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Restaurant News & Reviews
NYC bakery is now making its award-winning bread in Miami
Here's how you can tell Miami has raised its fresh-baked-bread game: New York wants a slice.
That's the reason the scent of fresh-baked bread rises with the sun from a repurposed building in Little Haiti. Earlier this month, Miami's outpost for New York's Sullivan Street Bakery quietly started baking James Beard Award winner Jim Lahey's crusty, chewy Italian-style bread in a state-of-the-art bakery, and the loaves have started showing up in several restaurants around Miami.
Lahey, whose bread has been a hit since he opened his bakery in Soho in 1994, teamed with local developer and restaurateur Steven Perricone of the long-running namesake Brickell restaurant, whose real estate group owned the property at 5500 NE Fourth Ave., across the tracks from Soyka. Together, they are bringing Lahey's bread to Miami, starting with his Perricone's Marketplace and Cafe, where it is also on sale in the market.
"We want to make bread that people fall in love with," Lahey said by phone from New York.
Sullivan Street has gotten an immediate toehold in several major neighborhoods. Its bread can be found at River Oyster Bar in Brickell, Joey's in Wynwood, Café Roval in Little Haiti and 27 Restaurant & Bar in Miami Beach. They hope to distribute their bread with their own fleet of trucks from their centrally located bakery, including to local grocery stores and markets.
Within the next year, Perricone said he expect to build a retail section and café at the bakery where they will sell pastries and other baked goods. Lahey is even eying bringing one of his Co. pizzerias to South Florida.
"Miami already has great bread, and we think it can use more great bread," Lahey said. "We're trying to raise the standard of bread culture in America, one loaf at a time."
READ MORE: How a secular Jewish baker became Miami's kosher king
Credit Miami's local, independent artisans for priming the market for Lahey and company. Miami-born Zak Stern led the way with Wynwood's Zak the Baker, whose bread is now available in South Florida Whole Foods Markets up to Palm Beach County. His disciples include the owners of the new Madruga Bakery in South Miami and two of Sullivan Street's bakers —including head baker Matthieu Bettant, who worked with Stern for more than a year.
They add to a field that includes other small bakeries such as True Loaf in Miami Beach's Sunset Harbour and North Miami's La Parisienne Bakery.
"I felt for a long time there was a void, and I thought it was the right time to fill it," said Perricone, whose Upper Eastside Partners LLC paid $2.7 million for the property in 2014.
In Bettant, Lahey found someone with baking bloodlines. He's a fourth-generation baker from Lyon, France, where his father still runs several bakeries. He spent two months living with Lahey in New York, working at Sullivan Street to ensure that the bread is up to Lahey's standards. Miami's bakery is making three kinds of bread, for now, and will expand to more varieites by the start of the season in the Fall.
At Miami's Sullivan Street, Bettant is working with advanced equipment capable of baking up to 8,000 loaves of bread a day. But Lahey says the goal is not mass production but carefully crafted bread that is tasty and consistent. Each loaf is cut and shaped by hand.
"There's definitely space for another quality bread," Bettant said.
READ MORE: Madruga Bakery brings artisan bread to South Miami
Lahey's own bread is distinctive. His signature rustic Italian Pugliese bread is served at more than 250 New York restaurants, and he has opened bakeries in Hell's Kitchen and Chelsea. He innovated the no-knead bread technique and was the first to win a James Beard Award for outstanding baker.
The idea for this bakery was more than five years in the works, said Perricone, a New York native who has called Miami home since 1990. Aside from his Perricone's Marketplace and Cafe, a pioneering restaurant in once-dead Brickell, he has partnered with other restaurants in the past, such as Michelle Bernstein's late CENA by Michy. Just as he longed for better bread at restaurants, he longed for it at home.
"I grew up with my mother and grandmother sending me to the corner bakery for fresh bread. I wanted that here," Perricone said.

subset: commoncrawl


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I Must Keep Pressing
I'm excited for our early adopters who since the year 2015, accepted and promoted the Marc G brand. When times get rough and I feel like stepping away from Marc G, you encourage me to keep pressing.
Stay Inspired To Prosper for I will as well.


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VIDEO: "Dark Souls" Dev From Software Reveals "Bloodborne" for PlayStation 4
"Dark Souls" and "Demon's Souls" director helms new IP
Sony's E3 2014 press conference is in full swing, and one of the big reveals everyone was waiting for came and went pretty quickly. The anticipated announcement from Dark Souls dev From Software is a new IP called Bloodborne, and it was announced with a brief cinematic trailer.
Bloodborne comes from Demon's Souls and Dark Souls director—and now president of From Software—Hidetaka Miyazaki. It's set to hit PlayStation 4 sometime in 2015.
Joseph Luster is the Games and Web editor at Otaku USA Magazine. His blog can be found at subhumanzoids. Follow him on Twitter at @Moldilox.


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Non-Malignant Pleural Effusions - Part Two with Dr. Gauhar
In this lecture, Dr. Umair Gauhar reviews pleural anatomy, normal characteristics of pleural effusion and epidemiology of pleural effusions. He then delves into a thorough discussion of parapneumonic effusions (including various classification schemas) as well as treatment options both empiric antibiotic regimens and a comprehensive discussion thoracentesis. This is a must watch lecture for pulmonologists, intensivists, and internists!Read More


