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From chaos to chaos, in Bengal
THE SUNDAY GUARDIAN
If any state of the Union has come to epitomise the word "chaos", it is Mamata Banerjee's West Bengal in 2019. Perhaps no other state in this country appears to be getting sucked into a whirlpool of violence and mayhem, from where coming out may get difficult in the near future. Bengal is no novice when it comes to political violence and bloodshed, but adding to the problem of political chaos—where post poll violence has become the order of the day—is administrative chaos. Considering Chief Minister Mamata Banerjee herself holds the portfolios of home and health, it is a surprise that she let the crisis stemming from the life-threatening attacks on junior doctors at Kolkata's Nilratan Sarkar Medical College to spin out of control. What did the CM achieve first by ignoring the crisis and then warning the doctors of dire consequences if they did not fall in line? What did she achieve by politicising the unrest by describing the doctors as "outsiders" backed by opposition forces? In fact, this was the tone of even her Saturday press conference: that if she wanted she could have taken punitive action against the doctors, but was not doing so and was instead requesting them to join work. She was also in no mood to apologise for the comments made against the doctors, a key demand of the striking professionals. The assurance of providing security to the doctors should have come right in the beginning. Also the promise to bring the culprits to book. But she waited for days before trying to address the doctors' concerns. In the meantime, the whole nation witnessed with horror the situation snowballing into a humanitarian crisis, apart from a law and order problem. Her threats hardened resolve and doctors across the nation rose up in protest in solidarity with the doctors of Bengal. It is not understood why immediate and exemplary action was not taken against the culprits. By taking exemplary action against the criminals, who came in truckloads to assault the junior doctors, the CM could have proved to her critics that she was not indulging in vote bank politics, a charge that has been hurled at her by her opponents in the Bharatiya Janata Party. Through her inaction she fed into the dominant narrative in Bengal that for her administration, one community—to which all the attackers belonged—is more equal than others. If it was ego that prevented the CM from taking a conciliatory approach, then it is highly deplorable. In fact, she is still unwilling to go and meet the protesting doctors at NRS. There is no place for pride in public service. Her party colleagues themselves are uneasy at the way things have unfolded and many of their family members, gauging the public mood, have started speaking out in favour of the protesting doctors. It is also not understood why a Chief Minister will use intemperate language against both her political opponents and protesters—language which can be interpreted by her party cadre as a signal for a "free for all". Political goons have added to the anarchy by attacking the protesting doctors. But then intimidation does not work in the face of public anger. Mamata Banerjee should have realised this by now, especially after the Lok Sabha election results, where intimidation could not stop voters from expressing their anger against her administration, by bringing the BJP on an even keel with the TMC.
BJP's growth in the state has been people-driven, else, given its organisational weakness there, it could not have won 18 Lok Sabha seats compared to TMC's 22. The doctors' agitation in the state is an expression of that anger. It is the ground that is seething with rage and sadly Mamata Banerjee, once a canny politician, is failing to read the pulse of her people. In fact it is this failure that is also resulting in the attempt to create a divide between Bengalis and the "outsider non Bengalis". The people of Bengal are far too integrated with the national mainstream for this pitiable attempt of promoting "soft separatism", or "Bengali sub nationalism", to succeed. But it's a dangerous attempt, nonetheless, apart from being desperate. In this context, her reaction to "provocations" of "Jai Sri Ram" slogan has been rather surprising and does not behove the Constitutional post she occupies. The head of a state government losing her temper in public does not inspire confidence among voters. As it is post poll political violence is reaching unimaginable proportions in the state. While the BJP too has been paying back in kind, there is no comparison to what the TMC has been perpetrating, especially since it rules the state and has the wherewithal to make the lives of its opponents miserable. In the process, the state is sliding down a dangerous path. The question uppermost on people's mind is: is Mamata Banerjee losing control of her administration and her party? Does she realise that she is on a self destructive mode? But why will people pay a price for that? Why will they suffer? The need of the day is the restoration of order. This anarchy cannot continue. There has to be accountability. Bengal is not the fiefdom of any person or a political party. Bengal is an integral part of the Union of India and short of Article 356, it's time the Central government thought of ways to mitigate the suffering of the people of the state. Federalism cannot be an excuse for perpetuating authoritarianism.


FACT: About 60% of our bodies are made up of water. Our cells are the building blocks of every part of our bodies, and water is the most vital part in their function and replication. Without water to keep everything flowing in and out of our cells, the body's natural processes would come to a screeching halt. Simply put: well-hydrated cells equals well-running systems!
MYTH: We need to drink eight, eight ounce glasses of water each day to be in optimal health. According to WebMD we should actually be drinking somewhere between 75-150 ounces per day, rather than 64 ounces as in the 8-glasses-per-day rule. The amount we require each day varies depending on gender, weight, daily activity level, and where we live. About 75% of Americans fall short of their daily intake, so get guzzling!
FACT: You can drink too much water. Yep, its possible. If the kidneys are overloaded with too much water, they cant process it quickly enough for the body to maintain balance. Sodium levels in the blood drop, causing hyponatremia and possibly death. This is very uncommon, and you would have to consume very high amounts of water all at once for this to be a risk (were talking gallons, folks). Unless you're an endurance athlete, you're pretty safe with boosting your daily intake!
FACT: Some researchers have had trouble backing up the health benefit claims of drinking water. There have been studies released that have not found good evidence that drinking more water has the magical qualities we once thought. However, doctors are still pushing the importance of it, and there have been plenty of findings of health benefits that coincide with good hydration. From digestion and reduced fatigue, to joint function and brain clarity - the proof is in the pudding (ahem, water). Think about this: when you're well hydrated, do you feel better or worse? Try drinking just one more glass of water every day this week, then check in and see how you feel. You may be surprised!
MYTH: Your main source of hydration should come from water alone. Actually, what you choose to eat every day provides a significant amount of your fluid needs! Food provides about 20 percent of total water intake, so having a healthy balanced diet full of foods with high water content is important. Some examples of water-heavy foods are watermelon and spinach which are 90% or more water by weight. We can even add to our intake from other beverage such as coffee, tea, and soda - however its important to be wary of sugar in these types of drinks. According to the American Dietary Guidelines, beverages account for almost half (47%) of all added sugars consumed by the U.S. population, and we don't need to add to that! True Citrus has plenty of products to add flavor to your water, without adding sugar.
What the water boils down to is this simple fact: yes, its important to drink plenty of water every day. Here are some tips and tricks for staying hydrated!


Have you ever felt disgusted at yourself? Yes, I said it out loud, with no nicer terms. Yes, I used a word that should never ever be used to describe any body, let alone our own. But still, I was looking at myself in some pictures and one of the parts of my body that lately I felt more proud and happy about, looked awful in any pic. My legs looked huge instead of fit. And I knew I could use any possible excuse, like I have worked out and my legs are sore, the perspective of the pic makes it look like this, but the truth is that nothing really could take away the disgust I was feeling.
The same happened a few days later. I was at the gym, at the squatting rack, which happens to be in front of a mirror (very useful to understand your mistakes at squatting, very bad if you have self-confident and body-love issues like myself), looking at my legs. They seemed fine, but then my tummy was huge and I couldn't help but be disgusted. My arms looked fat. My entire body was just a ball of fat.
Why am I telling you all of this? Because I believe I am not the only one. And also because it's very easy to focus solely on the bad aspects of our body. I couldn't even notice that I was lifting more than 70% of the men in the room, and the heaviest lifter among the present women. I couldn't even appreciate what my body was doing, how powerful those huge legs are, that those arms of mine were keeping the barbell right were it had to be, preventing me from injuring in the back, I was just concerned about how fat, and again, disgusted at myself I was.
I almost couldn't look at myself in the mirror. And while according to the fat percentage in my body I am in the average, according to the trainer everything is okay and I weight how much I weight because I have about 31kg of muscles alone, and according to my boyfriend, friends and relatives I am truly beautiful just like I am, I was disgusted. The number on the scale was there, in my mind, like a reminder of all the things I hated of myself.
Once I got back in the locker room and took a shower, I looked at myself once again. My boyfriend says that you can see my obliques right after training. I couldn't. My friends said that my skin is very clean these days, and I couldn't see it. Anything positive that has been said about my body was invisibile to me at that moment.
A few days later, I took a couple of pictures of myself. Everyone told me I had slimmed down. I did not believe to them. But I know I want to see progress. I want to see my obliques. I want to see my legs getting stronger.
So I am not gonna quit. I might still feel disgusted, every now and then, but I might also feel proud of what my body has achieved and is achieving. Will keep you posted.


