text:
Who Is Paying for India's Healthcare?
An overwhelming 70% of healthcare expenses in India are met by out of pocket expenditure by the individual, due to which about 7% population is pushed below the poverty threshold every year.
India spends 1.3% of its GDP on healthcare, much lower than the global average of 6%. Credit: Reuters/Saumya Khandelwal/Files
Nivedita Rao
The Union Cabinet recently approved the launch of the National Health Protection Mission which was announced during Budget 2018-19. The Mission aims to provide a cover of five lakh rupees per family per year to about 10.7 crore families belonging to poor and vulnerable populations. The insurance coverage is targeted for hospitalisation at the secondary and tertiary health care levels. This post explains the healthcare financing scenario in India, which is distributed across the centre, states, and individuals.
Indian health spending compared to other countries
The public health expenditure in India (total of centre and state governments) has remained constant at approximately 1.3% of the GDP between 2008 and 2015, and increased marginally to 1.4% in 2016-17. This is less than the world average of 6%. Note that the National Health Policy, 2017 proposes to increase this to 2.5% of GDP by 2025.
Including the private sector, the total health expenditure as a percentage of GDP is estimated at 3.9%. Out of the total expenditure, effectively about one-third (30%) is contributed by the public sector. This contribution is low compared to other developing and developed countries. Examples include Brazil (46%), China (56%), Indonesia (39%), USA (48%), and UK (83%) (see Figure 1).
The consumer pays out of his own pocket.
Given the public-private split of health care expenditure, it is quite clear that it is the private expenditure which dominates, i.e., the individual consumer bears the cost of her own healthcare. Let's look at a further disaggregation of public spending and private spending to understand this.
In 2018-19, the Ministry of Health and Family Welfare received an allocation of Rs 54,600 crore (an increase of 2% over 2017-18). The National Health Mission (NHM) received the highest allocation at Rs 30,130 crore and constitutes 55% of the total Ministry allocation (see Table 1). Despite a higher allocation, NHM has seen a decline in the allocation vis-à-vis 2017-18.
Interestingly, in 2017-18, expenditure on NHM is expected to be Rs 4,000 crore more than what had been estimated earlier. This may indicate a greater capacity to spend than what was earlier allocated. A similar trend is exhibited at the overall ministry level where the utilisation of the allocated funds has been over 100% in the last three years.
A NITI Aayog report (2017) noted that low income states with low revenue capacity spend significant lower on social services like health. Further, differences in the cost of delivering health services have contributed to health disparities among and within states.
Following the 14th Finance Commission recommendations, there has been an increase in the states' share in central pool of taxes and they were given greater autonomy and flexibility to spend according to their priorities. Despite the enhanced share of states in central taxes, the increase in health budgets by some states has been marginal (see Figure 2).
If cumulatively 30% of the total health expenditure is incurred by the public sector, the rest of the health expenditure, i.e. approximately 70% is borne by consumers. Household health expenditures include out of pocket expenditures (95%) and insurance (5%). Out of pocket expenditures– the payments made directly by individuals at the point of services which are not covered under any financial protection scheme– dominate. The highest percentage of out of pocket health expenditure (52%) is made towards medicines (see Figure 3).
This is followed by private hospitals (22%), medical and diagnostic labs (10%), and patient transportation, and emergency rescue (6%). Out of pocket expenditure is typically financed by household revenues (71%) (see Figure 4).
Note that 86% of rural population and 82% of urban population are not covered under any scheme of health expenditure support. Due to high out of pocket healthcare expenditure, about 7% population is pushed below the poverty threshold every year.
Out of the total number of persons covered under health insurance in India, three-fourths are covered under government-sponsored health schemes and the balance one-fourth are covered by private insurers. With respect to the government-sponsored health insurance, more claims have been made in comparison to the premiums collected, i.e., the returns to the government have been negative.
It is in this context that the newly proposed National Health Protection Mission will be implemented. First, the scheme seeks to provide coverage for hospitalisation at the secondary and tertiary levels of healthcare. The High Level Expert Group set up by the Planning Commission (2011) recommended that the focus of healthcare provision in the country should be towards providing primary health care. It observed that focus on prevention and early management of health problems can reduce the need for complicated specialist care provided at the tertiary level. Note that depending on the level of care required, health institutions in India are broadly classified into three types: primary care (provided at primary health centres), secondary care (provided at district hospitals), and tertiary care institutions (provided at specialised hospitals like AIIMS).
Second, the focus of the Mission seems to be on hospitalisation (including pre and post hospitalisation charges). However, most of the out of the pocket expenditure made by consumers is actually on buying medicines (52%) as seen earlier. Further, these purchases are mostly made for patients who do not need hospitalisation.
This article was originally published in the PRS Blog.

redpajama_set_name: RedPajamaCommonCrawl


Openkore.com • View topic - How to avoid unidentified items?
Post subject: How to avoid unidentified items?
but i don't wanna pick up unidentified knife, club, bow ect.
Post subject: Re: How to avoid unidentified items?
And your Knife is wrong.
Knife have slot, either 3 or 4.
Use the correct items name.
Yup, use Knife  or Knife  even if it unidentified based on what it actually is.
Can give screenshot of that item while in inventory?
IDK about Zero server (since there is lots going on there Haha) but how about these?
if that didn't work, contact sctnightcore/allisonrag if they can enlighten this or start issue in Github, fill the bug report template form regarding this matter.
Don't forget to mention your server and openkore version.


text:
[![No Maintenance Intended](http://unmaintained.tech/badge.svg)](http://unmaintained.tech/)

kerberos
========

Installs and configures Kerberos

Requirements
------------

This role requires Ansible 1.4 or higher.

Role Variables
--------------

Dependencies
------------

Example Playbook
----------------

1) Install Kerberos client

    - hosts: all
      roles:
         - { role: kerberos }

License
-------

BSD

Author Information
------------------

Kevin Brebanov

redpajama_set_name: RedPajamaGithub


text:
import mock

from heat.tests import common
from heat.tests import utils

class ZunClientPluginTest(common.HeatTestCase):

    def setUp(self):
        super(ZunClientPluginTest, self).setUp()
        self.client = mock.Mock()
        context = utils.dummy_context()
        self.plugin = context.clients.client_plugin('zun')
        self.plugin.client = lambda **kw: self.client
        self.resource_id = '123456'

    def test_create(self):
        context = utils.dummy_context()
        plugin = context.clients.client_plugin('zun')
        client = plugin.client()
        self.assertEqual('http://server.test:5000/v3',
                         client.containers.api.session.auth.endpoint)
        self.assertEqual('1.12',
                         client.api_version.get_string())

    def test_container_update(self):
        prop_diff = {'cpu': 10, 'memory': 10, 'name': 'fake-container'}
        self.plugin.update_container(self.resource_id, **prop_diff)
        self.client.containers.update.assert_called_once_with(
            self.resource_id, cpu=10, memory=10, name='fake-container')


text:
Q: How do I get the list of attributes of an object not returned by dir dir(OldStyleClass) does not return all the attributes of an OldStyleClass. In the following example a dir instance of an old style class does not return __class__:
class OldStyleClass:
    pass

old = OldStyleClass()
dir(old)
['__doc__', '__module__']
print  old.__class__
 __main__.OldStyleClass

help(dir) also says that "some of the attributes" are returned. Is there a way to get the list of attributes of an object that are not displayed by dir?

A: You'll have to follow the class down; the __class__ attribute is defined on the type:
>>> type(OldStyleClass)
<type 'classobj'>
>>> dir(type(OldStyleClass))
['__call__', '__class__', '__delattr__', '__doc__', '__format__', '__getattribute__', '__hash__', '__init__', '__new__', '__reduce__', '__reduce_ex__', '__repr__', '__setattr__', '__sizeof__', '__str__', '__subclasshook__']

redpajama_set_name: RedPajamaStackExchange


Overnight two Twitch livestreamers, Nikki Elise (Sajedene) and Shannon Scotten (SUNSfan) from Twitch community DOTACinema, were robbed at gunpoint in the middle of their broadcast. This according to video captured of the livestream and fellow broadcasters posting to web forums NeoGAF, and Reddit.
The video clip above shows Sajadene look up surprised then bolt as yelling is heard in the background. Later in the video a person appears who is apparently holding a gun.
Both Sajedene and SUSNfan have reached out to the Reddit and NeoGAF communities saying that they are alright but shaken up. Sajadene's Twitch channel is currently taken down do to "terms of service violation" which is probably do to there being a gun involved but doesn't differentiate, as of yet, who's holding it.
The take away? Just like people doing naughty things on livestreams, broadcasters are experiencing much more than just gaming in their homes. The more livestreamers there are the more those little windows are becoming portals into not only games, but to the randomness of real life.