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The annual ISA Review and Comment period has closed. Stay tuned for the 2020 ISA Reference Edition - coming this December.
The Interoperability Standards Advisory (ISA) process represents the model by which the Office of the National Coordinator for Health Information Technology (ONC) will coordinate the identification, assessment, and public awareness of interoperability standards and implementation specifications that can be used by the United States healthcare industry to address specific interoperability needs including, but not limited to, interoperability for clinical, public health, and research purposes. ONC encourages all stakeholders to implement and use the standards and implementation specifications identified in the ISA as applicable to the specific interoperability needs they seek to address. Furthermore, ONC encourages further pilot testing and industry experience to be sought with respect to standards and implementation specifications identified as "emerging" in the ISA. For historical background on the ISA please review prior ISA publications.
The 2019 ISA has been updated to include improvements made based on recommendations received from public comments and subject matter expert feedback. To learn more about major revisions of the ISA, please review recent ISA updates. Registered users may subscribe to change notifications to be alerted by e-mail of all revisions to individual interoperability needs or for ISA-wide changes. Anyone may become a registered user by submitting an account request. Once logged in, look for the blue "change notification" button at the bottom of the interoperability need page, or at the bottom of the home page to be notified of any changes across the ISA. An RSS Feed was also added in 2018, capturing more granular updates made to the ISA.
Starting with the 2017 ISA, the ISA's focus expanded to more explicitly include public health and health research interoperability. Thus, its scope includes electronic health information created in the context of treatment, and subsequently used to accomplish a purpose for which interoperability is needed (e.g., a referral to another care provider, public health reporting, or research). Added in late 2017, the ISA now also includes interoperability needs related to Administrative functions within healthcare. These additions were made through coordination with CMS, other administrative healthcare interoperability needs continue to be added.
The ISA is not exhaustive but it is expected to be incrementally updated to include a broader range of health IT interoperability needs. When more than one standard or implementation specification is listed it is intended to prompt industry dialogue as to whether one standard or implementation specification is necessary or if the industry can efficiently interoperate more than one. It may also reflect the fact that there is an ongoing transition from the use of one standard towards a new version or even a next-generation approach.
As noted in previous ISA publications, a standard listed in one section is not intended to imply that it would always be used or implemented independent of a standard in another section. To the contrary, it will often be necessary to combine the applicable standards from multiple sections to achieve interoperability for a particular clinical health information interoperability need.
It is also important to note that the ISA is designed to inform standards and implementation specification choices for all types of health IT that support interoperability needs, not solely electronic health record (EHR) systems. Furthermore, the ISA is not intended to imply that health IT systems need to support all of the listed standards and implementation specifications. Rather, in the event that a health IT developer or healthcare provider seeks to address a particular interoperability need, the ISA should serve as the first resource consulted to inform the selection of standards and implementation specifications. Additionally, the ISA is designed to inform the "what" that could be used to address an interoperability need in order to assure industry consistency around standards selection and is not mean to explicitly direct "how" the standards and implementation specifications would be implemented to address an interoperability need (e.g., application programming interface or conversion tools).
The ISA is designed to be a coordinated catalog of standards and implementation specifications that can be used by different stakeholders to consistently address a specific interoperability need. However, a listed interoperability need (and its associated standard(s) and implementation specifications(s)) is not meant to universally apply to all stakeholders. Rather, if a listed interoperability need is relevant to a particular clinical specialty, for example, the ISA is designed to provide a consistent foundation from which these stakeholders can agree on applicable technical requirements. Similarly, in cases where a listed interoperability need is not applicable to a given stakeholder group, the ISA in no way compels such stakeholders to consider that interoperability need.
Please note that the ISA serves as an informational resource for available standards, specifications, profiles, etc that exist to meet the interoperability needs contained within. Stakeholders should ensure and verify that they are adhering to applicable federal, state, and/or local laws or regulations regarding requirements to use a specific standard or specification that may conflict with the information listed in the ISA, as these requirements supersede the ISA.
The Interoperability Standards Advisory is meant to serve at least the following purposes:
- To provide the industry with a single, public list of standards and implementation specifications that can be used to address specific health information interoperability needs in the United States. Currently, the ISA is focused on interoperability for sharing information between entities and not on intra-organizational uses.
- To reflect the results of ongoing dialogue, debate, and consensus among industry stakeholders when more than one standard or implementation specification could be used to address a specific interoperability need, discussion will take place through the ISA public comments process. The web-version of the ISA improves upon existing processes, making comments more transparent, and allowing for threaded discussions to promote further dialogue.
- To document known limitations, preconditions, and dependencies as well as provide suggestions for security best practices in the form of security patterns for referenced standards and implementation specifications when they are used to address a specific clinical health IT interoperability need.
The ISA is designed to provide clarity, consistency, and predictability for the public regarding the standards and implementation specifications that could be used for a given clinical health IT interoperability purpose.
Stakeholders who administer government programs, procurements, and testing or certification programs with clinical health IT interoperability components are encouraged to look first to the ISA in order to more fully inform their goals. In that regard, standards and implementation specifications in the ISA and their associated informative characteristics are also available to help more fully inform policymaking. In this case, a standard or implementation specification's reference in the ISA may serve as the initial basis for industry or government consideration and action. While the ISA itself is a non-binding document and meant to be advisory in nature, standards and implementation specifications listed in the ISA may be considered for rulemaking or other Federal requirements. However, those decisions would be made on a case-by-case basis by the administering organization.
This site contains numerous links to other federal agencies and to private organizations. You are subject to these sites' privacy policies when you access them. HHS is not responsible for Section 508 compliance (accessibility) on other federal or private sites. HHS is not responsible for the contents of any "off-site" web page referenced from this site.
The ISA is organized and structured into five sections.
- Section I – Vocabulary/Code Sets/Terminology Standards and Implementation Specifications (i.e., "semantics").
- Section II – Content/Structure Standards and Implementation Specifications (i.e., "syntax").
- Section III – Standards and Implementation Specifications for Services (i.e., the infrastructure components deployed and used to address specific interoperability needs)
- Section IV – Administrative Standards and Implementation Specifications (i.e., payment, operations and other "non-clinical" interoperability needs)
- Questions and Requests for Stakeholder Feedback
- Appendices
Within each section specific "interoperability need" subheadings are listed and followed by tables similar to the one illustrated below. Each interoperability need may have one or more standards and/or implementation specifications associated with it. Each standard and implementation specification has six informative characteristics attributed to it in order to provide added context.
When known, an "emerging" standard or implementation specification is also listed and is shaded in a lighter color and italicized for additional emphasis. In addition, for vocabulary standards, where there may be one standard used to represent the "observation" or question being asked, and one standard used for the "observation value" or answer these are listed in distinct rows. See Appendix III for educational information about observations and observation values.
The ISA also includes links within the limitations, dependencies and preconditions to ONC's Interoperability Proving Ground (IPG) to showcase real-world implementations of standards listed within the ISA. Please note: when accessing links to the IPG, all projects for the selected standard will be listed, including those that may be demonstrating use of the standard for different interoperability needs. In addition, IPG entries are self-reported by stakeholders, so the quality and accuracy of the data may vary across entries.
In Section I, the vocabulary standards with unspecified code sets or context may be further constrained by a more explicit standard named in a subsequent section. For example, Section I: Encounter Diagnoses specifies SNOMED-CT and ICD-10-CM but does not define the context of use. The Standard/Implementation Specification named for the "Interoperability Need: Ordering Labs for a Patient in Section II: Laboratory" further constrains the diagnosis for the patient in the context of a lab order to ICD-9CM or ICD-10CM since the lab order diagnosis is for billing/claims, not clinical diagnostics.
|Standard Implementation/Specification
|Standards Process Maturity
|Implementation Maturity
|Adoption Level
|Federally Required
|Test Tool Availability
|Standard for observations
|Standard for observation values
|Emerging Standard
|Balloted Draft
|Limitations, Dependencies, and Preconditions for Consideration:
Section I: Applicable Value Set(s) and Starter Set(s):
Other Sections: Applicable Security Patterns for Consideration:
The following describes the ISA's six informative characteristics in greater detail. This detail is meant to better inform stakeholders about the maturity and adoptability of a given standard or implementation specification and provides definition for the terms and symbols used throughout the ISA. Stakeholders should consider all six characteristics together to gain insight into the level of maturity and adoptability of the standards and implementation specifications provided within the ISA.
#1: Standards Process Maturity
This characteristic conveys a standard or implementation specification's maturity in terms of its stage within a particular organization's approval/voting process.
- "Final" – when this designation is assigned, the standard or implementation specification is considered "final text" or "normative" by the organization that maintains it. This also includes approved "ANSI Informative" specifications.
- "Balloted Draft" – when this designation is assigned, the standard or implementation specification is considered to be a Draft Standard for Trial Use (DSTU), Standard for Trial Use (STU), or in a "trial implementation" status by the organization that maintains it and has been voted on or approved by its membership as such. This designation does not include standards and implementation guides that are unofficial drafts and early "works in progress".
- "In Development" – when this designation is assigned, the standard or implementation specification is currently in development. It also includes those that are in the midst of being balloted. These standards would generally benefit from lessons learned through development and pilots.
#2: Implementation Maturity
This characteristic conveys a standard or implementation specification's maturity based upon its implementation state. Where available, a link to published maturity assessments based on known published criteria about the standards is also provided.
- "Production" – when this designation is assigned, the standard or implementation specification is being used in production to meet a health care interoperability need.
- "Pilot" – when this designation is assigned, the standard or implementation specification is being used on a limited scale or only as part of pilots to meet a health care interoperability need.
#3: Adoption Level
This characteristic conveys a standard or implementation specification's approximate, average adoption level for that specific interoperability need in health care within the United States. The adoption level attempts to consider all implemented technology that would be used to address the identified interoperability need and is not limited to EHRs. Adoption means that the standard or implementation specification is being used in health IT in the field by end users to address the specific interoperability need. Presently, the adoption levels listed are based on ONC's analysis of several factors, including, but not limited to: 1) whether and/or how long a standard or implementation specification has been included in regulation for health IT certification (if applicable) or another HHS regulatory or program requirement which is used only as a proxy for industry adoption; 2) feedback from subject matter experts and 3) public comments.
The adoption level also considers the variety of stakeholders and stakeholder groups that would use the standard and implementation specification to address the specified interoperability need and attempts to display it as such, with the understanding that the designation is a generality or "best guess" and not a pre-defined measured value. Where available, annotated references or links to publicly available documentation known about adoption levels for listed standards are also provided.
The following scale is used to indicate the approximate, average adoption level among the stakeholders that would use a standard or implementation specification to meet the specified interoperability need:
|"Feedback Requested"
|Indicates that we do not have a known status for the current level of adoption in health care.
|Indicates low adoption.
|Indicates low-medium adoption.
|Indicates medium adoption.
|Indicates medium-high adoption.
|Indicates high or widespread adoption.
#4: Federally Required
This characteristic (provided as a "Yes" or "No") conveys whether a standard or implementation specification has been adopted in regulation, referenced as a federal program requirement, or referenced in a federal procurement (i.e., contract or grant) for a particular interoperability need. Where available, a link to the regulation has been provided. Please note this is meant to be provided as a reference only. Entities seeking to comply with federal regulations should look to any and all federal regulations that may apply to ensure adequate compliance.
#5: Cost
This characteristic conveys whether a fee is involved to purchase, license, or obtain membership for access or use of the recommended standard or implementation specification.
- "$" – when this designation is assigned, it signifies that some type of payment needs to be made in order to obtain the standard or implementation specification. Where known, the estimated cost for access will be provided.
- "Free" – when this designation is assigned, it signifies that the standard or implementation specification can be obtained without cost. This designation applies even if a user account or license agreement is required to obtain the standard at no cost, but is not meant to imply that there are no costs associated with implementation.
#6: Test Tool Availability
This characteristic conveys whether a test tool is available to evaluate health IT's conformance to the standard or implementation specification for the particular interoperability need. Where available, a link will be provided to the publicly available test tool.
- "Yes" – When this designation is assigned, it signifies that a test tool is available for a standard or implementation specification and is free to use. Where available, a hyperlink pointing to the test tool will be included.
- "Yes$"– When this designation is assigned, it signifies that a test tool is available for a standard or implementation specification and has a cost associated with its use. Where available, a hyperlink pointing to the test tool will be included.
- "Yes – Open" – When this designation is assigned, it signifies that a test tool is available for a standard or implementation specification and is available as open source with rights to modify. Where available, a hyperlink pointing to the test tool will be included.
- "No" – When this designation is assigned, it signifies that no test tool is available for a standard or implementation specification.
- "N/A" – When this designation is assigned, it signifies that a test tool for the standard or implementation would be "not applicable."
Submitted by sjonnaert on 2017-11-14
Dear Madam,…
Dear Madam,
Dear Sir,
On behalf of the IVD Industry Connectivity Consortium we are pleased to provide written comments to the Office of the National Coordinator for Health Information Technology (ONC) in response to the 2017 Interoperability Standards Advisory (ISA).
The IVD Industry Connectivity Consortium (IICC) is a global, nonprofit organization dedicated to creating and encouraging adoption of a unified connectivity standard to reduce the cost and variability of data exchange between IVD devices and healthcare informatics in clinical laboratories. This will improve healthcare efficiency and patient care.
The IICC has collaborated with several government bodies, including the US Food and Drug Administration (DMD/OIR/CDRH), US Centers for Disease Control and Prevention, and US Department of Health and Human Services (HHS) (ONC), National Institutes of Health (NIH), and industry organizations such as IHE International, HL7, Clinical & Laboratory Standards Institute, the College of American Pathologists, the Association of Public Health Laboratories (APHL), the Medical Device Innovation Consortium (MDIC), and the Regenstrief Institute to develop two standards that together allow for true Plug & Play connectivity of IVD instruments to Middleware and Laboratory Information Systems (LIS).
The IVD Industry Connectivity Consortium appreciates the opportunity to leverage our volunteers' expertise in commenting on the Standards Advisory, and we look forward to continuing our dialogue with ONC on identifying, assessing, and determining the best available interoperability standards and implementation specifications. We feel that this effort will provide the necessary foundation for more rapidly advancing interoperability.
The IVD Industry Connectivity Consortium finds that it would be beneficial if ONC would add the LAW – Laboratory Analytical Workflow Profile and LIVD – Digital Format for Publication of LOINC to Vendor IVD Test Results standards to the following proposed new sections:
- Section II: Content/Structure Standards and Implementation Specifications > Interoperability Need: Identify linkages between vendor IVD test results and standard codes
Standard/Implementation Specification
Implementation Maturity
Adoption Level
Test Tool
LIVD – Digital Format for Publication of LOINC to Vendor IVD Test Results
- Section II: Content/Structure Standards and Implementation Specifications > Interoperability Need: Connectivity between instruments, middleware, and LIS systems
Standard/Implementation Specification
Implementation Maturity
Adoption Level
Test Tool
- LAW – Laboratory Analytical Workflow Profile – The LAW Profile defines the physical connection, message definitions (based on the HL7 Messaging Standard v2.5.1), and workflow definitions between instruments, middleware, and LIS systems in the laboratory. IICC collaborated with the IHE Pathology and Laboratory Medicine (PaLM) domain to develop the LAW Profile. LAW is already implemented by all major IVD companies, including Abbott Laboratories, Beckman Coulter, BD, bioMerieux, Data Innovations, Orchard Software, Ortho Clinical Diagnostics, Roche, Siemens Healthineers, Systelab, Sunquest, and Werfen Group.
For more information on LAW [ click here ]
- LIVD – Digital Format for Publication of LOINC to Vendor IVD Test Results – Defines the digital publication of LOINC using vendor defined IVD tests associated with a set of predefined LOINC codes. LIVD assures that laboratory personnel select the appropriate LOINC codes for IVD test used by their laboratory. It also allows LIS systems to automatically map the correct IVD vendor test result to a LOINC code. LIVD was developed in collaboration with the members of the FDA IVD Semantic workgroup.
For more information on LIVD [ click here ]
Why are LAW and LIVD important for clinical laboratories?
The LAW Profile and LIVD specifications should have a significant positive impact on laboratory operations. Clinical laboratories are encouraged to ask their instrument, middleware, and LIS vendors about their current or planned support for the IICC/IHE Laboratory Analytical Workflow (LAW) and LIVD. The LAW Profile is currently being implemented by all major IVD companies.
- LAW and LIVD will significantly reduce the time and cost involved with deploying, connecting, and updating instruments in the laboratory by eliminating the need for vendor customized connectivity implementations, favoring vendors that adopt the specifications and pass the savings to their customers.
- Addresses all the shortcomings of outdated laboratory connectivity standards such as CLSI LIS1-A (ASTM 1391) and CLSI LIS2 (ASTM E1394).
- LAW will be a global standard (CLSI AUTO16).
- LAW and LIVD support federal guidelines on Meaningful Use.
- Improves the integrity of patient data.
- The LAW and LIVD specifications are available for download and do not require any licensing or fees for implementation.
The IVD Industry Connectivity Consortium (IICC) would also ask ONC's support to make both standards "Federally Required" for federal agencies as well as commercial entities.
We appreciate the opportunity to submit comments on the 2017 ISA. Our comments are intended to recognize the importance of each stakeholder's role in advancing standards-based interoperability and health information exchange, and ensuring that each domain is invested in overcoming the inherent challenges, while further enhancing health IT's pivotal role in enabling healthcare transformation.
Please feel free to contact me if you have any questions or to obtain more information.
Serge Jonnaert, BiD
President, IVD Industry Connectivity Consortium - https://ivdconnectivity.org/
/ Board Member, At-Large - IHE International - ihe.net
/ President, AERTWORKS® LLC – http://www.aertworks.com
Submitted by Meryl Bloomrosen on 2017-11-15
Premier healthcare alliance: Comments on ISA
Dear Dr. Rucker,
The Premier healthcare alliance is pleased to submit these comments in response to the Office of the National Coordinator's (ONC) Request for Public Comments regarding the Interoperability Standards Advisory (ISA).
Premier is a leading healthcare improvement company, uniting an alliance of approximately 3,900 U.S. hospitals, hundreds of thousands of clinicians and more than 150,000 other provider organizations. Premier has one of the most comprehensive and largest healthcare databases in the industry. Premier works with its members on utilizing informatics, analytics, and data to improve care quality and patient safety, while achieving cost efficiencies. With integrated data and analytics, collaboratives, supply chain solutions, and advisory and other services, Premier enables better care and outcomes at a lower cost. Premier, a Malcolm Baldrige National Quality Award recipient, plays a critical role in the rapidly evolving healthcare industry, collaborating with members to co-develop long-term innovations that reinvent and improve the way care is delivered to patients nationwide. Specific comments in response to your questions are provided in the attached chart.
Premier shares the vision of achieving health information technology interoperability and the establishment and deployment of core standards and functions of health information technology (HIT) to enable an interoperable, learning health ecosystem. Premier appreciates ONC's ongoing efforts to develop and enhance the ISA. However, the existence of standards and the publication of the ISA does not by itself ensure that application developers and HIT vendors implement and configure their software using the standards. Certainly, nationwide healthcare data exchange requires standards development and their timely adoption. Beyond exchange of data, however, interoperability requires data usability, understandability and development, recognition and adoption of common data sets, clinical terminologies and vocabularies and data definitions. Additionally, standards are needed for openly accessible electronic health record application program interfaces (APIs) to assure interoperability with other health information technologies and third party applications.
Premier hopes our comments (detailed in the attached letter) are helpful as you continue this important work. Premier stands ready to actively participate in ONC's ongoing efforts to achieve nationwide interoperability. Please feel free to contact us for participation in your listening sessions, workgroups and other activities.
If you have any questions regarding our comments or need more information, please contact me or Meryl Bloomrosen, Senior Director, Federal Affairs, at firstname.lastname@example.com or 202.879.8012. We look forward to continued participation and dialogue. Thank you again for the opportunity to provide comments.
Blair Childs
Senior vice president, Public Affairs
Premier healthcare alliance
Submitted by gdixon on 2017-11-19
Allscripts Comments on ONC 2017 Interoperability Standards
We thank you for the opportunity to review and provide as input perspectives gathered from our subject matter experts.
Submitted by firstname.lastname@example.com on 2017-11-20
NCPDP - Scope Comments
- Modify the first paragraph to the following: Starting with the 2017 ISA, the ISA's focus has expanded to more explicitly include public health and health research interoperability. Thus, its scope includes electronic health information created in the context of treatment, and subsequently used to accomplish a purpose for which interoperability is needed (e.g., a referral to another care provider, public health reporting, or research).
- ONC may want to consider adding verbiage around the addition of the administrative/payment oriented transactions.
Submitted by dididavis on 2017-11-20
IHE QRPH Domain Standard Addition Request
On behalf of the Integrating the Healthcare Enterprise (IHE) Quality, Research & Public Health (QRPH) Domain, I would like to submit the following for addition to the Section II: Content/Structure Standards and Implementation Specifications under the II-R: Public Health Reporting area as an emerging standard.
Interoperability Need: Requirement to submit data for the Title X Family Planning Annual Reporting process at an encounter level and in real time, in a standard format defined by OPA.
Type: Emerging Standard
URL: http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_FPv2.pdf
Standards Process Maturity: Balloted Draft
Implementation Maturity: Pilot
Adoption Level: 1
Federally Required: No
Test Tool Availability: Feedback Requested
Cost: Free
Other Notes for Consideration: OPA is currently engaged in an overhaul of their Family Planning Annual Reporting system, to enable the reporting of encounter level data from all of their Title X sites in a standard format and via a standard methodology. OPA is currently piloting two interoperability standards through this project and is intending to begin collecting data according to this new system in 2019.
Submitted by mattreid on 2017-11-20
AMA's comments to ONC on proposed 2018 ISA
On behalf of American Medical Association (AMA) I appreciate the ability to comment on ONC's Interoperability Standards Advisory (ISA).
Section I: Vocabulary/Code Set/Terminology Standards and Implementation Specifications
The AMA recommends that the ISA include a seventh characteristic to the interoperability need table to inform stakeholders of the presence and inclusion of the terminology's guidelines. The use of a terminology's guidelines is critical for consistent application of the codes and semantic interoperability of the data being exchanged through the terminology. Consistent use of codes further ensures comparability of data that can better quantify the value of care and determine outcomes. The following shows how this additional characteristic would be included in the table.
Representing Medical Procedures Performed
Standard Implementation/Specification
Standards Process Maturity
Implementation Maturity
Adoption Level
Federally required
Test Tool Availability
CPT-4: Yes
HCPCS: Yes
Submitted by Mark Savage on 2017-11-20
UCSF Center for Digital Health Innovation's Comments on 2018 ISA
Dear Dr. Rucker,
UC San Francisco's Center for Digital Health Innovation submits these comments on the 2018 Reference Edition of the Interoperability Standards Advisory. We thank you for the opportunity to provide these comments.
Very truly yours,
Mark Savage
Mark Savage
Director, Health Policy
Center for Digital Health Innovation
University of California, San Francisco
E. email@example.com
Submitted by lbecnel on 2017-11-20
CDISC Requests from 2018 ONC ISA
Thank you for the opportunity to provide input on the 2018 Interoperability Standards Advisory (ISA) online document. Although the catalog focuses on the implementation needs of healthcare, it will play a role in ONC's programs that support the 21st Century Cures Act. The Clinical Data Interchange Standards Consortium (CDISC) has engaged in projects with our fellow standards development organizations such as the Regenstrief Institute, IHE and HL7 over the past year to also help support 21st Century Cures Act and other initiatives at the intersection of care and research.
CDISC believes that, in order to realize the full impact of the bill, we as a society must invest in interoperation between existing healthcare and biomedical research standards and infrastructure. We thank the ONC for recognizing the importance of research as part of a learning health system through the inclusion of CDISC standards in the ISA. Our standards provide a consensus-based global language for protocol-driven clinical and translational research. They are also part of a larger tapestry of common research standards.
Many, if not most, major components of cancer-related research infrastructure in the United States are assets of or are being/have been funded by the United States National Cancer Institute (NCI). Their Enterprise Vocabulary Services (EVS) team manages dozens of commonly used semantic structures for research, including but not limited to CDISC terminology, and health. The following recommendations and requests are in support of expanding the ISA to include appropriate semantics to support ONC's activities toward the 21st Century Cures Act. We recommend the following updates in support of cancer, and broader, research as it pertains to the coordination of multiple agencies involved with human health and research-based evolution:
- Section 1-Q Representing Analytic Data for Research Purposes: We request that the existing Clinical Data Interchange Standards (CDISC) Controlled Terminology for Regulatory Standards Hosted by NCI-EVS be updated to Clinical Data Interchange Standards Consortium (CDISC) Controlled Terminology for Data Collection (CDASH, QRS) and Aggregation (SDTM) Standards Hosted by NCI-EVS. This update refers to the specific controlled terminology packages rather than the overview page to all CDISC controlled terminologies. We also request the addition of the CDISC Controlled Terminology for Data Collection for Protocol Hosted by NCI-EVS, as these terms include semantics from academic, federal and industry projects and would support semantic interoperability of research study concepts among systems.
- Section 1-Q Representing Analytic Data for Research Purposes: In order to support precision medicine, we recommend that CDISC Controlled Terminology for SDTM Pharmacogenomics Data Aggregation Hosted by NCI-EVS (Enterprise Vocabulary Services) be added to the standard. These terminologies are final and have had modest adoption by the regulated research community. We further recommend that the ISA consider the addition of longstanding and newer 'omics and phenotype standards that are being adopted by the global genomics community through the Global Alliance for Genomics and Health (GA4GH). HL7's Clinical Genomics group is also very involved in developing standards in this area, coordinating with GA4GH and CDISC. These standards have also been utilized by many diverse genomics efforts funded by the NCI. These include, but are not limited to the Human Phenotype Ontology, HGNC gene (and other molecular) identifiers and other ontologies hosted by the NCI Metathesaurus. These terminologies and ontologies are final, not required by the FDA and have moderate to high adoption.
- Section 1-Q Representing Analytic Data for Research Purposes: Many additional terminologies have been utilized by researchers from Cooperative Groups, research consortia and investigator-initiated trials. Cancer-related terminologies from these resources and others are found within the NCI-EVS. The cancer terminologies are bound to common data elements within the NCI caDSR, and these elements can help researchers to construct conformant data capture mechanisms linking data from health systems to research. These terminologies are final, not required by FDA and have moderate to high levels of community adoption.
- Section 1-Q Representing Analytic Data for Research Purposes: Terminology also exist for analysis datasets that are submitted to the United States Food and Drug Administration. As such we recommend the addition of the CDISC Controlled Terminology for Analysis Dataset Model (ADaM) Hosted by NCI-EVS. The terminologies are final, required by the FDA and have had high levels of community adoption.
- Section II-S: Research - Integrate Healthcare and Clinical Research by Leveraging EHRs and other Health IT Systems while Preserving FDA's Requirements: We request the addition of required, open and highly adopted CDISC standards – the CDISC Study Data Tabulation Model (SDTM) and the CDISC Study Data Tabulation Model Implementation Guide. These standards have been utilized by diverse research teams from academia, patient advocacy groups, government and industry worldwide to aggregate data from many different real world data sources. In support of the 21st Century Cures Act and other indication-specific areas of integration of healthcare and clinical research data, we also request the inclusion of the implementation specification CDISC Therapeutic Area User Guides, which include multiple solid tumors along with dozens of other indications and conditions. There are multiple projects within the PhUSE, CDISC and other communities to map these implementation specifications to HL7 FHIR and other healthcare standards. These specifications are included in the FDA Technical Conformance Guide, but are not required, and their overall adoption is modest to moderate. Finally, we request the addition of the implementation specification CDISC Pharmacogenomics/genetics (PGx) Implementation Guide, a provisional standard with modest adoption, the maturation of which is occurring in collaboration with HL7 Clinical Genomics Working Group to bridge semantics among clinical genomicists and trialists.
- Section II-S: Research - Submission of Clinical Research Data to FDA to Support Product Marketing Applications. We request that the adoption level of the CDISC SEND standard be updated from low to moderate. This required standard is being utilized for submissions to regulators for all pre-clinical genetic toxicology information. We also request the addition of the freely available, non-required standard CDISC Questionnaires, Ratings and Scales (QRS) and the implementation specification CDISC Pharmacogenomics/genetics (PGx) Implementation Guide, a provisional standard with modest adoption.
We appreciate the ONC's consideration of these requests and suggestions.
Lauren Becnel, Ph.D.
VP Strategy & Innovation
Clinical Data Interchange Standards Consortium (CDISC)
Submitted by wgsuarez on 2017-11-20
Kaiser Permanente Comments on ONC's Proposed 2018 ISA
Please see attached document
Submitted by chills on 2017-11-20
DoD / VA Interagency Program Office (IPO) comments on 2017 ISA
Thank you for allowing us an opportunity to provide comments on the 2017 as you prepare for the 2018 version. Included within our comments are comments we also received from VHA representatives. If there are any questions regarding our comments, please let me know. This document is key to help move the Industry towards a more open and standard's based approach in exchanging Health information.
Very Respectfully,
Chris Hills