Private sector forensic examiners work for consulting firms, corporate security departments, or independently. They become involved in cases and litigation at the request of attorneys or corporations. Computer forensics consulting agencies take part in everything from the forensic examination of a single computer to large-scale data mining projects in large e-discovery cases. Cases for large corporations may include disputes such as intellectual property theft, data theft, sexual harassment, corporate fraud, computer misuse, and misuse of investor funds. Attorneys in civil litigation practice may hire computer forensic examiners for anything from divorce cases to personal injury cases to wrongful termination cases.
Professionals working for computer forensics consulting agencies differ from law enforcement forensic professionals in that they typically come in to the field with a much stronger technology background, including a degree in information technology, computer forensics or information systems security, but less experience in investigation.
On the private side of the field, forensic examiners are typically well-versed in both information security and forensics. In many ways, private sector forensics is focused on the protection of information. Here's why. Information security is a separate field from forensics, but the two often collide. Information security is the practice of securing a company's information assets. This can include client information, secret company data, intellectual property, and privileged information. Information security is thus proactive in nature. Computer forensics is typically more reactive, responding to and understanding incidents involving technology. But here is where the two worlds collide. Private forensic examiners are typically called in to detect and investigate information security incidents to not only seek the appropriate remedy, as in a civil suit, but also to prevent further incidents. Beyond this, private sector examiners perform large-scale data recovery and electronic discovery jobs.
Private sector forensic examiners are more likely to have technology, computer forensics, and information systems security degrees. More and more, private firms are employing candidates with forensics degrees. Certifications are a huge plus, as are experience in investigations, and an ability to communicate orally and in writing. Experience, if it can be gained, is one of the top priorities for employers. Internships can be very helpful in gaining the necessary experience.
The most stark difference between the law enforcement side of the field and the consulting side is the type of work involved. Private sector examiners are typically engaged in examinations of evidence in support of civil litigation, private attorneys, private investigations, or corporate security incidents. Public sector examiners support criminal investigations, gather military intelligence, investigate regulatory violations, and analyze technical devices during military investigations.


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AZAB History & Information
Enter AZAB 2023
Official Noticeboard
Competitor's Guide
Entering the MailASail AZAB 2023? Here's what you need to know…
The AZAB has traditionally been open to single or two-handed crews.
In 2023 there will be a limited number of places for 'crewed yachts' with a maximum of four people on-board. Whilst the trophies will remain solely for single or two-handed entries, crewed yachts will compete for glassware. (If numbers for the 'crewed' class exceed the number limit a waiting list will be opened, and places assigned should places become available).
The race departs from Falmouth Harbour, in the UK, to the town of Ponta Delgada on the island of São Miguel, part of the Azores Islands in the mid-Atlantic.
There will be four monohull classes, split on handicap and a single multihull class. Starts will be for Class M, Class 1, Class 2, Class 3 and Class 4 regardless of crew numbers. The regatta will be governed by the rules as defined in The Racing Rules of Sailing, and boats will be rated using the IRC handicap or MOCRA handicap for Multihulls. The latest Edition of World Sailing Offshore Special Regulations will apply.
Is my boat eligible?
The regatta is open to boats that:
a)  are seaworthy Monohull or Multihull boats with hull length between 8.23m and 18.5m inclusive
b)  are sailed either single-handed or two-handed or with a maximum of four people onboard
c) have a current IRC rating or MOCRA Certificate
d) comply with OSR Category 1 requirements and all other requirements laid out in the Notice of Race and Amendments
Boats must carry a satellite telephone communication system which allows two-way voice communication with the organising committee throughout the race.
All competitors must complete a non-stop qualifying passage, under sail alone, of not less than 300nm (or as specified in the NoR) in the boat in which they will complete the race. The passage must be done alone if single-handed, or with your crew if double-handed or 'crewed'. The skipper and crew must each be a minimum age of 18 years on the day the race starts from Falmouth.
If it is intended that the boat be sailed single-handed in one leg and two-handed/crewed in the other leg then two separate qualifying passages are required, one single handed and one two-handed/crewed with the actual people who will compete.
The race will start from Falmouth at 1200 BST on Saturday on 3rd June 2023. (Notice of Race and The Sailing Instructions will provide all final details)
Expressions of Interest are open now by completing the form. This will enable the Organising Committee to keep you updated and once the Notice of Race is issued at the end of 2020 an initial deposit will be requested, on payment of which you will become an official entrant.
Keep up to date with the AZAB 2023 on social media with the hashtag #AZAB2023
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Organising Authority: Royal Cornwall Yacht Club
Incorporated as RCYC (Cornwall) Ltd a company limited by guarantee
Falmouth, Cornwall TR11 2SP
Registered in England and Wales No 12339822

redpajama_set_name: RedPajamaCommonCrawl


Compare multiple Kirksville, MO life insurance quotes in order to find the most affordable and best-quality coverage. Enter your Zip above and you will be able to choose from the best options available in Adair county. Life insurance comparison is the best way to save money on your coverage and ensure you are not overpaying.
If you want to buy Kirksville, Missouri life insurance you need to make sure you purchase the best policy for the best rate. Insurance can be expensive depending on the type of policy and the policy amount.
When you go online, you can find Kirksville, MO life insurance quotes from insurance companies and brokers. The insurance company would be the issuing company. They will generally give you a quote for their policies. Insurance brokers and agents can provide you with a number of quotes, depending on the companies they work with.
Daily life insurance is 1 of the most essential safeguards you can get to shield the welfare and help of your household in the occasion that anything dire have been to take place to you. But figuring out the greatest sort of plan for you and your family members can look like a maze often. Consider these guidelines as you operate via your own decisions.
Make certain to get quotes on different stages of procedures. Several insurance firms offer breaks at distinct ranges of protection that could wind up preserving you funds. Just since you've got made a decision that 175,000 is all the protection you need to have, does not imply you should not get quoted on other amounts just in scenario.
When you are thinking about how much lifestyle insurance policies to purchase, it truly is a good concept to get at least eight or ten occasions the quantity of your annual income. With this volume, if some thing happens to you, your dependents will be capable to invest correctly and keep on to get treatment of their residing expenses in the extended phrase.
Daily life insurance policies is an essential product to have in place, specially if you have a loved ones that will need to have to be offered for right after you have died. Do not go away this important issue until finally it is as well late. Examine a daily life insurance policy plan as quickly as you are in a position and make sure that it is backed up with a current will.
Do not put off purchasing a life insurance policy policy. The more mature you are when you acquire the policy, the higher your rates will be, even for the same sum of coverage. Also, if you are youthful and healthful, you will not have any problems acquiring accredited for protection, which may possibly be a difficulty as you expand older.
Get life insurance policy as early as you can afford to. The older you get, the larger your rates increase. Insurance policies firms foundation their charges on the likelihood of the insured contracting an sickness or other condition. Additionally, you run the chance of being turned down for protection if you occur to turn out to be unwell just before you apply for daily life insurance.
Do what you can to far better your credit history. The lower your credit rating rating, the greater your month to month rates could potentially be. This is because of to the reality that a coverage holder with a low score is witnessed as a higher chance to the insurance organization. This is what brings about them to charge the greater rates. It is so they can offset the threat.
Even if your employer gives lifestyle insurance, you should not depend on this plan to fulfill all your needs. These procedures are usually fairly limited, and have the drawback of not currently being portable. If you depart your job, you will also depart your life insurance coverage driving, which means you will have to discover a new coverage to replace it.
If you are a smoker who was addicted and using tobacco cigarettes at the time of your life insurance coverage policy, you can actually quit smoking cigarettes and preserve funds. Most businesses will allow you reapply for a coverage as a non-smoker following a certain sum of time has passed. So there is some incentive in it if you can quit.
Right after studying these ideas, you can commence to recognize what it normally takes to grow to be a smarter existence insurance buyer. There is a whole lot of data to be had, and you also want to know how to use it. With this in head, you can refine your approach to discover the coverage that works very best for your requirements.


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"Autonomic Effects After Anterior-To-Posterior Cervical Mobilization (L" by Francisco Xavier de Araujo, Fabricio Edler Macagnan et al.
A letter to the editor and a response is presented on the article "Blood Pressure and Heart Rate Response to Posteriorly Directed Pressure Applied to the Cervical Spine in Young, Pain-Free Individuals: A Randomized, Repeated-Measures, Double-Blind, Placebo-Controlled Study," by E. Yung and colleagues is presented.
de Araujo, Francisco Xavier; Edler Macagnan, Fabricio; Della Méa Plentz, Rodrigo; Faria Silva, Marcelo; Yung, Emmanuel; Williams, Haddie; and Mache, Kyle, "Autonomic Effects After Anterior-To-Posterior Cervical Mobilization (Letter)" (2015). All PTHMS Faculty Publications. 162.


This concludes the 7 Must-Read Holiday Blogs tour. We hope you have enjoyed our stories, personal memories, deep concerns, and general musings. All of our books may be found on Amazon or wherever fine books are sold. Thanks you for travelling this journey with us. We wish you a Merry Christmas or Happy Holiday!
If you missed any blogs or would like to start from the beginning, please click the button below.


