text:
Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor Under the Anti-Kickback Statute
A Proposed Rule by the Health and Human Services Department on 04/10/2013
To assure consideration, comments must be delivered to the
21314-21320 (7 pages)
Enhanced Content
Relevant information about this document from Regulations.gov provides additional context. This information is not part of the official Federal Register document.
Docket Number:
HHSIG-2013-0001
Docket Name:
Electronic Health Records Safe Harbors
Docket RIN
A. Purpose of the Regulatory Action
B. Summary of the Major Provisions
C. Costs and Benefits
A. Anti-Kickback Statute and Safe Harbors
B. The Electronic Health Records Safe Harbor
II. Provisions of the Proposed Rule
A. The Deeming Provision
B. The Electronic Prescribing Provision
C. The Sunset Provision
D. Additional Proposals and Considerations
1. Protected Donors
2. Data Lock-In and Exchange
3. Covered Technology
III. Regulatory Impact Statement
IV. Paperwork Reduction Act
List of Subjects in 42 CFR Part 1001
PART 1001—[AMENDED]
Read the 110 public comments on this document
This PDF is the current document as it appeared on Public Inspection on 04/08/2013 at 4:15 pm.
Office of Inspector General (OIG), HHS.
In this proposed rule, the Office of Inspector General (OIG) proposes to amend the safe harbor regulation concerning electronic health records items and services, which defines certain conduct that is protected from liability under the Federal anti-kickback statute in the Social Security Act (the Act). The proposed amendments include an update to the provision under which electronic health records software is deemed interoperable; removal of the electronic prescribing capability requirement; and extension of the sunset provision. In addition, OIG is requesting public comment on other changes it is considering.
To assure consideration, comments must be delivered to the address provided below by no later than 5 p.m. Eastern Standard Time on June 10, 2013.
In commenting, please reference file code OIG-404-P. Because of staff and resource limitations, we cannot accept comments by facsimile (fax) transmission. However, you may submit comments using one of three ways (no duplicates, please):
1. Electronically. You may submit electronically through the Federal eRulemaking Portal at http://www.regulations.gov. (Attachments should be in Microsoft Word, if possible.)
2. By regular, express, or overnight mail. You may mail your printed or written submissions to the following address: Patrice Drew, Office of Inspector General, Department of Health and Human Services, Attention: OIG-404-P, Room 5541C, Cohen Building, 330 Independence Avenue SW., Washington, DC 20201.
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By hand or courier. You may deliver, by hand or courier, before the close of the comment period, your Start Printed Page 21315printed or written comments to: Patrice Drew, Office of Inspector General, Department of Health and Human Services, Cohen Building, Room 5541C, 330 Independence Avenue SW., Washington, DC 20201.
Because access to the interior of the Cohen Building is not readily available to persons without Federal Government identification, commenters are encouraged to schedule their delivery with one of our staff members at (202) 619-1368.
Inspection of Public Comments: All comments received before the end of the comment period will be posted on http://www.regulations.gov for public viewing. Hard copies will also be available for public inspection at the Office of Inspector General, Department of Health and Human Services, Cohen Building, 330 Independence Avenue SW., Washington, DC 20201, Monday through Friday from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone (202) 619-1368. Comments received by OIG will be shared with the Centers for Medicare & Medicaid Services (CMS).
James A. Cannatti III or Heather L. Westphal, Office of Counsel to the Inspector General, (202) 619-0335.
Social Security Act Citation
United States Code Citation
1128B 42 U.S.C. 1320a-7b
Pursuant to section 14 of the Medicare and Medicaid Patient and Program Protection Act of 1987 and its legislative history, Congress required the Secretary of Health and Human Services (the Secretary) to promulgate regulations setting forth various "safe harbors" to the anti-kickback statute, which would be evolving rules that would be periodically updated to reflect changing business practices and technologies in the health care industry. In accordance with this authority, OIG published a safe harbor to protect certain arrangements involving the provision of interoperable electronic health records software or information technology and training services. The final rule for this safe harbor was published on August 8, 2006 (71 FR 45110) and is scheduled to sunset on December 31, 2013 (42 CFR 1001.952(y)(13)). The purpose of this proposed rule is to update certain aspects of the electronic health records safe harbor and to extend the sunset date.
This proposed rule would amend the current safe harbor in at least three ways. First, the proposed rule would update the provision under which electronic health records software is deemed interoperable. Second, we propose to remove the requirement related to electronic prescribing capability from the safe harbor. Third, we propose to extend the sunset date of the safe harbor. In addition to these proposals, we are soliciting public comment on other possible amendments to the safe harbor, including limiting the scope of protected donors and adding or modifying conditions to limit the risk of data and referral lock-in.
The proposed rule would modify an already-existing safe harbor to the anti-kickback statute. This safe harbor permits certain entities to provide technology-related items and services to certain parties to be used to create, maintain, transmit, or receive electronic health records. Parties may voluntarily seek to comply with safe harbors so that they have assurance that their conduct will not subject them to any enforcement actions under the anti-kickback statute, but safe harbors do not impose new requirements on any party.
This is not a major rule, as defined at 5 U.S.C. 804(2). It is also not economically significant, because it will not have a significant effect on program expenditures, and there are no additional substantive costs to implement the resulting provisions. The proposed rule would update the provision under which electronic health records software is deemed interoperable, remove the requirement related to electronic prescribing capability, and extend the safe harbor's sunset date (currently set at December 31, 2013). We expect these proposed changes to continue to facilitate the adoption of electronic health records technology.
Section 1128B(b) of the Social Security Act (the Act) (42 U.S.C. 1320a-7b(b), the anti-kickback statute) provides criminal penalties for individuals or entities that knowingly and willfully offer, pay, solicit, or receive remuneration in order to induce or reward the referral of business reimbursable under any of the Federal health care programs, as defined in section 1128B(f) of the Act. The offense is classified as a felony and is punishable by fines of up to $25,000 and imprisonment for up to 5 years. Violations of the anti-kickback statute may also result in the imposition of civil monetary penalties (CMP) under section 1128A(a)(7) of the Act (42 U.S.C. 1320a-7a(a)(7)), program exclusion under section 1128(b)(7) of the Act (42 U.S.C. 1320a-7(b)(7)), and liability under the False Claims Act (31 U.S.C. 3729-33).
The types of remuneration covered specifically include, without limitation, kickbacks, bribes, and rebates, whether made directly or indirectly, overtly or covertly, in cash or in kind. In addition, prohibited conduct includes not only the payment of remuneration intended to induce or reward referrals of patients, but also the payment of remuneration intended to induce or reward the purchasing, leasing, or ordering of, or arranging for or recommending the purchasing, leasing, or ordering of, any good, facility, service, or item reimbursable by any Federal health care program.
Because of the broad reach of the statute, concern was expressed that some relatively innocuous commercial arrangements were covered by the statute and, therefore, potentially subject to criminal prosecution. In response, Congress enacted section 14 of the Medicare and Medicaid Patient and Program Protection Act of 1987, Public Law 100-93 (section 1128B(b)(3)(E) of the Act; 42 U.S.C. 1320a-7b(B)(3)(E)), which specifically required the development and promulgation of regulations, the so-called "safe harbor" provisions, that would specify various payment and business practices that would not be subject to sanctions under the anti-kickback statute, even though they may potentially be capable of inducing referrals of business under the Federal health care programs. Since July 29, 1991, we have published in the Federal Register a series of final regulations establishing "safe harbors" in various areas.[1] These OIG safe harbor provisions have been developed "to limit the reach of the statute somewhat by permitting certain non-abusive arrangements, while encouraging beneficial or innocuous arrangements." 56 FR 35952, 35958 (July 29, 1991).
Health care providers and others may voluntarily seek to comply with safe harbors so that they have the assurance that their business practices will not be subject to any enforcement action under the anti-kickback statute, the CMP provision for anti-kickback violations, Start Printed Page 21316or the program exclusion authority related to kickbacks. In giving the Department of Health and Human Services (Department or HHS) the authority to protect certain arrangements and payment practices under the anti-kickback statute, Congress intended the safe harbor regulations to be updated periodically to reflect changing business practices and technologies in the health care industry.
In the October 11, 2005 Federal Register (70 FR 59015), we published a notice of proposed rulemaking (the 2005 Proposed Rule) that would promulgate two safe harbors to address donations of certain electronic health records software and directly related training services, using our authority at section 1128B(b)(3)(E) of the Act. See 70 FR 59015, 59021 (Oct. 11, 2005). One proposed safe harbor would have protected certain arrangements involving donations of electronic health records technology made before the adoption of certification criteria. The other proposed safe harbor would have protected certain arrangements involving nonmonetary remuneration in the form of interoperable electronic health records software certified in accordance with criteria adopted by the Secretary of HHS (Secretary) and directly related training services. In the same issue of the Federal Register (70 FR 59182 (Oct. 11, 2005)), CMS simultaneously proposed similar exceptions to the physician self-referral law.
On August 8, 2006 (71 FR 45110), we published a final rule (the 2006 Final Rule) that, among other things, finalized a safe harbor [2] at 42 CFR 1001.952(y) (the electronic health records safe harbor) for protecting certain arrangements involving interoperable electronic health records software or information technology and training services. In the same issue of the Federal Register (71 FR 45140 (Aug. 8, 2006)), CMS simultaneously published similar final regulations at 42 CFR 411.357(w). The electronic health records safe harbor is scheduled to sunset on December 31, 2013. 42 CFR 1001.952(y)(13).
The present proposed rule sets forth certain proposed changes to the electronic health records safe harbor. CMS is proposing almost identical changes to the physician self-referral law electronic health records exception [3] elsewhere in this issue of the Federal Register. We attempted to ensure as much consistency as possible between our proposed safe harbor changes and CMS's proposed exception changes, despite the differences in the respective underlying statutes. We intend the final rules to be similarly consistent. Because of the close nexus between this proposed rule and CMS's proposed rule, we may consider comments submitted in response to CMS's proposed rule when crafting our final rule. Similarly, CMS may consider comments submitted in response to this proposed rule in crafting its final rule.
Our current electronic health records safe harbor specifies at 42 CFR 1001.952(y)(2) that the donated software must be "interoperable at the time it is provided to the recipient." As discussed in a recently issued Request for Information (RFI) from the Department, "HHS envisions an information rich, person-centered, high performance health care system where every health care provider has access to longitudinal data on patients they treat to make evidence-based decisions, coordinate care and improve health outcomes." 78 FR 14793, 14795 (Mar. 7, 2013). Additionally, as emphasized in the RFI, interoperability will play a critical role in supporting this vision. Interoperability is also an important concept in the context of the electronic health records safe harbor. Although we have long been concerned that parties could use the offer or donation of technology to capture referrals, we have viewed interoperability as a potential mitigating factor, or safeguard, to justify other safe harbor conditions that are less stringent than might otherwise be appropriate in the absence of interoperability. This is because if the donated technology is interoperable, the recipient will be able to use it to transmit electronic health records not only to the donor, but to others, including competitors of the donor, and will not be "locked in" to communications with the donor only. See 70 FR 59015, 59023 (Oct. 11, 2005); 71 FR 45110, 45126 (Aug. 8, 2006). For purposes of this safe harbor, "interoperable" means "able to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks, in various settings, and exchange data such that the clinical or operational purpose and meaning of the data are preserved and unaltered." Note to paragraph (y) of 42 CFR 1001.952. The current provisions of the electronic health records safe harbor state that for purposes of meeting the condition set forth in subparagraph (y)(2), "software is deemed to be interoperable if a certifying body recognized by the Secretary has certified the software within no more than 12 months prior to the date it is provided to the recipient." 42 CFR 1001.952(y)(2). We propose to update two aspects of this deeming provision to reflect the current Office of the National Coordinator for Health Information Technology (ONC) certification program for electronic health record technology.
