News for today's 2018: 10/25/12

Quit Being So Difficult

9:00 PM Tukiyooo 0

<div dir="ltr" style="text-align: left;" trbidi="on"> Hola y’all! You know what really annoys me? The new trend here in Redneckville of people in Walmart walking along beside their cart holding onto the side of it and pulling it along with them. Way to take up the whole fucking isle assholes. Anyway, that’s not what I’m talking about today. I’m gonna talk about the annoying habit people have of acting as it they’re entitled to a different cuisine every night. Here’s a hypothetical type situation to show you what I mean… <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfiakxdsvEk31hZ4cgRX5Wanmcxp5af5ntIqeHkAQ4npO4mUHZJblr9ccn-LLFwyK0S4Y2QQAzJyant4pQ214x7RQADm992-JjqBY_qjc1sGEDvEDCzOqsaTM-7asz3Qp2e0EQ0E9XXtI/s1600/Hot+Asian+Hooters+Babes.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfiakxdsvEk31hZ4cgRX5Wanmcxp5af5ntIqeHkAQ4npO4mUHZJblr9ccn-LLFwyK0S4Y2QQAzJyant4pQ214x7RQADm992-JjqBY_qjc1sGEDvEDCzOqsaTM-7asz3Qp2e0EQ0E9XXtI/s320/Hot+Asian+Hooters+Babes.jpg" width="320" /></a></div>Me: Hey! Let’s get some dinner? Friend: Sure, sounds great. Me: What do you want? Friend: Oh anything is cool with me. Just whatever. Me: Okay, how ‘bout Chinese? Friend: Yeah, I don’t really like Chinese. Me: Why didn’t you say so? Friend: I didn’t think you’d suggest Chinese. Me: But, you could have said “Anything but Chinese.” Friend: I just thought I’d roll the dice on that one. Me: Okay, not problem. How ‘bout burgers? Friend: I had a burger last night. Now, this is when things get really dicey. When did we become so damn spoiled that we simply will not have the same thing two days in a row? Are we THAT entitled? Do we have some God-given right to have a variety in our meals and never have to double up? What’s worse is that people who do this have never think twice about having leftovers the next day at home or grabbing a cold slice of pizza from the night before and having it for breakfast. Why pretend to be so pretentious about this shit with your friends? And just because you had Mexican last night doesn’t mean you can’t have Mexican tonight! So you had a quesadilla yesterday? Big deal! Have chimichanga today. What’s so difficult about that? Mexicans have Mexican food almost every single day. They don’t bitch about it. Or maybe you had Eggplant Parmigiana last night. Have the Chicken Marsala tonight! It won’t hurt you. It’ll be delicious. Italians do shit like this all the time. And, like Mexicans, they don’t bitch about it either, which is amazing because Italians pretty much bitch about everything. Hell, A BILLION Chinese have Chinese food two or three times a day, every single day of their lives. They don’t DEMAND something different every night. They don’t ask to mix it up and not have the same thing twice in a row, or twice in a week. Hell, I could have Peking Duck several nights in a row without any complaint whatsoever. Love the crispy skin! Basically people, if someone asks where you want to go for lunch, don’t say “Oh anywhere you want is fine with me” if it isn’t. See, despite my love of Asian women, I’m not a fan of Chinese food. So, if I’m asked if I have a preference, I’ll say “Anything but Chinese is great” because it is. But, if they don’t ask for a preference and they go to a Chinese place, I will be able to find something I can live with and won’t complain. That’s just the considerate kind of guy I am. Of course, there’s another annoying person in this situation too. I’m talking about the guy who says “Hey let’s go to breakfast (or lunch or dinner), I’m paying. Wherever you want to go is good with me dude.” And then you get someplace and he’s like “Damn, this is a pretty expensive place. I was thinking Waffle House instead of Bob Evans.” Don’t be either of these people y’all. Just suck it up, order something yummy and have fun assholes. Jayman <a href="mailto:Jayman3768@gmail.com">Jayman3768@gmail.com</a> <a href="http://www.twitter.com/jayman_iws" target="_blank">@Jayman_IWS </a> </div>

Quit Being So Difficult

Hola y’all! You know what really annoys me? The new trend here in Redneckville of people in Walmart walking along beside their cart holding onto the side of it and pulling it along with them. Way to take up the whole fucking isle assholes. Anyway, th…

