text:
YAKIMA — The new chairman of a key Senate committee asked for a federal investigation Tuesday into leaking underground waste tanks at the nation's most contaminated nuclear site.
State and federal officials announced last week that six tanks at south-central Washington's Hanford Nuclear Reservation are leaking. The tanks hold a toxic and radioactive stew of waste left from decades of plutonium production for U.S. nuclear weapons.
The nuclear site borders the Columbia River, the Pacific Northwest's largest river that flows between Washington and Oregon, home state to Democratic Sen. Ron Wyden, the new chairman of the Senate Energy and Natural Resources Committee.
Wyden asked the Government Accountability Office by letter Tuesday to investigate when the Energy Department knew about the leaks and whether the agency and its cleanup contractors reported them appropriately. The letter also seeks a review of tank monitoring programs, including recommendations for changes.
"These new leak announcements raise a lot of questions about the monitoring and management of the Hanford tank farms," Wyden said in a statement. "After visiting Hanford for myself last week, I'm now asking GAO to get to the bottom of how and when DOE found out about these leaks, and what can be done to reduce the risk of radioactive waste contaminating the environment."
The federal government created Hanford in the 1940s as part of the top-secret Manhattan Project to build the atomic bomb. Today, it is the nation's most contaminated nuclear site, with cleanup expected to last decades and cost billions of dollars.
Central to that cleanup: the removal of millions of gallons of highly radioactive waste from 177 aging, underground tanks, many of which are known to have leaked in the past. Workers have since removed all liquids that could be pumped out from the tanks and reported the tanks were stabilized in 2005.
State and federal officials have stressed that the latest leaks pose no immediate threat to public health or the environment, because the tanks sit 5 miles from the Columbia River and the contaminants inside the tanks move very slowly. But the news has renewed discussion over delays for emptying the tanks, which were installed decades ago and are long past their 20-year life span.
-- The Associated Press


text:
Goldman Analysts Deserve a Thumbs Up for Their Zipcar Call
Less than two months ago Goldman Sachs analysts made a bold call on Zipcar: It upgraded to a buy rating, partly because it was looking like a takeover target.
Today, the analyst team, led by Steven Kent, looks pretty smart.
Goldman's buy rating, with a price target of $8.75, was the only such rating on the car rental company which today announced it had reached a deal to be sold to Avis for $12.25 a share. The buyout gave stockholders a 49% premium to Monday's close.
There had five analyst recommending investors buy the shares in July, before Zipcar reported dour second-quarter results that showed costs jumped and earnings plunge. Following those results, the Street turned sour, with three sell ratings and six neutral ratings, amid concerns about long-term growth potential.

subset: commoncrawl


text:
Bahamas police find 4 burnt bodies on remote cay
Police in the Bahamas say the badly burnt bodies of four people have been found on a remote southern cay of the sprawling archipelago.
The Royal Bahamas Defense Force said Sunday that the charred corpses of three men and one woman have been found on Anguilla Cay. The barren, uninhabited cay is relatively close to Cuba.
Lt. Commander Raymond King says tires appeared to have been set alight on top of the bodies.
He says investigators suspect the people may have been Haitian migrants. However, there was no sign of a vessel or any evidence to determine how the four victims arrived on the cay.
The corpses have been brought to New Providence, the main island of the country of over 700 islands, islets and cays off Florida's eastern coast.


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- 02 94 75 09 31 Lun-Gio: ore 10-18 · Ven: ore 10-16
we are glad about your interest in SeyVillas, the tour operator specialized on the Seychelles. We started this project a couple of years ago with a small team and a limited portfolio but the will to become the experts of this paradise. Nowadays we offer a high technology website, more than 150 accommodation (each with descriptions and pictures) and we sell the Seychelles all around the World in 4 different languages listening to our clients carefully and trying to build the perfect holiday for them.
Since the beginning we work directly with the owners of the hotels - building, day by day, a trustfull relationship. We visited the accommodation we offer in our website and we are constantly in touch with each owner for updates and important news.
Best regards from Germany,
Your SeyVillas Team
We, the SeyVillas Team, achieved a full knowledge of the destination thanks to personal visits, certifications, local contacts and constant updates about the Seychelles. We do our best to consult our clients, to answer them quickly and to build a holiday that matches with their preferences.
Here some comments from some hotels we have the pleasure to work with in these years:
"Super team. Always been a pleasure to work with. It is a privilege to work with SeyVillas. Really professional and communication is indeed excellent. We will continue to give and improve our services and in keeping the clientele happy and willing to come back."
"Chalets d'Anse Forbans have been working with the SeyVillas Team for over two years now. What most impresses us is that the team is very knowledgeable about the Seychelles and know the various properties they are selling very well. I have been very impressed that various members of the SeyVillas team visit from time to time to update themselves on the latest developments, and therefore all clients are reassured the property they have been sold will best suit their needs.
All emails are quickly answered and all clients special requests are passed on. We also really appreciate the prompt payment methods of the accounts department. The rooms sold by SeyVillas has increased greatly over this period of time and we look forward to many more years of bookings with this professional team of agents."
"All I can say is SeyVillas is one of the finest tour agent to work with composed of a team that is guaranteed to make your holiday success, the friendliest and experienced staff that you will be dealing with to plan your holiday away from home and come back home with unforgettable memories. They are the best. Keep up the good work guys. Kind regards"
"We have been privileged to work with SeyVillas for the last two years and it has been a great pleasure to work with a group of people who actually know their products. It makes such a difference when clients arrive at L'Habitation being well briefed by a professional team who have sampled our products and clients know exactly what to expect and thus make our job easier and results in very happy customers. There are odd little problems every now and then but nothing that cannot be sorted out and the end result is very satisfied customers."
"For one year now the Islander hotel is working with SeyVillas, we have found this travel agent to be really professional. communication with all the workers are so easy and efficient and really know what they are doing. Our occupancy with SeyVillas has really climbed the ladder. We are so satisfied because it is generating more income which we shall be able to upgrade our rooms and have a swimming pool in the near future. more facilities will be available to all our guests in general. As for the payment, this is top. even if you have forgotten to send in your invoice, you will find Walter or Michael who has sent the payment through the bank and this is really cool. keep up the good work because Seychelles and its people need you. From the Islander Villa"
We collaborate with the agencies on site Seyresa and Creole Travel Services for local assistance, transfer, tours and excursions.
For a new collaboration, questions or information, do no hesitate to contact us simply filling and sending us this form:


text:
I've got a new draft paper out with Nick Benton, Ultrametric Semantics of Reactive Programs.
We answer some longstanding open questions in FRP, namely:
1. What are higher-order reactive functions at all? How do you interpret them, and what are their semantics?
2. How can we implement FRP in a reasonable way, without compromising on either the equational theory or the ability to fit into the mutable callback event loop world of MVC?
It's got a little something for everyone -- some very pretty proof theory, some nice denotational semantics, and a hardcore separation logic proof with a step-indexed logical relation.


