text:
Not Going to Take it Anymore – Doctors in the Pacific Northwest Unionize
Posted on January 19, 2016 by Yves Smith
Yves here. This development is very important. Nurses' unions are effective and well respected. Doctors' unions should be even more so, particularly since their big grievance is corporatized medicine requiring them to spend less time with patients and reducing their autonomy. As this post explains, they are at odds with management because management cares only about profit while they prioritize the quality of care. And the managers are all MBAs, so it is not as if the effort to routinize care is driven by people who in theory might have ideas about how to achieve better medical outcomes.
By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Cross posted from the Health Care Renewal website
We have posted about the plight of the corporate physician. In the US, home of the most commercialized health care system among developed countries, physicians increasingly practice as employees of large organizations, usually hospitals and hospital systems, sometimes for-profit. The leaders of such systems meanwhile are now often generic managers, people trained as managers without specific training or experience in medicine or health care, and "managerialists" who apply generic management theory and dogma to medicine and health care just as it might be applied to building widgets or selling soap.
We have also frequently posted about what we have called generic management, the manager's coup d'etat, and mission-hostile management.
Managerialism wraps these concepts up into a single package. The idea is that all organizations, including health care organizations, ought to be run people with generic management training and background, not necessarily by people with specific backgrounds or training in the organizations' areas of operation. Thus, for example, hospitals ought to be run by MBAs, not doctors, nurses, or public health experts
Furthermore, all organizations ought to be run according to the same basic principles of business management. These principles in turn ought to be based on current neoliberal dogma, with the prime directive that short-term revenue is the primary goal.
Now there are a few signs that the physicians are getting fed up with having to answer to generic management and managerialism.
I found two stories, perhaps somewhat related, about physicians unionizing to stand up to their new often managerialist overseers. The most prominent was in the New York Times on January 9, 2016, provocatively titled "Doctors Unionize to Resist the Medical Machine." It tells the story of how the hospitalists at PeaceHealth Sacred Heart Medical Center in Springfield, Oregon, formed a union de novo. The second started with a brief article in the Seattle Times on December 27, 2015, about how housestaff at the University of Washington (UW) revived a housestaff association and turned it into a union.
Managerialism as the Stimulus at PeaceHealth
The long article about PeaceHealth showed that managerialist leadership of the hospital system was the chief stimulus for unionization.
Managerialist Tactics: Outsourcing
The NYT article opened with
in the spring of 2014, when the administration announced it would seek bids to outsource its 36 hospitalists, the hospital doctors who supervise patients' care, to a management company that would become their employer.
The outsourcing of hospitalists became relatively common in the last decade, driven by a combination of factors. There is the obvious hunger for efficiency gains. But there is also growing pressure on hospitals to measure quality and keep people healthy after they are discharged. This can be a complicated data collection and management challenge that many hospitals, especially smaller ones, are not set up for and that some outsourcing companies excel in.
Outsourcing is a now familiar entry in the managerialists' playbook. It is seen more in manufacturing than in health care. Although touted as improving economic "efficiency," it also may reduce the accountability of the managers of the organization that does the outsourcing.
Pursuit of Economic Efficiency
In this case,
Outsourced hospitalists tend to make as much or more money than those that hospitals employ directly, typically in excess of $200,000 a year. But the catch is that their compensation is often tied more directly to the number of patients they see in a day — which the hospitalists at Sacred Heart worried could be as many as 18 or 20, versus the 15 that they and many other hospitalists contend should be the maximum.
It was the idea that they could end up seeing more patients that prompted outrage among the hospitalists at Sacred Heart, which has two facilities in the area, with a total of nearly 450 beds. 'We're doctors, we're professionals,' Dr. [Rajeev] Alexander said. 'Giving me a bonus for seeing two more patients — I'm not sure I should be doing that. It's not safe.' (A hospital representative said patient safety was 'inviolate.')
A constant theme of managerialism, and the neoliberalism that underlies it, is economic efficiency. The usual narrative is that efficiency means providing better goods and services at lower costs. Instead, managerialism and neliberalism may mean decontenting goods and services so as to lower costs to the organizations providing them, but not necessarily providing more value to consumers. In health care terms, managerialism and neliberalism may lead to less accessible, more mediocre health care that increase revenue to the organizations providing it, as implied by the physicians' comments above. Making the US the most commercialized, managerialist run, and arguably neoliberal health care system among the developed countries has not led to lower costs, better access, or better health care
The backstory for the outsourcing emphasizes that managerialism, and the resulting economic efficiency was indeed the goal of PeaceHealth…
In 2012, Sacred Heart's parent, PeaceHealth, a nonprofit health care system, installed an executive named John Hill to adapt its Oregon hospitals to the latest trends in health care. Mr. Hill, in an effort to rein in the budget and improve the efficiency of a hospital that administrators said was lagging in key respects, including how long the typical patient stayed, eventually concluded that the hospitalists at Sacred Heart should be outsourced.
Centralization of Control
The hospitalists also chafe at the way the administration has tried to centralize decisions they used to make for themselves. This might include hiring fellow doctors or the order in which they see patients on any day. They also complain of being loaded down with administrative tasks.
'We're trained to be leaders, but they treat us like assembly line workers,' said Dr. Brittany Ellison, a hospitalist in the group. 'You need that time with the patient,…'
A major feature of managerialism is the concentration of power within (generic) management. To quote Komesaroff(1),
In the workplace, the authority of management is intensified, and behaviour that previously might have been regarded as bullying becomes accepted good practice. The autonomous discretion of the professional is undermined, and cuts in staff and increases in caseload occur without democratic consultation of staff. Loyal long-term staff are dismissed and often humiliated, and rigorous monitoring of the performance of the remaining employees focuses on narrowly defined criteria relating to attainment of financial targets, efficiency and effectiveness.
We're Only In It for the Money
Also, the negotiations that started once the PeaceHealth physicians formed their union demonstrated a central tenet of managerialism
Even starker than the divide over these questions are the differences in worldview represented on opposite sides of the table. During a bargaining session last fall, the administration proposed increasing the number of shifts a year. Hospitalists now earn about $223,000 a year for 173 shifts and are paid extra for working more. The hospital offered $260,000 for a mandatory 182 shifts, and up to $20,000 in bonus pay for hitting certain medical performance targets. The hospitalists work seven days on and seven days off, so this would have effectively eliminated any time off for sick days or vacation.
When the doctors pointed this out, the administration responded that if they missed a few days, it would make sure they got extra days to hit the required number of shifts for full pay.
The hospitalists assured the administration negotiators that their concern had nothing to do with money — that none of this had ever been about money. They preferred to work less and make less to avoid burnout, which was bad for them and worse for patients. At which point the administration responded that money was always the issue, according to several people in the room. (The hospital declined to comment.)
Suddenly it dawned on the doctors why they had failed to break through, Dr. Alexander said. 'Imagine Mr. Burns,' the cartoonishly evil capitalist from 'The Simpsons,' 'sitting across the table,' he said. 'There's no way we can say, 'This isn't what we're talking about. We're not trying to get the bonus."
Again, managerialism is based on neoliberalism, and neoliberal view is that the market rules. The market is the arbiter of success, and money is the only outcome that matters. As Komesaroff put it(1),
The particular system of beliefs and practices defining the roles and powers of managers in our present context is what is referred to as managerialism. This is defined by two basic tenets: (i) that all social organisations must conform to a single structure; and (ii) that the sole regulatory principle is the market.
Mission-Hostile Management
Never mind that the centrality of money seems entirely inconsistent with the stated mission of PeaceHealth,
We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way.
Ostensibly, this is accompanied by core values, such as,
We choose to serve the community and hold ourselves accountable to exercise ethical and responsible stewardship in the allocation and utilization of human, financial, and environmental resources.
We build and evaluate the structures of our organization and those of society to promote the just distribution of health care resources.
We have frequently discussed how leadership of contemporary health care organizations often seem to act contrary to the organizations' stated mission, that is, mission-hostile management.
Value Extraction
Finally, while managerialism is ostensibly concerned with economic efficiency, whose efficiency matters. When managers address physicians' efficiency, they seem to look at amount of work done divided by the cost to the hospital of paying
physicians. However, they never seem to look at their own costs, the costs of management, as being a negative.
The PeaceHealth 2014 form 990, the latest available, states that the then CEO, Mr Alan Yordy (whose highest academic degree was an MBA, according to his LinkedIn page) had total compensation in 2013 of $1,366,742, and 11 other managers had total compensation greater than $250,000, with 9 having total compensation greater than $500,000. Those figures should be compared to the highest compensation offered the hospitalists, a maximum of $280,000 for 182 shifts a year, eliminating all vacation and sick leave. So if it is all about the money, the managers are making the most of it.
We have discussed ad nauseum the ridiculous compensation of the leaders of health care organization, even non-profit organizations. Value extraction by top management has become a central feature of the US and global economy (look here).
The NYT article did not discuss whether the upset hospitalists knew about their bosses' compensation. I suspect they did.
Forming a Functioning Union at the University of Washington
The media coverage of the UW housestaff unionization was less detailed. It does appear, though, that a stimulus was the pursuit of economic efficiency by UW management through squeezing the pay of housestaff, as described in the December article in the Seattle Times. In it the house staff said,
they account for about one-fifth of King County's doctors and they want higher pay, new child-care benefits and free parking. Some UW residents and fellows earn so little that they qualify for welfare programs like Temporary Assistance for Needy Families and the Seattle City Light Utility Discount Program, according to the UWHA [University of Washington Housestaff Association.]
Another article in early January, 2016 in the Seattle Times added,
The association has proposed that residents and fellows earn at least the same salary as the UW's lowest-paid physician assistants. Because the doctors in training work very long hours, they sometimes earn less than Seattle's minimum hourly wage, the UWHA has said.
The council members, in their letter to Cauce, called the situation shocking. And based on information from the UWHA, they wrote that some residents and fellows qualify for welfare programs like Temporary Assistance for Needy Families (TANF).
The Seattle articles noted that the UW housestaff may earn from just over $53,000 to just under $70,000 a year. Keep in mind, however, that under current rules, house staff may work up to 80 hours a week. So $53,000 for someone working those hours translates into $13.25/ hour, under what many people now claim is the living wage. That could be considered exploitation of workers with doctoral degrees working in often highly stressful situations where lives may be on the line. Whether there were issues other than money (and the respect it implies) involved at UW was not apparent based on the minimal press coverage.
So it appeared that the hospitalist physicians working for PeaceHealth, and most likely the housestaff of the University of Washington were pushed to unionize to counteract the managerialism of their hospital leaders.
The Results of Unionization So Far
In my humble opinion, similar stories to those at the PeaceHealth hospital about managers pushing physicians to increase productivity and efficiency, seemingly with little regard for the effect that might have on patient care and physicians' professionalism can be found at many hospitals and health systems. Housestaff may be paid at little more than minimum wage rates at many training institutions. However, employed physicians have rarely effectively resisted up to now. Perhaps one reason is that at many institutions, each employed physician has his or her own contract, and may feel little power to negotiate his or her working conditions independently. Housestaff physicians obviously might feel they have even less leverage. But at PeaceHealth Sacred Heart, the physicians had other ideas:
Amid the groaning, a relatively new member of the group named Dr. David Schwartz observed, 'They can't fire all of us — there are unions.' This was a bit of a stretch: While there are hospitals around the country whose doctors are unionized, there did not appear to be a union anywhere composed of a single group of specialists. But Dr. Schwartz, a barrel-chested man with close-cropped hair and a bushy beard who would not look out of place at a graduate English seminar, thought unionizing might be worth a try.
At the time, it was only one of several options the doctors considered. They talked of forming an independent hospitalists group, of forming an alliance with an outsourcing firm of their choosing. But the alternatives gradually fell away for a variety of practical reasons, and the doctors were growing increasingly bitter.
Dr. Littell developed a riff, which the other hospitalists appropriated, about how the situation was like having your spouse of several decades announce he or she was going to play the field. 'You've been great, you've always been there,' he would joke. 'I just heard there could be better spouses out there.' The kicker: 'The good news is, you're in the running, too!'
Amazingly, the unionization at PeaceHealth Sacred Heart was at least partially successful,
By March 2015, the PeaceHealth leadership, whatever its interest in efficiency gains, was apparently not pleased that one of its hospitals had a white-collar labor insurrection on its hands. The company announced that it would not outsource the hospitalists, a move it later said was always a possibility. Mr. Hill, who declined to comment, left in May.
The union did defeat the outsourcing tactic. But otherwise results have not been so quick to appear,
Noting that the negotiations with the hospital administration have dragged on for roughly a year, Dr. Schwartz said, 'It's pretty obvious that they don't want to get a contract done.' He says the administration worries that if it essentially rewards the hospitalists with a contract, it encourages other hospital workers to unionize too.
The housestaff at UW used a slightly different set of tactics, but still managed to form a real union. Per the earlier Seattle Times article,
Established in 1964, the UWHA was mostly dormant during the 1980s and 1990s, according to the association's website. It became active again starting in 1999. In 2013, members proposed making it a state-recognized collective-bargaining unit.
The UW petitioned the state Public Employment Relations Commissionto block the move, arguing that the residents and fellows were students paid stipends rather than employees paid salaries. But the commission sided with the residents and fellows, who last year voted to unionize.
The housestaff association has succeeded in negotiating. But as did the PeaceHealth doctors, they have not yet been able to secure their positions, per the later article.
University of Washington brass say they're committed to providing the UW's medical residents and fellows with decent compensation and benefits, but they insist the newly unionized doctors in training are asking too much in contract negotiations.
Talks have been stalled for some time but are set to resume this month with a mediator assigned by the state Public Employment Relations Commission.
The two sides 'remain far apart in the area of compensation,' Joyner wrote in his letter.
Parenthetically, unexplored in any of the press coverage is whether the parallels between what is going on at PeaceHealth and the University of Washington have to do with explicit ties between the organizations. In 2013, per Beckers' Hospital Review, the news broke that the two institutions signed a letter of intent to create a "strategic alliance." In 2014, an article in the Seattle Times noted the ongoing concerns of housestaff and students at UW that the alliance could be diminishing their educational opportunities.
In one sense, it is amazing that physicians are now starting to unionize as a response to the managerialism of their leaders. It was not all that long ago when the majority of physicians worked as solo practitioners or in small group practices, and fiercely defended their autonomy. The last thing they would have thought about was unionization. Since physicians were their own bosses, with whom could their unions have negotiated? In addition, in the US, independent physicians and physician practices could not legally unionize. Practices that discussed such issues as fees were liable to anti-trust prosecution. And with what bosses could they have conceivably negotiated.
Yet now physicians are increasingly corporate employees, hence corporate physicians. At the moment, unionizing may be one of the few effective tactics health care professionals can use to halt the march of managerialism/ generic management and partially relieve the plight of the corporate physician (and health care professional.) However, in the long run, as long as people who care more about money than about patients' and the public's health run health care, even unions will not be able to make that much progress, and not without adverse effects.
It would take true health care reform to address the larger problems with health care and society that is now leading to physicians unionizing. In my humble opinion, hospitals, health care systems, and other "provider organizations" should seek better patient care, not growth. Should they not voluntarily downsize (an almost comical idea in the current context), anti-trust enforcement, and probably new legislation would be needed to stop their pursuit of market dominance and return them to responsible community organizations. The now much smaller hospitals, and provider organizations should not be run for profit, and the commercial practice of medicine should again be illegal. Most physicians should go back to being private practitioners as individuals or within small groups. Leaders of hospitals and provider organizations should be accountable for putting patients' and the public's health first, upholding professional values, and should not expect to get rich doing so. But I dream on….
This entry was posted in Banana republic, Guest Post, Health care, Ridiculously obvious scams on January 19, 2016 by Yves Smith.
← New Paper Makes Powerful Case Against Tax Treaties Links 1/19/16 →
Keith January 19, 2016 at 7:37 am
