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Last updated: Fri, Jan 3
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "If you were led blindfolded from Los Angeles' grand city hall a few blocks east, you would know when you entered Skid Row. There is the pungent smell of urine and burning marijuana smoke, and the sound of music and easy laughter. A carnival rising out of misery. This is the chaos that Chris Mack plunges into on most days. Once homeless himself, Mack is an outreach worker for the JWCH Institute's Center for Community Health, a free clinic that sits at the heart of Skid Row" (Varney, 1/2). Read the story.
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Kaiser Health News staff writer Daniela Hernandez reports: "In Silicon Valley, the executives and engineers who've helped build the Apple, Google and Facebook empires earn high salaries and enjoy a slew of perks, including stellar health benefits. The clients of the Ravenswood Family Health Center, a community clinic in East Palo Alto just two miles away from Facebook's sprawling headquarters, live in a very different Silicon Valley. They're the gardeners, nannies, factory workers and service staff who keep Silicon Valley homes and offices humming, the lawns manicured and the families comfortable" (Hernandez, 1/3). Read the story.
Kaiser Health News consumer columnist Michelle Andrews answers this question from a reader (1/3). Read her response.
Kaiser Health News staff writer Phil Galewitz reports: "Now, though, most of its major provisions are in effect, and arguments may hinge less on ideology and more on how the law is actually working for millions of people – for instance, how many get coverage through online marketplaces; whether they're able to see doctors when they need them; how they rate that care; and perhaps most important, whether having that coverage improves their lives in tangible ways. … No question that partisans on both sides will keep spinning, especially in the run-up to the 2014 midterm elections. To help make sense of the challenges ahead, here are six things that are likely to be important measuring sticks of the law in 2014 and beyond" (Galewitz, 1/3). Read the story.
Now on Kaiser Health News' blog, the St. Louis Post-Disptach's Virginia Young, working in partnership with KHN, reports on Missouri's Medicaid expansion: "Missouri Gov. Jay Nixon, a Democrat, is intensifying his effort to persuade Republican lawmakers to expand Medicaid with a pitch that uses some of the same themes that Republicans favor. At a news conference in his Capitol office this week, Nixon praised states such as Iowa and Arkansas for designing "common-sense, market-based approaches" that encourage personal responsibility on the part of Medicaid participants" (Young, 1/2).
Also on Capsules, Oregon Public Broadcasting's Kristian Foden-Vencil reports on how one health plan is working with elementary schools to encourage good health: "Behaving well in elementary school could reduce smoking in later life. At least, that's what Trillium Community Health Plan hopes, and it's putting money behind the idea. Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the 'Good Behavior Game.' Teacher Cami Railey sits at a small table, surrounded by four kids. She's about to teach them the 's' sound and the 'a' sound. But first, as she does every day, she goes over the rules" (Foden-Vencil, 1/2).
In addition, you can watch a video of KHN's Julie Appleby on PBS NewsHour Thursday discussing the status of the health law rollout as of Jan. 1. Check out what else is on the blog.
Kaiser Health News provides a fresh take on health policy developments with "A Cautionary Tail?" by Chris Wildt.
Here's today's health policy haiku:
If you go to the
doctor, and your health plan works,
will it make the news?
If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
News outlets take a look at how the health law's implementation is working out on the ground during these first days of January.
The Wall Street Journal: Consumers Hit Snags As Health Law Kicks In
Consumers began test-driving insurance coverage under the federal health-care law Thursday, seeking care at pharmacies and clinics, and in some cases running into hiccups as their policies took effect. Doctors' offices, hospitals and pharmacies said they saw a limited number of people with the new insurance, which kicked in at the beginning of the year (Mathews, Martin and Weaver, 1/2).
Politico: Quiet Start To Noisy Health Law
For a law that's inspired a lot of noise, the start of Obamacare coverage has been quiet. The health care industry is still trying to diagnose the depth of any implementation issues with the president's health care program since coverage took effect Jan. 1. Providers, insurers and patient advocates say it's too early to know whether people are rushing to get care or running into problems when they try to use their new insurance for the first time (Millman, 1/2).
The Washington Post's The Fact Checker: The White House's Claim That 7 Million Enrolled In Obamacare 'Was Never Our Target Number'
The White House this week crowed about the fact that, as of the end of the year, 2.1 million Americans have signed up for insurance either through the federal health care exchange or state-run exchanges. The message was that the Affordable Care Act Web site, which had a troubled launch, was turning a corner. At the same time, the administration has backed away from the idea that it suggested that it had a "target" of 7 million enrollees when the enrollment period for 2014 ends in March. As [White House aide Phil] Schiliro put it, "that was never our target number." Let's explore this figure and the administration's enrollment claims (Kessler, 1/3).
The Associated Press: Health Care Glitch Affects 18K W. Virginia Residents
A state official says a glitch in the federal health insurance marketplace has affected about 18,000 West Virginians trying to sign up for coverage under the Affordable Care Act. Jeremiah Samples of the state Department of Health and Human Resources tells the Charleston Gazette the federal exchange is having problems transferring account information to and from West Virginia's system. He says some other states are having the same problem (1/2).
The Oregonian: Cover Oregon Director Rocky King Resigns Citing Medical Reasons
Rocky King, Cover Oregon's executive director, gave notice of his resignation on Jan. 1, clearing the way for a permanent replacement. King announced his medical leave on Dec. 2, after which Oregon Health Authority Director Bruce Goldberg took over the post on an interim basis. King at the time cited an undisclosed medical condition that had already cost him significant time off work in the previous two years (Budnick, 1/2).
The CT Mirror: Obamacare Coverage Starts, But Some CT Customers Are Still Waiting
More than 34,000 state residents were slated to begin new private insurance plans Wednesday as part of the federal health law. But as the new year began, many people who bought policies through the state's health insurance exchange still hadn't received their first premium bills, which must be paid by Jan. 10 to get coverage this month. John Calkins, a Watertown insurance agent, is among those getting calls from clients who are "panicking a little bit" (Becker, 1/2).
Minnesota Public Radio: Even After January Coverage Deadline, MNsure Struggles
MNsure's serious problems continue even after Tuesday night's deadline for Minnesotans to sign up for coverage that would take effect Wednesday, Jan. 1. In theory, the end of the deadline rush might have resulted in a let-up in traffic on the site. But people hoping to access MNsure's website on Thursday were stymied for most of the business day (Catlin, 1/2).
The Star Tribune: Login Snag Prompts MNsure Website To Go Offline
Glitches and hitches continue to mar the MNsure website, even as the first of several enrollment deadlines for the state's new online insurance exchange has come and gone. The website went down Thursday about noon with a problem in the login area, MNsure spokesman John Schadl said. Consumers found a message that said: "Application and account services are currently unavailable. We are actively working on a resolution and ask that you visit us at a later time. We apologize for the inconvenience" (Crosby, 1/3).
California Healthline: Exchange Applications Hit Million Mark
Covered California signed up roughly 400,000 people for health insurance through Dec. 22, according to a preliminary estimate of enrollment numbers by Peter Lee, executive director of Covered California. The exchange topped the million mark for enrollment applications in the first three months of open enrollment with an official total of 1,064,872 applications through Dec. 28. The official release of complete December enrollment data is expected in mid-January (Gorn, 1/2).
Some people who applied early in the open enrollment period may not actually be signed up for the program and may be flummoxed by federal robocalls encouraging them to apply again directly to state agencies. Also, news outlets offer updates from Missouri, Pennsylvania and Maryland.
CQ HealthBeat: Federal Robocalls Urge Medicaid Applicants On Healthcare.Gov To Reapply For Coverage
Most consumers who applied for Medicaid coverage through healthcare.gov soon after the open enrollment period began on Oct. 1 under the health law still have not started receiving health benefits, said state Medicaid officials in two states and a National Association of Medicaid Directors official. People who have applied for Medicaid through healthcare.gov may be confused by federal robocalls that are now encouraging them to apply again through state agencies (Adams, 1/2).
Kaiser Health News: Capsules: Missouri Governor Pushes GOP-Led Legislature On Medicaid Expansion
Missouri Gov. Jay Nixon, a Democrat, is intensifying his effort to persuade Republican lawmakers to expand Medicaid with a pitch that uses some of the same themes that Republicans favor. At a news conference in his Capitol office this week, Nixon praised states such as Iowa and Arkansas for designing "common-sense, market-based approaches" that encourage personal responsibility on the part of Medicaid participants (Young, 1/2).
The Associated Press: Pa. Issues Warning Over Medicaid File Problems
Pennsylvanians who applied for health insurance through the federally run website Healthcare.gov and were found to be eligible or potentially eligible for Medicaid were cautioned Thursday by Gov. Tom Corbett's office that they may not have coverage yet. An administration spokesman said the federal government continues to have trouble transferring the electronic files of more than 25,000 applications to the state's Department of Public Welfare (Levy, 1/2).
The Baltimore Sun: State Leaders Embrace Medicaid Expansion
Nearly two out of every three people signing up for health care coverage so far on Maryland's troubled insurance exchange qualified for Medicaid — helping the state top its goal for the program's enrollment. Enrolling more lower-income residents in the state and federal insurance program has been embraced by state leaders as a success amid all the exchange's difficulties (Cohn, 1/2).
A variety of lists detail important provisions of the overhaul and how they might impact the public's feelings about it.
Kaiser Health News: Six Things That May Move Public Perception Of Obamacare
Now, though, most of its major provisions are in effect, and arguments may hinge less on ideology and more on how the law is actually working for millions of people – for instance, how many get coverage through online marketplaces; whether they're able to see doctors when they need them; how they rate that care; and perhaps most important, whether having that coverage improves their lives in tangible ways. … No question that partisans on both sides will keep spinning, especially in the run-up to the 2014 midterm elections. To help make sense of the challenges ahead, here are six things that are likely to be important measuring sticks of the law in 2014 and beyond (Galewitz, 1/3).
Medpage Today: 6 Things Docs Should Know About The ACA
MedPage Today reached out to a handful of experts to see what they think doctors should know and be aware of as the law's coverage expansion starts. 1. Many new plans will carry extremely high deductibles: Consumers who purchased coverage through the ACA's health insurance exchanges or marketplaces quickly found the cheapest option for them in many cases was "bronze"- or "silver"-level plans. However, those plans have the highest amount of cost-sharing via deductibles and copayments (Pittman, 1/2).
