Podcasts about determinations

What happens when a VR agency stops leading with compliance—and starts leading with trust? In this episode of Manager Minute, Carol Pankow sits down with Lea Dias, Director of the Hawaii Division of Vocational Rehabilitation, to talk about rebuilding an agency from the inside out. Facing high vacancies, low morale, and years of monitoring pressure, Lea chose a different path—one grounded in listening, kindness, and belief in her people. The result? ✔ Renewed staff engagement ✔ Stronger community partnerships ✔ Improved employment outcomes ✔ A culture moving from survival to purpose This is a powerful reminder that real change doesn't start with spreadsheets—it starts with people.   Listen Here   Full Transcript   Lea: I'm proud when I see my staff here at the administration level, thinking less about what the staff are doing wrong and focusing more on how can we help them, getting resources to help them, reaching out directly to help them. People talk a lot about rapid engagement and forget that ongoing part rapid and ongoing engagement. If you focus on culture first, the numbers I believe will follow. And if you focus only on numbers, the culture will crumble.   {Music} Intro Voice: Manager Minute, brought to you by the Vocational Rehabilitation Technical Assistance Center. Conversations powered by VR. One manager at a time, one minute at a time. Here is your host, Carol Pankow.   Carol: Well, welcome to the manager minute. Joining me in the studio today is Lea Dias, director of the Hawaii Division of Vocational Rehabilitation. Lea recently participated in a panel at the fall CSAVR Conference, sharing Hawaii's journey to improving employment outcomes and what she calls their secret sauce. So how are things going in Hawaii?   Lea: Oh gosh, a lot better now that the shutdown is over. And we got a couple of our grants came through recently. And so that's all good. I think a lot of people think, oh, Hawaii, it's Paradise, right?   Carol: Yes.   Lea: But we have the same sort of issues I think, that many other agencies do. But things are getting better in Hawaii. I'll say that.   Carol: That is awesome to hear. It's so good to see you again. Oh my gosh.   Lea: you too.   Carol: So for years, Hawaii has faced real challenges, including declining employment outcomes, significant work tied to addressing findings from an RSA monitoring report. In fact, you all were monitored the same year I was when I was still with Minnesota Blind back in 2019. And so I remember having a bond with you guys.   Lea: Yeah.   Carol: Because we were all going through it together.   Lea: Yes.   Carol: Now, I know when you stepped into the director role following the former director's retirement, you really brought this stabilizing, steady calmness that the agency really needed. And under your leadership, the team is rebuilding momentum, strengthening systems and really seeing some meaningful progress in the work being done across the islands. So today we're just going to explore that journey. What's changed, what's working and what other states can learn from your experience. So let's dig in.   Lea: Okay.   Carol: Can you start by sharing your journey with Hawaii VR and what led you into the director role?   Lea: Sure, Carol. Well, first of all, aloha, and thank you for having me. I have been with Hawaii Division of Vocational Rehabilitation, we're a combined agency, by the way, for over 30 years. And I started off about 34 years ago as an entry level VR counselor at the general site of our agency. And then in 2000, I moved over to become the supervisor of field services at our Ho'opono, which is our services for the blind branch. And Then I stayed there for a while. I then assumed the role of director of our New Visions Structured Discovery Orientation Center, and eventually I became the administrator of Blind Services, and I was honored to serve in that role until about July of 2023. So the majority of my career so far was spent at home. And I learned so much there, you know, working for a blind agency beyond what I got from my master's degree and all that. I learned so much about consumer empowerment. And, you know, the real dramatic changes that vocational rehabilitation can make in people's lives. So anyway, when the former Hawaii VR administrator left pretty abruptly, our agency was in a tough place. We had a vacancy rate of over 40%, I want to say close to 45% and rising low morale. We had that heavy corrective action plan you talked about from RSA and many staff were feeling really overwhelmed. So initially I stepped in as a temporary assignment just because I care so much about our agency. I love this profession. I care about the people we serve, and I wanted to do what I could to help stabilize and restore hope. And also, I had several staff approach me and ask me to do it, and that meant a lot to me. So I decided to apply after that. And I've been official in this job just a little over two and a half years, since July 2023.   Carol: That has gone really quickly.   Lea: Yes it has.   Carol: Well, and when you said bringing kind of that stabilizing calmness, everybody talks about that. You've been credited with doing that. How did you approach leading through that uncertainty and kind of rebuilding trust.   Lea: Oh gosh. Well, thank you for the compliment. But when I stepped in we were struggling across the board. And I know because I was part of that. Right. Coming from within the agency, we had declining successful employment outcomes way down. And a lot of the outcomes we had, they weren't really careers. In many cases, we had something like 77% of eligible participants leaving us before they even got to the point of IPE.   Carol: Wow!   Lea: Which is really atrocious. Super high vacancies. And because of those super high vacancies, we had counselors having to cover other counselors caseloads. So people were really burned out, overwhelmed. And because we had been working since 2019 to resolve that corrective action plan with RSA, and we had been so focused on that, staff were, I think, drowning in compliance tasks. And not that compliance isn't important because it is, of course, but there was a lot of blaming and overcorrecting in my opinion, and I think the human side of VR had been kind of pushed aside. When I was preparing for my speech for CSAVR, I kind of asked the line staff, I told them what I was going to be doing and asked them what they thought. And one counselor really summed up for me how it was by saying, just quote, we were all just Surviving.   Carol: Oh.   Lea: That's kind of pretty much where it was.   Carol: That's quite a statement.   Lea: Yeah.   Carol: it really is. And I know I worked with your team too throughout that.   Lea: Mhm.   Carol: You know, when we were trying to work on getting corrective actions done and just kind of redoing policies over and over and fifth iteration, sixth iteration.   Lea: Right.   Carol: Oh my gosh. It was.   Lea: Right.   Carol: It was a lot. And you lose that sense of, you know, you lose the sense of the people and the reason you're all there. I can completely understand that being in the midst of that.   Lea: Yeah.   Carol: I know at CSAVR the whole panel was talking about the secret sauce. What do you think has been the biggest impact so far for your agency?   Lea: Well, I focused on listening first and staff told me they felt hurt and they had felt mistrusted and they had felt disrespected. They talked about too many barriers to getting their work done. And, you know, I believed them because like I said, I know.   Carol: Yeah.   Lea: So I developed a pretty tight group of folks on my leadership team up here who I knew I could trust really implicitly to help me, you know, listen to people struggle with and overcome these barriers for our staff and our consumers. And this tight group of people, they shared my vision for the agency and my philosophy of the purpose of this great program called vocational rehabilitation. So we opened up leadership meetings. I decided to bring in frontline supervisors rather than just the people in the quote unquote, ivory tower, and line staff at all levels into our conversations. I really emphasize transparency and consistency and kindness and respect for ourselves. I demanded it to each other and to our consumers, because I really had to rebuild safety and rebuild trust. In the beginning because of the way our agency had been. When I would open up the floor, you know, for people to talk, it was crickets. People just didn't want to speak up. All of that to say, I think there's really to me and I think I said this at CSAVR, I don't think there's really a secret sauce, to be honest. We've made many improvements, but we still have a long way to go, particularly with our data collection and data analysis and reporting are performance measures. Still need a lot of work and my staff and I are learning together. I guess you could say our secret sauce is trust plus autonomy, plus removing barriers and trying to find a way to yes for our consumers and for our staff.   