text:
Managing Regulated Medical Waste
Guidelines for Implementation of Public Health Law 1389 AA-GG and Environmental Health Regulations of 10 NYCRR, Part 70
Original 12/95
(Revised 9/05)
Table of Contents
- Forward
- Introduction
- Statute, Regulation, and Guidelines
- Education
- Treated Regulated Medical Waste and its Disposal as Solid Waste
- Universal Precautions and Managing Regulated Medical Waste
- Guidelines
- Managing the Regulated Medical Waste Stream
- On-site Treatment and Disposal Strategies
- Sharps Collection from Private Residences
- Questions and Comments
- Informational Sources
- RMW Risk Group Table
- Infectious/Biohazard Symbols (PNG, 111KB)
General Overview of Roles and Responsibility for Department of Health Management of Regulated Medical Waste
In 2003, the Department of Health assigned the overall responsibility for implementation of regulations pertaining to regulated medical waste (10NYCRR, Part 70) with the Office of Health Systems Management, Division of Health Care Standards and Surveillance, Bureau of Hospital and Primary Care Services. These regulations affect all Article 28 providers (e.g., hospitals, residential health care facilities, diagnostic and treatment facilities and clinical laboratories). The lead role for part 70 was previously with the Center for Environmental Health with certain elements of Part 70 managed by the Bureau of Hospital and Primary Care Services (Sharps) and Wadsworth Center – Division of Clinical Labs for: alternative RMW technology systems/biologicals…).
The current roles and responsibilities for RMW is as follows:
- OHSM - Division of Health Care Standards and Surveillance - Bureau of Hospital and Primary Care Services - Overall - Part 70 - RMW
- Wadsworth Center - Division of Clinical Labs - issues involving Alternative RMW technology systems/biologicals
- CEH - Issues involving radiological, water contamination….
- Department of Environmental Conservation - 6 NYCRR, Part 350--all non-Article 28 entities-pharmaceuticals, research facilities, permits for incinerators, issues involving storage/transport/disposal of RMW….
These guidelines are intended to help medical facilities comply with the revised 10 NYCRR, Part 70 regulations which governs the management of regulated medical waste. In 1995 the Department issued a set of "Interpretive Guidelines" to implement PHL 1389 aa-gg. These new regulations set in motion a process to ensure regulated parties continue to upgrade their RMW practices. The criteria discussed in this document will provide a basis for determining what waste generated by health care providers meets the definitions of regulated medical waste and could pose a risk of disease transmission if not managed properly. Implementation waste management procedures based upon the definitions found in Public Health Law, plus these guidelines should reduce the overall amount of regulated medical waste. While 10 NYCRR, Part 70 does not govern how physician private practice, dental and veterinarian offices, as well as university settings manage their RMW streams, these entities may find these guidelines useful in developing their individual waste management protocols. Some materials that have been associated with the delivery of health care and managed as regulated medical waste will no longer be considered as such. One notable example is I.V. bags and associated tubing. Their inclusion into the broad definitions of regulated medical waste found in the federal Medical Waste Tracking Act of 1988 was based solely upon the fact that they looked "medical". Not only does this reasoning run contrary to the basic tenets of disease transmission, it also reinforces misconceptions about the waste stream generated in health care facilities. These guidelines point out that I.V. bags and associated tubing are no longer considered as regulated medical waste under the Public Health Law . These new guidelines follow the adoption of the "Revised Part 70" Environmental Health Regulations which consist of five (5) Subparts and are summarized here as follows:
Existing Part 70 is rescinded and replaced with a new Part 70 containing five Subparts: 70-1 Applications and Definitions; 70-2 Management of Regulated Medical Waste (RMW); 70-3 Requirements for Autoclaves to Treat Regulated Medical Waste; 70-4 Approval of Alternative Regulated Medical Waste Treatment Systems; and 70-5 Approval Process for Alternative Technologies. This amendment clarifies terminology; adds flexibility to existing regulatory requirements; and codifies advisories for RMW management previously promulgated in guidance documents, following 1993 statutory amendments. This proposal revises regulatory definitions for RMW, infectious agents and treatment in conformance with the Law; amends container-labeling requirements; and incorporates applicable requirements for transport and disposal of RMW, allowing for increased flexibility in financial management and planning.
Section 70-1.1 - This section specifies that the requirements apply to hospitals, residential health care facilities, and diagnostic and treatment centers and clinical laboratories.
Section 70-1.2 - This section includes new and revised definitions for terms used throughout the Subpart, including "alternative regulated medical waste treatment system", "autoclave", "biologicals", "certificate of treatment", "challenge testing", "clinical laboratory", "culture and stocks", "culture dishes and devices for transferring, inoculating and mixing cultures", "cycle", "decontamination", "destroyed waste", "efficacy testing", "hazardous waste", "household medical waste", "incinerator", "infectious agent", "monitoring", "operating parameters", "operation plan", "parametric control", "primary container", "residence time", "secondary container", "sharp", "solid waste", "sterilize", "universal warning sign", and "validation testing".
Section 70-2.1 - This section stipulates the minimum requirements of a written plan for the management of RMW.
Section 70-2.2 - This section contains requirements and standards for containment and storage of RMW; clarifies requirements for disposal and establishes time frames for storage of primary containers used to discard sharps; clarifies time frame for storage of RMW in patient care areas and clinical laboratories; sets requirements for rooms or areas used to store RMW; sets labeling requirements for secondary containers used to transport untreated RMW off-site for treatment; clarifies decontamination procedures and guidelines for reusing secondary containers; specifies disposal requirements for secondary containers intended for single use; clarifies on-site processing procedures for reusable sharps containers; and describes requirements for transport of RMW within a facility.
Section 70-2.3 - This section specifies treatment methods for RMW; provides disposal requirements for hazardous, chemotherapeutic and radioactive waste; provides requirements for treatment of human tissue(s), or organs and animal body parts; stipulates transport, packaging and treatment requirements for cultures and stocks containing infectious agents; provides provision for sharps destruction and treatment; stipulates requirement for a response plan for handling untreated waste found commingled with solid waste; requires a radiation detection system for a facility to screen incoming waste for the presence of radioactive materials; requires a contingency plan for handling radioactive material found commingled with RMW delivered for treatment at a treatment facility; and clarifies treated RMW disposal options.
Section 70-2.4 - This section describes requirements for transfer of untreated waste for off-site treatment; clarifies that generators of RMW must transfer custody of untreated waste only to an appropriately permitted (by DEC) hauler; provides exemption if monthly waste generation is under 50 pounds; establishes requirement for use of medical waste tracking forms; clarifies applicability of Federal Department of Transportation requirements to certain cultures and stocks; specifies treatment requirements for solid waste transported with untreated RMW.
Section 70-2.5 - This section contains record-keeping requirements and retention times for the quantity, types, on-site treatment and disposal of RMW.
Section 70-3.1 - This section contains validation testing requirements for autoclaves used to treat RMW; and specifies required elements of protocols for validation testing.
Section 70-3.2 - This section contains requirements for, and minimum elements of, an operational plan for facilities using autoclaves; specifies procedures that must be followed upon autoclave failure to meet operating parameters; contains requirements for monitoring autoclave performance; specifies standards for autoclave performance and for containment of RMW for treatment by autoclaving; and clarifies treatment of autoclaved sharps prior to disposal.
Section 70-3.3 - This section clarifies the minimum operating parameters for treatment of RMW in a gravity-feed autoclave and in a vacuum-displacement autoclave; specifies approval requirements for use of an autoclave at alternative operating parameters.
Autoclave parameter for RMW treatment processes shall conform to the following:
- Gravity Autoclaves
- Not less than 250° F (121° C) temperature @ 31 psig pressure use at residence time not less than 60 minutes.
- Not less than 275° F (135° C) temperature @ 31 psig with a residence time not less than 45 minutes.
- Not less than 300° F (147° C) temperature @ 52 psig with residence time not less than 30 minutes.
- Vacuum Autoclaves
- Not less than 250° F (121° C) temperature @ 15 psig with residence time not less than 30 minutes
Section 70-3.4 - This section contains record keeping requirements and time frames for efficacy and validation testing, autoclave training, and documentation of corrective actions, modification of approved operating plans, residence time, pressure and temperature of treated loads.
Section 70-4.1 - This section clarifies criteria for department approval of alternative treatment methods for RMW; and provides approval guidelines and time frames.
Section 70-4.2 - This section establishes requirement for an operational plan approved by the department for each facility using an alternative RMW treatment system; stipulates required elements of the operation plan, including segregation of waste, safety and training plans for personnel handling RMW, emergency procedures, performance monitoring and routine maintenance; describes requirements for modification of the approved operation plan; stipulates the need for an approved plan prior to operation; describes procedures for system failure during operation; specifies monitoring requirements during operation; and stipulates operating personnel training requirements.
Section 70-4.3 - This section clarifies the requirement for a protocol for validation testing; stipulates validation testing requirements to be met prior to placing system in operation.
Section 70-4.4 - This section stipulates the additional record-keeping requirements and retention times for efficacy and validation testing; for personnel records; for corrective actions; and for plan modifications.
Section 70-5 - This section summarizes the approval process for Alternative Treatment Technologies in New York State.
Statute, Regulation, and Guidelines
Similarly, the Environmental Conservation Law was amended by Chapter 438 so that the definitions of regulated medical waste found in ECL 27 - 1501 is consistent with the Public Health Law. This ensures that the universe of regulated medical waste generators operate under the same definitions.
Even though Chapter 438 of the Laws of 1993 transferred the responsibility of maintaining the definitions of regulated medical waste to the Department of Health, it is important to note that the Department of Environmental Conservation, pursuant to ECL, Article 27, Title 15 continues to have an important regulatory oversight role in the storage, transportation and disposal of regulated medical waste, including oversight of non-article facilities such as private medical practices, research and university facilities.
Educating the public to the actual issues and risks associated with regulated medical waste, while not addressed in Public Health Law or the enabling legislation, still is an important consideration. Often obscured in the public discussion and debate is the fact that truly infectious waste (as defined by being the source of transmissible diseases) is a minuscule component of the state's overall solid waste stream and that this type of waste is routinely handled every day inside and outside of health facilities all over the world without causing disease.
Treated Regulated Medical Waste and its Disposal as Solid Waste
One provision of Chapter 438 of the Laws of 1993 which provides opportunity for cost savings is the ability to dispose of properly treated regulated medical waste as solid waste. However, to fully realize this management option, solid waste handlers and disposers must be provided with specific details on how the waste has been treated. This has been provided for by a Certificate of Treatment which must accompany each load of treated waste to its ultimate destination. This form may not necessarily address all the concerns of the waste handler, particularly in light of the misconceptions they may share regarding the medical waste stream in general and the mechanisms of pathogen transmission in particular. However, the use of the form does provide the transporter and landfill operator greater assurance that the waste has been appropriately treated prior to shipment for disposal. It is also appropriate to initiate discussions with your local solid waste management authorities so that they are made aware of what additional materials may now be found in the solid waste stream as a result of the revision in the definitions. In addition it would be prudent to discuss what, if any, reservations they may have regarding the disposal of treated regulated medical waste, e.g., co-mingling of treated medical waste with other forms of solid waste. This highlights the importance of education which must be considered as a cornerstone in fully realizing the intent of Chapter Law 438 and the revised Part 70 regulations.
Universal Precautions and Managing Regulated Medical Waste
According to the Centers for Disease Control and Prevention (CDC) and occupational Safety and Health Administration (OSHA), "universal precautions" refers to an infection control system which assumes that any direct contact with a patient, particularly their body fluids, has the potential for transmitting disease. This system resulted from the heightened awareness and concern over the potential risk of transmitting Human Immunodeficiency Virus (HIV) and Hepatitis B (HBV) to health care providers. Therefore, universal precautions is a qualitative system designed to ensure the safety of the individual health care provider.
Contact with any body fluid, regardless of the quantity, is considered to be a potential source of infectious agents. Conversely, the revisions of Public Health Law as it relates to the definitions of regulated medical waste described in the following categories and the methods used to treat and process medical waste provide a quantitative system for the overall handling of regulated medical waste.
The revisions discussed in these guidelines are intended to ensure the public's health and safety, as well as those, within and outside health care facilities, who must manage medical waste. The quantity, as well as quality of the waste must be considered in determining if it should be designated as regulated medical waste.
At this point it is appropriate to clarify the application of universal precautions as it relates to the handling and disposal of tubing used in patient care. The critical factor for determining if the tubing used in patient care should be considered as regulated medical waste are: (1) direct contact with any of the fluids identified by OSHA as being possible sources of transmission of infectious agents, and (2) the quantities of these fluids. OSHA1 has described semen, vaginal secretions, pleural fluid, cerebrospinal fluid, synovial fluid, pericardial fluid, amniotic fluid, saliva in dental procedures, and any other fluid visibly contaminated with blood. Conversely, feces, urine and vomitus are not included unless they contain visible blood. For tubing to be designated as regulated medical waste, it would have to have been in contact with those fluids listed by OSHA. For example, tubing used in gastrointestinal procedures which is visibly coated with body fluids should be discarded as regulated medical waste.
Each section of the Public Health Law that was amended by Chapter 438 of the Laws of 1993 discussed both the Legislative intent and the Department's perspective.
Public Health Law 1389 - aa: Definitions
Chapter 180 of the Laws of 1989 broadened the state's regulated medical waste definitions to be consistent with the Federal Medical Waste Tracking Act. In doing so it increased the number of subcategories of medical waste and included many items which did not pose a risk of disease transmission but simply looked "medical". The revised definitions resulting from Chapter 438 of the Laws of 1993 reduced the number of subcategories and in some instances, provided for further qualification of items in the subcategory. However, it is important to note that the revised general definitions of medical waste includes wastes resulting from diagnosis and treatment of animals, as well as that produced from health care research and development.
The general definitions states,
- "Regulated medical waste
- shall mean any of the following waste which is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in production and testing of biologicals, provided however, that regulated medical waste shall not include hazardous waste identified or listed pursuant to Section 27-0903 of the Environmental Conservation Law, or any household waste promulgated under this section."
Six subcategories exist within the general definitions of regulated medical waste. The last subcategory provides for the Commissioner of Health to designate specific items which previously have not been considered as regulated medical waste. As no items have yet to be added to this subcategory, the remaining five are considered to be part of the current working definitions of regulated medical waste.
Subcategory 1 - Cultures and Stocks
"This waste shall include cultures and stocks of agents infectious to humans, and associated biologicals, cultures from medical or pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biologicals, discarded live or attenuated vaccines, or culture dishes and devices used to transfer, inoculate or mix cultures."
The key to this subcategory is understanding what is meant by agents infectious to humans. The department has identified that such agents are currently described in Section 2.1 of the State Sanitary Code as those causing communicable diseases (Attachment 1). These guidelines also recommend the inclusion within this subcategory of those agents designated as requiring biosafety level II - IV in the CDC/NIH Manual for Biosafety in Microbiological and Biomedical Laboratories (3rd edition, May, 1993).
In context of this subcategory, cultures and stocks refer to systems used to grow and maintain infectious agents in vitro, including, but not limited to:
- nutrient agars, gels, broths (including those utilizing human blood or blood products);
- human and primate cell lines; and
- impure animal cell lines.
The term biologicals is intended to mean preparations made from living organisms and their products which are used in diagnosing, immunizing, or treating human beings or animals, including, but not limited to:
- serums;
- vaccines;
- antigens; and
- antitoxins.
Last, the phrase "culture dishes and devices used to transfer, inoculate or mix cultures" refers to the use of items that have come in contact with high concentrations of infectious agents as in the recovery of such agents in culture from clinical specimens and includes:
- plastic or glass plates, flasks, vials, beakers, bottles, jars, and tubes;
- inoculation loops and wires;
- manual and mechanical stirring devices;
- rubber, plastic, and cotton stoppers and plugs;
- filtering devices made of natural and artificial substances; and
- materials used to clean and disinfect items indicated above after routine use or accident.
Subcategory 2 - Human Pathological Wastes
"This waste shall include tissue, organs, and body parts (except teeth and the contiguous structures of bone and gum), body fluids that are removed during surgery, autopsy, or other medical procedures, or specimens of body fluids and their containers, and discarded material saturated with such body fluids other than urine, provided that the Commissioner, by duly promulgated regulation, may exclude such discarded material saturated with body fluids from this definitions if the Commissioner finds that it does not pose a significant risk to public health. This waste shall not include urine or fecal materials submitted for other than diagnosis of infectious diseases."
It should be quite clear that organs, tissues and associated fluids removed as result of surgical or autopsy procedures are regulated medical waste. Some confusion however could exist regarding the phrase "discarded materials saturated with such body fluids other than urine". The determining factor for these materials to be regulated medical waste is if they are saturated to the point of dripping. This is consistent with OSHA's blood borne pathogen standard which defines saturated as referring to material that when squeezed produce free flowing fluid. The Department does not encourage individuals to squeeze any item to determine if it is saturated. Rather, the department expects that health care professionals will use their experience and training to make this determination. Examples of body fluids include, but are not limited to blood, cerebrospinal fluid and amniotic fluid and any body fluids which are visibly contaminated with blood.
One exception of particular interest in the definitions of this subcategory requires additional clarification. Urine is not considered regulated medical waste unless it is submitted as a clinical specimen for laboratory tests. However, if a patient is found to have a disease which may be transmitted through urine, then the material containing this fluid (including diapers) must be considered regulated medical waste. Similarly, incontinence materials are not regulated medical waste provided that the patient does not have an infectious disease transmissible by urine. Conversely, since feces always contain microorganisms and, since these microorganisms even if potentially pathogenic, cannot be transmitted from trash containers or disposal sites. Fecal contaminated materials are not considered to be regulated medical waste.
Questions have also arisen regarding the appropriate disposal of organs and tissues which have been fixed for cytological and/or histological examination. Since the fixatives are considered to be hazardous materials, organs and tissues discarded with these chemicals must be processed as hazardous waste, except for blocks of tissue in paraffin or similar embedding materials. The latter prevent the fixatives from leaching into the environment and the chemical fixatives destroy any potential pathogens in the tissue block. Therefore, tissue blocks can be discarded as solid waste. Conversely, if organs and tissues are disposed of separately from the fixatives, then they should be handled in accordance with Section 4215 of Article 42 of the Public Health Law. Specifically, tissues, organs, recognizable body parts and cadavers which have been chemically preserved and can no longer be sources of transmissible disease should be disposed of by cremation or interment. Section 4215 (1) allows the individual in possession of body parts removed by dissection from cadavers to retain the parts for scientific purposes. Similarly, organs or recognizable body parts which have been removed during surgery can be retained by the patient for religious purposes provided that the organs or body parts cannot serve as sources of disease transmission.
Subcategory 3 - Human Blood and Blood Products
