New premium for doctors aims to encourage more surgeries on evenings, weekends - CBC.ca

The Progressive Conservative government is taking another step to extend operating room hours in Nova Scotia, but it's not clear if it will cut into a stubborn backlog of surgical cases.

A contract the government recently signed with doctors extends a premium already paid for emergency surgeries to scheduled surgeries outside normal hours and on weekends and holidays. The premium would be available for surgeons, anesthesiologists and surgical assistants.

"I'm hopeful that this is going to result in more output and more surgeries for Nova Scotians who have been waiting but, you know, ultimately at the end of the day we're asking a lot out of a lot of people," Grayson Fulmer, the senior director of medical affairs for Nova Scotia Health, said in an interview.

"I think over time we're going to see much, much more success, and in the short term we're going to try everything within our power to coordinate and get as much access to Nova Scotians who need and deserve it."

Fulmer said a continuing challenge in reducing the backlog is an overall lack of staff. Along with needing enough doctors, additional surgeries require nurses, technicians to sterilize surgical instruments and people to clean and prepare operating rooms.

Premiums range from 35 to 50 per cent

As recruitment efforts continue, Fulmer said the new premium will come into play when hospitals have enough staff to take on the extra work, while recognizing that most doctors who could participate are already putting in full-time hours.

He compared the premium to overtime that unionized employees receive for putting in extra hours.

"It's about acknowledging their time, it's about acknowledging that we're already dealing with a busy cohort of people and we're asking for a little bit more out of them in certain cases."

According to guidelines obtained by CBC, cases that start between 5 p.m. and 11:59 p.m. on weekdays or from 8 a.m. to 4:59 p.m. on Saturdays would be eligible for a 35 per cent premium. Cases starting between 12 a.m. and 7:59 a.m. on weekdays, from 5 p.m. to 7:59 a.m. on Saturdays, or cases started anytime on Sundays or holidays would get a 50 per cent premium.

Surgeries scheduled for regular hours cannot be bumped to gain a premium and the cases occurring outside regular hours must result in demonstrable additional surgical activity to be eligible for the premium.

Level of interest yet to be determined

Fulmer said there will eventually be a change to the fee code system for doctors doing additional work, but at first the premiums will be authorized internally.

The premiums became available on Aug. 1, so it's too soon to know how many doctors are willing to take on additional cases, said Alexandra McNab, a spokesperson for Doctors Nova Scotia.

Surgical teams also include technicians who prepare the instruments and specialized nurses. This file photo from 2016 shows instruments used during an organ transplant. (Molly Riley/AP/The Canadian Press)

"What we do know, however, is that physicians are always willing to be a part of the solution," McNab said in an email.

"But it is of course difficult to ensure they are keeping that work-life balance and providing safe and sustainable care for patients."

Fulmer said it would be up to individual doctors to decide whether they will perform more surgeries. And doctors would follow regular safety standards using the professional judgment they already exercise to monitor for fatigue and burnout.

Change at some hospitals will be easier than others

Implementing the change could be easier at some hospitals than others, he said. Some sites have more resources than others, although the new contract for physicians also allows for travel-related payments for doctors willing to go certain distances for work.

"Making sure that all the right people are there at a particular site at a given time to enable this is going to be very, very challenging and our perioperative teams [who deal with patients before, during and after surgery] locally are trying their best to make sure that all of this aligns and moves forward."

A health authority spokesperson said that although the incentive applies to specialists' pay, the collective agreements for other health professionals such as nurses and medical device processing staff may allow for overtime in these settings. If other professions such as diagnostic imaging and laboratory services are required for surgeries, they may also be eligible for additional payments.

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U.S. judge sentences another Proud Boys member for Jan. 6 attack at Capitol - Reuters

WASHINGTON, Sept 1 (Reuters) - A federal judge on Friday sentenced a member of the far-right Proud Boys who stormed the U.S. Capitol on Jan. 6, 2021, in a failed bid by then-President Donald Trump's supporters to block Congress from certifying Joe Biden's election victory, to 10 years in prison.

