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This could get expensive!

Taxpayers on the hook for Cylvia Hayes’ legal fees

The Oregonian – March 20, 2015 …

Taxpayers will foot the bill for Cylvia Hayes’ defense in the federal investigation into the former first lady and her fiancee, John Kitzhaber.

Hayes is now being represented by two federal public defenders — Lisa Hay and Jerry Needham — in the influence-peddling investigation by the FBI and the IRS targeting Hayes and Kitzhaber.

Attorneys familiar with such cases say Hayes’ defense likely will be costly and there’s no cap on such a bill. Yet in other cases through the years, public defenders have billed defendants for some or all of the charges accrued.

Portland criminal defense attorney Whitney Boise had represented Hayes since October after news emerged she had accepted $5,000 to marry an Ethiopian immigrant seeking a green card.

Boise will continue to represent her in the near-term in her lawsuit filed against The Oregonian/OregonLive to block the release of Hayes’ emails related to her role as a state policy adviser and first lady on several of her personal accounts.

Hayes’ has been under scrutiny for accepting paid consulting contracts centered on the very policy issues that she pushed in her roles as first lady and as an adviser to Kitzhaber.

Questions also have been raised about her tax filings. Hayes disclosed earlier this year that she accepted $118,000 — $30,000 in 2011 and $88,000 in 2012 — for a fellowship with the Clean Economy Development Center. Yet those figures didn’t match tax filings she provided to The Oregonian/OregonLive that showed she claimed income of $27,361 in 2012.

There are no strict income limits to qualify for a federal public defender. Courts ultimately make the call and typically base decisions on a defendant’s resources and the anticipated cost of their defense.

Typically, federal fraud investigations are costly. “You have to keep in mind that a complex case with multiple crimes and multiple potential charges can be incredibly expensive,” said Steven Wax, Oregon’s former federal public defender, pointing out that good criminal attorneys in Portland charge between $350 and $500 an hour. “Cylvia’s situation could be incredibly expensive.”

A U.S. District Court judge in Oregon made the determination on Hayes, but Hay wouldn’t comment on which judge it was or when she began working for Hayes.

Hayes would have had to apply for a public defender and likely, complete a financial affidavit — all of which would be confidential, as with the rest of the federal investigation.

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Brool brool (n.) : a low roar; a deep murmur or humming

Quick iPhone Trick -- Easy Access To PDFs

 |  coding

A quick hack that I didn’t see elsewhere but is too easy and fast not to mention – currently, there isn’t a great method of storing files on the iPhone. I keep a bunch of papers around in PDF format that I like having available whenever I’m standing in line or whatnot. You can potentially mail it to yourself, but then you have network access to read it, and it takes a while to bring it up.

With a Jailbroken phone you can do much cooler stuff:

Voila! Instant access to all your PDFs and other files, with no network access required.

Comments are moderated whenever I remember that I have a blog.

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Comep 0.5c

This is a Script for PHP

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Edit By BS Editor: The program Internet RadioFan allows you to listen to Online Radio and Watch TV broadcasts on the Internet. All the radio and TV stations are grouped by country while the description of each channel contains the name of the city from which the broadcast originates and the style or genre of the given station. A special button can be set for quick connection to a given station.

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rndminiIRC 2 is a powerful IRC bot written in the Delphi language

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Edit by Brothersoft: rndminiIRC 2 is a powerful IRC bot written in the Delphi language. The IRC bot can control a little of your computer and lets you see what's going on from the screen. It's not focused on channel management, more on computer control - it hasn't any user levels yet. You can see what the bot can do on the Commands and functions PaGE, and view screenshots on the Screenshots page. From 2.0.4, rndminiIRC 2 is almost completely stable and functional. So why not try it Now?

You can suggest commands on the Suggest command page. If I think that your idea is good, I'll include it in the next version of rndminiIRC 2.

Beware downloading old versions on the Download old versions page. They may contain bugs, which will make the bot crash, or maybe they contain security holes. (Currently, no versions have had any security holes). You can view the updates on the versions on the Version History page.

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Wednesday, August 13, 2008

Diane Suchetka's Continuing Anti-Doctor Crusade

I was wondering if there was anyone of rational mind and character who thought the implementation of the new "Never Events" policy of Medicare/Medicaid was a good idea. Little did I know, that special someone was located right here in my neck of the woods. Diane Suchteka is the healthbeat columnist for the Cleveland Plain Dealer and yesterday's piece detailing the new policy was just mindboggling. Enough is enough, she says. Save us from these awful hospitals and doctors who willfully harm us!

This is the same columnist who actually wrote a piece a few weeks ago stating that hospital errors are the seventh leading cause of death in the country, culled from some uncited, arbitrary source. In this article Ms Suchetka uses someone named Michael McCauley for a quote:

"These are conditions that are considered preventable," said Michael McCauley, media director for the Stop Hospital Infections Campaign run by Consumers Union, the nonprofit publisher of Consumer Reports magazine. "If hospitals were to set up efforts to follow these longstanding practices, the vast majority of these medical errors and infections could be prevented."

What's the Stop Hospital Infectious Campaign? Do they go by SHIC? Sounds like a fringe activist group to me. It's like writing a piece entitled "The Health Benefits of Anabolic Steroids" and using Barry Bonds and Mark McGwire as your sole sources. Or an article entitled "Cockfighting: Your Key to Social Networking" featuring juicy tidbits from Michael Vick. Where's the counterquote from someone actually involved in the delivery of healthcare? Giving equal weight to arguments is apparently something Ms. Suchetka isn't interested in.

And there's no argument here. The whole concept of "never events" is absurd anyway. Recently, DVT's after orthopedic procedures and wound infections after bariatric surgery were added to the list. This is inexplicable. And frightening for a healthcare provider. Venous thromboembolism can occur in up to 70% of patients after hip replacement if no prophylaxis is utilized. Even with the use of heparin or lovenox or coumadin, the risk still remains at around 5-10%. All scientific papers published on DVT prophylaxis talk about risk reduction. In no work of science will you read about a method of eliminating all risk of DVT after elective orthopedic procedures. As for the occurence of wound infections after bariatric surgery, only an absolute moron would advocate the stance that such occurrences are completely preventable. We have over 60 years of scientific research on surgical site infections. There are established norms and percentages for the development of wound infections after certain invasive procedures. The number isn't zero, no matter what how sterile or careful you are or how appropriately perioperative antibiotics are given. With bariatric surgery, you're dealing with patients who are obese and who often have diabetes; the two conditions most highly associated with surgical site infections. The list also condemns things like delirium and foley catheter infections and decubitus ulcers as completely preventable. In other words, when you slide a foreign body made out of rubber through your urethra into your bladder, the possibility that no bacteria will travel along the catheter to your bladder, thus setting up an infection ought to be zero..... Those sounds you hear in the background are knives being sharpened by thousands of personal injury lawyers across the country.

It wouldn't bother me so much if a piece like this appeared in some wack-job anti-medical establishment blog. But this is an article that will be read by thousands of people in Northeast Ohio. It's featured in a major midwestern newspaper. And it isn't appropriate. As a physician I aspire for perfection, but I can only aspire. The reality is that the human body is a remarkably complex machine, susceptible to a variety of uncontrollable factors. As much as we'd like to think we can standardize health care like a Ford Motor assembly line, the viccissitudes of human illness and suffering make it an impossible task. Can we be better? Of course. But to demonize adverse outcomes as "medical errors" and "preventable events" is to further alienate patients from physicians at a time when the very delivery of adequate healthcare for all is in a crisis.

rlbates said...

Great outburst, and so justified, Buckeye! I've made similar comments to family/friends lately. How can you list an event as a "never event" when no one has a way of getting there?

Frank Drackman said...

Who reads Newspapers anyway?

Guy said...

what about uti's after a catheter, you can try to prevent them but they sometimes happen.

I just won't put catheters in my patients then they can't get an infection.. too bad the hole in the bladder may be a problem but that one is covered.

I just think it's a popular way to save money but it doesn't cover that some things are impossible to get rid of. wrong site surgery, ok... leaving in instruments ok. but some of these others are just stupid and not preventable.

The Happy Hospitalist said...

did you see the recent published data, I think out of Canada that blamed the incredible rise in c diff infections post op to the policies of peri operative antibiotics being used in just about every surgery known to man. Unintended consequences once again. C diff while transmitted by fecal oral, is also known to colonize guts of healthy people, rearing its ugly head only when all the good bacteria have all been killed by our pwerful antibiotics. People come into hospitals with c diff and they leave with c diff and there is no way to tell whether they had it on admission or not. It's the equivalent of blaming a hospital (which means you are blaming nurses and doctors) for the patient developing an MI while in for pneumonia.Absurd. The whole DVT never policy is also sill as well.These are relays into lawsuits. You will see the lawyers pile on with VTE and c diff lawsuits and the culture of fear roles on.

WhiteCoat said...

Well put.
The uninformed drivel this woman puts forth is just a sampling of what the mindset the general public will develop once implementation of "never pay" for "never events" begins.

