Thank you Dr Donnica, I really appreciate these videos- I hope they are highly searchable in the WWW search engines.
I also think it's fantastic that you are among us in the forums. I also urge other doctors to come and participate, as we try not to bite really hard unless you have a really bad attitude.
So lovely to hear "post-exertional exacerbation of symptoms" rather than the post exertional malaise that don't quite cut it, eh?
Thanks again to you and Dr. E.
I'm ordering my T-shirt now!
I think Kati's words would make a great T-shirt, too.
Thanks for all the great feedback (even about the hair--I've never had it curled before--I made the mistake of telling the hairdresser "just do whatever you think looks best" while I was studying my notes for my GMA Health segment that day!). I wouldn't typically use "medicalese" without explanations, but this was for an MD audience. Thanks to those who posted definitions! They put Brian (my son) on the spot to do an impromtu restaurant review of the place they had lunch before the appointment with Dr. Endlander (my whole family went into NYC to give blood for his ongoing XMRV trial--unfortunately it's blinded so we won't get the results). If you want to see Brian's restaurant review video, it's at http://www.thedoctorschannel.com/video/2808.html. . .and they gently poked fun of him for not being familiar with profiteroles! You can all relate to what an effort it was for him to shlep into NYC in the first place, let alone tape a video! He's been virtually housebound (except for doctor's visits & Thanksgiving at my mom's) since 11/8. I totally get the comment about having a "bad hair life".
My goodness, DrD, what a charming young man your son is! Is he interested in medicine or, perhaps, he has found his niche in TV? He is very camera friendly in every possible way. You must be very proud of him.
Your hair looks very good curled. We all have a notion about whether we are curly or not and, I hate to break this to you but, you just may be curly after all.
Thanks for being not just a doctor talking about this but a mum and a wife and a smart, good and brave person representing our community. You do us proud.
I hope that your son gets better and can enjoy his life as a young man really soon, much like the rest of us!
Oh dear, Dr.D, I hate to tell you this but my 27 year old girl kid thinks your son is "really cute" and she didn't mean like a puppy.
If you want to see Brian's restaurant review video, it's at http://www.thedoctorschannel.com/video/2808.html. . .and they gently poked fun of him for not being familiar with profiteroles! You can all relate to what an effort it was for him to shlep into NYC in the first place, let alone tape a video! He's been virtually housebound (except for doctor's visits & Thanksgiving at my mom's) since 11/8.
That is so sweet and fun. Your son has a great TV presence just like his mom. He can do patient videos for us. What a great spokesperson he would make. He can mispronounce any words he likes it's very endearing! Thanks for sharing your son with us. :Retro smile: :Retro smile: :Retro smile: Hi Brian.
And anyone watching Brian would say, "But you look so healthy. And you seem so energetic."
It's so hard to explain to people, yes, I am having fun now, but I will be in bed feeling like I have a hangover all day tomorrow. It's just such a dichotomy. And we don't want to go around explaining the details of our illness. I just feel frustrated that we can't get people to understand. I went to the grocery store on Wed. I felt pretty good. I was perky. But last weekend, for three days, I was stuck on the recliner as though I had the flu, hour after hour in a body that was dragging.
No wonder no one believes us, even the doctors.
I still say we need to stage a demonstration in front of some of these doctors' offices that we know don't believe us. We need to take loungers and place them on the sidewalk. We need to be in our PJs and have signs on the back of our loungers saying, "We're tired of being ignored." "We're tired of doctors not believing us."
After spending two days doing that, I bet a lot of us would actually look sick. News media will come take photos of us curled up with a blanket, our hair not done, no makeup, etc.
Thanks Dr. Donnica. I wondered, were you invited by this site to do this, or did you contact them?
(If they contacted you, then I would be very pleased.) Also, about how influential is this site? How many doctors use it? Would my doc on main street likely see it?
Tina I feel the same way. re:"We're tired of being ignored." "We're tired of doctors not believing us."
Dr Donnica is stating what CFS is, so I can't criticise her at all and don't wish to. I'm glad she said what she did and her TV appearences on Dr Oz and the other TV programme were really good and gave me some hope. It's slightly bizarre to see her (one of the few doctors in the world) go on camera and support some basic criteria on CFS - yet still think to oneself, this could have been done many years ago by many other doctors.
Where are the other doctors supporting Dr Donnica, to support us?! We've got Nancy Klimas, Dr Donnica, Dr Mikovits, Dr Peterson (All American). Who else?
I guess one person's CFS is another person's fatal Neuro immune disease is another person's depression. (Lots of different conditions all given the same labe). So we need a diagnostic test and fast. I'm sure for a lot of people with CFS Dr Donnica's explanation of CFS was actually very relevant - just not for all of us with the label CFS. It's impossible to please all of us, if we don't all share the same condition though.
Maybe one day, someone will say on camera about the levels of severe disability - not just in the CFSAC meeting of 2009. For many patients 'CFS' means spending a lot of time in ER, and trips into hospital when very sick indeed, being unable to speak or stand upright due to cardiac dysfunction, muscle wasting, shortness of breath leading to lack of abilty to complete daily living tasks etc.
Fukuda critera/explanation doesn't link to that level of disabilty.
There seems to be an embargo in Governments to either admit people with the label CFS can be extremely ill, or to say no, they have Canadian criteria CFS if severely ill - then never discuss Canadian criteria CFS! So it looks like we'll be looking out (and hoping) for Dr Donnica to maybe to list the symptoms of Canadian Criteria CFS also - because no one else seems prepared to help us.
Thank you so much for your support Dr. Donnica.
Thanks all! And I wish I could show you a photo of what Brian looks like when he's well! He HATES it when people say (or when I slip & say) he looks good or "fine" when he's crashing. My metaphor is that if you get a new BMW & drive it til it runs out of gas, it will still look great--but it won't go. OK--oversimplistic, but for some reason we need to keep it simple with explaining CFS! I was at a dinner party tonight with several physicians. The woman internist next to me new nothing about CFS, but as soon as the dermatologist acrossed the table heard us talking he asked me excitedly about what I thought about XMRV. He was very knowledgeable, especially about new onset allergies ("atopy") in PWC & various rashes.
The doctor who runs TheDoctorsChannel.com is a good friend of ours & a big fan of Brian's. My husband came up with the idea to do the CFS videos, & he was happy to do it. No idea how many MD's have viewed the video, but it's got nearly 1,000 views so far. But that could be just from folks on this forum!
Dr Donnica, little by little, people will get to learn about XMRV. They won't be able to afford not to know about XMRV.
So far I have "educated" my family dr, my dentist, a rheumy and an endocrinologist... oh and the ER dr that was pissed off at me this last week I keep a copy of the Science magazine article with me when I go to a new appointment.
I am not sure how helpful these people can be to me, since none of these doctors are familiar or treating this disease, but I think that in the long run, it will help them looking for more information and perhaps for some, change their attitudes towards the disease.
Interesting the dermatologist new of the rashes. That is one of the minor, less known symptoms. Looking back, I now see I had one, but my dermatologist never thought of CFS. Just a little reaction to dishwater soap. It last off and on for a year, then disappeared. I don't even remember when I got it in relation to my other symptoms. But I only recently connected that rash to CFS. I never had allergies to anything my whole life. Thankfully, that one episode is the only allergy / rash / sensitivity thing I have had to deal with. I don't have MCS and I don't have the sensitivity to meds that others describe.
Maybe this explanation: It's like a car with a defect that burns up all the fuel in half the normal time so it ends up running out of gas at the most unexpected times and much more often. The car looks fine, but that doesn't mean it can go and last like other cars without the defect.
Interesting the dermatologist new of the rashes.
But I'd be curious to see what it looks like- itchy/not itchy?
Thanks DrDonnica! I love that question to differentiate between depression and CFS. It really hits the nail on the head. What would I do if I got better? What wouldn't I do! So much thanks to you for giving physicians a clear, concise way to understand this.


