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How Soon Will COVID Be "Normal"?
How to Think About the Risks of Omicron
The Potential Impact of COVID Pills
The Economic Impact
The Promise and the Peril of Virtual Health Care
During the coronavirus pandemic, telemedicine looks like the future of health care. Is it a future that we want?
By John Seabrook
As the U.S. went into lockdown, in-person primary care effectively vanished.Illustration by Bianca Bagnarelli
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The call came in to the emergency department at Alice Peck Day Memorial Hospital, a twenty-five-bed facility in Lebanon, New Hampshire, around 2 P.M. on a weekday in mid-March. Patient X had arrived by car, and, by the time he reached the hospital, the pain in his legs was so severe that he couldn't move.
Jesse Webber, a paramedic, donned full personal protective equipment (P.P.E.) before going outside with a wheelchair. Since the onset of the pandemic, almost all sick people who entered the hospital's E.R. were considered, whatever their symptoms, to be P.U.I.s—persons under investigation for COVID-19.
The patient, a heavyset man in middle age, was lucid when Webber wheeled him into the emergency department's negative-pressure room—a seven-by-eleven-foot windowless space fitted with a noisy exhaust fan that removes contaminated air. Once the man was inside, his mental state deteriorated rapidly. A team made up of Nancy Ferguson, a doctor, and two critical-care nurses, Kacie Boyle and Laura Williams, in full P.P.E., joined Webber and Patient X in the cramped room.
The patient was having difficulty breathing. "Very quickly, his respiratory rate dropped," Webber later told me. He was "crumping," as nurses say—not crashing, but failing fast. "His body essentially stopped breathing in front of us," Webber said.
Ferguson ordered a rapid-sequence intubation, a procedure for swiftly connecting a patient to a ventilator. Ventilating a patient is a complex task that involves not just putting a breathing tube into the trachea but also inserting intravenous lines to deliver sedatives, so that the patient doesn't fight the tube—known in hospitals as "bucking the vent."
"As soon as I heard the doctor say that, I reached behind me and hit the emergency-telehealth button," Webber recalled. Within seconds, the team at Alice Peck Day was connected, through a secure audiovisual link, to the tele-emergency hub at Dartmouth-Hitchcock Medical Center, an academic training institution with more than five thousand employees, affiliated with Dartmouth College's Geisel School of Medicine. Sadie Smith, a nurse, and Victoria Martin, a doctor, were in the middle of twelve-hour shifts, sitting side by side at one of the hub's four-screen workstations. The workstations are hardwired into the emergency department at Alice Peck Day, and also into those of ten other community hospitals across the region; the most distant is a hundred and eighty miles away.
Smith's face popped up on the screen in the Alice Peck Day negative-pressure room. Smith is one of the most experienced tele-emergency nurses on the Dartmouth-Hitchcock staff, and she has an air of unflappable competence that would inspire calm in any crisis.
"How can we help?" she asked.
Smith and Martin had control of a high-resolution camera mounted on the wall of the negative-pressure room. They could zoom in on Patient X, watch his cardiac monitor, and talk to the doctor, nurses, and paramedic on the scene. Electronic-record-sharing allowed them to "chart on" the patient—to have real-time access to his vitals and his medications, just as though they were there. But, unlike the staff attending to him, who were working elbow to elbow in the negative-pressure room, straining to speak over the noise of the exhaust fan, the tele-hub team was unharried and safe from possible COVID-19 exposure. The hub personnel could check records and arrange for transport to the medical center, on the other side of town, without the nurses having to leave the room, thereby avoiding the hospital's P.P.E.-doffing procedure—a two-person, twenty-eight-step job—and the need to put on new P.P.E. on their return.
In the hub, Smith noticed that the hydration fluid the patient was receiving wasn't compatible with the sedative that he was on; the Alice Peck Day nurses switched fluids. The doctors decided to insert a second I.V. line, using the intraosseous method, which infuses medicine directly into the patient's bone marrow. Smith told me later that "really large patients are difficult, because it's really hard to find I.V. access. So I suggested going through the humeral head"—the top of the arm bone. "I'm standing there, with my camera view, going, 'Bring his arm over, lay it across his belly, then feel here, and right in the middle is where you want to go.' "
"Sadie kind of guided us in," Webber said.
Finally, they got Patient X intubated, and "it turned out his expired CO2 was really quite high," Smith told me. As the nurses used the ventilator to blow pressurized oxygen into his lungs, his CO2 level started to trend down. The crisis had passed.
Telemedicine and telehealth involve a myriad of remote-health-care technologies and services collectively known as "virtual care." For years, virtual care played a minor role in the United States' $3.6-trillion health-care industry; now, with the COVID-19 pandemic, millions of people are discovering its benefits and its shortcomings for the first time. If virtual care is the future of health care, is it a future that we want?
In a narrow sense, the word "telemedicine" can mean the type of hardwired hospital-to-clinic setup that allows workers in a large hub hospital to assist in complex emergency procedures in distant spokes. This approach is descended from NASA's pioneering research, in the nineteen-sixties and seventies, into satellite communications and methods of monitoring astronauts' well-being in space. One of the first telemedicine projects in a terrestrial setting, which operated between 1973 and 1977, offered remote health care on the Papago—now the Tohono O'odham—reservation in southern Arizona while also testing the technology for use in spaceflight. In the early eighties, NASA began developing a tele-I.C.U. for astronauts on Space Station Freedom. Telemedicine in the Dartmouth-Hitchcock Health system, a network of hospitals and clinics across New Hampshire and Vermont which serves 1.9 million people, is the twenty-first-century embodiment of the fifty-year-old prototype.
Telehealth also comprises virtual interactions between individual doctors and patients, in which the participants rely on an audiovisual hookup instead of an in-person visit. You have a bad sore throat but don't want to wait to see a doctor—or you are among the thirty per cent of millennials who don't have one. You could go to the E.R. or to a brick-and-mortar urgent-care center. Or you could download the telehealth app you saw advertised on MSNBC. Before long, you are connected to a physician, who, using your phone to look down your throat and relying on your description of the swollen glands in your neck, can prescribe antibiotics and other noncontrolled substances. You've saved yourself a trip to the clinic, and you haven't made other people sick or caught something else yourself.
Online visits can be enhanced by Internet-connected devices that collect patient data at home and then send it to a doctor. These include fitness trackers, blood-pressure cuffs, pulse oximeters, and gadgets like Kinsa's smart thermometer and TytoCare's self-examination kit, which link up with a phone and make it possible to perform at least part of an annual wellness check on yourself.
Telehealth providers typically offer virtual urgent care for non-emergencies. And patients suffering from chronic conditions, such as diabetes and colitis, can conduct routine follow-ups online. Proponents of telehealth have long argued that fifty to seventy per cent of visits to the doctor's office could be replaced by remote monitoring and checkups. But, until the pandemic, most Americans weren't interested.
Dartmouth and its affiliated think tank, the Dartmouth Institute for Health Policy and Clinical Practice, have been on the vanguard of health-care reform for decades. Twenty-four years ago, they began publishing the Dartmouth Atlas of Health Care, an annual survey of medical spending and patient outcomes in communities across the United States which was credited as an important influence on the 2010 Affordable Care Act. In 1999, Dartmouth-Hitchcock opened the Center for Shared Decision Making, with the aim of giving patients the tools to engage in their own health-care decisions. The Connected Care center, which was launched in 2012 and today includes the tele-emergency and tele-I.C.U. hubs, was an extension of its founders' belief in patient empowerment and data-based medicine.
Cartoon by Joe Dator
Among Dartmouth-Hitchcock's patient base are members of a number of medically underserved communities, as defined by the Department of Health and Human Services: poor, elderly, and special-needs populations who lack easy access to primary-care physicians and medical specialists. Patients who routinely drive two hours to visit a cardiologist or a gastroenterologist can "see the doctor" through a secure smartphone app. Dartmouth-Hitchcock offers a diverse menu of services for distant patients, including tele-psychiatry, tele-neurology, and tele-urgent care.
But even in rural northern New England telemedicine has been a hard sell. "We have been struggling in some areas, to be perfectly honest," Mary Oseid, the medical center's senior vice-president for connected care, told me. Many rural clinics and community hospitals in small American towns fear that their already meagre medical staffing, and the revenues generated from procedures that can be performed on-site, will be further hollowed out by remote medicine. And often the patients who need care the most—the old and the poor—don't have smartphones or broadband connectivity, or can't afford extra minutes on their wireless plans, placing one of telehealth's greatest promises, of allowing old people to "age in place," out of reach. Before the pandemic, outpatient telehealth across the entire Dartmouth-Hitchcock Health network averaged only thirty visits a week.
This is representative of virtual care throughout the country. Telehealth totalled just 0.1 per cent of all medical claims filed in 2018, according to FAIR Health, a nonprofit that analyzes data on insurance claims. The National Business Group on Health, which publishes an annual survey of employee health benefits offered by large firms, found that in 2016 seventy per cent of companies included telehealth as part of their plans, but only three per cent of their workers used it. Some employees weren't aware that the service existed; others didn't trust an anonymous doctor. According to a 2019 survey conducted by J.D. Power, forty-nine per cent of patients believed the quality of virtual care to be inferior to that of an old-fashioned in-person doctor's visit.
Reimbursement has been another issue. Until recently, Medicare covered telehealth only in rural areas, and required patients to conduct visits in a clinical setting. And, in spite of the time-and-money-saving advantages of telehealth, a lot of people clearly want to be in the physical presence of their physician, undergoing the familiar rituals of a checkup—the doctor's scrubbed hands emerging from the crisp cuffs of a white lab jacket—that no screen can yet provide.
Doctors haven't been sold on telehealth, either. In a 2019 survey conducted by the American Medical Association, only one in three specialists expressed full confidence that virtual care would benefit their practice, and only two in five primary-care doctors did. In addition to the diagnostic and therapeutic limitations of seeing patients on a screen, there are economic considerations, too: virtual doctors' visits can actually take longer than in-person ones, owing in part to the widely varying ability of patients to operate the necessary technology. Local regulations present another barrier. Last December, a team of legal analysts determined that only ten states required private insurers to reimburse virtual visits at the same rate and with the same freedom from restrictions as in-person visits. Tele-doctors could spend more time with fewer patients for less money. What's the appeal in that?
Then "lo and behold, a pandemic, right?" Oseid said. On Friday, February 28th, a Dartmouth-Hitchcock employee, recently back from a trip to Italy, reported flulike symptoms to medical staff at the hospital. He was told to self-isolate, but instead went to a party, hosted by Dartmouth's Tuck School of Business, at the Engine Room, a music venue in nearby White River Junction. Three days later, he tested positive for COVID-19—the first known case in New Hampshire. By the following Tuesday, a second Dartmouth-Hitchcock employee had tested positive. The story made national headlines. Thirty beds were allocated for the treatment of COVID-19 in the Dartmouth-Hitchcock Medical Center.
On an average day before the pandemic, Dartmouth-Hitchcock and its outpatient clinics scheduled forty-five hundred ambulatory visits and almost a hundred elective surgeries. The economic foundation of the medical center—like that of health-care facilities everywhere—rests on in-person visits and procedures. "Let's be clear," Mary Dale Peterson, the president of the American Society of Anesthesiologists, told Politico in March, "elective surgeries are the lifeblood of many hospitals, if not all hospitals."
By mid-March, Dartmouth-Hitchcock had all but shut down its ambulatory business and reduced its elective surgeries to only the most essential ones, in order to conserve supplies of P.P.E., and to protect both doctors and patients from COVID-19. By April 1st, the Dartmouth-Hitchcock Health system was managing two thousand outpatient telehealth visits a week. "Now everyone wants to do telehealth," Oseid said. Still, Joanne Conroy, the C.E.O. of Dartmouth-Hitchcock, told me, "the chief financial officer and I exchange e-mails all the time at night." The two discuss how they'll make up for the shortfall in the hospital's budget.
As the country went into lockdown, its health care went virtual. In-person primary care, which is responsible for nearly fifty per cent of medical visits, effectively ended. Some elective surgeries, like hip replacements, were postponed; patients who needed such procedures as a kidney-stone removal or a heart-valve replacement got sicker.
The regulations governing telehealth changed. On March 6th, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which, in part, cleared the way for fifty million seniors to use their Medicare benefits for telemedicine, including physical therapy and psychotherapy, without the former restrictions. Medicare claims for telemedicine jumped from ten thousand a week in March to well over a million a week in April. The government also temporarily waived privacy rules set by the Health Insurance Portability and Accountability Act (HIPAA), allowing doctors and patients to connect over FaceTime and Zoom. With White House encouragement, state governments suspended rules that limit doctors' practices to the states they are licensed in; similar injunctions against writing prescriptions for out-of-state patients were also lifted.
These are boom times for businesses that offer telehealth infrastructure to hospitals and to health-care providers and make direct-to-consumer telehealth apps. In the states that were hit first by the pandemic, telehealth companies became "forward triage" centers, allowing doctors to prescreen patients who exhibited COVID-like symptoms, in the hope of preventing all but the sickest from going to an emergency department. Teladoc, the largest such company in the U.S., saw a hundred-per-cent increase in virtual doctor's visits from the first week of March to the first week of April. Its C.E.O., Jason Gorevic, told me that within that approximate time span the company doubled its roster of doctors from three thousand to six thousand. It includes internists, dermatologists, dieticians, pediatricians, and psychiatrists, all of whom are turning to telehealth to keep their practices afloat. The platform now handles twenty thousand visits a day.
Both Teladoc and Amwell, a major competitor, also offer online doctor's appointments, starting at about eighty dollars, to people without insurance. Other companies sell yearly memberships that offer access to a particular virtual specialist, rather than billing per visit. Among the advantages of virtual health care is that patients can talk to a doctor outside office hours—by secure chat, for example. You can request a doctor you've had before, or you can take the first one who's available. The ability to text your physician or therapist whenever you need enables "less structured interactions," Gorevic said—a convenience for patients, if not always for doctors.
Prior to the pandemic, virtual doctors had to be licensed in the state that the patient called from. Mia Finkelston, an Amwell family doctor I spoke with who works from a basement office in her home, in Leonardtown, near Chesapeake Bay, is licensed in twenty-nine states. She used to work in a practice nearby, but she "just got tired of the commute," she said. Lindsay Henderson, an Amwell psychotherapist, told me that she switched to telehealth in 2016, after the birth of her second child; it allowed her to continue seeing patients without having to be away from her kids all day.
For many years, I have lived part time in rural Vermont, and I have a long and painful relationship with Dartmouth-Hitchcock's E.R. Most recently, my wife and my daughter drove me to the E.R. with a deep wound in my shin, the result of my aspirational belief in the health benefits of chopping firewood. (I now have a gas-powered log splitter.)
On a snowy day in early April, I visited the hospital's Connected Care center remotely. Mary Oseid FaceTimed with me while standing in the center, which is divided by a glassed-in corridor, with the tele-emergency room on one side and the tele-I.C.U. on the other. Through the glass, I could see Sadie Smith at work in the tele-emergency hub, with Kevin Curtis, an E.R. doctor and the center's medical director, next to her at a four-screen workstation. They were in the final stages of treating a patient who had suffered a cardiac arrest and been taken to one of their connected regional hospitals. Local staff had hit the emergency-telehealth button when the ambulance was on the way, and Smith and Curtis had been waiting in the hub when the patient arrived at the hospital, in Claremont, New Hampshire.
