Video: Routine Miracles with Dr. Conrad Fischer: Oncology I

"This book covers medical advances that would once have been called miracles but are now merely routine. The patients' stories within this book yield hope, optimism, and triumph. This is the best time to come out of medical school and training. This fact will inspire and uplift everyone in the medical profession as well as all of us who must, at some point, rely on the art of medicine to see us through." -- Conrad Fischer, M.D.

Visit http://seefisch.wordpress.com for more information about Dr. Fischer and Routine Miracles or follow Dr. Fischer on Twitter: @SeeFisch

See all videos of Routine Miracles with Dr. Conrad Fischer on YouTube: http://bit.ly/2TPUkU

Food Examples in Radiology

From Twitter account of @scanman, a radiologist in India:

scanman Food examples in radiology - apple core, scalloping, berry aneurysm, lemon & banana (Chiari II), hamburger sign, coffee bean, dinner fork… 27 minutes ago from Tweetie

scanman More… Onion skin (Ewing's), sausage digit (sarcoid), eggshell rice grain & popcorn calcification, pepper pot skull, honeycombing, donut… 24 minutes ago from Tweetie

scanman My personal favourite is "licked candy stick appearance" of psoriatic arthropathy 23 minutes ago from Tweetie

scanman Omental cake, pancake vertebra, celery stalk metaphysis, millet seed (miliary TB), cottage loaf sign (traumatic diaphragmatic rupture) 22 minutes ago from Tweetie

Related:
Selections from the Buffet of Food Signs in Radiology. Clare J. Roche et al. November 2002 RadioGraphics, 22, 1369-1384.
“Milk of Calcium” and Food Signs in Radiology. Lee A. Shratter, MD. May 2003 RadioGraphics, 23, 686.

US Diplomat Missing in Curacao

Image via Wikipedia

October 3 update here and previous update here.

Netherlands Antilles newspapers are reporting the disappearance of an American diplomat assigned to the U.S. Consulate General Curacao. The diplomat identified as James Hogan, 49, reportedly disappeared on Thursday evening, (September 24) after he attended a reception at the American Consulate.Police statement reported on September 29 says that “On Friday morning, at 09.00 a.m., Mrs. Hogan reported that her husband was missing. The evening before he left his home and never returned. He left his home to go for a walk.” It is reported here that local authorities are assisted by the” Dutch Forensic Investigation Team from the Forensic Institute of The Netherlands since last Sunday.” And that they also have at their disposal “four dogs trained especially in the realm of finding missing persons which were provided by said Dutch Forensic Institute of The Netherlands.”

St. Maarten Island News reported the search for James Hogan on September 28. The following day it published information released by the local police. Yesterday, it reported that the FBI and the State Department have joined the search for the missing diplomat.

The State Department says that “Vice Consul James Hogan left his residence last Thursday and has not been heard from since, and we continue to work this with Curaçaoan authorities.”

According to State Department info the Consulate General Curaçao represents U.S. interests to three governmental authorities: the Kingdom of the Netherlands, the autonomous Netherlands Antilles, and the quasi-independent country of Aruba. The consular district includes six islands and spreads over a distance of 500 miles. It is the destination of millions of American tourists each year, the home of about 6,000 U.S.-citizen residents, and the location of over $1 billion of American investments. There are important – and sometimes urgent – consular and representational demands on the post for all the islands, including the farthest and smallest.

The OIG report from 2008 indicates that Curaçao is a 15 percent cost of living post and a three-year, two rest and recuperation, assignment. Entry-level officers (ELOs) get a two-year tour with one rest and recuperation break. It is considered a medium threat for crime post. And that this usually manifests particularly towards tourists in Curaçao.

Curaçao, an “independent mission” within the Western Hemisphere Bureau has 27 direct-hire and eligible family member personnel and 13 LE staff personnel. Of the 27 direct hire employees, 23 are employees from different agencies. Mr. Hogan is listed as the consulate’s political/economic/consular officer. He is one of the four State Department direct-hire employees at the US Consulate General in Curacao.

Related Items:

• FBI and State Department officially joins search for James Hogan29 September 2009 20:39
• American Vice Consul still missing on CuracaoIncludes full report issued by the police on Monday, September 28Tuesday, 29 September 2009 03:27

• Huge man hunt for American Vice Consul Hogan launched on Curacao28 September 2009 01:40

• Report No. ISP-I-08-16, Limited-Scope Inspection of Consulate General Curaçao, Netherlands Antilles - March 2008 | PDF

A Lesson in "Good News” Reporting

Seated during the Clark Air Force Base turnover ceremonies arefrom left to right, Foreign Minister of the Philippines, Carlos P. Romulo;US Ambassador Richard W. Murphy;Philippine President and Mrs. Ferdinand Marcos;and Chairman of the Joint Chiefs of Staff, General David C. Jones.DOD Photo: 3/14/1979

Nicholas Kralev reported recently on U.S. embassies discouraging or suppressing negative reports to Washington about U.S. allies. Some 37 years ago this month, a dictatorship was born in a distant country. Would “bad news” reporting have made a difference in this case? Who knows? But from the records published in the FRUS series, one gets a sense that our reporting officials did not get this one right. Was it a simple matter of faulty analysis and interpretation? Or was it because there was a prevailing notion subscribed to by the mission that precluded a better reading of the situation on the ground? Not that it matters anymore. Most of the principal players in this game, except Imelda are dead. But given our country's involvement in Central Asia, an area populated by tyrants and dictators, the Philippines provide a lesson in history.