Dominic Pezzola did not play a leadership role in the group and was the only defendant of five to be acquitted of seditious conspiracy. He was convicted of other felonies, including obstructing an official proceeding and assaulting police.

"You personally played a significant role in the events that day," U.S. District Judge Timothy Kelly said. "It was a national disgrace, what happened."

Kelly noted that Pezzola was a new member of the group and had been acquitted of seditious conspiracy, but also took note of Pezzola's actions.

A second sentencing hearing for defendant Ethan Nordean, a leader of the group who was convicted of seditious conspiracy and other crimes, will take place later on Friday.

Kelly on Thursday ordered two other former Proud Boys leaders, Joseph Biggs and Zachary Rehl, to serve 17 years and 15 years in prison, respectively.

Thousands of Trump supporters attacked the Capitol following a speech in which the Republican falsely claimed that his November 2020 election defeat was the result of widespread fraud. Trump has continued to make those false claims even as he leads the Republican race for the 2024 nomination to challenge Democratic President Biden.

Five people including a police officer died during or shortly after the riot and more than 140 police officers were injured. The Capitol suffered millions of dollars in damage.

The government had sought a 20-year prison term for Pezzola and is seeking a 27-year term for Nordean.

Although Pezzola was found not guilty of sedition, prosecutors said his assault on former Capitol Police Officer Mark Ode, in which he stole Ode's riot shield and used it to smash at a window at the Capitol, helped to justify a lengthy prison term.

"He was an enthusiastic foot soldier in that conspiracy," Erik Kenerson, a prosecutor, told the judge on Friday.

Pezzola's attorneys had asked that their client be sentenced to around five years in prison, and said in their sentencing memo that he has already served about three years in jail awaiting trial. Steven Metcalf, one of Pezzola's attorneys, told the judge that Pezzola was caught in the "heat of the moment."

"I stand before you with a heart full of regret," Pezzola said in an emotional speech before the judge, in which he apologized to Ode and directed rueful comments to his wife and two daughters. "I never should've crossed the barrier at the Capitol that day."

Nordean's attorney, Nick Smith, plans to argue for a lower sentence within the range of 15-21 months.

"Nordean walked in and out of the Capitol like hundreds of Class B misdemeanants," Smith wrote. "When the government does distinguish Nordean's actions from any other January 6 defendant's, it relies on characterization, not facts."

More than 1,100 people have been arrested on charges related to the Capitol assault. Of those, more than 630 have pleaded guilty and at least 110 have been convicted at trial.

Former Proud Boys Chairman Enrique Tarrio will be sentenced on Sept 5. The government is asking for a 33-year sentence.

Reporting by Sarah N. Lynch and Makini Brice in Washington; editing by Scott Malone, Grant McCool and Jonathan Oatis

Our Standards: The Thomson Reuters Trust Principles.

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Makini Brice

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Reports on U.S. Congress

Sarah N. Lynch

Thomson Reuters

Sarah N. Lynch is the lead reporter for Reuters covering the U.S. Justice Department out of Washington, D.C. During her time on the beat, she has covered everything from the Mueller report and the use of federal agents to quell protesters in the wake of George Floyd’s murder, to the rampant spread of COVID-19 in prisons and the department's prosecutions following the Jan. 6 attack on the U.S. Capitol.

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Sharper and more flattering than the floral midi, the tea dress is making a comeback - The Guardian

First things first. What is a tea dress? Some of you will know what I mean. But some of you will be like: “Oh my days, what nonsense is she on about now?” – so I should explain that this is a real thing, not a name I’ve made up.

A tea dress usually has a 40s silhouette with a defined shoulder. The waist is most often emphasised with a raised seam, or with pin tucks or ruching. Around the ribs, waist and hips it is not skin-tight yet not baggy; loose enough that the lightweight, slippery fabric still has movement on the body rather than being fully stuffed. There might be flowers or polka dots. Little covered buttons, too.

So now you are picturing yourself riding a bicycle with a wicker basket, calling out cheerfully to the postie as you cycle into the village for a half pound of butter. Bingo. That’s precisely the dress I’m talking about.

