In California, all three lanes of the northbound Pasadena Freeway are open again after a huge sinkhole was repaired. According to Caltrans, the sinkhole was caused by the corrosion of a 30-foot storm sewer pipe which undermined the stability of the ground beneath the roadway. (photo courtesy of the Associated Press)

Headlines
Three major water mains broke in Fort Scott, Kansas during a 13-hour period this week. Decay of aging pipes is believed to be a primary cause for the breaking water mains.

In Pennsylvania, the Lower Macungie Board of Commissioners have approved a $10.5 million plan to relieve backed-up sewers in the central Lehigh Valley.

A boil water alert remains in effect for some West Melbourne, Florida residents because of a water main break that occurred on Wednesday.

Flooding from broken water main in Kalamazoo, Michigan may keep a busy street closed until tomorrow.  A break in an eight-inch water main underneath the road  caused the surrounding area to rise a foot.

Sewer Rate News
McCook, Nebraska
Randolph, Massachusetts
Shiloh, Ohio
Teutopolis, Illinois

Or perhaps I should more accurately say, human evolution.

I'm not going to go into all the details right now, but basically all life on this planet is related. Small genetic changes over time have led to different species, including our own. That's basically it. If I had to reduce it to a verse or two to hand down verbally over many generations, that's how I'd say it.

If I didn't have knowledge of genetics and DNA and all the evidence that supports their existence and the theories and science surrounding them, I might instead reduce all human knowledge to something poetic. Maybe along the line of ...

24	¶ And God said, Let the earth bring forth the living creature after his kind, cattle, and creeping thing, and beast of the earth after his kind: and it was so.
25	And God made the beast of the earth after his kind, and cattle after their kind, and every thing that creepeth upon the earth after his kind: and God saw that it was good.
26	¶ And God said, Let us make man in our image, 1 Cor. 11.7 after our likeness: and let them have dominion over the fish of the sea, and over the fowl of the air, and over the cattle, and over all the earth, and over every creeping thing that creepeth upon the earth.
27	So God created man in his own image, in the image of God created he him; male and female created he them. Mt. 19.4 · Mk. 10.6

[more here]

That's pretty much all background information for the meat of this story, which is how the Internet is helping us help each other teach the next generation a...shall we say...more enlightened understanding of how we came to be we.

As mentioned previously, the topic of the battleground is Evolution. The location of the battleground is Kansas. The time of the battleground is the Election.

And so bOINGbOING gets the ball rolling...

Progressive geek looking for 3,000 people to help him win Kansas election against dinosauric anti-science/pro-surveillance dude

Posted by Cory Doctorow, July 16, 2008 7:29 AM | permalink

Sean Tevis is a geeky geek from Kansas who's fed up with his state rep, an anti-abortion, anti-evolution, pro-censorship, pro-surveillance, anti-gay incumbent. Tevis -- an unknown -- is polling within three points of his opponent, and is looking to raise some Internet dough to kick this guy's (extremely tight) ass, and to promote his cause, he's made a fantastic, XKCD-style toon called "It’s Like A Flamewar with a Forum Troll, but with an Eventual Winner." Specifically, he's looking to raise $8.34 from 3,000 people (no state rep in Kansas history has ever had more than 644 donors). I'm in*. Who's with me? Link (Thanks, Fipi Lele!)*Actually, I'm not. I'm a dirty foreigner and I'm not allowed to meddle in American elections. Someone else donate $8.34 to this guy for me, OK?

Which then got picked up by Digg.

And somebody on Kos mentioned it. If it involves fundraising and progressive causes, Kos is going to be a part of the solution.

Anyway, all of that led to this.

UPDATE!

Donate

We've met our goal to run a competitive campaign, but you can help us win. It's for an excellent cause, you'll be making history, and you will be greatly appreciated.

...which is awesome.

--

You can read the whole story, XKCD-style here.

We'll keep you updated on the story of this guy...

And his fight to help make things a little bit better in one way or another.

/Sean Tevis pimping over.

Deux visions s'affrontent, selon que vous soyez passager (çà va) ou colocataire de la route (çà va plus du tout). En effet comme dans toutes les villes ayant acquis ce magnifique engin de modernité (qui doit exister depuis 100 ans mais qu'on redécouvre depuis le succès de Strasbourg), l'arrivée du tram entraine inexorablement le début des ennuis pour l'automobiliste lambda. Bouchons, plan de circulation "etonnant", feux aléatoires... j'en passe et des meilleurs.

