text:
Sunday, 11 December 2011
Rouge Bunny Rouge Caress of Mink and Embrace of Cashmere Loose Glitter Pigment
These two new shades are the focus of the beautiful 'Beyond the Looking Glass' look.
RBR used one of the liquid highlighters with the pigments to get this exquisite look so that is something I'll be trying soon.
Embrace of Cashmere is a shimmery antique gold, Caress of Mink is a shimmery medium taupe brown.
Below I have used a light dusting of both shades dry.
Here are all my Loose Glitter Pigments together L-R: Wishing for Wings, Eaten all the Cherries, Sleeping Under a Mandarin Tree, Embrace of Cashmere, Spun From Sunny Seawater and Caress of Mink.
Swatches (same order as above):
These two new pigments are infinitely wearable and pair so well together, RBR delight as always.
I bought these from Zuneta.com
8 comments:
I bought Caress of Mink and I am very impressed by these, so pretty! Thanks for swatches of the others too, this has me wanting the other shades.ReplyDelete
They look beautiful on you. xxxReplyDelete
Gorgeous! They look lovely & pigmented when dry so I can only imagine how pretty they will look used wet. These are going on my wishlist! :)ReplyDelete
I am getting Caress of Mink in the mail very very soon! Can't wait!ReplyDelete
Aren't they amazing! I was so excited by the description of Caress of Mink that I was surprised to discover that Embrace of Cashmere may actually be my favourite of the two. Don't overlook it ladies. It's GORGEOUS!ReplyDelete
Hi Meeta,ReplyDelete
They are such great shades,I think RBR has picked really well with these as I'd be surprise for anyone not to find them wearable.
I still have to get the last pigment in the collection for it to be complete ;)
Hi Nazia,
Thank you, glad you like :)
Hi Makeup Magpie,
Actually I should have swatched them wet as well, I might have to do that at some point! I bet your RBR wish list is pages long ;)
Hi LauraJean,
I'm sure you'll be thrilled with it, will look forward to seeing your thoughts on it :)
Hi PerilouslyPale,
Caress of Mink does seem to be what most people are going for, but I think Embrace of Cashmere is really beautiful as well, we need to get the word out that people need both of these ;)
I never would have thought about getting one of these glitter tubes for my RBI collection. But they are just beautiful and obviously are a grown up glitter. Thanks for the lovely swatches that changed my mind!ReplyDelete
Hi TrainReck22,ReplyDelete
I'm so glad this post was helpful and that you like them, they are lovely aren't they, I think a lot of people were put off by the word glitter in their name :)


text:
California's Sixth District Court of Appeals on Thursday rejected a request by Oracle to reverse a lower-court's 2012 ruling that a contract existed between HP and Oracle requiring ongoing support for HP servers running Intel's Itanium chip.
The Itanium imbroglio erupted in 2011 when Oracle unilaterally announced that it would no longer port its database or enterprise software -- applications like Oracle E-Business Suite, PeopleSoft and JD Edwards -- to run on the Itanium chip, which is now used almost exclusively by HP. HP responded with a lawsuit and, in August, state judge James Kleinberg backed HP's claim that a 2010 contract with Oracle explicitly required mutual product support to continue.
In his decision, Kleinberg required Oracle to continue support for HP's servers and to pay damages for losses incurred -- an amount that has yet be determined by a jury. Oracle complied with the ruling by resuming updates of its software to run on HP's Itanium servers. But Oracle also filed an objection that said the ruling "imposes on Oracle an unprecedented obligation to support the dying Itanium technology," and it filed an appeal.
[ Want more on HP's latest Itanium servers? Read HP's New Integrity Servers Use Itanium 9500 Chips. ]
The Sixth District Court of Appeals late Thursday rejected Oracle's appeal "without explanation," according to Reuters. The decision is a victory for HP and for joint HP-Oracle customers that use Itanium servers -- particularly recent buyers who previously had little hope of leveraging their investments before choosing either new software or new servers. It means that new software including enterprise applications and Oracle's new 12c database, expected to be released within weeks, will continue to be ported to run on Itanium servers.
HP hasn't backed away from developing new servers to run on Itanium chips. In November, for example, it released the Integrity Superdome 2, a Unix server that HP claims processes transactions almost three times faster than the previous model.
Nonetheless, Oracle's support move and the high-profile legal battle that followed have taken a toll on HP's sales of Itanium servers. IBM and Oracle Sun both claim to be gaining share against HP, but this high-end Unix server market is itself a shrinking pie that is losing ground to increasingly powerful commodity X86 servers.
The ongoing legal battle between Oracle and HP and the matter of damages is now in the hands of the 6th Appellate District court, and Oracle must now wait until the trial is over before filing another appeal.

