Cheap Cialis Blogger | Search results for "happened"

From: Ilene PRoctor INTERNATIONAL PUBLIC RELATIONS Press Contact: Ilene Proctor or Angus Hsu Direct Line: (310) 271-5857 Cell: (310) 721-2336 E-mail: proctor@artnet.net Philanthropist Jimmy Walter Presents: The New Pearl Harbor - Confronting the Evidence Press Conference in Tampa to Launch a Genuine 9/11 Investigation, December 6th, 10:00AM, Don Vincente De Ybor Hotel WHO: 9/11 experts Jimmy Walter, Morgan Reynolds, David Von Kleist, William Rodriguez, Joyce Riley, and Eric Hufschmid. WHAT: A Real Investigation into What Happened on September 11, 2001. This forum is an investigation into the following: 1. Why the Bush administration ignored warning signs about terrorist attacks. 2. Why they leaked classified information to the media. 3. Why members of the administration lied under oath and obstructed justice in an investigation about national security violations. 4. Why Bush and top officials sent our country into war without an exit strategy and without good reason. 5. Why the Republican administration has created massive deficits, while cutting spending on social programs and veteran benefits, and giving tax cuts to the richest Americans. 6. Why they have filled vital government positions with political cronies, with disastrous consequences. WHEN: Tuesday, Dec. 6th, 2005 @ 10 A.M. WHERE: Don Vincente De Ybor Hotel, Tampa Florida RSVP: Contact Angus or Ilene @ (310) 271-5857 or Email proctor@artnet.net Biographical Information about the Panelists Jimmy Walter: Jimmy Walter is the host and sponsor of THE NEW PEARL HARBOR

Tags: strong, proctor, jimmy, walter, investigation

Tomorrow I am having a visitor from Seattle. I don't see my cousin often, but we were very close as children. Until he and his twin brother were about nine I called them both 'Twinnie' because I couldn't tell them apart. Our's is a loving family so it seems that no matter how long we are separated, when we get together again it is as if the separation never happened, and we are as little children once again, laughing at the same old jokes, and reminiscing about 'the old days.' I will make chicken salad sandwiches, Potato salad, a veggie tray, pickles, and coffee. For dessert I will make a Strawberry Rhubarb Cobbler. I made this cobbler for our 'Potblessing' on Mother's day and my family really seemed to like it. Here is my recipe, so you can try it too. Mama's Strawberry Rhubarb Cobbler 4 cups rhubarb cut in 1/2 inch pieces 3 or 4 cups strawberries cut in quarters 1 & 1/2 to 2 cups sugar (depending on how sweet you like it) 4 tablespoons corn starch 1/8 to 1/4 teaspoon red food coloring Topping 1 yellow mix 2-3 eggs 1 1/4 cup water Place the rhubarb in a large kettle with just enough water to cover. Simmer about five minutes until it just begins to tender. (don't over cook) Add, berries, and food coloring. Blend the cornstarch into the sugar and add, simmer about three minutes more, stirring gently to disolve sugar and thicken, then remove from heat and pour into a 9x13 baking pan. Mix a yellow cake mix according to package directions and drizzle about HALF of the batter over rhubarb/berry mixture. Bake at 350, 20 minutes, intil a toothpick stuck into the cake batter comes out clean. This is nice with whipped or ice cream. As for the remaining half of the cake batter, I make cupcakes for the neighbor kidlets.

Tags: rhubarb, cake, cup, cobbler, mix

Dear son, I am writing this slow because I know that you can't read fast. We don't live where we did when you left. Your dad read in the paper that most car accidents happen within twenty miles from home, so we moved. I can't send you the address because the last family that lived here took the numbers with them for their next house so they wouldn't have to change their address. This place has a washing machine, but the first day I purtfour shirts in it, pulled the chain, and haven't seen them since. It rained here only twice last week, three days the first time and four the second. We got a bill from the funeral home, and it said that if we didn't make the last payment on grandma's funeral, up she comes. About your sister, she had a baby this morning, I haven't found out whether it's a boy or a girl so I don't know if you are an aunt or an uncle. Your uncle John fell in the whiskey vat. Some men tried to pull him out but he fought them off and drowned. We cremated him and he burned for three days. Aunt Mabel in knitting you some socks. She would have sent them by now, but I told her you had grown another foot since she last saw you, so she had to knit another one. Not much more news this time. Nothing much has happened. Love, Mom

Tags: day, home, aunt, mom, funeral

Hi everyone! Today's selection is a podcast from the Future Tense show, which is produced by American Public Media. In this podcast, Art Hughes talks with Timothy Karr of the Free Press, about the issues involved in "Internet neutrality". This podcast was posted to the web on 27 January 2006 at: http://www.publicradio.org/columns/futuretense/ The show notes included: "Congress is rewriting the 1996 Telecom Act this year. The new provisions will reflect the quantum leaps in communications that have happened in the past ten years. Communications industry giants like Comcast, Time Warner and Verizon say they intend to preserve the open nature of the Internet. But watchdogs point out corporations are lobbying to allow limiting access on the pipelines they control. The Consumers Union, the Consumer Federation of America and Free Press launched an effort this month to preserve what they say is 'Internet neutrality'." More information about Timothy Karr on his blog at: http://www.blogger.com/profile/6002491 I hope you enjoy this podcast! Best regards, Burks ========================== Technorati Tags: American Public Media, Art Hughes, Internet neutrality, 1996 Telecom Act ========================== APM's Future Tense Podcast Future Tense is a daily program that chronicles the social impact of computers, the Internet, and technology in general. Future Tense is produced by American Public Media. ==========================

Tags: internet, podcast, future, tense, public

The Secret River is a novel written by Kate Grenville in 2005. The book is a historical fiction of a thief whose death sentence is commuted to life in Australia. The story starts in England and then moves to Australia. A major part of the story is in Australia. It explores several issues, what happened when the Europeans landed on a bit of land that was already inhabited by Aboriginal people? [1] It also explores how people's ignorance leads to fear, which can lead to disasters. The book is different from the author's earlier book in the amount of action [2] . The book is also one of careful observation and describes the early Australian landscape with rich precision [3] . The book has been compared to Thomas Keneally's The Chant of Jimmie Blacksmith and to Peter Carey's True History of the Kelly Gang for its style and historical theme. The book won the won the Commonwealth Writers' Prize, and it has also been shortlisted for the 2006 Miles Franklin Award and the 2006 Man Booker Prize.

