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AHRQ Research and Other Activities Relevant to American Indians and Alaska Natives |
The main health challenges currently faced by AI/AN people are the health conditions and chronic diseases related to lifestyle issues such as obesity, physical inactivity, poor diet, substance abuse, and injuries. Preventive health initiatives for AI/AN populations have been undertaken to create healthier communities, improve quality of life, decrease health care utilization, control disability, and improve productivity. Initiatives include developing, coordinating, implementing, and disseminating effective health promotion and chronic disease prevention programs through collaboration with key stakeholders and by building on individual, family, and community strengths and assets. · Simple, effective methods to promote increased physical activity yield positive results Studies of geographically diverse American Indian tribes consistently show low levels of leisure-time physical activity, less frequent exercise, and a higher proportion of sedentary persons. Researchers found that physical activity among American Indian elders (aged 50-74) can be promoted in a brief, inexpensive manner in primary care. The study randomly divided 125 American Indians into 2 groups, with the first group receiving basic instruction in daily physical activity monitoring and the second group receiving instruction in daily physical activity monitoring augmented with a pedometer to track and record their total daily step counts. At the end of the 6-week study, participant fitness was measured by performance in a 6-minute walk test. Both groups showed similar results. The researchers suggest that the act of self-monitoring can raise awareness of modifiable health habits, create an external environmental reminder to increase personal responsibility, improve self-efficacy, and provide ongoing feedback on progress. Source: Sawchuk C, Charles S, Wen Y, et al. A randomized trial to increase physical activity among native elders. Preventive Medicine 2008; 47:89-94. (Grant HS10854). · Improving preventive services recommendations and reminders To improve the quality of preventive services recommendations and reminders, in 2009 AHRQ commissioned a gap analysis to compare its recommendations in the electronic Preventive Services Selector (ePSS) tool, to the preventive health reminders currently in use in the IHS's Resource and Patient Management System (RPMS). The analysis found that the majority of the recommendations in the ePSS tool are not currently contained in the RPMS, and the ones that are have slightly different logic definitions. However, the RPMS does contain sufficient data elements so that the AHRQ recommendations can easily be built into the Best Practice and Health Maintenance sections of the existing RPMS Health Summary. (AHRQ Contract). · AHRQ provides support for prevention and care management services An interagency agreement has allowed AHRQ to provide funding to the IHS to support the improvement of the delivery of prevention and care management services through the IHS Chronic Care Initiative (CCI). This agreement uses the CCI's key strategy, the Collaborative Innovations in Planned Care for the Indian Health System (IPC-IHS). The IPC collaborative will focus on the self-management support component of the Chronic Care Model and provide training in the 5 A's model of behavior change (Assess, Advise, Agree, Assist, Arrange) and motivational interviewing for teams. The collaborative also supports primary care practices to improve chronic illness and preventive care for AI/ANs. The 2-year project will help to answer questions about what elements can be integrated into the IHS electronic health record (EHR) to prompt and document self-management support. Another area to be explored is what key measures should be collected from the EHR to drive performance improvement. (AHRQ and IHS Interagency Agreement). A primary interest of AHRQ is improving the quality of health care in the United States. Improving quality of care for AI/ANs poses various challenges. Overall, AI/ANs receive worse care than whites for more than 40 percent (9 of 22) of core quality measures and better care for nearly 25 percent (5 of 22) of core quality measures, according to AHRQ's 2009 National Healthcare Quality Report. The Agency has funded several studies aimed at improving care quality for AI/ANs. · Project seeks ways to improve CAHPS® and enhance its impact The Yale CAHPS® team is conducting a Quality Indicators (QI) project with the Eastern Shoshone and Northern Arapaho Tribes of the Wind River Indian Reservation in Wyoming and with the Assinniboine and Sioux Tribes of the Fort Peck Indian Reservation in Montana. The Yale team has worked with the Tribal Health Directors at Wind River and the IHS leadership team to develop a modified version of the CAHPS® 3.0 instrument. This instrument is being used to collect data to identify specific areas for targeted QI interventions. Baseline data has been collected and reported to the Tribal-IHS Working Group. This team is now developing a detailed plan for the QI initiative which will be presented to the Tribal Health Directors and IHS for review. At the Fort Peck Indian Reservation, the Tribal Health Director is interested in conducting QI interventions at the tribally operated dialysis unit. The team, with input from the Tribal Health Director, has developed a modified version of the CAHPS® In-Center Hemodialysis Survey that will be used to collect baseline data through which to identify the specific QI initiative to be implemented. It is anticipated that a QI project will also be conducted with the Fort Peck IHS Service Unit. (Principal Investigator: Paul D. Cleary, Yale University; Grant HS16978, 9/01/07-8/31/12). · Project to improve race and health status data for Pacific Northwest States The Improving Data and Enhancing Access-Northwest Project seeks to more accurately characterize health status and clinical outcomes data for Northwest tribal people, while working to minimize and eventually eliminate racial misclassification errors in State surveillance data systems. To identify and correct racial misclassification, the project will conduct record linkages with an array of health-related data systems in a three-State region. Ultimately, it will disseminate results and develop concrete methods by which other States and Tribal Epidemiology Centers may implement similar programs. AHRQ is providing support for this project through funding received from the American Recovery and Reinvestment Act of 2009. (Principal Investigator: Victoria Warren-Mears, Northwest Portland Area Indian Health Board; Grant HS19972, 9/30/10-9/29/13). · Medical home model for Alaska Natives to be assessed for impact on patient care delivery The Southcentral Foundation (SCF), a tribally owned organization, implemented a patient-centered medical home (PCMH) in 1999 and 2000 in Anchorage, Alaska. The SCF PCMH has three key characteristics: patient-selected family match to a primary care team, patient-driven care, and advanced access. In this project, the University of Alaska and the SCF are partnering to determine the impact of the PCMH transformation on the characteristics and quality of patient care delivery, and to assess changes in health care delivery, such as quality and safety efforts, efforts to bring evidence to the point of care, use of information systems, and costs. This PCMH model could have national implications for improving the health of the AI/AN population and may also be relevant to other practices serving diverse populations with multiple health disparities. (Principal Investigator: David L. Driscoll, University of Alaska at Anchorage; Grant HS19154, 7/01/10-6/30/12). · Electronic clinical data to assist in assessing comparative effectiveness of quality improvement efforts Over the past decade, the IHS has developed a national information technology infrastructure that allows for the routine, reproducible measurement of ambulatory quality of care across a spectrum of conditions for AI/AN communities. This infrastructure represents a model for evaluating the use of a nationally integrated health information system to conduct comparative effectiveness research (CER) and ultimately identify the most capable quality improvement activities. This project will use electronic clinical data from the IHS national health information systems to create a longitudinal database linking quality of care measures for diabetes, cardiovascular disease, and cancer screening over a 9-year period. A second objective will be to conduct two comparative analyses to determine the effectiveness of delivery system interventions, such as the use of an advanced EHR, and a chronic care model (Improving Patient Care) to assess health care quality and outcomes for diabetes, cardiovascular care, and cancer screening. AHRQ is providing staff support to IHS in this project with funding received from the American Recovery and Reinvestment Act of 2009. · Study links funding levels of tribal health programs to outcomes Tribally Operated Health Programs (TOHPs) provide care nationally to more than one-third of the 1.8 million AI/ANs who obtain services from the IHS. Many unnecessary hospitalizations can be prevented with access to comprehensive effective ambulatory care. This study found that higher IHS funding levels for TOHPs in California were associated with lower rates of hospitalization for ambulatory care-sensitive conditions (HASCs) by the AI/ANs who used them. On average, IHS funding pays for less than 49 percent of the medical care provided by TOHPs in California. For TOHPs with funding less than 60 percent of what the Federal government pays for Federal employee medical care (benchmark), the HASC rate dropped 12 percent for every 10 percent increase in funding. Even when adjusted for confounding characteristics, the funding effect was between 9 and 11 percent. The authors concluded that additional funding of tribal program health care is likely to improve outcomes of care for the AI/AN population. Source: Korenbrot C, Kao C, Crouch JA. Funding of tribal health programs linked to lower rates of hospitalization for conditions sensitive to ambulatory care. Medical Care 2009 Jan; 47(1):88-96. · Collaboration creates community health information exchange network This project includes a collaborative partnership among 12 agencies, including a rural acute care hospital, a large American Indian tribal entity, an IHS hospital, a community health center, a health department, and a community consortium. The total patient population is 250,000 in 14 counties in rural northeastern Oklahoma. The project includes three components for improving quality of care. The first, Healthfinder, is an electronic and telephone resource to assist consumers in locating health providers and social services. It also assists providers in meeting community needs. Healthfinder (www.okhealthfinder.com) includes a special section to assist AI/ANs in finding tribal and IHS resources. The second component implements an integrated community health information exchange network to facilitate provider coordination and transfer of critical patient information. The network is using Hastings Indian Medical Center, an IHS facility, and the Cherokee tribe, the second largest tribe in the country, as initial connections with the goal of allowing all IHS and Native American tribes to connect quickly and inexpensively through the network.The last component explores areas for the most cost-effective prevention strategies and adopts common objectives for prevention interventions and outcome measurement. This project builds on an earlier 1-year planning grant (HS15364) by the same investigator. (Principal Investigator: Mark Jones, Tahlequah City Hospital; Grant HS16131, 9/30/05-9/29/08) · Study seeks strategies to improve performance based on priority issues In addition to supporting the development of a sustainable research infrastructure for the Montana/Wyoming Tribal Leaders Council, Black Hill State University, and the Black Hills Center for American Indian Health, this project funded a study aimed at designing, implementing, and evaluating the effectiveness of a structured process in which tribal members and IHS providers jointly developed strategies to improve performance based on priority issues identified through a consumer survey. Investigators developed a targeted research agenda that addressed tribally identified priority issues, such as hepatitis C, West Nile virus, and methamphetamine use. (Principal Investigator: Gordon Belcourt, Montana/Wyoming Tribal Leaders Council; Grant HS14034) · Database developed to assist in health care planning This grant enabled the development of a shared resource database for tribes to use in health care program planning and application