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Testimony on Health Care Industry Y2K Preparedness by Kevin Thurm
Deputy Secretary
U.S. Department of Health and Human Services
Before the Senate Special Committee on the Year 2000 Technology Problem
June 10, 1999
Thank you for inviting me here today to discuss the Department's number one priority -- the Year 2000 computer
challenge. I appreciate the opportunity to appear before the Committee again on this
important issue. Y2K is a challenge that we and the health care providers who serve our
programs' beneficiaries must meet. The
Department continues to make remarkable progress on its own systems such as the Medicare
claims processing. To ensure continued smooth operation of the health care system and the
health and safety of its patients, it is essential that providers also ready their systems
for the new millennium. To facilitate reaching this goal, we are engaged in an
unprecedented outreach effort to raise awareness in the provider community of the need to
be Year 2000-ready and to have contingency plans in place.
Mr. Chairman, I want to thank you for your role in helping us turn the corner on
the Y2K challenge. We would have had a much more difficult time meeting this challenge
without the support and attention we received from this Committee and the Congress.
In your letter of invitation, you asked me to address three issues: (1) the Department's assessment of the overall Y2K preparedness of the
healthcare industry; (2) any particular concerns that the Department may have with regard
to rural and inner-city hospitals and skilled nursing facilities; and (3) the Y2K status
of biomedical devices and FDA's role in ensuring
the preparedness and safety of these devices.
Update on HCFA's Preparedness
Before I address the readiness of the industry, I would like to comment on the
readiness of the Health Care Financing Administration. A year ago, few believed that HCFA
could be fully Y2K ready by December 31, 1999. Thanks to the strong leadership of
Administrator Nancy-Ann DeParle and the dedication of her staff, HCFA has made remarkable
progress. We are fully confident that HCFA will be able to timely and accurately pay
Medicare claims at the turn of the millennium. I'm
happy to reaffirm that all of HCFA's internal
systems were renovated, end-to-end and future-date tested, certified compliant, and
implemented by the government-wide Year 2000 deadline of March 31, 1999. Among other
things, these internal systems manage the eligibility, enrollment, and premium status of
39 million Medicare beneficiaries, and make payments to about 400 managed care
organizations. Second, all of the 75 mission-critical claims processing systems, operated
by private insurance contractors that process Medicare fee-for service claims and pay
bills, have been fully tested and certified as compliant, and are paying bills today.
HCFA's independent verification and
validation (IV&V) expert, with oversight from the Department's Office of the Inspector General (OIG), has verified
the readiness of the claims processing systems. HCFA has worked closely with the General
Accounting Office which has helped HCFA reach its goals by holding it to a high standard.
HCFA's progress in recent months has not
lured the agency into relaxing its efforts. Because of the complexity of the Medicare
program and the numerous small changes that need to be made to systems between now and
this fall, HCFA will continue to check and retest its systems for the remainder of 1999.
Assessment of Health Care Provider Readiness
As you know, last year HCFA notified all Medicare-participating providers and their
billing agents that they must submit 8-digit date Y2K-compliant claims by no later than
April 5, 1999, or their claims would be returned as unprocessable. To ease the transition
to the new billing format, Medicare's fiscal
intermediaries and carriers made compliant billing software available to all providers and
submitters for free or at a minimal cost. This has yielded positive results. Virtually
every claims submitter in the country is now submitting compliant claims to Medicare's contractors.
While the ability to submit 8-digit date claims is an important step toward Year 2000
readiness, it is only a first step. It does not mean that a provider's entire billing system is Y2K compliant, nor that
its office computer or practice management software will function into the millennium.
Providers must make sure that any and all software used in their practices has been made
compliant and has been future-date tested.
HCFA is giving providers the opportunity to test with the contractors' systems to determine whether provider claims,
including future-dated claims, can be successfully accepted and processed by the
contractors. This type of testing can assure providers that HCFA's data exchanges do work and that future-dated claims
will be accepted by Medicare's systems. It gives
HCFA a better indication of how many providers have actually done the necessary
renovations to make their entire billing systems compliant, and helps HCFA refine and
target its future outreach efforts to providers who may not be making adequate progress in
meeting their Y2K responsibility.
Of course, health care providers receive payment from insurance sources other than
Medicare. Providers need to work with their other payers to verify that those payers are
as ready as HCFA is to pay claims at the turn of the millennium.
Being able to submit claims and get paid is, of course, only one reason why health care
providers must meet their Year 2000 responsibility. Computer system problems could impact
quality of care and patient safety. Patient management systems, clinical information
systems, medical devices, such as defibrillators and infusion pumps, and even elevators
and security systems all must be checked, renovated, and tested to make sure they are
ready so that providers can give quality care.
We are concerned that some providers will not fully meet the Year 2000 challenge on
time. Monitoring of surveys of the health care sector by the Department's Inspector
General, HCFA, Rx2000, the Gartner Group, and others indicates that some providers are
substantially behind in their remediation efforts and could well fail. Providers have the
primary responsibility to ready their own systems for the Year 2000 in a timely manner to
meet the millennium challenge successfully. The Department does not have the authority,
ability, or resources to step in and fix systems for others. We are providing assistance
to the extent that we are able, but in some cases that may not be enough. This matter is
of urgent concern, and it grows in importance with each passing day.
While these surveys seem to indicate that many hospitals and clinical laboratories are
progressing well in addressing the Year 2000 problem, other types of providers, especially
physicians and skilled nursing facilities, do not indicate as great an overall state of
readiness. Also, smaller facilities, as measured by number of beds or number of employees,
seem less ready than larger facilities. This seems to be the case regardless of whether
the smaller facility is rural or urban, and I should note that our OIG specifically
over-sampled rural providers because they have been a special concern for us. In addition,
a recent study by the OIG on the readiness of managed care organizations yielded troubling
results. While most health plans report that all of their computer systems will be ready
by the turn of the millennium, only 22 percent of Medicare HMOs responding to the OIG
survey reported that they were ready in early 1999. Finally, we note that the various
surveys indicate that providers, by and large, have more work to do on developing and
validating realistic contingency plans.
According to the latest IG report, "Secondary
Analysis of Medicare Provider Readiness for Y2K,"
dated June 2, 1999, there is little difference between urban and rural providers on most
Y2K issues. However, there were a few specific areas where the responses of urban and
rural providers differed.
I don't need to caution you that the data reflected by these various surveys become
outdated very quickly. The burden is on us to continue close monitoring of the industry,
and we are committed to doing that. And the Office of the Inspector General is continuing
its survey work.
Of course, we did not wait for survey results to reach out to the health care
community. As you are aware, we have made and are continuing to make a vigorous and
unprecedented outreach effort to raise awareness of this critical issue and to encourage
providers to take the steps necessary for ensuring their own millennium compliance.
Because our mission is to ensure that beneficiaries continue to have access to quality
health care into the new millennium, we are going beyond our statutory responsibilities.
The surveys help us focus our outreach efforts on areas of greatest concern.
Provider Outreach Activities
The Department is leading the health care sector of the President's Council on Year 2000 Conversion. We chair
twice-monthly meetings in coordination with a number of provider trade associations and
our public sector health partners, like the Defense Department, the Department of Veterans
Affairs, and the Labor Department, among others, to share insights, raise millennium
awareness, and encourage all providers to become Year 2000 compliant.
Within the Department, HCFA has engaged in an unprecedented campaign to reach out to
the provider community. In January, Administrator DeParle sent letters to over one million
health care providers outlining the Year 2000 challenge, including a checklist for what
they must do to meet their responsibility. A second letter from the Administrator was
mailed a few days ago to these more than one million providers further urging them to
complete their Y2K remediation work, test their systems, and complete and test their
contingency plans. HCFA and the FDA collaborated on these letters. As such, these letters
also prompt providers to consult the FDA's website on the compliance of medical devices.
HCFA installed a toll-free telephone line where callers can receive up-to-date answers
to their Y2K questions relating to medical supplies, their facilities and business
operations, as well as referrals for more specific billing-related information. HCFA also
has a website dedicated to the Year 2000, which contains advice and information on Y2K
compliance, such as how to identify mission-critical hardware and software and assess its
readiness. It also explains how to test systems and how to develop contingency plans. HCFA
is also staffing a Y2K speakers bureau which works with provider groups on Year 2000
readiness. HCFA's speakers have made literally hundreds of presentations on Year 2000
issues to providers and others around the nation.
Finally, HCFA, in collaboration with the FDA, the Health Resources and Services
Administration (HRSA), and the Veterans Administration, is continuing to participate in a
series of training sessions, seminars and conferences, across the country. HCFA and HRSA
are sponsoring smaller, more individualized Year 2000 educational sessions targeted toward
rural providers.
HCFA has also been working to address the Year 2000 readiness of managed care plans, an
area of special concern. HCFA's first objective
-- to ensure its own systems for paying managed care plans were compliant -- has already
been accomplished. HCFA is now working hard to raise managed care plans' awareness of the importance of being Year 2000-ready
and of having meaningful contingency plans. HCFA has been meeting regularly with managed
care industry groups and trade associations to discuss and resolve Year 2000 issues.
Importantly, HCFA required all Medicare managed care organizations to submit
certifications about their Year 2000 readiness by April 15, 1999. HCFA is reviewing these
certifications and the results of these reviews and other information will determine which
health plans will receive focused onsite reviews by HCFA and its IV&V expert. HCFA is
also requiring managed care organizations to provide contingency plans by July 15, 1999.
HCFA will review these plans to determine that they address mission-critical systems
encompassing their business functions. Our goal is to make sure that our managed care
beneficiaries continue to receive uninterrupted quality health care during the transition
to the next millennium.
During the last quarter, the other HHS health care sector components conducted numerous
outreach activities. The following depicts only a few highlights of their most recent
The Centers for Disease Control and Prevention (CDC) has posted all Y2K
quarterly reports, white papers, assessments, outreach efforts, and other Year 2000
activities on the web at www.cdc.gov/y2k/y2khome. (This website can be reached
through the CDC home page.) Additionally, CDC systems managers have provided their
findings regarding Y2K compliant software on the CDC website for easy access and
distribution worldwide.
In February, CDC completed the first State health department readiness assessment and
received more than a 50 percent response rate, and, after analyzing the data, provided the
summary findings to the President's Council on
Y2K Conversion. This survey was sent again in June to State health agencies to complete.
The Food and Drug Administration (FDA) has developed a response to the public's concern about the availability of medical products
(e.g., pharmaceuticals, medical supplies). They have placed a notice in the Federal
Register to inform industry of the intent to request information, develop a survey, and
establish an audit program. FDA assisted in the White House Roundtables on Pharmaceuticals
and on Consumable Medical Supplies.
The Indian Health Service (IHS) is also engaged in an aggressive outreach effort
to raise Y2K awareness and provide information to the Tribal and urban health care
facilities where IHS has minimal authority and control. To support outreach activities to
Tribal and urban programs, a Y2K resource kit composed of videos, brochures, and reference
literatures was produced and distributed to nearly 1100 addressees. A Y2K Internet site
was also established (www.ihs.gov/y2k) and is continuously being updated to provide
a common source of pertinent information for IHS, Tribal, and urban Indian programs.
The Health Resources and Services Administration (HRSA) has disseminated Y2K
information through targeted direct mailings, through the HRSA, Human Services Sector and
other program specific web sites, speeches, conferences and the Human Services Y2K
Rural Health Outreach actions are being coordinated with HCFA and IHS.
HRSA also is committed to helping our Community and Migrant Health Centers address
their Y2K compliance issues:
To increase the visibility for their services, the Administration for Children and
Families (ACF) prepared and sent a post card to approximately 12,500 human services
providers informing them of available Y2K resources and how to access them. ACF also
prepared business cards containing similar information to be distributed at Y2K
conferences and meetings where sector representatives have been asked to speak. ACF
continues to receive and answer information requests on their Y2K e-mail inquiry line (Y2Kinquiry"ACF.DHHS.gov)
as well as by telephone.
ACF has also placed their revised "Y2K
Information Guide For Human Services Providers"
on the web and prominently displayed a link to view or download it from the first page of
the web site. Demand for the Guide has been so overwhelming that 25,000 more guides,
revised to be more generic and applicable to the entire Sector's audience, have been printed .
At the Department, we also welcome Congress's
help in making all providers aware of the need to become Year 2000-ready and appreciate
your ongoing attention to this critical issue. You can help in identifying additional
opportunities to publicize the Year 2000 message and we encourage you to stress the
importance of this issue whenever you meet with providers.
Contingency Planning
Regardless of success in renovating and testing systems for Year 2000 readiness, we and
providers must have business continuity and contingency plans prepared in case
unanticipated problems arise. HCFA has undertaken an extensive effort to develop these
plans for all its own critical business processes. HCFA's priorities are to ensure that it
can: continue prompt and accurate payments to providers, suppliers, and others; safeguard
the Medicare Trust Funds by preventing and recovering inappropriate payments; protect
quality of care; and sustain beneficiary entitlement and enrollment.
All of the Department's agencies are following the GAO's advice on contingency planning. HCFA and other
agencies are now in the process of refining and validating their contingency and Day One
plans. Each contingency plan has a designated Emergency Response Team responsible for
executing the various contingency plans, if necessary. During the validation phase, these
teams will run practice exercises and rehearse plans in a simulated environment.
Of course, contingency planning is not a static process. We will continue to rehearse
and refine our plans throughout the coming year and up until December 31, 1999. We will
make changes, if necessary, as we learn more about the readiness status of those with whom
we interact, such as providers, pharmaceutical and medical equipment suppliers, and
States, among others.
HCFA's contingency plans provide mechanisms
to make sure that providers' claims will get
processed and paid even if parts of HCFA's
systems experience unanticipated failure. In addition, you can be sure we will have in
place at the turn of the millennium, as we do today, financial and audit controls to help
protect the integrity of the Medicare Trust Funds.
We firmly believe that no contingency plan should cause providers who fail to prepare
for the Year 2000 to be rewarded for their lack of attention, effort, or due diligence.
