#emerging nonprofit

[cascadia-stack-blog]

Social Entrepreneur Update

It's been way too long since I've posted. Cascadia Stack is now a fiscally sponsored project of CascadiaNow a 501c3 nonprofit, which means for a portion of Stack's donations, I get all of the backend financial stuff taken from me, the project gets to work on it's programs without those stresses.

Cascadia Stack has held 3 events. Two Climate Resilience Circle gatherings and one Spanish preparedness workshop. The response has been lukewarm, although the Instagram followers are now over 150.

Our next Circle is Feb. 18 and the next Spanish preparedness workshop is Mar. 16. Our new website just landed, through Squarespace: www cascadiastack org

The problem is two-fold. One, finding free or very cheap indoor gathering spaces. And I believe we can solve that by partnering with organizations whose client base is our target audience, too. And that is precisely what I am working on now. Second problem is, just getting people at organizations to trust so that they spread the word to their base. Our events have had less than 10 people at each one. The money raised has not been close to what the professional facilitators should be paid.

That is the rant for now, but I am very excited for the upcoming partnerships that may be shaping!

[meneerdechiron]

Someone who knows nothing and knows that he knows nothing knows more than someone who knows nothing and does not know that he knows nothing. I know I don't know anything, so I know more than the people who think they know something.

[iamunriven]

If I could press rewind, and talk to my 19 year old self:

You are capable of greatness.

I don't care what the odds are.

At the end of the day,

Your chances are better at succeeding

If you believe in yourself, above all else.

So put the past behind you.

Yesterday's failures don't belong here, now.

Turn the page.

Begin again.

You can accomplish anything.

[nserekoisa]

Let’s bless a smile together

[riding-with-the-wild-hunt]

a whole bunch of gazan mutual aid projects and nonprofits. if the decision of which individual fundraiser to give to feels too daunting, or if you just want to help as many people as possible in one go, these are great initiatives to support.

care for gaza - focuses on providing food and essential supplies. donate here or here.

connecting humanity - securing internet access via donations of virtual sim cards (esims). if you can't afford a whole plan yourself, crips for esims is a communal pool that will use your donation to purchase and maintain esims

gaza soup kitchen - provides food, medical care, and classes for children. also has a gofundme

glia gaza medical support initiative - provides medical care through field clinics and tents at hospitals. donations can also be sent through their website.

ele elna elak - provides clean water, food, clothing, and shelter. they also have a gofundme

life for gaza - raising money for the gaza municipality to repair water and waste management infrastructure

taawon - partners with local civil organizations to provide food, water, medical care, shelter, and basic supplies

the sameer project - running various initiatives providing tents, medical care, and necessities. they have their own encampment project focused on sheltering families with children, sick and disabled members, or members in need of perinatal care

islamic relief worldwide's gaza emergency appeal - provides food, water, hygiene kits, medical supplies, and psychological support

baitulmaal - provides a variety of necessities, including food, water, shelter, and medical supplies

gaza mutual aid fund - distributes food, hygiene products, water, and other essential supplies, including financial support. run by @/el-shab-hussein's amazing friend Mona. updates can be found on her instagram.

hygiene kits for gaza - provides hygiene supplies including menstrual products, wipes, and toothbrushes/toothpaste

anera - provides a variety of necessities, including food, water, hygiene supplies, medicine, blankets and mattresses, and psychological care

palestine children's relief fund - provides supplies and support with a focus on children. also has an initiative for lebanon

dahnoun mutual aid - provides water, food, tents, baby supplies, financial support, and other necessities. updates can be found through their instagram

certainly this is not an exhaustive list, so please feel free to add on other projects or organizations that i didn't include. and as always, please take the time to donate if you can and share. it truly makes all the difference.

[schoolhater]

answering a couple questions i got on this post since i realized ppl genuinely wanna know:

tl;dr:

israel lets very, very little aid get into gaza. even the UN can't get in as much as they want to. funding individual families, gazan led initiatives, and mutual aid collectives operating out of gaza ensures gazans can provide for themselves and pay for the extremely expensive aid that is available.

with all the civil infrastructure destroyed by israel, the situation on the ground has devolved into unrestricted capitalism, driving up the price of aid (that should be free!). this makes it more urgent for people to have funding for daily survival.

the post linked above has examples of how donating to individual families can help a lot. if you want to help more than one family at a time, there are many gazan-led initiatives focusing on rebuilding their infrastructure and distributing aid fairly that are worth donating to instead of large charities that already get the majority of donations.