Study: We overestimate how much medicine can do - Washington Post

8:00 PM Tukiyooo 0

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; " class="">Between 2003 and 2005, a team of researchers at Harvard asked over 1,000 cancer patients about their expectations for chemotherapy.</div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">All patients surveyed had received a diagnosis of metastatic lung cancer or colorectal cancer four months earlier. These are some of the most difficult-to-treat conditions. Medical research says that, in these extremely challenging cases, chemotherapy can extend life by weeks or months but it is very unlikely to provide a cure.</div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; " class="">That's what the science tells us — but that's not what most late-stage cancer patients believed. The majority who elected to have chemotherapy believed there was a chance it would do something it wouldn't: Namely, provide a cure.</div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Sixty-nine percent of lung cancer patients and 81 percent of colorectal cancer patients gave responses "that were not consistent with understanding that chemotherapy was very unlikely to cure their cancer," the researchers <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1204410#t=articleDiscussion" style="border: 0px; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; color: rgb(0, 0, 0); text-decoration: underline; " class="">report</a> in this week's New England Journal of Medicine.</div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; " class="">"I was really surprised," says lead study author Jane Weeks, a professor at Harvard Medical School. "Prior studies have suggested maybe a third of patients don't understand. Those studies are done in the optimal setting though, and this was the first to look at a big population. I thought the numbers were disturbingly high." </div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">The most surprising finding in this study, though, might come from when the researchers looked at what the patients' thought of their doctors. The survey asked about how good their oncologists were at communicating about treatment.</div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">Patients who rated their doctors as the very best communicators, the most open and honest, were the most likely to have the unrealistic, inaccurate expectations.</div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">"This suggests that patients perceive physicians as better communicators when they convey a more optimistic view of chemotherapy," the authors conclude. "Similarly, the finding that patients, especially those with colorectal cancer, who were treated in integrated networks were somewhat more likely to understand that chemotherapy is not curative suggests that providers may be able to improve patients' understanding if they feel it is part of their professional role."</div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); " class="">In a weird way, the health-care law may encourage doctors to make a rosier prognosis than the medical evidence warrants. Beginning this month, <a href="http://online.wsj.com/article/SB10000872396390443890304578010264156073132.html" style="border: 0px; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; color: rgb(0, 0, 0); text-decoration: underline; " class="">the health-care law tethers some hospital payments to patients' rankings of their hospital experience</a>. The whole idea is to improve the patient's hospital stay. If patients are happier, the thinking goes, they're probably getting higher quality care. </div><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-family: georgia; font-style: normal; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 22px; padding-left: 0px; vertical-align: baseline; line-height: 1.5em; color: rgb(0, 0, 0); font-size: 15px; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; " class="">"This is a cautionary tale," Weeks says. "I think everybody agrees that satisfaction alone is an incomplete measure of quality. It doesn't give you the whole story. I think this is an example of that."</div></div><a href="http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/10/25/study-we-overestimate-how-much-medicine-can-do/?print=1" class="">http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/10/25/study-we-overestimate-how-much-medicine-can-do/?print=1</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""> </div>

Study: We overestimate how much medicine can do - Washington Post

Between 2003 and 2005, a team of researchers at Harvard asked over 1,000 cancer patients about their expectations for chemotherapy.All patients surveyed had received a diagnosis of metastatic lung cancer or colorectal cancer four months earlier. Thes…

Senior Internal Auditor (SOX/Operational auditing , Internal/General Audit Exp) (#108641)

