Monthly Archives: February 2020

Parties to Iran's nuclear deal made little progress on Wednesday towards saving the agreement as Iran is still breaching many of its central terms in response to U.S. sanctions, but efforts to ease Tehran's economic pain continued, delegates said.

Wednesday's meeting of senior officials came more than a month after European parties to the deal - France, Britain and Germany - formally accused Iran of violating its terms, setting off a process that could eventually reimpose international sanctions lifted under the agreement.

Israel's ready for corona - but not for women in powerHaaretz Weekly Ep. 65

But, in a move underlining how torn the Europeans are between pressuring Iran not to breach the deal and still trying to save it, the European Union's foreign policy chief said this month the powers would indefinitely extend the time limits in that process to avoid having to reimpose sanctions.

Delegates said that process, known as the dispute resolution mechanism, was not even discussed at Wednesday's meeting, though the Europeans did criticize Iran.

"Serious concerns were expressed regarding the implementation of Iran's nuclear commitments under the agreement," the EU foreign policy service's Secretary General Helga Schmid, who chaired the meeting, said in a statement.

"Participants also acknowledged that the re-imposition of U.S. sanctions did not allow Iran to reap the full benefits arising from sanctions-lifting," she added.

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Iran has breached several central limits of the deal, including on its stock of enriched uranium, in response to the U.S. withdrawal and Washington's reimposition of sanctions that have slashed Iran's oil exports.

Together its ongoing breaches are eroding the deal's central aim - keeping Iran a year away from being able to obtain enough fissile material for a nuclear bomb if it chose to. Iran says it can quickly reverse its breaches if U.S. sanctions are lifted. Washington says its campaign of "maximum pressure" will force Iran to negotiate a more sweeping deal.

Speaking to reporters after the meeting, Iran's Deputy Foreign Minister Abbas Araqchi focused on European efforts to set up a vehicle that will allow a small amount of barter trade with Iran, known as Instex, which has yet to perform a transaction.

"It is important that we can say that the JCPOA is still alive," he said, referring to the deal by its full name - the Joint Comprehensive Plan of Action.

"We know that the Europeans are trying. We know that there is willingness but the lack of ability is obvious."

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Parties to Iran nuclear deal meet but make little progress on saving it - Haaretz

Decades after the steel industry left Beaver County searching for a new identity, county officials are using those lessons learned to prepare for life after Shell.

Its said that insanity is doing the same action and expecting a different result.

Well, no one can tell the Beaver County Board of Commissioners theyre insane.

As completion looms on Shell Chemicals ethane cracker plant, the three men leading Beaver County into the future know they cant make the same mistakes the county made in the past.

Whether its planning capital projects out ahead to make sure that 20-year-old facilities will last a long time or making sure that all of the countys workforce eggs arent in Shells basket, Commissioner Chairman Daniel Camp, four-term Commissioner Tony Amadio and newly elected Commissioner Jack Manning believe the groundwork is laid for the county to not repeat the mistakes of the age of steel.

The board two terms ago spent time visiting other developments to see what happened after the initial construction boom, Camp said. And they saw hope.

Its the ancillary jobs, the downstream jobs that hopefully these companies are going to want to cut out the middleman and be closer to the source of their product, which is the plastic pellets, Camp said. Whether its in Beaver County, or Butler, Washington or Lawrence counties, as long as its in our region it will be a win for Beaver County.

Amadio shares that optimism, and believes that undeveloped riverfront properties could draw businesses who want to keep their transportation costs down to the Beaver Valley.

Hopefully, were going to be able to draw on businesses that will come here because they use the feedstock thats going to be produced from the cracker plant, Amadio said. For instance, I use Mattel toys, or any company that uses plastics in their product, thinking they can get their processing plant close to where the actual feedstock is, theyll save a lot of money.

And as that happens, Manning said, the county could grow more diverse.

I see Beaver County starting to grow more diverse economically and in population I think we have to, Manning said. It bodes well for the area to have a much more stable, much more diverse economy where were not putting all our eggs back in the petrochemical basket, any more than we were so reliant on the steel.

Amadio thinks that county leaders can learn from the exodus of the steel industry, but has faith that the oil and gas industry will be around just as long, if not longer, than steel was.

Were sitting on the BTU equivalent of Saudi Arabia. This product, this industry, is going to be here a very long time, Amadio said. The steel industry lasted what, 100 years, 80 years. So if we can get that out of the gas industry, that would be a pretty good plus for the county.

Camp said there has already been a lot of growth that will stay out of Shells investment.

Were already starting to see the Shell facility changing Beaver County to the point where were starting to see restaurants and hotels and things that might not have made the investment into Beaver County that wouldnt have made the investment, Camp said.

And some of that diversification that Manning maintains is needed is happening near the plant already health care expansion and other educational and social services cropping up by the Beaver Valley Mall, just a handful of miles from the cracker plant.

In Beaver County after decades of decline and struggle, were hopeful to find meaningful work and jobs, Manning said. But we still have significant challenges.

Continued here:

Progress 2020: Learning from the past to build a future post-Shell - The Times

Rachel OLone often has to explain her future job to people.