as i mentioned in the last post: @/careforgaza on twitter is a nonprofit started by gazans, it's been endorsed by multiple palestinian journalists.

the sameer project is a collective organized by diaspora palestinians offering emergency shelter to gazans.

ele elna elak is a project aiming to bring water, food, shelter, etc. to gazans and has been promoted by bisan owda.

and the municipality of gaza itself is fundraising to rebuild water infrastructure.

all of these organizations are active inside gaza right now and are being run by gazans. if anyone knows of other gazan-led mutual aid projects, nonprofits or charities feel free to link them in the notes! hope this helped!

long answers under the cut!

if you wanna donate to a charity that's absolutely fine, but the thing is most charities (and even the UN!) are unable to make it into gaza in the first place, leaving aid rotting at the egyptian side of the border or subject to israeli settler attacks

not to mention, charities and nonprofits also maintain a paternalistic colonial relationship with the indigenous people they are trying to help, determining what aid they need for them instead of returning power to them and letting them make their own choices

i'm not here to say that one option is better than the other, just that they achieve different things and are equally legitimate. there's an attitude among people who question the legitimacy of these gofundme campaigns that somehow the people promoting them are telling them not to donate to charities. nobody is stopping you from donating to charities. we are just asking that you do not dehumanize the very real gazans in your inbox just because their method of asking for aid is more direct and risky.

unfortunately that's exactly what has happened. because israel destroyed all of gaza's more formalized infrastructure, it seems that organized crime and rampant inflation has taken its place. aid is supposed to be free, but in order to save for evacuation or the cost of living, people have started selling them at an inflated price. and aid that is truly free attracts intense, large crowds that are dangerous to navigate.

this was posted on abc a few days ago

it's pure, unrestrained capitalism. i've had multiple palestinians describe this situation to me confidence. that's why everything's so expensive now. why people have to rent out tiny plots of land for their tents to sit on, why my friend @siraj2024 still has to buy tarps to cover the broken windows of the overpriced bombed out apartment he rented, and why a bag of flour can cost a thousand bucks in the north.

even before israel closed and then bombed the rafah crossing, the egyptian hala travel agency was only allowing people to cross the border if they paid a hefty $5000 USD per adult / $2500 USD per child bribe. it denies doing this, but the hundreds of stories from palestinians say otherwise.

with regard to the economy, here in america we saw something similar happen in the wake of hurricane helene and milton. the podcaster margaret killjoy describes how she saw dual economies rise after asheville was fully cut off from the rest of the country - some people offered each other supplies for free in a sort of mutual aid honor system, and some people required payment when they lent supplies because they themselves needed to buy stuff for their families. these dual economies exist in gaza too. and this means they all still need money to survive.

[ongole]

DAILY SCRIPTURE READINGS (DSR) 📚 Group, Mon April 22nd, 2024 ... Monday of the Fourth Week of Easter, Year B

Reading 1

__________

Acts 11:1-18

The Apostles and the brothers who were in Judea

heard that the Gentiles too had accepted the word of God.

So when Peter went up to Jerusalem

the circumcised believers confronted him, saying,

'You entered the house of uncircumcised people and ate with them."

Peter began and explained it to them step by step, saying,

"I was at prayer in the city of Joppa

when in a trance I had a vision,

something resembling a large sheet coming down,

lowered from the sky by its four corners, and it came to me.

Looking intently into it,

I observed and saw the four-legged animals of the earth,

the wild beasts, the reptiles, and the birds of the sky.

I also heard a voice say to me, 'Get up, Peter. Slaughter and eat.'

But I said, 'Certainly not, sir,

because nothing profane or unclean has ever entered my mouth.'

But a second time a voice from heaven answered,

'What God has made clean, you are not to call profane.'

This happened three times,

and then everything was drawn up again into the sky.

Just then three men appeared at the house where we were,

who had been sent to me from Caesarea.

The Spirit told me to accompany them without discriminating.

These six brothers also went with me,

and we entered the man's house.

He related to us how he had seen the angel standing in his house, saying,

'Send someone to Joppa and summon Simon, who is called Peter,

who will speak words to you

by which you and all your household will be saved.'

As I began to speak, the Holy Spirit fell upon them

as it had upon us at the beginning,

and I remembered the word of the Lord, how he had said,

'John baptized with water

but you will be baptized with the Holy Spirit.'

If then God gave them the same gift he gave to us

when we came to believe in the Lord Jesus Christ,

who was I to be able to hinder God?"

