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nysocboy · 1 year ago

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Gemstones Episode 3.8: Is Peter a woman? Are Kelvin and Keefe lovers? Does Jesse dye his hair?

Episode 3.7 was the worst in the series due to its chronological disaster, plot incongruity, annoying misdirections, and assertion that the guys were just good buddies. Maybe that was intentional, to disorient the viewers so they would not be expecting Episode 3.8 : It is intricately plotted, and gives us a huge number of queer codes, including one that most fans consider definitive.

Reunited with the Loved Ones: After their rescue, the siblings are taken to Rogers Regional Medical Center to be examined. Gideon must have finally phoned the family, because the partners and kids burst in, coincidentally in the order they need to be in to reach their loved ones without bumping into each other.

We cut to the siblings being interviewed by the police. BJ and Gideon stand in front of them. Amber is not present. Keefe waits by the door, still not included in the family; but he does get a bit where he knocks over a trash can and yells "I hate what you had to endure." They all hate Eli, who left them to suffer and possibly be killed.

Next, having established that May-May wasn't in on the kidnapping plot, she and Eli bond.

Which of you is a woman?: With the marital problem plotlines nearly over, we have time for a deep-dive into the Militia.

Peter and Chuck are driving a U-Haul full of explosives, followed by a ragtag caravan of militia men. Marshall and Dakota (Sturgill Simpson, Quinn Dunn-Baker) complain that they don't know where he's going.

Does Peter know? Two compounds have been destroyed. The kidnapping scheme has been foiled. Everyone has forgotten the first scheme, which required the truckload of explosives.

They stop at Dodge's Fried Chicken, a real fast-food place on Savannah Highway in Charleston (next to a KFC, har har). Marshall continues to grumble. Peter asserts that complaining is "like a woman," and Marshall retorts that he drives "like a woman." They continue to call each other women until Chuck gets tired of it and tells them to focus on the new plan. Whatever it is.

Peter re-asserts his authority: if they rebel against him, they are rebelling against God, because he is the Keeper of the Word. Uh-oh, another Messiah.We see again parallels between the Militia and Kelvin's God Squad in Season 2: both societies devoted to the masculine, suspicious of women, informed by homoerotic or homosocial desire. run by a messianic figure. The militia is the dark side of Kelvin's God Squad We can go even farther and juxtapose Kelvin's bodybuilder fetish with the militia's fetishization of the soldier.

Seasons 1 and 2 featured gay-subtext friendships to counterbalance the development of the Kelvin-Keefe romance. I was surprised to not find one in Season 3, but maybe it's here, in Peter and Marshall's bickering.

Sexy Time: With almost no sleep, almost nothing to eat, and only a bucket to poop in for 36 hours or several days (depending on the chronology), I'd be interested in dinner and bed rather than sexy time, but after two militia scenes, we cut to the two couples having sex.

First, BJ and Judy take a bath together. BJ: "The whole time you were in captivity, I would light candles and just cry." It sounds like they were held for longer than a day. Also, his eye, puffed out from his fight with Stephen, is almost healed. Maybe a week?

He continues: "The best way to reset is with a really good, deep f*king." They play a game of helicopter-penis with an incest motif. You can sort of see BJ's dick, actually a prosthetic, in the swirling water.

Next it's Kelvin and Keefe's turn. Keefe has changed into a sleeveless leather top with gold studs from the Jim Morrison Mr. Mojo collection. Kelvin has showered and restored his top wave. After keeping his body under wraps all season, he displays his backside and butt, again becoming an object of homoerotic desire. Keefe pretends to give him a massage, but slides right past his shoulders to concentrate on his butt.

After being invited to fondle an ex-boyfriend's bare butt, most people would assume that he wanted to get back together, but Keefe has received so many mixed signals in the past that he has to be very careful. His questions are skillfully designed to push Kelvin to a decision: are they going to be post-breakup pals, good buddies with benefits, or lovers?

First he eliminates the post-breakup pal option by asking if Kelvin and Taryn are dating. Immediately after asking, he has Kelvin spread his legs, feels up his inner thighs, and starts"taking liberties," as Adam Devine reveals. The actor needed to be semi-aroused so his penis would look bigger for a cut scene with frontal nudity. In-universe, Keefe is answering his own question.

Kelvin: "Nah. She ain't my type." I've heard gay men say "You're not my type" to reject a flirtatious woman without coming out, but why would Kelvin feel the need to be closeted with his ex-boyfriend? This must be a structural ploy to avoid having him say "gay."

He continues: "I hated all the forced claps and laughter and fun times. I like doing claps and laughters with you." I've analyzed this scene in detail, and I still can't think of an in-universe reason for bringing up Taryn's work performance. That wasn't the question, and besides, Kelvin quit his youth minister job, so he's in no position to hire Keefe back.

But Keefe assumes that he's talking about the assistant youth pastor job, and responds in kind: "I love getting the children zazzed up and excited to learn about Jesus with you."

Now Kelvin clarifies that he was answering the "Are you and Taryn dating" question, not "Can I have my old job back?" "I mean, Taryn was nice and all, but she's not you." She was nice, but you can't build a romance from niceness. You need passion.

Keefe understands: "She tried to replace me, but it was a failed try." They're going to be romantic partners, combining eros and phileo, trying to "build something" for the future., reguardless of its impact on Kelvin's career. Which shouldn't be a problem. He's not working for the church anymore. They can move to Atlanta and march in Pride Parades.

Cut to Gideon driving Eli somewhere while they discuss how the siblings still aren't talking to him.

Eli explains that he would have paid if he thought they were really in danger; "I knew they weren't." Dude, Peter killed a man, tortured another, and sent his guys out to assault his own sons. The militia was planning to kill one of them "after church." Their lives were definitely in danger. Besides, the church paid $500,000 to avoid a scandal. $1,000,000 to get its pastors back seems like a bargain.

Next they discuss what Gideon is going to do with his life. He doesn't know. Eli notes that when he was a young man, he never would have imagined becoming a preacher, hint hint. You want the succession to skip over your children and go straight to Gideon, Pontius, and Abraham? Gemstone Brothers Ministries.

Back at the mansion, Chuck sneaks a phone call to his brother Karl, to complain that escaping put him and his dad in a bad spot with the militia. Oh, was not wanting to be murdered inconsiderate? Terribly sorry, Bro. He insists that he wouldn't really have killed his cousins. Everybody's got excuses.

I can be true to myself: The siblings meet for lunch at Jason's Steak House, and discuss how the kidnapping ordeal has changed them.

Judy: "Things are better than before the kidnapping." You and BJ having a second honeymoon?

Kelvin: "Makes everything snap into focus, that's for sure." You and Keefe having a second honeymoon?

Jesse: "I can be more honest, true to myself." He's stopped dying his sideburns, letting the natural gray appear.

Jesse asks them to return to their jobs at the church, and they agree. They don't mention Keefe returning as assistant youth minister, but it's implied: everyone has apparently forgotten about the Smut Busters scandal. Then they hold hands. In this season, holding hands has been awkward and uncomfortable for the siblings, so this is an important milestone in their relationship.

Not much left in the episode, but what's left includes most important scene in the series.

Military fetish photos, Kelvin's butt, and BJ's dick on RG Beefcake and Boyfriends

#the righteous gemstones #kelvin gemstone #keefe chambers #Adam Devine #Tony Cavalero #Peter Montgomery #Chuck Montgomery

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vipmarketingcom · 14 days ago

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Top 5 Charleston Website Design Agencies to Elevate Your Brand in 2025

In today's digital-first world, having a stunning, functional website is no longer optional—it's essential. Whether you're a startup or a well-established business, your website is often the first impression customers have of your brand. That’s why choosing the right partner for your Charleston website design needs is crucial. If you're based in the Lowcountry or looking to work with a team that understands Charleston's unique charm and market dynamics, this list is for you.

Here are the Top 5 Charleston Website Design Agencies making waves in 2025:

1. VIP Marketing

Website: vipmarketing.com

When it comes to full-service digital strategy with a creative edge, VIP Marketing stands at the forefront of Charleston website design. Known for delivering visually striking and high-performing websites, VIP Marketing blends cutting-edge design with SEO, content marketing, and branding. Their tailored approach ensures each client gets a solution that not only looks great but also performs in search rankings and conversions.

Why Choose VIP Marketing?

Custom design tailored to your industry

Responsive, mobile-first development

Integrated digital marketing strategies

Deep understanding of the Charleston market

Whether you're a law firm, medical practice, or local business, VIP Marketing can transform your online presence into a powerful brand asset. VIP Marketing specially designs a Law firm website.

2. Cobble Hill Digital

Website: cobblehilldigital.com

Cobble Hill Digital is another trusted name in Charleston website design, especially popular among creative brands and eCommerce businesses. Their team is passionate about storytelling through design and excels in crafting visually cohesive experiences that reflect a brand’s essence.