First, we propose to modify the provision to reflect that ONC is responsible for "recognizing" certifying bodies, as referenced in this provision. See 42 U.S.C. 300jj-11(c)(5). To become a certifying body "recognized" by the Secretary, an entity must successfully complete an authorization process established by ONC. This authorization process constitutes the Secretary's recognition of a certifying body. Accordingly, we propose to revise the phrase "recognized by the Secretary" in the second sentence of subparagraph (y)(2) to read "authorized by the National Coordinator for Health Information Technology."
Second, we propose to modify the portion of this provision concerning the time period within which the software must have been certified. Currently, the electronic health records safe harbor deeming provision requires that software must have been certified within no more than 12 months prior to the date of donation in order to ensure that products have an up-to-date certification. Subsequent to issuing the final electronic health records safe harbor, ONC developed a regulatory process for adopting certification criteria and standards. That process is anticipated to occur on a 2-year regulatory interval. (For more information, see ONC's September 4, 2012 Final Rule titled "Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology" (77 FR 54163).) Further, some certification criteria could remain unchanged from one edition of the electronic health record certification criteria to the next. Thus, the current 12-month timeframe is Start Printed Page 21317not in line with the anticipated 2-year regulatory interval and does not account for the fact that some certification criteria may not change from one edition to the next. Therefore, we propose to modify this portion of the safe harbor by removing the 12-month timeframe and substituting a provision that more closely tracks the current ONC certification program. Accordingly, we propose that software would be eligible for deeming if, on the date it is provided to the recipient, it has been certified to any edition of the electronic health record certification criteria that is identified in the then-applicable definition of Certified EHR Technology in 45 CFR part 170. For example, for 2013, the applicable definition of Certified EHR Technology identifies both the 2011 and the 2014 editions of the electronic health record certification criteria. Therefore, in 2013, software certified to meet either the 2011 edition or the 2014 edition could satisfy the safe harbor provision as we proposed to modify it. The current definition of Certified EHR Technology applicable for 2014, however, identifies only the 2014 edition. Thus, based on that definition, in 2014, only software certified to the 2014 edition could satisfy our proposed, modified provision. Future modifications to the definition of Certified EHR Technology could result in the identification of other editions to which software could be certified and satisfy our proposed, modified provision. As we stated in the 2006 Final Rule, we understand "that the ability of software to be interoperable is evolving as technology develops. In assessing whether software is interoperable, we believe the appropriate inquiry is whether the software is as interoperable as feasible given the prevailing state of technology at the time [it] is provided to the recipient." 71 FR 45110, 45126 (Aug. 8, 2006). We believe our proposed change is consistent with that understanding and our objective of ensuring that products are certified to the current standard of interoperability when they are donated. We seek comment on our proposal, including if removing the 12-month period will impact donations and whether we should consider retaining it as an additional means of determining eligibility under the deeming provision.
Our current electronic health records safe harbor specifies at 42 CFR 1001.952(y)(10) that the donated software must "contain [ ] electronic prescribing capability, either through an electronic prescribing component or the ability to interface with the recipient's existing electronic prescribing system, that meets the applicable standards under Medicare Part D at the time the items and services are provided." In the preamble to the 2006 Final Rule, we stated that we included "this requirement, in part, because of the critical importance of electronic prescribing in producing the overall benefits of health information technology, as evidenced by section 101 of the [Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173]." 71 FR 45110, 45125 (Aug. 8, 2006). As we noted, it was "our understanding that most electronic health records systems already include an electronic prescribing component." Id.
We continue to believe in the critical importance of electronic prescribing. However, in light of developments since the 2006 Final Rule, we do not believe that it is necessary to retain a requirement related to electronic prescribing capability in the electronic health records safe harbor. First, Congress subsequently enacted legislation addressing electronic prescribing. In 2008, Congress passed the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Pub. L. 110-275. Section 132 of MIPPA authorized an electronic prescribing incentive program (starting in 2009) for certain types of eligible professionals. Further, in 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA), Pub. L. 111-5. The HITECH Act authorizes CMS to establish Medicare and Medicaid electronic health record incentive programs for certain eligible professionals, eligible hospitals, and critical access hospitals. 42 U.S.C. 1395w-4(o), 1395ww(n), 1395f(l)(3), and 1396b(t). The HITECH Act requires that eligible professionals under the Medicare and Medicaid electronic health record incentive programs demonstrate meaningful use of certified electronic health record technology, including the use of electronic prescribing. 42 U.S.C. 1395w-4(o)(2)(A)(i). Second, the industry has made great progress related to electronic prescribing. Recent analysis by ONC notes an increase in the percentage of physicians electronically prescribing via electronic health record technology from 7 percent in 2008 to 48 percent in 2012, reflecting rapid increases over the past few years in the rate of electronic health record-based electronic prescribing capabilities.[4] Furthermore, the regulations recently published to implement Stage 2 of the EHR Incentive Programs continue to encourage physicians' use of electronic prescribing technology. See 77 FR 53968, 53989 (Sept. 4, 2012); 77 FR 54163, 54198 (Sept. 4, 2012).
In light of these developments, we propose to delete the electronic prescribing condition at 42 CFR 1001.952(y)(10). We believe that there are sufficient alternative policy drivers supporting the adoption of electronic prescribing capabilities. We also note that electronic prescribing technology would remain eligible for donation under the electronic health records safe harbor or under the electronic prescribing safe harbor at 42 CFR 1001.952(x). Additionally, we considered whether removing this condition would increase the risk of fraud or abuse posed by donations made under the safe harbor; we do not believe that it would.
The electronic health records safe harbor is scheduled to sunset on December 31, 2013. In adopting this condition of the electronic health records safe harbor, we acknowledged "that the need for a safe harbor for donations of electronic health records technology should diminish substantially over time as the use of such technology becomes a standard and expected part of medical practice." 71 FR 45110, 45133 (Aug. 8, 2006). Some have suggested that we extend the sunset date or even remove the sunset provision entirely.
In recent years, electronic health record technology adoption has risen dramatically, largely as a result of the HITECH Act in 2009. For example, see Farzad Mostashari, M.D., ScM., National Coordinator, ONC, U.S. Department of Health and Human Services, Testimony before the Subcommittee on Technology and Innovation Committee on Science and Technology, available at http://science.house.gov/sites/republicans.science.house.gov/files/documents/HHRG-112-SY19-WState-FMostashari-20121114.pdf and HHS News Release, "More than 100,000 health care providers paid for using electronic health records," June 19, 2012, available at http://www.hhs.gov/news/press/2012pres/06/20120619a.html; see also OIG, OEI Report OEI-04-10-00184, Start Printed Page 21318"Memorandum Report: Use of Electronic Health Record Systems in 2011 Among Medicare Physicians Providing Evaluation and Management Services," June 2012, available at https://oig.hhs.gov/oei/reports/oei-04-10-00184.pdf. However, while the industry has made great progress, use of such technology has not yet been universally adopted nationwide, and continued electronic health record technology adoption remains an important Departmental goal. We continue to believe that as this goal is achieved, the need for a safe harbor for donations of such technology should continue to diminish over time. Accordingly, we propose to extend the sunset date to December 31, 2016. We selected this date because it corresponds to the last year in which one may receive a Medicare electronic health record incentive payment and the last year in which one may initiate participation in the Medicaid electronic health record incentive program. For more information, see "CMS Medicare and Medicaid EHR Incentive Payment Milestone Timeline," available at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EHRIncentProgtimeline508V1.pdf. As an alternative to this proposed extended sunset date of December 31, 2016, we are also considering establishing a later sunset date. For example, we are considering extending the sunset date to December 31, 2021, which corresponds to the end of the electronic health record Medicaid incentives. See id. While these sunset dates are associated with specific Medicare and Medicaid electronic health record incentive programs, we recognize that not all health care providers to whom donations can be made are eligible for such incentives. These health care providers include, for example, many in the mental health and behavioral health communities as well as long-term and post-acute care facilities. We specifically solicit comment on our proposed extension of the sunset date to December 31, 2016. We also seek comment on whether we should, as an alternative, select a later sunset date and what that date should be.
As we stated in the preamble to the 2006 Final Rule for the electronic health records safe harbor, "[w]e [originally] proposed to limit the scope of protected donors under § 1001.952(y) to hospitals, group practices, [prescription drug plan (PDP)] sponsors, and [Medicare Advantage (MA)] organizations, consistent with the MMA-mandated donors for the electronic prescribing safe harbor." 71 FR 45110, 45127 (Aug. 8, 2006); see also 70 FR 59015, 59023 (Oct. 11, 2005). However, "[m]indful that broad safe harbor protection may significantly further the important public policy goal of promoting electronic health records, and after carefully considering the recommendations of the commenters, we [ ] concluded that the safe harbor should protect any donor that is an individual or entity that provides patients with health care items or services covered by a Federal health care program and submits claims or requests for payment for those items or services (directly or pursuant to reassignment) to Medicare, Medicaid, or other Federal health care programs (and otherwise meets the safe harbor conditions)." 71 FR 45110, 45127 (Aug. 8, 2006). Notwithstanding this conclusion, we indicated that "[w]e remain concerned about the potential for abuse by laboratories, durable medical equipment suppliers, and others, but believe that the safe harbor conditions in the [2006 Final Rule] and the fact that the safe harbor is temporary should adequately address our concerns." 71 FR 45110, 45128 (Aug. 8, 2006). We went on to state that "[w]e intend to monitor the situation. If abuses occur, we may revisit our determination." Id.
We have received comments suggesting that abusive donations are being made under the electronic health records safe harbor. For example, some responses to our annual solicitation of safe harbors and special fraud alerts allege that donors are using the safe harbor to provide referral sources with items and services that appear to support the interoperable exchange of information on their face, but, in practice, lead to data and referral lock-in. See, e.g., https://oig.hhs.gov/publications/docs/semiannual/2009/semiannual_fall2009.pdf.