Politico Pro: 5 Key Questions About The Legal Issues Of The Contraception Mandate
The contraceptive coverage issue is already heading to the Supreme Court in two cases brought by for-profit companies. But dozens of religious-affiliated groups, from universities to social welfare organizations, have also petitioned federal courts to eliminate the requirement as well. In all, more than 90 legal challenges have been filed around the country. A Supreme Court decision against the contraceptive rule, whether in a case brought by a religious-affiliated plaintiff or for-profit company, would undercut but not cripple the ACA. Here are five questions and answers on the latest developments (Haberkorn, 1/3).
Health law coverage includes how the measure's implementation impacts a variety of different populations, as well as other key policy issues.
Kaiser Health News: Obamacare Comes To Skid Row
If you were led blindfolded from Los Angeles' grand city hall a few blocks east, you would know when you entered Skid Row. There is the pungent smell of urine and burning marijuana smoke, and the sound of music and easy laughter. A carnival rising out of misery. This is the chaos that Chris Mack plunges into on most days. Once homeless himself, Mack is an outreach worker for the JWCH Institute's Center for Community Health, a free clinic that sits at the heart of Skid Row (Varney, 1/2).
Kaiser Health News: Many Spanish Speakers Left Behind In First Wave Of Obamacare
In Silicon Valley, the executives and engineers who've helped build the Apple, Google and Facebook empires earn high salaries and enjoy a slew of perks, including stellar health benefits. The clients of the Ravenswood Family Health Center, a community clinic in East Palo Alto just two miles away from Facebook's sprawling headquarters, live in a very different Silicon Valley. They're the gardeners, nannies, factory workers and service staff who keep Silicon Valley homes and offices humming, the lawns manicured and the families comfortable (Hernandez, 1/3).
The Associated Press: Adding A Baby To A Health Plan Not Easy
There's another quirk in the Obama administration's new health insurance system: It lacks a way for consumers to quickly and easily update their coverage for the birth of a baby and other common life changes. With regular private insurance, parents just notify the health plan. Insurers will still cover new babies, the administration says, but parents will also have to contact the government at some point later on (Alonso-Zaldivar, 1/3).
Los Angeles Times: Compromise Remains Elusive On Health Law's Contraceptive Coverage
The intensifying Supreme Court clash over whether birth control should be required under President Obama's signature healthcare law has revealed just how deep divisions remain between administration officials and Catholic leaders over where to draw the line between religious freedom and women's reproductive rights (Savage and Levey, 1/2).
Americans For Prosperity, a group backed by the billionaire Koch brothers, said it will spend $2.5 million for TV ads targeting three vulnerable Democrats who supported the health care law -- Sens. Kay Hagan of North Carolina, Mary Landrieu of Louisiana and Jeanne Shaheen of New Hampshire. Other groups are using dueling personal stories to try to sway public opinion.
The New York Times: New Ad Campaign Criticizes Senators For Support Of Health Law
A conservative advocacy group backed by the billionaire Koch brothers said Thursday it will spend $2.5 million on television advertisements targeting three vulnerable Democratic senators who supported President Obama's health care law. Americans for Prosperity, which last year spent more than $16 million on television ads attacking the law popularly called "Obamacare," is running the ads against Senators Kay Hagan of North Carolina, Mary L. Landrieu of Louisiana and Jeanne Shaheen of New Hampshire, all Democrats who face tough re-election fights this year. They will air on cable and broadcast networks in the three states (Stolberg, 1/2).
Politico: Americans For Prosperity Launches Obamacare Blitz
The deep-pocketed Americans for Prosperity on Thursday morning unveiled a major Obamacare air offensive against three Democratic senators up for reelection in November. The group will begin airing 30-second ads this week targeting Sens. Mary Landrieu of Louisiana, Kay Hagan of North Carolina and Jeanne Shaheen of New Hampshire. The total ad buy is north of $2.5 million and the spots will run for three weeks in each state's major media markets, AFP said (Everett, 1/2).
Los Angeles Times: Next Phase Of The Obamacare Battle: Dueling Personal Stories
Those sorts of dueling stories are the next phase of the battle over Obamacare, and the question of which version Americans will find most compelling could tip the balance in a dozen or so Senate races this year that will determine the balance of power in Washington (Reston, 1/2).
Some insurers are pushing for a nationwide, as opposed to state-by-state, approach to policy fixes to the Affordable Care Act. Many also report that enrollment data errors remain a problem, despite assurances by the Obama administration.
Modern Healthcare: Payers At Odds Over Implementing Obamacare Policy Fixes
Some payers are pushing for nationwide implementation, rather than a state-by-state approach, to Patient Protection and Affordable Care Act policy fixes HHS suggested in December. Others, however, argue for maintaining the status quo to avoid further complications for insurers. The fixes are designed to offset financial losses plans may face after the Obama administration announced it is allowing people to keep plans that do not comply with the benefit standards in the act (Dickson, 1/2).
CQ HealthBeat: Insurers Say Enrollment Data Errors Still A Problem, Despite Officials' Assurances
Insurance companies continue to find that enrollment information for consumers who sign up for coverage through healthcare.gov is not always being sent on to the insurers, even though federal officials said they have fixed the issue. With enrollment growing, the number of missing enrollment reports could be increasingly problematic (Adams, 1/2).
A new study of a 2008 expansion of Oregon's Medicaid program showed those with new coverage used emergency rooms 40 percent more often than other adults, throwing some water on the long-held argument that expanding Medicaid coverage lowers ER usage and boosts primary care visits.
NPR: Medicaid Expansion Boosted Emergency Room Visits In Oregon
Giving poor people health insurance, the belief was, would decrease their dependence on hospital emergency rooms by providing them access to more appropriate, lower-cost primary care. But a study published in the journal Science on Thursday finds that's not the case. When you give people Medicaid, it seems they use both more primary care and more emergency room services (Rovner, 1/2).
The Oregonian: Oregon Study Finds That Medicaid Coverage Increases Emergency Room Visits
Advocates of universal health coverage have long argued that better access to primary care will lead to a reduction in costly emergency room visits. But a new study conducted in Oregon has found the reverse is true. Researchers poring through hospital administrative records found that expansion of the Medicaid-funded Oregon Health Plan in 2008 led to a 40 percent increase in emergency department usage by people in the 15 months after they enrolled, according to a study released Thursday in the journal Science (Budnick, 1/2).
Los Angeles Times: Expanding Medicaid Increases ER Visits In Oregon Study
An Oregon Medicaid expansion program found that low-income adults who were covered by government health insurance had visited hospital emergency rooms 40 percent more often than other adults. The study, published online Thursday in the journal Science, comes at a time when many states are expanding Medicaid as part of the Affordable Care Act, or Obamacare. While federal and state policymakers have argued that expanding Medicaid would reduce costly and inefficient use of hospital emergency rooms by increasing access to primary healthcare, the Science study suggests this is not the case (Morin, 1/2).
The New York Times: Emergency Visits Seen Increasing With Health Law
Supporters of President Obama's health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits because people would go to primary care doctors instead. But a rigorous new experiment in Oregon has raised questions about that assumption, finding that newly insured people actually went to the emergency room a good deal more often (Tavernise, 1/2).
The Washington Post's Wonkblog: Study: Expanding Medicaid Doesn't Reduce ER Trips. It Increases Them.
As the health care law expands Medicaid to cover millions more Americans, a new Harvard University study finds that enrollment in public program significantly increases enrollees' use of emergency departments. The research, published Thursday in the journal Science, showed a 40 percent increase in emergency department visits among those low-income adults in Oregon who gained Medicaid coverage in 2008 through a state lottery. This runs counter to some health-care law supporters' hope that Medicaid coverage would decrease this type of costly medical care, by making it easier for low income adults to see primary care providers (Kliff, 1/2).
The Wall Street Journal: Putting The Uninsured On Medicaid Doesn't Cut ER Visits
Some supporters of President Barack Obama's health care overhaul say that putting uninsured Americans on Medicaid will reduce costly emergency-room visits by giving them more access to care in other settings. But a new study found the reverse: A group of 10,000 low-income Oregon residents who recently obtained Medicaid coverage visited ERs 40 percent more often than those without insurance (Beck, 1/2).
The Associated Press: Study Finds Medicaid Expansion Drove Up ER Visits
A new study has found that people enrolled recently in Medicaid went to the emergency room 40 percent more frequently than others, often seeking help for conditions that could be treated less expensively in a doctor's office or an urgent care clinic (Cooper, 1/2).
Marketplace: How Obamacare Will Change The Emergency Room
A new report looking at the Oregon Medicaid program compares emergency room use between the uninsured and people with Medicaid -- the health care program for primarily low income and disabled people. And the report already has pundits worked up, especially with 9 million Americans projected to newly sign up for Medicaid this year under the Affordable Care Act. The reason this is so hot -- at least politically -- is because the report over turns conventional health care thinking (Gorenstein, 1/2).
Medpage Today: Medicaid Growth Burdens EDs
A sudden influx of patients insured through Medicaid was associated with a 40 percent increase in emergency department visits, researchers found. Under a lottery-based Medicaid program in Oregon, Medicaid enrollment increased the probability of visiting an emergency department by 7 percentage points and increased the number of emergency department visits by 40 percent relative to a control mean of 1.02 visits, according to Sarah Taubman, ScD, of the National Bureau of Economic Research in Cambridge, Mass., and colleagues (Petrochko, 1/2).
In what will likely be the GOP's first effort in 2014 to undercut the health law, House Majority Leader Eric Cantor, R-Va., said Thursday he plans to bring up the measure next week.
Politico: Eric Cantor Plans Vote On Obamacare
House Majority Leader Eric Cantor said Thursday that he plans to schedule a vote next week on a measure placing more security requirements on the new Obamacare insurance exchanges. He said he'll draw from legislation that's been introduced by Reps. Diane Black of Tennessee, Kerry Bentivolio of Michigan and Gus Bilirakis of Florida (Cunningham, 1/2).
Roll Call: House Will Vote On Obamacare Security Bill Next Week
House Republicans will kick off the second session of the 113th Congress next week by voting on another bill to undercut the president's health care law. In a memo sent to Republican colleagues on Thursday, Majority Leader Eric Cantor, R-Va., announced that the chamber would take up a measure next week to "strengthen security requirements" on the error-plagued HealthCare.gov website and "require prompt notification in the event of a breach involving personal information" (Dumain, 1/2).