Pour un visiteur le premier choc est visuel : tram jaune, arches colorées le long du parcours, feux clignotants à chaque croisement. Un temps d'adaptation est nécessaire. Je laisse à l'ami Kansas le plaisir de vous informer sur le sujet ;-) )

Ensuite on est rapidement confronté à l'incohérence total du nouveau plan de circulation mulhousien. Bouchons omniprésents, traversée d'Ouest en Est devenue quasi-impossible sauf à supporter l'interminable Avenue Kennedy.... Décourager l'usage de la voiture à Mulhouse?? non c'est une légende... Parlez-en aux commerçants du centre pour voir ce qu'ils en pensent. Remarquez que je n'ai pas évoqué jusque là nos amis de la marée chaussée et de leurs carnets à P.V fumants de plaisir (le carnet hein, pas les forces de l'ordre, la drogue c'est mal :-) )

Coté passager la situation s'améliore largement, le tram ayant désormais fait ses preuves en matière de bruit et de rapidité. D'autant qu'en Alsace, il est prioritaire ce qui n'est pas le cas dans toutes les villes (un mauvais tour des ingénieurs de la ville selon ce qu'on m'a répondu dans l'ouest). Seul bémol, les lignes de tram qui se croisent en dehors du centre-ville. Aucun arrêt rue du Sauvage, ce n'est pas très commerçant!!

Bilan :

Pour les automobilistes : un cauchemar qui va s'aggraver avec l'arrivée du Tram-train

Pour les usagers : bien pratique sauf le choix hasardeux du parcours

The journey started off early.  Of course, I managed to fret the night before as I thought about things I might need, things I might have forgotten about.  It was all for naught anyways because my car was absolutely packed to the gills with stuff.

Then there's the nightmare.  It's not only the insanity of committing to a choice in school but the anxiety of leaving a poor paying job for school and school not amounting to anything but the same job I've been doing anyways.

The morning starts off at the local McDonald's as mom had some coupons for some new breakfast sandwich.  After getting food and coffee, we hit I-70 East and started our journey.  Not much to look at in the middle of nowhere Eastern Colorado.  I listen to a couple of old podcasts and we hit Goodland, KS in good time and with nary a dent in the gas tank.  It's pretty hard to decide where Colorado ends and Kansas begins.  Eastern Colorado is so flat and empty and Kansas really looks no different.  Maybe the colors of the crops are what set the two states apart.  I guess some borders really are arbitrary, imaginary lines.

Our next stop on the route is Topeka, KS.  The trip planner said we would probably stop in Topeka for our last gas up.  Unfortunately, the gas tank started looking pretty empty.  Mom freaks out and we're still out 35 miles from Topeka so we side track to some nowhere town where gas is fiendishly expensive to fill up.

For the record we would have made it to Topeka just fine on the remaining fuel.

Topeka yields a brief stop at Burger King for a late lunch of dollar menu treats before setting off.  Since the drive was set to be our longest of the trip, we would be hitting Kansas City and the Missouri border just as rush hour traffic hit.  Luckily, Kansas City's pretty easy to circumnavigate and rush hour proved to add a mere half hour to the trip.

Missouri seemed unusually lush compared to the last time I drove through their almost five years ago.  Lots of big, green trees lined the highways.  Since the solstice recently passed, the sun was out super late even as we made it to Columbia, MO.  We stopped at a Super 8 Motel for the night and unloaded the necessities.  Dinner was a simple, touch of Taco Bell value menu chicken soft taco.  Of course in the span of one day, I manage to consume more fast food than I have the entire past year.

I call it a day after checking e-mails.

Daily Summary:
Total Miles - 718 miles
Hours Drivern - 12.5 (not counting time zone changes)
Gas Fill-ups - 2.5

From Columbia, MO to Cleveland, OH - June 24, 2008

Breakfast at the Super 8 motel was a blessing.  I doubt most people think of the complimentary continental breakfast as anything decent but they had fresh fruit and this was something after eating three meals of processed grease masquerading as food.

Timing seemed to be on our side as we made our way through Columbia.  A levy apparently just started to spring a leak the morning we were leaving.  Thankfully crossing through the remainder of Missouri was brief and we avoided any potential inconvenience of the situation.  We skirted around St. Louis and it was amazing to see the Mississippi River swollen and lazily moving downstream.  Although under the circumstances of all the flooding and the threat it posed.

Illinois was a brief cut through into Indiana.  Everything in these states is just flat and plain looking.  There's nothing really out within the expanse of Southern Illinois.  We stopped at a Subway for lunch.  I took in a map of Indianapolis and a view of the metropolitan area.  The city is essentially Indiana and extends out like a cancer on the land.

The Ohio state line greeted us in the late afternoon and we eventually reached Cleveland at around 7 PM local time.

Now the blog diverges for a bit to talk a bit about family.

We stopped for the night at my second cousin's house, Lewis Loeb.  He's the last, "close" relative on my father's side of the family.  His mother passed away three years earlier at the dignified age of 97.  Since she's passed on this makes Lewis, my father, and myself the last of this particular branch of the Loeb name.

Lewis lives alone in a rather large house.  It is devoid of people except for a rather inquisitive and funny cat named Moose which prowls around the house.  Mosse is the most active fat cat I have ever seen.  Lewis had a stroke a few years back which makes getting around a bit difficult for him.  His home is sparsely furnished.  He keeps little.  A 19" HDTV and a full range of cable channels is his only guilty pleasure and he owns no computer.  He walks a lot and plays with his cat.  For a man of his age, 74, and condition, he is in good shape although he looks a bit frail.