1:48 PM Anonymous 0

<div dir="ltr" style="text-align: left;" trbidi="on"> <div dir="LTR">Position: Senior Internal Auditor Location: Milpitas, CA Duration: Full time Job Description: Responsibilities: 1) Maintaining all organizational and professional ethical standards. Works independently under general supervision with considerable latitude for initiative and independent judgment. 2) Supports the development of the annual risk assessment and provides input to the development of the Annual Audit Plan. 3) Conducting and documenting audits of key internal controls (SOX 404) and key operational processes. 4) Performing audit procedures, including:                    + Designing audit program           + Conducting interviews, reviewing documents, and preparing working papers           + Reviewing and analyzing evidence and documenting processes and procedures           + Identifying, developing, and documenting audit issues and recommendations. 5) Communicating or assist in communicating the results of audit projects via written reports and/or oral presentations to management. 6) Working with divisional and functional management to develop and implement practical solutions to address audit findings. 7) Pursuing professional development opportunities, including external and internal training and professional association memberships, and shares information gained with co-workers. Preferred Qualifications: 1) Candidate must have BS/BA degree in Accounting or Finance; certification as a CIA /CISA /CPA is highly preferred. 2) Candidate must have a minimum of 2-4 years audit experience. Experience with the Big 4 audit firms or in similar internal audit roles in large organizations highly preferred. 3) Considerable knowledge of and skill in applying internal auditing and accounting principles and practices. 4) Considerable skill in planning and project management, and in maintaining composure under pressure while meeting multiple deadlines. 5) Considerable skill in effective verbal and written communications, including interviewing skills and presenting findings and recommendations. 6) Skill in negotiating issues and resolving problems. 7) Candidate must be a self-starter and be objective and work independently. Minimum Qualifications: Bachelor's Level Degree with at least 5 years of experience. OR Master's Level Degree with at least 4 years of experience. Kindly send your resumes to <a href="mailto:sivaram.bose@kla-tencor.com">sivaram.bose@kla-tencor.com</a></div></div>

Senior Internal Auditor (SOX/Operational auditing , Internal/General Audit Exp) (#108641)

Position: Senior Internal Auditor Location: Milpitas, CA Duration: Full time Job Description: Responsibilities: 1) Maintaining all organizational and professional ethical standards. Works independently under general supervision with consid…

Internal Auditor (SOX 404, Internal/General Audit, Planning, CPA) (#108696)

1:46 PM Anonymous 0

<div dir="ltr" style="text-align: left;" trbidi="on"> <div dir="LTR">Position: Internal Auditor Location: Milpitas, CA Duration: Full time Job Description: Responsibilities: 1) Maintaining all organizational and professional ethical standards. Works independently under general supervision with latitude for initiative and independent judgment. 2) Supports the development of the annual risk assessment and provides input to the development of the Annual Audit Plan. 3) Conducts and documents audits of key internal controls (SOX 404) and key operational processes 4) Performs operational audit procedures, including:           + Designing audit program           + Conducting interviews, reviewing documents, and preparing working papers           + Reviewing and analyzing evidence and documenting processes and procedures           + Identifying, developing, and documenting audit issues and recommendations. 5) Communicates or assists in communicating the results of audit projects via written reports and/or oral presentations to management. 6) Works with divisional and functional management to develop and implement practical solutions to address audit findings. 7) Pursues professional development opportunities, including external and internal training and professional association memberships, and shares information gained with co-workers. Preferred Qualifications: 1) Candidate must have BS/BA degree in Accounting or Finance; certification as a CIA /CISA /CPA is highly preferred. 2) Candidate must have a minimum of 1-3 years audit experience. Experience with the Big 4 audit firms or in similar internal audit roles in large organizations highly preferred. 3) Knowledge of and skill in applying internal auditing and accounting principles and practices. 4) Strong skills in planning and project management, and in maintaining composure under pressure while meeting multiple deadlines. 5) Effective verbal and written communications, including interviewing skills and presenting findings and recommendations. 6) Skill in negotiating issues and resolving problems. 7) Candidate must be a self-starter, be objective and work independently. Minimum Qualifications: Bachelor's Level Degree with at least 2-3 years of experience, or equivalent. OR Master's Level Degree with at least 1-3 years of experience, or equivalent. Kindly send your resumes to <a href="mailto:sivaram.bose@kla-tencor.com">sivaram.bose@kla-tencor.com</a></div></div>

Internal Auditor (SOX 404, Internal/General Audit, Planning, CPA) (#108696)

Position: Internal Auditor Location: Milpitas, CA Duration: Full time Job Description: Responsibilities: 1) Maintaining all organizational and professional ethical standards. Works independently under general supervision with latitude for …