Both Oseid and Curtis have master's degrees in health-care-delivery science from Dartmouth College. In their view, Dartmouth-Hitchcock's advanced telemedicine infrastructure is an example of "reverse innovation"—technologies devised in the developing world that are later adopted by wealthier nations—a concept that was popularized by the Tuck School management theorists Vijay Govindarajan and Chris Trimble. In a U.S. setting, Oseid told me, "we think of our work as something we've developed in a rural market that can go to an urban market and be just as successful."
Oseid turned around so that I could see into the tele-I.C.U., where Robert Westlake, a critical-care physician, was monitoring patients. The tele-I.C.U. is connected remotely to eighty-five I.C.U. beds—sixty in the main hospital, where the hub is situated, and twenty-five in the regional hospitals.
Oseid told me, "We have created a system where a patient who is potentially COVID-19-positive can be seen by a provider without going into the room. That's a huge benefit for us. We save P.P.E., and we save exposing the health-care worker to COVID."
The tele-I.C.U. uses a software platform designed for Dartmouth-Hitchcock by Philips, the Dutch technology company. It runs predictive algorithms powered by artificial intelligence to monitor patients' prognoses. The system constantly updates each patient's "acuity score," a grade that reflects remotely gathered patient data—such as blood pressure, oxygen level, heart rhythm, and pulse—to evaluate the risk of a sudden deterioration. When Westlake, in hospital scrubs, came out into the corridor, he told me that, because of data analytics, "we here in the tele-hub often know what's going on with the patients before the people who are ten feet away from them do." One recent analysis suggested a correlation between equipping an I.C.U. room with telemedicine technology and a reduction in patient mortality.
The Dartmouth-Hitchcock hub closely reflects the founding idea of telemedicine. It's space medicine, brought to a rural setting on Earth. According to some estimates, an I.C.U. can consume a quarter of a hospital's budget. And COVID-19 patients are likely to remain in intensive care for longer than the average stay, of four days. Studies have shown that telemedicine can reduce the expense of intensive care, but the cost of equipping and running a single hardwired I.C.U. room can be as high as a hundred thousand dollars a year—prohibitive for many smaller hospitals.
At Dartmouth-Hitchcock, Oseid told me, there are also tele-I.C.U. carts, which cost about twelve thousand dollars each. The carts carry audiovisual equipment and can connect directly to the tele-I.C.U. software from any hospital room. Another critical-care doctor I met at the hub observed, nodding at one of the carts, "We can just look at the patient and ask, 'How are you doing, sir? How is your breathing?' "
In theory, portable units of this kind could be used to deliver care at home. But that would also undercut the prevailing business model at many hospitals, which is to get as many "heads in beds" as possible.
Corey Siegel, a Dartmouth-Hitchcock doctor who is one of the top specialists in inflammatory-bowel diseases in the country, was an early adopter of telehealth. Many of his patients, such as Jessica Caron, a young mother of two from Manchester, New Hampshire, who has Crohn's disease, were driving an hour or more to see him at his office, in Lebanon, often with kids in tow. Siegel started to offer virtual visits in 2015. "It was a big win for me," Caron told me. "It doesn't replace the brick-and-mortar visit, but it complements it." Using the telehealth option, "Corey and I can get together and talk about what makes sense, and when we need to see each other in person."
When Caron heard about COVID-19, she panicked. "Managing chronic illness never really stops," she said. "I thought, Oh, gosh, I'm on immunosuppressant medication, is that going to be a problem for me?" Telehealth offered Caron a way to keep in touch with Siegel and manage her condition until she felt safe enough to visit the office again.
"I won't say anything good has come out of COVID-19," Siegel told me, in April. "But we've done almost seven hundred telemedicine visits since it hit. Already, my colleagues are saying, 'This is great, let's do this after the pandemic ends.' We might have learned in a very scary way that this is a great way to deliver care to patients."
But it's one thing to offer tele-care to a patient you know; it's another to try to distinguish a bowel disease from indigestion during a virtual first visit. A tele-doctor who misdiagnoses a stomach ache that turns out to be stomach cancer has the same liability that a traditional doctor does. For that reason, virtual doctors are supposed to tell patients whose symptoms suggest a more complicated underlying condition to make an in-person visit to an office, for lab tests and a hands-on physical exam.
Internists I spoke with in New York City were quick to point out the diagnostic limitations of telemedicine. "You can't have a belly exam" via a screen, my New York doctor, Martin Beitler, said. He was doing virtual visits from home as a necessity, but he wasn't a fan. He says that telehealth, at its worst, promotes a kind of "knee-jerk, 'give them antibiotics for every cold that they get' attitude. That's the kind of medicine you are going to get if you switch to all telehealth."
Thomas Nash, an internist whose practice is on the Upper East Side, said, "Is it doable? Of course it's doable. I'm doing it now." But, he added, "I worry that it's going to delay a good exam, and get in the way of deeper interactions between people and their doctors." David Avram, a dermatologist in Brooklyn, told me that telemedicine works well for checking moles, because you can look at a mole with a smartphone. But he's postponing full-body exams until he can return to the office.
In recent years, a wave of app-driven direct-to-consumer telehealth startups have appeared, offering to be Marcus Welby, e-M.D., for millennials—a virtual doctor who makes tele-house-calls. The idea of having a doctor who makes the equivalent of old-fashioned home visits came up in several of my conversations with people at telehealth companies. Roy Schoenberg, a co-C.E.O. of Amwell, likened the Amwell experience to a visit from Hiram Baker, the fictional physician in "Little House on the Prairie." In this idyllic view, virtual care is a way of returning the doctor-patient relationship to the pre-insurance days.
Zachariah Reitano is a twenty-nine-year-old co-founder of Ro, a telehealth company that allows consumers to request medications for erectile dysfunction and other sexual-health-related issues, in addition to those for allergies and weight loss, and get them delivered to their door. His father was a doctor. "When I think about what we are trying to build at Ro, I am really trying to re-create my dad in software," Reitano told me. "The man has saved my life, truly, and he has saved every person in my family. When you have a doctor in the home, when he can solve a problem for you, he'd solve it right then and there."
Our health-care system is user-unfriendly and wasteful. The average patient has to wait twenty-nine days to get a physician's appointment, and in most cases you don't know what the visit and the lab work will cost until you receive a bill. If you need a prescription, you have to make a separate trip to the pharmacy.
Reitano, noting that the annual deductible in employee insurance plans can be more than two thousand dollars, said, "That's insane. When you turn patients into more traditional consumers, they get to determine what they find valuable. They Google. They compare. They demand price transparency, metrics on the quality and efficacy of care, and the consumer-driven experience they get from Amazon, Apple, or Nike." He added, "Look at Lasik, cosmetic surgery, breast augmentation. The technology dramatically improves, prices come down, and the patient experience becomes better."
But what's to stop Amazon itself from offering health care to its hundred million Prime members? Amazon Care, a pilot program for Amazon employees and their families, was rolled out, in February, as a telehealth supplement to workers' existing insurance plans. Facebook, Apple, Microsoft, and Alphabet, Google's parent company, have also made big investments in the health-care field in recent years. Many of the health-care changes spurred by the coronavirus outbreak are in Big Tech's wheelhouse. At the same time, the economic losses caused by fewer in-person visits are likely to force smaller hospitals into bankruptcy, a trend that began before the pandemic. By one estimate, as many as sixty thousand physicians in family medicine may lose their practices because of the coronavirus crisis.
It's one thing to make an appointment with a virtual (but real) doctor at Amwell; it's another thing to list your symptoms on an Amazon or a Google portal and get a diagnosis from an A.I. So far, tech companies have focussed on developing diagnostic tools and sourcing supplies for medical workers during the pandemic. But how long are they likely to let the disaster go to waste?
"O.K., I had two crumbs, Doug had three. You know what? Let's just split the bill evenly."
Cartoon by Pia Guerra and Ian Boothby
On Good Friday, I had a Hiram Baker-like virtual house call in my home with Matthew Mackwood, a family doctor with a master's in public health who is one of the physicians on Dartmouth-Hitchcock's staff. There was a lump on my foot, and I worried that I might have stepped on a piece of glass, or that a critter had burrowed under my skin. Googling "chigger" only fed my cyberchondria.
Treatment at home offers certain advantages beyond those of keeping quarantine. Benjamin Fogel, a pediatrician at Penn State Children's Hospital, in Hershey, Pennsylvania, told me about some of his patients. "They are in their room with the door closed, and they feel like it's private, more than they feel like it's private in a doctor's office," he said. "These kids are sitting at their desks or on their beds. I can tell they are more at ease."
I'd had some experience with telehealth since the lockdown. My wife and I were having a weekly Zoom session with our therapist. To get some privacy from our kids, we had to sit in the back of our pickup truck, parked close enough to the house to get the Wi-Fi signal. (There's no cellular service where we live, which is not uncommon in certain parts of Vermont.)
In person, doctors often spend the first ten minutes of an appointment studying records on their computer while you sit across from them, looking at their framed degrees and family photos. But during a virtual visit the doctor meets you face to face, and her gaze mostly stays on you (or on your records on her screen—it can be hard to tell the difference). For fans of telehealth, this is one of its most appealing features. "You're looking at the physician, and the physician is looking at you," Schoenberg, the Amwell co-C.E.O., told me. "This is a very intimate encounter. And, once you get exposed to it, at some point you're going to say, 'If this is available to me, why should I revert to the laborious, dangerous, hard effort of going into the practice?' "
Thomas Nash, in Manhattan, was skeptical. "Eyeball to eyeball is not a normal human interaction, right? A normal human interaction—you shift your body a little, you look to the left for a second, you gather your thoughts, you take a pause, which you really can't do in this compressed screen-to-screen interaction."
When my appointment with Dr. Mackwood rolled around, my daughter had the iPad I was planning to use, my son was in a bandwidth-hogging Zoom class, and the cat was howling for food, so I grabbed my phone and retreated to the bathroom.
Mackwood began, "Let me ask you a few questions, and then I'll take a look at your foot. You said it hurts with pressure. What does that pain feel like? Sharp? Burning? How would you describe it?"
"It's not a sharp pain," I responded. "It's more of a burning, generalized pain. I have my index finger on it. The circumference of it is about the size of a dime, though not as round. It doesn't feel like there's a splinter or a piece of glass in there."
"Any numbness or tingling associated with that? Weakness in the foot or toes? Any drainage?"
"No, but it does have kind of a little dimple right in the middle of it. It's possible that it's a little critter that's burrowed in there. Maybe a chigger?"
"Very uncommon in these parts."
Using my phone, I showed the doctor my foot. I had to pretzel myself around to give him a good view.
Mackwood diagnosed my lump as an ordinary plantar wart. In normal times, he said, I would be able to come into the clinic, where, over a few visits, he would use liquid nitrogen to freeze it.
"There's also the duct-tape method," Mackwood added. You stick a small piece of duct tape to the wart, leave it on for a week, rub the softened wart with a pumice stone, and repeat, for four to six weeks.
I'm waiting for the clinic to reopen.
About a month after Patient X arrived at Alice Peck Day, I had a Zoom call with the team who had assisted him. Kacie Boyle emphatically stressed the benefit of having Sadie Smith there. "Jesse and I had no time to chart on this patient, so Sadie was writing down every medication that was given, every vital sign, reminding us to cycle blood pressures as needed," Boyle said. "She was just there as an extra set of eyes, and when sometimes we didn't feel we had enough hands."
Laura Williams, the other nurse on the scene, said that, in spite of the high-tech nature of their teamwork with Smith and Martin in the hub, telemedicine is "a human connection for me. It can be isolating when you're in one of those rooms with all your gear on. When I see Sadie pop up on the screen, I feel like she's right there for me. It's a reminder we're all in this together."
My daughter had made a colorful poster with a drawing of a masked health-care worker and lots of blue sky and rainbows. She asked me to hold it up in front of my laptop's camera, during my call with the team, to say tele-thanks to everyone who had saved Patient X's life. But Boyle and Williams were on audio only and couldn't see the poster, so I did my best to describe it. ♦
A Guide to the Coronavirus
The coronavirus vaccine is on track to be the fastest ever developed.
What the coronavirus has revealed about American medicine.
Recommendations for maintaining social distancing as the U.S. reopens, from socializing and using public bathrooms to wearing masks.
Why remote work is so hard—and how it can be fixed.
Seattle leaders let scientists take the lead in responding to the coronavirus. New York leaders did not.
The long crusade of Dr. Anthony Fauci, the infectious-disease expert pinned between Donald Trump and the American people.
What to read, watch, cook, and listen to under quarantine.
Published in the print edition of the June 29, 2020, issue, with the headline "Hands Off."
John Seabrook has been a contributor to The New Yorker since 1989 and became a staff writer in 1993. He has published four books, including, most recently, "The Song Machine: Inside the Hit Factory."
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Public History @UIUC
Mapping Places | Telling Stories In Review
April 24, 2016 April 25, 2016 / publichistoryuiuc	/ Leave a comment
Thank you all for attending our spring symposium, "Mapping Places | Telling Stories." Our Friday evening keynote by Prof. Ted Gordon (UT-Austin) was engaging – reminding us all that debates over public history, public space, and social memory are vital to the future of every university. Saturday's community and student panels revealed the forgotten and marginalized stories within the Champaign-Urbana community. We want to thank the 5th and Hill Association and Illinois Nurses Association members for their time, stories, and activism. Also, we are incredibly proud of our students for all their hard work this semester. Their presentations were both historically engaging and personally moving. Thank you all.
Stay tuned for more histories from UIUC and Champaign-Urbana. Our students our anxious to get back into the archive, record more oral histories, and bring hidden histories to light.
We would love to hear from you. Do you have a local story or historical documents you want to share? Reminisces from your time at the University of Illinois? Let us know! Email us at publichistoryUIUC@gmail.com or message us @PubHistoryUIUC
Research group tells the stories of hidden histories on the University of Illinois campus
"A public history project at the University of Illinois is exploring the hidden and forgotten stories of social movements on campus and in the community. Students are creating a map highlighting buildings or areas that were the sites of protest movements, and they are writing narratives about the significance of those places.
"We're thinking about how we can collectively understand and interpret our past beyond the traditional academic ways we do on campus," said Daniel Gilbert, a professor of labor and employment relations and a co-director of the project.
The project is part of a research cluster – Public History and Student Research – supported by the Illinois Program for Research in the Humanities. Gilbert and history professor Kathryn Oberdeck are co-directors of the research cluster, which includes a total of about a dozen people, including faculty, five undergraduate students enrolled in an independent study history course, and community members and organizations, including the Champaign County Historical Archives.
One goal of the project is to look at how the shared histories of campus and community are linked. So far, the research has focused largely on campus social movements, such as Project 500, an effort by the U. of I. in the late 1960s to enroll more African-American students; the establishment of cultural houses on campus; and the opposition to Chief Illiniwek. It will also include community events, including a labor strike by nurses at the old Burnham Hospital and the organizing of residents in the Fifth and Hill neighborhood around environmental issues and high-rise development in the area."
Learn more about our work here.
OUR APRIL MAPPING PLACES | TELLING STORIES EVENT IS ALMOST HERE!
Upcoming Public History Event at the Urbana Free Library
April 2, 2016 April 5, 2016 / publichistoryuiuc	/ Leave a comment
Interested in student activism, South African history, or Champaign-Urbana history? Then be sure to attend Student & Community Divestment Protests in the 1980s, an upcoming panel discussion sponsored by the Urbana Free Library.
Public History at UIUC is the website and blog for faculty-student Research Cluster sponsored by the Illinois Program for Research in the Humanities. Our goal is to explore, document, and promote hidden and forgotten stories and persons connected to our campus and the wider Champaign-Urbana community.
Public History Interns Blog

