text:
Health Trying Difficulty Treatment Coping Miscarriage
What I've Learned About Fat Fertility
Facts on Weight and Fertility
Understanding Your Surrogacy Options
Infertility Abbreviations & Acronyms
10 Things You Should Know About Exercise During IVF
A Guide to At-Home Insemination
Luteal Phase Length and Getting Pregnant: Q&A with Dr. Natalie Crawford
Fertility Blogger Directory: Here's How It Works
Identifying Stages of Cervical Mucus
Cervical Position and Fertility
5 Things I Learned From Experiencing Pregnancy Loss
Getting HER Pregnant: What Nobody Tells Intended Parents About Surrogate IVF
What to Include in a Surrogacy Agreement
9 Unique Challenges of Secondary Infertility
Endometriosis and Infertility
Our Journey to Pregnancy With Donor Eggs
A 12 Step Guide on What to (Really) Expect with IVF
Embryo Freezing and Thawing: What You Need to Know
Finding Infertility Support
What you need to know about Ovarian Hyperstimulation Syndrome (OHSS)
Reframing Male Infertility
How Men Can Talk About Their Needs During Infertility
Redefining Strength After Infertility
Dealing With the Pain of Infertility as a Stepparent
IVF and an Impossible Choice: Termination of a Wanted Pregnancy
The Importance of Sharing our Miscarriage & Infertility Stories
Excerpt: The Other Half - What About Men and Miscarriage?
Treating an Inevitable Miscarriage
Why I Don't Talk About My Miscarriage
Infertility Blogs
How Men Can Show Support During Infertility
Fertility Blogger of the Month: Karen of Hilariously Infertile
7 Ways the Two-Week Wait Messes With Your Mind
Implantation Calendar: What is Happening During the Two Week Wait?
What You Need to Know About Embryo Implantation
Fertility Awareness Method (FAM)
Quiz: Test Your Fertility IQ!
Editorial Review Policy
FertilitySmarts Staff | Published: June 20, 2017 | Updated: January 26, 2019
Source: olm26250 /istockphoto
Takeaway: Normal luteal phase function is important to conception. Women trying to conceive should consider using fertility awareness methods (FAM) such as charting with basal body temperature, cervical mucus monitoring, or testing with ovulation predictor tests in order to be aware of their cycle characteristics and seek earlier evaluation by a specialist if abnormalities in the cycle are detected.
We think that one of the best ways to get smart about your fertility is to go right to the research. We had the opportunity to do just that when we asked Dr. Natalie Crawford to explain what any woman or couple looking to conceive should know about her research article titled Prospective evaluation of luteal phase length and natural fertility, that explores how the length of a luteal phase in a woman's menstrual cycle impacts her ability to get pregnant.
Dr. Crawford is an accomplished reproductive endocrinologist with extensive clinical and research training. She is the Medical Director of Oncofertility and Fertility Preservation at Austin Fertility Institute in Austin, Texas. Dr. Crawford completed her undergraduate education at Auburn University, obtaining a degree in nutrition science. She has strong roots in Texas, having received her medical degree from the University of Texas Medical Branch in Galveston and completing her residency in obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas. Dr. Crawford completed a fellowship in reproductive endocrinology and infertility at the University of North Carolina while concurrently obtaining a masters degree in clinical research. Dr. Crawford values developing close connections with her patients throughout their infertility journeys and incorporates evidence-based medicine to help patients achieve their dreams of family building.
FertilitySmarts: Can you give us an overview of the question your research was looking to address?
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Dr. Crawford: Our study evaluated if women who had a short luteal phase had a decrease in fecundability (the probability of conceiving in a given menstrual cycle).
FertilitySmarts: Can you explain what a luteal phase is?
Dr. Crawford: The luteal phase is the second half of a woman's cycle. In typical terminology, the start of the menses is considered day 1. The first half of the cycle is known as the follicular phase - the period of time in which an egg develops within a follicle (approximately 2 weeks). After this egg ovulates, the follicle which released the egg forms what is known as the corpus luteum - a cyst which makes progesterone. Progesterone is essential for implantation and survival of early pregnancy. This time period after ovulation and until the next menses is known as the luteal phase.
FertilitySmarts How does the length of a luteal phase impact the chance of getting pregnant?
Dr. Crawford: Progesterone is essential in preparing the endometrium for survival and allowing early pregnancy success prior to progesterone production by the placenta. Excellent and reproducible studies have shown us that removing a woman's corpus luteum (thus ending progesterone production) will end an early pregnancy. Thus, it has long been believed that abnormalities in the luteal phase may decrease a woman's success with pregnancy. The length of the luteal phase represents the survival of the corpus luteal, and clinical signs of a luteal phase deficiency include a shortened luteal phase or spotting during the luteal phase (both of which are considered abnormal).
FertilitySmarts: How is an issue with a luteal phase diagnosed? Do you need a formal diagnosis?
There are data suggesting that a luteal phase can decrease with age and decreasing ovarian reserve. In addition, in our study, women who were smokers were also found to have a shorter luteal phase. Other studies have shown that vigorous activity (which was not evaluated in our study) may also be associated with a short luteal phase. Most infertility specialists consider a short luteal phase to be a possible marker for abnormal or suboptimal ovulation.
FertilitySmarts: Did your findings change your previous understanding of the luteal phase and its effects?
Dr. Crawford: Our findings expand upon previously held beliefs. Although it is difficult to study the luteal phase (by definition, it does not end in a cycle in which a woman conceives), we evaluated the cycle after one with a short luteal phase. In our study, a short luteal phase decreased short term fecundability (probability of conception), as pregnancy rates for the first 6 months after an isolated cycle with a short luteal phase were decreased. However, we were unable to observe significant differences by 12 months (meaning, not an increase overall in the definition of "infertility").
FertilitySmarts: What is the key takeaway from your research on luteal phase length that anyone trying to conceive should know?
Dr. Crawford: The takeaway message from our research is that normal luteal phase function is important to conception. Women trying to conceive should consider using fertility awareness methods (FAM) such as charting with basal body temperature (BBT), cervical mucus monitoring, or testing with ovulation predictor tests in order to be aware of their cycle characteristics and seek earlier evaluation by a specialist if abnormalities in the cycle are detected.
It is important to acknowledge that although current tracking apps can help with the collection of cycle data and are easy to use, most tracking apps use a typical calculation of ovulation by presuming a normal luteal phase (subtracting 14 days from the average cycle length). Thus, in women with a short luteal phase, reliance on tracking apps to determine the fertile window is often inaccurate.
Read: How Basal Body Temperature (BBT) Can Help You Get Pregnant
Read: Identifying Stages of Cervical Mucus
Read: Cervical Position and Fertility
Follow Dr. Crawford's fantastic Instagram account @nataliecrawfordmd for fertility-related tidbits and a gimps inside the life of a Reproductive Endocrinoligist.
About the Author: FertilitySmarts Staff
Whether you're seeking information or struggling to conceive, we break down the tough topics with the goal of helping you better understand your own fertility.
Fertility Tests for Women
Fertility Preservation Through Egg Freezing
How Basal Body Temperature (BBT) Can Help You Get Pregnant
Identifying Fertile Cervical Mucus
Luteal Phase
Luteal Phase Defect (LPD)
Basal Body Thermometer
Fertile Window
Cycle Day (CD)
Cycle Day 1
Can you get pregnant right after your period?
Can you get pregnant right before your period?
How long can sperm live in a woman's body after ejaculation?
When is a woman most fertile?
Do ovulation predictor kits (OPKs) work for everyone?
Cervical Mucus
FertilitySmarts Terms: # A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Copyright © 2020 FertilitySmarts Inc. - Terms of Use - Privacy Policy - Advice Policy - FertilitySmarts does not provide medical advice, diagnosis or treatment


Using appropriate Patient-Derived Xenograft (PDX) models in a specific indication, or with a specific gene mutation or amplification is the first step in optimizing preclinical and translational oncology research.
CrownBio has developed a powerful yet easy to use online database, HuBase, for accessing, mining, and managing the wealth of available HuPrime® and HuKemia® PDX model data.
Regularly updated with new model information.
Searching for models of interest can be as basic or in depth as individual clients require. Simple model searches are based on PDX with standard of care data available, or for models treated with a specific agent of choice. Models can also be stratified by known hotspot mutations.
Gene fusion, or combinations of these features.
Model Selection Made Easy by HuBase.
With all data easily exportable in both graphical and tabular form, HuBase provides an essential tool for the rapid discovery of appropriate and predictive preclinical models.