When they heard this,

they stopped objecting and glorified God, saying,

"God has then granted life-giving repentance to the Gentiles too."

Responsorial Psalm

______________

Ps 42:2-3; 43:3, 4

R. (see 3a) Athirst is my soul for the living God.

or:

R. Alleluia.

As the hind longs for the running waters,

so my soul longs for you, O God.

Athirst is my soul for God, the living God.

When shall I go and behold the face of God?

R. Athirst is my soul for the living God.

or:

R. Alleluia.

Send forth your light and your fidelity;

they shall lead me on

And bring me to your holy mountain,

to your dwelling-place.

R. Athirst is my soul for the living God.

or:

R. Alleluia.

Then will I go in to the altar of God,

the God of my gladness and joy;

Then will I give you thanks upon the harp,

O God, my God!

R. Athirst is my soul for the living God.

or:

R. Alleluia.

Alleluia

_______

Jn 10:14

R. Alleluia, alleluia.

I am the good shepherd, says the Lord;

I know my sheep, and mine know me.

R. Alleluia, alleluia.

Gospel

_________

Jn 10:1-10

Jesus said:

"Amen, amen, I say to you,

whoever does not enter a sheepfold through the gate

but climbs over elsewhere is a thief and a robber.

But whoever enters through the gate is the shepherd of the sheep.

The gatekeeper opens it for him, and the sheep hear his voice,

as he calls his own sheep by name and leads them out.

When he has driven out all his own,

he walks ahead of them, and the sheep follow him,

because they recognize his voice.

But they will not follow a stranger;

they will run away from him,

because they do not recognize the voice of strangers."

Although Jesus used this figure of speech,

they did not realize what he was trying to tell them.

So Jesus said again, "Amen, amen, I say to you,

I am the gate for the sheep.

All who came before me are thieves and robbers,

but the sheep did not listen to them.

I am the gate.

Whoever enters through me will be saved,

and will come in and go out and find pasture.

A thief comes only to steal and slaughter and destroy;

I came so that they might have life and have it more abundantly."

***

FOCUS AND LITURGY OF THE WORD

Good-News for Today

What is the “Good-news” for today? The “Good-news” is meant to remind us of the comfort, encouragement and most of all, God’s love for us.  Also, a challenge.  Jesus says, “I am the good shepherd”. The good shepherd tends his fold; calls them by name and “I lay down my life for the sheep”.  They know my voice, follow me and are not duped by strangers. Today, the comforting love is found in the intimate image of the relationship between the Good Shepherd, Jesus, and his fold and in Jesus’ relationship with his father.  We, all of us – children, women and men are invited to be in as trusting and faithful a relationship with Jesus as He is with His fold. This does not sound like much of a challenge. To be in a relationship as intimate as Jesus is with His Father, sounds much more challenging. We, like sheep, are not always discerning or faithful.  Jesus is the unconditionally loving and faithful one. As in all of the parables, Jesus is the focus. This reading from John is not about the sheep. Tt is about Jesus, about God, who says “I am…”.  An identity Jesus claims 7 times in John’s gospel alone.  This claim goes back as far as Moses when Yahweh, God,says “I am…”.  

Some of us are fortunate to have the experience of being loved and nurtured.  Jesus wants nothing more than to love and nurture me.  All of us! Jesus wants me, all of us, to know his voice and not be duped by false voices.  What could be more comforting than to be loved and wanted? Especially by God.

The challenge comes later in the chapter. Jesus says, “I have other sheep that do not belong to this fold.  I must bring them also… So there will be one flock, one shepherd.” I have grown accustomed to those in my fold. My fold recognizes who “belongs” and who does not. “We” belong. “They” do not.

Is it possible for all to become one flock? What do we have in common? Above all else we all want to be acceptable, welcomed, respected and valued for our individuality and uniqueness. We all thirst to belong. We all do belong; just haven’t recognized each other yet. Jews, Christians, Muslims, refugees, immigrants, Africans, Asians, LGBTQ+, the proverbial Other, the cherished and the shunned, the feared, the rich, the poor, the marginalized, the prisoner – all of us want to and do belong to God’s one loved flock.  Some of us cannot verbalize this desire to belong to Jesus’ one flock.  Some of us can only express the pain of exclusion.  

What a wonderful overwhelming invitation to be in a personal, unique and intimate loving relationship with God, with Jesus!  

What would that look like – hard for me to begin to imagine. Just attempting fills me with joy, hope, encouragement and most of all of overwhelming Love.  I am loved and so are you.

I want to love in return.

