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Initiation and weaning of mechanical ventilation by Ahmed Mohamed Hassan
Outline Definition. Indications Ventilator Settings
Modes of Ventilation Weaning Summary
Definition Use of a mechanical apparatus to provide the requirements of a patient's breathing. Use of positive pressure to physically transport gases into and out of lungs (earlier ventilators used negative pressure) Usually performed via ETT but not always (noninvasive ventilation)
Mechanical Ventilation ( MV )
A supportive measure – not a therapy Must diagnose and treat underlying cause Used to support &/or rest patient until underlying disorder improved
INDICATIONS FOR MV Acute resp failure: Acute exacerbations COPD.
ARDS Heart failure. Pneumonia Sepsis. Complication of surgery. Trauma Acute exacerbations COPD. Neuromuscular diseases.
Ventilator settings FIO2 Volume (VT) Rate Pressure PEEP I:E Flow rate
Ventilator settings Fraction of inspired oxygen (FiO2):
Target Sao2 90 % & Pao2< 60mmHg. Atempt to keep FiO2 <50% to avoid O2 toxicty. Tidal volume (Vt): Is constant in volume-cycled modes and variable with in pressure-limited modes. In patients without lung disease Vt of mL/kg . Lower Vt 6 ml/kg are recommended for ARDS, & Vt 8 mL/kg is recommended in patients with asthma, COPD(as long as no increase in plateau presure).
Ventilator settings Respiratory rate (RR): Minute ventilation (VE):
12 and 20 breaths per minute is reasonable. Determine minute ventilation. Minute ventilation (VE): Is the product of the Vt and RR. VE is based on PaCO2 as a marker of ventilatory requirements. VE of approximately 5 L/min maintain normocapnea. Permissive hypercapnia is allowed in ARDS and status asthmaticus.
Ventilator settings Inflation pressure limit:
High inflation pressures cause barotruama. Increased Pplat, is most injurious, reflecting alveolar overdistention and not airway resistance. Pplat > 30 cm H2O is recommended. Inspiratory Sensitivity : It is the drop in airway pressure that is required before the ventilator senses the patient's effort. 0.5 to 1 cm H2O allow very weak patients to initiate a breath, Higher values make triggering more difficult.
Ventilator settings Inspiratory flow rate:
The ratio of Vt to inspiratory flow rate determines inspiratory time (Ti). inspir flow rate Ti time for expiration auto PEEP. inspir flow rate PIP & not Pplat. COPD & asthma the expiratory time should be increased to allow exhalation of trapped gas. Positive end-expiratory pressure (PEEP): PEEP is the maintenance of positive pressure after expiratory flow is completed. Useful to treat refractory hypoxemia Complication: Hypotension Diastolic dysfunctions Barotrauma
Modes of MV MV may be: Invasive, delivered through an endotracheal tube (ETT) or tracheostomy tube. Noninvasive positive pressure ventilation (NIPPV) interfaces the ventilator with the patient through a full-face or nasal mask.
Moods of mechanical ventilation
Volume cycled MV: Delivers a preset (Vt) specified by the operator. (PIP) are, depending on the patient's compliance. Examples: Assist/Control Intermittent Mandatory Ventilation (IMV) Synchronous Intermittent Mandatory Ventilation (SIMV) Pressure-limited MV: Delivers a flow until a preset pressure limit that is set by the operator is reached. PIP is always the same but Vt is variable, according to the patient's compliance. Examples: Pressure Support Ventilation (PSV) Pressure Control Ventilation (PCV) CPAP BiPAP
Pressure Support Ventilation(PSV)
Every breath is an assisted breath. The patient determines the inspiratory flow rate and the RR. Advantages: Better patient synchrony Limits Peak inspiratory Pressure. Disadvantages: Inadequate volumes if the ETT is blocked or decreased lung compliance. Apnea backup is less supportive than that of AC
Pressure Control Ventilation (PCV)
Controlled breaths are delivered at a preset time interval. RR, maximal pressure limit are both controlled. Spontaneous breaths is allowed between the mandatory breaths. Advantades: Decrease risk of barotrauma Used in inverse ratio ventilation. Disadvantages: Cannot ensure minimal VE
Continuous positive airway pressure (CPAP):
Used for oxygenation and as a mode of weaning. patient assumes most of the work of breathing & determine RR, Vt & VE.
BIPAP Ventilator delivers two levels of positive airway pressure for preset periods of time. Advantages: Decreased requirement for sedation. Used in Obstructive Sleep Apnea. Disadvantages: Theoretical risk of over-distension of lungs.
Assist control (AC): Pt RR < preset rate so all breath will be assisted. Pt RR > preset rate so all breath will be controlled. Advantages: Ensures a minimum VE. Better patient synchrony. Disadvantages: Induce respiratory alkalosis if high respiratory drive (i.e., liver failure).
Intermitent mandatory ventilation (imv)
Ventilator will deliver a preset volume at a specific time intervals. Different from Controlled mode: pt can initiate spontaneous breaths. Different from Assisted mode: spontaneous breaths are not supported by machine. Advantages: Assures a VE Disadvantages: Patient asynchrony.
Synchronized intermittent mandatory ventilation (SIMV):
Delivered spontaneous, assisted, and mandatory breath. Most commonly used mode. Advantages: Ensures a minimum VE. Disadvantages: The worst mode of weaning.
Noninvasive Ventilation
Avoids intubation and complications. Can deliver various modes of ventilation Indications: Hypercapneic respiratory failure (COPD exac). Cardiogenic pulmonary edema. Hypoxic respiratory failure. Contraindications: Inability to cooperate (i.e. Confusion). Inability to clear secretions. Hemodynamic instability. Frature skull base as it may cause pneumoencephaly.
New modes of MV Volume Support.
Pressure-Regulated Volume Control (PRVC). Volume-Assured Pressure Support. Automode. Adaptive support ventilation (ASV). Proportional Assist Ventilation(PAV). Mandatory Minute Ventilation. Airway Pressure Release Ventilation (APRV).
weaning When: Indices: The underlying pathology improves.
Hemodynamically stable. Oxygenation: PaO2/FiO2 >200, PEEP<7.5 cm H2O, FiO2<0.5 Indices: Rapid shallow breathing: RR/Vt > 105 positive predictive value of 78%. RR/Vt < 105 negative predictive value of 95 %. Maximal Inspiratory Pressure(Pmax) Excellent negative predictive value if less than –20 cm H2O .
weaning Methods: Duration: Spontaneous breathing trials: CPAP: SIMV:
complete withdrawal of MV Only one trial every 24-hour CPAP: Allow monitoring of RR, Vt & VE Pressure support ventilation (PSV) Gradual reduction in the level of PSV SIMV: The worst mode of weaning. Duration: Short-term MV (<21 days) to 120 minutes prolonged MV (>21 days) at least 24 hours.
Causes of weaning failure
Auto-PEEP. Poor nutritional status. Overfeeding. Left heart failure. Decreased magnesium and phosphate levels. Infection/fever. Major organ failure.
Signs of weaning failure
Clinical criteria : Diaphoresis . Increased respiratory effort . Paradoxical breathing & use of accessory respiratory. Cardiac: HR < 30 beats/min over baseline. Profound bradycardia. Ventricular ectopy. Supraventricular tachyarrhythmias. Mean arterial blood pressure equal to or greater than 15 mm Hg or equal to or less than 30 mm Hg from baseline.
Signs of weaning failure
Respiratory: RR < 35 breaths/min . SaO2> 90%. PaCO2 50 mmHg or increase >8 mmHg. pH<7.33 or decrease >0.07. PaO2 60 mm Hg with FiO2 of 0.5.
Ventilator management algorithim
Modified from Sena et al, ACS Surgery: Principles and Practice (2005). Initial intubation FiO2 = 50% PEEP = 5 RR = 12 – 15 VT = 8 – 10 ml/kg SaO2 < 90% SaO2 > 90% SaO2 < 90% Increase FiO2 (keep SaO2>90%) Increase PEEP to max 20 Identify possible acute lung injury Identify respiratory failure causes SaO2 > 90% Adjust RR to maintain PaCO2 = 40 Reduce FiO2 < 50% as tolerated Reduce PEEP < 8 as tolerated Assess criteria for SBT daily No injury Pass SBT Extubate Airway stable Acute lung injury Fail SBT Airway stable Acute lung injury Low TV (lung-protective) settings Reduce TV to 6 ml/kg Increase RR up to 35 to keep pH > 7.2, PaCO2 < 50 Adjust PEEP to keep FiO2 < 60% Persistently fail SBT Consider tracheostomy Resume daily SBTs with CPAP or tracheostomy collar Pass SBT Intubated > 2 wks SaO2 < 90% SaO2 > 90% Prolonged ventilator dependence SaO2 < 90% Associated conditions (PTX, hemothorax, hydrothorax) Consider adjunct measures (prone positioning, HFOV, IRV) SaO2 > 90% Continue lung-protective ventilation until: PaO2/FiO2 > 300 Criteria met for SBT Consider PSV wean (gradual reduction of pressure support) Consider gradual increases in SBT duration until endurance improves Pass SBT
Summary Mechanical ventilation used to:
Improve oxygenation. Improve ventilation (CO2 removal). Unload respiratory muscles. Neuromuscular diseases. Decrease intracranial tension. A support until patients condition improves
summary Different modes for ventilation
Differ in how breaths are initiated, ended and assisted. No proven advantage of one mode over the other. Use ventilator strategies to avoid volutrauma and other adverse effects. Numerous trials performed to develop criteria for success weaning, however, not very useful to predict when to begin the weaning and physicians should rely on clinical judgement also.
summary Daily screening may reduce the duration of MV and ICU cost.