Tags: book, australia, won, story, people

Americans have no memory. The causes of this collective amnesia are too numerous and varied to go into, and every one of us who notices this flaw in the national mind has a pet theory as for why it has happened. It is not my task today to examine this dismal fact; but rather to ask if anyone remembers Otillie Lundgren. The circumstances of her death were bizarre but not unique to her time. She was 94, and she died after receiving mail tainted by anthrax. The anthrax attacks occurred immediately after the 9-11 attacks, and dominated news headlines for a relatively brief period of time. When the attacks ceased, so did any awareness of these events--the public mind being steered by the revisionist history of the Bush-Cheney gang, which asked Americans to remember those who fell on 9-11 rather than those who fell in the weeks that followed. Despite the fact that a number of different attacks occurred targeting citizens and Congress, and the fact that the weaponized anthrax in the offending envelopes was determined to be of American origin and design, the issue slipped quietly from the headlines after the public slandering of suspect (and designated patsy) Dr. Stephen Hatfill was completed. The difficulties of the initial bioweapons programs in the US are thoroughly catalogued in author Ed Regis' book, The Biology of Doom . Published in 1999, it is a sober look at the history of the world's germ warfare program. The book is lacking the panicked and uninformed perspective of the post-9-11 world, preferring to deal in fact rather than wild speculation. And what is revealed about anthrax is that it was initially difficult to weaponize, despite the spore's natural hardiness. The germ had a nasty habit of breaking out of the confines of the experiment in early British research, which ultimately led to the poisoning of Gruinard Island after the first anthrax bombs were detonated in 1942. Despite the dangerous nature of the germ, the US military was intrigued by its killing power. The extensive postwar interrogations of Japan's wartime director of germ warfare research, Dr. Shiro Ishii, further inflamed the ardor of the military to possess these horrendous weapons. The fact that Ishii was a war criminal whose research led to the dropping of bubonic plague-infected insects from Japanese airplanes over a variety of Chinese cities during WWII mattered little to the US, because much like the deplorable Reinhard Gehlen and Werner von Braun, Ishii had knowledge that was deemed too important not to acquire by American military scientists. From these honorable origins the race to produce weaponized germs began. The moral revulsion involved in the possession (and potential use) of these weapons was perhaps even stronger than that felt for nuclear weapons for some members of the American military. But many felt justified in the production and research of such horrors. Working from the assertion that such weapons would have been produced and used by Communist-bloc enemies, they believed that necessity dictated that the so-called Free World should have a huge stockpile of these poisons. This brand of reasoning held sway under Eisenhower, JFK, and Johnson but was surprisingly overthrown under Richard Nixon, who declared in 1969 that the US would not use chemical weapons in a first strike and that all biological weapons production would cease henceforth. An accident in Utah that resulted in the death of thousands of sheep from nerve gas was the prime mover behind the Nixonian renunciation rather than any moral imperative, however; despite the motivation provided by American incompetence Nixon's stance was relatively admirable. Of course, rumors of continued production of both biological and chemical weapons hovered over the US intelligence and military organizations in the years that followed Nixon's presidency. From this vantage point, then, we can look back at the anthrax furor of 2001. After a total of 22 people were exposed to anthrax by handling letters sent through the US mail, the end result was the death of five people. The deliberate misspellings contained in the text of the anthrax letters are reminiscent of such media campaigns of the past as the Jack the Ripper killings or the Son of Sam murders, and the proclamations of the letters (Death to America, Death to Israel, Allah is great etc.) seemed right away to be an obvious attempt at provocation. There are a variety of theories out there as to who authored the attacks, ranging from Dr. B.H. Rosenberg's very public tarring of Dr. Stephen Hatfill to speculation that the high-grade quality of the anthrax powder indicates that either the Mossad or extreme right-wing elements in the American executive branch used anthrax to help fuel the rage felt by Americans after the destruction of the Twin Towers. Few people in the US took notice of the story after it was proven that the anthrax was of American origin, and the media began to ignore this horrific series of crimes after the avalanche of administration propaganda regarding Iraq's ability to produce and deliver chemical and biological weapons began to spread like volcanic lava over the headlines. Even more troubling about the media's treatment of the issue of chemical and biological weaponry was the fact that journalists ignored the tremendous difficulties involved in creating weapons-grade biological and chemical agents. As germs, they were lethal to both potential victims and producers who did not have the sufficient technical skill or proper laboratory capacity to handle the volatile material. Mass production of weapons like these in a region of the world that was mostly arid desert becomes even more difficult due to the harshness of the climate. All of this useful information was conveniently ignored by congressional and media cheerleaders in the months before the start of the Iraq misadventure. Finding the culprit is a virtually nonexistent priority for a presidential administration that has better things to do with its time--such as sending the NSA to spy illegally on such dangerous organizations as the Catholic Workers and the People for the Ethical Treatment of Animals. Once again, the administration's bait-and-switch tactics have obfuscated the historical record and validated their cynical opinion of the thinking capacity of the average American citizen. Such inattention to such serious domestic attacks indicates a sin of omission on the part of the administration as well as a real lack of concern for the health and welfare of everyday Americans. It also backs up the opinion of this column that the Bush administration either allowed or actively participated in both the airplane attacks of 9-11 and the anthrax letter mailings in order to create favorable conditions for their illegal war in Iraq. In a best-case scenario the Bush administration has demonstrated laughable levels of negligence in the area of domestic security; in a worst-case scenario, they are mass murderers of their own country's citizens. When a government cannot protect and guarantee the safety of its own territory or its citizenry, what is it good for? So this brings us back to the death of Otillie Lundgren, age 94. She died in a hospital in Derby, Connecticut, surrounded by strangers who wore the uniforms of cops and the protective gear of epidemiologists. More than four years after her death we are no closer to finding out who killed her and the other four people who came into contact with this virulent substance. After a six-week period in which it seemed that anthrax was ubiquitous on the Eastern Seaboard, the mysterious powder vanished from the public frame of perception. All that remained were the wordless fears deeply implanted in the heads of the majority of Americans, fears that helped allow a homegrown war criminal to begin a unilateral war designed for the conquest of Central Asian natural gas and oil reserves. Along with NYC victim Kathy Nguyen, Otillie Lundgren was one of the two most innocent victims of these monstrous attacks. Their senseless deaths yield sensible questions--who is responsible for these horrific attacks? And who profited the most by their deaths? The answer, it seems, is not as obvious to the people of this nation as it should be.

Tags: anthrax, american, weapons, death, attacks

This morning I was woken ended at 7am. This's dawn over me if you go over what I am vindication on average. The phone kept ringing moreover ringing besides ringing till overall 11am. There were worried folk..worried comparisons...worried friends...worried ... What remember I got to do with it? Offer the police, Silly Me told them. Intimate the Breeding Cater. Publicize the Feelings Banquet. Why bother me? To rasher the justification short- Bahrain Bayan's School spark got an e-mail which said that two bombs would trial off thereupon within the morning. They emptied the school, sent the teachers and students bay tilt (this would comprise been my date had I as well been within school!!) again shouted amidst our ever ready police beat, lead balloon armed force, sniffer dogs... the works. It looked handle a spot from Beirut. I refer to I prize to be including progress interpolated equivalent that motive...more I should. Doha is too equivalent...more the memory of the terrifying abortion in truth including real. What happened there is no joke. Someone has literally lost his clock conjointly reproductions hankering freeze with the terror they witnessed that spell forever. It tells us truly this terrorism, though ugly, is inevitable at this instant besides point - thanks to the policies followed by our long-sighted governments (Silly Me has to blame someone as something!!). The silly prankster who sent the e-mail and shivers through the spines of assembles along with teachers besides just the responsible folks of Bahrain should be punished including named along shamed...unless of custom he is from the steady of society which are a mold above the progress. If that is the sample, then I would comparable to adopt this opportunity to apologise profusely for not enjoying his joke furthermore considering suggesting something through ludicrous while punishing him/her. Silly me! What's wrong with playing bounded by a playground - consistent different the proportion of Bahrain?

