text:
Q: Fabricators failing with mongoid from validation I can't get my any test to run because every user I try to fabricate generates validation errors.
I have the following test.

class BillTest < ActiveSupport::TestCase

  def setup
    load_all_sponsors
    @the_bill = Bill.new(:govtrack_name => "h1")
    @user1 = Fabricate(:user1)
    @user2 = Fabricate(:user2)

My fabrications are defined by:

Fabricator(:user) do
   email      'another_user_here@domain.com'
   name       'anew user'
   roles_mask 1
   password   "secret"
   password_confirmation "secret"
   polco_groups {[Fabricate(:polco_group, :name => 'foreign', :type => :custom)]}
end

Fabricator(:admin, :class_name => :user) do
  email 'admin@yourdomain.com'
  name  'Administrator'
  roles_mask  5
  password   "secret"
  password_confirmation "secret"
end

Fabricator(:registered, :class_name => :user) do
   email      'registered_user@domain.com'
   name       'Tim TheRegistered'
   roles_mask 2
   password   "the_secret"
   password_confirmation "the_secret"
   polco_groups {[Fabricate(:polco_group, {:name => 'AL', :type => :state}),
              Fabricate(:polco_group, {:name => 'AL01', :type => :district}),
              Fabricate(:polco_group, {:name => "Kirk\'s Kids" , :type => :custom})]}
end

Fabricator(:user1, :class_name => :user) do
   email      'user1@domain.com'
   name       'User1'
   roles_mask 2
   password   "the_big_secret"
   password_confirmation "the_big_secret"
   polco_groups {[Fabricate(:polco_group, {:name => 'AL', :type => :state}),
              Fabricate(:polco_group, {:name => 'AL01', :type => :district}),
              Fabricate(:polco_group, {:name => "Kirk\'s Kids" , :type => :custom})]}
end

Fabricator(:user2, :class_name => :user) do
   email      'user2@domain.com'
   name       'User2'
   roles_mask 2
   password   "the_big_secret"
   password_confirmation "the_big_secret"
   polco_groups {[Fabricate(:polco_group, {:name => 'AL', :type => :state}),
              Fabricate(:polco_group, {:name => 'FL01', :type => :district}),
              Fabricate(:polco_group, {:name => "Ft. Sam Washington 1st Grade" , :type => :custom})]}
end

No matter which test runs, I get the same error

  9) Error:
test_update_from_directory(BillTest):
Mongoid::Errors::Validations: Validation failed - Email is already taken, Email is already taken, Name is already taken.
    test/unit/bill_test.rb:8:in `setup'

I have tried a number of different fabricators, inheriting in all kinds of different ways and nothing gets past this error. I'm pretty desperate for help on this one.

A: You should be user the "ffaker" gem to generate email addresses and the like in your specs. Also, you should be inheriting fields form previously defined fabricators, as illustrated below.
Fabricator(:user) do
 email      { Faker::Internet.email }
 name       { Faker::Name.name }
 roles_mask 1
 password   "secret"
 password_confirmation "secret"
 polco_groups {[Fabricate(:polco_group, :name => 'foreign', :type => :custom)]}
end

Fabricator(:admin, :from => :user) do
  roles_mask  5
end

Fabricator(:registered, :from => :user) do
  roles_mask 2
  polco_groups {[Fabricate(:polco_group, :name => 'AL', :type => :state),
          Fabricate(:polco_group, :name => 'AL01', :type => :district),
          Fabricate(:polco_group, :name => "Kirk\'s Kids" , :type => :custom)]}
end

Fabricator(:user1, :from => :registered)

Fabricator(:user2, :from => :registered) do
  polco_groups {[Fabricate(:polco_group, {:name => 'AL', :type => :state}),
          Fabricate(:polco_group, {:name => 'FL01', :type => :district}),
          Fabricate(:polco_group, {:name => "Ft. Sam Washington 1st Grade" , :type => :custom})]}
end

It is unrelated to your issue, but it looks like user1 and user2 should just be calls to Fabricate and not actually defined as Fabricators. I don't recommend putting that much explicit information in the Fabricator. You should only be defining was is necessary to generate a valid object. Any specific data should be in the service of a particular spec.

A: After running in to Machinist and Fabricator issues with Mongoid I've settled on FactoryGirl - the syntax feels like a step back - but it works.
The issues I had with the others were related to validation, STI and polymorphism.


text:
Metar (en hebreu, מיתר) és un consell local situat en la part més septentrional del Nègueb que forma part del districte del Sud d'Israel. Metar es troba a 15 km al nord-est de Beerxeba, a la carretera Beerxeba-Hebron. Immediatament al nord, a dos quilòmetres, hi ha la frontera amb Palestina.

El poble fou fundat el 1980, i les primeres cases van ser construïdes el 1984. La majoria d'edificacions són cases unifamiliars i el nivell sociocultural dels habitants és dels més alts del país. Metar, com Lehavim i Ómer, funciona com a ciutat satèl·lit de Beerxeba.

Al voltant de la ciutat hi ha plantats alguns boscos que es compten entre els més extensos d'Israel, com ara el bosc de Lahav i el de Yatir.