In light of (1) these comments, (2) our continued concern about the potential for fraud and abuse by certain donors that we articulated in the 2006 Final Rule,[5] and (3) the proposed changes to the electronic health records safe harbor conditions discussed in this proposed rule, we propose to limit the scope of protected donors under the electronic health records safe harbor, with the continued goal of promoting adoption of interoperable electronic health record technology that benefits patient care while reducing the likelihood that donors will misuse electronic health record technology donations to secure referrals. In this regard, we are considering revising the safe harbor to cover only the original MMA-mandated donors: hospitals, group practices, PDP sponsors, and MA organizations. We are considering, and seek comments regarding, whether other individuals or entities with front-line patient care responsibilities across health care settings, such as safety net providers, should be included, and, if so, which ones. Alternatively, we are considering retaining the current definition of protected donors, but excluding specific types of donors. Specifically, we are considering excluding suppliers of ancillary services associated with a high risk of fraud and abuse, because donations by such suppliers may be more likely to be motivated by a purpose of securing future business than by a purpose of better coordinating care for beneficiaries across health care settings. In particular, we are considering excluding laboratory companies from the scope of permissible donors as their donations have been the subject of complaints. We are also considering excluding other high-risk categories, such as durable medical equipment suppliers and independent home health agencies. We seek comment on the alternatives under consideration, including comments, with supporting reasons, regarding particular types of providers and suppliers that should or should not be protected donors given the goals of the safe harbor.
In the preceding section, we propose to limit the scope of permissible donors as a means to prevent donations that subvert the intent of the safe harbor—because they are used to lock in referrals—from receiving safe harbor protection. We are also considering inclusion of new or modified conditions in the safe harbor as an alternative or additional means of achieving that result. We are particularly interested in new or modified conditions that will help achieve two related goals. The first goal is to prevent the misuse of the safe harbor in a way that results in data and referral lock-in. The second, related goal is to encourage the free exchange of data (in accordance with protections for privacy). These goals reflect our interest, which we discussed above, in promoting the adoption of interoperable electronic health record technology that benefits patient care while reducing the likelihood that donors will misuse electronic health record technology Start Printed Page 21319donations to secure referrals. The 2006 Final Rule requires donated software to be interoperable at the time it is donated to the recipient. The software is deemed interoperable if it is certified as described above. However, it has been suggested that even when donated software meets the interoperability requirements of the rule, policies and practices sometimes affect the true ability of electronic health record technology items and services to be used to exchange information across organizational and vendor boundaries.[6] We seek comments on what new or modified conditions could be added to the electronic health records safe harbor to achieve our two goals and whether those conditions, if any, should be in addition to, or in lieu of, our proposal to limit the scope of permissible donors. For example, 42 CFR 1001.952(y)(3)requires, as a condition of the safe harbor, that "[t]he donor (or any person on the donor's behalf) [ ] not take any action to limit or restrict the use, compatibility, or interoperability of the items or services with other electronic prescribing or electronic health records systems." We solicit comments with regard to whether this condition could be modified to reduce the possibility of lock-in.
We received questions concerning whether certain items or services, for example services that enable the interoperable exchange of electronic health records data, fall within the scope of covered technology under the electronic health records safe harbor. The answer to such questions depends on the exact items or services that are being donated. In the 2006 Final Rule, we explained that we interpreted the term " `software, information technology and training services necessary and used predominantly' for electronic health records purposes to include the following, by way of example: [i]nterface and translation software; rights, licenses, and intellectual property related to electronic health records software; connectivity services, including broadband and wireless Internet services; clinical support and information services related to patient care (but not separate research or marketing support services); maintenance services; secure messaging (e.g., permitting physicians to communicate with patients through electronic messaging); and training and support services (such as access to help desk services)." 71 FR 45110, 45125 (Aug. 8, 2006). It also has been suggested that we modify the regulatory text of the electronic health records safe harbor to explicitly reflect this interpretation. We believe that the current regulatory text, when read in light of the preamble discussion, is sufficiently clear concerning the scope of covered technology, but we seek input from the public regarding this issue.
We have examined the impact of this rule as required by Executive Order 12866 on Regulatory Planning and Review (Sept. 30, 1993); Executive Order 13563 on Improving Regulation and Regulatory Review (Jan. 18, 2011); the Regulatory Flexibility Act (RFA) (Sept. 19, 1980, Pub. L. 96-354, codified at 5 U.S.C. 601 et seq.); section 1102(b) of the Act; section 202 of the Unfunded Mandates Reform Act of 1995 (Mar. 22, 1995; Pub. L. 104-4); Executive Order 13132 on Federalism (August 4, 1999); and the Congressional Review Act (5 U.S.C. 804(2)).
Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). We believe this proposed rule does not reach the economic threshold for being considered economically significant and thus is not considered a major rule. We solicit comment on the assumptions and findings presented in this initial regulatory impact analysis.
The proposed rule would update the provision under which electronic health records software is deemed interoperable, remove the requirement related to electronic prescribing capability, and extend the safe harbor's sunset date (currently set at December 31, 2013). Neither this proposed rule nor the regulation it amends requires any entity to donate electronic health record technology, but we expect these proposed changes to continue to facilitate the adoption of electronic health record technology by filling a gap rather than creating the primary means by which this technology will be adopted.
The summation of the economic impact analysis regarding the effects of electronic health records in the ambulatory setting that is presented in the 2006 Final Rule still pertains to this proposed regulation. 71 FR 45110 (Aug. 8, 2006). However, since the 2006 Final Rule, several developments have occurred to make us conclude that it is no longer necessary to retain a requirement related to electronic prescribing capability in the electronic health records safe harbor. These developments include: (1) In 2008, Congress passed the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Pub. L. 110-275; (2) in 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA), Pub. L. 111-5; and (3) an increase over the past few years in the rate of electronic health record-based electronic prescribing capabilities.
As discussed in more detail earlier in the preamble, section 132 of MIPPA authorized an electronic prescribing incentive program (starting in 2009) for certain types of eligible professionals. The HITECH Act authorizes CMS to establish Medicare and Medicaid electronic health record incentive programs for certain eligible professionals, eligible hospitals, and critical access hospitals. Also, the HITECH Act requires that eligible professionals under the Medicare and Medicaid electronic health record incentive programs demonstrate meaningful use of certified electronic health record technology, including the use of electronic prescribing. Specifically, the final regulation of the Stage 2 meaningful use (77 FR 53968 (Sept. 4, 2012)) includes more demanding requirements for electronic prescribing and identifies electronic prescribing as a required core measure. As a result, beginning in CY 2015 an eligible professional risks a reduction in the Medicare Physician Fee Schedule amount that will otherwise apply for covered professional services if they are not a meaningful EHR user for an EHR reporting period during that year. Our intent remains to allow potential recipients not to receive products or services they already own, but rather to receive electronic health record technology that advances its adoption and use. Lastly, according to ONC, electronic prescribing by physicians using electronic health record technology has increased from 7 percent Start Printed Page 21320in December 2008 to approximately 48 percent in June 2012.[7] Furthermore, the regulations recently published to implement Stage 2 of the EHR Incentive Programs continue to encourage physicians' use of electronic prescribing technology. 77 FR 53968, 53989 (Sept. 4, 2012); 77 FR 54163, 54198 (Sept. 4, 2012). Due to data limitations, however, we are unable to accurately estimate the level of impact the electronic health records safe harbor has contributed to the increase in electronic prescribing. Therefore, we believe as a result of these legislative and regulatory developments advancing in parallel, the increase in the adoption of electronic prescribing using electronic health record technology will continue without making it necessary to retain the electronic prescribing capability requirement in the electronic health records safe harbor.
The RFA requires agencies to analyze options for regulatory relief of small entities, if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $7.0 million to $34.5 million in any 1 year. Individuals and States are not included in the definition of a small entity. The Secretary has determined that this proposed rule would not have a significant economic impact on a substantial number of small entities.
In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to section 603 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside a Metropolitan Statistical Area for Medicare payment regulations and has fewer than 100 beds. The Secretary has determined that this proposed rule would not have a significant impact on the operations of a substantial number of small rural hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2013, that threshold is approximately $141 million. This rule will have no consequential effect on State, local, or tribal governments or on the private sector.
Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. Since this regulation does not impose any costs on State or local governments, the requirements of Executive Order 13132 are not applicable.
In accordance with Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
This document does not impose information collection and recordkeeping requirements. Consequently, it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995.
Administrative practice and procedure
Grant programs—Health
End List of Subjects
Accordingly, 42 CFR part 1001 is proposed to be amended as set forth below:
End Part Start Amendment Part
1. The authority citation for part 1001 continues to read as follows:
End Amendment Part Start Authority
Authority: 42 U.S.C. 1302, 1320a-7, 1320a-7b, 1395u(j), 1395u(k), 1395w-104(e)(6), 1395y(d), 1395y(e), 1395cc(b)(2)(D), (E) and (F), and 1395hh; and sec. 2455, Pub. L. 103-355, 108 Stat. 3327 (31 U.S.C. 6101 note).
End Authority Start Amendment Part
2. Section 1001.952 is amended by revising the introductory text, paragraph (y) introductory text, and paragraphs (y)(2) and (y)(13), and by removing and reserving paragraph (y)(10).
End Amendment Part
§ 1001.952
Exceptions.
The following payment practices shall not be treated as a criminal offense under section 1128B of the Act and shall not serve as the basis for an exclusion:
(y) Electronic health records items and services. As used in section 1128B of the Act, "remuneration" does not include nonmonetary remuneration (consisting of items and services in the form of software or information technology and training services) necessary and used predominantly to create, maintain, transmit, or receive electronic health records, if all of the following conditions are met:
(2) The software is interoperable at the time it is provided to the recipient. For purposes of this subparagraph, software is deemed to be interoperable if a certifying body authorized by the National Coordinator for Health Information Technology has certified the software to any edition of the electronic health record certification criteria identified in the then-applicable definition of Certified EHR Technology in 45 CFR part 170, on the date it is provided to the recipient.
(13) The transfer of the items and services occurs, and all conditions in this paragraph (y) have been satisfied, on or before December 31, 2016.
Daniel R. Levinson,
Inspector General.
Approved: March 7, 2013.
Kathleen Sebelius,
1. 56 FR 35952 (July 29, 1991); 61 FR 2122 (Jan. 25, 1996); 64 FR 63518 (Nov. 19, 1999); 64 FR 63504 (Nov. 19, 1999); 66 FR 62979 (Dec. 4, 2001); 71 FR 45109 (Aug. 8, 2006); and 72 FR 56632 (Oct. 4, 2007).
Back to Citation
2. For the reasons discussed in more detail in the preamble to the 2006 Final Rule, we abandoned the proposal to have separate pre- and post-interoperability safe harbors for electronic health records arrangements. See 71 FR 45110, 45121 (Aug. 8, 2006).
3. 42 CFR 411.357(w).
4. State Variation in E-Prescribing Trends in the United States—available at: http://www.healthit.gov/sites/default/files/us_e-prescribingtrends_onc_brief_4_nov2012.pdf.
5. See 71 FR 45110, 45128 (Aug. 8, 2006).
6. For more information on interoperability in health IT, see "EHR Interoperability" on the HealthIT.gov Web site at http://www.healthit.gov/providers-professionals/ehr-interoperability. For further discussion of interoperability and other health IT issues, see Arthur L. Kellermann and Spencer S. Jones, ANALYSIS & COMMENTARY: What It Will Take to Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology, Health Aff. January 2013 32:163-68.
[FR Doc. 2013-08314 Filed 4-8-13; 4:15 pm]


