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At that point, you could select one recruiter per hospital and give them a green light to submit your profile to the specific hospital should the ideal opportunity arise. This way, you can get your profile submitted quickly so you stand a better chance of landing the job. The other recruiters shouldn’t even need to be informed because they should be abiding by your first rule, don’t submit without consent.

Fourth, always request the name of the hospital prior to approving a submission. This way, you can ensure you don’t accidentally agree to getting submitted a second time. Also, if you’re hearing about a hot job on the fly and want to shop around with all your recruiters to see who has the best rate, or who might have an inside track on landing the job, then you’ll need the hospital name to do that. This is perfectly acceptable. But remember, try to accomplish this quickly because the best jobs close quickly.

Finally, let all your recruiters know when you get submitted for a job. This will ensure that there are no mix-ups. It also has the added benefit of lighting a fire under their feet to find you a job!

By taking these steps, travel nurses should be able to realize all the advantages of working with multiple agencies while avoiding the pitfall of getting submitted by multiple agencies for the same job. As always, we hope you find this information useful. We’d love to hear about your experiences with this topic or answer any questions you may have. Please post them on BluePipes Forums!


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The concept of the pleurometabolic syndrome emerged many years ago and was introduced into the modern lexicon by Gerald Reaven as syndrome X ( 16 ). The concept of a relation between insulin resistance and cardiovascular risk has been generalized to the metabolic syndrome, and this inclusive concept includes the risk of many chronic diseases, such as visceral obesity, diabetes, hypertension, stroke, and cancer ( 17 , 18 ). Recently, this concept has come under fire, and it was suggested by Kahn et al ( 4 ) that risks of several diseases may occur independently but in common in certain individuals. We believe that the confusion regarding the metabolic syndrome emerges from the difference between an epidemiologic concept and a pathophysiologic concept. Observed epidemiologically, it is difficult to discern causality because most data are cross-sectional. However, if it is possible to observe the emergence of a condition longitudinally, evidence for causality may emerge. Thus, we suggest the term metabolic syndrome be used to represent the causal relation among obesity, insulin resistance, and hyperinsulinemia. Specifically, for the purposes of this review, we define the metabolic syndrome as visceral and subcutaneous adiposity associated with hepatic insulin resistance, elevated FFAs, adipokines, and hyperinsulinemia. The resultant hyperinsulinemia may well represent a risk factor for cancer and cardiovascular disease ( 19 , 20 ). But, this concept focuses on the pathophysiologic relations leading to the insulin-resistant, hyperinsulinemic state, while leaving open for further study the importance of hyperinsulinemia in disease pathogenesis.

Insulin resistance results from storage of lipid, and it appears from cross-sectional studies that the visceral fat depot is particularly egregious in this regard. A few instances have been noted in which reduction in visceral fat per se in animal models has been shown to increase insulin sensitivity ( 21 ), but more evidence is needed. What is more obvious is that feeding a high-fat diet causes fat deposition in the visceral depot, and insulin resistance follows. In the canine model, even a modest increase in the fat content of the diet, without increasing calories, results in visceral fat deposition and insulin resistance ( Figure 1 ). Insulin sensitivity was measured with glucose clamps, which showed that reduction in the sensitivity of the liver to insulin was the primary defect in the development of insulin resistance; insulin infused during clamps failed to depress glucose production, even though the effect of insulin on glucose disposal (primarily skeletal muscle) remained almost normal ( 13 ). The time course of changes indicates a rapid shift to an insulin-resistant state (1–2 wk). Interestingly, the plasma insulin response increases slowly, not peaking until 5–6 wk. Presumably, this represents an increase in either β-cell sensitivity to stimulation by nutrients or an increase in β-cell mass due to proliferation of β-cells or a reduction in β-cell apoptosis ( 14 ). Equally important was a reduction in clearance of insulin by the liver. In lean dogs, the liver extracts more than one-half of the insulin presented to it ( 22 ). Increased dietary fat reduced that extraction by 30%, presenting an increased fraction of secreted insulin into the systemic circulation ( 23 ). Taken together, increased secretion and reduced clearance result in hyperinsulinemia.



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SpaceX yesterday received US approval to launch 4,425 low-Earth orbit satellites, a key milestone in its plan to offer broadband with high speeds and low latency around the world.

The Federal Communications Commission issued an order approving SpaceX's application with some conditions. SpaceX intends to start launching operational satellites as early as 2019, with the goal of reaching the full capacity of 4,425 satellites in 2024. The FCC approval just requires SpaceX to launch 50 percent of the satellites by March 2024, and all of them by March 2027.

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SpaceX hits two milestones in plan for low-latency satellite broadband

"Grant of this application will enable SpaceX to bring high-speed, reliable, and affordable broadband service to consumers in the United States and around theworld, including areas underserved or currently unserved by existing networks," the FCC order said.

SpaceX's network (known as "Starlink") will need separate approval from the International Telecommunication Union (ITU). The FCC said its approval is conditioned on "SpaceX receiving a favorable or 'qualified favorable' rating of its EPFD [equivalent power flux-density limits] demonstration by the ITU prior to initiation of service." SpaceX will also have to follow other ITU rules .

Like other operators, SpaceX will have to comply with FCC spectrum-sharing requirements. Outside the US, coexistence between SpaceX operations and other companies' systems "are governed only by the ITU Radio Regulations as well as the regulations of the country where the earth station is located," the FCC said.

SpaceX and several other companies are planning satellite broadband networks with much higher speeds and much lower latencies than existing satellite Internet services. SpaceX satellites are planned to orbit at altitudes of 1,110km to 1,325km, whereas the existing HughesNet satellite network has an altitude of about 35,400km.

SpaceX has said it will offer speeds of up to a gigabit per second, with latencies between 25ms and 35ms. Those latencies would make SpaceX's service comparable to cable and fiber, while existing satellite broadband services have latencies of 600ms or more, according to FCC measurements .

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