Being able to submit a valid claim is the minimal requirement that is necessary to ensure
that a provider can operate in the Year 2000 environment and is actually furnishing
covered services. That is why Administrator DeParle has made it very clear that HCFA has
no contingency plan to make estimated payments to providers that cannot submit a bill.
Providers simply must have their own contingency plans in place to ensure that they can
get accurate and timely claims to Medicare. Providers might consider getting the Medicare
claims submission software that I mentioned earlier as one form of back-up to their
commercial billing software packages. We, of course, are ready, willing, and able to do
all we can to help them succeed, and HCFA has made a variety of contingency planning
resources available to the provider community.
Progress on Medicaid Readiness
Although HCFA provides most of the funding for Medicaid, it is the States that operate
these programs. The Department does not have the authority, ability or resources to fix
State systems. So, it is critical that the States be Y2K ready and have solid contingency
HCFA and its contractors, with the GAO, have made in-depth site visits to all 50 states
and the District of Columbia to review readiness and provide technical assistance, and we
are just beginning a second round of visits. HCFA is sharing whatever survey information
it gathers directly with the States to give them, at a minimum, an independent appraisal
of their Year 2000 issues and progress. What we have learned in these first round of
visits is consistent with earlier work by the GAO that suggests some States may need to
devote more time and attention to Y2K compliance. Those States that are at greatest risk
seem to lack senior management support and resources, or have not conducted adequate
end-to-end future date testing, or are not developing contingency plans in sufficient
detail. HCFA and its IV&V team are revisiting approximately 35 States between now and
the end of August to monitor progress and focus on the States' contingency planning
efforts. ACF is coordinating site visits with HCFA. Finally, the Secretary has written to
the governors three times to bring to their attention the progress that has been made in
their States and to indicate what work remains to be done. We have found that the direct
communication by the Secretary to the governors results in more attention and resources
for States' compliance efforts.
Pharmaceutical Industry and Y2K Compliance
We also have been examining the intersection of Y2K risk mitigation and the
availability and quality of certain prescription drugs. In fact, the White House recently
held a roundtable discussion on the Y2K readiness of the nation's pharmaceutical supply chain. The discussion focused
on those services and supply chains that are critical to the health and well-being of all
Americans, and in particular the ready availability of pharmaceuticals from their manufacture to the filling of
prescriptions at the drug store. The consensus of those present the brand name and generic drug manufacturers,
wholesalers, and health care providers, payers, along with consumer advocates and
government regulators is that allowing
patients to obtain a substantial advance buying or stockpiling is not necessary and may
actually cause the shortage that this kind of action is trying to prevent. We are
continuing to examine this issue and will have more factual information later this summer
when the results of a Food and Drug Administration (FDA) Y2K survey from pharmaceutical
manufacturers are received.
The FDA Commissioner sent a letter, dated April 21, 1999, to the Presidents and CEOs of
approximately 4230 pharmaceutical manufacturers, distributors and repackagers requesting
their assistance in assuring FDA and the American public that their firms have addressed
the Y2K problem as it affects the adequate supply of safe and effective drugs. Included
with the letter was a "Y2K Assessment Survey" concerning the status of actions
pharmaceutical firms have taken to address this issue. FDA is committed to maximizing the
response rate particularly with manufacturers of sole source, orphan and the most
prescribed drugs. The results of this survey will provide the basis for a clear message to
reassure the American public that drugs will continue to be available as we make the
transition to the new century. FDA and the pharmaceutical industry will continue to
monitor the Y2K status and availability of pharmaceutical supplies.
FDA has processes in place to address product availability and has used these
procedures to help get necessary products to patients. FDA will continue to work with the
health professional community, industry and the patient groups regarding Y2K readiness and
product availability.
Y2K Status of Biomedical Devices
In evaluating how computer-based equipment will handle the change in the
millennium date, this Committee has expressed some concern about the adaption of the wide
variety of medical devices upon which contemporary health care depends. The Food and Drug
Administration (FDA) regulates the manufacture of these devices and based on the Agency's
extensive communication with the industry, FDA believes that the Year 2000 problems with
medical devices will not be significant or widespread if facilities take appropriate,
identifiable actions to address this issue.
The FDA has taken a number of steps to enhance the confidence of the American public
that medical devices will function as intended as Year 2000 approaches. FDA is concerned
about the status of Y2K medical devices and has been actively pursuing information from
device manufacturers. FDA wants to provide sufficient information to health facilities,
professionals and consumers so that an assessment can be made as to the Y2K compliance
status of devices being used. For the past two years, FDA has continued to add to
its knowledge of medical devices to provide additional assurances. In attempting to
achieve this high level of confidence FDA has taken a number of constructive actions to
work with manufacturers and provide information to users about the Year 2000 compliance of
medical devices.
FDA's Year 2000
An important tool for obtaining information about biomedical equipment is FDA's
Federal Year 2000 Biomedical Equipment Clearinghouse database. In order to give the
general public, government agencies, and the healthcare and research communities one
comprehensive source of publicly available information on the Year 2000 compliance status
of biomedical equipment, FDA, VHA and DoD established the database in March 1998 and it is
available via the World Wide Web. The Biomedical Equipment Clearinghouse provides Year
2000 product status information in five categories including: products that are Year 2000
compliant; products that do not use a date; products that have a date related problem;
products whose status is provided on the manufacturers' websites; and identification of
manufacturers for whom no information is available (nonrespondents to FDA requests).
The database can be found on the Internet at fda.gov/cdrh/yr2000. Manufacturers
also may submit a World Wide Web link to their own website, if they so choose, where the
requested information is provided to the public.
While the database has proven to be useful to health facilities, professionals and
consumers -- receiving over 185,000 "hits" from 155,208 users over a period of
approximately 13 months -- FDA has continued to collect information from medical device
manufacturers. FDA wants to provide as much assurance as possible concerning the Y2K
status of medical devices. To that end, FDA has issued a series of letters requesting more
specific information about medical devices, not traditionally required by FDA. In
addition, FDA has taken a series of actions to ensure that information is available. These
Additional Outreach and Guidance
FDA has had a good response rate from those manufacturers believed to have potentially
vulnerable equipment (about 2,000). In fact, there are only about 200 manufacturers in
this group which have not responded and every effort is being made to determine the status
of these companies. In an effort to reach the widest group of individuals, both to get
information and to spread information, CDRH also has been conducting extensive outreach to
the device industry and to other consumers on this issue. These efforts are as follows:
Although most devices are regulated by CDRH, FDA's Center for Biologics Evaluation and
Research (CBER) regulates blood bank software, which is of particular concern for
potential Year 2000 problems. In January 1998, CBER posted guidance for industry entitled,
AYear 2000 Date Change for Computer Systems and Software Applications Used in the
Manufacture of Blood Products on the FDA website. The guidance provided specific
recommendations to assist industry in its evaluation of computer and software systems used
in the manufacture of blood products and to assist in evaluating the impact of potential
Year 2000 problems. CBER is aware of the status of these individual products and believes
that the blood bank software will be Y2K compliant or will have a "patch" or
"work-around" for the systems to ensure that the systems will work through Year
What Is the Data Telling Us Thus Far?
As of June 6, 1999, FDA has entered a total of 4,142 responses from the 16,000
manufacturers originally contacted. As indicated above, FDA believes that approximately
2,000 of the 16,000 manufacturers may produce equipment that may be affected by the
Year 2000 problem. The data from all of these manufacturers who have responded have been
entered into the database on the FDA website. In addition, 427 manufacturers have provided
World Wide Web links (URLs) to data provided on their own manufacturer-operated websites.
These numbers change daily as data are entered, corrected or even removed at the request
of manufacturers. Of the 4,142 manufacturers who have responded, 3,404 have reported that
their products do not use date-related data or all of their products are compliant. Six
hundred and fifty-nine manufacturers [311 manufacturers listed on the FDA website and 348
manufacturers listed on the manufacturer websites] have reported one or more products
with date-related problems. There are a few submissions in which the data were incomplete
or unclear in some manner. FDA is communicating with these manufacturers to obtain
clarification before entering the information into the database. FDA will continue to post
additional responses as they are received.
In reviewing the data received from the manufacturers so far, FDA sees no indication of
widespread problems which will place patients at risk, provided the solutions being
developed and offered by manufacturers are implemented. Of course, FDA can not make
assurances about manufacturers who have not reported product status. FDA believes that the
information received to date confirms our original expectation that the Year 2000 problems
with medical devices will not be significant or widespread if facilities take appropriate
actions to address this issue. There will be specific problems which need correction;
however, the current assessment is that, to the extent problems do arise, they are more
likely to disrupt patient care rather than be of direct danger to patients. Nonetheless,
such disruption could be serious and the potential for it to happen merits the continued
involvement of FDA in its activities of gathering, evaluating, and sharing information.
Potentially High Risk Devices
Although FDA firmly believes that its normal regulatory processes provide the necessary
assurances, FDA has come up with the following plan to provide additional assurances to
the public and healthcare facilities about the Y2K status of medical devices.
FDA is preparing a list of manufacturers with potentially high risk devices (PHRDs)
that are likely to be computer-controlled and that could present a significant risk of
immediate harm to the patient should the devices fail to operate as expected due to a Year
2000 problem. FDA will have a contractor conduct an on-site review of records to assess
the existence and adequacy of the controlled processes implemented under a quality system
to assure that potentially vulnerable devices have been adequately assessed and that any
upgrade is correctly implemented and appropriately tested and evaluated by the
The first phase will be a review of a random sample of the manufacturers to determine
if there is a significant potential that manufacturers have not taken appropriate steps to
address any Year 2000 problem which could present a risk to patients. After evaluating
the results of the first phase, a determination, after appropriate consultation, will be
made as to whether the second phase should proceed. The second phase would consist of
contractor review of a portion of the remaining manufacturers of identified devices not
yet audited. FDA is confident that this proposal will provide any additional assurances
needed by the public.
FDA will place additional emphasis on reviewing the Y2K status of potentially high risk
devices (PHRDs) during the remainder of 1999. Although there are a significant number of
device types in this category and a large number of different models for each type, FDA
expects that the number of devices that will actually present a significant risk due to
Y2K non-compliance to be only a small number.
Now that manufacturers should have completed their assessments of Y2K compliance status
and identified non-compliant devices, FDA will review this information to identify any
manufacturers of PHRDs for which information is not available or whose non-compliant
products pose an actual significant risk to patient health. FDA will review the steps
taken in these situations by the manufacturers to notify users regarding any problems that
might exist and to assure that appropriate corrections are implemented or the device
removed from service. In any situation identified where the action by the manufacturer has
been inadequate to assure patient safety, FDA will use its all of its statutory
authorities to require corrections and publicize the situations. These actions could
include public advisories to device users, suggestions to manufacturers regarding
voluntary recalls, mandatory recalls or seizure of the non-compliant devices in extreme
risk situations.
FDA's current plan is to complete the assessment of the PHRDs by October 1. The agency
believes, in most cases, this date strikes the appropriate balance between permitting
implementation of corrective actions and ensuring adequate time remains to recall the
device or take other remedial action. FDA will continue to evaluate the appropriateness of
enforcing Y2K compliance for particular devices before or after that date. FDA expects,
however, that the situations where such actions will be required to be rare as there are
many incentives in addition to possible FDA regulatory action which lead manufacturers to
address any such potentially high risk situations.
Legal Authority
FDA's legal authorities place responsibility on device manufacturers for establishing a
controlled system of device manufacture and design. FDA monitors, regulates, and when
necessary, enforces compliance with this required system of controls. Moreover, FDA has
enforcement authorities specific to devices that enable the Agency to take remedial action
before harm has occurred when the device presents a serious or significant risk of harm.
As noted above, this could result in seizure of products and mandatory recalls if FDA is
not convinced that a medical device manufacturer has provided adequate assurance of Y2K
compliance of particular medical devices.
FDA's Quality System Regulation (QSR) (21 CFR Part 820) requires manufacturers to take
corrective and preventive actions, which include recall, for problems with current
production. Devices automated with computer software are subject to all requirements of
Part 820 unless expressly exempted by regulation. Any computer-automated device that has a
Year 2000 problem for which the manufacturer has not made adequate corrections is
currently subject to legal action under the Food, Drug and Cosmetic Act, even if the
device will function properly until January 1, 2000. The Food, Drug and Cosmetic Act
expressly prohibits marketing such devices.
Should FDA learn of Year 2000 problems in devices that could pose serious health risks,
FDA will take immediate remedial steps, including enforcement action. FDA's enforcement
authorities include requiring notification of all purchasers and users of the device and
ordering a recall. Using these remedies, FDA will order, if necessary, the individuals
best able to locate current users and the device itself to notify those users of Year 2000
problems, fixes or work-arounds that are available, and to recall the device if necessary.
FDA continues to emphasize to manufacturers the importance of reporting on the Year
2000 compliance status of their products and take additional steps to boost the response
The Department have made remarkable progress in meeting the Year 2000 challenge, as
have many providers. However, we remain concerned with the progress of some types of
providers in meeting their own Year 2000 challenges. Again, surveys quickly become out of
date and, to the extent that they consist of self-reported information, are not fully
adequate indicators of the complex and rapidly changing private sector landscape. We are
committed to raising awareness and providing as much assistance as we can, but in some
cases that may not be enough. We all share a common goal of having our systems and
programs function and care for our program beneficiaries continue throughout the
millennium transition. Congress can help, as you are by this hearing, to focus attention
on the responsibilities of health care providers. I am happy to answer any questions you
may have.


