United Healthcare ("UHC"), the largest health insurance company in America, was found by the California Department of Insurance to have committed over 900,000 violations of California laws and regulations. As a result, the California Insurance Commissioner imposed $173 million in fines. UHC challenged the fines in court, and in early January the California Supreme Court upheld $91 million of those fines. The remaining $82 million in fines are still pending on appeal.
According to a CNN story the California Insurance Commissioner who began the investigation was quoted as saying: " PacifiCare [which was bought by UHC] sought to weaken consumer protections to allow insurers to escape liability when they intentionally deny expensive but life-preserving medical care. This is an important victory for California consumers and consumers across the country." UHC engaged in a long legal battle with the California Department of Insurance, but the commissioner ultimately imposed the fines, which the Supreme Court recently upheld.
There are very few ways the health insurance industry can be held accountable for wrongdoing. One of them is when an insurance commissioner is tenacious enough to take on the industry. A fine like the one in California should very well get the attention of UHC, and in theory it would cause UHC to change its ways. We can all hope.
The other way the health insurance industry can be held accountable is in a lawsuit filed by a policyholder with the guts and determination to fight a difficult battle, represented by lawyers who can go the distance. While the California fines against UHC are encouraging, they amount to only about $200 per violation. An insurance bad faith case can result in substantial amounts of money for each policyholder who brings such a case, and if the policyholder wins, he or she get compensated for what the insurance company put them through. In some cases, a jury might even award large punitive damages to send a message to the insurance company to change its ways.
Aggressive investigation and enforcement by insurance commissioners and departments, along with bad faith lawsuits, are the only meaningful way for regular people to stand up to the power of the multi billion-dollar insurance industry.
I am happy to announce we obtained a $25.6 million verdict for our clients Ron and Orrana Cunningham this week in Judge Lisa Davis' court in Oklahoma County. The case is Cunningham v. Aetna, CJ-2015-2826. It is a non-ERISA health insurance bad faith case. I apologize for the length of this post, but I think this is a story worth telling. I tried this case for 12 days with my former law partners, Justin Meek and Tom Paruolo. They were awesome. You can get in a fox hole with those two and know they'll fight with you to the bitter end.
Our client is Ron Cunningham, a retired OKC firefighter. He is the toughest, most tenacious client you could ever ask for. He has been battling for justice in this case for 3 ½ years. The case has been on file since May, 2015, and it has been fought by Aetna tooth and nail at every turn.
Ron's wife Orrana (a really amazing person) was diagnosed with stage IV nasopharyngeal cancer in November, 2014 when she was only 53 years old. This is Orrana.
Orrana is described by her loved ones as an extremely soft-hearted, caring person who always had a bright smile and a helping hand for those in need. Ron says he never knew anyone who met Orrana who wasn't immediately taken by her warm nature. She brightened everything she touched.
She was also a hard-working person who loved caring for the horses and cattle she and Ron kept on their beloved farm near Meeker, Oklahoma. Orrana was proud of the fact that she was an excellent fisherman, and invariably caught the most and biggest fish on every outing.
This diagnosis came a couple of months after Ron and Orrana had finished building a house (almost entirely with their own two hands) on a farm near Meeker in eastern Oklahoma County. It was Orrana's dream house. She hung sheetrock and set tile and stained the logs for the log cabin exterior. She and Ron worked on the house for three years. Orrana took care of the farm and worked on the house full time, while Ron would go to work as a firefighter then join Orrana to work on the house in the evenings, on weekends, etc. It took them three years to build. They built the house with a west-facing front porch so they could sit together and watch the sunset.
When Orrana was diagnosed, the Cunninghams sought medical advice here in OKC and were told, due to the difficulty of her case, they should go to MD Anderson. They immediately got down to Houston.
MD Anderson is an incredible place. I had never been there before this case (and hopefully will never be there as a patient or family member of one), but the level of expertise and professionalism is mind-boggling. MD Anderson is the kind of place where you can find an entire group of radiation oncologists who specialize in head and neck cancers. They are also, as you might imagine, on the cutting edge technologically. The MD Anderson doctors we met and deposed from there were incredibly compelling witnesses. Their testimony was powerful to the jury.
MD Anderson evaluated Orrana and determined she needed proton therapy. Her tumor was at the base of her skull, adjacent to multiple "critical structures" in her head. These included her brain, her optic nerves and her brain stem. For example, the tumor was between 2 mm and 3 mm from the brain stem. The advantage of proton therapy over traditional radiation therapy is that it can be delivered with the most precision of any kind of radiation, thus sparing radiation dose to the adjacent critical structures. When those critical structures are the brain, the optic nerves and the brain stem (among others) it is critically important to deliver the radiation as precisely as possible. The MD Anderson doctors told Ron and Orrana they could kill the tumor with both protons and traditional radiation, but proton therapy would increase the chances that she would be cured without devastating side effects. Those side effects included (among others) blindness, loss of memory, loss of the sense of taste, and potentially death. In order to kill the tumor, the doctors had to deliver a high enough radiation dose that the same dose delivered to the brain stem (2-3mm away) could kill her.
Obviously, the Cunninghams wanted proton therapy. MD Anderson submitted a request for coverage to Aetna on their behalf. The evidence at trial showed three different Aetna nurses recommended the claim be denied because proton therapy is "experimental or investigational," and three different Aetna in-house "medical directors" denied the claim because proton therapy is "experimental or investigational." One of the Aetna medical directors did a telephonic "peer to peer" call with one of the MD Anderson radiation oncologists. The evidence was this Aetna doctor was an internal medicine/family practice doctor before going in-house 25 years ago, and had never treated a single patient for anything since. The evidence was that during the "peer to peer" phone call, this Aetna doctor told the MD Anderson doctor (according to the MD Anderson doctor's testimony, which the Aetna doctor did not refute because he couldn't remember the call) that he knew the MD Anderson doctor was right, but he had to deny the claim anyway. The evidence was the other two doctors who denied the appeals of the initial denial were a general surgeon and a hematologist/oncologist, neither of whom have ever treated a single patient with radiation of any kind.
As it turned out, the evidence showed the Aetna doctors (in addition to being medically unqualified to make the decision on this claim), had never heard of the duty of good faith, had never received any training on the obligations owed by Aetna to its insureds under Oklahoma law, were sorely overworked (one was loudly complaining in her personnel file about working 16-hour days and deciding 80+ claims per day) and were receiving sizable bonuses each year, based in part on the profit of Aetna. Each of the medical directors spent about 30-45 minutes reviewing the claim (including a 150+ page appeal package sent to them by MD Anderson). At trial, each medical director claimed to have read everything in the file in that amount of time. Apparently, the jurors did not believe them on this. In contrast, each of the medical directors (who testified live in our case in chief) testified they had spent days and days preparing for their trial testimony. We presented an insurance industry expert, Stephen Prater, to testify regarding his opinion that Aetna's conduct in this case was egregious and an extreme deviation from industry standard practices.
Also, the evidence at trial was that none of the medical directors even read the insurance contract before denying the claim. Apparently, they instead relied on Aetna's "Clinical Policy Bulletin" or "CPB" as the basis of their denial, which is not a part of the insurance contract Aetna sold the Cunninghams. Aetna is very proud of the CPB, which purports to set forth the state of the science on proton therapy. We showed the jury through a radiation oncology/proton expert, Dr. Andrew Chang, (who also did an incredible job explaining to the jury what proton therapy is and why it was the thing Orrana needed) that the CPB is outdated, skewed and cherry-picked in the way it refers to the medical literature. In any event, at trial, the Home Office Aetna doctor in charge of writing the CPB's had to admit the CPB's are not designed to decide claims, but only to serve as a resource for the Aetna medical directors if they need it. The medical directors are supposed to decide these claims on the basis of their own expertise and judgment. This, of course, puts the Aetna medical directors' expertise and judgment squarely at issue.
After the denials, Orrana was in a horrible position. She needed this life-saving treatment for her life-threatening condition. The repeated denials had taken away Orrana's hope of receiving the treatment her doctors said would cure her cancer and minimize her side effects. At one point, she told Ron: "Maybe this wasn't meant to be. Let's just go home." Ron was willing to do whatever it took to get his wife the best care available. Ron told MD Anderson money was no object, and learned the treatment would cost $92,082.19. He went right straight to his bank in Oklahoma and borrowed the money against the dream house he and Orrana had built. He took a cashier's check to MD Anderson and paid cash on the barrel head up front for the full treatment. He never hesitated. He loved Orrana unconditionally. Orrana felt horrible about the fact her illness was causing this financial burden, but Ron wouldn't hear of it.
Orrana got the treatment (which is tough to go through – 30+ treatment days spread out over about 6 weeks in Houston) and it appeared to be working. Orrana hated tight spaces, so any time she was getting a scan or MRI, Ron was by her side, rubbing her feet and hands. Orrana's sister Pam testified at the trial that it was incredible how caring and attentive Ron was to Orrana. Pam said Ron never left her side. Ron was a cancer survivor himself. He testified at trial that Orrana never left his side when he had cancer, and he wasn't about to leave her side when she needed him.
Orrana was released to go home, and she got to "bang the gong" at MD Anderson, symbolizing the end of her treatment. The evidence was the financial stress of the whole situation (in addition to the fact she was battling cancer) weighed on her heavily. When she got home, she developed an outbreak of herpetic encephalitis, her brain swelled uncontrollably causing her brain stem to herniate and she died. Ron filed his lawsuit shortly thereafter. He and Orrana had talked about it and she wanted him to stand up for her and for himself against Aetna. And he sure has.
Aetna breached its insurance contract with the Cunninghams, effectively meaning they found there was coverage under the Aetna policy for proton therapy for Mrs. Cunningham's nasopharyngeal tumor. They awarded the Cunninghams the $92,082.19 they paid out of pocket for proton therapy. We believe this finding could be very important in the course of the ongoing effort by the insurance industry to restrict access by patients to protons. We hope so. This was one of Ron's major motivations in pursuing the case. In effect the jury determined the experimental and investigational exclusion in the policy does not apply to exclude proton therapy in this situation.
Aetna acted in reckless disregard of the duty of good faith and fair dealing it owed the Cunninghams in connection with the way it investigated and evaluated their request for coverage for proton therapy. This allegation focused on the manner in which the Aetna nurses and medical directors involved in the claim did their work. We offered evidence and argument in court that the Aetna claim handling system is designed to utilize unqualified, untrained, overworked and biased personnel to consider claims like this. The jury agreed.
The jury awarded compensatory damages for the emotional distress caused by Aetna's repeated denials. They awarded Mr. Cunningham $500,000.00 individually. Then they awarded Mrs. Cunningham's estate $15,000,000.00.
We then proceeded to a punitive damage phase of the trial. We argued to the jury that to send Aetna away without punishing them for what the jury had already found was reckless conduct would not be a just result. The jury agreed and awarded another $10,000,000.00 in punitive damages. This brought the total verdict to $25,592,089.19.
We anticipate Aetna will likely appeal the jury's verdict. Ron says he is prepared to continue his fight for Orrana as long as it takes. He is gratified to know the jury saw what Aetna did here the way he does. Ron says his goal has always been to bring Aetna's conduct into the public light in hopes Aetna will change the way it does things in the future. He says he does not want what he and Orrana went through to happen to anyone else.
Click here for a link to KFOR-TV's coverage of the verdict.
Click here for a link to the Daily Oklahoman story from Nolan Clay.
UPDATE: The story of Orrana's case has now garnered a lot of national news attention, including a detailed story by Wayne Drash on CNN.com. Orrana's story, originally reported very well by Nolan Clay of the Daily Oklahoman, was picked up by the Associated Press and has run in newspapers across the country, including the New York Times. It has also gotten attention from CBS, ABC, Fox, Law360, National Insurance Journal and many, many other outlets. To see more, please visit www.DougTerryLaw.com.
When an insurance company receives a claim from its policyholder, the first thing the adjuster does is "check coverage." This means they verify the policy is in force by making sure the premiums have been paid and the policy period is in effect. Then, the adjuster looks at the facts of the claim the policyholder is presenting to determine if the insurance policy language provides coverage for the claim.
This may sound simple (and it often is) but sometimes whether the facts of the claim are covered by the policy is not a black and white question. Often, there are shades of gray on whether coverage exists. Anyone who has read an insurance policy (or even part of one) knows they can be extremely hard to understand. It might be surprising, but this is true of lawyers, even lawyers who practice insurance law. There is a reason for this. Most insurance policies are written in such a way that they are almost impossible to understand.
Over the years, I have come to believe that insurance companies attempt to write insurance policies so that only they know what they really mean. If the language of the policy is incomprehensible and the policyholder has no idea what it really says, then the adjuster has the power to tell the policyholder what is covered and what isn't without the policyholder being able to dispute it. Way too often, policyholders hear an adjuster say "there's no coverage for your claim," throw up their hands and walk away. They feel like they can't take on the big, bad insurance company and win. This is not true.
In reality, most insurance adjusters have very little training or ability to fairly read and interpret policy language, even if they think they do. Insurance adjusters have a tendency to look for reasons there is not coverage, as opposed to broadly interpreting the policy language to attempt to find coverage. Also, adjusters often overlook the fact that the duty of good faith requires them to fully, fairly and timely investigate and even-handedly evaluate coverage questions, just like liability or damage issues. As a result, coverage denials are often based on superficial, knee-jerk readings of policy language by untrained or unknowledgeable adjusters.
