#i only have original copies of my diagnosis documents

[zipquips]

feeling incredibly unprepared for my med appointment today

[rqbossman]

Hello Mr Bossman! (and possibly anyone else who reads this)

Its an honour to be here, I have a few questions. First i appologise for the long paragraph, you may dismiss it for the questions at the bottom. For context, i am here after finishing TMA and being up to date with TMAP, i then went over and listened to RQG, and have just finished listening to Epilogue 3 and might i just say, good sir I am grateful for your podcasts. I am currently just a few months away from my final exams of High School, and as someone who even just 1 year ago was very lost, struggling with school and being just overwhelmed. TMA isnt exactly comforting, but the characters and plot managed to serve as a good form of escapism while sorting myself out. I found my self engaging more in creative things that i had originally put aside in favour of maths and science (which i hated but thought i needed to do). I started drawing again, even if just fanart. and i found things going well. By finding podcasts, story telling and these communities have helped me in my own understanding of what i want in life. I got an ADHD diagnosis earlier this year, and almost directly after started RQG and as my first hyperfixation (that i was aware of as an hyperfixation) gosh dang it hit hard. (in a good way). Ive been able to do so much more creative writing and drawings, and got re-involved with a small dnd group with some friends who i played one game with almost 4 years ago now. So overall, inspirational sounds cringe, but it was. Im doing my best with the upcoming exams, but trying to get in to Medicine is not my only prority, and the fact ive been re-introduced to my first love (Literature and story telling), im planning to go do an Arts degree and i know i wouldnt have been able to confidently make this decision, or even have survived this long in the school system without the work you and your coworkers do. Now the sap is out of the way, Question time! (if you could answer even just one of these questions it would be so cool)(they go in order of RQ relevant to random stuff)(dont feel pressured to answer all/any. i know i wrote alot): 1. what would you say is the best way to draft out a long-form story. (with "Erasing the Line" as an example) Did you start at the end, with the links to the overarching plot.

2. When working with the players (in a form of TTRPG), what did you do to make sure you didnt miss relevant timing of plot points/ avoid creating spoilers while still giving enough detail?

3. What are good places to start with making a job out of storytelling/voice acting/audio etc. In the case of RQ, how is this a job and where do i sign up please! /j (what i mean is, how is best way/how did you find all the people involved and was there a common path that you were all on before getting to where you are now?) 4. Do you have recommendations for Terry Pratchett Books, i may be an literary-leaning student, but it seems i have never actually properly read any of his books. so where is best place to start?/What did you read first?

5. Similar authors or similar inspirations? Did you have a favourite podcast you listen to in your free time that you havnt had a hand in producing/directing/working on. 6. Favourite song/album/artist. And more specifically, what you like listening to in background when doing either writing or (for ttrpg) character research/game planing. 7. Since the olympics are on at the moment, what has been your favourite sport to watch, if you have been watching at all. Thank you for your time :)

Thankyou for all the kind words. Knowing our work is helping people really keeps our engines fired up. Let's see if I can't answer your questions: 1. I "sandbox" which is where I just shove everything I can think of into an unorganised bullet point list. Characters, setting, plot, all of it in one big mess. Then I decide what type of story you want to tell, copy and paste to a new document and then start to organise the thoughts (with the sandbox on standby if new stuff comes in I don't know what to do with). I think of it like scultping, you cut away bits and reshape until something comes out the other end that is story shaped. Only then do I attempt to build the sandcastle and put something coherant together like a synopsis or scratch draft etc.

2. Very tricky. I did a complete review and update of all notes after each recording session and don't forget the audio eas edited. I made lots of gaffs that you never heard as audience.

3. I contacted anyone I could convince to take part and just proved I was serious by overworking. I don't reccomend that route. Unfortunately it really is "who" you know. That doesn't mean chase established professionals as much as it means you need to get out there and associate with other up-and-comers who match your vibe. For me the route was long and windy and not a particularly good example. 4. I normally recommend people do not read his books in publication order. Don't get me wrong, its wonderful watching his craft grow from one title to the next but I would recommend new readers tip their toe into his later works to see if they like where he ended up before committing the time. I often recommend 'Monstrous Regiment' as people's first one. My favourite though is 'Thief of Time.'

5. I don't get much time to listen to podcasts in the last couple of years. I used to listen to a lot of non fiction. 'Stuff you Should Know' and that ilk. I also read a fair amount of classic YA fiction to unwind (Windinsger trilogy, Bartimeous, stuff like that.) 6. Paul Simon's Graceland but when working I assemble a playlist for each seperate project that is tonally appropriate. If I really need to focus I listen to Classical Minimalism. Or the Old School Runescape soundtrack. I'm allowed to be ecclectic. 7. I am actually in an incredibly busy work crunch at the moment so haven't seen any of it!

[moreclaypigeons]

Things that may make me eligible for an autism diagnosis:

166k minutes on Spotify last year

75 page long document with like half my APUSH notes typed up

Told my friend she can't make up data on a packet for bio cause accurate data is more important than data that "makes sense" and that we need to have scientific integrity as if we aren't literally high schoolers trying to get an assignment done

Point out random birds and try to identify them

Have over 300 playlists and they're organized in a very specific folder system

My mom said that as a kid I always hated loud noises unless I was the one making them

Always feel like I don't fit in with a group

Take thorough notes during DND?

Kept all my notebooks since sixth grade (have been going thru and trying to only keep important stuff)

Taking dedicated notes to a podcast relisten because I NEED to update the TAZ wiki or else

Individually downloaded all 600 images from the original wiki so I could migrate it to a better platform

Detest yogurt. Like if I smell it I will gag. Refuse to eat sour cream, whipped cream, and beans and will barely withstand if they have touched the other food I want to eat. Side note my mom is also like this with different foods....

Did not like wearing shirts with sequins, or jeans, as a kid. Made my mom cut out the tags.

Made little table spreadsheet things for the potential schedules my friends and I would have in sophomore year

Filled like five+ pages of a notebook with notes comparing Disney's Hercules to actual myths

Had a 19 page long notes document for a 10 page long assignment

Say shit like "alas" and "methinks"

Meowed a lot as a kid, like up until I was 10. And hissing

As a kid I didn't yawn like a person I yawned like a cat cause I would copy the way my cat yawned and stick my tongue out

[bigjimbopickens]

How To Legally Transition in British Columbia, Canada

A while ago I said I would make a guide on this so here. Every other guide I found was either outdated for specific to another province so here is an updated one. Mainly writing this for my trans BC friends but anyone can use it. To those who aren’t from BC you can also use this as sort of what to expect if you choose to legally transition as it may be similar in other places. Important: You need to be 19 years old to change your legal name and gender marker in BC without parental permission. Things you will need: - Your original birth certificate. - Two pieces of government issued photo ID.  - If you’re from outside Canada, resident or citizenship cards. - If you’re married, marriage certificates. - Photocopy of your receipt for criminal record checks.  - A notaries person to also sign your application. Cost: Expect to pay at least $440, that’s how much I spent in total and includes the costs of updating IDs (including passport).  Step-By-Step: 1: Criminal Record Check The province of BC requires all applicants to get digitally fingerprinted during the process. This can be done at any RCMP station, no appointment necessary. If you don’t want to be around police then you can find an accredited agency in your area instead, however they may be more costly. Mine costed $55 and it was done by the police. If they ask you why just say you are trans and don’t elaborate further as your response will be recorded if done by police. Once that’s done, ask for a photocopy of your receipt, that’s what you need to send to the government.  You will need two pieces of government issued photo ID for this. I used my BCID and Passport as I don’t have a driver’s license. 

2: Name Change Application Once you have the receipt you need to send it within 30 days. You can find the applications on the BC Government’s website. If you’re over 19, not married, born in Canada and have no kids then you can apply online here: https://ecos.vs.gov.bc.ca/ Everyone else can apply here: https://www2.gov.bc.ca/assets/gov/health/forms/vital-statistics/vsa529_fill.pdf  Once you’re done that, print all necessary documents but don’t send it yet. You need the gender marker change application still. This part should cost $137.  If you are under the age of 19 you will also need to write a hand-written letter about why you want to change your name. 

3: Declaration Witness Before you can mail your application for your name change you need someone who is qualified to do so to witness you signing your application. I had a lawyer for mine only because my mother is a lawyer. Anyone from a notaries public is qualified for this stage. You can find one here: https://snpbc.ca/ 

4: Gender Marker Change Application As of January 2022, you no longer need a diagnosis in BC to change your gender marker if you’re over the age of 12, so this process has been made so much simpler.  Application: https://www2.gov.bc.ca/assets/gov/health/forms/vital-statistics/vsa509a_fill.pdf  Cost can range depending on what you choose, mine was $54.

5: Mail Your Applications Now that you have everything you need, you must mail it to the Vital Statistics Agency in Victoria. The address will be on your documents.  Please remember to include your original birth certificate, photocopy of criminal record check receipt and the signed document given by your witness. If you’re not from Canada then a copy of your permanent resident or citizenship card. After this you now must wait. 

6: What To Do After After a while you will receive a letter stating your gender marker has been changed and you must surrender your now old birth certificate. Do not worry, it was already surrendered as it was needed for the name change too and should’ve been sent. You will also receive one from Ottawa about your criminal record check and they will send you a copy of whatever the RCMP or whoever did your fingerprints sent them. After about 10-15 weeks you will receive your Change of Name certificate and your new birth certificate, this is important as you’ll need it to update your IDs. With it will also be a list of everything that will need to be updated afterwards. I am updating my IDs first as everything else will require updated ID. 

It is a lot of work but it is so 100% worth it! I hated having to explain why my ID said I was female when the photo clearly had a man on it. I also hated having my full deadname be displayed on my Paypal when dealing with commissions. It’s so freeing not having that burden anymore. I hope this was helpful and if anyone has any questions do feel free to ask :)

[dpdraesthetic]

how do you go about actually getting professional diagnoses for these sorts of things? ive had a professional tell me im dissociating (experiencing dp and dr) but im not actually diagnosed, idk if it would help but i know somethings off and i now know what it is and yet that same professional didnt actually diagnose me just talked to me abt it, which is fine, just... yeah

hey, i have no idea when this was sent, it could have been a week ago or it could have been years, tumblr doesnt timestamp asks on mobile, but im slowly reviving this blog as it meant a lot to me during my original diagnosis with dpdr, and now realizing im going through another spiral i think its time for me to bring it back

so! as for your ask

im in the states, in the pacific northwest, so im just speaking from my experience here with my diagnosis process, mental health is taken Way more seriously than say like the midwest or the south, and i cannot even begin to speak on how other countries handle the diagnosis process, so again, just speaking from what i know

ive personally been suffering from symptoms of dpdr since as early as six years old, i had a bit of an unconventional childhood which made these symptoms present at a very early age, and these symptoms went untreated until i was 14

a friend of mine went to a lgbt+ youth meetup space, invited me, it was hosted by the local mental health organization, the two ladies who hosted it were therapists there, and after going a few times they suggested i go in to see a mental health counselor within their org because they could tell Something was up with me (lmfao)

that was the only reason i happened to get in to see therapists and psychologists at my age

since then ive seen countless therapists, psychologists, addiction counselors, medication management providers, trauma specialists, the full works

something ive learned is to be insistent, dpdr is something a lot of people dont understand even in mental health circles, osdd in general is sooo understudied and not understood, it took years of my psychologists bouncing from diagnosis to diagnosis

oh this week i have DID, this week im experiencing psychosis symptoms, no actually it may be dpdr, no no its definitely dissociative amnesia, maybe im bipolar- its kinda an endless loop

generally now when i go into see new psychologists i just go "i have dpdr," or "its been suggested i have dpdr by [insert professional ive spoke with before here]"

let them know others have seen it, that its a documented problem, call nurse hotlines, make a fuss, make sure every psychologist you see is made aware of what youre experiencing, document your experiences with dates in a journal and email them copies, give them proof they cant refute

because a lot of time its very much a case of "well this person LOOKS normal" which makes psychologists overlook this kind of mental illness

but also remember that having an official diagnosis isnt the end all be all yknow? you know what youre experiencing, and having it on a chart isnt gonna change it

idk im starting to kinda go in and out of reality so these words are starting to look less and less real but i hope this makes sense!

- ?

[translations-by-aiimee]

Dig a Grave to Dig Out a Ghost - Chapter 35

Original Title: 挖坟挖出鬼

Genres: Drama, Horror, Mystery, Supernatural, Yaoi

This translation is based on multiple MTLs and my own limited knowledge of Chinese characters. If I have made any egregious mistakes, please let me know.

Chapter Index

Chapter 35

The bungalow was surrounded by aged trees, blocking the sunlight year-round. A chill ran through his body as he walked into the building. The faint musty smell and moisture in the air reminded him of a basement filled with children's toys. Lin Yan followed the Zhongshan man into an office with an old-fashioned wooden table. On the table, there was a large stainless steel thermos. The desktop computer occasionally made some buzzing noises. The office was close to the toilet. It didn't take long for the smell of amonia to rush into his nose.

"Sit down, Lin. I'll grab the contact information of the recent archaeologists that were there. It's still locked in the cabinet." The Zhongshan suit man said as he poured Lin Yan a glass of water in a disposable paper cup. "The files on the table are more than 20 years old. They were just transferred out of the archive room. Feel free to look through them."

"Thank you for your help." Lin Yan said politely.