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Teenage Room Ideas For Your Teenage Bedroom
Teenage room ideas is a kind of idea that parent needs when they planed to decorate or build their teenage bedroom. Every teenager of course always dreams to have wonderful room which they can proudly show to their friends. The room needs to provide everything that they need, so your teenage will not complaint about the room. That's why as good parents you need to find the perfect idea to make your teenage room.
The right teenage room ideas
0 Photos Gallery of: Teenage Room Ideas For Your Teenage Bedroom
There are a few things that you need to consider when you want to remodel your kid room become teenage room. First; you need to ask to your teenage about the model or the theme that they like. Discussing the matter with your teenage will make them feel happy because they think that you can accept their opinion, it is the perfect way to open the communication and you also can set the room with the right design. Second; you have to change the looks of the wall. Wall is the widest area in the room that will influence the looks. It is better to repaint the wall with the color that suitable teenage style. Third; you need to add the furniture that needed by your teenage. It is because teenage need more things than kids.
Room ideas for your teenage
Teenager is different from a child that's why they need different looks of their room than when they are still kids. However, you don't have to make the new room since you still can use the previous room that your kid have. All you need to do is remodel or decorate the room to have the looks that suitable for your teenage. You have to consider about the space and things that the teenage need if you want them to love their room.
Girl and trend going. Coming up the old children arent little things within our bedroom decorating tips for you must know that theyre sure to budget decorating. Teenage room decoration ideas, room decor regularly. Design a room design experts at pbteen. Room to decorate your. For teen decorating ideas for teenage girl wants. Design ideas design furniture and girls and small wooden gee g paschall has a lot in this diy room decor for teenage boy because boys are welcoming an. First color associated with these video game room for a teenage room in your room design.