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September 29, 2016
Framed for Crimea: Obama's Critics Issue Hollow Indictments
Posted on Mar 21, 2014
By Joe Conason
To hear the Republicans shrieking about Crimea—from those howling simpletons on Fox News to the churlish statesmen of the United States Senate—all blame rests with President Barack Obama. In the midst of a real and potentially dangerous crisis, every opportunistic politician and pundit on the right excoriates him as a president so "weak" that he practically invited Vladimir Putin's aggression.
Aggression is an apt description of the Russian takeover of the Crimean Peninsula, despite the complexity of the events and history that led here—and despite the evident enthusiasm of the Crimean population. Like many borders drawn on maps, this one was far from indisputable in moral or political terms. And without endorsing Russia's questionable version of events, it is also true that the overthrow of the Yanukovych regime and the inclusion of neo-fascist elements in Kiev's new government raised real issues of legitimacy and security.
Yet those questions cannot excuse Russia's military intimidation of Ukraine or the staged and stampeded referendum that led to annexation. What Putin is doing violates basic international norms, which demand respect for national sovereignty and democratic processes.
The problem faced by the Obama administration and its European allies is how to discourage further imperialistic adventures by Moscow without destructive economic and diplomatic consequences for the world. Among the complicating factors are the Russian roles in Iran, Syria, the Mideast peace process and Europe's energy economy—any of which could devolve into something far worse than the annexation of Crimea. In short, Ukraine presents a tricky and perilous situation that leaves the United States with limited options.
Square, Site wide
Which is why the Republicans have almost nothing to say about what Obama should do now, and so much to say about why this trouble is his fault. All the usual suspects have piped up to tell the world about the president's supposed frailty.
Former GOP presidential nominee Mitt Romney suggests that he was right to pillory Russia in 2012 as "the number one geopolitical foe" of the United States—and that Obama was wrong to mockingly demur. But the president's responsibilities required him to seek Putin's diplomatic cooperation—not to bait the Russian leader for partisan advantage. Arizona Sen. John McCain has been sputtering with rage, berating Obama as "the most naive president in history." His Senate sidekick Lindsey Graham, seeking reelection in South Carolina, went much further: "It started with Benghazi," he tweeted. "When you kill Americans and nobody pays a price, you invite this type of aggression."
Only Dick Cheney could be expected to exceed Graham's slur. Not only does the former vice president indict Obama for "weakness and indecisiveness" that have supposedly damaged American prestige around the world, but he urges provocative military actions that could rapidly worsen the crisis.
If Putin was tempted by American vacillation, that process started well before Obama entered the White House, when his troops invaded the former Soviet republic of Georgia—and the Republicans now shrieking about "weakness" said nothing when George W. Bush and Dick Cheney did nothing. When reminded about that episode, Cheney now says it occurred "at the end of the Bush administration, the beginning of the Obama administration"—in August 2008. Nobody should expect honesty, after all, from the man whose deceptions pushed this country into a disastrous war—and who single-handedly did more lasting damage to American prestige than any vice president in history.
There is at least one Republican, however, whose counsel should not be scorned, especially by his fellow Republicans. Former Defense Secretary Robert Gates—whose glancing criticism of Obama in his memoir was so heavily exaggerated—now clearly disdains partisan exploitation of the trouble in Ukraine to demean his former boss.
"In the middle of a major international crisis, that some of the criticism, domestic criticism of the president ought to be toned down, while he's trying to handle this crisis," said Gates on "Fox News Sunday." He flatly rejected the notion that Obama could somehow have deterred Putin by acting more "decisively." And having served under Bush before Obama kept him on, he bluntly recalled that other Russian invasion.
"My own view is, after all, Putin invaded Georgia when George W. Bush was president. Nobody ever accused George W. Bush of being weak or unwilling to use military force, so I think Putin is very opportunistic in these arenas. I think that ... even if we had launched attacks in Syria, even if we weren't cutting our defense budget, I think Putin saw an opportunity here in Crimea, and he has seized it."
Indeed, Obama is doing everything that critics like McCain and Romney would likely do in his place—pull together the allies, financially bolster Ukraine, impose sanctions, isolate and cajole Moscow. He is calibrating the response according to the broad interests of the United States and its allies, seeking to restrain Russian ambitions without incurring grave costs.
So far, the hysterical Republican attacks are inflicting little harm on the president. His approach to Ukraine and Crimea is polling higher than his overall approval numbers—and the latest CNN poll showed that his ratings as a "strong and decisive leader" who "inspires confidence" are actually higher than last autumn.
What Putin will do next is hard to predict; what remains perfectly predictable is the political reaction here. If the Russians push deeper into Ukraine, Obama will be blamed again. And if they don't, he will surely get no credit.
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text:
We live in a state where it's almost second nature for us to embrace thoughts and social norms that may be different than the status quo. We are a population of innovators who brought the world blue jeans, the iPod®, and fortune cookies. Best yet, we are a population of early adopters of cutting-edge ideas and technology like YouTube and Facebook.
So if you think about it, the emerging biotechnology and life sciences industry in San Diego didn't happen by chance. According to BayBio, an independent, nonprofit trade association serving the life science industry, there are around 4,348 life sciences companies based in Southern California. More companies are expected to follow in the next few years. In layman terms, San Diego is fast becoming a biotechnology hub – and with that comes jobs.
The Future of Biotech Jobs in San Diego
Currently, San Diego and Orange County employ around 150,000 in the life sciences industry, and if you look at sites like Biospace.com – an online community for industry news and careers for life science professionals – Indeed, Craigslist and Careerbuilder you will see dozens of biotech-related jobs posted in the San Diego area alone.
In an article by David Gollaher fromXconomy.com, he says that "San Diego should remain a magnet for jobs and funding, with its leading biopharmaceutical and diagnostic companies, top universities and world-class research institutes. According to a survey of the top 200 biomedical employers in California commissioned by CHI and PricewaterhouseCoopers, the industry is positioned for robust growth."
Is a Biotech Career Right For You?
Are you interested in biotechnology? Here are a few questions to answer if you are undecided in your pursuit of a career path or are considering a change in your career:
1. Do you want to be part of a possible medical breakthrough like advances in the treatment of cancers, arthritis, and multiple sclerosis to name a few?
2. Do you want to be work in an industry that will offer good wages and benefits far into the future?
3. Do you need assistance paying for college?
Now Is the Time
If you answered "Yes" to any of those questions, you might want to look into the field of biotechnology. Right now is an opportune time, since four local organizations – San Diego State University, San Diego Workforce Partnership and the Southern California Biotechnology Center at San Diego Miramar College – just received a three-year, $4.95 million grant from the U.S. Department of Labor to assist our region's life sciences industry's economic growth.
"We are very pleased to be able to reach out to veterans, the unemployed and other job seekers in the San Diego region and enable these individuals and San Diego's life sciences industry to benefit significantly from our nation's economic stimulus investment in higher education," said SDSU President Stephen L. Weber.


