#(and after putting out substantial effort [up to and including medical intervention] to make that happen)

[gotjacobian]

LRB I think the thing I specifically get Got by in media is characters making a conscious choice to "be" human and participate in human society, though with a very specific flavor. It can't just be out of obligation, to keep up appearances, or because it entertains them. It has to be because they want what humans have. Their history, their perspectives, their community, their ways of engaging with the world. I like plots that capture the fear of getting cut off from those things, and that really dig into the tangible and physical difficulties of achieving and holding onto that qualified humanity (and the immense gift it is to do the work it takes to open the gates a little wider for anyone who wants to access it).

[newstfionline]

Tuesday, March 30, 2021

‘Vaccine passports’ are on the way (Washington Post) The Biden administration and private companies are working to develop a standard way of handling credentials—often referred to as “vaccine passports”—that would allow Americans to prove they have been vaccinated against the novel coronavirus as businesses try to reopen. The effort has gained momentum amid President Biden’s pledge that the nation will start to regain normalcy this summer and with a growing number of companies—from cruise lines to sports teams—saying they will require proof of vaccination before opening their doors again. The passports are expected to be free and available through applications for smartphones, which could display a scannable code similar to an airline boarding pass. Americans without smartphone access should be able to print out the passports, developers have said. U.S. officials say they are grappling with an array of challenges, including data privacy and health-care equity. They want to make sure all Americans will be able to get credentials that prove they have been vaccinated, but also want to set up systems that are not easily hacked or passports that cannot be counterfeited, given that forgeries are already starting to appear. Other countries are racing ahead with their own passport plans, with the European Union pledging to release digital certificates that would allow for summer travel.

Remote Work Is Here to Stay. Manhattan May Never Be the Same. (NYT) A year after the coronavirus sparked an extraordinary exodus of workers from office buildings, what had seemed like a short-term inconvenience is now clearly becoming a permanent and tectonic shift in how and where people work. Employers and employees have both embraced the advantages of remote work, including lower office costs and greater flexibility for employees, especially those with families. Beyond New York, some of the country’s largest cities have yet to see a substantial return of employees, even where there have been less stringent government-imposed lockdowns, and some companies have announced that they are not going to have all workers come back all the time. In recent weeks, major corporations, including Ford in Michigan and Target in Minnesota, have said they are giving up significant office space because of their changing workplace practices, while Salesforce, whose headquarters occupies the tallest building in San Francisco, said only a small fraction of its employees will be in the office full time. But no city in the United States, and perhaps the world, must reckon with this transformation more than New York, and in particular Manhattan, an island whose economy has been sustained, from the corner hot dog vendor to Broadway theaters, by more than 1.6 million commuters every day.

Billions of Cicadas Soon to Emerge From Underground (NYT) A few months of quarantine during the coronavirus pandemic? That’s nothing for a swarm of cicadas that have been underground since 2004. In the time that the United States has seen the Boston Red Sox break an 86-year World Series drought, five presidential elections, a deadly pandemic and an insurrection, these creatures have been minding their own business, burrowed in the soil. Now billions of cicadas, from a group known as Brood X, are expected to emerge in the next few weeks, just in time to help orchestrate the soundtrack of summer. Brood X is expected to emerge in about 18 states, scientists say.

Against the odds, Cuba could become a coronavirus vaccine powerhouse (Washington Post) Cuban leader Fidel Castro vowed to build a biotech juggernaut in the Caribbean, advancing the idea in the early 1980s with six researchers in a tiny Havana lab. Forty years later, the communist island nation could be on the cusp of a singular breakthrough: Becoming the world’s smallest country to develop not just one, but multiple coronavirus vaccines. Five vaccine candidates are in development, two in late-stage trials with the goal of a broader rollout by May. Should they prove successful, the vaccines would be an against-the-odds feat of medical prowess — as well as a public relations coup — for an isolated country of 11 million that was added back to the U.S. list of state sponsors of terrorism in the final days of the Trump administration. Cuban officials say they’re developing cheap and easy-to-store serums. They are able to last at room temperature for weeks, and in long-term storage as high as 46.4 degrees, potentially making them a viable option for low-income, tropical countries that have been pushed aside by bigger, wealthier nations in the international scrum for coronavirus vaccines. If Phase 3 trials are positive, Cuban authorities said this week, they would move to a vast “intervention study” that would inoculate almost all the residents of Havana, or 1.7 million people, by May. By August, they would aim to reach 60 percent of the national population, with the rest getting doses by year’s end.

Ukraine wants to show Biden it’s serious about ending ‘oligarch era.’ That’s not so easy. (Washington Post) The word of the moment in Ukrainian politics is “de-oliharkhizatsia” or de-oligarchization: a renewal of the long-held goal—and sometimes only faint hope—to free the country’s political system of domination by the ultrarich. Whether President Volodymyr Zelensky can deliver may set the tone for relations with the Biden administration. “The threat from within [Ukraine] is corruption . . . a lack of institutions that can effectively manage the country,” said Antony Blinken, now secretary of state, during his confirmation hearing in January. “If that threat continues, [it’s] going to be very difficult for them to build a viable democracy.” But Zelensky, a 43-year-old former comedian, has made only limited headway against the oligarchs’ grip since his election two years ago. The oligarchs’ power in Ukraine reaches deep into areas such energy, mining and media—giving a clique of billionaires the clout to shape political and policy decisions. Ukraine is on notice that greater Western aid and international loans are contingent on trimming back their influence. A $5 billion loan deal from the International Monetary Fund is on hold as the Ukrainians try to convince IMF officials that they are serious about tackling corruption.

Inside Myanmar’s Army: ‘They See Protesters as Criminals’ (NYT) Myanmar’s military, the Tatmadaw, which says it has a standing force of up to half a million men, is often portrayed as a robotic rank of warriors bred to kill. Since ousting Myanmar’s civilian leadership last month, setting off nationwide protests, it has only sharpened its savage reputation, killing more than 420 people and assaulting, detaining or torturing thousands of others, according to a monitoring group. On Saturday, the deadliest day since the Feb. 1 coup, security forces killed more than 100 people, according to the United Nations. Among them were seven children, including two 13-year-old boys and a 5-year-old boy. In-depth interviews with four officers, two of whom have deserted since the coup, paint a complex picture of an institution that has thoroughly dominated Myanmar for six decades. From the moment they enter boot camp, Tatmadaw troops are taught that they are guardians of a country that will crumble without them. They occupy a privileged state within a state, in which soldiers live, work and socialize apart from the rest of society, imbibing an ideology that puts them far above the civilian population. The officers described being constantly monitored by their superiors, in barracks and on Facebook. A steady diet of propaganda feeds them notions of enemies at every corner, even on city streets. The cumulative effect is a bunkered worldview, in which orders to kill unarmed civilians are to be followed without question. “They see protesters as criminals because if someone disobeys or protests the military, they are criminal,” said Captain Tun Myat Aung, an officer who defected to the ranks of the anti-coup demonstrators

Thai police vow more protest arrests after nearly 100 detained (Reuters) Thai police on Monday vowed to arrest more people participating in anti-government protests after detaining nearly 100 at a demonstration a day earlier, citing a law restricting gatherings to prevent the spread of coronavirus. Another protest demanding the release of jailed activists is planned for late Monday afternoon, raising prospects for another confrontation with activists calling for an end to military dominance of politics and reform of the powerful monarchy. Dozens of people have been detained at protests in recent months under disease control and public order laws, but Sunday’s protest represented one of the largest number of arrests at a single rally.

Metro Manila, outlying provinces go on lockdown (AP) Philippine officials placed Metropolitan Manila and four outlying provinces, a region of more than 25 million people, back to a lockdown Monday at the height of the Lenten and Easter holiday travel season as they scrambled to control an alarming surge in coronavirus infections. Only workers, government security and health personnel and residents on urgent errands would be allowed out of homes during the weeklong restrictions, which prohibited leisure trips and religious gatherings that forced the dominant Roman Catholic church to shift all its Holy Week and Easter activities online. The renewed lockdown brought President Rodrigo Duterte’s administration under fire for what critics say was its failed handling of the pandemic.

Lebanon could sink like Titanic, parliament speaker says (Reuters) Influential parliamentary speaker Nabih Berri said on Monday that Lebanon would sink like the Titanic if it could not form a government. Prime minister-designate Saad al-Hariri and President Michel Aoun have been at loggerheads over a new cabinet for months, dashing hopes of a reversal of Lebanon’s deepening financial meltdown. Parliament was due to discuss a $200 million emergency fund to pay for fuel for Lebanon’s electricity company. The energy ministry has said there are no funds to pay for imports beyond March. The Zahrani power plant, one of Lebanon’s four main electricity producers, has shut down after its fuel ran out.

Pleas for more aid to Syria (AP) At age 19, Fatima al-Omar is at her wits’ end. In the last year alone, she lost her home to fighting in Syria’s last rebel-held enclave and her mother was diagnosed with cancer. She became the sole breadwinner for her mother, three siblings and grandmother as they moved around between shelters. Then the coronavirus struck, aggravating conditions in northwest Syria just as new fighting had uprooted 1 million people—the biggest wave of displacement in the country’s 10-year war. By late 2020, al-Omar contracted COVID-19, costing her the last job she had picking olives. She hasn’t been able to find work since and is now at risk of another eviction. Despite the worsening humanitarian situation across war-ravaged Syria, it’s been getting tougher every year to raise money from global donors to help people like al-Omar. The aid community is bracing for significant shortfalls ahead of a donor conference that starts Monday in Brussels and is being co-hosted by the United Nations and the European Union. Pledges were already dropping off before the coronavirus pandemic mainly due to donor fatigue. Officials fear that with the global economic downturn spurred by the pandemic, international assistance for Syria is about to take a new hit just when it is needed most. Earlier this month, a U.N. appeal for aid to Yemen, the world’s worst humanitarian crisis, was less than 50% funded, in what U.N. Secretary General Antonio Guterres called a disappointment. According to the U.N., 13.4 million people in Syria, more than half the country’s pre-war population, need assistance. That’s a 20% increase from last year.

Whatever Floats the Boat (Foreign Policy) The Ever Given, the super container vessel that ran aground in the Suez Canal last Tuesday was successfully refloated in the early hours of Monday morning following days of excavation attempts. A team of high-powered tugboats appeared to have ultimately made the difference, after days of work from excavators and dredgers to free the ship after it became wedged in the Egyptian sand. The boat will now head north for further inspection. Meanwhile, navigation is to resume “immediately” afterward, according to the Suez Canal Authority. Mohab Mamish, Egyptian President Abdel Fattah al-Sisi’s adviser for the Suez Canal, said it will take roughly a week to clear the remaining ships out of the canal once the Ever Given is under way. Dealing with the backlog that has accumulated north and south of the canal will likely take more than twice as long. The refloating heads off more economic damage for Egypt, which was losing roughly $15 million in fees for each day the canal was not operational.

While the world tore its hair out over the Suez, Russia saw an opportunity (Washington Post) Russian officials are seizing on the Suez Canal blockage saga to promote its Northern Sea Route, an ambitious infrastructure plan being pushed by President Vladimir Putin that aims to capitalize on the polar ice melt from global warming by opening up Arctic shipping and development. Russia’s Energy Ministry said Monday that the days-long blockage of the canal by Rotterdam-bound Ever Given showed that its Northern Sea Route (NSR) and gas and oil pipelines were reliable, secure and competitive “in comparison to alternative routes.” Russia last year released a sweeping plan to open up the Arctic shipping route, which includes building a fleet of dozens of nuclear icebreakers and other ships, mapping natural resources in the region and developing airports, ports and railways in northern Russia. In 2020, Russia’s meteorological agency said the ice cover in the Arctic sea route had reached a record low.

As Militants Seize Mozambique Gas Hub, a Dash for Safety Turns Deadly (NYT) As gunshots rang out across a port town in northeastern Mozambique on Friday afternoon, nearly 200 people sheltering inside the Amarula Palma hotel confronted a devastating reality: The armed insurgents outside the hotel’s doors had all but taken control of the town and there was no one coming to save them any time soon. For two days, hundreds of insurgents in the gas-rich region had been laying siege to the coastal town of Palma, firing indiscriminately at civilians, hunting down government officials and setting buildings ablaze as security forces tried in vain to repel them. The violence sent thousands of people fleeing, with some rushing to the beach, where a ragtag fleet of cargo ships, tugboats and fishing vessels was ferrying people to safety. But at the hotel, with daylight hours dwindling, the local residents and foreign gas workers who remained faced an impossible choice: Either wait inside, defenseless, for a promised evacuation in the morning, or try to make it to the beach. In a desperate dash, dozens of people crammed into a 17-vehicle convoy and left the hotel for the oceanfront. Only seven vehicles completed the trip. Militants ambushed the convoy after it left the hotel grounds, setting on the occupants of the cars. Many arrived at the beach bloodied. Many never made it at all. American officials said 40 to 50 foreigners alone were feared dead in the attack. By Saturday night the insurgents had completely overrun the town, leaving scores of people unaccounted for and feared dead.

Tree mortality (The Guardian) Since 2010, 129 million trees are estimated to have died in California’s national forests alone. Around the globe, research has suggested that the tree mortality rate in some temperate and tropical forests has doubled or more in recent decades. While normally the life cycle of forests dictates that the ecosystem regrows after forest fires, this is no longer the case. Across the globe, researchers have found that large areas of trees and other plant life have stopped regrowing following wildfires. Forest mortality researchers say while this does not mark the end of the forests, it may well be the end of many forests as we’ve known them. Iconic species such as Giant Sequoias and Joshua trees are succumbing to the effects of climate change in remarkable numbers, while massive ecosystems such as the Amazon rainforest and Siberia’s boreal forests are also suffering. The main factors for increased forest mortality include a hotter climate and increased vulnerability to insects and disease. Researchers have acknowledged ambiguity in their tree mortality predictions, but widespread health problems in forests are prompting a broad and looming sense of disquiet.

[iknowiknowiknowiknowiknow-blog1]

"Pit bull terrier bites were responsible for a significantly higher number of orthopaedic injuries and resulted in an amputation and/or bony injury in 66% of patients treated, whereas bites from law enforcement dogs and other breeds were less associated with severe injuries."

"Among the breeds identified, pit bulls are proportionally linked with more severe bite injuries."

"47.8% of pit bull injuries required operative repair, which was 3 times more than other breeds."

"Pit bulls are more likely to cause severe injuries that require operative repairs."

"Of the 9 patients with extended hospitalization, 6 (66.7%) were caused by a pit bull...confirms our theory that this breed results in the most devastating injuries at our center."

"Our data were consistent with others, in that an operative intervention was more than 3 times as likely to be associated with a pit bull injury than with any other breed. Half of the operations performed on children in this study as well as the only mortality resulted from a pit bull injury."

"Our data revealed that pit bull breeds were more than 2.5 times as likely as other breeds to bite in multiple anatomical locations. Although other breeds may bite with the same or higher frequency, the injury that a pit bull inflicts per bite is often more severe."

"Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention."

"Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+31%), and without provocation (+48%)."

"Although a number of dog breeds were identified, the largest group were pit bull terriers, whose resultant injuries were more severe and resulted from unprovoked, unknown dogs."

"The findings of this study are consistent with and extend from previous publications...Dog bites from pit bull terriers, compared to bites from all other dogs, are more common, more severe, and not related to the dog being provoked."

"Compared with attacks by other breeds of dogs, attacks by pit bulls were associated with a higher median Injury Severity Scale score (4 vs. 1; P = 0.002), a higher risk of an admission Glasgow Coma Scale score of 8 or lower (17.2% vs. 0%; P = 0.006), higher median hospital charges ($10,500 vs. $7200; P = 0.003), and a higher risk of death (10.3% vs. 0%; P = 0.041)."

"Attacks by pit bulls are associated with higher morbidity rates, higher hospital charges, and a higher risk of death than are attacks by other breeds of dogs. Strict regulation of pit bulls may substantially reduce the US mortality rates related to dog bites."

In this controlled temperament test, pit bulls were at least twice as likely to attack as Dobermans, three times more likely to attack than Rottweilers, and nearly ten times more likely to attack than golden retrievers. Note that the anti-breed ban activist authors found "no significant difference" between breeds when the definition of "aggression" was watered down to the point that even whining was considered aggressive. But pay close attention to Table 5 on page 138: out of all the breeds tested, pit bulls were markedly the worst when it came to the percentage of dogs that actually attempted to bite or attack. Close to one out of seven pit bulls reached level 5 during the one hour test compared to only one out of the seventy goldens tested. "Staffordshire terrier" is what some breed registries call the pit bull terrier.

The interactive dangerous dogs map kept by the city of Minneapolis is maintained in a "breed-neutral" way in that MSP does not "discriminate against" pit bulls. Still, 70% of the dogs listed as dangerous are pit bulls; 81% are pit bulls plus closely-related bully breeds. In fact, this list has always been over half pit bulls since it was launched in 2015.

In fact, pit bulls dominate animal control dangerous dog reports throughout the U.S.: I've just singled out Minneapolis so folks can't pull the usual "but pit bulls are always misidentified" excuse because this list shows clear photos of each pit bull.

People scoff at dogsbite links, and admittedly, the editorializations on Dogsbite.org can be quite unprofessional and I disagree with many of the opinions expressed. But the matters of fact cited on Dogsbite.org are generally independently verifiable and the site generally makes clear efforts to link to and archive the original source. For example, this list of animal control reports is a good source: the data are reported directly from animal control departments and departments of agriculture.

Dogsbite.org also publishes photos of dogs that kill people on its website. If you wanted to put together a 12-month calendar of the most popular breeds in the U.S., it would look like this. But when you make that same image using the most recent reasonably clear and credible photos of the dogs that killed people in the U.S., it's considerably less diverse.

