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Don’t Get Distracted: Value-Based Care Is Here to Stay—and Large Employers Are Leading the Way

A Conversation with GE’s Virginia Proestakes

March 11, 2017
by Mike Dunkley

The future of healthcare is value-based, and it’s being forged by large employers innovating in real time. General Electric, for instance. Their innovative approach to providing affordable knee and hip replacements for their employees—GE has partnered with New England Baptist Hospital—is a significant case study here. In bypassing insurers to work directly with a hospital, GE is doing something very new, and certainly brand-new in Boston. Virginia Proestakes, GE’s Director of Health Benefits, engineered the Baptist program, and on an afternoon in early March, I called her up to ask her a few questions.

When it comes to value-based healthcare, one has to consider both outcomes and cost. How does GE approach these?

Both cost and quality are equally important to GE. “Where you go [for treatment] matters,” said Proestakes. Employees want to go hospitals where doctors are expert enough “to recognize the subtleties of your condition. You don’t want to go to a generalist if you have a very specific condition or problem.” If you receive a scary diagnosis, “you don’t want to be limited to just [healthcare providers in] your backyard.”

Additionally, in order for employees to benefit from the cost element of the value equation, GE waives the employee deductible for these folks.

What, then, is GE’s role in the shift towards value? Is this a real driver of change?

“I think it is a driver of change,” said Proestakes. “Everybody approaches bundles differently.” She noted that in the Centers for Medicare and Medicaid Services (CMS) model, “things don’t get bundled until the end of the episode of care.” In the GE model, providers know “before they even see a patient what they’re gonna get as a payment—we guarantee payment—and that really doesn’t change unless something untoward happens in the course of treating a patient.”

The future of healthcare is value-based, and it’s being forged by large employers innovating in real time.

GE has a warranty with their various hip-and-knee deals. If anything goes bad after a certain period following the procedure (usually 60 days, but not always), the hospital will treat the patient, but not bill the employee or GE for the additional cost.

Proestakes talked about a GE program called Health Coach, which according to the GE website, features “specially trained nurses backed by a team of doctors” and provides medical and benefits support to GE’s workers. The Health Coach program creates the foundation for much of the work she’s done. And in that work, Proestakes said, she keeps bumping up against the idea of “narrow networks.” She’s not a proponent.

GE wanted their 100,000 employees to have the opportunity to go where they needed to go to get the best care for them. Their strategic decision was to focus on the top conditions, and to designate centers of excellence, and negotiate bundled payments with these facilities.

Why hips and knees?

Hip and knee replacements were, Proestakes said, “the number-one reason,” after having babies, that GE employees were getting hospitalized for surgery across the country.

GE is strategic about the kinds of bundled deals they cut. “The key is we have to go for an area or a service where we have critical mass,” she said. “We have to negotiate, particularly with maternity. Not many moms are gonna want to get on a plane to have a baby.”

With all the talk about GE employees traveling to get specialized care, I had to ask about how the company thought about things like employee engagement and productivity. “We don’t monetize productivity,” said Proestakes. “We look at days away from work but we don't factor that in or monetize that when we look at these initiatives.”

This seemed a human-centered response, and it made me wonder about other organizations and how they look at their employees’ health plans.

You don’t want to go to a generalist if you have a very specific condition or problem.

Another element of wonder: Why did GE choose Baptist? Did it have anything to do with the former’s upcoming move to Boston, which will make it our city’s biggest company?

Turns out, this initiative was not really related to GE’s geographical shift. If anything, they saw a secondary benefit in that Baptist was a convenient hospital for New England’s existing employees. Which made me think about intention: Was this program woven into a larger GE innovation strategy?

“Senior management is looking for us to innovate,” she said, just as they would with any other division of the company.

Turns out, GE has negotiated seven different orthopedic deals around the country, “each with its own particular flavor.” She said that “about 40 percent of hips and knees go through them.”

GE is “encouraging moonshots” while simultaneously focusing on “things are aren’t common to us or common to the industry,” she said.

“We’re trying to restructure the company to be very different than how it behaved 20 years ago, or even a year ago,” Proestakes said. “We have to try new things and innovate in ways that basically weren’t contemplated ever before.”

And where else in healthcare is the company innovating for employees?

GE is doing some great things in maternity, beyond delivery: “We have a new program that helps breastfeeding moms who travel for GE in the United States ship their breast milk back home to their babies,” she said, and GE’s paid parental leaves are “sort of leading edge compared to other employers.”

Bundled specialty pharma is another area. GE is partnering with United Healthcare, which owns assets in home therapy infusion services. “Giving them a bundled payment in order to treat these people who have things like immune deficiencies and arthritis.”

Proestakes admitted that she and GE, as a large employer, are “not necessarily fans of the fee-for-service model,” and they’re hardly alone here. “I think that bundled payments are here to stay.”

Image by Phalinn Ooi/CC/by-sa/2.0

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architecture & design studio

A customised, commercial space is an opportunity to express your business’ unique identity and story.

It also determines how you interact with your customers, and how your customers experience and feel towards your business. Through a bespoke design grounded in your core values, we create enduring, meaningful spaces. It is important that each building reflects the originality of your commercial ethic and character, and resists those superficial design trends that often scream uniformity.

Key Commercial Projects

It is my belief that the project’s success can mainly be attributed to Core Collective’s tireless commitment to the project and their availability on-site to ensure the client’s design intent was achieved. Their relationship management, attention to detail and ability to provide information quickly and efficiently, provided us with a confidence that is rare in the industry.
— Peter Ventieri, In2Construction, on The Press Hall

Like in all good relationships, we start with conversation. We’ll ask the curly questions up front.

What is your business’ philosophy?

What do you want from the space?

Who are your customers and what do they want?

Who are your employees, and what do they need from the space?

What emotions and energy do you wish to convey?

What are the functional requirements for the space?

How might the space evolve in the future?

Also like all good relationships, it pays to know what you’re in for. We discuss cost and time early on, mapping the way forward with a project plan and a timeline for building approvals and expenditure. Delays are a drag for everyone, so we aim to expedite common speed bumps (eg, authority approvals) by starting this process early and talking with the right people.

We also work with a cost consultant to ensure that your budget is spent wisely, maximising value.

This kind of round-table process results in a design that is an informed, efficient and cohesive expression of your business’ mission, one that communicates to your customers exactly who you are.

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Call Center & Customer Service

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- www.counterpunch.org - https://www.counterpunch.org -

Bad Teacher and Why We Need Her

I miss school, now that it’s out, mostly because I spent a lot of time this year thinking and writing about it for a Star series on public education. Luckily, there’s the summer movie, Bad Teacher. People like me, who are on the left or, as Alexander Cockburn terms them, “pwogwessives,” are supposed to hate it because it portrays teachers negatively at a time when they’re under right-wing attack for being the chief cause of U.S. education failure. But I adored the film.

Cameron Diaz is the bad teacher and she’s very funny. She went into teaching for “all the right reasons,” like summers off. In fact, the best teachers I know say that helped motivate them and I don’t see what’s bad about it: everyone deserves decent holidays. Nor how it differs from CEOs getting bonuses for making profits or athletes for making the playoffs. Oops, is that the problem?

She yearns for a boob job so she can snag a rich husband in a singles bar and quit teaching, but it costs too much. She doesn’t know her kids’ names (“You and you: hold that girl.”) Then she finds out there’s a big money prize for the teacher whose students score best on statewide tests so she steals the test, gives her students the answers, and wins the money.

I ask you: Is this an attack on teachers? No, it’s an attack on the rotten system that overstresses test results and undermines real teaching, as if education is a competitive marketplace like the stock exchange that you can quantify in numbers and dollars. It’s satire, stupid. It’s in the tradition of classical theatre like Moli?re’s plays in the 1600s. He wrote about religious hypocrites and inept doctors to expose the forces that produced and encouraged them. He portrayed his targets in order to dissect them. I’ve always felt the best U.S. sitcoms, from Mary Tyler Moore to Two and a Half Men, are Moli?re’s equal. Try the episode where Charlie’s family has dinner at his housekeeper, Berta’s, for a brilliant comedy of manners. Bad Teacher is big-screen sitcom.

Positive or inspirational films tend to be boring and to leave you (or at least, me) feeling manipulated. That warm gooey feeling is also slimy. If you pine for To Sir with Love, or Stand and Deliver, rent them.

Come to think of it, Moli?re was criticized too, though from the right, not the left. His answer, echoing down through the ages, was: “The comic is the outward and visible form that nature’s bounty” ? i.e. reality ? “has attached to everything unreasonable, so that we should see, and avoid, it.” Cameron Diaz couldn’t put it better, or maybe she could. Moliere also sometimes let his characters grow, or show ambiguity, versus being static targets.

Diaz has said she likes her character, Elizabeth Halsey, because she is totally unredeemed in the film, but I think that’s just something the PR people told her to say to sound devilish. In fact, her teacher is redeemed. She rejects the boob job, partners up with an impoverished gym teacher who has a sense of humour of gold, and returns to school, not in a classroom but in guidance, where she can really help kids by being her street-smart self. Of course, this is Hollywood. In reality, there likely won’t be many gym or guidance positions left, as most resources in the system continue to be directed at bumping up test scores while paying minimal attention to those complex entities, kids.

