![]() ![]() Lack of senior leadership engagement in the time-out.Performing time-outs without full participation of the staff.Time-outs occurring before all staff members are ready or before prep and drape occurs.Some errors related to misuse of time-outs/checklists as determined by The Joint Commission include the following: 4 From 2005 to 2016, a total of 1,281 wrong patient, wrong site, or wrong procedure sentinel events have been reported to The Joint Commission, underscoring the crucial need for effective preoperative communication and planning for surgical teams. More work to be doneĭespite the progress in time-out implementation, 104 sentinel events involving the wrong patient, wrong site, or wrong procedure were reported in 2016, according to data from The Joint Commission, making them the second-most reported sentinel events of the year. Administration of drugs, control of glycemia, allergies, and other factors that can affect an operation’s outcome are discussed in these briefings. It also establishes the leadership of the team and empowers all members to work on behalf of the patient. 3ĭuring the time-out, the team comes together and develops a shared mental model of what the procedure will be like, increasing the chances that all members will have the situational awareness needed to prevent harm. When done well, these time-outs reflected a patient-centered safety culture and developed an environment of trust in staff who were empowered to report patient safety events without fear of reprisal, while acknowledging that humans are fallible and make mistakes. We reviewed aspects of the patient medical history that may have been somewhat unrelated to the operation to be performed, yet vital to the anesthesiologist and other members of the team. During this briefing, I discussed with the resident assigned to the case his or her level of experience, and we planned what portion of the operation each of us would perform and set expectations for the rest of the procedure. This initial time-out is an opportunity for other members of the team to share their thoughts, which seemed to set up the group for a good day every time. ![]() 2Ī time-out breaks the ice at the beginning of the day with respectful discussion of the steps of the operation with the patient and team members, including potential challenges and a plan B if one is needed. In the late 2000s, during my tenure as chair of the department of surgery at The University of Washington Medical Center, Seattle, the center was one of eight hospitals around the world that participated in the development of the WHO checklist. ![]() As someone who participated in the development and initial application of the World Health Organization (WHO) surgical safety checklist, I became convinced early on that there is no better time to establish the necessary “bond for the day” of my team than a well-executed initial time-out. It is important to note that strong team member commitment is key to the successful implementation of checklists in preventing harm to patients and in improving quality. When practiced in this step-by-step manner, with true involvement of all members of the team led by the senior surgeon, checklists are extremely effective during the operation and postoperatively as they contribute to improved patient outcomes. A final debriefing takes place at the conclusion of the operation. Another pause before the end of the procedure turns the team’s attention toward ensuring that no foreign bodies are left behind and that all aspects of the operation have been successfully concluded. At different stages of the operation, even at initiation of the incision, other elements are verified, including the plan for the procedure and team member assignments, as well as the best ways to communicate with team members during the procedure. The original time-out took the form of checklists, to which the surgical care team refers at different phases of a surgical procedure. While initially viewed as a safety measure to prevent harm as a result of operating on the wrong patient or the wrong site or performing the wrong procedure, time-outs evolved to include quality patient care and enhanced performance of the surgical team. A time-out, which The Joint Commission defines as “an immediate pause by the entire surgical team to confirm the correct patient, procedure, and site,” was introduced in 2003, when The Joint Commission’s Board of Commissioners approved the original Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery for all accredited hospitals, ambulatory care centers, and office-based surgery facilities. ![]()