PLEASANTON, CA — Oct. 11, 2018 — Veeva Systems (NYSE:VEEV) today introduced its first application specifically built for clinical research centers, Veeva Vault SiteDocs. The new solution will help sites more effectively manage regulatory documentation and trial information to speed clinical research. Now clinical research centers can reduce the administrative burden of executing studies by streamlining document and trial processes for site qualification, study activation, and investigator site file management.
Veeva Vault SiteDocs provides sites a single application for managing trial documents and processes to speed study activation. With continuous visibility into document quality, completeness, and accuracy, Vault SiteDocs gives clinical research centers a full view into study progress for improved compliance and inspection-readiness.
Veeva Vault SiteDocs is available today for clinical research centers. Join Veeva at the upcoming 2018 Global Site Solutions Summit, Oct. 12-14, to learn more and see a demonstration of Veeva Vault SiteDocs in booth #501.
Veeva Systems Inc. is a leader in cloud-based software for the global life sciences industry. Committed to innovation, product excellence, and customer success, Veeva has more than 650 customers, ranging from the world's largest pharmaceutical companies to emerging biotechs. Veeva is headquartered in the San Francisco Bay Area, with offices throughout North America, Europe, Asia, and Latin America. For more information, visit veeva.com.
This release contains forward-looking statements, including the market demand for and acceptance of Veeva's products and services, the results from use of Veeva's products and services, and general business conditions, particularly in the life sciences industry. Any forward-looking statements contained in this press release are based upon Veeva's historical performance and its current plans, estimates, and expectations, and are not a representation that such plans, estimates, or expectations will be achieved. These forward-looking statements represent Veeva's expectations as of the date of this press announcement. Subsequent events may cause these expectations to change, and Veeva disclaims any obligation to update the forward-looking statements in the future. These forward-looking statements are subject to known and unknown risks and uncertainties that may cause actual results to differ materially. Additional risks and uncertainties that could affect Veeva's financial results are included under the captions, "Risk Factors" and "Management's Discussion and Analysis of Financial Condition and Results of Operations," in the company's filing on Form 10-Q for the period ended July 31, 2018. This is available on the company's website at veeva.com under the Investors section and on the SEC's website at sec.gov. Further information on potential risks that could affect actual results will be included in other filings Veeva makes with the SEC from time to time.


With the rising number of mobile phone users all over the world, the frequency of spam calls has increased too. The carriers we use do their best to segregate such calls from the useful ones but we still get them occasionally.
An independent study by HarrisX, the market research specialist focused on telecommunications, tested how well the top four US carriers – AT&T, Sprint, T-Mobile, and Verizon – identify both spam and non-spam phone calls. All phones were equipped and enabled with the highest tier of each carrier's available spam protection services. The study found AT&T Call Protect out-performed its competitors in correctly identifying spam and non-spam numbers.
AT&T catches the most spam calls: AT&T was the most accurate at identifying spam calls, correctly flagging them 58% of the time. Verizon was second at 54%. T-Mobile had 35%. Sprint had less than 1%.
AT&T has the lowest spam error rate: In this test, AT&T incorrectly flagged calls as spam only 6% of the time. T-Mobile and Verizon inaccurately tagged calls as spam 15% and 16% of the time, respectively. With less than 1% of spam calls caught, Sprint was deemed not relevant for this portion of the study.
AT&T has the most complete and accurate Caller ID information, at 80% of the time. Verizon's complete and accurate Caller ID information was 72%, T-Mobile's was 70% and Sprint's was 69%.
The test shows how AT&T rescues you against spams which are otherwise annoying. It is good to have your carrier do this job as third-party apps like Truecaller have been found leaking personal data.
Google is also quite aware of this issue. One of Pixel 3's key features was the ability of the Google Assistant to answer calls for you. When the Google Assistant is speaking, you get a live transcript of the ongoing call. The other Pixels have also received this feature.
Keep following us for more updates.
Xiaomi Mi Mix 3 To Be Launched in UK in January 2019.


Effects of sand sedimentation on the macroinvertebrate fauna of lowland streams: are the effects consistent?
Kootenai River velocities, depth, and white sturgeon spawning site selection , a mystery unraveled?
The distant activity of Short Period Comets,, II.


There are plenty of B3 revision P67 boards sitting in our labs at the moment, but the review of the Asus Sabertooth P67is the first one we've decided to publish. This is because the board has been one of the most talked-about LGA1155 motherboards on our forums. You can immediately see why too, as the Sabertooth P67 is extremely visually distinctive thanks to the huge plastic shroud that covers most of the motherboard.
This is Asus' new TUF Thermal Armor, which is one of the many TUF branded components on the motherboard. TUF stands for The Ultimate Force, and motherboards that bear this moniker are, Asus claims, built to higher specifications than standard motherboards, with the purpose of making them particularly hardy.
To reinforce this point, the Sabertooth P67 includes a certificate that details the military-level tests to which the on-board chokes, capacitors and MOSFETs have been subjected.
This is all well and good, but it's little more than a gimmick, as none of the components that you're going to bolt to the Sabertooth P67 will have passed any of these tests. There are some tangible benefits to purchasing a board in the TUF range, though, such as the extended five-year parts and labour warranty.
Asus claims that the primary benefit of the Thermal Armor is to enhance the motherboard's cooling ability; it's designed to channel air from the CPU cooler over important areas of the motherboard.
In reality, though, this will only work with coolers that blow downwards towards the motherboard in the same way as Intel's reference cooler - we'd hope that anyone buying the Sabertooth P67 wouldn't be using such a basic cooler. In addition, the air will be quite warm, having passed through the CPU cooler's heatsink. The shroud also made it a challenge to fit our test cooler, as it gets very close to the socket mounting holes. Thankfully, it's possible to remove the shroud by unscrewing half a dozen screws on the rear of the PCB.
Apart from this, the Sabertooth P67 is a fairly standard P67 motherboard. The two 16x PCI-E slots support SLI and CrossFireX, and there are three 1x PCI-E slots and a single PCI slot, so there's plenty of room for other expansion cards. It's clear that proper attention has been paid to the layout of the Sabertooth P67 too, as all the important sockets and headers are located on the edge of the PCB. All the SATA ports are orientated parallel to the PCB too, which aids cable tidying.
Meanwhile, the Sabertooth P67's heatsinks are finished in the same ceramic coating that we've seen on previous TUF boards, and they're pleasingly chunky. The two VRM heatsinks are also linked by a heatpipe, which means they should share the cooling burden more evenly than on boards with isolated VRM heatsinks. One concern, though, is that the Southbridge heatsink is swamped by the Thermal Armor shroud, and will therefore receive very little airflow in most cases.


Free legal aid is the system of providing legal aid to persons who are not financially supported to pay expenses of resolving legal problems, including judiciary expenses.
In the frame of mentioned program, special attention has been devoted to providing free legal aid to representatives of Roma population, women as victims of violence, victims of police torture, cases of politically motivated violence, victims of discrimination, and other marginalized groups. As there is no institutionalized system of providing free legal aid until adoption of Law on free legal aid, whose drafting is in course, Youth Initiative for Human Rights (YIHR), since the beginning of 2009, has started providing free legal aid to marginalized groups in cases of violation their rights. Also, SOS phone line has been opened, thus, victims of violation of human rights receive free legal aid.
Since YIHR has started providing free legal aid, large number of free legal advice has been delivered, and we represented before the court 15 cases.