CBS News: Obamacare Reform Tops House GOP's Post-Holiday Agenda
Republicans appear ready this year to focus on Obamacare's shortcomings, and ways to patch over them, rather than make more attempts to repeal the law. A month ago, when asked whether the House would vote on an Obamacare alternative in 2014, all House Speaker John Boehner, R-Ohio, had to say was, "We'll see." Later in the month, Boehner made clear he wasn't interested anymore in listening to conservative groups that convinced the GOP to shut down the government over Obamacare. "They've lost all credibility," he said, getting clearly angry. Outside groups opposed to Obamacare, however, are still waging an aggressive campaign against the law that conservatives hope will pay off in November's midterm elections (Condon, 1/3).
CNN: GOP-Led House Will Kick Off 2014 Like It Spent Most Of 2013
The GOP-led House of Representatives will kick off 2014 – a midterm election year – addressing an issue it spent much of last year debating: Obamacare. House Majority Leader Eric Cantor announced Thursday the House's first order of business when it returns next week from its extended holiday break would be a vote on legislation to address potential security risks for personal information collected on the Obamacare website, HealthCare.gov (Walsh, 1/2).
A selection of health policy stories from the District of Columbia, Kansas, Virginia, Georgia, North Carolina and California.
The Washington Post: D.C. Program Reflects National Trend Toward Moving Older Americans Out Of Nursing Homes
For 60 years, Bobbie Jones, 88, had lived in the same Petworth rowhouse where she raised four children -- including one born in an upstairs bedroom -- and became a grandmother to 10 and a great-grandmother to nine. But last year, a stroke and a fall landed her in the hospital and then in a nursing home. In the past, a nursing home might have wound up being where she lived out the rest of her days. But through a new program that helps District residents receive care in their homes and communities, Jones was able to go home. She is among 58 people who have been relocated since the D.C. Office on Aging launched its Nursing Home Transition Program in April (Bahrampour, 1/2).
Kansas Health Institute: Kansas To Get $10.8 Million Medicaid Bonus From Feds
Kansas will get $10.8 million in additional Medicaid money from the federal government as a bonus for enrolling more children from low-income homes in state-federal health insurance programs. The award was announced today by officials at the federal Centers for Medicare and Medicaid services. It is part of more than $307 million in bonuses to be paid out to 23 states (1/2).
The Richmond Times-Dispatch: McDonnell Names Mental Health Task Force
Gov. Bob McDonnell has named a task force that will meet for the first time next week to examine the gaps in Virginia's fragmented mental health system and recommend ways to fill them. The 36-member task force will convene Tuesday, less than two months after the son of state Sen. R. Creigh Deeds, D-Bath, attacked his father and then took his own life just 13 hours after being released from an expired emergency custody order (Martz, 1/3).
Georgia Health News: Doctor Shortage Remains Acute In Rural Areas
Georgia's physician shortage continues to limit patients' access to care, especially in rural areas, a recently released report indicates. But the report by the Georgia Board for Physician Workforce also highlights some promising trends on doctors practicing in Georgia. The state ranked 39th in the ratio of doctors per 100,000 population in 2010, the latest year for which data are available. That's a slight improvement from Georgia's 40th-place ranking in 2008 (Miller,1/2).
Charlotte Observer: Doctors Allege For-Proft Owner Of Two Local Hospitals Committed Medicare Fraud And Offered Kickbacks
Echoing other complaints across the country, two Charlotte-area emergency room doctors allege the for-profit company that owns hospitals in Mooresville and Statesville offered them illegal kickbacks to order unnecessary tests and admit more patients to increase corporate revenues (Garloch, 1/2).
WRAL: Chapel Hill Doctor Becomes Cheerleader For Health Law
Although still too early to gauge the impact of the Affordable Care Act on the nation's health care system, one Chapel Hill physician says the law will be a game-changer for his patients. ... Dr. Sam Weir said the goals of the law will mean a lot to UNC Family Medicine Center, where about 2,000 patients -- 11 to 12 percent of the clinic's total -- have no insurance (Browder, 1/2).
California Healthline: Los Angeles, Orange Counties Grapple With Shortage Of Nursing Instructors
Difficulty in recruiting nursing instructors may be a harbinger of an inadequate supply of nurses in the future, experts said. There are about 408,000 registered nurses statewide, according to the California Institute for Nursing and Health Care. For registered nursing, the projected rate of growth in employment between 2010 and 2020 is 26 percent, according to the U.S. Dept. of Labor Bureau of Labor Statistics -- faster than the 14 percent average growth rate for all occupations (Stephens, 1/2).
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Annals Of Internal Medicine: Health Policy Basics: Medicaid Expansion
Medicaid is the largest single source of health insurance coverage in the United States, providing insurance for more than 62 million persons and families in 2013. The Patient Protection and Affordable Care Act sought to expand Medicaid eligibility to nearly all low-income persons with incomes up to 138% of the federal poverty level. However, the U.S. Supreme Court ruled that states' expansion would be optional. Although more than half of the states and the District of Columbia have opted to expand Medicaid starting in 2014, many states continue to oppose increasing access to the program. This article will discuss the basic provisions of the expansion and the benefits and challenges patients and physicians may face as Medicaid grows (Crowley and Golden, 12/24).
JAMA Internal Medicine: Preoperative Consultations For Medicare Patients Undergoing Cataract Surgery
Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. ... Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556,637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. ... The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006..... Variation in frequency of consultation across hospital referral regions was substantial, even after accounting for differences in patient-level, anesthesia provider–level, and facility-level characteristics. ... Referrals for consultation seem to be primarily driven by nonmedical factors (Thilen et al., 12/23).
JAMA Surgery: Smoking Status And Health Care Costs In The Perioperative Period
Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear. ... This population-based, propensity-matched cohort study, with cohort membership based on smoking status (current smokers, former smokers, and never smokers) was performed at Mayo Clinic in Rochester ... Compared with never smokers, health care costs during the first year after hospital discharge for an inpatient surgical procedure are higher in both former and current smokers, although the cost of the index hospitalization is not affected by smoking status (Warner et al., 1/1).
JAMA Psychiatry: Race/Ethnicity And Geographic Access To Medicaid Substance Use Disorder Treatment Facilities In The United States
Although substance use disorders (SUDs) are prevalent and associated with adverse consequences, treatment rates remain low. ... We used data from the 2009 National Survey of Substance Abuse Treatment Services public use file and the 2011-2012 Area Resource file to examine sociodemographic factors associated with county-level access to SUD treatment facilities that serve Medicaid enrollees. ... Approximately 60% of US counties have at least 1 outpatient SUD facility that accepts Medicaid, although this rate is lower in many Southern and Midwestern states. ... The potential for increasing access to SUD treatment via Medicaid expansion may be tempered by the local availability of facilities to provide care, particularly for counties with a high percentage of black and/or uninsured residents and for rural counties (Cummings, Wen, Ko and Druss, 12/25).
JAMA Psychiatry: Comorbidity Of Severe Psychotic Disorders With Measures Of Substance Use
Although early mortality in severe psychiatric illness is linked to smoking and alcohol, to our knowledge, no studies have comprehensively characterized substance use behavior in severe psychotic illness. In particular, recent assessments of substance use in individuals with mental illness are based on population surveys that do not include individuals with severe psychotic illness. ... We assessed comorbidity between substance use and severe psychotic disorders in the Genomic Psychiatry Cohort. ... Relative to the general population, individuals with severe psychotic disorders have increased risks for smoking, heavy alcohol use, heavy marijuana use and recreational drug use.... Of specific concern, recent public health efforts that have successfully decreased smoking among individuals younger than age 30 years appear to have been ineffective among individuals with severe psychotic illness (Hartz et al., 1/1).
The Kaiser Family Foundation: Data Note: How Many People Have Nongroup Health Insurance?
The implementation of the Affordable Care Act (ACA) has focused attention on the composition of the nongroup market: how it looked before the new regulatory provisions take effect and how it will change afterwards. ... The pre-reform nongroup market is complicated. It was fairly small, serving less than 5 percent of the nonelderly population, with a much smaller population relying on the nongroup market as their only source of coverage. In addition, the nongroup market experiences substantial turnover. ... The turnover in, and varied populations served by, the pre-reform nongroup market have posed challenges for analysts and others trying to understand the changes occurring under the ACA. The number of people who have and keep nongroup coverage as their primary source of protection is considerably smaller than the number of people in the market at any given point in time. A considerably larger number of people have nongroup coverage sometime during a year, but many have short tenures and may or may not experience any of the changes underway. Looking forward, the size of the market is predicted to grow dramatically as millions of uninsured people, many assisted by new premium tax credits, obtain and retain nongroup coverage (Claxton, Levitt, Damico and Rae, 1/3).
American Journal of Critical Care: Association Of Sleep And Fatigue With Decision Regret Among Critical Care Nurses
Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome. ... Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (Scott, Arslanian-Engoren, Engoren, Jan. 2014).
Journal of General Internal Medicine: National Study Of Health Insurance Type And Reasons For Emergency Department Use
This was a cross-sectional analysis of the 2011 National Health Interview Survey. Adults whose last ED visit did not result in hospitalization (n = 4,606) were asked structured questions about reasons for seeking ED care. We classified responses as 1) perceived need for immediate evaluation (acuity issues), or 2) barriers to accessing outpatient services (access issues). ... Relative to those with private insurance, adults with Medicaid and those with Medicare were similarly likely to seek ED care due to an acuity issue. Adults with Medicaid and Medicaid + Medicare (dual eligible) were more likely than those with private insurance to seek ED care for access issues. ... Policymakers should focus on increasing access to alternate sites of care, particularly for Medicaid beneficiaries, as well as strategies to increase care coordination that involve ED patients and providers (Capp et al., 12/2013).
Here is a selection of news coverage of other recent research:
The New York Times: Common Knee Surgery Does Very Little For Some, Study Suggests
A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports. The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion (Belluck, 12/25).
MedPage Today: USPSTF Finalizes Lung Screening Recs
Annual low-dose CT screening for lung cancer is recommended for high-risk individuals, the U.S. Preventive Services Task Force (USPSTF) announced. The final grade B recommendation [is] for adults ages 55 through 79 with a 30 pack-year history of smoking or who have quit in the past 15 years ... The draft had included in the clinical considerations section a recommendation against screening individuals with significant comorbidity, especially those nearing the age cutoff of 80. The final recommendation, published online Monday in Annals of Internal Medicine, ... repeated it again in the main body of the document (Phend, 12/30/13).
