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Author Topic: Human Life is Fragile but EVERY Life is Valuable  (Read 3765 times)

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AGelbert

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New program to help young adults who are blind get hired

Intensive 10-week workshop teaches job-search skills to students and young adults with visual impairments 


The Perkins Pre-Employment Program is tailored to young adults between the ages of 15 and 22 who want to strengthen their job search skills.


October 1, 2015

BY Alix Hackett

Perkins School for the Blind has launched a groundbreaking new program to give young adults with visual impairments the skills and confidence they need to navigate the job-search process and find meaningful employment.

The Pre-Employment Program (PEP), which begins in January 2016, is tailored to young adults between the ages of 15 and 22 who want to strengthen their job readiness skills and break through the barriers that have traditionally kept many people who are blind from getting hired.

“Work, whether paid or voluntary, is a great equalizer in society,” said Karen Wolffe, an international expert on career counseling for people who are blind or visually impaired who helped design the PEP course. “For youth with visual impairments to be fully integrated, they must learn how they can contribute and help support themselves and their families.”

Every Saturday for 10 weeks, participants will immerse themselves in a different aspect of employment – from identifying their career interests and goals to searching for jobs online and preparing for interviews. They’ll also learn how to disclose and discuss their disability to potential employers, a common stumbling point for candidates who are visually impaired.

Quote
]“We’re going to be teaching them about advocacy and self-determination,” said Kate Katulak, a Perkins teacher and co-facilitator of the program. “It’s important that they’re able to communicate their disability and, more importantly, explain how they can overcome their disability to get things done.” 

During the program, Katulak and other Perkins educators will be joined by hiring professionals and disability specialists from leading Boston corporations like Wells Fargo and Tufts Health Plan. They’ve also invited a panel of young adults and professionals who are blind to share stories of their own employment journeys and lessons learned.

“One thing that research shows and that we’ve heard from parents and families is that students really need role models who are visually impaired who have gone through the process,” said Katulak. “I think they’re going to gain a lot of perspective from this.”

In addition to career education, the program stresses skills like assistive technology and social interaction, which often aren’t formally taught in public schools. For students who are visually impaired, these skills, which are part of the Expanded Core Curriculum taught at Perkins School for the Blind, are crucial for workplace success.

“Something as simple as smiling when you walk in the office and nodding to someone to say hello is an important way to establish yourself in the workplace,” said Katulak. “We’re going to be teaching students things like body language and facial expressions and providing opportunities for them to practice.”

By the end of the 10-week program, students will be armed with hiring portfolios stuffed with references, cover letters and a polished resume. They’ll know how to fill out a job application and put their best foot forward at an interview.
Quote

“Looking for work is often harder than working,”

said Wolffe. “But knowing how to find jobs and convince employers that you’re able to do the work tasks they need doing can make the job search process manageable. The Pre-Employment Program gives youth with visual impairments those skills in a structured and supportive environment.”

The Pre-Employment Program is open to students and young adults ages 15-22. Learn more at Perkins.org/gotowork.

http://www.perkins.org/stories/news/pre-employment-program
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AGelbert

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Former President Jimmy Carter told his Plains, Ga. Sunday school class Sunday that he is cancer-free, the Atlanta Journal-Constitution reported.


“He said he got a scan this week and the cancer was gone,” Jill Stuckey told the newspaper. “The church, everybody here, just erupted in applause.”

Carter, 91, announced In August that he had cancer, but that he hoped it was limited to his liver. He later said doctors found small melanoma lesions on his brain. He received drug treatments and radiation therapy.
http://onpolitics.usatoday.com/2015/12/06/report-carter-says-cancer-is-gone/#cx_ab_test_id=19&cx_ab_test_variant=cx_trend&cx_art_pos=4&cx_navSource=arttop&cx_tag=trend&cx_rec_type=trend&cx_ctrl_comp_grp=true&cxrecs_s
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AGelbert

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AGelbert

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What does it feel like to be a surgeon and have a patient die on your operating table?  ???

Greg W Self, Specialist Vascular Surgeon, Southern Vascular Clinic (Melbourne, Australia) •

Raghuraj S. Hegde, I'm an Ophthalmic plastic surgeon. What's that you ask? read my answer to that:


Quote

It depends on the situation, but in answering this question I am assuming that the patient was not on the operating table for last ditch, hail Mary pass kind of operation. That is, they were not expected to die.

This happens to me about 1 to 2 times per year, despite meticulous pre op planning, seemingly uncomplicated surgery can go pear shaped.

The first thing that happens is you begin to feel a little anxious, unnerved that something is not quite right - the operation is not moving the way it should be.

This is followed by fear, fear that the patient might actually not make it off the table, fear at how their family will react, fear at what your colleagues will say to you, or worse, what they will say about you to others. At this point a little panic begins to set in, as you mentally run through possible solutions to whatever it is that is the problem.

