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Focusing on the small stuff EDITORIAL 07/17/2010
Focusing on the small stuff
Administration executives are really something else.
Instead of focusing on the important issues related to their respective tasks, they center their attention on really minute stuff, dig up their predecessors' claimed anomalies or mistakes, merely to get media mileage.
A case in point is the new Justice chief, Leila de Lima. There is hardly any question about De Lima's legal experience and expertise. She certainly is qualified to head the Department of Justic (DoJ). But why does she waste her time running after former Justice Secretary Alberto Agra and former National Bureau of Investigation chief Nestor Mantaring as well as the chief of the NBI's Counter Terrorism Unit, Ricardo Diaz, on the matter of their being questioned on the issue of their having failed to initiate an investigation into the claim of an NBI official that a retired Air Force official attempted to bribe a witness in the Maguindanao massacre case?
Is there a need to probe them when she, who is now in position and authority within her realm of responsibility, can check on this matter herself, without necessarily making it appear that something sneaky went on and that her predecessor is guilty of not having this investigated?.... MORE
Blatant interference
N. Korea tests US 'strategic' patience
Blatant interference FRONTLINE Ninez Cacho-Olivares 07/17/2010
Noynoy Aquino really should know when to keep his trap shut, now that he is President of the Republic. But it seems he may never learn to do so.
Just yesterday, Aquino was written up as saying that the coup charge against Sen. Antonio Trillanes for his involvement in the 2003 Oakwood mutiny was "unjust."
If Noynoy was still a senator, there would be nothing wrong in airing his opinion on the coup charge against Trillanes. But as he is now president, Noynoy shouldn't even come up with such a statement, because this would be tantamount to influencing the courts that are hearing his case, especially as Trillanes has just posted bail that would release him from one court, even as he still has another coup case before another court, not to mention the fact that there is still the military — or the police — detention, which means that this would be another permit of sorts to release him.
But of course, this appears to be Noynoy's intent, as he is in the thick of getting votes for his candidate for the Senate presidency. Sen. Kiko Pangilinan, who certainly needs the vote of both Trillanes and Sen. Ping Lacson.
But to get this vote of Trillanes, and possibly Lacson's, if he surfaces at the Senate on voting day, Noynoy is directly influencing the courts to get Trillanes out of detention, which speaks badly of Noynoy.... MORE
But of course, this appears to be Noynoy's intent, as he is in the thick of getting votes for his candidate for the Senate presidency. Sen. Kiko Pangilinan, who certainly needs the vote of both Trillanes and Sen. Ping Lacson..... MORE
OMMENTARY
N. Korea tests US 'strategic' patience ANALYSIS 07/17/2010
WASHINGTON — With North Korea thumbing its nose at the response to the sinking of a warship, the United States is left wondering how long to keep up its policy of studied coolness toward the communist state.
The UN Security Council last week condemned the sinking of South Korea's Cheonan vessel, which killed 46 persons. But it stopped short of blaming North Korea, which claimed a diplomatic victory and demanded Thursday that the United States prove Pyongyang's involvement in the March incident.
The United States has responded to the Korean peninsula's deadliest incident in decades by standing firmly behind South Korea. Secretary of State Hillary Clinton and Secretary of Defense Robert Gates are expected next week in Seoul to announce joint naval exercises, despite objections by China.
But the longer-term US policy toward the North is less clear. Before the Cheonan's sinking, Clinton described a US stance of "strategic patience" — waiting for Pyongyang to come forward rather than hastily offering incentives.
"How to move forward, and when, are all questions that lots of people are thinking about," said Bonnie Glaser, a senior fellow at the Center for Strategic and International Studies, a Washington think tank.
"There's a recognition that, based on past patterns and practice, the longer there is a lack of dialog and interaction, the greater the likelihood for North Korean brinkmanship and provocative action," Glaser said.... MORE
Stranded OFWs in Dire Need of Assistance – Migrante Published on July 17, 2010
Stranded OFWs in Dire Need of Assistance – Migrante
Published on July 17, 2010By JANESS ANN J. ELLAO
ANILA — The Khandera Bridge in Jeddah, Saudi Arabia, has provided shelter to many stranded overseas Filipino workers. But since Saudi police barricaded it from migrant workers, OFWs have found a new home in the Philippine Consulate General in Saudi Arabia — but only outside its building.
John Leonard Monterona of Migrante Middle East described consular officials as "inhumane" and "heartless" for having the temerity to sit in their air-conditioned offices while stranded OFWs endure the hot temperature, reaching up to 40 degrees Celsius, outside. He said these Filipinos are living like "squatters" beside the consulate building.
Members of the local chapter of Migrante in Jeddah intervened on behalf of the OFWs through a dialogue with consular officials on May 14, 2010. They were able to talk to Vice Consul Leo Ausan, who informed them that consular officials were still waiting for the approval of their budget request from the national government.
"We find it ridiculous since there must be a government budget allocated for that on a yearly basis," Monterona said. In the interview, he cited the P13.6 billion ($293.4 million) funds from the Overseas Workers Welfare Administration, gathered through the collection of the $25 compulsory membership fee from OFWs.
OFWs endure a hot and humid day outside the PCG office (Photo courtesy of Migrante – KSA / bulatlat.com)
As of yesterday, Migrante reported that the 20 adults and four children residing outside the consulate building have been sent to the Hajj terminal, where they can temporarily stay.
URL: http://www.bulatlat.com/main/2010/07/17/stranded-ofws-in-dire-need-of-assistance-migrante/
After its CBA Was Suspended for 11 Years, Philippine Airlines Employees Face Lay-offs, Contractualization Published on July 17, 2010
After its CBA Was Suspended for 11 Years, Philippine Airlines Employees Face Lay-offs, Contractualization
Published on July 17, 2010
About 3,000 employees of the flag carrier Philippine Airlines (PAL) are in tenterhooks today over threats to their regular jobs and union. This week they expect to get a sample of what President Aquino said would be his "litmus test in labor relations."
The workers' fear of losing their regular jobs and union stems from PAL's plan to "spin-off" three "non-core businesses." It has been trying to implement it since May 31. The employees who stand to be affected comprise nearly half of the total 7,192 workforce including some foreign-based expat Filipino employees of PAL. It would also rout the membership of PALEA, the rank-and-file employees' union which, after PAL's early retirement drive in 2009, has been reduced to 3,732.
Up for "spin-off" are PAL's airport services department with about 2,000 workers (covering ground handling, cargo terminal/handling and ramp handling), inflight catering services with about 1,000 employees and call center reservations which has 172 currently employed, said Gina Licayan, union board member. They have been working with PAL from seven to more than 30 years now.
L-R: Danilo Palomena, Rigmo Ondevilla and Gina Licayan have been working with PAL from 7 to more than 30 years now. (Photo by Marya Salamat / bulatlat.com)
The spin-off means a sale of the businesses and transfer to third-party providers of said services. According to PAL employees, the third party providers about to takeover these "non-core businesses" do not have employees of their own and expect only to get the current employees thrown into the bargain to keep working and avoid disrupting PAL's services.
URL: http://www.bulatlat.com/main/2010/07/17/after-its-cba-was-suspended-for-11-years-philippine-airlines-employees-face-lay-offs-contractualization/
Pascual Guevarra and the Struggle for Land Published on July 17, 2010
Pascual Guevarra and the Struggle for Land
By RONALYN V. OLEA
MANILA — The death of 78-year-old farmer Pascual Guevarra is not a result of a personal feud but of a long struggle for land.
Guevarra was shot dead inside his house by a lone gunman in barangay San Isidro, Laur, Nueva Ecija, around 4:30 p.m., July 9. The killer whisked away with a male companion on board a black motorcycle without a license plate. They headed north.
Guevarra was preparing the evening meal at the kitchen located at the back of the house when a man in his mid to late 30s, fair skinned, 5'5" in height, medium built, wearing a light blue shirt, denim pants and a hat quickly walked towards him and pulled a handgun tucked in his waist.
A photo of Pascual Guevarra (Photo courtesy of Kilusang Magbubukid ng Pilipinas / bulatlat.com)
The shots were heard by Ronnel Villoria, the victim's grandson who was tying their carabao in the yard. He immediately rushed inside the house and saw the assailant standing over his wounded grandfather. Ronnel grabbed the assailant from behind and tried to wrest away the gun. He continued to struggle with the gunman until the latter broke free and shot Ronnel in the shoulder. The gunman hurriedly ran outside..... MORE
Source: Bulatlat
URL: http://www.bulatlat.com/main/2010/07/17/pascual-guevarra-and-the-struggle-for-land/
Guerra Patani by Bel Cunanan 8 July 2010
Bel Cunana
Two protest cases will be watched with great interest because of their far-reaching implications. One is the protest case filed in the Comelec by former Manila Mayor Lito Atienza against chief rival Alfredo Lim. The other protest case scheduled to be filed today, the last day for filing, by losing LP vice presidential bet Mar Roxas before the Presidential Electoral Tribunal is against Vice President Jejomar Binay. While the Atienza case is strictly local, it acquires a national significance because it involves the capital city. Atienza asserts that given the support of the Iglesia and El Shaddai, plus the popularity of former President Estrada under whose banner he ran, he would come out clearly the winner if the ballots of Manila were to be opened. The Comelec has approved his petition to this effect but Lim has filed a motion for reconsideration.