A new adventure playground could be created at Elvaston Castle as part of a revamp of the site which could create 73 jobs.
Running costs of £700,000 a year and a repair bill of £6.4 million have triggered plans by Derbyshire County Council to give up management of the Elvaston Castle estate and hand it over to a Trust.
A new visitor centre with café have also been proposed as part of the plans, which the Derby Telegraph first first revealed in 2016 but which the council has now announced more details about.
Visitors would still be welcome at the 200-acre site, although some areas would be occasionally cordoned off to be used for weddings and events.
There has been no mention of introducing entry fees at this stage.
Some of the ways the council is seeking to boost income include moving the car park and show ground, building a new visitor centre, and opening up and repairing more areas in the grounds to be used for weddings and large events.
The new visitor centre would have a café, shops, office space, education rooms – and the adventure playground.
Meanwhile, the upper floors of the castle would be converted into short-term holiday lets, which could be used by wedding parties, as well as long-term leases.
The downstairs rooms would be used for large events.
Since 2000, the council has been marketing the estate for sale to private companies and in 2011 sparked fury from community group The Friends of Elvaston Castle when plans to turn it into an hotel, and the park into several golf courses, were announced.
At the time, county councillor John Harrison said the council was committed to retaining public access, whatever plans came about, as long as it didn't burden the taxpayer with massive bills.
Discussing the new plans, a spokesperson for the county council said the masterplan aims to bring in more income to stem the £700,000 annual costs of the site and people will soon be able to give their views, if approved by the select leading group of councillors.
They said: "This is an exciting time for Elvaston Castle Country Park. We've been working together with the Elvaston Castle and Gardens Trust to develop a draft master plan for the estate and, if cabinet are happy to proceed, we want to know what people think of it.
Derbyshire County Council bought the estate, which sits around five miles from Derby, in 1968 and it became the first country park to open in the UK.
In the 1990s the council acknowledged an "increasingly untenable" financial position, with the castle and grounds needing significant repairs.
The council joined forces with the trust in 2015. At this time, the annual running costs of the castle and its grounds for the council were £900,000 – which has reduced but still sits at £700,000.
Included in the latest proposals are a potential move of the showground from its current location off the B5010 to the smaller site of Oak Flat, due to issues with the field becoming waterlogged.
The report also says using these areas as caravan sites has also been discussed.
Access to the castle would also be changed to better cope with the sheer volume of visitors, some 350,000 a year.
A new access route off the A6 and Shardlow Road junction at the Thulston Roundabout to the south of the castle estate would be constructed.
It would cut through fields and connect to Bridle Gate Lane, running between Oak Flat and Elvaston Cricket Club.
This has been chosen over using the historic South Drive due to it being "shorter and technically better in accommodating peak flows of traffic" – along with causing less damage to protected trees.
The main visitor car park would also be moved to the new visitor centre, with its current site judged as "remote". It would be moved from the current showground to what is currently an empty field to the north of the castle near St Bartholomew C of E Church, alongside a further overspill car park.
Significant restoration work on the Grade II-listed gardens and "nationally important" 19th century winter gardens would also be undertaken.
The former kennels would also be converted into 10 new houses, with access via Church Drive, along with two further homes on the former saw yard.
A full economic impact assessment has been made of the park to assess the "potential" of the castle estate.
It found that in 2017 alone, the country park generated £2.64 in "spending impacts" on the Derby and Derbyshire economy, with net impacts of £1.48 million – largely from visitors going to the estate for a walk.
The study also found that if all of the draft masterplan proposals are put in place the country park could support up to 135 full-time jobs in various roles, including crafts, events, hospitality and retail, creating 73 extra jobs in total.
Funding for the project, which states around £6.4 million in repairs would need to be made to the castle and its historic grounds, would come from a range of sources.
This would include contributions from housing developers in South Derbyshire, the Heritage Lottery Fund, D2N2 Local Enterprise Partnership, borrowing and match-funding from the county council itself.
Over the next year the county council has agreed to make budget cuts of £12 million to keep up with its target to have cut £53 million by 2021/2022.
The council would be "ultimately transferring" the castle and estate to the trust in several phases over the next few years.
Massive dog festival to be held at Elvaston Castle - and there'll be a gin bar for the owners!
As it stands, the Elvaston Castle & Gardens Trust is putting together a business plan, with help from the National Trust, which lays out how it can work with the council until it is ready to fully take on the managerial role.
The council has been spending up to £900,000 a year running the castle and estate, but it is thought the annual running costs have reduced and should continue to fall.
The annual running costs of the estate have been reduced due to income from a cafe upgrade on site and the re-introduction of weddings in the gardens and castle.
The council will continue to fund the estate until it is fully handed over and the trust will be able to apply for grants and funding itself.
In the report, council officers state "the community will benefit from the securing of a sympathetically-operated, sustainable visitor attraction", adding "the regeneration will secure the future of a much-needed and cherished greenspace".
Details of the new plans for the castle have been published in papers for the next meeting of the county council's ruling cabinet on Thursday, March 15.
In 1964 the estate was first put up for sale and was bought by an aggregates company.
After a number of failed attempts to gain planning permission to demolish the castle and extract aggregates from the site the consortium sold the estate to the county council.
The fixtures and fittings were sold before it was bought by DCC.


this one, features driverless programing of the keys.
as far as i know, it's first made by pop brand. Of pop brands, never buy razer, corsair. They force cloud. The keyboard may not even work in linux. logitech is good.


text:
package gogitlab

import (
	"github.com/stretchr/testify/assert"
	"io/ioutil"
	"testing"
)

func TestHook(t *testing.T) {
	ts, gitlab := Stub("stubs/hooks/show.json")
	hook, err := gitlab.ProjectHook("1", "2")

	assert.Equal(t, err, nil)
	assert.IsType(t, new(Hook), hook)
	assert.Equal(t, hook.Url, "http://example.com/hook")
	defer ts.Close()
}

func TestParsePushHook(t *testing.T) {
	stub, _ := ioutil.ReadFile("stubs/hooks/push.json")
	p, err := ParseHook([]byte(stub))

	assert.Equal(t, err, nil)
	assert.IsType(t, new(HookPayload), p)
	assert.Equal(t, p.After, "da1560886d4f094c3e6c9ef40349f7d38b5d27d7")
	assert.Equal(t, p.Repository.URL, "git@localhost:diaspora.git")
	assert.Equal(t, len(p.Commits), 2)
	assert.Equal(t, p.Commits[0].Author.Email, "jordi@softcatala.org")
	assert.Equal(t, p.Commits[1].Id, "da1560886d4f094c3e6c9ef40349f7d38b5d27d7")
	assert.Equal(t, p.Branch(), "master")
	assert.Equal(t, p.Head().Message, "fixed readme")
}

func TestParseIssueHook(t *testing.T) {
	stub, _ := ioutil.ReadFile("stubs/hooks/issue.json")
	p, err := ParseHook([]byte(stub))

	assert.Equal(t, err, nil)
	assert.Equal(t, p.ObjectKind, "issue")
	assert.Equal(t, p.ObjectAttributes.Id, 301)
}

func TestParseMergeRequestHook(t *testing.T) {
	stub, _ := ioutil.ReadFile("stubs/hooks/merge_request.json")
	p, err := ParseHook([]byte(stub))

	assert.Equal(t, err, nil)
	assert.Equal(t, p.ObjectKind, "merge_request")
	assert.Equal(t, p.ObjectAttributes.TargetBranch, "master")
	assert.Equal(t, p.ObjectAttributes.SourceProjectId, p.ObjectAttributes.TargetProjectId)
}


text:
using System;
using Cake.Core.IO;

namespace Cake.Common.Tools.OpenCover
{
    /// <summary>
    /// Contains extensions for <see cref="OpenCoverSettings"/>.
    /// </summary>
    public static class OpenCoverSettingsExtensions
    {
        /// <summary>
        /// Adds the filter.
        /// </summary>
        /// <param name="settings">The settings.</param>
        /// <param name="filter">The filter.</param>
        /// <returns>The same <see cref="OpenCoverSettings"/> instance so that multiple calls can be chained.</returns>
        public static OpenCoverSettings WithFilter(this OpenCoverSettings settings, string filter)
        {
            if (settings == null)
            {
                throw new ArgumentNullException("settings");
            }
            settings.Filters.Add(filter);
            return settings;
        }

        /// <summary>
        /// Exclude a class or method by filter
        /// that match attributes that have been applied.
        /// </summary>
        /// <param name="settings">The settings.</param>
        /// <param name="filter">The filter.</param>
        /// <returns>The same <see cref="OpenCoverSettings"/> instance so that multiple calls can be chained.</returns>
        public static OpenCoverSettings ExcludeByAttribute(this OpenCoverSettings settings, string filter)
        {
            if (settings == null)
            {
                throw new ArgumentNullException("settings");
            }
            settings.ExcludedAttributeFilters.Add(filter);
            return settings;
        }

        /// <summary>
        /// Exclude a class (or methods) by filter that match the filenames.
        /// </summary>
        /// <param name="settings">The settings.</param>
        /// <param name="filter">The filter.</param>
        /// <returns>The same <see cref="OpenCoverSettings"/> instance so that multiple calls can be chained.</returns>
        public static OpenCoverSettings ExcludeByFile(this OpenCoverSettings settings, string filter)
        {
            if (settings == null)
            {
                throw new ArgumentNullException("settings");
            }
            settings.ExcludedFileFilters.Add(filter);
            return settings;
        }
    }
}


Rob Rogers, Pittsburgh Post-Gazette editorial cartoonist, has announced that, after a weeks-long conflict with his editors regarding unpublished anti-Trump cartoons, he has been fired from the paper.
According to TribLive, the issue began when six of Rogers' cartoons were held back in late May and early June, after which he went on extended leave from the Post-Gazette's editorial page. When his case was looked over by the Columbia Journalism Review, they found that 19 of Rogers' cartoons or pre-publication ideas had been either left unpublished or were refused publication. Among the cartoons were several that Rogers has published on his Twitter feed, one depicting President Trump giving North Korea's Kim Jong Un accolades from on top of a pile of skulls.
The move was criticized by Michael Fuoco, president of the union representing the Post-Gazette's journalists.
Rogers' firing, following so closely after President Trump declaring that the news media is "Our Country's biggest enemy" has been cited by others as worrisome in a time when freedom of speech and the press are more vital than ever.
The post Editorial Cartoonist Fired Following Rejected Trump Cartoons appeared first on CBR.


