Hospitals and local physicians are noticing a spike in the no of respiratory cases in the city        
by Shrutee K/DNS

Mumbai, August 10th, 2017: The rains have arrived and so is the number of diseases along with it. People are aware of the most common ailments such as viral fever, the common cold, malaria, typhoid, diarrhoea, etc. But very few are aware of the respiratory ailments that stems from indoor air pollution in monsoon caused by the dampness in the walls, fungus from air conditioners, floor carpets, velvet upholsteries, sofa covers, wooden furniture harboring fungus, etc. The Hospitals and local physicians in the city have noticed a spike in the no. of cases with respiratory problems. Suspended Particulate Matter is the main trigger of damage in air Pollution. Other contents like SO2, ammonia, carbon, polyaromatic hydrocarbons add to the toxicity. Air pollutants which are less than 10 microns in size enter the smaller airways and causes damage. This may trigger cough, breathing difficulty, choking, chest tightness and Asthma.

Taking adequate precautions are one of the best ways to avoid monsoon-related ailments. All age groups are affected because of air pollution; however, there is a definite rise in asthma and lung infections among children. Also, elderly and diabetics are at a risk of lung infection because of air pollution. Avoiding floor carpets, velvet upholsteries, stuffed toys, burning incense sticks at home and regular cleaning of air conditioner filters are some of the precautions that can be taken to avoid indoor air pollution during the monsoon.

Mr. Girish Bapat, Blueair air purifier, Director West and South Asia Region further added, “Our mission at Blueair is to help Indian women, children and men confront the health challenges posed by rising air pollution. It is very essential to identify the Invisible dangers. Breathing in tiny, unseen pollutants put every individual at risk. These pollutants further pass through the lung tissue and puts you at risk of stroke, heart disease and developing Asthma, Allergy, Bronchitis, Infection and other respiratory problems. Getting acquainted of personal health records, heart rate and blood sugar level, is the best way to safeguard long-term health issues by classifying troublesome concerns at the earliest.”

Blueair’s air purifiers are innovated in Sweden to put people in control of their own air quality with superior filtration efficiency. Sold in over 60 countries around the world, Blueair delivers home and office users cleaner indoor air for enhanced user health and wellbeing faster than any competing air purifier thanks to its commitment to quality, energy efficiency and environmental care. A Blueair air purifier works efficiently and silently to remove airborne allergens, asthma triggers, viruses, bacteria and other pollutants.

          '..to get rid of petrol and diesel vehicles by 2025..' - Britain bans gasoline and diesel cars starting in 2040 (no replies)        
'..The Netherlands and Norway previously said they wanted to get rid of petrol and diesel vehicles by 2025 and Germany and India announced similar plans ahead of 2030.'

- Chloe Farand, France will 'ban all petrol and diesel vehicles by 2040', July 6, 2017


'..Dirty air has been linked to cancer, asthma, stroke and heart disease, among other health issues. The problem is especially pronounced in big cities including London.'

'Britain will ban sales of new gasoline and diesel cars starting in 2040 as part of a bid to clean up the country's air.

The decision to phase out the internal combustion engine heralds a new era of low-emission technologies with major implications for the auto industry, society and the environment.

"We can't carry on with diesel and petrol cars," U.K. environment secretary Michael Gove told the BBC on Wednesday. "There is no alternative to embracing new technology."

Gove said the government's air quality plan, which is set to be officially announced later on Wednesday, was needed because gasoline and diesel engines contribute to health problems, "accelerate climate change, do damage to the planet and the next generation."

Roughly 40,000 deaths in Britain each year are attributable to outdoor air pollution, according to a study published last year by the Royal College of Physicians. Dirty air has been linked to cancer, asthma, stroke and heart disease, among other health issues. The problem is especially pronounced in big cities including London.

The timeline for ending sales of internal combustion engines mirrors one proposed in early July by France. President Emmanuel Macron has given the auto industry the same deadline to make the switch to cleaner tech.

"We are quite rightly in a position of global leadership when it comes to shaping new technology," Gove said.

- Charles Riley, Britain bans gasoline and diesel cars starting in 2040, July 26, 2017


Context

'..to Ban Internal Combustion Engines by 2030'

'..committed to 100 percent clean energy by the year 2050.'

(Global) - '..a revolutionary shift to net zero emissions by 2080..'


'Thorium reactor: cleaner, safer and sustainable nuclear energy within sight'

(Fusion Power) - LPP Focus Fusion 1; '..FF-1 results are right now far ahead..'

'..to develop a series of electric and hybrid aircraft..'


The "CityTree" - 'Air pollution is one of the world's invisible killers.'

          Georgia’s Medical Marijuana Law May Complicate Some Workers’ Compensation Claims        
Back in 2015, the Governor signed into law Haleigh’s Hope Act, which established the Georgia Commission on Medical Cannabis to provide recommendations concerning medical marijuana regulations. The Act allowed individuals with certain illnesses to possess up to 20 ounces of cannabis oil, if approved by their physician. The qualifying illnesses were Crohn’s disease, seizure disorders, […]
          iPatientCare Announced its Significant Achievement of Successfully Reporting PQRS 2016        

iPatientCare abetted Physicians’ Offices in eluding payment adjustments by successfully reporting to CMS through iPatientCare PQRS Registry for 2016.

(PRWeb June 01, 2017)

Read the full story at http://www.prweb.com/releases/iPatientCare/PQRS-Reporting-2016/prweb14387014.htm


          iPatientCare is Pleased to Welcome Physicians' Desk Reference® and Area 51 Data Solutions On Board as Event Sponsors at its NUCON, October 21-23, 2016        

iPatientCare is Proud to Host Physicians' Desk Reference® and Area 51 Data Solutions on National User Conference 2016 as Sponsors and Exhibitors at the Event

(PRWeb October 12, 2016)

Read the full story at http://www.prweb.com/releases/iPatientCare/PDR-Area51/prweb13751489.htm


          iPatientCare EHR Ranked 1st for Osteopathic Physicians & Top 10 in Several Categories by Black Book™ in Its Latest Healthcare Industry Rankings for Physician EHR & PM        

iPatientCare is glad to announce its selection in top 10 position for various categories Including ‘Single & Solo Physician Practices: All Specialties’ by Black Book™ in its 2016 Rankings Ambulatory / Alternate Site EHR

(PRWeb August 30, 2016)

Read the full story at http://www.prweb.com/releases/iPatientCare/BlackBook-Market-Research/prweb13644940.htm


          iPatientCare is Proud to Announce a Launch of PQRS Registry Portal to Enhance Its PQRS Reporting Service        

iPatientCare introduces PQRS Registry Portal to enhance its assistance to Physicians’ Offices in avoiding payment adjustment by successfully Reporting to CMS through iPatientCare PQRS Registry

(PRWeb May 12, 2016)

Read the full story at http://www.prweb.com/releases/iPatientCare/PQRS-Registry-Portal/prweb13407509.htm


          iPatientCare to Demonstrate Physician Quality Reporting System (PQRS) in its Upcoming Virtual User Conference (VUCON)        

iPatientCare announces to conduct its upcoming VUCON session with agenda of sharing knowledge on PQRS to assists the Physicians’ Offices in avoiding payment adjustment by successfully Reporting to CMS through iPatientCare PQRS Registry for the year 2016

(PRWeb April 28, 2016)

Read the full story at http://www.prweb.com/releases/iPatientCare-VUCON2016/PQRS-Reporting-2016/prweb13370252.htm


          iPatientCare Announced its Significant Achievement of Successfully Reporting PQRS 2015 Measures for Eligible Providers and GPRO        

iPatientCare assists Physicians’ Offices in avoiding payment adjustment by successfully Reporting to CMS through iPatientcare PQRS Registry for 2015

(PRWeb April 20, 2016)

Read the full story at http://www.prweb.com/releases/iPatientCare/PQRS-Registry/prweb13352471.htm


          Pain Management        

Pain management (also called pain medicine or algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician assistants, nurse practitioners, and clinical nurse specialists. Types […]

The post Pain Management appeared first on Medical Treatment, Medical Treatment centre, Medical healthcare Centre.


          Diuretic Herbs Weight Loss        

Diuretic Herbs Weight Loss Quote:"I told my doc dr. md medico physician bushel fix I get identical selfsame rattling real really banal commonplace hackneyed ...

The post Diuretic Herbs Weight Loss appeared first on Buy Fat Burner Pills.


          Hand Therapy Using Hand Bath        
Special Recommend information on A H1N1 (swine flu)
As it is known to all, currently we human being are all faced with a big enemy-A/H1N1 flu (swine flu) which has been threatening our life. Now the situation is worsening. As health and medical to AH1N1organ, we shoulder more responsibility to handle outbreak of this emergency.

In TCM, A/H1N1 belongs to epidemic febrile disease of TCM which is the same as human avian influenza and SARS and similar to A/H1N1 flu syndrome differentiation and treatment of TCM prevention and cure. It is advocated “dispelling wind, reducing fever and dissipating dampness in clinical.

TCM center will provide latest Special Report Globally on the A/H1N1 flu; and you still can find the Symptoms and Prevention about A/H1N1 flu ; further more, TCM prevention for swine flu provides latest global news; Chinese medicine prevention for A/H1N1 flu ; Chinese herbal medicine and so on.


Hand bath is a steaming and washing therapy. The hot steam from an herbal decoction is used to heat the hands which are then soaked in the warm decoction after it gradually cools down. Diseases can be cured by the hot stimulation applied to the meridians and acupoints of the hand and by the gradual absorption of herbs through the skin.

1. Origin and classification of steaming and washing therapy:

Steaming and washing therapy originated in ancient times. Among 52 ancient herbal therapy recipes unearthed from the Han Dynasty Mawangdui Tomb, eight were used for steaming and washing therapy. This indicates that steaming and washing therapy has been used by Chinese people to treat diseases for at least 2,000 years. This therapy is also mentioned in classical medical books of the Han (206 B. C.-220) and Jin (265-420) dynasties. During the Tang Dynasty (618-907), this method was used to treat carbuncles, cellulitis, skin rashes, dermatitis, frostbite, hand and foot diseases, and gynecological and eye disorders. In the Kin (1115-1234) and Yuan (1271-1368) dynasties this method was classified as an essential medical therapy. In the Qing Dynasty ( 1644-1911 ), Wu Shangxian, a famous physician of traditional Chinese medicine, divided this therapy into smoking, steaming, shower, sitz bath, and hot ironing. It is a folk treatment used by common people to treat acute sprains, bone injuries, and contusions with a good therapeutic results.
Steaming and washing therapy can be classified as general and local. Local treatment includes steaming and washing therapy for the hand, foot, and eye, and sitz baths. Hand bath is steaming and washing therapy for the hand.

2. Function and characteristics of hand bath:

As demonstrated by the experiments of modern medicine. steaming and washing therapy with hot and moist air can promote the absorption of herbs through the skin, dilate the skin's small blood vessels, promote the circulation of blood and lymph, enhance the phagocytic functions of the reticuloendothelial system, increase the permeability of cellular membranes, and promote metabolism by stimulating the sensitive sensory nerves scattered along the skin. The effective components of herbs used in steaming and washing therapy can directly kill the pathogenic germs on the skin. According to the theory of traditional medicine, the meridians of the hand are closely related to the organs and meridians of the entire body. Therefore, this therapy can clear stagnation in meridians, adjust bodily deficiency and excess, and promote circulation of qi and blood.
The hand bath is simple, cheap, and easy to learn and practice, with numerous indications and good therapeutic effects, and without any harmful side effects. It is most useful for patients proscribed from taking drugs.

3. Methods of manipulation:

1) The proper recipe is selected according to the diseases and the basin, towel and sheets are prepared in use.
2) The hot decoction of herbs is poured into the basin and the hands and arms are put over the basin. Cover the arms and basin with a sheet to reserve the hot air from quickly escaping away. Some boiled water may be added to the basin to maintain the temperature. After the decoction is cooled down to an adequate temperature, the hands may be soaked and washed in the decoction.
3) After steaming and bathing, the hands should be dried with a towel and protected from attack of wind and coldness.
4) The steaming and washing therapy may last for 20-30 minutes, twice a day.

4. Precautions:

I) The water used to boil the herbs should be adequate to prepare a decoction of the proper concentration. Aromatic and volatile herbs should be boiled for only 10-15 minutes; and roots, stems and herbs in large clumps should be boiled for 30
minutes.
2) The temperature of the decoction for bathing and soaking the hands should be monitored to avoid burning the skin.
3) These decoctions are not for oral administration.

More information from TCM and health: Hand Therapy Using Hand Bath
          Hand Therapy Using Miscellaneous Methods        
Special Recommend information on A H1N1 (swine flu)
As it is known to all, currently we human being are all faced with a big enemy-A/H1N1 flu (swine flu) which has been threatening our life. Now the situation is worsening. As health and medical organ, we shoulder more responsibility to handle outbreak of this emergency.

In TCM, A/H1N1 belongs to epidemic febrile disease of TCM which is the same as human avian influenza and SARS and similar to A/H1N1 flu syndrome differentiation and treatment of TCM prevention and cure. It is advocated “dispelling wind, reducing fever and dissipating dampness in clinical.

TCM center will provide latest Special Report Globally on the A/H1N1 flu; and you still can find the Symptoms and Prevention about A/H1N1 flu ; further more, TCM prevention for swine flu provides latest global news; Chinese medicine prevention for A/H1N1 flu ; Chinese herbal medicine and so on.

Besides massage, acupuncture, hand bath, and hand qigong, there are some other therapies applied to or near the hand including holding herbs, pressing and kneading maneuvers applied along the second metacarpal bone, swinging arms, and playing bracelet or ball with the hand.
1. Holding herb therapy
As an external treatment herbs, properly selected according to the nature of the disease, are held in the hand as a treatment for various ailments.
This is an ancient therapy. Herbs that induce sweating and promote digestion are best absorbed through the skin of a hot and moist palm to stimulate the meridians and acupoints of the hand.
Herbs for particular diseases come in a variety of shapes and patterns such as pills or powders, easy to hold in the hand. Fresh raw herbs are also produced for therapeutic use. Before holding the herbs, the hands should be soaked in hot water for a while. The herbs are then held in the hand until a slight sweating is induced. The herbs should be wrapped in gauze and secured to the palm by bandage for babies and young children.
This method is used to treat common colds, headache, facial palsy, and indigestion in children.
Corrosive or allergenic herbs should not be used, and it is contraindicated for patients with ulcers or wounds of the palm.
2. Pressing and kneading therapy beside the second metacarpal bone
The pressing and kneading maneuvers are applied at the points on the radial side of the second metacarpal bone for treating various diseases.
The location, indications, and principles for selecting points have been discussed in Acupuncture for Hand Therapy.
The pressing and kneading maneuvers are chiefly applied in an area around Hegu (LI 4) acupoint. The Hegu acupoint is an important point used to control pain all over the body and is especially effective for stopping pain of the head and face and in the chest, abdomen, and upper and lower limbs.
The patient is asked to relax the hand muscles and make a hollow fist with the radial side facing upward. The physician holds the patient's fist by one hand and applies pressure with some kneading movement at a frequency of 150 per minute at Hegu acupoint with the thumb of the other hand to produce a sore, distending, heavy, and numb sensation for three minutes.
The point should be correctly located; the pressure should be vertically applied to a deep layer, and should be gentle to avoid damaging the skin.


3. Swinging arm exercise
This exercise was developed and taught by Mr. Tian Ruifang in Shanghai, 1961. It is a physical exercise, simple and easy to learn and practice and effective for treating certain chronic diseases.
l) Preparation: Before starting the exercise, the practitioner should be rid of all mental distractions, calm the mind, and fully relax every part of the body and remain this way for 3-5 minutes.
2) Posture:
(1) The feet are separated to a distance the width of the shoulders to maintain a natural stance, with the head and body kept erect, the knees naturally and slightly flexed, and the arms freely dangling down (Fig. 34).
(2) The neck is relaxed, the chin is held slightly backward and the vortex of the head, Baihui (GV 20) acupoint (at midpoint between bilateral tips of ear auricle), is intentionally raised upward.
(3) The pectoralis major muscles are relaxed and the shoulders are slightly drawn forward to draw in the chest and straighten the back and to produce a counteraction against the intentional upward ascent of the vortex of the head. The qi may move
downward to Dantian when the chest is drawn in; and the qi may diffuse all over the abdomen when the abdomen is relaxed. After the clear qi is moved upward and the dirty qi is moved downward, a result of "deficiency in upper part and excessiveness in lower part of body" can occur.
(4) The shoulders are relaxed and sagging to draw in the chest and move the qi downward to Dantian. Otherwise, the qi may move upward, if the shoulders are shrugged.
(5) The thigh, leg, and foot are all relaxed.
(6) The muscles all over the body are relaxed with a smiling face and a generally comfortable demeanor.
(7) The tongue should be naturally flat in the mouth. The mouth and teeth should be lightly closed, because the mouth and tongue may become dry if the mouth is opened; and the practitioner cannot relax the body if the mouth is tightly closed and the teeth gnashed.
3) Method of performance:
(1) Both naturally extended arms are moved forward with the shoulder joints as a fulcrum, the fingers are naturally and comfortably extended, the palms are slightly concave and facing forward, and the thumbs are slightly flexed and pointing downward. The hands are moved forward and upward, but not beyond the umbilicus (Fig. 35).
(2) The shoulders are relaxed and the arms swing freely backward to the initial position, but not beyond the buttocks, with the shape of the palms unchanged (Fig. 36). The forward and backward movement of the arms are continuously repeated.
(3) The arms are moved back and forth by the relaxed shoulders. The shoulders should not be shrugged and the arms always move parallel. The arms are moved forward by a force conducted from the shoulder and then freely swung backward by gravity, as a repeated movement with arms alternately kept tense and relaxed.
(4) The palms are slightly concave and the fingers are slightly flexed and separated, because the full extension of tight fingers may interfere with meridians and the free circulation of internal qi.
(5) The arms should be naturally extended throughout the back and forth movement and the elbows should not be flexed to move the forearms alone.
(6) The feet are flat on the ground. With increased experience, the practitioner may keep a stance with the toes firmly holding the ground.
(7) The swinging arm exercise should be carried with the body relaxed, quiet, and natural.
4) Repetitions, speed, and silent counting:
More information from
TCM and health
          Canadians Advocate Boosting Vitamin D in Pregnancy        

A Canadian medical society recommends pregnant women and nursing moms boost their intake of vitamin D dramatically

Food for Thought

Canadian pediatricians certainly aren't shirking controversy when it comes to a vitamin guideline they've developed for pregnant women and nursing moms. They're asking these women to boost their intake of vitamin D dramatically—to 10 times the daily doses advocated by most health organizations in the States. This new prescription is aimed at combating rickets—leg deformations caused by soft bones—in youngsters who get too little of the sunshine vitamin.

Vitamin D helps build strong bones by helping the body absorb calcium. Getting pregnant and nursing women to take more of the vitamin ensures that plenty will reach developing children.

In the past, most people had little trouble getting enough vitamin D—they just went outdoors where ultraviolet rays from the sun trigger chemical reactions in skin to make this vital nutrient. However, some people always had trouble making enough. Canadian kids at highest risk of vitamin deficits generally live in First Nations and Inuit communities. With sun-filtering pigments in their skin, and living at high latitudes, they must glean most of their vitamin D from the diet—generally a poor source—not the sun.

Most North American women—including those in the United States—eat diets delivering only about 100 international units, or IU, of vitamin D daily, according to the Institute of Medicine (IOM), in Washington, D.C. That is half of what IOM recommends and a mere 5 percent of what Canadian pediatricians are now advocating for new and soon-to-be moms.

Although IOM's dietary recommendations are for the United States, the Canadian health establishment has tended to rubber stamp them. In this case, though, Canada's health agency took the unusual tack of signing off on a Canadian Paediatric Society proposal to boost the recommended intake by women who are pregnant or breast feeding to 2,000 IU per day. This new guideline appears in a consensus statement published in September by the society in its journal, Paediatrics & Child Health.

Soon the society will begin sending its new guideline to every provincial, territorial, and aboriginal health department across Canada, notes Marie Adèle Davis, the group's executive director. The goal, she told Science News Online, is to make sure all public health officials learn about it—not just pediatricians.

The higher recommendation equals the amount that IOM has designated as the safe upper limit for vitamin D's daily consumption. Most nutritionists don't really consider that value is a true ceiling for safe intake—especially since sunbathing on a bright summer day can generate 10,000 to 20,000 IU in the body without harm. Still, for political and legal reasons, most organizations shy away from advocating intakes near what IOM has flagged as a potential maximum for safe consumption.

Now a number of researchers suspect that intakes by pregnant and lactating women much below 2,000 IU per day could actually prove unsafe for child health.

Reinhold Vieth of the University of Toronto explained why, recently, to officials with Health Canada, a counterpart to the U.S. Food and Drug Administration. To prevent rickets, he argued, a baby needs 400 IU of vitamin D per day. And in many parts of Canada, he said, nursing women may require several thousand IU of vitamin D per day to get 400 IU into their breast milk. Vieth had been recruited by the Canadian Paediatric Society to help defend its proposed guideline to government officials.

U.S. physicians won't quibble over the 400 IU figure for babies and young children, notes pediatrician Frank R. Greer, chair of the American Academy of Pediatrics' (AAP) committee on nutrition. Although the 1997 IOM report says 200 IU of vitamin D per day should be sufficient for anyone under 50—including children—few researchers buy that. "Everybody feels that we should be taking more than 200 IU," says Greer, of the University of Wisconsin–Madison.

Unlike the Canadian Paediatric Society, though, "We [at AAP] don't really have any influence on what pregnant and lactating women take," Greer says. "However, I can say that AAP's committee on nutrition has recommended to the board that we go back to [recommending] 400 IU for all children." That's the amount in a teaspoon of cod liver oil—the vitamin D supplement of choice throughout the early 20th century. Greer expects his committee's recommendation to be approved by AAP's board, perhaps within the next month.

Optimal needs vary

For most of the past century, nutrient guidelines have been set to prevent gross deficiencies—shortfalls that could cause disease. Those recommendations tended to represent minimally adequate intakes. Over the past decade, however, considerable debate has surrounded what vitamin D consumption levels would be optimal versus merely adequate.

The controversy has been fueled by a steady stream of studies that have emerged since the IOM set its vitamin D guidelines. Nearly all demonstrate substantial health benefits from relatively high intakes of vitamin D—amounts well in excess of what most individuals now get. Moreover, those benefits extend well beyond protecting bone. More vitamin D seems to diminish the risk of cancer, diabetes, autoimmune disorders, muscle loss, viral infections—even gum disease.

Researchers gauge vitamin D sufficiency on the basis of 25-hydroxy vitamin D (25-HD). This is not the form of the vitamin that is consumed—nor the hormonal form that the body actually uses—but an intermediary. To achieve optimal concentrations of 25-HD, growing numbers of nutrition and health scientists suggest, most of us would need intakes of 800 to 4,000 IU per day (see Vitamin D: What's Enough?).

How much vitamin D someone needs can vary widely, largely depending on the amount of skin that gets exposed to the sun each day—and for how long. Further complicating the picture, some skin is heavily pigmented, filtering sunlight out. Many people cover up with clothes or sunblock when they go outdoors. Still others live at high latitudes—as Canadians do—where little ultraviolet radiation makes it through the atmosphere during much of the year.

Even for women in the southern United States, however, "we've found that lactating women need about 6,000 IU a day to transfer enough vitamin D into their milk to supply adequate amounts to a nursing infant," says Bruce W. Hollis of the Medical University of South Carolina in Charleston.

Nor are nursing moms the only individuals who may need relatively large doses of the vitamin. Hollis' research has shown that black women may sometimes need 4,000 IU a day for months at a time to compensate for little time outdoors, heavy skin pigmentation, and/or obesity—a factor that appears to diminish the body's ability to use vitamin D efficiently (see Understanding Vitamin D Deficiency).

Another reason for moms' supplementation?

In March, researchers at Harvard Medical School reported evidence that ample vitamin D diminishes the chance a child will develop asthma, a scourge who's incidence has been rising, especially in black and low-income communities (see Childhood Vitamin D—A New Benefit?). Recently, an additional putative benefit has emerged for pregnant women and their developing babies.

A study linked elevated risk of preeclampsia—high blood pressure that develops in some women during the last half of pregnancy—with low intakes of vitamin D. This condition, which can lead to miscarriage and even the death of the mother—ordinarily develops in some three to seven percent of first pregnancies.

Pittsburgh researchers enrolled 1,198 women who were pregnant for the first time and measured their blood concentrations of vitamin D within the first 22 weeks of gestation. Subsequently, 59 women developed preeclampsia. Blood values from all but four were compared to a similar group of recruits who maintained normal blood pressure throughout their pregnancies.

The higher a woman's blood concentrations of 25-HD, the lower her chance of developing preeclampsia—and that risk fell steadily and "strikingly" with increasing vitamin D values, Lisa M. Bodnar of the University of Pittsburgh and her colleagues found.

Moreover, babies whose moms had developed preeclampsia were far more likely to have low vitamin-D values than were children whose moms had maintained normal blood pressure. "These differences were found in our population despite widespread prenatal/multivitamin use in the 3 months before delivery," Bodnar's group reports in the September Journal of Clinical Endocrinology and Metabolism.

Black women face far higher risks of developing this hypertensive syndrome. Overall, black women are also far likelier than other ethnic or racial groups to have low blood levels of vitamin D. Against this backdrop, Bodnar's group says, "our data linking vitamin D deficiency and preeclampsia risk raises the intriguing possibility that vitamin D may contribute to racial disparities in this [syndrome]."

"The story of deficiency begins with vitamin D itself and its primary mode of synthesis, which is from sunlight," argue Adekunle Dawodu of the University of Cincinnati and Carol L. Wagner of the Medical University of South Carolina in Charleston. In a commentary in the September Archives of Disease in Childhood, they report a resurgence of rickets around the world, not only in children at high latitudes, but also in the Arab world and Asia where culture or excessive temperatures may keep women and children indoors or covered up.

A shift from vitamin-D sufficiency to widespread deficiency has occurred rapidly—mostly throughout a half-century. The reason for it is clear, Dawodu and Wagner say: "insufficient sun exposure and inadequate corrective vitamin-D supplementation." They conclude, much as the Canadian Paediatric Society just has, that dosing moms during pregnancy and lactation "would achieve the double effect of preventing vitamin-D deficiency in both mothers and children." But unlike the Canadian society, they note that doses considerably higher than 2,000 IU may be necessary for some individuals and communities.

As a goal, achieving population-wide vitamin D sufficiency "may be one of the more important preventative public health initiatives," conclude Dawodu and Wagner.


If you would like to comment on this Food for Thought, please see the blog version.

Citations

American Academy of Pediatrics

141 Northwest Point Boulevard

Elk Grove Village, IL 60007-1098


Lisa M. Bodnar

Department of Epidemiology

University of Pittsburgh Graduate School of Public Health

A742 Crabtree Hall

130 DeSoto Street

Pittsburgh, PA 15261


John J. Cannell

Psychiatry Department

Atascadero State Hospital

10333 El Camino Real

Atascadero, CA 93423

Marie Adèle Davis

Canadian Paediatric Society

2305 St. Laurent Boulevard

Ottawa, Ont. K1G 4J8

Canada

Frank R. Greer

Department of Pediatrics

University of Wisconsin, Madison

Madison, WI 53792

Bruce W. Hollis

Department of Pediatrics

Medical University of South Carolina

P.O. Box 250917

171 Ashley Avenue, Room BM326

Charleston, SC 29425


Reinhold Vieth

Pathology and Laboratory Medicine

Mount Sinai Hospital

600 University Avenue

Toronto, ON M5G 1X5

Canada
Further Reading

Cannell, J.J. In press. Autism and vitamin D. Medical Hypotheses. Abstract available at [Go to].

Dijkstra, S.H., et al. 2007. High prevalence of vitamin D deficiency in newborn infants of high-risk mothers. Archives of Disease in Childhood 92(September):750-753. Available at [Go to].

Moore, C.E., M.M. Murphy, and M.F. Holick. 2005. Vitamin D intakes by children and adults in the United States differ among ethnic groups. Journal of Nutrition 135(October):2478-2485. Available at [Go to].

Raloff, J. 2007. Childhood vitamin D—A new benefit? Science News Online (May 19). Available at [Go to].

______. 2007. Childhood vitamin D—A dark side? Science News Online (May 12). Available at [Go to].

______. 2006. The antibiotic vitamin. Science News 170(Nov. 11):312-317. Available at [Go to].

______. 2005. Breathing easier with vitamin D. Science News Online (Dec. 17). Available at [Go to].

______. 2005. Vitamin D boosts calcium potency. Science News Online (Nov. 12). Available at [Go to].

______. 2005. Understanding vitamin D deficiency. Science News Online (April 30). Available at [Go to].

______. 2004. Vitamin D: What's enough? Science News 166(Oct. 16):248-249. Available at [Go to].

______. 2004. Vitamin boost. Science News 166(Oct. 9):232-233. Available at [Go to].

______. 2004. Should foods be fortified even more? Science News Online (Sept. 11). Available at [Go to].

______. 2000. Calcium may become a dieter's best friend. Science News 157(April 29):277. Available at [Go to].

Williams, A.F. 2007. Vitamin D in pregnancy: An old problem still to be solved? Archives of Disease in Childhood 92(September):740-741. Available at [Go to].

          Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists        
imageIn March of 2015, the United States Department of Health and Human Services identified 3 priority areas to reduce opioid use disorders and overdose, which are as follows: opioid-prescribing practices; expanded use and distribution of naloxone; and expansion of medication-assisted treatment. In this narrative review of overdose prevention and the role of prescribers and pharmacists in distributing naloxone, we address these priority areas and present a clinical scenario within the review involving a pharmacist, a patient with chronic pain and anxiety, and a primary care physician. We also discuss current laws related to naloxone prescribing and dispensing. This review was adapted from the Prescribe to Prevent online continuing medical education module created for prescribers and pharmacists (http://www.opioidprescribing.com/naloxone_module_1-landing ).
          Brief Opioid Overdose Knowledge (BOOK): A Questionnaire to Assess Overdose Knowledge in Individuals Who Use Illicit or Prescribed Opioids        
imageBackground: Opioid overdose is a public health crisis. This study describes efforts to develop and validate the Brief Opioid Overdose Knowledge (BOOK) questionnaire to assess patient knowledge gaps related to opioid overdose risks. Methods: Two samples of illicit opioid users and a third sample of patients receiving an opioid for the treatment of chronic pain (total N = 848) completed self-report items pertaining to opioid overdose risks. Results: A 3-factor scale was established, representing Opioid Knowledge (4 items), Opioid Overdose Knowledge (4 items), and Opioid Overdose Response Knowledge (4 items). The scale had strong internal and face validity. Patients with chronic pain performed worse than illicit drug users in almost all items assessed, highlighting the need to increase knowledge of opioid overdose risk to this population. Conclusions: This study sought to develop a brief, internally valid method for quickly assessing deficits in opioid overdose risk areas within users of illicit and prescribed opioids, to provide an efficient metric for assessing and comparing educational interventions, facilitate conversations between physicians and patients about overdose risks, and help formally identify knowledge deficits in other patient populations.
          American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use        
The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This “Practice Guideline” was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) – a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.
          Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact        
imageBackground: Opioid use disorders (OUDs) are reaching epidemic proportions in the United States, and many geographic areas struggle with a persistent shortage in availability of opioid agonist treatment. Over the past 5 years, Vermont addiction medicine physicians and public health leaders have responded to these challenges by developing an integrated hub-and-spoke opioid treatment network. Methods: In the present report, we review the development, implementation, and impact of this novel hub-and-spoke model for expanding OUD treatment in Vermont. Results: Vermont's hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state's OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed. Conclusions: Development and implementation of a hub-and-spoke system of care has contributed substantially to improvements in opioid agonist treatment capacity in Vermont. This system may serve as a model for other states grappling with the current opioid use epidemic.
          Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical Practice        
imageObjective: To assess the impact of hospital substance use disorder (SUD) initiative, which, beginning in October 2014, implemented an inpatient addiction consult team, a postdischarge addiction clinic, recovery coaches, and SUD treatment within primary care on general internists’ attitudes, clinical practice, and preparedness to care for SUD. Methods: Pre and postintervention survey of general internal medicine physicians at Massachusetts General Hospital, in Boston, Massachusetts, in September 2014 (n = 290) and 2015 (n = 296) was conducted. Results: There were 149 respondents for the pre and 143 respondents for the post survey. There were no significant differences between groups. In the follow-up group, 66% of physicians had a patient receive care from the initiative. These physicians were significantly more likely to have favorable attitudes towards SUD; 44% report caring for patients with SUD is as satisfying as other clinical activities versus 9% of physicians without experience with the initiative. These physicians were significantly more likely to feel very prepared to screen for SUD (27% vs 9%), diagnose SUD (23% vs 9%), deliver a brief intervention (16% vs 5%), refer to treatment (36% vs 14%), discuss medication treatments (22% vs 5%), discuss overdose prevention and naloxone (33% vs 5%), and discuss harm reduction (22% vs 7%). They were also significantly more likely to frequently prescribe naloxone (11% vs 0%), prescribe addiction pharmacotherapy (15% vs 2%), and provide addiction treatment themselves (18% vs 5%). Conclusion: General internists’ attitudes, preparedness, and clinical practice related to SUD significantly improved after having a patient receive care from new clinical services implemented through a hospital-wide SUD initiative.
          American Doctor in Nice Recalls Chaotic Scene Moments After Truck Attack        
Among those caught in the chaos of the attack in Nice, France was an American physician from Denver on a tour through Europe who told NBC’s Lester Holt he was running for his life.
          Truck attack in Nice, France: Eyewitnesses describe chaos and panic        
Dr. Kevin Motamedi, a physician from Denver, describes seeing a wave of people with panicked faces running toward him when a truck drove through crowds of people in Nice, France, on Thursday, killing at least 84 people and injuring many more. Bob Franken, a longtime television correspondent who now works for NBC News, tells TODAY that although there was a heavy police presence at the Bastille Day festivities, “they weren’t ready for this.” (Run time: 3:50)
          Wake Forest Medical Alumni Association Honors Five Physicians        
The Medical Alumni Association (MAA) of Wake Forest School of Medicine has presented its annual awards to distinguished alumni. Honored during Wake Forest School of Medicine’s 2017 M.D. Alumni Weekend activities on May 5 were: Steven M. Block, MBBCh, FAAP, of Clemmons, N.C., Distinguished Service Award; William R. Cowan, M.D. ’57, of Weaverville, N.C., and Louis Weinstein, M.D. ’72, of Charleston, S.C., Distinguished Achievement Award; and Gary Poehling, M.D., and John W. Reed, M.D. ’62, both of Winston-Salem, Distinguished Faculty Award.
          Petey Atrix and Simone to Teach Wake Forest School of Medicine Students about Treating Pediatric Patients        
During the Bowman Gray Center’s Opening Day Tour at the new facility, the donor learned of the need and wanted to make a difference in the medical education of future pediatric physicians. Thanks to this donor’s $80,000 donation, the School of Medicine was recently able to buy two pediatric manikins. 
          Making Sense of MACRA        

In January 2015, the US Department of Health and Human Services (DHHS) established new goals for Medicare to improve value while controlling costs. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) will help achieve these goals:

  • Goal 1: by the end of 2016, 30% of Medicare payments are tied to quality or value via alternative payment models (APMs), and 50% by the end of 2018.
  • Goal 2: by the end of 2016, 85% of Medicare fee-for-service (FFS) payments are tied to quality or value, and 90% by the end of 2018.

Why must we change Medicare reimbursement? As shown in Chart 1, based on DHHS reports, Medicare costs rose sharply from its enactment in the mid-1960s to today, both as a percent of the Gross Domestic Product (GDP) and as a percent of all national health expenditures (NHE). Currently, Medicare is estimated to account for roughly 4% of the GDP, and for over one in five health care dollars. There is also a need to improve the quality of health care services and delivery. Changing Medicare reimbursement is a way to better manage costs while enhancing care quality.

As discussed in the series of posts on bundled payments, traditional medical billing and payment is volume-based. In other words, the more hip replacements that surgeons perform, the more they can bill for. If the hip replacement procedures are more costly than necessary, the surgeons still get reimbursed. If the patient suffers complications following hip replacement surgery, the added days in the hospital and hospital readmissions are reimbursed. Providers are rewarded for doing more, but not for doing better.

Increasingly, Medicare and other payers are moving to value-based reimbursement systems that reward providers for improving the quality of care while controlling costs. MACRA changes the incentives for patient care to encourage providers, largely physicians, to become part of this value-based movement. MACRA also ends the Sustainable Growth Rate (SGR) formula used since 1997 for Medicare reimbursement to healthcare providers.

MIPS and APMs

MACRA establishes the Quality Payment Program (QPP) with two paths that move providers to value-based reimbursement:

  • The Merit-Based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (APMs).

Healthcare practitioners eligible for Medicare Part B reimbursement will participate in MIPS. For the first two years of MACRA, MIPS eligible clinicians include physicians, dentists, physician assistants and advance practice nurses such as nurse practitioners and certified registered nurse anesthetists. In following years, eligibility may be expanded to other practitioners such as physical or occupational therapists, nurse midwives, clinical social workers and audiologists. Hospitals and other facilities, clinicians with low patient volume or in their first year of Medicare Part B participation, and some clinicians in APMs are excluded from MIPS.

Under MIPs, the eligible clinician’s Medicare Part B reimbursement is adjusted based on a Composite Performance Score (CPS) that encompasses the categories of quality, resource use, clinical practice improvement activities and advancing care information. The scoring system is complex, and may also be adjusted for factors such as practices located in rural areas. The amount of the adjustment to Part B reimbursement may be positive or negative, beginning at ± 4% in 2019 and increasing to ± 9% by 2022. The adjustments are designed to be more reasonable and predictable than the earlier SGR annual adjustments. Exceptional performers may receive additional reimbursement in the adjustment. These payment adjustments and bonuses begin in 2019.

APMs include new financing initiatives that increase incentives for high value care, including bundled payment models and Accountable Care Organizations (ACOs). Bundled payment models and ACOs compel providers across a health care episode to work together to deliver high quality care while controlling costs. Physicians, hospitals, rehabilitation centers, home health agencies and other healthcare providers share accountability for their budget as well as their patients, and are rewarded for high-value performance. QPP providers may not need to participate in MIPS if they are part of an advanced APM.

Nurses in many healthcare settings will see changes to improve coordination and services as a response to MACRA and other value-based reimbursement strategies. My book helps nurses understand fundamental concepts of health care economics and financing, including innovations that tie quality to payment. It is essential that nurses, at the front lines of health care delivery, learn about healthcare finance and its impact on their work and their institutions.

Susan J. Penner, RN, MN, MPA, DrPH, CNL . Author, Economics and Financial Management for Nurses and Nurse Leaders, 3rd  Edition, 2016, and adjunct faculty at the University of San Francisco School of Nursing and Health Professions.


          Welcome to Edward Garren, LMFT CA License MFC27181        
"When you're ready for change."

Edward Garren is a California licensed psychotherapist, offering counseling services to individuals, couples and families.

"The purpose of therapy is to remove blocks to truth; to help you abandon any patterns of belief that no longer serve you in a productive way; to implement self-forgiveness.
 
Therapy can alleviate suffering and open the door to peace of mind. It can assist in separating illusion from reality and even reality from truth.
 
Finally, it can help you to learn to make your decisions from internal prompts because you have created an internal locus of control."
 
From "A Course in Miracles"

Mr. Garren has worked in the profession for many years and has a broad range of experiences and "styles" of doing therapy. He has particular expertise working people who are dealing with depression, anxiety, recovering from addiction or alcoholism, desiring to reduce or eliminate use of prescribed psychotropic medications* (*NOTE: any change in one's medication should always be done under the guidance and supervision of the prescribing or other physician).

Ed has experience providing Counseling, Psychotherapy, Coaching, Career Development and related services to: Individuals Couples Families GLBTQ Community Members Persons living with HIV Persons and Families of mixed heritages Adult Survivors to Childhood Trauma Persons with Post Traumatic Stress Disorder Military and Law Enforcement personnel.

His office is conveniently located on Rodeo Road, near Western Ave.  This location is within ten minutes of the USC main campus, Downtown Los Angeles, Koreatown, Leimert Park, Baldwin Hills, View Park, West Adams, etc.  It is within fifteen minutes of Hollywood, West Hollywood, Mid-Wilshire, Los Feliz, Silverlake, Echo Park, Chinatown, East Los Angeles, South Central, South Los Angeles, Inglewood, Playa del Rey, Marina del Rey.

You may contact Mr. Garren via telephone, (213) 596-9674 , or by eMail EdwardGarrenMFT@gmail.com

Fax # is (213) 596-9082 


          Nov 2012 Daring Cooks' Challenge Brining & Roasting        

Hello this Audax from Audax Artifex and I'm honoured to be your host this month. I have decided to concentrate on a couple of important cooking techniques that every good cook should have up his or her sleeve. The first technique is brining – which uses a brine (at its simplest, a combination of salt and water usually with some sugar) to infuse flavour and moisture into poultry, red- & white-meat, fish, seafood and most types of nuts and seeds. Brining guarantees moist succulent roast chickens and turkeys, fried steaks, steamed trout, BBQed prawns (shrimps), grilled seafood and toasted nuts and seeds. Brining is simple and only needs a few simple ingredients and really adds an extra dimension to your cooking. I will be providing a couple of different recipes and guidelines on how to brine which can be used with a whole array of meats, poultry, seafood, nuts and seeds.

Then for the second technique (once you have brined your chosen cut of meat) I want you to roast (or BBQ) it. Again I will be giving you guidelines and rules on how to roast your cut of meat. The roasting guidelines can be used for meat, vegetables, nuts and seeds. For our non-meat eating cooks I want you to use the roasting guidelines to roast a selection of vegetables and/or nuts or seeds to perfection.
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HOW IT WORKS (from http://www.cooksillustrated.com/images/document/howto/ND01_ISBriningbasics.pdf)

Soaking in brine improves the taste and the moistness of all fowl (chicken, turkey, goose, duck and guinea fowl), also it works on lean red- and lean white-meats, fish, most seafood and most nuts and seeds. It is simple, cheap and effective and will ensure that your Christmas roast will be the tastiest you have ever made. All you do is brine your cut of meat and then proceed as normal, you will find that the roast is juicy and the skin has a lovely colour. The recipe for all-purpose brine is simple - for each cup (240 ml) of water use 1 tablespoon (18 gm) of table salt this makes a 8% brine solution which can be used for most foods. (This is equivalent to 1 cup of table salt for each gallon (4 litres) of water.)

Brining works in accordance with two principles, called diffusion and osmosis, these two principles like to keep things in equilibrium (or in stable balance). When brining a fowl for example, there is a greater concentration of salt and sugar outside of the fowl (in the brine) than inside the fowl (in the cells that make up its flesh). The law of diffusion states that the salt and sugar will naturally flow from the area of greater concentration (the brine) to lesser concentration (the cells). There is also a greater concentration of water, so to speak, outside of the fowl than inside. Here, too, the water will naturally flow from the area of greater concentration (the brine) to lesser concentration (the cells). When water moves in this fashion, the process is called osmosis. Once inside the cells, the salt and, to a lesser extent, the sugar causes the cell proteins to unravel, or denature. As the individual proteins unravel, they become more likely to interact with one another. This interaction results in the formation of a sticky matrix that captures and holds moisture. Once exposed to heat, the matrix gels and forms a barrier that keeps much of the water from leaking out as the meat cooks. Thus you have a roast that is both better seasoned and much more moist than when you started.

HANGING IT OUT TO DRY

Brining does have one negative effect on poultry: Adding moisture to the skin as well as the flesh which can prevent the skin from crisping when cooked. This can be overcome by air-drying, a technique used in many Chinese recipes for roast duck and chicken. Letting brined chicken and turkey dry uncovered in the refrigerator allows surface moisture to evaporate, making the skin visibly more dry and taut and therefore promoting crispness when cooked. Although this step is optional, if crisp skin is a goal, it’s worth the extra time. For best results, air-dry whole brined birds overnight. Brined chicken parts can be air-dried for several hours. Transfer the brined bird to a heavy-duty cooling rack set over a rimmed baking sheet, pat the bird dry with paper towels, and refrigerate. The rack lifts the bird off the baking sheet, allowing air to circulate freely under the bird. If you are not air-drying your fowl it is best to pat dry the skin with paper towels before roasting in a hot oven.

Surprisingly, brining has one large positive effect on fish fillets, a quick brine (only 10 mins) greatly improves the appearance of cooked fillets, because the brine reduces the unsightly white layer of albumin that coagulates on the surface during cooking, I highly recommend brining fish fillets when presentation is paramount. 

ITEMS THAT BENEFIT FROM BRINING
Lean cuts of meat with mild flavour tend to benefit most from flavour brining also most nuts and seeds can be brined with good affect. These include:

Chicken: whole, butterflied, or pieces
Cornish Hens: whole or butterflied
Turkey: whole, butterflied, or pieces
Pork: chops, loin, tenderloin, fresh ham
Seafood: salmon, trout, shrimp
Beef: use lean pieces of beef
Nuts and Seeds: Most nuts and seeds are suitable i.e. pumpkin, peanuts, sesame, almonds etc.  

Fatty meats such as duck, beef, and lamb do not benefit as much from brining (but still can be brined)—they're naturally moist and flavourful. They also tend to be cooked to lower internal temperatures and thus don't lose as much of their natural moisture.

WHICH SALT TO USE
Kosher salt (called rock salt outside North America) and table salt are the most common salts used in brining.

Sea salt can be used for flavour brining, but it tends to be quite expensive. If you have a cheap supply available, go for it; otherwise, stick to kosher salt or table salt.
Some people say that kosher salt tastes "cleaner" than table salt because it does not contain the anti-caking agents added to table salt. Some people prefer non-iodized table salt over iodized table salt, believing that potassium iodide creates an off-taste. However, these flavour differences melt away when salt is diluted in large quantities of water in a brine. In an article about salt in the September/October 2002 issue of Cook's Illustrated magazine, taste testers felt that "all nine salts tasted pretty much the same" when dissolved in spring water and chicken stock, whether it was 36¢/pound iodized table salt, 66¢/pound kosher salt, or $36/pound Fleur de Sel de Camargue sea salt from France.

SALT EQUIVALENT MEASURES
Table salt and kosher salt do not have the same saltiness in a flavour brine when measured by volume—but they do when measured by weight.

Table salt weighs about 10 ounces (285 grams) per cup, while kosher salt weighs 5-8 ounces (140-225 grams) per cup, depending on the brand. If using kosher salt in a brine, you must use more than a cup to achieve the same salt flavour you would get from a cup of table salt.

The chart below shows equivalent amounts of table salt and the two most popular brands of kosher salt.

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Morton Kosher Salt weighs about 7.7 ounces (220 grams) per cup, making it three-fourths as strong as table salt. Diamond Crystal Kosher Salt weighs about 5 ounces (140 grams) per cup, making it half as strong as table salt.
What if you're using something other than Morton Kosher or Diamond Crystal Kosher salt? Regardless of the type of salt—sea salt, pickling salt, and any other brand of kosher salt—just measure 10 ounces (285 grams) of it on a kitchen scale and you will have the equivalent of 1 cup of table salt.

HOW LONG TO BRINE
The length of time meat soaks in a flavour brine depends on the type of meat and its size, as well as the amount of salt used in the brine—the saltier the brine mixture, the shorter the soaking time. Here are common brining times found in recipes:

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It is possible to end up with meat that's too salty for your taste, so you may want to brine on the low end of the time range to see how it turns out. You can always brine longer next time, but there's no way to salvage a piece of meat that's been brined too long.

ROASTING TIMES AND TEMPERATURES FOR POULTRY 
When we roast brined cuts of meat (or whole birds) the procedure firstly is to brown the skin in a hot oven then to lower the temperature so we reduce the moisture loss in the roasted food. It is important to rest (loosely covered in foil) your roast so that the moisture can redistribute itself in the meat, it greatly adds to the final tenderness of the cooked product.

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For other roasting times for red meat, fish, seafood, nuts and seeds see the additional information at the end of the challenge write-up.

Recipe Source:  The brine and roast chicken used are traditional recipes used in my family for many generations. The roast vegetable recipe is from my own family cookbook.   

Blog-checking lines:  Audax of Audax Artifax was our November 2012 Daring Cooks’ host.  Audax has brought us into the world of brining and roasting, where we brined meat and vegetables and roasted them afterwards for a delicious meal!

Posting Date:  November 14th, 2012

Download the printable .pdf file HERE


Note:  Important Information – brining must be done in the refrigerator the salt water will not stop the growth of germs and bacteria. Also brine cannot be reused always discard it after first use.  Make sure that the brine goes into the cavity of large chickens and turkeys when brining.  

Mandatory Items: If you eat meat you must brine a meat (or seafood) cut and then roast (or BBQ) it. For non-meat eaters please brine some nuts or seeds then roast them or just roast a load of vegetables. I have included an extensive listing of poultry, seafood, nut etc. recipes in the additional information section at the end of the challenge feel free to use any of these recipes. Of course you can use your own favourite recipe if you wish.

Variations allowed:  Any meat/seafood (or nuts/seeds) can be used for brining. And any vegetable can be used by non-meat eaters. 

Preparation time:  Generally brining takes from ½ hour to 2 days. Roasting can take up to 2 hours for most pieces of meat, for large poultry 6-7 hours.

Equipment required:
non-reactive container for the brine
roasting pans or trays

Challenge Recipes
I have included one all-purpose brine recipe, a roast chicken recipe and a roast vegetable recipe.

Recipe One – All-Purpose Brine:


Makes 4 cups of brine enough for about one pound (½ kg) of meat

This is the brine to use for most cuts of meat and poultry that will be roasted.

Ingredients
4 cups (1 litre) of cold water (see note 1)
¼ cup (70 gm) table salt or  ½ cup (70 gm) Diamond Crystal Kosher Salt
optional 2 tablespoons (30 ml) (30 gm/1 oz) sugar (see note 2)
optional 3-4 peppercorns, a few springs of herbs, a garlic clove or two, a knob of ginger etc. (see note 3)

Instructions
1. Heat 1 cup of water to boiling point add the salt and stir until all the salt has totally dissolved.
2. Place in a non-reactive container (glass, plastic, stainless steel, zip-lock bags etc). Add the remaining water and stir. Make sure that all the salt has dissolved. Wait until the brine has reached room temperature.
3. Add your cut of meat make sure that the meat is completely submerged (that is totally covered in the salty water) if need be you can weigh down the cut of meat with a clean plate (etc). If using plastic bags make sure that the meat is totally covered in brine and make sure that is bag is locked securely.
4. Cover the container with plastic wrap to prevent odours contaminating the flavour brine or the brine leaking.
5. Place the container into the refrigerator for the soaking time suggested by the guidelines above.
6. If desired you can air-dry your poultry (usually over night) in the refrigerator if you wish to have crispy skin on your bird. It is best to pat dry your brined item (inside and out) with paper towels before cooking.
7. Cook the brined item as directed by the roasting guidelines above.

Notes
1. You can replace all or some of the water with a combination of wine, cider, beer, tea, coffee, fruit juice, most sauces (tomato, soya, BBQ, chilli etc), chicken stock, beef stock or fish stock. Be careful with acidic liquids like wine, cider, fruit juices which can turn your meat to mush if brined too long.
2. A little sugar can help overcome the saltiness of the brine and helps to give a nice sheen to your piece of meat when roasted. You can use up to ¼ cup of sugar (use the lesser amount (2 tablespoons) for high temperature roasting since the brine can burn at high heats if you use too much sugar). You can use brown sugar or honey or other sweeteners if you wish.
3. Any combination of spices and herbs can be used to flavour the brine. Garlic powder, onion powder and ginger powder are excellent to use for brining.

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Recipe Two – Roast Brined Chicken
Serves four to six people

Ingredients:
1 whole chicken (organic is best) about 2 kg (4 ½ pounds)
Enough brine (see recipe above) to cover the chicken in a large non-reactive container

Directions:

1. Brine the whole chicken in the flavoured brine in the refrigerator overnight about 6 hours can be overnight. (Make sure that every part of the chicken is covered in the brine you can weigh the bird down with a clean plate so it is completely submerged.
2. Discard the brine and dry the skin and inside of the bird with paper towels.
3. If you desire crispy skin then leave the bird on a rack for several hours or overnight in the refrigerator so the skin can dry.
4. Preheat oven to moderately hot 220°C/425°F/gas 7.
5. Roast for 15 minutes.
6. Reduce oven to moderate 180°C/350°F/gas 4 and roast for a further 12-15 minutes per 450 grams/pound, You can check for done-ness the internal temperature should be 165°F/84°C, or the juices should run clear when you pierce the bird between the leg and thigh.  
7. Rest for approximately 30 minutes covered loosely in foil.

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Recipe Three – Roast Vegetables
Serves six people

For best results use the largest shallow heavy-weight roasting pan you have and make sure that the vegetable are well spaced out in the pan and only form one layer, use two trays if necessary. A very hot oven 475°F/240°C/gas mark 9 is the key to roasting vegetables. Only toss the vegetables once or twice during cooking. For lighter-weight vegetables such as cabbage, broccoli or cut corn add it to the pan 15 minutes later, so it doesn't get too brown. Greens like kale and mustard greens are done in only 15 minutes. Root vegetables should be cut into cubes of about one-inch (2½ cm). You can add a small amount of apricot fruit spread or honey in the last 10 minutes to enhance the caramelising process. Fresh basil, rosemary and thyme are best when used fresh. Curry, paprika and turmeric are also great. Grated ginger or crushed garlic can also be added.  

Ingredients:
1 small butternut squash (pumpkin), cubed
2 red bell peppers (capsicums), seeded and sliced
1 orange sweet potato, peeled and cubed OR 3 medium carrots, peeled and sliced lengthways
3 Yukon Gold (or any baking) potatoes, cubed
1 red onion, quartered
optional 1 fat clove of garlic, crushed
1 tablespoon chopped fresh thyme
2 tablespoons chopped fresh rosemary
2 tablespoon olive oil
1 tablespoon balsamic vinegar or 1 tablespoon lemon juice
Salt and pepper to taste

Directions:
1. Preheat oven to very hot 475°F/240°C/gas mark 9.
2. In a large bowl, combine the squash, red bell peppers, sweet potato, red onion and Yukon Gold potatoes and the optional garlic if using.
3. In a small bowl, stir together thyme, rosemary, olive oil, vinegar, salt, and pepper. Toss with vegetables until they are coated. Spread evenly on a large roasting pan.
4. Roast for 35 to 40 minutes in the preheated oven, stirring one or twice, or until vegetables are cooked through and browned. If using a smaller tray the vegetables will take about 50-60 minutes.

Roast Vegetables
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Brined and BBQed “seven-bone” steak (notice the shape of the bone in the steak)
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Brined and BBQed “wagyu” steak
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Brined and Roasted Peppered Ribeye Roast
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Additional Information:  Include links to videos or information that can be of assistance to members.
Kosher salt versus table salt http://bbq.about.com/od/spicesseasonings/a/aa102007a.htm
Everything you wanted to know about brining http://www.amazingribs.com/recipes/rubs_pastes_marinades_and_brines/zen_of_brines.html
Brining Nuts and Seeds http://www.jwright44.com/recipes/BrinedNuts.htm
How to brine pumpkin seeds http://www.ehow.com/how_8144233_brine-pumpkin-seeds.html
How a quick brine improves the appearance of fish fillets http://www.cooksillustrated.com/howto/detail.asp?docid=36992
Dry brining thick steaks (a great article) http://steamykitchen.com/163-how-to-turn-cheap-choice-steaks-into-gucci-prime-steaks.html
Brining turkey a primer http://bbq.about.com/od/turkey/ss/aa110808a.htm
Roast chicken ten ways http://culinaryarts.about.com/od/chickenturkeymore/tp/roastchixtenways.htm
Cooking a turkey (many articles) http://culinaryarts.about.com/od/chickenturkeymore/tp/Cooking-A-Turkey.htm
To roast a turkey http://culinaryarts.about.com/od/chickenturkeymore/r/Roast-Turkey-Recipe.htm
Roasting guidelines for red meat roasts http://www.donaldrussell.com/game-technique?ms=tab5 Jamie Oliver's Roast Potato, parsnips and carrot recipe http://www.jamieoliver.com/recipes/vegetarian-recipes/roast-potatoes-parsnips-carrots 
Jamie Oliver's Perfect Roast Potato recipe http://www.jamieoliver.com/recipes/vegetarian-recipes/perfect-roast-potatoes
Delia Smith's Roast Potato recipe http://www.deliaonline.com/how-to-cook/fruit-and-vegetables/how-to-roast-potatoes.html
How to brine fish http://www.ehow.com/how_5963061_brine-fish-before-cooking.html
Vegetable Roasting Guide http://www.eatingwell.com/healthy_cooking/healthy_cooking_101/shopping_cooking_guides/vegetable_roasting_guide
How to cook a steak to perfection http://howto.yellow.co.nz/food-drink/cooking-and-baking/how-to-cook-steak/
How to cook a steak (using American cuts of meat) http://www.marksdailyapple.com/how-to-cook-the-perfect-steak/

Disclaimer:
The Daring Kitchen and its members in no way suggest we are medical professionals and therefore are NOT responsible for any error in reporting of “alternate baking/cooking”.  If you have issues with digesting gluten, then it is YOUR responsibility to research the ingredient before using it.  If you have allergies, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. If you are lactose intolerant, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. If you are vegetarian or vegan, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. The responsibility is YOURS regardless of what health issue you’re dealing with. Please consult your physician with any questions before using an ingredient you are not familiar with.  Thank you! :)
          February 2012 Daring Cooks' Challenge: Flipping Fried Patties!!!        
Hi it is Lisa and Audax and we are hosting this month's Daring Cooks' challenge we have chosen a basic kitchen recipe and a basic cooking technique which can be adapted to suit any ingredient that you have to hand and are beloved by children and adults alike … of course we are talking about patties.
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Technically patties are flatten discs of ingredients held together by (added) binders (usually eggs, flour or breadcrumbs) usually coated in breadcrumbs (or  flour) then fried (and sometime baked). Burgers, rissoles, croquettes, fritters, and rösti are types of patties as well.

Irish chef Patrick "Patty" Seedhouse is said to have come up with the original concept and term as we know it today with his first production of burgers utilizing steamed meat pattys - the pattys were "packed and patted down" (and called pattys for short) in order to shape a flattened disc that would enflame with juices once steamed.

