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Home › Vga Connector Wiring Diagram
Posted on Feb, 18 2019 by Doe
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McCaskill's see-no-evil campaign
WILDWOOD, Mo. — Todd Akin's rape remarks have unnerved even his most ardent supporters here in his hometown. He's virtually disappeared from his home state. And the fallout has prompted a frantic GOP effort to boot him from the race.
But you wouldn't know any of that by talking to his opponent, Sen. Claire McCaskill.
Story Continued Below
The Democratic senator and her team argue that Akin's "legitimate rape" remark isn't moving throngs of voters into her column, and they think that Akin can still win in a state that has grown increasingly conservative with large pockets of rural and Christian voters.
( PHOTOS: 5 controversial Akin quotes)
So McCaskill is ready to move beyond the national fury surrounding Akin. Instead, she's embracing a more conventional attack, as if the "legitimate rape" remark never happened. She's slamming Akin on Medicare, Social Security, student loans and even school lunches. There's no mention of the "war on women." And she's attempting to sound sympathetic to Akin as he's faced an onslaught of calls from party bigwigs and conservative leaders for him to end his campaign immediately.
( Also on POLITICO: Akin's looming campaign of isolation)
The strategy also serves another purpose: McCaskill now has a far better chance of winning her race against Akin than she would against a less controversial GOP replacement candidate. So while the entire Republican establishment and leading conservative voices from St. Louis to Washington are yelling for Akin to get out, McCaskill is quietly hoping he stays in. The more the issue dominates the race, the more pressure Akin will have to end his campaign. And if he does drop out, McCaskill could easily lose a seat that is key to the Democratic majority in the Senate.
While McCaskill certainly has sent out fundraising solicitations in the wake of Akin's comments and conducted several national media interviews about it, how she views the next phase of the campaign was evident when she swung by a Veterans of Foreign Wars post in Overland, Mo., just outside of St. Louis.
"It's going to be an election between me and Todd Akin," McCaskill told reporters gathered next to her campaign RV. "I'm going to continue drawing those contrasts on many subjects where we have much different opinions — whether it's Social Security, whether it's Medicare, the minimum wage, student loans, school lunches, how we take care of veterans. There is a long laundry list of stark contrasts and that's what we're going to be talking about in this election."
Unmentioned in that laundry list: Whether "legitimate rape" rarely leads to pregnancies because female bodies can shut down, Akin's now-infamous comments that have sent the six-term congressman's Senate campaign into a tailspin. Indeed, interviews with many voters here show Akin's comments won't change their votes one way or the other and the congressman still has a solid base of support.
Still, McCaskill's posture is a sharp contrast to the furious, behind-the-scenes effort taking shape among Missouri and Washington Republicans to push Akin out of the race because they are convinced he will lose.
Rob Jesmer, executive director of the National Republican Senatorial Committee, underscored that effort in a private email to Senate chiefs of staff earlier this week, urging them to "keep up the pressure over the next several weeks." One method, he suggested, was if senators publicly pressure Akin to step aside or directly lobby Akin and his son Perry Akin, who is his campaign manager.

subset: commoncrawl


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Eddie Van Halen Donates 75 Guitars to School Music Programs
Being in the school band just got a whole lot cooler for some of the kids in the Los Angeles area: Eddie Van Halen has teamed up with the Mr. Holland's Opus Foundation to donate 75 guitars from his personal collection to schools that don't have enough funding to pay for instruments. For Van Halen, it was a simple case of giving back -- as he put it simply, "Music education and families are dealing with the economic times, and I wanted to help them."
Of course, the donation also had a lot to do with Eddie's desire to share his lifelong passion. "Music is the universal language," he explained. "It has the ability to transcend and convey every human emotion that exists without saying a word. Music kept me off the streets and out of trouble and gave me something that was mine that no one could take away from me."
Continued Van Halen, "If I can help a kid discover a liking, or even a passion for music in their life, then that's a wonderful thing. Music has provided a good life for me and hopefully it can help make life better for others with this donation."
The donation comes at a great time when Van Halen are as active as ever, as they're currently ramping up to promote the release of the band's first album in 14 years. Due Feb. 7, 'A Different Kind of Truth' finds Van Halen reuniting with original lead singer David Lee Roth for their first full-length collection of new material with DLR on vocals since 1984. The set's leadoff single, 'Tattoo,' was released this week.
Watch the video for Van Halen's 'Tattoo'


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(Reuters) - In a case prosecutors called "stranger than fiction," a former New York businessman pleaded guilty on Monday to defrauding the producers of Broadway production "Rebecca - The Musical" by creating an elaborate scheme involving fake overseas investors.
Mark Hotton, 46, pleaded guilty to two counts of wire fraud and agreed to forfeit $500,000 and to pay an additional $500,000 to the victims of his schemes.
The guilty plea included a second scheme in which he sought to defraud a Connecticut-based real estate company.
Hotton faces 20 years in prison for each count of wire fraud and is scheduled to be sentenced on November 1 by U.S. District Judge John Koeltl in Manhattan.
Hotton's attorney, Ira London, was not immediately available for comment.
"Though his lies and deceits were the stuff of fiction, they caused real harm to his victims," Preet Bharara, U.S. Attorney for the Southern District of New York, said in a statement.
Hotton was indicted in November.
A dark, gothic thriller based on a 1938 Daphne du Maurier novel, "Rebecca" had been slated to make its Broadway debut in the fall of 2012 but was postponed because of a shortfall in financing and scandal.
The proposed budget for the show was between $12 million and $14 million.
When the producers found themselves $4 million short, they entered into an agreement in February 2012 with a company controlled by Hotton.
He was to raise money in return for a $7,500 fee and an 8 percent return on any funds raised over $250,000.
Hotton told the producers he had secured $4.5 million from overseas investors, court records said, but the men, with names like "Julian Spencer" and "Walter Timmons," were all made up.
Hotton had even demanded an advance payment from the producers in April 2012 to cover the cost of a safari he had supposedly taken with one of the fictional investors.
In January, lead producer Ben Sprecher told the Broadway publication Playbill.com that he hoped to launch the show by the end of 2013.
The case is U.S. v. Mark Hotton, U.S. District Court for the Southern District of New York, No. 12-825.