The case of Mar Roxas, which is being handled by lawyers of "The Firm," has taken some time since the press conference a month ago, during which LP campaign manager Butch Abad and lawyer Joey Tenefrancia graphically detailed how all the "null votes" strangely got concentrated in Mar's bailiwicks. In fact I thought Roxas wouldn't file anymore and just sit out the one-year prescription period against an executive appointment, in the meantime continuing to act as de facto chief adviser of President Aquino until he could get back the Department of Trade post he held in the Estrada and Arroyo governments. ..... MORE
Source: Political Tidbits
URL: http://polbits.blogspot.com/2010/07/protest-cases-to-be-watched.html
'Basyang' leaves RP; death toll now 39, 84 missing 07/17/2010
'Basyang' leaves RP; death toll now 39, 84 missing
The National Disaster Coordinating Council (NDCC) yesterday lowered its alert level from code "red" to "blue" after Typhoon "Basyang" left the country's area of responsibility after battering several regions, including Metro Manila on Tuesday, leaving 39 persons dead while 84 others remained missing.
NDCC Executive Director and concurrent Office of the Civil Defense (OCD) Administrator Benito Ramos said the lowering of the NDCC alert level was prompted by normalcy after two days of power outages in the capital region and other Luzon areas and the exit of Typhoon Basyang.
Under the "blue" alert, only half of the NDCC and OCD personnel are required to monitor the situation while the other half can already rest.
"The NDCC is now on blue alert…The situation is now normal," Ramos said, although he admitted that electricity is not yet fully restored in some areas in Luzon.
As of 1 p.m. Friday, Ramos said the number of deaths was at 39, mostly in Region 4-A, which recorded 21 deaths. Region 3 and Region 5 recorded 13 and five deaths, respectively.
The number of missing rose to 84 following late reporting from the field, Ramos said.
Of the missing, 49 are from Region 5, 31 are from Region 4-A, three from Region 3 and one from Region 6.
The number of injured is at 18 – 12 in Region 4-A, four in Region 5, and two in Region 3.... MORE
Abrogate mining law, junk GMA EOs on sector
Police chief killed, 6 badly hurt in NPA ambush
'Protests no indication May 10 polls were fraudulent'
NBI seeks former PAF colonel in massacre witness bribe try
Radioman who survived slay try IDs suspect
Gov't to bring home 25,000 who fled Muslim conflict
Complaints, confusion mar P-Noy's first visit to Isabela
Enrile probable Senate President By Angie M. Rosales 07/17/2010
Realignment of forces up JPE landing top Senate post
Enrile probable Senate President
By Angie M. Rosales
He wasn't born with a silver spoon in his mouth, but he may just be handed the Senate presidency on a silver platter again — without even fighting or even wishing for it. Again.
There now appears to be an emerging consensus to keep Senate President Juan Ponce Enrile in his post, as more senators seem to be leaning toward his continued leadership in the upper chamber.
A major realignment of forces in the Senate has been taking place the past few days and the so-called "Angara bloc," currently considered the biggest group in the Senate which is being seen to provide the swing vote, appeared to have lost its steam after one of its members appeared to have already defected and committed the vote to the Liberal Party (LP) and its bet, Sen. Francis "Kiko" Panglinan.
"We have lost one (senator in our ranks) already," Zubiri admitted to reporters in a press conference yesterday, pertaining to Sen. Manuel "Lito" Lapid.
The Angara bloc is led by Sen. Edgardo Angara and includes Zubiri, Senators Loren Legarda, Ramon "Bong" Revilla Jr. and Lapid.
But the chances of the LP's bet for the Senate presidency grabbing the top post remain dim as those who have stayed on with the Angara bloc tend to favor a "compromise" candidate in the person of Enrile, who, even as he retains his post as Senate President, has not made a bid for it.... MORE
Migz decries Koko's false charges
Solons seek probe of DoJ charges vs AFP in new slays
Neri pleads not guilty to NBN charges
Rebel soldiers to file raps vs Garci generals
More than 100 Pinoys face death penalty abroad — DFA
Migz decries Koko's false charges By Angie M. Rosales 07/17/2010
Sen. Juan Miguel "Migz" Zubiri yesterday rapped defeated senatorial candidate Aquilino "Koko" Pimentel on what he termed as "falsities" and malicious charges following the accusations made by the latter who had claimed that Zubiri deceived the Senate Electoral Tribunal (SET) which had already come up with a resolution allowing the counter-suit filed by Zubiri.
Pimentel had charged that alleged staff members of Zubiri participated in and presented themselves as "representatives" of the three senators sitting as judges in a pending electoral case against their principal.
"This is absolutely false. This is a pure canard," Zubiri told the Tribune, in reaction to the charge made by Pimentel, adding that "it pains me that he (Pimentel) would engage in such malicious, dirty tricks."
Zubiri yesterday decried the malicious attempt by Pimentel to obstruct due process by trying to
railroad the rules and processes of the SET.
"How can Koko say the fight is over when my 25 percent counter protested area clearly shows that cheating took place in Metro Manila and Mega Manila especially when the SET revisors found tens of thousands of spurious or fake ballots in these areas?" Zubiri pointed out.
At the same time, however, Zubiri said he was willing to forgo the recount the remaining 75 percent of the contested ballots in the May 14, 2007 senatorial polls pending before the SET.... MORE
Solons seek probe of DoJ charges vs AFP in new slays 07/17/2010
Lawmakers yesterday said Justice Secretary Leila de Lima's reported allegation that the Armed Forces of the Philippines (AFP) is behind the recent killings of activists is so serious that it needs to be looked into.
"This is a very serious accusation considering that the AFP under the Constitution is the protector of the people," Cavite Rep. Elpidio Barzaga stressed.
He said the basic requirement of due process mandates that evidence should be presented to support the allegation and thereafter AFP should be given the opportunity to disprove the allegation.
"I anticipate that some of my colleagues in the 15th Congress would be filing a resolution calling for an investigation on this matter," Barzaga added.
Marikina Rep. Romero Federico Quimbo said while he trusts in the credibility and track record of the new Justice chief, "I do not want to immediately pass judgment on the culpability of the AFP."
"The circumstances are highly suspicious that should lead us to investigate the matter and definitely, Congress must look into it," he added.
Quimbo said he is deeply alarmed that the recent victims are mostly teachers whose numbers are already dwindling but continue to respond to the call of duty.
"In the end, the issue is not only about the death of activists, but how the country's democratic and government institutions are being misused and abused. These killings must stop," he added.
"There are quite a number of former activists that were elected in Congress. Maybe, this is a good opportunity for all of us to unite, regardless of parties we belong to, in this call to stop these killings of activists in the country," Quimbo stressed..... MORE
Neri pleads not guilty to NBN charges By Charlie V. Manalo 07/17/2010
Former National Economic and Development Authority (Neda) Director General Romulo Neri pleaded not guilty yesterday to graft charges filed against him before the Sandiganbayan in connection with the aborted $329-million national broadband (NBN) contract with ZTE Corp. of China.
Waiting for at least 30 minutes for the Sandiganbayan 5th Division justices to arrive, Neri took only a few minutes to enter his plea and leave the courtroom.
While Neri refused to comment on the possibility of his turning state witness, his counsel, Paul Lentajas said his client has no intention whatsoever of becoming a witness for the "Truth Commission" formed by President Aquino to investigate the alleged anomalies that hounded the Arroyo administration, including the ZTE-NBN deal fiasco.
"Whatever the Truth Commission will do is irrelevant as the case is already in court," Lentejas stressed.... MORE
Rebel soldiers to file raps vs Garci generals By Mario J. Mallari 07/17/2010
By Mario J. Mallari
Sleepless nights will hound the generals said to have been involved in the 2004 vote-rigging operations later tagged as the "Hello Garci" generals.
Rebel soldiers will be testing the "openness" of President Aquino's administration in upholding justice by pursuing cases against officers of the Armed Forces of the Philippines (AFP), active and retired alike, allegedly involved in the 2004 electoral cheating.
Lawyer Trixie Angeles, who represents Scout Ranger Maj. Jason Aquino and retired Marine Lt. Col. Achilles Segumilian in the ongoing general court martial proceedings, vowed that they will give the officers linked to the election fraud "sleepless nights."
According to Angeles, while her clients see "hopes" in the Aquino administration, they will be seeking justice by running after those who were involved in the 2004 electoral fraud as contained in the controversial "Hello Garci" recordings.
"We will test it by first going after those Garci officers," Angeles said.
More than 100 Pinoys face death penalty abroad — DFA 07/17/2010
More than 100 Filipinos, mostly in the Middle East and China, are facing death for committing various crimes, the Department of Foreign Affairs (DFA) yesterday said.
But the DFA stressed these concern the death penalty, not death row cases.
"The latter implies that final judgment of conviction has already been reached and the Filipinos concerned are simply awaiting execution," a department statement said.
The cases of the Filipinos involve several offenses such as rape, drug smuggling and homicide and are pending
in China, Malaysia, Kuwait, Brunei, United States and Saudi Arabia. The cases are in different stages, but in the event of conviction the maximum penalty is death.
Out of 102, 16 are Filipinos in the Middle East who are charged with murder/homicide (including rape/robbery with murder).
Seventy-four involve drug-related cases, most of which are in China, while three are non-drug related cases.... MORE
Focusing on the small stuff EDITORIAL 07/17/201...
Blatant interference FRONTLINE Ninez Cacho-Olivar...
N. Korea tests US 'strategic' patience ANALYSIS ...
Stranded OFWs in Dire Need of Assistance – Migrant...
After its CBA Was Suspended for 11 Years, Philippi...
Pascual Guevarra and the Struggle for Land Publish...
'Basyang' leaves RP; death toll now 39, 84 missing...
Enrile probable Senate President By Angie M. Rosa...
Migz decries Koko's false charges By Angie M. Ros...
Solons seek probe of DoJ charges vs AFP in new sla...
Neri pleads not guilty to NBN charges By Charlie ...
Rebel soldiers to file raps vs Garci generals By ...
More than 100 Pinoys face death penalty abroad — D...