It's not easy for a Democrat to win enough votes on a GOP-dominated Supreme Court to become chief justice, but that's exactly what Bridget McCormack did last month.
And the vote was unanimous. The court is currently split 4-3 in favor of Republicans.
But the once-fractured and highly partisan court has been a more collegial body over the last decade, as McCormack told the Advance in the first part of this interview. She even has her own Ruth Bader Ginsburg-Antonin Scalia-type relationship with former Chief Justice Robert Young, who briefly ran as a Republican for U.S. Senate in the 2018 cycle.
Nonetheless, McCormack has angered GOP partisans and befuddled some pundits with her ability to persuade colleagues on key cases. She said that there's no "witchcraft" involved; it's just a matter of the best arguments winning out.
"We all show up and make the best arguments we can and talk to one another. I don't think there's any witchcraft or trickery happening. It's actually just smart people trying to show up and get their job done," McCormack said.
Michigan has the distinction of being the only state in the nation with women in all four leadership posts: McCormack as chief justice, Gov. Gretchen Whitmer, Attorney General Dana Nessel and Secretary of State Jocelyn Benson.
While the state has only had two female governors, two female attorneys general and one female U.S. senator in history, the High Court been a more hospitable place for women. She is the sixth woman to ascend to the chief justice role, following in the footsteps of Mary Coleman, Dorothy Comstock Riley, Elizabeth Weaver, Maura Corrigan and Marilyn Kelly.
The number of female judges in Michigan has been rising steadily for two decades, according to statistics compiled by the Michigan Supreme Court. The percentage has grown from 21 percent in 1999 to 38 percent in 2019.
Of the 29 newly-elected judges in 2018, 18 were women, per Michigan Supreme Court data. The Michigan Judicial Institute, the Supreme Court's education division, recently held a training session for judges with less than two years' experience on the bench. There were 64 attendees and 57 percent were women.
Last month, McCormack told the Advance that she will run for re-election next year and hinted that another "West Wing" ad could be in the offing.
In this last installment of the interview, McCormack talked about President Trump's flurry of judicial appointments and the most significant case she's ever presided over.
Michigan Advance: You are the sixth female chief justice in Michigan history. We've only had two female governors, two attorneys general and one female U.S. senator. Why do you think more women have been able to break the glass ceiling on the High Court?
McCormack: That's a great question, and you're the first person who's ever asked that of me, so I'm spitballing. Gosh, I don't know. The Michigan Supreme Court at one point had a majority of women. There were four women on the court at one point, and that's pretty unusual among not just in government, but among high courts.
… The number of women judges creeps higher every year. I'm not sure why women are more likely to serve in this branch than the others. On the Supreme Court … there's no extra pay for being the chief, and you don't get like a break in one part of your work. It's the same amount of work, and then a whole lot more work.
… The administrative work in the court, in my view, turns out to be some of the most important work we can do because that's where we have an influence on how the trial courts actually serve the public. As you know, most people who interact with our courts interact with their local district or circuit courts because they've had something, usually something difficult happened in their family or their business or their life otherwise. How those courts really serve the public is kind of, I think, the most important of the work we do.
I don't know. Maybe administrative work might appeal to women, or women are better at doing more jobs. I didn't say that, not really. [laughs] I don't know what the answer is, but it's a lot of extra work and not really extra money. I think it's really important work, and I'm not sure why more women have been able to do it. I really don't know.
Michigan Advance: Michigan is right now the only state in the country with women in four top leadership positions: governor, attorney general, secretary of state and chief justice. How significant do you think that is?
McCormack: I think it's pretty significant to be the only state that has women in those positions. Probably more important is that the women in those positions do some good for the public, obviously, but I think for our kids, it's nice for them to see this moment in their state's elected leadership. I have … three sons and a daughter, but I'm delighted that that's what they see when they look at who's leading their government right now. When I was growing up, I never saw that.
Michigan Advance: Some longtime pundits, like Republican Bill Ballenger, seem to have been fascinated by your time on the court and your ability to persuade your colleagues, especially Republicans, on issues, like putting the redistricting initiative Proposal 2 on the ballot last year. Do you think there's been some sexism in that kind of analysis?
McCormack: I would invite others to put subjective labels on those analyses, but I would say that it's worth a look. Obviously, the court's conferences are confidential, but I didn't write the majority opinion in the redistricting case, so I'm not sure why I got singled out for having any special powers in decision-making.
If you look closely at the majority opinions of the court last year, I didn't write the majority of the majority opinions. If people are actually interested, we all show up and make the best arguments we can and talk to one another. I don't think there's any witchcraft or trickery happening. It's actually just smart people trying to show up and get their job done. The subjective labels are interesting though, and I would invite others to see what they think about those.
Michigan Advance: What are some of the biggest cases that the court might be handling this term?
McCormack: We have a lot of cases that we still haven't decided what action we're going to take on them, but a lot of the important cases in the state come to the court. That's just the way it goes. We did hear oral arguments in the unemployment insurance case in October, so that's a case that's under consideration. We have applications in many of the other major pieces of litigation going on in the state. We'll have to be deciding what to do about each of those.
Then again, even some of the cases that might not make headlines are still pretty important cases. We just finished a case call this week and had a couple of important double jeopardy cases and some additional cases about the sentencing guidelines. They might not make headlines, but each of them is important.
Michigan Advance: President Trump has made a lot of headway in his first two years with judicial appointments, well beyond his two Supreme Court nominees. How do you think Trump's remaking of the federal judiciary will impact key areas of law?
McCormack: As I said before, the federal judiciary's obviously important, and who sits on the federal bench is important, but most law happens in the state courts. That's always important to remind people. In addition to that, there is a lot of noise about which president's appointing which judges. Most judges, they take an oath to follow the law and apply it. I personally know a number of the people who have been appointed in the last two years, and they are excellent judges. I have every confidence that they're going to do the job that they took an oath to do.
Michigan Advance: In terms of the state judiciary, have you noticed any significant changes during your time on the state Supreme Court?
McCormack: I understand that the number of women serving on the state bench is up yet again. … I forget what the total tally is, but more and more women are serving in the state courts. That's one change. That's exciting.
Michigan Advance: What would you say are some of the most significant cases that you feel you've been able to preside over on the Supreme Court?
McCormack: I love all my cases equally, of course.
Michigan Advance: Like your children.
McCormack: Exactly. But yeah, there have been a few important ones, at least a few cases that I think have made an important difference in a bigger impact kind of way, not just the two parties who were there in court. Just for one example … it might have been in 2013 or '14, pretty early in my tenure. The court was asked to decide whether a longstanding policy of the Department of Health and Human Services … Actually, it was really the court's at the request of the department.
When one parent had been accused of abuse or neglect and had their children removed, there was a doctrine that permitted the court to remove the children from the second parent, even if there was no allegation whatsoever that the second parent had done anything to earn that result. We entertained a challenge to the constitutionality of that policy, and in a decision, In re Sanders, held that it's unconstitutional. It unconstitutionally interfered with the second parent's … right to parent their children.
I'm not sure anybody [noticed], except the courts that have to now adjudicate those claims — and I think it made a lot more work for them, so they might not be happy with me. The parents who end up losing their kids as a result of that policy noticed, but I think it was a pretty important decision for lots of families and frankly, usually, lots of poor families in the state. That's who usually fell into that system. There are probably others, but that one feels like a pretty important one.
Sometimes the cases that are blockbuster ones in the news are like not necessarily the ones that make the biggest impact on actual people's lives. Then these decisions that actually have an important impact on people's lives, no one ever writes about them or knows about them. I'm still proud that the court answered the question and figured out that the Constitution doesn't allow that.