"This waste shall include: (I) discarded waste human blood, discarded blood components (e.g. serum and plasma), containers with free flowing blood or blood components or discarded saturated material containing free flowing blood or blood components; and (II) materials saturated with blood or blood products provided that the commissioner, by duly promulgated regulation, may exclude such material saturated with blood or blood products from this definitions if the commissioner finds that it does not pose a significant risk to public health."
Blood and its components, including stocks from transfusion or materials saturated with free flowing blood, are viewed as regulated medical waste.
Questions have been raised regarding the appropriate disposal of menses pads. OSHA has ruled that feminine hygiene products used to absorb menstrual flow are not regulated medical waste. Waste containers into which these are discarded should protect individuals from physical contact with these items.
Subcategory 4 - Sharps
"This waste shall include but not be limited to discarded unused sharps and sharps used in animal or human patient care, medical research, or clinical or pharmaceutical laboratories, hypodermic, intravenous, or other medical needles, hypodermic or intravenous syringes to which a needle or other sharp is still attached, Pasteur pipettes, scalpel blades, or blood vials. This waste shall include, but not be limited to, other types of broken or unbroken glass (including slides and cover slips) in contact with infectious agents. This waste shall not include those parts of syringes from which sharps are specifically designed to be easily removed and from which sharps have actually been removed, and which are intended for recycling or other disposal, so long as such syringes have not come in contact with infectious agents."
The single most important aspect of sharps which gives rise to fear and apprehension is their inherent ability to cause puncture wounds and/or lacerations which may create a portal of entry for infectious agents. Although syringes with attached needles are the classic examples of sharps, other items used in the delivery of health care or in research and which have come in contact with infectious agents, e.g., glass or rigid plastic culture tubes, flasks, beakers, etc., must also be considered as sharps and be disposed of accordingly. Therefore, even though many of the items identified in this subcategory do not exemplify the "classic sharp", they still can give rise to puncture or laceration wounds.
One point needs to be clarified. No attempt should be taken to remove the needle from the barrel of the syringe. To do so would only increase the opportunity for needle stick injury. The total unit should be placed in a sharps container and disposed of as regulated medical waste. In those instances, however, where only the barrel of the unit is utilized, as found for example in infusion pump setups, then the barrel can be disposed of as solid waste provided it did not come into contact with infectious agents.
All syringes (barrel and needle) and those other sharps which have come into contact with infectious agents must be contained in a rigid, puncture resistant container, secured to preclude loss of contents, and either, red in color or conspicuously labeled with either the universal biohazard symbol or the word biohazard. In addition, all sharps after treatment must be destroyed to remove the risk of puncture wounds, before being disposed of as solid waste. Glass and plastic materials (other than syringes) which have not come in contact with infectious materials need not be treated and destroyed but should be disposed of carefully as solid waste, preferably in rigid containers. These containers are not required to be red in color or labeled with the universal biohazard symbol nor the word biohazard.
Even though they are not considered to be regulated medical waste certain types of medical equipment have found their way into sharps containers. The most common type of equipment to be disposed of in this manner is endoscopes, perhaps due to the pincers found at the end of the tubing. Medical equipment should not be disposed of in this manner as it is costly and an alternative decontamination (i.e. cold sterilization) would be more appropriate.
Subcategory 5 - Animal Waste
"This waste shall mean discarded materials including carcasses, body parts, body fluids, blood, or bedding originating from animals known to be contaminated with infectious agents (i.e. zoonotic organisms) or from animals inoculated during research, production of biologicals, or pharmaceutical testing with infectious agents."
Again, it is important to understand that exposure to a known infectious agent is necessary before the waste should be considered as regulated medical waste. In certain instances, most notably rabies, the ability to determine whether an animal has been exposed must await a specific laboratory analysis. Given the nature of the suspected infectious agent in this case, it would be prudent to manage the waste generated in handling and preparing the carcass as regulated medical waste. Preserved animals used for educational purposes are not regulated medical waste and can be disposed of as solid waste if they are not considered hazardous waste due to the fixative used to preserve the body.
Other Definition Revisions
Beyond the revisions in the definitions of regulated medical waste, two other terms were amended. These include:
- Treatment
- shall mean any method, technique or process designed to change the character or composition of any regulated medical waste so as to either neutralize such waste or to render such waste not infectious as approved by the commissioner pursuant to section thirteen hundred eighty-nine-dd of this title
The intent of the revision to this definition was to remove any illusion that effective treatment of regulated medical waste could be accomplished by any process other than one which directly reduces concentration of potential pathogens. It should be noted that by regulation, three treatment processes are approved; incineration, autoclaving and in the case of liquids, discharge to a sewerage system which is connected to a municipal secondary wastewater treatment facility.
- Infectious Agents
- shall mean any organisms that cause disease or an adverse health impact to humans, except that the commissioner may prescribe by regulation additional infectious agents as may be necessary to protect health and the environment
It is also important to point out one pathogen which will not be identified in the list found in Section 2.1 of the State Sanitary Code. Although HIV is not listed, it is prudent to recognize this pathogen as an infectious agent for the purposes of managing the regulated medical waste stream.
Managing the Regulated Medical Waste Stream
Beyond the revisions to several of the definitions found in the Public Health Law, Chapter 438 of the Laws of 1993 also revised two other sections that have an effect on the management of regulated medical waste. One revision effects the labeling of red bags used to contain regulated medical waste and the other concerns disposal of treated regulated medical waste.
Public Health Law 1389 - cc: Storage and containment of regulated medical waste. [Eff. July 1, 1995, as amended by L. 1993, c. 438]
Containment of regulated medical waste shall be separate from other wastes. Containers used for the containment of regulated medical waste shall be marked prominently on the containers with the universal warning sign or the word biohazard.
Prior to this provision's effective date of July 1, 1995, containers (bags and sharps containers) were required to be labeled prominently with either the word "infectious" or the words "regulated medical waste". Clearly, supplies of the outdated labeled bags and sharps containers held by health related facilities were not uniformly depleted on July 1, 1995. The department will allow facilities to use up their current stocks but when they reorder, they must acquire bags and containers which meet the labeling requirements of the new statute.
Public Health Law 1389 - dd: Treatment and disposal of regulated medical waste.
1. Treatment or disposal of regulated medical waste shall be by one of the following methods: (c) By decontamination by autoclaving, or by other technique approved by the department, so as to render the waste noninfectious. Regulated medical waste so treated shall be disposed of as solid waste provided it does not otherwise meet the definitions of hazardous waste as defined in the regulations promulgated under section 27-0903 of the environmental conservation law or the regulations promulgated thereunder, and is accompanied by a certificate, in a form prescribed by the commissioner, which evidences such treatment. 2. Regulated medical waste shall not be disposed of by burial at a landfill disposal facility, unless treated in accordance with subdivision one of this section. All sharps must be rendered unrecognizable prior to disposal.
This provision of the statute for the disposal of treated regulated medical waste as solid waste should result in decreased expenditure by health care facilities which elect to treat on-site. There are numerous alternative technologies which are currently available from over forty manufactures within the United States and Europe. They vary in capacity from those designed for use in physician/dentist offices, capable of treating twenty-five to one hundred pounds per cycle, to systems to be used in major medical centers or regional treatment facilities, which are able to treat one ton or more of waste per cycle (generally a cycle is one to one and one/half hours in length). In many instances these alternative technologies simultaneously treat, destroy, and reduce the volume of regulated medical waste through the use of pre- or post-treatment grinders/shredders or by use of extremely high temperatures (upwards of 15,000 o) to reduce the waste to ash. They vary in cost from less than $2,000 per unit to approximately $750,000 per system. The larger the capacity, the greater the waste reduction and the more automated the technology, the higher the initial cost of the unit.
However, regardless of the capacity, the extent of the automation, or overall volume reduction, all alternative systems treat regulated medical waste using one of three methods; (a) heating the waste to a minimum of 210o F by means of microwaves, radio waves, hot oil, hot water, steam or superheated gases; (b) exposing the waste to chemicals such as sodium hypochlorite (household bleach) or chlorine dioxide; or (c) by subjecting the waste to heated chemicals. As indicated in the above section, all alternative technologies must be reviewed and approved by the Department's Wadsworth Center (Regulated Medical Waste Program - RMWP) prior to being offered for sale in New York State. Each manufacturer seeking approval of an alternative treatment system for use in the State must comply with 10 NYCRR Part 70, Section 70-4&5. A list of such approved treatment technologies and information on the application procedures to obtain approval for alternative systems, as well as questions related to efficacy testing methods and results can be obtained by calling the RMWP at (518) 408-1146.
It is important to understand that a form which evidences treatment by an approved technology must accompany the treated waste to the solid waste facility. The department has developed a form for this purpose which must be used by those facilities that treat on-site by incineration or autoclaving. The department does not require the use of this specific form with waste treated by some alternative treatment technologies. For specific information contact the RMWP. There is one critical factor which must be pointed out. Sharps as defined in subcategory 4 must be treated and destroyed (rendered unrecognizable) before they can be disposed of in a landfill. Sharps which are only treated are still considered regulated medical waste and, therefore, can not be disposed of in a landfill.
On-site Treatment and Disposal Strategies
As a result of the revisions in definitions of regulated medical waste and the ability to dispose treated regulated medical waste as solid waste, on-site treatment programs should be equally or more cost effective than many commercial options. With regards to utilizing on-site treatment of RMW, two questions are frequently asked. One - why should the facility have an operational plan approved and on file with DOH? While it is required pursuant to 10NYCRR, Part 70-3.2, it is important to note that having such a plan in place will assist the facility in disposing of such waste as solid waste. Hospital and clinical laboratory RMW operational plans using autoclave treatment methodology must be submitted for review and approval to the Clinical Laboratory Evaluation Program, Wadsworth Center, New York State Department of Health, P.O. Box 509, Empire State Plaza, Albany, New York 12201-0509. All other Article 28 facilities must submit their operational plans developed to address the on-site treatment of regulated medical waste by autoclaves to the Bureau of Hospital and Primary Care Services, Hedley Park Place 433 River Street, Troy, New York 12180-2299.The second question relating to autoclaving regulated medical waste is the type of bag to be used to collect and store the waste prior to treatment by autoclaving. The typical red bag currently employed in the collection of regulated medical waste is not designed to withstand the high temperature and pressure conditions created in an autoclave. However, there are specially designed bags which are available to be used in autoclaving regulated medical waste. These bags not only remain intact, but also enhance the sterilization process by allowing easier passage of steam into the waste. The department encourages those facilities which utilize autoclaves to treat regulated medical waste to use autoclavable bags as they do come in the color red with the appropriate language imprinted on them.
Sharps Collection from Private Residences
In an effort to address the safe disposal of sharps generated in the private residence, Chapter 438 of the Laws of 1993 requires hospitals and nursing homes to establish procedures whereby such household generated waste can be dropped off for proper disposal. The overall intent of the 1993 legislation was to provide consumers with convenient and accessible means of disposing of household sharps, and to ensure that they do not cause injuries to sanitation and resource recovery workers, or end up in places where they may might pose a danger, including streets, playgrounds, recycling bins, beaches, etc. To be effective, hospitals and nursing home programs must be: convenient, accessible and easy to use, promoted in the community, understood and supported by staff, safe and secure, and they must be monitored and improved.
Household sharps collection programs have grown in visibility and importance as a result of several factors including:
- increase in the number of sharps generated from outpatient and home care treatment
- increase in the number of persons with diabetes, cancer, and the administration of fertility treatments and allergy medications
- increased awareness of the risks to sanitation workers resulting from the comingling of sharps and general household trash
In New York State we have an advantage as a result of existing laws, and our established Sharp Collection and Disposal Programs at hospitals and nursing homes. In addition, the Expanded Syringe Demonstration Program (ESAP) of 2001 reinvigorated and promoted safe sharps collection and disposal which included a resource directory of disposal locations and hours of operation. The development of new and convenient collection and disposal options to supplement facility-based programs have all contributed to the success of the program. This waste covered is specific to that generated as a result of self maintenance programs involving the delivery of injectable medication and includes sharps only. Sharps as described for purposes of this program include needles, syringes and lancets, only.
A common concern identified in the Public Health Law is the nature of the container used by the private resident to store used sharps. Containers which do not provide protection against needle stick injuries cannot be considered adequate for the purposes of this program. Individuals who are responsible within the health care facility for managing this program cannot be exposed to the risk of needle stick injury which may result from improperly packaging of sharps. Therefore, it is imperative that an individual who wishes to participate in this program be educated to make informed choices in disposing of their household generated sharps. At a minimum, the container adopted and / or accepted by the facility must be shatter proof, leak proof and puncture resistant. If this cannot be assured by the generator, the health facility does not have to accept the sharps. Each hospital or nursing home in the consumer health service area should be contacted to obtain literature on the facility sharps program. A directory of hospitals/nursing homes can be obtained from the Department. The primary elements which should be included in the household sharps disposal plan/procedure are:
- Establishment of the location for delivery
- Operational hours - Could range from daily to once a week, depending upon the locality.
- Drop-off points - Sharps must have controlled access. Residential sharps will not be considered as regulated medical waste until the health facility has accepted them according to their established procedure.
- Identification of responsible staff - Individuals involved with managing the household sharps program will need to be trained on the proper handling of sharps and precautions necessary in handling sharps not disposed of in the appropriate containers, or in the event spillage. Plans which detail the responsibilities of these individuals should also provide specific information on how staff will respond to spills.
- Use of secondary containers - The facility's site for drop-off of household sharps must have secondary containers available so that sharps containers brought in can be placed directly into the secured container. This will reduce the likelihood of direct contact by hospital personnel with household sharps
- Public Information - The public will need information regarding the procedure in order to participate in the program. This can take the form of brochures, press releases or television or radio spots.
Questions and Comments
If staff of any facility, consumer or interested party have questions concerning the information contained in these guidelines, contact the following:
- Article 28 Facilities (hospitals, nursing homes, etc) issues.
- The Bureau of Hospital & Primary Care Services (518) 402-1003
- Clinical Laboratories - Alternative Technologies issues.
- The Wadsworth Center, Regulated Medical Waste Program (RMWP) (518) 408-1146
- Non-Article 28 Facilities (research facilities, universities, and private physician offices, permited haulers, or storage, transport and disposal RMW) issues.
- The Department of Environmental Conservation (518) 402-8706
Informational Sources
- New York State Department of Health - Managing Regulated Medical Waste
- New York State Department of Environmental Conservation (ref. 6 NYCRR, Part 360)
- Hazardous agents
- U.S. Department of Transportation - RMW
- United States Postal Service - Transport of RMW
- U.S. Department of Labor - Occupational Health & Safety Administration (OSHA)
- U.S. CDC Select Agent Program (ref. 42 CFR. Part 72, Sec. 72.6)
- Health Care facilities Pollution Prevention Guidelines (Ref. NYS Department of Environmental Conservation - May 2001)
- Guidelines for RMW Treatment, Storage, Containment, and Disposal (Ref. NYS Department of Environmental Conservation - December 1996)
- EPA RMW Regulations & Compliance Requirements
- Federal Hazardous Waste Requirements (Ref. Resource Conservation and Recovery Act (RCRA) as amended in 1984 - Focus: Protection of Human Health & Environment)
- 40 CFR, Parts 260-265
- Part 260 - Hazardous Waste Management Systems
- Part 261 - Identification and Listing of Hazardous Waste (Ref. Symbols: Corrosive, Ignitable, Reactive or Toxic)
- Part 262 - Standards Applicable to Generators of Hazardous Waste
- Part 263 - Standards Applicable to Transporters of Hazardous Waste
- Part 264 - Standards for Owners and Operators of Hazardous Waste Treatment, Storage, and Disposal Facilities
- Part 265 - Interim Status Standards for Owners and Operators of Hazardous Waste Treatment, Storage, and Disposal Facilities
- 40 CFR, Parts 260-265
- Needlesticks/Bloodborne Infections (Ref. NYS Legislation - Assembly Bill 7144/Senate Bill 8126, April 2001)
- Medical Waste Tracking Act - 1988
- Focus: Requires the "Agency for Toxic Substances and Disease Register" (ATSDR) to submit reports to Congress on health effects of medical waste
- Hazardous Substances
- (Ref. The Agency for Toxic Substances and Diseases Registry is responsible for enforcing the Comprehensive Response, Compensation, and Liability Act (CERCLA), Section 104). This law requires the EPA and ATSDR to prepare in order, a priority list of substances that are most commonly found at facilities that have the potential of threat to human health due to their known or suspected toxicity and potential for human exposure.
- E-mail: firstname.lastname@example.com
- CDC - Guidelines for Environmental Infection Control in Health Care Facilities - 2003
Federal References
- 29 CFR, Part 1910 - RMW Transport - Labeling…
- Container, bag or box shall bear facility name, address, 24 hour telephone number and contact person
- Container shall reflect appropriate symbol and signage and should be appropriate size, at least 19" x 14" on outer surface of container and reflect words such as:
- "Bio-Medical Waste"
- "Biohazardous Waste"
- "Biohazardous"
- "Infection Waste"
- "Infection Substances"
- "Radioactive Substances"
- Bags - RMW bags shall be red in color
- Sharps containers should be packaged and sealed at the point of origin and comply with DOT requirements.
- If a bag or Sharps container is to be inserted into a secondary container, the larger container shall have the same appropriate labeling as described above.
- 49 CFR, Part 173 - Non-Bulk Packaging of RMW
- Meet DOT requirements
- Be containers in inner packaging
- Inner packaging of liquids must be rigid, contain absorbent material of sufficient quantity and appropriate location to absorb the entire amount of liquid in the event of a spill
- If transporting SHARPS, container must be puncture resistant and capable of retaining liquid
- Use of carts for transporting waste in facilities must have smooth, non-porous interior surfaces, free of cracks, crevices, and other defects that could damage plastic film inner packaging or impede disinfection operations
- After each carts use, the cart must be disinfected by any means effective for neutralizing the infectious substances (e.g., use of bleach…)
- Untreated cultures and stocks of class four(4)risk group must not be transported by cart or bulk outer packaging means (BOP)
- Radioactive waste must not be transported by cart of BOP
- Chemotherapeutic waste; untreated stocks and cultures or infectious substances containing risk group 2 or 3 pathogenic organisms; unabsorbed liquids; and SHARPS containers may be transported in a cart or BOP, if packaged in a rigid non-bulk package container
- Carts must be constructed of metal, rigid plastic or fiberglass; fitted with a lid to prevent leakage during transport.
RMW Risk Group Table
(Source: 49 CFR, Part 171)(2)
|Risk Group
|Risk to Individuals
|Risk to the Community
|A pathogen that usually causes serious or human or animal disease and that can be readily transmitted from one individual to another, directly or indirectly, and for which effective treatments and preventive measures are not usually available.
|A pathogen that usually causes serious human or animal disease but does not ordinarily spread from one infected individual to another, and for which effective treatments and preventive measures are available.
|A pathogen that can cause human or animal disease but is unlikely to be a serious infection on exposure, for which there are effective treatments and preventive measures available and the risk of spread of infection is limited.
|A micro-organism that is unlikely to cause human or animal disease.
|None or very low
|None or very low