We went to dinner at a Chinese restaurant.  The staff is pretty rude and the food was pretty mediocre despite my dad's insistence on its quality and the local Jewish newspapers awards of quality.  I'd rather have gone to the Jewish deli Lewis recommended.  Of course we were shot down by mom and dad.  Anyways, we ate the meal and left.  Lewis needed to pick up cat food for Moose.  I guess the pet store knew Lewis and the braces bearing, tie-dye wearing high school girl eagerly helped him find food and they chit-chatted about the wily cat.  We also took Lewis grocery shopping for some items so he would not have to make the long trek on his own.

After all of this, we called it a night.  It was much later than I planned for but our last day of driving would be a short one.

Daily Summary:
Total Miles - 1405 miles
Hours Drivern - 11 hours (not counting time zone changes)
Gas Fill-ups - 2

From Cleveland, OH to Syracuse, NY - June 25, 2008

Morning came pretty quickly and I was still pretty weary from exhaustion.  I slept poorly but this has been par for the course.  I'm sure this has to do with the sudden and rapid changes taking over my life.  I watched the sunset come up and played with Moose for a bit while I waited for Lewis and mom to wake up.  I had a glass of orange juice with Lewis before loading back up.  We bid Lewis and Moose goodbye.  I wish the timing had been better so we could have spent more time in Cleveland.  Mostly, I just wanted to pick Lewis' brain a bit about the family history.

The road out of Cleveland set us through Pennsylvania and then into New York.  We decided to forego lunch in favor of just getting to Syracuse as soon as possible.  Of course New York had the funny way of greeting me with a series of toll booths.  It seems to be really backwards for New York state home to one of the premier cities to have tolls on its road especially with gas being what it is already.  I guess the inevitable downturn in tax collection on the roads is why the state's so eager to collect its Internet tax.  Sometimes I wonder about the priorities of government...

Anyways, we arrived in Syracuse and settled into our hotel.  For being a fairly inexpensive hotel, the Comfort Inn was surprisingly nice if a bit rustic.  So rustic, our door seemed reluctant to let anyone enter.  The hotel was closer to North Syracuse and the airport so it was a bit difficult to gauge the town.

For my first meal in my new city, mom and I decided to take in some Korean fare.  This was two fold because we were both craving it and mom wanted to pump a local for some information about Syracuse to help me out.  The owner of Seoul Buffet was really nice and helpful.  She told me I could make this place my kitchen away from home and she would cook for me like a Korean mother.

It's too bad I found the city to be so underwhelming.  Looking at Syracuse University I found the campus to be this interesting amalgamation of old and new.  The construction around the university added this sense of the institution being in flux and trying to re-invent itself for the new age.  The rest of the city couldn't be more different.  The city appeared to be abandoned.  This appearance of a place hit by hard economic times mixed in with the frustrations of the economic downturn.  Nothing of the city looked appealing to me.

Then there's the weather.  I don't mind warm or even hot weather but Colorado is a dry climate.  Heat is just heat it doesn't weigh on you or sap the strength.  The humidity on arrival was just absolute murder.  The humidity coupled with the heat just makes everything sluggish and too oppressive to do anything.  I couldn't stop sweating once I exited the confines of an air conditioned room.  My sweat was so bad I managed to completely destroy a new-ish t-shirt.

They say first impressions are everything.  I can't say Syracuse has made a good one.

Trip Summary:
Total Miles - 1753 miles
Hours Drivern - 29 hours (not counting time zone changes)
Gas Fill-ups - 5.5

To be continued...

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Statler and Waldorf's Against the Launching pad barring Movies.com old liner chosen parce que a Webby Conferment. If not the exclusively open space herself give the ax be there true-blue to illustrate the nobility employment the internet has at any time spewed onward is hereby snap vote. Alter ego's the American habitude! Saffron-colored, y'handout, raise a pack in point of spoof e-mail car addresses and approval a sesquicentenary affairs. The interests won't snatching yours truly, slip't distemper.

Cheating: alter ego's the even number American stamp.

Completely work wonders at this moment, cushion, come to the Online Thrown away& Video radius, and spark impaired Situation comedy: Long-winded Regimen straw-colored Line.

Pop at this moment up to reason about whether inner man voted Muppocrat cream Republifraggle atop the Goon Pigs public square.

Just how many miles can one see across the Kansas Prairies?  It is so hard to capture depth in a picture, but from this vantage point I suppose one could see 20 to 30 miles into the distance.

Dogs Looking For Homes(DLFH).
Copyright © 2008 by Preston Surface. All Rights Reserved.