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PAGA Research
Committed to leveling the playing field for California's small-and medium-sized businesses.
Starting a business is hard work. Data from the Bureau of Labor Statistics shows that one-fifth of small businesses fail within their first year, and just half of them make it to the fifth year. In California, the state's 1,100-page labor code dictates all manner of workplace requirements and makes it difficult for any employer to comply. Small businesses, non-profits, religious institutions, charitable organizations, and other foundations are the most vulnerable.
CABIA Foundation exists to educate disadvantaged business owners. The CABIA Foundation seeks to guarantee that no small businesses are in the dark on their legal obligations simply because they can't afford the cost of compliance. The Foundation will conduct free seminars to educate businesses on avoiding wage and hour lawsuits, and produce no-cost educational guidebooks on common errors that can trip up anyone who has an employee.
Tom Manzo
Richard Frey
Member of the Firm
Epstein Becker Green
Michael Saltsman
Berman and Company
Richard Roussin
Coast to Coast Computers
Andres Gomez
Timely Industries
Ready to support our work?
Your support for the CABIA Foundation will go directly to support our cutting-edge research on the true cost to California of the Private Attorney General Act. This includes our upcoming project to built the first ever database of confidential PAGA settlement communications, where unscrupulous lawyers threaten small business owners into settling PAGA lawsuits. Your support also helps us ensure that no small businesses are in the dark on their legal obligations simply because they can't afford the cost of compliance.
CABIA Foundation is a §501(c)(3) organization, gifts to which are deductible as charitable contributions for Federal income tax purposes.
Copyright 2022, all rights reserved.

redpajama_set_name: RedPajamaCommonCrawl


text:
Johanna Gerecther Neumann describes Kristallnacht in Hamburg —US Holocaust Memorial Museum
Nazi Party officials, members of the SA and the Hitler Youth carry out a wave of violent anti-Jewish pogroms throughout Greater Germany. The rioters destroyed hundreds of synagogues, many of them burned in full view of firefighters and the German public and looted more than 7,000 Jewish-owned businesses and other commercial establishments. Jewish cemeteries became a particular object of desecration in many regions. Almost 100 Jewish residents in Germany lost their lives in the violence. In the weeks that followed, the German government promulgated dozens of laws and decrees designed to deprive Jews of their property and of their means of livelihood even as the intensification of government persecution sought to force Jews from public life and force their emigration from the country.
After the pogroms, the implementation of German anti-Jewish policy was gradually concentrated in the hands of the SS. Thus, Kristallnacht figures as an essential turning point in Nazi Germany's persecution of Jews, which culminated in the Holocaust, the attempt to annihilate European Jews during the war.
Demolition of the ruins of the Tempelgasse synagogue after its destruction during Kristallnacht. —US Holocaust Memorial Museum, courtesy of Dokumentationsarchiv des Oesterreichischen Widerstandes
Holocaust Encyclopedia article—1938: Key Dates
Holocaust Encyclopedia article—Kristallnacht
Special Focus—Kristallnacht
Bibliography—Kristallnacht
Previous: German Jews' Passports Declared Invalid Next: American Student Reflects


So, the leadership is in place. Maybe that a little bit more my personality. But we haven had players come in while we here who embarrass what we trying to do, or embarrass our sponsors, or community.. This will, however, not change our underlying profitability. Looking upon 2017, of course we will give an in depth briefing when we meet in March, but let me just give you a couple of comments. It's clear our plan is to continue a long term growth path also in 2017.
wholesale nfl jerseys from china Always been a traditionalist, Mora said at Pac 12 Media Days. Me, it as traditional as we can get in this day and age. The players, the jersey features a different cut that fits a little differently around the waist, receiver Ishmael Adams said. BRADBURY, Darrell Richard (1963 2014) It is with deep sadness that we announce Darrell's peaceful passing at LHSC in London, ON on September 29th. Darrell was born into a family of avid sports fans and he's now cheering eternally for his Jays, Rams and Islanders. Darrell also loved music, especially Broadway show tunes, and was known for writing his own lyrics to serenade friends and family at weddings and anniversaries wholesale nfl jerseys from china.


The pattern gets its name (I presume) because the sweater covers the baby's back and not its front – an open front makes better snuggling and less cleaning of inevitable spit-ups and dribbles. Plus, no buttons, button holes, or button bands.
I love the Neighborhood Fibre Co. yarn (worsted in Old Towne East) so much that I decided to add a little hat.
Many thanks for all the kind wishes for dear Mom. I'm happy to report she's home and getting a bit stronger each day. I'm still confident that knitting helps her, and I know it helps me.
This entry was posted on	August 21, 2018 at 8:19 am	and is filed under knitting, Saltwater Hill Knits.
Tags: baby hat, baby knits, baby sweater, Neighborhood Fiber Co.
The baby sweater and hat are SUPER cute!
Thanks! I agree completely – a mix of the yarn and patterns.


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Eolia, MO – Four Injured in Three-Vehicle Crash on Route Z near Sandy Creek Rd
Published November 15, 2021 By Peterson & Associates, P.C.
Eolia, MO (November 15, 2021) – A total of four people were hospitalized following an accident on Sunday evening in Jefferson County. Just before 8 p.m., on November 14, emergency crews were notified that their assistance was needed on-site at a crash on Route Z.
Car Accidents in Missouri
Eolia Personal Injury Lawyers
Reports from the Missouri State Highway Patrol show that a 2020 Chevrolet Silverado was traveling east on Route Z when it collided with a westbound 2020 Nissan Kick and a 2004 Saturn Vue near Sandy Creek Road.
The driver of the Vue was severely injured. The victim, 20-year-old Ashley Herren, was transported to Mercy Hospital South via Air Flight.
The driver of the Nissan, 26-year-old Nicholas Keating, and his passenger, 25-year-old Ashtin Keating, were both transported to Mercy Hospital south via Joachim Plattin Ambulance. The driver of the Chevrolet, 29-year-old Daniel Cronin, was transported to a nearby hospital for further care.
At this time, the incident remains under investigation.
Our thoughts are with Nicholas Keating, Ashtin Keating, Daniel Cronin, and Ashley Herren at this time. We hope for their full recovery.
According to reports provided by the Missouri State Department of Public Safety, more than 55,000 people are injured in auto accidents throughout our state each year. Although many accidents resolve with only minor injuries, thousands of people are hospitalized with life-threatening injuries that require emergency and ongoing care.
Not being able to work while being overwhelmed with tens of thousands of dollars in medical bills not only impacts victims but their families as well. It does not seem right that victims who are injured in accidents as a result of the actions of others are forced to spend substantial amounts of money on treatment.
When victims are injured in accidents, those harmed are able to pursue legal actions to obtain compensation to cover the financial burdens they face moving forward. Working with a knowledgeable and aggressive car accident attorney in the Eolia area after your accident can greatly improve your chances of recovering.
Our lawyers at Peterson & Associates, P.C. will help you to understand the legal options available to you in the aftermath of a car accident. Our Eolia personal injury attorneys strive to help our clients maximize their recoveries so they can get the medical treatment they need without worry.
Our team puts together solid legal claims on behalf of our clients to sure we are in the best position possible to negotiate full and fair compensation that helps them cover the financial burdens they face moving forward from their accident.
With thousands of successful claims, we have helped our clients obtain a total of $500 million in claims. We will stop at nothing to ensure your legal rights are protected after being harmed. If you have been injured in a car accident, contact our personal injury attorneys in Missouri as soon as possible. By calling 816-888-8888 you can schedule a free case evaluation at your earliest convenience with our team to explore legal options available to help you recover.