subset: commoncrawl


text:
Top flight deals to Geneva (GVA)*
Newcastle upon Tyne(NCL)toGeneva(GVA)
Press the Enter/Space key to load more items on the list or press the TAB key to continue
Fly to Geneva with KLM
Together with our global network, KLM Royal Dutch Airlines offers flights to Geneva, serving Geneva Airport (GVA). Plan and book your journey with our easy to use online service, and for further assistance, get in contact with our friendly customer support team, available 24/7. We're always happy to help!
Top Geneva attractions
- Lake Geneva: one of the largest lakes in western Europe, with stunning views and opportunities for a variety of activities.
- Chapel of the Maccabees: a fourteenth-century Gothic chapel in the heart of Geneva.
- Parc Bertrand: a public garden offering a paddling pool for children, a park for dogs, a soccer field, a toboggan area, a tennis wall, a pond, a small waterfall, a creek, and a Japanese garden.
- Victoria Hall: a concert hall located in downtown Geneva built in 1891–1894 by the architect John Camoletti.
- Mont Salève: view the city of Geneva from the stunning panorama atop this hill.
If you want the low-down of the best hotspots, restaurants and hotels in Geneva, why not take a look at our travel guide? There you'll find all the information you could need when planning a visit to Geneva.
What's the best way to get around Geneva?
Geneva's old town is best explored on foot, or you can rent a bicycle – be prepared for the hills though! There is also an excellent tram service with the majority of trams running through the main station of Gare Cornavin, and the old town stop of Place de Bel-Air. All visitors to Geneva are eligible for free use of the trams so make sure to ask at your hotels reception desk or pick up your pass at the airport before you head on out.
What's the weather in Geneva?
Geneva offers the best of both worlds: hot, sunny summers perfect for relaxing in the warmth and exploring the city, and cold, snowy winters perfect for skiing down the Swiss Alps. November through to February provide the best weather for those of you looking for some downhill excitement, while April to September are the best months to visit if you're looking for a more relaxed holiday.
Weather in Geneva
Powered by: OpenWeatherMap.org
28 °CThursday13/08/2020
26 °CFriday14/08/2020
26 °CSaturday15/08/2020
28 °CSunday16/08/2020
22 °CMonday17/08/2020
25 °CTuesday18/08/2020
27 °CWednesday19/08/2020
*All amounts are in GBP including taxes and surcharges. No booking fee is applicable, but a payment surcharge may apply. Prices and availability may change without notice, see KLM price display for more information.


text:
Part of planning for a disaster is assembling a family emergency preparedness kit. Basic kit supplies should include:
For a more complete kit, consider adding:
(From the Federal Emergency Management Agency and ready.gov)
Student loan forgiveness
Complete this form to receive your personal student loan analysis.
Find out if you qualify
Student Loan Solutions Workshop
Bring our workshop to your school. Learn how to manage student loan debt.
Request a workshop
One-on-one consultation
Get a complimentary review of your student loans.
Contact your local Horace Mann rep
Private loan solutions
Check if you can get a lower rate by privately refinancing in under 2 minutes.
Get my rate
Student Loan Forgiveness
Find out if you qualify
Student Loan Solutions Workshop
Request a workshop
One-on-one consultation
Contact your local rep
Private loan solutions
Get my rate
© 2017 Horace Mann Educators Corporation
CUSTOMER SERVICE Call 800-999-1030


text:
A pre-Deadline deadline for Doc?
If the Blue Jays are going to pull the trigger on a trade that sends ace Roy Halladay to a contender for a blockbuster package of players, the deal isn't likely to be of the last-minute variety. In fact, Toronto may be inclined to set an internal deadline prior to the July 31 non-waiver Trade Deadline.
"If you ask me today if we're going to trade Roy Halladay, I'd say no," Blue Jays general manager J.P. Ricciardi told the New York Times. "Something could happen between now and the Trade Deadline, but this isn't something that's suddenly going to happen with someone on the 30th."
As things currently line up, Halladay is scheduled to start on the road against the Mariners on July 29. According to the report in the NY Times, Ricciardi indicated that he doesn't want Toronto's ace taking the hill in Seattle with the thought that he could be dealt in the two days following his start.
Beyond that aspect, the Blue Jays would likely become sellers in the event that Doc is dealt. If Toronto is blown away by an offer and opts to trade Halladay, doing so before the 30th would give the club more time to shop some of its other players. Other Jays players involved in rumors include Scott Rolen, Alex Rios, Vernon Wells, Lyle Overbay, Jason Frasor and Scott Downs.
