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The “New Normal” for Managing Medical Office Space

The “New Normal” for Managing Medical Office Space

While the CDC and other governmental and trade groups have issued wide-ranging guidance on “reopening” medical office space in light of COVID, the realities are that these spaces never truly closed, and furthermore, it would be nearly impossible to abide by all of the standards that have been published. This session instead focuses on what hospitals and other MOB operators are actually doing from a facilities perspective to manage medical office space to reduce the risk of liability.
Attendees will:

  • Learn about industry trends and best practices for operating medical office facilities in light of COVID
  • Hear tips on reducing liability for COVID-related legal challenges that may be brought by patients and other users of medical space
  • Have an open forum to discuss experiences managing medical office space with similarly situated individuals navigating this complex issue

Podcast Participants

Joel Swider

Attorney at Hall Render

Julie Carmichael

Advisor at Hall Render Advisory Services and President of Carmichael & Company

Mark Theine

Executive Vice President – Asset Management at Physicians Realty Trust

Ryan Walters

Senior Real Estate Manager at Providence St. Joseph Health

Today we’re presenting The “New Normal” for Managing Medical Office Space, presented by Hall Render with a few guests.

Joel Swider: Thanks, Julie. And thanks so much to those joining the call for investing some of your time with us today. I’m Joel Swider and I’m a healthcare real estate attorney at Hall Render. Today we have a very experienced and distinguished panel here to talk about The “New Normal” for Managing Medical Office Space.

Joel Swider: We at Hall Render have had clients ask for the past year or so guidance about reopening medical office space post lockdown. And the reality is that most of these spaces never truly closed. And so owners and operators of medical office space have really had to learn and implement new procedures on the fly.

Joel Swider: We’re not really concerned as much anymore with reopening or getting ready for COVID, but we’re dealing with operating in this new reality, which we’ve called the new normal that we all have to navigate. So our goal in our discussion today is that whatever your role is in this industry, that you will come away with new ideas, fresh perspectives. Something that you can apply to be more successful in your day-to-day role, as it relates to COVID preparedness and liability protection.

Joel Swider: So I guess at this point, I’d love to have our panel introduce themselves. Julie, could you tell us a little bit about yourself and your background in this topic?

Julie Carmichael: Sure. It’s nice to be here today. Thanks everybody for logging on. My name’s Julie Carmichael, I’m a healthcare consultant in Indianapolis. I have a consulting business that I started about six years ago. Prior to that, I was the chief strategy officer for Ascension St. Vincent in Indiana. And I had responsibility there for all of our real estate and design and construction. So I have a practical hands-on experience in this area. And then I work today with health systems and private physician practices and get involved in quite a bit of their real estates and medical office issues. So glad to be here.

Joel Swider: Yeah. Well, thanks for being here, Julie. Mark.

Mark Theine: Yeah. Joel, thanks to you and thanks to Hall Render for including us on the panel. I’m really privileged to be here, appreciate it. So again, my name is Mark Theine. I’m the EVP of asset management for Physicians Realty Trust. We are a publicly traded REIT under the ticker symbol DOC. D-O-C go by a lot of times. So our portfolio today is about five million in healthcare real estate investments located in 36 States across the country. About 15 million square feet. So it’s really been interesting managing our portfolio through the [inaudible 00:03:00] and then the care nationwide and watching into this, we’ve had different spikes in different regions. So hopefully can bring a little perspective to that, but day in and day out. My role as the lead in the operations team is release asset management, property management, leasing in capital construction.

Joel Swider: Great. Well, thanks again, Mark and Ryan.

Ryan Walters: Yeah, thanks for the invite. My name’s Ryan. I’m our senior real estate manager for Provenance in the Washington and Montana region. Less are a big Swedish portfolio over in Seattle. So we’re across seven States, each area is broken up with a different real estate manager.

Ryan Walters: So today I’ll talk about our portfolio across Washington, Montana. It’s about 275 properties, mostly MOBs, but we have office buildings, industrial, land, and all sorts of fun gifts that people have donated. So I’ll try to talk mostly about the MOB perspective. We have a team of property managers at CVRE and Kiemle Hagood that are really out, seeing what the differences and implementing all these new best practices for us. So try to talk to some of those and what our technicians are seeing. So before this, I was a property manager and broker at Kiemle Hagood in Spokane, I guess that’s me.

Joel Swider: Great. Well, thanks again to our panel and for your time and expertise, by the way if those of you listening today enjoy our discussion. We have three additional ways that you can connect with us and continue the discussion on healthcare real estate. First is to consider subscribing to our podcast, which is called the Health Care Real Estate Advisor. And you can find it on the Apple Podcast app or on our website.

Joel Swider:The second is we publish a monthly newsletter with news and insights related to healthcare real estate. And if you’d like to be added to that list, please reach out to me by email,

Joel Swider: And third, I want to let the group know that we have another of these round table discussions similar to this happening on February 25th on healthcare real estate strategy consideration. So it’s sort of an offshoot of today’s discussion where we’ll be talking about the impact of COVID, recent regulatory updates and other trends on the broader strategy discussion.

Joel Swider: So I’m very excited to hear from our panelists. I want to give one or two quick backdrop notes from a legal perspective, because I think that we will find through this discussion that this is really more of a practical issue than a legal one.

Joel Swider: From a legal perspective, medical office space is really distinguishable from inpatient space in terms of the regulatory environment. So any certified provider or supplier that’s subject to survey by Medicare has to comply strict infection control protocols. Those require cohorting of positive or negative COVID patients. There’s a guidance level on surveys for social distancing and things along those lines. But outside of the inpatient setting and outside of the ASC setting, there’s not a licensure or accreditation requirement, in most States anyway, when it comes to medical office space.

Joel Swider: And so even though the guidance is there from CDC and CMS and [Ashe 00:06:25] and the World Health Organization and others, there’s no enforcement mechanism in this setting. So in some ways that’s a good thing because it means flexibility for landlords. In some ways it’s a difficult thing because it means it makes it more difficult to discern a reasonable approach when there’s no requirement.

Joel Swider: The last thing that I’ll say on the legal front is we did some research and found that the majority of States at this point have implemented or are advancing serious discussions around liability shield laws. And those generally protect a business owner from COVID liability so long as they act reasonably and are not negligent or grossly negligent.

Joel Swider: So what I’m hoping that we’ll come away with from today’s discussion is some sense of what is reasonable in this setting so that we can all serve our patients while also obviously avoiding liability.

Joel Swider: So with that as background, the first question that I want to pose to the group is, what are hospitals and other MOB operators actually doing from a facilities’ perspective to manage their medical office space? And maybe Ryan, if you could walk me through from the time somebody drives into the parking lot to receive medical care to the time that they leave what changes in protocols would that patient or visitor encounter?

Ryan Walters: Yeah, and I think my general response to this new normal, I think what we’re finding is if the buildings were professionally managed and following best practices pre-COVID, there’s really been minimal impact. I think there was a lot of unknown upfront of, “Oh no, what else are we going to have to do?” But I think we found our best practices have held true through this.

Ryan Walters: We obviously have more coordination, more PPE and some extra signage, but when a patient comes in, you’ll probably see some tents at some of our MOBs for testing facilities. So you might have to find a different parking spot. And I guess you’re used to. You’ll probably see some signage on the building entrance and maybe some directional signage on certain doors to enter or not enter. Please wear masks, social distance.

Ryan Walters: Often though when you walk into our lobby it’s the same friendly face. They’ll just have a mask on. You’ll probably see furniture spaced out a bit more in our waiting rooms. I think you’ll probably see less people in those waiting rooms. Trying to get patients back to an exam room as quick as possible. And we do have less people in our buildings. So it’s a much more coordinated effort. When vendors need to come onsite our technicians or property managers are meeting them at the front door, escorting them into the facility and getting out as efficient as they can. But other than that, for the most part, I think that’s what you’re going to expect to see.

Joel Swider: And Mark or Julie, I know when we talked earlier, you said there were some jurisdictional related items too, that you having a portfolio for example, Mark, that is in multiple States, you might see some variation in that. Any additional thoughts?

Mark Theine: Yeah, absolutely. Certainly. It’s going to be a customized approach based on the size of the building, location of the building geographically, climate, things like that. I guess even taking a step back it’s amazing that, I read an article this morning on [Axial Self Care 00:10:02], that one year ago today there were about 2000 confirmed cases of COVID and most of which started in China, of course. And there was just a handful in the US.

Mark Theine: So I mean what a ways we’ve come in just one year’s timeframe. And I’m really proud that within our company, we sent out our first communication to our healthcare partners around the country at the end of January of 2020, just about the importance of good hygiene. And if you’re feeling sick staying out of medical office buildings. And then obviously we got into March and pandemic started spreading a little bit faster and the awareness of what was coming at us increased.

Mark Theine: And within our team we formed our own COVID task force at that time. And we developed a 32 page building readiness manual for our property management workers around the country. So we could approach this with a customized and plan that we could implement all around the country.

Mark Theine: We also put together a tenant guide for all of our hospital partners with best practices and whatnot. And it outlined exactly what Ryan just said. All of those [inaudible 00:11:13] COVID crisis that we’re so used to seeing now with the importance of PPE, mask, ingress and egress of the building, and then your point about jurisdictional.

Mark Theine: And that was probably one of the biggest challenges that we addressed early on was about screening within buildings, medical office buildings. As patients were coming in, who was in charge of that screening? Was it the building owner? Was in the hospital system? And in the case of our portfolio, we partnered with the hospital system and entered into a license agreement to allow them to use common area space in a multi-tenant medical office building, or use a parking lot for screening or now the vaccine administration.