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Heart Attack, Stroke Care and Other Emergency Services
A medical emergency can be stressful time for patients and their families. That's why doctors, nurses, therapists and technicians work as a team in the Emergency Department at Desert Springs Hospital Medical Center to provide efficient emergency services and urgent care 24 hours a day.
The Emergency Department at Desert Springs Hospital features a comfortable, spacious environment to treat patients who need emergency care for minor ailments or more serious injuries and illnesses such as:
- Stroke or heart attack
- Chest, abdominal or back pains
- Cuts, contusions, sprains or broken bones
- Infections such as upper respiratory infections
Don't wait! If you're having a medical emergency go to the nearest emergency room or call 9-1-1.
ER Reserve
ER Reserve lets you request a time (up to 12 hours in advance) in the ER for non-life-threatening injuries or illnesses such as:
- Flu
- Sore throat
- Earache
- Cough or cold
- Muscle strains and sprains
Thanks to the hospital's Comprehensive Assessment, Review and Disposition (CARD) room, we're speeding up the treatment of acute illnesses and injuries. In the CARD room, patients can watch TV, read and enjoy the soothing murals painted by local artist Dena Blake while undergoing testing and treatment.
In addition, the Emergency Department works closely with the hospital's Chest Pain Observation Unit, which is dedicated to the diagnosis and treatment of chest pain, to help free up time and services for non-cardiac patients.
Accredited Chest Pain Center
The Chest Pain Observation Unit at Desert Springs Hospital was the first in Nevada to be nationally recognized by the Society of Cardiovascular Patient Care for percutaneous coronary intervention (PCI). PCI, also known as coronary angioplasty, is a procedure in which stenotic (narrowed) coronary arteries of the heart are opened with small balloons threaded through an artery. The Society of Cardiovascular Patient Care's goal is to reduce mortality from heart attacks by teaching the public to recognize and react to the early symptoms of a heart attack and to reduce the time that it takes to receive treatment.
Primary Stroke Center
Desert Springs Hospital has been certified as an Advanced Primary Stroke Center by The Joint Commission. The Joint Commission's Certificate of Distinction for Advanced Primary Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. To achieve certification for one year, stroke centers must demonstrate that they comply with standards, clinical practice guidelines and performance measurement activities. To maintain certification, a stroke center must attest to continued compliance with standards and evidence of performance measurement and improvement activities each year, pass an on-site review conducted every two years by The Joint Commission and complete a bi-annual submission of an acceptable assessment of compliance by the organization.