The tea dress is making a style comeback to fill the gap left after people like me ruthlessly cancelled the floral midi dress earlier this year. You may have noticed that it sounds a lot like that dress, what with often being floral and being knee length or longer. But the tea dress has a bit more oomph to it. The floral midi dress got cancelled for being a bit boring and generic; the tea dress is more shapely, more high energy. Where a floral midi can feel a bit schlumpy, a tea dress snaps its fingers at you, makes you stand up straight and pull your shoulders back.

Also, the tea dress looks good on most women. The shape emphasises the vertical line between your ribs at the front, rather than the horizontal one around your waist, which is more relaxing if, like me, you like being able to eat lunch without worrying that your tummy might stick out a bit afterwards. It also covers the shoulders and knees, which makes it more versatile than a skimpy holiday dress.

It is very important not to get hung up on the 40s thing. Historical accuracy is not the point. We are in the market for a mood, not a re-enactment. Two fancy designer dresses have done a lot to bring the tea dress back this summer, and both are modern interpretations that take the style somewhere different. The Victoria Beckham Gathered Waist Midi Dress, which has been worn in a very Agatha Christie poison green by everyone from Kendall Jenner to Queen Letizia of Spain, is tea-dress length, with delicate gathering and draped sleeves, but has a simple high neckline that makes it less sweet and flirty, a bit cooler. Alessandra Rich’s polka-dot dress, which is generally agreed to be the best thing about the Princess of Wales’s wardrobe, is a little more glam and starched, with pearl-and-gilt buttons and a formal ivory collar.

Excellent affordable tea dresses abound. Nobody’s Child makes a great modern tea dress: the £59 button-through Alexis has a shirred panel at the rear for gentle shaping and tie-detail sleeves, and comes in gingham or cherry print. Jigsaw’s Mini Graphic Pansy Tea Dress, reduced at the time of writing from £155 to £108, has decorative rouleau button loops trimming the V-shaped neckline, which is a nice quirky touch.

Or go vintage. I would bet that this classic’s return is partly because more of us are rummaging vintage rails. It was popular in the 1970s, and those versions are plentiful. But the more authentically retro your tea dress, the less faithful your styling should be. Brightly coloured trainers rather than a brogue; a big sweater around your neck rather than a little cardi. The tea dress is a real thing. I didn’t just make it up. But fashion history looks best when worn lightly.

Hair and makeup: Carol Morley at Carol Hayes Management. Model: Suzanne at Body London. Dress: Rixo

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Tesla Model 3 Highland officially unveiled with new design and more features - Electrek

Just hours after photos leaked of the upcoming Tesla Model 3 refresh, codenamed “Project Highland,” Tesla has officially unveiled its highly-anticipated facelift in Europe.

The refresh includes a “facelifted” front-end design, interior changes like more screen space (including a new rear display), and increased range. Tesla says that the refresh replaces more than half of the parts in the vehicle, though we’re not exactly sure how it measures that metric.

The most striking change is obviously the new design, which keeps most of the same look of the current Model 3, but changes the front end to look sleeker, removing the somewhat bulbous bump in the front end of the current Model 3.

We saw this front end in a leaked photo back in April, and it looks like it was the real thing all along. Now we have actual photos from Tesla, so you can see the changes in their full glory.

These photos show the new “Ultra Red” color, replacing the current red multi-coat. But this color may only be available in Europe – we’ll have to wait for more word from Tesla on this one.

The headlights have also gotten narrower and more aggressive-looking, in keeping with the general changes to make the front end look sleeker.

Tesla says that the refreshed Model 3 will have longer range, rated at 344 miles WLTP for the SR RWD version, and 421 miles WLTP for the LR, both with 18″ aero wheels. These numbers are an 11-12% improvement from WLTP ratings for the current Model 3.

But note that those are WLTP numbers, so they’re bigger than the US EPA numbers will be when they come out. If we expect a similar 11-12% improvement, then you’ll see roughly a ~300 mile EPA range on the SR and ~370 miles on the LR.