text:
Scenic Sunday #12
After a very long silence I am back to Scenic Sunday.
Here's a twilight shot on a hot spring day from Central Park.
My New York Minutes 15
Scenic Sunday comes weekly. Join us.
Amateur photog's online photo cache. All photos are original pics taken by author and her husband. This is not a place to see those awe inspiring Ansel Adams, these are ordinary subjects shot on a whim most of the time.
After a very long silence I am back to Scenic Sunday.
Here's a twilight shot on a hot spring day from Central Park.
My New York Minutes 15
Scenic Sunday comes weekly. Join us.
Gorgeous reflections!!
Serious, you've just been in N.Y for 15 minutes?
How come is that?
I'm planning to go over there, and I would love to stay more then 15 minutes ;)
Have a great sunday!
Nice picture from NY!//EvaReplyDelete
Great reflectionReplyDelete
Like this it looks like there is a balance between high buildings and green, I mean enough green space to compensate the concrete. I don't know if it feels that way when you live there.ReplyDelete
I've never seen such up close photos of Central Park - Very pretty & scenic, indeed!
Happy Scenic Sunday
Unique perspective of the city. Love the reflections.ReplyDelete
Love the reflection you captured and the light.ReplyDelete
A new view of the city!ReplyDelete
Photos like this with interesting water reflections make the city skyline look like a serene place!ReplyDelete
Superb capture. I love the Nature/concrete jungle contrast!ReplyDelete
beautiful light!ReplyDelete
Nothing beats the Central Park pond for reflective shots like yours - and moments of reflection on your own as well!ReplyDelete
the skyscrapers and the beautiful park...lovely combination indeed!ReplyDelete
You can almost forget you're in the city when you're in Central Park, can't you? Beautiful photo.ReplyDelete
That's an interesting view of the skyline and the sunlight on the buildings really warms the whole scene up...love that reflection in the water too. Thank goodness for parks and greenery. Great scenic shot...ReplyDelete
the soft light and reflection make this lovely.ReplyDelete
Makes NYC look like a tranquil place! Nice reflection and lovely capture of evening sunlight.
My most favorite place since living int he USA. Amazing skyline and a great picture. Great photography xxReplyDelete
great view of the city! i too like strolling on parks but cant find a really good one here.ReplyDelete
Love the city scene and the reflections on the water. Scenic it is.ReplyDelete
I love it ! Very creative ! That's actually really cool Thanks.ReplyDelete


text:
Do you agree with Josie,when at the conclusion of the meal with his girls, he states, "It (life) all
works out in the end"?
Created: 08/12/11
Replies: 4
Join Date: 08/11/11
Posts: 69
Join Date: 10/16/10
Posts: 84
I think that statement reflects more on Josie's character than it does on real life. Here's a man who left his family for a younger woman, refused to properly take care of his ex-wife, and then his ex-wife dies. Schine doesn't say so explicitly, but I think it's fairly clear that Betty would not have died if she had been comfortably ensconced at home, rather than living in a drafty cottage. In a way, you can see Betty's death as a result of Josie's treatment of her. I don't think Mirlanda and Annie would necessarily agree with this statement, either. Perhaps Miranda would see her relationship with Lynn as compensation enough for what she's lost, but I don't think Annie sees herself in a better situation.
Join Date: 06/13/11
Posts: 94
What a platitude! I think it is a total rationalization for his behavior. I have many friends, including myself, whose husband took up with a younger woman. Usually it is age 55 to 60 and they think a younger woman will make them younger. They all rationalize that the wife is better off without them and that they couldn't "help" themselves, they just fell "in love". The teenage romance image is so strong and they want to recapture it. In my case I have a much happier life by myself, but I think it takes its toll on the kids and grandkids; as Miranda and Annie discover. The new wife is never really accepted and the father has lost a lot of respect from his kids.
Join Date: 07/19/11
Posts: 2
I think the bigger statement here is that although we think we are living life in a reasonable way, we seldom take the big picture into consideration, much less give honest consideration to impact we have on our family. Sense doesn't always give way to grabbing a piece of life, while sensibility rarely allows for a life not based just on emmotion. Jane Austin's "Sense and Sensibility" make a case for each of these paths, but Cathleen Schine presents us a slighly different tilt. We must be both. Our lives are far more complex today and we must learn to value both our emmotional life and our practical life.
When Betty finds herself set adrift, she makes the basic change to survive, but denies the reality of her peril. Her daughters each have their own reasons for getting out of town and use the opportunity to deal with their own issues, but none of them seem to realize how inner connected they are.
I think these characters are very believeable, geniune and loveable. None seem too far fetched nor any of their actions out of character. The fact that Miranda would just decide to take up kayaking without a thought for doing it in open water.... Annie worries over the finances while Betty is oblivous to the amounts of money she spends to just keep up..... Funny stuff! The dialoge was right on for todays delimmas!
It matters not how a situation comes to us once it does... It matter how we deal with it. Things do "work out in the end"... that doesn't mean they worked out well... Josie did't sound too happy at the end. And he doesn't seem likely to have a change for the better. Felicity will have more control and he will have less freedom of choice. But it did "work out", just not as he thought it would!
Join Date: 05/19/11
Posts: 20
Please login to post a response.


text:
Law protects compassionate doctors
Doctors across Pennsylvania can now express sympathy to patients or their families following unanticipated medical outcomes without fearing their words will be used as evidence in liability lawsuits.
Gov. Tom Corbett on Wednesday signed into law the Benevolent Gesture Medical Professional Liability Act, which makes a health care provider's expression of commiseration or compassion - such as "I'm sorry" - inadmissible as evidence of liability, as long as its before the start of a lawsuit.
Lauded by state health care organizations and area lawyers, the safeguard excludes statements of negligence or fault, such as a misdiagnosis.
And it helps to break down a fear barrier many physicians feel while contemplating whether to apologize or express compassion after a bad outcome, said C. Richard Schott, M.D., president of the Pennsylvania Medical Society.
He referenced past situations in which doctors worried patients or families would "turn or twist" their apology or condolences into an admission of doing something wrong, leading to a malpractice liability claim.
"Clearly saying 'I'm sorry' doesn't necessarily mean there has been anything wrong done," Dr. Schott said.
Health care experts and trial lawyers say the legislation could also reduce medical malpractice claims and foster better patient-doctor relationships.
Andy Carter, CEO of the Hospital & Healthsystem Association of Pennsylvania, described the bill as a "significant win for Pennsylvanians and the hospitals that serve them."
While the legislation doesn't prevent patients from filing a liability lawsuit, it encourages an open discussion that "can lead to (a) resolution without the excessive costs" of going to court, he said.
An internal medicine physician in Scranton, Ariane Conaboy, D.O., said doctors have a moral and ethical responsibility to patients to try and achieve the best outcome.
"That being said, medicine is not exact science and can be unpredictable at times," said Dr. Conaboy, vice president of the Lackawanna County Medical Society.
"Now, physicians can have a very, very difficult but true and telling conversation with the family without worrying. It helps open the dialogue."
Scranton-based attorney David Fallk said officials should be focused on reducing the unnecessarily high rate of errors and consequent injuries and deaths.
But he added, "doctors owe their allegiance to their patients and full and open communication with them is paramount, especially when things go wrong. Truth is always the right thing."
Contact the writer: email@example.com, @miorfinoTT on Twitter


text:
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text: 09 Apr 2014 14:00 Etihad Airways, the national airline of the United Arab Emirates, has picked up two coveted Travelplus Awards for its unique 'Inspired by Sougha' amenity bags and its new all-natural First Class COCO-MAT bedding. The airline won the awards for 'Ethically Sustainable Amenity Kit' and 'In-Flight Amenity-Gift' at the annual Travelplus gala awards ceremony held yesterday in Hamburg. The Airline Amenity Bag Awards 2013 celebrate the best onboard comfort and hospitality products in the airline industry, and the innovation, creativity and design of both the airlines and their onboard suppliers. Over 120 submissions and entries in 20 categories were judged using a strict set of criteria covering trend, pleasure, luxury, usability and style. Peter Baumgartner, Chief Commercial Officer of Etihad Airways, said: "Sougha means 'a traveller's gift' in Arabic and we introduced our new amenity kits to provide something uniquely Arabian to our guests, and more importantly, as a way of supporting and celebrating local Emirati craftsmanship on a global stage. "To also receive an award for our Diamond First Class COCO-MAT bedding so soon after we introduced it onboard is a testament to the high standards of this unique all-natural product. Guest feedback has been universally positive, and Etihad Airways will continue to place great emphasis on providing the best sleep in the air." Launched in February this year, the new kits are the result of Etihad Airways' partnership with Sougha, a social enterprise initiative launched by the Khalifa Fund for Enterprise Development, which aims to preserve Emirati traditions and promote local artisans. The new amenity bags are offered in Diamond First, Pearl Business and Coral Economy cabins and feature patterns of Sadou, a colourful, intricate and centuries-old Abu Dhabi weaving craft traditionally used on blankets, cushions and Bedouin tents. Exclusive COCO-MAT multi-layered mattresses, made from extracts of the Hevea tree, and large down feather duvets and pillows were introduced in the airline's Diamond First Class suites in March of this year. Etihad Airways is the only airline to offer this bespoke product onboard. Athens-based COCO-MAT is widely considered the world's leading manufacturer of sustainably sourced sleep products. Contact met Etihad Als wereldwijd opererende luchtvaartmaatschappij hebben wij natuurlijk overal ter wereld vestigingen. Lees hoe u contact kunt opnemen met uw dichtstbijzijnde Etihad-kantoor. Bekijk onze contactgegevens Feedback Als u een opmerking, compliment of klacht wilt doorgeven, of een vraag wilt stellen, klik dan hier Vind ons leuk Bezoek onze Facebookpagina! Bekijk ons Bekijk ons YouTube-kanaal! Volg ons Etihad Airways | Etihad Aanbiedingen | Etihad Help | Etihad Rewards