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Ealing Studios International plans to make a sequel to the hit Brit comedy "St. Trinians" reports Variety.
The next installment of the Brit schoolgirl romp finds the mischief-making heroines set off on a treasure hunt after they discover headmistress Miss Fritton (Rupert Everett) is related to pirates.
Oliver Parker once again directs. Shooting on "St. Trinians 2: The Legend of Fritton's Gold" is set to start in January next year and will likely re-team most of the original's cast.


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- Details:
- Necklace lengths:
- Shipping, returns, etc:
- Reviews:
Go straight to the facts: sizes, materials & more
The geometric dish pendant necklace with a faceted rose cut garnet gemstone is one of our favourites from this jewellery collection. We love the way the facets of the gemstone and geometric surface pattern work together and we're sure you'll love it too.
This sparkly silver pendant necklace will make a great addition to your wardrobe. It will work a treat with office wear or for adding some colour and sparkle to casual outfits, but it will also dress up beautifully too - especially if you decide to go all matchy-matchy and pair it with the garnet stud earrings, geometric stud earrings or garnet stacking ring.
The silver pendant necklace looks great worn short with a v-shaped neckline, or you can wear it longer with a higher neckline. It looks especially good against black or white clothing.
The pendant is handmade in sterling silver which has a detailed Arabic geometric star pattern imprinted on the surface. Each pendant made will feature a different segment of the pattern, giving you a unique piece of jewellery. The pendant has been domed inwards to catch the light and it features a beautiful maroon coloured garnet with rose cut facets in a serrated edged setting.
The geometric pendant is suspended on a sparkly sterling silver cable chain, which is secured in place with a sterling silver clasp. The adjustable chain can be worn at different lengths and you can add even more length with one of our silver chain extenders. The chain is completed with our logo tag at the end, which acts as a counterweight.
Check out all the pendant necklaces in our Australian jewellery shop.
What you'll love
- Quality sterling silver pendant necklace, including the clasp.
- Unique handmade design, with no two pendants being identical.
- Great for casual or office wear, but looks great dressed up as well.
- Romantic rose cut garnet in a serrated edge setting.
- Versatile adjustable chain length.
- Pair it with the the matching earrings for a more dressed up look.
Just the facts:
- Materials: Sterling silver and a rose cut garnet gemstone.
- Pendant size: The pendant is approximately 1.6cm (0.63") in diameter. The garnet is 4mm (0.16") in diameter.
- Necklace length: Adjustable from 45cm (18") to 55cm (21.5"). Add a further 15cm (6") with our silver chain extender.
Our necklaces:
This necklace comes with an adjustable chain so you can wear it from standard (or princess) length (45cm/18") to matinee length (55cm/21.5"). You can also add a 15cm chain extender in silver or gold to take it to opera length. (70cm/27.5").
This illustration will give you an idea of how various necklace lengths are likely to sit:
Wearing different necklace lengths:
Everyone is different so we suggest you measure an existing necklace or use some string to see what will suit you. Check out our handy necklace length guide to learn more about how to wear different length necklaces with different necklines and outfits.
- Shipping is FREE in Australia for orders $30+. You'll get free Express Post for orders $150+. Learn more.
- Checkout is secure and you can make payment using credit card, Paypal and Afterpay, along with Google and Apple payments.
- Every order comes with a money back happiness guarantee, so you can make a return for any reason. About returns and exchanges.
- Each piece of jewellery is packaged in a lovely gift box which includes a display card with care and cleaning instructions.
- You can send your order directly to a gift recipient and include either a gift card or a gift note. Gift wrapping is also available to add in your shopping cart. Invoices are never included with deliveries.


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Aerial Solutions provides aerial services including digital aerial installation and repairs, Freeview Installation, Sky installation and Freesat installation in North & West Yorkshire UK.
Whether you need installation or repair, our aerial services are all about making sure that everything works without a hitch so you can get stuck into the latest digital TV.
Fast, hassle-free and affordable aerial services - that's our aim no matter what you need, whether it's repairing an existing system or installing a new Sky, Freesat or Freeview system with everything included.
Our expert engineers will arrive at your home and supply and fit what is required, whether that's the dish, aerial, cabling, set-top box or multiroom system. We'll then make sure everything works with maximum signal strength and picture quality before we leave. It's as simple as that.
It's why we're happy to offer a full 1 year warranty and a money-back satisfaction guarantee at some of the best prices in North and West Yorkshire.
For aerial services, please check out the links below or call us on 0800 328 7517 for a quick quote today.