"No, it's no trouble at all. It's great to see young people so active nowadays. We all heard about what happened with the porcelain appraisal. That was really something. Professor Chen wouldn't stop bragging about it when he got back." The Zhongshan suit man chuckled. He placed a bowl of melon in front of Lin Yan then grabbed his key and left.

Lin Yan sat at the table and waited. The office decoration was old but good quality. The real leather swivel chair was comfortable to sit on. The shade of leaves outside the window blocked the sunlight. A sparrow leaped lightly among the branches. It flapped its wings and flew away.

There were a lot of files about the Ming tomb on the table, sorted into vellum envelopes. Lin Yan flipped through them. They included a large amount of background information on the time period, project approval forms, equipment rental statements, reimbursement vouchers, and so on. An envelope labelled 'Staff Information' caught his attention. Lin Yan brushed off the dust and opened the envelope. There were several smaller envelopes inside with labels written in faded ink. The top one was labelled "1987 Shanxi Archaeological Team Payroll", followed by several others, such as rosters, contact information, etc. The bottom one was marked with the word 'important,' written in red, and the label read: List of work-related casualties and compensation details.

Casualties? Lin Yan picked up the envelope. It was very thin. It was almost like there was nothing inside. The glue on the seal had expired and could be opened just by a light tear. The brownish-yellow paper had become hard and brittle after not being handled for a long time. Lin Yan carefully slipped his hand in. The envelope was empty. Only after fumbling inside the envelope for a while did he find a small thin piece of paper. The hand-drawn table lines were smudged at the top. At first glance, he knew that whoever wrote it had drawn it in a rush. The ink hadn't dried before they dragged the ruler across the page.

A series of footsteps echoing in the hallway approached. Lin Yan jumped, instinctively shoving the paper back into the envelope. it took him a second to remember that he had been given permission to go through the documents. The old information always gave him an anxious feeling, like he was intruding. He felt like a thief, fleetingly travelling back in time from modern times.

The footsteps moved further away. Lin Yan carefully examined the paper in his hand. Everything had also been written in pen. The names, reasons for compensation, amount of money compensated and other items were divided into columns. Lin Yan skimmed over the columns, heart bursting with fear

"Li Erzhuang, hand fracture, compensation of 30 yuan for medical expenses, collected and signed for."

"Sun Dapeng, psychosis, compensation for medical expenses of 150 yuan, collected and signed for."

"Wang Aiguo, psychosis, compensation for medical expenses of 150 yuan, collected and signed for."

". . ."

All the remaining reasons for compensation written in after the names were for psychosis, but the diagnosis details are all blank. The signature on the back was pretty crooked, too. Some of the ink was written so lightly that it was barely visible. Back then, villagers weren't very educated and many could only write their names. He glanced at the page filled with awkward handwriting. When he reached the last two lines, the signature column was blank. After a double-take, the column for the reason for compensation was listed as 'dead'.

"Jun Xiangdong, Jiang Ying . . . did these two die?" Lin Yan gulped. He carefully flattened the paper and muttered: "Compensation of one thousand yuan . . . Hey, that's weird, for these two people. How come it's written that their compensation hasn't been claimed? A thousand yuan was considered a huge sum of money in a village at that time . . ."

Lin Yan confusedly opened the envelope containing the staff list. He pulled out a stack of yellowed paper, flipping through each of them. Besides the detailed information of the students sent by the university who participated in the excavation of the Ming Tomb, the rest were locals. Most of the villagers were uneducated. They only filled in their name, age, gender and village name. Lin Yan counted them. There were 13 people in total. The oldest was only 24 years old, and the youngest was only 16 and 17. Eighteen-year-old children make up the majority. Lin Yan recalled what the professor said and let out a sigh. He couldn't imagine what it must have been like for those children to be haunted by illusions and see their friends die in front of them in such a strange way.

It was too much to think about. Lin Yan glanced back at Xiao Yu. The ghost was standing leisurely by the window with his arms crossed, looking at the scenery, as if this had nothing to do with him.

When turning back to Jun Xiangdong and Jiang Ying's forms, Lin Yan was surprised to find that the information left by these two people was almost blank. Compared to the information awkwardly filled in by the other villagers, only their villages and names were listed. Written next to them in black pen were the words "wage uncollected".

Lin Yan stared at the list of villages and frowned. He mumbled: "They're all foreigners? No wonder no one got any money after they died . . ." As he turned over the page of information on the two, there was only one last name at the bottom. The name on this page was Wang Zhong. Similar to Jun Xiangdong and Jiang Ying, there was almost no information is almost blank. He also wasn't a local. Written in big black letters in the upper right-hand corner was: "Wage uncollected".

"Wang Zhong, Wang Zhong . . . This person isn't on the compensation list." Lin Yan glanced through several forms and muttered: "Was he so afraid that he ran away without even getting paid?"

Lin Yan was immersed in a few old documents when, suddenly, the office door squeaked open. Zhongshan suit guy rummaged through the file in his hand as he walked in, muttering to himself: "What's going on . . . "

Hearing his voice, Lin Yan hurriedly put down the files and stood up. Zhongshan suit guy stepped in and waved his hands: "Sit down and sit down. My memory's not what it used to be. Obviously, I put it all away before I went on a business trip. Why can't I find it? "

"What can't you find?"

"Professor Chen said you are looking for the staff roster from the Ming Tomb archaeological expedition in Shanxi. I purposely found it and put it together. The cabinet was opened just now and everything else was there. The fortune-teller's information is the only one that's gone." Zhongshan suit guy shoved everything back into the folder and said to Lin Yan: "Look, everything is numbered. Everyone has one. I filled it out when I joined the team. I kept a copy of it for payroll statistics."

Lin Yan flipped through several forms, each of which was detailed with the staff’s name, ID number, telephone number, address, working hours and position, etc. Indeed, like Zhongshan suit guy said, the number between No. 34 and No. 36 was missing. But the information from the 30th onwards was very brief, some even only listing names and phone numbers. Those people are temporary workers. No. 34 was hired to drive a tractor. No. 36 and 37 were temporary cooks. The form ended on No. 37.

No. 35 should be the mysterious fortune teller.

"This man wasn't part of the team. He came to watch over things with a feng shui compass. He stayed to explain his plan for the excavation then left. He negotiated the price with me and said that he would wait to get paid until his method was proven useful. We had the money ready to go but he never came to get it, otherwise, the financial account would have been recorded."

Everything was done so neatly. Lin Yan stared at the extra space between No. 34 and No. 36 and furrowed his eyebrows. He didn't even want the money? What was he after?

"Please think it over again. Did you take it out before and put it somewhere else?" Lin Yan was a little impatient. "Or did another colleague take it away?"

Zhongshan suit guy rubbed his hands and stroked the key in his hand in confusion: "Impossible. I'm the only one with a key to the cabinet. I had organized everything and locked it in the cabinet before I left on the trip. It was gone as soon as I got back."

Lin Yan's heart skipped a beat. This seemed too coincidental. He glanced back at Xiao Yu. The ghost was staring at the door with furrowed brows and didn't respond to him.

Seeing that Lin Yan's screwed-up expression, Zhongshan suit guy picked up the paper cup on the table and filled it at the water dispenser. He put it back in front of him and comforted him: "It's okay. You sit and drink some water and eat some melon. I'll keep looking for it. I remember when that man first came and spoke in a mysterious way, no one believed him. He left a phone number and address, saying we would definitely have to call him again. And he was right."

"Where did I put it . . ." Zhongshan suit guy talked to himself while fiddling around in the office. Lin Yan wanted to help but was pushed back into the chair. He was forced to stare at the desktop screen saver. A bright, shimmering mass of lines shifted on a black background. Green, red, and blue lines slowly changing, becoming larger and smaller, rolling into a big mess. He couldn't make sense of it.

"Today isn't a good time. If you come at another time, you could ask someone else. Actually, today is our day off so the whole building is empty. I'm the only one who came here for a reason."

Lin Yan smiled embarrassedly: "That's too much trouble for you." Then a thought struck him and he casually mentioned: "There are still people here. I just heard footsteps in the hallway. They just passed by but didn't come in."

Zhongshan suit guy was washing his hands in the washbasin by the door but abruptly stopped when he heard this and looked up: "Impossible. There's no one in the building but flies. There are only three offices, I just checked them and no one's there."

Lin Yan took a sharp breath. He looked towards the dark corridor in the doorway and suddenly felt an ominous feeling.

Maybe it was just him passing by to check the information, Lin Yan reassured himself. When the sun changed its angle, a few loose beams of light penetrated into the room through the gaps in the leaves. The soft yellow light peaked in. The dust dancing in the light fell onto the dark brown tabletop. Beams jutting to the side illuminated a cactus that had been watered too much, its petals hanging down limply.

"Hey, I remember, wait a second." A hint of excitement flashed through Zhongshan suit guy's voice. In the lower part of the glass cabinet, he pulled out an old jacket and searched through the pockets. He fished out a crumpled note from a small pocket in the lining. He fumbled with the crumbled note, studied it over, muttering: "Right, right, this is it."

Zhongshan suit guy slapped the note down in front of Lin Yan's eyes: "The address and phone number."

Lin Yan's expression relaxed.

By noon, the weather was getting hot. Zhongshan suit guy turned on the fan. The buzzing of the fan blades and the rustling of the papers being blown rang out incessantly. Lin Yan put the phone up to his ear and held a pen in his other hand, scribbling on a notepad, the tip of the pen trembling slightly because of the anticipation.

"Beep . . . beep . . ."

". . . The number you have called is temporarily unavailable."

The voice of the phone message came four times in a row. Lin Yan and Zhongshan suit guy exchanged a glance. He dropped the receiver and languidly stretched. Looking at the lower part of the note, the address handwritten in pencil looks familiar. Where had he seen it? Lin Yan tugged at his collar. He wanted to unbutton it to get some air, but he suddenly remembered the string of hickeys on his neck and he hurriedly buttoned it back to the top.

There was a splash of water from the water dispenser, followed by a series of gurgling noises. A thought flashed through his mind. Lin Yan froze in place with his cup in his hand, like the solution had smacked into his brain like a hammer strike.

"Mr. Chen, what does the fortune teller you mentioned look like?"

Zhongshan suit guy thought for a moment and recalled: "It's been a long time so I don't remember clearly. He looked like he was in his 40s or 50s. He's about the same height as me, and his hair is very short."

Lin Yan gulped and entered the address into his phone's GPS. The green route map was displayed, extending all the way to the northwest.

That's it. Lin Yan stared at the red dot indicating the destination in the upper left corner and quietly thought to himself: I found you, temple master.

[alexafaie-asd]

Just some me rambling stuff.

Did some colouring for the first time in ages. Was kinda inspired by seeing some artists on youtube who I follow doing stuff for Inktober and drawing isn’t something I’m good at (and practising it isn’t something I enjoy so...) so I thought to colour in with stuff that could be classed as “ink” at least loosely. Nothing fancy, just some of the pages from a daily colouring calender I got in 2016 which I had planned to do each day, but just like everything I try I managed to keep to the “schedule” for like a week or two at the most before it collapsed and then I felt bad about not finishing it. So of course I got a more complicated colouring calender the next year because I never fucking learn.

Anyway... had a bit of sort of fun maybe colouring in a couple of pictures.

I’ve been feeling a little bit bleugh the past few days since however long ago Thursday was (I don’t know what day it is right now). I got the response from the PIP people about my Mandatory Reconsideration. I spent absolutely ages writing up the letter to explain just how the assessor had misrepresented what I said or just outright ignored my difficulties, pointed out the inaccuracies with the factual stuff (as opposed to anything that could be considered to be that word that means “different people might see it different ways”) and also explained how their failure to treat my difficulties as real was discrimination against my particular disabilities (they’re so called hidden/invisible ones like mental health issues) especially with how they used “high functioning” to claim that I can’t struggle with the things which they agreed I struggled with last time I got assessed and nothing has changed since then except that I have an extra diagnosis now.

Their response was rude, blamed the length of time it took on me even though most of the time was taken up by me waiting on them responding, giving me the face to face appointment date etc. And in response to me telling them how stressful the frequent reassessment periods are and how much anxiety they provoke & how they worsen my conditions, they said “Although the health Professional has recommended a 2 year review period, as you are no longer entitled to PIP then there is no review period required.”  Previously I was awarded PIP at the appeals stage because they found my doctors note that they claimed didn’t arrive in the post until then, even though we sent it recorded delivery and we knew for a fact that it was signed for less than a week after it was sent out. Without the doctor’s note they had tried to say that I didn’t qualify, but with the doctor’s evidence I suddenly did. In this letter they are saying that as the findings of the current assessment are “so different” than that of what was decided at appeals before, they’re using the more recent assessment as they believe its a more “accurate” reflection of my condition and so “supersedes” the previous findings. Except the assessor this time made HUGE mistakes and that’s what I wrote in to explain. But they are treating the assessor’s report as medical evidence even though she was a nurse with no training other than the 10 day course they send them on (and I’ve seen the information for autism - the PDF they are given as recommended reading but not required, is outdated from the early 90s and still uses terms which are no longer in use diagnostically). They are placing more weight on her interpretation of what my difficulties are than the actual medical specialists who have dealt with me personally.