Real life often trumps art, even when the art is satirical. Yesterday came news from Atlanta, Ga., that 178 teachers and principals apparently “cheated on standardized tests to inflate student scores” due to “pressure to meet score targets.” The system’s boss, who was named National Superintendent of the Year in 2009, covered up and punished whistleblowers, going back to 2001. Now she’s no longer in the position. Wow. Maybe next summer’s follow-up will be Bad Principal or Bad Superintendent, to go along with yet another Pirates of the Caribbean. Moli?re never minded building on his successes. It’s part of the learning process.

Rick Salutin is a columnist for The Star, where this article first appeared. He can be reached at  ricksalutin@ca.inter.net


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Show Me Your Papers: Supreme Court Legalizes Arbitrary Searches

Less than three weeks after Hurricane Katrina plowed into New Orleans, George W. Bush’s Supreme Court nominee (current Chief Justice John Roberts) was asked, in the course of Senate hearings, to discuss his opinion concerning the power and role of judges. Roberts memorably responded that, in his view, judges were like umpires, or referees. Rather than legislating from the bench (making laws), judges, he said, should limit themselves to determining whether or not people or issues fell in or out of the bounds of the law. Willfully or not, Roberts ignored the intensive and extensive degree to which, in broadening and narrowing exceptions to the law, inter alia, judges do not merely call plays, but actively shape and reshape the law. Judges, however, are not alone in determining the law’s limits, or lack thereof. Judges and legislators are joined in their respective law-shaping practices by the enforcers of the law, the police, as well. Indeed, it is no secret that the police do not merely enforce the law as it exists on the books (as though there’s agreement concerning what the law on the books even is).

Often confused, contemptuous, or simply cynical about the laws they are employed to enforce, police regularly wind up, intentionally and unintentionally, enforcing distortions of the law. And, not unlike the acts and decisions of dictators, the unlawful acts and decisions of the police often become law. If and when the arbitrary re-positioning of the goal posts and boundary lines of the law that constitutes much of police work is challenged in the courts, judges can condemn these transgressions as violative of the law, reinforcing the pre-altered boundary line. Judges also, often, approve of challenged police acts as being necessary to the contemporary demands of policing, inspissating this repositioning of the boundary line of the law.

In overturning the holding of the Utah Supreme Court, and approving of Utah detective Douglas Fackrell’s illegal stop, in Utah v Strieff the US Supreme Court limited the Fourth Amendment of the US Constitution. Expanding the power of police throughout the country, and narrowing the right of everyday people to be free from unreasonable searches and seizures, the Court redrew the parameters of the law in a manner that has grievous implications.

Prior to this week’s decision, in order to legally stop and ask a person to see her or his identification, and search for warrants, police needed a “reasonable suspicion” that that person was involved in criminal activity. Now, however, the law is different. As Justice Sotomayor wrote in her highly praised dissent: “This case allows the police to stop you on the street, demand your identification, and check it for outstanding warrants – even if you are doing nothing wrong.”

The facts in Strieff are straightforward enough. South Salt Lake City narcotics detective Fackrell was surveilling a residence (that an anonymous tipster suggested was involved in drug sales) when Fackrell saw Edward Strieff leave the building. Although he lacked reasonable suspicion, and the state concedes this, Fackrell stopped Strieff and asked to see his identification. None, including Clarence Thomas, who wrote the majority opinion, dispute the conclusion that the stop was conducted illegally. In the course of this illegal stop, Fackrell conducted a warrant search on Strieff, discovered a traffic warrant, and arrested him. Searching Strieff, Fackrell discovered contraband. The issue before the Court was whether the contraband, discovered in the course of an illegal stop, should be excluded from the evidence, in conformity with the “fruit of the poisonous tree” doctrine that evidence discovered in the course of an illegal search should be excluded.

Before it arrived before the US Supreme Court, the case was decided by the Utah Supreme Court. Honoring longstanding legal precedent, the Utah Supreme Court held that, since the stop was illegal, all evidence that derived from it was “poison fruit,” and should be excluded. The US Supreme Court, however, reversed the Utah Supreme Court. Arguing that the case meets an exception to the fruit of the poisonous tree doctrine, the majority held that the discovery of the traffic warrant (though a necessary link connecting the illegal stop to the contraband-yielding search) sufficiently attenuated, or separated, the illegal investigatory stop from the evidence, rendering the latter admissible. Not only did the Utah Supreme Court err in excluding the illegally discovered evidence, the majority held; the US Supreme Court also held that Fackrell’s discovery of the warrant retroactively nullified the illegality of the initial stop as well. If this sounds highly illogical, that’s because it is. As Sotomayor summarized the new law in her dissent: “This is a remarkable proposition: The mere existence of a warrant not only gives an officer legal cause to arrest and search a person, it also forgives an officer who, with no knowledge of the warrant at all, unlawfully stops that person on a whim or hunch.”

Among the interesting details of the Supreme Court’s holding in Strieff is that the post-Scalia Court’s four conservatives (that peculiar variety of conservative whose professed respect for small government, states’ rights, and legal precedent is time and again shunted aside in favor of the aggrandizement of the police, military, and business) were joined by Steven Breyer. Had he sided with the Court’s liberal wing, as he typically does, the result would have been a 4-4 tie, and no change to the Fourth Amendment would have resulted. But this was not to be. A Clinton appointee, Breyer sided with Thomas, Alito, Kennedy, and Roberts, illustrating the degree to which, nearly 16 years after leaving the White House, Clinton’s destructive legacy (which includes NAFTA and the gutting of the working class, financial deregulation, his poverty-exacerbating welfare reform, as well as his 1994 Violent Crime Control and Law Enforcement Act, which implemented mandatory minimum sentences, along with the expansion of prisons, and death penalty enhancement, among other ongoing harms) continues to reverberate.

Green lighting arbitrary police harassment, Strieff poses disturbing implications on multiple levels. Among the most troubling of these is the Strieff ruling’s relation to immigration law, its “show your papers” implications removing nearly all foreseeable obstacles to the legalization of “ethnic cleansing” via federal forms of racist laws like Arizona’s notorious SB 1070. Opening the door widely to unaccountable racial profiling, the Fourth Amendment-squelching precedent in Strieff could easily allow such laws to spread across the territory – a term that, many argue, derives from the Latin territorium – described by the ancient Roman geographer Pomponius (in the Digest of Justinian) as “the sum of the lands within the boundaries of a community [civitatis]; which some say is so named because the magistrate of a place has the right of terrifying [terrendi], that is exercising jurisdiction, within its boundaries.”

With Strieff, the Court has redrawn these boundaries, right into people’s bodies, allowing the police (only the most visible administrators of the global territorium) to arbitrarily demand a person’s papers in a manner that, until last week, wasn’t regarded as characteristic of a police state so much as it was regarded as emblematic of a caricature of one.

More articles by:

Elliot Sperber is a writer, attorney, and adjunct professor. He lives in New York City and can be reached at elliot.sperber@gmail.com and on twitter @elliot_sperber

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California Inches Closer to Joining Giant Electricity Co-Op

500 kV Three-phase electric power Transmission Lines at Grand Coulee Dam. (Photo by Varistor60 via Wikipedia Commons)

SACRAMENTO, Calif. (CN) – A California Senate panel advanced a bill Tuesday that would merge California into a regional energy market, despite environmental groups remaining split on the measure and labor groups in opposition.

Assembly Bill 813 would lump the Golden State with up to 13 western states in the Regional Transmission Organization, a wholesale electricity market stretching from Canada to Baja California.

The measure would also turn over decision-making power for California’s portion of that energy transmission chain from the nonprofit California Independent System Operator to the multistate organization.

Thirty-eight separate operators known as “balancing authorities” stretch across the interconnected western United States and make up approximately 20 percent of all the electric capacity in the United States and Canada, according to legislative analysis of the bill. The balancing authorities ensure a real-time balancing of power supply and demand across the region.

California’s current system board, appointed by Gov. Jerry Brown, would be suspended and any regulations adopted by the multistate body would be subject to approval by the Federal Energy Regulatory Commission. Four out of five commission board members are appointed by President Donald Trump.

The 4-2 vote by the state Senate Judiciary Committee to approve AB 813 did not reflect the considerable amount of debate on the bill. Committee chair Hannah-Beth Jackson, D-Santa Barbara, voiced concern over turning the Legislature’s oversight of the state’s energy operator over to the feds.

“If we lose the last layer of protection we will have spent decades trying to create renewable energy future that will be obliterated,” said Jackson, who cast the lone vote against the bill. “It’s critical that we maintain protections against an administration has shown it will undermine [California’s] energy and environmental goals.”

Assemblyman and AB 813 author Chris Holden, D-Pasadena, told the committee the federal commission operates under powers limited by the Federal Power Act.

Holden also said that AB 813 would compel California’s system operator to adopt open smeeting and record-sharing practices that comply with the Open Records Act.

The system operator supports AB 813 and said in a recent study that a regional power grid market could generate $1 billion to $1.5 billion in annual benefits to California ratepayers.

The independent agency oversees 26,000 miles of transmission and a $10 billion-plus annual market that delivers 80 percent of the state’s electricity, according to its website.