text:
On Sat, 12 Jan 2008 14:58:39 +0100, Andreas Thiele wrote:
> Hi,
> I just installed Suse Enterprise 9 on a box with Matrox Parhelia card.
> After installation of the Matrox drivers, highest resolution I can set
> is 1600x1200 while the card should support 1920x1440. My 24'' Samsung
> 245B display supports up to 1920x1200 and looks best at this maximum
> resolution.
> Is there any recommandation for graphics adapters that run well under
> Linux (Suse) and support 1920x1200?
> Thanks for any hint.
> Andreas
You might be able to get your current card to do it be throwing some
switch in the xorg.conf file. I have an old Nvidia 5700 card which will
only run at 1920x1200 if I turn off the Max Pixel Clock check,
Option "ModeValidation" "NoMaxPClkCheck"
This is an Nvidia option, it's possible that there is something similar
for Matrox.
If you can't figure out how to get the Matrox card to support your
monitor then you might want to consider getting a reasonably recent model
Nvidia card, just check the specs on Newegg to see if that resolution is


text:
- Music
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- Listen to KSBJ online
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Community Events
Fun4Seniors Presents Shakespeare in the Shade Trees
Friday, April 12, 2013
Lone Star Tomball College Performing Arts Center
30555 Tomball Parkway #102
Tomball, Texas
Category: Performing-Arts
Target Audience: Seniors
General Info Phone: 2814011814
General Info Email: firstname.lastname@example.com
Website: http://www.hcp4.net/senioradult/shakespeare
Event Details:
Fun4Seniors, a nonprofit organization through Harris County Precinct 4's Senior Adult Program (SAP), is delighted to announce Shakespeare in the Shade Trees. This program, supported by Lone Star College-Tomball.
Fun4Seniors, a nonprofit organization through Harris County Precinct 4's Senior Adult Program (SAP), is delighted to announce Shakespeare in the Shade Trees. This program, supported by Lone Star College-Tomball.
Update this event's details.