The biggest problem with rent an MBA managers is that they don't understand the business.
Not understanding the business means they don't know how to grow it through investment, they only really understand efficiency savings and cuts.
With this mind set there is only one way to expand and that is trough mergers and acquisitions where they can take something that already works and then cut out or merge common areas where their expertise still comes into play.
Expansion through cuts in existing businesses.
The German engineering company is usually a family business where its leaders have lived and breathed that business for as long as they can remember. They know which areas are likely to yield growth and know where to invest for the future.
Inverness January 19, 2016 at 9:04 am
Managerialism and deprofessionalization. It started in education in the US over a decade ago. I never thought it would happen in a highly respected field like medicine, where MBAs would take over positions that medical professionals once had. According to our era's neoliberal dictates, the manager is king, and the professional is dead. The manager can do anything! Doctors and nurses are going to need the support of their patients (ie; us) in order to fight this beast.
Gio Bruno January 19, 2016 at 5:23 pm
I think it's important to understand the term "hospitalist". This term is for doctors (usually young, former interns) that practice solely within the hospital. Most, if not all, do not have separate private practices— yet. I don't know whether private practitioners are soon to be unionized.
In any case, this article is just another rationale for single payer insurance (and medicine for health sake, not big profits).
Joe Beckmann January 19, 2016 at 10:13 am
Until they also attack "big pharma," and the vastly inflated pricing like that of Martin Shkreli and J. Michael Pearson, of Valeant Pharmaceuticals, they will only look selfish in this era of organizing. The most obvious corruption in medicine is in pharma, but the rest of the "industry" is surely as vulnerable as higher education, for another example, and films like "Ivory Tower" make the case for organizing all the more apparent.
Synoia January 19, 2016 at 11:15 am
Management get the Unions it dissevers. Management want to cut overhead, but not themselves, It appears the same factors are at play in higher education.
Unions only succeed if ALL the members practice solidarity. As goes the famous (mis)quote, "Gentlemen, we must all hang together, or assuredly we will all hang separately."
flora January 19, 2016 at 11:51 am
Thanks for this article. Industrial time and motion studies to find more efficient production and better quality of widgets makes sense in industrial production. Applying time/motion industrial studies to the practice of medicine or education is a misapplication of industrial techniques; similar to misapplied metrics in corporate decision making you mentioned in earlier posts. Doctors and teachers are not assembly line workers turning out uniform widgets to sell. Patients and students are not widgets. Uniform production methodology does not work in medicine or education. It is not even capitalism. It is pure rent extraction from a captive population.
KYC January 19, 2016 at 12:15 pm
I don't see how physician unions can be too effective. If they strike, it ultimately impacts patient care which is one of the things that are important to them. It's similar for patients supporting physicians, it may come down to a choice of forgoing treatment to boycott management at the detriment to their own health.
The long term solution has some parallels to local vs national politics. Physicians need to create their own pipeline of future business managers who can take control back from the MBAs. Choosing to focus narrowly on medicine is not really a viable option for the collective group. Eventually, when the differences in quality of care are obvious between physician-managed versus generic manager led providers (and potentially with better costs), patients will vote with their feet and wallets.
Synoia January 20, 2016 at 1:09 am
Israeli doctors struck some years ago. The death rate fell.
guest January 20, 2016 at 8:15 am
Oh, they could be very effective — if they used the nuclear option.
Some years ago, nurses in Finland got into difficult negotiations on the renewal of their collective agreement.
The major point of dispute was wages. For years, many Finnish nurses preferred to emigrate to countries like Norway where they are far better paid, and where the working conditions are less stressful.
The main nurses union announced that if health ministry and hospital administrations continued to refuse negotiating the nurses demands, they would resign en masse.
As the deadline neared, panic struck hospital administrations and politicians, as the union appeared totally set to carry out its threat. There was even a last-ditch scramble to pass a law to force nurses to continue working after a resignation, a move which the union declared it would oppose in courts on constitutional grounds.
In the last days, negotiations became frantic and the nurses got largely (albeit not everything) what they were asking for.
There were similar movements in other countries (such as in Ireland and Canada), and the outcome of such actions has been analyzed.
KYC January 21, 2016 at 5:24 pm
Great examples! And yes, I can see that striking healthcare providers (physicians and/or nurses) en masse would frighten politicians. However, when I imagine how the business MBA would deal with this, it might just be to shut down the hospital/practice and move on to a different business altogether for their next rent-seeking gig. When it's treated purely as a business decision, I fear that striking unions would always lose.
The examples that were provided in the two responses above involve countries where there is government accountability for healthcare. In the US, who can the public get angry with when hospitals shut down? The CEOs are largely anonymous to the general public, and given the seemingly high salaries of many medical providers, propaganda stories can be planted in the media to villainize the unions (as is already done in other industries).
Dave January 19, 2016 at 12:15 pm
Yves wrote:
"And the managers are all MBAs, so it is not as if the effort to routinize care is driven by people who in theory might have ideas about how to achieve better medical outcomes."
Chelsea Clinton Mezvinsky has an MBA in Healthcare.
She is out campaigning for Mommie Dearest.
TedWa January 19, 2016 at 12:17 pm
Geez, I didn't realize they were doing this to doctors and staff. Commoditization I mean. RE Appraisers were independent contractors whose industry was commoditized by Andrew Cuomo's illegal HVCC and the logic used is that all appraisals and appraisers are the same. This logic is what caused inflated values and the meltdown but has now been made legal just as counterfeiting by the banks was made legal early in the 20th century through the Federal Reserve Act and fractional reserve banking (my understanding). Back to the neoliberal logic used here. All physicians are the same and do the same work with the same quality and talent so why not commoditize them by interjecting a management company in the process is the neolib thought process. That way they can get these "independent contractors" under control and by "managing" (getting rid of independent contractors) them at high fees. Appraisals now cost consumers about twice what independent appraisers would charge and that is to cover the management fees. But that isn't enough, these management companies also skim the fees appraisers are paid. The same goes for these physicians it appears. I see their quandary as being independent was a respected attribute but respect and individuality and talent has no place in neoliberalism. Like appraisers it's hard for them to organize to fight off these blood sucking leeches since they never had to before and most physicians (like appraisers) loved their independent status and lives and dislike this managerial structure being imposed on them with their fees being taken for their unnecessary "management". Like UBER, they are probably subcontractors to these management companies so these MC's don't have to pay any employee benefits.
I'm sure readers of NC all know this but I had to express my empathy for their plight. They could join the SEIU and/or the AMA, both Guilds. Truly independent contractors are done in this neoliberal age of vampire squids protected by neolibs and often illegal but made legal laws.
perpetualWAR January 19, 2016 at 12:49 pm
More and more I view the UW as a big evil. As seen in this case.
Keep in mind, Foster School of Business at UW brought Jamie Dimon to Seattle as keynote speaker for their "Leadership Awards". I now view UW as a scourge on the City of Seattle.
gardener1 January 19, 2016 at 4:46 pm
The highest paid employees of the state of Washington are state university sports coaches, football and basketball, ringing in at millions per year. Value baby, value.
Lambert Strether January 20, 2016 at 12:07 am
Who would have thought that weasels and badgers share the same habitat?
Michael Fiorillo January 20, 2016 at 6:14 am
UW, with funding from the Gates Foundation, is also a vehicle for privatizing K-12 public education, via its Center For the Reinvention of Public Education.
"Reinvention" translates from Newspeak into English as "Hostile Takeover Leading to Privatization."
Knute Rife January 20, 2016 at 3:10 pm
They invited the man who destroyed Washington Mutual to keep Chase afloat to talk about leadership, yet everyone in the region keeps preaching that UDub is a world-class institution.
Wade Riddick January 19, 2016 at 12:54 pm
If outsourcing was what this was really about, the over-priced parasites managing American medicine would have been expelled long ago and cheap Cuban communists imported to run our system. Cuba keeps more people healthy for less money than almost any place on Earth. The ultimate irony of neoliberalism is that it's getting outcompeted by people who don't believe in capitalism. The employees with the most unjustifiable wage increases and worst relative productivity in medicine are, as Dr. Poses points out, the guys at the top.
Neoliberalism is, of course, just another way of hiding managerial looting and fraud. It's all about agent loss. These guys are just coming up with new excuses each year to confiscate more of the healthcare budget for themselves.
None of these bonuses are measured by whether patients get healthier faster and at a lower cost – *to the patient*. What other important measure of efficiency should we consider?
Profit.
As Shkreli said, he's in a "price-inelastic business" and that's why he hiked prices the way he did. He could charge whatever he wanted because if patients didn't pay, they died. We should have paid closer attention to that logic because it's apropos here. This is only about how the patient is of use to the corporate bottom line.
This patient is actually the product being manufactured. We are traded back and forth to health insurers, drug companies and others for reimbursement – not dissimilar to the way TV news serves up consumers as a dish to their true customers, their advertisers.
All of the points Dr. Poses brings up are valid, but some clarification from economic theory here would be helpful. The healthcare business is not a business. It is a monopoly utility. When its profits are not properly regulated (as today) its prices quickly become extortionate.
If a patient has diabetes, they require insulin. There isn't any way around this unless you can replace the pancreatic beta cells (killed by autoantibodies in type I and innate cytokines in type II). How do you plan to ration care for that? There is, however, a way to jack up the price. Patent chemical variations on insulin and then take the public domain insulin off the market through collusion. This then divides up the captive market into a series of oligopolistic suppliers who face no competition from the real molecule and they can jack up prices just like they've been doing the last few years. Patients have no place to turn (and the pseudo-insulin probably isn't so great for their health either).
It's the patients who need to unionize but like Mancur Olson observed in _The Logic of Collective Action_, some interests are easier to organize than others. Rounding up three cartels to agree on a common political cause is much easier than organizing millions of very sick and financially stressed people and asking them to give money to politicians or opening up a nonprofit coop that passes FDA scrutiny to make insulin.
Relative organizational cost is a vitally important point to remember as we discuss physician unionization and the pending overthrow of a century of Supreme Court doctrine supporting collective bargaining.
It's a point that the lawyers in yesterday's New York Times article, "Case Could Widen Free-Speech Gap Between Unions and Corporations," don't quite understand. It's not just the shareholders of corporations who have their pockets picked when corporate management makes political donations. Shareholders of common stock are pretty low on the totem pole of interested parties in a bankruptcy. Ahead of their claims on the ownership of corporate assets come lenders, bondholders, customers and employees themselves (who after this recent court decision will probably have even less hope of unionizing than they do now).
According to the court's logic, shareholders can just sell if they don't like the decisions of management. They're also supposed to have the benefit of all this transparency in campaign finance that the delusional Justice Kennedy keeps assuming exists.
What about customers – who have a higher claim on corporate assets than common stockholders? How are *customers* supposed to navigate a marketplace made up of opaque monopolies and then make a choice about where they want to take their money? How does a customer of a cartel have more choice and freedom when they're overcharged for a service or good – especially if no other alternative is available to treat their illness? If everybody making insulin is stealing your money and charging you to buy off your politicians, how is this liberty? Maybe it's good for the freedom of the guy picking your pocket, but not for you.
This is the "freedom to contract" nonsense from Lochner all over again. Except it'll get rich people like Scalia killed when they pop up in this inefficient, error-prone sickcare system too. Corruption of the body politic, like the body personal, is often communicable – a fact this court routinely ignores.
Against this backdrop, doctors are going to unionize?
Expect to see more prescription writing authority migrate into the hands of bureaucratic tools.
The system is set up this way because it's the most efficient way of extracting political rents.
P.S. These are not the only ways solo medical practice is threatened. For years regulators have been restricting the sale of compounded medication to doctors for in office use making things like simple compounded Avastin eye injections harder and more expensive to do. Large hospital chains and main pharma products are, not so inconspicuously, exempted from these regs. A thicket of obstacles are preventing solo practices from being cost effective and on the same level playing field as regional cartels. It's occurring all up and down the supply chain.
PQS January 19, 2016 at 4:50 pm
"The ultimate irony of neoliberalism is that it's getting outcompeted by people who don't believe in capitalism."
Beans January 19, 2016 at 5:13 pm
Excellent post, Wade Riddick.
The healthcare industry has morphed into a jobs program. Not only does repairing it require the removal of the rentiers at the top, it will also result in the job losses of many who contribute to the maintenance of the status quo, but nothing to improving a patient's health.
I don't think there has to be job loss, net; after all, many of the positions now servicing insurance company billing systems could be repurposed for patient care — one of the cases where the neo-liberal "training" panacea would actually work!
Beans January 20, 2016 at 11:25 am
Power is maintained by the healthcare rentiers by supplying the market with thousands of jobs – not by providing healthcare. Right or wrong, politicians fear massive job losses that would come if power and control of healthcare delivery was wrested from their hands and returned to individuals, healthcare providers and non-profits. Obamacare is a jobs program – more IT jobs to launch, sell, maintain and upgrade the EHR. More jobs for healthcare navigators and administrators. More jobs by ensuring that the market remain inefficient with multiple ACO's run by multiple private insurance/ hospital groups instead of a single payer. More jobs for the medical device industry, medical real estate investors, medical building contractors, medical sales personel, etc. Obamacare masquerades as healthcare policy but it is an economic program that played a big role in "ending" the recession. That is why we now talk about consumers instead of patients.
You are correct that jobs could be re-purposed – as long as people do something that provides them money on which to live, the problem with job losses goes away. But as long as big healthcare power brokers control the economic fate of tens of thousands of their employees, they control the healthcare marketplace.
"the patient is the product being manufactured" – Wade Riddick – this sums it up nicely. The healthcare workers are the unrepresented factory workers of our current time.
hunkerdown February 10, 2016 at 2:05 am
There'd be hours lost on net, no question about it. Medical billers wouldn't be needed in every office (or maybe any office). Time wouldn't need to be spent arguing with insurers, so medical case management would give way to something more like traveling nursing. Nobody would need to punch buttons on accounting packages poorly disguised as health care IT; maybe nobody or nearly nobody would need to write them, the billing organization having standardized on some government open source project like Ontario's OSCAR. (Hopefully I'd be writing more patient-centered software myself.) And won't someone think of the personal injury law firms? There really would be a lot less to do, as suggested by the 18% of GDP "health" currently represents.
Then again, a BSN degree doesn't automatically confer bedside manner, and that some nursing grads decided to install themselves in offices rather than wards might be small acts of mercy.
Steve H. February 10, 2016 at 7:53 am
+. Aand +. Oh and +++.
Put everyone to work taking care of people or ferreting out Medicare fraud.
Salamander January 21, 2016 at 7:16 am
You sir are a brilliant writer. Thank you.
jkl January 19, 2016 at 2:30 pm
When did any of us make 'informed' choices about products. Beyond price and maybe utility, we all rely on the FDA/FTC to make sure the products don't cause cancer or kill us. As a health care professional, my nutrition information is pretty limited, about on par with a dietician. The chemical and unnatural components are a mystery to me.
Oregoncharles January 19, 2016 at 4:01 pm
There's a great irony here: Peacehealth/Sacred Heart, as the name implies, is a CATHOLIC hospital. Last I heard, its purpose was to support an order of nuns. No telling where the money goes now – but it's going somewhere.
On the one hand, that's a problem for the cities it serves (Springfield and Eugene), because Catholic doctrine limits the services available at their main hospital. But the irony is, neoliberalism runs right counter to the supposed charitable purpose of Catholic hospitals – and indeed, against recent pronouncements of the Pope. It's openly immoral.
If I can find an email address, I think I'll suggest to the hospitalists' union that they go over the negotiators' heads, using a MORAL argument. Might even manage to get the administrator fired – if they're public about it.
It's bad that it's Catholic, but just might give them leverage in this case.
Clive January 19, 2016 at 4:09 pm
Management at PeaceHealth really are Hell's Angels.
Wade Riddick January 20, 2016 at 5:18 am
Hell's Angels aren't as stingy with their drugs.
Malcolm MacLeod, MD January 19, 2016 at 9:00 pm
I feel that I have read this article elsewhere in the recent past, and shall simply state that money
and medicine make strange bedfellows. Medicine as a profession can and should be fun, and
attempts to increase income are maladaptive. I has a ball in general pediatrics, but I retired in
1996 and things were just starting to turn at that time with the advent of mediocre MBA's. Today,
I'm not certain that it's worth it here, but it is in Europe. So far as working seven day shifts in a
hospital, that's just plain stupid.
Ed Walker January 19, 2016 at 10:33 pm
Note that there are no union contracts. That's because the one thing that our managerial class has learned, is how to screw unions.
It's what the big, Chapter 11 bankruptcies are all about.