There's lots of little examples, you know, based on feedback that we got from our staff, we started allowing counselors to close their own cases. They weren't allowed to do that, as a result of the reaction to the corrective action plan. I would say we eliminated some things that were outdated or unnecessary, like some financial needs testing language. I stopped the communicating via solely via memo. All communication via memo. Training via memo. I mean, that kind of stuff just doesn't work. It's a good backup, but you can't rely on just written stuff.   Carol: No.   Lea: I cut out what I saw as unnecessary multi-layers of approvals for things as simple as a payment for a service to a consumer would have to come all the way up to the administrator's level if it was, I think, over $2,500. And I was like, this is ridiculous. We really started making a culture shift, I think, from compliance first to people first from distrust, mistrust, and I would say custodialism to communicating my belief, you know, in the skills and judgment of our people tried to make it a less intimidating environment where people could speak their truths and make suggestions for improvements because, you know, like I mentioned, I'm a leader, but I'm also a leader who in a lot of ways has been where they've been. And I know the power of what we can achieve when we all work together and I really believe all those things. I think all those little examples and more have really helped to make a difference.   Carol: I love that because you can always sense your authenticity. Always. I remember meeting you way back, you know, with NCSAB, and we would do work together on committees and all of that good stuff. And it's like, oh my gosh, I always just thought you were amazing because you truly, you walk the talk that you say and people believe you, you know, you're believable. And I think that trust you've put in your people. I could see a difference when we were out there, even last year as a TA center and came for a visit, there was just a whole different sense with that whole group. It was really nice to see. I can just tell. I mean, I can tell from the outside, having seen you all before in meetings where, you know, things were it just felt more chaotic and people didn't feel free to speak. And now you can just see everybody's faces. I mean, it was just their whole affect was so much better.   Lea: Oh, thank you. Thank you for your kindness. That makes me so happy to hear that. I see it, too. But it, I'm always questioning. Is it enough? Am I doing enough? There's still so much to do. But you gotta start somewhere.   Carol: Well, you have to start somewhere.   Lea: Yeah.   Carol: I think you've done an incredible job with that.   Lea: Ahh.   Carol:  What do you feel like? Maybe. What progress are you most proud of? Or. And what maybe lessons would help other agencies because other people are going through this. You are not the only one in the entire, you know, system here. It is all over the country.   Lea: Yeah. Well, I mean, closing out that corrective action plan was a huge milestone. Very proud of that, especially after so many years. So it took from 2019 till just earlier this year, 2025 for us to finally, you know, get out from under that so that we can focus on other things. But we didn't do it alone. You know, like you mentioned, Doctor Chaz Compton, Chaz and you and the entire VRTAC QM team were really instrumental in helping us get there, and you guys really walked alongside us with empathy and clarity and unwavering support. Even with the time difference and, you know, being an ocean away. I mean, you guys were always there. And, you know, after I assumed this role, you know, Doctor Compton visited us twice so far for in-person, all staff meetings. So I brought in all staff, not just counselors, not just rehab teachers, everybody on staff for in-person sessions. Zoom is great for a lot of things, but sometimes you need everyone there in person for kind of a call to action, you know what I mean?   Carol: Yeah.   Lea: Anyway, those sessions that we had together with Chaz were, I think, really helped us along in this transformation. His ability to connect with staff and reframe challenges helped us ignite what we're calling our Reimagine and Renew initiative. I also want to acknowledge you, Carol, you know, your leadership at the VRTAC QM and the way, you know, you mentioned you and your team guided our agency and you helped us see this journey not as a series of failures, which is how we felt, but really an opportunity more so for growth and renewal. So what am I most proud of? I am most proud when I see our line staff coming up with these fantastic suggestions and being willing to talk to me about it, and then acting on those where we can and making those changes.   I am proud that I see in so many of them, their passion reigniting. I'm proud that many of them don't just see this as a drudgery, kind of 9 to 5 case manager job sitting in front of a computer all day. They're out in the community a lot more now, engaging with consumers, engaging with other agency partners. And when I say engaging with consumers, things like evenings and weekends, graduations, award ceremonies, things like that might seem like a small thing to some, but I know those consumers remember and they appreciate that and their families. I'm proud when I see my staff here at the administration level thinking less about what the staff are doing wrong and focusing more on how can we help them, getting resources to help them, reaching out directly to help them. I see a lot less finger pointing in both directions, because I know when I was on the line, I'd be like those people in administration and administration, people going, are those people on the line? They don't. I see a lot less of a lot less of that. And I'm really pleased that a lot of our partners in the community are ready to talk to us again. I think a lot of those relationships, for various reasons, had been pretty badly damaged, and that's actually been a big part of my job, too, is rebuilding those relationships. So I would say the biggest lesson for other states is this you can't transform an agency just through compliance tasks alone. You need trusted partners, you need honest conversations, and you really need a willingness to go to the mat to rebuild your agency culture, like from the inside out.   Carol: That is really good advice.   Lea: Yeah.   Carol: I always think in this role it takes a village. Like when you were talking about assistance from the QM. And I know when we come alongside any state agency, we always refer to it like we. We always feel like we're part of you.   Lea: You are.   Carol: You know, even in the when we're meeting with staff and staff, it's like, okay, this is what we're going to do next, or...   Lea: Yeah.   Carol: ...let's work on this. And we always feel like we just become another we're another staff like in the group to help facilitate whatever getting done. And so.   Lea: Yeah.   Carol: That has been so fun and really fun to see. Like your people embracing all of it. You just see such a difference. It really is pretty incredible.   Lea: Yeah. And I want to be really clear. It's not about me. It's not. It's the village. It's everybody together that is making progress. And I think things are looking up.   Carol: But you did make it possible because you open the space and it takes time. Like you said, people at first weren't really willing to talk because there'd been a long time where you couldn't talk about it.   Lea: Yeah, yeah.   Carol: You know, you couldn't bring things up. I remember the whole finger pointing back and forth all the time. People were like, oh, people in Central office. They don't know what's going on out here.   Lea: Yeah, yeah. And it still happens sometimes, you know, I get it, but not, not as much as before.   Carol: Not like before, No, but it takes that. And that took you really coming in and opening up the space. And it's a time factor. Like look at you've been doing it over two years now. Probably another lesson would be it doesn't go quick. Like it takes time to do this and repairing relationships.   