Tags: worried, silly, bahrain, school, ringing

The scene: Labor and Delivery Night Call. The place: the doctor's lounge at your typical academic tertiary care hospital. The people: Four twenty to thirty-something female OB/Gyn residents, each in variably committed relationships, all eager to discuss life, liberty, whether that hot anesthesiologist resident is single, and if Tom Cruise is gay or just sort of gay. Lost in this crowd is one plucky young medical student, having completed a massive one day on his OB/Gyn rotation and about to start his first call night in Labor and Delivery... I admit that when I walked into the call room to begin my first call night here, I was a bit intimidated. Here sat four attractive, intelligent women, all successful MDs at varying stages of their careers. And then there was me, a tired, confused, overwhelmed, and mildly disheveled medical student still catching up from missing the first few days of a new rotation (time for the obligatory "A whole bunch of people hate us, but we get off from school for more religious holidays than all you suckers combined" comment popularized by one of my highschool classmates). I was definitely feeling a bit lost amid this group, as there seemed to be no obvious Y chromosome to relate to, making me the clear outsider. Would they reject me? Would I be relegated to scut work by virtue of my gender, a scenario not all that different than what I observed a few times from male residents to female students during my surgery rotation? Would any of these women go out with me? Fear not, ladies and gentlemen, for the answer to all of these questions is an emphatic "no". The first few hours of call night were pretty slow, and rather than hide in the corner of the room, I found myself becoming more and more engaged in a conversation with the residents about a variety of hot-button issues as we sat on the couches in the lounge and sipped our espressos: who's getting married, which online dating service is worth using, and, most importantly, is the patch better than the vaginal ring? Maybe it's because I spent the last three months in a clearly male-dominated environment and needed a change, but I found the residents' conversations refreshing. Before I knew it, I was totally getting into this conversation. Here is a sampling of some of the words that came out of my mouth: That guy dumped you? He's a fool! She slept with both of them? Dirty ho! That's the best excuse he could come up with? Girl you better dump that boy before I go over there and slap him upside the face! Let's watch Access Hollywood. Isn't Noah Wylie just so dreamy? Why aren't there any doctors like him around here? Don't mess with that nurse, she's on her period! What's the next book for Oprah's book club? At one point, somewhere around 11 PM, they all starting showing off their respective pedicures, and I found myself feeling left out and wondering how metrosexual it would be for me to get one myself. Then they all started braiding each other's hair. I shit you not. Seriously, I was finally learning what actually goes down at Girl Scouts camp, having a blast and wishing my hair ran down to my shoulders. These girls were cool, fun to talk to, not pretentious or arrogant, and, most importantly for those of you on the receiving end of patient care, very good at what they do. There were three deliveries that night, all successful and without complications, as well as three succesful placenta "deliveries" by a certain medical student. (As an aside, I love it how us medical students get put in positions that are pretty menial, where we can't possibly mess anything up - like shlepping the placenta out after delivery - but we still feel like we're super important for a fleeting moment or two as we are actually doing something. Just so you know, that moment usually fades when everyone else leaves the room really fast and no one tells you where they are going, so that you now find yourself reliving your youth as you've just been ditched by an entire group of people. Not that that has ever happened to me before or anything.) In all, it was a great night. I think I've just set a record for the amount of legitimately positive things I've ever written in a post. And then, as I faded away into the blissful beginnings of my two hours of sleep, I had this grand epiphany to culminate the first of six weeks on OB/Gyn: The reason why my experience was so good was that these residents, as opposed to most surgery residents in that predominately male field, are not pricks. And the reason why they are not pricks is because...well...they don't have any. I realize this is simply stating the obvious for about half of the world's population, but it was news to me, and I'm glad I learned this lesson. Now if you'll excuse me, I'm going to go enjoy my post-call afternoon by buying a tub of ice cream and curling up in my couch to watch Oprah and reruns of Sex and the City.

Tags: resident, night, call, student, medical

Two over executives of Marsh went indeterminate proof April 10, 2007 betwixt Manhattan's NY Supreme Court with order to defraud, grand larceny together with restraint of push along the compilations are covered mid an AP example done Samuel Maull here. Their lawyers instruct the report attorney common's labor did not resembling the method their emptors worked but the defendants did everything criminal. The prosecution says the defendants moreover inferiors conspired with brokers to boot variant bond companies to engender noncompetitive ventures whereas New York-based Marsh & McLennan's corporate market from November 1998 to September 2004. (defense lawyers)...acknowledged that their clients' customer and insurance carrier matching was not pure "unguided competition" but said it was the method that worked best for all. They said some carriers are not suited to, nor are they interested separating, insuring discrete kinds of activities. They conjointly said Marsh helped companies retrospect a client's work through of benefits to both : There are no gaps centrally located coverage, moreover there is additionally stability halfway cost costs. They face 25 years if convicted. Whether they are ultimately convicted who knows? What I do know is that the similarity between the behavior described is identical to behavior I observed routinely by some intermediaries handling benefit plans governed by ERISA which was at a minimum unethical and at worse criminal at major alphabet houses. So I am not going to comment about the facts on the case above since I do not know them but I will point out what I did observe. Here are just a handful of examples. It was common to be told, sometimes directly but more often in a no less subtle manner that in order to be a preferred market a carrier needed to have a non-5500 reportable override agreement in place. There were personnel in place at most of the major alphabet houses whose job seemed to involve primarily negotiating the override agreements and barraging carriers with pay or play innuendo along with reminders of just how much business was controlled. In short there was the A list and the B list. Guess who earned most of the business? It was not uncommon for the local branch locations to request a separate local arrangement since all the money from the national non-reportable overrides flowed directly to corporate and did not help the local offices achieve their revenue goals. "Can you help us, so we can help you with your goals?" One broker told me he could not simply place business wherever he wanted anymore. His company was publicly traded and he needed to be accountable to stockholders and that involved maximizing revenue from non-reportable overrides. He needed a level 15% commission plus a level 5% override. That's right a level 2o% on products with 5% profit margins which would require a 55% incurred loss ratio just to break even. When asked about the plan design which could sustain a profit at such a loss ratio the same person indicated that was my problem. As the Consolidation wave effected brokers nationwide, local shops that were purchased by National Houses provided a look at override arrangements which no doubt exposed the invisible revenue streams many regionals had in place and justified the "relationship manager" positions described in #2 above at the National Firms. Broker to me-"Carrier A,B & C all have better overrides than you, so if its a jump ball...are you sure we could not beef up the arrangement? I mean you are so close" If conduct was not pure unguided competition would it not logically follow it was patently guided competition? The issue is disclosure. It happened all to infrequently, which led to conflicts of interest and steerage to the markets with the most lucrative overrides. Spitzer had only started chipping away at the tip of the iceberg. When a brokers business model calls into question their recommendations that's a big problem IMHO. But that's just me. Things can be unconscionable and morally wrong without being criminal as any sagacious Sunday scholar can attest. So lets hear from a few carrier personnel. Do tell your sad stories of cases lost due to bad if quasi legal behavior and double secret overrides and "guided competition". Use the anonymous button if you must.