If you have been in an accident, you will need to file an insurance claim to get your vehicle repaired. Following the proper steps can make the process a bit easier for you. Here are a few tips for filing MA auto insurance claims for vehicle repairs.
Regardless of who was at fault for the accident, you should contact your personal MA auto insurance company to report the accident. Your insurance company will ask you for basic information such as the date and time of the accident, the names of individuals involved and whether anyone was injured. If another driver was involved, they will also ask for auto insurance information for that driver. You will be asked to fill out an accident report with the full details of the incident. If police responded, be sure to visit the police station to obtain a copy of the police report. For MA auto insurance claims, it is helpful to submit both reports to your insurance company.
Your insurance company will provide you with a list of authorized repair shops. These are shops that have agreed to the hourly labor rate set forth by the insurance company. You can actually use any repair shop of your choosing. However, please be aware that if your chosen repair shop charges a higher labor rate than the insurance company's approved labor rate, then you will be personally responsible for the difference. For example, if the approved rate is $75/hour and your repair shop charges $100/hour, then you will pay that $25/hour difference directly to the repair shop. Depending on how many hours are required to complete the repairs, the amount could be substantial.
Most Massachusetts auto repair shops will work directly with your MA auto insurance company to coordinate repairs and payment. The process typically involves an insurance adjuster inspecting the vehicle and providing an estimate of repairs (materials and labor). The repair shop may submit additional information to the adjuster for approval (if the adjuster missed anything or if the repair shop feels that the estimate is not accurate). Once the specific materials and labor is approved, the repair shop will start working on your vehicle. Upon completion, your auto insurance company will pay the repair shop directly. Before releasing your vehicle, you will need to pay the repair shop your deductible (if applicable) plus any labor rate difference (as discussed in the previous paragraph).
If another driver is at fault for an accident, you will still need to file a MA auto insurance claim with your own insurance company. Your insurance company covers the initial expenses, but they then get reimbursed by the other insurance company. This speeds up your car repair process and also makes it less complicated for you.
As with any accident, it is helpful to provide as much supplementary information as possible when filing MA auto insurance claims. This includes pictures of the accident scene, injured parties, damages to vehicles, etc. The more information you provide, the easier it will be for your insurance company to understand what took place, who was at fault, and what you should be reimbursed for. In cases where the party at fault is being disputed, your documentation can be extremely useful in protecting your rights.


The first meetings were held in Paris La Défense.
The Technical Committees met per Strategic Theme according to the following calendar.
(*) The D2 sub-committees will meet in parallel (no plenary session of D2).


Myopia Control are treatments that are intended to slow the progression of myopia (nearsightedness).
These treatments can induce changes in the structure and focusing of the eyes to reduce stress and fatigue associated with the development and progress of nearsightedness. The younger one starts, the better the outcome.
If your child has myopia (nearsightedness), most likely they will need stronger eyeglasses year after year.
The more nearsighted someone is, the thicker their eyeglasses are and high levels of myopia puts patients at risk of early cataracts, glaucoma and detached retinas.
The good news is that recent studies have shown it is possible to control myopia.
There are several types of treatments that have shown promising results for controlling myopia. Myopia Control may also be an option for young adults who are still experiencing changes in their prescription.
This drop is a medicine that is used to dilate the pupil and completely relax the eyes focusing mechanism. For myopia control, a very low dose (0.02%) is put into the child's eyes at bedtime. Upon awakening there is generally no side effects from the drops. Some studies have found a reduction of myopia progress of 81%. The recommendation is to treat for two years with drops then stop the drops for a year to see if progression occurs. If progression occurs, then re-start the drops for 2 more years.
These are special contact lenses that have different powers in different zones of the lens. The child wears the contact during the day and removes at night.
Studies have found that children wearing the multifocal contact lens had 30-54% less progression of their myopia.
The vision with the multifocal contact lenses is generally not as sharp as regular contact lenses or eyeglasses.
The multifocal contacts are worn during the day and removed in the evening. The eye drop is put in the eyes at bedtime each night.
Ortho K is the use of specialty designed gas permeable contact lenses that are worn overnight to temporarily correct nearsightedness so glasses and contact lenses are not needed during waking hours. Studies have shown an effect of 43% reduction in the progress of myopia.
Initial Visit: Eye Exam with Cycloplegic Refraction. Start Drop and/or contact lens wear.
1-2 Week Visit - Intermediate Eye Examination, Check for any side effects, check pupils.
1 Month Follow Up - Intermediate Eye Examination, Check for any side effects, check pupils.
3 Month Follow Up - Intermediate Eye Examination, Check for any side effects, check pupils.
Any additional visits necessary will be included in fee. Wellness Eye Examinations are not included.
** Does not include eyeglasses, solutions, or any other type of contact lens.
Outdoor Time – Studies have shown that being outside 2 hours per day can help prevent myopia progression.
Walking, Biking, Tennis, Golf, Walking the dog, Skateboarding, Rollerblading, Hiking and Yard Work.
Remove your eyeglasses when you are doing close activities such as reading, writing, computer use, texting and studying.
Eat healthy, especially dark leafy green vegetables such as broccoli, spinach, kale, turnip greens and collard greens. High carbohydrate diets can make myopia worse.
Replace all light bulbs with a full spectrum bulb (bulbs that are similar to the sun). These can be found at Home Depot or Lowes.
In Americans aged 12 to 54 years, the prevalence of myopia has almost doubled to over 40% in the past 30 years.
High Myopia is strongly linked to a higher risk of cataracts, retinal detachment, and myopic maculopathy.
Even 1.00D of myopia doubles the risk of myopic maculopathy and posterior subcapsular cataract and triples the risk of retinal detachment compared to emmetropes (not requiring correction).
Children who have one myopic parent have a three-fold risk of myopia development compared to their peers who do not have this family history; two myopic parents double the risk again.


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Greg Lynch
Gamblers Aquire Leyton Stenman
The Green Bay Gamblers have traded defenseman Damien Carfagna to the Sioux City Musketeers for defenseman Leyton Stenman, a Phase II – 1st round pick and a player to be named later. Carfagna has appeared in 40 games, tallying 5 goals and 32 assists. The University of New Hampshire recruit has played two season with … Gamblers Aquire Leyton Stenman
GAMBLERS TRADE HALLUM TO DUBUQUE
The Green Bay Gamblers have traded forward Jackson Hallum to the Dubuque Fighting Saints for forward Peter Kramer and players to be named later. Hallum appeared in 41 games, tallying 21 goals and 28 assists. The University of Michigan recruit was selected in the 3rd round of the 2022 NHL Entry Draft by the Vegas … GAMBLERS TRADE HALLUM TO DUBUQUE
Win Streak Ends at Three
The Green Bay Gamblers (11-12-0-1) fell to the Muskegon Lumberjacks (13-10-1-2) in a 3-2 loss on Saturday at the Resch Center on First Responder's Night. The first period proved to be a quiet one, with neither team scoring. However, the Gamblers would gain a 2-0 lead at the end of the second with goals from … Win Streak Ends at Three
Gamblers Take Three in a Row
The Green Bay Gamblers (11-11-0-1) extended their winning streak to three games as they toppled the Muskegon Lumberjacks (12-10-1-2) in a 6-3 win on Friday at the Resch Center. The game was a tight contest throughout. In the first period, a Ryan Greene (6) goal made it a 1-1 game heading into the second period. … Gamblers Take Three in a Row


Thank you to all who attended our Street Medicine Workshop!
From Vera Proctor: As director of FOCUS Minnesota, I would like to express my sincere gratitude to all who participated in our recent workshop, "Street Medicine: Healing in an Urban Environment." We are deeply thankful to Fr. Paul Hodge and the Minnesota Eastern Orthodox Christian Clergy Association (MEOCCA) for the inspiration and support in facilitating this meaningful connection with Doctors Without Walls—Santa Barbara Street Medicine.
We learned so much from Fr. Jon-Stephen Hedges and Jennifer Ferraez during the two-day workshops. Many participants commented that hearing their street medicine stories reinforced their commitment to our St. Luke Project.
Our work at FOCUS Minnesota constantly reminds us that serving members of our community in need is a blessing and a privilege. Now, we are even more energized with the prospect of the St. Luke Mobile Medical Clinic extending God's mercy beyond the walls of FOCUS and onto the streets of St. Paul and Minneapolis.
If you were unable to participate in this recent workshop there is an ongoing need for more volunteers—medical and non-medical! We are grateful for any gesture of support—volunteering, financial and of course, your prayers.


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DRTC Vanderbilt Diabetes: News & Events
CMB Aspirnaut Program
MMPC Contact Us
MMPC 12th Annual Glucose Clamping the Conscious Mouse: A Laboratory Course
Regulation of prostaglandin biosynthesis by nitric oxide is revealed by targeted deletion of inducible nitric-oxide synthase.
Marnett LJ, Wright TL, Crews BC, Tannenbaum SR, Morrow JD
J Biol Chem. 2000 275 (18): 13427-30
PMID: 10788454 · DOI:10.1074/jbc.275.18.13427
We investigated the effects of targeted deletion of the inducible NO synthase (iNOS) gene on the formation of prostaglandins in vivo and ex vivo. Peritoneal macrophages were obtained from control and iNOS-deficient mice, and prostaglandin E(2) (PGE(2)) was quantified after stimulation with gamma-interferon and lipopolysaccharide to induce COX-2. Total nitrate and nitrite production was completely abolished in cells from iNOS-deficient animals compared with control cells. PGE(2) formation by cells from iNOS-deficient animals was decreased compared with cells from control animals 80% at 12 h (0.85 +/- 0.90 ng/10(6) cells versus 15.4 +/- 2.1 ng/10(6) cells, p < 0.01) and 74% at 24 h (9.4 +/- 4.3 ng/10(6) cells versus 36.8 +/- 4.1 ng/10(6) cells, p < 0.01). COX-2 protein expression was not significantly different in cells from control or knockout animals. Levels of PGE(2) in the urine of iNOS-deficient mice were decreased 78% (0.24 +/- 0.14 ng/mg of creatinine versus 1.09 +/- 0.66 ng/mg of creatinine, p < 0.01) compared with control animals. In addition, the levels of urinary F(2)-isoprostanes, an index of endogenous oxidant stress, were significantly decreased in iNOS-deficient animals. In contrast, the levels of thromboxane B(2) derived from platelets allowed to aggregate ex vivo were significantly increased in iNOS-deficient mice compared with wild-type mice. These studies support the hypothesis that NO and/or NO-derived species modulate cyclooxygenase activity and eicosanoid production in vivo.
Animals Cells, Cultured Cyclooxygenase 2 Dinoprostone Gene Deletion Isoenzymes Macrophages, Peritoneal Mice Mice, Knockout Nitric Oxide Nitric Oxide Synthase Nitric Oxide Synthase Type II Prostaglandin-Endoperoxide Synthases
Lawrence Marnett (Member)