Highlights:

Beautiful, minimalist web design

Strong branding and UI/UX expertise

Ideal for lifestyle and boutique brands

3. Blue Ion

Website: blueion.com

With decades of experience under their belt, Blue Ion is a full-spectrum creative agency offering everything from digital strategy to custom development. Their websites are immersive, user-centric, and built to perform.

Why they stand out:

Focus on user experience and strategy

Comprehensive digital solutions

Collaboration with well-known Charleston brands

They’re a great option if you're looking for a design agency with a proven track record and creative edge.

4. Obviouslee Marketing

Website: obviouslee.com

Obviouslee is more than just a quirky name—they’re a powerhouse in digital marketing and Charleston website design. Their strength lies in creative storytelling, branding, and design that connects brands with their audiences in meaningful ways.

Specialties:

Creative web design that tells your brand story

Social media and digital strategy integration

Known for working with lifestyle and tourism clients

5. NetGALAXY Studios

Website: netgalaxystudios.com

For businesses seeking a technically sound yet stylish website, NetGALAXY Studios brings a unique blend of mobile app development, custom coding, and web design. They’re ideal for startups or companies with complex needs who want sleek design paired with technical capability.

Strengths:

Full-stack development + design

Mobile-responsive, fast-loading sites

Industry-specific website packages

Final Thoughts

Choosing the right Charleston website design agency can make a lasting impact on your digital presence. Whether you need branding expertise, a powerful eCommerce platform, or a sleek informational site, these top 5 agencies have the skills and local insight to help your business shine.

If you’re ready to elevate your website and brand presence, consider partnering with VIP Marketing—a leader in Charleston’s competitive digital scene.

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hayleymedbil · 4 months ago

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Leading 10 Accredited Schools for Medical Billing and Coding: Launch Your Career Today!

Top 10 Accredited‍ Schools for Medical Billing and Coding: Launch Your Career Today!

Top‍ 10 Accredited Schools for⁣ Medical Billing ‍and⁣ Coding: Launch Your Career Today!

Medical billing and coding is a vital part of the healthcare system, ensuring that ⁣healthcare providers ‍get reimbursed for their services. With the rising demand for professionals skilled in this area, now is an ⁣excellent time to pursue a career in medical billing⁤ and coding. This article explores the top 10 ⁢accredited schools for medical billing and coding, helping⁢ you find the right program to kick-start your career.

What is Medical Billing and‍ Coding?

Medical billing and coding involves translating healthcare ⁣services into universally accepted codes. These‍ codes are used for billing⁣ and insurance ⁤claims.Professionals in this field ensure that⁣ records are accurate, which is⁢ crucial ⁢for providers and patients alike. Accredited schools provide training that equips students with the necessary ‍skills and⁣ knowledge.

Benefits of Attending ⁣an Accredited School

Quality‍ Education: Accredited schools meet‌ specific standards of excellence.

Career Opportunities: ⁤ Employers‍ often prefer candidates from accredited ⁣programs.

Financial Aid: Federal financial aid‌ is available only for students attending accredited institutions.

Networking: Connect with professionals⁢ and peers in the⁤ field.

Top 10 Accredited Schools for ⁤Medical Billing and Coding

School Name

Location

Program Offered

Accreditation

Southern New Hampshire ⁤University

Manchester, NH

Online Associate and bachelor’s

NECHE

University of Phoenix

Multiple Locations

online Associate and Bachelor’s

HLC

Penn Foster

Online

Online ‍Certificate and Associate

DEAC

Herzing University

Multiple Locations

Online Associate

HLC

National American University

Multiple Locations

Online Associate and⁤ Bachelor’s

HLC

Western Governors University

Online

Online Bachelor’s

NWCCU

gateway Community College

New Haven, CT

Associate Degree

NEASC

City College of San Francisco

San Francisco,⁤ CA

Certificate Program

ACCJC

Charleston Southern University

Charleston,‌ SC

Online Bachelor’s

SACSCOC

Capella ⁤University

Minneapolis, MN

Online Bachelor’s

HLC

How to Choose the Right Program for You

Choosing the right accredited ‍school ⁤for medical billing and coding can substantially impact your career. Here ⁣are some factors to consider:

Delivery⁤ Method: ⁢ Decide⁢ if you prefer online, hybrid, or in-person classes.

Cost: Compare tuition rates and ⁤consider your budget.

Curriculum: Ensure the program⁢ covers essential topics like CPT,ICD,and HCPCS coding.

Support Services: Look ⁣for schools that offer career services, mentoring, and tutoring.

Case Studies: Success Stories ‌from Graduates

Case Study 1: Sarah graduated from Herzing University with an Associate Degree in Medical Billing and Coding. ⁢Within six⁣ months, she landed⁢ a job as a billing specialist⁣ at a local clinic. She attributes⁣ her⁢ success to the extensive ⁣training and⁢ hands-on experience⁢ provided by the program.

Case study 2: John completed his diploma‍ at Penn foster⁢ and immediately began working as a coder for a large hospital. He found the ‍self-paced online format convenient for‍ managing ‍work and study, which allowed him to⁤ excel in his new role.

practical Tips for Your Journey

Get Certified: Consider⁣ pursuing certification through organizations like AAPC⁤ or AHIMA.

Stay ‍Updated: Medical coding ‍is always evolving. Keep learning about ⁢changes in coding standards.

Network: Engage⁢ in professional groups and seminars to connect with others in the field.

Conclusion

Launching your career‍ in medical billing‌ and coding is a smart move in today’s healthcare landscape. By‍ selecting one⁣ of the top‍ accredited schools, you can acquire the skills and knowledge ‍necessary to excel in this ⁣rewarding profession. Evaluate your options carefully to ensure ⁣you choose ‍a program that aligns with your career goals. With the right education, you soon ‌will find ⁤yourself‌ on a ⁣path‍ to success in the growing world of medical billing and coding.

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https://medicalcodingandbillingclasses.net/leading-10-accredited-schools-for-medical-billing-and-coding-launch-your-career-today/

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brookemedbil · 6 months ago

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Open Your Career: Top Medical Billing and Coding Jobs in Charleston, SC

unlock Yoru Career: Top medical Billing and Coding Jobs in Charleston,SC

Unlock your Career: Top Medical Billing and Coding Jobs in Charleston, SC

Are you looking⁣ to launch a rewarding career ⁤in the ‌healthcare industry? Medical billing and coding offers an‍ exciting opportunity to enter ⁤a growing field with vast prospects for advancement.⁤ In the charming city of Charleston, South ‌Carolina,‍ this sector is thriving, ‍making it an excellent location to‍ find the best job opportunities. In this article, we’ll explore ⁣top medical billing and coding jobs, the benefits of working in this field, and practical tips to get started in Charleston.

Why Choose a Career in Medical⁣ Billing and Coding?

Medical billing and coding professionals play ⁣a crucial role in ensuring healthcare facilities receive proper reimbursement for services rendered. As the healthcare industry expands,so does the demand for⁢ qualified professionals. Here’s why you should consider ‌a career in this field:

Job Stability: the healthcare⁣ sector is always in need⁢ of skilled workers, ensuring job⁢ security.

Good Salary Potential: Average⁢ salaries for medical billers and coders in Charleston range from $40,000 to $70,000, depending on experience and specialization.

Flexibility: Many positions offer remote work options,allowing you⁤ to balance your professional and ⁤personal life.

Opportunities for Growth: With additional certifications and experience, professionals can advance to supervisory roles or specialized fields.

Top Medical ⁣Billing and Coding Jobs in Charleston,SC

Charleston is home to several⁣ healthcare facilities‍ and organizations that‍ are consistently‌ on the ⁣lookout‌ for medical billing and coding ⁤specialists. Here are some top job opportunities currently⁣ available ‍in the area:

Job Title

Company

Location

Salary Range

Qualifications

Medical Coder

MUSC⁢ Health

Charleston,SC

$50,000 – $70,000

Certification in AAPC or AHIMA

Billing Specialist

Trident Health

Charleston,SC

$40,000 – $60,000

High School Diploma + Coding knowledge

Healthcare Claims analyst

Tenet Healthcare

Charleston,SC

$45,000 – $65,000

CPC certification preferred

Certified medical Billing Specialist

Roper ⁣St. Francis ⁤Healthcare

Charleston,⁢ SC

$48,000 – $68,000

Associate degree + certification

Benefits of Working in Medical Billing and Coding

Beyond just salary, working in ⁢medical billing and ⁣coding⁢ offers several distinct‍ advantages:

Impact on Healthcare: By ensuring that claims are‍ processed accurately, you help healthcare providers maintain their operations⁤ and serve patients effectively.

Continuous Learning: Regulations and coding‌ standards are always evolving. This means⁢ you’ll continually learn and improve your skills.