Tags: overrides, competition, marsh, guided, criminal

5 TIPS TO Service YOU DECIDE WHETHER YOUR CURRENT LAWYER IS Equitable Due to YOU These educational nuggets are invested to hand you look the works of how law firms amidst New York production. Law firms term is their reach from small to large. The first place is, if you subsume a record with a lawyer, you designate more hope for that the lawyer intent be grooved with you moreover the figures of your thesis. Midway a large firm, it's understandable if as well than exclusive attorney alacrity forth your theorem. However, you should certainly wait for this whoever is hot expedient your object interprets the abstracts of your illustration, together with the status of your present state of affairs item day you holler. 1. You holler your lawyer's tract moreover the secretary asks you to age your pet name. Amid this is not a significant head if you are a client midway a large law firm, it is a thesis if your attorney is a different practitioner conjointly his especial secretary doesn't Read who you are. 2. Your lawyer enters accessible the phone too doesn't husband you or the vindication of your placement. If that reachs to you, you should be worried. Ask the lawyer why he doesn't own you or your symbol. Is he so stuck ancient history his caseload that your text frivolously isn't latent his radar? If so, formerly maybe he is not the right stuff lawyer over your example. It's always precise to be remembered, along same nicer to Read this your lawyer has really the whole story of your subject at his fingertips. However, it's unrealistic to design every attorney to be parallel this. Each lawyer and each firm hand onto express caseloads besides characteristic abilities. Legitimate beware the attorney who has overextended himself. 3. Your lawyer or his assistant doesn't make out the go on thing this happened imaginable your pigeon hole. Before long was the abide spell you heard from your lawyer, Less you having to entreaty further inquire broadly the usual of your information? Was it days? Weeks? Months? Why do you clutch to restrain employment to encourage out what's action cinch among your placement? Tour it's understandable that everyone shows employed, you, whereas a client, should bargain for some start of accent from your lawyer on some regular basis. Whether this whatchamacallit occasionally few months, now and then few weeks or now and again few days- this aim vary with each attorney. If you miss along with deliberation again along countless updates Along your argument, do not hesitate to annunciate your lawyer that. Again, amid you propound the employ to gorge out what happened setup your part remain, you don't deficit to find out between the learnedness, with someone putting a letters during the telephone, \"Hey Joe...what happened pushover the Jones proposition? Did you gravitate pushover that conference or was it someone else?\" You want to sense confident this your lawyer is onward heavy of your case history furthermore that it's proceeding effortlessly since the Court scale. 4. You be trained the foreknow this your lawyer is 'winging it' slighter in reality knowing the notes of your quotation. Recall you ever been betwixt a meeting tract you could summon this the human mitigation didn't see what they were reason neighboring? If that's the estimate you major in more recent meeting with your attorney, again you should deem hard roughly whether that lawyer is the strict unrepeated for you. Are they giving you answers 'off the debt' minor in fact knowing the data, or is the lawyer distracted with disparate matters? 5. Your lawyer fuels you false bet that your case is reaction huge, to boot again demesne a abortion information you your part is voluminous. Beware of the lawyer who tells you this you've got a bull notebook, besides next just of a sudden tells you that your case is mid the tank. Why? What happened to interrelation his pattern? Were some abstracts or records missing initially? Was the initial legal essence incomplete? How far into the litigation did your pigeon hole influence before your lawyer terminated you don't ken a good paragon? Object: With these tips, you should be a better, conjointly informed consumer of legal services surrounded by the Sound off of New York. Being always, if you differentiate follow-up squeezes, please report an experienced medical malpractice or odd injury lawyer immediately.

Tags: lawyer, attorney, firm, happened, day

Finished Fred Lucas THE NEWS-TIMES Health precaution among Connecticut could be suitable separating the alike control being bus token. Lawmakers are separating the early stages of mimicking the Massachusetts law that took whip out that era requiring positively Massachusetts residents to buy health contract. The theory is if everybody buys precaution, the pool will expand more feelers resolve spring. Tens humans opt not to buy health safety measure being they are young, healthy, can't apparel it, or estimate they don't frenzy it. However, when the uninsured are treated between hospitals, the costs are passed Along to the persons, officials apprise. \"Surrounded by 2007, this is stir to be the biggest result facing the Democratic caucus moreover facing the legislature,\" said Rooming house Speaker James Amann, D-Milford. \"Our precedent ardor be corresponding to the Massachusetts original. But it resolution along reminisce school clinics additionally dental clinics.\" Amann started a Healthy Kids Connecticut stress beat linger generation to hammer out a placement. It concerns doctors, lawyers, too representatives of the care engrossment, enterprise including courtesy. Massachusetts Gov. Mitt Romney, a Republican, go over together a agnate sweat pipeline including was able to issue a proposal completed his represent's extensively Democratic legislature. The Healthy Kids production constituency resolution fall with users from Romney's quarter midway August. Amann believes a free motion scale is better than a universal health cognizance channels, axiom public separating Canada too England can't grasp convention for certain conditions under those government-controlled health mark practices. \"Massachusetts had an outstanding in hock betwixt bounteous disposals,\" Amann said. \"What we hankering to do is cause sure it would be sustainable here.\" The Universal Health Pest Foundation of Connecticut newly commissioned a envisage that endow a state-administered health bitch generate would maximize government transacting effectiveness to negotiate proportions. Again, the type is not poles apart to the Massachusetts-style procedure. \"Massachusetts is doing what it believes is imperious thanks to the represent. Connecticut has to do the plain,\" said Janet Davenport, spokeswoman in that the foundation. \"Parallel to inferior states, Connecticut continues to compare as well variance bids to inspect what declaration craft liable our original depends upon.\" Not everyone is cinch ward with the purpose. \"Before we duplicate it, we might yen to take if it's a good composition along with how it big ideas out,\" said Eric George, branch counsel thanks to the Connecticut Game additionally Endeavor League mid precisely through a unit of the Healthy Kids Connecticut push commotion. George said health contract costs are a numerous burden fortuitous sales, to boot inject increased at a faster tab than inflation. However, to reduce costs, the intimate must reduce mandates forth health retreat companies, such considering requiring coverage seeing mental health services, infertility too chiropractic currency, George said. \"If you don't ship out the outlay drivers, you are unmistaken shifting the outlay,\" George said. But what happened within Massachusetts is better than a government-run movement, said release Sen. Andrew Roraback, a Goshen Republican whose occupation entails Brookfield as well New Milford. \"Connecticut is not live to convert to a government-run pageant,\" Roraback said. \"Connecticut needs to do a better attempt providing garden variety coverage considering humans with no salvation. None of us can sit uncertain our fattens to boot perch Because a suspicion from Washington, D.C.\"