text:
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Brand: Pleasure Works
Add a flash of brilliance to your next erotic escapade with the Lime Teaser Smoothie Vibrator. Read More
Related Products
Add a flash of brilliance to your next erotic escapade with the Lime Teaser Smoothie Vibrator. Fun and flirty, this vivid vibe features a classic smoothie shape and velvety soft exterior in electrifying color. Operated by a simple dial control and completely waterproof, this multi-speed vibe offers intense internal and external stimulation in the tub or out. Sleek and powerful, the Lime Teaser Vibe is sure to please!
Lime Teaser Mini Smoothie Vibrator
ABS Plastic
4 1/2" x 1 " (11.4cm x 2.5cm)
Takes 1 AA Batteries(not included)
Volume: 4, Intensity: 2
Body-safe -- Sex toys are made from many different materials, with varying amounts of information available about them, and many have not been tested for safety. We always choose better-quality items, and we give special attention to those we know to be safer.
Recyclable Packaging/Materials -- When the package and/or material for your toy can be recycled, you can reduce the impact of your purchase on the environment.
Brand: Pleasure Works
Material: ABS
Texture: Smooth
Color: Green
Power Source: 1 AA
Length: 5.5 inches
Insertable Length: 4.5 inches
Diameter: 1.03 inches
Intensity: 4/5
Volume: 2/5
Warranty: Standard
- Phthalates-free
- Waterproof
- Multi-speed
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I'm new to the world of toys, so this seemed like a non intimidating route to go. I liked that it is water proof, so there's no issue with using it in the shower, but it's super quiet, so using outside the shower is no problem. Great for external stimulation. Slowly increasing the speed of the vibration while rocking my hips against it does the trick, and quickly. Haven't used it for internal stimulation just yet because the satisfaction from external alone has been fine for me. It is a harder plastic, but if you like firm pressure on your clit, I find the hardness to be a bonus. The speed variation is great, and the highest setting can get me off quickly, which is great for multiple O's.
Since it was on sale at the time and since I had wanted to experiment with internal stimulation (previously I could only get off with clitoral vibrators), I decided to snag this. And I'm glad I did! Overall, a great first internal vibe. I like that it's waterproof and non-porous, however the outside texture is extremely firm, so if you like that kind of thing, this is great for you.
The vibrations were nice as well, and feel good on the clit! I have recently started pairing this little guy with the Blue Venus (also from GoodVibes), and the orgasms are AMAZING. Two toys at once is a little hard to handle, but it's worth it, I suppose!
Also: it's very quiet! I live in a dorm situation, but especially when it's under a blanket, it's virtually silent, but the vibrations are good despite that.
Highly recommended. Cheap, and gets the job done. Plus I like the bright color!
I am really new to sex toys and to using anything at all for penetration. I used to think that internal stimulation was just not my thing. I tried using this a few times internally, but had written it off and decided to keep it for external play because the lower vibration settings are great on my clit.
Then, after working myself up a lot, I decided to try penetration again. It is small enough that, with lube, I can get it in without any kind of pain. I found that the process of rocking my hips up with my hand pressed firmly against my clit caused the teaser to press against what I am assuming is my g-spot. I've had no success trying to stimulate my g-spot before, but this thing did the trick.
If you prefer bigger toys for internal stimulation or aren't into penetrative toys, the teaser is a good option for clitoral stimulation thanks to its range of vibration speeds.
It's hardness it the only downside for me, but it is hard to find softer body-safe toys at this price, so it's a good trade-off.
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subset: commoncrawl