SIDE NOTE: I will not be at the ballpark tonight. For some Blue Jays' updates, you can follow @BlueJays or @e_gilbert on Twitter. Catch you from the 'yard tomorrow.
22 Comments
Could Daniel Farquhar be the next reliever called up?
This 22 year old RH pitcher was drafted in the 10th round in 2008 and was the 309th pick overall and today after being a pro for just over 1 year is closing games for The Jays New Hampshire affiliate, going from Auburn to Lansing to Dunedin to New Hampshire in under a year. He's a rapid riser under the radar with improving performance at each level so far.
From various reports, Farquhar has a very deceptive delivery who throws over the top, side arm and maybe even lower than side arm or in between with a fastball that gets to either low 90's to mid 90's depending on arm slot with lots of late movement. Hitters say he comes at them from out of nowhere.
?There?s a lot of toughness to him,? scouts say. He?s got a lot of life on his fastball, whether he throws from the side, up top or in between.?
His aggregate minor league line this year is 41.2 innings pitched, 22 hits, 28 walks, 56 k's and 4 earned runs (era of .86), with hitters hitting just .150 against him.
It appears he's getting better control, which could have been a concern and in his last 7 outings, totaling 7.2 innings, he's walked 4, struck out 12 and given up no runs. He is effective against both left and right hand batters, although a bit better against left handers-which is interesting considering he's a rightie.
I suspect he either gets promoted to AAA soon, or possibly be a September call up. Looks like he could be a good one.
The other reliever that is interesting is Tim Collins. He is only 5'7, went undrafted out of high school and didn't go to college but signed with the Jays instead. He is a bit further away but is putting up a second full season of solid pitching. His BB are a little high but he is K'ing over 13/9 this year. Apparently doesn't throw that hard (89-90ish) but his curve is a hammer.
Another prospect that is intriguing to me is McDade. He is a huge (260 lbs) switch hitter, but struggles from the right side (.197). Will probably take a lot of time to develop but he has 9 HRs in 250 ABs in a pitchers league at 20.
I liked Collins more last year than this, I just hope he hasn't peaked out at Dunedin and continues to improve.
The kid I like in Lansing, who's having a good year, is 20 year old Johermyn Jose Chavez who's hit 14 hr's and knocked in 62 rbi's.in 329 at bats.
The other outfielder I like who's made a big improvement this year is 20 year old Moises Sierra in Dunedin, who I think could be a real good one in a few years.
In addition, one of our high cost draftees of 2008, John Tolisano, is finally starting to show promise and has hit 11 hr'/s as a 2nd baseman in a tough league and is now tied for 3rd in league hr.'s. and tied for second in rbi's with 52.
One thing we have to remember about Collins is that he is playing in A+ and I don't think he will be 20 (maybe 21) until the end of the year. Right now he is playing against competition that on average is probably a 1-2 years older.
Chavez and Sierra were both relatively big name prospects at the time of signings so I'm not that surprised with them.
The big signing a couple years ago Pierre is playing with the GCL team. It will be interesting to see what they do with him next year; whether he jumps to full season or not.
Something I keep reading is that the team needs a catcher in any trade package for Halladay. I really just don't see it with Arencibia, Jeroloman, and Jaspe not to mention what seems like a tonne of catchers 20 or under in the lower leagues. Seems to me like they don't have enough consistent playing time for the catchers they have now.
Is anyone else concerned that it is the 3rd and from what I've seen Cecil hasn't thrown anything other than fastball, slider?
Gameday says he threw a change but I'm pretty sure that was a slider.
Personally, he has to atleast show 1 other pitch the odd time.
I agree on the catchers. Arencibia is starting to settle in at AAA. It's not surprising that he struggled at first since he's only been playing pro ball for 2 years. But in the last 10 games he's hitting .350 with 5 doubles, 2 hr.'s (10 in total) and 9 rbi's, so I'd say he's starting to adjust.
I also think Vegas weather has something to do with it. Some game time temperatures are 110, and with all that gear on, it has to wear him out.
Maybe there's concern about Jeroloman, who's seriously struggling in AA. I still wish we hadn't traded Robinson Diaz, who'd have been a perfect partner with Arencibia and is now loved in Pittsburgh, while we're sitting with Bautista.
Must be something wrong with the lighting in the Rogers Center, Millar hit a double.
Cecil dodges another bullet
2 innings in a row runner on 2nd, 0 out and we can't in the least make a productive out.
Jeroloman's calling card is defence though. I wonder if there is any effect on him getting sent down after his promotion late last year?
Twice in a row, Wells didn't do his job. First time up-GIDP. Second time up Hill on 2nd none out. Wells job in a tight game like this is to get Hill to 3rd. All he had to do is slap a ball on the ground towards right field. He struck out instead.