The bill now moves on to the state Senate Appropriations Committee.

Gov. Brown and several prominent environmental groups including the Natural Resources Defense Council and the Environmental Defense Fund also back the measure, claiming it will cut costs for consumers and bring more clean energy into the state. They also hope the plan will phase out fossil fuel plants.

Opposing environmental groups fear a regional grid could increase fossil fuel input, particularly from coal, into California’s energy grid.

Holden told committee members the bill would allow for electricity to be traded “more efficiently across state lines” while allowing the state to export unused renewable energy from sources such as solar and wind energy producers.

Lauren Navarro, a policy manager with the Environmental Defense Fund, told the committee the bill would “cement California’s leadership” in the national movement to supply states with clean energy.

“The bill enables us to use more clean energy and take dirtier resources off the grid in other states,” Navarro said. “[California’s] renewables are less expensive and will be chosen in other markets. This will help states transition to clean resources.”

But opponents of the bill – at least 65 of which are listed in the state analysis – say deregulation of the market threatens the state’s transition away from reliance on fossil fuels, opens it up to malicious speculation and would cost residents billions of dollars in fees.

Opponents of the bill include the California State Association of Electrical Workers, Food and Water Watch, the California Labor Federation and the Southern California Public Power Authority.

Jaime Court with Consumer Watchdog said lawmakers caved to pressure and allowed the state’s environmental laws and renewable energy goal “on the chopping block.” Court said the bill would give away California’s control over its own grid to western states dominated by coal.

Consumer Watchdog released a 48-page report, “Betting Against the House: How California’s Leaders Could Gamble Away Our Energy Future on a Western Power Trading Casino,” on June 18 that said AB 813 undermines California’s control of carbon emissions and pollution from power plants and will lead to the overturning of California laws.

If passed, the bill would end California’s control of its own electricity market and force the state to buy power generated in other coal-heavy states, the report said.

Matt Freedman, attorney for The Utility Reform Network, said he was doubtful that California could every truly leave the regional body, as proponents have promised, if disagreements arise.

Freedman said legislators would be giving up control of the state’s “clean energy goals” by approving the bill.

“Your role [as legislators] would be marginalized and any bill passed would be trivial,” Freedman said. “[The new] CAISO would be free from control by the state.”

Ralph Cavanagh, energy program co-director at Natural Resources Defense Council, said there is an “unconditional right of exit” for all state members of the proposed regional body.

State Sen. John Moorlach, R-Costa Mesa, said the debate on AB 813 “aroused a lot of memories” of the state’s 2000-2001 energy crisis.

In those years, the state suffered a shortage of energy supply caused by market manipulations and capped retail electricity prices which led to multiple statewide blackouts and the collapse of one of the state’s largest energy companies.

The crisis also led to a successful recall of then-Gov. Gray Davis, in part due to voter outrage over his handling of the situation.

“We saw [Davis] turn a big problem into a mess,” Moorlach said. “Names like Enron are coming back to my mind.”

Enron was a U.S. energy-trading and utilities company that facilitated one of the biggest accounting frauds in history, using false narratives to inflate revenues. It was also implicated in the state’s energy crisis.

Moorlach said he was concerned the state would be charged for sending leftover energy from renewable sources such as solar power to other states.

Cavanagh, who backed Enron in a 1997 deal that saw the ill-fated company acquire Portland General Electric, told Moorlach he was identifying part of the “fragmentation problem” with the state’s current grid.

“We often have to turn off solar on sunny days,” Cavanagh said. “This bill would bring revenue to California by selling solar to other states who would in turn save money.”

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I quit my job 2 years ago and I don't regret it

2 years ago today, I walked into my boss's office at NASA and told him I was quitting. I still remember that gloomy October day - I was absolutely terrified and absolutely excited at the exact same time. I loved the people I worked with, and when I spoke to my boss, I had to hold back the tears. After all, I was leaving a family, of sorts, and also leaving the opportunities and career path I would have had with them. But I knew I was doing the right thing. Day in and day out, my skills and talents collected cobwebs. I went through the motions to get that paycheck every week. I tried hard to convince myself that I was doing the right thing for so long. "They have great benefits", I would say, or "it's a really low-stress job and the people are great". Or even, "the job security is awesome". But I couldn't change how I felt - job security did not equal job satisfaction.  At the time, I had plenty of excuses for why I was leaving. I used my startup as an excuse, and as true as that was, it wasn't the real reason. I wanted to make a difference - I knew I wasn't cutout to be isolated in a lab somewhere running tests. As much as I respect the people that thrive on that type of work, I knew it wasn't me. I realized that even though I always had high marks on performance reviews, I got lazy...professionally. I wasn't involved in any groups outside of work because I didn't care. I was disengaged. I stopped trying to learn and challenge myself. This was a dangerous place to be, and I see now that I had to leave to discover my true potential So I quit. And I never looked back.

I was fortunate to have a strong network. It's no mystery, my network is the reason I've been able to survive on my own. I made a relatively easy transition into a another job with a small consulting firm. Even though I'm no longer with them, I'll be forever thankful, because that job is where I got to discover my strengths and where I fit in the workplace. I discovered I had the skills, talents, and passions to fit in the role of a relationship builder and advocate (the dirty word for that is sales). But I found that I could make sales my own. It's not a dirty word for me - I loved building relationships and trust with customers and the employees that I worked with. I had found my place in the world, and now that I knew that, I could move-on to another job where I could use those skills to support a field I was passionate about - startups.

So I quit again. I realized that you can only discover your true potential when you let go of the safety nets in your life.

I think our generation has trouble with patience. We feel uneasy in a place of uncertainty so we tend to jump from one job directly to another without thinking about it. I did the opposite, and I am so glad I did. I took months doing nothing but networking, exploring, and learning about the field I love (entrepreneruship). I scheduled hundreds of meetings, and met hundreds of new people. I was a sponge. I wanted to know everything I possibly could about the field I wanted to work in, and it paid off. I eventually found a way to use my skills and talents and also work in the field I am passionate about (supporting entrepreneurs).

But I never planned for it.

I am a big fan of knowing what you want in life and what you're good at, but I'm not a big fan of plans. I find plans restrictive. Had I attempted to plan my career, I would have missed out on just about everything I've done since I left my job.

I let go of my financial planning. I know that sounds like a horrible idea, but to clarify, I let go of my obsession for investing I had acquired while working a regular job. I learned that like most things, you have to invest in the present to get a payoff in the future. So I invested in my career and myself. I drained my savings and my Roth IRA to take the time off I needed to find my next role.  Since I let go of the safety net and discovered my own potential, I am confident I can manage my finances. But I don't have to make a career of it. I was investing in myself today so I can live 70+ fulfilling years rather than investing in myself in 70+years and not living the way I want until then. I don't regret it.

I let go of my obsession with my pay rate temporarily, understanding that the payment I'm getting from the job I do now is worth more than millions. Being truly satisfied with your work and getting the non-financial payouts from the people you help is priceless. I let go of the high-paying salary I had after I left NASA and took a massive pay cut. I could barely survive, but I learned from that. I learned what is really important to me. And I'm happier. I don't feel like I'm working for money, I'm working for a greater purpose. And I know it will pay off. I know if I needed to I could go get a job. And I know one day I'll climb back up that salary ladder. But for now, I don't regret it.

So, if I could summarize these past 2 years and give advice to those reading this, here is it:

1. Decide what you're good at. What are those talents and passions where when you're using them, you feel absolutely fantastic.

2. Decide what you're passionate about and what you want to work for. Is it a particular industry? A special cause? A unique people-group? Find a way to work in that field and use the skills from #1

3. If you're not in the job from #2 using skills from #1, leave your current job, take some time off, and invest in yourself. It will be worth it

You won't regret it. :)


text:
A CRIMINAL court and two civil courts in Warwickshire are being axed to save money.

Rugby is losing both its magistrates court and county court, while Stratford’s county court will also shut.

The closures form part of plans to slash the number of courts in England and Wales from 530 to 388 to save £42 million a year.

The only magistrates and county courts in Warwickshire are now at new ‘justice centres’ in Leamington and Nuneaton.

The coalition government says the closures are necessary to save money and reflect population and transport changes since the buildings opened in the 1970s. The Ministry of Justice said Rugby Magistrates Court was used just 80 per cent of the time while Rugby County Court sat just 64 days a year.

Staff at all three courts will be transferred to either Leamington or Nuneaton.

MP Mark Pawsey (Con, Rugby) opposed the closure plans.

He said: “It’s disappointing and regrettable that the courts are closing.

“I argued they should be kept open for convenience, but with the amount of money spent on the two new justice centres in Warwickshire, it was always going to be difficult.”

Remaining magistrates courts will offer people the chance to give evidence by video link, and local ‘justice panels’ could be set up for low-level cases.

Justice minister Jonathan Djanogly said: “Our court estate has simply not kept pace with the changing nature of our society or with the demands modern society places on our justice system.

“An estate of over 500 court buildings is not now necessary or sustainable, nor is it a reasonable expense for the taxpayer.

“We are closing the worst courts in the estate so we can concentrate our limited resources on the best ones.

