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শুক্রবার, ৮ মার্চ, ২০১৩

Persistent Barriers to Affordable Contraception | The Doctor's Tablet

Woman holds her head while listening to her doctor I thought the financial barriers to intrauterine device (IUD) access would disappear on August 1, 2012, with the implementation of the Affordable Care Act, which stipulates that all ?FDA-approved contraception? will be covered without copayments. I was wrong. Since last summer I have often felt that helping my family-medicine patients get IUDs?the most reliable, reversible form of contraception?has become more time-consuming, and also potentially more expensive for them.

Because the IUD devices are so expensive, my office does not keep them in stock. Instead, for each patient who wants an IUD, we have to complete, fax and track a special pharmacy IUD order form. This can?t be done online, nor can we order the IUD from another pharmacy. In addition, the pharmacy has to talk with the patient to confirm the order and often to set up a payment plan if her insurance won?t cover the full cost of the expensive device. This process now seems to take weeks longer than it did before. And even when the device arrives, for some patients it?s the end of their waiting for an IUD but it?s not the end of their financial responsibilities.

Take, for example, a patient I?ll call Amy, a 24-year-old working woman who completed the numerous time-consuming steps needed to have her IUD sent to my office late last year. Amy paid the pharmacy in full for her IUD ($850) because it was not covered by insurance. Neither of us knew that her insurance wasn?t going to pay for the insertion of her IUD either. Last month she came back to me, angry and in tears. This young professional woman chose the most effective, reversible form of contraception, and none of the cost was covered by her commercial health insurance, even though abortion or prenatal care would have been.

Amy?s experience was almost the last straw for me. I have trouble justifying the time it takes my office to facilitate the ordering of the IUDs and the potential additional cost to patients. I think, ?Why don?t I just send them all to the clinic downtown, which has IUDs in stock and a sliding-scale fee for insertion??

And then the patients remind me of why I go on.

I offer them the referral option, but most of my patients feel strongly that they want to keep seeing their primary-care doctor in their primary-care office. They want their family physician to insert their IUD. I?m honored that patients value our doctor-patient relationship, so we proceed with filling out the IUD order form, faxing and calling. And my office staff and I go through these steps again and again. Some insurance covers the device; some patients set up a payment plan; others don?t get an IUD; a few go elsewhere.

There?s another reason I continue to offer and insert IUDs. I also work as a clinical researcher focusing on increasing the proportion of primary-care physicians who counsel adolescents about IUDs. Teen pregnancy continues to be a public health issue in the United States. Recent studies have shown that increasing IUD use decreases adolescent pregnancy and abortion rates.

As I?ve seen in my office, access to IUDs is a real issue. People want to receive care in a familiar place with a provider they know and trust. I believe that if we improve adolescents? access to IUDs?in their usual primary-care sites as well as in specialty-care sites?then the adolescents will be more likely to use IUDs.

So this family physician/clinical researcher wonders: if I?who have a clinical and research interest in improved contraception access?feel frustrated and at times ready to give up on inserting IUDs, how can I expect other clinicians to continue fighting for access?

While I hope that in 2015, after full implementation of the Affordable Care Act, more of the financial barriers to full-scope reproductive healthcare, including IUD access, will disappear, I?m now more realistic. New barriers will emerge. But I can?t give up; I owe it to my patients.

Susan Rubin, M.D.

Susan Rubin, M.D. is assistant professor, Department of Family and Social Medicine at Albert Einstein College of Medicine and attending physician, Department of Family and Social Medicine, Montefiore Medical Center

বৃহস্পতিবার, ৭ মার্চ, ২০১৩

Time management tips and secrets Werner | Self Improvement ...

Government (Carl Sandburg)

THE Government--I heard about the Government and
I went out to find it. I said I would look closely at
it when I saw it.
Then I saw a policeman dragging a drunken man to
the callaboose. It was the Government in action.
I saw a ward alderman slip into an office one morning
and talk with a judge. Later in the day the judge
dismissed a case against a pickpocket who was a
live ward worker for the alderman. Again I saw
this was the Government, doing things.
I saw militiamen level their rifles at a crowd of work-
ingmen who were trying to get other workingmen
to stay away from a shop where there was a strike
on. Government in action.
Everywhere I saw that Government is a thing made of
men, that Government has blood and bones, it is
many mouths whispering into many ears, sending
telegrams, aiming rifles, writing orders, saying
"yes" and "no."
Government dies as the men who form it die and are laid
away in their graves and the new Government that
comes after is human, made of heartbeats of blood,
ambitions, lusts, and money running through it all,
money paid and money taken, and money covered
up and spoken of with hushed voices.
A Government is just as secret and mysterious and sensi-
tive as any human sinner carrying a load of germs,
traditions and corpuscles handed down from
fathers and mothers away back.