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Feed the Children
The heart of Feed The Children's U.S. program is distributing food to families in need. To do this, we work closely with caring corporate partners that donate surplus food and other supplies, as well as with individual donors who help defray the cost of transporting the product donations.
Feed The Children's wholly-owned subsidiary, FTC Transportation, Inc., picks up in-kind contributions from corporate warehouses and brings them to one of six Feed The Children regional distribution centers. Some of the donations are then distributed in bulk and others are processed into individual relief boxes.
The supplies and boxes are then delivered to pre-approved, independent partner agencies that, in turn, distribute the supplies through our extensive network of feeding centers, homeless shelters, churches and various other organizations located in communities across the U.S. Individuals and groups can also sponsor a food distribution, during which boxes are given directly to families in need.
In 2008, over 75,000 backpacks – loaded with assorted children's books, school supplies, food and personal care items – were distributed to our nation's growing population of homeless children.
Through the generosity of committed partners, Feed The Children delivers much needed necessities to children and their families every day. As always, Feed The Children provides help to those in need absolutely free of charge.
For information about this organization, Click Here!
Smile Train
Clefts are a major problem in developing countries where there are millions of children who are suffering with unrepaired clefts. Most cannot eat or speak properly, aren't allowed to attend school or hold a job. Being born with a cleft in a developing country is truly a curse. Every baby born in Uganda with a cleft is given the name Ajok which means literally, "cursed by God." Some newborns are killed or abandoned right after birth. The good news is that every single child with a cleft can be helped with surgery that costs a few hundred dollars. It's a true modern-day medical miracle that gives a child back their life.
For more information on this organization, Click Here!
Dream Center
The Dream Center, a volunteer driven organization that finds and fills the needs of individuals and families alike, was founded in 1994 and currently serves over 40,000 people each month.
Services and programs offered include residential rehabilitation programs for teens and adults,a shelter for victims of human trafficking, a transitional shelter for homeless families, mobile hunger relief and medical programs, and a foster care intervention outreach that works closely with Los Angeles County's Department of Children and Family Services to keep families intact by delivering the required furnishings, clothing and food to assure that their homes meet DCFS standards. Educational development programs such as adult basic education, job skills training and life skills counseling to homeless families and individuals continue to establish The Dream Center as a vital community development resource.
The Dream Center has been successful in creating programs and services that meet the immediate requirements of those in need so that they can make long-term changes that move them from dependency to independence and financial stability thereby enhancing their quality of life.
The Dream Center's record of success has led to the launch of over 100 affiliate Dream Centers nationally, as well as internationally.
For more information on this organization, Click Here!
Go to Nations
Go To Nations is a missions sending agency that ispassionate about sharing the Gospel with every living person on the planet – every tribe, every tongue, every nation. We are peoplewith a burningdesire to take thetruth of Jesus Christ's redeeming loveto the lost, the hurting, and the broken, and to see that love transformtheir lives.
We welcome you and believe that you will be blessed, encouraged and inspired.
Let's go change the world.
For more information on this organization, Click Here!
TD Jakes Ministries
Bishop T.D. Jakes and Mrs. Serita A. Jakes are influential leaders who serve with excellence and integrity. Throughout their nearly 30 years of marriage, Mrs. Jakes has diligently served alongside her husband Bishop Jakes, founder and senior pastor of The Potter's House of Dallas, which has more than 30,000 members and over 50 outreach ministries. Together, they have touched the lives of millions around the globe through various humanitarian projects, relief efforts, community service initiatives and record-breaking conferences.
For more information on this organization, Click Here!


text:
Planning, developing, and implementing an enterprise-wide IT recovery plan is never easy; it requires in-depth knowledge, expertise, and resources. IBM IT recovery services provides a set of comprehensive, cost-effective solutions to help you quickly respond and resume operations following a disaster or business disruption. In addition to supporting multiple IT platforms and a host of IT-related infrastructure components, our flexible IT recovery solutions can help you better manage regulatory compliance requirements. With IBM IT recovery services, you can meet recovery time and recovery point objectives and gain peace of mind.
Finding the right IT recovery services to meet the needs of your business can be challenging, but at IBM we make it easy. We offer a comprehensive range of IT recovery services designed to meet your specific IT and business needs. With extensive experience across all industries, IBM IT recovery services can:
- Recover critical business data: Recover critical data through specialized IBM facilities, bundled recovery solution configurations, and on-site recovery support
- Manage regulatory compliance requirements: Protect your current and historical business data and improve management of regulatory compliance requirements
- Improve business continuity: Minimize financial setbacks by reducing data loss and shortening outage times
- Support multivendor platforms: Leverage IBM capabilities to provide cost-effective disaster recovery solutions across multivendor platforms
- Provide end to end services: Design, plan, and implement a flexible, cost-effective, enterprise-wide IT recovery plan
Download the data sheet (132KB)
How it works
Recovery Services facilitate enhanced recovery with:
- A range of simple hardware replacements to recovery of complex multivendor IT environments and onsite recovery support - depending on your business needs
- Solutions that protect your current and historical data to insure the continuity of your business operations and regulatory compliance requirements
- Security-rich features that help you maintain the integrity of your business data throughout its lifetime
- Customized industry-specific solutions that help reduce the loss of crucial data and shorten the time before business resumes
Understand the issues
Forrester Research examines the risks of DIY disaster recovery.
Understand the options
What will your next IT failure cost your company? IBM and Ponemon Institute detail what business continuity and IT security really mean to your organization.
Avoiding the pitfalls of outdated disaster recovery plans. IBM has identified seven outdated assumptions on which many organizations base their disaster recovery plans.
Contact IBM
Got questions? We're here to help.
- Request a conversation
Call: 1800 425 33031800 425 3303


text:
Jeffrey Doshier, MD, elected NARH Medical Staff President
Apr 09, 2012
(April 4, 2012) Jeffrey Doshier, MD, medical director
of psychiatric services at North Adams Regional Hospital, recently began a two-year term as president of the NARH Medical Staff. As president, Dr. Doshier serves as chief administrative officer of the Medical Staff, chairs the Medical Staff Executive Committee and calls and presides at all meetings of the Medical Staff.
Dr. Doshier earned his medical degree from the University of Washington School of Medicine and completed his internship and residency in psychiatry at Cambridge Hospital, affiliated with Harvard Medical School. Dr. Doshier joined the NARH Medical Staff in 2007 as medical director of Greylock Pavilion, NARH's inpatient psychiatric service.
"I am pleased to serve as the president of the NARH Medical Staff," said Dr. Doshier. "My colleagues, the physicians who practice in this area, are very talented physicians who have chosen the Berkshires to do their life's work." Dr. Doshier noted that an overwhelming majority of the NARH Medical Staff members are board certified in their respective fields. "Board certification means our physicians meet the highest standards of their specialties, ensuring the highest quality of care is provided in northern Berkshire County."
NARH has more than 80 physicians on its active medical staff representing more than two dozen medical specialties including anesthesiology, cardiology, dentistry, dermatology, emergency medicine, family practice, gastroenterology, general surgery, hospitalist medicine, internal medicine, neurology, obstetrics and gynecology, oncology, ophthalmology, oral surgery, orthopedics and sports medicine, pathology, pediatrics, plastic surgery, podiatry, psychiatry, pulmonary medicine, radiology, urology, and physiatry. For information on members of the NARH Medical Staff, click on "Find a Doctor" above.
Copyright 2014 © Northern Berkshire Healthcare. All rights reserved.


text:
Same Old Jets.
Same Old What?
The way Ellis sees it, little has been the same about this franchise since he arrived in 2000. He has played for four head coaches. He has depended on seven starting quarterbacks, from creaky old veterans to hot-shot rookies. He has embraced too many football philosophies to count.
"Something's changed almost every year," the defensive lineman said this week, looking around a training complex in Florham Park that was an empty field when he was drafted. "You'd go from coach to coach, not knowing who the next one would be, not knowing what kind of defense you'd end up playing."
- 'Journeymen' defensive linemen getting it done for Jets in wake of Kris Jenkins injury
- Politi: Time is now for Jets to finally define what 'Jets football' means
- Jets notebook: Jets linebacker David Harris plans to meet Bengals running back Cedric Benson 'early'
- Bengals' Double-A Gap blitz package turns defense of nobodies into elite unit
- Bengals notebook: Bengals insulted by coach Rex Ryan's claim that Jets should be Super Bowl favorites
Ellis rattled off the names of the players who were around when he started. Mo Lewis. Bryan Cox. Curtis Martin. He arrived during the Al Groh Era, which lasted all of one season, and he should have known then he wasn't exactly joining the Microsoft of NFL teams.
The Jets have not made a Super Bowl in 41 years. Ellis has suffered through nearly a quarter of them, more than any player on the roster, so he has a deeper perspective on the opportunity this team has now.
Editor's note: Join The Star-Ledger on Saturday for live game coverage of the Jets and Cincinnati Bengals. Follow along during the game as well as share questions and comments by signing in to participate.
This is about more than winning a playoff game or two, the first one coming Saturday in Cincinnati. This is a chance to finally become known for something more than those three annoying words. "Same Old Jets" has not only come to represent all the team's failings since Super Bowl III, it's become the identity of the franchise.
Think about the sports teams in this market. The Yankees are tradition and all those championships. The Giants are defense (this year not withstanding) and the Mara family.
The Devils are consistently excellent; the Nets, aside from the Jason Kidd Era, consistently terrible.
The Knicks and Rangers have the world's greatest arena and the allure of Manhattan. Even the Mets have had a couple miracles mixed in with their misery, even if '86 and '69 are distant memories.
So what are the Jets? For three decades, the other football team in a stadium named for the primary tenant, one that has tried everything to step out of that shadow besides winning a title.
This is a franchise that, for most of its existence, has been difficult to define. They are not always bad, despite their reputation (what, you don't think the Detroit Lions would trade for their record?) They are the team of Joe Namath, but that was four decades ago.
Same Old Jets.
Same Old What?
"Before I got here, when you said 'the New York Jets,' we didn't really have an identity," linebacker Bart Scott said this week, pointing to the league's top-rated defense as that new image. That sounds good, Bart, but to most of the country, the Jets are still just a team that lucked into the playoffs.
This is when they can define what "Jets football" means. The Patriots, remember, were a mostly rudderless franchise before the Belichick Era, and now they are known for only excellence.
It has to start somewhere. Ellis has been around long enough to witness plenty of false starts. He thought the breakthrough had come in 2004, when the Jets and Herm Edwards nearly stole one in Pittsburgh.
"The one year under Herm, I thought we had a great chance to go. We missed the field goal," Ellis said. "We basically dominated the whole game and missed the field goal."
Actually, it was two field goals, both in the final 2:02. Kicker Doug Brien missed both, and the Jets lost that divisional playoff game to the Steelers, 20-17. "That was the hardest one," Ellis said.
He is one of the few in their locker room unwilling to dub this the best Jets defense ever. He has been around too long. Rex Ryan, the rookie head coach, might talk big about his team being the favorite in the postseason, but after 10 seasons here Ellis has his feet on the ground.
"Every coach who comes here talks about winning Super Bowls, and they talk how long it's been, too. The fans are thirsty for one, and we have a team that's built to play in these conditions. Great defense. Great running game. If we put it all together, who knows where we can go?
"It's time. It's time."
Come to think of it, maybe that's the same part in the Same Old Jets. It's time. It's past time.
Steve Politi may be reached at email@example.com, or follow him at Twitter.com/NJ_StevePoliti
|Previewing the Jets against the Bengals in the Wild Card playoff game on Saturday
|New York Jets coach Rex Ryan talks about David Harris and Darrelle Revis at final presser before the Wild Card game