The binding of the ingredients in patties follows a couple of simple recipes (there is some overlap in the categories below)
Patties – patties are ingredients bound together and shaped as a disc.
Rissoles and croquettes – use egg with breadcrumbs as the binder, typical usage for 500 grams (1 lb) of filling ingredients is 1 egg with ½ cup of breadcrumbs (sometimes flour, cooked grains, nuts and bran can be used instead of the breadcrumbs). Some meat patties use no added binders in them they rely on the protein strands within the meat to bind the patty together.  Vegetarian and vegan patties may use mashed vegetables, mashed beans, grains, nuts and seeds to bind the patty. Generally croquettes are crumbed (breaded) patties which are  shallow- or deep-fried. Rissoles are not usually crumbed (but can be) and are pan- or shallow-fried. Most rissoles and croquettes can be baked.  (Examples are all-meat patties, hamburgers, meat rissoles, meatloaves, meatballs, tuna fish and rice patties, salmon and potato rissoles, most vegetable patties.)
Wet Fritters – use flour, eggs and milk as the binder, typical usage for 500 grams (1 lb) of filling ingredients is 2 cups flour, 1 egg with 1 cup of milk and are usually deep-fried and sometimes pan-fried  (examples deep fried apple fritters, potato fritters, some vegetable fritters, hushpuppies)
Dry Fritters – use eggs and (some) flour as the binder, typical usage for 500 grams  (1 lb) of filling ingredients is 1 to 2 eggs and (usually) some 2 to 8 tablespoons of flour (but sometimes no flour) and are pan- or shallow- fried. (examples most vegetable patties like zucchini fritters, Thai fish cakes, crab cakes, NZ whitebait fritters)
Röstis – use eggs (sometimes with a little flour) as the binder for the grated potato, carrot and other root vegetables, typical usage for 500 grams (1 lb) of filling ingredients is one egg yolk (potato rösti).

Sautéing, stir frying, pan frying, shallow frying, and deep frying use different amounts fat to cook the food. Sautéing uses the least amount of oil (a few teaspoons) while deep frying uses (many many cups) the most oil. The oil helps lubricate (sometimes adds flavour) the food being fried so it will not stick to the pan and helps transfer heat to the food being cooked.

In particular, as a form of cooking patties, pan- and shallow-frying relies on oil of the correct temperature to seal the surface (so retaining moisture) and to heat the interior ingredients (so binding them together) so cooking the patty. The exposed topside of the patty while cooking allows, unlike deep frying, some moisture loss and contact with the pan bottom with the patty creates greater browning on the contact surface that is the crust of the patty is browned and the interior is cooked by pan- and shallow-frying. Because the food is only being cooked on one side while being pan- or shallow-fried, the food must be flipped at least once to totally cook the patty.

So this month's challenge is to pan- or shallow-fry a patty, so giving us the title for this challenge “flipping fried patties”.

This challenge will help you understand how to form, what binders to use, and how to fry a patty so that it is cooked to picture perfect perfection.

Recipe Source:  Audax adapted a number of popular recipes to come up with the challenge patty recipes and Lisa has chosen to share two recipes – California Turkey Burger adapted from Cooking Light Magazine, and French Onion Salisbury Steak adapted from Cuisine at Home magazine.

Blog-checking lines:  The Daring Cooks’ February 2012 challenge was hosted by Audax & Lis and they chose to present Patties for their ease of construction, ingredients and deliciousness!  We were given several recipes, and learned the different types of binders and cooking methods to produce our own tasty patties!

Posting Date:  February 14th, 2012

Download the printable .pdf file HERE



Notes:
     
  • Binders
  •  
  • Eggs – are found in most patty recipes it acts as a binder, use cold eggs and lightly beat them before using  If you cannot use eggs try this tip  "1/4 cup of silken tofu, blended, or a commercial egg re-placer powder mixed with warm water."
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  • Flour – normal plain (all-purpose) flour is used in most fritter recipes it can be replaced with rice, corn or potato flours (in smaller quantities) in some recipes. If you want some rise in your patties then use self-raising flour or add some baking powder to the flour. 
  •  
  • Breadcrumb Preparation – breadcrumbs are a common ingredient in patties, burgers and fritters they act as a binding agent, ensuring the patty keeps it shape during the cooking process.
  •  
    • Fresh breadcrumbs – these crumbs are made at home with stale bread simply remove the crusts from one- or two-day old bread, break bread into pieces, place pieces in a blender or food processor then blend or process until fine. Store any excess in a plastic bag in the freezer. 1 cup of fresh crumbs = 3 slices of bread.
    •  
    • Packaged breadcrumbs – often called dry breadcrumbs, these are used to make a crisp coating on the burgers, patties and fritters they are easily found in the supermarket, You can make them at home. Place slices of one- or two-day bread on baking trays, bake in the oven on the lowest setting until slices are crisp and pale brown. Cool bread, break pieces in a blender or food processor then blend or process until fine. 1 cup fine dry breadcrumbs = 4 slices of bread.
     
  • Alternate binders – bran (oat, wheat, rice, barley etc) can be used instead of breadcrumbs in most recipes. Tofu (silken) can replace the egg. Also using mashed potato (or sweet potato, carrots, most root vegetables) and/or mashed beans can help bind most patties. Of course chickpea flour and most other flours can be used to help bind patties. Seeds, nuts and grains can help bind a patty especially when the patty has cooled after cooking. These binders are used in vegan recipes.
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  • Moisteners – Mayonnaise and other sauces, pesto and mustard are used in some meat patty recipes mainly for moisture and flavour but they can act as binders as well. For vegetable patties you can use chopped frozen spinach, shredded carrots, shredded zucchini, shredded apple and cooked grains to add extra moisture. Also sour cream and other milk products are used to increase the tenderness of patties.

     
  • Patty Perfection
  •  
  • When making meat patties the higher the fat content of the meat, the more the patties shrink during cooking this is especially true for ground (minced) red meat. Make patties larger than the bun they are to be served on to allow for shrinkage.
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  • For hamburgers keep the fat content to about 20 - 30% (don't use lean meat) this ensures juicy patties when cooked. Also use coarse freshly ground meat (if possible) to make patties, if the mixture is ground too fine the large patties will break apart since the protein strands are too short and are covered in fat and can only bind to nearby ingredients so when the large patty is cooked it will fall apart or be too dense. Compare this behaviour with small amounts of finely ground lean meat (almost a paste) where the protein can adhere to itself (since the protein chains are short, not covered in fat and all the ingredients are nearby) hence forming a small stable patty (lamb kofta, Asian chicken balls, prawn balls).
  •  
  • Patty mixtures should be kept cold as possible when preparing them and kept cold until you  cook them the cold helps bind the ingredients together.
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  • Don't over-mix the ingredients the resultant mixture will be heavy and dense.
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  • For meat patties chop, mince, grate the vegetable ingredients fairly finely, if too coarse the patties will break apart.
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  • Patties made mostly of meat (good quality hamburgers and rissoles) should be seasoned just before the cooking process, if salted too early liquid can be drawn out of the patty.
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  • Make all the patties the same size so they will cook at the same rate. To get even-sized patties, use measuring cups or spoons to measure out your mixture.
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  • For patties use your hands to combine the ingredients with the binders, mix gently until the mixture comes cleanly from the sides of the mixing bowl. Test that the final mixture forms a good patty (take a small amount in your palm and form into a ball it should hold together) before making the whole batch. Add extra liquid or dry binder as needed. Cook the test patty to check for seasoning, add extra if needed then cook the rest of the batch. 
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  • Usually patties should be rested (about an hour) before cooking they “firm” up during this time, a good technique to use if your patty is soft. Always wrap patties they can dry out if left in the fridge uncovered.
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  • Dampen your hands when shaping patties so the mixture won't stick to your fingers.
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  • If making vegetable patties it is best to squeeze the grated/chopped/minced vegetables to remove any excess liquid this is most important for these types of patties.
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  • When making fritters shred your vegetables because it makes long strands that gives a strong lattice for the patties. A food processor  or a box grater is great to use here.
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  • For veggie patties make sure your ingredients are free of extra water. Drain and dry your beans or other ingredients thoroughly before mashing. You can even pat them gently dry with a kitchen cloth or paper towel.
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  • Vegetable patties lack the fat of meat patties so oil the grill when BBQing them so the patty will not stick.
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  • Oil all-meat burgers rather than oiling the barbecue or grill pan – this ensures the burgers don’t stick to the grill allowing them to sear well. If they sear well in the first few minutes of cooking they’ll be golden brown and juicy. To make it easy brush the burgers with a brush dipped in oil or easier still use a spray can of oil.
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  • If you only have very lean ground beef try this tip from the Chicago Tribune newspaper  “To each 1 lb (½ kg) of ground beef add 2 tablespoons of cold water (with added salt and pepper) and 2 crushed ice cubs, form patties.” it really does work.
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  • A panade, or mixture of bread crumbs and milk, will add moisture and tenderness to meat patties when the burgers are cooked well-done.
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  • For vegetable patties it is best to focus on one main ingredient then add some interesting flavour notes to that major taste (examples carrot and caraway patties, beetroot, feta and chickpea fritters etc) this gives a much bolder flavour profile than a patty of mashed “mixed” vegetables which can be bland.
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  • Most vegetable  and meat/vegetable patties just need a light coating of seasoned breadcrumbs. Lightly pat breadcrumbs onto the surface of the patty there is enough moisture and binders on the surface of the patty to bind the breadcrumbs to the patty while it is cooking. You can use wheatgerm, bran flakes, crushed breakfast cereals, nuts and seeds to coat the patty.
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  • Use fine packet breadcrumbs as the coating if you want a fine smooth crust on your patties use coarser fresh breadcrumbs as the coating if you want a rougher crisper crust on your patty.
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  • Flip patties once and only once, over-flipping the patty results in uneven cooking of the interior and allows the juices to escape.
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  • Don't press the patties when they are cooking you'll squeeze out all of the succulent juices.
  •  
  • Rest patties a while before consuming.

     
  • Shaping the patty
  •  
  • Shaping – Shape the patty by pressing a ball of mixture with your clean hands it will form a disc shape which will crack and break up around the edges. What you want to do is press down in the middle and in from the sides, turning the patty  around in your hand until it is even and uniform. It should be a solid disc that is firm. Handle the mixture gently, use a light touch and don’t make them too compacted. Rather than a dense burger, which is difficult to cook well, aim for a loosely formed patty that holds together but is not too compressed.
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  • Depressing the centre – When patties cook, they shrink (especially red meat burgers). As they shrink the edges tend to break apart causing deep cracks to form in the patty. To combat this you want the burger patty to be thinner in the middle than it is around the edges. Slightly depress the center of the patty to push a little extra mixture towards the edges. This will give you an even patty once it is cooked.  

     
  • Shallow- and pan-frying 
  •  
  • Preheat the pan or BBQ.
  •  
  • Generally when shallow-frying patties use enough oil that it comes halfway up the sides of the food. Best for most meat and vegetable patties and where the ingredients in the patty are uncooked.
  •  
  • Generally when pan-frying use enough oil to cover the surface of the pan best for most vegetable patties where all the ingredients are precooked (or cook very quickly) and all-meat rissoles and hamburgers.
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  • Most oils are suitable for shallow- and pan-frying but butter is not it tends to burn. Butter can be used in combination with oil. Low-fat spreads cannot be used to shallow fry as they contain a high proportion of water. Rice bran oil is a great choice since it is almost tasteless and has a very high smoke point of 490°F/254°C. The smoke point is when the oil starts to break down into bitter fatty acids and produces a bluish smoke, Canola (smoke point 400°F/204°C) is also a great choice. Butter has a smoke point of 250–300°F/121–149°C. Olive oil Extra light 468°F/242°C. Olive oil Extra virgin 375°F/191°C. Ghee (Clarified Butter) 485°F/252°C.   
  •  
  • Do not overload the frying pan which allows steam to be trapped near the cooking food which might lead to the patties being steamed instead of fried. If you place too many patties at once into the preheated pan this reduces the heat and the patties will then release juices and begin to stew. Leave some space between each when you place them in the pan.
  •  
  • For most patties preheat the oil or fat until the oil seems to shimmer or a faint haze rises from it, but take care not to let it get so hot it smokes. If the oil is too cool before adding the patties, it will be absorbed by the food making the patty soggy. If the oil is too hot then the crumb coating will burn before the interior ingredients are cooked and/or warmed through. For vegetable and meat/vegetable patties start off cooking in a medium hot skillet and then reduce the heat to medium.  For all-meat patties start off cooking in a very hot skillet and then reduce the heat to hot, as celebrity chef Bobby Flay says that “the perfect [meat] burger should be a contrast in textures, which means a tender, juicy interior and a crusty, slightly charred exterior. This is achieved by cooking the meat [patty] directly over very hot heat, rather than the indirect method preferred for slow barbecues”. All patties should sizzle when they are placed onto the preheated pan.
  •  
  • Cast iron pans are best to fry patties.
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  • When the raw patty hits the hot cooking surface it will stick. And will stay so until the patty crust forms so causing a non-stick surface on the patty at this point you can lift the patty easily without sticking. So wait until the patties (with a gentle shaking of the pan or a light finger-twist of the patty) release themselves naturally from the frying pan surface (maybe a minute or two for meat patties maybe 3-6 minutes for a vegetable patty).  If you try to flip it too early the burger will fall apart. The secret is to wait for the the patty to naturally release itself from the pan surface then flip it over once.
  •  
  • Veggie burgers will firm up significantly as they cool.
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  • Most vegetable patties can be baked in the oven.
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  • Check the temperature of the oil by placing a few breadcrumbs into the pan they should take 30 seconds to brown.
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  • If you need to soak up excess oil place the patties on a rack to drain, do not place onto paper towels since steam will be trapped which can make the patty soggy, if you need to just press off the excess oil with paper towels then place onto a rack.



Mandatory Items: Make a batch of pan- or shallow-fried (or baked) patties.

Variations allowed:  Any variation on a patty is allowed. You can use the recipes provided or make your own recipe.

Preparation time:
Patties: Preparation time less than 60 minutes. Cooking time less than 20 minutes.

Equipment required:
Large mixing bowl
Large stirring spoon
Measuring cup
Frying pan

Basic Canned Fish and Rice Patties


Servings: makes about ten ½ cup  patties
Recipe can be doubled
adapted from http://www.taste.com.au/recipes/17181/tuna+rissoles

This is one my favourite patty recipes I make it once a week during the holidays. It is most important that you really mix and mash the patty ingredients well since the slightly mashed rice helps bind the patty together. 

Ingredients:
1 can (415 gm/15 oz) pink salmon or tuna or sardines, (not packed in oil) drained well
1 can (340 gm/13 oz) corn kernels, drained well
1 bunch spinach, cooked, chopped & squeezed dry or 60 gm/2 oz thawed frozen spinach squeezed dry
2 cups (300 gm/7 oz) cooked white rice (made from 2/3 cups of uncooked rice)
1 large egg, lightly beaten
about 3 tablespoons (20 gm/2/3 oz) fine packet breadcrumbs for binding
3 tablespoons (45 ml) oil, for frying
2 spring (green) onions, finely chopped
1 tablespoon (15 ml) tomato paste or 1 tablespoon (15 ml) hot chilli sauce
1 tablespoon (15 ml) oyster sauce
2 tablespoons (30 ml) sweet chilli sauce
Salt and pepper to taste
½ cup (60 gm/2 oz) seasoned fine packet bread crumbs to cover patties

Directions:
1) Place all of the ingredients into a large bowl.
2) Mix and mash using your hands or a strong spoon the ingredients with much force (while slowly adding tablespoons of breadcrumbs to the patty mixture) until the mixture starts to cling to itself about 4 minutes the longer you mix and mash the more compacted the final patty.  Day-old cold rice works best (only needs a tablespoon of breadcrumbs or less) but if the rice is hot or warm you will need more breadcrumbs to bind the mixture. Test the mixture by forming a small ball it should hold together. Cook the test ball adjust the seasoning (salt and pepper) of the mixture to taste.   
3) Form patties using a ½ cup measuring cup.
4) Cover in seasoned breadcrumbs.
5) Use immediately or can be refrigerated covered for a few hours.
6) Preheat fry pan (cast iron is best) to medium hot add 1½ tablespoons of oil and heat until the oil shimmers place the patties well spaced out onto the fry pan lower heat to medium.
7) Pan fry for about 3 minutes each side for a thin lightly browned crust about 10 minutes for a darker thicker crisper crust. Wait until the patties can be released from the pan with a shake of the pan or a light turning of the patty using your fingers before flipping over to cook the other side of the patty add the remaining 1½ tablespoons of oil when you flip the patties. Flip only once. You can fry the sides of the patty if you want brown sides on your patty.

Pictorial Guide
Some of the ingredients
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Starting to mix the patty mixture           
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About ready to be tested
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The test ball to check if the mixture will hold together
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Form patties using a ½ cup measuring cup
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Crumb (bread) the patties                   
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Cover and refrigerate


Preheat frying pan add oil wait until the oil shimmers add patties well spaced out onto the pan
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Wait until the patties can be released by a light shaking of the pan or by finger-turning the patty and then flip the patties over add some extra oil (these were fried for 10 minutes)
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Enjoy picture perfect patties
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This patty was pan-fried on my cast iron fry pan notice the shiny very crisp crust as compared to the patty above
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Zucchini, prosciutto & cheese fritters


Servings: makes about 8-10 two inch (five cm) fritters
Recipe can be doubled
adapted from http://smittenkitchen.com/2011/08/zucchini-fritters/

This makes a great light lunch or a lovely side dish for dinner. 

Ingredients:
500 gm (½ lb) zucchini (two medium)
1 teaspoon (5 ml) (7 gm) salt
½ cup (120 ml) (60 g/2 oz) grated cheese, a strong bitty cheese is best
5 slices (30 gm/1 oz) prosciutto, cut into small pieces
½ cup (120 ml) (70 gm/2½ oz) all-purpose (plain) flour plus ½ teaspoon baking powder, sifted together
2 large eggs, lightly beaten
2 spring onions, finely chopped
1 tablespoon (15 ml) chilli paste
1 teaspoon (5 ml) (3 gm) black pepper, freshly cracked
2 tablespoons (30 ml) oil, for frying

Directions:
     
  • Grate the zucchini with a box grater or food processor. Place into large bowl, add salt, wait 10 minutes.
  •  
  • While waiting for the zucchini, pan fry the prosciutto pieces until cooked. Remove from pan and place prosciutto onto rack this will crisp up the prosciutto when it cools. Paper towels tend to make prosciutto soggy if left on them.
  •  
  • When zucchini is ready wrap in a cloth and squeeze dry with as much force as you can you will get a lot of liquid over ½ cup, discard liquid it will be too salty to use.
  •  
  • Return dried zucchini to bowl add prosciutto, cheese, pepper, sifted flour and baking powder, chilli paste, pepper, a little salt and the lightly beaten eggs.
  •  
  • Mix until combined if the batter is too thick you can add water or milk or another egg, if too wet add some more flour. It should be thick and should not flow when placed onto the frying pan.
  •  
  • Preheat a frying pan (cast iron is best) until medium hot, add 1/3 of the oil wait until it shimmers.
  •  
  • Place dollops of batter (about 2 tablespoons each) onto the fry pan widely spaced out, with the back of a spoon smooth out each dollop to about 2 inches (5 cm) wide, do not make the fritters too thick. You should get three or four fritters in the average-sized fry pan. Lower heat to medium
  •  
  • Fry for 3-4 minutes the first side, flip, then fry the other side about 2-3 minutes until golden brown.  Repeat for the remaining batter. Adding extra oil as needed.
  •  
  • Place cooked fritters into a moderate oven on a baking dish for 10 minutes if you want extra crispy fritters.


Pictures of process – fresh zucchini, grated zucchini, liquid released from salted and squeezed dry zucchini, ingredients for the fritters, fritter batter and frying the fritters.
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Cooked fritters
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California Turkey Burger


Servings: makes about 10 burgers
Recipe can be doubled
adapted from Cooking Light Magazine September 2005:
http://www.myrecipes.com/recipe/california-burgers-10000001097016/

Sauce:
½ cup (120 ml) ketchup
1 tablespoon (15 ml) Dijon mustard
1 tablespoon (15 ml) fat-free mayonnaise

Patties:
½ cup (120 ml) (60 gm/2 oz) finely chopped shallots
¼ cup (60 ml) (30 gm/1 oz) dry breadcrumbs
1 teaspoon (5 ml) (6 gm) salt
1 teaspoon (5 ml) Worcestershire sauce
¼ teaspoon (¾ gm) freshly ground black pepper
3 garlic cloves, minced
1¼ lbs (600 gm) ground turkey
1¼ lbs (600 gm) ground turkey breast
Cooking spray

Remaining ingredients:
10 (2-ounce/60 gm) hamburger buns
10 red leaf lettuce leaves
20 bread-and-butter pickles
10 (1/4-inch thick/5 mm thick) slices red onion, separated into rings
2 peeled avocados, each cut into 10 slices
3 cups (750 ml) (60 gm/2 oz) alfalfa sprouts

Directions:
1. Prepare the grill to medium-high heat.
2. To prepare sauce, combine first 3 ingredients; set aside.
3. To prepare patties, combine shallots and the next 7 ingredients (through turkey breast), mixing well. Divide mixture into 10 equal portions, shaping each into a 1/2-inch-thick (1¼ cm thick) patty. Place patties on grill rack coated with cooking spray; grill 4 minutes on each side or until done.
4. Spread 1 tablespoon sauce on top half of each bun. Layer bottom half of each bun with 1 lettuce leaf, 1 patty, 2 pickles, 1 onion slice, 2 avocado slices, and about 1/3 cup of sprouts. Cover with top halves of buns.                                                                                                         

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Yield:  10 servings (serving size: 1 burger) - Nutritional Information – CALORIES 384(29% from fat); FAT 12.4g (sat 2.6g,mono 5.1g,poly 2.8g); PROTEIN 31.4g; CHOLESTEROL 68mg; CALCIUM 94mg; SODIUM 828mg; FIBER 3.9g; IRON 4mg; CARBOHYDRATE 37.5g
Lisa’s Notes:
Nutritional information provided above is correct for the recipe as written.  When I make these burgers, the only ingredients I change are using regular mayo, and dill pickles.  My red lettuce of choice is radicchio.  I’ve both grilled and pan fried these burgers and both are delicious.  If you decide to pan fry, you’ll need a little extra fat in the pan – so use about 2 tsp. of extra virgin olive oil, or canola oil before laying your patties on the pan.  Cook for approximately 5 minutes on each side, or until done.  Do not overcook as the patties will dry out and not be as juicy and tasty! :)

French Onion Salisbury Steak


Courtesy of Cuisine at Home April 2005 edition
Makes 4 Steaks; Total Time: 45 Minutes

Ingredients:
1 1/4 lb (600 gm) ground chuck 
1/4 cup (60 ml) (30 gm/1 oz) fresh parsley, minced
2 tablespoons (30 ml) (⅓ oz/10 gm) scallion (spring onions), minced
1 teaspoon (5ml) (3 gm) kosher salt or ½ teaspoon (2½ ml) (3 gm) table salt
1/2 teaspoon (2½ ml) (1½ gm) black pepper
2 tablespoons (30 ml) (½ oz/18 gm) all-purpose (plain) flour
2 tablespoons (30 ml) olive oil
2 cups (240 ml) (140 gm/5 oz) onions, sliced
1 teaspoon (5 ml) (4 gm) sugar
1 tablespoon (15 ml) (⅓ oz/10 gm) garlic, minced
1 tablespoon (15 ml) (½ oz/15 gm) tomato paste
2 cups (240 ml) beef broth
1/4 cup (60 ml) dry red wine
3/4 teaspoon (2 gm) kosher salt or a little less than ½ teaspoon (2 gm) table salt
1/2 teaspoon  (2½ ml) (1½ gm) dried thyme leaves
4 teaspoons (20 ml) (⅓ oz/10 gm) fresh parsley, minced
4 teaspoons (20 ml)  (2/3 oz/20 gm) Parmesan cheese, shredded

Cheese Toasts
4 slices French bread or baguette, cut diagonally (1/2" thick) (15 mm thick)
2 tablespoons (30 ml) (30 ml/1 oz) unsalted butter, softened
1/2 teaspoon (2½ ml) (2 gm) garlic, minced
Pinch of paprika
1/4 cup (60 ml) (30 gm/1 oz) Swiss cheese, grated (I used 4 Italian cheese blend, shredded)
1 tablespoon (15 ml) (⅓ oz/10 gm) Parmesan cheese, grated

Directions:
1. Combine chuck, parsley, scallion, salt and pepper. Divide evenly into 4 portions and shape each into 3/4"-1" (20-25 mm) thick oval patties. Place 2 tablespoons flour in a shallow dish; dredge each patty in flour. Reserve 1 teaspoon flour.
2. Heat 1 tablespoon oil in a sauté pan over medium-high heat. Add patties and sauté 3 minutes on each side, or until browned. Remove from pan.
3. Add onions and sugar to pan; sauté 5 minutes. Stir in garlic and tomato paste; sauté 1 minute, or until paste begins to brown. Sprinkle onions with reserved flour; cook 1 minute. Stir in broth and wine, then add the salt and thyme.
4. Return meat to pan and bring soup to a boil. Reduce heat to medium-low, cover and simmer 20 minutes.
5. Serve steaks on Cheese Toasts with onion soup ladled over. Garnish with parsley and Parmesan.

For the Cheese Toasts
6. Preheat oven to moderately hot 200°/400ºF/gas mark 6.
7. Place bread on baking sheet.
8. Combine butter, garlic and paprika and spread on one side of each slice of bread. Combine cheeses and sprinkle evenly over butter. Bake until bread is crisp and cheese is bubbly, 10-15 minutes.

French Onion Salisbury Steak
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Potato Rösti


Servings: makes two large rösti
adapted from a family recipe

The classic rösti; cheap, easy and so tasty.

Ingredients:
1 kg (2½ lb) potatoes
1 teaspoon (5 ml) (6 gm) salt
2 teaspoons (10 ml) (6 gm) black pepper, freshly milled
1 large egg, lightly beaten
2 tablespoons (30 ml) (½ oz/15 gm) cornflour (cornstarch) or use all-propose flour
3 tablespoons (45 ml) oil, for frying

Directions:
     
  1. Grate lengthwise the peeled potatoes with a box grater or a food processor.
  2.  
  3. Wrap the grated potato in a cloth and squeeze dry, you will get a lot of liquid over ½ cup, discard liquid since it is full of potato starch.
  4.  
  5. Return dried potato to bowl add the egg, cornflour, pepper, and salt.
  6.  
  7. Mix until combined.
  8.  
  9. Preheat a frying pan (cast iron is best) until medium hot, add 2 teaspoons of oil wait until oil shimmers.
  10.  
  11. Place half of mixture into the pan, flatten with a spoon until you get a smooth flat surface. Lower heat to medium.
  12.  
  13. Fry for 8-10 minutes (check at 6 minutes) the first side, flip by sliding the rösti onto a plate then use another plate invert the rösti then slide it back into the pan, then fry the other side about 6-8 minutes until golden brown. Repeat to make another rösti


Pictures of process – Peel 1 kg spuds, grate lengthwise, squeeze dry, add 1 egg, 2 tablespoons starch, salt and pepper. Pan fry.
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Pictures of the grated potato before (left) and after (right) squeezing dry. Notice in the left hand pictures the gratings are covered in moisture and starch, while in the right hand pictures the grated potato is dry and doesn't stick together.
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Pictures of the finished small rösti
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Pictures of the large rösti
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Chicken, potato and corn patties
I had some leftover chicken legs and boiled potatoes from dinner last night so I made up some patties. The patties are made from 1 kilogram of finely grated cold boiled potatoes, 4 chicken legs meat removed and finely chopped, and one can of corn kernels. The binder was one egg and 1/4 cup of self-raising wholewheat flour.

The crumbed (breaded) patties waiting to be pan fried
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Patties pan frying
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The finished patties
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Meatballs
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I made meatballs using high quality ground veal and pork (30% fat) I didn't use any binders in the mixture just a little seasoning chilli, garlic and dried mushroom powder.

The meatballs waiting to be fried
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Frying the meatballs
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The finished meatballs
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Of course I made spaghetti and meatballs for dinner so so delicious
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Thai Fish Cakes
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I adore Thai fish cakes but I have never really made them I was surprised how simple it is if you have a very strong food processor. Basically you make a paste from 1/2 kg (1 lb) of white fillet fish (I used catfish (basa) fillets) with 1 egg and 6 tablespoons of flavourings (a combination of 1 Tbsp fish sauce, 1 tsp chilli, 2 Tbsp red curry paste, 1 Tbsp coconut cream, 1 Tbsp chilli crab flakes, 1/2 tsp sugar, 1/2 tsp salt, 1/2 tsp shrimp paste, a few spices), 6 kaffir lime leaves and 2 tablespoons cornflour (cornstarch) with a teaspoon of baking powder, you form small patties (each 2 tablespoons) from the paste and pan fry until cooked. These are just as good as the cafe ones I buy and only cost about 30 cents each instead of $1.90 at the cafe. A good basic recipe for Thai fish cakes is here http://thaifood.about.com/od/thaiseafoodrecipes/r/classicfishcakes.htm I added some extra baking powder and cornflour to the basic recipe since it makes the cakes rise and the interiors are light and fluffy. Super tasty and so cute.

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Storage & Freezing Instructions/Tips:
Most rissoles, croquettes and dry fritters keep well for three or four days if covered and kept in the fridge. Uncooked and cooked rissoles and croquettes can be frozen for at least one month.

Additional Information: 
An index of Aussie patty recipes http://www.taste.com.au/search-recipes/?q=patties&publication=
An index of Aussie rissole recipes http://www.taste.com.au/search-recipes/?q=rissoles&publication=
An index of American patty recipes http://allrecipes.com/Search/Recipes.aspx?WithTerm=patty%20-peppermint%20-dressing&SearchIn=All&SortBy=Relevance&Direction=Descending
An index of American burger recipes http://busycooks.about.com/cs/easyentrees/a/burgers.htm 
A great vegetable and chickpea recipe http://www.exclusivelyfood.com.au/2006/06/vegetable-and-chickpea-patties-recipe.html
A baked vegetable patty recipe http://patternscolorsdesign.wordpress.com/2011/02/20/baked-vegetable-patties/
Vegetable patty recipes http://www.divinedinnerparty.com/veggie-burger-recipe.html
Best ever beet(root) and bean patty http://www.thekitchn.com/restaurant-reproduction-bestev-96967
Ultimate veggie burgers http://ask.metafilter.com/69336/How-to-make-awesome-veggie-burgers
One of best zucchini fritter recipes http://smittenkitchen.com/2011/08/zucchini-fritters/ 
Old School Meat rissoles http://www.exclusivelyfood.com.au/2008/07/rissoles-recipe.html
How to form a patty video http://www.youtube.com/watch?v=iHutN-u6jZc
Top 12 vegetable patty recipes http://vegetarian.about.com/od/veggieburgerrecipes/tp/bestburgers.htm
Ultimate Meat Patties Video http://www.chow.com/videos/show/youre-doing-it-all-wrong/55028/how-to-make-a-burger-with-hubert-keller
Beautiful vegetable fritters so pretty http://helengraves.co.uk/tag/beetroot-feta-and-chickpea-fritters-recipe/   
Information about veggie patties http://kblog.lunchboxbunch.com/2011/08/veggie-burger-test-kitchen-and-lemon.html  

Disclaimer:
The Daring Kitchen and its members in no way suggest we are medical professionals and therefore are NOT responsible for any error in reporting of “alternate baking/cooking”.  If you have issues with digesting gluten, then it is YOUR responsibility to research the ingredient before using it.  If you have allergies, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. If you are lactose intolerant, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. If you are vegetarian or vegan, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. The responsibility is YOURS regardless of what health issue you’re dealing with. Please consult your physician with any questions before using an ingredient you are not familiar with.  Thank you! :)
          January, 2012 Daring Baker Challenge: Back to Basics:Scones (Biscuits)        
Introduction:  Hi my name is Audax from Audax Artifex (yes this web site). Whenever I visit my sister and her family in S.E. Queensland Australia she always welcomes me with a fresh batch of my favourite baked treat which we devour gleefully with cups of tea while we chat and catch up with the events in our lives.

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The treat that I'm talking about is the basic scone (also know as baking powder biscuits in North America) my sister really knows how to make them, they are wondrously light with soft sides and a lovely airy crumb – superb with jam and cream. This month I want the Daring Bakers' to share my delight and I invite you to bake a batch of scones to enjoy with friends and family.

For our North American members I wish to clarify what this challenge is all about and try to avoid any confusions. Scones in North American are nearly always triangular in shape have a slightly crisp crust usually covered in sugar and have a soft interior crumb and sometimes are laced with dried fruit (these baked goods in Australia and England are called “rock cakes” since they are usually made to look like “rocky” cakes not wedges), meanwhile biscuits in North American are a round shaped buttery slightly flaky baked good usually eaten with meals (these items in Australia and England are called “scones” and are eaten with butter and jam usually with cups of tea or coffee as a sweet snack). So this challenge (using the North American name) is to make biscuits. Or using the Australian or English name this challenge is to make scones.

To further clarify for our North American bakers this month's challenge is to make biscuits (also called baking powder biscuits) if you choose to make your biscuits using buttermilk as the liquid you are making what are known as “Southern” Biscuits which are one of the most famous examples of home cooking in the Southern States of America (that is they are a baking powder biscuit made with buttermilk). In Australia and England “Southern” Biscuits would be called buttermilk scones. So restating the above, the challenge is to make scones (using the Australian/English name) or to make  biscuits (using the North American name). Incidentally if you use cream as your liquid in the challenge recipe the final baked good would be called a cream biscuit in North America or a cream scone in Australia and England.  

Scones (biscuits) contain only a small number of ingredients they are fast to make, quick to bake, only cost cents per batch and most importantly are super FUN to eat. In England and Australia scones are eaten with jam and butter usually with cups of tea or coffee mostly as a sweet snack, while in North America they are usually eaten with meals as a savoury side.

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Of course scones (biscuits) have a notorious reputation as being difficult for some people to make  comments like “hockey pucks”, “These made great door-stops ” and the like fill the comment sections of most recipe websites. You see scones (can be said as a rhyme with cone and also can be said as a rhyme with gone) are a type of quick bread that is a white flour dough that is raised using chemical agents usually baking powder and/or baking soda. Basic scones contain flour, raising agent(s), butter (or shortening or lard), salt, and milk (or buttermilk or soured milk or cream). Most recipes just say to “rub the fat into the flour” then combine the dry and wet ingredients until “gathered together” and then “lightly knead” the gathered mixture until a soft dough forms, then “roll or pat” out this dough and then “cut” out rounds and bake them in a hot oven. Well how hard could it really be I thought uh-mm as you can see below my first batch wasn't the greatest success … they didn't raise at all and the texture was barely OK I thought … I was left wondered what I had done wrong …   

My first attempt at scones (really pretty terrible I thought, no height no tenderness and no flakiness)

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So after studying many many (288 websites bookmarked) scone/biscuit recipes and the bakers' comments about these recipes and after doing 16 batches! myself I have acquired a lot of information to help you master the techniques involved I hope that at the end of this challenge that you will be able to make a good if not great scone (biscuit).

After much research and many attempts …  finally some scones (the 14th, 15th and 16th batches) that I wouldn't mind sharing with my sister.

The Classic Australian scone ring (Aussie Damper) – the crumb is very similar to bread
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Cheese and chives scones – a “sky-high” light and tender scone flavoured with cheese and chives
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The classic Southern Biscuit (buttermilk scone) – a superbly flaky scone made with buttermilk and laminated to form distinct layers when baked
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Fairy Ring
As I mentioned in the challenge posting in Australia and England scones are usually eaten as a sweet treat (with butter and jam) with cups of tea on that theme while doing my research for this challenge I thought I would do a variation on the sweet side of the scone. Here is one recipe that is suitable for kids and adults when you want something special and sweet yet can be made at a moment's notice.

In Australia one of the most popular children's party food item is fairy bread. This is a variation of fairy bread called Fairy Ring made with an Aussie Scone (Damper) ring laced with 100s and 1000s then iced (with some icing sugar and a touch of lemon juice made into a sticky paste) then sprinkled with more 100s and 1000s (coloured sprinkles). My 9 year old niece went crazy with delight and literally squealed with glee when I showed her this Fairy Ring and say I made it especially for her.

Normal (Damper) Scone Ring
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Fairy Ring straight from the oven
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Completed Fairy Ring
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Hot Dog Buns
Here is a savoury variation, I made hot dog buns using the basic scone recipe. They worked out great I couldn't believe the crumb and they tasted great with the hot dog and relishes and I made them in under 15 minutes (once the oven was hot enough). I was very surprised how well the basic scone dough complimented savoury food.  
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Touch of Grace Scones
(Click on the title to go to a great posting about this recipe)
Here is the answer to dry biscuits this recipe is called "touch of grace" biscuits which uses a few simple techniques to create a super moist crumb. These scones are all about tenderness everything is designed to obtain the softest and most tender crumb possible. These are very different from the normal bread-like scones that Australians like with jam and cream. These would be perfect with a savoury meal. They were so buttery with a soft creamy crumb that literally melts in your mouth, the mouth feel is like clouds. As one reviewer lovingly opined "They're squat little puffs you'll want to grab, steaming, from a basket passed over fried chicken or bacon and eggs". The way I make them is slightly adapted from the original recipe,  I use a lot of very large pieces of butter and all buttermilk with very low gluten cake flour and some resting time in the fridge. Resting the dough after the buttermilk is stirred into the dry ingredients is essential you would never be able to form the soft balls of dough coated in flour that are the "rounds" in this case and keeping everything cold helps the baking process. While baking the large pieces of butter melt into the flour causing large air holes to form in the baked dough and since we use soft flour (6%) which cannot form flaky layers we thus obtain a feather-light creamy tender crumb infused with the maximum amount of butter that the dough can hold.
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These scones are made entirely from cake flour (6% gluten), I used 1 cup of flour, 2 teaspoons baking powder, 1/2 teaspoon baking soda, 1/4 cup very large-sized butter pieces, about 1/2 cup buttermilk and 1/2 teaspoon sea salt. I rubbed in butter making sure most of the fat/flour where large pea sized pieces. I rested the dough after I mixed in the wet ingredients for 10 minutes until cold, during this time the dough "firms" up making it possible to turn it out in one cohesive dough ball onto a lightly floured board. I formed a rectangle of the soft dough floured the top lightly then I stamped out rounds. You could feel the pieces of butter in the formed round The rounds are very soft but can be picked up and placed into the baking dish. Then I place the baking dish with all the formed rounds back in the fridge for 10 minutes until cold then bake. (This procedure is much easier than the original recipe's method and it gives as good results I think). As you can see the crumb is saturated with butter and has masses of large airy pockets to trap your favourite topping. Absolutely delicious.
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Raisin Scones
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I wanted to make one batch of flavoured scones I went with sweet raisins and some molasses in the dough. I rubbed in the butter until it was like fine sand and I used "OO" cake flour about 7% protein and some cornflour (cornstarch), I was very happy with the look of the baked scones and the crumb was very tender very much like bread which is what I wanted. These were very cute looking but to be honest I like plain scones much better.
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The bread like crumb of the scone so so tasty and soft.
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As you can see scones (biscuits) are all about technique since the scones pictured above used the same basic recipe. 

Recipe Source:  The challenge scone (biscuit) recipe has been especially formulated by Audax Artifex after a large amount of research and experimentation. It is designed to help you master the techniques involved in making scones (biscuits) exactly the way you like them. 

Blog-checking lines: Audax Artifex was our January 2012 Daring Bakers’ host. Aud worked tirelessly to master light and fluffy scones (a/k/a biscuits) to help us create delicious and perfect batches in our own kitchens!

Posting Date:  January 27, 2012

Challenge Notes:
The Ingredients – since scones contain only a small number of ingredients each should be of the highest quality
Flour – lower gluten (i.e. soft) flours (about 9% or less protein) produce taller and lighter scones than normal plain (all-purpose) flour (about 10%+ protein). But to be honest it wasn't that great a difference so long you sifted the dry ingredients thoroughly at least three times. That is always triple sift the dry ingredients this will ensure that the flour is well aerated and the raising agents are evenly distributed so resulting in light scones. I found that finely milled soft “OO” flour gave the best results but don't worry you can get excellent results with sifted plain (all-purpose) flour. You can use self-raising flour if you wish (remember to leave out the raising agents and salt) in the recipe below it is important to triple sift the self-raising flour as well I like to add about ½ teaspoon of extra fresh baking powder per cup of self-raising flour to ensure a good lift in my scones. In the northern states of America and most of Canada all-purpose flour is generally very hard (high in protein) you can replace for each cup 4 tablespoons of all-purpose flour with cake flour  OR for each cup replace 2 tablespoons of all-purpose flour with cornflour (cornstarch). Or you can let the scones rest (20 mins) in the fridge before baking. 
Fat – unsalted butter gives the best flavour while lard gives the flakiest texture since it has a much higher melting point than butter so promoting a flaky texture in the final scones. The best compromise is to use a combination of the two in equal measure. I usually use all (unsalted) butter for flavour and health reasons. In most recipes the fat is rubbed into the flour using fingers or a pastry cutter (don't use two knives or forks since it takes too long to cut in the fat using this method). It is best to grate the butter using the coarse side of a box-grater and then freeze it until you need it. Freezing the butter prevents the fat from melting into the flour. The idea is to coat the fat particles with the flour. You are looking for a fat/flour combination that looks like very coarse bread crumbs with a few pieces of butter about the size of peas, the finer you make your fat pieces the more tender the crumb of your final scones. If you want very flaky scones then make the fat pieces large like Lima beans and only lightly coat them in the flour. If your kitchen is very hot you can refrigerate your flour so helping to keep the fat from melting. Don't freeze your flour as this will make it too difficult to rub the fat into the flour. (Typical usage about 1 to 8 tablespoons of fat per cup of flour).
Chemical raising agents – always use fresh raising agents, baking powder deteriorates within two months once the jar is opened, typical usage 1 to 2 teaspoons per cup. Baking powder nowadays is double action – there is an initial release of gas once the dry and wet ingredients are combined and there is another release of gas from the high heat of the oven. If you are using acidic ingredients (such as buttermilk, soured milk, honey, citrus juice, yoghurt, tomato sauce etc) then use an additional ¼ teaspoon of baking soda per cup of liquid to help neutralise the acid and make the final baked product raise correctly. Baking soda is much stronger (x4) in raising power than baking powder. You can make you own single action baking powder by triple sifting together one part baking soda and two parts cream of tartar store in an airtight container. To check if your double action baking powder is fresh place 1/4 teaspoon in 1/2 cup of water it should bubble a lot, then microwave it for 30 secs it should bubble it again. To check your baking soda place 1/8 teaspoon into 1 tablespoon of vinegar (or lemon juice) it should bubble a lot. 
Liquid – you can use milk (any sort), buttermilk, soured milk, yoghurt, half-and-half, cream, coconut cream, soda water, even lemon-flavoured soda pop (soft drink) or a combination of these as the liquid in your scones. You can sour regular milk with a tablespoon of cider vinegar or lemon juice for every cup. Just stir it in and let it sit for 10 minutes or so to curdle. Typical usage is 1/3 to 1/2 cup of liquid per cup of flour.
Salt – a small amount of salt (about ¼ teaspoon per cup of flour)  helps improve the action of the raising agents and enhances the flavour of the scones.

The Equipment
Baking pans – use dark coloured heavy weight baking pans as these have the best heat distribution and really give a great raise to your baked goods. Many people like to use cast iron skillets for best results.
Measuring cups and spoons – try to accurately measure all ingredients especially if this is your first attempt at making scones (biscuits) remember to scoop the ingredient into the measure and level with a knife. If you can weigh the flour using scales even better.
Scone (biscuit) cutters – use a cutter that is made of sharp thin metal with straight sides and is open at both ends this ensures that the scone will raise straight and evenly and ensures the cut scone is easy to remove from the cutter without compressing the dough. Try to avoid using cutters with wavy sides, thick walled cups, glasses, metal lids, small jars or any cutter with only one opening since it is difficult to remove the cut scones from these without compressing the dough therefore leading to 'tougher' scones. If you cannot get a good cutter you can cut out squares or wedges etc using a sharp knife if you wish.
Rolling pins – most scone doughs are very soft (and wet) so can be easily patted out using your fingers. For a large amount of dough you can use a rolling pin remember to use light pressure from the centre outwards to form an even thickness of dough ready to be cut into scones. Avoid rolling back and forth over the same area as this can overwork the dough.    

The Techniques
Triple sift the dry ingredients – sift your dry ingredients from a height this permits plenty of air to be incorporated into the mixture which allows for maximum lightness in your scones and ensures even distribution of all the raising agents and other ingredients.
Rubbing in the fat – this is the stage where you can control how tender or flaky your final scone crumb will be. The more you coat your fat with flour and the smaller the particles of the final mixture, the more tender the end product because you’re retarding gluten formation in the flour (unfortunately the price you pay for this tenderness is that the final dough will be soft and might not raise very well since the gluten isn't developed enough to form a stable structure to trap the gases that are released when the dough is baked). Conversely the larger you leave the pieces of fat (the infamous "pea-sized" direction you always see in scone/biscuit recipes), the flakier the final scones will be (that is the gluten in this case is more developed but you might find that the final baked product is dry and the mouth feel of crumb could be too firm i.e. tough). So summarising the tenderness/flakiness of your scone is achieved in this stage by manipulating the size of the fat particles and how much of the flour is used to coat the fat (the more flour used to coat the fat promotes more tenderness while larger fat pieces promote more flakiness).  Either way quickly rub in the grated frozen fat into the dry ingredients using
1)your finger tips – as you lightly rub and pinch the fat into the flour, lift it up high and let it fall back down into the bowl, this means that air is being incorporated all the time, and air is what makes scones light, continue this until you have the desired sized flour/fat particles in the mixture, or
2)a cold pastry cutter – begin by rocking the pastry cutter into the fat and flour mixture continue rocking until all the fat is coated in flour and the desired sized flour/fat particles are obtained.
Moistening and bringing the dough together -  add nearly all of the liquid at once to the rubbed-in dry ingredients.  When mixing the dough (I use a soft plastic spatula, my sister uses a knife), stir with some vigour from the bottom to the top and mix just until the dough is well-moistened and begins to just come together it will be wet (and sticky). And remember the old saying – the wetter the dough the lighter the scones (biscuits)!  
Handling the dough – as most people know it is important not to overwork the dough but what isn't appreciated is that under-working is almost as common a mistake as overworking. Look at my first attempt (the first photo in this article) at making the challenge recipe it is crumbly and a bit leaden and the crumb isn't flaky at all this is due to under-working the dough and making the flour/fat particles too small, it took me about six batches to understand this and not be afraid to handle the dough so the scone (biscuit) would raise correctly. Under-working causes as many problems as overworking. Overworking leads to tough, dry and heavy scones while under-working leads to crumbly leaden ones. If you are not happy with your baked goods look carefully at your final scones (biscuits) and decide if you have under- or over-worked your dough.
Kneading or folding/turning the dough – this is the stage where you can control whether or not your scone has distinct layers by 1) only kneading the dough (for no layering effect) or 2) only turning and folding the dough (for a layering effect).  As mentioned above given the same amounts of flour and fat, leaving larger pieces of fat equals more gluten formation and, therefore, flakiness. Leaving smaller pieces of fat equals less gluten formation and, therefore, tenderness. Your dough at this stage of the recipe will be a mixture of different gluten strengths since it is almost impossible to make a totally homogeneous dough at home. The major idea at this stage of the process is to exploit these gluten differences to achieve a desired degree of lamination (layering) in the final baked good. That is at this stage your dough (after you have added the liquid and mixed it until it just holds together), will have different layers of relatively gluten-rich (tougher) dough (the more floury parts of the dough), and layers of relatively gluten-free (tender-er) dough with small pieces of fat (the more fatty parts of the dough). So at this point if we only lightly knead the dough these layers will become less distinct which means the dough will become more homogeneous so producing a more even and more tender crumb when baked. But if at this stage you only fold and turn the dough (as shown below in pictures) over itself, these different layers will remain intact but will get thinner and thinner with each fold and turn, so when the fat melts and the liquid turns to steam in the oven, this steam pushes the tougher layers apart, leading to an overall flakiness and a layering effect in the scone crumb (see picture of the buttermilk biscuit above). So if you want an even more tender crumb just lightly knead (much like you would knead bread but with a very very light touch) the turned-out dough a few times until it looks smooth. If you want to form layers (laminations) in your final baked goods do a few folds and turns until it looks smooth. Always do at least one light knead to make the final dough structurally strong enough to raise and hold its shape whether you are aiming for a smooth tender crumb or a flaky layered crumb.
Pat or roll out the dough – since most scone (biscuit) doughs are soft (and sticky) it is best to use your fingers to gently pat out the dough once it has been kneaded or folded and turned. Use a very light touch with little pressure while forming the dough rectangle to be cut into rounds for the scones. If you want tall scones then pat out the dough tall, about 3/4 inch to 1 inch (2 cm to 2½ cm) thick is about right.
Cutting out your scones – use a well-floured scone (biscuit) cutter for each round that you stamp out from the dough. That is dip your cleaned cutter into fresh plain flour before each separate cut. Do not twist the cutter while stamping out the scone, push down firmly until you can feel the board then lift the cutter the round should stay inside the cutter then gently remove it from the cutter  and place the round onto the baking dish. You can use a sharp knife to cut out other shapes if you wish from the dough, also the knife should be floured before each cut as well. 
Baking your scones – always preheat your oven when baking scones. Place each scone almost touching onto the baking dish this encourages the scones to raise and also keeps the sides soft and moist. If you want crisp sides widely space your scones on the baking dish. Don’t over-bake your scones. Over-baking for even a minute or two will dry your scones out. As soon as the sides begin to turn brown and are set, remove them from the oven. Immediately, place the scones on a wire rack—the hot pan will continue to dry the scones.
Extra comments about resting the dough – I found in my researches that a number of respected sources mentioned resting the dough in various stages in the recipe. Surprisingly this advice is sound. I found that if you rested the just mixed dough (in the fridge) for 20 minutes there was a huge improvement in the dough's handling qualities and the final scones height, lightness and crumb were outstanding. Also I found that if you rest your patted out dough covered in plastic for 10 minutes in the fridge that the rounds are easier to stamp out and the final baked goods raise higher and have a better crumb. Also you can rest your stamped out rounds in the fridge for a couple of hours without harm so you can make your scones place them into the fridge and then at your leisure bake them later great for dinner parties etc. This is possible because modern baking powder is double action, i.e. there is another release of gas when you bake the rounds in the heat of the oven.

Troubleshooting  
Problems with bitter after-taste or dry chalky mouth-feel

The biggest problem that scone/biscuits can sometimes have is an after-taste (sometimes described as metallic or a salty chemical taste) or the mouthfeel is dry and chalky (i.e. the crumb is tough and doesn't have enough moisture).

If the problem is the after-taste try these tips
  • use freshly opened raising agents, many people claim old baking powder has a stronger taste
  • look for a single action baking powder (that only uses baking soda and cream of tar tar with a little cornflour) or make your own, since some double action baking powders can have metallic salts in them which some people can taste even in small quantities. Also keep in mind that homemade baking powder works faster and at a lower temperature, so put your recipe together quickly
  • look for a double action baking powder that uses non-metallic ingredients in it, check the ingredients listing on the packet.
  • use less baking powder
  • if you used an acidic liquid (buttermilk etc) and did not use some baking soda with the normal baking powder then some of the acid in the liquid wouldn't have been neutralised so leaving some salts behind causing the salty aftertase, that is make sure you are using the correct combination of agents for the liquids that you use, see the link below for full details about this. 
  • use only baking soda and an acidic liquid (buttermilk) like in the famous Irish Soda bread which very few people complain about having an aftertaste
  • use bakers' ammonium (available from King Arthur's flour) it was one of the most common chemical raising agents in the old days before modern baking powder, it smells like ammonia when baking but the ammonia smell totally dissipates and this chemical leaves nothing behind. I use it a lot in my baking it really gives baked goods that old-fashioned taste that people really can pick up on also it gives cookies extra crispness when baked.   

See here for a comprehensive posting on baking powder/baking soda and how to use them in recipes.
See here for the most interesting discussion on the use of baking soda and baking powder

If the problem is the mouthfeel try these tips
  • try smaller sized scones and bake them quickly in a very hot oven and make the dough wetter since large sized scones using a drier dough baked in a moderate oven will give you a dryer crumb therefore a dry chalky mouthfeel
  • over-handled dough will lead to a dry mouth
  • eat them immediately fresh out of the oven, scones do really suffer (they become dry and tough) when stored for any length of time
  • try using more fat about 1/4 cup+ per cup of flour - more fat gives moister crumb. Also try using all shortening, since shortening contains no water or milk solids it gives a very tender crumb.
  • use this great recipe they are called "a touch of grace" biscuits they are the most tender and moist biscuits (scones) that I have had.
  • some people claim that a very hot oven is best to start the baking process then lower the temperature to moderate to finish baking the scones

The problem lopsided scones
About lop-sided scones this is usually caused by uneven cutting out of the scone. Some hints
1. Clean and flour the scone cutter (by rubbing off any wet dough and then dipping the cutter into fresh flour the entire height of the cutter) every time you stamp out each round. Remember not to twist when you are stamping out the scones. If you are using a knife remember to clean and flour it for each cut.
2. Try to pat out or roll out the dough as evenly as possible.
3. Did you sift the dry ingredients three times? (uneven distribution of ingredients can lead to uneven scones).
4. Try to get the scone out of the cutter by applying gentle even pressure on the entire scone circumference that way you do not compress just one place so making that area less tender so raising less when cooked.
5. Turn the cut scone upside down onto the baking dish, since this side will be flatter than the patted out top surface.
6. Only glaze the tops of the scone, a small amount of liquid on the sides will inhibit raise in that area.
7. Some people like to use a fork and prick some holes in the top of the unbaked scones supposedly this helps the scone raise evenly.
8. Also some people like to use their thumb and press a small hollow into the top of the scone supposedly this helps the scone raise evenly.
9. A good article about "making the perfect scone" see here it goes through a lot of the best scone recipes by master bakers.
10. Try this recipe and its method from Bakers' 911 which seems to make straight-sided scones even from wavy-sided cutters

How to test baking soda
1. Place a 1/4 teaspoon of baking soda into a tablespoon of vinegar it should bubble a lot.

How to test your single action baking powder
1. Place a teaspoon of baking powder into a cup, add 1/4 cup room temperature water it should bubble a lot.

How to test your double action baking powder
1. Place a teaspoon of baking powder into a cup, add 1/4 cup room temperature water it should bubble a lot.
2. Wait 30 secs and then place your cup into the microwave heat for about 30 secs until about 180F it should bubble again.
3. If it doesn't then discard and buy a new jar.

How to test your self-raising flour - add one tablespoon of S.R. flour into some hot water it should bubble a bit. Or try adding some vinegar and see if it bubbles. Usually SR flour is only good for about three months.

The problem an unreliable oven
1. Try and use heavy grade dark metal baking dishes which give the best heat distribution.
2. If your oven heating cycle is unreliable (varies the temperature a lot) lower the temperature to hot 220C (430F), preheat the oven along with a heavy metal baking dish for a good 20 mins then bake the scones on the baking dish which acts as a heat sink helping to bake the scones more evenly. Try to bake smaller sized scones which helps with a constantly varying temperature.
3. If your oven has hot spots which mine does just rotate the dish at about 3/4 of the total baking time.

The problem my dairy-free margarine doesn't do a good job of cutting in
1. Just melt the margarine and add it to the liquid and proceed as normal (this is the best you can do if the margarine is "bad for cutting-in or just bad for scones" in the first place).

Mandatory Items: You must make one batch of basic scones (i.e. basic biscuits using the North American name). The challenge recipe has been designed to be fast, very cheap and easy to follow so allowing for multiple attempts to be made until you can achieve your desired result. I encourage you to make a couple of batches to see how small changes in technique can obtain vastly different final baked products. I estimate all of my 16 experimental batches cost less than $4 and took about four hours, so please do take this opportunity to explore the possibilities of the different techniques and advice that have been presented here in this challenge. I have included a number of links to the most popular scone (biscuit) recipes (and variations) in a number of countries feel free to use these if you can make a good basic scone (biscuit) already.  

Variations allowed:  A number of variations (cheese and chives, herb, etc) on the basic challenge recipe are included use them if you wish.  

Preparation time: Scones: Preparation time less than 10 minutes. Baking time about 10 minutes.

Equipment required:
Large mixing bowl
Baking dish
Measuring cups and  spoons (optional)
Flour Sifter (optional)
Board (optional)
Scone (biscuit) cutter (optional) or knife (optional)
Dough scraper (optional)
Spatula (optional)
Weighing scale (optional)
Cooling rack (optional)
Pastry brush (optional)

Basic Scones (a.k.a. Basic Biscuits)
Servings: about eight 2-inch (5 cm) scones or five 3-inch (7½ cm) scones
Recipe can be doubled

Ingredients:
1 cup (240 ml) (140 gm/5 oz) plain (all-purpose) flour
2 teaspoons (10 ml) (10 gm) (⅓ oz) fresh baking powder
¼ teaspoon (1¼ ml) (1½ gm) salt
2 tablespoons (30 gm/1 oz) frozen grated butter (or a combination of lard and butter)
approximately ½ cup (120 ml) cold milk
optional 1 tablespoon milk, for glazing the tops of the scones

Directions:
1. Preheat oven to very hot 475°F/240°C/gas mark 9. 
2. Triple sift the dry ingredients into a large bowl. (If your room temperature is very hot refrigerate the sifted ingredients until cold.)
3. Rub the frozen grated butter (or combination of fats) into the dry ingredients until it resembles very coarse bread crumbs with some pea-sized pieces if you want flaky scones or until it resembles coarse beach sand if you want tender scones.
4. Add nearly all of the liquid at once into the rubbed-in flour/fat mixture and mix until it just forms a sticky dough (add the remaining liquid if needed). The wetter the dough the lighter the scones (biscuits) will be!
5. Turn the dough out onto a lightly floured board, lightly flour the top of the dough. To achieve an even homogeneous crumb to your scones knead very gently about 4 or 5 times (do not press too firmly) the dough until it is smooth. To achieve a layered effect in your scones knead very gently once (do not press too firmly) then fold and turn the kneaded dough about 3 or 4 times until the dough has formed a smooth texture. (Use a floured plastic scraper to help you knead and/or fold and turn the dough if you wish.)
6. Pat or roll out the dough into a 6 inch by 4 inch rectangle by about ¾ inch thick (15¼ cm by 10 cm by 2 cm thick). Using a well-floured 2-inch (5 cm) scone cutter (biscuit cutter), stamp out without twisting six 2-inch (5 cm) rounds, gently reform the scraps into another ¾ inch (2 cm) layer and cut two more scones (these two scones will not raise as well as the others since the extra handling will slightly toughen the dough).  Or use a well-floured sharp knife to form squares or wedges as you desire.
7. Place the rounds just touching on a baking dish if you wish to have soft-sided scones or place the rounds spaced widely apart on the baking dish if you wish to have crisp-sided scones. Glaze the tops with milk if you want a golden colour on your scones or lightly flour if you want a more traditional look to your scones.
8. Bake in the preheated very hot oven for about 10 minutes  (check at 8 minutes since home ovens at these high temperatures are very unreliable) until the scones are well risen and are lightly coloured on the tops. The scones are ready when the sides are set.
9. Immediately place onto cooling rack to stop the cooking process, serve while still warm.

