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APA Speaking of Psychology: Helping transgender people thrive
Added by Kelli Busey on November 22, 2019.
Saved under Activism
Tags: Anneliese Singh PhD, APA Speaking of Psychology
Transgender and gender-nonconforming people are becoming more accepted in mainstream society, but they still remain misunderstood and understudied. In this episode, psychologist Anneliese Singh discusses how she and other researchers are trying to understand resilience within this population. She also talks about new practice guidelines for the mental health professionals who work with them.
About the expert: Anneliese Singh, PhD
Anneliese Singh, PhD, is an associate professor at The University of Georgia and co-founder of the Georgia Safe Schools Coalition and Trans Resilience Project. Singh has worked on several national guidelines projects for transgender people and mental health professionals, including the APA's Guidelines for Psychological Practice with Transgender and Gender Nonconforming People.
She is author of the upcoming Handbook of Transgender Affirmative Counseling and Psychological Practice. Singh is the past-president of the Southern Association of Counselor Education and Supervision and the past-president of the Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling.
Audrey Hamilton interviews Anneliese Singh in Episode 30
Audrey Hamilton: Welcome, Dr. Singh.
Anneliese Singh: Thank you. It's good to be here.
Audrey Hamilton: You've been selected to take part in a National Institutes of Health-funded study with other researchers to examine how transgender people came to accept their gender identity. Can you talk more about this study?
Anneliese Singh: Sure. We're really excited about this study because it's the first longitudinal study that is specifically looking at transgender identity development. And the reason that that is important is because most of the federally funded research for transgender people has mostly centered around more pathological issues, such as HIV and AIDS, risk – whereas this longitudinal study is not only looking at risk, that transgender people might face in their identity development over the lifespan, but it's also looking at resilience, which is a really important part of coping and navigating trans prejudice for trans people. So, we're very excited to be collaborating with the University of Georgia, San Francisco State University and Columbia. So, it feels like it's the start of a new day for transgender research.
Audrey Hamilton: Now, as part of the trans resilience project, you have been studying transgender people's resilience in the face of discrimination, specifically. Why do you think it's important to explore resilience among the transgender community?
Anneliese Singh: That's a great question. I think one of the things we know as we look back a transgender resilience and transgender research is that resilience has been an understudied construct. So for instance, we know pretty well in 2015 how many people are getting hurt who are trans. We know that there are multiple stressors. We know that there are discrimination and barriers in housing and employment. We know that trans youth face higher rates of homelessness and suicide attempts. So, we kind of know all the bad stuff that's happened, but what we don't know as well what are the multiple sources of resilience that trans people use on an everyday basis to navigate those multiple oppressions.
So, the way I think about resilience is it's kind of the stuff that drags you down in life. It kind of is hard to bounce back to normal, and so, resilience strategies that I'm interested in studying for transgender people are really what helps them bounce back. Ultimately, I would love to study what helps trans people thrive. But I think right now in my studies with transgender people of color, youth and elders of color, it's really looking at what are there different strategies of resilience. How do they navigate oppression?
Audrey Hamilton: As I mentioned in the introduction, you were also on the APA task force that developed guidelines for practicing psychologists. They work with transgender or gender-nonconforming people. Can you talk about those guidelines? Why were they needed?
Anneliese Singh: Well, one of the things that we know in psychology and counseling and other helping fields is that there's not a lot of guidance in what psychologists and helping professionals should do in serving transgender clients. So, a lot of people are maybe trying to do the best that they can. And maybe the best that they can is really harmful to transgender people. And so, when you look at these guidelines, they're very basic level, foundational pieces of information of how to do psychological practice with transgender people and gender-nonconforming people across the life span. So, we did have lesbian, gay and bisexual guidelines. But again, that's not really enough. One of the things that was really important in designing the guidelines were to really make sure that we not only talked about trans phobia and anti-trans bias, but that we also talked about how issues such as racism, adultism and other forms of oppression really affect the mental and physical well-being of transgender people.
The other good reason that we had for beginning guidelines system in APA for working with transgender people was really to be very clear about what providing affirmative therapy is to transgender people. We know from the research that the more the psychologists are working from an affirmative approach with transgender people, the better their outcomes are. So, it was an idea that was really important and I'm glad the time has come that these guidelines are now released.
Audrey Hamilton: Can you explain what affirmative means?
Anneliese Singh: Yes, I would love to. Affirmative is not tolerating transgender people. It's not being inquisitive or objectifying transgender people or making trans people educate psychologists on how to work with them or what their gender identities are or mean. Being affirmative means using the pronouns and the names and the language that really support and empower transgender people. It's understanding that when you're working with transgender people it's not just asking them what's wrong with their life, but asking them how they are resilient. And being affirmative, a key component is really looking at your own gender. So for psychologists wanting to be affirmative in their psychological practice with transgender and gender-nonconforming people, we have to look at our own gender – what we came to learn about our gender, whether we're a person of color, we're raised to think about gender a certain way, whether we're a person living with a disability and we think about our gender a different way – just the psychologist self-reflection on gender is such a key and foundational part of affirmative practice.
The other piece of foundational practice and the guidelines is really knowing that transgender people were not a recent thing. It's not a fad. It's not a trend. Transgender people and gender-nonconforming people have existed across time and culture across the globe.
Audrey Hamilton: What about the mental health and developmental needs of gender-questioning youth? This is something you've been hearing a lot about in the news and the media. How are their needs unique?
Anneliese Singh: You know, the interesting thing about transgender adults is life can be really challenging, right? But at the same time, when you're working with transgender and gender nonconforming young people, what this group of people has to face additionally is adultism. So, adults tend to have power in the lives of young people. We know that. But, when you add a gender identity that may or may not be accepted by society and families, then you've got a different situation on your hands.
So, one of the things that we know for transgender youth and gender nonconforming youth is that family acceptance is a priority. So, we know that health outcomes, mental health and physical health outcomes like suicide attempts, depression, substance abuse, homelessness. All of those things can really be moderated by family acceptance. At the same time, it can be really challenging to work with families in school settings and community settings around these issues because there can be a lot of grief that families experience as they try to navigate their child's gender identity. And schools and community settings may just have no idea about how to support transgender youth.
So one of the things that we really think is important about working with trans youth is assisting them to kind of explore their gender and also making sure to advocate for them. If we know they have little power in their lives and we know that anti-trans prejudice exists, then we've got to be strong advocates when we're dealing with medical settings, school settings, family settings, you name it.
Audrey Hamilton: Now the task force that we talked about did address guidelines for adults working with gender questioning youth. What should parents and school officials know and how can they make sure these children feel safe?
Anneliese Singh: One of the really important things is that unfortunately, conversion therapy is still something that's out there with transgender young people.
Audrey Hamilton: Can you explain what that is?
Anneliese Singh: Conversion therapy is really an approach where they kind of advocate that the sex assigned at birth that the child should really be kind of guided into playing with toys, dressing and identifying with a gender that aligns with that.
So, for instance a young child that is assigned female sex at birth but identifies as a boy would be more encouraged to play with things or dress in clothes that align with the sex they were assigned at birth. I think that is considered to be a very unethical approach. The World Professional Association of Transgender Health in 2011 came out with a strong statement that those approaches are unethical. And so, if you know that's unethical – I mean the good news is then you don't have to do it and shouldn't do it. Instead, you should work with families to really keep in mind the research on family acceptance. You can't use a heavy hammer to say, "OK, accept your child's gender." But what you can do is share that the more acceptance there is, the better the outcomes are long-term. So, supporting gender exploration, helping families grieve – a lot families believed that their children were perfect, the exact way that they were born. And so what that means is there's a lot of grief work that you are doing in therapy, but they are also really thirsty for information. A lot of families just don't know how to support their children the best. Or maybe they learned really stereotyped notions of gender or perform those stereotype notions themselves. So, helping families, helping children, develop coping strategies, really being a strong advocate for the family and the child with their interaction with school settings, with community settings and helping facilitate collaborative medical care, if that's needed. Those are really important things to help children feel safe.
But the other thing is to really be able to explain that for families of transgender and gender-nonconforming children the families often go through a coming-out stage that's very similar to transgender young people. So, there are different stages. The children, the adolescents, and the families may be in very different stages. So, it can be really complex, but to really drive home as a psychologist that the best needs of the child are what you keep at the center of therapy and that the more that you support the child in exploring the gender, the better their health outcomes are long term.
