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October 21, 2009
Good Morning Mr. Chairman and Members of the Committee:
Thank you for inviting me here today to present views on several bills that would affect Department of Veterans Affairs (VA) benefits and services. Joining me today are Mr. Brad Mayes, Director of the Compensation and Pension Service, Mr. Richard Hipolit, Assistant General Counsel, and Mr. Walter Hall, Assistant General Counsel. Unfortunately, we do not have views and estimates on several bills including S. 1109, S. 1467, S. 1556, S. 1753, and a draft bill regarding exposure to chemical hazards referred to in the list of bills provided in the Committee's witness letter of October 8. We will forward those as soon as they are available. We appreciate the opportunity to address these bills that would affect the Department's health care and benefits programs.
S. 977 "Prisoner of War Benefits Act of 2009"
S. 977 would eliminate two current requirements for presuming service connection of certain diseases in a former prisoner of war (POW): (1) the requirement that a Veteran be detained or interned as a POW for at least 30 days; and (2) the requirement that VA determine that a former POW has post-traumatic stress disorder (PTSD) for service connection of osteoporosis to be presumed. It would also add type II diabetes to the list of presumptive diseases. The bill would authorize the Secretary to add through rulemaking to the list of diseases that may be presumed service connected in a former POW, by reason of having a positive association with the experience of being a POW, and would establish procedures, including taking into account the recommendations of the Advisory Committee on Former Prisoners of War, on how those diseases should be added. Finally, if a disease is removed from the presumptive list and a Veteran was awarded compensation for that disease or a Veteran's survivor was awarded dependency and indemnity compensation for the Veteran's death resulting from that disease before the removal effective date, the bill would protect entitlement to benefits for that disease.
VA does not support this bill. The presumption for some conditions currently requires a minimum internment period for good reason. Some presumptive conditions, such as avitaminosis, malnutrition, and other nutritional deficiencies, require a minimum period of deprivation to develop. The 30-day minimum internment period reflects the need for a period during which a person would be deprived of a proper diet. As a result, VA relied upon the 30-day timeframe established by Congress when it added osteoporosis to the regulatory list of presumptive diseases. VA already recognized that the presumption of service connection for osteoporosis for former POWs should not be limited to former POWs who have PTSD. Based on studies suggesting a link between osteoporosis and internment or detention as a POW for a period sufficient to result in nutritional deficiency, we amended our regulations to provide a presumption of service connection for osteoporosis independent of any determination regarding PTSD. VA cannot support the addition of type II diabetes to the list of presumptive diseases because we are not aware of scientific evidence demonstrating that such a presumption is warranted.
VA agrees that it should amend applicable regulations when sound medical and scientific evidence shows a positive association between the experience of being a former POW and the occurrence of a disease. VA already relies upon recommendations from its advisory committees, such as the Advisory Committee on Former Prisoners of War, to carefully study and recommend appropriate regulatory amendments, including additional POW presumptive conditions and has added by regulation new presumptions recommended by the Advisory Committee on Former Prisoners of War. However, because VA already has in 38 U.S.C. 501 sufficient statutory authority to prescribe necessary or appropriate regulations, additional statutory authority to authorize such rulemaking is unnecessary. Moreover, because VA already consults the Advisory Committee, requiring it to do so is unnecessary. VA intends to continue to review for possible regulatory amendment any recommendations from the Advisory Committee, as well as from other sources. Congress created the Advisory Committee to assess the needs of POWs with respect to compensation, health care, and rehabilitation. We welcome the opportunity to meet with the Advisory Committee at any time.
However, VA opposes mandatory timeframes within which to promulgate regulations in response to an Advisory Committee recommendation and any requirement to publish a notice of a decision that a presumption is not warranted for a disease. Under 38 U.S.C. 541, every two years the Advisory Committee is to submit a report to the Secretary on the programs and activities of VA that pertain to former POWs. Within 60 days of receipt of this report, VA is required to submit a copy to Congress along with appropriate comments. The Advisory Committee may submit any other reports or recommendations that it considers appropriate. These statutory provisions are clear that the Advisory Committee is to assist VA in making reports and recommendations regarding the needs of former POWs. The Advisory Committee is not and should not be a substitute for VA's regulatory efforts.
VA is unable to provide costs on this bill at this time because sufficient data are not yet available. With the Chairman's permission, we will provide a cost estimate in writing for inclusion in the record.
S. 1118 "Increase in the Amount of Monthly Dependency and Indemnity Compensation to Surviving Spouses"
Section 1 of S. 1118 would increase the monthly amount of dependency and indemnity compensation (DIC) payable to a Veteran's surviving spouse. Instead of the current base amount, VA would pay 55 percent of the rate of monthly compensation in effect under 38 U.S.C. 1114(j), the rate of disability compensation for disability rated totally disabling. In the case of an individual who is eligible for DIC under section 1311 and for benefits under another provision of law by reason of the individual's status as a Veteran's surviving spouse, section 1 would also prohibit the reduction or offset in benefits under the other provision of law by reason of eligibility for DIC under section 1311. These changes would apply to DIC paid under 38 U.S.C. ch. 13 for months beginning after 180 days after the date of enactment.[1]
VA does not support section 1 of this bill because the current rates of DIC are appropriate. In October 2007, the Veterans' Disability Benefits Commission assessed the appropriateness of the level of DIC payments and found the current level of DIC paid to a surviving spouse is comparable to, or higher than, the earnings of a widow or widower in the general population. In addition, 89 percent of surviving spouses responding to a survey were satisfied with their DIC payments.[2] A May 2001 VA Program Evaluation of Benefits for Survivors indicated findings similar to those of the Veterans' Disability Benefits Commission–that DIC is a competitive survivor benefit compared to employer-provided benefits for survivors of non-Veterans. The report pointed out that DIC provides a benefit that is approximately twice as large as benefits for survivors of private sector employees, state employees, and Federal employees covered by the Civil Service Retirement System, and that VA provides a significantly broader array of non-income benefits for survivors of disabled Veterans.
DIC payments, unlike most other Federal benefits, are tax-free. Surviving spouses who are entitled to DIC are entitled to other non-income Federal benefits, such as care under the Civilian Health and Medical Program, Dependents' Educational Assistance, burial expense reimbursement, and Servicemembers' or Veterans' Group Life Insurance. These additional benefits significantly increase the value of a surviving spouse's "benefit package" and help a surviving spouse to adjust during the critical transition period after a Veteran's death.
The language of the provision that would eliminate the offset between DIC and other benefits for a Veteran's surviving spouse is broad enough to include annuities under the Survivor Benefit Plan (SBP) and other Federal benefits, such as payments under the Radiation Exposure Compensation Act of 1990, the Federal Tort Claims Act, and the Federal Employees Compensation Act based on "death due to service in the Armed Forces." Current law generally prohibits payment of any other Federal benefit to a surviving spouse who is receiving DIC payments.
If the scope of the offset elimination is intended only for DIC and SBP payments, then VA defers to the Department of Defense (DoD) because DoD would incur the costs associated with enactment of the bill. VA pays the full amount of DIC regardless of whether a surviving spouse is entitled to SBP benefits. A provision of title 10, United States Code, which governs DoD programs, requires that SBP payments be offset.
If the offset elimination is intended to cover Federal benefits in general, not only SBP, there would again be no financial implications for VA. However, this provision could result in some circumstances in duplication of benefits for the same condition or event.
If, for example, a surviving spouse receives DIC based on the Veteran's death, which was attributed to his service-connected bladder cancer due to radiation exposure, then the surviving spouse would also receive a lump sum payment for the same disability from the Department of Justice under the Radiation Exposure Compensation Act of 1990. In this hypothetical instance and others like it, the surviving spouse would receive duplicate payments for the same disability.
VA estimates the costs associated with section 1 of this bill would be $1.1 billion in the first year following enactment and $14.3 billion over ten years.
Current law authorizes the payment of DIC to the surviving spouse and children of a deceased Veteran who was entitled to receive compensation at the time death for a service-connected disability that was rated totally disabling for a minimum period of 10 years immediately preceding death. Section 2 of S. 1118 would reduce the amount of time required from 10 years to 5 years and would provide graduated rates of DIC depending on how long the disability was rated totally disabling. For example, if the disability was continuously rated totally disabling for at least five years but less than six years, DIC would be paid at the rate of 50 percent of the DIC otherwise payable. If the disability was continuously rated totally disabling for at least six years but less than seven years, DIC would be paid at the rate of 60 percent of the DIC otherwise payable.
VA needs additional time to evaluate section 2. We will forward views on this provision as soon as they are available.
Section 3 of S. 1118 would lower from 57 to 55 the age at which a surviving spouse can remarry and retain eligibility for several VA benefits, including DIC paid under section 1311, educational assistance paid under 38 U.S.C. ch. 35, and housing loans made under 38 U.S.C. ch. 37. The change would be effective on the later of the first day of the first month that begins after the date of enactment and the first day of the fiscal year that begins in the calendar year of enactment. Section 3 would prohibit the payment of any benefit for any period before the effective date. An individual who, but for having remarried, would be eligible for a VA benefit by reason of these amendments but who remarried before enactment and after attaining age 55, would be eligible for benefits under the amendment made by section 3, but only if the individual applies to VA not later than one year after enactment.
VA does not oppose enactment of this provision provided Congress finds savings to offset increased costs from its enactment. By lowering the age, this bill would make title 38 provisions similar to those already existing in title 10. Changing similar provisions in title 38 is not only equitable but would also simplify the administration of benefits under both titles.
VA is unable to provide a cost estimate for this provision at this time because sufficient data are not available. With the Chairman's permission, we will provide VA's estimate in writing at a later date.
S. 1155 "Establishing Position of Director of Physician Assistant Services"
S. 1155 would eliminate the Physician Assistant (PA) Advisor position established by Public Law 106-419, the Veterans Benefits and Health Care Improvement Act of 2000, and establish a Director of Physician Assistant (PA) Services within the Office of the Under Secretary for Health. VA does not support this bill.
The functions of the proposed Director of PA Services are already being performed by the PA Advisor. Moreover, the PA Advisor position was converted to full-time on April 14, 2008, and it will be based in VA Central Office at the expiration of the current incumbent's term in April 2010.
In addition, VA does not support the proposed organizational realignment of the Director of PA Services to the Office of the Under Secretary for Health. The position's current alignment within the Office of Patient Care Services is consistent with most other clinical program leadership positions and provides the PA Advisor access to the Under Secretary for Health for any issues that cannot be resolved within the current structure. The cost of implementing this bill is insignificant.
S. 1204 "Chiropractic Care Available to All Veterans Act of 2009"
S. 1204 would require VA to increase to not fewer than 75 the number of VA facilities directly providing chiropractic care through VA medical centers and clinics by December 31, 2009. In addition, S. 1204 would require that chiropractic care be provided at all VA medical centers by December 31, 2011.
VA opposes S. 1204. While musculoskeletal conditions are common in VA patients, and are increasingly prevalent among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, there is currently a facility with an in-house chiropractic care program in each of our geographic service areas. Specifically, VA has 28.5 chiropractors providing on-station care and services at 36 facilities. VA does not oppose eventually increasing the number of VA sites providing chiropractic care; however, the projected demand for chiropractic care is insufficient to justify mandating it at all VA medical centers by the end of 2011. Moreover, the requirement to increase the number of facilities in which VA provides chiropractic care from 36 facilities to 75 facilities by the end of the calendar year is unrealistic and unnecessary. Currently, 98 percent of VA patients are able to receive chiropractic care within thirty days of their desired date.
VA estimates that S. 1204 would cost $5.3 million in fiscal year (FY) 2010, $5.5 million in FY 2011, $29.8 million over 5 years, and $63.6 million over 10 years.
S. 1237 "Homeless Women Veterans and Homeless Veterans with Children Act of 2009"
S. 1237 would expand those eligible to receive grants under 38 U.S.C. 2061 beyond grant and per diem providers to include those entities eligible to receive grant and per diem payments. It would also provide that both male and female homeless Veterans who are responsible for the care of minor dependents may qualify as Veterans with special needs. In addition, S. 1237 would authorize the use of funds for the provision of direct services to the dependents of homeless Veterans. Section 3 of S. 1237 would require the Secretary of Labor to award grants to eligible programs and facilities to provide services to reintegrate homeless women Veterans and homeless Veterans with children into the workforce. Grant recipients would provide job training, counseling, job placement services and child care. The law would be implemented by the Assistant Secretary for Veterans' Employment and Training, who would report through the Secretary of Labor on this program biennially. An additional $10 million, in excess of other appropriated funds, would be made available for fiscal years 2010 and 2014.