Variations on the Basic recipe
Buttermilk – follow the Basic recipe above but replace the milk with buttermilk, add ¼ teaspoon of baking soda, increase the fat to 4 tablespoons, in Step 3 aim of pea-sized pieces of fat coated in flour, in Step 5 fold and turn the dough, rounds are just touching in the baking dish, glaze with buttermilk.
Australian Scone Ring (Damper Ring) – follow the Basic recipe above but decrease the fat to 1 tablespoon, in Step 3 aim of fine beach sand sized pieces of fat coated in flour, in Step 5 knead the dough, in Step 7 form seven rounds into a ring shape with the eighth round as the centre, glaze with milk.
Cream – follow the Basic recipe above but replace the milk with cream, add ¼ teaspoon of baking soda, in Step 3 aim of beach sand sized pieces of fat coated in flour, in Step 5 knead the dough, rounds are just touching in the baking dish, glaze with cream.
Cheese and Chive – follow the Basic recipe above but add ¼ teaspoon of baking soda, after Step 2 add ½ teaspoon sifted mustard powder, ¼ teaspoon sifted cayenne pepper (optional), ½ cup (60 gm/2 oz) grated cheese and 2 tablespoons finely chopped chives into the sifted ingredients, in Step 3 aim of beach sand sized pieces of fat coated in flour, in Step 5 knead the dough, rounds are widely spaced in the baking dish, sprinkle the rounds with cracked pepper.
Fresh Herb – follow the Basic recipe above but after Step 3 add 3 tablespoons finely chopped herbs (such as parsley, dill, chives etc).
Sweet Fruit – follow the Basic recipe above but after Step 3 add ¼ cup (45 gm) dried fruit (e.g. sultanas, raisins, currents, cranberries, cherries etc) and 1 tablespoon (15 gm) sugar.
Wholemeal –  follow the Basic recipe above but replace half of the plain flour with wholemeal flour.
Wholemeal and date – follow the Basic recipe above but replace half of the plain flour with wholemeal flour and after Step 3 add ¼ cup (45 gm) chopped dates and 1 tablespoon (15 gm) sugar.     
   
Pictorial guide to the challenge recipe
I was at my brother's house and we had a hankering for a baked treat so I decided to make the challenge recipe also I needed some photos of the challenge recipe being made for this posting. My brother isn't a cook, all he had to hand as equipment was concerned was a mixing bowl,a thin walled 20 cm (8 inch) cake tin and a knife, he didn't even have a cup measure only mugs so I improvised.

As you can see in the collage below I roughly chopped some butter (I eye-balled about 2 tablespoons) and froze it. Then I throw the frozen cubed butter onto one mug of cold self-raising flour I couldn't sift the flour since my brother doesn't own a sifter. Then I proceeded to rub in the butter with my fingers until I got pea-sized fat pieces coated in flour.
Photobucket

I added the liquid (½ mug of cold lite-milk) to the rubbed-in fat/flour mixture until I got a sticky dough I turned this out onto a floured board, I lightly floured the top of the sticky dough then I kneaded it once  then I patted it out into a rectangular shape then I proceeded to fold and turn the dough. Notice that you fold 1/3 of the dough over itself then the other 1/3 over that and turn it 90° degrees. Notice the lines on the broad this will help you understand how to do the folding and the turning.
Photobucket

I did a couple more folds and turns and used a well-floured knife to cut out squares of prepared dough.
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Here is a close-up of the finish patted-out dough notice how you can see the fat particles in the dough this is what causes flakiness in the final baked scone.
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I used the inverted cake tin as my baking dish and baked the scones in a very hot oven for 10 minutes they worked out really well I thought. Notice the nice central lamination in the scone and the great crumb and how well they rose in height.
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I placed two unbaked scones in the fridge to test whether resting them for 20 minutes helped improve the raise of the final baked product. As you can see the left scone and the middle scone are taller than the right scone which was baked immediately after it was cut out from the dough. So don't worry if you cannot bake the scones straight away they do better with a little resting time. 
Photobucket

Videos of my sister making scones (baking powder biscuits) – using a very popular Australian recipe
(http://www.taste.com.au/recipes/8163/basic+scones) 
Part 1 – my sister making the scones (baking powder biscuits)
(http://www.youtube.com/watch?v=ZF9YJiHZ1K0)
Part 2 – my sister showing off her scones (baking powder biscuits)
http://www.youtube.com/watch?v=GorStLKSoMo)
Pictures of my sister's scones
Photobucket

Storage & Freezing Instructions/Tips:
Scones are best eaten warm. Scones (biscuits) are really easy to store – bag the cooked and cooled scones and freeze until needed then reheat in a moderate hot for a few minutes.


Additional Information: 
Australia’s most popular scone recipe uses lemon-flavoured soda pop and cream as the liquid
(http://figjamandlimecordial.com/2010/08/08/lemonade-scones/)
A great English scone recipe this uses more sugar and fat and has an egg
(http://www.instructables.com/id/Perfect-English-Scones/)
Classic Southern Buttermilk Biscuits recipe by Alton Brown
(http://www.foodnetwork.com/recipes/alton-brown/southern-biscuits-recipe/index.html)
An index of North American recipes
(http://allrecipes.com/Recipes/Bread/Biscuits-and-Scones/Biscuits/Top.aspx)
Another index of North American recipes
(http://www.breadexperience.com/biscuit-recipes.html)
Three great Australian recipes
(http://www.smh.com.au/lifestyle/homestyle/blogs/tried-and-tasted/how-to-bake-the-perfect-scone-20110504-1e7xn.html)
An index of Irish recipes
(http://www.littleshamrocks.com/Irish-Bread-Scone-Recipes.html)
An interesting discussion on “what makes a scone a scone”
(http://chowhound.chow.com/topics/810928)  
Videos of Alton Brown making biscuits (scones) with his granny (super cute to watch)
Episode one ( http://www.youtube.com/watch?v=d3QuQSdjMVE)
Episode two (http://www.youtube.com/watch?v=Qcz4JQUwY9Q)
Links to advice about chemical raising agents
http://www.seriouseats.com/2010/06/what-is-the-difference-between-baking-powder-and-baking-soda-in-pancakes.html
http://www.kingarthurflour.com/tips/quick-bread-primer.html 

Disclaimer:
The Daring Kitchen and its members in no way suggest we are medical professionals and therefore are NOT responsible for any error in reporting of “alternate baking/cooking”.  If you have issues with digesting gluten, then it is YOUR responsibility to research the ingredient before using it.  If you have allergies, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. If you are lactose intolerant, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. If you are vegetarian or vegan, it is YOUR responsibility to make sure any ingredient in a recipe will not adversely affect you. The responsibility is YOURS regardless of what health issue you’re dealing with. Please consult your physician with any questions before using an ingredient you are not familiar with.  Thank you! :)[/quote]
          Medical Receptionist        
FL-Jacksonville, Description: This established office medical practice, with two locations (Jacksonville & Palatka), has been treating the community since 1970. With two practicing physicians (father & son) offering full Podiatric care and foot surgery, this specialty practice prides itself on delivering the best possible patient care. Their commitment is supported by a staff of responsible employees who work toge
          Alumnus Named Head Team Physician for WVU Athletics        

WEST LIBERTY, W.Va., Aug. 7, 2017 — Alumnus A.J. Monseau, M.D. was named head team physician and medical director for WVU Athletics recently. In his new role, he will lead the staff of team physicians and work in conjunction with the athletic training staff to provide healthcare to all student-athletes.  Formerly, he served as team … Read More

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The post Alumnus Named Head Team Physician for WVU Athletics appeared first on Academics.


          New PA Students Take First Professional Step        

WEST LIBERTY, W.Va., Aug. 1, 2017 — Every summer, the donning of the white coat and recitation of the professional oath is a big moment for students enrolled in West Liberty University’s Master of Physician Assistant Studies program. It signifies the acceptance of all the professional duties, responsibilities and work involved in caring for the … Read More

The post New PA Students Take First Professional Step appeared first on News & Media Relations.

The post New PA Students Take First Professional Step appeared first on Academics.


          Fitness and Exercise Prevent Disease        
Fitness and exercise prevent disease. That is a proven fact, and yet more Americans than ever are suffering from obesity and type two diabetes are considered an epidemic in the United States. If you are overweight, and especially if you are obese, or if you’ve been diagnosed with diabetes, then listen to your doctor and begin a regular fitness and exercise program. You’ll be glad you did.

One of the benefits of fitness and exercise, as any physician will tell you, it that fitness and exercise help control blood sugar. A diabetic who takes medication daily may find that less medication is needed with a regular fitness and exercise program. Many diabetics who stay with fitness and exercise programs find that they are able to quit the medication and get their diabetes under control in a totally natural way.

Triglycerides are also too high for most Americans. High triglycerides are linked to heart disease, including heart attacks and strokes. A great natural way to reduce your level of triglycerides is to simply begin and stick with a fitness and exercise program, while eating a sensible diet. Triglycerides at too high a level are also linked to high blood sugar, and it is common for diabetics to have high triglyceride levels. Therefore, in this case fitness and exercise can take care of two potential health risks at the same time.

Many people have marveled at the way being over weight has become an American way of life, and wondered what caused it. Many point to sedentary lifestyles, working in front of computers, and watching too much television. In addition, many Americans eat diets high in fat and carbohydrates. Whatever the root causes fitness and exercise can be a major part of the cure for this problem. Engaging in physical activity, increasing the heart rate, and just getting active can help a person loose weight, control triglyceride levels and improve diabetes and should not be ignored. Parents should restrict time spent by children with video games or watching television and encourage them to engage in fitness and exercise the way children in past generations have, playing games like baseball, basketball and jump rope. Children who learn the benefits of fitness and exercise at an early age will go into adults, who enjoy fitness and exercise, lead healthier lifestyles and tend to live longer, healthier and obviously happier lives.
          Termografía para la detección de Cáncer de Seno.        

Termografía para la detección de Cáncer de Seno.


Esta también llamada ‘termografía de pecho', ó termomastografía tiene la habilidad de descubrir las primeras señales que indiquen que un cáncer puede estarse formando, incluso 10 años antes de que cualquier otro procedimiento pueda detectarlo.


Desde 2006 el Centro de Estudios y Prevención del Cáncer A.C. (CEPREC), está evaluando esta novedosa e innovadora prueba. Este hecho, lo convierte en el único centro con ésta tecnología en el país: una cámara de rayos infrarrojos que al captar el calor de la mama permite detectar alteraciones tempranas.


Su ventaja es que no produce radiaciones, no es dolorosa y su sensibilidad para detectar el cáncer de mama es hasta el 94%.


"Este estudio, en combinación con la mastografía convencional de rayos X y la mastografía digital nos ayudará a diagnosticar el cáncer de mama en etapas más tempranas, aumentar la supervivencia y reducir la mortalidad por este tumor", aseguró a rotativo de Querétaro el Dr. Francisco Gutiérrez Delgado, director del CEPREC en Juchitán, Oaxaca.


El Dr. José G. Vázquez Luna, profesor investigador de la BUAP empleó la tecnología militar e hizo transferencia a la medicina, diseñando un sistema capaz de registrar ondas que registran calor.

El antecedente de ésta tecnología está en la investigación militar, durante la vigilancia nocturna de tropas. El calor de los cuerpos de los soldados enemigos, delata su posición a kilómetros de distancia. Con éste sistema se detecta, registra y produce imágenes de la superficie de la piel de los senos y es posible correlacionar los puntos de calor detectados con el tamaño del tumor. "El cáncer exige al cuerpo que lo alimente, existe un proceso de angiogénesis cuando se inicia el cáncer, es decir, se crean nuevos vasos sanguíneos que llevan alimento al tumor.


Este fenómeno de formación de nuevos vasos sanguíneos resulta revelador porque incrementa localmente la temperatura. Con la termografía se pueden detectar estos pequeños incrementos locales de temperatura.


La imagen térmica se convierte en un inmejorable coadyuvante, que el médico con otro grupo de pruebas determinará si es o no cáncer". "Es una prueba fisiológica que puede detectar cambios mínimos de temperatura, la termografía puede usarse como pesquisa o prueba discriminatoria, es decir, si una mujer pasa primero por esta prueba y no se localiza ningún riesgo no tendría caso exponerla a la masto grafía, y si se encuentra alguna anormalidad entonces con apoyo de la masto grafía y/o ultrasonido se lograra un certero diagnóstico" reveló el doctor en física.


El Investigador de la Escuela Físico Matemáticas de la BUAP, expuso que el principio físico es sencillo: La energía térmica ó infrarroja, por su longitud de onda, no es visible por el ojo humano, pero la termografía, por medio de una cámara, "ve" y "mide" la energía infrarroja que está siendo emitida por un objeto.


La capacidad de emisión de la piel humana es muy alta, por lo tanto, la radiación infrarroja emitida puede ser convertida a valores de temperatura. José G. Vázquez Luna, en entrevista para este medio, también explicó que existen más de 1200 estudios, incluidos en el Index Medicus que han evaluado su rol en la detección temprana del cáncer de mama. "En 1982, la FDA aprobó la termografía de pecho como un procedimiento válido para la detección de cáncer de mama, sin embargo, la termografía de pecho ha sido profusamente investigada desde 1950.


En más de 30 años de investigación se han reunido mas de 800 estudios en el área y se encuentran en la literatura médica. En esta base de datos, más de 300,000 mujeres se han incluido como participantes del estudio, algunos estudios han seguido a los pacientes a lo largo más de 12 años y se sabe que se han establecido estrictos protocolos de interpretación estandarizados durante mas de 15 años.


La termografía de pecho tiene una media sensibilidad y especificidad de 90%" argumenta Vázquez Luna. La literatura médica reporta que un termograma anormal es 10 veces más significativo, como un indicador de riesgo futuro de cáncer de mama, que un antecedente familiar de primer orden.


Un termograma anormal persistente incrementa 22 veces el riesgo de desarrollar en el futuro un cáncer de mama. Una imagen infrarroja anormal es por sí sola, el marcador mas importante de riesgo de desarrollar cáncer del pecho.


Cáncer de mama, un asunto nuestro: físico y oncólogo


El físico José G. Vázquez Luna y el oncólogo Francisco Gutiérrez Delgado comparten la certeza: Diariamente se diagnostican 26 casos nuevos de cáncer de mama. Y es que el cáncer de mama ocupa el segundo lugar como causa de muerte por tumores en el sexo femenino.


Esta situación es agravada por el insuficiente personal de salud entrenado para educar a la población femenina y el escaso equipo radiológico especializado (mastógrafos), el cual se concentra solamente en las grandes ciudades del país, el resultado es que 8 de 10 mujeres con cáncer de mama se diagnostican en etapa avanzada, prácticamente cuando cualquier tipo de tratamiento es ineficaz y 11 mujeres mueren diariamente por esta enfermedad.


"Evaluamos el rol de la termomastografía de nueva generación en la detección temprana del cáncer de mama en población abierta del Istmo de Tehuantepec. Este estudio tiene una sensibilidad y especificidad alta para el diagnóstico de patología de la mama (85%) aseguró su director, el Dr. Francisco Gutiérrez Delgado, especialista Oncología y Doctor en Ciencias Médicas.


"Cuando se utiliza con otros métodos Autoexploración, Ultrasonido y mastografía, se puede detectar hasta el 95% del cáncer.


Diversas investigaciones ha mostrado que la termografía de pecho aumenta significativamente la tasa de supervivencia de las mujeres hasta en un 61%".

Explicó también que las ventajas del termógrafo, es su elevada productividad ya que se pueden realizar mas de 10 termomastografías por hora con cada termógrafo, y como es un equipo ligero, puede ser desplazado a comunidades alejadas y municipios de todo el país, donde los servicios médicos no existen o son precarios.

El Dr. Gutiérrez Delgado es Fellow del American Collage of Physicians (FACP), miembro de la American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), y American Society for Blood and Marrow Transplantation (ASBMT) y sostiene que el objetivo del Centro, es educar a la población mexicana en una nueva cultura que incrementa el interés por la salud y que prioriza la prevención sobre la curación.


Fuente: http://rotativo.com.mx/?module=displaystory&story_id=6666&format=print



Is Breast Thermography Safe?

Breast thermography is very safe. There is no exposure to radiation or any compression of the breast tissue.

Es la Termografía segura?

La termografía de seno es muy segura. No hay exposición a radiaciones ó ningún tipo de compresión del tejido mamario.


How is Breast Thermography different from a Mammogram?


Both tests are looking for completely different signs of breast cancer. Thermography looks for changes that occur as a growing cancer alters the blood supply of the breast and changes the physiology and chemical environment of the tissue of the breast. Mammograms look for changes to the density of the breast that indicates the presence of a tumor. Mammography identifies the physical. The medical literature views both procedures as complimentary to each other.


http://www.creativewellnesscenter.com/thermographyinfo.html



Conf Proc IEEE Eng Med Biol Soc. 2007;2007:3312-4.

González FJ.Infrared imager requirements for breast cancer detection.

PMID: 18002704

Ann Acad Med Stetin. 2006;52(1):35-9; discussion 39-40.

Mikulska D.Contemporary applications of infrared imaging in medical diagnostics

PMID 17131845

Surg Technol Int. 2005;14:51-6.Agnese DM.Advances in breast imaging.

PMID: 16525954

          Rice Memorial, ACMC Health and CentraCare Health in talks to create a new regional health system        
May 24, 2017, WILLMAR, MINN – ACMC Health and Rice Memorial Hospital announced today that they have taken initial steps to create a new regional health system in partnership with CentraCare Health. Rice Memorial Hospital board members and ACMC Health physicians … Continue reading
          Physician Assistant - GMP Medical - Hialeah, FL        
GMP Medical LLC. GMP Medical is a growing internal medicine practice with the same well established location for the past 27 years....
From Indeed - Fri, 07 Jul 2017 13:46:12 GMT - View all Hialeah, FL jobs
          Read Robert Louis Stevenson’s weird fable “The Yellow Paint”        
“The Yellow Paint” by Robert Louis Stevenson In a certain city there lived a physician who sold yellow paint. This was of so singular a virtue that whoso was bedaubed with it from head to heel was set free from the dangers of life, and the bondage of sin, and the fear of death for… Continue reading Read Robert Louis Stevenson’s weird fable “The Yellow Paint”
          College Briefs Feb. 3        
Gerontology Institute to host speaker on hospice care issues Richard Payne, a neurologist and palliative medicine physician, will be speaking at 7 p.m.
          Stop Going Nuts over Nut Allergies        
Perhaps the justifiable concern over the salmonella contamination in commercial peanut butter makes this a good time to address the wholly unjustified hysteria over faux allergies to peanuts, especially in children.

As someone who grew up on peanut butter and continues to consume it regularly, I am happy to bring you Salon's thorough debunking of the "peanuts will kill your children!" fear campaign.

In 2005, a 15-year old Canadian teenager named Christina Desforges kissed her boyfriend and died. Her death, reported around the world, was initially blamed on peanuts. Desforges was allergic to peanuts and her boyfriend had eaten peanut-butter toast hours before their deadly smooch.

Sudden death due to an allergic reaction to food is known as anaphylaxis. When you eat peanuts (or some offending food), you break out in hives, your face swells and your larynx constricts until you can no longer breathe, all in a matter of minutes.

Shocking. Tragic. Scary.

Desforges' story is the kind that has moved anxious parents, politicians and school board members to join a crusade against peanuts. Several states have passed laws mandating public schools be "peanut-free zones," and parents now hover over food labels with Draconian vigilance, checking and double-checking them for signs of peanuts. Could that knife that just cut the birthday cake have been in the vicinity of peanut butter?

Peanut-allergy panic has spread across the nation. In a recent essay, Harvard physician and sociologist Nicholas Christakis relates an incident in which a peanut was spotted on the floor of a school bus, "whereupon the bus was evacuated and cleaned (I am tempted to say decontaminated), even though it was full of 10 year olds who, unlike 2 year olds, could actually be told not to eat off the floor."

SNIP

But on closer examination, food allergies are not the epidemic we've been led to believe. FAAN's advocacy may have helped to create rules and laws that are based less on sound science than on a significant misrepresentation of facts. Ironically, by accepting these facts, we may be increasing our risk of developing food allergies.

SNIP

Facts ought to be stubborn. In the past, Munoz-Furlong has stated that one child dying from an allergic is too many. But Harvard doctor Christakis, again, puts things into perspective. "There are no doubt thousands of parents who rid their cupboards of peanut butter but not of guns," he writes, comparing the alleged 150 children and adults who died from peanut allergies to the 1,300 who die from gun accidents each year. He goes on to note that 2,000 kids drown each year. Indeed, the most common cause of death in kids is accidents. "More children assuredly die walking or being driven to school each year than die from nut allergies," Christakis writes.

SNIP

And what about Christina Desforges, the young girl who received the kiss from the peanut-contaminated lips of her boyfriend? She suffered from asthma and died of a severe asthma attack, likely triggered by smoke. A coroner reported that on the night she collapsed she had smoked marijuana and spent hours at a party where people were smoking pot and tobacco.

Read the whole thing.
          Biocept Reports Second Quarter 2017 Financial Results        

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read more


          American Nurses' Assoc.: Dead Wrong on Death Penalty        
American Nurses' Association: Dead Wrong on Death Penalty

Notes for first draft

It is hard to fathom how the ANA could have gotten so much, so wrong (1).

A rebuttal to all of ANA's death penalty "facts".

Each one of these is a rebuttal to what ANA presented.

(p 4, para 1, fn1)

RACE & THE DEATH PENALTY: A REBUTTAL TO THE RACISM CLAIMS
http://prodpinnc.blogspot.com/2012/07/rebuttal-death-penalty-racism-claims.html

White murderers are twice as likely to be executed as are black murderers

56% of those executed are white, 35% black

For the White–Black comparisons, the Black level is 12.7 times greater than the White level for homicide, 15.6 times greater for robbery, 6.7 times greater for rape, and 4.5 times greater for aggravated assault.

For the Hispanic- White comparison, the Hispanic level is 4.0 times greater than the White level for homicide, 3.8 times greater for robbery, 2.8 times greater for rape, and 2.3 times greater for aggravated assault.

For the Hispanic–Black comparison, the Black level is 3.1 times greater than the Hispanic level for homicide, 4.1 times greater for robbery, 2.4 times greater for rape, and 1.9 times greater for aggravated assault.

As robbery/murder is, by far, the most common death penalty eligible murder, the multiples will be even greater.

From 1977-2012, white death row murderers have been executed at a rate 41% higher than are black death row murderers, 19.3% vs 13.7%, respectively. ( Table 12, Executions and other dispositions of inmates sentenced to death, by race and Hispanic origin, 1977–2012, Capital Punishment 2012, Bureau of Justice Statistics, last edited 11/3/14)

"There is no race of the offender / victim effect at either the decision to advance a case to penalty hearing or the decision to sentence a defendant to death given a penalty hearing."


Is There Class Disparity with Executions?
http://prodpinnc.blogspot.com/2013/03/is-there-class-disparity-with-executions.html

"99.8% of poor murderers have avoided execution.

It may be, solely, dependent upon the definitions of "wealthy" and "poor", as to whether wealthy murderers are any more or less likely to be executed, based upon the very small number and percentage of capital murders that are committed by the wealthy, as compared to the poor.

=======

 (p 5, para 2, fn1)

The Death Penalty: Saving More Innocent Lives
http://prodpinnc.blogspot.com/2013/10/the-death-penalty-do-innocents-matter.html
======

(p 5, para 3, fn1)

Saving Costs with The Death Penalty
http://prodpinnc.blogspot.com/2013/02/death-penalty-cost-saving-money.htm
======

(p 5, para 4, fn1)

It s impossible to prove that any sanction or any negative outcome does not deter some. Why? It would be contrary to reason and history, as we all well know.

--  Full rebuttal to Nagin (National Research Council)

Death Penalty Deterrence: Defended & Advanced
http://prodpinnc.blogspot.com/2013/06/death-penalty-deterrence-defended.html

--  Full Rebuttal to Radelet (Criminologists)

Deterrence and the Death Penalty: A Reply to Radelet and Lacock
http://prodpinnc.blogspot.com/2009/07/deterrence-and-death-penalty-reply-to.html
======

(p 5, para 5, fn1)

The Death Penalty: Fair and Just
http://prodpinnc.blogspot.com/2013/12/is-death-peanalty-fairjust.html
======

(p 5, para 6, fn1)

There is a huge body of very well known legal work with regard to mental illness and the death penalty.

Apparently, the ANA has no clue. No surprise.

Cases to follow.

======

(p 5, para 7, fn1)

The ANA is unaware that because of state governments and states' rights, that the death penalty statutes, as all laws, may be different from state to state. This is no surprise and is well known to all, but not the ANA?

Nebraska reinstated the death penalty by popular vote, 61-39%, in 2016.

The other six states that have, recently, revoked the death penalty all did so contrary to those states popular death penalty support and could only accomplish repeal based upon a Democratic majority legislature, with a Democratic governor.

======

(p6, para 8, fn 1)

--  "The normal moral reason for upholding capital punishment is reverence for life itself. Indeed, this is the reason why scripture and Christian tradition have upheld it, a fact which suggests that, if anything, it may be the abolition of capital punishment which threatens to cheapen life, not its retention." J. Budziszewski, Professor of Government and Philosophy at the University of Texas at Austin, Jan. 25, 2002 conference, Pew Forum, titled "A Call for Reckoning: Religion and the Death Penalty"

--   John Murray: "Nothing shows the moral bankruptcy of a people or of a generation more than disregard for the sanctity of human life." "... it is this same atrophy of moral fiber that appears in the plea for the abolition of the death penalty." "It is the sanctity of life that validates the death penalty for the crime of murder. It is the sense of this sanctity that constrains the demand for the infliction of this penalty. The deeper our regard for life the firmer will be our hold upon the penal sanction which the violation of that sanctity merit." (Page 122 of Principles of Conduct).

--  The biblical support for the death penalty is, specifically, based within human dignity.

Genesis 9:5-6, from the 1764 Quaker Bible, the only Quaker bible.

5 And I will certainly require the Blood of your Lives, and that from the Paw of any Beast: from the Hand likewise of Man, even of any one’s Brother, will I require the Life of a Man.

6 He that sheds Man’s Blood, shall have his own shed by Man; because in the Likeness of God he made Mankind.

--  Vengeance cannot be the foundation for the death penalty. The death penalty, as all sanctions, are based within justice, with a just, proportional sanction, given within due process, whereby no one connected to the crime can decide either the verdict or sentence, which are both the sole provinces of the judge(s) and/or jury, neither of which has a a vengeance component, nor foundation - again, very well known by all, except ANA.

======

(p6, para 9, fn 1)

No "Botched" Execution - Arizona (or Ohio)
http://prodpinnc.blogspot.com/2014/08/no-botched-execution-arizona-or-ohio.html
======

1) Capital Punishment and  Nurses’ Participation in Capital Punishment, http://www.nursingworld.org/CapitalPunishmentNursesRole-ANAPositionStatement

=======================

EDITED
Sent to ANA 2/23/2017

From: Dudley Sharp, a death penalty expert

The American Nurses' Association: Dead Wrong on Death Penalty

It is hard to fathom how the ANA could have gotten so much, so wrong (1).

ANA's Death Penalty Facts

ANA, primarily, used an anti death penalty site for all of the alleged "facts" about the death penalty. ANA fact checked none of it, with the foreseeable result.

Here are just two of ANA's blunders, from a field of blunders.

1) ANA writes: "Since 1973, over 155 people have been exonerated and freed from death row." (p 5, par 2, fn 1)

Untrue.

Anti death penalty folks, simply, redefined both "exonerated" and "innocent", as if they had redefined lie as truth, and stuffed a bunch of cases into those new "definitions", as is, easily, discovered by basic fact checking (2), ignored by ANA. Various reviews find the "exonerated" claims to be 70-83% in error (2). This has been known for nearly 20 years.

2) ANA writes: "In California, the cost of confining one inmate on death row is $90,000 more per year than the cost of maximum security prison ." ". . . a study in North Carolina showed that the cost of a death penalty sentence was $216,000 and the total cost per execution was $2.16 million, more than the cost of life imprisonment (p 5, para 3, fn 1)."

Ludicrous. Neither is possible (3),  just like much of the ANA nonsense, as revealed by fact checking (4).


ANA Confusing Politics for Ethics and Morality

Some have undertaken an ill advised or dishonest effort to show that medical ethics require medical professionals to shun the death penalty.

It is an, utterly, false narrative.

The effort to ban medical professionals' participation in executions is an unethical effort to fabricate professional ethical standards, based upon personal anti-death penalty activism, from those whose professions are medically related.

As with, ANA: " . . . the principles of  social justice speak to the  importance of  the nursing profession’s taking a stance against the death penalty, due to the preponderance of evidence against the fairness and effectiveness of capital punishment as a deterrent." (p1, fn 1)

The foundation for the death penalty, as for all sanctions, is justice. Deterrence cannot be negated for the death penalty nor for any other sanction, nor for any other negative prospect (5). ANA chooses to risk sacrificing more innocent lives (5).

Fairness is a highly subjective consideration. For example, based upon 2008-2011, US data, " . . . the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common (4-8 million) than lethal harm." (6) 

Fair?

There is no proof of an innocent executed in the US, at least since the 1930s.

Based upon ANA's constant errors (2-4), we know the ANA could not, possibly, have made an informed evaluation of fairness, as detailed.

ANA parrots that the death penalty is a human rights violation. Both freedom and life are fundamental human rights. Neither is inviolate, which is why we have both incarceration and executions, with due process. None of the groups stating that the death penalty is a human rights violation also state that incarceration is, as well. The only difference in the stances are that one is honest and the other not.

Nurses may ethically/morally participate in executions based upon their caring spirit, that they may assist in providing less painful executions and that they, also, may find the death penalty to be a just sanction that helps to save more innocent lives.

As per, Dr. Robert Truog, MD, Professor of Medical Ethics, Harvard Medical School:

"If I think of the kind of a hypothetical where you have an inmate who is about to be executed and knows that this execution may involve excruciating suffering, that inmate requests the involvement of a physician, because he knows that the physician can prevent that suffering from occurring, and if there is a physician who is willing to do that, and we know from surveys that many are, I honestly can't think of any principle of medical ethics that would say that that is an unethical thing for the physician to do." (7)

How could he reach that conclusion? Easily.

Just as per page 2, fn 1, ANA could have provided that "Nurses. . .  provide comfort care at the  end of life, if requested, including pain control, anxiety relief or procuring the services of a chaplain or spiritual advisor.", for nurses that find the death penalty to be just and ethical.

There has been a lot of ink used to review the long standing medical professions ethical prohibitions against the death penalty.

There is no such prohibition.

Some in the medical community have fabricated an ethical prohibition against medical professionals' involvement in state executions by invoking the famous "do no harm" credo and the Hippocratic Oath.

It is a dishonest effort.

THE ETHICS OF LYING - The Hippocratic Oath

Note: To their credit, ANA does not use the Hippocratic Oath to support their position, but does, foundationally, use "do no harm" (1).

Some have proclaimed that "First do no harm" is a centuries old foundation of medical ethics, weighing against death penalty participation.

Untrue.

It is an anti-death penalty fraud that "do no harm" is in the context of the state execution of murderers (8).

Neither the Hippocratic Oath nor "do no harm" have anything to do with executions (8).

Both are, solely, concerned with the medical profession and patients.

" 'do no harm' (a phrase translated into Latin as "Primum nonnocere") is often mistakenly ascribed to the (Hippocratic) oath, although it appears nowhere in that venerable pledge.(8)"

"Hippocrates came closest to issuing this directive in his treatise Epidemics, in an axiom that reads, 'As to disease, make a habit of two things - to help, or at least, to do no harm.'  (8)"

"As to disease" -  Nothing else.

There is no relevance outside medicine and, most certainly, no prohibition against medical professionals participation in the state execution of murderers.

The classic Hippocratic Oath & Its Brother, the Hypocrisy Oath

"I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art." (8)

This is a prohibition against euthanasia and abortion (8) and has nothing to do with the fabricated medical prohibition of participation in state sanctioned executions.

Do those anti-death penalty physicians and medical associations promise license revocation if any of their members participate in euthanasia or abortion?

Of course not.

In fact, we have Belgium approving the assisted suicides of children, of any age, with participation by physicians (9).

Many medical professionals fully accept and participate in both abortion and euthanasia.

Many could care less about the true ethical prohibitions that exist in a medical, historical context.

Instead, they just invent new ones, against the death penalty and for child suicide, while avoiding the true prohibitions, ushering in the newly renamed and truthful - Hypocrisy Oath.

Is the ANA unaware that the lethal injection executions of murderers are a criminal justice sanction and that it is not a medical procedure with patients?

If nurses wish to participate in end of life situations that have nothing to do with patients, medical associations should not place political roadblocks in their way.

The few legal reviews of this topic have found as reason and fact require:

"Other courts have addressed (physicians participating in executions) and found that it does not violate the physician's code of ethics to participate in an execution . . ." "The Court... does not find that Missouri physicians who are involved in administering the lethal injections are violating their ethical obligations . .  ." (Taylor v. Crawford, Jan. 31, 2006, Court Order issued by the US Western District Court of Missouri)

Let's look at some additional sensible reviews:

The editors of The Public Library of Science (PLoS) Medicine write:

"Execution by lethal injection, even if it uses tools of intensive care such as intravenous tubing and beeping heart monitors, has the same relationship to medicine that an executioner's axe has to surgery." ("Lethal Injection Is Not Humane", PLoS, 4/24/07).

So to, The American Society of Anesthesiologists:

"Although lethal injection mimics certain technical aspects of the practice of anesthesia, capital punishment in any form is not the practice of medicine. ("Statement on Physician Nonparticipation in Legally Authorized Executions," 10/18/06).

Both confirm the obvious: The state execution of murderers has no connection, ethically or otherwise, to the medical treatment of patients.

Rationally, there is no ethical nor moral connection, Some folks just want to fabricate a false narrative. So that's what they do - just another anti-death penalty fraud.

1) Capital Punishment and  Nurses’ Participation in Capital Punishment, http://www.nursingworld.org/CapitalPunishmentNursesRole-ANAPositionStatement

2) The Innocent Frauds: Standard Anti Death Penalty Strategy
READ SECTIONS 3&4 FIRST
http://prodpinnc.blogspot.com/2013/04/the-innocent-frauds-standard-anti-death.html

and

An Open Fraud in the Death Penalty Debate: How Death Penalty Opponents Lie - The "Innocent" and the "Exonerated"
http://prodpinnc.blogspot.com/2013/03/the-innocent-exonerated-and-death-row_19.html

3)  Death Penalty Costs: California
http://prodpinnc.blogspot.com/2012/08/death-penalty-costs-california.html

and

"Duke (North Carolina) Death Penalty Cost Study (1993): Let's be honest"
http://prodpinnc.blogspot.com/2009/06/duke-north-carolina-death-penalty-cost.html

4) Review of other ANA fact problems
http://prodpinnc.blogspot.com/2017/02/the-american-nurses-association-dead.html

5) The Death Penalty: Saving More Innocent Lives
http://prodpinnc.blogspot.com/2013/10/the-death-penalty-do-innocents-matter.html

6) A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care
James, John T. PhD, Journal of Patient Safety, September 2013 - Volume 9 - Issue 3 - p 122–128, john.t.james@earthlink.net


7) New England Journal of Medicine interview titled "Perspective Roundtable: Physicians and Execution", Jan. 18, 2008

8) Physicians & The State Execution of Murderers: No Medical Ethics Dilemma
http://prodpinnc.blogspot.com/2009/10/physicians-state-execution-of-murderers.html

and

The Death Penalty & Medical Ethics Revisited
http://prodpinnc.blogspot.com/2015/09/the-death-penalty-medical-ethics.html


9)  "What Belgium's child euthanasia law means for America and the Constitution", Eugene Kontorovich, Washington Post, February 13, 2014





          Rebuttal: Botched Executions        
Rebuttal: Botched Executions 
Dudley Sharp

To: Professors and Staff, Georgetown Law School
       and Georgetown Law Journal 

RE: Rebuttal:  Facing the Firing Squad, ANDREW JENSEN KERR, 104 Geo L.J. Online 74 (2016)

Note: This rebuttal applies to any of the related writings by Austin Sarat
 
From: Dudley Sharp 

I hope this helps Kerr and the Law Journal to vet a little better. 

It appears that lethal injection executions are "botched" about 1% of the time, not 7%.

 The vast majority of the "botched" executions are no such thing.

The majority of the false "botched" claims are attributed to multiple needle pricks and/or problems with the murderer's veins.

Everyone familiar with lethal injections and other IV procedures knows that multiple needle pricks are a responsible and necessary function to avoid "botched" executions or botched medical IV use. 

Multiple needle pricks are 1) not "botched" executions, but represent a common, normal safety practice with all IV procedures, daily and worldwide, 2) preparation for the execution, not the execution, and 3) often required to have secure needle insertion and retention.

 It would be negligent not to go through that procedure, the opposite of "botched". 

The entire process of looking for good veins is to prevent "botched" executions. Once good usable , secure veins were found,  the executions proceeded.

 It is the opposite of "botched". 

Other, wrongly, identified "botched" executions are when the murderer is gasping for breath, coughing, etc., which are the expected, known outcomes of respiratory distress, common effects with these drugs, whose effects are well known to  include . . . .  respiratory distress, (1) with very few of those incidents having any evidence to show consciousness or pain. 

Other false claims of "botched" executions are cases where the murderer is making noise, jerking, having spasms, etc., well known in cases of drug overdoses, which is, precisely, what we are dealing with (1) - drug overdoses are what lethal injections are -  with zero evidence of consciousness or pain. 

These are the well known side effects of the drugs used, not "botched" executions. 

In addition, many of  the sources for alleged "botched" are media, which, completely, blew the reality of the Arizona execution of Wood and the Ohio execution of McGuire cases, two infamous "botched" executions (2). 

These were not botched executions, but just took a long time to die, as expected, with no evidence of any consciousness or pain (2). 

What happens when an author doesn't fact check their sources and their sources are media that don't fact check? Will anyone rely on those sources or the conclusions drawn from them? 

"(Wood's execution) doesn’t actually sound like a botched execution. This actually sounds like a typical scenario if you used that drug combination,” said Karen Sibert, an anesthesiologist and associate professor at Cedars-Sinai Medical Center. Sibert was speaking on behalf of the California Society of Anesthesiologists." (2). 

Both of those executions are included in "botched" execution claims, only because folks depended upon inaccurate media reporting and did not fact check them. 

Kerr writes: " The desiccated market for  this anesthetic has forced U.S.  wardens to shop for off- brand  pharmaceuticals in  places  like  India or  U.S.  state regulated  “compounding”  pharmacies,  where  standards  of  quality  control  might  be lacking." 

"Might" is irrelevant. Facts are relevant. Quality control might not be lacking. 

Denno brings up, constantly, the 2012 meningitis outbreak at a compounding pharmacy, as if that is representative of compounding pharmacies. 

Has there been one case of improperly compounded drugs used in an execution? No. 

Somehow, that was left out of the article. 

Has Kerr or Denno considered how many innocent people have died and or been injured, in the US, since 1973, because of errors by non-compounding pharmacies and because of the FDA and the drug companies approving drugs that were, later, found to be deadly or injurious? 

My educated guess is that it is way over 100,000 innocents dead, with countless injured (2). Why don't they check  out "medical misadventures" (3), finding up to 400,000 innocent patients dying, every year in the US, due to such "misadventure" (3).

I am speaking of innocent patients, not guilty murderers. 

Has it been shown that compounding pharmacies are a less reliable source for execution drugs than other sources? Not that I am aware of. 

Did Kerr review the medical literature on the overdosing properties of all the drugs being used for executions? It appears not. 

Does Kerr understand that those properties are the same, whether in an execution setting, or not? 

The properties of the drugs don't, all of a sudden, magically, change, when they are used in lethal injection. 

This, below, indicates that Kerr is unaware. 

Kerr writes:    " . . . in  the  post Baze world of midazolam and other off brand substitutes the trigger  anesthetic  might  fail  to sedate  the  executed." 

"Might" is not a fact. Factually, all the cases Kerr is  speaking of were sedated.

 Kerr writes: "  . . . the anti epileptic drug  pentobarbital has even  been repurposed to replace  sodium  thiopental. The  deleterious  consequences  of  these  kinds of  substitute  compounds  are  exacerbated  by  the  tranquilizing  effect  of pancurium  (the  second  drug  of  the  traditional  three part  cocktail)." ""The feint here is that in the botched injection this muscle relaxant can mimic a look of serenity on the face of the executed, when they are in fact experiencing the visceral terror of their “whole body burning. It is the orca’s false smile of Blackfish." "the terrific pain of the botched lethal injection remains masked". "The executed person’s musculature is too incapacitated to reflect the existential pain of cardiac arrest. Instead, the mask of  the  executed  is inflected  as a  performance of dignified  passing  for  the execution audience. " 

Such fiction. Such drama. Kerr has no evidence to support his claims.

Texas uses a one drug protocol,  pentobarbital and has had no problems. 

What evidence does Kerr have that those states, which use  pentobarbital, first, and pancuriun, second, have had any problems with that protocol? None.

Is Kerr aware that those two drugs, used together, may increase the potency or effects of both? 

Kerr fails to tell us why and how the first drug, which causes unconsciousness just, all of a sudden, decides, on its own, to stop being effective, and thus, somehow allows the murderer to become conscious, even though such is not possible, with the drugs known characteristics, at the dosages given.

Magic? 

Kerr could not have botched this more. 

Kerr, also, botched the physician's "do no harm" oath.

"(D)o no harm" is not part of the Hippocratic Oath (5) and is, only, specified with regard to patients (5), in another document.  Death row inmates are not patients. 

The Hippocratic Oath bans physician participation in both euthanasia and abortions (5), practices which countless physicians participate in, millions of times per year, without any complaints from the AMA or any concern for the Hippocratic Oath. 

There is no death penalty ban in that oath. 

The AMA seems to only follow the Hypocrisy Oath. 

Alternate Executions Options

All states need to seek an exception for lethal injection drugs, from both DEA and FDA control, so the states can used whatever they find to be the best alternative.

The single drug, lethal injection  protocol with penatobarbitol seems to work very well.

Fentanyl maybe the best alternative. 

"The researchers asked the respondents to describe what happened during a suspected fentanyl overdose. The most common characteristic, described in 20 percent of the cases, was that the person's lips immediately turned blue, followed by gurgling sounds with breathing (16 percent of the cases), stiffening of the body or seizure-like activity (13 percent), foaming at the mouth (6 percent) and confusion or strange behavior before the person became unresponsive (6 percent), according to the report." (6)

Sound familiar? Sounds and body movement.

Nitrogen Gas

The alternate method for execution in Oklahoma and Alabama is nitrogen gas, by far the most foolproof method, when looking at 1) the fewest things that can go wrong, 2) the total lack of pain for the executed murderer and 3) it cannot be withheld or restricted (3). All organs are useful in the very off chance the murderer wishes to donate viable organs or their body to science. I agree that the firing squad is a responsible option. 

1)  There are a lot of medical writings on these issues. Here are just two. 

Opioid Drug Use and MyoclonusPosted in Physical Health
http://www.opiumabusetreatment.com/opioid-drug-use-and-myoclonus 

Opiates and Sleep-Disordered Breathingby Barry Krakow, Sleep Dynamic Therapy | Nov 12, 2015
http://www.sleepdynamictherapy.com/index.php/opiates-and-sleep-disordered-breathing/ 

2) No "Botched" Execution - Arizona (or Ohio)
http://prodpinnc.blogspot.com/2014/08/no-botched-execution-arizona-or-ohio.html 

3) see Do MORE Harm: The Anti Death Penalty Solution

 within The Death Penalty & Medical Ethics Revisited
http://prodpinnc.blogspot.com/2015/09/the-death-penalty-medical-ethics.html 

4) Nitrogen Gas; Flawless, peaceful, unrestricted method of execution
http://prodpinnc.blogspot.com/2014/09/nitrogen-gas-flawless-peaceful.html 

5)  see THE ETHICS OF LYING - The Hippocratic Oath 

within The Death Penalty & Medical Ethics Revisited
http://prodpinnc.blogspot.com/2015/09/the-death-penalty-medical-ethics.html



6) Here's What Happens During a Fentanyl Overdose, Sara G. Miller, LIVESCIENCE, April 13, 2017

https://www.livescience.com/58682-fentanyl-overdose-characteristics.html

          Juveniles & The Death Penalty        
Why Some “Juvenile” Murderers Should Qualify For The Death Penalty:
Brain Science and Other Issues
Dudley Sharp, 10/2/04

There are a number of inadequate issues raised in opposition to 16-17 year old murderers being culpable for the death penalty — Brain science and other arguments are either weak or false.

BRAIN SCIENCE & JUVENILE DEATH PENALTY — NO HOLY GRAIL (1)

“The brain data don't show that adolescents typically have reduced legal culpability for crimes.” Harvard University psychologist Jerome Kagan.

UCLA’s Elizabeth Sowell, another prominent brain-development researcher, takes a dim view of the movement to apply neuroscience to the law. She says that no current research connects specific brain traits of typical teenagers to any mental or behavioral problems.

“The scientific data aren't ready to be used by the judicial system,” she remarks. “The hardest thing [for neuroscientists to do] is to bring brain research into real-life contexts.”

The ambiguities of science don't mix with social and political causes, contends neuroscientist Bradley S. Peterson of the Columbia College of Physicians and Surgeons in New York City. For instance, it’s impossible to say at what age teenagers become biologically mature because the brain continues to develop in crucial ways well into adulthood, he argues.

Such findings underscore the lack of any sharp transition in brain development that signals maturity, according to neuroscientist William T. Greenough of the University of Illinois at Urbana-Champaign. Definitions of adulthood change depending on social circumstances, Greenough points out. Only 200 years ago, Western societies regarded 16-year-olds as adults.

“Brain science offers no simple take-home message about adolescents,” says B.J. Casey of Cornell University’s Weill Medical College in New York City. “It’s amazing how little we know about the developing brain.”

Brain-scanning techniques, including the popular MRI, remain a “crude level of analysis,” Casey notes. What’s more, many critical brain-cell responses are too fast for MRI to track.

Brain data, particularly those on delayed frontal-lobe growth in adolescents, also need to be put in a cultural and historical perspective, Harvard’s Kagan asserts. Frontal-lobe development presumably proceeds at roughly the same pace in teenagers everywhere. Yet current rates of teen violence and murder vary from remarkably low to alarmingly high from country to country, he notes.

“Something about cultural context must be critical here,” Kagan says. “Under the right conditions, 15-year-olds can control their impulses without having fully developed frontal lobes.”

If incomplete brains automatically reduce adolescents’ capacity to restrain their darker urges, “we should be having Columbine incidents every week,” he adds.

Science News summarizes these positions: ” . . .brain science doesn’t belong in court because there’s no evidence linking specific characteristics of teens’ brains to any legally relevant condition, such as impaired moral judgment or an inability to control murderous impulses. ”

AGE, ALONE, CANNOT DICTATE CULPABILITY

No one, including psychiatrists, psychologists and brain specialists, disputes that some 16-17 year olds are as mature, or more mature, than some of those 18 and older. US Supreme Court Justices, Nobel Peace Prize winners, the American Medical Association and the European Union agree.

Therefore, the argument against executing some 16-17 year old murderers is without merit, when it is based upon age, alone.

Is a murderer less culpable solely because they murdered someone one-second, one minute, one week, one month or one year before their 18th birthday? Of course not.

US Supreme Court Justice Sandra Day O’Connor writes:

“Furthermore, granting the premise that adolescents are generally less blameworthy than adults who commit similar crimes, it does not necessarily follow that all 15-year-olds are incapable of the moral culpability that would justify the imposition of capital punishment. Nor is there evidence that 15-year-olds as a class are inherently incapable of being deterred from major crimes by the prospect of the death penalty.” (2)

It is argued that because people have to be older to drink, vote, marry, etc., that it is hypocritical to say that some 16-17 year olds are mature enough to be death eligible for committing capital murder.
 
If society so wished we could individually evaluate 16-17 years olds (just as we do within the criminal justice system) to determine which of those were as mature as 18-21 year olds and allow those to participate in those responsibilities and privileges. No one doubts that many would qualify. Furthermore, there is a major difference between a social privilege and culpability for capital murder.

MacArthur Juvenile Competence Study: “The study did not find differences between juveniles aged 16 and 17 and young adults (18-24) in abilities relevant to their competence to stand trial.” (3)

HUMAN RIGHTS VIOLATION

Those who claim that the death penalty is a human rights violation have failed to make their case.

It is presented that some US states are equal with a number of less democratic nations that execute those who were under age 18 when they committed their murder(s).
 
First, the US criminal justice system is quite different from those nations. Second, as no one disputes that many 16-17 year olds are as mature as some 18-21 year olds, this argument means nothing.

In terms of proportionality, execution cannot be viewed as disproportionately severe in relation to the crime. The innocent murder victim did not earn or deserve their fate, whereas the murderer voluntarily took the lives of the innocent and thereby volunteered for the punishment available within that jurisdiction.

see A phony ‘consensus’ on youthful killers
by Jeff Jacoby in a Boston Globe op/ed
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2005/03/06/a_phony_consensus_on_youthful_killers/

======

(1) excerpts from “Teen Brains on Trial”, Bruce Bower, Science News, 5/8/04, vol. 165, No. 19, p.299
http://www.sciencenews.org/articles/20040508/bob9.asp

(2) Thompson v. Oklahoma, 487 U.S. 815 (1988) (USSC) at
www2.law.cornell.edu/cgi-bin/foliocgi.exe/historic/query=[group+487+u!2Es!2E+815!3A]!28[group+edited!3A]!7C[level++case+citation!3A]!29/doc/{@1}/hit_headings/words=4/hits_only?

(3) from Study Summary, ” MacArthur Juvenile Competence Study”,www.mac-adoldev-juvjustice.org/competence%20study%20summary.pdf
Full Study, Results, http://www.mac-adoldev-juvjustice.org/page23.html

 
NOTE: the study was partially funded by the Open Society Institute, one of the Soros Foundations, a product of George Soros, who may be he largest financier of anti death penalty efforts, worldwide.
 


          New High Tech Training Lab at Naval Hospital Camp Lejeune        
Naval Hospital Camp Lejeune is using futuristic simulation technology to train corpsman and give experienced physicians a place to refine their skills. We speak with experts about the new simulation lab and explain how it works. Life-like mannequins controlled by computers are part of a new simulation lab at Naval Hospital Camp Lejeune. The lab will be used to train new corpsmen on how to do procedures without having a real patient in front of them. It can also be used to keep experienced doctors proficient with their current skills and experiment with new treatment methods. Frank St. Denis is a simulation technician. He is responsible for setting up the training equipment. Before this technology existed, St. Denis says students would practice different procedures on patients. “Medical simulation is the new wave of the future. There’s a push to get away from live tissue training. So to facilitate the training, you need to have a simulation lab set up so that they can maintain their
          Statewide Telepsychiatry Program Starts Next Year        
This week, we speak with acting State Health Director Dr. Robin Cummings about the new, statewide telepsychiatry program starting in January, and how East Carolina University will be involved with the program. Last week, we heard an in-depth conversation about the future of telemedicine in eastern North Carolina and how new technology could be used to provide access to specialized healthcare for people living in rural and underserved areas of the state, such as Bertie, Beaufort, Duplin, and Edgecombe. This week, we continue our coverage of telemedicine with a feature about how it’s being used to make up for a shortage of psychiatrist in North Carolina. According to Deputy Secretary for Health Services and acting State Health Director Dr. Robin Cummings, 58 of the North Carolina’s 100 counties have too few physicians addressing mental health issues. “It’s severe. We have counties where there is no psychiatrist at all. And so patients are simply not being appropriately addressed.” Dr.
          Exterminate the Brutes: Fighting Back Against the Right        
by
Robert Markley
1996-04-01

Michael Bérubé’s essay on the politics of selling out is an eloquent investigation of the dilemmas confronting left intellectuals seeking to survive the long dark night of irrelevance. My only concern is that I wish Bérubé had provided more advice about how to sell out, while, at the same time, winning political converts and influencing influential people. While there is much that is admirable in Bérubé’s piece (originally delivered in March 1995 at the Cultural Studies Symposium at Kansas State), particularly his discussion of the Right’s negation of the “public” in the name of the “people,” I would like to sketch briefly an alternative to the politics of selling out by putting pressure on the term “intellectual,” the blind spot in many romantic calls to action by left cultural critics.

A crucial point: nobody cares about intellectuals, except other intellectuals. More to the point, unless intellectuals have another source of income, most of them wind up subordinating intellectual interests to the pursuit of livelihoods, or convincing the powers that be that intellectual activity can be profitable (see Bacon, Francis). Few people, for that matter, understand, care about, or are willing to spend the time and energy to follow the intricacies of rational discourse. Think of the sad history of presidential elections since World War II. The Democrats, admittedly a poor excuse for a left of far-right party, nominate Rhodes Scholars, Pulitzer Prize Winners, nuclear engineers, and so on for President; the dominant mode of communication for Clinton, Dukakis, Mondale, Carter, McGovern, Kennedy, and Stevenson has been explanation - a dubious strategy because the hegemonic rhetoric of multinational capitalism is the assurance that Life is Simple: advertising slogans, biblical homilies, capsule news summaries, crossword puzzles, billboards, true-false tests, and click on one of the following options all reinforce the belief that there are always “right” answers to be had, and that these answers can be summed up in a few words: “just say no”; “you deserve a break today”; “life is good.” Can you remember a Republican candidate for national office (since, say, John Lindsay) trying to explain anything to voters? Nixon, perhaps, but Nixon’s explanations were always corrosive and evasive.

The most successful Democrat since Roosevelt was, significantly, the least intellectually gifted and, if you have read the first two volume’s of Robert Caro’s biography, the most vicious, brutal, and amoral. What Lyndon Johnson understood far better than most cultural critics is that intellect (not to mention morality) is a handicap in politics: the purpose of policy is not to achieve moral clarity or intellectual rigor but to perpetuate networks, connections, positions of power, influence, and of course to accumulate symbolic capital and cold hard cash. The most successful, in many ways, of the handful of Left political leaders (broadly defined) in the past half century, Martin Luther King, did not analyze the semiotics of race, despite his Ph.D., so much as he evoked a religious vision: “I have a dream.” Dreams may have their own semiotics, but they do not, for audiences glued to Sightings, require complex modes of intellectual elucidation.

In my mind, then, our concern about the role of the public intellectual is misplaced. The arena in which the Left has to contest the Regime of the Right is not in the pages of The Nation or even The Village Voice but in the much devalued realm of cheap, anti-intellectual “entertainment”: tawdry talk shows, infomercials, trade shows for would-be entrepreneurs, tabloids, the Psychic Hot Line, etc. Bérubé reports that his editor at Harper’s suggested that a successful article renders the experience of reading almost non-cognitive; in any consumer culture, the separation between logic and rhetoric returns with a vengeance. In such a world, the Left needs to counter the vicious, mindless, kneecapping of the Right with vicious, mindless, kneecapping of its own: not nostalgia for JFK but a reinvigoration of the Realpolitik of LBJ.

Who better to contribute to public policy than college and university professors who are paid to study rhetoric and semiotics? Think of all the energy that cultural critics have devoted to interrogating racist, homophobic, misogynist, and classist rhetoric, values, and assumptions during the last fifteen years. This knowledge can and should be used to counter racism, sexism, homophobia, and the politics of privilege, but such an undertaking requires precisely that “we,” left erstwhile intellectuals, relinquish our stubborn faith in rational argument. Rational argument is what we do on our jobs; it is not necessarily an essential, unchanging measure of our intrinsic worth as human beings. You cannot argue morality; you can successfully challenge prejudice only by exploiting a complex psycho-social matrix that is largely unresponsive to causal reasoning. All of us know that, to varying degrees, it is often an uphill struggle to get students to distinguish between reason and bias. The mush-headed right, at least since George Wallace, has accumulated political capital by tarring and feathering “pointy-headed intellectuals” - cashing in on a politics of resentment by redirecting economic anxieties away from the unequal distribution of wealth to the distribution of specialized knowledge. For many Americans, elitists read poetry, not The Wall Street Journal. The Left will be more successful, as it has been in the (dim) past, by counterattacking the Rush Limbaughs of the world, not by noting inconsistencies in their presentations.

As Bérubé points out, the practice of left intellectuals attacking other left intellectuals for elitism, obscurity, and impracticality is old enough to have passed from history into the dark backward and abysm of myth. If the left seems doomed to repeat rituals of self-immolation, it is, in part, because we remain obsessed with the value of distinction, discrimination and purification rather than with the always impure strategies of success. What follows, then, are some suggestions to ensure that we sell out successfully:

1 Coopt the rhetoric of values, and beat the Right over the head with it. No self-styled Leftist should be allowed to offer political pronouncements without chanting the following mantra: greed, hypocrisy, and sin. Pro-Lifers who refuse to demand that the government raise taxes to provide funds for education, medical and dental care, food, clothing, shelter, and so on for each and every child who is “saved” are (repeat after me) hypocrites. Fundamentalists who ravage the environment to make money are sinners. Pat Buchanan has no values except greed.

2 Deploy the language of prejudice and exclusion by (for example) insistently feminizing right-wing males. Elected stooges of multinational capitalism are “whores”; candidates who turn a blind eye when workers are “downsized” into lower paying jobs are “cowards”; men who harass women on the job are “wimps who can’t get a date.” Officials who claim they cannot or should not intervene to help the homeless, the sick, the dying are “impotent.” The NRA should be ridiculed for playing with phallic symbols to compenstae for their psychosexual dysfunctions. Obviously, reproducing such rhetoric tends to reinscribe the dynamic of prejudice and exclusion that many of us are dedicated to overcoming. But politics is not about purity: the squeamish need to ask themselves whether living through the jihad that President Buchanan would visit upon us is a price worth paying for claiming the supposed moral high ground.

