPA's stance towards its customers may well be illustrated by its conduct at the angry meeting held in Folkestone attended by over 200 victims and relatives, over half of whom were private: unlike the NHS hospital where Ledward operated, BUPA didn't even bother to send a representative, only a curt leaflet advising of a telephone number for 'counselling'.
An inquiry has been instigated, but not an open one, so it is unlikely the truth will ever be known. And the 'Ritchie Report' into Ledward did not investigate his private hospital victims.
At least eight victims contacted APROP. Here are just a few publicised cases:
54 Brenda Johnson
, who was admitted to St Saviour's private hospital as long ago as Sept 1984 for a routine hysterectomy, carried out by Dr Ledward. In the following hours she lost six pints of blood, and had to have a second operation, requiring 76 stitches, to repair the damage. She could not walk for two years and will suffer pain for the rest of her life. BBC
Kilroy
11 Dec 98: You think you're getting the best of treatment but there's nobody on standby.. I was left bleeding all night. There was not proper nursing staffing in this private hospital, there were no intensive care facilities, you were left to suffer. The consultant couldn't be contacted, and eventually when he was brought back the following morning I was dying. I had less than ten minutes left to live. My husband was called and I was not going to make it. Fourteen years later I am still in pain. I had to take it to court because there was no redress anywhere. I got in touch with the hospital authoritiesthey didn't want to know. They said they're not responsible for the doctors working there, it's up to the doctor. You're paying a fortune for private care, thinking you're getting something. I got in touch with the GMC; they didn't want to knowthis was private. You've got no redress anywhere. I was desperately ill and couldn't get help.
Sun
17 Nov 98: "If somebody had listened to me and he had been stopped earlier, a lot of women would have been spared an awful lot of pain. If I had been tortured by the Nazis I think it would have been less painful. Marriages have ended over him because the women he operated on are just so beaten up inside that they still can't have a proper relationship..."
Independent
16 Nov 99: "It was a massive strain on the family. I have never held a full-time job since because I never felt well enough. I have spent most of the time going to see doctors. It has cost the NHS a fortune to sort out my case." ... She was originally treated for a bladder problem but has been told since that it could have been dealt with by a minor operation or physiotherapy.. She said: "He made such a mess of women in operation after operation. What they want to know is why it took 18 years to come out. They want the whole thing out in the open."
55 Anita Hill
who, following seven operations over six years by Ledward, mostly at St Saviour's private hospital, has been left permanently maimed. Her injuries included a perforated bowel resulting in an emergency colostomy.
Independent
14 Jan 99: The series of operations has left her with a weakened stomach wall and a misshapen abdomen. She suffers pain, is prone to vomiting and has been told she needs a further hernia repair and plastic surgery on her stomach to remove scar tissue. .. She said: "If it wasn't for the NHS I wouldn't have anyone to help me. They have told me who to turn to and what to do. The private sector have not been to any of our [victim] support meetings. The message is: 'If you still have got health insurance we can see you, but if not, tough'. .. I thought there would be someone in the private sector to go to if you had problems but I learnt to my cost that there wasn't. My whole life has been ruined and I have had nobody to turn to." ... The South East Kent community health council accused BUPA [owners of St Saviour's] of "dragging its heels" over the issue and lawyers for the victims said its refusal to accept a share of the responsibility was "reprehensible".
Independent
22 July 1999 added: 'She said in her own case she had tried to get help but had been blocked by the BUPA hospital's refusal to let her see her notes. In the end she had been forced to appeal for help to the NHS.'
56 Natasza Lambert
, a patient at the Chaucer private hospital, Canterbury, Kent.
Sun
17 Nov 98: .. went in for a routine hysterectomy a fit 40-year-old.. But she had to leave in a wheelchair. She said: I discovered that, thanks to his incompetence, my stomach muscles were ripped. .. [thirteen years] pure hell.. I'm still in pain. I was told by my doctor that he was a good surgeon. But I've since discovered that even then he was known as Butcher Ledward. He had no idea how to treat patients. When he told me I had to have the hysterectomy, he said "Never mind, dear. We'll get rid of the cradle and leave you with the playpen." When Natasza complained, she was seen by a psychiatrist at the Chaucer [private] Hospital who said she felt pain because she could not have more babies.
57 Sarah Lees
,
Sun
17 Nov 98: .. suffered a bungled hysterectomy at the hands of Ledward.. she said: "It was like medical rape and he didn't care.. I was not told it had gone wrong.. I spent seven years going to the doctor in pain but no-one could tell me what the problem was.. It was only recently that I discovered it was the op that had been wrong.. I am.. angry at the system that allowed Ledward to continue. I have been told by a friend who is a senior hospital staff member that Ledward's nickname was Rodney the Ripper." .. Sarah.. is now trying to sue St Saviour's Hospital over Ledward's botched operation..
58 Christine Laverty Independent
Sunday 4 Oct 98: .. was due to have a routine hysterectomy at the private St Saviour's hospital run by BUPA in Hythe, Kent. The operation almost cost her her life. Mr Ledward perforated her bladder and damaged one of her ureters (the tubes linking the kidneys to the bladder) but despite clear evidence of the injuries he had causedblood in the urinehe stitched her up and left the hospital.. [following] an emergency transfer to the William Harvey [NHS] hospital, surgeons spent three hours repairing the damage.
59 Anne Dowling. Sun
, 17 Nov 1998: '.. was left disabled after a "routine" op by Ledward in 1985 left her with a punctured bladder. Anne, 58, was given a hysterectomy in a second op that left her so debilitated that she had to quit her job as a stewardess on Channel Ferries. She said "I had to give up the job because I just couldn'tand still can'tlift heavy objects. I was single, had two daughters and a son and it caused me a great deal of distress. I got very depressed about it. I am now registered disabled because of that operation. After that, I needed three further operations, including a major one to repair my bladder."
ITV
News
, 21 July 1999: "Those [victims of Ledward] who were treated in the private sector found there was little they could do. It's all very well having a nice private room with fitted carpets and televisions, but if you're not getting proper care what good is that?"
60 Anne Rhodes.
(Reported in SE Kent Community Health Council's evidence to the Commons Health Select Committee's Inquiry into private health care). Persuaded by Ledward to have her hysterectomy done privately (at St.Saviour's in 1992), she came round to find that her healthy ovaries had also been removed. Ledward told her: "You won't be needing them any more, will you? And it saves going back in there again if there are problems." It seems she had signed for an oophorectomy as well a hysterectomy but no one at the hospital had explained to her what 'oophorectomy' meant.
61 Eileen Piddick
(as reported by SE Kent CHC). Encouraged by Ledward to go private at St.Saviour's for dilation and curettage, he then advised a hysterectomy as she "had an enlarged uterus". The operation was followed by haemmorrhaging, a wound infection, an ovarian cyst and urine leakage. Ledward explained that "this sometimes happens after a hysterectomy". His subsequent two repair operations on her bladder at St.Saviour's made her incontinence worse. Three further operations by a urologist at an NHS hospital were required and she is still undergoing investigation. The NHS could not find in her medical records any clear reason for the hysterectomy.
62 Ginette Rodesano
(as above). Following earlier operations by Ledward for removal of ovaries, laparotomy and hormone implant, she was admitted by Ledward to St. Saviour's in 1990 for further laparotomy, drainage of a torsion cyst and division of adhesions. The bowel was punctured resulting in leakage of faecal fluid accompanied by severe pain. Another surgeon had to remove part of her bowel and following discharge she was subsequently admitted as an emergency to an NHS hospital as there was an obstruction in the bowel. She is now in pain every day, caused by adhesions from all her surgery, but cannot be operated on again to divide the adhesions as this will exacerbate the problem.
251 James McAlpine
.. seven-year-old.. admitted to the private Ross Hall Hospital in Glasgow for an operation to remove a small blemish from his lower lip. A fatal accident enquiry into the case, which occurred in 1985, heard that the operation would have been better carried out at the Southern General Hospital where proper back-up facilities were available. His parents claimed they were not warned of the risk of the operation and said they had been recommended to go to Ross Hall by a plastic surgeon who had a £27,000 shareholding in the hospital. James died 20 hours after material injected into his face to try to block the blood supply of his lips lodged in the arteries leading to the brain, cutting off the flow of blood. The child came around from the anaesthetic, but had nightmares and became violent. Later he was transferred to the Royal Hospital for Sick Children at Yorkhill but was declared brain dead after being placed on a ventilator. .. (From
The Scotsman
, 22 July 99).
252 Ida Honeyman
.. had to be transferred from a private hospital in Dundee to the local acute unit when an operation to correct a sinus problem went wrong. Mrs Honeyman, 58, lost three-quarters of her blood after an operation carried out by a plastic surgeon at Fernbrae Hospital. At the time, her husband, Ian, blamed the hospital for its lack of back-up emergency care. .. (From
The Scotsman
, 22 July 99.
253-500? About 250 people who made contact
after recent media coverage of private hospitals. Many of these people had serious injuries or were relatives of people who had died in private hospitals; almost all were dissatisfied with their private hospital's response. We expect many more in future.
501 John Holmes
who in 1996 went for a hip operation. His wife Diane is quoted in
Good Housekeeping
(April 2000): 'When John came round from the second operation things obviously weren't as they should have been. He had low blood pressure and a high temperature. .. I waited at home.. About teatime the nurses admitted he wasn't very well.. By early evening.. the nurses said they'd called the anaesthetist. .. he realised John was seriously ill and had him transferred.. to an NHS hospital. But by that time it was too late. .. I had gone through sheer hell watching him die. .. This was a routine operationhow had it gone so wrong? .. I asked for John's notes, but they were spare and unclear.. in messy bundles.. I wouldn't use the private system for anything now. I feel frustrated with the system and terribly bitter. ..'
502 Anne Kennedy
from south London; hysterectomy went wrongcomplications included viral encephalitis and coma, which was unnoticed. At her husband's insistence she was taken to the NHS Maudsley hospital where in
Bella's
words 'they picked up the pieces, using a new drug, which cost £4,000.' She said "I'd never go back into a private hospital."
503 Pauline Radford
. Various media sources.
Bella
states she bought private insurance in 1992, and, since she'd had 'minor bowel trouble', a clause, to be reviewed in one year, was added, excluding bowel treatment. However, after 'tests showed her liver and kidneys were failing', 'she was asked to sign a form' despite being ill: "I didn't know what was going on." Crohn's disease was diagnosed and her colon removed. After more than four years, she was sued for £14,000presumably the cost of the operation. Someone had decided her treatment wasn't insured. About a year later judgment was made in favour of the hospital, leaving her £20,000 medical bills and £10,000 costs to pay, and liable to lose her home.
504 Margaret Waterhouse
'admitted to the South Cheshire private hospital in Crewe for a routine gynaecological operation. She was subsequently transferred, comatose and irreversibly brain-damaged, into NHS intensive care.' (
Sunday Times
, 7th May 2000,
Private health blunders take up NHS beds
. The following two cases come from the same article:)
She died in 1998 following treatment at the BMI South Cheshire private hospital near Crewe (BBC TV
Panorama
20 Sept 99). An epidural for pain relief was administered for a 15-minute minor gynaecological procedure. The resulting fall in blood pressure continued after she had been returned to her private room. Her heart stopped beating after some 20 minutes but it wasn't until ten minutes later that a nurse first checked up on her. She was resuscitated but the damage was such that she stayed in a coma, dying twelve days later in the NHS hospital to which she was transferred. According to expert, Prof Felicity Reynolds, she was in an unstable state following the epidural, her circulation was not stabilised, and steps should have been taken to ensure her condition was stable before placing her in a single room. It was a misjudgement with fatal consequences. BMI private hospitals said they concluded from the inquest evidence that her death was caused by a rare late-onset drug reaction and that she was properly monitored. The anaesthetist said she was attended by an experienced team. Husband Ray Waterhouse: "All hospitals should be centres of medical excellence regardless of whether they are NHS or private. They're dealing with human life and you cannot afford to make mistakes".
505 Richard Yarnell
an amateur athlete from Walsall, who died from an undiagnosed blood clot after knee surgery.
506 Catherine Kearney
died.. after a hysterectomy went wrong at the Rivers hospital near Sawbridgeworth.. Her sister.. claimed staff had no option but to call an ambulance. .. the hospital was told to use its own transport to move her into NHS intensive care, where Kearney subsequently died.
507-532? Private Hospital Patients of Richard Neale.
A consultant gynaecologist and obstetrician, now struck off, Neale returned to Britain in 1985 when his licence was revoked in Canada after a pregnant patient died in his care. A disciplinary hearing was told that Dr.Neale administered a drug banned in the hospital and altered the woman's medical notes after her death. Earlier, in 1979, he was stopped from operating at the Prince George Hospital in British Columbia after the death of a woman. The Chief of Obstetrics and Gynaecology at the Prince George reported that in a long series of cases Dr.Neale 'showed poor judgement and.. poor surgical procedure'. His 1987 appeal for reinstatement was dismissed. Dr. Eldon Lee, a senior gynaecologist at the Prince George stated recently to BBC TV's Panorama: "He was absolutely incompetent. He was incapable of making reasonable decisions as to a patient." Another Canadian former colleague, Dr. Andy Sear, says he warned the GMC in
1985
of his incompetence.
Neale worked as head of the maternity unit at Friarage Hospital, Northallerton, N. Yorks, but was suspended after complaints from colleagues and patients. He was eventually asked to leave in 1995 after complaints from colleagues and patients (the victim support group currently numbers over 100), but was given a reference and a £100,000 payoff. [The calculation presumably being it's cheaper to do this and get rid of him quietly than admit negligence-RW]. He continued to work in other NHS hospitals, in private hospitals (including St John of God (Yorkshire), the York Nuffield, The Cleveland Nuffield, London's Portland Clinic, Lister Hospital, and Harley Strret Clinic), and as an expert witness. Private patients who allege they have been injured make up nearly a quarter of the action/support group that has been formed.
A police inquiry has begun into a number of deaths among his former patients, whilst the broadcast of the BBC
Panorama
programme in Canada and the northern US resulted in forty further alleged victims coming forward. He is also being investigated for fraudulently claiming he was a fellow of the Royal College of Surgeons. The General Medical Council, however, stated that it allows doctors who have been struck off abroad to practise in Britain (
Sunday Telegraph
25 May 99), and in 1998 appointed him as an assessor in medical hit squads aimed at weeding out failing doctors.
Daily Mail
, 29 Jan 98: 'The GMC said: "We are not aware of any complaints to the GMC about Dr. Neale's practice in the UK".. Jim Cousins, Labour MP for Newcastle Central, said: "This makes the new [GMC] system a complete laughing stock. He should be dismissed instantly from this post."'
The
Independent
, 22 July 1999, reports the case of Sheila Wright-Hogeland, who 'suffered from endometriosis, which causes thickening of the womb lining. As a private patient, she was checked regularly by Dr Neale, but he failed to notice the worsening of her condition and she needed a hysterectomy, which left her unable to have children. Mr Neale operated on her at the St John of God hospital.. but the wound became infected and she had emergency surgery in the NHS Friarage hospital six weeks later..'
Independent
6 April 1999 reported "he told me I was fit and well, despite my increasing pain.. after six years I was in agony and bleeding. He said it was the worst case he had seen. After the operation the wound became badly infected. ..'
533-600? About 20 Private Hospital Patients of Dr Ingoldby. (And about 80 NHS). Including: Kathryn Glover, 38
, private hospital patient of Christopher Ingoldby. Gastro-intestinal surgeon Ingoldby is facing sixty [NHS and private] lawsuits following operations. Two families are suing after relatives died because of alleged botched stomach and bowel operations. Suspended from Pindersfield NHS hospital in Wakefield, West Yorkshire in January 1998, he continued to look after his private patients at BUPA's Methley Park Hospital outside Leeds for several months after his suspension.
Sunday Times
14 Nov 1999: 'A routine operation by Ingoldby allegedly failed to remove the diseased section of [Ms. Glover's] bowel and cut several blood vessels. She has since had seven operations to correct the problem. "It is highly irresponsible that he is deemed not fit to practise on the NHS but could still practise on private patients. I have been in agony for years. I am suing him but I am more interested that he is struck off so he cannot treat patients any more," she said.'
600-700? Patients of ENT specialist Julian Upton.
(Probably about 20 private hospital patients and 80 NHS).
Times
29 Mar 2000: '.. whose incompetence left more than 100 patients needing further treatment.. a highly critical independent inquiry into his 21-year career at Musgrove Park NHS hospital in Taunton Somerset made a series of recommendations.. six patients are now to have specialised care for tumours which spread after he failed to remove them properly. Others have suffered total or partial hearing loss as a result of his outdated remedies.. he is already facing 29 compensation claims'. [According to a local journalist he was also treating patients in private hospitals in Taunton and on the south coast -RE]. The GMC let him escape censure by allowing him to voluntarily resign from the medical register.
701 Lorraine Batt, 36
, who died two days after a routine cosmetic 'tummy tuck' operation at the Highgate private hospital in January 1999. Recording a verdict of death by misadventure, the coroner described the operation, on a patient of normal weight and size, as unnecessary. The patient's vomiting, and complaints of nausea and sickness were treated by an anti-emetic and morphine, but blood samples were not analysed nor does it seem that her fluid balance was being monitored. She died soon after transfer to the nearby NHS hospital. The cause of death was attributed to swelling from waterlogging of the brain, which went unnoticed (from the
Guardian
25 Jan 00)
702 Raquel Siganporia
(BBC TV
Panorama
and
Woman
magazine 28 Feb 2000): at age 11 had rod inserted to cure curvature of the spine in an operation at the private
London Clinic
. The small risk of damage to the spinal cord means that post-operative monitoring of movement of legs and toes is essential. The night nurse repeatedly failed to report the patient's absence of feeling, the one doctor on duty (typical of private hospitals at night) did not visit, and the surgeon, who lived nearby, was not contacted. Expert opinion is that had she been properly monitored, and had there been an operation to remove the rod immediately after her absence of feeling was noticed, much of the damage would have been reversed. She is now permanently paralysed from the waist down. The London Clinic took three years to admit liability and settle the case.
They said in a statement to
Panorama
: "Each year over 16,000 in-patient procedures take place at the London Clinic. The hospital implements a strict protocol for the care of patients in the post-operative period."
703 Quentin Grant, 45
. Policyholder of Cornhill Insurance. They used an exemption clause to withdraw funding for his £12,000 heart operationfor a life-threatening conditionjust two days before it was due. He died after the operation, in October 1999, and the widow claims the severe anxiety caused by the insurer's decisionhe was unable to afford this sumlessened his chances of survival. She is suing Cornhill, who had told her husband that their reassessment of his condition meant that they now regarded it as 'chronic' and therefore not covered as there was no cure. Specialists told Cornhill the operation would have cured him.
Express
16 Mar 2000: 'Their assessment contradicted that of leading medical specialists, including world famous heart surgeon Sir Magdi Jacoub. The case highlights growing concern..that insurers are employing an array of tactics to avoid paying claims for private health care.. Sir Magdi: "Often insurance companies put commercial interests before the patient. It's morally questionable. ".. President of the Hospital Consultants Specialists Association, surgeon Winston Peters, said: "People believe they'll be covered when they're not. It's a growing problem. Companies try to bypass payment on technicalities."' (The article goes on to cite several other cases including cancer patients facing bills of £40,000 and £20,000, one of whom must also now sell her house following unsuccessful legal action against Norwich Union).
704 David Williams, 55
, disabled actor who has starred in TV's 'The Bill' and 'Eastenders'. Has paid insurance premiums for private medical treatment for over twenty years.
Express
, 22 July 99: 'Two years ago, an operation on Mr. Williams' thigh carried out in a private hospital went wrong. It was left to the NHS to put it right... this week he was told by his insurers, Sigma, that a sore on his leg [requiring a further operation] was a 'chronic' condition and could not be treated.. he will have to wait four or five weeks for an NHS bed. In the meantime his condition will get worse and when he does get treatment he will have to spend longer in hospital. The case highlights concerns that the NHS is being forced to pick up patients which [sic] private hospitals refuse to treat.. Mr. Williams: "It is disgusting.. I have paid my dues for 22 years.. The consultant says five to six weeks of treatment and the sore will be gone, so it is not a chronic condition. They have never turned me down before and have always been happy to take my money."
[Back to Start] IN DIFFICULTIES? THIS IS WHAT MAY HAPPEN TO YOU Sawdust Saviours, Toothless Watchdogs, Inert Institutions... ...Organisations that don't do what they're supposed to do.
Theoretically, many organisations exist to help patients. In practice, victims have a difficult time of it.