It may not come as a surprise that most adults don't eat the recommended amount of fruits and vegetables each day. Across the nation, less than 15 percent are meeting the recommendations set by the Center for Disease Control and Prevention (CDC). The CDC's new way of studying adults' intake of fruits and vegetables includes examining each state individually instead of getting the national average. Southern states are overwhelming falling short of their recommended daily values. In Tennessee, only seven percent of adults are eating the right amount of fruits, while in Mississippi only 5.5 percent are eating enough vegetables. California comes out on top with 17.7 percent of adults getting enough fruits and 13 percent eating enough vegetables. So how much should adults be really consuming? The Dietary Guidelines of America suggest inactive adults should consume 1.5 to 2 cups of fruits and two to three cups of vegetables each day. The more active a person is, the more they should be increasing these amounts.
With over 235 million people suffering from asthma across the globe, finding new treatment options is a priority in the global healthcare system. A recent, small study has determined that for people who suffer with moderate to severe asthma, aerobic exercise can make it easier for asthma sufferers to manage their asthma. Of the 43 patients who took part in this study, all of them were required to take yoga-breathing classes twice a week, and half were required to walk on a treadmill for 35 minutes twice a week. The study found that the participants that added walking into their routine, in addition to their regular medications they take to treat their asthma, saw a decrease in heightened sensitivity in the airway, as well as inflammation. Asthma sufferers should consult with their doctor prior to implementing an aerobic exercise regimen as that itself could actually lead to an asthma attack. While asthma attacks were not mentioned in the study, Dr. Simon Bacon, who was not a part of the study, says people with asthma may need to use their inhaler before or during their exercise.
A small study posted in the European Journal of Clinical Nutrition found that participants struggled to estimate how many calories they burned in a workout and how much they could eat to replenish those calories burned. 50 adults and 49 children were asked to choose the size of chocolate and how much of a sports drink they believed their one-hour workout would allow them to consume. The majority of participants selected a piece of chocolate and sports drink that was half the size of what their workout would allow them to eat or drink. The study's findings show that not only do people not understand how many calories their workout will burn, they also don't understand the number of calories in food or beverages simply by looking at the product. Senior author Craig Williams pointed out that in many cases, participants underestimated the number of calories in the chocolate and sports drink because they believed it was the correct answer, but they also would eat more than what they had indicated in the study.


A new report from Deloitte may come as somewhat of a surprise to M&A consultants with an eye on the UK market. The report suggests that not only are mergers and acquisitions not suffering under the weight of Brexit uncertainty, but they are actually increasing in value. Buyers look willing to take aggressive action throughout Europe with the expectation that the politics will take care of themselves.
The Deloitte report shows that the total number of transactions fell from 212 in Q1 2016 to just 188 during the first three months of this year. But the value of those transactions jumped from £3.3 billion to £10.5 billion. As an M&A consultant, I can tell you that a trebling of M&A value in contrast to fewer transactions is exceptionally important.
Bear in mind that as many as 40% of Europe's CFOs predicted M&A activity would fall over the next several years as a result of the Brexit vote. That number has since dropped to just 10%. This suggests that enoughM&A consultants are urging aggressive action to more than make up for any squeamishness by a gradually shrinking pool of advisers betting against the future.
A Sound Economy – Our economy has been steadily growing in recent years. Despite many fears that we would experience an economic collapse after the vote, no such collapse has occurred. Combining these two realities paints an attractive picture for buyers who may have otherwise worried about putting their money into the UK.
The Lower Pound – A significant factor no one is talking about is the value of sterling. With the pound now hovering at the lowest values we've seen in decades, British businesses are suddenly very attractive from a financial standpoint. Foreign interests can buy now, while the pound is low, then enjoy the equity growth as sterling rebounds.
Political Realities – As much as both sides in the Brexit negotiations want the strongest possible deal for their side, at the expense of the other, the political realities are unavoidable. Both the UK and EU fundamentally depend on one another economically. They can split politically without ruining their respective economies – and they will. They cannot afford to do anything else.
M&A consultants look to be more than willing to push for aggressive mergers and acquisitions despite the economic and political uncertainty throughout Europe. Where many people saw few post-Brexit opportunities just a year ago, the vast majority of CFOs and other business executives now seem undaunted by what may come. The sharp rise in M&A value simply reflects that.


Let me tell you a little bit about Nan. She is my claim to fame… a quilter extraordinaire. She has even published some quilting books.. children's books.. cooking books. Oh and she has even been on that cooking show. What's his name.. Emeril? What a joy it is to have such a wonderful friend. (Okay, Nan, have I earned those coconut macaroons yet!?! LOL!!!) Nan's fabulous blog.
I finally got my new Cuttlebug embossing folders and was so excited to use the dotted swiss one on the little oval frame surrounding the nursery scene. It has been popped up on dimensionals. The onesies have been paper pieced and also popped up.
I came across this ancient set with the shelf and teddy bear images yesterday. I have been trying to go through some of my older sets to perhaps sell them to make room for the new. But I just can not seem to part with any of them. As I said in a forum over on SCS a couple of days ago, "They are more than just tools to stamp with. They are… family." I think I need some serious help!
Paper: Tempting Turquoise, Whisper White, East Coast Prep DP from SU!


text:
Cuellar will vote for plan that he warned would lay off oil and gas workers
Congressman Henry Cuellar announced he will in fact vote for Speaker Pelosi's massive tax and spending plan – even though he himself warned yesterday that the plan would cost his constituents their jobs.
According to Houston Chronicle, less than 24 hours ago Cuellar wrote Pelosi saying the plan "could force small oil and gas companies in their districts to lay off workers or even close their doors."
But he's still going to vote for it anyway.
"Congressman Cuellar himself admitted this plan will put his constituents out of work, and yet he's willing to vote for it anyway," said AAN Communications Director Calvin Moore. "It's a shame Texans can no longer count on Henry Cuellar to stand up and fight for their jobs."


Arrow exhausts has tied into the new single-make Suzuki Gladius Cup in Italy and become the official exhaust part for the newly launched championship.
Arrow already supply systems for the factory World Superbike Suzuki team and continue their close relationship with the Japanese brand by committing to being the official exhaust supplier for the Gladius Cup.
And this is what they'll be running.
The exhaust is due to become available to the general public to buy but no official information has yet been released.


Patience can be a fairly scarce commodity when it comes to collegiate athletes, especially while living in a climate often predicated on instant gratification. More often than not, tomorrow�s budding stars are required to sit and wait their turn.
That�s never an easy task for a young player accustomed to soaking up the spotlight.
In the case of Kenny Stills, his patience was put to the test from the moment he stepped onto the University of Oklahoma campus. After finishing up his high school requirements a semester early, the young receiver arrived in Norman back in January ready to get a head start on his college career.
Almost three weeks later, Stills was still waiting for word from the NCAA Clearinghouse as to whether or not he could start classes and join his new teammates for offseason workouts. Time dragged on and Stills� frustration level grew with every passing hour.
Finally, after watching roommate and fellow San Diego prep star Tony Jefferson become more and more acclimated to coach Bob Stoops� program while he himself was stuck in limbo, Stills received good news from the NCAA, clearing the way for him to start classes and work out with the team.
Evidence of that was clearly demonstrated during OU�s annual Red-White Spring Game when Stills led all receivers with six catches for 84 yards and a touchdown. The 6-foot-1, 175-pound freshman produced a pair of acrobatic catches, including a leaping grab that resulted in a 31-yard score.
Only time will tell if Stills continues to improve and progress to the point where he becomes one of quarterback Landry Jones� favorite targets. Other receivers like Ryan Broyles, Dejuan Miller, Jaz Reynolds, Brandon Caleb and Cam Kenney are firmly in the mix, while Stills knows he has plenty to prove before he earns a spot in the rotation.
�I was definitely encouraged about how everything went during the spring, but I also realize I have a lot of improving still to do,� said Stills, who chose the Sooners over Florida and several other big-name programs. �It�s a big step going from high school to college, but it�s still football to me. I�m comfortable wherever it is I�m playing ball.
Stills� biggest challenge through one college semester was surviving coach Jerry Schmidt�s rigorous conditioning routines. Next stop: an even more physically demanding summer program.
The rest of Stills� skills are more obvious, like his 4.36 speed and super soft hands. He�s elusive and tough and his work ethic is second to none. His spring game performance is definitely a positive sign for Oklahoma fans who watched Jones and his receiving corps � outside of Broyles � struggle to establish any real consistency last fall.
After being forced to wait to get his college career started, Stills may be on a fast track to making a major impact this fall. But first, he had a little business to take care of back home, as he returned to California on June 18 to walk with his high school classmates at graduation.