Mark Theine: But it definitely varied region by region. And we’ve worked with our revenue management teams across the country to implement those best practices that Ryan was outlining a minute ago.

Ryan Walters: And Mark that’s a good point too on who’s doing it. I think if you were to, I’m going to talk strictly from our real estate perspective. So our property managers and technicians, but really it’s our clinic managers that are in the buildings and the operations team that have taken on a bulk of the changes that need to be implemented. Because they’re there at the front door and taking on the temperature screening and those kinds of things.

Mark Theine: I would just say one additional thing we did this Summer was to partner with Julie and her company in a survey of health care consumers in five of our largest markets across the country.

Mark Theine: And we asked them just about their comfort level of coming back to medical office buildings, again, to your opening comments. They never really closed [inaudible 00:12:55] more people back and the volumes increased. But what would make them more comfortable coming back to medical office buildings?

Mark Theine: And one of the answers that didn’t surprise us, but one of the answers we heard loud and clear was, not just telling us the things that you’re doing in the buildings and you’re wearing PPE and you are cleaning, but physically seeing someone in the lobby, cleaning, cleaning the buildings, cleaning the common areas, elevator buttons, door handles, et cetera.

Mark Theine: So we’ll talk a little bit more about that survey, but yeah, those are the things that we’ve adjusted on our team to be very visible, very transparent in the communication and the efforts that we’re doing within our buildings.

Joel Swider: Yeah. I’d love to jump into that. Julie, how can we communicate to consumers that it’s safe to enter, and in some cases reenter, because a lot of people have put off care, right? So how do we get them comfortable?

Julie Carmichael: It’s a question that really puzzled me and why we started back in July with a survey in Indiana to see what consumers were feeling. I had heard a lot of anecdotal examples of patients not going to the hospital with heart attack symptoms. And I wanted to understand why that was and what it was going to take to get them feeling comfortable.

Julie Carmichael: So the results that we found in Indiana, and then when we did the survey for Docreit, really are similar across the country and we boiled it down to five key points. The first being consumers prefer strongly, 75% prefer to seek services not on a hospital campus. I think that’s important for us to think about from a strategic standpoint, especially as we’re trying bring patients back. If we have off-campus locations where medical office buildings and other facilities that are not on our main campus and we can ease people back into that setting. I think there’s an opportunity.

Julie Carmichael: As Mark mentioned consumers told us, “We want to see what you’re doing.” Show not tell. Just this need to visibly see that precautions are being taken and that we’re taking their safety very seriously. So I think that’s going to continue and will really contribute to getting people to come back.

Julie Carmichael: Consumers also want us to go above and beyond the requirements. Frankly, they look at what the CDC and others have said. And it’s great, but if you can do more than that, we would really prefer you to go further. And then when we’re communicating to patients, the last two points really get communication. One is physicians and nurses and clinical staff are the best way to communicate with patients that it’s safe to come back and what all you’re doing to keep them safe.

Julie Carmichael: We found, surprisingly, hospital CEOs were on the bottom of the list for folks that should be out in front and giving these messages. In fact, consumers told us they’d rather hear from their local legislators than hospital CEOs. Which I thought was very interesting. So think about who you’re putting out in front.

Julie Carmichael: And then the final point is, to the extent you can, one-to-one communication is appreciated. So rather than just putting out broad notices, broad marketing strategies, being able to send that email to your patient, kind of a one-on-one communication that, “Hey, these are the things we’re doing. This is what you’ll see. This is what you’ll experience when you come into the building.” I think consumers really like that knowing what they’re going to face, as Ryan discussed. What’s it going to be like when I come back to a health care facility?

Julie Carmichael: So that’s the study in a nutshell, and we can talk more about it and I’m happy to share if folks want to dive into that outside of today. Reach out and let me know. I think it’s helpful as you’re thinking about real estate strategy and just getting people to come back to your medical office buildings.

Joel Swider: Well, and that’s very interesting, Julie. I think one of the things that we’ve gotten some questions about is related to certifications and using that potentially as a way to say, maybe it’s a communication device, maybe it’s a sort of check the box item. I don’t know, but anybody on the panel have any experience with those sort of outside certifications that have come to the market recently? Is there any validity to those? Are they worthwhile or is your money better spent elsewhere? Any thoughts on that?

Ryan Walters: I can kick it off. We haven’t pursued any specific certifications. I mean, we have our employed infection preventionists and the relationship between that team and our real estate team is the strongest it’s ever been.

Ryan Walters: They are meeting with our janitorial vendors, looking at their scope and cleaning products, making sure they’re appropriate. And if there’s ever an issue they’ll run over to a building and meet the real estate team to look at the issue. Other than that, certification wise, we’ve definitely been doing more test adjust balance reports from certified vendors that are capable of doing those to make sure we have proper air flows.

Ryan Walters: But Mark or Julie, I don’t know if you’re seeing anything else on the certification front.

Mark Theine: I think you described it really well. Yeah, there’s a lot of groups obviously popping up now. Claiming to have the latest and greatest new certification and trying to monetize that.

Mark Theine: But back to Ryan’s initial point. I mean for groups that have already been operating their buildings to high level, we’ve already invested in the platforms to improve the patient and physician experience in the buildings. And what COVID’s really done, and managing through this right now, is improved the focus and communication of the operations teams.

Mark Theine: So to Ryan’s point again, we are communicating more and more frequently and sharing data in real time from our systems about what we’re doing for our work orders, for hours that people are in the building, screenings, tracking patient volumes. And these are systems that we had in place already pre-COVID, but the focus has really been on increased communication transparency around the efforts that we are doing. Both to our hospital partners and then ultimately to their patients.

Julie Carmichael: I would just add that our survey results really showed that consumers listened to the CDC more. The CDC and local health departments. So as these companies that do the building certifications have popped up, it’s really been after we’ve done the survey, but I go back to consumers have certain people that they view as experts. CDC, State Department of Health, your physicians. And then I think I’d spend my efforts making sure that what I’m doing is well communicated and visible and not necessarily putting a stamp on a building from an organization that consumers don’t know anything about.

Joel Swider: Yeah. That makes sense. And I guess we haven’t really gotten into, another question that we get a lot I’ve heard from you all so far today on communication and some of the protocols. Which to my mind don’t cost a lot or don’t have to cost a lot. Are there any capital outlays that have been necessitated in light of COVID that any of you have seen or recommend?

Mark Theine: Yeah, I can jump in and help here. So from a capital outlay perspective, certainly we’ve evaluated our entire portfolio form, mechanical systems, where we can improve, fresh air flow. We haven’t gone in, wholesale made changes to existing facilities. Where there’s new development facilities we can of course pick things as we’re in the projects, now with COVID implications in mind.

Mark Theine: But we haven’t gone back to retrofit an entire mechanical system or anything like that. But where we are investing our money now is in, when we’re doing common area renovations we’re putting in touchless sinks or automated doors. Sometimes elevators that you can have just one call button instead of pressing the button on every floor.

Mark Theine: So we’re looking at that. And then clearly on tenant improvements as we’re renewing leases and offering some capital to freshen up the space. We are looking sometimes at the design flow of how the office section lays out one way in and then a separate exit out. So it’s one way traffic.

Mark Theine: Some practices are considering not having as large a waiting room and taking patients straight back to the exam room and wait there, so that they’re separated. But then there’s other systems that want larger waiting rooms to separate everyone. So it’s customized by my practice there, but where we are investing our money, again, is more on the TI and the remodels as they’re coming up in our portfolio. But we haven’t gone back to wholesale [inaudible 00:22:51] yet.

Ryan Walters: Yeah, very similar opinion as Mark. We have design guidelines for our primary care and our specialty care clinics. So our architects have been revisiting those and having some conversations around some of the things that Mark mentioned.

Ryan Walters: So things we’re looking at are, should we have power and water hookups in our parking lots, or maybe a bigger plot of land? Should we need to use our parking lots to put up tents in the future? Should we have bigger entrance canopies if we have lines going out our front door? The automated door hardware and hands-free faucets for patients that Mark mentioned. What do we do in our exam rooms to increase our telehealth capabilities? Do we have some extra negative pressure exam rooms near a separate entrance? And where should the doctor’s workstations be for those telemedicine visits? Should they be in the clinic or elsewhere? Just some things we’re thinking about.

Joel Swider: Ryan, I want to follow up on one point you made. Talking about preparing the parking lot as another potential site of care. I suppose that’s easier when it’s owned real estate. I mean has that been successful on the tenant side as well and saying, “Hey, landlord, you’ve got to do something here.” Or it’s not really a TI issue as much as a facilities issue and amenity, if you will. Has anyone seen that on the tenant side?

Ryan Walters: Yeah, so we own about half our properties and lease about half. And I was just going to say, we do have tents set up. We are the single occupant in the MOB, which helps. But we’re very thankful to our landlords. It’s really come down to just a transparent conversation. Hey, who are the vendors? Show us some diagrams, how traffic flows going to work? What electrical systems are you going to tap? How are you going to restore it?

Mark Theine: Yeah, similar to me. Again it goes back to that collaboration with our hospital partners and how quickly can we help them set up something in the parking lots. Initially it was testing sites in the parking lots, but most recently in the last week or two, we’ve been having conversations about vaccine administration and drive-thru vaccine sites through larger tents.