Bongi said...

never is an interesting concept. i can't help wondering what this woman does when she gets sick. after all going to evil doctors and dangerous hospitals would be out.

Anonymous said...

Well said Buckeye. Just another example of something/someone other than evidence based medicine dictating medical policy. A VERY slippery slope here. Will post-op pneumonia not be paid for in a patient with COPD, stroke, diabetes, MI yada-yada-yada. How about DVT in a 350 lbs. patient who had emergency orthopedic surgery, despite all precautions taken? Or C. difficile colitis in a patient being treated with broad spectrum antibiotics for sepsis of unknown cause? The list is endless. For those who think not paying for these complications is equivalent to not paying your lawn guy for cutting down the wrong tree are delusional. I'm not talking about amputating the wrong extremity or removing the wrong breast. No one says these are not "never events".

And those who say this will decrease malpractice suits, I think the opposite will happen. A new area of litigation will arise from this. One will see "C. difficile", "DVT", "UTI" on lawyers websites.

Worst of all of the unintended consequences, docs may decline aggressively treating or treating at all some patients with multiple medical problems who are more apt to develope complications.

Alice said...

The best part is that most of these "never" events are aimed at interventionalists. These UTIs, wound infections, DVTs, etc, happen most frequently in post-op patients. I say we all go on strike together. It should only take a day or two, if we run the PR well, for the public outcry to put an end to this nonsense.

Anonymous said...

How did you get "anti-doctor crusade" from Diane Suchetka's article? When I read the article, I thought she was talking about Medicare not paying for problems are caused by SYSTEM errors that are preventable if hospitals improve the way care is delivered at all levels.

Buckeye Surgeon said...

Frank- What are you, some sort of netroots fanatic?

HHo- Well put my friend. Thanks for the order sets BTW.

White Coat- Thanks for stopping by. I liked your piece on Kevins reader take. Especially the part about how these guidelines lack any reference to prevention. Like, tell me how to prevent a hyperglycemia complication and I would gladly comply. Just an empty, empty initiative.

Anon 8:56- Hospitals are inanimate objects. Structures made out of stone and mortar do not prescribe medicines or perform operations. We have these people called "doctors" and "nurses" who do the bulk of the actual work once you have been admitted to said "hospital". Blaming "hospitals" for errors is, in essence, blaming the humans intimately involved in the provision of such care.

Anonymous said...

Good thread buckeye. You should really write an op-ed to the Cleveland Plain Dealer. As you correctly pointed out, even with the best of treatment catheter related infections occur. Even with the best of treatment ortho post-op DVT's occur. I have NEVER EVER hve seen a study that shows DVT prophylaxis decreases the risk to zero (and I am heme). That is the fact. So my question to the idiots at CMS is how do they define a "never" event. Clearly in my (and medicines book) a "never" event is one that should never, ever, ever happen. Like, wrong site surgery or ABO incompatability (something I totally agree with). If all the studies show tht even with the BEST OF TREATMENT THE COMPLICATION OCCURS, THEN BY DEFINITION IT IS NOT A NEVER EVENT...PERIOD.
I guess I miss the good ole day's when reporters actually critically evaluated their stories for accuaracies. Diane Suchteka is not a reporter, she's a hack. I tire of "reporters" (and I am obviously using the term losely here) who don't even try to get it right. The simple fact as every doc in the trenches knows, is that many of these "never" events by definition are not "never" events. Now wait until the lawyers start sueing the ortho's/hospitalist's for post op DVT's/PE's as the idiots at CMS have termed them never events. I highly doubt any of these CMS morons has actually practiced medicine since Ronald Reagan was president.

Trisha Torrey said...

According to today's Wall Street Journal, you may be wrong about whether those central line infections are, or are not, preventable.

Quote from the article:

Beth Israel Medical Center in New York City reports that it hasn't had a central line bloodstream infection in the cardiac intensive care unit in over 1,000 days. Dr. Brian Koll, chief of infection control there, explains that the key is using a checklist that doctors and nurses must follow. Implementing the checklist cost $30,000 and saved $1.5 million in treatment costs. Lives saved: priceless.

Other hospitals -- from Johns Hopkins Medical Center in Baltimore to Sutter Roseville Medical Center in Sacramento -- have reached the goal of zero central line bloodstream infections.
.... and....

A recent survey from the patient-safety organization Leapfrog found that 87% of hospitals fail to consistently practice infection prevention measures.

I'm just sayin'...

Trisha Torrey
Every Patient's Advocate

WhiteCoat said...

Central line infections: check

Now lets get on to the plethora of other infections: urinary catheters, Staph septicemia, C. diff.
While you're at it, give me a checklist for how to completely prevent dementia, patient falls, and DVTs.

Well ... I'm waiting.

Trisha Torrey said...

White Coat,

If you read the first sentence of my post, I was only presenting information about central line infections.

I'm not trying to pick any fights here. I believe we all have the same goals, don't we? The idea is for patients to leave a hospital in better shape than when they arrived, no matter who is -- or isn't -- picking up the tab.

Alice said...

It's easy to have zero central line infections: just change your criteria for diagnosing them. My ICU is currently boasting of having no ventilator associated pneumonias for six months, when I'm treating two patients who have one. As long as you don't diagnose it, it's not a problem. Ostriches have a similar strategy for avoiding predators.

Buckeye Surgeon said...

Thanks for bringing up the central line issue. Great issue in the New Yorker a while ago about the work of Peter Pronovost and his checklist.

Interestingly, despite the remarkable improvements in line infection rates with his techniques, two catheter infections still occured in his study. Never means never, however. The expectation is for ZERO complications and that's why we as physicians are all a little perturbed....

Anonymous said...

I would not waste a lot of time on trisha torrey. She often get's it wrong on her own website.

WhiteCoat said...

The problem is that you seem to accept the idea of "never events" as the "gold standard." By posting how two hospitals have reportedly reduced infections to "zero" in one small subsegment of patient care, you only increase the misinformation and the belief in the general public that all other "never events" should "never" happen. I'm picking the fight because you are using the classic "straw man" argument and you are doing a disservice to the medical profession and to the patients in the process. I know you're trying to help, but you're making things worse.

If you want the patients to "leave a hospital in better shape than when they arrived" then don't advocate a position that will decrease availability of health care and that will cause overt and/or covert discrimination against patients who are predisposed to a set of problems that are deemed "never" to happen.

You may be happy that "never events" are becoming a reality, but this policy is going to kill a lot more people than it will help.

I guarantee it.

Trisha Torrey said...

Alice -- your post actually contains more real "inside" info than the others -- the ostrich thing (or shall we call it exactly what it is? lying?) is never good.

Buckeye -- First, I would dispute that patients (and I can only speak for patients here, not professionals) believe these "never events" will never happen. We see it as a goal, like eradicating polio was a goal. In its day, polio would have been a never event! Will we ever get there? I expect it's pie in the sky.

Of course, that's not about the payers -- which is where you started. Patients are so removed from payment that most don't even realize how this non-payment issue will affect them.

Where you and I differ is not in the goals, but in the way we approach them. Anyone who reads my work finds that no matter how much I complain, or what problems I bring to patients to consider, I also attempt to find a way we can learn from the information.

An example: Within the complaints I have read about non-payment for infections, here and in other places, I find that one big hurdle is for patients who already have infections when they arrive at the hospital. C. Diff, MRSA. I know there are easy and inexpensive tests for MRSA -- but very few hospitals are testing on admission. I don't know about tests for C.Diff (Happy Hospitalist says there isn't a way to test on admission?) but it can't be that difficult to develop a test.

The point is -- demonstrate the patient had the infection on admission, and then it can no longer be shown to be acquired in the hospital and the reimbursements get made. Will it cost more to admit? Sure -- maybe $20. A very small investment for an excellent outcome.

The reason I do the work I do is because of my own HEINOUS (which is not a strong enough word) misdiagnosis four years ago. -- I was told I had a deadly cancer, and I did not. What I learned is that too many medical professionals think in straight lines and not nearly enough of them try to think of creative approaches to their work.

My bottom line? Instead of simply complaining, why not try to arrive at solutions that are win-win?

I'm not Pollyanna enough to believe that can always be possible, but I do challenge you all to stop pissing and moaning and to begin developing strategies and tools that benefit both patients and providers. Why not be heroes instead of exacerbating the problems?

Trisha Torrey
(don't bother reading any of the stuff on my website -- the master pisser and moaner, Anonymous, who doesn't have the cojones to give a real name, says too much of it is wrong.)

goatgirl said...

I have read your account of your cancer misdx.

You see it as black and white - they screwed up! - but in reality it's a lot more complex than that. There are more than three dozen different subtypes of lymphoma. Some of these categories behave so differently that on a molecular level, they are actually completely separate diseases. A physician might go through an entire career and not even encounter some of the rarer ones - yet you have your knickers in a twist because you think they somehow should have instantly, magically recognized your dx.

