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2014.07.21 13:39 woodcraftideas Wood Craft Ideas

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2011.07.10 20:29 l0stb0t bookbinding: the art and science of elegant hardcopy

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2024.05.16 09:59 Defiant_Buy_101 The diagnosis delemia: behind the multi million dollar industry of healthcare monitoring

Chapter 1: the event
It was the fall of my intern year as I bean my off service trauma rotation. This month was ubiquitously notorious for being the most labor intrusive and least productive rotaion of our emergency medicine program. Knowing this I entered with the intention of simply surviving the month.
Another intern and I let’s call them A for sake of ambiguity, we’re the first emergency medicine residents to roste on the trauma services that year. A shaky start would be an understatement. In the words of chance the raper “like my grama with the Parkinson’s playing operation.” Would better describe it. Medically we did well. We were very competent and completed our work daily, but communication and coordination was non existent. Our Cheifs had informed us that Tuesday was our day of and the Trauma cheif residents had minimum communication with us, or our Cheifs as it seams when A and I did not report on Tuesday they sternly made their dissatisfaction known.
I have struggled with insomnia sense the age of 10. Had 2 sleep studies by this point in my life and been prescribed nearly every sleeping aid on the market. The 80-94 hr work weeks of our trauma rotaion only worsened my insomnia. My lack of sleep likely contributed to a less than prime adaptive immune system and 2 days out of my trauma rotaion I contracted strep like symptoms with associated nausea, requiring me to call for a sick day the next day. No the first day that I felt too ill to work. I was not fully aware of the reporting process. I reported to my Chiefs, but I did not believe I could come to work tomorrow with amble time and notice, however I was somewhat delayed in letting their Cheifs know, because the surgical chiefs rotated every few days and I did not know who my was going to be the next day. The second day which I had to call out sick I was able to locate the cheif for the next day and reprot according to our university’s protocol, which requires that if a resident feels they are not fit for work they must not come in and the university must have staff coverage without any fear or implementation of punitive actions.
I had finally survived to the last week of my trauma rotaion and I could see the light at the end of the tunnel. What I could not see was the pile of stress, shitty diet, lack of mental well ness and sleep deprivation which I was pushing down to reach the light. By this time I had seen a psychiatrist regularly for sleep medication. I had mentioned to him that I had been experiencing more stressed lately and feel that I might be depressed. he reassured me that it was likely only due to my circumstances, given the difficulty of the trauma rotation and wish to reassess once the rotation was over. Looking back I had to fill the habit of drinking more than I usually do. My only on nights before I have days off became 1-2 beers every other night. All of this repressed unhealthy shit finally pushed bad on September 23rd. That night I was at work even later than usual, I stayed up later than usual and couldn’t seem to fall asleep. With the stress of only having minimal sleep and knowing I only had 2 more days of trauma left, I took an extra dose of my sleeping medication.
I opened my eyes to the fighting sight of sun beaming in my window and I instantly knew I was late. (Sense I hadn’t seen the sun in a month) . Due to my need for scrupulous sleep hygiene I have been sleeping with my phone of and away for me. I rushed to grab it and watched as the little Apple logo seamed to glow on the screen for an eternity. Then in conjunction with its fading I saw 3 missed calls from my director, a text from college A and 2 missed calls from the surgical director. Still, I was able to calm myself, knowing that resident A had been late to this rotation by a few hours 2 other days and nothing came of it. I called my director back and he asked me to report to his office where I was greeted by my director, my coordinator and another emergency medicine facility.
With the only explanation of: “we just want you to get better”, I was handed a letter, to my relief it did not entail my termination, but a declaration of administrative leave and a requirement to undergo an evaluation at a well known university in Florida.
Lake any other savvy millennial, I did my research. By research I mean numerous google searches and screeches thru the depts of redit. To my dismay I discovered that in order for a residency program to fire you, they must first initiate an administrative suspension. I would soon find out however, being terminated would have been a delightful outcome compared to what ensued.
I spend the next few weeks in the wallos of regret and depression. I indulged in higher qualities of alchohol then I ever have before. I all but ceased communing with peers, and abruptly stoped any physical activity I had once enjoyed. Frightened as I was I was ensured, it will be ok “we just want you to get better”
Chapter 2 The evaluation : guilty until proven innocent I did exactly as instructed and scheduled an evaluation, I supposed that this was either a mental evaluation to assess if I’m fit for work with plans of termination or it actually was an evaluation to better treat my insomnia. To this day I regret my ignorance, and wish I had researched the process more. The Hindi / sand-skrt idea of Hamsa 🪬 is that in order to do any good you must have full knowledge or else good intentions can result in harm. I truely believe my director had good intentions, however but him and I did not have full knowledge of the nature of this evaluation.
Looking back see how easily I could have avoided my troubles by asserting legal aid at this point or even by researching this evaluation process more in depth. If one searches impaired practitioner program which I now know this evaluator works for, the search entire will populate 5 or 6 layferms along side their home website and there is a valid reason for this.
If one every finds themself in this process I employ you to bring a DSM to your evaluation or at least be familiar with the most common use disorders in the DSM-5, because your evaluation will turn into a dance of questions where the evaluator attempts to trap you in a round about way to stating something that may qualify for one of the diagnosis. I have provided an image from the DSM-5 below outlining AUD, which the evaluator concluded that I had the most severe from:
Image
Example***** Here are 10 examples of how he fraudulently assessed me taken directly from his assessment note.
  1. Evaluator: Have you ever stoped drinking in the last year.
Me: yes I stoped every week day, I was only drinking on the weekends, until two weeks ago.
-Evaluator uses stoping and starting every week to qualify for 2 or more unsuccessful attempts to stop in the last year “There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.”
