text:
Home Tales of the Sausage Factory Life In The Sausage Factory The Progeny Waiver: Will the FCC Wipe Out Smart Grid? Save Thousands of Lives? Both? This Season on Spectrum Wars!
Harold March 5, 2013 - 11:18 am March 5, 2013 Life In The Sausage Factory, Spectrum, Tales of the Sausage Factory
Depending on whom you ask, the Progeny Waiver will either (a) totally wipe out the smart grid industry, annihilate wireless ISP service in urban areas, do untold millions of dollars of damage to the oil and gas industry, and wipe out hundreds of millions (possibly billions) of dollars in wireless products from baby monitors to garage door openers; (b) save thousands of lives annually by providing enhanced 9-1-1 geolocation so that EMTs and other first responders can find people inside apartment buildings and office complexes; (c) screw up EZ-Pass and other automatic toll readers, which use neighboring licensed spectrum; or (d) some combination of all of the above.
That's not bad for a proceeding you probably never heard about.
For me, the Progeny Waiver is a microcosm of why it has become so damn hard to repurpose spectrum for new uses. The added twist here is that this time it is largely the unlicensed spectrum users acting like incumbents and saying that it will be the end of the universe if Progeny lights up its system (although the licensed neighbors say the same thing, pretty much), and Progeny, the licensee, arguing that everything will be JUST FINE, really, and if it isn't too damn bad because we are licensed and they are unlicensed so there!
You might ask, "if this Progeny thingie is so gosh darn important, why have I never heard of it?" Well that's why you read this blog, you clever reader you. This amazing little proceeding is still so deep in the bowels of the FCC that only the true spectrum wonks have noticed. But action now appears imminent, so consider this a sneak preview of this season's favorite telecom reality show, Spectrum Wars.
What raises the stakes on this too damn high, however, is the implications for the future of unlicensed generally and the implications for the credibility of the FCC as an agency able to actually do the technical job of managing an increasingly complex spectrum world. Fairly or unfairly, everyone is going to compare this to Lightsquared (waiver, followed by worries about interference, arguments that the FCC failed to follow its own rules and procedures, blah blah). Let us add to this House Republicans who would love to call the FCC on the carpet for mismanaging spectrum – especially around unlicensed. Add to that the car manufacturers in the 5 GHz band and the federal users generally wanting to show that the FCC can't adequately manage the stuff it has and you have a pack of circling sharks just waiting for the FCC to screw this one up and commence the feeding frenzy. So no pressure.
Happily, I have, if not a solution, at least a better way for the FCC to cover it's rear-end and contain the damage, below . . . .
As always, the backstory takes awhile, so bear with me.
It All Started Almost 20 Years Ago . . .
Back in the mid-1990s, the FCC had a proceeding to set aside a slice of spectrum for the much anticipated "Intelligent Highways Initiative." As part of this, the FCC set aside some spectrum for the "Multilateration Location and Monitoring Service" (M-LMS) and a non-multilateration version, LMS. The new M-LMS service would help track cars and trucks on the new intelligent highway by using broadcast beacons that would triangulate with units in the cars and trucks. Unfortunately, things being rather crowded, the FCC selected the 902-928 MHz band for the new M-LMS and LMS service.
For those of you who do not have the table of allocations conveniently posted on your wall as if it were some prized Jackson Pollack print, the 902-928 MHz band is the one significant chunk of spectrum below 1 GHz open for unlicensed use at reasonable power. Spectrum below 1 GHz (as regularly readers have heard me say countless times) has propagation characteristics that make it extremely good for mobile data – particularly in urban areas, because the spectrum will more easily penetrate objects like walls. As cars also drive through urban areas, the same properties that made it attractive for unlicensed use made it very attractive for M-LMS.
Mind you, this was still in the days before WiFi. Most of the inhabitants of the band were consumer devices, although some folks (including a long-forgotten dotcom darling called Ricochet) were using the band for Internet access even then. Normally (and especially back in those days), the FCC resolves these conflicts by telling unlicensed users to suck it up because licensed users are important and unlicensed is about as valuable as stuff scraped off your shoes. The vast proliferation of unlicensed devices in the 900 MHz band (and the intense lobbying of their manufacturers), however, prompted the FCC to take the unusual step of actually protecting unlicensed use in the band from the future licensees (at least modestly).
Under the rules adopted by the FCC, an M-LMS licensee would need to show that operation of its system would not cause "unacceptable levels of interference" to unlicensed use in the band before commencing operation. Of course, the FCC did not define what "unacceptable levels of interference" actually meant, how it compared to the usual (and equally unclear) "protection from harmful interference" usually given to licensed services, or how it intended to certify that future M-LMS licensees had met their burden. In fairness to the FCC, defining what this sort of thing actually means – especially when predicting the nature of future systems that don't even exist yet – is hard. The FCC also likes to have flexibility to deal with changes in technology and so forth. Less charitably, this is a good way to kick the can down the road and hope things work out.
The FCC finally auctioned off a bunch of the LMS and M-LMS licenses in 1999. The LMS service ultimately morphed into those automatic toll collection thingies like EZ-Pass. But M-LMS went nowhere. For one thing, the intelligent highways initiative never really took off. For another, a much better and cheaper mobile location system called "GPS" came along at about the same time and pretty much eliminated the primary reason for the M-LMS service.
Enter Progeny
Fast forward to 2011. A company called Progeny LMS (Progeny) has a whole bunch of M-LMS licenses and a new technology for repurposing the band. Progeny has a system that it claims will provide much more accurate geolocation for mobile phones than standard GPS. If someone is in a multi-story apartment of office complex, GPS does not tell you what floor or apartment they are in, it just gets you to the right building. Progeny's modified M-LMS system will, according to Progeny, provide you with an accurate location so that EMTs don't have to keep knocking on doors asking "excuse me, are you suffering a stroke and are non-responsive so you couldn't tell the 9-1-1 dispatcher your address?" Then breaking down every door with no response.
To implement its system, Progeny needed a waiver of some of the old rules designed for the mid-1990s, particularly the one limiting the use of service to cars and trucks, but also some of the other network rules as well. Progeny applied, and the Wireless Bureau put the waiver application out on Public Notice. Perhaps unsurprisingly, very few people noticed the public notice seeking comment on "Request by Progeny LMS, LLC for waiver of certain Multilateration Location and Monitoring Service rules," or would have understood the significance even if they had, so the FCC got very few responses.
I will pause here to say that the FCC's actions here were entirely appropriate. The FCC is supposed to publish applications for waiver. This request involves a single licensee trying to implement a new technology. That's a situation waiver is for – does this licensee need a limited exception from the general rule for some very specific purpose. So there was nothing sneaky or underhanded about Progeny applying for a waiver, or the way the FCC simply tossed it out on routine public notice with the dozens of other items you find every day in "FCC Daily Digest" (official motto: "No one reads this unless they get paid to").
One of the companies that did notice the Notice, however, was Itron. Itron makes smart meters that use the 900 MHz spectrum. They also are one of the companies doing smart grid using 900 MHz. (Most companies doing smart grid use unlicensed, in fact.) Itron objected to the waiver, largely on the grounds of "we use this these frequencies so we don't want anyone to start mucking about and causing interference and stuff." The Wireless Bureau granted the waiver over Itron's objection, noting that Progeny would need to demonstrate that it did not cause "unacceptable levels of interference (whatever that means)" for unlicensed users in the 902-928 MHz band.
And Then Things Start To Go Horribly Wrong
Regular viewers of Spectrum Wars will recognize that testing is where things start to go wrong, because the definitions are fairly nebulous. Here, Progeny and the Wireless Bureau needed to address the fact that it had no definition for "unacceptable levels of interference." This makes designing a test to show that you won't cause "unacceptable levels of interference" a shade difficult, as I shall illustrate in this hypothetical conversation between Progeny and the Wireless Telecommunications Bureau (WTB).
WTB: Now you need to go and test whether turning on your service will create unacceptable level of interference.
Progeny: O.K., what do I need to do.
WTB: We're not sure actually, no one has ever tried to turn on a M-LMS system. What do you think you ought to do?
Progeny: Lets start with the most important question. What does "unacceptable levels of interference" mean? I can't design a test to show I don't cause it without knowing what it means.
WTB: Well, it's level of interference that are . . . ummmmm . . . unacceptable.
Progeny: Right. [pause] Lets try this the other way. What would be an acceptable level of interference?
WTB: Less than unacceptable.
Progeny: Right.
[Awkward pause]
WTB: Look, just go do some testing, O.K.?
So Progeny went off and did some testing. They came back later and were pleased to report that – on the test they made up themselves based on a definition they made up themselves – the TOTALLY ACED IT. WTB then put the test results out for public comment. Itron, now joined by the Wireless ISP Association (WISPA) and a few others (including yr hmbl obdn't blogger), objected in a conversation that basically went like this.
Itron, et al.: That test proved nothing!
Progeny: It proved we don't cause unacceptable levels of interference.
Itron, et al: It did not!
Progeny: Oh yes it did! Prove it didn't.
Itron, et al: You did no outside testing. You just grabbed a couple of Part 15 900 MHz devices from radio shack!
Progeny: And your point is?
Itron: There's no way that this shows that you won't cause unacceptable interference!
Progeny: Point to me in the rules where it says I need to do outdoor testing. Hmmmm……
Itron: Ummm….Show me where you don't have to.
Lets Do More Testing!
Regular viewers of Spectrum Wars! will not be surprised that, after a couple of rounds of this, the WTB sent Progeny off with Itron and WISPA to jointly come up with some tests. WTB still cherishes the belief that engineers can somehow magically forget that their companies futures ride on the outcome of these things and that, locked in a room with shiny lab equipment, they will revert back to being engineers. Sadly, this just about never happens.
Instead, what happened is exactly the same thing that happens whenever the FCC tells parties opposed to each other to work out their own testing. They squabbled about everything, including the results. Progeny reported that, after rigorous testing, it was utterly and absolutely obvious that operating Progeny's systems would not cause unacceptable levels of interference and can we please turn our system on before our investors give up and go home. Itron and WISPA argued that the testing had in no way been adequate to determine any such thing, and the data from the tests that were done shows that Progeny's systems will cause unacceptable levels of interference so Progeny should no way be allowed to turn on its system.
Those who harbor the cherished belief that engineering is a science that provides clear answers to any problem may wonder how this is possible and surely someone must be lying somewhere. But engineering is not a straight up or down answer. Engineering is applying the laws of physics to the real world, which makes it very messy. Most importantly, engineering cannot answer questions without some clear direction. Without knowing what the heck "unacceptable levels of interference" means, how do you know if a test proves or does not prove that a system will cause it?
More Parties Notice Progeny, Which Does Not Make Things Easier.
Meanwhile, as the process dragged on, more parties took notice of Progeny and their intent to activate a licensed system in this set of frequencies. This set off alarm bells with a surprising and diverse set of companies and interests that either manufacture devices that use this band of unlicensed frequencies, or which use the devices fairly extensively. This turns out to include WISPs, oil and gas companies (who use Part 15 devices in this band for a variety of purposes), other smart grid companies, other smart meter companies, and a whole bunch of others. So when the FCC put the second set of test results out on public notice, it got a *lot* more comments from a lot of very upset people (including the licensed LMS users) saying "Please don't destroy our business by letting Progeny go live!"
Why would so many companies invest so many millions in technology without interference protection? Because unlicensed means cheap and available, whereas getting ahold of licensed stuff in the right frequencies is impossible without striking a deal with one of the few licensees that has flexible spectrum in the right bands – which is so expensive and hard to do that it is practically impossible for most purposes. As a result, a lot of people have increasingly loaded up important functions on this band because they don't really have an economically viable choice. Sure, they understood the environment in which they worked meant no interference protection. And yeah, it's been on the table since 1999 that someone in M-LMS land might turn on a system and they would need to deal with the whole "unacceptable levels of interference" thing. But most people never thought about it. They just went and bought devices because if they wanted to have a business in the first place, they needed to buy devices.
And, of course, lots of consumers bought devices. That's why the FCC adopted the whole "no unacceptable levels of interference" in the first place.
And just to make things more interesting. The licensed LMS guys are also worried. After all, whenever you are a licensed user, you worry about what happens when a neighbor suddenly cranks up the volume. LMS licensees have interference protection, of course, but the FCC's process for resolving interference complaints assumes either that one of the users will have a superior right (primary v. secondary) or that one of the co-equal users is causing interference by operating in violation of its rules. Confronted with the paradox of two co-primary services operating within their rules causing interference to each other, the FCC tends to act like those computers on Star Trek confronted with an insolvable dilemma — shouting 'it does not compute!' — and shut down.
What's at Stake and What Happens Next?
At this point, the Wireless Bureau has three options: a) let it die by failing to act; b) act on the record as it exists now; or, c) something else.
Before deciding, lets pause to consider what's at stake. Part of the problem is that once Progeny goes live, no individual user of unlicensed devices has any protection from increased interference. That's the trade off for unlicensed. On the plus side, it's cheap, ubiquitous, and completely flexible. On the downside, you get no protection from interference.
Worst case, if it turns out the FCC is wrong and Progeny does cause "unacceptable levels of interference (whatever that means)," the unlicensed users have no recourse. Progeny going live could wipe out a huge chunk of the investment in smart grid (and smartmeters generally), kill a couple of hundred million dollars in investment by the oil and gas industry, drive WISPs out of urban areas, and kill a whole bunch of consumer product lines. That's pretty bad. Even if it seems unlikely to happen, it does give one pause.
Even without worst case, a bunch of folks who are providing service or using the 900 MHz unlicensed devices may find themselves experiencing significant declines in throughput or usefulness. Mind you, the same operators might have experienced similar problems at some point from the crowding of the band. Still, even a non-worst case jump in interference could be pretty bad for a bunch of folks providing useful services via unlicensed.
On the flip side, doing nothing effectively kills the M-LMS service, since it's not like things are going to become less crowded. Also, enhanced geolocation for Next Gen 9-1-1 is a rather useful little service. Mind you, the fact that Progeny has received only tepid support from public safety community to date (one half-hearted endorsement from NENA) raises a legitimate question as to just how valuable this service would be. But this is hardly conclusive.
Progeny's most powerful argument, IMO, is that it played nice and followed all the rules. What exactly could Progeny have done differently to get its service online. As far as I can tell, nothing. That bespeaks a real problem, because the rules encourage companies like Progeny to invest in new technologies that follow the rules. As I noted last year with regard to Lightsquared, no one will want to invest in developing new services if it is impossible to repurpose spectrum ever.
Political Consequences
As if actual consequences of betting wrong weren't enough, the Bureau needs to worry about political consequences. Here, I confess I worry much more about the negative consequences for unlicensed if the Bureau allows Progeny to light up its current system on the basis of the existing record.