Mark Theine: And some of the discussions get interesting and maybe you’ll appreciate this from a legal perspective is, some of those sites we own the buildings be simple, but in others we ground lease them. So the hospital may already own the land and we own the improvements of the building, but in those cases the hospital has decided on their campus to set up the tent and we just need to kind of over-communicate on where are we going to display some of that parking in those cars. Because a few of our leases do have minimum parking requirements in the leases.

Mark Theine: And it just creates some challenges operationally, in patient flow, and then again for our property managers to be able to communicate that to everyone. In the multi-tenant building those tenants that are not hospital tenants, so ground leases being reviewed a little bit more as we’ve set up testing sites and now vaccine locations.

Joel Swider: Yeah. I want to delve a little bit more into this idea of transparency. And Julie, you mentioned this earlier, Mark, you echoed it as well. Can we talk a little bit about how do we serve our customers, whether at patients or, Mark in your case, hospitals maybe by providing more transparent data. Have you seen that play out?

Julie Carmichael: Well, I think in a couple of the practices that I’ve worked with, I’m seeing the providers just be much more communicative. More regular communication, whether that’s newsletters, quick emails. That one office that’s done a great job putting out videos where the provider will talk about what’s the latest protocol in the office. What’s changed since the last time you were in.

Julie Carmichael: I think it’s just an extra attention to communicating things that we think that probably people already know. It’s that mindset of over-communicating. So that’s really what I’ve seen with most of the medical offices that I’ve worked with. I don’t know Mark, Ryan [crosstalk 00:27:49] seen something different.

Mark Theine: We’ve had employees before COVID, which really helped us excel in their customer service to the hospital partners during COVID. A work order management system platform, where we could track and measure and monitor all requests that we’re getting from our partners.

Mark Theine: So we could track how long until a work order is dispatched. How long until it’s completed? One of the most useful tools is at the end of the work order we can get a rating on how well we did. So thumbs up, thumbs sideways, thumbs down just like an Uber. You get a four star, five star Uber rating.

Mark Theine: We get real-time feedback on how well we’re doing on our work orders. And then in that system we can also track janitorial schedules, engineering hour schedules. And so we have all this data and we put together a [inaudible 00:28:40] report to our hospital systems.

Mark Theine: We share with them on a very routine basis all this data about here’s how we’re doing on work orders. Here’s our customer service to the physicians. They’re rating of our work order in our teams and then how quickly we’re responding to them. And then also showing them that we’re thinking about adjusting janitorial hours or engineering hours to take care of the team’s health, but yet also servicing the building. Those communication back and forth has just really gone long way to keep these buildings open and then ultimately keep the providers and patients safe in the buildings.

Joel Swider: Thanks one other, I want to switch gears a little bit, because one topic that we talked about on our prep calls was how taking the COVID response seriously when it comes to property management can actually enhance business. It could be an opportunity. And of course I don’t mean to be light of a very dire situation, but how can we, from a business perspective, enhanced business in our COVID response? Julie, I know you’ve talked about this before a little bit.

Julie Carmichael: it does feel somewhat awkward talking about trying to grow and expand market share in this environment. And at the same time, I think this is the kind of environment where there are opportunities to grow market share.

Julie Carmichael: Things that I think are important are looking at your portfolio. And if you’ve got assets that are not on campus, figuring out how to maybe drive more service there. I think consumers now like convenience, smaller offices, it’s just that big campus setting that I think people are a little bit leery of. So looking at where you’re providing services. If you can put services together in convenient locations and convenient packages so that people can do multiple things in one trip. I think that’s a good opportunity right now.

Julie Carmichael: And then just from a general standpoint, I think as you’re serving your competitive landscape there are a number of people that you’re probably competing with that are so focused on just responding to COVID because they’ve had to be. So if you’re not in that situation, or even if you are maybe pulling out a small group of people who you asked to focus on the future and think about where are the opportunities that we have.

Julie Carmichael: If everyone is thinking about today and no one’s thinking about tomorrow, I find that to be a bit dangerous from a strategic standpoint. So I like the idea of having at least a small team of people that are thinking about the future and where those growth opportunities are, because they are there.

Mark Theine: Yeah, I think that’s one of the trends that we’ve seen. Accelerated over the last year is the shift to the off campus buildings. I mean the reimbursement and technology and all those enhancements were already driving more and more care off campus. The COVID continued to accelerate that. As consumers didn’t want to go to the big box hospital where the COVID patients are being taken care of. They’d rather get their care closer to home in a clean and safe environment.

Mark Theine: So I think Julie’s spot on with her comments about shifting care to the off campus setting there. In fact 72% of new construction starts last year were in off campus buildings.

Mark Theine: And I think that historically healthcare has been very hospital centric and in the future, as Julie just said, it going to be very consumer centric. And it’s going to be more about the patients and their preferences. How to get care in a clean, safe, convenient way is the way to be thinking about healthcare in the future.

Ryan Walters: Which may or may not be in an exam room in a medical office building.

Joel Swider: Yeah. Ryan, could you elaborate on that? Because I think from the hospital perspective, I think, we just heard a lot of people are not wanting to come on campus or they’re not, obviously there are certain conditions where you have to, but for an office visit. Any thought from the hospital perspective in terms of how you’re responding or plan to respond in the year ahead?

Ryan Walters: Yeah. There’s lots of interesting conversations that I’m sure everyone’s asking throughout the industry, but with the care that’s being delivered in a car out in front of an MOB. What does it mean to look at a car as an exam room? What’s telemedicine do? And what’s an exam room look like if it’s in a patient’s home? Lots of interesting questions and conversations around that.

Joel Swider: Well, I’d like to wrap up our discussion with exploring the future horizon and what have we learned? What does this new normal look like? What will we keep and what will we discard? Obviously we can’t see the future. Any thoughts on that? On what we’ve learned and where we go from here.

Ryan Walters: I think, so big questions in my role, we oversee all of our leasing, buying, selling. Most of our office employees are remote today and plan to be through Summer.

Ryan Walters: I don’t know of many medical office buildings that have formally closed, at least not for very long, throughout this process. But we did close a lot of our office buildings. So we foresee a need for much less office space or a different type of office space. Where nobody has a reserved desk or cubicle. And we deploy a reservation system where you can reserve a cubicle or meeting room, depending on the type of work you need to do in the city that you’re currently located.

Ryan Walters: So we’re identifying which caregivers are fully remote moving forward. My VP recently told me I’m one of those. So I’m a guinea pig in this effort. And who needs to be in front of a desk five days per week can be assigned cubicle and who’s in between.

Ryan Walters: And then on the medical office side, it’s what is the impact of telemedicine? Does that allow us to see more patients and postpone the next new building a few years? Because we have some more capacity. Do we need a different type of space for telemedicine? Some of the questions we’re asking,

Julie Carmichael: I think it’s going to be a mix in some ways. I think a lot about the fact that people are pretty quick to forget things. And I wonder what the lasting impact on all of our psyches will be after living through a pandemic. Will it change our behavior forever, or will it change our behavior for a while?

Julie Carmichael: And I think there are probably some things that may change forever. I think telemedicine is something that has worked well in certain instances, but there are a number of practices and specialties. I think about obstetrics as an example, and a lot of women’s health where it’s just not practical to do a lot of that care via telehealth.

Julie Carmichael: So I think, to Ryan’s point, we’re going to have to live in both spaces. We’re going to have to figure out, maybe we can delay some additions that we thought we might need to do some expansions. And I also think it’s going to be interesting to watch what happens on the ambulatory surgery side. With changes to Medicare and other insurance companies being willing to pay more and cover more services in that setting. And providers, I think, starting to feel that the quality is comparable. I think we’re going to see a lot of activity in the ASE space going forward. But it’ll be interesting to see. I wish we knew for sure, but I think we’re all guessing.

Mark Theine: I love the optimistic question about thinking about what’s coming in the future, especially given how challenging this year has been. But the truth of the matter is that we are still in a crisis and there’s still a lot of COVID care being developed.

Mark Theine: And it’s really important for us to remain disciplined in our operations of the facilities today in what this new normal is that we’re talking about. It’s very easy to get COVID fatigue and not wear your mask or start settling into the new normal of your management hours and things like that. Your management tasks, but it’s really important to continue to stay disciplined for the very foreseeable future.

Mark Theine: And then further into the future to answer your question though. I, talking to a CFO yesterday of the hospital system, and one of the comments he made that really resonated with me is that they shifted more of their surgery procedures off campus, the AFCs.

Mark Theine: Again, the same capacity in the hospital system. And those procedures will probably now for a very long time continue to be located in that off campus surgery center. So there’s a lot of opportunities for certain off campus surgery centers, [inaudible 00:38:51] future. And procedures that have shifted away from the campus, off campus will continue to stay there in the future.

Joel Swider: Great. Well, that is the extent of my prepared questions here. Julie, Ryan, Mark, thank you so much for your insight and thank you to our audience for joining us.

Joel Swider: We will be sending out contact information to the extent that anybody has questions that didn’t get answered today and you’d like to continue the conversation. We have our strategy discussion coming up on February 25th, which I think will be an interesting follow-up to this one.