  1. Evaluator Have you ever had withdrawal symptoms
Me no
Evaluator Well Have you ever had a hangover? You know that’s a from of acute withdrawal
Me: yes in college, I had a few but that was years ago and I’m pretty sure the pathophysiology is different.
Evaluator uses this to count for withdrawal symptoms even tho is was more than a year ago
  1. Evaluator: Have you even taken your sleeping medication on a day or night which you drank? Me: Yes, I took my prescriptions are prescribed but I never drank close to bed
Evaluator: qualified this as dangerous behavior with alcohol (where the DSM gives examples such as unprotected sex and drunk driving). The sleeping medication I was on is not a benzodiazepine therefore it is not deadly with alcohol. I personally have seen many patients in the ED who have taken their entire bottle of the medication and drank copious amounts, we just monitor them over night and rehydrate them
  1. Evaluator Has anyone told you you drink to much or been worried about you Me: No I drink much less than my friends
Evaluator what about your girlfriend? Me: well she actually doesn’t drink at all she doesn’t like it. She often buys me beer for The Weeknd’s tho. One time we went to a movie and she got a little irritated because I waited for beer then complained about them not having any craft beer. So she said, “you couldn’t have just said no” and drank something else. However, she apologized after and said it’s worth waiting if it’s my only day off.
Evaluator said this qualifies for continued drinking despite causing significant relation consequences, ie divorce.
  1. Evaluator : you have sleep issues I hear, and your chart says you’ve had depression in the past, don’t you know that alcohol can effect your sleep and mood Me: yes that’s why I never drink within 3 hours of sleep.
Evaluator but you knew this and still drank
Evaluator: qualifies for drinking despite unwanted physical or psychological effects (this should be recurring to effects the alcohol is causing, I have had insomnia sense the age of 10 long before I took my first sip)
7 evaluator you were late for work and told my you had a drink the day before
Me: Yes but I was late because I didn’t sleep and took double my sleeping meds, I will never do that again
Qualifies for 2 significant work or school issues in the past year ( a therapist and other psychologist ensured me that being late on or a few days doesn’t count they typically are getting fired or failing) ( moreover, this would assume I was late do to drinking it’s self and also assume if happened more than once)
  1. • Alcohol is often taken in larger amounts or over a longer period than was intended
He never once asked anything related to this question yet said I qualified in his final report 9. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. The evaluators logic here was sense I was late for work and I had 2 beers the day before I must be taking long to recover from it (this is assuming I missed due to alcohol)
  1. Tolerance drinking more to require the same effect: this he checked as true in his final note however it was never even discussed in our evaluation. I did mention to him that I’ve been drinking more than I had earlier in the year frequency wise, but they said nothing to do with quantity or needing more.
  2. Wanting to drink so bad you can not think of anything else: this is the only qualification of SAUD my evaluator said I did not have.
Moreover, without legal help I was not aware that I could obtain a second evaluation or even oppose going to get evaluated at all, but that wouldn’t have mattered seeing I still thought this was for my health and wellbeing as seen when I was asked why do you think you are here to today, to which I replayed “so that I can be evaluated to see what is needed to get back to work”.
To maks the ordeal more infuriating the evaluator continues to ingratiate himself and lie through the process telling you, “it will be fine as long as you are 100% honest”, “anything you say in here is between you and me” or “you slipped up once with your meds, I know your residnecy program they will probably just want a few more out patient tests”
Two weeks later I received a phone call right before I left for an out of state vacation to visit my nice for her birthday. During the call I was informed that I would be required to complete a partial hospitalization program (PHP) lasting “6-10 weeks” which would coast from 15-50 grand not including doctor visits or housing which is billed separately. I suppressed this inconvenience, enjoyed my vocation and reported when I returned, knowing that I must complete this soon so I may return to work with due to the fact that my payed time off would soon be diminished. At this time I had not yet heard of the organization PRN.
Chapter 3 Guilty till proven innocent: The diagnosis
Shell shocked I arrived to a in patient psychiatric unit and was rapidly cleared to progress to treatment without detoxification. During my 90 day of forced rehabilitation I met a few other individuals who were unjustly and fraudulently forced into treatment. I began to look up to one of these such members of the men’s community, who I will refer to as patient X for ambiguity sake.
Unlike me patient X did have alcohol use disorder. He spent many clinic days drinking to avoid alcoholic withdraws. The curious component of his story is that he admitted his depravity, saught help and through his own journey became sober. The bodies at be, namely his local physician, Health monitoring program, rejected his personal path to sobriety and forced him to undergo 90 days of in patient treatment before he could practice medicine again. When he checked in to rehab he had been sober for over a year.
Ask for Stories of people from online
As for me I spend many sleepless nights pondering how consuming a legal substance in a moderate amount could throw me into significant legal financial issues. My labs my toxicology, my story and my collateral from colleagues from colleagues all indicated light to moderate alcohol use but my evaluators word stood as the word of God.
More frightening was the director of this rehabs acknowledgment of this. The director who happens to also coincidentally be the evaluator, stated to me as well as to staff on multiple occasions: “ I suggest inpatient treatment for everyone who is reported”. “This is safer for me not to miss anyone who could harm patients, and I figure there must be a reason someone reported them.”
I am still elucidating the reason why I was determined guilty and proven innocent, however I can say from my 90 day stent that the majority of the patients at this rehab needed to be there. This program is saving lives of both providers and patients, however it is destroying the lives of those wrongfully accused.