Work Habitat: You may work in a healthcare⁣ facility, from home, or in‍ a more corporate environment, giving you diverse choices.

How to ⁤Get Started in Medical Billing and Coding

To embark on a career in medical billing and ⁢coding, follow these essential steps:

1. Obtain Relevant Education⁤ and Certification

A degree or certification in medical billing and coding is often required.The following programs are widely recognized:

Associate Degree: A two-year program typically covering medical terminology, billing procedures, and coding systems.

Certification Courses: Certifications from organizations like AAPC or AHIMA can enhance your employability.

2. Gain Practical Experience

Look for internships or entry-level positions to gain hands-on experience.‌ Many healthcare organizations offer training programs for new hires.

3. Network with Local ⁢Professionals

Join local healthcare associations and attend industry events in Charleston to connect with other professionals,which can lead to‌ job opportunities.

4. Prepare for Job Applications

When applying for jobs, tailor your⁣ resume and cover⁢ letter to highlight relevant skills and experiences.Make sure to showcase any certifications you possess.

First-hand Experience:‍ A Case Study

Jane,‍ a⁣ resident of Charleston, decided to change ‍her career path after working in retail for several years. ‍She enrolled in a local ⁣community college ‌to pursue a certification in medical billing‌ and coding. After completing her program,she landed an entry-level position as a billing clerk at a local ‌hospital.

Within a year, Jane obtained her CPC certification and was promoted to a⁤ coding specialist role, where she now enjoys a rewarding salary and the flexibility of working ⁣from home two days a week. Jane credits her success to the connections ‌she made within ‍the ‍industry and continuously upgrading her skills.

Conclusion

With⁤ the robust growth of the healthcare industry in Charleston, SC, medical billing and⁢ coding jobs offer⁤ great potential for anyone seeking a ⁢stable and fulfilling career. By obtaining proper education, gaining experience,⁢ and networking with⁢ other professionals, you can position yourself for success in this field. ready‍ to start your ⁤journey in‌ medical billing⁤ and coding? The opportunities in Charleston are waiting for ⁣you!

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https://medicalbillingcodingcourses.net/open-your-career-top-medical-billing-and-coding-jobs-in-charleston-sc/

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test00660606 · 7 months ago

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Savannah Jane McKenzie is a siren that currently resides in Sunny Harbor and has been a Lunar Cove resident for a week now.

ITS THE END OF THE WORLD

GENDER/PRONOUNS: Cis Woman, She/Her

DATE OF BIRTH: March 5, 1993

OCCUPATION: Watress at Peggy’s & MC at On Pitch

FACECLAIM: Meghann Fahy

AS WE KNOW IT, AND I FEEL FINE

SPECIES: Fae

SUBCATEGORY: Siren

REGENERATED: Yes

FAE COURT POSITION: Non-Member

AGE THEY APPEAR: 31

WELCOME TO LUNAR COVE, SAVANNAH JANE MCKENZIE

Trigger Warnings: Implied Homophobia, Self Medication, Death, Murder

Savannah Jane McKenzie’s fate had already been sealed from the moment she took her first breath. The young girl with a thick southern twang would wander through the fields not too far from her house. The wind whisking through her hair as if to whisper a calm of the centuries in her ears. But, little did she know, there was a reason why each tiny petal she’d pluck off the forget-me-nots spoke to her like a morse code for her soul.

The faerie had once lived quite a life. Born by the name Sibhán, only to later rename herself as Sienna Cecaelia, the siren was rather infamous. A cruel beauty with a voice that was sickeningly sweet, at first, hardly left the water. Though her song sent shivers down the spines of those who would border the coasts. Calling out to sailors in the dead of night, amusement would flicker across her sharp gaze. The vixen, she was, would lean back against her make-shift throne of rock as she watched the men who would pollute her oceans drown one by one. The spiting image of her mother, she’d toy with them as if they were hers for the taking, and, as the centuries went by, she’d make her way onto land, dominating the social scene before she moved on to take Hollywood by storm. Her body count heavily increasing, not that she bother to keep track. The faerie hardly payed much mind to the politics of the Supernatural community or the Safe Haven with its plethora of rules and obligations. She made sure to keep a low enough profile for them to stay out of her hair, faking her own death from time to time so that no one would grow too suspicious. It was only after her mother, now going by the name Vanessa, had decided to make her way to the Cove, did the siren begin to take interest. But, before she could decide to join her, it was too late. On the eve of her 849th birthday, the Siren whose name had graced the pages of plenty of, what she had imagine to be, Lunar Cove history books had been taken down. Shot in the heart by a woman she had loved only whom had wound up betraying her. The femme fatale died a cautionary tale as to why you should never trust a human. Though, that is hardly where the story ends.

Reborn in a small town in Georgia, Savannah Jane awoke to the soft sea breeze and the warm rays of the sun. The sharp gaze she had once been known for replaced by a childlike curiosity which her new folks tried to foster. Her mamma used to say that she was born with lightning in her heels, given how she could never seem to sit still. But, concern quickly crept across their brows as their beautiful baby girl who always seemed to draw others in with the ease of her smile started to suffer for terrible nightmares that would keep her up well throughout the night. Sav would mumble on and on about these detailed dreams that seemed all too real. Dreams that a pre-teen hardly should be havin’ and, when their honey blonde child turned thirteen, her baby sister came screaming down the stairs calling out for help, because Savannah, god forbid, was crying tears of blood. At first, they didn’t know what was wrong with her. They took her to a few doctors in the area, before some peculiar events caught them up to speed and, a few weeks later, they were packing up their bags and moving up the Coast to South Carolina. They settled on the outskirts of Charleston and established some new family rules that applied more to Savannah than to anyone else. She was to avoid water in public at all costs. She was never to sing outside of the house. She had to do better at keeping her emotions under control so that a storm cloud wouldn’t suddenly break overhead and the list went on. It worked too, for a while. The McKenzies were embraced by their new community and everyone was non-the-wiser.

Though Sav, like any rebellious teenager, would push the limits when she could. She had snuck out one early summer morning down to the beach. She had swam far enough away to not be spotted by anyone laying out across the sand and, after, a few hours splashing about, a boat drew near from where she was basking across a pair of rocks. Though lucky for her, by the time the boat came in eyesight of her, her tail had fully dried off. Instead, the nineteen year old in his sailboat, saw what appeared to be a girl around his age ‘marooned’. The boy visiting from out of town for the summer, helped her into his boat to return to shore and she went along with the idea that he had 'rescued her’. Before they knew it, a whirlwind summer romance had begun. She was only eighteen and he was only in town for a couple months. But, they fell hard and they fell fast. Only before they knew it, the summer had come to an end. He headed back to New York and she spent the next few weeks none the wiser to how one night in the back of her daddy’s pickup truck would change her life.

Her mother’s petrified look when she finally had to tell her that she was pregnant was seared into her head. The fear in her mamma’s eyes that her baby would take after her hung over them like a thick cloud of smoke. While the man they would have asked to take accountability for their daughter was off miles away back home. 'Luckily’ for them, however, it wasn’t too uncommon to marry young down in the South and her parents didn’t have too much trouble finding another man who would happily marry her daughter and pretend her soon-to-be child was his. Savannah always had plenty of 'suitors’ following her about like a heard of wide eyed puppy dogs. She had that allure about her that she’d later realize came with the territory of being a fae. But, Tyler Montgomery had been a friend of the family. Their parents went back since their dad’s colleges days and the Montgomery’s happened to be part of the reason Sav’s father picked South Carolina to up move their family too. Tyler was a good man, as much as Savannah had wanted no part in marrying him.

She tried to call Devrim once when talk of an engagement started up. But, he didn’t pick up, he didn’t call her back and she couldn’t bring herself to 'derail’, as her mamma liked to refer to it as, someone else’s life on top of her own, even if he had been the one to get her pregnant. She was on her own and the mercy of her family’s wishes. She held off for as long as could, but as September rolled around, she found herself having to drop out of the college she had gotten into. Gone were her dreams of being an international relations major or getting out of the South. She pushed the gnawing feeling in her gut that she meant to be somewhere always down and, before she knew it, she was walking down the aisle at one of the biggest and quickest shotgun weddings her town had seen in a while.

The next fourteen years after that felt like a whirlwind. Tyler raised Serra, her daughter, better than she likely ever could have alone and they got along for the most part. She hide his secrets and he agreed to hide hers, though there was a few months they went without talking much after the freak out he had, having learned what kind of family he had married into. But, as the years went by, the dreams seemed harder and harder to ignore. It was as if Sav was living another life whenever she closed her eyes and the numb indifference of the woman she used to be before was seeping into her veins. Every morning she’d wake up to her hands shaking. She’d try to play it off. Pretend like she didn’t catch the questionable looks or overhear the whispers as to why Montgomery’s wife was drinkin’ so early in the mornin’, but no amount of self medicating could shake the pit in her chest that if she didn’t go lookin’ for answers, things for her would only grow a whole lot worse.