text:
By Claire Markham, KF16, Kenya
In the developed world, the recent increased attention to global warming and the importance of environmental preservation and restoration efforts is something that's hard to ignore. It's because of this ongoing Environmental Revolution that the majority of the population is aware of the increasing need to pay attention to our footprint. Regardless of whether or not people actually do their part or even believe in global warming, most people have at least been educated of the potential consequences of neglecting the environment and the harm we are causing both in the present and for future generations.
In Kenya, I have found this is not necessarily the case in my experiences so far. This realization becomes abundantly clear to me as I sit in traffic worse than anything I've encountered before and watch as passengers in my matatu nonchalantly throw their trash out the window, despite the stench of the burning garbage piles next to the road already permeating the vehicle. I am not saying this is true across the country for all Kenyans but am basing these observations solely on my experiences thus far from living in Nairobi and travels to several other urban and rural areas.
One of my tasks at SMEP is to help grow their green and water loan program. When I realized the cultural barriers to going green, I appreciated the enormous challenges that would lie ahead of me. When the borrowers that we work with so often have to worry about ensuring there is enough food on the table or money for school fees, adding the responsibility of being conscious of their environmental impact can be a hard notion to sell. How can an MFI break through these obstacles and implement a successful green and water loan program when so much of the population, including our borrowers, aren't environmentally aware?
This two-part blog post will attempt to answer this question. In this first part, I identify what the barriers are. In the second part, I will elaborate on the strategies that can be used to overcome these obstacles.
What are the barriers?
There are a wide variety of reasons that going green is a foreign concept in Kenya: lack of environmental education, inadequate waste collection, shorter time frame of decisions, and the side effects on the well educated, higher income population. This is by no means a comprehensive list, but rather what I have been able to observe in my experiences in Kenya thus far.
When asked about whether Kenyans are aware of their impact on the environment, one of my colleagues responded, "People with lower to middle income levels are not aware of their impact. Everyone else knows but just doesn't care." I will first focus on the enormous group of people who do not know about their impact and the challenges they face.
Lack of environmental education
In the developed world, children are educated about the environment from a young age. They are subject to repeat reinforcement of this message through means such as Earth Day. In Kenya, these educational programs are simply not in place to inform children about such matters. Children see their parents and friends act in a certain way and they follow; this serves as a repeat reminder to them that littering and polluting are acceptable. Without educational programs to inform them otherwise, how are they supposed to know to act differently?
Inadequate waste collection
Littering is considered to be an acceptable practice in Kenya. It is exceedingly common to see people throw their garbage on the street without hesitation. I think this is in part a result of the waste collection system; it is not a free service and if you would like somebody to pick up the garbage from your home, you are going to have to pay. In the slums, where disposable income is scarce, the residents simply cannot afford to pay someone to collect their garbage. Their only other option is to throw their garbage on the streets, and when the pile grows too large, they burn it.
Differences in time frame
In a country that struggles with famine, poverty and unemployment, the time frame of decisions become much shorter. The difficulty with environmental degradation is that many of its effects are often not immediate. One of the main selling points of caring for the environment is being able to ensure that future generations are able to enjoy the same beauty and cleanliness of the earth as we have been fortunate enough to experience. One of the motivations comes from knowing that our great grandchildren will benefit from our efforts now.
In the areas of Kenya which are devastated by poverty, such a long term time horizon does not exist. When concerns over whether someone will actually be able to provide food for their children that week are prominent, providing a clean environment for their great grandchildren becomes less of a focus.
There are certainly also immediate effects of environment neglect including a shortage of potable water due to a lack of proper waste management. The lack of access to clean water can in itself cause a variety of illnesses. Additionally, the conditions of many that live in polluted environments are at a heightened risk of diseases spreading more rapidly throughout the community. The difficulty here links back to one of the previously discussed barriers: lack of education. Many people are not aware that the challenges they face now with disease and poor water quality is in fact related to their own current actions. Another reason the immediate effects are ignored is lack of proper infrastructure and waste management as mentioned above.
Side effects on the educated higher income population
The preceding three points are issues facing people in the lower to middle income segments of the population. What about the well-educated, higher-income individuals who do know about their impact on the environment but choose not to act on it? One of the reasons they often fail to change their behaviours is because there is very limited negative stigma attached to acting in a non-environmentally friendly manner. It takes the contributions of everyone in society to make an impact; it is discouraging to make an effort towards a goal and look around and see rarely anyone else doing their part. What can be done to motivate all individuals to take their impact on the environment into consideration?
As you can see, there are significant obstacles to implementing a green and water loan program. However, this is not an impossible task and there are many ways to help microfinance clients to go green and educate them about their role in working with the environment rather than harming it. The growth in environmental awareness has huge potential in helping generate additional income and cost savings for Kenyan borrowers. Please stay tuned for my next blog post where I address strategies that can be used to overcome these barriers.
Claire Markham is part of KF16, serving with SMEP Deposit Taking Microfinance Limited (SMEP) in Nairobi, Kenya. To lend to SMEP's borrowers, become part of the SMEP lending team.


text:
Carolina Veterinary Specialists (CVS) is paying a signing bonus as we look for an Emergency Veterinarian to join our growing team of doctors and staff in Greensboro. Applicant should be internship trained, or have equivalent experience. For interested candidates, medical leadership opportunities are also available.
CVS operates six full service emergency & specialty referral facilities in the Carolinas, with locations in Huntersville, Charlotte, Matthews, Rock Hill, Greensboro, and Winston-Salem. Each location provides multiple referral specialties, as well as 24-hour emergency and critical care. Greensboro and Winston-Salem also have a Board Certified Criticalist, as well as a VTS certified technician.
Our Greensboro location is equipped to offer state of the art diagnostic and surgical procedures and features in-house helical CT, color-flow Doppler ultrasound, digital radiography, endoscopy, laparoscopy, complete anesthetic monitoring, and in-house laboratory capabilities.
The cost of living here is amazing. Real estate is very affordable. The money you earn will go a lot further here. And with that money in your pocket, you can enjoy lots of craft beer, excellent local restaurants, martini bars or whiskey bars. We have professional baseball, professional basketball, and multiple colleges in the city for college sports. Within a short driving distance we have major universities including UNC Chapel Hill, Duke University, and Wake Forest University, so you can easily enjoy all those universities have to offer. We are 3 hours from the beach and 1 1/2 hours from the mountains. We have an active cycling community with lots of trails and a greenway that runs through the city for cyclists to enjoy. We have multiple lakes for kayakers and boaters.
Our employees' quality of life outside of the practice is something we strongly value and support. We offer great compensation packages, including competitive salary, benefits, CE allowance, productivity bonuses, reimbursement of membership dues, relocation assistance (if applicable), and PTO. To apply, send your resume to Dr Shannon Bass at firstname.lastname@example.com.


