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About Citron
Citron Provides New Proof Why Mallinckrodt is on its way to ZERO
2017 Reports, Citron Reports, Featured Reports, Mallinckrodt, Questcor
Express Scripts lets the genie out the bottle!!!!
When Jim Chanos Speaks – Citron Listens.
First Enron, Then Valeant, Now Mallinckrodt.
Mallinckrodt is the most reviled company in the pharmaceutical industry. Its unsavory business practices have only survived in the "post Valeant" era because of the direct business support of Express Scripts, their "co-conspirator".
Two weeks ago at the SALT conference in Las Vegas, legendary short seller Jim Chanos described this unholy alliance, likening the Express Scripts companies' role to Valeant's Philidor.
Express Scripts has been taking so much heat from investors it was forced to throw Mallinckrodt under the bus. But a typo prevented Wall Street from taking full notice of this sea change in Mallinckrodt's fortunes.
For the rest of the story you won't read anywhere else, Click Here:
June 5, 2017 /by Citron Research
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Q: Redmine: create issues via GET request In JIRA it is possible to create new issues through a simple GET request: http://confluence.atlassian.com/display/JIRA/Creating+Issues+via+direct+HTML+links.
A simple example of such a link:
"http://jira.atlassian.com/secure/CreateIssueDetails!init.jspa?pid=10420&issuetype=3&summary=say+hello+world"
This would create a new issue in project with PID=1042 with summary "Say Hello world".
Is there Redmine plugin/api which allows for such a use case? The REST API is inconvenient for my use since I would like to allow users to create new issues (with pre filled data) through a link sent in email and I don't want to use JavaScript for the job (to send the REST json/xml data).
EDIT:
From what I see (http://www.redmine.org/projects/redmine/wiki/RedmineReceivingEmails) Redmine provides an email API for submitting issues, this would be a parital solution. I would be able to add a "mailto:" link which would pre fill the content of the message.
This solution requires additional emails so still I would prefer to have a post link solution.

A: I have implemented a basic plugin which fulfills my needs. You can find it at:
http://code.google.com/p/redmine-post-link-plugin/

A: You could also have a server-side script that actually sends the e-mail. There's no post link solution as far as I know.

A: You might want to look at the Redmine API for updating and creating issues.
http://www.redmine.org/projects/redmine/wiki/Rest_Issues

A: In Redmine2 there is oficial API for it.

redpajama_set_name: RedPajamaStackExchange


This is the professional home of Andrew Glen; freelance writer, blogger, and graduate student of journalism.
... began his professional writing career at the University of Lethbridge. He was originally a student in the Bachelor of Education program, but after realizing his passion for writing and publication, switched programs and spent a year earning his B.A. in History. At this time, he also began writing pieces for The Meliorist Publishing Society, an independent student publication at the University. In his last undergraduate year, he would become the editor of two separate sections of the publication. He's written for the Edmonton Journal, Vancouver Metro, and The Globe and Mail over a successful graduate student career, and has a masters degree in journalism from the UBC. He currently is a journalist in Southern Alberta with Postmedia.


