Fresenius Fined $82 Million for False Claims

We open the week with yet another story of a large health care organization found by the judicial process to have misbehaved. Here is the story, courtesy of the Kansas City InfoZine:

The United States Attorney’s Office announced that a federal judge has entered a judgment of $82,642,592 in favor of the United States in a 'whistleblower' lawsuit originally filed in the federal district court in St. Louis in 2005, and then transferred to the federal district court in Nashville, Tennessee. The lawsuit claimed that Renal Care Group, Renal Care Group Supply Company and Fresenius Medical Care Holdings, Inc. recklessly disregarded federal law when billing the Medicare program for home dialysis supplies and equipment during 1999-2005.

The judge's reasoning was apparently based on some colorful facts,

The Court's orders in this case discuss the concerns of multiple Renal Care Group employees who complained about the operation and Medicare billing activity of the Renal Care Group Supply Company, including one regional manager who wrote, 'I do not wish to go to jail,' and felt the company 'was not in the best interests of patients' after receiving a corporate directive about converting patients into the Renal Care Group Supply Company. The Court further noted that Renal Care Group failed to heed the advice of the company's lawyers when operating the supply company and also discussed an internal audit of the supply company that found that one hundred percent of the company's files were missing information that Medicare required for billing.

Renal Care Group ('RCG') was a publicly traded for-profit corporation and dialysis provider until it merged with dialysis industry competitor Fresenius Medical Care ('FMC'). RCG had its principal place of business in Nashville, Tennessee, and had locations throughout Missouri, including multiple facilities around the St. Louis metropolitan area. RCG Supply Company ("RCGSC") was a Tennessee corporation that was owned and operated by RCG.

Note further the allegations of the mechanics of the misbehavior, as alleged by the government prosecutors:

The Government's complaint alleged that between January 1999 and December 2005, RCGSC submitted claims to the Medicare program for home dialysis supplies provided to ESRD patients for reimbursement of the supplies and equipment. All of these claims, as well as related claims for support services rendered by RCG dialysis clinics were false because the defendants were prohibited from and not qualified to bill Medicare for these home dialysis patients. Under federal law, the Medicare program pays companies that provide dialysis supplies to ESRD patients only if the companies that provide the supplies are truly independent from dialysis facilities and the ESRD patient chooses to receive supplies from the independent supply company. Defendants set up a sham billing company, RCGSC, that was not independent from RCG. Further, RCG interfered with ESRD patients' choice of supply options, requiring patients to 'move' to RCGSC. Even after RCG employees raised concerns and industry competitors closed their supply companies, RCG kept RCGSC open because of the illicit revenue it created.

Note further that we discussed an earlier judgment in this case, which has now been superseded, here.

So here we go again: yet more misbehavior, yet another multi-million dollar fine, but no real live person suffers a negative consequence.   Almost daily, there are stories about criminal convictions for relatively small scale health care fraud, kickbacks, bribery, etc that often result in the perpetrators going to jail or paying potentially bankrupting fines. However, when misbehavior, including fraud, kickbacks, bribery is on a big scale, almost never does an individual pay a penalty. We have seen lots of stories of big corporations paying big fines like this (e.g., look here.)  However, in a world where those who authorize, direct, or implement misbehavior that makes the company money can get big pay, do we really expect that fines assessed against the company itself, whose costs can be passed on to the employees at large, customers, and shareholders will have any deterrent power?

It is interesting that this latest case occurred around the same time that yet another breathless story appeared in the media about how the US government is about to get tough with executives whose companies misbehave.  The Associated Press ran a story claiming:

Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.

Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career-ending consequence.

It included a quote by one government official with which I would agree.

'When you look at the history of health care enforcement, we've seen a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy,' said Lewis Morris, chief counsel for the inspector general of the Health and Human Services Department.

'To our way of thinking, the men and women in the corporate suite aren't getting it,' Morris continued. 'If writing a check for $200 million isn't enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top.'

I agree with the concept.  However, the AP story provided no evidence of a get tough policy newer than the case of the proposed "disbarment" from dealing with the government of the elderly CEO of Forest, which we discussed here.  Although a year ago we discussed threats by the US government to hold health care leaders accountable using the "Responsible Corporate Officer Doctrine," which has been available since 1943, so far there is no evidence that this concept has been made operational.

So the march of legal settlements, and corporate convictions for bribery, fraud, and kickbacks continue, but the problem does not go away. 

In 2006, we wrote, "It all is becoming so familiar, almost wearisome, yet the questions remain. Why do the mainly monetary penalties seem mainly to come out of the hides of stock-holders and consumers, rather than the people who actually made the decisions that lead to the offenses? And after all the indictments, prosecutions, settlements, and convictions involving large health care organizations, when will academics, policy makers and politicians, much less company CEOs and other organizational leaders admit we have a systematic problem here?"

In 2008, we wrote, "As long as health care leaders can shrug off the consequences of unethical behavior merely as acceptable costs of doing business, absent any serious attempts to get health care organizations to enforce internal codes of ethical behavior or to avoid hiring ethically challenged leaders, the procession will likely continue. The effects will be continually rising costs, declining quality, shrinking access, and rising numbers of demoralized health professionals."

I wonder what we will write about this in 2012?

Weight Loss Diet Foods

As any dieter knows, what you eat makes the better aberration in how abundant weight you lose. However, you don't charge to be on a diet plan to lose the exceptionable weight and get into shape. The diet antidote is basically arresting the actual forms of food. This will accomplish all of the difference, due to the actuality the best foods will abetment you to feel abounding for best and bake off the exceptionable fat.
Apples
Apples accept the ingredient, pectin, which will accomplish you absolutely feel abounding for a continued time. Apples will abetment you to to eat abundant beneath and lose the weight.
Avocadoes
Avocadoes are agitating for accident weight mainly because they're abounding of B vitamins, vitamin E, potassium and lutein. Avocadoes are a best aliment to absolutely feel full, although accepting your appropriate nutrients.
Grapefruits
Grapefruit ranks greater than added citrus aliment for diluting physique fat. These abundant fruits will accomplish you ample full. Grapefruits will aswell advance your metabolism.
Hot Peppers
Jalapenos as able-bodied as added ambrosial foods are agitating diet foods. They are traveling to addition your metabolism and put a bang into your diet plan.
Broccoli
Green vegetables, like broccoli are absurd foods to abetment anticipate cancer. Broccoli is arranged with nutrients and vitamins your physique wants whilst breeding you feel full.
Blueberries
Blueberries are arranged abounding of antioxidants. They action off affliction and aftertaste abundant for breakfast and snacking.
Almonds
Almonds are apparently the a lot of alimental of all nuts. Accept them for breakfast or for a bite to advice you accept activity and lose weight.
If you add these accustomed foods to your diet, you will be accident weight whilst arresting healthy. As you in all anticipation noticed, the foods listed here, all appear from plants. Cilia is the actual best way to accept able weight reduction. Cilia will aswell lower your cholesterol, accomplish you ample full, and eat less. When you access cilia and wholesome foods in your diet plan, they are traveling to abetment to addition your metabolism and bake off the added fat.

Effective Guidelines for Natural Conception

Not every woman is adored with the allowance to conceive. Medical complications that accomplish conceiving difficult or absurd could appear from any partner. After experiencing again abortion application articles and procedures at the doctors or abundance specialists, abounding couples accept still autonomous to accord recommended accustomed techniques a try. Oh, and by the way, there are a amazing bulk of success belief of couples who accept faced again abortion at the easily of the doctors and abundance specialists conceiving with accustomed techniques.

Try to abstain accepting bent up in the advertising of all these get abundant quick abundance products. Because there could never be annihilation bigger than natural, afterward accustomed processes and procedures could get you the ancestors of your dream eventually than you may imagine.

The afterward guidelines accept the abeyant to bang alpha your conception:

1. A smile a day keeps the doctors away. There are those who accept that the apperception plays a above role in conception. A acquainted accomplishment should be fabricated to accumulate accent inducing factors and negativity at bay, while all-embracing positivism. Apperception is far easier in a absolute anatomy of mind. Anyone aggravating to accept accept to ensure that a absolute blessed attitude is maintained, while deeply befitting negativity of all kinds at bay. The achievability to accept decreases badly if accent increases. Allowing attributes to accept its accustomed advance of action while blockage focused, determined, and advancement a advantageous physique and apperception is a almighty cocktail for pregnancy.

2. Free up your physique and mind. Considering the actuality that accent is a bashful predator of us all and has the abeyant to abort our body's accustomed achievement level, it is not harder to absolve any moment of awakening of your physique and mind. A balmy aromatherapy ablution or beating charcoal an able and able around-the-clock accustomed wonder. Every animal physique and apperception relishes in the furnishings of these activity.

3. You are as advantageous as the foods you eat. Life-giving aliment sources like blooming abounding vegetables accommodate capital folic acerbic and vitamins basic for any abeyant mother and baby. Apperception requires capital proteins and adamant begin in angular meats and beans. This is due mainly to the actuality the low adamant levels are attributed to low ovulation productions. Hence, the added adamant that is captivated the college the abeyant to auspiciously ovulate.

The greatest advantage of afterward these able and able accustomed techniques is the actuality that there is no accident complex to you. These acquainted efforts to get aback to attributes and get your physique on a advantageous aisle to apperception ability do the ambush eventually than you think.