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|The Plaid Square is a full service quilt shop brimming with the most current quilting supplies available! Our large fabric selection, boasting everything from bold colors and modern motifs, to quaint prints in traditional themes, is of the finest quality, carefully chosen from among today's most popular designers and manufacturers. And, to give you plenty of creative project options, we offer a large selection of quilt kits as well! Around here, we go the extra mile to offer prompt shipping, frequent sales and a product inventory that expands monthly to make room for the latest and greatest quilting products on the market. Ship anywhere n the US for only $5. Padded flat rate envelope to Canada is $19.95.
Customer Testimonial"Great service and super quick shipping with the latest Moda fabrics I was looking for AND only $5 to ship. Will definitely shop again!"
~ Karen D., Richmond, VA


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Events » Adult Education Classes » Afternoon Salon
Afternoon Salon
Untitled, 1968
Robert Irwin
American, 1928-
Synthetic polymer paint on metal disc and arm
60 in. diameter (152.4 cm); white metal arm: 20 x 8-3/8 in. (50.8 x 21.3 cm)
Norton Simon Museum, Gift of Mr. and Mrs. Eugene M. Schwartz
© 2013 Robert Irwin / Artists Rights Society (ARS), New York
Modern American Art: So Cal Cool
Date: Sunday, June 09, 2013
Time: 2:00 pm - 3:00 pm
Educator: Staff Educator
Type: Afternoon Salon
Inspired by timeless and limitless elements of the Southern California environment—light, air and sea—artists such as John McCracken, Larry Bell and Robert Irwin broke boundaries by expressing their conceptual concerns with perception, reflection, light and illusion through new materials and techniques. Discuss how these and other So Cal artists expanded the definition of sculpture.
Meets in Entrance Gallery | The program is free with admission and limited to 20 participants. | Please sign up at the Information Desk no later than 15 minutes prior to each session.