Consells locals d'Israel

redpajama_set_name: RedPajamaWikipedia


text:
Essay on United States
Sample Literature Review On Retention Barriers For Minority Students In Nursing Education
Type of paper: Literature Review
Topic: United States, Health, Education, Nursing, Democracy, Students, Profession, America
Minority students that can be targeted for retention programs include students from the African-American, Hispanic, Native American, Filipino and Hawaiian ethnicities. The issues that need to be addressed in order to retain minority students in higher education nursing programs include more academic preparation, more support from faculty, and the availability of health the insurance. The wrong perceptions about nurses start as young as Kindergarten and last through elementary and high school. Long term solutions to the retention problem can start when nursing associations and university departments need to reach out to local school districts by offering help in developing fact based curricula about a nursing career. Career counseling brochures for older students can be designed so that minority students as well as other students will find the materials attractive. Society's perceptions of nurses must be changed so the benefits of a nursing career are not ignored by minority students. The most attractive short term goal is to build bridges for paraprofessional auxiliary and allied health career workers so they can move into the professional sphere of nursing. Three ways to encourage minority paraprofessionals are to make target support services available, offer stipends and offer scholarships.
The online magazine titled Minority Nurse wants to attract African-American, Hispanic, Asian, Native American and Filipino nurses for their readership audience. Those are the main ethnicities defined under the category of minority students. Swail, Redd and Perna (2003) explained that the following minorities were not retained in higher education programs in large enough numbers: Native American, African American and Hispanic along with disabled students and low income students. On the other hand, white and Asian students have shown high retention levels (Swail, Redd and Perna (2003,p. 5) Ways to retain Hawaiians and other indigenous populations need to be found and applied because they are leaving higher educational programs before completion, too (Jensen, 2011). Another distinction for minority students is based on gender. Men do not enter nursing in numbers matching those of women.
Maintaining a larger number of minority nurses within the nursing pool is necessary to fill America's needs for nurses. Reaching this goal has not been successful, though, because of the barriers minority students face. Unfortunately, the barriers minority nurses face at work cause many to leave the profession. Minority nurses become discouraged and leave the profession before retirement age.
If well-planned recruitment strategies are targeted at minority high school students, than many of the difficulties could be resolved, and the retention of minority students in nursing education could be greatly improved.
Research studies have found that that the perceptions about the nursing profession in kindergarten, elementary school and high school are negative and they are not based on fact (Dower, McRee, Briggance, & O'Neil, 2001; Greenwald & Davis, 2000).
A Canadian research project evaluated the "attitudes and perceptions towards men in nursing education" (Bartfay, W.J., Barfay, E., Clow & Wu, 2010). The research was initiated because of the problems recruiting and retaining men as nurses. The authors noted the barriers were educational as well as social, and included the perception that women are supposed to be nurses and men who are nurses are "effeminate or gay" (Bartfay, W.J., Barfay, E., Clow & Wu,, p. 1). Initiatives are being planned and initiated in order to create a larger population in America's nursing pool by attracting minority students and then retaining them.
Keller and Collins (2004) carried out a research study titled "Nursing Education Barriers Survey." Nursing students who were working on Associate and Baccalaureate degrees participated. Out of the 3,020 nursing students who participated, 85.3 percent were female and 14.6 percent were male (Keller and Collins, p.7). African American students made up 17.5 percent of the participant pool, and 2.0 percent made up the other ethnic origins including Hispanic, Asian and Native American (Keller and Collins, p.7). The students received a different questionnaire from the faculty. The students were asked to identify the three main barriers that might not allow them to finish their degree. The top three barriers from the student group of participants were reported to be no financial support,, difficulty balancing family, children with their education, and they were not able to work and go to school at the same time. (Keller & Collins, 2004). Keller and Collins (2004) listed, in order of importance, the other barriers the students reported:
- not enough academic preparation,
- no support from their instructors,
- problems with health,
- no health insurance,
- problems associated with the faculty such as not prepared to teach, no concern for students, not thoroughly knowledgeable on the subject, and not organized,
- stress, and
- the requirements for being a full-time student.
The nursing faculty was asked to describe the barriers to student retention that were based on the professional images of nurses. The faculty listed "poor professional image of nursing" as the most often noted under the topic (Keller and Collins (p. 24).
Learn About Unlimited New Careers in Healthcare (L.A.U.N.C.H). is a California initiative with the goal of sharing accurate information about health career careers to school children. An outreach program carried out by members of the California Health Occupations Students of America (HOSA). Classes from Kindergarten to 12th grade are the focus of the Cal-HOSA initiative. The goal is to prepare and encourage students to pursue health careers at the university level (Dower, McRee, Briggance, & O'Neil, 2001). High school students are encouraged because they are eligible for academic scholarships. The four key parts of the Cal-HOSA initiative include the following features.
- Offer health education curricula with up-to-date facts,
- offer nursing specific academic programs,
- design career counseling materials, and
- develop a link with the community.
A study of standardized achievement test scores demonstrated that the students involved in the HOSA program have higher test scores than students who have not entered the program (Dower, McRee, Briggance, & O'Neil, 2001).
The MSU BSN program in Michigan has extended the idea of early enrollment for students in the Lansing School District. In 2008 students could enter the BSN program when they were juniors in high school. The new plan offers ten disadvantaged students an "Early Admit option" (Viau, 2011). The category disadvantaged students includes minority students and students from families without the economic resources to send their children to college. The program specifically focuses on retention by providing support in the following ways.
- Summer preparation study program before freshman classes start,
- targeted support services,
- stipends, and
- scholarships (Viau, 2011).
The strategies discussed above address the needs of minority students in a number of ways. Correcting the false perceptions about nursing in the primary and secondary educational system opens up the field to a new pool of recruits. Nursing needs minority students to fill positions and minority students need opportunities for a stable and satisfying career. Therefore educational outreach needs to start with children at a young age before false ideas about nursing become difficult to change.
Jensen (2011, p. 2) noted that high school G.P.A. and financial aid were the number one and number 2 factors that influenced the retention of native Hawaiians. Other important aspects that need to be evaluated for native Hawaiian and other minority students include "course load, academic self-discipline, a sense of belonging and social connectedness, academic engagement in research or clubs," support from family and the faculty and finally a sense of belonging to the community which nurtures a feeling of self-importance. Kawakami (1999, p. 26) surveyed Hawaiian educators who emphasized that "successful learning experiences for Hawaiian students much take place in a culturally authentic physical and social learning environment."
Paraprofessionals from the auxiliary and allied health care worker sector would be a great solution to the problem to the recruiting of minorities that that is needed (Dower, McRee, Briggance, & O'Neil, 2001. This can be done by changing the perception about nursing by sharing positive and factual information. Financial aid and academic study opportunities would help encourage minority health care workers into nursing. Flexible schedules would help the workers take classes and continue working at the same time.
Bartfay, W.J., Barfay, E., Clow & Wu,, (2010) concludes that in order to successfully retain men in the nursing profession the stereotypes about the nursing profession is only suitable for women must be contradicted. Therefore recruitment advertisements should portray men as nurses and male faculty in nursing higher education programs.
The first three features Cal-HOSA recommended for recruitment and retention involve working with other educational professionals but the fourth feature, developing a link with the community, involves parent and other community members. By including the family and neighbors of a minority student in the initiative, minority students have a local support system in place that would not otherwise be available.
In conclusion, an overall goal of any long term retention goals need to address the mistaken information students in Kindergarten, elementary and high school receive about a nursing career. A curriculum needs to be developed that matches the facts about the modern nursing profession. Career counseling brochures for older students can be designed so that minority students as well as other students will find the materials attractive. Society's perceptions of nurses must be changed so the benefits of a nursing career are not ignored by minority students. The best short term goal is to offer advantages to auxiliary and allied health care workers such as flexible scheduling, financial aid and non-traditional study opportunities as a bridge from paraprofessional to professional.
Bartfay, W., Bartfay, E., Clow, D., Wu, T. (2010). Attitudes and Perceptions towards Men in Nursing Education. The Internet Journal of Allied Health Sciences and Practice. 8(2).
Dower, C., McRee, T., Briggance, B., & O'Neil, E. H. (2001). Diversifying the nursing workforce: A California imperative . CA: California Workforce Initiative. University of California (UCSF) Available online.http://www.futurehealth.ucsf.edu/
Greenwald, H. P., & Davis, R. A. (2000). Minority recruitment and retention in dietetics: Issues and interventions. Journal of American Dietetic Association, 100 , 961-966
Immaculatan, I., Straker, K.C., Landson, M.J., Symes, L., Bernard, L.F., Hughes, L.A. & Carroll, T. L. (2011) An Innovative, Multidisciplinary Strategy to Improve Retention of Nursing Students from Disadvantaged Backgrounds. Nursing Education Perspectives, November 2011, (32)6, 375-379.
Jensen, U. 2011. Factors Influencing Student Retention in Higher Education. Summary of Influential Factors in Degree Attainment and Persistence to Career or Further Education for At-Risk/High Educational Need Students, Pacific Policy Research Center. Honolulu, HI: Kamehameha Schools–Research & Evaluation Division, pp. 1-4, http://www.ksbe.edu/spi/pdfs/retention_brief.pdf
Kawakami, A J. (1999). Sense of place, community, and identity: Bridging the gap between home and school for Hawaiian students. Education and Urban Society, 32(1), 18-40.
Keller, S.D.& Collins, V.B. (2004). Nursing Education Barriers Identification Survey. Mississippi Office of Nursing Workforce, Healthcare Research Group. LLC, Workforce Investment Network in Mississippi.
Swail, W.S., Redd, K.E., & Perna, L.W.. (2002). Retaining minority students in higher education: A framework for success. ASHE-ERIC higher education report, 30(2), eries editor, Kezar, A.J., San Francisco: Wiley Subscription Services.
MinorityNurse.comhttp://www.minoritynurse.com/magazine
Noone, J. (2008), The Diversity Imperative: Strategies to Address a Diverse Nursing Workforce. Nursing Forum, 43: 133–143. doi: 10.1111/j.1744-6198.2008.00105.x
Vaiu, T. (2011). 'Overcoming Educational Barriers.' Michigan State University (MSU), College of Nursing, http://nursing.msu.edu
Climate Change Essay Example
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redpajama_set_name: RedPajamaCommonCrawl


The comfortable kitchen is equipped with washing machine, oven and dishwasher.
The 5 bedrooms are equipped with comfortable beds, a wardrobe and a mobile fan. Especially the 4 bedrooms in the attic a unique impression caused by the beams and unusual natural and low windows.
From dining out to a courtyard, which is decorated with flowers, where you can enjoy the sun even when it's windy. Front of the room facing south is a terrace with two very large tables. You can enjoy panoramic views of the Viñuela reservoir, to the hills with olive groves and the sea.
Around the private pool of about 9 x 4.50 m there is another terrace with shower, ceiling shade, plenty of chairs, tables and chairs. The house has a paddle court. You can practice the sport of ping-pong table (no blades, rack and balls) or use the tennis court that is about 200 m. For children there are three swings in the playground itself.
The road is paved plot. Beside the house there is parking on the plot of 3500 m². The place is intimate and quiet.
It has weekly change of sheets and towels that provide customers with peace of mind and time to be comfortable, relax completely and absolutely enjoy the holidays. This near Periana, with its various shops and the old church, if they seduce them around the streets and then take a glass of wine in a bar or taste of home cooking in a restaurant.