Jesus’ death and resurrection is the open, ongoing invitation to all to belong and participate in Jesus’ one flock.

Amen

***

SAINT OF THE DAY

Saint Adalbert of Prague

(956 – April 23, 997)

Saint Adalbert of Prague’s Story

Opposition to the Good News of Jesus did not discourage Adalbert, who is now remembered with great honor in the Czech Republic, Poland, Hungary, and Germany.

Born to a noble family in Bohemia, he received part of his education from Saint Adalbert of Magdeburg. At the age of 27, he was chosen as bishop of Prague. Those who resisted his program of clerical reform forced him into exile eight years later.

In time, the people of Prague requested his return as their bishop. Within a short time, however, he was exiled again after excommunicating those who violated the right of sanctuary by dragging a woman accused of adultery from a church and murdering her.

After a short ministry in Hungary, he went to preach the Good News to people living near the Baltic Sea. He and two companions were martyred by pagan priests in that region. Adalbert’s body was immediately ransomed and buried in the Gniezno, Poland, cathedral. In the mid-11th century his relics were moved to Saint Vitus Cathedral in Prague. His liturgical feast is celebrated on April 23.

Reflection

_________

Preaching the Good News can be dangerous work whether the audience is already baptized or not. Adalbert fearlessly preached Jesus’ gospel and received a martyr’s crown for his efforts. Similar zeal has created modern martyrs in many places, especially in Central and South America. Some of those martyrs grew up in areas once evangelized by Adalbert.

***

【Build your Faith in Christ Jesus on #dailyscripturereadingsgroup 📚: +256 751 540 524 .. Whatsapp】

[fiercynn]

on ao3's current fundraiser

apparently it’s time for ao3’s biannual donation drive, which means it’s time for me to remind you all, that regardless of how much you love ao3, you shouldn’t donate to them because they HAVE TOO MUCH MONEY AND NO IDEA WHAT TO DO WITH IT.

we’ve known for years that ao3 – or, more specifically, the organization for transformative works (@transformativeworks on tumblr), or otw, who runs ao3 and other fandom projects – has a lot of money in their “reserves” that they had no plans for. but in 2023, @manogirl and i did some research on this, and now, after looking at their more recent financial statements, i’ve determined that at the beginning of 2024, they had almost $2.8 MILLION US DOLLARS IN SURPLUS.

our full post last year goes over the principles of how we determined this, even though the numbers are for 2023, but the key points still stand (with the updated numbers):

when we say “surplus”, we are not including money that they estimate they need to spend in 2024 for their regular expenses. just the extra that they have no plan for

yes, nonprofits do need to keep some money in reserves for emergencies; typically, nonprofits registered in the u.s. tend to keep enough to cover between six months and two years of their regular operating expenses (meaning, the rough amount they need each month to keep their services going). $2.8 million USD is enough to keep otw running for almost FIVE YEARS WITHOUT NEW DONATIONS

they always overshoot their fundraisers: as i’m posting this, they’ve already raised $104,751.62 USD from their current donation drive, which is over double what they’ve asked for! on day two of the fundraiser!!

no, we are not trying to claim they are embezzling this money or that it is a scam. we believe they are just super incompetent with their money. case in point: that surplus that they have? only earned them $146 USD in interest in 2022, because only about $10,000 USD of their money invested in an interest-bearing account. that’s the interest they earn off of MILLIONS. at the very least they should be using this extra money to generate new revenue – which would also help with their long-term financial security – but they can’t even do that

no, they do not need this money to use if they are sued. you can read more about this in the full post, but essentially, they get most of their legal services donated, and they have not, themselves, said this money is for that purpose

i'm not going to go through my process for determining the updated 2024 numbers because i want to get this post out quickly, and otw actually had not updated the sources i needed to get these numbers until the last couple days (seriously, i've been checking), but you can easily recreate the process that @manogirl and i outlined last year with these documents:

otw’s 2022 audited financial statement, to determine how much money they had at the end of 2022

otw’s 2024 budget spreadsheet, to determine their net income in 2023 and how much they transferred to and from reserves at the beginning of 2024

otw’s 2022 form 990 (also available on propublica), which is a tax document, and shows how much interest they earned in 2022 (search “interest” and you’ll find it in several places)  

also, otw has not been accountable to answering questions about their surplus. typically, they hold a public meeting with their finance committee every year in september or october so people can ask questions directly to their treasurer and other committee members; as you can imagine, after doing this deep dive last summer, i was looking forward to getting some answers at that meeting!