development. It includes area- and tribal-specific data, "best practices" papers, and links to resources on health topics of interest to the tribes. It is currently being maintained by the Rocky Mountain Tribal Epi-Center. Principal Investigator: Gordon Belcourt, Montana/Wyoming Tribal Leaders Council (Grant HS14034) When researchers study AI/AN people, they need to be able to understand, appreciate, and use culturally appropriate strategies. For example, they need to understand AI/AN cultural values and language barriers that alter perceptions of informed consent to research participation. By demonstrating cultural competence, researchers can avoid stereotypes and biases that can undermine their efforts. It also promotes a focus on the positive characteristics of a particular group. Cultural competence acknowledges and incorporates at all levels the importance of culture, the assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs. · Project to improve the quality of race and ethnicity data in hospital discharge and emergency department databases in New Mexico New Mexico's Improving the Quality of Race and Ethnicity Data Project will contribute to reducing racial and ethnic health and health care disparities by improving the reliability of race, ethnicity, and tribal affiliation hospital data in the State. Guided by a State advisory committee, between 5 and 10 pilot hospitals will field test training materials that will be developed for the project. These will include hospital procedure, data collection, patient education, and train-the-trainer materials. Hospital discharge records will be linked with birth certificate records and IHS records to track improvements. New Mexico expects to establish a model for the collection, reporting, and appropriate dissemination of tribal identifier data which will be informally disseminated to other States and through a published manuscript. AHRQ is providing support for this project through funding received from the American Recovery and Reinvestment Act of 2009. (Principal Investigator: Michael Landen, New Mexico State Department of Health; Grant HS20033, 9/30/10-9/29/13). · Coding problems inhibit ability to study American Indian acute inpatient hospital data Reliable coding of race and ethnicity by hospitals represents a critical step toward assessing and addressing racial and ethnic disparities in acute inpatient care. The authors examined the reliability of race and ethnicity classifications by different hospitals who admitted the same patients in a large, diverse State. The rates of coding agreement for American Indians were very low (19 percent), compared with whites (91 percent) and blacks (88 percent). There was a similar pattern for hospital data and death certificates with agreement of only 27 percent for American Indians. The authors concluded that coding agreement is too low for American Indians (as well as persons born in American Indian and selected Hispanic subgroups) for these groups to be studied using this data. Source: Fiscella K. and Meldrum S. Race and ethnicity coding agreement between hospitals and between hospital and death data. Med Sci Monit 2008; 14(3):SR9-SR13. (Grant HS10910). · Individual consent in research can clash with community values Reflecting on a decade of research among American Indians in the Southwest, the author studied the biomedical ethics of individual autonomy, which can be incompatible with the culture mores of strong family, community, and group decisionmaking. The author suggests that alternative approaches to informed consent and ethics are called for. Source: Smith-Morris, CM. Autonomous individuals or self-determined communities: The changing ethics of research in Indian country. Human Organization 2007 Fall;66(3);327-336. (Grant HS10802) · AI/ANs difficult to reach by mail The researchers sent a calendar with preventive health information to one group and no health information to the control group via first class mail to 5,633 patients who had been seen at a clinic during the past 2 years. Based on initial mailings and in-person location efforts, an estimated 61 percent of patients received the calendars. The mail verification process was significantly less likely to identify addresses for patients who were AI/AN and those who were seen more than 3 months before the study. In fact, AI/ANs were about half as likely as non-AI/ANs to have accurate addresses. The results suggest that it is difficult, but possible, to use the U.S. Postal Service to reach patients seen at an urban Indian health facility. Source: Duffy D, Goldberg J, Buchwald D. Using mail to reach patients seen at an urban health care facility. J Health Care Poor Underserved 2006 Aug;17: 522-31. (Grant HS10854) · Nearly half of urban AI/ANs travel back to their reservation yearly Of the more than two million AI/ANs living in the United States today, only 25 percent reside on reservations, while 60 percent live in cities. Those who live in cities often travel to reservations, yet little is known how this travel may be related to health. Researchers surveyed more than 500 AI/AN adults at a primary care clinic in Seattle about time spent visiting a reservation during the past year, and the person's sociodemographic, cultural, and clinical characteristics. Thirty-four percent of respondents had spent up to 30 days traveling, 14 percent had spent more than 30 days traveling, and 52 percent had not traveled to reservations. Strong Native American cultural identification, presence of lung disease, absence of thyroid or mental problems, and greater dissatisfaction with care were independently associated with more travel to reservations. Reservation visits were not consistently linked to self-reported health outcomes, nor could the researchers determine how often respondents traveled to the reservation for health care. The findings underscore the importance of considering the role of culture as well as residence and patterns of travel in both research and clinical care involving AI/ANs. Source: Rhoades DA, Manson SM, Noonan C, Buchwald D. Characteristics associated with reservation travel among urban Native American outpatients. J Health Care Poor Underserved 2005 Aug;16(3):464-74. (Grant HS10854) · Strictly translated informed consent documents promote mistrust Interpreters and a Navajo language consultant developed a translation in Navajo of a standard consent form for participating in a study. After using the form for 4 months, the researchers learned that the formal consent process often led to confusion and mistrust of the research. The researchers stress that cross-cultural communications and translations increase effectiveness. Source: McCabe M, Morgan F, Curley H, et al. The informed consent process in a cross-cultural setting: Is the process achieving the intended result? Ethn Dis 2005 Spring;15(2):300-4. (Grant HS10637) Research Infrastructure Development A major AHRQ goal is to build research infrastructure and enhance opportunities for AI/AN investigators in health services research. · Partnerships formed to foster research and research training In addition to building the research capacity for the Native American Research Center for Health (NARCH), this multiyear project aimed to identify which health care characteristics of tribal health program service systems are associated with preventable hospitalizations. AHRQ became a partner in the NARCH program in 2005, supporting the California Rural Indian Health Board's NARCH grant. This program—which aimed to develop opportunities for conducting research and research training that respond to the needs of AI/AN communities—was predominantly funded by the National Institutes of Health and managed by the IHS. The centers created partnerships between AI/AN organizations and research-intensive institutions. Further information on the NARCH grants can be found at http://www.ihs.gov/MedicalPrograms/Research/narch.cfm. · Project studies comparative effectiveness of disease management by IHS advanced practice pharmacists This project seeks to create an IHS database/data infrastructure that will support the conduct of comparative effectiveness research (CER) and to conduct a CER study of a health system delivery strategy designed to improve health outcomes among AI/ANs with diabetes and CVD. The data infrastructure will help identify interventions designed to improve health outcomes and reduce documented disparities. It will be based upon 3 consecutive years of data from four IHS data sources and will include health status measures, group codes (provider, clinic, drug, pharmacy), and cost measures. Data will be included from each of the 12 IHS regions (~650,000 patients). The CER study will compare disease management by advance practice pharmacists with other health care providers within the IHS. Pharmaceutical care and the expanded role of pharmacists have been associated with many positive diabetes-related outcomes, including improved clinical measures, improved patient and provider satisfaction, and improved cost management. Within the IHS, 22 percent of pharmacists are advance practice pharmacists who are nationally credentialed and locally privileged to provide prescriptive pharmacy care and clinical monitoring for acute and chronic disease management. AHRQ is providing staff support to IHS in this project with funding received from the American Recovery and Reinvestment Act of 2009. · Conceptual model of academic persistence aids in training of young AI/AN professionals Various programs have emerged to recruit junior investigators to the social, behavioral, and health sciences. Drawing on Tinto's general theory of academic persistence focusing on the undergraduate education and IHS experience with the Native Investigator Development Program, the author presents a conceptual model that applies to individuals early in the postdoctoral or postresidency experience. This model is exemplified in the Native Investigator Development Program at the University of Colorado, Denver. All trainees in this program are either American Indian or Alaska Native. The author describes program and institutional characteristics as well as trainee processes. He concludes by describing the various benefits of the model, such as providing a common language for discussing elements of the training process and serving as a guide for assessing trainee needs. Source: Manson SM. Professional journeys, professional paths: Persistence in navigating the crossroads of a research career. Am J of Pub Health 2009 Apr; 99 suppl 1:S20-S25. (Grant HS10854). · Project focuses on healthy weight and cancer outcomes for women This continuation grant builds upon its earlier capacity-building success during which the Montana-Wyoming Tribal Leaders Council developed a shared data resource and research infrastructure for participatory research among a majority of the 10 tribes it serves. The continuation project will further build capacity for health care research on the priority health issues identified by the tribes and continue to support culturally appropriate health programs. Three new research studies are planned: evaluation of interventions to promote healthy weight among women, examination of factors that contribute to breast and cervical cancer outcomes, and design and implementation of a "healthy reservations" model program for system-wide health improvement on reservations. (Principal Investigator: Gordon Belcourt, Montana-Wyoming Tribal Leaders Council; Grant HS14034). Technology (Health Information Technology, Telehealth) Health care is information intensive and increasingly dependent on technology to ensure that appropriate information is available whenever and wherever it is needed. AHRQ is assisting the IHS in enhancing its health information systems to improve quality of care and patient safety. For example, AHRQ:
· Project seeks to improve care for minority stroke survivors This mentored clinical scientist development award will assist a minority researcher in helping to achieve the aims of the Stroke Telemedicine Access Recovery (STAR) Project. STAR's long-term goal is to implement an innovative, multi-disciplinary, specialty-care intervention for stroke survivors that targets early introduction to rehabilitation and assists with transitions between levels of care. The project is to take place at the Southeastern Regional Medical Center, a rural hospital serving a Lumbee Indian, African American, and white population. The first phase of the project is to observe the current rehabilitation process to be followed by implementing a multi-disciplinary consultation service using telemedicine video-conference technology. The researcher will provide pilot data to improve inpatient management, discharge disposition, and recovery phase care. (Principal Investigator: Patricia C. Gregory, University of North Carolina at Chapel Hill; Grant HS17956, 7/01/09-6/30/14).