text:
Recent Debates in Congress
August 11, 2011 7:11 pm ⋅ 1 Comment ⋅ Leslie Ann Fox
In trying to figure out what the emotional process was that swept through the U.S. Congress over the past few months, I came across an article by Stephanie J. Ferrera, MSW, called "Collective Intelligence and Differentiation of Self" (Family Systems Forum, Volume 13, Number 2, pp. 3-4). Ferrera describes the difference between the way an anxious group makes decisions and the way a "collection of individuals" makes decisions. In an anxious group "the combination of togetherness pressure and emotional reactivity plays out in a thousand ways: focus on others, comparing self with others, status sensitivity, low tolerance for differences…, pressure on leaders to take charge but undermining them when they do." With a "collection of individuals" each person can be calm, flexible, have a defined mission, focus on goals, and try to develop a climate of "thoughtful collaboration."
A "collection of individuals" can also take responsibility for their own individual problems, tasks, and opportunities; communication among them is open and clear; and they monitor their emotional process so that they can work effectively together.
This seems to be a pretty good description of the way one would want the U.S. Congress to function when making important political and financial decisions for the country, and yet many of our elected representatives in Washington have apparently veered off course into anxious reactivity, as they express rigidly polarized "positions," and have a very low tolerance for differences. The sources of societal anxiety these days are huge, including an economy in a long-term downward slide, high unemployment, housing foreclosures, climate change, resource depletion, and the winding down of two wars. It's easy to be critical of the responses of leaders who are faced with making important decisions while under so much pressure to "do the right thing." How can one keep one's feet on the ground, maintain clear, calm thinking, and collaborate responsibly with one's fellow decision-makers when the stakes are so high, and mistakes have such long-lasting consequences?
How would you be doing, if you had been in Congress this year? Would societal pressures have swept you into either automatic agreement or automatic opposition to the issues at hand, without giving yourself time to define your own thinking and decide how you could collaborate most effectively with your peers? Of course it is incredibly hard to predict our own reactivity when the stressors are really high. We like to think that our "better selves" would prevail, but who knows.
Meanwhile we must all think carefully about who we want to have representing us and making the big decisions in Washington, as political, economic, and social intensity mounts in the coming years. The beauty of a democracy is that there is a regular evaluation process. We need to elect and re-elect representatives who are high on the scale of differentiation, whose decisions are rooted in well-defined principles, who can manage their anxiety when under pressure, and who can collaborate effectively as a "collection of individuals." We won't always agree with all their decisions, but we must insist that they are people of integrity and long-term vision, who are not just reacting to the anxieties of the moment, while jumping through hoops to please the voters and get re-elected over and over again.
Who are these people? What can we learn about how they handled major life challenges growing up? What does that tell us about their emotional maturity level and their capacity to keep thinking and resisting the contagion of anxiety in other settings? What kind of leaders have they been in the past that will give us a clue as to the kinds of leaders they will be in the future? It may be hard to find the answers to these questions, but as voters we must look beyond the superficialities of campaign literature, news headlines, and TV commentary, and seek substantial verifiable facts about the long-term functioning of our elected leaders. Those we choose will inevitably reflect our own maturity level as a society, and we are ultimately responsible when they fall short.
Please reread Chapter 5 in our book, "Leading a Business in Anxious Times." It is entitled, "Differentiation: The Key to Leadership in Anxious Times," and it may perhaps remind you of the qualities that will serve you best in your own role as an organizational leader, as well as the qualities we want to see in our societal leaders.
Katharine Baker
Posted in: Business leadership, management ⋅ Tagged: Collective intelligence, decision-making, differentiation of self, mature leadership, societal leadership, taking responsibility
The Sense of Urgency: Real or False?
August 4, 2011 1:02 pm ⋅ 2 Comments ⋅ lfox
In his 2008 book, A Sense of Urgency, change leadership expert John Kotter, Professor Emeritus of Leadership at Harvard Business School, asserts that "the single biggest error people make when they try to change is not creating a high enough sense of urgency among enough people to set the stage for making a challenging leap into some new direction." Kotter cautions that it is important to distinguish between "constructive true urgency and destructive false urgency". His words resonate with me deeply as a CEO and as a practitioner of systems-based leadership.
Working with clients on large scale transformative change over the past 40 years I recognize that constructive true urgency energizes people, and unleashes the creativity and passion needed to make changes successful for their family, organization, or in the wider community. Destructive false urgency makes people anxious. Anxiety lowers one's energy, clouds the thinking of individuals and groups; it makes them more rigid and less creative. It causes people to spin their wheels rather than achieve successful change. The consequences of failing to change when necessary can threaten the survival of families, organizations, or whole societies.
As I reflect on the recent debates in the U.S. Congress over raising the debt ceiling and lowering the national debt, I have not been energized by what I have seen. Anxiety is contagious and I have caught it. I am exhausted from worrying about problems that are beyond my ability to solve—problems for which we have elected representatives to solve—people whom we count on to meet their responsibilities energetically but thoughtfully. I expect our leaders to create true urgency for us to change in a responsible way, not a false urgency that increases anxiety at the societal level and pulls down the functioning of everyone in our country. Like evaluating performance in the workplace, I am thinking about these recent events through the lens of systems-based leadership—trying to understand the underlying emotional process that has led to months of anxious behaviors being played out publically—risky behaviors that have damaged the trust of the United States by other nations and institutions in the global economy. I saw in the way our leaders handled this discussion the symptoms of anxiety that I observe in low performing organizations: blaming, stonewalling, name-calling, cliques, and indecision.
Have we become a society that is so anxious that it cannot think creatively, that it cannot tackle its toughest challenges? Have we become a country that cannot pull up its own functioning enough to make the changes necessary to survive and thrive in the 21st Century? What do you think? What anxieties got stirred up for you as the situation played out?
Leslie Ann Fox, August, 4, 2011
Posted in: Uncategorized ⋅ Tagged: anxiety, Change Leadership, leadership, Urgency