Philippine strongman Ferdinand Marcos served as President of the Philippines from 1965-1986. He declared martial law on September 21, 1972, and by virtue of a presidential proclamation curtailed press freedom and other civil liberties, closed down Congress and media establishments, and ordered the arrest of opposition leaders and militant activists, including some of his staunchest critics like Senator Benigno Aquino, Jr.

In February 25, 1986 during the People Power Revolution, Ferdinand Marcos fled the country after 20 years of rule; Corazon Aquino became the first Filipino woman president. By 1991 when the Philippine Senate formally rejected the military base pact with the US, the bases became the most visible symbols not only of colonial legacy but also of America's long-term support of a dictator and a kleptocrat.

Read the excerpts below, all taken from the FRUS series unless otherwise noted:

Excerpt from a Memorandum of Conversation with President Nixon, Henry A. Byroade, American Ambassador to the Philippines and John H. Holdridge discussing developments in the PhilippinesWashington, January 15, 1971

Ambassador Byroade then declared that he had a very sensitive matter to lay before the President at Marcos' request. At the end of his predeparture conversation with Marcos, Marcos had warned him that he might find it necessary to suspend the writ of habeas corpus and establish martial law in the city of Manila—unprecedented steps which had not been taken by any Philippine President since the late 40's during the hukbalahap movement. What Marcos wanted to know was: in the event that he found it necessary to declare martial law in Manila, would the United States back him up, or would it work against him? Ambassador Byroade noted that he had promised Marcos he would bring back the President's personal reply.

The President declared that we would “absolutely” back Marcos up, and “to the hilt” so long as what he was doing was to preserve the system against those who would destroy it in the name of liberty. The President indicated that he had telephoned Trudeau of Canada to express this same position. We would not support anyone who was trying to set himself up as a military dictator, but we would do everything we could to back a man who was trying to make the system work and to preserve order.

Excerpt from an Airgram From the Embassy in the Philippines to the Department of State | Discussion with Filipino Senator Benigno Aquino, Jr., LP Secretary General)Manila, August 20, 1971

Aquino said that Marcos was becoming more and more of a dictator and was gaining control of the government and the country in line with his alleged intentions of continuing to stay in power beyond the end of his second term in 1973. Thus Marcos' present actions and future ambitions, Aquino argued, were creating a revolutionary situation for the Philippines. While Aquino said he could not predict with precision when a revolution would occur, he said that one of the key factors that any revolutionary must consider and which at present was unclear was the position the United States would take in a revolutionary situation in the Philippines.

Comment: Senator Aquino can be prone to exaggeration, and his remarks on the possibility of revolution and the role that he might play as one of its leaders seemed quite farfetched. Aquino, who is a longtime and prominent critic of Marcos, has no political ideology beyond his own personal ambitions. In this respect, his discussion of revolution can be interpreted as meaning that, if the Philippine political system has been changed to the extent that his political clique cannot alternate in power with the Marcoses by democratic means, then it will become necessary to resort to violent revolution as the means of gaining power. Although Aquino is believed to maintain regular contact with the Huks and the NPA, the jump from being a potential Liberal Party candidate for the 1973 Presidential election to leading a revolution in the hills may be a bit too much for the “boy wonder of Tarlac” to make.

Excerpt from a Telegram From the Embassy in the Philippines to the Department of State | Ambassador reporting about meeting with President Marcos and wife, ImeldaManila, September 3, 1971, 0937Z

4. Later on as I was sitting down with the President, Imelda asked to see him before his talk with me. When I later joined the President in his private library, he said that I had left the First Lady quite agitated and worried, with her worry centering on my remarks in the quotes above. Marcos said I must know that he had not suspended the writ solely on the Plaza Miranda incident, as he had stated publicly, that this was only the last straw. He said he was determined, during the period of the suspension of the writ, to break the back of Communist-led insurgency in the Philippines, even though this might take some time. He assured me that he would not misuse the suspension for political purposes, or against personal enemies. Interestingly, he said that it would not be difficult to have the constitutional convention extend his tenure of office, but that he was not going to do that. He said he would retire in 1973 unless at the time the country seemed in such a condition that he could not conscientiously leave the office of the President.

Excerpt from a Telegram From the Embassy in the Philippines to the Department of State | Ambassador reporting about meeting with MarcosManila, September 21, 1972, 1011Z.

8. I reminded him again that it was terribly important that he understands that it was only I, a friend, talking to him personally and privately. In that context, I said I wanted to talk to him about the type of things that cause me to pace the floor. He said he understood completely and I should go ahead without hesitation. I then reminded him that we are in the wind-up phase of an extremely important election campaign in our own country. I said I thought McGovern would seize on anything like a military takeover in the Philippines in an effort to use it as the final proof of his charge that the foreign policies of Nixon, particularly in the Asian area, were a total failure. I said I thought he would scream that “even the Philippines” had been so badly messed up that the very form of government which we instituted here was now in the hands of military dictatorship, supplied by our equipment. He would probably try to make a major thing of it, proving that this was the beginning of another Vietnam “even in the Philippines.” I said I know Nixon pretty well, and I thought he would be greatly upset if the Philippines gave the appearance of blowing up in his face at a time like this. I returned to the idea that our hands could become so tied up that as a practical fact we couldn't do any of the things we really wanted to do for the Philippines.