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High noon: Obama and House GOP
President Barack Obama tangled with House Republicans for more than an hour Wednesday, answering questions on topics ranging from whether the White House spends too much time campaigning to how serious the administration is about slashing the nation's deficit.
Republicans focused on political issues — quizzing Obama on why his White House stopped giving tours after the sequester took effect. But the House GOP also delved into policy, where Republicans heard Obama say he doesn't want to balance the budget in 10 years. That's the challenge issued by Rep. Paul Ryan in the GOP budget unveiled on Tuesday.
Story Continued Below
It was the first opportunity House Republicans had in nearly two years to directly confront Obama, a president that many of them were elected by lambasting, and all of them tried to defeat in 2012.
The exchange — which was serious, but interspersed with a few jokes — allowed the GOP lawmakers to vent on a range of concerns, including the time they think Obama spends campaigning against them. They're concerned that Obama's not committed to lowering the deficit and whether the president's so-called "charm offensive" in reaching out to lawmakers to strike a grand bargain on the deficit is sincere. Obama shook hands and answered private questions after the session, a source said.
The meeting was part of an aggressive outreach effort by the president to Hill lawmakers to try and find common ground on the deficit. On Tuesday, Obama met with Senate Democrats, and on Thursday, he will meet with Senate Republicans and House Democrats. Obama met with Senate Democrats on the Hill on Tuesday.
A White House official called the meeting a "good, substantive exchange" and said Obama "enjoyed the conversation."The aide said that the two parties didn't need to agree on everything to compromise on some things.
"The President handled a variety of questions on a range of topics from the members and reinforced his strong desire, especially now that the election is over, to find bipartisan common ground on a range of legislative priorities," the aide said.
The president heard from old and new faces. None of the issues that surfaced, though, were a complete surprise.
Rep. James Lankford (R-Okla.) — the Republican Policy Committee chairman — brought up a familiar hobby-horse for House Republicans: that Obama is always campaigning.
He asked about Organizing for Action's (OFA) meeting. He complained that Obama called Democratic Congressional Campaign Committee Chair Steve Israel (D-N.Y.) before Boehner on election night. Obama said that wasn't true and that he had called Boehner, but Boehner had gone to sleep, according to a source familiar with the meeting. The speaker said the president was right, the source said.
Lankford argued that Obama is too focused on defeating House Republicans instead of "saving the next generation" from debt problems. He then mentioned Bill Clinton working successfully to balance the budget and asked if he'd commit to balancing the budget in 10 years, as Ryan's budget dictates.
"OFA is organized around issues rather than 2014," Obama said in a lengthy, 10-minute answer to Lankford, according to a source inside the meeting.


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If you really have two left feet then I recommend you see prosthetician. He may need to amputate the extra left foot and replace it with the right foot. But please check with your medical doctor.
In dance people often use this phrase to refer to pedis confusio. Literally this means "feet confusion". This disease is the result of an underdeveloped coordination of the mind and feet. Don't worry, dysentery Dr. Swing can help with this problem. The problem manifests itself as an in ability to step with the desired foot, malady especially while the dance instructor is shouting "right, prostate now left". This can cause marital difficulties, too, if your partner is also your spouse. As such, you can imagine that this is a very important disease to treat.
Treatment usually consists of the patient spending time alone practicing stepping with their right foot then their left foot… over and over. Do this for 10-15 minutes at a time, a couple times a day. After a week or so, practice this exercise to music. Try to step with the music… if you have problems stepping with the music you may have another related disease: nullus audio rhythmos (can't hear the rhythm), which is the subject for another day.
After mastery of this simple exercise the patient must practice stepping in different directions, preferably in time with the music. Try stepping across the front of your body (e.g., with your right foot step to the left of your body, crossing over your left foot). Step to the right, left, backwards, forwards, etc.. Step in as many directions as possible, be creative.
Through these exercises and persistance, you will develope the ability to step with the desired foot and the disease will be cured.
Good luck! Don't hesitate to call if you need professional assistance. The Doctor is always available. In case of emergency, dial 911.


text:
Day by day we learn more about why U.S. officials and security forces failed to protect Ambassador Chris Stevens and three other Americans killed during Sept. 11 attacks in the strife-torn Libyan city of Benghazi. Congressional testimony by former security officials, expansive news accounts and a trove of emails and diplomatic cables from Stevens have begun to illuminate what went wrong.
This unfolding inquest is about more than assessing blame. The U.S. stations diplomats around the globe, often in hostile locales. We expect Washington to protect those diplomats — and, when they need help, to be ready to mount a prompt and muscular rescue. Americans and their elected representatives need to understand what went wrong in order to keep other diplomats from suffering the same fate.
Among the fresh and disturbing details on dangerous prelude, the attacks and the U.S. response:
— The system was blinking red: In the months before the attacks, Stevens and his security staff fired off a series of diplomatic messages to the Obama administration warning that security in Benghazi was deteriorating. In an Aug. 15 "emergency meeting" at the U.S. consulate, the State Department's regional security officer warned of al-Qaida training camps in Benghazi and expressed doubts about "the ability to defend Post in the event of a coordinated attack due to limited manpower, security measures, weapons capabilities, host nation support and the overall size of the compound," according to a classified cable reviewed by Fox News (and not disputed by the administration).
Chillingly, on Sept. 11, hours before the first attack, Stevens wrote to Washington specifically of "growing problems with security" in Benghazi. He described his "growing frustration" that security forces and Libyan police were too weak to protect the consulate or keep Libya secure. The response from Washington to all of these warnings? We don't yet know.
— There evidently was confusion between the Central Intelligence Agency, which had a nearby outpost, and the State Department about who was in charge of consulate security. That may have delayed an effective response. The Wall Street Journal reported: A seven-man CIA security team was dispatched within 25 minutes of the first attack at 9:40 p.m. Benghazi time. When they arrived, the consulate was on fire. The CIA team evacuated most American officials before midnight, but Stevens and another State employee were already dead. Congressional investigators told the Journal that the CIA and State Department "weren't on the same page about their respective roles on security, underlining the rift between agencies over taking responsibility and raising questions about whether the security arrangement in Benghazi was flawed."
Judging by the outcome, there is no question: Despite warnings from Stevens and others, the consulate was poorly protected. Given that this was the anniversary of the 2001 terror attacks on the U.S., that's especially perplexing.
— The U.S. didn't have military rapid-reaction teams — Special Forces or armed drones — close enough to help thwart the terrorists, The New York Times has reported: A quick-strike force had to be scrambled from the U.S. regional command in Europe because U.S. Africa Command forces were still being trained. Africa Command, established in 2007, had no heavily armed ground-attack aircraft or armed drones readily available, the Times reported. The Pentagon also took the extraordinary step of dispatching elite Delta Force commandos from their base at Fort Bragg, N.C. None of the American forces arrived in time to thwart the attacks — either at the consulate or, a few hours later, when the CIA outpost was attacked. The Los Angeles Times quoted a former Air Force general suggesting that thundering, low-flying U.S. warplanes — had they been dispatched — could have scared off the attackers, even without firing into the neighborhood.
From the start, the administration's accounts of what happened in Benghazi have been muddled and inconsistent. State Department officials have distanced themselves from the White House account, which initially blamed an anti-Muslim video for provoking the attacks. Inexplicably, U.S. ambassador to the United Nations Susan Rice was still parroting that line days later, despite growing U.S. intelligence to the contrary.
In congressional testimony, the U.S. security commander in Libya, Lt. Col. Andrew Wood of the Utah National Guard, said the attacks were "instantly recognizable" as terrorism, not a protest over insults to Islam. The State Department's regional security officer, Eric Nordstrom, reiterated what his cables had warned: State was withdrawing U.S. security too quickly from Benghazi and replacing it with untested Libyan guards. Congress had slightly reduced the administration's request for protecting U.S. diplomatic sites worldwide. But it's unclear whether budget constraints contributed to this epic failure.
Many questions remain. The Benghazi debacle demands answers, not political maneuvering or bureaucratic finger-pointing. Chris Stevens and three other Americans are dead. The Obama administration and those that succeed it need to make sure there is no sequel to Benghazi at a U.S. diplomatic outpost on some future Sept. 11 — or any other day.
— The Chicago Tribune
From the start, the administration's accounts of what happened in Benghazi have been muddled and inconsistent.