Fatal Attraction minus the taut suspense is how this film can best be described. Sharing the same director, Adrian Lyne, Unfaithful seems unlikely to gain the notoriety that Attraction did, as it lacks the hook that digs into mainstream audiences. The subject of infidelity has been tackled in films such as Mike Figgis' One Night Stand and Stanley Kubrick's Eyes Wide Shut to mostly less-than-stellar box-office performances. The subject matter itself is quite dark and doesn't lend itself well to boffo business. The genre is only successful when there is a hook, the best examples of which are the previously mentioned Fatal Attraction and Eyes Wide Shut and the Robert Redford bore-fest, Indecent Proposal. As it is, Unfaithful lacks the star power of Eyes and doesn't have the hook of Proposal or Attraction. We instead have Richard Gere being betrayed by Diane Lane, who has an affair with a strange-looking Frenchman. Unlikely to find much of a crowd, the movie will most probably do no better than tenth overall for the month, and it only ranks on the list because the number 11 and 12 spots are occupied by Deuces Wild, a small film set in the '50s starring a number of mid-level actors, and Woody Allen's latest film, Hollywood Ending.
The first rule of making a kids' movie is that kids should be able to pronounce the title. Unfortunately, that's not Spirit's biggest problem. Its biggest problem is that it is a children's animated movie that is neither a musical nor a comedy. Very few movies can be successful when they are described as a non-comedy, animated kids' film. Dinosaur comes to mind, but little else. Whatever the reasons might be, it is just not a safe bet to release a kids' movie while not including any gags. And while Spirit resembles Dinosaur in that it seemingly has very little dialogue, that unfortunately is not a plus. DreamWorks is taking a huge risk here, and depending on whether their expectations are realistic or not, the movie will most likely be considered a failure.
I'll say this: No one sells a comedy like Eddie Griffin. No one. No other actor can repeatedly make a movie seem funny in the span of 60 seconds like Eddie Griffin can. His ability to deliver with a mere look and his dead-on delivery have sold every comedy he has been in and headlined (ignoring the minute release of Foolish). Griffin is definitely a star on the rise, and he stars in Undercover Brother as the black Austin Powers. While Powers takes shots at the old spy movies of the '60s, Undercover Brother takes shots mainly at the blaxploitation films of the '70s. Other than looking funny, the film is the first comedy in a long time to tap into the African-American demo, and with Griffin's notoriety and the comedy of the film, the film looks to be a sure success. The biggest obstacle this film will have is whether it will be supported by the studio or not, and that remains to be seen. If pushed well, the film can open really well, even better than eighth overall for the month.
Based on the critically-acclaimed and incredibly well-received book by Nick Hornby, About a Boy is a male-driven Bridget Jones' Diary in feel. Starring Hugh Grant as a man who preys upon single mothers to feed his sexual appetite, the film is a product of part of the production team responsible for Bridget Jones' Diary. If anything, this film will show us if light Brit rom-coms can and will be a trend. The genre has found success in recent years with hits such as Notting Hill and the aforementioned Bridget Jones. The popularity is a reflection of the quality of the films; while the films aren't directly connected, they seem to share a commonality that has caused them to enjoy continuing success. About a Boy should be no different. The novel on which it is based is extremely popular, and the early buzz on the film and Grant's performance have been great. Above all, it should be a tremendous break from what is an action-packed month.
See Number Eight. Eddie Griffin alone sells this movie. And while he might be in only one-third of it at the most, he is the sole person selling this film. DJ Qualls plays the skinny geek who, after a trip to jail, becomes the hottest thing in high school. It's true this film does not work without Qualls as the lead. Qualls' nerd puts Tobey and Screech's to shame, and it is his silly look that probably sold the concept to the execs, but now it is up to Griffin to sell it to the public. And sell it he does. Of course, this doesn't take away from the fact that the movie looks horrible and is opening a week after what could be the biggest opener of the year and might be lost in the fray, not due to competition but just to hype. The one thing to note here is that The New Guy is being distributed by the same studio that is backing said big opener, so the release might not be that big of a risk.
Yes, it's an eye-rolling trailer and yet another movie where evil men get their just desserts when a woman decides to empower herself and take matters into her own hands, but unfortunately, it's going to sell. There's an apparently perceived moral dilemma at the heart of this Jennifer Lopez starrer, whose trailer basically shows you the entire movie in two-and-a-half minutes. All of Lopez's films have received a decent push, as she is definitely the star of the moment. This film should appeal heavily to women, as it is meant to, even though the trailer is painful to watch. This film has the edge that Unfaithful doesn't, and promises enough scares and chills to pull in decent business.
I cannot wait for this film so I will assume that everyone else feels the same way. Actually, the film does look intriguing, and seems to be destined for a decent push. The movie is supported with some decent star-power, as Al Pacino and Robin Williams face off in what will most likely be a classic showdown. The hottest thing about this film is that it is being directed by Christopher Nolan as the follow-up to his 2001 indie smash hit, Memento. This fact alone promises twists and turns, but in a more mainstream fashion. For anybody who thought that Memento was a bit out there, this film could be a perfect step down. Cast against type, Williams is once again playing a serious role, although with no beard this time, something that usually promises a decent quality flick. What will sell this film is the creepiness factor; the scarier it looks, the more it'll sell, and with that in mind, the film should do well.
A nuclear blast ripping through a city is as good a money shot as you can get for a film. Surround that with a tense political thriller, and you have a recipe for a hit. It would not be a stretch to say that Ben Affleck really does have some true star-power. While not all his films have been runaway successes, he has helped sell a lot of movies other couldn't have. He is a very marketable face, and Changing Lanes showed that he - along with some help, of course - can draw people to what is seemingly a very lame film. Additionally, the ageless Morgan Freeman sells movies when cast in the right role, as evidenced by last year's Along Came a Spider. So we have excellent casting and a seemingly intense political thriller with a strong marketing campaign behind it. Oh, did I mention that this was based on a very popular novel in a very popular series by a very popular author named Tom Clancy? Yeah, there's that. It's all a recipe for a very successful film, and Sum could very well be headed for a $20 million-plus opening.
This film is as sure of itself as Peter Parker is when his voice-over proclaims, "I'm Spider-Man". This is THE most anticipated movie of the year, bar none. All the others worth mentioning are sequels (Attack of the Clones, Harry Potter 2, MIB2, Austin Powers 3, LoTR: The Two Towers) and none have or will have the anticipation around them that Spider-Man does. The reasons for Spider-Man's success go beyond the hype and marketing and to the nature of the subject of the movie. One need only look to the success of X-Men and, more accurately, to Batman to ascertain what kind of impact Spider-Man will make on the box office. This will be a Batman for a new generation, as it looks levels beyond anything that has come out recently. And while it probably will not break Potter's three-day record, it should come close.


text:
Mihály Lukács (November 19, 1954 – October 18, 2012) was a Hungarian Romani politician, a founding member of the Lungo Drom party. He was a member of the National Assembly (MP) from Fidesz National List between 2002 and 2006.

He worked in the Committee on Employment and Work (2002–2005) and in the Committee on Youth and Sports (2005–2006). He served as Vice-President of the National Gypsy/Roma Council (OCÖ/ORÖ) since 1999. Lukács died on October 18, 2012, at the age of 57, following a long illness.

References

1954 births
2012 deaths
Hungarian Romani people
Members of the National Assembly of Hungary (2002–2006)
People from Jász-Nagykun-Szolnok County
Romani politicians