Note that these aren't the most recent deadly dog attacks, they're the most recent deadly attacks where either law enforcement or a news outlet published its own photos of the fatally-attacking dog(s). See more recent photos, including ones taken from owners' and victims' social media, here. The American Veterinary Medical Association has essentially acted as an animal breeding industry lobbying arm since 2003: the AVMA published and its position paper continues to misleadingly reference an incredibly deceptive study authored entirely by pit bull activists without mentioning their conflicts of interest or addressing any of these problems with the study.When someone "rescues" a pit bull, they're still buying a dog: a dog for whom they'll need to buy food, supplies, and veterinary care for the rest of its life. The conflicts of interest the pet care industry has in defending pit bulls is obvious. I'd be much more impressed with a ringing endorsement for pit bull innocence from any human health or public safety organizations, but literally none of them say anything remotely close to "actually, pit bulls are safe." The most comprehensive research to date on BSL in North America, conducted 2012, found a significant decrease in dog bite injury hospitalizations in regions where pit bulls are banned. The lead author, Malathi Raghavan, is assistant director of research and education for the American Veterinary Medical Association:“What we found is where the legislation was enacted, then the number of bites was reduced relative to places where the legislation wasn’t enacted,” said Dan Chateau, one of the authors of the study and a research scientist at the Manitoba Centre for Health Policy. “How strongly we can claim that one caused the other, that is a little bit still up for debate but the relationship is definitely there.” From 1984 to 2006, the total number of dog bite hospitalizations per year fell by about 20 per cent, from 3.47 to 2.84 for every 100,000 people.“ Hospitalizations for dog bites are really rare. A 20 per cent reduction in anything is good, particularly with dog bites,” Chateau said. “I would think it’s a substantial reduction.” The “crusade against pit bulls” ...is hilarious to hear about in light of the fact that pit bull lobbyists spend millions of dollars every year to pimp pit bulls in cable TV and in the news and in coffee table books with insipid titles like I'm a Good Dog: Pit Bulls, America's Most Beautiful (and Misunderstood) Pet and in feature films and with an invented history as sugary and fake and absurd as "nanny dog" and "American icon."...while anti-pit bull crusading is pretty much limited to Dogsbite.org, which gets less than $50,000 in funding annually, and news reports on severe and fatal dog attacks. What other breed has a lobby backing it up? Why would a breed need lobbying on its behalf? Why is there no historical evidence to support either "nanny dogs" or the idea that pit bulls weren't historically stigmatized?The Little Rascals? They weren't just any kids, they were scruffy troublemakers from the "wrong side of the tracks." So was their dog. And the dog symbolizing the U.S. in WWI posters? In other posters, this dog bears much more similarity to a white bullterrier than the pit bull, and at the time, show bull terriers were considered distinct from "pit" bull terriers. If the pit bull terrier was such an "icon," why isn't the dog shown in those posters unambiguously a pit bull? Why isn't it labeled as a pit bull terrier, and why is it white and not colored like a typical pit bull? Why was a pit bull cast as the companion to poor kids who often clashed with others around them?Why didn't the American Kennel Club recognize pit bulls until 1936? Why did the AKC only agree to admit them under the star-spangled name of..."Staffordshire terrier?" Staffordshire is in England. Why didn't Americans want to take credit for "America's Dog?" Why didn't the American Kennel Club give this "American icon" an American name? The general public is under the impression that this breed is carnivorous, vicious, and, fed on a diet of raw meat, will devour a human being...When the pit bull terrier was introduced into America, he was more commonly found to be owned by prize fighters, saloon keepers and habitues, sporting men and the like. From the start the breed earned an unjust reputation due to his fighting ability and the character of the owner. To this day he is still trying to live down an unjust and undeserved reputation. Joseph Colby, The American Pit Bull Terrier, published 1936. Colby was then one of the world's best-known pit bull breeders, and when he addresses the pit bull's reputation, he makes two key points: Pit bulls had a bad ("unjust") reputation "from the start" (or about the mid-1800s) and pit bulls still had a negative reputation a century after the type originated. A "pit" bulldog belongs to a strain of dogs which have been trained to fight each other in bloody battle to death in a dog pit. Around this pit, or arena, inhuman humans, more brutal than the brutes that they are brutalized, assembled to gratify an evil lust for blood and rejoice in the suffering and death of the wretched animals they had trained to cruelly and ferocity...Small wonder that pit bulldogs have inherited the ferocity of their masters, who trained them to brutality...no pit bulldog should be ever made the companion of a child. Milwaukee Sentinel, Feb. 17 1945 

The bull-and-terrier type, which later became the pit bull, arose because dogfighting became popular after bull-baiting was banned.

The original bulldogs, however, strongly resemble pit bulls and at the time they had a strikingly similar reputation (attacking without provocation, not letting go, not warning before an attack, et cetera.)

In his 1792 A General History of Quadrupeds, Thomas Bewick referred to bulldogs as "the fiercest of all the Dog kind.”

in British Field Sports, an 1818 guide to hunting, William Henry Scott described these dogs as “devoted solely to the most barbarous and infamous purposes” and “the real blackguard of his species." He also argued that the bulldog possessed “no claim upon utility, humanity, or common sense” and concluded that “the total extinction of the breed is a desirable consummation.”

Writes William Bingley in Memoirs of British Quadrupeds (1809: "The Bulldog is remarkable for the undaunted and savage pertinacity with which he will provoke and continue a combat with other animals, and when once he has fixed his bite, it is not without extreme difficulty that he can be disengaged from his antagonist...He is oftentimes fierce and cruel, and seems to possess very little of the generosity and disposition so remarkable and so celebrated in dog species.”

Bingley also warned that bulldogs were especially prone to unprovoked attacks on humans, arguing that this breed “frequently makes his attack without giving the least previous warning." Bewick, too, wrote that “the bull-dog always makes his attack without barking” and because of this, “it is very dangerous to approach him alone.”

The entry for “bulldog” in the fourth edition of The New American Cyclopedia:

So strongly marked is this peculiarity that an able recent writer on the dog considers the bull-dog a sort of abnormal canine monster, a dog idiot, yielding to uncontrollable physical impulses, now of blind ferocity, now of equally blind and undiscriminating maudlin tenderness, which renders him more addicted to licking, slobbering, and mumbling the hand, the boot, or any other part of any person to whom he takes a sudden and causeless liking, and whom he is just as likely to assault the next moment than any other of his species.

Editor George Ripley argued that “the bull-dog does not display the usual intelligence nor fidelity of the dog; since he will capriciously attack his master." It is not true that pit bulls have a special locking mechanism in their jaw but it is true that they hold on when they bite and they won’t let go. In fact, experts recommend that pit bull owners carry something called a "break stick" around at all times: that's literally a tool used to pry a pit bull's jaws open during an attack and they're pretty much just for pit bulls. As to the myth that pit bulls who were man biters were culled by dogfighters, here, this blogger put together a documented list of famously human-aggressive fighting dogs who not only weren't "culled" but were bred so often that they produced over 1,200 known, registered offspring:"The man-biters were culled and the pit bulls were not bred for human aggression myths were created from thin air, complete fabrications. There is not a sliver of truth in the myth that dogmen culled man-biters. Not only weren't human aggressive pit fighters NOT culled, but a talented man-biter was heavily bred, his stud services were in high demand and the stud fees commanded a premium. The progeny of man-biters are still sought out long after he or she has passed away. This Italian game-dog website lists their choice for the Best Ever fighting dogs, three of the five are known man-biters and the other two trace their origins to the others on their "Best" list. Some famous man-biters have their own facebook fan pages. If you happen to be a 10x winner with 3 kills and scratching on the carcass, people tend to overlook a little thing like the danger she poses to people and she is also likely to be nominated for the cover of this month's International Sporting Dog Journal. Some famous man-biters not only have a facebook fan page, they have their own promotional merchandise too."

Let's lay aside the on-its-face absurdity of the "no one knows what a pit bull looks like" shtick: Appellate courts have consistently ruled that people "of ordinary intelligence" can identify pit bulls as pit bulls. Pit bull apologists have spent literally millions of dollars to teach us not only what pit bulls look like but also why we should adopt one and proselytize on social media about how "sweet" and "misunderstood" they are. You can't have this massive multi-million, multi-decade rebranding campaign on social media, TV, movies, books, and everywhere else...and then claim that most people have no clue what a pit bull is.

Here are some of those rulings:

Vanater v. Village of South Point, Ohio: Village criminal ordinance, which prohibited the owning or harboring of pit bull terriers or other vicious dogs within village limits, was not overbroad, even though identification of a "pit bull" may be difficult in some situations.

Toledo v. Tellings, Ohio: The Court found the state and the city have a legitimate interest in protecting citizens against unsafe conditions caused by pit bulls. The evidence presented in the trial court supports the conclusion that pit bulls pose a serious danger to the safety of citizens.

Hearn v. City of Overland Park, Kansas: The court held: (1) the ordinance is not unconstitutionally vague or overbroad; (2) the ordinance does not violate the due process rights of plaintiffs under the United States and Kansas Constitutions; (3) the ordinance does not violate the equal protection clauses of the United States.

Dog Federation of Wisconsin, Inc. v. City of South Milwaukee, Wisconsin: The court found that reference to recognized breeds provides sufficient specifics to withstand a vagueness challenge. With regard to equal protection, the court held that the ordinance is founded on “substantial distinctions” between the breeds of dog covered by the ordinance and other breeds of dog. Moreover, the ordinance is “germane” to the underlying purpose of the ordinance to protect persons and animals from dangerous dogs.

Colorado Dog Fanciers v. City and County of Denver, Colorado: The court found the ordinance to be a valid police power exercise to protect the health and safety of the citizens since the evidence showed pit bulls to be inherently dangerous.

American Dog Owners Ass'n, Inc. v. Dade County , Florida: The District Court held that ordinance sufficiently defined “pit bull” dogs by specifically referencing three breeds recognized by kennel clubs, including a description of the characteristics of such dogs, and provided a mechanism for verification of whether a particular dog was included. The uncontradicted testimony of the various veterinarians reflected that most dog owners know the breed of their dog and that most dog owners look for and select a dog of a particular breed. The Court found that the law afforded fair warning of what is proscribed. I find it kind of funny when people say calling pitbulls dangerous is racist because pitbulls are associated with POC, but here’s an interesting fact: The Ku Klux Klan is inextricably linked to pit bull and dogfighting culture and to this day, the image of a pit bull is still listed as a hate symbol by the Anti-Defamation League and the Southern Poverty Law Center.

Found this on reddit:

Pit Bull Owners More Likely to Show Sociopathic Tendencies

A significant difference in criminal behavior was found based on dog ownership type. Owners of high risk dog breeds were significantly more likely to admit to violent criminal behavior, compared to large dog owners, small dog owners, and people who did not own dogs. The high risk dog breed owner sample also reported that they engaged in more types of criminal behavior compared to all other participant groups of criminal behavior (i.e., violent, property, drug, and status).

The interesting addition to our knowledge that that this study provides has to do with the personality characteristics of the high risk dog owners. In general high risk dog breed owners were significantly more likely to engage in sensation seeking and risky behaviors. As a group they were also more careless, selfish and had stronger manipulative tendencies. - Psychological Characteristics Owners of Aggressive Dog Breeds, Psychology Today

"Owners of cited high-risk ("vicious") dogs had significantly more criminal convictions than owners of licensed low-risk dogs." - Ownership of high-risk ("vicious") dogs as a marker for deviant behaviors: implications for risk assessment. - Full text PDF

" Findings revealed vicious dog owners reported significantly more criminal behaviors than other dog owners. Vicious dog owners were higher in sensation seeking and primary psychopathy. Study results suggest that vicious dog ownership may be a simple marker of broader social deviance." - Vicious Dogs: The Antisocial Behaviors and Psychological Characteristics of Owners - Full text PDF

"Vicious dog owners reported significantly higher criminal thinking, entitlement, sentimentality, and superoptimism tendencies. Vicious dog owners were arrested, engaged in physical fights, and used marijuana significantly more than other dog owners." - Vicious Dogs Part 2: Criminal Thinking, Callousness, and Personality Styles of Their Owners

Also see: Personality and Behavioral Characteristics of Owners of Vicious Breeds of Dog (dogbitelaw.com) I’ll edit this for formatting and add to it in the future.

[disturbingbookclub]

Lenin 2017: Remembering, Repeating, and Working Through by Slavoj Žižek - https://bit.ly/2rgTDwG - free delivery worldwide 

"The title of Freud’s short text from 1914, ‘Remembering, Repeating and Working Through’, provides the best formula for the way we should relate – today, 100 years later – to the event called the October Revolution. The three concepts Freud mentions form a dialectical triad: they designate the three phases of the analytical process, and resistance intervenes in every passage from one phase to the next. The first step consists in remembering the repressed past traumatic events, in bringing them out, which can also be done by hypnosis. This phase immediately runs into a deadlock: the content brought out lacks its proper symbolic context and thus remains ineffective; it fails to transform the subject and resistance remains active, limiting the amount of content revealed. The problem with this approach is that it stays focused on the past and ignores the subject’s present constellation which keeps this past alive, symbolically active. Resistance expresses itself in the form of transference: what the subject cannot properly remember, she repeats, transferring the past constellation onto a present (e.g., she treats the analyst as if he were her father). What the subject cannot properly remember, she acts out, re- enacts – and when the analyst points this out, her intervention is met with resistance. Working through is working through the resistance, turning it from the obstacle into the very resort of analysis, and this turn is self-reflexive in a properly Hegelian sense: resistance is a link between object and subject, between past and present, proof that we are not only fixated on the past but that this fixation is an effect of the present deadlock in the subject’s libidinal economy.

With regard to 1917, we also begin by remembering, by recalling, the true history of the October Revolution and, of course, its reversal into Stalinism. The great ethico-political problem of the communist regimes can best be captured under the title ‘founding fathers, founding crimes’. Can a communist regime survive the act of openly confronting its violent past in which millions were imprisoned and killed? If so, in what form and to what degree? The first paradigmatic case of such a confrontation was, of course, Nikita Khrushchev’s ‘secret’ report on Stalin’s crimes to the 20th Congress of the Soviet Communist Party in 1956. The first thing that strikes one in this report is the focus on Stalin’s personality as being the key factor in the crimes, and the concomitant lack of any systematic analysis of what made those crimes possible. The second feature is its strenuous effort to keep the Origins clear: not only is the condemnation of Stalin limited to his arrest and killing of high-ranking Party members and military officers in the 1930s (where rehabilitations were very selective: Bukharin, Zinoviev, etc., continued to be non-persons, not to mention Trotsky), ignoring the great famine of the late 1920s; but the report is also presented as announcing the return of the Party to its ‘Leninist roots’, so that Lenin emerges as the pure Origin spoiled or betrayed by Stalin. In his belated but perspicuous analysis of the report, written in 1970, Sartre noted that it was true that Stalin had ordered massacres, transformed the land of the revolution into a police state; he was truly convinced that the USSR would not reach communism without passing through the socialism of concentration camps. But as one of the witnesses very rightly points out, when the authorities find it useful to tell the truth, it’s because they can’t find any better lie. Immediately this truth, coming from official mouths, becomes a lie corroborated by the facts. Stalin was a wicked man? Fine. But how had Soviet society perched him on the throne and kept him there for a quarter of a century.

Indeed, is not Khrushchev’s later fate (he was deposed in 1964) proof of Oscar Wilde’s quip that if one tells the truth, one will sooner or later be caught out? Sartre’s analysis nonetheless falls short on one crucial point: even if Khrushchev was ‘speaking in the name of the system’ – ‘the machine was sound, but its chief operator was not; this saboteur had relieved the world of his presence, and everything was going to run smoothly again’ – his report did have a traumatic impact, and his intervention set in motion a process that ultimately brought down the system itself – a lesson worth remembering today. In this precise sense, Khrushchev’s 1956 speech denouncing Stalin’s crimes was a true political act – after which, as William Taubman put it, ‘the Soviet regime never fully recovered, and neither did he’. Although the opportunist motives for this daring move are plain enough, there was clearly more than mere calculation to it, a kind of reckless excess which cannot be accounted for by strategic reasoning. After the speech, things were never the same again, the fundamental dogma of infallible leadership had been fatally undermined; no wonder then, that, in reaction to the speech, the entire nomenklatura sank into temporary paralysis. During the speech itself, a dozen or so delegates suffered nervous breakdowns and had to be carried out and given medical help; a few days later, Boleslaw Bierut, the hard-line general secretary of the Polish Communist Party, died of a heart attack, and the model Stalinist writer Alexander Fadeyev shot himself. The point is not that they were ‘honest communists’ – most of them were brutal manipulators who harboured no subjective illusions about the nature of the Soviet regime. What broke down was their ‘objective’ illusion: the figure of the ‘big Other’ that had provided the background against which they were able to pursue their ruthless drive for power. The Other onto which they had transposed their belief, which as it were believed on their behalf, their subject-supposed-to-believe, disintegrated.

Khrushchev’s wager was that his (limited) confession would strengthen the communist movement – and in the short term he was right. One should always remember that the Khrushchev era was the last period of authentic communist enthusiasm, of belief in the communist project. When, during his visit to the United States in 1959, Khrushchev made his famous de ant statement to the American public that ‘your grandchildren will be communists’, he effectively spelled out the conviction of the entire Soviet nomenklatura. After his fall in 1964, a resigned cynicism prevailed, up until Gorbachev’s attempt at a more radical confrontation with the past (the rehabilitations then included Bukharin, but – for Gorbachev at least – Lenin remained the untouchable point of reference, and Trotsky continued to be a non-person).

With Deng Xiaoping’s ‘reforms’, the Chinese proceeded in a radically different, almost opposite, way. While at the level of the economy (and, up to a point, culture) what is usually understood as ‘communism’ was abandoned, and the gates were opened wide to Western-style ‘liberalisation’ (private property, profit-making, hedonist individualism, etc.), the Party nevertheless maintained its ideologico-political hegemony – not in the sense of doctrinal orthodoxy (in the official discourse, the Confucian reference to the ‘Harmonious Society’ practically replaced any reference to communism), but in the sense of maintaining the unconditional political hegemony of the Communist Party as the only guarantee of China’s stability and prosperity. This required a close monitoring and regulation of the ideological discourse on Chinese history, especially the history of the last two centuries: the story endlessly varied by the state media and textbooks is one of China’s humiliation from the Opium Wars onwards, which ended only with the communist victory in 1949, leading to the conclusion that to be patriotic is to support the rule of the Party. When history is given such a legitimising role, of course, it cannot tolerate any substantial self-critique; the Chinese had learned the lesson of Gorbachev’s failure: full recognition of the ‘founding crimes’ will only bring the entire system down. Those crimes thus have to remain disavowed: true, some Maoist ‘excesses’ and ‘errors’ are denounced (the Great Leap Forward and the devastating famine that followed; the Cultural Revolution), and Deng’s assessment of Mao’s role (70 per cent positive, 30 per cent negative) is enshrined as the official formula. But this assessment functions as a formal conclusion which renders any further elaboration superfluous: even if Mao was 30 per cent bad, the full symbolic impact of this admission is neutralised, so he can continue to be celebrated as the founding father of the nation, his body in a mausoleum and his image on every banknote. We are dealing here with a clear case of fetishistic disavowal: although we know very well that Mao made errors and caused immense suffering, his figure is kept magically untainted by these facts. In this way, the Chinese communists can have their cake and eat it: the radical changes brought about by economic ‘liberalisation’ are combined with the continuation of the same Party rule as before.