We have to play fundamental baseball particularly against a pitcher like Lse.. First run in this game is going to be huge and we should have already had it on the board.
Sloppy start for Shawn Marcum in New Hampshire tonight. 3 innings, 5 hits ( 1 home run), 1 walk, 4 k's, 5 runs given up-only 1 earned.
I surely hope we're not rushing him back.
Great start by Cecil, lets hope we bring it home for a win for the kid.
Crap time to commit an error.
The 9th inning shows exactly what's wrong with this team. This kind of scenario has played out over and over again this year. Overbay commits an error which costs us a run, so we go to the bottom of the 9th down 1 instead of tied. No blame on Downs here, closers sometimes don't get it done, and that's the first runs he's given up since May 26th.
So at the bottom of the 9th, we have our high paid guys up-Wells, Rolen, Overbay and Rios-the 4 guys paid to deliver when its needed.
So Wells hits a soft fly to center, Rolen does his job and gets a single, Overbay and Rios both pop up to end the game and we lose a heart breaker.
Wells goes 0-4, Overbay goes 0 for 4 and Rios goes 1-4. Other than Rolen, none of these guys deliver when its needed, their hits come when it doesn't matter, their hr's the same.
At the start of the year who would have though that Hill or Lind would have as many home runs as a combined two of three of Wells, Overbay and Rios-and it doesn't matter which two were picked against Hill or Lind.
Who would have bet that Hill or Lind would have 60% more rbi's than Vernon Wells, the guy we still owe over 100 million dollars to.
Well done JP, nice contracts on Wells and Rios. Now for the ones how think a few twinges here and there turn this team into a winner-think again, because that isn't going to happen until these losers (Wells, Rios and Overbay) are shipped out of town. They're scared of winning.
My god, hindsight is wonderful. When Wells and Rios were signed, they were both playing well enough to deserve their contracts, in which they traded long term job security for below market value salary. The fact that they have been inconsistent this year is a reflection, not on JP, but on the fact that it is very, very difficult to put up consistent numbers season after season. These guys both have the ability to turn it around and have a good season next year, but for chrissakes stop blaming JP because you have 20-20 hindsight!
Inconsistent, is that what you call what Wells has done this year-just inconsistent. And you think the Wells contract was below market salary. Please, drink your coffee before posting.
Wells hasn't had a good year since 2006 and he's only had 3 years in total that would justify him being paid above average for a center fielder. Above average does not mean elite or the most, it means above average. His career has been "inconsistent, 3 good years, the balance either mediocre or poor and this year-disaster.
Wells has never, not once in his career, performed under pressure, he can't handle it and never has. The majority of his hits have always came when the game is over, as have his home runs-that's the most consistent thing about him.
I wish Vegas would give odds about particular batting situations, cause with runners on 1st and 2nd, Wells almost always gidp, one could get rich taking that bet.
Even his defensive skills have declined since 2006 and they are declining more this year than last.
I was never for this contract when it was signed and certainly not now, and other than JP you must be the only one in the universe to think it was a good deal, cause no other team in baseball will touch this guy.
JP has been a disaster as a GM. All you need for further proof is how he started this Halladay fiasco and how he's handling it. JP's biggest problem has always been his mouth and his amazing burning need to see himself being quoted by the national media, particularly the MSM in the USA. Maybe he goes home, shows the clipping to his kids and says "look Daddy's in the papers." I don't know. But every time he opens his mouth, he looks and acts like an idiot, he always has and he always will.
I find its funny how anytime anyone ever posts anything negative about JP, you jump to JP's defense, almost like as if you are JP. Maybe you are or maybe one of the staff that works for him, because your continual defense of a non defendable record of losses, miscalculations, screw ups, bad trades, bad signings and bad statements makes no sense.
Marcum's start may be due to "dead Arm" that most pitchers go through in the Spring before their arms are really stretched out. I hope so anyway. Assuming he stays on schedule, August will be like April for him, and we can probably expect him to be on a reduced pitch count, and we will get some inconsistent starts from him until September. There is no way they are going to overwork him.
While I don't think JP is a bad 'baseball guy'; he has drafted pretty well particularly after the Comp A round (See: Marcum, Lind, Janssen, Jeroloman, Mills, Zepper, and more)
That being said he isn't polished enough to be a GM. If you really look at his mistakes them seem to revolve around the media and when he was given money he spent it like a drunken sailor regardless of who and where he it went. To me JP is a better ***'t GM, Director of Scouting, etc…
From some of the stuff I've heard though JP was pretty much flying solo making decisions before and since Beeston has come in it is more consensus using JP, Beeston, LaCava, and Antho in particular. Antho is apparently supposed to be next in line for the job.