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![]() ![]() And, of course, new features will be added over time, following the software’s release.Īs with Illustrator, Adobe is expected to offer some news on Photoshop for iPad at its upcoming Max conference. “Feature-wise, it feels like a beefed-up, cloud-based version of their existing iPad apps and not ‘real Photoshop’ as advertised,” one of the testers told Bloomberg.īut Scott Belsky, chief product officer of Adobe’s Creative Cloud division, was keen to point out that testers were using a beta version and that more features would be added before the official launch. Note: Photoshop only supports the new plug-ins (based on UXP, under Plugins in the menu) natively on Mac computers with Apple silicon. The report added that the Photoshop app would “lack some key features” when it launches in the coming months, despite Adobe earlier touting the software as “the real Photoshop.” Yes, you can install plug-ins or extensions on Mac computers with Apple silicon from the Stock and Marketplace tab in the Creative Cloud desktop app. This goes for Photoshop, too, with another Bloomberg report recently suggesting that some beta testers were finding Photoshop for iPad disappointing. The success of Illustrator on iPad would largely depend on the extent of its feature list. The move would surely help it to encourage additional subscriptions from professional creators attracted by the idea of having the ability to work on the go using a portable device like the iPad. With Adobe already in the process of launching iPad versions of apps in its subscription-based Creative Cloud software suite, it’s easy to believe that it’s prepping a version of Illustrator, too. Sources with knowledge of the matter told Bloomberg this week that the California-based software giant would unveil its plans for an iPad-based Illustrator app during the Adobe Max conference in November.Īdobe declined to confirm or deny the news, saying only: “We have nothing new to share at this time.” ![]() IPadOS 17 has a hidden surprise for fans of the original iPad I hope Apple brings this Vision Pro feature to the iPhone ![]() IPadOS 17 just made my favorite iPad feature even better ![]() ![]() ![]() She is credentialed in alcohol and other drug. Internal applications, then our B2B based Bizapedia Pro API™ might be the answer for you. Ed., CAP, LMHC is a Licensed Mental Health Counselor in Florida and a Licensed Professional Counselor in Georgia. ![]() If you are looking for something more than a web based search utility and need to automate company and officer searches from within your If you would like to schedule a counseling appointment please contact us at: Synergy Counseling Services, LLC. We strive to systematically treat the needs of the one, with a focus on improving the whole. WHAT'S INCLUDED IN THE ADVANCED SEARCH FORM? Our mission is to meet people where they are on the road of life. Erin earned a Bachelor of Science in Psychology from Missouri State University and a Master of Arts in Counseling from Assemblies of God Theological Seminary. The Bizapedia Pro API™ grants programmatic access to all the search forms and features you find on our site. Erin Cerio brings with her to Synergy over 10 years of experience providing services to individuals and families. Utilize our advanced search form to filter the search results by Company Name, City, State, Postal Code, Filing Jurisdiction, Entity Type, Registered Agent,įile Number, Filing Status, and Business Category. While logged in and authenticated, you will not be asked to solve any complicated Recaptcha V2 challenges. In addition, all pages on Bizapedia will be served to you completely ad freeĪnd you will be granted access to view every profile in its entirety, even if the company chooses to hide the private information on their profile from the general public. SYNERGY COUNSELING SERVICES can be reached at the following phone number(s). Your entire office will be able to use your search subscription. In addition, if we've collected "Sales Lead Information" for a given company, it will beĭisplayed on the company profile page along with the rest of the general data. With the Bizapedia Pro Search™ service you will get unlimited searches via our various search forms, with up to 5 times the number of I received my Massage Therapy license in 2002 through Central Oregon. If you are in need of enterprise level search, please consider signing up for a Bizapedia Pro Search account as described on this page. Born and raised in Bend, OR, Georgia is grateful to have joined the Synergy team in. To protect our site, we cannot process your request right now. He earned a Bachelors Degree from Hofstra University. Synergy Counseling Group LLC is a Vermont based private outpatient practice specializing in Behavioral Health, Mental Health, Family and Children Services. We are sorry, but your computer or network may be sending automated queries. David Kulla graduated from Life University in Atlanta, Georgia with a Doctorate in Chiropractic. ![]() ![]() ![]() "General Purpose Desktop Computers and Servers" means computers, including desktop and laptop computers, or servers, used for general computing functions under end user control (such as but not specifically limited to email, general purpose Internet browsing, and office suite