The removal of the artificial airway from a patient who has successfully been discontinued from ventilatory support should be based on assessment of airway patency and the ability of the patient to protect the airway. Patients receiving MV who fail an SBT should have the cause determined.
summary Tracheostomy should be considered after it becomes apparent that the patient will require prolonged MV.
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The store manager at a business in the 600 block of George Wallace Drive reported two men stole six Moultrie game cameras from the store about 4:17 p.m. Aug. 1. There is video footage of the theft, according to the police report. The woman said two men between the ages of 20 and 30 came into the store and took the cameras. She said she believed the two men were dwarfs. She told police it's believed the same suspects have stolen from multiple stores of the same franchise.
A .38 caliber Smith & Wesson snub nose revolver was reported stolen July 20 from a location in the 1600 block of Central Avenue.
A Rosewood Lane resident reported the possible theft of a Coach purse containing three kinds of prescriptions. She's not sure when or where the purse went missing between 8 a.m. and noon Thursday.
A mountain bike was reported stolen about 4:30 p.m. Thursday from a porch on West Wilkinson Avenue.
A Gadsden man reported getting a call from Bank of America Aug. 3 about an overdue account. He's never had an account with the bank; someone used his personal information to open the account.

subset: commoncrawl


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Housing Poster Gutless, Cowardly, ChildishHousing New Zealand Ltd
"A poster (copy attached) supporting evicted state housing tenant, Len Parker, is gutless, cowardly, and childish", Housing New Zealand Minister, Tony Ryall, said today.
"The poster gives an Auckland address which it purports to be that of Housing New Zealand spokesperson, Ms Margrit de Man", Mr Ryall said.
"The address given is not that of Ms de Man, but one wonders what the author of the poster is attempting to achieve by publishing someone's home address at all.
"It seems to be a veiled threat, akin to that made by the Invercargill Mongrel Mob earlier this week.
"This kind of personal attack on a neutral public servant simply doing their job, is totally repugnant.


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Joan Borysenko (author of Minding the Body, Minding the Mind) writes about her own experiences of plodding through the dark night of the soul. She writes, refreshingly, about how the psycho-therapeutic model discounts this kind of "mystical" transformational journey or therapy, because it lacks qualitative & scientific analysis & verification, thus, is not a variable in human change processes. However, there are many ways of viewing these internalized changes.
And again she writes,
This mythological approach to our stories of pain provides a larger context to personal growth then do traditional medical-psychological understandings. Dark nights of the soul-fear, depression, madness, trauma-are too often seen through the limiting lens of fear. In fear, we wish only to rid ourselves of apparent negativity rather than searching our souls for its gifts. Fear demands that the problem be fixed indirectly by drugs or therapy so that the person can be restored to his original '"normal"' state (p. 54).
The term dark night of the soul has its origins in the mystical writings of St. John of the Cross (he lived during the 1500s); St. John refers to it as "nakedness of spirit" [p. 118. The Collected Works of St. John of the Cross. (1991). Translated by Kieran Kavanaugh & Otilo Rodriguez. Washington: ICS Publications)].
In this volume, St. John states a conclusion very similar to Borysenko's:
The darkness and trials, spiritual and temporal, that fortunate souls ordinarily undergo on their way to the high state of perfection are so numerous and profound that human science cannot understand them adequately. Nor does experience of them equip one to explain them. Only those who suffer them will know what this experience is like, but they won't be able to describe it (emphasis added). In discussing this dark night, therefore, I will not rely on experience or science, for these can fail and deceive us (P. 115, Ibid.).
Here's another important distinction that ought to be made clear: the paradoxical contrast of religion and spirituality. As a rule, many religious systems have replaced/exchanged religion for spirituality. Here's the significant difference, however: religion consists of systemic rules, creeds, practices, norms, ideologies, and structures; spirituality is comprised of a deep-seated, human desire to belong, to be connected to something much larger and more transcendental than any humanly-devised set of maxims-a connection to our True Selves in our inner persons.
This goes beyond intellectual or pragmatic factors encountered on our spiritual journeys. You might say, it's very similar to Buddhism's Nirvana or Enlightenment, and their notion of emptiness.
Therefore, spirituality is of necessity more fluid, free, open, continually-changing with contexts and personal transformations-along with a more aligned sense of directness and affection in our hearts & minds. And, a sense of congruency with the structure of reality of biological & spiritual life.
It seems to me, that there is a missing, eliminated ingredient to understanding the dark night of the soul.. Christian theological-ideologies appear to have removed many of the practices of contemplation and mystical realization from their domain of influence. Instead, their focus seems to be more about action, creeds, activities, and discursive agendas!
In Christian, theological-ideologies, the Higher Power of Absence, is akin to the "dark night." If we think the HP is absent, our minds are often deluged with confusion, stress, contradiction, aloneness, uncertainty, and groundlessness; learning to "be in the process of listening" even when our HP appears to be gone on a vacation. It is a silent waiting period, anticipating the felt sensation of our HP being fully present, mindful to us, and friendly with our desires to become one with our Higher Power.
She writes in her book, Fire in the Soul: A New Psychology of Spiritual Optimism (1993). New York: Warner Books, Inc., about the nature of "dark nights":
"Dark nights of the soul are extended periods of dwelling at the threshold when it seems as if we can no longer trust the very ground we stand on even though there is nothing familiar left to hold onto that can give us comfort" (p. 62).
During dark nights our belief system is challenged and we are thrust into mortal combat with the forces of our own and the collective unconscious. For a variety of different reasons-loss, guilt, trauma, shame, war, shock-the world as we know it ceases to be and we are left with no familiar ground to stand on. A period of inner chaos characterized by fear, doubt, terror, depression or madness may follow (p. 65).
This "dark night" crisis usually resolves itself in one of these three ways:
1). After the crisis, we slowly put ourselves back together, but we may have some of the same, vague feelings of anxiety or dissatisfaction (Buddhists use the word "dukkah" for this type of discontentment).
2). This may also lead to success or the choice to stay in the "mud wrestling" match with Mental Illness, or
3). We come out of the crisis feeling a renewal of integrated strength, wisdom & vision.
Describing this "dark night" process, she writes, "Even when our old self is dying, the immortal Self at our core is untouched by the pain. In fact, because our old perceptions no longer filter reality in the same way, communication from the wisdom Self sometimes comes through more clearly in dreams, poems, and insights" (p. 66).
Here, Borysenko apparently agrees with the notion that spiritual insights may be learned best and most completely by an intuitional method, not necessarily an intellectual method of inner work.
Abraham H. Maslow, the Psychologist & Creative who described "peak experiences & self-actualization" as partners at work in a kind of "dark night" journey:
We may define it (the peak experience-my conclusion) as an episode or a spirit in which the powers of the person come together in a perfectly efficient and intensely enjoyable way, and in which he is more integrated and less split, more open for experience, more idiosyncratic, more perfectly expressive or spontaneous or fully functioning (p. 69).
Darkness has many degrees of lightlessness: in one, it's so dark, a person may feel blind and naked, unable to make out anything. The feeling or cognition of "groundlessness" is a part of the internal fabric of "dark nights." For more insight on "groundlessness" check out some of the writings of well-known Buddhist writer, Pema Chodron, through Shambhala Magazine.
On the other hand, the darkness just prior to sunrise is both dark and light. At this point, one can see the light (of union with a Higher Power) perhaps more than the darkness. As St. John notes, the darkness allows us to envision, actualize & envision the process of deadening the cravings & affections of our empirical body-minds. The arising light helps to unburden the blindness and see what the day brings.
It's in this way that we may be able to see the emptiness of society's false values, to deflect our attention to them; it's in this way that we're able to perceive our own, human emptiness, and that the only way we can make it to the light is to recognize that we aren't able to get their on our own human power & steam. Yet, as in Buddhism, emptiness isn't about "nothingness" or "non-existence." As we label it, "space" is empty of some things, but filled with others.