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Strategic Classroom Design
On the Podcast: Strategic Classroom Design with Jessica Martin and Jamaica Ross
Lucy Calkins
This week on the podcast we sat down with Jessica Martin and Jamaica Ross to talk about the importance of classroom design. In Jessica's new book, Strategic Classroom Design, Jessica reveals just how important a classroom environment is. She writes, "The attention you give to the layout of your classroom provides everyone with a greater sense of belonging and more opportunities to become an engaged, focused, and collaborative community of learners."
The conversation began with why it's so important to focus on design…
Below is a full transcript of this episode.
Jessica: One of the things that kids need to feel successful and to feel confident is to belong. When we spend time considering how we set up our spaces and we put our attention towards what we know in terms of how people learn best, and if we create spaces that have places to move, or if we create different spaces for whole group opportunities, small group opportunities, and places where kids can peel off and work one on one, then we start to imagine a place where everyone can feel they belong, and then when we also think about what we know about color and we know about light, it helps to think about that when we're designing a space because we don't want to overstimulate kids, and there's enough distraction happening already with 34 kids in a classroom, so if we can create a space that feels calm and comforting and cohesive, then it allows kids to relax and be themselves, and feel they have something to contribute, and ways to work positively and cooperatively.
Brett: How do the social emotional needs of our students fit into the classroom environment?
Jessica: I think that kids come to school with feelings about school already, and depending on their experiences, or depending even on that morning, we come with a lot of emotion, and our kids come with a lot of emotion, and I think that if we can mitigate the stressors of school, whether it be assignments that feel unrelated or challenging, or friendships that can be challenging, or a seat that doesn't feel comfortable, if we can figure out how to give kids more choice in how they work and move and collaborate, I think it allows for them to relax. Again, get back to the decreases anxiety, allows for them to express themselves in ways that sometimes they don't even realize. Sometimes they surprise themselves on what they can do, so putting them into or creating spaces where kids can share out who they are and how they feel, and time to talk and work those out.
That's a lot of the work I know Jamaica's been doing in her classroom, and then having that time and space to talk and think and process feelings allows kids to identify, notice how they feel, identify those feelings in others too, and then gives them ways to interact with one another so that when we get to the academic learning, they've had opportunities to see one another and talk with one another and negotiate things with one another, and to ideally learn to like one another, at least find ways to connect, and then learning is easy. That's why I think the emotional intelligence piece and the socioemotional learning piece is exactly the pieces we're trying to tap into when we think about classroom design, so that all the other stuff is cake after that.
Brett: Jamaica, you're featured in the book.
Jamaica: Yes.
Brett: Tell us a little bit about your classroom.
Jamaica: I would say I was thinking about what Jessica was saying as far as the coming into the space and starting. In my classroom we start the day in play, and as they enter the room, not only is it a space that they come in and they can breathe into, and they're comfortable there, because it's soft and it's appealing to the eye, but it's also, like Jessica was saying, it's a space they know they come in and they have relationships that are built there, and that they're working on relationships. I feel in my classroom, a lot of the work that we do is around, it peels back a lot of the hard work that then they're allowed to open up to do academically, if that makes sense.
So because they're able to play and they're able to communicate and they're able to work together playing UNO, then when it comes time to collaborate during math, or it comes time to talk about a book, a lot of the layers are already peeled back, so it's a safe space for them to be in. It's a place where asking questions is encouraged. It's a space where we're always negotiating, where we meet in circle and we're always trying to figure out how we can take responsibility for ourselves. So I would say my room is a student-centered space where they know that it's theirs, they own the space.
Brett: That's such an important, that collaboration between teacher and student, for the student to know that space. Something that Jessica writes about in the book is the traffic jams in the transitions from either going to recess or coming back from recess. How does that work in your classroom? How do you manage the traffic jams and the transitions with students?
Jamaica: I think the place that there was the most traffic jamming was in the cubbies as we were trying to get set up in using cubbies, and for a while it was kind of like, "How do you think we should do it? Is it too crowded? Are you having a hard time getting your things?" So if I notice something that's happening or that might be slowing us down, or that might be causing friction, then we talk about it together. "So what do you think is the best solution for that?" And they will say like, "Maybe half of us go at one time." Or, "The top row goes and then the bottom row goes."
Then we just alternate back and forth if I can remember who went first the last time, which not usually, but they're very patient with that. Then eventually they figure out how then to, we don't do that anymore, because now they've learned how to wait their turn. Now they learned how to say, "Oh, that person above me is already there. I'll come back in a second. I'll go get something else on my way," or whatever it might be. But the space is so open that there are so many options of different ways to go that we don't tend to have a lot of traffic jamming.
Brett: It can be overwhelming for some to set off to do a redesign within a classroom. What is your advice for how to get started and manage that anxiety around the redesign?
Jessica: So teachers say this to me all the time, "What's the best way to get started?" I always think about asking them to think about, "What do you want to work on?" Or, "What seems to be something that you think you would like to talk with your kids about in terms of a challenge?" Or I like to say an opportunity and start there, and that's when they'll say things like clutter, or "I want to try flexible seating, but I'm worried that disagreements or fights might erupt over a balance ball or something like that, or a stool." That keeps teachers from taking those steps sometimes. "I don't have any space to store things." Or, "I can't open my blinds." So then it's more about just, "Where would you like to start? What seems like an opportunity to dig into and practice and play with for a couple of weeks, and see what happens?"
That's where we'll usually land on something, and then I encourage the teacher to bring it to the classroom to get feedback and to co-author either the plan or, "How can we get started? How can we work together to figure out the traffic jam?" Or, "How can we figure out who gets to use the balance ball or the stool?" It doesn't feel like the teacher's making all the decisions, because then it feels very much like then the teacher has to do all of the consequences and all of the problem solving, and we get into this, "It's not worth it to make any changes." So I just encourage teachers to identify something they want to work on with their students, and the with is really important, and then start to brainstorm with them, brainstorm with the parent community, brainstorm with colleagues.
Brett: One of the things you write about pretty early on in the book is that if you were starting your first day as the teacher walking into the school, you would expect someone to give you a tour of the building. You would expect someone to show you where different things are. You say that's just as important on the first day of school, or when you do a redesign with your students, you say to teach into the physical environment. Why is that so important?
Jessica: I think grounding yourself in the space, becoming familiar with how it feels to walk and to be in it is important. I mean, I did that even presenting here at NTTE. I got here a little early, went to the room, looked at the space, walked around a little bit just to orientate myself to the surroundings, the feel of it, the bigness or the littleness of it.
Jamaica: Yeah, I definitely think that the room tour, and for me I feel you need to talk about the room and the space and where everything is. Because I think when I do that with my class, they realize, "This is all ours." I think that's really powerful for kids. I've even had kids say, "Well, where's your workspace? So where's your desk?" I'm like, "Oh, well, it's back over there. But when you leave, I work on this table that you work on during the day." But I feel what it creates for the kids is they realize everything is out right where they need it, and all this, "You could sit here or you could sit there," and it really makes them feel I could definitely say that my students know it's their classroom. It's definitely not my classroom in that sense. It's our classroom. That's why I think it's important to tour the room.
On the first day of school, I had some kids that were the same as last year and some kids that were new, and the very first day was, "What do you notice about the classroom? What do you wonder about the classroom? So just take a minute and look around the room. What is it that you're noticing? How does it feel for you?" So having that conversation with them is really important too. Now, every day they walk in, they know it's theirs, they know where everything is, they know they're allowed to be anywhere in this space.
Brett: Well, you mentioned something too, there, Jamaica, that I think is really important, is the teacher space. Jessica, you write it's important to not forget or not neglect the teacher's space. So Jamaica, maybe you can explain a little bit about your space in your classroom.
Jamaica: Yeah. The space that we created in this classroom, this space lot in my last year's classroom, that's more in the book, it was the space that we all shared together. So there were areas that were books that I would use in small groups, and materials that I might use more that were centered around a space in the room. The circle table was still theirs. It was actually really funny because sometimes I didn't keep on top of my own neatness and then they would come in the morning and they would realize that Ms. Ross didn't clean up her space, and they would just pile everything up in a pile and push it to the middle of the table and take their space around the table. It didn't phase them at all because again, it was their space.
This year is a little bit different. The room is a little bit different. So my personal space is behind a closet door where I get to put my own belongings, and I think it's important, Jessica's taught me too, during the day when the kids are there, I'm teaching the kids. I'm with the kids. I'm not sitting at a table trying to do work. So if I do need to do work, I pull out my little piles, keeps me more organized and keeps me more on top of my own stuff. I sit at a table and I do my work at lunch time or after school, I pull it out, and then I also have to be responsible to put it away. My room is beautiful. It's always clean, it's always tidy. Everything's put away, and I don't do it. So I also have to stay on top of that for myself, right? So it's a lot of self-reflection that way.
Brett: Yeah.
Jamaica: That's not my strength. So having to do that because I expect of them, so we expect of each other.
Brett: So good modeling, really.
Jamaica: It is.
Jamaica: They model for me really well.
Brett: They're modeling for you.
Brett: I love that they're modeling for you.
Jamaica: They model for me. Yeah.
Brett: That's great.
Jamaica: But there's not a ton of space, but there is space for, we've created curtained spaces so the stuff that's not used all the time doesn't need to be all the time. So let's put away and when I need it, I know where it is. It's kept me very organized.
Brett: Jessica, you mentioned earlier it's important to not get too stressed about the budget. What would your advice be for someone who's looking at this and they're reading your book and to thinking about how to best approach this with a small budget or maybe no budget or what's your thinking there?