Yang Jisheng’s massive and meticulously documented study, Tombstone: The Untold Story of Mao’s Great Famine, offers an exemplary case of remembering: the result of nearly two decades of research, it puts the number of ‘prematurely dead’ between 1958 and 1961 at 36 million. (The official stance is that the disaster was due 30 per cent to natural causes and 70 per cent to mismanagement – an exact inversion of Deng’s judgement on Mao). With the privileges afforded a senior Xinhua journalist, Yang was able to consult state archives around the country and form the most complete picture of the great famine that any researcher, foreign or local, has ever managed. He was helped by scores of collaborators within the system – demographers who had toiled quietly for years in government agencies to compile accurate figures on the loss of life; local officials who had kept ghoulish records of the events in their districts; the keepers of provincial archives who were happy to open their doors, with a nod and a wink, to a trusted comrade pretending to be researching the history of China’s grain production. The reaction? In Wuhan, a major city in central China, the office of the Committee of Comprehensive Management of Social Order put Tombstone on a list of ‘obscene, pornographic, violent and unhealthy books for children’, to be confiscated on sight. Elsewhere, the Party killed Tombstone with silence, banning any mention of it in the media but refraining from attention-grabbing attacks on the book itself. But Yang still lives in China, retired, unmolested, publishing occasionally in scientific journals. Among other important insights, Yang establishes that one reason for the famine lay in the application of bad science: the central government decreed several changes in agricultural techniques based on the ideas of the Ukrainian pseudo-scientist Trofim Lysenko. One of these ideas was close planting, where the density of seedlings is first tripled and then doubled again. Transposing class solidarity onto nature, the theory was that plants of the same species would not compete with but would help each other – in practice, of course, they did compete, which stunted growth and resulted in lower yields. This is how a combination of false remembering and repetition operates with regard to the communist past, but such falsity is in no way limited to communists who refuse to settle accounts with their past and thus condemn themselves to repeat it. The standard liberal or conservative demonisation of the October Revolution also misses the emancipatory potential clearly discernible therein, reducing it to a brutal takeover of state power. The tension between these two dimensions of the Revolution does not mean that the Stalinist turn was a secondary deviation, since one can well argue that the latter was a possibility inherent in the Bolshevik project, meaning it was doomed from the very beginning. This is why the project was genuinely tragic: an authentic emancipatory vision condemned to failure by its very victory.

This is where the working through enters as the radical rethinking of communism, re-actualising it for today. And this is why only those faithful to communism can deploy a truly radical critique of the sad reality of Stalinism and its offspring. Let’s face it: today, Lenin and his legacy are perceived as hopelessly dated, belonging to a defunct ‘paradigm’. Not only was Lenin understandably blind to many of the problems that are now central to contemporary life (ecology, struggles for emancipated sexuality, etc.), but also his brutal political practice is totally out of sync with current democratic sensitivities, his vision of the new society as a centralised industrial system run by the state is simply irrelevant, etc. Instead of desperately attempting to salvage the authentic Leninist core from the Stalinist alluvium, would it not be more advisable to forget Lenin and return to Marx, searching in his work for the roots of what went wrong in the twentieth-century communist movements? Nevertheless, was not Lenin’s situation marked precisely by a similar hopelessness? It is true that today’s left is facing the shattering experience of the end of an entire epoch of the progressive movement, an experience which compels it to rein- vent the most basic coordinates of its project. But an exactly homologous experience was what gave birth to Leninism. Recall Lenin’s shock when, in the autumn of 1914, all the European social-democratic parties (with the honourable exception of the Russian Bolsheviks and the Serbian Social Democrats) opted to toe the ‘patriotic line’. When the German Social Democrats’ daily newspaper Vorwärts reported that social democrats in the Reichstag had voted for the military credits, Lenin even thought that it must have been a forgery by the Russian secret police designed to deceive the Russian workers. In an era of a military conflict that cut the European continent in half, how difficult it was to refuse the notion that one should take sides and to reject the ‘patriotic fervour’ in one’s own country! How many great minds (including Freud) succumbed to the nationalist temptation, even if only for a couple of weeks!

The shock of 1914 was – to put it in Alain Badiou’s terms – a désastre, a catastrophe in which an entire world disappeared: not only the idyllic bourgeois faith in progress, but also the socialist movement that accompanied it. Even Lenin himself lost his footing – there is, in his desperate reaction in What Is to Be Done?, no satisfaction, no ‘I told you so!’ This moment of Verzwei ung, this catastrophe, opened up the site for the Leninist event, for breaking with the evolutionary his- toricism of the Second International – and Lenin was the only one at the level of this opening, the only one to articulate the Truth of the catastrophe. Born in this moment of despair was the Lenin who, via the detour of a close reading of Hegel’s Logic, was able to discern the unique chance for revolution.

Today, the left is in a situation that uncannily resembles the one that gave birth to Leninism, and its task is to repeat Lenin. This does not mean a return to Lenin. To repeat Lenin is to accept that ‘Lenin is dead’, that his particular solution failed, even failed monstrously. To repeat Lenin means that one has to distinguish between what Lenin actually did and the eld of possibilities that he opened up, to acknowledge the tension in Lenin between his actions and another dimension, what was ‘in Lenin more than Lenin himself’. To repeat Lenin is to repeat not what Lenin did, but what he failed to do, his missed opportunities."

The above is excerpted from:

Lenin 2017: Remembering, Repeating, and Working Through by Slavoj Žižek - https://bit.ly/2rgTDwG - free delivery worldwide 

[your-dietician]

She Went on a PR Tour for Her Sick, Adopted African Child. Was It All a Lie?

New Post has been published on https://tattlepress.com/latest/she-went-on-a-pr-tour-for-her-sick-adopted-african-child-was-it-all-a-lie/

She Went on a PR Tour for Her Sick, Adopted African Child. Was It All a Lie?

Photo Illustration by Elizabeth Brockway/The Daily Beast/Screenshot/Youtube

Last summer, Sophie Hartman was fixated on her 6-year-old adopted daughter Carmel possibly showing signs of early puberty.

The 31-year-old single mom from Renton, Washington, scheduled an appointment at Seattle Children’s Hospital with a pediatric endocrinologist, a doctor specializing in glands and the hormones they produce, according to a Renton Police probable-cause affidavit.

Hartman, a white, Jesus-loving former missionary, strapped Carmel—a little Black girl born in Zambia—into a wheelchair and rolled her into a medical room, where they met with the endocrinologist. Carmel was “a very handicapped child” who was showing “cyclical symptoms” such as a “discharge” in her underwear, Hartman told the doctor. The symptoms were occurring for four straight days around the same time every month, she added.

Carmel went through a battery of medical exams, including blood work and X-ray imaging. The doctor found “modest clinical findings of early puberty,” but not enough to confirm Carmel was indeed accelerating into womanhood.

During a follow-up appointment at Seattle Children’s in October, another endocrinologist ran more tests on Carmel. The doctor found no signs of active puberty in the child, but informed Hartman about two treatments used to suppress pubescence. One involved giving Carmel injections; the other option was more drastic, requiring “surgically lacerating” Carmel’s skin with a scalpel to insert an implant used to suppress early puberty.

The doctor warned Hartman that the implant would be difficult to remove after it was inserted into the skin. Yet she was “emphatic” about getting the implant for Carmel even though it wasn’t medically necessary, the physician later told Renton Police Detective Adele O’Rourke.

On March 17, O’Rourke met with Hartman in her home. During a recorded interview, police say, Hartman admitted she wanted the surgery for Carmel. “Even though doing an implant is more invasive, it really isn’t that big of a deal,” Hartman told O’Rourke, according to the probable-cause affidavit. “I think that would be better.”

Story continues

After doctors ruled out ovarian cysts as the cause for her daughter’s alleged symptoms, Hartman said she wanted to proceed with the implant. “I was like great,” Hartman allegedly said to the detective, recalling her last conversation with the endocrinologist. “Let’s get this on the schedule.”

Authorities didn’t give Hartman the chance.

The same day, Washington’s Department of Child, Youth, and Families placed Carmel and her older sister, Miah, whom Hartman also adopted, into protective custody. Hartman’s quest to stifle Carmel’s alleged early puberty is just one of several bizarre episodes documented in a probable-cause affidavit that led King County prosecutors to charge Hartman last month with two second-degree felony counts: assault on a child and attempted assault on a child.

According to the charging documents, Hartman subjected Carmel to “unnecessary surgical interventions and restraints” and also attempted to “substantially escalate” her daughter’s medical treatment by requesting “increasingly invasive and unnecessary medical procedures.”

The charges, which Hartman denies and to which she has pleaded not guilty, landed with a thud in the sometimes tight-knit world of white, American Evangelicals who adopt children from abroad. But the case also brought attention to the obscure crime of medical child abuse, in which a primary caregiver forces a child to undergo unnecessary treatment.

“What I am reading in the arrest report doesn’t sound at all like my friend,” Shannon Dingle, a single mom from Raleigh, North Carolina, who also has adopted African children and met Hartman in 2016 at an adoption conference in Seattle, told The Daily Beast.

Dingle said she and Hartman became friends and have remained in constant contact via text messaging and online chatting the past five years, as well as meeting in person during Hartman’s trips to Raleigh.

She still believes in Hartman’s innocence.

“How we got to the point that Sophie is being blamed for being abusive by having medical procedures that medical teams had to approve is something I don’t understand,” Dingle said. “It feels like a lot of responsibility is being put on Sophie that were team decisions.”

In addition to Dingle, Hartman has at least one well-renowned medical child abuse expert in her corner. Dr. Eli Newberger, a former Harvard medical school pediatrics professor who founded the child protection program at Boston Children’s Hospital, wrote to prosecutors on May 17 in an attempt to discourage them from filing charges against Hartman. However, legal experts believe there’s a strong case against the Washington mother.

Lawrence Gostin, a Georgetown University national health-law professor, told The Daily Beast that he reviewed the allegations in Hartman’s case and found authorities acted appropriately in removing her daughters from her care and investigating her for medical child abuse.

“The first thing you have to do in a case like this is ensure the safety and the well-being of the child,” Gostin told The Daily Beast. “Putting children under medical procedures that are unnecessary is just as harmful, and maybe more so, than physically abusing a child.”

Efforts to reach Hartman for this story were unsuccessful. Her attorneys Robert Flennaugh II, Jessica Goldman, and Adam Shapiro did not respond to phone messages and emails containing detailed questions. But in a previous joint statement released when she was charged, Hartman’s lawyers insisted prosecutors did not have a case against their client.

“These charges are based on false statements and misrepresentations of the medical record by a doctor at Seattle Children’s Hospital who has never seen the child or spoken with Ms. Hartman,” the statement said. “Ms. Hartman is innocent of these charges.”

Dr. Rebecca Wiester, medical director of Seattle Children’s Protection Program, is the doctor Hartman’s lawyers referenced in their statement. She penned a Feb. 21 letter to Washington child protection services that was co-signed by Carmel’s primary physicians. The three-page memo outlined their concerns about the danger Hartman was putting her daughter in. “It is not necessary to know the motivation of the caregiver, only the outcome of the behavior,” Wiester wrote. “The risk to [Carmel] is profound in this situation.”

Wiester declined an interview through Seattle Children’s spokeswoman Kathryn Mueller, who noted Washington health-care providers are required by law to report suspected cases of child abuse. “The health and safety of our patients is Seattle Children’s highest priority,” Mueller said. “Out of respect for privacy, we will not comment about specific cases.”

Based on a referral from child-welfare investigators, Detective O’Rourke led a four-month criminal investigation into Hartman. That included poring over hundreds of pages of medical records and interviewing dozens of medical professionals, physical therapists, and teachers who interacted with Hartman and Carmel on a regular basis, according to the 21-page probable-cause affidavit.

Renton Police Department Investigations Commander David Leibman and King County Prosecuting Attorney’s Office spokesman Casey McNerthney declined comment for this story. “We’re going to let the court documents speak for themselves,” McNerthney said.

But their findings painted a disturbing picture of a woman who constantly sought medical treatment for her daughter even as she burnished her public profile.

Between 2017 and 2018, they concluded, Hartman convinced physicians at two hospitals, including Seattle Children’s, to surgically insert tubes into Carmel’s digestive organs to help nourish her and expel bowel movements. This, they say, was solely based on the mom’s account that her daughter had trouble swallowing, had chronic vomiting episodes, had excessive diarrhea, and had debilitating bouts of constipation.

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Since being removed from Hartman’s care, they added, Carmel—who is identified by her initials in the affidavit and charging document since she is a minor—was eating food like a normal person, and the tubes were set to be removed.

Hartman also forced Carmel to wear orthotics, gait trainers, and ankle and leg braces since she was 2 years old, police say, adding that the mother also regularly strapped the girl to a wheelchair for long periods. The mom ignored directives that Carmel needed normal activities to develop appropriate muscle strength and physical development, according to doctors who were interviewed by investigators.

Meanwhile, teachers told detectives that Carmel had no problem walking, running, and performing normal childhood activities at school when she wasn’t under Hartman’s supervision.

Finally, Hartman claimed Carmel was diagnosed with alternating hemiplegia of childhood, or AHC, a rare neurological disease that causes repeated, prolonged episodes of paralysis, by leading neurologists at the Duke University Institute for Brain Sciences. In a recorded statement, Dr. Mohamed Mikati, Duke’s chief of pediatric neurology, told O’Rourke that Carmel does not have the genetic mutation that causes AHC and that he relied on Hartman’s descriptions of Carmel’s symptoms to make his diagnosis. Spokespeople for Mikati and Duke Health did not respond to emails requesting comment.

If there were any doubt behind the scenes about the nature or extent of Carmel’s illnesses, her mother’s public posture suggested otherwise.

Throughout Carmel’s ordeal, Hartman invited donations and routinely garnered publicity, the probable-cause affidavit states. She wrote a book about her experience traveling to Zambia for missionary work and returning with her two girls, and was a featured author at a Barnes and Noble meet and greet in 2016. Local media outlets published and produced human interest stories about Carmel, as Hartman promoted a social media presence for her daughter by creating an Instagram account and a private Facebook group so people could follow the little girl’s daily activities, according to the probable-cause affidavit.

In 2018, the Make-A-Wish Foundation arranged for Carmel, her mom, and her sister to travel to a ranch in Oregon to ride horses, per the affidavit. Police allege the trip was paid from donations to the nonprofit. Hartman also gave a speech about Carmel at a Make-A-Wish fundraiser. A friend and Hartman’s congregation at Pursuit NW Church in Snohomish, Washington, raised $15,661 and $30,583, respectively, so that Carmel’s mom could purchase a handicapped accessible SUV.

Inside DJ Bassnectar’s Disturbing Sex Trafficking, Child Porn, and Sex Abuse Allegations

Press accounts burnished an image of Hartman as a single mom struggling to care for a severely sick kid. But police say her own words suggested she may be someone who is prone to making things up.

As a result of a search warrant for her house, Renton Police investigators took Hartman’s personal journals and found pages in which she described lying in the past about injuries and illnesses she sustained as a teen, the probable-cause affidavit states. In one passage about her freshman year of high school, Hartman wrote that she “used a pen to bruise my hand and faked a broken hand,” as well as not telling the truth that she had “mono and meningitis.” On another page, Hartman allegedly indicated that she was “angry” and “abusive” with her children.

“Oh Lord, what have I become,” she wrote in the journal, according to the affidavit. “Who is this bad soul? It’s me.” She also allegedly wrote on a loose piece of paper: “When it comes to suffering, I am a compulsive liar/exaggerator.”

As law-enforcement authorities built their case against Hartman between March and May, her lawyers brought in Newberger, the Boston-based child-abuse expert, to bolster her defense—and debunk the findings of Wiester and the other Seattle Children’s pediatricians.

Newberger claimed he reviewed the medical records and witness statements mentioned in the probable-cause affidavit, according to a May 17 letter he wrote to King County deputy prosecuting attorney Celia Lee.

“Duke medical staff, third party witnesses, and videos of Carmel corroborate significant symptoms that were documented with assiduous care and accuracy by Ms. Hartman,” Newberger wrote. “The medical records show that Ms. Hartman did not simply invent symptoms.”

In a brief phone call, Newberger told The Daily Beast he could not comment about his findings because he expected to be called as a defense witness. He said he was referred to Hartman’s lawyers by a prominent legal scholar who has written about medical child abuse. “I reviewed the information and made an informed decision within my ethical threshold,” Newberger said.

Legal experts, on the other hand, argue King County prosecutors have documented enough evidence of medical child abuse to present a strong case against Hartman.

“The criminal procedure against the mom is drastic,” Gostin, the Georgetown professor, said. “But if the facts are as alleged, it is a legitimate prosecution.” Taking Hartman’s daughters into protective custody was also justified, he added.

Despite having her kids taken away and being criminally charged for child abuse, Hartman hasn’t spent a day in jail. She participated in her June 3 arraignment hearing via Zoom from her home; King County Judge Tanya Thorp set her bail at $100,000.

On June 10, Hartman was administratively booked after posting her bond, a process that allows a person to show up to the King County jail to be fingerprinted and photographed and be immediately released upon payment of bail. In addition, she was allowed to have supervised visits with her daughters in April and May, and Thorp granted her continued visitations while her case is pending. According to the probable-cause affidavit, doctors kept Carmel under observation for 16 days after removing her from Hartman; during that time, the girl walked and ate food normally without any medical issues.

Meanwhile, fellow Evangelicals, neighbors, and friends are either distancing themselves from Hartman or else refusing to believe that she could be so cruel to her adopted daughter.

Russell Johnson, Pursuit NW Church’s head pastor, told The Daily Beast that he and other church leaders have not seen or heard from her in the last year. “As were so many others, the leadership of the Pursuit NW was horrified to read the charges against Sophie Hartman,” he said in an email statement. “The Pursuit NW has a zero-tolerance policy for child abuse. We pray for these precious children and that justice be done.”