Lets start with the Hill. The American Petroleum Institute, oddly enough, knows Republicans on the House Energy and Commerce Committee. These guys already hate the FCC. Worse, Committee Chair Rep. Fred Upton (R-MI), and Rep. Greg Walden (R-OR), Chair of the Telecom Subcommittee, have launched a crusade to kill any attempt by the FCC to permit unlicensed in the reclaimed broadcast spectrum set aside he Incentive Auctions. I can just hear these guys bellowing at the next oversight hearing: "Why on Earth do you want to set aside 12 MHz for guard bands in the 600 MHz incentive auctions, costing taxpayers $19 Billion dollars, when you are trashing the existing allocation of 25 MHz below 1 GHz? Shouldn't you do a better job managing the unlicensed spectrum that already exists rather than looking to take spectrum designated for auction off the table?"
Sure, it's a rather silly argument. But it has just taken me 3000 words to explain why that is a silly argument (with 2000 more to go to get to the answer). On the surface, if you are not a regular viewer of Spectrum Wars, this argument makes sense. Given the ridiculous arguments that the House Rs have made so far against allowing any unlicensed in the reclaimed broadcast spectrum, I see no reason why they wouldn't make this one. Heck, given the significant number of parties arguing for more testing in the record, it's a very easy argument to make.
The counter argument is that if unlicensed users can stop Progeny from lighting up its system, it's going to re-ignite resistance by fed users to sharing spectrum. "Sure," say Fed users. "We let you guys start sharing and then you start taking over." While I acknowledge that's a concern, I am somewhat less worried about that one because the Fed users don't want to share. So either way, the FCC is going to be facing a Progeny argument. If the FCC doesn't lets Progeny light up, then the feds will say: "See, there is no sharing. As son as you guys get a toe-hold in the band, you want to take it all for yourselves." But if the FCC allows Progeny to light up, the Feds will say: "why are you coming after our spectrum? You should take better care of the stuff you already have." The car manufacturers, who don't want to see unlicensed expanded in the 5 GHz band, will argue that they are part of the same intelligent highways as M-LMS, and therefore deserve to be privileged as against unlicensed users.
So What Should the FCC Do? Surprise! I Have an Opinion.
So the FCC, as is so often the case, finds itself in a no-win situation. On the one hand, if they act, they get accused of putting smart grid out of business. If they don't act, they are killing innovation and investment in new licensed services. The best outcome is that the Wireless Bureau allows Progeny to light up under some set of conditions that minimize interference, interference is minimized, and everything works fine. In which case, no one will notice give the FCC credit for anything.
So what is a poor Wireless Bureau to do?
As you might imagine, I do not ask the question rhetorically. I actually have some recommendations for the FCC.
Let me start by restating my own prejudices and perspectives. As regular readers know, I'm a big fan of unlicensed. At the same time, I recognize that licensed stuff has an important role in the wireless ecosystem (at least for the foreseeable future). For years, I've advocated that we need to move to a "share the pain" approach where all users of the spectrum have to learn to work cooperatively and regard interference mitigation as a shared responsibility rather than the "I've got mine, Jack, and I'll fight to the death to keep you out."
The problem of Progeny is basically the problem we always have repurposing spectrum. No one using the spectrum now wants anyone new to come in and potentially mess things up. Since this is people's actual livelihoods on the line, they are not inclined to take a dispassionate view. If the spectrum they use gets messed up, they go out of business, or incur heavy costs. The best thing that can happen from an incumbent user's perspective is that nothing bad happens. So the rational spectrum incumbent user doesn't take the policy wonk view, the rational spectrum incumbent fights for its life.
The FCC needs to recognize this and stop hoping that somehow engineers can rise above that and come to an agreement based on engineering realities. Engineers are human beings like anyone else. The existing user community will always want conservative safeguards that the new entrant will always regard as ridiculously expensive. We just saw this with DISH v. Sprint in the AWS-4 v. H Block fight. We saw this with Lightsquared. We saw this with TV White Spaces. We saw this with M2Z.
Engineers are not special. They are human beings like everyone else. Get over it.
Notice and Comment Decisonmaking Is Your Friend
The FCC has to embrace that it will make hard decisions and that parties will not come together on the engineering issues. The way to protect yourself and make progress is to give up on the strategy of pushing the sides to work together and admit we are in an adversarial proceeding where the FCC needs to make the call.
What I think the FCC needs to do, as I have repeatedly said in this proceeding and elsewhere, is to figure out what it means by "unacceptable levels of interference" and what test (or set of tests) would determine whether Progeny will or won't cause unacceptable interference. You put that out on notice, take input, decide what changes need to get made, issue a final decision then run the tests. The new entrant either passes the test, or doesn't.
That's it. You don't argue about the test after you run it, because the entire point is to construct a set of tests that give you reason to believe you can move forward. Without this certainty, the debate always becomes about the test itself and the results of the test. Engineering is probabilistic, and the real world is hideously complicated. As a result, parties will always find things to argue about. Doing notice and comment proceedings that clearly define the definitions and the goals makes the process transparent. That won't make the parties happier, but it does mean the FCC can protect itself from allegations that it is futzing around with needless delay or cutting corners. In a no win situation like this, the only way to protect yourself is to use rigorous process as a shield.
No one likes this, because notice and comment proceedings take a long time and requires the agency to make tough decisions. In fact, Progeny has made it clear they totally hate this suggestion and that they ant to move forward already. Notice and comment processes also mean having less flexibility. Parties will still do their best to politicize the process. And, at the end of the day, there is still no guarantee the FCC won't guess wrong. So what's the advantage?
Following notice and comment consistently provides the agency with protection by enhancing its legitimacy and warding off criticism that it makes decisions based on politics or prejudices rather than engineering. To go back to our hypothetical attack by Rep. Walden that the FCC "contaminated" the 900 MHz unlicensed band so it shouldn't allow unlicensed in the guard bands in the 600 MHz Incentive Auctions, the FCC can say in response "we did not contaminate the 900 MHz band. We acted cautiously and transparently to find ways for multiple users to co-exist. We understand some people are unhappy, but we have a set of transparent procedures that make sure this is decided on the basis of engineering data."
Planning for when Things Go Wrong
The other way for the FCC to protect itself (and manage the spectrum responsibly) it to have some safety nets in their to address what happens if things go wrong. Because the reality is that even with the best engineering experiments in the lab, and the best open and transparent process in the world, actual deployment in the real world can still create lots of surprises. In the TV white spaces proceeding, we talked a lot about how the use of the database created a "kill switch," so that if we were wrong and use of the TVWS did cause interference the FCC could shut it down.
In the case of Progeny, I've proposed two precautions. First, the FCC ought to require Progeny to do a phased-in roll out. Choose a market, go live, watch for awhile to see what happens. If it works out, light up the next market. Have clearly defined criteria for what circumstances would prompt the FCC to either halt the roll out or shut down Progeny until the problems get resolved.
Second, the FCC ought to consider what happens if Progeny interferes with the existing LMS systems. In theory, M-LMS is not supposed to cause interference with existing LMS systems. I have three words: Sprint Nextel Rebanding. Stuff can go wrong, and the FCC's processes for resolving interference issues always breaks down when you have co-primaries operating within the scope of their service rules causing interference to each other. A little forethought now can solve big problems in the future.
None of this is easy, and no one likes delay. New entrants fume at yet-more-delay and the costs, with good reason. Incumbent users worry about interference screwing up their livelihood, also with good reason. That's why the road map out of this is to have a process and stick to it, accompanied by safeguards that let you pull things back if the reality on the ground evolves in a very different direction than it does in the lab.
It's a pain in the ass, but there are no short cuts. That applies here to the Progeny Waiver, and it applies for every effort to repurpose spectrum.
Otherwise, we will keep having new seasons of Spectrum Wars, with the same plot but different players.
fcc, federal communications commission, Itron, Progeny, unlicensed spectrum, wireless. Bookmark.
A Farewell to the Higgins
Pingback: The Progeny Waiver: Will the FCC Wipe Out Smart Grid, Save Thousands of Lives? Both? This Season on Spectrum Wars! | Wetmachine | Surfing the Broadband Bit Stream | Scoop.it
Steve Cahill
… and there's the question of whether Progeny's system will actually work, as it will have the same problems with multipath that GPS has – it has GPS chiprate and bandwidth. Progeny's much higher power still does not allow resolving multiple signal paths if the multipath delay spread is much less than the chip timespan, which is 1uS. So the math says it won't offer the location accuracy advertised. And the vertical location accuracy is barometric, not dependent on radio. Progeny also has a business problem in that in order to deliver value to shareholders, it has to have cellphone manufacturers incorporate its technology. That's not going to happen, unless it's a clear winner in location accuracy. Which, as noted, is unlikely.
Steve Crowley
These waivers subject to testing just don't seem to get buy-in from stakeholders. Waivers have their place, but for something such as this, or LightSquared, how about a rulemaking proceeding from the start? For this matter, now, well . . . maybe give it to NIST to arbitrate — it does work for both first responders and for the smart grid, and thus has an interest in both.
Bruce Olcott
Interesting article. You may have me hooked as a regular reader.
A couple of comments. First, full disclosure, I am Progeny's FCC counsel, so I have a personal interest in this.
You note that Progeny should consider a phased-in roll out, lighting up a few cities at a time. In fact, Progeny did this.
Three years ago it lit up its full commercial grade network in Santa Clara County, California, a very sophisticated high tech community. The network has been transmitting ever since and no problems have resulted for unlicensed devices or other services in the band.
Last year, Progeny expanded its commercial grade network to cover the entire Bay Area, including downtown San Francisco. Still no problems for other spectrum users.
Last year, Progeny also constructed and lit up initial networks (not full commercial grade) in 39 other major economic areas, including in Washington DC.
All of these networks continue to operate today, transmitting location signals without causing problems for other services. To this end, the predictions of doom if Progeny is permitted to turn on its network are the standard NIMBY arguments.
Thus, the question before the FCC is not whether to permit Progeny to begin operating its location service (it already is), but whether to permit Progeny to use its service to support public safety.
One additional note regarding the comment of Steve Cahill (Steve's company manufactures unlicensed devices). Cahill argues that Progeny's technology may not be able to precisely locate wireless callers to E911. Cahill should take a close look at the location accuracy test results that are scheduled to be released later this week by an FCC public safety advisor group (CSRIC).
CSRIC conducted independent third party tests of a number of indoor location technologies. I understand that the test results are very impressive. I also understand that the public safety community has been waiting for the test results and are likely to consider them very closely. Highly accurate indoor location capabilities, after all, would not only be extremely helpful in locating individuals in distress, but also in tracking the location of fire fighters inside large burning buildings.
Perhaps I will follow up here on the CSRIC test results once they are released, unless, Harold, you would like to take the pen on that.
Bruce, thanks for engaging here and thans for loads of useful input. I am unlikely to get the CSRIC data (as you can see from the dates, I don't get to blog nearly as often as I would like). Please feel free to contribute further in the comments (or contact me directly) when the CSRIC data comes out.
Christian Vogler
The CSRIC report is now out, and you can find it at http://transition.fcc.gov/bureaus/pshs/advisory/csric3/CSRIC-III-WG3-Final-Report.pdf
The results are good enough that this has captured the interest of the deaf and hard of hearing communities, for whom location accuracy is a higher-than-normal stakes issue.
Oops, I linked to the wrong report. The correct one was just approved yesterday and should be posted soon.
Pingback: Son of lightpoint, Swatting the news, Tort Reform, Now! | On the North River
Thank you for your views on this issue Dr. Vogler. The CSRIC Working Group 3 report is now available at the following link:
http://www.fcc.gov/bureaus/pshs/advisory/csric3/CSRIC_III_WG3_Report_March_%202013_ILTestBedReport.pdf.
Not surprisingly, we are very excited about the test results, as is the public safety community. Despite the very challenging test conditions, the NextNav/Progeny location technology delivered an indoor position fix that was significantly and consistently more accurate than other available technologies, reducing first responder search rings on average by 90% and identifying the test location either in or adjacent to the target building in more than 80% of the tests conducted.
Our service was also the only technology able to demonstrate very precise vertical accuracy across all locations, with a median accuracy of 2 meters (essentially "floor level"), even in large multistory buildings. These combined results document the significant ability of our service to assist public safety by dramatically reducing search rings for E911 wireless callers in indoor locations, including challenging urban, multistory structures. Our service could also be used by firefighters for use in tracking the locations of individual firefighters inside large burning buildings.
The recent FCC CSRIC report on the indoor location accuracy capabilities of Progeny's M-LMS network has attracted a lot of attention within the public safety community. Public safety appears to have realized that Progeny's service may be beneficial not just for locating individuals in distress, but also for locating downed firefighters inside large burning buildings. As a result, the public safety community has been urging the FCC to grant Progeny authority to begin using its operating M-LMS network to provide indoor location services. Letters of support have been filed with the FCC recently by:
The International Association of Fire Chiefs
The International Association of Police Chiefs
The International Association of Fire Fighters
The National Sheriffs' Association
NENA: The 9-1-1 Association
The San Francisco Department of Emergency Management
The Professional Firefighters of New Jersey
The Boulder Regional Emergency Telephone Service Authority
Keith Estes
I am new to this issue and after reading this blog and the comments, I am a little confused. The blog talks about how Progeny is asking for waivers to allow them to begin rolling out their new services; however, Bruce Olcott says in his comment that Progeny has already been rolled out in 39 major economic areas. If Progeny has already been rolled out, why all the challenges to their waver request now?
Bruce also mentions that the Progeny services that have been rolled out are not causing problems to existing users in the band. How is this known? Have they contacted existing users? Have they conducted testing with these users? It is my understanding that Progeny may be rolled out, but with a minor presence with a limited number of transmitters in each area. If that is the case, whether the Progency services will cause problems to existing users will not be known until the services are fully rolled out.
Thanks in advance for helping to clarify this issue for me.
And you haven't even taken into consideration a large interested licensed user of this spectrum on a secondary basis. The amateur radio community who have recently been burned by the fcc when the 450 mhz band wa taken away on the east and west coast for a military radar system. Now the ham radio people who also help the public during emergencies are being told to leave this band also. Maybe Progeny should move their operation to the same band as Pave Paws and work out a acceptable interference agreement with the military.
Pingback: Wetmachine » Tales of the Sausage Factory » Globalstar's Stellar Chutzpah: Trying To Hold Up New Free WiFi To Leverage "Licensed WiFi."