AHRQ is providing funding to the IHS to support the Family Health History initiative. At present, there is a paucity of EHR systems capable of capturing family health history data in a structured, standardized, and interoperable format that can be seamlessly integrated with electronic clinical decision support (CDS) tools. The IHS has taken the lead in developing the technical implementation of a system that is capable of producing a standards-based, machine-readable file that can be consumed by partner organizations across the government and private industry. The agreement outlines the scope, timeline, roles, and responsibilities of the project to be completed by the IHS. (AHRQ and IHS Interagency Agreement).
The California Rural Indian Health Board in September 2004 began partnering with three of its rural tribal health programs that implemented electronic health records with clinical decision support systems in an effort to reduce hospitalizations that may be preventable through improved care quality and reduced medical errors. The information technology systems that result will be used in conjunction with local hospitals to support the review of all hospitalizations for their preventability and to track the programs' medical and medication errors as well as their clinical care performance according to standardized performance guidelines. (Principal Investigator: Linda Aranaydo, California Rural Indian Health Board; Grant HS15339, 9/20/04-8/31/07) · Telehealth initiative sparks health information campaigns The authors examined the Native TeleHealth Outreach and Technical Assistance Program that transfers knowledge of health telecommunication technologies to community health professionals to empower them to use these resources in their communities. The program offered instruction on telehealth for care providers, who in turn developed culturally relevant information for recipients on health topics via CDs, videos, Web sites, and brochures. Source: Dick RW, Manson SM, Hansen AL, et al. The native telehealth outreach and technical assistance program: A community-based approach to the development of multimedia-focused health care information. American Indian and Alaska Native Mental Health Research: J National Center 2007;14(2):49-66. (Grant HS10854) · Health collaborative technology assessed in Alaska's Central Kenai Peninsula This project assessed the status of technological resources of a federally qualified health center for uninsured and underinsured patients, a mental health clinic, a long-term care provider, and a local acute care hospital serving a population of Alaska Natives, poor patients, and patients with disabilities. The study team prepared a plan for implementing health information technologies to allow for area-wide electronic communications and connectivity with an electronic health record and a Web-based data system for patient support. (Principal Investigator: Susan Caswell, Central Peninsula General Hospital; Grant HS14902, 09/30/04-09/29/06) · Patients and clinicians receptive to telepsychiatry services for youth To address the shortage of practitioners in child and adolescent psychiatry, the use of real-time interactive videoteleconferencing to deliver psychiatric services, or telepsychiatry, has been proposed as a way to meet the needs of American Indian youth. The authors reviewed the progress of a twice-monthly telepsychiatry program for children and adolescents undertaken by the University of Colorado School of Medicine's Center for Native American TeleHealth and TeleEducation and the IHS's Rapid City Hospital. Parents said they preferred the service to the 350-mile drive they would otherwise need to make to get help for their children. Clinicians said teleconsultations helped in diagnosing and managing complicated patients and families. Source: Savin D, Garry M, Zuccaro P, et al. Telepsychiatry for treating rural American Indian youth. J Am Acad Child Adolesc Psychiatry 2006 Apr: 45(4):484-8. (Grant HS10854)
The authors describe the rural telepsychiatry clinics run by the American Indian and Alaska Native Programs at the University of Colorado Health Sciences Center through a partnership with the Department of Veterans Affairs, the IHS, and local tribal health services. This service may offer a means to increase access to care for rural American Indian communities. The clinics primarily offer assistance to American Indian veterans with PTSD. Describing the model used for developing the services, the authors trace the program development, discuss challenges in implementing services, and offer solutions. The model can guide the development of telepsychiatry services for American Indians, especially rural populations. Source: Shore JH, Manson SM. A developmental model for rural telepsychiatry. Psychiatr Serv 2005 Aug;56(8):976-80. (Grant HS10854) Traditional tobacco has a spiritual role in Indian culture and varies from tribe to tribe. By some estimates, American Indians have used the tobacco plant for more than 18,000 years. Traditional tobacco is still used by many tribes for prayer, ceremonies, offerings, gift-giving, or as a healing medicine. Commercial tobacco use, however, is also significant among AI/ANs. Approximately 32 percent of AI/ANs are smokers. This is the highest rate of tobacco use among every age, ethnic, and gender category in the United States. Between 1983 and 2002, adult smoking rates fell in all racial and ethnic groups except for American Indians and Alaska Natives. · Northern Plains American Indians smoke more than Southwest Plains Indians This study of Southwest and Northern Plains American Indians (ages 15 to 54) found that about half of Northern Plains men and women currently smoked (49 and 51 percent, respectively), while 19 percent of Southwest men and 10 percent of Southwest women smoked. The study did not determine use of tobacco for ceremonial purposes. However, the Northern Plains tribe bases a large part of their spiritual philosophy around the concept of the "sacred pipe," considerably more so than the Southwest tribe. Thus, the differences in smoking rates could have a cultural basis. Men and younger people were more likely to smoke in the Southwest tribe but not the Northern Plains tribe. This finding is consistent with other studies that suggest cigarette smoking among tribes of the Southwest region is on the rise, especially among younger men. The results underscore the need to consider each tribal group's unique characteristics when designing and implementing culturally sensitive smoking intervention programs in American Indian communities. Source: Nez Henderson P, Jacobsen C, Beals J. Correlates of cigarette smoking among selected Southwest and Northern plains tribal groups: The AI-SUPERPFP Study. Am J Public Health 2005 May;95(5):867-72. (Grant HS10854) Many AI/ANs use traditional practices, such as herbs, to address their health care concerns. · Traditional herbs do not affect diabetes medication Many AI/ANs integrate traditional herbs with Western medicine, though there is limited data on the herbs' efficacy. During a randomized clinical trial from 2001-2003 on the Navajo Nation, 30 percent of the participants said they used herbs as medicine. Of the participants with diabetes who used traditional herbs, the study found no measurable adverse interaction with diabetes control medications. Source: McCabe M, Gohdes D, Morgan F, et al. Herbal therapies and diabetes among Navajo Indians. Diabetes Care 2005 Jun;28(6):1534-5. (Grant HS10637) Injury is a leading cause of death and disability for AI/AN communities. Overall, unintentional injury is the third leading cause of death among AI/ANs, and suicide and homicide are among the top 10 causes of death. Injuries and violence are especially a burden for the young AI/AN population, accounting for 75 percent of all deaths among those ages 1 to 19. Unintentional injury, suicide, and homicide are respectively the top three killers among AI/ANs 1 to 44 years old, accounting for 54 percent of all deaths. Injuries cause more deaths among AI/ANs 1 to 44 years of age than all other causes combined. Unintentional injuries account for more years of potential life lost among AI/AN than heart disease, cancer, and diabetes combined. · Trauma linked to alcohol problems in American Indians American Indians experience more traumas and alcohol disorders than the general population. Researchers interviewed 432 American Indians between the ages of 15 and 24, asking participants if they had experienced any of 16 types of traumatic events and about their use of alcohol. Overall, 21 percent had experienced one severe traumatic event, 10 percent had experienced two, and 16 percent had experienced three or more. Young adults (aged 20-24) experienced more traumatic events than adolescents (aged 15-19), as did participants in both age groups who reported that their parents used alcohol while they were growing up. More than one-fourth (26 percent) of those interviewed were diagnosed with alcohol use disorders. The odds for alcohol use disorders increased from nearly twofold for one trauma to somewhat less than fourfold for three or more traumas compared with no trauma. These results held after adjusting for age, gender, and parental alcohol use, suggesting a dose-response effect of trauma on alcohol disorders among American Indians living on or near reservations. Source: Boyd-Ball AJ, Manson SM, Noonan C, et al. Traumatic events and alcohol use disorders among American Indian adolescents and young adults. J Traumatic Stress 2006 Dec;19(6):937-47. (Grant HS10854) · Trauma strikes American Indians more often than the general U.S. population Southwest and Northern Plains American Indians more often experience trauma than the general U.S. population, according to this study of trauma exposure among two tribes. Researchers interviewed 3,084 members of two tribes about their exposure to 16 types of trauma. They compared tribal prevalence rates of trauma with a sample of the U.S. general population in the National Comorbidity Survey. Lifetime experience of any trauma was high across both tribes, ranging from 62.4 percent for male Southwest tribe members to 69.8 percent for female Northern Plains tribe members. This compares to lifetime exposure to any trauma among U.S. men and women at 60.7 percent and 51.2 percent, respectively. The researchers suggest that high rates of trauma exposure may contribute to the increasing prevalence of CVD, the leading cause of death among American Indian men and women. Similarly, trauma is closely linked to pain, which negatively affects compliance with treatment, help-seeking, and the speed of surgical recovery, all of which are often compromised in American Indians. Source: Manson SM, Beals J, Klein SA, et al. Social epidemiology of trauma among 2 American Indian reservation populations. Am J Public Health 2005 May;95(5):851-9. (Grant HS10854) AI/AN women have striking health concerns. They give birth to children at younger ages than do women in the general U.S. population. High birthweight births of 4,000 grams or more (vs. low birthweight births) are a relatively greater problem for AI/AN women. These women generally begin prenatal care later than other women in the United States and are more likely to exhibit risky behaviors, such as smoking or consuming alcohol, during pregnancy than their counterparts in the United States. · Study looks at breast and cervical cancer screening and followup In addition to supporting the development of a sustainable research infrastructure for the Montana/Wyoming Tribal Leaders Council, Black Hills State University, and the Black Hills Center for American Indian Health, this project funded a study for identifying factors that affect breast and cervical cancer screening and followup of abnormal findings. Investigators developed a pilot program to increase the proportion of American Indian women who receive screening tests. (Principal Investigator: Gordon Belcourt, Montana/Wyoming Tribal Leaders Council; Grant HS14034, 9/30/03-9/29/06) · Extremely obese American Indian and Alaska Native women may have higher bone mineral density than white counterparts Researchers compared baseline bone mineral density (BMD) of 139 AI/AN postmenopausal women with 1,431 non-Hispanic white postmenopausal women to determine the variability of BMD, osteoporosis, and hip fractures. The AI/AN women studied were twice as likely to be obese (body mass index of 30-39.9) or extremely obese (BMI of greater than 40) than non-Hispanic white women. The extremely obese AI/AN women had higher hip BMD than extremely obese non-Hispanic white women, but overweight AI/AN women had slightly lower spine and whole body BMD compared to non-Hispanic white postmenopausal women. Source: Wampler NS, Chen Z, Jacobsen C, et al. Bone mineral density of American Indian and Alaska Native women compared with non-Hispanic white women: Results from the Women's Health Initiative Study. Menopause: J North Am Menopause Society 2005 Sep-Oct;12(5):536-44. (Grant HS10854)
For further details about AI/AN projects and other activities at AHRQ, contact: Wendy Perry Current as of March 2011 Internet Citation: AHRQ Research and Other Activities Relevant to American Indians and Alaska Natives. Program Brief. Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 10-P007, Revised March 2011. http://www.ahrq.gov/research/amindbrf.htm |


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Taliban waging 'jihad to purge Pakistan' - Zawahiri
As the Pakistani Taliban merge forces and strike peace deals with the government, al Qaeda's second in command said that the Taliban is waging war against the Pakistani state.