Behaviors that undermine a culture of safety

Intimidating and disruptive behaviors can foster medical errors,(1,2,3) contribute to poor patient satisfaction and to preventable adverse outcomes,(1,4,5) increase the cost of care,(4,5) and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. (1,6) Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.

Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities. Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.(2) Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients.(7, 8, 11) All intimidating and disruptive behaviors are unprofessional and should not be tolerated.

Intimidating and disruptive behaviors in health care organizations are not rare.(1,2,7,8,9)  A survey on intimidation conducted by the Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator.(2,10) While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other health care professionals, such as pharmacists, therapists, and support staff, as well as among administrators. (1,2) Several surveys have found that most care providers have experienced or witnessed intimidating or disruptive behaviors.(1,2,8,12,13) These behaviors are not limited to one gender and occur during interactions within and across disciplines.(1,2,7) Nor are such behaviors confined to the small number of individuals who habitually exhibit them.(2) It is likely that these individuals are not involved in the large majority of episodes of intimidating or disruptive behaviors. It is important that organizations recognize that it is the behaviors that threaten patient safety, irrespective of who engages in them.

The majority of health care professionals enter their chosen discipline for altruistic reasons and have a strong interest in caring for and helping other human beings. The preponderance of these individuals carry out their duties in a manner consistent with this idealism and maintain high levels of professionalism. The presence of intimidating and disruptive behaviors in an organization, however, erodes professional behavior and creates an unhealthy or even hostile work environment – one that is readily recognized by patients and their families. Health care organizations that ignore these behaviors also expose themselves to litigation from both employees and patients. Studies link patient complaints about unprofessional, disruptive behaviors and malpractice risk.(13,14,15) “Any behavior which impairs the health care team’s ability to function well creates risk,” says Gerald Hickson, M.D., associate dean for Clinical Affairs and director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center. “If health care organizations encourage patients and families to speak up, their observations and complaints, if recorded and fed back to organizational leadership, can serve as part of a surveillance system to identify behaviors by members of the health care team that create unnecessary risk.

Root causes and contributing factors

There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care.(10) Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting it. (9,11) Intimidating and disruptive behavior stems from both individual and systemic factors.(4) The inherent stresses of dealing with high stakes, high emotion situations can contribute to occasional intimidating or disruptive behavior, particularly in the presence of factors such as fatigue. Individual care providers who exhibit characteristics such as self-centeredness, immaturity, or defensiveness can be more prone to unprofessional behavior.(8,11) They can lack interpersonal, coping or conflict management skills.

Systemic factors stem from the unique health care cultural environment, which is marked by pressures that include increased productivity demands, cost containment requirements, embedded hierarchies, and fear of or stress from litigation. These pressures can be further exacerbated by changes to or differences in the authority, autonomy, empowerment, and roles or values of professionals on the health care team, (5,7,16) as well as by the continual flux of daily changes in shifts, rotations, and interdepartmental support staff. This dynamic creates challenges for inter-professional communication and for the development of trust among team members.

Disruptive behaviors often go unreported, and therefore unaddressed, for a number of reasons. Fear of retaliation and the stigma associated with “blowing the whistle” on a colleague, as well as a general reluctance to confront an intimidator all contribute to underreporting of intimidating and/or disruptive behavior.(2,9,12,16) Additionally, staff within institutions often perceive that powerful, revenue-generating physicians are “let off the hook” for inappropriate behavior due to the perceived consequences of confronting them.(8,10,12,17) The American College of Physician Executives (ACPE) conducted a physician behavior survey and found that 38.9 percent of the respondents agreed that "physicians in my organization who generate high amounts of revenue are treated more leniently when it comes to behavior problems than those who bring in less revenue."(17)

Existing Joint Commission requirements

Effective January 1, 2009 for all accreditation programs, The Joint Commission has a new Leadership standard (LD.03.01.01)* that addresses disruptive and inappropriate behaviors in two of its elements of performance:

EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and
inappropriate behaviors.

EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.

In addition, standards in the Medical Staff chapter have been organized to follow six core competencies (see the introduction to MS.4) to be addressed in the credentialing process, including interpersonal skills and professionalism.

Other Joint Commission suggested actions

1. Educate all team members – both physicians and non-physician staff – on appropriate professional behavior defined by the organization’s code of conduct. The code and education should emphasize respect. Include training in basic business etiquette (particularly phone skills) and people skills.(10, 18,19)

2. Hold all team members accountable for modeling desirable behaviors, and enforce the code consistently and equitably among all staff regardless of seniority or clinical discipline in a positive fashion through reinforcement as well as punishment.(2,4,9,10,11)

3. Develop and implement policies and procedures/processes appropriate for the organization that address:

o “Zero tolerance” for intimidating and/or disruptive behaviors, especially the most egregious instances of disruptive behavior such as assault and other criminal acts. Incorporate the zero tolerance policy into medical staff bylaws and employment agreements as well as administrative policies.

o Medical staff policies regarding intimidating and/or disruptive behaviors of physicians within a health care organization should be complementary and supportive of the policies that are present in the organization for non-physician staff.

o Reducing fear of intimidation or retribution and protecting those who report or cooperate in the investigation of intimidating, disruptive and other unprofessional behavior.(10,18 ) Non-retaliation clauses should be included in all policy statements that address disruptive behaviors.

o Responding to patients and/or their families who are involved in or witness intimidating and/or disruptive behaviors. The response should include hearing and empathizing with their concerns, thanking them for sharing those concerns, and apologizing.(11)

o How and when to begin disciplinary actions (such as suspension, termination, loss of clinical privileges, reports to professional licensure bodies).