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Perspective > Medscape Internal Medicine
What Physicians and Other Healthcare Providers Need to Know Today About End-of-Life Care
Robert Glatter, MD; Ferdinando L. Mirarchi, DO
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End-of-Life Care: New CMS Reimbursement Rules
Robert Glatter, MD: This past summer, the federal government announced a proposal to reimburse healthcare providers for talking to Medicare beneficiaries about end-of-life care.[1] This move comes after increasing calls for a better approach to conversations about dying, which can ultimately improve patient care and reduce healthcare expenditures. The proposal will be finalized in November 2015, with the goal to begin reimbursement for such discussions on January 1, 2016.
The rule, announced in July of 2015, would allow doctors, nurses, nurse practitioners (NPs), and physician assistants (PAs) to bill for discussions about end-of-life care, which was supported by a September 2014 report[2] by the Institute of Medicine (IOM) titled, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.
End-of-life care has changed considerably since the IOM last reported on this issue in 1998.[3] To begin with, palliative care is now well established in medicine, nursing, and social work. Yet there is considerable room for improvement. Americans have strong preferences and feelings about the type of care they would like to receive at the end of life. They generally prefer to die at home and with the ability to maintain control over healthcare decisions, according to the recent report.[2] As of now, however, there is minimal or no planning really put in place.
The report details findings about more than a quarter of adults, including those aged 75 years and older, who have not given thought to specifics regarding end-of-life care. Many more have not written down their preferences or spoken with their families about their true wishes, according to the report. Because our healthcare system is often focused on curative care rather than supportive and comfort care, such discussions are vital to support the preferences of dying patients and their families.
In 2009, efforts to reimburse medical providers for having such discussions ran into opposition after mostly Republican opponents of the Affordable Care Act (ACA) believed that the law would lead to death panels that aim to produce cost savings by rationing care. A provision to pay physicians for such end-of-life counseling was actually stripped from the final bill. Physicians who counsel newly enrolled Medicare beneficiaries, however, are currently reimbursed under the ACA, but this reimbursement does not apply to those patients who are currently enrolled in Medicare.
Many medical providers believe that we are not having these conversations often and soon enough. Family members, trying to do the right thing, may end up feeling guilty and uncertain without having had this kind of conversation. Also, the approach to a proper conversation regarding end-of-life care should not only focus on the existence of advance directives such as do-not-resuscitate (DNR) orders, or whether a living will exists, but more recently there is a significant push to generate a document known as a physician orders for life-sustaining treatment (POLST). Ideally, a POLST or a living will should be in place well before a catastrophic event occurs that may require care in an emergency department (ED).
A POLST clarifies and spells out instructions for medical providers to follow after a catastrophic event, such as a cardiac arrest, or when caring for patients who might be entering the last stages of a terminal disease. One expert who is well qualified to discuss aspects of end-of-life care and POLST documents is Dr Ferdinando Mirarchi, medical director in the department of emergency medicine at University of Pittsburgh Medical Center-Hamot in Erie, Pennsylvania. He is also the principal investigator of The Realistic Interpretation of Advanced Directives (TRIAD) studies.[4] Welcome back, Dr Mirarchi.
Can you explain what a POLST document is? How is it different from a living will or other advance directives?
What Makes A POLST Different
Ferdinando L. Mirarchi, DO: Great point! It is really important to clarify the difference between the POLST document and an advance directive. POLST is a medical order set that is supposed to go into place, just like any other physician order set, and that other medical professionals like nurses follow. The point of it is to create an order set that would encompass a patient's care spectrum when in cardiac arrest and when not in cardiac arrest, as well as to address other issues, etc.
It is very important to clarify that POLST is an "immediately actionable document"—an order set—whereas a living will is not an immediately actionable order set. The POLST is a document that comes into play when a patient is frail, elderly, or expected to die within 6 months to 1 year. A living will comes into play when a patient cannot speak for themselves and has entered an end-stage medical condition or a persistent vegetative state. Although a living will can be helpful in creating a POLST document, the two are not the same. A living will declining treatment is not the same as a POLST specifying DNR with comfort measure only. Again, one is actionable (POLST), while the other one (living will) is not actionable.
Dr Glatter: To clarify, a DNR only refers to a condition when the patient has no pulse and is not breathing. Would you agree with that?
Dr Mirarchi: That is correct. A DNR does not equate with end-of-life care or do-not-treat orders. That is a misnomer that has developed over the years, which we in the healthcare community have allowed to happen. DNR orders only come into play when a patient is found in cardiac arrest.
Dr Glatter: In terms of a checklist or a resuscitation pause (what we would call an advance directive pause), where do you see this concept in terms of implementation into care? Do you see that happening in the near future?
Dr Mirarchi: I think it is imperative that it happens in the near future. In fact, the Joint Commission[5] recently came out with a statement about the whole issue of safety surrounding end-of-life care. We know from Atul Gawande's work[6] on surgical pauses that checklists have extreme benefit in preventing errors. At this point in time, I think a patient safety checklist is going to become imperative to making sure that we have safe, balanced discussions that will provide the patient with the ability to have informed consent. We have discussed the importance of checklists in previous conversations on Medscape.
Talking About End-of-Life
Dr Glatter: Getting to the discussions themselves, there have been several current procedural terminology (CPT) codes created for these types of discussions, though they have obviously not been activated. The codes are for coding of discussions of up to 30 minutes and even beyond. Certainly these discussions take time, and I think with the average amount of time that most medical physicians, PAs, and NPs have to care for patients, 30 minutes and even beyond is a significant amount of time. Do you see the time factor being an issue?
Dr Mirarchi: Yes and no. This is going to be new, so essentially physicians are going to have to figure out how they are going to go about having this discussion. If you are involved in a system today—and most of us are, because of all of the flux happening in medicine right now with increasing numbers of clinicians employed by big healthcare systems—that system is going to determine what resources clinicians will be utilizing to have these discussions based on the merits of compliance with the rule, so they can bill out for that first half-hour and second half-hour. There is going to be a lot of variable practice out there, ranging from the paternalistic approach of some organizations to the more patient-centered approaches of others. In order to ensure informed consent, it is important that these conversations be a balanced and not a leading discussion.
Dr Glatter: Another important question is whether the documents will be legally binding and official, assuming there is informed consent in these types of conversations.
Dr Mirarchi: I think they will be binding, and that is where the POLST is gaining ground as they are enacted into statutes across the states. There are states where there is physician or provider immunity. There are states where there is not provider immunity. If POLST documents are to really become embraced, there is going to have to be some immunity that comes with them. I think that when physicians do this, they are more than likely going to be creating POLST documents for people rather than attorneys. In contrast, patients might see their attorney to create a living will or go to a site like mydirectives.com and create a digitally created living will.
Dr Glatter: Anecdotally, I have seen social workers create these documents for patients in the throes of resuscitations. Nonmedical people are certainly informed, but they cannot give the type of advice a physician necessarily could give. Often a group discussion takes place with the family member and the social worker, and then the document is created. We need to be aware of that.
Dr Mirarchi: That is a great point. And to expand on it, to date there are numerous healthcare payer systems out there that essentially incentivize the completion of forms with quality financial bonuses for the institutions. What is happening there, as you said, is that a social worker—who may not have as in-depth knowledge as we do—is essentially looking at a living will and then pulling out a POLST form, checking off a box that says, "DNR comfort measures only," and having the patient sign it. That is a very dangerous thing to do outside of an informed conversation because the end result is an actionable order set. As you have seen with the current DNR forms, we are getting very good at scanning documents into our electronic health records and setting up banner bars. It is not uncommon for patients to return to the hospital with a critical illness and for clinicians to look in the system to see that patient's code status, advance directive, or POLST information. If it is incorrect, it is a pretty serious patient safety risk.
A Call for Education
Dr Glatter: How can we educate all kinds of providers—from NPs to physicians to PAs—about how to read these documents and create them? How can we standardize this process? Where do we start?
Dr Mirarchi: My views might be skewed, but personally I think this has to become part of the curricula of all the professional schools—including medical, nursing, PA, and NP. Every facet of healthcare has to be educated and brought up to speed quickly. For those who are currently in practice, it needs to come back down to some degree of a continuing medical education (CME) activity—CME that is made mandatory by the institution or the state. As we go to the next American College of Emergency Physicians Assembly, it is very interesting that some states have requirements that physicians earn some number of CME credits on the topic of end of life. At this point in time, we are going to need to look at that education, standardize it, and then really begin to enforce the requirements for physicians and providers of all sorts to get that education because it is going to be vital.
Dr Glatter: Do you see this as one criterion to meet for renewing a medical license or even passing a 10-year exam, with the maintenance of certification (MOC) such a current issue?
Dr Mirarchi: That's my hope and dream—that eventually this kind of education becomes a medical licensure requirement. Remember, our TRIAD research showed that the existing education out there today is either ineffective or flawed because those who receive education perform no differently from those who did not receive the education. That was a very surprising finding to us.
Dr Glatter: It almost begs the question of whether physicians should have some sort of legal course in how to decipher these documents.
Dr Mirarchi: Yes, and remember, this is a new realm for physicians. These kind of documents are only maybe 20-30 years old at best. The POLST is a very effective document. It is good at limiting resources utilized at the end of life. However, if a clinician does not know what to do with it, it becomes a patient safety risk, just as has been previously shown with advance directives. Standardizing the approach to education about these documents and getting out ahead of their widespread use is going to be very important. But the horse is already out of the gate here: POLST documents are already approved—or in the process of being approved—in 46 states to at least some degree. We need physicians to become aware that they really need to question these documents and orders.
Dr Glatter: Do you think we should be educating the public as well about the POLST document? Is it something they should be aware of as much as we should?
Dr Mirarchi: I might have a skewed approach, but I think that there should be efforts geared towards educating the public about what a DNR order is, a living will is, and a POLST, and when it's appropriate to have each of those. At this point in time, this is all new to medicine, and we do not know who is actually going to receive reimbursement yet for end-of-life care counseling and at what point in time a patient's care becomes end-of-life care. In the situation of a critical illness, there are paternalistic providers who seem to think that is the time to essentially withdraw care, treatment, or life-supporting measures. Then there are others who are more patient-centered who feel that you give the treatment and then allow the family to make the decision. I do not know which one is going to win out there, but I have the feeling it is going to be financially based to some degree.
Timing an End-of-Life Talk
Dr Glatter: When should this discussion ideally take place? Should it be when someone is just 50 years old? Sixty years old? Or only when they are on the cusp, or the throes, of a terminal illness? Oftentimes it happens in the ED, right before resuscitation is to take place. If Medicare sees this as a process that requires 30 minutes for this discussion, it is certainly not going to happen in the ED. It's going to be somewhere in an office, well away from the frenetic pace of the ED.
Dr Mirarchi: Yes, that is correct. The ED is a disconnected setting. The primary care office is very disconnected from the hospital these days, and in an emergency, because of different on-call systems, ED clinicians may have no way to contact a physician who might know the patient. So, unfortunately, even though the patient may have created these documents, we might not be able to talk to the physician who advised them or assisted with the creation of the document to get clarification as to what the patient's instructions mean and what we are supposed to be doing in terms of treatment. As far as when these discussions should occur, it would make sense that it would happen in the primary care physician's office and ideally as soon as possible. But in reality, I do not know if that is the most effective way to do it anymore because, with the birth of hospitalist physicians, primary care physicians are often not coming to the ED or hospitals anymore.
Dr Glatter: I think you bring up a good point about the separate nature of the office vs the hospital and the hospitalists because the hospitalist or intensivist is increasingly the provider who delivers medical care during a hospital stay—the time and place where there's a chance to intervene and really make clear changes in a patient's wishes and address these changes at that point.
Dr Mirarchi: I completely agree with you.
Dr Glatter: There was a recent article by Stub and colleagues[7] that looked at how resuscitation following out-of-hospital cardiac arrest occurs in hospitals and whether or not certain goals for resuscitation, including use of recommended interventions and amount of time per intervention, are met. I wonder if you could comment on this study and how it relates to our discussion.
Dr Mirarchi: In emergency medicine we are faced with this clinical scenario every day. Right now, with increased focus on public reporting, surgeons, emergency physicians, and interventional cardiologists are very concerned about the information, specifically mortality rates, that is publically reported. When you look at that study, it showed that our cardiac centers are actually following the guidelines on withdrawing life-sustaining treatment only 50% of the time.
The guidelines actually say that, for patients who have cardiac arrest either in or out of hospital (especially if there's hypothermia), healthcare professionals should wait at least 72 hours before withdrawing life-sustaining treatment. The most common reason for this decision is perceived neurologic damage that is expected to progress and be long term. In reality, we know that these patients need to be cooled, they need to go to the catheterization laboratory, and they need to have their artery opened up.
But what is happening, instead, is that centers and physicians are using these documents and orders to bypass that 72-hour period and withdrawing care too soon. We really need to look at this process and make sure that we are compliant with the guidelines for out-of-hospital cardiac arrest, whether it is a stroke or an intracerebral hemorrhage. There is a lot that we need to research still, and unfortunately this move towards payment for end-of-life care may precipitate some safety issues that we have not thought about.
Dr Glatter: I think that now that Medicare will be watching and possibly reporting on hospitals in terms of these issues, hospitals are going to be attentive to such data, assuming it does get incorporated into patient care.
I want to thank you so much for your time, and I appreciate your input into this important discussion about end-of-life care.
Dr Mirarchi: Thank you, Dr Glatter. Remember, above all else, just stick to a patient safety checklist and make the conversation balanced.
Medscape Internal Medicine © 2015 WebMD, LLC
Cite this: Robert D. Glatter, Ferdinando L. Mirarchi. What Physicians and Other Healthcare Providers Need to Know Today About End-of-Life Care - Medscape - Oct 22, 2015.
Robert D. Glatter, MD
Attending Physician, Department of Emergency Medicine, Lenox Hill Hospital, New York, New York
Disclosure: Robert Glatter, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Techcare, Inc.
Ferdinando L. Mirarchi, DO
Medical Director, Department of Emergency Medicine, University of Pittsburgh Medical Center Hamot, Erie, Pennsylvania
Disclosure: Ferdinando L. Mirarchi, DO, has disclosed no relevant financial relationships.
Diseases & Conditions Palliative Cancer Care Guidelines
CMS Proposes Paying for End-of-Life Discussions
POLST and DNR: Misunderstandings That Confound Critical Care
Advance Directives May Be Hazardous to Your Health