Anytime I say that I am a veterinary technician or I am going to school to be a veterinary technician to someone, theyre like: Oh, what is that? she said. And I have to be, Oh, its like a veterinary nurse. I always have to say nurse for them to even know what it is.

OLone is president of the Veterinary Technician Club and a second-year veterinary technology program student at Joliet Community College in Joliet, Illinois. OLone believes that changing the professional title from certified veterinary technician to registered veterinary nurse would help indicate to pet owners how important her role in the veterinary care team is.

In the veterinary field, we are respected as nurses, but I think the public just doesnt realize what we do and all that we do, OLone said. One of my (human health) nursing friends said: Oh, I just thought you were the one who weighed the dog. And Im like: No, oh, no, no. I am running the anesthesia during surgery.

The National Association of Veterinary Technicians in America formed the Veterinary Nurse Initiative in 2016 to unite the name change efforts.

Kenichiro Yagi, president-elect of NAVTA, said there has been some progress with the VNI. To date, no state has amended its laws to change the title. NAVTAs VNI has made strides in other areas.

I think one of the things we focused on in 2019 was to make sure people knew what VNI was about, Yagi said. I think people focus on the title a lot, which is really important for us, but at the same time, there is a lot more riding along with it.

The veterinary technician associations VNI has the following goals:

Erin Spencer, past president of NAVTA, said the organization has been focused on professional recognition within the veterinary industry for the past few years and it has paid off.

NAVTA has a seat at most tables now. For example, this past July, NAVTA was elected as a member of the World Small Animal Veterinary Association.

We have the profession and the veterinary community behind us, she said, noting that moving forward, efforts will focus on public education. Lets move out and start having those conversations and getting that education to the public so they can also support us.

Along with public education, NAVTAs VNI is working on finding solutions to title protection issues by building resources for members. Last year, the VNI created a Title Protection Task Force to specifically address this problem after continuing to hear of clinics not making a distinction between their credentialed veterinary technicians and those who learned on the job. The task force sent out a survey asking those in the veterinary profession what they knew about their state law on this matter and, if there was a law, whether it was being enforced. The VNI and NAVTA aim to create practical guides later this year based on the responses received from the survey to help individuals and organizations advocate for title protection.

We are trying to get fine details of what the current status is and get that out there and be able to say, in these states where title protection looks like this, we should be doing this, Yagi said. When there is no title protection or licensure, we should be doing this. Trying to make some suggestions as to how to improve the situation.

On the legislative front, NAVTAs VNI is still trying to pass a bill in Ohio to establish the registered veterinary nurse title. SB 131 passed the House last year and has been in the Senate Agriculture and Natural Resources Committee since last May.

The other state the VNI targeted last year, Indiana, also saw the introduction of a title-change bill, which made it to the Senate last February but failed to pass by a handful of votes. VNI advocates plan to reintroduce the bill this year.

Similar legislation was introduced in Georgia last year, but it failed to get a vote in the Senate. Yagi said the plan is to move forward without the bill and instead work with veterinary entities to change the title through regulatory and other means.

Finally, NAVTAs VNI is working with veterinary and veterinary technician organizations in Oklahoma to determine how to proceed with changes in that state.

At the same time, veterinary technician leaders have found themselves playing defense as well.

NAVTA and the VNI successfully opposed bills in Maine and North Carolina that proposed establishing an apprenticeshipexperience only rather than formal educationroute to obtain a veterinary technician credential. Veterinary technicians were taken off the list of occupations in these two states, thus preserving requirements for licensed technicians to graduate from an AVMA Committee on Veterinary Technician Education and Activitiesaccredited program and pass the Veterinary Technician National Exam.

Further, a bill that would have established licensing qualifications for veterinary technicians in Montana died last spring. HB 179, championed by the Big Sky Veterinary Technician Association, stalled in the Senate Agriculture, Livestock, and Irrigation Committee in March.

More recently, in West Virginia, HB 4813 was introduced in February that would remove licensing requirements for veterinary technicians in the state, according to the bill language. NAVTAs VNI has put out a notice on social media for advocates to contact lawmakers and express their opposition.

On the education front, the Michigan State University Veterinary Technology Program has moved to change its name this spring to the Veterinary Nursing Program. The name change was approved by the MSU academic governance. The MSU program joins six other programs that have changed their name to veterinary nursing.

Eileen McKee, a certified veterinary technician and program director of veterinary medical technology at Joliet Community College, tries to prepare her students for life as a veterinary technician, and that includes making them aware of the positives and negatives of the career.

I love teaching. I love seeing these guys get so excited about what options they have in this career, McKee said. I try to teach these guys, if in 20 years your back hurts, dont quit the field. Realize there are so many other opportunities for you. There is room for continual advancement.

McKee tries to prepare her students for the financial realities of the career, too. She agrees with the overall efforts of NAVTAs VNI, but she thinks title protection is key.

I think if you change the name but youre not protecting it, its a moot point, she said.

McKee has been on the faculty at JCC for 17 years and the program director for two years. She said she has tried to make changes to the program by focusing on the academic side as well as practical skills such as communication, veterinary terminology, and administering anesthesia.