With luck, you may find there's been a misunderstanding, if you're fortunate enough to find someone willing and able to discuss the issue. (There is no organisation for people who fear something may have gone wrong, but aren't sure.) With less luck, a typical sequence might be:
a patient (or surviving relative) wonders what happened, and tries to find out. The first problem may be to get any sort of reply. A standard technique (in politics, too, of course) is simply not to answer. Then there may be contemptuous or evasive replies. These may escalate to legal threats. And there may be simple lies, a tempting technique where there are complicated technical issues, with obstructions making them hard to check:'Independent Healthcare providers are demonstrably committed to delivering the highest quality of care' (IHA written evidence). Actors in these dramas may include:
If you are dragged in further, you'll become aware of organisations you probably never heard of before. GPs (General Practitioners), who are often complainants' first port of call after an untoward incident or unexpected death, especially if there is complete silence from the hospital or consultant. Conflicts of interest include: GPs may regularly refer other patients, NHS as well as private, to a consultant. He/she may be reluctant to help with medical questions if this may lead to criticism of an associate. It's possible also that some GPs may refer insured private patients to a consultant inappropriate for their needs in return for financial kickbacks. (This interesting area is completely unexplored, despite the millions of private referrals every year). GPs may be reluctant to offer assistance for fear of laying themselves open to scrutiny. If there is a subsequent legal investigation, the GP's medical records of the patient will also be required, in addition to those of the hospital and the consultant; the complainant's solicitors' letter seeking these will be referred to the GP's own medical defence organisation [i.e. his insurer] who will pass it on to its solicitors, and this can lead to further delay and confusion. Citizens Advice Bureaux. (CABs). Another frequent first contact, but until recently with little or no knowledge of complaints procedures in private hospitals and health authority investigations. Again, it was an APROP member who had to advise their National Association about this, and later tell them of the Medical Accidents Handbook. However, CABs are sometimes useful for quickly supplying details of specialist medical negligence lawyers, more quickly than AVMA. Whistleblowersor rather their absence in the private sector. Where there has been a serious untoward incident resulting in severe injury or death, a frequent cause of puzzlement amongst APROP members, usually bereaved relatives, is the consistent failure of private hospital staff, or consultants, or especially Medical Advisory Committeeswho are supposed to monitor such mattersto speak out. Whereas even in the NHS doctors and nurses such as Stephen Bolsin (Bristol babies heart deaths) or Graham Pink (abuse) will occasionally blow the whistle, the private sector maintains a consistent silence in this area, even in the 'charitable' or 'religious' private hospitals. This may be because of a gagging clause in staff contractsthere is no public information about this. Or perhaps because private sector practice is more attractive to clinical staff with a less 'caring' and more mercenary approach to illness. Holders of Medical Records. In theory, patient notes are available on request. In practice, these may be tampered with or 'lost'. (Tampering tends to be tailored to the competence of the person expected to examine the notes; if they're careless, important information may slip through; if they're hyper-careful, the notes are filled with non-standard medical expressions and abbreviations). Following the belated introduction of the Access to Health Records Act, complainants have the right to ask for copies of their or their relatives' medical records, in private as well as NHS settings, whether a complaint has been made or not. The experience of a number of APROP members, however, is that records are tampered with, key documents go 'missing', or that they are drip-fed slowly to complainants or their solicitors to lessen the time available for issuing writs. A written or verbal complaint prior to their request may also alert the hospital or doctor to which documents need doctoring. To date, there has never been a criminal prosecution for falsifying medical records, possibly because there is no specific law for this. Executives of Private Hospitals. Neither the hospital nor its staff nor the consultant are under any legal obligation to approach the family if there have been failures in a patient's care, and it is the experience of some APROP members that, if no complaint has been made, i.e. if the family haven't realised mistakes may have been made, all parties will stay silent, especially if death has resulted. In theory, however, once the family has approached the hospital, the complaints procedure should come into play which the registering authority expects all private hospitals to have in place. This should be along the lines of the IHA's 1988 (revised 1991) 'Code of Practice for Patient Complaints' (available free from the IHA, 22 Little Russell St, London WC1A 2HT) with a thorough investigation by a designated complaints officer, the interviewing of all staff involved, the participation of the hospital's Medical Advisory Committee if necessary, and resulting in 'as full an explanation as possible', with an acknowledgement of mistakes, apology, compensation and rectification proposal where appropriate. In practice, almost all APROP members have not even been advised of the existence of any complaints procedures, and complainants are sometimes simply responded to with an untrue statement of events, the detail and plausibility proportionate to the scale of the blunders, and the suggestion that they can go to lawyers if they're not satisfied. (In the IHA's written evidence to the Commons Health Committee's Inquiry, one member of its 'Inquiry Steering Group' has written (Paragraph 44) regarding private hospitals' complaints procedures: 'Regettably, but rarely, some complaints will not be resolved to the complainant's satisfaction. This may be because the view of the facts that the hospital has formed as a result of its investigation is at odds with the patients [sic], or perhaps the resolution that the complainant is seeking is not in the gift of [sic] the hospital.' This implies that most, if not all, complainants are advised of and use the private hospital's complaints procedure, and that only a rare few are dissatisfied with it. To make such a clearly mendacious claim to MPsnoticeably, no evidence is supplied to support itmay well illustrate the private sector's and medical establishment's sense of being above accountability). Alternatively, the hospital with or without any bogus statement, may invite complainants to a meeting to discuss their complaints verbally. The obvious danger is that this will be solely to try and ascertain just how much a relative knows and how damaging that information may be to the hospital or doctor, rather than to get at the truth or answer legitimate questions. They may also wish to know whether the complainant can afford lawyers. Deaths: the Registrar of Deaths, Coroners, and Crematorium Medical Referees. It is sometimes the case that relatives will not uncover mistakes until after the patient is dead and buried or cremated, especially if the hospital and consultants have elected to engage in a cover-up. Unfortunately the present system here as elsewhere conspires against the complainant. A Coroner's inquest is usually only called if the death occurs within 24 hours after admission and unusually beyond that time. If mistakes have been shown the coroner will almost always conclude that there was 'misadventure' rather than 'lack of care' partly because of the difficulty of showing this in coroner's law, but partly also probably because of pro-doctor prejudicea quarter of all coroners are doctors, the rest lawyers. The coroner is also primarily concerned with the cause of death rather than attributing blame. Where the death has occurred in a hospital, the Registrar of Deaths should, in theory and as good practice, ask relatives registering the death whether they were satisfied with and had and any concerns about the care [meeting with Sutton Registrar and RE]. In practice this does not always happen [call to Registrar-General's Office]. If the body is to be cremated, the crematorium's Medical Referee (a doctor) should satisfy himself as to the details of the death in the two forms filled out by the physician who attended the patient in his final hours and a second corroborating doctor. It is a criminal offence under Section 8 of the Cremation Act 1902 to make a false statement in these forms. In practice, he can only go by what is written, and if what is written seems plausible, he is not liable if false statements have been made [conversation between RE and medical referee]. Relatives are not allowed to view these forms, only the Home Office and police, and it is likely that many 'dodgy' deaths slip by. .... Health Insurers. Complainants may ask for help from their medical insurers, perhaps believing promotional claims, e.g. Allied Dunbar Healthcare: 'Patients [sic] comments on all aspects of their treatment are always welcome and are used to help improve standards of care and treatment.' In fact, insurers, whose advertising may suggest high clinical standards in private hospitals, show very little concern over injuries or deaths caused by iatrogenic neglect. Responses are unsympathetic, dismissive or evasive, e.g. BUPA, to the relative of a former BUPA insuree who had successfully sued: 'Thank you for your letter.. I was sorry to read about your concerns about your late father's care at this hospital.. As a third party insurer we cannot comment on the services provided by non BUPA hospitals or consultants. Thank you for again [sic] bringing your concerns to our attention. I regret, however, that BUPA cannot take this matter further.' This applies unless the insurers, if there is serious injury, are obliged to pay for their customer's continuing care; then, they often deem the condition 'chronic', to free themselves from liability. Evidence suggests insurers are much more concerned with not rocking the boat, even when there may have been very many adverse incidents at a hospital or involving a consultant. Annual private medical insurance revenues amount to approximately £2 billion.... AVMA (Action for the Victims of Medical Accidents. No connection with American Veterinarians) founded 1982. Says it 'offers independent specialist advice and information to people who feel they have been victims of a medical accident'. In fact it is mainly interested in law, and has made a successful attempt to establish a sort of monopoly. Its legal interests include directing cases to specialists in the medical negligence industry, and investigating complaints about solicitors. Most communication is by letter; for meetings and sympathetic talk, you'll need to go to their regional group support meetings. Valuable weeks may be lost before there is a response. Much of its funding comes from legal conferences and publications. It has plans to rename itself, dropping the word 'victims' which the medical establishment does not like. ('Medical' negligence has been renamed 'clinical' negligence in legal circles for the same reason). AVMA gets government money for assessing legal aid cases, and gets fees from insurance companies for estimating the chances of success of legal actions. Complaints include: unreturned phone calls, an unsympathetic response at an often very distressing time, and the sense of AVMA being too involved with looking after lawyers' rather than victims' interests. Lawyers. See Lack of Statutory Complaints Procedures for a long account of problems, and percentages of cases which proceed through the courts. To summarise: Precious time may be wasted by inexperienced high-street solicitors who can't deal with the insurance solicitors defending the hospital or consultant, usually from large City commercial firms. Specialist firms' fees are higher. Typical complaints include: work delegated to inexperienced juniors (charged at partner fee rates); correspondence unanswered for months; unanswered telephone calls; overcharging (e.g. a special 'care and consideration' clause); and missing the three year deadline for issuing writs. Solicitors will not forward records to a new firm until all their fees have been paid, no matter how shoddy their work may have been. Clients who complain to the Office for Supervision of Solicitors may wait for up to a year. Even if a complainant's case appears to have a high chance of success in court (i.e. if he is lucky enough to find an impartial expert), his solicitor may prefer to lose, and pressure him into an unsatisfactory settlement, because that solicitor's costs may be larger, and eassier to obtain (Michael Joseph, Lawyers can Seriously Damage your Health, 1985, pp. 260-1, who also says (p. 118) that some solicitors are bribed by the other side's insurance company). Insurance solicitors' prime concern, for their clients, is to settle claims deemed meritorious for the minimum figure possible, by exploiting the procedural processes to the fullignoring letters, delaying, threatening with defamationto increase the strain on the complainant. Medical negligence (or 'medneg') is an industry, largely unaccountable and unregulated, whose principal aim is to derive maximum profit from the effects of medical blunders. Lawyers' fees often exceed compensation payments. 'Experts'. Lack of Statutory Complaints Procedures has details. To summarise: Experts (who are consultants who do reports as a side-line) are biased in favour of fellow-doctors. Even if they are have untampered notes, important aspects of a case can be overlooked, blame may be unwarrantedly placed on nursing staff, and there may be little knowledge of the legal test for negligence (Bolam). This may be unconscious bias, or perhaps the result of the medical authorities' selection and appointment process, tacitly ensuring that those appointed consultants are the sort who can be relied upon to find only rarely against other doctors. The Woolf reforms do not appear to address this problem. Indeed the proposal that the experts of both parties should meet alone behind closed doors to examine a case, may make it worse. Legal Expenses Insurance. Claimants seeking funding for their legal costs may have legal expenses cover on insurance policies. However, such policies have limits and are unlikely to cover the very high costs of medical negligence cases. Insurance companies keep tight control on how the money is spent, the solicitors that can be used and how far a claim can proceed. There are also narrow time limits for claims.
And you'll become aware of such possibilities as secret collusion, careerism preventing frank criticism, strings-attached funding, legal devices to conceal truth. And of course plain laziness and incompetence:-
If you decide governmental organisations aren't helping, you might try professional bodies:- The Patients Association (8 Guildford Street, London, WC1N 1DT) is partly government-funded, and claims to be the 'voice of the patient', existing 'to help patients [including private patients] and their interests.' APROP members found their letters were unanswered, and that the association had little knowledge of private hospital problems and no awareness of private patients' right of access to the health authority. However, it does supply spokespersons for chat shows. Rita Pal writes: "... This is .. run by Clair Rayner [midwifery/nursing background, moved to novels/broadcasting-RW]. ... [It] is government funded and .. will not do anything to contradict the government. Furthermore it is a charity and by law charities cannot involve themselves in anything that is politically challenging. I have not come across any patient to date who has been supportive of the Patients Association." Community Health Councils (CHCs) are often complainants' first contact. They will find they assist only with NHS complaints. (However, S.E. Kent CHC chairman's exceptional taking up the case against Rodney Ledward may have contributed to the Health Committee's decision to investigate private healthcare). APROP members who have contacted CHCs have generally found them uninterested and unhelpful, and invariably unaware of the registering health authority's scope for investigation. APROP founder members had to advise the CHCs' National Association of this. Evidence shows one purpose of these government-funded organisations is to provide career paths and to prevent disturbing information from being made known. Examples include a Chief Officer of a CHC who ignored letters on this subject, but joined the Consumer Association and became a Senior Health Researcher; she also gave evidence to the Commons Health Select Committee. A former chief executive is now a 'New Labour' lord. Health Authorities should be approached after the hospital, if there is dissatisfaction with the hospital's response (as is almost always the case). Few private hospitals or health authorities will tell you about the authority's regulatory role and theoretical scope for investigations. In principle, thorough investigations could have positive benefits. In practice, health authorities may bend over backwards to avoid thisoften hiring lawyers, with public money, to do so. (Click here for an account by Richard Ennals of the Merton, Sutton and Wandsworth Health Authority. Other examples include the report into Owen Ennals deathwhich needed a plea to the Chief Executive after two years of non-activity, and the investigation into Christine Maloneywhich took letters from two MPs). No doubt health authorities are concerned with not upsetting the local medical establishment, contrary to the NHS Executive Guidelines HGS(95)41: 'The primary objectives of the registration and inspection system are to protect patients and maintain standards'. Health Authority Registration and Inspection Officers. The experience of all complainants has been that these people always find reasons not to investigate, being happier with small private nursing homes than huge private hospitals and chains. They may not be clinically qualified. Their publications seem to show that NAIRO, the National Association of Inspection and Registration Officers, and the Royal College of Nursing's 'Forum', are largely talking-shops. Twice yearly inspections: see above for their absurd limitations. Only one APROP member succeeded in obtaining inspection reports of the private hospital at the time of his wife's untoward death, and found them cursory and superficial. Other requests were refused, contrary to the Health Ombudsman's recommendations. The suspicion is that health authorities do not want their potential inadequacies scrutinised, even when this may help prevent injury or death. Department of health/ NHS Executive. There were no plans to legislate until mounting publicity forced a U-turn. Experience shows the DoH and the responsible minister do little, leaving the complainant to go to the GMC or sue. There is careerist interchange with the private sectorfor example with BUPAso that conditions have coasted along for many years. ( Times, 24 Apr 2000, 'Private sector 'secures favours' in Whitehall') NHS Confederation (formerly 'NAHAT'). This is funded by the NHS. Its objectives include 'how to disseminate good practice.' But its important guidelines on investigating incidents in private hospitals don't appear to be well disseminated. Many APROP members have found health authorities are unaware of these guidelines. Or you might explore other avenues: GMC, the General Medical Council (178 Great Portland St, London W1N 6JE) deals only with 'serious professional misconduct', which is largely undefined. It only recently started to investigate clinical incompetence. Doctors struck off abroad are allowed to practiceeven when patients have died, as with Richard Nealewhilst doctors struck off following convictions for manslaughter, drugs and sex offences are regularly allowed back. ( Guardian 6 Feb 2000, Independent 18 Mar 2000. Private Eye 29 Oct 1999: 'Everyone knows the GMC is a joke'). In 1993, only four of 1301 complaints resulted in deregistration. BMA, British Medical Association (Tavistock Square, London WC1H 9JP) is a trade union or club for medical people; benefits for the annual subscriptions include copies of the BMJ, and use of their library and other facilities. They offer no help to patients. The Royal Colleges specialise in branches of medicine: examples include general practitioners, midwives, physicians, pathologists, radiographers, surgeons. They organise and administer qualifications and examinations for their potential and actual members. They offer no help to patients (and would probably be amazed if patients approached them). UKCC, UK Central Council for Nursing, Midwifery and Health Visiting (23 Portland Place, London, W1N 3AF), the nurses' regulatory body, claims to 'protect the public'. Complainants have to have the criminal standard of proofbeyond reasonable doubt. It is concerned largely with conduct rather than clinical incompetence. Most complaints are rejected by the 'Preliminary Proceedings Committee', which is held in secret, and gives no explanation for the Committee's decision, even when a nurse's failures have resulted in injury or death. Richard Ennals' verdict: 'a complete waste of time'. There's a good unflattering description on Rita Pal's website. The UKCC recently altered their rules just sufficiently to comply with EC regulations on secrecy, due to come into force in October 2000. Think Tanks, Paper Factories, Research Institutions. For example the King's Fund (11-13 Cavendish Square, London W1M 0AN), with an organisational audit which allows hospital to imply that their clinical care has been checked. And medico-legal departments in Birmingham, Glasgow, Liverpool, and Oxford's Centre for Socio-Legal Studies. Apart from John Yates's research into the effect of consultants' private work on NHS waiting lists, there has been little or no investigation into private hospital problems. Such important obstacles to redress as falsification of notes and prejudiced experts, though well-known, are completely unexplored. Professional University Ethics Groups. Ethics 'researchers' usually prefer to dabble in marginal topics, or topics with a frissonembryo research, suicide, euthanasia. As is the case in much of 'social science', serious issues which conflict with establishment groups are tacitly ignored. Medical Defence Organisations. You may come into contact with the Medical Defence Union (MDU) or Medical Protection Society (MPS) which specifically deal with doctors' interests. They are doctors' insurers, each with reserves in the region of £300 million. Any serious complaint to a doctor will be referred to his defence organisation. They may help prepare a response or rebuttal to an initial complaint (e.g. the MDU in the Hospitals and Health Services Year Book: 'The benefits which may be granted to a member.. include: .. helping with complaints procedures and responses to complaints.'). Their solicitors will defend the doctor in ensuing litigation. Despite their stated objects, e.g. the MDU in its company memorandum 3(ii): 'To promote high standards of professional practice', complainants may find their stance to be one of obstructiveness. E.g. Prof. Margaret Brazier, Medicine, Patients and the Law, (Penguin 1987, repr. 1997): 'The private patient may be less fortunate.. The patient's task is made even harder because of an agreement between hospital authorities and medical protection societies that generally neither will join the other as co-defendant. They will not engage in mutual accusations of blame which might offer evidence which could assist the patient. They will simply remain silent, leaving the patient in the dark.' (Compare this with the MPS's advice to its members in Pitfalls of Practice: 'The MPS does not encourage members.. to retreat behind 'walls of silence'.') And: 'The medical profession perceives an action for negligence against a doctor as an attack on his professional integrity and a potential blight on his career. Backed by the medical defence societies, and aided by the skill of expensive lawyers, every opportunity provided by our adversary system of litigation may be invoked to defeat the patient's claim.' (Many individual instances of the defence organisations' 'blocking' tactics are listed in this publication and also in Indefensible Treatment, Corgi 1985. e.g. 'In 1976 Elizabeth Shewin entered hospital for a gall-bladder operation. In the course of the operation she suffered irreversible brain damage. On the advice of their medical defence union, all ten doctors involved with Mrs. Shewin refused to give evidence to the inquiry'. And: '.. a 26-year-old man, David Woodhouse, entered hospital.. for an appendectomy. He never regained consciousness and ten months later still lay in a coma. Pressure from MPs led the health authority to set up an inquiry. Again, on the advice of their defence union the doctors refused to testify. The inquiry was abandoned.' [Experts in a later investigation exposed a series of disasters in his care resulting in an out of court settlement - RE]). Also (from What's Wrong With Your Rights? (mid-90s publication): '.. doctors in Britain belong to one of two professional bodies, the MDU and the MPS. According to the pressure group AVMA these organisations habitually impede compensation settlements. 'In almost every case liability is not admitted by the doctor, and their societies act just like insurance companies disputing every claim,' says Derek Kartun, spokesman for AVMA. '..[they] behave callously and without regard for the victim.' Such conduct is the experience of a number of APROP members and the defence organisations' frequent statements to the contrary seem only to show hypocrisy on their part e.g. Independent, 2 Mar 96, letter, MDU Chief Executive Dr. Michael Saunders: 'Since the mid-Fifties, we have repeatedly advised our members to "say sorry" if something has gone wrong.. A sincere and honest apology should be made.. Doctors should not worry about inadvertently making an admission of legal liability, as this is something completely different.' Times, 2 May 97, letter: 'Most patients choose not to pursue a complaint or a claim because the doctor has given them an immediate explanation and apology.' Dr. Christine Tomkins of the MDU on Channel 4 News, 27 Jan 2000, following an item on negligent care of a child: "Well, I think when something tragic of this kind has happened it is crucially important that the patient should get an explanation very early.. explaining what has happened, and an apology. If it's clear that the patient has been negligently damaged, then it's in nobody's interest to drag that out." Some might also question whether the MDU's use of Asklepios (Latin: Aesculapius) on its logo, as its Patron god, is appropriate. The summer 1986 issue of its journal describes him as 'a god of infinite benevolence who sympathised with the physical miseries of humanity'. The MDU's true attitude to patients is possibly more accurately expressed by the senior partner of its solicitors, Hempsons, who describes the public outcry over recent, sometimes fatal, instances of doctors' incompetence as only "a very unpleasant attack [on doctors] by the sans culottes". Times 20 June 2000). The MDU's dismissive response to the solicitors of one of the listed cases (after an expert had confirmed failures), is probably typical: 'Dr. X does not accept that he has been negligent in the treatment of Mr. Y (deceased). If you wish to issue proceedings I will nominate solicitors to service.' The victim's tragedy is completely ignored in the knowledge that the victim's family are unlikely to be able to afford the law courts. Local newspapers
as this website shows are often willing to run short pieces, but don't usually have anything like the expertise to examine the issues in depth.
National newspapers
have a poor recordpartly on Chomskyan grounds (they know better what issues are to be censored). But partly because their medical correspondents often know little, and mainly want sensation. The
broadcast media
rarely have items. When they do, sensationalism is usually given precedence. Bear in mind there may be conflicts of interest, e.g. in women's magazines with cosmetic surgery ads, TV with BUPA ads, and so on.
Civil servants
have proved themselves unwilling to take any action spontaneously, even when such action is required by their own rules; instead they prefer to collude with large organisations.
The police:
patients and relatives frustrated by hospitals and medical authorities are turning to the police, as occurred with Ledward and Neale (and Shipman).
Consumer Groups
occasionally examine this area.
The National Consumer Council (NCC)
, government-funded, was set up in 1975 to 'champion the interests of consumers of all types of goods and services'. It ignored APROP members' letters from 1995; its Health Committee inquiry evidence (4 Mar 99) was superficial, subjective and ill informed, because it had not done any proper research into private healthcare.
Consumers Association
, not government funded, was also invited to give evidence to the Health Committee inquiry, without having ever researched problems of clinical care in private hospitals, and will also sit on the DoH consultation group as 'patients' representatives'. Neither the Consumers' Association nor the NCC even have patient helplines. In the case of 'charity hospitals', the
Charity Commission
is supposed to have responsibilities, but seem to take these lightly; even the accounting standards aren't enforced, as Richard Ennals' investigation into a nuns' charity proved. You might even try the
Advertising Standards Authority 'promoting and enforcing the highest standards'
unless advertisers claim medical expertise which they don't have.
[Back to Start] NEWS UPDATE AND EFFECTS OF THIS SITE Richard Ennals' information to The Observer coincided with the establishing of this website. Printouts of this document were given to Frank Dobson, former Secretary of State for Health, and (indirectly) to Anne Widdecombe, former Shadow Health Secretary, after a broadcast of BBC Any Questions? (3 July 1998). A letter from Anne Widdecombe's office dated Aug 1998 confirmed that 'the Shadow Health team is aware of these issues. The material you have supplied will act as a valuable resource for our research department..' Many other printouts are in circulation. BBC Here and Now accessed the website as part of the preparation for a critical feature on private hospitals. It filmed APROP's first meeting [see Links, below], and even advertised the piece in the Radio Times for Mon 6 July 1998, 7.30 pm., and other listings, but cancelled at the last moment. Sunday Times article 'Higher health risks at private hospitals', 2 August 1998. A few days earlier they visited this site for information before carrying out phonebook checking. 'Perils of jumping the queue', 1000 words criticising private healthcare in the Daily Telegraph (if you can stand this publication -RW) Tuesday 11th August. BBC Radio 4 You and Yours, 11 Aug 1998 also featured problems of private hospital care. Meridian TV (region SW of London) Fri 14 Aug early evening news 5 minute feature on private hospitals based on the Charalambides case; reporters had a copy. The Consumers Association has downloaded the site as a resource for a proposed report on private healthcare. Their report is in Which? dated Aug 1999. A 30 minute BBC regional TV current affairs programme on private hospitals is being planned. This site was downloaded. BBC Here and Now's critical feature was finally broadcast on 14 Sept 98; APROP was mentioned but the filmed meeting wasn't shown. However, the BBC announced: .. the Government's Health Select Committee has now decided to review the regulation of private hospitals. APROP's first new members' meetingsee phototook place on Sunday 8th November, 1998 in Victoria, London. We hadn't perceived at first the possible overseas effects of this site. For example, it might provide some information to counter the propaganda in the US in favour of their present system. Thanks to our many correspondents for their e-mails. BBC Radio Kent broadcasters on the Ledward case made use of this site. The Sunday Times accessed this site for its 14 Feb 99 piece, 'Private clinics use suspended NHS doctors'. The Express, 3 March 1999, 'Crackdown demand over private hospital failures'. Journalists used the site. BBC Radio 4 You and Yours 31 March 1999: feature on patients dying in NHS hospitals when consultants left for private practice, leaving operations to be finished by unsupervised junior doctors. The Sunday Times used this site for 'Botched private surgery patients take NHS beds', 11 April 1999. One of our listed cases was contacted. 22 April 1999: APROP testimony to Parliamentary Select Committee. The website was also submitted. Channel 4 News, 29 April 1999: six-minute piece on private hospitals described the 19 BUPA-treated NHS patients and the breast cancer case of H. Carmon (see above). Researchers accessed this site. The Scotsman, 22 July 1999; long article. Some civil servants in the various health departments may have been stirred a little. After all, the situation hasn't changed for years, and they must bear some responsibility. BBC Panorama of Mon 20 Sept, 1999, producer Sam Bagnall. Of the 21 people listed in the credits, Ingrid Geser actually seems to have made some enquiries. Three cases were examined, but there was no attempt to examine analyse the situation or to apportion blame. Falsification of notes wasn't mentioned; neither was the cost to the public of botched operations; nor were owners and controllers of the hospitals mentioned. Statements by various hospitals seem to have been issued anonymously. The advice that the best policy may be to go to private wings of NHS hospitals wasn't given. And, despite two categorical assurances, Panorama's own website didn't give this site, but preferred to link to trade and advertising outfits. Vallance-Owen was allowed to get away with his statement about everyone being entitled to NHS facilities, omitting the point that botched operations aren't the same thing as normal illnesses. [I thought he was showing some signs of strainhe seemed a bit high-pitched-RW]. Various TV, radio and newspaper items have made use of this site. Their presenters are not always well-informed. For example, a new ploy by Barry Hassell and others of the Independent Healthcare Association (IHA) is to claim they have been campaigning for more than ten years for better regulation. This is probably untrue, but the presenters haven't thought to ask for evidence.
Spreading the word: Richard Ennals helped advise Good Housekeeping, April 2000, on their four-page and generally excellent article. Concerns raised were: staffing problemsagency nurses without specialist training, RMOs on their ownand intensive care not available for emergencies. (Dr Carl Waldmann, Clinical Director of ICU at Reading's Royal Berks hospital, was quoted as saying 60 to 100 patient-days, about £100,000, each year, are taken up by private patients in this ICU. See above for details, and in Michael Caine's details for more). And insurance difficulties - even if they claim to be 'comprehensive'. Major exclusions are likely to include long-term, incurable, pre-existing and psychiatric conditions, and conditions which become more serious than was thought at first. Other exclusions may be pregnancy, optical and dental treatment, organ transplants, cosmetic surgery, X-rays, ECGs. Emma Nicholson (see above) was interviewed; she is campaigning for the word "hospital" to be legally defined. The article doesn't mention the point about private wings in NHS hospitals.
Bella at the end of April 2000 ran a three-page article. It outlines limitations of the NHS as well as of private hospitals. Graham Maloney and Tony Charalambides of APROP are quoted. other cases: Anne Kennedy, Pauline Radford. Bella says: 'Many patients opt to go private within an NHS hospital, thus being sure of proper back-up... Ask your GP to refer you to a consultant working in the private wing of an NHS hospital...' Sunday Times article 7th May 2000 based on our information. Early June 2000: GMC's 2nd hearing on the conduct of Dr Richard Neale. Graham Maloney has hired a coach for victims who wish to attend. Canadian (and other international) media attention is expected, too. The GMC is in Hallam Street. Health Matters (Spring 2000) has a short article 'Private Regulation needs Public Pressure', quoting Richard Ennals.