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Fall is here! As we welcome in the new season we also have the great pleasure of featuring one of fall's finest offerings: fresh hopped beer. Brave Horse Tavern is partnering with Fremont Brewing to host an evening of amazing food and exploration of some of Fremont's most popular creations– Field to Ferment and Cowiche Canyon. In attendance will be one of Fremont's knowledgeable Lead Brewers, to answer questions and give insight into the process of creating these delicious and award-winning beers. Chef Bradley Layfield and Brendon Bain will be curating a smashing menu to complement the fresh, dynamic flavors of fresh hops. Don't miss out on this opportunity to learn a little, drink a bit and to enjoy the offerings of fall a great deal.
Plus! Ticket holders for this dinner will also have access to our Fremont Fresh Hop Tasting Tent with Brave Horse Beer Club Members and complimentary samples of two featured fresh hop beers that will be highlighted during the dinner.
$75 per person / Get tickets here.
In October 2018, Borealis a festival of light will debut in Seattle. Based at the Museum of History and Industry on Lake Union, a new world of light and color will encompass South Lake Union for four nights October 11-14, showcasing an international video mapping presentation and light art installations from Northwest and international artists. These events are free to the public and open to all ages.
A kaleidoscope of light, color and illusion will transform the South Lake Union neighborhood with a walking tour of art installations, and an international video mapping showcase embellished with performances and music. The Borealis will bring together artists and the technological world to create this inaugural, annual event in Seattle.
Please join us for the 9th Annual Immanuel Community Services Fall Breakfast as we celebrate ICS and the people we serve.
• Food Bank~ distributing food weekly to anyone without restrictions.
• Recovery Program Shelter ~ providing food and shelter for 15 homeless men in recovery.
• Hygiene Center ~ offering showers, laundry, coffee, a meal and respite from the outdoors for our neighbors who live outside.
There is no cost to attend but there will be an opportunity to give.
Special thanks to our Presenting Sponsor, Vulcan Inc. Thanks to their generosity in sponsoring this event, 100% of contributions will go directly to serving neighbors experiencing homelessness and hunger in our community!!