“There will be longer journeys for some to their closest court but we should not operate courts just to shave minutes off a journey that many will never need to make.”

Keir Starmer, director of public prosecutions said: “We believe a smaller number of magistrates court centres will bring greater efficiencies and make savings.”


text:
Links to Learning Program

  • The Assistance League® of Mid-Missouri (ALMM) is a volunteer service organization that supports philanthropic projects that meet community needs.  Links to Learning is a competitive program sponsored by ALMM that provides funding for projects designed and implemented by Columbia Public School teachers.

    Applications for 2018-2019 Accepted

    May 15, 2018  - August 22, 2018

Technology Guidelines

  • Technology requests must be listed in the IT Purchasing Catalogue or be accompanied by an email from IT stating that it is compatible with CPS technology.
    The IT Purchasing Catalogue can be found at:
    • Technology Services - Purchasing
    • Near the top of the page under "Technology Services Requisition Process" click on "Welcome to Technology Services Online Purchasing"
    • Click on the category name to expand or collapse listings

Get the Word Out

  • Want to advertise the Links to Learning program at your school? Post the Links to Learning information flyer where it can be seen.


text:
Three Blind Mice

By  Pam Sicely

size: 5" tall

  • Three Blind Mice

  • Recycled toilet paper tubes, three
  • Felt, scraps: pink, gray
  • White craft foam, scrap
  • Chenille stems: three gray, one black
  • Black construction paper, scrap
  • Black pom-poms, three
  • Gray yarn, small amount
  • DecoArt Americana Acrylic Paints: Slate Grey, Cadmium Yellow
  • API Crafter’s Pick The Ultimate! Glue

  • Plaid Bucilla Doodle-Loom pom-pom maker
  • Hole punch
  • Scissors
  • Ruler
  • Paintbrush
  • Toothpick
  • Newspaper (to cover work surface)

Pattern - Three Blind Mice

  • 1. Print and cut out patterns.
  • 2. On covered work surface, paint feet Slate Grey and cheese Cadmium Yellow. Paint toilet paper tubes (bodies) Slate Grey. Let dry.
  • 3. For noses, measure and cut three 5" gray chenille stem lengths. Curl lengths into rings.
  • 4. For hair, use pom-pom maker to make three pompoms from gray yarn.
  • 5. Glue feet on bottom of bodies. For tails, cut three 6" gray chenille stem lengths. Poke tails through bottom of bodies; bend end on inside.
  • 6. Glue hair and noses on heads. Glue inner ears on ears. Glue ears on heads.
  • 7. For canes, measure and cut two 5" black chenille stem lengths. Bend ends. Glue hands on front of bodies and canes and cheese on hands.
  • 8. Glue eyeglasses above noses.


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Topic: Durian cozy - with irony (img heavy)  (Read 15762 times)
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« Reply #30 on: September 10, 2008 07:54:54 PM »

Does durian have a strange taste? Depends on who you ask, I suppose! The texture is rather creamy, like a good custard. The taste - well, for aficionados it is great, for others, strong and nasty.

I like the lunch basket cozy as well - I had given up using that basket because stuff fell out the bottom - but now it is revived! Bright colors too! Don't know how they will hold up in the rain, though - didn't use it this morning, afraid it might run all over my clothes!

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« Reply #31 on: September 18, 2008 12:42:01 PM »

haha that is so funny. i hate durian! my mother is from thailand so i grew up with it and hated it. i just went to thailand this summer so durian stench was everywhere. mangosteen cozy!
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« Reply #32 on: August 28, 2009 05:49:57 PM »

I love it! I spent the first 18 years of my life in  thailand and my whole family LOVES durian. One of these cozies would have been so helpful for bringing it home! I can't tell you how many times I've gotten my fingers pricked with them!

The frozen ones are pretty tasteless - and that's the only way I can get them here in the US now. I miss all my thai fruit! Durian and lychees, and  mangos and papaya! Oh, and mangosteen too!

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« Reply #33 on: August 30, 2009 07:19:41 PM »

Do NOT forget the mangosteens! They're some of my favorites! Also the Lumyai (no English) ... guess you'll just have to come back and taste the goodies all over again!

My dad found the frozen ones weren't too bad if he took them out of the freezer, let them thaw and then put all the sections into paper towels to sop up the extra moisture. Does help, he said, but nothing like a fresh one! Plus, those durian are Mong Tong, which are not the sweetest ones anyway, but the Thai prefer them because over the years they've gotten so they like them less flavorful and aromatic. Come on over and I'll find some Chinee and Kadoom for you!

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Welcome to the Internet's Biggest Little Collection of...

Chuck Norris Facts, Jokes, Quotes, & subtly Humorous Sayings!

[currently 101 astounding Chuck Norris facts and counting...]

about Chuck Norris   |    recent Google searches

submit your best Chuck Norris fact

When Mr T talks, people listen!Mr. T says: "Listen up, fool! Feel free to spread the gospel of my buddy Chuck Norris by copying a few of these awesome Chuck Norris jokes, facts, quotes, and sayings, and by sharing them with your friends, family, co-workers, and/or complete strangers. But if you do copy any of them, show my friend Chuck and my friends here at Cranial Borborygmus a little respect and include a link back to the original source here at Cranial Borborygmus ( If you don't include a link, well then someday you'll may hear a knock on your door, and you won't know if it's Chuck Norris knocking, or me and the A-Team, or just the pissed-off demented maniac genius who provides night security here at Cranial Borborygmus. So don't piss us off. If you copy any of these facts and jokes, then add a link back. Let others know where you found this great stuff. Thanks. And if you want to know an amazing, incredible fact about me, Mr. T, here's one: Did you know Mr. T has no hair on his testicles? Yeh, because hair doesn't grow on STEEL! OK, enough about me... back to my buddy Chuck... Remember to add that link if you copy any of these Chuck Norris sayings. And now keep on reading, and prepare to be awed... by the total awesomeness that is Chuck Norris!

1. A fear of confined spaces is known as claustrophobia. A fear of heights is known as acrophobia. A fear of spiders is known as arachnophobia.  A fear of Chuck Norris is known as logic.

2. Some kids write their names in snow with their pee. Chuck Norris can write his name in concrete with his pee.

3. Chuck Norris can do a wheelie on a unicycle.

4. If successfully harnessed for energy, a Chuck Norris roundhouse kick could provide the country of Sweden with power for 3 days, 8 hours and 14 minutes.

5. Chuck Norris can divide by zero.

6. Chuck Norris can speak braille.

7. Chuck Norris' calendar has no April 1st. Because nobody fools Chuck Norris.

8. If you spell Chuck Norris wrong on Google, Google doesn't provide its standard response, "Did you mean Chuck Norris?" Instead, Google simply responds, "Run. Run for your life. While you still have an infinitesimally small chance."

9. Chuck Norris once challenged the Hulk to an arm wrestling contest. It was agreed upon in advance that the loser would tattoo his complete body the color green.

10. Chuck Norris once challenged Superman to a race around the world. It was agreed upon in advance that the loser would have to wear tights for the rest of his life.

11. Not only is Chuck Norris's left testicle bigger than his right one, but his right testicle is also larger than his left one.

12. Chuck Norris can cut through a hot knife with butter.

13. Chuck Norris once ran an entire marathon that he could see what second place looks like.

14. Outer space exists because it's too terrified to be on the same planet with Chuck Norris.

15. There is no theory of evolution. There is just a list of creatures that Chuck Norris has allowed to live.

16. Archilles' weakness was his heel. Superman's weakness is Kryptonite. Chuck Norris's weakness is nothing.

17. A rattlesnake once made the mistake of biting Chuck Norris. After four extremely long days of agonizingly excruciating pain, the rattlesnake died.

18. Chuck Norris buys his pencils without erasers... because Chuck Norris never makes a mistake.

19. There is no such thing as global warming. Chuck Norris was a bit chilled, so he cranked up the temperature of the sun.

20. A Royal Flush beats any hand... except the hand of Chuck Norris.

21. It doesn't matter where Waldo is hiding... Chuck Norris will find him.

22. Chuck Norris gave Mona Lisa her smile.

23. Chuck Norris counted to infinity... three times.

24. The reason that Google can search for and find anything on the internet within milliseconds... is because it was taught how to by Chuck Norris. Norris just made Google promise that, unlike Chuck Norris, after Google finds something, it can't kill it.

25. If Chuck Norris dials long distance numbers, he doesn't get charged. In fact, if he needs money, he just holds up the phone and money falls out.

26. When Chuck Norris eats at KFC, he orders the whole roasted chicken... but he only eats its soul.

27. Chuck Norris invented the word "kill". He also invented the words "die", "beer", and "awesome".

28. Chuck Norris is so fast, he can sprint around the world and kick himself in the back of his head.

29. Chuck Norris can lead a horse to water AND he can make the horse drink.

30. Chuck Norris can slam a revolving door.

31. Chuck Norris's house has no doors. It only walls that he walks through.

32. Chuck Norris keeps his friends close and his enemies even closer... close enough to drop them with one swift round house kick to the face.

33. Chuck Norris can weld titanium with his breath.

34. Wilt Chamberlain says he slept with well over 10,000 women in his lifetime. Chuck Norris calls this "a slow Tuesday."