redpajama_set_name: RedPajamaCommonCrawl


Find out how to live with and treat your osteoporosis while still enjoying everything that life has to offer.
If our Doctor has recently told you that you have osteoporosis, you may certainly have a lot of questions for us. What is osteoporosis? How did it develop? How can I prevent my condition from getting worse? We are here to answer all of your questions and to help you manage your osteoporosis symptoms for the long term.
This bone disorder causes the bones to become porous or brittle. As the bones lose density they become weaker and are more prone to breaking. According to the National Osteoporosis Foundation, this condition is fairly common, affecting as many as 54 million American adults.
This condition is serious, particularly for older individuals. Besides affecting the health and strength of your bones it can also lead to chronic pain. Osteoporosis can also affect the health of your spine, which can cause the sufferer to hunch over. It can also affect mobility, which can greatly impact a person's quality of life.
Exercise regularly for about 30 minutes to 45 minutes three times a week. Consider an array of workouts, from swimming to weightlifting to yoga or running.
You may also be prescribed medications to help treat your osteoporosis. The goal of these medications is to prevent the bones from losing density. Common medications include Fosamax, Boniva and Actonel. There are a lot of medications from which to choose (and some newer ones on the market) so we will sit down and discuss with you to figure out which one might work best for your needs.
Hormone replacement therapy may also be recommended, as both estrogen and progestin can protect bones from fracturing. HRT may be a good course of action if a woman is at a high risk of developing osteoporosis.
Whether you have questions about osteoporosis or your treatment options turn to your Camden County Doctor for the care you need. Living with osteoporosis doesn't have to be a challenge. We can help make it easier for you!