redpajama_set_name: RedPajamaCommonCrawl


Finished the 2011 Buller Gorge Recreational Walk in 03:17:54 in F3544 class!
She came 50th in class and 258th overall!
No photos of Michelle Edwards in 2011 , we may still be uploading/processing, check back later.


This is a great dish for a casual supper; let everyone assemble their own tacos.
Combine the first 5 ingredients in a small bowl; sprinkle the spice mixture evenly over both sides of tuna.
Heat a grill pan over high heat. Coat pan with cooking spray. Add tuna; cook 2 minutes on each side or until medium-rare or until desired degree of doneness. Cut tuna into 1/4-inch-thick slices.
Warm tortillas according to package directions. Divide tuna evenly among tortillas; top each with 2 tablespoons avocado, 1 tablespoon onion, 1 1/2 teaspoons cilantro, and 3 jalapeño slices. Top each with 1 teaspoon sour cream. Serve tacos with lime wedges.
We love this recipe and have been making it for a few years now. I always get fresh tuna and I double the rub to make sure there is enough to coat the fish. The ingredients seem simple but they all go so well together. The pickled jalapeno is the key to their awesome flavor so if you don't like spicy, don't bother. I use ff yogurt instead of sour cream as well. We use soft corn tortillas which we only seem to find at trader joes, they have these corn/flour tortillas that work very well.
Not that great. Although we did use Whole Foods frozen tuna. The dish is lacking something. If you're looking for good fish tacos, the "grilled shrimp tacos" are outstanding. We followed instructions and I would not make this recipe again.


Special collections libraries in the twenty-first century have taken on an increasingly important role in the academic library. Moving out from their perceived "silo," special collections have become more integrated into academic life through creative partnerships and productive collaboration with other librarians, faculty, students, and the wider scholarly community. Leading a special collections library requires a portfolio of skills and strengths that are often difficult to develop within the traditional functional areas of a library. These skills and strengths include strategic thinking and planning, building and managing diverse collections, designing and managing facilities, development and fundraising, public relations and marketing, managing through others, grant writing, data-driven decision making, and administering complex budgets. This course provides an introduction to these competencies and an opportunity to discuss and explore them as a class. Faculty from the University of Virginia's Darden School of Business will visit the class to facilitate sessions on leadership. During the week students will assess their own strengths and areas for growth and will develop a personal professional development plan.
This course is intended for mid-career librarians and archivists who are interested in exploring a career as the director of a special collections library or department.
Participants are expected to bring a laptop with them to class.
Naomi Nelson teaches this course, as "Special Collections Leadership Seminar."
Samuel A. Streit and Merrily E. Taylor co-teach this course, as "Advanced Seminar in Special Collections Administration."
Samuel A. Streit and Merrily E. Taylor co-teach this course, as "Seminar in Special Collections Administration."
Samuel A. Streit and Merrily E. Taylor co-teach this course, as "Advanced Seminar in Special Collections Librarianship."
Samuel A. Streit and Merrily E. Taylor co-teach this course, as "Advanced Special Collections Administration."
Samuel A. Streit and Merrily E. Taylor co-teach this course, as "Strategies for Special Collections."


text:
The Other Me
Will Browning accidently creates a clone of himself when working on a science project.
The Other Me – fantastic movie. This movie, which I free even refuse to compare with the other ones is the masterpiece created by my favorite director. I know it gets a lot of stick for being the mainstream popular movie, but honestly I can not think of anything wrong with the movie online.
The Other Me 's one of the best movie films ever made, I love music. The story is really solid, the pacing is great, and all of the actors give great performances. The amount of details and little aspects of the movie that you can find years and years later is absolutely amazing.
After watching, I really liked the mix of feelings. I chose to load this wonderful movie in Soap2Day you can now watch movie online free.
Genre: Comedy, Family, Fantasy, TV Movie
Director: Manny Coto
Actors: Alison Pill, Andrew Lawrence, Brenden Richard Jefferson, Joe Grifasi, Lori Hallier, Mark L. Taylor, Robert Buck, Sarah Gadon, Scott McCord, Tyler Hynes
Keywords:sites to watch The Other Me online free The Other Me movie online watch free The Other Me watch online The Other Me watch online full movie watch The Other Me full movie online watch The Other Me online free hd watch The Other Me online watch series
Waxwork II: Lost in Time
The survivors of the first Waxwork must use a portal through time to defeat the evil that has followed them and turned their lives upside down. Soap2Day Review: Waxwork II:…
The Upside of Anger
After her husband runs off with his secretary, Terry Wolfmeyer is left to fend for herself — and her four daughters. As she hits rock bottom, Terry finds a friend…
A 16-year-old international assassin yearning for a "normal" adolescence fakes her own death and enrolls as a senior in a suburban high school. She quickly learns that being popular can…
Beautiful Thing
Set during a long, hot summer on the Thamesmead Estate in Southeast London, three teenagers edge towards adulthood. Soap2Day Review: Beautiful Thing – one of the best drama movies, I…
When an English cartographer arrives in Wales to tell the residents of the Welsh village of Ffynnon Garw that their 'mountain' is only a hill, the offended community sets out…
Fun with Dick and Jane
After Dick Harper loses his job at Globodyne in an Enron-esque collapse, he and his wife, Jane, turn to crime in order to handle the massive debt they now face….
Auntie Danielle
Tatie Danielle is a black comedy about a widow who is intent on ruining the lives of her great-nephew and his wife. Tsilla Chelton plays the title character, who mourns…
The Comics
A few funny little novels about different aspects of life. Soap2Day Review: The Comics – fantastic movie. I accept that my expectations are very low before I see this movie….
As part of a fertility research project, a male scientist agrees to carry a pregnancy in his own body. Soap2Day Review: Amazing movie from 1994. This movie, which I free…
Genre: Comedy, Family, Romance
Once Around
Renata Bella feels like a failure at life and career. But when Renata attends a seminar on selling real estate, she finally finds True Love. Sam Sharpe, while a top-notch,…
The Big Tease
Thinking he's competing in Los Angeles' hot Platinum Scissors contest, Scottish hairstylist Crawford (Craig Ferguson) leaves Glasgow with a film crew to capture the event. When he learns he's a…
The fledgling romance between Nick, a playboy bachelor, and Suzanne, a divorced mother of two, is threatened by a particularly harrowing New Years Eve. When Suzanne's work keeps her in…
Genre: Adventure, Comedy, Family, Romance


Some people call them Dunking Booths and some call them Dunk Tanks, but here in Jumping Hearts... we call them fun!
A Dunk Tank is a classic carnival game that guarantees lots of fun and laughs in your event.
If you've been dreaming about the perfect opportunity to get revenge on that co-worker that pranked you, or maybe you want to dunk your principal at a school fundraiser, our Dunk Tank rental is the way to go.
You must have a water sourse to fill the dunk tank and a hose long enough to reach were the dunk tank is going to be setup.


Cervantes & Prado Dental Care, located in Vallejo, CA specialize in comprehensive dentistry. As a patient, you can choose from a full range of dental services. Preventive dentistry is the main area of focus within Cervantes & Prado Dental Care. With recent studies showing that oral health is directly related to the health of your teeth, the methods used for dental damage and disease prevention have become more sophisticated and effective.
Our Vallejo dental office specializes in the treatment of all types of tooth damage from removing tartar build-up to filling cavities and restoring lost teeth using innovative technologies and procedures. Implant and restorative dentistry are also among the areas which Cervantes and Prado Dental Care professionals specialize in.
Dr. Cervantes is a graduate of the UCSF School of Dentistry, earning a DDS in 2003. Dr. Cervantes earned a B.A. History and Political Science from UC San Diego and later received a M.P.H. from UC Berkeley.
Dr. Cervantes-Prado is a graduate of the UCSF School of Dentistry, earning a D.D.S. degree in 2005. Prior to dental school, Dr. Cervantes-Prado earned a B.S. in Molecular Environmental Biology with an emphasis in Public Health from UC Berkeley.
Claudia has been providing preventative and therapeutic services in the dental field since 1995. My role as a registered dental hygienist is to provide comfortable care and dental hygiene treatment.
Angela is passionate about helping patients improve and maintain their oral and overall health. She received her Certificate in Dental Hygiene from Diablo Valley College in Pleasant Hill, CA.
"Great service, I had to get two fillings and my cleanning done and they did a great job. Their prices are affordable for uninsured people like me. I also brought my Dad and he received the same great service I did."
Cervantes & Prado Dental takes great pride in being able to provide each and every patient with dental services to achieve their individual needs and goals. We want our patients to understand that their oral health and personal well-being comes first. Because of this, our dental office offers flexible payment solutions as well as CareCredit that makes it as easy as possible for you to afford the dental procedures not covered by your dental insurance. Most patients are amazed just how affordable a new smile can be!
Give us a call, and we can give you more information on your specific situation. We work with most providers.