text:
Medicare Articles (404) 252-5859
Medicare Articles Presented by Georgia Medicare Plans
Category: Obamacare
Medicare Advantage Cuts
The insurance industry launched a second television ad Monday against proposed cuts to private Medicare Advantage plans.
The latest ad features seniors talking into the camera about the "drastic" consequences of losing access to their Medicare Advantage plans.
"If Medicare Advantage has some cuts to it, I'm going to be in bad shape financially," one man says in the new ad, which began airing in Washington, D.C. on Monday and will air in Louisiana on Tuesday.
It's the second television ad America's Health Insurance Plans (AHIP) has launched in a far-reaching lobbying campaign to block the proposed cuts. More than 100 members of Congress, representing both parties, have also written letters to the Medicare agency protesting the proposed cuts.
The agency recently proposed a 2.2 percent cut in payments to Medicare Advantage — Medicare plans administered by private insurance companies.
The 2 percent cut would come on top of reductions included in President Obama's healthcare law. All told, according to AHIP, plans would have to find benefit cuts or premium increases worth $50 to $90 per customer if the cuts go through.
Medicare Part D – Trouble Brewing
Medicare Part D is on the chopping block.
The much-discussed sequester has taken effect. But federal lawmakers are still trying to find ways to undo the $85 billion in spending cuts it has put in motion.
In his state -of-the-union address, President Obama trained his eyes on one of his favorite bogeymen — the pharmaceutical industry. The president has proposed a multibillion-dollar fee on drug companies by requiring them to issue the federal treasury rebates on prescription drugs consumed by low-income seniors.
Other Democrats want to go even further. They're calling for the feds to essentially dictate prices for drugs sold through Medicare Part D plans. They claim that such a move will save even more money.
But neither plan will deliver the savings its backers claim. Even worse, both will raise costs for seniors, deny them access to drugs they need, and dismantle the structure of the only portion of Medicare that has cost less than government projections — the Medicare Part D drug benefit.
Medicare Part D leverages the power of market competition to deliver prescription drug coverage to seniors. Private insurance plans compete with one another for seniors' business, offering different premiums, deductibles, and levels of drug coverage. Seniors can pick the plan that best suits their needs and budget, and the feds subsidize their premiums.
Today, the more than 27 million seniors enrolled in Part D can choose from about a thousand plans nationwide. Nearly 11 million people covered by Part D did not previously have prescription drug coverage. Ninety percent are satisfied with the program, according to KRC Research.
The competitive forces built into Medicare Part D have kept costs down. At an average of just $38 a month, premiums are 27 percent below where the government expected them to be. They've been essentially flat since 2009, according to the Kaiser Family Foundation.
Low premium costs, in turn, mean less taxpayer money for subsidies. In fact, Part D costs are 40 percent below where the Congressional Budget Office (CBO) initially predicted. Over the past six years, the CBO has lowered its long-term cost projections for Part D by hundreds of billions of dollars.
Try to name one other federal program that can boast such results. Certainly not the rest of Medicare. At the dawn of the program in 1965, Medicare's Part A hospital insurance program was projected to cost just $9 billion by 1990. The actual cost was more than seven times that — $67 billion.
Despite Medicar Part D's success at increasing prescription drug coverage at lower-than-expected cost, President Obama and his allies want to fundamentally change the nature of the program.
Obama's plan would force drug companies to rebate some of the money they make on drug sales to "dual eligibles" — low-income seniors who qualify for both Medicare and Medicaid. They currently receive drug coverage through Part D.
The federal government mandates that drug makers generally give Medicaid a 23-percent discount. By requiring a similar rebate for dual eligibles, proponents claim that the government would save more than $150 billion over 10 years.
But as former Congressional Budget Office Director Douglas Holtz-Eakin has said, "That money has to come from somewhere." And that somewhere will be other seniors' pockets.
Holtz-Eakin estimates that the rebate scheme will force Part D premiums up by as much as 40 percent. That would add up to $3.7 billion to seniors' out-of-pocket costs, as drug companies try to recoup the cost of those forced rebates.
As bad as Obama's plan is, a coalition of Democratic lawmakers and various activist groups want to go even further — and have the government take over the role of negotiating drug prices from the private insurance companies.
In effect, they want the government to impose price controls on prescription drugs. They argue that Washington bureaucrats could force drug prices down even further, as occurs in the drug benefit for military veterans run by the federal Veterans Administration (VA).
But if the VA is such a great model, why are so many veterans fleeing it? Thirty-eight percent of veterans paid to join Part D in 2010, according to the Department of Veterans Affairs, up from 34 percent in 2006. That's because the competitive principles that govern Part D have resulted in a marketplace with a wide array of plans that provide access to more drugs than the centralized VA bureaucracy does.
Meanwhile, the CBO has repeatedly said that the government will not be able to deliver the savings it promises, writing most recently, in 2009, "[we] still believe that granting the Secretary of HHS additional authority to negotiate for lower drug prices would have little, if any, effect on prices."
Medicare Part D has succeeded at expanding coverage at low cost precisely because it's operated without too much government meddling. In the end, this fight is less about saving Medicare money than it is about giving the federal government yet more control over our healthcare system.
Seniors should hope that the president and his allies don't succeed in their quest to upend Part D.
Obamacare Medicare Advantage Cuts
US federal ( Obamacare ) rules requiring health insurers to spend 80%-85% of their revenues on clinical services and other benefits are to be extended to Medicare Advantage and prescription drug plans, which will be required to spend "at least" 85% of their revenues on clinical services including prescription drugs.
The change, to be introduced next January, is included in a proposed rule which extends the 2010 Affordable Care Act (ACA)'s medical loss ratio (MLR) requirements, which limit how much insurance plans can spend on marketing, overheads and profit, to Medicare Advantage and Medicare Prescription Drug plans.
Similar MLR requirements are already benefitting consumers in the private health insurance market, says the Centers for Medicare and Medicaid Services (CMS), which has sent the proposed rule to the White House Office of Information and Regulatory Affairs (OIRA).
"We are working to ensure that people with Medicare have affordable access to health and drug plans, while making certain that plans are providing value to Medicare and taxpayers," said Jonathan Blum, acting principal deputy administrator at the CMS and director of the agency's Center for Medicare.
The MLR rules note that many insurance companies spend "a substantial portion of consumers' premium dollars on administrative costs and profits, including executive salaries, overhead and marketing." The ACA requires health insurers to submit data on the proportion of premium revenues spent on clinical services and quality improvement (which constitute MLR), and to issue rebates to enrolees if their spending on these benefits does not meet the minimum percentages.
The proposed new rule will require Medicare Advantage and Medicare Prescription Drug plans to meet a minimum MLR from the start of next year. "Plans must spend at least 85% of revenue on clinical services, prescription drugs, quality improvements, and or/direct benefits to beneficiaries in the form of reduced Medicare premiums. Enrolled seniors and individuals with disabilities will get more value and better benefits as plans spend more on health care," says CMS.
Failure to meet these percentage requirements for five consecutive years would lead to a plan's removal from Medicare Advantage, reports Washington newspaper The Hill, which points to the proposal's significant financial importance, as it is estimated to carry an economic impact of more than $100 million. However, it is not yet clear what will be defined as "quality care" and what will fall into "expenses and overhead," and this is very important, it says, quoting healthcare lawyer Bobby Guy, who suggests that how the prescription drug plans deal with the new caps could serve as a model for the rest of the health insurance industry.
– The initial MLR rule, first introduced in 2011, was a factor in the compression seen in health insurers' margins last year, according to a new report from ratings agency A M Best. The majority of health insurers have positioned themselves to implement strategies that will allow them to adapt to the new operating environment created by the ACA and to maintain profitability, says the firm, although it "has concerns" about the profitability of smaller, more specialised companies, particularly over the near to medium term, given the Obamacare minimum MLR requirements.
PharmaTimes
Posted on December 18, 2012 February 23, 2013
Medicare Cuts – Hospitals Feel the Brunt
As President Obama and Congress try to thrash out a budget deal, the question is not whether they will squeeze money out of Medicare, but how much and who will bear the brunt of the cuts.
Republicans say that some of the savings should come from beneficiaries, and they are pushing proposals like raising the eligibility age or increasing premiums for people with high incomes, who already pay more than the standard premium. Even President Obama has proposed higher premiums, increasing the likelihood that the idea could be adopted. But any significant tinkering with the benefits for older Americans comes with significant political risks, and most Democrats in Congress strenuously oppose raising the age when Medicare coverage begins.
With growing pressure to reach an agreement on deficit reduction by the end of the year, some consensus is building around the idea that the largest Medicare savings should come from hospitals and other institutional providers of care.
"Hospitals will be in the cross hairs for more cuts," said Lisa Goldstein, an analyst with Moody's Investors Service, which follows nonprofit hospitals that issue bonds. While hospital executives fiercely defend the payments their own institutions receive, many acknowledge that Medicare is spending too much and growing too fast.
Those executives point out, however, that they have already agreed to $155 billion in cuts over a decade as part of the Affordable Care Act and they face billions more in additional cuts as part of the current negotiations. They argue that such large cuts to hospitals will ultimately affect beneficiaries.
"There is no such thing as a cut to a provider that isn't a cut to a beneficiary," said Dr. Steven M. Safyer, the chief executive of Montefiore Medical Center, a large nonprofit hospital system in the Bronx.
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Mr. Obama and Speaker John A. Boehner continued trying on Tuesday to reach an overall budget agreement, which would call for significant savings in Medicare and would avert a deep cut in Medicare payments to doctors, scheduled to occur next month.
Mr. Boehner said that an increase in the eligibility age for Medicare, favored by many Republicans, could wait until next year.
"I don't believe it's an issue that has to be dealt with between now and the end of the year," Mr. Boehner said Tuesday when asked about a possible change in the Medicare eligibility age. "It is an issue, I think, if Congress were to do entitlement reform next year and tax reform, as we envision, if there is an agreement, that issue will certainly be open to debate in that context."
The starting point for the current negotiations is President Obama's most recent budget request, which proposed legislation that would save $300 billion, or 4 percent of projected Medicare spending, over 10 years.
By contrast, Republicans in Congress are seeking savings of $400 billion to $600 billion, at least some of which should come from beneficiaries, they say.
Members of the Medicare Payment Advisory Commission, an influential panel that advises Congress, see many opportunities to rein in costs, and they say that financial pressure on providers could make them more efficient without harming the quality of care. At a meeting of the panel earlier this month, one commission member, Scott Armstrong, president of Group Health Cooperative, a nonprofit health system in Seattle, said Medicare spent "too much" on inpatient hospital care — $117 billion last year. "In an efficient system," he said, "we wouldn't be spending that kind of money on hospital services."
Although Congress may leave the details of Medicare savings to be worked out next year, there is already discussion of cutting special payments to teaching hospitals and small rural hospitals. Lawmakers are also considering reducing payments to hospitals for certain outpatient services that can be performed at lower cost in doctors' offices. Medicare pays substantially higher rates for the same services when they are provided in a hospital outpatient department rather than a doctor's office. The differential added $1.5 billion to Medicare costs last year, and as hospitals buy physician practices around the country, the costs are likely to grow, the Medicare commission says.
The savings contemplated by Mr. Obama and Mr. Boehner are substantially larger than the Medicare savings that would be produced by automatic across-the-board cutbacks scheduled to start next month if Congress does not intervene. Those Medicare savings have been estimated at $123 billion from 2013 to 2021. Some hospital executives favor the automatic cuts as more equitable — and less painful — than some of the specific reductions being contemplated.
Hospital administrators and others warn of potential hospital closings, shutting down of unprofitable services like hospitalization for psychiatric care and less access to medical care for the most vulnerable if the cuts are too deep. Nancy M. Schlichting, the chief executive of the Henry Ford Health System in Detroit, says severe cuts might make it harder for hospitals like hers to treat patients without insurance. "It's a big question whether we can continue to do that," she said. "We would have to make tough decisions."
Many rural hospitals are worried about a reduction in certain special payments they received because they treat relatively few people and depend heavily on Medicare as a source of revenue. The payments were put in place after Medicare changed the way it paid hospitals in the 1980s and hundreds of rural hospitals disappeared, said Alan Morgan, the chief executive of the National Rural Health Association in Washington.
"We have really struggled in the last couple of years to improve our financial condition," said Jodi Schmidt, the chief executive of Labette Health, a small hospital in Parsons, Kan. The hospital was able to provide trauma services to people in nearby Joplin, Mo., after a tornado devastated the hospital there. "With more cuts, the reality is we're going to have to really cut services," she said.
Urban teaching hospitals, which are already receiving some reduced payments for treating poor people under the federal health care law, say they, too, will have difficulty managing if there are significant cuts to medical education programs to train physicians and to the higher payments they get for outpatient care. Some of the hospitals say they have created integrated systems of doctors and hospitals, already delivering care at lower costs, that will suffer.
And any significant reduction in payments is likely to increase the pace of mergers among hospitals as they combine to become more efficient — and try to negotiate better rates with insurers, industry analysts say.
Other providers that could see cutbacks include home health agencies. Glenn M. Hackbarth, the chairman of the Medicare payment commission, said they provided invaluable services but were receiving "high levels of payment, way above costs" in many cases.
Complicating the negotiations is also a fundamental disagreement over where the savings should go. Republicans want to use Medicare savings to reduce federal budget deficits. By contrast, many Democrats and health policy experts would prefer to use the money to pay doctors.
Under current law, doctors face a 26.5 percent cut in their Medicare fees on Jan. 1. Just to block that cut and freeze payments to doctors would cost $11 billion next year and more than $240 billion over 10 years, the Congressional Budget Office estimates.
Lawmakers are considering other alternatives, including raising the Medicare eligibility age, a top Republican priority. Republicans say an increase in the Medicare eligibility age is justified because life expectancy has increased significantly since the program was created in 1965. Congressional Democrats say the change would shift costs to older Americans and increase the number of uninsured.
Mr. Obama considered such a proposal in budget negotiations last year and again in the last month. On Thursday, the No. 2 Senate Democrat, Richard J. Durbin of Illinois, said he understood that the idea of increasing the Medicare eligibility age was "no longer one of the items being considered by the White House."
The Congressional Budget Office analyzed a proposal to increase the eligibility age by two months a year until it reached 67, up from the current 65. Under this proposal, the budget office said, the federal government could save $113 billion over 10 years.
Besides hospital cuts, negotiators are considering a proposal that would require drug manufacturers to provide deeper discounts on prescription drugs dispensed to low-income Medicare beneficiaries. Mr. Obama and many Democrats say this could save more than $150 billion over 10 years. But many Republicans and drug companies oppose it as a form of price controls.
Another proposal being debated would impose a surcharge on Medicare premiums for older Americans who buy the most generous private insurance to cover their deductibles, co-payments and other out-of-pocket costs. The White House and some economists say such Medigap insurance encourages the overuse of medical care. But many beneficiaries are willing to pay for the extra protection.
A White House proposal to impose the surcharge on new beneficiaries would save $2.5 billion over 10 years. The Congressional Budget Office says that another option, setting more stringent limits on Medigap policies, could save more than $50 billion.
But hospitals say they are worried that, in the end, Congress will turn to them for a large share of the savings. Montefiore's chief executive, Dr. Safyer, said hospitals like his had already made significant changes, focusing much more on keeping patients healthy and out of the hospital. "We've become much more efficient," he said. "We've had price compression. We're innovating and changing." Those changes take time, he said, but he said he was convinced that they would result in lower spending in the long run.
Dr. Safyer refused to speculate on what Montefiore might do if it faced additional cuts, which could easily total 6 percent of Montefiore's revenue. "This is not crying wolf," he said. He added, "I don't have a Plan B."