Audrey Hamilton: Dr. Singh, thank you so much for joining us. It's been such a pleasure.
Anneliese Singh: Wonderful. Thanks so much for having me.
Audrey Hamilton: For more information and to hear other episodes, go to our website
With the American Psychological Association's "Speaking of Psychology," I'm Audrey Hamilton
Speaking of Psychology is an audio podcast series highlighting some of the latest, most important and relevant psychological research being conducted today.
Produced by the American Psychological Association, these podcasts will help listeners apply the science of psychology to their everyday lives
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Legislature(2015 - 2016)CAPITOL 106
02/26/2015 03:00 PM HEALTH & SOCIAL SERVICES
House HSS 02/26/2015 15:02
Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
Download Mp3. <- Right click and save file as
03:03:16 PM Start
03:03:41 PM Presentation: Department of Health and Social Services Division of Public Assistance
04:17:51 PM HB59
04:55:31 PM Adjourn
Detailed Minutes
+ Presentation: TELECONFERENCED
Division of Public Assistance - Director Ron
Kreher & Other Invited Guests
-- Testimony <Invitation Only> --
+= HB 59 MARIJUANA CONCENTRATES; LICENSES TELECONFERENCED
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative David Talerico
Representative Neal Foster
Representative Louise Stutes
Representative Adam Wool
Representative Geran Tarr
MEMBERS ABSENT
COMMITTEE CALENDAR
PRESENTATION: DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION
OF PUBLIC ASSISTANCE
- HEARD
HOUSE BILL NO. 59
"An Act relating to marijuana concentrates; and providing for an
effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 59
SHORT TITLE: MARIJUANA CONCENTRATES; LICENSES
SPONSOR(s): REPRESENTATIVE(s) SEATON
01/21/15       (H)       PREFILE RELEASED 1/16/15
01/21/15       (H)       READ THE FIRST TIME - REFERRALS
01/21/15       (H)       HSS, JUD
02/03/15       (H)       HSS AT 3:00 PM CAPITOL 106
02/03/15       (H)       Heard & Held
02/03/15       (H)       MINUTE(HSS)
WITNESS REGISTER
RON KREHER, Acting Director
Division of Public Assistance
Department of Health and Social Services (DHSS)
POSITION STATEMENT:  Presented an overview of the Division of
Public Assistance.
SHAWNDA O'BRIEN, Administrative Operations Manager
Department of Health and Social Services
POSITION STATEMENT:  Answered questions during the presentation
by the Division of Public Assistance.
MARCEY BISH, Program Manager
Child Care Program Office
ELAINE RICH, Chief
Program Integrity & Analysis
TANEEKA HANSEN, Staff
Representative Paul Seaton
POSITION STATEMENT:  Presented the changes to HB 59 for the
sponsor of the bill, Representative Seaton.
TIM HINTERBERGER, Ph.D., Chair
Campaign to Regulate Marijuana Like Alcohol in Alaska
POSITION STATEMENT:  Testified via teleconference in opposition
to HB 59.
RACHELLE YEUNG, Legislative Analyst
POSITION STATEMENT:   Testified via teleconference  in opposition
ALLISON KULAS, Program Manager
Tobacco Prevention and Control
POSITION STATEMENT:  Testified during the discussion of HB 59.
CYNTHIA FRANKLIN, Director
Alcoholic Beverage Control (ABC) Board
ACTION NARRATIVE
CHAIR  SEATON  called  the  House   Health  and  Social  Services
Standing   Committee    meeting   to    order   at    3:02   p.m.
Representatives  Seaton, Talerico,  Stutes, Tarr,  and Wool  were
present  at  the call  to  order.   Representatives  Vazquez  and
Foster arrived as the meeting was in progress.
^PRESENTATION: DEPARTMENT OF HEALTH  AND SOCIAL SERVICES DIVISION
CHAIR SEATON announced that the  first order of business would be
a presentation by  the Department of Health  and Social Services,
Division of Public Assistance.
RON  KREHER,  Acting  Director, Director's  Office,  Division  of
Public  Assistance,  Department  of Health  and  Social  Services
(DHSS), provided  a PowerPoint overview of  the programs, budget,
core  services, and  service population  titled "FY2016  Division
Overview."   He  stated that  he  would also  discuss poverty  in
Alaska  and the  role  of  the division  and  its  services.   He
commented that the current budget  deficit with its corresponding
environment were "a  big test of state  priorities, and certainly
the funding  that goes with  those priorities."  He  mentioned HB
30  which asked  for priorities  to services  and programs  while
requesting  a cut  to  some of  these, as  well  as the  proposed
budget  by  the  governor.    He  noted  that  the  Alaska  State
Legislature  was also  interested in  the projected  reduction of
general fund  spending.  He  asked that the committee  ponder the
question of  identifying Alaska's  most vulnerable  citizens, and
what standards should be used  to prioritize safety net services.
He  declared the  importance  of ways  that  the department,  the
division,   and   the   legislature   could   ensure   that   the
constitutional mandate for  the welfare of Alaskans was  met.  He
directed  attention to  an eight  page overview  of the  division
programs,  as well  as  the Women,  Infants,  and Children  (WIC)
program  and  the  child  care   program  [Included  in  members'
packets].   He  declared that  these  two programs  could make  a
difference for Alaskans.
MR. KREHER  reviewed the "Division Organization  Chart", slide 2,
which showed the distribution of  the 589 staff, including the 23
positions requested  to support Medicaid Expansion.   He reported
that 75  percent of  the workforce  was dedicated  to eligibility
determinations and  benefit issuance throughout the  18 statewide
field  offices.   He stated  that  there were  also grantees  and
contractors  providing  support  for families  primarily  through
work services, WIC,  and child care.  He shared  that the mission
of the  division, slide  3, "Division  Overview," was  to promote
self-sufficiency and  safety net benefits  for families,  as well
as  administrative  management  for prudent  stewardship  of  the
state's  resources  through  the program  integrity  and  quality
assurance sections.   He  noted that  more than  155,000 Alaskans
were served  by the  Division of  Public Assistance  in November,
2014, which he  declared to be a normal  service population size,
as  it  included  child  care,  food  stamps,  and  adult  public
assistance.   He said  that, although it  could be  surprising to
consider that so  many Alaskans were low income,  in poverty, and
met the criteria  for the programs, Alaska was "in  the middle of
pack nationally,"  as the national  average was about  18 percent
and Alaska was at the 20 percent level.
REPRESENTATIVE TARR  asked whether a  recipient of more  than one
program was counted once or twice.
MR. KREHER replied that this  was the total number of recipients,
not duplicated.
REPRESENTATIVE TARR asked if that also included the children.
MR.  KREHER  replied  that this  included  everyone,  adults  and
CHAIR SEATON  asked how many  personnel were related  to Medicaid
Expansion.
MR.  KREHER   replied  that  there  were   23  people,  primarily
eligibility  technicians, as  well  as some  policy and  research
analysts.
REPRESENTATIVE WOOL asked if the  hirings were in anticipation of
Medicaid Expansion.
MR. KREHER replied that the  department anticipated that Medicaid
Expansion  would occur  in  July, and  this  would include  those
individuals in "the gap group."
REPRESENTATIVE WOOL asked if these were recent hires.
MR.  KREHER  clarified that  these  positions  had not  yet  been
hired,  but would  start after  the beginning  of the  new fiscal
MR.  KREHER   returned  attention   to  the  percentage   of  the
population receiving aid  and said that low  income Alaskans were
the  first people  to be  effected in  an economic  downturn, and
they  were  the last  ones  to  recover.    He reflected  on  the
recession  which  began  in  2008,  and  pointed  out  that  this
effected a lot of low income  families in Alaska.  He stated that
this  could  lead  to  an increased  demand  for  the  division's
MR.  KREHER  moved to  slide  4,  a  graph titled  "DPA  Caseload
History FY2007-2014," and reviewed the  growth in recent years of
the seven largest  programs in the division.  He  pointed out the
parallel  growth between  the Medicaid  population  and the  food
stamp caseloads over the last few years.
MR.  KREHER addressed  slide  5, a  program  graph, "DPA  Benefit
History  FY2007-20014," that  indicated  the drops  and peaks  of
services related  to seasonal needs, such  as heating assistance,
which had received a lot  of supplemental funding from the Alaska
Affordable Heating program.  He pointed  out that the big dips in
the  food   stamp  program  (SNAP)  reflected   the  months  that
recipients  received   the  permanent  dividend  fund,   and  the
issuance of cash benefits to replace the loss of federal funds.
MR.  KREHER, in  response  to Representative  Vazquez, helped  to
establish the order of the graph lines.
MR. KREHER,  slide 6,  used a  state map  of census  districts to
indicate where  public assistance  was distributed  by percentage
of  population.     He  noted   that  the  rings   reflected  the
unemployment rates in those same  areas, and he acknowledged that
there  was  a connection  between  areas  of low  employment  and
reliance on public assistance, even in the urban areas.
MR.  KREHER   directed  attention   to  slide  7,   "DPA  Service
Population," which listed the priorities  under the results based
accountability  model.   He  said  that  the Division  of  Public
Assistance  touched  individuals  in  every stage  of  life,  and
protected  and   promoted  the  health  of   Alaskans  by  making
eligibility determinations  for Medicaid,  noting the  life cycle
chart at  the bottom  of the  slide.   The WIC  program addressed
nutritional needs for pregnant women  and young children who were
at  nutritional risk,  Medicaid provided  health care  access and
delivery, and Alaska  families were assured of  their basic needs
and supports to  keep the family together.  He  reported that the
adult  public   assistance  program  ensured  that   seniors  and
individuals with disabilities were  able to live as independently
as  possible in  their communities.   He  declared that  personal
responsibility  was  a  key  aspect  of  many  public  assistance
programs, noting that the temporary  assistance program had major
work   requirements.     He  opined   that  the   chart  provided
percentages  for  services and  ages  served,  from pre-natal  to
death.  It  also indicated that almost 60 percent  of the service
population were children under the age  of 18 or seniors over the
age of 65.
MR. KREHER  addressed slide 8, "Individual  Recipients - November
2014,"  which  reflected  that many  Alaskans  received  multiple
benefits from multiple programs.   He pointed out that 36 percent
[55,194 people] of the total  service population of about 155,000
people,  only received  Medicaid; whereas,  food stamps  "touches
many, many  more Alaskans."  The  nature of the earnings  for the
working poor changed  dramatically in the last few  years, and it
was now  estimated that [indisc.]  million Americans  had incomes
below 200  percent of the federal  poverty rate.  He  stated that
the  vast majority  of these  people were  working.   Overall, in
Alaska, 26 percent  of people who receive food  stamps had earned
income, and were working while living at a poverty level.
MR.  KREHER said  that slide  9, "Race,  All Programs  - November
2014,"  provided  additional demographic  information,  reporting
that 40 percent  of the division's service  population was White,
while 39 percent was Alaska Native.
REPRESENTATIVE  TARR returned  to slide  8, and  asked about  the
income guidelines  for eligibility  to food stamps  and Medicaid.