Renewal by Andersen Philadelphia is the region's most trusted name in replacement windows and patio doors. Now, we're offering the same quality assurance with Provia entry systems to redefine your front door.
Provia entry doors exceed the industry standard in every category from style to function—and are now backed by the quality assurance of our certified master installers.
Provia entry doors are custom-designed by you to fit your home and your needs. Whether you're looking for a sturdy legacy steel door, or prefer the realistic wood-look of Embarq fiberglass, Provia has an ideal door solution for you. In addition to the perfect look and fit for your Philadelphia home style, Provia entry doors are made with lasting quality assurance.
Polyurethane cores keep your and your family comfortable while reinforced frames and steps protect against drafts and moisture.
Tough deadbolt panels and hardware close your home with a weatherproof and secure seal.
Every Provia exterior door style is made with rot-resistant, solid materials for long-term use.
Decide how you want your front door to look and operate, and we'll make it happen with custom options at every step.
Get the strength of wood with the versatility of fiberglass in a sleek, easily functioning design.
Signet doors are made to resemble natural wood through an exclusive Provia process called MasterGrain®. This process uses nickel vapor deposition to create a high-shine woodgrain finish, while additional compounds provide superior resistance to splitting or cracking overtime. Plus, hardwood features like hinge and strike stiles contribute create a sturdier look as well as composition.
This series is also highly customizable in your choice of wood patterns, stains, colors, and styles. Additionally, Signet doors can be custom-manufactured with contrasting interior and exterior designs for a distinct look in any home.
See below for Signet style variations to help inspire your next home improvement.
Embarq entry doors provide unmatched home insulation with fiberglass in your choice of smooth or woodgrain finishes.
The most energy efficient of our Fiberglass doors, the Embarq style is best suited for the homeowner looking for maximum energy savings. In addition to the standard Provia polyurethane core, Embarq doors feature frames 43% thicker than standard insulating fiberglass styles. As a result, this type reflects only the highest standards in draft protection, noise reduction, and interior temperature control.
Whether your home is more classic or modern, Provia has built-in windows, sidelights, and solid designs to match. Plus, all Provia doors are made to your house's exact specifications, so you know you're getting the most of Embarq's weatherproof properties.
Discover the style possibilities of front doors below.
A sophisticated complement to classic and historic homes, Heritage fiberglass doors feature our most realistic wooden door design.
An enhanced panel design provides wood-like dimension, while solid oak laminated stiles improves your door's structure. You can also customize your door with varying depth options to assume a traditional style. Plus, it comes standard with a nickel threshold and polyurethane core to keep the elements out for years to come.
The wood properties of Heritage doors last longer than standard wood doors because they're reinforced with durable composite materials. All fiberglass bottom doors are reinforced with durable weatherproof strips to keep out moisture as they protect your floors. This means you get all the perks of a solid wood look and feel with the longevity of fiberglass doors.
See how you can design a Heritage door to be classic, traditional, or modern.
A legacy steel door offers unrivaled insulation, security, and lasting value for your Philadelphia home.
Consider the legacy series if you'd benefit from optimal energy efficiency with a sleek, modern style. This door is available in smooth, woodgrain, and embossed skins, so you can match it to the exterior of your home regardless of its established style.
Legacy doors are completely foam-filled to ensure temperature control all year long. This core is covered by one continuous piece that contains 49% more galvanized steel than a standard steel door, and contains heat and cold-transfer-resistant materials throughout. Plus, its edges are protected with additional composite materials for total weather resistance.
Browse our collection of Provia steel doors.
Most Provia entry systems are Energy Star® certified, and all styles are backed by a lifetime limited transferable warranty. That means any style Provia entry door is equipped with unmatched quality assurance. Plus, Provia is committed to overall sustainability with environmentally friendly policies throughout the entire production process.
Provia entry doors are all made to incorporate a polyurethane core to prevent unnecessary strain on your heating and cooling appliances.
Durable locks, frames, and thresholds also contribute to maximum energy efficiency as well as lasting functionality for regular use.
A selection of glass types and styles gives your door windows dimension in nearly any shape, size, and position—including multiple sidelights.
All door frames are created with heath-resistant trim to maintain internal and external temperature control even in a black steel door style.
Finger-jointed composite trimming prevents swelling or bowing overtime while maintaining a modern door look.
Provia front doors with glass are custom-designed to match your unique vision. You can choose circular, full, partial or sidelight windows—which can all hand-beveled for a sophisticated finish.
Our window glasses are produced with signature ComforTech™ Warm Edge glazing system. This process is designed to keep windowed doors as energy efficient as possible, as well as warm to the touch.
Multiple levels of ComforTech™ glass also allow various design options. Incorporate one of 22 series of hand-beveled designs for a classic look, or go modern with solid clear or tinted windows. Each window type featured a unique privacy level denoted on an easy-to-understand 1-10 scale to help you choose how much goes in or out.
Regardless of your style, Provia can make a door to exceed every one of your expectations. Start designing yours today when you call to schedule an in-home consultation.
Renewal by Andersen Philadelphia is committed to a streamlined process, dedicated customer care, and a superior process. Provia exterior doors are no exception. Call or email us today and start enjoying your beautiful, lasting home improvement sooner than you think.
Our Philadelphia Renewal by Andersen professionals are with you every step of the way to design, plan, and install your new home improvement. Call to schedule an obligation-free, in-home consultation to discover the possibilities of Provia entry systems today.


Air charter service to and from Kentucky.
Everyday countless numbers of individuals travel all across the globe for a wide variety of reasons. Many will travel via the air on airplanes. While most will use commercial airliners and their services a select few will travel via private jet or a charter plane. For these sorts of individuals the very best can be expected. Flying via private jet is one of top signs of luxury and high living. This form of travel is especially true for individuals who travel to Kentucky $airport code also known as $airport name. The many high rollers who descend upon the city and its airport are a testament to the high value that they place not only on the city but of traveling in the very best that can be offered. Many individual are now discovering this, even If they are not high rollers, and now use private jets and charter services as well.
The private jet industry has flourished in the past decade, since more businesses have realized what the benefits of traveling this way can be. The main advantage to any private jet chartering is that you get get from one destination to another faster by being on such a jet. Since the plane doesn't need to land in different cities to let other passengers on and off, you can proceed directly to your destination. Taking a trip from Kentucky $airport code $airport name to any other city could be a much shorter trip than you are used to if you begin to charter private jets for business or personal travel. Though the cost can be expensive, the amount of time saved can make paying more money to charter a jet worth it.
Traveling on a private jet is among the more enjoyable and luxurious ways to travel. When using a private jet you will have the ability to travel on your own terms. Most people travel via commercial airline but there are many hassles that one needs to deal with. However with a private jet you are free from these hassles and have numerous benefits as well. With a private jet you will be able to have plenty of room to sit and sleep in. As a result you will have lots of comfort during your flight. When getting a private jet the options of buying or renting one are always available so you have flexibility in that regard. Private jets are very expensive so that is something to keep in mind. Chartering a private jet from Kentucky, $airport code or $airport name is very convenient for travelers.
Most people go on vacation to get away from the stress and strife that every day life brings. Standing in long check-in lines, and unnecessary lay overs that are found in commercial flights just add to it. The well deserved, relaxing vacation has just become another added stress and strife in life. Why not leave all those headaches on the front door step and charter a private jet and let the vacation begin. By chartering a private jet to Kentucky, from $airport code $airport name the hassles associated with commercial flights become a thing of the past. No more over head baggage to worry about, no more crying babies, just peace of mind. Besides there are more important things to concentrate on, rest and relaxation.
When chartering a private plane, keep in mind that you may need to pay for additional expenses on top of renting the actual aircraft. When shopping around for charter planes to rent from Kentucky $airport code $airport name, get a breakdown of the price for the entire trip. If you re chartering a plane for a trip that may take several hours, you may want to add in a catered meal for you and your guests. If chartering a plane in the far future, your quoted price may contain flexibility for the increase or decrease of fuel prices. If you re visiting a popular vacation spot, you may want to try and find another party to share the expense of the chartered plane with you, provided there are enough seats on the aircraft.


text:
Step-by-step guides are available for the following procedures:
Add a licence association to a fixed point-to-multipoint bi-directional licence
This guide shows approved radio engineers and certifiers (AREs & ARCs) how to add an associated licence to a fixed point-to-multipoint bi-directional licence in the Register of Radio Frequencies (the Register).
Download the document
Add a licence association to a fixed point-to-multipoint bi-directional licence [PDF, 1 MB]
Delete a licence from a fixed point-to-multipoint bi-directional licence
This step-by step-guide guide shows ARE and ARC how to delete an associated licence from a fixed point-to-multipoint bi-directional licence.
Delete an associated licence from a fixed point-to-multipoint bi-directional licence [PDF, 993 KB]
Change a channel of a fixed point-to-multipoint bi-directional licence
This guide shows approved radio engineers and certifiers (AREs & ARCs) how to modify the channel of a fixed point-to-multipoint bi-directional licence.
Change a channel of a fixed point-to-multipoint bi-directional licence [PDF, 1.2 MB]
Update a fixed point-to-multipoint bi-directional licence
This step-by-step guide shows ARE and ARC how to update the licence details (spectrum, and site details for transmit & receive locations) on a fixed point-to-multipoint bi-directional licence.
Update a fixed point-to-multipoint bi-directional licence [PDF, 1.1 MB]


text:
Per-Åke Nordlund, född 7 januari 1947 i Skogs församling i Gävleborgs län, är en svensk astrofysiker som är verksam som professor vid Niels Bohr-institutet vid Köpenhamns universitet.

Nordlund studerade inledningsvis vid Uppsala universitet där han blev filosofie kandidat 1969, och fortsatte sedan på forskarutbildningen. År 1973 bytte han till Stockholms universitet där han blev filosofie doktor 1976. Han anställdes som lektor vid Köpenhamns universitets astronomiska observatorium 1979 och blev professor vid Niels Bohr-institutet 2004.

Nordlunds forskning gäller området beräkningsastrofysik, och han har ägnat sig åt modellering av konvektion och magnetfält i ytterlagret hos stjärnor.

Nordlund invaldes som ledamot av Kungliga Vetenskapsakademien 2009.

Källor

Externa länkar
Åke Nordlunds webbsida vid Niels Bohr-institutet

Svenska professorer i astrofysik
Svenska astronomer under 1900-talet
Personer verksamma vid Köpenhamns universitet
Ledamöter av Kungliga Vetenskapsakademien
Födda 1947
Män
Levande personer
Personer från Skogs socken, Hälsingland

redpajama_set_name: RedPajamaWikipedia


Modern style coffee table with a light and airy feel that lends your home a charming personality. Spacious and chic, you can now keep your coffee table books and magazines organized. Also, its handcrafted with detailed attention to offer style and quality.


text:
Jumil, chinche de monte ou xotlinilli é o nome que se dá no México a várias espécies de insetos hemípteros comestíveis da família Pentatomidae (Edessa mexicana, Atizies taxcoensis, entre outros).