The Washington Post: Stop The Bailout — Now
Shrinking revenues and rising costs could bring on the "death spiral" — an unbalanced patient pool forcing huge premium increases (to restore revenue) that would further unbalance the patient pool as the young and healthy drop out. End result? Insolvency — before which the insurance companies will pull out of Obamacare. Solution? A huge government bailout. It's Obamacare's escape hatch. And — surprise, surprise — it's already baked into the law. Which is why the GOP needs to act (Charles Krauthammer, 1/2).
The Washington Post: The Affordable Care Act Is Here To Stay
Opponents of the law can hardly advocate going back to a system in which those who really need insurance can't get it. What they can do, and surely will, is make lots of noise by pretending that any problem with anyone's health insurance is due to the Affordable Care Act. Before Obamacare, millions of Americans had their policies canceled by the insurance companies every year. Millions more had their premiums raised, their coverage reduced or both. Now when these things happen, critics will try to blame the new law. ... The real problem with the ACA, and let's be honest, is that it doesn't go far enough (Eugene Robinson, 1/2).
The Washington Post's The Plum Line: The Three Stages Of Obamacare Acceptance
Now that Obamacare is clearly moving forward, Republicans are adjusting to a new reality: it may no longer be a realistic option to simply wait until the law collapses under its own weight and vanishes entirely. GOP lawmakers are increasingly discussing a range of responses, from proposing profound changes to finally embracing a comprehensive alternative. Which raises a question: Is it possible to envision a future in which Republicans and Democrats do enter into real negotiations over the future of the law and the health system, in which each side gets some changes it wants, in exchange for accepting some of the other's proposed changes? (Greg Sargent, 1/2).
The New York Times: No Burden on Religion
Adding a level of absurdity to the controversy, Little Sisters of the Poor's insurance plan qualifies as a self-insured "church plan" under an insurance statute known as Erisa. The Justice Department has conceded that it has no authority to compel a third-party administrator of such a plan to provide contraceptive coverage. In this case, contraceptives would not be made available even indirectly to the nuns' employees. Like the cases of the private employers, the suit by the nuns' group boils down to an unjustified attempt by an employer to impose its religious views on workers (1/2).
The New York Times' Economix: Medicare Advantage And The 'Theft' Of $156 Billion
A theft of $156 billion should catch one's attention, especially if government is the thief. It warrants a closer look. For starters, what is the time frame of this $156 billion "theft"? Greater clarity on this point would have been helpful, lest readers think that this is an annual figure. In fact, it is the sum of projected future annual cuts off projected future total payments to Medicare Advantage plans over the decade 2013-2022 (see line 8 of Table 2, page 5 in this Congressional Budget Office projection). That point aside, what the Affordable Care Act has done to the Medicare Advantage plans lies, like beauty, in the eyes of the beholder (Uwe E. Reinhardt, 1/3).
Forbes: New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare
For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals' emergency rooms. "Those of us with health insurance are also paying a hidden and growing tax for those without it—about $1,000 per year that pays for [the uninsureds'] emergency room and charitable care," said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured (Avik Roy, 1/2).
NBC News: How Not To Argue Against Medicaid Expansion
There are, by everyone's estimation, several hundred thousand folks in Mississippi who would benefit from Medicaid expansion. According to [Gov. Phil] Bryant, the state could help them, but he doesn't want to – because in his mind, Congress might repeal the health care law at some point in the future, and the state wouldn't be able to afford to pick up the slack. But even by GOP standards, it's impossible to take this seriously. For one thing, it's pretty obvious Congress isn't going to repeal the law, as even the most right-wing lawmakers on Capitol Hill are grudgingly conceding. For another, even in the extraordinarily unlikely event that the law is repealed sometime after 2017, Mississippi could simply revert back to its current policy once the federal well runs dry (Steve Benen, 1/2).
Journal of the American Medical Association: Realizing The Promise Of The Affordable Care Act—January 1, 2014
Never has the landscape of US health care changed so dramatically in a single day as on January 1, 2014. The challenges facing the HealthCare.gov website notwithstanding, the implementation of key provisions of the ACA will proceed apace in the upcoming year. Whether one cheers or jeers the transformational events of January 1, 2014, the US health care system will never be the same again (John E. McDonough and Dr. Eli Y. Adashi, 1/2).
Politico Magazine: Not One Penny In New Debt For Obamacare
There has been much acrimony and infighting within the Republican Party of late. But in the coming year, there are many upcoming battles that should be able to unite the party, most prominently, the effort to repeal the Affordable Care Act, more commonly known as Obamacare. Republicans agree that Obamacare must be repealed and replaced with policies that eliminate the burdensome interventions that drive up the cost of healthcare. And as the national debt continues to soar over $17 trillion, there must be an immediate push to reduce the size of government. That means there is no better opportunity to unite in the fight against both Obamacare and the growing national debt than with the upcoming debt-ceiling deadline in February (Ryun, 1/2).
And on other issues -
Los Angeles Times: The Gap In Medical Education
Since its inception more than a century ago, modern medical education has undergone a series of quiet revolutions, stretching and scaling to accommodate advances in biomedical science. Yet this comprehensive expansion in one critical area masks a relative neglect of another. Despite their staggering scope — spanning genetics to geriatrics, and everything in between — medical curricula today largely omit training on health policy (Rahul Rehki, 1/3).
Los Angeles Times: Polio's War Foothold
Once virtually eradicated, polio again stalks the Horn of Africa, the Middle East and South Asia. The innocent victims are mostly young children. The perpetrators are insurgents and indifferent governments. The polio resurgence is preventable and it is time to pull out an old but proven technique to halt its spread: Days of Tranquility (Nancy A. Aossey and William Garvelink, 1/3).
Bloomberg: Make Those Cows Pay For Their Penicillin
America's animals take more drugs than its people do. About 80 percent of the 51 tons of antibiotics consumed each day in the U.S. are used in agriculture and aquaculture. Such unrestrained use of the drugs may help farmers grow bigger cattle, but it has a drastic side effect: It prods bacteria to evolve defenses, so that the drugs don't work so well when given to people (or fish or animals, for that matter) suffering from bacterial infections. The loss of these drugs as medical weapons is also astoundingly expensive. The current stock's potential to prolong human life is worth upward of $60 trillion, according to a new report in the New England Journal of Medicine. And so it is welcome news that the authors of that report also have a novel way to protect this pharmaceutical treasure: Impose a fee on all uses of antibiotics outside of human medicine. Their market-based strategy is worth a try (1/2).
The Star Tribune: Let's Have A Full Debate On Medicaid Costs, Changes
Gov. Mark Dayton made a compassionate and politically savvy decision this week when he asked state officials to delay for a year cost-saving changes that would have phased in reduced home and nursing care for about 3,300 Minnesotans in 2014. ... It also gives the 2014 Legislature time to reconsider the long-delayed changes — expected to save about $50 million over the next four years — that were passed with bipartisan support in 2009 as legislators and then-Gov. Tim Pawlenty grappled with sobering budget deficits and soaring Medicaid costs (1/2).
Stephanie Stapleton
Andrew Villegas
Lisa Gillespie
Shefali Luthra
The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.
© 2014 Henry J. Kaiser Family Foundation. All rights reserved.


text:
i gave you hope
you gave me nothing
i drove you to suicide
and you told me to pull the trigger
i took back what i said
you took back what was yours
you took away my freedom
I took away your soul
i burned our little house down
you spent our entire savings
i called you a liar
you called me a lunatic
i wanted to destroy
you wanted to build
i gave you fire
you gave me a concussion
I could feel it in the air like a heavy fog that clogs your lungs and slowly suffocates you. You feel as though you have swallowed a wet towel and it is eternally lodged in your throat, and it never leaves.
you melt away down the slimy drains of greasy back alleyways and hand yourself over to the sudsy hands of cold, rotten men who tear you apart peice by peaice then leave you vulnerable and lost and shattered- when you are finally sober enough to see straight, you stumble down steamy corridors and across nappy lawns, like an escaped convict.
guilt-driven people wordlessly drop quarters at your feet like tokens of their regrets, and attach to those coins pieces of their remorse and discontent, not for your life- but for theirs.
you wander for days seeing mirages of the past and feel your life start to sway and tilt before it all topples over like an unstable house built on a sandy foundation in a high tide.
everything is washed out to sea and left there to drown and fade and corrode, the memories losing their grip and relevance, until those final moments where you finally just let the tears fall, instead of trying to wipe them back and hold them hostage in the tear ducts of your soul. you step closer to the edge of the eternal fiery pit of your life that seems to lack an end, and wonder out loud: "how will I ever get though this?"
You tell yourself the options, the easy way outs, but somewhere in the deep crevices of insanity that ovetook your brain long ago, a small glimmer of hope shines like a speck of gold paint on a vast black asphalt.
you cling to it, like the mast of a sailboat in a hurricane, and you close your eyes and take a step forward, launching yourself into the "afterwards"; slowly inching your way into the relief that comes after surviving a nightmare of a freakish life.
Even just being able to close your eyes at night starts to come as a relief and you can feel yourself again. It all comes back, slowly and painfully, but it does come back, and you will survive this.
close your eyes, you say, survive this moment, you say after every moment, and you grip to the truth.
"One word to describe you?"
Just because you don't wear makeup, does not make you better than me.
I would be the most handsome of hipster gentlemins. (◡ ‿ ◡ ✿)
u v u~
i'm such a cutie
lol im jus sew handsome.
Barelygender bent Daniel.
D: Are we the same person, Dan?
Everyday, millions of people are born. They are pushed out onto the stage of life against their will like understudies without their lines, and expected to act. They are forced to endure this life and the pains that come with it. Sometimes they find moments of happiness, but for the most part, they are unhappy, cold and alone. Some make the best of this cruel world, and try their best to find joy, belonging and hope, but some choose to destroy their fragile life with drugs, self harm, or even, in some cases, suicide. This is not the story of a man who did either one of those two things. he found no joy in the life he lived, nor found the need to destroy it. He was simply a man who did not live up to his dreams. He never reached any of his goals, he never felt success, he never won anything, never saw himself as anything special in the least. He was, like some people seem to be, a loser, a waste of air, and the worst of all, a failure.
From the moment he was old enough to form thoughts in his head, he became aware of his condition. He knew he would never amount to anything, and that his life would lead no-where. He tried to amount to something— anything, but all efforts were to no avail, and he just ended up feeling empty and tired and worthless. So he gave up, lived day to day without much of any change. A grey life.
she glanced at the girl in the mirror and tried to smile, but the girl in the mirror just glared back with peircing, waiting eyes.