Only two states do not have some form of credentialing for veterinary technicians, but states vary greatly with regard to definitions, standards, title protection, and scope of practice for veterinary technicians.

The American Association of Veterinary State Boards Regulatory Policy Task Force completed a draft of its Veterinary Technician Scope of Practice model regulations in late 2019. The AAVSBs newly proposed model regulations would delineate health care tasks that may be performed by veterinary technicians or veterinary technologists and would assign the appropriate level of supervision requiredimmediate, direct, or indirectfor each of those tasks. While some state boards do have regulations for veterinary technician scope of practice, this is the first model document that state boards could use to achieve a consistent standard across the country.

NAVTA and the VNI have provided input into the proposed model regulation language through representation on the task force. The association is currently receiving feedback on the draft, and the model will likely be available in the spring, said James T. Penrod, executive director of the AAVSB.

He said the AAVSBs model practice act already addresses the practice of veterinary technology, but the veterinary technician scope of practice model regulations will provide language that AAVSB member boards can use when enacting regulations. The process for passing regulations is typically easier than the process for changing statutes, so the model regulation language should allow member boards to more easily make changes they deem appropriate to the tasks veterinary technicians and technologists can perform, Penrod added.

In 2019, the AVMA Task Force on Veterinary Technician Utilization was created after the AVMA House of Delegates recommended asking the AVMA Board of Directors to convene a working group to design a plan to improve veterinary technician utilization.

The task force released its report during the AVMA Veterinary Leadership Conference Jan. 9 in Chicago.

The task force recommended, among other things, that the AVMA should encourage states to eliminate alternative routes to credentialing, so-called grandfather clauses, from state practice acts. It also suggested surveying credentialed veterinary technicians on a regular basis to track demographics, compensation, and utilization and surveying veterinarians to determine how many credentialed veterinary technicians versus veterinary assistants are employed in various practice types.

The Board referred the report to the AVMA Council on Veterinary Service, AVMA-NAVTA Leadership Committee, AVMA Veterinary Economics Strategy Committee, AVMA Committee on Veterinary Technician Education and Activities, and other entities for their consideration.

Despite the potential challenges, Rachel OLone is optimistic about the future of her profession. Although she hopes the name change will eventually happen, she has no concerns about her job prospects or her place within the industry. She already has two internships lined up and has plans to get into wildlife veterinary work after she graduates.

This is a growing field; I dont think well have a problem finding jobs, OLone said.

Link:

NAVTA's Veterinary Nurse Initiative a work in progress - American Veterinary Medical Association

IOWA CITY, Iowa (KCRG) - University of Iowa students, faculty and staff came together Tuesday at the campus Center for Diversity and Enrichment to break bread and recognize the progress their school has made in the last year.

This time last year, a group of students were advocating to be seen and heard and respected on our campus by not just the general population, but mostly just administrators, Isabela Flores, a fifth-year student, said.

Near the end of February 2019, Flores and sophomore Chris Vazquez were two of the students who started using #DoesUIowaLoveMe on social media. As the hashtag spread, more students shared their own experiences. Many of those stories had a common theme.

A lot of people were not feeling like they were included or that they belonged here on this campus in a lot of these spaces, Flores said.

Nadine Petty, the executive director of the universitys Center for Diversity & Enrichment, said it was difficult to read about these experiences.

When we read these stories, these very poignant, painful experiences, of course its painful because it shows us that were not doing as good a job as we need to do, Petty said.

It led to more collaboration between students and staff, particularly with the universitys Division of Diversity, Equity and Inclusion to figure out how to make the campus a more inclusive place.

Since then, Petty said the university has started new practices, the largest of which was the creation of a new position, the director of belonging and inclusion, which is currently held by Maria Bruno.

Theres great momentum around DEI work on campus, and thats what Im looking forward to and looking forward to seeing perpetuating down the road, Petty said.

Were definitely seeing that there are pockets and there are communities of people who are there for us, Flores said of the changes shes seen in the last year.

But she, Vazquez and other students are asking to see more of it, especially with the universitys leadership.

We arent seeing it necessarily from every administrator. We are seeing it from ones that are here tonight and ones that have always worked with students in general, Vazquez said.

Making sure that something like this doesnt have to manifest in order for change to happen, thats kind of my biggest thing, Flores added.

Excerpt from:

One year after #DoesUIowaLoveMe, some progress made, but more needed, on inclusion - KCRG

Curbside grocery pickups and home deliveries are growing in Beaver County. More and more, curbside grocery pickups, offered at local Giant Eagle and Walmart stores, are being welcomed as a time-savings measure by people on the go.

An increasing number of us are getting quicker at grocery shopping.

Now is a very interesting, dynamic time. Were seeing a little bit of everything, Giant Eagle spokeswoman Jonnah Jablonowski, a Beaver County native, said.

While the vast majority of grocery shoppers still prefer walking into a store, browsing then standing in line at the checkout, the Giant Eagle stores in Rochester and Hopewell Townships Green Garden Plaza are seeing a steady rise in curbside pickup orders.

The Hopewell store also offers home delivery.