Powered by Poems and Poetry

Source: http://self-improvement.roxy-publishing.com/blog/time-management/time-management-tips-and-secrets-werner

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Kenyans wait to know winner after tight presidential vote

NAIROBI (Reuters) - Kenyan authorities hope to deliver the final outcome of a presidential vote on Wednesday, after partial results showed a lead for a politician wanted in the Hague over tribal violence at the last election five years ago.

Counting since Monday's vote has been slow, and a new electronic voter system has been plagued by hitches, leading to complaints by political parties and anxiety among voters fearful that a flawed process could lead to another violent dispute.

Deputy Prime Minister Uhuru Kenyatta, 51, has kept an early lead since results started trickling in after polls closed on Monday, but some strongholds for his rival Prime Minister Raila Odinga, 68, have yet to declare their results.

After problems with the electronic system, the electoral commission said it would rely instead on results being delivered manually to a national tallying center overnight. It said it hoped to declare the winner on Wednesday and urged Kenyans to remain calm.

Results released on Tuesday with half of ballots counted showed Kenyatta, son of Kenya's independence leader and one of Africa's richest men, leading with 53 percent, against 42 percent for veteran politician Odinga.

Kenyatta and his deputy presidential running mate are both wanted in the Hague on charges of unleashing death squads after the last vote in 2007, which both men deny.

The last election saw some 1,200 people killed in ethnic violence after outgoing president Mwai Kibaki was declared the victor over Odinga. This time, Monday's vote saw at least 15 people killed in pockets of violence but no repeat so far of unrest on such a large scale.

If neither major candidate wins 50 percent of the vote, Kenyatta and Odinga would have to face each other in a second round run-off, penciled in for next month if necessary.

"We can confirm that our returning officers are expected to bring the physical results at anytime now, which will lead to the final results. What matters here is the final result and they are coming in," Ahmed Issack Hassan, chairman of the Independent Electoral and Boundaries commission, told a news conference on Tuesday evening.

Hassan repeated that despite the hitches, he expected the vote to be fair and credible.

"We therefore continue to appeal for patience from the public," he said earlier in the day. "Nobody should celebrate, nobody should complain."

To try to prevent a repeat of the contested outcome that sparked the violence after the December 2007 vote, the new, broadly-respected election commission is using more technology to prevent fraud, speed up counting and increase transparency. But the new system has come up short of its expectations.

EARLY LEAD

Election officials had said turnout was more than 70 percent of the 14.3 million eligible voters.

Kenyans, who waited patiently in long lines, hope the vote will restore the nation's image as one of Africa's more stable democracies, damaged by the tribal blood-letting in 2007.

Kenya is East Africa's biggest economy and, although led by authoritarian and corrupt rulers for most of its half century of independence, has been spared the civil wars that devastated neighbors like Somalia, Sudan, Uganda and Rwanda.

More recently it has served as an ally of the West against Islamist militancy in the horn of Africa, sending troops to Somalia to fight al-Shabaab rebels. An explosion struck a predominantly Somali neighborhood in the capital Nairobi late on Tuesday, injuring one person, highlighting the threat from insurgents in the region.

The United States and Western donors have watched the vote closely, concerned about the stability of their ally and fretting about what to do if Kenyatta wins and its new president is an indicted international crimes suspect.

REAL TEST

The broadly peaceful voting on Monday and the big turnout are positive signs, but the real test will be whether the candidates and their backers accept the result.

The shilling currency lost some of its earlier gains after the slow count cast doubt on whether a first-round victor would emerge. Analysts said an outright win would be preferred to a run-off, which would prolong uncertainty.

As in past elections in Kenya, much of the voting has been on ethnic lines, with Kenyatta enjoying strong support among his Kikuyu tribe, Kenya's largest, and Odinga backed by the Luo, the tribe which includes the family of U.S. President Barack Obama.

In a country with a handful of large tribes and dozens of smaller ones, both candidates lead broader coalitions and are also relying on support from the tribes of their running mates.

William Ruto, Kenyatta's running mate who also faces charges of crimes against humanity at the ICC, said the process of tallying and relaying results had seen serious challenges.

The electoral commission decided to count more than 330,000 ballots that had earlier been disallowed. Ruto suggested this could be a move to block a Kenyatta victory in the first round.