VA supports section 2 as it would allow any eligible entity providing services to special needs populations to apply for special needs grants by eliminating the requirement that recipients also be a grant and per diem recipient. VA also supports making the provision recognizing homeless Veterans with dependent children as a special needs population gender neutral because it would allow VA to directly provide equal services to all homeless Veterans with dependents.
VA estimates the cost of this section would be $8.9 million in FY 2010, $15.1 million in FY 2011, $91 million over 5 years, and $239.6 million over 10 years.
The Secretary of Labor is responsible for awarding grants under Section 3 of the bill. VA defers to the Department of Labor concerning this portion of the legislation.
S. 1302 "Veterans Health Care Improvement Act of 2009"
S. 1302 would require VA to submit to Congress within one year a plan to introduce pay-for-performance measures into community-based outpatient clinic (CBOC) contracts. This plan would require VA to include measures to ensure contracts utilize pay-for-performance mechanisms including incentives for providing high-quality health care, patient satisfaction, and data collection on the outcomes of services provided by CBOCs. The plan would also require VA to impose penalties for substandard care, and to eliminate abuses by CBOCs that use capitated-basis compensation. Moreover, VA's plan would need to include mechanisms to ensure Veterans are not denied care and do not face undue delays. VA would be required to implement this plan within 60 days of submitting it to Congress, though in implementing the plan the Secretary may initially carry out of one or more pilot programs to assess its feasibility and advisability. VA would be required to report to Congress every 6 months providing recommendations on the feasibility and advisability of utilizing pay-for-performance compensation in providing health care services through means other than CBOCs.
VA does not support S. 1302. VA is devoting significant effort into quality control and effective incentives in its CBOC contracting now, and that is a complex multi-faceted endeavor. There is a great deal of emerging research in the medical field on pay-for-performance, and it is clear that programs must be carefully thought out to avoid unintended consequences. Prescribing a fixed set of tools would impair VA flexibility. Additionally the legislation would not provide any additional statutory authority to establish a CBOC performance-based patient quality care incentive contract than what is currently provided in the Federal Acquisition Regulations.
VA estimates there would be no additional costs associated with this legislation as it only requires VA to develop a different type of contract during the normal acquisition process.
S. 1394 "Veterans Entitlement to Services (VETS) Act of 2009"
S. 1394, the "Veterans Entitlement to Service Act of 2009," would require the Secretary to acknowledge the receipt of any claim for medical services, disability compensation, or pension or other communication relating to those services or benefits within 30 days of receipt. The acknowledgment would have to specify the date of receipt and would be permitted to be communicated "via written or electronic means" including email.
VA does not support S. 1394. By requiring additional paperwork and administrative workload that would not materially advance the merits of a claim, the bill would be detrimental to VA's efforts to streamline and expedite claims processing. Moreover, the benefits of such a requirement are unclear; VA already contacts individuals who submit claims generally within 30 days. Individuals who submit claims electronically receive immediate acknowledgement. VA continues to communicate with claimants throughout the claims process.
In addition, the term, "or other communication" is too broad and could be interpreted to require VA to formally respond to an indefinite number of telephonic, written, or electronic contacts by Veterans to VA call centers, health care facilities, Regional Offices, Vet Centers and other locations. It is VA policy to respond as quickly as possible to any Veteran's request or inquiry but the legislation is too prescriptive in this regard. VA receives roughly 21 million telephone calls each year at the main Veterans Benefits Administration (VBA) call center; the Veterans Health Administration's (VHA) Pharmacy Customer Call Center is expected to receive in excess of 8 million calls per year, and VA estimates VHA, VISN, and medical center call centers receive in excess of 20 million calls per year.
Enactment of S. 1394 would not result in any mandatory costs. VA cannot estimate the cost for the proposed legislation as there is no central accounting system for the number of contacts made by Veterans to VA.
S. 1427 "Department of Veterans Affairs Hospital Quality Report Card Act of 2009"
S. 1427 would add section 1706A to title 38 and require VA, within 18 months of enactment, to establish and implement a Hospital Quality Report Card Initiative. This initiative would require the Secretary to publish a report at least twice a year on Department medical centers containing information on effectiveness, safety, timeliness, efficiency, patient-centeredness, patient satisfaction, health professional satisfaction, and equity of care for various populations (female, geriatric, disabled, rural, homeless, mentally ill, racial and ethnic minorities). VA would be required to grade facilities in these areas on a scale from A+ to F. VA would also be required to provide information, to the maximum extent practicable, on: staffing levels of nurses and other health professionals; rates of nosocomial infections; volumes of different procedures performed; hospital sanctions and violations; quality of care to various populations; availability of emergency rooms, intensive care units (ICUs), maternity and specialty services; quality of care in inpatient, outpatient, emergency, maternity and ICU; ongoing patient safety initiatives; use of health information technology; and other matters. S. 1427 would allow the Secretary to provide information in addition to or in lieu of the specific requirements identified in the bill by informing the Senate and House Committees on Veterans' Affairs at least 15 days before the report is to be published. S. 1427 would also allow Secretary to adjust quality measures based upon risk, but it would require VA to establish procedures for making unadjusted data available to the public in a manner deemed appropriate by VA and to disclose its analysis methodology. These reports would need to be written for non-medical professionals and available electronically and in hard copy upon request at each medical center. The legislation is intended to ensure information VA provides is of a type and in a form that is conducive to comparisons with other local or regional hospitals. At least once a year, VA would be required to annually compare quality measures across years to identify and report any false or artificial improvements in quality measurements. In addition, VA would be required to develop and implement effective safeguards to protect against unauthorized use or disclosure of medical center data and to ensure that no identifiable patient data is released to the public.
VA does not oppose increasing transparency of quality measures for its facilities and agrees with the general premise of this legislation; however, the agency does not support S. 1427 as written because some of the requirements may not be possible or would require VA to develop its own data categories that could not be compared or benchmarked to other leading health care organizations.
VA has identified health care transparency as one of its major Strategic Transformation Initiatives this fiscal year and is working with the Centers for Medicare & Medicaid Services (CMS) to post VA comparable data on their "Hospital Compare" Web site (www.hospitalcompare.hhs.gov). CMS requires three data streams, each of which has different reporting periods based on assuring data validity. They post process data quarterly but outcome and patient satisfaction data annually. VA consequently believes that it is impractical to report data twice a year as the data may be invalid. VA is similarly exploring other public reporting programs, such as the Medicare Prescription Drug Plan Finder, Medicare Options Compare, CMS' Nursing Home Compare, Commonwealth Fund's WhyNotTheBest, and others.
Additionally, VA is developing composite metrics meaningful to both consumers and stakeholders. While seemingly simple, an incremental letter grade scale may not be the best way to communicate the quality of a particular hospital to consumers. For example, CMS uses a five star rating system for Nursing Home Compare. VA will be conducting focus groups with Veterans to determine how they would like to be provided quality information about medical facilities. VA has proposed an initiative to develop an internal VA Hospital Report Card prototype for internal measurements and comparison at all organizational levels. The data elements are similar but not exactly the same as the elements identified in this legislation. VA proposes to include: structure and volume; workforce productivity; population and disease burden; care delivery utilization; quality, efficiency and outcomes; and trends and benchmarks. This approach offers VA the flexibility to provide meaningful measures that may be benchmarked with other hospitals and develop new measures through consensus-based processes involving all stakeholders. Measures should focus on areas with the greatest potential for making care safe, effective, timely, efficient or equitable, and patient-centered. Primarily, these data will be used to identify areas where VA can improve the most.
VA estimates S. 1427 would cost $2 million in FY 2010, $2.1 million in FY 2011, $10.8 million over 5 years, and $24.0 million over 10 years.
S. 1429 "Servicemembers Mental Health Care Commission Act"
S. 1429 would establish a 12 member commission, jointly appointed by VA and DoD, responsible for overseeing the monitoring and treatment of Veterans and service members with post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and other mental health disorders caused by service in the Armed Forces. The Commission would consist of at least one of each of the following: active duty service members, Veterans retired from armed services, VA employees, DoD employees, recognized medical or scientific authorities in related fields, non-physician mental health professionals, and Veterans who have undergone treatment for PTSD, TBI or other mental health disorders. VA and DoD would be required to consult with Veterans Service Organizations (VSO), members of the Armed Forces, and family members of Veterans and service members when identifying members of the Commission. The Commission would conduct a thorough study of all matters relating to the long-term adverse consequences of these conditions. This would include analyzing information gathered from post-deployment interviews, effective treatments, effects on military careers for those seeking care, and continuity and effectiveness of care provided individuals during transition from DoD to VA. The Commission would make recommendations to mitigate any adverse consequences identified in the study and reduce the cultural and professional stigmas associated with treatment. The Commission would, not later than September 30 of each year, submit a report to Congress on their findings, conclusions, and recommendations of the Commission. The Commission would be authorized to conduct site visits, secure information from any federal department or agency, and solicit testimony from service members, Veterans, caregivers and other sources. The Commission would be terminated at the joint discretion of the Secretaries of DoD and VA.
VA does not support S. 1429 because it is unnecessary. The Commission would review and advise on PTSD in current and former service members who developed this condition as a result of service, regardless of era, but would not have oversight responsibilities for the care of Veterans with mental health conditions that were not determined to be service-connected. VA's mental health program provides care for enrolled Veterans with mental health conditions regardless of the origin of their conditions. Consequently, this Commission would be overseeing part of VA's mental health program, but not the entirety. The charge to address care in both Departments, and to address VA care across the lifespan, but only for those with service-connected conditions, is likely to limit its impact in either setting.
Additionally, the Federal Advisory Committee on Prosthetics and Rehabilitation already addresses care for Veterans with TBI. Care for Veterans with mental health conditions is being address by two congressionally authorized committees: the Special Committee on Serious Mental Illness, and the Special Committee on PTSD. Membership for both committees is determined by the Under Secretary for Health, and each submits an annual report to Congress. The Commission proposed by this legislation would duplicate these existing and effective mechanisms for oversight.
VA estimates the bill would cost $1 million in FY 2010, $1 million in FY 2011, $5 million over 5 years, and $10 million over 10 years.
S. 1444 "Combat PTSD Act"
S. 1444 would clarify the meaning of the term "combat with the enemy" in 38 U.S.C. 1154(b) for the purpose of determining service connection. For Veterans who engaged in "combat with the enemy," section 1154(b) provides a relaxed evidentiary standard for proving service connection. Under this legislation, the term "combat with the enemy" would include active duty in a theater of combat operations (as determined by VA in consultation with DoD) during a period of war and active duty in combat against a hostile force during a period of hostilities. The clarification would apply to any disability compensation claim pending on or after the date of enactment.
VA opposes this bill. While we understand and support the intent to give every benefit of the doubt to combat Veterans, S. 1444 is too broad, encompasses more than just PTSD claims, and may unduly complicate the adjudication process.
Section 1154(b) provides a relaxed evidentiary standard that facilitates a combat Veteran's establishment of service connection for disease or injury alleged to have been incurred in or aggravated by certain active service. Specifically, section 1154(b) provides that, in the case of any Veteran who engaged in combat with the enemy in active service during a period of war, campaign, or expedition, VA shall accept as sufficient proof of service connection of any claimed disease or injury satisfactory lay or other evidence of service incurrence or aggravation, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the absence of an official record of such incurrence or aggravation. In short, section 1154(b) allows a combat Veteran to establish the incurrence or aggravation of a disease or injury in combat service by lay evidence alone. However, to be afforded this relaxed evidentiary standard, the Veteran must have "engaged in combat with the enemy." Furthermore, the relaxed evidentiary standard does not apply to the predicate fact of engagement in combat with the enemy.
Historically, evidence of combat engagement with the enemy required evidence of personal participation in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. Presence in a combat zone or participation in a campaign alone did not constitute engagement in combat with the enemy for purposes of the relaxed evidentiary standard.
The reason for relaxing the evidentiary requirements for combat Veterans was that official documentation of the incurrence or aggravation of disease or injury was unlikely during the heat of combat. Combat Veterans should not be disadvantaged by the circumstances of combat service in proving their benefit claims. Under the relaxed requirements, satisfactory lay or other evidence, if consistent with the circumstances, conditions, or hardships of the Veteran's service, is sufficient to establish that a disease or injury was incurred in or aggravated by combat service.