More and more, curbside grocery pickup, also offered at local Walmart stores, is being welcomed as a time-savings measure by people on the go.

Giant Eagle began curbside pickup in 2012 at its Robinson Township Market District store.

We were kind of ahead of that curve, Jablonowski, who grew up in Economy, said. It took time to fine tune. We had a very steady roll-out as we saw customers get a little more comfortable with it. Now we have nearly 100 curbside markets, which is nearly half of our supermarkets.

For curbside pickup, customers scroll through a website on their computer, phone or tablet, and choose the products they wish to buy.

Free with a minimum $35 order, curbside orders must be placed three hours in advance of the desired pickup time.

You choose the time you want and a bar code online verifies you get the correct products, Green Garden Giant Eagle manager George McGrady Jr. said.

Customers pre-select online if they will allow substitutions. Say you wanted a 26-ounce bottle of a gourmet pasta sauce but the store is out of it; you instead could settle for a smaller size bottle of the same sauce, or perhaps accept a bottle from a similar competitor if that was your choice.

Were pretty good at getting you the next most reasonable thing, McGrady said.

Once the grocery store processes an online order, an employee collects from shelves the ordered food and places it in separate containers for freezer and refrigerator items. When the customer arrives and parks in a designated spot outside the store, they notify the store by phone, and their order is wheeled out to them and placed inside their trunk, so they need not exit their car.

Curbside pickup appeals to that audience that feels they dont have enough time to invest to step into the store, Jablonowski said. Its often families with young kids who dont want to have to pull them out of the car.

Curbside pickup also cuts down on impulse buying, like when a child sees something in the store and demands mom or dad buy it.

The Hopewell Giant Eagle began curbside pickup in August 2018; Rochester Giant Eagle began curbside pickup in October 2019.

Starting last year, the Hopewell store also began home delivery to two zip codes, 15001 (Aliquippa) and 15061 (Center Township) with a fee of $5.95 for next-day delivery, while orders placed for same-day delivery cost $9.95.

For home deliveries, Giant Eagle uses a company called Shipt, which is sort of like an Uber, transporting grocery orders to a persons home.

Robert Morris University student Marcus Joyce drives for Shipt and does home delivery from the Green Garden Giant Eagle.

Its a good thing. You get to help people out, Joyce said. Like the one lady I just delivered to had surgery so she cant get her own groceries. So its a nice way to help people out and earn extra money.

As customer demand increases, curbside and home delivery could be added to other Beaver Valley Giant Eagles.

We take a very strategic approach, Jablonowski said.

Always trying to stay on top of trends, area Giant Eagles also are slowly rolling out Scan, Pay & Go, an expedited self-checkout system for shoppers who still want to enter a brick-and-mortar store.

With Scan, Pay & Go, theres a big kiosk where customers can borrow a hand-held scanner they take with them through the store to chalk up the items they buy. You scan the products and bag them as you go.

So you move through the store more quickly, Jablonowski said. Instead of picking all your items and then going to self-checkout youre kind of doing that as you go. It eliminates scanning at a register. Weve seen customers excited about this. So were looking at ways to roll it out.

The rest is here:

Progress 2020: Grocery shopping now on-the-go (or home delivered) - The Times

JACKSON, MI Jackson Mayor Derek Dobies is expected to tout the city's 2019 successes and lay out plans for new task forces and committees at Wednesday night's State of the City address.

The event begins at 6 p.m. Feb. 26, in the Michigan Theatre of Jackson, 124 N. Mechanic St. Attendance is free.

Projects like the $1.9-million renovation of the King Center which is ready to begin and the construction of a $13-million apartment complex downtown will be among the 2019 highlights Dobies will mention, he said.

King Center to close through summer for $1.9M renovation

He also plans to announce new task forces, commissions and committees including a pair of "corridor improvement authorities," Dobies said. These groups are meant to inspire improvements along a pair of corridors to downtown, Martin Luther King Jr. Drive and East Michigan Avenue, he said.

The success of the city is contingent on ordinary citizens also stepping up and leaning into that progress, Dobies said. Weve seen what can be done with the Bright Walls project, when people took ownership on making their city a better place.

Ken Toll, United Way of Jackson County president/CEO, is the guest speaker. Hell address his organizations initiatives to battle poverty in Jackson and how people can get involved.

Follow along with a live stream of Dobies speech on the Jackson Citizen Patriot Facebook page or for updates via the Twitter hashtag #JacksonSOTC.

Related Jackson news:

Bright Walls announces plans for third and final Jackson mural festival

Jackson should cut poverty level in half, mayor says in State of the City address

Love him or loath him, the feather-ruffling Patrick Burtch changed Jackson

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State of the City address to focus on expanding progress to Jacksons corridors - MLive.com

Company Recognized for Inclusive Employee Culture and Commitment to Improving Lives, Communities and the Environment

RADNOR, Pa.(BUSINESS WIRE)Today, Lincoln Financial Group (NYSE: LNC) celebrates recent accolades in corporate responsibility, highlighting the companys significant efforts to improve the lives of its customers, employees and communities, and setting the stage for the next decade of continued focus and momentum in these critical areas.