"We want to believe that this is not an attempt to deny the Jubilee Coalition a first round victory as is clearly now on the wall," he told reporters, referring to a screen with the latest tally. "We urge every Kenyan to be calm and very patient and await the official release of these results by the commission."

All the candidates have pledged to accept the outcome, and ordinary Kenyans speak passionately about their determination not to allow a repeat of the violence five years ago.

Streets have been all but deserted with businesses closed, including supermarkets and security personnel were beefed up countrywide in readiness for possible demonstrators.

Some residents in Odinga's western Kisumu heartland were still optimistic that the tide would change in his favor.

"People should be patient; in 2007 Mr Odinga was leading against Mwai Kibaki in preliminary results. The following day when we woke up, things turned upside down and Kibaki won the elections. I believe the same thing could happen," said 31 year old Christopher Otieno, a businessman.

(Additional reporting by Kevin Mwanza; Writing by James Macharia; Editing by Peter Graff)

Source: http://news.yahoo.com/kenyatta-takes-early-lead-kenya-counts-votes-015009601.html

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বুধবার, ৬ মার্চ, ২০১৩

Like Yahoo, Best Buy puts end to telecommuting

Following in the controversial footsteps of Yahoo, Best Buy has announced it will end its work-from-home program for 4,000 corporate employees in an effort to spark more "innovation and creativity." NBC's Kevin Tibbles reports.

By Isolde Raftery, TODAY

Struggling electronics retailer Best Buy, long known for a corporate culture that rewards employees for performance rather than office attendance, is following in Yahoo?s footsteps.

A week after Yahoo CEO Marissa Mayer banned working from home, Best Buy announced that it is ending its flexible workplace policies and will require its 4,000 or so headquarters staff to work a traditional 40-hour week at the office.

Best Buy spokesman Jeff Shelman said the decision is ?totally about making sure we do everything we can to reinvigorate the company for all our stakeholders.??

The new policy applies to the electronics retailer?s headquarters in Richfield, Minn., and not to most of the company?s 160,000 employees ? dubbed ?blue shirt? sales associates -- who work in stores.

Shelman emphasized that the new policy doesn?t mean an end to all flexibility.

?If you have a sick kid or say, like today, there?s nine inches of snow on the ground, or you have to go to the dentist, you can have a conversation with your manager,? he said.

The move comes a week after Best Buy announced it would lay off 400 employees at its headquarters, which the company said would help save about $150 million. The electronics retailer also had some good news: On Friday, it posted promising fourth-quarter results,?as revenue from U.S. stores open longer than 14 months rose 0.9 percent.

But the last year has been hard on Best Buy, during which it announced the closure of dozens of stores. In July, the company announced it would lose 2,400 jobs; a company statement this week said there would be more layoffs this year. CEO Hubert Joly took the helm in August after former CEO Brian Dunn abruptly resigned in April 2012.

Best Buy had long-touted its unorthodox workplace, which began in 2005 with a program called Results Only Work Environment, or ROWE. Employees were evaluated on performance alone and were not beholden to a schedule or to the office. ??

Jody Thompson, a former Best Buy employee who implemented the program there, said that when she left the company in 2007, about 80 percent of the corporate office ? between 2,500 and 3,000 employees ? had been trained in ROWE. She said nearly all took advantage of the flexible schedule that came with a ROWE-focused work environment. Thompson left Best Buy to co-found?Culture Rx?with another Best Buy employee.

?It was going really well,? she said. ?But over time, more and more happened in terms of new management coming in. There wasn?t the right thinking in place to continue to evolve, so they just decided go to back to 1952.? ?

Best Buy?s CEO doesn?t blame ROWE for its woes, Shelman said.

?There is no cause and effect that the struggles we?ve had as a company is directly tied to the flexible work schedule,? he said. ?It?s just that this time and place the decision has been made that we want as many people as possible physically in position.?

After an investor presentation in November,?Joly told the Star Tribune?that he wanted employees to feel ?disposable as opposed to indispensable.?

UBS analyst Brad Thomas has watched Best Buy for 12 years and said he?s not surprised by the company?s decision, noting that the new management team comes from outside the company. ?This kind of policy would be the type of thing they?re trying to change about the company from top to bottom,? he said.

But he said even the smartest management team may not be able to save Best Buy in the long run. The practice of ?showrooming,? in which customers visit a Best Buy store to check out an item like a TV and then buy it online for less, has cut into the company?s sales.

Despite the announcements by Yahoo and Best Buy, working from home appears to be growing rather than shrinking.?The U.S. Census Bureau reports?that 13.4 million people worked from home at least part-time during a typical week in 2010.?