Moose is renowned for being a lean meat. We've tried pretty much every way of cooking it over charcoal. By extensively researching and experimenting, we developed the perfect recipe so you can blow your guests away with these small strips of dry, salty, sweet, spicy, smoked meat!
Slice your defrosted meat into 1 x 1 cm pieces along the total length of your piece of meat (6 to 15 cm).
Mix ingredients for the marinade in a bowl.
Place the marinade and the strips in a large re-sealable plastic bag. Massage the bag to work the marinade into the meat. Store in the refrigerator for 20 to 40 minutes. The marinating period increases the action of the salt, sugar and spices. Warning! Moose meat is already very flavourful. If you leave it for more than one hour, it will have a very intense flavour!
While the marinade is working its magic, get your grill ready for smoking.
On the photo, we used our Kamado with the ceramic deflector, preheated to approximately 275ºF.
Once everything is nice and hot, take out the hot grill and place the strips on it. Place maple wood blocks pre-soaked in beer and water on the embers just before replacing the grill on the stand to start the smoking process.
Close your barbecue and wait. Check on the strips after 10 minutes, and then every five minutes thereafter. When they have a dry texture, turn a few strips over to see the colour underneath. When the surface of the pieces seems dry, taste one or two.
If desired, some people prefer to leave their jerky in the smoke for a little while longer.
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ABOUT LONGWOOD
LIVE AT LONGWOOD
Boasting trees that date back more than 800 years, MacMillan Provincial Park, commonly known as Cathedral Grove, offers one of Vancouver Island's most impressive displays of West Coast old growth forest. Straddling the Alberni Highway between Port Alberni and Coombs, the park also offers one of the most accessible such forests on the island. Despite its strong tourist draw, however, this forest could easily have been wiped off the map. Its preservation is due in part to locals who petitioned for its conservation, and to one forester who heeded their call.
With some trees stretching as wide as 9 metres, the park is home to abundant wildlife and constitutes an internationally important specimen of old growth Douglas fir trees. Housing big leaf maple, western hemlock, and of course, Douglas fir, the forest is also home to numerous animals, such as deer, owls, black bears, elk, and cougars.
MacMilan Park's majestic epithet "Cathedral Grove" is said to stem from a description made by the Governor General Viscount Willingdon in 1928. At this time, the park was part of the land owned by the Victoria Lumbering and Manufacturing Company was and therefore on track to becoming timber, like much of the forest that initially surrounded it. As early as 1929, The Associated Boards of Trade of Vancouver Island, a group of citizens who petitioned for the forest's protection, began to call for the government to protect the land in perpetuity. It took 15 more years of public appeal before this land was protected, and this conservation was only granted thanks to one forester, H.R. MacMillan, who in 1944 donated 136 hectares to be protected and used for public enjoyment. Three years later, this land was deemed a Class A provincial park.
Unfortunately, the park suffered considerable damage in 1997, when a severe wind storm brought down numerous old growth trees. Restoration efforts have since taken place, however, and many of the fallen trees now act as nurseries for younger trees, providing them with shelter and nutrients. Cathedral Grove continues to be an impressive sight, and in 2007 it was nominated on CBC as one of the Seven Wonders of Canada.
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Last week's dater Matt returns to try to redeem himself with another lady following his not-so-successful first attempt with his French date Julie. It can't go worse than that, in fairness.
The first in a two-part documentary following a group of volunteers with Parkinson's disease as they take part in a ground-breaking medical trial to test a new drug, run by doctors in Bristol. Filmed over six years, the first step is for all 42 volunteers to have surgery, implanting a device into the side of the head that allows the delivery of the drug into a deep part of the brain. The surgery and infusions that follow are medical firsts and the trial offers hope to the estimated 10 million affected globally.
Documentary telling the astonishing true story of three men – Robert Shafran, Edward Galland and David Kellman – who made the chance discovery at the age of 19 that they were identical triplets, who were separated at birth and adopted by three different sets of parents within a 100-mile radius of each other in New York State. The trio's joyous reunion catapults them to fame and they became instant media sensations – opening an A-list New York restaurant and even appearing in a movie with Madonna. But the brothers' discovery also sets in motion a chain of events that unearths an extraordinary and disturbing secret that goes far beyond their own lives.
Yep, there's another one a-coming. A six-episode event series is set to arrive later in the year, and OGs including Jason Priestly, Jennie Garth, Tori Spelling and more are on board to return.
Jump Girls (TG4. 9.30pm) Second of two programmes about women who are making their way in the male-dominated world of National Hunt horse racing.
Other Voices (RTÉ Two, 11.30pm) Performances by Villagers, Maria Kelly and winner of the Brits Critic's Choice 2019 Sam Fender, recorded live in St. Michael's Church, Ballina, Co Mayo.
Cold Feet (Virgin Media Two, 9.00pm) Last in the series of the recent reboot.


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Dance|Trolling the Past for Fresh Insights
https://nyti.ms/1k2zmBf
Trolling the Past for Fresh Insights
DD Dorvillier, left, shown with Katerina Andreou, will present two new works at Danspace Project.Credit...Chris Cameron
By Gia Kourlas
The latest round of Danspace Project's Platform series, which explores dance through the lens of a particular idea or theme, is dedicated to the work of the choreographer DD Dorvillier, who helped define contemporary dance beginning in the 1990s. For more than a decade Ms. Dorvillier lived and worked out of the Matzoh Factory, a loft she shared with the dancer and choreographer Jennifer Monson in Williamsburg, Brooklyn.
But "Platform 2014: 'Diary of an Image' by DD Dorvillier" is not a retrospective. She has created two new performance projects for the event, including the delicate "Diary of an Image," which features music by Zeena Parkins and incorporates Morse code as a way of organizing sound and rhythm. "A catalogue of steps," free to the public, is a chance for Ms. Dorvillier to excavate the dances she created from 1990 to 2004, presenting carefully selected fragments in an installation setting. In other words, she wants to learn from herself. (Wednesday through June 14, 131 East 10th Street, East Village; 866-811-4111, danspaceproject.org.)


It finally came this morning, nice, white and pristine. I'm almost afraid to use it! My old one looked like something from the 70s, so this is decidedly more modern. I did the half-hour test-burn per the instructions this morning and used it to reheat pizza at noon, and it did a nice job of it, too. This oven is self-cleaning which will be nice since I barely cleaned the old one. I'm not quite sure what I'm having for dinner, but I'll use one of the burners to pop popcorn on later for when I watch Howl's Moving Castle.
Plus I got some groceries this morning and did four loads of laundry this afternoon, so I feel somewhat accomplished for a weekend.