productivity tools). "Software" means the software identified above in binary form that you selected for download, install or use (in the version You selected for download, install or use) from Oracle or its authorized licensees, any other machine readable materials (including, but not limited to, libraries, source files, header files, and data files), any updates or error corrections provided by Oracle, and any user manuals, programming guides and other documentation provided to you by Oracle under this Agreement. IF YOU DO NOT HAVE SUCH AUTHORITY, OR IF YOU DO NOT WISH TO BE BOUND BY THE TERMS, THEN SELECT THE "DECLINE LICENSE AGREEMENT" (OR THE EQUIVALENT) BUTTON AND YOU MUST NOT USE THE SOFTWARE ON THIS SITE OR ANY OTHER MEDIA ON WHICH THE SOFTWARE IS CONTAINED.ġ. IF YOU ARE AGREEING TO THESE TERMS ON BEHALF OF A COMPANY OR OTHER LEGAL ENTITY, YOU REPRESENT THAT YOU HAVE THE LEGAL AUTHORITY TO BIND THE LEGAL ENTITY TO THESE TERMS. BY SELECTING THE "ACCEPT LICENSE AGREEMENT" (OR THE EQUIVALENT) BUTTON AND/OR BY USING THE SOFTWARE YOU ACKNOWLEDGE THAT YOU HAVE READ THE TERMS AND AGREE TO THEM. ("ORACLE"), FOR AND ON BEHALF OF ITSELF AND ITS SUBSIDIARIES AND AFFILIATES UNDER COMMON CONTROL, IS WILLING TO LICENSE THE SOFTWARE TO YOU ONLY UPON THE CONDITION THAT YOU ACCEPT ALL OF THE TERMS CONTAINED IN THIS BINARY CODE LICENSE AGREEMENT AND SUPPLEMENTAL LICENSE TERMS (COLLECTIVELY "AGREEMENT"). Oracle Binary Code License Agreement for the Java SE Platform Products and JavaFX ![]() ![]() At the time, the highest elevation on Galveston Island was 8.7 feet (2.7 m) ( City of Galveston 1900 Storm Committee 2010). The storm surge, estimated at 15.7 feet (4.8 m), swept ashore in advance of the hurricane’s vortex and caused a sudden rise in water depth, inundating most of Galveston Island and the City of Galveston. ![]() Later, meteorologists estimated that wind speeds probably reached 140 miles per hour (225 kph) ( City of Galveston 1900 Storm Committee 2010). The storm’s sustained wind velocity, which was registered before the anemometer blew away, was 84 miles per hour (135 kph), but gusts of 100 miles per hour (161 kph) had been recorded. ![]() Although the “Great Galveston Hurricane” also occurred before the establishment of the Saffir-Simpson hurricane scale, this estimated category 4 storm is still considered the United States’ deadliest natural disaster. Although predating the establishment of national parks in Texas, the hurricane that made landfall at Galveston, Texas, in 1900, was in the vicinity of what is now Padre Island National Seashore (authorized in 1962). Indeed the seascapes themselves are geologically youthful (i.e., covered by Pleistocene and Holocene landforms). Fitzpatrick, Matthew L.The town of Galveston, Texas, destroyed by the Galveston Hurricane of 1900.Įstablished in the 1960s and 1970s, all of the National Park System units on the coast of Texas are young. Hurricane Harvey's Aftermath: Place, Race, and Inequality in Disaster RecoveryĪuthors: Kevin M. Royal Resilience: Our Story of Surviving and Thriving After Hurricane Harvey Hurricane Harvey, Houston and Heroism: Celebrating the Compassion, Caring and Goodness of Ethical Intelligence in Action Heroes, Hope, and High Water: Life Lessons in Turbulent Times Here is a list of some of the Harvey-related books that have been published:īreathing Again: A Hurricane Harvey Memoir Some books, like Fitzpatrick's, look at the storm through an academic lens, while there also are children's books, faith-based works and photobooks about the storm. I do think about that every year."įive years after Harvey, a number of literary works have been published that chronicle the hurricane, its impact on the region, recovery efforts and accounts of both heartache and heroism. "I spent a lot of time talking to people right outside their homes that were destroyed. "Very impactful," Fitzpatrick said of his experience. "Hurricane Harvey's Aftermath: Place, Race, and Inequality in Disaster Recovery" was published in 2020 and examines inequities in recovery and community support along racial, ethnic and socioeconomic lines. ![]() ![]() And his memories remain vivid and intense, even though he was not directly impacted and was not on the Texas Gulf Coast when the powerful storm made landfall and caused unprecedented flooding in the Houston region.įitzpatrick, a sociology professor at the University of Arkansas, visited Houston and other locales along the coast in the months after the 2017 storm to conduct research and interviews for a book he co-authored with a colleague. Fitzpatrick reflects on Hurricane Harvey and its aftermath. Federal Emergency Management Agency, FEMA This file photo shows first responders conducting a rescue in the Houston area during the aftermath of Hurricane Harvey, in the late summer of 2017.