Next comes the rearguard action, where you take increasingly more desperate measures to try and save the patient.

Then, at the end, there is almost a feeling of acceptance and calm, a little like when you finally accept that you are not going to make that appointment and rushing panicked into traffic is not the answer.

Finally, after it is all over and you have spoken to the family, the coroner and often debriefed the nursing staff comes the anxiety, different this time to the beginning. What could I have been done differently or better? Did I leave something out, did I make mistake, should I have operated at all?

This last anxiety can be brief, running through the case with a colleague may be enough to realise that it wasn't you, that there were unknown forces at work. More often it lingers, burns itself into your subconscious to the point where it permanently affects the way you practice. This can be a good thing, you need to learn from your mistakes, but it can also be destructive, turning good surgeons to nervous, conservative practitioners. Worse, it can destroy careers and lives.

It is never easy. It never 'just is'.

https://www.quora.com/What-does-it-feel-like-to-be-a-surgeon-and-have-a-patient-die-on-your-operating-table
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AGelbert

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What you need to know about FROSTBITE that most people (even some doctors  :o) don't know:
So, you think you know what to do if you suspect frostbite?

Please take this quiz:
True  ???  or False  ???

1. The ABC's (Airway, Breathing and Circulation) basics of the victim must take priority over tending to the frostbite affected area.

2. If you come upon a victim of frostbite that you cannot carry and you need to walk a distance with the victim to get to a vehicle, it is better for the victim to walk on a frostbite affected limb, even if they risk further injury, than for you to begin suboptimal (less than 38-40C hydrotherapy - the use of circulating water at 40-42°C is common.) warming right away.   

3. Pressure bandages on a frostbite injury help to improve circulation. 

4. Rewarming in the field should not be attempted unless the time to arrival at a definitive care center exceeds 2 hours.

5. Massaging frostbite injuries for patient comfort and pain reduction during hydrotherapy at 40C degrees  (that is not part of this question and is the actual recommended ideal temperature for restoring adequate circulation and preventing added injury), initiated when normal reperfusion (the action of restoring the flow of blood to an organ or tissue) pain begins, is harmful to the patient.

6. Amputation of frostbite affected anatomy should be delayed until the necrotic tissue is clearly demarcated, normally 6-8 weeks.

7. Healed tissue that experienced some degree of frostbite injury will be subsequently more sensitive to, and susceptible to injury from, heat or cold than surrounding tissue.

8. Thawing and refreezing is preferable, for the reduction of tissue morbidity, to delayed thawing of a frostbite injury.

9. Topical application of Aloe Vera Cream on affected areas is an important part of frostbite therapy.

10. During hydrotherapy at 40 degrees C, you know when reperfusion (the action of restoring the flow of blood to an organ or tissue) occurs in a frostbite injury when the distal (situated away from the center of the body or from the point of attachment) area of the extremity is flushed, soft, and pliable. 


The correct answers to the above quiz are:
1. True
2. True   
3. False 
4. True   
5. True   
6. True 
7. True   
8. False 
9. True   
10. True 

The main thing you need to understand about frostbite injury, even if you forget everything else, is this:

Ischemic injury in frostbite is most often caused by vascular compromise from thrombosis and not by compression from edematous tissue, ... .

WHY?
Because ischemic injury (Ischemia comprises not only insufficiency of oxygen, but also reduced availability of nutrients and inadequate removal of metabolites.) is a HUGE part of the complications that ensue when frostbite is treated incorrectly. Tissue swelling (edema) contributes to Ischemia.

In the next post I will discuss each true or false statement of the quiz, one by one, to clarify and possibly enable you to save someone from excessive frostbite injury at some future date.

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AGelbert

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The management of frostbite itself may be divided into 3 phases: field management, rewarming, and postrewarming management.

Now I will discuss each question on the frostbite quiz.

NOTE: All the information provided is from the following article:
Frostbite Treatment & Management Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Dirk M Elston, MD


1. The ABC's (Airway, Breathing and Circulation) basics of the victim must take priority over tending to the frostbite affected area.
TRUE
Quote
Be sure to correct the ABCs (A irway, B reathing, and C irculation) and life-threatening conditions before treating frostbite. The goal of frostbite treatment is to salvage as much tissue as possible, to achieve maximal return of function, and to prevent complications. Correct any systemic hypothermia to a core temperature of 34°C before treating the frostbite. Remove the patient from cold.




2. If you come upon a victim of frostbite that you cannot carry and you need to walk a distance with the victim to get to a vehicle, it is better for the victim to walk on a frostbite affected limb, even if they risk further injury, than for you to begin suboptimal (less than 38-40C hydrotherapy - the use of circulating water at 40-42°C is common.) warming right away.
TRUE

Quote
Rewarm the frostbitten area if no danger of refreezing is observed. However, rewarming should be avoided if it cannot be maintained (freeze-thaw-freeze cycle). Walking on frozen frostbitten areas and risking tissue chipping and fracture is considered better than thawing and refreezing. Reports from Canada show that forced-air rewarming with portable units can be used effectively to warm victims of hypothermia and frostbite in the field and during transport to a regional medical center.