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Stories I Tell
Jason E. Norris
I have lots of ideas for stories, but an “idea” is not a story. So I’m pushing the ideas out of my imagination and into your mind. Some are science fiction. Some are realistic. Some are really real and personal. But there’s a gap between what I imagine and what you read, see, and hear. In order to jump that gap, I’m freely sharing imperfect stories with you. I hope you enjoy them. And if you’re kindhearted, perhaps you can offer feedback to help me become a better writer. And along the way I'll share with you the storytelling techniques I'm learning about.
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Our Father God - Introduction

Series: Our Father God

May 08, 2021
Douglas Muller

Isaiah 43:10-12 “You are my witnesses,” declares the LORD, “and my servant whom I have chosen, so that you may know and believe me and understand that I am He. Before me no god was formed, nor will there be one after Me. I, even I, am the LORD, and apart from Me there is no saviour. I have revealed and saved and proclaimed— I, and not some foreign god among you. You are My witnesses,” declares the LORD, “that I am God

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The Most Difficult Delta SkyMiles Redemption I’ve Ever Done: AirEuropa

by Adam

AirEuropa is a SkyTeam partner and has been for over a decade. The Madrid-based airline is among the smaller members of the alliance but offers reliable service between Spain and the U.S. and often an abundance of lie-flat business class seats available for miles bookings.

Unfortunately, hardly anyone at Delta Air Lines seems to know how to help SkyMiles members book flights on this partner. Many don’t even know what AirEuropa is.

Booking difficult Delta SkyMiles award flights AirEuropa

AirEuropa is now offering flat-bed seating on all U.S. routes, served by the 787 Dreamliner and Airbus A330.

I was in dire need of a return flight at the end of a very busy labor day weekend. This is one of the most difficult times of the year to travel, period, much less travel using primarily points and miles. To great relief, an AirEuropa business class seat opened between Madrid and New York Kennedy late last week. I immediately picked up the phone to nab the seat.

I found availability through an ExpertFlyer alert, then quickly confirmed through partner Air France’s website. You see, Delta used to allow SkyMiles members to book Air Europa nonstop flights on That functionality mysteriously vanished when the airline overhauled its website in June; AirEuropa flights no longer appear in any searches, ever, including this one.

Still, this was a nonstop flight, between two major SkyTeam hub airports, with confirmed availability showing in ExpertFlyer inventories and on all of the airline’s relevant partner websites. Should be a cinch, right? A 15-minute phone call, at most.

Little did I know it would take six separate phone calls to Delta’s Gold Medallion desk to find an agent who could put me in this seat.

Booking AirEuropa Delta SkyMiles

An AirEuropa Boeing 787. AirEuropa is the third-largest airline in Spain, serves 44 destinations, and doesn’t exist at the Delta Medallion call center.

Previously: Shame, Shame – Delta Kills Partner Awards With Devaluations

I was quoted 300,000-plus mile prices on Air France and KLM itineraries with stops in three European cities and Atlanta. By the end of an exhausting day, I was out of mobile minutes, practically begging for anyone who could even name the airline.

I’ll jump straight to some of the highlights.

ME: “I’d like to book a SkyMiles award on AirEuropa.”

AGENT 1: “Sir, are you thinking of Air Europe? We’re not partners with Air Europe.”

ME: “No, it’s AirEuropa, the SkyTeam airline. You are in an alliance with them.”

AGENT 1: “I’m sorry. There’s no such airline.”

ME (Facepalm): “Thanks anyway.”

Two other agents said there was no such partnership with the airline. Eventually, I broke protocol and explicitly told the agents that I had confirmed that the airline was making the seat available to Delta (this strategy rarely works, as it usually results in an agent saying that different airlines have different inventories, then giving up).

After six phone calls, I finally got a gentleman who took the bait. He couldn’t see the AirEuropa flight on screen, but after telling him my story, he put the phone on hold. I waited 10 minutes. He picked back up.

“Ok, I got you confirmed and you’re good to go.”

Just like that, I was booked on the flight and airline that, hours earlier, never existed.

I asked the representative what had changed, and why the other couldn’t see the availability. He said that he had to pull out the actual manual for booking AirEuropa seats, and discovered that AirEuropa seats have to be searched using an entirely different system.

“I have been at Delta for 19 years, and I’ve been on the phones for 9 years,” he said. “You’re the first person who has ever asked about AirEuropa.”

Wow. Just, wow.

On one hand, I’m not all that surprised that few people call about booking flights on AirEuropa. They operate just a few U.S. flights, and they don’t have the most extensive network or brand name recognition.

On the other hand, it’s downright strange that Delta would revamp their website and remove the ability to access some SkyMiles inventory. I spent so much time on the phone, grappling with agents to book a flight that I knew full well I could and should be able to book, I had to purchase a universal pass just to cover the calls.

This certainly makes for good use of a service like what we offer at Juicy Miles. The time savings alone, in this case, would be worth hiring a professional over.

But it’s ludicrous to think that procuring such a simple award — a one-way nonstop on a well-established alliance partner — would require so much human effort.

The responses below are not provided or commissioned by the bank advertiser. Responses have not been reviewed, approved or otherwise endorsed by the bank advertiser. It is not the bank advertiser's responsibility to ensure all posts and/or questions are answered.

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George September 5, 2018 - 5:04 pm

I was booked on a GIG-AMS with KLM on their 789. Halfway thru the flight the plane went tech and the pilot decided to return to GIG. So we were flying like 7 hours, GIG to GIG. We arrive past midnight and they would only rearrange us in the next day.
Instead of waiting what they would offer me, I went ahead and saw all the options I had. I did find an AirEurope seat available in C. So by the time I got in contact with the agent and told them about this flight, the lady did not even know what airline this was.
The end result: TAP, lol.

Skyteam should make a brand awareness campaign among their own airlines. 🙂

DaninMCI September 5, 2018 - 7:06 pm

I wasn’t aware of AirEuropa until recently doing an AF search. I think 300k is way too much for such a simple route.

Albert September 5, 2018 - 10:19 pm

Better have given that guy a Job Well Done certificate

Adam September 6, 2018 - 7:43 am

@Albert – you bet!

Marvin September 6, 2018 - 3:35 am

DaninMCI: I think he meant he was quoted 300k for a different, way too complex routing.

Adam: I actually think it makes a lot of sense that they “removed” this from the website: My guess is that AirEuropa is booked through an entirely different system (which is why they couldn’t find it), and they probably completely overhauled their online booking system and figured it would be too expensive to add support for that other booking system. So it probably wasn’t removed, but rather support wasn’t added in the new version of the website.

DLPTATL September 6, 2018 - 5:12 am

Maybe I’m missing it, what was the final cost in SkyMiles for the AirEuropa flight?

Interestingly I had AirEuropa show up on earlier this summer looking for ATL:LIS, but only for an intra-Europe connection from an AF flight if memory serves.

John Harper September 8, 2018 - 10:40 am

The partner rate to Europe and back is 75,000 SkyMiles. Taxes and fees were right about $300 for this one.

AirEuropa came off sometime in July.

Luca August 8, 2019 - 4:46 am

Does anyone know the starting price for Skymiles on an inter-Spain flight with Air Europa by chance? Would be a great help as i’m currently based at MAD.

Miles Jackson August 8, 2019 - 4:58 pm

For an economy award it should be 6,000 SkyMiles for distances up to 600 miles, 12,000 for distances up to 1,250 miles. A Business class award should run 12,000 and 24,000 SkyMiles respectively. Let us know if you have any luck!

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Tag Archives: Xanthippe Voorhees daughter Jacqueline Unbreakable Kimmy Schmidt

Unbreakable Kimmy Schmidt Season One Review

21 Mar

Note: Full spoilers for the season follow.

“We’re the strong ones, and you can’t break us.”

Unbreakable Kimmy Schmidt is an infectiously energetic, quick-witted, and constantly entertaining show that both reflects the 30 Rock roots of its creators and crafts its own world with aplomb. It’s an easily binge-able 13 episodes, and although its jokes come rapid fire and make you laugh, there’s also a beating heart underneath it all: the story of Kimmy Schmidt, one of four “Mole Women” who is rescued from an Indiana doomsday cult’s underground bunker.

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Posts Tagged ‘infinite interactive’

#779 Puzzle Quest

Posted: 7th September 2020 by Jeroen in Games
Tags: , , , , ,

896th played so far Genre: Puzzle/Role Playing Platform: Various Year of Release: 2007 Developer: Infinite Interactive Publisher: D3 Publisher Yeah, I’ve kept Puzzle Quest until the end. It’s a puzzle RPG which, to make it easier on myself, I’ll be playing on the DS so I have some TV distraction if I want it. I’ve […]


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Professional Pool Lighting Installation in Dallas, TX

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Dallas Pool Builders Pool Lighting

Our Dallas pool company is ready and waiting for you. Why? Because we think that you have been swimming in the dark for too long and it is high time that you get yourself some pool lighting. You can only swim in a dark pool once or twice before you decide that it just isn’t going to work anymore! Stop losing great late night swim parties and get a pool light installation in Dallas, Texas! Our pool lights are top quality so don’t expect them to burn out within a couple of weeks! Not only do we have quality pool lights, but we also have some great colors! If white is your delight then go ahead! However, if you want something a little more daring, you should check out some of our other colors!

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Pool Lighting in Dallas, Texas.

Pools are a fun place to hang out and you should be able to hang out in them whenever you want, even at night time. How can you hang out in the pool at night though? Simple, with a pool light installation in Dallas, Texas. Your pool is great, but when it gets dark outside so does your pool. Swimming around in the dark is filled with anxiety and strange… things. I mean, sure you just brushed up against a leaf, but in the dark? It’s ten times worse! You don’t have to suffer through this nightmare, you can just get some pool lights! Maybe you have been putting off that night time pool party because you don’t want any of your guests swimming in that dark pool or hang out on an unlit pool deck. Well, now, you don’t have to!