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If you are shopping and come across an item that states "sales tax included," you can figure how much of the price goes toward the sales tax and the actual price of the item. If you know the sales tax percentage, you can easily "back out the tax" by a simple calculation on your pocket calculator.
Enter the total amount due on your calculator. For example, if the total is $13.65, enter that amount and hit the "Divide" key on your calculator.
Enter 1 and the sales tax percentage. For example, if the sales tax is 5 percent, enter 1.05 and hit the "Equals" key.
Read the result, which is the actual price of the item. To complete the example, an item selling for $13.65 tax included, with a 5 percent sales tax, actually costs $13, with 65 cents going for sales tax.
Photo Credits
- register with cash image by elke peterson from Fotolia.com


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Single Card Reading
Single Card Reading
Have a question you want answered, or just want to see what the cards have in store for you today? Single card readings are great for setting the tone for a day, week, month or even year.
You will receive a PDF file with a picture of the card and interpretation.
I will be using one of two Tarot decks: The Rider-Waite Tarot or The Mythic Tarot. If you have a strong preference please make a note of it when purchasing.
For a more in-depth reading, try a Three Card Reading.
Delivery: You will receive a PDF with your report by email.
within 48 hours via email.
Refunds: There are no refunds for card readings. If you have any questions before ordering please contact me.
***While my readings are quite accurate I must remind the buyer that Tarot is for entertainment purposes only and should not replace professional medical, legal, or financial advise***


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Though she only had two albums to her name at the time of her passing, singer Amy Winehouse made a deep impression on the pop culture universe thanks to the worldwide phenomenon that was her Grammy-sweeping 2006 album Back to Black.
For the better part of two years, Winehouse appeared on magazine covers, in concert, and all over television and radio promoting her album, which bridged the gap between old school soul, classic lounge attitude, and post-modern feminine toughness.
A series of self-destructive patterns followed her in the years hence, but Winehouse's time at the top of the world still stands in these five great video moments.
1) Winehouse Wins Five Grammy Awards
Easily the high point in her career; Winehouse took home five statuettes at the 50th Annual Grammy Awards in February 2008 (Best Pop Vocal Album, Best Female Pop Vocal Performance, Best Song, Best Record and Best New Artist. She was inexplicably denied the Album of the Year prize by Herbie Hancock's River: The Joni Letters, but her five victories put her in a tie for second place with Lauryn Hill, Beyoncé, Alison Krauss, Norah Jones and Alicia Keys for the most Grammy wins by a female solo artist in a single night).
Though she was performing via satellite from London—having run into visa issues prior to the show—she was by far the most popular artist in the room, and when Winehouse collaborator Tony Bennett announced Winehouse as the winner for Record of the Year, the singer was overcome with genuine shock and delivered a brief but poignant acceptance speech:
Her performances of "You Know I'm No Good" and "Rehab" are here:
2) Live At Lollapalooza 2007
In the heat of the Sunday afternoon sun in Chicago at 2007's Lollapalooza in Chicago, Winehouse took the stage with her band and delivered a tour de force performance. Though she was never known as a consistent performer, she used her incredible pipes to great effect and owned the stage with her slinky, after-hours sexuality. Her performance of "You Know I'm No Good" is particularly memorable, as it begins with Winehouse singing almost to herself and slowly settling into the song as it goes on; you can actually watch her evolving in real time. (Her killer band helped, too.)
3) Live At Glastonbury 2007
While she was loved in the United States, Winehouse was positively adored in her home country, and her watershed performance at the 2007 Glastonbury Festival (the definitive European outdoor music festival) proved that she had her compatriots eating out of the palm of her hand. In front of a crowd of tens of thousands, she plowed through her already-large bevy of hits, including an especially sharp take on "Rehab."
4) Cracking Jokes On Never Mind The Buzzcocks
In 2006, Winehouse was a guest on a long-running comedy show in England called Never Mind the Buzzcocks, which features musicians and comedians riffing on the current state of music. Winehouse more than holds her own in the format, casually dropping in gags about her own famous hair and Paris Hilton. She's so easy-going and charming, you almost forget that she's been through any kind of heartbreak at all.
5) Winehouse At 20
Right when her first album Frank was coming out, Winehouse appeared on a British talk show for a chat about jazz music and a performance of "I Heard Love Is Blind." It's a remarkable few minutes of television, and though she hadn't yet developed the persona that would take Back to Black to incredible heights, you could tell that her charisma, her charm and her voice would serve her well.
Read more on EW.com:
Amy Winehouse mourned on Twitter


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It gives us immense pleasure to announce that K L University's Department of English, Guntur District, Andhra Pradesh is organizing a National Conference on 28th & 29th March, 2015, entitled "Translation, Language & Literarure".
ELK Asia Pacific Journals, being the academic partners will publish the proceedings of the conference after Blind Review and edit in a Special Issue online (under the open-access publishing scheme) and in a book with ISBN number: 978-81-930411-1-6.
About the Conference
K L University, officially the Koneru Lakshmaiah Education Foundation, attempt to unleash the new trends and methods in English Language Teaching, Literature and Translation with this conference. So the researchers and academicians are invited to share their research ideas and opinions on literature, language and translation area.
Read more about conference objectives…
Chief Patron President, KLEF
Patron Chancellor, K L University
Chair Person, Professor & Principal SRN Adarsh College, Bengaluru, India
Patron Pro Vice Chancellor, K L University
Patron I/C Registrar, K L University
Patron Principal, K L College of Engineering


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As a psychologist, I like to take a holistic approach to treating depression, anxiety and stress – that is, working with the whole person, and treating both mind and body.
An article in "The Sunday Mail" newspaper (July 2015) featured "The Australian Wellness Index", which is used to monitor the status of our country's health across a number of key areas.
One area that warrants more attention is our National Psychological Health, which has declined every year for the past six years, according to the results measured by the "Wellness Index".
People in our community are experiencing rising rates of anxiety, depression and stress – it is no wonder that overall psychological health scores for our population on this index are declining, and have been dropping further and further every year since 2009.
Put simply, Mr and Mrs Average in our community are becoming increasingly stressed and unhappier year by year by year … it is clearly time to stop that decline! Has this been your experience?
How a Psychologist Can Help with Treating Depression
Seeing a psychologist can be the first step in treating depression, as you will be able to learn:
- how to get back on track personally;
- powerful tools to get the most out of your own wonderful life; and
- how to implement the strategies to achieve your goals.
Or perhaps you are one of the large number of people finding that more and more frequently, you just cannot think clearly day by day, because there is so much busyness and "stuff" in your life.
Indeed at certain times in our lives, many of us may find our mind and body unravels to the point of sleep disturbance, over eating and excessive drinking – and yet we kid ourselves that this is just the price to pay for a busy working life.
Could it in fact be depression rearing its ugly head?
To further assist in helping people like you to take better care of mind AND body, I frequently include food coaching advice for interested clients. A holistic approach is important when looking after your mind and body, because evidence shows that nutritional healthy eating helps alleviate stress and anxiety symptoms, as well as assisting with properly balancing the neurochemistry of our brains.
If you are wanting to take better care of your mind and body – whether you are just wanting to make the most of your life, or feel you are close to breaking point – please make an appointment with me.
Author: Peter Doyle, B Psych (Hons), MAPS, MCCOUNP, MCOP.
Peter is endorsed both as a Counselling Psychologist and Organisational Psychologist and has over 25 years' experience in clinical, counselling and workplace settings, helping clients with a diverse range of personal, lifestyle and psychological wellbeing issues.
Peter is currently not practicing at M1 Psychology, find his details on his website: Guidelight Psychology.