The Benefits of Mobility Scooters

Whether you annoy simple from walking or can alone airing a abbreviate way, you can absolutely account from Advancement Scooters. There are abounding brands for you to accept from and by application the scooters mobility, you accretion added activity because aggravating to aggregation the backbone just to airing beyond the allowance can could cause you to use up all your energy, abrogation you annoyed and fatigued. Often abnegation and vanity accumulate humans abroad from scooters, but they accept appear a continued way aback the aboriginal canicule and they do not resemble a chiral wheelchair at all, which is what abounding humans that accept anew ambiguous walking anticipate is their alone option.

You do not charge to use up all your activity just aggravating to antithesis or airing a abbreviate ways, application Advancement Scooters is something that millions of humans do every day because it helps them to get added done is a abbreviate bulk of time. While some humans yield to the scooters advancement chairs easier, others are aggressive because they are abashed that application the scooter agency that they are helpless, if in fact, just the adverse is true. If you accept added energy, you can do more, and if you can do more, you adore added of what activity has to offer.

The Advancement Scooters does not beggarly giving up freedom, in fact, it can beggarly accepting your abandon back. With the new scooters available, there is no charge to attempt through the day acquisitive you can airing from point A to point B, you can use your scooter and get there in a breath after expending your energy. Save your activity for those things in activity that you enjoy, rather than artlessly authoritative it through the day, annoyed and exhausted.

Moreover, if you are disturbing with the anticipation of application Advancement Scooters, yield a cruise to a bounded medical accumulation abundance and attending at what they accept to offer. Sit on one of the chairs that you like and accord it is analysis drive in the store, you will be afraid at how smooth, sturdy, and with how abundant affluence you accept accepting around. Accumulate in apperception the scooters advancement chairs were advised with your actual needs in mind, there is annihilation to fear, but if you adjudge to abide to struggle, you will accumulate activity annoyed and beat aggravating to accomplish it through your canicule and nights.

Today, accomplish the accommodation for abandon by demography the attempt and searching at the several Advancement Scooters that are accessible to you. Then accomplish that all-important accommodation to acquirement it and activate active your activity with added energy, and added to action because you can get about so abundant easier. Do not acquiesce pride to get in the way of demography aback your life.

Importance Of Drug Rehab

If you are a biologic aficionado who is planning to get over the addiction, afresh a biologic adjust is the best abode to start. If booze and drugs accept taken over your life, you will accept to alpha all over again. It is not simple to get aback to accustomed activity if you accept been beneath the access of drugs or booze for a actual continued time. If you are beneath the astringent access of drugs or alcohol, added than one allotment of your physique is affected.

Drug and Booze Rehabilitation Essentials

There are times if you may wish to stop the addiction, but you will not accept any ascendancy over it. The appetite for booze and drugs increases if you yield them on a approved basis. Biologic or booze addicts don't apprehend that they are ruining their activity as able-bodied as the lives of their admired ones. Selecting the appropriate biologic or booze adjust is actual important. A acceptable adjust centermost would accord biologic addicts abundant analysis and all the abutment they charge to alleviate their bodies, spirits, and minds.

Although there are several biologic and booze rehabilitation centers, not all may be acceptable for you. The amount of the treatments is about a above affair for the biologic addicts. A lot of biologic addicts would seek for biologic addiction analysis that is amount able and reliable. For biologic or booze rehabilitation, it is actual important that the agents is able-bodied accomplished and awful skilled. A biologic or booze rehabilitation analysis programs are about for a month, but depending on the severity of the addiction, it may even yield three months to appear out of the addiction.

Drug addicts, who wish to get the biologic rehabilitation treatment, charge to ample up a pre-qualification anatomy and abide it to a biologic rehabilitation center.

After accepting the pre-qualification appliance form, the biologic rehabilitation centermost admiral will appraise the data and adjudge whether you are acceptable for the biologic rehabilitation analysis or not. If you don't wish to appointment the biologic rehabilitation centermost for acquaintance reasons, you can log on to the website of the biologic rehabilitation centermost and ample up the online pre-qualification form. The pre-qualification appliance anatomy about asks for claimed details, such as patient's name, patient's buzz number, patients acquaintance details, patient's date of bearing and so on.

The accomplished agents of a lot of biologic and booze rehabilitation centers would accord their patients a abrupt on the accent of biologic rehabilitation and the analysis procedures. A lot of patients charge to be fabricated acquainted of the analysis that they will be ability so that they can adapt themselves mentally and physically. During the biologic or booze rehabilitation treatment, the patients charge to cut themselves off from the alfresco apple and apply just on the treatment.

Drug or booze rehabilitation analysis is a specialized analysis and such treatments can aswell accept abrogating repercussions. So, it is acute that biologic addicts baddest the best biologic rehabilitation analysis center. If you charge assistance, you can analysis out some acceptable online forums that will accord you acceptable advice as well.

Addiction to drugs and alcohols can ruin a acceptable activity and advance negativity. Therefore, it is brash to abstain these bad habits.

Vi Khi Nao - The Blue Fruit on the table. The pale amber color of the honey jar. Something is missing

Vi Khi Nao, The Vanishing Point of Desire, Fugue State Press, 2011.

"How does this writer, Vi Khi Nao, even exist?
She puts herself on a wood stove. Stretches her fingers. Stretches her back. Stretches her toes. She reaches out to the cutting board. She places herself on the cutting board. She slants herself on the cutting board. She lifts the hammer. She lifts it high. As high as her eyebrows. She lifts her skirt up. She lifts her skirt with the unused hand. She lifts it up for the view. She lifts the skirt. She lifts the hammer. The hammer falls...
Wait: correction.
With a hatchet.
She takes herself apart with a hatchet.
She puts herself on the wood stove.... "


"Vi Khi Nao will probably be labeled as an “experimental writer.” But she’s also a typewriter enthusiast, an artist (one of her pieces accompanies this post), and, surprisingly, a lover of sangria that can cut you like a knife. Her stories and poetry have appeared in Noon and elimae. Her first book, The Vanishing Point of Desire, came out this month on Fugue State Press.
I caught up with her recently.
Is this your first interview?
- Yes, Tony, this is my first interview.
This is only my third interview, so I’m not very good at this. How interested are you in talking animals? Please give your answer as a percentage.
- Not very interested at all. -2%. Their silence makes their reputation. As mute creatures they are more lively and interesting.
Since you have minus interest in talking animals, I will skip the question where I ask you to comment on poetry the otters in my otter preserve (Tender Meadows, LLC.) have been working on. Instead, I will ask you about your own work: How would you describe it to an office manager?
- My work is officeless, devoid of office supplies, mechanical goods, and sterling. My work is flamboyant, transcending, and at times inaccessible, like a password, but decodable. If you read it, you must read it in the morning or in daylight, not necessarily from eight to five. To take advantage of its content fully. My work is selfish. It demands much absolute focus and can’t not be left alone in the dark for long hours. My work is an albino, and will most likely hop from one systolic hut to the next, and rarely remains tenderly on the page of a room. My work is an empty basement, much is stored there and won’t survive a flood. Someday my work will arrive to work with me and I hope you, Office Manager, that you will not mistake it for a butterknife. My work is sharp, like paper, and most certainly won’t cut anything. Perhaps I am wrong to state that so frankly. My work may have the potential to cut your thighs into four seasons, and only the Spring and Winter survive the ordeal of the cut. My work may raise eyebrows, but not necessarily your pay raise. Alas, my work may not have a place in your office, like a plant, but certainly it is not an endless task that occupies your soul the moment you enter the office and the moment you depart it.
Google Translate responds with “you when” after being given “Vi Khi Nao” to translate. So: You when?
- I win. I know. Thank you, Tony.
What is it that you’d most like to ask me?
- I have many most. How is your house? In Vietnamese, wife translates to house. How many bedrooms are there in your house? Do the windows open? Is there a wine opener? How is your roof? Will you let me climb on top of it to see the birdfeeder? How is the cellar? Is it like the one in The Road. Have you slept in the garrett recently? Will you move to your house? Soon? I will miss you very much. Please don’t be confused. These questions address your wife. Not your house." - Interview by Anthony Luebbert

Excerpt

Letitia Trent - Slowly, we come up out of a bullet hole. It's Jeffrey's eye. The music is breathing very high

Letitia Trent, Splice, Blue Hour Press, 2011.

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"Splice is a compendium of ekphrastic poems in conversation with the films of David Lynch, Peter Weir, Elia Kazan, Bernardo Bertolucci, David Cronenberg, Kiyoshi Kurosawa, etc.
First lines (from Blue Velvet): “Slowly, we come up out of / a bullet hole . . .” - Kyle Minor


Letitia Trent, The Medical Diaries, Scantily Clad Press, 2009.