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Venis Boutique Residence offers a wealth of thoughtful amenities and delivers an unparalleled guest experience. We invite you to enjoy every minute of your stay with us.
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Supervise young children. They must be watched at all times when near water. It takes only a little water and a matter of seconds for a child to accidentally drown when an adult turns away.
Learn to swim. Formal swimming lessons can help prevent all people, but especially young children, from drowning. It's never too late to learn.
Learn CPR. It can take paramedics several minutes to arrive. Having CPR skills can mean the difference between life and death or permanent brain damage.
Use the buddy system. Always pair up when swimming, and only swim in areas that have lifeguards on duty, if possible.
Avoid alcohol. Drinking alcohol while on a boat or swimming in the water can severely impair a person's judgment. Never consume alcohol while supervising children around water.
Use life jackets. When on a boat, make sure the number of (Coast Guard-approved) life jackets matches the number of passengers, and that they are easily accessible. Young children should have a life jacket on at all times when on a boat or in the water.
Do not use air-filled or foam toys as safety devices. These toys are not substitutes for life jackets and are not designed to keep swimmers safe.
Know weather conditions. If strong winds or heavy thunderstorms and lightning are rolling in, get out of the water and find shelter immediately.
Watch for waves and rip currents near the ocean. If you're caught in a rip current, swim parallel to shore. Once free of the current, swim toward the shore.
Potentially half of all boating deaths might be prevented by the use of life jackets.
Drowning is the second-most common cause of accidental death in children ages 1 to 14 (just behind motor vehicle accidents).
Drowning was the leading cause of death from an injury for those 1 to 4 years of age.
"If you're at the pool and someone is missing, check the water first. Every second counts. If you suspect a swimmer is struggling, ask. If that person is unresponsive or responds with a blank stare, immediate help is needed."
Do you know what drowning looks like? Know these signs to think like a lifeguard and prevent water accidents.