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Police Chief Joe Treviño said city detectives had received complaints of a woman soliciting customers on an Internet website and one detective scheduled a meeting with the woman.
She was taken into custody on a charge of prostitution on Jan. 29 at 10:29 p.m.
She was staying in a unit of the Motel 6 at 400 S. U.S. Highway 181 at the time.
Prostitution is a Class B misdemeanor and the woman could be fined $2,000 and sentenced to 180 days in the Bee County Jail if convicted.
Municipal Judge Joe Salinas set the defendant's bond.
"It is unusual," Treviño said of the charge. He said prostitution arrests almost never are made in Bee County. But he assured residents that BPD will continue to make prostitution arrests if someone reports that activity.
"If we get any information that this is happening, we will investigate it," the chief said. "We're not going to tolerate it."
Treviño said those planning to engage in prostitution might want to go elsewhere.


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18995 W. 183rd Street
Hours of Operation:
This century old dairy farm home of two generations of the Ensor family presents a view of their home and the life they led. You will enjoy an hour plus tour of the 1890's memory packed two story house and even older peg barn full of special Ensor archives. Other buildings are areas can be seen.
Factual information about the lives and times of the members of the Ensor family will capture your attention and give you an insight into their lives. You will feel what it was like to be an early pioneer of Johnson County, Kansas and to build a farm from bare materials and hard work. You may feel the excitement of being a young Ensor child helping out on the Dairy Farm and growing to love the life, the animals, and the learning skills from your parents that last a lifetime.
The treasures of their lives are everywhere to be seen and appreciated. Whether you see the farm implements, and tools, or the handcrafts of the women, who had strong aptitudes in artistic accomplishments, or the early woodworking projects and radio wizardry of Marshall Ensor, you will long consider what their lives were like.
For more information visit Ensor Park & Museum