So, the girl takes her first position, poised and confident. Her eyes closed for a moment. All of the loud conversations of the room faded and she could only hear the sound of her breathing, and she could feel the blood as they rushed though her veins… She knew she was ready, and that it was now or never. Her eyes flipped open, and with one flick of her hand, music filled the room, and she began to dance.
She moves with such grace and fluidity that her feet seem to lift off the ground at that moment and didn't touch back down until the last note finished echoing though the room like the final word of an argument. The room seemed to hold it's breath as the girl held her final position like a stone statue.
But nobody clapped, nobody said a word, until the crowd erupted into cheers and applause. But the only affirmation the girl needed was from the girl in the mirror, who's eye she finally caught.
but the girl in the mirror did not clap, or cheer or even smile, but she whispered "do better next time" in the girls ear, and then she walked away.
A quick list of who you should unfriend on Facebook.

subset: commoncrawl


text:
Firefox For Dummies
Firefox For Dummies
by Blake Ross
Firefox For Dummies gives you the inside scoop on the exciting new browser from the Web wizard that got it started. The book's author, Blake Ross, began developing Firefox as a teenager. Once...More
Firefox For Dummies gives you the inside scoop on the exciting new browser from the Web wizard that got it started. The book's author, Blake Ross, began developing Firefox as a teenager. Once...More
Available formats-
- Kindle Book
- OverDrive Read
- Adobe EPUB eBook
- Adobe PDF eBook
Library copies:1
Interest Level:
Reading Level:
Firefox For Dummies gives you the inside scoop on the exciting new browser from the Web wizard that got it started. The book's author, Blake Ross, began developing Firefox as a teenager. Once available to the world, the simple and powerful tool was an instant hit claiming a sizable share of the Web browser market with over 140 million downloads.
- In this book Blake not only gives you the lowdown on how to use Firefox for safe Web searching, but he also shares his insight into how the product came to life. It's a combination of practical tech insight and a good story that is rare in computer books.
- Topics covered include downloading and installing Firefox, creating a home page, searching with Google, creating customized themes and toolbars, using tabbed browsing, downloading and saving files, maintaining security and privacy, eliminating annoying popups, and adding Firefox extensions.
About the Author-
Blake Ross discovered computers when he was 4 and hasn't had time to eat since then. He began working at Netscape at 14 and cofounded the Firefox project two years later to make the Web easy to use for plain old human beings. He also cofounded the SpreadFirefox.com community evangelism project, which has changed the face of software marketing and distribution. Blake was featured on the cover of Wired Magazine in early 2005, and he has since been featured in dozens of international publications and television shows to promote computing simplicity. He is on leave from Stanford University, where he is an undergraduate.
Blake is currently working on a new project with some of the original Firefox team. If you enjoy Firefox, you'll enjoy what's coming next, so sign up at www.blakeross.com to hear when it launches.
Table of Contents-
Part I: Getting Fired Up.
Chapter 1: Why You Should Fire Your Old Browser.
Chapter 2: Finding Your Way Around Firefox.
Chapter 3: Setting Up Firefox.
Part II: Ready, Aim, Firefox.
Chapter 4: Finding Information Online.
Chapter 5: Bookmarking Great Sites.
Chapter 6: Returning to Sites You've Visited.
Chapter 7: Browsing with Tabs.
Chapter 8: Filling In Forms Quickly.
Chapter 9: Blocking Popup Ads.
Chapter 10: E-Mailing with Thunderbird.
Chapter 11: Downloading and Saving Files.
Chapter 12: Printing Web Pages.
Chapter 13: Finding Additional Help.
Part III: Outfoxing Hackers.
Chapter 14: Clearing Your Tracks.
Chapter 15: Staying Safe Online.
Part IV: Dressing Up the Fox.
Chapter 16: Setting Your Options.
Chapter 17: Finding Your Dream Theme.
Chapter 18: Tailoring Your Toolbars.
Chapter 19: Controlling the Way Web Sites Look.
Chapter 20: Extending Firefox.
Part V: The Part of Tens.
Chapter 21: Ten Secrets to a Foxier Web.
Chapter 22: The Ten Best Firefox Extensions.
Appendix A: Firefox Menu Reference.
Appendix B: Firefox Keyboard Reference.
Appendix C: Firefox Drag-and-Drop Reference.
Title Information+
Kindle BookRelease date:
OverDrive ReadRelease date:
Adobe EPUB eBookRelease date:
Adobe PDF eBookRelease date:
Digital Rights Information+
- Copyright Protection (DRM) required by the Publisher may be applied to this title to limit or prohibit printing or copying. File sharing or redistribution is prohibited. Your rights to access this material expire at the end of the lending period. Please see Important Notice about Copyrighted Materials for terms applicable to this content.


text:
How can it be Up setting to someone That I express myself With my heart? Makes me want to Rip it out and Stomp it to death It truly kills me when I feel I did something To make another person Feel bad It makes me sad I like happiness Although it may be a Superficial Happiness I just strive for that Daily. I don't want to be Sad and Miserable Anymore! Why? Why Live like that? I don't have much longer here On earth and I am determined to Be happy Even if it kills me
Most people are meant to come into our life and go. Those who stay are the ones that matter. It might not be many, but at the end of the day you know you can count on them. Everyone has their own problems and sometimes some people don't understand because they don't really know what is going on. If they knew what was going on behind closed doors maybe, just maybe, they would understand and wouldn't let you go. Sometimes it's hard to let go, but at times it's better. These people come into our life for a reason. You learn something from them that either changed you for good or for bad. Sometimes it's hard to understand what a relationship is about and that's why many let go. A relationship is between two people who are fond of each other and work towards being in harmony. A lot of people don't understand this simple concept and almost unwillingly cause damage by mentioning the past and focusing on the negatives instead of moving forward and thinking positive. Sometimes I wonder if it really is a hard concept to understand or if our generation has really changed for the worst? Are there others out there that think, or should i say believe, the way I do?


text:
Yakovlev Yak-130
|Yak-130 at the Farnborough Air Show 2012
|Advanced trainer / Light fighter
|National origin
|Irkut Corporation
|Design group
|First flight
|26 April 1996
|19 February 2010[1]
|Primary user
|Russian Air Force
|Number built
|Unit cost
$15 million[7]
|Developed into
|Alenia Aermacchi M-346 Master
The Yakovlev Yak-130 (NATO reporting name: Mitten[8]) is a subsonic two-seat advanced jet trainer/light attack aircraft or lead-in fighter trainer originally developed by Yakovlev and Aermacchi. Development of the plane began in 1991, and the maiden flight was conducted on 26 April 1996. In 2002, it won a Russian government tender for training aircraft, and in 2009 the aircraft entered service with the Russian Air Force. As an advanced training aircraft, the Yak-130 is able to replicate the characteristics of several 4+ generation fighters as well as the fifth-generation Sukhoi PAK FA. It can also perform light-attack and reconnaissance duties, carrying a combat load of 3,000 kg.
In the early 1990s, the Soviet government asked the industry to develop a new aircraft to replace the Czech-made Aero L-29 Delfín and Aero L-39 Albatros jet trainers. Five design bureaus put forward proposals. Among them were the Sukhoi S-54, Myasischev M-200, Mikoyan MiG-AT, and Yakovlev Yak-UTS. In 1991, the other proposals were dropped and only the MiG-AT and Yak-UTS remained.[citation needed]
Development of Yak-UTS started in 1991 and the design was completed in September 1993. The same year, Yakovlev entered an agreement with the Italian company Aermacchi to work together on the plane, which now became Yak/AEM-130. The Yak-130 version was to be offered for the Russian and the M-346 version for the Italian market.[citation needed] On 10 April 2002, it was announced that Yak-130 had been chosen as the winner of the tender for trainer aircraft for basic and advanced pilot training, beating the MiG-AT.[9]
Plans to develop a Light Attack Aircraft based on the Yak-130, came to a halt in the late 2011. Dubbed Yak-131, the aircraft failed to meet "enhanced pilot protection" requirements, put forward by the Russian Air Force.[10] Focus has shifted to a Sukhoi Su-25 replacement, instead.[11] The Light Attack Aircraft was slated to enter service by the year 2020.[10]
Yak-130 completed its maiden flight, registered as RA-431130, on 25 April 1996 at Zhukovsky. The plane was put on display for the first time at the Paris Air Show in June 2005.[9] The same year, the Russian Air Force made its first order for 12 Yak-130s. On 30 April 2004, the first pre-series Yak-130, assembled at the Sokol plant in Nizhny Novgorod, performed its maiden flight.[1] It was followed by three more pre-series aircraft. In December 2009, the aircraft completed state trials and was accepted for service.[1] The Russian Air Force intends to buy at least 72 Yak-130s, enough to equip four training regiments.[12] Commander-in-Chief, Colonel General Aleksander Zelin, announced on November 8, 2011, that the Russian Defence Ministry was to sign a contract within two weeks with Irkut Corporation for 65 additional aircraft[13] - 55 firm orders plus 10 options.[14] Zelin stated that deliveries were expected to be completed by 2017.[13]
The first serial aircraft was handed to a training center in Lipetsk on 19 February 2010.[1] Once the 2005 contract for 12 Sokol-made Yak-130s for the Russian Defence Ministry was fulfilled in June 2011, a decision was made that all subsequent Yak-130 orders, both domestic and export ones, would be handled by the Irkutsk Aviation Plant of the Irkut corporation.[15] However, the Russian Air Force only took delivery of the first Yak-130 by the Irkutsk in October 2012.[16]
Yak-130 is an advanced pilot training aircraft, able to replicate characteristics of Russian 4th and 5th generation fighters.[17] This is possible through the use of open-architecture digital avionics compliant with a 1553 Databus, a full digital glass cockpit, quadruplex-channel digital Fly-By-Wire System (FBWS) and Instructor controlled and variable FBWS handling characteristics and embedded simulation. The type also has a Head-Up-Display (HUD) and a Helmet-Mounted-Sighting-System (HMSS), with a double GPS/GLONASS receiver updating an Inertial Reference System (IRS) for highly accurate navigation and precision targeting.[14] The developer estimates that the plane can cover up to 80% of the entire pilot flight training program.[18]
In addition to its training role, the aircraft is capable of fulfilling Light Attack and Reconnaissance duties.[17] It can carry a combat load of 3,000 kilograms (6,600 pounds), consisting of various guided and un-guided weapons, auxiliary fuel tanks and electronic pods.[18] According to its chief designer Konstantin Popovich, during a testing phase that ended in December 2009, the plane was tested with "all airborne weapons with a weight of up to 500 kg that are in service in the Russian Air Force".[17] Yak-130 has nine hard points: two wingtip, six under-wing and one under-fuselage.[14]
The aircraft's twin engines are mounted under extended wing roots, which reach as far forward as the windscreen. Two Ivchenko Progress AI-222-25 Full Authority Digital Engine Control (FADEC) produce a combined total of 49 kilonewtons (11,000 pound-force) of thrust. An upgraded, "-28" engine is also on offer, increasing the thrust to 53 kN (12,000 lbf). At a normal Take-Off Weight of 7,250 kg (15,980 lb), a Thrust-to-Weight ratio of 0.70 is achieved with the "-25", or 0.77 with the "-28" engines. This compares with 0.65 for the BAE Systems Hawk 128 and 0.49 for the Aero Vodochody L-159B.[14]
Maximum internal fuel capacity is 1,700 kg (3,700 lb). With two external combat fuel tanks the figure increases to 2,600 kg (5,700 lb). Maximum true airspeed is Mach 0.93 (572 knots), service ceiling is 12,500 metres (41,000 feet) and load factors are from -3 to +9 g. Typical Take-Off speed and distance in a "clean" configuration are 209 km/h (113 kn) and 550 m (1,800 ft), whilst landing figures are 191 km/h (103 kn) and 750 m (2,460 ft), respectively. Cross wind limit is 56 km/h (30 kn).[14]
The Yakovlev Yak-130 is equipped with the FBWS controlled engine intake blanking doors, in order to prevent the aircraft's engines from sustaining Foreign object damage when operating from unpaved runways and grass strips.[19]
The large canopies are sideways hinged.