S. 1444 would extend the relaxed evidentiary standard to certain Veterans who did not engage in combat with the enemy during a period of war. It would require that a Veteran who served on active duty in a theater of combat operations during a period of war or in combat against a hostile force during a period of hostilities be treated as having "engaged in combat with the enemy" for purposes of establishing service connection for disease or injury alleged to have been incurred in or aggravated by such service. S. 1444 would also require that VA, in consultation with DoD, determine what constitutes a theater of combat operations. DoD defines theater of operations broadly to encompass geographic operational areas of significant size defined for the conduct or support of specific military operations. An area designated as a theater of combat operations in consultation with DoD would encompass all Veterans who served on active duty in that theater during a period of war, whether or not they were actually involved in combat.
Service in a theater of combat operations does not necessarily equate to engaging in combat with the enemy and does not in many cases present the same difficulties encountered by combat Veterans when later pursuing compensation claims. So, although we share the goals of this bill to improve the processing of compensation claims, we are concerned that it would extend the relaxed evidentiary standard to Veterans who served in a theater of combat operations regardless of whether their service involved combat or was even near actual combat and regardless of whether the circumstances of their service were of the kind that would inhibit official documentation of incurrence or aggravation of injury or disease.
We also are uncertain of the scope of S. 1444, which is broader than just PTSD claims and would provide a relaxed evidentiary standard for all types of physical and psychological diseases and injuries allegedly incurred in or aggravated by service in a theater of combat operations. In this regard, the subjective psychiatric symptoms associated with a traumatic experience are not always immediately manifested or apparent and thus are not subject to ready documentation. For example, a Veteran who witnesses a traumatic event may show no immediate observable signs of the mental trauma resulting from the in-service incident. On the other hand, a physical injury is more readily observable to lay witnesses and more likely to have been documented even in a combat theater.
In addition, this bill may unduly complicate the adjudication process by requiring separate determinations of whether a Veteran served on active duty in a theater of combat operations during a period of war or served on active duty in combat against a hostile force during a period of hostilities, questions that VA typically does not address. The need to make such determinations may delay claim processing for all Veterans.
Furthermore, on August 24, 2009, VA proposed a rule that would liberalize the evidentiary standard for establishing the required in-service stressor for entitlement to service connection for PTSD. The amendment to VA's adjudication regulations governing service connection of PTSD would eliminate the requirement for corroborating evidence that the claimed in-service stressor occurred if the stressor claimed by a Veteran is related to the Veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, provided that the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service, and that the Veteran's symptoms are related to the claimed stressor. This proposed rule has been lauded by many Veterans service organizations and Congress and would improve in the same area as this bill.
VA is unable to provide a cost estimate for this bill because we cannot estimate the number of Veterans who would be granted service-connection based on the provisions of this bill.
S. 1483 "Designating the Alexandria, Minnesota Outpatient Clinic"
S. 1483 would designate the Department of Veterans Affairs Outpatient Clinic in Alexandria, Minnesota as the "Max J. Beilke Department of Veterans Affairs Outpatient Clinic." Mr. Beilke died in service to his country at the Pentagon on September 11, 2001. The Department has no objection to this proposal and defers to Congress in the naming of federal property.
S. 1518 "Caring for Camp Lejeune Veterans Act of 2009"
S. 1518 would amend title 38 to extend eligibility for hospital care, medical services and nursing home care for certain Veterans stationed at Camp Lejeune during a period in which well water was contaminated notwithstanding that there is insufficient medical evidence to conclude that a particular illness is attributable to such contamination. It would also make family members of those Veterans who resided at Camp Lejeune eligible for the same services, but only for those conditions or disabilities associated with exposure to the contaminants in the water at Camp Lejeune, as determined by the Secretary.
VA takes the Camp Lejeune matter very seriously but has concerns with the legislation as written. S. 1518 would provide a very broad enrollment and treatment authority for service members and their families. As the legislation is written, any condition that cannot be specifically eliminated as related to the contaminated water at Camp Lejeune would require VA to provide treatment. We note this authority is broader than that conferred on radiation-exposed Veterans. Moreover, the legislation would also require VA to provide medical services and nursing home care to those family members who either consumed contaminated water or were in utero at the time of consumption if the condition or disability can be associated with exposure to contaminated water at Camp Lejeune.
From the 1950s through the mid-1980s, persons residing or working at the U.S. Marine Corps Base Camp Lejeune were potentially exposed to drinking water contaminated with volatile organic compounds. Two of the eight water treatment facilities supplying water to the base were contaminated with either tricholoroethylene (TCE) or tetrachloroethylene (perchloroethylene, or PCE). The Department of Health and Human Services' Agency for Toxic Substances and Disease Registry (ASTDR) estimated that the level of PCE in drinking water exceeded current standards from 1957 to 1987 (when the contaminated wells were shut down) and represented a potential public health hazard.
An ATSDR study begun in 2005 is evaluating whether children of mothers who were exposed while pregnant to contaminated drinking water at Camp Lejeune are at an increased risk of spina bifida, anecephaly, cleft lip or cleft palate, and childhood leukemia or non-Hodgkin's lymphoma. The results of this report have not yet been released. In the same year, a panel of independent scientists convened by ATSDR recommended the agency identify cohorts of individuals with potential exposure, including adults who lived or worked on the base and children who lived on the base (including those that may have been exposed while in utero), and conduct a feasibility assessment to address the issues involved in planning future studies at the base.
In October 2008, the Department of the Navy issued a letter to Veterans who were stationed at Camp Lejeune while in military service between 1957 and 1987. This letter informed Veterans that the Navy had established a health registry and encouraged them to participate. VA currently provides Veterans with information about this issue and referrals to the Navy registry. Veterans who are a part of this cohort may also apply for enrollment if they are otherwise eligible, and are encouraged to discuss any specific concerns they have about this issue with their health care provider. Veterans are also encouraged to file a claim for VA disability compensation for any injury or illness they believe is related to their military service. VA environmental health clinicians can provide these Veterans with information regarding the potential health effects of exposure to volatile organic compounds and VA's War-Related Illness and Injury Study Centers are also available as a resource to providers.
It is unclear exactly how many people were potentially affected, but some estimates place the number at one million Veterans and family members. Though the Department of the Navy has attempted to contact all service members who were stationed at Camp Lejeune during the three decades of potential exposure, it is possible not everyone was reached or identified. Records over a half-century old may not be available, and the legislation leaves open-ended what "resided" or "stationed" means because there is no limitation such as a minimum time requirement on the base. Consequently, a broad definition of these terms may mean VA's estimates of 500,000 Veterans and 500,000 family members are too conservative.
Because of these concerns, VA recommends that if any enhanced Veteran care is authorized, it should be modeled upon the authority providing for benefits and services for radiation-exposed Veterans and limited to conditions that can be associated with consumption of contaminated water. VA also would recommend that any care for potentially eligible family members be provided by DoD as the exposure is directly related to service at Camp Lejeune.
VA estimates the legislation, as written, would cost $299.7 million in FY 2010, $319.5 million in FY 2011, $1.71 billion over 5 years and $4.16 billion over 10 years.
S. 1531 "Department of Veterans Affairs Reorganization Act of 2009"
S. 1531 would amend 38 U.S.C. 308 to increase the number of Assistant Secretaries in the Department from seven to eight. It would also increase the number of Deputy Assistant Secretaries from 19 to 27. The bill would also require that one Assistant Secretary be appointed Assistant Secretary for Acquisition, Logistics, and Construction and would cap the number of Deputy Assistant Secretaries the Secretary may appoint to manage programs relating to construction, facilities, asset management, and IT. In addition, S. 1531 would modernize some of nomenclature relating to construction and acquisition functions in 38 U.S.C. 308.
VA generally supports this legislation. Elevating the construction and acquisition function to the Assistant Secretary (AS) level will help ensure consistent and sound business decisions are made in VA's acquisitions, logistics, and construction programs. This position will also further transform and modernize VA's business practices and processes. Similarly, expanding the number of Deputy Assistant Secretaries (DAS) is necessary given the size, scope, and complexity of VA's missions and geographic distribution. However, VA opposes language in S. 1531 which specifies the title and responsibilities of the AS and which caps the number of DAS assigned to certain functions as this limits the agency's flexibility to address changing needs and demands.
S. 1547 "Zero Tolerance for Veterans Homelessness Act of 2009"
S. 1547 proposes to alter and expand a number of authorities available to VA with regard to preventing and reducing Veteran homelessness. VA has initiated an ambitious plan to end homelessness among Veterans and supports the Committee's interest in providing additional services and assistance to homeless Veterans. However, VA needs additional time to evaluate S. 1547. We will provide views and costs on these provisions as soon as they are available.
S. 1556 "Veterans Voting Support Act"
S. 1556 would to require VA to support Veterans in registering to vote and voting. While VA is committed to helping Veterans exercise their right to vote, the agency needs additional time evaluate S. 1556. We will provide views and costs to the Committee as soon as they are available.
S. 1607 "Wounded Veteran Security Act of 2009"
S. 1607 would amend title 38 to establish certain employment rights for persons absent from work for treatment of a service-connected disability. VA defers to the Department of Labor on this legislation as it concerns rights and benefits of employment.
S. 1668 "National Guard Education Equality Act"
S. 1668 would amend section 3301 of title 38, United States Code, to add to the definition of "active duty" under the Post 9/11 GI Bill, full-time duty served under title 32, United States Code, by members of the Army National Guard or Air National Guard of any State, thereby making this service qualifying service for purposes of the Post 9/11 GI Bill. This would include, but not be limited to, active duty (1) under orders from the Governor of a State or Territory of the United States in response to a domestic emergency; (2) as part of the Active Guard Reserve; (3) as part of Air Sovereignty Alert; (4) as part of Operation Jumpstart; (5) in response to Hurricane Katrina; (6) as part of an airport security mission; or (7) as part of a counterdrug activity.
A bill similar to S. 1668 (H.R. 3554) was introduced in the House of Representatives on September 10, 2009. H.R. 3554 also proposes to amend the Post 9/11 GI Bill to include Army National Guard and Air National Guard active-duty service under title 32, United States Code, as qualifying service for the Post-9/11 GI Bill. However, H.R. 3554 would also allow individuals who served at least 30 continuous days in a Reserve Component and were released for a service-connected disability to be eligible for the Post-9/11 GI Bill.
VA does not oppose S. 1668, subject to Congress identifying offsets for the additional benefit costs; however, we would prefer to see a provision in this measure similar to the one in H.R. 3554, noted above, that would authorize eligibility under the Post-9/11 GI Bill for certain individuals released from active duty for service-connected disabilities.
On average, the Army National Guard has the largest number of beneficiaries in the Reserve Educational Assistance Program (REAP), as well as the Montgomery GI Bill - Selected Reserve program (MGIB-SR). The Air National Guard has the third largest number of beneficiaries in these programs. Enrollments in these programs would be reduced if title 32 active-duty service became qualifying service under the Post-9/11 GI Bill.
Servicemember- and service-period data are electronically exchanged between VA and DoD for some members who served under title 32 and became eligible for either the MGIB – Active Duty, REAP, or MGIB-SR. However, VA and DoD would need to manually verify this data until it could be electronically exchanged. Additionally, administration of the Post-9/11 GI Bill would be impacted by the anticipated increase in the number of individuals who would qualify for the Post-9/11 GI Bill.
VA estimates that the enactment of S. 1668 would result in a benefits cost to VA of $120.6 million in FY 2011, $1.1 billion over 5 years, and $2.3 billion over 10 years.
S. 1752 "Presumption of Service-Connection for Parkinson's Disease"
S. 1752 would add Parkinson's disease manifested to a degree of 10 percent or more to the list of diseases presumed service connected in a Veteran who served in Vietnam.
VA supports the objective of this bill. Based on an independent study by the Institute of Medicine, the Secretary announced on October 13, 2009, that VA would add Parkinson's disease to the list of presumptive diseases associated with herbicide exposure. However, this provision is unnecessary based on the Secretary's recent determination.
VA cannot provide a cost estimate on this bill at this time because sufficient data are not yet available. With the Chairman's permission, we will provide a cost estimate in writing for inclusion in the record.
This concludes my prepared statement. I would be pleased to answer any questions you or any of the members of the Committee may have.
[1] The bill language refers to "compensation" paid under chapter 13. We interpret the provision to apply to payments of DIC under chapter 13.
[2] Veterans' Disability Benefits Commission, "Honoring The Call To Duty: Veterans' Disability Benefits in the 21st Century, October 2007, page 393.
House Committees | Senate Committees | Find my Representative | Find my Senator
Veterans and their family members who wish to contact the Department regarding a claim, benefits, or services, may call VA Toll-Free at 1 (800) 827-1000 or 1 (800) 829-4833 [TDD], or Contact the VA via the web.
VA Home | Privacy | FOIA | Regulations | Web Policies | No FEAR Act | Site Index | USA.gov | White House | National Resource Directory | Inspector General
U.S. Department of Veterans Affairs - 810 Vermont Avenue, NW - Washington, DC 20420
Reviewed/Updated Date: November 10, 2009