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Why the Patent Cold War needs to end
0. phoneArena 03 Aug 2011, 22:57 posted on
Lawsuits are flying around everywhere in the mobile space. Patent law has become big business, and nothing is being hurt more by that than the mobile space which is the fastest growing tech sector. Unfortunately, it could probably be moving faster if it weren't for litigation...
This is a discussion for a news. To read the whole news, click here
Comments for : Why the Patent Cold War needs to end - page 2


text:
Saving a River from Poison
The Putumayo River is home to some of the purest water in the Amazon basin—but maybe not for long. The huge Amazon tributary forms the border between Colombia and Peru, draining from giant Amazonian forests, orchid-covered peatlands, and, most presciently, soil bearing traces of gold. But mining that gold has the unfortunate side-effect of poisoning the water with mercury. Read more about Saving a River from Poison


text:
Romeo and Juliet
Julius Caesar
don't seem to have. Please try a different browser.
Scroll through the page to review your answers. The correct answer is
highlighted in
Your incorrect answers (if any) are highlighted in
If you'd like to take the test over again, click the reset button at the end of the test.
1. What is the English translation of Himmel Street?
2. Where does Liesel's brother die?
3. Hans befriends Liesel by teaching her to
4. Why does Rudy cover his body with coal?
5. According to Death, the only thing worse than a boy who hates you is
6. At the book burning, when Liesel says she hates Hitler, Hans slaps her. He does this because
7. The first time Max's friend Walter Kugler visits him when Max is in hiding in Stuttgart, he brings
8. Ilsa Hermann, the mayor's wife, lost her son. He died
9. Liesel and Max are initially wary of each other. They begin to form a friendship when they start comparing their nightmares. Their nightmares are similar because
10. Max makes Liesel a book called The Standover Man for her tenth birthday. The story is about
11. In order to stay in shape in the basement, Max
12. Liesel continues going to Ilsa Hermann's house after Ilsa fires Rosa because
13. When Rudy rescues Liesel's book from the river, he hopes to be rewarded with
14. Despite having no money for food or presents, the Hubermanns have "the greatest Christmas ever." Why?
15. When Max gets sick, Rosa and Hans are very worried that
16. At the Hitler Youth Carnival, how many medals does Rudy win?
17. After he gives bread to a Jewish prisoner being paraded through town, Hans's attitude can best be described as
18. According to Death, everyone in Nazi Germany had to take their turn being punished. What was Hans's punishment?
19. After Hans leaves, Rosa stays up holding his accordion each night because
20. The book Max leaves for Liesel is called The Word Shaker. It is about
21. After Liesel tears up a book in Ilsa Hermann's library, Ilsa brings Liesel a blank notebook so that
22. When Himmel Street is bombed, Liesel is not killed because
23. Rudy finally gets what he wants from Liesel after the bombing when she gives him
24. When Death comes for Liesel, he gives her a book he rescued from the rubble the night of the bombing. What is it?
25. When Liesel asks Death if he read the book, he tells her he is
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9 people found this helpful
The writer of this mixed Rudy's and Max's names when Liesel goes to steal the book...
This shows excellent notations from the book.


text:
Most times, I do dishes~ and no, I don't think it improves digestion, I hate doing dishes.
Just curious -- what do you do after a meal? Anything that would improve digestion?
feel free to take a look at my journal!
Most times, I do dishes~ and no, I don't think it improves digestion, I hate doing dishes.
I usually watch tv, and I don't have an issue with indigestion since going primal. However I would suggest to you, if I may, that if you do have an indigestion problem - start cutting out one food at a time, for a few days at a time, keep a journal, and see if anything changes.
Experiment, experiment, experiment !
"never let the truth get in the way of a good story "
...small steps....
I actually don't have any apparent digestion problems, just wondering how to make it even better
feel free to take a look at my journal!
sorry, my bad !!!!! reading stuff into stuff - that aint there.
Have some fun in the bedroom, or on the landing, the basement......I dunno, just use your imagination. I am sure as hell you will come up with some fun, animalistic, primal ways to use your after dinner time - appropriately !
Us old wrinkled grey paleolithic types - well we just go with the flow.....if the zimmer frame doesn't get in the way !
"never let the truth get in the way of a good story "
...small steps....
I don't run after I eat - that's how I improve my digestion..
Everything is bad for something - How do you feel today?
I take time to enjoy time with my husband, just talking about our day or watching a bit of TV. We try to make lunch and tea times time just to relax together. DH works split shifts most days so has to go back to work mid afternoon so its important to have unwind time during the day.
1/ make sure you hydrate well more than 30 min before, better 1 hour so you don't drink anything with meal or immediately after, this will ensure you do not dilute stomach acid and enzymes when you start eating, your stomach will add as much fluid as it needs to.
2/ 15-20 min before the main meal, prepare and consume a small plate of bitter, sour foods, dried meats etc., just nibbles not enough for a meal, this will stimulate the digestive and many of the soured, cured foods meat & veg have bacteria that will make it past the stomach before the full on acid onslaught, this will help propogate your microbiota and prepare the entire digestive tract for the coming meal.
3/Eat the main meal at a slower pace, stretch it out to atleast 30 min so that you're stomach can keep pace with your mouth and also allow it to tell you when it is full.
4/About an hour after eating do some light movement, a walk (stroll) around the block, this is not cardio, just some light movement and letting gravity help the small intestine move the food through to the colon.
5/ That's about all I can think of, now just sit back, settle down and go to bed when ready.
I drink water or seltzer, watch TV for a while with the boyfriend, shower, and read in bed until I can't keep my eyes open!
>> Current Stats: 90% Primal / 143 lbs / ~25% BF
>> Goal (by 1 Jan 2014): 90% Primal / 135-ish pounds / 20-22% BF
>> Upcoming Fitness Feats: Tough Mudder, June 2013
>> Check out my super-exciting journal by clicking these words.
Weight does NOT equal health -- ditch the scale, don't be a slave to it!


text:
Handily located just an hour north of Phuket International Airport, and some 30km south of Takua Pa, KHAO LAK has established itself as a thriving, mid-market beach resort with plentiful opportunities for diving and snorkelling, easy access to the supreme national park reefs of Ko Similan, and a style that is determinedly unseedy. It lacks sophistication, and is mostly a bit pricey for backpackers, but is ideal for families and extremely popular with northern European tourists. High season here runs from November to April, when the weather and the swimming are at their best and the Similan Islands are open to the public; during the rest of the year, Khao Lak quietens down a lot – and becomes much cheaper too.
The area usually referred to as Khao Lak is in fact a string of beaches west off Highway 4. Khao Lak proper is the southernmost and least developed, 5km from the most commercial part of the resort, Nang Thong (aka Bang La On), which throngs with shops, restaurants, dive centres and countless places to stay, both on the beachfront and inland from Highway 4. North again about 3km (5min by taxi or a 45min walk up the beach) is lower-key, slightly more youthful Bang Niang, a lovely long stretch of golden sand that's backed by a developing tourist village whose network of sois is away from the highway and feels more enticing than its neighbour. Removed from all this commerce, Laem Pakarang, 12km further up the coast, a headland and popular sunset-watching spot that gives onto 11km Hat Pakweeb (Hat Bang Sak), is where you find the area's most exclusive accommodation.
There is, thankfully, little obvious evidence these days of the area's devastating experience during the December 2004 tsunami, when the undersea earthquake off Sumatra sent a series of murderous waves on to Khao Lak's shores (and the rest of the Andaman coast), vaporizing almost every shorefront home and hotel here and killing thousands. Nang Thong quickly became the centre of a huge reconstruction effort, with thousands of volunteers arriving to help, and rebuilding was mostly completed within a couple of years, though for many survivors recovery will probably take a lifetime.


text:
This is the right time for Tour players to be hot. It's Masters week, and four clutch rounds are all that separate any golfer from the eternal glory of donning a green jacket.
Not that being hot leading into any single tournament means a player will stay hot. The golf gods can author a reversal of fortune at any moment.
However, it does help the odds of successful prognostication to identify trends. This slideshow aims to do just that.