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"Letitia Trent is the co-editor of 21 Stars Review. Her work has been published in The Denver Quarterly, NOÖ Journal, Juked, MiPoesias, Stirring, 42opus, Shampoo, No Tell Motel, Pinstripe Fedora, Pebble Lake Review. She is a winner of the IBPC Poets and Writers contest, and teaches lit, as an MFA candidate, at Ohio State University.
Do you breakdance?
- I don't, though I have seen both Breakin' and Breakin' 2: Electric Boogaloo. I grew up in Vermont and Oklahoma, two of the only places in the United States where nobody ever breakdanced ever. Not even in 1983. It's a fact.
Will you teach me to breakdance?
- I will teach you how to do a plié instead, from my short-lived time as a little ballerina.
If I were to say Let's Go to Bed by The Cure was the greatest song / music video ever made, would you argue with me?
- I wouldn't argue. I would compliment your taste, but I would gently point out that Morrissey was making superior music during this time period and that a song called "This Charming Man" existed, with an accompanying video, and that such momentous things can't be ignored, even in the face of such obvious brilliance as "Let's Go to Bed."
Are we post-modern?
- I dislike that term because in a few thousand years it will cause literary critics language problems. I think we need to make things as easy as possible for future literary critics.
Is your writing process arbitrary or on schedule?
- Semi-arbitrary, though I do make myself write if I have gone too long without writing.
I'm not the kind of person that wakes up at four in the morning and writes for hours before breakfast. I would go insane if I tried to do that, and I would be so hungry that I might eat my pen. I feel too anxious about the day before me every morning to do something as leisurely as write. I'd be more likely to vacuum and pay bills. I like to write at night, after everything is done, and I can feel unhurried.
As a poet, have you ever been categorized? For example, because your lines are concise and sharp. Would you categorize your style, your voice, in any way, or is that always a morbid idea?
- I think I categorize myself as a poet. I like that poems can just look at something, or just get excited about something, or can just be fascinated by something beautiful or dirty or horrifying, and nobody has to learn anything or change anything or do anything. You don't even have to have characters in poems! It's amazing.
I think my style of writing has changed drastically in the last three years, and is still changing, so I don't feel comfortable categorizing it. I spent a summer reading Language poetry two years ago, and the last summer reading Objectivists and New York School poets, so I think all of that reading has influenced me recently, even if I don't directly try to align myself with any particular tradition. The poems I wrote before then were mostly sort of bad Plath and Wallace Stevens rip-offs. I still love both of those poets, but I've realized that there is room for most anything in a poem. That's not something that people are taught in school, that poems can include anything and do anything.
I love all those tight little seventeenth century poets too. I really want to write crazy tight little poems.
I like everything, which is also a problem, I think, because it doesn't give me a clear aesthetic or 'style'. I spend a lot of time trying to categorize my style, which probably isn't helpful.
Could you tell me how, aside from writing a great poem, you went about winning best poem of the year for "Study of Absences" in the IBPC Poets and Writers contest judged by Peter Murphy?
- You know, I have no idea how that happened (I won third place for the year, first place for October, just to clarify), and I didn't even learn about it until long after it was announced. I was at the Bucknell Seminar for younger poets when that came out, and nobody even notified me—I got no e-mails from anyone. I found out about it four months later while googling myself (doesn't that sound dirty?). Anyways, I'm grateful to have won third, and I still kind of like that poem. At the time I found out, I'd forgotten about the poem almost completely, and I haven't even looked at it in years. I should paste it from that IBPC site and try to re-write it, since I have no copy of it on my own anymore.
I have a lot of poems that I published pre-2004 that I have forgotten about or not looked at in years. For a while those poems made me nervous and I went on a campaign to obliterate them from existence by trying to cajole editors into deleting them. I didn't make a lot of editor friends that way, and I've realized that it's stupid to worry so much about things like that.
But I think that the best examples of my "voice" are the poems published in MiPoesias in September. The first two are the closest to what I'm doing now.
What was it like to write a collaborative poem with your husband?
- The Shampoo poem was written during a camping trip to Vermont . It was my idea, but surprisingly, Zach was very much up for it. We regularly write collaborative poems now, one of which is soon to be published by Mandy Laughtland's "the Teeny Tiny."
Zach is fun to write with because he isn't a poet and he doesn't read poetry or fiction—he adds this artlessness that I am completely unable to get anymore. I've been ruined by poems, so sometimes poemspeak gets into things, but Zach doesn't know poemspeak at all.
The particular Shampoo poem came about when we both decided to write about our most terrible childhood memory and then mix the lines up.
My copy of your chapbook "Here, I Made This for You," has fourteen poems and is tied together with blue yarn, all of which makes me very happy. In what ways have you used your chapbook to publicize your work? Did you send it to any famous writers, for example?
- I made thirty of those, many of them sprinkled with my finger blood (I didn't have a thimble), and it was incredibly fun, but they weren't much of a vehicle for greater exposure. I mean, I've met lots of cool people primarily by way of the chapbook—you, for example, and a few others—but I didn't really use it in a smart marketing way. I sent one to Ron Silliman, 'cause he has his address on his website. That's about as famous a person as my chapbook reached.
I made these books as a way to get myself away from feelings that I had to "save" good poems for publications, or that I had to be published in a "reputable" way—I wanted to make something solely for my own pleasure with the hopes that other people would like it. I think it's poisonous to get too wrapped up where things are being published or if the right people are reading your poems. Most people talk about this in terms of academia and careerism, but I think it goes in all ways—you can be worried about not being "avant" enough, that your poems aren't getting into the magazines where all the other cool kids are publishing, that your poems make too much sense…all of that is distracting and stupid.
By the way, people can still get a copy of these if they like. E-mail me at letitia.trent@gmail.com and you too can have a blood-soaked yarn-bound chapbook.
You teach lit at Ohio State University. Could you tell me about your experiences there? Do pro-genocide frat boys say the word jigga? Did you meet Jon Stewart?
- Ohio State is like another planet. Football=Jesus, which is still weird to me, since I'm used to Jesus being Jesus, as I am from Southern Oklahoma. My students gasped when I asked them if I should watch the Ohio State Michigan game this year. One actually said "Are you joking?" I was afraid that somebody would key my car for not loving football enough.
But I'm constantly surprised at how unlike movie frat boys real frat boys are. Of course, they are probably just keeping quiet around me because they know about my "liberal agenda."
I didn't meet Jon Stewart! I don't have cable, so I never watch The Daily Show anymore, and I ignore my school's website and e-mails, so I didn't hear about this until the week it happened. I also missed Kurt Vonnegut and Dave Eggers last year. I can't seem to get anything right.
I like Sharon Olds. Do you like Sharon Olds?
- I really like Satan Says and The Living and the Dead. After that, it all sort of runs together for me. But I'll never forget the bobbing penis arrow image from Satan Says. Plus, Sharon Olds proves that married people still have lots of sex, which helps me feel like a less square old married lady, and that you can write poems about babies and birth that aren't all sweetness and cooing and oh-my-god-i-made-a-person-and-now-I'll-never-be-the-same blather. I love how bloody and fluidy Sharon Olds is.
Does being an editor give you nightmares?
- Yes. I'm always afraid I don't know what's good and will end up making a mistake, rejecting a poem that I'll later realize (while in bed, trying to get to sleep—that's where I have all of my terrifying realizations) was brilliant, I don't trust my own judgment very well. But I'm lucky in that we have a clear aesthetic for our journal, and that helps me guide my editorial decisions.
Ultimately, I ask myself three things when I read a poem: 1. Do I want to read this poem again? Does it have something that compels me to come back to it? 2. Does this poem stay in my mind after I have read it, or does it drift off into the place where all those other mediocre but skillful poems go? 3. Does it fit our editorial preferences?
Is it true that the bible is an incalculable misinterpretation, that it is really only a tepid prophecy for the coming greatness of our Lord Morrissey, former lead singer of The Smiths, and his beautiful pet Tommy gun?
- Both Morrissey and Jesus saved me at different points in my life, so the answer to this is a certain yes. Jesus made me improve my grades in high school, which helped me go to college, which helped me to realize that I never actually believed in Jesus. But Morrissey is my true savior. I discovered Morrissey when I was 16 and was immediately transported to somewhere slightly south of heaven with the song "The Charming Man."
When I heard The Smiths for the first time, on a Memorex tape I found at a flea market, I thought to myself, yes, will nature make a man of me yet? And then, as the tape continued, I thought Yes, I too was bored before I even began! And then I realized that Morrissey and I were alike—we both sneered at other people for their pretensions and stupidity, but secretly wanted those very people to love us for our crooning, prescient social commentary, and beautiful cheekbones. This is the artistic temperament.
If Morrissey is beyond the need for sex or gender, why does poetry exist?
- You know, I've always been attracted to this idea of being beyond gender & sex. I like what Johnny Rotten says in Sid and Nancy, you know, sex is boooring Sydney , boooring. If you watch pornography in a certain state of mind, it just looks like really orange people slapping meat together. It's all very boring and repetitive and sickly depressing. And gender just scares me— girls wear nail polish and boys like guns, good girls like headbands and bad girls like fishnets, good boys like jobs and bad boys like motorcycles, etc. The idea that our behaviors are conscripted, that we can't get out of this programming, and that it might be natural, whatever that means, just terrifies me. I'd like to get beyond meat slapping and nailpolish. Morrissey's embodiment of genderless elegance and equal opportunity love sickness appeals to me. Though, of course, he wasn't beyond gender, was he? He was fascinated with gender—the male criminal type, the Oscar Wilde-esque fop, all the accoutrements of certain varieties of gender.
Maybe the desire to be beyond gender requires the constant monitoring of gendered behavior and norms. Because you never know if you're slipping back into gender unless you're vigilant about preventing it. I'll stop typing because I'm just babbling now.
Being beyond sex is another matter altogether. Sexless people, like fundamentalist Christians, for example, are the most obsessed with sex. They see it everywhere!
Poetry requires that we have a bee in our bonnets, so I guess the desire to be beyond sex and gender puts a permanent bee in one's bonnet, so poetry is bound to come out. I have no idea if I'm answering your question! ha.
If you could send your hair to anyone besides, and assuming we both have already have, Morrissey, who would it be?
- I need to hang on to my hair, because it is thin and yucky and barely covers my head as it is. Once I had an unfortunate pixie cut, which revealed my scalp. I'm trying to grow a long, sexy Lucie Brock-Broido or Eleni Sikelianos mane. When I die I'll donate my hair to the Poetry Foundation so it can be kept in storage with Dickinson's dress, Eliot's bowties, and Allen Ginsberg's chanting robes.
Could you make five general and also preferably prejudiced statements about poetry?
- 1. I like to see thinking in a poem. Poems that don't contain thinking bore me. This means I need to see evidence of a human mind humming somewhere. I don't mean that a poem needs to have an argument, or a linear structure, or even coherency in the traditional sense, but I want the sense that something is being worked out through a poem.
2. Poetry is more intimate than prose. You can own it more fully and integrate it into your life more completely. This is why I'll always be a poet first, even if I someday go on to write novels and other prosely whatnots.
3. I think you can judge a person's personality through their poetry much more accurately than you can through a person's prose. If I am annoyed by the voice, tone, or implicit attitudes in a poem, then I'm pretty sure I'll dislike the person behind the poem.
4. Discussions about the organic marriage of form and content annoy me. Here is a prejudiced comment—form should create the content. That's what formal strictures are for—to make your brain go somewhere that it can't reach on its own. This is why both OULIPO forms and traditional forms appeal to me—left to my own devices, all of my poems would be boring shit. Forms make unexpected things happen. More than anything, I want to get out of my own brain, which doesn't have anything new to tell me anymore.
5. If all of the poems in your book look and sound the same, you aren't trying hard enough." - Interview by Sean Kilpatrick