Medem pouco menos de um centímetro (as fêmeas são maiores que os machos). São consumidos principalmente nos estados mexicanos de Morelos e Guerrero, tendo um característico sabor parecido com o da canela, proveniente dos galhos e folhas dos quais os insetos se alimentam. Em Taxco e outras partes do México, são comidos vivos. Sem dúvida, na gastronomia, por influência da visão eurocentrista, que ignora o preparo de insetos (diferente dos asiáticos, africanos e indígenas americanos), o jumil foi depreciado pelo "gastronomia de luxo" mexicana. A Enciclopédia do México, por exemplo, qualifica como de "fétido cheiro" e "oleoso e picante sabor" o líquido oriundo destes insetos e pelo qual são tão apreciados em algumas comunidades indígenas, apesar de erroneamente se interpretar este consumo como resultado da falta de recursos e da superstição .

Na época pré-colonização espanhola, os astecas caminhavam em peregrinação ao Cerro del Huixteco, perto da cidade de Taxco, em Guerrero, para subir ao templo dedicado ao jumil. Atualmente, a peregrinação continua sendo celebrada na primeira segunda-feira depois do dia de finados, ainda que o habitat do inseto esteja em perigo devido ao processo de urbanização da região. Em Taxco, se celebra a "feira de jumil" durante o mês de outubro, onde se pode degustar estes insetos, vivos ou cozinhados .

Leituras recomendadas
 LOMELÍ, Arturo. La sabiduría de la comida popular. Grijalbo, México, 2004.
 MUÑOZ ZURITA, Ricardo. Diccionario enciclopédico de gastronomía mexicana. Editorial Clío, México, 2000.

Referências

Culinária do México
Hemiptera


text:
Announcing Conn Maciel Carey LLP's 2023 Labor and Employment Webinar Series
December 19, 2022 December 20, 2022 Theresa Green Leave a comment
Announcing Conn Maciel Carey LLP's
2023 Labor and Employment Webinar Series
The legal landscape facing employers seems as difficult to navigate as it has ever been. Keeping track of the ever-changing patchwork of federal, state and local laws governing the workplace may often seem like a full-time job whether you are a human resources professional, in-house attorney or business owner. Change appears to be the one constant. As we enter Year 3 of President Biden's Administration, employers will continue to closely track the changes taking place at the NLRB, the DOL and the EEOC. At the same time, a number of states will continue introducing new laws and regulations governing workplaces across the country, making it more important than ever for employers to pay attention to the bills pending in the legislatures of the states where they operate.
Conn Maciel Carey's complimentary 2023 Labor and Employment Webinar Series, which includes monthly programs (sometimes more often, if events warrant) put on by attorneys in the firm's national Labor and Employment Practice, will focus on a host of the most challenging and timely issues facing employers, examine past trends and look ahead at the issues most likely to arise.
To register for an individual webinar in the series, click on the link in the program description below. To register for the entire 2023 series, click here to send us an email request, and we will register you. If you missed any of our programs from the past eight years of our annual Labor and Employment Webinar Series, here is a link to an archive of recordings of those webinars.
Remote Work Challenges
Whistleblower/Retaliation Issues
Pay Transparency & Non-Compete Laws
Managing Internal Investigations
Hot Topics in Wage and Hour Law
Marijuana and Drug Testing
Privacy Issues in the Workplace
ADA Reasonable Accommodations
Artificial Intelligence in the Workplace
NLRB Issues and Joint Employer Update
See below for the full schedule with program descriptions, dates, times and links to register for each webinar event.
What Does the EEOC's Updated COVID-19 Testing Guidance Mean for Employers
August 4, 2022 Ashley D. Mitchell Leave a comment
By Kara M. Maciel and Ashley D. Mitchell
As COVID-19 infections continue to climb, the EEOC rolled back its guidance that COVID-19 viral screening tests conducted by employers is always permissive under the Americans with Disabilities Act ("ADA"). The updated guidance requires employers to weigh a host of factors and determine whether COVID-19 viral screening is "job-related and consistent with business necessity," the traditional standard for determining compliance with the ADA.
The Factors Employers Should Consider:
Under the EEOC's updated FAQs, an employer may, as a mandatory screening measure, administer a COVID-19 viral test, if the employer can show it is "job-related and consistent with business necessity." In making this determination, employers should assess these factors:
The level of community transmission
The vaccination status of employees
The accuracy and speed of processing different types of COVID-19 viral tests
The degree to which breakthrough infections are possible for employees who are "up to date" on vaccinations
The ease of transmissibility of the current variant(s)
The possible severity of illness from the current variant
What types of contact employees may have with others in the workplace or elsewhere that they are required to work
The potential effect on operations of an employee enters the workplace with COVID-19
It is worth noting, that employers still cannot require antibody testing before permitting employees to re-enter the workplace.
The State of the Pandemic:
Religious and Disability Accommodations in Response to COVID-19 Mandates [Webinar Recordings]
April 12, 2022 Theresa Green Leave a comment
On Thursday, April 7, 2022, Andrew J. Sommer and Lindsay A. DiSalvo presented a webinar regarding Religious and Disability Accommodations in Response to COVID-19 Mandates.
Employee requests for medical and/or religious accommodations in the workplace are not new. However, never before have these accommodation requests been such a hot-button topic, nor have these accommodation requests been used so frequently (and in particular, religious accommodation requests). The imposition of COVID-19 vaccine mandates has changed that, particularly with regard to religious accommodation requests, which has become the ultimate "gray area," as both employers and employees alike have learned that sincerely held religious belief can include an employee's religious-based objection to vaccinations. As a result, the Equal Employment Opportunity Commission ("EEOC") has issued guidance regarding the obligations of employers under Title VII when an employee presents with a religious objection to a mandatory COVID-19 vaccination policy, which actually builds upon prior EEOC guidance regarding COVID-19 vaccinations in the employment context. Thus, there are multiple issues that employers need to keep in mind and juggle when addressing these vaccination accommodation requests.
Participants in this webinar learned how to best deal with such requests by their employees, including: Continue reading →
VOSH Begins the Process of Withdrawing its "Permanent" COVID-19 Rule
March 2, 2022 Theresa Green Leave a comment
By Conn Maciel Carey LLP's COVID-19 Task Force
Last Wednesday (February 16th), at the direction of Virginia's new Governor, Virginia OSHA's Safety and Health Codes Board voted to withdraw VOSH's COVID-19 Regulation. The Board's vote came after VOSH recommended that COVID-19 no longer constituted a "grave danger," the legal showing required to justify an emergency rule. Procedurally, the board vote was just the first step. Next is a 30-day public comment period, followed by a public hearing, then a final Board vote. If the measure is in fact repealed after the final Board vote, then Virginia employers would no longer have to require employees who work indoors to wear a face covering,; social distance; provide employee training; improve or maintain ventilation systems; or inform the VA Department of Health about outbreaks.
Although this move comes in lock step with Friday's CDC announcement that it is rescinding mask guidance, along with other states like California and New Jersey rescinding their mask mandate, on January 15th Virginia's newly elected Governor Glenn Youngkin issued an Executive Order instructing the Board to Continue reading →
CDC Relaxes Face Covering and Distancing Guidelines
As governors and big city mayors across the country have been allowing indoor masking mandates to expire over the last few weeks, last Friday, February 25th, the CDC unveiled a brand new approach to assessing COVID-19 risks and setting mask and distancing recommendations. The CDC's old tool, which measured the number of COVID-19 cases to determine the relevant level of virus transmission in each community had lost its usefulness as it rendered nearly the entire country as high-risk (95% of all counties), even as the number of people getting seriously ill had dropped precipitously this year.
CDC's new guidelines measure the impact the pandemic by looking at three factors week over week:
New cases per capita (as with the prior guidelines; but also