This increased range largely comes from improvements in aerodynamics, with a lower and less bulbous front end, channeling air around the vehicle more effectively. This has resulted in a Cd of .219, Tesla’s lowest yet (down from .225 on the current Model 3), which improves range by 5-8% on its own.

Tesla’s new 18″ “Photon” wheels

Tesla’s new 19″ “Nova” wheels

Another improvement is new wheel cover inserts which strike a compromise between consumers’ desires for larger-looking wheels and more range. Aerodynamic wheel inserts can increase range by a lot, but many think the wheels look better without the caps on (personally, I disagree, but whatever floats your boat).

There is a significant slate of interior changes as well:

• A new rear 8-inch touchscreen, giving rear seat passengers control over climate change and entertainment
• Deleted stalks on the steering column, much as in the Model S and X, with the gear selector now on the touchscreen and turn signal buttons on the left side of the steering wheel
• Ventilated front seats, which can be controlled from outside the vehicle through Tesla’s phone app, heating or cooling them up before you get in the car
• Cushier rear seats (now perforated, but not ventilated like the front seats)
• The sound system has been upped to 17 speakers (from 14)
• Improved bluetooth microphone performance
• Improved wi-fi and bluetooth for better connectivity to routers and phone keys
• A quieter interior than on the original Model 3, due to several changes to aerodynamics and materials
• Customizable interior ambient lighting
• Larger rear trunk, up to 594 liters from 561

Changes are now live on Tesla’s European sites, where the refreshed Model 3 is now available for order.

Deliveries begin in October (right after Tesla’s shameless FSD transfer scheme expires) in left-hand drive markets in Europe and the Middle East. Tesla has not yet announced when deliveries begin for North America (or for RHD markets like the UK). We don’t have pricing for North America yet, either, but in Norway for example, the SR version is the same base price as before, and the LR version is 10,000 NOK (~$941 USD) more expensive. So far, no performance Highland version has been announced.

Electrek’s Take

We’ve expected this refresh for quite a while now, but now that we see it, it’s a lot more extensive than we had imagined it would be.

The front end changes have been well documented, but the significant overhaul of the interior is quite a lot more than we thought it would be.

I personally love most of the changes, but am not a fan of the new steering wheel. While I haven’t tried this specific one, the “yoke” wheel on the Model S was not that pleasant to use. I’m sure it would be fine after getting used to it, but turn signal stalks are just so convenient and familiar, and I don’t like the change to buttons.

Same for using the screen for gear selection, which just feels kludgy – though that command isn’t used nearly as often as the turn signals, so it’s not as offensive to me personally.

And, lest you think I am merely a luddite, recall that in our original Model 3 review, I raved about almost everything about this car, including the changes that many considered odd. It was and is an exceptional vehicle, and the Highland changes do not change that on balance.

We’ll have to wait and see if changing 50% of the parts in the car results in a few glitches here and there with early models, but Tesla has gotten a lot better at manufacturing since the early days, so hopefully it won’t be too bad. Even my early Model 3 (VIN ~2500) has been mostly free of problems (except for the stinky feet air conditioning issue – it remains to be seen if Tesla has finally solved this with Highland, but we sure hope they have).

What do you think of the new Project Highland Model 3 Refresh? Let us know in the comments below.

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When a child is shot, doctors must heal more than just bullet holes - BBC

By Rebecca Hartmann

BBC News in Washington, DC

With the number of young people shot by guns on the rise in the US, a children's hospital in the heart of the America's capital is trying to break the cycle of violence.

In the emergency room at Children's National hospital in Washington, DC, hospital beds line the corridors as cartoons blare on television sets.

Nearby, children with the most traumatic injuries are rushed to the trauma room. These are often victims of road traffic accidents, but in recent years, more and more children have arrived with gunshot wounds. Dr Mikael Petrosyan, a paediatric trauma surgeon who has operated on victims as young as three years old, says it's a near daily occurrence.

"It's shocking, because it's a senseless it's to me, it's mind boggling," he says.