text:
Howard Dean Criticizes Demoratic Party's Position on War, to Acclaim by DNC Delegates
by Jeremy D. Goodwin,
The apparent split between the official stance of the Democratic Party on the Iraq war and the general sentiment of its members provided one undercurrent during a well-received speech by former Vermont Governor and Democratic presidential candidate Howard Dean at the Royal Sonesta Hotel in Cambridge on Tuesday afternoon. Dean criticized, "the Democratic party, for not standing up to Bush. They thought the best way to oppose George Bush was to be like George Bush." A Boston Globe report claimed that some ninety-five percent of Convention delegates oppose the decision to go to war in Iraq.
Read the full article » (12 comments)
28 Jul 2004 | Filed under: News / DNC : International
Third Day of Protests, July 27th
by Matthew Williams,
Tuesday, July 27th saw the continuation of two things that have been continuing all week--the multimedia Eyes Wide Open exhibit portraying the grim realities of the Iraq War and the September 11th Families for Peaceful Tomorrow's march with a monument to civilians killed in war. There were also more festive events as well: from noon to 8:00 pm, the Really, Really Democratic Bazaar, a fair in which people gave away goods, services and political information for free, and, from 6:30 to 8:00 pm, a march by the satirical street theater group Billionaires for Bush to the Republican Party Headquarters. Finally, Medea Benjamin of Global Exchange and Code Pink was hauled off the floor of the DNC for unfurling an anti-war banner.
Read the full article » (4 comments)
Revolution or Alienation?
by Boston Anarchist,
I was at the bazaar today and I've been involved in anarchist organizing for a while. At some point today I started thinking about how the people who weren't involved in the "scene" perceived us. Vangaurdism is for authoritarians; not anarchists. But I think that we're perceived as vangaurdist sometimes. I feel that we've built some strains of a very interesting subculture and movement that is fun to be a part of and that is doing a lot of good work. But I feel like we need to step back a second and think about how our rhetoric, ascetic and project focus/ implementation relates to what we claim to want. For example, does "smash the state" or "up the punx" or half the rhetoric that we use mean anything to anyone outside our own egos?
28 Jul 2004 | Filed under: Commentary / DNC : Organizing
Barbed Wire Over Boston: Strong Police Presence at the Really, Really Democratic Bazaar
by Naomi,
The green grass of the Boston Common, along with the civil liberties of several thousand people were trampled today by squads of police that continually marched, biked and cycled around and through the peaceful displays of the Really, Really Democratic Bazaar. Under the propagandized shield of "combating terrorism" and "preventing violence", the growing security state seeks to protect itself from the exploding numbers of the disenfranchised that will inevitably rise against it. And on the Boston Common, approximately 2500 people of all flavors celebrated "another world is possible" while ignoring the police. Live music on two stages, free haircuts, free massages, free bikes, and free hugs were just several of the ways people expressed their commitment to the creation of community and the living protest to consumptive living.
28 Jul 2004 | Filed under: Commentary / DNC : Human Rights : Organizing
Art Exhibit Opening Minds In Copley Square
by Pete Stidman,
Visitors to the posh shopping area of Back Bay are finding themselves attracted to a powerful art exhibit put on by the American Friends Service Committee, a National Quaker Peace and Justice Aid Organization. The idea for the exhibit came from the groups Chicago office. A visitor to the site is confronted with a formation of 907 boots, a number that rises almost daily. It is the number of American Soldiers killed in Iraq. There is another pile of shoes that represents the 16,000 Iraqi's estimated killed.
27 Jul 2004 | Filed under: News / DNC : International : Media
9/11 Family Group Pushes Peace and a Giant Stone
by Adam Eidinger,
While politicians convene in Boston for the Democratic National Convention, family members of 9/11 victims are making a dramatic statement of solidarity with victims of terrorism, violence and war from around the world. They started on July 25 a walk from Boston to New York, pulling a 1400-pound granite memorial honoring the "Unknown Civilians Killed in War."
Battle of the Corp-Bots!--Kerry (& Bush's) Conservative Funders
by Sean Donahue,
Cover Story from the First issue of our Newspaper, "The Boston Independent", now available all over town. (check your local bettega, cafe, laundromat, bar, etc)
Most of the major contributors to John Kerry's presidential campaign are corporations or employees of corporations that have ties to a network of organizations dedicated to moving the Democratic Party to the right. These organizations, which include the Democratic Leadership Council, the New Democrat Network, and the Progressive Policy Institute, are dedicated to pursuing a policy agenda that includes support for high levels of military spending and an aggressive role for the U.S. military around the world. Kerry has a history of political links to these organizations as well, and though he has been using progressive rhetoric during his campaign, the details and nuances of his positions indicate that Kerry is still dedicated to pursuing their conservative agenda.
Read the full article » (1 comment)
27 Jul 2004 | Filed under: News / DNC : Politics
Protestors to DNC Delegates: Free Palestine!
by Holly Hand,
On Monday evening, delegates arriving at the Democratic National Convention were greeted by the sight of two to three hundred people rallying in the controversial fenced-in demonstration zone. The rally, "We All Pay for the Occupation of Palestine," was sponsored by United for Justice with Peace (UJP) and the Boston Committee for Palestinian Rights. "Welcome to the cage" said the opening speaker. "Our Palestinian brothers and sisters live in a cage." To cheers and applause, the speakers' messages were clear: end the occupation of Palestinian land and tear down the illegal 25-mile long wall that the Israelis are erecting to contain the Palestinians.
Previous Page | 1 | ...21 | ...41 | ...61 | ...81 | ...101 | ...121 | ...141 | ...161 | ...166 | ...171 | 172 | 173 | 174 | 175 | 176 | 177 | 178 | 179 | 180 | 181 | ...186 | ...191 | ...196 | ...204 | Next Page
OPEN NEWSWIRE
"In Celebration of Indigenous Peoples Day" with Tom Pacheco - 13 Oct 11am-1:30pm Boston ("0")
Presentation by socialist-feminist congresswoman from Brazil - 11 Oct @6-8pm Nonprofit Ctr Boston MA ("0")
Somerville: HONK! Festival of activist street bands - Fri 12pm 11 Oct Davis Square ("0")
Movie Screening: 'Objector' about imprisoned Israeli Conscientious objector - 10 Oct @6:30-8:30pm Jamaica Plain Boston MA ("0")
Book talk - Sidney Gottlieb and the CIA Search for Mind Control - 10 Oct @7-8pm Harvard Book Store Cambridge MA ("0")
Internationalist Day at Encuentro 5 - 10 Oct @ 6:30-9pm Boston Park Street ("0")
Boston Palestinian Film Festival October 18 - October 27 Museum of Fine Arts Boston MA ("0")
Fix It: Healthcare at the Tipping Point October 13 @ 6:30 pm	Chestnut Hill MA ("0")
Naomi Klein: The Burning Case for a Green New Deal October 10 @ 7:00 pm - 9:00 pm ("0")
Reading King in Boston: Jean-Luc Pierite October 10 @ 5:30 pm - 7:30 pm Grove Hall Library Boston ("0")
All newswire listings...
Crétinisme et jobarderie psychophysiologiques ("0")
Putanisme patriarcal, putanisme social ("0")
IMF Chief Warns of Financial Disaster Driven by Inequality ("0")
The Shortwave Report 01/17/20 Listen Globally! ("0")
Concrete Dystopia ("0")
Relookage de l'effet Macron ("0")
Paraphysique du connectome tératogène ("0")
Sowing Egoism and Harvesting Trump ("0")
Capitalisme catastrophiste autoréalisateur suivi des Bourgeoisies nationales, syndicales, patronales ("0")
Les égos colonisés ("0")
Paraphysique de robotique biométrique ("0")
Hidden articles...
View comments...