Summarizing the "dark night" of the soul, Borysenko suggests that the purpose of the dark night is to invite ourselves (all of us-ego, shadow-side, cognitive faculties, affective faculties, visions, near-death-experiences, & spiritualities, etc.) to join & connect with the inner Self; this is the triggering of a "threshold" for our True Selves to extinguish our False Selves, and to grow & develop.
In this author's opinion, Joan Borysenko has expanded the notion of alternative therapies that many fear, for the reason of 'how do we know if this really works and is really genuine?' In another way, using the "dark night" therapeutically may be effective for many who wouldn't necessarily seek the Medical Model for help with their therapeutic & spiritual needs and/or what they might term as "survival tactics."
As a reader, you may want to do a kind of life review, and recollect times in your life that might possibly have been "dark nights of the soul." There may be a difference between this entire "dark night" process, and apparent thresholds where you experienced a crossing-over into a higher consciousness.
Copy: CBB November 17, 2017


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Ofgem said SSE PLC (LON:SSE) has paid £190,000 to compensate customers who lost money due to delays in switching over to a new tariff after withdrawing 'label partnership' tariff with non-profit energy provider Ebico.
The UK energy regulator Ofgem said suppliers have 49 days to move customers onto another tariff, but SSE took almost six months, with some customers losing savings because of the delayed switch.
READ: Utilities under pressure: SSE and Thames Water pay the penalty after regulatory investigations
SSE also made a goodwill gesture payment of £475,000 to the customers who were switched but ended up paying more on the tariff.
At the end of 2016, SSE terminated its partnership with Ebico, and in February 2017, SSE withdrew the white label tariff with non-profit energy provider from the market.
SSE is currently in the process of merging with Npower, which is being investigated by the Competition and Markets Authority.
In lunchtime trading, SSE's shares rose 0.4% to 1,355.00p.


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I'd always wanted to make a lamp out of old books... don't ask me why, I just wanted to.
I picked up a couple of boxes full of books at an auction last fall and finally got around to doing something with them.
The idea of a book lamp isn't particularly original so I wanted to put a twist to it. I painted the books black and then added the Shakespeare silhouette to the side, and the comedy/drama masks in the top corner.
I like to think I'm creative. I don't claim to be an artist, merely a creator. Over the years I've created everything from stage sets to lamps, fireplace fronts to photographs. Recently I've become interested in the "upcycling" movement. Right now I'm not selling pieces but I'm thinking that might be something for me to work into, so I'm kind of branching out in what I'm creating. This site is where I will share some of those things with whoever cares to take a look… let me know what you think.
Sunday, January 10, 2016
Shakespeare Lamp
Labels: book, lamp, light, recycled, shakespeare, silhouette, tragedy comedy masks, upcycle


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This page can be viewed at http://www.historycommons.org/context.jsp?item=a01thompsonwi
This is a scalable context timeline. It contains events related to the event 2001: Travel Expert Hired to Oversee Wisconsin's State Travel Spending. You can narrow or broaden the context of this timeline by adjusting the zoom level. The lower the scale, the more relevant the items on average will be, while the higher the scale, the less relevant the items, on average, will be.
Georgia Thompson is hired to oversee Wisconsin's state travel spending. She soon builds a reputation as a quiet, pleasant, hard-working individual who is devoted to her job. She is not a political appointee, but rather a civil service hire with 27 years of experience in the travel industry. She is hired by the administration of Governor Scott McCallum (R-WI). (Milwaukee Journal-Sentinel 1/27/2006)
Justice Department official Kyle Sampson (see 2001-2003), now the deputy chief of staff for Attorney General Alberto Gonzales (see February 15, 2005) as well as the Special Assistant US Attorney for the Eastern District of Virginia, sends an email to Gonzales's successor, senior White House counsel Harriet Miers. Sampson is responding to a late February request for recommendations for firing US Attorneys in case the White House decides to ask for resignations from a "subset" of those officials (see February 24, 2005 and After). In the email, Sampson ranks all 93 US Attorneys, using a set of three broad criteria. Strong performers exhibit "loyalty to the president and attorney general" (see January 9, 2005). Poor performers are, he writes, "weak US Attorneys who have been ineffectual managers and prosecutors, chafed against administration initiatives, etc." A third group is not rated at all. US Attorney David Iglesias of New Mexico (see October 18, 2001, 2002 and November 14-18, 2005 ) and Kevin Ryan of the Northern District of California (see August 2, 2002) appear on the list as "recommended retaining." Gonzales has approved the idea of firing some of the US Attorneys.
Denoted for Firing - US Attorneys listed for possible firing are: David York of the Southern District of Alabama; H.E. "Bud" Cummins of the Eastern District of Arkansas (see January 9, 2002 and April or August 2002); Carol Lam of the Southern District of California (see November 8, 2002); Greg Miller of the Northern District of Florida; David Huber of the Western District of Kentucky; Margaret Chiara of the Western District of Michigan (see November 2, 2001); Jim Greenlee of the Northern District of Mississippi; Dunn O. Lampton of the Southern District of Mississippi; Anna Mills S. Wagoner of the Middle District of North Carolina; John McKay of the Western District of Washington state (see October 24, 2001, Late October 2001 - March 2002, and January 4, 2005); Kasey Warner of the Southern District of West Virginia; and Paula Silsby of Maine. Sampson sends a revised listing later this evening with two more names indicated for possible firing: Thomas B. Heffelfinger of Minnesota and Steven Biskupic of the Eastern District of Wisconsin. Sampson says he based his choices on his own personal judgments formed during his work at the White House and the Justice Department, and on input he received from other Justice Department officials. He will later testify that he cannot recall what any specific official told him about any specific US Attorney. He will call this list a "quick and dirty" compilation and a "preliminary list" that would be subject to "further vetting… down the road" from department leaders. (US Department of Justice 2005 ; US Department of Justice 2/15/2005; Eggen and Solomon 3/12/2007; US Department of Justice 3/13/2007 ; US Department of Justice, Office of the Inspector General 9/29/2008; Thomas 2011) Days later, a Federalist Society lawyer will email Mary Beth Buchanan, the director of the Executive Office of US Attorneys, with a recommendation for Lam's replacement (see March 7, 2005).