Reporting By Erin Geiger Smith


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Boards & Commissions
Climate Change Committee (CCC)
1) Documentation:
2) Description
The CCC shall have the following functions, purposes, powers and duties: 1) Develop a Climate Change Mitigation and Adaptation Plan including recommendations to achieve the City's greenhouse gas reduction commitments along with strategies and steps needed to prepare for the direct and indirect effects of climate change on the City's infrastructure and operations, as well as its ecological, economic and social capital. 2) Identify and prioritize concerns and issues relating to long-term environmental, social and economic sustainability of the Tucson community. 3) Annually review the City's Sustainability Strategic Plan, provide a written report on the status of implementation of the Plan, and recommend revisions to the Mayor and Council that reflect new information or priorities for pursuing a more sustainable community. 4) Review and report to the Mayor and Council on progress toward achieving adopted sustainability goals and objectives, including those adopted in the Mayor's Climate Protection Agreement, utilizing staff of the City Manager's Office of Conservation and Sustainable Development and other sources for the information necessary for such review. 5) Frame priorities for sustainability that balance environmental protection, judicious use of resources, economic vitality, healthy communities, and social equity and that are appropriate to the specific challenges and constraints of the Sonoran Desert, and develop and propose a comprehensive set of sustainability principles to inform City policies, including the General Plan. 6) Establish methods and indicators to measure success in meeting established sustainability goals. 7) Solicit and review recommendations from other City advisory committees regarding indicators, implementation, and/or other aspects of the City's Sustainability Strategic Plan. 8) Support and sponsor community programs and projects to provide information and education to the community on ways to improve individual, business, or organizational sustainability. 9) Develop and encourage community efforts and resources for community action on sustainability. 10) Consult and cooperate with federal, state, county, city, town, or other governmental or public agencies, commissions, and committees, citizens, community groups, academic institutions, and other entities on matters relating to sustainability. 11) Consult with the Mayor and Council as requested relative to specific sustainability issues and needs that may arise.
3) Maximum Number of Members
4) Meeting Location
To be provided
5) Meeting Time
Meets as required
6) Information Sheet
7) Members
No members exist for this board.
For further information please contact the City Clerk's Office at (520) 791-4213.
Datapages for the boards are provided in Adobe PDF format. You'll need the free Acrobat Reader to view the documents.


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Michael Slager sentenced to 20 years in prison for murdering Walter Scott
CHARLESTON, S.C. (WCIV) - In an historic civil rights case, a federal judge Thursday sentenced ex-North Charleston, South Carolina, police officer Michael Slager to 20 years in prison for shooting and killing unarmed black man Walter Scott in 2015.
Slager, who Norton also sentenced to two years of supervised release following his prison term, has two weeks to appeal the sentence.
U.S. District Judge David Norton announced his decision after four days of testimony that ended Thursday.
Norton ruled prior to sentencing Thursday morning Slager had committed second degree murder and obstruction of justice.
For an individual such as Slager with no prior criminal history, the federal sentence guideline for second degree murder is 19-24 years in prison, according to Norton.
Norton said after announcing his sentencing basis, however, that neither the Scott family nor Slager would like his impending sentence.
Slager himself spoke to the court moments before the judge's sentence. Slager said he was grateful to the Scott family for their forgiveness expressed to him earlier in the day.
"I wish this would have never happened," Slager told Scott's family.
Walter Scott's mother, Judy Scott, said during impact statements Thursday that she overheard her son moaning and groaning after he was tased by Slager. Despite the circumstances, Scott said she forgave MIchael Slager, and hoped he accepted Jesus Christ as his savior,
Despite racial narratives attached to the trial given that Slager is white and Scott was black, Scott's brother, Anthony, told the court Thursday he never saw the incident as racial.
"My mother and father raised us not to see color," Scott said.
Instead, Anthony Scott expressed regret that Slager shot his brother in the back, giving anecdotes about watching western movies as a children, and the rule while playing "cowboys and indians" that you should never shoot someone in the back.
During testimony Wednesday, Scott's son, Miles, asked Norton to give Slager "the strongest sentence the laws allow."
"He murdered my father," a tearful Miles Scott told Norton, as he clutched a photo of his father. "I miss my dad so much, I can't sleep at night usually ... I never thought I would lose my dad at such a young age."
Michael Slager's family, including his father, mother, sister and wife,took the stand to testify on the former officer's behalf Thursday prior to sentencing.
Tom Scott, Slager's father, Tom, tearfully shared with the court stories of his son's passion for helping others from a young age, and the good and helpful work his son had done in the community.
"I know he's devastated by this," Tom Slager said.
"As a father, I'm very sorry for what happened," Slager's father added, directly addressing the Scott family.
"The only 3 people who know what happened are God, Michael, and Mr. Scott," Slager's mother, Karen Sharpe said while on the stand.
Slager in May 2017 pleaded guilty to depriving Scott of his civil rights under the color of law through use of excessive force.
Federal prosecutors had asked for life imprisonment for Slager, claiming Slager committed second-degree murder when he fired eight gunshots at Scott in a vacant lot off Remount Road in North Charleston, April 4, 2015.
Slager had stopped Scott for a broken brake light. Moments into the traffic stop, Scott -- who was wanted on a family court bench warrant for unpaid child support -- ran away from the vehicle. Slager gave chase.
There has been exhaustive discussion and testimony regarding what happened between the moment Slager disappeared from view of his patrol car's dash camera in pursuit of Scott, and when Slager ultimately pulled his gun and fired shots toward a fleeing's Scott's back.
The latter scene was infamously and graphically captured on cellphone video recorded by bystander Feidin Santana.
Santana's video shows Scott involved in a struggle with Slager, who was trying to handcuff Scott and place him under arrest.
In the video, Scott is seen breaking free from Slager and beginning to run away. Santana's video shows Scott nearly 15 feet away from Slager with his back turned to him when the officer began firing his weapon.
Five bullets hit Scott, fatally wounding him.
Slager has said he believed Scott had taken control of his department-issued Taser during their struggle and opened fire in fear for his life.
After the shooting, Slager went to Scott's body and placed him in handcuffs. Slager then jogged back to the spot where he and Scott had been struggling on the ground and picked up the Taser.
Video showed Slager then returning to Scott's location, and briefly dropping the Taser on the ground beside Scott's body as another officer arrived on the scene. Slager would later retrieve the Taser and return it to its holster.
Slager's defense attorneys have continued to argue there was no malice on Slager's part in light of his pleading guilty to using excessive force.
Slager's attorneys had asked that Norton sentence Slager according to federal standards for voluntary manslaughter, a prison term of 10 to 12 1/2 years.
Slager previously went to trial in state court in late 2016, facing murder charges, but that case ended with a hung jury.
Scarlett A. Wilson, ninth circuit solicitor, who also testified during this case, said that it's meaningful that Slager has admitted that what he did was wrong.
Wilson also said that now that Slager has admitted that killing Scott was not justified, there shouldn't be any further debate about the ex-police officer's guilt.
"When an officer takes accountability for his/her actions, they have the potential to save the lives of other officers and civilians," also said Wilson.
On The Scott Family, Wilson said that she applauds them for their courage and respect throughout such a heartbreaking time, "They have demonstrated dignity and grace at every turn."
State representative Wendell Gilliard also issued a statement saying, "I've come to the realization that no matter the outcome today, both families will be negatively impacted. One bearing the pain of never seeing their father, son, or brother again. The other having to bear the burden of their family member causing that pain."
Congressman Mark Sanford and North Charleston Mayor Keith Summey also offered statements on Slager's sentencing.
"Today's sentencing represents the sad end to a tough chapter in the life of our community. While justice has been served, there are no winners, and it's my simple prayer that all of us learn, reflect, and mourn what it represents and, more importantly, work to better understand our neighbors whether across the street or the nation," said Congressman Sanford.
"We have trusted in the justice system from the very beginning of this case, and today, the system finished the process. The system worked," said Summey.