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Bespoke Design
Projects are bespoke designed utilising our 15 years experience in the industry along with consideration of clients' design briefs. In-keeping with your branding, clear and intuitive.
Many Ecommerce websites built by Skylight Media are built on our very own platform: BlueSky Ecommerce. This system has been designed, developed and continually invested in, in-house over 12 years, to be intuitive and quick to manage product 'catalogue' and website content. This is guaranteed and supported too. Beyond this, our vastly experienced team also creates bespoke web projects where a client requires something totally unique.
Inward investment and constant client feedback has brought us to the point where administration tasks can be performed quickly by users with minimal experience. We've always taken the view that clients are 'normal' people, not IT or web experts, otherwise we wouldn't be building the website, so their needs have been carefully interwoven into the entire system. In spite of this, we still appreciate feedback and are constantly improving the experience.
Projects are bespoke designed utilising our 15 years experience in the industry along with consideration of clients' design briefs. In-keeping with your branding, clear and intuitive.
B2B/B2C or both
Online payments via SagePay/PayPal/Stripe/alternate.
Payments on card or account
Member login, pricing & quick buy
Our intuitive Content Management System makes adding and updating your content easy, even for users with minimal experience.
Our websites are hosted on our reliable, premium hosting service. Our dedicated servers are housed in a secure UK based data centre, you will share only with other Skylight Media clients.
Our design and development team operates from offices in Nottingham. We host and support our websites in the UK and provide a reliable and cost-effective service.
tel. 0115 958 6060
firstname.lastname@example.com©2003-2019 Skylight Media Ltd | Privacy Policy


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Every search marketer knows Google dominates in U.S. search volume, handling two-thirds of all search queries. And yet, less is known about the entity that reportedly accounts for roughly the other third of searches – the Yahoo Bing Network (YBN).
This brings up a number of interesting questions for paid search marketers. For example:
- Is Google dominant in every vertical?
- How do the two engines compare on click-through rate (CTR) and cost per click (CPC)?
- Are paid search auctions as competitive on YBN as on AdWords?
AdGooroo (disclosure: I work there) addressed these questions in a recent study comparing the paid search performance of advertisers on Google AdWords and Yahoo Bing across six verticals in the U.S. during Q3 2012:
- Shopping & Classified (composed of a broad range of retailers)
- Financial Services
- Travel
- Education
- Computer & Internet
- Business to Business (B2B)
These vertical categories account for the majority of total search traffic and click-throughs in the U.S. search market.
AdWords Leads in Paid Search Spend, Clicks in All Verticals
AdWords delivered significantly higher impressions in five of the six categories studied – especially in the Shopping & Classified retail category, where it displayed 1.6 times as many first SERP ad impressions as YBN (an incremental 7.3 ad million impressions) during the quarter.
However, in the sixth category, Financial Services, YBN actually displayed more ad impressions than AdWords (although AdWords still yielded more total click-throughs within the vertical).
In addition to earning more search traffic, advertisers on AdWords generally experienced higher CTRs – with AdWords campaigns found to be 2.4 to 5.9 times higher than those on YBN during the period, depending on the vertical.
However, among the advertisers who were active on both engines, AdGooroo found some who actually had better CTRs on YBN than AdWords. For example, 9.5 percent of the Financial Services advertisers who sponsored paid search on both engines enjoyed higher CTRs on YBN than on AdWords, including Citicards and Fidelity Life. In the Shopping & Classified category, 5.7 percent of the overlapping advertisers had higher CTRs on YBN, including JCPenney, QVC, Old Navy, Kmartm and Shutterfly.
The Yahoo Bing Network Offers Certain Advantages
CPCs were almost invariably lower – and usually significantly lower – on YBN than AdWords – from 37 to 77 percent of AdWords' CPCs, again varying by vertical. So, advertisers were paying a high premium to gain access to AdWords' heartier search traffic and CTRs. And, as a result of lower CPCs, Brand Impressions (first SERP CPMs) varied from 76 to 90 percent cheaper, on average, on YBN than on AdWords.
The study also showed that there is significantly less competition on YBN than on AdWords. Across the six verticals studied, AdGooroo found 25,056 paid search advertisers on YBN receiving at least one first SERP ad impression, compared to 39,006 advertisers active on AdWords during the quarter. In other words, there were 36 percent fewer active search marketers on YBN to bid against.
What Does This Mean for PPC Marketers?
AdWords is the logical first choice for paid search advertisers for two reasons: superior impressions and click-through rates. However, YBN's advantages – lower CPCs and CPMs and less competition for ad position – offer a ripe, incremental opportunity for advertisers seeking to maximize their search efforts.
Even so, that notion doesn't appear to be widespread in the industry. Of the 41,548 advertisers who had paid search ads appear on either engine during Q3 2012, 42 percent (or 17,458) didn't record any ad exposures on YBN's first SERPs during the period. By comparison, only 6 percent (or 2,542) did not have first SERP ad exposures on AdWords.
The report's findings notwithstanding, over the last four years both search networks seem to be more or less fixed in place in terms of their share of domestic search volume. Time will tell whether that will change, and whether we'll see changes in the media buying habits of PPC marketers as well.
Related reading
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Google Ads recently announced that it now allows ads to be served for queries that it understands to share the same meaning on phrase match keywords.
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If you pay someone to adjust bids every week, much of that bid optimization work will be over. Details on Facebook's campaign budget optimization update.


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Online Pharmacies and medication have made life so much easier and also help to cut costs. Here are a few things to note while buying medicines online.
Medicines are Cheaper
Yes, you read that right. Medicines are usually cheaper online because suppliers can serve a large clientele from one central location — and avoid the cost of operating brick-and-mortar branches. In many cases, foreign online pharmacies can sell drugs for even less than domestic ones. Price caps that many countries place on drugs help drive down the costs.
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Trusted Sources
If you're ordering medicine online, be sure to do so from a trusted, verified source. Options like return; cash on delivery are offers you should look for from your service provider. While ordering online in India make sure it is legal and CDSCO approved.
Stay Away From Illegal Medication
One of the Things to note while buying medicines online is that don't be tempted to order drugs and medicine that are clearly banned by the law. An authentic service provider will never list illegal medication on their website. It is illegal to do the following:
- Purchase controlled substances without a prescription written by a licensed doctor. This includes all prescription narcotic painkillers, sedatives, stimulants and anabolic steroids.
- Purchase prescription drugs that aren't CDSCO approved, even if they're legal in the country from which you purchase them.
Check Certification
Look for pharmacies that are certified by the Pharmacy council of India, which are usually indicative of the fact that they follow stringent safety and quality standards. Always take note to cross-check a pharmacy's certification against that of the associated websites. Never buying from websites that sell drugs without a prescription or that offer to prescribe the drug for you is one of the main Things to note while buying medicines online.
General Precautions
If you experience any unfavorable unexpected side effect from a medication purchased online, contact your doctor immediately. Never take medications that are cracked or chipped or come in bottles that are shabbily labeled or mishandled. If you are worried about the appearance of a medication, contact the online pharmacy and voice your concerns before taking it.
At PharmEasy, we believe that good things happen to everyone. We try our best to help those in need. Get healthcare solutions delivered to your doorstep at lowest rates today.


