If you haven?t been enforcing your rule requiring absent employees to call in every day, start now. Just make sure employees know you plan to enforce it going forward.
Recent case: Amy, whose son has mental illness, was frequently absent from work. Her employer required employees to call in every day if they were going to be absent. Amy often didn?t. Then the employer started strictly enforcing the policy and eventually fired Amy for violating it.
She sued, alleging that she had really been fired because she needed FMLA leave to care for her son. She argued that because her em??ployer hadn?t fired her earlier for being a no-call, no show, it couldn?t now.
The court disagreed. It said em??ployers can begin enforcing their call-in policies at any time, even if they haven?t always before. (Riten??our v. Tennessee, No. 10-6366, 6th Cir., 2012)
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Contact: Rachel Harrison rachel.harrison@duke.edu 919-419-5069 Duke University Medical Center
DURHAM, N.C. Patients who received an implantable heart defibrillator in everyday practice had survival benefits on par with those who received the same devices in carefully controlled clinical trials, according to a new study that highlights the value of defibrillators in typical medical settings.
Led by the Duke Clinical Research Institute and published Jan. 2, 2013, in the Journal of the American Medical Association, the study used data from a large national Medicare registry to assess the survival of patients receiving defibrillators, which are commonly used to prevent sudden cardiac death.
Because clinical trial participants tend to receive more meticulous care while also being healthier than patients seen in clinical practice, the actual benefits of new drugs and medical devices can be less positive than initially reported. Not so for the defibrillators, at least when comparing patients with similar characteristics in both the clinical trials and real-world practice.
"Many people question how the results of clinical trials apply to patients in routine practice," said lead author Sana M. Al-Khatib, M.D., MHS, an electrophysiologist and member of the Duke Clinical Research Institute. "We showed that patients in real-world practice who receive a defibrillator but who are most likely not monitored at the same level provided in clinical trials have similar survival outcomes compared to patients who received a defibrillator in the clinical trials."
"This study demonstrated the real-world applicability of the results of recent randomized clinical trials," said Alice Mascette, M.D., of the NIH's National Heart, Lung, and Blood Institute.
Implantable cardioverter-defibrillators (ICDs) have been lifesavers for people with a history of cardiac arrest or heart failure. The devices, small electrical units implanted in the chest with wires that lead into the heart, send an electronic pulse when the heart stops beating to reestablish a normal rhythm.
To monitor treatment patterns, effectiveness and safety of ICDs among Medicare patients, the Centers for Medicare & Medicaid Services mandated that data on all Medicare patients receiving a primary prevention ICD be entered into a national registry. In response to this mandate, a national ICD Registry has been collecting data from hospitals performing implantations since 2005. The Duke-led research group used data from that registry to compare more than 5,300 real-world patients against more than 1,500 patients who had enrolled in two large clinical trials of ICD devices.
Al-Khatib said the patients who were included in the analysis were selected to closely resemble the patients who participated in the clinical trials, with much older and sicker patients in the registry excluded. Both groups study participants who received an ICD and ordinary recipients - had similar two-year and three-year survival rates. Ordinary recipients had better survival than patients in the clinical trial who did not receive an ICD. These findings were true for Medicare and non-Medicare patients.
By comparing similar populations, the researchers were able to address the concern that outcomes reported in clinical trials are overly optimistic because patients receive extraordinary care.
"We know from previous studies that many patients in real-world clinical settings don't receive the follow-up care that is recommended after the device is implanted," Al-Khatib said. She said doctors who participate in clinical trials also tend to be highly skilled specialists who do hundreds of the implantation surgeries, while physicians in ordinary practice may be less proficient. Studies have shown that patients have more complications when their doctors have less experience with a procedure.
Al-Khatib said the study had a limitation that could warrant additional examination. By eliminating Medicare patients who were appreciably older and sicker than those who enrolled in the clinical trials, the researchers were unable to determine how all patients seen in real-world practice compare to study participants.
"That is in an issue, and the only way to get at that is to randomly assign such patients to either receive an ICD or not in a clinical trial," Al-Khatib said. "Even without those data, however, our study gives patients and their health care providers reassurance that what we have been doing in clinical practice has been helpful, and is improving patient outcomes. Our findings support the continued use of this life saving therapy in clinical practice."