Chapter 4 your lisense rehab or jail : Upon arivil I was sent to a detox hospital underwent a medical examination and was “one of the lucky ones” who required no detoxification and could report directly to PHP. Like everyone else, I spent 90 days in a PHP, being as 6-10 weeks is simply a lie they tell patients to decrease the change of resisting the treatment. When discussing the topic one therapist sated “if we told patients 90 days they would never come.” She then attempted to justify the treatment by outlining the story of a patient she had called who “didn’t make it to treatment” and killed themselves”. It is my belief that it is not the lack of PHP which impelled such professionals to take their life, but them realizing that they now will be obliged to undergo 90 days of PHP, 5 years of PRN monitoring with a loss of autonomy and hundreds of thousands of dollars taken from them that induced their hopelessness. For even if these professionals were truly mentally unstable in their addictions, in every case it was only following a phone call where they were informed they must undergo treatment that they took their life’s. By this time I still haven’t the slightest clue what PRN was.
Despite the security these programs provide for many my 6 main issues with them can be summarized in : 1. Kick backs: evaluators are directors of treatment clinics 2. The reported are guilty till proven innocent 3. The price, the overflow of money these places drag in from both patients and state universities is appalling, they charge separately for every visit and test 4. Although they make the claim that they are individualized, they are anything but. Every patient gets the same stay and treatment from the doctor drunk on the job and the one who was late to a shift 5. They force voluntary treatment. remember that friendly evaluator who promised he had your best interest at heart, so you opened up and told him everything about your substance use/ developmental / family history, well if you don’t stay for 90 days he will be “normally obliged” to tip the board of medical off to you.
  1. The programs have overstepped their intended jurisdiction. -these programs work well if they function how they were intended at their inception. Cite original purpose. Originally these programs were designed to protect physicians and civilians from impaired practitioners; being healthcare workers who were impaired at work. Over the years, these organizations have extended their authority to encompass individuals with substance use disorders When not at work and also those who are in training to become healthcare professionals. Take for example myself compared to a physician who is impaired at work. A doctor who arrived for duty under the influence would surely benifit from the extensive testing, therapy and accountability enforced via these programs. In accordance the 20,000$ per year cost is appropriate when only making up roughly 7% of their yearly salary vs nearly half of a residents. In my case with my loss of income from employment, coast of treatment and monitoring, this year I will be required to pay 20,000$ to work. Yes, I will be losing money to work. Even if did indeed have a substance use disorder this level of monitoring wouldn’t not be considered appropriate.
Dispite all of the miscomings of this System My time spend in PHP was indeed helpful, as I believe it would be for anyone. Time for exercise, a reprieve from work and weekly counseling. A sample structure of my day to day schedule is provided below for insight:
Structure The general structure of these rehabitation centers is as follows: 1. One week of orientation phase, where you are not allowed in electronics or contact with the outside world world. Therefore, if you’re going, bring some things you would like to read or study. 2. In phase 2, you can use your phone however you cannot leave campus. You must stay in the dorm on campus. These shitty 1 room run down apartments with two other roommates will cost you about $1000 a week, they are required for at least four weeks and they are billed separately, no insurance will help you out here. 3. In phase 3 you can commute to campus if you beg your therapist and live very close. Whether you’re on campus or living off-campus, you are allowed to leave up to four hours per day. If you commute, you’ll be required to take a sober link decide you must Breath, alcohol test into every 6 hours. Like everything else in this program you must pay for this separately, a few hundred dollars a week. You advanced to other phases by completing assignments, however, assignments are limited by required built-in time, intrusive, scheduling, and reviewing. Therefore, if you do everything as rapidly as possible phase 1 will take one week phase 2 will take three weeks.
Every day schedule:
7:30: wake up, report to the front desk to inform them that you haven’t ran away yet and take and prescribed medications. They keep all your medications and require that you report to take them; for me this was antidepressants in an attempt to dispel the depression I contracted from being forced into treatment and whatever off label medication they were attempting to treat my ADHD with, since control medications were forbidden.
8 am: community group assessments This consisted of other patients presenting their assignments amongst the large group, on the weekends this was often an hour later and 12 study regularly took the place of assignment presentation.
10 am: process group. This was a two hour group therapy session with 6 to 12 other professionals in a therapist and training or occasionally a licensed mental health therapist.
1 pm: recreation This was generally about an hour of some sober themed craft or activity. Once a week this time slot was used for yoga.
2 pm: this was another time slot used for patients to present assignments as well as for individual therapy sessions. Each patient had one individual therapy session lasting 30 minutes per week.
3pm: This was time allotted to work on assignments or go to the gym on your sex specific scheduled gym day.
5pm: this time was used for guest speakers or another 12 step study group.
6 pm : this was generally an off-campus 12 step group
10 pm: report to the front desk and let them know you still haven’t ran away and take and Medication which are prescribed to take at night, then return to your cot bed in your room with 1-2 other roommates.
I found the community to be one of the most beneficial aspects of the PHP program. I was in a cohort of chill ass professionals of the same occupation who were always there to help each other.
Assignments The curriculum of the PHP consisted of assignment based on every step of the 12th step program. Generally, a patient would be required to complete an assignment on their own, review it with other patients, then faculty and finally present the assignment in front of the whole treatment group. You’re only given one assignment at a time and there are multiple steps to each which all requires scheduling this ensures that no matter how determined a patient is a full 90 days of treatment is required to complete all the assignments.
AA structure -the obsolete nature of AA has been verified in numbers studies, but I will refrain from divulging here and lend that endeavor to Dr. Lance Dodes very thorough discussion on the subject,in “the sober truth “