The Times (23rd June) reported at length the case of Mrs Laura Touche, (related to Presidents Jefferson and Coolidge), who died after giving birth in the Portland Clinic. Her blood pressure, which in the NHS is monitored at regular intervals, was left unchecked, leading to pre-eclampsia and death eight days later. She was transferred to an NHS hospital. The article added that the coroner's verdict of death by misadventure was overturned by the efforts of Philip Havers, QC, something which occurs very rarely. Further legal action is planned. On the 29th June, The Times printed the following letter from Barry Hassell, 'Chief Executive of the Independent Healthcare Association':-
This dishonesty deserves comment (especially as the Labour Government is including creatures like Hassell in its negotiations over new laws.)
Sir, The assertion in your report ("Private patients face risks in 'unregulated' medical centres", June 23) that the independent healthcare sector is "largely unregulated" is far from accurate. Indeed, the independent sector is the most regulated service in health. [1] Many independent hospitals now have full and appropriately staffed intensive care facilities. Where those are not in place, government regulations require agreements with NHS hospitals to facilitate transfers in the event of unexpected complications. [2] We welcome the fact that our ten-year campaign to see better regulations is currently bearing fruit in the shape of the Care Standards Bill. The independent sector is one of the key drivers of this reform and supports the principle of better regulation. [3] The independent sector makes a major contribution in delivering high-quality care to patients - both privately funded and on behalf of the NHS, as the Government itself has recently recognised. [4] Yours faithfully, BARRY HASSELL
[1] The total private sector includes psychiatric and nursing homes, cosmetic clinics, private dentists, eye clinics and so on; collectively they have a great deal of miscellaneous regulation. BUT private acute hospitals (which carry out operations), as we have documented, don't. [2] Hassell attempts to give the impression that 'intensive care facilities' resemble Intensive Care Units of the NHS type, with one-to-one 24 hours/day nursing. In fact, private hospital IC facilities are mostly only for post-operative supervision. 'HDUs'=high dependency units are not for emergencies. (See for example the Michael Caine case, when no there were no trained nurses). As for 'regulations for transfer', these are promised by the Care Standards Bill. [3] If the private sector has sent a few letters, they have remained unpublicised. The private sector's public statements make no reference to their supposed desire for reform. Their letters after deaths or accidents, and defensive quotations in the media, of course make no mention of any of this. And they showed no sign of unhappiness with the looseness of the Registered Homes Act. Their statements to the Health Select Committee miss out all references to accidents and deaths. The U-turn probably came about through adverse publicity of the Emma Nicholson type, and perhaps through APROP etc. In short, the 'key drivers' claim is a deliberate lie. [4] As we have documented, the care is not 'high quality'. The Government recognise the private sector, but only conditionallyproviding it meets acceptable clinical standards (and value for money) if it can do so. It remains to be seen how and whether high standards might be enforced. Mr Hassell naturally gives no indications on this front. Observer (Sunday 13th Aug 2000): long (half-page) article by Nick Cohen, Perils of going private: The rich may do it, but go outside the HNS and you enter a world of corruption and greed. This website address was included. An email:-
BBC collection of about fifty similar emails and letters . (Total response size not given by BBC).
Date: Mon, 14 Aug 2000 An interesting Web Site. I found it following the article Perils of going private in the Observer, 13 Aug 2000. I read it with particular interest as I am at this present moment the RMO on-call at one of London's Private 'Clinics'. I see my position in this job as a 'necessary evil'. A number of us are obliged to work in such places to fund our NHS researchsomething as trainee surgeons we are rail-roaded into doing. One reads the accounts on your site, but as you accept, this is merely the tip of the iceberg. Many 'Customer' slip off home unaware that their treatment is sub-NHS standard, and that their recovery has been more luck than judgment. When I started this 1 year contract 10 months ago hardly, I could recount a frightening event for almost every 24 hour session I worked. Having said that, discussion with other colleagues doing similar work in other places, show that there are a lot worse places. I initially dreaded coming to work, worried about what dilemma I might be faced with; observing sub-NHS treatment being carried out with no ability to intervene on my part. I am obviously allowed and capable of instituting my own treatment under life threatening situations but otherwise all other treatment must be carried out by the Consultants. These consultants are not necessarily bad doctors, they are making out-dated treatment decisions on areas outside their expertisedecisions which would be made by their junior team in the NHS whom are more in-tune with current treatments for general conditions. When I say 'frightening events', I do not mean imminently life threatening blunders, I mean omissions that if a junior was to do the same in the NHS they would be reprimanded by the team. I find it surprising that there is relatively so little adverse publicity concerning the private sector. The public still flock to these places and see them as the 'Gold Standard' of medical care. Perhaps it is not so surprising when you talk to medical students, whom you might think had some insight into the pros and cons of Private Hospitalsso many of them think the level of care must be excellent as it is being paid for. If they see the system through such rose tinted spectacles what hope have the un-initiated public! For my own part, I hope that I have helped initiate some safer practices in this work place and will hopefully be more aware of the limitations when I too am one of those consultants working in such hospitals. However, I feel, as you suggest, that the way forward is private wings in 'proper' hospitals were the appropriate skill mix is on tap 24 hours a day. Sadly with the 'buying up' tactics of some foreign companies who clearly have profit margins forefront in their minds, such units are likely to disappear rather than proliferate. Regards RB (MBBS FRCS) Readers Digest early 2001 UK edition has an article by Judy Jones, Private Hospitals Can Damage Your Health , recommended by Richard Ennals. Non-effects of this site:
In our quest for publicity, we have e-mailed a number of serious-seeming health journals and newspapers. No responses received from:
[Back to Start] 'International Journal of Health Care Quality Assurance' 'Nursing Times' 'Health Services Journal' 'Eurohealth' 'European Journal of Public Health' 'Qualitative Health Research' 'Journal of Integrated Care' Ian Murray, medical correspondent, 'The Times' LINKS TO OTHER ORGANISATIONS [Back to Start] A campaigning group, Action for the Proper Regulation of Private Hospitals (APROP) has been formed. This is not APROP's official website, though one has been discussed. Dissatisfied patients and relatives may e-mail APROP by clicking here, or may contact: APROP, PO Box 418, Weybridge, Surrey KT13 0FJ. APROP has had publicity in Here and Now, the Independent, the Daily Telegraph, The Sunday Times, Healthcare Market News, the Surrey Informer newspaper group, BBC Radio 4's You and Yours, BBC TV's Kilroy, and other media. Click for APROP's official memorandum to the Select Committee. The testimony of APROP's founder members including John Lambie, Caroline Buckley, Samantha Ryb, and Graham Maloney is here. Richard Ennals felt unable to testify because of legal threats, unaware at the time that the proceedings are privileged. Oral Evidence for the Parliamentary Select Committee on Health, which is investigating this subject, is on the Health Select Committee Website of the House of Commons. You may well find the arrangement of subjects and dates confusing. This site has the Consumers Association memorandum; and this is the submission of the National Consumer Council. Some APROP testimony is listed above. And you may like this concise summary of NHS/private sector differences. Minutes for 25th March are transcriptions of oral evidence by the heads of the Independent Healthcare Association, BUPA's hospitals, the General Healthcare Group, Nuffield Hospitals, and Community Hospitals Group. (Each also supplied at least one memorandum; these too are on Internet). Their oral evidence strategy was evasion and the infliction of acuteor rather chronicboredom. [-RW] Click here if you'd like to see. Possibly, however, their approach will not go unnoticed. More recent minutes record the views of medical witnesses. AVMA, Action for Victims of Medical Accidents (specific to Britainno connection with American Veterinarians) founded 1982, 44 High Street, Croydon, CR0 1YB, submitted an excellent memorandum to the Health Select Committee. Click for AVMA's memorandum. We hope in future to have information on groups involved with cosmetic surgery, and with private psychiatry. APRON ('Action for the Proper Regulation of Nursing') may be formed, for those who have complained without success to the UKCC. Another critical examination is being considered of medical defence organisations and defendants' law firms. Websites may follow - RE. Comments? Click here to e-mail this site about private hospitalsHTML Rae West. This subsite first adumbrated 98-01-18; first full version 98-04-10 (apologies for the delay). Optional sidebar 99-10-06. Revd 2000-03-22, 2000-06-04, 2000-07-03, 2000-07-14. Revd conclusions 2000-08-20. 'What may happen to you' fairly complete 2000-09-04. Full update 2000-09-11. Updated again 2000-10-02, 2000-11-01. 2001-01-21 Readers Digest link. 2001-06-17 Click for Home Page (www.big-lies.org) This site was originally http://www2.prestel.co.uk/littleton/private-hospitals.htm
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Ground zero for the next phase of historic Los Angeles’ gentrification appears to be the neighborhoods surrounding USC, thanks in large part to the expansion of reliable high-speed public transportation.
Set midway between Downtown and the Westside around the major east-west arteries south of the Santa Monica (10) Freeway, the communities of Jefferson Park, LeimertPark, West Adams and the Crenshaw District are attracting young professionals who have been priced out of the real estate market, according to the Los Angeles Times.
San Diego-based research firm DataQuick reports that prices in the ZIP codes of the above-mentioned neighborhoods are soaring, with the median home price increasing more than 40 percent to $450,000, in this year’s first quarter as compared with last year’s.
“People are finding what fits their pocket book,” said Los Angeles City Councilman Bernard Parks, whose district includes neighborhoods to the west and south of USC.
Making the area even more practical is the expanding Expo Line, which currently connects Downtown with Culver City, but will eventually reach downtown Santa Monica and, soon – knock wood – all parts of the city will be connected by rail without having to change trains. The area is rather centrally located and easily accessible from most parts of the city.
DataQuick reports that during the first quarter, nearly 12 percent of home sales in the area were so-called flips, in which investors have purchased, renovated and resold the properties. That rate surpasses even flip-friendly Highland Park.
Scott Bridges has covered the Los Angeles scene for over ten years as a journalist and food critic. Follow him on the Huffington Post
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WHO report shows progress in efforts to reduce malaria incidenceBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1678 (Published 17 September 2008) Cite this as: BMJ 2008;337:a1678 Susan Mayor 1London
Efforts to reduce the incidence of malaria are increasing significantly, says a major report published on 18 September by the World Health Organization. Parts of Africa that have made aggressive use of a combination of preventive measures over the past few years have seen dramatic falls in the number of cases, WHO says.
The
World Malaria Report 2008 found an estimated 247 million cases of malaria and 881 000 deaths from the disease, mostly among children in Africa, meaning that it remains one of the world’s leading causes of death. However, several countries had achieved a sharp fall in the number of people affected by malaria after increasing control measures.
Eritrea, Rwanda, São Tomé and Príncipe, and Zanzibar (in Tanzania) each reported reductions of 50% or more in the number of malaria cases and deaths between 2000 and 2006 or 2007.
These areas had achieved high coverage of …
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Who should be vaccinated against HPV?BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2244 (Published 12 May 2015) Cite this as: BMJ 2015;350:h2244 Karen Canfell, director1 1Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011, Australia Correspondence to:
Vaccination of girls against the human papillomavirus (HPV) has been implemented in most developed countries, driven by prevention of cervical cancer as a public health priority. Bivalent (Cervarix, GSK) and quadrivalent (Gardasil, Merck) vaccines protect against subsequent infection with oncogenic HPV16/18, and quadrivalent vaccine protects against HPV6/11, which cause anogenital warts. Although HPV vaccination effectively protects against external genital lesions and anal intraepithelial neoplasia in males, only a few jurisdictions have so far recommended universal vaccination of boys. These include Australia, Austria, two Canadian provinces, and the United States. In other countries, a cautious approach has been due, in part, to uncertainties around the population level impact and cost effectiveness of vaccination of boys.
In a linked article, Bogaards and colleagues (doi:10.1136/bmj.h2016) estimated the benefits to men of offering HPV vaccination to boys.1 They used a dynamic simulation and a bayesian synthesis to integrate the evidence on HPV related cancers in men. The analysis takes account of indirect protection from female vaccination: heterosexual men will benefit from reduced HPV circulation in females, so if coverage in girls is high the incremental benefit of vaccinating boys is driven by prevention of the residual burden of anal cancer in men who …
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201713
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Millard Erickson makes an important point when he says, “The church is one of the few aspects of Christian theology that can be observed (p. 1036 in
Christian Theology).” If his statement is true, then the place where theology should have its most tangible impact is in the community of people who strive to live in its truth.
Secular researcher Barry Duncan in his quest to determine what makes counseling effective found that 40% of what determines whether counseling will be effective is the quality of relational resources an individual has outside counseling (in
The Heart and Soul of Change).
Too often we only ask the question, “What does the profession of counseling have to offer to the church?” In light of this research, I believe the question, “What does the community of the church have to offer to counseling?” is at least equally valid.
In my counseling, I will frequently ask people, “Who do you have that you can talk to about this struggle? Who are you honest with and don’t have to pretend like everything is okay? Who asks you ‘how are you doing?’ and really wants to know the answer? When do you meet with another person(s) just to discuss how life is going and encourage one another?”
Most often the answer are no one and never. But it is being able to answer this question that accounts for 40% of the success rate in overcoming a life struggle. Notice that counseling will never be able to provide this kind of resource. Even in an ongoing support group you are forever defined by your struggle even as you seek to overcome it.
But the church (when operating as God designed – a living community) is precisely this kind of resource. This becomes even more profound when you consider the second largest variable in success: the level of trust between the counselor and counselee. This accounted for 30% of the success rate.
This means (by secular standards) that if the church operates as the community God designed and its members demonstrate the desire/ability to understand one another in a way that builds trust, the relationships within the church have achieved 70% of what is necessary for a successful helping relationship.
To this point we have not broached the subject of Scripture’s ability to provide a superior theory of counseling. We have only been considering the incredible benefits of living in community as God designed even in life’s toughest moments.
I want to be careful not to imply in this blog that formal counseling training is of no value. I am immensely grateful for the education and counseling experience I have received. I believe it does play an important role in understanding people’s struggles.
But my point here simply this: the church is the kind of community counseling would try to create if it thought such a therapeutically powerful reality could exist. My role as Pastor of Counseling at The Summit Church is not to try to solve the church’s problems with counseling knowledge. My role is to encourage the saints that with a biblical equipping to love and understand people that they live in a community designed to transform lives in a way no professional structure can (Eph.4:11-16).
What is the take away? Going to counseling without being meaningfully involved in a church and small group is like going to the dentist when you refuse to brush your teeth each night after eating chocolate covered caramels. In light of this, reflect on Proverbs 18:1, “Whoever isolates himself seeks his own desires; he breaks out against all sound judgment.” Are you in a small group?
If this post was beneficial for you, then considering reading other blogs from my “Favorite Posts on the Church and Counseling” post which address other facets of this subject.
If this post was beneficial for you, then considering reading other blogs from my “Favorite Posts on Counseling Theory” post which address other facets of this subject.
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201713
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SSW Steps up to Climate Change Challenge
Competing against 16 other colleges within Boston University, 45 School of Social Work faculty, staff, and student members won Sustainability@BU’s first Carbonrally environmental challenge. The new monthly contest seeks to reduce the University’s environmental footprint through campus infrastructure upgrades and by connecting faculty, staff, and students to partake in and support these efforts.
Co-sponsored by carbonrally.com, a web platform that provides individuals and groups an easy way to save energy, the monthly contests aim to motivate team members to make small adjustments in personal behavior that would help cut down on energy consumption and carbon dioxide emissions.
As the SSW team had the highest participation rate per member than any other BU team, they will be having a Bean Burrito Party on April 14, 2010 from 12-2pm in the SSW Student Lounge. Provided by Catering on the Charles, the party is open to all faculty, staff, and students.
SSW was the winner of the January challenge, which asked team members to not eat meat for two days in one week. According to Carbonrally, Americans, on average, eat about 200 pounds of meat each year, an increase of around 50 pounds per year since 1960. Meat carries an enormous impact on climate change, and as much as 22 percent of greenhouse gas emissions derive from agriculture. By not eating meat for two days per week, the SSW team reduced their carbon dioxide emissions by 13.2 pounds per week.
Staff members Jennifer Pace and Yen Pham served as Sustainability liaisons, providing a communications link between Sustainability@BU and SSW. Their role was to promote sustainable actions within the School, attend meetings with the Sustainability committee to share practices and lessons learned, and participate in the implementation of projects.
Together, Pace and Pham sought to sign up as many people from the School to join each month’s challenges. Through Facebook posts and messages, contacting faculty and staff, and emailing on-campus and off-campus students, they were able to encourage all 45 participants to join the SSW team.
“We talked to faculty, staff, and students – in the kitchen, the hallway, and the lounges – about how important it was to win the first competition," Pham said. "This was about all of us working together to make an impact. As a small school at BU, we wanted to make a gigantic impact and let the University know what we’re capable of doing as a whole.”
Each month Sustainability@BU posts a simple, short-term “challenge, which is a small, sustainable action that members can incorporate into their daily lives. Team members can track their progress via their “My Carbon Page” and view a “Total Impact Map” for real-time results in different colleges on campus and throughout the country.
“I am proud that we could stand out to the rest of the university,” Pace said. “While the School of Social Work is working on helping society, it is also important for us to be conscious of the environment we are living in. The Carbon Rally really opened our eyes to see how much damage we do to the earth every day.”
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201713
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The human brain is built for conversation, but we achieve better results when we think strategically about listening and make a few simple, deliberate choices that support our conversational goals.
Imagine yourself in a business conversation. Maybe you are the CEO of a Global 500 company meeting with your board of directors. Maybe you are a solo entrepreneur talking to your first big client about renewing your contract.
Whoever you are, whoever you talk with, the following steps can make you more effective in each conversation you have.
Step 1. Decide what your goals are for the conversation.
Step 2. Be aware of your options, and with your conversational goal in mind, deliberately choose whether to talk or to listen, to focus or clarify what you want to say, or to listen attentively.
Skilled listeners think about their purposes for having a conversation and make their choices based upon those purposes. Valid business purposes for a conversation include:
To exchange information. In many conversations you will be talking about what someone needs, or is offering. You may also be trying to figure out whether someone else has complementary offerings or needs, for example, to figure out if one of you is a potential buyer and one a potential seller. Finally, part of the exchange of information is often about whether someone accurately understood what they heard.
To build working relationships. People who know and respect one another, and who have a good experience working together, often work together more effectively. Personal style can make an enormous difference. Developing and maintaining positive personal relationships can be one of the most important components of customer-supplier conversations, employer-employee conversations, networking conversations, team communication, and more.
To feel good. Having an enjoyable and/or productive conversation can make you feel valuable, respected, and even liked. As such, conversations can be a key component of having a good day or even a good job, and of being motivated and productive.
To make someone else feel good. Good conversations can have the same effect on others as they have on you. Whether or not you have a vested interest in someone's state of mind--such as a customer, co-worker, or supplier--you may find merit in giving someone this experience.
For every conversation, and for every choice you make in that conversation, remind yourself: my choices affect whether or not I best accomplish the purposes of this conversation.
At risk of stating the obvious, in conversations people generally take turns talking and listening. Effective listeners are fully conscious of making a decision each time they decide to talk or to let someone else talk. If you haven't already, you can develop this self-awareness and reap its benefits.
The following flow chart shows a series of choices that you face in conversation starting with the most basic: whether to talk or listen. Your mission is to identify, and support, your goals for having this particular conversation in the first place.
These choices repeat over and over as your conversation continues.
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201713
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Farmers Markets and Food Safety: What a Week!
Love the farmers market? With more than 5,000 farmers markets in full swing across the country, there’s sure to be one right near you. US Secretary of Agriculture Tom Vislack has declared this week, August 1-7, National Farmers Market Week. If you haven’t ventured to one in your area, this may be the perfect opportunity to do so.
Don’t know where to go? Thousands of markets are listed in the USDA Farmers Market Directory. The latest version of the directory comes out this week, too — obviously in conjunction with National Farmers Market Week. Last year the number of markets grew 13%. What kind of surge will we see this year?
Will the S.510, the Food Safety Bill come to a vote this week?
This week, too, proponents of the federal food safety bill, S.510 — the FDA Food Safety Modernization Act — hope it will come to a vote. The legislation would give the federal government the power to make our food safer and help stem the spread of food borne illnesses by giving the FDA the authority to, among other things:
test for dangerous pathogens trace outbreaks back to their sources provide the FDA with mandatory food recall authority subject foods from overseas to the same standards as those for foods produced in the US TAKE ACTION: Urge your Senators to vote for the food safety bill! Food Dangers
The Centers for Disease Control and Prevention estimate that 5,000 people die each year as a result of food-borne illnesses. Many of these victims are toddlers who simply don’t have the immune systems to fight off infection. A mind-boggling
76 million people a year fall ill after eating tainted food, according to the CDC estimates. And 325,000 of them are sick enough to land in the hospital. TAKE ACTION: Help prevent foodborne illness!
A number of prominent advocacy groups and individuals support S.510, the Food Safety Bill, including Consumers Union and Eric Schlosser, co-producer of the Oscar-nominated documentary
Food Inc., and author of the best seller Fast Food Nation. Schlosser’s recent op-ed in The New York Times was right on target discussing the importance of passing the bill, and the surrounding issues of food safety. Here’s a video of Schlosser advocating for the bill:
Will the Food Safety Bill affect small farms?
The link to farmers markets is this: there’s been a good deal of concern that small producers — who by and large sell to farmers markets — wouldn’t be able to adhere to some of the regulations. Thus, the concern is that the bill would drive them out of business, in much the same way as small slaughterhouses were shut out by industrial plants after the massive consolidation of the meat industry.
“The Internet has been rife with wild rumors,” as Schlosser succinctly states in his op-ed, “that the bill is really a subterfuge cleverly designed to eliminate small farms and strengthen the grip of industrial agriculture.” But he continues, “the bill very clearly instructs the Food and Drug Administration to focus on its enforcement efforts on plants that pose the greatest risk of causing large-scale outbreaks. And the bill’s wording can still be clarified so that mom-and-pop producers aren’t threatened by heavy-handed government regulations.”
Jean Halloran, Director of Food Policy Initiatives at Consumers Union agrees that there’s no reason for concern. “I don’t think it poses any threat to farmers markets, especially with all the provisions that have been added to the legislation,” she says. “There are provisions that the FDA must take biological diversity and organic producers into account. I think those kinds of farmers are protected.”
Consumers Union also says the bill recognizes the importance of small, sustainable and organic farms by:
Directing FDA to ensure that its produce regulations do not conflict with and are not duplicative of organic requirements. (This was added by an amendment in Committee) Requiring the FDA to consider the impact of any produce regulations on small and diversified farms, as well as on conservation and the environment. (also added in Committee)
Concerns also abound that corporate farms would reap the benefits from exemptions proposed to help small farms. Halloran points to two amendments to the Food Safety Bill introduced by Senator Jon Tester (D-MT) in April, which are designed to ease the burden small farmers believe the bill will impose on them if it passes. “I’m confident that in the end the bill will include provisions that adequately and effectively protect small farmers and processors with no loopholes for larger producers,” she says. Schlosser also points out in his op-ed, as well as on the video, that “what the legislation actually seeks is some restraint on unchecked corporate power.”
Poll shows Americans think FDA should have power to recall food
Consumers Union recently conducted a poll, asking 1,000 Americans if they thought the FDA should be given the power to recall tainted products. An overwhelming majority — 80% — said yes. As Schlosser says in his op-ed, our food will never be 100% safe — it’s unrealistic to think that it ever can be, but passing the Food Safety Bill S.510 is “a good first step.”
And Halloran and the bill’s proponents say, it’s crucial for the Food Safety Bill to come to a vote this week before the August recess. “If it doesn’t pass this year, then we’re back at square one,” she worries.
More from Care2 on the Food Safety Bill:
Give the FDA the Power to Make Our Food Safe Join Care2, Eric Schlosser and Consumers Union in supporting S.510 — the FDA Food Safety Modernization Act. Sign this petition urging your Senators to bring the bill to a vote.
PHOTO CREDIT: freefoto.com
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201713
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Regional Pollution and Biodiversity Experts help the UN Caribbean Environment Programme develop its 2017-2018 Work Programme for protecting the Caribbean Sea
Over 60 scientific and technical experts from the Wider Caribbean Region (WCR), representing Governments, Research Institutions, Intergovernmental and Non-Governmental Organizations, and the Private Sector, will meet in Miami, Florida from October 31st - November 4th to discuss current and emerging pollution and biodiversity issues impacting the Caribbean Sea.