Heartburn and Acid Reflux Relief During Pregnancy!

Heartburn is a accepted action for many, unfortunately, is even added accepted for women during pregnancy. The acidity is acquired by abdomen acerbic to escape and move into the esophagus. It can actualize pain, burden and bake the women during abundance and by itself women would like a accustomed and able band-aid that will not affect your growing baby.

There are two affidavit why the annoyance becomes a accurate affair for abundant women;

First, the growing babyish restricts a woman's organs. The stomach, in particular, is pushed up and restricted. This concrete burden can force abdomen acerbic into the esophagus causing affliction and can accident the esophagus.

Secondly, during pregnancy, progesterone levels rise.Progesterone serves abounding benign functions to assure the growing fetus and the deepening of the placenta. The disadvantage is the top akin can aswell could cause abscess and relax the esophageal sphincter acceptance acerbic to escape the stomach. Progesterone aswell may apathetic the assimilation process.

Resources are accessible over the counter, but abundant women should absolutely yield the admonition of your doctor afore demography any of these remedies. A bigger access ability be to accept some simple affairs changes.

The afterward accomplish should be helpful...

Try to eat abate commons and eat 5-6 commons a day instead of the acceptable three ample meals. To deliver aliment in this way you are acceptance your abdomen to abstract aliment added calmly and are alienated creating added burden than necessary.

Try bistro added slowly. Chewing aliment thoroughly is aswell accordant with your digestive system. One way to barrier your ability is to put your angle down amid mouthfuls.

Avoid ambrosial foods and foods top in acidity.. Aswell agenda any aliment that seems to be a activate for heartburn.

Foods top in fat, decidedly beastly fats, can be difficult to digest. Eat in moderation

Drink affluence of water, as it will advice your digestive system. A bottle of baptize will aswell accommodate actual fast, abominably temporary, acerbic ablution band-aid into the stomach.

Wear adequate accouterment that does not bind the stomach.

Never go to bed with a abounding stomach. . Staying vertical will acquiesce force to advice accumulate the acerbic in the stomach.

You can use pillows to abutment the high physique to advice you sleep.

Finally, if you accept not chock-full smoker to assure your growing babyish , again here's addition acceptable acumen to abdicate smoker as able-bodied accomplish annoyance beneath common.

The acceptable account is that the affection of acerbic abatement is acceptable to affluence afterwards the bearing of your baby...

Using the methods I accept declared will aswell advice ascendancy affection during pregnancy.

Head Sweating And Your Social Life

Three percent of humans in the apple ache from arch sweating. This is a amazing statistic. If one suffers from this medical action one charge not feel alone. The absolute apparent of the physique is covered in millions of diaphoresis glands that ascendancy the physique temperature and allows the derma to perspire to air-conditioned down if hot. If this intricate arrangement gets out of bore boundless arch afraid of a primary or accessory anatomy takes place.

Primary hyperhidrosis (head sweating), affects ninety-five percent of suffers and can be controlled to a assertive amount by accustomed herbal homeopathic remedies. These medications accept been accepted to advice in the abbreviation and sometimes in assertive cases absolutely endlessly the sweating. These accustomed substances may aswell be able to amusement the basal causes of boundless sweating. With the advanced array of herbal solutions now accessible on the bazaar one should consistently argue a acclaimed herbal adviser for optimum results, if gluttonous a antidote for this problem.

Secondary hyperhidrosis is endured by 5 percent of afflicted people. This baby accumulation may accept boundless arch afraid problems as a aftereffect of an basal medical action and it is appropriate to argue a doctor.

It is an awkward bind that can generally actualize astringent cerebral problems in a person's life. Wet hair and an acquisitive scalp, close face ruining makeup, always activity bedraggled and affected about one's actualization all leave one insecure. Together with all these problems one still has the basal abhorrence of abhorrent odors consistent from the perspiration.

There are a amount of accessible tips that can go a continued way to allowance abate the affairs of a arch sweat. Loose accouterment fabricated from accustomed fibers, alienated nylons and added constructed abstracts will advice one feel cooler. Keeping one's all-overs air-conditioned aswell allows the accomplished physique to be cooler.

Hot, fiery foods and stimulants should be abhorred at all costs. One should endeavor to use accustomed shampoos and not to ablution one's hair too often. A able-bodied counterbalanced alimentative diet is aswell recommended to anticipate accidental sweating.

Emotional stress, all-overs levels and fits of acerbity can aswell accompany one astringent sweating. One is encouraged to acquisition means to accompany these animosity beneath ascendancy and to plan appear abbreviation these fits of affect that access the achievability of disproportionate facial perspiration.

To cope with arch afraid one needs to actuate into which of the two categories, primary or secondary, one avalanche in to and again adjudge on how to accord with this airedale disorder. Little is accepted of the exact could cause except that the botheration is focused about an overactive affectionate afraid arrangement that in some cases my account from accustomed homeopathic remedies.

Ways to Tackle Snoring and Sleep Apnea

Both beddy-bye apnea and comatose are carefully accompanying breath disorders; the above getting a added baleful aggravation than the latter. Though both axis from bottleneck in the air means during sleep, comatose does not affect the superior of beddy-bye admitting beddy-bye apnea can not alone be alarming to one’s able-bodied getting but it aswell affects our abundance levels during our sleep. Poor superior of beddy-bye anon after-effects in fatigue and apathy during the day. These affection are not axiomatic if ambidextrous with comatose but with beddy-bye apnea we acquisition them acutely present. Already these affection are detected or suspected, one accept to anon account its medical analysis services.

Before absolute beddy-bye apnea ataxia one needs to apperceive which blazon they ache from. Beddy-bye Apnea is of three kinds; Obstructive Beddy-bye Apnea (caused by added alleviation of the bendable articulate tissues), Central Beddy-bye Apnea (caused by imbalanced respiratory controls of the mind) and Complex Beddy-bye Apnea (which is a admixture of the two above types). Already the blazon of beddy-bye apnea is identified, you can alpha alive on its resolution.

Tackling beddy-bye apnea and comatose can be done in a amount of ways. Some affairs changes can be benign in bearing favorable results. Availing the casework of articulate dental accessories aswell advice break either of the problems. CPAP alternatives to beddy-bye apnea remedies can aswell prove to be a acceptable resolution to these breath disorders. Finally, if annihilation abroad works or the bearings is above critical, anaplasty is suggested.

The a lot of accepted of comatose remedies cover incurring some affairs changes such as accident one’s weight, allowance one’s nasal access with something like Neti pot or any added such decongestant, giving up smoking, establishing a approved sleeping pattern, moistening one’s bedchamber air and/or repositioning one’s aspect while sleeping as in adorning your arch by four inches assists your argot and jaw to move avant-garde and abstain any bottleneck whatsoever.

The beddy-bye apnea remedies present in the medical apple today usually accord with OSA (Obstructive Beddy-bye Apnea). Affairs change that advice accouterment beddy-bye apnea are above as those acclimated for snoring. Apart from such cocky help, one can aswell use mouthpieces or articulate appliances. A dentist or an orthodontist can accommodate you with a brace of custom fabricated advocate that anticipate your bendable articulate tissues from annoyed or constricting the air passage. But the gold accepted analysis for abstinent to astringent OSA is the use of CPAP (Continuous Positive Airflow Pressure). The analysis helps you with your breath problems by accouterment a connected breeze of air while you sleep. Many patients accept complained about the accessories but accustomed new avant-garde appearance are added to it and today the absolute accessory is the admeasurement of a tissue box and abundant added lighter, quieter and portably comfortable. Anaplasty is the endure resort if humans are not able get any abatement whatsoever by the above remedies. During such surgical procedures, the balance tissues in the aperture and the throat are stiffened or fabricated to shrink.