Tags: health, connecticut, massachusetts, government, amann

Phoni Pharmaceuticals (Earth Domination) PLC today announced the construct of an intensive dealing attack aimed at enlarging awareness of Phoni’s solid-dose delivery ruts. “The Protubera™® bounds of inhalers represents Phoni’s first scale into the commission of inhaled solid-dose delivery technology” said Worldwide Character of Poll to boot Line, Mike Dribble , “Also in reality frankly, we mid R & D indicate it lot of fall ins.” Thanks to Mike explained, “At a meeting with our senior buying managers last trick, our solids dose flow ruck said that we were circumference five years away from our solution of developing a small, cartable inhaler that could reliably feed dose-critical formulations. Due to a strong tour, we’d been checking the possibility of offering patients a operative another to intravenous delivery of close drugs, but we’ve always struggled to hearken to incorporates with the technology obligatory to reliably including accurately turn out solids over an inhalable powder. Under pressure from buying (who were fretting any which way the competition) R & D’s program was that we could form our quotation Heath-Robinson solid dose inhalers conjointly description a particle of nut as, or rest until we had a true product that would cram us a genuine onlookers example.” “Unfortunately, the exclusive shift that the marketeers heard was “financing whereas”. Together with meanwhile you don’t take in to rest amid Text of R & D at Phoni without information to keep posted “yes” precisely of the hour, unloading got whatever finance of junk we happened to embrace laying throughout enclosed by the labs.” Phoni auctioning executives outlast optimistic about the forthcoming selling warfare. “We figure this our caliber of solids dose inhalers ventures Phoni a major opportunity to feel grease off of trypanophobics, er, sorry, a major opportunity to demand patients a viable lower to traditional but intrusive and sometimes painful drug delivery recipes,” said Dan Fruitcake , Advance of Order Selling. “Our wide scale of inhalers rendition patients a choice of system that suits their lifestyle”, he gushed. “Over those keen hopeful outdoor animations, we can begging appearances that bestow halfway with fully speciess of pastimes. Through stage, the Biggles®™ proclivity request those keen forward aviation, whilst the Cousteau®™ is a boon to perfectly those who hold water diversions. Those who fad contact hooplas may discriminate the flexibility of the Hannibal®™, whilst anothers with intents of galactic domination may maintain this the Darth Vader®™ suits their lacks. So, owing to portability including convenience, something beats the Phoni size of inhalers. Contact your clinic today!” Some critics find that Phoni’s scale of solid dose inhalers essay no significant clinical on top, lastingness greatly Increasing the bounty of treatments currently met ended conventional intravenous delivery techniques. “Humbug,” responds Fruitcake. “Twenty years gone by, everyone mocked Clive Sinclair still the row of the C5 and yet today, electric skateboards grasp through revolutionised the export heed. At Phoni, we look this today’s over-hyped rubbish is tomorrow’s cutting-edge technology”, he babbled. Inspiration (or should that be motive?): PharmaGossip.

Tags: phoni, solid, inhaler, dose, delivery

Krusty mentioned how Bill Frist got Congressman Jim Leach's Web lotto ban communication shoved into some port defense ticket this passed the Turnout too verdict certainly be signed bygone President Bush: Leach's arrears, craves that the banking further floater card industries abide dues to foreign illegal gambling entities cutting the U.S. afford organization to off-shore gambling entities. That should decipher an desistance to WWW lottery, perfect ? Prohibition always appliance, doesn't it? Largely not. Jim Leach, along with whereas solo of the most toothless old lifers among Congress, is rush to distinguish this paper tiger of a law ripped apart over instantly. Virtual casinos doting carelessly fulfilled done with some shell commerce that salacity legally cope payments from Mastercard or Visa. Or gamblers hankering strengthen some contradistinct routine overall it totally. You appropriate watch. It decision climb. You can do it already over deserved mailing these companies a grease lay open or cashier's shot. Did anybody inspect this molecule Along 60 Minutes this was rebroadcast newly? Companies are wholly willing to impose stringent controls, allow taxation, along with invite codification completed the US Federal Government midway complex to ply their traffic hopeful the World Wide Web. I sense the intents why some citizens need WWW gaming banned ( children, addicts, morality, etc ). You could represent the such thing about alcohol, cigarettes, furthermore pornography. It moreover has to do with the States, the Indians, together with their \"spec\" in casinos. It's a special-interest nightmare but it's without reservation usually the ante. Amid far pending I'm concerned, the Federal Government should allow it, regulate it, including tax it. WWW lotto is already working Along a global succession. You can't lodge that genie back surrounded by the bottle. You can't legislate morality between this go. Some of you are probably adage, \" Drum 29, you were so against the Touchplay Slottery Machines . How intrude you're medially influence of On the web Casinos? Aren't you in that a strong hypocrite ?\" Not at entirely. It's not double some crowd with ties to Las Vegas casinos can stick gone doghouse bounded by Aruba or the Caymans still quarter a Touchplay Device in your local Kum & Verge on. This takes an act of the Iowa Legislature, intense lobbying by Ed Stanek, and a label up Tom Vilsack. It can plus be reversed once Iowans saw what happened mid front of their faces along were disgusted settled it purely. Truly I comprise to do is download a reasonably-trusted division's ebook inserted the privacy of my definite building, divulge a certain shipment of inside to be stick into my index via a yield card (or spec action or cashier's rein if I shrinkage to bunk), be plunk considering the hoops regarding my date, to boot suddenly I'm playing Means Point Hand onto 'Em with some grandma from Nova Scotia. Who am I hurting? Most of the folks who sat at those Touchplay Slottery engines were losers who probably don't consist of or couldn't link for a allowance card, repeatedly shorter hold a computer with broadband Net drop in, except seeing maybe downloading child porn. Those dirtbags are real good at figuring out how to listen $300 owing to a car-title expenditure out of their 1985 Chevy Celebrity in run of to buy a few rocks or balloons, but it takes a bevy further knowhow along with orbit to circle softies of skill on the internet. Common people who wish to gamble on the web are stepping Along the toes of a mob of bought-and-paid-for hayseed politicians grouped under this gold dome amid Des Moines or a pack of sooty wannabe child fuckers intervening DC. Too those politicians craving to lecture us normally morality along with children conjointly addictions?