Policyholders who are told there is "no coverage" for their claim should demand a written, detailed explanation of the adjuster's position, including reference to specific policy provisions the adjuster says preclude coverage. Then, if the policyholder has questions, they should contact an experienced lawyer to help them understand their rights.
There are many people working as claims professionals in the insurance business who strive to do the right thing by the company's policyholders. When I run into one of them, it is like a breath of fresh air. These folks seem to genuinely care about policyholders and work hard to try to find ways to pay claims. They do not relish denying a policyholder's claim and do not feel as though they have "won" somehow by denying a claim.
Unfortunately, there are too many claims professionals who seem to fall in the opposite camp. Some claim professionals appear to take some sort of perverse joy from saying "no" to their policyholders. I don't know what motivates these folks. Perhaps they have been indoctrinated by a culture that promotes this kind of behavior in their company's claim department. If being overly tough on claimants is rewarded with praise from supervisors, advancement in the company, or increased pay/bonuses, then a certain segment of a company's employees will act this way. I have certainly seen this dynamic play out in my experience suing insurance companies.
Sometimes I think the insurance claim business draws people to it whose personalities are geared toward saying "no" instead of "yes." Too many of the adjusters, supervisors and managers in insurance company claim departments I have met in depositions and trials over the last 25 years just seem to be constitutionally incapable of open-minded, evenhanded, caring attitudes toward policyholders who make claims. Too many of these folks fall too easily into a mindset in which they assume a policyholder making a claim is being dishonest and trying to get "something for nothing" by seeking compensation for their loss.
Either way, whether by company culture, personality type or a combination of the two, when claim handlers approach claims with a "say no first, ask questions later" attitude it often leads to a policyholder who feels aggrieved and ends up seeking legal advice. When a skilled lawyer reviews a claim handled by an adjuster looking to "beat down" a policyholder (oftentimes by delay, needless obstacles placed in the way of a claim settlement or just plain indifference) the bad faith litigation that results ends up costing the company way more money than a fair settlement would have in the first place.
Does Using Biased Experts Violate the Duty of Good Faith?
Most folks' common sense tells them there are real experts in a field and then there are "experts" willing to sell dishonest "opinions" for money. This is a sad commentary on the state of play in litigation, but it's as true as anything can be about our court system. Ask any lawyer and they'll tell you this is true. So how does this play out in bad faith cases?
Here's an example: Mrs. Jones, a policyholder of ABC Insurance Co., is involved in a car wreck with an uninsured driver. Mrs. Jones makes an uninsured motorist ("UM") insurance claim under the ABC policy, and submits a report from her treating neurosurgeon showing the policyholder needs a neck surgery as a result of her injuries in the accident. Of course, the cost of such a surgery is high and if the need for surgery was caused by the accident, then ABC will have to pay a lot more to resolve the claim than if it isn't. The ABC insurance adjuster knows this very well, so he decides to try to disprove Mrs. Jones needs a surgery at all, or if she does need a surgery, it wasn't caused by the car wreck.
ABC has trained its adjusters to demand policyholders undergo an "Independent Medical Examination" or IME when appropriate. Most auto insurance policies require the policyholder to submit to an exam by a doctor of the insurance company's choosing if the company asks, so the policyholder is obligated to do so or risk being paid nothing for her claim. The idea is that the company should be able to verify whether the alleged injuries are real, whether they were caused by the accident, and what the proper treatment for them would be. This is not a crazy idea, of course, because an insurance company ought to be able to conduct a thorough investigation of a claim before deciding to pay it or not.
The problem comes in the execution. Many insurance companies have conveniently created a list of "approved" doctors to perform IME's on their policyholders and given that "approved doctor list" to their policyholders. So, in our example above, ABC's adjuster refers to that list and demands that Mrs. Jones submit to an examination by a Dr. Payne, whose name was on the list. Of course, the adjuster is very familiar with Dr. Payne's work because the adjuster has sent dozens of policyholders to be examined by him. The adjuster would also be highly surprised if Dr. Payne said Mrs. Jones needed a surgery at all, and if so that the need for surgery was caused by the accident. Instead, the adjuster has a real good idea that Dr. Payne is going to say Mrs. Jones had a pre-existing neck problem (don't we all, by the way) and the need for surgery (if any) is related to that problem, not the car wreck.
Once Dr. Payne has written his report saying just that (oddly, it looks almost identical to all the other reports he has written for ABC with only the names changed), ABC's adjuster tells Mrs. Jones he's sorry, but the evidence indicates she doesn't need a surgery at all and if so it was because of her prior neck problem. Mrs. Jones tries to tell the ABC adjuster that she trusts her treating doctor more than an insurance-hired doctor, and tells the adjuster she's never had any symptoms of neck problems before. ABC says they're very sorry, but they are relying on Dr. Payne's report and won't consider the surgery when evaluating the claim.
Is this a legitimate dispute barring a claim for bad faith? What if in our example the evidence is that Dr. Payne has done over a hundred IME's for ABC, and several hundred for other insurance companies? And he's been paid tons of money for his work? And the percentage of the time he opines the policyholder is actually injured is less than 10%? And the majority of his income comes from IME's?
Believe it or not, this very kind of thing goes on regularly in the insurance industry. Is it a legitimate dispute for the insurance company to use a doctor to perform an IME doctor it knows good and well will always say exactly what the insurance company wants? Is it good faith to knowingly rely on a biased expert?
I say the answer is no. Other examples of this kind of conduct by insurance companies will be the subject of later posts.
In an excellent recent article in the New York Times, a claim-handling practice by Anthem Blue Cross Blue Shield was brought into the public light. Anthem has begun denying its policyholders' claims for coverage for emergency room visits if Anthem determines after the fact that the policyholder didn't really need to go to the emergency room in the first place. Anthem is basing these decisions on what the final diagnosis of the policyholder's condition turns out to be after being seen in the ER. For instance, a person with a heart condition who experiences heart attack-like symptoms and goes to the ER might have coverage for the ER charges (often thousands of dollars) denied if it turns out the symptoms were not a heart attack after all. This leaves the patient stuck to pay the ER bill out of pocket.
Apparently, Anthem's has concluded that since the cost of an ER visit is much higher than a visit to an urgent care clinic or a primary care doctor, Anthem is going to scrutinize ER visits in this way. I can see multiple problems with this approach from the policyholder's perspecitve.
First, as illustrated by the account of one of the Anthem policyholders interviewed in the the Times article, Anthem's position puts the policyholder in the unenviable spot of having to self-diagnose before visiting the ER. If a heart patient is having heart attack-like symptoms, they should not have to gauge the nature and severity of the symptoms before deciding whether to seek treatment at the ER. That's what ER doctors are for.
Wouldn't it be tragic if an Anthem policyholder decided not to go the the ER for fear Anthem would later deny coverage if the problem turned out to be less significant than they thought, then died of (for example) a heart attack? How would Anthem defend itself in a lawsuit then?
Second, who at Anthem is making the decisions as to whether policyholders' visits to the ER are covered? As noted in a previous post, in my experience deposing in-house insurance company doctors, it turns out they are often grossly unqualified to render the medical opinions they're called upon to give. If my experience in lawsuits the health insurance industry is any guide, it's likely insurance company doctors making decisions regarding ER visits to treat (for example) heart conditions will likely be (for example) family practitioners or internists not cardiologists. The gross unfairness of this situation should concern every Anthem insured. Plus, you can bet as Anthem's profit increases as a result of this practice, other insurance companies are sure to follow suit.
Predicatably, Anthem apparently attempts to defend this practice by pointing out how much money it costs Anthem to pay for ER visits it thinks in hindsight were unnecessary. The Times article says Anthem believes "as many as 5 percent" of ER visits are unnecessary. Of course, Anthem will also say this "unnecessary" expense makes everyone's premiums go up because Anthem has to pass these costs along to all of its policyholders. This argument, which insurance companies use at every opportunity, is just a scare tactic to distract the public from the real "money story" here.
Anthem has done extremely well financially, and that financial success is reflected in the amount of money Anthem's top executives make. Anthem's revenue for 2017 was over $90 billion (growing at an annual rate for the last five years of just under 8%). Anthem's profit for 2017 was $3.84 billion ($10.5 million per day). The CEO of Anthem made $16.5 million in 2016 and $13.6 million in 2015. How much would Mr. Swedish's bonus have been if Anthem had paid for ER visits without second-guessing them? Only $16.4 million?
The profit motive is a powerful force, even when people's lives hang in the balance. This is the state of our health care system in this country today. Management people at health insurance companies are squeezing every possible nickel of profit out of their claim-handling systems while endangering the lives of their policyholders. All in pursuit of the compensation package that will make them wealthy at the expense of real people's health and well-being.
Thanks to Reed Abelson (@reedabelson), Margot Sanger-Katz (@sangerkatz), and Julie Creswell (@julie_creswell) who wrote the Times piece on this telling subject.
CNN's Wayne Drash (@drashmanCNN) has written a series of gut-wrenching, infuriating and telling stories recently regarding the health insurance industry's treatment of policyholders. They illustrate how profit is a more powerful motivator to the health insurance industry that policyholders. Anyone interested in this issue specifically or responsible corporate behavior in general should take a look at Mr. Drash's work.
In the most recent of these stories, Mr. Drash tells the story of Erika Zak, a 38-year-old mother whose stage 4 metastatic colon cancer had spread to her liver. Without a liver transplant, Erika's doctors say, she would die. She is in the end stages of liver failure and her oncologists fear for her life every day. After Erika was evaluated by numerous highly qualified doctors, it was determined her only chance of survival was a liver transplant. She and her family rejoiced when she was put on the liver transplant recipient list.
That joy was short-lived. Soon thereafter, UnitedHealth denied coverage for the liver transplant. Erika and her family didn't take no for an answer, however, and fought UnitedHealth at every turn, in every way they knew how. All they wanted was what they knew Erika deserved, a chance at life with a new liver. UnitedHealth was persistent in its denials, even in the face of the medicla evidence and Erika's dire need for treatment. To their credit, Erika and her family didn't quit. They wrote scathing, heartfelt letters to the CEO of UnitedHealth. These fell on deaf ears. The suffering they went through was tremendous, and this affected Erika and her family. Then, incredibly, without explanation (even to CNN when asked) UnitedHealth changed its position and agreed to pay for Erika's liver transplant. Now Erika is waiting for a donor liver to come available. Mr. Drash's storytelling of Erika's journey is well worth the time to read. It's a real morality tale.
Here's hoping one comes available soon so Erika and her loving family and her little girl can enjoy a long and happy life together. Everyone should be pulling for Erika. I certainly am.
This travesty begs the question: Why should a person in Erika's shoes have to beg and cajole an insurance company to provide the coverage she is entitled to? The answer: she shouldn't. If there is coverage for Erika's transplant under her UnitedHealth insurance policy now, there has been all along. Why would UnitedHealth cause such pain and sorrow before reluctantly agreeing to pay? Why was it like pulling teeth for Erika to get the life-saving treatment she has always been owed?
Maybe, just maybe, the profit motive of the insurance company has something to do with it. I don't know what Erika's transplant and the treatment associated with it would cost, but I would imagine the bills would be huge to a normal person. Not to UnitedHealth, though. No one health insurance claim will move UnitedHealth's financial needle, but health insurance companies are good at making money. So they find every opportunity they can to squeeze the water out of their claim costs. Every claim is an opportunity to do so, especially the big ones like Erika's.
Like its competitors in the health insurance industry, UnitedHealth has perfected the art of making money. Its 2017 financial results tell that story. UnitedHealth's revenue for 2017 topped $200 billion for the first time ever. That's over $22.8 million in revenue per hour. UnitedHealth made profit of over $10 billion in 2017. That's over $27 million of profit per day and $1.1 million of profit per hour. The executives at UnitedHealth have done pretty well for themselves too. The total executive compensation at UnitedHealth for 2017 was up by 34.1%, and the compensation paid to David Wichmann (the CEO) went up by 41% in 2017. Mr. Wichmann was paid over $17 million in 2017.
What a breathtaking contrast. A young mother dying because a giant corporation won't pay for her life-saving health care, while the executives of the company (who are ultimately responsible for the way in which the company treats its policyholders) become obscenely wealthy. This is the state of health care in America today.
If you follow the money, you find out why insurance companies disregard their duty of good faith. A sickening morality tale if there ever was one.
When you make a health insurance claim, oftentimes your health insurance company will have a doctor employed by the company review the claim to see if it should be paid. The problem I have seen in a number of cases is the doctors reviewing policyholders' claims are horribly unqualified to make fair decisions on those claims. For instance, if you make a health insurance claim for payment of medical treatment involving your heart, you would expect a cardiologist to make medical decisions for the health insurance company about your claim. A claim involving your heart, in other words, should be reviewed by a heart doctor. Would it seem fair to you if you submitted a claim involving treatment for your heart and it was reviewed by a general practitioner? Or if you made a health insurance claim involving brain cancer and it was reviewed by a pediatrician?
Nobody would think this is fair. Ever. However, incredibly, this is exactly what goes on all day every day in the health insurance industry. Health insurance companies put in place claim processing systems involving claim reviews by completely unqualified doctors. To compound the problem with this practice is that it is not disclosed to the policyholder. Instead, the policyholder is almost always sent a generic denial letter from the insurance company that doesn't tell the policyholder the name of the doctor or the doctor's specialty/qualifications. Why would the insurance company not want its policyholders to know whose opinions it is relying on to deny claims?