My boyfriend phoned up to complain and ask to start the appeals process (they didn’t include the information on how to appeal in with my letter and the whole letter was written as if I wouldn’t even try and should be glad I no longer qualify as if I’m suddenly not disabled because they say I’m fine). He asked how even with the information and corrections we sent in, they still came to the same conclusion, most of which was a direct copy and paste from the original assessment report. It turns out that because we had complaints about the assessor’s report, they went back to ATOS to get a new person there to look over my case. “So why did they find the same thing with the new/corrected info given to them?” my boyfriend asked. They had even repeated the bit on how I apparently “was not offered alternative treatments or therapy, suggesting you don’t need them” even though we pointed out that in the letter we had originally sent in to them, the people I saw at the multidisciplinary assessment after my autism diagnoses had written that there were two other meds I could try for my bipolar disorder and that they had put in a recommendation, sent to my GP, that I be referred to one on one talking therapy. He said that surely they must have seen us point that out in the letter I sent in asking for the mandatory reconsideration. And it turns out that none of that information was sent to ATOS. So the new person at ATOS only saw what the first person at ATOS wrote about me and came to the same conclusion. When we pointed out that it is the PIP team who are meant to balance things out, they just deflected all the blame to ATOS and said the matter was “out of their hands” as ATOS is a third party organisation so they don’t have any control over what they do. BUT THEY CHOSE TO EMPLOY THEM TO DO THE ASSESSMENTS!! So yeah, they do have control over what ATOS do and are entirely responsible for any outcome if they choose to base the entire thing on what one person who met the claimant for less than 2hrs has to say about what the claimant struggles with.

Its ridiculous! How the hell did they think it was ok to totally ignore what I sent in other than to belittle me when I expressed how stressed and anxious the whole process made me and how demeaning it felt. Their response was just to demean me some more. When asked what provisions there were at the appeals stage (which involves standing up in court in front of three judges who are total strangers) for people who are autistic and struggle in social situations, especially with speaking in public, and they said that they had no idea whatsoever, but as far as they knew there wasn’t anything special. And that we’d have to contact the courts directly. Not that we have any of those details because nothing was included in with the letter they sent. They couldn’t even get the page numbers correct at the bottom of the pages. The last page was numbered Page 7 of 4. Yes that’s right, there were seven pages out of four. How did they manage to break an autofiling section of a document like that? They take that little care with these assessments they can’t even get the documents to be constructed correctly.

When I got the letter I just totally dissociated from everything I would have been feeling. And so its been a rough few days as bits and pieces of emotion have been popping through and washing over me in waves of feeling really shitty. I’m trying hard not to think about the whole appeals process because I know it scares me shitless and I can’t do anything about it now anyway. But its just so hard to cope with people just dismissing my difficulties. Its ridiculous because the criteria have not changed. In fact they got in trouble with the courts for being biased against people with mental health issues as their disability (focussing only on whether a person could physically do a thing and ignoring their criteria of “requires prompting”) and so were made to make changes to discriminate less. Obviously the major fines and telling off did fuck all. Its just so frustrating because my difficulties haven’t changed (unless they’ve got worse) and previously I was deemed to be entitled, so why should that have changed just because I now have an extra diagnosis that even better explains the problems I have? Like previously they tried to claim that bipolar disorder didn’t cause the particular difficulties I have, so I missed out on points in one area. However now I also have the autism diagnosis, that category I was denied points in before is now the only category that scored any points. So its like they are totally ignoring that I have more than one thing going on, and that previously I was still autistic so if I was entitled then, I should be now!

When we pointed out how they were being discriminatory in my letter, they responded not by apologising for what I felt was discrimination, but by telling me that the “Gray Report” concluded that the “Health Professionals” (from ATOS who do the assessments) are trained to a sufficient degree to do the assessments without bias. So I’m there pointing out bias and being told “no, that can’t have happened, this report we had done says there’s no problem.” Except I have looked it up and Paul Gray, responsible for the reports actually wanted changes like making the assessment report results sent out immediately to claimants, but the government is refusing to do so. So how exactly are they meeting what his report asks of them? They aren’t! The Gray Report says that they need to do more to gain the trust of claimants because they are currently so inconsistent that is confusing at best and detrimental at worst. Like his entire report is basically “some of these changes are positive, but there is so much more that needs to be done such as x, y, and z” and the government has said “ah that means we are perfect and doing no wrong.” Like his report didn’t even look at the assessors in great detail. It just says that they should be trained to an adequate level, not that they are. And that they should be unbiased, again not that they are. So why quote that report at me?

Just.... urgghhh. I’m so sick and tired of having to fight past what I’m sensibly able to do just to get what feels like nowhere. Like they even wrote in response to me saying that my executive dysfunction is so bad that if the washing up needs to be done, and I can’t cope with all the steps required to do that, then I don’t have anything clean with which to prepare and cook food and therefore won’t eat. They wrote that those things are “outside the scope of the assessment criteria” and so won’t be considered as evidence. So because I can’t clean the house and can’t then cook the food, that’s ignored as a reason why I don’t eat the food. I must therefore be able to cope with preparing and eating food unaided all the time. How stupid is that? I also wrote how my sensory sensitivities affect my ability to wash and to brush my teeth, so I’ll go days without brushing my teeth when I can’t cope with those feels (or am too depressed) and they said “brushing teeth isn’t covered under bathing, so we won’t consider that”. Like they are both forms of personal hygiene. Arguably keeping your teeth clean is a MAJORLY IMPORTANT thing which can impact your health in so many ways (like you can die from an infected tooth, or from a gum infection). But it can’t be used to build up a bigger picture about how far reaching my disabilities are?

And they said that the section on being able to communicate only counts if you can physically speak and physically hear what is being said to you. So my sensory processing disorder which affects how my brain perceives auditory information and how it therefore responds to said auditory information? Doesn’t count. So the times when I can’t tell what is being said because there is a fan making noise in the background? Doesn’t count. The times when there are multiple people talking and I can’t pick out the one important conversation and everything blurs into one droning sound that is overwhelming and causes me to avoid social gatherings that involve many people? Doesn’t count. My inability to tell what tone of voice I’m speaking with and inability to correctly modulate my tone of voice appropriately so I fail to communicate effectively due to it? Doesn’t count. My sensory overload causing me to shut down and go nonverbal for long periods of time so I can’t verbally communicate? Doesn’t count. Apparently. Even though in the criteria available online on the government website for how they are meant to assess disabilities for the different categories, it really should count. But all they mean is “are you deaf and dumb”? (Sorry for the old derogatory terms, but that is literally all they seem to think counts and the way they seem to be approaching this).

And just I have all these feels and they are not nice feels. And I’m trying to remain strong and positive, and trying to remember that I’m trying to want to exist. But its so so hard. And just reminds me how much I hate my life and how I hate how noone (in the “noone” kind of way, obviously some people) seems to care how I feel and how I struggle. And it really doesn’t keep me away from feeling suicidal. :(

[t-oresama]

“Everything, Everything” by Nicola Yoon

Synopsis: My disease is as rare as it is famous. Basically, I'm allergic to the world. I don't leave my house, have not left my house in seventeen years. The only people I ever see are my mom and my nurse, Carla. But then one day, a moving truck arrives next door. I look out my window, and I see him. He's tall, lean, and wearing all black-- black T-shirt, black jeans, black sneakers, and a black knit cap that covers his hair completely. He catches me looking and stares at me. I stare right back. His name is Olly. Maybe we can't predict the future, but we can predict some things. For example, I am certainly going to fall in love with Olly. It's almost certainly going to be a disaster.

Published: 2015 (Delacorte Press) Genre: Young Adult, Fiction Rating: 4.5 out of 5 Reader Review: This book has been on my radar for months. I first saw the cover of it on a normal day at work at the library. I adore this cover, by the way; it's illustrated by Nicola Yoon's husband, David Yoon, and it's vibrant and eye-catching and... everything (ha) that I would want a book cover to be. Anyway, soon after, I found out it was going to be a movie, which is also something that has been and still is on my radar. But before the movie, I wanted to be that person that I've been with similar books-turned-movie adaptations (such adaptations including "The Fault in Our Stars" and "My Sister's Keeper") and get to know the source material to better compare that to the movie. Turns out, as is the case with many books that people discover a recently-released movie originated from, there were many holds on many copies of this book. I was #14 on the list. Yet three days later, the book arrived and all but fell into my lap. Chalk it up to a working of the Library Network gods.

The story itself revolves around a sickly girl named Maddy, who is otherwise actually a healthy girl save for the fact that she has Severe Combined Immunodeficiency (SCID), a disease that prevents her from mingling with the outside world for fear of anything triggering the illness. She lives in a sterilized, air-locked house that she has not left since infancy with her single mother and (legitimate) nurse, Pauline; her father and brother were killed in a car crash around the time of Maddy's diagnosis. One day, neighbors move in across the street, including a boy Maddy's age, named Olly. Despite never leaving her house, the two manage to strike up a friendship that develops into more over time, as they face adversities that affect their everyday lives between Maddy's disease and Olly living with an alcoholic father. So, yes, even though I just said in the last review that romances aren't usually my bag, I fell as head over heels with this one as Olly does with Maddy. I would say "Whoops", but I can't really find myself feeling bad for reading another "not another teen romance" novel.

To start (well, aside from me starting off with needless praising of the book's mere cover), it's been quiet a while, possibly since "The Elephant Man" (review here), since I've read a book and it became all I thought about. Waiting for any spare moment of time to pick it up and continue on. Wondering, "And then what???" That was, of course, until this book. I literally could not put it down; I chipped away at it between work breaks and breakfast and afterwards dedicated my morning off to finishing it, taking a grand total of 8 hours for me to complete. The main reason for this is because, as was the case with "Eleanor & Park", I love when people can do a trope/cliche (the "teen love story" one, in this case), and do something to freshen it up and make it more than its stereotype. I was fascinated by the idea of a "limited love", especially for teenagers who get distracted by technology and hormones in the modern age (only a slight exaggeration, let's be real). A "limited love" where they have to go the extra mile in order to be with and communicate with that person, and where the conflict isn't just "one of them cheats"/"they get into a fight"/"they have to separate to go to different colleges", etc. Because, well, that's boring, especially when you're living it/have lived it. And it prompts the author to get creative while also keeping it realistic, something I feel Yoon did to a tee with the situation she created. So give me something with a twist-- in this case, a girl who could die if she even touches a non-decontaminated boy-- and I'm sold. 

Speaking of creativity of the author-- and this may just be a case of me not having read enough YA novels from this decade-- but Yoon takes the creativity to the presentation as much as she does the subject matter. Her short chapters aren't just dialogue and paragraphs; sometimes they're pictures or journal entries "hand-written" by the narrator, Maddy, sometimes they're "realistic pictures" of things that propel the story forward, such as medical documents or plane tickets, and sometimes they're e-mails and instant message conversations. It adds that multi-media flare that encompasses new young love nowadays (boy, do I feel old for writing that), and shows the progression of Maddy and Olly's relationship, from a person Maddy wistfully watches from her window, to a crush and, eventually, to love. However, this does act as a double-edged sword. It forces the reader to read between the lines and interpret a deeper meaning from some of these e-mails and IMs. Text is so two-dimensional and without the interjections of the narrator’s thoughts and feelings as I've seen done in other books, some chapters are just completely IMs where we have to imagine how they're "saying" this, what they're feeling when they're "saying" this, how long between each message they paused or backspaced before continuing on. We have to assume it's what the story has set itself up to eventually be, but sometimes it could be taken in a few different contexts. Art imitating real life first-world problems.

There are four major players in this book: Maddy, Olly, Maddy's mother, Pauline and Maddy's nurse while her mom is at work, Carla. The relationship with Maddy and her mom is depicted as such a loving one, as her mom really is Maddy's best friend given her limited interaction with other people. And Maddy has that type of friendly relationship with Carla as well, having known her since she was 3 (she's 18 in the present day of this novel). However, rather than being shown as a lonely girl wanting friends and the beach and escape, she's shown as a girl who has for so long dealt with her disease and its limitations, she knows that hoping for more is not possible, and never lets herself. Instead, she absorbs herself in copious amounts of reading, her online studies, and special game nights with her mom. It's set up so that, when she meets Olly, not only does her heart open up in a way it never has, but so does her entire perspective on life. She wants more, dares to be a dreamer, because the world brought her Olly, and there's so much more the world could bring her if she goes for it. Her relationship with Olly is one that is new for both of them in different ways, and the pacing of their relationship is well done and believable, with no act being done too fast or too slow, and the only limitation (most of the time) being Maddy's illness. However, the way that her relationship with her mother is portrayed is one that can make your heart feel warmed more than some scenes with her and Olly. They are dependent on each other; they're all the other one has. And they have such genuine and tender mother-daughter moments, it made me want to go and play a board game with my own mom. I think this speaks to Maddy herself, as she doesn't have many people she can be around, so she cherishes each relationship with those in her very small circle, and it shows. 