text:
Youth Team Fight Back To Beat Burnley
Karan Gadhia
Sumner And N'Guessan On Target
The youth team came back from behind in dramatic fashion to win 2-1 against Lancashire rivals Burnley on Saturday.
The Clarets went ahead in the first-half through Tinashe Chakwana's tap-in from a corner, but Dylan Sumner headed Ciaran Donnelly's side level after the interval.
With the game heading for a draw, Seb Des Pres tricked the Burnley defence by passing a free-kick to Christian N'Guessan, who rifled a shot into the top corner.
The Seasiders started the game well and came close to scoring through Will Dunne, who had a low shot that went just wide of the post.
Shortly after the half-hour mark the visitors broke the deadlock from a corner. The ball was headed against the post and Chakwana pounced on the rebound to give Burnley the lead.
Jack Sims made a great save to deny a second goal in quick succession, as Blackpool ended the first-half on the back foot.
Half-Time: Blackpool 0 Burnley 1
After a disappointing first half, Donnelly's side came flying out of the blocks and just minutes after Sumner rose highest to head in from Sinclair-Smith's cross.
Sinclair-Smith came close to scoring himself shortly after the equaliser with a curling shot, but it was palmed away by the goalkeeper.
At the other end, Sims was forced into a reflex save to deny a header from the close range.
In the 85th minute, The Seasiders took the lead for the first time in the match. Seb Des Pres' free-kick was cleared but the referee ordered it to be retaken due to a Burnley coach being behind the goal.
In the second attempt, the American midfielder tricked the defence by passing the free-kick to N'Guessan, who found the top corner.
The youth held on to secure the win and their three-point lead at the top of the North West Youth Alliance table.
Full-Time: Blackpool 2 Burnley 1


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GPA: Power outage in Anigua, Maina from 11 a.m. to noon
GPA line crews are clearing vegetation off power lines to improve power quality and reliability.
GPA: Power outage in Anigua, Maina from 11 a.m. to noon GPA line crews are clearing vegetation off power lines to improve power quality and reliability. Check out this story on guampdn.com: https://www.guampdn.com/story/news/local/2019/09/16/power-outage-anigua-maina-11-a-m-noon/2338356001/
Staff Reports, Pacific Daily News/USA TODAY Network Published 11:23 a.m. ChT Sept. 16, 2019 | Updated 11:24 a.m. ChT Sept. 16, 2019
Guam Power Authority emergency dispatch crew member James Santos closes a circuit to restore power to Ramirez Drive in Ordot. Several pocket areas reported low voltage and power outages after Typhoon Man-Yi skirted Guam Thanksgiving morning. (Photo: Jojo Santo Tomas/PDN)
A power outage will affect areas of Anigua and Maina, including areas of Gerber War Museum and Murray Way, from 11 a.m. to noon today, according to the Guam Power Authority.
GPA line crews are clearing vegetation off power lines to improve power quality and reliability. The outage is necessary for line crews to perform the work.
Customers using backup generators are asked to ensure main breakers are in the open position to ensure the safety of the GPA crews working on the lines, the announcement stated.
Read or Share this story: https://www.guampdn.com/story/news/local/2019/09/16/power-outage-anigua-maina-11-a-m-noon/2338356001/