Having lights around your pool is great, but it doesn’t help to light up the deep depths of your pool. The only thing that will help that is a pool light installation in Texas. Our pool contractors will come by your commercial or residential property and install some pool lights for you so that you can do all the late night swimming that you have been dreaming about since you got your pool! We have been called one of the best pool installation companies in Dallas, Texas and we understand why. It’s because we work hard, we treat the customers right, and because we have some amazing pool lights!

Pool Contractors for Lights in Dallas, Texas

Our pool contractors are experienced and they have the know how to make your pool amazing. Pool lighting is something to be careful with. Water and electricity have never been really good friends and that is why we want to make sure that when you get your pool light installation in Texas, you get it done by a company that knows what they are doing and that is not going to have you in a bad situation! Our pool contractors will install some beautiful pool lights for you and you will be very happy that you called a professional company to come and take care of it for you!

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Ready, Fire, Aim: US Interests In Afghanistan, Iraq, And Syria

Contribution to a Panel Discussion at the DACOR Annual Conference, September 27, 2019.

I have been asked to join my fellow panelists in speaking about U.S. interests in Afghanistan, Iraq, and Syria. For some reason, our government has never been able to articulate these interests, but, judging by the fiscal priority Americans have assigned to these three countries in this century, they must be immense – almost transcendent. Since we invaded Afghanistan in 2001, we have spent more than $5 trillion and incurred liabilities for veterans’ disabilities and medical expenses of at least another trillion dollars, for a total of something over $6 trillion for military efforts alone.

This is money we didn’t spend on sustaining, still less improving, our own human and physical infrastructure or current and future well-being. We borrowed almost all of it. Estimates of the costs of servicing the resulting debt run to an additional $8 trillion over the next few decades.[1] Future generations of Americans will suffer from our failure to invest in education, scientific research, and transportation. On top of that, we have put them in hock for at least $14 trillion in war debt. Who says foreign policy is irrelevant to ordinary Americans?

At the moment, it seems unlikely our descendants will feel they got their money’s worth. We have lost or are losing all our so-called “forever wars.” Nor are the people of West Asia and North Africa likely to remember our interventions favorably. Since we began them in 2001, well over one million individuals in West Asia have died violent deaths. Many times more than that have died as a result of sanctions, lost access to medical care, starvation, and other indirect effects of the battering of infrastructure, civil wars, and societal collapse our invasions have inflicted on Afghanistan, Iraq, Libya, and Syria and their neighbors.

The so-called “Global War on Terrorism” launched in Afghanistan in 2001 has metastasized. The US. Armed forces are now combating “terrorism” (and making new enemies) in eighty countries. In Syria alone, where since 2011 we have bombed and fueled proxy wars against both the Syrian government and its extremist foes, nearly 600,000 have died. 11 million have been driven from their homes, five million of them into refuge in other countries.

Future historians will struggle to explain how an originally limited post-9/11 punitive raid into Afghanistan morphed without debate into a failed effort to pacify and transform the country. Our intervention began on October 7, 2001. By December 17, when the battle of Tora Bora ended, we had accomplished our dual objectives of killing, capturing, or dispersing the al Qaeda architects of “9/11” and thrashing the Taliban to teach them that they could not afford to give safe haven to the enemies of the United States. We were well placed then to cut the deal we now belatedly seek to make, demanding that the governing authorities in Afghanistan deny their territory to terrorists with global reach as the price of our departure, and promising to return if they don’t.

Instead, carried away with our own brilliance in dislodging the Islamic Emirate from Kabul and the ninety percent of the rest of the country it then controlled, we nonchalantly moved the goal posts and committed ourselves to bringing Afghans the blessings of E PLURIBUS UNUM, liberty, and gender equality, whether they wanted these sacraments or not. Why? What interests of the United States – as opposed to ideological ambitions – justified this experiment in armed evangelism?

The success of policies is measurable only by the extent to which they achieve their objectives and serve a hierarchy of national interests. When, as in the case of the effort to pacify Afghanistan and reengineer Iraq, there is no coherent statement of war aims, one is left to evaluate policies in terms of their results. And one is also left to wonder what interests those policies were initially meant to support or advance.

In the end, our interests in Afghanistan seem to have come down to avoiding having to admit defeat, keeping faith with Afghans whose hopes we raised to unrealistic levels, and protecting those who have collaborated with us. In other words, we have acted in accordance with what behavioral economists call “the fallacy of sunk costs.” We have thrown good money after bad. We have doubled down on a losing game. We have reinforced failure.

To justify the continuation of costly but unsuccessful policies, our leaders have cited the definitive argument of all losers, the need to preserve “credibility.” This is the theory that steadfastness in counterproductive behavior is better for one’s reputation than acknowledging impasse and changing course. By hanging around in Afghanistan, we have indeed demonstrated that we value obduracy above strategy, wisdom, and tactical flexibility. It is hard to argue this this has enhanced our reputation internationally.

We invaded Iraq in 2003 for reasons that, aside from the pursuit of imaginary weapons of mass destruction, have never really been explained. To parody Hughes Mearns’s famous poem, Antigonish[2]:

Some time ago, Iraq was where

We looked for stuff that wasn’t there

We haven’t found it to this day,

And yet we feel obliged to stay.

By taking over Iraq, we successfully prevented Baghdad from transferring nonexistent weapons to terrorist groups that did not exist until our thoughtless vivisection of Iraqi society created them. We also destroyed Iraq as the balancer and check on Iran’s regional ambitions, an interest that had previously been a pillar of our policies in the Persian Gulf. This made continued offshore balancing impossible and compelled us for the first time to station U.S. forces in the region permanently. This, in turn, transformed the security relationship between the Gulf Arabs and Iran from regional rivalry into military confrontation, producing a series of proxy wars in which our Arab protégés have demanded and obtained our support.

Our intervention in Iraq ignited long-smoldering divisions between Shiite and Sunni Islam, fueling passions that have undermined religious tolerance and fostered terrorism both regionally and worldwide. The only gainers from our misadventures in Iraq were Iran and Israel, which saw their most formidable Arab rival flattened, and, of course, the U.S. defense and homeland security budgets, which fattened on the resulting threat of terrorist blowback. Ironically, the demise of Iraq as an effective adversary thrust Israel into enemy deprivation syndrome, leading to its (and later our) designation of Iran as the devil incarnate. Israel, joined by Saudi Arabia and the UAE, believes that the cure for its apprehensions about Iran is for the U.S. military to crush it on their behalf.

The other principal legacies of our lurch into strategy-free militarism, aside from debt and a bloated defense budget, are our now habitual pursuit of military solutions to non-military problems, our greatly diminished deference to foreign sovereignty and international law, domestic populism born of war weariness and disillusionment with Washington, declining willingness of allies to follow us, the incitement of violent anti-Americanism among the Muslim fourth of humanity, the entrenchment of Islamophobia in U.S. politics, and the paranoia and xenophobia these developments have catalyzed among Americans.

In March 2011, having unofficially cheered on the overthrow of our longtime Egyptian protégé, Hosni Mubarak, we joined some European allies in bombing and strafing Libya. The ostensible purpose for ignoring Libyan sovereignty was humanitarian – the alleged international “right to protect” civilians against their own governments (R2P). The immediate result was the overthrow and savage murder of Libya’s famously bizarre leader, Muammar Qadhafi. But the movement of the goal posts to encompass regime change was also the coup de grâce for any prospect that R2P might become established international law.

No matter. In April 2011, when unrest broke out in Syria, the Obama administration immediately called for the ouster of the Asad government. That government had the support of Iran, Iraq, and Lebanese Hezbollah, later joined by Russia. The insurgents enjoyed support from others in the region – primarily Qatar and Saudi Arabia, though each supported different factions. The Gulf Arabs were joined by the United States, France, and the U.K. Turkey facilitated these foreign interventions in Syria, as it did the passage through its territory of jihadis seeking to overthrow Asad. In 2015, Turkey intervened directly to confine hostile Syrian Kurds on its southwestern border.

Syria was soon the site of innumerable proxy wars. Saudi-supported Salafi jihadis fought Muslim Brotherhood-affiliated Salafis supported by Qatar and Turkey. Sunnis fought Shi`a. Saudi and Iranian-supported forces fought each other. Hezbollah fought Lebanese Sunni forces in Syria. Israel fought Iran and Hezbollah and supported selected anti-government jihadis. Russia escalated its support of the Asad government. The United States and Israel targeted Iranian forces and intervened against both Asad and the Islamist extremists who were his most effective antagonists. Lately, we have been at risk of war with our erstwhile ally, Turkey. Throughout, a very large number of Syrians have been more alarmed by the alternatives to Asad than they are by him.

It is widely claimed that the United States was inadequately engaged in the Syrian maelstrom. Nonsense! Since 2014, we have spent well over $50 billion in appropriated funds to train, arm, and otherwise support various factions in the conflict, including some with direct links to al Qaeda. This fiscal year alone, DoD has budgeted $15.3 billion and the Department of State about $1 billion for Syria. In total disregard of international law, we have carried out well over 11,000 air and missile strikes against both government and rebel forces in Syria and deployed about 2,000 U.S. troops there to support secessionist factions. We cannot escape a considerable measure of moral responsibility for both the perpetuation of the conflict in Syria and some of the 200,000 undocumented and 375,000 documented Syrian dead, about 125,000 of whom have been verified as pro-government, 133,000 as anti-government, and 112,000 as noncombatant, neutral civilians. But we have made it clear we will not contribute to Syria’s reconstruction.