Later Recollections - In the 2008 investigation of the US Attorney firings by the Justice Department's Office of the Inspector General (see September 29, 2008), Gonzales will tell investigators that he supported the concept of evaluating the US Attorneys' performance to see "where we could do better." Gonzales will say that he instructed Sampson to consult with the senior leadership of the Justice Department, obtain a consensus recommendation as to which US Attorneys should be removed, and coordinate with the White House on the process. Gonzales will say that he never discussed with Sampson how to evaluate US Attorneys or what factors to consider when discussing with department leaders which US Attorneys should be removed. Sampson will say that he did not share the list with Gonzales or any other department officials, but will say he believes he briefed Gonzales on it. Gonzales will say he recalls no such briefing, nor does he recall ever seeing the list. Then-Deputy Attorney General James Comey and then-Associate Deputy Attorney General David Margolis will tell OIG investigators about their discussions with Sampson. Comey will recall telling Sampson on February 28, 2005 that he felt Ryan and Lampton belonged in the "weak" category, and will say he may have denoted Heffelfinger and another US Attorney, David O'Meilia, as "weak" performers. Comey will say that he was not aware of Sampson's work with the White House in compiling a list of US Attorneys to be removed. He will say that he considered his conversation with Sampson "casual" and that Sampson "offhandedly" raised the subject with him. Margolis will recall speaking briefly with Sampson about "weak" performers among the US Attorneys in late 2004 or early 2005, but recall little about the conversation. He will remember that Sampson told him about Miers's idea of firing all 93 US Attorneys (see November 2004), and agreed with Sampson that such a move would be unwise. Margolis will recall Sampson viewing Miers's idea as a way to replace some US Attorneys for President Bush's second term, an idea Margolis will say he endorsed. He was not aware that political considerations may be used to compile a list of potential firings. He will recall looking at a list Sampson had of all 93 Attorneys. He will remember citing Ryan and Lampton as poor performers, as well as Chiara. He will remember saying that eight other US Attorneys might warrant replacement. Sampson will tell OIG investigators that he received no immediate reaction from Miers to the list, and will say he did not remember discussing the basis for his recommendations with her. As for McKay, though Washington state Republicans are sending a steady stream of complaints to the White House concerning McKay's alleged lack of interest in pursuing voter fraud allegations (see December 2004, Late 2004, Late 2004 or Early 2005, January 4, 2005, and January 4, 2005), Sampson will claim to be unaware of any of them and say he would not have used them as justification to advocate for McKay's termination. (US Department of Justice, Office of the Inspector General 9/29/2008)
US Attorney Steven M. Biskupic of Wisconsin investigates allegations that a travel firm used its influence with Governor Jim Doyle (D-WI) to improperly land a government contract (see October 19, 2005). Doyle denies any involvement with the affair and refuses to reopen bidding on the contract, saying the contract with Adelman Travel was awarded properly. Doyle also refuses to return $20,000 in donations from Adelman CEO Craig Adelman and board member Mitchell Fromstein, a decision Jay Heck of the liberal organization Common Cause says is a mistake: "You should always return money that's in question because the longer you hang onto it, the worse it's going to be." Heck says transparency proposals by Doyle's Republican opponents, Milwaukee County Executive Scott Walker (R-WI) and US Representative Mark Green (R-WI), would be of no real use. Furthermore, Heck notes, both Walker and Green have taken money from special interests along with Doyle. "All of them are taking money that at some point will compromise public policy because they have to raise so much of it and it almost all comes from special interests and it all comes with strings attached," he says. Green accepted almost $54,000 in donations from health care insurers and pharmaceutical interests before voting for a controversial, industry-supported Medicare prescription drug benefit in 2003. (Marley and Forster 10/21/2005)
The Omega World Travel agency claims that it was improperly denied a $750,000 contract by the Wisconsin state government in favor of another firm with ties to Governor Jim Doyle (D-WI). The other firm, Adelman Travel, is owned by Craig Adelman, a major contributor to Doyle's political campaign. Adelman and a member of the firm's board of directors, Mitchell Fromstein, both donated $10,000—the maximum allowed under the law—to Doyle's re-election campaign. Omega contends that the bidding process was rigged to favor Adelman Travel. State purchasing division supervisor Georgia Thompson (see 2001) says Omega and Adelman Travel were essentially tied as frontrunners during the bidding phase. Doyle denies any involvement in the selection of Adelman Travel as the state's supplier of travel services. Doyle's opponent for the 2006 gubernatorial race, Representative Mark Green (R-WI), says the affair has "cast a cloud on state government." (Walters 10/19/2005) Omega declined to formally contest the contract award. (Marley and Forster 10/21/2005) Department of Administration Secretary Stephen Bablitch will say there is no evidence that Adelman Travel was awarded the contract improperly, and will note that the firm lost out on three of the four contracts it bid for. (Barton, Forster, and Walters 1/24/2006)
Georgia Thompson, the supervisor of Wisconsin's state government travel spending (see 2001), is indicted by a federal grand jury. She is charged with manipulating the bid process on a state travel contract, intending to "cause political advantage for her supervisors" (see October 19, 2005 and October 2005). The indictment also says her actions "were intended to help her job security." If convicted, Thompson could receive up to 20 years in prison. The grand jury probed a contract Thompson and the state's purchasing division awarded to Adelman Travel, whose executives have made $20,000 in campaign contributions to Governor Jim Doyle (D-WI). Doyle was not interviewed by the jury and denies any involvement in the contract award process. The jury was convened by US Attorney Steven Biskupic. Investigators say Thompson was not fully cooperative with their probe, and some witnesses have told the jury that Thompson pushed for Adelman to receive the contract over another bidder, Omega World Travel. The travel bidding affair has become something of a political football, with Wisconsin Republicans using it to accuse Doyle of corruption. Milwaukee County Executive Scott Walker (R-WI), expected to challenge Doyle for the governor's office in 2006, says that Doyle's administration "condoned unethical and illegal behavior.… Today's indictment provides further confirmation that the Doyle administration is damaged and must be removed from the Capitol. Jim Doyle's political connections to this aide are, without question, mentioned as a defining piece of the evidence used to bring forth this indictment." Another Republican challenger, Representative Mark Green (R-WI), says electing him would help restore the public's confidence in elected officials: "The Doyle administration's ethical lapses have cast a cloud over state government that grows darker and darker each day." Department of Administration Secretary Stephen Bablitch says there is no evidence that Adelman Travel was awarded the contract improperly. (Marley and Forster 1/21/2006; Barton, Forster, and Walters 1/24/2006; Milwaukee Journal-Sentinel 1/27/2006)
Georgia Thompson, a Wisconsin state purchasing executive, is convicted of two felony charges of manipulating the bid process on a state travel contract, intending to "cause political advantage for her supervisors" (see October 19, 2005, October 2005, and January 24, 2006). The indictment said her actions "were intended to help her job security," though it did not allege the existence of a so-called "pay to play" scheme that traded campaign donations for contracts. Thompson was charged with improperly steering a travel contract with the state, worth $750,000, to a travel firm whose executives made political donations to Governor Jim Doyle (D-WI). She pled not guilty to the charges, and was not asked by prosecutors to take a deal in return for testifying about alleged improprieties by Doyle and other administration officials. Her lawyer, Stephen Hurley, said at the time: "They can squeeze all they want. There's nothing to squeeze out." Hurley called the charges against her "the most bizarre application of the statute I've ever seen." US Attorney Steven Biskupic, a Bush administration appointee, is using the Thompson case to find evidence of criminal corruption within the Doyle administration. Thompson faces up to 20 years in prison and a $1 million fine. Wisconsin Republicans have dubbed the affair "Travelgate," and are using it to drub Doyle in campaign ads. Doyle is expected to face stiff competition from Republican challengers in the November 2006 election. During the trial, prosecutors did not allege that Thompson colluded with anyone in the Doyle administration to rig the contract process. Instead, they said Thompson carried out the improprieties on her own in order to curry favor with her superiors. Biskupic called her actions "politically motivated bid-rigging," and said she inflated her scores for Adelman Travel in the bid assessment process "for private gain for herself and others" rather than using the criteria established by state law. Hurley called Biskupic's logic "bizarre," and noted that Thompson did not profit in any way from her alleged bid-rigging. In fact, Hurley said, her actions saved the state $27,000. Hurley said during the trial that she had no way of knowing about the campaign contributions, and her job did not depend on which company received the contract. Evidence presented during the trial showed that Adelman Travel was involved in setting the parameters for the contract awarding criteria months before being invited to take part in the bidding, though Thompson was not involved in those dealings. Thompson testified that she is not politically active and knew nothing of the politics behind the contract. She said she was not pressured to award Adelman Travel the contract. She said that she had a negative reaction to Adelman's competitor for the contract, Omega World Travel, because unlike Adelman Travel, it was not a local firm, and she found Omega's representatives "pushy, abrasive, and East Coast" in their manner. Through tears, she testified: "As a consumer, you can say, 'Gee, I need a new refrigerator,' look in the Sunday paper, see that there are refrigerators for sale, and say, 'Okay, this is the one I want. This looks like the right price.' You go in to buy it, and you don't like the salesperson, so you don't buy it. In state government, you can't do that." If you do, she said, the contract could be called into question. In his closing arguments, Biskupic called Thompson a liar, noting that her testimony in court was different in some aspects to statements she had given reporters. Doyle says after the conviction is issued: "It is clear that Georgia Thompson acted on her own and that no other state employee was involved.… As I have stated before, I have zero tolerance for ethical lapses in government. When public servants abuse the public's trust, they forfeit their rights to continue in the state's employ." Doyle says that Thompson will likely be fired after a review is conducted. (Barton 2/3/2006; Barton and Walters 6/3/2006; Barton 6/6/2006; Barton 6/9/2006; Schultze 6/13/2006) She will resign her position shortly after her conviction. (Walters and Diedrich 4/5/2007)