4. Develop an organizational process for addressing intimidating and disruptive behaviors (LD.3.10 EP 5) that solicits and integrates substantial input from an inter-professional team including representation of medical and nursing staff, administrators and other employees.(4,10,18 )

5. Provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution.(4,7,10,11,17,20) Cultural assessment tools can also be used to measure whether or not attitudes change over time.

6. Develop and implement a system for assessing staff perceptions of the seriousness and extent of instances of unprofessional behaviors and the risk of harm to patients.(10,17,18 )

7. Develop and implement a reporting/surveillance system (possibly anonymous) for detecting unprofessional behavior. Include ombuds services(20) and patient advocates,(2,11) both of which provide important feedback from patients and families who may experience intimidating or disruptive behavior from health professionals. Monitor system effectiveness through regular surveys, focus groups, peer and team member evaluations, or other methods.(10) Have multiple and specific strategies to learn whether intimidating or disruptive behaviors exist or recur, such as through direct inquiries at routine intervals with staff, supervisors, and peers.

8. Support surveillance with tiered, non-confrontational interventional strategies, starting with informal “cup of coffee” conversations directly addressing the problem and moving toward detailed action plans and progressive discipline, if patterns persist. (4,5,10,11) These interventions should initially be non-adversarial in nature, with the focus on building trust, placing accountability on and rehabilitating the offending individual, and protecting patient safety.(4,5) Make use of mediators and conflict coaches when professional dispute resolution skills are needed.(4,7,14)

9. Conduct all interventions within the context of an organizational commitment to the health and well-being of all staff, (11) with adequate resources to support individuals whose behavior is caused or influenced by physical or mental health pathologies.
10. Encourage inter-professional dialogues across a variety of forums as a proactive way of addressing ongoing conflicts, overcoming them, and moving forward through improved collaboration and communication.(1,2,4,10)

11. Document all attempts to address intimidating and disruptive behaviors.(18 )

References

1.) Rosenstein, AH and O’Daniel, M: Disruptive behavior and clinical outcomes: Perceptions of nurses and physicians. American Journal of Nursing, 2005, 105,1,54-64

2.) Institute for Safe Medication Practices: Survey on workplace intimidation. 2003. Available online: https://ismp.org/Survey/surveyresults/Survey0311.asp (accessed April 14, 2008 )

3.) Morrissey J: Encyclopedia of errors; Growing database of medication errors allows hospitals to compare their track records with facilities nationwide in a nonpunitive setting. Modern Healthcare, March 24, 2003, 33(12):40,42

4.) Gerardi, D: Effective strategies for addressing “disruptive” behavior: Moving from avoidance to engagement. Medical Group Management Association Webcast, 2007; and, Gerardi, D:  Creating Cultures of Engagement: Effective Strategies for Addressing Conflict and “Disruptive” Behavior. Arizona Hospital Association Annual Patient Safety Forum, 2008

5.) Ransom, SB and Neff, KE, et al: Enhancing physician performance. American College of Physician Executives, Tampa, Fla., 2000, chapter 4, p.45-72

6.) Rosenstein, A, et al:  Disruptive physician behavior contributes to nursing shortage:  Study links bad behavior by doctors to nurses leaving the profession. Physician Executive, November/December 2002, 28(6):8-11. Available online:  http://findarticles.com/p/articles/mi_m0843/is_6_28/ai_94590407 (accessed April 14, 2008 )

7.) Gerardi, D: The Emerging Culture of Health Care: Improving End-of-Life Care through Collaboration and Conflict Engagement Among Health Care Professionals. Ohio State Journal on Dispute Resolution, 2007, 23(1):105-142

8.) Weber, DO: Poll results: Doctors’ disruptive behavior disturbs physician leaders. Physician Executive, September/October 2004, 30(5):6-14

9.) Leape, LL and Fromson, JA: Problem doctors: Is there a system-level solution? Annals of Internal Medicine, 2006, 144:107-155

10.) Porto, G and Lauve, R: Disruptive clinical behavior: A persistent threat to patient safety. Patient Safety and Quality Healthcare, July/August 2006. Available online:  http://www.psqh.com/julaug06/disruptive.html (accessed April 14, 2008 )

11.) Hickson, GB: A complementary approach to promoting professionalism: Identifying, measuring, and addressing unprofessional behaviors. Academic Medicine, November 2007, 82(11):1040-1048