text:
ED Magedson – Founder
Ripoff Report
Lisa Gentile, esq519 Walnut St Reading, Pennsylvania USA
Lisa Gentile, esq Lisa D. Gentile, Lisa Bales Nasty, bitter, vindictive, and expensive Reading Pennsylvania
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Fix it the right way.
Corporate Advocacy Program™
It was difficult for me to believe that this woman actually graduated from law school. Her tactics seemed more that of a middle school adolescent. When you go to court, you don't want someone representing you who comes in with messy hair, stained clothes and smells like the cigarette she's just thrown out. Her game plan is always the same--to find dirt on the opposing party and destroy them.
That might sound good if you are going through a bitter divorce, but it is costly. Not only financially, but emotionally as well. My kids paid the biggest price out of any of us. I found that she disobeyed orders and encouraged me to file false police reports. If I didn't do what she said, she threatened me, my family or just threw a tantrum and cursed at me. Who needs to be abused by their attorney? No one. This is one gal who definitely needs one of those psych evals she's so famous for recommending. Avoid her.
This report was posted on Ripoff Report on 07/28/2013 05:05 PM and is a permanent record located here: http://www.ripoffreport.com/reports/lisa-gentile-esq/reading-pennsylvania-19601/lisa-gentile-esq-lisa-d-gentile-lisa-bales-nasty-bitter-vindictive-and-expensive-re-1070814. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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subset: commoncrawl