Some lymphomas are pretty straightforward, but the world is full of people who've had trouble getting a dx and getting an accurate read on the pathology.

I've had DLBC lymphoma. I ended up getting three separate pathology opinions, on the recommendation of the oncologists, because we had so much trouble nailing down the specific subtype. They bent over backwards to get it right.

The evil doctors who so heinously screwed up your case were motivated by the best of intentions, i.e. saving your life.

So who's not thinking outside the box?

P.S. I can't figure out why you're so angry because you didn't have cancer. Jesus H. Christ, I would have been *thrilled* if I'd been in your shoes.

Buckeye Surgeon said...

Trisha- I appreciate you stopping by but I have several problems with your take on the situation.

First of all, it's incredibly naive to think that the majority of Americans aren't going to interpret "never events" exactly as it's spelled out. Never. In other words, an event that is "never" supposed to happen. Why would they understand it as a goal rather than an end? Just look at Diane Suchteka....

Also, this controversy has nothing to do with payment. Our problem is with the terminology. Never is a very specific, definitive, non-negotiable term. It's one thing to reward healthcare providers for excellence and low complication rates and to explore methodologies for the reduction of adverse events such as bedsores and DVT's. But to create an environment of condemnation and blame doesn't do anyone any favors, patients and doctors alike......

What else ought to be a never event? Heart attacks? Progression of COPD? Death? You tell me. And let's say someone can be tested for CDiff upon admission but they arent manifesting any signs of acute infection (no diarrhea, benign abdomen). What now? What if we find out the incidence of cdiff in the general population is 80%? You going to give everyone antibiotic treatment? Isolate the whole hospital? Your solutions are simplistic and lack insight. Polio basically was eradicated because of the dedicated work of scientists and physicians. Not because FDR designated it as a "never event"....

WhiteCoat said...

Trisha -
If you dispute that people believe that "never events" will never happen, then you need to sample newspaper articles and comments to those articles throughout the internet. If you truly dispute the notion, why don't you put up a piece to clarify it on your web site?
You advocate extensive testing for these "never events" before patients receive treatment, yet you have little clue how much this testing will cost. $20 will get you a Kleenex and a Tylenol if you are lucky.
You won't find the information on the internet, but the cost for a C. diff culture runs about $200. Throw in a couple of $60 blood cultures and a $60 urine culture to rule out all the other "hospital acquired" "never events" and the patient is out almost $400 so the hospital can cover its ass. Who do you think is going to pay for all of this testing?
What if the patient develops symptoms after they arrive? Add another $400 to the cost. Still a "small investment"?
Through your experiences you engage in another straw man argument, namely: Your care was HEINOUS, so the entire medical system must be in shambles and no physicians think "outside the box."
There was a statistic out recently that there were 1 BILLION medical visits in the US last year. If we suppose (and I don't know the numbers for sure) that there were 1 million instances of malpractice last year, the incidence of malpractice is still 0.1%. Show me another industry with such numbers.
How do you expect medical providers to take time out to get "creative" when their payments are being cut each year and they have to pay increasing malpractice premiums, increasing office costs, large student loan debts, etc.?
It appears that your view is as narrow as that of the medical professionals you criticize. I agree with Buckeye Surgeon that you need insight into these matters before you propose solutions.

dr. bean said...

The only way to never have a complication to a procedure is to not do the procedure. Period.

I think we all agree that finding ways to reduce complication rates is a good thing.

These lists of "never events" however are completely unreasonable, unrealistic, and bizarre such that those of us who actually DO health care start to wonder if people who wrote them are in possession of their wits.

Of course they are. This is just bureaucratese for "we're not going to pay for it AND we're going to get patients mad at you so they won't get mad at us."

Remember the old "not medically necessary" BS we used to get from Medicare? Now they don't bother with that insulting bit of fiction and just say "non-covered benefit" or some such oxymoron. This latest bit of claims denial rhetoric however is a little more malevolent.

Trisha Torrey said...

Sorry folks -- have been out all day... returned to find the shift to attacking me instead of Medicare. Medicare thanks you.

I'll respond one at a time -- first to Goat Girl. In fact, they never wavered on the KIND of lymphoma I was diagnosed with. The point was that I was diagnosed at all with cancer when what I had was a benign tumor which was removed -- and I have had no recurrence or any problem at all since then (4 years later.) The bigger problem was that I was told two labs had confirmed the lymphoma, when that did not turn out to be true at all. In fact, the second lab ran a third test, called a clonality test, that showed I had no cancer. The problem was -- the oncologist never read past the diagnosis in the first lab report to realize another test and results were outstanding, then that same oncologist had the gall to tell me, despite results showing the contrary, that I should start chemo anyway. Errors compounded errors. He was just trying to save face once he was caught in his mistake. And had I not dug in my heals, I would have paid the price both through chemo and money. Was I happy I didn't have cancer? You bet!! But more than that (at the time) I was angry that the system had failed me like it did.

Surgeon -- you call me naive, and I'll give you that -- I am incredibly naive when it comes to all the problems that can crop up in the process of trying to get good healthcare. That said, I learn every day -- and I have learned from these posts. The difference between most patients and me is that I am aware, and sound the warnings, that problems occur constantly, daily, perhaps hourly, that cost lives. Most patients are just so unaware until they find a hiccup (or lose a loved one) themselves. I would rather sound warnings where they are not needed to make patients pay attention, than sit back and (naively) keep quiet about something that could have been prevented.

whitecoat -- I absolutely hear you on the point of reimbursements and the time you have to spend getting things right. no question. I'll help you with your statistic -- if there are 1 billion medical visits per year, divided by 5 million medical errors per year (that's the IOC's number), then the incidence is only 1/2 of 1%. Does that seem very low? Yes. but not low enough if you are one of the 5 million. Further, if you are one of the 44,000 to 98,000 that are killed by those errors -- well -- I'll bet your loved ones think it's far too high.

I'll also let you in on a piece of information that might help you understand why I get worked up about these infections. My mother in law acquired MRSA while in the hospital in early 2007 shortly after she had surgery -- and died a few months later. Yes, it's personal.

There are a couple of truths that I hope we would all agree on, no matter how we define never events, no matter how mad we are at the bureaucrats:

1. That we still ALL want what is best for the patient.

2. That having conversations about what will -- or won't -- work helps move the argument forward. It makes no difference whether we agree or disagree -- the outcomes will be the outcomes and if they truly do result, as commenters here have suggested, in extra lawsuits, or more deaths, or any of the other unintended consequences -- then changes will be made once again

Thanks to you all for putting up with me. I have learned from you and you, I expect, whether you want to admit it or not, have learned from me.

If nothing else, I provided you with entertainment for about 24 hours -- and I made you think.

Anonymous said...

I say we stop closing the skin on laparotomy incisions for colectomies and pack them instead. Wound infections are a never event, right? Maybe something like that would convince the public that this never event nonsense will just push doctors to avoid risk to the detriment of everyone (particularly patients).

Anonymous said...

re: "-- and I made you think"

Yeah about how totally uneducated you are about medicine?

re: "But more than that (at the time) I was angry that the system had failed me like it did."

A system didn't fail you ONE ONCOLOGIST DID (according to you). This is the fact, if you have an issue with the medical care provided you, file a complaint with your state medical board. You shouldn't smear and make innuendo's on the internet. That is what people with "cojones" do. That is the purpose of your state medical board; to ensure competence in clinical practice.

More about your
"diagnosis" Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) as you know is a rare diseae described by Gonzalez et al in 1991. In your words on your website: "What I did learn was that everyone died. And died fast." According to the latest paper on SPTCL that is untrue (Blood 111(2):838-845). A retrospective/workshop study (the best we have in rare diseases) concludes that SPTCL is indeed at least two disease subsets based on T-cell phenotype. SPTL-AB with a 5 year survial rate of 82% and SPTCL-GD with a 5 year survival rate of 11%. In fact, according to the REAL classification, SPTCL-GD will note even be considered a "SPTCL". Feel free to pubmed the reference.

So what's my point?

My point is that lymphoma has become a more and more heterogeneous disease as we learn more and more about the biology of the disease. Sorry but this is a little more complicated than making widgets for Walmart. There is still more about the disease we DON'T know than we do know. HOWEVER, compared to 30-40 years ago the survival rates are much higher based on what we do know. Making a diagnosis of a rare T cell lymphoma is not like figuring out how is gong to win dancing with the stars. Personally I use AFIP or Mayo when there is any question with diagnosis. Also, this is a good case where a patient is better served in the Ivory Tower (sorry buckeye) than with a community oncologist. Your issue should be with one oncologist not "the system". In fact wasn't it another oncologist who made confirmed the incorrct diagnosis (with the NIH path). You have turned this misdiagnosis into a vendetta against "the system" (whatever that means). Well I am here to tell you, I, buckeye, and others don't sit behind computers pontificating about what should be done. We sit on hosptial committee's and protocol committee's figuring out the best care for our patients. That is on top of our day to day grind of being docs. Day in, day out everyday. This is a just a little more than playing weblog patient advocate. Buckeye, whitecoat, and others have already discussed how stupid your idea is to test every patient for C. Diff. Let alone that you don't seem to have any clue as to the real cost of pan testing, the problems with false postives (and negatives), and exactly what to do with the results. Additionally, your "blog" is littered with doc reply's to your incorrect statements. You rail about responsibility but seem to accept none for your own writings. If you really want to help us then I recommend you become truly educated and become one of us. Google is not an education. Become an RN, BSN, MPH, MD/DO. Get a real education on the subject, not a google glossover. Then you will really understand the issues we face.