3 As Bérubé argues, the Left’s basic problem is that it lacks the financial resources of the Right; this unequal distribution of wealth and power is unlikely to change soon. Consequently, it becomes imperative for progressives, feminists, radicals, greens, pinkos, and reds to concentrate their financial resources in areas likely to have the most benefit. My suggestion, then, is that we scale back our commitments to worthy causes (ACT UP, Greenpeace, Amnesty International, battered women’s shelters, the United Negro College Fund, Ducks Unlimited, NPR, you name it), pool our resources, and…buy CBS. I wish I were kidding. But the ideology of corporate command, control, and communication renders us little choice if we want to sell out successfully enough to buy a fair share of political power and cultural capital. Left-Wing TV might bring back Gore Vidal to prime time as a Commentator on the CBS Evening News, offer variations on programs such as X-Files by hiring the best writers and producers to promote left-wing conspiracy theories: sexy agents combating corporate skullduggery; white supremacists in league with hostile aliens; mysterious conspiracies at the highest levels of telecommunications; and lonely forest rangers fighting off evil corporations intent on gutting the environment. There should be sympathetic portrayals of lesbian police officers, gay physicians, African-American labor organizers, and so on. If the Left is to counter the cultural dominance of right-wing talk shows, it needs the cultured voice of Gore Vidal intoning nightly that the political spectrum in the United States runs from the Right to the Far Right.

4 Get our own house in order by taking back our universities. One example of effective collective action. Imagine the end of the Fall Semester 1996. Professors all over the country rise up and give every scholarship basketball player in the country a real set of finals: “Discuss the influence of Hegel on Kierkegaard.” “Analyze the significance of Walter Lippman’s concept of the stereotype on the image of the African-American athlete.” “What are the implications of Coase`s theorem for negotiations between professional athletes and franchise owners?” This may sound like a vicious case of harassing the pawns by asking scholarship athletes (a high percentage of whom are African-American) to do work that almost all of their peers would fail abjectly to do, but such collective action could be the springboard to insist that scholarship athletes who generate hundreds of millions of dollars of revenue each year be paid stipends (much like research assistants). Think, too, of network executives (spending a half billion dollars a year on college basketball) stuck with a Final Four tournament that consists of walk-ons and white guys shooting two-hand set shots on national TV. Most educated Americans - doctors, lawyers, corporate chiefs - have little idea of the wages and working conditions of most college and university instructors, particularly part-timers. Instead of the disinformation campaigns presented at half-time of basketball and football games - half nostalgic images of ivy-strangled halls and half glitzy promos of hi-tech venture capitalism, show lines of students trying to get into closed out classes.

5 The African-American athlete is sadly underused by the Left. Michael Jordan, Shaq, Grant Hill, and so on exist for most Americans in a depoliticized state of glamorous consumption, as though their multi-million dollar contracts and highly publicized lifestyles negate the economic and cultural disadvantages of millions of African-Americans. A trivia question for cultural critics: who is Kellen Winslow and why am I bringing up his name now?

6 Finally, counter the Right’s simplistic slogans with simplistic slogans of our own. A general purpose campaign slogan to use against Republicans: “Your jobs going overseas.”

Irving Howe? Russell Jacoby? Shana Alexander? Alexander Cockburn. Hunter Thompson. Molly Ivins. Left intellectuals need to resist the blandishments of a rationalistic politics that remain tied to models of cause and effect, to the siren song that we can reason our way into cultural and political significance. How’s this for a slogan for the resurrection of the Left? “There’s only one Party in this country, and you’re not invited.”


          New Part B Buy-and-Bill Data: Physician Offices Are Losing to Hospital Outpatient Sites        
The Medicare Payment Advisory Commission (MedPAC), the independent agency that advises Congress on the Medicare program, recently released its June 2017 Data Book: Health Care Spending and the Medicare Program. The report is a 201-page wonktastic data dump. Chapter 10 focuses on prescription drugs.

In 2015, the most recent year available, Part B spending on drugs reached $25.7 billion. Hospital outpatient sites now constitute more than one-third of Medicare spending and have been crowding out physician offices. Part B payments to physician practices are growing much more slowly than payments to hospitals.

For some time, I have been tracking the evolution of the buy-and-bill system for provider-administered drugs. These new data confirm my predictions that physician offices’ will account for a declining share of the buy-and-bill market. Still unknown: Is this good or bad for patients?
Read more »
        

          Partnering with IDNs BioPharma Strategy Summit        
Partnering with IDNs BioPharma Strategy Summit
August 16-17, 2017 | Philadelphia, PA
www.cbinet.com/IDNStrategy

As health systems continue to grow and consolidate to form major Integrated Delivery Networks (IDNs), manufacturers are tasked with learning how to best contract with, and sell to, these evolving systems to ensure product success.

With conflict of interest policies in place and restricted access to physicians, manufacturers are changing their sales approach to better reach and engage these new customers. CBI’s Partnering with IDNs Strategy Summit convenes manufacturers and IDNs to discuss how to create a mutually beneficial partnership that contributes to continual care coordination, strategic product management and enhanced access.

Drug Channels readers save $400 with discount code BHN554!

A Dialogue-Driven Forum Providing Next-Generation Approaches:
  • Forecast the 2- and 5-year outlook for IDNs and the overall healthcare ecosystem
  • Understand the impact of current biologic and biosimilar legislation and regulations on Healthcare Information Technology (HIT) used by integrated delivery networks
  • Gain insight into how drug choice impacts speed-to-fill and how specialty pharmacy stewardship affects patient outcomes
  • Choose the right partners for your brand and identify the key decision-makers
  • Learn how to overcome the challenges of limited access to physicians in certain networks
  • Discuss what becoming more “customer-centric” actually means for manufacturers
  • Hear best practices and opportunities for measuring success in the IDN channel

All New For 2017! – Five Expert Case Studies from IDNs:
  • Establishing the Partnerships with IDNs to Affect the Patient Journey and Outcomes
    • Jerry Buller, Director, Specialty Pharmacy Services, Vanderbilt University Medical Center
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    • Scott Canfield, PharmD, Clinical Programs Manager, Specialty Pharmacy, Johns Hopkins Home Care Group
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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

        

          Why Can’t People Get Healthcare in Rural America?        

Why Can’t People Get Healthcare in Rural America? There is a medical crisis in rural America. There aren’t enough physicians to meet the needs of small towns, and the problem is only getting worse. According to the U.S. Department of Health and Human Services, there are more than 6,600 primary care health professional shortage areas […]

The post Why Can’t People Get Healthcare in Rural America? appeared first on Cliffside Malibu.


          Understanding Your Sleep Study Report        
Expert Interview with Dr. Anita Bhola The sleep study report may look like a jumble of numbers and cryptic medical terms that’s impossible to decipher. However, with a bit of guidance from Dr. Anita Bhola, a board-certified sleep medicine physician in New York City, you’ll be able to understand the basics in how to read and […]
          On the Right Track {InsideTracker Intro}        
I don't have a doctor.

This admission is a somewhat new revelation, one that I was somewhat surprised to make. For years, I have been reporting Dr. H as my primary care doc. I put her name on file with my OB, with the hospitals where I delivered the boys, at the pharmacy when filling prescriptions.

But when I called to make an appointment for a check-up, I was told that since it had been more than three years since my last appointment, I was no longer considered a patient and Dr. H was not accepting new patients. I could write her a note asking to consider seeing me or find someone new.

Well then ... I guess it doesn't pay to be healthy.

The news was as disappointing as it was confusing. For some time, I had wanted to check in with a doctor. I had wanted to see what my health – and blood – looked like after going through Whole30 and adopting a grain-free diet. And, let's be frank: I turned 35 this year; I'm not exactly young anymore, at least by some standards.

But the answer to my questions wasn't going to be just a call away anymore. I now had to research family doctors, see if they were accepting new paitients and then if my insurance covered my to ppick.

It seemed like such a hassle, and I was ready to put the idea to bed when I got the note. The note giving me the opportunity to try InsideTracker.

 photo InsideTracker-logo_zpscfc4nq3x.png

What is InsideTracker?

InsideTracker offers a personalized series of blood tests to establish a baseline, to compare your results to benchmarks, and to track your progress for key scientifically proven biomarkers for health, wellness and athletic performance. After receiving the results, InsideTracker offers personalized, actionable recommendations (nutrition, exercise, supplements, lifestyle) to improve areas that were marked after the results. Personalized dashboards and online tracking tools

How does it work?

After signing up for an account, athletes can select one of six plans. InsideTracker works with blood centers around the country (in my area, it is Quest), and participants can schedule an appointment online. After having blood drawn (a fast is required), one will receive an email with results. You log in, fill out a questionnaire and the receive recommendations for ways to improve areas that are not optimized or are at risk.

 photo insidetracker3-1_zpsnxatq6qs.png

Before you get your results, you fill out a short survey – questions about your lifestyle and diet preferences, methods of improving what’s “at risk” or “not optimized” (either exercise, diet, etc) and selecting your goals (reduce stress, sleep better, build endurance, boost energy) – “at risk” biomarkers first, then “not optimized” then “optimized”.

But why?

To put it simply, and somewhat arrogantly, most physicians don't know how to deal with very active people. I am not an elite athlete, I don't run 100 miles a week, I am not winning races. However, my activity level and needs are far different than the average patient.

 photo inside-tracker-1_zpsfrtbtuep.png

I learned this the hard way when I was seeing a physcial therapist for piriformis syndrome when I was pregnant. She wanted to help me get to a point where I could vacuum safely; I wanted to run. She wanted to show me how to squat to pick up something off the floor. I wanted to heal enough so that I could squat with a weighted bar on my back. Not having a physician, I now had the opportunity to find someone who would treat me – not just as a patient but as someone with certain needs. And that's what InsideTracker does. It would look at the results for ME, not the mom next door who enjoys a leisurely walk with friend a couple times a week.

Up next

I'll share my experience getting an InsideTracker test, my surprising results and what it all means for me.

Disclosure: I was offered the opportunity to try InsideTracker thanks to a partnership with Team Nuun. I will receive two Ultimate tests in exchange for posting about my experiences but I'm not being compensated in any way. All opinions are my own.
          Doctors and Patients Often Disagree on Pain Treatment Goals        

Disagreements between doctors and patients over the priorities of pain treatment are common during primary care office visits, new research from UC Davis Health shows. Patients hope to reduce pain intensity and identify the cause, while physicians aim to improve physical function and reduce medication side effects, including dependency.

(PRWeb March 13, 2017)

Read the full story at http://www.prweb.com/releases/2017/03/prweb14142034.htm


          UC Davis Leads the Nation in Kidney Transplants        

UC Davis physicians gave lifesaving kidney transplants to more than 400 people in 2016, making it the highest-volume kidney transplant program in the nation.

(PRWeb February 16, 2017)

Read the full story at http://www.prweb.com/releases/2017/02/prweb14072201.htm


          Nation's First State-funded Firearm Violence Research Center to be Established at UC Davis        

University of California President Janet Napolitano today announced her intent to establish the University of California Firearm Violence Research Center at UC Davis’ Sacramento campus under the direction of Garen Wintemute, an emergency department physician and recognized authority on the epidemiology of firearm violence who has conducted leading-edge research for more than 30 years.

(PRWeb August 30, 2016)

Read the full story at http://www.prweb.com/releases/2016/08/prweb13646921.htm


          At 100 years old, an Ohio doctor is still in        

Dr. Fred Goldman sits in his office in Cincinnati. Goldman, who turned 100 years old on Dec. 12, has been a practicing physician for 76 years. He still works three days a week and has an office in the old Jewish Hospital on Burnet Ave. Dr. Fred Goldman of Cincinnati, turned 100 this month and has no plans to retire. He is the oldest physician in Ohio still practicing medicine.



          Washington State sued by American College of Emergency Physicians        

The state of Washington is being sued by The American College of Emergency Physicians for its new health insurance mandate, allowing only three paid non-emergency visits to the emergency room for l

Latest News: 
Insurance and Money: 

          The jobs that take you to the top 1%        
Looks like being a manager, lawyer or a physician is a pretty reliable way to make it there.

29 Vote(s)
          Review of Roots & Herbs, Indian Ayurvedic Beauty Products         


Looking for some Ayurveda based Skin/Haircare options?

Well, try Roots & Herbs products.

I have tried few samples from Roots & Herbs, viz-
1) Argan Oil Face Cleanser
2) Kashmiri Kesar Toner
3) Brightening Under eye Tailam
4) 49 Herbs Hair Food
5) Hair Lep
6) Black sesame Pain relief Oil.

Video Review

I have uploaded my review on my Youtube Channel [Ekta Khetan]

Subscribe Me On YouTube!

To check the detailed review, visit my @Youtube Channel or watch this video here.



Products at a glance

Let's quickly discuss the products and my overall experience here.

Starting with my favourite product from the stash is the Argan Oil Cleanser. It is an oil based cleanser that I use to clean my makeup including eye makeup. It is simple to use. All you need to do is, take a good quantity of it in your hands. with the help of your fingers spread it around your face, massage lightly in a circular wash and wash with a good cleanser after 5 minutes.




The Hair lep was an ok-ok product. it has the goodness for hibiscus. The size was quite small for me to try it fully on my shoulder length hair.


The Black sesame Pain relief Oil is good to give you a temporary relief. The packaging was however quite shoddy and kept spilling at all times.

The bottle when received had very few drops of the product left. Though it emanated a good aroma and can be a good option to try. If you are suffering from orthopedic dislocation or pains like arthritis, it may be good option but do not forget to get it checked via your physician before you try.



The 49 Herbs Hair Food is basically a hair oil that claims to be enriched with 49 types of herbs. It is a good option for the hairs. I have used it around 5-6 times. While it has not helped to prevent my hair fall but gives a good shine to hair post the wash.



The toner is decent and can be used post-shower to accelerate the refreshen up feeling. It helps in mildly polishing your face but is not suitable for people with dry skins as once wiped, it may leave your skin feeling slightly dried.

The fragrance is good and the bottle is travel-friendly

.

What I liked about them

1) The efficient cleanser
2) Use of Ayurvedic Ingredients
3) List of ingredients clearly listed
4) Usage Instructions/ skin type appropriately earmarked on different products
5) Make In India

What Could Have Been Better

1) Packaging: The packaging for the liquid products is not spill proof. The leakage is unavoidable.
2) The Cost
3) The sizes are good enough to test allergy but quite small to find out the difference.

What I did not like

1) The under eye tailam: It was quite irritable on the eyes even when I applied a low quantity. Also, I was not too convinced about using an oil under my eyes as it can add to the wrinkles. 

You can check their vast list of ingredients before giving it a try.


Overall Verdict: I liked the choice of ingredients and the variety of the products that Root & Herbs offered. My favourite from the stash is- Facial Cleanser that helps in removing makeup. I also liked the concept of the pain relief oil but given the low quantity, it was difficult to determine actual benefit though.

Do give these products a try soon and let me know your feedback.

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Disclaimer: This is not a sponsored post The products sample were sent by Brand Directly for the experience. Opinion is Unbiased and personal.

          In the Pipeline -- New Plants for 2011 and Beyond, Part 3        
Another genus that I've been fascinated with for some time is Kniphofia (Red Hot Poker, Torchlily), named in honour of the German physician and botanist, Johann Hieronymus Kniphof (1704-1763). It has 60-70 species, typically native to Southern Africa.

Its unique and brightly-coloured flowers make it an easy "stand-out" in the summer garden, often adding a somewhat desert-like feel to the landscape with its tufts of narrow foliage.

For some reason, it is now described as "old" and out-of-fashion, and certainly is one of those plants that is often associated with "grandmother's garden". Terra Nova Nurseries however, in Oregon, which is well-known for breeding and introducing new perennials to the industry, has recently expanded their work to include this beautiful plant.

Two series are being introduced in 2010, and likely will be available to consumers this summer. The Popsicles are compact and long-blooming forms, starting in early summer and continuing through autumn. The Solar Flares are larger and known for heavy bloom production from mid-summer through to hard frosts.

First is 'Pineapple' (Popsicles series) with lovely golden-yellow flowers.























Second, is 'Ember Glow' (Solar Flare series) with warm tangerine-orange flowers.


Finally, is 'Fire Glow' (Solar Flare series) with hot orange-red flowers.























These plants have been tested for hardiness in Michgan, so should do well in zones 5-9. Once established they are very drought tolerant. Some early-spring pruning of the old, winter-beaten semi-evergreen foliage (do not cut back in the autumn), and periodic dead-heading during the flowering season, will make for a better presentation.

Here's to dirt under your nails in the coming months, and the return of the Red Hot Poker (now that's a cool common name).

Mark, the coolplantsguy
          An Adult Conversation About Medicare For All ... by gimleteye        
NOTE: What the hell is going on with Republicans in Congress? The GOP is spending itself on health care like waves on a beach; a great surge then slide back out to sea.

GOP leadership believes that its base is motivated by only one idea: overthrow Obamacare. What was a popular net to corral voters turns out to be much less popular, and not at all effective, as a matter of protecting people, jobs, family and income.

It would be far better for sober adults in the GOP majority in Congress to look at the outcomes of health care in the U.S. As Dr. Carol Paris and many others report: the United States lags health care metrics compared to nearly every other industrialized nation. "Compared to ten other wealthy countries, the U.S. ranks dead last for life expectancy, and access to care. We even have the lowest number of hospital beds per capita, a way that health experts measure the capacity of a nation’s health system. It’s as if our system was designed to deny care."

The only metric where U.S. health care exceeds beyond imagination: empowering and enriching intermediaries in the health care supply chain.

I understand that this point grossly simplifies a massively complex process, but if other Western nations can effectively institute a single-payer system, why can't we?

Published on
Friday, July 28, 2017
by Common Dreams
It's Time for the Adults in This Nation To Talk Seriously About Medicare for All
Today, we breathe a quick sigh a relief. But we cannot celebrate a return to the failed status quo.
by Dr. Carol Paris

Ruby Partin, 63, and her adoptive son Timothy Huff, 5, wait for a free clinic to open in the early morning of July 22, 2017 in Wise, Virginia. Hundreds of Appalachia residents waited through the night for the annual Remote Area Medical (RAM), clinic for dental, vision and medical services held at the Wise County Fairgrounds in western Virginia. The county is one of the poorest in the state, with high number of unemployed and underinsured residents. (Photo: John Moore/Getty Images)

Hundreds of people slept overnight in cars, or camped for days in a field. They told stories of yanking out their own teeth with pliers, of reusing insulin syringes until they broke in their arm, of chronic pain so debilitating they could hardly care for their own children. At daybreak, they lined up for several more hours outside a white tent, waiting for their chance to visit a doctor. For many, this was the first health care provider they’ve seen in years.

Is this a place torn by war, famine or natural disaster? No, this charity medical clinic was last weekend in southwest Virginia, in the wealthiest country in the world, where we spend nearly three times as much money on health care as other similar countries.

"It’s as if our system was designed to deny care."

And what do we get for our money? The very definition of health care rationing: 28 million Americans without insurance, and millions more insured, but avoiding treatment because of sky-high deductibles and co-pays. Compared to ten other wealthy countries, the U.S. ranks dead last for life expectancy, and access to care. We even have the lowest number of hospital beds per capita, a way that health experts measure the capacity of a nation’s health system. It’s as if our system was designed to deny care.

America does hit the top of the list in some areas. Compared to other nations, American doctors and patients waste the most hours on billing and insurance claims. We have the highest rate of infant mortality, and the highest percentage of avoidable deaths—patients who die from complications or conditions that could have been avoided with timely care.

Clearly, this system is broken. Like a cracked pipe, money gushes into our health care system but steadily leaks out. Money is siphoned into the advertising budgets of insurance companies and the army of corporate bureaucrats working to deny claims. Even more dollars are soaked up by the pockets of insurance CEOs who have collectively earned $9.8 billion since the Affordable Care Act was passed in 2010. Nearly a third of our health care dollars go to something other than health care.

President Trump recognized voters’ frustration and campaigned on a promise of more coverage, better benefits, and lower costs. We couldn’t agree more with these goals. However, instead of trying to fix our broken system, GOP leaders are acting more like toddlers, mid-tantrum, smashing our health system into smaller and smaller pieces, threatening to push even more Americans—the most vulnerable among us—through the cracks. Last night, a few Senate Republicans stood up and acted like adults, putting an end to this dangerous game.

Today, we breathe a quick sigh of relief. But we cannot celebrate a return to the status quo, a system that rations health care based on income and allows 18,000 Americans to die each year unnecessarily.

Where do we go from here?

Republicans had eight years to come up with a plan that achieves more coverage, better benefits and lower costs. Have our elected leaders simply run out of ideas?

"The good news is that we already have a proven model for health financing that is popular among both patients and physicians."
The good news is that we already have a proven model for health financing that is popular among both patients and physicians. It provides medically-necessary care to the oldest and sickest Americans with a fraction of the overhead of private insurance. It’s called Medicare, and I can tell you as a physician that it has worked pretty darn well for more than 50 years.

Not only do we have a model, we have a bill that would expand Medicare to cover everyone and improve it to include prescriptions, dental, vision, and long-term care. It’s called H.R. 676, the Expanded and Improved Medicare for All Act, a single-payer plan that would provide comprehensive care to everyone living in the U.S. The bill would yield about $500 billion annually in administrative savings while covering the 28 million currently uninsured. Medicare for all is gaining steam with a record 115 co-sponsors, a majority of House Democrats.

Now that Republican senators have finally worn themselves out, Sen. Bernie Sanders plans to file his own single-payer Medicare for all bill. Senators from both parties will be asked to choose a side: Do you support the current system of health care rationing, medical bankruptcies and unnecessary deaths; or a program proven to work both here and in every other developed country?

A majority of Americans now believe that health care is a human right, and that it is our government's responsibility to achieve universal coverage. We’ve tried everything else except Medicare for all. What are we waiting for?

          Ronald M. Berkman Announces Plan to Retire as President of Cleveland State University        

Tenure Marked by Transformation of University and Improvements in Student Success

CSU President Ronald M. Berkman

Cleveland State University President Ronald M. Berkman today announced his decision to retire from the presidency in June of 2018. Berkman, 70, is CSU’s sixth president and has served in that role since 2009. The University will mount a national search for his replacement beginning next month.

“It’s been one of the great honors of my career to lead CSU during an amazing period of progress,” said Berkman. “Thanks to the faculty, staff, trustees and donors, and to the Cleveland community that has embraced us, we’ve brought ‘engaged learning’ to life.  In so many ways, CSU is a different university than it was in 2009.”

“It’s hard to overstate the impact Ron has had on CSU during his tenure,” said Bernie Moreno, chair of CSU’s Board of Trustees. “He has led the transformation of the University across every dimension, from his focus on student success, to the many innovative community partnerships he’s created, to the remaking of the campus and his extraordinary success attracting philanthropy. We will miss having him as president, but we also owe him a huge debt of gratitude for putting us in position to attract a great candidate to succeed him.”

Moreno said Berkman approached him to propose the transition plan earlier this year. He added that the Board of Trustees is grateful that Berkman has given them ample time to find his successor, that he’s agreed to be available to help the new president and that he’ll be returning to CSU to teach following a one-year sabbatical.

A number of new initiatives that Berkman has undertaken will impact CSU in the years to come. In light of that, Berkman told Trustees he believed that the timing of the transition would help the new president get off to a good start.

“We’ve just successfully completed a number of major efforts, including our first capital campaign, and will soon be launching some large, multi-year projects that would be better to hand off early rather than in midstream,” Berkman added.

The search for CSU’s next president will begin in July. The Board will form a Search Committee, chaired by Moreno, that will include members of the University community as well as the community at large.  The board also plans to engage one of the leading national executive search firms. Moreno believes the search will attract highly qualified candidates, thanks to the progress made under Berkman’s leadership.

“Ron has created tremendous momentum during his tenure as president, and the highly successful capital campaign he led has added even more,” said Moreno. “We want to do everything we can to maintain that momentum for the ongoing benefit of the University.”

Accomplishments under Berkman’s leadership include:
 

Student Success
  • Affordability: CSU has implemented a number of initiatives that have reduced the cost of earning an undergraduate degree by more than $3,350 annually.  CSU’s average student loan debt is the second lowest among Ohio public universities, more than $1,800 less than the state average.
  • Multi-term registration: CSU is the first state university in Ohio to offer multi-term registration, allowing students to plan and schedule courses for fall, spring and summer terms at the same time and ensuring access to required courses.
  • Adjusted tuition band: CSU has expanded its tuition band to 18 credit hours per semester, which allows students to take up to 18 credit hours without incurring additional charges.
  • Innovation: CSU was awarded a 2015 Excellence and Innovation Award in the category of Student Success and College Completion given by the American Association of State Colleges and Universities (AASCU).
  • Recruitment: 2016 saw the largest freshman class with 1,900 first-year students and increases in GPA and ACT scores.
  • Graduation rates: Increased 60%
  • Awards, accreditations and national rankings: CSU’s number one rank in research growth over the last decade; winner of the AASCU national innovation award; finalist of the APLU national innovation award and accreditation as a Carnegie Engaged institution
 
$500 Million Campus Transformation
  • Student housing: 1,000 students living on campus
  • Center for Innovation in Medical Professions: The new CIMP building houses the Northeast Ohio Medical University (NEOMED), the CSU Health and Wellness Clinic, Speech and Hearing Clinic, Audiology labs, Nursing labs, and Occupational Therapy/ Physical Therapy (OT/PT) training rooms, as well as Distance Learning rooms, meetings rooms, lounge and quiet study areas, and associated faculty offices.
  • Washkewicz College of Engineering: A 100,000-square-foot addition providing students and faculty with state-of-the-art labs, learning spaces, classrooms, motion and control lab and makers’ space with the latest prototyping and fabrication technology.
  • Film School: CSU is the first university in Ohio to have a film, TV and interactive media school to uniquely prepare students for careers in the field. Created with a $7.5 million capital appropriation from the state, the school will also further the development of Cleveland as a center of media production.
  • Jack Joseph & Morton Mandel Honors College: The honors program was elevated to college status on receipt of a gift from the Mandel Foundation.  Renamed in honor of Jack, Joseph and Morton Mandel, the college became CSU’s ninth and moved into renovated space in the main classroom building.
  • Medical Mutual Tennis Pavilion: A $1.4 million donation from Medical Mutual enabled Cleveland State University to become the first, and only, Horizon League school with indoor tennis facilities on campus.
  • Completed additional buildings: The new Student Center and Julka Hall College of Education and School of Nursing buildings, begun during Michael Schwartz’s tenure at the University, were also completed.
 
Philanthropy
  • Engage: The Campaign for Cleveland State:  CSU’s first capital campaign reached its $100 million goal two years ahead of schedule, providing funds needed for scholarships and initiatives that enable student success.
  • Fundraising: Doubled the University endowment, personally raised over $60 million
  • Ahuja gift: Secured a $10M gift from alumnus Monte Ahuja, the largest in CSU history to that point, naming the business college the Monte Ahuja College of Business.
  • Washkewicz gift: Secured a $10M gift from Don Washkewicz and a matching $10M gift from the Parker Hannifin Foundation, together the largest in CSU history. The gift allows for the renovation and 100,000 square feet expansion of the engineering college, which will open in 2018 as the Washkewicz College of Engineering. 
 
Engaged Learning Partnerships
  • Playhouse Square: The original scope and vision of the theatre program’s move into Playhouse Square was expanded into a new CSU Arts Campus, which now includes the departments of theatre, dance and art. The program allows students to learn from professionals at the second largest performing arts complex in the nation.  The Department of Theatre and Dance performs in Playhouse Square’s Allen Theatre Complex, home to three state-of-the art stages: the 514-seat Allen Theatre, the 334-seat Outcalt Theatre, and the 150-seat Helen Rosenfeld Lewis Bialosky Lab Theatre (“The Helen”). The Campus also features a retail location for CSU art galleries on Euclid Avenue.
  • Northeast Ohio Medical University: CSU joined forces with NEOMED to create a dual-campus medical program for training general physicians to serve the health care needs of inner city populations. A $7.25M grant from The Cleveland Foundation helps fund the program.
  • Cleveland Metropolitan School District: CSU has established an “education park” that encompasses two Cleveland Metropolitan School District schools on the CSU campus: MC2STEM High School and Campus International School.
  • Partnerships and collaborations: Ongoing enhanced relationships and support from University Hospitals, Cleveland Clinic, and Metro hospitals; St. Vincent Charity Hospital research collaboration (engineering) behavioral health initiative and several Internet Of Things (IOT) initiatives, including the Governor’s request to build center of excellence in IT at CSU and collaboration with Case Western Reserve University on IOT as well as a growing inventory of projects.

 

About Ronald M. Berkman

Prior to his arrival at CSU, Dr. Berkman held various leadership positions at Florida International University (FIU), including Provost, Executive Vice President and Chief Operating Officer, Dean of the College of Urban and Public Affairs as well as Executive Dean of an interdisciplinary College with accredited Colleges of Nursing, Health Sciences, Public Health, Social Work and Policy and Management.

Dr. Berkman came to FIU from the City University of New York (CUNY), where he developed partnerships among city, state and federal government agencies as well as nongovernmental organizations as Dean of Urban Affairs. He also served as Dean of Academic Affairs and Founding Dean of CUNY’s first School of Public Affairs, located at Baruch College.

Dr. Berkman received his Ph.D. from Princeton University. He has taught at Princeton’s Woodrow Wilson School, the University of California at Berkeley, Brooklyn College, the CUNY Graduate Center, New York University and the University of Puerto Rico.

Dr. Berkman is chair of the Inter-University Council of Ohio, a consortium of the state’s 14 public universities. He also serves on the boards of many nonprofit organizations, including the Coalition of Urban Serving Universities, the Downtown Cleveland Alliance, the Greater Cleveland Partnership and the Jewish Federation of Cleveland.

 

About Cleveland State University

Founded in 1964, Cleveland State University is a public research institution that provides a dynamic setting for Engaged Learning. With an enrollment of more than 17,000 students, 10 colleges and schools and more than 175 academic programs, CSU was again chosen for 2017 as one of America’s best colleges by U.S. News & World Report. Find more information at www.csuohio.edu, on Facebook and by following @CLE_State.


          NEOMED-CSU Partnership Offers Free Middle School Med School        

The Saturday workshop series is designed to engage students in the health professions

Med Workshops

The NEOMED-CSU Partnership for Urban Health, a joint effort of Cleveland State University and the Northeast Ohio Medical University, will offer free introductory medical workshops to middle school students. The program, titled Middle School Med School, is for students in grades six through eight who have an interest in careers in the health professions.

Workshops will take place every Saturday from 9 a.m. to 1 p.m. April 8 - 29, 2017. They will be held in the Center for Innovation in Medical Professions, which is home to the Partnership and is located on the CSU campus at 2112 Euclid Ave., Cleveland, Ohio, 44115.

The workshops will give middle school students an opportunity to experience medical school through a number of hands-on projects and interactions with medical students and professionals. The middle schoolers will get exposure to medical procedures such as making plaster casts for broken bones, applying stitches to wounds, taking X-Rays and much more.

“By introducing science and medicine to children at an early age we can enhance understanding of and enthusiasm for health professions and increase the number of individuals going into these careers,” says Dr. Edgar B. Jackson, Jr., Special Assistant to the President for Health Affairs at CSU and Co-Director of the NEOMED-CSU Partnership

“This program was developed to allow students to not only receive hands-on experience, but to spend time with medical professionals and get an inside look at a potential career path,” adds Sonja Harris-Haywood, M.D., co-director of the Partnership and senior associate dean at NEOMED. “This is an outstanding opportunity for Cleveland-area youth to closely examine the health professions at a time when they are beginning to explore all the possibilities of their futures.”

Registration is open through March 10. To apply or receive more information, please contact 216.802.3175 or jtyes@neomed.edu.

The free program also includes lunch.

The NEOMED-CSU Partnership for Urban Health works to recruit future physicians who are interested in serving Northeast Ohio. The program strives to meet the health care needs of urban communities.

###


          CSU Study Assesses Impact of Paid Sick Leave on Preventive Care         

Workers without paid sick leave are 1.6 times less likely to get a flu shot

Preventative CareMore than 20 million Americans have gained health insurance coverage through the Affordable Care Act (ACA) and do not have to pay for 15 preventive screenings recommended by the U.S. Preventive Services Task Force. Yet, despite this advantage, many are not utilizing these lifesaving screenings and are contributing to the nation’s soaring health care costs, which reached a whopping $3 trillion in 2014.

Researchers from Cleveland State University and Florida Atlantic University are the first to use data after the implementation of the ACA to get to the root of what factors are contributing to the low rates of preventive care use. Results of their study, published in the current issue of the journal Preventive Medicine, illuminate the importance of the role paid sick leave benefits plays in the lives of employees and ultimately in public health. 

“Compared to 22 similarly developed countries, the United States is the only one that does not mandate employers to provide paid sick leave benefits or include paid sick leave in a universal social insurance plan,” said LeaAnne DeRigne, lead author and an associate professor in the School of Social Work within FAU’s College for Design and Social Inquiry.

For the study, the research team, co-led by Patricia Stoddard Dare an associate professor of social work at Cleveland State, used cross-sectional data from a sample of 13,545 adults aged 18-64 with current paid employment from the 2015 National Health Interview Survey (NHIS). They examined the relationship between having paid sick leave and obtaining eight preventive care services: blood pressure check; cholesterol check; fasting blood sugar check; getting a flu shot; being seen by a medical doctor or health care provider; getting a Pap test (females only); getting a mammogram (females only); and getting tested for colon cancer. The analysis controlled for demographic and other important predictor variables including gender, marital status, education, race/ethnicity, full time work, insurance coverage, health status, limiting health conditions, family income, age, and family size. 

Regardless of sociodemographic factors, the researchers found that workers who lack paid sick leave were significantly less likely to have received preventive health care screenings in the last 12 months, even among those previously told that they have a condition such as diabetes or cardiovascular disease that places them at higher medical risk. They also found that workers without paid sick leave are 1.6 times less likely to have received a flu shot in the past 12 months.

Additional findings from the study reveal that American workers without paid sick leave were:

  • 30 percent less likely to have had a blood pressure check in the last 12 months
  • 40 percent less likely to have had a cholesterol check in the last 12 months
  • 24 percent less likely to have had a fasting blood sugar check in the last 12 months
  • 19 percent less likely to have seen or talked to a physician or health care provider in the last 12 months
  • 23 percent less likely to have had a Pap test in the last 12 months

“Our findings demonstrate that even when insured adults are provided with free preventive screenings, paid sick leave is a significant factor associated with actually using the screenings,” said DeRigne.  “American workers risk foregoing preventive health care, which could lead to the need for medical care at later stages of disease progression and at a higher cost for workers and the American health care system as a whole.”

The two most common ways to offer paid sick leave is by mandating employer-funded benefits or through a universal social insurance program funded through taxes. The Healthy Families Act, introduced in Congress in 2015, uses the employer-funded model and would allow workers to earn up to seven days of paid sick leave if their employer has more than 15 employees and seven unpaid days for employers who have less than 15 employees. The bill has not yet been introduced in the current Congressional session.  

“Our data can be used by health care professionals, policy makers and others to consider the expansion of access to evening and weekend hours as well as mobile, community-based, and workplace health and wellness services,” added Stoddard Dare. “When workers forgo essential preventive health care such as flu shots, the public health implications are immense. This is particularly relevant for service related employees, food preparation workers and others who have low access to paid sick leave coverage.”

The article also was co-authored by Cyleste C. Collins, Ph.D., assistant professor at Cleveland State University, and Linda Quinn, Ph.D., college associate lecturer in the Department of Mathematics at Cleveland State University.

###


          105-Year-Old Japanese Physician Reveals His Secret to Long Life        

A Japanese physician reveals that the secret to living a long life is by not retiring. Dr. Shigeaki Hinohara passed away on July 18, but he lived an astounding 105 long years. As a matter of fact, Dr. Hinohara was still treating patients and working up to 18 hours daily even months before his death, […]

The post 105-Year-Old Japanese Physician Reveals His Secret to Long Life appeared first on NextShark.


          How Do I Choose A Doctor?        
Finding a new primary care physician takes time, patience and research. Start by considering your personal needs.
          Microbiology at Bayalpata Hosptial         
The staff at Bayalpata are always busy trying to find ways to improve and become more efficient. The focus on improvement doesn't leave much room for reminiscence. For a newcomer like myself I was preoccupied with how far the hospital has come since its opened its doors four years ago. The progress is even more impressive considering the formidable obstacles that Nyaya Health has faced and continues to face. 

Not only has Nyaya Health succeeded in establishing a free hospital in Far Western Nepal that provides basic health services, but it also continuously tries to expand its services. Take for example Bayalpata Hospital's Microbiology Lab that is currently expanding to include a bacterial culture facility. 

Bayalpata's lab is the only one of its kind in the district of Achham. It is currently staffed by four lab technicians and is equipped with an I-stat machine, a QBC Hematology Analyzer and a number of important serology tests, including HIV, Malaria, TB, and Hep-B. Having an in-house laboratory with the ability to analyze patients blood, kidney, and liver functions has allowed the physicians to more quickly and accurately diagnose their patients. The lab technicians approximate that they run biochemistry tests on 50 patients a day, at times discovering patients that are HIV+ and unaware of their condition. These patients can then be referred to Bayalpata's Anti-retroviral Therapy program. The biochemistry tests at the lab also allow the technicians to spot unusually high white blood cell counts that may be diagnosed by the doctors as leukemia. 

In the next few days, the technicians hope to begin growing and preserving bacteria cultures which will allow them to increase their diagnostic capabilities as well as pursue academic research, particularly concerning antibiotic resistant bacteria. Bayalpata is currently treating two patients that are suffering from multi-drug resistant tuberculosis. The capability of testing cultures with antibiotics can allow drug resistant strains to be more quickly recognized.

When Nyaya Health was founded in 2006, it opened a clinic in an abandoned goat shed. Today it is operating one of the few microbiology laboratories outside of Kathmandu. Hopefully similar progress is made over the next four years.

Bishnu, one of the four lab technicians working in the renovated microbiology lab at Bayalpata Hospital












          Heroes: The Physicians        
Dr. Payel has provided us invaluable guidance throughout our summer and we have been inspired by her work to transform the hospital. As a bridge between the clinical and administrative departments in her role as Clinical Operations Director, Dr. Payel has spear-headed innumerable projects to improve the quality of care and create clinical systems that result in the best patient outcomes. She has a keen eye for places where the hospital could improve and constructively does something to address any concerns. In our first several weeks, we saw her lead the efforts to make the hospital into a more dignified, hygienic place. ­­ There was rarely a night when she was not in the ER or IPD overnight assisting in the heroic and often creative efforts of the clinical team to save a patients’ life. Her energy carries through the rest of the hospital as she encourages others to produce top-quality work. In an organization with a basic tenet that ‘good intentions are not enough,’ Dr. Payel embodies efficiency and effectiveness in getting things done.
Dr. Bibhusan is among the kindest, most visionary physicians I have known. As Medical Director, he has earned tremendous respect from the entire clinical staff as a skilled physician, excellent teacher, and an effective manager. However, I have been most inspired by my interaction with Dr. Bibhusan as a physician who makes a concerted effort to improve community health beyond the clinical space. After attending a training program on the government’s HIV initiatives, Dr. Bibhusan came to Ashma and me to discuss how we could fill in the service gaps of the region’s community and home based HIV care model. Through our conversations over the next couple weeks, we created a program that would bridge several of our departments and bring all of the community stakeholders together. This was not a theoretical exercise – within a week of our initial conversations, we were able to begin bringing community partners together. Dr. Bibhusan’s gentle leadership throughout that process fostered the beginnings of a very positive and productive partnership among a group of people who had never before been able to work together in a meaningful way.

Dr. Roshan’s constant optimism is infectious. I’ve never once heard him complain and he claims to have never had a bad day. People seek Dr. Roshan out to be reminded of why we do what we do and maybe to be tossed a mango or a wide smile. Dr. Roshan is a role model for everyone at Bayalpata Hospital with his love of learning and teaching. Even after a long day in the clinic, Dr. Roshan always finds time to teach anyone interested in learning. One night while I was in the ER for rounds, Dr. Roshan was looking at a patient’s xray. He paused when he saw Sindhya and me to thoroughly explain the patient’s history and the relevance of the xray findings. He then went on to explain the difference between a number of similar-sounding medical terms related to the next patient’s condition. The next morning in the daily continuing medical education lecture for the health assistants, he made sure to slip a few of those new terms in and looked over to Sindhya and me to make sure we had caught the terms. As he did so, I was reminded of just what makes Dr. Roshan so incredible – he naturally connects with and improves the life of each individual he meets, whether patient, co-worker, or friend.

Dr. Rashmi’s passion to improve patient outcomes drives her work. As one of the first female physicians in the region, she has quickly gained the trust of the many female patients who come to Bayalpata Hospital with Ob/Gyn concerns. Dr. Rashmi looks out for others. One night she came to us quite concerned about the quality of the blankets we give to newborns and expressing the desire for a project where we could perhaps provide infants with their first (and likely only) outfit that they will receive in their first days of life. She takes the lead in addressing any complications with maternal and child care. Dr. Rashmi also greatly contributes to the morale among the staff by helping to organize staff bonding nights and by being a friend to all those in the Bayalpata community.


Drs. Payel, Bibhusan, Roshan, and Rashmi are heroes.

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If the abdominal enters my family room prior to deciding to, in that case aside from getting the bottom of comments, it is just a really serious health issue and should be dealt with from the right heated.
Unhealthy weight is considered as being the number one wellbeing danger afflicting Americans with the Centres for Illness Control in addition to Protection (CDC). With North america, morbid obesity can be a international affliction and not much effort is being manufactured to get people to aware about the risks inside weight they are really transporting.

Illustrates of the notable prescription slimming capsules

Phentermine- Phentermine can be obtained both equally as pills and supplements and employed as well as diet restriction and also exercise. P is so popular and utilized for short term obesity management. It belongs to the sympathomimetic course of diet pills.

Heard of BODY MASS INDEX

Obesity is a reason behind critical diseases just like diabetic, bring about, in addition to cardiovascular disorders and so forth Being overweight is really a BODY MASS INDEX (Body Bulk Index calculated by fat in kilos divided by means of height in metres squared) studying of around 30th. An overweight measurement falls in between a BODY MASS INDEX of 30 and 28. being unfaithful. If the BMI > 30, p remedy could possibly be proposed for these kinds of sufferers.
Consume a good amount of water- H2o always assists with flushing out the toxic compounds from entire body. 8 portions of waters is simple must.
A sensible way of life may be the want on the hours for each and every man alive. A nutritious and also disciplined way of living is necessary not only for the over weight but in addition for every single person. Being overweight need to be resolved by implementing a thorough plan of action. This sort of plan typically involves U.S. National Library of Medicine: Drug Information Portal - Phentermine, typically the dietician, actual trainer along with a competent general doctor.
The diet supplements have virtually similar unwanted side effects including dryness connected with mouth, fatigue, enhanced blood pressure, queasiness etc . Two things must always be considered whilst taking weight loss supplements. These weight loss supplements tend to be prescription medications along with needs to be obtained only after proper check-up by a skilled GP and the medicines are meant as dietary supplement (and not necessarily substitute) towards the natural ways of shedding pounds.
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Great could be rigorous diet

A new strict diet regime needs to be supplemented through physical activity. Jogging, fairly fast taking walks, inhaling as well as other workout routines are often called seeing that 'physical workout'. In addition , your own physical instructor may recommend you particular aerobic exercises that may slow up the weight swiftly.
Diet pills including Phen375 here be employed satiety enhancers. Reductil obstructs the sensation problems cells in which release along with reabsorb this. This increases serotonin levels, which will act from the brain and enrich feelings connected with fullness so that you will eat less and consequently lose weight.

Tend to be slimming pills harmless?

If you want to get beautiful and maigrir du ventre, you should remember tah slimming capsules are administered within extreme situations of unhealthy weight. Which means this information is out excessive and clear to any or all those trying to find some sort of way to pounds loss- Weight loss pills aren't going to be intended for beauty uses. They are really like the facilitators on the fat loss regime and therefore are designed for over weight (BMI involving 30 and above).
The best weight-loss plan involves a strict along with regulated diet plan. This can contain the carb supply operations, kcal administration, body fat management along with water therapy. This is actually the all-natural way of losing the additional gear through the human body.
The actual suitability involving slimming pills must be remaining on the medical professionals since these are definitely medicine pills in addition to OTC purchase of these kind of drugs really should be definitely avoided without exceptions.

Optimistic Weight-loss Approach

Any additional fat figure might mean critical consequences in the instances in the future. Excess weight of flesh extra rounds regarding visits for the doctor. Weight problems is the source of significant health problems such as diabetes, bring about, heart diseases and so forth
Keep away from oily food- Deep-fried food, junk and foamy solutions, alcohol consumption and saturated fat needs to be definitely avoided at any cost. This can also help out with enhancing skin area look. Yiu can read additional info about How to lose weight here.
The extreme fat conditions are normally treated simply by diet tablets (also known as diet plan pills). The diet supplements similar to Phenetermine, Adipex, Xenical, Didrex the top al are generally the more common doctor prescribed pills utilised in addition towards the organic fat reduction approaches.
    

          Raising The Norm In Weight-Reduction Plan Pills With Phenterex        
If you miss a dose, take it as quickly as you remember. Nonetheless, never take an extra dose to compensate for a dosage you missed as this may occasionally cause an overdose. this site, people taking antidepressants, insulin or oral drugs for diabetic issues and medications used to decrease hypertension should by no means take to food regimen pill because of drug interactions.
Consuming alcohol can also be avoided when on this tablet to keep away from rising the unintended effects of this weight reduction pill check this | Phentermine | link.
Usually, Phentermine pill is used on a short-term foundation and it should never be extended without the physician's advice as it could trigger dependence Phentermine here * http://www.shoppharmacycounter.com/t-Adipex-Medicine.aspx. So as to achieve optimal outcomes, it must also be coupled with a nutritious diet and a wholesome lifestyle.
Nowadays, Obephen is used to induce it check this | check this. When you find yourself using this food regimen tablet, just be sure you follow your physician's prescribed dose to the letter as a result of it may cause withdrawal signs and symptoms. Usually, this weight-reduction plan capsule is offered in prolonged-release tablets or capsules and perhaps taken 3 times day by day half-hour earlier than a meal or in a separate dosage throughout dinner.Http://stopfatgain.com Whether it is taken via the latter method, it is higher to take this medication an hour before dinner or roughly 2 hours after breakfast with a filled glass of water to optimize appetite suppression. It ought to never be taken a few hours earlier than bedtime as it could trigger sleeping tribulations adipex.
Previously, this weight loss program capsule has been used with fenfluramine and Redux in a drugs referred to as Phen to realize optimal side effects site *** link. However, this mixture has been stopped within the year 1997 as a result of development of coronary heart-valve problems has been related with the usage of fenfluramine.
Adipex p, additionally sold as fat burning pill, was first established in the mainstream marketplace after it was accredited by the Food and Meds Organization in the 12 months 1959. This link a popular treatment for weight problems and has been the subject of many studies and articles beginning in 1990.
The growing need for efficient slimming capsules can be attributed to the stereotype set by the storage devices when it comes to attractiveness. Magazines, tv and the internet have set thin folks within the peak podium of attractiveness. Happily, Mirapront exists. It's a widely used anti-weight problems remedy within the United States that is similar to amphetamines and activates the struggle or flight answer, in that way releasing epinephrine and norepinephrine. It is a good farther remedy for obesity along nutritional modification and visit page.

          What occurs when hormone treatment fails?        

The post What occurs when hormone treatment fails? appeared first on Health tips.

If the PSA stage will increase while you’re receiving whole androgen blockade (LHRH agonist or antagonist plus androgen receptor blocker), first your physician will cease the antiandrogen, which is known as antiandrogen withdrawal. This...


          Chantix and Zyban are prescription smoking cessation drugs        
What about the prescription smoking cessation drugs Zyban and Chantix?

Chantix is a non-nicotine pill that helps you stop smoking. Chantix is made by Pfizer, and is called Champix in Europe. It contains a form of varenicline tartrate. Chantix has been declared one of the most effective drugs for quitting smoking. You should always consult with your doctor when thinking about trying a new drug.

Zyban is an antidepressant medication (otherwise known as Bupropion Hydrochloride/Wellbutrin, made by GlaxoSmithKline) that was found to be effective in treating the smoking addiction, and helping smokers quit. However, bupropion's ability to help people quit smoking is not related to its antidepressant action. It can help you stop smoking even if you do not have depression.

Both of these smoking cessation drugs have risks of side-effects. Some people have had changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions while using Chantix or Zyban to help them quit smoking. These symptoms might occur as soon as you start taking these prescription smoking cessation drugs, or they might begin a couple of weeks after you start taking it. They could also continue for a couple of weeks after stopping them because the drug will need some time to completely leave your system.

Some people feel that the risks of the side-effects of prescription smoking cessation drugs are worth it just because they have tried quitting smoking so many times and failed. Chantix or Zyban might give them the edge they needed in order to finally quit. As long as you are being monitored by a physician, he or she will be able to tell you if the side-effects are normal and if they will go away over time.
          Some answers but lots more questions.         
Since Jadon's cardiac arrest on Sunday night he has undergone several tests to see if the medical team can determine the cause of his respiratory issues that have really been with him since his fundoplication surgery in early September.

The saliva scan indicated that he was pooling secretions above the fundoplication.  An endoscopy was done to see if the wrap was a little bit too tight and to dilate it if that was the case.  However it was shown to be fine and the opening was appropriate.  Thinking perhaps that there was a A flexible and rigid bronchoscopy were then performed to look at Jadon's trachea.  They found some 'interesting' structures (what isn't interesting about Jadon) but nothing that would indicated reasons for the obstruction/secretion build up.

The cardiac critical care attending physician has indicated that the team plans to continue to try and figure him out.  He was taken off the ventilator yesterday and is breathing on his own with some oxygen again.  He has also started coughing on his own which is encouraging because he has not been doing much of that over the past month.  At the very least the cough can help move secretions along.

So once again Jadon's complex condition raises many questions but provides few answers.  We continue to pray that things can be figured out and he can come home safely with the ability to protect his airway.
Singing Twinkle Twinkle Little Star... this is the "like a diamond in the sky"


          Re: William HOOD , Broadview, obit lookup please dod. March 4 1912         
Public Library - main library - may hold newspapers in their collection.
Obituary may have also been published .

Hi, , Did your Grandfather have a middle name - or may have reversed name used Middle name first - given name second ?
What was your GGrandmothers name ?
Searching Automated Genealogy - for the name William HOOD - does not find any in the aprox age.
1911 Census of Canada
Home / 1911 / Saskatchewan / Moose Jaw / 36 Townships 22 / page 1
There is a Thomas William HOOD - age 45 born 1864
Family: Spouse Margaret Hay 42,
Thomas William 25, Bessie Scott 22, Alexander B 20, Elizabeth B 18, Mary B 17

From Sask Vital Stats. Online
http://genealogy.ehealthsask.ca/vsgs_srch.aspx
Registration Number: 654
Name: HOOD : WILLIAM
Sex: M
Death Date (yyyy/mm/dd): 1912 / 3 / 4
Place of Death:
Registration of Death / Long form Death Certificate - may show personal information - May or may not show cause of death - there may be a Physicians Cause of death or similar - request same

https://familysearch.org/ark:/61903/1:1:QK9G-DFRM
William Hood
Saskatchewan Cemetery Transcripts, ca. 1850-1994
Name William Hood
Event Type Burial
Event Date 1912
Event Place Saskatchewan, Canada
Birth Date 1863
Death Date 04 Mar 1912

          Physician Assistant - TLCVision - Mississauga, ON        
TLC offers a great working environment, training, a competitive salary, comprehensive benefits, and excellend career development opportunities....
From TLCVision - Sat, 22 Jul 2017 00:41:33 GMT - View all Mississauga, ON jobs
          Physician Assistant - TLCVision - Toronto, ON        
TLC offers a great working environment, training, a competitive salary, comprehensive benefits, and excellend career development opportunities....
From TLCVision - Sat, 22 Jul 2017 00:41:27 GMT - View all Toronto, ON jobs
          Direct Talk - episode: 142        
Cynthia Maung is a refugee physician from Myanmar who runs a free clinic for displaced people and migrant workers in Thailand. She believes ensuring healthcare for all will benefit society as a whole.
Length: 
00:12:00
Rating: 
Closed Caption: 
CC
Episode Source: 
NHK

          It Seems Female Physicians Don't Factor Into Trudeau's Feminism        

Justin Trudeau frequently promotes himself as a feminist and supporter of women in the workplace. He tells us "we need women and girls to succeed because that's how we build stronger, more resilient communities." His recent budget hyped itself as the first ever application of gender-based analysis and he gives great advice to men who want to be allies: "don't interrupt women, and notice every time women get interrupted." (Hear hear!)

So perhaps when Finance Minister Bill Morneau announced the upcoming end to incorporation for certain small businesses, it was on the assumption there wouldn't be a gendered impact on the owners of health-care businesses. The shorter name for these business owners is "physicians," and they are up in arms over Morneau's suggestion that incorporated doctors are tax cheats.

I know this is difficult news

In spite of the well-worn image of a doctor as a grey-haired older man spending his free time on the golf course, a significant number of doctors are actually young to middle-aged moms, rushing straight home from the hospital or clinic to start their second shift with the kids. Fifty-two per cent of Canadian physicians under 45 are women, and this number is not static.Between 2011 and 2015, the number of female doctors grew three times faster than male doctors. In family medicine this change is even more pronounced, with women making up 59 per cent of the under 45 group and 65 per cent of the under 35 group. Yet despite Trudeau's many feminist-friendly statements lauding working women and their contributions, not a lot of us women in medicine feel that he supports us and our work.

That's why a petition was created a few days after Morneau's announcement, as physician moms nationwide looked at their finances and realized they were in danger of never retiring. Dr. Nadia Alam, president-elect of the OMA and a small-town family physician and anesthetist, writes that in addition to retirement planning, incorporation allows her to work demanding, irregular hours with four small kids and support her aging parents.

I have all the responsibilities and risks of a small business, yet the federal government doesn't think I should have any of the tax treatment.

Each woman in medicine is a female-owned small business that contributes to this country's heath-care infrastructure and economy. Physicians don't only provide their own labour, they fund other health-care staff, clinic space and medical equipment. A wide range of health-care infrastructure is paid for out of pocket by individual physicians, and a growing number of these physicians are women with young families like Dr. Alam and myself.

Later this month my son will celebrate his first birthday. I took six months off when he was born, although I would have liked to have taken more. Like other small business owners, I couldn't simply close up shop for my maternity leave. My patients still needed a doctor, the rent still needed to be paid and my staff still needed regular paycheques.

All of these costs were paid out by me (including paying the physician locum who covered my leave) and resulted in a tight financial squeeze during the months I was home with my son. I'm not complaining about my lack of maternity leave benefits, and certainly there are women in much more fragile financial positions who don't have maternity benefits, either. My point is that I have all the responsibilities and risks of a small business, yet the federal government doesn't think I should have any of the tax treatment available to other types of small businesses.

CANADA-BUDGET/

More unique to physicians is the deferral of saving for retirement because of the relatively late start to our careers. Another thing frequently deferred is starting a family, as is common for women who spend longer in school (doctors typically spend at least a decade in post-secondary studies). I had my first baby in residency, pushing back the start of my working life, as did many of my female colleagues. The lack of a pension or maternity benefits for most physician mothers presents a special challenge: having already delayed the start of your work life, what is the cost to your retirement savings if you want to have a baby? Last year, when I was a 36-year-old pregnant family physician, this question was frequently on my mind. And like many other female doctors, I'm the breadwinner in my family, and a breadwinner without maternity benefits can sometimes feel stuck between a rock and a hard place.

So when Trudeau calls himself a feminist, is he thinking about the women who fund health-care infrastructure in this country through their small businesses? I'm not sure he's aware how many of us are also the breadwinners for our family and how difficult a position that puts us in when we become mothers. It's obvious he isn't considering how being working moms in medicine disadvantages us in saving for retirement.

We're wondering why a prime minister who speaks glowingly about the societal contributions of working women can look right past us as if we don't exist.

Trudeau seems himself to have succumbed to the popular image of the older male physician on the golf course. This entrenched idea makes us hard-working "lady doctors" (yes, I have been called that MANY times) who are raising young families feel invisible, when what we really are is a major, growing demographic within health care. And since we also fund health-care infrastructure directly out of our female-owned small businesses, we're wondering why a prime minister who speaks glowingly about the societal contributions of working women can look right past us as if we don't exist.

Certainly the Liberal government doesn't want to be seen as the purveyor of empty feminist platitudes, however, that's already a well-establishedcriticism. The recent budget paid lip service to the idea of encouraging women to move into senior-level positions, yet medicine already is a key avenue for women to move into prominent positions in health care. Hamstringing the female physicians ready to do the hard work of health-care leadership can hardly be seen as supportive of working women. This policy will destabilize one of the few fields where women having been claiming the kind of success Trudeau waxes poetic about, and I don't see very much that's feminist about that.

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          EVERY PATIENT TELLS A STORY by Lisa Sanders        
EVERY PATIENT TELLS A STORY, by Dr. Lisa Sanders, an internist and teacher at the Yale University School of Medicine, is a mesmerizing look at the way sick people are treated and mistreated, often with the best of intentions, by their physicians. In her introduction, the author insists that every story she relates, however improbable, is real. The names of the patients and some of the doctors have been changed to protect confidentiality. Sanders is a technical advisor for the hit show, HOUSE...
          Things To Remember When Traveling Abroad        
By Thomas Clarke

When taking a trip overseas, you are giving yourself a wonderful opportunity to broaden your horizons and experience things that are new and fascinating. In order to truly enjoy such an experience, however, you need to be able to get around any mishaps that may happen while you are traveling. Here are a few tips that will help you while you are on your overseas vacation.

You want to start planning by obtaining a valid passport at least two months before you are scheduled to leave for your destination. You should also look into the requirements for obtaining a visa, this way you will also have one ready should it be required for your stay. After this is all squared away you should then contact your insurance company to see if you are covered while visiting overseas destinations. You should also contact your physician to get a physical and any vaccinations that are required or that may be helpful. You will also want to make sure that you have a supply of medication to last during your stay, as well as information on getting refills should you happen to lose your medications.

Prior to leaving for your trip you will want to make two copies of your passport, travel itinerary and visa (if one is required). One copy should be left with a family member or friend who will be staying in the states. The other copy should be placed in your luggage, and a different location than the original. Your passport is one of the most important pieces of paper during your trip, therefore it is very crucial that you keep it protected and safe. If you should happen to lose your passport while on vacation you need to go to the American Embassy and request assistance.

While looking into various accommodations and attractions, at your overseas destination, you should also take some time to look into the area laws. This will enable you to avoid any issues with customs, and make for a smoother traveling experience. Each country has a separate set of rules on what can be brought in and taken out, therefore it is important that you understand the custom allowed and prohibited list for the area you are planing to visit.

If you are going to a country where you do not speak the language, a tour group may be the best bet. Keep your itinerary with you, as citizens of other countries do not always speak English, but may recognize written names of hotels or tourist attractions. A point-and-conversation guide is a useful tool to help you communicate.