text: John Rich, Karl Rove, and Glenn Beck make a stop in the metro. Thanks to Don Spncer and Mike Rogers. Reid Mullins and Lee Matthews address the Sooner Tea Party Block Party before the show. Karl Rove signs copies of his book Karl Rove and his presentation. John Rich fires it up Glenn Beck and his now famous black board John signs again Joe the Plumber Lee Matthews reads "Gods Of The Copybook Headings" to the Sooner Tea Party crowd. A Rudyard Kipling poem about indoctrination. Back Stage Lee explains to Glenn about Mark Shannon. Photo 1 of 1 Continue Gallery


text:
Police confirmed a man was stabbed at around 1:30 a.m. Thursday near the intersection of Beausoleil Drive and York Street.
Police said they believe the incident was a mugging. They could not yet confirm how many people were involved.
Another stabbing reportedly occurred on Caldwell Avenue near Merivale Road at about 1:20 a.m.
Both men who were stabbed were sent to hospital with non-life-threatening injuries.
Police are investigating both incidents.


text:
Subject: Re: [htdig] Error compiling
From: Gilles Detillieux (firstname.lastname@example.com)
Date: Wed Jan 26 2000 - 08:47:27 PST
According to Ken Kyler:
> > According to Ken Kyler:
> > > I get an error in Configuration.cc about an unterminated string or
> > > character.
> > >
> > > I'm running RedHat 6.1.
> >
> > Sounds to me like the source was modified or corrupted somehow. What
> > version are you trying? I've compiled 3.1.3 successfully on 4.2, 5.0,
> > 6.0 & 6.1, and 3.1.4 (the latest release) on all of these except 6.1,
> > which I haven't tried yet (but the changes are minor between 3.1.4 and
> > 3.1.3, so I can't imagine why it wouldn't work).
> >
> > I'd suggest starting from scratch from a clean source distribution, or
> > using the "glibc21" RPMs from http://www.htdig.org/files/binaries/
> I've now tried everything suggested and get the same result. Has anyone
> successfully compiled HTDig on Redhat 6.1?
OK, could you be more explicit about what this "same result" is?
I thought you were talking about an error message from the C++ compiler,
but how can you get a compilation error when installing a binary RPM?
If you're trying to recompile from the source RPM, then perhaps you could
post the output of an "rpm --rebuild htdig-3.1.4-0glibc21.src.rpm".
If you installed htdig-3.1.4-0glibc21.i386.rpm, please indicate the
exact error message(s) you got while installing or running. If you're
building from the source tarball, the output from configure and make
may be informative. At this stage, I don't even know which lines
in Configuration.cc contain the error you've mentioned.
Also, be aware that if you want to compile htdig on any Red Hat system,
you must have not only gcc and glibc (or libc5 for 4.x) installed, but
also a C++ compiler and library. On 6.1, these would be:
If you have different version of any of these, or are running on a
non-Intel architecture, please state so, as it may be relevant.
Note that the list above is not that different than what 6.0 has:
so I can't imagine why the source would compile on 6.0 but not 6.1, if
you have all of these packages installed. As I said, I HAVE successfully
compiled htdig-3.1.3 on Red Hat 6.1 (Intel architecture, actually AMD K6),
and Configuration.cc has changed very little between 3.1.3 and 3.1.4.
One of the additions has a few lines with the character constant '\''
but if your compiler is choking on those it has a serious bug.
-- Gilles R. Detillieux E-mail: <firstname.lastname@example.com> Spinal Cord Research Centre WWW: http://www.scrc.umanitoba.ca/~grdetil Dept. Physiology, U. of Manitoba Phone: (204)789-3766 Winnipeg, MB R3E 3J7 (Canada) Fax: (204)789-3930
------------------------------------ To unsubscribe from the htdig mailing list, send a message to email@example.com You will receive a message to confirm this.
This archive was generated by hypermail 2b28 : Wed Jan 26 2000 - 08:48:49 PST


text:
2006.405: The Sensitivity of Computational Control Problems
2006.405: Nicholas J. Higham, Mihail Konstantinov, Volker Mehrmann and Petko Petkov (2004) The Sensitivity of Computational Control Problems. IEEE Control Systems Magazine, 24 (1). pp. 28-43. ISSN 0272-1708
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It is well-known that many factors contribute to the accurate and efficient numerical solution of mathematical problems such as those arising in computational control system design. In simple terms these are the arithmetic of the machine on which the calculations are carried out, sensitivity (or conditioning) of the mathematical model to small changes of the data and the numerical stability of the algorithms. It happens quite often that these concepts are confused. We define these concepts and demonstrate some of the subtleties that often lead to confusion. In particular we demonstrate with several examples what may happen when a problem is modularized, i.e., split into subproblems for which computational modules are available.
For three classical problems in computational control, pole placement, linear quadratic control and optimal $H_\infty$ control, we then discuss the conditioning of the problems and point out sources of difficulties. We give some ill-conditioned examples for which even numerically stable methods fail.
We also stress the need for condition and error estimators that supplement the numerical algorithm and inform the user about potential or actual difficulties, and we explain what can be done to avoid these difficulties.
We finally describe the current status of available condition estimators in numerical methods for control system design such as those available in the SLICOT library and we point out important areas of future research that need to be adressed.
|Item Type:
|Uncontrolled Keywords:
|Sensitivity and conditioning, numerical stability, machine arithmetic, pole placement, linear quadratic control, algebraic Riccati equation, $H_\infty$ control.
|MSC 2000 > 15 Linear and multilinear algebra; matrix theory
MSC 2000 > 65 Numerical analysis
MSC 2000 > 93 Systems theory; control
|MIMS number:
|Deposited By:
|Nick Higham
|Deposited On:
|22 November 2006
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Repository Staff Only: edit this item