text:
LG shifting its focus away from smartphones? Absolutely not!
0. phoneArena 22 Nov 2013, 01:46 posted on
LG has reached out to inform us that the rumors of it shifting its focus away from smartphones are completely untrue. Putting all of the information that follows below in the fiction category, an LG spokesperson has issued the following statement for us to let us know just how serious LG is when it comes to its smartphone business...
This is a discussion for a news. To read the whole news, click here
1. Ninetysix (Posts: 2380; Member since: 08 Oct 2012)
Couldn't compete with the big monopoly (Samsung). Oh wells.
34. itsdeepak4u2000 (Posts: 3718; Member since: 03 Nov 2012)
That's not true, but this thing would keep them very much behind in the competition.
55. itsdeepak4u2000 (Posts: 3718; Member since: 03 Nov 2012)
I knew it.
38. Dr.Phil (Posts: 1163; Member since: 14 Feb 2011)
I feel like people either don't actually read these articles or they are missing the big picture. No where does it say that LG is going to stop or even slow down on it's smartphone production. All it's saying is that they are shifting their focus to televisions so that they can take the revenue from that (since it's already a successful business and has the potential of getting them far more revenue than their smartphone business) and put that revenue back into investments in their smartphone industry. It is by far the smartest move they could ever make. They make more money by selling televisions than they do by having their entire focus on smartphones. If this works out the way they want it to, then it will mean the budget they have for their smartphone industry will be significantly more next year than it is this year. I mean just to give you some numbers: LG makes only a $200 million revenue from smartphone sales versus a $4.5 BILLION revenue from television sales. So now imagine if some of that revenue trickled back into their smartphone business. They could REALLY be making some innovative products then.
By the way, Samsung "shifted their focus" to displays a couple of years ago as well which enabled them to produce some of the display technology you see in Samsung smartphones today.
50. rihel_95 (Posts: 301; Member since: 21 Mar 2012)
Ah u r back. I missed u (& ur comments)!
2. E.S.1 (Posts: 297; Member since: 14 Sep 2013)
Damn it lol... I just bought an LG G2 (The best phone I ever had) after owning Samsungs for years, oh well...
5. Brendan126 (Posts: 14; Member since: 09 Dec 2010)
Yeah. Same here. Such a great phone! Now I'm sort of regretting getting it over the Nexus 5... Damn, oh well. :P
53. E.S.1 (Posts: 297; Member since: 14 Sep 2013)
Well, I guess we are safe :)
6. Ravail (Posts: 182; Member since: 14 Oct 2011)
same boat here. :/
28. _PHug_ (Posts: 444; Member since: 11 Oct 2011)
Well this is what I get for supporting the underdog.
Should have paid the extra $200 to get the Note 3 I guess :(
What's the chances of us G2 owners getting official 4.4 and beyond updates.
35. lallolu (Posts: 471; Member since: 18 Sep 2012)
The chances were low but now miniscule.
42. Finalflash (Posts: 3090; Member since: 23 Jul 2013)
Nope, just cynogen it or other custom rom, problem solved. This isn't iOS people, you do not have to stick with the crappy manufacturers ROM.
54. E.S.1 (Posts: 297; Member since: 14 Sep 2013)
I read somewhere that LG said Nov or Dec. before we get the update.
3. Yaldabaoth (Posts: 42; Member since: 06 Jun 2012)
Remember that LG bought webOS assets for use on their televisions. They may be looking to dominate the 2k/4k interactive television space by focusing on web integration, apps, etc.
4. darkkjedii (Posts: 21243; Member since: 05 Feb 2011)
Only two smartphone makers matter. Apple and Samsung, the rest just fill in the pie.
17. PBXtech (Posts: 1032; Member since: 21 Oct 2013)
Agreed. Some of the smaller companies keep those two in check from getting complacent. Xiaomi is eating Samsung's lunch in China, as an example. I'm sure both are keeping eyes on Nokia.
37. WindowsiDroid (Posts: 136; Member since: 22 Jul 2013)
Indeed, Nokia is moving faster than what I expected, I expect that Nokia will totally fall down, but today Nokia still manage to compete with this smartphone industry.
43. Finalflash (Posts: 3090; Member since: 23 Jul 2013)
But the problem is the US government, they are anti-competition to a ridiculous extreme. Not only will they not let the Chinese sell their phones here, they won't even let them make it locally and sell it (only the NSA can spy on US citizens). They won't even let the Koreans have justice on the locals. Without competition, everyone will suffer in the US other than Apple who largely sits on their laurels for years. So do not expect the monopolies to break in the US, expect it in the EU and other regions.
9. Long1 (banned) (Posts: 399; Member since: 18 May 2013)
But Apple is going aside little by little. Who will take Apple's place?
It's scary Samsung to take over all the market alone.
13. darkkjedii (Posts: 21243; Member since: 05 Feb 2011)
Don't bet your house on that
14. DAddYE (Posts: 48; Member since: 04 Oct 2013)
Sony is coming, stay tuned ;)
26. 9thWonderful (Posts: 232; Member since: 24 Jan 2013)
Yea that's what ppl said about Sony 3 phones ago...I don't think Sony is a threat to anyone in the smart phone space...at all.
39. cc3493 (Posts: 158; Member since: 06 Jul 2013)
lol its like those people who keep on saying its the year of linux...
59. ArtSim98 (Posts: 3535; Member since: 21 Dec 2012)
Sony is already here!
58. ArtSim98 (Posts: 3535; Member since: 21 Dec 2012)
You're so fuc*ing stupid that it annoys me. It's like you don't allow anything that you don't like to be in this world. Like you don't want ANY competition in this world. And that you don't want any changes. That you would buy even a toilet made by apple. Even if it looks the same, has the same features than a normal toilet but has an apple logo on it and costs 10x more. All that comes to my mind about you is Hitler. Just want's one thing to dominate the world. What a stupid idea.
60. ecmedic4 (Posts: 335; Member since: 02 May 2013)
I don't think the name calling was called for. Soon as you called dark fuc*ing stupid you lost all creditability. I think what he was meaning is that Apple and Samsung are the only ones making money and have the most marketshare, the ones that are most talked about. He never said anything like what your implying. He never said anything about wanting Apple to dominate the world. I think you need to chill and let others have their own opinions, just like you have yours. You obviously have a hate for Apple, but that doesn't mean everyone does or should. So what if dark has a preference for or likes Apple products, his choice and his money. I honestly don't think you should concern yourself so much with his preferences. He also never implied he didn't want any competition, your just freaking out on him over a simple post. I think you need some Ativan or just need to take a break from the computer as you sound pretty fanatic and are putting words in his mouth that he never said.
61. ArtSim98 (Posts: 3535; Member since: 21 Dec 2012)
He didn't say it directly of course but that what he actually thinks. You can (well you should be able to) easily tell from all his comments what he actually thinks and what kind of person he is.
8. jove39 (Posts: 1858; Member since: 18 Oct 2011)
LG is moving only support staff...it's not bad.
10. Android4Ever (Posts: 86; Member since: 12 Aug 2013)
Its about time! They finally realized that no one wants a clone Samsung phone. Very nice move LG! Bravo!!!
25. remtothemax (Posts: 260; Member since: 02 May 2012)
you realize that fanboyism is ultimately self destructive. the only reason samsung is who they are today is because they made something like an apple clone phone.
and i'm not taking shots with that comment. everyone clones everyone else. i'm just pointing out that the only reason they are who they are today is because they came into their own with the razor edge of the iphone against their throats.
why do you think competition-less state monopoly protected industries are havens for backwardness and inefficiency?
there also, i am not saying samsung is or is like a state sanctioned monopoly (i just know how fanboys and/or trolls work with regards to saying exactly what you mean). i am saying that the only reason samsung is spending millions to create innovations for phones as great as the gs4 and the n3 is because of the existence of lg, sony, htc, and others.
if you truly loved samsung and their devices the best thing you could hope for is for them to lose marketshare and fast.
because that sort of threat is what makes any of the great smartphone makers great.
anyone wishing for samsung to have a monopoly is effectively the same as an apple fanboy because the end result of either of those groups getting their fondest dreams is basically identical.
so go on, continue to fanboy, but i just want to point out the utter mindlessness and stupidity of your smartphone ideological position. cheer for your tribe. just remember that it is a tribe the next time you accuse anyone of being like a certain wooly, baaing mammal that often comes up in these discussions.
11. Mrmark (Posts: 277; Member since: 26 Jan 2013)
webOS phone please ! Lol had to say it sorry ...maybe not
12. GoBears (Posts: 449; Member since: 27 Apr 2012)
LG has always made awesome TV's. All I ever buy. I really like the Flex too, I just don't care for their Android skin.
15. jroc74 (Posts: 6005; Member since: 30 Dec 2010)
"Keep in mind that LG isn't disappearing from the smartphone industry completely, just cutting back on how much of the company will be devoted to the device."
I guess some ppl missed this lil tidbit of info. Read the entire article ppl, LG isnt giving up on smartphones, just going to focus more on their TV's.
18. PBXtech (Posts: 1032; Member since: 21 Oct 2013)
They ramped up phones if anything else. Getting two Nexus models helped a lot as well. Personally, I'd have never considered getting a LG phone if it wasn't for the Nexus 4 being so solid. Right now, I'm loving my G2.
16. Deadeye37 (Posts: 162; Member since: 25 Jan 2011)
I hope they put those phone engineers to good use on the smart TVs. To make a smart TV with a good interface & features that the phones have would be really good.
19. egbtmagus (Posts: 93; Member since: 12 Apr 2012)
LG is just slowing rollout of handsets, they don't plan to flood the market every 6 months with 12 devices like Samsung does. They don't plan to have the LG G2, G2 Active, G2 Mini, G2 Mega, G2 Ultra, G2 Flex and G2 Advance. They want a small product lineup thats more directly aimed.
21. jroc74 (Posts: 6005; Member since: 30 Dec 2010)
This sounds logical. So many good things said about the last 2 Nexus's... LG might take that Nexus, iPhone strategy and run with it.
27. ncarlosmiguel (Posts: 206; Member since: 14 May 2013)
You forgot G2 Zoom.
31. justsayit (Posts: 256; Member since: 09 May 2013)
so many g2 version will just make the sales lower
20. Cyberchum (Posts: 675; Member since: 24 Oct 2012)
And people wished Nokia had joined the Android ship. Small companies like Nokia can't survive here, only conglomerates like Sony, Samsung, LG etc can, at least other divisions can support them when their purse runs dry.
24. remtothemax (Posts: 260; Member since: 02 May 2012)
i think the reason people wanted nokia to jump on the android ship is because specifically they are the opposite of a small company.
yeah, they sort of lost everything, but the argument is that if they had jumped to android they might have turned it around.
up until very recently they were the smartphone company. no question. they may die, but they are definitely not small.
41. tasior (Posts: 265; Member since: 04 Nov 2012)
I remember watching stats of the biggest companiest several years ago. Nokia was the size of Microsoft, and three times of Google...
I know that Nokia was never big in US market, and recently it's a shadow of its former strength, but it's just funny reading opinions of people who think that Nokia has always been a small company...
46. corporateJP (Posts: 2431; Member since: 28 Nov 2009)
Nokia may not be what it was five or ten years ago, but calling them "small" makes you look extremely unknowledgeable. Their patent portfolio alone is worth billions of dollars.
22. joejoe5709 (Posts: 4; Member since: 09 Oct 2013)
I think that's a bad idea. I think they should follow Samsung and try to make their TV's more integrated with mobile tech. People are very willing to purchase devices that are all the same brand especially if they communicate well with each other. If you have an LG TV and you enjoy it, you're likely to buy an LG phone. And it goes both ways. Sorry to say, but Samsung's doing it right. Keep at it, LG!
23. mike2959 (Posts: 538; Member since: 08 Oct 2011)
If they would support their products with updates. I've had the G, G Pro, and now the G2. All awesome phones, so I end up rooting, custom ROM. Not to many custom ROMS though. Great phones.
29. GeekMovement (Posts: 2156; Member since: 09 Sep 2011)
Bugger I personally don't want an Apple vs Samsung competition. I hope Nokia, Sony, and Motorola will pull back up.
30. TechnoTechyes (Posts: 64; Member since: 24 Jan 2011)
All you need is 10,000 people earning a $1/hr. to build the phones, and 1,000 lawyers earning $1,000/hr. to defend them... What's the problem?
32. justsayit (Posts: 256; Member since: 09 May 2013)
lg need to more focus on its mid-low range device
more suggested to use the latest mediatek soc instance of 2~3year old mid-low range soc
and also their design, after optimus g , every new phone just has a terrible design
as a lg fans, feel sad about this
and also they should launch their phone global ASAP after anounced it
33. Taters (banned) (Posts: 6474; Member since: 28 Jan 2013)
They should just pull out of the USA like Sony. You can follow common sense when catering to other countries. The USA is unpredictable because the consumers are just so stupid.
36. Darkerm (Posts: 308; Member since: 31 Jan 2012)
I just hoping for LG G3 in jan 2014.
56. E.S.1 (Posts: 297; Member since: 14 Sep 2013)
If that happens I'll probably get it. Just because how good my LG G2 is. The best phone I ever had.
40. bugsbunny00 (Posts: 2054; Member since: 07 Jun 2013)
so its either samsung or sony on android,head to head.
44. Tsepz_GP (Posts: 987; Member since: 12 Apr 2012)
Thats a shame, I thought LG had finally arrived in the big leagues, with the G2 taking on the GS4, Note 3, iPhone5S, HTC One and One Max.
LOL at the Sony fanboys who say "Sony are coming", that rubbish is getting older than Apple iPhone's death rumours, lol. You've BEEEEN saying Sony is on their way and each year they fail. Thanks for the laugh though.
45. linaresx (Posts: 101; Member since: 13 Jun 2013)
People buy TVs about every 10 years but we buy mobile phones every 2 or less. Did Steve Ballmer leave Microsoft to head up LG?
47. xperiaDROID (banned) (Posts: 5629; Member since: 08 Mar 2013)
If Samsung's here, LG is also here. So they won't give up so fast, but they made consumers give up on their phones. For example, it's almost December and LG still haven't release the G2 in some countries including mine. This is one of the example of why LG can't beat Samsung.
48. GeekMovement (Posts: 2156; Member since: 09 Sep 2011)
Woot! I'm glad they're not shifting their focus away from the mobile market. I will look forward to their future handsets.
49. livyatan (Posts: 867; Member since: 19 Jun 2013)
Major fail of journalism, PA!
Can you Please ease down with spam articles?
I hope this will teach you a lesson
51. Jericho (unregistered)
All i can say is EPIC FAIL!!!!!!! on PA's Part.
52. Reeyawn (Posts: 65; Member since: 21 Apr 2013)
At least give us LG users a timeframe when you will give us KitKat to show that you are commited.