In all sincerity, if I truely did have a severe use disorder this experience could have been life saving. I only wish I could have used my 50 grand for someone who has spent their life time In addictive without reprieve. My first conversation when I was given my phone back was how I wish my father could be able to attend this PHP.
Chapter 5 reporting and PRN Self reporting What they ask you What you should tell them
There’s a third-party agency called professional resource network. Every state has their own. This agency works as a liaison between you and whatever credentialing service your occupation requires. Essentially they ensure your monitoring after treatment. Stake governments and licensing boards trust them, mainly because they monitor with the highest level of intrusiveness. This alleviates much work for state governments and licensing boards because once an individual is being monitored by a professional resource network, then they are deemed appropriate for duty and no further investigation/litigation needs to occur, as long as the monitored individual completely complies.
Because I was never impaired at work I was never reported to this agency. The general workflow of things someone would report you to professional resource network, then the resource network would contact you, and then you would be required to report for an evaluation at a treatment center, which would inevitably result in a suggestion I’ve treatment at that given treatment center. In my case I was sent to the treatment center without PRN being involved. Thus, two weeks into treatment. I was notified by my therapist that I needed to call PRN and self report. I attempted to resistance given that I did not have a problem and was not individually seeking help. I asked what happened if I didn’t self report. I was told that in order to stay in the treatment program I had to report to PRN. This meant either I report to PRN or I get kicked out of the treatment program and lose my job.
When you report to PRN they will ask you why you are in treatment. They will then list off every substance imaginable, asking you if you have ever tried the substance and when your last use was. Ultimately, they will obtain your discharge information from your treatment center, so it is in your best interest to report only what was found in your biochemical testing. If it wasn’t in your hair, I would argue that you don’t have a use disorder regarding that substance and it’s not relevant. I don’t believe it’s important for them to know that you smoked weed when you were 12.
Chapter 6 The contract:
Before being discharged from a treatment facility, a professional resource network will have you sign a contract. A little known fact which I was oblivious to is that contracts can be negotiated. Though this isn’t it possible, it is highly improbable that you can negotiate your contract since PRN has a power to delay your clearance to return to work.
Contractor almost never personalized, and I have not heard of a contract which is not a five-year agreement. You will sign releases of information so that PRN has access to all of your information which was gathered at the treatment facility. You must have a therapist, psychiatrist, primary care, doctor, and a addiction, medicine psychiatrist. You assign releases of information for all of them. You will be required To commit to: 1. three mutual aid meetings a week which you must log. I log smart recovery meetings. 2. Weekly therapy sessions with an approved mental health therapist from their list 3. Monthly doctors appointments with an addiction medicine psychiatrist 4. Yearly appointments with a primary care physician 5. Monthly appointments with a psychiatrist 6. Daily check-ins on a random drug testing app ( you will agree to weekly urine tests, a peth test 4 times a year, a hair test twice a year and a little caveat that says anything else they deem, clinically reasonable) 7. Quarterly update reports which you are required to obtain from a workplace monitor, therapist, addiction, medicine, psychiatrist, primary care physician and any other doctor you are seeing. 8. You must upload all of your prescriptions into a mobile application every single time you get them refilled and are not allowed to take them until they are approved. 9. Attendance of a PRN group via zoom. This is a local group you are assigned along with other monitored practitioners. There is a fee of roughly 130$ a month to attend this required group. For me all of these requirements coast around 20,000 a year. If you ever have a positive test even if it is the result of contamination from rubbing alcohol or unintentional ingestion of alcohol/ allergy medication your contract will rest to 5 years from the time of positive test. Once your five year contract is completed, you must ask to be released from monitoring. At that point they will search for any reason to keep you under monitoring. This could be dilute urines, daily check ins or a week where you did not attend mutual aid meetings. Every certification and license which you apply for will likely ask you if you were under a monitoring program/ have been treated for substance use. You must give an explanation and check yes. As far as licensing programs are concerned, if you were under the monitoring of PRN, you are safe, however they group practitioners who have had behavioral issues with practitioners who were diverting drugs from work. Therefore, keep in mind that you will be labeled as a sever addict.
7 Back to work and only work. During treatment your only goal is to return to work, however when you return your experience will be drastically distinct from what you remember. For me, I was now working in isolation. Missing six months of my training meant that no other Resident was on the same rotation as me. My coworkers at all formed friend groups. When I returned I was greeted with much concern for my well being. No one would speak to be about my absence, however everyone knew there is only one reason a resident would leave for 6 months then return. My Accdeemic meetings were consisting of attending telling me “I have a target on my back now” and “ I have to preform even better than others” in the light of my time missed. If this wasn’t alienating enough, the majority of Resident events, sponsored by recruiters and my university revolved around alcohol to which I had to give some excuse to why I can not partake with others. I’m fortunate that I do not have an addiction, because these stressful conditions along with the daunting amount of dead and requirements imposed by PRN are enough to make any addict relapse. While I was at treatment, I was in the dative with Samyr stories a physicians whose addictions got the best of them. Physicians who did not make it to treatment, often taking their own life. These stories were presented as a warning. Your addictions will kill you without our treatment was the message. When, in reality I did not hear one story in which the addiction killed physician. Every physician who didn’t make it to treatment took their life after being told they must report to a treatment facility. Perhaps they knew what this entailed and it was not their addiction or getting caught which caused them to end their lives, but the unmanageable and often unreasonable burden that treatment would put on their lives.