On April 15th participants of the 2nd Travel Trade Athens Workshop visited the Visitors Center of the SNFCC, where SNFCC representatives presented the project, its philosophy and the aspiration to become an educational, recreational and environmental landmark of international appeal.
Kathimerini reports on the progress of the SNFCC construction works in an article entitled "The Dream takes Flesh and Bones".
The Mobile Medical Units are visiting the island of Kasos. As was the case with the visits to Kastelorizo and Amorgos, the Mobile Medical Units will offer the residents of Kasos free access to comprehensive health care services. The Units will be in Kasos from Wednesday April 9th till Sunday April 13th.
On April 2nd, 2014 the University of Pennsylvania hosted a Scholarship Celebration in New York, bringing together the donors of undergraduate student scholarships with the extraordinary student recipients that those scholarships support. At the event, SNF staff members met with the student recipient of the Stavros Niarchos Foundation World Scholar Scholarship Fund, which was established by the Foundation to support students from Africa and other parts of the world.
The exhibition "Renzo Piano Building Workshop – Piece by Piece" opened in Padua on March 15th at the Palazzo della Ragione, as part of the International Biennial Architecture, showcasing models of architectural projects spanning more than thirty years by the Renzo Piano Building Workshop. The exhibition first took place in the Gagosian Gallery in New York, where it was solely funded by the SNF.
The "Journey to the SNFCC" continues in various municipalities across Attica, through the open participation of the public in cultural and educational events carried out as part of the program. The main purpose of the program is to give citizens the opportunity to familiarize themselves with the SNFCC and its philosophy, as well as to create a fresh approach through which the country's citizens may engage with the project that aims to contribute in the enhancement of their everyday lives.