PS: the 44,000-88,000 IOM numbers you quote have been parroted for a decade and are now a part of the lay press as gospel. I am not saying they are wrong, I am saying these figures come from extrapolated data FROM THE EARLY 1980'S (how many chevettes do you see on the road now). Review the medical journal letters to the editors of the era, there were significant questions as to where these numbers came from. Another example of your inability to critically read and understand the medical literature.

doctor trousers said...

it's so very very easy to accuse a faceless "system" of failing, that it should be perfect. But the system is made of thousands of fallible human beings, who make errors, (and I make the distinction between an error and a mistake). We cannot erase human errors from the healthcare system until it is run by machines only.

And more personally, do you really think that we don't try to prevent Never Events? Is our image so polluted that people seriously think we would wilfully DO HARM???? It would be stinking easy not to prep someone properly before catheterising, not to get a new catheter because you accidentally touched it with your "dirty" hand, or to not bother charting DVT prophylaxis. Do they really think we don't try hard to minimise these events? Do they really think we continue on our emotionally draining, financially unrewarding careers if we truly didn't like our patients enough to want them well?

Sheesh. Give us some credit. I'm sure as hell not doing it for the chicks, the money and the cred. I do it because I actually like making people better. Duh.

CancerDoc said...

There seems to be a suggestion that doctors want these "never" events to happen, or that it is through our own arrogance that we are unwilling to employ the techniques that will keep these events from happening. I argue both those premises.

I work in a rural community which does not have the benefit of ID or GI support. I decided to do a little self-education on C. diff this morning. C. diff colitis is something I frequently consider and frequently diagnose given my patient population (lots of lung cancer, lots of empiric antibiotics while on chemotherapy; chemotherapy which is, of it's own right without antibiotics, a risk factor for C. diff.)

I started with the CDC website. Guess what. There was no information about how to make C. diff a "never" event. I did find a presentation suggesting more research is needed to determine how antimicrobials might be used to "stem this growing epidemic," though.

As I expanded the scope of my search, I found that there is not even a good definition of community acquired vs. healthcare acquired C. diff. In a publication from the CDC, they define health care acquired C diff as infection that occurs within 4 months of hospitalization. In another paper, I found the definition as within 3 months, and another suggested TWELVE months.

I did find information about an emerging trend towards community acquired C. diff (i.e. C diff in people who don't have the usual high risk features of old age, antibiotic exposure, health facility exposure). The isolated strains have been more virulent (carrying two toxins). Perhaps, only the more virulent strains can be pathogenic in non-compromised hosts. However, in my mind, it raises the question of whether or not our failure to diagnose C diff in the community population has been our failure to put that on the differential.

According to the last ID doctor who came to our community to give a CME lecture, in the nearest large city, the vast majority of MRSA is now community acquired (the figure of 80% sticks in my mind). Please tell me, with THAT burgeoning epidemic, how we are supposed to make these infections in chemotherapy and surgically compromised patients a "never" event. Really. I want to learn.

E said...

great post buckeye!

as far as trish goes, i think most of the other posters already covered it.

DrCris said...

Very interesting discussion, Buckeye. I loved your take on this. In Australia we have a similar list of events, but they are called "critical indicators". If you wait long enough, critical events will happen, that shouldn't, and are preventable. But humans aren't robots, and hospital systems aren't perfect either.

I am all for creating a big investigation with wrong site surgery (which we hope would be never, but will happen with enough throughput). But falls? DVTs? That's bizarre. I can't see how those things can be never events.

The Aesthetic Blog said...

As a follow-on to Trisha's comments and the references to Betsy McCaughrey's Wall Street Journal op-ed piece from August 14, 2008.

The author, Betsy McCaughey, is a former Lt. Governor of New York State runs the organization RID (the Committee to Reduce Infection Deaths), and is on a campaign to force a kind of "zero tolerance" of patient infections of any kind at all hospitals. Sounds good on the surface, but what she's advocating is simplistic, perhaps simpleminded.

McCaughey, who is referred to as "Dr." in some online sources, is not articulating all sides of this important issue -- and as you and many others here state eloquently, is ignoring basic facts about the why/how of hospital infections and related phenomena that other doctors can articulate very clearly.

So... who exactly is McCaughey? A clue can be found at the Tapped blog:

"...[Is] this Betsy McCaughey the "Elizabeth McCaughey" who as a fellow at the Manhattan Institute wrote the legendary article, "No Exit," in The New Republic in 1993, in which she claimed to have read the entire Clinton health care plan and adduced all sorts of nightmare scenarios? Is this Betsy McCaughey the "Betsy McCaughey Ross" who, solely on the credential of having discredited the Clinton health care plan, was chosen as the Republican nominee for Lieutenant Governor of New York in 1995, becoming probably the first person ever to make news from that position by, for reasons never explained, standing up for the entirety of Governor Pataki's 1997 State of the State address? The same Betsy McCaughey who then became a Democrat, ran for governor, and divorced and sued her husband, Wilbur Ross, when he refused to bankroll her campaign?

"Yes, all the same person. And her new gig, the "Committe to Reduce Infection Deaths"? A good cause, to be sure: make sure doctors wash their hands. But the actual activities are vague and the "committee" itself consists of folks like Erica Jong, Tina Brown, Sir Harold Evans, the architect Richard Meier, and various other New York socialites."

Anonymous said...

Did you write a letter to the newspaper?

Anonymous said...

If this goes on, no many of us will be brave enough to treat sick people.

Buckeye Surgeon said...

Thanks for the info Aeshtetic...very interesting.

OregonDoc said...

Great post.

The originators of the "Never Event" phraseology are the National Quality Forum. They define the "Never Event" as "errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility". Certainly this sounds well and good. If there are serious and preventable errors that are not prevented and lead to serious ramifications for the patient, something should be done. However, a problem arises in identifying the criteria for such an event.

In the NQF appendix that spells out such criteria, they include:
1. Unambiguous - clearly identifiable and measurable
2. usually preventable - recognizing that some events are not always avoidable.
3. Serious
4. Adverse OR indicitave of a [system failure]

Unfortunately, the way any reasonable person will interpret a never event is one that does NOT recognize that "some events are not always avoidable". It also lends itself to the interpretation that this would ALWAYS be the indicative of a system failure.

So, what would be a better criteria for a "never" event? An event that is serious, unambiguous, and absolutely avoidable through systemic practices. One that comes to mind is Retained Surgical Instrument... but let's look at the data shall we?

Estimates of retained instrument report an incidence of anywhere between 1/5000- 1/10000 surgeries have a retained instrument. Current preventative measures commonly include an instrument count before and twice after every surgery as well as an "cavity sweep" before closing. Inaccurate counts prompt a post-operative x-ray. Nearly every surgical instrument as well as laps, sponges, guaze contain radio-opaque banding that allows for identification. However, despite these measures, retained foreign bodies occur. Instrument counts are prone to false-positives and account for extra expenditure in OR time and x-ray. Even routine post-op x-ray, studied in some locations and instituted as policy in others, reduces but does not eliminate risk of retained foreign body. There are several studies that have identified the threshold for identification of retained needles as 10mm in size by postop xray. Needles are the most common miscounted item. The possibility exists that there are a large number of postop retained needles, that even if detected, we are unlikely to find on re-exploration. And are unlikely, according to one AAORN study, to cause any patient harm.

So how could you even justify setting the expectation that a retained instrument -- one of the most shocking medical errors -- as a "Never" event? There is a known and absolute chance of this error occurring regardless of all reasonable and cost-effective measures to prevent it from occurring.

Sentinel Event. Yes. Never Event, unreasonable and ill-informed.

Anonymous said...

trisha: yep, we can test patients for MRSA on admission. we do in illinois icus. So what? What should we do about carriers? Deny them care? Treat them? How? Does it help? No answers to that question. Same as screening patients for c. diff: it's part of normal gut flora in many, many people. it becomes pathologic in certain circumstances, unfortunately.

in response to the posts about no catheter infections and no cases of pneumonia: if it sounds too good to be true, it is.

Anonymous said...

I think this is an excellent example of the interference of bureaucracy in medicine. Of course (pretty much) everyone has good intentions in handling the problem but to say that since nothing else is working, we're going to start punishing the hospitals and health care providers is a bad idea at best.