9. Marcos said he had made no decision to move towards martial law, and he had never considered anything beyond that, such as military rule. He did admit, however, that planning for martial law was at an advanced state. He said that under any conditions he could foresee he would not consider any extra-constitutional moves in the Philippines. We then got into a discussion as to what type of events had to happen under the Philippine Constitution wherein it would be constitutional to declare martial law. He concluded that words might have a different meaning for us and the Philippine Constitution was perhaps broader in this respect than our own.

11. Marcos told me at one point that guns were not the answer. He said he did not mean that over the long haul that the Philippines did not need adequate military forces. He then went into quite a brilliant description of the state of things in the Philippines and the absolute necessity for social reform. He said after all of his years in government, including seven in the Presidency, that he did indeed question the ability of the Philippines to achieve adequate reforms in time under the present system. His descriptions of its evils, and graft and corruption, of the impossibility of getting adequate legislation, and adequate resources for desperately needed reforms could hardly have been equalled by any harsh critic of this country. It is hard to escape [garble] that he thinks that his place in history might be made if he had the power of drastic reform. He might even see at this point this is his only route to regain his popularity even to the point where he could win handily in a future election, although he made no reference to either of these thoughts.

Excerpt from a Memorandum From the President's Assistant for National Security Affairs (Kissinger) to President Nixon Washington, September 23, 1972

President Marcos imposed martial law throughout the Philippines at midnight September 22. He proclaimed it officially at mid-day September 23, according to press reports, saying that it did not involve military rule and that civilian government would continue. We do not yet have the text of the proclamation, and thus do not at this point know its specifics, particularly as to whether Marcos suspended the Congress.

Patricia H. Kushlis writing in Whirled View: "[S]kewed, feel-good reporting from an Embassy too often helps to produce skewed, bad analysis that can result in skewed and hence bad policy decisions."

It turned out that Aquino was more prescient about Marcos' ambition and his warning of Marcos becoming a dictator was not an exaggeration. The day before martial law was imposed the US Ambassador sent a cable talking about economic issues in the host country. An embassy cable dated on the day martial law was declared states “Marcos said he had made no decision to move towards martial law.” It was a bad reading of the local situation, for sure; either that or one has to admit that the US Embassy at that time had been played exceptionally well by somebody with a more deft hand.

The text from Ambassador Henry Byroade's oral history interview talking about his stint in the Philippines can be accessed through the Truman Library here. If you read it with this FRUS series, you get quite a good picture in full colors.

Ambassador Hill is a "Bad Choice" -- the 36th Edition

POTUS with his Generals and AmbassadorWhite House Photo

Tom Ricks over at FP has posted an item about the power struggle in Baghdad that apparently nobody is covering:

“American insiders in Baghdad say the relationship between the top U.S. commander there, Gen. Raymond Odierno, and the top civilian official there, Amb. Christopher Hill, is deteriorating rapidly. Old hands say the chill between the two brings to the bad old days of Sanchez vs. Bremer, when those two unfortunates barely would speak to each other as the American position fell apart in early 2004, along with Iraq itself.”

With short tours in Iraq, I wonder how many old hands are still there to remember the bad old days. And who can talk about the ambassadorship in Iraq without talking about General Zinni?Ricks says that “for some inexplicable reason, we've never had a structure that gives the Americans unity of command, with one person in charge of the overall national effort. (Calling Gen. Tony Zinni! Oh wait, the Obama administration screwed him early on about an Iraq post, and he isn't taking their calls anymore.)” Ricks says he never understood why Ambassador Hill was picked for Baghdad.

Well, he’s not the only one it seems. Last August just months after Ambassador Hill was confirmed by the Senate, Robert Kaplan in The Atlantic writes that “Obama's new ambassador to Iraq is a star diplomat—but has no experience in the Arab world. Why Christopher Hill is a bad choice.” Kaplan helpfully goes through a short list of alternate choices for Hill’s job in Baghdad:Cameron Hume who is “a lifelong Arabic-speaking career diplomat with big-embassy experience as ambassador to Algeria, South Africa, and Indonesia—the world's most populous Moslem country.”

David D. Pearce who is the “current ambassador to Algeria, another lifelong Arabist, who began his career as a newspaper correspondent in Beirut, and went on to hold sensitive diplomatic positions in Syria, Iraq, and the Persian Gulf.”

And ta-da!

“[T]here’s former Combatant Commander for U.S. Central Command, Marine Gen. (Retired) Anthony C. Zinni, who was reportedly offered the job of replacing Crocker in Baghdad before the Administration reneged and settled on Hill […] Kaplan avers that Zinni does not speak Arabic either but that he is an expert on the Middle East as former Centcom commander and Israeli-Palestinian peace negotiator. “And as a former general he would have had instant credibility in Iraq's martial society.”

Kaplan also writes that “Maybe at some level the Obama Administration feels that if Iraq descends again into chaos it can always blame the Bush Administration for having invaded in the first place.”

Wha--aat!

Some says that the jury is still out on Iraq. You think? How long did it take for history to blame Britain for the artificial creation of a state out of the diverse religious and ethnic elements inhabiting the ancient lands of Mesopotamia? Whether Iraq descends into chaos again or not, the prevailing narrative already blames the Bush Administration for invading Iraq in the first place. And with reasons. Of course, history can come out the other way,too -- especially if the neo-culpas with this entertaining preview, writes their ultimate version of history (Oscar Wilde said once, “Any fool can make history, but it takes a genius to write it”) .

In any case, Ambassador Hill and General Odierno are both career professionals who happened to be joined at the hip like Siamese twins right now. They either do their mission well together or do it badly and fail together. I’d rather they don’t do the latter because that would be bad.