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Spotting the Comets of 2018 and Tracking Their Spectacular Encounters Using Mobile Apps
By Chris Vaughan 2018-09-08T12:49:26Z Skywatching
It's been quite a while since a bright, naked-eye comet graced the world's skies. But while we wait for the next spectacular visitor from the outskirts of our solar system, we can enjoy smaller, dimmer comets that pass close enough from time to time to be seen in binoculars and telescopes.
This month, a periodically returning comet designated 21P/Giacobini-Zinner will be bright enough to be seen in binoculars and small telescopes. It is expected to continue to brighten until the morning of Sept. 10, when it will pass within 36.3 million miles (58.5 million kilometers) of Earth on its way around the sun.
Sometimes, if its orbit is just right, a comet will appear to pass close to major stars in the sky, which makes it easier for non-experts to find the object. And, even better, comets occasionally pass close to the positions in the sky of distant deep-sky objects. This sets up spectacular telescope views and wide-field photo opportunities for tripod-mounted cameras or close-up views using DSLR cameras affixed to tracking telescopes. [Amazing Photos of Comet 21P/Giacobini-Zinner and Comet 46P/Wirtanen]
Recently, the periodically returning Comet 21P/Giacobini-Zinner has become bright enough to be seen in binoculars under dark skies. Next week, it will make its closest approach to Earth. Over the upcoming weeks, the path of the comet will carry it along the Milky Way, setting up a series of picturesque encounters with many deep-sky objects. Your favorite astronomy app can help you spot those events. This screen cap presents the sky at 1 a.m. local time on Sept. 8, 2018.
(Image credit: SkySafari App and Daniel Bamberger/Northolt Branch Observatories)
Lucky for us, Comet 21P's path will take it along the Milky Way, setting up a series of spectacular close encounters during September and October. And many of the best ones will occur when the moon is not very bright, as is the case this week.
In this edition of Mobile Stargazing, we'll tell you how to use your favorite astronomy app to hunt down Comet 21P. We'll also present a timeline of events that will give you the opportunity to see or photograph the comet in a picturesque setting.
And Comet 21P will just be a warm-up. Astronomers eagerly anticipate the arrival later this year of another, even brighter comet: 46P/Wirtanen.
With the SkySafari 6 app for Android and iOS, you can see the path of any selected solar-system object through the sky (gray line with labeled dates). For the next several nights, Comet 21P/Giacobini-Zinner will drift southward through Auriga, passing the Starfish and Pinwheel star clusters (Messier 38 and 36 respectively) on Friday night and the Messier 37 cluster on Sunday night.
(Image credit: SkySafari App)
Finding Comet 21P in the sky
Comet 21P/Giacobini-Zinner is located in the northeastern sky and is visible in both the Northern and Southern hemispheres. It rises in late evening and then is carried higher in the sky as the night wears on. Right now, the comet's brightness is approximately magnitude 7.5, and skywatchers have spotted it easily using binoculars in dark-sky locations. [Bright Comets of 2018: When, Where and How to See Them]
This comet's orbit is inclined by 32 degrees from our solar system's plane, so rather than moving east-west as the moon and planets do, it follows a southward path through the stars — which is down and toward the right for Northern Hemisphere observers. Between now and Sept. 13, the comet will pass through the roughly circular constellation Auriga. After that, 21P will move through the feet of Gemini's western twin, Castor, for a few nights and then follow the boundary between Orion and Gemini until Sept. 22.
The comet will finish September by following the Milky Way, traveling through the modest constellation of Monoceros, more or less toward the very bright star Sirius. Then, 21P will spend October skirting the eastern edge of Canis Major. It's unknown how long the comet will remain a target for binoculars, but telescope users with tracking capability should be able to find and view 21P for the next two months or so.
You can use your astronomy app to display the path of a comet against the sky. In the SkySafari app Plus and Pro versions, use the search option, select the comet and tap the Center icon on the Info page. Open the Settings/Solar System menu and put a check mark in the Selected Object Path box. The sky will now include the comet's path, with labeled tick marks at one-day intervals. You can also advance to future dates and see where the comet will be at any given date and time. [Best Binoculars for Earth and Sky]
On Aug. 17, 2018, Paul Mortfield captured this spectacular image of Comet 21P passing the Heart and Soul nebulas (IC 1848 and IC 1805) in Cassiopeia. The bright star clusters at the upper right constitute the well-known Double Cluster. This is a 2-minute unguided exposure using a DSLR camera equipped with a 200-mm lens.
(Image credit: P.Mortfield, RASC Remote Telescope, California, USA)
Comet 21P encounters
Below is a timeline of encounters for Comet 21P through the end of October. The times and locations are based on the currently predicted orbit of the comet and are subject to change. Apps such as SkySafari 6 for Android and iOS will update orbital parameters as they change.
You can preview each encounter by setting your app to the appropriate date and then selecting and centering the comet in the display. Configure the app's displayed field of view to include some of the surrounding sky. Because the comet will be moving quickly, its distance from objects will vary depending on the part of the world where you're observing. Adjust the time forward or back in your app to determine the best time to see each pairing at your location.
The comet will be observable worldwide, from mid-southern latitudes all the way to the Arctic, but Southern Hemisphere skywatchers will need to wait until the predawn hours for the comet to climb high enough to be seen clearly. In the descriptions, I provide the optimum viewing time for the Eastern Time zone and the corresponding Greenwich Mean Time (GMT). The comet will not be high enough for skywatchers to observe it until after midnight, so events in the list happen in the early hours on the date listed, i.e., after midnight on the preceding date. I have included some screen captures to illustrate the encounters.
I have provided the suggested observing tools for each encounter. The direction indications of "left and right" and "up and down" are for observers in the Northern Hemisphere. Reverse those if you are looking from south of the equator.
Sept. 8 after midnight EDT (after 0500 GMT) — The comet will pass 2.5 degrees west (left) of two bright open star clusters in Auriga designated Messier 38 and Messier 36 (use binoculars).
Sept. 9 to 10 — On these nights, the comet will pass between the bright stars Mahasim (Theta Aurigae) and Elnath (Beta Aurigae) while heading south (downward). The object will be somewhat closer to Mahasim, the dimmer, left-hand star (use binoculars).
In SkySafari 6, you can generate a 3D model of the solar system that illustrates how the highly inclined orbit of Comet 21P/Giacobini-Zinner intersects with the orbits of the inner planets. This image shows the comet at its closest approach to Earth on Sept. 10, 2018.
Sept. 10 — On Sept. 10, the comet will reach its closest point to both the sun and to Earth. Around this date, we expect the object to peak in visual brightness: around magnitude 7.0.
Sept. 10 to 11 — On these nights, the comet will glide past the open star cluster designated Messier 37, passing only 10 arc minutes (or one-third of the full moon's diameter) from the cluster at 1900 GMT on Sept. 10. Observers in Asia and Oceania will see the objects close together. Most of the Western Hemisphere will have to settle for seeing the comet 1 degree from the cluster on each night (best viewed in a telescope).
Sept. 15 — At about 6 a.m. in the Eastern time zone (1000 GMT), the comet will glide directly through the open star cluster designated Messier 35 (use a telescope).
Sept. 16 — During the night, the comet will approach the bright star Propus (Eta Geminorum), passing within 0.5 degrees west (to the upper right) of the star just before dawn. The Jellyfish Nebula (IC 443) will be within a telescope's field of view at low magnification. Closest approach to Propus will occur at around 1500 GMT, and the event is visible only for skywatchers in Asia and Oceania (use binoculars or a telescope). [Best Telescopes for the Money: 2018 Reviews and Guide]
On Sept. 15, Comet 21P will glide directly through the large open star cluster designated Messier 35. The actual passage will be observable only from Asia and Oceania. North America will see the comet farther from the cluster. On the subsequent two nights, the comet will pass bright Propus, the toe star of Gemini's twin Castor, setting up a photo opportunity that includes a supernova remnant called the Jellyfish Nebula (left of Propus) and the fainter nebula NGC 2174 (at right).
Sept. 17 — In the early hours of Sept. 17, the comet will be positioned below Propus and approximately midway between the bright star Tejat (Mu Geminorum) and NGC 2174, also known as the Monkey Head Nebula. The comet and the nebula will appear together in the field of view of a low-magnification telescope.
Sept. 23 — The comet will begin to move across the plane of our galaxy. During this night, the comet will pass near a collection of dim deep-sky objects in northern Monoceros, including the star clusters and nebulas designated NGC 2247, NGC 2245, IC 2167, IC 2169 and NGC 2259 (use a telescope). Note: The nearly full moon will wash out the sky somewhat for this encounter.
Sept. 24 — On this night, the comet will pass about 1 degree east (to the right) of NGC 2264, also known as the Christmas Tree Cluster. Both objects will fit in the field of view of a telescope. On the next night, the nebula will still be less than 2 degrees from the comet. Note: The full moon will wash out the sky somewhat for this encounter.
Sept. 26 — Look for the comet sitting 3 degrees northeast (to the left) of the spectacular star cluster and nebula combination known as the Rosette Nebula (NGC 2244) in Monoceros. This pairing will make an excellent wide-field photo opportunity and sight in binoculars. Note, the waning full moon will wash out the sky somewhat for this encounter.
The best close encounter for this comet's passage will occur on Sept. 26, when the object will pass several degrees to the left of the bright and spectacular Rosette Nebula in Monoceros. A wider-field photograph will also capture the Christmas Tree Cluster and nebulosity that surround the star designated 15 Monocerotis. The blue circle represents the field of view of binoculars.
Oct. 7 to 8 — On these dates, the comet will glide past the open star cluster designated Messier 50 in southern Monoceros. Closest approach, with the comet skimming the cluster's outskirts, will occur at 1900 GMT on Sept. 7 — an event visible only to Asia and Oceania. North American observers will see the comet positioned about 0.5 degrees from the cluster on those two mornings (first above and then below). (Use binoculars or a telescope.)
Oct. 9 to 10 — On these two mornings in the predawn hours, the comet will move past the bright Seagull Nebula (IC 2177) and then descend through the large and faint reflection nebula designated IC 2327. Other nearby objects will include the star clusters NGC 2335 and NGC 2343. This will be another wide-field photo opportunity, as well as a sight visible via binoculars and telescope.
By the end of October, astronomers expect Comet 21P/Giacobini-Zinner to fade below the range where binoculars can find it easily. In the meantime, users of GoTo tracking telescopes can continue to track the comet as it passes the Thor's Hammer Nebula (NGC 2359) on Oct. 13, Caroline's Cluster (NGC 2360) on Oct. 15, Charlie Brown's Christmas Tree Cluster (NGC 2367) on Oct. 22 and more. Use your astronomy app to preview all of the dates and mark your calendars for the events you wish to observe or photograph.
On the night of Oct. 10, 2018, Comet 21P, now fading, will pass through the beautiful Seagull Nebula, which sits on the border of the constellation Canis Major and is a palm's width to the left of the very bright star Sirius. The blue circle represents the field of view of a telescope at low magnification.
Comet 46P/Wirtanen preview
Comet 46P/Wirtanen is another eagerly anticipated periodic comet, and it will round the sun on Dec. 12, 2018. This one, when viewed under a dark sky, is predicted to reach naked-eye brightness of magnitude 3 around Dec. 16, when the object will pass closest to Earth.
Right now, the comet is in Cetus, located over the southern horizon after midnight local time — tickling the belly of that whale-shaped constellation. In late November, the comet will begin to climb the southern sky and enter southwestern Taurus around the perihelion date. That means the object will be perfectly placed for mid-evening viewing!
Let's cross our fingers that Comet Wirtanen lives up to expectations. In the meantime, you can practice your comet-spotting on Comet Giacobini-Zinner. If you capture any images of either comet's close encounters, be sure to share them with Space.com.
In upcoming editions of Mobile Astronomy, we'll show how constellations will look different in the far future, how to use mobile apps to plan and log astronomical observations, and more. Until then, keep looking up!
Editor's note: Chris Vaughan is an astronomy public-outreach and education specialist at AstroGeo, a member of the Royal Astronomical Society of Canada, and an operator of the historic 74-inch (1.88 meters) David Dunlap Observatory telescope. You can reach him via email and follow him on Twitter @astrogeoguy, as well as on Facebook and Tumblr.
This article was provided by Simulation Curriculum, the leader in space science curriculum solutions and the maker of the SkySafari app for Android and iOS. Follow SkySafari on Twitter @SkySafariAstro. Follow us @Spacedotcom, Facebook and Google+. Original article on Space.com.
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How can custom cabinets improve the way you organize?
We can also build wine racks and incorporate hood vents into your custom cabinet design. Sit down with us today to discuss your new painted or stained cabinets. Visit Dronet's Floor Gallery today to speak with our cabinet installers in Erath, LA.