Wisconsin Department of Administration supervisor Georgia Thompson (see 2001 and June 13, 2006) is sentenced to 18 months in prison for allegedly steering a state travel contract to a firm whose executives contributed $20,000 to the campaign of Governor Jim Doyle (D-WI—see October 19, 2005, October 2005, and January 24, 2006). She was convicted of misapplying government funds and of defrauding the state of its right to honest services. Aside from her prison term, Thompson is sentenced to pay $4,000 in fines and serve three years of supervised release. The jury concluded that the firm, Adelman Travel, would not have been awarded a $750,000 contract had Thompson not manipulated the selection process. "People are deserving of good and honest government," says District Judge Rudolph T. Randa. "There has been too much of this recently; people tend to lose confidence." Thompson is appealing the conviction. The judge and attorneys for both sides have acknowledged the political nature of the case. Wisconsin Republican Party chairman Rick Wiley has already used Thompson in attack ads targeting Doyle for the upcoming election, with one ad saying, "Jim Doyle has rigged contracts for cash, he's rigged votes to make political attacks, and by failing to protect our electoral process, this election is ripe for fraud once again." Wisconsin Democratic Party chair Joe Wineke says of the ads, "For months, Republicans have been trying to use the Georgia Thompson case for their own political advantage and to smear Governor Doyle." (Barton 9/22/2006)
A federal court of appeals overturns the conviction of former Wisconsin government official Georgia Thompson, who was convicted of two felony counts of manipulating a state bidding process to favor a Wisconsin travel agency whose executives had made campaign donations to Governor Jim Doyle (D-WI—see June 13, 2006). The Seventh Circuit Court of Appeals vacates the conviction and orders Thompson released from jail (see September 22, 2006) immediately. US Attorney Steven Biskupic, who prosecuted Thompson, says he will most likely not appeal the decision. The three-judge panel finds Thompson was wrongfully convicted after oral arguments were presented by both Biskupic's office and Thompson's attorney, not waiting for written submissions. Judge Diane T. Wood called the evidence submitted by Biskupic "beyond thin," telling prosecutors: "I have to say, in comparison to some of the cases this court has seen, that's a pretty thin set of facts to show some sort of tight political relationship. Am I missing something?" Judge William Bauer wondered why others were not prosecuted, asking why, if prosecutors felt Doyle and others were complicit in the alleged crimes, only Thompson was left to "carr[y] the sack." Chief Judge Frank Easterbrook noted Adelman Travel had the lowest bid and assailed math used to score competing bids. "Because they flunked high school math doesn't mean a felony was committed," he said. Doyle, a former state attorney general, says the court did an "extraordinary thing" by entering an order finding Thompson innocent and ordering her immediate release. Decisions like this usually take weeks or months to be rendered. Doyle says Thompson did nothing wrong, calls her "an innocent woman who was used as a political football," and says she deserves her job back and to be awarded back pay. "She was doing her job, and then she got caught up in all of this," he says. Doyle defeated gubernatorial challenger Mark Green (R-WI) in the November 2006 elections; Green attempted to make the Thompson "Travelgate" affair a centerpiece of his campaign, and repeatedly accused Doyle and his administration of corruption. Thompson's attorney, Stephen Hurley, argued in oral presentations that Thompson did not personally profit from the contract going to Adelman Travel, contending that her actions did not constitute "dishonest gain," a criteria many courts have applied to corruption cases. Hurley says that as a result of her conviction, she lost "her job, her life savings, her home, and her liberty; and it cost Georgia her good name.… At sentencing, the government urged a longer period of incarceration because Georgia did not accept responsibility. Today, the government ought to accept responsibility for the consequences of its acts." Wisconsin Republican Party director Mark Jefferson says Thompson's exoneration means nothing, and the Doyle administration should still be investigated regarding the contract process. (Rourke 4/5/2007; Walters and Diedrich 4/5/2007) Wisconsin lawyer Chris Van Wagner later says of the appeals court's decision: "That is more than a legal ruling; it's a slap in the face. This, no question about it, is a major affront to the government in many ways. Most significantly, it said you should have never brought this case.… Two or three cases out of 100 are vacated. This case wasn't just vacated and sent back for a retrial, but rather the judges ordered an acquittal." (Christopher T. Van Wagner 4/2007) Law professor Michael O'Hear agrees that the decision is unusual. "If this was a finding of insufficient evidence, what they're saying is it's unjust that Georgia Thompson has been in prison the last few months," he says. (Stein 4/6/2007)
Critics say that the legal pursuit of former Wisconsin state purchasing official Georgia Thompson, whose conviction on corruption charges was overturned by a federal appeals court (see April 5, 2007), may have been politically motivated. State Representative David Travis (D-Westport) says Thompson was persecuted by US Attorney Steven Biskupic, a Bush administration appointee. "I think it's right out of the Karl Rove playbook," he says, referring to White House political chief Karl Rove. "I never thought I'd see a prosecution like this. That woman is innocent. He's ruined her life." Republicans used Thompson's prosecution and conviction (see June 13, 2006) as a centerpiece of their attempt to thwart the re-election attempts of Governor Jim Doyle (D-WI), who survived a 2006 challenge by Mark Green (R-WI), who accused Doyle of corruption throughout the campaign. Representative Tammy Baldwin (D-WI) calls on Congress to investigate the prosecution, saying the prosecution ties into Congress's investigation into the firing of eight US Attorneys (see December 7, 2006 and December 20, 2006). "Congress should also look into whether partisan politics influenced, or even dictated, the investigations conducted by the US Attorneys' offices in order to stay in the [Bush] administration's good graces," Baldwin says. "The 7th Circuit acquittal of Georgia Thompson, after a widely publicized pre-election prosecution, certainly raises serious questions about the integrity and motivation of the prosecutor." Senator Patrick Leahy (D-VT), the chairman of the Senate Judiciary Committee, asks Attorney General Alberto Gonzales to turn over all of the Justice Department's records in the Georgia Thompson case to the committee, "including any communications between the Justice Department, the White House, and any other outside party, including party officials." Leahy, joined by Wisconsin's two senators Herb Kohl (D-WI) and Russell Feingold (D-WI), also asks Gonzales to turn over records related to voter fraud investigations in Wisconsin (see Early 2005) and any records pertaining to Biskupic's possible firing. Wisconsin Democrats have long considered Thompson's prosecution an attempt to besmirch Doyle before the 2006 election, and have accused Biskupic of mounting a politically motivated pursuit of an innocent government official. (Marley and Walters 4/7/2007; Frommer 4/10/2007; Rourke 4/10/2007) Feingold says in a statement that Thompson was the victim of a "miscarriage of justice," and adds, "In light of ongoing concerns about the politicization of US Attorneys' offices around the country, I am seeking further information from the Department of Justice on how this case and voter fraud cases after the 2004 election came about and whether there was improper political pressure to pursue them." (Federal Document Clearing House 4/10/2007)
Denials of Political Motivations - Biskupic's First Assistant US Attorney (FAUSA) Michelle Jacobs says that the prosecution of Thompson was not politically motivated, and the office received no contact from the White House or the Justice Department. "They acted on the evidence as they found it, convinced a jury of 12 that there was criminal conduct, convinced a judge who has been sitting on a state and federal bench for 33 years that the verdict was sound," Jacobs says. "But we just did not convince the court of appeals, and we'll respect the court of appeals decision." Andy Gussert, president of the state employees union AFT-Wisconsin, says Congress should look into the Thompson case because servants should "not become political footballs to be kicked around." He adds: "This prosecution raises additional questions that resonate with concerns about the recent firings of US Attorneys. If people are to have faith in our judicial system, those questions will need answers." Former State Attorney General Peg Lautenschlager, who was involved in the Thompson investigation, says the investigation was not politically motivated. Lautenschlager is a Democrat, but is considered a political enemy of Doyle's.
Thompson Nearly Destitute - Thompson's lawyer, Stephen Hurley, says Thompson has been left almost entirely penniless by the case. She lost her $77,300-a-year state job, about $60,000 in back wages, and owes somewhere between $250,000 and $400,000 in legal fees. She was forced to cash in her state pension and sell her $264,700 condominium, which she had paid off entirely. Travis says the federal government should pay her lost wages and legal costs, and compensate her for her time in prison. State officials say they are prepared to offer Thompson her old job or a similar position at the same salary, and are investigating whether they can reimburse her back wages and pay her legal bills. Thompson says she does not want her old job back, but would like another job in the same division. She is very concerned with staying out of the public spotlight. (Marley and Walters 4/7/2007; Rourke 4/10/2007)
Biskupic Considered for Firing - Unbeknownst to Congress or the press, Biskupic was considered for firing in 2005 (see March 2, 2005), but was later removed from the list of people to be fired. Biskupic himself will soon claim that he did not prosecute Thompson for political purposes (see April 14, 2007).
