text:
HOUSE . . . . . . . . . . . . . . . No. 1469
The Commonwealth of Massachusetts
Christine E. Canavan
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to patient safety.
Date Added:
Christine E. Canavan
10th Plymouth
Kevin Aguiar
7th Bristol
Denise Andrews
2nd Franklin
Brian M. Ashe
2nd Hampden
Cory Atkins
14th Middlesex
Ruth B. Balser
12th Middlesex
Carlo Basile
1st Suffolk
Jennifer E. Benson
37th Middlesex
John J. Binienda
17th Worcester
Garrett J. Bradley
3rd Plymouth
Michael D. Brady
9th Plymouth
Antonio F. D. Cabral
13th Bristol
Thomas J. Calter
12th Plymouth
Stephen R. Canessa
12th Bristol
James M. Cantwell
4th Plymouth
Tackey Chan
2nd Norfolk
Edward F. Coppinger
10th Suffolk
Geraldine M. Creedon
11th Plymouth
Sean Curran
9th Hampden
Marcos A. Devers
16th Essex
James J. Dwyer
30th Middlesex
Lori A. Ehrlich
8th Essex
Jennifer L. Flanagan
John P. Fresolo
16th Worcester
William C. Galvin
6th Norfolk
Sean Garballey
23rd Middlesex
Denise C. Garlick
13th Norfolk
Anne M. Gobi
5th Worcester
Patricia A. Haddad
5th Bristol
Patricia D. Jehlen
Louis L. Kafka
8th Norfolk
Timothy R. Madden
Barnstable, Dukes and Nantucket
Christopher M. Markey
9th Bristol
Paul McMurtry
11th Norfolk
Aaron Michlewitz
3rd Suffolk
Michael J. Moran
18th Suffolk
James M. Murphy
4th Norfolk
Rhonda Nyman
5th Plymouth
James J. O'Day
14th Worcester
Sarah K. Peake
4th Barnstable
Vincent A. Pedone
15th Worcester
Denise Provost
27th Middlesex
Angelo J. Puppolo, Jr.
12th Hampden
John H. Rogers
12th Norfolk
Richard J. Ross
Norfolk, Bristol and Middlesex
Tom Sannicandro
7th Middlesex
John W. Scibak
2nd Hampshire
Carl M. Sciortino, Jr.
34th Middlesex
Frank I. Smizik
15th Norfolk
Joyce A. Spiliotis
12th Essex
Ellen Story
3rd Hampshire
William M. Straus
10th Bristol
David B. Sullivan
6th Bristol
Benjamin Swan
11th Hampden
James E. Timilty
Walter F. Timilty
7th Norfolk
Timothy J. Toomey, Jr.
26th Middlesex
Cleon H. Turner
1st Barnstable
Martin J. Walsh
13th Suffolk
Steven M. Walsh
11th Essex
Alice K. Wolf
25th Middlesex
Nick Collins
4th Suffolk
HOUSE . . . . . . . . . . . . . . . No. 1469
By Ms. Canavan of Brockton, a petition (accompanied by bill, House, No. 1469) of Christine E. Canavan and others relative to the establishment of a nursing advisory board within the Executive Office of Health and Human Services. Public Health.
The Commonwealth of Massachusetts
In the Year Two Thousand Eleven
An Act relative to patient safety.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Chapter 118G of the General laws, as appearing in the 2004 Official Edition, is hereby amended by adding the following new section:-
Section 28:
a. The division shall require hospitals, nursing homes, chronic care and rehabilitation hospitals, other specialty hospitals, clinics, including mental health clinics, all other health care institutions, organizations and corporations licensed or registered by the
department of public health and health maintenance organizations as defined in chapter 176G to annually report appropriate data to the division. This data will be posted and made available to the general public via the internet and include but not be limited to:
i. measures which differentiate between severity of patient illness, readmission rates, length of stay, patient/family satisfaction with care, nurse satisfaction and nurse vacancy rates;
ii. indicators of the nature and amount of nursing care directly provided by licensed nurses including, but not limited to, the actual and the average ratio of registered nurses to patients or residents and the actual and the average skill mix ratio of licensed and supervised unlicensed personnel to patients or residents, and statistics as defined by the National Quality Forum (NQF) and/or the Center for Medicare and Medicaid Services (CMS) on the number of falls, number of incidents of failure to rescue, number of health care acquired infections, including sepsis and pneumonia, and number of medication errors.
iii. documentation of defined nursing interventions such as clinical assessment by a licensed provider, pain measurement and management, skin integrity management, patient education and discharge planning; and
iv. documentation of patient safety measures such as restraint checks, seizure precautions and suicidal precautions, to enable purchasers of group health insurance policies and health care services and for the public at large to make meaningful financial and quality of care comparisons.
b. The division shall consult with interested parties, including but not limited to; the group insurance commission, the Massachusetts nurses association, the Massachusetts health data consortium, the Massachusetts hospital association, the public health council, Massachusetts senior action council, associated industries of Massachusetts, a large labor union, the division of medical assistance, the board of registration in nursing, the division of insurance, the Massachusetts association of health maintenance organizations, and a national council of quality assurance accreditation expert to develop methodologies for collecting and reporting data pursuant to this section and to plan for its use and dissemination to culturally diverse populations.
c. Subject to the provisions of section 2(c) of chapter 66A, information collected by the division pursuant to this section shall be made available annually in the form of printed reports and through electronic medium derived from raw data and/or through
computer-to-computer access. All personal data shall be maintained with the physical safeguards enumerated in said chapter.
SECTION 2. Section 70E of Chapter 111 of the General Laws is hereby amended by striking out in line 89 the word "and".
SECTION 3. Said section 70E of said Chapter 111, as so appearing, is hereby further amended by striking out in line 99 the word "foregoing." and adding, the following words "foregoing; and".
SECTION 4. Said section 70E of said Chapter 111, as so appearing, is hereby further amended by adding at the end thereof the following new subsection:—
(o) upon request, to receive from a duly authorized representative of the facility, disclosure of
nursing sensitive outcome data as defined by NQF and/or CMS for statistics including but not limited to, the actual and the average ratio of registered nurses to patients or residents and the actual and the average skill mix ratio of licensed and supervised unlicensed personnel to patients or residents, the number of falls, the number of incidents of failure to rescue, the number of health care acquired infections, including sepsis and pneumonia, and the number of medication errors, and further, upon request, to receive from said duly authorized representative information regarding the educational preparation and length of employment of said facility's nursing staff, as well as information on nurse satisfaction and nurse vacancy rates, and to receive a copy of the comparative nursing care data report as outlined in chapter 118G, section 24 subsection (a). The fee for said report shall be determined by the rate of reasonable copying expenses.
SECTION 5. Chapter 111 of the General Laws is hereby amended by adding the following 9 sections:—
Section 221. As used in sections 221 to 229, inclusive, the following words shall, unless the context clearly requires otherwise, have the following meanings:—
"Adjustment of standards", the adjustment of nurse's patient assignment standards in accordance with patient acuity according to, or in addition to, direct-care registered nurse staffing levels determined by the nurse manager, or his designee, using the patient acuity system developed by the department and any alternative patient acuity system utilized by hospitals, if said system is certified by the department.
"Acuity", the intensity of nursing care required to meet the needs of a patient; higher acuity usually requires longer and more frequent nurse visits and more supplies and equipment.
"Assignment", the provision of care to a particular patient for which a direct-care registered nurse has responsibility within the scope of the nurse's practice, notwithstanding any general or special law to the contrary.
"Assist", patient care that a direct-care registered nurse may provide beyond his patient assignments if the tasks performed are specific and time-limited.
"Board", the board of registration in nursing.
"Circulator", a direct-care registered nurse devoted to tracking key activities in the operating room.
"Department", the department of public health.
"Direct-care registered nurse", a registered nurse who has accepted direct responsibility and
accountability to carry out medical regimens, nursing or other bedside care for patients.
"Facility", a hospital licensed under section 51, the teaching hospital of the University of Massachusetts medical school, any licensed private or state-owned and state-operated general acute care hospital, an acute psychiatric hospital, an acute care specialty hospital, or any acute care unit within a state-operated facility. As used in sections 221 to 229, inclusive, this definition shall not include rehabilitation facilities or long-term acute care facilities.
"Float nurse", a direct-care registered nurse that has demonstrated competence in any clinical area that he may be requested to work and is not assigned to a particular unit in a facility.
"Health Care Workforce", personnel that have an effect upon the delivery of quality care to patients, including but not limited to, licensed practical nurses, unlicensed assistive personnel and/or other service, maintenance, clerical, professional and/or technical workers and other health care workers.
"Mandatory overtime", any employer request with respect to overtime, which, if refused or declined by the employee, may result in an adverse employment consequence to the employee. The term overtime with respect to an employee means any hours that exceed the predetermined number of hours that the employer and employee have agreed that the employee shall work during the shift or week involved.
"Nurse's patient limit", the maximum number of patients assigned to each direct-care registered nurse at one time on a particular unit.
"Monitor in moderate sedation cases", a direct-care registered nurse devoted to continuously monitoring his patient's vital statistics and other critical symptoms.
"Nurse manager", the registered nurse, or his designee, whose tasks include, but are not limited to, assigning registered nurses to specific patients by evaluating the level of experience, training, and education of the direct-care nurse and the specific acuity levels of the patient.
"Nurse's patient assignment standard", the optimal number of patients to be assigned to each direct-care registered nurse at one time on a particular unit.