but they cancelled that meeting in 2023, and instead asked people to write to the finance committee through their contact us form online. fun fact: i wrote a one-line message to the finance committee on may 11, 2023 through that form, when @manogirl and i were doing this research, asking them for clarification on how much they have in their reserves. i have still not received a response.

so yeah. please spend your money on people who actually need it, like on mutual aid requests! anyone who wants to share their mutual aid requests, please do so in the replies and i’ll share them out – i didn’t want to link directly to individual requests without permission in case this leads to anyone getting harassed, but i would love to share your requests. to start with, here's operation olive branch and their ongoing spreadsheet sharing palestinian folks who need money to escape genocide.

oh, and if you want to write to otw and tell them why you are not donating, i'm not sure it’ll get any results, but it can’t hurt lol. here's their contact us form – just don’t expect a response! ¯\_(ツ)_/¯

[nerevarbignaturals]

Listen. Listen. SHUT THE FUCK UP. Kids aren't gonna do drugs because you tell them about drugs. Or maybe they will, but wouldn't you rather that your kid know exactly how drugs will affect them, how to reduce the harm that occurs when they take them, and how to stop an overdose than to not know any of that and do drugs alone & unsafely?? Like idk man personally, I'd rather have an open conversation so I know that if my kid gets in over their head they know they can talk to me and we'll get help together. :)))))

[mostlysignssomeportents]

Epic Systems, a lethal health record monopolist

Epic Systems makes the dominant electronic health record (EHR) system in America; if you're a doctor, chances are you are required to use it, and for every hour a doctor spends with a patient, they have to spend two hours doing clinically useless bureaucratic data-entry on an Epic EHR.

How could a product so manifestly unfit for purpose be the absolute market leader? Simple: as Robert Kuttner describes in an excellent feature in The American Prospect, Epic may be a clinical disaster, but it's a profit-generating miracle:

https://prospect.org/health/2024-10-01-epic-dystopia/

At the core of Epic's value proposition is "upcoding," a form of billing fraud that is beloved of hospital administrators, including the "nonprofit" hospitals that generate vast fortunes that are somehow not characterized as profits. Here's a particularly egregious form of upcoding: back in 2020, the Poudre Valley Hospital in Ft Collins, CO locked all its doors except the ER entrance. Every patient entering the hospital, including those receiving absolutely routine care, was therefore processed as an "emergency."

In April 2020, Caitlin Wells Salerno – a pregnant biologist – drove to Poudre Valley with normal labor pains. She walked herself up to obstetrics, declining the offer of a wheelchair, stopping only to snap a cheeky selfie. Nevertheless, the hospital recorded her normal, uncomplicated birth as a Level 5 emergency – comparable to a major heart-attack – and whacked her with a $2755 bill for emergency care:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

Upcoding has its origins in the Reagan revolution, when the market-worshipping cultists he'd put in charge of health care created the "Prospective Payment System," which paid a lump sum for care. The idea was to incentivize hospitals to provide efficient care, since they could keep the difference between whatever they spent getting you better and the set PPS amount that Medicare would reimburse them. Hospitals responded by inventing upcoding: a patient with controlled, long-term coronary disease who showed up with a broken leg would get coded for the coronary condition and the cast, and the hospital would pocket both lump sums:

https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled

The reason hospital administrators love Epic, and pay gigantic sums for systemwide software licenses, is directly connected to the two hours that doctors spent filling in Epic forms for every hour they spend treating patients. Epic collects all that extra information in order to identify potential sources of plausible upcodes, which allows hospitals to bill patients, insurers, and Medicare through the nose for routine care. Epic can automatically recode "diabetes with no complications" from a Hierarchical Condition Category code 19 (worth $894.40) as "diabetes with kidney failure," code 18 and 136, which gooses the reimbursement to $1273.60.

Epic snitches on doctors to their bosses, giving them a dashboard to track doctors' compliance with upcoding suggestions. One of Kuttner's doctor sources says her supervisor contacts her with questions like, "That appointment was a 2. Don’t you think it might be a 3?"

Robert Kuttner is the perfect journalist to unravel the Epic scam. As a journalist who wrote for The New England Journal of Medicine, he's got an insider's knowledge of the health industry, and plenty of sources among health professionals. As he tells it, Epic is a cultlike, insular company that employs 12.500 people in its hometown of Verona, WI.