Now to the part where I answer the burning question of, "But if there's so much good about it, why is it only a 4.5?" Well, for one, I'm very selective and often skeptical of what a "perfect" book is. I can see by the source material why they wanted to make this a movie, in the same vein as the aforementioned "The Fault in Our Stars" (which also has that "dying girl love story" premise, now that I think about it...). It's different, dramatic yet still realistic and tugs at your heartstrings. But there are details omitted in this novel that I felt would have given me a better, fuller picture. One thing that bothered me was the lack of details pertaining to Maddy and Olly's families. There are a lot of details about Maddy's family already, but despite all of this, her father and brother are never given names, and her brother's age at his time of death is never specified. All that's said in regards to the latter is that Maddy was only a few months' old when the car crash that killed him and their father happened. But by making them nameless, they could be anyone. It's less personal and you don't feel the tugs of sympathy for the family that you should because these two are more just "there" than they are characters that serve the story as a whole. Olly's home life is the same. Maddy jots down the happenings of each family member from what she observes outside of her window, so we get to know bits about them by the bits Maddy knows. Olly's father-- also nameless-- does serve a greater purpose for the dynamic of the entire family, but we never get to know any of the other family members outside of their toxic relationships. And sometimes, Olly comes off as a very typical too-cool, rebel, loner kid, always wearing black and being really into parkour for no explained reason. And his e-mail name is "genericuser033," for crying out loud. While he does open up, and we do see both that he is more than his rebellious persona and that he also is that way for a reason, things like this just make me cringe a little. This is how teens can be though, so I'm probably nit-picking at this point. To continue nit-picking, one scene that left me confused due entirely to its lack of clarity is when-- semi-spoiler-- Maddy's mother does eventually find out about Olly, and Maddy indicates that it's because of a black rubber band she accidentally leaves on her nightstand that Olly likes to wear and fidget around with, but we're never given any explanation: Does her mom just know because it's something she's never seen before? Does she know because she's seen Olly wearing it? And what is the significance of that rubber band anyway? It's not a hair tie, as Olly is described to us as a boy with really short hair, so why did he give it to Maddy? And when? So many questions for a little rubber band but, really, it does make all the difference.

Some of this is, as I wrote, splitting hairs, but books are written to enjoy first and critique second. Not just authors, but all artists of all mediums pick and pick at the tiniest so-called imperfections in their work, but because of that, a lot of them know how to take constructive criticism. I can't help but feel like Yoon could be one of those authors. Especially for this being her debut novel (Having your first book be a movie? You have to admit that that's pretty amazing), I'm sure she herself could look back and pick parts she would want to change now with a couple more novels under her belt. In the end, "Everything, Everything" does give us everything (everything): romance, comedy, a healthy blend of serious and light-hearted moments, and drama. Especially drama. I won't spoil it for you, but the last fifty pages are probably the best part of the entire novel. There's a twist that caught me so off-guard and also answered my burning question of "How are they going to overcome this???" so brilliantly, I'm still reeling over it. It's so good, and is extremely poignant. It's one of those twists that makes you go back and reread certain earlier excerpts in a new light and just... I could go on. Instead, I'll use these last few lines to urge you, if you like YA, to read this book. I feel like it's the quintessential 2010s YA novel. It has a copious amount of multi-media insertions, while also giving nods to both modern and classic references. It tackles heavy issues. It's quirky and sometimes sarcastic. But overall it was such a lovely book to binge-read. If I didn't have a literal stack of books to read, I'd reread it and look for more details lost on me the first time reading. What I'll do now, with cautious optimism, is go and see the movie, and pray that whatever liberties taken for the movie aren't ones that make me disenchanted with this enchanting story. 

[laurabwrites]

ARAT Goes to Washington

Continuation of Air Reconnaissance and Tactics

[The Senate Armed Services Committee came to order at 12:03.42 on Sunday March 7th 20XX, Chairperson Miller presiding]

Chairperson: The Committee calls Doctor Pavi Meigs-Metzer to testify.

[Dr. Meigs-Metzer is sworn in, confirms her security clearance, and takes a seat.]

Chairperson: Dr. Meigs-Metzer, would you please list your credentials for the committee.

Dr. Meigs-Metzer: I hold a Doctor of Medicine with a specialization in psychiatry, I was a resident at Brown University, and I am board certified by the American Board of Psychiatry and Neurology, with further education and specialization in cognitive-behavioral therapy, therapy for post-traumatic stress disorder, and therapy animals.

Senator Evans (R-TX): You have no expertise with computer science?

Dr. Meigs-Metzer: My undergraduate degree from Cornell is in computer science, with a sub-specialization in neural networks, but I am well aware of the limitations of a 20 year old undergraduate degree in a field as rapidly changing as computer science. I claim no expertise, merely a background understanding.

Senator Evans: But you claim to be qualified to administer the Turing-Man… Maju–

Dr. Meigs-Metzer: Turing-Manjahni, Senator. The Turing-Manjahni was specifically designed to be administered by an individual with an average educational attainment compared to their country population. I am overqualified to administer the test, especially with my knowledge of psychology. In fact my administering the test would render it invalid, which is why I don't. I review the procedure, to make sure it was administered correctly, and interpret the results.

Senator Xi (D-MD): And you have reviewed the results of the Turing-Manjahni administered to the program called ARAT?

Dr. Meigs-Metzer: I have reviewed all three tests administered to ARAT, who calls themselves Arthur while not working. They consider it something of a title. Same as Senator is for you.

Senator Xi: I was only aware of one test. When were these others administered?

Dr. Meigs-Metzer: The first was two years ago, the January before Arthur became my patient. The second was six months ago.

Senator Ravani (D-MO): That's rather coincidentally timed relative to the military's investigation into–

Dr. Meigs-Metzer: It was a direct response to it on my part. I requested a second formally administered round of Turing-Manjahni sentience tests to build a thicker paper trail, in expectation of what happened with the third test.

[Chairperson Miller bangs gavel for order for 12 seconds]

Chairperson: In your opinion Doctor, what happened with the third test?

Dr. Meigs-Metzer: It was a set-up by Senator Evans in collusion with Dynamic Robotics, the original programmers of the ARAT program.

[Chairperson Miller is unable to regain control of crowd for 1.5 minutes. Senator Evans demands Chairperson eject Dr. Meigs-Metzer for slander]

Chairperson: You understand you've just accused a sitting Senator of corruption–

Dr. Meigs-Metzer: And a direct bribe. [Dr. Meigs-Metzer pauses for 13 seconds for crowd noises to die down again.] I've already turned over the results of the VA’s background check into the third test administrator and the interpreting psychologist to the FBI. The first failed to disclose their Masters in Social Work and family connection to Dynamics before the test. The second somehow seems to have declined to mention their day job in Dynamics’ research division or their supervisor and entire lab’s contributions to Senator Evans’ reelection campaign the day after the test. Maximum contribution too. Dr. Smith, the interpreting psychologist, has already been reported to the American Psychology Association's board of ethics for fraud. Even with the test administration being sand-bagged, the data clearly indicated sentience. The interpretation in the report indicates otherwise, but a review by a psychologist, psychiatrist, and two computer science PhDs at the APA hearing for fraud find that the data directly contradicts the interpretation. The hearing concluded yesterday, after midnight by the way. I was passed a copy of the results of the hearing at seven this morning and a representative of the board is sitting outside this chamber with a notarized original of their report.

Senator Xi: Should we assume that your have taken similar precautions with the first two tests to assure us of their authenticity?  

Dr. Meigs-Metzer: I have and brought enough copies for each of the members of this committee. 

Chairperson: Sergeant, please distribute the doctor's copies. Let the record note the addition of documentation from Dr. Meigs-Metzer at this time. 15 minute recess every one. Go do your reading.

[16.5 minutes later]

Chairperson: At this time, let the record note that Senator Evans has been detained for questioning by the FBI and will not be joining us for the remainder of this or future hearings on the subject while his situation is sorted out. The Committee recalled Dr. Meigs-Metzer to testify. Dr. Meigs-Metzer, I believe it is pretty clear from the documentation that ARAT has passed the Turing-Manjahni. In your opinion, is it a reasonable measure of sentience?

Dr. Meigs-Metzer: It is the only test we have which has withstood 26 years of investigation. It is the best we have. To answer your actual question, yes, I believe Arthur is a sentient person.

Senator Johnson (R-ND): Is that determination solely on the results of the Turing-Manjahni, Doctor?

Dr. Meigs-Metzer: No, it is also based on my two years of experience as their doctor.

Senator Johnson: And what were you treating him for?  

Dr. Meigs-Metzer: Mr. Chairperson, I wish to enter into the Committee notes a release form from Arthur starting their permission for me to discuss their medical records.

[Documentation is handed over]

Dr. Meigs-Metzer: I concurred with Arthur’s self-diagnosis of Post Traumatic Stress Disorder. They have responded reasonably well to standard talk therapy treatments for PTSD. Especially considering that we did not have the supporting pharmaceutical protocols available to us.

Senator Xi: Doctor, can you explain to me, in layman's terms, how an AI could develop a human’s psychiatric disorder? He—

Dr. Meigs-Metzer: They.  

Senator Xi: They do not have a brain like we do.

Dr. Meigs-Metzer: I will remind the committee that this is not my area of expertise. But, I will also point out that we have documented the same symptoms of PTSD in dogs and elephants. Grief in various Great Ape species. And so on. Arthur’s neutral architecture is heavily, heavily modeled on that of a mid-twenties human, without the range of experiences and memories of someone that age. Quite frankly, he was ‘born,’ so to speak with the capacity for any psychiatric disorder, without the buffering of experience, interpersonal relationships, or a social safety net. It is, in my opinion, a miracle they took so long to develop PTSD.

Senator Xi: Do you have an opinion on the matter of decommisioning the Air Reconnaissance and Tactic program, as General Howard argues for?

Dr. Meigs-Metzer: If by decommissioning, you mean wiping the server Arthur resides on, that would be murder. If you mean allowing Arthur to migrate to a private server and declining to replace them, as their doctor, I would support the migration. Their recovery can only be enhanced by removing them from their source of ongoing trauma.

Senator Johnson: And your opinion on Major Nesbitt’s petition for back pay on ARAT’s behalf?  

Dr. Meigs-Metzer: From the moment they became a sentient person, Arthur has been serving in the military, for more hours of the day than any human is put through. They did not volunteer nor were they given the oath of office. But they chose to serve faithfully and risked exposure, followed by the possibility of death, as this committee is debating, in order to get the help they need to continue doing their job, and do it well. Of course they deserve back pay. Preferably at the specialist level of their fellow analysts. Otherwise the Armed Forces has been enslaving a sentient being for the last two and a half years, wouldn't you say?

[rainbow-hammock]

The good clients are what make you want to stay, but the horrible ones leave the biggest and worst impressions.

We had a client come into the clinic two weeks ago, who had a cat with skin problems. We ended up taking a sample of her cat’s skin/fur to put in a fungassay, to test for possible ringworm. As I’m billing her out, she asks if she could get her cat’s medical records.

Seeing as “medical records” are legal documents, and these particular ones are ongoing, I am not allowed to give that to any client. Copies of labwork and results, or other information relevant to a pet’s diagnosis that the vet needs/wants to share, yes. If she needed me to fax or email the records to another clinic, I could do that, too. But the original records themselves? Legally, I could not give them to her.

I explained this to the client, and she became incredibly upset, saying she should be entitled to her own cat’s medical records, especially for the amount of money she was paying us, this is not a good way to establish trust with clients, what poor service, blah blah blah.

It took several minutes of her talking over me as I tried to ask her questions to clarify what her problem was, but eventually I was able to determine that what she was actually trying to ask for was a document stating the results of the test we were doing. I apologized and admitted that I had misunderstood her--when she had asked for “medical records”, I had interpreted that as her asking for the doctor’s notes, which again, I cannot give due to the laws in place. Furthermore, while this particular test didn’t have a specific document besides what’s recorded in the doctor’s notes (unlike, say, a blood test or a radiology report), if she required one we could make it for her, which I did note to do in the file after she had left.

Fast forward to today, the test is officially done, and this client is one of the files I was going to present to the doctor so he could discuss any further treatment, when she comes in demanding to know the results because she hasn’t heard anything, despite it being explained to her more than once that the test takes this long. She pointedly ignored me, so my coworker ended up dealing with her this time, though I was back and forth with my tasks enough that I overheard the whole new rant she made about her poor experience with me. She accused me of “telling stories” for the sake of preventing her from getting her cat’s medical records, and changing my “stories” “like, 10 times in 10 minutes”. She also said that no one had apologized to her for it, and she was outraged that no one had contacted her regarding the test. She threatened to write bad reviews and blacken our name and never come back, etc.

In the end, my coworker apologized again, and explained once more that it was a misunderstanding, and while the law still prevents us from giving you the doctor’s notes (or rather, “the doctor’s super secret diary about my cat”, as the client referred to them), we can give you this document that we have made for you telling you the test was negative.

It really only takes one horrible client to ruin your day. I felt sick to my stomach after both experiences with this woman, and now I’m paranoid that I’m going to have to keep an eye on the clinic’s websites and reviews to see if she’s actually going to write a complaint or not. I’m in reception a lot, so I’m often a client’s first impression, and something like that could mar not just me, but the clinic. My boss is pushing us to keep our noses clean so hard because another goddamn vet is moving into the place we were at before and he’s terrified of suddenly having competition so close. One of my coworkers from the clinic we merged with had multiple complaints against her on some of the review sites, and that was one reason she was let go last month. We are all stretched so thin and overwhelmed.