It's happening. It might not be an appraiser who shows up for the appraisal inspection. I've been talking about the potential of "hybrid" valuations like this, and now they're here.
The gist is somebody besides the appraiser inspects the property and then gives the inspection details to the appraiser to do the "value part" (without seeing the property). Last week Chris Little, a Realtor friend, was talking to me about his first experience with a non-appraiser inspecting one of his listings, so I asked him some questions.
Ryan: What gave it away that this person wasn't an appraiser?
Chris: When he called and asked for an appointment to access the property he identified himself as a property inspector working on the appraisal. I asked if he had a lockbox key (every appraiser I know has one) and he said he did not. We agreed to meet at the property. At the house he gave me his card which said he was a project manager for a company in upstate New York. There was no mention of appraiser on his card.
Ryan: What did the inspector do at the house? Did he measure it?
Chris: He came in and took a bunch of photographs which he said he would upload to their portal so the appraiser could look at them. He went outside and measured the home.
Ryan: What price was this house?
Chris: The home was listed in the low $800,000's. The buyers sold their former home and were renting on a short term basis. They were putting down 55% of the purchase price.
Ryan: Did the inspector say he would pass along information you gave?
Chris: Yes, he asked a few questions and said he would include that in his report.
Ryan: What are your concerns about this new process?
Chris: My overarching concern is the validity of the "appraisal." The buyer was charged less than a traditional appraisal and in my view received less. The proper valuation of a property is essential for many reasons. Inaccurate or incomplete information can effect value and that can effect a transaction, both during the transaction and later on if there is ever a question about value resulting from loss bankruptcy, foreclosure.
Ryan: Anything else to add?
Chris: In my view, this "hybrid" appraisal is meant to streamline the lending process yet puts homeowners and lenders at risk. I don't think there is a lender out there who would use a discount Cardiologist or Oncologist if they had heart problems or cancer. Why would you underwrite a loan based on an unlicensed individual snapping pictures and taking measurements? One thing that particularly concerned me about the house in question was at almost 4,900 square feet it was more than twice as large as any other home so developing comps would take someone with real knowledge of the market to develop the appropriate value. This unusual Sacramento home doesn't seem like a good fit for a watered-down process like this.
Ryan: Thanks so much for your time Chris.
Now a few quick things.
1) This is a move that diminishes the role appraisers play in the housing market for the sake of so-called convenience. Banks are saying, "Don't worry. Trust us. It's all good…" While there is a place for big data in real estate, let's not forget the crucial role appraisers play as a systems of checks and balances. Do we really trust banks to do the right thing?
2) Value isn't just about size or bedroom and bathroom count. There is so much more an appraiser observes while walking through a house and talking with the agent. To be fair it seems like this would less of an issue on a cookie cutter house, but on something unique it could be a disaster waiting to happen.
3) If the inspector does not have adequate training, there could be a legitimate issue measuring the house accurately (and we know how important that is).
4) Could this become risky for the rest of the market if inflated appraisal waiver or "hybrid" sales become the new comps?
I hope that was helpful or interesting.
Questions: What do you think of "hybrid" valuations? What are the positives and negatives? Any stories to share?
These people being hired do not have our expertise and most likely miss things that add value. Is it waterfront? Are there riparian rights? A dock? Measured? Seawall? Were there non permitted additions? Not having this info, then expecting that an appraiser will look into all of it for a whopping fee of $55? Ummmmm no.
Thanks Helen. I share your concern. The problem becomes just because a person is putting lots of money down does not mean a more limited product is automatically viable. Moreover, when we pay people peanuts for anything, we cannot expect to attract the best of the best. So in some senses I wonder how this will all shake out. Yet if this is the way all lending work goes, appraisers will simply have to adapt or be weeded out.
There are many limited appraisal products, but I guess we have to know where to draw the line. I sometimes get orders to to drive-by appraisals on properties where that just won't work. So if someone wants a drive-by on a 5-acre custom home (when I cannot even see the home from the street), that's just not going to cut it. But if someone else did an inspection, could it be done? Maybe. But I'm still very hesitant to trust another person's data collection, perception of quality, camera lens, etc… Call me old school. If I cannot render a credible opinion of value, I better be cautious about accepting a limited scope of work.
With 55% down, in the past this might have been a desktop or a drive-by appraisal. Is this hybrid inspection better or worse than a desktop inspection? Just playing Devil's Advocate. Why not have a hybrid if the scope of work is sufficient to match the risk involved? I know that some of the final appraisal reports produced in conjunction with a hybrid appraisal inspections are poor in terms of analysis, but I think that is a problem with the appraiser performing the analysis or the client accepting the lower level of analysis. Just talking about the inspection, I think it is best to have the appraiser view the property if you want the most credible results but if you're dealing with a very low risk loan, why not send in someone who specializes in the inspection portion? I see this as similar to a doctor that might let the nurse visit a patient or even chat online if the condition is not serious. Times are changing. The hope is that this is not a slippery slope where at first it is just the 55% loan, then it becomes the 90% loan. If that happens, then the inspectors must be highly trained to pass along accurate and important information to the appraiser.
Thanks Gary. Fair point for sure. I think the key is that the person specializes. It may be hard to find someone who knows what they're doing and is committed to doing a great job for lower pay. I do wonder if these inspectors will end up in large part being appraisers eventually if traditional mortgage work keeps drying up. At the same time I have several agent friends who have considered doing this. We'll see.
Like I said, there is definitely a place for big data (or products like this) in the real estate valuation space. I think your last point is exactly the bigger issue. It can start out with Borrowers who are less risky, but then extend to everyone eventually. It reminds me of the appraisal waiver system and how it was rolled out. "Dude, don't worry man. This will be for refinances only and probably only 10% of them." As of now waivers are regularly happening with purchases and a few loan officer friends tell me they're happening on about 25% or more of their deals. Thus we see how strategic these roll-outs can be. People are thinking this through, setting up a system, slowly turning up the heat, and changing the game….
I concur with your last line on highly-trained inspectors. That will absolutely be needed if the market keeps evolving in this way. We are only as good as our data collection and our ability to analyze data. I think the appraisers doing these are going to have to figure out their part too and hopefully identify if the scope of work is adequate for the property at hand. Just because it can be done technically does not always mean it should be done. So we probably wouldn't want to appraise that $238M condo in New York just because it is ordered as a "hybrid"….
On a side note, for any onlookers I wanted to say I'm not shaming appraisers for doing this work. I'm dismayed this is happening because I'm a fan of the traditional product and I have big concerns for loosening up valuation. I've written about that quite a bit in the past and I won't rehash that here. But that's different than shaming colleagues. I've seen that too often on social media and that's not a good thing. The reality is markets are constantly changing, and if anything you don't want your business to be Blockbuster video in a Netflix world…. My advice? Pay attention to changes and start making decisions now to position yourself for the future – whatever that looks like. The struggle (or death-blow) is when a market begins to change and we don't position ourselves for it.
I don't do any lender work these days on purpose. Would I if I needed to though? That's my decision and I know what the answer is.
Gary, does the doctor accept a third of the regular fee just because their nurse checks the patient's vitals? That's what we are being asked to do.
I totally get the fee issue. Appraisers need to do a better job of standing up for fees. I'm with you, I said no to all lender work years ago because most lenders only care about fee and turn time, not quality analysis.
Tom, such a good analogy! I've been trying to think of ones that convey the absurdity of this, and you've nailed it.
Great article Ryan! I don't complete this kind of appraisal. In my area they pay a whopping $50-75. That's only one reason I don't. I'm just saying this because even if I wanted to complete these kinds of reports, I couldn't afford to. One of my biggest concerns is when these are used for purchases. Those sales become data that the real estate world relies upon. It is my belief that they are going to create big problems for real estate down the road. I really also don't buy that they are faster either. I think companies are using them solely because they are cheaper. Like the agent said in your interview, " You get what you pay for". Thanks for a great article!
Wow, thanks for sharing. I get these products coming to the market, but that's surprising to hear. I can see this product being viable with a reasonable fee, but without that it's a disaster.
Appraisers who take on these assignments are still responsible for their signatures of course, but can we really expect quality here? The system does not seem designed for it.
As I've said before, this is coming at a time where we've had a long run of price increases and the market appears poised to make a change at some point. Thus infusing the valuation space with appraisal waivers and products like this seems risky as well as convenient in some ways. If "customary and reasonable" fees aren't there, then I think we can conclude this is clearly about cost and quality doesn't matter at all.
Absolutly! I fear that with the low fees, appraisers who take on these kinds of appraisals will be so focused on getting them completed quickly that something is going to be lost in the analysis. I do also agree with you that there is a place for them in certain situations. However, now's not the time to het reckless. Actually, there's never a good time to be reckless!