Jessica: I loved what happened when we worked on Jamaica's classroom makeover, which was, we first went in and made friends with the custodial staff because they know where everything is and they know where things are that you don't even think about. So when we first got there, making friends with the folks that know where everything is, is key so that you don't have to reinvent the wheel or spend money on things that schools have hidden away somewhere. That first ask or that first airing out of like, "Here's what we're trying to do." All of a sudden there were two round tables that showed up in our classroom ... I said our classroom ... In her classroom. Once the word got out that what Jamaica was trying to do with her space, teachers would come by and say, "I've got a shelf, if you like the shelf."
We're like, "Let's go take a look." It was lovely how folks shared things. So the first thing is not to go buy anything. The first thing is to be really resourceful about seeing what's already available. Jamaica went to the district warehouse to see what teachers had turned in and so that you could mark or was it tag things that maybe you might want and they would deliver it to your classroom. I'm notorious for the second hand shops and that's where I was able to find things like baskets and pillow cases and things that you could repurpose. Just being really thrifty and keep your eye open, even for folks that live in a neighborhood where there's apartment buildings and so sometimes at the end of the month people will leave their stool out or things like that.
So my kids know that I'm going to stop if I see a stool, I'm stopping and throwing it in the back seat or in the back of the trunk. Because those are ways to make it doable, aesthetically pleasing, affordable. If you're after trying to rethink your color scheme and if you're after thinking about lighting, some of these, the secondhand shops and your colleagues are really and parents too, love to help out and they love to share some of the things- You can be picky, that's the thing too. You can turn things away, but it helps with folks who want to do some of those things in a way that feels affordable because teachers don't make a ton of money. So having that expectation of "I'm going to refurnish everything with tables and and baskets and materials is not reasonable and it's not equitable either." So how do we get smart about design in ways that feel practical and helpful?
Jamaica: I would say start with what you have.
Jessica: Yeah.
Jamaica: I think back to way back in the day before I even realized what I was doing maybe, that I was like, "I want to have all tables in my room." So across the few years I worked on getting all five tables in my room and I just put all the desks around the outside of the room. So I had a very furnished room but as that school closed, I brought all the tables with me and then I took a leave of absence. When I came back it was like, "You start with what you have." I had 35 desks again, so I just turned the desks the opposite way and pushed them together and created longer table groups and where children could sit at different places. So it wasn't like this is my desk. So you just start where you are with what you have and over many summers of going to Savers and going to the thrift shops and going on Facebook pages and the buying sites and yeah, all those places, right? You can do grants and such.
I didn't so much do that, but you can find a lot and you accumulate over time and teachers are really good at accumulating a lot of stuff over time. So if we pick the things we accumulate then it could work. It works out pretty quickly.
Brett: Jessica, one of the things that I love in the book is you have, throughout the book, these teaching into moments and then if then scenarios wondering if you could maybe just take a minute and just explain to us what you're doing it with those in the book and just how to approach the book.
Jessica: I usually get a lot of questions about how to make this happen or how to get started after sharing ideas or even in some of my usual work around literacy or math. I might make some connections to making tools accessible and creating spaces where kids can make choices about what they need. So in that, teachers will say, "Well, what are some ways I can do that are affordable? What are some ways ... How do I talk to my administration about supplies or creating a space for tools or I don't have any tools, how could I make that happen?" So the if then section of the book is really meant for, it's more a frequently asked question type of a format. I think a place that also allows for sharing of ideas that I've heard around the way, that are tried and true and work for teachers.
So I tried to incorporate a section that some of my most recent conversations and thoughts with teachers and just basically great idea sharing and it felt like something that was at the end of the chapter. So folks, I know sometimes it's easier to connect with an if then scenario than it is some of the other content because it feels quick and it answers my question. It feels very like, "This is my issue, this is my topic." Very present. So that was the idea behind it.
Brett: The book has tons of photos, a lot of graphic elements. The book itself is beautifully designed in addition to being a great design book. Talk folks through a little bit about how the book is laid out and your thinking that went into how the book is designed.
Jessica: Yeah, I'm so grateful that the way it turned out, I mean the photos are gorgeous. Just really so respectful of all the hard work that the teachers and students put into those spaces. I think that we tried to imagine creating a book where we started with just thinking about space on its own and the importance of creating different kinds of space in the classroom. So chapter one is about the essential spaces for when you want to meet with your students as a whole, as a community and then some smaller breakout spaces because so important, especially in today's teaching, that there are opportunities for kids to collaborate and break out and in smaller more intimate spaces for them to be intimate with one another in terms of thinking and talking and sharing. The idea was to be really intentional with smaller types of spaces where kids could be together.
Then what I've noticed too lately is kids saying, "I just want to work on my own too." That was really important to imagine, "Where are the nooks and crannies in your room that kids could gather their thoughts or ground themselves and then join the group? Or if I needed a minute to step out of the group, where are there spaces in the classroom that I can feel safe and be able to do that, regulate myself even, and then join the group again." So chapter one is all about that space consideration. Then chapter two we bring to light some of the work teachers have done around additional areas in the room. So if you're doing inquiry work, if you are thinking about math or if you wanted to create space for display and tools and supplies, how are you organizing your space so that kids can access the things they need quickly, they don't have to walk across the room to get a pencil.
There's lots of spaces for kids to access supplies. It talks a little bit about how you're displaying work so that it doesn't feel chaotic. So chapter two is what are the other spaces to consider? Then chapter three, which was the hardest chapter to write, is about moving in the space and creating agreements around how we're going to work together as a community because there isn't one right way. It really begins with how you are ... This culture that you're trying to create and making sure kids voices are heard. How do you set the parameters and how do you set the scene for kids to make mistakes and try things out and take risks? Which to make us so great at negotiate when you need things. That's what chapter three is about. I thought it was important because that's what teachers asked, "How do you handle disagreements and sharing?" That part that's dearest to me, but it's also for some reason it just felt more challenging to write about but important. Then chapter four is about the design element work.
So that's where we get into color and light and naturalness, flexibility. That was fun to write about because there's so much research on what matters most to how we learn and what matters most in terms of performance. We know things like having well lit areas helps kids focus more and also perform better on their tests and their assessments and things. So we get into the nitty gritty of some of the research based design elements. Then we end with chapter five, which is a closer look at one teacher's journey. We really wanted to make it feel doable and practical and interesting. We did a lot of before the school even started, we were in there thinking and talking and dreaming and designing two weeks in. So we had a blank slate and then we took pictures at different stages. So you could see how this space evolved once the kids arrived because the space really did change.
She had her own ideas about movement and accessibility and making sure everyone felt they belonged. Then she worked on that and we laid that out, but then when the kids came, we saw that they had some different needs and things needed to be moved and shifted and so we wanted to make sure that we documented all of that because it was happening in real time. Do we need more space for this or less clutter here? The kids piled your stuff up and took over this area. One of the biggest things was we had these pillows and kids wanted to hug them versus sit on them. So it was lovely and challenging and I thought the chapter came together really nicely because it was a real true journey of someone's adventure into flexible seating and design.
Brett: Jamaica, we'll end with you. How do you best maintain it throughout the school year? How do you keep it going?
Jamaica: Well to reflect on last year, I think the keeping it going was being flexible with it. At one point in the year we did say, "Do you guys mind if I move these this way?" We had a conversation, "Can I move these cabinets in a different place? What do you think? Can we try it out for the day?" I think having that constant conversation with kids is a way to keep it going, to keep it fresh. I think that one of the most beautiful things about the room is that it keeps itself going because no day is the same because they get to make a different choice every day and they get to move around and they're working in different teams and partnerships and whole group and small group. I'm definitely one who is not really great at sticking to a specific schedule. We like to co-construct a schedule and every eight weeks or so, talk about what's going well and what's not going well and when are you learning the most and when do you feel you're not learning the most.
There's a lot of, from my part that's a type of teacher that I am, is very reflective and always thinking about what's going well, what's not going well and how can we make it even better and even better and even better learning wise and space wise. I guess that's the answer, is just constantly reflecting and being flexible to be able to change things and then letting them have a voice and a say in it because it's so flexible every day. I feel that maintains it, right? They don't have to come in and sit in the same exact spot every single day, and if we want to have a change, it's this big huge desk. I remember desk changes, it was a 45 minute period of time when everybody's pulling their desks around, moving them all around the room, and it was this big ordeal. Now it's like every day they get a desk change. They get an opportunity for a different vantage point in this space, and that keeps it going.
Learn more about Strategic Classroom Design at Heinemann.com
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Jessica Martin (@growingjessica, @groweducators) is a former classroom teacher, a former resident advisor at UCLA's Teacher Education Program Center X, and a former staff developer at Teachers College Reading and Writing Project, Columbia University. Jessica now leads a small consulting team that partners with K-12 schools in English Language Arts (ELA), Cognitively Guided Instruction (CGI) math, and inquiry-based content-area instruction. She is grateful for the opportunity to collaborate with educators and learning communities committed to co-creating incredible spaces, amplifying student voices, and implementing equitable learning opportunities for all learners. When she is not in schools, you can usually find her with her family on a basketball court shooting hoops.
Posted by: Steph GeorgePublished: December 5, 2019
Topics: Podcast, Heinemann Podcast, Strategic Classroom Design, Jessica Martin
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redpajama_set_name: RedPajamaCommonCrawl