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: filter array of strings based on priorities javascript I have an object like this:
const array = {
"clientName": "xyz",
"exp": 0,
"roles": [
"dist-users",
"admin-dev"
]
};
I want to filter roles based on priority as admin-* then 2nd priority as dist-users, if none present then by default dist-users.How to achieve that?

A: filter iterates over all elements - you can't stop it.
I don't think this is the right approach, you should use Array.find or Array.findIndex to probe the roles array and figure out if it has an item starting with the desired prefix.

const array = {
    "clientName": "xyz",
    "exp": 0,
    "prefUserName": "admin-dev",
    "roles": [
        "dist-users",
        "admin-dev"
    ]
};

const admin = array.roles.find(role => role.includes('admin-'))
const dist = array.roles.find(role => role.includes('dist-users'))

const roles = [ admin || dist || 'dist-users' ]

console.log(roles)

redpajama_set_name: RedPajamaStackExchange


In the lead-up to Friday's presidential swearing-in ceremony and inaugural parade, Homeland Security Secretary Jeh Johnson said authorities are not aware of any specific, credible threat to the events.
But with a growing trend of lone-wolf attacks, he said, special precautions are being taken to prevent the kinds of truck attacks that killed dozens last year in Nice, France, and in Berlin.
Large vehicles such as dump trucks and buses will form barriers to strengthen the security perimeter.
An estimated 700,000 to 900,000 people will descend on the National Mall to watch Donald Trump be sworn in as the 45th president of the United States.
Though the expected crowd isn't as large as the 1.8 million estimated to have attended President Obama's 2009 swearing-in ceremony, security analysts say the nature of protests will make this inauguration more challenging.
Tallying organizations that have registered for demonstration permits as well as others that have expressed intent publicly, authorities count at least 63 Inauguration Day protest groups.
Another 36 groups are expected in the District of Columbia for demonstrations through the rest of the weekend.
"It's probably more complicated than anything we've seen because there is this divisiveness" between Trump supporters and protesters, said Mark Testoni, CEO of SAP National Security Services.
About 28,000 law enforcement officials will be providing security for inauguration events, which will leave about 3 square miles of the District cordoned off behind security barricades.
Ahead of the inauguration, law enforcement likely have been busy accounting for the whereabouts of people on internal watch lists and compiling data on planned protests, Mr. Testoni said.
Though police will have a tremendous physical presence to handle crowds and to serve as deterrents to any bad actors, Mr. Testoni said, there will likely be just as intense a focus behind the scenes to ensure the day's events do not distract from other types of intrusions such as a cyberattack targeting critical infrastructure.
Inaugural parade demonstrators will include groups supporting the new president, such as Bikers for Trump, longtime anti-war protesters, the ANSWER Coalition and a cohort of anarchists who have announced plans to bring the inauguration to a halt and to block entry to security checkpoints.
Interim Metropolitan Police Chief Peter Newsham said investigators have been monitoring social media and are aware of protesters' plans.
"Extra precautions are taken to ensure the actual official event cannot be disrupted or blocked," Mr. Johnson said.
The FBI's Washington Field Office will serve as a central command post for the more than 30 agencies providing security during Friday's events. Representatives stationed there from a variety agencies or local and federal agencies will have access to live video feeds of city streets and will coordinate any required response by specialty teams — including bomb technicians, crisis negotiators and those outfitted to handle hazardous materials.
During past mass arrests, authorities have taken people to the Metropolitan Police Academy in Southwest Washington for processing. Police department spokeswoman Rachel Reid declined to say where anyone arrested Friday would be taken for booking.
D.C. Mayor Muriel Bowser, describing the city's security plans for the inauguration, said all spectators and demonstrators are welcome in the nation's capital but must respect the District's laws.
"We expect them to exercise their rights peacefully, and we'll be prepared should anyone choose not to," she said.
The city has stressed in information disseminated about the inauguration that firearms are not allowed to be carried in the District without a city-issued permit and that even those with permits are barred from carrying guns at special events such as the inauguration.