Įvery year, when late August rolls around, Kevin M. ![]() ![]() ![]() We encourage you to seek personalized advice from qualified professionals regarding all personal finance issues. Put your income and expenses into our super and retirement budget planner and sort the must-haves from the nice-to-haves. Saving money for your retirement is as simple as spending less than you earn. All examples are hypothetical and are for illustrative purposes. Fidelity's retirement calculators can help you plan your retirement income, savings, and assess your financial health Fidelity Retirement calculators & tools Our calculators & tools will help you take the guesswork out of saving for retirement and assist in building an income strategy to meet your needs. Understand where you’re really spending your money. We cannot and do not guarantee their applicability or accuracy in regards to your individual circumstances. Do you know what it takes to work towards a secure retirement Use this calculator to help you create your retirement plan. ![]() Information and interactive calculators are made available to you only as self-help tools for your independent use and are not intended to provide investment or tax advice. By entering the details, you can get an accurate view of your real spending. You don’t just enter your housing expenses, you enter average water bill, your trash bill, your internet bill, your expected furniture expenses. Discover the financial guidance to help with your retirement goals. The retirement budget calculator prompts you to enter your spending in detail. The American Institute of Certified Public Accountants Whether you are looking for a retirement score or a retirement income calculator, Fidelitys retirement tools & calculators can help you plan for your retirement. ![]() ![]() On the one hand, if the vent takes the form of a crater, it is commonly surrounded by (1) vent-filling breccia comprising disaggregated wall rock material from the vent and (2) coarse primary tephra, commonly welded due to proximity to the vent. At the cone surface, the lithofacies found associated with the main vent are of two main types. The most important defining characteristic is that it is a long-term feature, and for a given volcano, it may change location several times during the history of activity. Typically, for a simple cone this would be a central/summit vent, but in cases where compound cones have been developed, this may be an inaccurate description. This association is defined as lithologies related to long-term vents at which volcanic products are erupted to the surface. The specific associations that characterize a composite cone can be defined largely on the basis of distance from the vent, which accounts for both the relative predominance of immediate volcanic products near the vent, versus recycled or mixed (with water) volcaniclastic material, and topographic effects with slope steepness typically decreasing away from vents (Fig. 9a usefully summarizes the distribution of volcanogenic products around a composite cone, perhaps the most helpful way to discuss the materials themselves and how they vary in nature and distribution relative to vents and topography is by use of the facies concept traditionally used to describe sedimentary environments. The control on the distribution of volcanogenic products is largely a result of this competition and is illustrated schematically in Fig. In fact, perhaps the single most important element in defining volcano morphology is the balance between construction (a function of magmatic flux to the surface) and erosion/weathering (a function of local climate). Sustained dome growth can result in a significant fraction of the upper part of a composite cone being formed entirely of one or more domes (e.g., Bezymianny).įinally, the effects of surface conditions (climate/weather), discussed in the previous section, will have a profound effect on the redistribution of volcanogenic material. Lava flows in steep summit regions or on upper flanks may also sustain gravitational instability collapse of their flow fronts, producing hot block avalanches. Dome talus landslides or avalanches may on occasion supply more extensive block-and-ash flows. The domes are commonly active, growing by slow addition of magma to the interior and periodically gravitational collapsewhich may or may not be accompanied by explosions. Lava domes, a common feature of evolved composition volcanoes, may dominate vent region morphologies over long periods of timeoccupying either craters (e.g., Soufrière and Montserrat) or sector-collapse scar amphitheaters (e.g., Mount St. The morphology of the summit region can have a significant effect in directing volcanogenic flows, particularly if there are distinct crater breaches. As gravity-driven phenomena, both pyroclastic and lava flows are typically channeled into valleys, producing a complex interplay of erosion and construction that leads to frequent topographic inversions on volcano flanks.