The EHR industry's origins start with a GW Bush-era law called the HITECH Act, which was later folded into Obama's Recovery Act in 2009. Obama provided $27b to hospitals that installed EHR systems. These systems had to more than track patient outcomes – they also provided the data for pay-for-performance incentives. EHRs were already trying to do something very complicated – track health outcomes – but now they were also meant to underpin a cockamamie "incentives" program that was supposed to provide a carrot to the health industry so it would stop killing people and ripping off Medicare. EHRs devolved into obscenely complex spaghetti systems that doctors and nurses loathed on sight.

But there was one group that loved EHRs: hospital administrators and the private companies offering Medicare Advantage plans (which also benefited from upcoding patients in order to soak Uncle Sucker):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

The spread of EHRs neatly tracks with a spike in upcharging: "from 2014 through 2019, the number of hospital stays billed at the highest severity level increased almost 20 percent…the number of stays billed at each of the other severity levels decreased":

https://oig.hhs.gov/oei/reports/OEI-02-18-00380.pdf

The purpose of a system is what it does. Epic's industry-dominating EHR is great at price-gouging, but it sucks as a clinical tool – it takes 18 keystrokes just to enter a prescription:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729481

Doctors need to see patients, but their bosses demand that they satisfy Epic's endless red tape. Doctors now routinely stay late after work and show up hours early, just to do paperwork. It's not enough. According to another one of Kuttner's sources, doctors routinely copy-and-paste earlier entries into the current one, a practice that generates rampant errors. Some just make up random numbers to fulfill Epic's nonsensical requirements: the same source told Kuttner that when prompted to enter a pain score for his TB patients, he just enters "zero."

Don't worry, Epic has a solution: AI. They've rolled out an "ambient listening" tool that attempts to transcribe everything the doctor and patient say during an exam and then bash it into a visit report. Not only is this prone to the customary mistakes that make AI unsuited to high-stakes, error-sensitive applications, it also represents a profound misunderstanding of the purpose of clinical notes.

The very exercise of organizing your thoughts and reflections about an event – such as a medical exam – into a coherent report makes you apply rigor and perspective to events that otherwise arrive as a series of fleeting impressions and reactions. That's why blogging is such an effective practice:

https://pluralistic.net/2021/05/09/the-memex-method/

The answer to doctors not having time to reflect and organize good notes is to give them more time – not more AI. As another doctor told Kuttner: "Ambient listening is a solution to a self-created problem of requiring too much data entry by clinicians."

EHRs are one of those especially hellish public-private partnerships. Health care doctrine from Reagan to Obama insisted that the system just needed to be exposed to market forces and incentives. EHRs are designed to allow hospitals to win as many of these incentives as possible. Epic's clinical care modules do this by bombarding doctors with low-quality diagnostic suggestions with "little to do with a patient’s actual condition and risks," leading to "alert fatigue," so doctors miss the important alerts in the storm of nonsense elbow-jostling:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058605/

Clinicians who actually want to improve the quality of care in their facilities end up recording data manually and keying it into spreadsheets, because they can't get Epic to give them the data they need. Meanwhile, an army of high-priced consultants stand ready to give clinicians advise on getting Epic to do what they need, but can't seem to deliver.

Ironically, one of the benefits that Epic touts is its interoperability: hospitals that buy Epic systems can interconnect those with other Epic systems, and there's a large ecosystem of aftermarket add-ons that work with Epic. But Epic is a product, not a protocol, so its much-touted interop exists entirely on its terms, and at its sufferance. If Epic chooses, a doctor using its products can send files to a doctor using a rival product. But Epic can also veto that activity – and its veto extends to deciding whether a hospital can export their patient records to a competing service and get off Epic altogether.

One major selling point for Epic is its capacity to export "anonymized" data for medical research. Very large patient data-sets like Epic's are reasonably believed to contain many potential medical insights, so medical researchers are very excited at the prospect of interrogating that data.

But Epic's approach – anonymizing files containing the most sensitive information imaginable, about millions of people, and then releasing them to third parties – is a nightmare. "De-identified" data-sets are notoriously vulnerable to "re-identification" and the threat of re-identification only increases every time there's another release or breach, which can used to reveal the identities of people in anonymized records. For example, if you have a database of all the prescribing at a given hospital – a numeric identifier representing the patient, and the time and date when they saw a doctor and got a scrip. At any time in the future, a big location-data breach – say, from Uber or a transit system – can show you which people went back and forth to the hospital at the times that line up with those doctor's appointments, unmasking the person who got abortion meds, cancer meds, psychiatric meds or other sensitive prescriptions.