It reminds me of BPO mills. There are of course quality BPOs, but when someone is doing an insane volume of BPOs because the fee structure is so low, there's likely going to be a quality issue.
Definitely! I know an agent that used to complete a lot of BPO's for REO's. He was doing a lot of them, but from what he described, it was just adding a few sales to the grid and making some adjustments that he plucked from the air.
Health and safety….I certainly worry when I do the observation, I would doubt they would get qualified people for minimum pay. I once spotted a radon situation that was a real life saver for the home. Just saying. Push button get mortgage!
Wow, nice catch. How did you detect radon? Yeah, push button. That sounds about right.
Just a hunch, subject was in serpentine type rock with basement. My background as a Forester helped pick up the geology, the rest was a simple test and fairly inexpensive venting system.
Great to hear an actual example of a hybrid inspection from the realtor standpoint. Chris brings a perspective that I wish was more recognized in the real estate industry.
Thanks Joe. Chris is an extremely sharp guy (and a former president at SAR). I think he articulated some of the huge concerns very well here. I spoke in an office this morning about hybrids actually, and people are surprised to hear what is happening. This is unknown territory for the real estate community.
Good idea. I'll bring it up at YAR and NSCAR soon. Real estate agents need to understand what's happening.
I find many agents are excited about appraisal waivers. I totally get it too. I know investors are also. But there is still a place for helping buyers make a well-informed decision. I know an agent who recommended a waiver not be accepted and it ended up saving her buyer $10-15K when the appraisal came in lower as it should have. That's a big deal. This is brand new stuff here with hybrids though, so we don't know how they'll be perceived in the market. If hybrids end up running smoothly, then people will love them. But if there are problems, then that's a real issue. Part of my concern here is a Borrower putting big money down is less risky, but that doesn't mean the property is a good candidate for a hybrid. The example that Chris shared is a little surprising to me as it seems like something that should require a deeper valuation.
Sounds like the algorithm needs tuning in this case. Clearly risk was low but the property is unusual and maybe should have gone to a full appraisal.
Great interview, Ryan. I'm not a big fan of these products but I guess we will have to see how effective they are.
Thank you Tom. I appreciate Chris sharing his perspective. It's important to keep tabs on what is happening in the market. This is a big deal and we're going to have to watch closely to see how it shakes out.
I'm utterly appalled that these "products" are being relied on for anything. It's imprudent, deceptive, not in the best interest of the borrower, and profoundly not in the best interest of the country. I think these "products" will exacerbate the next (current!) housing bubble crash.
Loans will absolutely go through that should not have.
Borrowers will be left on the hook for loans where the underlying collateral was insufficient to secure the loan.
Everyone is going to be looking for someone to pay. Who is going to be on that hook?
I don't believe for a second that the person who measured the house in this story was a "project manager". Actual, experienced Project Managers are in high demand all over the country and command high salaries. I can't imagine any scenario where a true Project Manager would accept this type of work for what is certain to be a very low payment per property. (If someone can prove me wrong, please do so.) Giving a card that says that is his "title" feels very much like an attempt to mislead the borrower and lender into seeing the loan through, thinking that a "professional" was sent to the home for the "inspection" for the appraisal. I suspect that "title" was selected because states regulate other professional titles, and for good reason, to ensure that people can't put themselves forward as being qualified for a certain type of work without having undergone rigorous training for that particular type of work. Regardless, this "service" performed wasn't a "project", which makes that "title" inherently misleading. Which begs the question of why someone would want to mislead a homeowner and/or buyer as to the nature of their role in the appraisal process? I suspect the people being sent to "inspect" are people who don't know enough to know the liability they are taking on when someone relies on their work product. They probably dropped of their ride share riders on the way over. I don't think you can just disclose and disclaim this away.
I can't even get my head around the language an appraiser would need to put in the report to basically say they didn't see it, didn't drive around the neighborhood, didn't measure it, relied on untrained personnel unknown to them from a company they have no control or influence over, to relay ALL of the critical information from a physical visit to the property, then "analyzed" the data in less than an hour (to avoid receiving minimum wage), and then attached their signature and E&O to the report. For a loan? No way. Are these being certified and signed by out of area appraisers in a mill somewhere? Are they farming out the bulk of the report to India and not disclosing the assistance? How is this credible? Who are the licensed appraisers willing to risk their license for so little?
We need to remember that people have been prosecuted for sending trainees to measure houses, even when the trainee had the required training within the scope of appraisal practice. Yes, the prosecution was about checking the box that the signing appraiser had inspected when that was not the case, but this to me feels like an even worse game being played.
Suddenly, it's okay to send someone that isn't an inspector, isn't an appraiser, isn't even an appraiser trainee to gather information about a property, and suddenly it's okay to dupe the public into thinking a home was properly "inspected" for an appraisal? USPAP might not require a physical inspection at all, but as soon as someone actually goes out and does one, then we have a whole giant pile of topics that should be, must be addressed.
Here's what I want to know: which E&O provider is going to pay out the claims that will invariably come in the future on these assignments? I am stunned that any E&O provider will provide coverage for any of these assignments at all. They shouldn't. And if they aren't going to cover them, they need to make certain the appraisers they sell E&O coverage to know they will deny claims from these products. And the banks need to know it's worthless to require an appraiser's E&O if the carrier is going to deny coverage for these assignments.
So, who is going to be left holding the bag?
Hi Ryan, Item 1 did you raise a glass for me at your happy hour??? How it was good and cold. As to the world of Hybrid, Not happy but I only do about 25% lender work these days. Course some of that is because I won't accept the other work at $50 or $250. Now I would be a little more comfortable if it was a home inspector. At least he / she has some idea as to what is going on with a home. But that said they won't all be home inspectors. Second did he measure to Anzi or AMS. Third can the appraiser on the proprietary forms put in an extraordinary assumption to CYA. I say this because several of the programs I saw did not allow EA to be added. Their comment was it was covered in the scope of work. Well not exactly and that is another reason I don't get involved. The last item, is does your E & O know you are doing these type of appraisals and will they cover them. I just am having a hard time wrapping my head around this whole process. They want it cheaper and faster and for most buyers this is their biggest investment of their lives. Course I love the excuse that is what the youngsters want is fast, my comment is that most of them don't know what they want until this get French fried in a RE deal and then maybe they won't want the next transaction to go so quickly. Last little item, so here is one for you. Agent called me today and asked some questions. She has a small house on a small lot 6,000 sf. She bundled the adjacent lot into the mix and it is a legal lot with its on APN and legal description. Now this little deal once it gets into escrow, how will that be handled. Better yet is the appraiser for $50 or $75 going to do a full HABU for excess land. I think I see a speed bump in the road here. This should be interesting. I just need to figure out how my litigation work can get a piece of this insanity. Thanks always Ryan great interview.
Thanks for your take. These are big issues not to be taken lightly. I have found measuring houses is something that takes a long while to master. There is lots to know and I'd be concerned if someone does not have adequate experience and/or training. I think your example of a lot is a perfect situation to consider too. I actually just had a buyer email me to ask me about how this is likely to go during an escrow for a property she is purchasing right now. I sent her a link I wrote about the issue. It just goes to show sometimes we encounter complex stuff in tract subdivisions. There are so many things to consider.
Biggest Bear on your RE blog here, Mr. Miyagi. I am officially striking down my bearish calls. With this new dovish Fed and rate compression I think there will be a big second leg of this boom and we are not in 2006 again. I think 2003/4. Total reversal yes. But thought I'd share my new thoughts :).
Hey, thanks Mr. Miyagi. I always appreciate your take and your sentiment here. Thank you. As you know, there is nothing wrong with changing our narrative. That's what we do as we get new information. We simply have to tell a different story as new or unexpected factors come into play.
To be fair the market really started to slump. In fact, sales volume has been down for basically 10 months in a row in Sacramento. So it's not like stats are incredibly glowing right now.
Low rates have really injected a steroid into the market lately. It's helped "normalize" stats so to speak and create lots more competition out there. This is especially true for sales volume as we had a strong month in March (still down from last year, but so much stronger).
Yet at the same time prices don't appear to be going crazy either. The market is very competitive, but it also feels a bit flat in terms of price appreciation in some areas as I'm pulling stats and making graphs. I'll have my big post out next week and talk more about that (and other stuff as I delve into the stats more).
Beyond rates, I can't help but keep watching appraisal waivers, new "hybrid" appraisals, and 0% down mortgages. These are all also "steroids" in some senses as they can help people get into the market and artificially boost prices too.
It's interesting out there. Thanks again.