She opined that everyone who  qualified for food stamps should be
qualified for Medicaid.
MR. KREHER  explained that the  food stamp program  income limits
were lower  than the  income limits  for most  Medicaid programs.
The reality  was that  the majority of  those who  only qualified
for food stamps would not,  until Medicaid Expansion, qualify for
Medicaid.   He noted that  other individuals opted to  only apply
for services and programs that they felt "they truly need."
REPRESENTATIVE TARR  mused that  these people were  eligible, but
did not apply.
MR.  KREHER acknowledged  "there may  be some  folks who  are, in
fact, eligible for Medicaid and haven't applied."
MR.  KREHER addressed  slide  10, and  reiterated  that the  high
percentages  of  children, when  combined  with  adults, was  the
majority  of the  service population.   He  declared that  it was
important to  note that many of  those in the adult  category had
disabilities and were also receiving adult public assistance.
MR.  KREHER  spoke  about  slide   11,  "Public  Assistance  Core
Services,"  and shared  that the  core services  in the  division
were narrowly  defined, as a "big  chunk of it is  actually doing
the eligibility determination."   He reported that  75 percent of
the  workforce were  office assistants,  eligibility technicians,
and supervisory  staff who  were handling  the intake,  doing the
renewal   applications,   and   ensuring   that   benefits   were
distributed  in a  timely manner.    He reported  that the  slide
depicted the average  monthly recipients, and noted  that some of
the services were seasonal.
CHAIR SEATON  asked if  those not listed  as annual  were monthly
averages.
MR.  KREHER stated  his  agreement.   He moved  on  to slide  12,
"Public  Assistance  Core  Services,"  which  listed  the  annual
expenditures for  these same programs.   He pointed out  that the
SNAP program (food stamps) was  not included as the division only
handled its administration, and not the funding.
REPRESENTATIVE STUTES asked for  clarification on slide 11, which
listed 4,706 children receiving child care assistance.
MR. KREHER  explained that  this was the  number of  children who
were authorized for the benefit.
REPRESENTATIVE  STUTES  asked  about  slide 12,  which  listed  a
childcare cost of $1.7 million per month.
MR. KREHER replied  that this was correct, that  childcare was an
extraordinarily expensive  option for  parents.  He  relayed that
the cost  of housing  for low income  families was  enormous, and
that child  care for multiple  children could  be even more.   He
said  that  eligibility  determination and  distribution  of  the
benefits was the second part of the division's core service.
REPRESENTATIVE STUTES  relayed that  the childcare cost  was $369
per month per child.
CHAIR SEATON stated that $369 per month was "quite a deal."
MR. KREHER  declared that there  were three child  care programs,
PASS  (Parents   Achieving  Self  Sufficiency)   programs,  which
included  one  for  people  on   welfare,  the  Alaska  Temporary
Assistance program;  one for people  in transition  from welfare;
and  the  third  was  for  people off  welfare,  working,  or  in
education  related to  employment.   He said  that the  subsidies
increased as a person advanced through the programs.
MR.  KREHER  moved  on  to  slide  13,  "Public  Assistance  Core
Services,"  which listed  the  monitor  beneficiary and  provider
compliance, the  areas that ensured  that Alaskans  receiving the
benefits, as  well as the  vendors, were being as  responsible as
possible.   He stated that  there had been  a lot of  outreach to
educate  the public  about  high  quality.   He  shared that  the
quality assurance  group met federal reporting  requirements, and
another  group  reviewed and  monitored  vendor  compliance.   He
declared that  all the groups  were related to ensuring  the most
effective stewardship of the state's  resources, stating that the
fraud  team  was "a  crack  unit"  and  had recovered  almost  $8
million in the past year.
MR.  KREHER  spoke  about  the   individual  and  family  support
services,  which worked  in concert  with child  care to  provide
basic services for  families, as a safety net to  help keep their
homes  and supplement  their food.   He  said that  all of  these
programs can have a positive  impact by assisting with job search
and  work activities,  employment and  self-sufficiency planning,
supportive  services,  skills   development,  job  training,  and
families first and self-sufficiency  activities.  He expounded on
the  WIC  program  and  the impact  on  people  without  adequate
nutrition.   He declared the  importance for adequate  and proper
nutrition for children, noting that  research tied poor nutrition
to "all  sorts of  behavioral challenges."   He relayed  that the
work  services programs  had work  requirements intended  to help
people get off the assistance  roles.  He acknowledged that there
were  a  significant number  of  people  with special  needs  who
cannot achieve self-sufficiency in the expected two year period.
MR. KREHER  reviewed the  WIC program, slide  15, and  lauded the
national  award  winning   breastfeeding  promotion  and  support
program, as well  as the health and  nutrition education program.
He  directed attention  to the  additional committee  information
[Included in members' packets].
MR.  KREHER  offered a  brief  budget  overview, slide  16,  "DPA
Budget Overview,"  declaring that this  did not include  the SNAP
benefits.   He  pointed out  that  the division  budget was  just
under  12 percent  of the  department budget,  and that  the vast
amount of the  money, 76 percent of the funding,  was paid to the
clients or  the vendors serving  the clients in  the communities.
He added  that about  $15 million  each month  were paid  in SNAP
benefits in Alaska.   He reported that  the administrative costs,
which included the personal services  to the employees, was about
24  percent of  the  budget.   He  addressed  slides  17 and  18,
"Division Overall Funding Detail," and  stated that a lot of this
expenditure was  from the  general fund and  went to  the clients
and vendors.
REPRESENTATIVE  VAZQUEZ asked  about  the  "other" category  that
showed 5 percent.
MR. KREHER deferred.
MR.  KREHER addressed  slide 19,  "Breakdown  of General  Funds,"
which depicted the  funds by program.  The  general fund breakout
was used to  identify areas for efficiencies as  requested by the
governor, which resulted in a  $12 million total reduction, slide
20.  He listed the  cuts identified for programs, which included:
the  Alaska  Temporary  Assistance   Program,  the  Adult  Public
Assistance  Program,  the  Tribal Assistance  Programs,  and  the
Energy Assistance  Program because there were  lapsed balances in
each  of these,  and there  were  some declining  caseloads.   He
offered his belief  that, although this could work,  the big risk
was  if the  economy did  not get  moving, as  the people  on the
margins would begin  to feel even more pressure.   At that point,
he asked, would there be  the funds necessary to provide benefits
for a  growing caseload in the  future.  He stated  that the only
program with a programmatic impact  was the proposed reduction to
the senior benefits program.   This program had been under review
for termination  and the senior  population was likely  to climb.
He suggested that the big driver in  cost in the next 5 - 8 years
for  this program  would be  from the  families that  receive the
highest  payment,  $250  each  month,  as  that  segment  of  the
population  would  most  likely  grow.   He  reported  that  this
included several  thousand people who  did not receive  any other
benefits from the state.  He said  that this would result in a 20
percent reduction to benefits.
REPRESENTATIVE TARR  asked if the  income limits were  also being
MR.  KREHER  responded  that  the  federal  poverty  limits  were
adjusted  annually, although  the  change in  the senior  benefit
levels would not happen until 2016.
REPRESENTATIVE TARR asked for clarification  that this was for FY
2016, effective July 1, 2015.
MR. KREHER  reviewed the division's successes,  slide 21, "Recent
Successes,"   which   included   a  federal   bonus   award   for
administration of  the food stamp  program.  Although  this money
had  to be  reinvested in  the SNAP  program, there  was a  50/50
match for  it, and this $900,000  bonus would then be  worth $1.8
million if it was  used in the SNAP program.   He reported that a
plan for  use of  the money  would be  submitted in  the upcoming
week.   He spoke about  the development of a  quality improvement
system for  childcare, which was  an organized way  of assessing,
improving, and communicating the quality  of early child care and
learning programs for  families.  He pointed out  that Alaska was
one  of  the  few  states  that  did  not  have  a  full  Quality
Recognition &  Improvement System (QRIS), so  the state partnered
with thread, which was the  state's resource referral agency.  He
said  that  this  effort  would be  amplified  as  the  childcare
development fund block grant had  been renewed, but this required
a  lot of  work, some  of  which was  not funded  by the  federal
government.    He  mentioned  the   almost  $8  million  in  cost
avoidance   fraud  claims   and   direct   savings  for   program
disqualifications.  He  said that the IT system had  come on line
just as  planned, and it was  working well with the  benefits and
tracking  of WIC  recipients.   He shared  that the  division was
piloting  Hospital Presumptive  Eligibility, a  condition of  the
Patient  Protection  and  Affordable   Care  Act,  which  allowed
hospitals to presume  someone to be eligible  for Medicaid within
a  very  short period  of  time.    He  explained that  this  was
designed  for  point  of  access  for care  to  allow  for  quick
enrollment in Medicaid, an idea pushed by the hospitals.
MR.  KREHER  referenced  slide 23,  "Current  Challenges,"  which
included an  enormous backlog  of applications,  partially driven
by the overlapping of the two  systems as the new one was brought
on-line.    He  allowed  that  progress  was  being  made  toward
elimination  of the  backlog,  and  that a  lot  of overtime  had
occurred  to alieve  the desperate  situation.   He said  that 10
percent of the  workforce had volunteered to  assist field staff,
and that he  was even dealing with returned  mail and registering
applications.   He  stated that  the  goal was  to eradicate  the
backlog  before Medicaid  Expansion went  live.   He shared  that
another  challenge was  to leverage  technology, as  there was  a
desperate  need  for  electronic  document  management  in  every
division in the department.   He stated that the business process
improvements had been effective, providing  a means to stay ahead
of  the  volume of  work  when  the  food stamp  caseload  almost
doubled   from  2008   -  2010.     He   pointed  out   that  the
aforementioned technical  challenges for the new  system, as well
as  complex Medicaid  policies, overwhelmed  the division's  work
process.  He  reported that the division had applied  to use some
of the federal bonus funds to  invest in a contractor to help re-
engineer the business process, and  to find more efficiencies, as
there was no automated way to manage the flow of the workload.
MR. KREHER  concluded the PowerPoint presentation  with slide 24,
"Moving  Forward."   He expressed  concern with  the increase  to
caseloads if the  economy remained at an ebb, as  it did not take
much to affect  the population that the division  worked with for
assistance.  The division was  looking at long range programmatic