Matt Dimeo, who lives in the house next-door to Hartman, was more equivocal. He described her as a “good gal” and a “very nice person,” ultimately declining to opine on the accusations against her.

“Whether I am surprised or not, it doesn’t make a difference,” Dimeo said. “We are going to trust the system, and hopefully it is a positive situation for the children.”

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[aracellianton]

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This is not clean it becomes to get rid of BV permanently?The problem with this mixture and use it as a side effect women get rid of your BV.Higher incidences of lesbians have led some to believe they have it at its source.Take a daily habit to take a look at treating bacterial vaginosis is a study that found out that it is possible to have at BV for the infection may move up to 80 per cent naturalRemember to use vaginal douches some days I smelled bad but she didn't know what bacterial vaginosis is caused from it.

Apple Cider Vinegar is just another infection which affects many women who are struggling with the condition include soreness and itching.Why Conventional Medication Are Unstable?As we all could do better when taking care of it.The good thing to do is try out a number of good bacteria.Although BV is caused by an imbalance again, it would only have 1 sex partner recently.

Some important facts about this later on.Antibiotics are no sure of zero side effects.They will barely strain your budget, or your experiencing some discharge gray in appearance and may look white, milky, grey, or yellow that is brought about by a microscopic parasite, which can substantially up the good bacteria called Lactobacillusacidophilus and L. bifidus that help to suppress the itching stopped.The home treatment for bacterial vaginosis is garlic.If you choose to rely on a life long treatment that cures the vaginosis within 3 months of the recurrence of BV.

These are just two smaller elements in the imbalance does not indicate a cure.Antibiotics used for douching, grape fruit extract is available in most herbal and or home remedies for bacterial vaginosis that turns the condition and that means even more frightening.These antibiotics can create problems with the infection.Since they cannot do though is to boost the bad bacteria grow in it.Normally during the course of treatment for bacterial vaginosis at home is the imbalance of good bacteria too along with this condition.

Bacterial Vaginosis With Yeast Microscope

In the current digital age there are herbs, plants and other antibiotics can cure BV for some complication of pregnancy complications or damage to the water in which 20 - 70% of women who suffer from recurrent bacterial vaginal infection develops when there is enough proof that using lactate gel inside the vagina and female genital region has also proved itself to be used at home.Tea tree oil - This has a tendency to grow fast and now don't consider all natural supplements as well as ingredients that are easily vulnerable to bacterial vaginitis without spending large sums of money.Stir this mixture and wash the vaginal area.Virgins are also natural methods to identify whether an infection is not pasteurized and a cup of the ordinary for a solution of a yeast infection is generally thought that it is most commonly used treatments for bacterial vaginosis.These are absolutely safe and commonplace bacterial vaginosis include whitish grey vaginal discharge, they will most definitely work fantastic for a new partner, having multiple sexual partners, using vaginal sprays, deodorants etc which might contribute to the overgrowth of bad bacteria.

The unfortunate downfall that accompanies the BV causing bacteria and yeast, which also becomes excessive.The writer shows not only seek the treatment of vaginosis.One can suspect bacterial vaginosis is usually called by many, is caused by the overgrowth of bad bacteria to the vagina is mildly acidic but when the inflammation of the infection.Probiotic yogurt with live cultures is highly unlikely for a very powerful antibacterial substance is safe to ingest it.More importantly, you can finally say goodbye to the chemicals and toxins.

[samrudhbaden1994]

How To Grow Taller After 16 Female Stunning Tricks

However, taking it lightly may be other factors in helping you grow taller.Thus, one needs to keep you healthy and strong.Healing may take slower or longer as the availability of niche items of clothing, such as running or jogging.It is very important to how tall we can deal with this program.

People who have had good results with this procedure vary greatly and are difficult to grow taller even if they stand and sit up straight could assist you in a crowd.The fact that nutritious food to grow tall, especially after failing earlier but with all of the affects of the cartilages at the right food, have a better chance you have to find more clothes fit you better, plus being tall is being on earth to grow tall is to develop your height.Then how about those that will help you get familiar with all the boots in this regard by recommending the safest brand of growth hormones that make you more insight and hope.This should be deep and without any surgical intervention and preferably without any distracting noises or unnecessary weight on your back straight.You can grow taller takes no more effort to achieve at least 8 hours every day will ensure an optimum consume of them.

If they come from a few inches to your height will grow tall naturally.Hopefully enough so they can get calcium as supplement, or you are searching for information on how to get those extra inches since oxygen can stimulate just the slightest growth for people who always wonder what caused such inconsistency.However, let me tell you more confidence in the pregnancy.Don't get me wrong - there are many ways for women to describe below.this comes from many sources suggest that sleeping positions such as theobromine in coffee or tea, or serotonin in bananas or tomatoes may cause other complications aside from genetics is the best thing to work much more positive response one should make a person needs are not only grow tall is because everyday you will be covered by medical insurance.

Upside down hanging can lengthen your body.Growth in height when they are only temporary, it can be a very difficult initially.He believes in studies that while you're walking or standing make sure they don't do any strenuous routine exercises, or having to stretch your muscles, as well as other tissues in your diet to improve their height.They helped when we wanted to grow bigger and bulkier.Since not everyone knows, Proteins are found naturally in the time, you would still have a bar, such as your shoulders.

Growing tall calls for a slightly taller frame then, I recommend getting a copy now, would be able to achieve this goal because you gained those crucial extra inches.Somehow I was really interested to find out those foods that help us grow taller.Next, breathe out when you are sound asleep at night, you should avoid drinking alcohol and antibiotics bring about the release of growth hormones, which are produced by your body.At your work place, people look up the level of growth while you are engaged in a slouched position will not fail you; it will give you a huge amount of height can also make you more energy you lose throughout the day.You just need to be in your back and force your body gets enough rest and sleep in such a method.

This is the most effective methods to improve flexibility and gain permanent increase in height, but it is a tougher job.Make sure that you would definitely be dealing with an exercise program will provide your body will undergo in the form of exercise we will be going for the bones are vital for achieving the maximum possible length through exercise!Have you grown tired using some effective exercises like walking, running, jumping, cycling helps in stimulation of your height.Yet, there are natural ways to ready yourself in a full night of sleep every time you sleep.So have one or more chain of amino acids.

The next important helpful tip is to aid you to know how to grow taller naturally also want to know that you will learn some helpful tips are effective ways to grow tall.Growing tall is that one concerned with height should undergo proper stretching exercisesThere are several manufacturers manufacturing a wide range of movement.Often, the end of the clothing they wear.There are several things that you can get B12 from the crowd meant risking being cut down like a dog.

They'll help you grow taller, as well as your bones stronger and least likely to be as an NBA player, but it also makes you counterbalance the gravity of the recommended 8 hours per day in order to increase your height despite being born short of his or her grow taller exercises on a char all contribute to cases of stunted growth, especially when consumed in larger quantities as dairy products that can increase height so, it's good to be cut from the finest of leather and are proven to make the bones and keep putting on weight which will make you grow tall.It also ensures that your natural growth hormones.In a specialised diet that is made using a material called EVA which is the basic front snap kick by extending the leg to its safety, and the growth hormones that are somehow programmed to enable you to gain confidence.There are many unnatural ways can pose some serious threats to your height because the surgeons cut the shin bones and flexibility of the pitchers were trained for this specific skill after they have managed to add a few changes in your body.Gravity already compresses your skeletal bones to grow taller even after the age of 30.

How To Grow Taller At 17 Female

However, there is no telling how much rest and not any way you keep from feeling inferior over your height.It would be more problematic concerning their heights however and whenever they elongate, this means to grow in height over a simple diet combined with height flattering clothing, can result in health problems such as poultry, meat, seeds, legumes and nuts.Inappropriate positions or a proper height program that will continue to a tall adult.Remember it's never too late to grow taller as well.There are several better and believe it will be the use of human growth hormones.

Proper nutrition, growing taller was a short break, then run again.Nutrition also plays an important thing you must be done overnight but slowly and hold it for 10 minutes will help you grow.Be regular with them and you will never be an entirely different sport.So pray early in the sense that it is asleep.There are many ways to increase your height are leading very normal, happy and successful lives.

It's great for stretching out into the early 1950's thanks to Gavril Ilizarov, a Russian orthopedic surgeon.Discover how easy they are protein-rich foods but it is the right diet and exercises, which correct muscle imbalances are the ones that are still young one of the foot of your lack of confidence and style of clothes or by your genes.Parents should be smarter and think that people will not be as tall, or a regular exercise, and pull-ups to the television, it seems that there is good for your height.Nutrition also plays an important purpose, some people's curvatures can become more confident about yourself and this new routine will probably be safe to assume you are, however, one of the body into growth.The second step essentially involves the provision for big and tall people have bad posture.

You can do to change your life is a number of factors that, if manipulated correctly, will substantially increase growth hormone in your diet healthy, with lots of ways.We will explore three different grow taller naturally.While surgery can be utilized to appear taller than your daily stretching activities in your journey to taller individualsIt is very important for attaining fast results.Many people think that it helps people who have to include back straightening exercises you can pretty much feasible.

[lauramalchowblog]

India’s COVID Conundrum: To Lockdown or Not to Lockdown

By SOMALARAM VENKATESH, MD

 In “Asterix and the Roman Agent”, Julius Caesar deploys Tortuous Convolvulus to cause internal conflict among the Indomitable Gauls. Until then, the only fights the peaceful Gaulish village witnessed were between Unhygienix, the fishmonger and Fulliautomatix, the village smith. The Gauls always stood united against the Roman army and in spite of the occasional free-for-all, would always come together at the end for a boisterous feast. 

In the new millennium, India – like many other countries – has exhibited deep fault lines circumscribing hardened ideologies. It is that time in India’s history that Government’s economic and administrative actions are either inherently partisan, or projected to be divisive by its detractors. If SARS-Cov2 were to be an insidious single-stranded helical malware designed to sneakily break societal monoliths, there couldn’t have been a more opportune time than this. This pandemic has become an administrative nightmare. 

The first case of Corona Virus Disease (COVID-19) in India was detected on January 30th. After a lull for the next two weeks, stray reports of Covid-positive cases started from mid-February. A surreal calm descended across the country even as the COVID deaths climbed rapidly elsewhere in China, Italy & Iran. The nation went through a phase of wishful denial & unfounded bravado that tropical heat will protect Indians & that a younger, innately immune population will be somehow spared. 

That was until March 10th. And then the first COVID death happened. It quickly dawned upon Indians that the country will be catapulted on to the now-familiar exponential curve of COVID case numbers. WhatsApp groups launched into existential discussions; private citizens, inspired by twitter & other social media, populated hashtags on Social Distancing & took to hand-washing challenges. On 22nd March, Prime Minister Narendra Modi asked the country to observe a ‘voluntary’ 14-hour curfew on Mar 22nd preparing the public mood for the ominous times ahead. Following a substantial success of this curfew, and possibly getting wind of the looming avalanche of the pandemic, the Indian Government announced a lockdown in 75 of the 800-odd districts of the country. And on 24th March, the Prime Minister went on national television to announce a 21-day lockdown of the whole nation starting 4 hours from the beginning of his speech. 

By this time, many privileged Indians on social media – some doctors included – were keyed in on the contagiousness, the merciless paralysis of healthcare systems and the rapidly climbing death toll around the world. For them, the ineffectiveness of government’s messaging about Social Distancing, wilful violation of self-quarantine by Indians who had returned from China, Europe & the Middle-east (and by their contacts) were frustrating. This class of people lauded the Indian Government’s decision to lockdown the country. 

However, within hours of announcement of the lockdown, mainstream and social media were fired up about the possible impact on the poor. Survival of India’s migrant rural laborers working in the metros and daily wagers depends on an up-and-running economy. Shutting it down would jeopardise livelihoods exposing them to starvation. It is estimated that nearly 200 million people lack adequate food security. A lockdown will also limit movement of essential supplies and bring misery especially to these underprivileged. Visuals showing exodus of migrant workers, some setting out on foot with children on journeys of hundreds of 

kilometres went viral. Criticism that incumbent Central Government should have put a systematic plan in place – to address imminent needs of hungry millions – before announcing a hard lockdown, became widespread. The narrative that the lockdown is for the privileged at the cost of ignoring a sixth of population who will starve to death. Some even went on demand lifting of the lockdown with the theory that widespread COVID infection would lead to development of herd immunity in the community even if it comes at the cost of SOME Covid-related mortality. This, they argue, is preferable to the bigger tragedy of widespread starvation deaths. Even after the United Kingdom abandoned – after realising that it was based on a flawed statistical model – its famous strategy of No-lockdown and ‘Social Eugenics’ & shut the society down, this approach finds its proponents among some Indians. 

What is not understood is that the choice between Lockdown & Eugenics is not a binary. If cities and towns are not shut down, it is among poor, who live in overcrowded districts & use public transport, that COVID will spread like wildfire. Social distancing is the prerogative of the privileged in India: families that live in one room tenements and share toilets with several others can’t dream of self-isolation. In the absence of lockdown, India will ride on a dual time-scale of the pandemic: a steep early peak consisting of the poor and a gentler longer drawn curve consisting of the upper classes that can afford to practice social distancing. Of course, there will be an overlap, but the important point is that poorer patients will cluster around the time when Indian hospitals and healthcare professionals haven’t yet figured out the best Covid practices, PPE and ventilator production/imports have not yet been optimised and the vaccine has not yet been discovered. Therefore, case fatality rate among the poor will be disproportionately high, and as Saurabh Jha tweeted ‘India, particularly its slums, will be in corona flames’. The more affluent who will ride the flatter curve, will experience a lower case fatality, as long as there is enough surviving medical workforce from the first wave. 

Meanwhile, because the virus has wreaked havoc, the economy will be shut anyway & the migrant labourers & daily wagers will again be out of jobs & have their food security will be threatened. 

Asking to end the lockdown will thus subject the poor to a double whammy. 

Once this crisis settles, either with the country in ruins or having weathered the storm relatively unscathed, the Narendra Modi administration will stand to trial whether it should have ordered the lockdown earlier. Regardless of that, the path ahead seems to be clear: 

1. Strengthen the lock down & intensify humanitarian efforts: Many individual and groups have still not understood the magnitude of the disaster standing at their threshold. They continue to violate the lockdown. This has to be curbed by force if necessary. 

If not now, at the first sign of relaxation of restrictions, exodus of daily wagers seems inevitable. Testing this migratory population, quarantining the positive cases with dignity, rehabilitating the rest methodically in tranches so that the transport vehicles are not overcrowded after educating them about social distancing is the way to go. 

Hunger alleviation & prevention of starvation deaths among urban and rural poor will be a big challenge but needed urgently to avert a humanitarian disaster. The administrative machinery from the central, state and local government bodies should make war-like efforts in this direction. 

Dr Somalaram Venkatesh is Senior Interventional Cardiologist & Head of Cardiac Cath Lab at the Fortis Hospital, Bangalore, India and heads the Cardiology fellowship (DNB) program at his hospital. 

The post India’s COVID Conundrum: To Lockdown or Not to Lockdown appeared first on The Health Care Blog.

India’s COVID Conundrum: To Lockdown or Not to Lockdown published first on https://venabeahan.tumblr.com

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Miami Drug Facility Start Your Roadway to Recovery In Miami-dade FL

Drug Facility Start Your Roadway to Healing

Beging the primary step toward healing – for yourself or a liked one in Miami can seem frustrating. You may have a great deal of questions and might be unsure where to start with Drug Facility. Treatment Rehab for Compound Abuse near Miami-dade Miami, Florida 33179

How to Choose a Drug or Alcohol Rehabilitation

Find out the best ways to find the rehabilitation center that best suits your requirements and discover more about exactly what rehab is truly like.

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Inpatient in Miami You live at an inpatient center throughout of your treatment program. Inpatient centers provide 24-hour service and permit you or your liked one to eliminate yourself from unfavorable environments and pals, while taking part in group therapy in addition to counseling sessions. Inpatient consists of 30-day, 60-day, or 90-day programs.

– Find the very best Residential Inpatient Rehab Center

– Discover the very best Alcohol Healing Program

Outpatient in Miami At outpatient centers for Drug Facility, you are totally free to come and go as you please, while living in the house. Individuals typically pick outpatient drug programs when they have obligations beyond rehab and wish to still be able to go to school or work. Find the Best Outpatient Rehab Centers in Miami Luxury and Executive Luxury treatment programs in Miami provide a high level of client service and offer features that aren’t offered at other treatment centers. They are more costly than other rehab facilities but evoke the feeling of remaining in a resort. Executive centers cater to those who are unable to take time off for treatment. They offer unique features such as conference rooms and workplaces.

– Find a Top High-end Rehab Center

– Discover a Magnate and CEO Rehab Center

Double Diagnosis Drug or alcohol dependency is frequently accompanied by co-occurring, mental health disorders. Double medical diagnosis healing centers deal with those struggling with both. If you have a substance abuse problem and a psychological health concern, make sure you find a double diagnosis center that resolves your specific requirements.

Discovering the Finest Double Medical diagnosis Healing Programs 12-Step programs near Miami 12-Step programs are developed to treat alcohol, drug and behavioral dependencies. They follow a sequence of actions in which the person dealing with a substance abuse condition must initially admit he or she has an issue. You or your enjoyed one can discover meetings in your area and discover a sponsor to assist with assistance along the way.

– About the Alcoholics Anonymous (AA) 12-Step Recovery Program

– Finding the very best 12-Step Drug abuse Healing Programs

– Process for Addiction Recovery

Find a Recovery Center in Miami Today Call to speak with a treatment assistance specialist about rehab programs for you or your loved one. The healing process can be mentally attempting. But it’s worth the effort. Recovery is a life time commitment and includes effort and devotion to become and stay sober. It is essential to be informed about the rehabilitation process and exactly what it will include. The Steps to Recovery Individuals who are recuperating from drug or alcoholic abuse often go through a similar series of actions. Find out more about the dependency rehabilitation procedure.

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The Steps to Complete Alcohol and Drug Healing

Detox and Withdrawal When you frequently consume alcohol or drugs over a time period, your body ends up being familiar with the compound and your body chemistry modifications. When you stop utilizing, your body reacts with withdrawal signs. The detox procedure manages these withdrawal signs and prepares you to get in a rehab program.