text:
Q: Resizing FlowLayout panels I'm trying to create a JPanel that uses the FlowLayout. This panel is placed inside of a container using BorderLayout. This container is then added to a card using CardLayout. I would like the panel using FLowLayout ot be a small box in the bottom left corner of the BorderLayout panel. How would I do this? I've used settingsPanel.setPreferredSize(new Dimension(10, 425)); but the width still spans across the whole panel no matter what size I set, although the height changes. How would I get the width to change?
Code:
import javax.swing.*;
import java.awt.*;
import java.awt.event.*;
import java.net.*;
import java.io.*;

public class Main {
    //Settings Panel variables
    JLabel settingsTitle = new JLabel("Settings");

    public Main()
    {
        JPanel mainCard = new JPanel(new BorderLayout(8,8));
        JPanel settingsPanel = new JPanel(new FlowLayout(FlowLayout.CENTER));
        settingsTitle.setFont(new Font("TimesRoman", Font.PLAIN, 35));
        settingsPanel.add(settingsTitle);

        final CardLayout layout = new CardLayout();
        final JPanel cards = new JPanel(layout);
        cards.add(mainCard, "2");

        mainCard.add(settingsPanel, BorderLayout.SOUTH);

        settingsPanel.setPreferredSize(new Dimension(10, 425));
        settingsPanel.setBorder(BorderFactory.createLineBorder(Color.black));

        layout.show(cards, "1");

        JFrame window = new JFrame("Test");
        window.setDefaultCloseOperation(JFrame.EXIT_ON_CLOSE);
        window.getContentPane().add(cards);
        window.setSize(1280, 720);
        window.setLocationRelativeTo(null);
        window.setResizable(false);
        window.setVisible(true);

    }

    public static void main(String[] args)
    {

        SwingUtilities.invokeLater(new Runnable() {
            @Override
            public void run() {
                new Main();
            }
        });

    }
}

Example:

A: So here's your code changing the BorderLayout with GridBagLayout. The core idea of the GridBagLayout is that you'll have a grid with several rows and columns (of different sizes) and you can place components in each cell. The neat thing about it is that it's very powerful: when you place a component in a cell you can customize the following:

*

*How many cells can it span through (vertically, horizontally or both) (gridwidth/gridheight)

*Where in the cell to put it on: center, top-left, bottom-right... (anchor)

*The weight of each row/column, this is how much space, proportionally, do they eat when resizing/distribuiting the window. (weightx, weighty)

*Whether they have to occupy the maximum or the minimum space necessary. (fill)

Among other things. The last point was your problem here, BorderLayout was forcing your panel to expand as much as it could. In my code I used fill = NONE and set it at the anchor = LAST_LINE_START so it stays at the bottom left and doesn't expand.
You can play with these parameters, all the info is in the tutorial.
The key to all of it is to know how is your grid. In this example it's very simple it's just a 1x1. But look at the tutorial: those images with a grid painted in red over them, that's what you have to have in your mind. Other than that and knowing all the variables the only tricky thing is how weights work.
    import java.awt.BorderLayout;
    import java.awt.CardLayout;
    import java.awt.Color;
    import java.awt.Dimension;
    import java.awt.FlowLayout;
    import java.awt.Font;
    import java.awt.GridBagConstraints;
    import java.awt.GridBagLayout;

    import javax.swing.BorderFactory;
    import javax.swing.BoxLayout;
    import javax.swing.JFrame;
    import javax.swing.JLabel;
    import javax.swing.JPanel;
    import javax.swing.SwingUtilities;
    public class Main {
    //Settings Panel variables
    JLabel settingsTitle = new JLabel("Settings");

    public Main()
    {
        JPanel mainCard = new JPanel(new GridBagLayout());
        JPanel settingsPanel = new JPanel(new FlowLayout(FlowLayout.CENTER));
        settingsTitle.setFont(new Font("TimesRoman", Font.PLAIN, 35));
        settingsPanel.add(settingsTitle);

        final CardLayout layout = new CardLayout();
        final JPanel cards = new JPanel(layout);
        cards.add(mainCard, "2");

        GridBagConstraints c = new GridBagConstraints();
        c.gridx = 0;
        c.gridy = 0;
        c.weightx = 1.0;
        c.weighty = 1.0;
        c.anchor = GridBagConstraints.LAST_LINE_START;
        c.fill = GridBagConstraints.NONE; //uneeded line because it's the default value, but it has to be NONE

        mainCard.add(settingsPanel, c);

       // settingsPanel.setPreferredSize(new Dimension(300, 425)); //the components inside settingsPanel will set its side
        settingsPanel.setBorder(BorderFactory.createLineBorder(Color.black));

        layout.show(cards, "1");

        JFrame window = new JFrame("Test");
        window.setDefaultCloseOperation(JFrame.EXIT_ON_CLOSE);
        window.getContentPane().add(cards);
        window.setSize(1280, 720); ///replace with window.pack()
        window.setLocationRelativeTo(null);
        window.setResizable(false);
        window.setVisible(true);

    }

    public static void main(String[] args)
    {

        SwingUtilities.invokeLater(new Runnable() {
            @Override
            public void run() {
                new Main();
            }
        });

    }
}

A: First of all get rid of this: settingsPanel.setPreferredSize(new Dimension(10, 425)) and let the layout managers do their job.
The easiest way I can think about is just wrap settingsPanel inside a different panel and add this last one to the SOUTH:
 JPanel wrapPanel = new JPanel(new FlowLayout(FlowLayout.LEFT));
 wrapPanel.add(settingsPanel);

 JPanel mainCard = new JPanel(new BorderLayout(8,8));
 mainCard.add(wrapPanel, BorderLayout.SOUTH); // add wrapPanel here instead of settingsPanel

This way you can take advantage of the FlowLayout property to fill the lesser space it needs:

Really off-topic but I think it's worth
As I've already comment in your previous question  this panels thing makes me remember this Portal 2: Panels video. We also need some time to laugh, don't you think?

redpajama_set_name: RedPajamaStackExchange


We love to hear feedback, suggestions, silly jokes, and general mischief that you've been up to in your MADWAG garms. Drop us a message at hello@madwagclothing.com to keep us up to date with whats going on in your little bubbles.
Like a proud parent, we keep all photos of you looking ridiculous in your MADWAG garms, and will show them to people at any given opportunity! Once a month we hand out a £40 MADWAG voucher to our favourite photo. To be in with a chance of winning, follow us on Instagram @madwagclothing and tag #madwagwinner on your photo.
All mail, including exchanges / returns, should be directed to: MADWAG, 59 Dove Street, Bristol, BS2 8LS, UK.