But what I find terribly hilarious is the persistent complaints about this non-Arabic speaking ambassador with no Middle East experience. Give it a rest, folks. President Obama had made his choice on who should be his personal representative. The jury won’t be convened until 2012.

And for those with selective memories, here’s one solid name for you – John Negroponte. He was confirmed by the United States Senate on May 6, 2004, by a vote of 95 to 3, and was officially sworn in on June 23, 2004 replacing L. Paul Bremer as the U.S.'s highest ranking American civilian in Iraq. As far as Google could determine, Negroponte speaks several languages but had no Arabic and had no Middle East experience when he was appointed US Ambassador to Iraq.

I don’t recall hearing persistent second guessing on Ambassador Negroponte months into his new assignment, with names of this General or that thrown about because the Ambassador spoke no Arabic and was without a Middle East experience. This feels like déjà vu without Senator Brownback.

Update @ 10:15 am: Ambassador Hill has officially denied a rift with General Odierno via Josh Rogin in The Cable:"Whatever 'source' he had was obviously not someone privy to my relationship with Ray. In short, Ricks is 180 degrees wrong about our relationship," Hill said, "I know Ray Odierno agrees with me that living and working in this place is tough enough without having to deal with this sort of thing out of Washington."

Fortress Embassies: A Tanka or Two

Image by Moto Pony via Flickr

Two blog friends, TSB of The Skeptical Bureaucrat and Digger of Life After Jerusalem have both written on the recent dancing in a tide pool about fortress embassies by an outgoing ambassador. After a weekend reading the OIG report on US Embassy Croatia, a very good report I must say, except for questionable staff morale attributed to the location of its new fortress office -- I feel I must wade into the tide pool with a tanka or two…

But first, the OIG on that fortress Embassy in rural Croatia:

In 2003, Embassy Zagreb moved into a new embassy compound (NEC) whose fortress-like exterior and remote location are seen by many employees as a source of irritation and an impediment to conducting efficient, open relations with Croatia. Falling staff levels mean that current occupancy is 20 percent lower than the level for which the building was built. […]

US Embassy Zagreb via Wikipedia

Despite unanimous high regard for the Ambassador among the embassy staff and the Ambassador’s and DCM’s attention to the community, staff morale is not quite as high as expected for an operation so well run, in a pleasant and pro-American country. The principal reason appears to be the location of the NEC. This facility, which opened in 2003, has a very attractive, spacious, and well-designed interior, but it lies amid farmland and industrial warehouses, well outside the urban or even suburban reaches of Zagreb. Consequently, Croatians and third-country interlocutors rarely visit the Embassy; every meeting with a government official or other contact requires a bracket of up to an hour before and after in transit time; and the distance factor inevitably reduces the number of such meetings. In addition, the morning and evening commute consumes almost as much time as in cities with 15 times the population of Zagreb. Housing U.S. employees near the Embassy, as is planned, will reduce the commute but isolate them from the life of the country. In 20 years, Zagreb may sprawl outward to reach the Embassy; meanwhile, the NEC’s location thwarts the primary purpose for its existence. Embassy Zagreb is paying for its safety with two decades or more of unnecessary staff transit time and aggravation. In addition to the location issue, the building is at least 20 percent larger than necessary for the staff now required in Croatia.

Second, I did not realize that an OIG report can be quite inspiring as a muse. A tanka or two below:

the new embassyfortress-like, aggravationan impedimentto open air relationsa beauty obscured, secured

~ * ~

the new embassyfortress-like irritationone big obstructionto candid conversationan eyesore for sure, secure

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• U.S. embassies too fortress-like, says American ambassador (seattletimes.nwsource.com)

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

Average family health plan premiums top $13,000. 22% of workers with employer coverage in 2009 had an annual deductible of $1,000 or more. http://bit.ly/2KGuWq

Women with diabetes may be 26% more likely to develop atrial fibrillation http://bit.ly/9ffvB

Semen sorting technology now used to breed female calves may one day let parents choose their baby’s sex. NYT http://bit.ly/IGG52

High Risk of Confusion in Dosing Tamiflu Oral Suspension in Children http://bit.ly/wV4TX

The American Way of Dentistry: The story of my teeth. Slate's 7-part series http://bit.ly/vwR5j

NYT: Health Concerns Are Raised Over Use of Popular Contraceptives http://s.nyt.com/s/CmtI-LlE

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

Social Media Related Tweets and Insights

From my Twitter account:

ER doctor: Why I sent a guy with a normal EKG to the cath lab http://bit.ly/JaSqB

Illustrating Differences between Eastern and Western Lifestyle http://bit.ly/inEy5

NYT: Unemployed in U.S. exceed number of jobs available by 6:1 ratio: http://rurl.org/1xto -- Getting the unemployment rate back to 5% in 5 years would require average monthly job creation of 250,000. http://bit.ly/3bzw0i

9 Workspaces Where Famous Folks Get Stuff Done http://bit.ly/jjLDv

Ask-A-Librarian Column: What Exactly Do You Do? A Clinician’s Guide to the Medical Librarian http://bit.ly/jGEU3

A Week in the Clouds Without a Notebook http://bit.ly/iXXSj

New prototype from the NYT serves up custom RSS feeds - you choose the topic http://bit.ly/SUjO5

"Partisan Political Contributions by U.S. Companies" http://bit.ly/6xN8k and http://bit.ly/2b2pTU

Video: Expand Your Blog By Adding a Book http://bit.ly/4DGwNA

Know When People Stop Following You on Twitter http://bit.ly/2iOlz4

Ortho surgeon @hjluks: "saw 2 patients in office today because I responded to their DM !! 3 patients from website" - What's you experience?