And research indicates that telecommuting doesn't hinder productivity. Washington State University psychology professor Tahira Probst said via email that research suggests that telecommuting also helps boss-worker relations.

"Telecommuting is associated with significantly higher levels of job satisfaction, lower turnover intentions, reduced role stress, and higher supervisor-ratings of job performance," Probst?

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সোমবার, ৪ মার্চ, ২০১৩

Guinea says investigating shootings as protest death toll mounts

CONAKRY (Reuters) - At least one person was killed by gunfire and three others injured in ongoing street clashes in Guinea on Saturday, and the government said it was investigating whether security forces used live rounds against civilians.

Two civilians and one police officer have been killed and hundreds of people injured since tensions over upcoming legislative polls triggered unrest in the West African nation's capital Conakry last week.

Much of the violence has been between rock-throwing demonstrators and security forces using tear gas and wielding truncheons, though witnesses said police were also firing guns in an effort to disperse protesters.

"We have heard of four people injured by bullets today, and one of them has died," said government spokesman Damantang Camara. "We are now investigating where these shots came from."

Long-delayed elections due in May are meant to complete a transition to civilian rule after a 2008 coup, and could open the door to hundreds of millions of dollars in European aid.

But preparations for the legislative poll have been hampered by opposition claims the government is seeking to rig the outcome in advance, leading to a political impasse and sparking sporadic street protests that often turn violent.

Politics in Guinea, the top world supplier of bauxite, raw material of aluminum, are mainly drawn along ethnic lines. The opposition coalition is broadly supported by the Peul, the biggest ethnic group, and the government by the Malinke.

Guinea's notoriously ill-disciplined security forces have a history of brutal crackdowns on protests, though the government has launched a U.N.-backed effort to professionalize them..

One of the wounded told Reuters on Saturday he was shot by a member of the security forces while he was trying to run away.

"I tried to run and he fired," Ibrahima Diallo said at a private clinic where he was seeking treatment.

Security forces in riot gear patrolled in pickup trucks and deployed on street corners on Saturday.

The violence, which began on Wednesday after opposition supporters clashed with police, has left a wake of burned-out shops and vehicles and spent tear gas canisters. By Friday, rival ethnic gangs battled in the ramshackle city using machetes, knives and clubs, witnesses said.

Guinean President Alpha Conde appealed for calm late on Friday and urged opposition leaders to do the same.

"All sides must avoid provocation, personal vengeance and taking justice into their own hands," Conde said in a televised address. "I ask religious leaders, security forces, elected officials and political leaders to call for calm."

Conde narrowly won a 2010 presidential election - billed as the former French colony's first free poll since 1958 independence - promising to unite Guinea in the same way Nelson Mandela did after apartheid in South Africa.

(Writing by Richard Valdmanis; Editing by Jason Webb)

Source: http://news.yahoo.com/guinea-says-investigating-shootings-protest-death-toll-mounts-183403231--sector.html

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Netanyahu gets 14 more days to form new Israeli government

JERUSALEM (Reuters) - Israeli President Shimon Peres on Saturday gave Prime Minister Benjamin Netanyahu an additional 14 days to try to form a new government after he was unable to complete the task during an initial 28-day period.

Talks with potential partners have been deadlocked since elections on January 22 and if he is unable to form a government by March 16 a new poll could be called - a delay that also puts into question a planned visit by President Barack Obama.

Netanyahu's Likud-Beitenu won 31 of the Knesset's 120 seats - an eroded lead that forced him to cast a wide net for partners while juggling their disparate demands.

During the 28-day period, Netanyahu managed to forge a pact only with the party of former foreign minister, Tzipi Livni, whose six-member faction "The Movement" has given him 37 seats, way short of the minimum 61 needed to confirm a new coalition.

In a brief statement following his meeting with Peres on Saturday night, Netanyahu hinted that at least one potential coalition partner refused to sit alongside others.

Netanyahu has faced demands from the parties that placed second and fourth, Yesh Atid (There is a Future) and Bayit Yehudi (Jewish Home), to slash mass exemptions from military conscription and cut welfare stipends to ultra-Orthodox Jews.

In coalition talks on Friday with Bayit Yehudi, Netanyahu's chief negotiator said the right-wing party was unwilling to sit alongside ultra-Orthodox parties but Bayit Yehudi officials denied this.

Although he did not name Bayit Yehudi or Yesh Atid as the reason for his inability to form a coalition, Netanyahu said some parties were boycotting others.