(HealthDay News) — Men and women with obstructive sleep apnea (OSA) are at equally increased risk of ischemic stroke, according to research presented at the annual meeting of the American Thoracic Society, held from May 16–21 in San Diego.
Suzie Bertisch, MD, MPH, of the Beth Israel Deaconess Medical Center in Boston, and colleagues conducted a longitudinal analysis of 5,442 participants in the Sleep Heart Health Study to assess the association between OSA index (the obstructive apnea-hypopnea index [OAHI]) and risk of ischemic stroke.
The researchers observed, after adjustment, a significant positive association between OAHI and risk of stroke, compared with quartile I of OAHI, for quartile II (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.02–2.57) and quartile III (HR, 1.79; 95% CI, 1.14–2.80). According to prespecified analysis stratified by gender, a nonsignificant increased risk of stroke was found for quartiles II through IV in both men and women, with no difference by gender (P value for interaction > 0.05).


text:
Syrian woman recalls regime jail torture, rape threats
A former inmate of Syrian prisons run by the Bashar al-Assad regime recounted the torture and abuse she faced during her incarceration as her scars keep horrific memories alive.
In an interview with Anadolu Agency, Nur Hammad -- a pseudonym to protect her identity -- spoke for the first time about the cruelty she was forced to endure during her nine-month imprisonment at several detention centers.
The 30-year old was arrested by the Assad regime soldiers in May 2018.
Rocket strike on Palestinian refugee camp in Syria
At least 10 civilians were killed and 30 wounded in Syria by a rocket strike on the Neirab camp for Palestinian refugees close to the city of Aleppo on Tuesday night, the United Nations said in a statement on May 14.
"As families gathered to break their fasts for the Ramadan Iftar meal, several rockets hit the densely populated Neirab camp for Palestine refugees in Aleppo," the statement from the U.N. humanitarian aid agency UNRWA said.
"Among those killed were four children,...
Rights group accuses Assad regime of deliberate attacks
The Assad regime is targeting health facilities, bakeries, schools and civilian settlements in northwestern Syria's opposition-held city of Idlib, a human rights watchdog said Thursday.
According to a new report released by Amnesty International, the Syrian regime, backed by Russia, has escalated its airstrikes and artillery attacks on heavily-populated areas located along the Damascus-Aleppo Highway.
In the report, Amnesty International's Middle East research director, Lynn...
Over 330 chemical attacks in Syria last 8 years
The Assad regime is behind the majority of over 330 alleged chemical weapons use in Syria over the last eight years, according to a German-based report.
In a report titled "Nowhere to Hide: The Logic of Chemical Weapons Use in Syria", Berlin-based Global Public Policy Institute (GPPI) said on Sunday that some 336 chemical attacks were recorded in Syria since the start of the civil war.
Nearly 98 percent of the attacks were carried out by the regime forces, the report added....
Cold kills 29 children fleeing Syria fighting: UN
The cold has killed close to 30 children in two months among the civilians who have been fleeing the last jihadist pocket in eastern Syria, the United Nations said Thursday.
The World Health Organization said it was extremely concerned by the conditions for those who make it to Al-Hol, where lies the main camp for people displaced by the fighting against the ISIS.
"At least 29 children and newborns are reported to have died over the past eight weeks, mainly from hypothermia,...
UNICEF: 15 Syria children dead due to extreme weather
The United Nations International Children's Emergency Fund (UNICEF) said that as many as 15 displaced Syrian children, most of them infants, have died from extreme cold and lack of medical care.
The children – 13 of them less than one year old – have died in Al-Rukban refugee camp in south eastern Syria, near the border with Jordan. The remaining two died while fleeing Daesh' stronghold in northern Syria.
"Freezing temperatures and harsh living conditions in Rukban are...
UN calls for Syria detainees to be accounted for after US citizen confirmed dead
UN war crimes investigators called for the Syrian government to inform families of the fate of their relatives who were disappeared or detained by the regime, after officials confirmed that a Syrian-American woman who went missing in 2015 was executed a year later.
The UN's demand comes amid news of the death of Syrian-American activist Layla Shweikani, who died in 2016 while detained by intelligence services.
Raised in Chicago, Shweikani travelled to Damascus in 2015 to help...
Syria's agriculture affected by erratic weather and prolonged conflict
Extreme weather conditions during Syria's seventh year of conflict has caused domestic cereal production to decline sharply, two UN agencies announced on October 10.
Wheat production this year fell to a 29-year low of 1.2 million tons, about two-thirds of 2017 levels.
This was due to an extended period of dry weather early in the cropping season followed by heavy out-of-season rains, according to the latest Crop and Food Security Assessment Mission (CFSAM), conducted jointly by...
Children killed as Syria regime bombs school in Idlib
The Syrian regime has resumed bombardment on the south of Idlib province on September 10, targeting a school in Jarjanaz town, killing at least nine civilians, mostly children, news sources from the ground have confirmed.
Heavy artillery and shelling has also taken place in the towns of Al-Heesh and Al-Teh as well as Qalaat Al Madeeq and Al-Janabra in the north of Hama province with a continuous barrage of missiles sending civilians fleeing further north towards the Turkish border....
836 detainees die in Syrian regime prisons
A total of 836 detainees have died in Syrian regime prisons, according to a Syrian NGO on Aug. 27.
In a statement, the Syrian Network for Human Rights (SNHR) said it has documented the forcible disappearance of around 82,000 civilians in Syria.
"Some 14,000 people have been tortured to death by the regime," the NGO said.
"Tens of thousands of Syrians have been subject to systematic arrests and Syrian authorities deny responsibility for these arrests," the SNHR said. ...
Syria's Assad says next priority is retaking Idlib
Syrian President Bashar al-Assad told Russian media on Thursday his regime's next priority would be retaking Idlib province, currently dominated by rebels and jihadists.
"Now Idlib is our goal, but not just Idlib," Assad said of the northwestern province, in comments carried on Russian newswires.
"There are of course territories in the eastern part of Syria that are controlled by various groups... So we will be moving into all these regions," Assad added.
"The military...
Assad forces bomb school in Quneitra; 10 killed
At least 10 refugees were killed in a barrel bomb attack by regime forces in south-western Syria on Tuesday, according to local sources.
Scores of people were also injured in the attack that targeted a school housing hundreds of displaced civilians in the town of Ain al-Tinah in Quneitra's southern countryside, the sources said on condition of anonymity due to security concerns.
On Monday, forces of the Bashar al-Assad regime announced the capture of Daraa before advancing...
4,759 civilians killed in Syria in the first half of 2018
No less than 4,759 civilians were killed in the first half of 2018 by the parties to the conflict in Syria, including 593 civilians who were killed in June.
SNHR's report notes that SNHR has largely focused, since it was founded, on documenting victims who were killed at the hands of the parties to the conflict, and created a database for the victims' names and their information such as sex, age, occupation, way of killing, the party that killed them, and the type of weapon used....
Assad regime massacres 20 civilians in Daraa
At least 20 civilians have been killed in an attack by the Assad regime and pro-government forces in Syria's Daraa.
Government warplanes have pounded towns in southwest Syria in recent days as a Syrian army offensive, backed by Russia, gathers pace.
As part of Astana process, Daraa was one of the de-escalation zones that was established in May 2017 by guarantor countries Turkey, Iran and Russia.
Later in July, the U.S. and Russia reached an agreement to declare Daraa a "...
Over 1,000 Syrians killed in Idlib since May 2017
The Syrian regime and allied Russian forces have killed at least 1,109 civilians in northern Syria's Idlib province since May 2017, according to the Syrian Network for Human Rights (SNHR).
The civilian deaths included at least 255 children and 209 women in at least 233 attacks.
The attacks also targeted 34 medical centers, 50 schools, and 16 marketplaces, SNHR said in a report Wednesday, adding at least 32 massacres have been committed.
Idlib is among a number of de-...


text:
Shadow Sorcerer ist nach Heroes of the Lance und Dragons of Flame der dritte Titel, den der britischen Entwickler U.S. Gold im Auftrag von Strategic Simulations, Inc. auf Grundlage der Kampagnenwelt Drachenlanze des Rollenspiel-Regelwerks Advanced Dungeons & Dragons entwickelte. Er wurde erstmals im Jahr 1991 veröffentlicht und erschien für die Plattformen Amiga, Atari ST und MS-DOS.

Handlung
Die Handlung knüpft inhaltlich an die Erzählung von Heroes of the Lance und Dragons of Flame an. Sie entspricht den Kampagnenmodulen Dragons of Hope und Dragons of Desolation, als Roman von Margaret Weis und Tracy Hickman auch unter dem Titel Dragons of the Dwarven Depths (dt.: Das Reich der Zwerge (2008), Die verlorenen Chroniken der Drachenlanze Band 1) veröffentlicht. Der Spieler steuert diesmal jedoch eine lediglich vierköpfige Heldengruppe, die 800 Sklaven aus der Festung Pax Tharkas befreit hat. Diese muss er nun durch die Wildnis zur Zwergenstadt Throbardin eskortieren. Doch sie werden von der Drakonierarmee des Fürsten Verminaard verfolgt, vor deren Nachstellung der Spieler den Flüchtlingskonvoi bewahren muss.