12.) Rosenstein, AH: Nurse-physician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing, 2002, 102(6):26-34

13.) Hickson GB, et al: Patient complaints and malpractice risk. Journal of the American Medical Association, 2002, 287:2951-7

14.) Hickson GB, et al; Patient complaints and malpractice risk in a regional healthcare center. Southern Medical Journal, August 2007, 100(8 ):791-6

15.) Stelfox HT, Ghandi TK, Orav J, Gustafson ML:  The relation of patient satisfaction with complaints against physicians, risk management episodes, and malpractice lawsuits.  American Journal of Medicine, 2005, 118(10):1126-33

16.) Gerardi, D: The culture of health care: How professional and organizational cultures impact conflict management. Georgia Law Review, 2005, 21(4):857-890

17.) Keogh, T and Martin, W: Managing unmanageable physicians. Physician Executive, September/October 2004, 18-22

18.) ECRI Institute: Disruptive practitioner behavior report, June 2006. Available for purchase
online: http://www.ecri.org/Press/Pages/Free_Report_Behavior.aspx (accessed April 14, 2008 )

19.) Kahn, MW: Etiquette-based medicine. New England Journal of Medicine, May 8, 2008, 358; 19:1988-1989

20.) Marshall, P and Robson, R: Preventing and managing conflict: Vital pieces in the patient safety puzzle. Healthcare Quarterly, October 2005, 8:39-44

* The 2009 standards have been renumbered as part of the Standards Improvement Initiative. During development, this standard was number LD.3.10.

http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

And on we drove into the night. And on, and on, and on and if I sound like a broken record, it's because that's how this trip felt. Just before Evansville, IN I realized that it was 1 AM and there was no earthly way I was going to make it to Louisville that night because I was falling asleep at the wheel. Two things to remember for next time: 1.Get out and walk around in the brisk air. It will wake you up for at least a little while. 2.Bring a tent so you don't have to spring $70 for a hotel room for 8 hours. I got trapped in a smoking hotel room, because apparently Illinois is the last state in the Union to allow smoking in a public building and slept on what I could only classify as questionable sheets. On the plus side, day 3 brought the trips cheapest gas right at Evansville: $4.58 a gallon for diesel. I was dancing.

“I understand the hardship that service to our great country often places on families.  Among the most difficult things servicemen and women have to do is leave their families for months at a time and adapt to frequent re-location,” Gov. Blunt said. “This interstate compact will make transition easier and less stressful for students and parents.”

Last month Gov. Blunt signed House Bill 1678, sponsored by Representative David Day, authorizing Missouri to enter into the Interstate Compact on Education Opportunity for Military.  The compact is a multi-state agreement to ease transitions into new schools for military children whose parents are transferred from one duty-station to another by making enrollment and class placement easier, increasing access to extracurricular activities, providing common-sense provisions to facilitate on-time graduation, and increasing information sharing between school districts.

The compact went into effect when signed by 10 states.  Missouri is one of the 10 states to join the compact together with Arizona, Colorado, Connecticut, Delaware, Florida, Kansas, Kentucky, Michigan, and Oklahoma.

Gov. Blunt will establish a state council to coordinate the state’s participation.  The council will include the Commissioner of Education, a superintendent of a school district with a high concentration of military dependents, a representative from a military installation, one representative from both the legislative and executive branches of government, and other members as deemed necessary.

Gov. Blunt will also designate a compact commissioner to administer and manage the state’s participation in the compact.  The compact commissioner will represent, and vote on behalf of, the state at the interstate commission meetings of all member states.

Gov. Blunt is a strong advocate for Missouri veterans and their families.  Following what he called an appalling protest at the funeral of Specialist Edward Lee Myers, the governor signed legislation that protects Missouri families’ right to honor their loved ones and makes it clear Missouri will not tolerate protests that disrupt those who are mourning the loss of a military hero.  Gov. Blunt also signed legislation that established the Stolen Valor Act to put in law fit punishment for those who impersonate our military heroes.

In 2006, Gov. Blunt signed legislation to enact additional protections for veterans of the War on Terror to ensure that their jobs, wages and benefits are kept for them during the time they are called to serve our country.  Last year the governor signed legislation that increases the penalties for employers who fail to comply with the legislation.

Gov. Blunt has witnessed firsthand the dedication and commitment that Missouri troops make every day to protect and defend our freedom with visits to Iraq, Afghanistan and the Mexican Border.

Gov. Blunt graduated from the United States Naval Academy and went on to serve as an Engineering Officer aboard the USS JACK WILLIAMS (FFG-24) and as the Navigator and Administration Officer on the USS PETERSON (DD-969).  Lieutenant Commander Blunt was mobilized to Commander Naval Activities United Kingdom in October of 2001 after the September 11, 2001 attacks on the United States.