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Chiffon cake—much like angel cake in the US (but tastes better)—is one of the most popular cakes in Malaysia and Singapore.
Walk into any cake shops or supermarkets, you can always find various flavors of chiffon cake for sale.
Chiffon cake is prized for its very light, soft, and cottony texture.
Everyone loves it.
Believe it or not, I was quite a Orange chiffon cake baker when I was in high school.
During one of my high school years, I remember my eldest sister-in-law started baking chiffon cake at home.
She had learned how to bake chiffon cake from her co-worker and started testing out the recipe.
I loved pottering in the kitchen, watching the preparation and baking process.
She started teaching me her recipe.
I remember vividly she had to beat the egg whites until soft peaks formed, during which she would turn the container with the egg whites upside down to test the readiness.
She cautioned me that if the egg whites were runny, the cake would fail.
The foamy texture of the egg whites mesmerized me…I thought it was amazing that the egg whites defy gravity!
Soon after that, I started testing out her chiffon cake recipe, with great success.
While the most popular is pandan chiffon cake, I loved making orange chiffon cake.
My late aunt would always buy me oranges.
Once in a while, I would bake coffee chiffon cake and she would ask her friend from the coffee shop for some Nescafe coffee mix.
For a month or two, my favorite pass time was baking orange chiffon cake.
I loved the citrusy fragrance and the mild tangy flavor of orange chiffon cake.
As with many teenage obsessions, soon I found another hobby and I stopped baking.
Fast forward to many years later, the last chiffon cake I made was this lemon chiffon cake I posted many years ago.
If you asked me if I still remember my sister-in-law's recipe, the answer is a clear no.
However, I am happy that my contributor CP Choong is sharing her Orange Chiffon Cake recipe with us, which brings back many memories of my high school days.
Latest Recipes:
SUBSCRIBE TO RASA MALAYSIA NEWSLETTER AND GET EASY AND DELICIOUS RECIPES DELIVERED TO YOUR INBOX. If you try my recipe, please use hashtag #rasamalaysia on social media so I can see your creations! Follow me on Facebook | Instagram | Pinterest | Twitter for new recipes, giveaways and more.


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Many Interesting Scenarios to Watch For As Draft Nears
Draft weekend is finally here. The day(s) that die-hard fans like myself liken to Christmas morning. Cowboys fans have come to expect the unexpected from Jerry Jones on draft day. His uncanny ability to wheel and deal on the clock is loved by some, and hated by others. Let's go through some scenarios that could unfold over the next three days.
1. The Cowboys stand pat in the first round and draft the best player on their board. That means that players like Jared Odrick, Maurkice Pouncey, Taylor Mays, Devin McCourty, or Sean Weatherspoon could be Dallas Cowboys by the end of tonight. The reality of the matter is that the Cowboys have very little need at any single position this year and that will enable them to take the best player available should they choose to stay at #27.
Players to watch for in this scenario:
- Jared Odrick – Defensive End, Penn State
- Maurkice Pouncey – Guard/Center, Florida
- Taylor Mays – Safety, USC
- Devin McCourty – Cornerback, Rutgers
- Sean Weatherspoon – Linebacker, Missouri
2. A player the Cowboys like drops considerably in the first round and they trade up to get him. I would not expect Jerry to move up a great deal in the first round since the Cowboys do not have many picks to give away in this draft. With that being said, if a player like Earl Thomas, Dez Bryant, or Mike Iupati were to slide into the late teens or early twenties, it would not be surprising to see Jerry trade up to get them.
Players to watch for in this scenario:
- Earl Thomas – Safety, Texas
- Dez Bryant – Receiver, Oklahoma State
- Mike Iupati – Guard, Idaho
3. The Cowboys do not see anyone they like in the first round and trade out of the first to stockpile some picks. I would think Jerry would demand another second round pick and possibly even a fifth (Dallas does not own a fifth rounder this year) to move out of the first round. The early second round is a spot where the Cowboys would likely draft someone like Sean Lee, who they are very high on. I could see them using their original second rounder on someone like Nate Allen or Morgan Burnett if they are still on the board. Personally I do not see the Cowboys trading down much this year because of the high number of picks they had last year. When you start to stockpile mountains of picks, keeping those players on the roster starts to become an issue.
Players to watch for in this scenario:
- Sean Lee – Linebacker, Penn State
- Nate Allen – Safety, South Florida
- Morgan Burnett – Safety, Georgia Tech
- Arrelious Benn – Receiver, Illinois
4. Dallas trades away current players for draft picks. Remember that the Bengals reportedly offered a second round pick for Martellus Bennett before the trade deadline last season. Many mock drafts have Cincinnati drafting Jermaine Gresham with their first round pick, so it is not a far stretch to think that they may offer Dallas a second rounder again for Bennett. Another player who could be on the block is Marcus Spears, who likely will only warrant a fourth or fifth round pick. Some "experts" say that Marion Barber should be on the trade block, but I just cannot see the Cowboys dealing him.
Players to watch in this scenario:
- Martellus Bennett
- Marcus Spears
5. Dallas trades a draft pick for a player currently on an NFL roster. There are a handful of NFL players who could find new homes on draft day, and it would not be a far stretch to think that Jerry may pull the trigger on a current player if the price is right. There have been reports that Baltimore Ravens offensive tackle Jared Gaither is on the block, and I think the Cowboys may be interested in him if the asking price was a second round pick. Recent reports have also surfaced about New Orleans Saints offensive tackle Jammal Brown being potential trade bait in this year's draft. I could also see the Cowboys being interested in him for a price similar to Jared Gaither's. Brown is also from nearby Waxahachie, Texas, so he has personal ties to the Dallas area.
Players to watch in this scenario:
- Jared Gaither – Offensive Tackle, Baltimore Ravens
- Jammal Brown – Offensive Tackle, New Orleans Saints


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A poison is any substance, including medications, that is harmful to your body if too much is eaten, inhaled, injected, or absorbed through the skin.
An unintentional poisoning occurs when a person taking or giving too much of a substance did not mean to cause harm.
Prescription Drug Overdose
Deaths from drug overdose have been rising steadily over the past two decades and have become the leading cause of injury death in the United States.
Protect the Ones You Love: Poisonings
Knowing how to prevent leading causes of child injury, like poisoning, helps keep our children safe and secure and helps them live to their full potential.