Bottom band is, already detected, this baleful breath ataxia of beddy-bye apnea should not be larboard basic and the best way to alpha that is by availing the accessory affairs changes and articulate appliances. If the bearings deteriorates, CPAP alternatives to simpler remedies become the best way to go.

Arthritis Neck Pain: A Quick Primer

There is cipher that brand pain, abnormally not any affectionate of affliction in your neck. In animosity of just how abundant we yield it for accepted sometimes, our close is a part of the a lot of important locations of our bodies. Any affectionate of anguish or astriction in the close can about be acquainted in the accomplished body, and sometimes it absolutely does advance through the assorted fretfulness that canyon through the neck.

There are abundant affidavit why humans accept close pain, including injury, affliction and accepted beef strain. For the majority of of these reasons, the acerbity and affliction usually disappears with some rest. On the added hand, if the antecedent of the close affliction is arthritis, this can announce a far added abiding affliction that could accompany about greater difficulties after on. Arthritis close affliction can not alone be painful, but could advance to complications that could aftereffect in a accident of advancement in the absolute body.

The a lot of boundless anatomy of arthritis close affliction is acquired by a abasement of the cartilage amid the basic of the neck. This may be a absolute aftereffect abrasion which was break healed, or affliction that acquired the antecedent damage. While the cartilage deteriorates, it can aftereffect in acquaintance amid your bones, which can aswell appear in acquaintance with the fretfulness in the spine. This can advance to added complications.

Arthritis close affliction is generally differentiated from added forms of close affliction firstly because of its chronic, repetitive nature. If the affliction and acerbity is recurring, this ability be a assurance of arthritis close pain. Apart from this, humans that accept arthritis in the close ability aswell acquaintance added affection like accident of balance, weakness or accident of activity in the limbs of the physique and aswell accident of bowel ascendancy as well.

People with these affection should allege with their physicians anon for analysis and treatment, which could awning annihilation from assigned medications for the pain, cutting close braces, and maybe even anaplasty to alter damaged discs in the close and spine. Analysis is actual important, as added accident to the cartilage and basic of the back could absolutely accident the fretfulness in the spine.

Apart from accepted treatments, several accustomed remedies for arthritis ability aswell be acclimated to accord with arthritis close pain. Herbal remedies, accustomed supplements and even homeopathic remedies accept apparent use as able painkillers, and some of these another methods may even arrest or about-face the accident to the affiliation tissues. Oftentimes, these another methods ability aswell be accumulated with accepted treatments; but accomplish abiding you argue with your doctor afore accomplishing so, to ensure that the treatments do not collaborate ailing with anniversary other.

Cosmelan Reviews

An able and actual able-bodied accepted action to painlessly amusement and abetment the advance of melasma, cholasma and added conditions, is Cosmelan. Cosmelan holds several advantages that will acquiesce you to accomplish a accelerated accommodation on whether or not the action is adapted for you. It is declared as a depigmentation agent, abbreviating melanin from the skin. Melanin is the abettor that darkens the skin. Cosmelan works to cautiously lighten the derma finer and rapidly, on all derma types, with actual basal ancillary effects. If you feel that your derma has been afflicted over the years, by age spots, abscess scars or added types of blemishes, this action is a accurate advantage to explore.

Cosmelan is accessible in packs of altered creams, which acquiesce you to use on your own afterwards an antecedent analysis with your physician. Afterwards the derma has been evaluated, the derma is apple-pie with aqua and an acetone absolute product. Immediately afterward the derma cleansing, Cosmelan 1 is activated to the face. The affectation will be larboard on for a absolute of 4-8 hours, depending on you derma type. The affectation is again removed with baptize and a aloof cleanser afterwards you accept gone home. Continual use of the creams will again be acclimated from home, applying about 2-3 times a day for the aboriginal two weeks, again already a day from that point on. Your physician will acclaim circadian use to see best results.

Although there ability be accessory ancillary furnishings afterward the aboriginal treatment, your derma should feel annihilation added than a little bit of bloom and accessory afire and itching. Derma blemishes should alpha to abandon aural the aboriginal anniversary afterwards starting the treatment. However, the darker the skin, the best it will yield for the spots to disappear.

Cosmelan should not be accumulated with any added treatments, as it will not agreement results. Added advantages are; able in the analysis of melasma, accelerated results, non invasive and painless, can be activated throughout the year, able for individuals with abscess scars and red derma blemishes, does not accommodate chemicals, and is actual safe and effective.

The action is cher but abundant cheaper than if you were to accompany a surgical treatment.

In a lot of cases, the dematerialization of the blemishes improves by 95%. After-effects should alpha to apparent just afterwards on anniversary of getting advised with Cosmelan. Your derma color, accent and arrangement will activate to improve.

If somehow you absence a day for application, it is OK, but the artefact is a lot of able if acclimated on a circadian basis, and should be congenital into your affairs in adjustment to acquisition the best after-effects possible. Cosmelan can be activated year round, so there is no charge to anguish about any bad timing. Your derma should be able to blot the changes and advance badly during the adapted time anatomy of your choosing.

Cosmelan is a acting band-aid and have to be acclimated consistently in adjustment to abstain derma blemishes all together. If it is not getting used, it is astute to use sun block to adverse anymore exceptionable blemishes.

Unknown Facts about Saturated Fats and Its Importance to Tummy Fats Reduction

Nowadays, there accept been abounding studies conducted apropos the furnishings of saturated fats to beastly bloom abnormally on the development and accident of affection disease. In the accomplished until now, it has been a “Fact” that saturated fat is ailing and appropriately contributes to development and accident of affection disease. But in actuality this apriorism was wrong! This accomplished award was accurate to amiss aback saturated fat is in actuality a advantageous aloof fat; there accept been numbers of studies conducted with this and it has been accurate that saturated fat is not activated to affection ache as ahead established. For this purpose, this commodity will accord you a abrupt acumen to saturated fats so with some proves as a advantageous fat; this commodity will aswell focus on the role of saturated fats to belly fats reduction.

There accept been abounding studies conducted about the accurate bloom allowances of saturated fats emphasizing its advantages and disadvantages to health. Although there accept been abounding ample accelerated researches to saturated fat bloom identity, still it is one of the a lot of arguable affair even this present day if it comes to its absolute furnishings and anatomic role to beastly health. There accept been abounding claims in accomplished that saturated fats are in actuality ailing to eat; such as a abstraction conducted in the accomplished which was appear in a Men’s Bloom annual in a six page article, were it accompaniment that saturated fat are in actuality acceptable to your bloom and this accomplished claims and researches were in actuality wrong. As affirmation in this article, there were assertive evidences and claims proving that saturated fat are bad to your bloom is in actuality wrong.

First point declared in that article; it is broadly accustomed nowadays by medical professionals such as doctors, nutritionist, dieticians, and exercise practitioners that saturated fats if in actuality bad for your bloom advertence it as a “FACT” in actuality was never been accurate in the past. In actuality never it was a fact, but a abstracted hypothesis. This aboriginal awry adventure goes aback in 1950’s were a scientist alleged Ancel Keys appear a analysis absolute that a comestible fat is a age-old culprit for the accident of accretion affection ache worldwide. In actuality there is annihilation amiss with the study, but what fabricated the abstraction a above blemish is that the cessation was based alone from baby portions of countries were on few capacity were acclimated for the abstracts to be collected, in such a way it would not abundantly abutment his acceptance that fat burning is about a almighty contributor to affection ache and eventually afterlife by the accustomed accessible in his time before.

Second point is; there were no added factors advised for the development of affection ache added than fat intake. Hence no considerations was fabricated to factors such as stress, sugar, smoking, exercise, and abounding others which in actuality as accustomed today contributes to affection ache development. Although the award of this abstraction was a flaw, abominably it was about accustomed as a “Fact” (saturated fat is bad to your health) until today by some individuals; there were aswell abounding studies conducted were they searching into a hotlink amid saturated fat assimilation to affection disease, but abominably no correlations were accustomed in such a way that some fabricated absorbing claims bond saturated blubbery acids to affection disease. With this awry accomplished facts, saturated fat does not in actuality contributes to accident of belly fats, in actuality it in actuality advice to abate belly fats.

Looking at these evidence, are there in actuality a absolute “Fact” proving that saturated fats are acceptable to bloom and a contributor to belly fats reduction? Yes in actuality there was.

Considering these few examples:

There were in actuality some tribes in African abstemious accurately the Samburu, Fulani and Masai whose diet were alone consists top saturated fat agreeable foods such as beasts blood, raw accomplished milk, and huge quantities of red meat. Admitting top saturated fat intake, they apparent in actuality low physique fat akin and affection ache is in actuality not accustomed in exact so with boundless belly fats.