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5 Questions with Génesis Rodríguez of "Casa de mi Padre"
Posted by Bob Westal (03/12/2012 @ 9:29 pm)
Be sure to check out our interview with the "Casa de mi Padre" cast and crew, including Will Farrell, Diego Luna, Génesis Rodríguez, Nick Offerman, and writer Andrew Steele!
If you're a regular viewer of Telemundo telenovelas such as "Prisionera," "Dame Chocolate" and "Doña Bárbara," it's a bit odd you're reading an online men's magazine. If you have watched them, however, odds are you are already a fan of the beautiful young woman whose full name is Génesis Rodríguez Pérez. A second generation Latin American TV star — her father is Venezuelan legend José Luis Rodríguez, aka "el Puma" — Ms. Rodríguez ("La Pumita") is Miami born and bred. She is, to say the least, equally loquacious in both Spanish and English and, in the nicest possible way, just a bit wacky in her approach to chatting up the press. So much so, in fact, we expect her to conquer Hollywood shortly.
A seasoned veteran with plenty of onscreen gravitas at the shockingly young age of 24, she makes a entirely credible romantically conflicted leading lady opposite budding Latin American leading man Will Ferrell (pronounced "Wheel Fer-all") in the over-the-top Spanish language Mexploitation/telenovela spoof, "Casa de mi Padre." "Casa" however, is not Ms. Rodríguez's only recent brush with the big time. After a relatively small part as one of Turtle's bevy of attractive drivers on "Entourage," she has also appeared in her first really big American movie as Jamie Bell's girlfriend in the hit thriller, "Man On a Ledge." The high profile production also gave her a scene with thespian living legend Ed Harris (see a photo from the film below, before question #4). Her next gig is "Hours," an intense drama set during Hurricane Katrina and co-starring Paul Walker.
Clearly, Génesis Rodríguez is more than holding her own in the world of Yanqui entertainment. She certainly gave much better than she got when it was time for us to ask her five questions.
1. Who's more intimidating, Ed Harris or Will Ferrell?
Ed Harris, because Will Ferrell's a teddy bear. Will Ferrell's the sweetest individual you could ever come across. Ed Harris is very method, so if he plays a villain, good God. You're going to be scared. You're going to be very scared.
2. You obviously did just fine in the movie, but since this was your first big, funny movie with some pretty major comedy talent, are we going to see your cracking up all over the "Casa de mi Padre" Blu-ray?
I really tried to keep it together. There were moments. I don't take myself very seriously, as you can see; I'm kind of a goofball. I kind of get nervous when people are extremely intense. So I tend to crack. I just start laughing for no reason. If someone has an accidental fall or something, and they're hurt, I can't help it. It just happens out of nervousness. So, I really had to learn how to keep it together. I didn't want to be that jerk that Will hired that's a newbie that can't hang around the comedy people.
I had to say different, random things in my head, like, "This isn't funny, Génesis, why don't you just come on?" "He's not funny." "This is not funny, come on." I would think about my grandmother and what I was going to eat later and just random things to keep my mind occupied — as well as thinking about my acting. It's a very complicated thing to do!
3. Since this is for an online men's magazine, I am forced to ask you about "Entourage." What was the best thing and what was the worst thing about your stint there?
The best thing was just the people who do "Entourage." They're so very respectful. They're a very nice group of guys to hang out with on set.
The worst thing about it is that I was hired to be a driver and I didn't know how to drive. I had to drive the car and I didn't know how to do that. They said, "Hey, Gen, this is a $500,000 car. Are you okay with this?"
And I said, "No, see, I don't know how to drive." So, they had to get a stunt [person] for my little part in "Entourage," which I find to be very ridiculous.
4. And what's the best and the worst thing about being a telenovela superstar?
Telenovelas have a stigma to them but it's part of our culture. People don't know how hard it is to be in a telenovela. It's 18 hour workdays, Monday through Saturday, for eleven to [16] months straight. No breaks. We only had Sunday off. We really became vegetables by the end of it. It was extreme hard work.
The good thing about it was the audience that we got. We were on the air five days a week and we were in prime time. People were watching us when they were cooking, or putting the kids to bed, or eating dinner. You really became a part of their home. When people recognize me, they hug me, they kiss me, and they love you because you're part of their family.
The same thing. When I see someone from a telenovela that I love, I kind of melt. I kind of melt because I adore them. You don't even know the person but you feel like you love them. That's the beauty of a soap opera; it's a very special fan, a very special audience.
5. Speaking of your telenovela work, Will Ferrell has publicly marveled at your ability to cry on cue. What's the secret?
This is something you learn doing a soap opera. It's something that you automatically know that you just have to do. People get scared when they hear that, especially men. They're like, "Ohhh — this one; she knows how to cry on command. This is kind of scary." But you kind of can tell when I'm faking it.
You can tell because when I really cry, my face just completely distorts and morphs into another ugly, ugly face. My chin starts trembling and that's when it really hurts to cry. The tears thing — it's just technique. It's just like anything else, for me. Which is a gift, I know. I know, it's a gift. Do you want me to do it right now?
[We were initially startled, but of course we did!]
You don't have a camera, but you'll see.
[At this point, Ms. Rodríguez took a gulp of water. An intense, but not particularly disturbed, look crossed her face as she began the tearing up process. Her voice got noticeably more quiet, but she continued talking.]
It's coming…You get glassy. You just start getting watery. I'm not thinking about absolutely anything. It's coming. You see it? You can't see it yet? It's going to happen.
[And sure enough, the waterworks flow. Very impressive.]
It's nothing. I could talk about cupcakes and dogs. I can talk about happy things and rainbows.
Posted in: Entertainment, Interviews, Movies
Tags: Casa de mi Padre, Ed Harris, El Puma, Entourage, Gael García Bernal, Génesis Rodríguez, Hours, José Luis Rodríguez, La Pumita, Man on a Ledge, Paul Walker, Telenovelas, Turtle, Will Ferrell


text:
Q: Any workaround to allow using hyperref package with the combine package? I need to use the combine package so that each included LaTeX document shows up with its its own toc in the main document, with its own heading. (similar to how papers appear in journal books, each as a separate document within one large document)
The problem is that it seems not to work with  hyperref, and I have to use  hyperref. I googled around, and can't find any help on this. This seems to be a known issue. Hence the reason to ask, may be someone knows something.
Any one knows of a work around? It does not matter if I add \usepackage{hyperref} in the main document, or in the included document. Nothing seems to work for me. I also tried using standalone in the main document. But another problem showed up. So not sure what to do now. The included file does build OK on its own ofcourse but not when combined.
Here is a MWE: main.tex
\documentclass[report]{combine}
%\usepackage{hyperref}
\title{my book}
\author{me}

\begin{document}
\pagestyle{combine}
\maketitle
\tableofcontents

\section{papers}

\begin{papers}
   \import{art1}
\end{papers}

\end{document}

here is art1.tex (in same folder)
\documentclass{article}
\usepackage{hyperref}

\title{my paper 1}
\author{me inside article 1}

\begin{document}
\maketitle
\tableofcontents

\href{someURL}{home}    %problem is here

\end{document}

and now
pdflatex main.tex
This is pdfTeX, Version 3.1415926-2.5-1.40.14 (TeX Live 2013)
 restricted \write18 enabled.
entering extended mode
(./main.tex
LaTeX2e <2011/06/27>
...................
No file art1.aux.
(./art1.toc)
! Undefined control sequence.
l.11 \href
          {someURL}{home}    %problem is here
?

Update:
I tried the trick shown here. But did not work:
\documentclass[report]{combine}
%\usepackage{hyperref}
\title{my book}
\author{me}

\begin{document}
\pagestyle{combine}
\maketitle
\tableofcontents

\section{papers}

\makeatletter    %see link above. Is this supposed to fix this? it did not for me
\let\@begindocumenthook\relax
\makeatother

\begin{papers}
   \import{art1}
\end{papers}

\end{document}

redpajama_set_name: RedPajamaStackExchange


text:
Q: optional variable argument to a constructor I tried to create a set constructor which can accept an optional variable argument
def __init__(self,*initElements = None)

But it gave me the error "SyntaxError: invalid syntax" at this line. I thought this constructor will take some argument or set it to be None if no  argument is given. How can I deal with this problem? Could anyone give me a helping hand?
Thanks^^


text:
SPACE AVAILABLE AT ARTS AND CRAFTS SHOW
Susan FlanaganTHE ORLANDO SENTINEL
The Harvest of Crafts, an arts and crafts show sponsored by Port Orange, will be Oct. 11 and 12 around the lake at city hall, 1000 City Center Circle. There are still a few spaces available for craftsmen wishing to show and sell their handmade items. Register at the recreation department. There is a $25 fee.
-- Barefoot Park Homeowners Association will have a covered dish dinner and meeting at 6 p.m. Wednesday at the civic center, 3738 Halifax Drive. Members should provide food to serve the number in their group. Bread and beverages will be provided.
Treasurer Marie Burg will accept membership dues and issue a new card for 1986-87. During the business meeting there will be nominations for new officers and an election.
President John Grozinger has reminded members that dogs and cats must be on a leash when off their property; bicycle riding is not permitted on sidewalks; lawns must be kept mowed; and the 20 mph speed limit is enforced in the park. -- The Independent Order of Foresters Court 1601 will meet at 8 p.m. Thursday at the Golden Corral Restaurant, 2055 Ridgewood Ave., South Daytona. Any member wishing to attend the 7 p.m. dutch treat dinner is welcome.
During a seminar recently held in Fort Lauderdale, public relations officer Marge Duffy received an award of distinction for her work in the local
court. She and her husband, Harry, chief ranger of court 1601, are informing members of the new fraternal benefits, a new type of membership called social fraternal and fund-raisers discussed at the seminar.
-- Port Orange United Methodist Church Women recently met. Love Circle hosted the meeting and Charity Circle presented the program.
The circles that met during September were: Charity Circle at the home of Andi Pereksta, 194 Gibson Way, Port Orange; Faith Circle at the home of Marion Duhrels, 164 Yorktowne Drive, Port Orange; Harmony Circle in the church lounge with hostesses Mary Alice Riley and Ann Bowermaster; Hope Circle at the home of Callie Jones, 1082 York Way, Kingswood, Port Orange; Love Circle at the home of Liz Wilbanks, 719 Palm Circle Drive, Port Orange; and Sunshine Circle at the home of Sarah Dearduff, 1228 Jeffrey Drive, Willow Run.
-- Our Lady of Hope Catholic Church, 4675 Clyde Morris Blvd., offers a meeting for seniors every third Wednesday of the month at the church after the 11:30 a.m. Mass. A catechist training class is available and offers the opportunity to train as a religious educator. More information is available by calling (904) 788-6144.
Parish teen-agers are offered a program for recreational activities; adults are needed to help. Call Cathy Mojock at (904) 768-0058.


Earning her Bachelor of Interior Design Degree in less than 4 years, Sara Kuchta has always enjoyed the fast track schedule of the construction business.
Joining BJC in 2014 she brought her 6 years of experience (and many hats) from a Design/Build firm and works as both a Project Manager & Project Engineer.
Sara appreciates designers vision and strides to make them the owners reality in every project.
Having two children, Benjamin and EmmaRay, Sara and her Husband Robert enjoy spending together in there Harrison Township home.
She loves to paint murals and has illustrated a published children's book for her Aunt.