"In these past four weeks I tried to form the broadest possible government ... I think the ultra-Orthodox public is prepared to accept (demands by other partners) but the main reason that I have not managed to complete the task by today is ... because there is a boycott of a certain sector," he said.

Netanyahu's outgoing coalition includes two ultra-Orthodox parties which have generally backed him on policies such the settlement of occupied West Bank land in defiance of world powers who support the Palestinians' drive for statehood there.

Bayit Yehudi is even less accommodating of the Palestinians than Netanyahu, who says he wants to revive stalled peace talks.

NEW ELECTIONS

Should Netanyahu fail to co-opt allies for a parliamentary majority by March 16, Peres could hand the coalition-building task to another lawmaker and if after an additional period no government emerges, Israelis would have to return to the polls.

Netanyahu was backed by 82 of parliament's 120 lawmakers to form the next government so Peres, whose only real executive power is to nominate a Knesset member to form a government, may opt not to pick another candidate and elections would be called.

Obama is due to visit Israel at the end of March and Netanyahu's trouble in building a new government raises the question of whether he may call off that visit.

But when asked about Israeli reports he might cancel, an official in Washington, speaking on condition of anonymity, said there was no talk at this point about the possibility of Obama scrubbing the trip.

White House spokeswoman Bernadette Meehan said: "President Obama looks forward to travelling to Jerusalem, Ramallah and Amman later this month."

(Additional reporting by Matt Spetalnick in Washington; Writing by Ori Lewis; Editing by Robin Pomeroy)

Source: http://news.yahoo.com/netanyahu-gets-14-more-days-form-israeli-government-003716165.html

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Obama 'Jedi Mind Meld' flub mixes confuses 'Star Trek' and 'Star Wars'

Obama Jedi Mind Meld:?Yoda-quoting nerds, Beltway insiders, and even Hollywood heroes were instantly abuzz.

By Darlene Superville,?Associated Press / March 1, 2013

President Barack Obama gestures as he speaks to reporters in the White House briefing room in Washington, March 1, following a meeting with congressional leaders regarding the automatic spending cuts.

Carolyn Kaster/AP

Enlarge

He's not a dictator and won't entertain the idea of a "Jedi mind-meld" with opponents. There's no "secret formula or special sauce" he can slip foes to make them see things his way. And not to worry, he says, the situation may look dire but won't be an "apocalypse."

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So who was the guy in a suit and tie who showed up Friday in the White House briefing room, mixing metaphors and references to "Star?Wars" and "Star?Trek"?

"I am not a dictator. I'm the president," Barack?Obama?declared as he rejected the idea of using Secret Service agents to keep lawmakers from leaving until everyone agreed on a budget. He answered reporters' questions shortly after an inconclusive, 52-minute meeting with the Democratic and Republican leaders of the House and Senate.

"So ultimately, if (Senate Minority leader) Mitch McConnell or (House Speaker) John Boehner say, 'We need to go to catch a plane,' I can't have Secret Service block the doorway. Right?"

Even if he did bar his office ? the oval one ??Obama?said he wouldn't do a "Jedi mind-meld" with Congress' top two Republicans to persuade them "to do what's right."

Yoda-quoting nerds, Beltway insiders and even Hollywood heroes were instantly abuzz. The presidential mishmash of sci-fi references went viral, turning off geeks who had considered?Obama?one of their own after a slip of the tongue that was almost as bad as confusing Klingons and Ewoks, or even Democrats and Republicans.

Jedi are from "Star?Wars," while mind melds happened on "Star?Trek."

Mister Spock of "Star?Trek" weighed in.

"Only a Vulcan mind-meld would be effective on this Congress. LLAP," Leonard Nimoy emailed after The Associated Press sought his reaction. Nimoy signed off with the abbreviation for his "Live long and prosper."

Maybe it was the power of the Force or some kind of Starfleet prime directive, but the White House couldn't ignore comments like that, flashing in and out of time and space and mixed metaphors like a Tardis traveling at warp speed in social media. It later tweeted: "We must bring balance to the force," with a link to an?Obamaphoto inside a border designed to look like outer space.

As for the situation that led?Obama?to the briefing room in the first place, he could have quoted Bobby McFerrin and just said: "Don't worry. Be happy."

Instead, the president went with: "This is not going to be a apocalypse."

Source: http://rss.csmonitor.com/~r/feeds/csm/~3/mDVM4lMj1hE/Obama-Jedi-Mind-Meld-flub-mixes-confuses-Star-Trek-and-Star-Wars

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