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Archive for December 1st, 2007
Of Angels and Prostates
Praise the Lord and pass the Alpha Blockers! I can tell this story now.
Besides hanging out with the Gaither crew Wednesday, Mr. Smiff had another adventure that very day, yes he did. Mr. Smiff went and had him a Big Boy Physical done.
I don't remember the last time the Mr. had bloodwork and all that stuff done. It's been a long time. He's been to the doctor for sinus infections and stuff like that. He's never had the exam that most menfolk types dread, I think worse than us womenfolk type dread ours. Yeah, THAT one.
I am not lying when I say that poor Mr. Smiff had himself worked up into a tizzy over this physical. He literally made himself nauseous the day before. I think he had convinced himself that he had prostate cancer, the poor feller. He's had some "issews" of late that made him concerned. He was even thinking things like "How ironic would it be for Sharon to lose her father to prostate cancer and then me?" I understand that cause I have an inner hypochondriac myself.
Oh Precious Jesus in Heaven, how I wish I could have been a tse tse fly on the wall in the doctor's office when my Mista had to do the manly version of the Stirrup Scoot Boogie. He did tell more detail that I won't enlighten y'all with, however, I asked permission from him to tell the funniest observation he had about the whole experience:
And I quote…."I will be farting petroleum jelly for a week."
I think maybe the Man version is a little worse than what women do. (Don't tell him I said that) Or maybe it's just that I've been having the woman thing done for about 20 years, I'm somewhat used to it. This was UNCHARTERED TERRITORY, if you will, for the Mista. I'm very glad he had it done and that all his bloodwork checked out a.o.k. His LDL could maybe be a little lower but he's good.
I texted Mr. S. last night after he and the Grascals did a beautiful rendition of Farther Along on the Grand Ole Opry (it was so sweet…they sent it out in memory of Josh) to thank them for doing that number. Ole Mr. Smiff hit that high note perfectly. He usually does baritone with the Grascals but on this one he went way up there and it was fabulous. I texted him and said "You hit that high note perfectly, enlarged prostate and all!"
All my life it seems I've been hearing about our friend, The Prostate. No, I do not have one (last I checked anyway) but jeebus, that word has been in the air since I can remember.
I was in the 8th grade when my father was told he had Prostate Cancer. I was introduced back then to the world of "Radiation Seeds", "TUR" procedures (remember when Al Franken described this in detail on SNL after Reagan had it? Heh.) and our family was never able to stand in Forest Hills Baptist Church and sing "All Hail The Power of Jesus' Name" the same again. All because of the line that says:
All hail the power of Jesus' name, let angels' PROSTATE fall
Yes, we were wrong for that. I still get the giggles whenever that hymn is sung in my presence. I'm glad I come from a bunch that can laugh in the face of fear. The whole prostate cancer issue hovered in the background, even though it was not discussed at length, at least with me. My mother prefers the "Let's Not Talk About Reality Method" of living because it might create an uncomfortable feeling and we can't have that, now can we?
Dad would have regular checkups and a procedure done here and there and never had any radiation or anything like that until the year before he died. He was only supposed to live 3 years but he hung around for 9. For that, I'm quite grateful. He was diagnosed before the PSA test was around.
I kid and can laugh about prostatic things, but, I am serious when I say that all the menfolk past a certain age should do what they need to do, get regular checkups and stay on top of that part of your health. My dad let his go too long. Take advatnage of the advances in prostate screenings.
The preceeding blog post has been a public service, courtesy your Sista and the Mista (and the Biffer, too, if he were around to say so)
December 1, 2007 sistasmiff 5 Comments
Categories: Medical Reports, Mr. Smiff Tags: Health


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New traffic tech could see the back of late running buses
A recent trial carried out by Transport for Greater Manchester could see improved bus punctuality on some of the region's busiest routes.
The four-week long pilot used the latest traffic signalling technology to help late running buses make-up time on one of Greater Manchester's busiest bus corridors, the A6 Stockport Road. The scheme monitored both benefits to buses and general traffic, as well as the impact on pedestrian wait times.
SCOOT (Split Cycle Offset Optimisation Technique), technology was used, which analyses real-time traffic data to optimise and co-ordinate traffic signal timings. The system was used to prioritise the journeys of Greater Manchester's busiest bus service, the 192, at 14 sets of traffic lights along the busy route between Stockport and Manchester, by the 'lateness' of each given bus.
By using transmitters found on most modern buses, the SCOOT system would quickly identify the vehicle to extend the green time as it approached lights – effectively enabling late running services to pass through the junction without the need to stop and wait.
Results showed that of all messages received by the signals throughout the week, 11.8% resulted in priority being granted to buses running behind schedule, providing an average saving of 31 seconds per junction. Across an average commuter's journey, these savings could add up to a considerable reduction in journey time.
Across weekday morning and evening peaks, respectively, 8.2% and 12.9% of messages resulted in priority being granted, with 11.5% over the weekend.
Punctuality and reliability are always cited by current or potential bus passengers as a key consideration when they are deciding whether to travel by bus or not. Delays to services are often caused by congestion across the region's road network.
It's estimated that congestion costs Greater Manchester's economy around £1.3 billion each year in lost time and productivity, not to mention the health and wellbeing impacts it has on the region's 2.8 million residents.
Alison Chew, Head of Bus Services at TfGM, said: "The A6 bus priority trial was extremely positive and could see us permanently extend the use of this technology across more of the region's busiest routes.
"Tackling congestion and improving air quality are two priorities for us at the minute and clearly measures that improve the reliability of public transport is one way of encouraging more people to leave the car at home.
"Buses carry around 200 million passengers per year, representing 75% of all public transport trips in Greater Manchester. When you also consider that around three quarters of all journeys made by cars and vans in the morning peak only carry one person, and that a bus can carry in excess of 70 passengers, it's clear that buses represent a more efficient use of road space.
"While it's early days, the results that we've seen from this initial pilot suggest that if bus priority schemes were increased, services would be more punctual, encouraging more users to use buses and helping to contribute to reduced congestion across the region. Therefore benefitting not only bus users but other road users and pedestrians as well."


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February 13, 2019 / 9:03 AM / 5 months ago
World Cup title defence the undercurrent to New Zealand Super Rugby season
Greg Stutchbury
WELLINGTON, (Reuters) - The All Blacks' Rugby World Cup defence will be a strong undercurrent for Super Rugby teams in New Zealand this season with several places in Steve Hansen's squad still up for grabs.
Unlike four years ago when the World Cup side was virtually settled before Super Rugby kicked off, players such as loose forwards Dalton Papalii and Akira Ioane, hooker Asafo Aumua, utility back George Bridge and lock Jackson Hemopo could all force themselves into the final 31-man squad for Japan.
In terms of Super Rugby storylines, while the Canterbury Crusaders are bidding for a third successive title the most intriguing aspect of the new season, for the first few weeks at least, will be the Auckland Blues.
The side have struggled in recent years and underwent a coaching shake-up with Leon MacDonald promoted to succeed Tana Umaga despite the former All Blacks captain being handed a contract extension earlier last year.
Umaga has said he was happy to be an assistant to his former All Blacks team mate, who also has former Waikato Chiefs assistant coach Tom Coventry to oversee the forwards and instil the kind of hard-nosed physicality that has been missing in recent years.
The Blues have also recruited two-times World Cup winner Ma'a Nonu to link up with Sonny Bill Williams in the midfield, and drafted in several players from the Auckland side that won New Zealand's provincial championship last year.
The spotlight, however, will again fall on whether Stephen Perofeta or Otere Black can drive the side around from flyhalf, a position the Blues have struggled to fill since Carlos Spencer left in 2005.
Spencer will return to Eden Park on May 10 with the Wellington Hurricanes, where the enigmatic flyhalf is an assistant to new coach John Plumtree, who has taken over from Chris Boyd.
The Hurricanes also lost forwards Brad Shields and Michael Fatialofa to overseas contracts and while still having the competition's most explosive backline could again struggle against bigger packs, like that of the Crusaders.
The Christchurch-based side's pack, which boasts nine current All Blacks, ensures they are again the strong favourites for the title and Scott Robertson could become the first coach to guide a side to three-successive championships.
Victory would also likely improve Robertson's chances of replacing Hansen, who has said he would step down following the World Cup in Japan.
Former All Blacks loose forward Robertson told reporters last year that he was interested in the second-most scrutinised job in New Zealand after the prime minister, but added that a stint overseas might not hurt his career.
Factbox - New Zealand Super Rugby Conference
The probably mid-season return of All Blacks flanker Sam Cane from a broken neck should boost a Chiefs side that has shaken off several long-term injuries and has arguably the world's best player — Brodie Retallick — leading this year but Damian McKenzie still needs to convince at flyhalf.
Aaron Mauger's Otago Highlanders should again be in the running for the playoffs, with a hard-working and deep pack hoping to farewell stalwart Ben Smith to French club Pau after the World Cup with his second title.
Editing by Peter Rutherford Greg.Stutchbury@thomsonreuters.com ; +64 4 802-8162; Reuters Messaging: Reuters Messaging: greg.stutchbury.thomsonreuters.com@reuters.net


N.B.: This article pertains to the businessman Edson Queiroz, not the controversial medical figure by the same name.
Edson Queiroz (1925–1982) was a Brazilian entrepreneur, founder of one of the largest business groups in Brazil.
Edson Queiroz was born on April 12, 1925, in Cascavel, state of Ceará. At the age of 15, he took over the management of Genesio Queiroz Warehouse, belonging to his father. He has attended important schools in the region, including Seminário Arquidiocesano da Prainha and later Liceu do Ceará, where he concluded his technical studies.
In September 1945 he married Yolanda Vidal Queiroz, whom he regarded as just as responsible for his business success as himself.
Edson Queiroz has always refused the standard business model. He was a man of the frontline and well known for getting deep into management issues. Recognized as an honored citizen of the state of Ceará, Edson was always considered ahead of his time.
He was among the 137 people killed in the VASP Flight 168 crash on June 8, 1982 — at the time, the worst accident in Brazilian aviation history.
"If at any time you are caught by surprise by injustice and ingratitude, do not stop believing in life, empowering it by decency, building it by labour."