New COVID-19 related hospital admissions; and
The percentage of area hospital beds occupied by COVID-19 patients.
Each county will have a weekly "COVID Community Level Rating" that is either Low (green), Medium (yellow) or High (orange). Each level/color has recommended mitigation strategies, set in the table below:
Here is a link to CDC's tool to identify the level of COVID-19 transmission in your county.
The big news is that CDC recommends Continue reading →
Paid COVID-19 Supplemental Sick Leave Returns to California, Again
February 10, 2022 Megan Shaked Leave a comment
California Governor Newsom has signed legislation extending a new allotment of up to 80 hours of COVID-19 supplemental paid sick leave to California workers through new Labor Code Sections 248.6 and 248.7. The leave is retroactive to January 1, 2022, and continues through September 30, 2022. Small businesses that employ 25 or fewer workers are not covered by the legislation.
Use of Sick Leave for Reasons Related to COVID-19
The legislation provides for up to 40 hours of COVID-19 supplemental paid sick leave for employees who are unable to work or telework for certain reasons related to COVID-19, including:
[Webinar] 2022 California Employment Law Update
February 10, 2022 Theresa Green Leave a comment
On Wednesday, Feb. 16, 2022 at 1 p.m. ET / 10 a.m. PT, join Andrew J. Sommer and Megan S. Shaked for a webinar regarding 2022 California Employment Law Updates: New Legal Requirements and Practical Compliance Strategies Every HR Professional and Manager Should Know.
2022 brings changes for California employers to a range of topics touching on traditional employment law matters as well as health and safety concerns, including related to COVID-19. This webinar will review compliance obligations for companies doing business in California, as well as discuss the practical impact of these new laws and best practices for avoiding potential employment-related claims.
Participants in this webinar will learn about: Continue reading →
California Appellate Court Rejects Challenge to COVID-19 Emergency Rule
February 3, 2022 Andrew J. Sommer Leave a comment
In Western Growers Association, et al, v. Occupational Safety and Health Standards Board, et al, the California appellate court recently affirmed the lower court's decision denying a challenge to Cal/OSHA's COVID-19 Emergency Temporary Standard (ETS). This decision has far-reaching implications, affording considerable deference to the California Occupational Safety and Health Standards Board's (Board) rulemaking process and authority to bypass regular rulemaking with emergency temporary standards supported by its own "declaration of emergency." The Board – which is tasked with promulgating workplace safety rules – has had an oversized role during the COVID-19 pandemic.
As background, the Board's COVID-19 ETS was approved, effective November 30, 2020, over the recommendation of Board staff finding that "Cal/OSHA's limited resources should continue to be focused on enforcement and consultation outreach specifically targeted at employers and sectors of the economy with deficient COVID-19 protections," as this is likely to be more effective than new rulemaking. Since then Cal/OSHA's ETS has undergone numerous revisions, being "re-adopted" effective June 17, 2021 and then again on January 14, 2022. The regulation has been a moving target for employers, with the Board each time adopting modified text followed by updated FAQs .
The Latest with Pres. Biden's Federal Contractor COVID-19 Vaccine-Mandate Executive Order
January 26, 2022 January 25, 2022 Theresa Green Leave a comment
It has been a real adventure trying to track all the different legal challenges in so many different courts to President Biden's various different executive actions related to vaccination. While the fate of the OSHA Vaccinate-or-Test ETS (dead) and the CMC Healthcare Vaccine-Mandate (very much alive) are essentially settled by the Supreme Court, the Federal Contractor Vaccine-Mandate Executive Order (EO 14042) is still meandering its way through the federal courts. And there was a lot of activity in the courts this past Friday, January 21st, regarding the federal contractor EO and the federal employee vaccination mandate.
In the first case, Feds for Medical Freedom v. Biden, employees of federal contractors and employees of the federal government together are challenging both Executive Orders 14042 (vaccine-mandate for federal contractors) and 14043 (vaccine-mandate for federal employees). Judge Jeffrey V. Brown (a Trump-appointee to the S.D. of Texas) issued an opinion and order enjoining only enforcement of the federal employee mandate. Judge Brown's reasoning in that case boiled down to a conclusion that injunctive relief is appropriate because: (1) the "Hobson's Choice" of a workplace vaccine-mandate creates irreparable harm; and (2) the challenging federal employees have a likelihood of success on the merits because the President acted ultra vires and the implementation of EO 14043 violates the Administrative Procedures Act. Notably, Judge Brown declined to take action with regard to the federal contractor EO, noting that Judge R. Stan Baker (a Trump appointee to the S.D. of Georgia) in Georgia v. Biden had previously enjoined the federal government from enforcing the vaccination mandate on a nationwide basis.
While Judge Brown's decision in Feds for Medical Freedom v. Biden did not change the status of the federal contractor EO, on the same day, Judge Baker issued a new order with regard to the injunction he had put in place in Georgia v. Biden in December. First, Judge Baker declined to address whether private federal contractors are enjoined from mutually agreeing with a federal agency to include COVID-19 safety clauses in their contracts; i.e., to voluntarily comply with the Safer Federal Workforce Task Force ("Task Force") guidelines, as he viewed that as improperly seeking an advisory opinion while the case is pending on appeal. But on the broader question as to the scope of his national injunction, on Friday he wrote: Continue reading →
NYC's Private Employer Vaccine Mandate – Everything You Need to Know [Webinar Recording]
On Tuesday, January 18, 2022, Dan C. Deacon presented a webinar regarding NYC's Private Employer Vaccine Mandate – Everything You Need to Know.
On December 19, 2021, Mayor Bill de Blasio and the New York City Commissioner of Health and Mental Hygiene issued a private employer vaccine mandate which requires workers in New York City who perform in-person work or interact with the public for work to provide proof of vaccination before entering the workplace. The mandate did not provide much of a runway for employers to come into compliance, as employers had to make sure employees received their first vaccine dose by December 27th – just eleven days from the announcement.
It is also important to remember that all New York employers remain subject to the NY HERO Act, which requires employers to implement a written airborne infectious disease plan and certain exposure controls whenever the Health Commissioner declares a public health emergency involving an airborne infectious disease.
During this webinar, we provided a detailed analysis of this latest development and answered key questions including: Continue reading →
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MSU's Hamilton takes fifth in steeplechase to earn All-American honors
Montana State's Corbett earns All-American honors in women's high jump
May has interim tag removed as Montana track coach
MSU track standouts to compete at national meet in Eugene
Live Results | WatchESPN | Broadcast Schedule BOZEMAN, Mont. – The Montana State track and field program will be represented on the national stage this...
Big Sky Conference entries into NCAA Transfer Portal
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Bobcat Men 2nd, Women 4th in Big Sky Outdoor Track & Field Coaches' Poll
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Missoula duo Mustard, Reneau to sprint one more time in Garden City
Paul Reneau couldn't believe his eyes. In one of his first races for the Missoula Youth Track Club, Paul's 8-year...
ESPN Roundtable – Montana women's track & field stars
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McLeod ready to write final chapter at Big Sky Outdoor championships
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ESPN Roundtable – Montana head track & field coach Brian Schweyen
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Q: Monte Carlo (MC) dropout in Keras with R How to implement Monte Carlo dropout with Keras in Convolutional neural networks to estimate predictive uncertainty as suggested by YARIN GAL? I am using R.R-Code is here
I am fitting the model in small batches and want to evaluate the model in small batches as well with Monte Carlo dropout.Could not find any hint in Keras documentation.BTW, I trained my model with flag training=TRUE.
Thanks