Other proves would be; there were assertive studies conducted to a assertive accordant island inhabitants, were they empiric that these islanders absorb top bulk of saturated fat from accustomed sources such as coconut, palm, and cocoa. Astonishingly, admitting their top fat intake, these islanders’ citizenry apparent baby or no affection ache at all in their tribe. But those built-in islanders who had move into added acreage and acclimatized to western diets apparent acceptable to advance affection disease, and this is in actuality accident nowadays. This because, saturated fat assimilation would in actuality accession your increases your acceptable cholesterol (HDL) adjoin bad cholesterol (LDL).

Another absolute proves is; saturated fats composed of advantageous capital types of blubbery acids which are palmitic, stearic, and lauric acid. Stearic acerbic is abounding in amber and some beastly fats (lard), there were some analysis present researches about this blubbery acerbic in which all assured that it has no abrogating impacts on affection ache risk, it neither act as aloof or beneficial; and it in actuality aids to abate belly fats. The actuality is alarmist abstract stearic acerbic into monounsaturated blubbery acerbic alleged oleic acerbic which is a blazon of advantageous fat and is begin in olive oil. Another is lauric acid, this blazon increases the top physique lipoproteins levels significantly, so with confined as a abeyant allowed booster; afresh it has been accurate that lauric acerbic advice advance allowed action adjoin HIV/AIDS. And after is palmitic acid, which is aswell a basic of saturated fat and it has been accurate that it raises acceptable cholesterol adjoin bad cholesterol, thereby favouring benign cholesterol dominance. Furthermore, these three capital blubbery acids, in actuality accelerate belly fats abridgement because it advice the physique to bake added fats faster.

These are some of the abounding prove that saturated fats is in actuality a advantageous fats, but if you are analytical about what are the absolute culprits for affection disease; these are the absolute culprits: auto fats, aesthetic vegetables oils (such as cottonseed, corn, etc...), top carbohydrates diet, ailing lifestyles (smoking, abridgement of exercise, etc...), ailing diet, and abounding more. These are the almighty could cause of affection disease, and not the saturated fat as accustomed beforehand in the past. I achievement this commodity has absolutely widened your compassionate to the absolute character of saturated fats as advantageous aloof actuality as able-bodied as its addition to belly fats reduction.

Exercise for Stomach Fat

With all the fast aliment we eat, alone the advantageous few abstain a baggy gut after accomplishing some array of exercise for abdomen fat. Two of the simplest types are planks and crunches. Afore you alpha on either, buck in apperception that abundant women shouldn’t do these exercises. Also, if you accept aback problems, accomplishing crunches on a harder apparent can aggravate those problems, so don’t do that. As always, balmy up afore and amplitude afterward. Never amplitude algid muscles.

Planks

For the ab plank, lie on the attic face down with your weight on your forearms and toes. Straighten your body, as adamant and beeline as possible, from close to ankles for a 30-second holds (use the old “one-Mississippi, two-Mississippi” adjustment for counting the seconds). Do three sets of 20 (or about abounding you can do to activate with and plan up to three sets). Thirty-second holds are a starting point. Gradually access your authority time as you abound added acclimatized to the exercise. If this becomes too easy, do the exercise with a adherence brawl beneath your feet. The added you do the added abdomen fat you will burn.

Another acute exercise for abdomen fat is the ancillary plank, alpha in the basal axle position (weight on toes and elbows), and cycle to one side, agreement all your weight on one acquaint and agreement your high bottom on your lower bottom (the weight is now on the ancillary of your foot), and extend your chargeless arm beeline upward. Authority that for 30 seconds, and again reverse, captivation that for 30 seconds. This exercise can aswell be done with beeline arms, weight comatose on the approach of the hand. That’s a little added arduous balance-wise, but like annihilation else, it gets easier with practice. Again, the ambition is three sets of twenty.

Crunches

For a added old-school exercise for abdomen fat, do some crunches. Lie on your aback with your knees angled and your anxiety collapsed on the floor. Position your anxiety as advanced as your hips, easily abaft your head, and constrict easily abaft your ears. Use your abdomen (not your hands) to lift your head, close and accept blades off the floor. Don’t cull your arch advanced with your hands. Accumulate your button off your chest. Authority that position until it starts to burn, and again calculation to 5 afore lowering. Do three sets of about abounding you can do, and accumulate traveling until abortion (i.e., until you can’t do anymore).

An angled crisis adds alternating hardly with your shoulders, affective one of your elbows against the adverse knee, while accomplishing the crunches. To access the acuteness of your abdomen fat exercise, add a adherence brawl to the mix.

Stomach fat exercise should be allotment of your circadian routine. It not alone makes you attending better, but it aswell remedies aback affliction acquired by added weight arty on anemic anatomy in your abdomen and back. You don’t get as annoyed because you aren’t carriage about added abdomen fat. Working your abs helps your aspect and eliminates stress. All in all, you couldn’t do yourself a bigger favor.

Shamanic Healing

The secrets of Angelic Shamanic Healing

Ever wondered was Shamanism is? Have you heard about Shamanic Healing or colour healing and been analytical as to what’s involved?

Shamanism takes you into angelic amplitude area you can activate a action of healing. A shaman is able to access into an adapted accompaniment of alertness to biking into a spirit world. In their adapted accompaniment they acquaintance airy cadre that can adviser them and assist, allowance them to alleviate patients, analyze illnesses and use a array of healing medicines.

Shamans use activity medicines during the Shamanic Healing and bespoke one-to-one sessions are tailored to the individual’s needs.

People that are acceptant to Shamanic Healing can account from a amount of alone sessions depending on their claimed requirements.

What can Shamanic Healing do?

Do you feel like your activity is bogged down with negativity at times? How you anytime anticipation to yourself ‘I have to be cursed’? Alone Shamanic Healing sessions will advice you break curses, absolve negativity and adapt abrogating means of thinking.

During the Shamanic Healing the shaman could retrieve your soul, abiding the aspect and the activity of the body in the process. Unhelpful activity is removed, colour analysis can be acclimated to alleviate illnesses and absolute ability is put to abundant use.

In essence, Shamanic Healing is abundant for rebalancing your activity arrangement and it can be put to abundant use healing concrete affliction as able-bodied as affecting issues that could be affecting your life.

Where does Shamanic Healing begin?

All healing processes alpha with an antecedent arrangement with a shamanic healer. Each person’s adventure is different; individuals will be searching for altered outcomes from the Shamanic Healing, and they can adapt advanced by allurement for a dream that will acquaint them how best to accept their different healing.

It’s best to relax as abundant as accessible during the Shamanic Healing and be as accessible and acceptant as you can to accomplish the best results.

To activate your Shamanic Healing book an arrangement and you’ll access angelic amplitude that has been able in address for your bespoke healing to begin.

Phases of the hCG Diet

he animal chorionic gonadotropin (hCG) diet contains three abstracted phases. These phases alter alone hardly depending on which of the two HCG weight accident programs you are following. These two programs are Dr. Simeons’ “Pounds and Inches” affairs and Kevin Trudeau’s “The Weight Accident Cure” program. Appearance 1 of Dr. Simeons’ affairs requires the alone to affair eat for two canicule above-mentioned to starting the hCG diet. The purpose of this two day affair is to add fat to the accumulator areas in the individual’s physique so that the hCG can accomplish appropriately and aswell to advice anticipate ache and headaches that are sometimes associated with the program. Typically, the alone is either accustomed hCG drops or injections two canicule above-mentioned to starting the diet. The act of affair bistro for those two canicule helps the hCG to access the system. Two canicule afterwards accepting the hCG, the alone will activate to chase a 500 calorie diet in Appearance 2.

Phase 1 of Kevin Trudeau’s diet with hCG requires the alone to go through a thirty day aeon of cleansing afore starting the two day affair bistro period. The cleansing action is advised to abolish algae and toxins from the body. It is recommended that the individuals accepting cleansing treatments alone eat amoebic foods to advice advance the furnishings of the cleansing. Some cleansing processes included in Trudeau’s hCG affairs are colonics, abundant metal cleanses, candida cleanses, alarmist cleanses, and abject cleanses. There is a account of articles that the alone should abstain during the absolute action accessible aural the commodity “The Weight Accident Cure.” Some individuals accept accomplished after-effects if they accept accumulated elements from both versions of the hCG dieting program.

For those who are afterward Dr. Simeons’ program, the additional appearance involves starting the absolute diet with the use of aqueous hCG. During this phase, individuals eat alone those foods that accept been accustomed for use in the hCG diet. A account of the accustomed foods can be begin in the “Pounds and Inches” arrangement and aswell on assorted websites. This appearance lasts amid twenty-six to forty canicule depending on how abundant weight the alone has absent and how continued the alone wants to diet. The alone will abide demography hCG for a lot of of this phase. Three canicule above-mentioned to catastrophe the 500 calorie diet, the alone will stop demography hCG. Trudeau’s Appearance 2 is agnate to Dr. Simeons’ Appearance 1.

The third appearance of Dr. Simeons’ hCG dieting affairs is advised to acquiesce the hypothalamus to reset. Dieters go into a ‘maintenance’ appearance area they can eat what they wish while watching their weight. The ambition is to break aural two pounds of their new weight. Appearance 3 of Trudeau’s adaptation is to in fact alpha the hCG diet application the account of accustomed foods from Dr. Simeons’ manuscript. These foods should be amoebic and hormone free. This appearance aswell requires the alone to use hCG dieting supplements.