With a durable duo-tone webbing base, this modern dog leash features a supple vegan leather handle with smooth burnished edges and a cross-hatched texture.
This dog lead includes a sturdy metal clip for reliable connection to a collar or harness. The additional metal D-rings at the base makes it easy to tether your dog whilst the D-ring at the handle is used for attaching wast bag holder or treat bags.
This lightweight style includes a reflective tab for added night-time safety and a branded woven label.
Made with: Cotton, nylon, PU.
Please note this size chart is only a guideline and measurements are approximate depending on the stretch of product.


Discover what ancient secrets lie hidden in the sands of the Caribbean Sea!
The Caribbean Sea is full of buried treasures beyond our wildest dreams. Even today they await discovery by any adventurers brave enough to look. Now you too have the chance to team up with pirates and set out on an amazing journey to become one yourself.
Explore 20 locations and earn lots of cool pirate trophies, including three famous ships from pirate history that even Jack Sparrow would be honored to captain. Multiple difficulty levels are perfect for several hours of exciting gameplay every day, and unique Gold Cards give the game a fun new twist. Discover what ancient secrets lie hidden in the sand in Solitaire Legend of the Pirates 3.
Build the sparkling city of Luxor - the gods need you!
Endless deserts mark the wide landscapes of Egypt. It's time for the gods to finally establish a luxurious capital that lives up to their power: Luxor! But all the temples, shrines and statues are not easy to build. That's why they chose you to learn how to master the art of Solitaire and to find the precious scarabs. It's the only way to fulfill your duties to the gods! Are you up for this job?
Garry and Penny are going on their first date to eplore a magical fairytale place. Let's see what they're going to discover and meet the inhabitants.


Mommy Gossip: WW: I Am Thankful for... Make Believe!
WW: I Am Thankful for... Make Believe!
Wet. Shivering. Seven. Running full speed ahead, I crashed into a wave in the Pacific ocean that buckled my knees, knocking me flat on my sandy bum. Exhilaration set in as not only salt water poured out of my mouth, but blood as well, because that meant I had lost my top front tooth.
The two—the fall of my body and my tooth—as it turns out, were completely unrelated. I had wiggled all the wiggle room right out of that tooth. But... as most kids do, I wouldn't make that final tug—the twist or turn that would set it free from its secure space in my mouth. And yet, when it came out of its own free will, I was elated, thinking of fairies and pixie dust and pots of gold at the ends of rainbows, and all things magical. Fairies can do that to a young girl, you know! And, the Tooth Fairy was no different.
In my out-of-this-world state of mind, I began my note to said fairy. But, what started out as magical quickly turned matter of fact when I ended my short note with this statement: "Just in case you are wondering, I accept credit cards!"
My parents (I mean, the Tooth Fairy—hope I didn't ruin it for any of you) rewarded my "creativity" with a crisp $5 bill.
More than 20 years later—tonight, in fact—I watched as my son went through the same rollercoaster ride of emotion with his top front tooth. Should it stay or should it go? Until finally the tooth made its voice heard by going toward greener pastures. And I am glad it did, because in an instant make believe was alive and kicking in our home as Red Rover ran around half laughing, half crying and totally elated. Then, he posed for, perhaps, one of the worst pictures we have of him, which was difficult to take since he was singing "All I Want for Christmas Is My Two Front Teeth!" No problem with bedtime for this one!
BTW: No credit cards for this Tooth Fairy!
I am participating at Wordful Wednesday and at Wordless Wednesday.
I just remembered how awful it feels when you rub your tongue on your gums just after you've lost a tooth! ICK!!
Haha! Love the pictures! The beach of course, I have never seen... I know I know.. very sad.
I have never done the tooth fairy thing in my house, yet anyway. I may have to get creative!
hilarious- so remember that and am dreading my son's teeth falling out - he will not take it well!!!!
I love the picture...especially after knowing he's singing as you took it. PERFECT lost tooth shot.
And I love your tooth fairy note. Clearly your creativity and way with words started early!
Jyl, that thoothless picture is hilarious!
And congrats on raising so much money!
I would love to participate, but it starts when I'm at work, and then I have to leave, so I have a hard time with it.
I love the description of how you lost your front tooth...and Red Rover looks mighty cute without his too!
Enjoyed GNO last night! Have a great day!
Aw! My middle child smashed her face when she was two, so had no front teeth until she was seven. Then two weeks later, she smashed those teeth and had to get falsies. Then she smashed those. Two more times.
LOL! My son is missing his 2 front teeth as well! It is ADORABLE!
Too funny! Hope the tooth fairy was generous!
Sweet Post, and how adorable!


text:
Epstein Pal's Lawyer: Nightly Checks 'Positively Orwellian'
Prosecutors say flashing light into her cell every 15 minutes at night is necessary for her own safety
By Newser Editors and Wire Services
Posted May 6, 2021 7:06 AM CDT
Ghislaine Maxwell, in a recent photo. (Court documents)
Federal prosecutors say Ghislaine Maxwell isn't under suicide watch, but that it's still necessary to flash light into her cell every 15 minutes as she sleeps while she awaits a sex trafficking trial. They told a judge Wednesday via a letter that heightened security for Maxwell was necessary because of the nature of the charges she faces, the potential stress she faces in a high-profile criminal case, and a need to ensure her safety in a cell where she's alone. Maxwell's lawyers say the light-flashing is a response to ex-boyfriend Jeffrey Epstein's August 2019 suicide as he awaited trial on sex trafficking charges, reports the AP. Prosecutors based their letter on a consultation with lawyers for the Metropolitan Detention Center in Brooklyn, where Maxwell is held, after a judge requested an explanation for the flashing of light at the ceiling of Maxwell's cell every 15 minutes while she sleeps.
In a Wednesday email, Maxwell attorney David Oscar Markus said, "This is positively Orwellian," slamming the contention that Maxwell needed to be woken up every 15 minutes for her own well-being. "What's next? Bread and water diet to eliminate the risk of diabetes?" Two judges of the 2nd US Circuit Court of Appeals who recommended the explanations be sought questioned why Maxwell wasn't allowed to wear a mask that would shield her eyes at night. Her lawyer told the 2nd Circuit that she puts socks or a towel over her eyes to try to sleep. In their letter, prosecutors said Maxwell can't be issued an eye mask because they're not available for purchase in the jail commissary and are thus considered contraband. Maxwell, 59, has been held without bail since July on charges alleging she recruited teenage girls from 1994 to 2004 for Epstein to sexually abuse. She has pleaded not guilty. Her trial was postponed this week from July until early fall, with no date yet set.
(Read more Ghislaine Maxwell stories.)
Copyright 2023 Newser, LLC. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. AP contributed to this report.


The Trendy Totes patterns has instructions for both a center square design (finished size is 13" x 13") and a raggy square tote (finished size is 14" x 14"). These totes come with instructions and are easy to make. The recommended fabric is flannel and there is 2 different fat quarters used in this design.
Batting - 30" x 36"


Immerse yourself and your guests into a stunning Asian jungle with a function held at Adelaide Zoo's Immersion Longhouse. The undercover, outdoor venue is constructed out of natural materials and colours that blend with the garden setting, a function under the Immersion Longhouse is sure to impress.
Your guests will also be overlooking the amazing Sumatran orangutan exhibit.
Thrill your guests by getting up close and personal with the stunning Sumatran tiger and arranging a Tiger Feed.
You'll never get closer than this to the world's ultimate predator, our Sumatran tiger. One of our tigers will be fed on the rock, close to the glass of the Immersion Rainforest exhibit, giving you and your guests the perfect opportunity to see the tiger in action! If desired, the tiger keeper can also come out to mingle with your guests and share their stories and information about these incredible animals.