It's funny how they censored the abbreviation of Assistant.
I'm not convinced JP has drafted all that well, particularly in his first years here. I think he continually played it safe with drafting college players (as per moneyball) versus high school kids and drafted, for the most part, a number of kids that might make it but with limited upside, just nice players-with very few exceptions on that.
In addition, JP decimated the scouting department, instead relying on central scouting and until Beeston made changes, we had probably the smallest scouting group in MLB.
The point is of the 400+ kids drafted by JP, only Lind and Hill on the current MLB roster are showing they might be better than average players. It's too early to tell on Romero and Cecil.Remember as well, if it hadn't been for Cito, Lind would have either been traded or left in AAA. Second, remember how many Russ Adams, Zach Jacksons and other top draft choices JP made who never made it.
Continuing the discussion on draft choices, I wonder why 8 of our first 10 draftees from this year are not yet signed, including the top 5 and only one of the top eight. The minor league season ends September 1st, there's only 5 weeks left, we're at risk of these kids missing their first year development or losing them as draft choices.
I wonder what the problem is.
I think when evaluating the draft though one always has to remember that there is a structurally high amount of draft picks that never do pan out. I know I was reading an article on the NHL and there only 50% of first round choices play any meaningful time in the league. (The Jays also have to draft with an eye towarsd signability because of their budget.) I would assume baseball is even lower because of injuries, especially to pitchers, and the long incubation time of development in baseballs minor leagues; most players don't even make it until they in their mid-20's and CAN be drafted when they are 17 depending on when the finish HS.
I agree that the scouting by video method never realy panned out. It was an experiment at best.
I've read that a lot of draft choices that have options (High Schoolers, Jr. College, and College Underclassmen) tend to wait until the top draft choices start signing. They determine their value off of comparisons of those signings based on a number of factors. Apparently, Strasburg and the Nationals haven't even talked yet and he isn't the only one. Also, the Commish has declined some contracts in the lower rounds because they were above slot (not sure who or which team).


text:
The NIH convened a group of senior scientists, administrators, and policy makers from the HMO Research Network (HMORN), supported by the National Cancer Institute (NCI) and National Heart, Lung and Blood Institute (NHLBI), as well as the Centers for Medicare and Medicaid Services (CMS) and Agency for Healthcare Research and Quality (AHRQ), to identify opportunities and strategies to enhance coordination and research infrastructure of the HMORN to benefit research programs of many ICs.
The NIH Director, Dr. Francis Collins, opened the meeting and gave the charge to participants. Senior HMORN representatives followed with brief presentations on the successes, challenges, and opportunities in three critical areas that could benefit from network enhancement:
- Rapid scale-up of mega-epidemiologic studies to enhance understanding of etiology, diagnostics, therapeutics, personalized medicine and disease burden;
- Transformation of the clinical trial enterprise; and
- Development of an evidentiary basis for improved health care delivery.
- Developing a more synergistic partnership between HMORN members and the NIH, especially with smaller institutes, could maximize the efficiencies and benefits of a HMO Collaboratory.
- HMORN representatives suggested expanding comparative effectiveness research (CER) capabilities and developing joint research positions among NIH, HMO-affiliated academic health centers (AHCs) and training programs.
- A thoughtful organizational structure would help forward research projects more quickly and generate new research hypotheses especially in the areas of mega-epidemiology, clinical trials, and health care delivery research.
- HMORN representatives stated that many of their faculty members are "at the limit of bandwidth for taking on more collaborative research,"; and that infrastructure expansion would entail additional resources, including for central core staff.
Meeting Summary
NIH Perspective and Vision
Dr. Collins, NIH Director, charged the participants with finding possible solutions for creating a more vigorous collaborative network which many NIH ICs could access in order to get rapid responses to important questions about healthcare. Dr. Collins highlighted five major opportunities for the NIH, several of which could be addressed by strengthening the HMORN and NIH collaborations. The themes include:
- Applications for high-throughput technologies to better understand fundamental biology and to uncover the causes of specific diseases;
- Translating basic science discoveries into new and better treatments;
- Putting science to work for the benefit of health care reform;
- Encouraging a greater focus on global health;
- Reinvigorating and empowering the biomedical research community by encouraging young investigators and stimulating innovation.