In a videotape released on the internet on Feb. 23, Ayman al Zawahiri said that the Pakistani Taliban is fighting the Pakistani government just as the Afghan Taliban has fought the Afghan government and NATO forces.
"Your brothers in the Taliban are not fighting to liberate Afghanistan only, but also the Taliban in Pakistan are carrying out jihad to purge Pakistan from the United States and its agents in the Pakistani Government and army," Zawahiri said.
Zawahiri's video appeared on the internet just days after the three major Taliban factions in North and South Waziristan put aside their differences and formed the Council of United Mujahideen. Baitullah Mehsud, Mullah Nazir, and Hafiz Gul Bahadar created the umbrella group at the behest of Osama bin Laden and Taliban leader Mullah Omar. They promised to fight against "infidels" in Pakistan, Afghanistan, and the US.
Al Qaeda has advocated for the Pakistani people to fight their government since August 2007. Abu Yahya al Libi, an al Qaeda spokesman and ideologue, urged the Pakistani people and the Army to turn against then-President Pervez Musharraf's regime after the military stormed the radical Red Mosque in the heart of Islamabad. Zawahiri has repeated this call to rebellion several times since then.
In his latest tape, Zawahiri also urged the Pakistani and Afghan people to continue to fight their governments and eject Western countries from the region.
He mocked the West and Afghan President Hamid Karzai for attempting to negotiate with Taliban outsiders "not linked to al Qaeda," highlighting the interconnectedness of the two groups and dispelling the rumors that there is a split between al Qaeda and the Taliban.
He described the attempted negotiations as a sign of weakness. "Americans are in a serious predicament, and their agents are in a state of confusion and turbulence," Zawahiri said.
"We saw Hamid Karzai in Munich inviting those members of Taliban residing outside Afghanistan who are not linked to al Qaeda to return to Afghanistan in order to participate in the political process," Zawahiri said. "It is an invitation which draws out ridicule, similar to what the United States and Saudi Arabia tried to promote earlier in regard to holding negotiations with Taliban through Saudi mediation."
The Taliban issued multiple public statements, including several statements by Mullah Omar that said the negotiations were being carried out with people who no longer represented the group. The Taliban also described these negotiations as a sign the West's failure in Afghanistan.
READER COMMENTS: "Taliban waging 'jihad to purge Pakistan' - Zawahiri"
Posted by Bill Roggio at February 24, 2009 9:43 PM ET:
wYSe Guy,
I am currently looking into the Bajaur situation and hope to have a report on this later this evening.
I would warn that listening to & believing the Pak military spokesman comes with much peril. I can, and have, cite numerous instance where he has blatantly lied to the media, only to backtrack days later. Whatever Abbas is saying, he is putting the best possible spin on it.
It should be noted that Faqir Mohammed is lying through his teeth when he says that there are no foreign fighters in Bajaur.
Also, Baitullah Mehsud signed off on the Swat peace deal. And why wouldn't he? The Taliban got what they wanted; they brought the military and government to its knees.
Finally, Zawahiri and the Taliban have much to be happy about, they've carved out a large chunk of territory on both sides of the border.
Posted by Ayamo at February 25, 2009 2:21 AM ET:
Bill is right.
Remember how the Pakistani army claimed to have cleared Bajaur TWICE in 2008?
They will call the capture of a small village a huge victory.
I doubt that the Taliban and their allies are beaten in Bajaur.
Posted by Raj Kumar at February 25, 2009 4:26 AM ET:
IMO it is obvious to all of us now that Pakistan will fall to the Taliban sometime in 2009 or 2010 at the latest and we must start preparing for a world were the Taliban are in control of a country which has a functioning 'nuclear' industry and the implications of the black turban brigade getting their paws on radioactive nuclear material.
I hope all democratic governments have already prepared for this 'black swan' event!!!
Posted by KW64 at February 25, 2009 1:16 PM ET:
Re: Raj comment 4
For what it is worth, my limited number of Pakistani friends feel that Pakistan will NOT fall to the Taliban/Al Queda. The Northwest highland's tribal areas are not of much concern to them but they feel the army will be more willing to fight for the heavily populated lowlands and that the majority population will reject their style of rule.
One could expect a number of sources of foreign assitance becoming available against a move to take over the whole country by radical elements. One would also expect that the guerilla style fighting against air, armor and artillery that we have seen in FATA will be less effective away from the mountains and their base of support. The army may even be willing to pull some 1st class units away from the Indian front if the leadership sees the potential for a khomeini style take over when they look at what happened to the Shah's generals.
Posted by Libertyship46 at February 25, 2009 1:47 PM ET:
Everyone in the West would be foolish not to start drawing up contingency plans for the fall of Pakistan to Muslim fundamentalists like the Taliban.
But perhaps the general public, like the Iranian people during the fall of the Shah, want the radical fundamentalists to win? Pakistanis are no fools. They must be seeing what is going on in their own country and if they really wanted to defeat Muslim fundamentalists like the Taliban they certainly would have done it by now. After all, are the moderates in Pakistan only going to take the threat seriously after more than two-thirds of the country is taken over by the Taliban?
Also, another thing the West may not be considering about Al Qaeda is that maybe, just maybe, their primary objective is NOT to stage more 9/11-type attacks. After all, if they did stage another 9/11 against a Western target, it would only further unify the vacillating Western nations against them. What if all of Al Qaeda's rhetoric against the West is just that, rhetoric, and that their primary objective is to take over Pakistan? After all, if the Taliban and Al Qaeda take over Pakistan, then that makes them a defacto nuclear power, which puts them in a much more dangerous position than if they simply committed a random act of terrorism against the West. What we may be seeing here playing out in Pakistan is Al Qaeda's true game plan, which is to become a nuclear power by overthrowing the Pakistani government. Question is, what is the West doing to stop this from happening?
Posted by rational enquirer at February 25, 2009 7:17 PM ET:
Excellent points, Libertyship. Sometimes the worst possibilities are the hardest to face.
Posted by Adayamo at February 26, 2009 3:46 AM ET:
@ Raj Kumar:
I also doubt that PAK will fall to the Taliban by 2010.
What they need is support of the population which they have in the NWFP and the FATA.
Those are the places where the Pashtuns are living.
But for example Punjab would be another league and I do not think that the Taliban will start to conquer other provinces.
First of all they'll try to grab as much of NWFP and FATA as they can.
And also it is sad to say: The can grab a lot, and they will grab a lot there throughout 2009.
That's for sure.
We won't see the Taliban defeated. Not in 2009 and not in 2010. As long as the Pashtun tribes support the Taliban, as long there will be no chance to achieve final victory over the Taliban.
Posted by Bangash Khan at March 1, 2009 1:27 AM ET:
The Pashtuns of Pakistan no longer support the Taliban. The problem is that there are too many Taliban-type groups now, with lots of heavy weapons and no humanity.


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"As if this needs another 5 star rating; but here it is! My only alterations are to cut out the red pepper (too spicy for us; but we're wimps!) and to use boneless thighs as they don't dry out as easily when cooked for awhile. This is a definite keeper; thanks for sharing!"