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/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/nationalsurveyofbereavedpeoplevoices/2015-07-09
National Survey of Bereaved People (VOICES)
National Survey of Bereaved People (VOICES): 2014
The quality of care delivered in the last 3 months of life for adults who died in England, including variations between different parts of the country and for different groups of patients.
A small correction has been made to the text in section 10 'pain relief'. A sentence incorrectly references care homes for data that corresponds to care at home. No data has been altered. We apologise for any inconvenience.
Email Helen R Colvin
Main findings
Quality of care in the last 3 months of life
Quality of care by place of death
Quality of care by cause of death
Quality of care by deprivation
Quality of care by setting or service provider in the last 3 months of life
Dignity and respect in the last 3 months of life
Coordination of care in the last 3 months of life
Relief of pain in the last 3 months of life
Overall level of care in the last 2 days of life
Support for relatives, friends or carers at the end of life
Decision making at the end of life
Preferences and choice at the end of life
Questionnaire changes
Uses and users of end of life care statistics
1. Main findings
3 out of 4 bereaved people (75%) rate the overall quality of end of life care for their relative as outstanding, excellent or good; 1 out of 10 (10%) rated care as poor
7 out of 10 bereaved people (69%) whose relative or friend died in a hospital, rated care as outstanding, excellent or good. This is significantly lower than outstanding, excellent or good ratings of care for those who died in a hospice (83%), care home (82%) or at home (79%)
Ratings of fair or poor quality of care are significantly higher for those living in the most deprived areas (30%) compared to the least deprived areas (21%)
1 out of 3 (33%) reported that the hospital services did not work well together with GP and other services outside the hospital
3 out of 4 bereaved people (75%) agreed that the patient's nutritional needs were met in the last 2 days of life, 1 out of 8 (13%) responded that the patient did not have enough support to eat or receive nutrition
More than 5 out of 6 bereaved people (86%) understood the information provided by health care professionals, but 1 out of 6 (16%) disagreed they had time to ask questions with health care professionals
7 out of 10 (73%) respondents felt hospital was the right place for the patient to die, despite only 3% of all respondents stating patients wanted to die in hospital
The National Survey of Bereaved People (VOICES, Views of Informal Carers – Evaluation of Services) collects information on bereaved peoples' views on the quality of care provided to a friend or relative in the last 3 months of life, for England. The survey has now been run for 4 years and was commissioned by the Department of Health in 2011 and 2012, and NHS England from 2013. It is administered by the Office for National Statistics (ONS).
VOICES data provides information to inform policy requirements, including the End of Life Care Strategy, published by the Department of Health in July 2008. This set out a commitment to promote high quality care for all adults at the end of life and stated that outcomes of end of life care would be monitored through surveys of bereaved relatives ([Department of Health, 2008][1]). Recently, the Liverpool Care Pathway, which provided a protocol for end of life care, has received criticism ([Department of Health, 2013][2]). As a result, new questions were added to the VOICES survey in 2014 to measure changes in delivery of care while the Liverpool Care Pathway is replaced. Full details of the changes can be seen in the questionnaire changes section of the bulletin.
This statistical bulletin reports on the national results from the 2014 VOICES survey. This report includes findings from new survey questions, such as adequate provision of food and fluid in the last 2 days of life and quality of communication with carers. Full results can be seen in the [downloadable reference tables][3] (468.5 Kb Excel sheet) linked from this bulletin. NHS Area Team findings for the combined results of the 2012 and 2013 surveys can be seen in the bulletin: [National Survey of Bereaved People (VOICES) by NHS Area Team (England), 2012 – 2013][4] (ONS, 2015).
VOICES results are based on the opinions of relatives who rate the quality of care provided to their friend or relative. While 21,403 people responded to the survey, not all of the survey questions are relevant to, or answered by all respondents so some results are based on the answers from fewer people than others. Where relevant the number of respondents for a question is provided to aid interpretation. Further guidance on interpreting the results in this bulletin is provided in background notes 7 to 9.
[1]: https://www.gov.uk/government/publications/end-of-life-care-strategy-promoting-high-quality-care-for-adults-at-the-end-of-their-life (Department for Health, 2008" [2]: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf "Department of Health, 2013" [3]: http://www.ons.gov.uk/ons/rel/subnational-health1/national-survey-of-bereaved-people--voices-/2014/rft-1.xls "Reference table 1" [4]: http://www.ons.gov.uk/ons/rel/subnational-health1/national-survey-of-bereaved-people--voices-/by-nhs-area-team--england---2012-13/stb-national-survey-of-bereaved-people--voices-.html "National survey of bereaved people by NHS area team, 2012 to 2013"
3. Quality of care in the last 3 months of life
Ratings of the overall quality of care across all services in the last 3 months of life were reported by most respondents (95%, 20,226 responses). Services included care provided by hospitals, care homes, hospices and care while at home from GPs and care services. Of all responders, 3 out of 4 (75%) rated care as outstanding, excellent or good, while 1 in 10 (10%) rated care as poor (see Figure 1).
Figure 1: Ratings of overall quality of care across all services in the last 3 months of life, England, 2014
Percentages may not sum to 100 due to rounding.
3 out of 4 (75%) rated the overall quality of care as outstanding, excellent of good. 1 in 10 rated the overall quality or care as poor.
95% (20,226) of respondents answered this question.
4. Quality of care by place of death
The relatives of people who died in hospital rated overall quality of care significantly worse than any other place of death. Almost one third (31%) rated care in hospitals as fair or poor, compared to the lowest rate of 17% rating care as fair or poor in hospices. Respondents for approximately 8 out of 10 people who died in hospices (83%), care homes (82%) or their own home (79%) rated care as outstanding, excellent or good. Again, hospitals are significantly below this, with 7 out of 10 (69%) respondents rating care as outstanding, excellent or good (Figure 2).
Figure 2: Overall quality of care by place of death, England, 2014
5. Quality of care by cause of death
When looking at overall quality of care for different causes of death, outstanding, excellent and good ratings combined do not differ significantly for people rating the care of cancer patients (78%), cardiovascular patients (74%) or patients dying from other causes (74%). However, when examining the ratings for outstanding and excellent only, overall quality of care for cancer patients in the last 3 months of life is rated significantly higher than care for people dying from cardiovascular disease or other causes. Just under half (49%) of cancer patients had care rated as outstanding or excellent, compared with 39% of cardiovascular disease patients and 40% of people dying from other causes (see Figure 3).
Figure 3: Overall quality of care by cause of death, England, 2014
6. Quality of care by deprivation
A notable pattern of overall quality of care exists when considering the level of deprivation of the deceased. While there is no difference in the proportion of people rated as receiving outstanding care by deprivation level, there is an association between greater deprivation and ratings of poor care (see Figure 4). Significantly more people with the most deprived status have care rated as fair or poor (30%) compared to the least deprived group (21%). This echoes the finding from the VOICES by area deprivation bulletin (ONS, 2013a). Further details are available in the downloadable Reference Table 1 (468.5 Kb Excel sheet) , "Overall quality" tab.
Figure 4: Overall quality of care by deprivation quintile, England, 2014
7. Quality of care by setting or service provider in the last 3 months of life
Respondents are asked to rate the quality of care within each setting that the patient was looked after in the last 3 months of life. Overall quality of care questions asked respondents to consider all aspects of care provided and rate them together, while in contrast, quality of care by setting or provider questions enabled respondents to rate specific care settings that the patient had experienced. These included rating care at home, in a hospital, in a care home or in a hospice and from specific care providers such as district nurses and health professionals who can respond to urgent needs outside normal working hours (urgent care providers). Quality of care by setting is measured on a 4 point scale from excellent to poor.
Quality of care rated as excellent was highest where care was provided by hospices (75%) and lowest where care was provided by urgent care services (26%). As seen in overall quality of care, approximately 1 in 10 people rated care provided by hospital doctors (9%) and hospital nurses (11%) and GPs (13%) as poor (see Figure 5).
Figure 5: Quality of care by care setting or provider in the last 3 months of life, England, 2014
Percentages may not sum due to rounding.
This question is multi coded so the respondent can tick more than one option.
3 out or 4 people (75%)rated the care provided by hospice staff as excellent. 1 out of 4 people (26%) rated the care provided by urgent care services as excellent.
Reference Table 1 contains results of quality of care ratings within each health care setting. Quality of care is significantly higher for people who died of cancer compared with cardiovascular disease or other causes. For cancer patients, hospice care was rated 81% excellent, district and community nurses 51% excellent, GPs 41% excellent and urgent care 29% excellent. See Reference Table 1 (468.5 Kb Excel sheet) ("Quality of care (3mnth)" tab).
8. Dignity and respect in the last 3 months of life
One aspect of care measured was how much staff in different settings treated the patient with dignity and respect. Staff in hospices were most likely to be rated as always showing dignity and respect to the patient in the last 3 months of life (88% for hospice doctors and 85% for hospice nurses). Hospital staff received the lowest ratings of always showing dignity and respect. This was 59% for hospital doctors and 53% for hospital nurses. While dignity and respect from hospital nurses is lower than from doctors, it has increased significantly from 48% in 2011 to 53% in 2014 (see Figure 6).
Figure 6 presents information on how often the patient was treated with dignity and respect in the last 3 months by setting or service provider in 2014. Where settings are less likely to be rated as always treating patients with dignity and respect, such as care homes and hospitals, more people (roughly 1 in 4) rate that dignity and respect was given most of the time (care homes 28%, hospital doctors 25%, and hospital nurses 27%). 1 out of 5 people (21%) rate hospital nurses as only treating patients with dignity and respect some of the time or never, while GPs are significantly more likely to be rated as never treating patients with dignity and respect in comparison to all other settings (4%).
Figure 6: Dignity and respect by care setting or provider in the last 3 months of life, England, 2014
Hospice doctors and hospice nurses are significantly more likely to be rated as always treating patients with dignity and respect in comparison to other settings.
1 out of 5 people (21%) rate hospital nurses as only treatin patients with dignity and respect some of the time, or never.
Always receiving dignity and respect from health care professionals is reported as higher for people who die of cancer than for patients dying of cardiovascular or other causes. This is significantly higher for cancer patients receiving care from hospice doctors and nurses as well as GPs and community nurses, compared to cardiovascular patients or patients with other diseases. Differences in dignity and respect shown to patients of different ages tend to be small and non significant. Further details of responses related to dignity and respect reported by the different care settings and care providers in the last 3 months and the last 2 days of life are provided (see "Dignity and Respect 3 months" and "Dignity and Respect 2 days" tables in reference table 1 (468.5 Kb Excel sheet) ).
9. Coordination of care in the last 3 months of life
Two questions were asked about coordination of care. One question was asked in relation to those patients who had spent some or all of the last 3 months at home, about whether community services worked well together. Of the 47% (9,530) of people who responded to this question, 42% said that the services definitely worked well together (see Figure 7). This was significantly higher for people who died at home (55%) compared to those who died in a hospice (40%), hospital (35%) or care home (32%, see Reference Table 1 (468.5 Kb Excel sheet) "Coordination of care (3mnth)" tab). This provides support for the view that coordinated services in the community can enable people to die at home.
Figure 7: Coordination of care between care services in the last 3 months of life, England, 2014
1 in 3 respondents (33%) reported the hospital services did not work well together with GP and other services outside of the hospital.
42% of respondents whose relative or friend had spent some or all of the last 3 months at home agreed that the care services defiantly worked well together.
Respondents were asked to answer the second coordination of care question if the patient had spent some time in hospital in the last 3 months of life. This asked if hospital services worked well with the GP and other community services outside the hospital. Here, 46% (9,405) responded to the question (9,405 people) with 1 in 3 people (33%) reporting that services did not work well together. About 2 out of 3 (67%) said that the services definitely worked well together or worked well together to some extent. Statement 8 of the National Institute for Health and Care Excellence (NICE) quality standards for End of Life Care for Adults emphasises the importance of effectively coordinated care across all relevant settings (NICE, 2011). See "Coordination of care" table in Reference Table 1 (468.5 Kb Excel sheet) .
10. Relief of pain in the last 3 months of life
Figure 8 presents results on how well pain was relieved during the last 3 months of life, by care setting. Questions on relief of pain were relevant only for certain patients. Where it was relevant, relief of pain was reported as being provided "completely, all of the time" most frequently for patients in hospices (64%) and least frequently for those at home (18%). Almost 1 in 13 (8%) of people cared for at home did not have their pain relieved at all. Pain relief does not vary significantly between cause of death or age of death at home, in a hospital or in a hospice. More than 2 out of 5 (22%) cancer patients who died at home had their pain relieved all of the time, which was significantly higher than people who died from cardiovascular disease (13%) or other causes (15%). For further information, see "Relief of pain 3 months" and "Relief of pain 2 days" tables in Reference Table 1 (468.5 Kb Excel sheet) .
Figure 8: Relief of pain by care setting in the last 3 months of life, England, 2014