"Nursing care", care which falls within the scope of practice as defined in section 80B of chapter 112 or is otherwise encompassed within recognized professional standards of nursing practice, including assessment, nursing diagnosis, planning, intervention, evaluation and patient advocacy.
"Overwhelming patient influx", an unpredictable or unavoidable occurrence at unscheduled or
unpredictable intervals that causes a substantial increase in the number of patients requiring emergent and immediate medical interventions and care, a declared national or state emergency, or the activation of the health care facility disaster diversion plan to protect the public health or safety.
"Patient acuity system", a measurement system that is based on scientific data and compares the registered nurse staffing level in each nursing department or unit against actual patient nursing care requirements of each patient, taking into consideration the health care workforce on duty and available for work appropriate to their level of training or education, in order to predict registered nursing direct-care requirements for individual patients based on the severity of patient illness. Said system shall be both practical and effective in terms of hospital implementation.
"Teaching hospital", a facility as defined in section 51 that meets the teaching facility definition of the American Association of Medical Colleges.
"Temporary nursing service agencies", also known as the nursing pool as defined in section 72Y, and as regulated by the department.
"Unassigned registered nurse", includes, but not limited to, any nurse administrator, nurse supervisor, nurse manager, or charge nurse that maintains his registered nurse licensing certification but is not assigned to a patient for direct care duties.
Section 222. The department shall reevaluate the numbers that comprise the nurse's patient assignment standards and nurse's patient limits and the patient acuity system in the evaluation period and then every 3 years thereafter, taking into consideration evolving technology or changing treatment protocols and care practices and other relevant clinical factors.
Section 223. (a) The department shall develop nurse's patient assignment standards which shall be an ideal number of patients assigned to a direct-care registered nurse that will promote equal, high-quality, and safe patient care at all facilities. The standards shall form the basis of nurse staffing plans set forth in section 225. The department shall use, at a minimum, the following information to develop nurse's patient assignment standards for all facilities: (1) Massachusetts specific data, including, but not limited to, the role of registered nurses in the commonwealth by type of unit, the current staffing plans of facilities, the relative experience and education of registered nurses, the variability of facilities, and the needs of the
patient population; (2) fluctuating patient acuity levels; (3) variations among facilities and patient care units; (4) scientific data related to patient outcomes, a rigorous analysis of clinical data related to patient outcomes and valid nationally recognized scientific evidence on patient care, facility medical error rates, and health care quality measures; (5) availability of technology; (6) treatment modalities within behavioral health facilities; and (7) public testimony from both the public and experts within the field.
(b) The nurse's patient assignment standards may be adjustable and flexible, as determined by the department, to consider factors, including but not limited to; varying patient acuity, time of day, and registered nurse experience. The number of patients assigned to each direct-care registered nurse may not be averaged. The nurse's patient assignment standards may not refer to a total number of patients and a total number of direct-care registered nurses on a unit and shall not be factored over a period of time.
(c) The department shall develop nurse's patient limits which represent the maximum number of patients to be safely assigned to each direct-care registered nurse at one time on a particular unit. The number of patients assigned to each direct-care registered nurse shall not be averaged and each limit shall pertain to only one direct-care registered nurse. Nurse's patient limits shall not refer to a total number of patients and a total number of direct-care registered nurses on a unit and shall not be factored over a period of time. A facility's failure to adhere to these nurse's patient limits shall result in non-compliance with this section and the facility shall be subject to the enforcement procedures herein and section 228.
(d) If the commissioner finds that, for any unit, the department cannot arrive at a rationally based limit using available scientific data, the commissioner shall report to: (1) the clerks of the house of representatives and the senate who shall forward the same to the speaker of the house of representatives, the president of the senate , the chairs of the joint committee on public health, and the joint committee on state administration and regulatory oversight; (2) the commissioner of the division of health care financing and policy; and (3) the nursing advisory board as defined in section 16H of chapter 6A, the reasons for the department's failure to arrive at a rationally based limit and the data necessary for the department to determine a limit by the next review period.
(e) The setting of nurse's patient assignment standards and nurse's patient limits for registered nurses shall not result in the understaffing or reductions in staffing levels of the health care workforce. The availability of the health care workforce enables registered nurses to focus on the nursing care functions that only registered nurses, by law, are permitted to perform and thereby helps to ensure adequate staffing levels.
(f)Nurse's patient assignment standards and nurse's patient limits shall be determined for the following departments, units or types of nursing care:— intensive care units, (a) critical patient(s) (b) critical unstable patient(s); critical care units, (a) critical patient(s) (b) critical unstable patient(s); neo-natal intensive care (a) critical patient(s) (b) critical unstable patient(s); burn units (a) critical patient(s) (b)critical unstable patient(s); step-down/intermediate care; operating rooms, (a) not to include a registered nurse working as a circulator (b) to be determined for registered nurse working as a monitor in moderate sedation cases; post anesthesia care with the patient remaining under anesthesia; post-anesthesia care with
the patient in a post-anesthesia state; emergency department overall; emergency critical care, provided that the triage, radio or other specialty registered nurse is not included; emergency trauma; labor and delivery with separate standards for (i) a patient in active labor, (ii) patients, or couplets, in immediate postpartum, and (iii) patients, or couplets, in postpartum; intermediate care nurseries; well-baby nurseries; pediatric units; psychiatric units; medical and surgical; telemetry; observational/out-patient treatment; transitional care; acute inpatient rehabilitation; specialty care unit; and any other units or types of care determined necessary by the department.
(g) The department shall jointly, with the department of mental health, develop nurse's patient assignment standards and nurse's patient limits in acute psychiatric care units. These standards and limits shall not interfere with the licensing standards of the department of mental health.
(h) Nothing in this section shall exempt a facility that identifies a unit by a name or term other than those used in this section, from complying with the nurse's patient assignment standards and nurse's patient limits and other provisions established in this section for care specific to the types of units listed.
Section 224. (a) The department shall develop a patient acuity system, as defined in section 221. The department may also certify patient acuity systems developed or utilized by facilities. Patient acuity systems shall include standardized criteria determined by the department. The patient acuity system shall be used by facilities to: (1) assess the acuity of individual patients and assign a value, within a numerical scale, to each individual patient; (2) establish a methodology for aggregating patient acuity; (3) monitor and address the fluctuating level of acuity of each patient; (4) supplement the nurse's patient assignments and indicate the need for adjustment of direct-care registered nurse staffing as patient acuity changes; and (5) assess the need for health care workforce staff to ensure nurses' focus on the delivery of patient care.
(b) The patient acuity system designed by the department or other patient acuity system used by a facility and certified by the department shall be used in determining adjustments in the number of direct-care registered nurses due to the following factors: (1) the need for specialized equipment and technology; (2) the intensity of nursing interventions required and the complexity of clinical nursing judgment needed to design, implement and evaluate the patient's nursing care plan consistent with professional standards of care; (3) the amount of nursing care needed, both in number of direct-care registered nurses and skill mix of members of the health care workforce necessary to the delivery of quality patient care required on a daily basis for each patient in a nursing department or unit, the proximity of patients, the proximity and
availability of other resources, and facility design; (4) appropriate terms and language that are readily used and understood by direct-care registered nurses; and (5) patient care services provided by registered nurses and the health care workforce.
(c) The patient acuity system shall include a method by which facilities may adjust a nurse's patient assignments within the limits determined by the department as follows: (1) a nurse manager or designee shall adjust the patient assignments according to the patient acuity system whenever practicable as determined by need; (2) a nurse manager or designee shall adjust the patient assignments when the department-developed or certified patient acuity system indicates a change in acuity of any particular patient to the extent that it triggers an alert mechanism tied to the aggregate patient acuity; (3) a nurse manager or designee shall be responsible for reassigning patients to comply with the patient acuity system, provided that the nurse manager may rearrange patient assignments within the direct-care registered nurses already under management and may also utilize an available float nurse; (4) at any time,
any registered nurse may assess the accuracy of the patient acuity system as applied to a patient in the registered nurse's care. Nothing in this section shall supersede or replace any requirements otherwise mandated by law, regulation or collective bargaining contract so long as the facility meets the requirements determined by the department.
Section 225. As a condition of licensing by the department, each facility shall submit annually to the department a prospective staffing plan with a written certification that the staffing plan is sufficient to provide adequate and appropriate delivery of health care services to patients for the ensuing year. A staffing plan shall: (1) incorporate information regarding the number of licensed beds and amount of critical technical equipment associated with each bed in the entire facility; (2) adhere to the nurse's patient assignment standards; (3) employ the department -developed or facility-developed or any alternative patient acuity system developed or utilized by a facility and certified by the department when addressing fluctuations in patient acuity levels that may require adjustments in registered nurse staffing levels as determined by the department; (4) provide for orientation of registered nursing staff to assigned clinical practice areas, including temporary assignments; (5) include other unit or department activity such as discharges, transfers and admissions, and administrative and support tasks that are expected to be
done by direct-care registered nurses in addition to direct nursing care; (6) include written reports of the facility's patient aggregate outcome data; (7) incorporate the assessment criteria used to validate the acuity system relied upon in the plan; and (8) include services provided by the health care workforce necessary to the delivery of quality patient care. As a condition of licensing, each facility shall submit annually to the department an audit of the preceding year's staffing plan. The audit shall compare the staffing plan with measurements of actual staffing, as well as measurements of actual acuity for all units within the facility assessed through the patient acuity system.