- Page last reviewed: November 24, 2015
- Page last updated: November 24, 2015
- Content source:
- Centers for Disease Control and Prevention,
- National Center for Injury Prevention and Control,
- Division of Unintentional Injury Prevention


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Posts Tagged 'frederick crs remax'
Enter for a chance to win – NFL Legends
September 20th, 2018 by Darren Ahearn
The Wave of Millennial Homebuyers Continues to Swell – KCM Article
September 14th, 2018 by Darren Ahearn
The Wave of Millennial Homebuyers Continues to Swell Many have written about the millennial generation and whether or not they, as a whole, believe in homeownership as a part of attaining their American Dream. Comparatively speaking, millennials have taken longer to obtain traditional milestones (like getting married, having kids and buying a home) than generations […]
Millionaire to Millennials: Owning Your Home Can Help You Retire Sooner! – KCM Article
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Millionaire to Millennials: Owning Your Home Can Help You Retire Sooner! In a CNBC article, self-made millionaire David Bach explained that: "Buying a home is the escalator to wealth in America. Homeownership can also help you retire early, that is, if you pay your mortgage off." Bach suggests that homebuyers should, "Take out a 30-year mortgage, but with the […]
Latest Broadcast
August 22nd, 2018 by Darren Ahearn
Check out my latest broadcast! And be sure to tune in every Saturday from 11-11:30am on WFMD 930AM! >> Click Here to Listen! <<
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Are Lending Standards Propping Up Home Prices? Back in 2005, Federal Reserve Chairman Alan Greenspan described the dramatic increases in residential real estate values as a "froth in housing markets." Greenspan went on to say: "The increase in the prevalence of interest-only loans and the introduction of more-exotic forms of adjustable-rate mortgages are developments of particular concern…some households may […]
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You Need an Agent Who Will Always Put You First Whether you are a rookie homebuyer or have gone through the process many times, having a local real estate expert who is well versed in the neighborhood you are looking to move to, as well as the trends of that area, should be your goal while home […]
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Will Your Current House Fit Your Needs in Retirement? As more and more baby boomers enter retirement age, the question of whether or not to sell their homes and move will become a hot topic. In today's housing market climate, with low available inventory in the starter and trade-up home categories, it makes sense to […]
What You Need to Know About the Mortgage Process – KCM Infographic
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What You Need to Know About the Mortgage Process [INFOGRAPHIC] Some Highlights: Many buyers are purchasing a home with a down payment as little as 3%. You may already qualify for a loan, even if you don't have perfect credit. Take advantage of the knowledge of your local professionals who are there to help you […]
House-Buying Power at Near-Historic Levels – KCM Article
July 20th, 2018 by Darren Ahearn
House-Buying Power at Near-Historic Levels We keep hearing that home affordability is approaching crisis levels. While this may be true in a few metros across the country, housing affordability is not a challenge in the clear majority of the country. In their most recent Real House Price Index, First Americanreported that consumer "house-buying power" is at "near-historic […]


text:
The Big Surprise
Carrie M. Groseclose 2/7/2009 9:12:49 AMAbsolutely adorable expression! Love the red hat
Michelle Alton 2/7/2009 9:23:15 AMBabies in adult hats can be magnificent...like this one, Susana. Great lighting! #7137717
Donna La Mattino Pagakis 2/7/2009 9:47:03 AMToo cute and funny Susana, those eyes~! #7137786
Dale Hardin 2/7/2009 10:31:44 AMStunning image Susana. Love the composition, the color, tones and of course the eyes and expression. Couldn't be better. #7137937
Linda L. Ruiz 2/7/2009 10:43:37 AMI just love the lighting. You caught this on perfectly. #7137963
Kay E. Mahoney 2/7/2009 10:54:35 AMNice capture, Susana. She is adorable. Love that hat. #7138000
Melissa Olsen 2/7/2009 12:01:54 PMOutstanding clarity, color and light. Your composition is wonderful! #7138232
Susana Ms Heide 2/7/2009 12:25:40 PMThank you Carrie, Michelle, Donna, Dale, Linda, Kay and Melissa! She had so many cute expressions but also lots of smiles :o) #7138333
Ron Jones 2/7/2009 12:37:14 PMNicely composed, Susana. The expression and color are outstanding but it is the framing that makes this image exceptional. #7138378
Joy Rector 2/7/2009 12:55:56 PMhow precious #7138425
Lynne Morris 2/7/2009 1:33:05 PMHaha, this is so adorable Susana, great light, tones and comp. #7138541
Melissa G. Meiselman 2/7/2009 1:51:42 PMOHHH that red hat is really something, Susana!!! Her expression is simply priceless and your photo is terrific!!! #7138590
Mitch Spence 2/7/2009 2:05:21 PMGreat, Susana. She'll either love this when she's grown or hate it and hide it from perspective suitors. :) #7138608
Dianna Murphy 2/7/2009 4:31:33 PMWell I think you have a winner. Wonderful! #7138974
Susana Ms Heide 2/7/2009 6:25:08 PMMany THANKS to each one of you (Ron, Joy, Lynne, Melissa, Mitch and Dianna) for responding with such positive comments! Mitch, lol on your comment... no kidding :o) #7139291
Sheila D. Robertson 2/7/2009 8:13:41 PMToo Cute! Your timing, pov, light and comp are beautiful #7139577
Jane Holestine 2/8/2009 5:10:08 AMGorgeous! Adorable expression, great comp, lighting and color. #7140741
Nikki McDonald 2/8/2009 6:01:01 AMTerrific expression you caught here, Susana, and the angle of presentation is just right. Great lighting and color. #7140960
Susana Ms Heide 2/8/2009 9:30:33 AMSheila, Jane and Nikki: Thanks for the wonderful messages!! #7141770
Walter H. Wiesbeck 2/8/2009 11:16:25 AMA adorable and cut expression on this one,Susana beautiful work #7142095
Eva Pastor 2/8/2009 4:03:08 PMI love it! Great expression on the little girl's face ... and the red hat ... perfect! #7142871
Susana Ms Heide 2/8/2009 8:53:10 PMI'm glad you liked it Walter and Eva! THANK YOU! #7143528
Nancy J. Locke 2/9/2009 10:58:58 AMHow precious and adorable. This will be one happy baby when she grows up and has this pic to treasure. :D
Cheers! Nancy L #7145894
Gena L. Talbot 2/10/2009 10:26:41 PMSo adorable and with perfect lighting! Love this image Susana :) Great work!!! #7151939
Susana Ms Heide 2/11/2009 7:33:45 PMThank you very much Nancy and Gena!! #7155673
Susana Ms Heide 2/14/2009 4:16:41 PMWhat a fun portrait! And you really achieved clarity in those eyes! #7166126
Susana Ms Heide 2/15/2009 10:10:29 PMThank you very much, Deborah!! #7169943
Corinne M. Thompson 2/27/2009 5:26:29 PMHer expression is pricelss, fabulous portrait! #7223932
Chuck Bruton 2/28/2009 1:09:20 PMBeautiful,
Datha Y. Thompson 3/1/2009 8:52:45 PMP E R F E C T ! ! ! ! #7231050
Susana Ms Heide 3/9/2009 11:09:29 AMCorinne, Chuck and Datha: It means a lot to get your positive reviews! THANKS! #7263090
Howard B. Cheek 3/10/2009 7:04:07 AMThis is wonderful Susana..