text:
Security and mobility app adoption increasing - Okta
Identity services provider Okta has announced the results of its fifth annual Businesses @ Work report, which leverages anonymised data from Okta's customer base to shed light on technology adoption in the enterprise.
The fastest-of-the-fastest growing apps focus on identity-driven security, indicating that companies are taking Zero Trust seriously.
User-focused security apps dominate with KnowBe4, LastPass, and Proofpoint in the top three spots. KnowBe4, a security awareness training company, beat other apps by far with its 178% year-over-year growth to claim the top spot.
Okta APAC general manager Graham Sowden says, "More and more businesses are realising that with the rise in advanced insider threats, not everything or everyone inside a network can be trusted.
"Adopting a new Zero Trust framework, organisations are leaving traditional network security strategies behind, and instead shifting to perimeter-less approaches, focusing on users, data, and locations," Sowden says.
"People – and their digital identities – are the framework's foundation, and businesses are sourcing tools to help protect valuable user credentials."
Additional key findings include:
The Microsoft vs. Google rivalry continues: Office 365 is the most popular app and can claim nearly twice as many customers as G Suite. Office 365 increased its lead and continues to dominate the total pool of apps, growing its active unique users by 55% year over year, while G Suite's user base is growing more quickly, at 116% year over year.
Although Office 365 is the top app in Okta's network, data shows that companies prefer to use a variety of different apps rather than using the full Microsoft suite. Over three quarters (76%) of Okta's Office 365 customers have one or more apps that offer duplicative functionality to apps offered by Microsoft. Over 28% are chatting on Slack and nearly 24% are connecting with their colleagues on Zoom.
Also, companies investing in developer tools are three times as likely to deploy G Suite than businesses without any developer tools. Our data shows that 46% of companies with at least one developer tool have G-suite compared to only 17% of non-developers.
Companies have a growing app-etite: In today's tech-first environment, companies and employees alike are insisting on flexibility, as evidence by five of the top ten most popular apps being collaboration tools. There's a clear trend that larger companies are deploying more apps over time. Large companies (2,000 or more employees) who have been with Okta for three years are deploying 163 apps on average. And in the past four years, large customers have increased their number of deployed apps by 68%.
The more factors the merrier: In 2018, a total of 812 notifiable data breaches were reported to the Office of the Australian Information Commissioner (OAIC). To increase security, more companies have turned to MFA to protect against breaches, with 70% of Okta customers using 2-4 different factors for authentication, up from 65% last year.
The two most commonly used factors are Okta Verify (a mobile app-based factor) and SMS. Use of Okta Verify has increased by 13 percentage points in the past three years, whereas SMS has dropped 3 percentage points. Security questions have shown the largest drop, from 29% three years ago down to 18% today. Over two-thirds of the Okta customers who enrolled since 2016 with less secure factors added more secure factors within two years, as 71% of customers had added Okta Verify, 44% had added Google Authenticator, while 15% had added Yubikey and 5% had added Duo.
Airbnb continues to grow: Airbnb is now the second most popular hotel and lodging app, climbing from its #4 spot last year. Nearly 700,000 companies are using Airbnb for work and many are extending these trips to include personal travel. For the more traditional hotel experience, the Starwood Hotels group (which includes the Westin, Sheraton, and W Hotels) and Marriott lead the pack.
Other top travel apps this year include Southwest Airlines and Uber, which has held the top spot in the ground transportation app race for the past year and continues to grow.
Sowden concludes, "Our research shows that organisations are increasingly reliant on technology in every aspect of their business, and are investing in new apps, solutions and tools to keep their workforce operating in harmony. Companies will continue to seek and adopt tools that allow them to remain competitive while embracing flexible and customised solutions in an effort to optimise productivity and security in the workplace."