Section 226. (a) A direct-care registered nurse at the beginning of the nurse's shift will be assigned to a certain patient or patients by the nurse manager, who shall use professional judgment in so assigning, provided that the number of patients so assigned shall not exceed the nurse's patient limit associated with the unit.
(b) An unassigned registered nurse may be included in the counting of the nurse to patient assignment standards only when that unassigned registered nurse is providing direct care. When an unassigned registered nurse is engaged in activities other than direct patient care, that nurse shall not be included in the counting of the nurse to patient assignments. Only an unassigned registered nurse, who has demonstrated current competence to the facility to provide the level of care specific to the unit to which the patient is admitted, may relieve a direct-care registered nurse from said unit during breaks, meals, and other routine and expected absences.
(c) Nothing in this section shall prohibit a direct-care registered nurse from assisting with specific tasks within the scope of the nurse's practice for a patient assigned to another nurse.
(d) Each facility shall plan for routine fluctuations in patient census. In the event of an overwhelming patient influx, said facility shall demonstrate that prompt efforts were made to maintain required staffing levels during the influx and that mandated limits were reestablished as soon as possible, and no longer than a total of 48 hours after termination of the event, unless approved by the department.
(e) For the purposes of complying with the requirements set forth in this section, except in cases of federal or state government declared public emergencies, or a facility-wide emergency, no facility may employ mandatory overtime.
Section 227. (a) No facility shall directly assign any unlicensed personnel to perform non-delegable licensed nurse functions to replace care delivered by a licensed registered nurse. Unlicensed personnel are prohibited from performing functions which require the clinical assessment, judgment and skill of a licensed registered nurse. Such functions shall include, but not be limited to: (1) nursing activities which require nursing assessment and judgment during implementation; (2) physical, psychological, and social assessment which requires nursing judgment, intervention, referral or follow-up; (3) formulation of the plan of nursing care and evaluation of the patient's response to the care provided; (4) administration of medications; and (5) health teaching and health counseling. (b) For purposes of compliance with this section, no registered nurse shall be assigned to a unit or a clinical area within a facility unless the registered nurse has an appropriate orientation in the clinical area sufficient to provide competent nursing care and has demonstrated current competency levels through
accredited institutions and other continuing education providers.
Section 228. (A) If a facility can reasonably demonstrate to the department, with sufficient documentation as determined by the appropriate entity, the attorney general or the division of health care finance and policy, extreme financial hardship as a consequence of meeting the requirements set forth in sections 221 to 229, inclusive, then the facility may apply to the department for a waiver of up to 9 months.
(B) As a condition of licensing, a facility required to have a staffing plan under this section shall make available daily on each unit the written nurse staffing plan to reflect the nurse's patient assignment standard and the nurse's patient limit as a means of consumer information and protection.
(C) The department shall enforce paragraphs (1) to (6), inclusive, as follows: (1) If the department determines that there is an apparent pattern of failure by a facility to maintain or adhere to nurse's patient limits in accordance with sections 221 to 228, inclusive, the facility may be subject to an inquiry by the department to determine the causes of the apparent pattern. If, after such inquiry, the department determines that an official investigation is appropriate and after issuance of written notification to the facility, the department may conduct an investigation. Upon completion of the investigation and a finding of noncompliance, the department shall give written notification to the facility as to the manner in which the facility failed to comply with sections 221 to 228, inclusive. Facilities shall be granted due process during the investigation, which shall include the following: (a) notice shall be granted to facilities that are
noncompliant with sections 221 to 228, inclusive; (b) facilities shall be afforded the opportunity to submit to the department, through written clarification, justifications for failure to comply with sections 221 to 228, inclusive, if so determined by said department, including, but not limited to, patient outcome data and other resources and personnel available to support the registered nurse and patients in the unit, provided however, that facilities shall bear the burden of proof for any and all justifications submitted to the department; (c) based upon such justifications, the department may determine any corrective measures to be taken, if any. Such measures may include: (i) an official notice of failure to comply; (ii) the imposition of additional reporting and monitoring requirements; (iii) revocation of said facility's license or registration; and (iv) the
closing of the particular unit that is noncompliant. (2) Failure to comply with limited nurse staffing requirements shall be evidence of noncompliance with this section. (3) Failure to comply with the provisions of this section is actionable. (4) If the department issues an official notice of
failure to comply, as set forth in paragraph (1) of subsection (C) and subclause (i) of clause (c) of said paragraph (1) following submission to and adjudication by the department of justifications for failure to comply submitted by a facility pursuant to clause (b) of paragraph (1) of said subsection (C) to a facility found in noncompliance with limits, the facility shall prominently post its notice within each noncompliant unit. Copies of the notice shall be posted by the facility immediately upon receipt and maintained for 14 consecutive days in conspicuous places including all places where notices to employees are customarily posted. The department shall post the notices on its website immediately after a finding of noncompliance. The notice shall remain on the department's website for 14 consecutive days or until such noncompliance is rectified, whichever is longer. (5) If a facility is repeatedly found in noncompliance based on a pattern of failure to comply as determined by the department, the commissioner may fine the
facility not more than $3,000 for each finding of noncompliance. (6) Any facility may appeal any measure or fine sought to be enforced by the department hereunder to the division of administrative law appeals and any such measure or fine shall not be enforced by the department until final adjudication by the division. (7) The department may promulgate rules and regulations necessary to enforce this section.
Section 229. The department of public health shall provide for (1) an accessible and confidential system to report any failure to comply with requirements of sections 221 to 228, inclusive, and (2) public access to information regarding reports of inspections, results, deficiencies and corrections under said sections 221 to 228, inclusive, unless such information is restricted by law or regulation. Any person who makes such a report shall identify themselves and substantiate the basis for the report; provided, however, that the identity of said person shall be kept confidential by the department.
SECTION 6. The department of public health shall include in its regulations pertaining to temporary nursing service agencies, or nursing pools, as defined in section 72Y of chapter 111 of the General Laws, and as regulated by the department, parameters in which the department shall deny registration and operation of said agencies only if the agency attempts to increase costs to facilities by at least 10 per cent.
SECTION 7. Section 7 is hereby repealed.
SECTION 8. The department of public health shall submit 2 written reports on its progress in carrying out this act. Said department shall report to the general court the results of its 2 written reports to the clerks of the house of representatives and the senate who shall forward the same to the president of the senate, the speaker of the house of representatives, the chairs of the joint committee on public health. The first report shall be filed on or before March 1, 2012 and the second report shall be filed on or before December 1, 2013.
SECTION 9. The department of public health shall initially evaluate the numbers that comprise the nurse's patient assignment standards and nurse's patient limits set forth in sections 221 to 228, inclusive of chapter 111 of the General Laws on or before January 1, 2015.
SECTION 10. The department of public health, shall develop a comprehensive statewide plan to promote the nursing profession in collaboration with: the executive office of housing and economic development, the board of education, the board of higher education, the board of registration in nursing, the Massachusetts Nurses Association, 1199SEIU, the Massachusetts Hospital Association, Inc., the Massachusetts Organization of Nurse Executives Inc., and any other entity deemed relevant by the department. The plan shall include specific recommendations to increase interest in the nursing profession and increase the supply of registered nurses in the workforce, including recommendations that may be carried out by state agencies. The plan shall be filed with the clerks of the house of representatives and the
senate, who shall forward the same to the president of the senate and the speaker of the house of representatives on or before April 15, 2012.
SECTION 11. Teaching hospitals, as defined in section 221 of chapter 111 of the General Laws, shall meet the applicable requirements of sections 221 to 229, inclusive of said chapter 111 of the General Laws on or before October 1, 2012. All other facilities, as defined in section 221 of chapter 111 of the General Laws, shall meet the applicable requirements of sections 221 to 229, inclusive of said chapter 111 of the General Laws no later than October 1, 2012.
SECTION 12. Section 8 shall take effect on December 1, 2016.
SECTION 13. The department of public health shall, on or before January, 1, 2012, promulgate
regulations defining criteria and proscribing the process for establishing or certifying by the department a standardized patient acuity system, as defined in section 221 of chapter 111 of the General Laws, developed or utilized by a facility as defined in said section 221 of said chapter 111.
SECTION 14. The department of public health shall, on or before March 1, 2012, develop a standardized patient acuity system or certify a facility developed or utilized patient acuity systems, as defined in section 221 of chapter 111 of the General Laws, to be utilized by all facilities to monitor the number of direct-care registered nurses needed to meet patient acuity level.
SECTION 15. The department of public health shall, on or before June 1, 2012, establish, but not before the development or certification of standardized patient acuity systems, nurse's patient assignment standards and nurse's patient limits as defined in section 221 of chapter 111 of the General Laws.
SECTION 16. The department of public health shall, on or before June 1, 2012, promulgate regulations to implement the requirements of section 229 of chapter 111 of the General Laws.


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I'm going to start by defining shot discipline. There are two aspects: timing and technique.
Miss it, and the moment is gone. Procession, Nepal. Nikon D700, 24/1.4
Part one: Timing
Imagine having a revolver, and say four enemies that are going to come towards you in a short space of time – too short for you to reload. You've got six shots. If you're good, you'll only need four; if you miss three times, you're screwed. How is this relevant to photography? What part of the workflow is limited to just a few shots? Your buffer, especially during fast paced action. (Why do you think pro cameras have huge buffers? Insurance.) Anticipation and waiting for the critical moment – that peak in action when everything comes together – is very important; more so if your camera doesn't have a motor drive or a huge buffer.