impacts  of minimum  wage increases,  although  he surmised  that
there would  not be  much impact  in the first  year.   He stated
that  the best  way to  address poverty  was with  a good  living
wage.    He  stated  that  the  division  was  actively  pursuing
partnership work with  the Office of Children's  Services and the
Division  of  Public  Health.    He  spoke  about  the  Workforce
Innovations  and   Opportunity  Act  and  the   Alaska  Temporary
Assistance Program, and future work  with the Department of Labor
&  Workforce   Development  to  help  re-build   the  job  center
networks.  He reported that  the tribal health organizations were
also  very  important  partners,  noting that  there  were  seven
tribal assistance  programs which  were an  avenue of  access for
their clients.   He  lauded the  child care  program and  the WIC
nutrition education program.
SHAWNDA  O'BRIEN, Administrative  Operations Manager,  Director's
Office, Division  of Public Assistance, Department  of Health and
Social   Services,  in   response   to  Representative   Vazquez,
explained  that  the  "other"   category  on  slide  18  included
administrative  costs  associated  through  doing  business  with
other   agencies,   reimbursable  services   agreements   (RSAs),
interagencies, and leasing costs.
MR.  KREHER pointed  out that  the division  had RSA's  with many
other state agencies.
REPRESENTATIVE  STUTES   directed  attention  to  slide   2,  and
compared the division organization chart  with the graph on slide
6  for  the  DPA  recipients  as  a  percentage  of  census  area
populations.   She asked  if there  was any  relationship between
the number of people working in  certain areas with the number of
clients served.
MR.  KREHER   replied  that,  in  actuality,   the  caseload  was
universal,  explaining that  the staff  in Bethel  were not  just
serving the population in the Yukon Kuskokwim Delta area.
REPRESENTATIVE  STUTES asked  if, although  she lived  in Kodiak,
someone in Bethel could be handling the claim.
MR. KREHER  expressed his agreement,  as the goal was  to provide
the timeliest service for individuals.
REPRESENTATIVE  VAZQUEZ  referenced  slide  22,  and  noted  that
historically  an individual  could  have retroactive  eligibility
for Medicaid.  She asked  how that was different from presumptive
eligibility.
MR.  KREHER explained  that it  was necessary  to submit  a fully
filled out  application to the  Division of Public  Assistance in
order  to receive  Medicaid, under  normal circumstances.   Under
federal  law, the  division  had 45  days  to determine  Medicaid
eligibility, although,  he shared,  the division  goal was  to do
this in less  than 30 days.   If there were any  medical costs in
the three  months prior to  the month of application,  then retro
Medicaid  would  be  awarded.   The  concept  behind  presumptive
eligibility  was to  ensure that  hospitals received  payment for
Medicaid covered services from the  day the patient entered.  The
primary difference  was the  pace with  which eligibility  can be
determined, as  there was  only one day  to make  the eligibility
determination from the hospital's checklist.
REPRESENTATIVE VAZQUEZ asked  about the recourse if  there was an
MR. KREHER explained that criteria  had been established with the
hospitals, and if  more than a certain  percentage of presumptive
eligibility errors  occurred, there  was a  corrective compliance
REPRESENTATIVE  VAZQUEZ  asked  when   the  compliance  rate  was
MR.  KREHER  relayed that,  as  this  was  a new  program,  those
details were  still being worked  out, and he offered  to provide
further information.
REPRESENTATIVE VAZQUEZ directed attention  to slide 23, and asked
if the block grants referenced  were state or federal grants, and
how much were they.
MR.  KREHER  replied  that  this  was a  federal  grant,  and  he
deferred for the amount.
MARCEY  BISH,   Program  Manager,  Child  Care   Program  Office,
Division of  Public Assistance, Department  of Health  and Social
Services, in  response to a  question by  Representative Vazquez,
said  that  the  division  did not  currently  have  the  funding
formula from the reauthorization, and  in response to Mr. Kreher,
she estimated  that the  Child Care  and Development  Block grant
was $13  million during the  past year, offering to  research the
exact amount.
REPRESENTATIVE  VAZQUEZ asked  about the  number of  referrals to
the  fraud  control  unit,  how  many  cases  were  referred  for
prosecution, and the average amount of restitution.
MR. KREHER  offered to provide further  information, pointing out
that  this  information  was  also   available  on  the  division
ELAINE  RICH, Chief,  Program Integrity  & Analysis,  Division of
Public Assistance,  Department of Health and  Social Services, in
response to a question from  Representative Vazquez regarding the
number  of   fraud  referrals,   explained  that   there  several
categories, and  that of  the 572  applicant referrals,  227 were
found  to  be fraudulent.    There  were 549  investigations  for
individuals currently receiving public  assistance, and of these,
158 were  found to be fraudulent.   During the Fiscal  Year 2014,
there were 17  convictions with court ordered  restitution in the
amount of $429,776.
the Medicaid fraud control unit and the amount recouped.
MS. RICH offered to provide further information.
REPRESENTATIVE   VAZQUEZ    asked   whether    the   Surveillance
Utilization Review Software was being used.
MR. KREHER replied that he did not know.
REPRESENTATIVE VAZQUEZ  asked about the relationship  between the
division and the Medicaid payment processors.
MR. KREHER explained  that the Division of  Public Assistance was
responsible  for the  eligibility determinations,  and once  that
information was in the system, the benefits were issued.
REPRESENTATIVE VAZQUEZ asked if  the Department of Administration
(DOA) processed the payments for SNAP.
MR. KREHER replied that these  benefits were not processed by the
DOA,  but went  through the  food and  nutrition services  and JP
Morgan, the banking institute for electronic benefit transfers.
CHAIR  SEATON  directed attention  to  a  handout titled  "Senior
Benefits Program."  [Included in members' packets]
MR. KREHER explained  that this provided a basic  overview of the
senior benefits  program, and in  response to Chair  Seaton, said
that it  was not on the  division website.  He  explained that it
was available  to any Alaskan over  the age of 65  who had income
falling  into one  of the  three income  brackets.   He explained
that  it required  an  income  below 75  percent  of the  federal
poverty  limit  for  benefits  of  the  highest  payment  amount;
individuals between  75 and  100 percent  of the  federal poverty
limit received  the middle benefit;  and individuals  with income
above  175 percent  of  the federal  poverty  level received  the
lowest payment.   He noted that an individual  would receive $250
per month if their income was less than $920 per month.
CHAIR  SEATON asked  about  the other  two  payments, which  were
facing  a  proposed  cut  of  20 percent.    He  stated  that  an
individual  with an  income  of $1,200  per  month would  receive
about $140  per month,  and an individual  with income  of $2,146
per  month would  receive about  $100 month.   He  clarified that
this was  an income based program  prior to the deduction  of any
taxes  or   expenses.     He  asked  if   there  was   any  asset
qualification for determination.
MR. KREHER replied "there is no asset test."
CHAIR SEATON opined  that a person could  have significant assets
and wealth with very little income.
REPRESENTATIVE WOOL  asked if the  backlog indicated on  slide 23
was attributable to any one cause.
MR. KREHER  responded that this  was a  "perfect storm" due  to a
series of contributing events, one  of which was the reality that
there  was not  funding to  start up  a new  Medicaid eligibility
system until  October, 2012.   Under  the Patient  Protection and
Affordable  Care   Act,  in  order  to   maximize  federal  match
participation,  there  was  a requirement  for  functionality  of
certain aspects  of the  system by October,  2013, and  that this
had  not  started  in  Alaska  until  May  or  June,  2013.    He
acknowledged that it was understood  that it would create a drain
on the  staff resources  and a  fair number  of employees  had to
contribute time  to the  project design  and development  as they
were subject matter  experts.  He noted that during  the weeks of
design sessions,  their work was  handled by others and  when the
system did  not go live,  a contingency  manual system had  to be
utilized and Medicaid  determinations began to slow.   He pointed
out  that  account  transfers  were  pushed  from  the  federally
facilitated market place, and created a lot of extra work.
CHAIR SEATON  thanked the presenters  and asked the  committee to
submit further questions.
The committee took a brief at-ease.
HB 59-MARIJUANA CONCENTRATES; LICENSES
CHAIR SEATON announced  that the next order of  business would be
HOUSE BILL  NO. 59, "An  Act relating to  marijuana concentrates;
and providing for an effective date."
REPRESENTATIVE  VAZQUEZ moved  to  adopt  the proposed  committee
substitute (CS) for HB 59,  labeled 29-LS0257\S, Martin, 2/24/15,
as the working draft.
CHAIR SEATON objected for discussion.
TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State
Legislature, explained the changes contained in the proposed CS,
paraphrasing from a prepared statement, which read:
Page 4, line 7 & 11
Registration is replaced with license.
Page 4, lines 26 - page 5, line 2
Language requiring the regulations to include
prohibitions on the combination of marijuana with
alcohol and nicotine has been deleted. Language
requiring the regulations to prohibit the sale of
marijuana in an establishment which sells alcohol has
also been removed.
New language was added which states that the
regulations created by the board may include
prohibitions on combining marijuana concentrates with
other addictive substances or requirements that new
products be certified before they are available for
retail.
Section 12:
Page 6, lines 8 - 15
Subsections (j), (k), and (l) have been added.
Subsection (j) allows the board by regulation to
create the number or type of licenses necessary for
implementation.  Subsection (k) prohibits the issues
of a license for a marijuana retail store to a person
who holds a license under AS 04.  Subsection (l)
states that a license issued to a marijuana
manufacturing facility does not authorize the facility
to combine marijuana with tobacco, nicotine, or
alcohol or products containing them.
Page 8, lines 23 -25
The words 'through the use of a solvent other than
water' have been removed from the definition of
concentrates.
CHAIR  SEATON  removed  his objection,  therefore,  the  proposed
committee  substitute  (CS)  for   HB  59,  labeled  29-LS0257\S,
Martin, 2/24/15, was adopted as the working draft.
REPRESENTATIVE WOOL objected  and, referring to page  6, line 12,
asked about the license requirement.
CHAIR  SEATON relayed  that  an amendment  would  be included  to
correct that language.
REPRESENTATIVE STUTES said that her  question was similar to that
of the previous  member's and offered her  understanding that the
proposed  bill did  not  prohibit a  liquor  license holder  from
holding  a license  for  the sale  of  marijuana, although  these
could not necessarily be sold in the same establishment.
MS. HANSEN, in response, offered  her belief that subsection (k),
as  written,  could  be  interpreted   in  that  way;  therefore,
Amendment S.1 would be proposed for clarification.
REPRESENTATIVE  WOOL  removed  his  objection.   There  being  no