text:
Die Hawaiʻi State Route 460 ist eine Straße, welche den Westen der Insel Molokaʻi im US-Bundesstaat Hawaiʻi erschließt.

Verlauf
Die auch als Maunaloa Highway bekannte Straße verbindet die Ortschaft Kaunakakai an der Südküste der Insel Molokaʻi mit der im Westen der Insel gelegenen Ortschaft Maunaloa und führt vorbei am Flughafen Molokaʻi Airport. Von der 16 Meilen (26 Kilometer) langen Strecke gehen die State Routes 465, 470 und 480 ab, in Kaunakakai geht sie in die State Route 450 über.

0460
Molokaʻi
Hawaii Stateroute 0460
Bauwerk im Maui County

redpajama_set_name: RedPajamaWikipedia


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Friday Night Pre-Ride Meet Up.
If anyone is interested in meeting up on Friday night, September 28th, organizer's will be at The Bar starting at 7pm.
all ride details, sign the Route 91 Memorial Ride Flag, and we will have Route 91 Memorial Ride T's, patches, and ride pins available for anyone that wants them.
8560 S. Las Vegas Blvd.
From our meet up location we will travel as a group to Las Vegas Harley Davidson and stage there with the Vegas Strong Run Ride Group, their ride is doing a poker run, ours is going to the Healing Garden and then to the Route 91 Reunion, we will have reserved parking at the Reunion.
The Vegas Strip is going to be closed to traffic from Las Vegas Harley Davidson to Sahara.


This dissertation was undertaken to develop an understanding of the internal world of premature infants and their developing relationships. Initially, the literature regarding attachment in normal infant-mother dyads is reviewed. An overview of the world of the preterm infant in the Neonatal Intensive Care Unite (NICU) is provided. Factors that are special to mother-preterm dyads are evaluated: the emotional challenges facing preterm mothers, the availability of the preterm infants to be in relationship and the 'facilitating environment' (the NICU).
Holding an understanding of the above factors, a review of articles that consider the security of attachment in infants born prematurely was conducted. The resilience of the attachment relationship became clear. However, it is evident that this relationship can be significantly compromised by psychosocial factors in the mother or by extreme prematurity or severe medical complications in the infant. The paucity of data addressing long term relationship stability for these tiny graduates is of concern.
The developmental model of care proposed by Als (1986) offers an intervention that integrates the psychosocial and biologic needs of the infants and their families.