The revolver analogy is a good one. I'd compare a D3/D4 class camera to a machine gun with a telescopic sight: it's complicated, but you can spray and pray indefinitely and probably get something good – even if you have no skill or experience whatsoever, simply by the sheer weight of statistics. (If you take a thousand photographs, one or two will probably be okay – similarly, aim in the right general direction and you'll probably hit the target once or twice). In experienced hands, it's impossible NOT to get the shot.
Honestly, I found shooting with the D3 too easy. Same goes for the D700. The M9-P, on the other hand, is a completely different beast. It's like a Magnum .44 or a Desert Eagle 50 Cal; utterly useless to a beginner, but a fantastic tool if you know how to use it. But, you pretty much only get six RAW shots when the barrel is hot. See why timing is important while shooting action?
Do I find it limiting? Yes, but only if I'm not paying attention. And guess what: that was the simple part to shot discipline.
Spot the Himalayas. Would more resolution be better? Actually no, it wouldn't have made a difference. The scene itself was resolution-limited by atmospheric mist. Nikon D700, 85/1.4 G
Part two: Technique
The higher the pixel density of your camera, the more technique matters. For a fixed sensor size, small movement on a low-resolution camera matters less than on a high resolution one. Let's say camera A has 4MP, and camera B has 16MP – that's double the resolution, not quadruple (2x in each linear axis). If you move by a factor of half a pixel on camera A, the image is still pretty much aligned with the original pixel it was focused on; your edges might be a bit blur, but you could probably use unsharp masking to fix the perceived acuity. If you move by the same factor on camera B, you're going to be out by a whole pixel. And that's not fixable by unsharp masking. Increase the resolution further, and the effect is compounded. Those original 2.7MP APSC cameras were pretty forgiving, actually. The 24MP APSC ones will not be.
Technique actually covers several things.
1. Stability. This is the biggest one. If you don't move, then your edges will stay where you focused them on the sensor plane. All will be sharp. So how do we achieve this? Several ways – the easiest is a sturdy tripod. Good shutter tripping technique – roll gently, don't jab. And the last way is to reduce apparent movement by maintaining a high shutter speed, either by cranking the ISO, using faster lenses, or using a flash.
2. Lenses. Good lenses have better resolving power, right? Yes, but these days, the difference is mostly visible only when shot at maximum aperture. By f8 or f11, most lenses are capable of resolving identically to near as enough makes no difference at the sensor plane. And certainly not enough to be noticed in a moderately-sized print. Having said that, test your lenses carefully to determine what the optimal aperture is, and by what point resolution is 'acceptable'. Look at the corners. It's pretty important to do this before buying too, to avoid any issues or inconvenience later on. Just one of the reasons I'm still happy to go to a real retail store to buy stuff; I want to make sure the lens I'm going to use is going to perform the way I expect it.
Speake-Marin Immortal Dragon. The eternal fight between more DoF and diffraction limits. I cheated a little by using a wider focal length, which has more DOF for a given aperture. Nikon D700, Zeiss ZM 2.8/28 Biogon
3. Watch out for diffraction. Although all lenses have an optimal aperture, the smaller the pixels, the closer the diffraction limit will be to wide open. Most compact cameras – especially the 1/2.33″ kind – will resolve optimally wide open, and be noticeably softer if set to f5.6 or f8. (This is one reason most manufacturers use a switchable ND filter rather than a real aperture; also on a sensor that small, everything is in focus all the time.) For instance: I can use f45 to shoot macros on the 4.1MP D2H without noticing any diffraction softening; however, by f27 on the D700, I'm seeing a noticeable reduction in acuity. That limit becomes f16 on the 16MP APS-C cameras, and I suspect as low as f11 on 24MP APS-C. F8 is as far as I'd go with any lens on Micro Four Thirds.
Missed focus in either direction would turn this from a keeper into junk. Nikon D700, Zeiss ZF 1.4/85 Planar – manual focus
4. Focusing. If you're shooting a rangefinder, make sure the RF is properly calibrated for the lenses you normally use. Be aware of focus shift with aperture stop down. If you're shooting an SLR, make sure your AF system is properly calibrated, especially for wide open lenses; use the AF fine tune function if you've got one. Shoot live view, wide open, manual focus and magnified to determine what the absolute best result you can obtain is, and then adjust your AF system until you achieve that consistently. AF accuracy matters most when shooting wide open – sadly these days SLR focus screens are optimized for brightness rather than focusing snap, which means it's much harder to see when something is in focus or not. (Camera makers want to sell you the latest AF lenses, so they discourage you from focusing yourself.) It isn't helped either by tiny viewfinders. If you're going to use your SLR manual-focus, it's worth adjusting your mirror zero position and focus screen shimming to ensure that what you see in the finder does in fact match what the sensor sees. And a coarser matte split prism or micro prism screen helps immensely, too. Don't try to do this yourself, however – it's difficult and there are a lot of fragile, easily scratched components inside the finder which can be irreparably damaged if you don't know what you're doing.
5. Maintenance. This also covers several things: make sure your lenses and mounts are clean, for one. Clean lenses are obvious. Clean mounts, less so: a little bit of misalignment between the lens/ mount/ sensor combination can cause noticeable softness on one side of the image. It mattered less in the days of film because the 'sensor' plane had some thickness to it; you could be off by a bit and the image would still be focused on the emulsion. A digital sensor is a perfectly flat single plane, with no forgiveness in the front-back direction.
A good example of condition-induced limits. Paris. Leica M8, 21/1.4 ASPH
Bottom line: if you don't think you can handle that many pixels, shoot in a binned and downsized raw mode, or get a camera with fewer pixels. You'll save yourself the hassle of handling enormous files, too. I know that under certain conditions – photojournalism and street, for example – it's extremely unlikely that I'll be able to fully achieve more than 12MP of resolution on a full frame camera. This isn't because I've got poor technique, but simply because there are restrictions put on you by the shooting conditions – for instance, being jostled by people; having to shoot in extremely dark environments at high ISO; using a MF rangefinder with wide open shallow-DOF lenses on a moving subject. The list of excuses goes on. Bottom line: I know I'm the weak link in the imaging process here; I'll try to improve, but I also recognize my limits and won't fall into the trap of thinking more MP will make for a better image. It won't. In the studio however, that's a totally different matter. MT

subset: commoncrawl


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• LIVE FROM GERMANY: New Robotic Cars & Systems Coming to the Road
SAN FRANCISCO— As fuel prices head frighteningly close to the $5 per gallon mark—even past it in some states—the question from many consumers has become a simple one: What's next? For Volkswagen, it's certainly clean diesel, as dealerships are ramping up to receive the 2009 VW Jetta TDI and its 50 miles per gallon. Two weeks ago today, VW took a step even further ahead by announcing the 2010 Golf Twin Drive Concept, a plug-in hybrid with a diesel range extender to boot. But what's beyond Twin Drive? Is Volkswagen ready for a hydrogen economy? We sat down with John Tilman, program manager for VW of America's advanced powertrain research program, and got the inside scoop on the real future of driving. —Basem Wasef
Many manufacturers have been working on hydrogen fuel cells. How's the VW program going?
Let's say that compared to some of the other OEMs, we're not as near term as some in terms of bringing something to market. We want to bring a vehicle to market when the infrastructure is there, which is a really big issue. Also, we absolutely need it to be dependable and durable, so consumers can drive and not feel that it's a (too) new technology, that's not comfortable for them. We want to make certain that when that car hits the market, consumer is ready and understands what it is, understands if there are any limitations with what they're getting. We want to make certain that we have the best solution that's well timed in the market.
How does hydrogen fit into our future fuels universe?
As you know, there's going to be a requirement in California and many states in the future for zero emissions vehicles. There's really only two solutions for zero emissions: battery/electric, of course, and fuel cell. The only limitation with battery/electrics is range. Fuel cells don't really have those limitations, per se. We can actually get 200-300 mile ranges, depending on our storage capacity. And consumers are very comfortable with that scenario. They fill their cars now, go 300 miles, fill them again. With battery/electrics, you have these long charge cycles: 2, 3, 5, 10 hours. Consumers aren't really going to accept that as long-term solutions for long distance vehicles.
More From Popular Mechanics
Does that mean that you could combine the two—EVs and fuel cells?
That is one solution. The best solution for a fuel cell, actually, is a plug in hybrid with a fuel cell range extender. The reason for that, you can have a fuel cell at 20-30 kilowatts, steady state, most efficient operation for a fuel cell, plug it in for the first 80-100 mile range, and then the fuel cell will extend the range to 200-300 miles.
Do you have any particular angle that you would take? That sounds similar to the GM E-Flex system. Is there a Volkswagen twist?
Actually, yes. We're working on high temperature technology. A fuel cell that runs at a higher temperature has much higher efficiency. But because of the fact that it doesn't have the limitations of a low temperature system, we can actually downsize, lower the parts count, get a more dependable system for the consumer. We're the only manufacturer right now doing a high temperature system in a light duty application.
So how does the high temperature system work, exactly?
We run it between 120 and 160 degrees Celsius average, compared to systems that are 80 to 100 degrees Celsius, their efficiencies are lower, and they actually run water as a coolant. We actually run a more viscous fluid, more like an oil, as a coolant. And that downsizes the coolant system.
These are temperatures inside?
The actual ambient temperature of the stack is 120-160 degrees. It's not the outside of the stack itself.
What are the cycle demands of that high temperature? Does it take longer to get to operating mode?