In a very sad way, that’s progress. Our forever wars have repurposed much development assistance into support for warfare and the amelioration of its consequences. The humanitarian crises in Gaza and Yemen exemplify this tragic transformation. What we and our security partners knock down with one hand, we rebuild with another before knocking it down again. This has discredited our aid to foreign societies in the eyes of Americans as well as its recipients.

To say, “we meant well” is true – as true of the members of our armed forces as it is of our diplomats and development specialists. But good intentions are not a persuasive excuse for the outcomes wars contrive. We have hoped that the many good things we have done to advance human and civil rights in Afghanistan and Iraq might survive our inevitable disengagement from both. They won’t. The years to come are less likely to gratify us than to force us to acknowledge that the harm we have done to our own country in this century vastly exceeds the good we have done abroad.

Of course, we will leave behind some concrete legacies of our misadventures in West Asia. The region is now littered with depopulated American bases and fortified bastions serving as embassies. But this architectural legacy inevitably recalls Shelley’s “Ozymandias.”

I met a traveler from an antique land,

Who said – “Two vast and trunkless legs of stone

Stand in the desert. . .. Near them, on the sand,

Half sunk a shattered visage lies, whose frown,

And wrinkled lip, and sneer of cold command,

Tell that its sculptor well those passions read

Which yet survive, stamped on these lifeless things,

The hand that mocked them, and the heart that fed;

And on the pedestal, these words appear:

My name is Ozymandias, King of Kings;

Look on my Works, ye Mighty, and despair!

Nothing beside remains. Round the decayOf that colossal Wreck, boundless and bare

The lone and level sands stretch far away.”

For $14 trillion or more, we should get something more than that. But we won’t unless we finally figure out what our interests really are, build a strategy that addresses them rather than politically popular delusions, and rediscover the merits of diplomacy as an alternative to the use of force.

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Silver Fox Brushes

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– Size (length x ferrule width): 18mm x 4mm
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How to report Toucan bugs

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How to report Toucan bugs

Due to foum engine limitations, it's not possible to subscribe to all new topics created in the Toucan forum. And given my free time limitations, it is unfortunately rather inconvenient for me to visit forum all the time just to check if there are any updates, so I'd prefer folks to report issues on GitHub right away, their notifications system helps me be up-to-date with much less effort. And forums, on the contrary, are a good place for general questions, usage tips and so on, where my direct involvement is not that important as community can chime in.

So, if you have a bug (confirmed or suspected) or a feature request for Toucan - please submit it at
If you have general question, unsure of how some functionality works or need a usage advice - please use this forum.


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Peninsula Connection

The Peninsula Connection project will widen Portobello and Harington Point roads to make them safer and more attractive for everyone who uses the road – locals, visitors, cyclists, walkers and runners, drivers and nearby residents and businesses.

While the project is nearing completion, a few key segments remain, including the rerouting of the shared pathway along the Portobello waterfront and the eventual construction of a roundabout at the village’s main intersection (where Portobello,Highcliff, Harington Point and Hatchery Roads come together). A preliminary layout for this work is shown above.

For the latest updates, the Dunedin City Council maintains a page with the plans and the latest progress reports for the Peninsula Connection.


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World Water Day 2022. Groundwater, making the invisible visible.

22 March is World Water Day and this year the focus is on groundwater.

History of the day:

World Water Day emerged in 1992, at the United Nations Conference on Environment and Development in Rio de Janeiro. That same year, the General Assembly adopted the resolution that 22 March of each year be declared World Water Day, with 1993 being the first year of celebration.

The importance of water.

World Water Day is celebrated every 22 March to remind us of the importance of this basic element for our lives. Despite this importance in our daily lives, 2.2 billion people live without access to drinking water. The aim of this celebration is to raise awareness of the global water crisis and the need to find measures to address it in order to achieve Sustainable Development Goal 6.

Groundwater, making the invisible visible.

This year we are focusing on groundwater. This is the water found underground in aquifers (aquifers are formations of rocks, sands and gravels that contain significant quantities of water). These waters, after feeding springs, rivers, lakes and wetlands (such as the Empordà), filter into the oceans. Their main source of recharge is rain and snow that seep from the ground and can be extracted to the surface by means of wells and pumps.

Life would not be possible without these waters. Most arid areas of the planet are totally dependent on this resource, which supplies a large proportion of the water used for drinking, sanitation, food production and industrial processes. They are also essential for the proper functioning of ecosystems.

This is why we need to protect them from the overexploitation and pollution that currently threatens them, which can lead to the depletion of this resource, price increases in the treatment and regeneration processes and even the paralysis of its use.

World Water Day 2022. Groundwater, making the invisible visible.


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tv Ted Cruz Condemns Big Bird For Advocating Covid Vaccines For Kids

Other rightwingers piled on Cruz's criticism of Big Bird: ‘Brainwashing children’

Big Bird on getting the Covid vaccine. ‘My wing is feeling a little sore, but it’ll give my body an extra protective boost that keeps me and others healthy.’ , Photograph: Wenn Rights Ltd/Alamy

The Texas senator Ted Cruz led conservatives in condemnation of a prominent public figure for advocating Covid-19 vaccinations for children. Big Bird.

FILES-US-HEALTH-VIRUS-VACCINE-POLITICS-MANDATE<br>(FILES) In this file photo taken on August 23, 2021, a Los Angeles County emergency medical technician administers a second dose of Pfizer-BioNTech Covid-19 vaccine at a pop up vaccine clinic in the Arleta neighborhood of Los Angeles. - Strict rules intended to push tens of millions of US workers into getting vaccinated against Covid-19 will come into effect on January 4, 2022, President Joe Biden's administration announced November 4, 2021. The mandates targeting businesses with more than 100 employees, health care workers, and federal contractors represent the most aggressive steps Washington has taken yet against the virus and its Delta variant. (Photo by Robyn Beck / AFP) (Photo by ROBYN BECK/AFP via Getty Images)

This week saw final US approval for five- to 11-year-olds to receive the Pfizer-BioNTech vaccine. Sesame Street, which has offered Covid advice before, duly deployed its popular characters to encourage parents to protect their children.

Big Bird, who despite his vast size and to some slightly overbearing mien is according to the beloved show perpetually six-and-a-half-years-old, announced on Saturday that he had been vaccinated.

“I got the Covid-19 vaccine today!” the hulkingly benevolent yellow avian announced, using an appropriate communications platform, Twitter.

“My wing is feeling a little sore, but it’ll give my body an extra protective boost that keeps me and others healthy. [CNN reporter] Erica Hill even said I’ve been getting vaccines since I was a little bird. I had no idea!”

Cruz responded: “Government propaganda … for your 5 year old!”

Other rightwingers piled in. Lisa Boothe, a Fox News contributor, said “brainwashing children who are not at risk from Covid” was “twisted”.

Children are at risk from Covid, if less so than adults. In October, the federal Centers for Disease Control and Prevention (CDC) said 66 children aged between five and 11 had died from Covid-19 in the US. Children can infect others and infections in the five-to-11 age group are rising, the CDC said, accounting for 10.6% of new Covid cases.

If you like this article, please sign up for Snapshot, Portside's daily summary.

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Undeterred, Steve Cortes, a host on the conservative Newsmax network, said of Big Bird’s tweet: “This kind of propaganda is actually evil. Your children are not statistically at risk, and should not be pressured into a brand new treatment. Do Not Comply!”

Resistance to vaccine mandates and other Covid public health measures persists among Republican voters, despite a US death toll of more than 753,000 from a caseload of almost 46.5m.

On Saturday, a conservative judge in New Orleans issued a temporary stay on a federal rule which says businesses with more than 100 employees must demand vaccinations or weekly testing. The Biden administration said it was confident it would prevail.

Cruz, who recently made headlines by defending the first amendment right to give Nazi salutes at school board meetings, seemed to enjoy his work on the day’s active front in the broiling culture war.

He also tweeted: “Liberals are weird. They don’t care about open borders. Or rising inflation. Or schools covering up sexual assaults. Or the disaster of Afghanistan. Or tyrannical Dem[ocrat]s violating medical privacy and freedom.

“But criticise Big Bird? And they lose their sh[it].”

The bad news for Cruz was that Big Bird seems unlikely to stop his public health advocacy, which he has pursued for years. In 1972, for example, he helped tell children: “Don’t wait, vaccinate!”

As the Twitter account Muppet Wiki – “fans and professionals working together to build the best resource about the Muppets, Sesame Street and Jim Henson” – put it: “Big Bird is so polite. Be like Big Bird.”

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What is customer premises equipment deployment?

Virtual CPE, the first step in the commitment of NFV service providers: vendor independent network.

A key starting point for CSP and ISP NFV solutions is the use of virtual CPE (consumer based equipment), especially the industrial variant of vE-CPE – Virtual CPE. The immediate benefits of reduced CapEx and flexibility mean that enterprise networks grow into one of the first to receive vCPE format NFV solutions from service providers.

But there are still obstacles to overcome and 3 different Virtual CPE implementations have been developed as a solution to some of these problems. In this article, I will describe the 3 different implementation types as well as the existing problems that prevent service providers from implementing complete CPE Deployment.