Google Docs has added an equation editor so students can complete math problems within a document http://bit.ly/23HQxd

Tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Why you should write a blog for yourself rather than for a shifting audience

An RSS subscriber just unsubscribed from my blog citing "content no longer relevant". Yet the content has never been more relevant to me :)

When you blog and/or tweet, you will always gain and lose subscribers and followers. It's a normal process.

When you write an educational blog, it is probably better to write for yourself - if you find the content useful, others will probably find it useful too.

And if you keep it up, the number of readers, subscribers and followers will gradually grow. I started with zero RSS subscribers in 2005 and that number has now surpassed 7,000.

However, this is not the main point. In the process, you will meet people you would have never had the chance to meet if you were not a blogger.

In general, when you blog, you always receive more than what you give in terms of information and knowledge.

There is no single way or rule how to use social media right. See how @common_squirrel has 6,000 Twitter followers with tweets such as "run run run run - eat eat eat - stare" - We're doing it wrong :)


Does this squirrel really have a walking stick? Click here to see the larger size photo on Flickr: Walk in the woods. Originally uploaded by Roselea.

Related:
Who? Me?
A Squirrel with a Walking Stick?
Has Blogging Peaked?
Using a Blog to Build an Educational Portfolio
How to write a medical blog and not get fired?

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.
Image source: Wikipedia

WALES: State Dept's New $35M Payroll Contract

Image by Jeremy Brooks via Flickr

A Virginia-based company, STG, Inc. (STG) announced yesterday, September 28, 2009 that it has been awarded the Department of State’s Bureau of Resource Management (RM) Worldwide Agency-wide Locally Engaged Staff (WALES) contract. Under this $35 million, 5-year contract, STG will design, develop and implement a payroll solution for more than 90,000 American & Foreign Service National staff and Foreign Service Annuitants.

“The State Department has placed a lot of confidence in STG and we are proud to have been selected for this unique responsibility,” said STG CEO Simon Lee. “STG has a long tradition of providing mission critical support to 20 of the 28 Bureaus and separate offices at the Department. We will continue to provide that same level of support to ensure the success of this important program.”

This is the first time I’ve heard of WALES, the contract, so I had to look it up. Here is what USAspending.gov says about it:

As the exclusive "civilian" provider, over 40 agencies rely on DoS to deliver Foreign Service National (FSN) employee e-Payroll services. This is a major challenge because, in contrast to most multi-nationals, the USG has staff in over 180 countries and must: * accurately pay 49,000 employees * comply with 500+ compensation plans tailored to local laws/prevailing practices * deal with 150+ currencies and their fluctuating exchange rates.

DoS currently operates/maintains four versions of FSNPay in Charleston and Bangkok, each requiring its own cadre of support experts. These 20+ year old, legacy systems represent major operational risk as they require modification each pay period. Moreover, DoS faces similar challenges with respect to the legacy FARADS system (the application used to generate annuitant payments to over 15,000 retired Foreign Service Officers (FSOs) and qualified beneficiaries).Following rigorous product demonstrations (that were conducted as part of a Sources Sought/Market Research RFI), DoS concluded that several COTS products could address most of the USG's FSN employee and FSO annuitant payroll needs. This means that WALES will replace this obsolete technology with a single, modern rules-based COTS system better suited to support constant change. This is critical because the USG must satisfy time-sensitive taxation/benefits requirements that arise from legislation/regulatory rules enacted in 180+ countries.In short, this will help DoS make accurate and timely payments to its FSNs and retired FSOs, achieve clean audit opinions, and continue to satisfy the 40+ agencies that rely on its overseas payroll services. In addition to the USG-wide "share-in" savings achieved by providing e-Payroll services to other agencies, this investment promotes cost avoidance by replacing five payroll systems with one to eliminate redundant:* Acquisition/deployment activities* Service center operations* Hardware* Software licensing* System maintenanceThese benefits will be largely realized in FY11, following a phased implementation. Total FY2009 spending: $7.0 M; Investment End Date: 09/30/2011

More here on WALES from state.gov. Check out the original solicitation for this contract at FedBiz.

Bradley v. Vance: The Yesterday You Worried About Tomorrow

Image via Wikipedia

Wholesale replacements of experienced employees with inexperienced beginners is a bad bet

This is a follow up to my post here and here on a recent case challenging the mandatory age retirement (MAR) in the Foreign Service. I’ve dug and read the Bradley v. Vance decision more than once since MAR had come up as a topic during the most recent AFSA election. I remember thinking, especially after reading Justice Marshall’s dissenting opinion that he seemed to be ahead of his time on this. Perhaps reading it in light of today’s realities, gives it more resonance.

I should note that two years after the Bradley decision, Congress reversed course and again raised the mandatory Foreign Service retirement age to 65 in the Foreign Service Act of 1980, as it had been from 1924 to 1946. And 65 has remained the mandatory age for retirement in the Foreign Service since.

I don’t know if this can be overturned. Obviously, the Sutherland Asbill & Brennan lawyers believed they have a good case in Colton v. Clinton or they would not have taken the case. How difficult the task would be, I don’t know. I do believe that if you should seek to overturn this precedent, there is no better time to do it than now. (Side note: I don't think this is over sharing but my best friend is turning 65; and I am protected under ADEA though nowhere near collecting Social Security, nor a candidate for MAR).