Spielprinzip
Das Spielablauf wechselt hauptsächlich zwischen zwei Bereichen, einer strategischen Überlandkarte und der dreidimensionalen, isometrischen Wildniskarte. Auf der aus Hexagonalfeldern aufgebauten Überlandkarte legt der Spieler die Reiseroute fest. Seine Heldengruppe wird durch eine goldene Statuette symbolisiert, die Sklavengruppe durch eine silberne, die der Heldengruppe in gewissem Abstand folgt. Von der Überlandkarte aus tritt der Spieler zudem regelmäßig in Verhandlungen mit den Anführern der Sklaven, bei denen er sie davon überzeugen muss, weiterhin der Heldengruppe nach Throbardin zu folgen. Um die Sklaven regelmäßig überzeugen zu können, muss der Spieler unter anderem regelmäßig Nahrung für die Flüchtlinge finden. Kommt es während der Reise zu einer Begegnung oder entdeckt der Spieler einen speziellen Dungeon, wechselt die Ansicht zu einer isometrischen Wildniskarte. Das gesamte Spielgeschehen verläuft in Echtzeit und wird mit Hilfe einer Point-and-Click-Benutzeroberfläche gesteuert. Für erfolgreich überstandene Kämpfe erhalten die Spielfiguren Erfahrungspunkte und können so im Laufe des Spiels weiterentwickelt werden. Weiterhin finden sich in Dungeons und den Hinterlassenschaften getöteter Gegner Ausrüstungsgegenstände, die von der Heldengruppe genutzt werden können.

Rezeption

Todd Threadgill vom US-amerikanischen Computerspiel-Printmagazin Computer Gaming World bezeichnete das Spiel "als großen Schritt vorwärts für die Spielbarkeit von AD&D-Computerspielen". Den Diplomatieteil bezeichnete er als größtenteils unlogisch und frustrierend. Allen Rausch von GameSpy kritisierte in einer Retrospektive hauptsächlich die mangelhafte Wegfindung, die bei Unaufmerksamkeit des Spielers aus den Figuren bewegungsunfähige Zielscheiben für gegnerische Angriffe machte. Volker Weitz von der Power Play vergab 43 %, wobei er den Entwicklern in seinem Testbericht vorwarf, sie hätten das Spiel "derart schlampig zusammenprogrammiert, daß es mit der Freude bald vorbei ist". Neben der Wegfindung bemängelte er die unübersichtliche Inventarführung und viele kleinere technische Mängel. Der Amiga Joker lobte die Steuerung und Menüführung sowie Grafik und Animationen des Spiels. Kritisiert wurde lediglich der Verzicht auf individuelle Gegenstandsbeschreibungen.

Weblinks

Einzelnachweise

Action-Rollenspiel
Computerspiel 1991
Amiga-Spiel
Atari-ST-Spiel
DOS-Spiel
Dungeons & Dragons
Fantasy-Computerspiel

redpajama_set_name: RedPajamaWikipedia


How do I sign up for Harp Academy?
Simply click the Golden Harmonica to register your interest. We will then contact you and run through the options available. In principle, these involve a one-off taster session to check that you're completely happy before committing, or else subscribing to a term with your first lesson free of charge.
For many newcomers, Harp Academy is their first experience of learning a musical instrument. It may also be their first extra-curricular activity. When this is the case, we recommend a taster session to begin with. This allows them to meet their Harp Academy teacher and see how everything works. Alternatively, where newstarters already have a sibling or friend who has enrolled in Harp Academy, it may make more sense to sign up straight away.
Either way, take a moment to read our Terms & Conditions. They're not extensive, so it only takes a moment. They will help you gain a clearer idea of how Harp Academy operates and will probably answer many of your questions.
Once you're ready to subscribe in full, you'll need a Music Pack. This is available from our Web Store. Your Music Pack is a one-off investment. It contains everything your child will need for their harmonica lessons and it's theirs to keep. They should bring their pack to every lesson. It's a good idea to write their name on all the contents, as well as the Tuff zip folder itself.
You'll also need to pay for the lessons themselves. Our How To Pay page explains what to do, with options for termly or monthly subscriptions. Please note that tuition payment is always made in advance, but you can cancel your subscription at any time. All we ask is a month's notice period so that we can make adjustments and recruit a replacement for our group.


The Cozy Rocket sidecar has been the standard in solid steel construction for decades and is the best value in the sidecar world today. Cozy Rockets were designed in collaboration with the Steib company decades ago to mimic the Vintage Steib 350 and 500 series sidecars.
The Rocket with it's Vintage look is the ultimate finishing touch for your motorcycle.
We stock the sidecars in our US warehouse and they are normally available for immediate shipment.
The Rocket is supplied with a mounting kit which will allow it to bolt right up to a Royal Enfield motorcycle or many other single down-tube motorcycles.
Note: Shipping the sidecar to you will require a nominal freight charges, which cannot be displayed during checkout. We will contact you to arrange shipping and quote final delivery costs or contact us at 1-623-512-0377 or email us at customerservice@classicmotorworks.com. We answer the phone 7 days a week and actually return calls.
The Cozy Rocket sidecar has been the standard in solid steel construction for years. This rugged sidecar is well-built but weighs less than 200 lbs. Now, with the Universal Mount System, this proven design can attach to many types of motorcycles. The Rocket features a 19" wheel and tire. It comes with a shock absorber-type suspension and rubber mounted body.
For more information, please visit the Cozy Rocket page in the Cycle Sidecar showroom.
Note: Shipping the sidecar to you will require nominal freight charges, which cannot be displayed during checkout. A representative will contact you to arrange shipping and quote final delivery costs or contact us to place your order & get estimated shipping costs.


text:
Today in Hip-Hop
The Notorious B.I.G. Died 24 Years Ago Today
On this day, March 9, in hip-hop history, Brooklyn's own The Notorious B.I.G. was shot and killed in Los Angeles.
Eric Diep
Ruff Ryders Drop Ryde or Die Vol. 1 Album: Today in Hip-Hop
Ruff Ryders' shining moment.
XXL Staff
Mac Miller Dies - Today in Hip-Hop
R.I.P. to Mac Miller.
Tupac Shakur Drops 'All Eyez On Me' Album - Today in Hip-Hop
On this day, Feb.13, in hip-hop history, Tupac Shakur dropped his monumental album, 'All Eyez On Me.'
Joe Echevarria
Happy Birthday, Smoke DZA!
Today, Feb. 8, marks the birthday of Harlem, N.Y. rapper, Smoke DZA.
Happy Birthday, Jahlil Beats!
Today, Feb. 8, marks the birthday of producer and songwriter, Jahlil Beats.
Happy Birthday, J. Cole!
Today, Jan. 28, marks the birthday of North Carolina MC and Dreamville Records founder, J. Cole.
Happy Birthday, Rick Ross!
Today, Jan. 28, marks the birthday of Miami rapper and record executive, Rick Ross.
Happy Birthday, Rakim!
Today, Jan. 28, marks the birthday of God MC, Rakim.
Kendrick Loses to Macklemore at 2014 Grammys - Today in Hip-Hop
On this day, Jan. 26, in hip-hop history, Macklemore & Ryan Lewis beat out Kendrick Lamar in all four competing categories at the 56th Annual Grammy Awards in 2014.
Happy Birthday, Mistah F.A.B.!
Today, Jan. 23, Marks the 37th birthday of Oakland, CA. rapper, Mistah F.A.B.
Happy Birthday, Statik Selektah!
Today, Jan. 23, marks the birthday of Massachusetts-born DJ and producer, Statik Selektah.


With most households in America owning at least one, and often two or more vehicles, finding a way to use the value of their equity to obtain needed funds can be a logical step to take. One of the most easiest methods of doing this is with a title loan. Before taking out a title loan, however, it is important for consumers to know how they work and proactive management tips to make sure the experience is a positive one.
When considering a title loan, prospective borrowers are encouraged to take the time to read over all the terms and make sure they understand each one fully. Title loans typically charge a higher interest rate than other forms of credit, so it is important to make sure you know the total cost of the loan, instead of focusing solely on the amount of each payment.
Some title loans require borrowers to also purchase added features, like roadside assistance or a vehicle warranty. When the purchase of added features is required, their cost will be added to the finance charges, which then increases the cost of borrowing. Opting for a title loan that does not require any added features will make the loan less expensive to repay.
Most title loans give borrowers an option to roll the loan over into a new loan at the end of the finance period, instead of repaying the entire amount plus interest, as originally agreed. While doing this can seem appealing to a cash-strapped borrower, it can easily lead to a situation where the amount of the interest owed is more than the amount of the original loan. To avoid this problem, it is important to always have a plan for meeting the repayment deadline before agreeing to take out the loan.
Some title loan companies require the use of ignition devices that interrupt your ability to start your car if a payment deadline is missed or you default on the loan. Some also use global positioning system (GPS) equipment so that they can locate your car, should they seek to repossess it. Since either of these options can be embarrassing or inconvenient, make sure you are informed about them before agreeing to a title loan.
Title loans can help you access immediate funds in case of an urgent need. If you are seeking this type of lending option, always make sure to contact a reputable title loan provider in your area to learn all the details.


Resume template teenager no job experience picture word luxury. Resume template teenagero job experience picture business plan for highschool students with. Resume template teenager no jobnce first examplesle.
Resume template teenager no job experience business plan picture teenagers first awesome. Resumes for teenager with no work experience inspirational 11 resume template job picture business. Resumemplateenager no job experience picture keni candlecomfortzone com business plan.
Business plan 21 inspirational resumes for teenager with no work experience resume template. Resume template teenager no job experience high school examples and writing tips picture business. Resume no experience templateer job student with business plan picture. Resumeemplateeenager no job experienceikir reitschule pegasus co picture business plan.