35. When you take the SAT, write "Chuck Norris" for every answer. You will get a perfect score.

36. The age old saying, "the grass is always greener on the opposite side of the fence" is generally true, unless Chuck Norris has been on the opposite side of the fence. In that event, the grass is will be stained red from blood and heavily soaked with tears.

37. A picture may be worth a thousand words, but the image of Chuck Norris is worth one trillion words.

38. Chuck Norris can't shave his whiskers; he must kick himself in the face, for the only thing able to cut Chuck Norris is Chuck Norris.

39. When Chuck Norris makes coffee in the morning, he grinds the beans with his teeth and boils the water with his rage.

40. Chuck Norris ordered a Whopper at McDonalds. He got it.

41. When Chuck Norris donates blood, he declines the syringe. He simply asks for a hand gun and a bucket.

42. Chuck Norris can drink a whole gallon of milk in five seconds.

43. The Bermuda Triangle was actually once known as the Bermuda Square, but Chuck Norris was a TV remote that he had misplaced, got mad, and roundhouse-kicked off one of the corners.

44. The TV show Survivor originally was supposed to be about marooning people on an secluded island with Chuck Norris. But when they attempted to shoot the pilot episode, there were no survivors, and the producers are afraid to go to the island to try retrieving the footage.

45. Chuck Norris doesn't have to bowl a strike. He simply knocks down one pin and the remaining nine pins faint.

46. Chuck Norris can touch MC Hammer.

47. Chuck Norris can understand women.

48. Chuck Norris played Russian Roulette with a fully loaded revolver. He won.

49. Chuck Norris is credited for inventing the Caesarean section method of childhood when he roundhouse-kicked his way out of his mother's womb.

50. Some time in the distant past, Chuck Norris came upon a huge, fierce bear. But when the bear spied Chuck Norris, the bear became so completely scared that all of its hair turned ghostly white, and it fled north in terror to the far reaches of  the arctic. Today, the descendants of this bear still have its white fur and are known as Polar bears.

51. There are no weapons of mass destruction in Iraq. Chuck Norris lives in Oklahoma.

52. Chuck Norris once swallowed a complete bottle of sleeping pills. They made him blink.

53. Chuck Norris is responsible for China's over-population problem. He hosted a Karate tournament in Beijing and all women within 500 kilometers became pregnant instantly.

54. Some people wear Superman pajamas. Superman wears Chuck Norris pajamas.

55. Tom Clancy pays royalties to Chuck Norris because "The Sum of All Fears" is the title of Chuck Norris' autobiography.

56. Chuck Norris does not have an oven, a stove, a microwave, or even a fireplace in his home... because revenge is a dish best served cold.

57. Chuck Norris invented a better mousetrap, but the world was too afraid to beat a path to his door.

58. Chuck Norris is suing myspace because that is the name for what he calls everything that is around you.

59. During World War II, the army initially wanted to name a newly developed battle tank the Norris tank,  but Chuck Norris decided the new tank wasn't tough enough to be associated with him, so the army named the new tank the Sherman tank instead. Since then, the Army has promised to develop another weapon that would be worthy of the Norris name, but to date, they have been unable to develop a weapon that is fearsome enough to bear the Chuck Norris name, though rumor has it that the MOAB (mother-of-all-bombs) almost made the grade.

60. Chuck Norris doesn't bleed blood. Chuck Norris bleeds magma.

61. Chuck Norris doesn't need a can opener. If he needs a can opened, he simply bites through the lid.

62. If a tree falls in the woods, does anybody hear it? Yes. Absolutely yes. Chuck Norris hears it fall. Chuck Norris hears everything. Chuck Norris even hear the quivering fear deep in your soul.

63. Chuck Norris doesn't worry about leaving his pickup truck headlights on, because he can jump start his pickup truck by connecting jumper cables to his biceps and then flexing.

64. Led Zeppelin may have sung the now famous song about the stairway to heaven, but Chuck Norris built the stairway.

65. On his birthday, Chuck Norris randomly selects one lucky child to be thrown into the sun.

66. Chuck Norris invented duct tape... and bubble gum... and the bikini.

67. Chuck Norris doesn't believe in France

68. James Cameron considered Chuck Norris for the role of the Terminator. However, upon reflection, Cameron realized that would turned the movie into a documentary, so he decided to choose Arnold Schwarzenegger instead.

69. Chuck Norris doesn't own a house. If he sees a home he wants, he walks into it, and the people living in it move out.

70. Actually, what President FDR really said was: "We have nothing to fear but fear itself... and Chuck Norris."

71. It is generally believed that a giant asteroid caused the dinosaurs to become extinct. The giant asteroid is also known by the name Chuck Norris.

72. Chuck Norris doesn't recognize the periodic table, because the only element Chuck Norris recognizes is the element of surprise.

73. Chuck Norris once tried skydiving, but afterwards he promised to never to do it again. One Grand Canyon is enough.

74. What they don't teach you in high school science class (but should)... The Laws of Physics are awesome and all, but even the Laws of Physics are subservient to the Supreme Law of Chuck Norris!

75. Chuck Norris can unscramble an egg.

76. If you hold the American flag up to the sun and look really closely, you'll see an image of Chuck Norris staring back at you.

77. Long ago, a horse was dumb enough to talk back to Chuck Norris. So Chuck Norris knocked the horse out with an uppercut to the jaw. The horse survived, and today its descendents are known as giraffe.

78. Duct tape can fix most things. Chuck Norris armed with a roll of duct tape can fix anything.

79. If at first you don't succeed, you aren't Chuck Norris.

80. The law of gravity for beginners: What goes up, must come down... unless Chuck Norris throws it up.

81. When Chuck Norris punches an unmovable object, the unmovable object moves.

82. Chuck Norris can start a fire by rubbing two ice cubes together.

83. If Chuck Norris gives you the finger, he is simply informing you of how many seconds you have left in your life.

84. No streets are ever named after Chuck Norris, because no one can cross Chuck Norris and live.

85. Chuck Norris can gargle peanut butter.

86. If life gives Chuck Norris lemons, he makes apple pie, and it's the best tasting steak you'll ever eat.

87. Bill Gates never gets a good night's sleep because he worries that Chuck Norris's computer may crash.

88. Chuck Norris once appeared on Celebrity Wheel of Fortune. He spun the wheel first. The rest of the show was spent waiting for the wheel to stop.

89. Chuck Norris can strangle you with a cordless phone.

90. The real reason Rosa Parks refused to give up her seat on the bus was because she was saving it for Chuck Norris.

91. Chuck Norris and Mr T walked into a bar. The bar exploded. That level of awesomeness cannot be contained by a building.

92. Chuck Norris makes his fresh brewed coffee by grinding the beans with his teeth and boiling the water with his rage.

93. At the beginning of time, there was nothing...then Chuck Norris roundhouse kicked that nothing in the face and told it to "Get a job". And that is how the universe began.

94. If you don't know the answer to something, answer "Chuck Norris." You will never be wrong.

95. Chuck Norris can squeeze a lemon and get orange juice.

95. When Dr Bruce Banner gets extremely angry, he turns into the Incredible Hulk. When the Incredible Hulk gets extremely angry, he turns into Chuck Norris. When Chuck Norris gets incredibly angry... run.

96. The Holy Grail has never been recovered because no one will ask Chuck Norris to give up his favorite coffee cup.

97. Chuck Norris can kill your imaginary friend.

98. Chuck Norris has never been charged with attempted murder, because Chuck Norris does not "attempt" murder.

99. Chuck Norris can hear sign language.

100. Aaron Rodgers can throw a football 80 yards. Chuck Norris can throw Aaron Rodgers 800 yards.

101. On the seventh day, God rested... and reflected. Then on the eighth day, He realized He could make the world even better, and he created Chuck Norris.

101  Excellent Chuck Norris Jokes and counting... yours could be next! :-)

Reader Submissions:

Submitted by Steve Shirar from Arkansas on Thursday, December 21, 2017
 Chuck Norris once parallel parked a train.

Submit your own best Chuck Norris fact, joke, or saying:

Do you know of an amazing Chuck Norris fact that should be listed on this page? Let me know below.
If your Chuck Norris fact is deemed worthy, it will be added to the list above.