Do you think docs like missing diagnoses? Or having MRSA crawl all over the places in which they work? I can only imagine the embarrassment of a surgeon that leaves an instrument behind in a patient. Forcing hospitals to pick up the tab on mistakes that, to some degree, will always exist only serves to drive up health care costs.

With that said, that is by no means a license of complacency for hospitals and health care providers to not try to lower the stats as much as possible.

dharmesh said...

Normally I wouldn’t comment on posts but I felt that I had to as your writing style is really good. You have broken down a difficult area so that it easy to understand.

lebistourie said...

Soon the group will morph into the Stop Health Infections Tribunal, and we will all be in it!

melissa said...

this is one of the worst things that could happen and only the start trust me- i am now a patient i spent 13 years on the business side of medicine and hospitals/physician and then i had a baby via csection 7 years ago- i remained sick and about a year or so ago it was suggested i have a foreign body left inside of me it has been confirmed december of this year and i cannot find anyone to remove it- no surgeon wants to help esp since it wasnt their error- now imagine being threatened that they wont get paid for these events a patient will never get help ever and it doesnt help if you continue to take money away from doctors there will be nothing left I just dont get whats happening to this world- i just wanted a surgery so i can get better and become an advocate for both doctors and patients and try to connect that mistakes can happen its how its handled that makes it repairable or a travesty- this new issue will only make it worst


WARC-Truncated: length

text:
What: Bucknell (5-3) at St. Bonaventure (4-3)
Where: Reilly Center (5,480)
When: Tuesday, Dec. 6 -- 7 p.m.
Webcast: A-10 Network ($)
Radio: 90.5 WVBU
Internet Radio: BucknellBison.com
Live Statistics: GoBonnies.com

Bucknell Probable Starters
G: Kyi English (8.9 ppg, 2.6 rpg, 1.5 apg)
G: Megan McGurk (2.6 ppg, 3.9 rpg, 2.6 apg)
F: Claire DeBoer (13.1 ppg, 7.3 rpg, 2.4 apg)
F: Kaitlyn Slagus (14.3 ppg, 10.3 rpg)
F: Sune Swart (13.8 ppg, 8.0 rpg)

With a Win Over St. Bonaventure, Bucknell Would ...
• Improve to 6-3 overall.
• Improve to 4-3 on the road this season.
• Improve to 3-7 in the all-time series with the Bonnies.
• Improve to 19-38 all-time against current members of the Atlantic 10.
• Improve to 2-0 against the Atlantic 10 this season.
• Improve to 2-0 against current members of the Atlantic 10 under head coach Aaron Roussell.

• Bucknell plays a team that qualified for a national postseason tournament for the fifth straight game when it travels to take on St. Bonaventure on Tuesday at 7 p.m. The Bonnies advanced to the NCAA Tournament as the No. 10 seed last year and knocked off No. 7 seed Oklahoma State in the opening round.
• Tuesday marks the seventh road game in the first nine contests of the season for the Bison.
• Bucknell is 5-3 after a 57-53 loss at Rutgers on Saturday. The Bison trailed by 20 (41-21) at the half and battled all the way back to as close as two points midway through the fourth quarter.
• Senior forward Claire DeBoer led the comeback attempt, scoring 11 of her team-high 17 points in the second half. She moved into a tie for 12th with Hope Foster (2004-08) on the school's career scoring list with 1,256 career points. She added eight rebounds, moving into ninth on Bucknell's career rebounds list with 714.
• Sophomore forward Kaitlyn Slagus is still averaging a double-double after recording eight points and 10 rebounds against Akron. She leads the team in scoring at 14.3 ppg and the league in rebounding at 10.3. Bucknell Hal-of-Famer Desire Almind was the last Bison player to average a double-double in a season with 17.3 points and 13.4 rebounds during the 2003-04 season.
• St. Bonaventure is 4-3 overall after three straight win over Austin Peay (58-57), Rider (60-47), and Stony Brook (51-37). The Bonnies also have a win over Colgate and losses to Niagara and Canisius.
• The Bonnies have the top-ranked defense in the Atlantic-10, allowing 54.3 points per game. Opponents are shooting just 33 percent from the field.

How to Get the Game
• Tuesday's game can be seen online for a fee on the A-10 Network.
• The game can be heard online via BucknellBison.com and on the radio on 90.5 WVBU, with Justin Antweil calling the action. The pregame show begins 15 minutes before tip-off.
• Live stats can be accessed at GoBonnies.com
• Follow @Bucknell_WBB on Twitter for live updates

Bucknell vs. St. Bonaventure Series Notes
• St. Bonaventure leads the all-time series 7-2, including a 61-55 in the most recent meeting in 2007.
• Bucknell’s last win came in 2006 by a 54-48 score at Sojka Pavilion.
• The Bison are 0-4 all-time on the road against St. Bonaventure.

Bucknell vs. the Atlantic 10
• Bucknell is 18-38 against current members of the Atlantic 10. The Bison have played eight of the 14 teams and have a winning record against George Mason. The six teams they haven’t played are Dayton, George Washington, UMass, Rhode Island, Saint Louis, and VCU.
• Head coach Aaron Roussell went against an Atlantic 10 opponent for the first time when the Bison beat Saint Joseph’s 64-61 earlier this season.

Career-HighsSet Last Game
Kaitlyn Slagus -- blocks (3)
Sune Swart -- free throws made (8), free throw attempts (11)

Where Do They Rank?
• Bucknell is ranked 14th in the latest edition of the CollegeInsider.com Mid-Major Top 25. The Bison are 85th out of 349 teams in the Division I national RPI.
• St. Bonaventure is 205th in the latest RPI.

Up Next
• Bucknell will be off until Dec. 18, when it hosts Cleveland State for a 2 p.m. game at Sojka Pavilion. It will be the first of three straight home games for the Bison.


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text:
Here's a note we received from a fan in Canada:

Hello Ken,
The 'Biscuit Joint' CD that I got from you in September is intended as a 'stocking stuffer' gift for a friend and colleague in the development business. In the past few months I have listened to it quite often and enjoy particularly the tale of the inspector in the Porta-john.

I recall your interest in that the "Tales from the Job Site" had travelled north of the 48th parallel and thought you'd enjoy a couple of snaps of your CD product in surroundings outside the U.S.

There is a touch of snow in the picture as we enjoyed a 6 inch fall yesterday and - as usual - have a nice sunny day to see it at its best.

Kind regards, and I look forward to hearing of your next production of songs from the job site.

Alan Smith

©2005 Biscuit Joint


text:
Adrian Marion Stuke Jr.

09/30/1941 - 02/15/2013

Adrian (Rocko) M. Stuke, 71, of Mesa, Arizona was called home peacefully on February 15, 2013 after a battle with cancer. Adrian was born September 30, 1941 to Adrian Sr. and Frances Stuke in Quincy, IL where he grew up and graduated from Quincy Notre Dame High School. Adrian joined the Navy and was very proud to be submariner. After his military career, Adrian moved to Mesa, Arizona where he began his second career at Motorola. There he met the love of his life, Janie Denning. Adrian was a member of the US Submarine Veterans where he served as Vice Commander. He is survived by his loving wife Janie, son Troy (Beth) of Arizona, sister’s Sharon (Bob) Schonhoff and Patty (Bob) Kelley both of Quincy, IL, grandchildren, 1 great-grandchild, many nieces, nephews, extended family and friends. There will be a viewing at Bunker’s Garden Chapel, 33 N. Centennial Way in Mesa, Tuesday, February 19, 2013 from 6-8pm. Graveside service will be held at National Veteran’s Cemetery, 23029 N. Cave Creek Road, Phoenix on Wednesday morning.

Add Condolence


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Property Details

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text:
Bride Valley Branch

History of our Branch

Poppy Appeal

Useful Links

In 1921 the British Legion was founded by Field Marshall Earl Haigh.
The organisations purpose was to help needy ex-servicemen financially and to restore their self respect by providing employment.

Fifteen years later in 1936 the Bride Valley Branch of the British Legion was inaugurated. The first meeting took place in the school hall at Burton Bradstock on the 18th September, 1936. At that meeting the following appointments were made:

President:- Rev. A.R. Dittmer
Chairman:- Major J.M.B. Wratislaw
Treasurer:- Mr. A. Hackett.
Secretary:- Mr. R.B. Howarth
Committee Members:- Messrs. Elton, Cammell, Nethercott, Hawkins and Brown.

Alfred BrownWilliam Nethercott ? EltonEdgar HawkinsRobert CammellMajor J.M.B. WratislawRev, A.R, DittmerR.B. HowarthA. Hackett plus dogAlfred Churchouse

First Committee:
Back Row:
Alfred Brown, William Nethercott, ? Elton, Edgar Hawkins, Robert Cammell, Alfred Churchouse,
Major J.M.B.Wratislaw, Rev. A.R. Dittmer, R.B. Howarth and A. Hackett plus dog!

In 1938 the Women's Section was formed under the chairship of Mrs. Green.

Since that date and through the various wars that have taken place the local branch has continued another 60 plus years.