Published date: Wednesday April 10, 2019 .
Samsung Display has begun mass production of the foldable OLED panels going into the Galaxy Fold smartphone, the company has announced.
Samsung Electronics is expected to begin sales of its foldable smartphone globally on April 26. The 5G version of the foldable smartphone, meanwhile, is expected to be available in South Korea in May, its mobile boss said in February.
The smartphone is expected to launch earlier than its rival product, the Huawei Mate X, which is expected to go on sale sometime in June.
It will be Samsung's first commercial foldable smartphone, with the tech giant expecting to move over a million units of the device.
The foldable display will use new polymer materials that make it 50% thinner than the ones used for conventional displays.
The Galaxy Fold will be 4.6-inches in size when folded and 7.3-inches when spread out.
Samsung Display was the first to market in delivering small-sized OLED panels aimed at smartphones and is also the major supplier for its affiliate Samsung Electronics.
It also supplies its goods to Apple and Chinese vendors, which have all followed Samsung in using OLED panels for their premium smartphones.
Samsung Display was the first to produce flexible OLED panels -- rather than rigid ones -- for smartphones in 2013. The panels have since been used by the South Korean tech giant to provide an edge design and full screen for its smartphones.
Meanwhile, compatriot and archrival LG Display has fallen behind in the small-sized OLED race, but has focused on building its market share in large-sized OLEDs for TVs instead.
Samsung Electronics expects operating profits of 6.2 trillion won for the first quarter of 2019, a steep 60% drop from a year ago and the South Korean tech giant's lowest in ten quarters.
Samsung Electronics and Universal Pictures Home Entertainment will collaborate on HDR10+ content, the companies announced, as the South Korean tech giant continues to woo content producers into pushing the next-generation video standard.
The Korea Herald has reported that Samsung's 5G smartphone will launch on April 5 without pre-orders.


A lot happened today: Most importantly I met some lovely young women for brunch who have a book club and read Dogs with Bagels! It was a lot of fun! Especially the part where I asked them what other books they'd read recently and we discovered that some of them were books that absolutely haunted me.
Something else that happened today was that I realized my Escapist Solo Show on July 27th falls on a full moon, and not just any full moon, but the Buck Moon. The Buck Moon is when deer get new antlers! How fabulous is that? Especially since, if we went by the book, my spirit animal would probably be a deer (Native Americans had yet to encounter giraffes when they discovered spirit animal symbols!). So yes, this will be the perfect full moon for me. In its honor I painted a deer with a tiara. I hope it'll help everyone remember the date of my solo show!