DANZANTES • The spiritual nature of this series is undeniable; these works attempt to weave a beautiful impression of the magical and mystical Indigenous ritual of dance. Inspired by my travels to Peru for Inti Raymi (The Festival of the Sun), Oaxaca for the Guelaguetza (The Festival of Indigenous Dance), and by San Francisco's Mission Carnaval celebration, Danzantes depicts powerful and enchanting ritual dancers. Paying homage to the rich craft culture in South and Central American communities, the paintings feature embroidery and beading stitched directly on to the painted canvas. The ornate, handmade costumes of the dancers are a testament to the importance of craft in these ceremonies and cultures and are an integral part of the dances themselves. The colorfully costumed Danzantes are painted on extremely textured mixed media canvases to reflect the raw essence and crumbling beauty of the walls and buildings in the villages.


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Chapter: 5 Human Health and the Social Environment
« Previous: 4 Human Health and the "Built" Environment
Suggested Citation:"5 Human Health and the Social Environment ." Institute of Medicine. 2001. Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10044.
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 28 5 Human Health and the Social Environment Human behavior stands as the most immediate proximate cause of many of the adverse consequences to the environment. Thus, any solution will come from some constellation of changes in human attitude, knowledge, capacity, behavior, and perhaps incentives. According to the speakers in this session, one area that historically has received considerably less attention is the role of people and social activity as part of the environment and as part of the basis on which an environment may be salutary or the source of harm. Human behavior itself is an aspect of the environment that may benefit or harm our health. SUSTAINABLE DEVELOPMENT, ENVIRONMENT, AND HEALTH At this time, our ability to deliver public health or environmental quality is being overtaxed, said Nicholas Ashford of the Massachusetts Institute of Technology. Part of our inability lies in the fact that science is increasingly uncovering problems that we never thought existed, such as endocrine disruption or low-level chemical exposure associated with behavioral problems. There is a dynamic nature to the trends in industrial development and the diverging impact that this development is having on public health and the environment, said Ashford. Moreover, there is a disconnect between the industrial encouragement of more production and more consumption and industries' alleged commitment to sustainable development. For example, the manufacture and promotion of sports utility vehicles —currently 50 percent of new cars being
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 29 sold—does not conform with the automobile industry's assertion that it is interested in sustainable development. Some believe that innovation and commitment to sustainable development will not occur without deliberate directive policies, stated Ashford. There is an important role for government to provide a solution-focused, technology-based approach to addressing and setting priorities for environmental and public health problems. However, government actions must not rest on the false assumption that cost–benefit analysis, including risk assessment and rational choice theory, is the way to plan public policy. We need to shift attention from problems to solutions. We need to shift our attention from problems to solutions, from what we are doing to what we can be doing. —Nicolas Ashford Health and the environment do not drive industrial and economic systems. In the United States, trade is considered the engine of economic growth. An economy based on trade tends to keep its industrial plant and sell as much as it can of the old product to the rest of the world. It cannot be assumed that the industries that have caused the problems are the industries that will come up with the solutions, stated Ashford. Industries that have a technological fix and a narrow view are not capable of displacing themselves in the significant ways needed to achieve sustainable development. Who is going to give us the pollution control device—the pollution control industry, which constitutes half of the environmental export industry in this country? The regulated firm may be able to change some things, but it takes other respondents—new entrants—to displace the products and change the nature of services. Regulation is another positive force for change. Technological responses to regulation have produced such innovations as end-of-pipe pollution control, changed inputs to production processes, or entirely new products or services. The history of regulation in this country has forced the formation of new technologies, concluded Ashford. Thus, said Ashford, achieving sustainable production and consumption requires (1) a shift in policy focus from assessing and characterizing problems to designing solutions; (2) an appreciation of the differences between targeting technological innovation and diffusion as a policy goal; (3) the realization that the most desirable technological responses do not necessarily come from the regulated or polluting firms; (4) understanding that comprehensive technological changes are needed that co-optimize productivity, environmental quality, and worker/public health and safety; and (5) an appreciation of the fact that in order to change its technology, a firm must have willingness, opportunity, and capacity to change (Box 5.1).
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 30 BOX 5.1 SUSTAINABLE BUSINESS, ECONOMY, AND HEALTH— A CASE STUDY The Dow Chemical Company has 40 manufacturing sites globally. The Midland, Michigan, plant is the third largest, with 550 buildings and 40 chemical production plants in a 1,900-acre facility. The air emissions of the facility have declined over time as it shifted from high-volume, commodity-type chemical processes to more of a specialty batch-based process. In 1994, the Dow Chemical Company set a goal for 2005 to cut all wastes and emissions by 50 percent, said Jeffrey Feerer of Dow Chemical Company. The attitude and belief inside the company by the late 1990s were that no further gains could be made in emission control at this facility. Two new goals were set: (1) to have capital accrued by April 30, 1999, to essentially cut waste and emissions by 35 percent, and (2) to start to foster institutional changes within Dow to shift the corporation's thinking from compliance to pollution prevention and to further integrate health and environmental concerns into core business decision making through the Michigan Source Reduction Initiative (MSRI). Working with the community, activists, and pollution control consultants, Dow engineers identified pollution prevention opportunities and brought these opportunities to the entire group for consideration. The company decided early on that since its had a goal of reducing all chemicals by 50 percent, it did not care which chemicals the group decided to work on first. Of the chemicals identified by the group, it turned out that essentially 18 million pounds were produced a year: 81 percent were incinerated, none were land filled, 13 percent went to a wastewater treatment plant, 4 percent went up the stack as air emissions, and 2 percent were fugitive emissions. So the MSRI process was deceptively simple, but the interactions were very complex. Every plant that had an MSRI chemical in it participated in the study and came up with pollution prevention opportunities for the group to consider. One of the boundaries of the project was that Dow was looking for cost-effective pollution prevention. A key attribute of the process was direct interaction of environmental activists with Dow's key business and manufacturing leaders. The resulting projects reduced waste and emissions by 12 million pounds per year. MSRI wastes were reduced from 17.5 million to 11 million pounds per year, a 37 percent reduction. MSRI emissions were reduced from 1 million pounds a year to slightly more than a half a million pounds per year, a 43 percent reduction. Non-MSRI waste and emissions were reduced by another 5 million pounds per year. In this facility, the common belief had been that there were no cost-effective pollution prevention projects left to pursue. In the end, 17 projects were identified with a combined return on investment of 180 percent, or a savings of $5.4 million per year. The total one-time capital expenditure was $3.1 million per year, so the company is saving $5.4 million a year.
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 31 HEALTH AND THE URBAN ENVIRONMENT: THE FORGOTTEN ECOSYSTEM A photographic essay of environmental hazards in a number of cities was presented. Until the 1980s, the swamps of Newark Bay in Jersey City, New Jersey, contained 4 billion pounds of chromium slag, used as "clean" fill for a good part of the past century throughout the city. During the 1960s, Jersey City underwent what was called "urban renewal," which basically meant knocking down housing and filling in with chromium slag, reported Thomas Burke of the Johns Hopkins School of Public Health. In the 1980s, the city realized that it had an environmental hazard on its hands, in addition to rampant drug abuse. Those working within the public health infrastructure had to worry about the physical safety of the field crews. Upriver, the Diamond Shamrock plant in Newark produced Agent Orange and other chemicals, as well as some of the nation's highest levels of dioxincontaminated soils. Further south is the oldest refinery complex in America, in South Philadelphia, in close proximity to the neighborhoods of South Philadelphia. Still further south, in east Baltimore, a waste incinerator sits near a major housing project, Armistead Garden. These scenes are repeated in every city in America, said Burke. Often, urban areas are polluted because of neglect of the simple basics of sanitation, siting of facilities such as coal- and oil-burning generating stations in close proximity to housing, sewage treatment, and abandonment of factories containing hazardous materials. A direct result of efforts on a national scale to control pollution is neglect of the ecosystem in the cities, said Burke. Fragmentation of environmental health definitions of environmental regulations has resulted in an inability to deal with these broad public health problems, which are very much tied to the economics and the social and behavioral aspects of public health. This has resulted, in part, from the scientific community's distancing itself from the local community, said Burke. Communities have a good idea of the kinds of things that are troubling them. They also are realistic about this, not looking to close down business, but, rather, seeking a fair enforcement of existing laws. Citizens in these communities are concerned about cancer rates, asthma and respiratory disease, chemical sensitivity, and the general health of their children. Sometimes by trying to solve one problem—for example, ocean dumping— we create another, such as enormous composting operations for solid waste. These shifts in the problem inevitably land next to poor neighborhoods. For example, legislation that required the removal of underground storage tanks necessitated the construction of rotary kilns to bake out the volatile components of petroleum-contaminated soil. These kilns were placed in already environmentally and economically stressed areas, such as those found in South Philadelphia. Although disease rates show these urban areas to be unhealthy communities with ecosystems in trouble, indicators of health are difficult to obtain for most major cities. In an era of unprecedented economic growth there is an opportunity
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 32 to do something for the environment of the cities, said Burke. The greatest gains in public health could be made by cleaning up the urban ecosystem. Revitalization calls for a public health approach with a much broader context than the current environmental regulatory approach. SOCIOECONOMIC STATUS AND HEALTH It is common sense to assume that socioeconomic factors contribute to health and illnessaccording to Nancy Adler of the University of California, San Francisco. However, the association between socioeconomic status and health is not simply due to the adversities of poverty, although these are important and pervasive. The predominant view has been one of a threshold effect; that is, better income will bring you better health, up to a certain point but not beyond it. This view has been challenged by results from the Whitehall studies, * which are ongoing investigations of the British Civil Service. The British Civil Service has nine gradations, from the lowest entry level through the top level of management. All of the participants are employed, none are in abject poverty, and all have access to the National Health Service. When Whitehall participants were followed over 10 years it was found that there were significant differences in mortality and that these differences formed an upward gradient. So, the higherlevel administrators had cumulatively lower mortality than the lower occupational grades. What are the mechanisms or pathways by which socioeconomic status affects health? One way to think about this, said Adler, is to study the major causes of early mortality and morbidity ( Table 5.1 ) or the proximal causes of death. Scientists at the Centers for Disease Control and Prevention (CDC) analyzed these in terms of four factors. They found that inadequacy of health care accounts for about 10 percent of premature mortality, genetics for about 20 percent, environment for about 20 percent, and health behaviors and life-style TABLE 5.1 Factors Contributing to Premature Mortality Factor Percent Health care system 10 Genetics and inherited factors 20 Environment 30 Health behaviors and life-style 50 * The Whitehall studies, which began in the 1960s, grew out of a productive working relationship with the British Civil Service. Involving a large number of colleagues at UCL and other institutions, the study was of great importance in demonstrating the relation between aspects of life-style, biological risk factors, and subsequent disease.
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 33 FIGURE 5.1 Mortality rate by scoioeconomic status level. SOURCE: N.E. Adler. Reprinted with permission. for about 50 percent. There are interactions among these, but the order of magnitude is instructive. Socioeconomic status is pervasive in part because it influences many of these factors ( Figure 5.1 ). Poorer neighborhoods tend to have fewer doctors and pharmacies; inadequate transportation, lack of safe and convenient recreational facilities; and low availability of affordable, healthy food. So even if an individual is motivated to be healthy, it is harder if he or she lives in a poorer area. One implication, then, is that efforts to improve environmental health might be explicitly tied to the very factors that are going to encourage health- promoting behaviors and discourage health-damaging behaviors. Improving access to recreational facilities, increasing the availability of affordable healthy foods, and reducing the easy availability and marketing of tobacco and alcohol would be particularly helpful, said Adler. Similarly, we know that exercise is an important health benefit. A recent survey found that those who viewed their neighborhoods as unsafe were more likely to be physically inactive. So, as we design neighborhoods, if we can design them in ways that will facilitate health-promoting behaviors, this might have a powerful impact on health. The other pathway to health or illness is through differential exposure to stress, said Adler. This has to do less with the physical and material aspects of environments than with the psychsocial environment. Stress follows the same gradient as income, education, and health; that is, the lower one is in the social hierarchy the greater is the stress. There is substantial evidence that stress is