It was in August of 2024, when Savannah and Tyler decided to call it off. His home was in South Carolina, while she knew in her gut that the answers to everything that she had been dealing with since she was thirteen laid elsewhere. Memories of a small town in Rhode Island were whispering in her ear from the moment she woke up to the second she fell asleep. Calling out to her and drawing her near. Not to mention, while she had been more than willing to play the role of his loving wife in public, they both knew his heart laid elsewhere. He had been too afraid of what their neighbors might think to act on it, but he deserved to be happy, just as much as she deserved, to once and for all, know the truth about herself. So, she packed up her things and before she knew it, she was moving her own fourteen year old daughter and herself to a town she knew next to nothing about, but had this sinking suspicion in her chest that she had been there before.

Now, brand new to Lunar Cove, Savannah has been reconnected with the woman who was her mother before she regenerated. Vanessa is practically a shut-in within Lunar Cove, having hardly left her home in ages. She isn’t a fan of visitors or other residences, casting an ominous storm cloud over her house that was built precariously over a cliff to keep passerbys at back. She believes sirens are the superior species and refuses to ever leave her siren form, so she roams around the deteriorating house in a wheel chair with her tail out which makes the floor creek so badly it can be heard by passerbys from the street. A house Savannah and her daughter are now crashing at until she can find a place of her own. Though, Vanessa is hardly the only one from her past she is bound to run into. The siren has left a fair share of damage her wake. Some of it she remembers, some she has a vague idea to next to no recollection of. But, you can’t always out swim the current and, sooner or later, her past will wind up catching up to her.

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sahraeyll · 7 months ago

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Open Your Career Potential: Top Medical Billing and Coding Jobs in Charleston, SC

Unlock ‍Your Career Potential: Top Medical Billing and Coding Jobs in Charleston, SC

If you’re looking to advance your⁤ career in‍ the healthcare industry, exploring medical billing ‌and coding jobs in Charleston, SC, could be your golden ticket. With Charleston’s growing healthcare sector,‌ there⁢ are ⁤numerous opportunities ⁤for qualified professionals to thrive. This article dives‌ deep into ‍the best jobs available, ‌the benefits of pursuing a ‍career in this field, practical tips to enhance your ⁢job search, and valuable insights from industry experts.

Understanding Medical Billing and Coding

Medical billing ‌and⁢ coding are integral parts of the healthcare system. Professionals in this field ensure‌ that⁢ healthcare providers are properly reimbursed for the services they provide. Below are⁣ some key components of medical billing‌ and coding:

Medical Coding: ‌Assigning standardized ⁤codes to diagnoses and procedures.

Medical Billing: ⁢Preparing and submitting claims to insurance companies.

Insurance Verification: Confirming patient coverage and benefits.

Top ‍Medical Billing and Coding Jobs in Charleston, SC

Charleston, SC, is⁤ home to various employers seeking skilled medical billing and coding professionals. Here’s a list of some of the top job titles ⁤available in the area:

Job Title

Average Salary

Job Growth Rate

Medical Biller

$45,000

12% (Faster than average)

Medical Coder

$48,000

10% (Faster than average)

Billing Specialist

$50,000

13% (Faster than average)

Compliance Officer

$60,000

8% (Average)

Benefits of Pursuing‌ a Career in Medical Billing and Coding

A career⁣ in medical billing and coding offers several advantages ⁤that can⁣ help unlock your career potential:

Job Stability: The healthcare sector is constantly expanding, leading to high demand for billing and coding specialists.

Flexibility: ‍Many positions offer remote work options, allowing ⁤for a better work-life⁤ balance.

Competitive Salaries: ⁤ Salaries in this field are competitive, with opportunities⁣ for advancement.

Short Training Programs: Many certification programs can be⁢ completed in under a year, allowing‍ you to start your career quickly.

Practical Tips ‍for Securing a Job in Charleston

Here are some tips to ‌help you land your ideal medical billing and coding⁣ job in⁣ Charleston, SC:

Obtain Relevant Certifications: Pursue ‍certifications from recognized organizations, such as AAPC ⁣or AHIMA.

Network Effectively: Attend local healthcare events to meet potential employers and⁤ connect ⁣with industry professionals.

Tailor Your Resume: Customize your resume for each application, showcasing relevant skills and experiences.

Utilize Job Boards: Make use of job boards like Indeed, LinkedIn, and‌ CareerBuilder ‌to ⁢find local listings.

Prepare for ⁢Interviews: Practice common interview questions and demonstrate your knowledge of medical ⁢coding guidelines.

Case Studies:⁢ Success Stories from Charleston, SC

Let’s explore a couple ‍of success stories from those who have‍ carved their path in medical billing and coding in Charleston:

Case Study 1: Sarah Johnson

After completing ‌a 9-month certification program, Sarah found a job as a medical coder at a local⁤ hospital. She started earning $48,000 annually and within two years was promoted to a senior coding position, increasing her salary and responsibilities.

Case Study 2: Mark Thompson

Mark initially struggled to find a job post-certification. However, after attending networking events and taking part-time work as⁣ a billing specialist, he secured a ‌permanent position with a competitive salary by expanding his professional connections.

First-Hand Experience: Voices from⁣ the Industry

Hearing‍ from those currently working⁣ in ⁢the field⁢ can provide invaluable insight. Here are‌ a few testimonials from Charleston professionals:

“Working in medical billing has allowed me to grow my career while enjoying flexibility in my schedule. The demand for professionals like me is higher than ever!” – ⁢ Emily Lane, Medical Biller

“The coding world is exciting and ever-changing. I love that I am‌ always learning new things, and every day‌ is different.” –‌ Jason Reyes, Medical Coder

Conclusion

As you can see,‍ pursuing a career ‍in medical billing and coding in Charleston, SC, can‌ unlock numerous opportunities for professional growth and stability. By understanding the ‌job market, acquiring the necessary skills and ⁣certifications, and networking effectively, you can position yourself for success ⁤in this thriving field. Whether you are just starting out or looking ⁢to advance your career, Charleston offers a vibrant landscape for medical billing and ‌coding professionals to flourish.

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https://medicalbillingcertificationprograms.org/open-your-career-potential-top-medical-billing-and-coding-jobs-in-charleston-sc/

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lunarcovehq · 8 months ago

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WELCOME TO LUNAR COVE, SAVANNAH JANE MCKENZIE

GENDER/PRONOUNS: Cis Woman, She/Her

DATE OF BIRTH: March 5th, 1993

OCCUPATION: Baker at Doce & MC at On Pitch

RESIDENCY: Sunny Harbor

FACECLAIM: Michelle Randolph

IF I DIE YOUNG

SPECIES: Fae

SUBCATEGORY: Siren

REGENERATED: Yes

FAE COURT POSITION: Lesser Fae

AGE THEY APPEAR: 31

LAY ME DOWN IN A BED OF ROSES

Trigger Warnings: Implied Homophobia, Self Medication, Death, Murder

Savannah Jane McKenzie's fate had already been sealed from the moment she took her first breath. The young girl with a thick southern twang would wander through the fields not too far from her house. The wind whisking through her hair as if to whisper a calm of the centuries in her ears. But, little did she know, there was a reason why each tiny petal she'd pluck off the forget-me-nots spoke to her like a morse code for her soul.

The faerie had once lived quite a life. Born by the name Sibhán, only to later rename herself as Sienna Cecaelia, the siren was rather infamous. A cruel beauty with a voice that was sickeningly sweet, at first, hardly left the water. Though her song sent shivers down the spines of those who would border the coasts. Calling out to sailors in the dead of night, amusement would flicker across her sharp gaze. The vixen, she was, would lean back against her make-shift throne of rock as she watched the men who would pollute her oceans drown one by one. The spiting image of her mother, she'd toy with them as if they were hers for the taking, and, as the centuries went by, she'd make her way onto land, dominating the social scene before she moved on to take Hollywood by storm. Her body count heavily increasing, not that she bother to keep track. The faerie hardly payed much mind to the politics of the Supernatural community or the Safe Haven with its plethora of rules and obligations. She made sure to keep a low enough profile for them to stay out of her hair, faking her own death from time to time so that no one would grow too suspicious. It was only after her mother, now going by the name Vanessa, had decided to make her way to the Cove, did the siren begin to take interest. But, before she could decide to join her, it was too late. On the eve of her 849th birthday, the Siren whose name had graced the pages of plenty of, what she had imagine to be, Lunar Cove history books had been taken down. Shot in the heart by a woman she had loved only whom had wound up betraying her. The femme fatale died a cautionary tale as to why you should never trust a human. Though, that is hardly where the story ends.