Naturally, men's feet are larger than women's feet. This is one of the biggest problems male to female crossdressers face when shopping for shoes.
Choose from our wide range of affordable crossdresser shoes that perfectly fit most MtF transsexual and crossdresser feet. Our sizes range up to 17, and come in different widths. Shoes have to be fashionable, comfortable yet visually make your feet appear smaller than it is. Usually, modern and stylish shoes can be found only in small sizes. Feet length reduction surgeries are very limited, risky and rare, so the only solution is to choose large sized ladies shoes.
Browse through this category to find carefully selected, beautiful and stylish women shoes for male feet. Check out our: high heels for men, pumps, drag queen heels, crossdresser boots, open toe footwear, flats, sandals, closed toed shoes and much more.


The campus programs are offered by the colleges and universities at their own campuses. Under the on-campus program, a student is required to visit the campus daily at fixed time to attend the classes. One can attain- degrees, certificates or diplomas by enrolling in the campus programs offered by colleges and universities.
Face to face interaction with teachers: The on-campus programs gives a student the chance to have a direct interaction with the teacher, which is not at all possible through online education or education through distance learning. The direct interaction is the most beneficial when a student has a query about a topic being taught in the class and an immediate solution to it is necessary. No mode of education can satisfy a students curiosity or queries as instantly as the on-campus program.
The on-campus program provides a student to know another student in the same class. The students form a group usually go for hanging around also. Studying in campus is all together different experience.
USAeducation.info has designed this section to help aspiring students, career professionals and working adults find reputable and accredited career education programs. We have listed the degrees by level to make your selection easy and simple.


SEO Abbreviation = "search engine optimization". it is a process of getting organic traffic from the free editorial or natural search results on search engines.I provide you authentic submission's links to offsite SEO and also give you tips and tricks to getting proper traffic on your website I provide you different types of submissions links like article submission, audio submission, image, press release, video, classified ads, pdf & ppt, infographics, directory submission. I provide All Submission Top High PR links of offsite SEO.
SEO stands for "Search Engine Optimization". It helps a website to getting higher position in SERP and increasing the organic traffic form search engines like Google, yahoo, Bing etc.
SEO means search engine optimization. It helps to rank our site on the first page.
SEO stands for "Search engine optimization" it's a free, natural, organic process to get high rank in Search engine and increase visitors on site.
it is a part of digital marketing.
it's the best way for increasing the popularity of your products and service. another benefit of SEO that you can get your targeted audience from targeted location.
SEO provides results for the long-term purpose with organic ranking.


J Calif Dent Assoc. 2003 Feb;31(2):149-60.
Dental disease prevention and people with special needs.
People with special needs are the most underserved of the underserved in our society. They have more dental disease, more missing teeth, and more difficulty obtaining dental care than other segments of the population. Many individuals and groups, including the authors of this paper, have developed community-based systems to improve oral health for people with special needs. However, these systems have not been as successful as they might be because of lack of effective preventive protocols specifically designed for people with special needs. This paper reviews strategies for overcoming informational, physical, and behavioral barriers to oral health and presents a summary of the results of a conference titled "Practical Preventive Protocols for Prevention of Dental Disease in People with Special Needs in Community Settings." The rationale for using an Oral Health Care Plan is presented as well as a sample plan. These strategies and protocols are designed to complement the system of supported community-based oral health care. The goal of this system is to help people with special needs enjoy a lifetime of oral health the same as other members of our society.


Action for property damages and damages for personal injuries and loss of services, as a consequence of a collision between a truck, owned by defendant Collins and operated by defendant Goggins, and a fire truck of the city of New York at a street intersection, in the course of which collision or immediately thereafter the fire truck came in contact with and damaged a house owned by the plaintiffs, inflicted personal injuries on one of the plaintiffs, and caused the other plaintiff to suffer damages by way of loss of services. Order granting plaintiffs' motion to strike out defendants' answers and to direct the assessment of damages on behalf of the plaintiffs, reversed on the law and the facts, with ten dollars costs and disbursements, and the motion denied, without costs. After the collision occurred the city of New York obtained judgment against defendant Collins for property damage on the theory that the conduct of the present defendants was the sole negligent cause of the accident. The plaintiffs in this action then moved to strike out their answers on the ground that the issue of negligence had been resolved against defendants and an adjudication had that their conduct was the sole negligent cause of the accident. It appears that after the defendants' truck collided with the fire truck, the fire truck cut across and collided with the house of the present plaintiffs and caused certain alleged damage. The defendants assert that the prior adjudication did not determine certain issues which they claim are present in this case and were not present in the prior case, that is, they say there was a second collision after their truck had negligently collided with the fire truck and that there is still an issue as to whether or not the fire truck operator was the sole cause of colliding with the house of the plaintiffs, even though it has been adjudicated that the present defendants were the sole cause of the collision between their truck and the city fire truck. This contention is somewhat illusory but it may not be said as a matter of law that it has no substance; hence plaintiffs may not successfully invoke the doctrine of res judicata under the circumstances. Carswell, Adel and Close, JJ., concur; Lazansky, P.J., and Hagarty, J., concur in result.


text:
Q: Move semantics from one type to another using templates Is it possible to have a struct A with a move constructor for itself and some constructor which can move from other types (e.g struct B ) but with having a template deduction going on such that the type B is not hardcoded directly as another move constructor:
 struct A{
      A()= default;
      A(A&&a){ /* A's move constructor */ }

      template<typename T>
      A(T&&t){
        /* (not a move constructor! by std., matches also lvalues)

        move from t
        (meta programming to check if we can move the type)
        */
      }

}

struct B{};

the problem with the above is that
B b;
A a(std::move(b)); // select the templated constructor (which moves)

A a(b);  // selects the same copy constructor (which moves but we do not want!!

How does one achieve this?

A: The cleanest solution is to create a better constructor for lvalues, then =delete it:
struct A{
  A()= default;
  A(A&&a){ /* A's move constructor */ }

  template<class T>
  A(T&&t){
  }
  template<class T>
  A(T const&&)=delete;
  template<class T>
  A(T&t)=delete;
};

under this method, A a(b); will fail to compile.
If you want lvalues to follow a different path, then:
struct A{
  A()= default;
  A(A&&a){ /* A's move constructor */ }

  template<class T>
  A(T&&t){
    // rvalues end up here
  }
  template<class T>
  A(T const&&t):A(t) {} // forward to lvalue ctor
  template<class T>
  A(T&t){
    // lvalues end up here
  }
};

the use of SFINAE is probably only worth the complexity if you don't know which of these two options you are going to want -- ie, where you are inheriting constructors from elsewhere.
There is a final corner case -- A(T const&&) (and A(A const&&)) which can crop up in some corner cases.  I made it act like an lvalue ctor, as you cannot "move from" a T const&& usually.  (unless the guts of the T are mutable, and even then I'd consider it a bad idea).

A: If you want the constructor template to accept arbitrary rvalues, you can use enable_if:
template <
  class T,
  class Sfinae = typename std::enable_if<!std::is_lvalue_reference<T>::value>::type
>
A(T &&t)

This will enable the constructor only if T was not deduced to an lvalue reference, which is equivalent to saying that the argument was not an lvalue.
As @dyp mentioned in the comments, it can also be expressed more explicitly:
template <
  class T,
  class Sfinae = typename std::enable_if<std::is_rvalue_reference<T&&>::value>::type
>
A(T &&t)

A: Simply take a B&& in the constructor, exactly as you did for A.