Firearms are now the most common cause of death amongst people under 17 years old, outranking road traffic accidents. The rate of gun-related deaths amongst youths has doubled in the last decade, according to a study published in JAMA Network Open medical journal, but it has got even worse since Covid. According to Pew Research gun deaths among under 18's in the US rose by 50% between 2019-2021.

• How gun violence is reshaping American lives
• How many US mass shootings have there been in 2023?

But it's not just the physical wounds though that need treating, say experts who work with gunshot victims. Dr Petrosyan says that children who have been shot before are much more likely to be shot again, often because they go right back to the same places, and the same people, that led to the initial shooting.

"That child not only gets traumatized, physically, but also mentally," he says.

Young victims may need help getting back on the right track - whether that means enrolling in school, finding a new group of friends or getting a job - in order to break the cycle of violence.

Dr Katie Donnelly, an emergency medical physician at National Children's Hospital, likens gun violence to a chronic illness that eventually proves fatal and says its endemic in parts of Washington DC.

"We have lots of families, who will say to us, every one of my children has been shot, or I still have my bullets in my body or his father was killed on the same street corner where he was shot," she told the BBC.

Last year, she launched the hospital's first youth violence intervention program. Instead of treating gun-shot wounds as isolated incidents, the programme takes that horrific moment in a young person's life and turns it into a starting point for change.

Yvonne Doerre, a social worker in DC for nearly thirty years, says there are many reasons behind the rise in youth gun violence. Guns are relatively easy to access, but there is also the lingering effects of the pandemic.

"When you go back to when Covid started, these kids were in fifth or sixth grades [ages 10-12], which are very volatile times in people's lives," she says. Without the structure of having to attend school in person, many young teens stopped attending online classes, and even failed to enrol in secondary school when the time came, she says.

"If you enrol then don't show, they'll look for you, but they never enrolled. You're just persona non grata. You don't exist," Ms Doerre says.

Getting youths enrolled and attending schools is one of the programme's key goals, but keeping them in school is not the only consideration. There is also the question of keeping young people caught up in gang violence away from the environment that made them a victim in the first place.

It's a fact the team has had to experience first hand. One of the first young men to enter the programme had his first gunshot wound when he was 13 years old. He joined the programme after his second shooting, and the team engaged with his family to talk about how best to help him. A few months later, he was shot and killed for a third and final time.

But there are successes. In their weekly meeting the team talked to a teenager who recently managed to get his job back due to the advice they gave him. For Dr Donnelly, there are many markers of success.

"How many Kids did I get back in school? How many kids did a summer work experience, and they're so proud and they show us their little their debit card with their first paycheque on it," Dr Donnelly says. "There are so many factors that affect whether or not a kid gets shot. We're just one piece of the puzzle."

Jewanna Hardy, who runs a youth programme called Guns Down Friday and has been working with the hospital team, agrees.

"Before this programme a kid would just get shot and go home," she says.

"They'd patch you up and you go on about your way."

"But now it's like a team of us, trying to figure out how we can change that kid's life, how we can change that family's life or community's lives."

Related Topics

• US gun violence
• Gun crime
• United States

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A new way to buy more farmland - Successful Farming

It’s becoming increasingly common for farmers to compete with investors for land. A new company is seeking to turn competitors into partners. 

Fractal, a farmland equity financing company, intends to help U.S. row-crop farmers purchase new land by accessing the equity in the land they already own. Fractal will connect the farmer with an investor who will purchase a minority share, up to 45%, of their owned land for cash to assist in the purchase of new land. The farmer maintains majority ownership and total control of their land. 

"We strongly believe farmland investment can be a force for good by aligning farmers with capital," says Ben Gordon, CEO and co-founder of Fractal. "We believe farmers are best positioned to manage the land and that investors can drive the greatest impact and returns by supporting strong farm businesses."

Under Fractal’s financing plan, the farmer pays the investor an annually-adjusted fee for the partnership. Any time after two years, the farmer may choose to buy out the investor but Gordon says their hope is farmers see the value in maintaining the partnership as it frees up cash for other opportunities. Fractal is also offering a discount to farmers who choose to enact approved conservation practices. 