Lea: Yes.   Carol: That's a time factor. They've got to trust you and over and over see what you're doing.   Lea: Yeah. And this is probably bad advice, but forget the work life balance thing. For me, it's like I'm at home thinking about this stuff. Like, what can I do? You know what I mean?   Carol: I know I used to sleep, I'd sleep with a pad of paper by my bed, because I'd often wake up in the middle of the night and be like, I'd have an idea, and I'd write it down because I didn't want to lose it for the morning. And then I'd come in. I'd be like, I was thinking last night, and staff would be like, oh my God, you had your pad of paper by the bed?   Lea: Yep, I talked to Siri. Siri, take a note.   Carol: Yes!   Lea: yes.   Carol: Oh, that's so funny. What strategies do you think just a little bit on your, you know, the employment outcomes. And you've done better with those. Chaz was super jazzed about that.   Lea: Yeah.   Carol: What strategies do you think contributed most to those improvements you've had in your employment outcomes?   Lea: I've been thinking about this. I think our internal strategies, people talk a lot about rapid engagement and forget that ongoing part, rapid and ongoing engagement. Talking, you know, just like a broken record, talking with staff about that and the importance of that. And I'm seeing that happening more like I mentioned with those evenings, weekends being out in the field.   Carol: Yeah.   Lea: Streamlining processes, as I mentioned, empowering our counselors and trusting them to do their jobs. I think those were all essential. But and of course, the partnership and the help that we got from the TAC-QM, helping us look at our systems with fresh eyes and supporting us in building some sustainable, long term solutions so that external guidance also gave us confidence and helped accelerate our progress. So with all of those pieces kind of working together, some of our results have really improved dramatically. So you mentioned our successful closures. So between program year 23 and program year 24 our successful closures more than tripled. Okay.   Carol: Amazing.   Lea: The numbers are the numbers are small okay. Compared to like New York or something. But you know, in prog ram year 23 we had 30 closures. In program 24 we had 107.   Carol: That is awesome.   Lea: So yeah, I think that's pretty cool. I'm talking some of them are real careers, too, to real success story.   Carol: Oh, I love that.   Lea: That whole thing with the attrition before IPE has dropped really sharply. University of Hawaii at Manoa. They do a consumer satisfaction survey right for clients post closure, and we had the highest return rates ever and the highest levels of satisfaction ever, according to the university Hawaii, who's been doing these surveys for us. And then just some other stats to throw at you. But from program year 23 to 24, we saw our applications increase by 55%. That's applications for services. Determinations of eligibility increased by 59%, IPE development went up by 52%, and our vacancy rate for our staff has dropped to about 30 something percent. It's still high, but it's a lot lower than it was, and it's continuing to drop. And I've been able to fill some really key leadership positions where we had lost some very good people over those tumultuous years. So yeah, I hope I answered your question, but it's I think it's a lot of factors.   Carol: You did. It's been amazing though. And you look at that. I love that those kind of family sustaining wages, people in careers. That was always super important to me. I didn't want to just, you know, jobs and food, filth and flowers. Although people can do, you know, there are people that do want those jobs, but that isn't the only job that's out there.   Lea: Right. And that thinking long term.   Carol: Yeah.   Lea: You know, Chaz did training with us too. I'm thinking long term, like nurse's aide.  Or have you thought about nurse? Let's see. What are the differences here.   Carol: right.   Lea: Yeah, I like that.   Carol: Chaz is great at that. Bring it all.   Lea: Yeah.   Carol: Oh my gosh. Good for you though. Look at I think that just shows the power of when staff are trusted and they're feeling really good about their work and they're you're all in alignment on the same mission. You can really make huge things happen and including impacting your vacancy rate for employees, because I know you were much higher. I mean, it felt like you were like at 50% or something. So to have it even down to 30 is better.   Lea: Yeah. I'm also looking at revising our CSPD requirements because they're super high right now. And of course, I believe in the master's degree and the CRC and all that, but I think there's some room for us to loosen that up just a bit, still be in line with federal regulations. But that's another thing that I've heard from staff.   Carol: Yeah, that's a good idea. And there's probably a lot of people we could connect you with. Other states have done something similar to...   Lea: Yes.   Carol: ...kind of create space and layers and ways for people to get in and all of that.   Lea: Yes. Now is a good time because of the Unified State Plan is coming.   Carol: Yes. Perfect timing.   Lea: Yes.   Carol: Good pitch to make. It's like take advantage of that state plan. Time to make those changes.   Lea: Yes.   Carol: So what kind of advice would you have for other VR directors navigating tough challenges based on this experience? Do you have any other things you could offer your colleagues across the country? Because we got a lot of new people in, and there's a lot of really tough situations happening everywhere. You had quite a lot on your plate. So is there any other kind of things that could help them?   Lea: Gosh. Well, I would say start by listening. Trust your staff. They already know what the barriers are. Trust yourself. Listen to your consumers. Your consumer organizations encourage, expect, I should say, rapid and ongoing engagement with our consumers. Help them to dream big and to think long term. Find a way to say yes wherever possible. Give our consumers all the skills and confidence that they need to really achieve their life goals. Celebrate wins, even the small ones. Be a broken record if you have to. Keep your mission visible. And just remember, if you focus on culture first, the numbers I believe will follow. And if you focus only on numbers, the culture will crumble.   Carol: Really good advice.   Lea: Yeah, there's just no task too big when it's done together.   Carol: Oh, Lea, look at you go.   Lea: Ahh.   Carol: you made it all happen. Oh my God.!   Lea: Oh, stop it, I'm gonna cry.   Carol: Nah, you've been great. It's so fun to talk to you. I know chaz said at the conference people were crying when you had talked. There were so many people crying and coming up to you and really feeling so engaged and energized.   Lea: And I was surprised how many people came up because I thought our story was going to be like the worst in the whole, you know, all VR. And I had people coming up kind of, yeah, sharing that they had gone or they are going through a similar situation and, people, can I hug you?   Carol: Oh yeah.   Lea: And I was like, oh sure. You know. So no, I, I'm, I'm so humbled and honored that you even asked me to speak here because although I know we've made as a team some progress, we still have a way to go. But we're going to get there.   Carol: Yeah. See I just want other people to hear your message of hope and positivity, because I think we have a lot of directors feeling pretty, pretty sad right now. I'm pretty tough there in some pretty tough spots. And it you kind of you get that all internalized. I know from being a director too. Boy, it's hard to kind of pull out of all of that when you have just all of this piled on top of you, right? And it's hard to see sort of the light at the end of the tunnel. But your, your vision and just your whole message of really the hope and, and living into that mission and really the trust and all the things you've done, you've been doing the right things. And I think other people need to hear it. So I appreciate you doing this so much.   Lea: Oh, thank you so much again. Thank you.   Carol: Well, so I wish you much continued success. Thanks for your time. I hope you have a great day. Thank you.   Lea: Thank you, thank you.   {Music} Outro Voice: Conversations powered by VR. One manager at a time. One minute at a time. Brought to you by the VRTAC. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts, or wherever you listen to podcasts. Thanks for listening.