Canuck Investments was founded in 2009 simply as a way to "dabble" in real estate, but as our dreams grew bigger and our asset base continued to increase.
Our goal at Canuck Investments is to provide clients with a turn key solution to the many needs that people encounter in this industry.
I'm happy to say that it was the best decision we have ever made and has allowed me to exit out of engineering full time and focus 100% on my passion of real estate.


text:
YouTube HOF: College
Youtube Hall of Fame
by Grantland Staff
Chuck Klosterman: When I was in college and lived in a dormitory, this is what we watched every day (immediately after dinner and just before Beavis & Butt-Head). It's a show called Fifteen, which was a non-comedic Canadian version of Saved by the Bell, halfway crossed with Beverly Hills: 90210 (they even had their own handsome rebel named Dylan). My favorite character was Brooke, the meanest girl in school. A lot of the dudes I got drunk with liked Ashley, but she was such a grade-grubber. The little kid playing the drums (Billy) was portrayed by a young Ryan Reynolds; he had a lot of problems at home. Matt dated Ashley and was the star of the basketball team, but he acquired a drinking problem; Brooke crucified him for that. Kelly was a total gossip. Courtney (Billy's older sister) was lame, but I still liked her. She just needed confidence. Jake and Theresa didn't bring much to the table.
Kanye West, "School Spirit"
Andy Greenwald: Who can say for sure why Kanye West never made a video for this, my favorite song from the early part of his career, back when he was rapping about working in the mall, not getting married in one. Was he distracted by a fresh pair of kicks? A delicious fish sandwich? Or maybe it was just some flashing lights? Either way, the absence was an opening for young Mike "MYU" Nicolas, an entrepreneurial student from Norfolk State who made a near-perfect clip himself back in 2010. It's a riot of very excited undergrads dancing, very attractive coeds waving, and some excellent tracking shots of escalators. The entire thing is anchored by the assured performance of Danquai Draughon as Mr. West, an inspired bit of lip-synched swag that more than makes up for what it lacks in accuracy (I doubt Kanye would let his Sherpa wear Danquai's Husky chain) with exuberance. "Back to school / and I hate it there, I hate it there," Kanye/Danquai raps, but he's clearly lying. Look how much fun everyone's having!
The Ultimate Lax Bro
Katie Baker: This video is about so much more than its titular Ultimate Lax Bro. Yes, it involves pinnies and passouts and A Crazy Game of Poker, and it has a sequel that deploys a Pomfret Lacrosse Boathouse jacket with uncanny precision. But beneath the facade and the flow and the "false" is a portrait of the more universal college freshman, from the nonchalance that masks insecurity ("I've never been to L.A., but it's a pretty chill place") to the utter harmlessness that's so often mistaken for being a douche. (The latter condition requires a level of malevolence that doesn't typically set in until a few weeks into sophomore year, or after one's first Preakness, whichever comes first.) We have all been Brantford Winstonworth in some way at some point, even if we don't want to admit it. For all the easy jokes that can be and have been made about the Ultimate Lax Bro, the truth is that he offers some pretty sage college (and life) advice. D-I, club, whatever. It doesn't matter. Remember that.
The Sopranos, "College"
Dan Silver: In four episodes, The Sopranos was well on its way to being a huge hit for HBO, but the fifth episode, titled "College," quickly demonstrated that The Sopranos was operating on a much more subtle and nuanced level than other programs on TV. "College" is a series-defining episode, as it simply but effectively plays out the constant battle in mobster Tony Soprano's life — the struggle between being a good family man and a good soldier — when on a college visitation trip with his daughter, Tony spots a snitch who's been in hiding. The scene where Tony's inner turmoil is best displayed is when he attempts to deflect accusations from his daughter that he's involved with the Mob. Given how The Sopranos ended (not the cut to black, but the final scene of the family coming together for dinner) it could be argued that this scene is the foundation for the next five seasons, and the one where the comparisons to Coppola and Pacino (instead of Bochco and Franz) for series creator David Chase and star James Galdolfini started.
PCU, "Don't be that guy."
Chris Ryan: This comedy (directed by "Ellis" from Die Hard!) was embarrassingly formative in my high school years. I legit thought this is what college was going to be like, and I genuinely thought Jeremy Piven's character was a righteous dude. I still really like this scene, though. "Don't be that guy" is still solid advice, and the jaw-dropping hair (on Jon Favreau) and lack of hair (Piv!) is pretty great.
Campus PD: Pink Pantydroppers
Tess Lynch: This moment, which I always just think of as "pink pantydroppers," does not encapsulate my college experience or anything good about college at all. In fact, it's like an anxiety dream you might have in college: You drink something embarrassing, like, well, peppermint schnapps and skim milk with gin, or yogurt and peach schnapps frozen into little booze-stinking yogurt pops, or, worst of all, three cups of pink pantydroppers, and then police officers assault you with complicated questions about the date and your name, embarrassing you horribly. And it's caught on film. I assume that Quentin's (Quinton? Quinten? Who cares, really, though?) nightmare concluded with slipping on soft serve at the late-night campus convenience store, having a shitty one-night stand, and sleeping through his midterm. And barfing on his dorm floor. Which is just to say, I think Quentin was probably a freshman.
Mark Lisanti: Someone had to do Animal House. So here's an Animal House thing! I went to a Jesuit university, so there were no fraternities, but that doesn't mean there weren't robed tormentors constantly paddling you.
Kicking and Screaming
Michael Weinreb: I've linked to this clip before, but I don't care; this is the greatest college-related movie ever made, and I'm going to keep finding any excuse to link to it until someone sends me either a satin jacket or a recipe for a cheese-fry-flavored lager. Also, watching this will alleviate any need for you to actually read All the Pretty Horses.
In conclusion: Cougars!
Alabama Fan Belittles LSU
Molly Lambert: "You're nothing. You're nothing. You'll never be nothing."
Frat Life
Jovan Buha: A satirical depiction of 21st-century fraternity life, including: having sex with sorority girls, chasing shots with Muscle Milk, making fun of GDIs (God Damn Independents — or those not in Greek Life), and being a cocky douche bag.
Filed Under: Youtube Hall of Fame
More Youtube Hall of Fame
YouTube HOF: Wes Anderson Characters March 5, 2014
YouTube HOF: Good Costner/Bad Costner February 19, 2014
YouTube HOF: Necessary Remakes February 12, 2014
YouTube HOF: Toy Stories February 5, 2014
YouTube HOF: Bad Movies by Good Directors January 29, 2014
See all Youtube Hall of Fame
We Found It on Netflix Instant — Atlas Shrugged: Part 1
SXSW: Tuesday's Winners and Losers


Indonesian "thugs for hire" are playing an increasing role in the nation's presidential election, less than a week out from the world's biggest single-day poll.
Known as "preman" from the Dutch term for "free man," they can be seen at every political rally dressed in military fatigues, army boots and berets.
"They will almost do anything, for any cause, for the right kind of money."
There is a lot of money to be made at election time, according to Andreas Harsono from Human Rights Watch, Indonesia.
"They provide security. They open doors when a politician would like to enter another [candidate's] territory," Mr Harsono said.
Preman groups also use "intimidation and threats" to capture votes by targeting rival grassroots campaigners who seek to unseat their political masters, according to Mr Harsono.
"Visiting their houses, visiting their parent's houses, visiting their grandfathers. If those things don't work, then they will use violence," he said.
There are dozens of preman groups across the Indonesian archipelago, each conducting regular military-style parades and bootcamp training sessions.
They also put on displays of strength and bravery for the public, including slashing at their own necks and tongues with machetes and setting off string necklaces made of firecrackers.
"I think that's deliberate. They want to be seen as tough and for people [to be] afraid of them," Mr Bayuni said.
Political muscle or organised crime?
Their fearsome reputation is linked to their long association with organised criminal gangs.
"If you run a restaurant in Jakarta, sometimes you have to pay more than one [preman] organisation to make sure your establishment is protected," Mr Bayuni said.
One of the biggest groups, known as Banser, is providing support to President Joko Widodo's campaign this year.
The group is affiliated with Nahdlatul Ulama (NU), the largest Islamic mass organisation in the world, which is also publicly backing President Widodo.
"Banser is certainly a paramilitary-style group, but many of its members would object to being called 'preman', which carries the connotation of thug or gangster," said Dr Ian Wilson, a senior lecturer at Murdoch University.
Dr Wilson, who has done extensive research on Indonesia's crime gangs, said Banser's support for President Widodo has been welcomed by some Indonesian voters.
"During the 2016 Jakarta [governor] election, the Islamic Defenders Front (FPI) called for its members to go and 'monitor the process', which was code for going to polling stations in large numbers to intimidate would-be voters," he said.
"In 2019, many see Banser's role as a positive one, because it's being used to balance out some of that intimidation."
Banser in particular has a dark history.
During the communist purge of 1965 to 1966, the group was enlisted by the military to assist in the massacre of hundreds of thousands of Indonesians.
Indonesia: Fake news capital of the world?
"The campaign was led by the military to crush the communists, but many of the killings were conducted by these paramilitary groups, including Banser," said Mr Bayuni.
Presidential challenger Prabowo Subianto has his own paramilitary group, known as Brigade 08.
It was first established by the ex-general's political party Gerindra, to help with security on the ground during the 2014 presidential campaign.
"We are tasked with helping the candidates win [the election] and securing their campaign activities," head of Brigade '08 Jakarta Chapter, Fasran Viqki told ABC.
"We're also doing social, people-to-people activities … helping people in need, for example those with health problems."
Some militant groups have been starting getting involved in humanitarian assistance, like disaster relief.
But Endy Bayuni said the move is still financially motivated.
"We seem to be getting more and more of them, different organisations offering their services. For services rendered of course. They expect payment," Mr Bayuni said.