text:
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
Glutathione (L-
Normal cells respond to external stimuli by different tightly regulated pathways. However, in cancer cells, physiology is altered leading to, e.g., excessive growth and reduced cell death. Classically, the loss of growth regulation has been attributed to the mutation of oncogenes and tumor suppressor genes. Besides, reduction in the response to cell death stimuli is related to aberrant anti-death and pro-death protein expression [
Glutathione (GSH, γ-glutamyl-cysteinyl-glycine), is the most abundant non-protein thiol in eukaryotic cells. The synthesis of this ubiquitous tripeptide is catalyzed by two cytosolic enzymes: γ-glutamate-cysteine ligase (first step), and GSH synthetase (second step; which combines γ-glutamyl-cysteine with glycine to generate GSH). Cys availability and γ-glutamate-cysteine ligase activity are the rate-limiting factors in GSH synthesis [
GSH biochemistry deregulation in tumors has been observed in many different murine and human cancers [
Modifications of GSH metabolism and the introduction of agents able to modulate GSH concentration in tumor cells opened up the possibility of regulating the cellular response to different anticancer treatments [
In mammals, under physiological conditions, the equilibrium between cell death and division helps to maintain tissue/organ homeostasis. Mechanisms related to this equilibrium involve cell cycle checkpoints, DNA repair and recombination, and cell death. In all these mechanisms the oxidation and reduction of proteins, as well as the rate and nature of free radicals generation, play important roles.
The term cellular redox state is classically used to describe the balance of NAD+/NADH, NADP+/NADPH, and/or GSH/GSSG, and its relationship to different sets of metabolites and the control of cell metabolism [
Free radicals are defined as molecules or fragments of molecules containing one or more unpaired electrons [
Reactive oxygen species (ROS) represent the more abundant free radicals in mammalian cells [
An increase in free radicals levels may lead to an increase in different cellular defense systems or, if the damage is irreversible, to cell death [
Although several mechanisms of cell death have been characterized, their classification is difficult because more than one single mechanism can be activated by the same signal [
Apoptosis can be triggered either through an intrinsic pathway, which involves procaspase-9 activation downstream of mitochondrial proapoptotic events; or through an extrinsic pathway, triggered by membrane receptors [such as Fas ligand or tumor necrosis factor-α (TNF-α)] without direct involvement of mitochondria-derived signals [
Cells possess antioxidant systems to control the redox state and, thereby, survival [
Oxidative stress associates with carbohydrate, lipid, protein and DNA damages, which lead to cellular dysfunction and, eventually, cell death [
Oxidative stress is a known inducer of the transcription of specific genes involved in cell death [
As well as in transcription factors, changes in the thiol-disulfide status affecting critical Cys in enzymes, receptors, or transport proteins, can be reversible or irreversible [
In response to stress, the thioredoxin/glutaredoxin complex induces the autophosphorylation and activation of apoptosis signal regulating kinase 1 (ASK1), which causes phosphorylation and activation of JNK and p38, both involved in apoptosis initiation [
In case of DNA damage, p53 mediates the response through initiation of DNA repair, cell cycle arrest, or activation of an apoptotic signaling cascade. p53 activity is regulated by posttranslational modifications, including phosphorylation, acetylation, ubiquitination, sumoylation, glutathionylation, cytoplasmic sequestration,
Finally, it is worthy to remark that some differences among mitochondria, cytoplasm, and nuclei can be found. For instance, a possible translocation of GSH into the nucleus in response to acute oxidative stress has been suggested [
Alterations in cell death mechanisms are common in the pathophysiology of different human diseases including cancer, neurodegenerative or autoimmune disorders. The signaling pathways leading to cell death, and to programmed cell death type I or apoptosis in particular, have been extensively characterized. However, recent studies point out the importance of changes in the intracellular milieu affecting apoptosis and other types of cell death. GSH depletion, in particular, is a common feature preceding cell demise.
Although the relationship between GSH and apoptosis is not fully understood, GSH is essential for cell survival and its depletion increases the cellular susceptibility to apoptosis [
The intrinsic apoptotic pathway is mainly activated by ROS, which induces opening of the mitochondrial permeability transition pore [
Apoptosome complexation, results in activation of caspase-9, which in turn activates effector caspases to carry out the process of apoptosis [
Furthermore, cellular GSH depletion induced by either abolishment of the γ-glutamate-cysteine ligase activity in knock-out mice, Cys starvation, or knockdown of γ-glutamate-cysteine ligase in culture cells, induces apoptosis [
On the other hand, GSH synthesis is upregulated during oxidative stress and inflammation. In practice, oxidants such as ozone, hyperoxia, H2O2,
Different studies have been tried to elucidate the molecular mechanisms implicated in GSH synthesis regulation [
Nrf-2 is a transcription factor essential in HepG2 cells for the ARE-mediated induction of phase II detoxifying and γ-glutamate-cysteine ligase genes in response to ROS, electrophiles and phenolic oxidants [
Furthermore, Kelch-like ECH associated protein 1 (Keap-1) plays a critical role in ARE-mediated signaling by down regulating Nrf-2. Keap-1 inhibits Nrf-2 action by binding and retention of the transcription factor in the cytoplasm [
Nrf-2 expression is also regulated by GSH [
The induction of apoptosis through ASK1, under ROS stimulation, is dependent of cellular redox status. Treatment of A549, an established cellular line from human lung adenocarcinoma, with denbinobin induced ROS production and JNK activation with downstream Bim expression. Bim knockdown by siRNA, and
Autophagy or programmed cell death type II consists of the selective degradation of cellular components through the lysosomal machinery [
Classically cellular necrosis refers to a cell that, in response to severe physical or chemical damage or a critical decrease in energy availability, swells and explodes, then releases its intracellular content into the surrounding space. Thus, necrosis has been considered an uncontrolled type of cell death [
The fact that GSH depletion can be deleterious for cancer cells and, potentially, enhance the effectiveness of chemotherapy and/or ionizing radiations, is known [
The relationship between GSH depletion, chemotherapy, and/or the radiation response has been examined in many tumor cells after treatment with different drugs, including BSO, diethylmaleate, 2-oxothiazolidine-4-carboxylate, and different radiosensitizing agents [
In fact, since the molecular background was firmly established, the potential benefits of GSH depletion for cancer therapy have remained in the shadow for two decades. Nevertheless, recently, new research has offered some light on how to make GSH depletion a useful tool in cancer therapy.
Drug resistance frequently associates with over-expression of P-glycoprotein and/or multidrug resistance proteins (MRPs), which work as pumps extruding cytotoxic drugs out of the tumor cells [
MRP1, the first to be cloned, is overexpressed in many drug-resistant cancer cells and functions as a drug efflux pump [
GSH depletion by BSO-induced inhibition of γ-glutamate-cysteine ligase [
We have presented evidence showing that GSH is released from highly metastatic B16-F10 melanoma cells through MRP1 and the cystic fibrosis transmembrane conductance regulator (CFTR) [
We showed that Bcl-2 antisense oligodeoxynucleotides (Bcl-2-AS; which prevent the Bcl-2-dependent inhibition of GSH efflux through CFTR) and VRP (which increases the MRP1-dependent GSH efflux) independently increased rates of GSH efflux from perifused B16M-F10 cells [
In growing tumors, cyst(e)ine, whose concentration in blood is low, may become rate-limiting for GSH synthesis and cell growth [
Tumor γ-glutamyl transpeptidase (GGT) activity (frequently overexpressed in many tumors [
Therefore, if the increase in GSH content, which follows the effect of Bcl-2-AS and VRP on GSH efflux, depends on cyst(e)ine availability, and if this is provided in part by GGT, then inhibition of the activity of this enzyme could limit GSH synthesis. This possibility was tested by adding acivicin (ACV), an irreversible GGT inhibitor [
Mitochondrial dysfunction is a common event in the mechanisms leading to cell death [
GSH, which is not synthesized by mitochondria but taken up from the cytosol through a multicomponent transport system [
Tumor cells need a constant supply of both energy and nitrogen substrates. Having originated from Warburg's [
Providing supplemental L-Gln during cancer treatment, by reducing the incidence of gastrointestinal, neurological and possibly cardiac complications, has the potential to minimize chemotherapy- and/or radiation-related toxicity [
We developed an original methodology to produce L-Gln-adapted malignant cells with very high metastatic potential (B16M-F10-Gln+). These cells grew as a local tumor in the footpad of mice fed a GED which, as compared with control tumor-bearing mice fed an standard diet, did not accelerate cancer growth [
As explained above, GSH efflux activation through MRP1 and a putative GSH transporter of an undefined molecular nature that was found to correspond to CFTR in B16 melanoma cells, limitation of Cys supply for
Nevertheless, it is essential to keep in mind that
What is then the good news? This approach is the first to achieve selective GSH depletion in different cancer cell types growing
VRP (activating GSH efflux through MRP1), is a calcium ion influx inhibitor frequently used for the management of hypertension and angina pectoris, which has also been used in patients receiving chemotherapy for example, myeloma or acute lymphocytic leukemia. Cells isolated from these patients showed increased accumulation of daunorubicin or vincristine [
ACV (a GGT inhibitor) has been evaluated for antitumor activity in phases I and II clinical trials because expression of GGT was observed in melanoma and cancers of the liver, lung, breast, and ovary [
Bcl-2-AS therapy has been evaluated in multiple clinical trials [
GEDs are used clinically (see above) and, thus, tumor cell adaptation to a GED (as a previous step before cytotoxic/target therapies are applied) is feasible.
Therefore the proposed strategy (or variations of it) can easily be applied and may represent a significant improvement in the therapy of different cancers. With this aim, further experimental work and clinical trials, combining GSH depletion with current cancer therapy protocols, are necessary steps forward.
GSH participates in cancer cell protection against xenobiotics, ionizing radiations, and oxidative stress-inducing biotherapy. In addition mitochondrial GSH oxidation, in particular, favors opening of the mitochondrial permeability transition pore complex, thus facilitating the release of death-related molecular signals. Moreover, GSH is also involved in regulating other types of cancer cell death, including necrosis and autophagy.Identification of the mechanisms controlling GSH homeostasis and fluxes in cancer cells allowed to elucidate a potential, GSH-depletion-based, strategy to improve the efficacy of cancer therapy. This involves (a) cytosolic GSH depletionthrough an increase of GSH efflux out of cells; and (b) mitochondrial GSH depletion through inhibition of its transport into these organelles. Nevertheless these mechanisms need to be assayed in different tumor types in order to make this strategy as general as possible.
Cellular redox balance control regulatory pathways determining cell viability. Different effectors can lead to redox system oxidations triggering a plethora of cellular responses. If stimulation does not compromise cell resistance mechanisms negative feed-back systems restore the redox homeostasis and allow cell survival. However, if stimuli cannot be counteracted by the antioxidant machinery, redox status alterations cause irreversible loss of cell viability.
Experimental therapy to deplete GSH levels in cancer cells. Increased cytosolic GSH efflux, Cys shortage-induced decrease in GSH synthesis and inhibition of GSH transport into mitochondria, lead to cytosolic and mitochondrial GSH depletion, thus sensitizing tumor cells to chemo- and radiotherapy. Cytosolic GSH efflux is stimulated by verapamil and Bcl-2 antisense oligodeoxynucleotides treatment. Acivicin-induced γ-GT inhibition limits Cys availability for GSH synthesis. L-Glu is a competetive inhibitor of GSH transport into mitochondria. High levels of cytosolic L-Glu are achieved by a glutamine-enriched diet which promotes a higher mitochondrial glutaminase activity. This strategy may render cancer cells (and abnormal cells) more sensitive to oxidative stress inducers and cytotoxic drugs.
This work was supported by grants from the MICINN (SAF2009-07729 and IPT-010000-2010-21), Spain.
Reactive oxygen species
Tumor necrosis factor
Antioxidant response elements
Mitogen-activated protein kinase
Buthionine sulfoximine
Mitochondrial GSH
Oxidized GSH
Multidrug resistance protein
ATP-binding cassette
Cystic fibrosis transmembrane conductance regulator
Protein kinase A
Bcl-2 antisense oligodeoxynucleotides
γ-glutamyl transpeptidase


text:
In the interest of publishing a sensationalist Pinterest story (it's all the rage right now, ya know), tonight VentureBeat seriously bungled their story about a move by Flickr to restrict the pinning of some images. VentureBeat's article is titled Flickr disables Pinterest pins on all copyrighted images. However, as they say in the voiceover in the opening credits of the Alcatraz TV show, that's not what happened. Not at all.
The Flickr restrictions have nothing to do with whether the photos are copyrighted.
In a quick primer on US copyright law1 (which we'll cite since Flickr is here in the US), I'll note that all works, such as photographs, are protected by copyright at the moment they are created. Even those works that the creator has chosen to license under Creative Commons (relatively common on Flickr) are protected by copyright law. Thus, if Flickr truly were disabling pinning for any copyrighted photo, they'd be disabling sharing site-wide.
What Flickr actually said, according to the VentureBeat article, was this:
Flickr has implemented the tag and it appears on all non-public/non-safe pages, as well as when a member has disabled sharing of their Flickr content … This means only content that is 'safe,' 'public' and has the sharing button enabled can be pinned to Pinterest.
What this means:
- You can't pin photos marked as private
- You can't pin photos that are marked as being for adult audiences only
- You can't pin photos where the Flickr user has explicitly disabled sharing
- Photos not in one of these three categories can be pinned.
If a photographer is allowing their content to be Tweeted, blogged, or otherwise shared, it can still be shared via Pinterest. If a photographer has chosen to lock things down so that their work can't be shared, that restriction is now honered with respect to Pinterest. This seems like a correct decision by Flickr. A better headline might have been "Flickr Adds Pinterest Restrictions to Better Reflect Users' Sharing Preferences" but that just doesn't sound quite as exciting.
The fact that writers for a major publication, itself protected by copyright law, don't understand copyright law, bothers me. ↩


text:
Diving Bell – Diving Bell
Catalogue number: [HAZE151] | Artist: Diving Bell | Date: 05/08/2012
- Mangonel
- Christi's Favorite
- Kalimba
- Caligula's Sunken Galleys
- Haast's Eagle
Jerod Sommerfeldt
Focusing on the creation of algorithmic and stochastic processes, utilizing the results for both fixed and real-time composition and improvisation, Jerod Sommerfeldt's music explores digital audio artifacts and the destruction of technology, resulting in work that questions the dichotomy between the intended and unintentional. He is currently teaching coursework in computer music at the University of Dayton and music theory and counterpoint at Miami University.
Jerod served as an adjunct faculty at the College-Conservatory of Music at the University of Cincinnati and his music and research have been included at the Cincinnati Ballet, Electronic Music Midwest, 2012 Front Wave New Music Festival in Palm Beach, FL, 2012 SEAMUS Conference in Appleton, WI, 2011 SEAMUS Conference in Miami, FL, 2009 Society of Composers National Conference in Santa Fe, NM, 2008 soundON Festival of Modern Music in La Jolla, CA, 2010 Midwest Composers Symposium, La Crosse New Music Festival, Music From Almost Yesterday Concert Series, Unruly Music Concert Series, Sonic Explorations, Performance Time and Arts Series, the University of Wyoming, by the NOISE Ensemble of San Diego, CA, the Thelema Trio (Belgium), and a commission by concert:nova (Cincinnati). Jerod is a member of the International Computer Music Association (ICMA), Society for Electroacoustic Musicians in the United States (SEAMUS), the Electronic Music Foundation (EMF), the Wisconsin Alliance for Composers, the Society of Composers, the College Music Society, and ASCAP. His music is recorded on Petcord, HAZE, Don't Be a Stranger, Bohn Media, and can be found on SoundCloud, last.fm, YouTube, and Vimeo.
David McDonnell
"I'm a Composer-Multi Instrumentalist-Computer Music Programmer. A Chicago native, I'm currenty based in Cincinnati, where I'm finishing up a Doctorate in Composition at Cincinnati College-Conservatory of Music."
Free download from Sonicsquirrel
If you think our work meaningful, we would be grateful for any help: tell your friends about us, share our releases in social networks, comment here – we welcome your feedback and your solidarity.
Also, we will be happy if you donate to the HAZE netlabel.
Your help will enable us to grow up and make the world better.