Combat training suite on the Yak-130 includes simulated and real firing systems with air-to-air and air-to-surface missiles, bomb dropping, gun firing and on-board self-protection systems.
Operational history[edit]
The Yak-130 entered Russian Air Force service in 2009. On 29 May 2010, one aircraft crashed near Lipetsk during testing (both pilots ejected).[20]
Libya put an order for 6 planes. Deliveries to Libya were expected in 2011–2012,[17] but the Libyan National Transitional Council cancelled Libya's order for Yak-130s in September 2011 as part of a review of all existing arms contracts.[21]
Syria has agreed to purchase 36 aircraft,[22] but delivery of these has been postponed by Russia due to the conflict in Syria.[23]
The Uruguayan Air Force is considering the aircraft for the future replacement of the A-37[24] with the F-5 Freedom Fighter as another possible candidate.[25] Russia has offered the Yak-130 to Serbia as part of a US$3 billion loan for the upgrading of the Serbian Armed Forces.
In October 2012 Russia took delivery of six fighters. The first batch of Yak-130 combat trainers fly from the Irkut plant to the Borisoglebsk airfield [Voronezh region] after an extensive flight testing program," Col. Andrei Bobrun said.[26]
In April 2012, Irkut Corporation president, Alexey Fedorov claimed that there are "more than ten potential customers".[27]
In November 2012, Sergey Kornev, a representative of the Rosoboronexport (Russia's state intermediary agency for exports/imports of defense-related products) said Malaysia and several other countries are also interested of Yak-130. He was speaking at the China Airshow 2012 in the Chinese city of Zhuhai.[28]
In January 2014 Bangladesh orders 24 Yak-130. The planes will be bought with an extended loan from Russia.[29]
In February 2014 Irkut Corporation signed a contract with the Russian Ministry of Defense (MoD) to supply additional Yakovlev Yak-130 advanced jet trainer aircraft to the national Air Force.[30][31]
In May 2014 Russia announced that it will supply Syria with Yakovlev YaK-130 advanced jet trainer aircraft. Syria is expected to receive nine aircraft by the end of 2014, twelve in 2015 and fifteen in 2016, for overall of 36 airplanes.[32][33]
- Yakovlev Yak-130 – basic dual seat advanced trainer
- Yakovlev Yak-131, Yak-133 and Yak-135 – for single seat light attack aircraft/recon/4 seat VIP transport [34]
- Algeria
- Algerian Air Force 16 aircraft [35]
- Bangladesh
- Bangladesh Air Force has ordered 24 aircraft.[36][37]
- Belarus
- Belarusian Air Force has 4.[38][39] + 4 on order[40]
- Russia
- Russian Air Force has 50 in service[41][42] of 55 from "Irkut" contract, they were delivered by July 17th of 2014. The RuAF placed a firm order for 55 aircraft.[43][44] Russia has a total requirement of 72 to 200 aircraft.[45]
- Syria
- Syrian Air Force has ordered 36.[46] Russia will deliver 9 Yak-130s to Syria by the end of 2014.[47]
Specifications (Yak-130)[edit]
Data from www.yak.ru[48]
General characteristics
- Crew: 2 pilots
- Length: 11.49 m (37 ft 8 in)
- Wingspan: 9.72 m (31 ft 10 in)
- Height: 4.76 m (15 ft 7 in)
- Wing area: 23.52 m² (253.2 sq ft)
- Empty weight: 4,600 kg (10,141 lb)
- Loaded weight: 6,350 kg (14,000 lb)
- Max. takeoff weight: 10,290 kg[49] (22,685 lb)
- Powerplant: 2 × Progress AI-222-25 turbofan, 24.52 KN (5,512 lbf) each
- Maximum speed: 1,050 km/h (644 mph)
- Cruise speed: 887 km/h (551 mph)
- Stall speed: 165 km/h (103 mph)
- Range: 2,546 km (1,582 miles)
- Service ceiling: 12,500 m (42,660 ft)
- Rate of climb: 50 m/s (10,000 ft/min)
- Wing loading: 276.4 kg/m² (56.60 lb/sq ft)
- Thrust/weight: 0.78
A symmetric or asymmetric weapon load, weighing up to 3,000 kg (6,600 lb) and consisting of various guided and un-guided weapons, auxiliary fuel tanks and electronics pods[18] can be carried on 9 hardpoints: 1 on each wingtip, 3 under each wing, and 1 under the fuselage.[14]
See also[edit]
- Related development
- Aircraft of comparable role, configuration and era
- Notes
- ^ a b c d Piotr Butowski, Jakowlew Jak-130 wszedł do służby w Rosji in: Lotnictwo Nr. 4/2010, p.10 (Polish)
- ^ "В начале 1997 года была начата опытная эксплуатация 10 самолетов Як-130 в ВВС Российской Федерации". Retrieved 2008-07-19.
- ^ "Боевые самолёты и вертолёты для ВВС России-контракты". Retrieved 2008-07-19.
- ^ "Иркутский авиазавод собрал 30 самолетов Як-130 для ВВС Алжира". 12 September 2011.
- ^ "Russian Military Plans to Order More Yak-130 Combat Trainers". 2013-12-26.
- ^ "Борисоглебская учебная авиабаза ВУНЦ ВВС получила еще 2 новых учебно-боевых самолета Як-130". 2014-02-07.
- ^ "Warplanes: Little Yak With Big Teeth". Strategypage.com. 2008-07-19. Retrieved 2011-10-17.
- ^ Parsch, Andreas; Aleksey V. Martynov (2008). "Designations of Soviet and Russian Military Aircraft and Missiles". Designation-Systems.net. Retrieved 2010-04-13.
- ^ a b "Yakovlev Yak-130 (Russian Federation), Aircraft – Fixed-wing – Civil/military". Jane's All the World's Aircraft. 2010-07-20.
- ^ a b "Russia to Field New Ground Attack Jet". RIA Novosti. Retrieved 17 June 2012.
- ^ Hoyle, Craig. "IN FOCUS: United Aircraft's sky-high ambitions". Flightglobal. Retrieved 14 July 2012.
- ^ "YAK-130 delivery goes hand in hand with Russian training overhaul | INTERNATIONAL AVIATION NEWS". Aviationnews.eu. 2010-03-04. Retrieved 2011-10-17.
- ^ a b "Russia to order 65 more Yak-130s". Air Forces Monthly (286): 28. January 2012.
- ^ a b c d e f Collins, Peter. "FLIGHT TEST: Yak-130 proves versatility". Flighglobal. Retrieved 14 July 2012.
- ^ http://en.take-off.ru/news/107-june2012/752-cadets-learning-fly-on-yak-130
- ^ "PICTURES: Russian air force receives first Yak-130 combat trainers". Flightglobal. Retrieved 9 October 2012.
- ^ a b c d Pyadushkin, Maxim (2010-02-16). "Reprogrammed Trainer – Yak-130 jet trainer is cleared for service". Russia & CIS Observer.
- ^ a b c "Yak-130". United Aircraft Corporation. Retrieved 2011-11-01.
- ^ Hoyle, Craig. "FARNBOROUGH: Yak-130's engine intakes cause confusion". Flightglobal. Retrieved 19 July 2012.
- ^ Russia investigates cause of Yak-130 crash
- ^ "New Libyan Government Cancels Russian Arms Deals". Air International, Vol 81 No 5, November 2011. p. 11.
- ^ Russland verkauft Syrien 36 Militärflugzeuge Tages Anzeiger.
- ^ "Russia Prods Syria's President Assad With Message of Growing Impatience". nytimes.com. 2012-07-09. Retrieved 2012-07-10.
- ^ "Uruguay MoD to publish future combat aircraft RfP". Dmilt.com. 2010-08-08. Retrieved 2011-10-17.
- ^ Uruguay; Air force mulls Russian YaK-130 procurement - Dmilt.com, 19 December 2013
- ^ "Russian Air Force Accepts First Yak-130 | Defense | RIA Novosti". En.rian.ru. Retrieved 2012-12-20.
- ^ "More than 10 nations considering Yak-130, says Irkut boss". Flightglobal. Retrieved 23 April 2012.
- ^ "Bangladesh wants to buy Russia's Yak-130 aircraft : Voice of Russia". :. 2012-11-15. Retrieved 2012-12-20.
- ^ http://en.ria.ru/military_news/20140128/186986607/Bangladesh-Buys-Russian-Combat-Training-Jets-Worth-800M.html
- ^ "New Russian Air Force Stunt Team to Have 12 Yak-130 Jets". :. 2014-02-11.
- ^ "Irkut to supply additional Yak-130 trainers to Russian Air Force". :. 2014-02-13.