3. Pressure bandages on a frostbite injury help to improve circulation.
FALSE
Quote

Replace wet and constrictive clothing with dry loose clothing. Dress the extremity in a manner that minimizes mechanical trauma.

Pressure dressings, occlusive dressings, and elastic wraps will decrease tissue perfusion and increase the risk of tissue loss. The presence of a concomitant injury with active bleeding requires direct pressure over the bleeding site, but caregivers should be aware that such actions are performed as life-saving measures and can result in increased morbidity.

In a report of a single patient treated with vacuum-assisted closure (VAC) therapy, Poulakidas et al described improved tissue salvage and early reepithelialization, suggesting that VAC may be of some benefit in the management of frostbite-induced tissue damage.



4. Rewarming in the field should not be attempted unless the time to arrival at a definitive care center exceeds 2 hours.
TRUE
Quote

When suspected frostbite does occur, transport to a trauma or burn center becomes a priority. Field rewarming should be started only if the time to arrival at a definitive care center exceeds 2 hours.


5. Massaging frostbite injuries for patient comfort and pain reduction during hydrotherapy at 40C degrees  (that is not part of this question and is the actual recommended ideal temperature for restoring adequate circulation and preventing added injury), initiated when normal reperfusion (the action of restoring the flow of blood to an organ or tissue) pain begins, is harmful to the patient.
TRUE

Quote
On admission, rapidly rewarm the affected area in circulating water (ie, a whirlpool bath) containing an antibacterial soap at 38-40°C. Constantly monitor water temperature. Thawing takes about 20-40 minutes for superficial injuries and as long as 1 hour for deep injuries.

Analgesics (eg, ibuprofen and morphine) for pain relief are indicated during and after rewarming.

The most common error in this stage of treatment is premature termination of the rewarming process because of reperfusion pain. Mechanical trauma (massaging or rubbing with ice or by hand) and rewarming at higher temperatures and for longer periods of time are detrimental to preserving viable tissue and should be avoided. Direct dry heating using fire or a heater can lead to burns secondary to loss of temperature sensation and so should be avoided.



6. Amputation of frostbite affected anatomy should be delayed until the necrotic tissue is clearly demarcated, normally 6-8 weeks.
TRUE
Quote
Because of the extreme difficulty in differentiating viable tissue from nonviable tissue in the first few weeks after frostbite injury, amputation surgery is best avoided until complete demarcation and separation of gangrenous tissue occurs. This process normally takes 6-8 weeks. Consider early amputation if liquefaction, moist gangrene, or infection develops in the frostbitten area.

It may take weeks to months for frostbitten tissue to be declared viable. The affected area generally heals or mummifies without surgery. Lower-extremity involvement, infection, and delay in seeking medical attention are associated with an increased likelihood that operative therapy will be necessary.

Early surgery usually is contraindicated in frostbite, because of the time the nonviable tissue takes to demarcate. Older series show that performing debridement earlier than 2-3 weeks after warming significantly increases the amount of viable tissue removed and is harmful to the patient, resulting in increased amputation rate, mortality, and morbidity. The only indication for early surgical intervention is postthaw compartment syndrome warranting fasciotomy.
Compartment syndrome is generally not applicable in frostbite. WHY? Because the main issue here is the injury that results from reperfusion of frostbite areas. The Ischemic Cascade is a huge part of that contribution to tissue injury. But the injury itself has nothing to do with the compression of tissue.
Quote
Ischemic injury in frostbite is most often caused by vascular compromise from thrombosis and not by compression from edematous tissue, ...
The part of the tissue below the dermal layers called the fascia looks like a white jellylike substance. It is composed mostly of collagen. When it swells it compresses tissue around it and can result in necrosis of said tissue from loss of circulation. They call that "Compartment Syndrome". To reduce the pressure on the tissues so adequate perfusion can be maintained, some of the fascia is removed (fasciotomy). In frostbite, unnecessary tissue destruction, and possibly compartment syndrome, will occur when tight bandages are put on the affected area and also when the area is massaged during hydrotherapy. This is because both those actions will result in the cells producing more inflammation triggering chemicals.



7. Healed tissue that experienced some degree of frostbite injury will be subsequently more sensitive to, and susceptible to injury from, heat or cold than surrounding tissue.
TRUE
Quote
Counsel patients that the frostbitten area is more vulnerable to future heat and cold injury. Encourage patients to undergo active physical therapy.

Further outpatient care includes wound management, analgesia, and avoiding re-exposure to the cold. The choice of outpatient medications is dictated by the patient’s hospital course and may include antibiotics, analgesics, and ibuprofen.