"I also used about 4 lbs of wings and kept the same amounts for the remaining ingredients. I used Splenda brown sugar and low sodium soy sauce. Basted this twice while baking after turning them. My sauce didn't thicken a whole lot either; but was still fabulous. However, next time I will use a disposable tin pan... even with triple layers of fo..."
"I hate writing anything negative; but I followed this exactly and was very disappointed. The dough was VERY thick and that worried me; but after double checking; I was sure I had included all the ingredients. It was very dense; had a very dry texture and little flavor. I was very hopeful; but honestly won't use this again."
"Add another fan to your list! Wonderful dish; easy to make and lots of variations open to it. After reading other reviews; I made ours with 3 cups cabbage and omitted the regular oil and used 2 Tbls or sesame oil. Ran out of soy sauce with earlier recipe so substituted teriyaki and added a dash of salt to cut the sweetness. Also added 3 Tbls. ..."
"I have also been using this recipe for years; it is my most "asked for" dish for parties. Like some of the others, I add 1/2 a cup to a cup of Kahlua to the cake (taking a fork and running it across the top of the cooling cake). And I have never tried the mousse; always used plain chocolate pudding. I will have to try it with the mousse next ti..."
"Really great recipe and easy to make! Family loved cranberries in a nontraditional way. A keeper!"
"A friend gave me her recipe for this and although the ingredients are slightly different, it sounds pretty close. Very easy to make and big crowd pleaser. Thanks for sharing!Shelly"
"This is a real crowd pleaser. I have made this same thing (even calling it the same name!), but use a chocolate cake mix in a 9X13 pan rather than the brownie mix. After taking the cake from the over, I score the top of it with a fork and pour 1 cup of Kahlua over it. Marvelous! Thanks for sharing Kathy!"
"This was so simple and so popular I was tempted to let friends believe it was harder than it was. Actually, the most time consuming part was unwrapping the candy-canes. At other reviewers suggestions; I used 2 tsp. of peppermint extract and would actually go to 3 tsp. if using milk chocolate, but only to give it more zing. I used chocolate bark..."


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Someone has compiled a fewbroadcasts of the former state senator's cable access show into 8 ½ minutes of
hilarity. With some clever editing and
tape loops, the presentation makes Jaye look like a buffoon. Yet, the notorious
ex-lawmaker needs no help from the cutting room floor.
It's rather astonishing what Jaye
got away with on a routine basis back then. In an age when controversial
statements by public officials instantly become fodder for Facebook and
Twitter, it's impossible to imagine that Jaye, who was happy to spout off on
camera, would have survived in today's political atmosphere.
Here's the former Shelby Township
Republican calling for life sentences for repeat criminal offenders: "Lock 'em
up for good, or at least until they're 70-years-old – unless they're perverts.
Lock'em up forever, or at least until we get the death penalty, whichever comes
first. Fry 'em, or keep them forever."
Jaye refers to "looney-tunes"
defenses of violent juveniles. The problem, he agrees, is that there's too many
single moms raising kids ("it is a sex thing") and not enough disciplinarian
fathers ("sometimes you need your Pop to whack you on the fanny").
Jaye is now best remembered for
drunkenness, spending time in jail, domestic violence and getting kicked out of
the Senate. What you notice when you watch the video is that Jaye had an
obsession with tough law enforcement – and the word "pervert."
Over at Deadline Detroit, Jeff
Wattrick had a little fun with this audio/visual trip in the way-back machine
to a time when politicians like Jaye thrived.
Wattrick wrote: "What camera
wouldn't love Jaye's creepy smile, his bad comb-over that leaves you wondering
if he's wearing a hair piece, and his fun demand that Detroit Mayor Dennis
Archer submit to a drug test? You know, because Archer was (maybe still is!)
one of those blacks! In Detroit! Then there was the time Jaye "joked"
about Native American casino operators trying to scalp him. Classic."


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Any of several North and South American blowfly species named for the screwlike appearance of the larva's body, which is ringed with small spines. Screwworms attack livestock and other animals, including humans. The true screwworm (Cochliomyia hominivorax) and the secondary screwworm (Callitroga macellaria) develop in decaying flesh; they may also attack healthy tissue. Each female deposits 200–400 eggs near an open wound. The larvae burrow into the tissue and, when mature, drop to the ground to pupate. Severe infestations (myiasis) may kill the affected animal.
This entry comes from Encyclopædia Britannica Concise.
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EM-JE003-FI - Smile Jamaica In Ear Earphones with Apple 3-Button Remote/Mic - Fire
These affordable, eco-responsible in-ear headphones offer sound isolation, three colors to choose from, a comfortable fit with three sizes of ear tips and amazing sound quality. Small and simple, with the smile Jamaica ear buds what you see is what you get. We've stripped the ear buds down to its essence and built it back up using natural materials. Then we stopped when the sound was just...
GR10 - In Ear Series Hi Performance Sound Isolating Moving Armature Earphones
Learning never ends and the GR10 is a result of a constant desire to look at designs and materials and improve upon them. Improvements upon the single armature design found in the GR8 are now in the GR10. A higher level of precision and new materials allows for the performance of the GR10 to add frequency extension in both the higher and lower ranges as well as lowering distortion. A...
The House of Marley People Get Ready IEM
" I want to thank The House of Marley for allowing me to review their headphones. For those who aren't aware of The House of Marley go check out their website! They are partners with the 1LOVE movement to spread peace. Pros: Eco-Friendly, iPod Remote, Wood, Bass lovers IEM Cons: Pushy bass, recessed miss, rolled off highs,..." --keanex


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Latest News
EXCLUSIVE INTERVIEW: Celebrity Boxing's Damon Feldman Hospitaliz...
Celebrity Boxing Federation founder Damon Feldman is being hospitalized under a 72-hour-hold following a suicide attempt on Sunday, RadarOnline.com h… READ MORE
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Wearing a pint-sized bikini and gyrating as only she knows how, Jesse James mistress #1, Michelle "Bombshell" McGee, is set to get down and dirty in her cele… READ MORE
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Before she even takes to the boxing ring, Michael Lohan's fiancé Kate Major is on the ropes — and it could be a knockout blow.
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Michael Lohan To Train Kate Major In Her Celebrity Boxing Debut
Now that she's stepped in to fight for her pal Hailey Glassman, Kate Major intends to get some serious training in for her upcoming celebrity boxing match ag… READ MORE
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Round three of the war of words between Hailey Glassman and Jesse James mistress Michelle "Bombshell" McGee is under way and Glassman is taki… READ MORE
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Hailey Glassman will not attend a promotional news conference to promote her Celebrity Boxing match, RadarOnline.com has learned exclusively.
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When Michelle "Bombshell" McGee learned that Hailey Glassman was furious that she was going to be the referee at her celebrity boxing match she exclusivel… READ MORE
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You knew this was coming.
Jesse James' mistress Michelle Bombshell McGee is firing back at Hailey Glassman for calling her "trash" and "garbage.… READ MORE
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Jon Gosselin's former gal pal, Hailey Glassman, is getting ready to participate in a celebrity boxing match but she's already come out swinging – against t… READ MORE
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Jon Gosselin's ex-girlfriend, Hailey Glassman, says she's ready to put the past behind her, like 3,000 miles behind her, and is about to embark on an exciti… READ MORE
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UPDATE: Michael Lohan's medical emergency was a "near stroke," he tells RadarOnline.com exclusively. "I'm okay so … READ MORE
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Michael Lohan had his girlfriend Kate Major at his side when he jumped into the ring for Celebrity Boxing 16 Friday night at the Ramada Philadelphia Airport … READ MORE
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Not since Rocky Balboa has the City of Brotherly Love seen a boxer like this: Michael Lohan Wednesday announced he will fight aspiring actor Derek Macintos… READ MORE
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Everybody wants a piece of Jon Gosselin….well, except his former wife Kate Gosselin, that is.
PHOTOS: Jon Gosselin Tries To Dance
Jon's ex-b… READ MORE


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Washington, D.C. and North Hollywood, Calif. -- The National Association of Theatre Owners (NATO) is pleased at the significant improvement in enforcement of the voluntary ratings system at the nation's movie theaters.
According to the Federal Trade Commission (FTC) report (http://www.ftc.gov/opa/2013/03/mysteryshop.shtm) on the results of its undercover shopper survey of ratings enforcement at the nation's entertainment retailers, movie theaters have shown "marked improvement in box office enforcement" with 76% of underage shoppers turned away from R-rated movies, compared to 67% in the last survey.
NATO President and CEO John Fithian stated, "We are proud of the significant improvement in ratings enforcement at America's movie theaters and we renew our commitment to parents to continue to improve. We also congratulate our colleagues in video game retail for their industry leading levels of enforcement."
"This report and its results continue to reinforce the importance and effectiveness of the voluntary ratings system," Fithian continued. "As the Supreme Court noted in its decision in Brown v. EMA, retailers' voluntary enforcement of the ratings provide an effective alternative to state regulation. We will continue to do our part in enforcing the voluntary ratings system that allows creators to create and parents to make informed decisions about their children's entertainment."


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About NurseLCoop2B
By NurseLCoop2B
Joined Jan 11, '12 - from 'Monroe, CT'. NurseLCoop2B is a Nursing Student. Posts: 30 (7% Liked) Likes: 15
Hi I am a Nursing Student at Bridgeport Hospital SON which is a diploma RN program. I am looking forward to the experience and hopefully this will benefit towards my ultimate goal of being a PA or NP one day. I have researched most things it takes to be an excellent Nurse but I'm still learning new things along the way. I am very interested in working as a traveling Nurse while going to school for NP. I joined this very helpful website to communicate with potential nurses like myself. Any help and advice is highly appreciated!