Susana Ms Heide 3/11/2009 9:47:17 AMThank you Howard for your compliments! #7272150
Max Aureli 3/23/2009 7:00:45 PMhe he ... It just make me laugh this portrait!!! :-))
Susana Ms Heide 3/23/2009 9:35:10 PMMax, I really appreciate your generous compliments on my work! Thank you for taking the time to look! #7321084
Mary Beth Aiello 3/25/2009 12:38:42 PMIt doeosn't get any cuter than this. Huge congrats on this beautiful finalist Susana. #7329010
David M. Montero 3/25/2009 2:08:36 PMBeautiful!!! Congratulations Susana!!! #7329735
Elida Gutierrez 3/25/2009 2:10:04 PMCute, cute, cute, CONGRATULATIONS!!! #7329750
Susan Fox 3/25/2009 4:32:53 PMCongratulations Susana! #7330791
Michelle Alton 3/25/2009 5:30:19 PMBrilliant finalist, Susana. I have loved this from the start! #7331177
Leslie McLain 3/25/2009 6:18:32 PMCongrats on your beautiful finalist. #7331500
Pat Gamwell 3/25/2009 6:29:29 PMI can see a 'gold' coming! SUPERB finalist! #7331584
Terry L. Ellis 3/25/2009 6:32:13 PMAn exquisite finalist, Susana! A joy to view! Congratulations! #7331603
Debra R. Harder 3/25/2009 6:51:37 PMOMGOSH, Susana! This put a huge smile on my face. Absolutely PRECIOUS!! Congratulations on another brilliant finalist! Deb #7331722
Michelle L. Frick 3/25/2009 6:58:26 PMTee hee - I knew we'd see this again! Congratulations Susana! #7331780
Sherran Andersen 3/25/2009 9:03:00 PMCongrats on your finalist. Sherran #7332391
Laurence Saliba 3/25/2009 9:38:48 PMADORABLE!!!!!!! Congrats again Susana!!!! #7332472
Gena L. Talbot 3/25/2009 10:58:49 PMCongratulations on this WONDERFUL finalist Susana! Huge Favorite of mine for sure :) Great Work!!! #7332565
Susana Ms Heide 3/25/2009 11:17:32 PMAll of your messages have been so encouraging! THANKS so much, everyone!!! #7332591
Nick Lagos 3/25/2009 11:34:54 PMOne can't help but smile when you see this..perfect timing..well done Susana.. good luck with it #7332620
Susie Peek-Swint 3/26/2009 7:35:28 AMThis is so adorable Susana ~ congrats on a well-deserved finalist! #7334390
Angie Sidles 3/26/2009 1:23:16 PMAbsolutely ADORABLE!! So well deserved Susana. Congrats! Hope to see it again! :) #7335717
Donna La Mattino Pagakis 3/26/2009 3:33:47 PMYou already know I love this Susana! Congratulations on your finalist! #7336252
Susan Fox 3/26/2009 4:25:20 PMCongratulations on your win Susana! #7336478
Max Aureli 3/26/2009 4:26:03 PMCongratulations Susana for this fantastic Winner!!!!! :-)))) #7336485
Larry L. Redmon 3/26/2009 4:26:29 PMFantastic portrait, Susana! Congratulations! #7336487
Erin Kirsten 3/26/2009 4:38:26 PMCongratulations on your finish!! This is so phenomenally done and so amazingly cute!! #7336582
A P 3/26/2009 5:08:26 PMSo cute
Evy Johansen 3/26/2009 6:05:17 PMLove it, Susana!! Big congratulations on this wonderful and well deserved win!! #7337181
Wendy Moghadam 3/26/2009 6:25:17 PMThis is priceless!! Congratulations on your win! #7337328
Pat Gamwell 3/26/2009 8:52:13 PMA perfect GOLD WINNER, Susana! Not at all surprised! Big congrats! #7337818
Kate Baumgartner 3/26/2009 9:01:44 PMInnocence and simplicity. Congratulations. Looking forward to seeing more of your work. #7337863
Susana Ms Heide 3/26/2009 9:41:00 PMMany THANKS to each one of you for the kind messages (Nick, Susie, Angie, Donna, Susan, Max, Larry, Erin, Ann, Evy, Wendy, Pat and Kate)!! I truly appreciate all the support! :o))) #7338005
Tiia Vissak 3/27/2009 2:17:49 AMCongratulations! #7338569
Max Aureli 3/27/2009 2:21:28 AMhe he he :-))) I was not wrong, Susana!!! :-))) #7338582
Laurence Saliba 3/27/2009 6:20:42 AMA BIG Congratulations!!!! #7339494
JO ANN CLEVELAND 3/27/2009 8:18:47 AMThis is adorable!
jo ann c. #7339940
Judi Morrissey 3/27/2009 10:41:38 AMCongrats! What a wonderful expression! #7340566
Mitch Spence 3/27/2009 11:42:00 AMNo surprise here, Susana. A great portrait. #7340758
Rhonda Burger 3/27/2009 12:12:15 PMC O N G R A T U L A T I O N S !!!
Mary Beth Aiello 3/27/2009 1:03:31 PMHuge congrats on bringing home the Gold, Susana. #7341138
Cora Miller 3/27/2009 8:34:08 PMSimply delightful. You can't help but smile looking at this cute expression and the hat frames it perfectly. Congratulations on your win, Susana. #7342296
Walter Graziano 3/28/2009 3:36:15 AMWonderful capture of a fabulous expression!!! Congratulations on your WIN! #7343084
Susana Ms Heide 3/28/2009 11:26:24 AMWOW!! I'm in AWE of all the support!! THANK YOU so very much everyone!!! #7344705
Wanda Judd 3/28/2009 2:12:21 PMSusana, congratulations...I love the bight red hat and clarity in this shot... #7345238
Candy Avera 3/28/2009 2:21:02 PMQuite adorable! Congrats! #7345289
Renee Doyle 3/28/2009 5:08:32 PMThis really is simply superb!!! Big congrats to you Susana!!! #7345830
Michael Umbreit 3/28/2009 5:26:52 PMSusana - Congratulations on your win! Wow, what a shot! - Mike #7345918
Terry L. Ellis 3/28/2009 9:01:06 PMBrings a huge smile to my face everytime I see it. Congratulations, Susana! A sensational win! #7346500
Donna La Mattino Pagakis 3/28/2009 11:25:44 PMCongratulations on your win Susana, so cute! #7346689
Christian Rosito 3/29/2009 6:33:51 AMCongratulations on your win Susana! #7347418
Anna Diederich 3/29/2009 1:56:00 PMHow adorable! Congratulations, Susana!! #7349232
Susana Ms Heide 3/30/2009 10:54:04 AMI apprecite each one of your messages!!! THANKS guys!!! #7352866
Katarina Mansson 3/31/2009 3:43:47 AMYEAH lovely to see this with a yellow badge - congratulations Susana! #7355407
Les Rhoades 3/31/2009 6:09:42 AMCongrats on your selection for the BP SNAP-SHOT newsletter #414 #7355811
Dr Silly 3/31/2009 6:42:19 AMWOW, Awesome portrait. Congrats on the Gold and the selection for the BP Snap-Shot news letter. :O)
Datha Y. Thompson 3/31/2009 6:51:55 AMOMG I love this soooo much!!! Everything about it is just PERFECT!!!