Pain was reported being relieved 'completely, all of the time' most frequently for patients in hospices (64%) and least frequently for those at home (18%).
Almost 1 in 13 (8%) of people cared for at home did not have their pain relieved at all.
11. Overall level of care in the last 2 days of life
In 2014, new questions were added to the VOICES questionnaire to understand the overall level of care given by health professionals in the last 2 days of life. These related to the respondent's opinions on whether the patient was given adequate nutrition, fluid and pain relief in the last 2 days of life as well as how well the patient's non medical needs were met. These questions were added to provide an indicator of how well needs are met at the end of life following the withdrawal of the Liverpool Care Pathway.
Figure 9 shows that between 75% and 81% of cases, relatives agreed or strongly agreed that patients had adequate support to relieve thirst, hunger, pain and other problems. This indicates that in at least 3 out of 4 cases, people's primary needs are met at the end of life. Despite this, 1 in 8 respondents (13%) disagreed or strongly disagreed that the patient's need for food or nutrition was met. A similar proportion (11%) disagreed that there was adequate support for the patient to receive fluids and 12% disagreed that other problems were supported. One in 10 (10%) disagreed that pain relief was sufficient in the last 2 days of life.
Figure 9: Overall level of practical care provided by health professionals in the last 2 days of life, England, 2014
Other new questions asked about the emotional and practical support provided in the last 2 days of life. Similar proportions of people agreed or strongly agreed that the patient's emotional needs were considered and supported (70%) and that the patient was cared for in the place they wanted to be (70%). Despite this, 1 in 7 people disagreed that these needs were met, with 15% disagreeing or strongly disagreeing that the patients emotional needs were supported or that they were cared for in the place they wanted to be (15%, see Figure 10).
Significantly fewer people agreed that support and consideration for spiritual and/or religious needs was provided in comparison to other needs. Only 60% of people agreed or strongly agreed that support for religious and/or spiritual needs was provided, although a higher proportion of people responded with neither agree or disagree than for any other question (25%). This may reflect that this is not an important factor for all patients, or that respondents do not expect this need to be supported by health care staff. The result that 33% of respondents to the survey ticked the additional "does not apply" option may further reflect this. Full results are available in Reference Table 1 (468.5 Kb Excel sheet) , "overall care (2 day)" tab.
Figure 10: Overall level of emotional care provided by health professionals in the last 2 days of life, England, 2014
12. Support for relatives, friends or carers at the end of life
In 2014, new questions were asked about the quality of communication between relatives, friends or carers and health care professionals in the last 2 days of life. The majority of people responded agree or strongly agree to the questions "we understood the information given to us" (86%), "we were kept informed of his/her condition and care" (79%), "we had enough time with staff to ask questions and discuss his/her condition and care" (76%) and "we had a supportive relationship with the health care professionals" (74%, see Figure 11). In contrast, between 7% and 16% disagreed or strongly disagreed with these statements.
Figure 11: Quality of communication with health care professionals in the last 2 days of life, England, 2014
Reference Table 1 (468.5 Kb Excel sheet) ("communication (2 day)" tab) presents these results broken down by different categories. When comparing quality of communication results by place of death, respondents whose friend or relative died in hospital were significantly less likely to agree or strongly agree that they were kept informed of the patient's condition (74% compared to the next lowest of 82% at home), that staff had enough time to discuss the patient's condition and care (68% compared to the next lowest of 80% at home), or that the health professionals had a supportive relationship with the carer (66% compared to the next lowest of 79% in a care home).
Significantly more relatives of people treated in hospital than other settings reported poor communication with health professionals. As many as 1 in 5 people disagreed or strongly disagreed that they were able to discuss the patient's condition with staff (22%), that they had a supportive relationship with staff (20%) or that they were kept informed of the patient's condition (19%). Significantly more people whose relative or friend died in hospital also did not understand the information provided to them (10%) in comparison to other settings.
Notably, respondents aged under 60 are significantly less likely to answer positively to these questions than those aged over 60. For instance, those aged under 60 agreed or strongly agreed that they had enough time to ask questions and discuss the patient's condition less than those aged over 60 (71% compared to 80% respectively).
Other questions on the survey asked about the support the respondent and family of the deceased received and whether they were dealt with sensitively. More than half of respondents to these questions (59%) said that they had definitely been given enough support at the time of the death. A further 27% said that they had to some extent.
When asked whether they had talked to anyone from any support services since the death, most respondents reported that they had not, and did not want to (66%). However, 20% said that they had not, but would have liked to. This was significantly higher for female respondents (23% versus 16% for males) and younger respondents (25% for under 60 years and 16% for those 60 years and over).
The National Institute for Health and Care Excellence (NICE) quality standards for End of Life Care for Adults (Statements 7 and 14) focuses on the importance of sensitive communication to those closely affected by death and the need to offer timely support "appropriate to their needs and preferences" (NICE, 2011). Further information is presented in the "Support for carer 3 months" and "Support for carer 2 days" tables in Reference Table 1 (468.5 Kb Excel sheet) .
13. Decision making at the end of life
Most people (97%, 20,705) responded to the question of whether decisions were made about care which the patient would not have wanted. Of these, almost 1 out of 5 (19%) respondents said that decisions were made about the patient's care, which the patient would not have wanted. Approximately 3 out of 5 (61%) respondents said that no decisions were made that the patient would not have wanted.
Respondents reported that they believed the majority of patients (86%) were involved in decisions about their care as much as they wanted (62% of the sample (13,314 people) responded to this question). Statement 3 of the National Institute for Health and Care Excellence (NICE) quality standards for End of Life Care for Adults, emphasises the importance of people approaching the end of life feeling satisfied that they have been able to discuss, record and review their needs and preferences and take a role in planning and decision-making, if they would like to do so (NICE, 2011). Further details about decision making around care are reported in the "Patients Needs and Preferences 3 Months" tables in Reference Table 1 (468.5 Kb Excel sheet) with results presented by cause of death, place of death and age at death.
14. Preferences and choice at the end of life
Respondents were asked if the patient had expressed a preference for where they would like to die and asked to state where this was (for instance, at home, in a hospice etc.). The majority believed the deceased had wanted to die at home (82%), 8% said they wanted to die in a hospice, 6% in a care home, 3% in hospital and 1% somewhere else (see Reference Table 1 (468.5 Kb Excel sheet) , "priorities (3mnth)" tab). Previous VOICES evidence also shows that 54% of people died in their preferred place of death but only 4% of these died in hospital, indicating that this is not where people choose to die (ONS, 2015).
Respondents were asked if the patient had died in the right place and 99% of people who responded to the survey, answered this question (21,087). Figure 12 presents those who were believed to have died in the right place for their circumstance, by the place of death. This shows that in hospices and at home more than 9 out of 10 people (94% for each place) were believed to have died in the right place for them. This figure reduces to 73% for people dying in hospitals. Hospitals also have the highest proportion of respondents who felt the deceased did not die in the right place (16%) and respondents who were not sure if hospital was the right place for the deceased to have died (11%).
Figure 12: Did the patient die in the right place, by place of death, England, 2014
15. Sample information
The sample for the 2014 VOICES survey was selected from the adult deaths registered between 1 January 2014 and 30 April 2014, which were extracted from our death registration database. Records were removed where cause of death and place of death were outside the criteria (see below), where the informant's name and address was missing and where the informant was designated an official (See Background Note 4).
From the 135,880 deaths that were eligible for the survey, a stratified sample of 49,614 was drawn for the actual survey.
Informants were contacted between 4 and 11 months following the death, the recommended time for such surveys to balance the need for privacy and sensitivity during early bereavement while ensuring reliable recall about care provision (Hunt et al, 2011). The mailing period was also timed to exclude Christmas and the anniversary of the death. The VOICES-SF questionnaire was used: the Views of Informal Carers – Evaluation of Services (VOICES) short-form (see Background Note 3), which incorporated the new survey questions outlined in the questionnaire changes section of this report.
Sex of deceased
This was determined from information recorded on the death certificate.
male (47% of the selected sample)
female (53% of the selected sample)
Deaths were excluded where the place of death was recorded as "Elsewhere", which includes external sites (such as roads or parks), public venues (such as shops or restaurants), work places and any other place which could not be identified to a specified location type. Location types that were included were grouped in the following way:
home: the home of the deceased as reported on the death certificate. (23% of the selected sample)
hospital: NHS and private (49% of the selected sample)
care homes (including residential homes) (22% of the selected sample)
hospices (6% of the selected sample)
In some cases, it may be appropriate to group residential homes with home, since these all describe the usual residence of the person. However, for the purposes of the 2014 VOICES survey, residential homes were grouped with care homes because the survey addresses the quality of care provided by staff.
All details relevant to the cause of death on the death certificate are coded using the International Statistical Classification of Diseases and Related Health Problems – Tenth Revision, or ICD–10 (WHO, 1992).
Deaths were excluded from the sampling frame where the underlying cause of death was accident, suicide or homicide (ICD–10 codes V01 to Y98 and U50.9). The following deaths were included where they were recorded as the underlying cause:
cardiovascular disease (CVD): ICD–10 codes I00 to I99 (29% of the selected sample)
cancer ICD–10 codes C00 to D48.9 (This includes benign neoplasms) (30% of the selected sample)
other: ICD–10 codes A00 to R99 (excluding CVD and Cancer) (41% of the selected sample)
Deaths of people aged under 18 years were excluded, leaving an age range of 18 to 110 years for the sample. Ages were split into 3 groups.
under 65 years (12% of the selected sample)
65 to 79 years (28% of the selected sample)
80 years or older (60% of the selected sample)
This older age group becomes of greater importance as the number of older adults increases (ONS, 2014a), mortality rates fall (ONS, 2013b) and people live longer (ONS, 2014b).
Geographical spread
To ensure a geographical spread, death records were assigned to an NHS Area Team based on the postcode of usual residence of the deceased. In 2014, there were 25 NHS Area Teams covering the whole of England.
Of the sample of 49,614 deaths, 21,403 completed responses were received from informants, giving a response rate of 43%. The overall response rate has reduced by 3% in comparison with the 2013 survey (ONS, 2014c). This is likely to be due to changes to the questionnaire, such as making the method to refuse to participate more explicit and a declining trend in survey response rates more widely.
Reference Table 1 (468.5 Kb Excel sheet) ("Response rates" tab) presents the response rates by characteristics of the deceased. Our mortality database contains the name and address of informants of the death and, in most cases, the relationship of the informant to the deceased. No further information about the informant was available so it was not possible to estimate response rates based on respondent details. Although the questionnaire is sent to the informant on the death certificate, they are encouraged to pass on the questionnaire to another family member if deemed more appropriate. In the questionnaire, respondents were asked their age, sex, ethnic group and relationship to the deceased. Where answers were provided, 61% of the sample were female, 56% aged over 60 and 97% were white.
16. Questionnaire changes
The Liverpool Care Pathway provided a protocol for end of life care which has received criticism in a recent review (Department of Health, 2013). Following this review, the Leadership Alliance for the Care of Dying People was established to deliver improvements in end of life care (NHS England, 2013). The Leadership Alliance has published a commitment to priorities for improving care of the dying person, including improving communication between staff, the dying person and their carers, involving the dying person and their carers in decisions about their care and providing an individual plan of care to meet physical and psychological needs of the dying person (Department of Health, 2014).
The VOICES questionnaire has been developed to take account of these policy changes. New questions were developed in relation to provision of fluid, nutrition and other aspects of care at the end of life and the quality of communication with carers and support for their needs. These new questions were cognitively tested in spring 2014 and included in the 2014 VOICES survey. The results can be found within this bulletin in the sections Overall level of care in the last 2 day of life and Support for friends, relatives and carers at the end of life.
Cognitive testing of these new questions has also lead to small changes in existing parts of the questionnaire. These changes will ensure the questionnaire continues to provide policy relevant information and is easy for respondents to complete. A full comparison of the old and current VOICES survey is available here (144 Kb Excel sheet) and the male version (107.1 Kb Pdf) and female version (112.9 Kb Pdf) of the questionnaires can also be downloaded.
The policy changes in end of life care will affect the delivery of services, furthering the importance of continuing to monitor quality of care through surveys such as the National Survey of Bereaved People (VOICES).
17. Uses and users of end of life care statistics