9 How to escape So your fucked your in PRN and should be or you should and now your recovered and want to terminated your contract.
  1. You ask to be released early done at 1/2 time ( good luck)
  2. You have “good reason” (no one has ever been let out of contract because of this reason, the verbiage is far too vague)
  3. You serve all your time and they let you out(maybe, as discussed earlier, they would do everything they can to keep you in your contract as long as your practicing)
  4. You can’t practice medicine anymore
10 Layer up butter cup : I cannot emphasize the extent to which legal help is required in this process. You much seek it and seek it early. Lawyers can provide many avenues to you early in the process. Once you have committed to treatment, gone for evaluation or are in a PRN contract , this is very little that you or legal help can do. Spend a few thousand dollars when you are accused and save the 20-30,000 later.
After you have been evaluated if you disagree as I did, then this is the process you must undergo. 1. Hire a occupation, defense, lawyer 2. Prove you don’t have an addiction, this is done by having an alternative evaluator with similar credentials state that either you don’t have an addiction or that PRN’s level of monitoring is not medically appropriate ( this will need to be a multi day neuropsychological evaluation, which will cost about $5000). 3. Your lawyer must draft in writing that the medical level of monitoring is not required such as another medical professional and send this to PRN 4. PRN will tattle on you to the board of medicine. 5. The board of medicine will conduct an investigation. 6. At the end or when they believe they have enough reasonable evidence to the board of medicine will suspend your license or claim, you must comply with the PRN contract to practice. 7. At this time your lawyer will defend you in the state court against the board. This is costly but much less than the coast of a 5 year PRN contract 8. If you win you will likely suggest an alternative level of care such as gonna get therapy every week. If you lose, than you wasted a fuck ton of money and are still bound by your PRN contract.
Overall this entire process has coast me Over all coast:
My finances for this year only including PRN and rent are as follows:
120-200$ every week for testing 480-800/ month
65 every week for therapy 195/month
125 every month for PRN group
About 50-69 every month for 2 doctor apts
So at least 745$/month at the lowest
Treatment at the recovery center coast 20,000 for me out of pocket and
I wasn’t payed for 6 months with no FMLA because I am a first year. At the 1 year mark I will have made 26,000 this year after taxes And payed About 29,000 on PRN alone
Rent is 1,000 so that’s 12,000 a year
Just in rent and PRN alone I will be at 26,000- 41,600 -15,600.
I will be in debt by at least 18,000 at the 1 year mark
Coast of treatment center 20,000 (with insurance) For each year of PRN roughly 20,000 Add that to 6 months of attending salary which was delayed due to my treatment time: at least 150,000 Layer coasts along with other evaluations 25,000 Missing 6 months of residency pay 30,000 Coast of 1 year in monitoring: 245,000 Coast of 5 years 325,000
If my case progress to a trail I will require an extra 20,000 in court coasts
Chapter 11 My secondary eval: Dr sushi After I arrived at my treatment center I challenge my evaluation multiple times. Each and every time I was discharged and often accused of alternate mental health/ substance abuse issues to discourage my advances. I was never given the opportunity to undergo alternative assessment, however PRN guidelines state that you can obtain a second option within 7 days of your first. This is a mute point, however, because you will not receive the results of your evaluation until over a week after it is conducted and the second evaluation must be conducted by another PRN hired evaluator of their choosing. During my stay in rehab I contacted PRN multiple times to attempt another evaluation/ legal help. They warned against both stating they were a “waste of money” and “pointless”.
After completing my treatment with the guidance of many addiction, experienced physicians, mental health counselors and psychiatrists recommendations I sought in a secondary evaluation. I chose a highly qualified professional with over 30 years of experience to conduct an extensive neuo psycho social evaluation of me. One that I was sure would be more extensive than the evaluation I received at treatment and more importantly an unbiased evaluation.
The results from my evaluation not only showed that I did not have a substance abuse problem warranting PRN level monitoring, but also that PRN was falling to allow adequate treatment of other conditions such as my ADHD. My evaluation showed my ADHD was not only untreated by PRNs attempt at using non controlled medication, but also in the top 3% most severe presentations of ADHD. My evaluator went on to explain my results by questioning why my treatment center even mandated I undergo neuro cognitive evaluation. The only neurodiverse findings were my IQ, my dyslexia and my ADHD. However, a neuo cognitive examination can be billed separately by treatment centers, therefore they always recommend one.
Chapter 12 Amongst its greed, intrusive nature and faulty accusations, professional recourse network function highly proficiently at the task they were designed to; protective physicians and patients from physicians who are impaired at work. In this domain they save lives, offer second changes and protect the public. When they act beyond their intended jurisdiction by imposing unnecessary monetary demands on practitionersin training, accuse practitioners without proof or act on behavior exemplified outside of a work setting they unjustly and inappropriately attack the week and innocent.
Proposed reform: As a trainee my universities malpractice insurance covers me for mistakes made at work. If a learner mistakenly harms a patient, then the university stands on their behalf. If the learner does something wrong under a teachers direct guidance, then the teacher is at fault. This makes sense logically as well as pragmatically. The state entrusts large amounts of money to hospital systems and universities to train resident physicians. A portion of this money is allocated to malpractice insurance. This should extend to accused impairment.
Suppose a training university was required to cover rehabilitation and monitoring of a resident of whom they claim is impaired. Alternatively they have the option of firing the trainee. This would reduce the number of innocent trainees being accused of impairment, make the process of rehabilitation more fair and provide a better use for tax payer derived dollars, which hospital systems are given to train residents. The truly impaired could still seek help, less false accusations would be made and with the employers having the ability to fire at the moment of impairment, there would be less chance of impairment at work.
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2024.05.16 09:59 adulting4kids Figures of Speech