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Delay in reviewing test results prolongs hospital length of stay: a retrospective cohort study
Mei-Sing Ong1,
Farah Magrabi2 &
Enrico Coiera2
Failure in the timely follow-up of test results has been widely documented, contributing to delayed medical care. Yet, the impact of delay in reviewing test results on hospital length of stay (LOS) has not been studied. We examine the relationship between laboratory tests review time and hospital LOS.
A retrospective cohort study of inpatients admitted to a metropolitan teaching hospital in Sydney, Australia, between 2011 and 2012 (n = 5804). Generalized linear models were developed to examine the relationship between hospital LOS and cumulative clinician read time (CRT), defined as the time taken by clinicians to review laboratory test results performed during an inpatient stay after they were reported in the computerized test reporting system. The models were adjusted for patients' age, sex, and disease severity (measured by the Charlson Comorbidity index), the number of test panels performed, the number of unreviewed tests pre-discharge, and the cumulative laboratory turnaround time (LTAT) of tests performed during an inpatient stay.
Cumulative CRT is significantly associated with prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of prolonged LOS by 13.2% (p < 0.0001). Restricting the analysis to tests with abnormal results strengthened the relationship between cumulative CRT and prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of delayed discharge by 33.6% (p < 0.0001). Increasing age, disease severity and total number of tests were also significantly associated with prolonged LOS. Increasing number of unreviewed tests was negatively associated with prolonged LOS.
Reducing unnecessary hospital LOS has become a critical health policy goal as healthcare costs escalate. Preventing delay in reviewing test results represents an important opportunity to address potentially avoidable hospital stays and unnecessary resource utilization.
Inpatient hospital services constitute almost one-third of all health care expenditures in the United States [1]. Substantial research and policy efforts have been directed at reducing unnecessary hospital length of stay (LOS), a key indicator for inpatient resource use. Research into the determinants of hospital length of stay (LOS) has identified a range of patient characteristics and clinical predictors contributing to prolonged LOS [2]. These include age, sex, disease severity, presenting conditions and complications [3,4,5,6,7,8,9,10]. While useful in guiding resource planning, most patient and disease-specific variables are not amenable to interventions that would reduce unnecessary hospital stays.
More often than not, hospital LOS is also driven by institutional factors unrelated to individual patients' conditions, such as clinical workflow and hospital resources. Patients may experience prolonged hospitalizations due to delays in accessing care [11]. Identifying these modifiable factors can provide important opportunities for interventions.
Here, we conduct the first study to explore the relationship between laboratory tests review time and LOS. Because clinical laboratory testing is an integral part of healthcare delivery, driving a large proportion of critical medical decisions, we hypothesize that delay in reviewing test results prolongs hospital LOS.
Settings and participants
This study was conducted at a 370-bed metropolitan teaching hospital. A hospital-wide computerized system was in place for reporting all diagnostic tests. The system captured detailed information on the time and date when laboratory tests were requested, when the results were available for review, and when they were viewed by the providers. Participants included all inpatients admitted to the hospital between February 2011 and February 2012. Clinical pathology tests performed were extracted from the computerized test-reporting system; these included clinical chemistry, clinical pharmacology, hematology, immunology and microbiology. Tests relating to arterial blood gases were excluded, since the results for these tests were communicated directly to the ordering physician. We further extracted from the hospital admission database the admission details of the patients, including date of admission and discharge, principal diagnosis (expressed as free text), and the department where inpatient care was provided. This study was approved by the Human Research Ethics Committee at the University of New South Wales (Sydney, Australia), with patient consent waived.
Study outcomes
The primary outcome of interest was the relationship between hospital LOS and clinician read time (CRT), defined as the time taken by a provider to access laboratory test results after they were available for review in the test reporting system (Fig. 1). The provider who reviewed the test results may be the ordering provider or any members of the healthcare team. Since patients often underwent multiple tests, we calculated the cumulative CRT for all tests performed during an inpatient stay.
Laboratory tests processing and review workflow
Timeliness in reviewing test results is dependent on timely processing of laboratory tests. The impact of laboratory turnaround time (LTAT), defined as the time between ordering of test and when the test results are available for review, has been reported to prolong LOS in high-volume patient care settings such as the emergency department. We therefore assessed the modifying effect of LTAT on the relationship between CRT and hospital LOS, and compare the effects of CRT and LTAT on hospital LOS. We hypothesize that cumulative CRT is independently associated with prolonged hospital LOS.
Descriptive statistics were used to quantify the prevalence of baseline characteristics, including patient demographics, inpatient medical specialties, the time of day tests were ordered, processed and reviewed. The impact of CRT on LOS was evaluated using generalized linear models. We used the gamma family of distributions to account for skewness in the distribution of LOS, with logarithm as the link function. We included in the model patients' age, sex, and disease severity (measured by the Charlson Comorbidity index), the total number of test panels performed during the inpatient stay, and the cumulative LTAT. We further controlled for the number of tests that were not reviewed during the inpatient stay, since tests that were not followed up were unlikely to prolong hospital LOS. An additional sensitivity analysis was performed that excluded patients with tests that were not followed up during an inpatient stay. To compare the impact of delay in reviewing abnormal test results and normal test results, we conducted a sensitivity analysis that considered only tests with abnormal findings, and a separate analysis that included only normal test results. With the exception of sex, all variables were modeled as continuous variables. The resulting estimated coefficients are presented as back-transformed (exponentiated), which are interpretable as the multiplicative effects of predictor variables on the expected LOS.
To address potential reverse causation in the association between CRT and LOS, whereby prolonged LOS causes delay in CRT, we assessed variability in the follow-up behavior of providers throughout inpatient stays, by quantifying the average CRT for tests ordered on each day of hospital admission, from day one to day 14 of admission. We observed that tests ordered on the first 2 days of admission had an average CRT of 26 and 21 h, respectively (Additional file 1: Figure S1). The average CRT for tests ordered on subsequent days (i.e. day three to 14 of admission) was about 12 h and did not vary with prolonged LOS. To account for this pattern, we conducted an additional sensitivity analysis where CRT was measured based only on tests ordered in the first 48 h of admission, and a further analysis that quantified CRT based on tests ordered after the first 48 h of admission among patients who were hospitalized for two or more days.
Analyses were conducted using R statistical software version 3.4.3. All tests of statistical significance were two-tailed and used an α level of p < 0.05.
Subgroup analyses
Clinical workflow and resources may differ across departments within the hospital, which may alter the relationship between CRT and hospital LOS. To assess if the effect of CRT on hospital LOS was consistently observed across different medical departments, we performed subgroup analyses for four of the departments with the largest number of inpatient admissions during the study period: geriatrics, cardiology, general surgery, and psychiatry. Separate models were developed for each department to assess the relationship between cumulative CRT and LOS. To account for potential confounding associated with patient heterogeneity, we further performed additional subgroup analyses that considered inpatients with the same principal admitting diagnosis. Two subgroups were selected a priori: patients with renal failure and patients who underwent elective knee or hip replacement surgery; the former represents a group of critically ill patients requiring urgent care, and the latter represents a more routine and non-urgent patient population. We hypothesize that the impact of CRT on LOS was greater among the renal failure population, compared with patients who were admitted for an elective knee or hip replacement surgery.
A total of 5804 inpatient admissions satisfied the inclusion criteria (Table 1). The mean and median LOS were 7.5 and 4 days, respectively. The distribution of LOS is illustrated in Fig. 2a. On average, 7.2 test panels were performed during an inpatient stay, with a median of 4 test panels per inpatient stay. An inpatient experienced a mean cumulative CRT of 1.6 days, and a cumulative LTAT of 2.5 days. The average CRT and LTAT for individual tests was 12.7 h and 16.1 h, respectively; the median CRT and LTAT for individual tests was an hour.
Table 1 Study participants (n = 5804)
Distribution of hospital length of stay (LOS) and patterns of test ordering, processing and review
Cumulative CRT is significantly associated with prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of prolonged hospital stay by 13.2% (p < 0.0001). Increasing age, disease severity and total number of tests were also significantly associated with prolonged LOS (Table 2a). Patient's sex was not associated with LOS in univariate analysis, and was therefore excluded from the multivariate models. While cumulative LTAT was significantly associated with LOS in univariate analysis, its effect on LOS became insignificant in the multivariate generalized linear model. Increasing number of unreviewed tests was negatively associated with prolonged LOS.
Table 2 Generalized linear model for predicting hospital LOS
A total of 3129 (53.9%) patients had one or more test results that were not followed up during hospitalization. Excluding these patients from the analysis strengthened the impact of cumulative CRT on prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of delayed discharge by 18.6% (p < 0.0001). In this subpopulation, increasing age and disease severity were not associated with prolonged LOS; increasing number of test panels and cumulative LTAT were associated with prolonged LOS (Table 2b).
Of the laboratory tests ordered, 30.4% had abnormal results. Including only tests with abnormal results in the analysis strengthened the relationship between cumulative CRT and prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of delayed discharge by 33.6% (p < 0.0001), compared with 12.2% (p < 0.0001) when only tests with normal results were considered (Table 2c, d). In the two sensitivity analyses that quantified delay based on tests ordered within the first 48 h of admission and tests ordered after the first 48 h of admission, respectively, cumulative CRT remained a significant predictor of LOS (p < 0.0001) (Table 2e, f).
The effect of cumulative CRT on prolonged LOS was consistently observed across different departments (geriatrics, cardiology, general surgery and psychiatry) and patient subgroups with varying principal diagnoses (renal failure, knee or hip replacement) (Table 3). Increasing number of tests performed during inpatient stay was also consistently associated with prolonged LOS. The relationship between prolonged LOS and the remaining covariates were variably observed across departments and principal diagnoses.
Table 3 Subgroup analyses by department and principal diagnoses
Clinical workflow
The majority of inpatient laboratory tests were ordered between 6 am and 12 pm (Fig. 2b), and most test results were available for review between 8 am and 2 pm (Fig. 2c). Review of test results followed the same trend, peaking between 9 am and 3 pm (Fig. 2d).
Figure 3 depicts the relationship between the time of day a laboratory test was placed, and the average CRT and LTAT, considering only tests that were reviewed during the inpatient stay. Both CRT and LTAT appeared to peak at around 2 pm, where the average total time taken to process and review a test was 23.7 h after a test was ordered. Comparing the CRT and LTAT of laboratory tests ordered before and after 2 pm, those that were placed after 2 pm experienced a much greater total delay (18.0 h vs 12.4 h; p < 0.0001), with both a greater CRT (7.5 vs 5.2 h; p < 0.0001) and LTAT (10.1 vs 6.8 h; p < 0.0001).
The relationship between hour of day tests were ordered, and the laboratory turnaround time (LTAT), clinician read time (CRT), and the total time (LTAT + CRT)
We established for the first time that delay in reviewing laboratory test results is significantly associated with prolonged hospital LOS. Delay in reviewing test results may prevent timely diagnosis and treatment, resulting in suboptimal outcomes that may further contribute to prolonged LOS. In our study, only one-third of test results had abnormal findings. Thus, in most cases, delay in test results follow-up was unlikely to affect health outcomes. However, our analysis shows that delay in reviewing normal test results is also a significant predictor of prolonged hospitalization. Patients may remain hospitalized while awaiting their test results to be reviewed before a discharge decision can be made. Reducing test review delay therefore represents an important opportunity to address potentially avoidable hospital stays and unnecessary resource utilization.
Turnaround time for laboratory tests did not appear to affect hospital LOS in the primary analysis that included all inpatients. A probable explanation is that a large proportion of laboratory tests were not actually reviewed prior to patient discharge [12] – delay in processing these tests were therefore unlikely to influence LOS. Indeed, the number of unreviewed tests was found to be negatively associated with LOS. In the secondary analysis that considered only patients who had their test results reviewed during their inpatient stay, a significant relationship between increasing cumulative LTAT and prolonged LOS was observed. However, the strength of the association was notably weaker than the association between delay in reviewing test results and LOS. The effects of LTAT on LOS have been extensively studied, primarily in the emergency care setting [13]. While a number of studies demonstrated a significant relationship between LTAT and LOS, others have failed to show the benefit of reducing LTAT on LOS [14, 15]. Substantial efforts to improve the efficiency of pathology workflow has significantly reduced the delay associated with laboratory turnaround time. However, delay in reviewing test results has received much less attention. Our analysis suggests that unless test results are reviewed in a timely manner, any benefits gained from reducing LTAT will be greatly diminished.
The time of day laboratory tests were ordered, processed and reviewed followed similar trends, increasing in volume during late mornings and early afternoons, and tapering off during late-afternoon (Fig. 2b-d). This likely reflects the window of time whereby the bulk of routine clinical decision-making took place. We further observed that the average CRT and LTAT for individual tests varied by the time of day the tests were ordered, peaking at around 2 pm, coinciding with the time with the highest volume of tests ordered (Fig. 3). The high load of laboratory tests may have caused the delay in turnaround time, and as a result, laboratory tests that were ordered after 2 pm had a substantially longer delay in CRT and LTAT. These findings strongly suggest that clinical workflow and available resources played an important role in influencing when test results were processed and reviewed. Improving workflow and resource allocation may therefore offer an opportunity to reduce unnecessary hospital stay. For example, enhancing capacity planning to address variability in staffing workload, such as increasing resources during peak periods [16], and reviewing test results when they are available and discharging patients when they are clinically ready for discharge, regardless of the time of day, may improve patient flow and reduce unnecessary LOS. There are also potential opportunities for leveraging health informatics technology to facilitate the timely notification of available test results to providers more quickly. Any such interventions would need to ensure that providers are not unduly burdened with alarm fatigue and additional workload, and that the interventions do not lead to other unintended consequences.
Study limitations
Our study is limited to a single center. Other centers may vary greatly in resources and organizational structure, which may in turn influence the relationship between delay in reviewing test results and LOS. Nonetheless, we believe that the organization of care in this teaching hospital is similar to other hospitals in most developed countries. To address the potential bias caused by variability in clinical workflow, we performed subgroup analyses of departments that served vastly different patient subpopulations within the hospital, including geriatrics, general surgery, cardiology and psychiatry. Additionally, subgroup analyses that considered patients with different principal diagnosis were conducted. The relationship between delay in test results follow-up and LOS was consistently observed in these analyses. Indeed, cumulative CRT and the number of tests performed were the only variables that were significantly associated with LOS across all settings and patient populations.
Our study cannot establish causality. While we have included potential confounders in our models, including disease severity and patient's age, we could not account for other important factors such as staffing level, team rotations, and the behavior of individual providers – these factors can lead to delay in test results follow-up and directly impact the quality of care that results in prolonged hospitalization independent of delay in test results follow-up. Providers may also be less inclined to rapidly review test results if they expect patients to remain hospitalized due to their conditions. However, our analysis of the follow-up behavior of test results by day of admission suggests that on average, the overall test results follow-up patterns were not driven by the expected LOS. Furthermore, in sensitivity analyses that considered separately tests ordered within the first 2 days of admission and tests ordered after the first 2 days of admission, the association between delay in test results follow-up and LOS remained significant.
There is also limitation in the use of Charlson comorbidity index to adjust for disease severity, an important determinant of LOS. While Charlson comorbidity index – a weighted score of comorbidities based on their relative risk of mortality – has been extensively validated in published literature as a reliable prognostic indicator for mortality [17,18,19,20], its predictive power may vary across different patient subpopulations. To address this limitation, we conducted additional subgroup analyses for patients who were likely to have similar disease severity based on their principal reason for admission, including patients with renal failure and those who were admitted for an elective hip or knee replacement. In all analyses, the relationship between test follow-up delay and prolonged LOS was consistently observed. While further research is needed to understand the relationship between delay in reviewing test results and LOS and to account for unmeasured confounders, our unique data source that captures fine-grained timestamps of when tests were ordered, processed and reviewed, offer the rare opportunity to quantify delay in test results follow-up and to study its impact on LOS.
Reducing unnecessary hospital LOS has become a critical health policy goal as the costs of healthcare escalate, and budgetary constraints in health care limit available resources. Our study highlights an important, yet underexplored, risk factor of prolonged LOS that warrants further investigation. Preventing delay in reviewing test results may provide a low-hanging fruit for ameliorating unnecessary hospital stays.
CRT:
Clinician read time
LOS:
LTAT:
Laboratory turnaround time
Gonzalez JM. National Health Care Expenses in the U.S. civilian noninstitutionalized population, 2011. MEPS statistical brief no. 425. Rockville, MD: Agency for Healthcare Research and Quality; 2013.
Lu M, Sajobi T, Lucyk K, Lorenzetti D, Quan H. Systematic review of risk adjustment models of hospital length of stay (LOS). Med Care. 2015 Apr;53(4):355–65.
Carey M, Sheth H, Braithwaite R. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med. 2005;20:108–15.
Geissler A, Scheller-Kreinsen D, Quentin W. Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries. Health Econ. 2012;21:103–15.
Ghali WA, Hall RE, Ash AS, et al. Identifying pre- and postoperative predictors of cost and length of stay for coronary artery bypass surgery. Am J Med Qual. 1999;14:248–54.
Every NR, Spertus J, Fihn SD, et al. Length of hospital stay after acute myocardial infarction in the myocardial infarction triage and intervention (MITI) project registry. J Am Coll Cardiol. 1996;28:287–93.
Iezzoni LI, Shwartz M, Ash AS, et al. Does severity explain difference in hospital length of stay for pneumonia patients? Health Serv Res. 1996;1:65–76.
Matsui K, Goldman L, Johnson PA, et al. Comorbidity as a correlate of length of stay for hospitalized patients with acute chest pain. J Gen Intern Med. 1996;11:262–8.
Rochon PA, Katz JA, Morrow LA, et al. Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability: a prospective comparison of three comorbidity indices. Med Care. 1996;34:1093–101.
Kieszak S, Flanders D, Kosinski A, et al. A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. J Clin Epidemiol. 1999;52:137–42.
Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to healthcare: risk factors, reasons, and consequences. Ann Intern Med. 1991;114(4):325–31.
Ong MS, Magrabi F, Jones G, Coiera E. Last orders: follow-up of tests ordered on the day of hospital discharge. Arch Intern Med. 2012;172(17):1347–9.
Hawkins RC. Laboratory turnaround time. Clin Biochem Rev. 2007;28(4):179–94.
Bruins M, Oord H, Bloembergen P, Wolfhagen M, Casparie A, Degener J, Ruijs G. Lack of effect of shorter turnaround time of microbiological procedures on clinical outcomes: a randomised controlled trial among hospitalised patients in the Netherlands. Eur J Clin Microbiol Infect Dis. 2005;24(5):305–13.
Saunders CE, Makens PK, Leblanc LJ. Modeling emergency department operations using advanced computer simulation systems. Ann Emerg Med. 1989;18:134–40.
Litvak E, Buerhaus PI, Davidoff F, Long MC, McManus ML, Berwick DM. Managing unnecessary variability in patient demand to reduce nursing stress and improve patient safety. Jt Comm J Qual Patient Saf. 2005;31(6):330–8.
Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–82.
Frenkel WJ, Jongerius EJ, Mandjes-van Uitert MJ, van Munster BC, de Rooij SE. Validation of the Charlson comorbidity index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc. 2014;62(2):342–6.
Birim O, Kappetein AP, Bogers AJ. Charlson comorbidity index as a predictor of long-term outcome after surgery for nonsmall cell lung cancer. Eur J Cardiothorac Surg. 2005;28(5):759–62.
Tessier A, Finch L, Daskalopoulou SS, Mayo NE. Validation of the Charlson comorbidity index for predicting functional outcome of stroke. Arch Phys Med Rehabil. 2008;89(7):1276–83.
We thank the study site for providing the data source used in this study, and Dr. Fang Zhang (Harvard Medical School and Harvard Pilgrim Healthcare) for his guidance on power analysis.
The data that support the findings of this study are available from the University of New South Wales, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of University of New South Wales and the affiliated hospital.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401E, Boston, MA, 02115, USA
Mei-Sing Ong
Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
Farah Magrabi
& Enrico Coiera
Search for Mei-Sing Ong in:
Search for Farah Magrabi in:
Search for Enrico Coiera in:
All authors made substantial contribution to the conception and design of the study, and interpretation of data. MO performed the study analysis and drafted the manuscript; EO and FM revised the manuscript and gave final approval of the version to be published. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Correspondence to Mei-Sing Ong.
This study was approved by the Human Research Ethics Committee at the University of New South Wales (Sydney, Australia), with patient consent waived.
Figure S1. Average clinical read time (CRT) for tests ordered on a given day of admission. (DOCX 100 kb)