The National Survey of Bereaved People (VOICES) has a range of uses and users. The Department of Health commissioned this survey to follow up on a commitment made in the End of Life Care Strategy. The results of this survey will be used to inform policy decisions and to enable evaluation of the quality of end of life care in different settings, across different ages and different causes of death.
The Liverpool Care Pathway has provided a protocol for end of life care which has received criticism in a recent review (Department of Health, 2013). Following this review, the Leadership Alliance for the Care of Dying People has been established to provide improvements in end of life care (NHS England, 2013). VOICES statistics provide data which will enable the impact of end of life care policies to be monitored during this transitional period.
NHS England are taking this work forward. Quality of end of life care is 1 of the main areas in the NHS Outcomes Framework. This has relevance for Domain 2 "Enhancing quality of life for people with long-term conditions" and Domain 4 "Ensuring that people have a positive experience of care". Indicator 4.6 "Improving the experience of care for people at the end of their lives" uses data from VOICES to gather bereaved carers' views on the quality of care in the last 3 months of life.
VOICES data is also used to support third sector activity, such as supporting lobbying campaigns to improve care at home, allocating charity resources and evaluating and comparing service provision across settings. VOICES results also have value in academic research and have been used in numerous studies, for example, identifying factors influencing quality of care and the impact of pain management on experience of care.
There is also wide public interest in VOICES results, which help to inform differences in quality of care between settings, health conditions and stage of life and can inform lifestyle choices on preferences for care and place of death. Survey respondents in particular have an interest in the results. The full range of uses for official statistics can be seen in The Use Made of Official Statistics (2010).
We welcome feedback from users on the content, format and relevance of this release. Data users can post or email feedback to the address in the background notes section.
18 .Further information
The Department of Health commissioned the first 2 VOICES surveys carried out in 2011 and 2012 by the Office for National Statistics. From 1 April 2013, responsibility for this area of work was transferred by the Department of Health to NHS England.
The VOICES survey has now been conducted for 4 years. Previous publications are:
First National Bereavement Survey (VOICES), 2011
National Bereavement Survey (VOICES) by PCT Cluster level, 2011
National Bereavement Survey (VOICES) by area deprivation, 2011
National Bereavement Survey (VOICES), 2012
National Survey of Bereaved People (VOICES), by NHS Area Team, 2011 to 2012
National Survey of Bereaved People (VOICES), 2013
National Survey of Bereaved People (VOICES) by NHS Area Team (England), 2012 to 2013
An accompanying report was also published in 2012 on the Department of Health website "First national VOICES survey of bereaved people – key findings report" This contains information about adapting the VOICES survey for national use. A copy of the VOICES questionnaire used in this survey can be found in appendix B.
A Quality and Methodology Information report (104.7 Kb Pdf) for this survey is also available on our website. This outlines the methodology used in the survey and the strengths and limitations of the survey design.
19 .Acknowledgements
NHS England, who commissioned this survey, and the Office for National Statistics are grateful to all the respondents who shared their experiences and opinions in the year following their bereavement.
20 .References
Communities and Local Government (2011) The English Indices of Deprivation 2010: Summary, Available on the Communities and Local Government website
Department of Health (2008) End of Life Care Strategy - promoting high quality care for all adults at the end of life. London: HMSO
Department of Health (2013) 'More Care, Less Pathway', a review of the Liverpool care pathway
Department of Health (2014) One Chance to Get it Right: how health and care organisations should care for people in the last days of their life
Hunt KJ, Shlomo N, Richardson A, Addington–Hall JM. (2011) VOICES Redesign and Testing to Inform a National End of Life Care Survey. Southampton: University of Southampton.
NHS England (2013) Leadership Alliance for the Care of Dying People
NICE Quality standards (2011). End of life care for adults: quality standard QS13
Office for National Statistics (2013a) National Bereavement Survey (VOICES) by Area Deprivation, 2011
Office for National Statistics (2013b) Mortality statistics: Deaths registered in England and Wales (Series DR), 2013
Office for National Statistics (2014a) Estimates of the Very Old (including Centenarians), 2002 - 2013, England and Wales; United Kingdom
Office for National Statistics (2014b) National Population Projections, 2012-based Reference Volume: Series PP2
Office for National Statistics (2014c) National Survey of Bereaved People (VOICES), 2013
Office for National Statistics (2015) National Survey of Bereaved People (VOICES) by NHS Area Team (England), 2012 to 2013
World Health Organisation (1992) International Statistical Classification of Diseases and Related Health Problems – 10th Revision. WHO: Geneva, Switzerland.
21 .Background notes
The Statistics and Registration Service Act of 2007 authorises us to use the data received in connection with death registrations for statistical purposes, including the conducting of surveys. The Code of Practice which governs our use of this private information for statistical purposes states clearly how confidentiality will be maintained (Principle 5). The survey plans and materials were reviewed by members of our Ethics Advisory Panel. At all stages of the process procedures were put in place to comply with the Data Protection Act 1998 and the Code of Practice.
We carried out all processes related to the administration of this survey. For details of the Survey Process, Data Scanning and Capture and Mechanisms for dealing with distress and complaints, see the bulletin for the first National Bereavement Survey (VOICES) and the Quality and Methodology Information paper (104.7 Kb Pdf) for this survey.
The VOICES questionnaire: the survey used the VOICES questionnaire short form (VOICES-SF), amended slightly according to recommendations arising from the pilot survey (Hunt et al, 2011). Several questions were further clarified and, for the first time, an additional over-arching question was added. This asked: "Overall, and taking all services into account, how would you rate his or her care in the last 3 months of life?" The layout of the questionnaire was slightly amended to accommodate the needs of a large national survey. Space for respondents to write their own comments was consolidated into 1 large area at the end of the questionnaire, for separate analysis. The VOICES-SF questionnaire is personalised using the appropriate pronouns according to the sex of the deceased. All questionnaires were printed by us using a mail-merge approach to add the details in the letter, the study ID number on every page and the appropriate gender of the deceased. Further details can be found in the bulletin for the first National Bereavement Survey (VOICES) and in the Quality and Methodology Information paper (104.7 Kb Pdf) for this survey. In 2014, the VOICES survey underwent a review and new questions were added in line with concerns raised by the Liverpool Care Pathway review (Department of Health, 2013). Details of changes can be seen in the questionnaire changes section of this report.
Sampling frame: each year a sample of approximately 49,000 adults in England are selected from our registration database. Deaths were selected from those registered between January 1 and April 30 in 2013. Respondents are excluded from the sampling frame if the death was due to accident, suicide or homicide or where the death had occurred "elsewhere" than the designated locations (home, care home, hospital or hospice) or where address details of the informant or deceased were missing. For further details see the Quality and Methodology Information paper (104.7 Kb Pdf) for this survey.
Following data collection, a weight is created for each respondent as the combination of the sampling weight and the non-response weight. The sampling weights are constructed as the inverse of the selection probability. The non-response weights are created to adjust for bias in response using the same 3 characteristics used to stratify the sample: cause of death, place of death (that is, establishment) and regional spread, as well as age of deceased. In 2013, deprivation was added to the non-response weighting method as a review of the methodology found that deceased from areas of greater poverty were less likely to be represented. Weights are created through the use of logistic regressions which are run in SAS with "response" as the outcome variable and each characteristic as the predictor. Significant predictors are then entered into the logistic regression together to check the association with response. The predicted values indicating the probability of response are saved and the non-response weight is created by taking the inverse of this value. The sampling weight and non-response weight are then combined by taking the product of the two. Analysis is undertaken in SAS using both the weights and the sampling stratification.
Other measures: Index of Multiple Deprivation (2010) for England. This index assesses deprivation across 7 domains: Income, Employment, Health Deprivation and Disability, Education, Skills and Training, Barriers to Housing and Services, Crime and Living Environment (Communities and Local Government, 2011). The indices were applied in quintiles at the Lower Super Output Area (LSOA) level using the postcode of the deceased's usual residence. There are 32,482 LSOAs in England, each with a minimum population of 1,000.
Interpreting results: the VOICES survey is based on a sample and as such is subject to variability in the results found. To aid interpretation, the results are presented with confidence intervals in Reference Table 1. Confidence intervals enable comparisons to be drawn between groups or areas and indicate the amount of uncertainty there is around a figure (the larger the interval, the greater the uncertainty). Where confidence intervals between 2 figures overlap, we cannot say with certainty that there is more than a chance difference between the figures.
The survey routes respondents to questions relevant to their situation and therefore some questions have more responses than others. For instance, fewer people experienced care in hospices and the number of responses to hospice related questions is far lower than to questions on themes such as support provided to carers at the end of a life, which are relevant to all respondents. Questions with fewer responses are less robust and consequently have wider confidence intervals, reducing the likelihood of significant differences. As well as question response differences, VOICES is also subject to response bias and it is important to remember that the survey reflects the views of responders only and nothing is known about the experiences of people who do not respond. The survey data is weighted to account for probability of selection and response bias (see back ground note 5). More information on the sample characteristics can be found under the sample section of this report.
Confidence intervals provide a measure of the variability, error or uncertainty surrounding a value. They are especially important when using findings from a sample rather than the whole population and are calculated around the estimated value to give a range in which the true value for the population is likely to fall. The width of the confidence interval depends to a large extent on the sample size and so larger studies tend to give more precise estimates of effects (and hence have narrower confidence intervals) than smaller studies. Thus, wide confidence intervals show greater uncertainty and narrow ones show greater confidence in the estimated value. In this bulletin confidence intervals are wider for questions answered by fewer people, such as experiences in hospices, and narrower for questions that all respondents answer.
A confidence interval may be reported for any level of confidence but most commonly is reported at the 95% level. This can be taken to mean that there is only a 5% chance that the true population value lies outside the confidence interval. Confidence intervals are also used to guide interpretation of the data when comparing change over time, examining differences between geographical areas or between certain groups, such as sex or age. As a general rule and for the same measure, if the confidence interval around 1 value overlaps with the interval around another, we cannot say with certainty that there is more than a chance difference between the 2 values. For example, for a value of 45.3 at time 1 with a 95% confidence interval of 42.1 – 48.5 and a value of 47.5 at time 2 with a 95% per cent confidence interval of 44.2 – 50.8, the intervals overlap and so we could not say with certainty that there had been a [significant] change over time. Confidence intervals should therefore be taken into consideration when making comparisons between figures.
The annual 2014 deaths registration data is due to be published on 15 July 2015. Therefore, figures in this bulletin based on deaths registration data, including place of death, cause of death, age and sex of the deceased are provisional. Changes following this release are expected to be minimal; the largest change within a category is for cause of death, where fewer than 30 cases are altered each year. Changes to VOICES data would be smaller than 1% within any category so figures will not be revised.
The VOICES survey is not subject to regular planned data revisions. In some instances the statistics may be subject to revisions or corrections. Any changes to published statistics adhere to our Revisions and Corrections Policy.
A list of the names of those given pre-publication access to the statistics and written commentary is available in the pre-release access document. The rules and principles which govern pre-release access are featured within the Pre-release Access to Official Statistics Order 2008.
Details of the policy governing the release of new data are available from our Media Relations Office.
Special extracts and tabulations of data from the National Bereavement Survey (VOICES), 2011, 2012, 2013 and 2014 are available to order for a charge (subject to legal frameworks, disclosure control, resources and agreement of costs, where appropriate). Such enquiries should be made to:
End of Life Care Team
Life Events and Population Sources Division
Office for National Statistics
South Wales NP10 8XG
Email: EOLC@ons.gov.uk
Our charging policy is available on our website
We welcome feedback on the content, format and relevance of this release. Please send feedback to the postal or email address above.
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You may re-use this document/publication (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. View this licence or write to the Information Policy Team, The National Archives, Kew, Richmond, Surrey, TW9 4DU; or email.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This document/publication is also available on our website.
Any enquiries regarding this document/publication should be sent to us at eolc@ons.gov.uk
Next publication:
National Survey of Bereaved People (VOICES) 2015, April 2016
A combined publication of the 2013 and 2014 data will not be published due to some questions on the 2013 and 2014 surveys being different and a lack of visible change between publications containing 1 year of the same data.
22 . Methodology
National Bereavement Survey (VOICES) QMI
Helen R Colvin
eolc@ons.gov.uk