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Who do you think looks best today? (5 photos)
The best street style from London Fashion Week: http://ow.ly/p48HS via @StyleCaster
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Our holiday fragrance lineup just got more decadent thanks to #Marni's...
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The Daily Troll: Marijuana leeway. Gun tragedy localized. A healthy living thought.
Love the Daily Troll? Now you can sign up to get it in your inbox every afternoon.
Updated: 3:50 p.m.
Marijuana and Obama
President Barack Obama dealt today with one law-enforcement matter that was very much in the White House's realm of responsibility: He said the federal government won't go after recreational pot users.
The president, as Associated Press reported, makes his remarks in an interview with Barbara Walters recorded for broadcast tonight.
Governor-elect Jay Inslee said in an email statement, "The President's statement is welcome news to a state where voters have clearly expressed the same sentiment."
School massacre
In the bigger news gripping the nation, Obama spoke movingly about Connecticut's tragic school shooting today, saying he was reacting as a parent, not the president. His press secretary said this was not the day to deal with gun control; the president did mention the need for "meaningful action to prevent more tragedies like this, regardless of politics."
Given that the president has no role in changing the Constitution, his voice — whether or not it is eventually heard — may not be the most important, although he would have a decision to make if Congress were to decide to pass something like a ban on the most rapid-fire forms of guns or ammunition.
Though we don't know the details in Connecticut yet, there is, in each of these tragedies, a public back-and-forth about gun control and mental health. Japan, which has approached the issue with ultra strict gun control laws, sees almost no gun murders. Switzerland and Israel, however, manage the same feat with significant gun ownership, though apparently at lower ownership rates than here.
Regardless of Obama's inability to amend the Constitution, Democratic silence has been remarkable. A guest opinion article on Crosscut that argued in September for Democrats to speak up is here.
As it is, D.C. has largely left it to state and local law enforcement to deal with the guns in the hands of people whose intent is not defense but the slaughter of the defenseless. How are people reacting locally?
- Mayor Mike McGinn made a sober, forceful statement calling on the state Legislature to take action of its own and allow the city to enact stronger measures, such as banning guns from community centers. He specifically mentioned a state ban on asault weapons and closing of a gun-show loophole on criminal background checks. He noted the Legislature has cut funding for the mental health and suggested, instead, increases in services.
- The Herald in Everett was the first paper we noticed locally to talk with school officials about their fears and preparation.
- Seattle Police said they were stepping up patrols around schools.
- Seattle Schools Superintendent José Banda sent a letter to parents.
- In Oregon, where a mall shooting just occurred, a state senator has already said she will introduce a bill to limit gun magazine rounds.
Another view
One more thought before we leave law enforcement alone: At The Stranger, Cienna Madrid did a cool thing. She asked leaders of the NRA's state chapter today for their ideas on school safety and guns and presented it simply as a question and an answer piece. It's informative and, if people want to talk seriously, worth reading.
Looking ahead to 2013
On the theory that total immersion in a tragedy isn't the answer, we made some of our usual rounds and stumbled across one of the first stories to take a New Year's Resolution angle. On Gig Harbor Patch, there's a story about a couple who together have lost more than 200 pounds.
They both happen to be physicians. There's a lovely photo of the couple, Drs. Francis and Margaret Mercado, holding their two children.
Like what you just read? Support high quality local journalism. Become a member of Crosscut today!
Posted Fri, Dec 14, 5:16 p.m.
"Hugging your loved ones and taking care of yourself: Those are always good ideas."
Yes, they are. Thank you.
Posted Fri, Dec 14, 5:34 p.m.
Very much enjoying your work on the daily troll.
Please keep up the good work Joe.
Posted Fri, Dec 14, 6:19 p.m.
This is good. Thanks
I still want to talk (to Greg?) about getting the whole column in the email........
Posted Sat, Dec 15, 12:59 a.m.
McGinn's speech was pure exploitation by a loathsome slimeball seeking to propose nonsensical "solutions" to his gullible "progressive" constituents.
Posted Sun, Dec 16, 9:50 a.m.
"Hugging your loved ones and taking care of yourself: Those are always good ideas."
Do it every day, not just when bad things remind you how precious your family is.
Login or register to add your voice to the conversation.


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Mini Oreo Surprise Cupcakes
Okay, seriously: Oreos, cupcakes . . . the goodness is right there in the title, is it not? These very easy-to-whip-up cupcakes have very few ingredients (chocolate cake mix, Cool Whip, mini Oreos, cream cheese, sugar and an egg), don't require any fancy equipment and can be made in less than an hour - which puts them at the top of our list as the perfect back-to-school/end-of-summer party treat! Make a bunch for your friends and fam, or better yet, invite your pals over and make several batches for a final summer beach blowout - if you can wait that long to eat them, of course.
Check out the recipe now at Food.yahoo.com.


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Three players – Katie Futcher, Kristy McPherson and Vicky Hurst – will make a last-ditch effort to unseat Christina Kim who is currently No. 10 in the U.S. Solheim Cup standings. The Safeway Classic Presented by Coca-Cola is the last chance for American-born LPGA players to make the team which will be officially named by Captain Rosie Jones Sunday night after play. The top-nine players in the standings are already assured a spot on the team including 51-year old Juli Inkster who will become the first playing assistant captain in Solheim Cup history.
Topics: Futcher, Katie, Mcpherson, Kristy, Hurst, Vicky, Portland Classic, Jones, Rosie, Inkster, Juli [+]


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The UK government has published a new improvement initiative for its local councils. Called 'Business Improvement Package (BIP)', it utilises tools and methods that will be familiar to the Six Sigma and Lean professional.
The initiative is one of the key commitments of last year's Local Government White Paper, Strong and prosperous communities, charging Communities and Local Government to publish an integrated package of improvement tools covering business process improvement, technology and collaboration – a 'Business Improvement Package' – early in 2007. It urges local authorities to deliver leaner operational management to reduce inefficiencies, join up services and adopt a customer-led service culture. The BIP is designed to help local authorities and their partners improve services by adopting new methods, including processes and tools similar to DMAIC, Visual Process Mapping and Pugh Matrix.
Local Government Minister, Mr Phil Woolas, said: "Everyone wants to see improvements to their local services, however in order to deliver the transformed services and value for money that communities want, local authority leaders will have to challenge traditional methods of delivery."
Communities and Local Government are holding a series of regional events with local authorities over the coming weeks to help shape the development of the business improvement materials that will be made available through the BIP during 2007/08.
The BIP will deliver a national support infrastructure to help build local authority business improvement capability and to join-up relevant work across government. A key part of this involves raising awareness nationally of innovative local authority developments that are already providing better, more efficient services.
A spokesman for BIP said: "Process improvement is critical to the goal of citizen-focused improvement. Through the review and reshaping of the way public services are provided and the reduction in the number of tasks which do not benefit a customer, front line and corporate support services can be enhanced. Public sector organisations who have undertaken business process improvement have already demonstrated how to eliminate low value activity, free up of front-line staff, improve information management and cut transaction costs. Local authorities have also secured quality and cost improvements of up to 20% through the adoption of service redesign process improvement methods."
BIP forms a part of the National Process Improvement Project (NPIP), which was established in October 2006 to develop consistent good practice service redesign method. The NPIP builds directly on the work started by local authorities in the North West who produced some 260 generic process activity maps covering each council tier.
It also includes sharing best practice from other councils, such as:. work on identifying service delivery costs across access channels led by the North West e-Government Group (NWeGG), developing the use of lifestyle profiling techniques for improving customer insight pioneered in authorities such as the London Borough of Hammersmith and Fulham and work to identify best practice in Front Office Shared Services (FOSS) being undertaken with the local government Improvement & Development Agency (IDeA).
Details of the Business Improvement Package are available online at www.communities.gov.uk/BIP.
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Thursday, October 30, 2008
Metallix - From 2003
The newly formed Future Comics has a couple of very positive things going for it. First, it's run by long-time comics professionals who have experience in the business, and who know what makes a good comics story. The second positive thing? A comic called Metallix.
Written by David Michelinie, and drawn by Ron Lim, Metallix chronicles the adventures of a team of "industrial troubleshooters," who all share one suit of armor, made from a liquid metal substance called "Metal X." The suit augments the natural abilities of each wearer, making an acrobat more agile, a martial artist more formidable, a marksman a better shot, and...well, you get the idea.
The book's art chores are well handled by penciller Lim, who excels at high-octane action stories, as well as characterization and expression. Having his work inked by comic veteran Bob Layton (who also co-plots) only sweetens the deal, as Layton tends to bring a polished "smoothness" to any pencils he goes over.
The two make a great team, indeed. Michelinie does a great job of fleshing out characters, as the beginning of major conflicts and possible storylines can be seen from issue one. Much of the conflict comes from the sharing of the suit, itself. It could safely be predicted that how to decide whose "turn" it is to don Metal X could quickly become a hot issue. These are not "cookie-cutter" characters, as it seems each has their own motivations and bold personalities.
The format of the comic is also appealing, as each issue features a back-up story dealing with the origin of the Metallix suit. The one thing the book has going against it, however, is the price. Three dollars and fifty cents for approximately ten to fifteen minutes of reading enjoyment is, to say the least, a bit steep.
Metallix is suggested for those who enjoy action-oriented super hero fun. Find it at comic shops, comic conventions, or by logging on to www.futurecomicsonline.com. Metallix is published by Future Comics, 32 pages, $3.50.