Note: After this podcast was recorded, the Federal Court postponed the determination for Waturta into early 2026. Payarri Determination remains the same.This podcast shares some thoughts and observations from Kado Muir in relation to native title determination for his tribal lands.

IDWR agents work to bring all 743 water users into compliance with July Methodology Order.

This Dhamma talk was offered on July 3, 2025 at Abhayagiri Buddhist Monastery.

Let the scrubbing commence. Once clean, we're deploying a burgle, only robbing the rich folks, assuming Reza's city planners were children, reading the big book of suckers, imagining “podcasting town,” falling off a high horse, tangling undergarments, giving up all passions, becoming the next Chutney Dallas, looping family trees like clover, purifying the soul, feeling manly dirt, fixin' that ice grime, having intercourse communion, and pre-visiting inventor town. Work Hard. Learn Much. Steal All (except for podcasts). 00:00:00 Season 8 Determinations  00:07:40 Intro 00:08:48 Reza NPCs 00:15:22 Reza Indoors 00:31:51 Reza Bar 00:41:21 Male Hot Spring 00:45:09 Iluk 01:00:24 Real Net 01:06:29 Outro Patreon: patreon.com/retroam Bluesky: @retrogradeamnesia.bsky.social YouTube: www.youtube.com/@RetrogradeAmnesia E-Mail: podcast@retrogradeamnesia.com Website: www.retrogradeamnesia.com  

Be sure to tune in to this episode of the Precision Health and PGX Podcast as Dr. Becky Winslow, CEO of inGENEious RX Incorporated Pharmacogenomics Consulting, and Dr. Megan Landsverk, Scientific Director of MolDX® and Chief Science Officer of Palmetto GBA®, discuss how laboratories may overcome the challenges they face earning MolDX® coverage and reimbursement for their clinical pharmacogenomics tests. Specific to coverage determinations, the PGx veterans discuss test design, post-genotype translations, and technical assessments. Specific to reimbursement, the duo discusses evidence-based reporting and complete claim submissions. Also discussed is the importance of labs clearly defining intended use populations for tests and academic partnerships importance when labs develop and validate panels including drug-gene pairs the Clinical Pharmacogenetics Implementation Consortium and the United States Food and Drug Administration does not recognize as clinically utile for managing medications. Dr. Megan Landsverk is a Science Officer for Palmetto GBA, a Medicare Administrative Contractor (MAC) and a Science Director for the Molecular Diagnostic Services (MolDX) program developed to identify and establish coverage and reimbursement for molecular diagnostic services on behalf of Medicare. Dr. Landsverk received her PhD in Biochemistry and Molecular Biology from Baylor College of Medicine and postdoctoral training in Medical Genetics at the University of Washington. She is a board-certified Molecular Geneticist, completing her molecular genetics fellowship at Baylor College of Medicine. She has held multiple academic faculty positions and has numerous publications in the field of genetics. Prior to joining Palmetto, she served as a clinical laboratory director in academic, hospital, and commercial clinical laboratories and has experience in several genetic specialties including rare disease (pediatric and adult), cancer (somatic and inherited), and pharmacogenetics.

Be sure to tune in to this episode of the Precision Health and PGX Podcast as Dr. Becky Winslow, CEO of inGENEious RX Incorporated Pharmacogenomics Consulting, and Dr. Megan Landsverk, Scientific Director of MolDX® and Chief Science Officer of Palmetto GBA®, discuss how laboratories may overcome the challenges they face earning MolDX® coverage and reimbursement for their clinical pharmacogenomics tests. Specific to coverage determinations, the PGx veterans discuss test design, post-genotype translations, and technical assessments. Specific to reimbursement, the duo discusses evidence-based reporting and complete claim submissions. Also discussed is the importance of labs clearly defining intended use populations for tests and academic partnerships importance when labs develop and validate panels including drug-gene pairs the Clinical Pharmacogenetics Implementation Consortium and the United States Food and Drug Administration does not recognize as clinically utile for managing medications.  Dr. Megan Landsverk is a Science Officer for Palmetto GBA, a Medicare Administrative Contractor (MAC) and a Science Director for the Molecular Diagnostic Services (MolDX) program developed to identify and establish coverage and reimbursement for molecular diagnostic services on behalf of Medicare. Dr. Landsverk received her PhD in Biochemistry and Molecular Biology from Baylor College of Medicine and postdoctoral training in Medical Genetics at the University of Washington. She is a board-certified Molecular Geneticist, completing her molecular genetics fellowship at Baylor College of Medicine. She has held multiple academic faculty positions and has numerous publications in the field of genetics. Prior to joining Palmetto, she served as a clinical laboratory director in academic, hospital, and commercial clinical laboratories and has experience in several genetic specialties including rare disease (pediatric and adult), cancer (somatic and inherited), and pharmacogenetics.