Reborn in a small town in Georgia, Savannah Jane awoke to the soft sea breeze and the warm rays of the sun. The sharp gaze she had once been known for replaced by a childlike curiosity which her new folks tried to foster. Her mamma used to say that she was born with lightning in her heels, given how she could never seem to sit still. But, concern quickly crept across their brows as their beautiful baby girl who always seemed to draw others in with the ease of her smile started to suffer for terrible nightmares that would keep her up well throughout the night. Sav would mumble on and on about these detailed dreams that seemed all too real. Dreams that a pre-teen hardly should be havin' and, when their honey blonde child turned thirteen, her baby sister came screaming down the stairs calling out for help, because Savannah, god forbid, was crying tears of blood. At first, they didn't know what was wrong with her. They took her to a few doctors in the area, before some peculiar events caught them up to speed and, a few weeks later, they were packing up their bags and moving up the Coast to South Carolina. They settled on the outskirts of Charleston and established some new family rules that applied more to Savannah than to anyone else. She was to avoid water in public at all costs. She was never to sing outside of the house. She had to do better at keeping her emotions under control so that a storm cloud wouldn't suddenly break overhead and the list went on. It worked too, for a while. The McKenzies were embraced by their new community and everyone was non-the-wiser.

Though Sav, like any rebellious teenager, would push the limits when she could. She had snuck out one early summer morning down to the beach. She had swam far enough away to not be spotted by anyone laying out across the sand and, after, a few hours splashing about, a boat drew near from where she was basking across a pair of rocks. Though lucky for her, by the time the boat came in eyesight of her, her tail had fully dried off. Instead, the nineteen year old in his sailboat, saw what appeared to be a girl around his age 'marooned'. The boy visiting from out of town for the summer, helped her into his boat to return to shore and she went along with the idea that he had 'rescued her'. Before they knew it, a whirlwind summer romance had begun. She was only eighteen and he was only in town for a couple months. But, they fell hard and they fell fast. Only before they knew it, the summer had come to an end. He headed back to New York and she spent the next few weeks none the wiser to how one night in the back of her daddy's pickup truck would change her life.

Her mother's petrified look when she finally had to tell her that she was pregnant was seared into her head. The fear in her mamma's eyes that her baby would take after her hung over them like a thick cloud of smoke. While the man they would have asked to take accountability for their daughter was off miles away back home. 'Luckily' for them, however, it wasn't too uncommon to marry young down in the South and her parents didn't have too much trouble finding another man who would happily marry her daughter and pretend her soon-to-be child was his. Savannah always had plenty of 'suitors' following her about like a heard of wide eyed puppy dogs. She had that allure about her that she'd later realize came with the territory of being a fae. But, Tyler Montgomery had been a friend of the family. Their parents went back since their dad's colleges days and the Montgomery's happened to be part of the reason Sav's father picked South Carolina to up move their family too. Tyler was a good man, as much as Savannah had wanted no part in marrying him.

She tried to call Devrim once when talk of an engagement started up. But, he didn't pick up, he didn't call her back and she couldn't bring herself to 'derail', as her mamma liked to refer to it as, someone else's life on top of her own, even if he had been the one to get her pregnant. She was on her own and the mercy of her family's wishes. She held off for as long as could, but as September rolled around, she found herself having to drop out of the college she had gotten into. Gone were her dreams of being an international relations major or getting out of the South. She pushed the gnawing feeling in her gut that she meant to be somewhere always down and, before she knew it, she was walking down the aisle at one of the biggest and quickest shotgun weddings her town had seen in a while.

The next fourteen years after that felt like a whirlwind. Tyler raised Serra, her daughter, better than she likely ever could have alone and they got along for the most part. She hide his secrets and he agreed to hide hers, though there was a few months they went without talking much after the freak out he had, having learned what kind of family he had married into. But, as the years went by, the dreams seemed harder and harder to ignore. It was as if Sav was living another life whenever she closed her eyes and the numb indifference of the woman she used to be before was seeping into her veins. Every morning she'd wake up to her hands shaking. She'd try to play it off. Pretend like she didn't catch the questionable looks or overhear the whispers as to why Montgomery's wife was drinkin' so early in the mornin', but no amount of self medicating could shake the pit in her chest that if she didn't go lookin' for answers, things for her would only grow a whole lot worse.

Now, brand new to Lunar Cove, Savannah has been reconnected with the woman who was her mother before she regenerated. Vanessa is practically a shut-in within Lunar Cove, having hardly left her home in ages. She isn't a fan of visitors or other residences, casting an ominous storm cloud over her house that was built precariously over a cliff to keep passerbys at back. She believes sirens are the superior species and refuses to ever leave her siren form, so she roams around the deteriorating house in a wheel chair with her tail out which makes the floor creek so badly it can be heard by passerbys from the street. A house Savannah and her daughter are now crashing at until she can find a place of her own. Though, Vanessa is hardly the only one from her past she is bound to run into. The siren has left a fair share of damage her wake. Some of it she remembers, some she has a vague idea to next to no recollection of. But, you can't always out swim the current and, sooner or later, her past will wind up catching up to her.

#michelle randolph #Savannah Jane McKenzie #taken fae #on pitch #nonmember fae #sunny harbor #all #doce

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brooklynblerd · 5 years ago

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So You Want To Be An Ally

Over the last 2 weeks, I have been fielding many white-guilt questions at work and having very interesting conversations and Zoom calls. Overall, they have been well received, but I am not sure if anything will happen once this is no longer a hot topic. I hope we keep up the momentum, but the media and Politicians and other power holders will try to silence us as quickly as possible. All of the companies realizing that #BlackLivesMatter will inevitably fade away as well. WE HAVE TO KEEP THE PRESSURE ON. So I made a list of talking points for the company that I work for, I hope they put it to use. I will begin sending this to anyone that reaches out to me to “talk” or “to see if I am ok”. While I appreciate the concern (if it’s genuine), I cannot continue being your only Black friend or the only Black person that you feel comfortable speaking to.

I saw this on Twitter recently, White privilege doesn't mean that your life hasn't been hard, it just means that the color of your skin isn't one of the things that makes it harder. I think this pretty much sums up what white people need to understand, what those people calling themselves our allies need to understand. Having Black pride & saying Black Lives Matter should not offend anyone. It does not mean that we are anti white people.

Black people are not a monolith. While we have all experienced racism in some form or another, we do not share the exact same experiences with it. To try and get an overall view of the different types of racism, you need to speak to many different Black people. Stop treating us as a collective, we are all individuals. Racism has permeated every single institution in this country. Education, Housing, Banking, Healthcare, Criminal Justice, Entertainment, etc. Racism is very much systemic, not always overt. There are also many different microaggressions that do not present as overt racism. Also, if we are going to have these discussions, please make sure that we feel safe, that we will be heard without reprimand or cynicism or disbelief. Our silence is the reason why this has gone on for so long. We want to be heard. We are no longer willing to stay invisible. Fear makes many of us stay silent, not willing to upset the status quo.

Revamp your hiring strategy/quota. People and organizations tend to conflate diversity and inclusivity. They are NOT the same. While there are many women, LGBTQIA members, Black and other People of Color, the Executives, Sales Management, and HR do not reflect this.

Conversations about race and other social justice issues are uncomfortable. Having these conversations without any Black and People of color present is pointless. Make sure you have Black people and other People of Color in any discussions you have regarding race relations and any other social justice issues. Empathy and sympathy is great, but it will not replace an actual experience.

Understand that the current state of the world has been a long time coming. George Floyd was the straw that broke the camel's back. The only difference is that everyone has a camera now and the police aren't doing themselves any favors by brutalizing everyone who is protesting police brutality.

Acknowledge your privilege. Acknowledge that the system is built to benefit you more than it does us and that it always has.

Saying "I'm not racist" isn't enough anymore. You have to be anti-racist. You have to stop the jokes, stereotypes, etc amongst your circle of friends and family members. This will be hard. But Black and Brown lives have to matter more than offending anyone that is unwilling to change.

Racism is not up to Black people and other People of Color to solve. This wasn't created or instituted by us and as we remain the "minority" in positions of power, we are unable to change it. We only have the ability to fight it, to rise up and demand change. To show that we will no longer take it. We will no longer be silent. We were all taught to be quiet and hold our feelings in to make sure that white people are comfortable. To make sure that we don’t appear threatening or angry. That is changing. Things will not go back to the way that they were.