text:
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South Melbourne Community Centre
South Melbourne Community Centre
Where is it?
Corner Park Street and Ferrars Place, South Melbourne.
Entry to the building on Ferrars Place
Telephone: (03) 9209 6349
Email: email@example.com
Melways map reference 2K/B4
Venue photos: South Melbourne Community Centre
For booking: Booking application
Getting there
- South Melbourne Beach tram no. 1 Park Street stop (25 metres)
- St Kilda light rail no. 96. Albert Park or South Melbourne stop (200 metres)
- St Kilda / South Melbourne Beach tram no. 12. Stops 131, 132 on Albert Road (200 metres)
There is plenty of street parking in Ferrars Place. The Centre is accessible with disabled parking out front of Ferrars Place entrance.
What's there?
A modern well equipped activity centre located in South Melbourne close to Emerald Hill, the South Melbourne Market, Clarendon Street shops, Albert Park and public transport. The centre is shared by a number of different groups and is also available for individual use or drop-in.
- A large hall with a stage and a large dining room / multi purpose room is complemented by a number of smaller spaces that can be used for a wide range of activities.
- A well groomed Trugo lawn is attached to the building.
More Information
Contact Us or use eServices to ask us a question, request information or give us feedback online.
Ask for the Facilities Officer.


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Reviewed By Harry B (CATSKILL, NY) Reviewed for a 2012 Toyota Tacoma —8/11/2016 4:45 AM
Has lots of room and compacts well when not in use. Happy with purchase.
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The straps, as mentioned in other reviews, are difficult to assemble. However, they worked very well. We traveled at speeds around 70 mph and had no problems with them holding the carrier. The carrier did move backwards slightly so we had to adjust them once or twice day. (We did not have a rack on the car.) The carrier is waterproof and worked well.


text: DayBreak of Fostoria Inc., a nonprofit, adult daycare center for persons with memory loss or Alzheimer's Disease, is pleased to announce The Columbus Foundation has awarded DayBreak $5,000 for the Allen Eiry Fund for 2013. DayBreak is very grateful for this grant, as it will provide funding to support the activities and events of the DayBreak program for the 2013 year. This generous grant is so important as it allows the cost to be kept to the daily charge to attend the program and no other expenses for the family. This is very important for us at DayBreak to be able to offer to families.


text:
Buttermilk Fried Chicken
From Everyday Foods
Serves 8 | Prep time: 30 minutes | Total time: 1 hour
2 cups low-fat buttermilk
Coarse salt
3 teaspoons cayenne pepper
2 whole chickens (2-½ to 3 pounds each), each cut into 10 serving pieces (wings, thighs, drumsticks, and 4 breast pieces)
3 cups all-purpose flour
2 cups vegetable oil
1. Marinating the chicken in buttermilk makes the meat moist and flavorful. Chicken breasts cook faster than other parts, so fry them separately in the last batch. For fried chicken with less fat and fewer calories, remove the skin before marinating.
2. In each of two 1-gallon resealable plastic bags, combine 1 cup buttermilk, 1/2 tablespoon salt, 1/2 teaspoon cayenne, and half the chicken pieces. Shake to coat; refrigerate up to 2 days.
3. In a large, shallow bowl, whisk flour with 2 tablespoons salt and remaining 2 teaspoons cayenne. (This pungent spice is made from ground dried chiles. Used in small quantities, it adds heat to dishes without being overpowering.) Dredge chicken pieces, one at a time, in mixture, shaking off excess.
4. In a 12-inch cast-iron skillet (or other heavy-bottom skillet), heat oil to 350° on a deep-fry thermometer (or until a pinch of flour sizzles when dropped in the oil).
5. Carefully add 1/3 of the chicken. Cook 10 minutes; turn chicken with tongs. Cook until golden brown, juices run clear, and internal temperature is 165°, about 10 minutes more. Transfer to a rack to drain. Season with salt, if desired.
6. Return oil temperature to 350°. Repeat with remaining chicken.


text:
Paper proposals should include a title, abstract, and contact information (address, phone number, and email) for each author. Panel proposals should include a panel title, paper titles and abstracts, and contact information for each panel participant.
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