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Advance Auto Parts Q1 Sales Increase 1.3%
Comparable-store sales increased by 0.6%.
Advance Auto Parts reported first-quarter net sales of $3.4 billion, a 1.3% year-over-year increase.
- Advance Auto Parts Reports Q3 Net Sales Of $2.6 Billion
- Genuine Parts Company Reports Strong Q3 Results
- O'Reilly Q3 Sales Up 9%
Comparable-store sales increased by 0.6%. However, comparable sales increased by 25.3% on a two-year stack, which blends comparable-sales from 2022 and 2021.
"In the first quarter of 2022, we delivered our eighth consecutive quarter of comparable-store sales, adjusted operating income and adjusted earnings per share growth," said Tom Greco, president and chief executive officer. "We started 2022 with strong mid-single-digit comp growth through the first 10 weeks of our 16-week quarter. During the final six weeks, we experienced comp declines driven by our DIY omnichannel business. This was primarily a result of headwinds from the expected lap of the DIY sales boost from the 2021 stimulus as well as a slower start to the spring selling season due to cooler temperatures and higher precipitation. These headwinds have subsided during the first four weeks of our second quarter with comparable-sales growth within our full-year guidance range."
On the same day that Advance announced its first-quarter results, the company introduced the DieHard EV with xEV by Clarios. Advance says it's the first auto parts retailer to sell 12-volt batteries designed specifically for hybrid and battery-electric vehicles.
"We believe the investments we've made in the company, our team members as well as our supplier partners are enabling us to capitalize on emerging opportunities while staying focused on the disciplined execution of our long-term strategic plan," Greco said. "Consistent with this, we continue to build and strengthen a differentiated customer offering behind improved parts availability, industry-leading innovation and an enhanced online and in-store experience. This includes today's announcement that Advance Auto Parts is the first-to-market with our exclusive DieHard EV battery for hybrid and battery electric vehicles. This innovative 12-volt battery will provide improved and longer-lasting battery performance for the increasing power demands of hybrid and electric vehicles."
Advance reaffirmed its full-year guidance of net sales between $11.2 billion and $11.5 billion and comparable sales increasing by 1% to 3%, among other metrics.
"We continue to execute against our long-term plans, despite volatility within the broader macro environment," said Jeff Shepherd, executive vice president and chief financial officer. "Based on our Q1 results and 2022 outlook, we're reaffirming our 2022 guidance including comparable-store sales growth, adjusted operating-margin expansion and double-digit adjusted earnings-per-share growth. Importantly, we're slightly increasing our adjusted diluted EPS guidance range reflecting year-to-date share repurchases."
Tags: Advance Auto Parts
AutoZone's Fiscal Q4 Sales Up 9%
Advance Auto Parts Feels Effects Of Inflation In 2nd Quarter
Inflation Dents DIY Spending, Crimps O'Reilly's Q2 Sales
NAPA Parent GPC Reports Strong Second Quarter
Record DIFM Sales Drive Solid Q3 For AutoZone
DIFM sales continue to rebound from the lows of the pandemic.
By Josh Cable
During AutoZone's fiscal second-quarter 2022 conference call in March, company executives asserted that its pandemic-driven sales momentum could be sustained, even after consumers blow through their stimulus payments.
AutoZone's fiscal third-quarter results did nothing to convince them otherwise.
"We believed our competitive positioning was materially improved, as indicated by our significant retail share gains and rapidly accelerated commercial sales growth," AutoZone CEO Bill Rhodes reflected during the company's third-quarter conference call on May 24. "We believed customer behavior may have permanently changed. We continue to believe all of this today."
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GPC Reports 19% Jump In Q1 Sales, Boosts 2022 Guidance
Sales in the Automotive Parts Group were $3.3 billion, up nearly 11%.
By Counterman Staff May 3, 2022
O'Reilly Reports 7% Increase In Q1 Sales
Comparable-store sales were up 4.8%.
By Josh Cable April 28, 2022
AutoZone Fiscal Q2 Sales Up 15.8%
Domestic same-store sales for the quarter, which ended Feb. 12, increased 13.8%.
NAPA Parent GPC Reports 14.1% Increase In 2021 Sales
Full-year sales for GPC's Automotive Parts Group were $12.5 billion, up from $10.9 billion in 2021.
Advance, Worldpac Announce Return of STX in 2024
STX is scheduled for April 24-28, 2024, at the Gaylord Opryland Resort and Convention Center in Nashville.
The campaign features former Marine sergeant and world-renowned climber Kirstie Ennis.
Advance Receives 2022 NASCAR Marketing Achievement Award
In its third season as an official partner, Advance Auto Parts has demonstrated its commitment to grassroots racing.
By Counterman Staff December 5, 2022
Carquest, Worldpac Announce Opening Of New DC In Ontario
The 580,000-square-foot facility is the first to combine Carquest and Worldpac DC operations under one roof.
By Counterman Staff November 3, 2022