redpajama_set_name: RedPajamaCommonCrawl


ban a Romanian monetary unit. Pl. BANI.
cobza a Romanian folk instrument.
gospodar hospodar a title borne by the princes or governors of Moldavia and Wallachia before those countries were united as Roumania.
leu a Romanian monetary unit. [Romanian leu, lion]. Pl. LEI.
mamaliga a type of cornmeal mush eaten by Romanians.


Alumni action is recent male graduates in basketball in 2016.
Basketball alumni action hits the floor of the Floyd County High School gym Saturday with action throughout the day and hosted by Joshua's HOPE – Helping Out by Promotion Education.
The Floyd Country Store offers a Saturday night show featuring Spencer and Rains: Fiddlers who preserve old time music traditions.
Dogtown Roadhouse has Urban Soil on Stage. Lone Ivy String Band hits the stage Saturday night at Wildwood Farms General Store.
Busy Saturday for Easter weekend.


Implosion is a techno project by Arne Kaupang from Oslo, Norway. He is a former DJ, and has been following the house scene and it's development since the first 12" submerged from Chicago and Detroit in the mid 80's. His music is made primarily for raves and clubs, and groove is very essential.
His first EP, "The Vivid Mind EP" was strongly influenced by German hardtrance ala Harthouse, but his music of today is more towards an exciting mixture of European minimalistic techno and American deephouse swingbeat grooves.
His live debut was at the Hyperstate II rave at Oslo Spectrum april 31th 96 (crowd: 8000), where he played alongside Prodigy, Koxbox and Josh Wink. (Josh Wink's favourite moment from Hyperstate was the Implosion live show!) He was also one of the main acts at the Meltdown Rave II at Centrum Scene june 8th 96 (crowd: 2500).
Booking, contact Arne Kaupang at (+47) 22 73 40 26 or (+47) 90 85 93 41.
Implosion is now signed to the Dutch Emergency Broadcast label.


Have you ever wondered where a dentist goes for his dental care? Many of them go to Dr. Baird. His unique blend of relaxed, personable care and 38 years experience, combined with the latest in technology, create for you an exceptional dental experience.
After graduating from the University of Nebraska College of Dentistry in 1981 Dr. Baird established his practice here in Utah. He has been designing smiles ever since.
Many of our new patients, for whatever reason, have neglected their needed dental care. Often they are fearful that the visits will be long and painful. Dr. Baird has been solving this problem for over 15 years with sedation dentistry. He was doing "sleep dentistry" long before it became "cool". Others may be avoiding their needed care because of the cost. Our financial coordinator has a variety of creative ways for you to afford your dental treatment. Sadly we have found that neglecting our teeth always leads to increased costs and more pain.
Outside the office Dr. B enjoys rock climbing, ice climbing, mountain climbing, technical slot canyoneering, scuba divng, caving, back country skiing, hiking, canoeing, hunting, camping, fishing…..if it is outside, he likes it. Most of the pictures you see around the office were taken by Dr. Baird or show him on one of his many adventures. Ask him where he was last week end, he loves to tell you about it.