the end of pure nucs in the U.S.
Currently, the Center for Medicare and Medicaid spend an average of $80,000 per resident per year to train Nuclear Medicine Physicians in residency programs around the country. The trouble is... nobody wants them.
Nuclear medicine residents (currently trained with three years of nuclear medicine instruction and experience to become Nuclear Medicine Physicians, or NMPs) have dismal job prospects. On AuntMinnie.com, a popular radiology community website that gets its name from the types of patterns in imaging that radiologists should recognize as easily as they would their "Aunt Minnie," there are zero (yes, that's a goose-egg ZERO) jobs posted for nuclear medicine physicians. Some might say it's because NMPs don't use AuntMinnie.com. However, if you view job postings at the Society of Nuclear Medicine website (snm.org), you will see the true demand for NMPs: again, ZERO. On the date of the submission of this letter, there is not one job posted looking for an NMP. There are several postings, however, for wide-open training positions (resident or fellow in nuclear medicine or PET/CT). Granted, there are significantly fewer graduates of NMP training programs (total NMP residents numbering 193 according to http://www.acgme.org/adspublic, divided by [the former duration of] 2 years of training, producing about 97 new NMPs per year). But ZERO jobs is a very small number for these 97 newly trained NMPs hoping for a career. That means AuntMinnie.com job postings cover ZERO percent of the supply of new NMPs. All NMPs must find their jobs by word of mouth recruiting or other posting sources unknown to me. One might speculate, accurately in my estimation, that most recruiters are looking for nuclear radiologists (radiologists with a fellowship in NM) to read their nuclear medicine, but then settle for an NMP due to supply issues (often negotiated at a significantly lower salary and even exclusion from the partnership career track).
On the other hand, there is enormous demand for radiologists in the United States. On just AuntMinnie.com alone, there are 704 jobs posted looking for radiologists, covering 35% of yearly supply of new radiologists. The American College of Radiology website (ACR.org) posts 74 jobs. There are many other sites advertising more positions. I get spam from recruiting and staffing agencies that advertise hundreds of jobs for radiologists. As is the case in most career fields, the majority of jobs available are actually never posted but are filled by word-of-mouth recruiting (i.e., internally or with people already familiar to the group). Around 1,100 radiologists complete their training every year to cover this demand (4,670 total residents according to http://www.acgme.org/adspublic, divided by 4 years of training). For radiologists, the field is wide open, the demand intense, which is why radiologists are well paid (low supply, high demand). During their training, radiologists receive instruction and experience in all fields of imaging, including nuclear medicine (only 4 months, but that is considered by most credentialling institutions to be enough to read and bill for any nuclear medicine imaging and therapies). Board-eligible radiologists interested in more training in nuclear medicine can do a one year "fellowship" (actually, they jump in at year #3 of nuclear medicine residency) and qualify for board certification by the American Board of Nuclear Medicine, the same certification that we get after 3 years of training (under new rules as of 2006). The biggest difference is that... they get the jobs. We don't.
In another comparison, radiation oncology residencies (four-year training in the delivery of external and sealed internal radiation to treat cancer) have a total of 600 residents (according to http://www.acgme.org/adspublic), meaning that about 150 new physicians are produced every year. AuntMinnie.com posts 54 jobs for radiation oncologists (matching to 36% of the supply). By comparison, nuclear medicine should have between 35 and 38 jobs posted on AuntMinnie.com to be considered of equal demand compared with radiologists and radiation oncologists. Even 10-15 posted jobs would be somewhat respectable and make an enormous difference. But ZERO?
It should be clear to any layperson at this point that U.S. tax dollars should not be going toward training more NMPs. They are not "needed" in a true market sense. They are not trained to perform the needed broad-based cross-coverage and multimodality imaging interpretation (MRI, ultrasound, mammography, muskuloskeletal) and interventional procedures that radiologists can provide. Radiologists in comparison are in sharp demand. The government (more specifically, the Centers for Medicare and Medicaid, which funds residency training) should be putting tax money toward more radiology training positions; if that happens, this nation will have all the nuclear medicine services it needs. Radiologists will be able to cover the need, partly also because nuclear medicine will become a more respected field rather than being the "red-headed stepchild" in the room. As it is right now, many in the radiologist-dominated U.S. medical imaging profession view non-radiologist (and even radiology-trained) nuclear medicine physicians as a lesser breed.
I should know. I am a resident in my third year (PGY-4 if you include internship) of nuclear medicine training at one of the top hospitals in the country (according to U.S. News & World Report). The published job prospects for me are slim (none, really). I am still confident I'll find something decent through networking and word of mouth, plus my own hard work, but each day that passes brings me closer to finishing...jobless.
One might ask why training programs want to keep pumping out NMPs. In reality, they don't. What academic nuclear medicine division faculty members want is a continuing and growing supply of residents, because these trainees perform a considerable amount of clinical and research work, freeing the faculty to concentrate on research and expansion. A few years ago, it was decided that the programs should last 3 years, not just two. My class is the first 3-year class at my institution. The people that started a year ahead of me finished in only two years. Why I took the position is a long and complicated story, and unique to me. However, the bleak job prospects and absurdly low demand that I am now seeing is common to all nuclear medicine residents in training. Even with ZERO NMP program graduates last year due to the move from 2 years to 3, nobody complained about insufficient supply of NMPs. We have been sold on a training route that pumps us out into a market in which nobody is looking for us (because they are ALL looking for radiologists).
Taxpayer dollars in the form of Medicare funding and reimbursements at teaching hospitals should be excluded from funding any more new residents pursuing 3-year nuclear medicine training pathways. Residents currently in NMP training should be funded through the completion of their training. Funding for 2-year fellowship-level training in nuclear medicine imaging and therapies should continue for the small number of internal medicine-trained physicians that want to incorporate nuclear therapies into their internal medicine practices, and 1-year fellowship training should be made available for radiologists who want specialty training in nuclear medicine and PET/CT. Any further available funding for primary residency training in imaging should be routed toward radiology training. This will dry up much of the supply of residents to do the clinical work for academic/research NMPs, but that demand will be filled by an increased number of radiologists choosing to do fellowships in nuclear medicine and PET/CT as the demand (and respect) for imagers in nuclear medicine and PET picks up. More importantly, no longer will there be a divide between radiologists and NMPs; they will be coming from the same fold -- they will all be radiologists. The only pure NMPs out there would be internists who practice therapeutic as well as possibly some traditional diagnostic nuclear medicine (likely in addition to other primary care or specialty clinic duties).
Wow... and I thought pathologists had it bad. Thanks for that detailed post and good luck in your job hunt, I'm sure you'll find something suitable!
Unfortunately I think that you are right in some aspects, but you forgot to mention that part of the problem is that the SNM is not supporting the residents or coming up with a solution, meaning that they are not backing up the specialty.
I am a second year NM resident and this is a daily discussion within my program, residents, fellows, attendings, etc... we all agree. There are two solutions; as you mentioned, one is to stop training residents and let radiology to take over. I don't know why NM has to become a radiology fellowship, currently the are not required to have a NM fellowship in order to read nuclear medicine, no?, they have a few months of NM rotation during the residency and everyone thinks that they are ready to read, probably this is one of the reasons of the ZERO jobs for NM. We all know that the problem is not because of academics job positions; the real problem is private practice, they don't look for NM physicians because we can only read NM, so they prefer to get a radiologist who can read NM and Radiology, this will save them money, etc.
Is a radiologist without NM fellowship capable of reading NM? Yes; is the quality of their reading as good ours? I don't think so. Are we capable of reading CT? Yes; is the quality of your reading as good as theirs? No. But the difference is that they can take care of our business with only a rotation during the residency.
The second solution and most remotely, is that the regulatory entities, such as SNM, ABNM, RSNA, etc... come with new rules, restrictions and regulations to stop radiologist without NM fellowship to read nuclear medicine. But we know that this is unreal.
Bottom line, we need a stronger and more supportive SNM who can come up with a quick and wise solution; unfortunately this is also unreal!
SNM and ABNM does not have control over credentialing at each hospital and insurance group, and credentialing is where the problem is. If hospitals and insurance groups refused to reimburse for NM reads by people not certified by ABNM, things would change. But ABR is going to continue certifying radiologists to read NM with only a minimum of NM training, and the hospitals and insurance companies will continue to recognize such minimal training as adequate.
The only solution is to stop the wasted tax dollars on training doctors who can't get jobs. CMS should stop supporting new 3-year tracks. Make ABNM certification strictly a fellowship-level subspecialization.
Call HHS and let them know that CMS is wasting their money.
I agree, but who is our representation as a society? Who has to try to change the current situation? Can you speak to the ABR? Can you speak with the insurances?. The SNM and ABNM should act like our lawyers and try defend their ''clients''. I don't think that closing the residencies is feasible and I don't think it can happen in the near future. Do you have another solution? Unfortunately for me, the only solution is to finish NM residency and start a second specialty, anything except radiology!!
The ABNM is effectively infiltrated by ABR-certified radiologists. There is no incentive to compete with ABR. The ABNM is not going to try to keep an exclusive hold on nuclear medicine training certification, and is not in a position to start offering its own certification in CT, MRI, ultrasound, mammogram, or IR.
I do not advocate shutting down NM training programs. Rather, I advocate the combination of all nuclear medicine training with radiology training (except in cases of the 2-year post-clinical-specialty track, which I think is fine to leave as it is). The challenge is to produce a combined nuc-med/radiology track that provides the needed number of residents in both programs but also respecting ACGME accreditation resident quotas (maximum approved residency positions) in both the Radiology program and the Nuclear Medicine program. At my institution, there are plenty of nucs residents, often spilling over into elective and research rotations, whereas the radiology residents are clamoring for help on call rotations.
PGY-5 "Nuc Med resident" for ACGME quota purposes, but organized around a radiology 3rd year structure and counting also toward Radiology R3 (including call).
PGY-6 Nuclear Medicine and PET/CT (counted toward the Nuc Med ACGME resident quota).