įIGURE 8 Broad classification of volcanogenic products (lavas vs volcaniclastic rock types, distinguished by shading of boxes) at composite volcanoes. ![]() ![]() In the latter category, the surface morphology controls the distribution of lava flows. High volatile concentrat ions increase the propensity for eruption as fragmented magma (pyroclastic) relative to lava, although the influences of effective magma viscosity and ascent rate will ultimately determine the occurrence and extent of explosivity. In this respect, the role of volatiles is critical ("Volatiles in Magmas"). In the former category are included the melting and differentiation processes discussed earlier in this volume (e.g., "Composition of Magmas," "Origin of Magmas," "Volatiles in Magmas," and "Magma Chambers") that determine the physical propertiesdensity and viscosityof the magma. The controls on the nature and distribution of erupted products are twofold-magmatic differentiation processes and syneruptive modulation by interaction with the surface environment. Characteristics and Distribution of Volcanogenic Products at Composite VolcanoesĬomposite volcanoes are characterized by a greater diversity of volcanogenic products than any other volcanic landform (Fig. The Encyclopedia of Volcanoes - Chapter 43 ![]() ![]() ![]() Plex: Free Streaming with an Extensive Catalog Moreover, Peacock offers more than 50 channels, making it a comprehensive entertainment platform that caters to diverse interests. While viewers need to provide an email address and sign in to access the free streaming content, Peacock provides a remarkable collection of over 40,000 hours of free movies, TV shows, and other engaging content. Peacock, also known as Peacock TV, is a streaming service from NBC that offers multiple viewing tiers, including a free tier. Peacock: Free Streaming with Exclusive Offerings By catering to specific interests, Pluto TV ensures that viewers can indulge in their preferred content genres. What sets Pluto TV apart is its dedicated channels for favorite and classic television shows, such as the Classic Doctor Who channel, Survivor channel, Star Trek channel, CBS News channel, and Hell’s Kitchen channel. With over 250 channels, including TV shows and movies, Pluto TV offers a wide range of entertainment options. Pluto TV is a 100% free and legal internet television service owned by Paramount Streaming. Plutotv Pluto TV: A Vast Array of Free Channels With its extensive content library, Freevee ensures that viewers can enjoy high-quality entertainment without subscription costs. Additionally, users can access the free catalog through web-based platforms, including Amazon. The service is available as an app on popular platforms like Android TV, Roku, Fire TV, and iOS devices. Freevee (formerly IMDb): A Vast Library of Free Entertainmentįormerly known as IMDb TV, Freevee is a free and legal streaming service that offers access to a wide variety of television shows and movies. However, if users do choose to sign up, they can save their progress in movies and shows, as well as curate a personalized Watch Later list for future viewing. One of the significant advantages of Crackle is that it doesn’t require users to enter their credit card information or sign up with their email. The app operates on an ad-supported model, ensuring that users can enjoy their favorite content without any subscription fees. Crackle: Free Streaming with No Sign-up HasslesĬrackle is a legal and free streaming app that provides a diverse range of TV shows, movies, and video content. Let’s explore the most popular free streaming services available and discover their unique features. While some streaming platforms require paid subscriptions, several popular free streaming services offer great entertainment without the need for a credit card or email sign-up. In today’s digital age, streaming services have become increasingly popular, providing a wide range of TV shows, movies, IPTV, and other video content to users. ![]() ![]() This feature requires the virtualbox-unattended-templates AUR package. At the end of the setup process, the operating system is installed without requiring any further user interaction. This allows the user to configure the system to be installed in VirtualBox's interface prior to starting the machine. In order to avoid having to install the guest system manually, some operating systems support unattended installation. Once mounted, you can run the guest additions installer inside the guest. iso file will be located at /usr/lib/virtualbox/additions/VBoxGuestAdditions.iso, and may have to be mounted manually inside the virtual machine. This package will act as a disc image that can be used to install the guest additions onto guest systems other than Arch Linux. It is also recommended to install the virtualbox-guest-iso package on the host running VirtualBox. To use the USB ports of your host machine in your virtual machines, add users that will be authorized to use this feature to the vboxusers user group. Note: If the VirtualBox kernel modules were loaded in the kernel while you updated the modules, you need