Your name:
Where you are from (optional):
Your Chuck Norris fact:

recent Google Chuck Norris searches

Chuck Norris doesn't need to use Google. Chuck Norris knows what he wants, and he knows where to find it. But mere mortals do use Google to find this amazing page of amazing Chuck Norris sayings, and here are a few of the recent Google searches that landed them here...
 "chuck norris world war 2 joke" > see Chuck Norris fact #59 above
 "chuck norris bear joke" > see Chuck Norris fact #50 above
 "chuck norris mona lisa" > see Chuck Norris fact #22 above
 "chuck norris doesn't bleed" > see Chuck Norris fact #60 above
 "chuck norris duct tape" > see Chuck Norris fact #66 and #78 above
 "how far can aaron rodgers throw a football?" see Chuck Norris fact #100 above
 "why is chuck norris so awesome" > see all of the Chuck Norris facts above
 "best chuck norris jokes" > again, see all of the Chuck Norris facts above

~ about Chuck Norris ~

the Real Chuck NorrisChuck Norris was actually originally named Carlos Ray Norris and was born on March 10, 1940 in Ryan, Oklahoma. His father, Ray Norris, was a mechanic, bus driver, and truck driver. Chuck Norris is an American martial artist, action-hero actor and media personality. After serving in the United States Air Force, he began his rise to fame as a martial artist and has since founded his own school, Chun Kuk Do. Chuck Norris appeared in a variety of action films, including Way of the Dragon in which he starred with Bruce Lee. Chuck Norris was The Cannon Group's leading star in the 1980s. He moved on to play the lead role in the television series Walker, Texas Ranger from 1993 until 2001. Today, Chuck Norris is actively involved in Republic politics, endorsing and campaigning for Mike Huckabee for President in 2008, and recently endorsing Newt Gingrich for President in 2012. Based on Chuck Norris' action-hero-macho-man-tough-guy image, an Internet phenomenon sprang up in 2005 known as Chuck Norris facts, attributing various implausible feats of strength and courage to Chuck Norris.

~ a few great Chuhkizmz* ~

! Chuck Norris can make an onion cry.

*What are Chuhkizmz? Chuhkizmz(SM) (a term I coined myself, and which is the plural form of Chuhkizm) are pithy Chuck Norris facts consisting of ten words or less, that succinctly convey the unique awesomeness of Chuck Norris.

chucktopia - a state of chuyktastik enlightenment enjoyed by people to know and respect the power of Chuck Norris.

copyright 2009-2017 by Cranial Borborygmus |  remember what Mr. T says, fool!


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Short-Sleeve B. Kliban Rock N' Roll Cats Black Classic Crewneck T-Shirt
Short-Sleeve B. Kliban Rock N' Roll Cats Black Classic Crewneck T-Shirt
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We've gotten the band back together and they sound great. More importantly, they look amazing in this B.Kliban inspired design that rocks. Made from 100% cotton that is ring-spun then combed to remove impurities, this fabric is luxuriously soft and lightweight yet incredibly strong. To do Kliban's artwork justice, we only use environmentally friendly water-based inks that penetrate the material's fiber resulting in more vibrant colors, softer feel and artwork that doesn't crack or peel. Plus, it is proudly printed in the United States for quality you can see and designs-just like Kliban's cats-that stand the test of time as well as the bond between Crazy Shirts and The Cat has for all these years.
Sizes: S - XXL

  • 100% Combed Ringspun Cotton
  • Jersey Knit

  • Fabric made of combed ringspun cotton for softness and durability
  • Heavyweight fabric that is durable and long lasting
  • Relaxed, generous fit
  • Continuous collar with added spandex for comfort and durability
  • Tubular knit construction for a durable, comfortable fit
  • Reinforced neck and shoulder seams
  • Import
  • Design Placement: Large prints on front and back
  • Design Quote: Sex and Cheese and Rock and Roll!

Care Instructions:
  • Machine wash cold
  • Only non-chlorine bleach when needed
  • Tumble dry low
  • Warm iron when needed
  • Do not dry clean
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Thursday , September 20 2018
Blog » Health Blog » Ears, Nose and Throat » Understanding Tinnitus ( Ringing in the Ear ) – Causes & Treatment
tinnitus treatment & treatment meaning & tinnitus causes

Understanding Tinnitus ( Ringing in the Ear ) – Causes & Treatment

Tinnitus is the sensation of a ringing noise in the ear. People experience a sort of a whistling or buzzing sound in their ear although there is no external source of sound. This sound comes from inside the ear in the form of clicking, roaring or hissing sounds that can be intermittent or continuous with varying degrees of loudness. These ringing noises ocassionally beat in sync with your heartbeat which is known as pulsatile tinnitus. The patients may experience the sound in one year or both the ears. This sound source can cause the sufferer depression, problems in concentrating or even anxiety among other psychological disorders. Now, let us delve deeper into types of tinnitus, tinnitus symptoms, causes and tinnitus treatment.

Tinnitus Types

  • Subjective tinnitus – this the most common type of tinnitus wherein only the patient can experience these noises.
  • Objective tinnitus – this type can be heard by somebody who is examining the patient. The occurrence is very uncommon and is generally caused due to a variety of physical factors like, blood vessels related abnormalities and spasm in the muscle ears.
    • Pulsatile tinnitus – in this type people experience a sound that beats in sync with their pulse. Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow, increased blood turbulence near the ear (such as from atherosclerosis, venous hum, or it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear.

The true tinnitus definition does not come in the category of diseases. It should not be mistaken that, tinnitus is not a disease but a symptom which can result due to a number of underlying causes. Tinnitus treatment should be undertaken as it may worsen with age.

If you facing this problem, visit an ENT Doctor as soon as possible. Need help in finding a doctor? Click here to find the Best ENT Specialist in India.

Tinnitus Causes

One of the most common causes of tinnitus is continuous and prolonged exposure to extremely loud noises. Large chunk of patients suffering from tinnitus have had some levels of hearing loss due to high levels of noise. The noise also causes permanent ear damage to the cells of cochlea (a spiral shaped organ presents in the inner ear), which are extremely sensitive to sound. People working as pilots, carpenters, street repair workers and rock musicians are generally among the most who’s jobs put them at a risk of suffering from tinnitus.

Other causes

A variety of other illnesses and conditions which can cause tinnitus are:

  • Ear blockages that is caused due to a build-up of excessive ear wax, infection in the ear, benign nerve tumour which makes the auditory nerve audible for the patient.
  • Heart diseases and problems
  • Drugs like, aspirin, antibiotics and anti-inflammatory medicines have been listed as one of the causes for tinnitus.
  • Meniere’s disease which adversely effects the inner part of the ear causing tinnitus
  • The ageing process of an individual causes the cochlea along with the other parts of the ear to deteriorate.
  • An ear disease known as otosclerosis which results in the stiffening of the small bones in the mid ear region.
  • Medical conditions like, cardiovascular disease, allergies, high blood pressure, anemia, diabetes and autoimmune diseases.
  • Problems related to neck or jaws known as temporomandibular joint syndrome.
  • Head or neck injuries may also result in tinnitus.
  • On consumption of excessive alcohol, smokes, caffeinated beverages or eat certain types of foods
  • Eustachian tube problem (mid ear related problems)
  • Tinnitus is the brain’s way of filling the gap when it hears some missing sound in the frequencies that it no longer receives from its own auditory system.

Tinnitus Treatment

Tinnitus is diagnosed based on the patient’s descriptions of the ringing sound he hears. The patient may first undergo a questionnaire that helps to express how severe is his/her tinnitus problem to the doctor. Tinnitus treatment begins with an audiogram and a neurological examination.

While there is no cure for tinnitus treatment, most people get used to it over time as for a minority, it remains a significant problem. However, if there is an underlying cause, treating it may lead to improvements. Otherwise, the primary treatment for tinnitus is talk therapy and sound therapy; there are no effective medications

It is highly advisable to treat your tinnitus symptoms and undertake proper tinnitus treatment before the problem gets worse. If it has been found that your tinnitus is caused due to external forces (like loud noises) you’re your doctor will suggest various non-medical options that may help in make the situation a lot better for you.

Also, read about: What is Filariasis and Recovery after CABG.

Based on the cause of the problem, tinnitus treatment is undertaken:

  • If the cause of tinnitus is excessive ear wax the doctor will then your doctor will do a procedure of ear wax cleaning through suction method with the help of a small curved instrument known as curette or they can also flush the wax out through warm water.
  • If the cause of tinnitus is a result of temporomandibular joint syndrome the doctor will most likely refer to an orthodontist or some other dental specialist for a more accurate treatment route.
  • If the cause of tinnitus is an ear infection the doctor will prescribe ear drops (containing hydrocortisone) in order to help the relieve the problem of itching along with acting as an antibiotic (which fights infection).
  • If the cause of tinnitus is an abnormal growth i.e. tumour or cyst the doctor will have to undertake a surgery.


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After her mother dies from a heroin overdose, Jeliza-Rose is taken from the big city to a rural farmhouse by her father. As she tries to settle into a new life in a house her father had purchased for his now-deceased mother, Jeliza-Rose's attempts to deal with what's happened result in increasingly odd behavior, as she begins to communicate mainly with her bodiless Barbie doll heads and Dell, a neighborhood woman who always wears a beekeeper's veil. (imdb)

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Crosswalk.com aims to offer the most compelling biblically-based content to Christians on their walk with Jesus. Crosswalk.com is your online destination for all areas of Christian Living – faith, family, fun, and community. Each category is further divided into areas important to you and your Christian faith including Bible study, daily devotions, marriage, parenting, movie reviews, music, news, and more.

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<< Girlfriends in God

Reaching and Teaching - Girlfriends in God - October 17, 2014

  • 2014 Oct 17

October 17, 2014
Reaching and Teaching
Gwen Smith

Today’s Truth

Likewise, teach the older women to be reverent in the way they live, not to be slanderers or addicted to much wine, but to teach what is good.  Then they can train the younger women to love their husbands and children, to be self-controlled and pure, to be busy at home, to be kind… (Titus 2:3-5, NIV).