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Monday, November 2, 2009
Memory Monday: Scary Movies
Why do most little kids enjoy being frightened? Not truly frightened, of course, but Haunted House Frightened or Scary Movie Frightened. Those were states of fear that were not inspired by anything actually existing, but rather by seeing something scary on TV or at the movies or by participating in a created scary scenario such as a haunted house or a Halloween lawn display (you know, the ones with mummies, Frankensteins, brains-in-a-box, etc.).
I was a total scary movie addict from an early age, and many of my friends were, too. We must have enjoyed that adrenalin rush. The movie did not have to have high production values to have its intended effect – heck, Frankenstein's Daughter scared the living daylights out of me. Yet, some classic horror movies – Frankenstein, Bride of Frankenstein, and the Bela Lugosi Dracula movies – did not scare me at all. I remember that TV Guide used to describe them as "melodramas," and this was probably a better description. Still, they were fascinating, too, especially Elsa Lanchester's hair as the Bride of Frankenstein.
My best bet for catching a horror show was on the Early Show, since I was not allowed to stay up past 7:30. But the Early Show rarely featured anything higher on the Fright Scale than the Frankenstein/Wolfman/Dracula/Mummy classics. And the "horror" movies shown during the day on the weekends were mostly Creature from the Black Lagoon caliber – So Not Scary.
The Real Scary Stuff was either on the Late Show (or even better, the Late, Late Show) or on Chiller Theatre at 10:00 on Saturday night. When my parents were home, this was an impossible dream. Not only would they never allow me to stay up late, but they had no interest in horror movies.
The nights when my big brother Don babysat me were another matter. If these movies were on TV, Don would be watching them. And especially when his friends came over to watch TV with him, there was at least a small chance that I could sneak into the living room behind the sofa and catch a peak.
I would wait until the lights were turned off and the smell of popcorn wafted back along the hall to my bedroom. This meant that Don and his friends were absorbed in the movie and in eating. Then I would creep down from the bed and out into the hall, where I slithered, down on the floor next to the wall, until I reached the living room. The trick was never to let the textured plastic bottoms on the feet of my Dr. Denton's touch the floor, because they would make a loud, sticky sound that would immediately give away my presence. It was therefore necessary to creep along on my hands and knees, with my toes pointed backward so that only the soft flannel came into contact with the floor.
After I finally made it to the living room, I moved extremely slowly and attempted to position myself perfectly in the corner so that I could see the TV screen without being seen.
There were many great horror films that I viewed in 5-, 10-, and maybe even 15-minute segments. Because that's how long I usually remained undetected. At least Don's friends usually pled the case for letting me have a handful of popcorn before I was sent back, crestfallen, to my bedroom.
There was one truly scary movie (well, it scared me) that I remember seeing on the Early Show: The Beast with Five Fingers. No other scary movie affected my behavior for such a long period of time. For months after viewing it, every night at bedtime, I was very careful to pull the covers up over my chin. Because you never know when a disembodied hand is going to crawl up on your bed and try to strangle you.
10 comments:
Oooh, I used to love scary movies. That is, until I became an adult. [sigh.] One of my older sisters especially liked to torment me. Oh well, that's what sisters are for, right? She did tell a good scary & haunted story for my slumber parties, guaranteed to scare the living daylights out of you. Ah. The good ol' days. Thanks for the post and walk down memory lane!ReplyDelete
Oh, some of those scary stories told at parties gave me nightmares for years to come! I think our imaginations can cook up really frightening pictures, perhaps even more so than the movies. Thanks for stopping by!ReplyDelete
Scary movies and ghost stories combined with the Ouija Board...the stuff that pajama parties back in elementary school were made of. I always found that when I was home and in bed by myself that those movies would come back to haunt me. No way I could watch one now...lolReplyDelete
Linda - Yes, it's much easier to be brave when someone else is there. But when you're in your own bed, all alone, Yikes!ReplyDelete
Greta, I laughed so hard at your description of the Dr. Denton's making the noise against the floor - I could actually hear it in my head!!!! That's something I had completely forgotten about! I was also a scary movie addict - I grew up on the 1960s-70s british horror movies that were on the "Creature Double Feature" saturday afternoons. Loved them!ReplyDelete
Leah - Yes, that noise gave me away on more than one occasion.ReplyDelete
And I totally forgot about Creature Feature! I think that was the name of the horror flick show that was on here in the DC area. If I am not mistaken, "Count Gore DeVol" is still around. British horror movies - Christopher Lee - oh, yeah!
You were braver than I was. I usually begged to watch them and if Pap let me-then I begged for someone to sleep with me until somebody gave in : )ReplyDelete
Tipper - Oh, I remember, that sleeping part after seeing the movie was always the hard part!ReplyDelete
You have great taste in movies. I've been able to introduce my wife to some of these, but I don't think she'll ever love them as much as folks like us.ReplyDelete
dmsbr - Ah, good to find someone who appreciates the good old movies the way we do!ReplyDelete