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Providing low-cost, high-quality dental services for the entire community.
Providing low-cost, high-quality dental services for the entire community.
LCCC dental hygiene students and our highly qualified dental professionals are looking forward to providing you with educational, preventive and therapeutic dental hygiene services at a nominal fee.
Because of the nature of a clinic in an educational setting such as ours, your treatment will progress at a slower pace than in a dental office. Patients can expect an appointment that is one to three hours long, and you may need to return for two to three appointments. Patients can be assured that the instructor/student interaction that requires more time during your appointment also means that your care meets the highest standards of quality.
At the LCCC Dental Hygiene Clinic, we are happy to make this service available to all the residents of our community. This program benefits not only our patients, but our LCCC dental hygiene students and future dental hygiene professionals.
Services performed at the LCCC Dental Hygiene Clinic are limited to preventive services, and are in no way intended to replace comprehensive dental care provided by your dentist.
Preventive services offered at the LCCC Dental Hygiene Clinic include:
Children under 16
Dental sealants
Duplicate or referral radiographs
$10 Payment is expected when services are rendered.
Appointments are required, and patients should expect to spend one to three hours per appointment. The clinic is open through the year, including summer. For current hours of operation or to make an appointment, call toll free, 800-995-5222, extension 4948, or direct-dial 440-366-4948.
If it is necessary to cancel an appointment, please call 24 hours in advance of the scheduled appointment.
The Dental Hygiene Clinic at Lorain County Community College is located on the first floor of the Health Sciences building (on the east side of campus, opposite from the Abbe Road side of the campus). Click here for driving directions and a campus map.
Free parking is provided. Permits for reserved parking for handicapped and elderly patients may be obtained in the dental reception area.
All patients at the LCCC Dental Hygiene Clinic have the right to and opportunity to:
Bloodborne Pathogens and Needlestick Prevention Standards (OSHA)
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Dear members,
Thank you, NarutoBase Staff
Originally Posted by kit
I think Kakashi and Rin may have been surrounded. I mean think about this way. We've been told they were surrounded by ninja of the mist. Also mist ninja are known to use mist techniques (like Zabuza) to sort of impair the vision of their foes.
Look at this for instance:
Obito thought he was initially seeing rain but then retracts that thought once seeing some of the battlefield. IMO the rain was probably some kind of mist tech.
If any of what I said above is true then I don't find it hard to believe Kakashi accidentally stabbed Rin during all of the commotion.
except its already been proven the sharingan can see through the mist, the only person who had such prowess in the mist jutsu that could effect the sharingan was zabuza so...
Originally Posted by Amelius
except its already been proven the sharingan can see through the mist, the only person who had such prowess in the mist jutsu that could effect the sharingan was zabuza so...
LOL You wouldn't happen to be talking about Naruto Shippuden episode 15 right? You do know the part where Kakashi used the mist tech on Itachi is filler right? Never happened in the manga so...
And just in case you don't believe me, here is a link to the episode (check 10:40-11:15 for the part you're talking about):
And here are the manga pages where the entire episode takes place:
chapter 259 pg 11 to chapter 260 pg 15
Here I'll even give you a head start:
Originally Posted by Amelius
he is more like void of emotion with the exception of the tear! Thats the only bit of emotion you see from him. there are only 3 types of catatonia and the kakashi wasnt diplaying any that we could see. you have stupor ( which is the closest to what your trying to prove, but you cant defend that with what was shown. the other 2 are Catatonic excitement which we didnt see any excitement from him and Malignant catatonia which we didnt see instability. So using reason, we can deduce that kakashi( or whoever) is not in shock, or even catatonic shock. Like I said, the attacker looks more emotionless with the exception of the tear. Therefore it was not an accident, the attack was intentional.
He's in a state of daze and related psychological stupor brought about by an acute stress reaction.
best thread so far,more convincing
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Would you like to receive free chapters from popular books in your daily email?
Click here to join the Jordan-Newby Branch book club. With your free book chapters, you will also receive a list of events at Jordan-Newby Branch Library.
- Date: 11/13/2013 10:30 AM - 11:30 AM
- Location: Jordan-Newby Branch Library
961 Park Avenue
Norfolk, Virginia 23504
Help your child get ready for kindergarten! KinderREAD is a fun, educational program that teaches a variety of concepts through hands-on activities and books. (Preschool, ages 3-5)Return to full list >>


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How Grey Goose is Capitalizing on Luxury Using Social
Image from: Grey Goose Hotel Noir / GreyGoose.com People love to advertise their experiences. Social media is more or less about the marketing of the self, and so the move of Grey Goose to host its interactive Hotel Noir campaign on social upstarts Pinterest and Instagram makes complete sense. Luxury is embedded in this brand's story, and they know it. Just watch the film paired with the campaign; it's that


text: Jeffrey L. Moy, (left) City Carrier at the Karnes City Post Office was recently presented with a 30 Year Service Award Pin. Rio Grande District Manager Kim Quayle awarded Mr. Moy for his continued dedication of providing service to the community. Mr. Moy demonstrates professional service in delivering the mail and is also very knowledgeable of various postal products. He was presented his award by Karnes City Postmaster Jimmy Loya (right).


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For the longest time, Zack was known as Isaac Theo Carver, the long-awaited and much-beloved son of Abe and Lexie Carver. For years the two had tried unsuccessfully to have a child of their own with no success, until Lexie's father, Stefano, got them in touch with Marlo...a young pregnant woman. Abe and Lexie adopted the baby that Marlo gave birth to...or so they thought. They didn't realize that Stefano had arranged to have Marlo's baby switched with Hope's baby when it was born.
Both Abe and Lexie were thrilled with their new son...he was everything that they had ever wanted. Even when the baby Hope had was found to have fetal alcohol syndrome and Isaac was normal, no one really thought anything of it. Lexie fell deeper and deeper in love with her newborn baby, and when she learned that Stefano had switched the babies at birth, it devastated her. Hope was her best friend, but Isaac was the child of her heart. In her desperation to keep the child she craved, there was no limit to what Lexie would do.
Everything came to a head when the boys were almost two years old. Paternity tests proved that J.T., the baby Hope and Bo were raising, was actually the son of Glen Reiber and Marlo, which meant that someone else was Hope's baby. Originally Bo and Hope wanted to keep both babies, but when they lost custody of J.T. to his biological father, they fought all that much harder for Isaac. Abe was prepared to give the Bradys their son, but Lexie fought against it. Isaac had been with them for nearly two years and thought of them as his parents; why disrupt his world now? Unfortunately, when Lexie attempted to flee with her son, Abe arranged for a judge to give custody to Bo and Hope, and Hope was finally reunited with her son (who at the time they thought was not Bo's).
When Bo and Hope reclaimed their child, they renamed him Beauregard Isaac Theo Brady. Rather than put the child through any more trauma (switching parents mid-stream was bad enough), they opted to refer to him by the nickname Zack. They held a christening for Zack with all their family and friends present, which was almost ruined when Lexie burst in, but what no one realized is that Lexie knew the baptismal water was poisoned, and was trying to save Zack's life. Lexie was dragged off to the hospital, and the christening went on without a hitch.
Since the christening, Zack has been living with his parents and brother (until Shawn moved out), and has adjusted well to his new life. He was briefly left in the care of his brother, Shawn, when his parents were presumed dead, but now they're home, alive and well, and all is right with Zack's world. Zack was thrilled to discover he had a half-sister named Chelsea, and he accepted her unconditionally. Unfortunately, tragedy struck when, on New Year's Eve, Chelsea was driving recklessly in Bo's car and accidentally hit Zack, who had gone out to check on a cat. Zack never recovered from his injuries and Bo and Hope chose to take him off life support later that night so that he could give his liver to his niece Claire.
Zack appeared several times to Bo and Hope in dreams or visions after his death.


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Fat relative: "You're still nursing?!"
Me: (with significant glance at fat relative's midsection) "Yes, it's cheaper than Weight Watchers!"
Fat relative: "You're still nursing?!"
Me: (with significant glance at fat relative's midsection) "Yes, it's cheaper than Weight Watchers!"
I only said this once to MIL, her eyes about popped out of her head.
Yes we're still nursing. Logan's favorite nursing position is standing up when I'm laying on the couch watching TV.
(hee hee he doesn't nurse like this......... too often)
And to my friends that I can get away with saying this.....
Yes we're still nursing. It feels as good as after you have sex.
I guess I'm lucky though. My whole family on both sides have several women who have breastfed toddlers. It's always enough people that at family gatherings I get more positive comments than negative. It's just MIL that shoots the zingers to me about it. Stupid $#%^&%^. (lol).
Mommy to
Logan 5-23-07
Colby 12-14-09
I'm Laura, mamma of 2
We love and
We have been nursing for over 2 years now!
I admit, I am not confident NIP with Noah all the time. I think it is because I know he is old enough to wait and can eat/drink other things.
Mommy to Maxwell 10-9-07 weaned with love (a party and a remote control monster truck) on his 4th birthday
My Boy 3-16-10
And my sweet pea Sam 2-12-11
Watch Your Language
"why do you ask?" or "why do you want to know?"
turns it back on them and sometimes makes them think.
Proud mom of 2 boys, both weaned gradually and with love.
Find a local LLL leader
For each and every one of us, the person from whom we can learn the most is our own baby: listen to him. - Mary White, LLL co-founder
The best-kept secret in child psychology is that children who were never spanked are among the best behaved."
Murray Straus, Ph.D.
lately ive just been saying " well yah why woudlnt I be?" dd is only 10 months.
Usually its "WHAT YOUR NOT FEEDING HER SOLIDS YET"
I havent come up with a good one yet to say back.. I dont plan on giving DD real solid MEALS untl she's ayear old.
Mama 2 Allie who Self-weaned @ 2 1/2
Korben Jon born 07/25/2011*
Wife to Ray (09/07/07)and Mama to:
Xander (01/19/07) nursed for 30 months
Liam (12/12/09) still nursing through the night and in the mornings!
Sebastian (7/29/12) my newest little nursling who graciously shares his milk with big brother!
I get this, and my lo is only 22 weeks! Ha ha, man are they going to get a big shock!
Proud mummy to Lillypig, in love with my best friend and partner, Batfink
One year done, and still going strong.