###
In addition to Al-Khatib, study authors include Anne Hellkamp, Gust H. Bardy, Stephen Hammill, W. Jackson Hall, Daniel B. Mark, Kevin J. Anstrom, Jeptha Curtis, Hussein Al-Khalidi, Lesley H. Curtis, Paul Heidenreich, Eric D. Peterson, Gillian Sanders, Nancy Clapp-Channing, Kerry L. Lee and Arthur J. Moss.
The National Heart, Lung, and Blood Institute funded the study (grant #1R01-HL093071-01A1).
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Contact: Rachel Harrison rachel.harrison@duke.edu 919-419-5069 Duke University Medical Center
DURHAM, N.C. Patients who received an implantable heart defibrillator in everyday practice had survival benefits on par with those who received the same devices in carefully controlled clinical trials, according to a new study that highlights the value of defibrillators in typical medical settings.
Led by the Duke Clinical Research Institute and published Jan. 2, 2013, in the Journal of the American Medical Association, the study used data from a large national Medicare registry to assess the survival of patients receiving defibrillators, which are commonly used to prevent sudden cardiac death.
Because clinical trial participants tend to receive more meticulous care while also being healthier than patients seen in clinical practice, the actual benefits of new drugs and medical devices can be less positive than initially reported. Not so for the defibrillators, at least when comparing patients with similar characteristics in both the clinical trials and real-world practice.
"Many people question how the results of clinical trials apply to patients in routine practice," said lead author Sana M. Al-Khatib, M.D., MHS, an electrophysiologist and member of the Duke Clinical Research Institute. "We showed that patients in real-world practice who receive a defibrillator but who are most likely not monitored at the same level provided in clinical trials have similar survival outcomes compared to patients who received a defibrillator in the clinical trials."
"This study demonstrated the real-world applicability of the results of recent randomized clinical trials," said Alice Mascette, M.D., of the NIH's National Heart, Lung, and Blood Institute.
Implantable cardioverter-defibrillators (ICDs) have been lifesavers for people with a history of cardiac arrest or heart failure. The devices, small electrical units implanted in the chest with wires that lead into the heart, send an electronic pulse when the heart stops beating to reestablish a normal rhythm.
To monitor treatment patterns, effectiveness and safety of ICDs among Medicare patients, the Centers for Medicare & Medicaid Services mandated that data on all Medicare patients receiving a primary prevention ICD be entered into a national registry. In response to this mandate, a national ICD Registry has been collecting data from hospitals performing implantations since 2005. The Duke-led research group used data from that registry to compare more than 5,300 real-world patients against more than 1,500 patients who had enrolled in two large clinical trials of ICD devices.
Al-Khatib said the patients who were included in the analysis were selected to closely resemble the patients who participated in the clinical trials, with much older and sicker patients in the registry excluded. Both groups study participants who received an ICD and ordinary recipients - had similar two-year and three-year survival rates. Ordinary recipients had better survival than patients in the clinical trial who did not receive an ICD. These findings were true for Medicare and non-Medicare patients.
By comparing similar populations, the researchers were able to address the concern that outcomes reported in clinical trials are overly optimistic because patients receive extraordinary care.
"We know from previous studies that many patients in real-world clinical settings don't receive the follow-up care that is recommended after the device is implanted," Al-Khatib said. She said doctors who participate in clinical trials also tend to be highly skilled specialists who do hundreds of the implantation surgeries, while physicians in ordinary practice may be less proficient. Studies have shown that patients have more complications when their doctors have less experience with a procedure.
Al-Khatib said the study had a limitation that could warrant additional examination. By eliminating Medicare patients who were appreciably older and sicker than those who enrolled in the clinical trials, the researchers were unable to determine how all patients seen in real-world practice compare to study participants.
"That is in an issue, and the only way to get at that is to randomly assign such patients to either receive an ICD or not in a clinical trial," Al-Khatib said. "Even without those data, however, our study gives patients and their health care providers reassurance that what we have been doing in clinical practice has been helpful, and is improving patient outcomes. Our findings support the continued use of this life saving therapy in clinical practice."