A: Regular dropout only drops neurons randomly at training time, not a test time, so this is the default behavior of the Dropout class. If you want MC dropout, you need to use training=TRUE at test time as well, and you must run the forward pass multiple times: this will give you a distribution of predictions, which you can use as you please, for example to compute the mean.
I'm not familiar enough with R, so here is the class I use instead of the standard Dropout class:
class MCDropout(keras.layers.Dropout):
    def call(self, inputs, training=None):
        return super(MCDropout, self).call(inputs, training=True)

redpajama_set_name: RedPajamaStackExchange


Coloring. You can color the ready-made drawing with the help of the crayons, the markers or the watercolors.... Ready to Create a Cartoon Hedehog? Follow along as I guide you, step-by-step, into the wonderful world of drawing! Through this creative experience, you will not only have fun, you will learn important tools to create fabulous images.
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Easy, step by step how to draw Hedgehog drawing tutorials for kids. Learn how to draw Hedgehog simply by following the steps outlined in our video lessons.
Coloring. You can color the ready-made drawing with the help of the crayons, the markers or the watercolors.


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Your State Alabama Alaska Arizona Arkansas California Colorado Conn. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Mass. Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hamp. New Jersey New Mexico New York N. Carolina N. Dakota Ohio Oklahoma Oregon Penn. Rhode Isl. S. Carolina S. Dakota Tennessee Texas Utah Virginia Vermont Washington W. Virginia Wisconsin Wyoming
Georgia: Stamps | Fun Facts | Map | Travel Tips | Postcards
Georgia Travel Tips
GEORGIA TOURIST INFORMATION: (404) 656-3590
Statehouse, (404) 656-2844
When James Oglethorpe landed in 1733 he chose the coastal town of Savannah as Georgia's capital. But after the Revolutionary War the capital moved four times: to Augusta in 1786, Louisville in 1796 and Milledgeville in 1897 before permanently settling in Atlanta in 1868. Still reeling from the ravages of the Civil War it was nearly impossible at that time to find funding for a new Capitol. It was not until 1883 that the General Assembly appropriated one million dollars, and on July 4, 1889 Governor John Brown dedicated the building to "the indomitable will and recuperative energies of this great people." The Capitol is styled in the Classical Renaissance design with an Indiana oolitic limestone exterior and a Georgia marble interior. It features a center dome rising 75 feet, covered in native Georgia gold (the original dome was of terra cotta and tin). The cupola above the dome supports a female statue holding a torch in one hand and a sword in the other. "Miss Freedom," as she's known, stands 15 feet and weighs 2000 pounds. Facing west, the front facade features a four-story portico with stone pediment supported by six Corinthian columns and engraved in Georgia's coat-of-arms. The interior reflects the Victorian style of its day with classical pilasters and oak paneling. The Rotunda is flanked by two wings, each with a grand staircase and three-story atrium crowned by clerestory windows that cast varying beams of light across the floor as the sun makes its way westward. The Georgia Capitol was one of the earliest public buildings with elevators, central heat, and electric lights.
The Carter Center: Jimmy Carter Presidential Library and Museum, (404) 331-0296
The Carter Presidential Library, Museum and Political Center are situated on a tranquil green in the midst of urban Atlanta. Reflecting pools, fountains, ponds and Japanese gardens make it appear an oasis of optimism amid city strife. Inside the museum is an extensive photographic exhibit chronicling the life of former President Jimmy Carter as he traveled from a dirt road in Plains to the inaugural walk down Pennsylvania Avenue. In the museum, visitors can partake in a Town Hall meeting and choose from a series of questions, push the button and a video of Carter appears with his answer to the selected question. Other exhibit rooms show such things as his Campaign Headquarters with television sets broadcasting debates, commercials and speeches. The Iran-hostage exhibit details the long national kidnapping. The Gifts of State Exhibit showcases some of the lavish gifts received from foreign dignitaries. The Formal Presidential Dinner Exhibit displays a table set in expectation of a formal state dinner. And the Oval Office Exhibit is a complete replica of the Presidential suite during the time when Carter was president. An audio voiceover takes the listener back in time to 1978.
Tip: In addition to a great collection of books on Jimmy Carter, or written by Jimmy Carter hemelf, the gift shop sells replicas of Presidential dinnerware with the exact patterns from many of the former presidents. Take home a piece of dinnerware from any former president, from Thomas Jefferson to Rutherford B. Hayes.
Martin Luther King Jr. National Historic Site, (404) 331-3919
The Visitor Center at the Martin Luther King National Historic Site shows a photographic exhibit of King's life and work as well as a constantly streaming video of his famous speeches, including the "I Have A Dream" speech. From here, visitors can tour King's boyhood home and the neighborhood where he grew up. The neighborhood, called "Sweet Auburn" was a block of Victorian homes owned by well-to-do blacks during the 1920s. After touring King's home, one may walk a block away and visit the church where King co-preached with his father, and the shrine recently constructed to honor the slain black leader. The shrine, an oblong swimming pool with King's white marble tomb jutting out on a pedestal, makes the tomb seem to be floating on the pool. It is a strange place: part reflecting pool, part gravesite. Beside the shrine is the famous Ebenezer Baptist Church, founded by King's maternal grandfather. When he died King's father became the preacher, and Martin Junior co-preached with Martin Senior before moving on to his own parish in Montgomery. This church is also the site where King's mother was shot and killed in 1974 while playing the organ during a Sunday service.
Atlanta Underground, (404) 523-2311
Next to the World of Coca-Cola Museum is what appears to be a large multi-story shopping mall, but the basement is part mall, part museum. Within the subterranean mall lies the remains of a former railroad. Built after the Civil War the railroad traffic grew increasingly year after year until the hub of its activity began to choke the center of Atlanta. Rather than dismantle the station, viaducts were built over the tracks, moving the traffic up and out over the city. Today, while browsing through the modern retailers, shoppers can see remnants from the old railroad tracks, the facades from some of 19th century retailers who had catered to former rail travelers, and other railroad memorabilia.
Atlanta Cyclorama, (404) 523-2311
The Battle of Atlanta is vividly recreated in a massive circular painting and diorama. Visitors experience this horrendous Civil War conflict from a revolving 184-seat platform. The story begins on a blistering hot day in mid-July 1864 and is detailed through narrated diary entries, with special effect lighting and music.
Gone with the Wind Movie Museum at the Margaret Mitchell House, (404) 624-1071
Housed in the two-story midtown Atlanta home of Margaret Mitchell, author of Gone with the Wind, the museum contains the portrait of Scarlett and the actual Tara doorway from the set of the Academy Award-winning film version of the book. A guided tour of the home provides a glimpse into the author's life, herself a champion of human rights, and suggests possible reasons for her writing this epic novel.
MILLEDGEVILLE (912) 452-4687 or (800) 653-1804
The birthplace of author Flannery O'Connor, and comedian Oliver Hardy, Milledgeville holds the additional distinction of being one of the few cities in the nation to have been founded, designed, and laid out for the sole purpose of serving as a state capital. Today the town is the centerpiece of the Antebellum Trail, Route 441, which begins in Athens and ends in Macon. Many of the towns along this route have charming historic districts and marvelous antebellum mansions. Since Milledgeville served as the state capital from 1803-1868, (this is where Georgia seceded from the Union), we opted to stay in Milledgeville to enjoy the following attractions:
Old State Capitol
The Old State Capitol, (now on the campus of Georgia's Military College, which grew around the the old building), is a gray limestone Gothic structure that appears more like a fortress than a statehouse. An enormous arched gate made from the bricks of the old arsenal destroyed by Sherman, leads visitors down a long, straight driveway to the front facade dominated by a medieval-like clock tower. Currently being restored to its appearance at the time when Georgia seceded from the Union, it will reopen in October with an extravagant event. The townspeople will be reenacting the famous 1825 visit of the Marquis de Lafayette, following every item on his original agenda, including his coming down the river, being met by the mayor, followed by a parade. Formal balls, fireworks, and even the southern BBQ, which Lafayette was treated to on his visit here are all planned for this exciting event.
St. Stephen's Episcopal Church
During the Civil War when Sherman's troops destroyed the arsenal, the explosion destroyed many other objects nearby, including blowing the roof off the 1843 St. Stephens' Church. While stationed in occupied Milledgeville, Union troops poured sorghum down the pipes of church's organ to prevent its being used to rally Confederate sympathizers. A restoration effort after the war brought to the church gifts of hand-carved chancel furniture, a chancel window of Old English glass, a new Gothic roof, and new walls and ceilings made of beaded boards. These additions transformed the simple, cottage-like structure into the elegant Carpenter Gothic structure it is today.
Old Governor's Mansion
On a shady street in a thickly settled neighborhood stands a imposing Greek Revival mansion, the former home to Georgia's governors from 1839-1868. A magnificent creme-colored building with four large Doric columns, standing like sentries before the front door, it was spared Sherman's torch and is open today for guided tours of its high-domed interior furnished in period antiques.
Lockerly Aboretum and Mansion
Founded in 1966 as an outdoor horticultural laboratory, the arboretum showcases flora specimens native to the Piedmont area. Primarily landscaped in native trees and shrubs, the lovely wooded walking trail frequently opens to beautiful perennial gardens, such as herb gardens, Iris gardens, camelia gardens and butterfly gardens. In the midst of the walking trail is a picnic area by a pond, a lovely oasis adorned with an old gazebo and an old-fashioned water pump. After walking the trail, this picnic oasis and the cool water from the water pump offer heavenly relief from a long, hot walk. Beyond its natural beauty the arboretum also contains geologic and fossil displays and a unique Woods Museum, a cabin-in-the-woods structure filled with fantastic educational displays about all kinds of trees and their different personalities. Tree-lovers can see and feel the difference between chestnut and walnut, for example. This garden not only offers a spiritual retreat, but stimulates the mind with fascinating facts about the life of the woods.
Tip: Allow enough time, to tour the Lockerly mansion, a huge, 1839 antebellum plantation estate located beside the Lockerly Arboretum.
STONE MOUNTAIN PARK (770) 498-5702
Stone Mountain Park is a 3200-acre recreational and historic park, featuring a championship golf course, an antique car museum, a petting zoo, beaches, picnic areas, riverboat cruises, scenic skylifts and scenic railroads, with the park's centerpiece being the colossal equestrian sculpture, The Confederate Memorial, carved on the stony face of the gray granite Stone Mountain. The best place to begin the day's adventure is Memorial Hall, which shows a videotape of the mountain's geological makeup, its history, and a tour of the recreational facilities within the park.
Confederate Memorial
Stone Mountain, a massive dome of solid granite rises 825 feet above the surrounding plain. It is said to be the largest solid block of granite in the world. Covering 583 acres, this 300-million-year-old monolith is surprisingly easy to climb. Sprawling gradually like a whale hump it can be easily scaled by following the park's 1.3 mile trail or, one may opt for the more encompassing 5-mile trail that covers the circumference of this huge, gray whale-back rock. Looking closely, one can see rivulets of red streaming down the face of the mountain, like tears of blood. The red is natural garnet. Of course, the main feature of Stone Mountain is the Confederate Memorial, a colossal carving of the three most prominent Confederate leaders on horseback: Jefferson Davis, General Thomas "Stonewall" Jackson, and General Robert E. Lee. The height of the Lee figure alone is nine stories while the entire sculpture rests in an oval niche the size of a full city block. They say a 6 ft. man can fit in the horse's mouth. Legend has it that the workers on the sculpture used to take cover inside the horse's mouth when it rained. Started in 1915 by the famous sculptor Gutzon Borglum (who had yet to begin his famous Mount Rushmore project), work on this massive artistic endeavor was intermittent. Interrupted by two world wars, it was not fully complete until 1970. Sprawling directly below the sculpture is a long green lawn with side alcoves dedicated to each of the Confederate States presenting its own mini-memorial to the Confederacy.
The Bells of Stone Mountain
Featured in the 1963 World's Fair, this 13-story bell tower, rising from the lake at Stone Mountain Park, uses miniature bell-tone rods and amplification to create its 732 bell sounds, which can be heard chiming everyday at noon and four o'clock.
OUR CAMPSITE FOR THE WEEK
Riverside Estates Travel-Trailer Park, Covington (770) 787-3707
Some RV Parks have a friendly host, or at least helpful hosts, but here at Riverside, the host is more than friendly, more than helpful. Barry seems to really love his job. He's always happy to see you and always eager to help satisfy all requests. His policy is "never say no to a customer." It's truly refreshing to have one's request so readily and happily tended to. The campground itself, along the historic Yellow River, is enormous. A Historic Marker less than a half mile from Riverside Estates describes the scene where, during the Civil War, Union troops built pontoon bridges to get across. Unfortunately the banks along the river are overgrown, and campers can only gain access to the Yellow river by going through brush and overgrowth. But it's nice to know one is so close to history. The park's swimming pool is large and after six o'clock in the evening, is reserved for "adults only." A lovely treat, knowing one can go for a relaxing, quiet swim in the evening without fear of cannonballs. Most of the clientele here are itinerant workers, staying for months, possibly years, which gives the place a very neighborly feel to it. Unlike most RV parks where people stay a day or maybe a week, here you know you'll see your neighbor tomorrow, so you tend to be more friendly and courteous than usual. The rates are very reasonable and restrooms are clean and well-maintained.