A thoughtful organizational structure would help accelerate research projects and generate new research hypotheses. Dr. Collins suggested that this could be accomplished by focusing on three priority areas:
- Mega-epidemiology studies that employ high-throughput genetic and laboratory analyses, biobanking, record linkage, standardized data collection and reporting, and high quality information technology systems to study disease burden, etiology, course, treatment and prevention, to empower personalized medicine,
- Transformation of government-sponsored clinical trials to be efficient, practical, and applicable to patients with common and rare diseases, Improving health care delivery research by creating a shared research platform to enable health systems analyses (including CER) to develop and deliver practical evidence on health care delivery, including provider incentives, and inform health care reform.
Dr. Larson, Executive Director of Group Health Research Institute and Chair of the HMORN Board of Governors, described the history of the HMORN. The HMORN sites consists of 15 U.S. research centers (along with one international member in Israel), all of which are embedded in integrated delivery systems; they are highly interdisciplinary and collaborative across sites, have long-standing partnerships with academic institutions, and are different enough to ensure diversity among patient populations, patterns of care, and delivery system designs. The culture is one of evidence-based practice and supports the concept of a learning healthcare system.
Dr. Larson addressed the goal of this meeting to explore what it would take to scale up and augment the HMORN's capabilities as a research collaboratory with the NIH and other external partners. He identified two major areas that present barriers — data/infrastructure and capacity. He emphasized that it will take significant efforts to align the data systems of all HMORN members. In addition, the HMORN is near its capacity with regard to the amount of work that can be accomplished with the current system. Several HMORN leaders spoke about the barriers, what it would take, and what could be done to scale up the HMO collaboratory.
Mega-Epidemiology Research
Dr. Joe Selby and Dr. Raymond Baxter from Kaiser Permanente addressed the barriers and facilitators for the HMORN becoming a leader in mega-epidemiology, with regard to resources, science and technology. Although many HMORN sites have been doing large-scale epidemiological studies for years, the challenge will be to bring these projects to a network-wide, membership-wide level. They identified several barriers to accomplishing this, including data availability, comparability and completeness, a scarcity of behavioral, environmental and patient reported outcomes data, the learning curve for using new EMR data, the time limits of existing HMORN investigators, and data access by non-HMORN scientists with concerns for patient privacy, data interpretability, and proprietary interests. They emphasized that it will take advancement in several key areas to scale up the collaboratory: funding to enhance the virtual data warehouse; standardization and validation of data definitions, endpoints, and collection of patient-reported data; a systematic and integrated approach to collection and storage of biospecimens that can be linked to EMR data (consent for research samples built into routine care); re-thinking the national research training strategies; and a thoughtful approach to expanding collaborations with non-population-based researchers.
Clinical Trial Enterprise
Drs. Eric Larson and Alan Go from Kaiser Permanente and Dr. James Hereford from Group Cooperative Health discussed the barriers and potential for improving the clinical trial enterprise to a network-wide level. They highlighted a need for better trial coordination and prioritization based on scientific evidence and patients' needs, standardization of procedures and integration of clinical trial protocols in EMRs, increased investigator-level research capacities, a more efficient infrastructure to streamline IRB and regulatory issues and integrate clinical trials into routine patient care, a cross-disciplinary approach to trials, and a better health care plan that aligns reimbursement with true costs of care. Several HMORN sites already have large, productive clinical trials groups that could be used as a guide for leveraging HMORN assets.
Health Care Delivery
Drs. Walter Stewart and Ronald Paulus from Geisinger Health System discussed how the health care delivery system could be leveraged to improve research and enhance the relationships between the infrastructure of the network, scientific resources, and delivery of care. However, there are several barriers. There is a lack of resources for enhancing infrastructure, such as centralized management and data standardization. There are organizational and socio-cultural barriers to collaboration and constant changes in heath care, which can affect patient enrollment and benefit design. Improvements would take a substantial investment to develop a central management system and should include development of more harmonized policies for data use and IRB review. The key issue will be to establish stronger ties between research centers and their delivery systems.
Discussion Session 1
Dr. Collins asked how representative of the U.S. population is the HMORN membership and; are there any limitations in using the network for research? The HMORN panel noted that the HMORN population is representative of families with health insurance, and consequently, patients in clinical trials tend to be wealthier individuals on average. Rural populations were underrepresented until Geisinger and Scott and White Health System (based in central Texas) joined the network. The panel commented that the patient population is very stable over time; however, the population composition often changes when there is a change in health benefits. The key would be to develop a system by which different HMORN members could access patient stability data from other members. Individuals will need to be placed within the context of their environment and communities. Some HMORN members have developed metrics around activity, behavior, diet, and other lifestyle factors to better track patient populations, and potential risk factors, and predict outcomes.