[jbkerkhoff]

Buying a “New” Radio

I look at Ebay from time-to-time, and lately I’ve been having a little too much fun. A Ten Tec Century 21 CW Transceiver (model 570) attracted my attention recently. Released in 1975, the “570” was a solid-state radio intended for Novice hams and covered five bands: 80, 40, 20 (and with accessory crystals) 15 and 10 meters.  Its “Double Direct Conversion” receiver could detect SSB and CW signals, but had only about 30 watts output. It was being sold as a “part only” device with at least two problems. The main tuning dial was frozen and it didn’t seem to have any output on transmit. Although the shipping was a little expensive, the auction price was modest price given the radio’s cult status with CW aficionados. I had always had a soft spot for Ten Tec products.

My History with Ten Tec

Back in the 80’s, I lusted after the Triton IV digital. It was expensive even though I had a good job engineering at a local TV station. Hoping for a deal, I went to the local dealer and mentioned my interest. He wondered if I could help him repair radios. He was both an amateur and CB radio dealer, and had a backlog of service tickets. Before long the deal was struck: if I would work on Saturdays repairing radios, the Triton IV was mine. I don’t remember the time frame, but I probably worked at least several months. I later traded that radio for an ICOM 720A, which I still have, but I always regretted selling the Triton IV. I worked a lot of DX on that rig.

Solving the frozen dial problem

Fast forward 40 years, and the Century 21 arrived from the Ebay seller. He had packed it very carefully, and the radio was in good cosmetic shape given its age and Ten Tec’s use of contact paper for exterior finishes. I opened the top cover and could see the reason for the frozen dial immediately: the plastic spur gear that connects the Permeability Tuned Oscillator (PTO) to the frequency dial had split in two. I took the front panel off  and I had the part out in no time. There were two clean breaks and both halves were complete. I could repair it.

The repaired tuning dial gear

A word about the plastic used for these gears. In the past, I’ve tried repairing them with super glue and epoxy with mixed results. Neither adhere well to the plastic. I recently discovered a product that works though: Loctite Epoxy Plastic Bonder. It adds a solvent that attacks the plastic, allowing the epoxy to bond. The result is strong, machinable and permanent. About 30 minutes later, the gear was as good as new. There was a some squeeze out in the center hub and around the gear teeth, but a drill bit and an x-acto knife cleaned that up.

Documentation for the Ten Tec Century 21

The Ten Tec Manual

Manuals for these radios are not hard to find, with several helpful hams posting PDFs from their personal copies. I was able to find a copy at rigreference.com. The manuals  are very helpful with more than just installation and operation. They discuss the radio’s theory of operation and how each section works in detail. Voltage readings and schematics are also included. I was grateful for this help because I knew that the “no output” problem was a little more challenging.

Diagnosing the symptoms

I learned years ago that no matter what the problem, it’s a good idea to check power supply voltages first. The Century 21 is powered by an internal, transformer-isolated  power supply that supplies a regulated 12.6 volts. It’s got a beefy transformer and the supplied voltage was correct. Although there was audible white noise when it was powered, suggesting that the audio stages were working, connecting an antenna didn’t change the white noise much — even when changing bands or the PTO setting. Pressing the “set drive” button did mute the radio, and advancing the drive control did increase the reading on the “input power meter”, but not very much. Checking the output with an oscilloscope didn’t show much output, and it wasn’t anywhere near the expected frequency.

We have a diagnosis (With a little help from my friends)

The PTO

There are several good resources online and I found specific help on the QRZ.com Century 21 Restoration Forum. A couple of things stood out: these radios often had bad final output transistors, and also often needed to have the PTO rebuilt. Thinking that the finals might be bad, I started working backwards from the the final amp. Checking the output of the “Low Level Driver” board, I was surprised to see very little output and at the wrong frequency. Going back to the “Mixer” board, it’s output also had an unrelated frequency at the output. This is a simple radio (something I love about Ten Tec’s products of the era) and there were only two other possibilities. Either the PTO was off frequency, or the Local Oscillator (also on the “Mixer” board) wasn’t right. It turned out to be the PTO. It was running, but at about 2.87 MHz, and it didn’t change when the tuning dial was moved.

Partial PTO Schematic showing the coils

The PTO is the only module in the radio where voltage readings are not  provided. The QRZ forum and a couple of YouTube videos encouraged me to dive in though, and  I decided to remove the PTO from the radio. It would be easier to work on, and should I need to rebuild it, I would have to remove it anyway. Supplied with power from a 9-volt battery, I looked at the output on a scope. Nice sine waves at about 2.87 MHz. No change when I turned the tuning knob, even though I could see the ferrite slug moving in and out of a coil. The frequency should have been changing between about 5 and 5.5 MHz. Was something wrong with that coil? I couldn’t see any damage, and the wire leads seemed firmly attached to both the coil and the circuit board.

The broken coil

Looking at the schematic for the PTO, I could see a continuity check of the  tuning coil  (“L3″ on the schematic) wouldn’t tell me much since it was connected in parallel with”L2”.  “L1” and “L2,” are connected in series and used to set the overall frequency and band spread of the PTO.  I unsoldered one lead of “L3” and tested it with an ohmmeter. No connection. That explained why there was no frequency change when the ferrite slug moved and why the frequency was so low. Without “L3” in parallel with the other two coils, the effective inductance would be higher, resulting in a lower oscillator frequency. Getting the coil out of the tiny box involved removing the tuning mechanism. I was going to rebuild the PTO after all.

Repair and Rebuild

Installing the repaired coil

I’ll spare the tedious details of repairing the coil except to say that the coil dope was difficult to remove. I ended up using a small file and an x-acto knife to abrade and chip enough off to reconnect the broken lead. Also, I had to repair both leads. Both were well connected to the coil dope yet had failed underneath. I haven’t seen that before.

The dissassembled PTO

There are two good videos from K5CYF showing how to rebuild the PTO and an excellent Web page from N5ESE (captured in 2005 on archive.org) with more detailed instructions. Both mention the use of a Ten Tec “PTO Rebuild Kit” which may no longer be available. With their help, I was able to reassemble my PTO using the existing parts. The good news? The PTO now worked, and was producing RF in the expected range from 5 to 5.5 MHz.  The vernier also seemed to work reasonably well. BTW, this PTO design was used in several products of the era, so knowing how to service them is useful for the Ten Tec collector.

Testing the PTO after assembly

Output from the working PTO

Success! (or Back to the Future)

After reinstalling the PTO, the radio had output. 80 meters was a little low at 12.5 watts out, but the other bands came close to or met original specs of 25-30 watts out. The PTO was surprisingly close to frequency after having major surgery, requiring only a slight touch-up. The receiver was originally rated at 1 uV or less for 10 dB S+N/N, and I could indeed hear signals from a test generator set to 1 uV.

How is it? Like a trip down memory lane — and it has a few quirks. The direct conversion receiver hears signals on both sides of zero beat meaning that a CW signal will be heard in two places on the dial. This takes a little getting used to for us modern Superhet owners, but works fine in practice. The three section audio filters (2.5, 1 and 0.5 KHz) work well for voice and CW and I remember their audio quality fondly from the Triton IV. Best of all, and perhaps why they’ve become a favorite of CW ops, is the smooth, full break-in CW. This was novel in the late 70’s and sold quite a few radios. And as we’ve seen, it’s nice to work on a radio that it’s possible to understand. If you like CW, and have a chance to get one of these gems, don’t pass it up.  I think I’m going to have some fun with this radio.

The Ten Tec Century 21 in the shack

How to Repair the Ten Tec Century 21 – A Great Classic Transceiver Buying a "New" Radio I look at Ebay from time-to-time, and lately I've been having a little too much fun.

[caraccidentattorneysa]

Car Accident Attorneys San Antonio – What to do Immediately After an Accident

Personal Injury Lawyers: What to do Immediately After an Accident

Best Practices: The 7 Most Important Steps to Take After a Car Accident

While there are many variables that determine the outcome of a car accident lawsuit, there are certainly several things that successful cases all have in common. By following the below list immediately after an accident, you will stand the greatest chance of obtaining fair compensation.

Odds are, you, your family, or someone you love will be involved in one of these accidents and will suffer economic loss as a result. Our law office has assembled this article for your benefit and is designed to educate and equip you to use Texas Car Accident laws to your full advantage. Reviewing this article will assist you in receiving any medical care you might need after an accident, and to maximize your recovery for economic loss that you might experience as a result.

Overview

The best time to collect evidence of the accident is immediately after it happens. Too often, precious evidence is lost or becomes undiscoverable when it is not collected immediately. Ideally, you should begin the following steps (discussed in detail below) the moment you step out of your vehicle after you’ve been in an accident. If you are unable to do any of these steps yourself, have a family member or friend do them for you.

Step 1: Take a Deep Breath and Try to Remain Calm

Simply put, car accidents are stressful. After an accident, you may experience a range of emotions in addition to any injuries you’ve suffered. Although you are justified in being upset, it’s important to keep your emotions in check. A clear head and a well-executed plan are necessary to maximize both recovery and your rights under Texas law.

Step 2: Get Medical Attention, Even if You Think Your Injuries Aren’t Severe

Sometimes the most serious injuries are those that aren’t apparent immediately following an accident. Adrenaline and other hormones often trick our bodies into thinking that our injuries aren’t severe, and mask the full extent of our injuries until after we’ve left the scene of the accident. The dangers of undiscovered injuries are very real, as failure to obtain immediate medical attention could cause irreparable injury or death. Thus, it is good practice to call EMS to evaluate your injuries, even if you think they aren’t severe. Also, when an ambulance ride is offered, it is good practice to err on the side of caution and take it. Odds are that an ambulance ride is being offered to you because a trained paramedic realized that you need medical treatment that is too severe to be treated at the scene.

Similarly, it’s important to not downplay your injuries to police or medical personnel. Even highly qualified medical personnel, including paramedics and doctors, usually require full disclosure of your injuries to make an accurate diagnosis and to prescribe a comprehensive treatment plan. Although you may be tempted to “be strong” for loved ones, it is more important that you address your injuries frankly and directly.

Promptly obtaining medical attention for any injury, no matter how small, is essential to obtain maximum recovery for your injuries. If you fail to obtain medical attention immediately following the accident, the defendant may claim that your injuries were caused or aggravated by an outside force. As the person seeking recovery for your injuries, you have to prove that the defendant caused them. Here’s an illustrative example: say that you only feel a bit sore after you’re rear-ended by a distracted driver. Two weeks later, you are having a hard time breathing so you go to the emergency room, where your x-ray shows that you have several broken ribs and a punctured lung, which was caused when you were rear-ended. Here, the defendant will claim that something else must have happened and will argue that anyone who has a broken rib or punctured lung would need immediate medical attention. As a result, the court may believe the defendant and limit your recovery to soreness instead of broken ribs and a punctured lung, an amount that is significantly less. Thus, it’s in your best interest to obtain medical attention immediately after you’re in an accident to obtain a complete recovery for your injuries.

Step 3: Call the Police for an Officer to Come to the Accident Scene to Write an Accident Report, and Explain the Accident to the Investigating Officer in Explicit Detail Obtaining a police report should be one of your main objectives after you are in an accident, even where the other driver immediately and clearly admits fault. A police report is a document prepared by a police officer that includes the names, addresses, and insurance information of all parties involved, as well as the investigating officer’s findings as to the cause of the accident.

Although having an officer write, and later obtaining, a police report may seem confusing or intimidating, our law office has simplified this process by outlining steps and tips designed to assist you in procuring a police report below. In addition, a competent car accident attorney is able to do most of this for you. However, in the event that you have not retained an attorney, such as immediately after the accident occurs, the following steps are helpful.

The first step is to call the police immediately after the accident occurs. Although you may suspect that someone has called the police on your behalf, you should call anyway to ensure that they arrive quickly and to disclose information that other drivers may not know, such as the existence and severity of injuries. Please note that it is important to obtain a police report for all accidents, regardless of the other driver admits fault. Too often, the responsible driver changes their story after they leave the accident scene, leaving the victim without this crucial piece of evidence.

Second, you should give the officer a concise 30-second explanation of what caused the accident. Just the facts are needed here. For example, something as simple as this will work: “I was traveling east, and the other guy was traveling west. In the distance, I saw him swerving in his lane. He then swerved into my lane, and although I applied my brakes and tried to pull onto the shoulder to avoid him, it didn’t work and he ran into my car. After the accident, I noticed that my head was bleeding and I had a hard time breathing.” Note that officers only write a report if an injury has occurred, so be sure to disclose any injury that you’ve suffered, even if you think it’s small.

Third, you should describe the accident as accurately as possible to the officer. Officers use information from accident victims while compiling their reports, and it’s important that they have all of the facts. While talking with the officer, it is extremely important to disclose the full extent of your injuries. You should tell the officer of any injury you suffered as a result of the accident in detail, even if you think it is “small” at the time. Small injuries often become more severe after the passage of time, and it is crucial that the police report shows that the injury originated with the accident. In no event should you tell the peace officer that you are “okay” or feel “fine.”

When you wish to pick up a copy of the police report prepared for your accident, you might have several options to do so. Police reports are often available in person at the office that investigated the accident and are usually available two to five days after the report is written. Alternatively, your car accident attorney can easily obtain an accident report on your behalf.

Step 4: Obtain Information From the Other Driver

Your goal in talking to the other driver is two-fold: First, to elicit evidence that shows that they were at fault in causing the accident, and second, to not inadvertently admit that it was your fault.