Loan Tran 3/31/2009 7:00:20 AMLove the baby's expression and the red hat, so precious, so adorable. #7355930
Corinne M. Thompson 3/31/2009 7:02:41 AMCongrats on both, the win and your SnapShot feature! #7355935
Susie Peek-Swint 3/31/2009 8:04:35 AMMany congrats Susana ~ both the gold and snap-shot feature .. adorable capture! #7356146
Mitch Spence 3/31/2009 8:28:32 AMYou bet, big congratulations on both! #7356248
Donna La Mattino Pagakis 3/31/2009 8:39:22 AMCongratulations on your SNAPSHOT gallery feature Susana!!!! This image makes me smile every time!! #7356302
Colleen Farrell 3/31/2009 8:51:03 AMThis is SO cute--great title. She's saying, "But I'm too young for the Red Hat Society!" lol Big congrats on a most well-deserved WIN and feature in Snapshot! #7356343
Susana Ms Heide 3/31/2009 9:04:28 AMNow I'm the one who got a "Big Surprise" by having BP choose this for the SNAP SHOT newsletter! Thank you so much for the honor, BP!! And a BIG THANK YOU to all of you, my wonderful friends here at BP, for the congrats!! You better believe that I'm smiling today :o) #7356398
Cesar J. La Rosa 3/31/2009 9:22:37 AMBig Congratulations on your SnapShot Gallery Feature, Susana!!! I was so happy to see those familiar eyes when I opened my inbox this morning. You're an excellent photographer and this recognition is very well-deserved.
Max Aureli 3/31/2009 9:28:00 AMhe he he :-))))
Susana Ms Heide 3/31/2009 9:42:43 AMhttp://www.betterphoto.com/snapshots/archive.asp?snapNumber=414
I believe that link should work, Max! You can subscribe to receive BP's newsletters and mailings. Thanks for the enthusiastic cheer Max and thank you Cesar for your constant support! #7356491
Max Aureli 3/31/2009 9:54:24 AMThank you Susana. Yes, your image of the surprised red hat baby girl is in that link!!! LOL!!! :-))
Susana Ms Heide 3/31/2009 4:54:39 PMGlad you found the newsletter, Max and thanks agan for your kind words!! #7357668
Usman M. Bajwa 4/1/2009 12:08:18 AMCONGRATS. on getting Golden
Usman. #7358439
Dominick M. Dimacale 4/2/2009 1:28:16 AMCongratulations Susana on your 2nd Win!!!
Dominick #7362618
Elida Gutierrez 4/2/2009 7:25:34 AM
Kathy L. Clark 4/2/2009 1:44:35 PMSusana congrats on our absolutely fabulous winner and snap shot of the day. What a beautiful baby and wonderful portrait. #7365212
Susana Ms Heide 4/2/2009 3:50:56 PMThank you very much Usman, Dominick, Elida and Kathy! And a special THANK YOU to Elida for that special gesture of creating these beautiful trophies every month! :o)) #7365424
Susan Jane Allen 4/4/2009 11:18:10 PMSO AMAZINGLY SWEET! Congratulations! #7372697
Thomas E. Hinds 9/10/2009 8:16:22 PMThis is simply a stunning, precious image! What a beautiful little one and what an expression captured! I have so enjoyed my visit to your gallery! Awesome stuff everywhere! #7933379
Susana Ms Heide 9/11/2009 3:53:49 PMThank you so much Susan!! Thomas, I truly appreciate the time you took to check out my gallery! Thank you for the generous compliments :o) #7935540
Christine Lobsinger 11/26/2010 10:21:50 PMOutstanding baby portrait and HAT and LIGHTING!!!
Susana Ms Heide 12/14/2010 8:20:07 AMChristina, it has been an honor to have you stop in my gallery and shower me with such wonderful compliments!!! You've been very encouraging! THANKS a mil!! #9102299
Cynthia j. Lesley 12/21/2014 6:58:03 PMWonderful photo and what a great job taking this photo. #11210717
1/250 sec
Studio Strobes
Category: People
Exif: F Number: 7.1, Exposure Bias Value: 0.00, ExposureTime: 1/250 seconds, Flash: did not fire, compulsory flash mode, ISO: 100, White balance: Auto white balance, FocalLength: 70.00 mm, Model: Canon EOS-1D Mark II
Uploaded on 2/7/2009 9:06:29 AM
Copyright for this gallery photo belongs solely to Susana Ms Heide. Images may not be copied, downloaded, or used in any way without the expressed, written permission of the photographer.
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text:
If you attend a Farm Service Agency meeting, you may find yourself plugging numbers into a spreadsheet to determine whether or not to update your yields on commodity base acreage. Congratulations if you figure out that bit of confusion without reaching for the aspirin bottle.
But don't take off your thinking cap yet. Instead, turn your attention to the new Conservation Security Program (CSP) that's still being finalized. With a total of $17 billion earmarked for conservation incentives though 2007, you could become one of the farmers who gets a bonus for operating with resource conservation in mind.
Start early. CSP offers alternate strategies to complement the existing Environmental Quality Incentives Program and set-aside Conservation Reserve Program (CRP). Although the exact rules for CSP are not yet available, the proposed program would offer financial incentives to producers for adopting and/or maintaining a wide range of management, vegetative and land-based structural practices that address one or more "resources of concern." These resources include soil, water, air and wildlife habitat. Contracts are expected to be for five to 10 years, with maximum payments of up to $45,000 annually. But even with $17 billion to draw from, not everyone who applies is going to qualify.
As farmers turn their attention to conservation funding, Dan Towery, a natural resources specialist with the Conservation Technology Information Center, says he expects that there will be more applications filed than dollars to give. But you'll increase your chances of success by starting a dialog early with your local soil conservation office. Each state has somewhat different rules. And some states give counties further administrative discretion.
"First, talk with your local Natural Resources Conservation Service and conservation district planner about the program as it applies to your district," Towery says. "Then explain what you'd like to do on your farm. Together you can agree on a plan and specific conservation systems that work for you and your district. Addressing more than one resource with your plan may boost your payment."
High on the list of acceptable programs will be systems and practices such as contour buffers, terraces, waterways, strip-till/no-till, cover crops/grazing management, nutrient management plans and use of Roundup Ready crops that encourage no-till. Your district may wish to place more emphasis on some practices and systems than others. Look at all the options to find the best program for you.
For something like a grass waterway, you may get a better contract by going with the existing CRP. The new CSP shows the greatest potential where farmers want to keep land in production while still addressing resource conservation. Among other things, it appears that CSP will be an excellent incentive for promoting conservation tillage and soil nutrient management.
Tillage incentives. While cautiously optimistic, implement manufacturers are hoping the new CSP incentives will add momentum to the adoption of tools such as deep rippers, strip tillage tools and other implements that condition the soil or prepare a seedbed while leaving surface residue intact.
Towery explains that, although no dollars are allocated specifically for equipment, the government payments may help you justify certain equipment purchases if the equipment will help achieve the obligations of your contract. So think in terms of conservation and acres first, then look at the iron you'll need to conserve soil and boost yield.
Keith Whitaker, tillage product manager for Case IH, isn't willing to speculate on how the final language on CSP will read, but he does think the program could provide an extra incentive for farmers who are interested in buying in-line rippers that break up deep compaction without disturbing the surface. "While I'm not at liberty to say exactly what our plans are, I do think the impact of CSP will influence how we develop tillage products in the future," Whitaker says. "And it's certainly possible that CSP, combined with new GPS technology, could be the catalyst that helps strip tillage become a more common practice."