If we actually run the mode of operation correctly, you'd be able to get in, start the car, and run it without really noticing any difference. What we would do in that case is likely step it. Basically, we'd have a low power setting under 30 or 40 precent of low power, then when it warms up, go to a higher power and then full power setting. That's the most efficient operation for a high temperature system.
What are some of the tradeoffs with hydrogen in general?
Right now, the easiest way and most industrially accessible way (to make hydrogen) is steam reformation of natural gas. That means you get energy from steam, the byproduct of natural gas's reaction to it, and so there are issues with the current means of getting hydrogen. Long term, though, of course you can get hydrogen from electrolysis of water, probably the way that would make the most sense. Then you could actually electrolyze the water onsite, in the home possibly, with solar panels or wind. That's a totally green solution. If you want to go mid-term between that solution and where we're at now, you would go with a micro steam reformer in your garage. It's a shoebox size device sitting on your wall, uses natural gas which is already piped into the home, and you could directly put [hydrogen] into the car. So let's say in a 5-7 hour timeframe you could go from zero or low fuel to full fuel overnight.
How far out do you think we are from that kind of technology?
Actually, Honda already has a solution for that, and VW is part of a consortium of manufacturers developing a device that will go in the garage. It costs about $50,000. We're working on a solution with eight other OEMs, I can't mention the names because of NDAs at the moment, but we're developing another home solution not based on the Honda technology, that we'll be able to license and sell in our own showrooms when these vehicles hit the showrooms.
Are you broadening your scope at all, or are you focusing on hydrogen?
The reality is, when hydrogen fuel cell vehicles come to the market, they won't be alone. There will be diesel and biofuels of different types. There will be gas to liquid type fuel where you convert cellulose to liquid fuel, you can make diesel, gasoline, many different fuels out of that. There will be electric cars too. We don't want to put ourselves in a position where we have only solution of the market. We have to be looking at multiple solutions. So we're looking at multiple technologies including pure EVs and plug in hybrids with fuel cell range extenders, different kinds of range extenders, even. So the range extender can be based on biofuel, fuel cell or gasoline, different solutions for different market segments. There will be electric vehicles in San Francisco; short driving distances, easy to deal with. But if you're in Kansas, that won't be the solution.
Do you see different technologies spreading across the product line to suit different driving styles?
One of the advantages of electric—whether it's battery electric or fuel cells—is that you literally change the software. A consumer could do it, I suppose, but if they want more power off the line we can suit their needs. They'll sacrifice the power towards the top end of the powerband. We can customize that particular situation to the consumer. Current technologies don't really allow that, but as we move forward and it becomes more software based, we can.
Certain car manufacturers are allied with different companies, such as Nissan's relationship with NEC. Does VW have special relationships with certain companies?
We do have working relationships with different research companies. We recently announced a battery project with Sanyo, I believe, a long-term five year project to develop the next generation of batteries. We are not just tied to them, we want to keep our options open. We've got about 4 or 5 really good, high quality battery chemistries. We don't want to limit ourselves to just one company, and that technology, and that chemistry. We have to keep our options open when the market solution arrives.
How much of your team is in Sacramento?
The entire advanced powertrain team is there now. But it's a very small team. In the U.S. right now it's two. In the entire U.S. We're really, really busy. But we are constantly finding that Germany's starting to see the value in having German staffers on the ground in North America to really answer the questions that are coming up. And the questions are coming up faster than the answers are. So we need more staff, and in fact I'm going to Germany next week to discuss the issue of doubling our staff in the next year to cover the number of issues that are coming up.
I recently read about regenerating energy from exhaust heat. What are your thoughts on that?
That is possible. There are piezoelectric devices that take the difference between ambient temperature and generating electricity off of that, but they're finding that the amount of energy generated is fairly low. It's good quality. It will power devices, but it won't power systems. There is no solution for getting as much energy out as you put in. You only really supply it a small portion of our energy. But we are looking at it.


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It seems like every day you hear about another celeb hooking up with a hot costar on set, while his or her significant other is out of sight and obviously out of mind. And as much as we'd like to think it's the kind of thing that only happens in Hollywood, on-the-job liaisons are just as common outside Tinseltown.
In fact, statistics show that the workplace has become the number one breeding ground for cheating. According to a study done by infidelity expert Shirley Glass, Ph.D., 62 percent of men who admitted to having an affair had done so with someone they met at work. "You often spend more time with coworkers than with your partner, which can create intense bonding," says Bonnie Eaker Weil, Ph.D., author of Can We Cure and Forgive Adultery? To ensure your guy is doing his job rather than his coffee-break buddy, follow these tips.
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Know His Business
Sure, it may get boring when he goes on and on about his pain-in-the-ass boss or other people he works with, but if he can't talk to you about the workplace highs and lows, he may open up to someone who understands all the pressure he's under. "The more you know, the more he can share with you and the less likely he'll be to confide in his attractive coworker," says Don-David Lusterman, Ph.D., author of Infidelity: A Survival Guide.
To come across as genuinely interested (rather than annoyingly nosy), ask specific questions that address how he handled certain tasks or dealt with a difficult higher-up. Otherwise, it's like pulling teeth. "If you simply ask him how work is or what's up, he'll say, 'It's fine' or 'Nothing,'" says Alon Gratch, Ph.D., author of If Men Could Talk. "But when you ask targeted questions, it's easier to get him talking."
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With some insight, you'll also be able to determine if his late nights make sense or seem suspicious. Is he working on a project that would require him to work more hours or send him out of town for a long weekend? If he knows that you know what he's up to, it's harder for him to pull late nights or grab drinks with a cute coworker without any explanation.
Be a Presence
Another cheat-proof-him strategy: Make sure everyone at his job knows he has a woman ... and a kick-ass one at that. Be enthusiastic about joining him for work gatherings, whether it's the company party, after-work beers, or his coworker's birthday bash. Otherwise, a potential rival will assume she can steal your man because she doesn't take your commitment seriously. In her mind, if the relationship is legit, you'd be there.
By making your presence known, you're marking your turf as well. "It humanizes you and gives you a face," says Weil. "Not only will she realize you're a real part of his life, but it will also make her feel guilty about trying to get it on with your guy once she's socialized with you."
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Identify the Biggest Threat
You may think that blond bombshell at the front desk has Man Stealer written all over her face, but the chick you least expect could be the real danger to your relationship. "She could simply have some quality that plays to your man's weaknesses or boosts his ego," says Susan K. Perry, Ph.D., author of Loving in Flow: How the Happiest Couples Stay That Way. Translation: She may not necessarily be a gorgeous vixen. Some suspicious chicks: "Women working on long-term projects with him or who have cell phone or pager access to him during off-hours," says Gratch. "Also, pay attention when a coworker invites him to nonwork functions, especially if he goes without you."
That being said, try not to be paranoid about every woman that crosses his path - just keep your eyes open. Once you have the enemy in your crosshairs, you don't need to attack. "If you are uncomfortable, rude, or possessive when you see her complimenting your man or laughing at an inside joke, she'll pick up on your insecurity," says Lusterman. One strategy she might use to screw you over is making comments to him like, "Aren't you annoyed that she checks up on you all the time?" Stay cool and confident, and she'll have no ammo to use against you.
Stay on His Mind 24/7
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Unfortunately, if your guy travels a lot for business, you have a whole other set of concerns. "People are more likely to be unfaithful out of their normal surroundings," says Lusterman. "Loneliness plays a part, but also the sex is more anonymous, so there's less chance of getting caught." In other words, they cheat just because they can. To keep him from straying while on the road, send him off feeling fantastic about your relationship. "Save up some fun, novel sex ideas and try them out the night before his trip to leave a sexy lasting impression," suggests Perry. And avoid getting into any last-minute fights or disagreements; he'll leave with a bad taste in his mouth and a "screw her" attitude. "That last, unflattering image might be the one that comes to mind when someone seductive enters the picture," Perry warns. In other words, he won't feel as badly about boinking some other chick.
While your guy's away, agree to chat once every day or so (you might even want to engage in some phone sex to get him aching for you). When he knows he's going to be touching base, even if it's just to say good night, it will reinforce his sense of responsibility - and commitment - to you.
Interoffice Romps
Seventy-five percent of human-resource professionals and 59 percent of employees said that their organization had no formal policy on office romances.
Source: Survey by the Society for Human Resource Management
Reprinted with Permission of Hearst Communications, Inc. Originally Published: Is Your Guy Hooking Up at Work?


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Meet the new boss: a lot like the old boss, except for the accent.
Confirming days of media leaks, to succeed its hapless British chief executive Tony Hayward and begin the long process of rebuilding the oil giant's image after one of the nation's worst environmental disasters.
BP has been here before. Hayward himself was named to succeed a predecessor who oversaw a series of safety lapses that culminated in a blast at a refinery in Texas City, Texas, that killed 15 people in 2005.
Now, Dudley will embark on the clean-up of a company saddled with huge liabilities, a broken corporate culture, strained government relations and a badly damaged brand.
Dudley has already developed a high profile as the most senior American manager involved in the Gulf cleanup. Just hours after being officially named the incoming CEO, Dudley was busy reassuring customers, shareholders, employees and retirees that cleaning up BP's image is a top priority.