The Women’s section was disbanded at the end of 2004


text:
Torey Lovullo of the Arizona Diamondbacks has won the NL Manager of the Year award after his first full season as a big league skipper.

Lovullo won the honor in voting by members of the Baseball Writers' Association of America. The prize was announced Tuesday on MLB Network.

The 52-year-old Lovullo guided the Diamondbacks to a 93-69 record and their first playoff spot since 2011, a year after they went 69-93.

Lovullo was Boston's bench coach when he ran the Red Sox for 48 games in 2015 while manager John Farrell underwent cancer treatment.

Powered by Paul Goldschmidt, Jake Lamb and midseason acquisition J.D. Martinez, and led by pitchers Zack Greinke and Robbie Ray, the Diamondbacks made the playoffs this year. They beat Colorado in the NL wild-card game before getting swept by the Los Angeles Dodgers in the Division Series.

Dave Roberts of the Dodgers was second and Colorado's Bud Black was third. Voting was completed before the playoffs began.

The AL Manager of the Year was to be announced later Tuesday.

More MLB baseball:


text:
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Retailers that offer Free Shipping for 2012 holiday orders

submitted on December 9, 2012 by HouTex in "Sales / Promotions", last updated on December 14, 2012 by HouTex
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  • 165263
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Maybelline ExpertWear Eye Shadow Single

Dress up your eyes in bold, lasting color with Maybelline ExpertWear Eye Shadow Single. The easily blendable colors are highly pigmented and last up to 12 hours without fading or creasing. The silky texture smoothly and easily glides on your lids, and has high blending capability so you can mix your favorite shades to create creative, bold eye looks.
  • Ultra-blendable formula, silky smooth feel.
  • All day, crease-proof wear
  • Contact lens safe
  • Safe for sensitive eyes
  • Ophthalmologist tested

For longest lasting results, apply on top of an eye primer.

Note: Price may vary by shade.

Product Reviews

Write a Review
  • 5
    5 star

    Posted by Shirley on 24th Aug 2017

    so glad to find what i was looking 4.

  • 5
    Happy that I can still get it!!

    Posted by Glenda Kidd on 23rd Aug 2017

    Maybelline Expert wear eyeshadow single ( Amethyst) is perfect for me. I was very upset when I could no longer get it in the store but I'm so happy to find that I can still get it. I have some of my family and friends to start using this and they are very satisfied with it and so am I.

  • 5

    Posted by Sabrina Archambault on 7th Aug 2017

    I was so disappointed when I could not get this color any longer at the store. I get compliments all the time and it goes with everything it is my most used eye shadow. I am glad I can still order it at least.

  • 5
    Glad I can still get it

    Posted by Unknown on 10th Jun 2017

    I am so glad you have the eyeshadow I love. I was very upset when the retail store did not carry it anymore. I love the color and am glad I found somewhere I can get it. I just hope you guys continue to carry it so I can continue to use the color I love. Thank you so much.

  • 5
    Eye shadow that does not disappear

    Posted by CarolynJ on 19th Apr 2017

    This eye shadow stays on all day. I tried other manufacturers and the eye shadow disappears if you touch your eyelid.

  • 5
    Great Find!

    Posted by Unknown on 6th Oct 2016

    The color I have always worn has been discontinued, so I was thrilled to find it here. I purchased 3 - they will last a long time.

  • 5
    Eye shadow

    Posted by Unknown on 9th Aug 2016

    I love this color. But I think Maybelline discontinued it so I could not find it anywhere. So glad I was able to order it through !!!!!

  • 5
    True Colors

    Posted by Debbie on 29th Jun 2016

    I have been looking for a good neutral color of eye shadow to wear so I bought Tastefully Taupe. It is perfect. Just dark enough to be effective and light enough to not "take over the eye". The price was lower than the stores so I bought several. It goes on smooth also.

  • 5
    Great product

    Posted by Ann on 29th Jun 2016

    Great eyeshadow and for the price is just as good is very expensive brands.


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13 Unusual Gifts Idea for this Valentine – Bizarre Valentine Gifts

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Few days remaining to valentine week starts. One week of valentine giving and taking gifts from your lover. Few are still waiting for their valentine to come and few have got. If you are thinking to make this valentine unique and memorable then we have something for you. Here we have 13 unusual gifts idea for this valentine – bizarre valentine gifts. These gifts are not normal these are unique and bizarre.

I strongly recommend to know a little about your valentine before giving any of these gifts. May be she/he does not like these type of gifts. If you will present these gifts to him/her your valentine day will be ruined.  So know about the nature of your valentine before giving such gifts.

13 Unusual Gifts Idea for this Valentine – Bizarre Valentine Gifts

1. Photo Bracelet for your Valentine

Photo Bracelet for your ValentineSource

Give this awesome bracelet for your valentine. This gift is good for carrying all memorable photographs. When she will see it her eyes will shine with the memories.

2. Toilet Paper full of Love

13 Unusual Gifts Idea for this ValentineSource

Every time when your valentine will use this toilet paper, she/he will remember you. It is an unique and bizarre valentine gift.

3. Unique Message Card for Valentine

Bizarre Valentine GiftsSource

This Card show that how much you lover your valentine. This is an unique gifts for this valentine.

4.  Unique Underwear for Him

Unique Elephant Underwear for HimSource

Most bizarre gift in this unusual gifts for this valentine is this elephant underwear. You can present it to your boyfriend. Be sure that he will like it or not.

5. Zombie Teddy Bear Gift for Valentine

Bizarre Valentine GiftsSource

This is a zombie style teddy bear gift for your valentine. If your girlfriend is scared to zombie this is good present to reduce her fear. 😉

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Hi myself Vipin Pandey, the guy behind Buzz Odd. I love to listen music, watching some good movies, and coding to make some cool web pages.
In the Buzz Odd I explore my Odd side :)

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Customer service               We ship worldwide

Hello and welcome to B,Wear!

Our store has everything you need for lingerie, swimwear making and many other fun things in all kinds of colors to cover your sewing projects. (Even matching thread. ????)

For the last five years , we are proud to be the 1st European Distributor for Bra-Makers Supply in Canada.

Not only do we ship all over Europe, we ship all over the world!

Want to know more about BWear?

Under the Menu section to the left of our website, scroll down to: “A Little About Us,” “Tips & Trix,” and “Up This Year”. Here you will find a lot of great information about our store.

Don't miss to read our Blogg

Have you made something you want to share? Send us a picture with a few words about the item and we will post them here. ????

Customer pictures - Ohhhlulus Lola made by Angelia Friman and Ohhhlulus Claudia made by Malin Nobrant.

This is the woman behind all my               Missed Kat Klebenows blog about
beautiful handdrawn pictures                   making your own hook & eye. Read about it here!

 Craftsy classes with Beverly

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PostHeaderIcon Drink Up: Drambuie Cocktail Competition at Riffle NW

Bar Competition, Ken Norris, Ariana Vitale, Jordan Felix, Brandon Josie, Jabriel Donohue at Riffle NW

DRAM-A-RAMA: Ten local bartending legends gathered late Tuesday night for a cocktail competition at Riffle NW featuring Drambuie spirit. There were secret ingredients (including Jacobsen Sea Salt and Fernet Branca) and plenty of egg whites used in sweetly balanced drinks that had to be made in less than seven minutes.

Clyde Common's "Junior" came away the big winner with his perfectly mixed cocktail and big ass ice cubes. I was lucky enough to be a judge, and had a chance to judge next to two cocktail experts: Riffle's bar manager Brandon Josie and Drambuie brand ambassador Jabriel Donohue.

Last Updated (Wednesday, 30 January 2013 09:00)

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Welcome to Caber Floors!

The specialists in the supply and fit of all types of hardwood flooring.

At Caber Floors we want to give you quality hardwood floors at affordable prices.

With over 25 years of hard experience dealing with wood and all it can throw at you.  Laying the floor is the easy part - laying the floor correctly is where the challenge lies.

In recent years we became so saddened with the poor workmanship and poor quality of materials used that we  set up our own company enabling us to guarantee my own high standards.

There are many products on the market that have been poorly milled and cheaply manufactured.  Caber Floors will only ever use quality materials and it is for this reason that we realise that it is possible you may find a cheaper quote - but you will not find a company who cares about your floor the way we do.  We put our heart and soul into each job we carry out - taking time to get it right and giving the attention to detail that is often overlooked.

And Caber floors will always guarantee quality workmanship.  If a job is worth doing - it's worth doing right.

Call us now on 01252 710844 to arrange your free no obligation quotation

For more information of our products and services, or more examples of beautiful wooden floors in all types of settings - read on.......

Home  Your Style  Products & Services  Restoration  Decking  Portfolio  Customer Quotes  Careers  Caring for your floor  Contact Us

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West Midlands Football Team Results: 0-1 to Cadbury!

Congratulations to the sixth form boys who put in an impressive away display to beat Solihull College 1-0 and remain undefeated this season.