to reload them manually to use the new updated version. scripts/sign-file sha1 certs/signing_key.pem certs/signing_key.x509 $module done # for module in `ls /lib/modules/$(uname -r)/kernel/misc/` do. Navigate to your kernel tree folder and execute the following command: When using a custom kernel with CONFIG_MODULE_SIG_FORCE option enabled, you must sign your modules with a key generated during kernel compilation. When either VirtualBox or the kernel is updated, the kernel modules will be automatically recompiled thanks to the DKMS pacman hook. To compile the VirtualBox modules provided by virtualbox-host-dkms, it will also be necessary to install the appropriate headers package(s) for your installed kernel(s) (e.g. for any other kernel (including linux-lts), choose virtualbox-host-dkms.for the linux kernel, choose virtualbox-host-modules-arch.You will also need to choose a package to provide host modules: In order to launch VirtualBox virtual machines on your Arch Linux box, follow these installation steps. In order to integrate functions of the host system to the guests, including shared folders and clipboard, video acceleration and a seamless window integration mode, guest additions are provided for some guest operating systems. ![]() ![]() It comes with a Qt GUI interface, as well as headless and SDL command-line tools for managing and running virtual machines. VirtualBox is in constant development and new features are implemented continuously. VirtualBox is a hypervisor used to run operating systems in a special environment, called a virtual machine, on top of the existing operating system. Moving an existing install into (or out of) a virtual machine.VirtualBox/Install Arch Linux as a guest. ![]() ![]() ![]() I immediately sent the link to our agent and told her that we’d love to look at it in a couple weeks when we went for house hunting leave (if it was still on the market). I looked at the listing date – January! It had been listed for nearly three months. The pictures looked inviting: simple, open, lots of green, and above average condition. Its price had recently been reduced from $925,000 to $895,000. I was doing my usual online search for Oahu homes and suddenly a 3 bedroom/2 bathroom home in Kailua appeared that I had not seen come up yet. That would be difficult in Kailua, because homes sell pretty fast, but nevertheless, I continued to focus on the amount of time a home was listed, because the longer a home was on the market, perhaps the seller would be more willing to contemplate a lower offer. One of the house hunting strategies I had was to look at homes up to $900,000 that were on the market for more than a couple months. Again, we’d be going all in with BAH and COLA. Purchase Price ($860,000) – (Down Payment) $41,062 = Base Loan Amount of $818,938Īfter calculating, that would give us about a $4,100/month mortgage payment with the VA’s benefit of no mortgage insurance required.Then, subtract the down payment requirement from the purchase price and get the “Base Loan Amount”: Since the VA will guarantee 25% of the total loan amount, we would need to cover 25% of the difference shown above: Honolulu County VA Loan Limit in 2012 = $695,750.We calculated that our comfortable max offer on a home would be $860,000 to leave us some home improvement funds.įor a VA Jumbo Loan, that down payment and financing scenario would look like this: Now that we were headed over the VA loan limit price, we had to look at the VA JUMBO LOAN option which required a down payment. We continued looking, but increased our search to homes around $900,000. Was it worth going “all in” with BAH and COLA to get the type of home we wanted? We decided that it would be, if we found something that we considered our perfect investment. If we used both BAH and COLA, that would give us a monthly mortgage payment of $4,268 and an estimated home price of $850,000 at a 3.75% interest rate.At the time, COLA was roughly $1,100 per month. ![]() We’d have to consider using COLA (Cost of Living Allowance).So, how could we afford a higher mortgage payment with a current BAH of $3,168? What they told us was exciting: due to our current financial situation, if we paid off our highest car payment, we could get pre-qualified for approximately $900,000. We called a VA loan lender to get pre-approved and pre-qualified. Personal note: I worked full-time before having kids, and we saved a large percentage of my paychecks each month and used the rest to pay off student-loan debt. We had a good chunk of savings for a down payment. ![]() We paid off any credit card purchases each month. We had a couple of good things going for us: How would we be able to afford a higher mortgage payment to get the kind of home we wanted? At an interest rate of 3.75%, that gave us an estimated single family home price of $617,000 – under the VA loan limit, but well under our desirable listing price range of $750K-$800K.
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