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Franck Carducci & The Fantastic Squad
Dave Ridley 26 December 2022 Franck | CarducciFranck Carducci & the Fantastic Squad
Innisfree Sports & Social Club, Newcastle
Tuesday, 6th December 2022
It's a wet, cold Tuesday night, but we find ourselves at this rejuvenated venue hosting its first rock gig, and it's a full house. Local music enthusiast extraordinaire Les Routledge has pulled this event together in an effort to promote Franck and his band to the masses and tonight he is head of security, promotion, catering, and the welcome committee, as he says himself, he is "a 16-year-old trapped in a seventy-year-old man's body."
There is a level of excitement in this local crowd as they await a show that is a blend of prog, pop, blues and theatre. So, who is Frank Carducci and what inspires him to drag this crazy musical tea party across Europe?
I chat with him before the gig and he explains that he grew up in France where he was exposed to his parents' record collection and was immersed in the sounds of Pink Floyd and Genesis, remembering the first LP he purchased himself as The Eagles' Hotel California.
Franck has a broad musical palette and wants to reach all audiences with his music. It wasn't until he moved to Amsterdam and supported one of his musical heroes, Steve Hackett, that he thought to record his own songs, mainly at Steve's urging.
Tonight's show will feature material from the last ten years, plus compositions from his latest album The Answer.
Indeed, the first number (Love is) The Answer swirls into life as the band take the stage with Franck beaming at the audience. This is followed by Closer To Irreversible, which actually featured Steve Hackett on the album version and gives full reign to those prog influences with guitar and organ racing back forth to then give way to subtle acoustic passages.
We are then introduced to a new song that has not yet been recorded, Betrayal of Blue giving the viewpoint of Planet Earth and introducing the Theremin, interestingly played by Mary Reynaud gyrating her body.
As well as singing and playing guitar, Mary performs visual pieces, such as in The Angel, donning an illuminated costume that transforms into wings as she cavorts across the stage in time to the pulsating organ of Cedric Selzer and frenetic guitar solos of Barth Sky, all to the steady back beat of Lea Fernandez bashing her kit whilst maintaining a beatific smile. Its stunning, a dazzling body light show.
As a tribute to Sting, who they supported in front of 16,000 people at the Printemps de Pérouges festival earlier in the year, we are treated to a solo version of Roxanne by Franck on acoustic guitar, which highlights his high-pitched rock vocals.
This band are having fun and it's both a visual and audio experience. The mood generated by them onstage is infectious and we are drawn into Franck's world with Alice in Wonderland portrayed as a mischievous lady of the night by Mary, who pouts and twirls her way through the performance, whilst Franck runs off stage through the audience as the Mad Hatter, like a psychedelic Lewis Carroll.
With every song you hear snatches of Franck's extensive musical influences; Supertramp, Pink Floyd, Sting and God help me, was that Hawaii Five-O?
The encore is the fitting Slave to Rock'n'Roll and Franck invites support act Russ Tippins to join them on stage for a rousing version of Led Zeppelin's Rock and Roll.
It's a Tuesday night in a social club but this band make you check your reality; surely, I am really at a packed Newcastle City Hall?
Welcome to the rapture.
Click HERE to view Chris Simmons' Photo Gallery
Love Is (The Answer)
Closer to Irreversible
Betrayal of Blue
Mr. Hyde & Dr. Jekyll
A Brief Tale of Time
Torn Apart
Alice's Eerie Dream
On The Road To Nowhere
~ Encore:
Slave to Rock 'n' Roll
Rock and Roll (with Russ Tippins)
Franck Carducci – Vocals, Bass, Guitar, Acoustic Guitar
Mary Reynaud – Vocals, Acoustic Guitar, Theremin, Percussion, Performance Artist
Barth Sky – Guitar, Backing Vocals
Cédric Selzer – Keyboards, Backing Vocals
Léa Fernandez – Drums & Percussion
Franck Carducci – Website | Facebook
Fusion 3.5 Festival 202218th Mar 2022
Franck Carducci & The Fantastic Squad13th Mar 2022
Franck Carducci26th Oct 2021
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text:
Kailash Kher on a mission to spread the colors of Rangeele across the country.
More in Events:
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Singer Kailash Kher who recently released his new music album "Rangeele" is busy travelling different cities with an aim to spread its colors across the country.
The album released under the banner of Kailasa records is not only appreciated by the audience but has also been sold beyond the expectations of the company. In today's era, when many albums of well-known singers are shown the way to the bin, the audience response for Rangeele is commendable. When asked about the uniqueness of the album that is alluring the audience, Kailash Kher said, "One reason for the audience appreciation of the album can be the usage of simple language which is very common in my songs. It is the love of the audience that has made Kailash Kher. The reason why my previous albums were hit is all because of my fans. Today, I am what I am because of my fans and my lord. I wish that their blessings and good wishes stay with me forever like this."
So far Kailash Kher has been to Delhi, Kolkata, Lucknow, Kanpur and Bangalore to promote his album 'Rangeele'. And wherever he has been to his fans have greeted him with much applause, love and a long list of song requests and Kailash Kher has fulfilled his audiences' wishes with much zeal and enthusiasm.


Review the list of General Practice courses offered. Click on any course title to reveal the course description, information about registering, and course details.
Understand what techniques may be applied to reduce the risk of exposure to pathogens related to bloodborne pathogens.
Identify the standard of care regarding bloodborne pathogens in the healthcare workplace.
This distance-based course will provide you with the current information concerning the assessment and treatment of soft tissue injuries. In this course, you will develop a methodology for treatment of soft tissue conditions, review the current and past history as it relates to soft tissue care, investigate the current science as it relates to soft tissue injuries, understand the risks associated with using sort tissue techniques, and define different methods of therapeutic stretching.
This course provides an overview of ancillary diagnostic testing to include diagnostic testing strategies and standards, radiography, computed tomography, magnetic resonance imaging, and electro diagnostic testing procedures.
This course will provide guidance on how to recognize the signs and symptoms of disease, how to formulate differential diagnostic impressions, take a patient history, review examination essentials, and discuss the options for chiropractic and alternate treatment of disease.
This course provides an overview of the theories of pain covering the analysis of the types of physiological pain to include cutaneous, somatic, visceral, phantom limb, and neuropathic pain. The course will cover the anatomy and physiology of the body's pain pathways, common causes of pain by body region, clinical assessment of acute versus chronic pain, diagnosis of pain syndromes, and chiropractic pain management methods.
This course will provide a comprehensive analysis of physical therapy modalities and introduce the physiological effects, indications, contraindications, and proper dosage of physical therapy modalities. It will also cover manipulation under anesthesia/Vax-D protocols and guidelines, fundamentals of clinical nutrition, and alternative treatment methodologies.
This course will discuss physical examination techniques and findings, orthopedic testing procedures and findings, neurological testing procedures and findings, techniques to develop an accurate diagnostic impression, and provide an overview of neuromuscular pathologies.


text:
#include "ProjectorWidget.hpp"

#include <QApplication>
#include <QDesktopWidget>
#include <QPainter>

#include <stdio.h>
#include <iostream>
#include <assert.h>

#include "structured_light.hpp"

ProjectorWidget::ProjectorWidget(QWidget * parent, Qt::WindowFlags flags) :
    QWidget(parent, flags),
    _screen(0),
    _current_pattern(-1),
    _pattern_count(4),
    _vbits(1),
    _hbits(1),
    _updated(false)
{
}

ProjectorWidget::~ProjectorWidget()
{
    stop();
}

void ProjectorWidget::reset(void)
{
    _current_pattern = -1;
    _updated = false;
    _pixmap = QPixmap();
    emit new_image(_pixmap);
}

void ProjectorWidget::start(void)
{
    stop();
    reset();

    //validate screen
    QDesktopWidget * desktop = QApplication::desktop();
    int screens =  desktop->screenCount();
    if (_screen<0 || _screen>=screens)
    {   //error, fix it
        _screen = screens;
    }

    //display
    QRect screen_resolution = desktop->screenGeometry(_screen);
    move(QPoint(screen_resolution.x(), screen_resolution.y()));
    showFullScreen();