An editorial by Adam Cohen in the New York Times concurs that Wisconsin state employee Georgia Thompson was the victim of a politically motivated prosecution. Thompson's conviction on corruption charges was recently overturned (see April 5, 2007), and critics are now alleging that state Republicans used the Thompson case to help defeat incumbent Governor Jim Doyle (D-WI), who defeated a Republican challenger in November 2006 (see April 7-10, 2007). "The entire affair is raising serious questions about why a United States Attorney put an innocent woman in jail," Cohen writes. Cohen implies that US Attorney Steven Biskupic of Wisconsin may have pursued the Thompson allegations in order to avoid being fired in the 2006 US Attorney purge (see December 7, 2006 and December 20, 2006). "Members of Congress should ask whether it was by coincidence or design that [Biskupic] turned a flimsy case into a campaign issue that nearly helped Republicans win a pivotal governor's race," he writes. The appeals court that overturned Thompson's conviction was "shocked," Cohen writes, at the lack of evidence against Thompson. Moreover, Biskupic, the US Attorney for Eastern Wisconsin, took over the case even though it originated in Madison, in the Western District. And he spoke to reporters about the investigation, in apparent defiance of Justice Department guidelines saying federal prosecutors can publicly discuss investigations before an indictment only under extraordinary circumstances. Cohen says the scheduling of the prosecution "worked out perfectly for the Republican candidate for governor. Mr. Biskupic announced Ms. Thompson's indictment in January 2006. She went to trial that summer, and was sentenced in late September, weeks before the election." While Biskupic has denied that the timing of the prosecution was "tied to the political calendar," it was, says Wisconsin Democratic Party chair Joe Wineke, "the No. 1 issue" in the governor's race. Cohen then writes: "Most of the eight dismissed prosecutors came from swing states, and Democrats suspect they may have been purged to make room for prosecutors who would help Republicans win close elections. If so, it might also mean that United States Attorneys in all swing states were under unusual pressure. Wisconsin may be the closest swing state of all." President Bush lost Wisconsin by a vanishingly small margin of 12,000 votes in 2004, and by an even narrower margin in 2000. Wisconsin politicians say that Karl Rove, the White House's political chief, told them Wisconsin was his highest priority, because he believed that having a Republican win the 2006 gubernatorial race would help Republicans win in the 2008 presidential election. Cohen concludes by pointing out the irony of one element of the prosecution: Biskupic charged that Thompson committed the alleged crime to obtain "political advantage for her superiors" and to improve her own "job security." Cohen writes, "Those motivations, of course, may well describe why Mr. Biskupic prosecuted Ms. Thompson. (Cohen 4/16/2007)
Biskupic Considered for Firing - Biskupic was considered for firing in 2005 (see March 2, 2005), but was later removed from the list of attorneys under consideration for removal.
Former Wisconsin procurement officer Georgia Thompson, wrongly convicted of corruption in 2006 (see 2001 and June 13, 2006) and freed by an appeals court in 2007 (see April 5, 2007) amid speculation that her prosecution was politically motivated (see April 7-10, 2007, April 16, 2007, and April 24, 2007), was pressured by federal prosecutors to turn on high-ranking Democrats in Wisconsin state government, according to officials involved in the case. In return, prosecutors promised leniency or dropping the charges in their entirety. Her lawyer, Stephen Hurley, says prosecutors wanted her to testify against Governor Jim Doyle (D-WI), the then-Department of Administration Secretary Marc Marotta, and other elected officials. The pressure came from US Attorney Steven Biskupic and others in his office, according to Hurley and co-counsel Marcus Berghahn. "I began to get the impression that the indictment was being used to squeeze her," says Hurley, saying that these attempts continued even after Thompson's sentencing (see September 22, 2006), with offers to seek a reduced sentence if Thompson produced evidence that Doyle or others in his administration had broken the law. Hurley, who has been a criminal defense attorney for over 30 years, says: "It was the only time in my career that, after the person was sentenced, the prosecutor has called to renew the discussion. I've never had that happen before." Reporter Bill Lueders writes, "These offers, though not necessarily indicative of improper conduct, suggest that Biskupic and his staff prosecuted Thompson as part of a larger agenda, with potential political overtones." Biskupic has denied any political motivations behind the prosecution (see April 14, 2007) and refuses to discuss any plea offers with Lueders. Former Dane County assistant district attorney John Burr, a past president of the Association of State Prosecutors, says of Biskupic's plea offers: "You can't tell me it was not politically motivated. The powers that be over there thought they were going to go all the way to the governor." Biskupic's office, says Burr, prosecuted Thompson to get to Doyle and others. And, "[w]hen they didn't find anything, they were stuck with it. It blew up in their faces." Republican gubernatorial candidate Mark Green (R-WI) used the Thompson prosecution as the centerpiece of his campaign against Doyle in the 2006 elections, accusing Doyle of running a corrupt administration. Doyle defeated Green in the election. Many have speculated that the case can be tied to the 2006 US Attorney purge (see March 10, 2006, December 7, 2006, and December 20, 2006), with Biskupic pursuing the Thompson case to curry favor with the Bush administration and keep himself from being fired. Biskupic was considered for firing in 2005 (see March 2, 2005), but was later removed from the list of those being considered for firing. Biskupic insisted throughout the prosecution that the case was entirely about Thompson, and not about Doyle or other elected officials, but in his closing arguments, he cited Doyle, Marotta, and others as "players" in the affair, saying: "She's the link. She's the one who made this happen. What a terrible coincidence for her that she is in the middle of all this." One juror later said that "nobody in the jury room had any doubt whatsoever" that Doyle and others were involved, though there is no evidence to support such a conclusion. Former US Attorney Frank Tuerkheimer says there is nothing untoward or unusual about Biskupic trying to "flip" Thompson to get information about higher-ups. "In principle, there is nothing wrong with it," he says. "There's no question in my mind that Biskupic was after Thompson to get higher-ups." The problem was, Tuerkheimer adds, that "Biskupic had a theory of criminality that was ridiculous"—that Thompson was acting at others' behest. "It just bothers you 'cause the woman got screwed." Tuerkheimer notes that Biskupic had Thompson jailed pending her appeal, which was unusual for such a case. She had no criminal history, was not a flight risk, and had a legitimate case for appeal. Most people in her position would have been allowed to stay out of jail pending the appeal. Why did Biskupic insist on having her jailed? Tuerkheimer replies, "It appeared to me that they were trying to pressure her to talk." (Lueders 5/18/2007) Doyle says he is alarmed by the reports that Biskupic and others tried to pressure Thompson into testifying against members of his administration. "The story is pretty alarming, particularly given that she had testified under oath that nobody had ever asked her to do anything inappropriately," Doyle says. "Even after… testifying under oath they were still trying to get her to give information that just wasn't true." Doyle refuses to say directly that the prosecution was politically motivated, but asks rhetorically, "Does anybody really think that Georgia Thompson, if it hadn't been an election year, that this would have ever happened to her?" Biskupic's chief assistant Michelle Jacobs denies that the prosecution had any political components to it, saying: "We would never, and have never, encouraged a defendant to lie to us. To suggest that it is somehow untoward or unusual to approach a post-trial defendant, even a defendant who has testified, about cooperating with us, it's just not unusual." (Foley 5/18/2007)
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If you stay signed-in for a long time and if you are handling sensitive documents, you may want to take extra security measures. You can use "Passcode Required" option which requires you to choose and enter a 4 digit passcode, every time you launch the app.
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Energy labels need to be easier to understand
Improving the energy efficiency of household appliances makes good sense, domestically it reduces your household bills and globally it reduces energy use and, depending on the appliance, environmentally damaging emissions. It would help then if consumers could easily see which appliances were energy efficient. Energy labels were first introduced (by EU mandate it should be noted) in 1994 on a simple A-G scale, with G being the least efficient and A the most. However, as manufacturers responded competitively, it was … Continued


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I know alot of people are weary about becoming an LPN these days. They are getting phased out, not getting paid well, or whatever else crap you can come up with. I too didn't want to an LPN program, I thought It wasn't worth it. Boy was I wrong. I applied and got accepted into Gateway Community College LPN fast track program in Phoenix Arizona. It was a nine month program , with amazing clinical experience in great facilities . They taught us very well and got us very prepared for HESI, and NCLEX. I passed everything with flying colors.I am now eligable to transfer into third block of the RN program and finish fourth block there after. In the time I would of spent waiting on an RN program waiting list at this same college, I can have my RN. I took my NCLEX, and am now a state licensed LPN. I paid out of pocket for my education, book and and all. I am a single mother working two jobs. I got hired as a pediatric home health LPN making in the 90th percent of the national average LPN salary. Pretty darn good! In my first two paychecks I will get back every penny I put into my education.That seems worth it doesnt it? I have worked in the ER and hospitals for a long time, so i have experience, but nonetheless the LPN program has allowed to be secure a well paying job as a LPN, while working towards my RN. I will be an experienced nurse when i get my first RN job. I will know what I am doing, and how I am going to do it.I will be confident, skilled and desired.An LPN is a respected member of the healthcare team and we should remember that when we dress our confidence for the day . I am a success story, I am a single young mother who attained her LPN in 9 months, passed the NCLEX on the first try, secured a job I wanted ( got many calls for jobs I didn't want) within two months, and will have a very well paying job while I am finishing my RN in 9 more months. Tell me that isn't worth it…I deff recommend becoming an LPN prior to RN. I am a CNA, with phlebotomy and EKG certification, now I am a new grad LPN and soon will be an RN. Just the first of my life long career path. I want the old me to read this post..the old me who almost went to a 90k private college to avoid a 2 yr waiting list for the RN program. This route is just as fast, financially smart and well worth it.
Life goes on
We are now in Late July and life has gone on . Two of my classmates did 3rd block in the summer block, and the majority of the rest of them start August 27th for third block in the fall. So if your ready, have your hesi scores utd and ready to go, you can go into third block right after. I will be applying for third block in the spring due to life, and I am okay with that now. I've had some legal issues and can't leave arizona until June of 2015, so I guess I am stuck here now.