Books to read in your journey of becoming an ally:

How To Be An Antiracist - Ibram X. Kensi

White Fragility: Why It's So Hard for White People to Talk About Racism - Robin Diangelo

So You Want To Talk About Race - Ijeoma Oluo

Me and white Supremacy - Layla F. Saad

The New Jim Crow: Mass Incarceration In The Age of Colorblindness - Michelle Alexander

Stamped from the Beginning: The Definitive History of Racist Ideas in America - Ibram X. Kendi

Between the World and Me - Ta-Nehisi Coates

Notes of A Native Son - James Baldwin

Born A Crime - Trevor Noah

Eloquent Rage: A Black Feminist Discovers Her Superpower - Brittany Cooper

Reproductive Injustice: Racism, Pregnancy, and Premature Birth - Dana-Ain Davis

Racism without Racists: Colorblind Racism and the Persistence of Racial Inequality in the United States - Edwardo Bonilla-Silva

Towards the Other America: Anti-Racist Resources for White People Taking Action for Black Lives Matter - Chris Crass

Two Faced Racism: Whites in the Backstage and Frontstage - Leslie Picca and Joe Feagin

How To Be Less Stupid About Race: On Racism, White Supremacy and the Racial Divide - Crystal Fleming

The Ethnic Project: Transforming Racial Fiction into Ethnic Factions - Vilna Bashi Treitler

Race and Racisms: A Critical Approach - Tanya Golash Boza

Racist America: Roots, Current Realities, and Future Reparations - Joe Feagin

White Rage; the Unspoken Truth of Our Racial Divide - Carol Anderson

Black Americans - Alphonso Pinkney

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to Present - Harriet Washington

The Hollywood Jim Crow: The Racial Politics of the Movie Industry- Maryann Erigha

Code of the Street - Elijah Anderson

The Wretched of the Earth - Frantz Fanon

The Mis-Education of the Negro - Carter Woodson

UNESCO General History of Africa, Vol.1 - Joseph Zerbo

UNESCO General History of Africa, Vol. 2 - G. Mokhtar

Black Wealth/White Wealth - Melvin Oliver and Thomas Shapiro

Why Are All the Black Kids Sitting Together in the Cafeteria? And Other Conversations About Race - Beverly Daniel Tatum

Uprooting Racism: How White People Can Work for Racial Justice - Paul Kivel

Witnessing Whiteness - Shelly Tochluk

Race Talk and the Conspiracy of Silence: Understanding and Facilitating Difficult Dialogues on Race - Derald Wing Sue

The Emperor Has No Clothes: Teaching about Race and Racism to People Who Don't Want to Know - Tema Jon Okun

Understanding White Privilege: Creating Pathways to Authentic Relationships Across Race - Frances Kendall

The Possessive Investment in Whiteness: How White People Profit from Identity Politics - George Lipsitz

Waking Up White, and Finding Myself in the Story of Race - Debby Irving

How I Shed My Skin: Unlearning the Racist Lessons of a Southern Childhood - Jim Grimsley

Everyday White People Confront Racial and Social Injustice: 15 Stories - editors = Eddie Moore, Marguerite W. Penick-Parks & Ali Michael

Understanding and Dismantling Racism: The Twenty-First Century Challenge to White America - Joseph Barndt

Beyond the Pale: White Women, Racism, and History - Vron Ware

Charleston Syllabus: Readings on Race, Racism, and Racial Violence - editors = Chad Williams, Kidada E. Williams & Keisha N. Blain

We Have Not Been Moved: Resisting Racism and Militarism in 21st Century America - editors = Elizabeth Betita Martinez, Matt Meyer & Mandy Carter. Forward by Cornel West. Afterword by Alice Walker & Sonia Sanchez

killing rage: Ending Racism - bell hooks

Acting White? Rethinking Race in Post-Racial America - Devon W. Carbado and Mitu Gulati

Towards Collective Liberation: Anti-Racist Organizing, Feminist Praxis, and Movement Building Strategy - Chris Crass

White Like Me: Reflections on Race form A Privileged Son - Tim Wise

White Trash: Race and Class in America - editors = Annalee Newitz & Matt Wray

Rise of the Warrior Cop: The Militarization of America's Police Forces - Radley Balko

Race Traitor - editors = Noel Ignatiev & John Garvey

Feeling White: Whiteness, Emotionality, and Education (Cultural Pluralism #2) - Cheryl E. Matias

Disrupting White Supremacy

Hillbilly Nationalists, Urban Race Rebels, and Black Power: Community Organizing in Radical Times - AmySonnie, James Tracy

For White Folks Who Teach in The Hood...and the Rest of Y'all Too: Reality Pedagogy and Urban Education (Race, Education, and Democracy) - Christopher Emdin

Benign Bigotry: The Psychology Subtle Prejudice - Kristin J. Anderson

Subversive Southern: Anne Braden and the Struggle for Racial Justice in the Cold War South (Civil Rights and the Struggle for Black Equality in the Twentieth Century) - Catherine Fosl

How Jews Became White Folks and What That Says About Race in America - Karen Brodkin

America's Original Sin: Racism, White Privilege, and the Bridge to a New America - Jim Wells

Why I'm No Longer Talking to White People About Race - Reni Eddo-Lodge

Living Into God's Dream: Dismantling Racism in America - editor = Catherine Meeks

Promise And A Way Of Live: White Antiracist Activism - Becky Thompson

What Does It Mean to Be White?: Developing White Racial Literacy (Counterpoints #398) - Robin Diangelo

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bountyofbeads · 6 years ago

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76 billion opioid pills: Newly released federal data unmasks the epidemic

https://wapo.st/2JCwnTB

76 billion opioid pills: Newly released federal data unmasks the epidemic

By Scott Higham, Sari Horwitz and Steven Rich | Published July 16 at 8:19 PM ET | Washington Post | Posted July 17, 2019 |

America’s largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012 as the nation’s deadliest drug epidemic spun out of control, according to previously undisclosed company data released as part of the largest civil action in U.S. history.

The information comes from a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city. The data provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012.

Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post. Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

Purdue Pharma, which the plaintiffs allege sparked the epidemic in the 1990s with its introduction of OxyContin, its version of oxycodone, was ranked fourth among manufacturers with about 3 percent of the market.

The volume of the pills handled by the companies skyrocketed as the epidemic surged, increasing about 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the period.

Those 10 companies along with about a dozen others are now being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids. The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief.

The database reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year by year, town by town. In case after case, the companies allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market, according to the lawsuits.

Plaintiffs have long accused drug manufacturers and wholesalers of fueling the opioid epidemic by producing and distributing billions of pain pills while making billions of dollars. The companies have paid more than $1 billion in fines to the Justice Department and Food and Drug Administration over opioid-related issues, and hundreds of millions more to settle state lawsuits.

But the previous cases addressed only a portion of the problem, never allowing the public to see the size and scope of the behavior underlying the epidemic. Monetary settlements by the companies were accompanied by agreements that kept such information hidden.

The drug companies, along with the DEA and the Justice Department, have fought furiously against the public release of the database, the Automation of Reports and Consolidated Order System, known as ARCOS. The companies argued that the release of the “transactional data” could give competitors an unfair advantage in the marketplace. The Justice Department argued that the release of the information could compromise ongoing DEA investigations.

Until now, the litigation has proceeded in unusual secrecy. Many filings and exhibits in the case have been sealed under a judicial protective order. The secrecy finally lifted after The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to documents and data from the case.

On Monday evening, U.S. District Judge Dan Polster removed the protective order for part of the ARCOS database.

Lawyers for the local governments suing the companies hailed the release of the data.

“The data provides statistical insights that help pinpoint the origins and spread of the opioid epidemic — an epidemic that thousands of communities across the country argue was both sparked and inflamed by opioid manufacturers, distributors, and pharmacies,” said Paul T. Farrell Jr. of West Virginia, co-lead counsel for the plaintiffs.

In statements emailed to The Post on Tuesday, the drug distributors stressed that the ARCOS data would not exist unless they had accurately reported shipments and questioned why the government had not done more to address the crisis.

“For decades, DEA has had exclusive access to this data, which can identify the total volumes of controlled substances being ordered, pharmacy-by-pharmacy, across the country,” McKesson spokeswoman Kristin Chasen said.

A DEA spokeswoman declined to comment Tuesday “due to ongoing litigation.”

Cardinal Health said that it has learned from its experience, increasing training and doing a better job to “spot, stop and report suspicious orders,” company spokeswoman Brandi Martin wrote.

AmerisourceBergen derided the release of the ARCOS data, saying it “offers a very misleading picture” of the problem. The company said its internal “controls played an important role in enabling us to, as best we could, walk the tight rope of creating appropriate access to FDA approved medications while combating prescription drug diversion.”

While Walgreens still dispenses opioids, the company said it has not distributed prescription-controlled substances to its stores since 2014. “Walgreens has been an industry leader in combatting this crisis in the communities where our pharmacists live and work, ” said Phil Caruso, a Walgreens spokesman.

Mike DeAngelis, a spokesman for CVS, said the plaintiffs’ allegations about the company have no merit and CVS is aggressively defending against them.

Walmart, Purdue and Endo declined to comment about the ARCOS database.

A Mallinckrodt spokesman said in a statement that the company produced opioids only within a government controlled quota and sold only to DEA-approved distributors.

Actavis Pharma was acquired by Teva Pharmaceutical Industries in 2016, and a spokeswoman there said the company “cannot speak to any systems in place beforehand.”