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text:
eJewish Philanthropy
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The Courageous Leader
"Al Chet" Confession List
October 7, 2019 By eJP
Image credit: Chabad.org
By Erica Brown
Last year at this season, I published a confessional for Jewish leaders. This year, in light of Shalom Hartman Institute's white paper, "Courageous Leadership: The Challenges Facing Jewish Leadership in a Partisan Age," I've created a new list with a few repeats. Feel free to add to the list, circle the issues that you struggle with or share with your board and staff. We create our cultures, and we can do better in the year to come.
A Lay Leadership Confessional
For the sin of being overly critical of a Jewish organization or a Jewish leader.
For the sin of using social media to attack a policy, speaker or Jewish leader instead of engaging in private conversations.
For the sin of not thanking rabbis/Jewish communal leaders/educators enough.
For the sin or treating those who serve us as Jewish communal servants rather than professionals.
For the sin of being on the phone, texting and posting instead of being fully focused on the sacred work at hand.
For the sin of not advocating for an issue because of fear of what others think.
For the sin of serving on boards and not showing up, preparing or doing the work.
For the sin of not financially supporting Jewish organizations at the heart and soul of a community.
For the sin of reducing Jewish communal professionals or organizations to the last mistake they made.
For the sin of not believing that organizations can also do teshuva: change leadership, evolve structures and re-shape their missions.
For the sin of not forgiving and moving on when disagreeing with an opinion.
For the sin of hearing but not listening.
For the sin of undermining teachers and administrators in Jewish schools rather than trusting them.
For the sin of manufacturing unnecessary drama that will hurt a Jewish organization or its employees.
For the sin of engaging in harsh and unremitting political discourse that makes meetings and gatherings partisan and unsafe.
For the sin of creating climates in Jewish organizations that discourage Jewish communal professionals from applying for or staying in leadership positions.
For the sin of alienating those whose political views on Israel are different.
For the sin of believing that big gifts entitle someone to make all the big decisions.
For the sin of being too certain.
A Jewish Communal Professional Confessional
For the sin of not being courageous about one's convictions.
For the sin of making politics more important than people.
For the sin of trash talking donors and volunteers to other employees.
For the sin of texting at meetings while pretending to be present.
For the sin of caring about Israel too little.
For the sin of caring about Israel so much that it prevents the legitimization of other points of view.
For the sin of not communicating often enough with lay leaders so they feel valued and informed.
For the sin of complimenting only those with power and money and not investing meaningfully in those without power and money.
For the sin of not standing up for a colleague attacked or undermined by other colleagues or lay leaders.
For the sin of seeing fellow human beings as donors first and people second.
For the sin of coasting at work.
For the sin of allowing lay leaders with money to have too much decision-making power.
For the sin of being overly judgmental.
For the sin of forgetting the sacred mission of our work.
For the sin of talking about tikkun olam but doing little to advance it.
For the sin of not promoting enough women to leadership positions.
For the sin of inequity where the top organizational salaries are multiples of the lowest.
For the sin of not being grateful enough about a career where meaning matters.
For the sin of not knowing enough about Jewish texts, values and traditions to represent a Jewish organization well.
For the sin of turning the other cheek when someone complains about harassment.
For the sin of office gossip that makes our workplaces toxic.
For the sin of too much kvetching.
These are challenges we can overcome when we think hard about who we want to be and what we want our organizational cultures to be. Reflection helps us fight the urge to ask our leaders to be charismatic saviors instead of taking more accountability for problems. Let this be the year we have great leaders because we have great followers, that we strengthen our leadership pipelines and return the nobility to serving our community. May we all be sealed for good in the Book of Jewish Communal Life.
Dr. Erica Brown is an associate professor at the Graduate School of Education and Human Development at The George Washington University and director of its Mayberg Center for Jewish Education and Leadership.
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Marla Eglash Abraham says
Yasher koach- we need to say these out loud and to ourselves much more often than once a year as part of an ongoing chesbon nefesh!
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text:
'Petty and Racist': Madame Tussauds Slammed For Removing Prince Harry, Meghan's Wax Statues
Calling them 'petty' and 'racist', people on Twitter slammed the move, with many calling for a boycott of the wax museum.
Updated: January 11, 2020 1:15 PM IST
By India.com Buzz Desk Email
Edited by Ritu Singh Email
Prince Harry and Meghan Markle /Instagram
London: Netizens are furious after Madame Tussauds museum removed the wax figures of Prince Harry and Meghan Markle, post their decision to quit their 'senior roles' in the British royal family.
In a statement released on Thursday, the museum said that the waxworks of the Duke and Duchess of Sussex had been removed from its display to "mirror their progressive new role within the Royal institution."
"We've got to respect their wishes," the wax museum tweeted, followed by the hashtag #Megxit, which invited a barrage of criticism. Calling them 'petty' and 'racist', people on Twitter slammed the move, with many calling for a boycott of the wax museum.
Many asked why Prince Philip's figurine was not moved since he had retired or if they removed Princess Diana's figure after she separated from Prince Charles.
Why wasn't Prince Philip removed when he retired from public duties? He is no longer seen in public, if you are removing the Sussexes for their desire for a bit more privacy, I think you should do the same for the retired prince. But I guess that wouldn't be white of you.— ChiLanta (@ChiLanta_180) January 9, 2020
Did Madame Tussauds disappear Princess Diana's wax figure when she left the Royal Family?I think not. Because back then, someone in charge was smart enough to realize that she was their main draw.Bring back that guy.#Megxit pic.twitter.com/hUdQWO1col— Pièce de Résistance (@PieceDeReSister) January 9, 2020
Here's how other people reacted:
This is why they're leaving. Britain is just beyond disgusting now. We are also aware of your history with the monarchy, so it's clear that this is a snub to the couple. But honestly, it's your loss. Meghan & Harry are the future. Long may they reign in our hearts. #RIPMonarchy— Րυɱ૦Ր Һคς ɿ੮ 🇺🇲🆘 (@BrandiLynn4Ever) January 9, 2020
This makes me want to avoid Britain. Americans tend to favor Britain, but after seeing the way Meghan was treated, I'm not visiting anytime soon. That was some sexist, racist, anti-American BS.— BeSeriousUSA (@BeSeriousUSA) January 9, 2020
They are still family. How petty of you.No wonder they are leaving, the majority of the press has been terrible to them.#ShameOnYou— kuba (@jkgood1) January 9, 2020
Crazy, petty, rude and subtly racist. This right here proves their point in wanting to step back from the madness. This was a very poor decision on your museum's part.— Bizzi (@bizzimomma2) January 9, 2020
Shame on you!! Using a racist hashtag to place blame on one member of a couple for a mutual life decision. You're gross af.— Kassandra Seven (@KassandraSeven) January 9, 2020
This was a very foolish decision. You will have a very difficult time convincing people that this move wasn't influenced by racism.— Shari Lynn (@LynnSharig8) January 10, 2020
In a statement, Prince Harry and Meghan announced on Wednesday that they would be stepping back as "senior" royals, and work to become financially independent.
"We intend to step back as 'senior' members of the royal family and work to become financially independent, while continuing to fully support Her Majesty The Queen," they said in their unexpected statement released by Buckingham Palace on Wednesday.
The wax figures of the couple were unveiled in May 2018 ahead of their wedding in Windsor, England. Each statue costs roughly £150,000 ($195,000) to make.
Megxit! Madame Tussauds Removes Wax Figures of Harry and Meghan From British Royal Family Display
Prince Harry, Meghan Step Back as 'Senior' Royal Family Members
Madame TussaudsMeghan MarklePrince HarryRoyal family
Published Date: January 11, 2020 1:14 PM IST
Updated Date: January 11, 2020 1:15 PM IST


text:
#include <event2/event.h>
#include <event2/http.h>
#include <event2/http_struct.h>
#include <stdlib.h>
#include <string.h>
#include <unistd.h>
#include <errno.h>
#include "obelisk.h"
#include "obelisk_error.h"

static int
compare_methods(const void * va, const void * vb)
{
    return strcmp(va, ((obelisk_rpc_t*)vb)->method);
}

static obelisk_error_t*
obelisk_execute_rpc(json_t *request, json_t **response, obelisk_baton_t *baton)
{
    obelisk_error_t *obelisk_err = OBELISK_SUCCESS;
    json_t *method;
    json_t *params;
    json_t *id;
    const char *method_string;

    /* fetch the ID first and make sure we have it, because we need it later */
    if ((id = json_object_get(request, "id")) == NULL) {
        obelisk_err = obelisk_error_create(id, OBELISK_ERROR_INVALID_REQUEST,
                                 "id missing");
    }

    /* Check the method and params parameters */
    if ((method = json_object_get(request, "method")) == NULL ||
        (method_string = json_string_value(method)) == NULL) {
        obelisk_err = obelisk_error_create(id, OBELISK_ERROR_INVALID_REQUEST,
                                 "method missing");
    }
    else if ((params = json_object_get(request, "params")) == NULL) {
        obelisk_err = obelisk_error_create(id, OBELISK_ERROR_INVALID_REQUEST,
                                 "params missing");
    }
    else {
        json_t *result;
        obelisk_rpc_t *rpc = bsearch(method_string,
                                     baton->rpc,
                                     baton->rpc_size / sizeof(obelisk_rpc_t),
                                     sizeof(obelisk_rpc_t),
                                     compare_methods);
        if (!rpc) {
            obelisk_err = obelisk_error_create(id, OBELISK_ERROR_METHOD_NOT_FOUND, "");
            goto done;
        }

        obelisk_err = (*rpc->cb)(params, &result);
        if (obelisk_err) {
            goto done;
        }

        *response = obelisk_json_response(result, id);

        json_decref(result);
    }

done:
    return obelisk_err;
}

/**
 * @brief Run the JSON-RPC handler
 * @param request The entire request object
 * @param response response object, freed by caller
 * @return obelisk_SUCCESS on success
 */
static obelisk_error_t*
obelisk_run_handle(json_t *request, json_t **response, obelisk_baton_t *baton)
{
    obelisk_error_t *obelisk_err = OBELISK_SUCCESS;
    int array_size = json_array_size(request);
    if (array_size == 0) { /* Single RPC Call */
        obelisk_err = obelisk_execute_rpc(request, response, baton);
    }
    else { /* Multi-RPC Call */
        int i;
        json_t *rsp_element;
        json_t *req_element;
        obelisk_error_t *rsp_err;