8. Thawing and refreezing is preferable, for the reduction of tissue morbidity, to delayed thawing of a frostbite injury.
FALSE
Quote
Partial thawing and refreezing generate more damage than does prolonged freezing alone, through the release of multiple inflammatory mediators. In patients who experience a refreezing injury of thawed areas, rewarming should be delayed until it can be maintained.




9.
Topical application of Aloe Vera Cream on affected areas is an important part of frostbite therapy.
TRUE

Quote
Apply topical aloe vera cream to all frostbitten areas every 6 hours to inhibit the arachidonic cascade ("induces inflammation by its chemotactic and degranulating actions on polymorphonuclear lymphocytes (PML), and of LTC4, LTD4, and LTE4, the amino acid-containing LTs that induce vasoconstriction and bronchoconstriction ...") , especially thromboxane synthesis. Other arachidonic cascade inhibitor agents currently being investigated include topical methimazole (a thromboxane synthetase inhibitor) and topical methylprednisolone acetate (a phospholipase A2 inhibitor).
What all that means is that your tissue cells, when they 'wake up' while thawing and receiving oxygen again (reperfusion), release all kinds of chemicals that destroy cell walls and trigger inflammation. The Ischemic Cascade and the Arachidonic Cascade are tissue destroyers in frostbite victims. The biochemistry of the Ischemic Cascade in frostbite is even more damaging than in heart attack victims because the jacked edges of ice crystals in your tissues have scored and cut and pierced cell walls. The cells 'think' they are being attacked so they send their chemical warfare agents out - which end up killing healthy cells along with damaged or defective ones.  :P So, agents which thin the blood (to prevent clotting), agents to reduce histone release (inflammation triggering chemicals) and agents to reduce release from injured cells of cell wall attacking chemicals help to prevent further tissue injury. Finally, the therapy must include pain relief because sensed pain will also contribute constricted blood vessels from stress hormone release. You need MORE oxygen reaching your cells and wider blood vessels to carry away the waste products from the mentioned deleterious cascades.



10. During hydrotherapy at 40 degrees C, you know when reperfusion (the action of restoring the flow of blood to an organ or tissue) occurs in a frostbite injury when the distal (situated away from the center of the body or from the point of attachment) area of the extremity is flushed, soft, and pliable. 
TRUE

Quote
Rapid rewarming is the single most effective therapy for frostbite. Variations on the original work of McCauley et al are used at most centers experienced in the management of the frostbite patient. This includes admission of all frostbite patients to a specialty unit, if possible. Consider obtaining photographic records on admission, at 24 hours, and serially every 2-3 days until discharge.

On admission, rapidly rewarm the affected area in circulating water (ie, a whirlpool bath) containing an antibacterial soap at 38-40°C. The circulation of water allows a constant temperature to be applied to the affected area. Warming is continued for 15-30 minutes or until thawing is, by clinical assessment, complete (ie, when the distal area of the extremity is flushed, soft, and pliable).


They don't mention it, but I'm certain Cannabis products, that are anti-inflammatory, vasodilators and analgesic, would help in treating frostbite. Below are some of the mentioned potential therapies for reducing tissue damage by preventing blood clotting (Thrombolytics), insufficient perfusion (oxygenation) and promoting cell wall repair and blood thinning.

Quote
There are several other medication regimens that appear potentially beneficial, but they have not been prospectively validated, and standard doses have not been established. Such regimens include daily infusion of low-molecular-weight dextran, which may prevent erythrocyte clumping in cold-injured blood vessels. Low-dose infusions of heparin may prevent microthrombosis.

In addition, some data suggest that intravenous tissue plasminogen activator (tPA) with or without heparin, prostacyclin, or iloprost may improve outcome in some patients.[41, 42] Finally, bupivacaine has been used for either cervical or lumbar sympathetic blockade to decrease sympathetic tone and relieve pain, but its efficacy is unclear.

Other ancillary modalities that appear promising but have not been tested in well-controlled human trials include the following:

• Thrombolysis using intra-arterial tPA in deep frostbite to decrease tissue loss by 10% when administered within 24 hours of exposure

• Limaprost (a prostaglandin E 1 analogue) as a thera peutic vasodilator to increase peripheral blood flow

• Buflomedil (an alpha-blocker) to increase peripheral blood flow

• Hyperbaric oxygen [43, 44] 

• Subatmospheric pressure therapy (anecdotal) [45] 

• Pentoxifylline

• Vitamin C

• Superoxide dismutase

• Nifedipine
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AGelbert

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Progress can Kill: Survival report reveals world's highest suicide rate

Suicide is often seen as the only option by people forced from their land and into a way of life they did not choose © João Ripper/Survival

A new report published by Survival International reveals that the appalling suicide rate among the indigenous Guarani Kaiowá people of southern Brazil is the highest in the world.   

The rate of self-inflicted deaths within the tribe is 34 times the Brazilian national average, and statistically the highest among any society anywhere on earth. Suicide rates among many other indigenous peoples such as Aboriginal Australians and Native Americans in Alaska also remain exceptionally high. This can be viewed as the inevitable result of the historical and continuing theft of their land and of "development” being forced upon them.