After a slow start for both teams on a windy and wet afternoon, Cadbury began to take control and created the better chances throughout the first half. After half an hour, a break down the right wing saw the ball crossed for Trai Jackson to neatly finish past the goalkeeper.

The second half produced a wave of attacks by Cadbury, but a combination of goalkeeper saves and desperate defending saw the game remain at 1-0 to Cadbury throughout the second half.

Well done to all 15 players involved, with special mentions to Akil Scott and Kibria Rahman in central defence.

Cadbury will play the winner of the match between Solihull 6th Form and Dudley College in the semi-final of the West Midlands Cup next month.

Stay informed with student life at Cadbury College: FacebookInstagramPinterest Twitter Vimeo


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 Reform Party

Canada History

Canada History   timelines
AskAHistorian    blog

Prehistory | 2 Worlds Meet | New France | England Arrives | Clash of Empires | Revolution | British America | Reform/Revolt | Responsible Government | Confederation | Nation Building | Laurier | The Great War | Roaring 20's | Great Depression | WWII | The Peace | Cold War | Trudeau | PC's in Power | Modern Canada

Chretien | 1995 Referendum  | 1998 Seperation Ruling | Nunavut | Budget Surplus | Reform Party | The Bloc

Although various revenue sharing agreements had been negotiated by the Liberals and the Alberta government, the National Energy Policy (NEP) had left a deep and bitter taste in many westerns mouths. Even under the Mulroney government many in the west did not believe that they were getting the representation they deserved.

By 1986, many of the alienated people and groups in Alberta and western Canada began to coalesce around a dynamic speaker who was the son of a former Premier of Alberta, Preston Manning. By the autumn of 1987 what had started as a reform association became a political party with the founding of the Reform Party of Canada in Winnipeg. The main objectives of the party were fiscal responsibility and constitutional reform that would give the west a greater say in the Canadian Government.

The basic principles were a continuation of a long prairie traditional of populism which had manifested itself in the Social Credit, the CCF and even the Diefenbaker Conservatives. he constitutional reform which the party aspired to were items such as a tripe E Senate (Equal, elected and  effective), the ability to recall elected officials, ballot day propositions directly voted on, reducing the size of the Federal government and opposition to any special deals for Quebec.

During the 1988 election passions ran high over the free trade debate and Reform failed to make any electoral breakthrough although it did do well as a percentage of he vote in western Canada. In 1989 in a Federal by-election Reform managed to win the seat in Alberta and elected it's first MP Deborah Grey. That same year, Alberta under pressure from Reform, held and election for the Senate, although not legally binding, and a Reform candidate was election and was in fact appointed by the Conservatives in Ottawa.

Reform opposition to both Meech Lake and the Charlottetown Accords helped them gain many new supports in the west and their opposition to the GST brought in many more fiscal conservatives. By the time a Federal election was called in 1993 Reform was capitalizing on the collapse of support for the Conservatives in the west and a general dislike of the Liberals which remained from the Trudeau years. Reform won 22 seats in Alberta, 24 seats in BC, 4 seats in Saskatchewan and 1 in Manitoba, and 1 in Ontario for a total of 52 seats. The Bloc Quebecoise won 54 seats in Quebec and the Conservatives were reduced to just 2 seats.

Manning's claim that Reform was a national party was obviously not supported by the election results but they at least now had a strong voice in Parliament.  The party was unable to make much progress with the public due to it's extremely conservative stance on social issues such as women's rights, homosexuality, ethnic groups and social justice programs. They also effectively eliminated themselves from contention in Quebec due to their anti-Quebec rhetoric, resistance to any compromise with Quebec and general pro-western agenda. This substantially eliminated them from any opportunities of becoming a majority governing party.

The other conservative issues which they focused in on was fiscal responsibility, balancing the budget and paying down the debt which the Progressive Conservatives had completely failed to address. The Liberals under Paul Martin undertook fiscal reform as their main objective which completely undercut any criticism which they could have aimed at the Liberals.

The other issue which permeated the party was the infighting which emerged as the party grew in status. The basic populist tendencies of the Reform Party attracted supports who believed in grass roots politics with recall and direct propositions as examples. This political philosophy does not generally translate well into a disciplined, centralized, unified party which operates as one organic whole. The secondary result of diffused democracy in a party is the over emphasis that is placed on disciple in order to maintain control and a sometimes harsh restriction of membership.

With those issues retarding party effectiveness the Reform managed to increase their support in the 1997 election and captured 60 seats but it lost it's one Ontario seat and remained an exclusively western party. As the official opposition the Reform Party started to lose some of the support it had built up when Preston Manning reneged on his original refusal to use the Official Opposition leaders residence and the Reform MP's decided to accept MP perks which they had previously criticized as a waste of money. The Progressive Conservatives had also rebounded and won 20 seats in the election which maintained a split on the right of the political spectrum.

By 2000 in an attempt to bury its' issues with Ontario and Quebec the Reform Party decided to hold  a series of meetings and conventions to re-unit the right. The result was the formation of the Canadian Alliance Party and the disbanding of the Reform Party.

Reference: www.canadahistory.com/sections/eras/eras.html


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Red Deer RCMP charge man with second degree murder

Red Deer, Alberta – Red Deer RCMP and the RCMP’s Southern Alberta Major Crimes Unit (MCU), have charged 26-year-old Jordan Koizumi of Red Deer with one count of second degree murder in the death of 50-year-old Tina-Marie Pfeiffer, also of Red Deer.

At approximately 3:56 A.M., yesterday morning, members of the Red Deer RCMP Detachment were dispatched to a residence in the area of West Park Crescent where they discovered a deceased woman inside a residence.

It was while police were at the scene that they received a report of a man who was nearby and walking down the street in his underwear. Police made a patrol to the area where it was reported that the man was seen and located Jordan Koizumi, who was taken into custody at that time.

The investigation into Ms. Pfeiffer’s murder included assistance from the RCMP’s Southern Alberta MCU, Red Deer RCMP General Investigation Section (GIS), Red Deer Forensic Identification Section (FIS) and the “K” Division Special Tactical Operations Unit (STO).

Today, an autopsy by the Office of the Chief Medical Examiner in Calgary determined that Ms. Pfeiffer’s death was a homicide.
Jordan Koizumi is scheduled to appear in provincial court in Red Deer on Monday, October 31, 2016. Additional information about this case is not available through the RCMP as it is now before the courts

RCMP, Strategic Communications Unit

October 27, 2016

Red Deer RCMP investigate sudden death

Red Deer, Alberta – Members of the Red Deer RCMP Detachment, as well as the RCMP’s Southern Alberta Major Crimes Unit (MCU), are investigating the circumstances of a sudden death which occurred at a residence in the city and was reported to police early this morning.

The investigation is ongoing and police wish to reassure the public that they do not believe that there is any concern for the safety of the residents of the community.

The RCMP will provide an updated media release once new information becomes available, however, at this time no addition details shall be released as investigators continue their efforts in this matter.

Red Deer RCMP


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Good Bird Inc

Barbara Heidenreich will also be at her table in the vendor area with her books and videos.

The Mission of Good Bird Inc is to give people the tools and information to:

  • Be kinder and gentler with their parrots
  • Build a relationship based on trust
  • Solve behavior problems using the least intrusive methods
  • Experience the amazing relationship one can have with a parrot when you train with positive reinforcement
Posted in CPC09vendors, cpc15vendors.

Comments are closed.


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Home grown tyranny

June 27, 2013
Cape Coral Daily Breeze

To the editor:

The George W. Bush (43) administration sold to the American public the idea that the 5th President of Iraq, Saddam Hussein, had weapons of mass destruction (WMD's) and intended to use them. The Zionist, Neo-con warmongering members of the George W. Bush administration convinced "W" to go to war first with Iraq and then with Afghanistan. This demonic lie that Iraq had WMD's perpetrated by Zionist influence for the benefit of "Eretz Israel" cost the United States of America dearly in blood and treasure. The Wikipedia information states that the total U.S. casualties from the War on Terror are 66,077-plus with total Americans killed (military and civilian) 9,655-plus. The financial cost according to Wikipedia, covering spending related to the war as of 2011 is $2.7 trillion with the estimated long term spending at $5.4 trillion including interest.

Another insufferable lie was that Osama Bin Laden (former U.S. ally on the payroll of the CIA) and Saddam Hussein somehow acted in tandem to plot the 9/11 terrorist attack. Nothing could be farther from the truth. Go to: Also, read War Is a Racket by Major General Smedley D. Butler.

We have had three ten year plus "invasions" (wars) in my lifetime; Vietnam, Iraq and Afghanistan. Vietnam is now a communist nation which we help through our foreign aid programs. I wonder how the extended families of those 58,282 American lives lost in Vietnam feel now about sending their sons to die in a no-win war for corporate America which raked in billions of dollars for the intelligence-military-industrial-complex. As the conflict continues in Iraq and Afghanistan our own former Vice-President, Dick Cheney, receives tens of millions of dollars from his stock with Halliburton Corporation (where he was a former CEO) which won no bid contracts from our own government. Cheney recently called whistle blower and patriot, Edward Snowden, a traitor. Cheney only has to look in the mirror to see what a real traitor to our republic looks like. For this government to fund the anti-Assad Syrian rebels, many of whom are Al-Qaeda mercenaries (supposedly our mortal enemies) is traitorous and insane. Anyone who believes that the Assad government is using chemical warfare in this Syrian Civil War is an idiot. This is a typical fairytale made up by our own Zionist-biased media. As a veteran I say bring them all home and defend our own borders.