A series of two meetings, hosted by the Government of the United States - the Third Meeting of the Scientific Committee to the Protocol Concerning Pollution from Land-based Sources (LBS) (
3 1 s t October - 2 nd N ovember) and the Seventh Meeting of the Scientific Committee to the Protocol concerning Protected Areas and Wildlife (SPAW) ( 2 nd – 4 t h N ovember) will be convened by UN Environment (UNEP’s) Caribbean Environmental Programme in its capacity as Secretariat to the Cartagena Convention for the Protection and Development of the Caribbean Sea.
These technical advisory meetings are convened every two years by the Jamaica-based Secretariat to evaluate its work over the previous biennium, review achievements and challenges, and develop the Secretariat’s next Work Plan and Budget.
According to Dr. Lorna Inniss, Coordinator of the Caribbean Environment Programme,
“the region’s continued economic development relies on the sustainable use and management of its vulnerable coastal and marine resources, which are the basis for tourism, fisheries and coastal protection.” According to Dr. Inniss, “ while the region had made some progress in pollution prevention and biodiversity protection, much more needs to be done in the area of oceans governance if we are to fully benefit from emerging blue growth opportunities”.
Financial support for these meetings has been provided by the Government of the United States and the Global Environment Facility funded Caribbean and North Brazil Shelf Large Marine Ecosystems Project (“the UNDP/GEF CLME+ Project”, 2015-2020). The support from the UNDP/GEF CLME+ project in particular has enabled the CEP Secretariat, for the first time, to have pollution and biodiversity experts from the region meeting together to foster more integrated management approaches and management solutions to more complex environmental challenges.
Habitat degradation, pollution and unsustainable fisheries and fishing practices, exacerbated by climate change are the main challenges for coastal and marine resources managers and are at the core for sustainable livelihoods in the region. To address these issues, more integrated approaches have been articulated in the 10-year Strategic Action Programme (“the CLME+ SAP”, 2015-2025) and its vision of having “a healthy marine environment that provides benefits and livelihoods for the well-being of its people”. This SAP has been politically endorsed by 25 countries and is being directly supported by the work of UNEP CEP along with several other regional partner agencies.
According to Mr. Christopher Corbin, Programme Officer with responsibility for the Pollution sub- programme of UNEP CEP,
“the development of regional platforms for reducing pollution from solid waste and marine litter, nutrients from poor agricultural practices, and untreated wastewater has been one of the main achievements for the sub-programme”. While expressing disappointment that Jamaica was the only new country to ratify the Pollution (LBS) Protocol during the last biennium, bringing the total number of Contracting Parties to 12 out of a total of 28, several other countries have indicated a commitment to sign. The LBS Protocol calls on countries to reduce the negative environmental and human health impacts of land-based pollution including solid waste and sewage.
Coastal and Marine Biodiversity Programme Officer, Mrs. Alessandra Vanzella–Khouri, emphasized that “
many of the pollutants from land and sea, as well as poor practices, are directly impacting on coastal and marine ecosystems such as coral reefs and mangroves. These sustain many of the countries’ economies by providing services for tourism, fisheries and coastal protection”. Poor land use practices, overfishing and destruction of marine habitats underscores the critical need for integrated ecosystem- based approaches. According to Mrs. Vanzella-Khouri, “ such approaches are already showing direct benefits in countries like The Bahamas, Belize, Colombia, Grenada and the USA where management and conservation tools like Marine Protected Areas and networks are effectively being implemented.” Additional countries also need to join Cartagena’s biodiversity treaty (SPAW Protocol) to ensure that regional cooperation efforts for the sustainable management of marine resources are not undermined but rather integrated and enhanced.
The 2017-2018 work plan and budget for CEP’s pollution and biodiversity sub-programmes is an ambitious one with a total budget of over USD18 million. According to Dr. Inniss, the Secretariat has already been successful in mobilizing over 60% of the resources required for implementation. With the additional demands being placed on Governments to achieve the Sustainable Development Goals (SDGs) in particular Goal 14 on Oceans, the Secretariat is well placed to expand on its technical and capacity building support to its Contracting Parties and Member States and to continue to foster regional collaboration for the betterment of all the peoples of the Wider Caribbean Region.
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201713
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The time measured by clocks is constant, but the time measured by the soul is bewildering.
Time is something we are all very familiar with, and yet some scientists doubt that it exists: The equations that describe the universe work just as well without time. It seems to be just a name we have put on the increase of chaos: Intuitively if we see a video of a glass assembling itself from scattered shards, we know that it is being played in reverse. And yet, arguably, for most of our lives we are such a thing as that glass coming together. Our memories come together creating a more or less whole and balanced self. Even plants that grow are such things, being assembled from tiny pieces into an impressive whole. Life is like a countercurrent in the stream of time.
Although recent science dismisses time, and classic science presents a clean arrow of time, most humans have a more vague sense of causality. Yes, causes lead to effects, the past creates the present and the present the future. But we also feel that the future is real and influences the present. In English we even use the same word, for instance: “The reason I get paid is that I go to work. The reason I go to work is to get paid.” How can the two things be each other’s reason?
Our mind seems able to travel through time to a certain degree. Through the power of our memory, we can revisit the past and relive the joys and sufferings, although we cannot change it except in our imagination. By the power of anticipation we look into the future, although a future that is less certain than the past, and we take with us information back to the present. We study the outcome of our actions before we even act. And then we decide: “No, it is not worth it” or “Yes, it is worth it” and so the future – which does not yet exist – changes the present, which definitely exists.
Time is weird.
***
Time does not always seem to move at the same speed, either. Objectively it does, or very nearly so. (It slows down slightly when we accelerate, or so the theory of relativity says. But in ordinary life this is not measurable. You won’t live longer by speeding on the highway, possibly quite the opposite!)
When we are children, time seems to move quite slowly. A summer holiday is an ocean of time and we arrive on the other side as a changed person. In old age, the same summer is like a puddle in the road that we step over, barely noticing. Or that is the general tendency. But do all of us experience time the same way? I don’t think so. I have a strong feeling that, for some reason, my subjective time runs less fast than others my age.
“If you are a lifelong bachelor, you may not live till you are 100, but at least it will feel that way” someone said when I was a kid. As a lifelong bachelor, I certainly agree with this, but I don’t see it as a bad thing. “Don’t kill time, it is your life” said the Christian mystic and teacher Elias Aslaksen. I try to not dissolve completely into my habits and obligations, but learn something new and be aware of at least some of what goes on during my day.
Part of my subjective feeling of slow time is that I spend a lot of time observing lower worlds where time moves faster. Most notably, I have read books since I was little, although I read less novels now. The experience of the book’s characters are added to my own, giving me a feeling that I have lived much more than I actually have. (It is not just me: Old people sometimes tell of something that happened to them when they were younger, which the bookish listener will recognize as having happened to a literary character.) I am not sure if the same applies to movies, in which case most people should have this experience. I don’t watch movies much, except for some Japanese animation.
As a (mainly hobby) writer, I create worlds where years pass over the course of weeks of real time. (Not all writers do this – some my spend a year on describing a week.) I also play games such as The Sims series, where simulated humans live, age and eventually die after some days or weeks of real time. Other favorite games of my past are the Civilization series, where entire civilizations rise and fall over the course of a few days. Watching this gave me a subjective feeling of old age, which blends well with my lifelong interest in history and my reading of old books. I know objectively that I was born in 1958, but a part of me feels like I wandered the streets of ancient Uruk before Rome was even a village.
***
Yet another factor that determines subjective time may be how fast you process information. The more data that passes through and is consciously registered by your brain, the more time would seem to have passed. We know that in certain critical moments, the doors of perceptions are thrown wide open and time seems to slow to a crawl. Unfortunately it is usually not possible to make your body speed up to the same degree.
In my fourth dicewriting story, which I stared just after my previous entry, the main character seems set to become a speedster. Not on the scale of The Flash from the TV series that I believe is still ongoing in America, or the comic books of the same name. Just … living faster.
In that story, speed is one of Erlend’s five specializations, and with an expected duration of 6 years this could make a big difference. I look forward to seeing how this will unfold when we reach the borderlands of human experience. How is it like when the world slows down to half speed and a day feels like it has 48 hours? How do you interact with the people around you? If it happens gradually enough, you probably adapt seamlessly, and don’t rock the boat by being too different in everyday life.
As it happens, I have a coworker of sorts – technically his company is the client of ours, but we work together and eat lunch together – and he is highly intelligent, possibly more than me. It is hard to say: While my intelligence is exceptionally wide, reaching into thoughts that most people never consider thinking, his intelligence is
fast. Ordinary humans try his patience, because he knows what they are trying to say while they are still beginning to say it, and then they just keep rambling on, unaware that he already understands it better than they do. Usually he spends his lunch break reading his smartphone. The leftover attention is sufficient to keep up with what everyone in the room is saying. This guy strikes me as a good match for a “near speedster”, someone who lives fast in a slow world. (Of course I won’t borrow any other traits from him. My characters are all unique, not based on real people.)
The clocks keep ticking, but perhaps we each hear them tick at our own speed…
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201713
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16 September -
100 organisations including Christian Aid have jointly welcomed the cessation of hostilities negotiated by the US and Russia this week, and have demanded that the US and Russia use their influence to ensure full and unhindered humanitarian access throughout Syria.
In a joint statement, the Syrian, regional and international humanitarian and human rights organisations say:
This week’s cessation of hostilities agreement negotiated by Russia and the US could be an important and welcome step forward for the future of Syria. Countless lives are saved each day this cessation holds. Now that Russia and the US have brought about a significant reduction in violence and a cessation of airstrikes, they must use their influence over the Syrian government, non-state armed groups and other parties to the conflict to ensure full and unhindered humanitarian access across the country. Besieged areas like eastern Aleppo, where 275,000 people are trapped and desperate for food, fuel and medical supplies, and Madaya, where there has been an outbreak of meningitis, should be prioritized.
Sporadic and temporary cessations of violence cannot become ends in themselves. The success of this agreement should not be measured just by a reduction in fighting.
It needs to be accompanied by unfettered and sustained humanitarian access throughout Syria; an end to the forced displacement of communities as seen recently in Darayya; and a political process that addresses the root causes of the crisis.
Russia and the United States have proved for the second time that they have the power to silence the weapons in Syria. The lives of innocent Syrian civilians are in their hands.
The brutal conflict and unlawful targeting of civilians and civilian structures such as hospitals, schools and markets cannot be allowed to recommence.
This cessation of hostilities agreement may provide a rare opportunity to move towards a negotiated political solution to Syria’s devastating conflict. We call on Russia and the United States to ensure that this opportunity is not wasted.
The US and Russia’s counterparts in the International Syria Support Group must also stand up to their responsibilities to use their influence to encourage all parties to the conflict to respect the cessation, to monitor and report violations of the cessation, and to comply with their obligations under international humanitarian and human rights law.
Signed:
1. 11.11.11 2. Abrar Halap Association for Relief and Development 3. Action Contre la Faim 4. Ahl Horan 5. Al Seeraj For Development And Healthcare 6. Alkawakibi Human Rights Organization 7. American Relief Coalition for Syria 8. Amrha 9. Andalus Institute for Tolerance & Anti-Violence Studies 10. Arab Center for the Promotion of Human Rights 11. Arab Coalition for Sudan 12. Arab Foundation for Civil Society 13. Arab Organisation for Human Rights - Mauritania 14. Arab program for human rights activists (APHRA) 15. Association de Soutien aux Médias Libres 16. Attaa for Relief and Development (ARD) 17. Balad Syria Organization 18. Bihar Relief Organization 19. Bonyan 20. Bridge of Peace 21. Cairo Institute for Human Rights Studies 22. CAFOD 23. CARE Internationa 24. CCFD - Terre Solidaire 25. Christian Aid 26. Concern Worldwide 27. Council for Arab-British Understanding 28. Damascene House Foundation for Society Development 29. Deir Elzzor United Association (FURAT) 30. Doctors of the World UK 31. Education Without Borders (MIDAD) 32. Emaar AL Sham Humanitarian Association 33. Enjaz Development Foundation 34. Euro-Mediterranean Human Rights Monitor- Geneva 35. Fraternity Foundation For Human Rights 36. Ghiath Matar Foundation 37. Ghiras Al Nahda 38. Ghiras Foundation 39. Ghiras Syria 40. Global Call to Action Against Poverty 41. Global Centre for the Responsibility to Protect 42. Handicap International 43. Help 4 Syria 44. Human Appeal 45. Humanitarian Relief Association (IYD) 46. Ihsan Relief and Development 47. Insan for Psychosocial Support 48. International Humanitarian Relief 49. International Supporting Woman Association (ISWA) 50. International Rescue Committee 51. Irtiqaa Foundation 52. Islamic Relief 53. Just Foreign Policy, US 54. Karam Foundation, NFP 55. Local Development and Small-Projects Support (LDSPS) 56. Maram Foundation for Relief & Development 57. Middle East and North Africa Partnership for Preventing of Armed Conflict 58. Montreal Institute for Genocide and Human Rights Studies 59. Mountain Foundation 60. Najda Now 61. Nasaem Khair 62. Nuon Organization for Peacebuilding 63. Orient for Human Relief 64. Oxfam 65. Pax Christi International 66. Permanent Peace Movement 67. Qitaf Al Khair Relief Association 68. Rethink Rebuild Society 69. Saed Charity Association 70. Save A Soul 71. Save the Children 72. Sedra Association for Charity 73. Shama Association 74. Snabel Al Khyr 75. Society for Threatened Peoples 76. Student-led Movement to End Mass Atrocities 77. Syria Charity 78. Syria Network for Human Rights 79. Syria Relief 80. Syria Relief and Development 81. Syria Relief Organization 82. Syrian American Medical Society 83. Syrian Education Commission (SEC) 84. Syrian Network for Human Rights 85. Syrian Engineers for Construction and Development Organization (SECD) 86. Syrian Expatriate Medical Association (SEMA) 87. Syrian Medical Mission 88. Syrian Orphans Organization 89. Takaful Al Sham Charity Organization 90. The Centre for Victims of Torture 91. The Syrian Establishment for Human Care & Enhancement (MASRRAT) 92. Tuba Dernegi 93. Unified Revolutionary Medical Bureau in East Gouta 94. Union of Relief and Medical Care Organizations (UOSSM) 95. Union of Syrians Abroad 96. Violations Documentation Center in Syria 97. Vision GRAM-International 98. White Hands - Beyazeller 99. World Vision 100. Zain Foundation
Ends
For more information please contact Jo Rogers: jrogers@christian-aid.org Notes to editors:
1. Christian Aid works in some of the world's poorest communities in around 40 countries at any one time. We act where there is great need, regardless of religion, helping people to live a full life, free from poverty. We provide urgent, practical and effective assistance in tackling the root causes of poverty as well as its effects.
2. Christian Aid’s core belief is that the world can and must be changed so that poverty is ended: this is what we stand for. Everything we do is about ending poverty and injustice: swiftly, effectively, sustainably. Our strategy document Partnership for Change explains how we set about this task. 3. Christian Aid is a member of ACT Alliance, a global coalition of more than 130 churches and church-related organisations that work together in humanitarian assistance, advocacy and development. 4. Follow Christian Aid's newswire on Twitter: http://twitter.com/caid_newswire 5. For more information about the work of Christian Aid, visit http://www.christianaid.org.uk
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It has been two years to the day since the crime of Ayotzinapa. A moment of soul-searching for Mexico.
You can feel it in the streets. You can read it in the many articles and messages that look back to the terrible night that that six lives were lost and 43 disappeared and a nation was forced to come to terms with the violence and corruption at its heart
Ayotzinapa, the rural teachers’ college set on a mountainside in the dirt-poor state of Guerrero, marches again, like on the 26
th of every month, but now to commemorate two full years of impunity and lies.
It could be a time for mourning. It could be an act of rage. Many, especially the families, do still feel the mourning and the rage, and they will every day until, unless, their sons are returned. But to see that day, after hundreds of nights of tears and scores of meetings, marches, press conferences, community talks, parents and fellow students have one message: Organize.
“We need more participation of the people. More serious and responsible organization,” says Omar Garcia, an Ayotzinapa student who survived the attacks and has become a powerful spokesperson for the movement to bring his friends back alive.
It’s grassroots organization– in Mexico and the world– that has kept the memory of the students alive far beyond the aggrieved hearts of their parents and demanded that the crime of the state be punished. Today, to remember is more important than ever.
The power of transformation
Mexicans from all over the country felt something snap when they heard of the students abducted and disappeared in the city of Iguala. They responded with demonstrations that reached hundreds of thousands strong in late 2014. Their slogan—IT WAS THE STATE—changed the way people think about the Mexican government, its relationship to organized crime and the war on drugs that has taken more than 140,000 lives in the past nine years.
Looking back, there’s no doubt that the crime of Ayotzinapa has transformed the grassroots of the country. While the government has responded by closing ranks and attempting to close the case, the people have taken to the streets.
The movement has been relentless in its demands of a government that refuses to investigate itself. The Ayotzinapa movement won a major victory with the invitation to allow an independent body form the Organization of American States, the Interdisciplinary Group of Independent Experts or GIEI, to investigate the crime. Their final report, presented in May of this year, showed that state involvement went way beyond the municipal police working with a local crime group.
It proved that the events of September 26 and 27 were coordinated actions among several government agencies, with the direct participation of at least the federal, state and municipal police, and a criminal organization. The report established the presence of the Mexican Army at the scene of the crime, and emphasized the importance of taking testimonies from the Army to clarify events and its role in them. The Army refused repeatedly to allow the GIEI to directly interview Army personnel involved the night of the crime. The role of the armed forces continues to be key to the state cover-up of the case.
The GIEI report shot down the government position that the students were burned at the Cocula dump, for lack of consistency and proof. As the Peña Nieto administration put forth modifications to its false history, the experts critically analyzed them and revealed the factual inconsistencies. In other words, they were exposed as lies. Most glaringly, the state was left without a hypothetical motive, fanning suspicions that the students were attacked for political reasons and that the governments–on all levels–moved fast to hide grave acts of corruption, complicity and violence.
The group of experts left the country without having arrived at the truth or the missing students. They left, angry and disappointed, because the federal government refused to extend their investigation. The experts presented evidence of the obstacles and lack of cooperation from Peña Nieto’s Attorney General’s Office and other government agencies. The hundreds of people who listened to the presentation and the millions more who saw it or read about it felt a deep sense of gratitude, but at the same time abandonment. If you live in a nation where impunity is the rule, impartial and professional assistance from outside can be a lifeline.
But it is no doubt the grassroots organization that has made this case a turning point in history and that will continue the pressure to find the students and to the change the country. Omar Garcia sends out a challenge: “We’ve asked the Mexican government officials not to abandon the investigation, and we also want to ask the movement–the students themselves, people who have been involved in social change historically and those who have not but are beginning to be—that the struggle be for real. We have to transform this country.”
That means everyone, everywhere, and not just for Ayotzinapa. Ayotzinapa has become a symbol of fighting back against the forces that seek to stifle the necessary rebellion of youth. The kind of transformation he refers to is global and local, direct and transcendent.
“To organize in serious way for us means to use the resources you have, as an individual and as a collective,” Garcia told me in an interview. “You can do things. And even though they’re very small things, do them. Inform yourself, analyze the information. Now information is accessible through the social networks. We don’t need Televisa and Television Azteca and all these other mass media. As long as you have an interest in being informed, you can find information.”
For Mexico two years after Ayotzinapa there is a huge unfinished agenda. The first point on the Ayotzinapa Agenda is to find the disappeared students and the other 28,000 disappeared in the country. Ayotzinapa spurred a movement of the disappeared that reminds us that the problem runs deep and affects thousands of families, with more being added each day.
Other points include tasks related to the investigation itself: to follow up on unresolved questions such as the fifth bus that was escorted out of the scene of the crime that night by federal police; to thoroughly interrogate, and prosecute if need be, military personnel involved in the events; to demand new interviews with witnesses, and presentation and analysis of missing phone registers; to prosecute any government officials responsible for violation of procedures, tampering with, destruction of and loss of evidence, and distortion of the facts; to further investigate evidence of torture discovered in at least 17 of the suspects’ questioning.
Most important, are the big tasks of establishing why the students were attacked, killed and disappeared–exposing the masterminds of the crime and not just the perpetrators. And we must all take on a serious commitment to find the other 28,000 disappeared, demand prosecution for disappearance and forced disappearance (disappearance with the involvement of the state), and guarantee the safety of family members and human rights defenders.
These are government responsibilities, but in the context of a criminal state, society itself must assume responsibility.
No one is exempt from this responsibility. In Mexico, the process has begun. In large part, thanks to the tragedy of Ayotzinapa. Demands for truth and justice grow. The families of the disappeared in Coahuila, Veracruz, Guerrero and states throughout the nation remember and demand and search the fields for their loved ones with shovels and picks. Solidarity groups exist in every continent of the globe. The faces of the 43 are born solemnly in the streets of Madrid, Los Angeles, New York and Athens. The movement struck a chord, a chord not just of compassion but also of resistance.
Therein lies the hope amid the pain. “We have to participate, to dedicate part of our time to participate in organized associations to change the country,” Garcia states. “There are already examples on the national level, examples in different states, that can show us the way. On the Latin American level, too. There are experiences that demonstrate that you really can change things in a positive way.“
If grief-stricken mothers and fathers and friends and siblings can take on that challenge, so can the rest of us.
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201713
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Category: Crystals, Gems, Elixirs Hits: 851
The power of the Shungite benefits lie in what makes it unique. Touted as the Miracle Stone of the 21st Century,
has been around for an estimated 2 billion years, but it wasn’t until the 1996 Nobel Prize winning research that discovered antioxidant fullerenes within the stone, that people began to wake up to Shungite’s healing potential. It’s like the best friend in every romantic comedy who the love interest doesn’t realize is amazing until halfway through the film. How could we have overlooked Shungite for so long?! Now that it’s finally in the spotlight, we can’t get enough. Shungite
The hallow fullerenes that make Shungite so remarkable are called “Buckyballs.” They’re molecular formations specific to Carbon, like that in the noncrystalline carbon mineraloid, that is Shungite. Just as Carbon has been used within water filters for centuries, so, too, does Shungite possess this purifying property. In fact, that’s how the Shungite benefits received its first bit of notoriety. It can only be found in Karelia, a remote location of Russia. During the time of Peter I the Great’s rule, he was looking to promote travel spots in Russia, and he decided to feature the long revered springs of Karelia. These springs run over sheets of Shungite, and even before Peter I the Great turned them into natural spas, locals would use pieces of Shungite to bring that spring freshness to the water in their home. All of these years later, science has helped to provide the evidence for what Russian’s have long known.
Infographic : energymuse.com
Use the
shungite metaphysical properties in an elixir in your water to add fresh-from-the-spring taste to home. We could all drink more water, and what could give you more encouragement than having cool crystal water to drink? The antioxidants in Shungite are powerful influencers on health and a fully functioning immune system. Trying enhancing your workout by replenishing with the Shungite benefits afterward. The anti-inflammatory aspect of these antioxidants is great for those aching muscles!
Even more stunning than its cleansing properties in water are Shungite’s protective qualities. As a conductor of electricity, Shungite is known to aid in the inhibiting of EMFs, or electromagnetic fields, that are the result of electromagnetic radiation. Electromagnetic fields are created by electronic devices. Common electronic items such as laptops, cell phones, computers, and tablets all putout EMFs. Placing a Shungite sphere at the base of a computer, microwave or around your various home electronic devices will not interfere with their operations, but it will block out some of their free radial output. We’re all surrounded by electronics at work and home—maybe even more than we’d like—but with an added Shungite shield, that doesn’t have to be a bad thing; except for where distractions are concerned!
Speaking of distractions, Shungite meditation can help with those too. Seriously, this is why it’s called the miracle stone. What can’t it do? Meditation with Shungite boosts performance by helping you to focus. Through reducing stress and relieving anxiety,
can calm the mind of worry flurries, and give it the clarity needed for productive work. It also significantly enhances energy, which you can direct toward grounded concentration and a more positive outlook. Shungite rejuvenates and balances the spirit. Shungite properties
Whether you’re wearing it or meditating with it, Shungite works with your root chakra to support and raise your entire spiritual being from the ground up. This provides balance between the left and right sides of the body, and harmony between chakras. As a neutralizer, it will also block out the negative energy that comes from outside sources. People who act as energy vampires, draining you of your life zest, won’t have that effect when you are wearing Shungite. The energy is so strong, it counteracts their vibes with equally powerful positivity to neutralize their influence on your energy. Combine it with another crystal to amplify the desired effect.