###
In addition to Al-Khatib, study authors include Anne Hellkamp, Gust H. Bardy, Stephen Hammill, W. Jackson Hall, Daniel B. Mark, Kevin J. Anstrom, Jeptha Curtis, Hussein Al-Khalidi, Lesley H. Curtis, Paul Heidenreich, Eric D. Peterson, Gillian Sanders, Nancy Clapp-Channing, Kerry L. Lee and Arthur J. Moss.
The National Heart, Lung, and Blood Institute funded the study (grant #1R01-HL093071-01A1).
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
I went to a conference a few years ago that set me on the path to publication. It wasn't for writers, but the message was on how our dreams are better accomplished in community with other people. When the speaker specifically mentioned the profession of writing, I felt like she was talking to me. She convinced me to seek a team of private and professional supporters.
Why does a writer need a team? They don't unless they plan to publish. This was the other half of her message: Communities benefits when people share their passions. There is no project too big or too small to share with others. This encouraged me to publish. If even one child enjoys my books, then I have enriched another person's life and, to me, that qualifies as success.
After years of writing stories in isolation, I "came out" and let it be known to everyone, not just my closest friends, that I write stories. I pulled The Pet Washer off my hard drive, invited some friends to be beta readers, asked an artist to draw the cover, joined online writer forums, opened accounts at Createspace, Smashwords and the like, and I published my first book. Listening to children talk happily about The Pet Washer fulfills me and thrills me as much as I thought I would. I have my team to thank for how far I've come since I attended that conference.
I want to encourage all writers to build their own teams in the New Year. Writing is not a solitary profession. I didn't think I needed anybody, but I was wrong. My team has improved me, supported me, and invested in me. They enjoy my successes and feel my failures with me. I might do the typing alone, but I am not alone.
Whether you are self-publishing or seeking a traditional publisher, your team will improve your chances of success--if you are traditionally published then some of the following team members are provided for you.
A Writer's Team
Beta readers--the first readers of your novel before publication. Look for people who are avid readers in your genre. If you write science fiction, don't ask your friend who only reads romance novels to read your manuscript.
Professional editor--if you don't know a professional book editor, hire one. An editor finds all the errors and inconsistencies you can't see in our own work, and trust me--they are there! I didn't understand my need for an editor until I worked with one. It was a humbling experience. In the future, I will never publish without one. Ideally, find an editor who works in the genre you write.
Professional Book Cover--if you have the mad skills to make your own, go for it. Otherwise, hire someone! Make sure your cover looks good as a thumbnail image.
Publishing Partner--You don't have to pay to publish an ebook or a print-on-demand book. I used Createspace for my paperback and KDP and Smashwords for my ebook.
Interior Book Design--this is a vital component to publishing a paperback. It's a step that can't be skipped so if you don't have the computer skills to pull it off, hire someone. I couldn't afford a professional design program or a designer, but I found I could do a very good job using Word and getting input from others.
Publicist--they are expensive so I am my own publicist. To get ideas, I read articles online and visit indie forums. I will admit that when I first published The Pet Washer I believed it would sell itself. I was wrong! Books need to be marketed and even with a traditional publisher, authors are expected to help with this. Marketing for me includes book signings, speaking in public, garnering reviews, writing press releases, doing interviews, submitting guest posts, hosting giveaways and contests, creating swag, and relating with fans.
Distributors--my publishing partners are distributors, but only online. To get my book into stores I have to leave my house. I make appointments with store owners, provide consignment contracts, provide inventory and handle re-orders. The people who agree to stock my books become part of my team.?
Fans--I welcome my fans onto my team. I invest them in my career with giveaways, personal attention to their emails, thanking them, providing quizzes and trivia for them, visiting book clubs and schools, and asking them their opinions. The more involved they are, the more my success is also their success. This establishes mutual loyalty.
No book is too small to deserve a team. Once I opened up my writing to others, I discovered a village of people who enjoy helping authors. Most of them don't write themselves, but they love books. Their skills and passions take over where mine end. My supporters include librarians, graphic designers, readers, professional marketers, fellow writers, editors, artists, shop owners, and children to name a few. My writing career is supported by a village and this brings me great comfort, accountability, fun, companionship, and hope.