text:
UCI VSO Mentorship Program
Our goal with this program is to help student veterans assimilate back into the academic environment by providing them with a faculty or staff mentor that can help guide them along this process. This program can also help the student establish a personal connection in the university.
How to Become a Mentor
Mentor's Responsibilites
The mentor's role would be to meet up with their mentee at least once a quarter, and answer any questions the mentee might have. Mentors can also provide them with guidance on how to successfully assimilate back into a civilian academic lifestyle. Multiple meet ups are highly encouraged, but this will be completely at the mentor and mentee's discretions. At this time mentors must be UCI faculty or staff members.
If you are interested in becoming a mentor, fill out the survey on the following link and we will pair you up with a veteran or reservist student mentee.
For Students that want a Mentor
Your Role
The mentee's role would be meet up with their mentor at least once a quarter. Feel free to ask any questions that you may have on about this school, your classes, or even for general advice on how to transition back into the civilian lifestyle. Multiple meet ups are highly encouraged but that will be completely up to you and your mentor.
If you are interested in this program, fill out the survey on the following link and we will pair you up with a mentor that best suits your needs/interests.


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8 May 2013
Immediate Release
Funding for Positive Behaviour programme welcome but no silver bullet
NZEI Te Riu Roa says the increased funding for a programme aimed at addressing problem behaviour in children and young people is welcome recognition that out-of-school factors are key influencers of educational achievement.
NZEI representative on the Ministry of Education's Education Sector Reference Group, Rikki Sheterline says the Positive Behaviour for Learning programme is successful because it recognises positive behaviour as well as provides support to address and turn around disruptive and negative behaviour.
But he says the increased funding is not a silver bullet and needs to be part of a bigger economic and social policy that puts children's needs first.
"The biggest causes of disruptive behaviour and educational underachievement are issues associated with poverty, transience and family stress and dysfunction.
"These issues have a far greater impact on learning and achievement than in-school factors so it's important that the Positive Behaviour for Learning programmes are part of a joined up social and economic policy that puts children's needs first.
"If the Government is serious about ensuring ALL children can engage in learning, it is important to continue to invest in more successful programmes such as this.
Mr Sheterline says he's concerned that the Minister of Education's pre-Budget comments today may indicate a cut in other areas of education designed to support vulnerable children and that this is being done without adequate consultation with the sector.
"Unfortunately we are also seeing too much money and effort being wasted on misguided policies like National Standards that do nothing except label children that teachers already know need support.
"And sadly Charter schools are another costly and wasteful diversion of time and resourcing away from addressing real issues of underachievement."


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Carmen McLean: "Posttraumatic stress disorder"
Dr. McLean is an Assistant Professor of Clinical Psychology in Psychiatry at the Center for the Treatment and Study of Anxiety at Penn. Dr. McLean received her Bachelor's degree in psychology from the University of British Columbia and her Master's and Doctoral degrees in clinical psychology from the University of Nebraska at Lincoln. After completing her clinical internship at the University of Chicago Medical Center in 2008, Dr. McLean completed a postdoctoral fellowship at the National Center for PTSD at the Boston VA, where she conducted research on Web-based interventions for PTSD. Her current interests include gender effects in anxiety disorders, treatment augmentation, and novel treatment delivery methods.
The luncheon is at 12:00 noon on Wednesday, September 12, 2012 in the
Lenape Room of the University Club. Cost
and University Club details.


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Working to hard that I miss the time when we can do crazy things. like falling in love with someone easily.
But now still I want to catch up the time, but still want to fall in love with someone honest and kind and funny have passion for life and someone who love to share and help the people in need.
why 6 things?
If you insist I can think 2 more , honest and good hope.


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The Executive Office/Central Services Division (Purchasing) adheres to the fundamental principles of public sector procurement, which strives to: (1) foster maximum open and free competition for County purchases and contracts; (2) promote the greatest economy and efficiency in County procurement; (3) ensure adherence to proper standards of conduct by County officers and employees; (4) maintain procurement policies and procedures that guarantee compliance with local, state, and federal laws and regulations; (5) establish and maintain a professional, business-like, ethical relationship with all contractors; and (6) treat all prospective contractors, consultants, and vendors in an equal and equitable manner.
It is the responsibility of the Purchasing Agent to coordinate, monitor and record all phases of County procurement of supplies, equipment, materials, services, and public projects bids. Purchasing is also responsible for the sale of County surplus personal property, and leasing of real and personal property.
In the course of performing its responsibilities, the Purchasing Agent is guided by certain policy objectives, broadly stated as follows:
- Conserving public funds through reduction in cost and improvement in the quality of supplies, equipment, materials, contractual services, and reducing the overhead cost of contracting, buying, leasing, renting and selling;
- Analyzing alternative approaches for each procurement, such as direct purchasing, timesharing, leasing, and intergovernmental/inter-agency agreements (cooperative purchasing);
- Structuring each procurement through consolidation of similar products and separation of dissimilar ones;
- Eliminating purchase of unnecessary or duplicate items and services;
- Encouraging price and quality competition among suppliers, vendors, contractors and consultants;
- Reducing volume, streamlining the flow of paperwork and simultaneously maintaining accurate documentation of procurement transactions;
- Utilizing competent technical expertise where needed in the initiation and administration of procurement and contracts;
- Performing all duties and responsibilities in compliance with local, state and federal law, and consistent with applicable standards of conduct and ethics;
- Requiring that vendors present acceptable documentation evidencing the quality of the product and the accuracy of representations relative to the product.
In the field of Materials Management, the Executive Office uses a number of professional purchasing tools, such as formal and informal requests for quotations, in-house and external supply contracts, bulk purchasing through the revolving Stores account and direct negotiation to provide County departments with the requisite materials at the lowest possible cost. Uniform specifications and centralized ordering help achieve this goal, while at the same time assuring vendors a maximum of fairness and opportunity with a minimum of costly confusion.
Specifically, the Executive Office/Central Services Division (Purchasing) provides the following services for County departments:
- Assists departments in developing specifications, contract requirements and terms and conditions;
- Recommends cost effective alternatives, when appropriate;
- Maintains vendor lists for internal use and for use of other departments on request;
- Prior to renewing agreements, reviews for pricing, item improvements and possible alternatives and informs departments of findings;
- Benchmarks prices for specific items on requests;
- Develops and distributes solicitation documents (bid, request for quotes and requests for proposals);
- Schedules and conducts bidders' conferences;
- Evaluates bids, develops vendor selection processes and participates with departments in evaluating proposals received from vendors;
- Negotiates discounted shipping rates, determines most cost effective shipping method (vendor delivery or common carrier), shipping/transportation issues;
- Awards, renews or extends purchase orders and agreements.
Contact Information:
Executive Office - Purchasing
841 Low Gap Road, Ukiah CA 95482
(707) 234-6050; (707) 463-4673-fax


text:
Richard Hutten
Richard Hutten
Richard Hutten is a ceramics, furniture, glass, interior, metalwork, and product designer, whose work is made for his own company, as well as for Cor Unum, Droog Design, E&Y, Gispen, Idée, Moooi, and Sawaya & Moroni. He has won several awards, including the Dutch Furniture Award (in 1992 and 1996); the Golden Monkey Award, Casa Brutus magazine (2001); and Honorable Mention for the Dutch Design Award (2005). He has also received nominations for the German Design Award (2006), the Dutch Design Award (2007), the Great Indoors Award (2007), and the LAI Interior Award (2007).
Year Born:
Current Location:
The Netherlands
Country of Birth:
The Netherlands
* Designer biographies provided by Merrell Publishers, London and New York.