If you are looking to cut energy vampires out of your life, enhance creativity or bring abundance into your business, you can use crystal specific to those goals in tandem with Shungite for added efficacy and protection in the process. Shungite benefits are all about taking things to next level. Working with it allows you the opportunity to invest in yourself and ask what is it that you’d like to enhance. With this miracle stone in hand, the possibilities are limitless.
Energy Muse jewelry pieces are designed with gemstone combinations that have a specific energy focus. They can aid you achieving wealth, finding love, enhancing performance and improving health. When you wear our jewelry and combine the energy of the gemstones with your thoughts and your own energy, a powerful union is created to help you achieve what you desire. Credit: energymuse.com
If you appreciate the information provided, please help keep this website running. Blessings! Latest Articles Articles: Crystals In Depth Archive: Crystals, Gems, Elixirs 2017 (14) March (6) • The Meaning of Your Birthstone and How to Use its Magic Energy • Chrysocolla Crystal Ritual for New Beginnings • The Crystals To Use Based On Your Zodiac Sign! • 7 Crystals to Change Your Luck • Keep Calm, and Carry These Four Crystals During the Eclipse/Equinox Window! • 10 Reasons Why Kyanite is an Essential Stone for Healing and Spiritual Growth February (4) January (4) March (6) 2016 (33) December (2) October (3) September (1) August (2) July (1) June (2) May (2) April (3) March (5) February (3) January (9) • Love Rituals With Rose Quartz Points • Using Crystals For Support Throughout The Year Of The Monkey • Himalayan Salt Lamps – More Than Pretty In Peach • Benefits Of Wearing Shungite • Enhance Your Three Energy Channels Using Healing Crystals • Emotional Clearing Ritual with Crystals • Crystal Divination: What Does 2016 Hold in Store for You? • CRYSTAL FORECAST FOR 2016 • Create A Healthy Lifestyle Crystal Grid For The New Year 2015 (17) December (1) October (1) September (3) August (3) July (4) June (2) April (1) March (1) February (1) 2014 (8) December (1) October (4) August (1) May (1) March (1) 2013 (7) November (2) October (1) June (1) April (2) February (1) 2012 (2) 2010 (1) May (1)
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201713
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Auto Enrolment in 8 Simple Steps.
The law on workplace pensions has changed. Every employer with at least one member of staff now has new duties, including enrolling those who are eligible into a workplace pension scheme and contributing towards it. This is called Auto Enrolment and The Pensions Regulator should have already notified you of your staging date. Employers need to take steps to ensure that eligible staff are enrolled into a pension scheme.
By 2018, all employers must operate a pension scheme for qualifying employees, with employee and employer contributions.
How can Davisons help?
Step 1
By now you should have received a letter from the Pensions Regulator – what have you done since you received it? If nothing, please contact Davisons on autoenrol@davisons-uk.com and we will help you with this.
Why can’t I do it myself? – the answer is you can, however research from The Centre for Economics and Business Research (CEBR) is predicting that SMEs will face set-up costs of up to £28,300 if they try and do it themselves and could take businesses up to 103 working days to implement.
Step 2 Knowing your staging date and creating a plan with you
Your ‘staging date’ is the date from which your auto enrolment duties first apply. This date is determined by the total number of employees in your PAYE scheme, based on HMRC’s records as at 1 April 2012.
Step 3 Assess your workforce
You will need to establish any eligible employees working for you. Automatic enrolment is required for those who:
are aged between 22 years of age and state pension age have qualifying earnings above the earnings trigger for automatic enrolment (£10,000 in 2015/16) are working or ordinarily working in the UK are not already a member of a qualifying pension scheme.
You will also need to consider whether you have an employer duty in relation to other types of workers including non-eligible employees and entitled employees which we can advise you on.
Step 4 Review your pension arrangements
We can work with you to decide on a pension scheme that you can offer your staff.
Step 5 Communicate the changes
We can work with you to create communications to your staff explaining what automatic enrolment into a workplace pension means for them. We can also make sure you have a strategy in place for briefing employees and plan how you will manage any queries that arise.
Step 6 Automatically enrol eligible employees and new staff
Under the new regulations, employers are required to:
provide information to the pension scheme about the eligible employees. give enrolment information to the eligible employees. make arrangements to achieve active membership for the eligible employees.
This should be carried out within the ‘joining window’ (the one-month period from the eligible employees’ automatic enrolment date). We can help you with this.
Step 7 Register with the Pensions Regulator and keep records
All employers will need to register online with the Pensions Regulator prior to five months of their staging date. Employers must also keep specific records about their workers and their pension scheme(s). At Davisons, we are able to complete this for you.
Step 8 Contributions to workers’ pensions
From October 2018 all businesses will need to contribute a minimum of 3% on the qualifying pensionable earnings for eligible employees. Employers are also required to make contributions for non-eligible employees who choose to opt in to the pension scheme.
How can Davisons help you?
Identifying who will be affected– and who will need to be auto-enrolled. Take over the Administration. Incorporate this into your Payroll Communicating with your staff– as to how they will be affected. Planning for your staging date– to ensure your payroll is ready for auto-enrolment. Selecting the appropriate pension advisor– based on your requirements/people. Explaining the financial impact of auto-enrolment– on your profit/cash flow. Advising on salary sacrifice– and how you and your staff could benefit.
Davisons can offer an all-encompassing solution to include payroll processing, the on-going administration of auto-enrolment, advice on salary sacrifice, employer savings, and the implementation of an auto-enrolment pension scheme compliant with the auto-enrolment legislation.
Davisons will ensure you are fully compliant with all your employer responsibilities and meet statutory deadlines in regards to both initial preparation and implementation and we can assist you to choose the most suitable pension scheme for your company and your employees.
To find out more information, please call us on 01769 572404 and ask to speak to Suzanne Cheek or email autoenrol@davisons-uk.com
www.thepensionsregulator.gov.uk/employers/tools/staging-date.aspx enter your PAYE reference and you will be given the date by when you need to Auto Enrol.
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201713
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Why You Should Have an Attorney File Your Divorce Petition on Your Behalf
When you file for divorce, you are required to provide the court with certain information. For example, you must give the court the legal authority to actually process your case.
A divorce petition — occasionally also referred to as a divorce complaint — allows you to present certain facts that indicate you meet all jurisdictional requirements for the divorce. These conditions vary depending on the state in which you live.
If you have somehow made a mistake regarding the requirements for filing the divorce petition, a court will instantly dismiss it. Your case could also be dismissed if you fail to include any required item in the petition.
That’s not the only way you could make your case more difficult on yourself by improperly filing the petition. You must inform the court on what you are seeking in your divorce. If you do not understand the divorce laws in New York, you could accidentally leave out requests for benefits to which you are legally entitled, which means you will not get that benefit once the divorce is finalized.
Importance of properly filing the petition
For your divorce proceedings to begin, you must serve your spouse with a copy of the petition. However, you are not allowed to mail it. Instead, you may have a police officer or process server deliver the petition in person. This individual will also deliver what’s called a “summons,” which notifies your spouse of the due date by which he or she needs to respond.
Divorce attorneys are well-versed on all of the requirements associated with divorce petitions and how to properly file and serve them. To learn more, consult a respected Long Island divorce attorney at Bryan L. Salamone & Associates.
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201713
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The Committee for Medicinal Products for Human Use (CHMP) communicates the European Medicines Agency’s (EMA) opinions on new drugs being introduced into the European union. Interestingly CHMP controls marketing for new drugs in Europe. They scientifically assess new drugs to be marketed for quality, safety and efficacy according to law. Most medicines have a risk/benefit balance relative to the patient’s well being. CHMP makes certain the balance is in favor of the patient – that the benefits are greater than the risks. CHMP also monitors drugs after they are introduced. If there is subsequent evidence that drugs are harming patients, CHMP has the power to remove them from the market.
October 22, 2012 – CHMP did not recommend the weight loss drug Qsymia (marketed as Qsiva in Europe) in the report from their October 15 – 18 meeting. Qsymia was rejected because of potential cardiovascular and central nervous system effects from long-term use.
So what does CHMP know that the US Food and Drug Administration (FDA) doesn’t? Qsymia was approved by the FDA in July 2012. CHMP not recommending Qsymia makes the the drug’s worrisome side effects even more scary. Who wants to take a drug that is deemed unacceptably dangerous by any world authority?
Children with high BPA levels are 200% more likely to be Obese
Now that’s a scary statistic. How could that be? Bisphenol A (BPA) is a colorless solid that is soluble (dissolvable) in organic solvents but not so soluble in water. It’s used in consumer products and food containers such as water bottles, soft drink and juice bottles – food packaging and canned food. Canada has declared BPA to be toxic. The European Union and Canada have banned it in the manufacture of baby bottles. The problem is that BPA may look like estrogen to the human body and because of that the human body assumes that it is something it should absorb. Compounds that look like estrogen are called xenoestrogens.
Studies show that BPA very possibly can cause neurological problems for babies in the womb. There is research that shows BPA at the normal concentrations in humans can cause changes in brain structure and function when tested on laboratory animals. Studies have also shown changes in body size and chemistry from typical human exposure levels. Typical human concentrations may also result in heart disease, diabetes – abnormalities in mammary glands (possibly breast cancer), uterus, thyroid gland, testicles, prostate (including prostate cancer) and erectile dysfunction. The list of bad effects went on and on, well beyond the scope of this writing. Again, many of these results are from tests done on animals (but more and more tests are being done on humans). This is very sobering information given almost everything is and has been (for many years) packed in plastics.
BPA exposure can result in childhood obesity? That’s not hard to believe after considering the list of ailments above. New research has shown that children with high BPA levels double their chances of becoming obese over those with lower levels. This is new information at the time of this writing so researches are quick to qualify that there may be other factors at play. This is also the first research linking a chemical as a cause for childhood obesity. It’s interesting to note that higher BPA levels only cause increased obesity in Caucasian children.
STOBBE, MIKE . “Study suggests tie between BPA and child obesity.” Yahoo News. Associated Press, 18 2012. Web. 30 Oct 2012.
“Bisphenol A.” Wikipedia. Wikipedia. Web. 30 Oct 2012.
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201713
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In this second installment ofWriting The Ellipsis , writer Cesar Diaz explores how the process of building and rebuilding his own family narrative led him to discover and understand his voice. You can read part one of this piece here.
Early on in Mary Karr’s
The Art of Memoir, Karr imparts some words of wisdom, a simple proclamation: “Truth is not the enemy.” The real enemy of memoir, she asserts is “blinking back at you from the shaving glass when you floss at night.” This serves as a warning to would-be memoirists who grapple with the ethical obligation to truth and artistic clarity while fearing the psychological consequences the form has on a nonfiction writer. In order to follow through with a memoir, the writer should have a particular disposition that matches the intention to capture a lived experience. They must feel summoned towards the past, that calling gnawing at the writer, haunting them everyday. The challenge lies in whether a writer is compelled to take on for themselves what it all means. Therefore, truth alone is not enough when writing a powerful memoir. In order to navigate between the ethical and moral obstacles that line the genre, one has to arrive at a “true” voice, one that establishes an emotional connection with a reader.
According to Karr, the master memoirist creates a “personal interior space” out of “clear” pieced together memories so that a reader never loses sight of the writer’s intentions. To do this, a writer must first jettison the vague (dubious) memories and foster the crystal clear ones that hold truth. The task then is to develop a voice that “lodges [itself along with] your own memories inside someone else’s head.” But how does one write one’s way into someone’s head? How does one create a gateway that transmutes that gnawing of one’s past to connect readers? In my case, you just stumble into it.
I failed at those early attempts at memoir because although I had a story to tell, I hadn’t quite arrived at my own authentic voice. Like many of us who endured an MFA program, I tried on many voices, succeeding at some that articulated and highlighted aspects of my family’s narrative, but overall these voices weren’t strong enough to sustain a book-length work. If I wanted to write honestly and openly about my past life as a child of migrant farmworkers, detailing my coming of age along with the perils of having one foot planted in the rows of strawberry fields, the other in the aisles of my elementary school library, I had to construct a voice that carried a wide range of emotions and allowed me as a writer (and in turn, the reader) to feel completely inside the past. This required a self-awareness that allowed for ample amount of time, patience and discipline—lots of starting and stopping, and thinking and stumbling, and thinking and trying—that’s lasted years. The results thus far have allowed me to arrive at a sharper voice, one that’s given me a lens though which to see my world.
I feel a strong sense of obligation towards my story, longing to capture my childhood experiences as they happened, even if that experience is imperfect. My voice grew out of this fallout, which evolved from the realization that my constructed voice (and persona)
wasmy crystal clear truth. I’ve learned that a good memoirist lets the “edges show” as a way to remind readers of the narrator’s persona. In form, these rough edges stitched together become that personal interior space where readers connect emotionally with the memoirist’s experience.
Even then, I admit feeling concerned about how I represent others on the page, no matter how crystal clear I call my truth. My parents were open and helpful during my summer interview but as first generation immigrants (who also don’t speak or read English), they fail to grasp (or fathom) why I’m so drawn to retrace a time in our lives that’s long gone. For them, it happened and that was that. There was no need to bring these things out in the open. But not soon after our interview, I spoke to my mother, who had since begun to seriously retrace her own past. In tears she apologized.
“I’m sorry,” she said in Spanish.
“For what?”
“For putting you and your brothers through [the hardships of migrant farm work]. We had no idea. It was all we knew.”
I was taken aback. How do you respond to a parent who suddenly understood why I’ve been so haunted by my past?
I told her, “I wouldn’t be who I am now.”
The stories make the life. “A writer doesn’t get to choose [style/structure/voice],” suggests Karr in
The Art of Memoir, “so much as he is born into them.” All of this takes patience, determination, and a willingness to stumble our way into being. Rigoberto Gonzalez addresses this very process. He writes, “And in the process of building and rebuilding, I have learned an art. And like any art, memory and memoir is meant to go public, no matter how personal, no matter how small.” César Díaz teaches creative nonfiction at St. Edward’s University in Austin, Texas. He is currently working on a memoir about his life as migrant farm worker in the 1980s.
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201713
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INTEROPERABILITY
A summit on interoperability that the Continental Automated Buildings Association held last month may point the way to greater success in building high-bandwidth infrastructure into homes.
Much like the electrical code changes in the 1970s mandated a drastic increase in the number and placement of electrical outlets so that today one who lives in a relatively new home can plug in appliances anytime and anywhere (Californias power supply permitting), CABA hopes to make building automation a no-brainer.
This makes sense because the distinction between home and office is blurring and because e-commerce applications, from distance learning to on-demand video to utility management, will work better if standardized network devices and protocols are incorporated in building design.
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201713
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EWG scientists reviewed bump patrol Cool Shave Gel for Sensitive Skin, Menthol for safety according to the methodology outlined in our Skin Deep Cosmetics Database. We assess the ingredients listed on the labels of personal care products based on data in toxicity and regulatory databases, government and health agency assessments and the open scientific literature. EWG's rating for bump patrol Cool Shave Gel for Sensitive Skin, Menthol is 4.
Ingredient Concerns
Ingredient Concerns Score FRAGRANCE Allergies/immunotoxicity, Miscellaneous, Irritation (skin, eyes, or lungs), Organ system toxicity (non-reproductive), Ecotoxicology PEG-150 DISTEARATE Organ system toxicity (non-reproductive), Data gaps, Contamination concerns (ETHYLENE OXIDE, 1,4-DIOXANE, ETHYLENE OXIDE, 1,4-DIOXANE) SODIUM LAUROYL SARCOSINATE Enhanced skin absorption, Use restrictions, Ecotoxicology, Contamination concerns (NITROSAMINES-in the presence of nitrosating agents) POTASSIUM HYDROXIDE Occupational hazards, Use restrictions, Organ system toxicity (non-reproductive), Irritation (skin, eyes, or lungs) FD&C GREEN 5 GREEN 5 (CI 61570) None Identified SORBITOL None Identified MENTHOL Multiple, additive exposure sources HYDROXYETHYLCELLULOSE None Identified BUTYLENE GLYCOL Irritation (skin, eyes, or lungs) MYRISTIC ACID Ecotoxicology, Data gaps PALMITIC ACID Ecotoxicology WATER Innocuous About the Skin Deep® ratings EWG provides information on personal care product ingredients from the published scientific literature, to supplement incomplete data available from companies and the government.
The ratings below indicate the relative level of concern posed by exposure to the ingredients in this product - not the product itself - compared to other product formulations. The ratings reflect potential health hazards but do not account for the level of exposure or individual susceptibility, factors which determine actual health risks, if any. Learn more
| Legal Disclaimer
About EWG VERIFIED™ Beyond providing Skin Deep® as an educational tool for consumers, EWG offers its EWG VERIFIED™ mark as a quick and easily identifiable way of conveying personal care products that meet EWG's strict health criteria.
Before a company can use EWG VERIFIEDTM on such products, the company must show that it fully discloses the products' ingredients on their labels or packaging, they do not contain EWG ingredients of concern, and are made with good manufacturing practices, among other criteria. Note that EWG receives licensing fees from all EWG VERIFIED member companies that help to support the important work we do. Learn more
| Legal Disclaimer
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201713
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Tax administration is going digital
The digital age is rapidly transforming the relationship between tax authorities and taxpayers.
Driven by a desire for more revenue, greater efficiency and improved compliance in an atmosphere of shrinking resources, tax authorities are increasingly relying on digital tax data gathering and analysis — using digital platforms to facilitate real-time or near real-time collection and assessment of taxpayer data.
This move toward tax “digitization” is allowing tax authorities to collect tax data in real time or near real time; they can then use the information to respond quickly and in more targeted ways to perceived compliance risks. Digitization is, in some cases, allowing taxpayer information to be cross-referenced and shared among governments and agencies.
Some countries are leading the digital revolution, others are forming a second wave and still others are years away from embracing digitization. Some Latin American countries, such as Brazil, are among the more advanced, while the United States is not as far along in its efforts.
Businesses with dated systems or those that are not able to adapt quickly may face increased risk, unexpected costs and compliance challenges to which they are not prepared to respond.
As countries move toward digitizing their tax administration, their efforts can often follow a similar pattern. Of course, the move to digitization is not necessarily linear, nor should higher levels of digitization be viewed as the ultimate goal of either taxpayers or tax authorities.
Levels of digitization *
*Note that not all governments collect the same information or treat it the same under this model. For example, a country might be at Level 1 for certain data, but at Level 3 for other data. Further, the move to digitization is not necessarily linear, nor should higher levels of digitization be viewed as the ultimate goal of either taxpayers or tax authorities.
Timing
Digitization is accelerating the timing of tax reporting and filing obligations for businesses. Many governments are beginning to expect data in real time or near real time, often collecting it directly from taxpayers’ own systems, changing how and how often businesses must collect, format and report tax information.
Value-added taxes (VAT) and goods and services taxes (GST) are often among the first taxes in a country to be fully digitized. Technologies that enable VAT and GST digitization will likely, sooner or later, enable business income tax systems as well.
Automation
Automation and process standardization are cornerstones of digitization. The requirement that data be submitted in standard formats facilitates tax authorities’ expanded use of tax, accounting and other source data for compliance purposes.
Analytics
The increasing reliance on the electronic submission of tax, accounting and other company data has also allowed for the growth of another hallmark of the digital tax age — the use of data analytics and data matching to target compliance and audit initiatives.
Tax authorities are uncovering complex business relationships, reflected in the data companies submit, that they then use to trigger audits or stop the payment of refunds.
Transparency
Tax authorities’ use of data analytics for audit and compliance purposes is likely to expand, fueled by the increase in the amount of tax data available and the frequency of reporting under tax digitization.
The push for global tax transparency will place a great deal more responsibility on companies, which will soon be required to produce large volumes of data in new formats.
One potential source of taxpayer information will be country-by-country (CbC) reports filed by large multinational corporations (MNCs). The reporting initiative, part of the Organisation for Economic Cooperation and Development’s (OECD) Base Erosion and Profit Shifting (BEPS) project, applies to MNCs with aggregate annual revenue of more than €750m.
Under the OECD model, which many countries are adopting, companies use a three-tier framework for providing information on global allocation of income, economic activity and intercompany pricing across all of their global operations.
Companies generally file the CbC report with the tax authority in the home country of the MNC group’s parent company, and the report is automatically shared with tax authorities in other relevant countries under government information exchange mechanisms.
Business impact
The data businesses are being asked to submit under tax digitization reaches far beyond tax forms, and often includes accounting and sales data. Legacy systems and processes may not be able to support these and other government requirements.
Challenges may include:
Lack of data available in the required formats Difficulty submitting data Inefficient processes for transforming data Lack of process support for new data requirements Outdated tax operating models More frequent need for more comprehensive analytics, in advance of submission to tax authorities Inability to respond to audit notices in a timely or effective manner Inability to respond quickly when there is disagreement with a tax assessment
A detailed review and possible reengineering of the processes companies use to record and report their data may be required. Businesses that outsource these and related functions need to make sure that their third-party solutions are flexible and updated frequently.
Businesses will also experience a financial impact as tax administration is digitized — more complex data requirements, delayed refunds, construction of new systems, retooling of processes and more time spent on compliance could negatively affect cash flow. Data security will also be a major concern as governments share data and BEPS reports.
Meeting the challenge
As tax authorities move at varying speeds toward greater digitization of tax information, businesses need to develop a detailed understanding of digital tax requirements in their markets. Following developments closely and engaging in conversations can help businesses better meet the challenges as governments expand their digital capabilities.
They must also determine whether their tax function is able to meet digital data and filing obligations in operating jurisdictions and is prepared to defend audits in real time or near real time.
Businesses will need to implement digital solutions that can work within and across countries and that can respond to evolving compliance and controversy requirements. They should explore the use of real-time data analytics for tax planning and compliance purposes, to measure and mitigate risk, to better target controversy interventions and resolve issues as they occur.
Businesses should consider what investment may be needed to respond to the increasing demand for digital tax information and how to manage the risks inherent in the expansion of electronic data submission. Taking the time to understand these issues and explore forward-looking solutions today — and conveying these options to policymakers — may help avoid more costly and time-consuming remedies tomorrow.
For more information, including a snapshot of tax digitization across the Americas, download the full report.
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201713
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The world today has become so modern that some people have already forgotten the traditional things that we used to do in the past like the traditional dances that are done all over the world. It should not be forgotten because it is part of our lives. Aside from that, there are a lot of great benefits that we can get from traditional dances. Check out the benefits and learn the importance of it.
1. Promotes socialization and enjoyment
If we can remember how the traditional events bring people together, we should all know that it is the best way to socialize with the people around you. The traditional way of dancing depending on the culture has something in common. All of those give joy to the people.
2. Sense of local identity to the people
Traditional dances created a unique identity for the local people who are participating in these dances. It will make you stand out due to the artistic inclination of the performance.
3. Learning the cultural value
These days, we can’t help but be engrossed with all the technology that surrounds us. Most people have forgotten the values of their culture. Traditional dances will turn you back in time, where these events are the only form of entertainment.
4. Grasp of history of art
We all know that the traditional dances are made out of numerous historical events that happened in the past. The more we expose ourselves in seeing these kinds of activities, the more we will learn about the rich history of our origin.
We should all know that despite the modern advancement in the world, we should never forget the things that we value in the past. Put in mind that without all the things we have learned we will not be how we are right now.
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201713
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FPAN Associate Director Dr. Della Scott-Ireton, RPA, has been awarded one of Florida’s highest honors in Historic Preservation: the 2015 Senator Bob Williams Award. It was presented to her at the annual Florida Heritage Awards ceremony in Tallahassee on March 11, 2015.
The award is named for the Senator Bob Williams, an individual who served as Florida’s first State Historic Preservation Officer. The Williams Award recognizes those public employees whose service is
so exceptional that it has changed the course of historic preservation in Florida. In the letter informing her of the award, Secretary of State Ken Detzner detailed the rational for bestowing the 2015 award on Della,
“Throughout your career your dedication to the preservation of submerged cultural resources in Florida has immeasurably increased public awareness of the significance of these fragile and unique resources. The effects of your legacy of preservation will be felt for generations to come.”
Watch the video presentation prepared by the Department of State for the awards ceremony.
Della graduated from the University of West Florida with a Bachelor’s degree in Anthropology and a Master’s degree in Historical Archaeology. She also holds a Master’s in International Relations from Troy University, and a Ph.D. in Anthropology from Florida State University. Della is certified as a Scuba Instructor with the National Association of Underwater Instructors (NAUI). She is a Registered Professional Archaeologist (RPA).
In the presentation of this award, Della was recognized for twenty years of work in raising public awareness of Florida’s underwater cultural heritage. Notable has been her work on the Pensacola Shipwreck Survey, which led to discovery of shipwrecks from the ill-fated 1559 fleet of Don Tristan de Luna, and work as an Underwater Archaeologist with the Florida Bureau of Archaeological Research (BAR) where she expanded the number of Florida’s Underwater Archaeological Preserves. Della left BAR in 2006 to join FPAN as the Public Archaeologist in the Coordinating Center. Before being named as Associate Director, she developed and directed the Northwest and North Central Regional Centers of FPAN.