Be knowledgeable of the currency, and be sure to exchange your money prior to making a purchase at your destinations. There is always a fee for theses transactions, therefore one of the best things you can do is utilize credit cards for all your purchases while you are on vacation. - 31980

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          Ace Weight Loss - Review        

What is Ace ? 


ACE - Appetite Control and Energy nutritional supplement is just a complete mixture of ingredients including Natural Caffeine and Dark Cocoa, as well as added important ingredients. A couple of pills will turn-off your craving for food and help you lose weight
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Almost all of my entire life I've been skinny and found it fairly simple. The most I would gain is 5lbs of fat but it was easy to lose that again in a few weeks of work outs.

When Don and I got married 9 years ago, I was a size 1! The week before my wedding I was thinking I should have tried to get rid of some weight because a month or so later, we had the extra special news that I was pregnant.After gaining about 70 extra pounds, then I have quickly that my body wouldn't be the same. But perhaps then, the majority of the weight dropped down since  I have coaching color guard four times per week.
A year passed, breastfeeding, nursing and carrying my little ones, I realized exactly what my physician meant. He couldn't be more right. I was 70 pounds heavier that I was during my wedding and no muscle tone.
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 I know I have many months to go, to gain back the body I desire, but I know I can do it till the summer comes. I understand that I might not be the size 1 again, might be 2, but that’s not a huge difference, and what's more important I feel good and look the way I want to with the help of. The sad thing, I haven’t measured my self before starting using pills.  From the last time I have checked, I have lost 15 pounds in just 5 weeks. What’s more important, I haven’t done any workouts, nope, no gym, no yoga. Now I have to wear a belt Ace weight loss review.
The sad thing, I haven’t measured my self before starting using pills.  From the last time I have checked, I have lost 15 pounds in just 5 weeks. What’s more important, I haven’t done any  workout, nope, no gym, no yoga. Now I have to have a beltJI know I have many months to go, to gain back the body I desire, but I know I can do it till the summer comes. I understand that I might not be the size 1 again, might be 2, but that’s not a huge difference, and whats more important I feel good and look the way I want to with the help of Ace weight loss.


          Snippet: GRAY BISHOP (Cornerstone Run #2)        


Taken from Chapter 2. Read the rest October 21st!

 

He and Rook went inside and straight down the long hallway to the kitchen. Mrs. Troost, their housekeeper since before Bishop was born, had laid out a platter of sandwiches and a note that cold broccoli salad was in the fridge. Bishop and Rook helped themselves to food, then took their plates outside to the back patio.

Brynn and Shay were seated on opposite sides of the long picnic table, beneath the shade of an umbrella. They looked up at their arrival, Brynn’s face breaking into a wide grin. Shay simply watched them approach, her face blank, her eyes empty. Always empty. The girl’s spirit had been broken, and Bishop’s beast snarled with the unfairness of it all.

“Mind if we join you?” Rook asked.

Brynn deferred to Shay, who nodded slowly. Rook sat next to Brynn, such an odd contrast, the pair of them. Rook was a head taller than Brynn, his muscled arms decked out with tattoos and scars, with a ragged ear that made him look downright dangerous. Or like the alternative rock band star he’d tried to be. Brynn was small and pale-skinned with stick-straight black hair and big blue eyes. A true odd-couple in terms of physical appearance. Very much matched in every other way.

Bishop sat on the same side as Shay, keeping a solid arm’s reach of distance from the spooked girl. The only people she seemed to allow close proximity to her were Knight and Dr. Mike, the town’s physician. She was underweight, average height, with long, strawberry-blond hair and pale, gray eyes that had no life in them. She was also quite pretty. He imagined the girl had a heart-stopping smile, and he hoped one day to see it.

“Your ears must have been burning,” Brynn said to Rook. “Shay and I were just talking about you.”

“Oh?” Rook said. “Good things, I hope.”

“She asked about your ear. I was telling her about that night.”

Bishop paused before taking a big bite of his roast beef sandwich and studied Shay’s profile. She was staring at her half-eaten sandwich, hands clasped in her lap. Shay had been informed about the events that followed the attack on her town in bits and pieces over the last two weeks, mostly by Brynn and Knight. She’d been badly wounded and catatonic for a while, until Knight coaxed her back into the world. No one wanted to overwhelm her or frighten her with the reality that Cornerstone was still under attack by an unknown, unstable enemy. That she was showing curiosity about the people she lived with had to mean she was making progress in her recovery.

“I’m surprised Knight hasn’t told you about that yet,” Bishop said softly.

Her gaze flickered toward him. “I don’t ask.” Her voice was soft, melodic, and almost impossible to hear. “It hurts him to talk about it.”

It hurt all of them to talk about it. Bishop didn’t test her statement, though. He could be blunt to a fault, but he knew when to hold his tongue around grieving women—except when it came to Jillian.

He’d have deserved it if she had hit him for throwing her late husband in her face last month.

“Did Brynn tell you how she faced off against a Black Wolf with only a shovel?” Rook asked, levity in his voice.

Brynn had been down and on the ground when Bishop, Jillian , and Father arrived at the barn, but the mental image the description conjured up made Bishop smile. Brynn was small, but she was fierce when it came to Rook.

Shay glanced up at Rook. “She mentioned defending you until help arrived.”

“I was scared out of my wits,” Brynn said. She leaned against Rook’s arm and rested her chin on his shoulder. The picture was obnoxiously cute. Bishop attacked his sandwich so he didn’t have to see it.

“Where’s Knight, anyway?” Rook asked.

“I don’t know. He said he had to do something at the auction house, but that was over an hour ago.”

Bishop frowned at his food. Father had temporarily shut down the auction house until the triplets had been dealt with. Their weekly auctions were what kept outside cash flowing into Cornerstone without tempting humans to stay too long, or get any ideas about moving to town. They hadn’t had an auction these last two weeks, and they weren’t likely to have another one for the foreseeable future. They couldn’t risk the triplets attacking with so many clueless humans in the way, and the fewer outsiders around the better.

Father’s office was at the auction house, and he used it for both auction and run business, so it was possible Knight went to see him. Bishop sent a text to Knight’s phone anyway, asking for a location. Knight was the triplets’ primary target, and even though he was relatively safe within the confines of town, Father insisted he not wander around alone. No one wanted to risk losing him again.

“Paranoid much?” Knight said, his voice a welcome sound from the patio doors.

Four heads turned. He stepped outside with a glass of iced tea in hand, sunglasses on even though he’d just been inside.

“Who’s paranoid?” Rook asked.

“Bishop.”

Rook snickered, then shoved broccoli salad into his mouth without asking for clarification.

“I don’t like you walking around alone,” Bishop said. He didn’t give a damn if that made him paranoid. He preferred to think of it as smothering and overprotective.

“I went to the auction house and back,” Knight said. “I didn’t even stub my toe.” A month ago, his tone might have been light and teasing. Today it was bordering on hostile. Knight didn’t like being handled, but damn it, he’d been kidnapped twice in his life already. Bishop wasn’t going to allow that to happen a third time.

Instead of joining them at the table, Knight flopped into one of the patio’s lounge chairs, angled away. He seemed intent on ignoring them—something else he wouldn’t have done a month ago. Rook had twisted around to stare, and as he turned again to finish his meal, Bishop caught a stray emotion on his face that stirred up his gut.

Fear.

Fear of what, he didn’t know and couldn’t ask, but fear all the same.

His phone buzzed. Rook jumped at the same moment. They retrieved their phones, to an identical message from Father: 911 Office.

Bishop got up without a word, barely listening to Rook explain their abrupt departure to the women. Knight wasn’t following them, which surprised him briefly until he realized Knight’s exclusion could mean they had a lead on the triplets.

The auction house was a five-minute walk, and a ninety-second run. Despite the late summer heat, Bishop jogged down their road to Main Street, made a sharp right, and pounded pavement to the end of the official town limits where McQueen Auction House had been built three generations ago. Rook stayed on his heels. Devlin and his cousin Winston met up with them at the front door, and they all followed Bishop inside.

Father was behind his desk, standing with his arms folded, agitation all over his face. “We’re waiting on two more,” he said in lieu of a greeting.

They fell into line around the room, waiting for their Alpha to begin the meeting. Bishop studied his father’s face, but found no hint as to their agenda in his set jaw or narrowed eyes. Moments later, two pairs of footsteps pounded up the stairs to the office. Jillian Reynolds came in first, Jonas right behind her. Bishop’s beast stirred at her appearance.

“This information stays in this room for now,” Father said. He picked up a folded sheet of paper with four sets of numbers printed in black marker. “I received this in today’s mail. No return address, no distinguishing scents attached. Postmarked from Welton, our nearest neighboring town.”

Bishop accepted the paper when handed to him. The numbers seemed familiar in some way. “Coordinates?”

“Correct. The coordinates are for a location just off Route 12, about six miles from here.”

“No indication of what we’re expected to find there?”

“None. That was the only thing in the envelope.”

“Feels like an ambush invitation.”

“My thought as well. I want you six to go there and see what we’re meant to find, if anything. Go in as pairs, one beast and one skin, from different directions so you can see from all sides. Keep in constant contact with each other.”

“With respect, Alpha, is six of us enough?” Jillian asked.

Father’s eyes flashed with annoyance. “Six is all I will risk sending. This could be an ambush, or it could be a tactic to draw my enforcers out of town and make us more vulnerable to an outside attack. Once you’ve left, I’ll inform the other patrols of what’s going on so everyone is on their toes.”

The plan was a good one. They didn’t know what they were going to find out there in the woods, and putting all of their strongest fighters in one place was a bad move.

“Understood,” Bishop said. “We’ll leave right away.”

“Good. Be careful, all of you.”

Verbal affirmatives rose up, and then the group filed out of the office and downstairs.

Bishop hung back. “Was Knight over here within the last hour?”

“No, I’ve been alone all morning,” Father said, concern furrowing his brow. “Why?”

“He told Brynn this was where he was heading.”

“Knight probably needed a few minutes to himself. I don’t like it, either, son, but he does need personal space in order to control his empathy. If your mother was around others for too long, too consistently, she became agitated. Especially when something was already bothering her.”

“Right.” Their mother had been a White Wolf, too, so Father had a unique perspective on the responsibilities and side effects of the burden. Balancing the emotional control of seven hundred-plus loup garou was a monumental task. “I’ll let you know when we’re close to our location.”

“Be careful, son.”

“I will.”
          That was my project        
Originally Published 2004-03-23 02:33:10

Hot damn. That six weeks in the UK last summer was actually worthwhile.



http://biz.yahoo.com/prnews/040322/nem005_1.html



DUBLIN, Calif, March 22 /PRNewswire-FirstCall/ -- iAnywhere Solutions, Inc., a subsidiary of Sybase, Inc. (NYSE: SY - News), and Eli Lilly, a top ten global pharmaceutical company, today announced the completion of a pilot project in Italy to provide a PDA-based sales force automation solution to Eli Lilly's cancer specialist sales team. The solution leverages Mobile Pharma from iAnywhere to improve the quality and quantity of sales data, while eliminating time spent on paper administration. The iAnywhere® technology provided Eli Lilly with flexibility in the choice of mobile device while enabling it to mobilize its Siebel ePharma (6.x) system, business pages from the company intranet and information from other applications.



iAnywhere configured its Mobile Pharma solution specifically for Eli Lilly, allowing the sales team to capture call report information immediately following meetings with physicians, thereby enabling Lilly sales executives to build stronger relationships with physicians more quickly. The solution will also enable Eli Lilly to get more accurate, timely and pertinent drug information out to its sales force in order to boost productivity.



"Previously, our pharmaceutical sales executives spent a significant amount of time filling out data on paper, which then needed to be transferred to laptops. Eli Lilly realized that this system was not only time consuming, but also affected the quantity and quality of information from remote staff," said Geoff Kretzschmar, European CRM implementation manager for Eli Lilly. "We looked at various mobile options when considering the pilot trial in Italy and iAnywhere's Mobile Pharma was chosen as it offered the most flexible solution. The iAnywhere Professional Services team not only adapted Mobile Pharma to suit Eli Lilly's requirements, it also provided training to the IT administrators."



"Pharmaceutical companies operate in one of the most fiercely competitive industries, and it is becoming increasingly difficult to build strong relationships with physicians in order to enhance sales. Mobile applications offer a means to significantly improve the effectiveness of the sales executive, while increasing productivity and lowering costs throughout the sales process," said Alan Mair, new business development manager at iAnywhere. "The Mobile Pharma trial has given the Italian team of sales executives a more strategic view of the company/physician relationship, as well as easier access to the information they need to be more knowledgeable for the sales calls, such as key product messaging and data vital to the physician. In the future, Eli Lilly can also extend the mobile application to encompass more enterprise information so that sales executives can get all of the information they need anytime, anywhere."



Eli Lilly conducted a user survey with the participating sales executives three months into project. The feedback revealed that there has been excellent adoption among users with a marked increase in the number of updates made to its Siebel system, coinciding with an improvement in quantity and quality of data. Based on the increase in the motivation and effectiveness of the Italian sales force following the pilot project, Eli Lilly is now looking at other implementations of the Mobile Pharma solution across its European businesses.



          Apotemnophilia        
Recently I read the article Brain Games by John Colapinto in the New Yorker. It's a wonderful portrait, 13 or so pages long, of V.S. Ramachandran, the father of mirror therapy for phantom limb pain (according to me, at least). It provides the reader with a biographical account of Ramachandran, glimpses into his childhood, how he thinks (like Sherlock Holmes), a window into his personal life (can't remember his wife's birthday, forgets where he parked the car), and an account of his professional trajectory through life, how he ended up with a dinosaur fossil named after him, discussions of his interest in mirror neurons, synesthesia, ichthyology.

Lately he's been studying a patient, dubbed for the article, "Arthur Jamison". I am going to provide excerpts from the article now, direct quotes:
"Jamieson is seventy years old and lives in the Midwest. He is a physician and an amateur cellist, and has been married for forty-seven years. He also suffers from a rare and bewildering condition called apotemnophilia, the compulsion to have a perfectly healthy limb amputated--in his case, the right leg, at mid-thigh."
"After interviewing several apotemnophiliacs--Jamieson is the fifth person with the disorder whom he has studied--Ramachandran was struck by the fact that all of them said they became aware of the compulsion in early childhood, that it centered on a particular limb (or limbs), that they could draw a line at the exact spot where they wanted the amputation to occur, and that they attached little or no erotic significance to the condition. Furthermore, none rejected the limb as "not belonging" to them, as some stroke victims do in the case of a paralyzed arm or leg, and as Ramachandran had predicted they might. Instead, they said that the limb over-belonged to them: it felt intrusive. "If you talk to independent apotemnophiliacs, they say the same bloody things," Ramachandran told me. " 'The line for cutting is here.' 'It started in early childhood.' 'It's over-present.'
They're not crazy.""
"Asked where he would make the cut line for the amputation, Jamieson unhesitatingly drew an index finger across the middle of his right thigh. As to whether he felt that his leg didn't "belong" to him, Jamieson was emphatic. "Somehow, for me, that just doesn't compute, that kind of language," he said. "I have always been fascinated by amputation and wished that I had one. Why? Who the hell knows?"
"Ramachandran and other researchers have shown that the brain is what scientists call "plastic"--it can reorganize itself. Not only are different regions of the brain engaged inongoing communication with one another, with the body, and with the surrounding world; these relationships can be manipulated in ways that can reverse damage or dysfunction previously believed to be permanent. Ramachandran's work with patients at U.C.S.D. has led to one of the most effective treatments for chronic phantom-limb pain and to a new therapy for paralysis resulting from a stroke. (In both instances, his treatment involves only a five-dollar household mirror.) It has also provided suggestive insights into the physiological cause of such mystifying syndromes as autism."
"In the seventies, Michael Merzenich became expert at using microelectrodes to map the sensory cortex of monkeys. In one experiment, he mapped a monkey's hand area in the brain, then amputated its middle finger. Some months later, he remapped the monkey's hand and discovered that the brain map for the missing finger had vanished and been replaced by maps for the two adjacent fingers, which had spread to fill the gap. The results, published in the Journal of Comparative Neurology in 1984, were decisive proof that the brain can reorganize itself--at least across very short distances of one to two millimetres."
"After interviewing Jamieson in his office, Ramachandran led him to a lab for a Galvanic Skin Response, or GSR, test, which would reveal how Jamieson's legs reacted to a mild pain stimulus... David Brang, one of Ramachandran's graduate students, attached a sensor to the middle two fingers of Jamieson's right hand using a Velcro strap. The sensor would measure the reaction of Jamieson's sympathetic nervous system by monitoring the sweat on his fingers. With a sterilized pin, Brang pricked Jamieson's legs at random points, waiting a few seconds between each prick. A scrolling graph on the computer screen registered Jamieson's responses.

The unaffected leg--the left one--and the right leg above where he wished to have it amputated showed a normal response: the graph at first shot upward with each prick, but with further pricks it ceased to rise, then began to flatten out, indicating that Jamieson's nervous system was getting used to the stimulus. But when Brang pricked Jamieson anywhere on the leg below the amputation line, his nervous system responded with increasing distress, the graph climbing higher and higher with each prick.

The experiment seemed to support Ramachandran's theory about the disorder. He believed that people with apotemnophilia had a deficit in the right superior parietal lobule, where the body-image map is assembled. According to this notion, Jamieson was missing the neurons in the map that corresponded to his right leg from the mid-thigh down. He had normal sensation in the unwanted part of his leg--he felt the pin prick. But when the pain signal travelled to the right superior parietal lobule there was nothing in the body-image map to receive it.

"So there's a big discrepancy--a clash--and the brain doesn't like discrepancies," Ramachandran said."When a discrepancy comes in, it says, 'Shit! What the hell is going on here?,' and it kicks in and sends a message to the insular part of the brain, which is involved in emotional reactions--so you're getting this crazy GSR." In apotemnophilia sufferers, the discrepancy causes a feeling of distress that is no less agonizing for being below the level of conscious awareness.

In the past two years, Ramachandran has tested four other apotemnophiliacs using MEG brain scans. "You touch them anywhere in the body and the right superior parietal lobule lights up, as you would expect," Ramachandran said. "But if you touch him here"--he gestured to a point on Jamieson's leg below the amputation line--"nothing happens." Ramachandran said that the experiment needed to be repeated by other researchers, but, he added, "This takes a spooky psychological phenomenon and, as Shakespeare said, gives it a 'habitation and a name.' " Furthermore, the findings suggested to Ramachandran a possible method for alleviating the oppressive sensations in the unwanted limb.

Later, he asked Jamieson to stand in a corner of his office and placed a three foot-high mirror in front of him, in such a way that in place of his right leg Jamieson saw his left, which he held bent at the knee. Jamieson gazed into the mirror. "Astonishing," he said. For a moment, the leg looked "right.""


This is fascinating stuff. I was reminded of reading Michael Gershon's book The Second Brain, about the gut and enteric nervous system, how if neural crest cells didn't make it in to colonize the large intestine, Hirschsprung's Disease (Megacolon) is the unfortunate result. So much depends on exquisite timing during embryological unfoldment. Miss one little beat and some batch of baby neurons won't exist, and the resulting human organism can end up with major deficit. It can affect the body, and maybe, as in the case of Apotemnophilia, one's sensory perception of one's body.

As I checked out Apotemnophilia online, I saw it was quite consistently coupled with notions of a sexualized nature with heavy overtones of psychiatric implications.

About this, Colapinto writes:
"Jamieson, who was born and raised in New York City, first remembers having an unusual relationship with his right leg when, at around the age of seven, he was waiting for a bus. He found himself thinking that if he stuck out his leg it would be crushed and severed by the bus. "What came to me was not 'No, I don't want to do that' but 'How would I ever explain this?' " he told Ramachandran. In recounting his childhood memories, he said, "One of the things that's astonishing to me is how clear these recollections are."

"These things are very salient," Ramachandran said... "It's interesting to contrast these very clear-cut descriptions with these vague, Freudian notions about this whole phenomenon--that it's primarily connected with sexual stuff."

"Yeah," Jamieson said with disgust. "I've got no desire to cozy up to anyone with a stump. It's psychobabble.""


That it could be due to some embryologic formation error makes more sense. The thigh is actually the last part of the leg to form. Feet (in the form of ectodermic limb buds) poke out first, from the body wall. As toes begin to form, these feet, already containing vasculature and neural structure, begin to lengthen away from the body wall, and the "lines" of supply (vasculature) and communication (nerves) must grow to keep pace. Within the lengthening limb buds, bones begin to condense from cartilaginous masses which have formed from prior condensations of mesoderm; neural and vascular structures must simultaneously penetrate these condensations. Pathways of sensation of a limb to a brain include not just large diameter fibers from skin, but also many sorts of receptors, some very tiny, which report on all sorts of tissue, including vascular tissue (nervi vasorum). Some of these report on the sensory nerves themselves (nervi nervorum). Lots end up just inside the spinal cord, while others get all the way up as far as the insular cortex (1). The brain uses information coming in from many parallel kinesthetic channels(3) as well as visual ones, to construct its sense of self and body awareness/embodiment, to learn who is touching its organism, how it feels about that, what salience to assign in that moment. Apparently some sort of reverse processing occurs between afferents that go to the somatosensory cortex and those that go only to the insula(2). Apparently those going to the left insula are processed differently from those which go to the right (4).

All it would take would be some little screw-up in neural crest implantation into either the limb itself or else at the other end, in the brain itself (it would seem that quite a bit of "peripheral" "nerve", from neural crest, goes all the way into the brain, into some of its very touchy touch processing areas), so I can see how neural crest mishaps could be connected with body perception problems. Perhaps neural crest abnormality might become a target of investigation for body perception disorders some day.

1. Unmyelinated tactile afferents signal touch and project to insular cortex (Olausson et al.)
2.
Unmyelinated tactile afferents have opposite effects on insular and somatosensory cortical processing. (Olausson et al.)
3.
Unmyelinated afferents constitute a second system coding tactile stimuli of the human hairy skin. (Olausson et al.)
4.
Coding of pleasant touch by unmyelinated afferents in humans. (Löken et al.)

          As A Weight Management Product, Nuratrim Functions!        

There are very few health associated products that can claim duality.

Exactly what do we mean by that?

Well, Nuratrim tackles two distinct aspects of weight administration.

One associates with enhancing electricity degrees, food digestion and metabolic rate, while the various other deals with and boosts, digestive uniformity.

To Learn More About Nuratrim Go to nuratrim

With greater power degrees, it is so much easier to locate the motivation to work out more compared to ever, and thus burn even more of those all-important additional calories.

While with enhanced food digestion likewise addressed, our system functions much more properly at regulating the calories our physiques takes in from the food we eat.

Nuratrim s examine reduction item seems to have seamlessly met BOTH of these duality criterion, and, not remarkably, as a result, it has turninged into one of the leading weight, health-related products on the market today.

Helped obviously by its one-of-a-kind blend of leading-edge, scientifically proven, weight management boosting components, it is obtaining an excellent share of the weight management supplement market.

What is really featured in this mix that makes Nuratrim operates quite so efficiently?

Well, to start with, permit s have a look at the following, partial listing, to see the perks that could be stemmed from Nuratrim:.

Glucomannan: Nature s richest source of soluble fiber and which guarantees to help you discover your trick to health, fitness and stamina.

Licorice Extract: This not just lessens your body fat, but it considerably eliminates body weight, physical body mass index, and LDL cholesterol degrees.

Eco-friendly Coffee: Baseding on an individual study, when made use of for an extended time, Environment-friendly coffee could lead to reduced body mass test figures, and physical body fatty tissue clearly, when ased opposed to the use of typical instant coffee.

Capsicum Extract: Medical researches have likewise shown, that capsicum extract can help burn about 278 even more calories previously, during and after exercising on a treadmill for one hr.

Thus, with this excellent mix of ingredients, it s little wonder that Nuratrim workings so efficiently in doing away with unwanted body fat.

Nuratrim, created by Nuropharm Limited, is readily available throughout the world. While there are no high road stockists where you could get Nuratrim, its developers are stating that soon it will certainly be offered.

While Nuratrim is not currently readily available offline, it could obviously be provided right to your doorstep via on the internet stockists.

Going by the forgoing, there are great deals of positives for Nuratrim. There are a few negatives.

One is, that regrettably, Nuratrim is not ideal for vegetarians and vegans. Why? The product has gelatin, something that all vegans and vegetarians purely prevent. Sorry vegetarians.

Others will certainly be satisfied to understand that Nuratrim consists of a cocktail of proven, metabolic rate enhancing stimulants, that.

While numerous weighting loss tablet computers contain amphetamines and guaranam, it has actually been proven that these stimulants have at the very least unpleasant adverse effects that can, in some people, feature, anxiousness, irritability and sleeping disorder.

Nuratrim, on the other hand, stays well free from all artificial active ingredients, hence priding itself in being ONE HUNDRED each cent natural.

Nuratrim is just taken once a day, preferably in the morning with breakfast and a glass of water. Each container stands for a month s provide of 30 pills.

Although Nuratrim is extremely extremely considereded as a class-leading weight-loss item, it isn t for everyone.

Just like all weight management items, Nuratrim actually isn t recommended for expecting ladies, or for children under the age of 18.

And once more, as is common to all weight management products, it is suggested to first speak with your medical physician prior to taking any type of fat loss supplement.

The ingesting of any caffeine-related item could at first have some impact on rest. However, with Nuratrim, sleeping habits are rarely too disturbed, just because of the really small amounts of caffeine it has.

Just like any kind of product, prospective customers will always want to know if the product that they are interested, in sources any damaging negative side effects. With Nuratrim, there are no such issues, as it consists of just 100 % all-natural ingredients.

We must include this, that one of its natural components is a chilli draw out, which normally improves body temperature level in order to burn fat a lot more successfully. This extract can, sometimes, give some individuals, the sensation of what us described by some as, moderate hot flushes, and undoubtedly, this has been stated by an extremely little portion of Nuratrim individuals.

Yet apart from that, it seems from all records, that there is little else to bother with from eating Nuratrim.

Nuratrim does appear therefore, to be one of the greatest weight management items on the free market, and without a doubt most of users concur, that there ought to be few bookings about utilizing it.

For more information Regarding Nuratrim See nuratrim


          Former Blackhawks Star Eddie Olczyk Diagnosed with Colon Cancer        

Former Stanley Cup champion and current NBC Sports analyst Eddie Olczyk is recovering from surgery after he was diagnosed with colon cancer.

"I have been diagnosed with a form of colon cancer and am currently undergoing treatment for the disease," Olczyk said in a statement released by the Chicago Blackhawks on Tuesday. "I have been working with outstanding health care professionals and expect to be back in the broadcast booth after I complete my treatment."

Blackhawks team physician Dr. Michael Terry added Olczyk "is recovering well from the procedure and will be undergoing further treatment in the coming weeks, including chemotherapy."

Olczyk, 50, spent 16 years in the NHL after he was selected third overall by the Blackhawks in the 1984 draft. 

By the time Olczyk retired in 2000, he had tallied 794 points on 342 goals and 452 assists. 

Since calling it quits, the 1994 Stanley Cup champion has served as the primary color commentator for NBC Sports' No. 1 hockey booth alongside Doc Emrick. 

Olczyk has also contributed to NBC Sports as a horse racing analyst, making regular appearances on the network's various television platforms during Triple Crown season. 

Read more NHL Central news on BleacherReport.com


          What to Expect During a Hysterosalpingogram        

As part of the initial infertility work-up, your physician will wish to schedule a hysterosalpingogram, or HSG. The HSG is a type of x-ray test, designed to give your doctor a view inside your uterus, fallopian tubes and the surrounding area, in order to check for obstructions and abnormalities…

Continue reading on the Path2Parenthood Blog »


          Am I Annoying My Nurse? Insights into the Mind of a Fertility Nurse        

As a physician assistant and fertility case manager, I often take calls from patients that start with, “I am sorry to bother you again but…” If you’re a patient at an IVF clinic, you may wonder, are you bothering your nurse? Calling too often? Asking too many questions? Allow me to provide…

Continue reading on the Path2Parenthood Blog »


          British Hospitals Among Targets Of Global Ransomware Attack        
Copyright 2017 NPR. To see more, visit AUDIE CORNISH, HOST: Cyber extortion attacks spread across the world today. They hit organizations ranging from a telecom giant in Spain to the National Health Service in England. The attacks used ransomware, which demands payment before allowing users to access their own data again. NPR's Frank Langfitt begins our coverage from London. FRANK LANGFITT, BYLINE: The ransomware attack struck more than 30 facilities in England's vaunted National Health Service, or NHS, forcing some hospitals and clinics to shut down their computer systems to prevent the malware from spreading. Physicians had to return to working with pen and paper. Hospitals told patients not to come to emergency centers unless their condition was urgent. Malware typically gets into a computer when someone clicks on an infected attachment. Craig Williams, a cybersecurity specialist with Cisco Talos, the firm's threat intelligence unit, explains how ransomware generally operates from
          Interview of Donald McLean by Brian Shoemaker        
Interview of Donald McLean by Brian Shoemaker McLean, Donald Dr. Donald McLean, a medical doctor and surgeon, participated in the Ronne Antarctic Expedition during 1946 and 1947. After being interviewed by Finn and Jackie Ronne in Washington, D.C., McLean joined the ship in December 1946 for the voyage south to Antarctica. En route he visited Panama, Valparaiso and Punta Arenas. In Chile there was discussion about the wisdom of having two women, Jackie Ronne, and Jenny Darlington, wife of the pilot, Harry, join the expedition. In fact, they did so, and became the first women to over-winter in Antarctica. At first the two women were good friends, but when Finn Ronne demoted Harry Darlington as Chief Pilot of the expedition, even before the ship reached Antarctica, the women’s friendship abruptly ended. Approaching Antarctica, the ship anchored near Stonington Island. Admiral Byrd had established his East Base there previously, although it had since been abandoned, and was later ransacked by the Chileans and Argentines. There were 23 members of the Ronne Antarctic Expedition counting the two women. The British had already established another base just a quarter mile away. It had 13 members, including Bernard Stonehouse, an ornithologist. Ronne ordered the Americans to have little to do with the British. The Americans, however, did need to use the British dog teams to run cover for the planes. Most of the dogs Ronne had brought from home had died en route. What was left of the American dog team was unreliable. The dog teams also functioned as potential rescue backups for the planes in the event of a crash. One British plane crashed and the crew was rescued. Several dog sled trips were made to different locations. One trip of about 400 miles lasted for eight weeks. McLean participated with the British in one survey trip of several weeks across the Palmer Peninsula. Control points were surveyed where caches, including 50-gallon drums of fuel, could be left to service the planes. The British dog team also proved invaluable when one of the Americans, Harris-Clichy Peterson, fell in a crevasse, and with the aid of the dog team was found alive and rescued two days later. He suffered no permanent ill effects. Nelson McClary once tumbled 50 feet over the edge of a glacier, but he too was rescued unharmed. In fact Mclean reports there were no serious injuries or any serious illness during the Expedition, although he himself once suffered a broken ankle. The split between Finn Ronne and Harry Darlington caused tension in the camp. About one-third of the crew sided with the Darlingtons, about one-third with Ronne, and about one-third in the middle. One’s position at the dinner table was a clear indication of his personal relationship to Ronne. Darlington and Ronne always sat at opposite ends of the table. What Ronne really wanted from the team was “a great deal of respect, but didn’t get it because he didn’t seem to deserve it.” For example he resorted to petty punishments of his critics by taking away their jam and jelly. Despite Ronne’s objections, McLean cultivated a relationship with the nearby British team, especially the British doctor, Dick Budson. The British were never invited to visit the American base, and there was never any mutual socializing on holidays such as Christmas or New Year’s. McLean, however, visited the British base on several occasions for scones and tea. For many years he maintained a friendship with Kevin Walton. Years later, Walton gave McLean an American flag that he had stolen from the American base. McLean donated it to the Byrd Polar Research Center at Ohio State. There were several principal scientists on the Expedition. These included two geologists, Bob Nickles and Bob Dodson; Andy Thompson, a geophysicist; and H.C. Peterson, a cosmologist. As for Finn Ronne, McLean said that he did a great job of organizing and planning the expedition, including fund raising, but he was very petty in his criticisms and not a great leader. He once drew a beautiful map of a penguin rookery McLean planned to visit, but usually he was not seen as a sharing individual or one who had warm feelings for others. He had a “tremendous ego,” and sometimes became emotionally upset. Typically he would turn his back and walk away from confrontational situations. Most of McLean’s usual duties were not related to medicine. Aboard ship he stood regular watch, and took care of the sick dogs. On shore he helped Andy Thompson with his seismograph recordings. He sought to keep in personal contact with all team members, including Finn Ronne. Ronne did not come to realize until the end of the Expedition how little respect McLean had for him. McLean was very close to Harry Darlington and Andy Thompson, and they remained friends for life. Ike Schlossback was a valuable member of the expedition. He had been a submariner and a pilot, and was always friendly and fair. Many years later he lived with the McLean’s for two months before entering a retirement home. The Ronne Antarctic Expedition ended in March, 1948, and arrived back in the states in June. Their departure from Antarctica was facilitated by the icebreakers Edisto and Burton Island. Had Jenny Darlington not been pregnant, the expedition might have stayed on an additional year. McLean returned to active duty in the Navy and served for two years in Greenland. He became a specialist in micro-surgery. After his service in Greenland ended, McLean left the Navy and went into private practice in Alaska. But he considers his polar experiences to have been instrumental in his later interests and successes in life. Major Topics Recollections of the Finn Ronne Antarctic Expedition, 1947-1948 Leadership style of Finn Ronne Contributions of other team members of the Expedition Personal interactions and occasional conflicts Occasional contacts with a nearby British base, including use of their dog teams Adams, Chuck, pilot, pp. 4-5, 10, 25 Budson, Dick, British physician, pp. 17 Darlington, Harry, pilot, pp. 2-5, 14-16, 18, 22 Darlington, Jenny, wife of Harry, pp. 2-5, 16 Dodson, Bob, pp. 9, 12, 27 Gutenko, Sig, camp cook, pp. 11 Lassiter, Jim, head pilot, pp. 4-5 Latady, Bill, photographer, pp. 3, 27 McClary, Nelson, pp. 2, 9-11, 17, 26 Nickles, Bob, geologist, p. 19 Peterson, Harris-Clichy, expert on cosmic rays, pp. 9, 19 Robertson, Jim, airplane mechanic, p. 3 Ronne, Edith “Jackie,” wife of Finn, pp. 2-6, 16 Ronne, Finn, mentioned throughout document Schlossback, Ike, pilot, pp. 3, 9, 22-24 Stonehouse, Bernard, British ornithologist, p. 7 Thompson, Andy, geophysicist, pp. 2, 11, 19, 21-11 Walton, Kevin, member of British Antarctic team, pp. 7, 17
          Interview of Martin A. Pomerantz by Brian Shoemaker        
Interview of Martin A. Pomerantz by Brian Shoemaker Pomerantz, Martin A., 1916- Dr. Martin Pomerantz, a physicist who specialized in cosmic ray research, had a long and distinguished career in polar studies. As a graduate student at the University of Pennsylvania he took a challenging course in 1938 at the Bartol Research Foundation of the Franklin Institute, a course called Cosmic Rays and Nuclear Physics. At the time researchers were using balloons and ships to determine how the intensity of cosmic rays, which came into the Earth’s outer atmosphere from space, varied according to geomagnetic latitude and the location of the Earth. There were only two locations on Earth –the geomagnetic pole in Antarctica, and a second one in northern Canada – where cosmic rays were not impeded by the earth’s magnetic field. Pomerantz found the graduate course at Bartol fascinating, decided to pursue a Ph.D. in physics, and started a long career that took him both to Antarctica and the Arctic region. It was the International Geophysical Year (IGY), from July 1, 1957 to December 31, 1958, that inspired Pomerantz to concentrate on the polar regions. He and a Canadian colleague built a neutron monitor (something like a nuclear reactor in reverse) to detect sensitive cosmic rays. The Pomerantz monitor was placed on a Swedish ship that went from Gottinberg to Cape Town and back. The experiment was very successful, lasted for some years, and got definitive results on the question of the location of the geomagnetic equator, the point on Earth where cosmic ray intensity would be lowest. Conversely, the geomagnetic pole is the place where the geomagnetic intensity is highest. With a growing reputation, Pomerantz was invited by the Navy Hydrographic Office to put equipment in Project Magnet, an aircraft which produced definitive geomagnetic measurements in fairly close-spaced grids all over the Earth. These advances opened the door for him to participate in the IGY to undertake further cosmic ray research. Concurrently, Pomerantz also loaded an experiment in 1958 aboard Explorer VII, the first satellite to be launched under IGY auspices. James Van Allen, the noted physicist, also loaded some different experiments of his own on Explorer VII, which employed, in part, a Geiger counter. In 1959, encouraged by the progress made on various scientific fronts under the IGY, which ended December 31, 1958, the National Science Foundation established the Office of Polar Programs. In the spring of 1959, Pomerantz received a grant from the National Science Foundation to put a cosmic ray detector in the Antarctic. This was the beginning of his long association with Antarctica. Pomerantz started immediately on his new assignment. A Terry building, a modular unit built with copper shielding inside the whole building, was constructed at the Coast Guard Station at Baltimore, Maryland. Hugo Newberg, a friend from Bartol, joined the project, left immediately in mid-1959 for Antarctica, and oversaw installation of the building at McMurdo Sound in Antarctica. Data was transmitted by teletype using punched paper tape. Pomerantz did not join Newberg in Antarctica until November, 1960. As he arrived at McMurdo, a major solar flare was underway, and, for the first time, data on a solar cosmic ray event was observed at both ends of the earth. McMurdo was considered a 100% Navy base. Pomerantz and the other civilians were considered “visitors,” and stayed at a separate Jamesway hut. In addition to the two centers at Thule and McMurdo, two others were added later, at Swarthmore and the South Pole for a total in time of four neutron detector stations. Once this worldwide network was functioning exciting new discoveries were made. Studies were done on the way the solar wind interacted with cosmic rays, and how it changed with time. Eventually data was collected on three solar cycles. After two very successful years at McMurdo, the Navy decided to build a nuclear reactor there, and within 100 yards of the Cosmic Ray Station. Since such a plant would cause massive interference with the neutron detector, the Cosmic Ray Station was relocated to a completely new, larger, building three miles from the main base. The old building was moved to the South Pole in 1964, and so there were then two Cosmic Ray Detector Stations in Antarctica. That year – 1964 – was designated as the International Quiet Sun Year (IQSY). Pomerantz was the US Chairman of that event. This was envisioned as a successor to the IGY of 1957-58, but it had better funding and a much greater participation. Over 50 nations took part. The South Pole was seen as the best location worldwide for cosmic ray research, and Pomerantz relocated to the South Pole to set up the new station. Over time, Pomerantz spent 26 different summers in Antarctica. Pomerantz and others saw an opportunity to do significant astronomical research at the South Pole. Arnie Wyler, a solar astronomer from Sweden, and Brad Wood, an astronomer from the University of Pennsylvania, joined Pomerantz. The location was ideal for astronomy since there is a constant background – nothing but snow – and any object in the sky is always at the same altitude, and is always there, day after day. Because of the extremely dry atmosphere it seemed particularly well suited to do infrared astronomy. Unfortunately their seven or eight proposals were all turned down. Finally, in 1978, using some surplus equipment from a Swedish observatory, Pomerantz and friends built a solar telescope that was specifically designed for use at the South Pole. Officially it was presented as a part of the cosmic ray program. For the first time anywhere a continuous solar flare patrol was achieved. New pictures were taken every ten minutes for over a week. There was no other place on Earth where this could be done. The results were so impressive that Eric Fossat, a French astronomer, an expert on helio-seismology, secured additional funding so that the new field of solar seismology could also be studied at the Pole. The National Science Foundation (NSF) approved a proposal and this resulted, among other findings, in the best observations ever made of solar oscillations of the sun’s vibrations. It’s the only technique that exists for studying the sun’s interior. One of the telescope pictures appeared on the cover of Nature in January, 1979. That same year a new building was constructed for this project. The outstanding results led to additional funding and support from the National Solar Observatory. Studies of solar oscillations and helio-seismology continued at the South Pole until 1974. In that year the program was shut down since everything had been accomplished that could be done at the time with available technology. In 1975 a new base, “New Pole,” was constructed, and the first one, “Old Pole,” was shut down. Initially no provision was made for cosmic ray facilities at “New Pole, but eventually Pomerantz also secured space there. So there continued to be two cosmic ray stations in Antarctica, one at McMurdo and one at New Pole. This second base at the South Pole became known as Skylab. Through the years equipment was expanded and modernized at both stations. Research on astronomy at the South Pole turned out to be “a spectacular success.” The program was expanded to include infrared or millimeter or sub-millimeter astronomy. In 1984 there was a joint research program with a French team, but the difficulty of getting adequate supplies of liquid helium (needed to cool the detectors) limited its success. Even so enough was accomplished to prove that Skylab was an excellent place to do microwave astronomy. By the time of Pomerantz’s last visit to the South Pole, 38 astronomers were working there, of which 4 or 5 would overwinter. It was decided to build a new observatory. The new AMANDA observatory built at the Pole was named the Martin A. Pomerantz Observatory. Leading Themes Distinguished career of Pomerantz for many years at South Pole & elsewhere Director of Bartol at the Franklin Institute Major innovations in the field of cosmic ray research Emergence of the South Pole as a major center for astronomy Founding of the Martin A. Pomerantz Observatory Research at the South Pole in helio-seismology International Geophysical Year Baird, George, physicist, pp. 42, 45 Bentley, Charlie, geophysicist, pp. 70-71 Fossat, Eric, French astronomer, pp. 51-52 Friedman, Herbert, nuclear physicist, p. 14 Holsrichter, Harry, Navy physician, p. 37 Jackson, Bernie, astronomer, p. 52 Jezek, Ken, Director of the Byrd Polar Institute, pp. 69-70 Jones, Tom, Haverford College, first Director, Office of Polar Programs, p. 21 Merrifield, Bill, theorist in helio-seismology, pp. 70-71 Newberg, Hugo, cosmic ray physicist, p. 24 Ramsey, Norman, nuclear physicist at Harvard, pp. 11-12 Simpson, John, nuclear physicist, University of Chicago, pp. 8, 14, 18 Stark, Tony, astronomer, p. 62 Van Allen, James, nuclear physicist, pp. 9, 13-14, 18 Wilson, Bob, Noble Prize astronomer (microwave background radiation), pp. 61-2 Wood, Brad, astronomer, p. 46 Wyller, Arnie, Swedish astronomer, p. 46
          Indian Pictures Actress        
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Indian Pictures Actress Biography


Priyanka Chopra (pronounced [prɪˈjəŋkaː ˈtʃoːpɽaː]; born 18 July 1982)is an Indian actress. She was born to parents who were both army physicians. Due to their frequent reassignments, she grew up in many different cities in India, as well as spending a few years in the United States. Before starting her acting career, she gained fame after winning the Miss India and Miss World titles in 2000.During her career, Chopra has received one National Film Award and four Filmfare Awards.
Making her acting debut with the 2002 Tamil film Thamizhan, Chopra then made her Bollywood debut with The Hero in 2003. She followed that with the hit Andaaz, for which she won a Filmfare Award for Best Female Debut. She subsequently earned critical acclaim for her performance in Aitraaz (2004), and appeared in the commercially successful projects Mujhse Shaadi Karogi (2004), Krrish (2006) and Don (2006). The year 2008 marked the beginning of a new phase in Chopra's career, as her portrayal of a troubled model in the film Fashion earned her the National Film Award for Best Actress and the Filmfare Award for Best Actress. She was later noted for her performances in Kaminey (2009), What's Your Raashee? (2009), 7 Khoon Maaf (2011), which garnered her the Filmfare Critics Award for Best Actress, and for Barfi! (2012). Having done so, Chopra established herself as one of the leading contemporary actresses in Bollywood.
In addition to film acting, Chopra has performed on television and in stage shows. She has written columns in national Indian newspapers, and is active in charity work. She is regarded as one of most popular and attractive celebrities in India, and has many endorsement deals. In 2011, she signed an agreement with Universal Music Group and DesiHits to record and release her first music album. The first single, "In My City" was released in September 2012, and the full album is expected in December 2012.

Priyanka Chopra was born on 18 July 1982, in Jamshedpur, Jharkhand, India to Capt. Dr. Ashok Chopra and Dr. Madhu Chopra, both physicians by profession in the Indian Army. She has a brother, Siddharth, who is seven years younger than her.[8] Actress Parineeti Chopra is her cousin.Since her father was in the Army, her family frequently moved from one city to another during her schooling days. In an interview with Daily News and Analysis, Chopra said that she didn't mind moving around and shifting schools. She welcomed it as a new experience and a way to discover the multicultural Indian society.Places where she lived as a child include Jamshedpur, Delhi, Pune, Lucknow, Bareilly, Ladakh, Chandigarh and Ambala.
Chopra studied at La Martiniere Girls' School in Lucknow and St. Maria Goretti College in Bareilly as a young girl. She subsequently re-located to the U.S. where she attended Newton North High School in Newton, Massachusetts, and then John F. Kennedy High School in Cedar Rapids, Iowa.She later recalled, "It was a huge culture shock for me when I went to study for three years in Boston at the age of 13."[14] However, she was selected at state level for the National Opus Honour Choir.While in Boston, she participated in several theatre productions, and studied Western classical, chorus and choir singing, as well as Kathak dance.Having completed the tenth class, Chopra returned to India and finished her high school education at Army Public School in Bareilly; during this period she won a local beauty pageant called "May Queen".She registered for her college studies at Jai Hind College in Mumbai to study either Software engineering or Criminal psychology, but left after winning the Miss World pageant.
Chopra's mother enrolled her for the Femina Miss India contest,in which she came second at the Femina Miss India 2000 competition, behind Lara Dutta, winning the Femina Miss India World title.She was subsequently sent to the Miss World pageant, where she was crowned Miss World 2000, along with Miss World Continental Queen of Beauty − Asia & Oceania.In the same year, her Miss India co-winners Lara Dutta and Dia Mirza, won the Miss Universe and Miss Asia Pacific crowns respectively, in a rare triple victory for one country. When Chopra won the Miss World crown, she became the fifth Indian woman to win the title, and the fourth Indian woman to do so in a span of seven years.She stated that the Miss World title brought her recognition and fame, and then she started getting offers for film roles.

Priyanka Chopra made her debut in the 2002 Tamil film Thamizhan playing the role of Priya, the love interest of the protagonist in the film played by Vijay. The film was praised for its wit and dialogues, although the depth of Chopra's character was seen as lacking.In 2003, she appeared in her first Bollywood film, opposite Sunny Deol and Preity Zinta in the Anil Sharma film The Hero: Love Story of a Spy. She played a supporting role as a doctor named Shaheen in the film. Despite being one of the highest grossing films of that year,it received mixed reviews from critics.Though Chopra played the second female lead, her acting performance did get her noticed.Later that year she appeared in Raj Kanwar's Andaaz, playing the character of Jiya who falls in love with Raj Malhotra, played by Akshay Kumar. The film was a success at the box office,earning her a Filmfare Best Female Debut Award and a nomination for Filmfare Best Supporting Actress Award.Ashish Magotra writing for Rediff.com said of her role, "Priyanka Chopra alone clicks with the audience, thanks to her skimpy outfits."

Her next films which released in 2004, Plan, Kismat, and Asambhav performed poorly at the box office. Later that year she appeared in David Dhawan's romantic comedy Mujhse Shaadi Karogi playing the role of a young fashion designer Rani along with Salman Khan and Akshay Kumar. The film turned out to be the third-highest grossing film of that year.She next starred in Abbas-Mustan's thriller Aitraaz alongside Kumar and Kareena Kapoor. It was her first negative role and her performance was critically acclaimed.Film critic Subhash K. Jha noted, "A star is born! As the predatory social-climbing seductress who can go to any length to satiate her lust for life, Priyanka Chopra rocks the scene like never before. The film is undoubtedly a triumph for Priyanka Chopra. With half a smile, a twitch of her lip and a movement of her eyebrow she seems to slip into her man-eater's role with captivating ease".She earned a Filmfare Award for Best Performance in a Negative Role (also known as the Best Villain Award), becoming the second and last female actor to win the award after Kajol (the category has been retired since 2008). She also received a second nomination for Filmfare Best Supporting Actress Award for the role.
In 2005, she starred in six films. Four of them, Blackmail, Karam, Yakeen and Barsaat failed to do well.However, her performance in Yakeen garnered good reviews from critics. Her other two 2005 releases, Waqt: The Race Against Time and Bluffmaster! were moderately successful at the box office.Subhash K Jha wrote about her performance in Bluffmaster!, "Chopra has little to do. But she does it with eye-catching aplomb."In 2006, Chopra starred in Rakesh Roshan's Krrish which was a sequel to the 2004 sci-fi film Koi... Mil Gaya. She shared the screen with Hrithik Roshan and Rekha. The film was declared a blockbuster and was one of the highest grossing films of the year.She also appeared in Aap Ki Khatir opposite Akshaye Khanna and Dino Morea. Her last release was Farhan Akhtar's Don, alongside Shahrukh Khan which was a remake of the 1978 film of the same name. She was cast to play Roma, a role which was played by Zeenat Aman in the original movie. Chopra and Khan underwent special martial arts training for their roles in the movie and both performed their own stunts.Upon release, the film was generally well received both in India and abroad. A week after its theatrical run, Box Office India declared the film a hit in India, and a "blockbuster" overseas.Aside from that, she made special appearances in three other films that year.
In 2007, she appeared in Nikhil Advani's ensemble piece Salaam-e-Ishq: A Tribute to Love. Despite a promising opening, the movie was a financial failure.Chopra was criticized for her performance in the film, with Lidia Ostepeev of Planet Bollywood calling it "forced" and "overly exaggerated".Her next release, the much-delayed Big Brother, also failed at the box-office.In 2008, Chopra acted in six films. Her first four films, Love Story 2050, God Tussi Great Ho, Chamku and Drona, were critical and commercial failures. During this time, Chopra received mixed reviews for her performances, with some critics pondering why she chose to do these films.

"I will give full credit to Madhur Bhandarkar and the crew. I am really honoured. National Award is the biggest honour of our country and I am really honoured to have received one."
—Chopra on winning the National Film Award for Best Actress for her performance in Fashion (2008)
After a series of flops, Chopra was cast in Madhur Bhandarkar's Fashion (2008), for the lead role of Meghna Mathur. Revolving around the fashion world through Chopra's role of an ambitious model, the film was a critical success. Her performance in the film was appreciated and earned her several awards for Best Actress including the National Film Award for Best Actress,as well as the Filmfare Award for Best Actress. Subhash K Jha predicted that this would be Priyanka’s coming-of-age film, and Rajeev Masand wrote, "Chopra turns in a respectable performance, one that will inevitably go down as her best." The film became a major turning point in her career.Chopra's final release of the year was Tarun Mansukhani's romantic comedy Dostana alongside Abhishek Bachchan and John Abraham. The film explores the story of two men who pretend to be gay, so that they can rent an apartment from an older lady. Both the men fall in love with the same girl, their roommate, but are unable to express their feelings because she is related to the old landlady. The film was a financial success and went on to become the eight-highest grossing film at the Indian box office in 2008.Chopra received positive reviews for her performance and her look in the film.
In 2009, she appeared in Vishal Bhardwaj's caper thriller Kaminey alongside Shahid Kapoor, playing the role of a feisty Marathi girl named Sweety. The film was a critical and commercial success. Her performance received positive reviews.Her work in the film brought her several awards and nominations including a second Filmfare Award for Best Actress nomination and a second consecutive Apsara Award for Best Actress in a Leading Role after Fashion.She subsequently appeared in Ashutosh Gowariker's romantic comedy What's Your Raashee?, a film which made Chopra the first actress in cinema history to portray 12 distinct characters in one film, and for which she was reportedly being cosidered for inclusion in the Guinness World Records book.The film itself was a financial and critical failure,but Chopra's performance was appreciated by the critics.Rediff wrote, "Priyanka Chopra transforms into 12 new skins with astonishing distinction, voice and spirit. The actress reinvents herself into this unique individual every single time ranging from batty, bashful and boisterous. This is simply her show."
In 2010, Chopra appeared in Jugal Hansraj's Pyaar Impossible! opposite Uday Chopra, where she portrayed the role of a beautiful college girl who eventually falls in love with a nerdy boy. The film was a commercial and critical failure.Her next release, Siddharth Anand's Anjaana Anjaani alongside Ranbir Kapoor, got a good initial response at the box office,but was not well received by the critics. She received positive to mixed comments from critics for her performance.

Chopra at the audio release of 7 Khoon Maaf (2011). Her performance in the film received critical acclaim and among other wins, fetched her a Filmfare Critics Award for Best Actress.
Chopra's first release of 2011 was Vishal Bhardwaj's black comedy 7 Khoon Maaf, in which she portrayed the role of Susanna Anna-Marie Johannes, an Anglo-Indian woman who murders her seven husbands in an unending quest for love. The film was a commercial failure and received mixed response from the critics, however her performance received good reviews.and Nikhat Kazmi from The Times of India noted, "7 Khoon Maaf would undoubtedly end up as a milestone in Priyanka Chopra's career graph. The actor displays exquisite command over a complex character that is definitely a first in Indian cinema."Chopra eventually earned the Filmfare Critics Award for Best Actress and a third Filmfare Award for Best Actress nomination along with a few other awards at other ceremonies.
Her next release was Farhan Akhtar's Don 2 alongside Shahrukh Khan, in which she reprised her role of Roma. The film was a sequel to the 2006 action thriller Don. Upon release, while Indian critics gave positive to mixed reviews, overseas film critics praised it.Chopra's performance received positive feedback from foreign critics, with the reviewer from The Express Tribune writing, "Chopra pulls of her role with aplomb and seems to be the perfect choice for an action heroine. As you watch her effortlessly beat up some thugs in the movie, you come to the realisation that she may be the first proper female action hero in Bollywood."A review carried by Divanee South Asian News mentioned that Chopra surprises with a demeanor like that of Tomb Raider's Lara Croft.The film was a major success in India and a blockbuster overseas. It went on to break multiple box-office records in India and overseas, including the highest grossing Bollywood movie overseas in 2011.

In early 2012, Chopra became the first Bollywood actor to be signed by Creative Artists Agency (CAA), a prominent entertainment and sports agency headquartered in Los Angeles. The agency will handle her acting career in Hollywood.Her first release of the year was Karan Johar's Agneepath alongside Hrithik Roshan, Sanjay Dutt and Rishi Kapoor. The film was a remake of the 1990 classic of the same name. Upon release, the film broke the highest opening day collections record and became a critical and commercial success.[80] Her performance in the film was appreciated by most critics, such as Mayank Shekhar, who noted that she stood out in a male-centric movie.Her next release was Kunal Kohli's Teri Meri Kahaani, a love story set in three different eras. The film opened to mixed reactions from critics, however Chopra's performance, and her on-screen chemistry with co-star Shahid Kapoor received good reviews. Sonia Chopra of Sify wrote, "Priyanka delivers a superb performance easily slipping in-and-out of the layered characters with dexterity."Taran Adarsh commented, "As the spirited Aradhana of 1910, the dazzling movie star Rukhsar of 1960, or the joyful Radha of 2012, Priyanka is a complete livewire in each of the acts."However, despite the positive critical acclaim, the film failed to do well at the Indian box office, although was a moderate success in the overseas markets.

Chopra with co-star Ranbir Kapoor promoting Barfi! in 2012
In September 2012, Chopra featured in Anurag Basu's Barfi! alongside Ranbir Kapoor and Ileana D'Cruz. She was cast as Jhilmil Chatterjee; an autistic girl who falls in love with a deaf and mute boy. While preparing for her role, Chopra visited mental institutions and spent time with autistic people. She said, "I had to research a little for the role because in India awareness about a condition such as autism is very low."The film opened to major critical acclaim and Chopra received unanimous praise for her portrayal, which several reviewers regarded as her best performance to date.IANS observed, "Priyanka Chopra as the autistic Jhilmil steals the show from Ranbir, if that's possible. Her inherent glamorous personality simply disappears into her character. We don't see the actress on screen at all! We see only Jhilmil who reminds us in a very pleasant way of Sridevi in Sadma. This is one of the most flawless interpretations of a physical-psychological disability seen on celluloid."The film was chosen as India’s official entry to the Oscars for the 85th Academy Awards to be held in February 2013.
Chopra's next release will be Deewana Main Deewana, which was actually filmed four years ago.She is currently filming Krrish 3 alongside Hrithik Roshan, Vivek Oberoi and Kangna Ranaut in which she is respring her role of Priya. The film is a sequel to the 2006 superhero film Krrish.She has signed Apoorva Lakhia's Zanjeer opposite Ram Charan Teja, who is making his Bollywood debut. It is a remake of the 1973 film of the same name.She has also signed on for Ekta Kapoor's next production Milan Talkies,and Ali Abbas Zafar's next Gunday, which is set to start shooting in December 2012.

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Indian Pictures Actress
Indian Pictures Actress
Indian Pictures Actress
Indian Pictures Actress
Indian Pictures Actress
Indian Pictures Actress
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Indian Pictures Actress
Indian Pictures Actress
Indian Pictures Actress
Indian Pictures Actress
Indian Pictures Actress

          South Indian Hot Actress Pics        
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South Indian Hot Actress Pics Biography


Priyanka Chopra (pronounced [prɪˈjəŋkaː ˈtʃoːpɽaː]; born 18 July 1982)is an Indian actress. She was born to parents who were both army physicians. Due to their frequent reassignments, she grew up in many different cities in India, as well as spending a few years in the United States. Before starting her acting career, she gained fame after winning the Miss India and Miss World titles in 2000.During her career, Chopra has received one National Film Award and four Filmfare Awards.
Making her acting debut with the 2002 Tamil film Thamizhan, Chopra then made her Bollywood debut with The Hero in 2003. She followed that with the hit Andaaz, for which she won a Filmfare Award for Best Female Debut. She subsequently earned critical acclaim for her performance in Aitraaz (2004), and appeared in the commercially successful projects Mujhse Shaadi Karogi (2004), Krrish (2006) and Don (2006). The year 2008 marked the beginning of a new phase in Chopra's career, as her portrayal of a troubled model in the film Fashion earned her the National Film Award for Best Actress and the Filmfare Award for Best Actress. She was later noted for her performances in Kaminey (2009), What's Your Raashee? (2009), 7 Khoon Maaf (2011), which garnered her the Filmfare Critics Award for Best Actress, and for Barfi! (2012). Having done so, Chopra established herself as one of the leading contemporary actresses in Bollywood.
In addition to film acting, Chopra has performed on television and in stage shows. She has written columns in national Indian newspapers, and is active in charity work. She is regarded as one of most popular and attractive celebrities in India, and has many endorsement deals. In 2011, she signed an agreement with Universal Music Group and DesiHits to record and release her first music album. The first single, "In My City" was released in September 2012, and the full album is expected in December 2012.