Set up coherent programmes of transport R&D as an integral element of the Eighth Framework Programme.
Include a dedicated automotive R&D initiative with a budget share consistent with the sector's contribution to the EU economy.
Ensure that EU automotive R&D is oriented towards providing solutions for the sector's societal demands, including mobility, transport, environment, energy efficiency and competitiveness, by integrating expert input from the industry.
Support relevant Innovation Partnerships with these dedicated automotive R&D activities in the Framework Programmes.
On the basis of these recommendations, EUCAR will continue to engage with policymakers and all stakeholders regarding the future of the Research Framework Programmes and looks forward to an intensive exchange of expertise as the policy debate progresses.


Santa Barbara's Current Median Sales Price! Plus home sales year-to-date.
Santa Barbara's Real Estate Market Update for the past three weeks!
Santa Barbara's Real Estate Market Update for 2016!
Live by the beach in a beautiful condo!
Beautiful condo in Winchester Commons at a low price!
Time to buy! Santa Barbara's home prices are starting to level out.
Beautiful new listing with amazing views!!!
Santa Barbara's home and condo sales for the FIRST QUARTER!!
Amazing new listing in beautiful Santa Barbara!
Price trends in Santa Barbara over the last 26 years!
Beautiful new listing in Goleta's Crown Collection. Must See!!
The 2015 market update from Carpinteria to Goleta.
Santa Barbara's market for this November compared to last November.
Pay for the right upgrades that will make you money when its time to sell.
Statistics for the last four weeks on Santa Barbara's Real Estate Market.
3rd quarter and year to date statistics for Santa Barbara's Real Estate Market.
Here are a few key tips on hiring a contractor.
Homeowners thoughts on selling in today's market!
Homes in Bel Air Knolls are moving fast, even with a high price tag.
Semi annual market update compared to last year.
Incredible New Listing on the Upper East Side!
Amazing upgraded home with permitted guest house and jacuzzi.
What do Millennials prefer? City or Suburban Living?
Millennials prefer suburban living to city living!
Is purchasing a new home better than renovating your current home?
Are you better off purchasing a new home or renovating your current home?
Awesome non-profit organization. Anyone can make a difference. #LiveBeyond!
How is the market trending?
Don't know where to take your kids Trick or Treating? We do!! Or maybe you need some snack ideas for your own party. We have those too!!
Good News for Sellers property values are up! Good News for Buyers interest rates remain LOW!
Monthly mortgage payments for the typical U.S. home currently compare more favorably to rents than at any time since the early 1970s. In California, prices vary widely by region. Here are the areas in California where buying a home will save you money in the long run.
So you're ready to buy your first home. How much are entry-level homes in the different areas of California? How much do you need to earn to qualify for a home loan? And what can you expect your monthly mortgage payment to be once you move in?
Santa Barbara, framed by the Santa Ynez mountains and kissed by the Pacific Ocean, is a hiker's paradise. Here are a few of my favorite day hikes. They range from a short 45 minutes to 1/2 day treks. I hope you will enjoy them as much as I do.
Looking for something new and exciting to enjoy this summer? Experience Santa Barbara's own Greek festival this July. The 39th Annual Greek Festival is taking place from 11 am to 7 pm on Saturday, July 28nd Sunday July 29th in beautiful Oak Park.
With the uncertainty of the real estate climate, home staging can be an effective tool to help sell your home quickly. Hiring someone to prepare your home so it makes a good impression on buyers can really pay off for several reasons.
With today's real estate market dramatically changing daily, it is still always better to be a homeowner. Here are 5 brief reasons why it is so great to own your own home.
How is Santa Barbara Real Estate?
Live on Cloud 9! This Spanish Hacienda has unobstructed 360 degree views extending from the SB Airport to Pt Mugu. The focal point of the home is the South facing Living/Dining room with walls of glass 18 ft vaulted, tongue groove cedar ceiling. The mountain top retreat is perfect for those looking for a sense of serenity seclusion or a weekend pied-a-terre.


text:
Q: Room - LiveData unnecessary when reading data only once? I am following this codelab and one of the suggested best practices for retrieving data from a database was to use a LiveData wrapper for my DAO return values (step 6 in the codelab).
But in my app, I am reading an existing .sqlite file only once at the start of the activity. Thus using this wrapper should be unnecessary, am I correct?
So is it acceptable (in terms of best practices) to make my DAO return a simple object instead of using the LiveData construct around it?

A: There are two features of LiveData: delivery of updates and asynchronous operation.
If you will not be changing the data during the run of your app, you will not take advantage of the update-delivery feature of LiveData.
However, you still need to arrange to load the data on a background thread. If you plan on doing that by some other means (e.g., RxJava, your own background thread), you could avoid using LiveData.
Also, if your plan is to load all of the data in the database at the outset and never change it, then SQLite and Room are pointless. Just use a JSON file. The value in SQLite is in being able to query and modify parts of the data.


text:
Ghatail is an upazila located in Tangail District, Bangladesh. The upazila is bounded by Gopalpur and Madhupur upazilas on the north, Fulbaria and Bhaluka upazilas on the east, Kalihati and Sakhipur upazilas on the south, Bhuapur and Gopalpur upazilas on the west. Main rivers are Bangshai, Jhinai, Toak.

History

Naming: According to Akbarnama, one fight happened between Ishakha Army and Mughal Army in 1601 and Mughal Bahini defeated Ishakha on Atia fight. There was a small soldier post of Ishakha on Bank of Toke river which was called GHAT as well, and the connecting road between Ghat and Ghuiler Gor( hilly area of eastern part of Ghatail, which is also part of Madhupurer Gor) called AIL, joining this two part Ghat and Ail created name Ghatail.

Early history
During the rule of the Pala Dynasty this area was used as a corridor between Borendro Somapura   MahaBihara and Mayanamti Mahabihara. Lausen established   Pala ruling at Mymensisg area, Lauasen who was general of Dabaplala, second Pala King of Pala Dynasty. There was a small Pala landlord named Kalidash Pala, Josho Pala and Harishchanda Pala was ruling as zonal king under Debapala. Joshopala's capital was located between Vawal and Miadhupur Gor. Many old superstructures and buildings still exist at Shohor Gopinpur, Shamsher Chala of Ghatail and the name of the surrounding area( Fulmalir chala, Malir Chala, Besshar Chala,) also state the existence of that king.
The Bangshi River once used as river way that time supporting the thousands years old lighthouse located on a top of deopara hill. there is a local Myth son of Dharamapala name Shagar Pala came here and start living, Shagar Pala had made one big pond, still name of that pond is Shagardighi size 12.80 Acre.

Economy
Main occupations: Agriculture 59.46%, agricultural laborer 16.7%, wage labourer 1.47%, commerce 7.78%, transport 1.54%, service 5.23%, others 7.82%.Land use: Total land under cultivation 33300 hectares; fallow land 11871 hectares; single crop 22%, double crop 49% and treble crop land 29%.
Land control: Among the peasants 48% are landless, 35% small, 11% marginal and 6% rich.

Value of land: The market value of the land of the first grade is Tk 8500 per 0.01 hectare.
Main crops: Paddy, jute, mustard seed and potato, pineapple, ginger, turmeric and banana.
Extinct and nearly extinct crops: Sesame, linseed, wheat, garlic.Main fruits: Mango, jackfruit, banana, papaya, berry, watermelon and pineapple.
Fisheries, dairies, poultry: Livestock welfare center 3, artificial insemination center 3, diary 7, poultry 21.
Communication facilities Roads: pucca 4722 km, semi pucca 28.98 km, mud road 844.59 km.
Traditional transport: palanquin, horse carriage, bullock cart, buffalo cart and dhuli. These means of transport are either extinct or nearly extinct.Cottage industries: Goldsmith 150, blacksmith 50, potteries 780, wood work 540.
Hats, bazaars and fairs: Hats and bazaars are 22, most noted of which are Hamidpur, Ghatail, Dhalapara, Sagardighi and Pakutia; fairs 3.Main exports: Jute, pineapple, watermelon, paddy, oil and pipe.NGO activities: Operationally important NGOs are BRAC, Prosika, ASA, Buro Tangail, Thengamara Mohila Sabuj Songa, Palli Unnayan Sangstha, Shamadha and Jibika.Health centersP: Upazila health complex 1, satellite clinic 6, family welfare center 10 and community clinic 24.

Administration
Ghatail Upazila is divided into Ghatail Municipality and 14 union parishads: Anehola, Deulabari, Deopara, Dhalapara, Digalkandi, Digar, Ghatail, Jamuria, Lakherpara, Lakkhindar, Rasulpur, Sagardighi, Sandhanpur, and Sangrampur. The union parishads are subdivided into 291 mauzas and 411 villages.

Ghatail Municipality is subdivided into 9 wards and 17 mahallas.

Educationone' University college( GBG university college), Three colleges and one women's college, 3 higher secondary schools, one English medium School( Ghatail International School, Play group to O level, Sponsored by ghatail Cantonment ) 37 secondary schools, 103 government primary schools, 52 non-government primary schools, 10 community primary schools and 52 madrasas.
 Pakutia Public School and College
Ghatail Cantonment Public School and College, Ghatail, Tangail
Ghatail Govt. Pilot High School, Ghatail, Tangail
Athail Shimul High School, Ghatail, Tangail
Wisdom Valley, Ghatail, Tangail

Notable residents
 Rafiq Azad, poet, was born in Guni village in 1941.
 Mamunur Rashid, actor, director, and scriptwriter, was born in Bhabandatta village in 1948.