At FPAN, Della has developed the Heritage Awareness Diving Seminar (HADS) and the Submerged Sites Education and Archaeological Stewardship (SSEAS) programs, both aimed at increasing respect for the Underwater Cultural Heritage. HADS focuses on training the professionals who train scuba divers on the value of archaeological heritage and stewardship, and SSEAS takes a similar message directly to recreational divers with an interest in heritage.
Della’s professional contribution these days goes well beyond her daily work at FPAN. She was chair of the 2010 Society for Historical Archaeology Conference on Historical and Underwater Archaeology at Amelia Island, Florida, has recently served on the SHA Board of Directors, and currently serves SHA as Conference Coordinator. She has also served on the board of the Advisory Council on Underwater Archaeology. She has lectured and consulted on the preservation and interpretation of the Underwater Cultural Heritage both nationally and internationally, and sits on a number of national and international advisory boards.
Della’s success is in no small measure a result of her clear vision, focus, and dedication, but is also enabled by her collegial nature and professional demeanor. FPAN is indeed fortunate to have Della as part of our leadership!
William B. Lees, PhD, RPA
Executive Director Florida Public Archaeology Network
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201713
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The Supreme Court today granted a writ of
certiorari (meaning they agreed to hear the appeal) in Assoc. for Molecular Pathology v. Myriad Genetics, Inc., et al., the famous case centered on patents covering two human genes: BRCA1 and BRCA2.
Of note is that the Court limited its grant of the appeal to the first of the three questions posed by the petitioners/plaintiffs: “
Are human genes patentable?”
Earlier this week 23andMe, the Silicon Valley-based personal genomics company, was awarded its first patent: US Patent Number 8,187,811, entitled “Polymorphisms associated with Parkinson’s disease”.
23andMe co-founder Anne Wojcicki announced the issuance of the patent via a post on the company’s blog late Monday evening, attempting to strike a tenuous balance between her company’s oft-championed philosophical devotion to providing individuals with “unfettered access to their genomes” and its desire to commercialize the genomic information so many of those very same individuals have shared, free of charge, with 23andMe. With its new patent, 23andMe also injected itself into the middle of what Wojcicki herself described as the “hot debate” surrounding the patentability of “inventions related to genetics.” Wojcicki’s announcement appeared to catch more than a few of the company’s customers by surprise, sparking concern about the company’s intentions on 23andMe’s blog, Twitter and elsewhere, along with rapid and pointed commentaries from Stuart Hogarth and Madeleine Ball, among others.
Of the various questions asked of and about 23andMe and its new patent, these may be the three most common:
Where did this patent come from, and why didn’t I hear about it before? What does 23andMe’s patent cover? How is 23andMe going to use its patent? Let’s take each question in turn.
The Federal Circuit’s long-awaited decision (pdf) in
Association for Molecular Pathology v. USPTO (the Myriad gene patent litigation) was issued this past Friday. As we were writing, with the economy having slowed to a barely perceptible crawl and a government default looming more likely by the hour, there were plenty of reasons to believe that the sky was falling. But the Myriad decision was not, and is not, one of them.
For the most part, the Federal Circuit’s 2-1 decision returned the law to the state it was in before District Judge Sweet’s opinion turned things upside-down last March. Although full of interesting rhetoric, the court’s three lengthy opinions (a total of 105 pages) are less remarkable for what they decide than for what they invite higher authorities—the Supreme Court and the Congress—to decide down the road.
First, the scorecard. The court’s judgment—that is, the holding, or outcome—was joined by Judges Lourie and Moore. A third member of the panel, Judge Bryson, dissented in part, meaning that he joined only a portion of the judgment (more on that below) and disagreed with another part.
Unless you have been living under a rock – or, if you hail from the Northeast, living under water – Monday’s decision in
Association for Molecular Pathology v. USPTO is no longer new news. Previous coverage from the Genomics Law Report (here and here) reviews Judge Sweet’s opinion and its implications. Moving Beyond Single Gene Patents. Much of the discussion following the decision has centered on what effect the invalidation of Myriad’s gene patents – should that decision be affirmed by a higher court and extended to other similar patents – will have on scientific and commercial innovation.
In many ways, that issue is at the center of the policy debate surrounding Sweet’s opinion and, more generally, the appropriateness of certain biotechnology patents. It’s a question that’s difficult to answer prospectively, but Andrew Pollack’s piece in
The New York Times succinctly makes an important point about an emerging reality in the biotechnology industry.
…[T]he [biotechnology] industry is already moving to a period of somewhat less dependence on DNA patents for its sustenance. Diagnostic laboratories, for instance, are shifting from testing individual genes to testing multiple genes or even a person’s entire genome. When hundreds or thousands of genes are being tested at once, patents on each individual gene can become a hindrance to innovation rather than a spur.
Late on the afternoon of Monday, March 29, 2010, Judge Robert W. Sweet of the United States District Court for the Southern District of New York issued a jaw-dropping summary judgment ruling (pdf) in
Association for Molecular Pathology v. USPTO that invalidates certain of Myriad Genetics’ patents related to the BRCA 1 and 2 breast and ovarian cancer susceptibility genes. In a post written immediately after the release of the opinion, Dan gave a thorough summary of the ruling. Our objective here is to offer a bit more depth on what the ruling means—and what it doesn’t mean. On the one hand, Judge Sweet’s order is radical and astonishing in its sweep. On the other, it will be some time before we have any idea what impact it will ultimately have.
We should first disclose that one of us (John) has a dog in this fight, albeit a small one. In 2003, (along with biologist and patent lawyer Roberte Makowski), John published an article in the
Journal of the Patent and Trademark Office Society entitled Back to the Future: Rethinking the Product of Nature Doctrine as a Barrier to Biotechnology Patents (pdf). In that article, Roberte and John laid out an argument for challenging Myriad-style patents on “isolated” genes as claiming products that are only trivially different from the naturally-occurring versions. Judge Sweet cited this article and, in several parts of his opinion, followed the roadmap it created. So, if you oppose the Myriad patents, you’re welcome; if you like them, we’re sorry. What Summary Judgment Means. As Dan noted, and John first wrote last fall, it is rare for plaintiffs to win on summary judgment. For either side to receive summary judgment, it must show that there are no disputed issues of fact that require a trial to resolve, and that, on the undisputed facts, the law mandates judgment in its favor. This standard is especially hard for a plaintiff to meet, since it bears the burden of proof at trial. At the summary judgment stage, a defendant can usually create an issue of fact and thereby avoid summary judgment just by saying “they have the burden of proof at trial, and a jury might not believe them.” Although this is an unusual case in that the basic facts—most notably Myriad’s patent claims and the fundamental biology and genetics that makes possible those claims—really are not in dispute, a summary judgment ruling for the plaintiffs nonetheless sends a clear message about how strong this particular judge thought their case was—and how weak he thought Myriad’s was. The Road to Invalidation. The court broke Myriad’s patent claims into two major groups: (i) those claiming isolated DNA sequences and (ii) those claiming methods for comparing or analyzing gene sequences to identify the presence of mutations corresponding to a predisposition to breast or ovarian cancer (p. 2). Both sets of patents were rejected under Section 101 of the Patent Act, which enumerates the permissible categories of patentable subject matter: processes, machines, manufactures, and compositions of matter. As the judge noted, a long history of cases forbids claims on laws of nature, abstract ideas, and natural phenomena, which include products of nature.
The highly anticipated decision in
Association for Molecular Pathology v. U.S. Patent and Trademark Office, the frontal attack on Myriad Genetics’ breast cancer gene patents, was handed down today. A copy of the opinion, from Judge Robert Sweet of the Southern District of New York is available here.
The opinion was released late this afternoon and it weighs in at 156 pages, so a more complete analysis will be forthcoming.
[Edit 3/30: John Conley and I have published a more detailed review and analysis of the decision here: Pigs Fly: Federal Court Invalidates Myriad’s Patent Claims . For just the highlights, continue reading below.] However, there are a few crucial points that deserve an initial reaction. 1. The Plaintiffs Win. The ruling appears to be a nearly complete victory for the plaintiffs and their supporters, including the ACLU. With respect to Myriad’s issued patents on the BRCA1 and BRCA2 genes, Judge Sweet’s ruling invalidates both Myriad’s composition of matter claims (its patents on isolated DNA sequences to all or a portion of the breast cancer genes) and its method claims (those patent claims that relate to analyzing or comparing isolated DNA sequences in order to detect mutations in a patient’s BRCA1/2 genes that might cause breast cancer).
The overall tone of the Court’s ruling is best captured by this passage (from page 135):
The identification of the BRCA1 and BRCA2 gene sequences is unquestionably a valuable scientific achievement for which Myriad deserves recognition, but that is not the same as concluding that it is something for which they are entitled to a patent.
Two of the defendants in
Association for Molecular Pathology v. U.S. Patent and Trademark Office, the frontal attack on Myriad Genetics’ breast cancer gene patents organized by the American Civil Liberties Union, have now filed their own summary judgment motions. (Click through to read the memorandum in support of Myriad Genetics’ motion (pdf) filed on December 23 and the memorandum in support of the PTO’s motion (pdf) filed on December 24). As we explained in an earlier post, a summary judgment motion seeks to convince the trial judge that the facts are so clear-cut that there is no reason to go ahead with the trial—in legal jargon, that there is “no issue of material fact” that needs to be tried. This is the rare case in which both sides have asked for summary judgment (the plaintiffs filed their motion and supporting memorandum (pdf) back on August 26). The filings by both sides are not a surprise here, however, since the facts surrounding the challenged patents are largely undisputed and the real question is how to apply patent law to those facts.
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201713
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(Photo credit: Wikipedia) RICHMOND –Governor Terry McAuliffe announced the 30 members of the Governor’s Task Force on Combating Campus Sexual Violence to the administration today. The appointees include a wide variety of experts in the field of sexual assault from law enforcement to educators, forensic nurses, Title IX coordinators, advocates, and more. The Task Force, chaired by Attorney General Mark Herring, will hold quarterly meetings that will focus on finding common solutions to building safer, more educated college communities within the Commonwealth, with the goal of creating best practices for education and prevention of sexual violence on campus.
“There is no bigger concern then the health and safety of our citizens in the Commonwealth. As Governor, I am committed to building a new Virginia economy where students are free from the threat of sexual violence. It is circuital that we work together with the schools, educators, and law enforcement to build on our goal for all higher education institutions to be safe places of learning and growing,”
said Governor McAuliffe.“Dorothy and I care deeply about this issue, and as parents we know the importance of sending your children off to a new and safe place, and we want that for all of Virginia’s young people. This task force is the first step in making sure that prevention, education, and awareness are spread about sexual violence, and ensures that Virginia will lead the way on combating this issue.”
In addition to the task force, the Office of Attorney General has begun a review with each college and university of current policies and procedures for prevention and response.
"Governor McAuliffe, Virginia's college and university presidents, and I have sent a clear message that sexual violence will not be tolerated on our college campuses, nor will a societal culture that condones it in any way,"
said Attorney General Herring. "I look forward to working with this exceptional group of advocates, students, administrators, and experts to make sure that, as a Commonwealth, we are doing everything we can to prevent sexual violence, and to ensure that our response to reports of sexual violence is timely, appropriate, and survivor-centered. Virginia schools must remain safe and welcoming places where students, faculty and staff can live, learn, and work." Governor’s Task Force on Combating Campus Sexual Violence Task Force Members: · Peter A. Blakeof Richmond, Director, State Council of Higher Education for Virginia · Fran Bradfordof Richmond, Associate Vice President for Government Relations, The College of William and Mary · Ángel Cabreraof Fairfax, President of George Mason University · Judy Casteeleof Buena Vista, Executive Director, Project Horizon, Inc. · Jean A. Cheek, RN BS SANE-Aof Henrico, Forensic Nurse Examiner, Virginia Commonwealth University · Leah K. Cox, PhD of Fredericksburg, Special Assistant to the President for Diversity and Inclusion, Title IX Coordinator, University of Mary Washington · Maggie Cullinanof Charlottesville, Director, Charlottesville Victim/Witness Assistance Program · Brandon T. Dayof Richmond, President, Student Government Association, Virginia Commonwealth University · Daniel Dusseauof Fairfax, Chief of Police, Northern Virginia Community College · Dorothy J Edwards, Ph.D.of Burke, Executive Director of Green Dot · William R. Grace, Colonel USMC (Ret)of Lexington, Inspector General and Title IX Coordinator, Parents Council Liaison, Virginia Military Institute · Allen W. Grovesof Waynesboro, University Dean of Students, University of Virginia · Melissa Ratcliff Harperof Roanoke, Forensic Nurse Examiner, Carilion Clinic-Carilion Roanoke Memorial Hospital · Tom Kramerof Richmond, Executive Director, Virginia21 · Penelope W. Kyleof Radford, President, Radford University · Michael C. Maxeyof Salem, President, Roanoke College · Donna Poulsen Michaelisof Chesterfield, Manager, Virginia Center for School and Campus Safety · Christopher N. Ndirituof Norfolk, Student Body President, Student Government Association, Old Dominion University · Nancy Oglesbyof Henrico, Deputy Commonwealth's Attorney, Henrico Commonwealth's Attorney's Office · Ellen W. Plummer, Ph.Dof Blacksburg, Assistant Provost of Virginia Tech University · Marianne M. Radcliffof Richmond, Vice-President, Kemper Consulting; Member, Longwood University Board of Visitors · The Honorable Abby Raphaelof Arlington, Vice Chair, Arlington County School Board; former Assistant Commonwealth's Attorney, Arlington County · Daphne Maxwell Reidof Petersburg, Member, Virginia State University Board of Visitors · Emily Rendaof Charlottesville, Program Coordinator in Student Affairs, University of Virginia · Tracy S. Rusilloof Hanover, Major, Virginia State Police · Frank Shushok, Jr.of Blacksburg, Senior Associate Vice President for Student Affairs, Virginia Tech · Rosemary D. Tribleof Newport News, President of Fear 2 Freedom · John A. Venutiof Richmond, Assistant Vice President of Public Safety/Chief of Police, Virginia Commonwealth University · Kristi VanAudenhoveof Whitestone, Executive Director, Virginia Sexual and Domestic Violence Action Alliance · Raychel Whyteof Washington D.C., Administrator at MedStar Georgetown University Hospital
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CROSS-REFERENCES TO RELATED APPLICATIONS BACKGROUND OF THE INVENTION
[0001]
This application is a divisional of application Ser. No. 10/682,765 filed on Oct. 9, 2003.
[0002]
(1) Field of the Invention
[0003]
This invention relates to providing industry specific education and professional services programs to various entities.
[0004]
(2) Description of the Related Art
[0005]
In general, most individuals or businesses fail to properly manage and accumulate wealth due to a variety of reasons such as lack of knowledge in financing, accounting, business formation issues, or various federal, state, or local tax laws, or any or all combinations of laws or regulations that are of interest to an individual or a business. Unfortunately, even with a full knowledge, the individual or the business must be updated with the latest changes in all laws or practices related to their business interests. Wealth management is further complicated because it also requires full access to a variety of professionals specialized in their own field. In most instances, these professionals are not likely to be able to cooperate for proper representation of their client's full interest. For example, an estate-planning attorney should ideally coordinate his or her work with at least a Real Estate professional, a financial advisor, an attorney specializing in business formation issues (e.g. limited liability companies, corporations, etc.), and an accountant. Assembling such a “team” is very expensive for any size organization, including multinational corporations. Of course, even if an individual or a business does have the luxury of unlimited access to a team of professionals who are willing and able to coordinate their work for that individual or business, all their advise will be limited to the jurisdictions that they are allowed to practice. For instance, an attorney in one state jurisdiction will most likely fail to recognize business formation issues in another state jurisdiction. In addition, all members in this team of advisors must also be able to fully understand the “business” of their client to take advantage of any industry specific laws, such as those related taxes. Unfortunately, even full access to a team of professionals across all jurisdictional areas will not be enough for appropriate wealth management. This is the case because an individual or a business would also require access to a variety of services, including banking, credit, checking, or payroll services, or any or all combinations thereof that are of interest to the individual or the business.
[0006]
There are varieties of financial or accounting software packages available today that provide rudimentary financing or accounting solutions. However, most software applications are generic bookkeeping or accounting packages, and are not specific to any jurisdictions, industry, or an individual's needs. Therefore, they cannot provide a complete business or personal wealth management solution to end-users. In addition, to correctly set-up and use these software systems, an individual or a business must have some understanding of financing, accounting, business formation issues, taxes, or any or all combinations of laws or other personal or business issues that are of interest to the end user. Further more, there are no software applications that can provide solutions to every aspect of every individual or business's wealth management requirements. Of course, there are also no software available that can provide legal or business counsel to its end user, no matter how complex or versatile.
[0007]
Paramount among all the above mentioned concerns that individuals or businesses may have for wealth management is the constantly changing, difficult to follow, and very complex legal issues related to taxes. Tax laws are complex because every jurisdiction in the country has its own separate tax code. In addition, all tax laws are further divided by industry specific groups. Most tax advisors today provide a very limited, general tax advise to individuals or businesses. Tax advisors may have some understanding of federal, state, or local tax laws, but will most likely fail to recognize tax laws outside their state or local jurisdictions. This is an important problem facing most businesses today, especially those that have on-line Internet presence, and conduct business across jurisdictional lines. In addition, most tax advisors are not familiar with the “business” of their clients, and therefore fail in providing appropriate tax related counsel. As indicated above, tax code is not only jurisdiction specific, but also industry specific. A tax advisor will need to know a client's “business” before providing any counsel.
[0008]
Chief among the issues that the Internal Revenue Service (IRS) identifies with individuals or businesses is the problem of adequate or proper records in case of an IRS audit. Most individuals or businesses fail to recognize the types of records to maintain and moreover, fail to identify a number of allowable tax deductions for legitimate business or personal expenses related to the specific business industry group due in large part to (1) a lack of knowledge and understanding about the U.S. tax laws; and (2) a lack of knowledge and understanding about the complex issues involving business related expense deduction requirements.
BRIEF SUMMARY OF THE INVENTION
[0009]
Additionally, tax professionals also fail to understand the complex issues involving legitimate business expense deductions with respect to specific industry groups, and compound the problem of reporting requirements for a specific business type. This compels their clients to be aware of all tax issues relevant to their field of specialty—a very unlikely scenario. Most professional counsels (including tax professionals) are not aware of the details of the business their clients are involved with, and their clients are not aware of various legal, insurance, tax and other business related issues specifically relevant to their business.
[0010]
The wealth management system of the present invention provides a unique, novel and expansive variety of important business support systems for today's fast paced business owner, while allowing the business owner to be educated and trained within the comfort of their home or business office, without having to hire a wide variety of skilled professionals within each category of service the business owner may require or need.
[0011]
The system and its Industry Specific Business Modules (ISBM) are a business system that incorporate a variety of mediums for delivery and support, while at the same time provide the delivery of many skilled professionals to assist the business owner from a one-on-one case, to a small, medium or large group web-based session.
[0012]
The system of the present invention brings customized business support and services directly to the business owner, including staff support and training. It also brings interactive communication virtually around the world to the business using technology and communications support for delivery. In addition, it provides general business information on a variety of topics and issues, and specific business information based upon the type of business. Additionally, the present invention further provides for competitive pricing for services the business owner may desire, need or require for their business because of significant cost reductions attained through the unique methods of delivery provided within the business system of the ISBM design. This of course translates into lower costs associated with a variety of important services for the business owner for those services. These are but a few of the many benefits attained from use of the present invention.
[0013]
A single business owner, an association of business owners, or individuals within the same industry group can use the present invention. In other words, a single business owner providing for example daycare services can use the present invention for that industry, or an association, which has several hundred or thousand daycare providers, can implement the present invention for their entire member association.
[0014]
A specific association, which has many members of the same type of business, can use the present invention because it can be customized to provide all the support necessary for that industry and the specific association members. Companies providing single service products to business owners can utilize the present invention for customer support to their client base and customize product training, product information, customer support and education as well as a variety of other services required by the clients of the firm.
[0015]
The unique aspect and novel application of the present invention is the capability to provide industry specific training and support for today's business owner, through ISBM. In addition, the business owner can be both a consumer of the present invention as well as a “provider” in that the business utilizes one level of the system design for its varied needs, while at the same time providing different service and support to its staff, customers or prospects. This multi-versatility of the present invention makes the ISBM both unique and innovative.
[0016]
Business owners within a specific industry group do not have to be limited by the constraints of geographic restrictions due to the utilization of modern technology and communication that virtually extends the reach of the present invention to a global audience versus a small geographic community audience. The other unique aspect of the present invention however enables the system to provide yet further industry specific training and support for only those within the a specific jurisdiction area taking into account local regulatory issues that will vary greatly from jurisdiction to jurisdiction.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017]
These and other features, aspects, and advantages of the invention will be apparent to those skilled in the art from the following detailed description of preferred non-limiting embodiments, taken together with the drawings and the claims that follow.
[0018]
For purposes of illustration, programs and other executable program components are illustrated herein as discrete blocks, although it is recognized that such programs and components may reside at various time in different storage components, and are executed by the data processor(s) of the computers.
[0019]
It is to be understood that the drawings are to be used for the purposes of exemplary illustration only and not as a definition of the limits of the invention.
[0020]
Referring to the drawings in which like reference numbers present corresponding parts throughout:
[0021]
FIG. 1 is an exemplary illustration of the overall business system in accordance with the present invention;
[0022]
FIG. 2 is an exemplary illustration of a classification system of various entities in accordance with the present invention;
[0023]
FIG. 3 is an exemplary illustration of a sample industry specific educational system for each industry classified entity illustrated in FIG. 2 in accordance with the present invention;
[0024]
FIGS.
4 to 7 are specific detailed illustrations of a few exemplary educational modules of FIG. 3 in accordance with the present invention;
[0025]
FIG. 8 is an exemplary flowchart illustrating the industry specific professional services programs in accordance with the present invention;
[0026]
FIG. 9 is an exemplary flowchart illustration of a mere sampling of different types of industry specific professional counsel available to entities in accordance with the present invention;
[0027]
FIG. 10 is an exemplary flowchart illustration of different business records accessed by entities as well as professional counsel in accordance with the present invention;
[0028]
FIG. 11 is an exemplary flowchart illustration of a typical access method to different records by both professional counsel and entities in accordance with the present invention;
[0029]
FIG. 12 is an exemplary illustration of a customized general ledger, showing a representative list of few expense categories for daily record keeping in accordance with the present invention;
[0030]
FIG. 13 illustrates a well-known method of access to the educational as well as the professional services programs of the present invention;
[0031]
FIG. 14 is an exemplary illustration of the libraries and resource centers that may be used by professionals as well as entities, including clients in accordance with the present invention;
[0032]
FIG. 15 is an exemplary illustration of some of the specific topics covered by an on-line video library in accordance with the present invention;
[0033]
FIG. 16 is an exemplary flowchart illustration of the educational programs delivered in a well known method of live on-line interactive system in accordance with the present invention;
DESCRIPTION OF THE INVENTION
[0034]
FIG. 17 is a specific exemplary illustration of a typical live on-line interactive session between a professional counsel and an entity.
[0035]
The industry specific personal and business wealth management system
2 (hereinafter “system 2”), illustrated in FIG. 1 provides both industry specific educational services 12 and industry specific professional services 14 to various entities 20 (shown in FIG. 2) such as businesses 4, individuals 6, employees 8, and groups or associations 10 based on agreements 16 between the system 2 and each entity. The groups or association 10 may also be considered as institutional entities that work with system 2 under agreements 16. Revenues for system 2 are derived from the services 12, 14 provided to each entity 20 based on agreements 16. System 2 is fully modularized by specific economic sectors based on an industry classification system of the present invention such as industry sectors, segments, groups, and types, and can readily be accessed by any entity 20 across any jurisdiction. Accordingly, all of the services provided by system 2 are available to all entities through agreements 16 for fees. These fees used by system 2 cover that year's audit protection for participant entities as part of their member (enrollment) benefit. The members of system 2 also pay a continuous fee for access to educational programs 12, industry specific professionals programs 14, protection and asset recovery, and other business related services. These other services may include, but should not be limited to, for example, entity formation services based on industry specific ISBM models, entity support services such as specific minutes and resolutions for the business entity based upon the uniqueness of the business industry; employee wage classification analysis, all using the established methods developed.