The fact that anonymized data can – will! – be re-identified doesn't mean we have to give up on the prospect of gleaning insight from medical records. In the UK, the eminent doctor Ben Goldacre and colleagues built an incredible effective, privacy-preserving "trusted research environment" (TRE) to operate on millions of NHS records across a decentralized system of hospitals and trusts without ever moving the data off their own servers:

https://pluralistic.net/2024/03/08/the-fire-of-orodruin/#are-we-the-baddies

The TRE is an open source, transparent server that accepts complex research questions in the form of database queries. These queries are posted to a public server for peer-review and revision, and when they're ready, the TRE sends them to each of the databases where the records are held. Those databases transmit responses to the TRE, which then publishes them. This has been unimaginably successful: the prototype of the TRE launched during the lockdown generated sixty papers in Nature in a matter of months.

Monopolies are inefficient, and Epic's outmoded and dangerous approach to research, along with the roadblocks it puts in the way of clinical excellence, epitomizes the problems with monopoly. America's health care industry is a dumpster fire from top to bottom – from Medicare Advantage to hospital cartels – and allowing Epic to dominate the EHR market has somehow, incredibly, made that system even worse.

Naturally, Kuttner finishes out his article with some antitrust analysis, sketching out how the Sherman Act could be brought to bear on Epic. Something has to be done. Epic's software is one of the many reasons that MDs are leaving the medical profession in droves.

Epic epitomizes the long-standing class war between doctors who want to take care of their patients and hospital executives who want to make a buck off of those patients.

Tor Books as just published two new, free LITTLE BROTHER stories: VIGILANT, about creepy surveillance in distance education; and SPILL, about oil pipelines and indigenous landback.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/10/02/upcoded-to-death/#thanks-obama

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0/deed.en

[meneerdechiron]

Made an alternative to WEF's great reset

[sayruq]

A bipartisan bill would give the secretary of the treasury unilateral power to classify any charity as a terrorist-supporting organization, automatically stripping away its nonprofit status. The bill, H.R. 6408, already passed the House of Representatives in November, and a companion bill, S. 4136, was introduced to the Senate by Sens. John Cornyn (R–Texas) and Angus King (I–Maine) last week. In theory, the bill is a measure to fight terrorism financing. At least, that's what sponsor Rep. David Kustoff (R–Tenn.) claimed. "I urge the swift passage of this legislation that will significantly diminish the ability of Hamas and other terrorist groups to finance their operations and carry out future attacks," he said in a November statement. Financing terrorism is already very illegal. Anyone who gives money, goods, or services to a U.S.-designated terrorist organization can be charged with a felony under the Antiterrorism Act and the International Emergency Economic Powers Act. And those terrorist organizations are already banned from claiming tax-exempt status under section 501(c)(3) of the tax code. Nine charities have been shut down since 2001 under the law. The new bill would allow the feds to shut down a charity without an official terrorism designation. It creates a new label called "terrorist-supporting organization" that the secretary of the treasury could slap onto nonprofits, removing their tax exempt status within 90 days. Only the secretary of the treasury could cancel that designation.

[reasonsforhope]

"Tuesday’s [April 9, 2024] definition-shifting court ruling means nearly 50 governments must now contend with a new era of climate litigation.

Governments be warned: You must protect your citizens from climate change — it’s their human right.

The prescient message was laced throughout a dense ruling Tuesday from Europe’s top human rights court. The court’s conclusion? Humans have a right to safety from climate catastrophes that is rooted in their right to life, privacy and family.

The definition-shifting decision from the European Court of Human Rights means nearly 50 governments representing almost 700 million people will now have to contend with a new era of litigation from climate-stricken communities alleging inaction. 

While the judgment itself doesn’t include any penalties — the case featured several women accusing Switzerland of failing to shield them from climate dangers — it does establish a potent precedent that people can use to sue governments in national courts.

The verdict will serve “as a blueprint for how to successfully sue your own government over climate failures,” said Ruth Delbaere, a legal specialist at Avaaz, a U.S.-based nonprofit that promotes climate activism...

Courting the courts on climate

The European Court of Human Rights was established in the decade following World War II but has grown in importance over the last generation. As the judicial arm of the Council of Europe, an international human rights organization, the court’s rulings are binding on the council’s 46 members, spanning all of Europe and numerous countries on its borders.

As a result, Tuesday’s [April 9, 2024] ruling will help elevate climate litigation from a country-by-country battle to one that stretches across continents.

Previously, climate activists had mostly found success in suing individual countries to force climate action. 