44. Antimetabole:
Construct a pivotal dialogue exchange where characters engage in antimetabole, exchanging and repeating phrases in reverse order. Explore how this reversal of words or ideas adds complexity and nuance to their interaction, revealing hidden motivations or contrasting perspectives.
45. Aposiopesis:
Create a moment of suspense or tension using aposiopesis, where a character's speech is intentionally cut off, leaving a statement unfinished. Explore the emotional impact and intrigue generated as readers are left to imagine the unspoken words or implications.
46. Paralipsis:
Craft a scene where a character uses paralipsis to address a sensitive topic indirectly. Explore the art of saying something by pretending not to say it, and delve into the consequences of this rhetorical maneuver within the context of your narrative.
47. Hendiadys:
Develop a dialogue exchange where characters express a single complex idea using hendiadys, employing two words connected by "and" to convey a nuanced concept. Explore how this rhetorical device enriches the depth of their communication and understanding.
48. Apophasis:
Create a moment where a character uses apophasis to mention something by explicitly stating that they will not mention it. Explore the impact of this rhetorical strategy on the unfolding plot and the dynamics between characters.
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2024.05.16 09:58 adulting4kids Figures of Speech

39. Polysyndeton:
Craft a scene where the use of polysyndeton adds a rhythmic cadence to a character's thoughts or dialogue. Explore how the deliberate repetition of conjunctions contributes to the emotional intensity or reflective nature of the moment.
40. Enjambment:
Utilize enjambment to create a fluid and continuous flow in a descriptive passage or dialogue. Explore how breaking traditional syntax enhances the sense of movement and connectivity between ideas, contributing to the overall atmosphere of the scene.
41. Caesura:
Introduce a moment of reflection or contemplation using caesura, a pause within a sentence. Develop a scene where this deliberate interruption in rhythm emphasizes the significance of a character's thoughts or the gravity of the situation.
42. Meiosis:
Explore a scenario where a character downplays a significant achievement or event using meiosis. Develop the repercussions of their modesty and the contrast between their understated acknowledgment and the true impact of the accomplishment.
43. Epizeuxis:
Craft a powerful moment in your story where a character repeats a word or phrase for emphasis, employing epizeuxis to convey heightened emotion or urgency. Explore how this rhetorical device amplifies the impact of their words in a critical situation.
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2024.05.16 09:52 Illustrious-Value774 [TOMT] mouse sewing kit from Michael’s or hobby lobby