- ^ http://www.avionews.com/index.php?corpo=see_news_home.php&news_id=1159917&pagina_chiamante=index.php
- ^ http://english.alarabiya.net/en/News/2014/05/05/Report-Russia-to-send-first-batch-of-Yak-130-jets-to-Syria-.html
- ^ John Pike. "Yak-130". Globalsecurity.org. Retrieved 2011-10-17.
- ^ http://www.flightglobal.com/airspace/media/reports_pdf/emptys/90190/world-air-forces-2011-2012.pdf
- ^ ""Рособоронэкспорт": Бангладеш рассматривает возможность приобретения 24 учебно-боевых самолетов Як-130". ITAR-TASS. 27 March 2013. Retrieved 27 March 2013.
- ^ "Бангладеш подписал контракт на 24 учебно-боевых самолета Як-130". Комерсант.ру. 28 January 2014. Retrieved 2014-01-28.
- ^ Россия поставила Белоруссии четыре Як-130 и дивизион «Тор-М2» Итар-тасс, 10.07.2014
- ^ "Russia to Deliver Four Warplanes to Belarus in 2015". RIANOVOSTI. Retrieved 2011-12-18.
- ^ http://www.vpk-news.ru/news/21012
- ^ http://ria.ru/defense_safety/20140717/1016386338.html
- ^ http://sdelanounas.ru/blogs/42624/
- ^ "Russia Orders Yak-130 Trainer Light & Attack Jets". Defense Industry Daily. Retrieved 24 February 2013.
- ^ http://bmpd.livejournal.com/524923.html
- ^ Sokol starts deliveries of Yak-130 combat trainers to Russian AF
- ^ "Insight - Syria pays for Russian weapons to boost ties with Moscow". Reuters. 29 August 2013. Retrieved 16 April 2014.
- ^ Anton Denisov Russia will provide Syria with first batch of jet trainers by the year end RIA, 05.05.2014
- ^ Разрешенная взлетная масса самолета Як-130 повышена до 10290 кг[dead link], vpk, 24/3 – 2010
- Bibliography
- Butowski, Piotr. "Russian T-Bird". Air International, Vol. 83 No. 3, September 2012. pp. 92–95. ISSN 0306-5634.
- Gunston, Bill. Yakovlev Aircraft since 1924. London, UK: Putnam Aeronautical Books, 1997. ISBN 1-55750-978-6.
The initial version of this article was based on material from aviation.ru. It has been released under the GFDL by the copyright holder.
External links[edit]
|Wikimedia Commons has media related to Yakovlev Yak-130.
- Yak-130 Air Force Technology
- A.S.Yakovlev designe bureau–Yak-130
- Yak-130 Light attack and training aircraft (Combat Trainer Jet)
- The Yak-130: The Russian Army's 'flying iPhone'


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Latest Department News
Latest Department News
2014 Isakson Mentoring Award goes to Thurl Harris!
October 3, 2014
At the 2014 Pharmacology Retreat on Wednesday, October 1st, Thurl Harris was announced as the 2014 Peter Isakson Mentoring Award recipient for his excellent work with Pharmacology Graduate Student Garrett Mullins. This marks the second time Dr. Harris has received this prestigious award; his work with James Eaton, Ph.D., was recognized when he … [Read More...]
2014 Haynes Award Recipients
October 3, 2014
Congratulations to Rhianna Laker (post-doc) and Garrett Mullins (pre-doc) for taking home the 2014 Robert Haynes Award for the best presentations at the 2014 Pharmacology Retreat! Rhianna is a postdoctoral fellow in Zhen Yan's lab and she presented on Exercise in the Embryo - Shape Up the Epigenome. Garrett is a Ph.D. candidate in Thurl Harris's … [Read More...]


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SPRINGFIELD | Dr. Cynthia Clark said it has been difficult during her 25 years practicing psychology to watch and wait for some of her clients to receive treatment.
The Carbondale psychologist said she supports a recent measure that would allow psychologists to prescribe medication like psychiatrists do now because there is not enough access to psychiatric care in her area.
"I've done all kinds of things to try to find ways to get people the help that they need — and support them while they wait to get the help that they need," Clark said.
The measure would allow psychologists to prescribe drugs for treating mental, emotional and psychological illnesses, which observers said are a broad description of psychotropic drugs. It was approved earlier by a Senate panel and is likely get a vote in the full Senate in April.
Yet the Illinois Psychiatric Society and the Illinois State Medical Society, among others, are opposed.
Dr. William N. Werner, president of the Illinois State Medical Society, said that rural areas of the state need more trained psychiatrists available.
"In the case of psychologists wanting prescriptive authority to write for psychotropic drugs, we know from studies from the AMA that psychologists don't go out and practice in the rural areas, and they would not fill in for the psychiatrists who are in rural areas," Werner said in an earlier interview.
Jagannathan Srinivasaraghavan, professor emeritus of psychiatry at Southern Illinois University School of Medicine, said the training for psychologists and psychiatrists is very different, beginning even with the undergraduate degrees, where psychologists might not have a required biology or chemistry course.
"Basically we are talking about inadequately trained people to be prescribing medication," Srinivasaraghavan said.
He said that drugs can affect many different organs, causing reactions for which psychologists might not be prepared.
However, Dr. Jeffrey Kellogg, an independent practice clinical child psychologist in Carbondale, said a collaborative effort between psychologists and primary care physicians will remain under the measure.
"We're not trying to compete with anybody," said Kellogg said. "And given the difficulty anybody has seeing a psychiatrist, I don't think we're going to be changing their workload whatsoever. We're just going to be able to provide more services to more people."
The measure would require that psychologists take additional training as a two-year master's degree in psychopharmacology followed by a year's supervision from a physician.
Currently, New Mexico and Louisiana are the only two states that allow prescriptive authority for psychologists.
"I am a person who has visited every country in the world," Srinivasaraghavan said. "To my knowledge, other than the United States, there is not even any other place that allows psychologists to be prescribing medication."
The legislation is Senate Bill 2187.
Hannah Douglas can be reached at email@example.com or 217-528-1079


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Should You See the 'Oldboy' Remake?
Published: November 27, 2013
The Sign-Off
According to a recent interview with Lee on The Verge, the only reason Brolin participated was that Park gave his blessing to the re-make.
No Subtitles
And no unfamiliar Asian culture crap to distract the idiot masses from the plot at hand. Yeehaw!
Samuel L. Jackson in a Mohawk and a Leather Kilt
'Nuff said.
The Style
One of the thrills of Oldboy was its striking visual appeal. Park and his art department carefully curated sets and costumes—just look at all that funky wallpaper, the avant-garde clothing, the dim lighting. The result is as if Wes Anderson art- directed a David Fincher film. In comparison, the remake's art department is helmed by a team best known for The Town, which went hard for realism over style.
The Director
While Spike Lee has some fancy camera tricks up his sleeves, his more recent efforts at surrealism and dark humor—both hallmarks of the original Oldboy—have been panned. In some ways, what made the original's gruesomeness in plot and action palatable was its over-the-top, intriguingly odd packaging. Like a Quentin Tarantino film, the hyperstylization is almost soothing, as if to say, "it's OK. This is only a story." Lee's earnestness, by contrast, is all about highlighting the real, albeit with his auteur eye. And trust me, this is one story that you don't want to believe could happen in reality.
The Octopus Scene
Many fans of the original might go to the remake just to see how the infamous live octopus scene is reinterpreted in an American setting. In fact, since Olsen's character is now a doctor, not a sushi chef, I wonder if it will even make it in at all, and if it did, what would be the relevance? In the original, the scene helped spark a budding relationship between Dae-su and the chef, simultaneously adding an intriguing layer to the mystery (why would any woman be attracted to someone who just ate that?)
The Plot
More shocking than the violence, which seems almost quaint now compared to the films Oldboy inspired, is its fucked-up ending. It's a story that need only exist in this world once, and it's unnerving that Hollywood found the twist ending so titillating that it needed to be remade in a more familiar context, sans subtitles and transplanted to American soil, just to maximize the story's reach. It's sort of like remaking The Crying Game because people couldn't understand the actors' British and Irish accents.
In the end, I'm wary that all the things I loved about the original will be "reinterpreted" by Lee into a dour, uberviolent and exceedingly icky version, despite some potentially stellar performances, a smarter female lead and Samuel L. Jackson in a mohawk. Even the advertising for the remake shows signs of the kind of heavy-handed foreshadowing—"Ask not why you were imprisoned. Ask why you were set free."—that studios insist upon for American multiplex audiences, but which was so refreshingly absent from the original. I fear Lee's joint might end up like Dae-su in Park's cult classic, stripped of wonder and unable to say anything new.
Dir. Spike Lee; writ. Mark Prostosevich (based on a manga novel by Garon Tsuchiya and Nobuaki Minegishi); feat. Josh Brolin, Elizabeth Olsen and Samuel L. Jackson (R)
Opens Nov 27 at Palladium and Silverado 16
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We iz serious web professionals from all different sides of the industry, with one thing that brings us together — we know a great video when we see it, and want to share great videos with others.
Five days of the week means one video a week from each of us, as follows:
Monday: Liz
Tuesday: Matt
Wednesday: Barrett
Thursday: Felicia
Friday: Jon
The only rules we have for picking:
1) The poster can't have been personally involved in the video's making.
2) It has to be awesome.
Have something we should watch? Email us here.
Timelapse Tour of San Diego
I love road trips because it's one of the few chances I get to see the nothingness that surrounds many of Americas cities. This video is a visual road trip of San Diego County. All of the locations are within a two hour drive of the city itself and according to the videographer, Jeff Morris, he 'could take you to every single location in this film in the same day.' Though the cinematography-like motion makes each scene appear to be a recording, this timelapse consists of over 40,000 still photographs all shot on the Canon 5D Mark (II or III).
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Before you attempt to acquire a non-fake college degrees from any institution take time to ask yourself if that institution is a fake or legitimate institution that will not award you with useless fake degrees. The impact a fake college degree will have on your career is worst compared to you not having a degree. You may be able to secure a job with your high School diploma. It is possible to even obtain a job without any level of academic training. However, you face major embarrassment if you are caught with fake college degrees.