"How do I book a party?
Because we are a farm it isn't easy to be available on call. I check our email perodicaly throughout the day. Please email us your name, phone number, address, date and time of you event. Also, what you are hoping to have at your event or party. There is a form here on our site you are welcome to fill out and send to us CONTACT US .
We will then answer as quickly as possible, most of the time with in 2 business days and also give you a call to talk about the details. I love being a part of making your party or event a memory!
it involves picking staff, animals and keeping our overall appearace up to high standards.
I have been doing this for 20 years. The stories I could tell... I have been told many times I should have a television show!
This is a service you have to love to do. I do. I am also blessed to have a supportive husband!
"What type of events do you service?"
We will arrive for single special birthday child, or set up for crowds of people.
"What if it rains or the weather is bad?" I am a mother too - so I understand, and leave that up to you, the parent.
we require that you call 24 hours before your party time for a refundable deposit. At any time, after 24 hours, you are welcome to reschedule and the $50 will be applied to your new booking.
I make every effort to be there, even in bad weather. We can always substitute the Petting Zoo for ponies and set it up in a garage. We've even done living rooms!
In the winter there are times when we are unable to drive the truck and trailer safely. At these times we would need to reschedule and do apologize. Safety is very important to us both for your guest, family and our animals.
"How long does it take to set up? Is it included in my hour?"
The ponies are ready to go when we arrive. Depending on how far we have to carry zoo animals, affects the set up time. It usually takes us 15min. to set up for a small zoo. Your party starts when the first ride starts or the first animal is being cuddled and loved. If we are late due to traffic or other uncontrollable reasons, you will still get an entire hour of entertainment.
"Can we feed the animals treats?" We do not allow feeding of our ponies or donkey unless supervized by staff. Often parties have carrots at the end to feed the pony. Carrots are also permitted for the other animals. We do suggest large carrots for the petting zoo animals to keep hands a safe distance away.
"How many children do you recommend per pony?" For the children to have at least 2 rides each, I have found up to 10 children per pony works best. The petting zoo, face painting or one of the party ideas work well to keep eager riders entertained.
"Do you carry insurance?" Yes we do. If you would like to have the party in a park you may need to fill out the proper paperwork ahead of time. You also may then request a copy of our policy for park pre-approval.
If necessary, customers may become additionally insured for the day of their event. This service is available for a $100.00 fee, charged to us by our Insurance company. For copies of our insurance there is a $75.00 charge our insurance company charges. We voluntarily comply with USDA Federal requirements and standards for animal health, care and safety.
"What about party rules?" We ask that none of the petting zoo animals are picked up. If you have towels or blankets for the children's laps that is a great addition. Our horses are very use to children, toys and decorations involved in parties, however preparation is best.
"Hand Washing?" We recommend a small hand washing station with wet wipes and a Purell bottle. We do provide purell hand sanitizers.
"What time will you arrive?' We plan to allow 20 extra min's for travel based on mapquest. Please when you send your booking form include any land marks or details that may help us find your location.
We strive to arrive on time.
Our set up time is approx.. 5 min for pony rides only and 15 min's. for parties with petting zoo.
We stay for the full hour of booked party time.
I do need to note - sometimes things unexpected happen... a flat trailer tire, a mapquest detour... and as we all know DC traffic. Have a back up plan if for any reason we are delayed. Don't panic, we will be there, very very sorry for any delays. In the 10 years of business this is the one problem we do our best to avoid and often can't control (I have to say the most stressful part is being delayed when we know you have guests waiting!).
If for some reason we are running late we will call to give you notice of our arrival time.
"What is the best age to have a pony party?" Any age from 2 to 9 but we do offer larger ponies for children over 9.
We have horses for the "big kids" no age limit here!
Please, Just make sure to let us know the largest child's age so we bring a pony that fits and they don't get left out.
Where can we find places pony to go will be open to the public? I do my best to keep up with places we will be on facebook. You can check the different sites to see what is the latest activity we are doing or place we will be.
We love to see customers we have shared a birthday with!
If you feel our staff went above your expectations tips are appreciated.
"Tipping is appreciated but never expected..."
Our business survives and grows from your referrals and feedback.
Thank you for allowing us to be part of your celebration!
We do accept all major credit cards with a 4% convenience fee for amounts over $100.
A Deposit of $100 at time of booking secures your requested event date.
I'm sure there are a million other questions, don't hesitate to email me if I haven't covered something!
WE ARE A FAMILY OWNED AND RUN BUSINESS!
The earlier you contact us the better!
Again I want to say - don't worry!
Being safe is best and thinking ahead can avoid any accidents.