This fits perfectly into the new radiology 3+1 training paradigm (3 years general and 1 year of specialty "mini-fellowship" training), which is set up to motivate for an additional year of fellowship for all residents (basically, more like a 3+1mini+1fellow). Only, in this case, the "fellowship" year would be tacked onto the front side.
1. The "first year radiology resident" coming from his/her nucs year would already be savvy at dictating and reporting, and have a nice grasp of nuclear medicine and the general medical imaging profession, and would be an asset to the educational environment for other radiology 1st years.
2. All nuclear medicine residents in this type of track would be far more competitive (higher testing, better IQs, better work ethic/professionalism/bedside manner, "best and brightest"), because they would have to pass muster for the radiology residency program.
3. With only 2 years counted against its quota, the radiology program gets to produce a radiologist that would otherwise require 4 years of training against its quota. It's like a free resident to them.
The benefit to the nuclear medicine program should be obvious: better residents, better reputation.
This won't help you or me get a job this year. However, it will end the injustice of program directors promising a job with nice income (even if a big step down from radiology) and a nice lifestyle (in many respects BETTER than radiologists'), when those jobs are really being preferentially marketed to dual-boarded nuclear radiologists (ABR/ABNM), which are apparently plentiful enough to marginalize me out of a job so far.
Keep going. I heard our current and next SNM leaders are both great advocator. I hope they can achieve sth during their terms.
Right now, you can do radiology, then nuclear medicine fellowship and if you are not happy with the exposure to NUCS, you can spend a year after your fellowship in a PET/CT fellowship. I think that is the same as your proposal to combine residencies.
I am sorry, but what pisses me off, is that they extended NM residency to 3 years, because 2 years were not enough, but they didn't change the 4 month rotation for radiology residents. What if we rotate through radiology for 4 months, are we able to read radiologic studies? NOOOOOOOOOO!!! because it's a different imaging modality. (sarcastic LOL)!!
This is the only specialty screwed by other specialties, and it's because we don't have good representation, because as you said, our Society is inflitrated by radiologist.
Things are not going to change, if we don't make something. Who is in charge of medical credentialing? Who regulates who can read NM studies? What do you think of creating a document or letter, get the signatures from all the residents, fellows, etc and sending that to the AMA or someone who can do something? There is nothing to lose.
There is no rationale for NM residency to continue as it is. Most of the graduates pursue second residency. Actually I know only one graduate practicing nuc med, I know roughly 15 residents collectively from 3 intuitions, since 2004. Unless the the practice separated as in Europe, Canada or the rest of the world, nuc med residency is waste of resources.
Nuclear medicine regulatory bodies, SNM or ABNM, do not care about residents' future. Should they care? I hope so. Have I seen any evidence of imminent change? Definitely no.
In the end, if you are looking for your residency options, you should eliminate NM. If you are currently a NM resident, start searching for new residency. Don't be fooled by imaginary future development.
I believe all of us are willing to join this battle. This is for the benefit of us and the community. Please start it. Would everybody who reads this post requests people who are sufferring to follow the steps. Please start and continue.
We would like to do something, the problem is that we don't know where to start, but we know that we don't have to start taking to the SNM or ABNM, and we all know why!!. Who do we need to write to? Senate? AMA? Medicare? Who regulates medical specialties? Can we make a nuclear medicine residents and fellows association and fight for our rights?.
I know that there is a PD meeting in the SNM, but there most important topic, is not the job market, they look to make the residency harder, increasing requirements, etc... .
We wish to send an email to all the residents and fellows, in order to get signatures from all of them and include them in a document. But we need to know who is the indicated person to write to, so he/she can do something about our situation.
If you or someone who reads this post have an idea, please share it!!
This situation has been the case for quite awhile now. It certainly isn't a recent development. It has difficult to get jobs in private practice just doing nucs for at least the last 15 years. It pays to do your research before you apply for residency. Simple solution: apply for a radiology residency. Your nuc experience will count. We had several former nucs residents in our program.
Can we set up a group and ask all the people involved to join? We need a organization. We are smart. Someone may come up with novel ideas. In my opinion, the current hurdle is that we can not take radiology call. If we can address that, even wo radiology board, there will be enough job opening for us.
Thanks for your reply! I know that this problem is not new and I think part of the problem is because people doesn't want to get involve in politics with radiology, and I am taking about current SNM, attending, PD's, etc..., they don't want to be ''tagged'' and placed in the "black list" and then struggle to switch between jobs, this is my point of view. Right now, for the residents, there is nothing to lose and if this problem has been in the NM field for a long time, doesn't mean it cannot be changed.
With all my respect to you, I cannot understand why everybody is trying to make NM residents to continue with radiology. They are completely different specialties and that's why probably RADS residents get into rads and not into NM residency and vice versa.
It doesn't make sense that a NM resident has to be 3 years in a residency in order to read NM studies and a radiologist with only 4 months of NM can take over our job. If you take a NM resident during his 4 month of residency, he will probably know more than a radiology resident at the end of the rotation, because he is interested in the specialty and besides that radiology residents take vacation, personal days, come late to work, get out early for conferences, etc... meaning that those 4 months equals to 3 months and there is only 1 reason, because they are not interested in the specialty, right?
"The American Board of Radiology had offered certification in diagnostic radiology with special competence in nuclear medicine between 1957 and 1966, at which point the board no longer offered the certification (ABR)." Why? "American Board of Radiology had little affinity for the NM specialty since it was not viewed as an imaging specialty." In 1970 with the improvement of pharmaceuticals and technology, and promising future ($$$$), the ABR re-started the certification.
This is not so complicated, and I believe that the solution is simple but complicated at the same time.
- NM specialist, with full NM training or Radiologist with NM fellowship and ABNM certification must be the only specialists who can read pure NM studies.
- Make NM an elective rotation for radiology residents, who are really interested in the field and are planning to do a NM fellowship. By the way, this will make radiology residents VERY HAPPY X 3, no nuclear medicine rotation; they can use that time to rotate through their area of interest or to study for the boards and NO MORE NM in the radiology boards!
My point is that hybrid imaging can be read by radiologist and NM; however I have to say that PET/CT currently uses CT for anatomical correlation and not for diagnostic purposes, but I think that can be read by both specialties, if the training in CT for NM and PET for rads is adequate.
If this is applied, there will be a lot of job opportunities for NM physicians, with no "collateral damage" in radiology jobs opportunities or salaries. This will benefit both parts.
However without the SNM and ACR collaboration, this will be impossible to achieve.
I don't think that we are prepared to take radiology call, like radiologist are not prepared to read NM studies.
Radiology residents spend 4 years in residency, do you really think that we can take call and make a decent job, with only a few months of radiology rotation?.
I believe we are still physicians, even if we don't spend much time with the patients, meaning that we are here to help them, and if we are not prepare in a specific field, we shouldn't get involved. I don't want to miss something in a radiologic study and cause harm to the patient, because I was not prepared to read the study. In my personal opinion, this is what disqualified radiologist are doing, reading NM studies.
Read my previous post and let me know what you think about my proposal!.
Keep writing and please tell the residents in your program to get involved. I am very confident that if we fight together, we will achieve something.
I hear it is a little better if you want to do academics...you can balance your time with research, etc if you like that sort of thing, which is a reason I ended up liking nucs. I will not be double boarded when I graduate in 2 more years, but I was a resident in another field for 3 years and decided to switch.
This thread is what residents in our program have been discussing the last few months. We need to organize together. I suggest we start a group via e-mail and try to get as many residents from the different programs together. We need to formally write letters to the SNM, ABNM and even the ACGME, signed by as many residents/programs possible. We should consider getting together during the SNM meeting, maybe during the Board Review? Should we designate one of us on this board to organize an e-mail list from people who PM their information? We need to come up with a solid plan together and explain what our goals/objectives are, and how we can best achieve them.
Partusa @ Shaolin Avatar, (what's up J?) nice to see you joining the cause!! Tell the residents in your program to join us.
Partusa @ ResConfused, I agree with you, but in my personal opinion I don't think the SNM or the ABNM are willing to help us, why is NM like this? but maybe I am wrong.
so we can come up with a definite solution. We don't have anything to lose here!.
Unfortunately, we are doctors, not polititians, so problably all of the NM residents and fellows are taking about this topic, but no one is speaking up.
Do you think that creating a group in facebook can help?. It's easy and anyone can join it.
It's a good idea to get together after the board review in order to discussed about this topic.
simply start a facebook group as the first step. Totally agree. Be organized! I will call my colleagues to join.
Shaolin, you should change your name to KUNG-FU PANDA! Did you talk to your peers? What are they saying? Are you assisting to the SNM meeting?
This situation is ridiculous. Cathance is right. Check out the job postings! See for yourself!
I'm taking this a step further and writing my senators and congresspeople. Heck if I'm going to put my name on it though. Nucs is a small world. You could get blackballed by the academic community.
Just make sure what you write will help nucs, not hurt it. There are a lot of residents still in training who are expecting to finish. We just need to stop the influx of residents who think they can actually get a job coming out of nucs. "Do nucs if you want, but realize you have to do something else, too," should be our message. And don't bite the hand that feeds you.
The solution is not to stop people to get into NUCS residency. That's not going to happen. Lot of IMG's are getting into nucs, because in my personal opinion, right now it's the easiest specialty to get into and lot of people interested in NUCS as a specialty. In other parts of the world, the specialty is very respected!!
I know that you will have to get into a second residency after nucs.
What I think it will hurt nucs, is to stop the influx of residents, to integrate nuclear medicine to radiology, etc... of course that's the easiest way to solve this problem.
What are you trying to say with don't bite the had that feeds you? Don't go against radiology? Don't go against the SNM?