Will you still need me, will you still feed me - when I’m 64?

According to the report, An Aging World: 2008, the average age of the world’s population is increasing at an unprecedented rate. The number of people worldwide 65 and older is estimated at 506 million as of midyear 2008; by 2040, that number will hit 1.3 billion. Thus, in just over 30 years, the proportion of older people will double from 7 percent to 14 percent of the total world population.

One government study estimates that 93% of the growth in the U.S. labor force from 2006 to 2016 will be among workers ages 55 and older.

Finally, a Pew Research Center analysis indicates that older workers are the happiest workers. The Center says that some 54% of workers ages 65 and older say they are "completely satisfied" with their job, compared with just 29% of workers ages 16 to 64. The explanation lies in figures cited above -- a high percentage of these workers are working because they want to, not because they need to.

Somethings to keep in mind…

Overturning a Precedent

A CRS report on the Supreme Court’s overturning a precedent says that “as a general rule, the Supreme Court adheres to precedent, citing the doctrine of stare decisis ("to stand by a decision"). However it also states that “There are numerous other instances of the Court’s overruling of hoary precedent. Indeed, the older a precedent is, the more possibility there is that its doctrinal underpinnings will have been eroded through developments in the law. Age of a precedent can provide the opportunity for its reinforcement as well as for its erosion.”

It also explains that a “a precedent “that has become integrated into the fabric of the law” is more likely to have engendered reliance interests, and its overruling may even damage “the ideal of the rule of law.” The CRS report says that under this theory, “stronger arguments should be required to overrule a precedent.”

I don’t know how much stronger an argument would be required in this case. But things have changed in significant ways the last 30 years …

"Wear and Tear" wears no age

The appellees in Bradley v. Vance say that “many overseas posts are as pleasant as those in the United States, and that many people over age 60 are healthy, and many younger people are not. But they admit that age does, in fact, take its toll, and that Congress could perhaps have rationally chosen age 70 as the cutoff.”

The way I see it -- majority of overseas conditions are certainly not as pleasant as those in the United States. But when they are taxing and difficult, they impact not just 60-65 year old employees, but everyone assigned overseas (including spouses and children). Thus, the wear and tear of constant relocation, emotional toll and dislocation, changing weather, frustration from living away from family members, adjustment to a new culture and security threats is not unique to people of older age but affects everyone in the Service.

"I call to the attention of the gentleman the fact that the kind of service which these men must render involves going to the Tropics; it involves very difficult and unsettling changes in the mode of life. The consensus of opinion was that the country was better off to retire them, as a general rule, at 65." 65 Cong.Rec. 7564-7565 (1924) (Rep. Rogers).

In 1924, Mercedes-Benz had just been formed; an American airman flies from NY to San Francisco in 21 hours and 48 minutes and two U.S. Army planes complete the first round-the-world flight in 175 days. Also in 1924, the first regular airmail services start in the USA and you can get an Underwood typewriter with just a $3.00 down payment. Regular commercial flights between North America and Europe also did not start until 1945.Thus, the modes of travel for our diplomats assigned to distant places in Europe, the Far East, and Africa in 1924 … those invariably included rail and sea travel which took days, weeks, even months. Today, however, 21 hours in an economy class is what you get. Most travel from DC to our overseas missions occurs less than 24 hours.

You're getting older and getting better ...

In 1983, four years after the Bradley decision, Congress recognized the fact that life expectancy has increased substantially since 1940 and enacted increases in the normal retirement age gradually from 65-67. In 2008, the American Academy of Actuaries even issued a rare "public interest" statement advocating raising Social Security's age when an eligible retiree receives full pension benefits another two years to 69.

The life expectancy in 1980 measuring overall quality of life in a country and mortality at all ages was 70 years for males in America. For females the life expectancy was 77.4. In 2009, the estimated life expectancy in the United States has increased to 75.65 years for males and 80.69 years for females.

The Colton lawsuit cites several current political appointees who are over 65 namely:

• George Mitchell, Jr. (Special Envoy to the Middle East) 76 years old
• Stephen Bosworth (Special Envoy to North Korea Policy) 79 years old
• Dan Rooney (US Ambassador to Ireland) 76 years old
• Richard Holbrooke (Special Rep to Af/Pak) 67 years old

It also points out that the current Director General of the Foreign Service Nancy Powell will turn 65 during her tenure, and Secretary Clinton will be past 65 if she serves her full 4-year term. It did not include in the list the new US Ambassador to the UK, Louis Susman who is 71 years old or Johnnie Carson, a retired diplomat who was recently asked to come back as Assistant Secretary for the Africa Bureau who was born in 1943. If Carson's Wikipedia entry is accurate, he is 66 years old. There is obviously, a prevailing belief that experience matters … that the old hands at this game are effective in what they do. But how can one argue that political appointees over 65 are just as effective at their jobs, while career employees over 65 are no longer as good? Or that they must get out as soon as they turn 65 -- on the dot or they turn into pumpkins?

The complaint also did not include the fact that a large number of work at State and USAID are performed by contractors recruited for their experience by private companies with no mandatory age requirements. In 1979 when USAID was a 20-year old agency with full staffing and funding, this argument put forward by Justice Marshall did not resonate. But in today’s reality where USAID is a poor shadow of its old self, it might be harder to argue that a 65 year old employee must leave employment under MAR, when weeks later he/she could be working in the same job as a USAID contractor (or as a political appointee, for that matter).