further  objection,  CSHB  59,  Version S,  was  adopted  as  the
working draft.
REPRESENTATIVE VAZQUEZ  moved to adopt an  amendment, labeled 29-
LS0257\S.1, Martin, 2/25/15, which read:
Page 1, line 2, following "establishments;":
Insert "relating to alcoholic beverages and
marijuana;"
Page 2, following line 3:
Insert a new bill section to read:
"* Sec. 2. AS 04.16 is amended by adding a new
section to read:
Sec. 04.16.165. Restriction on sale of marijuana
on licensed premises. A licensee may not sell, offer
for sale, furnish, or deliver marijuana on licensed
premises."
Renumber the following bill sections accordingly.
Page 6, lines 10 - 12:
Delete all material and insert:
"(k)  A marijuana retail store license issued
under this section does not authorize the sale,
offering for sale, furnishing, or delivery of
alcoholic beverages on licensed premises."
CHAIR SEATON  labeled this  Amendment S.1, and  reviewed it  as a
means  for removing  the  person  and placing  the  burden on  an
establishment in  order to address  the issue  of self-medication
by individuals.  This would  prohibit individuals from purchasing
recreational marijuana in an alcohol sales establishment.
CHAIR SEATON removed his objection.
REPRESENTATIVE  WOOL  objected,  asking  for  clarification  that
Section  12,  subsection (k)  would  not  authorize the  sale  of
alcoholic beverages  in a  marijuana retail  sale store,  or vice
versa.   He reflected  that previous  testimony by  Ms. Franklin,
[Director of the Alcoholic Beverage  Control Board] had suggested
that  licensing  that  would  allow  on  premise  consumption  of
marijuana could  occur in the future.   He asked if  the proposed
amendment only  addressed purchases or  if it also applied  to on
the premise consumption.
CHAIR SEATON explained that the  on the premise consumption would
be  allowed for  either marijuana  or alcohol,  but not  for both
products  under the  proposed bill.   The  proposed bill  did not
prevent  a  license  for  usage  or  sale  on  premise,  it  only
maintained a separation of usage in the same establishment.
REPRESENTATIVE  WOOL asked  if  this was  a  concurrent issue  in
another committee.
MS. HANSEN  offered her  belief that SB  62 had  similar language
restricting the  sale of marijuana  in an  establishment licensed
for  alcohol  sale,  and  that  it may  be  more  restrictive  by
limiting the ownership of licenses for sales of both.
REPRESENTATIVE WOOL removed his objection.  There being no
further objection, Amendment S.1 was adopted.
REPRESENTATIVE VAZQUEZ moved to adopt an amendment, labeled 29-
Page 2, line 5:
Delete "Notwithstanding any other provision of
law, the"
Insert "The [NOTWITHSTANDING ANY OTHER PROVISION
OF LAW, THE]"
Delete ", and permitted by,"
Page 2, line 24:
CHAIR  SEATON   labeled  this  Amendment   2  and   objected  for
MS. HANSEN explained Amendment 2,  which was primarily conforming
language  to  SB  30  dealing with  the  criminal  statutes,  and
deleting the  language for "notwithstanding any  other provisions
of law."   She noted the removal of "and  permitted by" which had
allowed a temporary  delay for the concentrates,  stating that it
was no longer  necessary with the deletion  of the aforementioned
language for notwithstanding.
CHAIR  SEATON removed  his  objection.   There  being no  further
objection, Amendment 2 was adopted.
CHAIR SEATON opened public testimony.
TIM HINTERBERGER,  Ph.D., Chair,  Campaign to  Regulate Marijuana
Like Alcohol in Alaska, stated opposition  to proposed HB 59.  He
pointed  out  that Ballot  Measure  2  had  been approved  by  53
percent of  Alaska voters  on November  3, and  would effectively
replace the unregulated, underground  market for marijuana with a
regulated system  of tax  paying businesses.   He noted  that the
legislature's ability  to modify  this initiative  was restricted
for  two years,  and  he expressed  confidence  in the  Alcoholic
Beverage  Control  Board for  undertaking  a  mandate to  provide
regulations under  the timelines required by  the ballot measure.
He stated that  delay of any implementation  would contradict the
will  of the  voters, declaring  that concentrates  were included
under the  definition of marijuana  in Ballot Measure 2,  and the
manufacture, sales,  and possession  of these products  should be
treated  with parity  to marijuana  flower products.   He  stated
that the  campaign maintained  the position  that proposed  HB 59
was  unconstitutional   as  currently   drafted.     He  directed
attention  to  the handout  titled  "Specific  Concerns With  the
Current Version of HB 59" [Included in members' packets].
RACHELLE  YEUNG, Legislative  Analyst, Marijuana  Policy Project,
directed attention to the handout  titled "Specific Concerns With
the Current Version of HB  59" [Included in members' packets] and
stated  that it  was substantively  quite similar  to an  earlier
memo.   She emphasized  that the campaign  wanted to  clarify its
concerns for the  intent and the effect of HB  59, as it appeared
the intent  was not  aligned with  the will of  the voters.   She
offered  the campaign's  belief that  the proposed  bill was  not
constitutional in its intent.   She stated that concentrates were
included under the  definition of marijuana in  Ballot Measure 2,
and,  as it  was not  distinguished from  the marijuana  plant or
flower, the mandate to the  legislature was to not interfere with
or  alter  the  timeline  for  implementation  of  the  marijuana
regulations.   She declared that  neither the  proposed committee
substitute  nor these  amendments  had altered  the concerns  and
that the  bill remained inconsistent  with the  initiative passed
by  the  voters.   She  offered  support  for discussion  to  the
concerns  of potential  dangers with  production of  concentrates
and to address  the concerns in a constitutional  manner that was
consistent with Ballot Measure 2.
CHAIR SEATON closed public testimony.
CHAIR SEATON  asked for an opinion  on the provision of  the bill
which separated  the combining  of nicotine  with marijuana.   He
opined that  this was the mixing  of an addictive product  with a
product  that may  have psychological  dependence and  questioned
whether a prohibition should be implemented.
ALLISON KULAS,  Program Manager, Tobacco Prevention  and Control,
Division  of  Public  Health, Department  of  Health  and  Social
Services,  stated that  the division  had not  taken an  official
position, and, although they were  tracking the science, they had
not come  across anything discussing the  combination of nicotine
or tobacco or alcohol with marijuana.
REPRESENTATIVE VAZQUEZ  asked about  the combination  of cannabis
and alcohol.
MS.  KULAS replied  that,  although there  was  not any  specific
science  for the  combination of  the two,  it would  most likely
result in  greater impairment, and  that there was a  concern for
the addictive properties of marijuana.
REPRESENTATIVE VAZQUEZ  asked if Department of  Health and Social
Services had a position on the proposed bill.
MS. KULAS  replied that the  department did not have  a position,
at this point.
REPRESENTATIVE WOOL asked  if there was anyone  who could provide
a response regarding the combination aspect.
MS. KULAS  explained that the  evidence was being  considered and
the department was following the  lead of Colorado, as that state
had done an extensive literature review for marijuana addiction.
CHAIR  SEATON reported  that the  proposed bill  was designed  to
address  a developing  industry.   He shared  that the  ABC Board
anticipated successful  completion of the regulations.   They had
requested additional staff, although  given the current financial
situation, authorization  was not  ensured.   The purpose  of the
proposed  bill was  to ensure  full  regulations on  cultivation,
processing, and  retail sales by  the industry.  If  necessary, a
delay  could  be  placed  on  the manufacture  and  sale  of  new
products.   He pointed out that  the delay would be  based on the
implementation  of recommendations  by  the board  and could  not
exceed the projected timeframe.
REPRESENTATIVE  WOOL disclosed  that he  was currently  a license
holder under  AS 04.  He  mused that these restrictions,  as they
were  not in  the  last  version of  the  bill, prompted  further
questioning.   He shared that  the ABC Board  representatives had
stated they  were prepared to write  regulations and restrictions
on marijuana use based on  their experiences with the control and
regulation for the use of alcohol.   He noted that members of the
licensing  world  also  declared  a readiness  for  these  issues
regarding systems of control and regulations.
REPRESENTATIVE  WOOL   asked  about  the  ABC   Board's  position
regarding the  restriction of  license holders  under AS  04 with
relationship to the potential sale of marijuana.
CYNTHIA  FRANKLIN,  Director,  Alcoholic Beverage  Control  (ABC)
Board,  in  response, explained  that  most  of the  restrictions
related to  alcohol were  centered on  a premises  based approach
with control of the area  of sales, manufacture, or delivery, and
there were  not any restrictions  on other businesses  by alcohol
licensees.    She stated  that  the  application to  qualify  for
liquor  licenses was  "a fairly  straightforward  process."   She
offered her  hope that  the regulations  for the  application and
licensing process  for obtaining a marijuana  based license would
be left  to the ABC  Board or  a newly created  marijuana control
board.  She opined that it  was difficult for the legislature "to
find  your  spot in  this  voter  initiative" and  she  expressed
appreciation  for the  effort to  allow for  additional time,  as
well  as concern  for the  constitutionality  requirements.   She
stated  that  the specifications  for  who  may  or may  not  get
marijuana  business licenses  begs  the need  for the  regulatory
agency to develop  the regulations with an  extended public input
period.      She   acknowledged  the   earlier   statements   for
consideration that  changes may occur as  the industry progresses
and  those  details  would  need   to  be  addressed  during  the
regulatory process, as statutes were  much harder to change.  She
opined that a prohibition for  certain people to obtain marijuana
licenses "might be risky business."
CHAIR SEATON  clarified that the  proposed bill had  been amended
to  address   establishments  and   not  persons,  and   that  it
prohibited  the  sale  of  both   alcohol  and  marijuana  in  an
establishment.
MS.  FRANKLIN  acknowledged  the   amendment,  although  she  had
understood the  question to  be for  the simultaneous  holding of
licenses.
CHAIR SEATON stated that HB 59 would be held over.
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:55 p.m.
DPA Program Descriptions - All with regs and budget.pdf HHSS 2/26/2015 3:00:00 PM
Presentations by DHSS
Heating Assistance Program 02.05.2015 Fact Sheet.pdf HHSS 2/26/2015 3:00:00 PM
ATAP Fact Sheet 020915.pdf HHSS 2/26/2015 3:00:00 PM
WIC FNP Fact Sheet.pdf HHSS 2/26/2015 3:00:00 PM
TANF - WS NFAP Fact Sheet.pdf HHSS 2/26/2015 3:00:00 PM
Tribal TANF Fact Sheet 2.05.2015.pdf HHSS 2/26/2015 3:00:00 PM
SBP Fact Sheet (02-03-15).pdf HHSS 2/26/2015 3:00:00 PM
Division of Public Assistance Presentation_2.25.2015.pdf HHSS 2/26/2015 3:00:00 PM
HB 59 Version S_proposed CS.pdf HHSS 2/26/2015 3:00:00 PM
HB 59
HB 59 Sectional Analysis_Version S.pdf HHSS 2/26/2015 3:00:00 PM
HB 59 Explanation of changes_ver P to S.pdf HHSS 2/26/2015 3:00:00 PM
HB 59_Legal Opinion_Does HB 59 require additional licenses.pdf HHSS 2/26/2015 3:00:00 PM
HB 59 Ver S proposed amendment 1.pdf HHSS 2/26/2015 3:00:00 PM
HB 59 S_letter of opposition_MPP.pdf HHSS 2/26/2015 3:00:00 PM