The report, “Progress can Kill”, exposes the devastating consequences of loss of land and autonomy on tribal peoples. As well as the shockingly high suicide rates among tribes, it also reveals high rates of alcoholism, obesity, depression and other health problems.

Particularly striking statistics include the sky-rocketing rates of HIV infection in West Papua, which increased from almost no cases in 2000 to over 10,000 by 2015, and the rate of infant mortality among Aboriginal Australians – twice that in wider Australian society. In large parts of the world, poor nutrition continues to cause further problems, such as malnutrition for Guarani children in Brazil, who are forced to live on roadsides, and obesity for many Native Americans, for whom junk food is the only viable option.

Many Aché starved to death after being forced from their forest home in Paraguay © Don McCullin/Survival

Roy Sesana of the Botswana Bushmen, forcibly evicted from their land in 2002, said: “What kind of development is this when the people lead shorter lives than before? They catch HIV/AIDS. Our children are beaten in school and won’t go. Some become prostitutes. We are not allowed to hunt. They fight because they are bored and get drunk. They are starting to commit suicide. We never saw this before. Is this “development”?”

Olimpio, of the Guajajara tribe in the Brazilian Amazon, said: “We are against the type of development the government is proposing. I think some non-Indians’ idea of “progress” is crazy! They come with these aggressive ideas of progress and impose them on us, human beings, especially on indigenous peoples who are the most oppressed of all. For us, this is not progress at all.”

All of these statistics demonstrate the fatal consequences of forcing change on tribal societies in the name of “progress” and “development”. In many cases, tribes have been forced to move away from abundant and sustainable food sources and a sure source of identity in favour of poverty and marginalization on the fringes of mainstream society. Tragic repercussions of such forced change can continue even several generations down the line.

Around the world, tribes continue to fight for the recognition of their right to live on their lands in peace. Where this right has been respected or restored, tribes flourish. For example after the creation of an indigenous reserve in the northern Amazon in 1992, medical teams worked with tribal shamans and together they halved the mortality rate among the Yanomami Indians. Likewise, the Jarawa In India live on their ancestral lands and enjoy what has been called a “life of opulence”. Nutrionists rate their diet as “optimum”.

Survival International, the global movement for tribal peoples’ rights, is calling for the United Nations to enforce better protection of tribal land rights and to call on governments to uphold their commitments to their indigenous peoples.

http://www.survivalinternational.org/news/11071?
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Suspend loans tainted by Uzbek slavery  >:(

In Uzbekistan, the whole country suffers because of the government’s dependence on revenue from the cotton harvest. The government operate the world’s largest state-run system of forced labour where activists like Elena are brutally repressed, pensioners are being forced to pick cotton or submit 50% of their pension, and education and health care are undermined for two months every year due to the mass mobilisation of teachers and doctors.2

What’s worse is that there are international actors helping Uzbekistan keep its dirty secret – including the World Bank. The World Bank is an international institution that provides loans for developing countries. Right now they are funding projects totalling $500 million in Uzbekistan that are documented to be using forced labour.3

The good news is that the World Bank signed a contract agreeing to suspend loans if evidence of forced labour was uncovered.4 Now we need your help to hold them to this promise.

This year, as the latest announcements calling “everyone to the cotton fields” were heard echoing around the countryside of Uzbekistan, we’re planning to hit the Uzbek government where it hurts – its pocket.5

By calling on the World Bank to account for its actions in propagating Uzbekistan’s forced labour regime, we’re showing that the international community will not accept or fund this state-sanctioned form of modern slavery. But without huge public pressure, the World Bank may turn a blind eye – please don’t let this happen:

Sign our petition now and help put an end to forced labour in Uzbekistan.

https://www.walkfree.org/uzbek-slavery/?utm_source=taf&utm_medium=post-action&utm_campaign=uzbek-slavery
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Which is the most horrifying thing/disease you have seen in your medicine career?

Crysti Drake, Am a University of Oklahoma grad. Have two grown children

Crysti is a Most Viewed Writer in Medical Professions and Professionals.


I was an R.N. in Oklahoma for awhile. One day we had a young couple come in the E.R., he had cut his arm off with an axe. We immediately took him into surgery. A little while later I told his wife we were able to reattach the arm. She began to cry, while I calmed her, she told me that they were short on money and had insurance for a disability, they had purposely cut his arm off hoping to cash in on the insurance, she was distraught because they had no way to pay for the surgery. I was appalled at the length they were willing to go to pay their bills. He survived and recovered very well. I never said a word about the situation.

Anthony G. Gelbert
 
There is no excuse for people being placed in such an economically difficult position in this country. This is an indictment on the empathy deficit disordered 'greed is good' worshipping society that is degrading our biosphere, our society and our democracy.
 