Friend to Friend

One day after I had led worship at church, another worship leader approached me. She is a hip, just-turned-30, Jesus-loving-chick. To my surprise, she asked if I would consider becoming her mentor.

What? I thought at first… I’m WAY too young to be your mentor!

Then I woke up from the dream and remembered that I am a wise-on-my-good-days, slightly-seasoned-40-something girl with a decade of life, marriage, mothering, and ministry on her.

Excitement and trepidation danced together in my heart when I prayerfully agreed.

Over the years I have come to realize that mentoring is very important. I’ve been deeply blessed and rightfully challenged by the wisdom of women who are slightly more gray and less green than me.

Have you ever longed for advice but didn’t know who to talk to? I know I have.

We need spiritual mentors to take our hands as we face life and ministry challenges. Likewise, we also need to grab hold of younger spiritual hands for the journey: to bring them along in Christ, to help strengthen their spiritual muscles, to encourage, teach, and admonish.

In a relay race, a runner reaches forward to grab the baton from a teammate who has run ahead of them. She also extends the baton back to the runner behind who is about to take off on her own leg of the race. Just like the runners in a relay race, we need to be reaching forward and reaching backward. Reaching and teaching!

Look at what the apostle Paul wrote to his disciple, Titus, about how women should do life with other women:

“Likewise, teach the older women to be reverent in the way they live, not to be slanderers or addicted to much wine, but to teach what is good. Then they can train the younger women to love their husbands and children, to be self-controlled and pure, to be busy at home, to be kind, and to be subject to their husbands, so that no one will malign the word of God” (Titus 2:3-5, NIV).

Paul threw down the gauntlet and challenged mature women of faith to step up to the plate and help younger women know how to serve Christ. Show her how to love her husband. Teach her to live set-apart and Spirit-led… beyond addictions, distractions, and complications. Train her to honor God with excellence in the work place, at home, and in relationships. Make disciples!

The Bible says in Mark 6:29, that after John the Baptist died his disciples came and took his body and laid it in a tomb. I find it interesting that the word disciples is used instead of the word friends or associates.

A disciple is defined as, “Someone who follows another person or another way of life and who submits himself to the discipline (teaching) of that leader or way. In the Bible the term “disciple” is found almost exclusively in the Gospels and the Book of Acts, the only exceptions being Isaiah 8:16 and less directly Isaiah 50:4 and 54:13, where the same Hebrew word is translated “learned” and “taught,” respectively. Yet clearly wherever there is a teacher and those taught, the idea of discipleship is present.[1]

John poured his life into guiding and teaching these men in the truth and hope of Christ. So, let me ask you this, if a godly man like John the Baptist, who was set apart for a special God-mission to prepare the way of the LORD, reached forward to Jesus for guidance and wisdom, how much more must we? Though he was not one of the twelve disciples hand picked by Jesus during His years of public ministry, John the Baptist was, indeed, a disciple of the Lord.

What a beautiful example we see here. John WAS a disciple and he MADE disciples. With God’s help and a little effort, we can too.

I challenge you to prayerfully connect with one or two women this week to discuss this mentoring topic.

Reach ahead. Get a mentor.

Reach behind. Get a mentee.

Glean wisdom. Give wisdom. Grow. Dream. Achieve!

When you do, I am confident that deep blessings, increased efficacy, and maturity will be evidenced in your life and in the lives of those with whom you connect.

Let’s Pray

Dear Lord,

You are so good to instruct us toward relationships… both with You and with others. Would you help me to grow in faith?  Would you use me to make a difference in the lives of other women as well? Please lead me in Your will and in Your ways.

In Jesus’ name,

Now It’s Your Turn

Do you have a spiritual mentor? Have you spoken with her recently? Why not call or email her to set up a date to meet for coffee or lunch this week?

Are you mentoring anyone right now? If you are not a spiritual mentor yet or don’t have a spiritual mentor, take a few moments to seek God’s heart about this for your life.

More from the Girlfriends

I want to impact YOU today, so I’m giving away 3 copies of my latest music project: “My Strength, My Song.” For a chance to win, CLICK HERE to visit my blog and leave a comment. Who do you want to impact?

Speaking of things that make an impact, my website recently got a bit of a makeover! Woot! Grab a fresh cup of coffee, and swing over to hang for a bit. There are tons of videos, posts, songs, and FREE resources that will be a deep well of encouragement to you. www.GwenSmith.net. (NEW: Get 3 FREE song downloads when you sign up for my blog and ministry updates!)

[1] Elwell, W. A., & Beitzel, B. J. (1988). In Baker encyclopedia of the Bible. Grand Rapids, MI: Baker Book House.

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Crosswalk.com aims to offer the most compelling biblically-based content to Christians on their walk with Jesus. Crosswalk.com is your online destination for all areas of Christian Living – faith, family, fun, and community. Each category is further divided into areas important to you and your Christian faith including Bible study, daily devotions, marriage, parenting, movie reviews, music, news, and more.

Intersection of Life and Faith

<< Sparkling Gems from the Greek, with Rick Renner

Sparkling Gems from the Greek - Week of March 5

  • 2018 Mar 05

Two Friends Bury Jesus

And after this Joseph of Arimathaea, being a disciple of Jesus, but secretly for fear of the Jews, he besought Pilate that he might take away the body of Jesus: and Pilate gave him leave. He came therefore, and took the body of Jesus. And there came also Nicodemus, which at the first came to Jesus by night, and brought a mixture of myrrh and aloes, about an hundred pound weight. Then they took the body of Jesus, and wound it in linen clothes with the spices, as the manner of the Jews is to bury.
John 19:38-40

When it was time for Jesus' body to be brought down from the Cross, Pilate received a surprise visit from a high-ranking member of the Sanhedrin who was a secret follower of Jesus. His name was Joseph, from the city of Arimathea; thus, we know this man as Joseph of Arimathea. He was accompanied by another high-ranking member of the Sanhedrin who was also a secret disciple of Jesus. This second man's relationship with Jesus began with a secret visit in the middle of the night, recorded in John 3:1-21  That second admirer was Nicodemus.

Let's begin with Joseph of Arimathea and see what we know of him. To obtain an accurate picture of this man, we must turn to Mark 15:42-43, which says, "And now when the even was come, because it was the preparation, that is, the day before the sabbath, Joseph of Arimathaea, an honourable counseller, which also waited for the kingdom of God, came, and went in boldly unto Pilate, and craved the body of Jesus."

This verse tells us that Joseph of Arimathea was an "honorable counselor." The Greek word for "honorable" is euschemon, a compound of the words eu, meaning well or good, and the word schema, meaning form, often referring to an outward appearance. When compounded together, it means a good outward appearance. It refers to people who have a good reputation, who have a good standing in society, or who are prominent, influential, and wealthy. The word "counselor" is the Greek word bouleutes, the word for a member of the Sanhedrin. This is the same word used to describe Roman senators. By using this word bouleutes, Mark tells us that Joseph of Arimathea's position in the land of Israel was one of great honor and respect.

The above verse also tells us that he "waited for the kingdom of God." The Greek word for "waited" is prosdechomai. Other examples of this word are found in Acts 24:15, where it describes a hope or expectation. In Romans 16:2, Paul uses this word to tell the Roman church to receive Phebe, suggesting that they fully receive and embrace her. In Hebrews 10:34, it is translated to take, and it means to fully and completely take something without reservation of hesitation. So when Mark 15:43 tells us Joseph of Arimathea "…waited for the kingdom of God…," this doesn't refer to a do-nothing, "hang-around-and-see-what-happens" kind of waiting. Joseph was earnestly looking for and anticipating the Kingdom. He was inwardly ready to take it, to fully receive it, and to embrace it without any reservation or hesitation.

This explains why Joseph was attracted to the ministry of Jesus. Because of his deep hunger and longing to see the Kingdom of God, he ventured out to see this Jesus of Nazareth. Spiritual hunger is always a prerequisite to receiving the Kingdom of God, and Joseph of Arimathea possessed that hunger. His willingness to think "outside the circle" of how others in the Sanhedrin thought no doubt made him unique in the supreme council. However, it appears that the other members of the council shut their eyes and tolerated him due to his prominent position and extreme wealth.

Next Mark tells us that Joseph of Arimathea went "boldly unto Pilate." Although he was undoubtedly known for his spiritual hunger, John 19:38 informs us that this Joseph had never publicly announced that he was a follower of Jesus "for fear of the Jews."

As a member of the Sanhedrin, Joseph was well aware of the exultation the supreme council members felt over Jesus' death. If it became known that Joseph was the one who took the body and buried it, it could place him in considerable jeopardy. Therefore, going to Pilate to request that he might remove the body of Jesus before the Sabbath began was an act of bravery on Joseph's part.

Joseph's desire to take the body of Jesus and prepare it for burial was so powerful that Mark 15:43 says he "craved the body of Jesus." The word "craved" is the Greek word aiteo, a word that means to be adamant in requesting and demanding something. In the New Testament, the word aiteo is used to portray a person addressing a superior, as in this case when Joseph of Arimathea appealed to Pilate. The person may insist or demand that a need be met, but he approaches and speaks to his superior with respect. Therefore, although Joseph showed respect toward Pilate's position, he also presented a strong demand to the governor, adamantly insisting that Jesus' body be released to him.