Former Buffalo Fire Marshal Edwin Ortiz on investigating fires and coming to determinations for the cause of a blaze full 440 Wed, 08 Jan 2025 09:30:40 +0000 JBb1CyKfx5ttenxlIBW7pnUcvx73KziX buffalo,news,wben,buffalo fire department WBEN Extras buffalo,news,wben,buffalo fire department Former Buffalo Fire Marshal Edwin Ortiz on investigating fires and coming to determinations for the cause of a blaze Archive of various reports and news events 2024 © 2021 Audacy, Inc. News False

More and more people turn to quantified health, achievement, and ability measures, such as fitness apps and economic measures of well-being every single day. As part of this trend, medicalized approaches to human health often describe people in terms of statistics and data, sometimes failing to capture more important details. In particular, the quantified approach falls short in describing the needs and rights of disabled people, as seen in lawsuits and case studies involving algorithmic decision-making about disability benefits. Here to talk about algorithmic decision-making and quantification in disability benefits in the United States and India are Vandana Chaudhry, Associate Professor in the Department of Social Work and Disability Studies at the City University of New York who focuses on disability and digital justice in the Global South, and Lydia X.Z. Brown, activist for disability justice, Director of Public Policy at the National Disability Institute, and CDT's very own former policy counsel.

In celebration of the annual three-month Rains Retreat, Ajahn Kovilo challenges listeners to come up with specific determinations in the realms of: - Giving (dāna): How will bring giving more into your life? - Morality (sīla): How will you make virtue more a part of your life? - Meditation (bhāvana): How will you add more mental cultivation to your life?

A talk by Thanissaro Bhikkhu entitled "Four Determinations"

A talk by Thanissaro Bhikkhu entitled "Four Determinations"

For the most powerful voice in business in Michigan. The Michigan Chamber Business Brief. Mike Alaimo, director of environmental and energy affairs. EPA's ozone attainment determinations and pending legal challenges (ie Sierra Club) that could be very burdensome for businesses and communities if successful.

Determining Land Use and Onsite/Offsite Determinations is a two-hour webinar course that provides an overview of land use determinations under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Reasonably anticipated future land use at CERCLA sites is important in determining the appropriate extent of remediation. Onsite and offsite determinations impact the need for permits and offsite transfer of CERCLA wastes. By taking this course, participants will achieve the following objectives: Identify factors that influence land use determinations under CERCLA;Explore Environmental Protection Agency (EPA) guidance and policy related to land use determinations;Learn about onsite permit requirements and exemptions at Federal Facilities; and,Understand off-site determinations and the Off-Site Rule and how these differ from on-site determinations. The instructional methodology for this course includes lecture and group discussion. The target audience for this course is federal, state, and tribal representatives who work on Federal Facility cleanups. Ideally, students should have a basic understanding of land use and the CERCLA process. This course is part of the Federal Facilities Academy training program. Please consider registering for other Federal Facility Academy courses and obtain a certificate upon completion of the entire Federal Facility Academy series (12 courses total). To view this archive online or download the slides associated with this seminar, please visit http://www.clu-in.org/conf/tio/FFAcademy4_022024/

Determining Land Use and Onsite/Offsite Determinations is a two-hour webinar course that provides an overview of land use determinations under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Reasonably anticipated future land use at CERCLA sites is important in determining the appropriate extent of remediation. Onsite and offsite determinations impact the need for permits and offsite transfer of CERCLA wastes. By taking this course, participants will achieve the following objectives: Identify factors that influence land use determinations under CERCLA;Explore Environmental Protection Agency (EPA) guidance and policy related to land use determinations;Learn about onsite permit requirements and exemptions at Federal Facilities; and,Understand off-site determinations and the Off-Site Rule and how these differ from on-site determinations. The instructional methodology for this course includes lecture and group discussion. The target audience for this course is federal, state, and tribal representatives who work on Federal Facility cleanups. Ideally, students should have a basic understanding of land use and the CERCLA process. This course is part of the Federal Facilities Academy training program. Please consider registering for other Federal Facility Academy courses and obtain a certificate upon completion of the entire Federal Facility Academy series (12 courses total). To view this archive online or download the slides associated with this seminar, please visit http://www.clu-in.org/conf/tio/FFAcademy4_022024/

Have you ever wondered about the complex world of manifestation determinations in school psychology? Join Jenny Ponzuric, a seasoned school psychologist with over 20 years of experience, as she delves into this intriguing topic. Here are some key insights from the episode:

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: EV investigation into Owen and Community Health, published by EV US Board on January 29, 2024 on The Effective Altruism Forum. Introduction Last year, Owen Cotton-Barratt resigned from EV UK's board of directors following reports of sexual misconduct. Prior to his resignation, accusations of misconduct from Owen had been reported to Julia Wise at CEA's Community Health team, which is led by Nicole Ross. EV US and EV UK jointly commissioned an independent investigation led by the law firm Herbert Smith Freehills into Owen's conduct and whether the Community Health team had acted appropriately with the information they had been given. Following the investigation, the boards of EV US[1] and EV UK jointly deliberated over the findings and the appropriate response. Below, the EV boards report their determinations and actions. We considered saying nothing or sharing significantly less information but decided it was in the best interests of the community to have some information upon which to update on the behavior of Owen Cotton-Barratt and the Community Health team. Our desire for transparency was not particularly motivated by the magnitude of the findings, and was instead motivated by the relevancy of the information for informing community members' future interactions with Owen and / or Community Health, the public nature of Owen's resignation, and community norms towards transparency and accountability. Additionally, we felt that sharing as much information as we could was particularly important because of the recent news that EV's projects are spinning out, as the boards' decisions only have an effect for projects so long as they remain part of EV. Projects will eventually set their own policies and won't have access to all of the facts we do, so we wanted to provide some information to enable the broader EA ecosystem to make better-informed decisions. With that being said, we are constrained in how much detail we can share without risking the anonymity of the interviewees. The investigators noted that multiple interviewees made requests to protect their anonymity, and given their voluntary participation, we want to respect their wishes. We want people to continue to feel comfortable coming forward in investigations knowing that potentially identifying information will not be made public. This means that in some cases below we present claims and board actions without all of the underlying evidence or reasoning. We recognize that this post does not have the same level of reasoning transparency we would normally aim for and think readers should update less than they would if they had as much detail as we do, but we ultimately felt like this was a reasonable middle ground to strike to allow us to share as much information with the community as possible while protecting the anonymity of interviewees. appendix below. Determinations regarding Owen Cotton-Barratt The boards unanimously agree on the following: On multiple occasions, Owen expressed sexual and / or romantic interest in women who were younger and less influential than he was. There were important power differentials between Owen and the women involved, sometimes formal and sometimes informal. Multiple women expressed being upset by Owen's advances. Both the frequency and the content of the advances contributed to the women's feelings. Julia Wise from CEA's Community Health Team gave Owen feedback that his behavior was inappropriate prior to some of the later instances of similar behavior. Owen was inconsistent at acknowledging potential conflicts of interest with persons whom he expressed sexual and / or romantic interest in. He recused himself in at least one professional context, but did not seem to consistently acknowledge other potential conflicts in other instances. In at least one case, Owen did not stop m...