 Not all vCPEs are created equa

Although recent studies show that most, if not all major service providers plan their network infrastructure and services towards SDN / NFV, they do not have the ability to use the Virtual CPE solution yet. Given the wide range of levels of advancement and development, no two CPE practices are exactly alike, and because not all networking functions can be implemented in a way that can be used for performance-critical applications, many have achieved hybrid CPE or almost complete. solutions in response to these shortcomings.

“Virtual” centralized VCPE – All VNFs (virtual network functions) are implemented on the side of the service provider, with the physical CPE operating as little as level 2 on to the network and services aige. Currently the purest and rarest implementation of CPE, only the most advanced vendors on the market (i.e. Versas, pictured above) have offerings in this sector. Because network functions are downloaded over the service provider network, only a low-power device (like the one above) should be a gateway to the cloud network where network activity is located. all hosted.

Hybrid CPE – some performance-critical VNFs are run on local hardware and the rest are available through the cloud of service providers. This is currently the most popular method, as it allows companies to use resources to address performance issues on both sides and provide a complete, cost-effective solution. Since an ISP

network is used to download many of the network functions, one network device can use a small feature like the one above.

 uCPE or local vCPE – All NFVs are used in fixed network devices. Universal CPE, a term recently coined by AT&T, is an NFV platform where all network functions are integrated into standard x86 hardware, unlike the standard CPE implementation by the a big difference is that the proprietary hardware is now virtual and rooted in the white box of vendor-agnostic tools. Because this solution requires a capable infrastructure and powerful hardware, it is usually in the form of high-performance Intel x86 network rack devices (like the one pictured above).

Use issues and boundaries for these different implementations

These three different approaches arose from the need to cross boundaries in conventional VNF networks and service providers.

True vCPE as of now is only possible for small to medium sized businesses, partly due to issues such as dual encryption and tromboning. Because of the obvious security implications of sending unencrypted plaintext data to a cloud network, we must first encrypt any data sent from vCPE to cloud provider networks. The data then needs to be decrypted, processed, encrypted once and finally sent back to vCPE. This creates a great deal of confusion and nostalgia which makes this solution inconvenient when applied to a critical application of performance on a larger scale. Also, at a more basic level, network tromboning occurs when data is sent, processed, and returned. Although this can be done in small volumes with DHCP, DNS etc… Density can still be a problem as it builds.

Implementing vCPE on premises, or designated “private clouds”, is more appropriate for large companies that need or prefer to implement their own Infrastructure (for performance reasons, security concerns or other factors). While a powerful solution, it is also costly and infertile to NFV’s commitment to reduced Capital spending.

That is why hybrid solutions now make up the majority of high-end CPEs in the market. The ability to implement critical functions on local hardware as well as service provider networks gives businesses the flexibility they need to deploy critical applications in finding new revenue streams. As CPE’s flexible platforms continue to grow, businesses can decide what VNFS will run in the building and what will be downloaded to the cloud.

Below is an example of a flexible VNF that can be used as a centralized CPE, Hybrid CPE, or full build with only the orchestrator running on the service provider’s network:

In this picture we see how branch size determines the best architecture to implement, with small businesses able to fully rely on service provider networks, a medium-sized business running critical performance tasks in a more hybrid environment , and ultimately large branches of a company that require specialized fixed hardware to meet demands. This flexible architecture allows service providers to deploy NFV solutions in areas that would otherwise be inconvenient.

In Summary:

The best solution is the one that suits you.One of the most widespread benefits is the transition to SDN, NFV and Virtual CPE. It is therefore not surprising that vendors focus on a hybrid action architecture that incorporates the diverse needs of the enterprise equipment consumer enterprise business priority.

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Nama Japa

A mantra is not a prayer invented by a human being or composed by some privileged intellect, but comes directly from the realization of a ṛṣi, or “realized seer.” It is a mystical energy contained within a sound structure. It consists of a sacred word or phrase containing a divine power whose effect cannot be verbalized. Just as it is impossible to verbally explain the taste of an orange or an apple, the mantra has to be experienced directly.

The repetition of mantra is called in Sanskrit japa, or “murmuring.” It constitutes a very ancient spiritual activity within the Vedic tradition. The Śiva-saṁhitā (4.9) states that “Through practice one attains perfection; through practice one attains liberation.”

Likewise, the sage Patañjali says in his Yoga-sūtra (1.13), “Abhyāsa is the effort to obtain stability in that state of cessation of the fluctuations of the mind.” And he explains in sūtra 1.14: “But this practice is firmly rooted only after it has been cultivated properly and for a long time uninterruptedly.”

The Sanskrit word abhyāsa means “repetition.” Patañjali reminds us that to advance on the yogic path, abhyāsa is necessary. Only through repetition is it possible to achieve authentic transformation.

Attentive and devoted repetition purifies us and such power is released by deeply influencing the sadhaka. The mantra-japa helps us to transcend darkness and spiritual stagnation.

As stated in the last chapter of the Kulārṇava-tantra: “Japa is so called because it removes the accumulated sin of thousands of lives and reveals the Supreme Deity.” Sin refers obviously to the egoic phenomenon and to the ignorance of who we really are. Mantra is a bridge that leads the devotee to God. It is a relatively simple spiritual discipline because there are no restrictions on chanting the divine names with devotion. Hari-nama-japa is not just repeating the mantra automatically but with devotion.

Mantra-japa is mentioned in many scriptures as a highly effective means to transcend the negative influences of this age of Kali.

hare kṛṣṇa hare kṛṣṇa
kṛṣṇa kṛṣṇa hare hare
hare rāma hare rāma
rāma rāma hare hare

iti ṣoḍaśakaṁ nāmnāṁ
nātaḥ parataropāyaḥ
sarva-vedeṣu dṛśyate

“The sixteen names of the Hare Kṛṣṇa māhā-mantra: Hare Kṛṣṇa Hare Kṛṣṇa, Kṛṣṇa Kṛṣṇa Hare Hare, Hare Rāma Hare Rāma, Rāma Rāma Hare Hare destroy all the inauspiciousness of the age of Kali. This is the conclusion of all the Vedas.” (Kali-santarana Upanisad from Kṛṣṇa Yajur Veda)

sāṅketyaṁ pārihāsyaṁ vā
stobhaṁ helanam eva vā
aśeṣāgha-haraṁ viduḥ

“One who chants the holy name of the Lord is immediately freed from the reactions of unlimited sins, even if he chants indirectly [to indicate something else], jokingly, for musical entertainment, or even neglectfully. This is accepted by all the learned scholars of the scriptures.” (Srimad-Bhagavatam, 6.2.14)

nama sankirtana deva tarakam brahma drsyate
hare krishna hare krishna krishna krishna hare hare
hare rama hare rama rama rama hare hare

“The nama sankirtana (public chanting) of Hare Kṛṣṇa māhā-mantra delivers a complete revelation of all of spiritual reality.” (Brahmanda Purana, 6.59–60)

hare krishna hare krishna krishna krishna hare hare
hare rama hare rama rama rama hare hare
sodasaitani namani dvatrimsad varnakani hi
kalau yuge maha-mantrah sammato jivatarane
varjayitva tu namaitad durjanaih parikalpitam
chandobaddham susiddhanta viruddham nabhyaset padam
tarakam brahma-namaitad brahmana gurunadina
kalisantaranadyasu sruti-svadhigatam hareh
praptam sri brahma-sisyena sri naradena dhimata
namaitad-uttamam srauta-paramparyena brahmanah
utsrjyaitan-maha-mantram ye tvanyat kalpitam padam
mahanameti gayanti te sastra-guru langhanah
tattva-virodha-sanprktam tadrsam daurjanam matam
sravatha pariharyam syadatma-hitarthina sada
hare krishna hare krishna krishna krishna hare hare
hare rama hare rama rama rama hare hare

Hare Kṛṣṇa Hare Kṛṣṇa, Kṛṣṇa Kṛṣṇa Hare Hare, Hare Rāma Hare Rāma, Rāma Rāma Hare Hare: This sixteen-name, thirty-two syllable mantra is the māhā-mantra in the age of Kali by which all living beings can be delivered. One should never abandon chanting this māhā-mantra and take to other so-called purificatory processes which are practiced by rascals or engage in chanting other metrical compositions of the name of Kṛṣṇa that are against the pure conclusions of the scriptures or are filled with rasabhasa. About this divinely spiritual māhā-mantra, which delivers one from material existence, the original guru, Lord Brahma, has said, kali-santararadi srutite, ‘The srutis have declared this mantra to be the best means of deliverance in the age of Kali’. Having all heard this from Brahma, the sons and disciples of Brahma, beginning with Narada, all accepted the Hare Kṛṣṇa māhā-mantra and, having meditated on it, attained perfection.” (Ananta-samhita is part of the Narada Pancaratra)

harir eva samaradhyah sarva deve suresvarah
hari nama maha mantrair nasyatpapa pisacakam

“All the grievous sins of one who worships Lord Sri Hari, the Lord of all lords, and chants the holy name, the māhā-mantra, are removed.” (Padma Purana, Svarga Khanda, 50.6)

japato hari namani sthane sata-gunadhikah
atmanam ca punaty-uccair-japan srotrn-punati ca

“Compared to that person who is attached to chanting japa, the person who performs loud chanting of the holy name of Sri Hari is one hundred times better. This is because the person who chants japa purifies himself, whereas the person who chants the holy name loudly in kirtana purifies himself, all those who are with him, and everyone else who hear the holy vibration.” (Naradiya Purana, Prahlada-vakya)

It should be noted that for a mantra to be truly effective it must be received directly from a real master within an authentic line of disciplic succession. A mantra received from just anyone does not contain divine power. As stated in the Padma Purana:

sampradaya vihina ye mantras te nisphala matah

“Any mantra that does not descend through a line of disciplic succession (parampara) is considered useless.” (Padma Purana).