The NIH asked what the biggest barriers were for the HMORN in conducting clinical trials. The panel commented that two components of clinical trials have undergone great improvement. The first is streamlining the institutional review board (IRB) process and the second is the integration of electronic medical record (EMR) systems such as EPIC. The HMORN has undergone many efforts to improve access to various databases, similar to CMS and Veterans Administration (VA) databases. This enhanced data access capability can help to increase patient enrollment in trials. CMS has been trying to integrate all the databases to make data more available and easier to use. The panel also commented that cluster trials, while not trivial, are valuable for learning details that could not have been done with a traditional trial design. The NIH provided examples of their own successful collaborations such as Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and ARHQ. DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) is an AHRQ program that has been essential for a shared vision between NIH and AHRQ. It employs a coordinated approach and provides networking tools.
Dr. Collins commented that data access is critical for discovery. Several barriers such as academic conflicts and the informed consent process can slow down progress. The panel felt it was important for the HMORN to involve non-HMOs in this process to help fill gaps in patient populations. More analytic resources are needed; the HMORN has more data than can be analyzed. The panel expressed that there is a mismatch between where the researchers are and where the data are. Most researchers want to share data, however many are concerned about patient privacy, especially in regards to biospecimens, as well as data interpretability. The underlying data sources are typically collected for clinical care or financial reimbursement purposes, and therefore must be rendered useful for research. This data transformation process is often complex and nuanced, and studies benefit tremendously from having HMORN scientists involved rather than simply supplying data and subjecting it to misinterpretation. Patients are generally supportive of sharing their data for research, however, autonomy is a fundamental principle; they want to be asked, rather than told. Patients are also duly concerned about privacy and whether a profit is being made from their data. Data sharing in the context of the collaboratory would require thoughtful scrutiny and deliberation to maximize the value while respecting legal provisions that vary by site.
The interaction between research enterprise/data collection and quality improvement enterprise was addressed. The panel commented that joint planning groups take place to set priorities and forecast outcomes and quality improvements.
The HMORN leaders commented on effectiveness trials. It is important to examine which patterns of care are more beneficial than what is considered care as usual. The HMORN has the capacity to more efficiently identify logical targets for intervention for effectiveness trials. Using variation in practice and outcomes has been successfully demonstrated. However, it is very difficult to integrate health services interventions into this type of system. There is a consensus that there is a difference in quality of data from research studies versus routine health data from diagnostic studies in the clinic. These data need to be better integrated.
The NIH asked about the ease of participating in NIH studies and whether HMORN members work on NIH funded trials. The panel commented that the network looks at NIH proposals as they are submitted. Most collaborative trials are conducted in the institutes where the network PI has interest. The panel felt that more direct interaction and bidirectional communication between the HMORN and smaller NIH institutes would help foster collaboration among these groups.
The panel suggested that in order for the network to be strengthened, it would require some type of coordination function. It is not clear where this coordinating body would be located, what type of staff is required, or how it would be governed. Currently there is a rich network of centers, but no "headquarters"; and no clear answer for an optimal organizational model. However, one example comes from the Kaiser institutions, which have been conducting an experiment through The Center for Effectiveness and Safety Research (CESR). The Kaiser community benefit has provided all of the 8 Kaiser regions, which are not all HMORN members, resources to address these exact issues. A national director is being recruited that could be located in any of the Kaiser regions. However, they are still struggling with issues of governance and establishing administrative and investigator networks, a data-coordinating center, and a steering committee. It has taken a tremendous amount of time to prioritize opportunities, considering investigator capacity. The key question is how a coordinated data system across sites can be developed. For the Kaisers, this has taken substantial time and resources.
Discussion Session 2
The group addressed the next steps for creating an HMORN collaboratory with NIH. The funding required for such a network was discussed. The panel felt that the traditional NIH model for supporting a network was not appropriate in this case. There was a perceived advantage to having active participants that are embedded in the organizations and not staff that are located at a distant coordinating center. The key question is how this will become operational and high-functioning, given the distributed nature of the research. What could the formal structure look like? There are 2 steps that could be taken. One is for NIH to facilitate the HMORN to develop planning activities and another is to propose a funding model to support a coordinated entity.
One suggested approach for developing the coordinating center is a milestone driven model. It includes four primary levels of engagement:
- the legal and organizational nature of the entity, i.e. what does the network do versus the individual organization,
- a staffing model to make the collaboratory functional; this should correspond with the goals of the network,
- a central group to ensure progress at all 15 centers; NIH could be this central group or candidate sites could be proposed, an
- a funding model to sustain the organization.
This page last reviewed on December 20, 2013


text:
David Lloyd Glover has a 25 year international reputation exhibiting in major galleries in the US, Canada, Mexico and Japan. His works have been acquired by collectors all over the world. Glover creates masterworks in watercolor on paper, gouache on paper, oil on canvas and acrylic on canvas with equal facility. After a career in the advertising industry he embarked on a full time vocation of creating fine art for gallery sales.