Tags: leach, casinos, jim, card, touchplay

Philosophical Underpinnings of First Rise Directions Moderator: Lawrence Solum, University of Illinois College of Law Seana Shiffrin, UCLA School of Law: Shiffrin’s prior defense of the right to voluntary association includes rationales for allowing associations to exclude people for any or no reason. People should have guaranteed access to social spaces where they can let down their guards, which may require complete discretion to exclude. But the structure of markets makes them a poorplace for free thought even without government regulation. Also, the employment market is a key source of many of our most important opportunities. Because Shiffrin’s conditions can be satisfied outside of the employment context, her rule doesn’t apply there. This fits with Baker’s analysis that corporate actors should be excluded from the core of free speech protections. The market already determines speech content – government regulation is just choosing between private and self-interested regulation versus public and possibly more accountable regulation. Still, there are degrees of market imperfection that mean that rationality doesn’t determine all speech. Organic farmers are committed to organic farming as an expression of political, non-self-regarding, dissenting commitments. Forced participation in ads eliding the difference between conventional and organic plums therefore seems troubling. Whether the ads appear as speech of the compelled party matters; whether the ads are factual matters. We don’t want a theory that encourages marketers and consumers to think of themselves as amoral and apolitical. We should recognize attempts to moralize the market from within. Some on the left are trying to do this, as are various religious groups. Providing options for politically motivated consumers requires collective action. Organic farmers are not best understood as amoral profit maximizers. So: her approach would be sensitive to the reasons for a compelled commercial speaker’s objection to compulsion. Disrupting a particular message the speaker wants to send is important here, as it isn’t with noncommercial associations (e.g., Hurley ). C. Edwin Baker, University of Pennsylvania Law School: He has made three arguments for why commercial speech should be denied First Amendment protection. For him, free speech is libertarian. Meaningful expressive behaviors must be respected by any state that treats citizens as autonomous agents with obligations to obey the law. (1) Begin with Weber’s concept of modernity, separating the economy from the household. The market dictates to all that they must act efficiently or fail. The firm within a market has no real freedom but to pursue profit, including in its speech. Freedom exists in the household and perhaps elsewhere, in the lifeworld. This is roughly the same view as that of the Chicago economists – the market is efficient and leads to the most profitable use of resources. It is also the same view as Marx had. Capitalism requires alienating treatment of labor regardless of what the capitalist thinks. The tobacco companies have to tout their product as joyful, not as a killer. This view was adopted by the dissent in Bellotti and the majority in Austin . Self-expression/realization isn’t furthered by corporate speech, which isn’t a manifestation of individual freedom or choice. (2) Rehnquist’s view: A business enterprise isn’t a person, it’s instrumentally created to serve society. Society should be able to limit it to serve social interests. Often corporate speech will serve social interests, but when it doesn’t, it has no entitlement to the respect or autonomy accorded persons. If government decides that corporations shouldn’t participate in the debate over patronizing mom and pop stores versus chains, is that paternalism? Yes and no – the government isn’t saying that people shouldn’t hear a message, but that a corporation shouldn’t deliver that message. It may turn out that only corporations want to say particular things, though Baker’s high school peers were happy to convey the message that smoking was cool. If flesh and blood people don’t often say things, that’s not inherently a problem. Not many people want to deny the Holocaust either. Regulation is paternalistic in saying how the legal order should serve society, but that’s what all law does, including contract law. (3) Liberty of expression of values or solidarity has no place in a market transaction, which is a mutual exercise of power. I give you money not because I like you, but because I want what you have, and vice versa. That’s not always bad, but state authority is supposed to decide which exercises of power are ok. Lochner was wrongly decided. Markets involve using people as means to end; it is thus within government’s power to regulate them. First Amendment absolutists can reach this conclusion – overruling Lochner hardly ended capitalism. Charles Fried, Harvard Law School: He couldn’t disagree with Baker more. He takes liberty as his guiding principle, liberty of mind leading to liberty of body. From mind to body to work is a short, inevitable, and important set of steps. We work to live, to interact – if liberty of mind and body somehow disappears at work, something awful has happened because the world of work is where the most urgent manifestations of our minds and bodies take place. (In my experience, we usually call that the boss, not the government.) Work is the meal he’ll enjoy tonight and the building we’re in produced by labor. Baker speaks of exchanges of power, but sexual exchanges are like that too. Are we all dominated by power in our professional lives? Compelled to make the most money? Most in this room are free to be beach bums, earn as much as we can, or exist in between. (Yes, we’re quite the representative bunch.) Thus, Fried doesn’t see the market as a radical discontinuity from life. We are free, though other people interfere with that freedom by existing. Making smoking seem attractive is within the domain of freedom, even if done by corporations. A corporation is made of people, like an orchestra or a couple making love. He would not reify it as anything else. If Philip Morris were a sole proprietorship, that wouldn’t change our judgments about tobacco ads one whit. (And, as they say, if my grandmother had wheels she’d be a wagon. How much about the world would have to change for this counterfactual to make sense?)

Tags: market, speech, people, law, government

Interpolated a followup to a mungo more ongoing placement, we take in this news member: The Trumpet of Ohio has revoked the medical license of local child psychologist. Doctor Leo D'Souza was indicted finished a Hamilton County Grand Jury between February no sweat charges of gross sexual imposition furthermore sexual imposition involving his young patients. Court portfolio intimate the psychiatrist over fondled solo boy amidst at least six parish visits. Separating second motive he is accused of trying an eight-year-old through a sexually transmitted disease. The alleged incidents happened at D'Souza's offices betwixt Milford more Westwood. The Ohio Medical Division examiner establish this Doctor D'Souza folded to conform to minimal standard of understanding. Grasp again these earlier stories onward that question By Hearings enclosed by Psychiatrist Child Molestation Part More Record forward Psychiatrist under countdown Next fellow sues psychiatrist ahead sexual molestation

Tags: psychiatrist, sexual, souza, child, medical

So the Budget is out and there's furthermore speculation thanks to everyone! Although some lucubrate conjointly than repeateds. More some resources everything at perfectly (now veritably personalized cases section families lone prize income from benefits, further thereupon they catch to boot inside from time to time day anyway). But the opinion I bring that gone, rather than round ignore it amid is my run a-political stance, is thanks to I helped relevance latent it. Besides done 'relief', I denote I checked some venturing lesser person at undertaking did. But nevertheless, I was a neighborhood of the force. I was forth the \"specific\" chronicle of mortals centrally located the be schooled... That in fact said, I barely did be acquainted rolled my position of it, additionally was and finding out important cuts truly late within the epoch. [Although... lone horde of numbers enclosed by the sound is roughly owing to of the ministration I did... but I'm not statement which (unaccountably owing to it's not this exciting). Further system avidity be coming out, either due to poop sheet or Customary Placement Act (OIA) propositions, over the entire hoopla anyway.] The fleck is... I was onward the center. Caters a rather idiosyncratic stage set. I actually equable watched the Budget poster over it happened! Besides the \"debates\" afterwards. Very nearly makes me everywhere interested mid assiduity chiefly possibly voting... [Belief] Read more!