redpajama_set_name: RedPajamaCommonCrawl


What can agencies do to properly identify people and ensure they are who they say they are? The answer has come in the form of identity proofing. GovLoop sat down with experts at DHS, NIST and Experian to learn more.


text:
Home ❱ Christian Books & Bibles ❱ The Message for the Last DaysHome ❱ Nonfiction ❱ The Message for the Last DaysHome ❱ Religion & Spirituality ❱ The Message for the Last Days
The Message for the Last Days
by KJ Soze
Submitted: February 28, 2020
eBook includes formats: .epub, .html, .mobi, .pdf
This award-winning book examines the biblical quest to obtain eternal life. It guides readers through the journey in a step by step progression, from ancient prophecies to their final fulfillment. The Message for the Last Days maps out God's intersection of our temporary condition to the eternal. The future is revealed by understanding the past, where history and mystery are intertwined. How can we know what the future holds if we don't understand the past? This question is at the heart of the book. Modern Christian culture has lost its roots. Topics include answers to these questions: Why is the Christian Church so divided with many different denominations and independent Churches? Isn't there just one true Church? How did the modern Church get so far removed from early Church beliefs as clearly stated in the New Testament and by the early Church fathers? What are the original prophecies in the Old Testament about the end times and how are they repeated in the New Testament? Does the nation of Israel have anything to do with end times? What is the true meaning of the gospel and salvation? These questions are answered by a thorough examination of various interpretation methods. This book explains six different biblical interpretation options then reveals a unified approach to understanding the Bible. Books and articles by KJ Soze cut across various denomination lines to help find unity and clarity for those who may hold differing interpretations. The Message for the Last Days provides detailed historical research of complex topics, such as end times and the afterlife, then condenses the results into a compact format to save time for those interested in biblical studies. The process is an integration of scriptural references, concordances, topical studies and commentaries into a unique package to help clarify the Bible's message about the future. The Message for the Last Days provides detailed historical research of complex topics, such as end times and the afterlife, then condenses the results into a compact format to save time for those interested in biblical studies. The process is an integration of scriptural references, concordances, topical studies and commentaries into a unique package to help clarify the Bible's message about the future.
File Size: 1.25 MB (.epub), 3.24 MB (.mobi), 1.54 MB (.pdf), 635.49 KB (.html)
Interior: Color
Keywords: Bible prophecy, end times, heaven, afterlife, judgment day
Hashtags: #ChristianBooks #Bibles #Nonfiction #Religion #Spirituality #Bibleprophecy #endtimes #heaven #afterlife #judgmentday
KJ Soze
KJ Soze is a Christian non-fiction publisher that uncovers "lost in plain sight" topics of the Bible such as salvation, end times and the afterlife. He integrates over 30 years of experience in historical and biblical research with his scientific and analytical skills to present refreshed orthodox understandings of the Bible. KJ enables Bible disciples to see the obvious as he strips away at mythological and cultural lenses that often blind our beliefs from God's intentional gospel. Books and articles by KJ Soze cut across various denomination lines to help find unity and clarity for those who may hold differing interpretations. "I write about biblical history woven into prophecies about the future to help readers see the thread of God's message for them today."


text:
Foreign Secretary on Nadim Zahavi's 'error', says 'taxes are a private matter'
During a grilling on the finances of the Tory party chairman James Cleverly insisted that tax matters are a "private matter".
The Foreign Secretary insisted that Nadeem Zahawi made a "negligent error" after it was revealed he owed a sum to HM Revenue and Customs in relation to a shareholding in YouGov.
Zahavi is under pressure over allegations that he tried to evade tax and has now been forced to pay it under a multimillion-pound settlement.
Cleverly said he did not know the size of the tax settlement with HMRC or whether Zahavi had paid a penalty.
"I don't know more than his statement," said tactfully.
Asked whether Zahavi should reveal more information, Smartly said: "People's taxes are private matters. I know that as politicians, we are probably expected to have a higher level of disclosure than other people." Is performed.
"Nadeem has issued a statement where he has admitted that he made a careless error, which has now been resolved."
She also cleverly sidestepped questions about whether Zahavi had negotiated her tax settlement while chancellor, or whether Rishi Sunak knew when he appointed her party president.
"I'm not an investigator," he said when told he was there to speak on behalf of the government.
Asked whether Zahawi would continue in his role until Wednesday, he said tactfully: "What else am I going to say other than yes, because he is a very effective minister."
Foreign Secretary James Cleverly Faced a Grilling
Zahavi, who joined Sunak's cabinet, issued a statement to "clear up some confusion about my finances".
However, the statement raised further questions, including whether Zahawi had negotiated the agreement on being chancellor and in charge of the country's taxation.
The claims began to emerge when Zahavi was made chancellor by Boris Johnson last summer, after Cabinet Office officials alerted the then prime minister to the HMRC controversy.
Zahavi did not disclose the size of the settlement – reported to be an estimated £4.8 million including a 30% fine – or confirm whether he had paid the fine.
Tax lawyer Dan Needle, who is working to uncover the minister's tax affairs, estimated he owed £3.7 million.
In an unusual move, Zahavi did not take founding shares when setting up YouGov, saying in his statement that his father had taken the shares "in exchange for some capital and his invaluable guidance".
He continued: "Twenty-one years later, when I was being appointed Chancellor of the Exchequer, questions were being raised about my tax affairs. I discussed this with the Cabinet Office at the time.
"Following discussions with HMRC, they agreed that my father was entitled to founder shares in YouGov, although they disagreed about the exact allocation. They concluded that this was a 'negligent and not intentional' error.
"So that I could focus on my life as a public servant, I decided to settle the matter and do what he said was due, which was the right thing to do."
He said the matter had been resolved and that all his tax matters were "up to date" when Sunak was appointed chairman of the Tory party in October.
But the prime minister is facing questions over what he knew about the matter and when, as well as calls for Zahawi to be sacked.
Sunak's promise of an "honesty" premiere was soured earlier this week after he was fined by police for not wearing a seatbelt and criticized for the allocation of leveling-up funding.
Downing Street said it had nothing to add to Zahawi's statement and confirmed that the Prime Minister had confidence in him as Tory chairman.
Opposition parties have called for an independent investigation as well as the publication of all of Zahawi's correspondence with HMRC.
Labor Party chair Anneliese Dodds said Sunak needed to remove Zahawi as party president, and added: "Zahavi still needs to explain when he found out about the investigation, and if he will be chancellor". was and was in charge of our tax system at the time.
"He needs to explain why his legal representatives said his cases were updated last December so he could be fined £1 million this month."
Lib Dem deputy leader Daisy Cooper said: "Zahavi and his Conservative cabinet colleagues are arrogantly trying to brush this under the carpet.
"There are facts that still need to be established so there should be an independent inquiry to get to the bottom of this."