The weather couldn't have been nicer for Meriden's annual Daffodil 5k at Hubbard Park on Sunday morning. The running was pretty sweet, as well.
The sun was shining and, although there was a brisk breeze in the air, it still made for a beautiful day for the runners.
Best in the field were Matthew Wong and Liz Fengler. Wong, a Meriden native who now lives in Brooklyn, was first across the line in 17:53. Fengler, a 2014 Sheehan High grad who still lives in Wallingford, was the women's champ in 19:27.
This is the 19th year Meriden has held the race ahead of the Daffodil Festival. The 5K is sponsored by the Meriden Rotary Club and the proceeds go to several causes and charities.
This year, the event drew close to 200 participants in the race.
Wong's motivation for coming back to his home city and running the race? He wanted to complete in a 5K here before the age of 40.
Wong said he used to be able to run a 5K in under 17 minutes when he was younger. In recent years, Wong's best time has been 17:15.
Wong also hasn't ruled out doing more races in Meriden in the future.
"I know there's a one-mile race on Memorial Day weekend and I'd definitely come to this one again." said Wong.
Fengler, a regular face in area road races, ran cross country throughout high school. Like Wong, Fengler said the course's hills were a challenge.
This isn't the first time Fengler has run the Daffodil 5K. Her personal best time on this course came a couple of years ago, when she finished in 19:25.
If able to register in time, Fengler plans to compete in next Sunday's races in Cheshire. Beyond that, Fengler has broader plans.
So far, Fengler has run races in about 20 different towns.
Meanwhile, in Meriden, the Daffodil 5K will remain a fixture for Fengler and anyone else who wants to tackle the hills of Hubbard Park in April with the daffodils in bloom.