text:
Search Collections
Aurora Borealis
Frederic Edwin Church
Born: Hartford, Connecticut 1826
Died: New York, New York 1900
oil on canvas 56 x 83 1/2 in. (142.3 x 212.2 cm) Smithsonian American Art Museum Gift of Eleanor Blodgett
Smithsonian American Art Museum
2nd Floor, East Wing
Exhibition Label
The ship and sled team in this image belonged to Frederic Church's friend, polar explorer Dr. Isaac Hayes. Hayes had led an Arctic expedition in 1860, and gave his sketches from the trip to the artist as inspiration for this painting. Hayes returned from his voyage to find the country in the thick of the Civil War, and in a rousing speech vowed that "God willing, I trust yet to carry the flag of the great Republic, with not a single star erased from its glorious Union, to the extreme northern limits of the earth." Viewers understood Church's painting of the Aurora Borealis (also known as the northern lights) as a portent of disaster, a divine omen relating to the conflict.
Exhibition Label, Smithsonian American Art Museum, 2006
Artwork Description
The Civil War defined America and forever changed American art. American artists of this era could not depict the conflict using the conventions of European history painting, which glamorized the hero on the battlefield. Instead, America's finest painters captured the transformative impact of the war. Through landscapes and genre paintings, these artists gave voice to the nation's highest ideals and deepest concerns — illustrating a time that has been described as the second American Revolution.
Smithsonian American Art Museum: Commemorative Guide. Nashville, TN: Beckon Books, 2015.
Research Notes
Read research notes for Aurora Borealis. (pdf)
Landscape - phenomenon - aurora
Landscape - weather - snow
Waterscape - boat
Waterscape - coast
Waterscape - sea
paint - oil
fabric - canvas
About Frederic Edwin Church
Born: Hartford, Connecticut 1826 Died: New York, New York 1900


text:
Ask Health Experts and Get Answers to Your Health Question ASAP
Apart from diabetes, medications, metabolic disorders and gastrointestinal disorders can cause sweet taste in mouth. Medications cause dry mouth and lead to growth of some bacteria which gives sweet taste. Oral hygiene is another issue which need to be considered for the causative of sweet taste in mouth. People who are on weight reducing diet and are burning fat faster can experience sweet taste in mouth.
But since diabetes is one of the commonest and she has high blood sugar; this issue should be further investigated.
A fasting blood sugar and post prandial (after eating food) blood sugar level are sometimes normal or only just high. In these cases a glucose tolerance test is needed which is done after drinking 75 gms glucose and taking blood sugar levels at half hourly intervals. It detects sugar intolerance. Glycosylated hemoglobin is another investigation which gives average blood sugar levels of last three months and would rule out or rule in diabetes. In her this is likely to be responsible for the sweet taste in mouth.
Please feel free for your follow up questions.
Dr. Arun
Good day Dr Arun
Thank you for your replies. Is their any possibility that it could be related to her dentures? To my recollection this whole issue started after she had new denturs made. She appears to be convinced of this.
You are very welcome and very good day to you.
A denture can be issue if it is responsible for the inadequacy of proper oral hygeine. As mentioned, this accumulates the bacterial flora causing sweet taste.
It is pleasure and privilege assisting you.
I hope this was helpful to you. If it was, please remember to ACCEPT the answer so I can get compensated for my work. if you have any more questions, please feel free to ask. I am truly privileged to help you, and I want to make sure that you are satisfied with the answer. Good luck!


text:
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text:
Nan had a plentiful supply of warm winter clothing, and she took a trunkful.
She is going to return to Broadway this autumn, and she has a trunkful of plays to read.
She had brought half a trunkful with her, to help while away the time at Manituck.
I'll bet you have a trunkful of letters from me—unless you've destroyed them.
Well go shopping to-morrow morning bright and early, and get a trunkful of new clothes.
I've made Betsy send home for a trunkful of evening gowns in order to keep up our social standing.
Mercy had tried to beg off at first; then she had agreed to go, if she could take half a trunkful of books with her.
Hes got a trunkful of itwothless stuff, of coursethat he carries with him everywhere.
Uncle John wanted to send a trunkful of family silver, I have been told, but the Pater refused to be bothered with it.
Also he had built himself a rustic table, and unpacked a trunkful of blankets and dishes and writing-pads and books.


text:
The end of plagues : the global battle against infectious disease / John Rhodes.
- Book
- ISBN: 9781137278524 (hbk.)
- ISBN: 1137278528 (hbk.)
- Description: xii, 235 p., [8] p. of plates : ill. ; 25 cm.
- Edition: 1st ed.
- Publisher: New York : Palgrave Macmillan, 2013.
Available copies
- 6 of 6 copies available at NOBLE (All Libraries).
- 1 of 1 copy available at Gloucester. (Show all copies)
Current holds
0 current holds with 6 total copies.
|Call Number
|Due Date
|Adult Nonfiction
|362.19691/Rhodes (Text to Phone)
|Beverly Main
|Adult Nonfiction
|RC 114.5 .R56 2013 (Text to Phone)
|Adult Nonfiction
|RC 114.5 R56 2013 (Text to Phone)
|Endicott College
|General Collection
|RC 114.5 .R463 2013 (Text to Phone)
|Gordon College
|Stack Level 5
|RC 114.5 .R463 2013 (Text to Phone)
|Northern Essex - Haverhill Campus
|RC114.5 .R463 2013 (Text to Phone)
Content descriptions
|Bibliography, etc. Note:
| Includes bibliographical references (p. [221]-226) and index.
|Contents Note:
| The power of the invisible -- Circassian beauties and pioneering women -- The making of Jenner -- Why not try the experiment? -- The fourth achievement -- The foundling voyages -- The teeming humanity of nations -- A great and loud commotion -- Completing the picture -- Germ theory and the birth of immunology -- Victorious weapons against illness and death -- First light on the mystery of infantile paralysis -- Yearning to breathe free -- A great step forward -- Great themes and dirty little secrets -- The war on influenza -- Forged in the crucible of war -- Smallpox in a land of ancient wisdom -- The final defeat of smallpox -- Invisible weapons of war -- Benefits, risks, and fears -- Inspiration in the global village -- A team of many colors -- The milkmaid and the cuckoo.
| "At the turn of the twentieth century, smallpox claimed the lives of two million people per year. By 1979, the disease had been eradicated and victory was declared across the globe. Yet the story of smallpox remains the exception, as today a host of deadly contagions, from polio to AIDS, continue to threaten human health around the world. Spanning three centuries, The End of Plagues weaves together the discovery of vaccination, the birth and growth of immunology, and the fight to eradicate the world's most feared diseases. From Edward Jenner's discovery of vaccination in 1796, to the early nineteenth-century foundling voyages in which chains of orphans, vaccinated one by one, were sent to colonies around the globe, to the development of polio vaccines and the stockpiling of smallpox as a biological weapon in the Cold War, world-renown immunologist John Rhodes charts our fight against these plagues, and shows how vaccinations gave humanity the upper hand. Today, aid groups including the Bill and Melinda Gates Foundation and the World Health Organization have made the eradication of polio a priority, and Rhodes takes us behind the scenes to witness the hard-fought battles of scientist, philanthropists, volunteers, and more, and how soon we may be celebrating the eradication of a second infectious disease, polio"--Provided by publisher.
Search for related items by subject
|Virus diseases > History.
Rhodes, John. "The end of plagues : the global battle against infectious disease." New York : Palgrave Macmillan, 2013.
Link to this record:http://gloucester.noblenet.org/eg/opac/record/3456533?copy_depth=0;locg=18


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News from the Hilltop
Birmingham-Southern College once again named one of America's "Best Buys"
BIRMINGHAM, Ala.—Birmingham-Southern College is one of 26 private institutions in the nation named as a Best Buy in the 2009 edition of the "Fiske Guide to Colleges." In addition to the 26 private institutions, The Best Buys List of 2009 includes 23 public universities from the U.S., Canada and Great Britain.
Of the 49 total colleges and universities selected, BSC is the only school in the state, private or public, to make the list. According to the recently released guidebook, the college's selection is based on the quality of academic offerings in relation to the cost of attendance.
Compiled by Edward B. Fiske, an internationally known education writer and editor and formerly the education editor for "The New York Times," the 25th edition of the annual sourcebook is now available in bookstores and online.
Birmingham-Southern is a four-year, private liberal arts college founded in 1856 and affiliated with the United Methodist Church.
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text: To the Leopard Hunter Leopard tags are much sought after in Namibia and we at Jan Oelofse Hunting Safaris have one more leopard tag to be sold this year, going for a trophy fee of U$ 6000.00 (daily rates are U$ 500.00, including the full-time service of a PH, all meals, laundry service and luxury accommodation). Due to recent changes, the Namibian conservation board does no longer permit hunting leopard with dogs and thus chances of success are unpredictable, as is the hunt for most cats. Patient baiting and waiting is a prerequisite, but the more challenging hunts offer the greatest reward. A leopard hunt is scheduled for a minimum of 14 days. The hunt may be upgraded at request by addition of other species. For further inquiries contact us by email.


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Not like I'm pointing fingers (I am. At all of you) but I know I'm the only person to blame for my incredibly lapsed postings. But look. I do live:
|Me and my incredible boss persons Bret and Mimi
A Lauren spotting no less than two weeks ago. Phew. I know you all were concerned. Until I really get my life together you should follow me on my day to day on Boxwood's Facebook page here.
You'll just be that much closer to me. And I know you want that.


text:
Swedish Medical Center is looking for a Clinical Nurse Specialist to work in Clinical Education at Swedish Cherry Hill in Seattle, WA\.
The Clinical Nurse Specialist \(CNS\) functions in collaboration with and acts as a liaison between service directors and managers across the whole Swedish System for the emergency patient population\.
In this position you will:
Required qualifications for this position include:
Preferred qualifications for this position include:
About Swedish Shared Services:
Swedish is the largest, most comprehensive, nonprofit health provider in the Greater Seattle area\. Our expanding network of facilities currently includes three hospital locations in Seattle, a hospital in Edmonds and the new Swedish Issaquah campus\. It also consists of Swedish Medical Group's network of primary care clinics, and affiliations with suburban hospitals and specialty clinics throughout Greater Seattle\.
Each campus has a local operations leadership team, supported by centrally located and led corporate services, such as Human Resources, Financial and Information Services\.
Our Non\-Profit Mission: Improve the health and well\-being of each person we serve\.
Since 1910, Swedish has been a hallmark of excellence\. Swedish has grown to become the largest non\-profit health provider in the Greater Seattle area with 11,000 employees, more than 2,800 physicians and 1,700 volunteers\. Swedish is committed to being the best place to receive care, and also the best place to work\. We reward our employees with generous compensation and benefits, individualized orientation, education and a supportive work environment\. Swedish is proud to be an Equal Opportunity Employer\. Swedish does not discriminate on the basis of race, color, gender, disability, protected veteran, military status, religion, age, creed, national origin, gender identity, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law\.
Schedule: Full\-time
Shift: Day
Job Category: Advance Practice Nursing / Clinical Nurse Specialist
Location: Washington\-Seattle
Req ID: 150940
An engaging three-day event you won't want to miss.