This one is tricky. If your office doesn't provide a closet or any other proper place for your purse, you might be inclined to leave it on your desk — after all, it's better than the floor.
But Barbarino advises against keeping it there, and especially keeping it open. "It looks careless and invites fraudulent behavior," she said. See if your company will allow you to hang a purse hook under your desk.
But even if you don't evangelize at work, simply keeping political pamphlets, posters, pins — basically anything promoting your affiliation — on your desk runs the risk of making you look inappropriate in the office.
Some of your colleagues might find the very act of taking a cigarette break to be unprofessional, so that pack of Camels on your desk isn't doing you any favors. But the smell of cigarettes — even unlit ones — could also create an issue for your office mates.
Okay, so you love Halloween. But gourds and ghouls are only appropriate in the fall, according to Nicole Belyna, a recruitment manager at Thompson Creek Window Company and talent acquisition panelist for the SHRM. Keeping decor up after it's relevant will make you look overzealous at best and lazy or neglectful at worst. Be festive, not forgetful.
"The weirdest thing I've ever seen on anyone's desk was a faux lion's rug with a severed ear ornament sitting in the mouth," said Mark Marsen, a director of HR at Allies for Health + Wellbeing and disciplines panelist for SHRM — and he admits that bizarre rug is in his own office. "Our definition of professional is unique," he said.


text:
package org.kuali.rice.krad.labs.performanceviews;

import org.junit.Test;
import org.kuali.rice.testtools.selenium.WebDriverLegacyITBase;

/**
 * @author Kuali Rice Team (rice.collab@kuali.org)
 */
public class LabsCourseSearchLightTableAft extends WebDriverLegacyITBase {

    /**
     * /kr-krad/kitchensinkperformance?viewId=Demo-Performance-LightTable
     */
    public static final String BOOKMARK_URL = "/kr-krad/kitchensinkperformance?viewId=Demo-Performance-LightTable";

    @Override
    protected String getBookmarkUrl() {
        return BOOKMARK_URL;
    }

    @Override
    protected void navigate() throws Exception {
    	waitAndClickByLinkText("Course Search Light Table");
    }

    protected void testCourseSearchLightTable() throws InterruptedException {
    	waitAndClickButtonByExactText("Generate Table");
    	waitForElementPresentByXpath("//table[@class='uif-lightTable dataTable']");
    }

    @Test
    public void testCourseSearchLightTableBookmark() throws Exception {
    	testCourseSearchLightTable();
        passed();
    }

    @Test
    public void testCourseSearchLightTableNav() throws Exception {
    	testCourseSearchLightTable();
        passed();
    }
}

redpajama_set_name: RedPajamaGithub


Belgian artist Johan Van Mullem is renowned for his ethereal paintings of seemingly otherworldly figures. His second solo show at Unit London, there's over fifty works on show, including "Reverence" — which the exhibition derives its name from.
Guest Curated by Christian Levett, the show brings together works that fit with the theme. Speaking about the show, Levett said "'Reverence' presents Johan's rich aesthetic, drawing together his emotive, dramatic and haunting paintings in one location." Take a look through the gallery above to see the exhibition for yourself. "Reverence" is on until April 13.
In other news, take a closer look inside Cj Hendry's "RORSACH" exhibition.


The UK and the EU have now agreed a further Brexit delay. The European Council decision of 11 April 2019 (agreed by the UK) sets out the details of this "Brextension".
Article 50(3) TEU itself provides for an earlier exit date: "The Treaties shall cease to apply to the State in question from the date of entry into force of the Withdrawal Agreement […]." Accordingly, the Council decision emphasises that "should the parties complete their respective ratification procedures before 31 October 2019", the UK would leave the EU "on the first day of the month following the completion of the ratification procedure".
The Council decision provides for a third possible exit date, with Article 2 providing that "this decision shall cease to apply on 31 May 2019" (i.e. the UK would exit the EU) if the UK does not ratify the Withdrawal Agreement before the European Parliament elections (23-26 May) and does not hold those elections. For more information on the UK's obligations regarding the EP elections read our latest legal update here.
In addition, the Council decision records the UK's commitment "to act in a constructive and responsible manner throughout the extension period in accordance with the duty of sincere cooperation" and the EU's expectation that the UK shall fulfil its Treaty obligations and shall "refrain from any measure which could jeopardise" the EU's objectives, especially when participating in the decision-making process of the EU.
The decision does not include any provision for sanction should the UK breach this principle (which is in any event a feature of EU membership).
If you have any questions, please get in touch with Christine O'Neill, Charles Livingstone or Hannah Frahm. Visit our Brexit Hub for regular updates on Brexit related matters.


Hidden in the heart of the Herefordshire countryside, Brinsop Court, set in the secluded 800 acre Private Estate, is one like no other. Escape the everyday hustle and bustle of city life, and retreat to this hidden gem that promises to be an unforgettable experience.
Whisk your team, guests or clients away and let them be 'wowed' by the tranquil setting and breath-taking scenery. Brinsop's flexible approach allows you to arrange a bespoke programme of activities that can both inspire and relax.
Let our dedicated, experienced and passionate team work with you to create a retreat package that is perfect for you and your team.
This moated country manor house can be the perfect venue to host activity filled away days and country escapes. The extensive woodland, gardens and fishing lake are exclusively yours and are fantastic locations to host activities to develop and strengthen team bonds.
Brinsop Court is guaranteed to create not only long lasting memories but also an environment to promote relaxation, inspiration and productivity.
We also have a diverse selection of indoor activities that may more appealing to your group; A Brinsop Bake Off or Cookery demonstrations in our Farmhouse Kitchens, a Wine Tasting or Cocktail Master Class, or perhaps a Murder Mystery evening. Perhaps something a little more relaxing such as massages, beauty treatments or a spot of yoga……….. something for everybody.
Relax and unwind in front of the roaring fire in our Oak Parlour, or perhaps in your private outdoor Hot Tub whilst sipping on that well-earned beverage, before enjoying a magnificent feast in our candle lit Banqueting Hall, followed by a game of snooker and a night cap in our Games Room. A productive and satisfying day ends in the best way possible, with a great night's sleep in one of our eighteen luxuriously decorated and comfortable bedrooms.
Whether it is a Strategy Planning Board Meeting or a Team Presentation, let creativity and innovation flow in our many calming and modernised work spaces, fully equipped for any kind of meetings, seminars or brainstorming sessions.
Our key is exclusivity and flexibility, so let us work together to design and create your perfect stay.
The Brinsop Business Pack: Screen and Projectors, Sound System, Flipcharts, Whiteboards and Stationary.
An excellent place for a company get together / large gathering. We rented the whole of Brinsop Court for a team get together. The venue is excellent, and we were looked after throughout by Ali, who did a really good job. I could wax lyrical, but with fifteen bedrooms across the three building, an incredible dining room, great library as well as lots of sitting rooms to spend time in, the accommodation is fantastic. Each of the rooms, bedrooms, seating areas and dining areas is well appointed and beautiful. The grounds are extensive, and great for a walk. We hope that we are able to book for next year!
The Gadget Show filmed an entire programme for their current series at Brinsop Court and what a fabulous location it was!
The staff at Brinsop Court were very accommodating to all of our filming needs and went out of their way to make things work for us.
The rooms we filmed in were large and clean and made our experience of filming there a pleasure.
The staff are very organised and this helped us to complete our filming effectively and efficiently.
We also stayed there overnight during the week and all meals were provided. Accommodation and Catering were of a very high standard.
Needless to say The Gadget Show will no doubt be filming there again in the future!


Beautiful Traditional Style home on a cul-de-sac, in Troutdale OR, this one is a fixer, come take a look to see if you can bring this one back to its glory days. Bring your contractor, to see if this one is a fit for you, also features 5 bedroom, 5 bathroom, 3 car garage, level lot, sliding glass doors leading to back yard. Estimated 3,641 sq ft of livable space, convenient to amenities, parks and highways.


text:
Jack Chesbro
Series: Pioneer Portraits II: 1875-1899
City: Richmond
Team: Bluebirds
League: Atlantic League
Hall: National Baseball Hall of Fame
John Dwight "Happy Jack" Chesbro (1874-1931) had the most formidable year as a pitcher in the modern era in 1904 with the New York Highlanders (Yankees.) Chesbro won 41 of 58 starts, completing 48—all unsurpassed since. The Veteran's Committee elected him to Cooperstown in 1946 on the strength of that remarkable season.
Pitched the NY Highlanders' first game in 1903
In his banner year, Chesbro began using the spitball, learned from inventor Elmer Stricklett
Elected to Hall of Fame: 1946
Lowest winning bid: $7.95


The runtime was moved to .NET Core 2.0.6, which includes recently released security fixes.
A tutorial for writing a module in Python was added to documentation. It accompanies the Python client and service SDKs, which were released last month.
Azure Functions on IoT Edge now can run on ARM32 devices.
Watch this demo video for more information.


e-Commerce Fraud is Rising Fast. Do You Know Exactly What Your Business is Up Against?
Magento Pricing: $1,500–$100,000+ Why Such A Wide Range? Here's The Answer.
SEO in ecommerce is somewhat different from the usual search engine optimization: you have to strengthen different areas to be able to reach better rankings on the search results pages, and these areas mainly have to cover specific, relevant information. We are going to describe in detail what this exactly means.
Right now, tens of thousands of ecommerce businesses use Magento 1.x with huge success – for them, upgrading is not a very pressing matter, but a great opportunity. So you might be wondering: should all ecommerce businesses upgrade now?