A VIRTUAL ROAD MAP

The Post has been trying to gain access to the ARCOS database since 2016, when the news organization filed a Freedom of Information Act request with the DEA. The agency denied the request, saying some of the data was available on its website. But that data did not contain the transactional information the companies are required to report to the DEA every time they sell a controlled substance such as oxycodone and hydrocodone.

The drug companies and pharmacies themselves provided the sales data to the DEA. Company officials have testified before Congress that they bear no responsibility for the nation’s opioid epidemic.

The numbers of pills the companies sold during the seven-year time frame are staggering, far exceeding what has been previously disclosed in limited court filings and news stories.

Three companies distributed nearly half of the pills: McKesson with 14.1 billion, Walgreens with 12.6 billion and Cardinal Health with 10.7 billion. The leading manufacturer was Mallinckrodt’s SpecGx with nearly 28.9 billion pills, or nearly 38 percent of the market.

The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate during this period.

Rural areas were hit particularly hard: Norton, Va., with 306 pills per person; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175.

In that time, the companies distributed enough pills to supply every adult and child in the country with 36 each year.

The database is a virtual road map to the nation’s opioid epidemic that began with prescription pills, spawned increased heroin use and resulted in the current fentanyl crisis, which added more than 67,000 to the death toll from 2013 to 2017.

The transactional data kept by ARCOS is highly detailed. It includes the name, DEA registration number, address and business activity of every seller and buyer of a controlled substance in the United States. The database also includes drug codes, transaction dates, and total dosage units and grams of narcotics sold.

The data tracks a dozen different opioids, including oxycodone and hydrocodone, which make up three-quarters of the total pill shipments to pharmacies.

Under federal law, drug manufacturers, distributors and pharmacies must report each transaction of a narcotic to the DEA, where it is logged into the ARCOS database. If company officials notice orders of drugs that appear to be suspicious because of their unusual size or frequency, they must report those sales to the DEA and hold back the shipments.

As more and more towns and cities became inundated by pain pills, they fought back. They filed federal lawsuits against the drug industry, alleging that opioids from the companies were devastating their communities. They alleged the companies not only failed to report suspicious orders, but they also filled those orders to maximize profits.

As the hundreds of lawsuits began to pile up, they were consolidated into the one centralized case in U.S. District Court in Cleveland. The opioid litigation is now larger in scope than the tobacco litigation of the 1980s, which resulted in a $246 billion settlement over 25 years.

‘WHERE THE VIRUS GREW ’

Judge Polster is now overseeing the consolidated case of nearly 2,000 lawsuits. The case is among a wave of actions that includes other lawsuits filed by more than 40 state attorneys general and tribal nations. In May, Purdue settled with the Oklahoma attorney general for $270 million.

In the Cleveland case, Polster has been pressing the drug companies and the plaintiffs to reach a global settlement so communities can start receiving financial assistance to mitigate the damage that has been done by the opioid epidemic.

To facilitate a settlement, Polster had permitted the drug companies and the towns and cities to review the ARCOS database under a protective order while barring public access to the material. He also permitted some court filings to be made under seal and excluded the public and press from a global settlement conference at the outset of the case.

Last June, The Post and the Charleston Gazette-Mail asked Polster to lift the protective order covering the ARCOS database and the court filings. A month later, Polster denied the requests, even though he had said earlier that “the vast oversupply of opioid drugs in the United States has caused a plague on its citizens” and the ARCOS database reveals “how and where the virus grew.” He also said disclosure of the ARCOS data “is a reasonable step toward defeating the disease.”

Lawyers for The Post and the Gazette-Mail appealed Polster’s ruling. They argued that the ARCOS material would not harm companies or investigations because the judge had already decided to allow the local government plaintiffs to collect information from 2006 through 2014, withholding the most recent years beginning with 2015 from the lawsuit.

“Access to the ARCOS Data can only enhance the public’s confidence that the epidemic and the ensuing litigation are being handled appropriately now — even if they might not have been handled appropriately earlier,” The Post’s lawyer, Karen C. Lefton, wrote in her Jan. 17 appeal.

The lawyers also noted the DEA did not object when the West Virginia attorney general’s office provided partial ARCOS data to the Gazette-Mail in 2016. That data showed that drug distribution companies shipped 780 million doses of oxycodone and hydrocodone into the state between 2007 and 2012.

On June 20, the 6th Circuit Court of Appeals in Ohio sided with the news organizations. A three-judge panel reversed Polster, ruling that the protective order sealing the ARCOS database be lifted with reasonable redactions and directed the judge to reconsider whether any of the records in the case should be sealed.

On Monday, Polster lifted the protective order on the database, ruling that all the data from 2006 through 2012 should be released to the public, withholding the 2013 and 2014 data.

‘PRESCRIPTION TOURISTS’

The pain pill epidemic began nearly three decades ago, shortly after Purdue Pharma introduced what it marketed as a less addictive form of opioid it called OxyContin. Purdue paid doctors and nonprofit groups advocating for patients in pain to help market the drug as a safe and effective way to treat pain.

But the new drug was highly addictive. As more and more people were hooked, more and more companies entered the market, manufacturing, distributing and dispensing massive quantities of pain pills.

Purdue ending up paying a $634 million fine to the Food and Drug Administration for claiming OxyContin was less addictive than other pain medications.

Annual opioid sales nationwide rose from $6.1 billion in 2006 to $8.5 billion in 2012, according to industry data gathered by IQVIA, a health care information and consulting company.

Individual drug company revenues ranged in single years at the epidemic’s peak from $403 million for opioids sold by Endo to $3.1 billion in OxyContin sales by Purdue Pharma, according to a 2018 lawsuit against multiple defendants by San Juan County in New Mexico.

During the past two decades, Florida became ground zero for pill mills — pain management clinics that served as fronts for corrupt doctors and drug dealers. They became so brazen that some clinics set up storefronts along I-75 and I-95, advertising their products on billboards by interstate exit ramps. So many people traveled to Florida to stock up on oxycodone and hydrocodone, they were sometimes referred to as “prescription tourists.”

The route from Florida to Georgia, Kentucky, West Virginia and Ohio became known as the “Blue Highway.” It was named after the color of one of the most popular pills on the street — 30 mg oxycodone tablets made by Mallinckrodt, which shipped more than 500 million of the pills to Florida between 2008 and 2012.

When state troopers began pulling over and arresting out-of-state drivers for transporting narcotics, drug dealers took to the air. One airline offered nonstop flights to Florida from Ohio and other Appalachian states, and the route became known as the Oxy Express.

A decade ago, the DEA began cracking down on the industry. In 2005 and 2006, the agency sent letters to drug distributors, warning them that they were required to report suspicious orders of painkillers and halt sales until the red flags could be resolved. The letter also went to drug manufacturers.

Even just one distributor that fails to follow the law “can cause enormous harm,” the 2006 DEA letter said.

DEA officials said the companies paid little attention to the warnings and kept shipping millions of pills in the face of suspicious circumstances.

As part of its crackdown, the DEA brought a series of civil enforcement cases against the largest distributors.

The corporations to date have paid nearly $500 million in fines to the Justice Department for failing to report and prevent suspicious drug orders, a number that is dwarfed by the revenue of the companies.

But the settlements of those cases revealed only limited details about the volume of pills that were being shipped.

In 2007, the DEA brought a case against McKesson. The DEA accused the company of shipping millions of doses of hydrocodone to Internet pharmacies after the agency had briefed the company about its obligations under the law to report suspicious orders.

“By failing to report suspicious orders for controlled substances that it received from rogue Internet pharmacies, the McKesson Corporation fueled the explosive prescription drug abuse problem we have in this country,” the DEA’s administrator said at the time.

In 2008, McKesson agreed to pay a $13.25 million fine to settle the case and pledged to more closely monitor suspicious orders from its customers.

That same year, the DEA brought a case against Cardinal Health, accusing the nation’s second-largest drug distributor of shipping millions of doses of painkillers to online and retail pharmacies without notifying the DEA of signs that the drugs were being diverted to the black market.

Cardinal settled the case by paying a $34 million fine and promising to improve its suspicious monitoring program.

SOME COMPANIES WERE REPEAT OFFENDERS.

In 2012, the DEA began investigating McKesson again, this time for shipping suspiciously large orders of narcotics to pharmacies in Colorado. One store in Brighton, Colo., population 38,000, was ordering 2,000 pain pills per day. The DEA discovered that McKesson had filled 1.6 million orders from its Aurora, Colo., warehouse between 2008 and 2013 and reported just 16 as suspicious. None involved the Colorado store.

DEA agents and investigators said they had amassed enough information to file criminal charges against McKesson and its officers but they were overruled by federal prosecutors. The company wound up paying a $150 million fine to settle, a record amount for a diversion case.