In todays tight job market, a companys commitment to doing the right thing for its communities, its employees and the environment can make a difference when it comes to recruiting and retaining top talent. According to a new survey, 40% of employed US adults say they would turn down their dream job if they werent sure of an employers commitment to doing the right thing, and 53% say they would turn down the opportunity to leave their current employer for a higher-paying job if the new company was less socially responsible1.

Lincoln is dedicated to building vital communities through philanthropy, creating a diverse and inclusive culture that develops and empowers its employees, protecting the environment through sustainable business practices, and operating with transparency and responsibility.

In all that we do at Lincoln, we are focused on a common purpose: to provide financial peace of mind to everyday consumers across the United States. This shared mission infuses each of our actions with meaning in both our business practices and community outreach programs, said Dennis R. Glass, president and CEO of Lincoln Financial Group. The more diversity of thought, experience and people we have, the better our decisions will be. More support for the communities in which we live and work translates to higher employee engagement. Not only is being a responsible company the right thing to do it also makes us stronger and helps us best serve our customers.

Recent industry accolades recognizing Lincolns commitment include:

With the help of its 12,000 employees, Lincoln has expanded existing programs while launching several new initiatives to help improve lives, communities and the environment, including:

Read more about Lincoln Financials strategy, actions and achievements in the areas of corporate philanthropy, environmental sustainability and responsible business practices in the 2018 Corporate Social Responsibility report, Making it count: Real people, real stories.

About Lincoln Financial Group

Lincoln Financial Group provides advice and solutions that help empower people to take charge of their financial lives with confidence and optimism. Today, more than 17 million customers trust our retirement, insurance and wealth protection expertise to help address their lifestyle, savings and income goals, as well as to guard against long-term care expenses. Headquartered in Radnor, Pennsylvania, Lincoln Financial Group is the marketing name for Lincoln National Corporation (NYSE:LNC) and its affiliates. The company had $275 billion in assets under management as of December 31, 2019. Lincoln Financial Group is a committed corporate citizen included on major sustainability indices including the Dow Jones Sustainability Index North America and FTSE4Good. Dedicated to diversity and inclusion, Lincoln earned perfect 100 percent scores on the Corporate Equality Index and the Disability Equality Index. Lincoln has also been recognized in Newsweeks Most Responsible Companies and is among Forbes Worlds Best Employers, Best Large Employers, Best Employers for Diversity, Best Employers for Women and ranked on the JUST 100 list. Learn more at: http://www.LincolnFinancial.com. Follow us on Facebook, Twitter, LinkedIn, and Instagram. Sign up for email alerts at http://newsroom.lfg.com.

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Continued here:

A Decade of Progress: Multiple Perspectives, Diverse Backgrounds and Community Giving Propel Lincoln Into 2020 - Yahoo Finance

Every time I did something, it felt like someone was stabbing me with a knife in my back putting my shoes on, putting my socks on, said Verdugo. Now, I dont have any pain, nothing like that. I maybe have some soreness.

Verdugo and the Sox are trying to measure the pace of his buildup in activity, wanting to take a conservative approach to avoid a setback. Still, he characterized himself as close, very close to swinging.

We dont have a set date, but its soon, he said.

While Verdugo is still weeks away from being ready to play in games, interim manager Ron Roenicke hasnt given up on the idea that the outfielder might be ready to play in spring training games.

I would say that we start getting into the middle of March and on that hes got a chance to play some games, said Roenicke. I think he does [have a chance] depending on how fast he comes along with his swinging. Hes doing really well. We just havent asked him to swing a bat yet.

Major League Baseballs investigation into the 2018 Red Sox will not be finished this week after all. An industry source told the Globe on Tuesday that the findings will not be announced until next week at the earliest.

Commissioner Rob Manfred said Feb. 16 that his goal was to wrap up the inquiry by the end of this week. But unexpected delays related to scheduling have pushed that back.

The probe started six weeks ago after anonymous sources told The Athletic the Red Sox used live video to steal signs then relayed the information to runners at second base.

Andrew Benintendi, Rafael Devers, Ian Kinsler, and J.D. Martinez are among the current and former Sox players who have denied that.

Red Sox principal owner John Henry, who also owns the Globe, and team president Sam Kennedy also said the teams 2018 championship was won fairly.

Sox manager Ron Roenicke said earlier Tuesday that the team was eager to have the investigation finished.

Tony Clark and members of the MLB Players Association met for roughly 1 hour, 45 minutes on Tuesday morning with Red Sox players and coaches. The conversation was split largely between potential sign-stealing regulations and matters related to the collective bargaining agreement.

After the conclusion, however, Clark couldnt help but notice a glaring absence from the meeting. Two weeks removed from the trade that sent Mookie Betts to the Dodgers, the MLBPA remained puzzled by the transaction.

Boston made whatever decision they made for whatever reason they made it. I think that a face of our game, someone that should be more a face of our game, being put in that position, I dont think it was necessary, said Clark. I know theyve offered some commentary publicly, but youd have to ask Boston as to why thats the case. We simply believe that Mookie is a generational talent. And the idea that he is no longer here is one that we just didnt believe was necessary.