I remember when I was in like 5th grade (I’m 20 now) I had this little kids sewing kit and it was 2 mice and they had their own little like sleeping bag that you made. You made everything except for the little tin box with a latch. I remember finding the box a few years ago and feeling devastated that they weren’t in there. I need help remembering what the name of the product was. I’ve tried searching online but I have no idea how to look for it. I think it was from Michael’s or hobby lobby. It was from an arts and crafts store, that’s what I remember. I wanna do one again cause they were so cute and it made me feel happy at the time that I made them by myself.
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2024.05.16 09:50 mr-grey10 mmmm yes muslim craft (ask in comments if u want to know how to the these, and give more ideas)

mmmm yes muslim craft (ask in comments if u want to know how to the these, and give more ideas) submitted by mr-grey10 to infinitecraft [link] [comments]


2024.05.16 09:39 myguestblogs Top 10 Digital Marketing Books to Skyrocket Your Skills

Top 10 Digital Marketing Books to Skyrocket Your Skills
digital marketing books
Feeling like you're lost in the digital marketing jungle? Don't worry, we've all been there! The online world moves fast, with new tricks and trends popping up all the time. But hold on, there's a secret weapon to help you become a digital marketing master: books by industry experts!

Why Learn from the Best?

Think of these experts as your digital marketing gurus. They've spent years in the trenches, figuring out what works and what doesn't. By cracking open their books, you gain access to their knowledge, battle-tested strategies, and best practices. It's like getting personalized marketing coaching, but way cheaper (and with pajamas optional!).

Top 10 Books Digital Marketing to Supercharge You

Now, the good stuff! Here are 10 incredible digital marketing books, perfect for beginners and seasoned marketers alike:
  1. Jab, Jab, Jab, Right Hook by Gary Vaynerchuk: Learn how to tell your brand's story in a noisy online world and build meaningful relationships with your audience.
  2. Epic Content Marketing by Joe Pulizzi: Discover the secrets of creating high-quality content that attracts, engages, and converts customers.
  3. Hooked by Nir Eyal: Understand how to build habits and keep your audience coming back for more.
  4. Digital Marketing for Dummies by Ryan Deiss and Russ Hennesberry: This beginner-friendly book breaks down the basics of digital marketing in an easy-to-understand way.
  5. Youtility by Jay Baer: Learn how to create useful content that solves your audience's problems and positions you as a trusted expert.
  6. Marketing Made Simple by Donald Miller: Master the storytelling framework that helps any business connect with customers on an emotional level.
  7. The 22 Immutable Laws of Marketing by Al Ries and Jack Trout: Timeless principles that will guide you in crafting a winning marketing strategy.
  8. Contagious by Jonah Berger: Discover the science behind word-of-mouth marketing and how to create ideas that spread like wildfire.
  9. Building a StoryBrand by Donald Miller: Learn how to use storytelling to clarify your message and connect with your ideal customers.
  10. DotCom Secrets by Russell Brunson: Discover the power of sales funnels and how to use them to convert website visitors into paying customers.
Bonus Tip: Don't be afraid to mix and match! Choose a few books based on your current needs and interests.
Remember, the best digital marketing book is the one you actually read! So grab a cup of coffee, settle into a comfy spot, and get ready to learn from the best. With these expert insights by your side, you'll be well on your way to digital marketing mastery!
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2024.05.16 09:37 wishcoworker What impact does coworking space design have on startup creativity and collaboration?