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SAMJ: South African Medical Journal
versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.101 no.7 Cape Town jul. 2011
Improving operating theatre efficiency in South Africa
A B van As; Z Brey; A Numanoglu
South African health and wellbeing indicators are poor for a middle-income country, and are usually attributed to inequity.1 Despite notable successes,2,3 South Africa's Gini co-efficient is one of the highest globally, compounded by weaknesses in implementation and planning, lack of creativity in designing incentive frameworks, and shortfalls in management and information systems.
The Western Cape Provincial Administration has developed the Comprehensive Service Plan (CSP), aided by the provincial Burden of Disease Project. The plan sets out how health services in the Western Cape will be provided; what health services will be provided at tertiary, regional and district level; and what is needed to provide the service. Its goal is to improve service delivery by ensuring that approximately 3.5 million uninsured patients using the services are treated at the level of care appropriate to their need, with better access to services.
The situation is complicated by the high levels of trauma and HIV in South Africa. Trauma is a leading cause of admission to all provincial hospitals and for patients to require a surgical procedure.4 Of all acute trauma, 80 - 90% present 'after hours'; and trauma patients often require emergency surgery. The trauma burden unpredictability and mismatch between supply and demand poses particular challenges for systems improvement and streamlining. Although the unpredictability is largely a product of the occurrence of accidents, managers and clinicians can identify patterns usefully. During office hours, work-related injuries are more likely to occur, while most stabbings and firearm injuries take place on weekends and pay days. Mapping of injury patterns can facilitate identifying the mismatch between supply and demand.
HIV/AIDS also affects the spectrum of diseases in hospitals, and its complications have increased their clinical loads. Although children infected or exposed to HIV/AIDS may have a higher rate of complications, surgery can be performed safely and should not be withheld.
Nationally, significant funds have been shifted to primary health care (PHC), and over 500 new primary level facilities constructed,5 but the latter do not function optimally.2 These services are largely nurse-driven but their development is often sub-optimal, with skills shortages, poor supply chains and inadequate support for nursebased services. The quality of care in many public hospitals is suboptimal, compounded by many higher-paid public sector employees using private health services and not being affected as services deteriorate.6
In the state health system, it is difficult to reward staff members who can improve efficiencies - they are more likely to be 'punished' for being efficient. For example, if patients are distributed across provincial services for a procedure X with an average waiting time of 3 months before the procedure can take place, an efficient facility that reduces this waiting time to 2 months will be over-burdened by patients from elsewhere, so creating a negative incentive loop. It is helpful to think of operating theatre utilisation from 3 aspects: Demand (number of patients, number of procedures); operating theatre (utilisation); and supply of beds (postoperatively). Each aspect has a set of criteria that directly affect the efficiency of any given operating theatre (Table I).
Since surgical specialists have criticised the Western Cape Department of Health because of the decline of available surgical slates, theatre efficiency is a key issue. Therefore the Department intends to develop a provincial policy to eliminate ineffective and wasteful use of the available theatre slates.
The UK's NHS has experimented with the 'Productive Ward and Productive Theatre' concept, with modest results, but the potential for further improvement was astounding. An average Trust (that has about 16 theatres) could save more than £7 million.7 This included savings on theatre time, consumables and specialist time.
Measuring theatre efficiency
Efficiency and productivity are often used as synonyms. Successful operating theatre work is based on interdependent communication and understanding between the involved parties. Unfortunately, there is still no overall definition of the concept of efficiency. Staff members generally believe that increased efficiency means increased stress and workload.8 Operating room efficiency outcomes should include patient safety, high quality of care, and cost-effectiveness and access. International indicators to measure theatre efficiency9 can be categorised into two main groups:
1. Pre-operative performance indicators
1.1 Admission time to procedure start time. This is the time difference between the admission time and the procedure start time for selected emergency procedures that may be further subdivided according to specific diagnoses. Examples are the time difference between admission time and procedure start time; e.g. stabbed abdomen (very acute), compound fracture (could probably be performed during day hours) and appendicitis (an emergency probably falling between the previous two).
1.2 Ratio elective/emergency cases. The percentage of elective and emergency cases by a hospital is also a vital measurement for measuring theatre efficiency. Hospitals that have 100% elective cases can be better and more efficiently organised than hospitals where the theatre load comprises only irregularly presenting emergencies. Studies have shown that elective cases can vary from a few per cent to 99%. Paediatric surgery units often have 70 - 80% of their cases categorised as emergencies, making theatre usage even more difficult.
1.3 Cancellation rates by reason. Measuring cancellation rates on the day of surgery by reason is an internationally accepted methodology to assess operating theatre efficiency and management. Typical categories for cancellation are: Insufficient theatre time, no postoperative bed available, changed clinical condition, cancelled by patient, and patient not ready for surgery. It may, however, be difficult to compare various hospitals since there are many complex factors that vary between hospitals that can influence the cancellation rates e.g. general workload and turn-over, and availability of both pre-and postoperative surgical beds (also specialised high care beds and intensive care beds required).
1.4 Availability of surgical beds. Availability of surgical beds is another performance indicator that assesses the availability of postoperative surgical beds (earmarked beds). The efficiency with which surgical beds are managed directly affects their availability at the right time.
2. Intra-operative performance indicators
2.1 Average procedure time. This analyses the average procedure done in minutes for common diagnoses. Studies show that few diagnoses can be compared because of the range of procedures for which it is not appropriate to calculate an average procedure time. Since South Africa's burden of disease differs from other countries, an analysis of the diagnoses that can be utilised for this measurement may be required. An innovative way to analyse this problem is to construct a 2 x 2 matrix that looks at procedure time and complexity; this allows planning around quadrants ranging from highly complex and of long duration v. highly complex and of short duration (Fig. 1).
A prerequisite for this specific measurement is to establish clear, strict and agreed-upon definitions of times e.g.:10
Anaesthesia start time: The time when the anaesthetist is preparing the patient.
Procedure/surgery start time: The earliest time of either specific positioning of the patient or skin preparation.
Procedure/surgery finish time: The time when all instrument counts are complete and verified, all postoperative radiological studies performed and completed, and all dressings and drains secured.
Patient out of room time: The time at which a patient leaves the operating theatre.
Out of recovery time: The time at which the patient is transported out of the recovery room.
In the absence of clear definitions and understanding of these times by all staff, measurements will be insignificant.
2.2 Change-over time. Change-over time is the time between cases in minutes. There will be large differences between 'clean' and 'septic' as well as between 'emergency' and 'elective' cases. It is difficult to compare the change-over time between institutions and hospitals since many factors differ, e.g. cleaning and sterilisation of the theatre between cases may depend on the theatre infrastructure and equipment, the amount of contamination of the operating theatre during the previous procedure, and theatre staff availability.10 It is critical to determine the impact of 'controllable' hold-ups such as porters, laboratory results, equipment availability, and surgeon availability.
2.3 Ratio of utilised theatre time/total theatre time. Measuring the total procedure time as a percentage of the total time (Monday to Friday) is useful to improve the utilisation of non-surgical time through improving operating theatre management. Delays, preparation time and clean-up time or inefficient scheduling would typically account for non-surgical time.10 Theatre managers must ensure that departmental staffing matches the clinical activity and is sufficient to cover elective and emergency operating lists and to deal with the unexpected. Internationally, it is agreed that theatres should not run at 100% capacity and that a 70 - 80% utilisation is ideal. Many countries, including South Africa, run theatres at only 30 - 40%.
In these measurements, it is important to understand that any efficiency indicator of operating theatre management must consider the resource inputs to achieve such efficiency. Any overall measurements of theatre activity should be measured in terms of full staff equivalent, which is difficult in South Africa owing to shortages of nursing staff, anaesthetists and/or surgeons.
How hospitals and operating theatres are managed and run varies significantly, and it is difficult to recommend a single format. Differences in practice of forecasting, utilisation, and management of working lists, sessions, non-elective surgery, discharge and posthospital care indicate the need for continuous system improvement.
Operating theatres are complex entities and could be described as the engine room of hospitals. To run a theatre efficiently, there must be interaction and close co-operation between theatre personnel (nurses, anaesthetists and surgeons) and many others such as porters, technicians, IT managers, supply chain people and pharmacists. Making a small change in theatre management affects the activities of many health professionals working inside and outside the theatre complex.
Effective operating theatre management depends on many external processes that may or may not co-ordinate with the operating theatres processes. The relevant and appropriateness of data and data collection processes to effectively manage operating theatres must be improved, including a strong case for considering theatre efficiencies. If a tertiary hospital with 20 theatres 'operates' 1 000 hours per week with theatres running at 60% efficiency, an increase to 70% could release over 5 000 hours of operating time per year. The emphasis should be on better utilisation of existing resources, and not solely on acquiring additional resources. This can be done in several ways by aligning demand and supply (where possible), ensuring support staff availability, maximising theatre utilisation, and optimising patient selection and surgical bed utilisation. Theatre time is said to cost R14 000 per hour.7 The relative cost saving could therefore be R70 million per annum for an institution.
We make three main recommendations to deal with these issues:
1. Allocating a director of theatre services with full budgetary authority, adequate sessional allowance, accountability and knowledge about information and administration systems is a key requirement.11 This director should be a senior staff member with a clear understanding and experience of working in operating theatres, and have a broad view across specialities.
2. A theatre manager must be appointed to each theatre, to be in charge of the day-to-day running of theatres and collecting accurate data. The appointee should preferably be a senior nurse or doctor located within the theatre complex. Both the departments of anaesthesia and surgery should appoint a specialist in each hospital, the so-called rota-maker, who ensures that all operating lists are staffed with a suitable trained clinician and that, where possible, medical staff are allocated to cover for absence.
3. Because of the complexity of theatre complex activities, proper communication is paramount. All hospitals should institute regular theatre management meetings with the different theatre user groups to anticipate and discuss problems, promulgate new ideas, agree on strategies, and report on theatre efficiency.
Although we tend to equate poor health care with lack of funding, the health care system can be improved by appropriate assessment of surgical procedures, taking the serious constraints into consideration. Improving the utilisation of available theatres and increasing their efficiency can be achieved by strengthening incentives for performance and linking funding more explicitly to efficiency and quality. Invigorating theatre management will add significant value and lead to better health for all.
We thank Dr A Reed and Mrs E Fourie for their valuable comments in compiling this manuscript.
1. World Health Organization. World Development Report 2001. Geneva: World Health Organization, 2001. [ Links ]
2. Department of Health. Annual report 2001/2002. Pretoria: Department of Health, 2002. [ Links ]
3. Health Systems Trust. South African Health Review 2000. Durban: Health Systems Trust, 2000. [ Links ]
4. van As AB, Navsaria P, Numanoglu A, McCulloch M. Modified sandwich vacuum pack technique for temporary closure of abdominal wounds: An African perspective. M Acta Clinica Belgica 2007;62(1):215-219. [ Links ]
5. National Treasury. Intergovernmental Fiscal Review. Pretoria: National Treasury, 2001. [ Links ]
6. Registrar of Medical Schemes. Annual Report 2001. Pretoria: Registrar of Medical Schemes, 2002. [ Links ]
7. NHS Institute. The productive theatre - improving quality and efficiency in the operating theatre. http://www.institute.nhs.uk/quality_and_value/productivity_series/the_productive_operating_theatre.html (accessed 28 February 2011). [ Links ]
8. Arakelian E, Gunningberg L, Larsson J. Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study. Acta Anaesthesiologica Scandinavica 2008;52(10):1423-1428. [ Links ]
9. NSW Health. Operating Theatre Management Project Report 2002. http://www.health.nsw.gov.au/pubs/2002/pdf/op_theatre_mgmt_repo.pdf (accessed 28 February 2011). [ Links ]
10. Friedman, AM, Sokal SM, Yuchiao Chang MSPH, Beger DL. Increasing operating rooom efficiency through parallel processing. Ann Surg 2006;243(1):10-14. [ Links ]
11. The Association of Anaesthesists of Great Britain and Ireland. Theatre efficiency; Safety, quality of care and optimal use of resources. August 2003. http://www.aagbi.org/publications/guidelines/docs/theatreefficiency03.pdf (accessed 31 January 2008). [ Links ]
Professor Sebastian van As is Head of the Trauma Unit at the Red Cross War Memorial Children's Hospital, and President of Childsafe South Africa.
Dr Zameer Brey is Research Assistant, Office of the Dean, UCT Medical School, and serves on the recently appointed Western Cape Health Independent Complaints Commission.
Professor Alp Numanoglu is Associate Professor in the Department of Paediatric Surgery at the Red Cross War Memorial Children's Hospital, and was heavily involved with the design of the new theatre complex.
Corresponding author: A van As (email@example.com)