The Sox have stated that their trade of Betts was driven by baseball reasons. Nonetheless, the teams stated desire to get its payroll below the $208 million luxury-tax threshold in the coming season and thus resetting the penalties associated with future overages is consistent with what Clark sees as teams using the threshold as an excuse to cap payroll.

We think there are a number of aspects in our CBA that need to be addressed. If the competitive balance tax is being used in the fashion that its being used and the excuse that its being used for, then its something were going to look at, said Clark. The assumptions that we made [in negotiating the current CBA] were predicated on what it was that teams had been doing in the past.

What weve seen, though, is a dramatic change and shift in how those teams are functioning against the backdrop of how they may have functioned five or 10 years ago. As a result, were going to need to modernize the system to reflect the changes that were seeing.

A year ago, Ryan Weber was a nonroster invitee to camp, a virtual unknown simply hoping to position himself for a big league call-up during the season. But after making 18 big league appearances, including three starts, with the Sox last year going 2-4 with a 5.09 ERA in 40 innings Weber is now in a very different position.

The 29-year-old is competing for a potential rotation spot. In his first appearance in that quest, he threw a pair of scoreless innings against an Orioles split-squad unit on Tuesday, allowing two hits, walking none, and striking out a batter.

Just knowing that they have the confidence in me puts a lot of accountability on me, which I really like, said Weber. Im not just another depth piece to them, I think. It makes every pitch really, really matter at this point. Im trying to make the team and prove to them that ... I am a big league pitcher and I can go out and I can start games, I can pitch deep in the games or I can throw multiple innings out of the bullpen. I can do what they want me to do.

Lefthander Chris Sale is scheduled to have a bullpen session on Wednesday in which he throws, sits, then throws again, a controlled simulation of a multi-inning workload ... Eduardo Rodriguez (left knee) was fine after Mondays live batting practice session and will start in a Grapefruit League game on Saturday ... The Red Sox lineup against the Orioles featured J.D. Martinez in left field, Andrew Benintendi in center, and Jackie Bradley Jr. in right, an alignment Roenicke said the team might use during the season at Fenway ... Xander Bogaerts (ankle) took ground balls for a second straight day ... Rafael Devers could make his first appearance in a game as soon as Friday.

Alex Speier can be reached at alex.speier@globe.com. Follow him on Twitter at @alexspeier.

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Red Sox Alex Verdugo making progress in injury rehab - The Boston Globe

Health care, especially as it relates to its physical footprint, changed dramatically in Beaver County in the last century with hospital closings, mergers and acquisitions, and joint ventures.

In simpler times, your family doctor, black bag in hand, showed up at your doorstep to treat grippe, quinsy, dropsy, lumbago and consumption maladies better known today as flu, sore throat, edema, lower back pain and tuberculosis.

More than a century ago, if you were pregnant, your son broke his leg sliding into home plate, dad gashed his hand or grandpa got pneumonia, you hustled to a community hospital in Beaver County to birth a baby, set a fracture, stitch a wound or fight a lung infection.

If you lived in Rochester, you went to Rochester General Hospital. If you lived in Beaver Falls, you went to Providence Hospital. If you lived in New Brighton, you went to Beaver Valley General Hospital. And if you lived in Aliquippa in the late 1950s, you went to Aliquippa Hospital.

House calls made up 40 percent of doctors visits in the 1930s, according to Forbes. Today, they represent only 1 percent. And none of the aforementioned hospitals exists today.

One of our favorite phrases is health care is ever changing, ever challenging, said Norm Mitry, president and chief executive officer of Heritage Valley Health System, an integrated network that provides health care for residents in Allegheny, Beaver, Butler, and Lawrence counties in Pennsylvania, eastern Ohio and panhandle of West Virginia at three hospitals and numerous satellite facilities.

Economic volatility, legislative policy changes and continuous evolution of technology underscore those changes and challenges.

Health care, especially as it relates to its physical footprint, changed dramatically in Beaver County in the last century with hospital closings, mergers and acquisitions, and joint ventures.

Hospitals in Rochester, New Brighton and Beaver Falls joined in 1980 to form The Medical Center of Beaver County that was built on farmland off Dutch Ridge Road in Brighton Township.

I can only imagine the articles in the paper and the community uprising, Mitry said, when those three communities agreed to give up their community hospitals to build this new medical center on a hill in a township that never had a hospital.

However, that visionary decision, Mitry said, was so far ahead of its time and started the hospital on a path of continued growth to support its mission of improving health and well being of people in communities it serves.

In the mid-90s, The Medical Center merged with Sewickley Valley Hospital which opened in 1907 to form Heritage Valley Health System. And last year, Ohio Valley Hospital in Kennedy Township, Allegheny County, affiliated with Heritage Valley Health System to become Heritage Valley Kennedy.

That partnership brought a very robust pain center and wound care center, Mitry said, along with an ambulance company and an assisted living, personal and memory care facility.

But maybe another phrase should be added: Everything old is new again, especially with the emergence of community based, convenient-care clinics and medical neighborhoods, and connected care via sophisticated digital tools that measure and monitor everything from blood pressure to blood glucose and relay results to physicians.