    //update bit count for the current resolution
    update_pattern_bit_count();
}

void ProjectorWidget::stop(void)
{
    hide();
    reset();
}

void ProjectorWidget::prev(void)
{
    if (_updated)
    {   //pattern not processed: wait
        return;
    }

    if (_current_pattern<1)
    {
        return;
    }

    _current_pattern--;
    _pixmap = QPixmap();
    update();
    QApplication::processEvents();
}

void ProjectorWidget::next(void)
{
    if (_updated)
    {   //pattern not processed: wait
        return;
    }

    if (finished())
    {
        return;
    }

    _current_pattern++;
    _pixmap = QPixmap();
    update();
    QApplication::processEvents();
}

bool ProjectorWidget::finished(void)
{
    return (_current_pattern+2 > 2+4*_pattern_count);
}

void ProjectorWidget::paintEvent(QPaintEvent *)
{
    QPainter painter(this);
    //if (_pixmap.isNull())
    if (_current_pattern<0)
    {   //stopped
        QRectF rect = QRectF(QPointF(0,0), QPointF(width(),height()));
        painter.drawText(rect, Qt::AlignCenter, "No image");
    }
    else
    {
        bool updated = false;
        if (_pixmap.isNull())
        {   //update
            updated = true;
            make_pattern();
        }

        //draw
        QRectF rect = QRectF(QPointF(0,0), QPointF(width(),height()));
        painter.drawPixmap(rect, _pixmap, rect);

        if (updated)
        {   //notfy update
            _updated = true;
            emit new_image(_pixmap);
        }
    }
}

void ProjectorWidget::update_pattern_bit_count(void)
{
    int cols = width();
    int rows = height();

    //search bit number
    _vbits = 1;
    _hbits = 1;
    for (int i=(1<<_vbits); i<cols; i=(1<<_vbits)) { _vbits++; }
    for (int i=(1<<_hbits); i<rows; i=(1<<_hbits)) { _hbits++; }
    _pattern_count = std::min(std::min(_vbits, _hbits), _pattern_count);
    std::cerr << " vbits " << _vbits << " / cols="<<cols<<", mvalue="<< ((1<<_vbits)-1) << std::endl;
    std::cerr << " hbits " << _hbits << " / rows="<<rows<<", mvalue="<< ((1<<_hbits)-1) << std::endl;
    std::cerr << " pattern_count="<< _pattern_count << std::endl;
}

void ProjectorWidget::make_pattern(void)
{
    int cols = width();
    int rows = height();

    /*
    if (_current_pattern<1)
    {   //search bit number
        _vbits = 1;
        _hbits = 1;
        for (int i=(1<<_vbits); i<cols; i=(1<<_vbits)) { _vbits++; }
        for (int i=(1<<_hbits); i<rows; i=(1<<_hbits)) { _hbits++; }
        _pattern_count = std::min(std::min(_vbits, _hbits), _pattern_count);
        std::cerr << " vbits " << _vbits << " / cols="<<cols<<", mvalue="<< ((1<<_vbits)-1) << std::endl;
        std::cerr << " hbits " << _hbits << " / rows="<<rows<<", mvalue="<< ((1<<_hbits)-1) << std::endl;
        std::cerr << " pattern_count="<< _pattern_count << std::endl;
    }
    */

    int vmask = 0, voffset = ((1<<_vbits)-cols)/2, hmask = 0, hoffset = ((1<<_hbits)-rows)/2, inverted = (_current_pattern%2)==0;

    // patterns
    // -----------
    // 00 white
    // 01 black
    // -----------
    // 02 vertical, bit N-0, normal
    // 03 vertical, bit N-0, inverted
    // 04 vertical, bit N-1, normal
    // 04 vertical, bit N-2, inverted
    // ..
    // XX =  (2*_pattern_count + 2) - 2 vertical, bit N, normal
    // XX =  (2*_pattern_count + 2) - 1 vertical, bit N, inverted
    // -----------
    // 2+N+00 = 2*(_pattern_count + 2) horizontal, bit N-0, normal
    // 2+N+01 horizontal, bit N-0, inverted
    // ..
    // YY =  (4*_pattern_count + 2) - 2 horizontal, bit N, normal
    // YY =  (4*_pattern_count + 2) - 1 horizontal, bit N, inverted

    if (_current_pattern<2)
    {   //white or black
        _pixmap = make_pattern(rows, cols, vmask, voffset, hmask, hoffset, inverted);
    }
    else if (_current_pattern<2*_pattern_count+2)
    {   //vertical
        int bit = _vbits - _current_pattern/2;
        vmask = 1<<bit;
        //std::cerr << "v# cp: " << _current_pattern << " bit:" << bit << " mask:" << vmask << std::endl;
        _pixmap = make_pattern(rows, cols, vmask, voffset, hmask, hoffset, !inverted);
    }
    else if (_current_pattern<4*_pattern_count+2)
    {   //horizontal
        int bit = _hbits + _pattern_count - _current_pattern/2;
        hmask = 1<<bit;
        //std::cerr << "h# cp: " << _current_pattern << " bit:" << bit << " mask:" << hmask << std::endl;
        _pixmap = make_pattern(rows, cols, vmask, voffset, hmask, hoffset, !inverted);
    }
    else
    {   //error
        assert(false);
        stop();
        return;
    }

    //_pixmap.save(QString("pat_%1.png").arg(_current_pattern, 2, 10, QLatin1Char('0')));
}

QPixmap ProjectorWidget::make_pattern(int rows, int cols, int vmask, int voffset, int hmask, int hoffset, int inverted)
{
    QImage image(cols, rows, QImage::Format_ARGB32);

    int tvalue = (inverted ? 0 : 255);
    int fvalue = (inverted ? 255 : 0);

    for (int h=0; h<rows; h++)
    {
        uchar * row = image.scanLine(h);
        for (int w=0; w<cols; w++)
        {
            uchar * px = row + (4*w);
            int test = (sl::binaryToGray(h+hoffset) & hmask) + (sl::binaryToGray(w+voffset) & vmask);
            int value = (test ? tvalue : fvalue);

            px[0] = value; //B
            px[1] = value; //G
            px[2] = value; //R
            px[3] = 0xff;  //A
        }
    }

    return QPixmap::fromImage(image);
}

bool ProjectorWidget::save_info(QString const& filename) const
{
    FILE * fp = fopen(qPrintable(filename), "w");
    if (!fp)
    {   //failed
        std::cerr << "Projector save_info failed, file: " << qPrintable(filename) << std::endl;
        return false;
    }

    int cols = width();
    int rows = height();

    int effective_width = cols;
    int effective_height = rows;

    int max_vert_value = (1<<std::min(_vbits,_pattern_count));
    while (effective_width>max_vert_value )
    {
        effective_width >>= 1;
    }
    int max_horz_value = (1<<std::min(_hbits,_pattern_count));
    while (effective_height>max_horz_value)
    {
        effective_height >>= 1;
    }

    fprintf(fp, "%u %u\n", effective_width, effective_height);

    fprintf(fp, "\n# width height\n"); //help

    std::cerr << "Saved projetor info: " << qPrintable(filename) << std::endl
              << " - Effective resolution: " << effective_width << "x" << effective_height << std::endl;

    //close
    fclose(fp);
    return true;
}

redpajama_set_name: RedPajamaGithub


text:
Dickies is een kledingbedrijf dat in 1922 is opgericht door oprichter Williamson-Dickie. Het is een Amerikaans kledingmerk waarvan het hoofdkantoor gevestigd is in Fort Worth, Texas. Dickies maakt vooral werkkleding zoals bouwvakkerskleding, uniformen en accessoires.

Dickies in Amerika
"Dickies" is van een oorsprong een echt bouwvakkerskledingmerk. Bouwvakkers kochten deze kleding omdat ze hun gereedschap handig erin kwijt konden, maar ook om de lange levensduur en stevigheid van het kledingmerk.
Tegenwoordig maakt Dickies ook moderne kleding die niet gericht is op bouwvakkers.

Dickies in Europa
In Europa staat Dickies bekend als skaterkleding. Van de originele amerikaanse bouwvakkersafkomst is in Europa weinig te bekennen.
De beroemde Big Daddy Jeans is in Europa het meest populaire Dickiesproduct.

Naast T-shirts en jeans laat Dickies ook nog andere producten maken zoals: schoenen, sokken, rugzakken, schoudertassen, schooluniformen, pantalons, jassen en horloges.