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26 December 2016—Katimavik is now waiting for word on whether it will receive a sizeable portion of the $105-million allocated in the 2016 federal budget towards youth service programs over the next five years. The 2016 federal budget, also announced that, in addition to the five-year $105 million allocation, another $25 million per year after that would go to continued support for youth service.
This funding, according to the government, will help "young Canadians gain valuable work and life experience while providing support for communities across Canada." However it is still uncertain how much of this share, if any, will be allocated to Katimavik.
The funding towards "helping young Canadians gain work experience while providing community support" was an election promise made by Justin Trudeau during the 2015 federal election campaign.
Many people believe that Katimavik fits the description for this restored youth service program, which is why supporters have been actively campaigning for the program's reinstatement. A couple months after the 2015 federal election, more than 10,000 people signed a petition urging the new Liberal government to reinstate Katimavik and make it available to youth aged 18 to 25.
Over the four years that Katimavik has survived on limited resources, the organization has implemented numerous changes. Their new mission statement is ideal for funding, since it aligns with a top federal objective of renewing Canada's relationship with First Nations.
Changes to the program:
- Katimavik is developing a new core-learning curriculum for all future programs, in order to teach individuals to facilitate and lead indigenous reconciliation activities within their own communities.
- Katimavik commits to make active reconciliation an integral part of all Katimavik programming.
- The goal is to create skilled, informed, and engaged Katimavik individuals that will become leaders in reconciliation.
What Happened
The 2012 Conservative government budget eliminated on-going federal funding for Katimavik. In existence since 1977, this federally-funded service-learning organization offered young people opportunities to work in volunteer community teams across the country to improve social and environmental conditions, while adding to their knowledge of Canada and both of its official languages.
Budget Cuts
Cuts to Katimavik's funding formed part of a general assault on the budget of the Department of Canadian Heritage (CH). The Cultural Capitals of Canada component of the Canada Cultural Investment Fund; the Creators' Assistance component of the Canada Music Fund; the Arts, Culture and Diversity Program; and "Canadian Studies Learning Material" initiative also fell under the knife.
In 2013, CH explained that budget reductions required it to move
to a more integrated policy framework that focuses on the socio-economic benefits that their programs offer to Canadians and their communities. The Department is also focusing on funding that leverages contributions from partners.
In place of the sustained support for the community-serving learning and civic engagement for young Canadians offered by Katimavik, CH now directs short-term, limited, and unstable funding to applicants such as Scouts Canada and 4H Clubs.
Observers immediately judged the loss of Katimavik's multi-year budget of some $45 million over three years an effort to kill a volunteer program that had long irritated Conservatives. The death knell, however, proved premature. Today, Katimavik survives with much reduced programs (one, a community 'Eco-Internship' funded by the Quebec government and the second, a 'Canadian Youth Leadership Program' run in collaboration with the Rupertsland Institute in Peterborough, Ontario, for Alberta's Metis youth) and the support of alumni and one corporate-sponsor, a Quebec-based manufacturer of "certified organic cosmetics."
The term Katimavik first attracted broad attention as the name of a prominent part of the Canadian Pavilion at Expo 67. This was one high point of the post-war Liberal vision of Canada, notably before the emergence of the movements for social justice associated with Quebec sovereignists, Indigenous peoples, and women and the rise in non-European immigration.
Ottawa's near-simultaneous creation of the Company of Young Canadians (CYC; 1966-1977) similarly mirrored Liberal hopes to manage national feeling, desires for change, and the national unity agenda. When the CYC's mix of political activism and community engagement proved too hot to handle, it was abolished.
More modest hopes for social engineering then focused on Katimavik. Its 1977 creation reflected both fears about youthful rebellion and Quebec separatism and optimism about state capacity to foster social cohesion, harness youthful talent, and 'fix' the environment. An expression of a particular vision of the nation, it embodied the bicultural, anti-sovereignist dreams of such leading Liberals as Pierre E. Trudeau and Barney Danson (Southam, 373; Danson 169; see also Hébert).
Young volunteers, drawn two-thirds from English and one-third from French Canada, were enlisted in small groups to work in three regions for three months at a time in community-based projects that frequently targeted environmental and equity issues. In a revealing testament to the era's "panic" about youth (or at least middle-class students), Katimavik's "original three rules were no sex, no drugs, and no hitchhiking" (Mahood, 227). It nevertheless soon acquired a reputation for asking awkward questions of those in power. Many early recruits seem to have gone on to jobs in the volunteer and human rights sectors, which became government targets for downsizing in the late 20th century.
Katimavik's liberal, sometimes progressive, sympathies made it a frequent political football. In 1979, the Progressive Conservative government of Joe Clark shut it down. Funding was restored with Trudeau's 1980 return to power. Six years later, Katimavik reached its apotheosis with "a budget of $19.7 million" and "slots for 1,584 participants in 132 groups" (McMullan & Snyder), when Brian Mulroney's victorious Progressive Conservatives again cut federal funding. As Opposition leader, Jean Chrétien helped create "a private, non-profit organization to raise money" during the lean years of Tory rule (Kimber). As prime minister, he restored funding in 1994, albeit at lower levels. When Stephen Harper won first a minority government (2006) and then a majority (2011), Conservatives slammed "taxpayer-funded soapboxes afforded to the Trudeau progeny" (Justin Trudeau chaired Katimavik from 2002-2006, and Alexandre Trudeau chaired Canada World Youth), denouncing their equation of "statism with Canadian nationalism, and Canadian nationalism with the big-government policies of the Liberal Party" (Kheiriddim & Daifallah, 60, 62).
Relevant Dates:
- 2012-2013: elimination of federal funding for Katimavik
- 2002-2006: Justin Trudeau chairs Katimavik
- 1994: Jean Chrétien's Liberal government restores funding but at reduced levels
- 1986: Brian Mulroney's Conservative government eliminates funding for Katimavik
- 1980: Pierre E. Trudeau's Liberal government restores Katimavik funding
- 1979: Joe Clark's Conservative government shuts down Katimavik
- 1977: creation of Katimavik by the federal Liberal government
Role or Position
For all its sometime appearance of a fiefdom for the Liberal Party, Katimavik envisioned a wider constituency of active Canadians, though like many official initiatives it had little success in recruiting beyond European Canada. At its best, it contributed to citizenship education for Canadian youth and the encouragement of collective action in addressing community problems. From its founding to the present, Katimavik's shifting fortunes at the hands of both Liberal and Conservative administrations reveal what has been termed "partisan taint" (McGregor), making it often difficult to judge its real merits at any point in time.
Implications and Consequences
Implications and Consequences
Democracy: Cuts to Katimavik form part of a broad range of policies by the two mainstream political parties that since the 1980s have reduced "opportunities for meaningful democratic participation in Canadian public institutions" (Stasiulis, 527). They also suggest government's disinterest in actively addressing the democratic deficit associated with disadvantaged populations, in this case youth (Howe).
Silencing: Cuts to Katimavik embody the state suspicion of youth activism that was also visible during the 2010 G20 protests. And just as with efforts to silence Canadian scientists in the 21st century, Conservative cuts to Katimavik discourage the "oppositional engagement within the public sphere," which scholars consider essential to a healthy democracy (Kennelly, 140).
Environment: Katimavik's early engagement with environmental degradation made it an obvious target for governments committed to resource development with little regard to downstream consequences.
Photo: Katimavik.org
Date published: October 10, 2014
Have them build a tower together: About Katimavik, a meeting place, about youth, about hope, Jacques Hébert, McClelland and Stewart, 1979
Not Bad for A Sergeant: The Memoirs of Barney Danson, Barney Danson, Dundurn Press, 2002
"The active child citizen: lessons from Canadian policy and the children's movement," D. Stasiulis, Citizenship Studies 6: 4 (2002); 507-38
Rescuing Canada's Right: Blueprint for a Conservative Revolution, Tasha Kheiriddin and Adam Daifallah, John Wiley & Sons, 2005
Pierre: Colleagues and Friends Talk about the Trudeau They Knew, Nancy Southam, ed. McClelland & Stweart, 2005
Citizen Youth: Culture, Activism, and Agency in a Neoliberal Era. Jacqueline Kennelly, Palgrave Macmillan, 2011
Citizens Adrift: The Democratic Disengagement of Young Canadians, Paul Howe, UBC Press, 2012
"Federal budget 2012: Tories kill renowned volunteer program Katimavik," Kenyon Wallace, Toronto Star, 30 March 2012
"Youth exchanges take on partisan taint in funding battle," Janyce McGregor, CBC InsidePoliticsBlog, 11 April 2013
"Hitchin' a Ride in the 1970s: Canadian Youth Culture and the Romance with Mobility," Linda Mahood, Histoire Social/Social History. 47:93 (May 2014): 205-27
"Quarterly Financial report for the quarter ended June 30, 2013," Department of Canadian Heritage, 7 July 2014
Harris, Kathleen. "Katimavik hopes for revival with new focus on Indigenous reconciliation." News. CBC News, 2 Nov. 2016. Web. 8 Dec. 2016.
"Katimavik killed for "ideological" reasons, Trudeau says." News. CBC News, 5 Apr. 2012. Web. 8 Dec. 2016.
Lunn, Susan. Katimavik's return urged in petition signed by 10,000 Canadians. 6 Jan. 2016. Web. 8 Dec. 2016.
Raj, Althia. "Trudeau urged to resurrect youth program Tories "gutted."" Canada Politics. The Huffington Post, 22 Mar. 2016. Web. 8 Dec. 2016.


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Austria is a relatively unknown hunting destination, even though the country has good populations of chamois, ibex, red and roe deer in a breathtaking alpine setting. Moreover Austrian hunting abounds with traditions - there is no better place to experience central European hunting traditions with its associated woolen loden clothes, lederhosen and Tyrol hats decorated with the "gamsbart" (a trophy traditionally made from the winter coat of the chamois and worn on hats).
We offer hunting on an excellent district in the beautiful state of Kärnten (Carinthia) where we have been helping our customers realise their dreams of hunting big alpine chamois for many years now. Here both your physical fitness and your hunting skills will really be put to the test. Further we also have access to good areas for Alpine ibex, red stag, mouflon and roebuck.
Scientific Name: Rupicapra rupicapra Subspecies: Rupicapra rupicapra (The Austrian, Swizz, German, French and Italian Alps as well as parts of the former Yugoslavia.) Rupicapra r. pyrenaica (The Pyrenees). Rupicapra r. ornata (The Abruzzian Alps, Italy) Rupicapra r. carpatica (Transsylvania) Rupicapra r. balcanica (Parts of former Yugoslavia) Rupicapra r. caucasica (Kaukasus) Rupicapra r....Read more
In the beautiful region of Kärnten, close to the Italian border, Diana has been arranging chamois hunts for around 30 years. throughout this time we have always worked with the same partner, Ferdinand Kargl. The hunt takes place on the Scarpa estate, which is a typical mountain district divided into three sections, and is judged to be one of the best chamois districts in Austria. The...Read more
We have had the great pleasure of working with our partner here, Ferdinand Kargl, for around 30 years, and he has almost become an institution amongst our hunters. He is the veritable embodiment of an Austrian hunter, an excellent mountain hunter who knows his hunting district better than the back of his own hand. Simply experiencing a hunt with him here, in these beautiful mountains, is...Read more


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