Review by Mark Allen
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The poverty rate for the United States as a whole was 15.9% in 2012, the most recent year for which data is available.
The Poverty Rate has increased steadily between 2005 and 2012.
These rates increased at different rates across race between 2007 and 2012.
The Median Income for Full-Time/Year Round workers varied across race in 2012.
Youth Poverty (< 18 years of age) has increased since 2007, but Black, Hispanic, and American Indian youth still suffer elevated rates of poverty.
The same holds true for minority children below age 5.


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Introduction to Transfinancial Economics
Robert Searle:
What is presented here is a new paradigm known as Transfinancial Economics, or TFE. The word "Transfinancial" implies innovative funding which goes beyond (ie.trans) our present conventional understanding of money. TFE is not only an abbreviation for Transfinancial Economics, but also implies a genuine scientific dimension to the subject of economics. In science many key terms use abbreviations.
It should be added here that we will not discuss the Great Financial Crisis, or the pathetic state of mainstream Neo-Classical Economics. Both topics have been discussed ad nauseum in any number of media sources, especially the former.
TFE can be summed up as follows. Essentially, it believes that new largely monitored non-repayable money can be created electronically in a highly responsible way by future governments, and/or by special banks to speed up, and reform the economy, society, and politics into something more ethical, and environmentally sustainable.With the right legal arrangement an initial limited form of it could be undertaken NOW such as famine relief without resorting to fundraising for earned capital from people. With the introduction of special electronic monitoring, and tracking (replacing interest, and taxation overtime), or ETM of the entire economy it would be possible to produce new money on an "industrial scale" without fear of serious inflation as special direct super flexible electronic controls would be in place. Ultimately, an advanced understanding of the productive capacities of relevant companies plays a vital role in determining the amount of mainly new non-repayable money.. otherwise "sudden" unexpected demands for more production could lead to unacceptable inflationary pressures.
Part One: The Core Concepts of Transfinancial Economics.
TFE recognizes the basic reality that virtually all money exists as electronic information. It also recognizes the seeming reality that large sums of largely non-repayable money does not lead to serious inflation. Taxation could be seen as an example of this. It takes earned money from the people, and re-distributes it for various social, economic, and political "needs". However, if the government overspends it can create bonds which are sold to mainly wealthy people, and institutions. This borrowed capital is returned to the lenders after a period of time with interest. Generally speaking, bonds are regarded as safe bets by investors because they know that in normal circumstances governments can raise taxes to pay off debts. Ofcourse, governments could as a last resort print money (with the right legal arrangements) to deal with economic problems but this can lead to serious inflation, and even hyperinflation.
What people though do not realize is that huge sums of money are electronically created out of thin air by banks...but as something which is repayable. In other words, loans with interest ofcourse. This fact whether we like it, or not is supported by any number of statements made in economic textbooks, and other "respected" sources. It is generally referred to as fractional reserve banking, or more commonly in economic circles as credit creation. In it, the amount of new repayable money created electronically is "determined" by a fraction(s) of how much the bank holds as reserves. The so-called "reserves," or more precisely a fraction(s) of them are meant to act as security against any default by the borrower(s). However, the amount of money created electronically by the bank is often "many" times greater than the reserves. However, the details, and interpretations of the "model" presented here are subject to controversy by "experts". Yet, official documents seem to suggest that some form of fractional reserve banking still persists. Yet, in most cases (perhaps all) the amounts of new repayable money created are probably NOT based on any set amount of reserves held.
Transfinancial Economics claims that it is possible for special Smart Banks, or Facilitation Banks, or FBs, and governments to create Facilitation Finance, or new non-repayable money, in a responsible fashion. However, both FBs, and governments if desired could also create interest free loans. If enough, new non-repayable money creation is carried out it will not lead to serious inflation (with aid of specific conventional Economic Indicators such as the Consumer Price Index). Evidence, and reason would seem to bear this out. It is notably indictated by the ordinary mainstream banks creation of it as repayable loans.
It should now be noted that there are four basic phases of TFE. They are:
Phase I (also, called Primary Stage TFE) The Emergence of FBs.
This is the essential first step towards the setting up of a new financial system. The remit of FBs is concerned with the responsible limited creation of new non-repayable money to fund in full, or in part mainly carefully vetted environmental, and social entrepreneurship projects. This would be a huge boom for the world because it would also imply that many social, and economic projects (especially climate change ones) which were formerly unviable could become viable concerns with Financial Facilitation from the FBs.
Phase II (also called Advanced Stage TFE). The Phasing in of Electronic Transaction Monitoring (ETM) of National Economies.
Most products, and even services have special business codes of one sort, or another. This is mainly for the ease of accounting.
In shops, and supermakets barcodes exist, and are used extensively. At the checkout transactions are recorded. In TFE such electronic records are not only collected electronically by the shop, or supermarket but are also at the sametime transmitted to the Resource/Inflation Authority. Thus, such transactions at the point of sale could if they are largely identified (via a barcode, or by just a written code tapped into some form of accessible technology such as a mobile phone, or computer) build up a highly accurate picture of the entire economy. This is revolutionary.
The above development is thus concerned with Electronic Price Monitoring, and indeed with what is notably known as Data Mining, and Big Data.
Anyway, all this would mean...
a) we would get a far more accurate understanding of the workings of the real economy
b) we would get a more accurate knowledge of how much resources are being used....
c) we would also be able to pinpoint serious inflationary pressures, which if necessary could be targetted, and controlled by direct electronic means. This could spell the end of the business cycle, or the famous boom, and bust scenario in economics.
What all thos means is that if we can have a highly advanced, and credible understanding of the real economy on more scientific lines (unlike the present dismal "science" of economics) we would also be able to know with great confidence how much new non-repayable money is enough thus avoiding serious inflation. This is explained more in Part II.
Moreover, in TFE taxation, and interest could overtime be phased out. In the latter case, interest could still be paid for in part, or in full by new capital rather than by earned money of the customer. Thus, the banks would not loose out. Ofcourse, none of this rules out uncertainty, or the irrationality of the markets.
Phase III. Growing Automation, and Greater Financial Empowerment of Non-Government Organizations.
Phase II, and Phase III can be seen as being part of the transition process towards an advanced environmentally sustainable world. It could involve the total phasing out of taxation, and interest on repayable loans. This though would only happen if all, or most businesses have been seriously restructuring themselves into something truly sustainable, and environmentally friendly in every respect(rather than relying purely on market forces which would make the whole process a lot longer, and more difficult to do). To speed up such a process the FBs, and governments would have supplied the necessary capital to bring this about. This capital ofcourse would in the main be non-repayable (ie. Facilitation Finance). For businesses, such funding is extremely attractive because virtually no money is paid back during their restructuring. Moreover, when they are truly green they could well receive a Zero Tax, and Zero Interest Status.
During this transition there would be increasing automation, and greater unemployment. The present limited tax system would probably be unable to fully cope with the latter. Thus, Facillitation Finance becomes increasingly critical as time goes by.
Moreover, since we would have such an accurate understanding of the actual workings of the real economy it would be possible to get largely accurate data on the amounts of largely identified transactions as well as the supply, and demand from the Resource/Inflation Authority. This would act as the basis on which new money could be created for unemployment benefits. It could be accurately assessed without serious inflation along with any "top up", and/or extra electronic capital for the creation of any social, economic, or political "employment" project, or NGO.
Ofcourse, existing NGOs concerned with any number of social, economic, and political issues would be increasingly able to recruit more, and more people as access to funds from Facilitation Finance becomes increasingly available. This could represent a big step in the evolutionary process of humanity.
Certain NGOs may also work in possible partnerships with governments(if necessary) in connection with the education of the masses towards the changing of their social, economic, and political values in society. They would become increasingly influential. Their open agenda would include such ideas as human rights; open source data; happiness economics; altruism; internet campaigning; direct (digital) democracy; smart technology; decentralisation of power; challenging plutocratic power structures; energy efficiency; new green technologies; human-scale sustainable communitie; et al.In other words, enlightened, and progressive thinking.
Phase IV. The Automated World.
The last phase of TFE could involve the abolition of money. When the world has reached a "fully" automated stage wage slavery would completely disappear. Work as we would presently understand it would no longer exist, and human beings would be involved in "higher things."
As far as is known TFE arguably offers the "first" really practical transition plan for the world to become something far more advanced, and civilized as never before.
Part Two: the role of Facilitation Banks and also Electronic Transaction Monitoring
In Part Two of Transfinancial Economics, or TFE we will examine in more detail about the role of Facilitation Banks, or FBs, and also Electronic Transaction Monitoring, or ETM.
Facilitation Banks.
These would be quite different to the ordinary mainstream banks..even though they would probably be part of the existing banking system. They would have special legal powers to electronically create sufficient new non-repayable money as commercial grants to deal with large, or small-scale environmental, and/or social enterprise projects. There are a number of key features for FBs.
i) Application for funding must go through a highly rigorous, and credible decision-making process which must be publicly transparent, and involve any number of experts. Ideally, this should be independent of pressure from corporations, and governments.
ii) If feasible, checks on the productive capacity of relevant companies to fulfill orders for a certain project should be carried out as far possible ideally. However, funding would always be available if there is a need to increase capacity. This is a subject which we will return to later as it is somewhat important.
iii) The actions of FBs are electronically monitored, and tracked by an independent body, or the Central Bank. It should be said here that mainstreams banks would ofcourse still exist. But they would probably not be as well regulated as FBs.
iv) Commercial grants awards could also be subject to close electronic tracking, and monitoring to avoid fraud. Special binding contracts could be involved.
v) Unlike normal mainstream banks, the FBs do not need reserves on which to base the amount of money they can create electronically. This is instead determined by the cost. In TFE this is known as the Resource Capacity Requirements, or RCRs.
vi) Unlike the International Monetary Fund, and its so-called "structural adjustments" FBs adopt often, or not a more serious microeconomic "bottoms-up" approach in which parts of the economy are dealt with rather than the whole. This can at times prove more effective than a macroeconomic approach.