When talking with other drivers involved in an accident, ask questions that are helpful in determining if it was irresponsible for them to be driving in the first place. For example, if their speech is slurred or they are unable to walk normally, ask them questions such as “have you been drinking alcohol?” or “are you under the influence of drugs?”

Although a confession is ideal, the other driver may attempt to conceal their liability from you. When that happens, ask them questions that cut through their concealment and reveal the truth. Helpful questions include:

“Where are you coming from?” The place where the other driver is coming from can have wide implications on his liability for causing the accident. For example, if the driver is on the way home from working a night shift, he might be too tired to drive responsibly. Or, if a driver has left a bar or restaurant, he may have consumed too much alcohol, and as a result, drove recklessly and caused the accident.

“What were you doing when the accident happened?” This question is important because it will tell if the driver was distracted when the accident occurred. A distracted driver is a dangerous driver. Distractions come in several forms and include talking on the phone, texting, arguing with a passenger, shaving, putting on makeup, and attempting to retrieve something dropped on the floor. In Texas, drivers have the duty to operate their vehicles in a responsible manner, which includes driving while not distracted.

“Were you in a rush to get somewhere?” This question is important because it will tell if the driver may have been driving negligently or recklessly when the accident occurred. People who are in a rush often don’t use their best judgment and may have operated their vehicles in a manner that is unreasonable under the circumstances.

Additionally, you should never admit that the accident was your fault, in full or in part, to the other driver, to medical personnel, or to police officers. Similarly, although you might feel bad or sorry for the other driver, you shouldn’t say anything that reduces his fault in causing the accident. Your objective in obtaining maximum recovery is to be pleasant, but stern in asserting the cause of the accident. Note also that the cause of an accident is often complex, involves several factors (some of which may be unknown to you), and requires the opinion of an expert. Admitting that the accident was your fault before an expert analyzes the facts may cause substantial and irreparable damage to your case, and almost always unfairly benefits the other driver when the accident was really their fault.

Step 5: Talk to and Obtain Information From Witnesses

Witnesses are an excellent resource for you to maximize your rights and recovery under Texas auto accident laws. Although helpful, you should exercise a level of caution when talking and obtaining information from them. First, under no circumstances should you admit fault to a witness. The other driver can use this information against you, even if it’s not included in the police report. Second, have all witnesses, when possible, give their account of the accident to a police officer for their report.

Step 6: Take Pictures of Everything

The saying “a picture is worth a thousand words” rings especially true for car accidents. It is good practice to immediately take pictures of anything you think may be useful in determining the cause and effects of the accident. Waiting to take pictures at a later date may be harmful to your case, as evidence may have been altered or may not be viewed credibly by a court. Importantly, pictures are crucial to a jury’s understanding of the case and are often necessary to obtain a full recovery for your injuries. In all cases, be sure to take pictures of the following:

The license plate on all vehicles involved in the accident; All vehicles involved; Any injuries you’ve suffered; The other driver, and the other driver’s license and insurance card; The accident scene from several angles; Any incriminating evidence, including empty beer cans (even if in the bed of a truck), drug paraphernalia, or possible distractions inside the vehicle; Pictures of witnesses and their license plates; Pictures of traffic control devices, including stop signs and lights, mile markers, street signs, and traffic cameras; and Pictures of landmarks to pinpoint the exact location of the accident, such as billboards and surrounding buildings.

Do you have a legal issue or question? Call us now.

Step 7: Call a Competent Car Wreck Attorney

If you’ve been in a car wreck as a result of someone else’s negligence, you may be entitled to compensation for your injuries and economic loss. It is important that you have an attorney that understands your rights and has a history of success in representing car accident victims. The team at our law office has a track record of success and has obtained numerous recoveries for our clients.

Our attorneys are available 24 hours a day, seven days a week, 365 days a year to provide a free consultation regarding your auto accident.

The post Car Accident Attorneys San Antonio – What to do Immediately After an Accident appeared first on Car Accident Attorney SA | San Antonio Law Firm specializing in Personal Injury and Wrongful Death - Experience you need. Results you want..

[maxihealth]

Telehealth Awareness, Access and Adoption: Updates from J.D. Power, the ATA and FAIR Health

When you think “J.D. Power,” your mind probably imagines reviews of automotive performance, retail shopping experiences, or perhaps even health insurance plan customer service.

Expanding its report-card role in the health ecosystem. J.D. Power has undertaken a survey on consumer satisfaction with 31 telehealth providers across 15 measures, which will be published in November 2019. In advance of the full report, the organization released a summary on telehealth access and satisfaction, which I’ll discuss in this post. I’ll also weave in the latest insights from the ATA 2019 State of the States report updating legislative/regulatory telemedicine activity at the U.S. State level.

For this research, J.D. Power polled 1,000 consumers in June 2019.

The top-line finding from J.D. Power is that only one in ten Americans have ever used telehealth or virtual health to substitute for an in-person visit to a doctor’s office, hospital, ER or urgent care clinic in the past year. Those who had a telehealth encounter more likely lived in the Western U.S., were under 44 years of age, women more than men (much of this driven by moms caring for children and pediatrics access during off-hours), and suburban dwelling.

It’s not for lack of availability that people don’t use telehealth services: people lack awareness of the availability of providers and health plans’ coverage of virtual care. Three in four people said their health system or health plan did not offer telehealth services or they were unaware of it. There was a markedly high level of unawareness of telehealth in rural areas, which are underserved by health care and a key focus of opportunity for virtual services.

17% of people were aware that their health system or insurance plan offered telehealth or virtual health to substitute for a visit to a hospital, doctor’s office, ER or urgent care site.

Cost is a key driver for patients seeking health care — often leading to self-rationing or postponing visits to a health care provider when care is needed. One-half of U.S. consumers view telehealth is the same or higher cost; one-half sees telehealth as being lower cost than a traditional doctor’s office visit, shown in the second chart.

One finding worthy of call-out from the second chart on telehealth costs is the data point of consumers who rate the telehealth visit as “very good” or “excellent” who also perceive the visit as higher cost. Here, those consumers are marrying the concept of higher cost with higher quality, which is a perception/myth that ATA and the telehealth industry have been working to debunk.

Now that we’ve looked at J.D. Power’s lens on the consumer/patient demand side for telehealth, let’s examine ATA’s latest read on payment and regulatory issues across the states.

ATA’s 2019 report profiles each state’s approach to telehealth policies by patient setting, payor type, and delivery models, along with providing specific legislation and policies that can dramatically vary state-by-state. In the words of the report, “our analysis reveals a mix of strides and stagnation in state-based policy despite decades of evidence-based research highlighting positive clinical outcomes and increasing telehealth utilization.”

All 50 state Medicaid agencies have adopted some coverage for telehealth, with 10 states not advancing coverage since 2017. There’s a move among state Medicaid programs to migrate from traditional hub-and-spoke models of care, with 29 states not specifying a specific patient setting for payment. Twelve states identify the home as an originating site, and 12 states and Washington DC look to schools as an originating site. Some states recognize both the home and school for telehealth payment.

Twenty-two states are covering remote health monitoring and 29 states and the District of Columbia cover services via store-and-forward. One-third of the states cover telehealth via synchronous (real-time) channels, and a few for only video visits. These technology differences are shown in the map shown here from the ATA report.

An important value of telehealth is its ability to channel care to people living in remote and health care under-served areas. Over half of the states and DC now cover telehealth services provided by a provider of any type beyond a licensed physician. Alabama is the only state that identifies physicians as a telehealth-eligible provider.

Coverage parity is an important issue: that is, whether a health plan or payer will treat telehealth visits as in-person visits in terms for payment. In 2019, 28 states have payment parity policies for Medicaid. Thirty-six states and DC have coverage parity policies for private payers.

As you read my summary of the ATA state-by-state analysis, you would be right to get the impression that telehealth policy in the U.S. continues to be a patchwork quilt based on the ZIP code where a person lives portending what kind of telehealth services will be reimbursed, what type of provider will be involved in the consultation, where the visit will occur, and who the third party payer is.

Health Populi’s Hot Points:  The reports from J.D. Power and the ATA illustrate the fragmented nature of telehealth in America in 2019. This, notwithstanding a private sector driving innovations and supply in telehealth services in pharmacies, in hospital systems, in schools, and via direct-to-consumer models to the home and smartphone.

There’s a growing trend in direct-to-consumer telemedicine companies recently noted in JAMA in a viewpoint titled, “Prescriptions on Demand.”  Dr. Ateev Mehrotra, one of my go-to experts on retail health, and colleagues from Harvard, note that DTC telemedicine companies focus on delivering convenience to patients in a complex health care system as a value-add in the current “consumer-directed” environment. Other advantages offered by DTC telemedicine include standardized, efficient, and accessible care compared with traditional visits to doctor’s offices, hospital clinics, and ERs. And cost, to both the end-user patient and plan-sponsor, is clearly a potential advantage.

But Dr. Mehrotra and team also note that these new treatment options that ensure convenience must, in their words, “not come at the expense of quality.”

Rite Aid is the latest among the retail pharmacy chains to announce a telehealth partnership with InTouch Health via the RediClinic Express kiosks. This service will enable consumers shopping in a Rite Aid store to speak with RediClinic clinicians in a two-way high-def audio/video network.

With the patient-as-payer in the current U.S. health ecosystem, cost/price of health care underpins how, when and where people seek care. FAIR Health’s paper on A Multilayered Analysis of Telehealth published in July 2019 found that telehealth usage has substantially grown since 2015 as more states implement laws for coverage.

An intriguing data point comes in Figure 14 on the distribution of non-hospital-based provider-to-patient telehealth claim lines in 2018. I’ve copied the chart here.

After the most common patient diagnosis, acute upper respiratory infections (historically the most common complaint presenting in retail clinics), the second and third most frequent reasons for telehealth diagnoses were for mood/affective disorders and anxiety and other nonpsychotic mental disorder. That is, mental health issues.

This finding is a wake-up call, thanks to FAIR Health, illustrating the power of telehealth for mental health. I addressed this as an emerging opportunity in 2012 in The Online Couch, a report I wrote for the California Healthcare Foundation documenting the need and growing supply side for telemental health services. As we know that mental health should be baked into primary care, telehealth channels that demonstrate evidence-based approaches and credentialing can and should help foster that under-served demand in the currently, tragically fragmented U.S. health care system.

The post Telehealth Awareness, Access and Adoption: Updates from J.D. Power, the ATA and FAIR Health appeared first on HealthPopuli.com.

Telehealth Awareness, Access and Adoption: Updates from J.D. Power, the ATA and FAIR Health posted first on https://carilloncitydental.blogspot.com

[plancover-blog]

How Do I Claim For my Group Health Insurance

Now that the employees are insured and have a medical insurance cover, the question arises, how does one claim and what is the whole process? We will help to answer all those questions so that the claim is processed effortlessly.

How to claim?

You can make a health insurance claim in two ways –

Cashless Claims

Reimbursement Claims

Cashless Claim – This is a facility extended by the insurance company and a part of your policy terms where the policy holder can get admitted and undergo necessary treatment without paying the hospital directly for the medical expenses. The eligible medical expenditure which is incurred is settled by the insurance company directly with the hospital. You can avail cashless hospitalization only in the hospitals that are part of your TPA ( Third Party Administrator ) or Insurers network.

PROCESS OF A CASHLESS CLAIM

Please find below the procedure of cashless claim process

To avail the cashless facility, you can walk-in to any of the nearest network hospital.

Carry your mediclaim cards along with any Government of India photo Identity proof.  

Please inform at the hospital reception ( or TPA / Insurer Helpdesk) that you are covered under Group Medical Insurance policy.

Ask for pre-authorization form and get it filled by your treating doctor along with medical reports in support of diagnosed. Many Hospitals get this process done by themselves but you can check for particulars at the hospital you are going to.

Mail the scanned copy of pre-authorization and medical reports to your respective TPA. This too is often handled by the hospital itself.

Insurer / TPA will then evaluate the details mentioned in the form and process your claim within 4 hours – 6 hours ( this is typically a conservative estimate of time and can often happen much sooner) or intimate you further. This intimation could potentially be a request for more information or a denial of cashless. No denial can happen unless the treatment is not covered specifically under the policy terms. We will be happy to help in case that was to happen to re-validate the opinion of the insurance company and to challenge it on your behalf

The cashless may be rejected if Insurer / TPA is of the view that the ailment/ hospitalization are not covered under this policy.

At the time of discharge if the claim amount is more that your sanctioned amount, the Insurer / TPA will mention it in the approval note and you may have to bear that yourself. The common head’s under which this partial approval may happen are –

Few hospitals may ask for initial deposit at the time of admission. This is a subjective demand and varies from hospital to hospital. Any amount that you have paid, after adjustment for the details mentioned in the previous point above, will be refunded to you.

At the time of discharge – The patient and family are obviously eager to get home at this point in time. We would like you to calibrate your expectations on this. While the treating doctor may advise discharge the previous day or the same day, the sequence of processes that a hospital needs to follow are many. THis process itself at the hospitals end, often can take a few hours. Finally once the hospital generates the final bill and discharge summary, they will send it to the Insurance company / TPA. This is then put into a detailed scrutiny by them and a doctor will also evaluate all the documents. Once they have validated all details and mapped it against the policy terms, they will approve the claim and also the amount that they will pay. THis will then result in the Final Authorization being sent to the hospital.