        /* Create response array */
        *response = json_array();

        for (i=0; i<array_size; i++) {
            req_element = json_array_get(request, i);
            rsp_err = obelisk_execute_rpc(req_element, &rsp_element, baton);
            if (rsp_err) {
                /* RPC call errored out */
                json_array_append(*response, rsp_err->json);
                obelisk_error_destroy(rsp_err);
            }
            else {
                json_array_append(*response, rsp_element);
                json_decref(rsp_element);
            }
        }
    }

    return obelisk_err;
}

static void
obelisk_api_cb(struct evhttp_request *req, void *arg)
{
    obelisk_error_t *obelisk_err = NULL;
    json_error_t js_err;
    json_t *js_rsp;
    json_t *js_req;
    unsigned char *json_request;
    unsigned char *json_response;
    struct evbuffer *evb = evbuffer_new();
    struct evbuffer *evr = evhttp_request_get_input_buffer(req);
    ev_ssize_t request_length = evbuffer_get_length(evr);
    obelisk_baton_t *baton = (obelisk_baton_t*) arg;

    /* Check for POST */
    if (req->type != EVHTTP_REQ_POST) {
        json_incref(js_rsp);
        goto done;
    }

    /* Check for an empty request */
    if (request_length == 0) {
        obelisk_err = obelisk_error_create(0, OBELISK_ERROR_INVALID_REQUEST, "Empty Request");
        js_rsp = obelisk_err->json;
        json_incref(js_rsp);
        goto done;
    }

    json_request = evbuffer_pullup(evr, request_length);
    if (json_request == NULL) {
        obelisk_err = obelisk_error_create(0, OBELISK_ERROR_INVALID_REQUEST, "Empty Request");
        js_rsp = obelisk_err->json;
        json_incref(js_rsp);
        goto done;
    }

    json_request[request_length] = 0;

    if (baton->settings->verbose > 1) {
        fprintf(stderr, "Request(%s:%i) %s\n",
                (req->remote_host) ? req->remote_host : "0.0.0.0",
                req->remote_port, json_request);
    }

    /* Parse Request */
    js_req = json_loads(json_request, &js_err);
    if (js_req == NULL) {
        /* Format Parse Error */
        obelisk_err = obelisk_error_create(0, OBELISK_ERROR_PARSE, js_err.text);
        js_rsp = obelisk_err->json;
        json_incref(js_rsp);
        goto done;
    }

    /* Run Handler */
    obelisk_err = obelisk_run_handle(js_req, &js_rsp, baton);
    if (obelisk_err) {
        obelisk_err = obelisk_error_create(0, OBELISK_ERROR_INVALID_REQUEST, obelisk_err->msg);
        js_rsp = obelisk_err->json;
        json_incref(js_rsp);
        goto done;
    }

    /* Write data */
done:
    json_response = json_dumps(js_rsp, 0);
    if (json_response) {
        if (baton->settings->verbose > 1) {
            fprintf(stderr, "Response(%s:%i): %s",
                    req->remote_host,
                    req->remote_port,
                    json_response);
        }
        evbuffer_add(evb, json_response, strlen(json_response));
    }
    free(json_response);

    /* Send the reply */
    evhttp_send_reply(req, HTTP_OK, "ej", evb);

    /* Free data */
    json_decref(js_rsp);
    if (obelisk_err) obelisk_error_destroy(obelisk_err);
    evbuffer_free(evb);
}

static void
obelisk_daemonize(obelisk_settings_t *settings)
{
    pid_t pid, sid;

    pid = fork();
    if (pid < 0) {
        fprintf(stderr, "fork error %s\n", strerror(errno));
        exit(EXIT_FAILURE);
    }

    if (pid > 0) {
        exit(0);
    }

    umask(0);

    sid = setsid();
    if (sid < 0) {
        exit(EXIT_FAILURE);
    }

    if (chdir("/") < 0) {
        exit(EXIT_FAILURE);
    }

    freopen( "/dev/null", "r", stdin);
    freopen( "/dev/null", "w", stdout);
    freopen( "/dev/null", "w", stderr);
}

void
obelisk_init(obelisk_settings_t *settings)
{
    memset(settings, 0, sizeof(*settings));
    settings->port = OBELISK_DEFAULT_PORT;
}

void
obelisk_run(obelisk_baton_t *baton)
{
    obelisk_settings_t *settings = baton->settings;

    if (settings->daemonize) {
        if (settings->verbose) {
            fprintf(stderr, "becoming a daemon\n");
        }
        obelisk_daemonize(settings);
    }

    {
        struct event_base *base = event_base_new();
        struct evhttp *http = evhttp_new(base);

        evhttp_set_cb(http, "/api", obelisk_api_cb, baton);
        evhttp_bind_socket(http, settings->bindaddr, settings->port);

        event_base_dispatch(base);
    }
}


text:
D3 Joins OpenGov Hub
In April 2015, D3 Systems joined the OpenGov Hub Community in Washington, D.C. OpenGov Hub brings together distinct, yet like-minded organizations in a shared physical workspace in downtown Washington, D.C. at 1110 Vermont Avenue NW. The Hub is a day-to-day home to a range of institutions working on the open government agenda, while also serving as a community gathering point for open government learning and networking.
In addition to our headquarters in Tysons Corner, D3 Systems now has a space at OpenGov Hub as a way of further expanding the reach of our data and making it more available to a broader audience of groups and individuals working on government initiatives. D3 looks forward to collaborating with policy-oriented advocates and development organizations on research and evaluation efforts that encourage public dialogue and directly impact US government policy, in particular in the fields of security and development.
Contact us at research@d3systems.com if you'd like to meet up at OpenGov Hub!
This entry was posted on April 23, 2015
Topics: News & Events
Type: D3 News
Topic: News & Events
D3 Welcomes Eight New Hires to the Team!
It's official: D3 has never before had a larger number of staff! We are pleased to announce that we are expanding our team to help keep up with the new research opportunities that have emerged in 2021! Please join us in welcoming our newest members: Brittany, Brina, Ricki, Libby, Jake, Shelbie, Jeffrey, and Kriscel. Brittany […]


Go anywhere versatility with roomy practicality! With just over 25,000 miles on the odometer, this 4 door sport utility vehicle prioritizes comfort, safety and convenience. Top features include remote keyless entry, telescoping steering wheel, a roof rack, and power windows. It features an automatic transmission, 4-wheel drive, and a refined 6 cylinder engine.


text:
Mckinney Junk Removal
Stand Up Guys Junk Removal Service Areas - Mckinney, TX
Mckinney's Most Beloved Junk Removal Crew
Are you sick and tired of being sick and tired of your unwanted junk and clutter? Have you been wanting and wishing to get the clutter taken out of your home or office for quite some time but just don't know how to even go about it? If this sounds anything like you and you live or work in the McKinney, Tx area, then I have the perfect remedy to your junk issues! The Stand Up Guys Junk Removal Crew!
The Stand Up Guys are the number one option for junk removal and junk hauling in all of McKinney and the surrounding areas. We've earned the title of #1 through years of hard work and dedication to one very important thing; Customer service! Here at Stand Up Guys Junk Removal our customers and their needs are of the upmost importance. We ensure that all of our McKinney customers and clients are continually WOW'd by our service 100% of the time. Our customers happiness is number one on our list of importance.
Another reason why The Stand Up Guys have earned the great rapport with the people and businesses of McKinney is because we will pretty much do anything and everything for our clients! The Stand Up Guys will take anything from furniture, household junk, construction debris, appliances and more. You name it and we'll remove it for you! Don't worry about breaking a sweat either, because The Stand Up Guys will take care of all the heavy lifting, loading, hauling and disposal. All you have to do is point out what you want gone, and we take care of the rest.
Junk Removal Services We Offer In Mckinney, TX
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Playset Removal
Garage Cleaning
Bulk Trash Removal
Construction Debris Removal
Household Junk Removal
Driveway Junk Removal
More About Mckinney, TX
McKinney is one of Collin Counties finest, along with one of the largest towns in all of Texas. To be exact, McKinney is the 19th most populated city in the great state of Texas. That stat says a lot, given that Texas is the second largest state in America. There are quite a few reasons for the massive population here. One being McKinney is nicely located to the city of Dallas as well, only about 30 miles from downtown. The commute from Dallas to McKinney is a breeze. So if you work downtown, but live and raise your family in McKinney, you can do it with ease.
The word has really gotten out there about McKinney too. People from all over are moving to the great city and it shows. McKinney was listed as the nations FASTEST growing city from 2000-2003 and then all over again in 2006, and a measly second fastest in 2007. With all that growth, McKinney is said to now have more than 160,000 people.
There is a lot of history to McKinney as well. The area dates back to the late 1800's when William Davis donated 3,000 acres for the townsite that is now known as McKinney. The town would later incorporate in 1913. It took quite a long time for the area to become populated. It was known mostly for farming of flour, corn, and cotton mills, cotton gins, a cotton compress, and a cottonseed oil mill. The population was around 10,000 in the 1950's. The cities boom in population began in the 1980's and never looked back.
The Stand Up Guys Junk Removal Crew service all of McKinney and it's fine residents and businesses. We cover the entire town from one end to the other and offer our top notch customer service. We love all of our fine McKinney customers.
Dallas Office:
13640 Marquis Drive
Austin Office:
111 West Anderson Lane
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