End the FED, end the WARS, end the IRS!!!

Jon Larsen Shudlick

Fort Myers

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#1 Posted : 17 May 2016 01:39:57(UTC)
Rank: Advanced Member

Groups: Registered
Joined: 04/01/2016(UTC)
Posts: 765

Got a question on rule clarification, comments on rule enforcements or some memorable NHL stories? Kerry wants to answer your emails at cmonref@tsn. Nicolas Batum White Jersey .ca. Dear Kerry, I was watching the fourth goal for the Islanders in the game against the Leafs, it seemed the Leafs goalie Bernier had the puck covered and the referee blew the whistle raised his arms in the air to signal the play was dead and then moments later signaled good goal. On the overhead replay, you could see the puck cross the line before the whistle, however it seems to me that the referee thought the puck was covered and intended to blow the play dead as he blew the whistle before ever seeing the puck free. Would this fall under the intent to blow the play dead under Rule 31.2: "As there is a human factor involved in blowing the whistle to stop play, the Referee may deem the play to be stopped slightly prior to the whistle actually being blown. The fact that the puck may come loose or cross the goal line prior to the sound of the whistle has no bearing if the referee has ruled that the play had been stopped prior to this happening." Look forwards to hearing your take on the play. Jordan Anstey --- Hi Kerry, I have a question regarding the Leaf/Islanders game. The Islanders just tied the game 4-4 on a questionable goal, in my opinion. The puck was never frozen by Bernier, as it rolled across the goal line. The referee at the crease blew his whistle, waved it dead and then immediately pointed to the puck in the net. How on earth can you blow the play dead and then reverse it? That shouldnt have counted! Please correct me if I am wrong. Best Regards,Dale Jordan and Dale: Referee Denis LaRue did everything correctly from the moment he attacked the net with speed and eventually located the puck across the goal line the goal line behind Jonathan Bernier. Any evidence or question of the referees "intent to blow the whistle" would have resulted from the fact that he could not see the puck as he approached the net and therefore might have assumed it was frozen under Berniers equipment (puck out of sight). The referee demonstrated patience in not blowing the whistle pre-maturely as he continued on a path toward the goal crease in an effort to find the puck. Once referee LaRue got to the net he did in fact locate the puck across the goal line almost simultaneously with his decision to kill the play. This visual picture was quickly processed and abruptly changed any thought he might have had that the puck was frozen. The puck in the net was now a reality for the referee. As such, Denis LaRues hands immediately went from the field goal position signaling "play is dead" to pointing into the net signaling that a legal goal had been scored! This visual evidence demonstrated and confirmed to the referee that the puck had entered the net prior to his whistle and any "intent" he might have had to blow the play dead. It is somewhat speculative to assume the puck is frozen just because you dont see it. Definitive evidence is presented whenever the referee sees the puck across the goal line. A legal goal must be based on that evidence. Far too many times I have seen referees misjudge plays in and around the goal crease when they remained stationary in the corner or kept an obstructed view without moving their feet. Had it not been for LaRues quick reaction this could have been just another one of those unfortunate times. On the play Travis Hamonics shot from the point was deflected by Carl Gunnarsson and picked up behind the goal line half way to the corner by Ryan Strome. This altered puck position forced the referee to retreat to the corner just ahead of the goal line. Strome then threw the puck to the front of the net and it was redirected by Anders Lee between Berniers pads. Rather than remain in the corner, Referee LaRue read the situation and reacted without hesitation by sprinting to the net on angle that allowed him to avoid Nazim Kadri and Ryan Strome. En route to the net the refs inability to immediately locate the puck, along with his instinct and experience might have caused him to think the puck was underneath Jonathan Bernier. LaRues patience with the whistle and his quick footed attack toward the net to locate the puck behind Bernier resulted in the correct call to allow the goal scored by Anders Lee to stand. In this situation the referee demonstrated a text book attack of the net in order to render the correct call. Frank Kaminsky Hornets Jersey . The offensive drought ended with flurry, though, as Boston scored eight times in the fourth inning Saturday, including a grand slam by Carl Crawford, in a 12-7 win over the Texas Rangers. Spencer Hawes Hornets Jersey .com) - Mikko Korhonen carded a 5-under 67 on Thursday to claim medalist honors at the European Tours Final Qualifying Stage tournament.LOS ANGELES, Calif. - Kobe Bryant and LeBron James traded hugs, big shots and verbal jabs all night with warmth and humour. In the waning minutes, they went head-to-head in yet another entertaining duel between two of this generations greatest talents.Although LeBron ended up topping his friendly rival again, King James relished what could be one of his final chances to share a court with one of his few true peers.James scored 36 points and the Cleveland Cavaliers snapped their six-game losing streak with a 109-102 victory over the Los Angeles Lakers on Thursday night despite Bryants 19 points and career-high 17 assists.Its always fun, a pleasure, James said. Its two of the best competitors this game has probably ever seen, and to be on the same floor with him, somebody I looked up to when I was a child growing up, seeing him go straight from high school to the NBA, its fun, its great. I hated him being out of the NBA last year because of injury, and its fun having him back.Cleveland had lost nine of 10 before James held off Bryant down the stretch in a scintillating exchange between the basketball icons.Bryant hit a 3-pointer with 1:54 left and two free throws with 43 seconds to play, cutting Clevelands lead to 103-99. But James drove past Bryant for an acrobatic layup with 20.9 seconds left, and Bryant missed a jumper that essentially ended it.Bryant and James embraced again afterward, and even Kobe allowed himself to relish the moment.If we were contending for a championship, Id be my same moody self, Bryant said. But right now, I tend to have a little more perspective, knowing I really wont get a chance to play against him for much longer. So you want to enjoy it.Bryant set a career high for assists in his 1,279th regular-season game, playing in his second straight after skipping three of four games to rest his 36-year-old body. He showed off his playmaking skills, but James got the Cavs comfortably ahead while Kobe sat out the start of the fourth quarter under a strict minutes limit.James and Bryant laughed and joked throughout the game, exchanging good-natured jibes while waiting to check into the game together. James turned 30 last month, while Bryants season has been defined by his weariness from a 19-year career.Kobe even had something to say when LeBron spectacularly clanged a dunk attempt off the rim.He said, Thats wwhat old age will get you, James said with a laugh. Kemba Walker White Jersey. You start missing dunks when you thought you was up there.James has won 13 of his last 16 matchups with Kobe since 2006. When Bryant went back to the bench after getting his 15th assist in the third quarter, James took charge of the Cavs rally to an 11-point lead in the fourth.For all of us, those are two all-time greats going at it ... like two prizefighters, Cavs coach David Blatt said. Its great to see two guys playing the game at that level for so many years and still involving their teammates in the way that they did.Kyrie Irving added 22 points and Kevin Love scored 17 for the Cavaliers, who moved back to .500 with their first victory since Jan. 2.On the fourth stop of Clevelands five-game West Coast trip, James hit four 3-pointers in his second game back from an eight-game absence with an injured right knee.Jordan Hill scored 20 points in the Lakers ninth loss in 12 games.TIP-INSCavaliers: James ripped off the protective sleeve on his elbow in frustration after missing his first three free throws, only to miss a fourth without the support. ... Loves back appeared to be bothering him throughout the game. A trainer attended to him during a second-quarter timeout. ... Cleveland began the night under .500 for the first time since Nov. 24.Lakers: Bryant set his previous career high in assists on Feb. 2, 2002, against Michael Jordan and the Washington Wizards. ... Nick Young scored 14 points, but his streak of consecutive free throws made ended at 31 in the fourth quarter. ... NBA career assists leader John Stockton also played 19 seasons, getting a season high of 13 assists that year.TIGHT COREBlatt used just three reserves, but got significant contributions from all eight players. J.R. Smith had three 3-pointers and 14 points, while Timofey Mozgov had 10 rebounds.SHUTDOWNBryant wont travel to the Lakers road game against the Jazz on Friday, and he realizes coach Byron Scott has suggested the team might decide to shut him down for the season in several weeks. Thats a tough one for me, Bryant said. I want to play, but at the same time, I understand his position, and I understand managements position, and I will do what they ask of me. But its very, very hard for me to miss one game.UP NEXTCavaliers: At Clippers on Friday.Lakers: At Utah on Friday. Cheap China Jerseys Cheap NFL Jerseys Cheap NFL Jerseys China Cheap Jerseys From China China NFL Jerseys Cheap Jerseys Cheap Jerseys China ' ' '
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