Electronic Transaction Monitoring, or ETM.
As mentioned before, in Part I most products, and services have identified codes for accounting. For example, barcodes notably at many shops, and supermarkets play an important part in the retail industry in finding out which products sell well. Such data though at the point of sale could also be transmitted to the Resource/Inflation Authority. If a process like this came into being (and this does not always have to require barcodes, or written codes as indicated in Part One) for most if not "all" products, and indeed, services, a highly accurate profile could be created of the productivity of the entire economy. In other words, an accounting process existing largely in real-time.
The Restructuring of Businesses.
The aim of the ETM is essential to allow the massive increase in the electronic creation of closely monitored new non-repayable money as commercial grants without the risk of serious inflation. These could "nudge" businesses into incentivizing them into restructuring them into something environmentally friendly. This would most notably include the mass phasing in of low carbon, or indeed, non carbon technologies for their line of business. These should be largely automated. Interventionism by FBs, and governments via Facilitation Finance as indicated could prove vital.
It is important to understand that most businesses during the mass restructuring process would be largely on an equal footing as far as competition is concerned....as the opportunity to apply would be open to everyone.
The Relevance, and Importance of Resource Capacity Requirements in ETM.
To understand the need for Resource Capacity Requirements, or RCRs, becomes somewhat important when ETM exists. The fomer are the means by which we can access to a large extent the inflation risk of creating new monitored non-repayable money, or commercial grants for a business which wants to restructure itself.It cannot though fully discount the factor of uncertainty.
To understand the importance of productive capacity we need to take an example. As economies grow in terms of wealth they start to "overheat". The key reason is because there would appear to be an increasing amount of money buying products, and services. However, if too much money is around the companies creating goods find it increasingly difficult to match demand. The reason in part for this is that their capacity to produce gets stretched. Hence, they start putting up their free market prices, and a situation may even be reached when shortages start happening.
In order to reduce the flow of money into the economy, taxes, and interest on borrowing can be raised. This may help reduce the "flows" of money in the real economy. A recession though may follow. Thus, the so-called business cycles ends, and later begins again when a low level of inflation is reached, and a new cycle of boom, and "bust" begins. To spur on this new economic growth, taxes, and interest may be lowered to encourge businesses to grow again, or be created.
Quite often economists argue about what are the exact causal sources of these business cycles are. With ETM we may be able to find out exactly why based directly on the electronic transaction data transmitted to the Resource/Inflation Authority. Moreover, in TFE, taxes, and interest are gradually phased out altogether to be replaced by a whole series of direct electronic methods to reduce any kind of inflation. This could mean the end of boom, and bust.
In TFE, it would be possible to get an accurate picture of the productive capacity of companies relevant to a business wishing to seriously restructure itself via the powerful incentives of Facilitation Finance. it would have to disclose its new, and old suppliers. If their electronic wholesale, and retail transaction data are on record on the computers, or rather the supercomputers, then these can be examined. The actual supply and demand of their raw materials, and resulting products would with the aid of mathematical modelling be able to determine how much productive capacity may, or may not be necessary. This would infact involve a computer simulation in which new grants, or Facilitation Finance were created to see how likely the free market prices would rise (based ofcourse on the electronic price record of the company, or companies involved) . If there is little spare productive capacity the FB can step in with funding be it an interest free loan, or indeed, a commercial grant ofcourse depending on the importance of the restructuring process. Yet, in spite of this there is always the problem of uncertainty, but TFE is robust enough to deal with any economic problems.
The Use of Super-Flexible Electronic Controls.
As transactions of most products, and services at the point of sale are continually tracked, and monitored they can be electronically targetted by supercomputers by Resource/Inflation Authority. These supercomputers would be programmed to check all kinds of price changes. They would also instantly compare, and contrast prices of any set of like goods,and services to see if there are any inflationary risks. This programming is dependant on the quality of data given by barcodes, or commercial codes of most products, and services. The following are the key controls.
i) Automatic Inflation Deduction.
This is when a temporary "tax" is created at the point of sale for the customer in which the inflated portion is instantly taken off at the point of sale. However, it can be re-created electronically in the customer's bank account. This is called a False Tax, or False Inflation Taxation. It is essentially an accounting adjustment in which the value of money from the point of view of the customer is retained.
ii) Instant Electronic Price Subsidization.
This is when a price of a product maybe below the inflation rate, and an instant subsidy, or adjustment is created at the Point of Sale. It is transmitted back by the Inflation Authority to the relevant bank account of the retailer after an instant supercomputer check.
iii) Electronic Price Capping.
Here, a maximun price maybe set by a government, or by an FB in certain circumstances. If the price of production starts to exceed the maximun price, the producers would recieve instant financial help, or compensation where necessary. Ofcourse, electronic price capping should be avoided if possible.
What has been said so far should give us some idea as to the basic mechanics of TFE. There will always ofcourse be critics who will say that it is impossible, or that it would lead to continous "price controls" (but ones which are far more advanced, and super-flexible to anything that has existed before). Some would say that the ETM is like a command/control economy. But this is incorrect as Captalism,and the Free Market Price still plays its part, and would would still exist until everything were "fully" automated. It would then be that money itself as we as presently understand it would become unnecessary along with wage slavery . This would be the natural, and ultimate result of automation.
Part Three: Some Outstanding Implications of Transfinancial Economics.
The potential implications of Transfinancial Economics are vast, and outstanding in many respects. Alot of the Facilitation Finance would occur with the introduction of Electronic Transaction Monitoring, or ETM which would take into account in advance the productive capacity of relevant businesses in a commercial project. Thus, the production of the "right" amount of new non-repayable capital could be assessed without fear of serious inflation.
It is also becoming increasingly clear that funding via redistribution of financial wealth through taxation, and donations to NGOs using earned money will probably not be enough to bring about genuine global change. Hence, the pressing necessity of Facilitation Finance.
Anyway, let us now list some outstanding implication of TFE with some comments.
I. Democratic Governments.
They would find it easier to fund social, economic, and political projects as taxation is gradually phased out. Bonds could also be gradually replaced with alternative investments notably in a growing ethical/green business market replacing old "unsustainable" businesses.
II. Independent Grant-Giving Bodies for Non-Government Organizations, or NGOs.
These would have money from earned sources, and also most notably hold new non-repayable capital from FBs. The latter may ultimately replace the former as the sole source of funding. All this implies that NGOs, and other non-profit societies would be able to increasingly undertake more, and more social, economic, and political work for the betterment hopefully of humanity. Thus, organizations for example dealing with heart disease, cancer, AIDs, and the like would find this highly beneficial.
III. Ethical Takeover.
This is a controversial measure which could be undertaken in which companies regarded as being somehow unethical, and/or environmentally unfriendly (eg.the arms trade), or producing wasteful, or"unnessary" products could be taken over in a "hostile" bid. This could come about with pressure from campaigning NGOs possibly in partnership with certain democratic governments. Facilitation Finance could come from a government, or even a FB using extraordinary legal powers to create the new capital to finance the ethical takeover bid. This could have implications for the corporate world in general especially if it does not gets it act together by becoming more ethical, and environmentally friendly.
IV. Green Technologies.
At present, governments find it difficult to fully switch to green technologies such as wind farms, and solar energy. They require subsidies of earned money from the taxpayer.However, with the right legal arrangement there is no reason in the world that Facililtation Finance could be used to speed the process forwards rather than have the installation of nuclear power stations.
Incidently, TFE does not believe in continous economic growth. But growth would be necessary for the initial mass financing, and restructuring of various businesses. With mass education by certain organizations society must learn to accept to live in a simpler, and less greedy world.. but one in which advanced technology exists.
VI. The Ageing Population.
Notably in the developed world people are living longer. With Facilitation Finance it could be possible to fund in full, or in part quality care homes, hospitals, hospices, and carers. This can happen with the help of private commercial providers, and the state.
VII. Adaption, and Mitigation.
With the probability of unpredictable weather changes which could threaten whole populations, Facilitation Finance could in full, or in part expedite adaption, and mitigation projects which could protect people.
VIII. Mega Resource, and Environmental Projects.
Here, again Facilitation Finance could be created by FBs, and governments using extraordinary legal powers. It could for example be used in full, or in part for mining resources on other planets notably the moon. Such extraterrrestrial resources could be brought back to earth.
VIII. Inequality.
Be they poverty reduction projects in the developed, or undeveloped world there would always be funding from FBs, and in certain cases from governments for social enterprises that help to improve the economic status of people.
IX. Universal Health Care.
TFE raises the serious possiblility of quality universal health for everyone in the world, and not just in the rich countries. Facilitation Finance could in full, or in part create a business model which could be largely controlled by private firms, or mainly by the state.
Many other outstanding implications of TFE could be listed. The above should give us an idea of the sheer scope of what could be done with a revolutionary, and ultimately high-tech financial system. If its claims are true, and workable this new global paradigm could become the greatest revolution in the history of economics.
It should be added that "full"development of TFE would also need the help of experts notably in the law, economics, and information technology. Moreover, a largely pragmatic approach towards banks, and corporations would probably be adopted to ensure that the introduction of this paradigm becomes reality.
More Information
http://www.p2pfoundation.net/Transfinancial_Economics This link represents a more fuller, and authorative version of the above text.