text:
Iraq Progress Report: A Time to Assess and Reflect
A "Slow Motion Train Wreck"
America and Venezuela – Constitutional Worlds Apart
Published by Stephen Lendman at August 20, 2007
Iraq Progress Report: A Time to Assess and Reflect – by Stephen Lendman
The Bush administration is required to submit three progress reports on Iraq to Congress in September after it returns from its August recess. The US Comptroller General will issue one around September 1 on how well so-called congressional benchmarks have been met. Near the end of the month, the Center for Strategic and International Studies (CSIS) conservative think tank will report on "The readiness of the Iraqi Security Forces (ISF) to assume responsibility for maintaining the territorial integrity of Iraq, denying international terrorists a safe haven, bringing greater security to Iraq's 18 provinces in the next 12 to 18 months, and bringing an end to sectarian violence to achieve national reconciliation."
Then, on or about September 15, General David Petraeus, US "Multi-National Force" – Iraq (MNF-I) commander will submit his assessment of progress before multi-billions more funding are released for a war the Pentagon and most others in Washington know is unwinnable and lost. No matter, his report (and the others) will state progress has been made and the "surge" is working even though details will be sketchy in what's expected to be a vaguely worded deceptive snapshot of contrived positive trends. It'll fool no one, but Congress will be asked to accept it (and the others) on faith that more time, money, sustained troop levels and patience are needed.
That's assured from friendly Democrats and Republicans alike. They continue turning a blind eye to the daily nationwide out-of-control carnage like the August 14 Kurdish area truck bombings local Nineveh province officials report killed at least 500 (far above initial reports), seriously wounded hundreds more, and destroyed over 30 homes in the northwest Yazidi communities.
No matter, and who in Washington is watching and counting. The generalissimo's wishes are all that matter, and he'll have a list of them prepared for him by his bosses and handlers in "the White House, with inputs from officials throughout the government,"according to an August 15 report in the Los Angeles Times. All Petraeus has to do is transcribe them to his letterhead, sign them, and return them to Washington in the enclosed stamp-addressed envelope.
The generalissimo knows what's expected of him which is why he was picked for the top Iraq job. He's also an image-maker's creation portrayed by the White House and dominant media as aggressive in nature, an innovative thinker on counterinsurgency warfare, a talisman, a white knight, a do-or-die competitive legend, and a man able to turn defeat into victory. Those of us old enough don't remember adulation that strong for Eisenhower or MacArthur. Nor did we read about it for John Pershing in the earlier war or for George Washington either, for that matter. As for heaping it on Petraeus, borrowing a quote from a past article – "Phew."
The generalissimo has now been in Iraq six months, and despite claims of progress, conditions are worse than ever and heading south under his stewardship. Still, the commander's hope springs eternal and won't likely wane (at least publicly) lest he risk another 4-star aspirant stepping in to replace him. With upper lip stiffened and reciting his prepared lines, he tells a New York Times reporter "we're going to try (to) win (this war, but)….it's likely to muddle along for quite a long time."
The boy emperor "commander-in-chief" back home has his ideas, too. He plans to continue the "surge" well into next year, all the while claiming "our new strategy is delivering good results, and our commanders recently reported more good news." Army Chief of Staff George Casey (who got bumped in February for Petraeus) was part of the amen chorus August 14 after a weekend visit to Iraq. "Our guys are seeing progress on the security front," he claimed. "From the time I was there, there was progress….every day….and there continues to be progress….We will succeed….if we demonstrate patience and will." More hype still came from an August 10 White House document citing positive reports from "several unexpected (unidentified) sources" and a recent uptick in polling numbers any able pollster can produce.
It's all part of a careful Washington-scripted scheme to band-aid-over an unfixable gaping wound. It includes dispatching hordes of congressmen, senators, friendly journalists and assorted think tank types to a series of staged events and meetings in Iraq, far removed from what's, in fact, happening on the ground. Their mission is to get it all down and tell it to the home folks on return, and that's what's happening.
Some of it comes from two on-off-and on again war-supporting flacks, Michael O'Hanlon and Kenneth Pollack. It was in their New York Times July 30 op ed piece titled "A War We Just Might Win." Neither one is credible, and that status earned them prominent space in "the newspaper of record" to pile on more hype for a failed and illegal enterprise.
Both men supported (illegally) attacking Iraq in the run-up to war when a quick victory looked easy. When it failed, they became harsh critics of administration bumbling until now. After being whisked to Iraq as part of the thinly veiled PR scheme, they returned after eight days of dog and pony show theater claiming the following: "the political debate in Washington is surreal (with its) critics unaware of….significant changes taking place (in Iraq.) We are finally (making progress), at least in military terms….In previous trips….American troops were angry and frustrated….Today, morale is high….they see real results." This over-the-top assessment stopped just short of claiming the troops are so elated they can't wait to come back for another tour when their current one ends.
After four and a half years of failure in a war longer in duration than WW I or II, and likely to exceed the latter one in inflation-adjusted cost before it ends, it's hard believing Congress would swallow any assessment ignoring reality. But you can bet it will on both sides of the aisle even though the generalissimo says success depends on a long-term US presence likely to be at least "9 or 10 years." In plain English, that means permanent occupation and turning a blind eye to defeat until the pain gets so great we give it up and leave.
That's not imminent as the administration-friendly horde descended on Iraq for an advance taste of what's coming next month straight from the generalissimo's mouth. They heard progress is slow but being made in places like Al Anbar province where Sunni tribal leaders have been armed and enlisted to help in an act of desperation likely to backfire. These same men are former and almost certain future resistance fighters. They turned against fellow Iraqis (called Al Queda as standard hot button Pavlovian scare talk) because their views and actions got too extreme. That will change when American duplicity again is seen as the main threat. At that point, these same tribal leaders will rejoin the fight to liberate their country from a hostile occupier they and other Iraqi fighters won't tolerate.
The present detente will prove short-lived when they become as disillusioned as the main Sunni Accordance Front 44 seat bloc that left the Shia-dominated power-sharing government August 1 because their demands were ignored. A week later, five more ministers joined them by announcing a boycott of cabinet meetings. There's now no Sunni representation in the al-Makiki government causing fissures in it big enough to drive an M1A1 tank through, and all the Pentagon and Bush administration can do is blame it on Iranian meddling and al-Maliki's inability to contain it. It makes as much sense as a 1960s pop song blaming a magic spell of love on the bossa nova, but that Latin beat hasn't been cited yet for any of Iraq's problems.
In a sign of desperation, al-Maliki assembled top Iraqi political leaders August 13 to prepare for an August 14 summit of sorts to end the current crisis and restore unity. "Everything (he said would) be on the table," to resolve the impasse that may be unresolvable. Major contentious issues remain, and one of the biggest is Big Oil's drafted grand theft oil law unacceptable to most Iraqis and still to be legislatively settled one way or another. Nothing permanent will be settled, however, until a real Iraqi government is in place after the occupation ends, and the puppet one is gone. How pathetic it is showed when the "crisis summit" met. Like previous efforts, it produced nothing, and the largest Sunni bloc leader, Adnan Dulaimi, said there were no negotiations, nothing political was discussed, but it was a nice lunch.
It's more evidence claims of progress are pure fantasy, and despite the hype, the so-called "surge" is a bust. All that's "surging" is the number of:
— daily attacks played down in the major media;
— deaths that a Just Foreign Policy report calculates at over 1 million since March, 2003 based on updating an earlier Lancet study estimating 655,000 or more deaths through July, 2006;
— uncontrollable violence throughout the country;
— refugees fleeing for safety; the International Rescue Committee and UNHCR estimate the number at around four million including the internally displaced with a further 40,000 Iraqis fleeing their homes each month; and
— a near-total breakdown of essential services like electricity, drinking water, sanitation, medical care, education, security and even food compounded by mass unemployment and extreme poverty; the result is a crisis level humanitarian disaster of epic proportions that continues to worsen.
A July 30, 2007 Oxfam International and NCCI network of aid organizations report had grim findings. It estimates:
— eight million Iraqis need emergency aid – one-third of the population;
— four million can't buy enough to eat;
— 70% of Iraqis have no adequate water supply;
— 80% lack adequate sanitation;
— 28% of children are malnourished;
— the rate of underweight baby births has tripled;
— 92% of Iraqi children suffer learning problems due to fear; and
— there's been a mass exodus of around 80% of doctors, nurses, teaching staff at schools and hospitals and other vitally needed professionals.
This writer observed back in February and earlier that conditions would continue to deteriorate, and the greater number of US forces there are on the ground, the worse things will get. That's the current situation, but it's not being reported. Nor do we hear about Joint Chiefs of Staff Admiral Michael G. Mullen's end of July assessment that "no amount of troops in no amount of time will make much of a difference," agreeing with other military analysts with similar views going back decades.
Instead, spin begets super-spin in an effort to keep defeat from becoming Armageddon or at least dampen or conceal it until a new President takes office and then it's his or her problem to sort out and explain. So far, it doesn't look promising according to accurate reports, some of which are Department of Defense (DOD) ones hushed up.
DOD notes the average number of daily attacks peaked in June at a level higher than any month since May, 2003, right after the invasion. Other independent reports note Baghdad is an out-of-control battle zone looking hopeless, conditions are nearly as bad in other parts of the country, and dead bodies are everywhere in numbers too great to keep accurate count. Morgues can't handle the volume and don't even try. To conceal the true toll, journalists aren't allowed at bombing site scenes and are kept out of hospitals and wherever else they can document carnage. The Bush administration calls it progress, and the hyperventilating media play along with people denied the truth unless they rely on unembedded independent journalists as growing numbers are doing.
Few parts of the country have escaped turmoil that's even in the Kurdish North as the August 14 bombings there proved. It's also hitting the British-occupied South around Basra that was never spared violence but once got much less than in American-controlled areas. Now it's pretty intense forcing the Brown government to consider heeding the recommendation of its senior military commanders that "nothing more can be accomplished" in Iraq and the remaining 5500 British troops should be withdrawn "without further delay," according to an August 19 report in the London Independent.
An earlier August 7 Washington Post report said "Shiite militias there have escalated a violent battle against each other for political supremacy and control over oil revenues" or maybe for other reasons the Post ignored. The report continued stating "Three major Shiite political groups are locked in a bloody conflict that has left (Basra) in the hands of militias and criminal gangs, whose control extends to municipal offices and neighborhood streets." Their main goal, in fact, may be no different than other resistance groups – to drive out a repressive occupier (the British in the South in their case) and reclaim their sovereignty. Afterwards they can sort out how to run their country.
Things are little different in Afghanistan according to an August 19 London Guardian report revealing a shocking human toll on British forces (likely affecting Americans, too) that may signal a future withdrawal there as well as from Iraq. It cites military figures showing nearly "half of frontline troops have required significant medical treatment during this summer's fighting….in southern Helmand province (that) offered some of the most intense fighting (British troops had been engaged in) for 50 years." One soldier on the ground said "You could be in the army for decades and you will never get anything like that again." It's so intense, many British soldiers intend to leave the military when their duty tours end – if they survive them.
Back Home It's Politics As Usual
Bush-supportive Republican and Democrat hopefuls have their own issues to deal with and getting reelected (or elected President) tops them. They're stuck with the Iraq quagmire they backed from the start, know America is in Iraq to stay, but have to appeal to their base with soothing rhetoric even knowing expecting victory is pure fantasy. Billions spent on huge super-bases, an extensive base infrastructure and the largest US embassy in the world dispel talk of withdrawal with proof on the ground. So while pledging to end the war and bring home the troops, all major Democrat and Republican candidates say it will take years to accomplish and America must stay engaged for the duration. They mean forever.
The reasons given are pathetic and the usual kind of campaigning blather by aspirants trying to have it both ways – withdraw, but leave enough there to prevent:
— Iraqi genocide,
— civil war,
— violence from spilling into other countries,
— out-of-control lawlessness and the country becoming a breeding ground and staging area for broad-based "terrorist" attacks anywhere – that, in fact, the occupation incites,
— instability only our presence can contain (that, in fact, causes). We also must:
— protect American personnel (who shouldn't be there) and Iraqis (we're "killing" with our "kindness"),
— train Iraqis (who can run their own country quite nicely without us),
— contend with all other possibilities, and more.
Rhetoric goes even further with Hillary Clinton citing the need to fight "terrorism" and stabilize the Kurdish North, never mentioning the serious threat Turkey may invade in force and ignite a whole new war with untold consequences if it happens.
The logistical problem of troop withdrawal then comes up. Candidates claim it'll take a year or more to accomplish when, if fact, the only issue is the will to do it. Iraqis will be delighted to help. Candidates like flexible options, however, so it's easy saying future policy depends on conditions at the time that now look "uncertain" at best.
Hillary Clinton is a metaphor for the times by her pious comment that if George Bush doesn't end this war, she will if elected. She won't say when, and in a turnaround states her real view that America has "remaining vital national security issues in Iraq" (spelled O-I-L) requiring our permanent presence in the country. So for her and other hopefuls, withdrawal is nice-sounding rhetoric, but when it gets down to policy, America is in Iraq to stay, so get over it.
Her leading opponent, Barak Obama feels no different with high-minded speechifying that "It is time to bring our troops home because it has made us less safe" (never mentioning the toll on Iraqis). He then admits away from supportive crowds he supports a permanent military presence in the country for the usual phony reasons hiding the real ones.
Dick Cheney's hidden ones just surfaced in a 1994 video explaining why he advocated leaving Iraq after the Gulf war. When asked then if US or UN forces should have occupied Baghdad, he answered "no" because it would become "a quagmire if you go that far and try to take over (the country)." He then highlighted the issue of casualties stating "how many additional dead Americans is Saddam worth? Our judgment was, not very many, and I think we got it right." Indeed he did, yet he ended up doing in 2003 what he thought foolhardy nine years earlier. So much for leadership, let alone honor and respect for the rule of law and rights of people everywhere to be sovereign and free.
Honor, public service and respect for sovereign freedom aren't parts of the New York Times agenda either, nor was it ever going back decades. A recent example was its August 13 editorial titled "Wrong Way Out of Iraq" in which it argues for a permanent US military presence in the country and against a significant troop drawdown. The Times position is pathetic but typical of its kind of reporting and editorial positions. It pledges allegiance to the US empire and the corporate giants for which it stands….with liberty and justice for them alone. Wars of aggression, scorn for the law, massive human suffering and deprivation are just business as usual for "the newspaper of record," indifferent to it all.
The editorial bluntly stated "The United States cannot walk away from the new international terrorist front it created in Iraq" while never admitting our presence causes violence that won't end while the occupation continues. It then added "there should be no illusions about trying to continue the war on a reduced scale. It is folly to expect a smaller American force to do in a short time what a much larger" one couldn't do over a longer period.
From the start, the Times was in the lead (with Judith Miller its chief front page voice) supporting the Bush war agenda to establish imperial control over the part of the world with two-thirds of all proved oil reserves. Look for more "stay the course" editorials and front page features in the run-up to Petraeus' mid-September "progress" report calling for continued patience, no troop drawdown, and lots more funding indefinitely. Democrats and Republicans alike are supportive with the Times out in front as lead cheerleader.
Unmentioned is that the war is unwinnable and Dick Cheney's 1994 prediction proved accurate. Those factors likely played into Karl Rove's August 13 resignation, but he didn't let on why beyond the usual stuff they all say about wanting more time with his family. Nonsense, but shed no tears for a man who may have outsmarted himself, yet isn't going away. Rove may move out of the spotlight, but he's not out of the game. He's sure to continue as a master-manipulator elsewhere, for another right wing scheme, or perhaps for the entire Republican party behind the scenes in some reengineering or new strategizing capacity if anyone wants him. Later on they'll be lucrative book deal and lecture circuit fees sweet enough to keep any fallen politico living happily ever after.
In the end, however, the record will show Bush's Svengali failed to pull off his greatest scheme – solidifying the Republican base, building a generation-long super-party majority in Congress, and assuring a Republican gets elected President in 2008. His bungled post-9/11 strategy also resulted in the 2006 mid-term election defeat with things looking even bleaker as 2008 approaches.
Rove may also be leaving for another reason that at this point is pure conjecture. It may involve avoiding further congressional scrutiny. It's not off the table, but soon may be as part of a White House deal with Democrats softening in return for something its leaders want. That's how business is done in Washington where the criminal class is bipartisan and one favor begets another. Expect anything ahead in the dirtiest game around for the highest stakes with the public left out, in the dark, and nowhere in sight.
Looking Ahead in Iraq
In his August 10 AntiWar.com article titled "Mechanistic Destruction: American Foreign Policy at Point Zero," distinguished historian Gabriel Kolko notes the US rarely ever "lost any conventional military battle since at least 1950. Nor has it….ever won a war." In all its wars since Korea, it failed to win a single victory. It's good at overthrowing governments, but the political fallout often ends up "far, far more tenuous. In a word, in international affairs it bumbles very badly" making an "unstable world far more precarious" than if it left well enough alone. "All this is very well known," Kolko states. "The real issue is why the US makes the identical mistakes over and over again and never learns from its errors."
We're now "losing two wars and creating a vast arc of profound strategic and political instability from the Mediterranean Sea to South Asia." In addition, we reignited the arms race in Europe, turned a friendly Russia into a foe, and are heading the country toward possible bankruptcy through reckless fiscal policy. In sum, "this administration has been at least as bad as any (in the nation's history and perhaps it's) "the worst" ever.
By its record (with plenty of Capitol Hill help), it's fair to compare Washington to an asylum with members of both parties the inmates. An outside observer would have to conclude the inmates were in charge, and it shows by what's happening. It also brings to mind the Wile E. Coyote cartoon character as a way to explain it. Bush's political agenda has been disastrous, yet both parties continue supporting the same mistakes expecting a different outcome.
Impossible, according to Kolko, saying the nation is "at point zero in the application of American power in the world." We can't win two "extremely expensive adventures nor will (we) abstain from policies" hurting other nations and our own. Myopia, self-interest and a lot of arrogance have led us to this "impasse," and Kolko isn't optimistic. He's also a noted expert on the Vietnam war having written the seminal work on its history he says was "purchased by many base libraries, (and) military journals (treat) it in detail and very respectfully."
With that in mind, it's fitting to draw parallels to that earlier time. They're striking even though marked differences exist as well. By the late 1960s, victory in Southeast Asia was considered unattainable and a new strategy was needed, even though it developed slowly. It was called Vietnamization combined with duplicitous and delaying diplomacy orchestrated by Nixon's Svengali, Henry Kissinger. He also ended discredited with Karl Rove his Bush administration equivalent for domestic policy in the role of former Deputy Chief of Staff to the President as of August 31.
The Pentagon has a current version of the Vietnam era plan. It's been arming and training Iraqi Security Forces (ISF) as our enforcer hoping US troops eventually can stay hunkered down in super-bases as backup. In the early to mid-1970s, Vietnamization failed because, as Kolko explained, victory isn't just about tactics, weapons and winning battles. Economic, social, political and morale factors come into play. The same holds true today in Iraq.
In Vietnam, the revolution was a powerful defense against a foreign invader. An emboldened North used it, was more committed, and had majority popular support on its side. They had enough of the Japanese earlier followed by the French and Americans making any alternative an improvement as long as it meant peace with their own leaders in charge.
Those leaders didn't resist the Japanese and then fight a 30 year war to give it up in the end a foreign occupier and its imperial ambitions. At least that's how it was then. Vietnam kept its territory but, in the end, surrendered its economic sovereignty to the lord and master of the universe it could outlast on the battlefield but not in the marketplace.
Iraq one day may be no different turning a future resistance victory into eventual economic defeat somewhere down the road. The country has enormous untapped oil reserves thought by some analysts to be potentially greater than Saudi Arabia's they believe are overstated. Iraq's remained undeveloped because of almost continuous war preventing any since September, 1980, or for nearly 27 years.
Even so, it has around 10% of proved world reserves that will be far greater when all potential deposits come online. Whoever controls them will have an economic bonanza worth many trillions of dollars. It may entice a future Iraqi government to partner with the US-led West, and by so doing let America win in the marketplace what it can't achieve in battle. In the end, Iraq may surrender as Vietnam did and lose everything now being fought for. How this plays out will only be known in the fullness of time. Millions of Iraqis hope equity and justice will triumph over greed and are betting their lives on it. May their struggle not be in vain.
Stephen Lendman lives in Chicago and can be reached at lendmanstephen@sbcglobal.net.
Also visit his blog site at sjlendman.blogspot.com and listen to The Steve Lendman News and Information Hour on TheMicroEffect.com Saturdays at noon US central time and now archived for easy listening.