Irrespective of what any religious book may correctly claim, biosphere math (i.e. the successful perpetuation of a species in harmony with those life forms from it and around it), dictates that we ARE our brother's keeper. Spencer was WRONG. Darwin made it CLEAR that altruistic behavior was sine qua non for a successful species.
 
I know there are quite a few hairsplitters here (and some INTJ/psychopaths too!) that will scoff. They are wrong. They are, true to their egocentric and selfish nature, defending 'greed is good'. GREED IS BAD!
 
I applaud Crysti Drake for this post and for the way she handled this tragic case.

https://www.quora.com/Which-is-the-most-horrifying-thing-disease-you-have-seen-in-your-medicine-career




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AGelbert

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Agelbert NOTE: The following article, comment and references are even more applicable today than they were in 2013. The "Poverty Level" is so ridiculously low balled in this country that it should be a national disgrace    (unless you are an empathy deficit disordered crook    - then you consider it 'too high' and a 'giveaway' to 'welfare cheats'. ).



Why is the Federal Poverty Line So Far Off? ???


September 18, 2013

by John Light

SNIPPET:


Origins of the poverty measure

From the early 1980s until last September, the Health and Human Services employee responsible for responding to that frustrated mother and others like her was Gordon M. Fisher. Fisher worked in the Office of the Assistant Secretary for Planning and Evaluation, where his job was to calculate the poverty guidelines — commonly referred to as the “poverty line,” used to determine benefit program eligibility — and to answer questions from the public.

http://billmoyers.com/2013/09/18/why-is-the-federal-poverty-line-so-low/

Quote
SophieBlue 

I like the idea of a new series of poverty measures that take into account real expenses, but then there is the battle of what expenses should be considered. When I teach Sociology of Poverty, I always ask my students whether an internet connection should be considered a basic expense, like electricity. Until they think about what is required to get a good job, they don't. But the more complicated the measure gets, the less useful it is.

Then there is the problem of trying to define poverty. Do we use a subsistence measure, or do we use
Sen's and Nussbaum's capabilities approaches?

One option is to measure inequality instead of "poverty." The OECD generally uses a percentage of the median income. The problem with that is that it assumes that the median is a good measure of well-being. We are seeing the median income lose value over time, so that people who earn the median have a more difficult time affording all those things that denote them as "middle class."


What is the Capability Approach?

• Sen’s capability approach is a moral framework. It proposes that social arrangements should be primarily evaluated according to the extent of freedom people have to promote or achieve functionings they value.

• This is an Evaluative Approach.


Welfare Motivation

– Atkinson notes that ‘despite the prevalence of welfare statements in economics, we are no longer subjecting them to critical analysis

– ‘The welfare basis of policy evaluation is a topic which should receive greater priority in economics.’ ‘The Strange Disappearance of Welfare Economics’ 2001.  ;) 


Capability Approach (CA) provides a partial basis for econ policy


Intellectual History of CA

• 1979 – Sen ‘Equality of What’?

• Basic Needs – same motivation but in some versions people are passive. CA adds freedom

• 1980s – focused on growth as end; CA growth as means; needs to be complemented by HD / CA

• 1990s to present: Annual Human Devt Reports

• Key texts by Sen:
– 1984: Commodities and Capabilities
– 1992: Inequality Re-Examined.
– 1993: Quality of Life (edited with Martha Nussbaum)
– 1999: Development as Freedom
– 2009: The Idea of Justice


• Now a large group of other authors (Nussbaum et al)
• Is this approach still relevant, or has it been superseded?


Capability

• the various combinations of functionings (beings and doings) that the person can achieve. [It] is, thus, a set of vectors of functionings, reflecting the person’s freedom to lead one type of life or another...to choose from possible livings. (Inequality Re-examined)

• think of it as a budget set

• “The focus here is on the freedom that a person actually has to do this or be that – things that he or she may value doing or being.” Idea of Justice 232

• All formulations of capability have two parts: freedom and valuable beings and doings (functionings). Sen’s key contribution has been to unite the two concepts.

Indicators of Functionings

Which are direct indicators of functionings?

A. Asset index
B. Access to schooling
C. Body Mass Index
D. Income
E. Self-reported health
F. Times per week consume egg


Freedom is regularly misunderstood

• Freedom is Not a ‘paper’ freedom: it has to be effective freedom, a real possibility.

• Freedom is Not maximization of choices without regard to their quality and people’s values “Indeed sometimes more freedom of choice can bemuse and befuddle, and make one’s life more wretched.”

• Freedom is Not necessarily direct control by an individual , groups, states, etc can increase freedoms by public action and investment.


Freedom

• “the real opportunity that we have to accomplish what we value”

• “The ‘good life’ is partly a life of genuine choice, and not one in which the person is forced into a particular life – however rich it might be in other respects.”

It is authentic self-direction – the ability to shape one’s own destiny as a person and a part of various communities.