A 2019 Dutch Supreme Court verdict forced the Netherlands to slash its greenhouse gas emissions by 25 percent, while in 2021 a French court ruled the government was responsible for environmental damage after it failed to meet greenhouse gas reduction goals. That same year, Germany’s Constitutional Court issued a sweeping judgment that the country’s 2019 climate law was partly “unconstitutional” because it put too much of the emissions-cutting burden on future generations.

Even in the U.S., young environmental activists won a local case last year against state agencies after arguing that the continued use of fossil fuels violated their right to a "clean and healthful environment."

But 2024 is shaping up to be a turning point for climate litigation, redefining who has a right to sue over climate issues, what arguments they can use, and whom they can target. 

To start, experts overwhelmingly expect that Tuesday’s ruling will reverberate across future lawsuits — both in Europe and globally. The judgment even includes specifics about what steps governments must take to comply with their new climate-related human rights obligations. The list includes things like a concrete deadline to reach climate neutrality, a pathway to getting there, and evidence the country is actually on that path...

Concretely, the verdict could also affect the outcomes of six other high-profile climate lawsuits pending before the human rights court, including a Greenpeace-backed suit questioning whether Norway's decision to grant new oil and gas licenses complies with its carbon-cutting strategy.

An emerging legal strategy

In the coming months, other international bodies are also expected to issue their own rulings on the same thorny legal issues, which could further solidify the evolving trend. 

The International Court of Justice, the International Tribunal for the Law of the Sea and the Inter-American Court of Human Rights all have similar cases working through the system.

"All these cases together will clarify the legal obligations of states to protect rights in the context of climate change — and will set the stage for decades to come," said Chowdhury, from the environmental law center."

-via Politico, April 9, 2024

[riding-with-the-wild-hunt]

compiling some mutual aid projects and nonprofits working in sudan. though depending on where you get your news you may not see very much coverage of the unfolding crisis, millions of people are in danger every day as the situation continues to deteriorate. i've been really astounded by the scale of your response to the earlier list of gazan initiatives, and i hope you extend the same support to these organizations too!

khartoum aid kitchen - currently running 12 community kitchen sites and supporting five others that collectively provide food for over 10,000 people

fill a heart - provides financial support to sudanese hospitals and families displaced in egypt. updates are available on their instagram.

sudan solidarity collective - supporting civil society organizations and providing psychological and educational programs for displaced people. can also donate through their paypal

darfur women action - runs programs for displaced women and girls

sudanese american physicians association - provides medical treatment and supports healthcare infrastructure

amal for women - currently focused on providing water, food, hygiene products, and shelter for displaced people. general projects include education programs for children, support and professional training for single mothers, and providing trauma care. also has a gofundme

hadhreen - provides food, water, solar panels for hospitals, children's educational programming, and a variety of other support services

hometax - provides necessities for displaced people, including food, shelter, and medical assistance. updates can be found on their instagram.

barana hanabneiho - originally focused on rebuilding and equipping schools, currently providing food, water, tents, mosquito nets, and weather-appropriate necessities to displaced people. they have an instagram and also accept donations through zeffy

saving algeneina initiative - provides a variety of necessities, including food, rain covers for tents, and medical care. works with displaced people in both sudan and chad.

sudanese red crescent society - runs health programs across all 18 states as well as delivering essential supplies

sadagaat - various initiatives including water stations and community kitchens

hope relief and rehabilitation for disabilities support (hrrds) - originally focused on disability justice programs. currently providing food, water, hygiene products, mobility aids, and other necessities with a focus on supporting disabled people and other vulnerable groups

medglobal's sudan emergency appeal - provides medical supplies, equipment for doctors, and fuel for hospitals

sudanese american medical association - provides food, water, and medical equipment, as well as training clinicians and sending extra doctors to hospitals

siha network - provides menstrual products and obstetric/gynecological care

as before, this is not an exhaustive list, so please feel free to add any similar initiatives or organizations you know of. and as always please donate whatever amount you can and share! every small action makes a difference, even if it feels inconsequential to you.

[benicebefunny]

The manager angrily approached and “shouted blatantly discriminatory remarks” toward the mother and the 15-year-old, the lawsuit alleges. “A grown man should not be in the women’s restroom,” the manager said in the crowded lobby, according to the suit. “This is not a transgender bathroom.” Even though there were no other complaints, the manager allegedly ordered the Gallinaros off the property and directed an assistant manager to call the police, the suit states.

Many trans and disability advocates have expressed how transphobic bathroom policies harm the disability community, and cases like this unfortunately illustrate that point. Discrimination always spreads, and we must work in solidarity to combat it.