The word "body" is the Greek word ptoma, which always referred to a dead body and is often translated as the word "corpse." The Roman custom was to leave the body hanging on the cross until it rotted or until the vultures had picked away at it. Afterward, they discarded of the corpse in the wilderness, where it was eaten by wild dogs. The Jews, however, held the human body in great honor because it was made in the image of God. Even those who were executed by the Jews were respected in the way they were handled after death. Thus, it was not permitted for a Jew's body to hang on a cross after sunset or to be left to rot or for the birds to devour.

Mark 15:44, 45 says, "And Pilate marvelled if he were already dead: and calling unto him the centurion, he asked him whether he had been any while dead. And when he knew it of the centurion, he gave the body to Joseph."

At this point, Nicodemus enters the picture. The third chapter of John gives the greatest insight into Nicodemus. It says, "There was a man of the Pharisees, named Nicodemus, a ruler of the Jews: the same came to Jesus by night and said unto him, Rabbi, we know that thou art a teacher from God: for no man can do the miracles that thou doest, except God be with him" (vv. 1, 2).

John 3:1 tells us that Nicodemus was a "Pharisee." The word "Pharisee" means the separated ones. This means they viewed themselves separated by God for His purposes; thus, they were extremely committed and even fanatical in their service to God.

During the time Jesus lived, the Pharisees were the most respected and esteemed religious leaders in Israel. The Pharisees believed in the supernatural and earnestly waited for the arrival of the Messiah, contrary to the Sadducees who did not believe in the supernatural and did not wait for the Messiah's coming. The Pharisees held strictly to the Law, whereas the Sadducees took a more liberal approach to the Law that the Pharisees found unacceptable. Flavius Josephus, the famous Jewish historian, was a Pharisee, as was Gamaliel (see >Acts 5:34) and the apostle Paul before he was converted to Christ on the road to Damascus (see >Philippians 3:5).

Verse 1 goes on to tell us that Nicodemus was "a ruler of the Jews." The word "ruler" is the Greek word archon, which means the chief one, ruler, or prince. This word was used to denote the rulers of local synagogues and members of the Sanhedrin who were the highest authorities in the land. Due to this high-ranking position, Nicodemus, like Joseph of Arimathea, was prominent, influential, and wealthy.

Nicodemus' notoriety among the Jews in Jerusalem was the reason he visited Jesus by night. Nicodemus' fame most likely created a stir every time he passed through the city. Therefore, he wanted to avoid visiting Jesus by day, as it would draw attention to the fact that he was spending time with a teacher the Sanhedrin viewed to be a maverick and out of their control. Consequently, Nicodemus came to Jesus by night when his visit would not be observable.

What he told Jesus during this visit reveals much about the spiritual hunger that Nicodemus possessed. First, he called Jesus "Rabbi." The word itself means great, but it was used as a title of respect that was used only in reference to the great teachers of the Law. The Pharisees loved to be called "Rabbi," for they viewed themselves as the chief keepers of the Law.

For Nicodemus to call Jesus "Rabbi" was remarkable indeed. The Jewish leader would never have used that title unless he had already heard Jesus interpret the Law and thereby judged His ability to do so. The fact that Nicodemus called Jesus by this privileged title, given only to those who were viewed as the greatest theologians in Israel, tells us that he was very impressed with Jesus' knowledge of the Scriptures.

This means that Nicodemus, like Joseph of Arimathea, was open-minded enough to receive from people who were "outside the circle" of what most religious people viewed as acceptable. In fact, Nicodemus was so hungry to find a touch of God that it appears he himself visited Jesus' meetings that had just been conducted in the city of Jersusalem.

John 2:23 says, "Now when he [Jesus] was in Jerusalem at the passover, in the feast day, many believed in his name, when they saw the miracles which he did." When Nicodemus visited with Jesus, he referred to these miracles, saying in John 3:2, "…Rabbi, we know that thou art a teacher come from God: for no man can do these miracles that thou doest, except God be with him."

It seems that Nicodemus had come close enough to these miracle meetings to personally view the miracles. This must have been the occasion when he heard Jesus teach and deemed Him worthy of the title "Rabbi." As a Pharisee, Nicodemus believed in the supernatural. He was so moved by the miracles and so convinced of their legitimacy that he wanted to personally meet Jesus and ask Him questions. In the conversation that followed, Jesus told Nicodemus, "…Verily, verily, I say unto thee, Except a man be born again, he cannot see the kingdom of God" (John 3:3). The famous conversation that followed has been read, quoted, and preached all over the world for two thousand years.

After Joseph of Arimathea received permission to remove Jesus' body from the Cross, he took the body to begin preparations for burial. John 19:39 tells us what happened next: "And there came also Nicodemus, which at the first came to Jesus by night, and brought a mixture of myrrh and aloes, about an hundred pound weight."

This verse tells us Nicodemus "…brought a mixture of myrrh and aloes, about an hundred pound weight…." "Myrrh" was an expensive yellowish-brown, sweet-smelling gum resin that was obtained from a tree and had a bitter taste. It was chiefly used as a chemical for embalming the dead. "Aloes" was a sweet-smelling fragrance derived from the juice pressed from the leaves of a tree found in the Middle East. It was used to ceremonially cleanse, to purify, and to counteract the terrible smell of the corpse as it decomposed. Like myrrh, this substance was also very expensive and rare - yet the Bible tells us that Nicodemus "brought a mixture" of both substances - about a hundred pounds' worth!

Nicodemus' cost for this offering of love must have been out of sight! Only a rich man could have purchased such a massive combination of these costly, uncommon substances. Nicodemus obviously intended to fully cover the body of Jesus, so he spared no cost in preparing the body for burial, demonstrating his love for Jesus right up to the very end.

John goes on to tell us, "Then took they the body of Jesus, and wound it in linen clothes with the spices, as the manner of the Jews is to bury" (v. 40). The word for "linen" is the Greek word othonion, which describes a cloth made of very fine and extremely expensive materials that was fabricated primarily in Egypt. Nobles in that day were known to pay very high prices to have robes made for their wives from this material.

When Lazarus came forth from the tomb after being resurrected by Jesus, he was "…bound hand and foot with graveclothes: and his face was bound about with a napkin…" (John 11:44). This shows that Lazarus was bound with bandages made of strips of material. However, the word othonion tends to suggest that Jesus was carefully laid in a large linen sheet of fine weave. Specially prepared spices were then mingled between the folds of this high-priced garment in which Jesus' dead body was wrapped.

This is an amazing story of two men who dearly loved Jesus. Although Joseph and Nicodemus lived in circumstances that made it difficult for them to publicly follow Jesus, they chose to follow Him to their fullest capability. When Jesus died, they continued to demonstrate their deep love for Him, treating His dead body with tender care and using their personal wealth to bury Him with honor. As far as they understood at the time, this was their last opportunity to show Jesus how much they loved Him, and they were going to take full advantage of it!

Jesus taught, "For where your treasure is, there will be your heart also" (Matthew 6:21). When these two men used their wealth to bury Jesus, they illustrated that their heart was with Jesus. He was their highest priority, so they invested their assets in showing their love for Him. They literally sowed their money into the ground when they bathed Jesus in one hundred pounds of those rare substances, wrapped Him in an expensive cloth, and then buried Him in a rich man's tomb.

If people were to look at the way you spend your finances, would they be able to see that Jesus is the highest priority in your life? Do you treat Him with honor and respect in the way you serve Him, or is He the last priority on your list? According to the words of Jesus, what you do with your finances really does tell the truth about what you love the most. So what would He say that your finances reveal about how much you love Him?

As Joseph of Arimathea and Nicodemus honored Jesus in death, let's commit to honor Him with everything we possess as we serve Him every day of our lives. Right now, let's make the choice to upgrade our giving, our living, and every other way that we are privileged to serve Jesus!

Lord, I want to become a better and bigger giver! I love You with all my heart, and I want to demonstrate my love with my finances. Your Word says where my treasure is, that is where my heart is also. What I do with my treasure reveals what is precious to me and the true condition of my heart. Therefore, I want to give more to You; I want to live better for You; and I want to serve You more fully than ever before. I am making the decision today to make You and Your Kingdom the highest priority when it comes to how I spend my personal finances!

I pray this in Jesus' name!

I boldly declare that Jesus Christ and His Kingdom are the highest priorities in my life. I faithfully tithe and give special offerings to help advance the message of Jesus Christ around the world. There is no higher priority in my life than getting the Gospel to the ends of the earth, so I use my finances wisely and carefully, making certain that I am able to give my maximum gift to Jesus. Because I give so faithfully, I am blessed!

I declare this by faith in Jesus' name!

  1. If Jesus were to look at your finances to determine what is the greatest priority in your life, would He be able to say that He and His Kingdom were most important to you, or would He see that He is somewhere lower on your list of priorities?
  2. Are you faithful in the giving of your tithe, or are you sporadic in the way you honor God with your money?
  3. In order to become faithful with your tithe and offering, what changes do you need to make in your spending habits? Why don't you think it over and then make the needed adjustments so you can start treating Jesus like He is the most important priority in your life?

For more from this ministry please visit Renner.org.

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