"Strong" brand
"I think the BP brand globally is very strong," he told CNBC. "There's no question we're going to be associated with this incident in the U.S. for a long time. But I think, it's a bit aspirational, but down the road when people see, you know, what this company actually responded on a massive scale to a tragedy that is quite unusual, then the seeds of rebuilding our reputation and brand may be there. "
With the runaway well apparently capped, BP is now hoping to cap the massive financial liability brought by the spill. Dudley's appointment as CEO came as the global energy giant posted a $17 billion net loss for the latest quarter, its first in 18 years, compared with a profit of $4.39 billion a year earlier. The company's stock has lost 35 percent of its value, or about $60 billion, since the April 20 explosion of the Macondo well on the Deepwater Horizon platform.
And pressure from the White House prompted the company to cancel dividends to shareholders this year, angering millions of retirees who rely on the payments. The company's stock has bounced back from its lows a month ago, however.
Tuesday's announcement virtually ends the a 30-year career for Hayward, who will become a non-executive director of BP's Russian joint venture. He leaves the CEO job with a $1.6 million severance payout on top of a pension valued at $17 million, which will pay him close to $1 million a year.
Hayward, who formally will step down Oct. 1, took over as CEO less than three years ago, succeeding Lord John Browne, who oversaw a period of cost-cutting that coincided with a string of accidents and safety violations, including the Texas City explosion.
Dudley vowed to continue to overhaul BP's corporate culture. He's got his work cut out for him. The company's problems, say industry observers, can be traced partly to a series of acquisitions including Amoco, ARCO and Castrol. The huge company operates with four separate units, each of which has its own board of directors.
"BP never fully integrated its big acquisitions," said former Shell Oil CEO John Hofmeister. "They had an entrepreneurial, strategic CEO in John Browne. Tony Hayward tried to make some changes. But I think now (Dudley) really has to get down to the boring bits — the structures, the processes, the systems that the company needs to really run like an institution."
Restructuring assets
The company is already restructuring, selling off pieces of itself to help pay for the estimated $32 billion cost of cleaning up the Gulf, including damage claims to local business and property owners. Though the ultimate price tag could go higher, BP Chairman Carl-Henric Svanberg said Tuesday the company has enough financial might to cover it.
"We have $250 billion of assets, so it corresponds to about 10 percent of our total asset base," he said. "Any company of our kind will have always some assets that have higher value to others than to us. So although this is a crisis nobody would have liked to happen, it also gives a moment when we can reassess those assets."
When you skim off the cost of the Gulf spill, BP is one of the world's biggest cash machines. The company operates in 80 countries, with major exploration and production in Angola, Egypt, Libya, the North Sea, Oman, Latin America, the Middle East, Russia, Trinidad, the United Kingdom and the United States. Those wells, along with substantial refining and marketing operations, generated revenues of $75.8 billion in the latest quarter, up 34 percent from a year ago.
With underlying profits of roughly $5 billion a quarter, BP could pay off the estimated cleanup cost in less than two years — without selling a single asset. Those costs could rise, especially if the company is found to be "grossly negligent" in a series of class-actions lawsuits wending through the courts.
But Dudley said he's confident that won't happen.
"We've seen nothing that indicates that we were grossly negligent in any way," he said Tuesday. "If you look at the Marine Board testimony from last week, you'll begin to get an idea why we believe that. If we thought we were, we would have put bigger numbers in terms of the ($32 billion in) liabilities. We think it's a fair estimate."
Preliminary results of the accident investigation are due next month and may assign responsibility to the various players in the accident, which include TransOcean, the operator of the rig; Halliburton, which performed a critical operation sealing the well; and Cameron, the company that made the device that failed to seal the well blowout.
Other major oil company CEOs have sought to distance themselves from BP's failures, saying the accident would not have happened if their company had been overseeing the well. But even as he pledged to apply lessons learned from the disaster, Dudley made clear that BP was not a rogue industry player.
"I think the entire Gulf of Mexico energy industry is going to be altered by this accident," he said. "We're going to find it's people, judgment, individuals, multiple equipment failures, of many companies, (were) involved. And we're going to make sure we share all of that as well."
The results of the investigation could help ease the tense relationship between the company and Congress and the White House, which imposed a moratorium on new drilling until the causes of the accident are better established. As the largest rig operator in the Gulf, BP will be among those most severely affected by tighter regulation and oversight.
Dudley said he's hopeful relations with the government are improving.
"The rhetoric was very heavy a few months ago, and I think what the president has said -- and what officials now say often -- is that the last thing they want to do is to damage BP," he said. "A strong and viable BP is in the best interest of the United States; it's in the best interest of the Gulf coast."
Dudley now takes on the task of righting a company that proved unmanageable for the two most recent predecessors. If he can't, BP will be seeking another CEO to get the job done.


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Celebrating the Fourth
Here's a sampling of local holiday fireworks and festivities.
ALTAMONTE SPRINGS July 3 Red, Hot and Boom features live entertainment brought to you by XL 106.7 Radio, children's activities, food, drink and a fireworks display set to music. 4-11 p.m. Free. Cranes Roost Park, 150 Cranes Roost Blvd. uptownaltamonte.com
AVALON PARK July 4 This traditional celebration includes an apple pie bake-off, a hot-dog eating contest, and fireworks. 5 p.m., with fireworks beginning at 9. Free. Five miles south of S.R. 408 off Alafaya Trail. 407-658-6565. avalonpark.com
BALDWIN PARK July 1 This event will have a hometown feel with vendors from 4-10 p.m. on New Broad Street and fireworks taking place at 9 p.m. off of Lake Baldwin, downtown Baldwin Park. 407-745-9345.
CELEBRATION July 4 Go back in time with live entertainment and fireworks. Free. Celebration Town Center on Front Street, Celebration. 407-566-2200. celebrationtowncenter.com/events
CENTRAL FLORIDA ZOO June 30 and July 1 Red, White and ZOO will be held from 9 a.m.-3 p.m. and will feature animal encounters, live music, games, food and children's crafts. 3755 U.S. 17-92, Sanford. centralfloridazoo.org
THEME PARKS July 4 Walt Disney World, Universal Orlando Resort and SeaWorld Orlando will have festivities and fireworks, starting between 9 and 10 p.m. Included with admission. disneyworld.disney.go.com; universalorlando.com; seaworldorlando.com
ORLANDO July 4 The city's annual Fireworks at the Fountain offers entertainment, food and a kids area. 4–10 p.m. Fireworks begin at 9:30. Free. Lake Eola Park, 195 N. Rosalind Ave. 407-246-3104. cityoforlando.net
WINTER GARDEN July 4 The Party in the Park will celebrate with live music, family activities, food and fireworks. Begins at 5 p.m., fireworks at 9:15. Free. Newton Park, 29 W. Garden Ave. wintergarden-fl.gov
WINTER PARK July 4 An old-fashioned party in the park presents the Bach Festival Brass Band and Choir performing patriotic music, horse-drawn wagon rides, live entertainment and children's activities. 9 a.m.-1 p.m. Free. Central Park, Park Avenue, Winter Park. 407-599-3203. cityofwinterpark.org


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Implement network interface default labeling for Smack
Today all unlabeled networking traffic is treated with one "ambient" Smack label. This project consists of taking advantage of mechanisms already in the labeled networking code to allow different labels to be assigned to packets based on the interface upon which they appeared.
Contact: Casey Schaufler - casey (at) schaufler-ca.com
Difficulty: 5
Language: C


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This Wood Pen & Ink Calligraphy Journal Set makes an ideal gift. Features Wood Pen, two Bottles of Ink, Blotter and Hardcover Writing Journal all in an attractive Gift Box. Made in Italy.
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The Big Dig made things look easy. Sure, it cost a fortune, took forever, and caused countless engineering headaches. But for reach, the project can't be touched: The demolition of the hugely disruptive highway unlocked billions of dollars in economic development, from North Station to South Boston and Chinatown. The Southeast Expressway came down, and the rest snapped into place. Easy.
Things are not so simple in Boston's outlying neighborhoods. The generation of engineers that ran the old Southeast Expressway between Boston's downtown and its waterfront sent scores of similar roadways barreling through the city's neighborhoods. These roads are smaller in scale than the downtown highway was, but they're no less disruptive. They're only now beginning to fall, a decade after the old elevated Expressway gave way to a manicured surface boulevard. And chopping the Expressway's offspring down to size is just the first step. The fact that these mini-highways are dying, in and of itself, means almost nothing. It's what comes after the roadways' demise that really counts.
Jamaica Plain's Casey Overpass, Charlestown's Rutherford Avenue, and Roxbury's Melnea Cass Boulevard will all be disassembled in the near future. State construction crews are preparing to replace the Casey, a rickety overpass from the 1950s that soars high over Forest Hills, with an at-grade boulevard. City planners are close to narrowing Rutherford, a wide speedway that runs the length of Charlestown between Sullivan Square and the edge of the Mystic; the lost traffic lanes will become greenery, paths for walking and biking, and on-street parking. Melnea Cass, the 1960s-vintage artery that covers the ground cleared for the unbuilt Inner Belt highway, will become a tree-lined street where cars share space with buses, bikers, and walkers.
All three projects draw on the Big Dig playbook: They repair the relationship between urban neighborhoods and the roads that run through them. Engineers built the Southeast Expressway, the Casey Overpass, Rutherford, and the Melnea Cass/Inner Belt corridor for the convenience of drivers passing through Boston neighborhoods, on their way to somewhere else. At the same time, these mini-highways darken the streets around them and discourage neighborhood-level economic development. The slimmed down, reformatted roadways should bring Bostonians closer to each other, and to the transit network that knits the city together.