Priyanka Chopra was born on 18 July 1982, in Jamshedpur, Jharkhand, India to Capt. Dr. Ashok Chopra and Dr. Madhu Chopra, both physicians by profession in the Indian Army.She has a brother, Siddharth, who is seven years younger than her.Actress Parineeti Chopra is her cousin.Since her father was in the Army, her family frequently moved from one city to another during her schooling days. In an interview with Daily News and Analysis, Chopra said that she didn't mind moving around and shifting schools. She welcomed it as a new experience and a way to discover the multicultural Indian society.Places where she lived as a child include Jamshedpur, Delhi, Pune, Lucknow, Bareilly, Ladakh, Chandigarh and Ambala.
Chopra studied at La Martiniere Girls' School in Lucknow and St. Maria Goretti College in Bareilly as a young girl. She subsequently re-located to the U.S. where she attended Newton North High School in Newton, Massachusetts, and then John F. Kennedy High School in Cedar Rapids, Iowa.She later recalled, "It was a huge culture shock for me when I went to study for three years in Boston at the age of 13."However, she was selected at state level for the National Opus Honour Choir.While in Boston, she participated in several theatre productions, and studied Western classical, chorus and choir singing, as well as Kathak dance.Having completed the tenth class, Chopra returned to India and finished her high school education at Army Public School in Bareilly; during this period she won a local beauty pageant called "May Queen".She registered for her college studies at Jai Hind College in Mumbai to study either Software engineering or Criminal psychology, but left after winning the Miss World pageant.
Chopra's mother enrolled her for the Femina Miss India contest,in which she came second at the Femina Miss India 2000 competition, behind Lara Dutta, winning the Femina Miss India World title.She was subsequently sent to the Miss World pageant, where she was crowned Miss World 2000, along with Miss World Continental Queen of Beauty − Asia & Oceania.In the same year, her Miss India co-winners Lara Dutta and Dia Mirza, won the Miss Universe and Miss Asia Pacific crowns respectively, in a rare triple victory for one country.When Chopra won the Miss World crown, she became the fifth Indian woman to win the title, and the fourth Indian woman to do so in a span of seven years.She stated that the Miss World title brought her recognition and fame, and then she started getting offers for film roles.

Priyanka Chopra made her debut in the 2002 Tamil film Thamizhan playing the role of Priya, the love interest of the protagonist in the film played by Vijay. The film was praised for its wit and dialogues, although the depth of Chopra's character was seen as lacking.In 2003, she appeared in her first Bollywood film, opposite Sunny Deol and Preity Zinta in the Anil Sharma film The Hero: Love Story of a Spy. She played a supporting role as a doctor named Shaheen in the film. Despite being one of the highest grossing films of that year,it received mixed reviews from critics.Though Chopra played the second female lead, her acting performance did get her noticed.Later that year she appeared in Raj Kanwar's Andaaz, playing the character of Jiya who falls in love with Raj Malhotra, played by Akshay Kumar. The film was a success at the box office,earning her a Filmfare Best Female Debut Award and a nomination for Filmfare Best Supporting Actress Award.Ashish Magotra writing for Rediff.com said of her role, "Priyanka Chopra alone clicks with the audience, thanks to her skimpy outfits.
Her next films which released in 2004, Plan, Kismat, and Asambhav performed poorly at the box office.Later that year she appeared in David Dhawan's romantic comedy Mujhse Shaadi Karogi playing the role of a young fashion designer Rani along with Salman Khan and Akshay Kumar. The film turned out to be the third-highest grossing film of that year.She next starred in Abbas-Mustan's thriller Aitraaz alongside Kumar and Kareena Kapoor. It was her first negative role and her performance was critically acclaimed.Film critic Subhash K. Jha noted, "A star is born! As the predatory social-climbing seductress who can go to any length to satiate her lust for life, Priyanka Chopra rocks the scene like never before. The film is undoubtedly a triumph for Priyanka Chopra. With half a smile, a twitch of her lip and a movement of her eyebrow she seems to slip into her man-eater's role with captivating ease".She earned a Filmfare Award for Best Performance in a Negative Role (also known as the Best Villain Award),becoming the second and last female actor to win the award after Kajol (the category has been retired since 2008). She also received a second nomination for Filmfare Best Supporting Actress Award for the role.
In 2005, she starred in six films. Four of them, Blackmail, Karam, Yakeen and Barsaat failed to do well.However, her performance in Yakeen garnered good reviews from critics. Her other two 2005 releases, Waqt: The Race Against Time and Bluffmaster! were moderately successful at the box office.Subhash K Jha wrote about her performance in Bluffmaster!, "Chopra has little to do. But she does it with eye-catching aplomb."In 2006, Chopra starred in Rakesh Roshan's Krrish which was a sequel to the 2004 sci-fi film Koi... Mil Gaya. She shared the screen with Hrithik Roshan and Rekha. The film was declared a blockbuster and was one of the highest grossing films of the year.She also appeared in Aap Ki Khatir opposite Akshaye Khanna and Dino Morea. Her last release was Farhan Akhtar's Don, alongside Shahrukh Khan which was a remake of the 1978 film of the same name. She was cast to play Roma, a role which was played by Zeenat Aman in the original movie. Chopra and Khan underwent special martial arts training for their roles in the movie and both performed their own stunts.[40] Upon release, the film was generally well received both in India and abroad. A week after its theatrical run, Box Office India declared the film a hit in India, and a "blockbuster" overseas.Aside from that, she made special appearances in three other films that year.
In 2007, she appeared in Nikhil Advani's ensemble piece Salaam-e-Ishq: A Tribute to Love. Despite a promising opening, the movie was a financial failure.Chopra was criticized for her performance in the film, with Lidia Ostepeev of Planet Bollywood calling it "forced" and "overly exaggerated".Her next release, the much-delayed Big Brother, also failed at the box-office.In 2008, Chopra acted in six films. Her first four films, Love Story 2050, God Tussi Great Ho, Chamku and Drona, were critical and commercial failures.During this time, Chopra received mixed reviews for her performances, with some critics pondering why she chose to do these
"I will give full credit to Madhur Bhandarkar and the crew. I am really honoured. National Award is the biggest honour of our country and I am really honoured to have received one."
—Chopra on winning the National Film Award for Best Actress for her performance in Fashion (2008)
After a series of flops, Chopra was cast in Madhur Bhandarkar's Fashion (2008), for the lead role of Meghna Mathur. Revolving around the fashion world through Chopra's role of an ambitious model, the film was a critical success. Her performance in the film was appreciated and earned her several awards for Best Actress including the National Film Award for Best Actress,as well as the Filmfare Award for Best Actress.Subhash K Jha predicted that this would be Priyanka’s coming-of-age film, and Rajeev Masand wrote, "Chopra turns in a respectable performance, one that will inevitably go down as her best." The film became a major turning point in her career.Chopra's final release of the year was Tarun Mansukhani's romantic comedy Dostana alongside Abhishek Bachchan and John Abraham. The film explores the story of two men who pretend to be gay, so that they can rent an apartment from an older lady. Both the men fall in love with the same girl, their roommate, but are unable to express their feelings because she is related to the old landlady. The film was a financial success and went on to become the eight-highest grossing film at the Indian box office in 2008.Chopra received positive reviews for her performance and her look in the film.
In 2009, she appeared in Vishal Bhardwaj's caper thriller Kaminey alongside Shahid Kapoor, playing the role of a feisty Marathi girl named Sweety. The film was a critical and commercial success. Her performance received positive reviews.Her work in the film brought her several awards and nominations including a second Filmfare Award for Best Actress nomination and a second consecutive Apsara Award for Best Actress in a Leading Role after Fashion.She subsequently appeared in Ashutosh Gowariker's romantic comedy What's Your Raashee?, a film which made Chopra the first actress in cinema history to portray 12 distinct characters in one film, and for which she was reportedly being considered for inclusion in the Guinness World Records book.The film itself was a financial and critical failure,but Chopra's performance was appreciated by the critics. Rediff wrote, "Priyanka Chopra transforms into 12 new skins with astonishing distinction, voice and spirit. The actress reinvents herself into this unique individual every single time ranging from batty, bashful and boisterous. This is simply her show."
In 2010, Chopra appeared in Jugal Hansraj's Pyaar Impossible! opposite Uday Chopra, where she portrayed the role of a beautiful college girl who eventually falls in love with a nerdy boy. The film was a commercial and critical failure. Her next release, Siddharth Anand's Anjaana Anjaani alongside Ranbir Kapoor, got a good initial response at the box office,but was not well received by the critics. She received positive to mixed comments from critics for her performance.

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          Visit a kiosk in the UK to diagnose your cold        

We have app doctors that can help diagnose you from your phone and in the future, we very well might have AI physicians, but the UK is now offering another option -- medical kiosks. A company called MedicSpot has set up tiny clinics in pharmacies across the UK that virtually connect you to a real physician and are stocked with all of the necessary equipment for an examination. The mini clinic has a blood pressure cuff, stethoscope, pulse oximeter, thermometer and a camera that can give the doctor a look into your throat and ears. The doctor can even write you a prescription if need be.

Source: MedicSpot


          Comment on Visionary Park by enochsvision        
Harmony's children are forced to color only within the lines. In its bleak and soulless world children grow up without knowing anything of the arts, of independent thought, or even the right to ask questions. Imagination is stifled in the name of conformity and order. You see that scenario play out in certain dictatorships around the world –here– on earth –today. <blockquote>“Man is the supreme Talisman. Lack of a proper education hath, however, deprived him of that which he doth inherently possess. Through a word proceeding out of the mouth of God he was called into being; by one word more he was guided to recognize the Source of his education; by yet another word his station and destiny were safeguarded. The Great Being saith: Regard man as a mine rich in gems of inestimable value.” (Baha’u'llah, <em>Gleanings from the Writings of Baha’u'llah</em>)</blockquote> The Harmony scenario represents a place or a fanatical faction within it that exercises absolute power over its members or inhabitants. It denies poets, seers, and thinkers the right of free expression. An ideology of oppression reigns. It dominates education. It controls all areas of culture. The state or sect also controls the media. It forbids access to outside thought. It is a crime to question the social order in any way. Punishment for dissent or nonconformity is swift and severe. There seems to be little hope of raising a generation that will bring about change because they don't know what freedom is like, having never experienced it. Whatever freedoms existed in the past were purged from history books and records. Thus, Harmony's Order is normal to its inhabitants. Change only comes from upheaval in worlds like Harmony or from the outside. Harmony took control in various guises and with many names in parts of our own cosmic neighborhood. I needn't mention them directly by name. Outsiders refer to one of them as the Hermit Kingdom. Other examples are where ultraconservative theocratic ideologies hold absolute power. They enforce their dystopian vision of Harmony. Sometimes those worlds experience revolutions that are either brutally crushed or appear to succeed yet soon become the very thing they claimed to fight against. <strong>There is hope. Where will it come from? Who will bring it?</strong> <blockquote>"The All-Knowing Physician hath His finger on the pulse of mankind. He perceiveth the disease, and prescribeth, in His unerring wisdom, the remedy. Every age hath its own problem, and every soul its particular aspiration. The remedy the world needeth in its present-day afflictions can never be the same as that which a subsequent age may require. Be anxiously concerned with the needs of the age ye live in, and center your deliberations on its exigencies and requirements. "We can well perceive how the whole human race is encompassed with great, with incalculable afflictions. We see it languishing on its bed of sickness, sore-tried and disillusioned. They that are intoxicated by self-conceit have interposed themselves between it and the Divine and infallible Physician. Witness how they have entangled all men, themselves included, in the mesh of their devices. They can neither discover the cause of the disease, nor have they any knowledge of the remedy. They have conceived the straight to be crooked, and have imagined their friend an enemy. "Incline your ears to the sweet melody of this Prisoner. Arise, and lift up your voices, that haply they that are fast asleep may be awakened. Say: O ye who are as dead! The Hand of Divine bounty proffereth unto you the Water of Life. Hasten and drink your fill. Whoso hath been re-born in this Day, shall never die; whoso remaineth dead, shall never live." (Baha'u'llah, <em>Gleanings from the Writings of Baha'u'llah</em>)</blockquote>
          COLOSTOMY IRRIGATION        
By. Haryanto, S.Kep,Ns,WOCN


INTRODUCTION
The word “colostomy” comes from two Greek words. colon is the original Greek word meaning ”large intestine.” It became the English word for colon. Stoma, in Greek, means “mouth or opening.” A colostomy is “a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, “(1), leaving the patient with an opening on the abdomen called a stoma. (1-2) This provides a new path for waste material and gas to leave the body after part of the colon or rectum is removed because of disease or injury. A colostomy may be any where in the colon. It can do to ascending, transverse, descending and sigmoid. With the increase quantity patient with colostomy, irrigation should be considered as a management alternatif for help improve quality of life, especially to permanent colostomy. Patient with colostomy (ostomies) is not obstructed for activities because they can do colostomy irrigation activities before. They can do it with assisted by ET nurse or patient with independently.

COLOSTOMY IRRIGATION
Colostomy irrigation is “ a way to regulate the intestinal activity of colostomized patients, followed by emptying the colon (2-4) done in stoma,(2-4) scheduled at time,(2-4) in which a specified volume of liquid, usually water at body temperature. (2)
The first colostomy irrigation was introduced by duret over two hundred years ago. (2) In Indonesia did not yet founded when colostomy irrigation did.




PURPOSE
Physiologically, the introduction of a volume of water in the colon causes a structural dilation, which stimulates contraction, thus promoting the emptying of the fecal content. It reduces the formation of gas since, by removing the residues, the bacterial microbiota is reduced quantitatively, and consequently the production of gases is also reduced. (3). Besides, it can maintain normal bowel function(5) and also can help avoid constipation.(3)

CANDIDATE AND TIME FOR COLOSTOMY IRRIGATION
Colostomy irrigation can do to patients have a descending or sigmoid colostomy, because their stools tend to be more formed,(3,8) a history of regular bowel perform the procedure, the ability (manual dexterity and visual acuity) to perform procedure, a lifestyle that is compatible to irrigation (work schedule, bathroom facilities, adequate time, other family or personal issue. (5,8) Patient with a urostomy, ileostomy, asending colon cannot do irrigation, (4) and in case rare, transverse colostomies can irrigate but results are generally too poor to justify the effort.
Colostomy irrigation is most effective when it is done about one hour after a meal, when the colon is most likely to be full. Irrigation may be done once a day or once every other day depending on your patient preference and ability to regulate bowel movements. It generally takes about six to eight weeks(3) or two weeks to six months(2) for the bowel to become regulated with irrigation. It is important to establish a routine and irrigate at the same time each day.(5)

CONTRAINDICATION
Contraindication do colostomy irrigation includes people with irritable bowel syndrome, stomas in the ascending or transverse colons are less likely to have success with irrigation, (3) stomal prolapse or peristomal hernia because the procedur could potentially exacerbate or cause bowel perforation, leakage between irrigation. Chemoteraphy, pelvic radiation, a poor diagnosis, and diarrhea are also contraindication colostomy irrigation.(5,8)

THE TIME OF SPENT AND THE VOLUME OF LIQUID OF COLOSTOMY IRRIGATION
The time spent the procedure was from 33 minute to 90 minute.(2) The volume of liquid infused varied from 500mls to 1500mls.(2)

COLOSTOMY IRRIGATION PROCEDURE

Equipment
A trolley [which is cleansed with an appropriate solution] with the following:
01. Irrigation container
02. Irrigation fluid 500 to 1,000 ml lukewarm water or other solution
03. Soft rubber catheter No. 22 or No. 24
04. New colostomy appliance
05. Irrigation sleeve
06. Disposable gloves
07. Apron
08. Lubricant
09. Receiver / plastic bag for the disposal of old colostomy pouch / dressing
10. Cotton wool swabs
11. Protector / plastic sheet [if patient is confined to bed]
12. Bedpan





Figure 1.

Procedure
01. Verify physician’s order, progress notes, and nursing care plan for colostomy.
Rationale: to obtain specific instructions and / or information.
02. Assess patient’s condition to determine if procedure should be done in bed or
in the bathroom.
03. Ensure privacy. Rationale: to avoid unnecessary embarrassment to the
patient during the procedure. Respect for patient's privacy is an essential
aspect of the holistic care of a patient.
04. Wash hands and dry hands.(refer Hand washing procedure). Rationale: to
reduce nosocomial infection.
05. Don gloves.
06. Assemble equipment correctly. Rationale: it ensures the procedure is carried
out smoothly.
07. Explain procedure to patient. Rationale: to allay fears and gain patient's
confidence and cooperation.
08. Position patient. Lie patient on the side closest to the stoma or in supine
position if patient is confined to bed. Sit the patient on toilet if ambulatoy.
09. Remove regular ostomy pouch by unsnapping the pouch from the skin barrier
with flange. Rationale: proper disposal of the colostomy to avoid
contamination.
10. Cleanse stoma and surrounding skin area. Rationale: it promotes comfort
and hygiene.
11. Apply irrigator sleeve by snapping it onto the skin barrier with flange. (Figure
2)
12. Connect irrigation bag to tubing. The two pieces slide apart and push
together. If stoma protrudes, use the cone tip.
13. Put on glove, lubricate small finger and gently insert into colostomy to
determine the direction of the lumen.
14. Fill irrigating bag with 1000 mL lukewarm water. If new ostomy, begin with
250 mL lukewarm water, or as ordered by physician.
15. Hang bag so that bottom of bag is at patient’s shoulder level, (Figure 3) or if
patient is on bed rest, 18 inches ( 45 cm ) above stoma. Rationale: it ensures
the irrigation fluid will flow by gravity.
16.Allow small amount of water to run through tubing to clear it of air. Rationale:
air will not be introduced into the colon that could cause discomfort to the
patient.




17.If using a catheter, lubricate and gently insert about two inches. Rationale:
ensures a smooth entry into the stoma and avoids friction. If any resistance is
felt, change direction of catheter and/or allow small amount of water to flow
through catheter before attempting to insert it further.
DO NOT FORCE CATHETER.
18.If using cone tip, hold snugly into stoma.
19.Open clamp and allow water to enter bowl. Patient may complain of cramping
if irrigation flows too rapidly. If cramping occurs, clamp off tubing until cramps
subside.
20. Remove catheter and fold over top of drain sleeve and fasten closed with
clamp provided to prevent return from splashing.
21. Allow about 15-20 minutes for most of drainage to return, then rinse sleeve
with lukewarm water through top of sleeve.
22. Fold end of irrigating sleeve up twice and clip to top, thus making a
temporary catch bag. Patient may now go out into room for remaining 45
minutes. (Allow 1 hour for complete return). Note color and amount of
drainage. Observe stoma for color.
23. After 1-hour, rinse irrigating sleeve and remove by unsnapping it from skin
barrier with flange.
24. Apply clean pouch by snapping it onto skin barrier with flange.
May apply Banish deodorant into pouch.
25. Wash and dry hands. Rationale: to reduce the risk of nosocomial infection.
26. Wash irrigating equipment and allow to dry. Place patient’s name and room
number on a piece of tape and attach to equipment hanging in the bathroom.
Rationale: the clean equipment will be ready for re-use.


27. Complete Documentation (type and amount of irrigant,whether cone tip or
cath use, description of stoma, amount and type of returns, If wafer and pouch changed, description of peristomal skin). Rationale: to determine skin
/ stoma integrity and to detect early signs of infection and any possible problems.


CONCLUSION

Colostomy irrigation is a methode that purpose to waste stool in large intestine. Even thoungh colostomy irrigation is not required to maintain bowel function, the procedure is a management option that may allow a patient to be free from fecal discharge. The most important factors before to irrigate, ET nurse (ETN) have to know patient’s clinical situation and life style. Irrigation is more effective for patient have a descending or sigmoid colostomy, because their stools tend to be more formed. Colostomy irrigation is most effective when it is done about one hour after a meal, Patient and family are explained about advantage and purpose before colostomy irrigation do. So that patient can be active to regulate do. ET nurse have to know principal irrigation, so that can do irrigation truly. After The colostomy irrigation, patient and family can do it them self in house. So ostometies will maintain their quality of life.



REFERENCES

1. Http://en.wikipedia.org/wiki/colostomy.com colostomy (cited; November, 2008)

2. Cesaretti R, Colostomy irrigation: review of a number of technical aspect.
APE (serial on the internet). 2008 Feb 9; (citied; 2008 Oktober 29); 21 (2): (about 8 screens). Available from: http://www.scielo.br/scielo.php.com

3. Haines, CD. Editor Haines, CD. Digestive deases: colostomy irrigation (homepage on the internet). Webmed, Inc. (update 2006 March 01; cited: 2008 Oktober 18).Available from: http://www.webmed.com/colorectal-ancer/colostomy-irrigation

4. United Ostomy Association of Canada. A handbook for new ostomy patients
(monograph on the internet). Canada: Second printing; 2007 (cited 2008 Oct 17) Available from: http://www.ostomy.evansville.net

5. Turnbull, GB. A look at purpose and outcome of colostomy irrigation. OWM
(serial on the internet). 2003 Feb 01; (cited 2008 Oct 28); 49 (2): (about 2 screens) Available from: http://www.O_WM.Com/article/1257


6. Turnbull, GB. Managing oversight of colostomy irrigation in long term-care.
OWM ( serial on the internet). 2003 Oct 01; (cited 2008 Oct 28) 49 (10): (about 2 screens) Available from: http://www.O_WM.Com/article/1258

7. Blackley, P. Practical stoma wound and continence management.
2nd ed. Research publication Pty Ltd Vermont, Victoria, Australia; 2004

8. Turnbull, GB. An alternative solution for difficult to manage colostomies in the
descending and sigmoid colon. OWM (serial on the internet). 2007 Agt 01 (cited 2008 Oct 28) 53 (8): (about 2 screens) Available from:http://www.O_WM.Com/article/1259

9. Shorehealth (homepage on the Internet). Colostomy Irrigation (uptade 2008 January; cited 2008 Nov 01) Available from : http://doctors.shorehealth.org/nursing/pdf/colostomy%20irrigation.pdf

10. Horn, CV. Having a colostomy: a primer for the colostomy patient (monograph on the internet). Ohio: The department of grapich service; 1992 (cited 2008 Nov 01). Available from: http://my.clevelandclinic.org/Document/digestive disease/havingcolostomy.pdf






