Substitute Children’s Librarian - Russell Library, Middletown

12:06 PM Anonymous 0

Substitute Children’s Librarian - Russell Library, Middletown. Join an exciting and energized Children’s Services Team. Russell Library needs qualified substitutes for our busy Children’s Department. You will be actively involved in reader’s advisory and reference and occasionally assist with programming. Applicants must have a Master’s Degree in Library Science and a genuine desire to work with children of all ages. Strong reference and reader’s advisory skills and comfort with a variety of computer software programs are required, as is knowledge of children’s literature and child development in terms of age-appropriate activities and behaviors. Hourly pay rate: $25.39. Applications are available at: <a _fcksavedurl="http://russelllibrary.org/about_us/employment.html" href="http://russelllibrary.org/about_us/employment.html" target="_blank">http://russelllibrary.org/about_us/employment.html</a>. Submit applications by email (or in hard copy) by November 23, 2012 to: Arthur S. Meyers, Director, Russell Library, <a _fcksavedurl="mailto:ameyers@russell.lioninc.org" href="mailto:ameyers@russell.lioninc.org">ameyers@russell.lioninc.org</a>,123 Broad Street, Middletown, CT 06457. You may include your email address to expedite communication.

Substitute Children’s Librarian - Russell Library, Middletown

Substitute Children’s Librarian - Russell Library, Middletown. Join an exciting and energized Children’s Services Team. Russell Library needs qualified substitutes for our busy Children’s Department. You will be actively involved in reader’s advis…

sick

6:43 AM Anonymous 0

Sorry I've been MIA y'all. (I swear this wasn't part of my 'teasing' plan). This flu is no joke!! I'm going on day two and still no better. I'll be back as soon as the room stops spinning. <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5wsGeIBzUfvpkzxiW8yMNBjG3kVmcJj0PPcy79YzDVGL9V2RKpjiAJj23YPOnKk9fnNANuMsCZruvT-oh4npqYCpPnPlVpQdZUbku973nmsMBsV-fUFgkwdMKdbR2gNRQhd_kutMDj4dz/s1600/likes.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5wsGeIBzUfvpkzxiW8yMNBjG3kVmcJj0PPcy79YzDVGL9V2RKpjiAJj23YPOnKk9fnNANuMsCZruvT-oh4npqYCpPnPlVpQdZUbku973nmsMBsV-fUFgkwdMKdbR2gNRQhd_kutMDj4dz/s400/likes.jpeg" width="246" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">via <a href="https://www.tumblr.com/">Tumblr</a></td></tr></tbody></table>