text:
Ethics: A Patient's Right to Not Know
Ethics: A Patient's Right to Not Know.
Writing in Science, the chair of the Presidential Commission for the Study of Bioethical Issues notes it is increasingly common for physicians and medical researchers to discover a disease that was not the original target of a medical test or screening.
Amy Guttman Ph.D. notes these surprise clinical test results are called incidental and secondary findings. Guttman explains the surprise discovery of an unexpected illness from screening and similar tests is called an 'incidental' finding. Guttman adds when clinicians deliberately seek to discover a second or third disease in addition to the primary target, these results are called 'secondary' findings.
Guttman, who is the president of the University of Pennsylvania, writes (and we quote): 'Improved technologies are making incidental and secondary findings increasingly common. They are becoming a growing certainty in clinical practice as well as in the distinct contexts of research and direct-to-consumer testing' (end of quote). For example, Guttman notes an array of unexpected clinical findings may be generated by new CT scans intended to detect lung cancer in heavy smokers. The increased screening will occur because of recent recommendations from the U.S. Preventive Services Task Force, which we discussed in last week's podcast.
Guttman writes before CT scans or other medical tests, clinicians should alert patients about the possibility of surprise findings regardless whether screening deliberately seeks (or accidentally finds) new, unexpected illnesses.
http://www.jakebouma.com/i-have-hodgkin-lymphoma/
Guttman notes while some persons will ask a physician to tell them about whatever clinical tests discover, some patients do not want to learn about incidental or secondary findings.
As a result, the Presidential Bioethics Commission recommends physicians and medical practitioners need to know a patient's health priorities and tolerance to manage surprising results prior to clinical testing. Guttman writes (and we quote) 'A patient who does not wish to learn about information related to the primary purpose of the test should not undergo the test. If a patient wishes to opt out of receiving incidental or secondary findings that are clinically significant and actionable, then clinicians should exercise their discretion whether to proceed with testing' (end of quote).
Guttman notes health care providers should explain both the risks and rewards of finding unexpected illnesses that can occur from a new generation of sophisticated clinical tests, such as human genome screenings. While false positive findings are among the risks, Guttman explains the rewards include the detection of diseases and illness that could be clinically actionable.
In terms of biomedical ethics, Guttman concludes (and we quote):' In keeping with shared decision-making, clinicians live up to their highest calling when they discuss how they will handle incidental findings with their patients' (end of quote). While the Presidential Bioethics Commission provides more specific recommendations in their report, their overall intent is to improve patient-provider disclosure and communication as well as help patients anticipate the possibility of unexpected findings from routine testing.
The Commission's report is available at bioethics.gov.
Meanwhile, a link to a website that explains some of the ethical issues associated with patient and provider health decision making (from Beth Israel Medical Center) is available in the 'specific conditions' section of MedlinePlus.gov's medical ethics health topic page.
Similarly, a link to a website that explains some of the ethical issues associated with patient and provider treatment decisions (also from Beth Israel Medical Center) can be found in the 'specific conditions' section of MedlinePlus.gov's medical ethics health topic page.
MedlinePlus.gov's medical ethics health topic page also provides links to the latest pertinent journal research articles, which are available in the 'journal articles' section. You can sign up to receive updates about medical ethics as they become available on MedlinePlus.gov.
To find MedlinePlus.gov's medical ethics health topic page type 'medical ethics' in the search box on MedlinePlus.gov's home page. Then, click on 'medical ethics (National Library of Medicine).' MedlinePlus.gov additionally contains a health topic page on talking with your doctor, which provides tips to enhance provider and patient communication.
Bioethics Commission on incidental findings: Anticipate and communicate
Panel Discussions – Bioethics at Huntington Hospital and Neurological Disorders with PALAC
Improving the quality of clinical ethics consultants
March 26, 2014 Posted by Janice Flahiff | health care	| clinical test results, doctor patient relations, ethics, Incidental findings, laboratory test results, laboratory tests, medical ethics, office visits, patient rights, physician patient relations | Leave a comment
[Journal article] How Basic Scientists Help the Pharmaceutical Industry Market Drugs
Excerpt from the December 2013 PLoS article by Adriane Fugh-Berman
In the 1970s, a Baltimore city senator who also owned a tavern backed legislation that helped his business. Accused of having a conflict of interest, Joseph J. Staszak, responded, "What conflict of interest? How does this conflict with my interest?" [1].
According to the Institute of Medicine, a conflict of interest is "a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary influence" [2]. More simply, conflicts of interest may be seen as circumstances in which "individuals' professional responsibilities diverge from their personal interests (or when different professional responsibilities clash)" [3].
In biomedicine, discourse on conflicts of interest (also called competing interests) has focused on relationships between industry and physicians or clinical researchers. However, basic scientists are not immune to industry influence on research and publications, and may be important to industry in the production and dissemination of marketing messages.
Depending on Industry
In 2007, industry was the largest funder of biomedical research, paying for nearly twice as much research (58%) as the federal government (33%) [4]. Most of this funding goes to clinical research; the share of spending by pharmaceutical and device industry on preclinical research has decreased from about half (55%) in 1998 to a quarter (25%) in 2010 [5]. A 2007 survey of 3,080 academic life science researchers found that half (53%) have some form of relationship with industry [6]. Among the 1,663 research faculty at academic medical centers, 42% of basic scientists had a relationship with industry. This number was similar to health services researchers/clinical epidemiologists (40%), but less than clinical researchers (67%) translational researchers (61%), or "multimodal" researchers (71%) [7]. At the 50 universities that received the most NIH research funding, 43% of 2,167 life science researchers reported receiving a research-related gift in the late 1990s [8]. Gifts included biomaterials (24% of respondents), discretionary funds (15%), equipment (11%), travel funds to professional meetings (11%), student support (9%), and other (3%).
Researchers were aware that something was expected in return for the gift. Sponsor expectations that the gift be used for its intended purpose and not be re-gifted, and that the sponsor be acknowledged in publications, are certainly reasonable. Disturbingly, however, about a third (32%) of gift recipients reported that the funder wanted prepublication review of any articles or reports stemming from the use of the gift. This expectation was higher for gifts of biomaterials: 40% of respondents reported that the firm wanted to receive prepublication review of articles or reports. Also, 44% of firms wanted assurances that the biomaterial was not to be used for applications that competed with company products [8].
Industry Funding Affects Results
In clinical research, investigators who receive industry funding are more likely to publish results that favor a sponsor's marketing goals than are investigators who do not receive industry funding. The Cochrane Collaboration, renowned for creating and publishing high-quality systematic reviews, analyzed 48 clinical studies, systematic reviews, and meta-analyses that compared results from studies of drugs or medical devices based on sponsorship. This systematic review found that industry-sponsored studies, compared to non-industry-sponsored studies, were more likely to report favorable efficacy results for drugs or medical devices; less likely to find harms; and more likely to conclude that a therapy was beneficial [9].
Selective Publication
Selective presentations and publications are important tactics for industry. Industry relies on abstracts and posters to convey marketing messages at scientific meetings, because abstracts and posters are usually not peer-reviewed and can be easily altered up to the time of presentation. Posters and abstracts are often used for preclinical studies, case reports, or preliminary results of clinical trials. Promising preliminary results might be presented as a poster, and the results may be publicized, but if the final results of the study do not support commercial goals, the full study may never be published – or may be buried in an obscure, low-impact journal. In either case, scientists may have a positive impression of a therapy from a poster, and never learn that the therapy failed to show efficacy in the final study.
Perhaps because negative outcomes from industry-funded studies are less likely to be submitted for publication, industry-funded clinical trials overall are less likely to be published. An analysis of 546 drug trials listed in ClinicalTrials.gov found that within two years of study completion, about a third of studies that received full (32%) or partial (39%) industry support were published. In contrast, more than half (54%) of trials funded by government, and 56% of trials funded entirely through nonprofit/nonfederal funds, were published [19].
The majority of meeting abstracts and posters are never published. Posters and abstracts with positive results are far more likely to be published than negative studies [14],[15].
Once a drug is on the market, it can be prescribed "off-label" – that is, for any condition other than that for which the drug was approved. Although it is legal for physicians and other prescribers to prescribe a drug off-label, it is illegal for pharmaceutical companies to promote drugs off-label. Off-label use is common, accounting for about one in five prescriptions [23]. It is unknown how much off-label use is due to promotion.
Pharmaceutical companies use paid speakers, consultants, and researchers to promote off-label use [24].
Companies have paid billions of dollars in fines for off-label promotion, often using company-generated research, company-paid speakers, and ghostwritten articles to imply clinical benefits in the absence of clinical trials (or the presence of negative trials); fines have also been imposed for suppressing risks or misleading clinicians about risks [34].
How basic scientists help the pharmaceutical industry market drugs (medicalnewstoday.com)
'All Trials': because no test should go unheralded (nsnbc.me)
How Manipulated Clinical Evidence Could Distort Guidelines – the Case of Statins for Primary Prevention (hcrenewal.blogspot.com)
UAlberta researchers uncover why combination drug treatment ineffective in cancer clinical trials (eurekalert.org)
Drug Safety: Conditions bordering Corruption threaten Public Health (nsnbc.me)
Why combination drug treatment ineffective in cancer clinical trials (medicalnewstoday.com)
Transparency in cancer trials is vital (alltrials.net)
Monitoring the healing resources by clinical research (socialdigitalbuzz.wordpress.com)
December 8, 2013 Posted by Janice Flahiff | Biomedical Research Resources	| clinical research, clinical trials, Cochrane Collaboration, Conflict of interest, ethics, medical ethics, pharmaceutical companies, pharmaceutical research | Leave a comment
Ethics Abandoned: Medical Professionalism and Detainee Abuse in the 'War on Terror'
From the summary at Full Text Reports (November 6, 2013)
Source: Institute on Medicine as a Profession and Open Society Institute (via Harvard Law School)
the task Force has determined that actions taken by the U.s. government immediately following 9/11 included three key elements affecting the role of health professionals in detention centers:
1. The declaration that as part of a "war on terror," individuals captured and detained in Afghanistan, Pakistan, and elsewhere were "unlawful combatants" who did not qualify as prisoners of war under the geneva conventions. Additionally, the U.S. Department of Justice approved of interrogation methods recognized domestically and internationally as constituting torture or cruel, inhuman, or degrading treatment.
2. The DoD and CIA's development of internal mechanisms to direct the participation of military and intelligence-agency physicians and psychologists in abusive interrogation and breaking of hunger strikes. Although the involvement of health professionals in human rights violations against detainees progressed differently in the military and the CIA, both facilitated that involvement in similar ways, including undermining health professionals' allegiances to established principles of professional ethics and conduct through reinterpretation of those principles.
[my emphasis – Janice]
3. The secrecy surrounding detention policies that prevailed until 2004– 2005, when leaked documents began to reveal those policies. secrecy allowed the unlawful and unethical interrogation and mistreatment of detainees to proceed unfettered by established ethical principles and standards of conduct as well as societal, professional, and nongovernmental commentary and legal review.
These key elements, as well as the task Force's recommendations for remediating the participation of health professionals in detainee torture or cruel, inhuman, or degrading treatment, are summarized below and addressed in detail in the body of this report.
New report condemns US medical professionals' role in torture (counterinformation.wordpress.com)
Doctors' role in enhanced military interrogation 'clearly violates' ethics (PBS News Hour)
November 7, 2013 Posted by Janice Flahiff | health care, Psychiatry	| Central Intelligence Agency, CIA, ethics, guantanamo prisoners, medical ethics, torture, United States Department of Justice | 2 Comments
NLM Director's Comments Transcript Force Feeding Guantanamo Detainees Criticized
The NLM Director showed some courage in commenting on the force feeding of prisoners in Guantanamo.
This is indeed a health issue, because we are indeed responsible for the health (including mental health) of these detainees.
Some excerpts from the comments, full text may be found here.
A candid and stimulating editorial, recently published in the New England Journal of Medicine, strongly suggests physicians at the Guantanamo Bay detainment camp in Cuba should not force feed detainees who are on a hunger strike. The editorial's three authors argue the force feeding of some Guantanamo prisoners is medically unethical — and the practice warrants more criticism from health care professionals.
A news story about the editorial published in the U.K. Guardian reports the Guantanamo Bay camp currently houses about 166 prisoners (most of whom are held for alleged terrorist activities). Many of these detainees or prisoners have been held at Guantanamo Bay (a U.S. military base in Cuba) in an era that began with the destruction of the World Trade Center in New York City on September 11, 2001. At the time the editorial was published, the Guardian reported 104 prisoners were on a hunger strike and 43 detainees received forced feeding.
The editorial's authors (who are highly respected senior faculty at Boston University's Schools of Public Health and Medicine) write [and we quote]: 'Guantanamo is not just going to fade away, and neither is the stain on medical ethics it represents' (end of quote).
The editorial's authors explain the ethical principle to not force feed prisoners initially was advanced by the World Medical Association's Declaration of Helsinki after World War II. The authors cite the declaration that says (and we quote): 'forcible feeding (of mentally competent hunger strikers) is never ethically acceptable' (end of quote). The authors add forced feeding (and we quote): 'is a form of inhumane and degrading treatment' (end of quote).
The editorial's authors note a U.S. Department of Defense's 2006 directive on force feeding detainees says (and we quote): 'In the case of a hunger strike, attempted suicide, or other attempted serious self-harm, medical treatment or intervention may be directed without the consent of the detainee to prevent death or serious harm' (end of quote).
However, the authors explain a hunger strike is not an attempt to commit suicide. They discern the goal of the hunger strikers (and we quote): 'is not to die but to have perceived injustices addressed' (end of quote).
In addition, the authors suggest physicians abdicate their professional responsibilities to make individual and independent medical assessments when they participate in penological decisions that maintain prison order by force feeding detainees. The authors write (and we quote): 'physicians who participate in this nonmedical practice become weapons for maintaining prison order' (end of quote).
The editorial's authors also imply a sense of frustration with the dearth of criticism among physicians regarding Guantanamo's forced feeding efforts.
The authors conclude (and we quote): 'As (Guantanamo) increasingly becomes a medical ethics-free zone, we believe it's time for the medical profession to take constructive political action to try to heal the damage and ensure that civilian and military physicians follow the same medical ethics principles' (end of quote).
We should add it is rare to see such a frank and critical editorial in one of the world's leading medical journals. The editorial is a reminder of the field of medical ethics' capacity to illuminate health and social issues.
Meanwhile, a helpful overview of the legal and ethical issues in health care (provided by Merck and Co. Inc) is provided in the 'overviews' section of MedlinePlus.gov's medical ethics health topic page.
A link to information about the nutritional needs of end-of-life patients is available within the introduction of MedlinePlus.gov's medical ethics health topic page. MedlinePlus.gov's medical ethics health topic page also provides updated, comprehensive, evidence-based information about diverse healthcare ethics issues such as: genetic and prenatal testing, birth control, organ donation, and patient rights.
MedlinePlus.gov's medical ethics health topic page additionally contains links to the latest pertinent journal research articles, which are available in the 'journal articles' section. From the medical ethics health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov's medical ethics health topic page, just type 'medical ethics' in the search box at the top of MedlinePlus.gov's home page. Then, click on 'Medical ethics (National Library of Medicine).' MedlinePlus.gov also has a health topic page devoted to nutrition and health.
July 22, 2013 Posted by Janice Flahiff | health care, Psychiatry, Psychology	| Force-feeding, Guantanamo Bay, guantanamo bay detainment camp, Guantanamo Bay detention camp, guantanamo prisoners, hunger strikers, medical ethics, new england journal of medicine, World Medical Association | Leave a comment
Medical devices and shared decision-making
Medical devices and shared decision-making.
From the 18 October 2012 article at HealthNewsReview.org
The journal Arthritis Care & Research has accepted for future publication – and posted online (for subscribers) – an unedited paper, "Preceding the Procedure: Medical Devices and Shared Decision-Making." The paper builds on a hypothetical example of a man in his 50s with hip arthritis who is facing a decision about total hip replacement. Excerpts:
"(The surgeon – Dr. Jones) reviews the procedure with him and confirms that he understands his options. Then (the patient – Mr.Thomas) signs the surgical consent form. This discussion appears to include all the elements of informed consent, but several ethical questions linger beneath the surface. Dr. Jones discussed the risks and benefits of total hip replacement in some detail to help Mr. Thomas decide whether or not to have surgery, but should Mr. Thomas also have participated in the decision about the specific implant to be used?…
This article teases out the ethical issues underlying the choice of a medical device for surgical procedures, using the example of total joint arthroplasty to illustrate the interactions between surgeons and their patients. We highlight shortcomings in the current regulatory process that result in a thin evidence base on which to anchor these technical decisions, and we note the potential for decisions to be influenced by the surgeon's personal beliefs and possible conflicts of interest. We suggest that the informed consent process could be enriched with a greater focus on shared decision-making. This would include discussing the choice of implant and other technical decisions that may affect the outcome of the procedure, in addition to disclosing any relevant financial relationships. We note the challenge of providing patients with easily digestible information that helps them make decisions consistent with their own values. …
urgeons reporting "that that they typically face few institutional constraints on their choice of implants, so many are able to decide for themselves when they wish to begin using newer models."
Photo credit: dpstyles™ via Flickr
And it provides background for consideration of conflicts of interest: "The choice of implant is complicated further by the possibility for conflicts of interest stemming from the consulting fees that some orthopedists receive from device manufacturers. In 2007, the five largest manufacturers made payments to approximately 4% of the 25,000 registeredorthopedic surgeons in the United States. These payments typically involve surgeons in high volume practices and academic settings. Orthopedists who receive industry support express, on average, a greater sense of shared goals and priorities with their vendors and sales representatives than surgeons who don't."
Shared decision making leads to a better patient experience and higher levels of patient satisfaction (introcommblog.wordpress.com)
What is the Impact on Shared Decision Making of the Daily Tsunami of Health News? (engagingthepatient.com)
Addressing Health Literacy: A Variation of Perspectives (engagingthepatient.com)
October 29, 2012 Posted by Janice Flahiff | health care	| ethics, medical ethics, surgeons, surgery | Leave a comment