COLOSTOMY IRRIGATION











HARYANTO








INDONESIAN ENTEROSTOMAL THERAPY NURSING EDUCATION PROGRAMME
2nd 2008









;
          (USA-CA-Merced) Certified Nursing Assistant (CNA)        
Position Summary Consistent with Mercy Medical Center (MMC) policy and procedure, renders basic nursing care to assigned patient populations under the direction of a Registered Nurse. Collects data that allows the Registered Nurse to assess patients for nursing needs, and establish and implement a problem oriented plan of nursing care. Implements the plan of nursing care, performs basic nursing procedures and provides direct nursing care. Patient age populations served and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department/Unit Orientation & Initial Assessment of Competency” checklists for this unit/position and by reference form a part of this job description. If employee is required to float to another department, he/she will not be asked to perform task(s) not qualified to perform. Qualifications Minimum 1. Must possess and maintain a current Certified Nursing Assistant (CNA) issued by the State ofCalifornia. 2. Must possess and maintain a current Basic Life Support (BLS) certificate 3. Must be able to take call, float to other areas, and work on weekends as required. Desired 1. Minimum of six months experience in acute care or skilled facility. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **CNA / NA / PCT / HH Aide* **Organization:** **Mercy Medical Center Merced* **Title:** *Certified Nursing Assistant (CNA)* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017407* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Pharmacy Tech        
*Position Summary* Under direction and supervision of a pharmacist, fills individual drug orders from the pharmacy medication profile. Prepares intravenous additive solutions for individual patients from the IV profile. Prepares bulk solutions. *Qualifications Minimum* 1. Must possess and maintain a current Pharmacy Technician license from the State of California *Desired* . High school graduate or equivalent 2. Knowledge of medical terminology as it relates to the pharmacy department, proper aseptic technique used in the preparation of IV admixture products. 3. Knowledge of drug names and therapeutic uses. 4. National Certification as a Pharmacy Technician. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Pharmacy* **Organization:** **Mercy Medical Center Merced* **Title:** *Pharmacy Tech* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017281* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Clinical Lab Scientist        
*Qualifications Minimum* 1. Education level necessary to obtain required licensure and certifications: · A doctor of medicine, osteopathy, or doctor of podiatric medicine licensed to practice, osteopathy, podiatry in the state in which the laboratory is located, or have earned a doctoral, masters or bachelor’s degree in a chemical, physical, biological, or clinical laboratory science or medical technology from an accredited institution; or An associate degree in a chemical, physical, or biological l science or medical laboratory technology from an accredited institution; or · High school diploma or equivalent and have successfully completed an official military medical laboratory procedures course of at least 50 weeks duration, and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Medical Technician); or · High school diploma or equivalent, and have such documentation of training appropriate for the testing performed prior to analyzing patient specimens. Such training must ensure that the individual has the skills required for the proper specimen collection, including patient preparation, if applicable, labeling handling, preservation or fixation, processing or preparation, transportation and storage of specimens etc., etc. 2. Must possess and maintain a current Clinical Laboratory Scientist (CLS) license within the state of California. 3. Computer literate *Desired* 1. One (1) year experience in an acute care facility. * * * * Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Laboratory* **Organization:** **Mercy Medical Center Merced* **Title:** *Clinical Lab Scientist* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017164* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Ward Clerk Per Diem        
*Position Summary* Under the direction of the Clinical Manager and/or Registered Nurse, assists nursing personnel in maintaining required medical record documentation, as well as administrative/clerical processes surrounding the daily operations of the Nursing Unit. Monitors the nurse's station, call lights, phones, and charts. Alerts appropriate members of the healthcare team to the presence of problematic and/or emergent issues. *Qualifications Minimum* 1.Excellent organizational and clerical skills. 2.Familiarity with computer operations 3.Must possess and maintain a current Basic Life Support (BLS) certificate within 6 months of hire 4.Must be able to take call, float to other areas, and work on weekends as required *Desired* 1.Prior experience as a Unit Clerk and/or Monitor Technician . 2.Medical Terminology. Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Other* **Organization:** **Mercy Medical Center Merced* **Title:** *Ward Clerk Per Diem* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017023* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Center Manager (RN)        
**Requisition Number** 17-0695 **Post Date** 8/7/2017 **Title** Center Manager (RN) **Location** Merced **Job Status** Full Time **Work Hours** 40 **City** Merced **State** CA **Description** We're Satellite Healthcare, one of the country's most innovative providers of patient-centered dialysis and kidney disease services. Known for our collegial and supportive corporate culture, our medical and clinical staffs are highly motivated and committed to promoting patient wellness and improved quality of life. At our attractive and comfortable treatment centers, our patients receive unparalleled renal disease education and treatment, medical technology, nutrition programs and social services. **Satellite Healthcare** The Center Manager (Registered Nurse) is responsible for the day to day operations of the dialysis center. This includes, but not is not limited to patient, clinic, personnel, and financial management. Possesses a strong understanding of the quality performance assessment and improvement program. Ability to assess and proactively address potential patient and/or staff safety issues. Considered an experienced expert in the field who acts as a liaison to physicians. Ability to communicate with patients, physicians, direct reports and other co-workers is critical. A team leader who educates and mentors staff members as appropriate. Provides nursing support services to the center for unscheduled absences or for patient care, as needed. This component of the job is variable and will be defined in conjunction with the Territory Director. **Wellbound** In addition to the above, the Center Manager has overall responsibility for overseeing home dialysis services including promotion of home dialysis modalities, patient education and training, primary nursing, patient follow-up care, quality management in the center, on call coverage, and coordination of physician clinics. This position also has responsibility for oversight of facility and equipment maintenance as well as supplies and inventory. In startup situations, this position is responsible for the recruitment and training of initial staff, state licensure and Medicare certification. This position may also be called the “Administrator”, “Supervising Nurse” and/or “Director of Nursing” for the clinic. **Essential Functions** _The essential functions listed are not a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. All employees must work in accordance with Satellite’s I-CARE Standards._ **Patient Management:** + **Patient Care Supervision** Understands basic renal function and the consequences of renal failure. Observes and records patient’s responses to renal failure and its treatment. Directs and supervises the care of the patients on dialysis. Performs thorough patient assessments as evidencedby documentation. + **Critical Results/Situations** Uses professional discretion in critical or emergency situations and directs the necessary intervention. Recognizes changes in patient’s condition on dialysis and makes necessary adjustments in their therapy. Notifies the physician, providing the appropriateinformation, and implements physician’s orders. + **Patient Schedule** Provides oversight of the patient schedule and makes staff assignments based on priorities for patient care and skill level of the staff, maintains on-call schedule for home programs with 24/7 call support. Consistently reviews and evaluates patient prioritiesas changes occur in the condition of the patient or center. Directs staff in work assignments to address these changes. + **Patient Admissions and Discharges** Verifies the accuracy and safety of all orders, implements them and/or delegates to appropriate staff. Ensures discharge management is accurate and complete. + **Access Management** Leads the VAL team and ensures consistent, timely monitoring and verifies appropriate action of identified problems. Collects Infiltration Reports, ensures infiltration instructions are delivered, and notifies MD as appropriate. + **Anemia Management** Provides routine oversight and assures appropriate action of critical lab values. Assumes responsibility in the absence of the Anemia Manager. + **Adequacy Management** Sets the admission dialysis prescription per MD approved Adequacy Protocol for new admissions. Assembles the monthly adequacy team including, but not limited to, the Dietician and Center Manager to discuss what aspects of the treatment can be modified tocorrect deficiencies in the delivery of dialysis. + **Patient Rounding** Implements routine rounding of patients to proactively identify needs and concerns of in-center patients. For home programs, patient needs and concerns will be evaluated at point of service. Ensures the confidentiality of patient and employee information. + **Incident Reports** Responsible for the review and analysis of internal incident reports and reports significant incidents promptly to the TerritoryDirector. Aggregates data to identify trends in accordance with the QAPI program. + **Patient Care Conferences** Responsible for monthly management of interdisciplinary team care conferences. + **Medical Record Management** Assumes responsibility for the overall supervision and management of the medical records as outlined in the Operational Policy and Procedures manual. Responsible for accuracy, completeness and timeliness of all data entry including Crown Web data. **Center Management:** + **Quality Assessment Performance Improvement** A required member of the QAPI team who monitors aggregate clinical outcome data to identify trends, analyze root causes and implement interventions to correct real and/or potential problems in the center. Responsible for oversight of QAPI projects relatedto identified problems. + **Infection Control and Vaccinations** Ensures employee compliance with all infection control policies and procedures to prevent and control infections. Maintains neat and clean environment. Ensures all infections are correctly documented (including NHSN reporting as required) and appropriatecare is rendered per protocol or MD order. Provides oversight of patient vaccinations including Hepatitis B, Seasonal Flu, and Pneumonia. Provides data as required by the Renal Network Environmental/Vaccination Scans. + **Renal Network Compliance** Follows guidelines and goals in accordance with the legislative mandate for the ESRD Network Program. + **Governing Body Meetings** The Center Manager is a member of the local governing body and is responsible for the direct supervision of all aspects of the center operations and serves as the designated Administrator for the center. Meetings shall be held according to the GoverningBody and Center Governance Policy. **Personnel Management:** + **Staffing** Promotes a teamwork approach by offering information, advice, and assistance to all unit staff members in a positive, courteous, and cooperative manner. Assists in staff scheduling and interprets staffing policies. Arranges coverage for unscheduledabsences. + **Staff Meetings** Responsible for conducting monthly staff meeting to address any areas of concern and to ensure proper communication between all staff members. + **Focal Reviews** Participates in evaluations. Supervises, evaluates, and determines clinical competency in conjunction with the Territory Director. + **Policy and Procedure** Provides oversight of policies and procedures and acts on non-compliance including notifying the TerritoryDirector. Ensures staff documents thoroughly and correctly. Effectively communicates new policy and procedure updates. **Fiscal Management:** + **Supplies** Ensures proper use of supplies to minimize waste. Oversees adequate supply stock, and communicates needs to the in-center Technical Supervisor or home program Technical Program Coordinator. + **Budget** Monitors operating and capital budget to ensure containment of controllable costs. **Facility Management for Home Centers:** + Facility maintained in good repair + Equipment maintained and safe + Responsible for communicating request/needs to Technical Program Coordinator **Conduct** : + Understands legal consequences of nursing actions, both immediate and long term. Adheres to all policies found in the Employee Conduct Expectations (i.e. dress code, professionalism, etc.) found in the Employee Handbook. + Contributes to harmonious and constructive working relationships with all staff members. **Requirements** **Minimum Qualifications** **Satellite Healthcare:** **Education:** Graduation from an accredited school of nursing or equivalent, BSN preferred **Experience:** Two (2) years of Clinical Manager experience or two (2) years of Satellite Clinical Coordinator experience; Three (3) years hemodialysis nursing experience **License/Certification:** Current Registered Nurse (RN) license within state of practice; CNN or CDN certification or within 1 year of eligibility; Current CPR certification **Wellbound** : (California, Indiana & Illinois) **Education:** Graduation from an accredited school of nursing or equivalent, BSN preferred **Experience:** One (1) year hemodialysis or peritoneal dialysis, three (3) years preferred; Three (3) months experience in training patients in self-care for both PD & HHD **License/Certification:** Current Registered Nurse (RN) license within state of practice; CNN or CDN certification or within 1 year of eligibility; Current CPR certification (Texas) **Education:** Graduation from an accredited school of nursing or equivalent, BSN preferred **Experience:** One (1) year of management or supervisory experience in a health related setting; three (3) months experience in both PD & HHD; three (3) years current dialysis experience as an RN or 2 years experience as an RN and possess a current CDN or CNN **License/Certification:** Current Registered Nurse (RN) license within state of practice; CNN or CDN certification or within 1 year of eligibility; Current CPR certification (New Jersey) **Education:** Graduation from an accredited school of nursing or equivalent, BSN preferred **Experience:** One (1) year of experience as supervisor or manager in a dialysis setting within the last 24 months; Three (3) months experience in both PD & HHD **License/Certification:** Current Registered Nurse (RN) license within state of practice; CNN or CDN certification or within 1 year of eligibility; Current CPR certification **Knowledge, Skills & Abilities:** + Maintains professional competence via continuing education + Ability to read, write, speak, understand and satisfactorily communicate in English + Proficient computer skills - e.g. Outlook, Word + Effectively demonstrates leadership competencies + Critical thinker + Effective delegator + Effective quality manager/accountable for outcomes + Integrates clinical knowledge and leadership skills into practical action + Facilitates collaborative relationships, customer–focused + Effective in staff and patient education + Effective coach and mentor + Able to effectively use quality process to meet clinical goals + Strong regulatory knowledge + Ability to partner with MD’s + Demonstrates fiscal accountability, quality management and strategic planning skills + Demonstrates ability to take a broad view of issues considering both short and long term perspective Satellite Healthcare, Inc. (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability. Women and men, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. We offer a drug-free work environment.
          (USA-CA-Merced) PHARMACIST        
*Position Summary* Under general supervision, to provide prescribed medications, drugs, and other pharmaceutical, compound medications to neonatal, pediatric, adolescent, adult and geriatric patients, according to professional and division standards and practices; to advise and consult with patients and families, medical and nursing staff; to do related work. *Qualifications Minimum* 1. Possess and maintain a current Pharmacist license with the State of California *Desired* 1. Knowledge of unit dose drug distribution and IV admixture services, compounding of prescriptions, pharmaceutical preparations, drug interactions, incompatibilities, adverse reactions, and drug toxicities. 2. Knowledge of laws and regulations relative to the dispensing, storage, and use of controlled and prescriptions drugs, Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Pharmacy* **Organization:** **Mercy Medical Center Merced* **Title:** *PHARMACIST* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017402* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse        
*Minimum Qualifications:* * Must possess and maintain a current Registered Nurse (RN) license with the state of California. * Must possess and maintain a current Basic Life Support (BLS) certificate. * Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment and or transfer into department. * Must be able to take call, float to other areas, and work on weekends as required. *Preferred Qualifications:* * Bilingual * One year experience in an acute care setting Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Med / Surg* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017201* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Telephone Operator - Per Diem        
*Position Summary* Responsible for the operation of multiple phone line telephone console and related functions. *Qualifications Minimum* * Two (2) years of recent experience of a telephone console system preferably in a hospital environment. *Desired* * High school graduate or equivalent. * Demonstrated both written and verbal communication skills. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Information Technology (IT)* **Organization:** **Mercy Medical Center Merced* **Title:** *Telephone Operator - Per Diem* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700016892* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse        
*Position Summary:* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. * Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. * Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. * Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Qualifications:* * Must possess and maintain a current Registered Nurse (RN) license with the state of California. * Must possess and maintain a current Basic Life Support (BLS) certificate. * Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment and or transfer into department. * Must be able to take call, float to other areas, and work on weekends as required. *Preferred Qualifications:* * Bilingual * One year experience in an acute care setting Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Med / Surg* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017032* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse-OR Circulator        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMCM) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Provides immediate direction to assigned LVNs, OR ancillary or Surgical technicians as assigned. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Qualifications Minimum* 1. Must possess and maintain a current Registered Nurse license issued by the State of California. 2. Must possess and maintain a current Basic Life Support (BLS) Certificate 3. Must possess and maintain a current Advanced Cardiac Life Support Certificate (ACLS) 4. Must possess and maintain a current Pediatrics Advanced Life Support Certificate (PALS) - MOSS only *Desired* 1. Clinical experience in Operating Room/PACU. 2. Possess and maintain a current Certified Nurse-Operating Room (CNOR) certificate Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Surgical Services / PACU* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse-OR Circulator* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700017143* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Licensed Vocational Nurse (Telehealth)        
Job Overview ## Job Overview ### Summary **Vacancy Identification Number (VIN):** 1991434 **OUR MISSION:** To fulfill President Lincoln's promise – "To care for him who shall have borne the battle, and for his widow, and his orphan" – by serving and honoring the men and women who are America's Veterans. How would you like to become a part of a team providing compassionate care to Veterans? The **Department of Veterans Affairs** (VA) needs employees who possess the energy, compassion, and commitment to serve those who served our Country. Whatever the job title, every position in VA will give you a chance to make a meaningful and personal contribution to the lives of truly special and deserving people - our Veterans. VA professionals feel good about their careers and their ability to balance work and home life. VA offers generous paid time off and a variety of predictable and flexible scheduling opportunities. Working for VA is one of the most emotionally satisfying and professionally rewarding ways to dedicate the best within you to your Country's service. If you are transitioning from the military or a Veteran already, we invite you to explore the benefits of continuing your career at the VA. **The VA is committed to hiring Veterans.** The VA is much more than just another employer. It is an honorable, open and welcoming community of those who care. Gratitude is our motivation and service is our mission. The VA has adopted Core Values and Characteristics that apply universally across the Department. The five Core Values define "who we are," our culture, and how we care for Veterans, their families and other beneficiaries. The Values are** I**ntegrity, **C**ommitment, **A**dvocacy, **R**espect and **E**xcellence ("**I CARE**"). **America's Veterans need you!** To find out more, go to http://www.va.gov/jobs/. VA encourages persons with disabilities to apply. The health related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. **NOTE:** Current permanent VA Central CA Health Care System (VACCHCS) employee or current, permanent VA nationwide employee, you must apply under internal announcement number NP-17-AGC-1991438-BU. 1st Area of Consideration - Current permanent VA Central California Health Care System (VACCHCS)/CBOC employees; 2nd Area of Consideration - Current permanent VA Nationwide employees. This position does not require the filing of a financial disclosure report. A Recruitment/Relocation Incentive is not authorized. PCS/Relocation Allowances are not authorized. ### Duties This Licensed Vocational Nurse (LVN) position is located in our Community Based Outpatient Clinic (CBOC) with the VA Central California Healthcare System (VACCHCS), in Merced, CA. The Veterans Health Administration (VHA) expands the provision of patient care to various institutional and non-institutional settings, such as the Department of Veterans Affairs Medical Centers (VAMCs), Community-Based Outpatient Clinics (CBOCs), State Veteran Homes, Vet Centers, homeless shelters, Indian Health Services (IHS), Department of Defense (DOD) and other affiliated organizations by utilizing innovative telecommunication technologies to enhance care coordination, access to care, and to routinely and proactively manage diseases to prevent healthcare crises. These programs may include, but are not limited to, Video Conferencing, Learning Management System, My Health E Vet, Care Coordination Home Technology (CCHT), Clinical Video Telehealth (CVT) and Store and Forward (CCSF) technologies. The Telehealth Clinical LVN serves in a generalist role to support (but not limited to): *video conferencing and staff training *learning management systems *telehealth clinical encounters from the patient and provider locations and *the site Telehealth Clinical LVN for telehealth store and forward applications *CCHT technology support *clinical presenter/facilitator for real time telehealth events, including patient education activities, technical support, training, help desk, business processes, and scheduling support *other program duties as needed **Designated Drug Testing Position:** Applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Applicants will not be appointed to the position if a verified positive drug test result is received. **Work Schedule:** Monday through Friday, 8:00 am to 4:30 pm **Functional Statement Title:** GS-06 LVN (Telehealth Clinical) FS-023080 This position is not eligible for telework. ### Supervisory Status No ### Promotion Potential 06 ### Travel Required * Not Required ### Relocation Authorized * No ### Who May Apply #### This job is open to… U.S. Citizens and current permanent Federal employees of other Agencies Questions? This job is open to 2 groups. Job Requirements ## Job Requirements ### Key Requirements * Must pass pre-employment examination * Must be proficient in written and spoken English * Designated and-or Random Drug Testing required * Background and-or Security Investigation required * Selective Service Registration is required for males born after 12/31/1959. ### Qualifications **Basic Requirements:** **Citizenship:** Citizen of the United States. Non-Citizens may be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. **Education:** Graduate of a school of practical or vocational nursing approved by the appropriate State agency and/or accredited by the National League for Nursing Accrediting Commission (NLNAC) at the time the program was completed by the applicant. **Licensure:** Full, active, current and unrestricted licensure as a licensed practical or vocational nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or District of Columbia. **English Language Proficiency:** Licensed practical or vocational nurses appointed to direct patient care positions must be proficient in both spoken and written English as required by 38 U.S.C. 7402(d), and 7407(d). **Preferred Experience:** * Experience in Outpatient Clinic Care * Experience with Telehealth technology Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. **Note:** A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. **Grade Determinations:** **GS-6:** * Completion of at least one (1) year of additional qualifying experience at the GS-5 level or equivalent, fully meeting all performance requirements for the GS-5 LPN/LVN. * Technically proficient in initiating, performing and completing assigned duties in providing care to variable patient populations. * Knowledge and ability to appropriately carry out assigned patient care based on the patients' conditions; to use judgment in selecting the appropriate order and sequence of procedures and treatments; and to accurately recognize, report and record relevant] patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness and conformity with established policies/procedures. * Ability to observe, identify and respond to the patient's needs for care, including medication, equipment-assisted care and patient/family education. In organizing and delivering care, the LPN/LVN recognizes and considers emotional, cultural, spiritual, socio-economic, and age-related factors. * Prepares and administers prescribed medications (oral, topical, subcutaneous, intramuscular and/or intravenous) and performs treatments according to established policies/procedures. Observes for physical and/or emotional changes in patient's condition from prescribed medications/treatments, promptly and accurately documenting noted changes, and reporting any deviations from normal to RN or MD/DO. * Knowledge and ability to recognize urgent or emergent patient care situations, seek assistance of the RN and/or MD/DO, and initiate appropriate emergency interventions as directed. * Knowledge and understanding of human behavior, patient motivations and reactions to situations, and ability to appropriately utilize this knowledge in working effectively with patients, family members, and other staff. * Establishes constructive relationships with individual patients and their families to elicit feelings and attitudes, and to promote positive relationships, communication and socialization skills. Fosters an environment of respect for individual patient and family rights to privacy and dignity in all aspects of care delivery. Effectively incorporates knowledge and understanding of established customer service standards in all interactions with patients, family members, and/or other internal/external customers. * Knowledge and skill in performing support duties for complex diagnostic tests and/or specialized practices or procedures, which include preparing the patient, assisting in the diagnostic examination, preparing and handling specialized instruments or other specialized equipment, and monitoring the patient's condition before, during, and following the procedure. Serves as a preceptor in orienting, educating, and training less experienced LPNs/LVNs or NAs/HTs related to support duties for these more complex, specialized tests/procedures. * Actively seeks out educational opportunities to enhance nursing knowledge and skills, sharing new knowledge gained with other staff to improve and advance nursing practice. **References:** VA Handbook 5005, Part II, Appendix G13. This can be found in the local Human Resources Office. **Note:** Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. **PLEASE NOTE:** Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications (particularly positions with a positive education requirement.) Therefore, applicants must report only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Applicants can verify accreditation at the following website: http://www.ed.gov/admins/finaid/accred/index.html. All education claimed by applicants will be verified by the appointing agency accordingly. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. **Physical Requirements:** Heavy Lifting (45 lbs and over); Heavy Carrying (45 lbs and over); Straight Pulling (7 to 8 hours); Pushing (7 to 8 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (7 to 8 hours); Standing (1 hour); kneeling (1 hour); Repeated bending (7 to 8 hours); both legs required; Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13" to 16"; far vision correctable in one eye to 20/20 and to 20/40 in the other; Hearing (aid permitted); emotional/ mental stability. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at http://www.opm.gov/qualifications. ### Security Clearance Other Additional Information ## Additional Information ### What To Expect Next After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. During our review, if your résumé and application package do not support your questionnaire answers, we will adjust your rating accordingly. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email (if provided); otherwise, applicants will receive a notification letter via the U.S. Postal Service. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made. You may check the status of your application at any time by logging into your USAJOBS account and clicking on "Application Status." For a more detailed update of your status, click on "more information." Information regarding applicant notification points can be found in the USAJobs Resource Center. #### BENEFITS **Receiving Service Credit for Earning Annual (Vacation) Leave:**Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. VA may offer newly-appointed Federal employees credit for their job-related non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. ### Other Information * It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment. * This job opportunity announcement may be used to fill additional vacancies. * This position is in the Excepted Service and does not confer competitive status. This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/475310200. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered. *Open & closing dates:* 2017-07-26 to 2017-08-15 *Salary:* $52,820 to $68,671 / per year *Pay scale & grade:* GS 06 *Series:* 0620 Practical Nurse *Appointment type:* Excepted Service Permanent *Work schedule:* Full Time *Job announcement number:* NP-17-AGC-1991434-BU *Control number:* 475310200
          (USA-CA-Merced) Licensed Vocational Nurse (Telehealth)        
Job Overview ## Job Overview ### Summary **Vacancy Identification Number (VIN):** 1991438 **OUR MISSION:** To fulfill President Lincoln's promise – "To care for him who shall have borne the battle, and for his widow, and his orphan" – by serving and honoring the men and women who are America's Veterans. How would you like to become a part of a team providing compassionate care to Veterans? The **Department of Veterans Affairs** (VA) needs employees who possess the energy, compassion, and commitment to serve those who served our Country. Whatever the job title, every position in VA will give you a chance to make a meaningful and personal contribution to the lives of truly special and deserving people - our Veterans. VA professionals feel good about their careers and their ability to balance work and home life. VA offers generous paid time off and a variety of predictable and flexible scheduling opportunities. Working for VA is one of the most emotionally satisfying and professionally rewarding ways to dedicate the best within you to your Country's service. If you are transitioning from the military or a Veteran already, we invite you to explore the benefits of continuing your career at the VA. **The VA is committed to hiring Veterans.** The VA is much more than just another employer. It is an honorable, open and welcoming community of those who care. Gratitude is our motivation and service is our mission. The VA has adopted Core Values and Characteristics that apply universally across the Department. The five Core Values define "who we are," our culture, and how we care for Veterans, their families and other beneficiaries. The Values are** I**ntegrity, **C**ommitment, **A**dvocacy, **R**espect and **E**xcellence ("**I CARE**"). **America's Veterans need you!** To find out more, go to http://www.va.gov/jobs/. VA encourages persons with disabilities to apply. The health related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. **NOTE:** If you are not a current, permanent VA Central CA Health Care System (VACCHCS) employee or current, permanent VA nationwide employee, you must apply under external announcement NP-17-AGC-1991434-BU. **NOTE:** Fee Basis, WOC, Contract, Volunteer, Resident/Trainee, and Temporary personnel must apply to the external announcement in order to receive consideration.* This position does not require the filing of a financial disclosure report. A Recruitment/Relocation Incentive is not authorized. PCS/Relocation Allowances are not authorized. ### Duties This Licensed Vocational Nurse (LVN) position is located in our Community Based Outpatient Clinic (CBOC) with the VA Central California Healthcare System (VACCHCS), in Merced, CA. The Veterans Health Administration (VHA) expands the provision of patient care to various institutional and non-institutional settings, such as the Department of Veterans Affairs Medical Centers (VAMCs), Community-Based Outpatient Clinics (CBOCs), State Veteran Homes, Vet Centers, homeless shelters, Indian Health Services (IHS), Department of Defense (DOD) and other affiliated organizations by utilizing innovative telecommunication technologies to enhance care coordination, access to care, and to routinely and proactively manage diseases to prevent healthcare crises. These programs may include, but are not limited to, Video Conferencing, Learning Management System, My Health E Vet, Care Coordination Home Technology (CCHT), Clinical Video Telehealth (CVT) and Store and Forward (CCSF) technologies. The Telehealth Clinical LVN serves in a generalist role to support (but not limited to): *video conferencing and staff training *learning management systems *telehealth clinical encounters from the patient and provider locations and *the site Telehealth Clinical LVN for telehealth store and forward applications *CCHT technology support *clinical presenter/facilitator for real time telehealth events, including patient education activities, technical support, training, help desk, business processes, and scheduling support *other program duties as needed **Designated Drug Testing Position:** Applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Applicants will not be appointed to the position if a verified positive drug test result is received. **Work Schedule:** Monday through Friday, 8:00 am to 4:30 pm **Functional Statement Title:** GS-03 LVN (Telehealth Clinical) FS-023080 GS-04 LVN (Telehealth Clinical) FS-023270 GS-05 LVN (Telehealth Clinical) FS-023280 GS-06 LVN (Telehealth Clinical) FS-023080 ### Supervisory Status No ### Promotion Potential 06 ### Travel Required * Not Required ### Relocation Authorized * No ### Who May Apply #### This job is open to… 1st Area of Consideration - Current permanent VA Central California Health Care System (VACCHCS)/CBOC employees; 2nd Area of Consideration - Current permanent VA Nationwide employees. Questions? This job is open to 3 groups. Job Requirements ## Job Requirements ### Key Requirements * Must pass pre-employment examination. * Must be proficient in written and spoken English. * Designated and-or Random Drug Testing required. * Background and-or Security Investigation required. * Selective Service Registration is required for males born after 12/31/1959. ### Qualifications **Basic Requirements:** **Citizenship:** Citizen of the United States. Noncitizens may be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. **Education:** Graduate of a school of practical or vocational nursing approved by the appropriate State agency and/or accredited by the National League for Nursing Accrediting Commission (NLNAC) at the time the program was completed by the applicant. **Licensure:** Full, active, current and unrestricted licensure as a licensed practical or vocational nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or District of Columbia. **English Language Proficiency:** Licensed practical or vocational nurses appointed to direct patient care positions must be proficient in both spoken and written English as required by 38 U.S.C. 7402(d), and 7407(d). **Preferred Experience:** * Experience in Outpatient Clinic Care * Experience with Telehealth technology Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. **Note:** A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. **Grade Determinations:** **GS-3:** * None beyond the basic requirements **GS-4:** * Six months of qualifying experience as an LPN or LVN; **OR** * Graduation from an approved school and one year of experience that involved nursing care work in a hospital, outpatient clinic, nursing home, or other supervised medical, nursing, or patient care facility that provided a practical knowledge of human body structure and sterile techniques and procedures; **OR** * Graduation from an approved school of at least 24 months duration. **GS-5:** * Completion of at least 1 year of qualifying experience at the GS-4 level or equivalent. * Demonstrated knowledge and ability to provide a full range of practical nursing care to patients with a variety of physical and/or behavioral problems. * Demonstrated ability to serve as a responsible member of the nursing team and interact in an appropriate manner with patients, family members, professional and other supportive personnel involved in the delivery of patient care, incorporating acceptable, established customer service standards into practice. * Knowledge and skill sufficient to prepare, administer, and appropriately document actions taken specific to commonly prescribed oral, topical, subcutaneous, intramuscular, and/or intravenous medications as permitted by approved local facility policies and procedures. Observation and documentation will include patient's response to medication administered and the reporting of any noted change in patient's condition to RN or MD/DO. * Knowledge and ability to recognize the need for and to institute emergency measures when indicated, promptly seek the assistance of the RN or MD/DO, and assist in resuscitation procedures in cardiac and/or pulmonary arrest. * Recognizes and appropriately responds to breakage/malfunction or loss of equipment, safety hazards, and supply deficiencies, promptly reporting to appropriate personnel for corrective action. * Completed work is under the general supervision of an RN or MD/DO. Individuals at this grade level are expected to have a broad working knowledge of practical nursing procedures. However, completion of more complex practices or procedures may be subject to closer higher-level review. **GS-6:** * Completion of at least one (1) year of additional qualifying experience at the GS-5 level or equivalent, fully meeting all performance requirements for the GS-5 LPN/LVN. * Technically proficient in initiating, performing and completing assigned duties in providing care to variable patient populations. * Knowledge and ability to appropriately carry out assigned patient care based on the patients' conditions; to use judgment in selecting the appropriate order and sequence of procedures and treatments; and to accurately recognize, report and record relevant] patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness and conformity with established policies/procedures. * Ability to observe, identify and respond to the patient's needs for care, including medication, equipment-assisted care and patient/family education. In organizing and delivering care, the LPN/LVN recognizes and considers emotional, cultural, spiritual, socio-economic, and age-related factors. * Prepares and administers prescribed medications (oral, topical, subcutaneous, intramuscular and/or intravenous) and performs treatments according to established policies/procedures. Observes for physical and/or emotional changes in patient's condition from prescribed medications/treatments, promptly and accurately documenting noted changes, and reporting any deviations from normal to RN or MD/DO. * Knowledge and ability to recognize urgent or emergent patient care situations, seek assistance of the RN and/or MD/DO, and initiate appropriate emergency interventions as directed. * Knowledge and understanding of human behavior, patient motivations and reactions to situations, and ability to appropriately utilize this knowledge in working effectively with patients, family members, and other staff. * Establishes constructive relationships with individual patients and their families to elicit feelings and attitudes, and to promote positive relationships, communication and socialization skills. Fosters an environment of respect for individual patient and family rights to privacy and dignity in all aspects of care delivery. Effectively incorporates knowledge and understanding of established customer service standards in all interactions with patients, family members, and/or other internal/external customers. * Knowledge and skill in performing support duties for complex diagnostic tests and/or specialized practices or procedures, which include preparing the patient, assisting in the diagnostic examination, preparing and handling specialized instruments or other specialized equipment, and monitoring the patient's condition before, during, and following the procedure. Serves as a preceptor in orienting, educating, and training less experienced LPNs/LVNs or NAs/HTs related to support duties for these more complex, specialized tests/procedures. * Actively seeks out educational opportunities to enhance nursing knowledge and skills, sharing new knowledge gained with other staff to improve and advance nursing practice. **References:** VA Handbook 5005, Part II, Appendix G13. This can be found in the local Human Resources Office. **Note:** Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. **PLEASE NOTE:** Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications (particularly positions with a positive education requirement.) Therefore, applicants must report only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Applicants can verify accreditation at the following website: http://www.ed.gov/admins/finaid/accred/index.html. All education claimed by applicants will be verified by the appointing agency accordingly. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. **Physical Requirements:** Heavy Lifting (45 lbs and over); Heavy Carrying (45 lbs and over); Straight Pulling (7 to 8 hours); Pushing (7 to 8 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (7 to 8 hours); Standing (1 hour); kneeling (1 hour); Repeated bending (7 to 8 hours); both legs required; Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13" to 16"; far vision correctable in one eye to 20/20 and to 20/40 in the other; Hearing (aid permitted); emotional/ mental stability. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at http://www.opm.gov/qualifications. ### Security Clearance Other Additional Information ## Additional Information ### What To Expect Next After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. During our review, if your résumé and application package do not support your questionnaire answers, we will adjust your rating accordingly. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email (if provided); otherwise, applicants will receive a notification letter via the U.S. Postal Service. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made. You may check the status of your application at any time by logging into your USAJOBS account and clicking on "Application Status." For a more detailed update of your status, click on "more information." Information regarding applicant notification points can be found in the USAJobs Resource Center. #### BENEFITS **Receiving Service Credit for Earning Annual (Vacation) Leave:**Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. VA may offer newly-appointed Federal employees credit for their job-related non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. ### Other Information * It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment. * This job opportunity announcement may be used to fill additional vacancies. * This position is in the Excepted Service and does not confer competitive status. This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/475305200. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered. *Open & closing dates:* 2017-07-26 to 2017-08-15 *Salary:* $37,727 to $68,671 / per year *Pay scale & grade:* GS 00 *Series:* 0620 Practical Nurse *Appointment type:* Agency Employees Only *Work schedule:* Full Time *Job announcement number:* NP-17-AGC-1991438-BU *Control number:* 475305200
          (USA-CA-Merced) Registered Nurse        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Qualifications* 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Pediatric Advance Life Support (PALS) certificate or obtain one within 6 months of employment, if working in Pediatrics. 4. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment. 5. Must be able to take call, float to other areas, and work on weekends as required. *Desired* 1. Bilingual 2. One year previous pediatric or acute care experience Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Patient Care Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015878* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) RN Experienced        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMCM) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Qualifications Minimum* 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Neonatal Resuscitation (NRP) certificate or obtain one within six months of employment 4. Must possess and maintain a current ACLS within 6 months of employment. 5. Must be able to take call, float to other areas, and work on weekends as required. 6 Experience Category: a.New Grad RN – Graduated less than 18 months prior to date of hire from accredited Registered Nursing Program b.Registered Nurse – Greater than 1 year recent experience in Post Partum c.Experienced Registered Nurse – Greater than 5 years recent experience in Labor and Delivery 7.Must have completed AWHONN Perinatal Orientation and Education Program 8.Must possess and maintain a current National Certification Corporation (NCC) certificate in Electronic Fetal Monitoring. OR 9.Association of Women’s Health Obstetric and neonatal Nurses (AWHONN)-Intermediate Fetal Monitoring Certification within six months of hire for RN’s with qualifying experience and 18 months for new grads. Due to department needs, if new grads cannot complete L&D training within 18 months, they will be provided with an additional extension. (Once new grad has completed L&D training, they must complete NCC certification or AWHONN Intermediate EFM course within 3 months). AWHONN Intermediate EFM Certification must be renewed every 2 years *Desired:* Bilingual Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nursing - Registered Nurse* **Organization:** **Mercy Medical Center Merced* **Title:** *RN Experienced* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015278* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) New Grad RN        
Position Summary Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Minimum Qualifications 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Neonatal Resuscitation (NRP) certificate or obtain one within six months of employment 4. Must possess and maintain a current ACLS within 6 months of employment. 5. Must be able to take call, float to other areas, and work on weekends as required. 6. Experience Category: a. New Grad RN – Graduated less than 18 months prior to date of hire from accredited Registered Nursing Program b. Registered Nurse – Greater than 1 year recent experience in Post-Partum c. Experienced Registered Nurse – Greater than 5 years recent experience in Labor and Deliver 7. Must have completed AWHONN Perinatal Orientation and Education Program. 8. Must possess and maintain a current National Certification Corporation (NCC) certificate in Electronic Fetal Monitoring. OR 9. Association of Women’s Health Obstetric and neonatal Nurses (AWHONN)-Intermediate Fetal Monitoring Certification within six months of hire for RN’s with qualifying experience and 18 months for new grads. Due to department needs, if new grads cannot complete L&D training within 18 months, they will be provided with an additional extension. (Once new grad has completed L&D training, they must complete NCC certification or AWHONN Intermediate EFM course within 3 months). AWHONN Intermediate EFM Certification must be renewed every 2 years. Desired 1. Bilingual Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **New Grad* **Organization:** **Mercy Medical Center Merced* **Title:** *New Grad RN* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015160* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Patient Registration Representative        
*Position Summary* Employing excellent customer service skills, the Patient Registration Representative is responsible for ensuring a positive patient experience throughout the registration process. In order to ensure appropriate reimbursement for services rendered, primary duties include: a)Appropriate patient identification b)Collecting accurate and thorough patient demographic data c)Obtaining insurance information and verifying eligibility and benefits d)Determining and collecting patient financial liability e)Referring patients to the Patient Registration Specialist as needed for assistance with financial counseling and/or clearance The Patient Registration Representative adheres to the organization's policies and procedures for resolution of patient financial liability. Additionally, the Patient Registration Representative is an information source for patients and families by explaining hospital policies, patient financial responsibilities and Patient Rights and Responsibilities. *Qualifications Minimum* 1. Minimum 1 year of experience working in a hospital Patient Registration department, physician office setting, healthcare insurance company, revenue cycle vendor, and/or other revenue cycle related roles. 2. Experience in requesting and processing financial payments. *Desired* 1. 2 years of experience preferred working in a hospital Patient Registration department, physician office setting, healthcare insurance company, revenue cycle vendor, and/or other revenue cycle related roles. 2. Knowledge of charity programs as well as the various government and non-government programs preferred *Education* Applicable education and/or training can be used to balance a lack of experience High School diploma, GED or equivalent. *Training/Special Skills* Thorough understanding of insurance policies and procedures. Working knowledge of medical terminology. Able to perform basic mathematics for payment calculation. Intermediate to advanced computer skills. Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Admitting / Patient Registration* **Organization:** **Mercy Medical Center Merced* **Title:** *Patient Registration Representative* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015197* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse New Grad        
Position Summary Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Minimum Qualifications 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Neonatal Resuscitation (NRP) certificate or obtain one within six months of employment 4. Must possess and maintain a current ACLS within 6 months of employment. 5. Must be able to take call, float to other areas, and work on weekends as required. 6. Experience Category: a. New Grad RN – Graduated less than 18 months prior to date of hire from accredited Registered Nursing Program b. Registered Nurse – Greater than 1 year recent experience in Post-Partum c. Experienced Registered Nurse – Greater than 5 years recent experience in Labor and Deliver 7. Must have completed AWHONN Perinatal Orientation and Education Program. 8. Must possess and maintain a current National Certification Corporation (NCC) certificate in Electronic Fetal Monitoring. OR 9. Association of Women’s Health Obstetric and neonatal Nurses (AWHONN)-Intermediate Fetal Monitoring Certification within six months of hire for RN’s with qualifying experience and 18 months for new grads. Due to department needs, if new grads cannot complete L&D training within 18 months, they will be provided with an additional extension. (Once new grad has completed L&D training, they must complete NCC certification or AWHONN Intermediate EFM course within 3 months). AWHONN Intermediate EFM Certification must be renewed every 2 years. Desired 1. Bilingual Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **New Grad* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse New Grad* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015157* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Echo Tech II        
*Position Summary* The Echo Tech II performs echocardiogram procedures. Follows physician written orders in providing these services. The Echo Tech II assists in developing policies and procedures regarding the clinical application of Cardiovascular services following accepted clinical practices. Follows physician orders in providing these services. *Qualifications Minimum* 1. Registered Cardiovascular Technologist (RCVT) or Diagnostic Cardiac Sonographer (RDCS). 2. Minimum of two (2) years acute care Echo Tech experience. 3. Must possess and maintain a current valid Basic Life Support (BLS) certificate. *Desired* 1. Experience in Stress testing. 2. Experience in Holter monitoring. 3. Experience in records management for procedures and patient files. Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Other* **Organization:** **Mercy Medical Center Merced* **Title:** *Echo Tech II* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700016625* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Pharmacy Tech        
*Position Summary* Under direction and supervision of a pharmacist, fills individual drug orders from the pharmacy medication profile. Prepares intravenous additive solutions for individual patients from the IV profile. Prepares bulk solutions. *Qualifications Minimum* 1. Must possess and maintain a current Pharmacy Technician license from the State of California *Desired* . High school graduate or equivalent 2. Knowledge of medical terminology as it relates to the pharmacy department, proper aseptic technique used in the preparation of IV admixture products. 3. Knowledge of drug names and therapeutic uses. 4. National Certification as a Pharmacy Technician. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Pharmacy* **Organization:** **Mercy Medical Center Merced* **Title:** *Pharmacy Tech* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700016446* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Provides immediate direction to assigned LVNs, and OR ancillary as assigned. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. Provides direct post-operative patient care to patients of all ages, from infancy to the elderly. Competently performs staff nurse responsibilities and follows accepted nursing standards, MMCM policies and procedures, and physician’s order. *Minimum Qualifications:* * Must possess and maintain a current Registered Nurse license issued by the State of California. * Must possess and maintain a current Basic Life Support (BLS) Certificate * Must possess and maintain a current Advance Cardiac Life Support (ACLS) Certificate * Must attain a current Pediatrics Advanced Life Support Certificate (PALS) three months after hire date. * Must be able to take call shifts as assigned *Desired:* * Previous experience in PACU, OR, or ICU * CPAN Certification * Computer skills Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Surgical Services / PACU* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700016060* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Echo Tech Per Diem        
*Position Summary* The Echo Tech performs Echocardiogram procedures. Follows physician written orders in providing these services. *Qualifications Minimum* 1. Have at least one (1) year experience in non-invasive cardiovascular diagnostic procedures. 2. Registered Cardiovascular Technologist (RCVT) or Diagnostic Cardiac Sonographer (RDCS) within 1 years of hire. 3. Completion of Echocardiogram program or equivalent training. 4. Must possess and maintain a current valid Basic Life Support (BLS) certificate. *Desired* 1. Experience in Stress testing. 2. Experience in Holter monitoring. 3. Experience in records management for procedures and patient files. Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Other* **Organization:** **Mercy Medical Center Merced* **Title:** *Echo Tech Per Diem* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700016587* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Qualifications* 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Pediatric Advance Life Support (PALS) certificate or obtain one within 6 months of employment, if working in Pediatrics. 4. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment. 5. Must be able to take call, float to other areas, and work on weekends as required. *Desired* 1. Bilingual 2. One year previous pediatric or acute care experience Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Patient Care Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015877* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse        
*Position Summary:* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. * Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. * Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. * Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Qualifications:* * Must possess and maintain a current Registered Nurse (RN) license with the state of California. * Must possess and maintain a current Basic Life Support (BLS) certificate. * Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate. * Must be able to take call, float to other areas, and work on weekends as required. *Preferred Qualifications:* * One or more years’ experience in Telemetry or acute care setting * Bilingual * Basic EKG certificate Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Patient Care Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700016168* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) RN-Experienced        
Position Summary: Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. * Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. * Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Minimum Qualifications: * Must possess and maintain a current Registered Nurse (RN) license with the state of California. * Must possess and maintain a current Basic Life Support (BLS) certificate. * Must possess and maintain a current Neonatal Resuscitation (NRP) certificate or obtain one within six months of employment. * Must possess and maintain a current ACLS within 6 months of employment. * Must be able to take call, float to other areas, and work on weekends as required. * Experience Category: o New Grad RN – Graduated less than 18 months prior to date of hire from accredited Registered Nursing Program o Registered Nurse – Greater than 1 year recent experience in Post-Partum o Experienced Registered Nurse – Greater than 5 years recent experience in Labor and Deliver * Must have completed AWHONN Perinatal Orientation and Education Program. * Must possess and maintain a current National Certification Corporation (NCC) certificate in Electronic Fetal Monitoring. OR * Association of Women’s Health Obstetric and neonatal Nurses (AWHONN)-Intermediate Fetal Monitoring Certification within six months of hire for RN’s with qualifying experience and 18 months for new grads. Due to department needs, if new grads cannot complete L&D training within 18 months, they will be provided with an additional extension. (Once new grad has completed L&D training, they must complete NCC certification or AWHONN Intermediate EFM course within 3 months). AWHONN Intermediate EFM Certification must be renewed every 2 years. Preferred Qualifications: * Bilingual Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nursing - Registered Nurse* **Organization:** **Mercy Medical Center Merced* **Title:** *RN-Experienced* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015282* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Physician - OB/GYN (Women's Health)        
## Description **Specialty: Physician - OB/GYN (Women's Health) Location: Merced, CA** **TO APPLY**: Please contact Sam Cajudo at 707.398.6066 or email sam@nationwide-pr.com. We have many practice opportunities that go unadvertised. Please contact us directly at the number and email provided here for a personalized search! **H1B and J1 physicians are welcome to apply.** We are seeking multiple full-time OB/GYN Physicians to join our client/group in Modesto, CA. The ideal candidate should be Board Certified or Board Eligible, CA license or in the process of getting one. BLS or ACLS, call schedule 1:3 or better, salary guarantee plus productivity bonus and excellent benefits. The staff Obstetrician-Gynecologist (OB-GYN) will be responsible for providing both primary and consultation obstetrical and gynecological services to patients in the clinic and hospital settings. Patients served shall consist of patients of the Group as well as patients derived from agreements and professional relationships deemed appropriate by the Administration. In addition to direct clinical services, the staff OB-GYN shall serve as a consultant and participant in the Group's Perinatal project and assist with OB-GYN protocol and policy development. The staff OB-GYN shall report to the Medical Director. *Community information*: Merced is a unique city, filled with warm, friendly people that will instantly make visitors feel welcome. The city offers a wide variety of attractions, historical sites, accommodations and dining opportunities that are sure to please. Arts and Culture are thriving in this proud community. From the galleries at their Multicultural Center to the live performances at Playhouse Merced, there is sure to be something for everyone! *Job ID:* Job-6281 OB *Job Title:* Physician - OB/GYN (Women's Health)
          (USA-CA-Merced) Physician - Family Practice        
## Description **Specialty: Physician - Family Practice Location: Merced, CA** **TO APPLY**: Please contact Sam Cajudo at 707.398.6066 or SEND us your updated CV at: sam@nationwide-pr.com. We have many practice opportunities that go unadvertised. Please contact us directly at the number and email provided here for a personalized search! **H1B and J1 physicians are welcome to apply.** We are seeking multiple full-time Family Practice physician to join our group in Merced, CA. The ideal candidate should be Board Certified or Board Eligible, CA license or in the process of getting one. Flexible schedule of either 4 or 5 day work weeks. Direct primary outpatient care at least 40 hours per work, provide comprehensive, ongoing, and family oriented pediatric care, maintain active staff hospital privileges at local hospitals and share on call and hospitalization responsibilities with other physicians whenever feasible Market adjusted salary and an Incentive Program related to productivity and quality. Sign On bonus and relocation reimbursement. Payment of licensure, DEA and one professional society in your specialty, 403B matching program of 2% plus defined pension plan contribution. Loan Forgiveness Program Opportunities, CME reimbursements, dedicated time for CME and Administrative time. Medical, Dental and Vision Insurance with a small premium - in the top 2% in the nation for insurance benefits and benefits at start on the first day of the month following 30 days employment. Provides premium payment for Life, Accidental Death and Dismemberment insurance. Option to purchase short term disability insurance. Paid Vacation Days and Holidays, Paid Sick Leave. *Community information*: Merced is a unique city, filled with warm, friendly people that will instantly make visitors feel welcome. The city offers a wide variety of attractions, historical sites, accommodations and dining opportunities that are sure to please. Arts and Culture are thriving in this proud community. From the galleries at their Multicultural Center to the live performances at Playhouse Merced, there is sure to be something for everyone! Go see the world’s largest cheese factory, visit the best military air museum in the country or take your family to a space & science learning center. And who can for forget, Merced is the Gateway to Yosemite. Whether summer, fall, winter or spring…Yosemite is picture perfect anytime you visit Merced. *Job ID:* Job-6267 FP *Job Title:* Physician - Family Practice
          (USA-CA-Merced) Psychiatrist (General)        
## Description **Specialty: Psychiatrist (General) Location: Merced, CA** **TO APPLY**: Please contact Sam Cajudo at 707.398.6066 or SEND us your updated CV at: sam@nationwide-pr.com. We have many practice opportunities that go unadvertised. Please contact us directly at the number and email provided here for a personalized search! **H1B and J1 physicians are welcome to apply**. We are seeking multiple full-time Psychiatrist to join our group in Merced, CA. The ideal candidate should be Board Certified or Board Eligible, CA license or in the process of getting one. Market adjusted salary and an Incentive Program related to productivity and quality. Sign On bonus and relocation reimbursement. Payment of licensure, DEA and one professional society in your specialty, 403B matching program of 2% plus defined pension plan contribution. Loan Forgiveness Program Opportunities, CME reimbursements, dedicated time for CME and Administrative time. Medical, Dental and Vision Insurance with a small premium - in the top 2% in the nation for insurance benefits and benefits at start on the first day of the month following 30 days employment. Provides premium payment for Life, Accidental Death and Dismemberment insurance. Option to purchase short term disability insurance. Paid Vacation Days and Holidays, Paid Sick Leave. *Community information*: Merced is a unique city, filled with warm, friendly people that will instantly make visitors feel welcome. The city offers a wide variety of attractions, historical sites, accommodations and dining opportunities that are sure to please. Arts and Culture are thriving in this proud community. From the galleries at their Multicultural Center to the live performances at Playhouse Merced, there is sure to be something for everyone! Go see the world’s largest cheese factory, visit the best military air museum in the country or take your family to a space & science learning center. And who can for forget, Merced is the Gateway to Yosemite. Whether summer, fall, winter or spring…Yosemite is picture perfect anytime you visit Merced. *Job ID:* Job-6269 PSY *Job Title:* Psychiatrist (General)
          (USA-CA-Merced) Physician - Internal Medicine        
## Description **Specialty: Physician - Internal Medicine Location: Merced, CA** **TO APPLY**: Please contact Sam Cajudo at 707.398.6066 or SEND us your updated CV at: sam@nationwide-pr.com. We have many practice opportunities that go unadvertised. Please contact us directly at the number and email provided here for a personalized search! **H1B and J1 physicians are welcome to apply**. We are seeking multiple full-time Internal Medicine physician to join our group in Merced, CA. The ideal candidate should be Board Certified or Board Eligible, CA license or in the process of getting one. Flexible schedule of either 4 or 5 day work weeks. Direct primary outpatient care at least 40 hours per work, provide comprehensive, ongoing, and family oriented pediatric care, maintain active staff hospital privileges at local hospitals and share on call and hospitalization responsibilities with other physicians whenever feasible Market adjusted salary and an Incentive Program related to productivity and quality. Sign On bonus and relocation reimbursement. Payment of licensure, DEA and one professional society in your specialty, 403B matching program of 2% plus defined pension plan contribution. Loan Forgiveness Program Opportunities, CME reimbursements, dedicated time for CME and Administrative time. Medical, Dental and Vision Insurance with a small premium - in the top 2% in the nation for insurance benefits and benefits at start on the first day of the month following 30 days employment. Provides premium payment for Life, Accidental Death and Dismemberment insurance. Option to purchase short term disability insurance. Paid Vacation Days and Holidays, Paid Sick Leave. *Community information*: Merced is a unique city, filled with warm, friendly people that will instantly make visitors feel welcome. The city offers a wide variety of attractions, historical sites, accommodations and dining opportunities that are sure to please. Arts and Culture are thriving in this proud community. From the galleries at their Multicultural Center to the live performances at Playhouse Merced, there is sure to be something for everyone! Go see the world’s largest cheese factory, visit the best military air museum in the country or take your family to a space & science learning center. And who can for forget, Merced is the Gateway to Yosemite. Whether summer, fall, winter or spring…Yosemite is picture perfect anytime you visit Merced. *Job ID:* Job-6268 IM *Job Title:* Physician - Internal Medicine
          (USA-CA-Merced) Licensed Vocational Nurse (LVN)        
Licensed Vocational Nurse \(LVN\) Primary Location: United States\-CA\-CAMerced Function: Clinical Organization: Redwood _Everybody needs a job but only extraordinary people work here\._ Our team is fun, creative, and dedicated to making a difference every day in the lives of the people we serve\. The heart of what we do is support people with Intellectual and Developmental Disabilities of all ages\. Description As a **Licensed Vocational Nurse \(LVN\)** with Loyd's Liberty Homes, a partner of California MENTOR, you’ll be one of those extraordinary people\. This position supports adult individuals we serve in our group homes, under the Intermediate Care Facility \(ICF\) classification\. We seek a passionate individual who can provide consistent clinical care to persons with intellectual and developmental disabilities\. In this role you will utilize your license skills and knowledge to carry out each individual’s health care plan and providing direct care with the support of a Registered Nurse and QIDP \(Administrator\)\. Do you have nursing experience and are looking for a meaningful change in your work life? Leverage your education and skill set with California MENTOR to make an impact in people’s lives\. Join our dedicated, dynamic and fast growing team today\! Job Responsibilities: + Provides technical assistance and training to staff to ensure the effective implementation of medically related services + Administers medications and provides documentation according to established guidelines + Provides input regarding health care services to be included in each individual’s service plan + Monitors and ensures physicians orders are performed as prescribed + Accompanies individuals to routine and emergency medical visits + Responsible for following nursing care plans according to program requirements + Provide direct support to individuals we serve, such as the duties of our Direct Support Professional \- as needed
          (USA-CA-Merced) Registered Nurse- Full Time Night Shift        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. * Qualifications Minimum * 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment and or transfer into department. 4. Must be able to take call, float to other areas, and work on weekends as required *Desired* 1. Bilingual 2. One year experience in an acute care setting Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nursing - Registered Nurse* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse- Full Time Night Shift* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012541* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Physical Therapist - Physical Therapy - Full Time Days        
*Position Summary* Plans and carries out a full range of physical therapy treatment where therapeutic objectives are complex and the procedures involved require the application of advanced skills and knowledge. *Qualifications Minimum* 1. Must possess and maintain a current California Physical Therapy license 2. Must possess and maintain a current Basic Life Support (BLS) certificate 3. Must demonstrate knowledge of the fundamentals, technical and procedures relating to the practice of physical therapy Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Rehabilitation (PCS)* **Organization:** **Mercy Medical Center Merced* **Title:** *Physical Therapist - Physical Therapy - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700004582* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Speech Therapist - Speech Therapy - Per Diem Days        
Position Summary Ability to deliver care to patients in a variety of hospital settings including outpatient and home health. The majority of care will be performed within the hospital and outpatient setting. In keeping with the Dignity Health core values, is responsible for effective and competent delivery of care. Able to administer diagnostic and treatment techniques designed to comprehensively evaluate and treat patient conditions. These interventions will help to relieve pain, develop or restore speech, language, and improve oral pharyngeal functioning according to the patient plan of care. Qualifications Minimum 1. Must possess and maintain a current Speech and Language Pathology Therapist Registration License with the State of California 2. Must possess and maintain a current Basic Life Support (BLS) certificate 3. One to two years’ experience as a Registered Speech/Language Pathologist in an acute hospital setting including inpatient, outpatient, and home health settings. Willing to work with a variety of patient types and ages (5-95). 4. Must demonstrate good interpersonal skills and the ability to work in a professional manner exhibiting tactful and effective communication with fellow staff members, physicians, hospital departments, and the general public 5. Demonstrate competent working knowledge of the principles, practice standards, procedures, and equipment utilized. This includes the use of Fluoroscopy in performing Modified Barium Swallows. 6. Ability to work independently and be a functional team member in a team oriented environment 7. Ability to be flexible with caseload, within any given day through prioritization of patients based on their needs 8. Be an advocate for the hospital’s mission, vision, and values and the community in which it serves 9. Must possess and maintain a valid California driver’s license and proof of auto insurance 10. Must provide a DMV printout that indicates driver is in good standing 11. Must be able to drive a motor vehicle safely for moderate period of time. Desired 1. Use of Vital Stim 2. Home health experience desirable 3. Pediatric experience 4. Second language skills in Spanish Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Rehabilitation (PCS)* **Organization:** **Mercy Medical Center Merced* **Title:** *Speech Therapist - Speech Therapy - Per Diem Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700007666* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse - Full Time Days        
Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMCM) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. Minimum Qualifications: * * 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one prior to start date. 4. Completion of Critical Care Course within one year of employment for RN without ICU experience 5. One or more year experience in a Critical Care, Step Down or Telemetry setting 6. Must be able to take call, float to other areas, and work on weekends as required. Desired * * 1. Advanced EKG Course. 2. Possess a current Critical Care Registered Nurse (CCRN) certificate. 3. Bilingual Mercy Medical Center has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Critical Care* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700011289* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse- Full Time Day Shift        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. * Qualifications Minimum * 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment and or transfer into department. 4. Must be able to take call, float to other areas, and work on weekends as required *Desired* 1. Bilingual 2. One year experience in an acute care setting Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nursing - Registered Nurse* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse- Full Time Day Shift* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700013640* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse Float Pool Per Diem        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. As a new graduate, will participate in the New Graduate RN Residency program. Work schedule during the residency will be a set schedule and at the conclusion of the program, will be assigned to a per diem float pool supporting the Medical, Surgical and Telemetry units. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the Department / Unit Orientation & Initial Assessment of Competency checklists for this unit/position, and -by reference - form a part of this job description. *Minimum Qualifications:* 1.Must possess and maintain a current Registered Nurse (RN) license with the state of California or have a current IPN license. 2.Must possess and maintain a current BLS certificate. 3.Must possess and maintain a current ACLS certificate or obtain one within 6 months of hire 4.Must be able to take call, float to other areas, and work on weekends as required. Mercy Medical Center has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nursing - Registered Nurse* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse Float Pool Per Diem* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700015311* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse        
Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMCM) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. Minimum Qualifications: * * 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one prior to start date. 4. Completion of Critical Care Course within one year of employment for RN without ICU experience 5. One or more year experience in a Critical Care, Step Down or Telemetry setting, Medical/Surgical, or completion of New Graduate Nurse Residency Program 6. Must be able to take call, float to other areas, and work on weekends as required. Desired * * 1. Advanced EKG Course. 2. Possess a current Critical Care Registered Nurse (CCRN) certificate. 3. Bilingual Mercy Medical Center has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Critical Care* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012031* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Aide Dietary - Nutritional Services - Per Diem Days        
*Position Summary* Performs clerical and administrative task related to the preparation and service of normal and therapeutic diets for hospital pediatric, adolescent, adult, and geriatric patients. Reviews amounts to be prepared by the kitchen. *Minimum Qualifications* * Six (6) months of general clerical experience, involving routine office duties OR one (1) year experience in a hospital or institutional kitchen, which includes three (3) month of general record keeping OR completion of twelve (12) semester hours at the community college level, including three (3) units in food and nutrition and six (6) months of general record keeping experience. * Basic Computer Skills * Telephone Etiquette *Desired* * Graduation from high school or equivalent * Food service experience, preferably in a hospital or institutional setting * Certification in Dietary Manager (CDM) * Graduation from high school or equivalent Mercy Medical Center has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nutrition / Food Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Aide Dietary - Nutritional Services - Per Diem Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700011340* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Surgical Technician        
*Position Summary* Under direct supervision of the Physician and Registered Nurse, assists in the performance of technical surgical procedures in the operative environment. Sets up the operating room for procedures according to physician preference card and the type of surgical intervention to be performed, the patient’s age, developmental and size considerations. Performs selected surgical scrub functions in the operative suite involving patient preparation, as well as preparation of the suite and attendant instruments and supplies. Patient age populations served, and the specific competencies that comprise this job title are found in the Department/Unit Orientation & Initial Assessment of Competency” checklist for this unit/positions, and -by reference- form a part of this job description. *Qualifications Minimum* 1. High school graduate or equivalent 2. Must possess and maintain a current Basic Life Support (BLS) certificate 3. Must be able to take call shifts as assigned 4. Graduate of accredited school of surgical technology / US Military program and or National certification in surgical technology. *Desired* 1. One year experience as an OR technician 2. Certified Surgical Technician (CST) Certificate Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Surgical Tech / ORT* **Organization:** **Mercy Medical Center Merced* **Title:** *Surgical Technician* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012447* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Surgical Technician- Surgery - Full Time Days        
*Position Summary* Under direct supervision of the Physician and Registered Nurse, assists in the performance of technical surgical procedures in the operative environment. Sets up the operating room for procedures according to physician preference card and the type of surgical intervention to be performed, the patient’s age, developmental and size considerations. Performs selected surgical scrub functions in the operative suite involving patient preparation, as well as preparation of the suite and attendant instruments and supplies. Patient age populations served, and the specific competencies that comprise this job title are found in the Department/Unit Orientation & Initial Assessment of Competency” checklist for this unit/positions, and -by reference- form a part of this job description. *Qualifications Minimum* 1. High school graduate or equivalent 2. Must possess and maintain a current Basic Life Support (BLS) certificate 3. Must be able to take call shifts as assigned 4. Graduate of accredited school of surgical technology / US Military program and or National certification in surgical technology. *Desired* 1. One year experience as an OR technician 2. Certified Surgical Technician (CST) Certificate Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Surgical Tech / ORT* **Organization:** **Mercy Medical Center Merced* **Title:** *Surgical Technician- Surgery - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700008834* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Director of HIM - Mercy Medical Center - Merced, CA - $5,000 SIGN ON BONUS!!        
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) Responsible for effectively leading and directing the work of assigned staff within the parameters of designated performance standards and metrics. The HIM Facility and/or CEO Director is expected to motivate staff to achieve the highest levels of customer satisfaction and to meet the organization goals for customer service and financial performance. This position is key in delivering critical feedback and coaching to facility-based leadership, consistently improving the patient, employee and client experience. . This position is directly accountable for meeting performance metrics, key performance indicators established by both the client and Optum 360 to ensure accurate and timely patient health information management and coding. This role is also responsible for creating a patient centric culture while maintaining strong operational metrics and being financially fiscal. The HIM Facility and/or CEO Director interacts with other departments within the assigned client site(s), and serves as a representative of the O360 HIM Operations department. The incumbent attends managerial meetings as required and supports the core values of Optum360, which is an integral part of this position. The HIM Facility and/or CEO Director drives continuous improvements and tracks, monitors and trends performance to improve business objectives and to disrupt the status quo in order to exceed Service Level Agreement commitments. This position must maintain strong client relationships and represent Optum 360 in all aspects of its values. This HIM Facility and/or CEO Director will serve as a conduit to drive employee engagement, set and balance expectations and reward and recognize winning performance through accountability, performance management, and strong leadership. Although this position is primarily focused upon the provision of service at the Facility (Hospital and/or Clinics) and/or or within the HIM CEO, the position has frequent contact with the Regional HIM Directors, as well as facility-based clinical and administrative leadership. This is an office based position located in Merced, CA at the Mercy Medical Center Merced. Primary Responsibilities: Provides system level oversight for the development of processes and initiatives designed to improve Revenue Cycle performance in assigned areas which includes: SLA and MSA Compliance Audit Follow-up and Compliance Client Liaison (i.e., Relationship development, program coordination) Client/Customer Engagement Leads and monitors targeted customer engagement improvement initiatives Collaborates with and actively coach HIM/Coding leaders, managers, and frontline staff to implement evidence-based strategies to improve the client/customer experience Monitors and evaluates the results of various service / satisfaction surveys. Maintains reporting system including aggregation, correlation, and analysis of data to identify opportunities for operational improvements Evaluates progress, synthesizes feedback, and identifies barriers to success; collaborates with HIM/Coding senior leadership and client leaders to develop and implement interventions to mitigate / remove barriers and achieve positive experience goals Provides administrative oversight for related HIM/Coding initiatives Communications including but not limited to: scheduling and conducting regular individual, mgmt. and department meetings for the purposes of disseminating information, performance feedback and development. Department Status Report Compilation Other duties as assigned Provides system level oversight for Optum360 client improvement programs and initiatives related to assigned HIM/Coding activities, working within the functional HIM/Coding and Client leadership, as warranted. Effectively participates in HIM/Coding Quality Assurance, Patient Satisfaction, Client Satisfaction, Employee Engagement and Process Improvement activities; ensuring associate understanding and commitment, as well as expected process improvement outcomes. Leads by example: promotes teamwork and operational relationships by fostering a positive, transparent and focused working environment which achieves maximum results. Maintains and demonstrates expert knowledge of the application of HIM/Coding processes and best practices; drives the integration of Optum360 HIM/Coding related business objectives within the client environment. Knows, understands, incorporates, and demonstrates the Optum360 Mission, Vision, and Values in behaviors, practices, and decisions. Serves in a leadership role and promotes positive Human Capital Management skills: Interviews, selects and is accountable for the on-going development and evaluation of individuals within the area of responsibility Develops associate loyalty and retention through effective associate engagement, inclusion and participation; Proactively solicits, listens to and addresses associate suggestions; Promotes a professional environment that recognizes and respects diversity Develops or oversees the development of associate work schedules to ensure cost effective staffing that meets customer requirements, while promoting an economical, efficient workforce and considers associate work-life balance Establishes, implements and evaluates on-going performance improvement programs, utilizing an interdisciplinary approach; Escalates to the Regional Director any unfavorable trends or disciplinary actions; Provides managerial follow-up related to performance, up to and including disciplinary actions and termination Provides staff training and mentoring to promote growth and development of assigned resources Responsible for the financial and personnel management of assigned areas Provides leadership for departmental services through collaboration with customers, employees, physicians, clinics, other Optum360 / client departments and services, vendors, etc. Scope of job duties, include and are not limited to: Directly responsible for effectively managing the assigned HIM/Coding activities and staff members; recommend, design and implement procedures for compliance with regulations and standards Uses knowledge of HIM/Coding industry leading practices, performance metrics and monitors, and other documentation Responsible for distributing process updates regarding criteria changes, regulation changes, process and program changes to assigned staff, ensuring their understanding and future compliance Manages assigned staff in order to ensure steady workflow balance and high quality outcomes: Effectively directs and facilitates a multidisciplinary team to achieve its desired outcome Creates a culture supportive of personnel, fostering individual motivation, teamwork and high levels of performance and accountability, and staff retention Supports a collaborative, participative management style Fosters teamwork atmosphere between business and clinical stakeholders Maintains close business relationship with associates at the regional and local levels by ensuring onsite and virtual presence at regular intervals and during special events Educates client and organizational associates regarding assigned HIM/Coding requirements: Functions as a consultant to Regional and facility-based leadership, physicians, and others regarding assigned performance guidelines and standards for HIM/Coding services Identifies action plans to improve the quality of services in a cost efficient manner and facilitates plan implementation Prepares required reports using statistically sound information, displaying content in easily understandable format; escalates to the Regional Director any unfavorable trends Maintains professional development and growth through journals, professional affiliations, seminars, and workshops to keep abreast of trends in revenue cycle operations and healthcare in general: Participates as appropriate in continuing educational programs and activities that pertain to healthcare and revenue cycle management, as well as specific functional areas Develops and implements an annual plan of personal and professional development Demonstrates the competencies necessary to influence others’ behaviors toward a common dedication to the Optum360’s mission, goals, and objectives Participates in local, regional and national health care revenue activities and professionally represents Optum360 at these function Other duties as needed and assigned by the Regional Director or in coordination with other Optum360 HIM/Coding or Revenue Cycle Leadership, including but not limited to leading and conducting special projects. Develops project work plans, facilitates resource allocation, executes project tasks and obtains assistance from other intra and inter-functional resources, as required Subject Matter Expert of applicable federal, state, and local laws and regulations, Optum360’s Compliance, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior Required Qualifications: Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field Required Certifications include RHIT or RHIA CCS or AAPC for direct oversight of coding functions 5+ years in leadership role with experience in the management of supervisors / leaders Acute Care Facility HIM and / or Coding Department leadership experience, managing one or more functional areas of: HIM, Coding, or other management functions related to revenue cycle activities in a complex, multi - site environment Experience consulting and project management experience in revenue cycle design and optimization Technical Knowledge Experience leading or participating in HIM and / or Coding - related IT and / or Contact Center program implementation Requires proficiency with: Microsoft Excel, Word, Project, PowerPoint and SharePoint Prior experience with the major HIM and / or Coding technologies currently in use, and / or other “like” systems Preferred Qualifications: Excellent organizational skills (ability to multi - task, produce rapid turnaround, and effectively manage multiple projects) Exemplary level leadership and business driver skills (ability to make hard decisions focusing upon operational goals and business requirements) Experience working in a union environment Exemplary level ability to influence change and serve as primary change agent Demonstrated client service / account management orientation Strong program management skills with the ability to lead and manage multiple, concurrent running projects, prioritize tasks and adapt to frequent changes in departmental priorities. Ability to recognize necessary changes in priority of tasks and allocation of resources, and bring them to the attention of Optum360 leadership, as required. Demonstrated knowledge of process improvement techniques are essential to success, as is the ability to be a self - starter and work independently to move projects successfully forward Ability to work with a variety of individuals in executive, managerial and staff level positions. The incumbent frequently interacts with staff at the Corporate / National, Regional and Local organizations. May also interact with external parties, such as financial auditors, third party payer auditors, consultants, and various hospital associations Must be comfortable operating in a collaborative, shared leadership environment that encourages change engagement and participation, and open dialogue. Ability to work within the organization at all levels utilizing a very “hands - on” approach to creating value and buy - ins as the lead change facilitator Ability to attract, develop, deploy and retain a world - class revenue cycle team, capable of performing as a team and of evolving with the organization’s vision and with cutting - edge technologies Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Optum360 and our client organization(s) Operational knowledge of Federal and State regulations pertaining to patient admissions, as well as standards from regulatory agencies and accrediting organizations (DHS, HCFA, OSHA, TJC) Operational knowledge of Federal and State regulations pertaining to patient admissions, as well as standards from regulatory agencies and accrediting organizations (DHS, HCFA, OSHA, TJC) Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: RHIA, RHIT, Health Information Management, Merced, CA, California 83b265e0-6ee6-4958-9644-c83705ee9435 *Director of HIM - Mercy Medical Center - Merced, CA - $5,000 SIGN ON BONUS!!* *California-Merced* *723003*
          (USA-CA-Merced) Environmental Services Tech Lead - Relief (Nights)        
*Position Summary* Provides a clean environment for patient care. Performs a variety of cleaning duties, keeps assigned areas and hospital building in a clean, neat and orderly condition. Provides lead direction for a group of EVS technicians. On the various shifts, acts as lead person. Schedules coverage of staff in the event of a call-in sick. *Qualifications Minimum* 1. Two (2) years experience in cleaning or housekeeping activities, preferably in an acute care hospital. 2. Possession of valid California driver’s license may be required by some of the positions. 3. Basic leadership skills, written and verbal. *Desired* 1. High school diploma or equivalent. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Environmental Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Environmental Services Tech Lead - Relief (Nights)* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700011712* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Certified Phlebotomist        
*Position Summary* Performs phlebotomy on neonatal, pediatric, adolescent, adult, and geriatric patients; prepares specimens for testing; performs clerical duties when necessary. *Minimum Qualifications* 1. High school graduate or equivalent 2. Must possess and maintain a current Phlebotomy licensed with the State of California. 3. Computer literate *Desired* 1. One year experience in phlebotomy in a clinical hospital laboratory. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Laboratory* **Organization:** **Mercy Medical Center Merced* **Title:** *Certified Phlebotomist* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700014619* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Radiology Technologist        
*Position Summary* Operates diagnostic imaging equipment to produce clinical diagnostic x-ray images. Performs diagnostic radiologic procedures on neonatal, pediatric, adolescent, adult and geriatric patients. Ensures images are delivered to PACS in proper sequence, position, along with all required documents. Performs daily room checks at end of shift and signs check list, prepares room, equipment, supplies and contrast media as needed. Directly assists the physician in the performance of procedures. Positions and communicates instructions to patients before and during procedures. Ensures the clinical history is appropriate for the exam that is ordered. Ensures patient safety through appropriate monitoring during the procedures. *Minimum Qualifications* 1. Must possess and maintain a current California radiography certificate (CRT) and national registry certificate (ARRT). 2. Must possess and maintain a current Fluoroscopy certification within six months of hire. 3. Must possess and maintain current Basic Life Support certificate (BLS). 4. Will be required to take call. Will be required to work weekends on a rotational basis. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Imaging / Radiology (PCS)* **Organization:** **Mercy Medical Center Merced* **Title:** *Radiology Technologist* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700014581* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse        
Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMCM) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. Minimum Qualifications: * * 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one prior to start date. 4. Completion of Critical Care Course within one year of employment for RN without ICU experience 5. One or more year experience in a Critical Care, Step Down or Telemetry setting, Medical/Surgical, or completion of New Graduate Nurse Residency Program 6. Must be able to take call, float to other areas, and work on weekends as required. Desired * * 1. Advanced EKG Course. 2. Possess a current Critical Care Registered Nurse (CCRN) certificate. 3. Bilingual Mercy Medical Center has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Critical Care* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012788* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Environmental Services Tech Lead - Relief (Day)        
*Position Summary* Provides a clean environment for patient care. Performs a variety of cleaning duties, keeps assigned areas and hospital building in a clean, neat and orderly condition. Provides lead direction for a group of EVS technicians. On the various shifts, acts as lead person. Schedules coverage of staff in the event of a call-in sick. *Qualifications Minimum* 1. Two (2) years experience in cleaning or housekeeping activities, preferably in an acute care hospital. 2. Possession of valid California driver’s license may be required by some of the positions. 3. Basic leadership skills, written and verbal. *Desired* 1. High school diploma or equivalent. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Environmental Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Environmental Services Tech Lead - Relief (Day)* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700011709* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse - New Grad Per Diem        
At Dignity Health Mercy Merced Medical Center, we deliver humankindness through serving the health care needs of the greater Merced Community. Our vision is to help the people of our community become physically, emotionally and spiritually healthy. As part of our team, you will provide clinical expertise; support and oversight that helps ensure our patients receive exceptional care. This is your opportunity to champion the charge by joining in our mission of healing through humankindness. *Job Summary*: Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, this position renders direct and indirect nursing care to assigned patient populations; assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided and provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation and Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Requirements*: * Must possess and maintain a current Registered Nurse (RN) license with the state of California. * Must possess and maintain a current Basic Life Support (BLS) certificate. * Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of hire. * Must possess and maintain a current Pediatrics Advance Life Support (PALS) or Emergency Nurse Pediatrics Certified (ENPC) certificate at the time of employment. New Nurse Graduates must obtain one within 6 months of employment and or transfer. *Preferred Requirements*: * Current MICN or TNCC certification * Bilingual * Previous acute or emergency experience a plus * Certification for Emergency Nurse (CEN) Certificate Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Emergency* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse - New Grad Per Diem* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012580* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse- Day Shift Full Time        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. * Qualifications Minimum * 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment and or transfer into department. 4. Must be able to take call, float to other areas, and work on weekends as required *Desired* 1. Bilingual 2. One year experience in an acute care setting Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nursing - Registered Nurse* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse- Day Shift Full Time* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012537* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Engineer        
*Position Summary* Performs a variety of skilled work in the repair, maintenance and inspection of patient rooms, clinical suites, medical offices and a wide variety of associated medical and facility equipment used in patient care. *Qualifications Minimum* 1. Must possess and maintain a valid California driver’s license in good standing 2. Two (2) years of responsible skilled level maintenance experience in one of the building maintenance trades such as carpentry, painting, plumbing or electrical repair and maintenance. 3. Ability to work any and all assigned shifts as required. 4. Will be required to take call. *Desired* 1. High school graduate or equivalent. 2. Computer literate 3. Completion of two (2) year mechanical Engineering Technology Program Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Facilities Engineering / Operations* **Organization:** **Mercy Medical Center Merced* **Title:** *Engineer* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700013467* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Engineer        
*Position Summary* Performs a variety of skilled work in the repair, maintenance and inspection of patient rooms, clinical suites, medical offices and a wide variety of associated medical and facility equipment used in patient care. *Qualifications Minimum* 1. Must possess and maintain a valid California driver’s license in good standing 2. Two (2) years of responsible skilled level maintenance experience in one of the building maintenance trades such as carpentry, painting, plumbing or electrical repair and maintenance. 3. Ability to work any and all assigned shifts as required. 4. Will be required to take call. *Desired* 1. High school graduate or equivalent. 2. Computer literate 3. Completion of two (2) year mechanical Engineering Technology Program Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Facilities Engineering / Operations* **Organization:** **Mercy Medical Center Merced* **Title:** *Engineer* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700013470* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) MEDICAL OFFICE REP - NR        
The Medical Office Representative position is the first point of phone customer service contact for our patients, physicians, other clinic staff, internal and external laboratory and imaging staff, hospital staff, patient family members, and vendors by offering customer service, communications, and appropriate distribution of phone calls and messages. The Medical Office Representative may also perform a variety of other duties including but not limited to collecting and updating demographics and insurance information, verification of health plan eligibility, taking complete and accurate messages, and scheduling mutually acceptable appointment times utilizing an electronic practice management system. The Medical Office Representative may also be asked to perform other clerical duties as needed and requested to support daily clinic operation goals, bench marks, and quality patient care initiatives per departmental guidelines. Six (6) month's experience in an outpatient setting as a Medical Office Receptionist preferred; or an equivalent amount of experience in a high-volume customer service role in another industry/environment; or 6 months experience as a Phone Receptionist or Health Information Associate within Dignity Health Medical Foundation. High School diploma or equivalent. Excellent interpersonal, organizational, and customer service skills are essential. Keyboarding skills and the ability to utilize computer equipment and software are required as is experience with other types of standard office equipment. Familiarity with an electronic practice management system is preferred. Experience with multi-line phones/ACD phones preferred. Medical terminology preferred. None required for this position. Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - the fifth largest hospital system in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive healthcare services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. **Job:** **Other* **Organization:** **Dignity Health Medical Foundation Merced* **Title:** *MEDICAL OFFICE REP - NR* **Location:** *California-Central California Service Area-Merced-Dignity Health Medical Foundation Merced* **Requisition ID:** *1700013144* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Quality Consultant        
*Position Summary* Under the direction of the Quality Director, the incumbent is a frontline member of the Quality Resource Team responsible for supporting hospital-wide leadership and medical staff on the full range of operational quality and performance improvement activities throughout the facility. The incumbent performs a hands-on role in providing expertise in clinical knowledge and skills, process improvement techniques, clinical outcomes management, data management and coaching and development of hospital and medical staff regarding quality improvement activities to improve clinical outcomes and patient satisfaction. The incumbent also supports the concurrent review and medical staff peer review processes. The incumbent is able to independently support various hospital leaders in improving clinical process outcomes in their specific areas of responsibility. The incumbent also utilizes educational training techniques to increase the knowledge base of hospital and medical staff to improve outcomes throughout the facility. The incumbent leads and/or supports various committees throughout the facility to assist the nurses and physicians in the improvement of outcomes and data management by providing them with education on outcome requirements and feedback on incomplete clinical measures. The incumbent possesses a strong knowledge base of Title 22, CMS and CDPH regulations and is able to demonstrate the ability to advise on these regulations in order to improve management of outcomes. Incumbent is also has experience and knowledge base to work with other external agencies, such as QualityNet, NSQIP, CalNOC, and others to utilize comparative databases and resources to further the ability to analyze the improvement of clinical outcomes. The incumbent would also participate in other duties, including but not limited to, participation in Medical Staff and Nursing Department meetings and providing nurse counseling and recommendation for corrective action where quality standards and processes are not being met. *Minimum Qualifications* 1.Must possess and maintain a current Registered Nurse license with the State of California. 2.Must possess and maintain a current BLS certification or obtain within 6 months of hire. 3.Two years clinical experience in an acute care setting. 4.Two years of experience in quality and performance improvement processes. 5.Strong computer skills to include Word, Excel, PowerPoint, and Access. 6.Ability to effectively communicate with others in difficult situations utilizing conflict resolution skills. 7.Bachelor of Science in Nursing or other related field or currently working toward the degree or demonstrates sufficient current experience in Quality field. *Desired* 1.Strong statistical analysis skills. 2.Experience in education and training techniques. RN License, BLS Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Quality / Performance Improvement* **Organization:** **Mercy Medical Center Merced* **Title:** *Quality Consultant* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700014555* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Quality Consultant        
*Position Summary* Under the direction of the Quality Director, the incumbent is a frontline member of the Quality Resource Team responsible for supporting hospital-wide leadership and medical staff on the full range of operational quality and performance improvement activities throughout the facility. The incumbent performs a hands-on role in providing expertise in clinical knowledge and skills, process improvement techniques, clinical outcomes management, data management and coaching and development of hospital and medical staff regarding quality improvement activities to improve clinical outcomes and patient satisfaction. The incumbent also supports the concurrent review and medical staff peer review processes. The incumbent is able to independently support various hospital leaders in improving clinical process outcomes in their specific areas of responsibility. The incumbent also utilizes educational training techniques to increase the knowledge base of hospital and medical staff to improve outcomes throughout the facility. The incumbent leads and/or supports various committees throughout the facility to assist the nurses and physicians in the improvement of outcomes and data management by providing them with education on outcome requirements and feedback on incomplete clinical measures. The incumbent possesses a strong knowledge base of Title 22, CMS and CDPH regulations and is able to demonstrate the ability to advise on these regulations in order to improve management of outcomes. Incumbent is also has experience and knowledge base to work with other external agencies, such as QualityNet, NSQIP, CalNOC, and others to utilize comparative databases and resources to further the ability to analyze the improvement of clinical outcomes. The incumbent would also participate in other duties, including but not limited to, participation in Medical Staff and Nursing Department meetings and providing nurse counseling and recommendation for corrective action where quality standards and processes are not being met. *Minimum Qualifications* 1.Must possess and maintain a current Registered Nurse license with the State of California. 2.Must possess and maintain a current BLS certification or obtain within 6 months of hire. 3.Two years clinical experience in an acute care setting. 4.Two years of experience in quality and performance improvement processes. 5.Strong computer skills to include Word, Excel, PowerPoint, and Access. 6.Ability to effectively communicate with others in difficult situations utilizing conflict resolution skills. 7.Bachelor of Science in Nursing or other related field or currently working toward the degree or demonstrates sufficient current experience in Quality field. *Desired* 1.Strong statistical analysis skills. 2.Experience in education and training techniques. RN License, BLS Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Quality / Performance Improvement* **Organization:** **Mercy Medical Center Merced* **Title:** *Quality Consultant* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012524* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse-OR Circulator        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center Merced (MMCM) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Provides immediate direction to assigned LVNs, OR ancillary or Surgical technicians as assigned. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Qualifications Minimum* 1. Must possess and maintain a current Registered Nurse license issued by the State of California. 2. Must possess and maintain a current Basic Life Support (BLS) Certificate 3. Must possess and maintain a current Advanced Cardiac Life Support Certificate (ACLS) 4. Must possess and maintain a current Pediatrics Advanced Life Support Certificate (PALS) within (3) months of hire *Desired* 1. Clinical experience in Operating Room/PACU. 2. Possess and maintain a current Certified Nurse-Operating Room (CNOR) certificate Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Surgical Services / PACU* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse-OR Circulator* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700012443* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Clinical Dietician - Nutritional Services - Full Time Days        
Position Title: Clinical Dietitian Position Summary: Provides medical nutritional therapy to patients by assessing nutritional status, developing a plan of care to maintain or improve nutritional status, periodically evaluating the patient's response to the plan of care, and modifying it as required for optimal outcomes. Counsels patients and/or families about food requirement, eating habits, and therapeutic nutrition. · Completes patient nutritional assessment and establishes plan of care for patient's nutritional requirements; utilizes assessment and evaluation techniques that consider the varied needs of age-specific populations as well as cultural, religious, and ethnic concerns. · Documents assessment, plan, actions and patients' progress. · Develops, reviews, updates and implements educational materials to meet the needs of patients and clinical professionals. Serves as an expert resource and collaborates with the multi-disciplinary medical team on any nutrition-related matters. · Participate in care planning meetings, rounds, and test trays in the kitchen. Requirements: · Knowledge of therapeutic approaches and principles of Medical Nutrition Therapy and ability to plan, develop and deliver nutritional interventions as well as provide individualized dietary consultations. · Knowledge of and ability to assess patients and develop and implement a treatment plan. · Knowledge of education concepts and techniques; the ability to educate people about food requirement, eating habits, and therapeutic nutrition. · Knowledge of principles and practices associated with menu planning; ability to plan nutritious and varied meals for patients and staff. · Knowledge of applicable laws, rules and regulations governing dietary guidelines; ability to apply these theories to design, develop and maintain a healthy diet. · Knowledge of customer service concepts and techniques; ability to meet or exceed customer needs and expectations and provide excellent service in a direct or indirect manner. Education and Experience: · Minimum one (1) year experience as a Registered Dietitian; Working experience in an acute care hospital highly preferred · Bachelor’s degree in Nutrition or related field · Valid registration as a Registered Dietitian #HelloDietitian Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nutrition / Food Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Clinical Dietician - Nutritional Services - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700011248* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse - Telemetry - Full Time - Day Shift        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Qualifications* * Must possess and maintain a current Registered Nurse (RN) license with the state of California. * Must possess and maintain a current Basic Life Support (BLS) certificate. * Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate. * Must be able to take call, float to other areas, and work on weekends as required. *Desired* * One or more years’ experience in Telemetry or acute care setting * Bilingual * Basic EKG certificate Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Patient Care Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse - Telemetry - Full Time - Day Shift* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700009745* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Environmental Services Technician        
**Requisition Number** 17-0417 **Post Date** 6/12/2017 **Title** Environmental Services Technician **Location** Merced **Job Status** Full Time **Work Hours** 40 **City** Merced **State** CA **Description** Satellite Healthcare is a successful, nonprofit organization that has improved the lives of people living with kidney disease since 1973. We earn our national reputation for excellent patient care each day by offering a complete range of dialysis therapy choices, personalized clinical services, and unparalleled wellness education. Satellite Healthcare provides expert, personalized kidney care at over 80 centers across the U.S. as well as at acute dialysis locations in California and Texas. Learn more about Satellite Healthcare at www.satellitehealth.com . The Environmental Services Technician in an Acute setting is responsible for assisting the clinical staff with the day to day tasks associated with bleaching and disinfecting of dialysis machines, receiving supplies and the stocking and rotation of all medical supplies. The Environmental Services Technician in a non-Acute setting also assists with water treatment documentation, and bicarbonate mixing and disinfection. **Essential Functions** _The essential functions listed are not a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. All employees must work in accordance with Satellite’s I-CARE Standards. Employees must abideby all Satellite’s standards of patient care, patient’s rights and ethical treatment, and adhere to safety and quality programs._ + Ensures accordance with manufacturers’ instructions and recommendations, follows company regulatory compliance procedures, and all local, state, federal regulatory requirements + Infection Control o Follows all infection control procedures and understands the associated hazards with failing to follow those procedures o Wears appropriate personal protective equipment (PPE) o Follows all clean/dirty procedures in order to eliminate cross-contamination o Demonstrates an understanding of aseptic technique for all required procedures o Disinfects machines, station area, and chairs after each patient treatment o Assist in disinfection of isolation area as requested + Supplies o Distributes and maintains adequate level of supplies in patient care area o Receives, verify packing slip, put away and rotate all stock o Check all expiration dates on supplies o Maintains the supply room in a neat and orderly fashion o Verify acid concentrate transfers as needed + Assists with patients as directed o Acknowledges and responds to patients’ needs promptly and appropriately o Assist in escorting patients to and from the treatment station o May assist with patient mechanical lifts, but not take the lead + Performs appropriate out-of-center duties as requested by supervisor + Responsible for technical projects as directed by the Clinical Manager or Technical Services + Attends and participates in regular staff/in-services education programs in the center + Maintains professional competence through participation in annual competency reviews + Maintains a neat and clean environment + Participates in CPR as needed + Recommends changes in technical procedures when new knowledge indicates a need for change in cooperation with the Clinical Manager or Technical Services + Ensures the confidentiality of patient and employee information + Responsible for driving the Satellite Healthcare culture through values and customer service standards + Accountable for outstanding customer service to all external and internal customers + Develops and maintains effective relationships through effective and timely communication + Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner + In a non-Acute setting, the following operational duties may also be assigned: o Closing duties of the center, if applicable o Rinse bicarb system and loop at the end of the treatment day o Disinfect bicarbonate system and loop weekly o Disposes of garbage and boxes to appropriate receptacles o Prepares daily water treatment logs and gathers supplies for each shift of patients as directed o Disposes of biohazard waste according to policy and procedure and state regulation o Prepares 1% bleach solution, check potency and document o Maintain cleanliness of outside perimeter o Clean lobby restrooms and restock as needed o Sweep and mop water room and storage room as needed **Requirements** **Minimum Qualifications** **Education:** High School Diploma, G.E.D or equivalent **Experience:** Six (6) months experience working in an industrial/medical setting **License/Certification:** CPR Certification (or within three months of hire) **Knowledge, Skills & Abilities:** + Contributes to harmonious and constructive working relationships with all staff members to promote a positive and productive atmosphere + Demonstrates a caring, respectful attitude to our patients, visitors, physicians and co-workers + Ability to do basic calculations of addition, subtraction, multiplication, and percentages + Ability to read, writes, speak, understand and satisfactorily communicate in English + Must be able to independently travel to assigned locations as needed + Able to work flexible hours according to the needs of the business + Must have valid driver’s license + Ability to work independently (with minimal supervision) Satellite Healthcare, Inc. (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability. Women and men, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. We offer a drug-free work environment.
          (USA-CA-Merced) Executive Assistant/Contract Specialist - Hospital Administration - Full Time Days        
*Position Summary* The Executive Assistant/Physician Contract Specialist serve as support to the Vice President/Strategy and serves as the Physician Contract Specialist overseeing and coordinating the management and renewal processes for all physician//physician recruitment contracts. Performs difficult and/or sensitive tasks for the Business Development Team and other Sr. Leaders, dealing with sensitive information, recruitment matters, preparation of correspondence, minutes, or projects, manages calendars, processing of purchase orders, and provides personal administrative support. Handle physician invoices as assigned. Assists with family/patient situations and complaints. Acts as back up to Regulatory Administrative Assistant to manage Policies and Procedures according to hospital policy. Duties assigned to this position require the independent development of information necessary to complete job assignments, and the exercise of initiative and good judgment. This individual must be selft-directed, with the ability to exercise discretion and independent judgement in the performance of his/her work. This individual must have excellent interpersonal skills in addition to technical skills relating to database management and use of spreadsheets. *Qualifications Minimum* 1. High School graduate 2. A minimum of 5-7 years of increasingly responsible secretarial or administrative assistant experience, preferably in a healthcare setting. 3. Special technical skills required include the ability to manage (including report writing) a relational database to support contract management functions, 4. Advance knowledge of Microsoft product including Microsoft Word, Excel, and Access. *Desired* 1. AA degree or certificate 2. BA or Bachelors Degree 3. Demonstrate experience managing the renewal process and/or implementation of new contracts including maintaining a filing system and a contract database, and safeguarding the security and confidentiality of such contracts. 4. Substantial knowledge of applicable State, Federal laws and regulatory compliance process, relating to Hospital/Physician contracts, including Stark II laws. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Administrative Support / Clerical* **Organization:** **Mercy Medical Center Merced* **Title:** *Executive Assistant/Contract Specialist - Hospital Administration - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700009134* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Licensed Vocational Nurse (LVN) - Family Practice Clinic - Full Time Days        
Position Summary Perform routine patient care and para-professional nursing services for adult, geriatric, adolescent, pediatric and neonatal patients in a family practice clinic, and to perform related duties. Qualifications Minimum 1. Must posses and maintain a current LVN license with the state ofCalifornia 2. Must possess and maintain a current Basic Life Support (BLS) certificate. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **LVN / LPN* **Organization:** **Mercy Medical Center Merced* **Title:** *Licensed Vocational Nurse (LVN) - Family Practice Clinic - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700007752* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Physical Therapist Assistant - Physical Therapy - Full Time Days        
*Position Summary* May perform physical therapy procedure and related tasks that have been selected and delegated by the Physical therapist incorporating age specific requirements for neonatal, pediatric, young adult, adult and geriatric patients. May modify a specific intervention procedure in accordance with changes in patient status and within the scope of the established plan of care. *Qualifications Minimum* 1.Must possess and maintain a valid California Physical Therapist Assistant license 2.Must possess and maintain a valid Basic Life Support (BLS) certificate 3.Must have demonstrated clinical competency in a manner approved by American Physical Therapy Association and the Physical Therapy Board of California. Physical Therapist Assistant License, BLS Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Rehabilitation (PCS)* **Organization:** **Mercy Medical Center Merced* **Title:** *Physical Therapist Assistant - Physical Therapy - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700007295* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Clinical Lab Scientist - Clinical Laboratory Services - Full Time Days        
*Position Summary* Provides laboratory testing to inpatients and outpatients, quality control, and instrument maintenance and related record keeping and result reporting. May be assigned to or rotate to various areas such as: Microbiology, Chemistry/Special Chemistry, Transfusion Services, Coagulation, Hematology, Urinalysis and Immunology. Patients served are neonatal, pediatric, adolescent, adults, and geriatric age groups. *Qualifications Minimum* 1. Education level necessary to obtain required licensure and certifications: · A doctor of medicine, osteopathy, or doctor of podiatric medicine licensed to practice, osteopathy, podiatry in the state in which the laboratory is located, or have earned a doctoral, masters or bachelor’s degree in a chemical, physical, biological, or clinical laboratory science or medical technology from an accredited institution; or An associate degree in a chemical, physical, or biological l science or medical laboratory technology from an accredited institution; or · High school diploma or equivalent and have successfully completed an official military medical laboratory procedures course of at least 50 weeks duration, and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Medical Technician); or · High school diploma or equivalent, and have such documentation of training appropriate for the testing performed prior to analyzing patient specimens. Such training must ensure that the individual has the skills required for the proper specimen collection, including patient preparation, if applicable, labeling handling, preservation or fixation, processing or preparation, transportation and storage of specimens etc., etc. 2. Must possess and maintain a current Clinical Laboratory Scientist (CLS) license within the state of California. 3. Computer literate *Desired* 1. One (1) year experience in an acute care facility. Mercy Medical Center , a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. Mercy Medical Center Laboratory offers the use of state-of-the art equipment in a fast-paced environment. You’ll enjoy working with laboratorians who care about their patients and the quality of their work. Merced is located in the San Joaquin Valley of California, and is home to the 10thand newest campus of the University of California. Considered the “Gateway to Yosemite”, Merced is the closest (just 69 miles away) large community to Yosemite National Park and its tremendous recreational opportunities. Other national parks, rivers and lakes are within close reach. Monterey, San Francisco, Sacramento are all within an easy two hour drive. On top of all that, Merced is a great place to raise your kids! **Job:** **Laboratory* **Organization:** **Mercy Medical Center Merced* **Title:** *Clinical Lab Scientist - Clinical Laboratory Services - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700008446* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Community Health Nurse        
This recruitment is for the California Childrenand#39;s Services Program and Clinical Services.Duties may include, but are not limited to the following:Provides nursing advice to patients; administers medications and performs assessments.May provide case management services and utilization review for programs including CCS, CHDP, MCAH, Outreach, Medi-Cal Targeted case management, Indigent Health Care and other programs.Will assist clients to gain access to needed medical, social, educational and other services.Promotes the control of communicable disease by early detection and preventive treatment.Records communicable diseases as prescribed by State and County laws and regulations.Makes home visits to follow up on identified at-risk mother and infants; teaches parenting skills.Functions as an On-Call nurse to give information and make appropriate referrals by telephone.Explains physicianand#39;s instructions and recommendations to patient and patientand#39;s families.Promotes preventative medicine by providing health education and conducting presentations.May provide grief counseling to parents in Sudden Infant Death Syndrome.Engage in outreach and other activities to enhance services to Medi-Cal beneficiaries.MINIMUM QUALIFICATIONSExperience:One (1) year of professional nursing experience. (Possession of a Bachelorand#39;s degree in Nursing, or a closely related field may be substituted for the one (1) year of required experience.)
          Advocate Recovery Center Now Offers Buprenorphine Treatment For Opiate Addiction In North West Houston        

Advocate Recovery Center, a top rehab center in the Greater Houston Area, is now offering individualized treatment options for prescription drug addiction in the Houston suburb of Cypress. The program has an exceptional success rate by offering medically treatment options by Board Certified physicians.