Strip it. Whitaker points out that some farmers have been doing strip tillage for years, but the practice hasn't caught on big yet. Along with the inherent uncertainty of changing traditional tillage practices, it's been difficult to drive a tractor in a straight line over the same strip of soil twice. Now that limitation is slowly going away as GPS technology becomes more widespread.
Strip-till becomes practical when you can drive the same line every time you go across the field. Then you can get the benefits of tillage and reduced fertilizer and chemical use, and still maintain significant surface residue for soil conservation.
Conceivably, CSP might provide added financial incentives for farmers to invest in a strip-tillage implement and a GPS guidance system, for example. One of the new autosteer systems might also fit well with strip tillage. We shouldn't be surprised to see more companies coming out with new strip-till implements in the near future. In the meantime, it might be worthwhile to take a quick look at some of the existing tools that could help attain specific conservation and yield objectives. Following are just a few.
DMI 5310. Cary Sizelove, crop production specialist for DMI fertilizer products, suggests that farmers without a yield-limiting compaction problem may be interested in the company's DMI Nutri-till'r 5310.
Farm Industry News first covered this implement in November 2001. Since then, DMI has continued to promote it with claims that strip-till shows an income-per-acre advantage of $23.20/acre over no-till.
The 5310 cuts through residue without burying it and raises the soil into a berm. Berm conditioner baskets reduce clods to further develop a seedbed that warms faster for earlier planting and greater yield potential. A strip-till knife can place dry, liquid or NH3 fertilizer, or can be used for tillage. You can use the implement with or without GPS, too. Optional side-mount row markers can index the strip rows for planting. Starting price for the 5310 is $31,000. For more information, contact Case Corp., Box 65, 600 E. Peoria St., Goodfield, IL 61742, 309/965-2233, or www.dmifarm.com visit or www.freeproductinfo.net/fin.
Rip it. "We've seen an increase in farmers' use of in-line rippers," Case's Whitaker says. "Our Ecolo-til 2500 used in soybean fields is one way to address soil compaction problems and improve subsurface soil tilth with very little disturbance of surface residue.
"This rip-strip tillage tool allows farmers to economically achieve an optimum soil environment while complying with residue retention guidelines set by the Natural Resources Conservation Service. Now with the continuing adoption of GPS guidance systems, our Case IH 2500 Rip Strip is a tillage implement that could see added interest with this year's farm program. The tool is a good fit for farmers who wish to adopt strip-till practices but need to manage compaction."
Farm Industry News first covered this tillage tool in January 2002. It provides the benefits of both deep tillage and no-till, fracturing compaction while building and conditioning a strip that settles ready for planting.
The 2500 addresses common no-till problems — such as slow seed germination due to cool, wet seedbeds or poor seed-to-soil contact — with a four-step system. Coulters manage residue; low-disturbance shanks with patented points improve tilth; soil-gathering disc blades elevate the bed; and a soil-conditioning system reduces clods to provide a uniform seedbed. Price ranges from $12,800 to $27,500. For more information, contact Case IH, 700 State St., Racine, WI 53504, 262/636-5678, or visit www.caseih.com or www.freeproductinfo.net/fin.
Redball strip-till. Most folks know Redball LLC for its spray equipment and cultivators. Now the company is introducing its own line of strip-till equipment.
Redball President Steve Claussen says his company moved into the new category in response to research that points to measurable yield and cost-of-production advantages over conventional tillage and strict no-till programs.
"For strip-till to take off, farmers need equipment that produces a uniform, accurately fertilized seedbed with the same reliability in equipment that they are used to with more conventional systems," Claussen says. "Our equipment will address those needs."
Redball strip-till row units are mounted on parallel linkages so that individual units hug field contours. The company claims this results in a uniform seedbed and provides fertilizer placement that is more precise than is possible with rigid systems with gauge wheels for the full toolbar. Because row units can adjust to terrain, they don't have to be set deeper than necessary. That should reduce horsepower requirements over certain types of terrain.
Row units are configured with 22-in. coulters in front to slice through field residue and reduce plugging potential. They are followed by a row cleaner, a tillage/fertilizer knife, and two independently floating, 18-in. berm-building discs.
Several row-unit options are available, including adjustable down-pressure springs. Row units may be attached to any 7- x 7-in. toolbar or to one of the new Redball strip-till toolbars, including 3-pt. and pull-type straight bars up to 22 ft. wide, vertical-fold 3-pt. bars up to 30 ft. wide, and front-fold pull-type bars up to 44 ft. wide. A new Redball 1660 air fertilizer cart is available in 6- or 8-ton capacity. It uses a Raven speed-compensated controller to assure accuracy. The cart chassis is available with a fixed or adjustable axle.
Estimated price per strip-till row unit is $1,200 to $1,600, depending on options. A 2000 series toolbar ranges from $14,000 to $16,000. The 1660 6-ton air fertilizer cart starts at $17,000. For more information, contact Redball LLC, Box 159, 140 30th Ave. SE, Benson, MN 56215, 877/332-2551, or visit www.redballproducts.com or www.freeproductinfo.net/fin.
McFarlane Reel Till. Introduced at last year's National Farm Machinery Show in Louisville, KY, the McFarlane Reel Till grabbed the attention of many farmers interested in spending less time on their conservation tillage acres. Like four tools in one, the Reel Till has a coulter for soil and residue cutting, a spiral reel for stalk chopping, a five-bar flexible spike tooth harrow for breaking up soil and mixing residue, and a leveling board for smoothing the surface and feathering out residue. Stan McFarlane says customers like that the implement can turn hard, packed stalk stubble into a perfect seedbed in one pass while not burying residue. "Whether you use this tool in the fall or spring, it saves preparation time and lets you plant sooner. We recommend pulling at a speed of 9 mph, but some of our customers say they regularly pull the Reel Till at 12 mph."
The Reel Till uses a heavy-duty, 7-in. toolbar for strength and stability. The single row of hardened steel spiral reels is mounted directly behind the coulters. Heavy-duty support arms have five rows of flexible spike tooth harrows and the leveling bar. Units feature a massive hinge and hydraulics for easy transport folding. Prices range from $17,200 for the 12-ft. 8-in. model to $37,800 for the 30-ft. model.
For more information, contact McFarlane's Inc., Box 100, Sauk City, WI 53583, 800/627-8569, or visit www.mcfarlanesonline.com or www.freeproductinfo.net/fin.


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So why are ERs so damn overcrowded, anyway?
Turns out that there are a lot of interrelated reasons. Simple demographics plays a role, of course. This point has been made in spades before, but to recap: there are more Americans than there were 20 years ago, but there are fewer acute care hospitals and fewer ERs to serve them. Additionally, there are people living longer with more chronic diseases.
The corollary to fewer acute care hospitals is that there are fewer inpatient hospital beds. This trend started in the '90s when it was generally agreed that there was an oversupply of hospital beds, and that managed care would drastically reduce the utilization of inpatient capacity. The result was that the industry went through a wave of consolidation and downsizing. This may have made good policy sense at the time -- I don't really know -- but it certainly made good economic sense for hospitals. Like an airline that doesn't want to fly with empty seats, hospitals don't like to operate with empty beds -- it's wasted overhead, and more efficient if you can cut the marginal capacity and operate close to full all the time. Only problem was that this leaves precious little margin for surge capacity come flu season, and little room for population growth.