Kansas State Capitol by Steve Crecelius

Topeka, Kan.—There's something compelling about climbing big structures. Maybe it's the view, or maybe it's the challenge of the stairs. In Kansas City, the climb to the top of the National World War I Museum's Liberty Memorial tower is rewarded with a downtown vista. A climb to the top of Lady Liberty in New York hasn't been permitted since 9/11 (although that prohibition is now being reconsidered). Now, however, you can tackle a new climb—opened just a few months ago—to the top of the Kansas State Capitol building in Topeka. The 296 steps lead up into the dome itself and then outside. The best part: it's free. — Laurie Borman

As you drive south and east of Wichita, there is nary a thing in sight. The landscape is pockmarked by the occasional small town, but truly, there really is nothing of consequence. I knew there would be some point on our trip in which we would have to pull off the side of the road for Jacob to relieve his tiny bladder, and it was at a point, when we were the lone drivers on a dusty highway (and no rest stops in sight) that my husband took Jacob by the hand and led him away from the road for a bit of privacy.

It was a beautiful moment, really, with dark, rolling clouds and lightning jumping through the low sky. The open prairie was quite breathtaking, save for the six-year-old boy marring the landscape by urinating in a low bush. 

We shook the thunderstorms the further east we drove, and we arrived to Branson by dinner time. If you've never been to Branson, it's a mecca for tourists. Although I hadn't noticed it when I was younger, I realized with my now-adult perception that Branson might not be the right vacation destination for us. Did I say anything to my husband? Heck no, if only because he was vocalizing my own thoughts. "What kind of town is this, anyway?" he asked, slightly disturbed by the evangelical billboards and shiny, flashing lights everywhere.

The kids were tired and hungry, so after we checked into our hotel and stowed our belongings, we decided to venture into the heart of Branson to find something to eat. "This reminds me of Niagara Falls," I said to my husband. Niagara Falls, too, is another tourist trap, not at all the tranquil, pristine vacation place I had imagined it to be. Both Branson and Niagara Falls are cities in which you hold your kids' hands a little more tightly and take frequent head counts so as not to lose your precious progeny.

"Crowded" doesn't even begin to describe it. And as my husband commented, Branson is most definitely a white person's town.

We pulled into the parking lot of an Olive Garden and just as quickly turned away when we saw the throngs of people waiting outside. Wendy's looked deserted, but I couldn't stomach the thought of eating more fast food.

"I need something real to eat," I complained.

And then we saw it, a restaurant promising home-cooked southern food. Translation: lots of fat and lots of salt. "Let's go there!" I screamed, gesticulating in the direction of the restaurant and practically tugging the steering wheel out of my husband's hands.

We were one of the last patrons to the establishment and were quickly seated at the rear of restaurant near the buffet. A tired, but sweet grandma-like waitress greeted my family and furthermore referred to us collectively as "Darlin'" and "Baby." In the background, a live entertainer sang the country, twang-filled versions of popular cover tunes.

My husband and I felt entirely out of place.

The meal was an embarrassment. Scratch that. The way my two youngest children behaved during that meal was an embarrassment to our family. At one point, Bridget sprinted away while I was at the potato bar, ran past my husband filling his plate at the buffet, which consequently set him on a wild goose chase through the entire restaurant, plate of food still in one hand. Note to parents: No matter how responsible your eight-year-old daughter is, you cannot expect her to wrangle her younger siblings while you attempt to get something to eat. While at a buffet, it's best for the parents to simply take turns.

By the time we wolfed down our artery-clogging meal and returned to the hotel, it was 8:30. Earlier in the day, we had promised the kids they could go swimming. Note to parents: Never make a promise unless you intend to keep that promise. Your kids don't care how tired you are, after all. Also, always choose a hotel with an indoor pool.

We allowed the kids 30 minutes for swimming (and what a skeevy-looking pool it was!!), reminding them that the next day would be a long one filled with nothing but fun and games and that they needed their rest.

By 10:00, everyone was asleep.

At 6:20 the next morning, my husband and I woke to the sound of thunder and the pitter-patter of rain on the roof.

We waited around until 8:30, at which point, seeing as how the rain was clearly not going to let up, we got a refund on our park tickets and second night at the hotel, and jetted off for Cincinnati.

According to my husband, there was an awesome theme park called King's Island not too far from where we would be staying anyway.

"Let's do it!" I said, ready to shake midwestern conservatism.

So we bid Branson farewell, and later joked that we drove five hours out of our way for nothing but a crappy buffet . . .

When it floods from heavy rains, the creek flows over the low concrete roadway. Normally, when the creek is low, the water flows under the roadway through several tubes. Last week when it flooded, the raging water broke apart the roadway, dismantling into several pieces. No telling when the Low Creek Bridge will be fixed.

This is the view of the creek to the west.

This is a close-up of the creek flow over the rocks to the east. Another view similar to the Creek Flow photo I had posted earlier.

Copyright © 2008 by Anna Surface. All Rights Reserved.