"Our customer is that farmer who is constantly tinkering, growing, and improving, and has these other opportunities and the desire to improve their farm," says Gordon.  

The company’s launch is following a testing period that raised $5 million in investments. 

"Having capital ready to buy the must-have farms that come across my desk is very intensive," says Kyle Mehmen of MBS Family Farms, a 5th generation family farming operation in northeast Iowa. "Many farms become available at an inopportune time. Access to equity capital gives us the flexibility to plan for growth to support the next generation, and Fractal has become a trusted tool to help me capitalize on land opportunities when they arise to ensure that growth."

Fractal is backed by Trailhead Capital, Serra Ventures, LLC, Groove Capital, and Virta Ventures and supported by industry partners such as UnCommon Farms.

Learn more by visiting the company's website or signing up for this upcoming informational webinar.

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Russia faces domestic fuel crunch, braces for more shortages - The Globe and Mail

Russia, one of the world’s biggest oil producers, has faced shortages of fuel crucial for gathering the harvest in some parts of its southern breadbasket and the situation may get worse in coming months, market sources told Reuters.

Traders said that the fuel market has been hit by a combination of different factors, including maintenance at oil refineries, infrastructure bottlenecks on railways and the weaker ruble, which incentivizes fuel exports.

Russia has tried to tackle diesel and gasoline shortages over recent months, contemplating export curbs as the last-ditch attempt to prevent a serious fuel crisis – which is sensitive for the Kremlin ahead of a presidential election in March.

A government decision to cut subsidies for refineries is likely to worsen the availability of fuel in the world’s biggest grain exporter.

Regional oil product depots in Russia’s southern regions have had to cut or even suspend fuel sales, while retail filling stations were forced to limit fuel sale volumes to customers.

“The AI-92 gasoline is not available for retail sales in Krasnodar region, Adygea and Astrakhan, there is hardly any AI-95 gasoline and diesel,” a trader in Russia’s south said.

Another trader said there have been no diesel sales at oil depots and there is no diesel on retail markets for the second week running in the whole Samara region, located in the Volga river region.

Russian Deputy Prime Minister Alexander Novak said on Wednesday that there were no fuel shortages.

But he also said government was working on measures to ensure a stable supply of it on the domestic market, including increasing levels of mandatory sales on exchanges and limiting the number of exporters.

Traders said the shortages on the retail market followed by a sharp rise of wholesales prices. The state caps the retail prices, ordering the sellers to raise prices of gasoline and diesel only in line with official inflation.

Industry sources say the situation will improve no earlier than October when many oil refineries will wrap up their maintenance, while seasonal demand is expected to decline.

Some farmers also complained about scarcity of fuel.

“There are shortages of fuel … oil products prices rose in the range of between 10% and 20%,” Andrei Neduzhko, director-general of agricultural holding Step said in written comments.

His company operates in Russia’s southern regions of Rostov, Krasnodar and Stavropol. He said, however, there are no risks to the autumn sowing campaign for his holding.

Wholesale diesel prices started to sharply rise in July. For the past two months, commodity exchange diesel prices jumped on average by more than a quarter to 67,000 rubles (about $944) a ton.

“We do not buy. The prices are crazy,” an owner of a fuel depot said.

The energy ministry said last week that the volume of Russia’s oil products output fully met current demand for fuel, taking into account the redirection of some gasoline and diesel exports to the domestic market, as well as the use of stockpiles.

The energy ministry also was recommending earlier this month that oil companies find ways to curb wholesale fuel price rises in agricultural regions.

It has said in a statement that some supply issues had arisen because of high congestion on railways in southern Russia during the tourism season.

Russian Railways has said it was in discussions with oil producers, and was ready to solve the issues.

It also said in comments to Reuters that fuel supplies to southern regions via railways do not depend on an increase in passenger traffic.

“All requests for the transportation of fuel on domestic routes are given a priority … and “almost 100% of all products are delivered on time,” it said.

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