text:
Health Care Law Today
Health Law & Managed Care
Prescribing Controlled Substances Without In-Person Exam: Practice of Telemedicine Under Ryan Haight Act
As providers are becoming more comfortable with delivering care via telemedicine technologies, many of them are looking to explore services other than low acuity triage consults. One area of patient service opportunity – and particular confusion – is prescribing controlled substances via telemedicine.
As discussed in greater detail in the first article in this series, the Ryan Haight Online Pharmacy Consumer Protection Act was designed to combat the rogue internet pharmacies that proliferated in the late 1990s, selling controlled substances online. Although the Act was intended to target "rogue" internet pharmacies, legitimate healthcare providers who prescribe controlled substances via telemedicine must carefully review the regulations to ensure compliance. Among other things, the Act requires a practitioner to have conducted at least one in-person medical evaluation of the patient prior to issuing a prescription for a controlled substance.
However, the Ryan Haight Act contains an important exception to the in-person exam requirement for practitioners engaged in the "practice of telemedicine." Indeed, there are seven separate "practice of telemedicine" exceptions under the Act. They are technical, and providers should not assume their approach to telemedicine or telehealth does, in fact, meet an exception under the Ryan Haight Act. Providers must devote the resources to really understanding these laws and how to apply them to their business or services.
Practice of Telemedicine Under the Ryan Haight Act
The Act contains the following "practice of telemedicine" exceptions:
(1) Treatment in a hospital or clinic. The practice of telemedicine is being conducted while the patient is being treated by, and physically located in, a hospital or clinic registered under section 303(f) of the Act (21 U.S.C. 823(f)) by a practitioner acting in the usual course of professional practice, who is acting in accordance with applicable State law, and who is registered under section 303(f) of the Act (21 U.S.C. 823(f)) in the State in which the patient is located, unless the practitioner:
(i) Is exempted from such registration in all States under section 302(d) of the Act (21 U.S.C. 822(d); or
(ii) Is an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract, and registered under section 303(f) of the Act (21 U.S.C. 823(f)) in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f);
(2) Treatment in the physical presence of a practitioner. The practice of telemedicine is being conducted while the patient is being treated by, and in the physical presence of, a practitioner acting in the usual course of professional practice, who is acting in accordance with applicable State law, and who is registered under section 303(f) of the Act (21 U.S.C. 823(f)) in the State in which the patient is located, unless the practitioner:
(i) Is exempted from such registration in all States under section 302(d) of the Act (21 U.S.C. 822(d)); or
(ii) Is an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract, and registered under section 303(f) of the Act (21 U.S.C. 823(f)) in any State or is using the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f);
(3) Indian Health Service or tribal organization. The practice of telemedicine is being conducted by a practitioner who is an employee or contractor of the Indian Health Service, or is working for an Indian tribe or tribal organization under its contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act; who is acting within the scope of the employment, contract, or compact; and who is designated as an Internet Eligible Controlled Substances Provider by the Secretary of Health and Human Services under section 311(g)(2) of the Act (21 U.S.C. 831(g)(2));
(4) Public health emergency declared by the Secretary of Health and Human Services.The practice of telemedicine is being conducted during a public health emergency declared by the Secretary of Health and Human Services under section 319 of the Public Health Service Act (42 U.S.C. 247d), and involves patients located in such areas, and such controlled substances, as the Secretary of Health and Human Services, with the concurrence of the Administrator, designates, provided that such designation shall not be subject to the procedures prescribed by the Administrative Procedure Act (5 U.S.C. 551–559 and 701–706);
(5) Special registration. The practice of telemedicine is being conducted by a practitioner who has obtained from the Administrator a special registration under section 311(h) of the Act (21 U.S.C. 831(h));
(6) Department of Veterans Affairs medical emergency. The practice of telemedicine is being conducted:
(i) In a medical emergency situation:
(A) That prevents the patient from being in the physical presence of a practitioner registered under section 303(f) of the Act (21 U.S.C. 823(f)) who is an employee or contractor of the Veterans Health Administration acting in the usual course of business and employment and within the scope of the official duties or contract of that employee or contractor;
(B) That prevents the patient from being physically present at a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f) of the Act (21 U.S.C. 823(f));
(C) During which the primary care practitioner of the patient or a practitioner otherwise practicing telemedicine within the meaning of this paragraph is unable to provide care or consultation; and
(D) That requires immediate intervention by a health care practitioner using controlled substances to prevent what the practitioner reasonably believes in good faith will be imminent and serious clinical consequences, such as further injury or death; and
(ii) By a practitioner that:
(A) Is an employee or contractor of the Veterans Health Administration acting within the scope of that employment or contract;
(B) Is registered under section 303(f) of the Act (21 U.S.C. 823(f)) in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f); and
(C) Issues a controlled substance prescription in this emergency context that is limited to a maximum of a five-day supply which may not be extended or refilled; or
(7) Other circumstances specified by regulation. The practice of telemedicine is being conducted under any other circumstances that the Administrator and the Secretary of Health and Human Services have jointly, by regulation, determined to be consistent with effective controls against diversion and otherwise consistent with the public health and safety.
How Useful Are the Ryan Haight Act Exceptions for Telemedicine?
Some of the exceptions are very narrow and do not account for current clinical telemedicine practices. However, others are well-suited to institutional telemedicine arrangements. And others are of use to only a limited subset of practitioners or particular environments (e.g.,public health emergency, Indian tribal organization). One exception requires a patient-site telepresenter who is also registered with the Drug Enforcement Agency (DEA) (and presumably independently able to prescribe controlled substances for the patient).
Overall, the exceptions have limited utility in contemporary telemedicine arrangements, most notably telemedicine services directly to the patient's home. For that reason, the exceptions do not easily align with direct-to-patient service models frequently sought by patients in areas such as telepsychiatry (e.g., where the patient is at his or her home at the time of the telemedicine consult). The main exception designed to accommodate this type of telemedicine practice – the special registration – has not yet been implemented by the DEA.
The DEA seems to recognize the exceptions have not kept pace with the rapid developments in telemedicine-based practices. To be fair, Congress gave the DEA a very brief window to draft regulations in order to implement the Act within the short time period between the passage of the Act and its effective date (only six months). The DEA's interim final rule was effective a mere nine days after it was published, leaving no time for public comment. Fortunately, DEA has announced plans to activate the special telemedicine registration provision (exception #5). This would allow practitioners to use telemedicine to prescribe controlled substances without the per se in-person exam. The new rule is anticipated to be published this year.
If I Meet an Exception, Can I Prescribe Controlled Substances Without Any In-Person Exam?
No, not necessarily. Whether the exam is conducted in-person or via the practice of telemedicine, a prescription for a controlled substance must always be issued for a legitimate medical purpose by a practitioner acting in the usual course of his or her professional practice. Moreover, practitioners must comply with both federal and state laws, as DEA considers a physician who engages in the unauthorized practice of medicine under state law to be someone who is not acting in the usual course of his or her professional practice. For example, according to DEA, a controlled substance prescription issued by a physician who lacks the license or other authority necessary to practice medicine within the state is not a valid prescription under federal law.
Some states prohibit the prescribing of controlled substances via telemedicine, but others do allow it. The remaining states are silent, or allow/disallow its use in certain specialties (e.g., cannot be used in connection with treatment of chronic nonmalignant pain). The federal and state laws must be read in harmony with each other (not unlike how HIPAA interacts with more restrictive state medical privacy laws). Understanding how these layers intersect will enable providers to see the pathways and approaches available to compliant prescribing of controlled substances via telemedicine. This is particularly useful for those telemedicine providers in specialties that involve chronic disease management with pharmacotherapy, for example, adolescent and adult psychiatry, substance abuse/recovery, endocrinology, hormone replacement therapy, and medical weight loss.
© 2022 Foley & Lardner LLPNational Law Review, Volume VII, Number 107
After the Supreme Court Decision, What Comes Next for OSHA and COVID-19
Mark N. Duvall
Building on the Success of Medicare-Medicaid Plans, CMS Proposes Modifications for D-SNPs
Lauren M. Moldawer
Supreme Court Nixes OSHA Vax, Upholds Health Worker Mandate
Abby S. Tilkens
CMS Vaccine Mandate Allowed By U.S. Supreme Court
J. Michael Grubbs
Nathaniel (Nate) Lacktman is a partner and health care lawyer with Foley & Lardner LLP, and a Certified Compliance & Ethics Professional (CCEP). His practice focuses on health care compliance, counseling, enforcement and litigation, as well as telemedicine and telehealth. Mr. Lacktman is a member of the firm's Health Care Industry Team which was named "Law Firm of the Year — Health Care Law" for three of the past four years on the U.S. News – Best Lawyers® "Best Law Firms" list.
www.foley.com
www.foley.com/blogs


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This studio version used a drum machine. Brown was born on May 3, 1933, in Barnwell, South Carolina, to 16- year- old Susie ( née Behling, 1917– ) and 22- year- old Joseph Gardner Brown ( 1911– 1993), in a small wooden shack.
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Easy Fudge recipe. Sweet and rich Fudge made with sugar, cocoa, golden syrup, milk, butter, salt, vanilla essence, baking powder, chopped walnuts or ginger.
Put in a deep pan sugar, cocoa, golden syrup, milk and salt.
Stir well with a wooden spoon and place pan on a very small fire. Do not stir before sugar is dissolved, but with the spoon gently move sugar at the bottom of the pan once in a while to prevent burning.
When mixture begins to boil, stir, add butter and keep on stirring.
Increase flame a little till mixture thickens. When tiny bubbles appear on edge of spoon and the bottom of pan as you stir, test drops of fudge in a cup of cold water, and if they form soft balls in your fingers, add vanilla essence and baking powder.
Remove pan from fire. After five mins. of cooling, beat mixture till it begins to harden.
Add walnuts and/or pickled ginger and quickly pour on to greased square tin.
When cool cut into squares, and desired size.


My love for you is much bigger than this filter paper, you spicy minx!!
I still vividly remember when I locked eyes on you across the cupping table. It was hot and sunny day in Brazil. Your sweet. Tropical and rum chocolate scent was intoxicating. I returned home with painful reluctance… I heard you are coming to my country soon. I can't wait to introduce you to all my loved ones.
Brighter than the stars, I love you just the way you are.
that freed me from experience: you are my deliverance.
I swear I tasted cherry, with syrupy sweet sensations.
Can I filter a ruined past with an apology your way?
If you're still around, let's start again, slow, come Valentines day?
Am I alone in this infatuation?
Karagoto, when you're touching my soul in the candle light.
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You tasty, tasty beverage sparkles citrus, berry balance!
If you reckon you could fall in love with these sweet coffees too, head here to get the feels.


Why do you think the United States has not implemented a national, universal healthcare insurance program?
Children under the age of 14 should be allowed to play highly competitive sports. create an ethical position to this issue agreeing.
Critically discuss the various strategic option of Extension and Adaptation.
1. What, according to Earley & Mosakowski are the two major traditional streams in Cross Cultural Management? Please give a management example of each stream.
1) Identify the current legislation and codes of practice eleven to the promotion of equality and valuing of diversity?
1. Hypertension (in addition to a number of medical conditions) may be considered as primary or secondary.
our experience as possible" (p. 8). According to Aerts and his coauthors, world view provides a template for explaining, predicting, and assessing global reality and our role in it.
(a) 'There was effectively no recognizable 'legal system' in England until 1066′.
This essay should be about, rich people and their dispute on paying high taxes vs. poor people paying taxes that kill their pocket.
1. Describe the challenge or problem, and identify it as a school-wide, local, state, national, and / or global issue.
Discuss the ways in which Jane Austen uses caricature to ridicule or point out the faults of a rigid class system portrayed in Pride and Prejudice.
The research assignment is to choose a European country and compare its government spending and taxation to the United States.
1. The paper should center around issues, events, or law pertaining to at least one branch of the federal government (Legislative, Executive, or Judicial).


text:
Phortica excrescentiosa är en tvåvingeart som först beskrevs av Masanori Joseph Toda och Peng 1990.  Phortica excrescentiosa ingår i släktet Phortica och familjen daggflugor. Inga underarter finns listade i Catalogue of Life.