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 34 associated with physiological responses that increase the likelihood of diseases, including cardiovascular disease, metabolic syndromes, diabetes, and infection. Stress occurs when individuals feel that they do not have adequate resources to deal with the challenges that face them. One of the factors that buffers people from the adverse effects of stress is a sense of control. The Whitehall studies have found that the sense of control is closely related to occupational grade; as one moves up the occupational ladder, there is a greater feeling of control. A sense of control also appears to be important in communities. The term "collective efficacy" describes the extent to which a neighborhood shows high levels of the sense that people can control what is happening there. It can be measured in terms of social control—that is, the likelihood that neighbors can be counted on to intervene in different adverse situations—or by social cohesion —how much neighborhood residents feel that others in their neighborhood can be trusted, share their values, and get along with one another. Collective efficacy is highly related to socioeconomic characteristics and shows a direct relationship to rates of violence and health outcomes. These issues speak to the role of nonregulatory communities in addressing environmental health, suggesting not only that greater empowerment of community groups might help through the changes they achieve in the physical environment, but also that the very process may be beneficial to health through increasing collective efficacy, building social capital, and enhancing the social environment. The health effects associated with this process might be equal to or perhaps even greater than those associated with the outcome. NUTRITION, PHYSICAL ACTIVITY, AND HEALTH The relationship between the food supply and health is changing in at least three significant ways, said Bill Dietz of the CDC. First, the biodiversity of the nutritional food supply is narrowing as we concentrate seed production in the hands of fewer and fewer agricultural companies. Second, the opportunity to use genetic engineering of plants to concentrate limited nutrients, such as vitamin A or iron, could address major nutritional deficiencies around the world. Third, increasingly, socioeconomic status, even in the United States, affects one's access to affordable and nutritious foods. The importance of nutrition and pure water to health has been recognized for a long time, most notably when the prevalence of rickets was determined to be related to the lack of enrichment of milk with vitamin D and of sun exposure in urban areas because of coal smoke and particulates. More than a century ago, the country was swept with epidemics of dysentery, which were eliminated by water sanitation. These basic public health measures had a phenomenal impact. Today, however, the responsibility for water and air purity and quality has moved into a fairly esoteric area, characterized largely by toxics and toxicology. It might be necessary to return to a basic appreciation of the role of the physical environment in chronic disease prevention.
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 35 One of the newest health threats to Americans is obesity (Figure 5.2), that is, a body mass index greater than or equal to 30, which is about 30 pounds overweight, said Dietz. Obesity accounted for about 5 percent of the U.S. health care budget in 1995 dollars, mediated through the comorbidities associated with obesity, such as diabetes, cardiovascular disease, hypertension, gallbladder disease, and cancer. Physical activity, or the lack thereof, plays a very important role. From the prevention point of view, the promotion of physical activity—in contrast to a singular focus on the food supply—might go a long way toward weight maintenance. If the entire population started maintaining its weight today, rather than gaining weight with age and time, we could arrest many of the comorbidities associated with the obesity epidemic. Despite the fact that physical activity may not contribute substantially to weight reduction, the promotion of physical activity alone may have an impact on chronic diseases independent of any effect on weight. Thus, the strategy is to understand the factors that contribute to the inactivity of the population so that they might be reversed. In the United States, only 1 percent of trips are by bicycle, 10 percent are by walking, and 85 percent are by car. In addition, 25 percent of all of the trips made in the United States are less than 1 mile, but 75 percent of these are by car. Moreover, one third of all children who live within a mile of school walk to school. All of this is a consequence of the infrastructure of our communities. Thus, the suburbs may now be more hazardous to our health in some respects than urban areas because of the consequences for physical inactivity. In developments where the streets are more densely populated, and there are more ways to get from one place to another (i.e., connectivity), the likelihood of physical activity is increased. Increased walking is an essential strategy for weight maintenance, which will require that many communities retrofit their streets with bicycle paths and sidewalks. Likewise, we cannot expect our children to walk to school unless there are safe crossing areas for them to do so. This requires a community-based strategy (Figure 5.3). There are also opportunities for physical activity within our buildings, for example, through stair use. Passive, inexpensive changes in stairwells can promote physical activity, reported the CDC's Dietz. We need to employ a social strategy that is based not only in health services and aimed at life-style changes but that also employs the regulatory strategies necessary to influence the political will, concluded Dietz. Perhaps it is necessary to promote these changes not so much for the sake of public health, but because they improve the livability of communities, which creates an alliance of groups not commonly considered partners in public health. A MORE COMMUNAL APPROACH TO HEALTH During the last three decades of the 20th century, industrial capitalism gave rise to an electronic era and the globalization of trade. These trends have influenced medicine, healing, and the environment, in particular. Ancient history
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 36 FIGURE 5.2 Prevalence of obesity among U.S. adults, 1991, 1993, 1995, and 1998. SOURCE: Must et al. (1999). Reprinted with permission.
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 37 reveals how the impact of humans—in terms of overgrazing, or misuse of waer—led to abandonment of the sites of early civilization. This history teaches us that the globalization of the earth is just in its infancy, said Donald Conroy, president of the International Consortium on Religion and Ecology. Over much of this history, a male-dominated view of medicine, which is very mechanistic, as predominated, with a strong emphasis on the individual and less on the spiritual or community involvement in health.
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 38 FIGURE 5.3 Exercise, including walking, is essential to weight maintenance. Many communities will need to retrofit their streets with sidewalks and bicycle paths. SOURCE: W. Dietz. Reprinted with permission. A comprehensive survey of cultures in the history of health care and medicine, however, provides an alternative approach to health care, one with a more communal and "feminine" emphasis. This approach emphasizes the value of various noninvasive therapeutic methods, including diet and nutrition; includes holistic types of body, mind, and soul techniques for curing; views healing within the context of community and family; and is more open to a perspective in which life and death are seen as part of a natural ecological cycle of birth and regeneration. It also relies on nonmechanistic and nonintrusive methods of diagnosis, including a greater emphasis on the patient's own story and cultural habits. Therefore, treatment is multifaceted, requiring rest, relaxation, reassurance, and a sense of hope to activate the natural healing powers within the person. Conroy emphasized the need to view these approaches as another way of recovering from and dealing with illness and as an alternative to the singular "battlefield" type of medicine practiced today. CHANGING THE EDUCATIONAL ENVIRONMENT Health is a hard word to define. It cannot be reduced in its essence to any kind of single discipline, said David Orr, director of the Environmental Studies Program at Oberlin College. Quoting Richard Levins of Harvard Medical School, Orr said that "the emphasis ought to be on wholeness and process in complexly connected networks of causes that cross the boundaries of disciplines." Moreover, health is a big subject, not a single discipline, thus, it should not be confined to schools of public health or schools of medicine. Humans cannot be healthy in an ailing ecosystem, said Orr. Human health is related to climate, the loss of biological diversity, soil, and rainforests, increased population, and the death of the seas. This ecological disorder, or the
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 39 disordering of ecosystems, reflects a prior disorder of mind and of the way in which we think, said Orr. Thus, it should be a matter of great importance to educational institutions that purport to improve the way we think. Humans cannot be healthy in an ailing ecosystem. —David Orr Orr believes that those in education have been and are part of the problem. "What would it mean if colleges and universities and public schools took health seriously in this large sense of the word, in the sense of dealing with causes not symptoms?" he asked. No institution or organization has a right to undermine the stability, integrity, and beauty of natural systems—the consequences of which would always fall as a kind of "irrevocable remote tyranny" on students and future generations. The same institutions that purport to induct young people into responsible adulthood ought themselves to operate responsibly. The work of organizations such as Second Nature, the National Wildlife Federation, and the Center for Respect of Life and Environment is leading a revolution in higher education, said Orr. They are effecting a change in the operations of universities and colleges through promoting policies on college and university campuses that govern the purchase of food, materials, paper, and all of the goods that flow through and across a campus. Second, they are working to revolutionize how we build college campuses, constructing buildings that emit no waste products, use solar power, locate materials from sources certified as sustainably managed and sustainably harvested, and develop fabrics that are compostable and free of carcinogens. A third revolution continues in terms of investments and how colleges buy, purchase, and exert financial power in the world. Orr believes that these efforts are beginning to change operations in a way that makes campuses models of ecological designs so that they reflect health in all that they do. If health is not the aim of education, as Orr paraphrased Aldo Leopold, then what is education for? SUMMARY Human behavior stands as the most immediate proximate cause of many of the consequences to the environment that are the basis for environmental health research. If indeed there is to be any solution or change, that too will come from some assemblage of changes in human attitude, knowledge, capacity, behavior, and perhaps incentives, noted Lynn Goldman. Any intervention to change the status quo will certainly involve the role of people in the environment. Several workshop participants discussed that these changes must include involvement (and empowerment) of the community, intentionally designed opportunities for increased activity, freedom from toxic exposures (especially in the poorest neighborhoods), reexamination of the incentives provided by government and industry ( Box 5.2 ) to achieve environmental health, and education of the young by example.
HUMAN HEALTH AND THE SOCIAL ENVIRONMENT 40 BOX 5.2 INDUSTRY AND THE NATURAL ENVIRONMENT: REDUCING INTEL'S ENVIRONMENTAL FOOTPRINT—A CASE STUDY Intel, manufacturer of microprocessors, changes its manufacturing process every 2 years as it miniaturizes the next generation of computer chips. During each transition, reported Terrence McManus of Intel, there are major opportunities for environmental improvements, for example, through chemical selection, facility design, waste management, ergonomics, and manufacturing equipment selection. The Resource Conservation Recovery Act, or RCRA, required companies to focus on waste minimization, which resulted in an evolution in the technology. In making changes, Intel often has to make critical choices with different environmental implications, for example, should the chemical be consumed in the product or should the company "borrow" the chemical from the manufacturer and return it for recycling? Other aspects of planning include projecting over 10 years, or five generations of manufacturing, to predict environmental health and safety impacts. Goals are then set that must be integrated into the design development process as opposed to being some appendage to it. Examples exist from improvements made in past transitions. For example, one process uses hydrofluoric acid to etch wafers. Intel reduced the water use in this process by 40 percent and achieved better management of the exhaust, which actually reduced energy use. Other efforts have resulted in the recycling of hazardous waste and reductions in emissions of volatile organic compounds: currently 37 percent of waste is recycled; 17 percent goes to energy recovery; and 46 percent goes to landfill, incineration, or other treatment. Intel has been able to reduce water and energy use per manufacturing unit on each of its last four generations of semiconductor technology. Intel also builds ergonomics into the equipment, going so far as to design a handbook for the people who make its equipment. Intel's StRUT program, or Students Recycling Used Technology, recycles personal computers, after students have upgraded and cleaned the hard drives, for donation to schools and nonprofit organizations. A key to Intel's successful environmental record, said McManus, has been the company's ability to put together a green plan that integrates design for the environment while aiming for sustainable activities of other operations, which often requires partners in diverse fields to make it work. Design, as McDonough, Lovins, and others are defining it, begins by seeing nature as the standard for what humans do: how we farm, how we build, how we work, and how we live. They see civilization as being powered by contemporary sunlight, not ancient sunlight stored as fossil fuel. They see design, when we get it right, as protecting diversity—not just biological diversity but cultural diversity as well. They see an economic system, when we get the design right, characterized by prices that tell the truth about what we do in the world. Finally, when we get design right, said McDonough, we do not just recycle waste, we eliminate the very concept of waste.
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namespace Orleans.Runtime.Host
{
    internal sealed class AzureConstants
    {
        public static readonly TimeSpan STARTUP_TIME_PAUSE = TimeSpan.FromSeconds(5); // In seconds
        public const int MAX_RETRIES = 120;  // 120 x 5s = Total: 10 minutes
        public const string DataConnectionConfigurationSettingName = "DataConnectionString";
        public const string SiloEndpointConfigurationKeyName = "OrleansSiloEndpoint";
        public const string ProxyEndpointConfigurationKeyName = "OrleansProxyEndpoint";
    }
}


Since January 2018, the new online report of the Hauska & Partner Group is available at sustainability-report.hauska.com. It provides information about the company's activities in Austria and Croatia and meets the requirements of the UN Global Compact regarding the yearly Communication on Progress Report. It also provides a comprehensive view of the company's focus on the United Nations Sustainable Development Goals.
The new online report will be updated on an ongoing basis. For specific reporting dates, additional PDF extracts are produced and offered for download.


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