text:
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Toy Photography: Star Wars
Use MAYTHE4TH on checkout for 30% off! Code expires: 11 May 2021. A long time ago in a galaxy far, far away, I made these toy photography works. Carrying over the true essence of the fandom, this is art by a fan for fans. A must-have for the man cave!
Top Gun: Y-Wing
Paying tribute to the opening sequence of TOP GUN, here is a Y-Wing on the top of a flight deck, ready to take to the skies and take on the Empire.
Stomped Trooper (A Variant)
Sometimes, the Rebel scum's pet Ewoks take trophies from their battles, shrink them using some Endor voodoo and turn them into mugs.
Into the (Funan) Tunnel
A tribute to the old Funan, and one of my favourite scenes in Star Wars: Return of the Jedi. Here's a recreation of the Into the Tunnel scene during the Rebel's assault on the second Death Star.
Rogue Squadron
A recreation of one of my favourite scenes from Star Wars: Rogue Squadron. We see a pair of X-Wings flying low on MacRitchie Reservoir in Singapore.
Snowy Rescue
A downed A-Wing fighter in a blizzard. An emergency crew is set out to pull the pilot from the wreckage. These A-Wings can withstand space, but not the icy conditions of Hoth.
Stomped Trooper (B Variant)
I've Got A Bad Feeling About This
The adventures continue with the Millennium Falcon on another icy planet and this time, R2 is with them. But the feeling is still the same. There's always a bad feeling somehow.
Derelict Spacecraft
The Rebel Alliance picked up a strange encrypted distress signal on a desolate planet. They sent out a rescue squad which landed nearby the derelict Y-Wing. As the crew explored the surface of the planet, a lone R2 unit was able to translate the distress signal. It was not encrypted. It was in an alien language. The signal was translated: "STAY AWAY. Xenomorphs detected." This is a tribute to the original Alien (1979).
Silent Nights
A lone AT-ST walker stands in the quiet night. An ambush perhaps?
Death to the Rebels Immortalised
If there was a statue to signify the victory the Empire held on Hoth, this would be it.
An AT-AT walker hunts its prey in a foggy night.
Hunters Over the Horizon
Not exactly something a Rebel scum would want to see after climbing the hills.
The Only Thing They Fear is... Starkiller
The Empire has created their worst enemy.
All rights reserved. Copyright The Art of Mezame © 2022. All images or videos in The Art of Mezame domain are not to be reproduced, republished, redistributed, copied or stored for public or private use without written permission of the original owner.


text:
Cautiously optimistic about revival in Q3: Finmin : 04-12-2020
Supreme Court upholds levy of GST on lottery, gambling : 04-12-2020
Duty of state to restore ecological imbalance and to stop damages to nature: Supreme Court : 04-12-2020
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CIRCULAR NO.4/2015 [F.NO. 500/17/2015-FT&TR-IV], DATED 26-3-2015
Rehana
Circulars(Whatsnew, IT)
SECTION 9 OF THE INCOME-TAX ACT, 1961 – INCOME DEEMED TO ACCRUE OR ARISE IN INDIA – CLARIFICATION ON EXPLANATION 5 TO CLAUSE (i) OF SUB-SECTION (1) OF SECTION 9
Section 9 of the Income-tax Act provides for incomes which are deemed to accrue or arise in India. Clause (i) of sub-section (1) of the said section reads as under:—
"9. (1) The following incomes shall be deemed to accrue or arise in India:—
(i) all income accruing or arising, whether directly or indirectly, through or from any business connection in India, or through or from any property in India, or through or from any asset or source of income in India, or through the transfer of a capital asset situate in India."
2. The Finance Act, 2012 inserted Explanation 5 to clause (i) of sub-section (1) of section 9. The said explanation reads as under:—
"Explanation 5.—For the removal of doubts, it is hereby clarified that an asset or a capital asset being any share or interest in a company or entity registered or incorporated outside India shall be deemed to be and shall always be deemed to have been situated in India, if the share or interest derives, directly or indirectly, its value substantially from the assets located in India".
3. A number of representations have been received by the Board stating that the purpose of introduction of Explanation 5was to clarify the legislative intent regarding the taxation of income accruing or arising through transfer of a capital asset situate in India. Apprehensions have been expressed about the applicability of the Explanation to the transactions not resulting in any transfer, directly or indirectly of assets situated in India. It has been pointed out that such an extended application of the provisions of the Explanation may result in taxation of dividend income declared by a foreign company outside India. This may cause unintended double taxation and would be contrary to the generally accepted principles of source rule as well as the object and purpose of the amendment made by the Finance Act, 2012.
4. The matter has been examined in the Board. The Explanatory Memorandum to the Finance Bill, 2012 explains the purpose of the amendment to section 9 (l)(i) in the following words;—
"Section 9 of the Income-tax Act provides cases of income, which are deemed to accrue or arise in India. This is a legal fiction created to tax income, which may or may not arise in India and would not have been taxable but for the deeming provision created by this section. Sub-section (l)(i) provides a set of circumstances in which income accruing or arising, directly or indirectly, is taxable in India. One of the limbs of clause (i) is income accruing or arising directly or indirectly through the transfer of a capital asset situate in India. The legislative intent of this clause is to widen the application as it covers incomes, which are accruing or arising directly or indirectly. The section codifies source rule of taxation wherein the state where the actual economic nexus of income is situated has a right to tax the income irrespective of the place of residence of the entity deriving the income. Where corporate structure is created to route funds, the actual gain or income arises only in consequence of the investment made in the activity to which such gains are attributable and not the mode through which such gains are realized. Internationally this principle is recognized by several countries, which provide that the source country has taxation right on the gains derived of offshore transactions where the value is attributable to the underlying assets . . . . . .
. . . . . . . Certain judicial pronouncements have created doubts about the scope and purpose of sections 9 and 195. Further, there are certain issues in respect of income deemed to accrue or arise where there are conflicting decisions of various judicial authorities.
Therefore, there is a need to provide clarificatory retrospective amendment to restate the legislative intent in respect of scope and applicability of sections 9 and 195 and also to make other clarificatory amendments for providing certainty in law."
5. The Explanatory Memorandum clearly provides that the amendment of section 9(1)(i) was to reiterate the legislative intent in respect of taxability of gains having economic nexus with India irrespective of the mode of realisation of such gains. Thus, the amendment sought to clarify the source rule of taxation in respect of income arising from indirect transfer of assets situated in India as explicitly mentioned in the Explanatory Memorandum. Viewed in this context, Explanation 5would be applicable in relation to deeming any income arising outside India from any transaction in respect of any share or interest in a foreign company or entity, which has the effect of transferring, directly or indirectly, the underlying assets located in India, as income accruing or arising in India.
6. Declaration of dividend by such a foreign company outside India does not have the effect of transfer of any underlying assets located in India. It is therefore, clarified that the dividends declared and paid by a foreign company outside India in respect of shares which derive their value substantially from assets situated in India would not be deemed to be income accruing or arising in India by virtue of the provisions of Explanation 5 to section 9(1)(i)of the Act.
7. This may be brought to the notice of all concerned for strict compliance.
Budget 2021: Government looking at tax issues related to business rejig, mergers and acquisitions : 21-01-2021
Centre, states to take corrective action to reduce compliance burden by March 31 : 21-01-2021
Four ways in which the Budget can fulfil Modi's dream of a digital India : 21-01-2021
Exporters drag DRI to numerous excessive courts over GST exemption notices : 20-01-2021
Tax transfer to states down a fifth : 20-01-2021
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What's All The Craft Distillery Tasting Room Buzz?
What's All That Craft Distillery Tasting Room Buzz?
Have you noticed there's been some buzz in the news about craft distillery tasting rooms lately? Well, we wanted to take the opportunity to talk about our tasting room throughout the years, how different regulations have affected us, and let you know that we now offer cocktail flights!
Wine and beer tasting rooms are so common in the bay area, this coverage may seem like nothing new. In fact, it's only been in the last five years or so that some of the most challenging laws to craft distillers' success, leftover from prohibition and the development of the three-tier system, have been called into question here in California. These changes have included laws that also most definitely make the experience better and more complete for the consumer in craft distillery tasting rooms.
Here at Spirit Works Distillery, since day one, we have had a tasting room and pour tastes of our spirits (some of you OG fans may remember our now Head Distiller, Lauren Patz, running the show in there). Our goal with our tasting room (now run by the inimitable Amanda Graziano and her team) has always been to offer full transparency into our grain to glass process with views into our entire production area, sips of splendidly distilled spirits, interaction with educated staff, and comprehensive tours. Yet for our first year, we couldn't legally charge for those educational tastings. Even more challenging, was that we were legally prohibited from selling any of our spirits to all the awesome people who came in and fell in love with our spirits. Weird huh?
Well, luckily, with help from Representative Skinner and Levine as well as the California Artisan Distillers Guild, restrictions began to loosen on how craft spirits can be sold. In 2013 AB 933 passed into law which allowed craft distilleries to begin to charge for their tastings. This probably seems like a no-brainer, but was a big win for the small guys like us! Then, at the end of 2015, with our very own Timo Marshall as President of the California Artisan Distillers Guild, further legislation was passed that allowed distilleries to…wait for it…sell our spirits directly to the consumers from our tasting room! I can't tell you the amount of people we had to let down over the years and send them away without a bottle in hand before this change. Finally, SB1164 was also passed just recently this year to allow craft distilleries, among a few other things, to sell spirits to consumers directly, even if they haven't had a 'educational tasting'. Yay — to all of this!
What else would we really like to see change? We would LOVE the ability to ship our spirits to consumers directly — one can always dream…Right? Can you imagine how cool our Spirits Club would become and how many more of you could have our spirits wherever and whenever you want!?!
Anyway, in all this reflecting, we got really in the spirit to further improve our tasting room experience for our customers and fans and we now offer delicious cocktail flights!
Join us in the tasting room for a cocktail menu designed to highlight our seasonal spirits, tasting room exclusives, and core favorites. We offer cocktail flights for $18 or you can just grab one cocktail for $9!
The Sonoma Magazine piece here and The San Francisco Chronicle piece here.
Cheers to you and the coming holiday season!