I'm wishing you great success in the New Year and I hope, in some small way, you consider me part of your team!
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WASHINGTON (AP) ? Congress has drastically trimmed the budget for U.S. spies and satellites for 2013, though not quite as deeply as the White House wanted.
In one of the last votes of the year, House lawmakers voted Monday 373-29 in favor of a Senate-passed bill to slightly boost the president's $72 billion budget request for intelligence agencies including the CIA, adding extra cash for the counterterrorism fight against al-Qaida, and the counterintelligence fight against foreign governments trying to spy on the U.S.
That's down sharply from roughly $80 billion in 2012, which marked the peak of intelligence spending since the attacks of Sept. 11, 2001.
"The bill holds personnel levels, one of the biggest cost drivers, generally at last year's levels," said House Intelligence Committee Chairman Mike Rogers, R-Mich. "Even so, the bill adds a limited number of new personnel positions for select, high-priority positions, such as FBI surveillance officers to keep watch on terrorists."
The House Intelligence Committee's ranking member, Rep. Dutch Ruppersberger, D-Md., said the bill "invests in personnel and programs that are working and cuts things that aren't."
The bill was stripped of several measures meant to block the leaking of classified information, including a provision that would have limited which government officials could brief journalists on intelligence. The measures had been drafted after lawmakers objected to a series of news stories that anonymously quoted senior administration sources describing sensitive intelligence programs, such as the process by which targets are chosen for lethal drone strikes overseas.
The chair of the Senate Intelligence Committee, Dianne Feinstein, D-Calif., says the measures were taken out to get the bill passed but that the issue remains a problem.
"Unfortunately, I am certain that damaging leaks of classified information will continue, and so the committee will need to continue to look for acceptable ways to address this problem," Feinstein said Friday after the Senate version of the bill passed.
The legislation, if signed into law by President Barack Obama, will require the White House to inform Congress when it decides to share classified information with reporters, giving lawmakers a heads-up before they read about it in the media.
___
Dozier can be followed on Twitter (at)kimberlydozier.
How much would you actually find out about Florida auto insurance? A great deal of people can invariably use more knowledge about Florida car insurance because it is a subject that affects us all. Research is definitely a fantastic key in locating the insurance company and policy that?s suitable for you. With so many kinds of automobile insurance out there, people can easily become confused about what type of coverage they require and which companies to select overall car insurance in Sneads Florida. Auto insurance policies represent a significant expense to most drivers, and therefore it is essential to comprehend exactly how they work. There can be so much to consider also to choose from. This article can enable you to know very well what your Florida car insurance policy provides for you. Auto insurance is planning to be one of the largest and most financially demanding options you need to decide upon. Auto insurance policies represent a substantial expense to most drivers, and therefore it is important to understand exactly how they work.
As you?ve seen, Florida auto insurance policies, while various, share many fundamentals. Having the best website inside the business does not always mean a company gets the best insurance inside the business. Having an even more experienced driver on your own plan can lower your premiums. This leaves a negative mark on your record and can lead to higher rates in the future auto insurance policies policy queries and facts. When it comes down time and energy to cancel your existing Florida auto insurance policy, be sure you comprehend the carrier?s cancellation policy. Find out how much your car will probably be worth and calculate what you pay every year to insure it. If you do not commute very often, this could help get a cheaper rate.
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A great deal of people have speeding and parking tickets that they?re not even aware of until they attempt to have a new Florida car insurance policy. In all cases, if you are between renewal dates, ensure you comprehend the carrier?s practice on premium?s owed. As with any insurance policy, the higher the deductible, the low the premiums. By taking this test, car insurance firms will note that you have gone the extra mile in order being a safe driver and is planning to be not as likely to get into an accident. In this case, you could even want to reconsider your new car purchase because full coverage is significantly higher priced than liability alone.
In conclusion, Florida auto insurance is helpful for drivers, because it provides protections for drivers in accidents. The point is, take your time and calculate your costs carefully. By heeding the recommendation and the knowledge contained within this article, you can make informed decisions about Florida auto insurance. This article has compiled some of the best information available. Hopefully you?ll stretch your budget inside the process!.