Click here for pdf on the Capability Approach


Measuring Poverty

Quote
The most significant shortcoming of the federal poverty measure is that for most families, in most places, the poverty level is simply too low. While the Standard changes by family type to account for the increase in costs specific to the type of family member—whether this person is an adult or child, and for children, by age—the FPL increases by a constant $4,160 for each additional family member and therefore does not adequately account for the real costs of meeting basic needs.


Quote
The Self-Sufficiency Standard    shows that the income needed to meet basic needs is often far above the FPL, indicating that families can have incomes above the federal poverty measure and yet lack sufficient resources to adequately meet their basic needs. For this reason, most assistance programs use a multiple of the federal poverty measure to determine need. For instance, children’s health insurance with low-cost premiums is available through Colorado Child Health Plan Plus program for families with incomes up to 260% of the FPL.

However, simply raising the poverty level, or using a multiple of the FPL, cannot solve the structural problems inherent in the official poverty measure. In addition to the fundamental problem of being too low, there are five basic methodological problems with the federal poverty measure.
 

First, the measure is based on the cost of a single item—food—rather than a “market basket” of all basic needs.


Over five decades ago, when the FPL was first developed by Mollie Orshansky, food was the only budget item for which the cost of meeting a minimal standard, in this case nutrition, was known. (The Department of Agriculture had determined household food budgets based on nutritional standards.) Knowing that the average American family spent a third of their budget on food, Orshansky reasoned that multiplying the food budget by three would yield an estimate of the amount needed to meet other basic needs, and thus this became the basis of the FPL.
 

Second, the poverty measure’s methodology is “frozen,” not allowing for changes in the relative cost of food or non-food items, nor the addition of new necessary costs.


Since it was developed, the poverty level has only been updated annually using the Consumer Price Index. As a result, the percentage of the household budget devoted to food has remained at one-third of the FPL even though American families now spend an average of only 13% of their income on food. At the same time, other costs have risen much faster—such as health care, housing, and more recently, and energy—and new costs have arisen, such as child care and taxes. None of these changes are, or can be, reflected in the federal poverty measure based on a “frozen” methodology.
 

Third, the poverty measure is dated, implicitly using the demographic model of a two-parent family with a “stay-at-home” wife, or implicitly assumes she is not employed.


This family demographic no longer reflects the reality of the majority of American families today. According to the U.S. Bureau of Labor Statistics, both parents were employed in 59% of two-parent families with children in 2013. Likewise, 68% of single mothers with children were employed and 81% of single fathers with children were employed in 2013. Thus paid employment with its associated costs such as child care, transportation, and taxes is the norm for the majority of families today rather than the exception. Moreover, when the poverty measure was first developed, these employment-related items were not a significant expense for most families: taxes were relatively low and child care for families with young children was not common. However, today these expenses are substantial, and borne by most families, and thus these costs should be included in a modern poverty measure.
 

Fourth, the poverty measure does not vary by geographic location.


That is, the federal poverty measure is the same whether one lives in Louisiana or in the San Francisco Bay Area of California (with Alaska and Hawaii the only exceptions to the rule). However, housing in the most expensive areas of the United States costs nearly four times as much as in the least expensive areas. Using the 2015 Fair Market Rents, the cost of housing (including utilities) at the 40th percentile for a two-bedroom unit in the most expensive place—the San Francisco metropolitan area—is $2,062 per month. This is nearly four times as much as the least expensive housing in the country, found in most counties in Kentucky, where two-bedroom units cost $558 per month. Even within states, costs vary considerably: in Colorado, the cost of a three-bedroom housing rental in Bent County is $801 per month, while in Park County a three-bedroom unit is $2,307 per month.
 

Finally, the poverty measure provides no information or means to track changes in specific costs, nor the impact of subsidies, taxes, and tax credits that reduce (or increase) these costs.


The federal poverty measure does not allow for determining how specific costs (such as housing, child care, etc.) rise or fall over time. Likewise, when assessing the impact of subsidies, taxes, and tax credits, poverty measures cannot trace the impact they have on net costs unless they are explicitly included in the measure itself.

For these and other reasons, many researchers and analysts have proposed revising the federal poverty measure. Suggested changes would reflect twenty-first century needs, incorporate geographically based differences in costs, and respond to changes over time. One such effort is the Supplemental Poverty Measure (SPM). Read more about the SPM and how it differs from the Standard.

http://www.selfsufficiencystandard.org/measuring-poverty







Leges         Sine    Moribus     Vanae   
Faith,
if it has not works, is dead, being alone.

AGelbert

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How to Grieve: 5 Myths That Hurt

By Paula Spencer Scott, Caring.com Author

Grief is a natural response to loss, and it can unfold in many ways. Unfortunately, well-intentioned onlookers -- dubbed "grief police" by grief expert Robert Neimeyer, professor of psychology at the University of Memphis -- often say things that mistakenly imply to the bereaved that there's a "right" way to grieve.