As FDGme said in his post, we are afraid of getting blackballed by our colleagues in the academic world. It should be the opposite, no? We are trying to help the community of NM physicians, we are fighting for our rights, we want to keep this specialty alive.
FDGme, do you think writing to the congress or senate can help?
I proposed a solution in one of my previous posts, what do you think about it? I think that's the only reasonable solution. Probably dreaming; No?.
I would like to know what's the reason, besides the economic factor, for the RSNA to certify radiology residents in NM. Do they really believe that a 4 month NM rotation is critical in the training of a radiologist?
Do you believe the ACGME can help us?
Probably a lot of NM residents are waiting to be transfered to radiology if they decide to close the NM residencies, and that's not going to happen!!
PLEASE KEEP FORWARDING THIS FORUM TO ALL THE RESIDENTS AND FELLOWS!!!
Folks, this is very good discussion. I am a PGY3 Nuc Med resident at a top Nuc Med residency program. I am also a member of NMRO (Nuclear Medicine Resident Organization)I really want to say something about the depressing reality.
I think the problems lies within Nuc Med itself, and we are destroying ourselves. In reality, Nuc Med residents are just working slaves for 3 years, "freeing attendings for their research and..." If you are willing to believe this is true, do we get what we deserved at the end of training?
At the end of trainig, you would often hear "Sorry, you may have to do something else to get job"----God DM it! It's THREE years!!!
The new 3-year residency is a BS, I think they should have just kept 2-yr NM residency and push ACGME credit PET CT fellowship, or try to combine NM and Rad as a 1+4+1 program at the first place.
Nuc Med is, maybe the only one, specialty having "Life members" certified by ABNM. These 3000 life members do not need to take board to be recertified even though they were trained in 1960-1970s. They are WORKING, and get 350k salary, not strongly speak for NM residents though some of them need in death to have residents predictate the scans. I hate to say they are out of date, but they do need take more current education and recertified, as other younger NM physicians do have to recertified from ABNM every 10 years. Plus, it's important for better patient care!!When my senior friend wrote to ABNM to inquire about this, ABNM's answer is these life members will need to take board exam STARTING form 2017!! Can you image that?? Why? ABNM said they need preparation! My God! we are able to answer all the board questions even during our PGY4 year, and they need 7 years to prepare, and at that time they will be in later 70s or early 80s!
I have to say, lots of these members are really good, however, they are not strong enough to speak for us, not agressive enough even though they are representing ABNM, SNM or ACNM.
Just imaging, if all the 3000 life members were forced to take ABNM board exam in order to actively practice in hospital, maybe half of them will chose to retire now, at their late 60s or early 70s, which is reasonable. Then there will be lots of job vacancy for new graduates.
No doubt we should downsizing NM residencies. We have to urge ACGME/ABNM made the solid criteria for NM residency, such as how much CT, PET/CT, MRI, Cardiac, General NM, General Rad and dedicated research training time, how many cases we should have, etc. If we have these solid numbers, we will be in better position neotiating with future employer, and we will be more confident reading CT and PET/CT.
If the program can't meet those criteria, they should close and stop wasting tax payer's money and, our resident's time.
The NMRO is affiliated to ACNM, we are targeted to recurite all the NM residents. We need such an oragnization to speak for our residents. With such an organization, we can write on behalf of all NM residents, to the Senator, to Medicare, to ACGME, to ABNM, even to the President.
Bottomline is, we need action to change the depressing situation.
for your post!! You are right, however don't forget that besides the old NM physicians, the real problem is that radiology is taking our jobs away with only 4 months of training, they are less prepare that those old NM physicians.
The job market is directed towards radiologist with NM training, they don't even consider you, me or a pure NM trained physician. Even with good training in CT and MRI, you cannot compete with radiologists.
Unfortunately the imaging field, NM & RADS, is not "physical demanding" meaning that we don't have to be rouding in the floors, or standing during surgery for 3 hours, so you can be 100 years old and still reading studies or signing studies read by your residents!! but we cannot change this, unless they force old physicians to retire at 65.
Please keep posting and forward this forum to the people you know!!
I am a member of NMRO, but I see no action from them!!
Is this problem the same for you, even if you are graduating from a TOP program?
Are the the attendings in your program helping you in order to get you a job?
How many recent graduates from your program are working in NM?
Do you think that graduating from a TOP program makes a difference?
I just want to confirm that this is not a problem for some graduates! In my program. A recent PET/CT fellow who spent 2 years in fellowship just got a part time job as NM, the current fellow is getting into his second year of fellowship without any interviews.
We are not having any residency graduates till 2011, so I cannot comment on residents with no fellowship.
I should say, from what I was told and have seen, lots of "life members" are really not qualified, I would say they are really not as good as Rad resident w 4 month NM training. I personally witnessed a life member (now retired b/o hospital bankrupcy) flip-flop reading a scan within 5min, right before the Chair of Rad, and his face turned red, saying :"listen clear, I changed,... or no, I changed again....", Another life member was not awared of the time between FDG injection and PET scanning can have effect on SUV, thus attention should be paied when doing direct comparison, let alone draw a conclusion out of it.
I was embarrassed, shame for NM! lots of old life mebers came into NM major b/o its easiness and good life style, and some research at that time. They, themselves are "unclear" about this "Unclear Medicine" at their time. Thus they are not confident enough to fight for NM, for new generation NM physicians.
So, we are not forcing them to retire, we are forcing them to be at least good as us, for God's sake, they are NM leaders!!! If people don't see excellence from them, what they are expecting NM residents??
So, my opinion is, life members, if you at least can pass the new ABNM exam, okay, you can keep working. Otherwise, pls, retire, enjoy your personal life and let us, the new generation NM physician to make change. And,don't let the NM specialty die at the time you have to retire.
Folks, let's push NMRO to speak for us, with the power of vote.---- We need a "union".
I agree we need a union, an entity managed by NM residents, no attending, no nuclear radiologists, only people who care about the future of the field, who is eager to work and progress in the field!
I was thinking of starting a facebook page and send an email to the NM programs asking to forward that email to their residents, so they can sign in. What do you think?
Absolutely agree. If NMRO can not do the job, let register a formal independant NMRO.
BTW, to answer your earlier questions. Our fellows do have lots of trouble to find a job at the time of graduation. Unfortunately, I don't see lots of, or some, help from attending. You are kind of on your own. Maybe you can get some recommendation letters from them, nothing else.
And, more depressingly, I see, not a few, attending relying on residents doing all the clinic job. Research? Some would like the resident do all the job, he or she get the corresponding author at the end. ----- I have to say some are very good, and I like their teaching and dedication. But, some get annoyed even when tech go to them for signing doses, because they think that's resident's job.
I see lots of radiology do their own dictations, however, not uncommonly, NM attendings want residents to do all the dictations, then they modify it.
First, we should target at ACGME to change NM (this we can do through a letter with the signatures from all current NM residents), then ABNM (may needs politician to intervene, and now would be a good timing, b/o healthcare reform), we can use the same letter to Senator, President Obama, ABNM, ACGME, ACR, SNM, ACNM, and news media.
That's the way the residency is. Residents take care of the studies, research, presentations, journal clubs, etc and this is the only reason why NM residencies are still open.
The Hospital/Department gets around 90k for each resident, you get paid around 40-50, the rest of the money is used to cover ''administrative costs'', so bottom line, the department is getting money from the government only by having a few residents.
By the way the PI always is the last Author, and you need their name and backup to get an abstract accepted in a meeting or journal, it's a kind of parasitic relationship.
I think that a good way to show to the SNM that we are not kidding, and we want to do something about this crisis is to stop submitting abstract, papers and assisting to their annual SNM meeting, by the way, the crisis that NM is suffering is not reflected in those meetings at all!!
We are spending $1000 to go to the SNM meeting, what for? all your time and effort doing research is worthless, at the end not even your own colleagues care about your future.
The residents and fellows in my program are ready to sign any letter that can lead to a change in NM.
I understand life is not fair, especially NM residency. However, the fairness we are asking for is the decent training, since now we are doing 3 years. Do you guys notice the difference between 3 yr and 2 yr residency?
Do we have solid criteria such as how many CT scans, PET-CT scans, cardiac stress test, EKG training, I-131 therapy/scan, Bexxa/Zevalin treatment, and research time?
I bet you not. No single residency has! Not even ACGME! Do you know why there is NONE criteria for such things? Because lots of program don't have enough volumn!
So, the 3 year residency benefit the unqualified program most, let them survive longer. If these unqualified program close, and existing program meet all the criteria, then even though there will be fewer NM residents, all NM graduates will be more competitive at the end of training, and these new generation NM physicians will change the aspect of NM.
Resident will have to do all the jobs, however, we also have our career goals, we need decent and deserved training, not just cover the service, right?
We need the solid criteria for our training, this is the bottom line.
Once we have these, we are at much better position to negotiate with PD/Dept./Hospital, and our future employers.
I cannot comment on the difference between the 2 and a 3 year program, but if radiologist can get certified in NM after 4 month rotation, increasing the residency to 3 years was a joke.
I don't think that having less residents and fewer programs would change the actual crisis. As we mentioned before, I strongly believe that the problem is not our training at all. The problem is that radiology is taking over our specialty with no adequate training and probably causing harm to patients, but $$$$ is first and patient is second.
Have you ever heard of a patient suing a radiologist because they misread a NM study? I never heard of any, but if they start getting sued for NM studies, they will start refusing to read NM and people with REAL TRAINING will get the jobs.
A similar thing happened with breast imaging, why do you think that no one want to get involved in breast imaging?
"Philadelphia Jury Awarded $12 M for Delayed Diagnosis of Breast Cancer... 2 doctors at 2 different hospitals missed suspicious findings on mammograms that required follow-up evaluation" I can paste more cases like this.
If the insurance companied cut down on reimbursement arguing that radiologist are not qualified to read NM, they will stop reading.
Someone posted before that medicare is wasting money in our training as NMPs, but no one is saying that medicare is wasting their money paying reading fees to people without the adequate training.
Bottom line, there is a lot of things that are wrong. Can we change any?
I still think we can start to make change from the traininig criteria.
As you said, "people without adequate training", so, how " adequate " do you think is "adequate"?