If you are not forced to resign due to the negative fake college degree impact of the situation, the employer would have no choice than to fire you because you have bought illegal fake degrees. When an employer hires you even though you do not have the requisite qualification, it is assumed the employer might have seen something great in you and so believes quite strongly that you are the ideal man for the job cause you do not possess fake college degrees. In a situation where the employer unknowingly offered you the job on the basis of the fake degree you presented, then it can be said that you obtain the job by false pretence because you possess a fake degree.
When it is finally revealed that the non fake college degree that were to hand over to the employer were an illegitimate one, the employer would feel betrayed. Once there is a source of doubt between you and your employer then it becomes obvious that you cannot build any great relationship with your employer. Fake college degrees sow seeds of doubts and destroy great working relationships. As a degree seeker, you primary goal is to obtain an accredited non-fake college degree but most importantly, a legitimate degree that will not bring you major embarrassment in the not too distant future where recruitment staff tend to fire employees having fake degrees.
There have been cases where people have acquired higher non-fake college degree and successfully used these non-fake college degrees to obtain higher positions in their area of operation. Unfortunately, it is later revealed that the non-fake degrees held by these people were from institutions that do not have the mandate to award degrees. Imagine cases where PhD holders who have grown accustomed to the title Dr have to shameless drop such titles and then resign from their high paying positions due to getting indulge in fake college degree purchases. This problem would not have occurred had the degree seekers looked beyond the supposed benefits advocated by the institution that awarded the fake degrees. The only online institution that provides value for money services and non fake college degrees is Degrees-on-linenet. We look beyond each customer or a college student in need to buy a certificate or a non-fake college degrees; this means that when one approaches us for a degree, we see the person as a potential graduate who would better our course by encouraging others to apply for degrees from us. This is the reason why we are always at our wits end in an attempt to upgrade and improve our services for the benefit of everyone wishing for non-fake degrees.
Note that when you use fake college degrees to apply for jobs and it is later found out that the degree you used was not legitimate, you destroy all your chances of ever getting a respectable job. The chance of being convicted for fraud is very high; some countries would not let an event like this pass without prosecuting the offender. Your search for a good job should not lead you into prison. Avoid fake degrees by acquiring all your academic degrees from Degrees-on-line.net.
If you thought that acquiring fake degrees, was the only option you had for enhancing your career, then think again! Our legal and accredited non fake college degree program is available to working adults and professionals irrespective of your age, sex, marital status, or physical location. The only qualifications for getting hold of legal and accredited non fake degrees are that you should possess any of the following experiences such as; work experience, military training, classroom education, workshops, voluntary activities or personal hobbies.
A fake degree or fake college degrees in comparison can be possessed just by virtue of spending some money. But you should question yourself whether getting hold of a fake college degree or fake college degrees is worth risking your whole academic career. Through our help, you can choose a suitable accredited and legal college degree for yourself instead of a fake college degree or fake degrees from the available wide range of college and university level degrees at an affordable price and with a 100% guarantee of approval.
A common wrong perception that people ignore while buying non fake degrees is that they go and approach diploma makers. What they do and sound is like an accredited body who sells genuine degree by an accredited body but in real its a scam and they are selling fake college degrees. Therefore before buying a non-fake degree first properly research and then move forward or you would be standing behind bars and crying for your career loss.
The sign of a proper accredited university which gives genuine non-fake college degrees is that it must have a proper course work and learning material on its site with a proper online chat system to assure students get proper knowledge and counseling so as to avoid them in going to the wrong direction of buying fake college degrees.
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Head & Shoulders shampoo classic clean 2in1
£2.99 (£1.20 per 100ml)
Product Summary
Shampoo formulated to clean and condition without build-up, leaving your hair soft and shinyBalanced, clean hair starts with the scalp. This daily shampoo with conditioning system is expertly formulated to thoroughly clean and condition without build-up, leaving your hair soft and shiny.
Aqua, Sodium Lauryl Sulfate, Sodium Laureth Sulfate, Glycol Distearate, Zinc Carbonate, Sodium Chloride, Sodium Xylenesulfonate, Dimethicone, Zinc Pyrithione, Cocamidopropyl Betaine, Parfum, Sodium Benzoate, Guar Hydroxypropyltrimonium Chloride, Hydrochloric Acid, Hexyl Cinnamal, Linalool, Butylphenyl Methylpropional, Magnesium Carbonate Hydroxide, Ammonium Laureth Sulfate, Magnesium Nitrate, Sodium Polynaphthalenesulfonate, Methylchloroisothiazolinone, Magnesium Chloride, Cl 42090, Citric Acid, Methylisothiazolinone, Tetrasodium EDTA, DMDM Hydantoin, CI 17200
Usage Instructions
- Gentle pH-balanced formula for everyday use.Your daily treat. Gently massage into your scalp and work though to the tips of your hair. Rinse and repeat if desired.
Please note that whilst we take every care to ensure the product information displayed on our website is correct, product recipes are regularly changed and this may affect nutrition and allergen information therefore you should always check product labels and not rely solely on the information presented here.If you require specific advice on any Waitrose branded product, please contact Customer Support on 0800 188884 or email email@example.com. For all other products, please contact the manufacturer.This information is supplied for personal use only. It may not be reproduced in any way whatsoever without the prior consent of Waitrose Limited nor without due acknowledgement.


text:
The best thing about making your own jewelry is that you can create a piece that is uniquely you. Whether you like leather, bling, vintage or simple styling, you can find a way to express your personality through jewelry. As I've shared before, I have a soft spot for all things antique and unique. The new Vintaj and Steampunk lines at Consumer Crafts made it easy for me to put together this cool statement steampunk necklace, which is really fun {Read More}
Statement Steampunk Necklace Tutorial
August 20, 2014 by 7 Comments


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Indianapolis Colts RB Trent Richardson is returning to the field after having surgery on his shoulder earlier in the year and in order for the team to protect him, he is wearing the good ol' red jersey during OTAs. The red jersey usually is designated for the quarterbacks on the roster so that the defense knows not to hit the prize on the roster, but this time around it will be used to protect Richardson from getting touched during practice.
I don't know how much that will help Richardson though. It will keep him healthy during the year, but how many holes are going to open up in practice because of the red jersey that are not going to open up during the regular season.
The Colts invested a lot in order to bring Richardson onto the roster and they are hoping that he will be able to step his game up. He has been a disappointment since his arrival to the team and he will have some competition for carries during camp. Vick Ballard and Ahmad Bradshaw will both be returning from injuries this season and will be hoping to take some of those carries away.


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Exclusive: Naledge Talks Solo Album, Upcoming Projects
A testament to this style has been Naledge, the emcee of the duo. HipHopDX recently got a chance to catch up with Mr. Jabari Evans after a show in Seattle, where he discussed a few upcoming projects he has in store.
Though not giving up much information on his debut solo album, Naledge flaunted a production list that many emcees can only imagine having.
"My solo album is still in the process of being put together. Ive been busy with shows, but I have some tracks in the works," says Naledge. "I got beats from 9th Wonder, Black Milk, Double-O, Pete Rock and [two or three from] Just Blaze. Just Blaze has been my yes man, okaying tracks for the album."
For fans that cant wait on his solo album material, The Chicago-bred emcee has plans to release a mixtape early next year that features the Midwests finest.
"I have a mixtape project coming out in January of 09 called The Chicago Picasso," adds Naledge. "I got everybody on it. I got GLC, Rhymefest, Mickey [Factz], Kid Sister, Kid Cudi and Im talking to Kanye about being on it."
In terms of the groups next release, Naledge stated the third album will be out sometime next summer, after which Kidz In The Hall will once again be negotiating a new record deal with various labels, including their current home Duck Down Records.
More News On HipHopDX
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ATRI seeking driver feedback on CSA
For the third year in a row, the American Transportation Research Institute wants to hear from drivers about their experiences CSA.
Inconsistent enforcement: Insist on inspection, not citation
The way the DataQs challenge system is working suggests conventional wisdom about citations and CSA scores is flawed, with the issue of unfinished clean inspections looming larger for carriers looking to improve CSA scores.
Committee to finalize work on driver training April 8-10
The full MCSAC committee will meet Aprli 8-10 to issue recommendations on entry-level driver training regulations as well as hear briefings on a bevy of subjects from CSA to in-cab video monitoring.
Hours of service delay backed by members of Congress
Transportation leaders from Congress have sent FMCSA a request to delay hours of service rule implementation until a final ruling in court has been made.
FMCSA hears testimony on entry level driver training
Driver training standards were the subject of a four-hour regulatory listening session held at the Mid-America Trucking Show. Find highlights and links to full video in this story.
Inconsistent enforcement: CSA's heat index
State inspection intensity ratings range from Maryland, where 32 inspections per lane-mile of National Highway System were conducted during CSA's first two year, to Idaho, where only two inspections per lane-mile were done.
Owner-operator walk-and-talk with Anne Ferro
Several operators took the opportunity the Trucking Solutions Group's health walk at MATS represented to walk-and-talk issues with FMCSA Administrator Anne Ferro.
ATA, OOIDA fight hours of service in court
A three-judge panel heard oral arguments Friday, March 15, from ATA and FMCSA, with ATA arguing against upcoming hours of service rule changes.
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text:
Turnkey SugarCRM mysql database and adding .sql
I have sugarCRM Version 6.5.2 running on proxmox 2.1-1. I've gotten the module loader in sugarCRM to install the select service desk module, and the instructions tell me to installed stored function in the data base. Does anyone have a clue if I'm supposed to add it to the SugarCRM tables? And if so, what is the name of the database installed by turnkey sugarcrm?
And just to be clear, once I know the name of the database, from the mysql> i can just type \. procedura.sql ?
Thanks for any mysql gurus out there; I've only worked with mssql from 2008 server thus far.
I'm not sure
Perhaps the best place to get specific SugarCRM advice is via their forums. As for the TKL SugarCRM DB, I suggest that you have a look with phpMyAdmin (https://<appliance-IP-or-FQDN>:12322 - use username root and your MySQL root password to login). I suspect that you will need to load the .sql file you have into the SugarCRM DB, but you should be able to do that within phpMyAdmin.
Glad you got it sorted
Thanks for posting back and thanks for the kudos! :)


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I have a full set of 20/20 collector staves, 1 for each attribute. (Blood, Curse and Death) Each has a +5 head and each has a various wrapping of fortitude or enchanting.
I don't believe that I have ever seen a wrapping drop for Blood, Curse or Death. Is there a collector? What is the best place to farm/look. Suggestions?
PC Gaming News
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Thread: Staff wrappings
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14-04-2006, 21:27 #1
Staff wrappings