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Pankaj Tripathi On His Late Success: "Every Achievement Makes Me Humble & Not Arrogant"
In the year 2020, Pankaj appeared in films like Angrezi Medium, Extraction, Gunjan Saxena: The Kargil Girl, and Ludo'.
Pankaj Tripathi Opens Up On His Late Success (Pic credit: Facebook/Pankaj Tripathi)
Actor Pankaj Tripathi has had a phenomenal run of success so far, but he is aware that there might come a time when his work draws criticism. Every actor goes through such a phase, he says, and he knows how to deal with it.
"I know that a day will come when I may face criticism because I am a human being and we all have some flaws. No one is perfect. But I am not, and will never be, that arrogant man who would say 'audience ko kya pata performance kya hota hai (what does the audience know of performance)?' I think that is a very wrong approach. I have a way and that has come from the fact that I have got late success," Pankaj told IANS.
"If there is constructive criticism, I will surely introspect, because that is the way to grow as an individual. I cannot say I know it all. No. As an actor, I am constantly working on the nuances in my performance, and the possibility is endless," Pankaj Tripathi added.
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"I am the same actor who started from zero, I started with one scene, one dialogue… a small part. My aim is to make that single opportunity magnify. I will make you remember that one dialogue. since I did not get success overnight, I do not have the arrogance. I could have, if I would have got success at the age of 30! I have crossed 45 now, and every achievement makes me humble and not arrogant," explained the actor.
In the year 2020, Pankaj appeared in films like Angrezi Medium, Extraction, Gunjan Saxena: The Kargil Girl, and Ludo'. He was also the star of web series like Mirzapur season 2 and Criminal Justice: Behind Closed Doors, where he is oddly famous for his characters — Kaleen Bhaiya and Madhav Mishra respectively.
So, what has changed with success?
"Firstly the fact that I know places, as in when I came to Mumbai, I did not know all the studios and production houses where I had to go and give an audition. After searching for the address, when finally I reached there, many a time the gatekeeper said that the shooting of the film was over and there was no audition happening! I do not give auditions anymore. Earlier I never said 'no' to any work because I needed the money to survive. Now that I have a fan-following, credibility matters to me," he replied.
"Again, I am not talking about the length of the role, but the credibility. Of course, I would also like to be part of stories in which, I am the central character, for example Kaagaz," smiled Pankaj, referring to his new OTT-released film that streams on ZEE5.
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Gunjan Saxena The Kargil Girl
Pankaj Tripathi
Tripathi
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Technology for screening fruit juice could provide rapid COVID screening
by Lucille Avery on November 28, 2020 in Technology Evolution
Dr Mark Platt. Credit: Loughborough University
Loughborough University researchers are hoping a technology they developed to quickly screen liquids for microorganisms can be adapted to provide rapid testing for COVID-19.
The team's unique device, which uses a technique known as resistive pulse sensing, is being launched as a University spin out for use within the soft drinks industry to test for contaminants.
Now the researchers are investigating its capability to provide both coronavirus pre-screening—with results shown in less than five minutes—and a COVID-19 diagnosis—with results shown in less than 20 minutes—by counting and identifying viral particles in a small saliva sample.
Although vaccines are now in the pipeline, rapid testing for COVID-19 will remain crucial for many months to come.
The team have already been able validate their technology against lab developed mimics of the virus particles. This proved the technology was able to count small particles at the limits needed to monitor saliva for COVID-19, and preliminary data for the test to confirm the presence of SARS-cov-2 mimic viral particles.
To the use the testing device—which is about the size of a laptop and has the potential to be a handheld device—the person being screened would go through a two-stage process:
Stage One—Monitoring
Studies show that people infected with coronavirus have an elevated number of viral particles in their saliva, even if other symptoms do not develop. Loughborough's testing unit uses resistive pulse sensing to count viral particles directly from a saliva sample. The number of particles detected could be displayed on the machine in less than 5 minutes. If the number of particles is shown to be in the normal range, the individual is cleared to proceed (e.g. enter a care home, travel). If the number is high, they may be carrying coronavirus and they would then use the same testing unit for the second test, which could offer a rapid diagnosis of COVID-19.
Stage Two—COVID-19 assay
From the same saliva sample, the unit uses the resistive pulse sensing technology again, this time to identify the nature of the virus. A positive or negative result for coronavirus could be shown on the device in less than 20 minutes.
Rhush Maugi, a Chemistry graduate and early-career researcher at Loughborough, is one of the lead developers of the technology. Whilst the Loughborough team try to secure further funding, he is working with a company in Italy—Elements SRL—on a project funded by the Italian government to create specific sensors for COVID-19.
In partnership with Loughborough's Dr. Mark Platt, Rhush is also aiming to translate their innovative diagnostic research for commercial use in the soft drinks industry through a University spin-out, Figura Analytics.
Speaking about the future of the testing device, Rhush said: "The technology developed at Loughborough has many applications, and the detection of SARS-CoV-2 is one immediate way we can help and demonstrate the power of the platform technology. And we already have NHS partners lined up ready to collaborate on this area of work, we just need to secure further funding.
"The team is also exploring the many other applications for this tech, from healthcare, food and drink and environmental monitoring, with a growing list of partners from around the world."
Dr. Platt added: "If this existing technology can be adapted for COVID screening, it could play a crucial part in opening up transport hubs, enabling safe access to family in care homes and help kick start the events industry."
On-the-spot coronavirus test within spitting distance
For more information, see www.lboro.ac.uk/internal/resea … case-studies/figura/
Technology for screening fruit juice could provide rapid COVID screening (2020, November 24)
retrieved 27 November 2020
from https://medicalxpress.com/news/2020-11-technology-screening-fruit-juice-rapid.html
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On September 20, 2016, 21 states – Alabama, Arizona, Arkansas, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, New Mexico, Ohio, Oklahoma, South Carolina, Texas, Utah, and Wisconsin – filed suit against the United States federal government, specifically the Department of Labor, challenging its new rule of overtime exemption. The group of states argue that the agency unconstitutionally overstepped its authority to establish a minimum salary level for workers in the white collar group.
The new rule, which will become effective on December 1, 2016, dictates that it will (1) raise the salary threshold indicating eligibility from $455/week to $913 ($47,476 per year); (2) automatically update the salary threshold every three years, based on wage growth over time; (3) strengthen overtime protections for salaried workers already entitled to overtime; and (4) provide greater clarity for workers and employers.
However, the 21-state group argues that the worker's salary level does not reflect the kind of work an employee actually performs. They argue that the Department of Labor regulation does not consider the text of the Fair Labor Standards Act by setting a salary threshold without even considering whether an employee of a state or private company is actually performing actual executive, professional or administrative roles.
Since the new rule would bring upon a lot of burden to both government and private employers, it would be noteworthy to keep an eye out for how the case proceeds since if the court rules for the states, that would mean that the new rule cannot be implemented, thus keeping the status quo of the current rule on overtime pay.
 Jess Davis, Dozens Of States, Biz Groups Challenge DOL Overtime Rule, Law 360, Sept. 2016, at 1.
 THE OVERTIME RULE, https://www.dol.gov/featured/overtime/ (last visited Oct. 24, 2016).