Such things are our NM training criteria, we definitely need this, and anyone who wants to be certified by ABNM need to meet this minimal (resident level) criteria.
Thus, NM would become a series specialty rather than a joke.
And, I strongly believe this is something we can do, and should do. With the signature from all NM residents, and maybe we can even get some attendings support, we can write to ACGME , medicare and ABNM, no one would dare to ignore this.
Only when we are qualified and confident in our own ability/specialty, we can push this specialty advance and revive it.
Less residents and less programs are good thing, we need quality, not quantity.
I agree that the minimun requirements in order be eligible to take the ABNM should be strict, and that's the main problem. As you know, the radiologist are not taking the ABNM after their residency, they just need to pass 10 oral NM cases during the ABR, no?
I think that after 3 years in a good NM residency you are more than qualified to read NM studies, confidence comes with experience, so I disagree with you in that point.
By the way, the main problem is that you cannot get any NM job after residency, because as we mentioned radiologist are getting those positions. So even if you want to increase the NM residency requirements, number of years in training, get the best medical school grads with highest scores and honors, etc... at the end you will end up having highly qualified jobless NM graduates, because of the previously described reason.
Looks like you are not very happy with your current training! Honestly I am happy with mine, I have a very good number of cases reported in general nucs, PET/CT, as well as in Body CT (we rotate through radiology for cross sectional anatomy) and research exposure.
I will try to write a draft during the weekend and I will post it here for your opinion.
How many signatures can you get from your program?. I can probably get 5 or 6.
We can send out the draft to all NM residents. At least to NMRO president, a PGY 3 NM resident, Dr. Erin Grady [email protected] urge her to distribute to all NMRO members, ask for other's opinion. If NMRO doesn't want to do it, we may need post here or auntminni.com to get more response.
I suggest regist a specific email address to handle this. Once we have our well-accepted draft, we fax/email to all resident, and ask them to fax back with their signatures on it. For that purpose, we may need a fax number. I think efax.com can do this. Or, if you have personal fax number, we can do that.
I am willing to share the cost for this.
Talking about training, overall I am satisfied about my current program though it is not perfect, pitches here and there.
However, I am worried NM specialty as a whole, not only for my own future career. I believe I have enough publications and am confident reading all scans.
But, I want NM residents to get more, such as to get enough CT training that makes us eligible and confortable to read body CT; know MRI so we can read PET-MRI when it comes to use otherwise it will be taken over by radiologist.
To set up training criteria, is better for patient care, better for training, better for NM specialty. Having these, we can negotiate with ABR, ask them to follow the criteria in order to let radiologist eligible for ABNM.
To your another point. Yes, 3 year residency make you feel confident to read NM scans. Actually, it is way too much for you to feel confident to read NM scans. And this is exactly my point, for a good program, 2 years training is enough for you to read current clinical NM scans. The 3rd year is unnecessary, or extra. How to use this extra year, is debatable. And that's why we need raise the bar, make us more capable doing other stuff, not just regular NM scans. We need to be able to read CT, do lab research just as Rad Onc resident who can do 9-12 month research in their residency, more general radiology training--- more training in the aspects people think is our NM weakness, to make NM became a "New Clear Medicine", rather than "Unclear Medicine"
I posted some questions for radiology residents. We all know the answers to those quetions, no?.
I will try work on the draft during the weekend. I did some research in this topic, so I have a couple of articles that I am going to use as reference. Please communicate with other residents and tell them to get involved in the forum.
I think any effort to push radiologists out of the NM world will be an exercise in futility. ABR-certified radiologists already make up a large portion of the ABNM diplomats. More importantly, the RSNA and the ACR are both far more powerful than the ABNM. Most radiologists in the U.S. consider NM to be a subspecialty of radiology. I agree that outside of the U.S., things are different. In Australia, the NMPs read most of the MRI. In most or all of Europe, the NMPs read ultrasound and do biopsies, etc. Also, NMPs in other countries tend to garner much more respect. Indeed, NM is a competitive specialty outside of the U.S.
I do believe the ABNM should require more of the radiologists who want ABNM certification. I think 2 years of NM should be required for ABNM certification, but with the new 3+1+1 paradigm of radiology residency, a radiology resident can do 3 months of nucs during the first 3 years, then a full year of nucs during year 4, then a year of fellowship, and thereby become eligible for ABNM certification. This is reasonable. Absolutely under no circumstances should the ABNM allow a radiology resident to take just 4 months of NM during the 3 general years, then a year during year 4, and be eligible to sit for the ABNM (after just 4 years of combined radiology/NM training). Only 16 months is not enough time.
I also think that the NRC should require much more from radiologists wanting authorized user status. For one thing, radiologists should be expected to get ABNM certification. prior to applying for AU status. That radiology residents only need 3 (or even if raised to 6) radioiodine therapies to qualify for authorized user status is RIDICULOUS. They need to be as verse as any NM resident in all regulations, dosimetry, and safety measures.
I do think that the ABNM (both straight NMPs and dual-boarded radiologists) should start challenging the privileging of non-ABNM radiologists to perform and read NM studies at all major medical institutions (Kaiser, universities, insurance companies). This would be a good place to start. Demand that the issue be addressed from the perspective of safety and professionalism. But this will only be possible with the help of our dual-boarded radiologist friends.
I still think the road to nuclear medicine needs to be a fellowship pathway (radiologists 1 year (plus 1 during their 4th year), all other clinical specialites 2 full years). Then, all graduates from NM programs will have plenty of jobs (either radiology based or medicine/oncology/cardiology based). No longer will NM be only a refuge for people who couldn't get into another residency for whatever reason. NM needs to get out of the business of just taking the leftovers from the NRMP radiology match, and the only way to make that happen is to make nuclear medicine a fellowship level of training (after some other primary specialty).
What will happen to the current NM residents, recent graduates and PET/CT fellows without jobs? Do you think that's going to get us jobs?
I can tell that your main point is to shut down the NM residencies, and I still don't know why?.
I don't believe that the main problem is NM as a separate specialty. I don't believe that you were proposing to close the NM residency and make it a subspecialty, if the job market for NM was good.
We all know that the problem is the lack of regulations and adequate requirements for non-NM physicians to read NM, the problem is as simple as that.
You can rotate through radiology for 4 months, but you will never be eligible to take the radiology boards, no? probably because they don't want other people to take their jobs away from them.
At the end, nothing is going to happen and we know that, but its worth trying.
I think turning NM into a fellowship subspecialty is a good idea.
No matter what's the background of residents coming into NM, they need meet the criteria to be ABNM BC/BE. We welcome more people come into NM, but we need qualified people only.
And, more important thing, we need push Medicare/Insurance/Hospital to allow only ABNM BC/BE physicians to read NM scans (You can be any other specialty such as ABR, Internal medicine, cardiology AND ABNM double BC/BE, but minimal requirement is ABNM BC/BE).
With all these be done, I believe NM will have a wonderful future.
Another important thing is we need a DIFFERENT criteria for 3-yr residency. We CANNOT stay on the same old 2-yr residency criteria.
We should make ACGME set up a case log for NM residents/fellows, as surgery do. This way, we can follow up our training seriously.
Also, I think 3-6 month lab research, with 3 month as minimal, is necessary. And it's better to put this dedicated research time at PGY3/4 year as a rotation block, don't just slice them into pieces among 3 yr training time.
in my ipinion, these kind of problem is quite complicated. In addition, different person has different understanding. This is not one person's war. We'd better start the organization first( like facebook, etc). AFter we have most of the victims involved, we can send a survey to summarize all the possible problems and solutions and followed by a vote. Step by step in a systematic way. We have a big pool of intellegence to use. We should not waste it.
Please forward the page to the people you know!
Here is the link for the group. I also created a facebook page with the same name.
I agree with you guys. We should do it.
Just want to point out, given current situation, turning NM to a pure radiology fellowship is a good idea,or we can push them generate a 1+1+4 or 1+2+3 NM-Radiology program, just like DIRECT pathway for Interventional Radiology.
And, just let you know, the Departmental Chair in my program (a radiologist, and has utmost dominancy over our faculty), already set up the rule, the future NM vacancy is for Radiologist with NM fellowship training, not for NM physician. And, sadly, our faculty is not brave or selfconfident(scientfically and clinically ) enough to fight against it. So, situation in my institution is NM resident as cheap labor for 3 years, covering all the service, dictate all the scans, then get on ourselves at the time of graduation.
So, what do you think they want the 3-yr residency for?
In my personal opinion, the radiology residency structure is not our problem. I think that right now, the radiologist interested in NM have the option of 1 year fellowship. Why are we trying to change their residency, if the problem is not their residency.
By the way, do you think that changing the radiology residency structure and abolishing the NM residency, will open the job market for the current and future NM physicians?
I strongly believe turning NM into a radiology fellowship will change the future of NM.
BTW, my proposal is NOT changing radiology residency, rather, is CHANGING Nuc Med residency.
If you google "DIRECT PATHWAY, INTERVENTIONAL RADIOLOGY", you may get some idea what I am proposing.
Unfortunately, under current situation, I would say maybe 5% NM graduates, or even less, can find a position. They all think we are lack of radiology training, and we can not prove them how we are different during this 3-yr residency.
Imaging you are the employer, can you convince yourself hiring a NM physicain rather than a radiologist + NM fellowship training?
And if you can not, then we should address our weakness in the training requirement.
If I have to hire someone to read NM I will hire either a NMp or like you said a radiologist with NM fellowship = Nuclear Radiologist (radiology residency + 1 year NM fellowship) but I will never hire a radiologist with only 4 months of training in NM. If you have a private practice and you need someone to read both, NM and radiology, I will hire a Nuclear Radiologist (meaning rads + 1 year fellowship).
The problem is that right now, any radiologist with only 4 months NM is able to read NM.
In the real world, it's cheaper for the employer to hire someone who can do a mediocre job in NM and is also able to read radiology, instead of paying 2 salaries, no?.
What I am trying to say is that ethically, morally, etc... any physician without proper, adequate, etc... training should not read NM. Only NMp, Nuclear cardiologist and Nuclear radiologist, should take care of NM studies, because they are trained to do so!
Yeah, we are on the same page.