Also in 2012, Cardinal Health attracted renewed attention from the DEA when it discovered that the company was again shipping unusually large amounts of painkillers to its Florida customers. The company had sold 12 million oxycodone pills to four pharmacies over four years.

In 2011, Cardinal shipped 2 million doses to a pharmacy in Fort Myers, Fla. Comparable pharmacies in Florida typically ordered 65,000 doses per year.

The DEA also noticed that Cardinal was shipping unusually large amounts of oxycodone to a pair of CVS stores near Sanford, Fla. Between 2008 and 2011, Cardinal sold 2.2 million pills to one of the stores. In 2010, that store purchased 885,900 doses — a 748 percent increase over the previous year. Cardinal did not report any of those sales as suspicious.

Cardinal later paid a $34 million fine to settle the case. The DEA suspended the company from selling narcotics from its warehouse in Lakeland, Fla. CVS paid a $22 million fine.

As the companies paid fines and promised to do a better job of stopping suspicious orders, they continued to manufacture, ship and dispense large amounts of pills, according to the newly released data.

“The depth and penetration of the opioid epidemic becomes readily apparent from the data,” said Peter J. Mougey, a lawyer for the plaintiffs from Pensacola, Fla. “This disclosure will serve as a wake up call to every community in the country. America should brace itself for the harsh reality of the scope of the opioid epidemic. Transparency will lead to accountability.”

Aaron Williams, Andrew Ba Tran, Jenn Abelson, Aaron C. Davis and Christopher Rowland contributed to this report.

Scott Higham is a Pulitzer-Prize winning investigative reporter at The Washington Post, where he has worked on Metro, National and Foreign projects since 2000.

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feltondgdamianaaf21insuranc-blog · 6 years ago

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south carolina medical insurance companies

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south carolina medical insurance companies

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reseau-actu · 6 years ago

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Les chercheurs mettent au point un système d’entraînement des gènes dit «en guirlande» qui permet de contrôler le génie génétique de certaines populations.

Les outils de génie génétique qui propagent les gènes au sein d'une espèce cible ont le potentiel de contrôler humainement les nuisibles et d'éradiquer les maladies parasitaires telles que le paludisme.

Les outils, connus sous le nom de lecteurs génétiques, garantissent que les organismes modifiés transmettent les variants génétiques souhaités à leur progéniture. Ces variantes pourraient par exemple garantir que les organismes ne produisent que des progénitures mâles ou des femelles stériles.

De cette manière, des clés génétiques pourraient être utilisées pour exterminer des insectes tels que les moustiques porteurs d’agents pathogènes, susceptibles de propager le paludisme, la dengue et le virus Zika. Les lecteurs de gènes pourraient également être utilisés pour lutter contre des espèces envahissantes telles que les rongeurs pouvant menacer la survie des animaux indigènes.

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Cependant, les versions précédemment décrites de lecteurs de gènes basés sur le système d'édition du génome CRISPR ont le potentiel de se propager beaucoup plus largement que leur population locale prévue - pour affecter une espèce entière. Les effets pourraient également s'étendre au-delà des frontières internationales, entraînant potentiellement des différends entre pays où aucun accord préalable n'avait été conclu.

Ces types de problèmes pourraient retarder considérablement, voire empêcher complètement, la sécurité des tests et l’introduction de la technologie.

À présent, dans un article publié aujourd'hui dans les Actes de la National Academy of Sciences , des chercheurs du MIT et de l'Université de Harvard décrivent un système de contrôle des gènes avec des contrôles intégrés.

L’entraînement basé sur CRISPR consiste en une série d’éléments génétiques disposés en chaîne, selon Kevin Esvelt, professeur adjoint en arts et sciences des médias et chef du groupe de recherche Sculpting Evolution au MIT Media Lab, qui a dirigé la recherche.

Un lien au sein du système de commande en marguerite code le système d'édition de gène CRISPR lui-même, tandis que chacun des autres liens code pour les séquences d'ARN guide. Ces séquences de guidage indiquent au système CRISPR de couper et de copier le prochain maillon de la chaîne, explique Esvelt.

L'ajout de liens supplémentaires permet au système de marguerite de se propager pour des générations supplémentaires au sein de la population.

«Imaginez que vous avez une chaîne de pâquerettes et que, à chaque génération, vous enlevez celle qui se trouve à la fin. Esvelt explique que lorsque vous êtes à court de matériel, la connexion en guirlande s'arrête.

De cette manière, un petit nombre d’organismes modifiés par génie génétique pourraient être relâchés dans la nature pour propager la pousse en marguerite au sein de la population locale, puis s’arrêter lorsqu’ils ont été programmés.

«Nous programmons l’organisme pour qu’il édite le génome CRISPR lui-même, au sein de ses cellules reproductrices, à chaque génération», explique Esvelt.

Esvelt a développé le système en collaboration avec George Church, professeur de génétique à la Harvard Medical School, professeur invité au Media Lab et membre associé principal du Broad Institute of MIT et de Harvard. Les co-premiers auteurs, Charleston Noble et John Min, tous deux diplômés de la Harvard Medical School, ont dirigé les expériences de modélisation et de biologie moléculaire conçues pour assurer la stabilité du système, respectivement.

«Si nous voulons que le monde profite des nouvelles technologies induisant des gènes, nous devons être très confiants de pouvoir l’inverser et le contenir, à la fois théoriquement et au moyen de tests contrôlés», a déclaré Church.

"De nombreuses applications des entraînements géniques impliquent des îles et d'autres isolements géographiques, du moins pour les tests initiaux, y compris les espèces invasives et la maladie de Lyme", a-t-il noté. «Il serait bon que ces administrations locales très motivées puissent effectuer des tests qui ne touchent pas automatiquement les îles ou les métropoles adjacentes. Les disques en guirlande offrent cela. "

La recherche suggère que pour 100 homologues sauvages, la libération d'un seul organisme modifié doté d'un système de contrôle en chaîne à trois chaînons, une fois par génération, devrait suffire à modifier la population entière en deux générations environ, à peu près un an dans un environnement rapide. insecte reproducteur. Cela se compare aux systèmes existants qui doivent libérer au moins autant d’organismes que ceux qui existent déjà dans une population locale, et parfois 10 à 100 fois plus.

Le processus pourrait prendre plusieurs années chez des espèces qui se reproduisent plus lentement, telles que les souris, mais serait plus humain que l'utilisation actuelle de rodenticides, qui peut également nuire aux humains et aux espèces prédatrices, explique Esvelt.

En 2014, Esvelt et ses collègues ont d'abord suggéré que CRISPR-Cas9 pourrait être utilisé dans des systèmes de contrôle des gènes, et il s'est senti moralement responsable de développer une alternative aux systèmes auto-propagateurs, dit-il. «Idéalement, la localisation permettra à chaque communauté de prendre des décisions concernant son propre environnement, sans imposer ces décisions aux autres.

Selon le professeur Luke Alphey, responsable de la génétique des arthropodes à l'Institut Pirbright du Royaume-Uni, les systèmes de transmission auto-propagateurs peuvent se propager rapidement au sein des populations cibles. Cependant, de tels systèmes d'entraînement sont également susceptibles de s'étendre à toutes les populations connectées de l'espèce cible - ce qui est souhaitable si vous souhaitez modifier l'ensemble de l'espèce, indésirable si vous ne le faites pas, dit-il.

«Les campagnes de marguerites offrent potentiellement le moyen de tirer le meilleur parti de ce type de gènes, tout en limitant la propagation et en limitant la persistance de ces gènes, même au sein de la population cible», explique Alphey. «C’est probablement très souhaitable lorsque l’on veut toucher une population mais pas une autre de la même espèce, peut-être une population de ravageurs envahissante, mais pas des populations de la même espèce dans son aire de répartition naturelle.»

Alphey n'était pas impliqué dans les recherches initiales sur le daisy drive, mais collabore maintenant avec Esvelt, notamment sur les travaux relatifs à l'utilisation du daisy drive chez les moustiques.

Esvelt et le groupe Sculpting Evolution commencent également à explorer l'utilisation possible de cette technologie pour immuniser de manière héréditaire les souris à pattes blanches, le principal réservoir de la bactérie responsable de la maladie de Lyme en Amérique du Nord. Ils sont également en train de mettre en place une collaboration de recherche pour explorer l'utilisation de la marguerite en Cochliomyia , également connue sous le nom de ver à vis du Nouveau Monde, une mouche parasite qui produit des larves qui dévorent les tissus vivants d'animaux à sang chaud et causent des souffrances considérables.

En outre, les chercheurs étudient également cette technologie pour une utilisation chez les vers nématodes, créatures microscopiques qui se reproduisent tous les trois jours. Cela leur permettra de mener des études évolutives en laboratoire sur les organismes modifiés par le processus de marguerite, dans le but de s'assurer que les systèmes ne peuvent pas se propager de manière autonome.

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