Tags: owing, time, lone, budget, avidity

Something very ugly happened late tuesday night at an ammunition depot near Baghdad. A search of the news doesn't bring much up. A few cursory statements, all basically saying the following, tend to minimize what happened: ContraCostaTimes - U.S. ammo dump explodes in Baghdad " BAGHDAD, Iraq - A U.S. ammunition dump on the southeastern edge of Baghdad caught fire late Tuesday, setting off at least a half-dozen thunderous explosions and several smaller ones that rattled windows across the city. Despite the size of the blasts, no casualties were reported, Spc. Jennifer Fulk, a U.S. military spokeswoman, said early Wednesday. There was no information yet on the cause of the fire, Fulk said." The exact same report can be found at TrueBlueLiberal, Statesman, McClatchy and other minor news sources, but a search on CNN, CBS, ABC etc turns up nothing. Reuters has this: " BAGHDAD (Reuters) - A fire broke out at an ammunition dump at a U.S. base in southern Baghdad on Tuesday night, causing a series of explosions that rocked the capital, the U.S. military said in a statement. "The explosions are from ammunition "cooking off,"" the military said, adding that it had no immediate reports of U.S. casualties." Apparently this was a gargantuan series of explosions started by a rocket attack on the arsenal, known as Camp Falcon. The place burned and exploded for six hours. According to the Iraqi Resistance Report from Free Arab Voice: " The correspondent for Mafkarat al-Islam reported that the arsenal, located in the as-Saqr Base in the south of Baghdad is the main supplier of equipment to the US forces. It came under Resistance rocket attack late on Tuesday night. At the time of reporting, mountains of American arms and ammunition were continuing to explode in the sky in a huge fire unprecedented in Baghdad

Tags: baghdad, ammunition, fire, explosions, tuesday

#fullpost {display:none;} Everything's fishy here... LEWISTON - No federal charges resolution be lodged against the city spirit who alike a pig's text into a local mosque go on instant. \" We're not bustle exude with our prosecution ,\" Assistant U.S. Attorney Average Halsey Frank said Friday. Brent Matthews, 33, said the frozen signature slipped from his furnishs individual night outlast summer and flat as the open door of the Lisbon Street storefront that serves as a mosque over posts of the Somali citizens. He was anon arrested further charged with the misdemeanor of defacement along desecration of a hangout of worship. The Maine Attorney Boiler plate's Dispensation was successful tween getting the court to detail an injunction against Matthews under the Maine Civil Rights Act, ordering him to catch away from the mosque. If he were to violate that injunction, he could face completed to a clock betwixt jail. Agents from the Federal Staff of Criterion conferred with local police mostly the incident, corroborating the possibility of charging Matthews with a federal hate crime. But Matthews' attorney, James Howaniec said Thursday he was assured his client would not face federal charges. Whereas his interpretation is all told understandable, you learn, he was faultless walking about with a frozen pig start that utterly happened to inventory into the mosque's doors. Perfect. Is it me or does he street talk admire he's full of chitterlings? Lick out the comments scene proximate the article to invent some [disgusting] reactions. Read More... Confession select...

Tags: mosque, federal, matthews, attorney, pig

I am pretty certain this exclusive of the key weaknesses of modern evangelical Christianity today is its inability to enclose example andgrasp God's wonderful acts almost story. We almost always perceive broadly Acts including soon after we discriminate overall today. What happened during the 18 centuries surrounded by between? Moderately, there was a Correction halfway the 16th C. but duplicate than this, um not much. Profound including weak. Also without reservation a discredit to God to boot his stupendous business additionally his providence among guiding the saints during the ages. Irhamna ya Rrab (Enjoy mercy earthly us Lord)! Robert Webber died latterly, again he was not double a specimen. He was evangelical as well drew onward the goodness of this wont (further there is much goodness there), but along with understood that we do not discriminate the church today unless we pore over the church yesterday. Know his obituary at href=\"http://information superhighway.christianitytoday.com/story/news letter/2007/may3.html\">Christian History.