text:
Iran 'Won't Retreat' From Nuclear Path Amid Threats Of New Sanctions
Last updated (GMT/UTC): 09.11.2011 17:38
Iran says it "will not budge an iota" from its nuclear program, rejecting a United Nations report strongly suggesting Tehran is engaged in nuclear weapons development.
In a speech addressing thousands of people in the central city of Shahr-e Kord and broadcast live on state television on November 9, President Mahmud Ahmadinejad suggested that the UN's nuclear watchdog had discredited itself by siding with what he maintained were dubious U.S. claims that Iran was seeking to develop nuclear weapons.
"Why do you damage the agency's dignity because of America's empty claims?" he said. "It will be in your interest to be a friend of the Iranian nation. History has shown that Iran's enemies have not tasted glory and victory."
"We do not need an atomic bomb," Ahmadinejad added. "The Iranian nation is wise. It won't build two atomic bombs while you have 20,000 warheads. This nation will build something that you will not be able to match, and it will be morality."
In its latest report on Iran, the International Atomic Energy Agency (IAEA) said it has information indicating that the Islamic republic has carried out tests "relevant to the development of a nuclear explosive device."
This was the first time that the UN agency has directly tied Iran's nuclear program to weapons production.
On top of existing UN, U.S., and EU sanctions, France and U.S. lawmakers threatened to extend measures against Iran following the report.
France called for a UN Security Council meeting to discuss possible action against Iran.
In a statement, French Foreign Minister Alain Juppe said Paris stands ready to adopt sanctions on "an unprecedented scale" if Iran refuses to abide by the demands of the international community.
Report 'Aggravates Existing Concerns'
Juppe also made similar calls on French radio station Radio France International.
"Firstly, we think the [IAEA] board of governors must explicitly condemn Iran's conduct," he said. "I think convening the Security Council is also called for. France is ready, with others, to go one step forward with sanctions, which already exist but must be reinforced to force Iran to yield."
German Foreign Minister Guido Westerwelle called the IAEA report "alarming" and said in the case of Iranian intransigence, "more severe sanctions would be inevitable."
In Brussels, Maja Kocijancic, spokeswoman for EU foreign-policy chief Catherine Ashton, told RFE/RL that the IAEA's findings "strongly indicated that there is an existence of a full-fledged nuclear weapons development program in Iran."
"The report actually seriously aggravates existing concerns on the nature of the Iranian nuclear program," she said. "This report, as you know, puts particular emphasis on information that was corroborated by the IAEA regarding the possible military dimensions of Iran's nuclear program."
Ashton has been representing six world powers -- Britain, China, France, Germany, Russia, and the United States -- in stalled negotiations with Iran.
U.S. House Foreign Affairs Committee Chairwoman Ileana Ros-Lehtinen said Congress should "ratchet up the pressure" with new sanctions legislation to "cripple" Iran's ability to pursue its nuclear program.
And Republican Senator Mark Kirk called for Washington to take steps toward "collapsing the central bank of Iran" in light of the report.
Path To More UN Sanctions Could Be Complicated
The State Department said Washington would have no comment until it had time to study the report.
The path to more UN sanctions on Iran could be complicated, however, with Russia and China expressing reservations about the publication of the IAEA report.
A Chinese Foreign Ministry spokesman said Beijing was studying the report, adding that "avoiding fresh turmoil in the Middle Eastern security environment is important for both the region and for the international community."
Hong Lei also called for "peaceful means to resolve the Iran nuclear issue:"
"The IAEA should adopt an impartial and objective stance and actively work on clarifying certain issues with Iran through cooperation," he said. "The Iranian side should also demonstrate flexibility and sincerity and engage in serious cooperation with the agency."
Russia Critical Of Report's Publication
Russia criticized the report's public release, suggesting it could harm chances for a diplomatic solution to the nuclear standoff.
In a statement the Foreign Ministry said, "We have serious doubts about the justification for steps to reveal the contents of the report to a broad public, primarily because it is precisely now that certain chances for the renewal of dialogue between the 'sextet' of international mediators and Tehran have begun to appear."
In Moscow, Deputy Foreign Minister Gennady Gatilov said Russia would not support new, tougher sanctions against Tehran.
In a statement, Israeli Prime Minister Benjamin Netanyahu said: "The significance of the report is that the international community must bring about the cessation of Iran's pursuit of nuclear weapons, which endanger the peace of the world and of the Middle East."
Tzipi Livni, a former Israeli foreign minister and head of the main opposition Kadima party, said on November 9 that Israel "expect(s) the international community, the free world, to stop Iran and prevent Iran from having a nuclear weapon."
"Now after the [IAEA] report the facts are clear," Livni said. "The world knows where Iran is going and the world needs to stop Iran. Iran threatens not only the interests of the free world but the values of the free world."
Israeli President Shimon Peres recently warned that an attack on Iran was becoming "more and more likely."
France, Germany, and Russia have spoken against the possibility of a military strike on Iran's nuclear facilities.
Source: http://www.rferl.org/content/iran_will_not_retreat_from_nuclear_path_amid_threats_of_new_sanctions/24385567.html