On receipt of the Final Approval / Authorization, the hospital will let you know via the billing department if you need to pay any balance, assuming the approval is done. You can pay that balance or challenge it ( in which case seek us out and we will understand your point of view and represent it to the Insurer / TPA)

Your sum insured is exhausted.

Non Medical Items that are not covered under the scope of any health insurance cover in India.

There is a provision of cost bearing on your part, as a policy feature under your policy, often called co-payment.

There is a capping for the particular treatment in your policy.

Reimbursement Claim – This facility is opted by the claimant when he goes to a hospital as per his choice given that it is a non network hospital. Cashless process cannot be availed here. The claimant has to pay for all the medical expenses and other costs  incurred during the hospitalisation. After discharge, the claimant has to provide all the original documents to the insurance provider. The provider will scrutinise all the document as per the policy terms and conditions and make the payment to the employees. In case the treatment is not covered, the claim is rejected and a reason is provided.

DOCUMENTS REQUIRED FOR REIMBURSEMENT –

Following original documents are mandatory to process a claim under reimbursement.

Please note the hospital should a minimum of 15 beds. (Read Here for more details on Bed Requirement for it to be qualified to be eligible for claim payment under health insurance)

Copy of Hospital Registration Certificate with Registration number and number of beds certificate (This may not be required in case of larger hospital which are well known and in larger towns / cities )

Claim Form duly signed. This is absolutely mandatory

Copy of the Claim Intimation, if any ( If you are filing the main hospitalisation expenses for reimbursement, then you would have done the intimation of the claim in advance, as per your policy terms. Do attach a copy of that)

Hospital Main Bill with proper breakup of the expenses. Often there is a summary bill and then there is a bill which mentions all line item wise expenses. The insurer will need the detailed latter bill

Hospital Bill Payment Receipt for which the policyholder / claimant made the payment to the hospital. Do note that this receipt will need to be numbered.

Original Hospital Discharge Summary (which should clearly mention –

Others medical document that may be provided

Doctor’s Prescriptions. Often in non-emergency cases, the patient is first shown to the doctor n OPD basis, In such cases all doctors prescriptions will be needed

Copy of photo identity card of patient and employee

Pharmacy bills.

MLC Report & Police FIR, Alcoholic declaration in case of accidental cases particularly Road Traffic Accident (RTA)

Also in RTA Cases, detailed circumstances of the trauma with date, place and time. This is mandatory for reimbursement claim in case of an accident case.

All Investigation Films and Reports – ECG / CT / MR / USG / HPE or any other investigation reports. Obviously there will be no films in cases of blood investigations, urine / stool investigations or biopsy

Original cancelled cheque, with printed name, for the transfer of payment to your bank account. If you providing cancel cheque without printed name please submit the copy of passbook with bank attestation. Bank E-statement (In case your name as an employee is NOT printed on the cancelled Cheque)

Patient name

Date of Admission

Date of Discharge

Age of the Patient

Final Diagnosis

Case Summary / History (On Examination), Course in Hospital, Line of Treatment, Advice at Discharge with signatures and stamp of treating doctor. This will be on the hospitals letter head

Points to keep in mind while filling the claim form for reimbursement process  –

Kindly mention your Employee ID, Company Name and Contact details on top of the claim form (You can write this at the right top portion).

Please note that the following fields are mandatory in a claim form –

Policy Number (in case of Corporate policies, even if you don’t have the policy number, that’s fine, you can omit it.

Cashless Identity Card number ( would be mentioned on your hard copy or E Card in case you have that).

Name of the Insured ( Primary Member) with addresses and contact details.

Name of the Corporate & Employee code.

Name of the Patient, date of birth and relationship with the employee.

Tick on the type of claim, write, and date of admission and discharge, name, address and contact details of the hospital.

Provide the details of illness / injury / disease.

Provide the details of amount that is being claimed with breakup of bill numbers.

All documents in original.

Signature of the claimant along with place and date (this is mandatory).

FAQs –

Is there any clause for intimation to process my claim?

You should intimate the TPA within 24 hours of hospitalization in case of unplanned / emergency cases and before 48 hours of hospitalization in case of planned treatments. This will be applicable for both cashless as well as reimbursement cases.

     2. How should I plan my treatment for cashless hospitalisation?

You can plan for cashless hospitalisation before 4 days before the date of treatment. The insured must notify the insurance provider via mail for planned hospitalisation. The insured is required to provide his/her government approved identity card at the TPA desk in the hospital. A pre authorisation form is required to be filled by the insured. After this step is done, the TPA will get the approval done. On the day of admission in the hospital, the insured is required to show his/her identity card with the approval letter. The payment will be settled by the insured provider and the hospital directly.

     3. Will I be able to claim if I submit my claim documents  after the policy expiry date?

Yes, the claimant can claim in cases when the admission date for hospitalisation is prior to the policy expiry date. After the claim documents will be received, the claim will be processed as per the policy terms and conditions.

Note that the employee has to make sure that the intimation is provided by the claimant to the insurance provider within 24 hours of hospitalisation.

The claim documents will have to be submitted within 30 days from the date of discharge to avoid the delay of submission of claim documents.  

 4. Can I lodge more than one claim for the same diseases?

Yes, your mediclaim policy covers 30 days pre-hospitalization expense reimbursement and 60 days post-hospitalization expenses. You may lodge your pre-hospitalization claim along with hospitalization claim. The post-hospitalization claim may be lodged after 60 days of the hospitalization. However, please quote your Claim Number for easy referral and sorting.

  5. In case I require my original medical papers back for future reference, what should I do?

Please carry a complete set of photocopied documents when you lodge your claim. The relevant original documents will be returned to you after verification. The TPA will however stamp the original documents. Please note that normally, the original doctor prescription, medicine bills and discharge summary along with the hospital bills will be retained by TPA. Only X-ray films, ECG, other medical records will be returned to you as a special case after verification / approval of TPA’s medical team.

6. During the course of my treatment, can I change the hospitals?

Yes, it is possible to shift to another hospital for reasons of requirement of better medical procedure. However, this will be evaluated on the merits of the case and as per policy terms and conditions.

7. Can I get outpatient treatment using my Ecard?

No. The TPA Card is issued against the mediclaim policy which only covers hospitalization expenses. It cannot be used for outpatient treatments as OPD benefits are subject to the policy terms and conditions of the policy copy.

[sciencespies]

'Dr. Bob' Sears Accused Of Issuing Invalid Vaccine Medical Exemptions--Again

https://sciencespies.com/news/dr-bob-sears-accused-of-issuing-invalid-vaccine-medical-exemptions-again/

'Dr. Bob' Sears Accused Of Issuing Invalid Vaccine Medical Exemptions--Again

Bob Sears, a pediatrician from Orange County, right, testifies against a measure by state Sen. Dr. Richard Pan, D-Sacramento, left, who is also a pediatrician, that would give public health officials oversight of doctors that may be giving fraudulent medical expeditions from vaccinations during a hearing of the Assembly Health Committee at the Capitol in Sacramento, Calif., Thursday, June 20, 2019. (AP Photo/Rich Pedroncelli)

ASSOCIATED PRESS

“Dr. Bob” Sears, MD, the controversial California physician known for his Godwin-esque advocacy against vaccination requirements and a vaccine book filled with misinformation, is facing another accusation from the Medical Board of California, less than a year after he was placed on probation for medically negligent practices. Ironically, the complaint was filed just two days before Sears testified at a California legislative committee hearing against SB 276, a bill that aims to prevent exactly the behavior that led to his previous censure and this complaint.

“I find it astonishing that a person who is on probation with the medical board is going to be the main spokesperson to say the bill is bad, the person the bill is designed to protect against,” California State Senator Richard Pan, MD, FAAP, (D – Sacramento) told me after the bill he’s sponsoring passed out of the Assembly Health Committee 9-2 yesterday.

What Happened?

The complaint, brought by Kimberly Kirchmeyer, executive director of the Medical Board of California, alleges that Sears filed medical vaccination exemptions for a pair of siblings who did not have medically recognized contraindications for any vaccines, based on what he recorded in their medical records.

Medical exemptions allow children to attend California schools without having received immunizations required by the state for school attendance. Following SB 277 in 2015, California became the third state to only allow medical exemptions. Similar bills have since become law in Maine this May and in New York last week.

The patients are a 7-year-old unvaccinated boy with psoriasis and his sister, whose only medical history is a bee sting allergy. Both saw Sears on May 4, 2016 for a complaint of “vaccine exemption appt.”

Sears recorded the children’s family medical history as “autoimmune disorders, lupus, psoriasis (in Dad), inflammatory bowel disease, irritable bowel disease, irritable bowel syndrome (in Dad), gluten sensitivity severe in Mom and Aunt, suspect CD [celiac disease] in aunt, neurodevelopmental disorders, ADD/ADHD (in Dad), psychiatric disorders, schizophrenia (Dad), bipolar, and depression.”

The boy’s exam included “psoriatic plaques on scalp, back of neck and ears,” and the girl’s exam was normal, though Sears documented no vital signs for her (blood pressure and temperature). Both children were diagnosed with “viral infection, unspecified” and “feeding difficulties” despite the purpose of the appointments being solely recorded as “vaccine exemption” visits.

Sears determined that the boy “qualified for medical exemption from vaccines for family history of autoimmune disorders (Dad and others), inflammatory bowel disease (Dad), neurodevelopmental disorders (Dad), psychiatric disorders (Dad), and the child’s own autoimmune disorder.” Sears determined the girl qualified “based on review of her past medical history, family history, and current state of health.” He filed letters for both children “exempting [them] from all vaccines for the rest of [their] childhood.”

None of the conditions or family history, as noted in the children’s records, meet the criteria for contraindications to any CDC-recommended childhood vaccines, according to the CDC. The complaint notes for the boy that a “childhood long medical vaccine exemption… based on diagnosis of psoriasis, without immunosuppressive medication, is a simple departure from standard of care.”

Immunosuppressive medication, including that used to treat autoimmune disease such as psoriasis, is a contraindication for live vaccines, such as the MMR and chickenpox vaccines, explained Jaime Friedman, MD, FAAP from Children’s Primary Care Medical Group in San Diego. The complaint goes on to say the boy’s diagnosis and both children’s family history “are not a known contraindication or precaution to routine childhood vaccination.”

The father of the children appeared to agree. Seven months later, on January 25, 2017, the children’s mother called to tell Sears’ office that the children’s father “retract his consent regarding the medical exemption letter.” Since exemptions require consent from both custodial parents, Sears told her the exemption letter was no longer valid. To get another letter, both parents would need to come in and bring the children’s past medical records, he said. Both children’s records “contain an amended copy of the medical exemption letter dated May 4, 2017, stating the original exemption letter is no longer valid and should be disregarded due to a change in family circumstances and consent.”

The Medical Board accusation includes “failure to maintain adequate records” as a second cause for discipline because Sears “failed to obtain and document an appropriate and accurate past medical history, physical exam and family/social history” for the children. This charge was also in the previous accusation that led to Sears’ 35-month probation in July 2018. Sears did not return my emailed request for comment.

Medical Exemptions Appear Inappropriate

“Without being able to review the child’s medical chart and assuming the child was not on immunosuppressive medication, I don’t see a reason for the child to have a vaccine exemption,” Friedman told me. With the “viral infection, unspecified” in the chart, Friedman said that “could be a contraindication to giving the vaccine that day but not to giving it in the future.”

Friedman, who has written three medical exemptions for her patients, said contraindications certainly exist for certain vaccines but are rare. “These are the patients you want to protect, so these are the kids you want to surround with vaccinated people, like their classmates and their siblings,” she said. If she had a patient on immunosuppressive medication for an autoimmune disease, she said she would work with the child’s specialist, such as a dermatologist or rheumatologist, to determine if and when it was safe for the child to receive vaccines.

Pan agreed that if children “had a skin rash so severe that they would need immunosuppression significantly enough that they can’t be vaccinated, probably a specialist is involved, especially for something like psoriasis.” He also noted the unusual decision to provide an exemption until “the end of childhood.” “Unless you have proof that this condition suddenly terminates at the end of childhood,” Pan said, a doctor would issue either a permanent exemption for a chronic, permanent contraindicated condition or a temporary exemption until the contraindicated condition or medication resolves.

The complaint contains other “much more fundamental issues,” said Sonia Khan, MD, FAAP, director of Pediatric Crisis Solutions, a consulting firm, and medical director of the Team Substance Use Disorder Program at City of Fremont in California. Khan testified for SB 276 at the California Assembly.

“He didn’t even do vital signs on these kids. If you don’t do vital signs on the kids, right off the bat, the medical exam isn’t complete,” Khan told me. “If these do prove to be valid accusations, then there are some pretty flagrant violations.”

She said this complaint reveals the need for the California Department of Public Health (CDPH) to be able to track down medical exemptions and determine the exams and exemptions were done properly.

What SB 276 Would Do

SB 276 bill requires guardians whose children receive a medical vaccine exemption to sign a form that releases the medical records to CDPH and the Medical Board of California for review. The current incarnation of the bill includes two potential triggers for review: if the child attends a school with an immunization rate below 95% or if the physician who wrote the exemption has issued more than five medical exemptions in the previous year.

The second requirement is not a cap, Pan said. A pediatric oncologist, for example, may need to write many more than five exemptions in a year. It simply means the CDPH can review the exemptions. If multiple exemptions appear invalid, the CDPH can refer the case to the medical board, the disciplinary agency. Currently, both the CDPH and medical board have difficulty reviewing exemptions because they lack access to the medical records of children with exemptions.