See also
 Ghatail
 Upazilas of Bangladesh
 Districts of Bangladesh

References

External links

Upazilas of Tangail District

ru:Гхатайл

redpajama_set_name: RedPajamaWikipedia


The state of Alaska wants more housing for residents recovering from opioid abuse.
The Department of Health and Social Services is asking for bids to set up as many as 10 residential facilities across different areas of the state. The federal funds will bring up to $2.042 million over two years for what are called "recovery residences." The term applies to peer-supported homes for people in outpatient treatment or long-term recovery from addiction. As it's laid out, the grant would serve up to 100 people over two years.
"What these funds are aiming to do is to really further develop the recovery support services that are needed across the state," said Katie Chapman, who works on opioid treatment for the state's Division of Behavioral Health.
The money can't be used for new construction or significant renovations. Instead, the state is hoping to expand existing treatment resources or establish new recovery residences by paying operating costs. Part of the selection criteria is a sustainability plan. According to Chapman, there are already a small number of similar facilities up and running, but the state hopes to expand its capacity offering treatment in ways that differ from older models like halfway houses.
The areas targeted for new residences are Anchorage, the Fairbanks North Star Borrow, Matanuska-Susitna Borough, Kenai Peninsula Borough, Southeast and Southwest regions.
Alaska has seen a dramatic rise in opioid abuse over the last several years, with over 100 fatal overdoses attributed to opioids last year.


After six months of sales in the Amazon marketplace the 100% pure organic acai berry launched by Superior labs with the help of Phare Enterprises is one of the hottest selling acai berry supplements within Amazon.
Prior to launching their supplement on Amazon Superior Labs was selling their acai berry diet pills locally to mom and pop supplement shops. In an attempt to reach a larger market of customers Superior Labs contact Phare Enterprises to help them expand their product offering through the online world. After only six months within the Amazon marketplace their sales had skyrocketed and they were able to reach a whole new demographic of customers both directly and indirectly. In addition they were able to sell directly to consumers which increased their profit margin.
Superior Labs 100% certified organic acai berry weight loss supplement was created for customers looking for an all natural and certified organic acai product. In addition they chose to make this product in the USA to take advantage of a consumer trend in buying strictly USA products.
Superior labs noted that one reason for the success of their products is their offering of supplements that are made in the USA as well as some supplements being 100% certified organic. One such example is the recent successful launch of their natural testosterone booster also in the Amazon marketplace. With the recent trend in consumers looking for not only all natural products but also made in the USA it has positioned Superior Labs to capitalize on this segment in the industry.
Phare Enterprises run by Jake Hyten has been helping small businesses like Superior Labs bring their product to the marketplace through online technologies and marketing mediums. Phare Enterprises has increased revenues for dozens of companies in the hundreds of thousands of dollars.


text:
Chagas sygdom, eller amerikansk trypanosomiasis, er en tropisk parasitsygdom forårsaget af protozoan Trypanosoma cruzi. Den spredes for det meste via blodsugende insekter, også kendt som kysseinsekter. Symptomerne ændrer sig i løbet af infektionen. I begyndelsen er symptomerne enten ikke til stede eller de er milde og kan omfatte: feber, hævede lymfeknuder, hovedpine eller lokal hævelse omkring insektstikket. Efter 8–12 uger går patienten ind i den kroniske fase af sygdommen, og i 60–70 % opstår der ikke yderligere symptomer. De øvrige 30 til 40 % udvikler symptomer 10 til 30 år efter den oprindelige infektion. Disse omfatter forstørrelse af ventriklerne i hjertet hos 20 til 30 % fører det til hjertesvigt. Et forstørret spiserør eller en forstørret tyktarm kan også forekomme hos 10 % af mennesker.

T. cruzi spredes normalt til mennesker og andre pattedyr via blodsugning("kysseinsekter") i underfamilien Triatominae. Disse insekter er kendt under en række lokale navne, herunder: vinchuca i Argentina, Bolivia, Chile og Paraguay, barbeiro ( barber) i Brasilien, pito i Colombia, chinche i Mellemamerika og chipo i Venezuela. Sygdommen kan også spredes igennem blodtransfusion, organtransplantation, ved at spise mad, der er inficeret med parasitter og fra en mor til sit ufødte barn. Tidlig diagnose af sygdommen kan ske ved at finde parasitten i blodet ved hjælp af et mikroskop. Kronisk sygdom diagnosticeres ved at finde immunstoffer for T. cruzi i blodet.

Forebyggelse indebærer at man undgår blodsugende insekter og undgår deres stik. Andre præventive tiltag omfatter blodscreening ved blodtransfusion. Der er i 2013 endnu ikke udviklet en vaccine. Tidlige infektioner kan behandles med medicin benznidazol eller nifurtimox. Disse resulterer næsten altid i helbredelse, hvis de administreres tidligt, men bliver dog mindre effektive, jo længere en person har haft Chagas sygdom. Når medicinen bruges ved kronisk sygdom, kan den være med til at udsætte eller forebygge udvikling af slutstadie-symptomer. Benznidazol og nifurtimox giver midlertidige bivirkninger i op imod 40 % af mennesker herunder hudsygdomme, hjernetoksicitet og fordøjelsesbesvær.

Det antages, at 7 til 8 millioner mennesker, de fleste i Mexico, Mellemamerika og Sydamerika har Chagas sygdom. Sygdommen resulterer i ca. 12.500 dødsfald om året pr. 2006. De fleste mennesker med sygdommen er fattige og de fleste mennesker med sygdommen ved ikke, at de er inficerede. Storstilede befolkningsbevægelser har øget de områder, hvor der forekommer tilfælde af Chagas sygdom og disse omfatter nu mange europæiske lande og USA. Disse områder har også oplevet en stigning i årene op til 2014. Sygdommen blev først beskrevet i 1909 af Carlos Chagas som sygdommen er opkaldt efter. Den påvirker mere end 150 andre dyrearter.

Referencer

Sygdomme


Nickel Toilet Paper Holder Home And Furniture | Dumpjaygarner nickel toilet paper holder with magazine rack. delta brushed nickel toilet paper holders. nickel toilet paper holder.
Glamorous Nickel Toilet Paper Holder At Gatco Latitude II Satin HD Supply. Best Choice Of Nickel Toilet Paper Holder In Rohl ROT8PN Country Bath Hook Polished. Elegant Nickel Toilet Paper Holder At Geesa 6512 05 By Nameek S Nemox Stainless Satin Steel. Luxurious Nickel Toilet Paper Holder Of Pivot Moen Dn0708bn Iso Pivoting Tissue. Remarkable Nickel Toilet Paper Holder At Polished Redmagonline Com. Adorable Nickel Toilet Paper Holder Of Bistro Tissue Brushed. Fascinating Nickel Toilet Paper Holder On Recessed Brushed Playensemble Org. Cool Nickel Toilet Paper Holder At Zenith Wilmont Single Post With Shelf In Brushed. Tremendeous Nickel Toilet Paper Holder In Moen DN9108BN Ellsworth Pivoting Brushed. Enchanting Nickel Toilet Paper Holder In Delta Holders Bathroom Hardware The Home. Entranching Nickel Toilet Paper Holder At Holders Bathroom Hardware The Home Depot. Sophisticated Nickel Toilet Paper Holder On Brushed Holders Free Shipping Bellacor. Cool Nickel Toilet Paper Holder In Geesa 6509 05 By Nameek S Nemox Stainless Satin Steel. Sophisticated Nickel Toilet Paper Holder Of Moen DN8308BN Retreat Pivoting Brushed. Wonderful Nickel Toilet Paper Holder At Holders VintageBathroom. Fascinating Nickel Toilet Paper Holder Of Brushed Ultrathin Wall Mounted Roll. Vanity Nickel Toilet Paper Holder In Holders Tissue Signature Hardware. Wonderful Nickel Toilet Paper Holder In Commercial And Unique Frog Design Ikea. Terrific Nickel Toilet Paper Holder At Danze Sirius Modern Brushed Hand Towel. Appealing Nickel Toilet Paper Holder On Brushed Bar Wall Mounted Bathroom Roll. Astounding Nickel Toilet Paper Holder On Adelaide Bathroom. Exquisite Nickel Toilet Paper Holder In Holders Bathroom Hardware The Home Depot. Marvelous Nickel Toilet Paper Holder In StilHaus U11 36 By Nameek S Urania Square Satin. Amusing Nickel Toilet Paper Holder At Pirouette Satin Delta Faucet Target. Unique Nickel Toilet Paper Holder On TOTO YP624 Legato Brushed Homeclick Com.


text:
Die Iowa Railroad Company (AAR-reporting mark: IRRC) war eine Class-3-Bahngesellschaft (local railroad), die von Oktober 1981 bis November 1984 Schienengüterverkehr im US-Bundesstaat Iowa erbrachte und anschließend noch bis 1987 Rangierdienste in Council Bluffs anbot.

Geschichte
Eine der Stammverbindungen der Chicago, Rock Island and Pacific Railroad führte von Chicago durch den Norden des Bundesstaats Illinois nach Rock Island und weiter quer durch Iowa über Des Moines nach Council Bluffs und Omaha. Dieser Teil des Rock Island-Netzes war der Hauptgrund für die Aufnahme von Fusionsverhandlungen mit der Union Pacific Railroad (UP) im Jahr 1964, da sie der UP – deren Netz von Westen kommend in Omaho endete – einen direkten Zugang zum wichtigen Knotenpunkt Chicago ermöglicht hätte. Unter anderem aufgrund zahlreicher Einsprüche von Mitbewerbern zog sich das Genehmigungsverfahren der Interstate Commerce Commission (ICC) bis 1974 hin. Die Rock Island schrieb ab 1965 durchwegs Verluste und reduzierte die Instandhaltung ihrer Infrastruktur, so dass die UP zum Zeitpunkt der mit zahlreichen Auflagen verbundenen ICC-Zusage das Interesse am Zusammenschluss verloren hatte und darauf verzichtete. Die Rock Island meldete daraufhin am 17. März 1975 Insolvenz an. Sie war jedoch unter Insolvenzverwaltung weiter aktiv, bis im September 1979 die Kansas City Terminal Railway per gerichtlicher Directed Service Order den Bahnbetrieb übernahm. Nach Ablehnung des Sanierungsplans vor dem Insolvenzgericht im Januar 1980 wurde der Verkehr schrittweise bis 31. März 1980 eingestellt.