Todays health-care shift is community based health care thats available closer to home. Thats what drove Heritage Valley Health System to develop new strategies to meet patient needs.

People dont think about health care until they need it, Mitry said, and the last place they want to go is a hospital.

People want health care when and where they want it, he said fit into the routine of their busy days.

The vision wasnt to wait for people to come to the hospital, but take health care to the communities. And it came from four words, Mitry said: quality, cost, access and experience.

Seamless, convenient and accessible health care led Heritage Valley Health System to develop its retail medical strategy in 2009. Thats when the first convenient-care, walk-in clinic opened in Beaver with a goal of providing high-quality, accessible care for minor illness and injury flu shots, stitches, sprains, antibiotics, for example.

Clinics, which have been very successful, Mitry said, are open 8 a.m. to 8 p.m. Monday through Saturday; 8 a.m. to 4 p.m. Sunday and require no appointments.

The Affordable Care Act helped shift health care to community based, too, prompting Heritage Valley Health System to develop medical neighborhoods that offer primary care, pediatrics, lab testing, physical rehabilitation, and diagnostic imaging including MRI and CT scans.

Previously, Mitry said support services like radiology, blood draw, and primary care sites were scattered, but medical neighborhoods bring them all together in one place with equivalent quality and less wait time than if one went to a hospital.

The first medical neighborhood opened in 2012 in Chippewa Township.

The eighth and largest at more than 60,000 square feet opened last March at Bluffs at Glade Path in Center Township behind Beaver Valley Mall. It also features an ambulatory surgery center and outpatient surgical services in orthopedics, ophthalmology, otolaryngology, general surgery, gynecology, podiatry and urology.

We dont own any of the buildings, Mitry emphasized. We either lease them or somebody builds them for us and we lease. We spend zero capital on brick and mortar for this. Thats important for people to know.

The beauty of medical neighborhoods is efficiency.

If a physician puts a stethoscope to your chest and doesnt like what he hears, hell direct you across the hall for an X-ray. Since all radiology readings are online, he can see results immediately and order whatever further treatment is necessary.

Before, a doctor would write a prescription for blood work and chest X-ray for which you would have to schedule an appointment.

Women are really good at that, Mitry said, while men tend to delay or ignore it.

At a medical neighborhood, everything can be done efficiently and effectively.

That really helped to drive our mission, he said, making sure patients receive services they need to take better care of themselves.

And they are using those services.

Mitry referenced a site that opened Dec. 4, 2018, in Aliquippa as an example.

From the day it opened through today, every day of the week it sees double-digit patients. Heres a city starved for health care. It has had double-digit activity from the very first day, which blew us away, he said.

Patients like the medical facilities because its convenient, its high quality, its cost effective, he said.

If one isnt feeling well and visits an emergency room, likely hed face a co-payment of $100 to $150. But co-pay at a convenient care might be $30.

Still, emergency room visits havent gone down, which surprises Mitry.

The Beaver campus sees 60,000 patients a year, he said. The Sewickley campus sees anywhere from 35,000 to 40,000 annually. And the Kennedy campus sees approximately 25,000.

At the end of last year, convenient-care sites treated 70,000 people.

Its an incredible number, he said. The good news is people are going for health care they probably need, but emergency rooms are just as busy as theyve always been.

Over time, care has shifted 35 percent inpatient; 65 percent outpatient, he said.

Medical neighborhoods helped Heritage Valley Health System to not only survive into the future, but help us thrive. Had we not done that, had our board not had that vision, Im not sure the shape wed be in today. Somebody else would be doing it.

Electronic health records keep physicians and neighborhoods connected.

For instance, if one visits the medical neighborhood in Aliquippa today, his primary care physician in Beaver knows hes been there. Whatever treatment was dispensed is logged into his electronic care chart. Likewise, treatment providers at the Aliquippa medical neighborhood can access that electronic record and see health history back to 1996 when Heritage Valley Health System started saving data electronically.

Similarly, if a patients physician retires or relocates requiring the patient to find a new doctor, that doctor can review that electronic history to better know a patient.

Thats pretty incredible, Mitry said.

Todays technology things like apps and interactive portals keeps patients even more connected to care.

The Heritage Valley Health System App enables patients to identify physicians, locate services and in real time see patient volume at emergency departments, diagnostic centers and satellite sites.

Health Link a free, secure and interactive portal enables patients to view lab and test results, health records, request prescription renewals, schedule appointments online, and manage health.

More than 250,000 people have used the mobile app the past two years and this year its on path toward 350,000. Quarterly, about 30,000 people use the patient health portal.

Doctors are really encouraging people to get on and look up their numbers and take ownership of their health, said Suzanne Sakson, director of marketing and communications. We do have that buy in from physicians and I think that has helped tremendously.

Heritage Valley Health System also offers community health and disease-management programs smoking cessation, pre-diabetes and diabetes education, and pregnancy classes, for example to improve patients qualify of life and reduce use of medical resources.

And offers interactive community events like the upcoming Whats On Your Plate, a healthy food and wellness expo from 10 a.m. to 2 p.m. March 21 at Community College of Beaver County in Center Township.