Wala Wala Cafe Bar at Lorong Mambong in Holland Village is one of the old but hip places to go to for drinks and live music. The popular Cafe Bar has a new outlet in the revamped annex block of Furama Riverfront Hotel in Havelock Road. Called Hive by Wala Wala, the new outlet occupies a large space on the ground level offering food and beverages, screenings of sporting events and, of course, live music.
Hive by Wala Wala is huge and can accommodate more than 400 patrons. It must be one of the largest restaurant bar in Singapore. It has an al fresco dining area, spacious indoor dining hall, an outdoor bar and an indoor bar, a DJ console and a stage for live performances. It also houses a wine retail shop, cigar room, ice cream counter and bakery. It even has a merchandise shop a la Hard Rock Cafe style. To top it off, there is a private room.
It is nicely decorated with a dark wood and gold theme. The look is modern and quite elegant and the mood is casual. The sound system is excellent.
Hive by Wala Wala is first and foremost a watering hole. It has an extensive range of drinks. Beers, ciders, port, wine, aperitif and cocktails are available. There is also a good collection of premium champagne and whisky.
The food menu is not as extensive as the drinks menu but there is a good mix of Western food, Asian fare and snack items. Affordably priced set lunches are available. Unusually for a restaurant bar, it also has a kids menu. Below are a few pictures of random pages from its electronic menu.
We went to Hive by Wala Wala for lunch and it was quiet. It was not yet time to start imbibing alchohol so we did the next best thing – we ordered a Beer Battered Fish & Chips ($12). We also ordered the Claypot Chicken ($10) with a bowl of plain steamed rice ($1). GST would be added to the bill but there was no service charge.
Ice watered was offered and served. The wait for the food was about 15 minutes. We enjoyed the music played over the very good sound system while we waited.
The fish & chips were of the expected standard. The batter was crisp and not oily and the fish had good texture. The thick cut fries were well done and enjoyable.
The claypot chicken was not quite what we had expected. It was a soupy version and did not look very interesting. The portion was quite generous but it looked like lots of tofu and vegetables. The pieces of chicken were hidden underneath and looked pale and insipid. The soup was slightly sweet and tasted quite good. On the whole the dish was quite good with the bowl of plain teamed rice.
We could imagine Hive by Wala Wala to be a lively place with nice music in the evening. In the day it is a nice quiet spot for simple meal at very reasonable prices.