text:
package de.oliver_heger.linedj.platform.bus

import de.oliver_heger.linedj.platform.comm.{MessageBus, MessageBusListener}

/**
 * A class that handles the registration of message bus listeners.
 *
 * This class is used to allow the declaration of message bus listeners in UI
 * or bean definition files. The idea is that a bean of this class is declared
 * which is passed a collection of all [[MessageBusListener]] objects to be
 * registered. This instance gets further injected the message bus object, so
 * that it can perform the listener registration.
 *
 * During application startup it just has to be ensured that the
 * ''MessageBusRegistration'' bean instance is queried from the bean context;
 * this ensures the creation of all referenced bus listeners and their
 * registration.
 *
 * @param listeners a collection with the listeners to be registered
 */
class MessageBusRegistration(val listeners: java.util.Collection[MessageBusListener]) {
  /** The message bus. */
  private var messageBus: MessageBus = _

  /** Stores the registration IDs for the single bus listeners. */
  private var registrationIDs: Iterable[Int] = _

  /**
    * Injection method for the message bus. This method (with this bean-like
    * signature) is called by the dependency injection framework to inject a
    * reference to the central message bus. The bus is not only stored, but all
    * managed bus listeners are registered.
    *
    * @param bus the ''MessageBus''
    */
  def setMessageBus(bus: MessageBus): Unit = {
    import scala.jdk.CollectionConverters._

    messageBus = bus
    registrationIDs = listeners.asScala map { l =>
      bus registerListener l.receive
    }
  }

  /**
    * Removes all registrations that have been made in ''setMessageBus()''.
    */
  def removeRegistrations(): Unit = {
    registrationIDs foreach (messageBus removeListener _)
  }
}

redpajama_set_name: RedPajamaGithub


Focus on the Puck — Ottawa Senators center Colin White, center, and Los Angeles Kings defenseman Jake Muzzin, right, battle for the puck during the first period on Thursday in Los Angeles. The Senators won 4-1.
LOS ANGELES — Chris Tierney scored twice and the Ottawa Senators beat the Los Angeles Kings 4-1 on Thursday night.
Ottawa also got its first consecutive wins since a three-game streak Nov. 27-Dec. 1.
The Senators took the lead by scoring two goals 2:41 apart in the second period. Tierney put the Senators ahead 2-1 at 16:40 after Ryan scored on the power play at 14:59 to tie it at 1 and extend his point streak to seven games.
The Kings went up 1-0 at 3:47 of the second period when Clifford redirected Jake Muzzin's shot. It was Clifford's second goal in the past three games.
Wolanin made it 3-1 at 1:22 of the third period, and Tierney added an empty-netter at 19:02.
NOTES: Senators C Matt Duchene is not expected to rejoin the team for the conclusion of their three-game California trip at San Jose on Saturday following the birth of the son. ... Kings D Alec Martinez returned after missing 14 games because of an upper-body injury. ... Senators D Ben Harpur did not play because of an upper-body injury and is day-to-day.


text:
Publish date30 Nov 2020 - 9:40
Yemeni ballistic missiles hit Saudi positions, eight coalition forces killed
Yemeni forces have targeted Saudi-led coalition positions in Ma'rib with ballistic missiles killing at least eight Saudi forces.
Spokesman for the Yemeni Armed Forces Brigadier general Yahya Saree announced on Sunday that the missile attack targeted the Joint Operations Room of the coalition camp in Ma'rib, central Yemen.
According to Saree, the Badr-P ballistic missile used in this operation killed eight and wounded at least seven other coalition troops.
The Yemeni spokesman warned that such operations against the coalition positions will continue as long as the Saudi aggression and the siege of Yemen continues.
He also noted that Yemeni forces are observing and controlling the enemy's movements, and will target them wherever they are.
Supported militarily by the US, the UK, and several other Western countries, Saudi Arabia and a number of its regional allies launched the devastating war on Yemen in March 2015 to crush a popular uprising that had overthrown a regime friendly to Riyadh.
The US-based Armed Conflict Location and Event Data Project (ACLED) estimates that the war has claimed more than 100,000 lives in Yemen.
Nearly 3,500 children have been killed in Yemen since 2015, Yemen's Human Rights Center says.
It says that some 5,500,000 Yemeni children are also at the risk of catching diseases due to malnutrition and shortage of health services.
Late last year, Yemen's health ministry warned that around three million children under the age of five were suffering from malnutrition, 400,000 of whom were suffering from severe malnutrition and were at risk of death every ten minutes if they did not receive appropriate medical care.
More than half of Yemen's hospitals and clinics have been destroyed or closed during the war at a time when Yemenis are in desperate need of medical supplies to fight the COVID-19 pandemic.
At least 80 percent of the 28-million-strong population is also reliant on aid to survive in what the United Nations (UN) has called the world's worst humanitarian crisis.
The conflict has also resulted in what the world body has described as the worst humanitarian crisis in the world.
http://www.taghribnews.com/vdcguw9t3ak97y4.5jra.html
taghribnews.com/vdcguw9t3ak97y4.5jra.html
HRW warns of Saudi forces abusing Yemeni civilians in al-Mahrah
Tehran rebukes Saudi air strike killing 31 Yemenis as war crime
3,800 Yemeni minors killed, thousands suffer malnutrition over Saudi-led war
HRW warns of Israel's systematic repression of Palestinians in 2020
Israeli report warns of Hezbollah boosting missile power during Tel Aviv aggression on Syria


WASHINGTON (APRIL 2, 2015) The Coca-Cola Company and The Coca-Cola Foundation announced today that they will contribute to the National Park Foundation, the official charity of America's national parks, to support the 2015 White House Easter Egg Roll.
The White House Easter Egg Roll takes place in President's Park on the South Lawn of the White House. This year's theme, "#GimmeFive," encourages Americans across the country to share five things they are doing to eat better, be more active, and lead a healthier life, and supports the First Lady's Let's Move! initiative to help kids grow up healthy and have the opportunity to reach their full potential.
In support of this year's theme, there will be a Coca-Cola Troops for Fitness activation. Made possible through a grant from The Coca-Cola Foundation to National Recreation and Park Association, Coca-Cola Troops for Fitness (CCTFF) is a military boot camp-style fitness program taught by US military veterans. CCTFF helps demonstrate the commitment of The Coca-Cola Foundation and The Coca-Cola Company to promote balanced living, support veteran employment recruitment, and partner with local communities to create a meaningful impact on obesity.
In addition, the official White House Easter Eggs, sold by the National Park Foundation and benefiting America's national parks, are available at easter.nationalparks.org.
Find more information about the National Park Foundation at www.nationalparks.org. Join the national park community by visiting www.facebook.com/nationalpark and www.twitter.com/goparks.
Since its inception, The Coca-Cola Foundation has awarded more than $660 million to support global sustainable community initiatives, including water stewardship, women's empowerment, active healthy living, and education. For more information about The Coca-Cola Foundation, please go to http://www.coca-colacompany.com/our-company/the-coca-cola-foundation.


Silly Mommy : Visit to Uncle Kenny's!
My kids get so excited when they find out we get to go to my uncle's family's house :) We try to go at least every other year to the golf tournament they hold in honor of my cousin, Kyle. We wish we could go every year and would if we could..but we usually have just had a baby...or we're moving..or we are going on a big trip to CA or somewhere big we've planned so our extra money is going to that. So its a minimum of every other at least! But I'm hoping this coming year we still can:) Its just so fun and I love being part of it. Its like a family reunion.
So this year was one of those years...and my kids were counting down the days:) My Uncle Kenny and Aunt Karen(and my sweet cousin Kellye:) have a beautiful home and gorgeous land(I believe two acres!) and pool/patio. They heat the pool for this event and its perfection. Its so fun to be there with everyone! Joey and the men golf while the women and kids hangout poolside. And this year was the first year we were able to see their new chicken/hen farm. So neat! The kids all had a blast with their cousins and I loved catching up with mine. Thanks y'all for a wonderful weekend!!
Poolside fun with everyone!! Wesley had lots of Grandmas to cuddle:) And the kids had lots of fun swimming!
And of course I have to include this one: my sister, the photobomber.
:) Love hanging out with the fam, especially at Kenny's. It's just so wonderful! Thanks Kenny and fam for a wonderful weekend!!!