Källor

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redpajama_set_name: RedPajamaWikipedia


This mixer is used, but in good condition. We are a full service production company.
Mixer has been tested and working fine. The Yamaha LS9 line of mixers are compact, lightweight digital live sound reinforcement consoles with instant recall, onboard digital effects, and multiple fader functions. It is aimed at temporary installation and permanent installation for small to mid-sized clubs.
The LS9-32 features 32 mono mic/line inputs, 4 stereo inputs, 16 mix busses, and 8 matrix busses. The LS9-32 is expandable to 64 inputs with external mic amplifiers and MY-Series optional expansion card. The item "Yamaha LS9-32 Digital Mixing Console withRoadcase" is in sale since Saturday, January 5, 2019. This item is in the category "Musical Instruments & Gear\Pro Audio Equipment\Live & Studio Mixers". The seller is "cgrajewski701u" and is located in Andover, New Jersey.


text:
Fake: There is no ban on sharing or forwarding COVID-19 updates
A message that barring the government no one can share COVID-19 related updates, and doing so is a punishable offence has gone viral.
Delve Fake news Saturday, April 04, 2020 - 18:49
A viral message is doing rounds claiming that other than the government, no one else, particularly citizens are allowed to post any update or share any forwards related to the coronavirus, and that it is a punishable offence to do so.
"Tonight 12 (midnight) onwards Disaster Management Act has been implemented across the country. According to this update, apart from the Govt department no other citizen is allowed to post any update or share any forward related to Corona virus and it being a punishable offence. Group Admins are requested to post the above update and inform the groups. Please adhere this strictly," (sic) reads the message.
To give credibility to the false message, a news link from the website LiveLaw .in titled "Centre Seeks SC Direction That No Media Should Publish COVID-19 News Without First Ascertaining Facts With Govt" has been attached.
However, there is no such order and the message is explicitly false. While posting fake news and forwarding panic-inducing messages are definitely an offence under the Disaster Management Act of 2005 and IT Act, there is no ban on individuals posting news relating to coronavirus. Livelaw has also published a new link, debunking the fake news that's being circulated using their link.
What the LiveLaw.in story is about?
On March 31, while responding to a Public Interest Litigation (PIL) regarding the measures taken up by the Union government to control the coronavirus pandemic and the welfare measures for migrant workers, Home Secretary Ajay Bhalla sought the intervention of the Supreme Court asking them to issue directions against the media. The government, in a bid to control the narrative, wanted media to publish news pertaining to coronavirus only with the government version.
"In an unprecedented situation of this nature, any deliberate or unintended fake or inaccurate reporting either in electronic, print, social media or web portals has a serious and inevitable potential of causing panic in large sections of the society," the government said.
"In the largest interest of justice that when this court has taken cognizance, this court is pleased to issue a direction that no electronic/print media/web portal or social media shall print/publish or telecast anything without first ascertaining the true factual position from the separate mechanism provided by the Central government." the government said in its affidavit.
However, after hearing the plea, the apex court held the right to free discussion. However, the bench headed by Chief Justice SA Bobde directed the media to refer to and publish the official version of the developments in order to avoid inaccuracies and large-scale panic, besides asking the government to publish daily bulletins on COVID-19 developments.
"We do not intend to interfere with the free discussion about the pandemic, but direct the media to refer to and publish the official version about the developments," the court ordered.
Responding to the government's stand and the court's directive to 'publish official version', Editors Guild of India, the media watchdog said that they were "deeply perturbed" over it.
"Government told the Supreme Court that mass movement of migrant labourers in the wake of the lockdown was due to falsified media reports. This led the apex court to observe that while it didn't want to inhibit the debate on the pandemic in any way, the media should refer to and publish the official version of the developments pertaining to the coronavirus pandemic. The Guild would state in all humility that it holds the court in the highest respect, but finds this advice gratuitous and unnecessary. Blaming the media at this juncture can only undermine the current work being done by it under trying circumstances. Such charges can also obstruct in the process of dissemination of news during an unprecedented crisis facing the country. No democracy anywhere in the world fighting the pandemic by gagging its media," the EGI said.
The Editors Guild of India has issued a statement pic.twitter.com/eCYKoY73BO
— Editors Guild of India (@IndEditorsGuild) April 2, 2020


This straw crossbody bag was made for swaying through social occasions. Before you make your exit, feel free to do another loop to show off the faux-leather shoulder strap, bow-detailed toggle closure, and emerald green hue of this canteen-style, ModCloth namesake label purse.
Shell: 90% Vine, 10% Polyurethane. Lining: 100% Polyester.
Measures 8 inches in diameter, 3.25 inches in width.


The PTO Timeline shows the entire 15 weeks and demonstrates the applicable sections of the program and when they occur. For example, the coaching and training reports (CTRs) are due each week.
The two problem-based learning excercises are completed through phases A/B and C/D.
The daily journal runs throughout and the neighborhood portfolio excercise is a program-long effort by the trainee.
This image of Bloom's Taxonomy (right) shows the various levels of learning that the Reno Model PTO Program adopts. The venn diagram demonstrates the foundation of training philosophy found in the model.
The Hoover Group Logo (below) was redesigned in 2012.


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It's 1986 in California. A group of friends discover a mysterious pink stone that allows to travel between two realms. This gang will live the summer of their lives in an adventure that will get them involved in a government conspiracy. Control five kids with special skills while fighting and solving puzzles in order to save their families and the world.
Crossing Souls is an action-adventure set in a California suburb in the midst of a supernatural event that rocks the small community as grand forces siege the town. Control five characters: Chris, Matt, Charlie, Big Joe and Kevin, each one with their own skills and combat styles. Change characters on the fly and use each character's specialties to overcome any obstacle and target your foe's weaknesses. Fight in real-time, solve clever puzzles, face off against powerful bosses and play special levels inspired by 80's arcade video games.
Feel the eighties: Do you feel that? Do you smell that? Yeah, it's the eighties. A story set in 1986 full of references such as The Goonies, Gremlins, Back to the Future and many more.
Do you like Cartoons? The cutscenes are inspired by 80's cartoons, totally original and never seen before in a videogame.
Why is this happening? Be part of a journey between two realms, two realities: life and death. The story includes a government conspiracy, thousand-year-old characters, cowboys, pirates, ice cream, pizza, cheeseburgers, basketball… well, you got it.
This music rocks! An original score that includes tracks inspired by John Williams and Jerry Goldsmith as well as radical Synth-Pop in the purest 80's style. Play as if it was one of your favorite movies!
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OS: Windows Vista / 7 /8 /8.1 /10 x86 x64
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Processor: Intel Core i3-2100
Graphics: GeForce GTX 460 [1024 MB VRAM]
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Copyright 2017 Fourattic. All Rights Reserved.
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I remember when broadband first became available in the UK. I begged my parents to upgrade our slow, slow AOL dial-up internet access, so I could download bigger files and actually be competitive in online games (it was some years later when I discovered my poor performance was not solely attached to my slow connection). No avail, they were happy with AOL, which is a sentence you don't see very often these days.
Regardless, they have (or had, rather – they got broadband pretty sharpish as soon as I'd left for university) quite a lot in common with 24% of the UK, who also don't see the point in this high speed internet malarkey. That's according to OFCOM's CEO Ed Richards, who made the claim in a speech to the London School of Economics.
Doing some quick figures, he estimated that 40% of the UK is still in the technological dark ages of dial up or (gasp) without internet altogether. Yet, only 15% of this figure is thanks to expense with 55% not wanting it at all despite the exciting draw of YouTube and iPlayer.
No clue as to what the remaining 30% think. Perhaps they spoiled their ballot paper.
Still, this is a challenge that needs to be tackled, according to Richards, if the UK is to meet its target of Digital Britain, with everyone in the UK connected to broadband of a minimum 2Mbps speed. If the rest of the UK remains as stubbon as my parents were in the summer of 2001, they may face an uphill struggle.


text:
Young Boozer (R) sworn in as Alabama state treasurer
By Madison Adkins
In State
Young Boozer (R) became the 41st Alabama state treasurer on Oct. 1. Governor Kay Ivey (R) appointed Boozer on Sept. 17, following the resignation of John McMillan (R), effective Sept. 30. McMillan had served as treasurer since 2019.
Boozer previously served as state treasurer from 2011 to 2019. He is the fifth Alabama state treasurer since 1819 that has served two non-consecutive terms as treasurer.
In 2021, Ballotpedia has identified 31 state executive officeholders who have left office before their term end date. Of those, 7 were Republican officeholders, 7 were Democrats, and 17 were nonpartisan.
Alabama Treasurer
State executive office irregular office changes
Madison Adkins
Madison Adkins is a staff writer at Ballotpedia. Contact us at editor@ballotpedia.org.