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First medical marijuana dispensary opens in New Jersey
MONTCLAIR, N.J. They skulked in and out like criminals, shoulders hunched, heads down, declining to comment.
It was the opening of New Jerseys first and so far only medical marijuana dispensary, in downtown Montclair, on Thursday, nearly three years after the law allowing such enterprises was passed. The opening had been delayed by political battles over whether it would lead to the de facto legalization of marijuana.
Patronizing the dispensary was perfectly legal, provided a doctors prescription for a list of specified medical conditions was presented, yet the pioneering visitors it was not clear if they were patients seemed none too eager to declare themselves, perhaps taken aback by the horde of news reporters there to greet them. One visitor, who would give only a first name, Ed, said he had been in pain since being shocked on the job for an electric company in 2003.
Not for them the whimsicality of the Magical Mystery Tour and other happy drug allusions of the 60s. The opening was all business, down to the pious name, the Greenleaf Compassion Center. Visits were by appointment only, and a uniformed security guard stood outside the front door at 395 Bloomfield Ave., checking identifications before letting anyone into the black glass storefront, which made it all but impossible to see inside.
The operators of the dispensary did step out for a cigarette break, strictly tobacco.
The chief executive, Joseph Stevens, 40, said he had been a funeral director in Nutley for 12 years, where he was inspired to go into his current business by seeing firsthand the suffering of families whose relatives had died of painful diseases.
Its a comforting experience, Stevens said, describing how patients had reacted to the dispensary. Theyve lived in the shadows for so many years. He said this was a place where they could get the therapy they needed yet feel safe, have no fear of prosecution, and go home.
His business partner, Julio Valentin Jr., 43, the chief operating officer, is a former Newark police officer who had run a Montclair establishment, the Cafe Eclectic, known for its funky ambience, up the street for 15 years.
Valentin said the town had been very welcoming, and stressed that the dispensary was not going to be your typical head shop or mom-and-pop shop. This is a professional program. He had designed the interior decor, which he described as beautiful, with earth tones, a soothing atmosphere, leather couches, like an upscale doctors office.
The partners said they had been friends for 32 years, and Stevens said they were growing the marijuana in a very clean, very secure warehouse. Asked if they had ever personally smoked their product, Stevens said, No, I dont. I just dont like it, but quickly added that if he were sick, that would be a different story.
Valentin gave a theatrical shrug and a sheepish smile.
They said they received several patients Thursday and dispense between a half ounce and two ounces of marijuana to each of them. Two inspectors from the state Health Department also paid a monitoring visit.
Montclair is known as a suburban version of Park Slope, Brooklyn, a town with an haute bohemian feel, home to many writers and journalists. But the dispensary is in a down-at-the-heels section of the commercial strip reserved for offbeat and pariah businesses: a string of ethnic restaurants; a cigar lounge; a head shop with an adults-only section in back; and right next door, an abortion clinic with a forbidding concrete facade.
Passers-by reacted mostly enthusiastically to the dispensary on its first day.
Looking on in fascination, Francis David Robinson, or FDR, as he likes to be called, a debonair 74-year-old who runs errands for tips, said, Could I get a freebie?
Told that his glaucoma was one of the conditions that could qualify, along with diseases like terminal cancer and muscular dystrophy, he said dismissively, I hate doctors.
One person unabashedly rejoiced in the arrival of the dispensary. Surrounded by colorful glass bongs, Candi Cooper, the manager of the combination head shop and adult shop, called the Montclair Video Boutique, with peace signs in every O in its name on the sign out front, said she looked forward to a fruitful relationship.
Its kind of like a hospital, she said, of the dispensary. You get morphine and Dilaudid at the hospital. Does that make the place that sells medical equipment to put the morphine in a bad thing? No.MORE IN Wire NewsMADISON, Wis. Full StoryKABUL, Afghanistan Afghanistan has fallen so far from Americans consciousness that some may... Full StoryCHARLESTON, S.C. Full Story
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My daughter Ava turned 1 year old on 1/26 and is still a consummate nurser, refusing most solids most of the time. She has a good pediatrician who is not putting pressure on me, but who is concerned nevertheless, because Ava is such a featherweight. She weighed in at only 15 lb. 4 oz. when she had her 1-year check-up. Her other values are good (29" long and 44 cm head circumference). She is also reaching her milestones - she is walking and seriously trying to produce her first words. She is also perpetually in motion, taking everything apart she can get her little fingers on.
Her pediatrician still thinks that Ava needs to gain some weight - she actually suggested that I should put her on a diet of chocolate and ice cream and soak the cheerios, one of the few foods she nibbles on, in butter. I am not having any success with this diet. Ava is also refusing Pediasure and to try to get her to take a vitamin supplement would be a two-person endeavor - not counting Ava!
So, I continue nursing her as much as she wants. Starving her to motivate her to eat won't work, I am convinced of that. I returned to work 3x per week when she was 5 months old and Ava stays home with her dad and refuses to eat for him. She now drinks a little bit of soymilk when I am gone, but refuses everything else, including formula and whole milk. (BTW, she refused to drink anything from bottles scince she was 2 1/2 months old.)
I am wondering how worried I should be. My gut tells me that she's okay, but it would be nice on many levels if she would start eating. But mostly, I want to make sure that she gets adequate nutrition. I guess this is the essential question that the pediatrician is concerned about. Is it possible that a mother's breast milk is not adequate? I am very skinny (5'5", about 105 lb.) - can my weight affect the quality of my breast milk? My diet is good, I eat like a horse with lots of rich and nutricious foods to make sure there are all the ingredients to make rich and nutricious breast milk.
My mother actually faced a similar issue when I was a baby: she was told to stop nursing and feed me formula since obviously her breastmilk was no good, because I was not gaining enough weight. It did not work.
I have another question: Does anyone know if is there any correlation between when a baby's teeth come in and when they get into solids? Ava didn't get her first teeth until she was 11 months old ...
Any thoughts and advice on what I should/could do are much appreciated!
Thank you,


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State of euphoria
Tri-Valley eighth grader Autumn Bender (19:19.25) placed third and will return to the state meet. Bender was 52nd at states last year. She will be joined by senior Oliva Rehm who finished 10th, and sophomores Brooke Gillette, Sabrena Smith and Danielle Graham who finished 14th, 15th and 17th. Freshman Alex Brooks and sophomore Devon Jones will also compete by dint of the team victory, its first since 2007 and its 19th overall. Missing out from Sullivan West was junior Dani Myers (19:45.22) who finished just one place out in 7th. Myers won a medal at states last year for her 20th-place finish where she was joined by freshman Kelsey Dutton, who finished ninth at this year's sectionals in 19:55.63. Eighth grader Courtney Meyerer (19:53.79) was eighth.
Other state qualifiers include Monticello eighth-grade twins Camryn and Sidney Johnson, who took third and eighth in the Class B Sectional with times of 19:14.14 and 19:53.59 respectively. Tri-Valley's Omar Lopez returns to states with his seventh-place finish of 16:51.62. Lopez fell, which cost him several places. Making it to states for the first time is Sullivan West junior Reed Scott (16:56.50). They will join Bernstein in the Class C state race. Eldred senior Hunter Proscia (16:54.97) took second in the Class D sectional and returns to states with Campanella. Proscia was 42nd at states a year ago. Eldred eighth grader Sarah Malzahn (21.59.62) will join Donnelly in the Class D state race as the youngster parlays her eighth-place finish at sectionals into a chance to run at states. Last but not least is Livingston Manor/Roscoe senior Neil Mock (18:02.10), who took ninth in the Class D run in LMR's first cross-country season.
In other final news of fall, Liberty's boys soccer team lost 3-0 to James I. O'Neill in a Class B quarterfinal, while the Lady Indians lost a 2-1 heartbreaker to O'Neill. Sullivan West's volleyball team put up a great fight but fell 3-0 to O'Neill in a quarterfinal match.


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Yield: 9 burgers, 6 oz. each. 1 Chicken of the Sea® Premium White Tuna Pouch Pack (43 oz.) 1 cup green peppers, diced 1 cup red peppers, diced 1 cup green onions, diced 1/4 cup capers 1/4 cup Cajun spice 2 Tbsp. olive oil 2 cups bread crumbs, plain 1 Tbsp. Tabasco® brand Pepper Sauce Heat oil in sautè pan. Add green and red peppers. SautÈ for 2 minutes. Add green onions and sautè for 1 minute. Add capers and spice. Mix tuna and bread crumbs in bowl. Add ingredients from sautÈ pan. Mix ...
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August 21, 2012
ISBE DELL e-Broadcast 2012.232 – FY13 Statewide Bilingual Program Directors' Meeting Memo
TO: Bilingual Program Directors
FROM: Reyna P. Hernandez, Assistant Superintendent, Center for Language and Early Child Development
DATE: August 21, 2012
RE: FY13 Annual State Bilingual Directors' Meeting
On Monday, September 10, 2012 and Tuesday, September 11, 2012, the Division of English Language Learning (DELL) will hold a two-day meeting required for all program directors of TBE/TPI and Title Ill (LIPLEPS/IEP) programs. The purpose of this mandatory annual meeting is to provide useful administrative information for implementation of your programs, professional development opportunities, and peer-networking. This year, the meeting will include information on the new Alternative ACCESS for ELLs assessment, new policy updates related to part-time programs and RTI, as well as professional development sessions on program design and implementing the Common Core in ELL classrooms. DELL will provide each director with new and updated materials and resources.
Please download the registration form at http://www.thecenterweb.org and return it to the Illinois Resource Center no later than September 4, 2012. Pre-registered guests will receive a confirmation postcard from the Illinois Resource Center.
This year's meeting will be held at the Lisle/Naperville Hilton, 3003 Corporate West Drive, Lisle, IL, 60532. A block of rooms has been reserved for Sunday and Monday nights, September 9-10, 2012. You must call the hotel directly to reserve your room at (630) 505-0900 and refer to group code "CISB". The deadline to make hotel reservations is Monday, August 27, 2012. The single room rate is $80 (state rate) and $100 for a double. Room rates are also subject to a 11% tax.
As a reminder, please contact DELL at (312) 814-3850 for technical assistance related to any programmatic issues or if you need assistance with revising/amending your FY13 LIPLEPS or TBE/TPI program budget.
I wish you and your programs great success this year and look forward to seeing you in September.
Welcome back!