A father of an aid worker, who was killed by gunmen, mourns the death of his daughter at a hospital in Swabi, Pakistan, Tuesday, Jan. 1, 2013. Gunmen in northwest Pakistan killed at least five female teachers and two aid workers on Tuesday in an ambush on a van carrying workers home from their jobs at a community center, officials said. (AP Photo/Mohammad Sajjad)
A father of an aid worker, who was killed by gunmen, mourns the death of his daughter at a hospital in Swabi, Pakistan, Tuesday, Jan. 1, 2013. Gunmen in northwest Pakistan killed at least five female teachers and two aid workers on Tuesday in an ambush on a van carrying workers home from their jobs at a community center, officials said. (AP Photo/Mohammad Sajjad)
A Pakistani driver who survived an attack on a van which was targeted by gunmen in Swabi , lies at the Lady Reading Hospital bed after being admitted for treatment, in Peshawar, Pakistan, Tuesday, Jan. 1, 2013. Gunmen killed several female teachers and two other people on Tuesday in an ambush on a van carrying workers home from their jobs at a community center in northwest Pakistan, officials said. The attack was a reminder of the risks faced by educators and aid workers, especially women, in an area where Islamic militants often target women and girls trying to get an education or female teachers working with both genders. (AP Photo/Mohammad Sajjad)
A Pakistani police officer, left, talks on the radio while cameramen flim the site of a blast in Karachi, Pakistan, Tuesday, Jan. 1, 2013. At least 30 people were injured when a bomb went off in the port city of Karachi just as a large political rally was dispersing. A Senior police officer said the bomb was planted in a motorcycle parked amid a crowd of buses for political workers returning from the rally held by the Muttahida Qaumi Movement, the dominant political party in Karachi. (AP Photo/Shakil Adil)
A Pakistani policeman stands next to the body of an aid worker, who was killed by gunmen, at a hospital in Swabi, Pakistan, Tuesday, Jan. 1, 2013. Gunmen in northwest Pakistan killed at least five female teachers and two aid workers on Tuesday in an ambush on a van carrying workers home from their jobs at a community center, officials said. (AP Photo/Mohammad Sajjad)
Pakistani men carry the body of a teacher, who was killed by gunmen, from a hospital for burial in Swabi, Pakistan, Tuesday, Jan. 1, 2013. Gunmen in northwest Pakistan killed five female teachers and two aid workers on Tuesday in an ambush on a van carrying workers home from their jobs at a community center, officials said. (AP Photo/Mohammad Sajjad)
PESHAWAR, Pakistan (AP) ? Gunmen in northwest Pakistan killed five teachers and two aid workers from a non-governmental organization Tuesday as they were driving home from work. The group's director said they may have been targeted for their anti-polio work.
Militants in the past have accused health workers of acting as spies for the U.S., alleging the vaccine is intended to make Muslim children sterile. Last month, nine people working on an anti-polio vaccination campaign were shot and killed. Four of those shootings were in the northwest where Tuesday's attack took place.
The attack was another reminder of the risks to women educators and aid workers from Islamic militants who oppose their work. It was in the same conservative province where militants shot and seriously wounded 15-year-old Malala Yousufzai, an outspoken young activist for girls' education, in October.
There was no immediate claim of responsibility for the latest shootings.
In a separate attack in the southern city of Karachi, also likely to have been carried out by militants, four people were killed and dozens injured when a bomb went off just as a large political rally was dispersing.
The teachers and aid workers in the northwest were killed in Khyber Pakhtunkhwa province on their way home from a community center where they worked at a medical clinic and primary school.
The director of the group targeted Tuesday said he suspected that the workers were attacked because the non-governmental organization has been active in vaccination campaigns designed to wipe out polio.
Javed Akhtar, from Support With Working Solutions, said the clinic where the aid workers worked had helped vaccinate children, and many of the NGO's staff had taken part in vaccination campaigns.
That attack was in an area where Islamic militants often target women and girls trying to get an education or female teachers.
Militants in the province have blown up schools and killed female educators. They have also kidnapped and killed aid workers, viewing them as promoting a foreign agenda.