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"When buying a Horizons condo, we are all seduced by the decor, the ambiance, the view, and other visual effects, when we should really be checking something else that is not visual!
The Home Owners Association (HOA) often plays a very nondescript part in the whole process of choosing a condo – especially for first-time condo buyers. However, the HOA can play a very large part in using up your finances if you hit an unlucky situation after moving in.
The maintenance reserves will be important; there will hopefully be approximately one third of the gross annual fees charged to all residents in the reserves.


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Breaking News: The Naked Truth: Hong Kong's lack of sexual desire and what stressed out, phone-addicted couples can do about it
By Ifeanyi Dimkpa	 Last updated May 25, 2018
In a new column about modern relationships, Luisa Tam goes to the heart of a burning issue in Hong Kong – how little sex couples have – and suggests some ways to rekindle the flame of desire
Hong Kong tends to come across as a sexually conservative society. Most local Chinese are reluctant to say the word "sex" or "sexual intercourse" even in private. People are so prudish that they often refer to sex as "that thing" and coyly refer to intercourse as "walking closely together". (So be careful next time you ask someone to walk a bit closer to you while strolling down the street – it could be wrongly interpreted as an indecent proposal.)
But this new column is all about tackling head on the burning issues of human intimacy and family relationships, so let's cut to the chase on this week's topic: there's not enough steamy activity happening to rock Hong Kong bedrooms.
5 health benefits of sex, as if you needed any reasons to have more of it
I once saw a survey that claimed couples in the city, on average, had sexual intercourse a dismal 3.9 times per month. No matter how you look at it, an average of once a week is pretty pathetic (I'll leave it to you to interpret the remaining 0.1 decimal points).
It appears Hongkongers are simply not that eager about getting amorous. Similar results from another study confirmed the frigid nature of our love life.
According to a 2011 survey by City University of Hong Kong's Community College of nearly 1,000 adults, Hong Kong men were satisfied with having sex an average of 1.9 times a week, while women were content with 1.6 times a week. Compared with at least three times per week in Greece (hailed as one of the world's most sexually active nations), Hong Kong does seem a little asexual.
It may not be 100 per cent scientific, but research of this kind – including condom maker Durex's annual survey – does attest to the attitudes towards sex of Hong Kong people, says Dr Paul Wong Wai-ching, associate professor in the department of social work and Social Administration at the University of Hong Kong.
Sex talk: gender expert on why Hongkongers are getting fewer intimate moments
"To be honest, Hong Kong's social environment is not conducive to helping people to get in the mood. The vibes and the general attitude are not there to encourage people to be intimate, so what do you expect?" says Wong.
Work demands bring long hours and stress, he says, and the prevalence of electronic devices gets in the way of bedroom antics.
"To have good sex we need to wind down first and then warm up, but this takes time and effort. That's why many Hongkongers say it's too much trouble to have sex. If you ask me, 'What's killing our sex life in Hong Kong?' I would say life and life's other priorities, and the need to juggle so many things, have inadvertently taken sex out of the daily life equation," says Wong.
The lack of sex drive may lead to unhappy marriages and high divorce rates and, in the long term, a drastically low birth rate, he points out.
But Vera Lui, owner of Sally's Toys, an intimate lifestyle shop, says factors that kill the mood for sex, such as a lack of personal space, professional priorities and stress, could be turned into motivational sex drivers.
"There is opportunity in adversity. We have to adapt to difficult and changing circumstances. People say sex has to be spontaneous. That's a myth. Planning a sexy time together can be fun and exciting. Even if you have to set a date to get intimate doesn't mean you cannot be spontaneous. It's all about matching each other's needs and wants," Lui says.
This is Hong Kong: no time for love, no interest in marriage and not enough men
"Don't wait for your sexual desires to start bubbling. People in a monogamous relationship can set a time, date and place to get intimate. Treat the preparation process like foreplay. And try to make it as flirtatious and salacious as possible – you can be spontaneous during this process," she adds.
Wong is not so sure. "In a city like Hong Kong, communication among people is already infrequent and fragile. We don't spend enough time in face-to-face communication, and in some cases, it's close to being non-existent," he says.
Hong Kong is not unique in this aspect, though. Modern-day relationships are becoming too mundane and people sometimes feel as if they're living a life in a TV episode stuck in a loop.
Electronic devices like our mobile phones, televisions and laptops are to blame for this, as we pay more attention to them than to our other half. This is a global phenomenon that is eating into relationships around the world.
Thankfully, we can take matters in our own hands. First, make time for your partner, not your phone. Set time limits on use of these devices and don't slip back into bad habits. You might be surprised by how much time you actually spend slouched gormless over your phone compared to the attention you give your loved ones.
Finally, be honest and direct. Make sure you talk regularly to your partner and find a way to bring back a genuine connection. Once you are reconnected, don't jump back into bed right away. Just take the time to savour what it's like to have that burning desire again.
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This retelling of the Loser's encounter with Pennywise the Clown brings the horror to new audiences.
The stories Stephen King tells have long been a staple of the horror genre. His novels convey some of the most terrifying tales known to man. There have been many film adaptations of his work over most of his career. Perhaps his most acclaimed (and terrifying) novel is It. Spanning almost 1200 pages, this beast of a novel had previously been adapted into a mini series in the 1990s. Now in 2017, It is receiving a reboot for the big screen with the first film in a two part series of a reboot, helmed by Mama director Andy Muschietti.
The book tells two stories; one from the main characters childhood and one in 27 years later. This film tells the first story, that follows the kids adventure through the small Maine town of Derry in 1989. Audiences are pulled in from the very first opening scene where Georgie meets Pennywise. The same uneasy and terrified feelings that came with reading that first chapter are brought to life in cinematic glory. It is one of the most faithful film adaptations of a book in recent memory. All of the characters feel like they crawled right off the page to star in the movie. There are subtle nods to other details, such as Bill's bike. The script takes a few liberties switching up some scenes from the book, but they are welcome here as it allows for a better story to be told in a visual medium.
The cast may have been the most perfect pairing of actors in a movie ever. The kids that play the Losers are perfect. Jaeden Lieberher as Stuttering Bill and Finn Wolfhard as Richie Tozier standout above the rest. Jaeden brings a nervous charm that is required of the character while flawlessly nailing the dialogue through a tricky stutter, and Finn proves he is a capable young actor by bringing some genuine comedy that keeps the movie from getting so bogged down. Sophia Lillis as Beverly Marsh brings a strong female character to the the gang of boys and makes her feel more essential to the story than a token girl in a horror story. While the rest of the Losers may not get as fleshed out as they do in the book, the chemistry between the kids is definitely there.
Bill Skarsgård as Pennywise the Dancing Clown gives one of the most terrifying performances ever to be given in a film. Every scene he is in will send chills down every viewer's spine. While he does not have that much dialogue outside his fear inducing "you'll float too" lines, the aura he brings to the character infects every scene with fear-inducing tension that lingers long after he has left the screen. One of the genius qualities of the character, a clown who preys on the fear of children, is how he is able to seamlessly shift from an seemingly innocent friend to a horrifying demon at the snap of a finger. It may be sacrilege to say, but Skarsgård's may greatly overshadow Tim Curry's classic performance in the original series.
The production quality of It overall is very sound. The film has very clear and concise direction that realized the full potential of the source material. That, coupled with the set design, allow for the town of Derry and it's looming cloud of evil to come to life. The cinematography elegantly captures a scene and, with the subtle tilt of a camera, transforms an innocent scene through the eyes of a child into a horrific nightmare. The special effects and make up are used sparingly enough to elevate the otherworldly terror of Pennywise to a whole other level. The film relies on is terrifying atmosphere to realize it's horrific potential. There are quite a bit of jump scares but they are welcome part of the movie since the play into the very nature of Pennywise's character, who demands to be seen and feared.
While being both a reboot and a horror blockbuster, It feels fresh with both it's source material and it's genre. Muschietti utilizes all of his resources to build a childlike story with his wonderful cast, and the twist it into something unholy with his perfect Pennywise. The production quality is solid enough to create a fear-inducing atmosphere and while it does play into a few jump scare, none of them feel cheap. This is a must see film for any horror fanatic, and opens in theaters everywhere this Friday!


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Federal Court Rules it is Illegal to Patent Unaltered Human Genes
Friday, 02 April 2010 18:15
From Daily Tech
A U.S. Federal Court ruled this week that unaltered human genes are products of nature and not patentable. It revoked the patents on breast cancer genes held by Myriad Genetics.
Until now, Myriad Genetics "owned" the human breast cancer genes. It blocked competitors from developing tests for commonly occurring variants of the genes, essentially preventing patients from getting a second opinion. (Source: Think Gene)
ACLU triumphs over Myriad Genetics, but future legal challenges are likely forthcoming
A court decision this week may at last spell the end to companies' rights to claim ownership of your genes. However, the story started long ago in the biotechnology industry's nascent days in the year 1980.
The 1980 U.S. Supreme Court Decision Diamond v. Chakrabarty was among the most important legal precedents of the last two decades of the previous millennia. While it will never enjoy the instant recognition of a case like Roe v Wade or Brown v Board of Education, the case was among the most important commercial and medical decisions in modern history.
It ruled that "organisms" made from human DNA were patentable if they were "man-made" -- produced by human processes. This was interpreted, over time, to mean that genes of organisms could be patented, granting the holder exclusive ownership of that gene. [More...] [Comments...]