Mid-level Staffing/Experience Deficit

A report dated May 2009 states that a January 2008 analysis by State’s Human Resources Bureau indicates that mid-level shortages continue. The report notes the public diplomacy cone has the highest mid-level deficit among the five generalist cones, and public diplomacy officers are being promoted through the mid-levels at higher rates than other cones. State officials expect it will take several years before the mid-level deficit is erased. The GAO report released this month on staffing at hardship posts says that “while new resources may enable State to partially address vacancies and the department has reduced its mid-level deficit since 2006, the remaining shortage of mid-level officers represents a continuing experience gap. State faced a 28 percent greater deficit at the FS-02 level than it did in 2006, with mid-level positions in the public diplomacy and consular cones continuing to experience the largest shortages of staff overall.”

In this post, I also talked about the language shortfalls in the State Department. The reality is growing a language competent corps takes time and practice. It is safe to assume then that our most competent foreign language speakers at State have had multiple assignments in specific areas of the world in the last 20-30 years of their careers. And just when they are hitting their peak, they also hit the MAR brick wall.

So even if the State Department is repopulating its mid-level ranks with faster promotion, it is at the same time reducing its already thin mid-level ranks under MAR. This, of course, could result in continued staffing gap at the mid-levels and persistent shortage of foreign language speakers.

Tell me again that this is our most adaptive strategy for talent management.

Baby Boomers Sailing into the Sunset

Remember that saying about the Army having more band members than the Foreign Service? The Foreign Service employees number approximately 11,500: 6,500 Foreign Service Officers and 5,000 Foreign Service Specialists.Remember the National Council on Aging saying that a member of the baby-boom generation will turn 50 on the average of every 7.5 seconds?

The Partnership for Public Service projects that some 7200 Foreign Service employees will retire in 2009-2012. If that projection is correct, we are talking about the departure of over 60% of the staff. And even with a projected hire of 5,663 in 2010-2012, how quickly can you replaced the experience of those sitting at the top of the pyramid? State might be able to fast-tracked promotion at any speed it wants, but wholesale replacement of experienced diplomats with inexperienced beginners is a bad bet.

In the end the real issue when it comes to mandatory age retirement is a simple one made complicated by more details than necessary.

As Justice Marshall says in 1979 “The issue, […] is not whether persons between age 60 and 70 "wear down," but whether they are competent Foreign Service personnel.”

Related articles by Zemanta

• You're Likely to Live! (freakonomics.blogs.nytimes.com)
• Coping with an ageing population: A caring challenge that cannot be ducked (telegraph.co.uk)

Best websites for Kindle (mobile) - please add more

This is a list of some of the best websites for Kindle (mobile) - please add more to the wiki at Google Docs - it is open to anybody to edit http://j.mp/kindle33

Best Websites for Kindle - mobile
(please add more below)

NYTimes
http://m.nytimes.com

WSJ
http://m.wsj.com

USA Today
http://m.usatoday.com

CNN
http://m.cnn.com

FT
http://m.ft.com

Reuters
http://m.reuters.com

Google Mobilizer (makes websites mobile-friendly)
http://google.com/gwt/n

Gmail
http://m.gmail.com

Skweezer (makes websites mobile-friendly)
http://skweezer.com

TIME
http://mobile.time.com

Twitter
http://m.twitter.com


Video: What Can Amazon Kindle 2 Do for You?


Image source: Amazon.com.

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

PSA cannot distinguish between lethal and harmless prostate cancer, leading to overdiagnosis and overtreatment - BMJ http://bit.ly/1AseSi -- Prostate specific antigen (PSA) concentrations below 1.0 ng/ml virtually ruled out a prostate cancer during follow-up. http://bit.ly/1AseSi

HIV vaccine reduces infection rate by a third, study shows http://bit.ly/StbUG

BMJ: Rebecca McKnight was diagnosed with anorexia nervosa at age 15 but is now a qualified doctor with a healthy weight http://bit.ly/AuBxN

Increased prevalence of septal heart defects among children whose mothers were prescribed an SSRI in early pregnancy http://bit.ly/2kpWds

A low thigh circumference (small thighs) associated with increased risk of developing heart disease or premature death http://bit.ly/AVgOy -- BMJ editorial: Thigh circumference and risk of heart disease and premature death but association needs further research http://bit.ly/2xJ4Wg

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

Pre-test: Check to see if you have the brain for science

Do not take this seriously.

Pre-test: Check to see if you have the brain for science. Do you understand what this PubMed abstract is about? http://bit.ly/zkbss

(trans-1,4-bis[(4-pyridyl)ethenyl]benzene)(2,2'-bipyridine)ruthenium(II) complexes and their supramolecular assemblies with beta-cyclodextrin.

Toma SH, Uemi M, Nikolaou S, Tomazela DM, Eberlin MN, Toma HE.

Inorg Chem. 2004 May 31;43(11):3521-7.