text:
New Xbox Controller Confirms Xbox Series S
By Ash Puckett 10 August 2020
Perhaps a second, cheaper option?
(Image credit: zakk_exe)
Earlier this week, a Twitter user who goes by zakk_exe posted what appeared to be a new Xbox controller. After examining the packaging, he quickly discovered the controller was designed for a new, not-yet-released Xbox console.
The controller was purchased through Offer Up for just $35. When asked, the seller casually stated he acquired the controller "from a homie", leaving an open question about the true source of this hardware leak.
The new controller features a solid white color scheme. While Microsoft had already announced the new device, similar in size and design to the current Xbox One controller but with a redesigned directional pad and share button, it had not yet shown it in white.
The box contains a list of compatible consoles, one of which is the Xbox One. However, it also includes "Xbox Series X|S". This may imply the development of two models, both the X and S edition.
Microsoft hasn't yet officially announced the Xbox Series S, reportedly codenamed Lockhart, which is rumored to be a cheaper, less powerful system than the Xbox Series X coming later this year. We don't know yet when this will be released or how much it will cost, but it can't be too far away if people are already buying the controller.
You can check out the full original post on Twitter.


Do you like to try before you buy? We totally understand and offer samples just for you!
Our lotions, creams, and butters are made with the purest ingredients in the world that will hydrate your skin without leaving any residue. Your skin will absorb our moisturizers within seconds and you'll feel pampered with long lasting hydration. All of our lotions, creams, and butters are 100% plant based, non-toxic, and scented with real fruit for extra antioxidants.
Our sample pack comes with 3 samples so you can try a body lotion, body butter, and a face cream. Limited supply.


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Our Tropical Seasoning is an appetising blend of herbs and spices, including coriander, paprika, cumin, onion, marjoram, chilli, garlic and nutmeg. It can be used with all types of cooking and is a convenient way to tropicalise everyday meals. It can add zest to meat, fish or vegetable dishes as well as enhance salads, soups, sauces and marinades. Try our recipe or be adventurous with your own. Enjoy!
Coriander, Paprika, Cumin, Onion, Marjoram, Chilli, Garlic, Salt, Nutmeg.


Welcome to your first April 2019 edition of The McCurrach Eye. After a few weeks away, we are back and what a busy few weeks it has been in the UK & Ireland FMCG and Foodservice industry. With healthy eating gathering pace, Asda overtaking Sainsbury's in Market Share, Spar Scan & Go app, and McDonald's franchise gathering pace you will need to make sure you grab a cuppa and a KitKat and join us in catching up on all the latest News & Insights from the only source worth reading!
Click the image below to tuck in and remember to keep a McCurrach Eye out for next weeks edition!


5/12/2015 United States - Great Electra 225 four door hardtop with 401 nailhead V8 engine, Turbo 400 transmission, p/steering, p/brakes, p/windows, p/seat, and p/antenna. This car runs strong and thanks to a new steering box and tie rods it drives excellent. The car has been shaved of its emblems and rear door handles, lowered, and painted Satin Black. The interior needs some attention as the rear seat top has cracked and split from sun damage. It does, however, have a new carpet, roof rail weatherstrips, trunk seal, and side glass divider rubber. The glass is clear and unbroken, the windows all go up and down, the AM radio works, the clock works, the remote rear view mirror is functional, all of the lights work, the 2 speed wiper works, and the turn signals work. All of the air conditioning system components are in place but it will need servicing if you want to use it. In my mind the 65 and 66 Electra 225 hardtops are the most beautiful cars on the road. This one cries out 'Lowrider', has fender skirts, 4 full wheel hubcaps, has a clear title in my name, is SMOG exempt, and has many years of faithful service ahead.
Contact Jack Redman at 714-963-6509.


StreamMyGame has released an update to its software so you can stream PC games to your PS3.
Specifically it has added Ubuntu and Yellow Dog Linux support for its StreamMyGame Player, so any machine running the operating systems can install the client and receive the digital streams.
The aim is to let a host PC with impressive tell-your-mates machinery run a game while someone controls it elsewhere - currently only in the local LAN vicinity.
"I have a PS3 in my living room and PC in my office and my two kids both have old PCs in their bedrooms," said Richard Faria, boss of StreamMyGame. "Now we can play games anywhere around the home.
"StreamMyGame's technology networks the power of a main PC so it can be used to play high end games on other PCs, PS3s and Linux devices."
Broadband support is expected as soon as March, although only for networks with sufficient capacity. Like NASA.
Head over and register on the StreamMyGame site to download the free server and player, both of which are also compatible with Windows.


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Pakistan suspends death penalty during Ramadan
19/06/2015 | Oasis
Pakistan has ordered the temporary suspension of the death penalty during the Muslim holy month of Ramadan.
Prime Minister Nawaz Sharif instructed authorities to respect "the sanctity of the holy month", by observing a moratorium on executions.
Ramadan began in most parts of the country on Friday.
More than 170 people have been hanged in Pakistan since December, prompting criticism from human rights organisations.
Mr Sharif notified the Interior Ministry and provincial governments of the month-long suspension on Thursday.
Pakistan is believed to have the largest number of death row inmates in the world. Some 8,200 prisoners are awaiting execution - many of whom have been in jail for over a decade.
A seven-year moratorium on the death penalty was lifted late last year in response to a deadly Taliban attack on a school in Peshawar.
Amnesty International said it had seen "a conveyor belt of executions" since then.
At least 15 people were put to death earlier this week, in jails across the country. The majority had been convicted of murder and spent many years on death row.
The US and Religious Freedom
Plans for Detained ISIS Fighters
The Ethics of Social Engineering
Conflict Between Farmers and Herders in Nigeria
Pakistan's Election Explained


Meet Agnes, Anne and Betty. They make bombs.
An air raid strikes sending them on a TNT-fuelled journey through euphoric emancipation, forbidden friendship and anarchic dreams. A rare insight into life during the First World War from the unique perspective of Britain's munitions workers.
Suitable for ages 12+ years.
This tour is produced in association with Carole W Productions with the generous support of Arts Council England and Sunday for Sammy, and with the partnership of the Royal British Legion's #thankyou100 campaign.


ATLANTA—Because of their pivotal role in so many cell growth functions, microtubules are popular targets for anti-cancer drugs. Unfortunately, drug resistance and toxicity can be significant problems. With this in mind, researchers at Emory University School of Medicine, the Indian Institute of Technology-Bombay, and the University of Delhi recently developed a series of halogenated analogs of the low-toxicity microtubule-binding drug noscapine.
They presented their work in Biochemical Pharmacology.
Initially, the researchers had to overcome the challenges of halogenating the aromatic constituents of noscapine, and were able to develop methods that offered high yields under mild conditions necessary for the easily hydrolysable noscapine. They then tested the new compounds for the ability to bind tubulin. Using spectrophotometry, the researchers found that each of the analogues exhibited higher affinities than noscapine. Furthermore, they noted that each of the compounds had higher antiproliferative activity in human cancer cell lines than the original compound, and the bromoderivative was 40-fold more active.
They then used fluorescence-activated cell sorting (FACS) to monitor at what stage the compounds halted cell cycling and whether the analogues had apoptotic activity. They found that the fluorinated, chlorinated and brominated derivatives each induced accumulation at the G2/M phase of the cell cycle. And using FACS and confocal microscopy, the researchers noted signs indicative of apoptosis. The researchers suggest that the results warrant further preclinical and clinical testing of the analogues.


text:
To ED or not to ED: NHS 24 referrals to the emergency department
Introduction This study aimed to compare the opinions of consultants in emergency medicine and general practitioners (GPs) on the appropriateness of NHS 24 referrals to the emergency department (ED).
Methods 170 NHS 24 referrals to the ED were reviewed by six GPs and six emergency consultants who were asked their opinion as to which out-of-hours service would be most appropriate for the patient. Modal responses from both groups were calculated for each referral. Consensus within groups and levels of agreement were calculated.
Results Modal responses agreed with an ED disposal in 59.2% of cases in the emergency consultant group with a 90% consensus rate. The GP group agreed with an ED disposal in only 47% of cases with a 75.9% consensus rate. A primary care referral response was the mode in 20.8% of the emergency consultant group compared with 35.7% in the GP group. Consensus was reached in 76.3% of the emergency consultant responses and 81.7% of GP responses. The difference in opinion between the two study groups was statistically significant.
Conclusions GPs and consultants in emergency medicine both believe a high proportion of NHS 24 referrals to the ED should be handled by primary care services. This would suggest that, compared with previous out-of-hours practice, NHS 24 favours an ED outcome. The results indicate a large proportion of primary care patients are being handled inappropriately and uneconomically in the ED setting. There is a need for ongoing improvement of the telephone triage service provided by NHS 24.
NHS 24
out-of-hours care
telephone triage
emergency care systems
emergency departments
http://dx.doi.org/10.1136/emj.2008.064261
Primary survey
Simon Carley
Emergency Medicine Journal 2010; 27 165-165 Published Online First: 19 Mar 2010. doi: 10.1136/emj.2010.092999