Während bislang durch die Rock Island geführte überregionale Gütertransporte auf Verbindungen anderer Betreiber verlagert wurden, bestand häufig auch weiterhin Transportbedarf direkt (und ausschließlich) an Rock Island-Strecken gelegener Frachtkunden. Auf der Route von Chicago nach Omaha übernahm zwischen Blue Island bei Chicago und dem 158,5 Streckenkilometer westlich gelegenen Bureau die im Chessie System organisierte Baltimore and Ohio Railroad (B&O) den Betrieb. Zwischen den Quad Cities Rock Island und Davenport sowie Iowa City führte die von der Burlington Northern Railroad und der Milwaukee Road gehaltene Davenport, Rock Island and North Western Railway den Güterverkehr mit Material und Personal der Muttergesellschaften fort, und übergab diese Leistungen 1981 ganz an die Milwaukee Road. Zwischen Des Moines und Newton sowie Des Moines und Dexter sorgte die Chicago and North Western Transportation (CNW) für die Bedienung der Frachtkunden. Alle Betreiber mieteten die jeweilige Infrastruktur vom Insolvenzverwalter der Rock Island, wobei die B&O für den von ihr genutzten Abschnitt noch 1981 einen langfristigen Mietvertrag über 50 Jahre abschließen konnte und die CNW wenig später einen 22,5 km langen, im Ortsgebiet von Des Moines gelegenen Streckenteil direkt erwarb.

Am westlichen Ende der Chicago–Omaha-Verbindung blieben die Anlagen zunächst ungenutzt. Der Unternehmer Gene R. Schwab, seine Schwester Susan Schwab und weitere Partner gründeten jedoch 1981 in Atlantic die Iowa Railroad Company mit dem Ziel, den Güterverkehr auf der brachliegenden Bahnstrecke wiederaufzunehmen. Gene Schwab hielt etwa zwei Drittel der Firmenanteile. Mit Genehmigung der ICC konnte die neue Gesellschaft den 156 km langen Abschnitt Council Bluffs–Dexter sowie die davon abzweigenden Nebenstrecken Audubon Junction–Audubon (39 km) und Hancock–Oakland (9,5 km) anmieten. Am 19. Oktober 1981 nahm die Iowa Railroad dort den Bahnbetrieb zunächst bis Adair, später im Jahr auch bis Dexter, wieder auf.

Zum 1. Juni 1982 konnte die Iowa Railroad den Mietvertrag mit dem Rock Island-Insolvenzverwalter auf die gesamte Strecke von Bureau im Westen von Illinois durch Iowa bis Council Bluffs erweitern. Ausgenommen war lediglich der durch die CNW erworbene Abschnitt in Des Moines, eingeschlossen hingegen die Nebenstrecke von Altoona nach Pella. Die Iowa Railroad wurde somit Betreiber von Strecken einer Gesamtlänge von 888 km (552 Meilen). Die CNW zog sich auf ihren eigenen Abschnitt in Des Moines zurück, während Dexter und Newton nun ausschließlich durch die Iowa Railroad bedient wurden. Auf dem CNW-Streckenteil erhielt die Iowa Railroad Trackage Rights, erhob aber vor allem ab 1983 wiederholt Vorwürfe, dabei von der CNW benachteiligt zu werden. Die Milwaukee Road war weiterhin parallel zur Iowa Railroad zwischen Davenport und Iowa City tätig, wo sie Vorrechte auf Fracht von bzw. nach Iowa City und Wilton hatte. Organisatorisch wurde eine ungewöhnliche Regelung vereinbart: Die Milwaukee Road durfte den Streckenabschnitt von 8 bis 20 Uhr nutzen, die Iowa Railroad von 20 bis 8 Uhr. In Bureau tauschte die Iowa Railroad Wagen mit der B&O, was durch unzureichende Gleisinfrastruktur in dem kleinen Bahnhof und ungünstige B&O-Anschlussverbindungen allerdings zu unattraktiv langen Laufzeiten führte. Trackage Rights zwischen Bureau und Blue Island konnte die Iowa Railroad jedoch nicht erlangen.

Im Sommer 1983 beschäftigte die Iowa Railroad 130 Mitarbeiter, von denen rund 85 % zuvor für die Rock Island tätig waren. Nach Angaben der Geschäftsführung sei das Unternehmen zu diesem Zeitpunkt profitabel und in Verhandlungen über den Kauf der bislang angemieteten Bahnstrecken gewesen.

Bedeutende Frachtkunden der Iowa Railroad unter Führung von Maytag zweifelten jedoch ab Spätsommer 1983 an der finanziellen Leistungsfähigkeit des Unternehmens und der Rolle, die Schwab nach dem Kauf der Infrastruktur einnehmen sollte. Sie gründeten Ende 1983 mit der Heartland Rail Corporation eine eigene Gesellschaft zum Erwerb der Hauptverbindung Bureau–Council Bluffs samt den bislang an die Iowa Railroad vermieteten Nebenstrecken. Heartland und der Rock Island-Insolvenzverwalter einigten sich im Februar 1984 auf einen Kaufpreis von 31 Millionen Dollar, der unter anderem mit einem 15 Millionen Dollar-Kredit des Bundesstaats Iowa gedeckt wurde. Heartland begann daraufhin mit der Suche nach einem Betreiber, der die Infrastruktur von ihr anmieten, nutzen und langfristig erwerben sollte. Die Iowa Railroad bewarb sich nicht um den Betrieb; stattdessen wurde unter mehreren Bewerbern die neu gegründete Iowa Interstate Railroad (IAIS) ausgewählt.

Heartland war ab 10. Oktober 1984 Eigentümer der Infrastruktur und plante die Übergabe des Betriebs an die IAIS in der zweiten Oktoberwoche durchzuführen. Sowohl Iowa Railroad als auch Milwaukee Road zeigten sich jedoch zunächst wenig kooperativ. Erst nach gerichtlicher Anordnung übernahm die IAIS schließlich am 2. November 1984 alle Verkehrsleistungen auf der Heartland-Infrastruktur. Die Iowa Railroad meldete wenige Tage später Insolvenz an, betrieb jedoch noch bis 1987 Rangierdienste in einem Intermodal-Terminal in Council Bluffs.

Verkehr
Hauptfrachtgut der Iowa Railroad war Getreide. Mit der Erweiterung des Streckennetzes im Jahr 1982 nahm jedoch auch die Bedeutung weiterer Güter zu, beispielsweise Produkte des Hausgeräteherstellers Maytag mit Stammwerk in Newton sowie des Fensterproduzenten Pella im gleichnamigen Ort.

Fahrzeuge
Die Iowa Railroad mietete mehrere  EMD SD7 der Burlington Northern. Das Unternehmen erwarb ferner fünf GE U30B-Diesellokomotiven von der Illinois Central Gulf Railroad (ICG), die sich jedoch im Betrieb als unzuverlässig erwiesen. Sie wurden 1982 durch vormals von der Louisville and Nashville Railroad genutzte ALCO C420 ergänzt, die die Iowa Railroad vom Fahrzeuginstandhalter Chrome Crankshaft mietete. Die Iowa Railroad setzte ferner unter anderem ehemalige ICG-EMD GP28 ein. 1983 besaß die Gesellschaft insgesamt 27 Diesellokomotiven und 926 eigene Güterwagen, davon 541 covered hoppers für den Getreidetransport.

Einzelnachweise

Bahngesellschaft (Iowa)
Gegründet 1981
Aufgelöst 1987
Organisation (Cass County, Iowa)
Atlantic (Iowa)
Ehemaliges Unternehmen (Iowa)
Ehemaliges Verkehrsunternehmen (Vereinigte Staaten)


text:
Cruise News Norwegian Cruise Line
Norwegian Cruise Line President and CEO Steps Down
By Emrys Thakkar
Latest Cruise News
How the CDC's New Air Travel Requirements Could Impact Cruising
Could Cuba Be a Cruise Destination Once Again?
Cruise Hive Weekly News: January 16, 2021
Has Another Holiday-Class Cruise Ship Been Sold for Scrap?
Norwegian Cruise Line has announced that the President and CEO Andy Stuart will step down from his role on December 31, 2019.
NCL Makes Leadership Role Change
The leadership of Norwegian Cruise Line is changing with the announcement that the current president and CEO Andy Stuart is to step down. He will leave his role on December 31, 2019.
Andy Stuart, President and Chief Executive Officer of Norwegian Cruise Line, said:
"I could only have dreamed about my journey at Norwegian when I joined the company in 1988 and am extremely fortunate to have witnessed firsthand the incredible evolution of this pioneering brand."
"I am honored to have played a role in the leadership position Norwegian now holds in this incredible industry and continue to be proud of the commitment, dedication and passion of our team for delivering a best-in-class vacation experience. I have worked closely with Harry and am confident he is the right person to take the helm and continue the journey for Norwegian Cruise Line."
The departure of Andy Stuart has been planned for a while and he will still remain as senior Advisor through March 31, 2020, to ensure a smooth transition.
He first started at the cruise line in 1988 and held several important executive roles and has been involved in some key areas of the business such as the freestyle cruising concept.
Taking over the role will be Harry Sommer, current President, International for Norwegian Cruise Line Holdings. Sommer has had some key roles for the company and has operated public relations, marketing and more across the globe for the business.
Also Read: First Major Cruise Line to Eliminate Single-Use Plastic Bottles
It will be interesting to see how NCL moves forward into a new era of ships and away from the popular Breakaway and Breakaway Pluss class vessels.
The cruise line currently has six new-generation ships on order not including the shiny new Norwegian encore which is about to join the fleet.
Images: NCL
Cruise news, tips & trends to your inbox.
View All Cruises
Powered by Cruiseline.com

redpajama_set_name: RedPajamaCommonCrawl


Already in 2006 Famostar discussed with AMS the possibility of complete assembly of their emergency lighting systems at AMS in China. In the conceptual stages of the new product line "Flow" both companies saw the opportunity to do the product assembly at the newly owned AMS assembly facility in China. Since then AMS continuously produces exclusively for Famostar their Flow product line with great success.
The AMS scope includes the complete sourcing of subcomponents. Both electrical components (PCBA, power packs, wires etc.) and the plastic and metal parts.
The assembly line at AMS is annually audited and certified by KEMA.
Famostar and AMS have from day 1 worked intensively together to optimize the products for efficient manufacturing, including sourced electronics, in China.
Besides the assembly of Flow, AMS is already from 2005 onwards the supplier for many plastic- and aluminium subcomponents & (sub) assemblies for Famostar.
AMS looks also after the complete product configuration- and change management process of all electrical and plastic components as well as the final testing, packaging and logistics.
Since 2007 AMS has supplied emergency lighting systems and components at zero defects. It has helped to develop a strong and sustainable relationship with Famostar.