Consider these all-too-common grief myths:

Myth #1: It's possible to cry too much.


Everyone grieves differently. There's no single correct way to express the pain, sorrow, yearning, and other aspects of the transition of adjusting to the death of a loved one. Intense responses are sometimes seen as "losing control," when in fact they're simply how that person is actively (and productively) processing the loss.



Myth #2: If you don't cry now, it'll be worse later.


Some people never cry. Tears or outward expressions of anguish simply aren't everyone's grieving style, says psychologist Neimeyer. This doesn't mean they're grieving less intensely than a visibly shaken individual, or that they loved the person who died any less. Nor does a lack of obvious emotion mean the griever has an emotional block or problem or will face a longer, more difficult adjustment to the loss.



Myth #3: Grief is something you "get over."


Most people never stop grieving a death; they learn to live with it. Grief is a response, not a straight line with an endpoint. Many psychologists bristle at words such as "acceptance" or "resolution" or "healed" as a final stage of grief. The real stages of grief involve tasks of processing and adjustment that one returns to all through life.



Myth #4: Time heals slowly but steadily.

Time is the commodity through which a grieving person sorts through the effects and meaning of a loss. But that process isn't a steady fade-out, like a photograph left in the sun. Grief is a chaotic roller coaster -- a mix of ups, downs, steady straight lines, and the occasional slam. Periods of intense sadness and pain can flare and fade for years or decades.



Myth #5: Grieving should end after a set amount of time.

Ignore oft-quoted rules of thumb that purport to predict how long certain types of grief should last. A downside to six-week or eight-week bereavement groups, says Sherry E. Showalter, a psychotherapist specializing in grief and the author of Healing Heartaches: Stories of Loss and Life, is that at the end of the sessions, people mistakenly expect to be "better" (or their friends expect this). "Everyone tells me the same story: 'I failed Grief 101,' because they still feel pain," Showalter says.
Quote
"We grieve for a lifetime, because we're forever working to incorporate the death into our own tapestry of life."
Learning how to grieve is ultimately part instinct, part stumbling along, part slogging along -- a bit like learning how to live.  


https://www.caring.com/articles/how-to-grieve
Leges         Sine    Moribus     Vanae   
Faith,
if it has not works, is dead, being alone.

AGelbert

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"We grieve for a lifetime, because we're forever working to incorporate the death into our own tapestry of life."
Learning how to grieve is ultimately part instinct, part stumbling along, part slogging along -- a bit like learning how to live.
https://www.caring.com/articles/how-to-grieve


How surprising to read this here. But I am glad I did.
You're full of surprises, AG.

Thanks for sharing this.


You are very welcome, my friend in need and in deed.           

By the way, I got a ride to my pacemaker appointment (which was routine so no worries )  with Vermont SSTA. The donation was just $2. You just have to be over 65 and lacking suitable transportation.

Special Services Transportation Agency. SSTA   http://sstarides.org/]http://sstarides.org/

Yeah, they have volunteers that drive fossil fuel powered vehicles so I guess I'm a hypocrite, at least according to MKing. Mea Culpa. Beggars can't be choosers.  8)
Leges         Sine    Moribus     Vanae   
Faith,
if it has not works, is dead, being alone.

AGelbert

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What Are the Odds That You Exist?  ;D
Leges         Sine    Moribus     Vanae   
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if it has not works, is dead, being alone.

AGelbert

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RIP Anton Yelchin: ‘Star Trek’ Actor Dead at 27 After Freak Accident 

Yelchin was crushed by his own vehicle

Jun 20, 2016, 1:54 pm EDT  |  By William White, InvestorPlace Writer
 
 
Anton Yelchin, who played Pavel Chekov in the new Star Trek films, died on Saturday in a freak accident.

Anton Yelchin was found by friends pinned between his 2015 Jeep Cherokee and the front gate of his house. His death is being attributed to blunt traumatic asphyxia. He will appear posthumously in Star Trek Beyond, which comes out on July 22.

It’s possible that Anton Yelchin’s death was the result of a recall concerning 2014 and 2015 Jeep Cherokee vehicles. The recall is due to the vehicles not properly letting owners know that it isn’t in park before getting out. The actor’s driveway is steep and it’s believed the Jeep rolled back and crushed him after he got out of it, reports USA Today.
Quote
“Anton, you were brilliant. You were kind. You were funny as hell, and supremely talented. And you weren’t here nearly long enough,”
Star Trek director J.J. Abrams wrote in a letter to Yelchin after learning of his death.

http://investorplace.com/2016/06/anton-yelchin-star-trek/?cc=marketbeat&cp=referral#.V2n3xa32bm4

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Faith,
if it has not works, is dead, being alone.

AGelbert

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Dexter August 2014 - December 2014 R.I.P.

Leges         Sine    Moribus     Vanae   
Faith,
if it has not works, is dead, being alone.

 

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