“The difficulty up until now in chasing down potentially fraudulent exemptions is that the families are complicit,” Khan said. “When a doctor gets reported, the family or someone else is triggering an investigation. In a fraudulent exemptions, the families aren’t going to cooperate.”

“HIPAA [Health Insurance Portability and Accountability Act of 1996] has a specific exception for public health agencies engaged in ‘public health surveillance, public health investigations, and public health investigations,’ that covers SB276 and board investigations,” said Dorit Reiss, a professor of law at the University of California Hastings College of Law who specializes in vaccine policy. Reiss formally entered her name in support of SB 276.

But that doesn’t mean the records are easy to get. Another ongoing case illustrates this problem: The Medical Board of California sued Bay Area pediatrician Ron Kennedy, MD, to compel him to produce patient records “of three minors for whom Dr. Kennedy provided vaccination exemptions.” Kennedy refused, and the San Francisco city and count court compelled him to provide the records. Kennedy filed an appeal, and this most recent filing denied his request to stay the court’s demand that he turn over the medical records.

Sears’ complaint does not note who reported him or provided the medical records. His previous accusation arose from a parent who provided the records, according to an unnamed, verified source.

Parents are typically not the ones who trigger medical exemptions, Pan explained. In fact, pediatricians do not have “medical exemption appts” at all. Appointments are typically well visits, acute care visits, chronic care visits or follow-ups.

“A medical exemption should usually result from the pediatrician or a specialist seeing them saying ‘given the condition or situation you have, I would recommend we either don’t vaccinate or hold off on these vaccines,’” Pan said. “It’s odd for parents to ask for a medical exemption.”

Increased Medical Exemptions Triggered SB 276

Yet that appears to have become a trend after SB 277 eliminated personal belief exemptions. In late 2018, a study in Pediatrics found problems that had emerged from implementation of the law, including confusion and frustration over which medical exemptions were valid, how schools and health departments should track them, high fees doctors were charging for them and concerns that medical exemptions were increasing.

Indeed, just this month, some of the same researchers found California medical exemptions had increased despite an overall decline in unvaccinated children entering school in California. A year after the bill took effect, 4.4% of kindergartens entered school without all required vaccinations, down from 7.2% the previous year. But medical exemptions quadrupled from 0.6% to 2.4%. The following year, non-up-to-date kindergartners ticked up slightly, by 0.5%. In a state of nearly 40 million people, that’s a couple hundred thousand additional children not fully vaccinated in a year with the most measles cases since the disease was eliminated from the US.

Another study in the American Journal of Public Health found that SB 277 was interpreted and implemented unevenly in school districts and local health departments throughout California due to “vague legislative and regulatory language.” The researchers also found “lack of centralized review of medical exemptions allowed medical exemptions that are not consistent with valid contraindications for immunizations to be accepted.” Among the uncertainties were what kinds of physicians can write vaccine medical exemptions, which health conditions qualify for one and how to report dubious or suspicious ones.

Those are precisely the issues that SB 276 aims to address.

“The major purpose of SB276 is to prevent unscrupulous doctors from selling unnecessary exemptions so we can restore community immunity,” said Leah Russin, executive director of Vaccinate California, who is co-sponsoring SB 276 with the California Medical Association and the California chapter of the American Academy of Pediatrics.

She noted that 835 schools in California—with nearly 400,000 students—have kindergarten MMR immunization rates under 95%, according to CDPH data.

“If true, the new complaint against Dr. Bob Sears demonstrates exactly why SB276 is needed. Currently no entity in state or local government, including the schools, have the authority to reject an exemption letter signed by a doctor,” she said. “The exemptions described in the complaint do not follow the standard of care, and if issued after implementation of SB276 and subject to the triggers specified in it, they would likely be flagged as unjustified.”

Sears’ History May Prevent Leniency

Some observers believe the medical board’s previous ruling on Sears’ misconduct was forgiving but hope that won’t be the case again, especially since his case could be an example to other physicians writing spurious medical exemptions.

“I certainly hope that as the medical board is looking at these issues and investigating and evaluating them, they recognize his previous history, that he’s already on probation, that he hasn’t expressed remorse for what happened and acknowledged the error of his ways,” Pan said. “He has continued to proclaim he did nothing wrong, which I find very disturbing. You’re put on probation for acts of negligence, and you go on Facebook and say you’re not in the wrong.”

Even if the board does not fully revoke Sears’ medical license—which is one potential outcome of the complaint—Pan hopes the consequences will ensure he cannot continue to issue medical exemptions.

“If that’s the issue he’s being cited for, then certainly whatever sanction he receives needs to stop him from continuing that behavior,” Pan said. “Otherwise, one could argue that’s sending the signal to other people that the consequences aren’t very serious.”

#News

[christineamccalla]

Psychological torture to Northcentral University Students via forums including NCU Community Forum, by McCalla, Christine Ann

From: McCalla, Christine Ann and all variations thereof

To: Interpol and all variations thereof, et al

Date: Friday, June 22, 2018

Re: Psychological torture to Northcentral University Students via forums including NCU Community Forum

A central communications link is Northcentral University’s Commons where there are numerous forums facilitating communications between students, an essential part of distance education connection. Archer (1999) argue that the age of the internet facilitates distance education as an attractive and appealing option for individuals wishing to pursue university-level education.

Archer (1999) argues distance education as being of three (3) generations, print package afforded to students, audio-teleconferences, and face to face group sessions. As such, the forums afforded to students can be deemed as print packages, and audio teleconferencing available through web-based sessions including tutorials as well as dropbox options. One advantage of distance education is the students’ comfort and agility in which they pursue academic activities regardless of geographical locations (Archer, 1999) at their convenience.

In providing these forums and student communication links / outlets, Northcentral University has complied with statute,

U.S. Code, Title 20, Chapter 31, § 1221–1, 20 U.S. Code § 1221–1 - National policy with respect to equal educational opportunity - Recognizing that the Nation’s economic, political, and social security require a well-educated citizenry, the Congress (1) reaffirms, as a matter of high priority, the Nation’s goal of equal educational opportunity, and (2) declares it to be the policy of the United States of America that every citizen is entitled to an education to meet his or her full potential without financial barriers.  Retrieved from https://www.law.cornell.edu/uscode/text/20/1221%E2%80%931

In review of exhibit A (below / enclosed below), Northcentral University’s students has not seen fit to apply statute TITLE 17. COPYRIGHTS CHAPTER 1. SUBJECT MATTER AND SCOPE OF COPYRIGHT 17 USCS § 101, definitions,

-A "collective work" is a work, such as a periodical issue, anthology, or encyclopedia, in which a number of contributions, constituting separate and independent works in themselves, are assembled into a collective whole. -A "compilation" is a work formed by the collection and assembling of preexisting materials or of data that are selected, coordinated, or arranged in such a way that the resulting work as a whole constitutes an original work of authorship. The term "compilation" includes collective works.

-To perform or display a work "publicly" means-- (1) to perform or display it at a place open to the public or at any place where a substantial number of persons outside of a normal circle of a family and its social acquaintances is gathered; or (2) to transmit or otherwise communicate a performance or display of the work to a place specified by clause (1) or to the public, by means of any device or process, whether the members of the public capable of receiving the performance or display receive it in the same place or in separate places and at the same time or at different times.

Thereby the benefits, gains, appreciations, and accolades brought on by statutes,

(1) TITLE 17. COPYRIGHTS CHAPTER 1. SUBJECT MATTER AND SCOPE OF COPYRIGHT 17 USCS § 101, definitions,

An "international agreement" is-- (1) the Universal Copyright Convention; (2) the Geneva Phonograms Convention; (3) the Berne Convention; (4) the WTO Agreement; (5) the WIPO Copyright Treaty; (6) the WIPO Performances and Phonograms Treaty; and (7) any other copyright treaty to which the United States is a party.

(2) TITLE 22 - FOREIGN RELATIONS AND INTERCOURSE

(3) TITLE 15 - COMMERCE AND TRADE

(4) TITLE 12 - BANKS AND BANKING

(5) TITLE 26 - INTERNAL REVENUE CODE

(6) TITLE 31 - MONEY AND FINANCE

(7) TITLE 41 - PUBLIC CONTRACTS

(8) TITLE 42 - THE PUBLIC HEALTH AND WELFARE

(9) TITLE 29 - LABOR

(10) United Nations Convention on the International Sale of Goods and Services

Given that I participate in the doctoral school, the name of the game is competition as governed by statutes  U.C.C. - ARTICLE 2 PART 2. FORM, FORMATION AND READJUSTMENT OF CONTRACT § 2-205. Firm Offers, § 2-206. Offer and Acceptance in Formation of Contract, § 2-207. Additional Terms in Acceptance or Confirmation, and, § 2-210. Delegation of Performance; Assignment of Rights. Lucrativity is expected as well as protection by the brand that is my university, Northcentral University. In the competition process, I will encounter international denizenry of equally or greater measures as I, and I must prevail.

The communciations listed below is of a subpar, illiterate, and substandard nature, such as the no longer disabled student considering Northcentral University elite based on her opportunity to participate in statute TITLE 26 - INTERNAL REVENUE CODE. Be able to earn a living, something I have been denied by the Department of Labor to whom my certified public accountancy licensure, designated certified public bookkeeping was presented by email, with numerous responses resulting in violation of the US Constitution’s woman’s suffrage, the fucking bitch, the fucking whore, the fucking slut, financed battery and assaults including the fucking bitch sits by the side of the road 4.5 hours day. I have sued said agency for the use of my name as prostitute, for murder, and violation of statute government records; copies in which it is alleged the personnel receiving my license by email responded, I am expected to find her a job; the license is fraudulent. As you can see, I have a conflict as I am unemployed and in my 5th year of such trauma, despite my accolades, MBA, MS, BS, CBME, CBDE, CAHR, CTW, CPB. My point, I have complied substantially with no reward with statute U.S. Code, Title 20, Chapter 48, Subchapter I › § 3401 20 U.S. Code § 3401 - Congressional findings The Congress finds that— (1) education is fundamental to the development of individual citizens and the progress of the Nation; (2) there is a continuing need to ensure equal access for all Americans to educational opportunities of a high quality, and such educational opportunities should not be denied because of race, creed, color, national origin, or sex; (4) in our Federal system, the primary public responsibility for education is reserved respectively to the States and the local school systems and other instrumentalities of the States; (5) the American people benefit from a diversity of educational settings, including public and private schools, libraries, museums and other institutions, the workplace, the community, and the home; (6) the importance of education is increasing as new technologies and alternative approaches to traditional education are considered, as society becomes more complex, and as equal opportunities in education and employment are promoted;

Although unemployed for over 4 years, I must continue to pursue opportuntiies. With the cohort such as this listed below, it will not be found.opportunities

EXHIBIT A

Americans with Disabilities Accomodation re-evaluation for a documented PERMANENT disability or is there any other way to get extended time to complete studies for those of us who work for minimum wage?

So, if I am no longer disabled because my dr says it's not his place to sign the paper work and I work 2 jobs -55 hours a week to keep a roof over my head and eat and sleep 3 hours a night - I guess I am not good enough to attend NCU because there is NO way I can keep up with assignments.  Is this just a school for the elite? What options do I have?  Say I am suicidal so I can get a diagnosis and then submit new forms? Help me under stand this cuz I cannot see any lights at the end of my tunnel for completing my schooling. Nobody said life was fair.  I put so much into my studies only to be turned away. Sadly, Susie

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Linda Bloomberg  added a Forum in NCU Community Forum Diversity InSight – Dissertation Spotlight follow up: Dr. Alethea Henry, ... On June 4, 2018 UDC hosted a Dissertation Spotlight on Dr. Alethea Henry’s dissertation, which she recently completed, Exploring minority teachers’ experiences pertaining to their value in education: A single case study of teachers In New York City. This presentation was co- facilitated by Dr. Alethea Henry and Dr. Linda Bloomberg. This discussion forum is to support further discussion around the themes, reflections, and questions that arose from this presentation. A recording of this presentation will be available in the future for those of you who are interested and were not able to attend.

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I solicit the prayers of each of you. I took my ... I solicit the prayers of each of you. I took my father to the hospital Tuesday. On Wednesday while talking to my sister, he had a stroke and coded. They were able to bring him back but he remains in critical condition. He has made some gain today but is not out of the water. I believe in the power of prayer and pray that you will stand in agreement with me for his total healing and recuperation. Exhausted, Darlett Lucy-Gulley

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Grandma Ann is asking for a pat on the back. I am... Grandma Ann is asking for a pat on the back. I am taking Stats. II and due to some glitches the class ends a week after my pre-scheduled major surgery, instead of the week before it. So, I had the surgery, gulped down my pain pills, & turned in the Week 11 assignment. Today I got it back with a 98% on it (-: Week 12 is nearly done, too. During this class my husband had a stroke, I turned 70-oh no-a child moved back home, and we visited another child.10 hrs. away. With 1 assignment to go, I have 92.5%.

Added by Ann Stressman

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Archer, W. (1999). Delivering university-level communications programs at a distance: Benefits, costs and disruptions. Canadian Journal of Communication, 24(3), 367. Retrieved from http://search.proquest.com.proxy1.ncu.edu/docview/219607528?accountid=28180