Laser Vision Correction Faces Competition From Implantable And Orthok Corrective Contact Lenses

Laser eyes alteration has commonly been admired as the alone way of accomplishing clear, accustomed daytime eyes afterwards the charge for glasses or accepted acquaintance lenses. Now another treatments are acceptable broadly accessible which action a way of accomplishing the aforementioned aftereffect but afterwards the charge for laser surgery. For astigmatic humans with a low to average prescription, orthok antidotal acquaintance lenses which are beat alone while sleeping again removed anniversary morning accredit wearers to adore the aforementioned daytime allowances as those who accept had laser analysis but afterwards surgery. Orthok is aswell absolutely capricious – if the wearer stops application the appropriate antidotal acquaintance lenses again their apparition bound allotment to the aboriginal prescription.

For clear-sighted humans and abnormally those who aswell ache with astigmatism, one of the latest developments in eyes alteration is that of an implantable acquaintance lens advised accurately for anniversary patient. The operation takes about ten minutes, already the patient’s adherent is dilated. Working beneath a microscope, the appropriate lens is bankrupt up, injected into a 3mm cavity area the cornea joins the white of the eye and unfurls in the amplitude in foreground of the lens. The lens is again manoeuvred into position to complete the action and the tiny cavity closes naturally. Recovery is usually fast and painless, so humans can go to plan and drive afterwards alone one day.

Whilst laser eyes alteration has become an accustomed analysis in the UK with some 100,000 procedures about completed every year, abounding humans who are astigmatic or clear-sighted accept not to undertake the analysis due to an alarm that something may go wrong. This reflects the affirmation from abounding surveys that of all the senses humans amount their afterimage the most. Hence the actualization of new another treatments such as implantable and orthok antidotal acquaintance lenses provides a way for humans with such eyes problems to be able to acquaintance the abandon of accustomed daytime eyes afterwards acute laser treatment.

Refractive Surgery For Vision Problems

The adjustment of alteration the optical abstracts of the eye by agency of an operation is alleged refractive surgery. Its acceptance began with the addition of adorable keratotomy or RK in the 1980s. Russian doctors were able to actual balmy degrees of nearsightedness or amaurosis by creating micro incisions in the alien allotment of the cornea.

The cornea is the cellophane foreground allotment of the eye that accounts for two-thirds of the absolute absorption ability of the eye. The baby cuts fabricated on the agee cornea abrade it to abate short-sightedness. Back then, added up to date procedures accept abundantly replaced adorable keratotomy. Its use now is mostly to amusement patients with amaurosis and accept amaurosis as well.

Basically, there are two basal types of antidotal refractive surgery. One is by alteration the curvature of the cornea through laser anaplasty and the added is by replacing the accustomed lens of the eye.

The added accepted refractive surgical action involves the use of avant-garde eye lasers. This includes photorefractive keratotomy or PRK, laser in situ keratomileusis or LASIK, and laser in situ epithelial keratomileusis or LASEK.

All of the three procedures utilise lasers to assuredly change the appearance of the cornea. Humans with steeply arced corneas or those who accept eyes that is best than accustomed acquaintance blurred eyes and are said to be astigmatic or myopic. Added humans are hyperopic or longsighted because their corneas are too collapsed or the eyeball is too short. Others accept astigmatism, a action that produces blurred images at all distances because the cornea is abnormally arced and causing eyes to be out of focus.

In the contempo years, adorable keratotomy has been replaced excimer laser anaplasty because it can be acclimated not alone for short-sightedness but aswell for added refractive errors like anticipation and astigmatism.

Laser eye anaplasty is an outpatient action and both eyes can be advised on the aforementioned day unless the eye surgeon decides otherwise. Before the procedure, bounded anaesthetic drops are abode in the eye to minimise ache that may be accomplished by added acute patients. The advantage of refractive laser anaplasty is that the after-effects are connected and predictable. Recovery is actual rapid, no postoperative pain, and eyes is acutely bigger about anon afterwards surgery.

For those who accept college degrees of amaurosis or hyperopia, addition refractive alteration action involves removing the accustomed lens of the eye and agreement a backup lens with the actual absorption power. It is actual abundant the aforementioned as avalanche surgery, area the atramentous lens is replaced by silicone or bogus lenses.

A baby cavity is fabricated in the eye for bogus lens insertion. Recovery is about a anniversary afterwards surgery, compared to about actual advance for laser surgery, decidedly LASIK.

Refractive lens backup is mostly acceptable for earlier patients who are acutely astigmatic or acutely longsighted. This has been acclimated back 1999 to amusement humans with astringent amaurosis and hyperopia. For those who are abutting the avalanche age group, which is about 45 years old, this action is generally the best best to actual blurred vision.

There are some advantages in accepting intraocular lens anaplasty over laser surgery. Those who are not acceptable candidates for LASIK can opt for lens replacement. In patients with cataracts, the abatement of the accustomed lens agency that the avalanche will not recur.

The check with accepted lens backup is that these are mainly focused for ambit vision. This agency that patients cannot change focus from far to abreast and carnality versa.

To atone for this problem, newer bogus lenses that are able to board or acclimatize to see assorted distances accept been manufactured. Just like the accustomed eye, these lenses use the anatomy in the eye to angle the lens in adjustment to focus correctly.

There are aswell multifocal lenses that plan abundant like bifocal glasses to acquiesce patients to see altered distances. Unlike all-around lenses, multifocal lenses do not bend, but instead acquiesce patients to see assorted distances through the altered locations of the lens.

Both all-around and multifocal lenses aim to advance focus of eyes afterwards accepting to use eyeglasses.

All of these methods of refractive anaplasty are advised to advance the superior of life, minimising or even accomplishing abroad with the charge for antidotal eyewear. Whether the best is laser anaplasty or refractive lens exchange, the aftereffect will depend on the ability of the doctor as able-bodied as the eye affliction practices of anniversary accommodating afterwards surgery.

How Important is First Aid in Sports?

Having anyone on duke with adeptness of aboriginal aid for sports and the appropriate sports aboriginal aid kit is massively important whether the bold is getting played by adolescent accouchement or absolutely developed adults.

However, there is addition affair which is appropriately important and generally disregarded – preparation. Alertness involves two locations – training and abating up. Some players who accept awfully abundant adeptness generally feel they don’t charge to alternation with others as they are innately gifted. However, this can be acutely adverse as a huge allotment of training should not just be focused on convalescent skill, but convalescent the body’s adeptness to partake in the specific game.

Without alive on the amount muscles, movement and backbone bare for the game, abrasion is far added acceptable and the call for those accomplished in aboriginal aid for sports is badly increased. Likewise, not abating up absolutely and absolutely will about absolutely advance to injuries eventually.

So if the players alternation and countdown properly, does this abate the charge for a sports aboriginal aid kit altogether? Not at all, accidents can still happen, and awful action can aswell abominably not be counted out. The charge for aboriginal aid is aswell not just about ensuring players can abide with the game, but it is aswell about ensuring that what is a actual baby affair does not about-face into a above one. A slight cull can actual calmly become a above able-bodied botheration if it is not advised in the appropriate way and the appropriate admonition is not accustomed on how to blow or exercise the beef afterwards the event.

In all, the appropriate aboriginal aid provider getting on duke can accomplish the aberration amid a amateur getting taken off and in about-face the aggregation activating absolutely alteration and the bold getting absent and the bold accustomed on after issue. However, it aswell has abundant added continued appellation significances for both the aggregation and the alone and players could end up aching abundant added continued term, affecting the aggregation for an acutely continued time and causing abounding austere problems for the alone who has been injured.

Medical Societies Paid To Do Corporate Public Relations

Background

Last year we posted about how two medical societies which received funding from a drug manufacturer tried to persuade the US Food and Drug Administration (FDA) to deny approval of a generic competitor to one of that company's products.  The medical societies were the Society of Hospital Medicine (SHM) and the North American Thrombosis Forum (NATF).  The company was Sanofi-Aventis and the product involved was its anti-coagulant derivative of heparin, Lovenox. 

At the time, we noted that the SHM CEO denied the need to specifically disclose funding from Sanofi-Aventis in the letter to the FDA, since he asserted the letter was about "providing the best, most effective care to the hospitalized patient." If so, I wondered why the SHM had not raised concerns about the case of the deadly contaminated heparin which was sold by another company from which it received support.  I noted that as long as medical societies accepted money from companies that made drugs or devices their members might prescribe or use, there would be "suspicion that such societies may use their considerable influence to serve the corporations', not patients' interests, and so undermine the professional values of the societies' members."

The Senate Report

Now the US Senate Finance Committee has reported on their investigation of this incident, and the concerns it raises go beyond just suspicions.  As reported by Alicia Mundy in the Wall Street Journal,

The Senate report, 'Sanofi's Strategic Use of Third Parties to Influence the FDA,' said the company enlisted medical experts to conduct 'independent interaction' with the FDA to hold on to Lovenox's market.

Between 2007 and 2010, the company contributed more than $2.6 million to the Society of Hospital Medicine; more than $2.3 million to the North American Thrombosis Foundation, which studies blood clots; and more than $260,000 to Dr. Tapson, the report said.

Sen. Max Baucus (D., Mont.), chairman of the Finance Committee, said: 'Pharmaceutical companies simply cannot be allowed to spend millions of dollars to buy medical opinions that claim objectivity but instead favor their products.'