As things stand now, the Casey severs the Emerald Necklace park system, and it cuts Jamaica Plain off from Forest Hills (the neighborhood, and the Orange Line stop). Rutherford causes Charlestown to dead-end in a tangle of fast-moving car lanes, with residents sitting on one side, and the subway stations they use on the other. Melnea Cass is an asphalt moat lined with vacant, publicly-owned parcels that keep Dudley Square at arm's length from the South End.
The huge roadways are only part of the problem, though. They darken neighborhoods because they replace active civic space with high-speed traffic, but an at-grade Casey Overpass or a slower, narrower Rutherford won't automatically become the kind of catalysts for sweeping change that the Big Dig became. Each still needs a plan to take advantage of new, neighborhood-friendly roadways.
Residents shouldn't settle for simple road beautification projects. They should demand the kind of transformative redevelopment efforts the Big Dig showcased. Both Jamaica Plain and Charlestown have the elbow room to pull this trick off. There's enough publicly owned real estate lying around Forest Hills, Sullivan Square, and Community College (the latter two are major nodes along the Rutherford corridor) to jumpstart the creation of the kind of tightly knit, pedestrian-focused neighborhoods the road reconstruction projects enable. What's needed is the land, and the zoning, to give the opportunities running room.
The city and state are previewing this sort of leap along Melnea Cass. It's happening quietly, but it has clear parallels in Forest Hills and Charlestown. The act of leveling thousands of Roxbury homes for the Inner Belt highway left both the city and state in possession of strips of vacant land along a roadway that now looks like a sort of mini-Inner Belt. So at the same time that Boston is putting the roadway on a diet, the city and state are actively encouraging the creation of new, dense development on the new road's edges. The construction projects will reassert Roxbury as a destination, not just a place to speed through. And they'll serve as a reminder that, even when highways disappear, the work is still only half finished.
Paul McMorrow is an associate editor at Commonwealth Magazine. His column appears regularly in the Globe.


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American Winter Premiere this Sunday
February 11, 2013
Please join us on February 17 for the premiere of American Winter at the Portland International Film Festival.
Working with local non-profit 211Info, filmmakers Joe and Harry Gantz document the struggles of eight Portland families.
This morning, Nick was proud to join Carl Wolfson for Carl in the Morning to discuss the film and Sunday's premiere. Listen to the interview online here.
Sunday, February 17 - 3 pm
Portland Art Museum Whitsell Auditorium
1219 SW Park Avenue
General admission is $11; buy tickets online now
Immediately following the premiere, the filmmakers will host a benefit reception for 211Info.
Sunday, February 17
Immediately following the film
Portland Art Museum – Fields Ballroom
Today, February 11 (2/11) is National 211 Day, a day to recognize and thank the often life-saving number: 2-1-1. Millions of Americans depend on the services 2-1-1 lines provide nationwide.
Special thanks to our own 211Info for being a great partner and supporter for Oregon families.
American Winter on Carl in the Morning
Chuck Sheketoff in BlueOregon


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This piece opens OurKingdom's new debate, "Uneconomics".
When economists Lucas Papademos and Mario Monti were parachuted in as Prime Ministers of Greece and Italy respectively in November of last year, this heralded a new era in the power of the economics profession. With questions still being asked about the failings of economics and economists in the build-up to the financial crisis, this technocratic rebuke to democracy was further evidence that this crisis is entrenching existing elite power, rather than weakening it. Not that you would hear any of this being discussed in an economics classroom.
In the same month, Harvard economics students staged a walkout from the classroom of conservative economist Greg Mankiw, accompanied by an open letter explaining why. As the letter argued:
Harvard graduates play major roles in the financial institutions and in shaping public policy around the world. If Harvard fails to equip its students with a broad and critical understanding of economics, their actions are likely to harm the global financial system. The last five years of economic turmoil have been proof enough of this.
Elsewhere, the documentary, Inside Job, contained startling reports of how senior economics professors had been paid large consultancy fees to report that economies such as Iceland's were fundamentally sound. From the 1990s onwards, a number of senior American economists repeatedly 'discovered' that financial derivatives were reducing risks within the financial system.
We now know that the financial crisis has produced a depression in many Western economies, which will destroy lives and many cherished public institutions. According to the figures of the UK government, living standards in 2015 will be lower than 2002. One of the ingredients of this crisis was that the financial system (including its regulators) was a mineshaft crammed with canaries, scarcely any of whom had any inclination or ability to sing. Those that did, such as Nassim Taleb or Nouriel Roubini, have since acquired the status of gurus for this single reason.
And yet, five years on from the origins of the crisis, the power (if not the authority) of economics in public life is, if anything, greater than it was before. Credit-rating agencies make governments shudder with their risk models. The UK government's austerity programme was backed up by zany claims from conservative economists (especially in the think tank Policy Exchange) that rapid cuts in public spending would result in economic growth. When these predictions turned out to be false, few even bothered to register their surprise.
As Woolfgang Streeck recently argued, there has always been an implicit tension between the demands of economic experts and those of democracy, but the crisis has elevated this to a new level. We are used to elected politicians (such as Ruth Kelly and Vince Cable in Britain) being trained economists or to economic advisors shaping undemocratic regimes (such as Milton Friedman in Chile in the 1970s or Jeffrey Sachs in Russia in the 1990s). But, until 2011, we had never witnessed the phenomenon of economist as unelected Prime Minister.
It is time to acknowledge an uncomfortable truth about the public status of economics as an expert discipline: it has grown to be far more powerful as a tool of political rhetoric, blame avoidance and elite strategy than for the empirical representation of economic life. This is damaging to politics, for it enables value judgements and political agendas to be endlessly presented in 'factual' terms. But it is equally damaging to economics, which is losing the authority to describe reality in a credible, disinterested, Enlightenment fashion.
The status of economists in public life has taken many twists and turns, since Adam Smith's Wealth of Nations was published in 1776. The classical political economists, such as David Ricardo and John Stuart Mill, were engaged public intellectuals, whose analysis covered institutions, politics and morals. It was only after the 'marginal revolution' of the 1870s that economics reappeared in its neo-classical manifestation, the form with which we associate the term 'economics' today. In drastically delimiting the scope of economics to the study of rational decision-making by individuals, the marginalists withdrew from describing capitalism or society, creating space for rival social sciences to emerge for this purpose.
The methodology of neo-classical economics famously presupposes that human beings are rational maximisers of their own utility. This idea has worked wonderfully for the economics profession as a basis for model creation, but dreadfully badly for the world that economics purports to describe. It has generated images of economic life, which are excessively simple and quantifiable. The political and cultural function of economics (which, with the notable exception of Deirdre McCloskey, economists have scarcely ever reflected upon) has become one of stripping out ambiguity and complexity. Their usefulness to politicians lies in the rigidity and global reach of their methods, but not necessarily in the truthfulness of their findings.
Two caveats should be made in defence of economists at this point. Firstly, many neo-classical economists go to great lengths to acknowledge the unrealism of their methodological assumptions. As Gary Becker, the esteemed Chicago School economist, likes to put it, neo-classical economics is simply one particular "approach" to human behaviour. This apparent humility then enables Becker and his acolytes to extend this 'approach' into all walks of life without any further justification for doing so, as popularised in the best-selling Freakonomics.
Secondly, economists are typically far more alert to the frailty of economic knowledge than those they are advising. Academic economists will stress the presence of 'uncertainty' underlying all situations, highlight the limitations of their data and qualify their presuppositions. The problem is that adrenalin-fuelled bankers, over-worked politicians and regulators have little interest in such nerdish conditionality. They want numerical answers with which to defend their actions.
The bizarre truth, then, is that economics has attained its current pre-eminence in public life through saying as little as possible about the institutions, character and practices of contemporary capitalism. Combining acute humility regarding the realism of its premises, with the appearance of certainty regarding its conclusions, it has created a dangerous form of rationalism that is deeply entangled with economic life, while being entirely unable to reflect on that fact.
The discipline has performed a modicum of self-criticism over recent years through admitting findings from two rival fields, namely psychology and biology. Behavioural economics, neuro-economics, happiness economics (as debated here on OurKingdom), ecological finance and complexity theory are now being looked to, in search of a more realistic vision of economic life. George Soros's Institute for New Economic Thinking, which was founded in 2009 in response to the financial crisis, is dominated by these modified versions of neo-classical economics. Andrew Haldane of the Bank of England has seized on many of these schools of thought, to criticise the status quo. While efforts by economists to re-engage with economic reality must be welcomed, there is still a total dearth of institutions, power or culture in the portraits that these sub-fields paint.
Yet this is far from true across the social sciences more broadly. Following the marginal revolution, sociologists took up the task of describing the institutions and regulation of industrial capitalism, which economics had abandoned. Anthropologists asked fundamental questions of economic life, regarding the nature of exchange, of money and of production. Political economy survived in various Marxist, evolutionary, Keynesian and neo-institutionalist traditions, which now go under the umbrella term 'heterodox economics'.
Leading figures from these disciplines have attained great public influence in the past. Keynes's role at the 1944 Bretton Woods conference is the leading example, but evolutionary economists (such as Richard Nelson in the US), sociologists (such as Anthony Giddens in Britain) and Marxists (such as Michel Aglietta in France) have all performed roles as senior economic advisors to governments. But neo-classical economic thinking has become the vernacular of contemporary government, and much of what these thinkers address would nowadays be described by policy-makers as 'externalities', the neo-classical term for that which occurs outside of the market price system.