(PRWeb August 11, 2016)

Read the full story at http://www.prweb.com/releases/2016/08/prweb13605235.htm


          Advocate Recovery Center Now Offers Buprenorphine Treatment for Opiate Addiction        

Advocate Recovery Center, a top rehab center in the Greater Houston Area, is now offering individualized treatment options for prescription drug addiction. The program has an exceptional success rate by offering medical treatment options by Board Certified physicians.

(PRWeb July 01, 2016)

Read the full story at http://www.prweb.com/releases/2016/07/prweb13524172.htm


          (USA-CA-Merced) Pharmacy (Pharmacist) Manager        
The primary purpose of this position is to oversee the daily activities of the Pharmacy department within a retail store. Additionally, to assist customers with their health care needs by filling prescriptions and providing excellent customer service. The incumbent is also required to perform all tasks in a safe manner consistent with corporate policies and state and federal laws. The associate is responsible for the functions below, in addition to other duties as assigned: • Ensure the accuracy and appropriateness of all prescriptions filled by completing Drug Utilization Review and Final Quality Assurance, applicable to state and federal Board of Pharmacy regulations. • Build profitable business and script growth through recommended clinical programs including appropriate immunization and when available MTM (Medication Therapy Management), DCS (Diabetes Care Specialist), and all ongoing other programs as identified. • Oversee the daily activities of the Pharmacy department. • Counsel customers with regard to medications filled at the pharmacy. • Ensure growth and profitability of Pharmacy Department. • Handle and resolve customer issues, complaints and questions to build customer trust and loyalty. • Comply with all federal and state laws and regulations. • Interact with physicians to gain additional information about customers and prescriptions to be filled. • Ensure excellent customer service by Pharmacy associates. • Maintain a clean and efficient Pharmacy department. • Provide leadership and development for associates by communicating career opportunities, providing regular performance feedback, and demonstrating RAPTAR (Recognition, Appreciation, Praise, Treat Associates Respectfully) behaviors. • Maintain appropriate security of the Pharmacy department. • Maintain reports for controlled, outdated, and recalled medications; and prescription and customer files. • Manage pharmacy inventory at acceptable levels to fulfill customer need. • Ensure compliance with all policies and procedures for controlled substance dispensing and record keeping. • Prioritize Pharmacy Department tasks and follow through to ensure all tasks are completed in a timely manner. Including, but not limited, to cycle counts, inventory management and will-calls to customers. The following qualities are required: -Minimum age of 21 years old meet education and experience requirements. -Ability to pass drug test. -Committed to providing customer service that makes both internal and external customers feel welcome, important, and appreciated. -Ability to preserve confidentiality of information. -Ability and willingness to move with purpose and a strong sense of urgency. -Ability to work weekends and extended days on a frequent basis. -Ability to work day, evening, and/or night shift. -Accuracy and attention to detail. -Ability to organize and prioritize a variety of tasks/projects. -Familiarity with industry/technical terms and processes. -Ability to work within strict time frames and resolute deadlines. -Excellent communication and customer service skills. -Ability to adapt to change quickly and frequently. -Ability to perform different tasks on different days as necessary. -Ability to respond to interruptions and then return seamlessly to task at hand -Ability to handle stressful situations while maintaining a sense of calm. -Ability to multi-task for extended periods of time. Bachelor's degree (BS), Doctoral degree (PHARM.D.), or equivalent in Pharmacy, and Immunization Certification through an accredited organization (i.e. APhA) plus a minimum of one(1) year experience as a licensed Pharmacist; or equivalent combination of education and experience. In addition, the associate should have experience in a retail environment. Position ID#: 78386 External Company Name: Rite Aid Hdqtrs. Corp. External Company URL: www.riteaid.com
          (USA-CA-Merced) Pharmacist        
The primary purpose of this position is to assist customers with their health care needs by filling prescriptions and providing excellent customer service and assisting with supervising Pharmacy associates. Frequent independent judgments are essential. The incumbent is also required to perform all tasks in a safe manner consistent with corporate policies and state and federal laws. The associate is responsible for the functions below, in addition to other duties as assigned: • Ensure the accuracy and appropriateness of all prescriptions filled by completing Drug Utilization Review and Final Quality Assurance, applicable to state and federal Board of Pharmacy regulations. • Build profitable business and script growth through recommended clinical programs including appropriate immunization and when available MTM (Medication Therapy Management), DCS (Diabetes Care Specialist), and all ongoing other programs as identified. • Provide excellent customer service by assisting customers with medical-related issues and providing healthcare counseling. • Supervise the work completed by Pharmacy Technicians and support staff while on duty. • Assist Pharmacy Manager to train, coach, and manage Pharmacy associates. • Assume management responsibility over the entire pharmacy in the absence of the Pharmacy Manager. • Maintain appropriate security of the Pharmacy department. • Comply with all federal and state laws and regulations. • Handle and resolve customer issues, complaints and questions to build customer trust and loyalty. • Interact with physicians and utilize reference material to gain information on customers and prescriptions and to resolve any issues that arise. • Assist with maintaining the Pharmacy department by keeping it clean and in order. • Prioritize Pharmacy Department tasks and follow through to ensure all tasks are completed in a timely manner. Including, but not limited, to cycle counts, inventory management and will-calls to customers. *All duties described in this document are to be performed in keeping with the core values and service attributes consistent with the Rite Aid brand and strategy. • Minimum age of 18 to meet education and experience requirements. • Ability to pass drug test. • Committed to providing customer service that makes both internal and external customers feel welcome, important, and appreciated. • Ability to preserve confidentiality of information. • Ability and willingness to move with purpose and a strong sense of urgency. • Ability to work weekends and extended days on a frequent basis. • Ability to work day, evening, and/or night shift. • Accuracy and attention to detail. • Ability to organize and prioritize a variety of tasks/projects. • Familiarity with industry/technical terms and processes. • Ability to work within strict time frames and resolute deadlines. • Excellent communication and customer service skills. • Ability to adapt to change quickly and frequently. • Ability to perform different tasks on different days as necessary. • Ability to respond to interruptions and then return seamlessly to task at hand • Ability to handle stressful situations while maintaining a sense of calm. • Ability to multi-task for extended periods of time. Bachelor's degree (BS), Doctoral degree (PHARM.D.), or equivalent in Pharmacy, and Immunization Certification through an accredited organization (i.e. APhA). Position ID#: 78384 External Company Name: Rite Aid Hdqtrs. Corp. External Company URL: www.riteaid.com
          (USA-CA-Merced) Clinical Lab Scientist - Clinical Laboratory Services - Full Time Days        
*Qualifications Minimum* 1. Education level necessary to obtain required licensure and certifications: · A doctor of medicine, osteopathy, or doctor of podiatric medicine licensed to practice, osteopathy, podiatry in the state in which the laboratory is located, or have earned a doctoral, masters or bachelor’s degree in a chemical, physical, biological, or clinical laboratory science or medical technology from an accredited institution; or An associate degree in a chemical, physical, or biological l science or medical laboratory technology from an accredited institution; or · High school diploma or equivalent and have successfully completed an official military medical laboratory procedures course of at least 50 weeks duration, and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Medical Technician); or · High school diploma or equivalent, and have such documentation of training appropriate for the testing performed prior to analyzing patient specimens. Such training must ensure that the individual has the skills required for the proper specimen collection, including patient preparation, if applicable, labeling handling, preservation or fixation, processing or preparation, transportation and storage of specimens etc., etc. 2. Must possess and maintain a current Clinical Laboratory Scientist (CLS) license within the state of California. 3. Computer literate *Desired* 1. One (1) year experience in an acute care facility. * * * * Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. Mercy Medical Center Laboratory offers the use of state-of-the art equipment in a fast-paced environment. You’ll enjoy working with laboratorians who care about their patients and the quality of their work. Merced is located in the San Joaquin Valley of California, and is home to the 10thand newest campus of the University of California. Considered the “Gateway to Yosemite”, Merced is the closest (just 69 miles away) large community to Yosemite National Park and its tremendous recreational opportunities. Other national parks, rivers and lakes are within close reach. Monterey, San Francisco, Sacramento are all within an easy two hour drive. On top of all that, Merced is a great place to raise your kids! **Job:** **Laboratory* **Organization:** **Mercy Medical Center Merced* **Title:** *Clinical Lab Scientist - Clinical Laboratory Services - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700001154* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) ID Pharmacist - Pharmacy - Full Time Days        
This position is responsible for the day-to-day coordination of antimicrobial Stewardship program to ensure the safe, effective, and rationale use of antimicrobials throughout the hospital. Responsible for the implementation, monitoring, quality/performance improvement, drug use monitoring, and employee education revolving around antimicrobials. Responsible for the coordination of the antimicrobial stewardship meetings. Minimum Qualifications: * Must possess and maintain a current license as a pharmacist in the state of California * Knowledge in current trends and technological developments in Infectious Disease practices. Desired: * Completion of an American Society of Heath Systems Pharmacist approved ID residency program Pharmacist License Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, aCancerCenterand several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center . **Job:** **Pharmacy* **Organization:** **Mercy Medical Center Merced* **Title:** *ID Pharmacist - Pharmacy - Full Time Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1700000550* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse - Cardiac Catherization Services - Per Diem Days        
*Position Summary* The Cath Lab / Diagnostic Imaging RN demonstrates full clinical competency in a specific nursing care area and supervises ancillary nursing staff. The Cardiac Catheterization Lab performs elective diagnostic cardiac catheterization procedures. The Diagnostic Imaging Department performs invasive diagnostic procedures. The primary patient populations are adult and geriatric patients. Monitors and performs daily checks of crash cart. *Minimum Qualifications* 1.Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2.Must possess and maintain current Basic Life Support (BLS) certificate. 3.Must possess and maintain a current Advanced Cardiac Life Support (ACLS) certificate. 4.One year experience as a Registered Nurse in a critical care or catheterization laboratory nursing area. *Desired* 1.EKG interpretation class RN, BLS, ACLS Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Cardiac / Cath Lab* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse - Cardiac Catherization Services - Per Diem Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600030293* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Physical Therapist Assistant - Physical Therapy - Per Diem Days        
*Position Summary* May perform physical therapy procedure and related tasks that have been selected and delegated by the Physical therapist incorporating age specific requirements for neonatal, pediatric, young adult, adult and geriatric patients. May modify a specific intervention procedure in accordance with changes in patient status and within the scope of the established plan of care. *Qualifications Minimum* 1. Must possess and maintain a valid California Physical Therapist Assistant license 2. Must possess and maintain a valid Basic Life Support (BLS) certificate 3. Must have demonstrated clinical competency in a manner approved by American Physical Therapy Association and the Physical Therapy Board of California. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Rehabilitation (PCS)* **Organization:** **Mercy Medical Center Merced* **Title:** *Physical Therapist Assistant - Physical Therapy - Per Diem Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600027551* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse - Med Surg - Per Diem / Varied        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Qualifications* 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Pediatric Advance Life Support (PALS) certificate or obtain one within 6 months of employment, if working in Pediatrics. 4. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment. 5. Must be able to take call, float to other areas, and work on weekends as required. *Desired* 1. Bilingual 2. One year previous pediatric or acute care experience Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Patient Care Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse - Med Surg - Per Diem / Varied* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600027273* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Registered Nurse - Med Surg - Per Diem Days        
*Position Summary* Consistent with scope of licensure, parameters of the California Nurse Practice Act, and Mercy Medical Center (MMC) policy and procedure, renders direct and indirect nursing care to assigned patient populations. Assesses patients for nursing needs, establishes and implements a problem oriented plan of nursing care, and evaluates the effectiveness of care provided. Provides immediate direction to other members of the nursing care team to assure the appropriate provision of nursing services. Patient age populations served, and the specific competencies that comprise this job title may vary among nursing units. These specifics are found in the “Department / Unit Orientation & Initial Assessment of Competency” checklists for this unit/position, and –by reference – form a part of this job description. *Minimum Qualifications* 1. Must possess and maintain a current Registered Nurse (RN) license with the state of California. 2. Must possess and maintain a current Basic Life Support (BLS) certificate. 3. Must possess and maintain a current Pediatric Advance Life Support (PALS) certificate or obtain one within 6 months of employment, if working in Pediatrics. 4. Must possess and maintain a current Advance Cardiac Life Support (ACLS) certificate or obtain one within 6 months of employment. 5. Must be able to take call, float to other areas, and work on weekends as required. *Desired* 1. Bilingual 2. One year previous pediatric or acute care experience Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Patient Care Services* **Organization:** **Mercy Medical Center Merced* **Title:** *Registered Nurse - Med Surg - Per Diem Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600027267* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Speech Therapist - Home Care- Per Diem Days        
*Qualifications Minimum* 1. Must possess and maintain a current Speech and Language Pathology Therapist Registration License with the state of California. 2. One year experience as Registered Speech and Language Pathology Therapist in an acute care, rehab or long-term care setting. 3. Must possess and maintain a current Basic Life Support (BLS) certificate 4. Must possess and matintain a valid California driver's license and proof of auto insurance. 5. Must provide a clean DMV printout. Must be able to drive a motor vehicle safely for moderate period of time *Desired* Previous home care experience. Second language skills in Spanish Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Rehabilitation (PCS)* **Organization:** **Mercy Medical Center Merced* **Title:** *Speech Therapist - Home Care- Per Diem Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600025910* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Administrative House Supervisor - Nursing Administration - Per Diem Varied        
*Position Title:**Supervisor of House* *Position Summary:* Supervises and coordinates activities of nursing personnel in patient care units. Plans work of assigned units and coordinates activities with other patient care units and related departments. Organizes and oversees patient care delivery during an assigned shift. Document daily staffing and administrative records and maintains compliance with governmental policies and procedures. Provides input to employee performance and assists in the coaching of staff members. Provides nursing care to patients on an as needed basis. Maintains communication with patient and family members regarding care needed. * Organizes and oversees patient care delivery during an assigned shift. Monitors and assesses current environment for smooth hospital operations. * Assesses and allocates resources as needed. Provides input to employee performance. Assists in the coaching of staff members. * Documents daily staffing and administrative records and maintains compliance with governmental policies and procedures. Presents documentation to senior staff. * Provides nursing care to patients on an as needed basis. Maintains communication to patient and family members regarding care needed. *Requirements:* * Knowledge, insight, and understanding of business concepts, tools, and processes that are needed for making sound decisions in the context of the company's business; ability to apply this knowledge appropriately in both clinical and non-clinical situations. * Knowledge of the decision-making process and associated tools and techniques; ability to accurately analyze situations and reach productive decisions based on informed judgment. * Understanding of the business value of diverse perspectives and opinions and ability to understand, appreciate and employ the unique contributions of associates of varied cultures, nationalities, ethnic backgrounds, genders, ages, points of view, etc. * Knowledge of and ability to use industry standards, evidence-based practice and policies and procedures relevant to function and organization. * Knowledge of healthcare policies for all clinical practices and applicable laws and regulations governing proper clinical practice; ability to demonstrate ethical behavior in diverse situations. * Knowledge of the factors contributing to quality patient care, and the ability to influence these factors in a positive way. *Education and Experience:* * Experience: Minimum of three (3) years of nursing experience and one (1) year of leadership experience. * Education: Associate's Degree in Nursing (e.g., ADN) and actively pursuing a Bachelor's Degree in Nursing or other-related field (e.g., BSN/BBA/BHA). * Licensure: Registered Nursing License (RN), Basic Life Support (BLS) * Special Skills: None specified. * Training: None specified. * * Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Administration* **Organization:** **Mercy Medical Center Merced* **Title:** *Administrative House Supervisor - Nursing Administration - Per Diem Varied* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600025850* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Nurse Shift Manager - Nursing Administration - FT Evening        
Position Title: Nurse Shift Manager Position Summary: Plans the overall nursing care and functions in a particular nursing unit during an assigned shift. Supervises nursing staff assigned to a particular shift. Assigns patients to available nursing staff, taking into consideration the patient's condition and the employee's skill level. Anticipates staffing needs and moves proactively to respond to them. Oversees stocking of supplies and updating patient records to ensure that the nursing floor is ready for subsequent shifts.. * Supervises nursing staff assigned to a particular shift. Assigns patients to available nursing staff, taking into consideration the patient's condition and the employee's skill level. * Assesses, monitors, and educates the nursing staff on patient care. Institutes emergency procedures as necessary. * Anticipates staffing needs and moves proactively to respond to them. * Oversees stocking of supplies and updating patient records to ensure that the nursing floor is ready for subsequent shifts. Requirements: * Knowledge, insight, and understanding of business concepts, tools, and processes that are needed for making sound decisions in the context of the company's business; ability to apply this knowledge appropriately in both clinical and non-clinical situations. * Knowledge of the decision-making process and associated tools and techniques; ability to accurately analyze situations and reach productive decisions based on informed judgment. * Understanding of the business value of diverse perspectives and opinions and ability to understand, appreciate and employ the unique contributions of associates of varied cultures, nationalities, ethnic backgrounds, genders, ages, points of view, etc. * Knowledge of and ability to use industry standards, evidence-based practice and policies and procedures relevant to function and organization. * Knowledge of healthcare policies for all clinical practices and applicable laws and regulations governing proper clinical practice; ability to demonstrate ethical behavior in diverse situations. * Knowledge of the factors contributing to quality patient care, and the ability to influence these factors in a positive way. Education and Experience: * Experience: Minimum of two (2) years of clinical experience as a registered nurse * Education: Associate's Degree in Nursing (e.g., ADN) * Licensure: Registered Nursing License (RN), Basic Life Support (BLS) * Special Skills: None specified. * Training: None specified. Mercy Medical Center, a Dignity Health member, has been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Nursing - Registered Nurse* **Organization:** **Mercy Medical Center Merced* **Title:** *Nurse Shift Manager - Nursing Administration - FT Evening* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600023213* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          (USA-CA-Merced) Director of Nursing - Family Birth Center - FT Days        
*Position Title:**Director of Nursing* *Position Summary:* Directs the provision of nursing care in a business unit while maintaining standards of patient care. * Responsible for the overall quality of care provided by the nursing personnel. Advises medical staff, department heads, and administrators in matters related to nursing service and strategies. * Interprets policies and objectives of nursing service to staff and community groups. * Monitors the operations of the nursing staff and ensures compliance with regulations on organizational and governmental standards and practices. Schedules staff and conducts employee performance reviews. * Provides nursing care to patients on an as needed basis. *Requirements:* * Knowledge, insight, and understanding of business concepts, tools, and processes that are needed for making sound decisions in the context of the company's business; ability to apply this knowledge appropriately in both clinical and non-clinical situations. * Knowledge of the decision-making process and associated tools and techniques; ability to accurately analyze situations and reach productive decisions based on informed judgment. * Understanding of the business value of diverse perspectives and opinions and ability to understand, appreciate and employ the unique contributions of associates of varied cultures, nationalities, ethnic backgrounds, genders, ages, points of view, etc. * Knowledge of and ability to use industry standards, evidence-based practice and policies and procedures relevant to function and organization. * Knowledge of healthcare policies for all clinical practices and applicable laws and regulations governing proper clinical practice; ability to demonstrate ethical behavior in diverse situations. * Knowledge of the factors contributing to quality patient care, and the ability to influence these factors in a positive way. *Education and Experience:* * Experience: Minimum of three (3) years of nursing experience and two (2) years of leadership experience. * Education: Bachelor's Degree in Nursing (e.g. BSN) and Master's degree in nursing or other-related field (e.g., MSN/MBA/MHA). * Licensure: Registered Nursing License (RN), Basic Life Support (BLS) * Special Skills: None specified. * Training: None specified. Mercy Medical Centerhas been building a rich history of care in our community for more than 100 years. We have grown from a small one-story wooden structure into a major healthcare provider with a brand new 186-bed main campus, offering the latest in facility design and technology. Mercy also operates Outpatient Centers, a Cancer Center and several rural clinics. Wherever you work throughout our system, you will find faces of experience with dedication to high quality, personalized care. Joining our 1,300 employees, 230 physicians and many volunteers, you can help carry out our commitment to providing our community with the excellence they have come to associate with Mercy Medical Center. **Job:** **Administration* **Organization:** **Mercy Medical Center Merced* **Title:** *Director of Nursing - Family Birth Center - FT Days* **Location:** *California-Central California Service Area-Merced-Mercy Merced Community* **Requisition ID:** *1600019374* **Equal Opportunity** Dignity Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected Veteran status or any other characteristic protected by law.
          1st International Diabetes Expert Conclave (IDEC) 2017        
Last week I was an invited plenary speaker at the 1st International Diabetes Expert Conclave (IDEC2017) held in Pune, India. This 3-day event, organised by Drs. Neeta Deshpande (Belgaum), Sanjay Agrawal (Pune) and colleagues, brought together well over 900 physicians from across India for a jam-packed program that covered everything from diabetic food disease and neuropathy to the latest in insulin pumps and devices – all in a uniquely Indian context. I, of course, was there to speak on obesity, which featured prominently in the program. Topics on obesity ranged from the potential role of gut bugs to bariatric surgery. While Dr. Allison Goldfine, former Director of Clinical Research at the Joslin Diabetes Center in Boston spoke on the latest developments in anti-obesity pharmacotherapy (delivering her talk via Skype), I spoke about obesity as a chronic disease and the need to redefine obesity based on actual indicators of health rather than BMI. During my visit in Pune, I also had the opportunity to visit with my friend and colleague Dr. Shashank Shah, whose bariatric surgical center in Pune alone performs about 75 to 100 bariatric operations per month – a remarkable number by any standards. Of course, the overwhelming number of talks were given by Indian faculty (there being only a handful of select invited international faculty at the meeting), and I did come away most impressed by the breadth and depth of knowledge presented by the local speakers. Diabetes care certainly appears to be in good hands although the sheer number of patients with diabetes (estimated at about 70 million, which I assume to be a rather conservative assessment), would provide a challenge to any health care system. On the obesity front, things are a lot less rosy, given that (as everywhere else) obesity has yet to receive the same level of professional attention and expertise afforded to diabetes or other chronic diseases. Thanks again to the organisers for inviting me to this exciting meeting and congratulations on an excellent event that bodes well for the 2nd Conclave planned for 2018. @DrSharma Edmonton, AB
          Canadians Have Virtually No Access To Interdisciplinary Obesity Care        
Every single guideline on obesity management emphasises the importance of interdisciplinary obesity management by a team that not only consists of a physician and a dietitian but also includes psychologists, exercise specialists, social workers, and other health professionals as deemed necessary. As is evident from the evident from the 2017 Report Card on Access To Obesity Treatment For Adults, released last week at the 5th Canadian Obesity Summit, the overwhelming majority of Canadians living with obesity have no access to anything that even comes close. Thus, the report finds that Among the health services provided at the primary care level for obesity management, dietitian services are most commonly available. Access to exercise professionals, such as exercise physiologists and kinesiologists, at the primary care level is limited throughout Canada. Access to mental health support and cognitive behavioural therapy for obesity management at the primary care level is also limited throughout Canada. bariatric surgery programs often have a psychologist or a social worker that offers mental health support and cognitive behavioural therapy to patients on the bariatric surgery route, but the availability of these supports outside of these programs is scarce. Centres where bariatric surgery is conducted also have inter- disciplinary teams that work within the bariatric surgical programs and provide support for patients on the surgical route. Alberta and ontario have provincial programs with dedicated bariatric specialty clinics that offer physician-supervised medical programs with interdisciplinary teams for obesity management. Interdisciplinary teams for obesity management outside of the bariatric surgical programs are available in one out of five regional health authorities (RHa) in british Columbia, one out of 18 RHas in Québec, one out of two RHas in new brunswick and one out of four RHas in newfoundland and labrador. Among the territories, only yukon has a program with an interdisciplinary team focusing on obesity management in adults. I hardly need to remind readers, that this is in stark contrast to the resources and teams available to patients with diabetes, heart disease, lung disease, or any other common chronic disease, that are regularly available in virtually every health jurisdiction across the country (not to say that they are perfect or sufficient – but at least there is some level of service available). I understand that our current obesity treatments are extremely limited (at least when effectiveness is measured in terms of weight loss). But even if access to these resources could simply help stabilise and… Read More »
          Get Big Results Fast With 3 Simple Exercises        
OK, as a precaution, I must emphasize the importance of consulting with your physician before you start any exercise regimen. With that out of the way, let's get started.
          Hoodia Pills        

Hoodia Pills

Is a pill in fact, is not use of your physician before?

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          Dr. Kiki Hunt MD        
Dr. Kiki Hurt is a personal health consultant and founder of "Medicine, Life, and a little Laughter" a comprehensive wellness program that provides medical expertise and knowledge to help people lead healthier and happier lives. An author and board certified anesthesiologist, trauma critical care anesthesiologist, and internal medicine physician; "Medicine, Life, and a little Laughter" grew out of a more than two-decade career spent studying the management of acutely dying patients. Dr Kiki Hurt is a board certified critical care physician, internal medicine physician, and anesthesiologist physician. Dr. Hurt trained in Internal Medicine at Lutheran General Hospital in Park, IL, Anesthesiology at the University of Illinois at Chicago, and Critical Care Medicine at Northwestern University, Chicago, Illinois. She received her medical degree at Rush Medical College in Chicago, and studied advanced training in Cardiac Tran esophageal Echo at David Geffen School of Medicine at UCLA. A member of the American Society of Critical Care Anesthesiologists (www.ascca.org) and the Society of Cardiovascular Anesthesiologists (www.scahq.org), Dr. Hurt has appeared on numerous Internet and radio shows.   Connect with Dr. Hurt Twitter: https://twitter.com/drkikihurt Facebook: https://www.facebook.com/pages/Dr-Kiki-Hurt-MD/153600483415 Website: http://www.drkikihurtmd.com/bio.php Download Dr. Hurt Application for Iphone and Android phones to get music and medical blogs: GloalMusic4life
          Christian Drug Rehab Offers Spiritual Healing        
I joined a prominent clinic after spending several years in school training to be a nurse. Most of my classmates were hoping to land positions with hospitals, the traditional employers of nursing graduates, although a few were looking to nursing homes, which have been identified as a major opportunity in our field with the aging population. I was raised in a Christian household and I took a slightly different approach when it came to practicing my trade. If Jesus was willing to help lepers when no-one else wanted to be anywhere near them, how could I follow his example and practice nursing among society"??s outcasts? After some searching and considering options like following his lead literally and traveling to a third world medical clinic to volunteer my services, I opted for what I felt was a very close modern equivalent: helping recovering addicts to heal.



My family was a little shocked at my choice, but when I explained the parallels, they fully supported me. After all, who needs help more but is subject to public scorn the way that drug addicts are? They"??re blamed for their problem, accused of moral weakness, blamed for crimes and held up as the poster children for everything that"??s wrong with our modern world.



So I signed on and showed up for my first day at the clinic. By the end of that day I was second guessing my decision and after a week I was finished. I could not deal with the treatment programs and the methodology the clinic practiced. It seemed to me that the patients were dehumanized and treated as "??cases,"?? not as individual human beings. The counselors kept an emotional distance between themselves and the patients and when I asked why they did this, I was told that it was needed to prevent staff from becoming depressed and feeling responsible when the patients relapsed and showed up again in six months. It was all very clinical and very scientific, but there was something missing -a spiritual component.



I very nearly gave up on nursing altogether but for a tip from one of the physicians. He pointed me to an "??alternative"?? facility, the rehab clinic where I have worked for the past decade. Emphasizing traditional Christian values and incorporating key components of our faith (like hope, forgiveness, faith and perseverance); this center embraces patients and combines addiction treatment therapies with the support of Christian faith. It"??s a combination that works wonders for both patients and staff.


Emily Prentice is a supervising nurse who is familiar with traditional drug rehab treatment and its shortcomings. After a brief stint working in a popular treatment center, Emily discovered a facility offering Christian drug rehab, a formula she finds personally fulfilling as well as far more effective in helping addicted patients to recover.

substance abuse addictions: alcholisim

substance abuse addictions: substance abuse

Article Source: www.articlesnatch.com


          How to get a Justin Bieber on board with your nonprofit        


Sara Choe

As you foray into online fundraising for your nonprofit, you might have stumbled upon the term “social media influencer”. You might wonder what that is exactly and where would you even get one of those.

A social media influencer is simply a person whose online presence carries weight. There are many kinds of influencers, but they share the following qualities:

1. Credibility

An influencer has had to earn their audience’s trust in some way, and more trust means longer attention spans.

Being an expert in a field is one way an influencer gains credibility. Physicians like Sanjay Gupta or Dr. Oz are influential – the former as a CNN medical correspondent and the latter as host of the eponymous television show – primarily due to their medical expertise.

2. Reach

Social media influencers have extensive audiences. They have numerous followers across several platforms; sometimes there are overlaps; that is to say, one might follow a blogger both on Facebook and Twitter. For example, author, blogger and speaker Jon Acuff has more than 49,000 fans on Facebook and nearly 186,000 followers on Facebook.

3. Quality engagement

The influencer’s audience is marked by quantity and quality. That is to say, she has many meaningful interactions with most of her many followers. Her followers not only consume her content but share it with their respective audiences.

Searching for Social Media Influencers

Now that you know who social media influencers are, you need to learn how to connect with those who would best advocate for your organization.

Hint: An influencer’s celebrity doesn’t translate into being an effective endorser of your cause. While not impossible, an urban fashionista probably would not be the best spokesperson for a nonprofit focused on promoting sustainable agriculture in the global south. A food critic who writes extensively about organic farming and shopping at farmers’ markets, on the other hand, would be a better fit.

Finding the right social media influencers involves more than just referring to industry and social rankings; you’ll have to do your own research to identify these key people. Fortunately, searching for them is not like trying to find Waldo.

Basically, you’ll be relying heavily on search engines and social media to find and befriend these influencers. Here are our tips on engaging with social media influencers.

1. Search online

Search for content –news articles, blogposts, research papers, trade magazines and books – germane to your field of work. Note the authors and their respective sources.

Chances are you’ve already come across these names if you’re already keeping up your industry’s news. Create a spreadsheet where you can record and keep track of these names.

2. “Stalk” them

Plug these names into Twitter and start following them. Add their handles to your spreadsheet and note other interesting facts about them.

Do likewise on other channels, such as Facebook, Google+, LinkedIn, Pinterest and YouTube. Skim through their information and content, and record your findings in your spreadsheet.

Sometimes, social media channels are search engines unto themselves. Run a Twitter search for industry keywords to find people that your Google (or Bing or Yahoo!) search might have overlooked.

3. Measure their social influence

Use Klout or a similar platform to get detailed, statistical analyses of the influencers’ influence. You can use these tools to find more influencers, too.

4. Determine your targets

Now that you’ve gathered information on the persons of interest, narrow the field of candidates. You’re free to lend as much or as little weight to the myriad opinions on the who’s who in the social media sphere.

But at the end of the day, only you can decide who is right for your cause and your campaign. One factor you might consider could be how much time you can devote to engaging with these influencers, in addition to their degree of relevance.

5. Organize them

Once you’ve finalized your selection of social media influencers, group them by categories of your choice. You can create lists on Twitter and circles on Google+ to help manage your interactions.

You can publicize or keep private the lists/circles you make. If you opt to share your lists publicly, be careful how you display them; avoid giving the impression that you’re familiar with these people if you actually haven’t met them before.

6. Interact with them

Across the various platforms, start following your chosen influencers. Listen to what they’re saying. Respond to their thoughts. Start conversations. Ask questions.

This is a marathon, not a sprint

Remember that influencers are ultimately people to connect with, not instruments to be played. So offer ways to serve them; in that way, both your mission and your influencers benefit.

For more info, read our free online guide on social media influencers.

Sara Choe is an online fundraising expert at CauseVox, a crowdfunding platform for nonprofits and social good projects.

          Tackling obesity: Foundations and nonprofits go local for greater impact        


Local nonprofits partner with food markets to provide low-income areas with access to fresh food. © Shutterstock

Special to Philanthropy Journal

Garth Graham

Even as childhood obesity rates are starting to level off in this country, 5 five percent of American children and teens remain severely obese, according to new information from the American Heart Association. Individuals in low-income communities across the nation are statistically more likely to suffer from obesity and obesity-related diseases such as diabetes and heart conditions. 

As obesity rates have increased in the United States, we have been provided a broader view to see and understand the factors that multiply the issue, from genetics to food access. And, unfortunately, it’s a fact that individuals living in low-income communities eat greater amounts of cheap, unhealthy foods, contributing greatly to the public health crisis. 

Driving collaboration—Community by community

Recently, the Aetna Foundation sponsored an international meeting on global health and wellness. The meeting brought together 100 of the most notable national and international experts on obesity and chronic disease. As experts discussed successful efforts to combat obesity, it became clear that local programs are having a significant impact in changing people’s health across the U.S.

As a physician and president of the Aetna Foundation, I’m continuously reminded of the duty we have to help advance the health of children and adults. Over the years, Aetna and the Aetna Foundation have supported disease prevention programs, helped revitalize neighborhoods, provided aid to those in need and listened to the varied voices that shape our community and our nation.

Today, as we work to increase the health and quality of care for individuals and communities, we also focus our energy on possibilities that may lead to meaningful improvements in health and the health care system. Foundations play a vital role in making this happen, with their ability to bring together experts and assets to address the preventive and individualized care that promotes health and wellness. 

Foundations can utilize grant support and research to serve as catalysts for sharing information, collecting data and bridging partners with a common goal in a way that conventional businesses and other nonprofits cannot. We operate in an area that makes it possible to bring together policy makers, businesses, health professionals and community nonprofits to look holistically at the issue at hand and together develop the changes necessary for positive health outcomes. 

Local focus 

Along with the work of foundations and nonprofits on a national level, the Aetna Foundation provides grant support to a number of local nonprofits implementing programs in low-income communities to increase access to healthy, fresh foods. Take, for example, the Double Up Food Bucks program from the Fair Food Network helps recipients of the Supplemental Nutrition Assistance Program (SNAP) make the most nutritious use of their food stamps. Started in 2009 as a pilot project at five Detroit farmers’ markets, the program has expanded to more than 150 markets throughout Michigan. Through this program, SNAP recipients can double their purchasing power at participating farmers' markets to buy locally grown fruits and vegetables. Through a study we supported by Fair Food Network and several similar organizations, we determined that incentive-based programs are effective at promoting healthier eating habits.

In Brooklyn, United Community Centers’ East New York Farms project has significantly increased the availability of fresh produce. In this low-income neighborhood, the project supports two community-run farmers’ markets, manages two urban farms and provides resources and horticultural know-how to expand the number of community gardens and backyard vegetable beds.

On the other side of the country, Special Service for Groups has launched a program to enroll low-income residents of several Asian neighborhoods in their own Community Service Agriculture program, which provides biweekly bags of locally grown, organic Asian vegetables at a greatly reduced price. 

As a foundation, we have a unique opportunity to help improve health and wellness for people across the nation. In my days as a practicing clinician, I held the importance of each and every individual’s health as paramount. In my role as a grant maker, I strive to bring this sense of passion and mindfulness to help change lives through continued research and partnerships.

Dr. Garth Graham is president of the Aetna Foundation. In this role, Dr. Graham is responsible for the Foundation’s philanthropic work, including its grant-making strategies to improve the health of people from underserved communities and increase their access to high-quality health care. A national authority on health disparities and health care quality, Dr. Graham is a frequent spokesperson for the Foundation on health care and health equity issues.

          Cause & Effect: The CFI Newsletter - No. 86        

Cause & Effect is the biweekly newsletter of the Center for Inquiry community, covering the wide range of work that you help make possible. Become a member today!

The Main Events


dawktawk.jpgBerkeley’s KPFA Abruptly Cancels Dawkins Event 

Last Wednesday, the Royal Society released the results of a poll that placed The Selfish Gene by Richard Dawkins atop a list of the most influential science books of all time, a list that includes in its top ten such foundational and revolutionary works as Charles Darwin’s On the Origin of Species and Rachel Carson’s Silent Spring.

Imagine the surprise, then, when two days later Berkeley, California, radio station KPFA suddenly cancelled a speaking engagement with Dawkins scheduled for August 9. Intended as a fundraiser for the station, Dawkins was set to discuss his new book of essays, Science in the Soul: Selected Writings of a Passionate Rationalist, for an audience of several hundred. What happened?

Well, according to a message to ticket holders, KPFA claims to have been unaware of Dawkins’s “views” and considered his comments on Islam to be “offensive” and “hurtful.” (Funny, the station had hosted Prof. Dawkins in 2015 and didn’t seem bothered at the time by his well known criticism of religion, including Islam, Christianity, ` and other faiths.

CFI provided its own public response, lamenting KPFA’s decision and the baseless justification proffered for it. “We understand the difference between a people and the beliefs they may hold,” said CFI’s president and CEO, Robyn Blumner. “All of us must be free to debate and criticize ideas and harmful ideas must be exposed. It is incredibly disappointing that KPFA does not understand this.”

But the clearest and most compelling response came from Prof. Dawkins himself, in an open letter to KPFA. He wrote of his long admiration for KPFA’s journalism, and his decades of support of their work. The cancellation of the August event was “a matter of personal sorrow” for him.

At the core of the conflict, Dawkins pointed out, was the lack of reason and critical thinking that went into the station’s decision to break its commitment. He wrote in his letter:

You conspicuously did not quote a source when accusing me of “abusive speech”. Why didn’t you check your facts – or at least have the common courtesy to alert me – before summarily cancelling my event? If you had consulted me, or if you had done even rudimentary fact-checking, you would have concluded that I have never used abusive speech against Islam.

I have called IslamISM “vile” but surely you, of all people, understand that Islamism is not the same as Islam. I have criticised the ridiculous pseudoscientific claims made by Islamic apologists (“the sun sets in a marsh” etc), and the opposition of Islamic “ scholars” to evolution and other scientific truths. I have criticised the appalling misogyny and homophobia of Islam, I have criticised the murdering of apostates for no crime other than their disbelief. Far from attacking Muslims, I understand – as perhaps you do not – that Muslims themselves are the prime victims of the oppressive cruelties of Islamism, especially Muslim women.

I am known as a frequent critic of Christianity and have never been de-platformed for that. Why do you give Islam a free pass? Why is it fine to criticise Christianity but not Islam?

Neil_deGrasse_Tyson_and_Richard_Dawkins_at_Howard_UniversitySince news of the cancellation broke, a number of leading figures in science and reason have made their voices heard in support of Dawkins. Jerry Coyne called the move “craven”; Steven Pinker told KPFA that “you have handed a precious gift to the political right”; Vilayanur S. Ramachandran called Dawkins “the most intellectually honest and courageous person I know”; and Daniel Dennett (in such a way that only he can successfully pull off) tweeted, “Shame on these Know-nothing Pathetic Fraidy-cat, um, folks!” You can read these responses in full at the Richard Dawkins Foundation website.

In a special message to CFI supporters, Board Chair Eddie Tabash said, “Richard is a kind man, even in the face of unfounded criticism. However, kindness cannot deter us from fighting as hard as we can against this severely troubling action by KPFA.”

Discussion of the controversy continues in the press, with coverage by The New York Times, The Guardian, Newsweek, and more, including KPFA radio itself, where CFI Communications Director Paul Fidalgo tries to explain the distinction between the vital criticism of bad ideas and the demonization of an entire people.

 


12052.jpgBertha Vazquez Publishes Schools’ Evolution Evaluation

It is 2017, and yet the teaching of evolution in public schools remains a flashpoint of controversy. The enduring resistance to evolution education is a primary reason for the existence of TIES, the Teacher Institute for Evolutionary Science, a program of the Richard Dawkins Foundation that trains middle school science teachers to teach evolution.

Leading the work of TIES is Florida middle school science teacher Bertha Vazquez, and as part of her important work for the program, she has been evaluating state evolution education standards throughout the U.S. Her findings have just been published in a new paper for the journal Evolution: Education and Outreach. The results are fascinating and trending in a positive direction.

Bertha’s evaluation looks at school evolution standards using a ten-point scale based on five categories of questions, which determine each state’s grade. For example, New York and Florida are among the states that received an A grade for earning the maximum number of points for meeting certain benchmarks such as providing a clear definition of evolution, presenting several kinds of evidence for evolution, and so on. South Carolina and Tennessee, however, are two states that received F’s because their curricula don’t even mention or define evolution to middle schoolers, among other issues.

If the study had a “winner,” it would be New Hampshire. “New Hampshire should not be commended just for its middle school standards on evolution,” writes Bertha. “It starts incorporating evolution into the curriculum earlier than any other state.”

The full paper can be accessed here.

 

News from the CFI Community


DFCs0hiXsAEJmih.pngPoint of Inquiry...IN SPACE!!!

When will humans set foot on Mars? What are the prospects for NASA in the Trump era? And what exactly did Mike Pence touch that he clearly wasn’t supposed to? All these burning questions and more are answered in the latest episode of CFI’s long-running flagship podcast Point of Inquiry.

Host Paul Fidalgo is joined by Loren Grush, space reporter for The Verge, for a fun and enlightening conversation about the drama, politics, and technological challenges of space exploration. Grush brings both passionate enthusiasm and healthy skepticism to her coverage of space, providing sharp analysis of the private space industry, public attitudes toward space exploration, and the hostility that women in the space community continue to face.

And of course, we’ll find out if the vice president ruined something expensive.

There’s more space-talk in the next episode of Point of Inquiry coming later this week, when the subject turns to extraterrestrial life, so be sure to subscribe free on iTunes, Google Play, or through your podcast service of choice.

 


14523152_10154078848800698_2045554596559655301_n.jpgCountdown to CSICon 2017: New Videos with Paul Offit and Joe Nickell

For several weeks now, CFI’s video series Reasonable Talk has been bringing you some of the excellent presentations that made CSICon 2016 such a fantastic event. We have two more for you, hot off the servers, all in a blatant effort to inspire you to get registered for CSICon 2017 this October 26–29 in Las Vegas!

  • Paul Offit is a leading light in science and skepticism for his work as a life-saving virologist and as a bestselling critic of the anti-vaccine movement and other kinds of fake medicine. In his CSICon 2016 presentation, Offit takes a critical look at the medical profession itself, going back centuries to see how opioids have been used and misused by physicians and patients and showing how the over-prescription of painkillers has enabled today’s opioid crisis.
  • CFI’s own Joe Nickell is the world’s best known investigator of the paranormal, with decades of experience uncovering the truth about claims of ghost sightings, UFO encounters, psychic powers, and more. But what also sets Joe apart is his compassion and empathy for those who believe they have had these supernatural experiences and his steadfast devotion to the pursuit of the truth over merely proving someone wrong. In his presentation, Joe discusses the crucial distinction between “investigation” and “debunking.”

Plus: Susan Gerbic has a special interview with CSICon 2017 speaker and mentalist Mark Edward.

Now it’s your turn to investigate all the goings-on at the next big event, CSICon 2017. Incredible speakers and exciting entertainment await at Las Vegas’s Excalibur Hotel and Casino. But don’t take these claims at face value. Investigate them yourself and get registered now.

 

CFI Highlights on the Web


  • flatearth.pngCraig A. Foster, a professor of psychology at the U.S. Air Force Academy who has contributed to Skeptical Inquirer, writes an op-ed in The Denver Post welcoming the sudden attention given to Flat Earthers. Touting his membership with CFI’s Committee for Skeptical Inquiry, he asserts that Flat-Earthers present a prime opportunity to discuss the importance of applying critical thinking to outlandish beliefs.
  • Marking the 70th anniversary of the Roswell UFO sightings, Kendrick Frazier, editor of Skeptical Inquirer, writes in a piece for the Albuquerque Journal about how the story has managed to endure all these decades, concluding, “Established facts of the Roswell incident will of course never catch up with the charming myth.”
  • For a short while in recent weeks, it seemed to many that the mystery of Amelia Earhart had been solved. But as Benjamin Radford points out in a special report, the claims were laughably easy to disprove and show us how the History Channel, which promoted the finding, went “spectacularly off the rails.”
  • For his latest Unco Junto “blog symposium,” Ben assembles Michael Hartwell, Ian Harris, and Celestia Ward (taking part in web-comic form) to weigh in on the topic of hypocrisy.
  • Recent skeptics’ conferences are reviewed for CSI, with Susan Gerbic at SkeptiCal 2017 and Russ Dobler at the ninth Northeast Conference on Science and Skepticism.

And of course, you can keep up with news relevant to skeptics and seculars every weekday with The Morning Heresy.


Upcoming CFI Events


July 26:

  • Paul HannCFI Michigan hosts a presentation on environmental health after the Flint water crisis by Paul Hann, executive director of the Healthy Homes Coalition of West Michigan.

July 29:

August 9:

August 10:

August 13:

August 19:

August 21:

August 23:

August 27:

 

Thank you!


Everything we do at CFI is made possible by you and your support. Let’s keep working together for science, reason, and secular values.  Donate today!


CFI Logo MarkFortnightly updates not enough? Of course they’re not.

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Cause & Effect: The Center for Inquiry Newsletter is edited by Paul Fidalgo, Center for Inquiry communications director.

The Center for Inquiry (CFI) is a nonprofit educational, advocacy, and research organization headquartered in Amherst, New York, with executive offices in Washington, D.C. It is also home to both the Committee for Skeptical Inquiry, the Council for Secular Humanism, and the Richard Dawkins Foundation for Reason & Science. The mission of CFI is to foster a secular society based on science, reason, freedom of inquiry, and humanist values. Visit CFI on the web at www.centerforinquiry.net. 



 


          Obituary: Estella A. Carabajal        
Estella A. Carabajal February 2, 1924 - November 28, 2011 Estella was born in Albuquerque, New Mexico. She came to California in 1944 with her family. She resided in Bakersfield from 1970 until her death. She is preceded in death by her son Kenneth J. Carabajal. She is survived by her husband Ernest B. Carabajal; her sons Ernest Carabajal Jr. and wife Maye, Steven J. Carabajal and wife Susan of Bakersfield. Her daughter Victoria L. Carabajal of Bakersfield. Grandchildren: Paulette Raper and husband Jeff, Craig Carabajal, Holly Garcia and husband Anthony, Heather Carabajal, Daniel Carabajal and wife Dawne, Amanda Rodriguez and husband Ryan, Cory Carabajal, Cody Carabajal. Great Grandchildren: Kayla Thomas, Jacob Raper, Crissy Raper, Kailey Fernandez and husband Sonny, Cassidy Carabajal, Campbell Carabajal, Molly Rodriguez. Her brother Raymond Armijo, her sister Frances Harvey. Thank you to the staff and physicians at the Golden Living Center and with Optimal Hospice. Visitation/Rosary services will be held on Thursday, December 8, 2011 starting at 6:00pm at Hillcrest Mortuary. A mass will be held on Friday, December 9, 2011 at 10:30am at Our Lady of Guadalupe Church. Hillcrest Memorial Park & Mortuary www.bakersfield.com/obits
Published in Bakersfield Californian on December 7, 2011

          How to Apply for Green Card for Parent, Spouse in 5 Minutes        
Applying for a K-4 visa The following documents are required: Two copies of the DS-156 application form Two passport-sized, frontal view color photographs with a white background of the principal K-3 and K-4 visa applicant Local police certificates of the principal K-3 and K-4 visa applicant Birth certificates of the principal K-3 and K-4 visa applicant Local marriage certificate of the principal K-3 applicant Divorce or Death certificates of the principal K-3 applicant Medical report from one of the Embassy's panel physicians Separate valid passports of the principal K-3 and K-4 visa applicant Children of K-1 fiance(e) visa holders One of the priveleges of having a K-1 visa is that you may bring your children under age 21 with you. They will need a K-2 visa. When you apply to bring your fiance(e) to the United States, you should apply for their unmarried, minor children at the same time. They may work in the US on this visa. Frequently Asked Questions 3470 Can I be denied a K-4 visa if my name is not mentioned on my K-3 parents' I-129F petition for alien fiance(e)? No, you won't be denied the K-4 visa because your name is not listed in the Form I-129F, Petition for Alien Fiance(e), filed by your K-3 parent as long as you are able to establish that you are the minor, unmarried child of the applicant issued a K-3 visa. Free application Forms, 65434
          The Pseudoscientists Episode 124: Dystopian Sci-Fi City        

Podcast Feature Image 2 scale

Joanna, Nicola and Jack discuss the heavy topic of physician-assisted suicide/euthanasia, why it costs so much to make drugs, and why antibiotic resistant-bacteria might be a bigger future health problem than HIV/AIDS, while "gynandromorphism" is delved into on Jargonauts.
          Sports and Orthopedic Center to Participate in 2012 Dolphins Cycling Challenge        

The 2012 Dolphins Cycling Challenge will take place in South Florida on November 3rd and 4th. The physicians at Sports and Orthopedic Center, Dr. Manish Gupta and Dr. Jace Provo, will be participating in this year's ride to help raise money for cancer research. This is part of Sports and Orthopedic Center's continuing commitment to serving the South Florida community.

(PRWeb October 31, 2012)

Read the full story at http://www.prweb.com/releases/SportsMedicineBocaRaton/DolphinsCyclingChallenge/prweb10071970.htm


          Orthopedic Specialists to Join Florida Atlantic University as a Team Physician for Anticipated 2011 Football Season Opener in The Swamp        

Dr. Manish Gupta of Specialty Orthopedic Center Proudly Joins FAU Football’s Medical Staff

(PRWeb September 01, 2011)

Read the full story at http://www.prweb.com/releases/SpecialtyOC/Coach/prweb8764607.htm


          Dark Money and the new American politics        


Last weekend I finished Dark Money by Jane Mayer, which appeared last year.  It was marketed, largely, as a history of the involvement of the fossil fuel magnates Charles and David Koch in American politics over the last few decades, but it is much more than that.  I intend in what follows to summarize what I found in the book, but from a slightly different perspective than Mayer’s, and without much of any attention to the voluminous, and fascinating, personal data that she provides about the Kochs and other financiers of our new “conservative” political movement.  Instead I am going to treat the book as the first draft, as it were, of a genuine political history of the last 40 or 50 years—because it explains more about where we are and how we got here than anything else that I have ever read.   Mayer leads her readers through the story in rough chronological order, and I recommend the book to everyone.  I on the other hand am going to try to identify its major features in an effort to explain how we got to the miserable point at which we find ourselves.

Charles and David Koch are the most striking example of extraordinarily wealthy Americans who have had an outsized impact on the politics of the last forty years—and whose impact is reaching a new peak right now.  They followed in the footsteps of their father Fred, who in the 1950s was one of the founding members, along with candy manufacturer Robert Welch, of the John Birch Society.  Nothing illustrates what has happened to American politics in my lifetime in more striking fashion than this.  The ideas of the John Birch Society, a group of fanatically anti-government lunatics who in the 1950s identified Dwight D. Eisenhower as a member of the international Communist conspiracy, are now the single most influential set of ideas in American political life. Their main tenets are an unlimited faith in free enterprise and a conviction that government attempts to moderate the negative impacts of capitalism are simply a power grab designed to establish dictatorship.  And because of the success of their political movement, their fortunes have grown by orders of magnitude over the last few decades.

In addition to the Kochs, the superrich political elite has included John Olin, a chemical manufacturer; Richard Mellon Scaife, a scion of a Pittsburgh family prominent in banking and industry; and Harry Bradley, another Birch Society acolyte who ran the Allen-Bradley Electronics Company in New York.  In the middle of the twentieth century, when marginal income tax rates topped out at 91%, these men had all taken advantage of a provision in the tax code—first used by the Rockefeller family—to create a “philanthropic” foundation to shield substantial portions of their enormous income from taxes.  Unfortunately, the definition of philanthropy has been broad enough to include the subsidy of a particular ideology—and ultimately, direct intervention in politics.  That one tragic flaw in our tax code has reshaped opinion and redistributed power at every level of American government.

            Now I have rarely been impressed by any of the ideas coming out of the new Right during the last few decades, but like many liberal Democrats, I suspect, I have assumed that conservative intellectuals had honestly come by their ideas.  I am not suggesting now that they have lied about them, but Mayer leaves no doubt that the entire new right wing intellectual establishment was created from the ground up by the handful of major benefactors listed above.  Both the American Enterprise Institute and the Heritage Foundation—the two centers of conservative “thought” in Washington—were originally funded largely by Richard Mellon Scaife. The Bradley and Olin Foundations were also powers behind the Heritage Foundation, and the Kochs have been involved as well.  I have always thought of the Cato Institute as a nest of principled libertarians—partly because it tends to oppose foreign interventions—but it turns out to have been started by Charles Koch.  Charles Murray was an unknown writer before the Olin foundation adopted him and subsidized his first book, Losing Ground, arguing that social programs were hurting the poor.  (Spoiled, perhaps, by success, Murray went a bridge too far when he and Richard Herrnstein argued in The Bell Curve that black people were intellectually inferior to whites.)  And I was amazed to learn from Mayer that the Bradley foundation gives four annual awards of $250,000 each to leading conservative journalists, activists, and intellectuals. Winners have included George Will, Charles Krauthammer, Thomas Sowell, Ward Connerly, Heather MacDonald, Shelby Steele, Victor Davis Hanson, John Bolton, William Kristol, Paul Gigot, Michael Barone, Jeb Bush, Harvey Mansfield, Edwin Meese, Roger Ailes of Fox News, General John Keane, and Charles Murray.

Changing the intellectual climate was step 1 in the program.  Another spectacularly successful front was opened within the American legal system, Started in 1982 with money from the Olin Foundation and affiliates of the Scaifes and the Kochs, the Federalist Society has become a behemoth, an organization of conservative legal thinkers that includes all the conservative members of the US Supreme Court.   That is not all. The Olin Foundation has sponsored two week seminars on Law and Economics for sitting judges, somewhat reminiscent of the seminars drug companies hold for physicians at major resorts.  There they have exposed sitting judges to the evils of regulation and the glories of the free market—and this may explain some of the more extraordinary decisions that federal courts have handed down lately, such as one that limited the legal definition of insider trading to narrowly as to make most prosecutions for it impossible.

Nor is this all: the foundations have not hesitated to challenge liberal intellectuals in their own presumed stronghold, universities.  Using the irresistible lever of their wealth—which no American university, in this day and age, can resist—they have established beachheads such as the Olin Center at Harvard University (promoting conservative ideas on foreign policy) and several institutes at George Mason University, conveniently located in the Washington suburbs.  These have opened career paths for conservative public policy intellectuals—at the same time that mainstream academic departments have been going in directions largely irrelevant to real politics.

This vast intellectual infrastructure works in tandem, of course, with the right wing media, led by Fox News and Clear Channel Radio, to shift public opinion on key events.  The alternative media outlets are largely self-financing, of course, but I was very surprised that another key rightwing organization, Freedom Works—funded largely by the Scaife foundation—had paid Glenn Beck more than $1 million a year to allow them to write his monologues.  And this infrastructure has not only convinced many Americans, and probably most better-off Americans, that social programs do more harm than good, but it has also convinced millions that lower taxes on the wealthy increase economic growth—and, critically, created real doubt as to whether man-made global warming exists.  Mayer traces the campaign against global warming effectively.  It employed some of the same personnel and used the same playbook as the tobacco companies’ earlier effort to create doubt as to whether cigarettes caused cancer—but evidently with far more significant results.  (I am leaving out of this essay the names of many key operatives within the network who have organized particular legal, lobbying and electoral campaigns.  They are the battlefield commanders of our new political struggle.)  The intellectual infrastructure also carries out campaigns against academics and journalists who stand in its way—including Mayer herself.

The other long-running campaign waged by the new right was the attempt to undo a century of regulation of spending on political campaigns. At the dawn of the Progressive Era a consensus emerged that the influence of money on politics had to be restricted, and Watergate had reinforced that lesson. But the counteroffensive against regulation began in the decade after Watergate, won various victories, and culminated in the Citizens United decision, the Kochs’ and their allies’ greatest and perhaps most influential triumph.  The floodgates are now open, and the results are clear for all to see.

The right wing network gained much power over the Republican Party by 2000 and was rewarded by very friendly Bush Administration policies towards the energy industry, which turned fracking loose and set the US on the path to energy independence.  It could not prevent a groundswell of negative feeling against the Bush Administration in its second term, however, or stop the election of a Democratic Congress and Barack Obama.  But it went into high gear to stop Obama from accomplishing very