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With a 27-year history of drinking, using drugs and sleeping with hundreds of women, Greg Braxton's AIDS diagnosis in 1994 came as no surprise. He'd blown through a string of careers because of his addictions: steel mill worker, Chicago police officer, taxi driver, bus driver. Even after his diagnosis, he struggled with his crack cocaine addiction, which would often cause him to skip essential doses of his HIV meds.
A Downward Spiral
Greg's self-destructiveness continued for several years. During this time he was frequently admitted to his hospital's intensive care unit. "I was extremely sick, and a few times they didn't know if I would live or die," he says. "I was always able to pull myself together eventually, but would get sick again, with pneumonia, histoplasmosis and other opportunistic infections."
At one point, he even suffered a heart attack, although this didn't deter him from his crack use. He just thought he'd accidentally taken too much crack at once. It wasn't until the summer of 2001, seven years after his HIV diagnosis, that Greg finally got his addictions under control. With a laugh, Greg recalls the real reason he entered a treatment program for substance-abuse for what turned out to be the final time: He was trying to escape a drug dealer he owed money.
Although his previous attempts had failed, this time, he says, something "clicked." He managed to stay focused and struggled to change his life.
The Long Road Back
|Greg says his addiction to drugs and alcohol has been transformed into a passion for exercise.
Greg spent nine months in Haymarket Center, one of the largest substance abuse programs in Chicago. Once he completed the program, he was placed into a transitional community living program called AIDS Care. Since then, Greg has been in an independent-living group home that provides him with the support he needs in order to recover from so many years of drinking and drug use.
"I couldn't have stayed sober without it," Greg says. "I needed the structure. If you need something it is always there. I'm pretty independent now, but at first I had to take it slowly." There are substance abuse counselors and support groups available if he needs them. He tries to attend at least three Alcoholics Anonymous meetings a week.
Once he was in recovery, Greg was finally able to adhere to his HAART regimen. But by then he had exhausted his options: By failing to take his meds on time for so many years, he had become resistant to most of the available medications. His CD4 count continued to drop while his viral load continued to rise. "I never thought beyond two or three years, didn't make any plans as far as employment and going back to school, because I never expected to live that long," Greg said. "Then a friend gave me information on this new drug, T-20 or Fuzeon, and that's when I really got hope."
Since his medications were no longer working, Greg assumed he had little time left to live. He never imagined he would be around long enough to see the younger of his two sons graduate from high school (which he did in the spring of 2004), or his daughter give birth to his first grandson, who is now two years old. "It's really a miracle for me to see my grandson," Greg acknowledges. "I didn't think I would see my kids grow up. I remember telling my kids that I had AIDS and my daughter was crying. I really thought I would die soon."
From Crack to College
Greg started Fuzeon as part of a clinical trial in November 2002. He took the drug in combination with Epivir (3TC, lamivudine), Norvir (ritonavir), Viracept (nelfinavir) and TMC-114, an experimental protease inhibitor. "At that point I was out of options," he said. "If my doctor told me to jump off a building I would -- as long as I had a parachute!" By sticking to his regimen, Greg has seen his viral load slowly plummet to around 900 and his CD4 count rise from 1 to 100.
The same year he started taking Fuzeon, Greg decided to finish college. He had dropped out of Chicago State University in his junior year in 1974. He was majoring in accounting and had decided it would be more interesting to get a job. He finally graduated in October 2004 with a GPA of 3.8 and a bachelor's degree in applied behavioral science, which he will put to use in the HIV community. "That's all because of the Fuzeon, the hope that it gave me," he says. "I haven't got to undetectable yet, but to me this is a big improvement from over a million copies to 900!"
Adjusting to Fuzeon
|Greg on injection site reactions: Massage the injection site with a small vibrator. "I use it on the site right after the injection," he explains. "It helps diffuse the medication and the injection site reaction is much less severe."
When asked what he thought when his doctor told him that he would have to inject Fuzeon twice a day, Greg didn't blink. Though he had never injected during his crack addiction, he says, "the thought of injections didn't bother me too much, because I had experience injecting Procrit for anemia. I wanted to do whatever was necessary to get the virus under control. The first three or four times I injected I had to play the training video to do it. After that it became second nature. It really was no big deal considering the benefit I was trying to get from the drug."
It was actually the preparation of Fuzeon that concerned Greg. "It seemed a little complicated at first because you have to mix the drug, and I had a little apprehension about that," he said." But after my doctor went over the training video with me, I was confident that I could do it."
How does Greg work the twice-daily injections into his schedule? "It takes an adjustment; you have to plan," he explains. "I mix two batches at night, inject one and do the other in the morning. You have to allow time for it to come out of the refrigerator and warm up. By and large, I've adjusted to it quite well. It doesn't burden me."
And what about his adherence? "I've been on Fuzeon for a year and a half and I might have missed only three doses."
|Greg on getting help taking Fuzeon: Attend a support group. "It's amazing how many small tips you can pick up in the Fuzeon support group," he says.
Although people in Greg's Fuzeon support group talk about bad injection site reactions, he says that his are pretty much average. "Sometimes I inject and have very little reaction at all, and sometimes I get a little bruise there. On average, it's just something that's barely noticeable to me. It's nothing that would prohibit me from injecting. I have to look around for a fresh site to inject. I have problems injecting in my legs and arms, so I stick to the abdomen area and I seem to do okay."
So how long will Greg stay on Fuzeon? "As long as necessary, that's my outlook on it. If medications come out that will allow me [to] take pills, then I'll do that. But I'll inject as long as I have to because I'm getting results from it."
Greg's Treatment History
The Power of Support
For people beginning a regimen that includes Fuzeon or those who are considering it, Greg firmly believes in the importance of attending a support group. "You can get honest feedback on the pros and cons of injections," he says. "The bottom line is, if this is what you need to do to save your life, then you learn how to manage it, and get over the fears of injecting. If you don't have a support group in your area, then talk to people who are on it and get feedback, ask questions."
The Power of Recovery
Greg's turnaround in life has been nothing short of remarkable. His health has improved, as has his romantic life: Almost two years ago, he met his current girlfriend, and they're still going strong. Greg has also discovered a passion for exercise -- an obsession that's yielded several benefits. "My addiction to drugs and alcohol have switched to exercise," he says. "Even in recovery, my T cells plummeted, my viral load was a million and my T cells were 1. The only thing that kept me going was juicing and exercise."
Greg makes fresh vegetable juices, he says, with broccoli, carrots, beets and celery or whatever else he has on hand. He also makes strawberry, raspberry, apple and grape smoothies. "The exercise and diet helped me to stay healthy when the meds weren't working."
In his tiny studio apartment, Greg keeps 10 to 15 pieces of exercise equipment, including a stationary bike, total gym, Power Flex for strength training, a crossbow trainer and a rowing machine.
Despite devoting his time over the past several years to his full-time college schedule, and his exercise regimen, Greg also contributes his time and energy to the HIV/AIDS community. He leads a support group for HIV-positive Alcoholics Anonymous members; he's a member of various AIDS policy and planning groups; and he serves as a board member of the agency that runs the independent-living group home where he lives in Chicago. Most recently, Greg joined the National AIDS Fund AmeriCorps Program, a yearlong community service program. His assignment: an 11-month stint at Haymarket Center, the same substance-abuse program that started him on his path to recovery. While there, he'll perform a wide range of duties, including HIV testing, one-on-one counseling, outreach and training.
Whenever he's asked, Greg speaks freely about substance abuse and HIV -- at colleges, at high schools, wherever he can. "It's a way of giving back; it's 12-step work," he says. "Having HIV is something negative, so I can flip it to a positive; I can use my disease to prevent others from getting it. I really get a lot out of doing that."
Copyright © 2005 Body Health Resources Corporation. All rights reserved.