sick

The Nurse as Family Doctor - NYTimes.com

3:42 AM Tukiyooo 0

The Family Health Clinic of Carroll County, in Delphi, Ind., and its smaller sibling about 40 minutes away in Monon provide full-service health care for about 10,000 people a year, most of them farmers or employees of the local pork production plant. About half the patients are Hispanic but there are also many German Baptist Brethren. Most of the patients are uninsured, and pay according to their income — the vast majority paying the $20 minimum charge for an appointment. About 30 percent are on Medicaid. The clinics, which are part of Purdue University's School of Nursing, offer family care, pediatrics, mental health and pregnancy care. Many patients come in for chronic problems: obesity, diabetes, hypertension, depression, alcoholism. What these clinics don't offer are doctors. They are two of around 250 health clinics across America run completely by nurse practitioners: nurses with a master's degree that includes two or three years of advanced training in diagnosing and treating disease. By 2015, nurse practitioners will be required to have a doctorate of nursing practice, which means two or three more years of study. Nurse practitioners do everything primary care doctors do, including prescribing, although some states require that a physician provide review. Like doctors, of course, nurse practitioners refer patients to specialists or a hospital when needed. America has a serious shortage of primary care physicians, and the deficit is growing. The population is aging — and getting sicker, with chronic disease ever more prevalent. Obamacare will bring 32 million uninsured people into the health system — and these newbies will need a lot of medical care. According to the American Association of Medical Colleges, the United States will be short some 45,000 primary care physicians by 2020. The primary care physicians who do exist are badly distributed — 90 percent of internal medicine physicians, for example, work in urban areas. Some doctors go to work in rural areas or the poor parts of major cities, treating people who have Medicaid or no insurance. But they are few. In part it's the money. Primary care doctors make less than specialists anywhere, but they take an even larger financial hit to treat the poor. Particularly in the countryside — even with programs that offer partial loan forgiveness, it's very hard to pay off medical school debt treating Medicaid patients, much less those with no insurance at all. And the job of a primary care doctor today is largely managing chronic disease — coordinating the patient's care with specialists, convincing him to exercise or eat better. Poor patients can be a frustrating struggle. Compared with wealthier patients, they tend to have more serious diseases and fewer resources for getting better. They are less educated, take worse care of themselves and have lower levels of compliance with doctors' orders. Very few people start medical school hoping to do this kind of work. Those who do it may burn out quickly. It might seem that offering the rural poor a clinic staffed only by nurses is to give them second-class primary care. It is not. The alternative for residents of Carroll County was not first-class primary care, but none. Before the clinic opened in 1996, the area had some family physicians, but very few accepted Medicaid or uninsured patients. When people got sick, they went to the emergency room. Or they waited it out — and then often landed in the emergency room anyway, now much sicker. Just as important, while nurses take a different approach to patient care than doctors, it has proven just as effective. It might be particularly useful for treating chronic diseases, where so much depends on the patients' behavioral choices. Doctors are trained to focus on a disease — what is it? How do we make it go away? Nurses are trained to think more holistically. The medical profession is trying to get doctors to ask about their patients' lives, listen more, coach more and lecture less — being "patient-centered" is the term — in order to better understand what ails them. "I've been out of nursing school since 1972 and I still remember that when faculty members finished talking about the scientific parts of the disease they would talk about the psycho-social part," said Donna Torrisi, the executive director of the Family Practice and Counseling Network, which has three clinics in Philadelphia. "It's not about the disease, it's about the person who has the disease. While in the hospital you'll often hear doctors refer to a patient as 'the cardiac down the hall.'" Younger doctors are no doubt better at this than their older peers. But the system conspires against them. The 15-minute appointment standard in fee-for-service medicine — which pays doctors according to how many patients they see and treatments they provide — makes it unlikely that doctors will spend time discussing a patient's life in any detail. Physician reimbursement places a zero value on talking to the patient. But nurse practitioners are salaried, giving them the luxury of time. At the Family Health clinics, appointments last half an hour — an hour for a new diabetic or pregnant patient. Jennifer Coddington, a pediatric nurse practitioner who is a co-clinical director of Family Health Clinics, said that she spends a lot of time teaching patients and their families about their diseases and how to manage it. "We want to know socially and economically what's going on in their life — their educational level, how are they making it financially," she said. "You can't teach patients if you're not at their educational level. And if a patient can't afford something, what's the point of trying to prescribe it? He's going to be non-compliant." A physician might suggest that a patient lose weight and hand him a diet plan — or refer him to a nutritionist. At the Family Health clinics, nutrition counselors — graduate students at Purdue — will sit down with patients to talk about the specific consequence of their diet, and suggest good foods and how to cook them, Coddington said. "When you don't have enough money to buy fruits and vegetables, so you go to the dollar menu at McDonald's — we help those people put planners together for the week." Data has shown that nurse practitioners provide good health care. A reviewof 118 published studies over 18 years comparing health outcomes and patient satisfaction at doctor-led and nurse practioner-led clinics found the two groups to be equivalent on most outcomes. The nurses did better at controlling blood glucose and lipid levels, and on many aspects of birthing. There were no measures on which the nurses did worse. Nurse-led clinics can save money — but not always in the obvious way. Many are cheaper than comparable physician-led clinics. Suzan Overholser, the business manager of the Family Health clinics, said that their cost per patient was $453 per year — lower than the Indiana average for similarly federally qualified clinics (all the others physician-led) of $549. But nurse-led clinics aren't always cheaper. Coddington examinedpublished studies of clinic costs and found that in some cases, nurse-managed clinics had slightly higher per-patient costs than traditional clinics. Although nurses are paid less than doctors (Medicare reimburses them at 85 percent of what it pays doctors,) nurse-led clinics are often very small, and so don't have the variety of practitioners necessary to keep a clinic running at full capacity. They also serve the most difficult and expensive patients. The biggest financial benefit, however, likely comes from offering patients an alternative to the emergency room. Coddington's review cites studies showing large savings in paramedic, police, emergency room and hospital use. A traditional clinic in an underserved area would do that, too, of course — it's just that nurses tend to go where doctors won't. There are about 150,000 nurse practitioners in America today. The vast majority practice in traditional settings — only about a thousand are in nurse-managed clinics. One reason these clinics are rare is that they may equal traditional clinics in health care, but not in business success. Nurse-managed clinics have to overcome regulatory and financial obstacles that traditional clinics don't face. Powerful physicians' groups such as the American Academy of Family Physicians opposeallowing nurses to practice independently. "Granting independent practice to nurse practitioners would be creating two classes of care: one run by a physician-led team and one run by less-qualified health professionals,"says a paper from the A.A.F.P., citing the fact that doctors get more years of education and training. "Americans should not be forced into this two-tier scenario. Everyone deserves to be under the care of a doctor." Only 16 states and Washington, D.C., allow nurses complete independence. In other states, some of the restrictions are bizarre — in Indiana, for example, nurse practitioners may do everything doctors do, with two exceptions: they can't prescribe physical therapy or do physicals for high school sports. Jim Layman, the executive director of the Family Health clinics, said he thought that nurse practitioners cared for the majority of Medicaid patients in Indiana. But if you look through Medicaid records, you'll find only doctors — nurses are not allowed to be the primary caregiver of record. So the Family Health clinics, like others, employ a physician off-site from 4 to 6 hours a week who uses electronic health records to examine a sample of cases and consult when necessary. Medicaid is billed in his name. It is not easy for nurse-run clinics to win status as a Federally Qualified Community Health clinic, which would allow them to get federal grants. This is largely because most come out of universities, and most universities don't want to cede control to the community — a requirement for this status. Purdue decided it would, and the Family Health clinics qualified in 2009. Before that, they received some money from the state, and raised the rest from local March of Dimes, United Way and Chamber of Commerce donations, plus fund-raising dinners and auctions. This was enough to support just one full-time provider at each clinic. Getting F.Q.C.H. status allowed them to hire more staff and move the Carroll County clinic into a modern new building — and probably saved them from collapse. "It would have been very difficult for us had we not gotten F.Q.C.H. status," said Coddington. The Affordable Care Act — Obamacare — did authorize $50 million for five years for nurse-managed clinics. So far 10 clinics have gotten a total of $15 million. In some ways, the nurse practitioner-managed clinic is a throwback to the small-town family practice, when your doctor asked about the schoolyard bully and your dad's unemployment. Among the many changes needed in how America values and reimburses health care, it's important to encourage and support these clinics. They may be old-fashioned, but that doesn't mean they should be financed with bake sales. <a href="http://opinionator.blogs.nytimes.com/2012/10/24/the-family-doctor-minus-the-m-d/">http://opinionator.blogs.nytimes.com/2012/10/24/the-family-doctor-minus-the-m-d/</a>?