If you're not filing to FMCSA's DataQs system for crash preventability reviews, says compliance consultant Rick Gobbell in this edition of Overdrive Radio, you're "playing badminton in the dark" when it comes to the compliance game. Proprietor today of his Gobbell Transportation Safety compliance consulting business, Gobbell draws on long experience around trucks and trucking, first on the road as an enforcement officer, then in government directly. He's a past "head fed," as he put it, division lead in Tennessee for federal motor carrier enforcement, yet now represents carriers during audits and files a whole lot of DataQs. His business website: https://rgobbell.com/ This episode features his talk from the conference of the National Association of Small Trucking Companies this past November, where he emphasized the importance of the Federal Motor Carrier Safety Administration's DataQs system for the smallest fleets, particularly when it comes to the agency's several-years-old Crash Preventability Determination Program. Regular readers will know Overdrive's and our sister publication CCJ's “Preventable or not?” series of videos illustrating crash scenarios that in past have been judged either preventable or nonpreventable for the truck's driver by the National Safety Council: https://www.overdriveonline.com/t/4381538 That same preventability standard underpins FMCSA's crash program. For any carrier who submits a crash in the DataQs system and has it judged nonpreventable, the crash then is excluded from calculations of the carrier's scores in the CSA Safety Measurement System. If you never request a crash review in cases that might be nonpreventable, as Rick Gobbell sees it, though the system is not set up to designate every crash that happens as "preventable," reality is that the crash might be de facto assumed to have been preventable by anyone using the SMS there. That includes federal and state safety auditors, insurers, brokers and shippers. "You just made the audit list," he said. His talk aimed to drill home the importance of the crash review system for the small fleets in attendance, lending the benefit of his own experience assisting others in DataQs filings. Also: To emphasize proposed improvements to the program to potentially include many more crash types, including any crash with solid video evidence. FMCSA's in the process of making those improvements in part to address core complaints about the review system, potentially doubling the number of crashes that could be reviewed: https://www.overdriveonline.com/regulations/article/15382943/fmcsa-eyes-changes-to-crash-preventability-determination-program With the agency also eyeing a safety rating change that might hinge on data quality in the SMS, DataQ-ing nonpreventable crashes could assume far greater importance for carriers large and small in the future, as Gobbell suggests here. Find Rick Gobbell's comment, one of just 62 filed in response to FMCSA's notice last year about the potential changes, by searching the notice docket here: https://www.regulations.gov/document/FMCSA-2022-0233-0001 DataQs resources at OverdriveOnline.com: **How to request a data review for an eligible crash: https://www.overdriveonline.com/channel-19/article/14897753/how-to-dataq-a-crash-in-new-fmcsa-preventability-program **Overdrive's 2021 series exploring inequities in the DataQs system and ideas for improvement also includes plenty in the way of DataQs advice/tips: https://www.overdriveonline.com/regulations/article/15063803/criticism-of-dataqs-review-system-continues-to-rise **How to mount an effective DataQs challenge: https://www.overdriveonline.com/regulations/article/15063812/how-to-dataq-to-challenge-a-violation

CONTINOUSILY WALK WITH DETERMINATIONS

The Inspector general has finally, after almost four years of investigation, has released it's report about what happened to Jeffrey Epstein while in the custody of the federal government at MCC. According to the report, it was nothing more than systemic failures and guards who were incompetent in their duties.Even after releasing his scathing report, nobody will face jail time for the errors included in the report and no sanctions will be leveled at any specific person and it leaves us wondering what, if anything, was accomplished by this three year investigation.(commercial at 7:28)to contact me:bobbycapucci@protonmail.comsource:DOJ issues scathing rebuke of Bureau of Prisons detailing multiple failures that led to Jeffrey Epstein's suicide | CNN PoliticsThis show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/5003294/advertisement

In this episode Scott Becker discusses the importance of goals, plans, and determinations.

In this episode Scott Becker discusses the importance of goals, plans, and determinations.

Episode #368 Part 4 of a 4 part seriesOriginal Air Date: 06.05.23

Episode #368 Part 3 of a 4 part seriesOriginal Air Date: 6.02.23

Episode #368 Part 2 of a 4 part seriesOriginal Air Date: 6.01.23

Episode #368 Part 1 of a 4 part seriesOriginal Air Date: 5.31.23

A talk by Thanissaro Bhikkhu entitled "Four Determinations"

Tune in for today's industry updates.

Tune in for today's industry updates.