It features exhibitors, speakers, fitness and cooking demonstrations, free health screenings, and free food and product samples.

More than 2,000 people many who queue at the door before the expo opens attend, Mitry said.

Over the years, joint ventures with 12 complementary health care organizations enabled Heritage Valley Health System to expand its services range.

One of the more recent is a partnership with Encompass Health Rehabilitation Hospital of Sewickley.

Its a huge plus for this service area to have a specialized rehabilitation hospital in the Heritage Valley service area, but the average person has no clue that were related to that, Mitry said. But thats OK.

Other ventures include those with Concordia Visiting Nurses, Good Samaritan Hospice, and LIFE Beaver County.

Whats in the future?

Mitry, understandably, cant reveal his cards.

Ive got to be careful what I say because health care is incredibly competitive, he said.

Other health providers have already encroached on Heritage Valley Health Systems territory.

MedExpress has urgent care centers in Center, Chippewa and Moon townships.

Last spring, Allegheny Health Network opened a $20 million cancer center on Wagner Road Extension behind Beaver Valley Mall in Center Township the same street as Heritage Valley Health Systems newest medical neighborhood.

A group of physicians from the North Hills is building an independent surgery center in Center Township and Weirton Medical Center in West Virginia is encroaching on us, Mitry said.

But Heritage Valley Health System is blessed, he said, to be payer and provider neutral, which means it takes all insurers.

As long as we can stay what we refer to as Switzerland, our future is much better off than not, he said.

And he complimented Heritage Valley Health Systems board and senior management team for its vision and support in decisions affecting 2020 and beyond.

Continued here:

Progress 2020: Today's health care returns to its community-based roots - The Times

Joseph Cyr | Houlton Pioneer Times

Joseph Cyr | Houlton Pioneer Times

Jessica Hemmingway, left, gets her heart checked by peers Sam Keegan, center, and Tammy Tanner during a classroom exercise in December 2017.

In this era of deep partisan divides, policy change can be difficult. This is all too clear at the federal level and was, for many years, in Maine as well. But over the past five months Ive had the refreshing opportunity to see both bipartisanship and policy progress as a member of the Commission to Study Long-term Care Workforce Issues. The commission, which met five times this past fall, submitted its report to the Joint Standing Committee on Health and Human Services on Feb. 4.

The recommended changes are not as dramatic or wide sweeping as those proposed by 2018s Homecare For All referendum, which I supported, but rather incremental. Nonetheless, they could be profoundly important to Maines direct care workers, the providers who employ them, and the adults with disabilities who rely on their services.

Commissions to study issues hardly represent radical change. One pictures reports gathering dusk on shelves, often with little impact from their work. And indeed, this is not the first time this issue has been studied in Maine: a previous commission, convened 10 years ago, produced the 2010 Direct Care Worker Report, referred to with frustration by Helen Roy in a recent letter to the editor. Some members of this years commission had also served on the earlier one and were emphatic that if we wanted follow through, oversight was essential. I admit to harboring some skepticism myself regarding how much impact a commission might have, but from the first meeting in September through the delivery of the report to the committee five months later, I was continually impressed by the level of commitment by all involved.

The commission, chaired by Sen. Erin Herbig and Rep. Jessica Fay, included legislators from both parties, a direct care worker, representatives from provider organizations and the Departments of Labor and Health and Human Services, and advocates for consumers and workers. At each meeting, experts were invited to inform us both of the current dire situation as well as potential interventions that had been tried elsewhere in the country. We also heard from the public, many of whom came to every meeting.

We learned of the ever-increasing demand for direct care worker services and the difficulty in meeting that demand, resulting in many people going without the assistance they need. We learned how both residential and community-based provider agencies are being squeezed by low reimbursement rates and ever-increasing costs. We learned of the challenges faced by direct care workers, including low pay, inconsistent hours, lack of paid time off, and feeling they and their work are not valued by society or medical teams. We learned how essential direct care workers are to consumers who use their services, and the consequences for them and their family members when those services are not available.

The discussions were interesting, respectful and informative and systematically moved us toward our goal of laying out recommendations in a report. The report included 29 recommendations and suggested legislation incorporating three of the most immediate ones: increasing wages for direct care workers to no less than 125 percent of the minimum wage, adjusting reimbursement rates for provider organizations sufficient to meet their costs, and creating an oversight advisory committee.

When the report was presented to the Health and Human Services Committee earlier this month, I was again impressed by the thoughtful questions posed by legislators who ultimately unanimously accepted the proposed legislation, LD 2109. But the journey is not over. The bill will have a public hearing on Wednesday. There will be a work session, where bills are frequently revised, and then votes by the committee and both chambers of the Legislature.

I remain guardedly hopeful that this long-awaited, much needed policy change may indeed occur. This may not represent revolutionary change, but it is essential for sustaining and growing our long-term services and supports system, on which any of us could depend at some point in our lives. LD 2109 deserves our support.

Sandra Butler is a professor in the School of Social Work at the University of Maine in Orono. Her views are her own and do not represent those of any group with which she is affiliated. She is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members columns appear in the BDN every other week.

Excerpt from:

Maine making incremental progress on long-term care - Bangor Daily News