In the last month I've applied for some LPN jobs, have gotten quite a bit of response back from Skilled nursing facilities, doctor offices, home health and even corrections. I have given careful though to where I want to work, what environment and I've decided and taken a job as a home health pediatric nurse. I am sad leaving my emergency room positions right now, but taking a leap of faith that this is where I need to be. The position is with a great pediatric company that I've always wanted to work with as an LPN. I am very blessed to have gotten the position I've wanted. The pay rate is good as well. I've looked up the average LPN rate in the nation, and I will be getting paid in the 90th % , I am satisfied with that.
Honesty time…. I am scared to be a nurse on my own. I am scared to be in charge of the daily life of a two yr old with chronic health issues. What if i get the medication mixed up, what if I don't do the feeding pump correctly, or if I freak out with the trach/vent. I know I will be fine, I know I am competent to do such, but it still makes me nervous thinking about the responsibility I will be having. I've been around vents/trachs/feeding tubes for many years, and have been in life threatening positions with them and have been fine. But I've had my nurse close by, a call away…now I am the NURSE. I am the NURSE…….


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I specialize in helping homeowners save money on their mortgage. As a federally licensed Loan Officer, I have been trained in all areas of mortgage banking and I'm required to meet continuing education goals. My goal is to make the mortgage process easy for you by making sure your loan request is processed smoothly and efficiently. Although you will be kept up to date on the loan status automatically, I offer personalized advice to help with your unique situation. Although I have been in the mortgage business for many years, I chose Allied Mortgage Group because of our commitment to the community and educating our customers about responsible lending and home-ownership. As a company, we prove ourselves every day with a 98% satisfaction rating. I believe that treating customers properly is the best way to grow my business. I live in Philadelphia and graduated from Penn State University. I look forward to helping you with your loan request.
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develops gradually, but the symptoms may seem to come on suddenly. When there's no more insulin in the body, blood glucose levels rise quickly, and these symptoms can rapidly develop: Extreme weakness and/or tiredness.
If type 2 goes untreated, the high blood sugar can affect various cells and organs in the body. Complications include kidney damage, often leading to dialysis, eye damage, which could result in blindness, or an increased risk for heart disease or stroke.
No matter how thin you are, you can still get . "Diabetes comes from insulin resistance, which causes high blood sugar. While about 80 percent of people with are overweight or obese, it happens to thin people as well." Right now, 30 million people in the U.S. have .
It's normal to feel strong hunger if blood sugar is low, or if your stomach is too empty. ... Diabetes can cause hunger if glucose is not getting into the cells where it's needed. Other medical causes of excess hunger include thyroid problems (such as Graves' disease,) pregnancy, cannabis smoking, and depression.
Diabetes can be effectively managed when caught early. However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney damage, and nerve damage. If you have , your pancreas either produces too little insulin or none at all.
It's rare, but people with can see blisters suddenly appear on their skin. You may see a large blister, a group of blisters, or both. The blisters tend to form on the hands, feet, legs, or forearms and look like the blisters that appear after a serious burn. Sometimes, it's called diabetic bullae (bull-lie).
Most early symptoms are from higher-than-normal levels of glucose, a kind of sugar, in your blood. The warning signs can be so mild that you don't notice them. That's especially true of type 2 . Some people don't find out they have it until they get problems from long-term damage caused by the disease.
You have multiple signs and symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion.
You could have and not know it. The symptoms of can be very mild. In fact, of the 29 million people in the U.S. who have , 8 million are undiagnosed, according to the American Diabetes Association. However, you don't know just by your symptoms if you have .
What causes type 1 ? occurs when your immune system, the body's system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 is caused by genes and environmental factors, such as viruses, that might trigger the disease.
In the current global marketplace|the global marketplace of today}, the world wide web is a essential part of these strategies of any successful business the strategies of almost any small business that is successful any successful any business' strategies. The advice and information contained in this article can help you understand, even learn if you are just a beginner. {As your confidence in Internet develops, You can start {implementing more complex strategies as your confidence in Internet grows, as your confidence in Web develops. You should begin implementing strategies that are more complicated, as your confidence in Web develops|You can begin implementing strategies that are more complex. As your confidence in Web grows, you can start implementing strategies that are more complicated.
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Keep your sentences brief and to the stage. {An average. An sentence will probably be in the assortment of 13-16 words. If you're including a lot of unnecessary information in a post, you will lose your reader's attention. Keep it clear and exact, in order to make an impression in your viewers.
Ensure that your website includes worthwhile content. You might be able to attract people to your website, but do you've got anything to keep them ? Quality content is important. Make sure your site has something useful to say, and make sure that stated content is succinct and well written.
When dealing with real estate internet , your site needs both traffic and a lead generation system. A busy website without the means for direct generation will never raise your business. Visitors will travel in and out, but will never leave behind this is genuine of value to you.
{Use real life acquaintances to gain online subscribers. Inform family, your friends and anyone you know, that you have a website and that you would love for them to {check it take a look and for them to let others know. Some of the greatest and most prosperous businesses today started with a small group of determined people.
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To help your organization internet , make sure that your website is user friendly. You may think it looks good, but try it on different computers and with numerous browsers. Sometimes certain features are disabled on various browsers, and this might affect how much material that your audience has access too, in addition to how long they will appear around the site they will appear around the site. {Keep things simple and easy to find.
In important tip regarding internet would be to be certain that you always keep on top of the latest trends and news concerning the internet. This is extremely important because this is a changing medium which can, and will change the way you go about your business.
Contain interesting photographs that are interesting along with your articles. People are very visual, particularly on the world wide web, particularly and a photo will make them interested in reading more. Colorful and fascinating photographs are greatest. {Always make certain that to have the proper permissions to post any photos you intend to use along with your articles.
Place graphics on your page which provides users an idea of what to expect from your products. You may include pictures of your product in the hands of smiling people. If it is a product that was created to sculpt the human body or to improve the visual appeal of whatever, you ought to have before and after pictures.
Make certain that you offer your customers extra incentives along with the purchases that they create on your website. This may include items like free shipping options, gift wrap options, and even more. It's possible to use numbers such as the very first X amount of clients get this incentive or that everyone can find this incentive should they purchase by this season.
Among the wonderful things about online is that it does not require a huge investment of capitol for novices. It may even be done by high school or college students having the correct skills and company spirit. If you can, you should begin your first project young to have a sense for this.
Although Internet can seem catchy, it uses a number of ideas ideas|It uses {ideas from traditional advertising and approaches, Though Internet can seem tricky|It uses ideas from traditional strategies Though Internet advertising can seem catchy! Use what you learned from this article and search for more Internet tips before you start your online enterprise.
Learning how to use search tips. Finding out is a really helpful skill for online marketers. Knowing how to find exactly what you are looking for in the most fast and effective way possible will save you a great deal of time. This article will teach you how you can do your internet searching efficiently.
Using search engine optimization will make sure that your website is listed for its content, not its presence! To put it differently, popular sites cannot harvest information from certain types of content. For example, if your user interface utilizes Flash, your lists can be bereft of information. Search engine optimization techniques will add more info information to your site, making it much easier for search engines to represent your site correctly site.
Take a day away. Internet can really consume as you're sitting in the front of the computer|As you're sitting in the front of the pc, internet can very easily consume your entire day|As you're sitting in front of the computer internet can really easily consume your whole day. This can cause you to be irritable tired and someone who isn't great to be around. Take some time to exercise or clear your mind and you're going to return to work, well-rested and invigorated.
To promote what it is you are selling, write a review of the product. Be sure to use the name of the merchandise and the word review on your title. People looking for the key word'review' will locate your web page and odds are they are currently thinking about purchasing the item, if they {were looking for a review.
To target your audience better, you should track where each single visit came from, and in which the person ended up, especially if they clicked on an ad and purchased a product. You can achieve this thanks to visitors tracking tools easily. This allows you to see what directs people to your website.
When designing a website to advertise a product or service online, add a resources section. Adding a resources department attracts potential clients to your website clients by increasing your search engine ranking. It also means that viewers of your website are inclined to return to see those sources, and could wind up buying your product.
When your products and services on the internet, always world wide web react to e-mails out of clients and respond to {them fast. Should they whine about a error, fix it. If there's a broken link is there is that is broken is get that fixed fast. Always react in a skilled and personal manner. Do not argue with the client. Building customer relationships is important, even over the net.
Incorporate a website banner which contains your mission statement or slogan, or possibly both slogan or your mission statement, or maybe both or slogan, or maybe your mission statement. This will let people know precisely who you are and help them to remember you. A banner is a great way to highlight your enterprise.