Geoff Patterson | Based on 1 Corinthians 13:13

Welcome back to the Sutta Meditation Series Podcast. A short extract from our Full Duruthu Poya Dhamma session (on 6 January 2023) explaining the connection between the Four Noble Truths and having the Four Determinations as taught by the Buddha in the Dhātuvibhaṅga Sutta (MN 140), that lead to the four concentrations. This gives a broader picture of what underpins the verse "One should not neglect wisdom, should preserve Truth, should cultivate relinquishment and should train for peace" The Buddha give very clear and sequential instructions in his teaching to venerable Pukkusāti about - not neglecting wisdom (which means being vigilant in actively developing wisdom), preserving Truth (about Nibbāna), cultivating relinquishment (of all acquisitions), and training for peace (pacification from lust, hatred and delusion). It's important to see the link between having these Determinations based on understanding dukkha, wishing to abandon craving, realising cessation and fully developing the Noble Eightfold Path. And to see how they lead to the four developments and concentrations, inclining towards Nibbāna. **A table of "The Four Profitable Directions" as referenced in this extract has been posted to our Telegram channel (https://t.me/suttameditationseries/650) In the FULL session, we start to go into the sequential and powerful instructions of the Buddha in the Dhātuvibhaṅga Sutta (MN 140): To watch the full session (video) - https://bit.ly/3Gf539O To listen to the full session (audio) - https://bit.ly/3XfsqqV The video of this Extract has also been published to the Sutta Meditation YouTube channel - https://bit.ly/3GvBwZV Blessings of the Triple Gem. Theruwan saranai To find the YT Sutta Meditation Series playlists visit: https://www.youtube.com/c/SuttaMeditationSeries/playlists, or click on 'Playlists' in the top menu bar. Selected tables, slides and documents are shared via the Sutta Meditation Series Telegram channel - https://t.me/suttameditationseries For all enquiries - suttameditationseries@gmail.com --- Send in a voice message: https://anchor.fm/suttameditationseries/message

Section 301 duties imposed on China imports forced U.S. importers to consider alternative sourcing.  New litigation may transform CBP's approach to country of origin determinations.

The nations narrow to one family line, from which God will select Abram to bless and make a blessing to all peoples, through the Messiah. Pastor Pilgrim teaches Genesis 11:10-32 at Shoreline Church.

Each July, the Medicare Administrative Contractors issue notices of a 2% Medicare payment reduction to those providers who did not meet quality data reporting requirements. Those notices have been sent. In this episode, Husch Blackwell's Meg Pekarske and Jacob Harris talk about the issues providers faced in 2021 and how to pursue an appeal of the 2% payment reduction.

Join us July 14th for a discussion pertaining to medical necessity. This presentation will include a brief literature review on the topic of medical necessity. Additionally, the presenters will discuss how medical necessity is conceptualized in practice, including specific strategies when making medical necessity determinations. Visit www.Behaviorlive.com for more information.

In this episode we look at one of the most critical aspects of Chapter 3 (Section 3.3.1.1) of the #Medicare Program Integrity Manual. This section speaks to #Clinical Review #Judgment and #Medical #Necessity. This section applies to the MACs, CERT, MRAC, SMRC, and UPICs and should be used by all #healthcareprofessionals to stand your ground against payers and their contractors! So much to unpack in such a short period of time!

BLUF: An Officer Grade Determination (OGD) is a very serious matter. You should definitely begin preparing before your Commander serves you the OGD notification memorandum and preferably before you submit your retirement request. https://ferahozbek.com/officer-grade-determinations-ogds/ https://ferahozbek.com/officer-grade-determinations-the-tangibles-and-intangibles-of-retiring-at-a-lower-grade/ https://ferahozbek.com/officer-grade-determinations-ogds-what-you-need-to-know-now-before-you-even-think-about-retiring/ https://podcasts.apple.com/cz/podcast/mlm-91-officer-grade-determinations/id1292680966?i=1000551162044 AFI 36-3203, Officer Retirements, 29 January 2021 https://static.e-publishing.af.mil/production/1/af_a1/publication/afi36-3203/afi36-3203.pdf --- Send in a voice message: https://anchor.fm/ferah-ozbek/message

Determining Land Use and Onsite/Offsite Determinations is a two-hour webinar course that provides an overview of land use determinations under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Reasonably anticipated future land use at CERCLA sites is important in determining the appropriate extent of remediation. Onsite and offsite determinations impact the need for permits and offsite transfer of CERCLA wastes. By taking this course, participants will achieve the following objectives:Identify factors that influence land use determinations under CERCLA;Explore Environmental Protection Agency (EPA) guidance and policy related to land use determinations;Learn about onsite permit requirements and exemptions at Federal Facilities; and,Understand off-site determinations and the Off-Site Rule and how these differ from on-site determinations.The instructional methodology for this course includes lecture and group discussion. The target audience for this course is federal, state, and tribal representatives who work on Federal Facility cleanups. Ideally, students should have a basic understanding of land use and the CERCLA process. This course is part of the Federal Facilities Academy training program. Please consider registering for other Federal Facility Academy courses and obtain a certificate upon completion of the entire Federal Facility Academy series (12 courses total). To view this archive online or download the slides associated with this seminar, please visit http://www.clu-in.org/conf/tio/FFAcademy4_051122/

Determining Land Use and Onsite/Offsite Determinations is a two-hour webinar course that provides an overview of land use determinations under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Reasonably anticipated future land use at CERCLA sites is important in determining the appropriate extent of remediation. Onsite and offsite determinations impact the need for permits and offsite transfer of CERCLA wastes. By taking this course, participants will achieve the following objectives:Identify factors that influence land use determinations under CERCLA;Explore Environmental Protection Agency (EPA) guidance and policy related to land use determinations;Learn about onsite permit requirements and exemptions at Federal Facilities; and,Understand off-site determinations and the Off-Site Rule and how these differ from on-site determinations.The instructional methodology for this course includes lecture and group discussion. The target audience for this course is federal, state, and tribal representatives who work on Federal Facility cleanups. Ideally, students should have a basic understanding of land use and the CERCLA process. This course is part of the Federal Facilities Academy training program. Please consider registering for other Federal Facility Academy courses and obtain a certificate upon completion of the entire Federal Facility Academy series (12 courses total). To view this archive online or download the slides associated with this seminar, please visit http://www.clu-in.org/conf/tio/FFAcademy4_051122/