text:
Q: delete multiple elements from a MAP in cassandra? I have a field cat_to_pub with type as MAP.
{1: '9-20-21', 2: '2-5-21', 4: '2-5-21', 5: '2', 6: '2', 9: '2-83-153-149', 11: '2-5-21-31', 29: '100', 32: '113-198-21'}

I can delete an individual element from this MAP by using
DELETE cat_to_pub[1] FROM user_preferences  WHERE user_id = 'jayeshjain';

How do I remove multiple elements from this set?
for example.if I want to remove key 1 and 2,how do I form my query?

A: With newer version of cassandra (tried with 3.7) you could

update user_preference set cat_to_pub = cat_to_pub - { 1, 2 } where user_id = 'jayeshjain';

A: I don't think there is a way of doing it as a single simple statement, but you should be able to do it as a batch statement.  Since you are deleting from the same partition (because you are deleting from the same map column), the performance should still be pretty good as this will still be done as one operation (verified by doing a query trace).
BEGIN UNLOGGED BATCH
    DELETE cat_to_pub[1] from user_preferences where user_id ='jayeshjain';
    DELETE cat_to_pub[2] from user_preferences where user_id ='jayeshjain';
APPLY BATCH;

redpajama_set_name: RedPajamaStackExchange


Our body of believers is a strong, growing assembly. To ensure the next generation is prepared for service requires a sense of purpose, and the dedication of many people. These people are volunteers who know how vital it is that our children know who our Lord is, know the importance of a personal relationship with Him, and know the privilege of being called one of His.
Overseeing this vital ministry are Pastor Jacob Kliebe and Pam Allen. They share a common desire to serve Jesus, and to help believers understand their role and mission for the Lord.
Ministries for all ages, including nursery through 6th grade, are provided at each of our Sunday morning and Saturday night studies.
In addition to our children's ministry programs for each age group during each service on the weekends, we also have special kids club programs every Wednesday night at 6:45 PM. Pick up a brochure in the lobby, or call the church office today for more information!
Hey Kids! Come meet up with all your friends at the Clubhouse. Join in and learn the club motto and handshake. If you want to have tons of fun while growing closer to God, then this is the place!
Out in the wide-open spaces, kids will discover a colorful old town where all the excitement of the Wild West awaits!


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