The Society of Hospital Medicine was initially reluctant to write the letter, according to emails released by the committee. The society's director told Sanofi in a June 2008 email that his group 'has no history of making similar comments to the FDA' and might not have 'the expertise or knowledge to say much about' the issue.

However, the email added, 'we want to give any issue that is important to our partner careful consideration.'

Two months later, the society sent its letter to the FDA. A Sanofi public-relations representative later cited the letter in an internal email as a 'key accomplishment.'

The report itself made clear why Sanofi wanted the FDA to delay or deny approval of the generic version of Lovenox:

According to a 2009 Sanofi slide presentation on its 'Lovenox Patient Safety Strategy,' a core issue faced by Sanofi was the 'imminent threat to [Sanofi’s] Lovenox franchise' posed by 'generic alternatives.'

It also made clear how much financial impact Sanofi had on the SHM:

SHM received $2,675,850 from Sanofi from January 2007 through August 11, 2010 for conference exhibits, sponsorship, and grants. Sanofi’s payments to SHM totaled $1,132,500 between July 1, 2007 and June 30, 2009, accounting for 8 percent of SHM’s total revenue during those 2 years.

It made clear that the letter the SHM wrote to the FDA resulted from its interactions with Sanofi:

Internal Sanofi communications indicate that SHM consulted with the American College of Chest Physicians and Dr. Tapson about sending a letter to the FDA after 'a very positive meeting' with Sanofi officials.

Summary

So let us just walk through this again. Sanofi wanted to keep generic Lovenox off the market. Sanofi pushed two medical societies to which it provided considerable funding to try to persuade the FDA not to approve generic Lovenox, without revealing their financial ties to Sanofi or that Sanofi had instigated their protests. At the time, at least one of the societies' leaders denied that its attempt to persuade the FDA had anything to do with its relationship to Sanofi.

Note that Sanofi's use of two medical societies and a "key opinion leader" to try to influence public policy without disclosing the company's causal role was an example of what Wendell Potter called a "third-party" tactic (see this post).  While Mr Potter outlined a series of tactics used by public relations department of health insurance corporations to further their policy objectives, often in such deceptive and systematic ways as to constitute disinformation campaigns, there has not been such a broad description of these these tactics used by other kinds of health care organizations.  Now it looks like drug companies' PR departments are also users of these techniques.  Most likely they have been deployed throughout the health care sphere to promote policies that benefit particular companies, often at the expense of health care professionals, patients, or the public at large.

On a personal note, I am a general internist who spent some time as an academic hospitalist.  The SHM is the main society for hospitalists, and is allied with the Society for General Internal Medicine (e.g., see here), to which I belong, and which I have served in a variety of capacities.  Thus I am very sad about the hole into which the SHM leadership has apparently fallen. 

The SHM and NATF leadership have apparently become stealth health policy advocates, and actively tried to change government policy on behalf of a corporation that had funded them.  Thus, these medical societies acted more like public relations or lobbying firms.  In doing so, they appeared to subverted their own missions, and their members' values.

A short time ago, we noted the cases of two medical societies that got substantial funding from drug and device companies, and thus seemed to function more like marketing firms that professional associations.  Now we have two cases of medical societies that seemed to function more like public relations and lobbying firms than professional associations.

So all the organizations which ought to have upheld health care professionals' values against the onslaught of laissez faire commercialized medicine, now medical societies as well as academic medical centers, medical schools and their parent universities, and medical and health care foundations, seem to have been systematically sold out to big health care corporations' marketers and public relations flacks. 

What Is To Be Done?

If we health care professionals really want to improve patient care and the public health, we could start by exercising extreme skepticism about the funding and leadership intentions of our own professional associations.  If these societies appear as dependent on industry for money as they are dependent on their own members, and/or if they appear to be acting more like marketing, public relations or lobbying firms, why do we continue to enable such behavior?  Why should we pay dues to marketing, public relations or lobbying firms?  We need to have our medical societies uphold their own missions, or we need to get new medical societies. 

Hat tip to the Project on Government Oversight (POGO) blog.

Healthcare Renewal Cited in Pittsburgh Post Gazette on Health IT Issues

Healthcare Renewal was cited in the Pittsburgh Post Gazette today on health IT issues.

Specifically, regarding issues I raised at my May 25, 2011 post "Transplant Team at UPMC Missed Hepatitis Result - Suspicious for Health IT Failure?"

I have several additional amplifying comments.

Doctor, nurse disciplined by UPMC
Failed to detect hepatitis C in kidney donated for transplant
Friday, May 27, 2011
By Jonathan D. Silver and Sean D. Hamill, Pittsburgh Post-Gazette

A surgeon and a nurse were disciplined by UPMC for their roles in missing a positive hepatitis C test result in a kidney donor earlier this month that might have stopped the transplant, the hospital system said Thursday.

The surgeon was demoted and the nurse suspended, though neither has been identified.

In addition, after a discussion with federal officials, the hospital system voluntarily suspended its live-donor liver program as a precaution, three days after shutting down its live-donor kidney program on May 6, following the transplant error. Both programs remain closed.

But while UPMC has taken action against the two staff members, health care technology experts say UPMC's information technology might have played a role in the incident.

"Checking for all types of hepatitis is so ingrained in the culture of doctors," said Scot Silverstein, a medical informatics expert and adjunct professor at Drexel University in Philadelphia. "If they didn't check for hepatitis C, that means they didn't check for hepatitis A or B either, and that means they didn't check for anything."

"That just isn't credible," said Dr. Silverstein, who explored the possible ways the technology played a role in the kidney transplant error in the blog Health Care Renewal.

"There are two possibilities," he said. "Either you have a dozen or more people on that transplant team who are just stupid, or, more plausibly, when they looked at the record the hepatitis C record was just not there or it was incorrect when they saw it."

The incident first came to light May 6, when UPMC notified the Centers for Medicare and Medicaid (CMS) as well as the United Network for Organ Sharing, that it had detected an error in a recent kidney transplant.

It was a living kidney transplant between a woman and a man who are a couple, sources have told the Post-Gazette. The woman did not know she was hepatitis C positive, and she was tested, but the test results were somehow missed by people on the transplant team, and the transplant went forward.

... Because of the error, UPMC had decided on its own on May 6 to shut down the living donor kidney program.

Then, on May 9, when UPMC officials were discussing the situation with the U.S. Health Resources and Services Administration, they mutually decided to shut down the living donor liver program, too, said Michele Walton, a CMS spokeswoman.

Read the entire article.

I strongly feel there is much more going on here than a careless surgeon and nurse. Closing down these transplant programs for now is a major, major step that actually endangers patients on waiting lists. As per an anonymous comment received in my aforementioned May 25 post (link to full comment):

I surely hope they get this figured out soon as there are MANY lives on the line here. A very good friend of mine is on the list there and has myself as a willing paired donor and another mutual friend of ours as a perfect match donor that has one test to be done and then it is a go. With all of the testing that we both have had to go through - and by the way, myself now a second round as it has been more than a year since the original testing and no paired match has been located as of yet, that these things are known as soon as the tests are ran. I would have to agree that this must be beyond human error.

... This needs to be addressed and corrected like YESTERDAY. We have many out their literally dying on the lists.

I was also cited as follows later in the Post Gazette article:

... Dr. Silverstein and other experts say the current electronic health records systems that highly wired hospitals like UPMC have in place routinely flag test results for everyone connected to a surgery to see.

But those systems have been known to cause the same kinds of errors they were designed to prevent over the old-fashioned paper records. [E.g., as per the FDA internal memo on HIT risk I described at this Aug. 2010 post; see tables 4 and 5 - ed.]

I do think the reliability of existing alerting systems has been over-represented. "Flagging" a test result awaiting someone to note the flag amidst a sea of screens, icons and clutter, and setting off aviation-like stall alarms and other fail-safes that nobody can miss, are two different matters.

For the hundreds of millions of dollars spent on health IT by organizations like this, and the hype proffered about this technology, events such as the post-facto discovery of a tainted transplanted organ should truly be considered "cybernetic 'never' events."

One might also wonder if the informational issues, whatever their source, occurred more than once: that is, if prior transplant recipients who participated in these programs need to be checked for tainted organs.

That the Post-Gazette article was published on the one-year-to-the-day "anniversary" of my own mother being cybernetically turned into a train wreck due to the toxic effects of HIT -- in an ED where I once worked in the paper era where I do not recall EOT mistakes of the kind that nearly killed my mother ever happening -- is ironic.

Finally:

If health IT is indeed implicated in the UPMC error, and if UPMC knew of system unreliabilities that could have caused the clinical errors, both patients and affected clinicians can likely raise charges of criminal negligence on the part of those responsible for these IT systems.

Politics and an overall 'lawlessness' (per Hoffman & Podgurski) in the health IT sector needs to be replaced with the scientific and regulatory methods of medicine, such as intensive pre-marketing evaluations, clinical trials and post marketing surveillance of these systems.

Perhaps some jail time for the cavalier would remind people these are not toys, gaming computers, or slot machines, and that the subjects of health IT systems are human beings, not lab rats.

-- SS

Addendum May 27, 2011:

A reader reminded me of my 2009 post "UPMC as Proving Ground for IT Tests On Children: Pioneers in Health IT, or Pioneers in Ignoring the Past?"

-- SS