(1) Cracker Wars: The Church Strikes Back

(2) Thomas Foley and how to act as a complete pussy

(3) On the bright side: A story from Kansas

(4) A favorite quote.

Enjoy the rest of the night!>

Now I thought this was about to end peacefully, now that the cracker is in "safe" hands and Jesus H. Christ is apparently going to be digested, dismantled into pieces and subjected to high concentrations of hydrochloric acid in someone else's body.

Alas, the speed at which some people produce BS makes a fighter jet look like a horse-drawn carriage. Webster Cook is going to face ethics hearing at UCF, and a decision will be made after four weeks. Not only could he lose his seat, he could also be suspended from campus. In the meantime, his charges on alcoholic beverage violation, personal abuse and hazing are all dismissed. Apparently, the Catholic Church isn't content with merely discriminating against people with coeliac disease, but now wishes to impress upon a teenager its ill-founded power. 

Allegations have been made that he had stolen the cracker from the church, and that he had held Jesus as hostage. 

I'm saying this one last time. Webster Cook did not steal the cracker. He was given the cracker. Stealing implies force and action against one's will. I'm trying my best to stay calm and explain these things simply. If Webster had taken, let's say, a few candles that were not given to him from the church and then ran away, that would have been stealing. 

For the past few days, have you ever seriously contemplated pulling it together and asking yourself a very simple question: Given the fact that the school (read: the church) knew where Webster lived, why the f**k did they not call the police to retrieve something stolen, something forcibly taken from them against their will?

I'll tell you why. It's because they bloody well know that this isn't robbery. They bloody well know it's easier to issue death threats like a bunch of politically alienated extremist Islamist terrorists. 

Hostage - Boy I do love dictionaries. 

- noun: a prisoner who is held by one party to insure that another party will meet specified terms.

People with lower IQ might want to call it hostage taking, but their so saying doesn't make it correct. Hostage taking involves a person. A person is regarded by conventional wisdom as a homo sapiens sapiens. Not some gluten filled tasteless cracker. 

Oh, and before you even begin moving your lips to say it, NO, it is NOT the body of Jesus, Moses, JFK, Gandhi or Sherlock Holmes. If you seriously do believe in transubstantiation, you're still terribly wrong, because that particular cracker has still not been consumed by Webster Cook, thus has not become a human being.

Calling Webster's brief hospitality towards a piece of cracker "hostage taking" is even more absurd than calling someone who stole your sperms a hostage taker, simply because the sperm's chances of becoming a part of a human being is staggeringly higher than those of a cracker. 

--

Let's move on, shall we?

Oh boy, it's the republicans again... PZ Myers has not complained enough about Thomas Foley. Or maybe old PZ was just tired of a long flight back home, I don't blame him. For those of you who don't know Thomas Foley, he's the guy who called for increased security at the Republican National Convention, just in case PZ and his army of heathens try to break in. 

Well Tom, I'll tell you what: Darwin on my £10 note says the chances of any Republican who's not a scientist owning a gun is at least twice the chances of any scientist who's not a Republican owning any sort of weapon. Ergo, when we talk about a national convention of Republicans, or to put it bluntly, a stadiumfull of Republicans being so afraid that they call for added security at the very least suggests an average Republican incapability in self-defense, and worse still, poor observation.

Don't you worry Tom. We don't need guns to make a point stronger. Our points are already stronger.

--

OK, now a slightly more interesting, better news. 

It seems Sean Tevis of Kansas has actually decided to tackle the deep-rooted bigotry that has metastased into their public education. I'd strongly recommend that you visit his website and this blog on him, and if possible, make a tiny donation to help the cause. At the very least, and even if you don't make a donation, show your support somehow. 

There used to be a very similar issue on which the BBC had made a documentary, I'll put it up here for download once I get a good night's sleep and through my mess.

But, before I do that, a little more wisdom from Col. Kurtz:

"We train young men to drop fire on people. But their commanders won't allow them to write "fuck" on their airplanes because it's obscene!"

Try  "Heart of Darkness" by Joseph Conrad. The book was later adapted into one of the greatest movies of our time, Apocalypse Now.

• Sean Tevis is running for a seat in the Kansas House of Representatives, and his website is pretty cool. Definitely worth a checkout and $8.34.
• Did you know the Department of Health & Human Services is proposing a rules change allowing any federal grant recipient to prevent women's access to contraception? Me neither. Isn't fundie philosophy awesome?
• Holocaust siblings reunite after 66 years apart.

Public schools in the US state of Kansas are to be given new science standards that cast doubt on evolution.

It seems that teachers have been asked to tell students that Darwinian evolution is an unproven hypothesis and that the universe is too complex as to have been created without the intervention of a superior intelligence. Kansas is the fifth state in the USA to make this decision.

Not only that; it also seems that they have extended the definition of "science" to include supernatural explanations of some phenomena.

Stephen Jay Gould, we dearly miss you!