As a contribution towards reversing some of these trends, OurKingdom and openEconomy are hosting a debate entitled 'Uneconomics'. Commissioning and inviting contributions from sociologists, anthropologists and heterodox economists, the debate will seek to further public understanding of economic life and the present crisis in two ways.
Firstly, we will seek contributions from social scientists doing detailed empirical work inside the dominant institutions of contemporary capitalism. For example, the 'social studies of finance' has greatly illuminated institutions such as derivatives, stock markets, trading screens and Wall Street culture, thanks to ethnographic work of scholars such as Donald MacKenzie and Caitlin Zaloom. The skills to watch and to listen – in the hands of journalists such as Michael Lewis and the anthropologist-turned-journalist Gillian Tett - have proven far more important in furthering our understanding of the current crisis than orthodox economics.
Sociologists, anthropologists and 'cultural economists' also have important things to say about institutions such as debt, accounting, regulation and credit-rating. The anthropological insight, that how we represent things affects how we act, has become more widely accepted since the beginning of the crisis; think how the practice of 'mark-to-market' accounting has been held up as one of the culprits for the banking crisis. But public debate is typically denied the insights of anthropologists and sociologists.
Undoubtedly this is partly the fault of scholars themselves, who either refuse to or fail to present their evidence in ways that meet the demands of a numbers-hungry, attention-deficient media. But if we accept that simplistic, mechanical portrayals of economic life contributed to our current crisis, then we must also create more space for nuanced and ambiguous depictions of reality. Strangely, this has been accepted in management theory for decades, but public policy-making still clings to a machine-like view of the world.
Secondly, we will seek contributions which reflect critically on the relationship between social sciences and the state. Sociologists such as Marion Fourcade and Peter Wagner have written extensively on the co-evolution of social sciences and public policy, while Phillip Mirowski has provided brilliant studies of the history and delusions of economics. Science studies scholars, such as Michel Callon and Fabian Muniesa, now analyse economics purely as a facilitator of economic activity, rather than as its representation. Manchester University's CRESC centre has published numerous papers on the present crisis as an 'elite debacle', in which particular experts failed in their public duties.
But how might things be done differently? How could the stranglehold of the neo-classical worldview over public policy be weakened (if it should be at all)? What are the historical precedents of more nuanced, culturally-attuned forms of social science being used as a basis on which to form public policy and advise politicians? And how can public understanding of capitalism be furthered, in ways that don't simply replace one blanket explanation (the rational maximiser) with another (the brain)? Could the marginal revolution be reversed, and classical political economy be put back together again?
These questions are not new. But their urgency is heightened by the present crisis. Of all the social sciences, economics has proven itself to be the most politically useful – some might say politically malleable – but its lack of realism has become a critical issue with serious economic and political consequences. 'Uneconomics' is needed to explore alternative forms of expertise and advice, and an alternative basis for public economic debate.
The second article in the debate, by Judith Marquand, will be published early next week.
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Dragged into the 21st Century
Did you wake up this morning the proud/confused/intimidated owner of something small, electrical, and vaguely rectangular? Did you smile meekly last night while your loved ones looked on with bated breath as you apprehensively ripped open the packaging and did they cheer and clap their hands welcoming you into the technological age?
And did they notice when you reached for that glass of single malt and took a gulp instead of a sip? Thousands of years in the future, archeologists will discover that man had a propensity to collect random items and leave them in their boxes. Often, they will claim to skeptical crowds, these gifts ran off of some obtuse energy source which was, no doubt very rare, since these gadgets seem to be hardly used.
Furthermore, they will note, primitive humans had a propensity to acquire the same gadget with slightly better features despite barely understanding the gadget's predecessor.
Have another sip of scotch. Oh, I forgot it is the morning after. Well you can always lace your cereal if you do it discreetly.
We are all entering the technological age, whether through brave adventurism, or without choice. You might as well take a deep breath and plunge in. Who knows, you might actually enjoy it.
Such things as cell phones and iPods seem to be accepted by all but a brazen few, even if the desire for the latest phone has nothing to do with actually making a call. The battle, for now, is over the tablet. The world (at least those of us who don't need to worry about the little things like a roof over our heads, food at our next meal, or what's in the water supply) is divided into three groups.
1. Embracing the technology. These people don't just read on their iPad, Kindle or Nook, they embrace it, often with an annoying missionary zest. They don't take it out of their bag at the coffee shop or on the bus, they brandish it, like a mighty sword from days long past.
They are liable to chastise you, often in a smug, sympathetic way, as you balance your hardcover on your lap. "Oh," they whine in true Bob Dylan style, "How many trees does a Luddite reader fell…" When dealing with these people, it can be advantageous to note that the hefty hardcover has a distinct advantage over the light, sleek screen – it is far more effective when you take a swing at aforementioned annoying individual.
2. Luddite Conviction. No way! We are already spending too much time on screens. A book is more than just words on paper. You can smell it, feel the page crackle as you move through the novel, feel the weight of the author's perseverance as you hold his/her masterpiece in your hand… And then the classic, yet oft-doomed line: It will never catch on.
3. Dithering in the Middle. There is some middle ground. I have to admit that I love my Kindle. It is light, convenient, and I get a kick about the environmental aspects. I am also a confirmed Star Trek fan. However, I do also miss the feel and smell of the book. I love the art of a well thought out book cover, and I also love reading while soaking in a hot bath. My bookshelves are an important part of my identity in our house and I hope sets a certain tone with my family.
So, some Advice for The Morning After:
Firstly: Don't Panic! Take a deep breath and slowly unwrap the gadget and take it out of its box.
Then: Go on your computer and find either the website for the company or go to You Tube. There are some really good, simple, step-by-step videos for people like us. I know, half of my readers are men and we read instruction manuals like we ask people for directions (btw – you might have a GPS navigator on your tablet).
Finally: Have another whisky. It is the holiday season after all. And take note: if you are reading this blog, then you have already embraced the blogosphere: the cutting edge of the Internet. You are already firmly in the 21st century, dude. YOU CAN DO THIS!
Oh, and if you did receive a Kindle, iPad, or whatever, this might be a good first book to read on your gadget (couldn't resist!).
Happy Hols'
Alon Shalev is the author of three social justice-themed novels: Unwanted Heroes, The Accidental Activist and A Gardener's Tale. He is the Executive Director of the San Francisco Hillel Jewish Student Center, a non-profit that provides spiritual and social justice opportunities to Jewish students in the Bay Area. More on Alon Shalev at http://www.alonshalev.com and on Twitter (@alonshalevsf).


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|Love Letters, Traffic Stopper Copper
Disclosure: I purchased these.
|Love Letters, Traffic Stopper Copper
About me: I enjoy reviewing the makeup and beauty products I buy as well as reading reviews from others. Skincare concerns: oily/congested, aging, and sun damage. Fortunately, the semi-tropical climate and humidity of where I live helps me from looking like the crypt keeper, in spite of all those years soaking up the sun :-) So let's talk skincare and makeup and anything else that strikes our fancy.


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I am writing this post while curled up on the sofa, wrapped in a warm blanket, my mind and body swimming with sugar, surrounded by piles of empty wrappers. Yes…it's Halloween night! I've consumed enough Laffy Taffy to giggle for days, and enough snack size chocolate bars to build a buffet. You might assume that having eaten more than my share of sweets, they would be the furthest thing from my mind, yet that is simply not the case! But instead of thinking of the traditional Halloween candy, of which I have just immensely partaken, my mind is on the Halloween candy of the future. Or, more specifically, the new candy of today that may become the traditional candy of the future.
With all the exciting new treats that are created every year, and the fact that most of us (myself included) most often eat the same few favorites we've been eating for as long as we can remember, it can be easy to miss some bright new stars in the candy circuit. But for as satisfying as Peanut M&Ms may be, and as perfectly sweet as Trolli Gummi Peaches, its only fair to give the new candies a taste as well, for their benefit and our own! After all, what if nobody every tried that first handful of Peanut M&Ms many years ago and they weren't still with us today? I know, I'm sorry…I shouldn't have gone there. It's too horrible to imagine, but I'm trying to make a point, so bear with me! And my point is simply that we should take a peek and lend a taste bud or two to some of the newest candy creations…
Hershey's Air Delight Chocolate Bars – You already know how delicious Hershey's chocolate is, and that much of the enjoyment of eating chocolate is in relishing its many tantalizing consistencies, so it's only natural to want to give a new consistency a try – aerated chocolate! Bursting with airy bubbles, the Air Delight bar is unlike anything you've ever tried before, while still being decidedly 'Hershey's.'
Skittles Blenders – As far as I'm concerned, with the possible exception of the green ones (sorry, green fans!), original Skittles are pretty much perfection in the non-chocolate category o' candy. They're my go-to favorite at the movies, I NEVER get tired of them, and even after all these years I can't decide if I like the red or purple better. Ahh, they're both so good! And the orange, and the yellow… Yes, original Skittles will make my '5 Candies You Can Bring to a Deserted Island List' every time, no matter what. But for as strongly as I feel that the original is their best work, I have to admit that I've recently been more drawn to Skittles Blenders. It may be the rush of a new romance; the way the Melon Berry Burst makes me feel young again! It may be their brilliantly bright colors. It may be the way they dance across my tongue, exploding in a fruity splash of Skittles-tastic-ness! Whatever it is, please don't tell original Skittles. I'm sure I'll return to my true love one day, but for now I'm rather enjoying my Blenders adventures!