You're a Medicare provider. And you know that the Centers for Medicare and Medicaid Services (CMS) runs Medicare. But did you know that CMS is just the umbrella organization? The actual administration is done by a Medicare Administrative Contractor (MAC.)  What is a MAC? A MAC is a private health care insurer that's been awarded a geographic jurisdiction to process claims for Medicare Fee-For-Service beneficiaries.  CMS relies on the network of MACs to serve as the primary operational contact between the Medicare Fee-For-Services program and providers enrolled in the program.   Some of the activities the MACs include:Processing claims, enrolling providers, handling 1st stage appeals redetermination requests, responding to provider inquiries, educating providers about Medicare billing requirements, reviewing medical records for selected claims and establishing local coverage determinations One of the functions of each MAC is to establish local coverage determinations (LCD.)  An LCD is a determination of whether a particular item or service is going to be covered on a contractor–wide basis. Before an LCD can be put in place, there's a whole process:The Proposed LCD describes the MAC's proposed determination regarding coverage, non-coverage or limited coverage for a particular item or service. The public announcement  begins with the date the proposed LCD is published on the Medicare Coverage Database.After the proposed LCD is published, the MAC has to provide a minimum of 45 calendar days for public comment. The MAC has to establish a Contractor Advisory Committee to discuss the quality of evidence used to make a determination. You can volunteer to be part of the CAC. The MAC holds open meetings to discuss the review of the evidence and the rationale for the proposed LCD.  Once these steps are completed, the final LCD and the response to comment  is published. This marks the beginning of the required notice period of a minimum 45 calendar days before the LCD can take effect. There is an LCD reconsideration process. As a physician you can request a revision to an LCD—either in its entirety or any provision. An LCD can definitely throw a wrench into your revenue cycle management if it takes you by surprise. It's imperative that your billing folks keep you abreast of any new LCDs or changes to an existing one. You want to make sure that your billers are checking the MAC website regularly. While it may seem that an LCD is merely a billing thing, that's a very simplistic and largely incorrect view. LCDs have a direct impact on how you practice medicine. The more informed you are the easier it is to evaluate how an LCD effects your practice and can respond pre-emptively.Here is a list of the MACs: https://www.cms.gov/files/document/macs-state-jun-2021.pdfIf you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.    And, be sure to join my FB group, The Private Medical Practice Academy. Enroll in my course,  How To Start Your Own Practice and get the step-by-step process for opening your doors. Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. 

As a former senior legal advisor at the SECAF Personnel Council, I was the action officer, lawyer and voting member on OGD Boards. Things you need to know about your OGD What does the OGD Board look at? How to prepare ahead of time if you know you will undergo an OGD. How does a reduction in your rank affect you post-retirement, including your retirement pay AFI 36-3203, Service Retirements https://static.e-publishing.af.mil/production/1/af_a1/publication/afi36-3203/afi36-3203.pdf Blog article--The Tangibles and Intangibles of Retiring at a Lower Grade https://ferahozbek.com/officer-grade-determinations-the-tangibles-and-intangibles-of-retiring-at-a-lower-grade/ Blog article--What you need to know BEFORE you decide to retire https://ferahozbek.com/officer-grade-determinations-ogds-what-you-need-to-know-now-before-you-apply-for-retirement/ --- Send in a voice message: https://anchor.fm/ferah-ozbek/message

This podcast episode discusses legal standards to determine disability arising from Lyme disease.

There is a definite force that has a profound impact on the economy and the stock market at all times, and that force is The Fed. When the Fed Chairman, Jerome Powell, speaks, we need to be listening. The decisions that he and the rest of the federal open market committee make can have a very real impact on your savings, your investments, your ability to borrow, and the cost of goods and services, among other things. When the decisions that they make around interest rates hold so much weight, I think we should know just what their decisions mean. Today, we will discuss: 1. What the Fed does 2. What the Fed decided at the most recent FOMC meeting 3. How the Fed's setting of interest rates impacts your life   Begin your path to financial freedom today: https://www.youtube.com/channel/UCjyCApAbHBN0Jtw5bAehbRg?sub_confirmation=1   Don't forget to like, subscribe, and leave comments below as I would love your feedback. Be sure to check out my website (www.mnowithdylan.com) where you can get more information on my financial coaching services and more, the podcast of these shows if you are more of a listener than a watcher, and follow the show on any social media outlet (FB, Twitter, & Instagram) @mnowithdylan (Money's No Object with Dylan Howell) [All links in description]. Tune in for more personal finance concepts. Don't forget to check-in every weekday (Monday-Friday) for new videos which will be uploaded each day at 6 a.m. CDT. Thank you, guys, for tuning into this episode of Money's No Object. I'm Dylan Howell. God Bless!   Facebook: https://www.facebook.com/mnowithdylan/   Instagram Page: https://www.instagram.com/mnowithdylan/   Twitter: https://twitter.com/mnowithdylan     (Please keep in mind that I am not a financial advisor. I create these videos for educational purposes only. You and only you are responsible for the investment decisions that you make.)

In this week's Tax Credit Tuesday podcast, Michael Novogradac, CPA, and Novogradac partner Brad Weinberg, MAI, CVA, CRE, discuss rent reasonableness determinations and rent comparability studies, including how public housing authorities (PHAs) can benefit from them, what considerations go into rent reasonableness determinations and how the COVID-19 pandemic has affected rental trends in the United States. They also discuss how a PHA should evaluate a service provider, the intersection of Section 8 and low-income housing tax credit (LIHTC) properties in rent reasonableness determinations and more.

This talk was originally posted on Ven. Yuttadhammo Bhikkhu's YouTube Channel. To watch this talk on YouTube kindly visit https://youtu.be/u-WfM1omN2A .

If you haven't realized it yet, risk management in the medical device industry isn't going away. How do you navigate, capture, and document when and what to do? In this episode, Jon Speer invites guest Mike Drues of Vascular Sciences to join the show as the two discuss FDA's two, new guidance documents that provide additional transparency, consistency, and objectivity regarding benefit-risk determinations. Some of the highlights of the show include: ● Differences between Documents: Under what circumstances that pose a greater risk are acceptable for product submissions vs. appendices related to ISO 14971. ● New nine-page benefit-risk assessment worksheet is oversimplified and presents a non-traditional instead of analytical approach to determining benefit-risk. ● New guidance documents don't mention 510(k) device, but why? People should already know about uncertainty and risk of 510(k) medical devices via predicates. ● Higher risk is acceptable in various classifications of medical devices, including PMAs and BDPs, and when dealing with small populations. ● Adding to the complexity of medical devices, the guidance documents now include low-, medium-, and high-risk categories and criteria of uncertainty. ● Pay attention to patient's perspective of uncertainty when available. Are patients willing to truly accept risks and uncertainty to achieve unmet clinical need? ● Mitigate uncertainty in other ways, such as through labeling, degree of need, and clinical evidence/market data of product. ● Probable Benefit of HDE: Efficacy at a lower statistical power may diminish uncertainty due to giving patients early access to a medical device.

This Dhamma talk was given by Ajahn Sundara on 19 April 2017, waning half moon day, at Amaravati Buddhist Monastery, UK. The post Four Determinations appeared first on Amaravati Buddhist Monastery.