[0036]
Central to the present invention are solutions to various business issues in general and tax-related issues in particular. For example, in response to IRS's extensive auditing techniques aimed at specific business industries, the present invention provides an Industry Specific Tax Module (ISTM), which is a designed application of multi-tasked record keeping and tax return preparation modes specifically designed for any entities within specific industries and types. The system
2 provides entities with industry specific education 12, practical hands-on assistance through professional services 14, protection and recovery of assets, and other services described below. Both the educational programs 12 and the industry specific professional services program 14 allow access to professionals who are specialists in the specific industry and type that the entity is interested. In addition, the assistance by the professional services program 14 enables entities access to a plurality of services such as banking, credit, checking, payroll, taxes, or any or all combinations of legal or other personal wealth issues or business services that are of interest to an entity. These may include, but should not be limited to, for example, insurance, law, marketing, development of trust, financial (retirements, investments, etc.), and others described below in more detail. The protection and recovery of assets within the system 2 industry specific professional services program 14 allows recovery of lost assets due to a variety of reasons, including asset loss due to tax audit for incorrect filing of returns. The system 2 may be accessed through any known medium in a variety of well known formats appropriate to the topics discussed in both the education 12 as well as the professional services program 14. The formats may include print, digital, audio, video, visual, on-line, including live on-line sessions, or any or all combinations best suited for the subject matter under discussion.
[0037]
FIG. 2 is an exemplary illustration of an industry classification system of various entities
20 in accordance with the present invention. The classification system identifies unique issues related to each industry classification leve—issues related to a variety of unique challenges for each entity 20. Through the specific identification of the entity class within an industry classification system of the present invention, the system 2 can provide targeted defined planning objectives and strategies that will provide far greater efficient savings, reduction of costs, and increased overall economic performance. The industry classification system of the present invention identifies an “industry sector” (e.g. the construction industry), then defines “industry segments” within that industry sector (e.g. painting companies, roofing companies, etc.), and it further defines worker classifications within each of the industry segments to the industry sector (e.g. roofing installer, clerk, tar crew, etc.) to provide the industry specific educational 12 and professional services 14 programs of system 2. The industry classification system provides a comprehensive overview of the entire operations of a specific industry segment's business with a focus on the issues of taxation affecting that entity. The industry classification system of the present invention is unique in that it covers all entities, i.e. businesses, associations, and individuals that work for them.
[0038]
The present invention has recognized that each industry segment or worker classification has unique aspects or issues specific to that classification level that must be evaluated regardless of the industry sector core. For example, each employee classified within the industry segment of roofing has an identified worker class code that provides information about job description. Using that code the present invention identifies the nature of employment, its relationship to the various entity industry classification levels, evaluates the various tax strategies that may be employed and provides specific integrated opportunities based upon the efficiencies of this relationship. As another example, the classification system of the present invention may be used to identify each inter-relationship between the employer and the worker in terms of a variety of issues that may provide planning opportunities to increase efficiency, lower operational costs, and in turn increase the opportunities for building profits as part of the tax and business planning process of the present invention.
[0039]
The education
12 and the professional services programs 14 of system 2 are truly industry specific, based on the industry classification system of FIG. 2. Both the educational 12 and the professional services programs 14 of system 2 are unique in that they create awareness defined by specific industry classification to the important tax or other business considerations that so often consume financial resources through inefficient control of revenues. Moreover, the identification of these and many other issues within the classification of industry in accordance with the present invention provide specific strategic opportunities to add to and contribute in the process of bringing economic efficiency, which in turn contribute to the lowering of overall costs. As a specific example, the industry classification system of FIG. 2 may be used by both the education and professional services programs 12, 14 of system 2 to select an industry sector (e.g. construction), and then an industry segment (e.g. roofing) within that sector, and then from this selection define the various issues impacting the business for use in tax planning, business operations, and other related core industry segment issues of the business. This provides a single collective source of unified information to define the total level of taxation, operations, and financial management tools designed by the industry segment for both the business as well as the classes of workers within the business.
[0040]
FIG. 3 is an exemplary illustration of a sample industry specific educational system for each industry-classified entity
20 illustrated in FIG. 2 in accordance with the present invention. The system 2 (both the educational services 12 and the professional services programs 14) identifies important issues by industry type (classified in accordance with principles illustrated in FIG. 2), and focuses strategies based upon the class levels of the industry core. As an example, the roofing industry segment of the construction industry sector will received specific industry segment education related to the roofing industry. This may include, but is not limited to, for example, tax issues for roofing companies, such as entity operations, tax strategies, business guides, tax guides, audit guides, etc. that are specifically related to roofing contractors. More specifically, they may include issues related to wage and hour analysis for determination of accountable reimbursement plans, working condition fringe benefits, insurance, or human resource issues specifically related to roofers. Just the issues related to taxes regarding the roofing industry segment may include, but not be limited to, for example, issues related to entity type, income tax, property tax, employee tax, sales taxes, states taxes, and others.
[0041]
FIG. 3 illustrates the various educational modules aimed at entities for specific business education relevant to their field of work, based on the industry classification system of the present invention. The education programs
12 of system 2 take into consideration all business related issues relevant to all specific industry groups, types, and jurisdictions for wealth management. Some of the modules of the educational programs 12 include for example, business manuals 50, tax guides 52, business plans 54, guides to a variety of worksheets and business records 56, and other topics of interest illustrated. Examples of a few specific industry groups covered by the programs 12 include such businesses as day care centers, retail stores, service industry groups, multi-level marking direct sales (MLM) companies or affiliates, consultants, etc. Of course, this list is not exhaustive.
[0042]
The educational information related to the specific types of businesses covered by the educational programs
12 also include all topics related to all kinds of business formation issues. The focus of this information is on different types of business entities (or business formations) within specific industry classes and jurisdictions. To illustrate, a consultant will learn that an incorporated consulting firm has different legal or financial benefits compared to a proprietary or a limited partnership consultant company. In addition, the consultant will also learn that an incorporated consulting firm in one jurisdiction will most likely have different tax requirements compared to the same at another jurisdiction. Further more, the consultant will also learn that certain types of business formations are not allowed for specific industry classes within particular jurisdictions. The program 12 will therefore provide all entities with the tools to identify the best type of business formation within any specific industry class and jurisdiction. This same level of detailed, industry specific education is provided to any participant within all the modules illustrated in FIG. 3. For example, the insurance module 74 for a physician with a private practice will include materials specific to medical professionals within a particular jurisdiction. Within this module 74, the medical professional will learn about the types of insurance required for their field of work, including any jurisdictional requirements for insurance where they have their practice. In this manner the physician as well as the insurance provider can evaluate the insurance needs, and determine the most cost effective method to spread risks among specialty insurance companies, compressing total overall risks associated with equipment loss, business liability loss, business income loss, building loss risks, and other loss potentials unique to the business. Therefore, the integration of more efficient management and administration of the business using the system of the present invention contribute to overall reduction of typical risks. All materials covered by all the modules illustrated in FIG. 3 are industry specific based on the industry classification system of the present invention. Accordingly, for example, the insurance material covered by module 74 for a physician will differ from those covered for a day care provider or a roofing contractor.
[0043]
FIGS.
4 to 7 are specific exemplary illustrations of the general contents for a few specific modules of the educational program 12 of system 2, shown in FIG. 3. The educational contents of all components will vary depending on different business categories (or classification) such as a business's specific industry group, type, and jurisdiction. In addition, they also include the latest changes (updates) related to all aspects of the business within those categories. These may include changes in industry specific regulations, taxes, new requirements for business plans, changes in record keeping rules, etc. As a specific example for the contents of a typical module shown in FIG. 3, FIG. 4 illustrates the general content 60 of a typical business manual 50 currently used for training of businesses or individuals interested in direct selling. This manual explains in detail the various elements and requirements that must be met in order for an “Affiliate” to be entitled to tax deductions for operating a direct selling business under current tax laws. FIG. 5 illustrates the tax guide module 52 of FIG. 3 as another example of a typical educational component currently used for training those interested in direct selling. This guide explains in detail different requirements for tax reporting purposes for all direct sellers. FIG. 6 is yet another specific example of a module illustrating the general content 64 for a representative business plan 54 (shown in FIG. 3) used currently for training purposes. The plan 54 explains in detail how to write a business plan, and includes sample plans and blank forms. FIG. 7 illustrates the general content 66 of a typical worksheet manual 56 of FIG. 3 currently used for training businesses or individual interested in direct selling. Worksheet manual 56 explains in detail the worksheets designed for record keeping purposes. Each educational module illustrated in FIG. 3 will have a corresponding set of educational material, similar to the above specific examples. The delivery of the educational material to the program 12 participants will be via any appropriate delivery medium, including the Internet.
[0044]
The industry specific educational programs
12 for tax professionals, which mirrors those of others, in addition includes information about operations, marketing, and practice and procedure (tax law) for a tax consultant. A tax professional may be defined as one that prepares, files, or provides advice on tax issues. The program access is provided under enrollment by the tax professional into selected program, and a license is granted to the professional to authorize access use, and integration of all the program assets as defined under each program description guide. The license granted also provides authorization for the tax professional to sell any of the various audit protection programs developed, and earn commissions on a periodic gross revenues generated from these sales. The educational program 12 for the tax professionals offers practice evaluations, fees and revenue analysis, fee billing codes, marketing program, and professional service classification and tracking system. The professional services classification (PSC) determines the services provided by the professional, and analyzes the services potential of the firm. It uses a formatted methodologies (described below) to determine the revenue potential based upon the firms “client classification” in order to determine the revenue potential of a given tax practice. It is used to guide the professional in a manner necessary to understand the composition of the firm's client database. Client classifications are established using a coding system to determine the industry specific types of clients within a given firm, then matching this database with the various resources available through the system.
[0045]
The operations part of the tax professional education includes study material about the operations of a tax service office. System
2 educates the tax professional on methods of evaluating the profiles of all their clients using a database to classify and rank their clients based on their tax return profile. Return profile of a tax office client comprises the number of tax forms and schedules used for a specific client, the types of tax forms and schedules used as it relates to market segment in an industry core, and others. The profile provides the tax professional with information about the value of their practice through practice fee evaluation. The practice fee evaluation informs the tax professional the exact value or worth of their practice, and the correct fees that should be charged for any specific tax services provided. The tax professional educational program of system 2 has also developed a fee coding system for the tax professional to charge clients based on this code. Hence, everything done in a tax office in an uniformed approach under system 2 has a specific fee code, which take the guesswork out of the evaluation process of what a client should be charged for a specific tax service. This fee code is also based on the industry specific classification system illustrated in FIG. 2. A typical example for a fee code for home repair industry segment is “TXPREP-CY-0200”, which describes tax preparation services for a current year tax return involving a home repair company, where the coding -0200 ties the industry to the fee to track revenue based upon the specific work. Yet another specific example, the tax preparation for a prior year involving a typical day care provider client may be represented by the code “TXPREP-PY-0400”.
[0046]
System
2 use two methods to evaluate the worth or value of tax services practice, both of which are based on the industry specific classification system of the present invention illustrated in FIG. 2. The square foot method uses the size of the tax office to determine the maximum (or most) dollars that may be generated therefrom. Tax professionals may also use this method to determine how much more value will be added to a tax office if the physical dimensions of the office are enlarged. The following formula is used by this first method to determine the worth of a tax service practice.
[0000]
Where
[0000]
AR=Annual Revenue TSQ=Total Square Foot of a firm ARSQ=Annual Revenue per Square Foot of the firm.
[0050]
The monthly revenue per square foot of the firm may be obtained by simply dividing the annual revenue per square foot (ARSQ) by the number of months in a year.
Where
MRSQ=Monthly Revenue per Square foot.
[0052]
The equation (2) may be used to establish a guideline for the firm to evaluate revenue based on fixed lease space that is measured by the monthly cost (MRSQ) of the lease per square foot area. Assuming a minimum revenue baseline multiplier value (Bv) times this cost, it could be determined that the costs associated with operations within a given space will be as follows:
C=Bv×MRSQ Where Bv is the baseline value arrived at from the weighted averages of revenues derived from clients of a tax office based on industry segment, and C is the monthly per square foot Cost of the least space. The baseline multiplier Bv is determined by the following: Where F is weighted average fee for tax services based on the client industry classification system of the present invention, and R is last year's revenue of the tax office. As a specific example, if last years revenues R were 74,560.00, and the weighted average fees or revenues based on the industry classification system of the present invention are 187,455.00, then the baseline multiplier value Bv would be 2.51. The value for the baseline multiplier Bv will differ depending on the client tax return profile and client industry classification. For example, tax offices with a majority of their clients classified in the construction industry sector would have a higher baseline multiplier value Bv than those with clients who simply work for an organization as employees with no complicated tax issues.
[0053]
The methodology for deriving the baseline multiplier value Bv may also be used to evaluate and determine the value of a tax firm in the event of purchase opportunities, based on Return On Investment (ROI). Accordingly, the tax professional may use this methodology to make a business decisions regarding the purchase of an existing tax firm or the firm's clients. Using weighted average industry segmented fees F from equation 4 above, the tax professional may determine if the firm being sold is undervalued in price, and determine the amount of ROI. As a specific example, in general, most tax firms are usually sold at about 1.0 to 1.5 times their prior year revenue. Assuming exemplary revenue of about $100,000.00, a tax firm may be sold for 1.2 times this revenue or about $120,000.00. However, the exemplary $100,000.00 revenue is not industry classified or segmented, and does not provide a correct information regarding the actual or true revenues of the firm. Accordingly, using equation (4) above, the true revenue potential of this firm based on the fees per industry segment (represented by F in the numerator) may be much higher or lower. For example, Real Estate industry sector clients of a tax office in accordance with the fee coding and classification system of the present invention will and should produce a higher weighted average fees for the tax office than those clients who simply work for an organization as employees with no complicated tax issues. Therefore depending on the client classification (client profile), a tax office with more clients classified in segments of the industry that produce higher weighted average income will and should be worth more. Assuming an investor pays the selling price of $120,000.00, but the firm has a true potential to generate $187,600.00, which is the income determined based on the weighted average industry segmented fees F, the dollar value of the return will be $67,600 increase in revenues above the base line sale price (an ROI of 56.3%). That is, the revenue of $187,600.00 is 1.88 times last year's revenue of $100,000.00. As described, weighted average industry segmented fees F serves two functions, to determine the multiplier for the Square Foot analysis and the valuation on ROI for the purchase of a tax office.
[0054]
If the monthly revenue per square foot, MRSQ is less than the cost C (equation 3), then obviously the annual revenues AR is too low. As a specific example, a professional considering an office space of 1200 square feet that has a cost of $1.25 per square foot would have a yearly fixed lease cost relative to the area under lease of about (($1.25*4*12*1200)=$72,000). This analysis, using a baseline multiplier
4, illustrates to the professional that a minimum annual revenue to operate the firm must be $72,000 in order to safely operate the firm and support the fixed lease costs. Other variables are taken into account in revenue considerations.
[0055]
The square foot cost analysis methodology simply provides a guideline to determine if the space will support the revenue potential of the firm and meet the fixed lease costs. Accordingly, if a tax office under performs in accordance with this method, the educational programs
12 of system 2 for tax professionals can teach the tax professionals how to make the most efficient use of their office space, with expense models and tracking models to operate their practice using fee codes (described above) and using record keeping system that is unique to the tax professional. Expense models simply determine and group various expenses into direct and indirect costs related to the operations of the firm. All direct costs are tied to the firm in order to evaluate its ability to operate on a 65% to 70% GPM (Gross Profit Margin). For example, if $72,000 is the fixed space costs, and 65% is the target GPM, revenues will need to be at $118,000 (72,000 *1.65). The model can also establish through evaluation of direct and indirect costs associations portions of the direct costs attributes that can be reduced by establishing more efficient cost models to control direct costs associated with providing tax preparation services. For example, the per client or per return fixed costs enable the tax professional to establish a fixed cost amount necessary to maintain a 65% GPM simply by paying the tax technician based upon revenues generated so that the relative costs are fixed and tied to the revenues using the fees established for the firm.
[0056]
The second method is the dollar ratio method, which uses the dollars per clients, and dollars per client return profile to determine the worth or value of a practice. The dollars per client ratio provides information about average gross dollars that a tax office generates per client. Fee evaluations use the dollar per client return profile ratio. This ratio provides information about clients that bring more value to the business than others in terms of their tax business dollars for the tax professional. For example, how much more profitable are day care clients vs. construction clients. The cost factors for day care provider returns are different for construction returns because the worksheets, the forms, the integration of all other parts is different for each industry segment. The time it takes to do a tax return for each industry segment is different. Using the fee codes (described above), the practitioner therefore knows how to track and monitor cost to control profitability, but more importantly, how to evaluate whether he is charging enough for the actual tax work done for that specific industry segment client.
[0057]
The marketing aspect of the tax professional educational program
12 of system 2 comprises the integration of all the program segments for each industry to enable the tax professional to penetrate specific markets. One example of marketing tools for the tax professional is to create a series of tax tips unique to the segment of the indicatory sector core. This provides insightful industry specific tax tips to their clients. Another example of marketing tool is to provide free consultation for a review and an analysis of client's tax return based on a proprietary model to find all its errors and the omissions. The tax professional will then develop a tax strategy unique to client based on the return and the client position in the segment of the market and the industry core. The proprietary model for review of a tax return is a process by which the tax professional is trained under program 12 of system 2 to evaluate the accuracy of the tax return based on the market segment and industry sector core. The process for the model is an industry segment review and analysis (ISRA). The ISRA identifies the industry sector, than identify the industry segment within the industry sector, than through a reference guide evaluates clients' tax return. The reference guide is specific to the industry sector and industry segment. For example, day care providers operating at home have a reference guide for all the deductions allowed. The guide also includes all the errors and omissions that are most common on the tax return for home based day cares, including various tax formulas, the computations, methodologies, and processes for completing an accurate review of the return to determined error and omission. The completion of the review of clients' returns leads to development of a tax Performa, informing the client about tax inefficiencies.
[0058]
In practice and procedure, the system
2 educates the tax professional about tax law that includes specific industries that the tax professional has targeted to provide services. For example, the educational program 12 may provide tax-related information that teaches about tax issues relevant to day care providers. In this case, under program 12 of system 2 the tax professional will learn about all tax related issues relevant to day care provider, including secondary tax issues such as those illustrated in FIG. 3. The industry specific educational program 12 of system 2 provides an insight into the day-to-day operations of any entity classified within the industry classification system illustrated in FIG. 2. This way, regardless of the client's understanding of tax issues relevant to their specific industry, the tax professional is able to provide highly specialized tax advice that specifically meets the needs of their client.
[0059]
Various details of industry specific professional services programs
14 are illustrated in FIG. 8, and comprises of applications and systems that readily provide industry specific hands-on assistance to entities. These may include industry specific professional counsel 200, access to industry specific worksheets and records 202, ancillary business services 204, and others 206 that will be described below in more details. Ancillary business services 204 may include those related to banking credit payroll, working condition fringe benefit analysis, business credit, business insurance, etc.
[0060]
FIG. 9 illustrates different types of industry specific professional counsel
200 available to entities through the system 2. All counsel 200 have expertise in their own field of specialty, and appropriate training through system 2 educational programs 12 with respect to specific industries for which they may provide counsel. They are also participants within industry specific professionals program 14 of system 2 under agreement 16, generating fees for system 2. Other professionals 218 may include those who counsel on matters that requires specific knowledge of a business the entity is interested. For example, they may include professionals who can provide hands-on assistance with writing a business plan for a specific business. Industry specific professional programs 14 allow entities full access to professional counsel across all jurisdictions. An entity may for example have access to legal counsel 216 with respect to business formation issues for any jurisdiction. Tax professionals 208 may be accessed from any location for personal or business related tax advice for a particular business within a specific industry classification group, type, and jurisdiction.
[0061]
All professional counsels
200 are trained within the industry specific educational programs 12 of system 2, and are members of the industry specific professionals programs 14. For example, an insurance provider 214 will be trained about the specific needs, requirements, and operations of a roofing company. A legal firm 216 may also be trained in the same. Hence, every professional will learn about specifics related to targeted markets that they wish to penetrate. Once taught, these professionals gain expertise in all issues related to that specific industry. The legal firm 216 will know all business-related issues of a roofing company. This information provides an invaluable tool for the legal professional and the business owner alike, while at the same time contributes to reducing the exposure to risks for legal issues unique to the business through effective management and administration of these important legal issues unique to the specific business segment. The insurance provider 214 will learn all business related issues (exemplary list of issues provided in FIG. 3) about home based day care providers. This enables the insurance professional 214 to penetrate this market to provide and expand its business to all day care providers. Hence, not only a day care provider can go through the educational system 2 as described above, the professionals who wish to provide advise within their own field of expertise to day care providers may also learn about all aspects of day care business, this way the advice provided by the professional to the day care provider will be targeted industry specific advice.
[0062]
The membership to programs
14 of system 2 may be under an agreement 16 that may take any form, including, but not limited to, licensing, franchising or other agreements that is best suited for the professional to delivery system 2 to entities. This may for example include a temporary agreement on a project basis. All agreements (under both educational and professional programs 12, 14, respectively) will generate fees for system 2. For example, most tax professionals 208 trained by system 2 may also become professional members 14 of system 2 as franchise units. These units provide a variety of services, including, but not limited to, tax advise for all taxes across all jurisdictions, audit protection, personal loans or mortgage reduction tools, business formation strategies, tax reduction tools unique to specific industry group and type, or any or all combinations thereof. The audit protection programs within the industry specific professional programs 14 provide an entity full, unlimited representation in audits. The audit protection programs may include at least a first level “Personal Audit Protection Model” that every entity receives in addition to a second level “Business Audit Protection Model” covering any tax return in the business. The first level of the personal audit protection program factors for representing only an audit notice received by the client. The second level factors for representing any notice from any tax agency the client may receive. Risks associated with level 1 are far less than level 2 simply because of the limitations for representation of only an audit notice. The pricing for level 2 is more attractive to the consumer, including risk management of the exposures in terms of paying a given firm for representation. Other levels allow a member to cover prior years as well, or upgrade for an eventual pre-paid legal component. In general, the audit protection representation is handled by a tax franchise or licensed unit or trained tax professional 208 authorized (and trained) under both the educational 12 and the professional 14 programs of system 2, nearest the entities jurisdiction under agreement 16 (illustrated in FIG. 1). The entities may access any audit professional through a variety of different methods, including on-line. The tax professionals under agreement 16 address potential audit issues that IRS may review during a routine audit of tax return, and provide guidance to individuals, businesses, and tax professionals about the complex rules related to tax issues, including for example, record keeping and substantiation before any audit takes place. All advice is based on industry specific classification system illustrated in FIG. 2.
[0063]
During an audit, the tax professional
208 will provide the entity with a tax review and analysis based on the information obtained from entity 20, and write a short memorandum of findings, which point out all errors and omissions with respect to the taxes filed. In addition, the tax professional 208 will also file a new claim under the rules of the IRS or any other jurisdictions, and amend the entity's return, and recover any money due, plus interest. The entity 20 is also referred to legal counsel 216 for malpractice to recover incurred damages due to negligence of prior tax representation.
[0064]
The system
2 comprises of applications and systems that readily provide accurate information about the economic condition of individuals or businesses. It provides a variety of record keeping systems and services that are customized for each individual or business within specific industry groups. FIG. 10 illustrates a general overview of different business records that may be accessed by entities 20 as well as professional counsel 200. Business records 220 accessed by all relevant entities may include records related to business formations 222, marketing 224, taxes 226, reports 228, and others 230 that may relate to an industry specific business group and type. Entities 20 are provided with record keeping systems and services that are facilitated through a variety of software applications available. The system 2 provides an efficient means by which the entity 20 as well as the professional counsel 200 may interact with various databases, including certain business records 220 for review of all business related transactions. This may include records related to taxes 226, such as review of deductions for correctness in terms of reporting requirements. System 2 can also generate a variety of customized business reports for entities that fully comply with all legal reporting requirements for any jurisdiction. These may for example include today's “ordinary and necessary” requirements of the tax code. In addition, all records 220 are also continuously updated to meet the ever-changing business requirements.
[0065]
The tax records system
226 for an individual or a business provides tax related documents that comport to various industry specific, type, and jurisdictional requirements for taxes. These may include for example record keeping systems and applications that comport to the record keeping requirements of different tax jurisdictions for tax reporting purposes, including the IRS. Within each industry specific group (as classified), type, and jurisdiction, the entity 20 has an application for identification of a variety of tax deductions within that industry grouping, type and jurisdiction that will reduce overall taxes the entity 20 may otherwise have to pay.