The Nurse as Family Doctor - NYTimes.com

Daily Education and Technology News for Schools 10/25/2012

2:30 AM Tukiyooo 0

<ul class="diigo-linkroll"> <li> <a href="http://www.ted.com/talks/matt_mills_image_recognition_that_triggers_augmented_reality.html">Matt Mills: Image recognition that triggers augmented reality | Video on TED.com</a> My students and I have been playing with Aurasma today on our ipads and iphones. You have to have a unique image (digital or distinct images are best) and you can attach animations or videos to them. So, a book's page can have a video attached or a painting could have a description attached. It is very cool. This TED video explains the concept. tags: <a href="http://www.diigo.com/user/coolcatteacher/computer_science">computer_science</a> <a href="http://www.diigo.com/user/coolcatteacher/augmentedreality">augmentedreality</a> <a href="http://www.diigo.com/user/coolcatteacher/news">news</a> <a href="http://www.diigo.com/user/coolcatteacher/augmented">augmented</a> <a href="http://www.diigo.com/user/coolcatteacher/arts_entertainment">arts_entertainment</a> <a href="http://www.diigo.com/user/coolcatteacher/education">education</a> <a href="http://www.diigo.com/user/coolcatteacher/invention">invention</a> <a href="http://www.diigo.com/user/coolcatteacher/tumblr">tumblr</a> <ul class="diigo-comments"> </ul> </li> </ul>Posted from <a href='http://www.diigo.com'>Diigo</a>. The rest of my favorite links are <a href='http://www.diigo.com/user/coolcatteacher'>here</a>.

Daily Education and Technology News for Schools 10/25/2012

Matt Mills: Image recognition that triggers augmented reality | Video on TED.com My students and I have been playing with Aurasma today on our ipads and iphones. You have to have a unique image (digital or disti…