Ohio's American College of Osteopathic Family Physicians (ACOFP) recognized Dr. Jonathan Winner at its annual awards symposium in April. Selected for his leadership and service to his profession, his community and his patients, Dr. Jonathan Winner was awarded the Young Family Physician of the Year.
Dr. Jonathan Winner has continued to work towards providing the highest quality, compassionate care to his patients. In 2015, Dr. Winner, received the NCQA (National Committee for Quality Assurance) Patient-Centered Medical Home (PCMH) Recognition for using evidence-based, patient-centered processes that focus on highly coordinated care and long-term, participative relationships.


All will soon be available to invited users and teams.
METACEO™ is a trademark of JMA SYSTEMS.
© JMA SYSTEMS All Rights Reserved.
While we'll never share your email with anyone else, we will keep you up-to-date with the latest news and availabilities regarding METACEO.


Customers across the world rely on N/S Wash when they want to make sure their vehicles are sparking clean. Through our dedication to washing the world one vehicle at a time for more than five decades, we have been able to produce equipment that has made us a leader among car wash manufacturers. One publication that featured our innovative technology and information shared by our N/S Wash brand president Thomas Ennis is Auto Laundry News.
Who Is Auto Laundry News?
Of all the publications covering the car care industry, Auto Laundry News has the longest history. Since 1953, they have featured information helpful to car wash manufacturers to stay on the cutting edge of innovation. Every month the magazine puts out content covering a variety of topics including technical information to "how-to" articles, new-product announcements, facility profiles, and analyses of industry surveys.
In addition to articles covering every aspect of the car wash industry, the publication has a comprehensive buyer's guide to the car care industry featuring more than 1,000 entries for car wash, detail, and fast-lube product and equipment manufacturers and distributors. This publication is used daily by car wash operators, detailers, and fast lube operators and features some of the leading experts in regards to car wash manufacturers. As a standard in the industry, N/S Wash is proud to have been involved in their feature on green operations.
At N/S Wash, we are not content to merely provide efficient washing technology. We know many of our customers care about the environment, just like us. Gone are the antiquated facilities that are wasteful and draining on water resources. Instead, modern car wash manufacturers are looking for ways to upgrade facilities to not only cut down on costs, but on their environmental impact, as well. Auto Laundry's article "Green Operation – Make Your Car Wash More Environmentally Friendly" is a great resource with tips and tricks for doing that.
One area the article focuses on is the debate between whether foam soap or bubble systems are better. As our president Thomas Ennis explains, "Foam is a thick concentrate and it takes a lot more water to rinse a car clean." Foam systems can easily be adapted to a soap application system and operators can change the concentrate of the foam to make it thinner and easier to rinse. He also spends time discussing the use of hydraulic vs. electric motors, and how the motors utilized by N/S Wash are much quieter and energy efficient than predecessors.
These are just a few of the tips featured in the article on how car wash manufacturers can reduce their water use to stay in business and lessen their environmental impact. Read the full article to see all the featured tips and advice from operators across the country.
The wrap around brush was one of N/S Corporation's first patents, issued in 1967. These brushes—especially those made with Lammscloth (another N/S Corporation patent)—are still in use today. Wash systems everywhere use wrap around brushes during a vehicle wash.
Please watch the video below if you're interested in arm adjustment, and browse our NS Corporation channel on Youtube for more helpful wash system videos.
Each wash system usually has two wrap around brushes stationed on either side of the wash system. These brushes spin on an axis in a circular motion, resembling the action of a hand wash, in order to reach a wider surface area while the vehicle is moving through an automated wash system.
The brush walks on either side of the vehicle, and as the brush reaches the end of the vehicle, a properly aligned brush should have enough pressure and penetration to sweep against the rear bumper and clean it. In this way, wrap around brushes eliminate the need for a rear brush installment.
Unfortunately, when wrap around brushes aren't properly aligned, they don't have appropriate pressure or coverage when washing a vehicle. Fortunately, an alignment is easy and usually only requires the use of an impact ratchet, a rubber mallet, a ¾ inch wrench, a marker, a ladder, and measuring tape.
Penetration is the term that refers to the amount of coverage each strip of cloth, foam, or other material should have along a vehicle. For the best wash, N/S Corporation recommends that 3-6 inches of material lays against the surface each time the wrap around brush swishes by the vehicle.
Adjusting the brushes throughout your wash system should be part of your regular maintenance.
Please refer to our video to aid you in your arm adjustment efforts, along with many other helpful wash system videos from N/S Corporation.


text:
Fox Television Stations é uma divisão de televisão da Fox Corporation. A divisão é responsável pela operação das emissoras próprias da Fox e da MyNetworkTV, além de ser co-proprietária do canal de filmes clássicos.

História

Em 1986, a 20th Century Fox criou a Fox Television Stations. A nova divisão iniciou as operações com a compra da Metromedia. Seis emissoras foram incorporadas a nova divisão: WNEW em Nova York (renomeada mais tarde para WNYW), KTTV em Los Angeles, WFLD em Chicago, KRIV em Houston, KDAF em Dallas e WTTG em Washington DC. A emissora de TV WCVB, que também fazia parte do pacote, foi descartada durante o processo de transição e vendida posteriormente para a Hearst Corporation. Porém, havia um problema. A legislação proibia que 25% de uma emissora e/ou grupo de mídia sejam controladas por empresas e/ou cidadãos estrangeiros. Nesse caso, o empresário australiano e principal acionista da 20th Century Fox Rupert Murdoch teria que nomear um sócio norte-americano para administrar a empresa. Ele adquiriu a 20th Century Fox, em sociedade com o investidor Marvin Davis. Após obter a cidadania norte-americana, em 1985, ele comprou o restante das ações de Davis e com isso passou a ter maior poder de decisão.

Expansão

A FOX Broadcasting Company entrou oficialmente ao ar em 9 de outubro de 1986, com seis emissoras próprias e cobertura em quase 100% do território estadunidense. O crescimento da audiência garantiu a possibilidade de competir com as três principais redes de TV do país.

Após a aquisição dos direitos de transmissão da NFL (conferencia nacional), a FTS intensificou a aquisição de emissoras afiliadas a outras redes, principalmente da CBS. A intenção da FTS era controlar as emissoras de cidades representadas por equipes da NFL (Conferencia Nacional). Um acordo com a New World Communications garantiu a afiliação de oito emissoras nessas cidades. Três anos depois a FTS comprou as emissoras e incorporou-as a divisão. Em 2001, a FTS adquiriu a BHC communications, e com isso, passou a controlar 25 emissoras, e em alguns casos,formou-se duopólios em algumas cidades.

Nasce uma nova rede

Em 2006, a Time Warner e a CBS anunciaram a fusão das redes de TV UPN e The WB. Dessa fusão, nasceu a 5ª rede de TV dos EUA: a The CW. No dia seguinte, as emissoras da FTS afiliadas a UPN interromperam a promoção da marca e qualquer referencia a rede deixou de ser mencionada nos noticiários e na internet. Um mês Depois, a FTS anunciou a criação de uma nova rede. A nova rede, chamada de MyNetworkTV, tem uma programação diferenciada. As emissoras afiliadas a UPN foram as primeiras a aderir a nova rede, seguida de três afiliadas da The WB pertencentes a Tribune Broadcasting. As emissoras da FTS afiliadas a UPN, juntamente com a independente KDFI e as três ex-afiliadas da WB pertencentes a Tribune iniciaram as transmissões no dia 5 de setembro de 2006. Em 28 de janeiro 2013, a FTS formou uma joint venture com a Weigel Broadcasting para a criação do canal de filmes clássicos Movies!. O novo canal está disponível nas cidades onde a FTS possui concessão. Em 2015, a FTS irá disponibilizar para as suas emissoras o novo canal de variedades Buzzr TV.

Canais

Atualmente, a Fox Television Stations possui a seguinte estrutura:

17 emissoras operadas pela Fox Broadcasting Company
11 emissoras operadas pela MyNetworkTV
1 emissora independente
Fox Television Stations Productions
MyNetworkTV
Movies! (Joint venture com a Weigel Broadcasting)

Emissoras da FTS

Operadas pela Fox

Operadas pela MyNetworkTV

Empresas de mídia dos Estados Unidos
Empresas fundadas em 1986
Fox Corporation


G.T. Jones - Melbourne, Victoria, Australia, Distributors of Ex Explosion Protected Electrical Equipment.
G.T. Jones, Melbourne, Victoria, Australia, Distributors, Ex Explosion Protected, Electrical Equipment.
E-mail: [email protected] © Copyright 2006. All rights reserved.


Oct, 2017 — October 2018 Calendar With Holidays Daily Work schedule Holidays, additional Special Times All textual content and picture content copyrighted by HolidaysCalendar. com. Almost all rights set aside. Free 2018 Calendar about Holidays. Month-to-month, weekly, Minor and major calendars obtainable in Microsoft Term format. Simply click to straight down load. 2017 Diary to help strategy your holidays throughout the year.
Federal government Holidays and Special Events Appointments offering the day, day time and month of Valentine Day time Info and times intended for festivities, celebrations and attention all over the world. Choice for strange holidays included. Free October 2018 Calendar With Holidays Empty Calendar with AU Vacations as MS Word straight down load. Month to month, every week, Little and Huge calendars obtainable. Just click to down weight..
Download or perhaps perhaps printing 2018 Philippines work schedule vacations. Condition & nationwide getaways will be included in to totally free savings diary. You may also produce your personal calendar. Canada 2018 : Calendar With Holidays. Yearly appointments showing weeks for 2018. Calendars ~ online and print out friendly : to get any 12 months and month Calendar 2018, with federal government holidays and free good October 2018 Calendar With Holidays as Phrase (. doc/. docx), Stand out (. xls/. xlsx) & PDF documents United Says 2018 — Date with American holiday seasons. Annual date displaying a few months pertaining to the year 2018. Calendars — on the web and produce friendly — for just about any yr and.