Khyber Pakhtunkhwa province, formerly called the Northwest Frontier province, borders the tribal areas of Pakistan along the frontier with Afghanistan to the west. Militant groups such as the Taliban have used the tribal areas as a stronghold from which to wage war both in Afghanistan and against the Pakistani government. Often that violence has spilled over into the mostly Pashtun province of Khyber Pakhtunkhwa.
In 2007, the Taliban led by Maulana Fazlullah took over the scenic Swat Valley, marking the height of their strength there. The Pakistani military later pushed the militant group from the valley but the Taliban has repeatedly tried to reassert itself.
The teachers were killed along with two health workers, one man and one woman. Their driver was wounded. They were on their way home from a community center in the town of Swabi where they were working at a primary school for girls and adjoining medical center.
The injured driver told investigators that the gunmen stopped the vehicle and removed a boy ? the son of one of the women ? before indiscriminately opening fire, said police officer Fazal Malik.
Swabi police chief Abdur Rasheed said most of the women killed were between the ages of 20 and 22. He said four gunmen who used two motorcycles fled the scene and have not been apprehended.
The gunmen on motorcycles opened fire with automatic weapons, said Akhtar. The NGO conducts programs in the education and health sectors and runs the community center in Swabi, he said. The group has been active in the city since 1992, and started the Ujala Community Welfare Center in 2010, he added. Ujala means "light" in Urdu.
The center is financed by the Pakistani government's Poverty Alleviation Program and a German organization, said Akhtar.
He said the NGO also runs health and education projects in the South Waziristan tribal area, as well as health projects in the cities of Tank and Dera Ismail Khan and the regions of Lower Dir and Upper Kurram. All of those cities and regions are in northwest Pakistan, the area that has been most affected by the ongoing fight with militants opposed to the current government.
Aid groups such as Support With Working Solutions often provide a vital role in many areas of Pakistan where the government has been unable to provide services such as medical clinics or schools. In some areas like the northwest, they have had to work to overcome community fears that they are promoting a foreign agenda at odds with local traditions and values.
But many local residents in Swabi said the school and medical center provided a vital service to the community and mourned those who were killed.
Murad Khan said his daughter was studying at the primary school, which provided free books and uniforms to students. He said many people in the area are now worried that the school and clinic will close.
"This school is like a gift for all of us, the poor people of the village," he said. "People in our area are sad."
The NGO director said he has directed staff at all projects to stop working for the time being until security measures are reviewed but vowed that they would resume their work soon.
He said that the NGO had not received any threats before the attack.
In Karachi, senior police officer Asif Ejaz Shaikh said the bomb that killed four was planted in a motorcycle parked amid a crowd of buses for political workers returning from the rally held by the Muttahida Qaumi Movement. The MQM is the dominant political party in Karachi.
There was no immediate claim of responsibility for the attack.
The provincial health minister Dr. Saghir Ahmed said four people were killed and 41 injured.
__
Associated Press writers Zarar Khan in Islamabad and Adil Jawad in Karachi contributed to this report.
Foursquare is changing its privacy policy so that all users will have to share their full name on the location-based social network. Some users already do, but others go by a first name with last name initial. That's going to end, starting Jan. 28.
The change was announced in an email sent to users. Foursquare also said in the same email that businesses using the social network, now limited to seeing customers who have checked in in the last three hours, will be able to ?have more time to review those logs.
"This is great for helping store owners identify their customers and give them more personal service or offers," Foursquare said in the?email. "But a lot of businesses only have time to log in at the end of the day to look at it. So, with this change, we?re going to be showing them more of those recent check-ins, instead of just three hours worth."
Foursquare notes, that, "as?always, if you?d prefer not to permit businesses to see when you check into their locations going forward, you can uncheck the box under ?Location Information? at?https://foursquare.com/settings/privacy."
The extra-diplomatic tone of the email likely was shaped by the recent?Instagram debacle over user privacy.
Foursquare, which says it has more than 25 million users worldwide now, with more than 3 billion check-ins, noted in the email that users who want to know more about the social network's privacy policy can find those details and others in its "Privacy 101" document online.
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Public release date: 1-Jan-2013
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