Prabhuji was initiated by his master into the Māhā-mantra, devoting many years of his life to its nectarean repetition.

Retroprogressive Hatha-yoga

Retroprogressive Hatha Yoga is the result of Prabhuji’s efforts to improve his own practice and teaching. It is a system based solely on the teachings of his gurus and the sacred scriptures.

Prabhuji has systematized different traditional yoga techniques to create a methodology suitable for the Western public.

Retroprogressive Hatha Yoga aims for experiencing our true nature. It promotes balance, health, and flexibility through proper diet, cleansing techniques, preparations (āyojanas), sequences (vinyāsas), postures (asanas), breathing exercises (prāṇayama), relaxation (śavāsana), meditation (dhyāna), and locks (bandhas) and seals (mudras) to direct and empower prāṇa.

Social benefit to the community

Does the Prabhuji Mission offer any social benefits in a practical way to the community?

Prabhuji founded his mission with the intention of serving humanity and benefiting it both spiritually and socially. One of the ways in which this noble aspiration is expressed is “Prabhuji Annadanam” or the “Prabhuji Food Distribution Program.” On a weekly basis, the Prabhuji Mission distributes food free of charge to anyone who comes to the Avadhutashram. There is no need to register or present documents.

The term annadānam is composed of two words: annam, or “food” and dānam, or “the act of giving and sharing.” Thus, annadānam means “feeding the hungry and needy.” Among the various kinds of giving, the act of sharing food is called māhādānam, or the “great act of sharing,” because satisfying hunger is a basic and essential service.

The Taittirīya Upaniṣad states, “All life force comes from food (annam vai pranah) and let food be produced in abundance (annam bahu kurveet).” The importance of charity is clearly explained in the Varāha-purāṇa. Among the different ways in which charity is expressed, sharing food is considered the highest. In the Varāha-purāṇa, Śrī Varāha says, “One who gives food, gives all that is worth giving in this world.” In the Bhagavad Gita, Śrī Kṛṣṇa states, “All beings evolve from food (annād bhavanti bhūtāni). Even in the Vedas, Upanishads, Rāmāyana or Mahābhārata during all these periods, feeding a hungry person was considered the greatest service to humanity.

“Give food, give food, give food” is Kṛṣṇa’s advice to Yudhiṣṭhira in the Bhaviṣya-purāṇa when referring to dānam, or “the giving.” Yudhiṣṭhira requests Kṛṣṇa to impart to him the essence of Bhīṣma Pitamaha’s discourse in the Śanti Parva of the Mahābhārata about dharma. Then, Kṛṣṇa says, “Both the animate and inanimate worlds are sustained by food. The bestower of food is the bestower of life and obviously of all the rest. Therefore, one who desires good in this world and beyond should especially strive to give food. He should offer food with venerable hospitality to the old man, the child, and the exhausted traveler.”

The Bible instructs:

“Then the righteous will answer him: ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink? When did we see you a stranger and invite you in, or נאמר in need of clothing and clothe you? When did we see you sick or in prison and come to visit you?’”. (Matthew, 25:37–40)

Also the Qur’an says:

“They give food, for love of Him (Allah), to the poor, the orphans, and the slaves, saying, ‘We feed you only to please Allah; We desire not from you reward or appreciation.’”  (Qur’an, 76:8–9)

For Prabhuji, service to the human being is service to God, giving food to those in need is equal to a yagña, or ‘the most elaborate ritual sacrifice’.

ayaṃ nijaḥ paro veti
gaṇanā laghucetasām
udāracaritānāṃ tu
vasudhaiva kuṭumbakam

“This is mine, that is his, say the small minded. The wise believe that the entire world is a family.” (Māhā Upanishad, 6.71–75)

Different yogas

How does Prabhuji view the different paths of yoga such as bhakti, karma, jñāna, rāja, tantra, karma, kuṇḍalinī, and so on?

Prabhuji accepts all the different yogic modalities as integral paths of Retroprogressive Yoga. If we wish to prepare a delicious meal, we will need the correct ingredients and the recipe explaining the preparation process. Time and interest are also required to carry out the task successfully. In the same way, Retroprogressive Yoga combines the different yogic modalities in an integral way. Sadhakas, or “aspirants,” should receive from their master the appropriate combination according to their particular situation.

Shri Shri Radha-Shyamasundara Mandir

What is the need for a temple like the Śrī Śrī Radha-Śyāmasundara Mandir in the Avadhutashram?

A temple constitutes a place where human beings gather with a selfless spirit and devotional attitude to worship God. It is the proper place for the practice of bhakti-yoga. It is a place capable of elevating us to the recognition of consciousness. Seeing the deities, praying, and leaving a donation are pious acts traditionally done when visiting a temple. A true mandir is not only a religious site, but also a spiritual one. There are many schools, colleges, institutes, universities, and educational institutions. However, temples are not only capable of informing us, but also of transforming us.


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Creating the Perfect Candy Buffet

Posted October 5, 2016

It’s October! The beginning of the Holiday Season is upon us…and with it party after party…after party. We here at love a good party but, are the first to admit that our events are usually not Pinterest worthy. Thanks to a little help from I am happy to… Read More »

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Devendra Pagnis is Director – Analytics and Global Data Management for Colgate-Palmolive’s Global Business Services. He joined Colgate 25 years ago and has had the opportunity to work across various functions and roles with increasing responsibilities. Devendra brings diverse experience having been part of . and leading teams across Asia , Europe and the Americas.
In his current role, he works closely with Colgate’s Analytics and Global Data Management Centers of Expertise to provide Analytics and data services to Colgate’s business teams across the world.
Devendra manages the overall relationship with Analytics partners including facilitating the governance and fulfillment of analytics requests. As a member of Colgate’s Analytics Council, he is responsible for analytics talent development and delivery of solutions in support of Colgate’s analytics roadmap.
Prior to this, Devendra was part of Colgate Palmolive’s Information Technology organization, in the role of Director for Software Applications/Systems.
Devendra has completed Electronics Engineering and Masters in Marketing Management from Mumbai University. He loves watching and analyzing football games and is an avid reader.

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Cavity protection

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AMD Ryzen 9 5950X Processor

  • Model: Ryzen 9 5950X
  • Speed: 3.4GHz Up to 4.9GHz
  • L2 Cache: 8MB, L3 Cache: 64MB
  • Cores: 16, Threads: 32
  • Up to 3200MHz DDR4 Memory

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Basic Information
Base Frequency 3.4GHz
Maximum Turbo Frequency Up to 4.9GHz
Cache Total L2 Cache: 8MB
Total L3 Cache: 64MB
Cores 16
Threads 32
Default TDP 105W
Supported Technologies AMD “Zen 3” Core Architecture
AMD StoreMI Technology
AMD Ryzen Master Utility
AMD Ryzen VR-Ready Premium
Memory Specifications
Maximum Speed Up to 3200MHz
Type DDR4
Graphics Specifications
Base Frequency 3.4GHz
Warranty Information
Manufacturing Warranty 03 years warranty (No Warranty for Fan or Cooler)

AMD Ryzen 9 5950X Processor

Power up your computing experience with the AMD Ryzen 9 5950X 3.4 GHz 16-Core AM4 Processor, which features 16 cores and 32 threads to help quickly load and multitask demanding applications. Designed for socket AM4 motherboards using the powerful Zen 3 architecture, the 7nm 5th generation Ryzen processor offers significantly improved performance compared to its predecessor. With a base clock speed of 3.4 GHz and a max boost clock speed of 4.9 GHz in addition to 64MB of L3 Cache, the Ryzen 9 5950X is built to deliver the performance needed to smoothly handle tasks ranging from content creation to immersive gaming experiences. Other features include support for PCIe Gen 4 technology and 3200 MHz DDR4 RAM with compatible motherboards. This processor has a 105W TDP (Thermal Design Power) and does not include a cooling solution. Please note that it does not have an integrated GPU, so a dedicated graphics card is required.

Precision Boost 2

AMD Ryzen processors monitor the system’s energy consumption, temperatures, and other factors to automatically raise clock speeds, allowing applications to perform faster.

Precision Boost Overdrive

Precision Boost Overdrive technology takes advantage of your compatible motherboard’s design to boost clock speeds higher and for longer periods of time. It also allows you overclock the processor at the touch of a button.

AMD StoreMI Technology

AMD StoreMI technology helps to improve load times and overall system performance by combining solid-state drives and mechanical hard drives into a single hybrid storage drive. Frequently used files and programs are cached onto the fast SSD while other files are stored on the high-capacity HDD.

AMD Ryzen VR Ready Premium

Ryzen VR Ready Premium processors are designed to meet or exceed the recommended specifications from the top HMD manufacturers, including Oculus Rift, HTC Vive, and Windows Mixed Reality for smooth performance.

Personalized Performance

The AMD Ryzen Master Utility provides you with multiple custom profiles to store CPU, GPU, and DDR4 memory configurations. Use it to configure performance parameters for the active cores and adjust memory times. You can also optimize general performance or fine tune your favorite applications.

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Monitor your system in real-time using the AMD Ryzen Master Utility, which features a histogram of per-core clock rates and temperature, including average and peak readings.

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