Externe links
Amerikaanse website van Dickies
DEuropese website van Dickies

Kledingmerk
Amerikaans kledingbedrijf
Economie van Texas
Fort Worth


Well, okay, my workout isn't all that frugal: I work out with my Wii Fit. Sure, after the initial purchase, it costs me zero in terms of commute time, extra equipment, special clothes, memberships, etc., but that initial purchase . . . let's just say we're still paying it off!
If my partner and I were both using it regularly, we could say it was replacing a gym membership for both of us which would make sense financially, but at the moment it's just me. In any case, we bought the thing so it makes sense to use it.
But what about some other frugal workout options? I suppose the ideal would be that our lifestyles would be healthy and active enough that we wouldn't need to take out a gym membership. Or even better, a day job that used your body and kept it healthy: some jobs that spring to mind are letter carrier, bike courier, farmer, sanitation engineer, gym instructor/personal trainer . . . even teachers, on their feet all day, get a work-out as they work.
But for those of us with desk jobs, it feels good to move the body after a long day of hard sitting. But what are our most frugal options?
Many of my friends love jogging. The arguments for it: you don't need fancy clothes or a membership, and there is no extra travel time or time spent showering to factor in. You do need good shoes for jogging, and there are many clothes and gadgets you can buy to make your jog more expensive (like a thingy that synchs up to your iPod Touch that records your distance and calories burned which you can then upload to a Nike website to compete compare with other people). But if you just want a cheap and amazingly efficient workout, jogging is one of the best.
I've never been a jogger, but one thing I love is swimming. It works out the whole body with very little impact on the joints. The trick here is finding a pool with a monthly or multi-session pass that isn't too expensive. In my neighbourhood, there's Jack Purcell (which is actually too warm for lap swimming), University of Ottawa which has very good prices, but the best deal may be the Cartier Suites Hotel. You can get access to their pool, sauna, hot tub and work out room, all for only $25 per month! It's a pretty amazing deal; the only catch is it only runs from the 1st to the end of the month so you can't start mid-month. But this is a deal many of my neighbours take advantage of.
There is also a new website called Fit-In 15 that encourages people to do just 15 minutes of exercise per day. They have sample exercises and suggestions for working a simple exercise regime into your day. This is great for people who don't have a big chunk of time to dedicate to working out, but would like to fit in exercise a few minutes here and there throughout the day. The exercises are not new, but what's wrong with that?
You might think that the Wii Fit has some amazing trick to make your workout "fun". There are the "balance games" but those aren't real exercise. The core of Wii Fit is a selection of simple classic exercises that a virtual trainer leads you through. Exercises like torso twists, sit-ups, push-ups, leg lifts, squats, as well as a variety of yoga poses that stretch and strengthen different parts of the body.
These are exercises people have been using for generations to tone their bodies in high schools, army boot camps and cheerleader training. If you have decent technique and perhaps a book or website to suggest smart combinations, you could do a thorough workout in your own living room, no shirt, no shoes, no service fees. You don't really need a balance board or a cartoon lady in a blue room to lead you through a set of 20 sit-ups.
The trick with any of these workouts is motivation, and that is a topic for another day.


News has just come in about a member of President Donald Trump's secret service. One of his agents has passed away from a severe stroke. He served for 19 years and was in Europe last week protecting the president and the First Lady from attacks and protestors, according to "The Daily Caller."
The U.S. Secret Service agent "suffered a cerebrovascular accident in Scotland, U.K. where he was travelling in support of Presidential Protection," the official statement read on Monday.
According to the U.S. Secret Service Twitter page, the secret service agent's name was Nole E. Remagen.
The statement read that Remagen was receiving "much needed critical care" while in Scotland.
On Saturday, July 15, the agent fell ill during Trump's visit to Turnberry golf resort in Ayrshire. On Tuesday, U.S. officials confirmed the agent's death at Queen Elizabeth University Hospital in Glasgow. Remagen was surrounded by loved ones when he passed away, according to reports.
President Trump and the Secret Service thanked the medical team and police in Scotland, as well as White House medics for their "exceptional care" he received.
The Secret Service described Remagen as a "dedicated professional of the highest order."
Will you join us in praying for the agent's family and all who provided medical attention?


Meringue on top of a brownie – ?
Nope, just meringue. It was going to be topped with whipped cream and berries.
Unfortunately, the oven in my apartment is TERRIBLE and I have a hard time compensating for it. Sometimes dropping 50 degrees is all I need to do, sometimes I have to drop temperature and time, sometimes I just need something else in the oven. It's weird.


text:
Home Lifestyle My Classic Car European road trip fuels long Porsche 911 Carrera rebuild
European road trip fuels long Porsche 911 Carrera rebuild
Zsolt's 1987 Porsche 911 Carrera started out as a fun vacation idea. Instead, it became a full resto-mod. | Zsolt Kovacs photo
Editor's note: This piece is part of the ClassicCars.com Journal's Road Trip Month. We'll be celebrating anything that helps pass the miles and the cars that get us there during the month of June.
My story began in 2001, when I bought a 1984 Porsche 911 Targa sight unseen in Germany.
My then-girlfriend (now wife) and I traveled Europe for a month with that car — camping most of the time — then shipped it home at the end. That was a fun trip, which is why we had the idea to do the same with a 1987 Porsche 911 Carrera. The car was located across the country in New Hampshire. We planned to fly out and drive it back to Southern California.
Unfortunately, it did not quite work out as planned. I also bought this one site unseen and trusted the seller, who, as it turned out, was rather dishonest.
The car was not roadworthy. It had a couple of broken head studs and a myriad of other issues. I had it shipped home and we pulled the engine to replace the broken head studs and — guess what? — it snowballed from there.
Since I knew we were tearing down the engine, I was considering making some performance enhancements but I wanted make sure I could register the car in California, so I decided to keep it mostly stock. The top end was rebuilt — heads machined, some valves replaced, cylinders honed and new rings installed on the Nikasil pistons. I also put in new oil lines, filters, plugs, seals, distributor, sensors and oil tensioner guides, just to name a few things.
I always thought the most prominent part of the air-cooled engine bay was the fan and I wanted to make it stand out. The car is silver with a red interior, so the idea was to have red accent colors on silver. I had the fan and valve covers powder coated red while all other sheet metal was done in black.
At that time, I didn't realize that I was going to rebuild the rest of the car. The engine bay was cleaned up and new insulation added. As I was looking at the nice, clean engine and the sad-looking suspension parts, I decided to take it all out, and rebuild/replace everything.
The oil tank was removed, hot tank-dipped and refinished, the oil lines replaced, the spring plates were powder coated and new Billstein sport shocks were installed. We put in new bearings, bushings, a new set of Zimmermann coated rotors and had the calipers rebuilt and zinc coated like new. We put on new braided brake lines and a set of new pads. The entire front end was also done to match the back (powder coat, bushings, bearings, brakes shocks — the whole nine yards).
Before the engine went in, we installed a new clutch. The axles were rebuilt and new dust covers installed. The original OEM muffler was in good shape, but we thought it was too quiet, so we decided to do something different and installed a small muffler that made just the right amount of noise. The new muffler still has the stock 1 in and 1 out setup, but instead of having the tail pipe coming out in the corner, we opted for the shortest way: through the bumper. I found a stainless steel exhaust tip with a carbon fiber cover, which gave it the finishing look I wanted.
Luckily, the body was in good shape but there were paint chips and it was flaking at spots with some small dings, and after all this work I could not leave it as-is. I wanted to make some modifications in a way that it could have been done by the factory.
During the bodywork, we removed the targa bar. I stripped the paint from the stainless steel and gave it a brushed look. The bumpers were replaced with new fiberglass parts. I removed the original decklid and replaced it with a ducktail. I removed the original side skirts to expose the oil lines and fabricated aluminum covers over the torsion bars.
I made perforated aluminum grills for the vents on the lid and the new front bumper to match. I removed the rear center reflector and designed a hot rod-style louvered panel in its place. Since we removed the heat shield above the OEM muffler, the panel is also functional. After all the bodywork was done, the car was painted, polished and custom decals installed.
The windshield went in with a new and improved gasket. The targa roof was re-covered with a German vinyl and a new headliner installed.
The headlights of these late model 911s were H5 lights that look like the H4 (European version), but they had terrible output, so I built custom LED units with clear Hella lenses. The new LED inserts have a beautiful cut off and are really bright.
After the body was finished I moved on to the interior. As with the rest of the car, I wanted it a little different, but use a pattern that carries through the whole car.
The doors are RS style with a leather strap opener and the door pull is made of aluminum whose center section is wrapped to match the new Momo Prototipo steering wheel. I modified the center console and cut off the top section. The remaining gear shift surround was covered in red leather as well. The entire A/C system was removed as well as the stereo.
For the floor I sourced square weave synthetic carpet in charcoal color and custom fit it to replace the original carpeting. I paid attention to details, such as aluminum floor boards (although they are not visible under the carpet) and accents on the shift knob, steering wheel, and door pulls to keep with the red and silver theme.
When the car was all finished, I put on a set of Cup-style 17-inch wheels with new tires, had the car corner balanced and the wheels aligned. I ended up needing a new catalytic converter, and the car passed the smog test with flying colors.
There are still a few small things to play with but those can be done while I enjoy my classic 911.
-Zsolt Kovacs in San Diego, California
http://classiccars.com