What impact does coworking space design have on startup creativity and collaboration?
https://preview.redd.it/8zwmfdd7sq0d1.png?width=1080&format=png&auto=webp&s=b02ab8fe745d69b37a7e05bb108be097510d9e9d
In the dynamic landscape of startup culture, where innovation thrives and collaboration fuels success, the design of the workspace plays a pivotal role. Coworking spaces, with their versatile layouts and community-driven environments, have emerged as incubators for creativity and collaboration among startups. But what exactly is the impact of coworking space design on the creative processes and collaborative efforts of startups? Let’s delve into this intriguing question.
· One of the hallmarks of coworking spaces is their open layout, designed to encourage chance encounters and spontaneous interactions among members. These serendipitous encounters often lead to the exchange of ideas, feedback, and even partnerships that can catalyze innovation within startups. By breaking down physical barriers and facilitating informal communication, coworking space design creates an environment where creativity can flourish organically.
· The layout and amenities of coworking spaces are intentionally crafted to foster a culture of collaboration. Shared work areas, communal lounges, and collaboration zones provide opportunities for startups to come together, share resources, and collaborate on projects. Whether it’s a brainstorming session in a cozy breakout area or a casual conversation over coffee in the communal kitchen, the design of coworking spaces encourages startups to leverage the collective intelligence of the community.
· The design aesthetic of coworking spaces often draws inspiration from modern architecture, contemporary art, and innovative technology. Bright, airy spaces with abundant natural light, vibrant colors, and eclectic decor create an atmosphere that stimulates creativity and inspires innovation. Flexible workstations, ergonomic furniture, and adaptable meeting rooms cater to the diverse needs of startups, empowering them to work comfortably and productively.
· Beyond the physical aspects, coworking space design is instrumental in fostering a sense of belonging and community among startups. Thoughtfully curated events, workshops, and networking sessions bring members together, facilitating meaningful connections and collaborations. From mentorship programs to collaborative projects, the design of coworking spaces provides a framework for startups to engage with each other and tap into the collective knowledge of the community.
· The design of coworking spaces isn’t just about aesthetics; it’s also about functionality and user experience. Well-designed coworking spaces prioritize elements such as acoustics, lighting, and air quality to create an environment that supports productivity and well-being. Quiet zones for focused work, soundproof meeting rooms for confidential discussions, and wellness amenities like standing desks and relaxation areas contribute to a conducive work environment for startups.
The impact of coworking space design on startup creativity and collaboration is profound and multifaceted. By fostering serendipitous encounters, cultivating a culture of collaboration, inspiring creativity through thoughtful design, nurturing a sense of community, and driving productivity and well-being, coworking spaces empower startups to thrive in an ever-evolving landscape of innovation. As the demand for flexible and collaborative workspaces continues to grow, the design of coworking spaces will play an increasingly crucial role in shaping the future of entrepreneurship and creativity.
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2024.05.16 09:12 Primary-Reach-7513 Top Data Science Skills in High Demand in 2024

Data science skills have become even more crucial today with the massive growth and revolution of AI technologies. We have witness in the recent few years a significant growth of the data volume. Building a data science career today means crafting a prospective future. Businesses, individuals and government agencies today require enhanced and informed decision-making, which is facilitated by data science professionals. It takes professional skills and expertise to turn data into relevant information, and this is where a data science skills become critical. To break into a data science career, it's crucial that one have a fair idea of what skills they may expect to learn in their training, like a master of science in data science. If you are seeking to attain data science skills through a well-structured training like a master of science in data science, this post will be of crucial help. Let's delve into the top skills that will remain critical in 2024.

Top skills for a data science career in 2024

To thrive with a data science career, it's essential to develop the following key skills. While self-learning can be an option, acquiring these essential skills from a well-structured and formal training such as a Master of science in data science is often the most ideal trajectory. Let us explore the top data science skills:
Programming Language: Programming languages is one of the most critical data science skills. Among the many languages, Python is the most preferred and suitable language given its powerful and ready-made libraries like NumPy, Pandas, and Matplotlib. It enables programmers and data science professionals to perform all sorts of data activities like cleaning, manipulation, statistical analysis and visualization with ease. Learning Python will be a big boost to your data science career.
Mathematics and Statistics: Although it may seem less critical in the initial stage, one cannot go far in a data science career without knowledge and good foundation in mathematical and statistical concepts. Statistical knowledge is essential to choose and apply the varied data techniques, to build strong data models and to accurate comprehend the data. Mathematical concepts of probability, calculus and linear algebra are critical data science skills.
SQL: This remains a must-have skill for data science professionals. SQL is the industry's standard tool for managing and communicating with relational databases, which allows storing of structured data in tables. Companies across the globe own huge amounts of data that are typically stored in relational databases. Hence, SQL is one of the critical data science skills that one must expect to learn in a degree programme like a master of science in data science to prepare for the future of data science. In additional, having knowledge of NoSQL is essential to handle various types of unstructured data.
Data Visualization: This is the most effective technique to communicate critical findings in the most comprehensible manner. It is only when stakeholders or decision-makers understand the data findings thoroughly, effective actions could be generated. Hence, building a data science career must entail attaining data visualization skills. Data Visualization is the art of representing data in a graphical manner like charts, graphs and maps. These representations enable data science professionals to manage numerous rows and columns of complex data and prepare them in a comprehensible and accessible format.
AI and Machine Learning: If you intend to build a data science career, attaining AI and Machine learning skills is an indispensable step in today's time. Almost every professional degree, like a master of science in data science, include these concepts as core areas. AI and ML are among the hot topics in data science. It's crucial for aspiring professionals to build competencies in the fundamental of AI and ML.
Deep Learning: Another trending concept that has brought several disruptive innovations in technology is Deep learning that is based on neural networks. Familiarising the theory and practice of Deep learning would be a game-changer for data science professionals. A master of science in Data science programme will effectively help in learning how to build neural networks.
NLP: Natural Language Processing is an emerging technique based on Deep learning and Machine Learning. For today's data scientists, NLP is one of the data science skills they must develop. As innovative technologies like Chatbots, Search Engine etc are powered by NLP.
Cloud Computing: Cloud computing technology and services have emerged as an innovative technology that enables enterprises to store their data efficiently. Data Science professionals must develop expertise in cloud computing to help companies make the most out of their organization's data
Besides these technical data science skills, there are a few interpersonal skills that essential for every data science professional, such as
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