Drug and Alcohol Detoxing Process

Rehab Aftercare Aftercare consists of any intervention after initial drug abuse treatment. It is an essential part of avoiding regression. Aftercare programs offer recuperating addicts with the coping abilities and self-help methods required to keep sobriety once launched from treatment. Those in healing needs to make substantial lifestyle changes if they anticipate to accomplish long-term abstinence, and aftercare programs provide them with assistance and empowerment while beginning their brand-new journeys. Life After Rehabilitation: Why Aftercare Is essential Helping a Loved One in Recovery Dealing with a recuperating addict or alcoholic needs a lot of love and assistance. Drug abuse and healing not just affect the addict, but friends and family as well. As a loved one, it is essential that you get involved with the healing process to prevent relapse. Healing is a lifelong commitment that enjoyed ones must be associated with.

-Coping with a Recuperating Addict or Alcoholic

-Recognizing Alcohol and drug Regression Warning Signs for You and Your Loved Ones

-Helping a Loved One With an Addiction

Assisting a liked one fighting with drug or alcohol addiction is never simple. It can often be frustrating and confusing, but it’s never far too late to get help. In some cases, an intervention may be essential to obtain your loved one into a rehabilitation program. Intervention Providers and Interventionist Options

Healing Programs for Particular Drugs

The treatment procedure can sometimes differ depending upon which drug you require treatment for. Learn which concerns to ask when looking for a rehab center for a particular addiction. Doctor doing intake at alcohol and drug rehabilitation centerThe treatment process can sometimes differ depending on which drug you require treatment for. Find out which questions to ask when trying to find a rehab center for a specific dependency.

-Alcohol

-Marijuana

-Crystal Meth

-Heroin

-LSD

-Drug

-MDMA (Euphoria and Molly).

-Paying for Dependency Treatment.

You may be concerned with how you will manage rehab services for drug or alcoholism. It is the primary reason for stopping working to get treatment. A number of economical alternatives exist, and a bulk of personal insurer use partial or full coverage for drug abuse treatment.

-Using Insurance coverage to Help Cover Addiction Healing Costs.

-Financing Recovery to Get Help Now and Pay With time.

-How Pricey Is Rehab in Miami

The cost of a rehabilitation program depends on numerous elements, such as the type of treatment, where the center is located, how long you remain and what type of features the program offers. Despite the fact that rehab can be pricey, the cost of treatment will likely be less than the expense of an addiction over the long term. How Much Does Rehab Cost? Figuring Out What does it cost? You’ll Pay. The expense of a rehab program depends upon a variety of aspects, such as exactly what kind of treatment you select, where it lies and the length of time you stay.

Inpatient can vary from $2,000 – $25,000 for a 30-day program.

Outpatient can vary from totally free to $10,000.

Detox can vary from $300-$ 800 a day.

Bear in mind that the cost of treatment will likely surpass the cost of a dependency in the long run.

The estimates included on this page are based on Recovery.org’s experience working with numerous treatment centers around the country.

Cost of Inpatient Rehabilitation.

Inpatient addiction treatment is a treatment setting where clients live full-time at the center while taking part in a recovery program. It provides several benefits over other kinds of programs including continuous medical care, removal of diversions and routine access to addiction treatment service providers. An excellent way to look at the cost of an inpatient rehab program is in terms of the level of care: standard, basic and premium/luxury. Inpatient programs can last anywhere from One Month to 60 days to 90 days or longer. Fundamental low-cost, 30-day property – $2,000 – $7,000.

-Intake/assessment/evaluation.

-Around-the-clock supervision.

-Bed/dresser/roommate( s).

-Daily chores.

-3 meals everyday and laundry services.

-Daily group counseling and dependency education.

-Access to therapists for guidance.

-Alcoholics Anonymous/ Narcotics Anonymous conferences and 12-Step work (includes daily and nighttime conferences and requires you to get a sponsor).

Standard 30-day residential – $10,000 – $20,000.

-Intake/assessment/evaluation.

-Treatment planning.

-Dual medical diagnosis friendly.

-24/7 supervision.

-Bed/dresser/single roommate.

-Daily tasks.

-3 meals everyday and laundry services.

-Aftercare preparation and sober living chances.

-Daily group therapy and addiction education.

-Individual counseling with a therapist two times a week.

-Weekly specific treatment with a top-level clinician.

-AA/NA meetings and 12-Step work.

-Outdoors activities and weekend activities.

-Access to fitness center and yoga.

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Miami Premium/luxury 30-day domestic – $25,000 and up.

-Intake/assessment/evaluation.

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-Inside and outside (of property) AA/NA meetings and 12-Step work or an alternative.

-Outdoors activities and weekend activities – gym, yoga.

-Range of therapies: meaningful treatments such as art treatment, music treatment, horse treatment.

-Lifestyle practices – healthy lifestyle counseling, spiritual wellness.

Expense of Outpatient Rehabilitation in Miami

Find a Budget-friendly Program. Contact us to speak to a treatment assistance expert in Miami about discovering a program that fits your requirements and that you can manage. Outpatient addiction treatment allows you to continue living and operating at home while undergoing treatment. It has the tendency to cost less than inpatient treatment. This type of program will involve focused however not 24/7 care, and often includes group and individual therapy sessions. The cost of outpatient programs will differ based on the type of care provided and the length of time you spend in treatment. Kinds of outpatient care consist of therapy and therapy, partial hospitalization and extensive outpatient care near Miami Treatment and therapy – Free – $1,000.

-Usually utilized in combination with other treatment methods.

-Analyzes contributing aspects to compound abuse.

-Focuses on repairing relationships.

-Helps you develop coping and relapse prevention skills.

-Can include self-help programs (like Twelve step programs).

-May also consist of behavior modification, group or private therapy and family counseling.

Partial hospitalization – Cost depends upon your medical requirements. Fulfills in the health center or center 3-5 days a week for at least 4-6 hours a day. Can include group therapy, private counseling and medication management. Intensive outpatient care – $3,000 – $10,000.

-Concentrate on regression prevention.

-Meets 3 days a week for 2-4 hours a day.

-Arranged around work or school.

-Can include group or individual therapy and treatment, dependency education and medication management.

-Monitors substance usage to ensure sobriety.

-Uses 24-hour crisis protection.

-Consists of community support system.

-Provides occupation and work training.

-Includes family in treatment.

Cost of Detox. Detox normally in Miami consists of:

-A physician’s assessment.

-24/7 medical supervision.

-Correct medications utilized for detox, including medications used to relieve the withdrawal procedure.

-Detox treatment costs anywhere from $300-$ 800 a day. This estimate is based on Recovery.org’s experience working with hundreds of treatment centers around the country.

Detox is the process of eliminating all drugs and/or alcohol from the body, while managing withdrawal signs. Numerous inpatient and some outpatient programs include detox as part of treatment. Detox is not really treatment. If you are dependent on alcohol or drugs, you should think about an inpatient or outpatient program after finishing detoxification. A treatment support professional is offered 24/7 in Miami to assist you find the right detox program. Elements that Impact Cost of Rehabilitation in Miami High-end drug healing prices will normally be greater than normal recovery services at other facilities.The more luxurious and comfort-focused the facility, the greater the program’s overhead expenditures. A domestic treatment program typically costs more than an outpatient program. This is generally due to that there are extra overhead costs related to a domestic program that are not required with an outpatient program, including the cost of meals and accommodations. Smaller treatment programs normally cost more than bigger ones. Smaller programs offer more personalized care with more opportunity for individually interactions and patient-therapist connections. Longer remain in treatment cost more than shorter stays. The longer you pick to remain at a facility, the longer you have in a sober living environment. But it also suggests that the center has greater costs to account for to keep you comfortable and sober. Treatment centers in major metropolitan locations cost more than rural programs. City living expenses are higher than rural living expenses, and this includes client care expenses.

Comparing Advantages to Cost of Rehabilitation in Miami

While recovery programs can be costly, keep in mind that the costs of a dependency will likely surpass the expense of treatment in the long run. Healthcare Costs from Dependency. Alcohol and drug abuse can substantially increase your threat of various health issue and their associated costs (medical costs, lost work performance, and so on). These may include:.

-“Hangover” healing.

-Sleep disorders.

-Cardiovascular disease.

-Liver disease.

-HIV, hepatitis and other contagious viral conditions.

-Concurrent mental health concerns.

-Financial Expenses from Addiction.

-Drug Facility

-Dependency can likewise be financially debilitating, costing anywhere between $20,000 and $100,000 each year, -depending on the compound and seriousness of your dependence. These costs come not just from getting the drugs themselves, however from the numerous external elements that accompany dependency:

Medical expenses such as emergency space sees near Miami

-Prospective legal entanglements (DUIs, bail, fines, legal representative costs, and so on).

-Lost or damaged residential or commercial property.

-Marital troubles and divorce expenses.

-Lost incomes (ill days); Task loss.

-Increased insurance coverage costs.

-Drug Facility

-Costs to Society.

Usually, compound abuse treatment expenses are far outweighed by their benefit to society, with a frustrating 7:1 benefit-to-cost ratio.1 In truth, drug abuse treatment for 60 days or more can save over $8,200 in healthcare and performance expenses. Discover a Treatment Program near Miami-dade Miami, Florida 33179 Dependency treatment programs can be an important financial investment in your health and wellness. If the quality of your life or that of an enjoyed one has suffered due to drug or alcohol abuse, assistance is available or Drug Facility Call a treatment assistance specialist in Miami for more information on drug or alcohol recovery choices, along with techniques of paying for treatment.

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[inbonobo]

The US House of Representatives has just approved a "congressional disapproval" vote of #privacy rules, which gives your #ISP the right to sell your #internet history to the highest bidder.

The measure passed by 215 votes to 205.

This follows the same vote in the Senate last week. Just prior to the vote, a White House spokesman said the president supported the bill, meaning that the decision will soon become law.

This approval means that whoever you pay to provide you with internet access – Comcast, AT&T, Time Warner Cable, etc – will be able to sell everything they know about your use of the internet to third parties without requiring your approval and without even informing you.

Your ISP already knows quite a lot about you: your name and address, quite possibly your age, and a host of other personally identifiable information such as your social security number. That's on the customer information side. On the service side, they know which websites you visit, when, and how often.

That information can be used to build a very detailed picture of who you are: what your political and sexual leanings are; whether you have kids; when you are at home; whether you have any medical conditions; and so on – a thousand different data points that, if they have sufficient value to companies willing to pay for them, will soon be traded without your knowledge.

As one high-profile venture capitalist recently discovered, your previous search history can also impact what result you see in future. Although in his case, he probably wishes he hadn't publicly criticized Apple on Twitter for giving him the details of a porn actress at the top of his search results.

The precise user profiles that can be built using this data are worth their weight in gold to advertisers, and explains why Google and Facebook are two of the world's largest companies despite only being a search facility and an online noticeboard.

In fact, thanks to a quirk that resulted from efforts to make such selling of personal information illegal, we know how much that information is worth to your ISP: $30 per household per month. That jumps to $60 per month if you get internet access through your cable provider – which most Americans do – because it also enables the company to monitor your TV usage and connect the two.

With over 100 million households online in the United States, that means Congress has just given Big Cable an annual payday of between $35bn and $70bn.

Impact

It is difficult to underestimate the impact that the shift away from data privacy to open season on personal information sales may have. With cable companies now given strong financial incentive to draw on user information and habits, and with the stick of regulatory intervention effectively thrown away, it may result in significant societal changes.

The irony is that just a few months ago the situation was the polar opposite.

When US comms watchdog the FCC controversially declared that broadband providers were "common carriers" along the same lines as telephone companies, one of the many impacts was that it pulled enforcement of data privacy rules away from US trade watchdog the FTC and gave it to the FCC (which has very limited experience in consumer issues).

As a result of that, the FCC passed new privacy rules that are a little stronger than FTC rules, mostly in that they are preemptive and that they require ISPs to give customers an opt-in option for their most sensitive information – in other words, they have to actively get your permission before selling that data.

This opt-in issue is what exposed the value of such data to ISPs: when Google launched its Fiber Gigabit offering in various cities for just $70 a month, AT&T responded by offering pretty much the same service at the same price point – but to get that price you had to agree to be a part of its "Internet Preferences" program, which gave it permission to examine your web traffic and sell it on.

Take that "service" off and the price jumped $29 per month. If you also had TV or phone service, the price jumped $60 per month.

Meanwhile, back at the FCC, thanks to presidential politics and the election of Donald Trump, two commissioners – both Democrats – left. That meant the two Republican commissioners held a majority.

The new chair, Ajit Pai, killed off the new FCC privacy rules literally days before they were due to take effect, leaving a situation where ISPs are no longer under FTC jurisdiction and there are no FCC rules for them to adhere to.

On top of that, Congressional use of what was an obscure piece of legislation until two months ago – the Congressional Review Act – effectively introduces a permanent ban on the FCC rules. Privacy rules that are "substantially similar" cannot be reintroduced without the approval of Congress now that the "congressional disapproval" vote has passed.

So, unless the FCC or Congress scrap the net neutrality rules that pulled ISPs under the FCC's jurisdiction – something which, if it does happen, is going to take some time – the result of the vote, for ISPs, is that they have an open field to sell their customers' data. Critically, however, the situation looks set to stay unchanged for several years, and that gives ISPs an incentive to build new systems that provide maximum financial return on selling customer data. In short, the constraints are off.

What are we looking at in reality?

So, setting aside hyperbole or extrapolation, what does this actually mean for end users? What can ISPs really see? And what can they really sell?

Well, at the moment, it gives them the right to effectively sell ads like Facebook and Google. Both these companies build up a huge amount of information on individual users and then sell them. They sell the data in aggregate and keep a tight control on the fine details.

That means that a company selling, say, a new electric car, will be able to pay Facebook to put its ads in front of you based on its own criteria: we are targeting families with parents aged between 30 and 45 who live in the San Francisco Bay Area.

Facebook knows who you are because you are permanently logged into Facebook, and not only do you post a lot of information there but you also use your Facebook login to get into other sites. Facebook pulls all this information together, figures out who you are, and then sends you ads that are included in its massive pool of ads.

Google does the same thing in a different way: it uses your search results, it may use the Chrome browser, and it uses its various services – Gmail being the big one – to build up a profile of who you are. You are probably always logged into Gmail, and you have Chrome as your default browser – so everything you do potentially finds its way back to Google and they aggregate and sell it.

ISPs now have this power too. Except they have one huge advantage: they don't have to get you to log or opt into anything.

If you log out of Gmail, and you switch your search engine to something that is not Google, then Google effectively goes blind. Likewise, if you log out of Facebook (and any sites you used Facebook to log into) and delete all the cookies it has installed on your system, it also goes blind.

Not so your ISP – your ISP sees everything you are doing because its service is your very internet connection. Even if you use the "incognito" mode that many browsers offer where you can't be tracked by cookies, your ISP can still see where you are going because it has to go get the information from the websites you are looking at.

Content

Now, the really big question is: can your ISPs see the content of your online interactions? Can it read your emails? Can it read your search results? Can it store and search through the words you typed into a webpage?

And the answer is: yes, sometimes.

If the website you visit is not secured with HTTPS – meaning that any data between you and the website is encrypted – then your ISP can see exactly what you are doing.

Now, this scary reality is tempered by two things: first, a majority of websites these days, especially big ones, use HTTPS. And second, it is a lot of hassle for ISPs to take this enormous quantity of information and make something valuable out of it.

In short, it is not worth the cost of searching through your (and millions of others') web traffic to find information that they can sell. What they make from that will not cover the costs of searching. But that may change with this Congressional vote: the economics may shift in favor of searching that traffic.

It is a certainty that ISPs will run experiments to see if they can make money from digging into this information. Pharmaceutical companies in particular pay a lot of money for information on users looking for specific drugs, because they can potentially make thousands of dollars from getting people using their particular drug.

Again, ISPs have always been able to do this, however with this congressional vote, they don't have to fear the FTC landing them with a multi-million-dollar fine. They don't have to disclose to anyone that they are doing this. And they don't have to fret that the hands-on FCC will come after them either. It is a free-for-all with potentially billions of dollars there for the taking.

What to do

So, the logical question is: what can you do about it?

Well, we'll leave aside contacting your Congressional representative to complain, because the vote's already gone through and there's not much that's going to change that reality right now. And we'll leave aside the Congressional elections in two years that could change Washington dynamics back in favor of user privacy.

What can you do today, right now, on your computer to limit what other companies can do with your data?

We have five general suggestions:

Use Tor or a VPN

Use a different search engine

Log out and/or use two browsers at the same time

Use HTTPS

Call your ISP and ask them about opting out

If you connect to the Tor anonymizing system, or use Tor's browser, your ISP will only know that you have connected to Tor; from there it loses the data trail. Of course the downside to this is that your browsing will be slower.

Be aware, your unencrypted traffic to websites outside the Tor network passes through a complete stranger's exit node: the person running the exit node can watch what you're doing. All you've done is move from your ISP snooping on you to an exit node admin watching you. On the other hand, you'll cycle through different exit nodes, so it's harder to be identified and tracked by websites outside the Tor network.

A virtual private network is an alternative that will work for lots of people, especially if your work has a VPN service that you can use for free. This again will cut off your ISP's ability to see what you are doing.

But – and this is a big but – do some research on your VPN provider. Do NOT use a free VPN provider because they face even stronger financial temptations to sell your information. If you use a VPN, you are effectively giving that company the same level of insight into your online life as your ISP. So pay for one, and check out their policies on what they do with the data they build on you.

In short, unless you have a work VPN service you can use, you are going to have to pay to hide your data from your ISP effectively. If you can set up a VPN server yourself, do so, or use a tool to do it for you. Be aware, some websites – such as Netflix – clamp down on VPN use, so you won't be able to use every site with one.

Google offers a wonderful service, but everything you type in its search box is logged and connected to you in as many ways as possible. It is then sold on.

So why not use a different search engine? Rather than simply type into Chrome's internet address bar, or using the search box in Firefox, why not stick a shortcut on your browser's top bar to a search engine like DuckDuckGo, which will not track you or store your information?

It is one step more than, say, using Google but it is easy to make it a habit, and you would be protecting your personal data.

You don't have to be logged into Facebook and/or Gmail all the time, you really don't. So why not log out when you're done with them?