Two novel ruthenium polypyridine complexes, [Ru(bpy)(2)Cl(BPEB)](PF(6)) and ([Ru(bpy)(2)Cl](2)(BPEB))(PF(6))(2) (BPEB = trans-1,4-bis[2-(4-pyridyl)ethenyl]benzene), were synthesized and their characterization carried out by means of elemental analysis, UV-visible spectroscopy, positive ion electrospray (ESI-MS), and tandem mass (ESI-MS/MS) spectrometry, as well as by NMR spectroscopy and cyclic voltammetry. Cyclic and differential pulse voltammetry for the mononuclear complex showed three set of waves around 1.2 V (Ru(2+/3+)), -1.0 V (BPEB(0/)(-)), and -1.15 (BPEB(-/2-)). This complex exhibited aggregation phenomena in aqueous solution, involving pi-pi stacking of the planar, hydrophobic BPEB ligands. According to NMR measurements and variable-temperature experiments, the addition of beta-cyclodextrin (betaCD) to [Ru(bpy)(2)Cl(BPEB)](+) leads to an inclusion complex, breaking down the aggregated array.

Image source: OpenClipArt.org, public domain.

Officially In: Michael C. Polt to Tallinn

Image by Claudio.Ar via Flickr

On September 25 President Obama announced his intent to nominate Michael C. Polt to be Ambassador to the Republic of Estonia. The WH released the following official bio below:

Michael Polt is a career member of the Senior Foreign Service and has been the Principal Deputy Assistant Secretary in the Bureau of Legislative Affairs since August 2008. Prior to that he was a State Department Senior Transatlantic Fellow to the German Marshall Fund of the US. Mr. Polt was sworn in as United States Ambassador to Serbia and Montenegro in May 2004. Following Montenegro's secession from the State Union of Serbia and Montenegro, Mr. Polt became the U.S. Ambassador to the Republic of Serbia. He completed his Mission to Serbia in August 2007.

During his three decades as a career diplomat, Mr. Polt served as U.S. Minister and Deputy Chief of Mission of the U.S. Embassy in Berlin, Germany and Deputy Chief of Mission and Charge’ d’ Affaires of the U.S. Embassy in Bern, Switzerland. He has also served as Senior Advisor to the Director General of the Foreign Service for Management Reform and was a key member of the Senior Management Steering Board directing the State Department’s 2003-2005 multi-million dollar reinvention of its Diplomatic Communications System. Mr. Polt has held other senior positions in the Department of State, as Deputy Director for European Security and Arms Control issues, and in Panama City as Political Counselor of the U.S. Embassy during the time leading up to the U.S. military action against the Noriega regime in 1989. Earlier in his career, Mr. Polt was assigned to Embassies in Bonn, Mexico City, and Copenhagen, as well as the U.S. Consulate in Bremen, Germany.Mr. Polt received his bachelor’s degree from American International College and his master’s from University of Tennessee.

* * *

All U.S. diplomatic officials accredited to Estonia were withdrawn from Tallinn on September 4, 1940. The Legation in Tallinn was officially closed on September 5, 1940. In 1991, the United States announced its readiness to re-establish relations with Estonia and Embassy Tallinn was established Oct 2, 1991, with Robert C. Frasure as Chargé d'Affaires ad interim.

Since 1995, we have had three career diplomats and two non-career appointees assigned as US Ambassador to Tallinn. The last two were political appointees with the most recent one, Stanley Davis Phillips of North Carolina, appointed US Ambassador to Estonia on March 21, 2007-2009. If confirmed, Ambassador Polt would take over the reins of running US Embassy Tallinn from career diplomat, Karen Decker, who is the chargé d’affaires ad interim.

Related Item: President Obama Announces More Key Administration Posts, 9/25/09

Reviewing Diplomatic Readiness

Gaps in Staffing, Experience and Languages

The Senate Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia conducted a hearing last week on “A Review of U.S. Diplomatic Readiness: Addressing the Staffing and Foreign Language Challenges Facing the Foreign Service” (Thursday, September 24, 2009 | 02:30 PM | Dirksen Senate Office Building, room 342).

[view archive webcast]

This hearing addressed critical issues affecting diplomatic readiness; specifically foreign service officer (FSO) language capabilities and hardship post assignments. These issues have been highlighted by two U.S. Government Accountability Office reports requested by this Subcommittee (see links to reports below).

Member Statements

• Senator Daniel K. Akaka [View PDF]
• Senator George V. Voinovich [View PDF]

Witnesses

Panel 1

• Ambassador Nancy J. Powell [view testimony] Director General of the Foreign Service and Director of Human ResourcesU.S. Department of State
• Mr. Jess T. Ford [view testimony] Director, International Affairs and TradeU.S. Government Accountability Office

Panel 2

• Thomas D. Boyatt, President of the Foreign Affairs CouncilDelivered by Ambassador Ronald E. Neumann, (Ret.)[view testimony] PresidentAmerican Academy of Diplomacy
• Ms. Susan R. Johnson [view testimony] President American Foreign Service Association

Related Items:

Department of State: Additional Steps Needed to Address Continuing Staffing and Experience Gaps at Hardship Posts | GAO-09-874 September 17, 2009

Department of State: Comprehensive Plan Needed to Address Persistent Foreign Language Shortfalls | GAO-09-955 September 17, 2009

Hypertension Paradox and Treatments Reviewed in NEJM

Hypertension Paradox: Despite better recognition & treatment of HTN, prevalence of untreated HTN continues to increase http://bit.ly/Pnmkv

Figures and tables:

Advances in the Treatment of Hypertension, 1940s-2000s http://bit.ly/YuKm1

Algorithm for Management of Hypertension - NEJM http://bit.ly/SYi1A

Risk Factors for Hypertension. http://bit.ly/3nGdNP

Comparative Drug Trials in Patients with Hypertension http://bit.ly/zBcR7 - See what works.

Image source: BP device used for measuring arterial pressure. Wikipedia, GNU Free Documentation License.