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D&E sets Open House events through fall semester
Davis & Elkins College has set dates for five Admission Open House sessions throughout the fall semester.
The visits give prospective students and their families an opportunity to tour the 170-acre campus, meet professors and Student Life representatives, and enjoy a meal from the College's dining services.
The sessions, coordinated by D&E Assistant Director of Admission Joey VanDevender, will take place on Saturdays, Sept. 28, Oct.12 and 19, and Nov. 2 and 11.
"Visiting a college is the best way to determine if the college is a good fit, and helps prospective students decide if they feel comfortable, not only on the campus but also interacting with the student body," VanDevender says.
Each session begins at 9:30 a.m. and includes a meet and greet with faculty and financial planning representatives, a welcome in the historic Halliehurst Mansion, and lunch.
To register online, visit www.dewv.edu. For further information, call VanDevender at 304-637-1230 or email firstname.lastname@example.com.


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With the recent discovery of a new boson, which is likely to be the elusive Higgs boson, the standard model for particle physics would not be complete. Keep in mind that this only confirms the model that has been used for a long time now. This explains the early moments after the big bang where there was the electroweak force which separated and became the electromagnetic and weak nuclear forces (there's also the strong nuclear force). This doesn't unify the theory of gravity. Physicists must still develop a theory of quantum gravity.
July 11th, 2012
The Standard Model of Particle Physics Written Out
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Certificate III in Business Administration
Work Skills
Certificate III
|Mid Year Intake?
|Study Mode
|Entry Requirements
|Flexible Delivery, Part-time Block or Day Release
No minimum education
Course Description
This qualification is part of the Business Services Training Package. It aims to develop communication and record keeping skills at a higher level for those seeking employment in a wide range of business and administrative positions.
Subjects you can Study
Core: Develop keyboarding speed and accuracy; Contribute to health and safety of self and others. Electives: Process payroll; Process accounts payable and receivable; Maintain a general ledger; Create electronic presentations; Design and produce business documents; Write simple documents; Handle receipt and despatch of information; Comply with organisational requirements for protection and use of intellectual property; Conduct online transactions; Utilise a knowledge management system; Recommend products and services; plus more.
About Work SkillsEstablished in 1993, Work Skills is a Registered Training Organisation based in Queensland. The provider offers training and assessment in Vocational Education and Training areas such as automotive, business, hospitality, media, and training and assessment. throughout the whole of Australia. RTO code: 31384
Certificate IIICourse code: BSB30415
- Flexible Delivery
- Part-time Block or Day Release
13 units: 2 core; 11 elective
Entry Requirements
No minimum education
Study Pathways
Certificate IV in Business Administration
Life after Study
Related Careers
Administrative Assistant
Administrative assistants perform a range of administrative tasks in an organisation.
Office Administrator
Office administrators undertake a range of functions to make sure the administration activities within an organisation run smoothly. They may be responsible for the management of human resources, budgets, accommodation and property facilities and records. These functions can be performed at various levels ranging from junior through to upper management.
Receptionists act as the first point of contact in an organisation, greeting people and attending to enquiries made by phone or in person.
Word Processing Operator
Word processing operators type, edit and print documents, using computers with word processing software programmes and printers.


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Survivors include his wife, Vicki Gilley of Refugio; two daughters, Connie Linney of Woodsboro and Deanna (Jason) Sifuentes of Portland; a son, Keith (Michelle) Jackson of Cuero; a sister, Elsie Hageman of Marble Falls; eight grandchildren; and two nieces.
Visitation was held from 1-8 p.m. Sunday, Aug. 4, at Moore Funeral Home Chapel.
The funeral service was conducted there at 10 a.m. Monday, Aug. 5. A graveside service was held at 10 a.m. Wednesday, Aug. 7, in Fall Creek Cemetery.
Pallbearers were Jason Sifuentes, Cody Linney, Wayne Gilley, Mark Gilley and Tom Kelley.
Honorary pallbearer was Keith Jackson.


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The real news out of Toronto for the APICS community isn't about that town's embattled mayor, it's that supply chain professionals are in high demand. According to Toronto's Globe and Mail, the region's logistics and supply chain education programs are experiencing growth and touting jobs available to trained professionals.
"On the first day, [Gunja Bhatt's] accounting teacher said to students in Seneca College's postgraduate certificate program in logistics and supply chain management that they needn't fret. The jobs will be there."
(A team from Seneca College, no stranger to APICS, took home third-place honors in the 2013 International Student Team Competition at APICS 2013.)
While Bhatt went into the program after graduating with a neuroscience and biodiversity degree, it's not just young professionals seeking supply chain education. More experienced workers are looking for career security and advancement as well. For many, supply chain education brings career promise.
Supply chain as a profession expanded as computer systems evolved, says John Bottomly, the coordinator of Seneca College's program. "Once we got integrated computer systems, coordination could become easier across countries, across time zones, and therefore companies could become global."
Still, it's not just about computer and other technical skills. Employers want supply chain professionals who are skilled communicators as well. The Globe and Mail reports a wide variety of employers—from retailers and distribution centers to logistics and trucking companies—seeking supply chain practitioners via career fairs.
Meeting your career potential
This drive for education isn't limited to Canada. Here in the United States, The Manufacturing Institute launched the National Association of Manufacturers-Endorsed Skills Certification System to address the skills gap challenge and to promote a renaissance of manufacturing education across the country.
APICS is proud to be part of the system, which consists of stackable credentials that apply to all sectors of manufacturing. They are nationally portable, industry-recognized credentials that validate the skills and competencies needed to be productive and successful in manufacturing environments.
According to The Manufacturing Institute, "when used in conjunction with other criteria, such as references, interviews, and assessment of prior work experience, industry certifications validate an applicant's readiness for work in advanced manufacturing."
Find out how APICS certifications can help you meet your career potential. Visit apics.org/certification today.
Type the code from the image


text: Halter top dresses come in many styles and variations from the subtle high neck halter top cocktail dress to the sexy low cut halter prom gown with plunging neckline. This selection of halter top dresses range from the most elegant formal halter evening gowns for prom or pageant, to sexy halter mini dresses for those wild nights out in the clubs. Always consider your size and comfort when choosing a halter dress. A plus size full figure girl may want to go with wide straps and a long skirt with a sexy slit to draw attention to her upper body. A slender frame girl can add shape with a short full skirt or tiered ruffles. Choose from short halter party dresses for holidays and homecoming, elegant bridesmaid halter dresses or glamorous halter evening gowns like you see on the red carpet for prom. Whatever you need PromGirl is here to help you find the perfect dress to fit your style.


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Graduation Day at SUNY Canton
Nearly 1,000 students were recognized by SUNY Canton Saturday in the college's 105th annual commencement ceremony.
According to a press release put out by the college, approximately 964 new graduates gathered in the Convocation, Athletic and Recreation Center, known as the "Roos House".
Zachary Smith was just one of those new graduates. "It has been a journey," said Smith. "I never knew the end result. I didn't know what was going to be the end result, but I just took advantage of every opportunity that was directly in front of me."
Smith used four and a half year at SUNY Canton to earn three degrees and travel to Africa to oversee the construction of a school.
Megan Mydosh also walked across the stage today, formally receiving her diploma. For her, it was the end of an uncertain journey.
"I wasn't even sure if I was even going to go to college. Then, I just kind of believe everything happens for a reason," she said. SUNY Canton president Carli Schiffner gave her final commencement speech to graduates. She will step down May 31, and Joseph Hoffman will assume her position as president of the college.
Click below to see the college's press release on commencement:
Click on the picture above to watch 7news reporter Matt McClusky's story.
Saturday, December 10, 2016, Watertown, NY


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Monday - Friday 10:00 am - 7:00 pm
Saturday 10:00 am - 6:00 pm
Sunday 11:00 am - 4:00 pm
*Unless noted on Store Profile page
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Watts Pick to Hit Pop Up Content
Diamonds in the Rough
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Price promotion(s) are valid on Internet and Phone orders only. Due to manufacturer restrictions, offers exclude select new release and other select products.
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Hope springs eternal
March 19, 2014 —
It's no secret that I've had a bad attitude over the weather for the past few months. I've moaned, complained and whined incessantly about the cold, the snow and ice. Like many of you, I had come to the conclusion that it just wouldn't end and that spring would never arrive at all. According to the calendar, as of today, spring is officially in the air. Hmm. Oh sure, there are signs of life. Yesterday, from my sick bed, I saw my first robin and quietly rejoiced. Glimpsing the proverbial red breast, I hauled myself up and grabbed the camera, determined to capture the moment to review later and ensure that it wasn't a mirage brought on by high-temperature hallucinations. I'm on day nine of the flu and not a happy camper. Again, many of you have also succumbed to what has been described as a season fraught with "dramatic cases of the H1N1 [Swine Flu] across the nation" (www.weather.com). I don't know anything about drama and personally never exaggerate, so I'll just stick to the facts. This has been the worst cold anyone on earth has ever been forced to endure, and it's a miracle that I've survived at all. Most likely, I am the only man on the planet to suffer this much, and undoubtedly deserve a medal of sorts for getting up each morning, walking the dog and putting one foot in front of the other, defying the odds and (IMHO) inspiring others with my super-human will to live.