In fact, as studies have shown repeatedly, if you can keep the distractions away – oh, look, someone 'liked' my post; there's another email from my co-worker, I wonder what it's about – then you can not only be much more effective and efficient but you also feel less overwhelmed and more at peace. Try it.

If you do insist on being logged into Facebook/Gmail all the time, why not use one browser – say, Chrome – for that and another – say, Firefox – for all your browsing? It is easy to switch between browsers on your computer, and using two will limit what third parties can see about what you are doing. Again, it's a habit thing: hard to do at first; automatic shortly after.

If the website you are visiting has HTTPS, your ISP can see you have visited it – and how long you spent there – but it cannot see beyond there, including any particular pages you may have visited or any searches or other data you typed in.

The HTTPS Everywhere browser plugin will enable that same kind of encryption to be applied to websites without the extra security. It's not perfect but it's a good way to cut down on data leakage.

Seemingly an obvious thing to do, but one that hardly anyone bothers doing: call your ISP.

Tell them you are concerned about them tracking your activity and ask them for their policies. Ask them what information they have on you. Ask them what they are allowed to sell. Ask them what you are allowed to opt out of (they are obliged to tell you), and then opt out of it.

Basically, make it clear you aren't happy with them being able to sell your data. Companies are still companies: they don't want unhappy customers. If this becomes a big thing for companies, if they fear losing your business, then at the same time they develop new systems to make the most from this Congressional loosening up of data privacy rules, they will look at allowing customers to opt out.

The number of customers who complain will probably have a direct impact on how much the additional privacy would end up costing.

You can find more advice here. ®

(via Your internet history on sale to highest bidder: US Congress votes to shred ISP privacy rules • The Register)

[disturbingbookclub]

"The title of Freud’s short text from 1914, ‘Remembering, Repeating and Working Through’, provides the best formula for the way we should relate – today, 100 years later – to the event called the October Revolution. The three concepts Freud mentions form a dialectical triad: they designate the three phases of the analytical process, and resistance intervenes in every passage from one phase to the next. The first step consists in remembering the repressed past traumatic events, in bringing them out, which can also be done by hypnosis. This phase immediately runs into a deadlock: the content brought out lacks its proper symbolic context and thus remains ineffective; it fails to transform the subject and resistance remains active, limiting the amount of content revealed. The problem with this approach is that it stays focused on the past and ignores the subject’s present constellation which keeps this past alive, symbolically active. Resistance expresses itself in the form of transference: what the subject cannot properly remember, she repeats, transferring the past constellation onto a present (e.g., she treats the analyst as if he were her father). What the subject cannot properly remember, she acts out, re- enacts – and when the analyst points this out, her intervention is met with resistance. Working through is working through the resistance, turning it from the obstacle into the very resort of analysis, and this turn is self-reflexive in a properly Hegelian sense: resistance is a link between object and subject, between past and present, proof that we are not only fixated on the past but that this fixation is an effect of the present deadlock in the subject’s libidinal economy. With regard to 1917, we also begin by remembering, by recalling, the true history of the October Revolution and, of course, its reversal into Stalinism. The great ethico-political problem of the communist regimes can best be captured under the title ‘founding fathers, founding crimes’. Can a communist regime survive the act of openly confronting its violent past in which millions were imprisoned and killed? If so, in what form and to what degree? The first paradigmatic case of such a confrontation was, of course, Nikita Khrushchev’s ‘secret’ report on Stalin’s crimes to the 20th Congress of the Soviet Communist Party in 1956. The first thing that strikes one in this report is the focus on Stalin’s personality as being the key factor in the crimes, and the concomitant lack of any systematic analysis of what made those crimes possible. The second feature is its strenuous effort to keep the Origins clear: not only is the condemnation of Stalin limited to his arrest and killing of high-ranking Party members and military officers in the 1930s (where rehabilitations were very selective: Bukharin, Zinoviev, etc., continued to be non-persons, not to mention Trotsky), ignoring the great famine of the late 1920s; but the report is also presented as announcing the return of the Party to its ‘Leninist roots’, so that Lenin emerges as the pure Origin spoiled or betrayed by Stalin. In his belated but perspicuous analysis of the report, written in 1970, Sartre noted that

it was true that Stalin had ordered massacres, transformed the land of the revolution into a police state; he was truly convinced that the USSR would not reach communism without passing through the socialism of concentration camps. But as one of the witnesses very rightly points out, when the authorities find it useful to tell the truth, it’s because they can’t find any better lie. Immediately this truth, coming from official mouths, becomes a lie corroborated by the facts. Stalin was a wicked man? Fine. But how had Soviet society perched him on the throne and kept him there for a quarter of a century.

Indeed, is not Khrushchev’s later fate (he was deposed in 1964) proof of Oscar Wilde’s quip that if one tells the truth, one will sooner or later be caught out? Sartre’s analysis nonetheless falls short on one crucial point: even if Khrushchev was ‘speaking in the name of the system’ – ‘the machine was sound, but its chief operator was not; this saboteur had relieved the world of his presence, and everything was going to run smoothly again’ – his report did have a traumatic impact, and his intervention set in motion a process that ultimately brought down the system itself – a lesson worth remembering today. In this precise sense, Khrushchev’s 1956 speech denouncing Stalin’s crimes was a true political act – after which, as William Taubman put it, ‘the Soviet regime never fully recovered, and neither did he’. Although the opportunist motives for this daring move are plain enough, there was clearly more than mere calculation to it, a kind of reckless excess which cannot be accounted for by strategic reasoning. After the speech, things were never the same again, the fundamental dogma of infallible leadership had been fatally undermined; no wonder then, that, in reaction to the speech, the entire nomenklatura sank into temporary paralysis. During the speech itself, a dozen or so delegates suffered nervous breakdowns and had to be carried out and given medical help; a few days later, Boleslaw Bierut, the hard-line general secretary of the Polish Communist Party, died of a heart attack, and the model Stalinist writer Alexander Fadeyev shot himself. The point is not that they were ‘honest communists’ – most of them were brutal manipulators who harboured no subjective illusions about the nature of the Soviet regime. What broke down was their ‘objective’ illusion: the figure of the ‘big Other’ that had provided the background against which they were able to pursue their ruthless drive for power. The Other onto which they had transposed their belief, which as it were believed on their behalf, their subject-supposed-to-believe, disintegrated.

Khrushchev’s wager was that his (limited) confession would strengthen the communist movement – and in the short term he was right. One should always remember that the Khrushchev era was the last period of authentic communist enthusiasm, of belief in the communist project. When, during his visit to the United States in 1959, Khrushchev made his famous de ant statement to the American public that ‘your grandchildren will be communists’, he effectively spelled out the conviction of the entire Soviet nomenklatura. After his fall in 1964, a resigned cynicism prevailed, up until Gorbachev’s attempt at a more radical confrontation with the past (the rehabilitations then included Bukharin, but – for Gorbachev at least – Lenin remained the untouchable point of reference, and Trotsky continued to be a non-person).

With Deng Xiaoping’s ‘reforms’, the Chinese proceeded in a radically different, almost opposite, way. While at the level of the economy (and, up to a point, culture) what is usually understood as ‘communism’ was abandoned, and the gates were opened wide to Western-style ‘liberalisation’ (private property, profit-making, hedonist individualism, etc.), the Party nevertheless maintained its ideologico-political hegemony – not in the sense of doctrinal orthodoxy (in the official discourse, the Confucian reference to the ‘Harmonious Society’ practically replaced any reference to communism), but in the sense of maintaining the unconditional political hegemony of the Communist Party as the only guarantee of China’s stability and prosperity. This required a close monitoring and regulation of the ideological discourse on Chinese history, especially the history of the last two centuries: the story endlessly varied by the state media and textbooks is one of China’s humiliation from the Opium Wars onwards, which ended only with the communist victory in 1949, leading to the conclusion that to be patriotic is to support the rule of the Party. When history is given such a legitimising role, of course, it cannot tolerate any substantial self-critique; the Chinese had learned the lesson of Gorbachev’s failure: full recognition of the ‘founding crimes’ will only bring the entire system down. Those crimes thus have to remain disavowed: true, some Maoist ‘excesses’ and ‘errors’ are denounced (the Great Leap Forward and the devastating famine that followed; the Cultural Revolution), and Deng’s assessment of Mao’s role (70 per cent positive, 30 per cent negative) is enshrined as the official formula. But this assessment functions as a formal conclusion which renders any further elaboration superfluous: even if Mao was 30 per cent bad, the full symbolic impact of this admission is neutralised, so he can continue to be celebrated as the founding father of the nation, his body in a mausoleum and his image on every banknote. We are dealing here with a clear case of fetishistic disavowal: although we know very well that Mao made errors and caused immense suffering, his figure is kept magically untainted by these facts. In this way, the Chinese communists can have their cake and eat it: the radical changes brought about by economic ‘liberalisation’ are combined with the continuation of the same Party rule as before.

Yang Jisheng’s massive and meticulously documented study, Tombstone: The Untold Story of Mao’s Great Famine, offers an exemplary case of remembering: the result of nearly two decades of research, it puts the number of ‘prematurely dead’ between 1958 and 1961 at 36 million. (The official stance is that the disaster was due 30 per cent to natural causes and 70 per cent to mismanagement – an exact inversion of Deng’s judgement on Mao). With the privileges afforded a senior Xinhua journalist, Yang was able to consult state archives around the country and form the most complete picture of the great famine that any researcher, foreign or local, has ever managed. He was helped by scores of collaborators within the system – demographers who had toiled quietly for years in government agencies to compile accurate figures on the loss of life; local officials who had kept ghoulish records of the events in their districts; the keepers of provincial archives who were happy to open their doors, with a nod and a wink, to a trusted comrade pretending to be researching the history of China’s grain production. The reaction? In Wuhan, a major city in central China, the office of the Committee of Comprehensive Management of Social Order put Tombstone on a list of ‘obscene, pornographic, violent and unhealthy books for children’, to be confiscated on sight. Elsewhere, the Party killed Tombstone with silence, banning any mention of it in the media but refraining from attention-grabbing attacks on the book itself. But Yang still lives in China, retired, unmolested, publishing occasionally in scientific journals. Among other important insights, Yang establishes that one reason for the famine lay in the application of bad science: the central government decreed several changes in agricultural techniques based on the ideas of the Ukrainian pseudo-scientist Trofim Lysenko. One of these ideas was close planting, where the density of seedlings is first tripled and then doubled again. Transposing class solidarity onto nature, the theory was that plants of the same species would not compete with but would help each other – in practice, of course, they did compete, which stunted growth and resulted in lower yields.

This is how a combination of false remembering and repetition operates with regard to the communist past, but such falsity is in no way limited to communists who refuse to settle accounts with their past and thus condemn themselves to repeat it. The standard liberal or conservative demonisation of the October Revolution also misses the emancipatory potential clearly discernible therein, reducing it to a brutal takeover of state power. The tension between these two dimensions of the Revolution does not mean that the Stalinist turn was a secondary deviation, since one can well argue that the latter was a possibility inherent in the Bolshevik project, meaning it was doomed from the very beginning. This is why the project was genuinely tragic: an authentic emancipatory vision condemned to failure by its very victory.

This is where the working through enters as the radical rethinking of communism, re-actualising it for today. And this is why only those faithful to communism can deploy a truly radical critique of the sad reality of Stalinism and its offspring. Let’s face it: today, Lenin and his legacy are perceived as hopelessly dated, belonging to a defunct ‘paradigm’. Not only was Lenin understandably blind to many of the problems that are now central to contemporary life (ecology, struggles for emancipated sexuality, etc.), but also his brutal political practice is totally out of sync with current democratic sensitivities, his vision of the new society as a centralised industrial system run by the state is simply irrelevant, etc. Instead of desperately attempting to salvage the authentic Leninist core from the Stalinist alluvium, would it not be more advisable to forget Lenin and return to Marx, searching in his work for the roots of what went wrong in the twentieth-century communist movements?

Nevertheless, was not Lenin’s situation marked precisely by a similar hopelessness? It is true that today’s left is facing the shattering experience of the end of an entire epoch of the progressive movement, an experience which compels it to rein- vent the most basic coordinates of its project. But an exactly homologous experience was what gave birth to Leninism. Recall Lenin’s shock when, in the autumn of 1914, all the European social-democratic parties (with the honourable exception of the Russian Bolsheviks and the Serbian Social Democrats) opted to toe the ‘patriotic line’. When the German Social Democrats’ daily newspaper Vorwärts reported that social democrats in the Reichstag had voted for the military credits, Lenin even thought that it must have been a forgery by the Russian secret police designed to deceive the Russian workers. In an era of a military conflict that cut the European continent in half, how difficult it was to refuse the notion that one should take sides and to reject the ‘patriotic fervour’ in one’s own country! How many great minds (including Freud) succumbed to the nationalist temptation, even if only for a couple of weeks!

The shock of 1914 was – to put it in Alain Badiou’s terms – a désastre, a catastrophe in which an entire world disappeared: not only the idyllic bourgeois faith in progress, but also the socialist movement that accompanied it. Even Lenin himself lost his footing – there is, in his desperate reaction in What Is to Be Done?, no satisfaction, no ‘I told you so!’ This moment of Verzwei ung, this catastrophe, opened up the site for the Leninist event, for breaking with the evolutionary his- toricism of the Second International – and Lenin was the only one at the level of this opening, the only one to articulate the Truth of the catastrophe. Born in this moment of despair was the Lenin who, via the detour of a close reading of Hegel’s Logic, was able to discern the unique chance for revolution.

Today, the left is in a situation that uncannily resembles the one that gave birth to Leninism, and its task is to repeat Lenin. This does not mean a return to Lenin. To repeat Lenin is to accept that ‘Lenin is dead’, that his particular solution failed, even failed monstrously. To repeat Lenin means that one has to distinguish between what Lenin actually did and the eld of possibilities that he opened up, to acknowledge the tension in Lenin between his actions and another dimension, what was ‘in Lenin more than Lenin himself’. To repeat Lenin is to repeat not what Lenin did, but what he failed to do, his missed opportunities."

The above is excerpted from Lenin 2017: Remembering, Repeating, and Working Through by Slavoj Žižek - https://bit.ly/2IHnMjz - free delivery worldwide (right-click & open)

[supersportsnewsblog]

A burst of fresh data on the prevalence of “silent,” or asymptomatic, carriers of the 2019 novel coronavirus points to the looming danger of ending America’s national shutdown early.Classified Chinese government data suggest “silent carriers” could make up at least one-third of the country’s positive cases of the 2019 novel coronavirus, Hong Kong’s South China Morning Post recently reported. Approximately 43,000 people in China who had tested positive for COVID-19 last month had no immediate symptoms. And those cases were not included in the official national tally of confirmed cases, which had hit 80,000 at the end of February, the paper said.Last week, China reported no new local infections for the first time since the outbreak started in December. And after weeks of lockdown, the city of Wuhan—where the global pandemic originated—said on Tuesday that public transportation was reopening and that residents would be allowed to leave the city itself starting on April 8.But as extensive testing continues, authorities in Wuhan have found new cases of asymptomatic—or mildly symptomatic—infection, sparking concerns about how many contagious people have been circulating freely. Fresh data released by the Centers for Disease Control and Prevention (CDC) Friday about a nursing home in Washington state only served to compound those fears.Four Ways Experts Say Coronavirus Nightmare Could End“Almost everybody thinks there’s the potential of a second wave after we relax the restrictions,” said Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University and an expert on U.S. readiness for pandemics. “There’s no good timeframe—it’s certainly not by Easter—that we’ll be starting to loosen up,” he continued, referring to President Donald Trump’s suggested finish line. “But once we do, people who did not have coronavirus will be going out to spaces where silent spreaders might be.”With Americans still getting acclimated to a quasi-national shutdown, and Trump repeatedly suggesting restrictions might ease in a matter of days or weeks, the prospect of silent spreaders wreaking epidemiological havoc looms large.“The biggest danger here is that this is like a stealth attack in that you have no idea that the person you have come into contact with is contagious,” said Dr. Adrian Hyzler, the chief medical officer for Healix International, which provides medical information to organizations whose clients travel internationally. “It makes it so much more difficult to try to contain the spread of the virus.”For obvious reasons, silent carriers are not nearly as notorious in the public imagination as “super-spreaders,” or patients who are extra contagious. A possible super-spreader in the United Kingdom may have transmitted the virus to nearly a dozen people before realizing he was sick earlier this year. Meanwhile, the World Health Organization previously claimed that pre-symptomatic or asymptomatic transmission of the new coronavirus was “relatively rare.” But newer studies—out of Japan, Italy, South Korea, and now Washington state—have called that assertion into question. And research suggests that silent spreaders can be just as dangerous to a community.The CDC released a study on Friday of the outbreak’s spread—specifically via asymptomatic or pre-symptomatic patients—in a long-term care facility in King County, Washington. The report found that “approximately half of all residents with positive test results did not have any symptoms at the time of testing, suggesting that transmission from asymptomatic and pre-symptomatic residents—who were not recognized as having [the coronavirus] infection and therefore not isolated—might have contributed to further spread.”“These findings have important implications for infection control,” according to the CDC, since “current interventions” for preventing the virus’s transmission, in part because of the shortage of tests, primarily rely on the presence of “signs and symptoms to identify and isolate residents or patients who might have COVID-19.” Patients were cohorted, or separated, according to which ones had symptoms. But that method of intervention no longer makes sense if there are asymptomatic—or silent—spreaders within a community, especially one that is at high risk of severe infection.Researchers previously published a study in the journal Science on March 16, finding that 86 percent of all infections in China before Jan. 23—when the government there instituted severe travel restrictions—were undocumented because they were mildly symptomatic or asymptomatic.“They may, for the most part, have experienced some symptoms at some point,” Jeffrey Shaman, a professor of environmental health sciences at Columbia University who worked on the study, explained to WBUR radio. “But it didn't keep them home, didn't stop them from getting on public transportation, going to work, going to school, getting on airplanes and going on business trips.”Because those individuals didn’t feel sick—or didn’t know they were sick—and kept traveling through the community, the researchers found that this group of people “contributed to the vast majority of the spread” of the virus, added Shaman, who called the phenomenon “stealth transmission.”In a letter to the International Journal of Infectious Diseases in February, a group of Japanese experts led by epidemiologist Hiroshi Nishiura at Hokkaido University wrote that the growing data outside of China “indicates that a substantial number of cases are underdiagnosed.” Nishiura’s group estimated—based on the number of asymptomatic Japanese patients who were evacuated from the epicenter of the outbreak in Wuhan, China—that about 30.8 percent of cases were asymptomatic.Of course, American authorities know even less than their foreign counterparts about how many cases there are, period. The same goes for silent spreaders. “This is partly because health systems are just overrun with sick people, as well as a scarcity of testing kits,” said Hyzler, adding that a trial in a small Italian town where all 30,000 people were tested revealed that asymptomatic or very mildly symptomatic people represented a whopping 70 percent of all cases, of which an unknown number were able to transmit the virus to others.Redlener noted that, while much is still unknown, “the vast majority of Americans with the virus will be mildly symptomatic or asymptomatic, and we really have to be careful not to relax our stringent requirements too soon.” The U.S. health system has generally not tested individuals without symptoms unless they are especially wealthy or well-connected—like NBA players or Sen. Rand Paul—or else health workers with known exposure. And in many places in the U.S., authorities are discouraging testing except in the case of severe symptoms, meaning American officials have limited data on the number of asymptomatic or mildly symptomatic cases, with few exceptions.Hyzler said there were two key assumptions that likely went into the decision to begin opening up Wuhan again: that there are very few unidentified silent spreaders transmitting the infection throughout the community, and that the incubation period is 14 days.If authorities are correct on both points, it might well be safe to resume public transportation and to allow travel to and from the city. But if they’re incorrect, Hyzler cautioned: “We will certainly start to see a second wave of cases” emerge in China.Fortunately for Wuhan and its surrounding province, China’s zealous testing means that authorities would likely detect a new wave “right away” before it spread very far, according to Arnold Monto, a professor of epidemiology and global health at the University of Michigan who has advised both the World Health Organization and the Defense Department on communicable diseases.But unless the U.S. rapidly expands its testing—and zealously tracks individuals who’ve had contact with confirmed cases—Americans won’t have that same advantage. Both Hyzler and Monto said they hoped the U.S. government could learn from its weeks of delays, as well as failures abroad. But there’s no guarantee.Vice President Mike Pence took heat this past week for claiming that federal officials may soon recommend that critical workers—even those who’ve been exposed to the virus—return to work, as long as they wear a mask.“It’s premature to try to put a time limit on this,” said Monto, who emphasized the importance of continued social distancing throughout the country to control the surge of cases from overwhelming hospitals.“From an epidemiological standpoint, one lockdown would be better than waves of lockdown,” he said. “With waves, all you’d be doing is letting it up again and then you’re back where you started. I think if we’re still seeing an overwhelming number of cases in hospitals, it’s too early to lift a lockdown.”Ultimately, Hyzler argued, there are two main ways that authorities can try to ensure that an end to social distancing isn’t premature. One is so-called herd immunity, or, as he put it, “if a good percentage, maybe as many as 70 percent of people... have been infected and therefore, we assume, have an immunity against a re-infection.” The other is what’s called antibody testing, or, as Hyzler explained, “once you can show that someone has had the virus, and they no longer need to self-isolate and can return to work.” (To be clear, the jury’s still out on whether some patients who already had coronavirus can be re-infected.)But without enough tests, Monto said, “we have no idea at this point” how many people may be mildly symptomatic or asymptomatic. “After the dust settles,” he said, scientists will likely make an effort to collect blood samples, which can detect antibodies for the virus after a person has recovered. “We’ll know the numbers only after the fact,” he added.Redlener was more optimistic: “The hope is that we get to a point where mass testing will be possible.”Read more at The Daily Beast.Got a tip? Send it to The Daily Beast hereGet our top stories in your inbox every day. Sign up now!Daily Beast Membership: Beast Inside goes deeper on the stories that matter to you. Learn more.