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Mark Blair Claims His Jeep Is the World's Quickest Street-Driven Cherokee
It's always cool to see a vehicle do something that it was never meant to. That's probably why Monster Garage was so popular. They'd turn a PT Cruiser into a wood chipper, or a Miata into a jet ski—goofy, entertaining stuff like that. Mark Blair's wheel-standing Jeep Cherokee is kinda like that. You don't expect to see a Jeep with a luggage rack run low 9s. This thing stands on the bumper thanks to an S&W back half with a four-link, a 4.56-geared 9-inch with a Detroit Locker, 31×15 Hoosier slicks (on the track, and Quick Time Pros on the street), and power from a 930hp, 505ci Dodge motor (with 300-500 hp-worth of nitrous) and a 727 automatic with a brake and a TCI converter. The Jeep has run as quick as 9.15 at 149 mph, but Blair has his sites set on the 8-second zone in his street-driven SUV. He races it all over the place.


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I don't remember another puzzle game seducing me that much, except Deadly Rooms of Death, and that's quite the compliment! Thanks a lot, dev team
Anyways, on to the questions :
I remember reading a quest (not sure, but what else could it have been?) popup telling me that doing this or that would unlock a vicious difficulty dungeon. Now I can't find this text anywhere by hovering over the quests still open to me.
But where do I click to actually select a vicious difficulty dungeon?
Or alternatively, did I drink too much and have I actually not unlocked vicious mode?
Here's what I have on my adventure screen :
Halls of Steel : Dancing Blades
Grimm's Grotto : Halfling's Ho
Ick Swamp : Challenge Accepted
Magma Mines : Minecraft
Havendale Bridge : Unlikely Heroes Forest Edition
The Labyrinth : Muu
and Rock Garden : Hard Rock, Unlikely Heroes Desert Edition, Complicated Tasks, pt 4
Hobbler's Hold, Northern Desert, Den of Danger, Western Jungle, Southern Swamp, Venture Cave, Eastern Tundra, Double Doom, Hexx Ruins, The Slime Pit, Creeplight Ruins, Berserker Camp are devoid of quests (I have finished those I had).
The game hasn't proposed me a town upgrade in a very long while, so I suppose no more upgrades are to be had (or maybe when I reach vicious?).
So what am I missing, please?
Secondly, I have unlocked every normal class, plus tinker and transmuter. I have done every normal quest's bronze challenge, yet didn't get the steam achievement 'Hero Literate' - I suppose I must do the special classes bronze challenges - how, they don't have a building to select the challenge from, as far as I am aware?
PS : I am playing the game under Wine/Ubuntu 13, if that might be the cause of my puzzlements, which I very much doubt.


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Want To Layout Websites? Check out These Great Tips
Saturday, 4. August 2012
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The overall concept in this article is actually to obtain the essence of world wide web layout, certainly not to come to be a pro overnight. The moment someone start to discover pertaining to a couple of unique tactics, someone will comprehend the notions behind world wide web design as well as will be actually able in order to translate your expertise into tangible design elements. Examine back with these suggestions if someone have certainly got any kind of dilemmas.


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mikenz66 wrote:H Dhamma Follower,So, this is just as much a "method" as anything else. And certainly seems be a "method" that your are convinced will "work". Of course, that "strong emphasis" arises from conditions, just as in any other "method".dhamma follower wrote:... When there's more and more understanding in different aspects, it can condition the moment of direct experience of realities, by way of upanissaya paccaya. This would not be possible without a clear understanding of what is the object of satipatthana and what is not, and a strong emphasis on the realities NOW. ...
I have no argument with your "method". It seems perfectly reasonable to me, since it's actually the same as what the rest of us think we are doing.
The disagreement, to me, is mostly over the insistence of KS students that they are "just letting conditions work", in contrast to "meditators". I think you (the students) would be much more convincing if you simply explained your approach, and discussed commonalities with other Dhamma students, rather than putting so much effort into arguing about differences. In my experience, that is never fruitful.
This is the reason I wrote this:So, this is just as much a "method" as anything else
And that is also the reason why have to stress again and again on the differences, at the risk of sounding antagonist.This description might lead one to think that there is in fact an exercise that one must try to do. But in reality, it is totally an empty process, causes and effects, causes and effects. If there is trying to make it, it can not happen, because then it is done by the idea of someone who can, and by the desire to get something. The entire process is ignated actually by a clear understanding that it is an empty proccess, which is conditioned by right understanding now. This is a subtle point that we have a great difficulty getting across
I don't think we should a avoid talking about differences, because it's there that lies any potential for growth. All AS' students are exposed to having their questions/arguments/sharings subjected to cristism under the light of right understanding, either by her or by others. I think that's is also the way it was in many sutta among the Buddha's disciples.
Now back to that line. To some, it seems to be a method, but that is not so. As soon as there's idea of a method, it is the idea of someone who can (attend to the realities as they arise). Actually, when there's emphasis on now, it doesn't mean that one should try to attend to what appears now, because then, it is a citta accompanied by wrong understanding and wanting that tries. Realities arise and pass away so rapidly, it can not be approached by a citta which wants to approach it. Actually, when we say " we try to be aware of what appears", we actually only think of what have arisen and fallen away, there's no actual approaching to that reality with right awareness. Only by the power of right understanding, when it is conditioned to arise, which can have vitaka leading the citta directly to the object, which is an extremely feeling dhamma which now can appear clearly. But hearing again and again that what is talked about is only the dhammas which appear now, and knowing clearly the difference between what is only thinking about a fallen away dhamma, and what is a dhamma, all that can condition the moment of direct understanding. But most important of all, it's the understanding that is is not a technique that one can do, but something that happens by conditions. This is an extremly subtle point.
Sayadaw U Tejanyia that you mentioned sometimes also says that there's no method for vipassana. When people come to him for instructions he usually says: now you are sitting, do you need to make an effort to know that you are sitting? Do you need to make an effort to know there's seeing, touching, hearing, thinking?
Once someone asked him "what is the secret meaning of the schedule "1 hour sitting, 1 hour walking"?", he laughed and said: "just because it is a meditation center and we have to have a schedule so people are not at loss as how to spend their time, otherwise they would just sit and chat."
Being one of his old students and having had many conversations with him, I personally think that he would agree with most, if not all, the points raised by AS. He also says: let's wisdom do its own work. However, the very idea that there should be a method, a technique, there's a person who has to strive, be it in a meditation center or in daily life, is very deeply anchored. So I think what I have found extremly helpful in AS's way of explaining the Dhamma, is that she places the utmost importance on explaining that the Path is an impersonal process, and on what are the right causes for the right effects. She also pointed out what is not sati that is usually taken to be sati, and that is a very important step too.
There are many people, who read or listen to AS's discussions, and say that they agree with everything, but usually, when it comes to this point, they either can't agree or see it at a breakthrough. That is the reason why we pick out that point again and again, because it is the corner stone. Fruitful or not, I don't know, because it depends rather on the accumulations of each person.