If your client base is on the world wide web and you would like to reach them out stay in continuous contact. However, do not be overly burdensome either. Send out emails on a periodic basis emails on a basis out reminding them of service or your product, or perhaps of new specials. This should ensure that you maintain your current clientele and may quite could possibly help you expand your clientele.
One method for increasing your website's exposure would be to add the URL to the Open Directory Project at. Submissions are evaluated for quality, but if your website is accepted, it will be part of a massive, comprehensive human-edited Web directory and be listed in Google's index, opening the door to a whole new audience of potential customers.
Choosing Google to handle your ads is the best, therefore try whatever you can to be certain you're using Google. You can use ad services alongside Google, but remember that Google is the king and the remaining services are just pretenders to the throne. Follow Google's guidelines for acceptance and remember this is a make-or-break factor of your small business.
Post all of your articles on your site. This will help your readers and potential clients to know who you are and where to look for you. It adds to your own aura of authenticity and trustworthiness. Additionally, by incorporating your great articles to your site, will attract a lot of great targeted, good traffic traffic your way.
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Make sure that the colors you use on your own website that do not make it hard for users to locate navigation links. If your site is in black but your navigation links are in blue users might not see them and that will mean less time they will spend on your website.
Don't expect {visitors to purchase items to be bought by visitors, convince them to! You can't simply post a listing of the products that you need for Christmas and expect that your customers will blindly agree and buy all of them. You should write an explanation of why you want each item, detail its usage, include a photograph, and mention some customer testimonials that exist.
Keeping up with your competition is another important aspect of Internet . You have to be up to date with what your competitors are doing. There's a great deal is which you may get from watching others. And possibly most importantly, learn from other people's mistakes so that you do not make them yourself!
When you are getting to be interested in online you have to steer clear of the concept that it is a get rich quick type of deal. While there are always stories of those people that were powerful in this way, for the most part it is a great deal of hard work to generate a small to medium return.
You have now spent some time reading about search tips studying. Some of these you probably already knew, though some might have been new to you. Hopefully you found these tips helpful and will be able to save time searching and more time working on your advertising strategies utilizing the web.


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I've breastfed two babies now, so that obviously makes me an expert with a wealth of breastfeeding wisdom to share with the masses! LOL. jk. I'm not even close to an expert, I've got nothing particularly novel to share, and I'm approximately 0% qualified to educate anyone on the art of the boob feast. Nevertheless, I've learned some things just by fumbling through it and maybe this will help a new, frantically googling mom or at least give her a laugh or something… plus it's World Breastfeeding Week so it seems like an appropriate post for today!
Breastfeeding is pretty cool. You make actual, perfectly balanced food from your body and then use it to nourish your precious little baby. You've got a ready-made meal for your mini, anywhere, anytime! Plus there's about a million-and-a-half health benefits for both mom and baby, but mom blogs and breastfeeding crusader warrior mothers like to shove those down our throats every chance they get so you already know about those ; )
Breastfeeding is also sometimes the worst garbage. And it's absolutely NOT for everyone, so you do you, mama, NO SHAME! In fact, check out this post on formula shaming if you're so inclined.
With all that said, here are 10 things I've learned about breastfeeding!
1. It's a full time freaking job.
When I was reading up on breastfeeding pre-baby, I imagined feeding my newborn every few hours, and then putting it down to sleep while I floated around the house doing fun, nesty, new mom things. HAHAHA. How naïve. Both of my boys spent their first three months almost permanently latched to my breast. Forget the "make sure the baby eats every three hours, or 8 times a day" guidelines because those are crap. Expect to spend a huge amount of time literally stuck under your constantly nursing newborn. You're going to feel pretty useless, but try to embrace it. It's temporary – eventually they slow down and also start eating things that don't come out of your body. But for now, get some good podcasts, or like the entire Harry Potter series, and settle in mama, cause you're not going anywhere.
2. It's the easiest way to calm a baby.
In my experience, there was literally never ANY kind of problem that my boobs wouldn't fix. Baby's hungry? Breastfeed. Baby wont nap? Breastfeed. Baby's getting stabbed with needles at his immunization appointment? Breastfeed. Baby's screaming at the top of their lungs in a restaurant and disturbing the happy diners? Breastfeed. You get the picture. For some people soothers/dummies work wonders. But my kids only wanted the boob. On the upside, I never had to listen to my child cry for longer than I wanted to because the second I got a boob in their face, they'd instantly chill. It's kind of like magic.
3. Your nips will never be the same.
I used to have cute, petal pink, lady nipples. Now they're these weird, dark, uneven disaster nipples that just keep getting longer and coarser the more I breastfeed. Maybe they'll go back to their former splendor when they're no longer abused by hungry animal babies, but I doubt it. I'm pretty sure I could light them on fire at this point and not notice.
4. Lactation cookies don't really work.
Most women, at some point in their breastfeeding journey, will worry about their milk supply. If you're like me, you'll turn to the internet for some magical granola fixes to get the juices flowing again. Enter: Lactation Cookies – A miraculous baked good designed with all of the finest galactogogue ingredients! I whipped up multiple batches of these babies, chock full of brewers yeast, flax, oatmeal, wheat germ, herbal supplements etc. etc. etc… But the only thing that wound up being engorged was my waistline. IF (and that's a big if…) those fancy ingredients actually work to promote milk supply, you'd have to eat a whole lot of cookies to see a difference. If you're going to go that route, opt for brewer's yeast, blessed thistle, and fenugreek tablets instead of ingesting 17 cookies every day. Or just make regular cookies that don't taste like grass and stale beer, and go to town on those instead!
5. People will judge you.
Unfortunate, but true! I breastfeed in public without a nursing cover all the time (mostly because I'm just too lazy and too cheap to buy one) and I've had so many people make judgemental comments such as…
"If you'd like some privacy, there's a bathroom over there" … NO THANKS, Edna. If you'd rather not observe the miracle of my nursing infant you can go hang out in the toilet while everyone else enjoys real life. EYE ROLL.
"Could you cover up, please?"… NOPE. I'm feeding a child, not waving my tits around! It's not my fault your raunchy mind can think of nothing other than inappropriate and sexual things when you see a nursing mother, and I'm not going to hide under a blanket so that you can feel more comfy behind your conservative, patriarchal buffer. FACE. PALM.
Uhggg. But that's not all you get judged for. If you do choose to cover up (because maybe it's winter and you're literally freezing your titties off, or you feel more comfortable that way, or you have a cute nursing cover that you actually like using, or whatever!) people will still make comments!
"You don't have to cover up! It's natural and beautiful!" … I'm glad YOU feel comfortable with MY boobs, but it still my body and I'd rather not be told what to do with it, thanks.
You'll also be judged for how long you breastfeed…
"Isn't he a little old?" … Aren't you a little bit of a nosy asshole?
"You quit already? I'm still breastfeeding my two-year-old because there's a second wave of evolved immuno-excellent milk at that stage!" … GO AWAY.
So you basically can't win. Try not to let it bug you!
6. Pumping is lame.
It's uncomfortable and it makes your nipples swell up like gross cherries. You do what you gotta do, but it's still lame AF.
7. Some people's milk tastes like awful soapy dishwater after freezing it.
I did not know about this one until I finally thawed one of the bags from the MASSIVE stash of breastmilk I had pumped and frozen, and my baby literally gagged on it because it was so awful. Moms with a lot of lipase in their milk can run into this problem after freezing. There's nothing wrong with the milk, and some babies will still drink it, but mine definitely wouldn't. So I had to dump all of that beautiful liquid gold I had extracted and start over! Now I scald all of my pumped milk before freezing and that takes care of it. Not cool, though!
8. Cabbage leaves don't help mastitis.
Mastitis hurts like a bitch. Putting cabbage in your bra does nothing other than make you smell like your mouldy old great aunt.
9. You probably don't have to worry about it.
I'm pretty sure my Google search history in the first few months of nursing looked something like this: Is my baby getting enough milk and how much wine is too much when nursing and what is the optimal sleeping position for milk supply and how long can an adult survive off of only her own breastmilk and help. Truth is, you probably don't need to worry about it. If you ARE worried about it, ask your doctor. Otherwise, odds are that you're doing great and you can relax!
10. You're the boss of when you stop.
When I got pregnant with my second, my first was still nursing. I could really only handle one cute little parasite sucking out my life-force, so I decided that was that and cut my son off. He was sad for maybe one day? And then that was it. It's up to you when you stop. Don't let your kid boss you into keeping nursing longer than you want. Don't let nosy Anne from Mom's Group boss you into weaning your toddler if you're not ready. It's your body, and you're in charge!
So there! 10 random things I learned about breastfeeding! What did you learn about breastfeeding that surprised you? What do you wish you'd known? Let us know below!