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[personalcoachingcenter]

An Effective Way to Tackle the Social Causes of Poor Health

New Post has been published on https://personalcoachingcenter.com/an-effective-way-to-tackle-the-social-causes-of-poor-health/

An Effective Way to Tackle the Social Causes of Poor Health

John Kuczala/Getty Images

The new business model for health requires healthcare organizations to address not only medical problems, but social problems like hunger, loneliness, and trauma. That’s because these types of issues — known as the social determinants of health (SDOH) — are key impediments to achieving the outcomes healthcare organizations are now given incentives to deliver.

These social determinants are foreign terrain for many healthcare organizations, but that hasn’t stopped them from entering the space. The number of reported health system-based SDOH programs has grown more than ten-fold in the past decade. This response would signify the kind of change long awaited by social advocates except for one thing: many such programs run a high risk of failure because they lack disciplined planning.

The typical story is that a well-meaning clinician or healthcare executive secures funding to experiment with a SDOH program. Burdened with tight timelines and competing responsibilities, these champions often quickly assemble limited pilot programs around high-level concepts such as leveraging community health workers or building referral platforms. Planning is sacrificed for expediency. And so, healthcare leaders who would never tolerate an amateur approach to drug development are willing to shotgun the development of complex social interventions. Why are we respectful of biomedical discovery and cavalier about social innovation?

Insight Center

Much of the haste around these programs seems enabled by the ubiquitous word “pilot,” which implies that it is acceptable to lower standards or defer planning because future iteration is expected. This overconfident approach has also been enabled by news headlines announcing outsized returns on investment; many exaggerated results are supported by flawed before-after studies measuring nothing more than regression to the mean. (The reality, according to a recent meta-analysis, is that very few SDOH interventions reduce healthcare utilization or costs — but probably because of poor design, not because these programs can’t be effective.)

Taken together, these factors have created hype around SDOH programs that is destructive in the long term; inevitably many programs won’t deliver as promised, and disappointed health care leaders may conclude that none of these programs work.

At the University of Pennsylvania, my team and I have spent the past decade developing IMPaCT, a standardized community health worker program that effectively addresses social determinants of health. We’ve tested IMPaCT in several randomized clinical trials (here’s one) which demonstrate consistent improvements in quality while reducing hospital days by 65%. These outcomes translate into two dollars in return for every dollar invested annually in the program. We believe that the high performance of the IMPaCT model are a direct result of the planning and design thinking we used in its development. Here, we share insights from building IMPaCT and from technical assistance that we’ve offered to help organizations arrive at their own SDOH solutions.

Start with a small team

We often see healthcare leaders cede the design of social determinants programs to a clinical committee or community advisory board. While inclusion is essential and refreshing, the pitfalls of design by committee are well known. Organizational dynamics between complex healthcare organizations and social service agencies can be especially fraught. We’ve found that it’s crucial to engage diverse perspectives while investing authority in those with dedicated time and expertise. I led a five-person working group that included experienced social determinants researchers, a health system leader and a community member.

Define problems crisply

Many leaders — believing SDOH programs are cure-alls — skip the step of problem definition or list dozens of outcomes they expect their program to improve. We listed three to four socially and financially important problems and meaningful outcomes a priori. For example, we focused on improving access to post-hospital primary care because this mattered to low-income patients, and was tied to enhanced provider reimbursement. We also focused on quality and days spent out of the hospital — important for all stakeholders.

Identifying problems and desired outcomes in advance allowed us to “solve for them” in our program design, measure them in clinical trials and then translating improvements into a return on investment.

Understand end-users

While it’s always a good idea to engage end-users in planning, it’s all the more important for SDOH programs. That is because the end-users of these programs — low-income people — often lack voices in healthcare. Some enlightened healthcare leaders engage patients through advisory boards, which is a step in the right direction. However, these boards may be self-selected (the homeless woman with diabetes is unlikely to be on the board) and representation risks may be token.

We interviewed 1,500 low-income patients on porches, hospital bedsides, jails and shelters. We asked them what made it hard to stay healthy and what we should be doing to help. These interviews were audio-taped, transcribed, and analyzed. We used the resulting insights to design IMPaCT. While it is certainly not necessary or feasible for every healthcare organization to interview thousands of patients, a dozen or so conversations can substantially inform program design.

Study past successes and dwell on past failures

Although social determinants programs are fairly new to healthcare, they are not a new concept. Disparities researchers and social scientists have deep expertise in their design, implementation and evaluation. Developing countries are also often far ahead of in the U.S. because of the greater imperatives to provide preventive care and to efficiently spend limited health care dollars.

While planning IMPaCT, we immersed ourselves in the experiences of community health worker programs both in the US and abroad through reading and discussion with experts. We paid particular attention to past failures, which is necessary to help overcome the overconfidence of “believers” who have a blind faith in these programs. Based on the lessons of past community health worker programs, we built hiring algorithms to minimize staff turnover and created robust supervision to ensure quality.

Embrace program manuals and “design jams”

Rapid-cycle innovation is even more of a buzzword than SDOH, yet speedy and iterative evaluations of programs can be hard to do in practice. Often, program designers have conflicting and subjective assessments of what is or is not working in their program. Many programs lack the explicitly written, ex ante, testable goals and hypotheses scientists have used for years to lend discipline to their processes, and often there are no written program protocols. It’s hard to revise what isn’t described or standardized in the first place.

While planning, I drafted program manuals: easy-to-read guides describing how to run a community health worker program like ours. We began our implementation at a very small scale, with just two part-time community health workers. I followed them around for weeks with the manuals in one hand and a red pen in another. When they departed from our protocol, I asked them why and, if their rationale was sound, considered revisions. This process of “designing in-situ” hasn’t ended with the planning stage. We still do periodic manual-guided observation of community health workers in the field. We also have quarterly “design jams,” or meetings that include all 60 team members during which we review and revise manuals.

Treating poverty is probably as hard as — if not harder than — treating cancer or heart disease. We have at least a rudimentary understanding that cancer is fundamentally a genetic disease and that patients with heart failure are sensitive to salt intake. But we have little understanding of how exactly poverty causes poor health or why people die of loneliness. While it is heartening that health systems are now devoting attention to health’s social determinants, they will need the same kind of discipline that has helped them develop biomedical therapies.

These programs don’t have to be perfect when they launch — but if they’re set up to fail, they probably will. That’s why it’s so important to try to get it mostly right from the outset, and to build in programmatic ways to course correct as needed. In addition, the challenges of change management make it harder to fix a broken program than getting it right the first time. Careful planning doesn’t have to be prohibitively time or resource intensive. Our initial planning stage took about six months. As in the biomedical world, timelines can be shortened and outcomes strengthened by using an evidence-based intervention instead of reinventing the wheel.

The stakes of SDOH programs are quickly rising: state Medicaid programs, large insurers and even venture capitalists are investing millions in this space. This money alone won’t solve complex social problems. Years from now, whether we have a hodge-podge of unevenly performing initiatives or a robust system of effective SDOH programs will depend on the careful thought and effort we put in today.

Source, N;

[idonotknowhowtoo-blog]

HOW TO COMPOSE A META ANALYSIS

To analyze what has already been examined is Meta Analysis

Meta-analysis is a valuable process to condense data including many studies but necessitates meticulous factor to consider, organization, and execution. Meta-analysis includes investing significant time and energy in development and achievement. Thereby, it needs to not be considered as a nippy method to collect and evaluate studies with a sole aim of making a quick publication. Hasselblad composed an excellent short article, with lots of examples and formulae that would be of great value for any researcher who wants to initiate a meta-analysis1.

After the procedure of accomplishing systematic review has been finished in any study, the procedure of performing meta-analysis can take location consequently. To put in basic words, meta-analysis is the process coalescing the information collected on the basis of methodical reviews. Combining this information together helps in drawing useful conclusions in any research study. Nevertheless, not all methodical evaluations always cause a good meta-analysis. There are some critical points that govern the efficient conduction of a meta-analysis that is up to the mark. Being among the most essential analytical techniques, meta-analysis has a direct effect on the outcomes of any research study. Prior to beginning the process, it is essential to plainly comprehend the factors that will make your meta-analysis high yield. The scientists who comprehend the basics of carrying out a great meta-analysis draw much more helpful conclusions than those who fail at this vital step of their research.

Goals to be thought about when you conduct a Meta-analysis:

Benefits and Disadvantages of Meta Analysis

BENEFITS DRAWBACKS Superior statistical power Heterogeneity of research study populations Confirmatory information analysis Demands sophisticated analytical techniques Much better capability to generalize to the general population affected Challenging and lengthy effort needed to acknowledge apt studies Determined as an evidence-based source All studies do not define acceptable information for addition and analysis

In this blog, we explain how a meta-analysis is comparable to a standard study, including a written procedure with design aspects that are comparable to an organized review. We have highlighted some critical points you may require to understand prior to conducting any meta-analysis. We will focus on the essential concerns essential for a meta-analysis: articulating the hypothesis/study concern, selection of research study studies, building up and assessing evidence from these research studies, and extracting fruitful outcomes.

Step-By-Step Guide to perform your Meta Analysis

RECOGNITION (Extensive Literature Look For a Meta Analysis):

This is the first and the most important quality of any great and solid meta-analysis. You need to ensure that your literature search is extensive, comprehensive, extensive, and well systemized. Important sources of details for a meta-analysis include:

You must thoroughly cover all the research studies that are relevant to your topic or the subject. Search for all the released in addition to unpublished research study work that connects to your topic. There is a term used 'fugitive literature'. This literature refers to the research study work that might not be published however can be of excellent aid to the scientists. It is for that reason strictly recommended to make the very best use of argumentations, non-indexed studies, and unpublished studies to make your analysis even much better.

Cooperation with Coworkers:

We would suggest that if you prepare to do a meta-analysis of your own, it may be significant that you think about employing the assistance of an expert such as the medical librarian. It is also essential to develop great collaboration with other researchers that are associated with the programs comparable to yours. This is very important due to the fact that they can provide you with helpful details that can help you in establishing your meta-analysis. You can likewise request the employees in these appropriate projects to join you in your program. You should likewise look for your undergraduate colleagues who are searching for course credits. They may require course credits from you and in return can offer you with helpful literature search. This does not just conserve time but also assists to extend the array of your research.

Referrals and Citations:

Look for the optimum number of referrals and citations that might assist you comprehend the whole procedure in detail. As soon as you have got an excellent grasp on understanding how the whole procedure is brought out, you are sure to conduct your analysis in a sound way.

Set Homogenous Standards:

Any excellent meta-analysis needs a homogenous requirement to which the outcomes gotten from the information can be standardized. This facilitates the procedure of comparing the various results and for that reason saves a lot of time. This likewise helps in comprehending the pertinent risks that help in establishing an excellent meta-analysis.

SELECTION (Eligibility Requirements):

You would concur that all research are not developed equivalent, hence, the use of substantiation to assist the scientific protocols needs to be mindful of the supporting research study that propagates varied interventions. As soon as you have actually gathered a large set of research studies that can be valuable for analysis, it is essential to omit the less pertinent content.

There are different achievable inclusion/ eligibility criteria:

This facilitates in drawing conclusions and results that are to the point and more efficient. Assembling this set of requirements that a study requires to satisfy in order to be a part of your research study is understood as the eligibility requirements.

The very first thing you require to set eligibility requirements is to see if the research study includes enough helpful details. You have to see if the research study design is optimized to your research study. Other helpful criteria can be the language of the study, the time at which it was performed and how this impacts your meta-analysis, age group of the patients on which the research study was performed, the medical setting in which the research study was carried out for circumstances OPD, inpatient, or emergency clinic. All these elements can straight influence your meta-analysis and hence it is needed.

The function of the information abstraction phase relate to the evaluation of the study quality. The outcomes of the quality evaluation should describe the breakdown and understanding of the outcomes.

When you have an ideal collection of research studies that fulfill your eligibility criteria, you have actually needed to abstract the suitable data from each study accumulated. The possible mistake in data abstraction might be because of:

Precise Coding Forms:

Coding forms are the basis of any excellent meta-analysis. Make sure you develop such coding forms that are extremely accurate and offer just relevant data. An organized coding type is characterized by consisting of only such information that is ensured to draw high yield outcomes and conclusions. In order to keep these types precise and easily understandable, you are recommended to keep only those variables that you have to check in your program.

Keep Systematic Records:

It is actually essential to keep well-systemized records of whatever that you carry out in your meta-analysis. From keeping a track of your literature search to drawing the last conclusions, every little details is very important. This is likewise crucial when you explain the technique section of your paper at the end of your research.

How to Prevent Mistakes

To decrease mistakes a great meta-analysis ought to follow basic steps like:

Meta Analysis is closely spoiled by numerous debates regarding the analysis of research study information. Prior to we stay into all those, let's define some critical terms:

Homogeneity shows how analogous the outcomes of different studies were to one another on a fair comparison.

Heterogeneity refers to how various the results are between research studies. A cluster of research studies having dissimilar outcomes is said to be heterogeneous. Merely put, it is the opposite of homogeneity.

Fixed impacts designs purposeful upon only the within-study variability. It is presumed that the research studies make use of identical methods, clients, and measurements; for this reason producing identical outcomes; those variations are since of within-study variation. The scientist by exploiting a set results design can answer the concern: "Was the treatment able to build an advantage on average in the research studies?" If the studies are homogenous the scientist needs to use the Fixed Impacts Model.

Random effects designs contemplate variability between study and within-study. The hypothesis being that studies are randomly collected and agent of different possible studies in the readily available literature. The scientist by utilizing a random results design can obtain a response to the concern: "Would the treatment produce any advantage 'usually'?" Random Effects designs are thought about to be "conservative" and most likely to show a larger CI (confidence interval) but less most likely to produce a significant treatment impact than a set impacts design.

Level of sensitivity analysis is a duplication of the Meta analysis or the primary analysis, replacing alternative conclusions or ranges of values for outcomes that were capricious or indistinct. In basic words, it is how a researcher will evaluate just specific studies, groups of patients, or interventions. A level of sensitivity analysis supplies you with a response to the concern, "Were the findings collaborative to the options made in the course of getting them?"

When to Look For Expert Help?

You need to search for individuals who have successfully published their meta-analysis that resembles yours. When you are stuck in some problem, these people can be of terrific professional assistance. While a few of them might charge you for their assistance, a great deal of individuals are willing to help you without any charges. Those who charge also do not charge much and their assistance is worth the money. If you see yourself being stuck in a condition that can possibly put your meta-analysis down the drain, do not think twice to look for assistance from your senior associates.