The lack of inpatient beds led to inpatients boarding in the ER. There was just today a nice article in Annals of Emergency Medicine which purported to show that Admitted Patient Boarding Times have a more significant contribution to ED congestion than physical plant size (number of beds).
Boarding is probably the most significant contributor to congestion in most facilities, but it's not the only. One insight I drew today from the talk about the
The MA experience was interesting in that there were 600,000 uninsured in that state prior to the reform, about 500,000 of whom ultimately wound up getting health care coverage as a result. The data shows, however, that ED utilization did not decrease as a result, and in fact, it continued to increase at a pace beyond that of population growth. Why is this the case?
First, as many have pointed out, there are simply not enough idle primary care physicians out there to absorb all these newly insured patients into their practice. The hope had been that patients would gain access to primary care services and that this might decrease demand for ER services, but that was not to be the case. (Given the dearth of medical students intending to enter primary care, do not expect that situation to improve.)
But when you look back at some of the other data published, the larger point rings through -- that ER congestion is as much due to the insured as the uninsured, and provision of universal health insurance will probably do little to alleviate the overcrowding.
Non-urgent use of the ED also does not seem to be a large driver of congestion. Understand, though, that non-urgent patients and low-acuity patients are not one and the same. A broken ankle, a sore throat, or a laceration are all low-acuity. They are also urgent, at least in the eyes of a patient who is unable to walk, in pain, bleeding, et cetera. And the truth is that the ER is better at treating these acute presentations than physician's offices are.
Not better in the sense of skill or quality, better from the patient's perspective of their time and convenience. We are open 24/7, and for places with functional fast tracks it's possible to be in and out in under an hour. Even for patients with slightly more complex problems - vomiting or abdominal pain -- two to four hours is the median range of their LOS. This is awesome from a patient's point of view, compared to trying to get cared for in the office of your primary care doctor. (Which assumes that you even have one.)
It's challenging to get in for an acute appointment, assuming that same-day appointments are avilable at all: you have to wait for office hours, call in, try to get the nurse, and hope to convince them that you are sick enough to be seen that day. You may see your doctor, or you may see a doctor you don't know. Then you have to wait for your appointment time, and if any ancillary tests are needed, you may have to go over to the lab, to x-ray, etc. Often you then go home and wait for the doctor to call with the results. It's an all-day experience, frustrating and a hassle. This is in spite of the fact that many PCPs want to see the acute cases. The low reimbursement for office-based practice forces them to schedule their clinic so tightly that patient convenience is not something easily accomodated, and certainly not in any large quantity.
So it's no wonder that consumers of health care, being rational actors, preferentially elect the more convenient avenue of care. And two very necessary and very well-purposed pieces of legislation conspire to encourage patients to pursue this quick but very expensive option: EMTALA and Prudent Layperson. Since EMTALA was passed, most ERs simply gave up trying to screen or redirect patients away from the front door, believing it illegal. Those that try run terrible PR and legal risks. So we have accepted the burden of the low-acuity urgent cases, built fast tracks, and tried very hard to make the care for these patients as quick as possible. In part, this was intended to allow more resources to be focused on the more seriously ill, and in part this was due to the fact that fast tracks turned out to be nice profit centers. By making ER care faster, quicker, and easier, we have further incentivized patients to eschew the clinic and just come on down.
Similarly, the Prudent Layperson rules have had the same effect. Prudent layperson was a completely appropriate response to the bad behavior of insurers, just as EMTALA was a necessary response to bad behavior on the part of providers. Both serve to remove any disincentive to come to the ER for minor conditions. If the payer could require pre-authorization or credibly threaten to refuse payment, then patients would be more likely to choose a more cost-effective care setting. But since this is now all but forbidden, patients have carte blanche to utilize the ER as a convenience clinic.
I'm not sure this is all bad, by the way. If boarding went away as an issue, it's entirely possible that ERs might be able to accomodate the volumes, and despite the expense they incur, the ER does a lot very quickly and efficiently. If the proposed medicare rules for Type B EDs go into effect, then fast tracks will be a much more cost-effective site for urgent care. This also frees up the internal medicine physicians to manage complex and chronic conditions, which is ultimately their core competency. Perhaps this is the future - Emergency Medicine blends into an over-arching Acute Care Medicine specialty. It might not be the way an ideal system would have been designed, but it looks like that is where we are going, and I don't see any way to put that genie back into the bottle.


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I made so many of these cards I used up all the paper I originally bought for a paper crafting class I'm teaching this spring. Of course I can't find anything similar, so I'll have to improvise on the class project.
I made lots of thank you cards and birthday cards with this design. The paper has a velvet raised finish, which really set off the flowers on the bright background. I haven't found anything like it.
I go in streaks with my card making days. I'm determined to have handmade card for every occasion this year. They really are so much more personal than those that are store bought.
Hoping you have time to enjoy some creative time this weekend as well!
7 hours ago


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TAKE THE CHALLENGE: Simon Says Stamp Challenge! | Vintage Simon Says Stamp & Show Challenge
Friday, April 1, 2011
Inspiration by Linda Coughlin!
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14 comments:
Ha ha ha ha ha I just loved your April fools day prank here, and I would have loved to see her face, when she saw all these ha ha ha.ReplyDelete
And a big congratulations to all the winners here today too.
Hope you´ll all have a wonderful week-end ahead dear friends.
Love the flowers ... Still looking for my fool today...ReplyDelete
Thanks for the info on the flowers, lovely. And congrats to those winners!ReplyDelete
LOL - bet you were popular!!ReplyDelete
Love those flowers, thanks for sharing. Will definately be giving these a go. xx
Oh thank you, thank you, thank you. I love Edwin and only have 1, now I will have 2! :O) I've been kind of down in the dumps and today, I got home, got the mail, had a wonderful card from one of my blog candy winners, and then I won! I feel better! Thanks so much!!! You've made my day :O)ReplyDelete
I love basic gray papers. I love your flowers tutorial! I've been checking out all kinds of flowers tutorial's lately, this is very pretty!!! Thanks for showing us! HugS! Leah AnnReplyDelete
Wow, these are really gorgeous, thanks!ReplyDelete
lol :-) Fab April Fool's joke I bet Liz laughed ha ha :-)ReplyDelete
LOVE the flowers ,, I have popped some of the Crinoline in my basket ,,I will definitely have a go at making these :-) Thanks for the inspiration Linda xx
Congratulations to the winners :-)
Lols x x x
beautiful flowers..!ReplyDelete
Pretty flowers. Nice tutorial.ReplyDelete
Great Tutorial - thanks for this! The flowers looks sooo wonderful.ReplyDelete
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Linda's Hat is divine!! She has such a variety of talents. Great tutorial. Thanks for the laugh!! EnjoyReplyDelete
Those flowers are gorgeous!ReplyDelete
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