text:
Feds Put N.J. on Fast Track
The nation's transportation chief on Monday said a $450 million investment in high-speed rail in the North Jersey-New York region will create construction jobs, cut congestion on roads and allow Amtrak to operate faster -- up to 160 mph in parts of the region -- and more efficiently.
Lawmakers and Transportation Secretary Ray LaHood also addressed the scuttled Hudson River tunnel project, which used $271 million federal dollars. The money for the upgrades comes from redistribution of $2 billion in high-speed rail funds that Florida Gov. Rick Scott rejected this year.
Still, LaHood said during a news conference at New York Penn Station that high-speed rail must be part of the legacy of the region and the country. By 2050, there will be 100 million new people in the United States, he said.
"We simply cannot build enough highways, airports to support this growth," he said.
LaHood said the Federal Railroad Administration selected 15 states and Amtrak to receive $2 billion for 22 high-speed intercity passenger rail projects. The funds for Amtrak will support power, signal, track and catenary improvements that will boost capacity, reliability and speed.
New Jersey Sen. Frank Lautenberg and New York Sen. Chuck Schumer both facetiously thanked Scott for turning back the funds, which had originally been awarded to Florida to build a high-speed line between Tampa and Orlando.
"We'll take it," Schumer said. "Florida's loss is New York and New Jersey's gain."
Lautenberg criticized Scott's rejection of the money, then extended that criticism to Governor Christie, who in October turned away $3 billion in federal dollars that was slated for a project that called for constructing a commuter rail tunnel under the Hudson River that linked North Jersey and New York.
"A governor that rejects transportation dollars is penny-wise and pound-foolish," Lautenberg said. "Imagine what would happen if our transportation [system] would come to a standstill, if we see cars piling up on the highways ... pockets drained by $4 gasoline."
New Jersey "learned that if you reject federal money, you gain nothing and you pay a heck of a price," he said.
Christie spokesman Kevin Roberts said the governor felt that the Hudson River commuter rail project, known as the Access to the Region's Core, or ARC, project was a bad deal for New Jersey and the taxpayers, with billions in overruns that would have been borne exclusively by New Jersey."
ARC, an NJ Transit project, was budgeted at $8.7 billion, including $3 billion the Federal Transit Administration was to contribute and $3 billion that was to come from the Port Authority. Christie canceled it after projections said costs could climb to as much as $13 billion.
Roberts said Christie recognizes the need for trans-Hudson rail, but believes the costs should be shared. New Jersey alone was responsible for covering the costs of ARC that went over its $8.7 billion budget, Roberts said.
The FTA has since demanded that NJ Transit return $271 million in federal funding the state had already spent on ARC before Christie killed the project in October.
Lautenberg on Monday chastised the Christie administration for hiring a Washington, D.C., law firm to fight the FTA's demand for repayment. Invoices released by the Attorney General's Office on Monday show the law firm, Patton Boggs, has so far been paid more than $950,000 to fight the FTA. That amount covers work the law firm performed between December and February.
However, the FTA in April rejected the law firm's arguments and said Christie was aware the state would be on the hook to pay back the federal dollars already spent if ARC was canceled. Christie has said publicly that he is not going to pay back the $271 million.
At Monday's news conference, LaHood brushed aside those comments, saying: "We have been working with the Governor's Office on this issue" and are awaiting an official response.
Meanwhile, Amtrak President Joseph Boardman said high-speed rail funding will help lay the groundwork for Amtrak's proposed $13.5 million Gateway Project, a high-speed rail project that includes plans for a new pair of rail tunnels under the Hudson River, between North Jersey and New York.
Boardman is still seeking public and private money to support the Gateway project.
Amtrak's Acela Express trains travel at their top speeds of 150 mph in parts of Massachusetts and west of Providence, R.I., Amtrak spokesman Cliff Cole said. However, the average speed between New York and Washington is 82 mph. It is 76 mph between New York and Boston, Cole said.
The improvements will allow speeds to climb to 160 mph in one 24-mile section of the Northeast Corridor.
By the numbers - U.S. Transportation Secretary Ray LaHood on Monday announced the Federal Railroad Administration's awarding of $2 billion for high-speed intercity rail projects.
* 24 states, the District of Columbia and Amtrak submitted nearly 100 applications for a share of the money, which was rejected by Florida earlier this year.
* 15 states and Amtrak were selected by the FRA to receive money for 22 high-speed intercity passenger rail projects.
* The projects will be part of a nationwide network that will connect 80 percent of Americans to high-speed rail in 25 years.
* $795 million will go to the Northeast Corridor, including $450 million for Amtrak.
* Investments in Amtrak will increase speeds to 160 mph in some parts of the corridor, which runs from Boston to Washington, D.C.
Copyright 2008 LexisNexis, a division of Reed Elsevier Inc. All rights reserved.


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Q: .click / .insertAfter creates 2 divs instead of 1 first time posting here, hope I'm doing everything right :)
I'm kind of new to the whole programming thing and I've started to try different things out. Right now I'm playing with jQuery and having a little problem here.
This is my jQuery-Code:
$('#objekt1 ul li a').click(function() {
    $('

').insertAfter("#objekt1");
});

When I click on a link inside a list inside a div, I want to insert a new div after the first one (#objekt1). The thing is, when I click the link, I get two new divs instead of just one
What am I doing wrong?
EDIT:
This is what the html code looks like:

 Hans Mustername

 Hans Mustername

 Hans Mustername

A: There is no problem in your code. Take a look this code http://jsfiddle.net/xv14j3hL/

anchor

redpajama_set_name: RedPajamaStackExchange


text:
Q: Remove duplicated matching values from array PHP  $arrempty =array();

 for($i=0;$i<count($courseinfo['olinelist']);$i++){
     if(!in_array($courseinfo['olinelist'][$i]['onday'],$arrempty)){
         echo "<pre>";
         print_r($courseinfo['olinelist']);
     }
 }

INPUT:
Array
(
    [date] => 2016-02-23
    [onday] => 1
    [session] => Morning
    [start_time] => 08:30:00
    [cd_desc] => REGISTRATION
    [end_time] => 09:00:00
    [Name] => Fname Lname
    [profile_Pic] => 145464959476.jpg
)
Array
(
    [date] => 2016-02-23
    [onday] => 1
    [session] => Morning
    [start_time] => 09:30:00
    [cd_desc] => ON LABEL VS OFF LABEL (BOTOX)
    [end_time] => 09:45:00
    [Name] => Fname Lname
    [profile_Pic] => 145464959476.jpg
)
Array
(
    [date] => 2016-02-23
    [onday] => 2
    [session] => Morning
    [start_time] => 09:00:00
    [cd_desc] => INTRODUCTION
    [end_time] => 09:15:00
    [Name] => Fname Lname
    [profile_Pic] => 145464959476.jpg
)

Array
(
    [date] => 2016-02-20
    [onday] => 2
    [session] => Morning
    [start_time] => 01:00:00
    [cd_desc] => Lunch
    [end_time] => 02:15:00
    [Name] => Fname Lname
    [profile_Pic] => 146.jpg
)

Output:

    date =>
    onday => 1
    session =>
    start_time => 08:30:00
    cd_desc => REGISTRATION
    end_time => 09:00:00
    Name => Fname Lname
    profile_Pic => 145464959476.jpg

    date =>
    onday =>
    session =>
    start_time => 09:30:00
    cd_desc => ON LABEL VS OFF LABEL (BOTOX)
    end_time => 09:45:00
    Name => Fname Lname
    profile_Pic => 145464959476.jpg

    date =>
    onday => 2
    session =>
    start_time => 09:00:00
    cd_desc => INTRODUCTION
    end_time => 09:15:00
    Name => Fname Lname
    profile_Pic => 145464959476.jpg

    date =>
    onday =>
    session =>
    start_time => 01:00:00
    cd_desc => Lunch
    end_time => 02:15:00
    Name => Fname Lname
    profile_Pic => 146.jpg

Look at date, onday and session should be blank while displaying into for each loop
what I want to do is to remove duplicate element values from array and keep key as blank. I have tried to use array_unique($myarray) , but it seem not working. Please help!!!

A: Try this:
 $arrempty =array();

 for($i=0;$i<count($courseinfo['olinelist']);$i++){
     if(!in_array($courseinfo['olinelist'][$i]['onday'],$arrempty['onday'])){
         $arrempty[] = $courseinfo['olinelist'][$i];
         echo "<pre>";
         print_r($courseinfo['olinelist'][$i]);
     }
 }


For the more adventurous of us, kitchens are the perfect way to have fun with your home decor and bring out your quirky side. Whether it's mismatching paint colours, clashing patterns or just decorating everything in gold (we don't really know why either) these kitchens will surely make you say 'WOW!' and might even convince you to be more daring with your decor.
Creating a more unusual kitchen is a great way to experiment with bright colours, bold patterns, oddly shaped objects or just anything a bit out of your comfort zone.
Accessorising with bold, bright colours or experimenting with unique styles can make an unsual kitchen a real talking point – and still a stylish room that's something to be proud of.
They may not be to everybody's taste, but these kitchens show us how to be more creative and they'll surely be a talking point amongst any visitors if you decide to take up the weird and wonderful challenge!
Believe it or not, there's a kitchen under here somewhere. This Arabian-styled room might not be to everyone's taste, but we give its owners full marks for creativity. We especially love the 'Onion' domed-shaped cooker hoods!
This striking design gets a round of applause for its slick, modern styling, but we're not sure we could handle the lime green first thing in the morning.
What do you get when you combine bright red paint and curved wood panelling in a small space? Claustrophobia! This narrowboat kitchen leaves us gasping for air.
This sleek, handleless kitchen looks like something out of Doctor Who. The yellow backlit glass bricks are the perfect foil for the shiny floor and equally shiny pristine white cabinets.
Ah cute. This candy-coloured kitchen is like something a four-year-old girl would dream up, but we can't help liking it all the same. Bonus points for the great retro pendant light above the table.
We think the owners of this unique design got a bit carried away on their last holiday and decided to try to bring a little provincial French chic to their kitchen. And why not?
No it's not a spaceship. Honest. It's a kitchen. Promise. Really, it is.