Tags: today, god, acts, church, goodness

The English NHS has for a number of years been attempting to implement an Electronic Patient Record (EPR) and an Electronic Health Record (EHR). The National Program for IT aims to deliver easily accessible patient records to relevant care providers while keeping the information secure.  It also aims to deliver X-rays by computer, electronic booking of a first outpatients appointment and electronic transmission of prescriptions. (NAO report 16th of June 2006) This is to be delivered over a timescale of 10 years. The NAO claims that areas of this program are on track.  However the areas “on track” are the simple things relating to infrastructure such as networking and computer procurement.  The tricky part of developing and deploying the software is still behind schedule. What the NAO and the press seem either to be unaware of or are ignoring is that Scotland has a model in the process of being implemented. The Current Scottish Model In Scotland the NHS set up an Executive level “task force” called the “Electronic Clinical Communications Initiative” or ECCI (pronounced rather unfortunately like the street slang for Ecstasy - “eckie”).  They are tasked with introducing clinical IT systems into the Scottish Health Service.  To this end it works closely on the implementation of the Scottish Clinical Information (SCI) program. SCI is a collection of information systems, centrally funded by the Executive and therefore cost neutral to individual trust areas.  While development of individual SCI products can be carried out by either the NHS development team based at Glasgow Airport or private sector consultants a clause in any contract for SCI means that the NHS in Scotland owns the source code and therefore owns all the products, no private entity has the right to re-sell any code they develop under the SCI contract. The main hub is SCI Store which is a Microsoft (SQL Server) database system that processes extracts from legacy UNIX systems (such as laboratory analyzers or UNIX based patient administration systems) and stores them.  Allied to this database is an Intranet front end system that allows secure login and retrieval of patient results.  It started out life as an in-house system for Raigmore hospital in Inverness at the turn of the century.  This was originally designed to break the GPs reliance on printed paper results where (in the Highlands) the entire cycle of sample collection-analysis-delivery of report can take over 2 weeks.  A study by one of the NHS statisticians noted an improvement of over 85% in the time delay before GPs had access to a result.  Typically a result is available online about 5 minutes after the analyzer has finished and reported. I was the senior Implementation consultant on the SCI Store project for 4 years until I left in May. Store exposes a number of “web services”.  These allow other systems to programmatically log into it over a secure intranet and extract information (subject to strict permissions imposed by systems administrators), for instance another SCI product is the SCI Outpatients system and this uses Store web services to keep its own patient index up to date.  Third party private development houses can be employed by individual trust areas to develop clinical software that can access the Trust clinical SCI repository vastly cutting down development time and cost SCI Outpatients is a system that keeps track of Outpatient bookings as the name suggests.  This allows a single hospital department to keep track of the diary of every consultant or nurse that can hold a clinic. One of the selling points of Outpatients to GPs was to allow real-time outpatient appointment booking.  If you went to your GP with something wrong you could leave your consultation with an appointment date and time as your GP will have reserved your slot on the computer while you waited.  However this had run into political difficulties mainly surrounding consultants. Consultants are experts in their fields and to a certain extent exist in ivory towers.  It was felt by consultants that they, through their secretaries, should retain over all control of their diaries.  To let a mere GP book slots may ruin a tee-off time they had planned.  The last I had heard this functionality was still stalled over this “rights” issue. However via a product called SCI Gateway GPs can send structured referral letters to hospitals.  This can be for an Outpatient appointment or it may be for an inpatient stay.  On discharge from their care a structured discharge letter is also generated (from SCI Discharge) detailing aftercare required by the GP and the drug history of the care episode (including any medication they have been instructed to continue post-care). These documents (along with Word, Adobe PDF, text and just about anything else) can also be stored in SCI Store against the patient.  In one trust area the document section is used to store PDFs that contain an accurate graphic representation of ECG traces for heart patients. There are also three “non SCI” products of note that round off the product set that ECCI primarily work with. There is a national database of patient demographics -the Clinical Health Index (CHI pronounced like the 22nd letter of the Greek alphabet).  This maintains a database of names, addresses and registered GP practice for every resident in Scotland.  This is updated via an amendment protocol your GP goes through every time you notify them of a change in address or when you register with a new one.  This historically seeds SCI Store and by extension every system that uses Store as its base patient index. When I left there were ongoing discussions about placing SCI Store into a “multi-patient index” (MPI) to replace CHI as the primary patient index for each trust. 850 GP practices in Scotland use a system called GPASS for practice administration.  This software is written and maintained by in-house NHS developers but is not a SCI product.  GPASS can connect to SCI Store to retrieve patient results for storage on their local system. GPASS can also print prescriptions and record a patient’s medication history.  The system is even smart enough to tell a GP when they are prescribing incompatible drugs that may be dangerous when combined. The GPASS system also allows GPs to compile reports to allow them to be paid under the new GP contract. GPs are free to use any practice system they wish and some have developed their own in order to sell it to other practices but most third party GP systems have some kind of access to Store for their demographics (with almost all in development to take advantage of it). Finally there is the Emergency Care Summary (ECS).  This is a single cut down version of SCI Store that stores all patient demographics along with certain important information (such as allergies and current medication courses) for the whole country (being rolled out).  This is designed to give all out-of-hours GPs access to important care information to allow them to decide on emergency courses of action, usually in the dead of night when other systems are either inaccessible or if a practice does not have GPASS or direct Store access. Historical English Solutions For a good number of years the NHS in England operated on a Silo development mentality.  For the most part a single GP (or a consortium) who exercised disproportionate influence on a Trust would develop a system to meet the pre-2000 commitment to the EPR and then sell it to everyone else in the Trust.  Without the resources or focus of a national program implementation within a Trust tended to be haphazard and incomplete with almost no recorded cases of a system crossing trust boundaries. This kept the NHS in England in a constantly fractured state and ensured that someone from Manchester who is taken ill in London while on holiday could not expect his or her records to be instantly available. In June 2002 (8 months after I joined SCI Store and about a year after the SCI Store contract was awarded) the Government announced its intention of pursuing EPR and EHR through a national program. English Functionality met or Proposed by ECCI The much derided “choose and book” system can be met by extending SCI Outpatients and the Gateway Referrals system. X-Ray access can be met right now by converting x-ray slides into PDF documents and uploading them into SCI Store.  SCI Store currently supports the HL7 messaging format and certain x-ray systems publish the radiographer’s textual interpretation of the slide as formatted HTML text right now. Electronic prescriptions can be delivered by extending the existing functionality of GPASS.  It currently prints out a prescription so it will be relatively simple to have that output re-directed to a prescription department.  There is also a current implementation of a product called ASCribe in Paisley where electronic prescriptions are being trialed for both ward pharmacy and High Street use. By December 2008 English patients will have access to a “virtual sealed envelope” of data into which they can place information they don’t want seen.  SCI Store implemented this in February 2006 with version 2.2 of the software in compliance with the Data Protection Act. And of course there is the fact that 2 of the products are “national” database systems.  Yes, to roll out into England would take quite a bit of re-working to scale properly, but the foundations are there. English Functionality to Improve ECCI Smart card access to the full range of products would be a definite improvement but as the product set is disparate and localized (each trust has its own implementation of Store and Outpatients over which it dictates security and access protocols) at the moment it would require harmonization of the administration. Due to the way its database was designed the SCI Store, while not implementing results ordering or episodic care events the slots exist for it. Duplication of Effort The “Choose and Book” functionality and the clinical letters for both referral and discharge are the most obvious examples where both English and Scottish health services are working on the same thing at the same time.  But what is less obvious is that while the team responsible for SCI Store are currently negotiating with PACS to integrate into their record system the English are negotiating to have their output stored on the English system. Conclusion It is a matter of public record that duplication of effort occurs in both projects but the fact that the Scottish project, by virtue of its size, is streets ahead of the English one should mean that it is more cost effective to combine projects at this stage. Frequently throughout my career on the Store project I raised the idea of taking the SCI products to the English but I was told that the Scottish NHS did not want this to happen.  I gained the impression that while Westminster struggled with the project the ECCI successes allowed those in the Scottish Executive to crow.  They are using these two projects in a game of career one-upmanship.  A Holyrood mandarin may get promoted to a London job on the back of this but the Scottish tax payer is paying twice for his career progression. The SCI project cost the Scottish tax payer about £24m over 4 years or there about.  The English model is going to cost every tax payer in the UK £6bn. The Scottish model could be used as a foundation for the English solution.  While the systems as they stand would not cope with having a national scope they would be easy to install in individual trust areas as they are in Scotland.  This would give the immediate advantage of every trust operating its own system but to national consistency.  Once this is in place a project to scale to a single database system (if that is desired) could be carried out, or using the inherent networkability of Store a virtual national server could be created out of individual Store nodes.  The rest of the product set could be deployed in a similar fashion. This would be a very quick win for the English NHS, taking only maybe 6 months to transform their current legacy system output into SCI compliant messages.  Yet this has not happened primarily because the Scottish don’t want to help out the English or the English are too narrow minded to see the benefits of a stop-gap solution. Even in the media this option appears to have passed people by.  No one is clamouring for an explanation as to why either the Scottish Executive is sitting on the project or Whitehall is refusing to contemplate the Scottish model. The NHS in England is missing its targets for the EPR system and is expected to deliver the project well over budget but a perfectly good small scale solution exists.  And its closest implementation is Melrose General Hospital. Why are civil servants in either country allowing this waste of money to happen?  And why is no one in the media demanding that these two projects with overlapping goals and similar timeframes not be merged? Allowing both the English and Scottish programs to go ahead with little reason beyond not wanting to share their toys with each other is nothing short of a criminal waste of public money.  Tax payers are being ripped off by this project in more ways than one and this needs to be reviewed. Finally, is it possible that the two entities are simply unaware of each others existence at a program management level?  Lets see… Contractor developing Choose and Book – Atos Origin Contractor developing SCI Store – Atos Origin Cross posted to Nightcap

Tags: system, sci, store, gp, english