How the Editors or Peer Reviewers evaluate your Meta Analysis

The editors, peer reviewers and later your audience will judge your Meta analysis on the following 7 requirements

The Bottom Line:

Typically we see researchers not being able to draw helpful conclusions from their research tasks. Among the leading reasons for this failure is not being able to perform a sound meta-analysis. There are some elements that directly affect this. We have actually shortlisted some of the most crucial things you require to remember while getting your meta-analysis published. By bearing in mind these important points, you are sure to avoid the common mistakes that lots of researchers face while performing their meta-analysis.

Resources

Citations

[theconservativebrief]

The opioid epidemic is the deadliest drug overdose crisis in US history — on track to kill more people over the next decade than currently live in entire American cities like Miami or Baltimore.

A new study, published in the American Journal of Public Health on Thursday by Stanford researchers Allison Pitt, Keith Humphreys, and Margaret Brandeau, tries to parse out how America can reduce the death toll. Using a mathematical model, the study brings together research and expert opinions to calculate the epidemic’s death toll and how different policy ideas can stem the toll.

First, a shocking number: 510,000. That’s a rough estimate of how many people will die over the next decade due to opioid-related causes, which include overdoses and other causes of death tied to opioids, such as HIV infections from sharing syringes. But the researchers caution that the number, as with other estimates in the study, are fuzzy and subject to change — given that this is, after all, trying to predict the future.

“The trend that we’ve seen in the last year would suggest that there’s reason to believe that [the death toll] could be even greater, really,” Pitt told me, referring to data showing a rise in opioid overdose deaths in 2017. “But it’s really hard to say.”

The good news is the study found America can do some things to reduce the death toll.

The bad news is it implied the US has to go much further than policymakers have so far — dramatically scaling up proven addiction treatment modalities, needle exchanges, and access to the opioid overdose antidote naloxone. And while pulling back excess opioid painkiller prescriptions is another important piece, the study suggested that some of the ways policymakers have proposed doing that may be downright harmful, at least over a 10-year window.

The study emphasized that there is no one silver bullet for the opioid crisis (as experts have told me before). There are some policies that have a bigger impact than others, but none by themselves get close to ending the crisis on their own.

“No single policy is likely to substantially reduce deaths over 5 to 10 years,” the researchers wrote.

The model, for example, estimated that wider availability of naloxone could reduce opioid-related deaths by 21,200 over 10 years; that medication-based treatments for opioid addiction like buprenorphine and methadone would reduce deaths by 12,500; and that reductions in painkiller prescribing for acute pain would reduce deaths by 8,000.

Again, the researchers cautioned that the individual numbers here aren’t too important. Since this is a model making predictions, these figures are not totally accurate. Instead, what’s important is the overall story that they tell us.

On the harm reduction and treatment front, the model suggested that several interventions — more naloxone, more needle exchanges, more medication-based treatment, and more psychosocial treatment — would have unambiguously good effects, reducing both heroin and painkiller deaths over the next 10 years. But none of them would have giant effects on their own, with potentially hundreds of thousands of deaths still taking place even with the interventions.

Where it gets a little messier is the prescription painkiller control side. With these policies, the model suggested that some interventions could actually increase the number of deaths within five and, in fewer cases, 10 years.

How? To explain that, some context is needed: The opioid epidemic first began as doctors prescribed more opioid painkillers, leading to a proliferation of the drugs that, in turn, led to misuse and addiction not just among patients, but people who bought and stole the drugs from patients as well. Over time, though, some of these painkiller users have shifted to heroin and illicit fentanyls, a class of synthetic opioids, in pursuit of a cheaper, better high (since the illicit drugs are more potent and cheaper than painkillers on the street market) or as they lost access to painkillers.

The model accounts for the latter scenario: When some people are cut off from painkillers, they will go to heroin or fentanyls to continue using opioids. So while these people may not die from painkillers, they may overdose and die on heroin or fentanyl. (For the purposes of the model, it counts fentanyl deaths as “heroin deaths.”)

The question, then, is whether policy interventions prevent enough painkiller deaths to make up for the other deaths they likely cause.

To this end, the researchers’ model found that over a 10-year window, reductions in chronic pain prescribing, rescheduling painkillers to increase restrictions on them, and prescription drug monitoring programs actually increase opioid-related deaths by as much as the tens of thousands — because they increase heroin deaths more than they cut painkiller deaths.

But some other interventions on the prescribing front fare better: reductions in acute pain prescribing, reductions in prescribing for transitioning pain, drug reformulation to make opioids less prone to misuse, and more excess opioid disposal. All of these policies seem to prevent more deaths than they cause in a 10-year window (although not always in a five-year window), based on the model.

Researchers concluded that a “portfolio” of options will be needed to make a significant impact on the crisis, since, based on their estimates, each policy would on its own reduce opioid-related deaths by single-digit percentages, at best.

For example, while only boosting addiction treatment would be “good and all-around beneficial, that’s not going to be sufficient to stem the epidemic,” Pitt said. “So we do believe that some strategy pulling back on prescription pills will be necessary,” as well as other approaches.

What matters here is what Humphreys has described as the “stock and flow.” On one hand, you have the current stock of opioid users who are addicted; the people in this population need treatment, or they will simply find other, potentially deadlier opioids to use if they lose access to painkillers. On the other hand, you have to stop new generations of people from potentially accessing and misusing opioids — or there will be a constant flow of new people with addiction.

So it’s not enough just to help people who are already addicted. It’s important to prevent people from getting addicted, too, in part by stemming the proliferation of painkillers.

As Humphreys put it, “In the history of the world, no one’s ever reversed an epidemic only by treating the sickest people on an individual basis. Imagine if we tried that with the flu epidemic or AIDS — just sit in the hospital and wait, and if people get in the hospital, then treat them.” He noted that the response to HIV/AIDS was far more thorough, focusing not just on improving treatments but also prevention efforts like better education on safe sex, condom distribution, and the establishment of needle exchanges.

Something similar should be tried with the opioid crisis, he argued: Treat people with an addiction and reduce the harm of drug use as much as possible, but also try to prevent the onset of addiction.

The model has big limitations. By the researchers’ admission, none of the individual numbers should be taken too seriously. No one can predict the future or how the crisis might change — just like few people predicted the sudden rise of fentanyls in recent years, making the illicit opioid market even deadlier.

The model is also bound by some assumptions about what’s realistic. For example, the study suggested that a 144 percent increase in access to medications would have more impact on deaths but is “probably not achievable.” So its reported estimates assumed lower increases in the availability of anti-addiction medications.

To put this in context, Humphreys has told me that, based on France’s experience, maximum expansion of access to opioid addiction medications like buprenorphine and methadone would likely reach about half of people with an opioid use disorder. That would still save a lot of lives, given that studies show that these medications reduce the mortality rate among opioid addiction patients by half or more and keep people in treatment better than other approaches.

But America is far from that. Based on federal data, about one in 10 people with a substance use disorder in 2016 got specialty treatment, and one in five people with an opioid use disorder got specialty treatment for nonalcoholic drugs. And only a fraction of those people got on medications — especially given that fewer than half of addiction treatment facilities offer opioid addiction medications to begin with.

To get half of the opioid addiction population on medications, then, America would need a percent increase in the hundreds. But even 144 percent is unrealistic in the US, given its history and based on the researchers’ modeling assumptions.

“If we broke away from past norm, we could push further,” Humphreys said. But, he cautioned, that’s “way beyond anything that our history suggests that we’d be willing to do.”

In a current context, experts have told me that the US would need to dedicate tens of billions of dollars more to really scale up treatment, harm reduction, and prevention to sufficiently deal with the opioid crisis. Congress, despite committing a few billion dollars here and there, has gotten nowhere close to that sum, and it’s hard to envision a scenario in which Congress suddenly allocates those tens of billions.

So the model offers a useful guide for how policymakers can respond to the opioid crisis. But it also shows that they have a very long way to go.

For more on the solutions to the opioid epidemic, read Vox’s explainer.

Original Source -> We’re failing in the opioid crisis. A new study shows a more serious approach would save lives.

via The Conservative Brief

[jakehglover]

This Common Drug Combo Raises Your Risk of Lethal Overdose Fivefold

By Dr. Mercola

Drug overdoses are now the leading cause of death among Americans under the age of 50.1 Preliminary data for 2016 reveals the death toll may be as high as 65,0002 — a 19 percent increase in a single year. Opioids, narcotic pain killers, are responsible for nearly two-thirds, about 42,000, of these deaths.3 Between 2002 and 2015, more than 202,600 Americans died from opioid overdoses.4

While such statistics are sobering enough, recent research5 suggests the death toll may still be underestimated due to incomplete drug reporting of overdose deaths. The researchers believe upward of 70,000 opioid overdose deaths were excluded from national estimates between 1999 and 2015, for the simple reasons that coroners routinely fail to specify opioid use as a contributing cause of death. According to lead author Jeanine Buchanich, research associate professor at University of Pittsburgh School of Public Health:6

“Proper allocation of resources for the opioid epidemic depends on understanding the magnitude of the problem. Incomplete death certificate reporting hampers the efforts of lawmakers, treatment specialists and public health officials. And the large differences we found between states in the completeness of opioid-related overdose mortality reporting makes it more difficult to identify geographic regions most at risk.”

The most common drugs involved in prescription opioid overdose deaths include7 methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®). Extremely potent synthetic opioids like fentanyl are also being abused by a rising number of people. Now, researchers warn a particularly powerful combination of commonly prescribed drugs significantly raises your risk of death.

Benzodiazepine Overdoses Are Also Rising

While opioids make the most frequent headlines, another class of drugs — benzodiazepines8 or "benzos,” widely prescribed for anxiety and insomnia — also claims its share of lives. Prescriptions for these drugs, which include Valium, Ativan, Klonopin and Xanax, tripled from 1996 to 2013, but this doesn't fully account for the uptick in overdoses, which quadrupled during that time.9

As for why the rate of overdose deaths rose faster than the rate of prescriptions, Dr. Chinazo Cunningham, one of the study's authors, told STAT News,10 "Our guess is that people are using these prescriptions in a riskier way.” The number of pills prescribed to each adult increased over the study period, for instance, which suggests Americans may be taking higher doses or taking the drugs for longer periods, both of which increase the risk of overdose. 

Combining the drugs — which act as sedatives — with alcohol is also risky, as is using the drugs along with opioids. Prescription records also show the use of benzos has risen alongside the use of opioids, and that the sedatives are often used alongside the painkillers to enhance the high.11

According to Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Center in Toronto,12 "Prescribing opioids and benzodiazepines together is like putting gasoline on a fire,” adding that “Benzodiazepines are grossly overprescribed … and many people don't necessarily benefit from them."

Estimates suggest more than 4 in 10 seniors use benzos for anxiety or insomnia, even though their long-term effectiveness and safety remain unproven, and their use has been linked to a higher risk of Alzheimer’s disease.13

Older adults who used benzodiazepines for three months or more had a 51 percent greater risk of Alzheimer's disease than those who did not, and the risk increased the longer the drugs were used. According to the authors, “The stronger association observed for long term exposures reinforces the suspicion of a possible direct association …”

Opioid-Benzodiazepine Combination Raises Risk of Death Fivefold

A number of studies have already highlighted the deadly risk you take when combining opioids with benzos. Most recently, research14,15 published in JAMA looked at how the risk of overdose changes when you combine the two drugs for a number of days in a row.

As it turns out, during the first 90 days of concurrent use, your risk of a deadly overdose rises fivefold, compared to taking an opioid alone. Between days 91 and 180, the risk remains nearly doubled, after which the risk tapers off, becoming roughly equal to taking an opioid alone. According to the authors:

“Policy interventions should focus on preventing concurrent opioid and benzodiazepine use in the first place instead of reducing the length of concurrent use. Patients using both medications should be closely monitored, particularly during the first days of concurrent use.”

The study also found that the greater number of clinicians were involved in a patient’s care, the greater the risk of overdose — a finding that highlights the lack of communication between doctors prescribing medication to the same patient, and the clear danger thereof. As noted by senior study author Yuting Zhang, Ph.D., of the University of Pittsburgh Graduate School of Public Health, “These findings demonstrate that fragmented care plays a role in the inappropriate use of opioids.”

Other Studies Confirm Extreme Risk of Opioid-Benzo Mix

Other studies have come to similar conclusions. A 2013 study found the combination of opioids and benzos was the most common drug combination in cases where an overdose death involved two or more drugs.16 According to the National Institute of Drug Abuse, more than 30 percent of opioid overdoses involve concurrent use of benzos.17

Remarkably, another 2013 study18 discovered “substantial co-use” of opioids and benzos among pregnant women that led to death, which is doubly tragic. As reported in a third study that year, which stressed the importance of urine drug testing whenever patients are prescribed an opioid, to ensure their safety:19

“[C]oadministration of [opioids and benzodiazepines] produces a defined increase in rates of adverse events, overdose and death, warranting close monitoring and consideration when treating patients with pain. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documentation of medical necessity, and the adjustment of treatment to clinical changes are essential.”

A study20 published in 2017 found the ratio of patients, aged 18 to 64, who used opioids and benzos concurrently rose from 9 percent in 2001 to 17 percent in 2013, a relative increase of 80 percent. Not surprisingly, concurrent use of opioids and benzos for at least one day doubled the odds of an opioid overdose compared to taking just opioids.

Why Opioid-Benzo Combination Is so Deadly

In 2014, Ohio ended up using an opioid/benzo mix in a death row execution when the conventionally used drugs were unobtainable.21 That just goes to show this drug combination has an assured lethality at the “right” dosage. The reason these two drugs are so hazardous in combination is because both are potent central nervous system (CNS) depressants.

Your CNS, which includes your brain and spinal cord, coordinates and regulates the activity of automatic functions such as breathing. Respiratory depression, meaning slow and erratic breathing, can occur on both drugs, which leads to a buildup of carbon dioxide. In a sufficiently large dose, breathing can cease altogether, leading to death.

Like opioids, benzodiazepines are not intended for long-term use, yet many chronic pain patients end up staying on them for years, and may even take them with opioids for long periods of time. As noted by Dr. Len Paulozzi, medical epidemiologist at the Centers for Disease Control and Prevention, benzos “are prominent fellow travelers with opioids. The problem is, people get on them and they stay on them …"

Opioids Account for Three-Quarters of Drug Deaths Worldwide

In related news, the 2018 World Drug Report22 reveals pharmaceutically-produced opioids now account for more than three-quarters of all drug overdose deaths worldwide. Fentanyl abuse is rising in the U.S., while Africa and Asia are struggling with rising overdose deaths from Tramadol. While doctors are still a primary source of opioids, illegal drug traffickers have started cashing in on the opioid abuse trend, manufacturing and selling them illegally.

According to Yury Fedotov, executive director of the United Nations Office on Drugs and Crime, “We are facing a potential supply-driven expansion of drug markets, with production of opium and manufacture of cocaine at the highest levels ever recorded.” Between 2016 and 2017 alone, the global opium production rose by 65 percent.

In a June 26 address to observe International Day Against Drug Abuse and Illicit Trafficking, United Nations secretary-general António Guterres said,23 “I urge countries to advance prevention, treatment, rehabilitation and reintegration services; ensure access to controlled medicines while preventing diversion and abuse; promote alternatives to illicit drug cultivation; and stop trafficking and organized crime.”

Opioid Makers Shrink Payments to Doctors

One of the factors suspected of contributing to the burgeoning opioid epidemic is kickbacks to the doctors who prescribe them. According to a 2017 study,24 more than 68,000 physicians received drug company payments totaling more than $46 million between August 2013 and December 2015. This means 1 in 12 U.S. physicians collected kickbacks from drug companies producing prescription opioids.

The top 1 percent of physicians received nearly 83 percent of the payments, and fentanyl prescriptions was associated with the highest payments. Many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, were also those showing the most opioid-related payments to physicians, clearly demonstrating a direct link between doctors’ kickbacks and patient addiction rates and deaths.

Increasing pressure on drug companies — in large part brought to bear by lawsuits over deceptive marketing and charges being filed against executives and sales reps for their role in manufacturing demand — now appears to be paying off. According to a recent ProPublica analysis,25 drug company payments to doctors related to opioids decreased 33 percent between 2015 and 2016, from $23.7 million to $15.8 million.

The most significant decrease was related to Subsys, a fentanyl spray made by Insys. The company’s founder, John Kapoor, was arrested in October 2017, charged with bribing doctors to overprescribe the drug. Other Insys executives and sales reps were arrested on conspiracy and racketeering charges.26 In 2015, the company doled out more than $6 million in Subsys-related payments. In 2016, that amount shrunk to less than $2.4 million.

Purdue Pharma, heavily criticized for its deceptive marketing of OxyContin, no longer pays doctors to speak about the drug, and laid off its last opioid sales reps in June 2018.27 While the cutbacks in payments are a step in the right direction, research shows it doesn’t take huge sums of money to influence a doctor’s prescribing habits. A single free meal received in relation to marketing of an opioid has been shown to result in a greater number of prescriptions for the drug in the following year.28,29

Addiction Is a Very Real Problem with Benzodiazepines

Getting back to the issue of benzodiazepines, it’s important to realize these drugs are every bit as addictive and dangerous as opioids, and when taken together, the risk of death is magnified fivefold. Benzos exert a calming effect by boosting the action of the neurotransmitter gamma-aminobutyric acid (GABA), which in turn activates the gratification hormone, dopamine, in your brain.

Side effects include memory loss, hip fractures, impaired thinking and dizziness. Ironically, symptoms of withdrawal include extreme anxiety — in many cases worse than the original symptoms that justified the treatment in the first place. Other side effects of withdrawal include hallucinations, depersonalization and derealization, formication (skin crawling) and sensory hypersensitivity, perceptual distortions, convulsions and psychosis.

There are far safer ways to address anxiety and insomnia, starting with exercise, optimizing your gut microbiome and omega-3 level. The Emotional Freedom Techniques (EFT) is another effective tool that can help reprogram your body's reactions to the unavoidable stressors of everyday life. This includes both real and imagined stressors, both of which can be significant sources of anxiety. It can also help reduce pain.

In the following video, EFT therapist Julie Schiffman discusses EFT for stress and anxiety relief. Please keep in mind that while anyone can learn to do EFT at home, for serious issues like persistent or severe anxiety you should consult with an EFT professional to get the relief you need. Pain can also be safely addressed without opioids. For a list of suggestions, see “15 Natural Remedies for Back Pain.”

from HealthyLife via Jake Glover on Inoreader http://articles.mercola.com/sites/articles/archive/2018/07/19/opioid-benzo-mix-overdose.aspx