[0066]
The tax records system
226 also provides a design application for recording business transactions that will meet both the record keeping as well as substantiation requirements imposed by the tax laws. The tax records system 226 of the present invention ties together a variety of tax related issues, including the recording of business transactions for a specific business type to match the reporting requirements of different tax jurisdictions with an understanding of the rules for deducting specific business expenses, or business expenses that may be unique to that specifically industry classified business. The system identifies every tax issue affecting the business, and then establishes a records management system to monitor how each of these taxes are computed. This includes various elements that are factored into the basis for imposition of the various taxes, and other issues (if any) that can mitigate all or any portion of a given tax affecting the business. Thus, the methodology provides more efficiency in the control and administration of all taxes affecting the business no matter what jurisdiction the business may be situated.
[0067]
All business records
220 may be accessed continuously at all times by any interested party, from any geographic location. FIG. 11 provides an overview illustration of a typical access to different records by both professional counsel 200 and entities 20. As illustrated, system 2 provides accurate recording of various income and expense items while at the same time allowing continuous access by the tax professional 208 to assist entities 20 in reporting issues 220, report generation 220, and tax returns. The system allows the entity 20 to be fully informed about the nature and deductibility of various expense items, thus reducing errors in return preparation and filing, which translates into a more accurate return in case of an audit. Illustrated in FIG. 12 is a customized general ledger 262, showing a representative list of few expense categories for daily record keeping. Ledger 262 is obviously not an all-inclusive list. Every business record 220 generated by the system 2 is specific (or customized) to a particular industry classification, type, and jurisdictional requirements.
[0068]
The delivery modes for system
2 are many and well known. Both the industry specific educational programs 12 and the industry specific professional programs 14 are readily available to both professional counsel 200 and others in a variety of well-known formats best suited for the particular topic of discussion. These may include, but are not limited to, manuals and worksheets, in person one-on-one support training or counsel, live on-line one-on-one support training or counsel, on-line training or counsel, class room setting in the place of business, school or any or all appropriate combinations suitable to the specific educational program 12 or professional programs 14. The delivery method of the different components of both the educational programs 12 and the professional programs 14 may be of any well known format that is appropriate to the topics under discussion, including for example, print, videos, CDs, on-line, various digital formats, or any or all suitable combinations. The digital file formats may be of any known type apt for the variety of educational 12 or professional 14 programs under discussion, and may include for example, doc, pdf, etc.
[0069]
The on-line (live or otherwise) format for systems and services of the system
2 may be provided through any medium that enable members to communicate with one another and with professional counsel 200. The preferred method of communication would be through any well known means that would enable both visual as well as audio interactions between members and professional counsel 200. The well known formats also provides the capability for at least one professional counsel 200 to simultaneously train or counsel a multitude of entities across different jurisdictions, from any location. This may for example include the use of the Internet.
[0070]
FIG. 13 illustrates a well-known method of access to system
2 on-line educational programs 12 via the Internet. After logging-in, the end user (entities 20 or professional counsel 200) may select from a variety of educational programs 12 available on-line in several well-known formats. The on-line “printed” format 274 may be of any sort suitable to the topic being discussed. These may include a variety of file formats such as pdf, doc, or any or all combinations appropriate for delivery of any topic of interest. The on-line “video” format 276 is a streaming video for any topic chosen by the end user 270. All topics for both formats are segregated into individual segments 278, 280 for quick and easy access to information relevant to the end user 20 or 200.
[0071]
FIG. 14 is an exemplary illustration of two of the more than 12 libraries
284 and resource centers 288 located on the web site, including main on-line video libraries 290 and 292 of the educational programs 12. On-line video library 290 has an extensive collection of manuals, guides, business plans, worksheets, and others that are categorized by industry classification, type, and jurisdiction and may be accessed by any entity 20 or professional 200 from any location. The on-line video library 292 provides an extensive collection of different business forms for each specific industry group, type, and jurisdiction. Each topic available in all library 284 and resource centers 288 may be viewed or accessed by well known methods, including streaming videos 300 by end users 302. End users 302 may also access a variety of directories 296 available on-line as part of the library system 284 and resource center 288. The directories 296 provide general information (location, telephones, expertise, experience, etc.) about professional counsel 200 who are participants within the professional program 14 of system 2. Other directories 298 may include detailed information about all professionals 200 who were fully trained and certified under the system 2 educational programs 12, but may not be under an agreement 16 with system 2.
[0072]
FIG. 15 illustrates some of the specific topics covered by the on-line video library
290. These may include manuals on a specific business 306, taxes 308, plurality of industry specific business plans 310, relevant worksheets 312, or any or all other topics 314 of interest required by an entity 20 or professional 200. Each of the topics further provides a subset of video streams that have even more detailed material and information specific to that topic. One such example is illustrated for the subject matter related to taxes 308, where a plurality of subset video streams 318 are available on each of the general topics covered by the video stream 308. Topics of interest to end-users are all specific to industry classification, type, and jurisdiction. For example, topics on business plans 310 may include general industry specific guidelines for a typical business plan that is most appropriate for that specific industry sector and segment. In addition, it further includes other details related to business formation issues within a specific jurisdiction.
[0073]
The educational programs
12 delivered in the well known method of live on-line interactive system is illustrated in FIG. 16, providing support and training 320 that can be scheduled 322 on-line for entities 20 or professionals 200. After a log-in session to a web conference “room” 324, the end users will be provided broadcast 326 from a remote site where software modules of system 2 reside. In these live on-line interactive sessions, the screens of all end users are fully controlled by the instructors through broadcast 328. The system 2 and all modules thereof may be brought onto broadcast screen, and viewed on member screens for live interactive web training 330.
[0074]
In a live on-line environment conference, professional counsel
200 and their clients will have both audio and visual access to all documentation and records 220. The counsel 200 can have instantaneous and simultaneous access to at least one or more clients, including their records on computer screens through any known medium such as the Internet. Such access enables counsel 200 to discuss or describe any documentation or records 220 during the sessions with respective clients. These may for example include issues related to records 220, audits, substantiation requirements, and client's legal rights under the law or any or all topics of interest to clients. The technology for the live on line interactive conference is based on a plurality of well-known software applications available today.
[0075]
FIG. 17 is a specific exemplary illustration of a typical live on-line interactive session between a professional counsel
200 and an entity, under professional programs 14 of system 2 for bookkeeping. Any business record 220 may be brought into a live on-line session and not just topics related to taxes or bookkeeping. For example, business formation issues and any forms related thereto can be brought into an on-line session for both education and professional programs 12, 14. To access any live on-line industry specific professional programs 14, an entity 332 signs onto the system 336 through an Internet Service Provider (ISP) 334. A professional counsel 200 may generate, establish, edit, or perform a variety of business related functions in these sessions with direct mutual access 344 to the individuals or business's records 220. The visual portion of the sessions is such that professional counsel 200 will have full mutual control of the client's computer screen during the interactive conference. This enables the professional counsel 200 to “walk” the client systematically through even the most complicated business related tasks. The audio portion allows the professional counsel 200 to speak to the client during the session.
[0076]
The advice provided by counsel
200 may be on any topic suitable for an on-line live interactive conference environment. For instance, if an individual living in one jurisdiction is interested in opening a garage shop, counsel will be provided through such sessions to train and assist this individual with respect to all aspects of this business. The topics may include business formation issues, marketing, taxes, equipment used in that business, financing, or any or all other business related issues that are of interest to the client. Of course, both the training and the assistance are always specific to industry groups and types, and targeted to any jurisdiction that the client is interested.
[0077]
The employees
8 and the members of groups or association 10 are a special category of users of system 2 of the present invention. The educational and professional programs 12, 14 of system 2 are available to employees or members of associations or groups through sponsorship agreements 16 between the employer or the association and the system 2. The employee or member program through system 2 provides industry specific information and services related to taxes, employee or member resources, discounted employee or member services, and employee or member pre-paid audit protection to employees or members of an entity (business or an association) under agreement 16. The system 2 classifies, identifies, and provides resources for various specific occupational classifications in order to identify unique business or money related issues (such as taxes) for the specific occupational classes, while providing worksheets for the employees of a business or members of an association to use in record keeping of employee/member business/association related expenses as well as other general business information ranging from tax filing status to itemized deductions.
[0078]
The program administration, tracking, deployment of resources, and program assets are made available to the employees of a business or members of an association through system
2 employee or member resource center (EMRC). The EMRC has the capability of customization to integrate the program sponsor employer or association identity onto the various assets and resources available to their respective employees or members through system 2. For example, system 2 can provide each employee/member within the classified group (illustrated in FIG. 2) with periodic business messages (such as a tips related to taxes) printed on any document that is disseminated by their respective employer or association on a periodic basis such as, for example, the employee payroll check stub for an employee. These industry specific grouped messages are designed to educate the employee or the member in looking at their money management methods in more detail. Under the employee or member program design, the system 2 provides customized identity to the employer or the association sponsor, advertising the employee or the member of the association that the employer or the association has sponsored the message. Each message is designed to provide information along with an action step to prompt the employee or the member to review further, information that is more specifics related to the topic in the message. This method of delivery along with the content is designed to take into account the occupational classification of the employee or member in many of the message formats being disseminated. For example, if the employee program of system 2 is provided to a restaurant, the waiters will be provided with different messages compared to other restaurant employees because waiters have different tax issues regarding the collection of gratuities.
[0079]
The system
2 employee or member program has specific resources and assets available to each employee of a business or member of an association or group enrolled in the program. Among these resources as described above with respect to specific industry education 12 and the specific industry professional 14 programs, the system 2 includes practical illustration and how-to information along with custom designed worksheets that contribute to supporting the program for each enrollee. The specific industry educational program 12 for enrollees may include enrollee tax guides (specific to the occupational field of the employee/member), employee or member financial plan guides (e.g. financial plan, tax planning, retirement planning, etc.), and business use of home guide for enrollees who work from home. Other educational programs 12 resources may further include enrollee personal expense guide, tax organizer guide, audit guide, pre-paid audit protection coverage, enrollee discounts on tax services through industry specific professionals programs 14 of system 2, and enrollee consultations. As described above, each of the various resources and program assets are made available through a variety of delivery mediums, including the Internet to deliver resources and assets to employees or members in appropriate formats. The delivery medium also provides illustrated use and examples of the specific topics, integrates the employer or association sponsor identity onto the various resources, and provides useful instruction for the enrollee on using any or all of the various resources.
[0080]
The employee or member program of system
2 may be provided as a working condition or membership fringe benefit to all employees of a business or members of an association. The industry specific professional services programs 14 is also available to each enrollee, and provides tax consulting services, enrollee discounts on tax related services, audit protection for employee or member enrolled, tax problem resolution services (e.g. tax liens, levies, etc.), and prior year tax reviews. The employee or member program of system 2 can be provided by the employer or association as an added benefit to employees or members, making the enrollee enrollment fees paid with pre-tax dollars depending upon the enrollment (an open enrollment election by the employee or member). The employer or association may also provide the employee/member program as a direct enrollment plan sponsored specifically by the employer or the association as a working or membership condition fringe benefit, as stated above. This would be a unified enrollment election by the employer or member.
[0081]
Although the invention has been described in language specific to business features and or business methodological steps, it is to be understood that the invention defined in the appended claims is not necessarily limited to the specific features or steps described. Rather, the specific features and steps are disclosed as preferred forms of implementing the claimed invention. Accordingly, while illustrative embodiments of the invention have been described, numerous variations and alternative embodiments will occur to those skilled in the art. For example, the fee code system of the present invention may be modified to be numeric or non-numeric rather than alphanumeric. It may also include other characters that may better provide information to users. Such variations and alternate embodiments are contemplated, and can be made without departing from the spirit and scope of the invention.
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201713
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Nationwide, home affordability has received a serious boost from the combination of falling home prices and falling mortgage rates.
Today, because of the sagging economy, in most parts of the country, the cost of owning a home versus renting one is now
very close to its historical average.
That said, though, near every major city, there are
some neighborhoods in which home affordability and quality of life are stand-out. Using real estate data from OnBoard Informatics, Business Week highlights these areas in a report it calls the “Best Affordable Suburbs“.
Now, the country’s “Best Affordable Suburbs” doesn’t list the nation’s most affordable suburbs, but instead, a group of cities, towns, and villages in which the populace sits between five and sixty-thousand, and the economy, the schools, the lifestyle and the crime levels are all within a desirable range.
As concluded by Business Week, these are areas in which buying a home is a good value.
At the top of the list is Awake, Wisconsin, a suburb 20 minutes west of Milwaukee, prized for its outdoor lifestyle and healthy jobs market. The complete 50-state listing is posted at Business Week’s website.
In reading the headlines this morning, you’d think that last month’s Existing Home Sales figure signaled more trouble ahead for the housing market.
Quite the contrary.
Beyond the attention-grabbing headlines is the
real story; the one that shows — once again — that housing market fundaments are coming back into balance.
As home values tick lower, it appears, value buyers are stepping in and snapping up supply. It’s true that the number of homes sold fell to its lowest levels in 12 years, but we can’t ignore the fact that the number of homes available to
buy fell, too. Banks have put the brakes on foreclosures Economic uncertainty is reducing job-related relocations Builders have all but stopped building new homes
The national housing supply is as low as it’s been in more than a year.
Based on the current rate of sales activity, the national housing supply would be 100% sold in 9.6 months — a two-month improvement from the high point set in June 2008.
Demand for homes is expected to rise, too:
The Federal Reserve is trying to hold mortgage rates low Fannie Mae is opening its checkbook to real estate investors The stimulus package is granting tax credits to first-timers
So, it’s not that the headlines are
wrong; it’s just that they’re incomplete.
In looking at
all of the data and not just one sliver of it, we can find hope. Falling supply plus rising demand leads home values higher and that’s the basis for a recovery.
One popular housing theory is that — before a bona fide housing recovery can begin — the cost of owning a home versus renting one must return to historical levels.
If that belief is a truth, a national return to rising home prices may be in store for 2009.
Falling home prices coupled with falling mortgage rates, too, have dropped the relative, after-tax cost of owning a home to 125% of the cost of renting a home.
This is the
exact 18-year historical average and not since 2001 has the gap been this small.
As reported by the Wall Street Journal, though, the study has some flaws. For example, the data doesn’t account for ongoing home maintenance costs, nor does it consider real estate tax bills and insurance policies.
But, combining a relatively low cost of ownership with the government’s $8,000 tax credit for first-time home buyers is likely to convert long-time renters into never-before homeowners.
This, too, is thought to be a key element of the housing recovery.
In many markets (but not all), home prices are expected to edge lower through 2009. Provided mortgage rates stay low, the cost gap between owning and renting will shrink even more.
As part of the stimulus package passed last week, Congress authorized a temporary increase to conforming loan limits in certain high-cost parts of the country.
“High cost” is defined by a regions’ median sales price.
With the temporary increase, a greater share of Americans can now qualify for Fannie Mae- and Freddie Mac-backed loans, usually the least expensive source for mortgage money.
Higher loan limits can be good for the housing market and the broader economy for two reasons:
Cheaper money can spur new home demand, supporting home values. Higher loan limits render more homeowners refinance-eligible, freeing up cash for spending, saving, or investing.
The complete county-by-county loan limit list is available on the OFHEO website.
Of the 3,232 U.S. counties, 10 percent are considered “high-cost”. Residents of these areas can expect the same low rates offered to the rest of the country, but with a slight premium. Be sure to ask your loan officer about how it works.
Food-borne illness is three times more likely to occur at home than in a commercial kitchen. It’s a fact that surprises a lot of people and one that experts attribute to a myriad of blunders including the improper storage of food, lack of cleanliness and unsafe food handling.
As it turns out, keeping your fridge clean and orderly is just a start.
Here’s a few other helpful tips:
Produce for salads often grows low to the ground and, therefore, is exposed to fertilizers. Wash thoroughly before placing in the produce bin. Never put washed produce back into its original, contaminated container. Even if fruit comes with a “peel”, wash it. Whatever’s on the outside transfers to the inside when you cut it. Keep milk and cold cuts off the refrigerator door — it’s the warmest part of the interior. Adhere to expiration and “use by” dates. If you see mold on bread, throw out the entire loaf.
Lastly, remember to wash your hands before handling your food. You don’t have to be playing in dirt to get your hands dirty. The simple act of typing on a keyboard is enough to spread germs.
Clean food + dirty hands = dirty food.
Source I love you … Let’s clean out the fridge Kristen Browning-Blas Denver Post, February 11, 2009 http://www.denverpost.com/ci_11666028
Everything old is new again.
Conforming mortgages are limited by loan size, based on “typical” housing costs around the country. The current conforming limit on a single-unit property is $417,000.
In 2008, as part of the Economic Stimulus Act of 2008, Congress authorized conforming loan limits increases in “high-cost” areas around the country. In Los Angeles County, for example, a mortgage could be as large as $729,750 and still be considered “conforming”.
Those temporary increases rolled back effective January 1, 2009, to a maximum of $625,500.
However, as part of the American Recovery and Reinvestment Act of 2009 signed into law this week, conforming loan limits in high-cost areas have been returned to their elevated levels of 2008.
You can see the text on the bottom of page 111 of 407.
Changes to conforming loan limits impact everyone with a stake in real estate, even if their neighborhoods are not considered “high-cost”. This is because conforming mortgages offer the widest selection of home loan products, and often at the lowest rates. The widespread availability of conforming mortgages helps to support home sales nationwide as well as providing ample refinancing options for people that need it.
Lenders have yet to pick up the change, but are expected to shortly. Once they do, more homeowners will be eligible for cheap home financing.
To lookup your neighborhood’s conforming loan limits, visit the HUD Web site. Or, if you have specific questions related to your home or an upcoming purchase, contact me directly anytime.
In Mesa, Arizona, Wednesday, the President presented the Homeowner Affordability and Stability plan, a multi-pronged effort to support the housing market.
The story made the front page of nearly every newspaper in the country.
The president’s plan is sweeping:
Incent mortgage servicers to work with at-risk homeowners before delinquency starts Let homeowners with good credit but little equity refinance to today’s low rates Fund Fannie Mae and Freddie Mac to support mortgage markets
It’s a broad plan with many positive angles, but for now, we can’t forget that it’s just a
plan. Although the White House shapes and influences housing policy, Congress, Loan Servicers, and the Federal Agencies must still implement and execute it. Until that implementation occurs, these reforms exist only on paper.
It’s a key aspect of the speech that’s not getting coverage.
One thing we learned during the stimulus package debate was that just because the President
wants something to happen doesn’t mean that it will. There are always details to be worked out and that’s one reason why the Homeowner Affordability and Stability Plan couldn’t go into effect immediately. There are still loose ends to tie and details to define.
According to its website, the White House lists March 4, 2009 as the plan’s effective date. Until March 4, therefore, nothing in Wednesday’s speech is guaranteed.
The American Recovery and Reinvestment Act of 2009 was signed into law Tuesday in Denver, Colorado. Also on Tuesday, stock markets fell near their November 2008 lows.
The two moves are related.
With each new stimulus; with each potential jumpstart of the economy, Wall Street questions whether the federal push will be enough to make an impact.
Traders ended undecided on that issue yesterday, but resolute in something
else — that whatever change stimulus bill brings, it’s not going to come fast enough to help.
The sell-off in equities was a boon to home buyers. For the first time since early-December, mortgage markets gave a sustained rally, extending gains from the 8:30 AM market open through the 4:00 PM market close. Conforming mortgage rates were down on the day.
Longer-term, though, it’s not likely that pattern will last. Not only will the stock market eventually find balance, but, more importantly, there was verbiage in the stimulus bill that increased the nation’s debt ceiling by 53.4 percent. Debt, of course, is often financed with the printing more money and that leads to inflation.
Inflation is the enemy of mortgage rates.
So, for now, the stimulus plan is helping mortgage markets, albeit indirectly. If you’re shopping for home loan, consider locking quickly. When markets flip — and they always do — it figures to be sudden.
(
Image courtesy: Recovery.gov)
It looks like a propane tank, but this device is a washing machine, if you can believe it.
Pictured at right is the WonderWash, an environmentally- and budget-friendly laundry product that fits on a countertop and washes with even less water than hand-washing.
From Laundry Alternative, the WonderWash washes 5 pounds of clothes in just a few minutes with a couple of turns on the crank. Its internal pressure system forces detergent through clothes at very high speeds — up to 100 times faster than by a machine.
WonderWash is safe for delicates, too.
So how much is 5 pounds worth of clothes? It’s 10 t-shirts, 30 pairs of socks, or 2 pairs of jeans — the kind of stuff that needs a frequent wash and sometimes in a hurry. It’s great for camping and RV trips, too.
WonderWash comes with a 1-year warranty and a 30-day, money-back policy. It costs $42.95.
Consumer Confidence fell this month for the first time in three months, reflecting Americans’ concern for the economy, housing, and the financial system.
The reading isn’t much of a surprise given our collective exposure to a near-constant stream of negative news. Before long, the reports become a self-fulfilling prophecy.
Despite falling confidence, however, the housing industry appears to be reviving. Sales of existing homes are on the rise and an increasing number of homes are under contract to sell. And, if these statistics seem out of place, consider the external forces that are accompanying this “down” economy:
In some markets, home values have plummeted to early-2000 levels Government intervention has brought mortgage rates to near-5 percent Congress is pledging key support to housing and mortgage markets
These points can’t be captured in confidence surveys which, by comparison, ignore facts and focus on Big Picture behavioral questions like “Do you think you’ll be better off a year from now?” and “What’s your attitude toward buying major household items?”. It’s useful information for economists, but not so much for home buyers.
Anecdotally, a lot of the country’s housing markets have already started their recovery. Couple that with the natural momentum of Spring Buying and the stimulus package’s proposed first-time home buyer tax credit and you can clearly see the disconnect.
Just because confidence is down doesn’t mean that home prices will be, too.
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201713
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One of the biggest concerns faced by the parents is about how to make sure the kids can be healthy all the time. This may sound simple. As long as the kids want to eat properly everything should be just fine. However it’s quite common for the kids to have eating problems. Normally, they don’t really want to eat properly. All they want to eat is just snacks. Of course, the nutrients are not enough.
This can be really worrying. Parents need to do something about it as soon as possible. But what to do? The best solution is to give additional nutrition to the kids like to give vitamins to them. But, then again what kind of vitamins to get? Have you ever heard about Chubears? For your information, it’s known as India’s favorite multivitamin for kids. Yes, there are several reasons for the popularity.
For example, the taste is so good so the kids like it. And without any doubt, the nutrition inside the multivitamin is so great. The reasons mentioned above should be more than enough to make you want to get this tastiest calcium and vitamin D for Indian children. Get it and make your kids healthier without any trouble because your kids will be more than willing to take the vitamins.
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201713
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With an effort to provide free doorstep healthcare to the city's poor, the All India Institute of Medical Sciences (AIIMS) Bhopal will soon rope neighbourhood residents to coordinate between the doctors and the slum dwellers.
Under the initiative, a local resident from a selected neighbourhood will be trained as a ‘slum mobile dost (friend)', officials said Saturday.
Doctors at the AIIMS, who have launched a pilot project at a settlement close to the institute, said the venture besides providing immediate healthcare will also map the dwellers medical history.
Ten settlements are to be included in the project, but not identified yet. They would be identified soon.
"The project is aimed as an intervention for improving healthcare seeking behavior of residents of poor settlements with support of our Telemedicine Centre in AIIMS Bhopal," said Dr Surya Bali, an associate professor at the premier medical institute and the man behind the project.
Around 28% of the state’s urban population lives in slum areas, Dr Bali said quoting the 2011 census figures.
The 'dosts' or volunteer healthcare workers besides being trained in basic healthcare will also be taught how to handle smartphones to coordinate with doctors at AIIMS.
Dr Bali said that the mobile healthcare workers would also post pictures of the patients and set up teleconferencing with doctors at the institute’s telemedicine centre.
"If necessary, doctors would visit the settlement on being called by the mobile dost."
The mobile healthcare workers will be paid an honorarium depending on the patients they serve, said Dr Bali.
The first of its kind initiative in the city, besides addressing issues like accessibility and affordability of primary healthcare of slum dwellers, will also map their medical, social and economic profiles, Dr Bali said.
Dr Bali said this project would address many factors which affect the accessibility and affordability of slum dwellers to healthcare services such as transportation cost, consultation cost, timely medication, compromise his/her daily wages etc. The project has been divided into three phases.
The first phase will comprise of identification of settlements to be included in the project. This would be done based on census data.
A base line survey to understand the current health, social and economic situations of slums would be conducted.
The second phase will include geographical information system (GIS) mapping — a computer aided data mapping system— of the health, social and economic profiles of the slums under the project.
In concluding phase, tele-counseling in all the selected slums will be initiated.
The initiative will also conduct medical camps and drug distributions at regular intervals.
It will also carry out information, education, and communication (IEC) activities to generate awareness among the community.
Weekly meeting with adolescent girls, pregnant and lactating mothers and influential people of the community will be also held through the slum mobile dost.
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