text:
The President's New, Souped-Up Cadillac Limo Rolls Out
President Trump showed off the old model of The Beast to Kim Jong Un during their summit in Singapore
Published Sep 26, 2018 at 7:39 AM
Evan Vucci/AP
A Secret Service agent cleans the presidential limo before the arrival of Marine One carrying President Donald Trump at the Downtown Manhattan Heliport, Sunday, Sept. 23, 2018, in New York. Trump is riding around in a new set of wheels. A sleeker version of the armored presidential limousine known as "The Beast" is ferrying Trump around midtown Manhattan, where he is attending the annual U.N. General Assembly session.
The newest version of the heavily armored presidential limousine known as The Beast rolled out this week during the United Nations General Assembly, and it's full of threat-neutralizing tricks, NBC News reported.
The souped-up Cadillac is thought to carry a mix of armors, run-flat tires, tear gas, electric shock-equipped door handles and more. It is sealed from biochemical attacks and has medical supplies on board, including blood in the president's blood type.
Commissioned by the Secret Service in 2014, the dozen new vehicles were initially expected to cost $15.8 million — the agency is tight-lipped on specifications about the roughly 20,000-pound vehicles.
Trump showed off the old model of The Beast to Kim Jong Un during their summit in Singapore. Other world leaders have upgraded their armored vehicles recently, including Russia's Vladimir Putin and China's Xi Jinping. (Kim rides in a decade-old, modified Mercedes.)
Trump to UN: 'The United States Will Not Tell You How to Live'
President Donald Trump on Tuesday emphasized nations' sovereignty over global governance in his second address to the United Nations.
(Published Tuesday, Sept. 25, 2018)


text:
Lit Is Opening a Place in the McKibbin Lofts
February 25, 2014 By Daniel Maurer
Barack and Mitt at Lit. (Photo: Daniel Maurer)
We've been hearing rumblings that the folks behind Lit, which just celebrated 12 years in the East Village, were working on a new bar in the McKibbin lofts. Back in December, Erik Foss said those were just rumors, but now he's let the cat out of the bag.
Foss tells us the new place at 248 McKibbin is a partnership between himself, Lit co-owner David Schwartz, Rafik Video owner Mindy Wyatt, and Trash Bar owner Aaron Pierce. The bi-level venue, about half the size of Lit but boasting 17-foot-tall ceilings, will consist of a small upstairs restaurant, open daily and run by artist Tessa Hughes-Freeland. After Currant Cafe launches March 16 (Foss's birthday) with a basic menu of coffee and pastries, chef Ryan Pico, a longtime bartender at Lit, will eventually introduce a broader menu of "simple, affordable and very delicious" food, Foss says.
Downstairs, in what's currently a raw basement, a club with a separate entrance will open sometime around September. Asked whether we can expect drop-ins from the Melvins and such, Foss texted, "As of now we have no plan for live music. But that's what we said about Lit, haha." There will be DJs and regular parties, however.
Foss describes a "very rustic" design consisting of old barn wood, concrete, rusted steel, old leather and ironwork. The downstairs club space will have black-painted concrete walls and floors, with half of the room dedicated to a mural that will change sporadically. Naturally, there will be a platform for gogo dancers.
So there you have it — consolation for North Brooklynites who may not get that new location of Max Fish after all.
Correction: The original version of this post was revised to correct the address.
Tags: Bushwick, david schwartz, East Village, erik foss, lit, mckibbin lofts, trash bar
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