- Art Classification : Contemporary Looks
- This ready to hang, gallery-wrapped art piece features a corner cafe
- Giclee (jee-clay) is an advanced printmaking process for creating high quality fine art reproductions, the attainable excellence that Giclee printmaking affords makes the reproduction virtually indistinguishable from the original piece
- Artist: David Lloyd Glover
- Subject: Landscape
- Style: Contemporary
- Product Type: Gallery-Wrapped Canvas Art
- Made in USA


text:
- LostCousins: The LostCousins site is totally free to 2 May 2011. This is probably the only web site that has virtually 100% accuracy in matching people who share the same ancestors. You do not waste time corresponding with people who are not related to you. To use LostCousins you need to have found relatives in one of these censuses: USA 1880; Canada 1881; Scotland 1881; Ireland 1911; England and Wales 1841, 1881 or 1911. Be sure to enter data for brothers and sisters of your direct ancestors. It is their descendants who are most likely to have letters or photos from your line. Start by reading the LostCousins 'How-to' page. Remember to log in periodically, go to your 'My Ancestors' page and click 'Search'.
- Central Queensland cemeteries: Burial indexes and maps for many Rockhampton Regional Council cemeteries are now online (and frequently updated).
- Orphanage records: Some Queensland orphanage records have recently been opened to the public.
- 'Inside History' magazine: Inside History is a new magazine about Australian and New Zealand genealogy, history and heritage. Published bi-monthly, Inside History has genealogy articles and tips, expert advice, stories about history (old houses, country towns, biographies etc), and lots more. I received a complimentary copy and was so impressed by the quality of the magazine that I asked Brisbane City Council libraries to subscribe so that it will reach a wider audience.
- Ryerson Index: The Ryerson Index is an online index to death notices (and some obituaries, funeral and probate notices) in current Australian newspapers. Family history or local history societies who would like to index notices from their local paper should use the contact link on the Web site.
- Irish research: Have a look at this collection of Web sites for Irish Research.
- Outback Story: Outback Story is a personal account of what life was like on a grazing property in the Cunnamulla area (southwest Queensland) from about 1919 onwards.
- Environmentally friendly genealogy: How to make your genealogy research environmentally friendly.
- Bookmarking State Archives Web pages: Many indexes on the Qld State Archives Web site consist of an introduction (as a Web page) with links to different sections of an index (as PDF files). If the index is updated, a name that was in one PDF file may be moved to another. You should therefore bookmark or cite the introductory Web page, not the PDF file.
UpdatesGenie has genealogy news and tips from all over the world (Queensland, other Australian States, England, Scotland, Wales, Ireland, New Zealand, Canada, USA etc.) Find out about indexes, Web sites, publications, discounts, events, research strategies and lots more. Explore all the options in the tabs below, in the sidebar and at the bottom of the page, and on my main Web site.
30 April 2011
No.1 (genealogy worldwide)
Links open in new windows so you won't lose your place on this page.
© Copyright, Judy Webster
Subscribe to: Post Comments (Atom)


text:
Rome, Italy, Feb 11, 2014 / 04:02 am MT ().- As many look for signs of change in Pope Francis' comments on people with same-sex attraction, the leader of a ministry for those with homosexual inclinations instead believes the Pope's words hearken back to Christ himself.
"I don't think there's any reason to believe that anything our Holy Father is saying now is inconsistent with 2000 years of Church teaching, so I would hope people could be at peace and at rest about that," said Father Paul Check, executive director of Courage International.
Fr. Check, who has led the Roman Catholic organization dedicated to offering spiritual and practical support to people with same-sex attraction since 2008, spoke with CNA on Jan. 25.
Touching on remarks like those made in July of 2013 – when the Pope said, "If a person is gay and seeks the Lord and has good will, who am I to judge?" – Fr. Check pointed to Jesus' own method of preaching the gospel.
In the Scriptures, Jesus does not hesitate to teach doctrine and basic truths to large groups, as in the sermon on the mount. Yet he also "engages people in another way, a very personal way, one at a time."
"I think that the emphasis Pope Francis is bringing to us right now is on the second way: very personally, listening to people and speaking with them and 'walking with' them, guiding them, bringing them to Christ," explained Fr. Check.
"I am not an authoritative interpreter of the Pope's comments," he cautioned, "but here's the way I understand them."
The priest then turned to the story of Jesus' meeting with the Samaritan woman at the well who has had five husbands.
"Our Lord knows well that there is a moral question here that's involved, and indeed it's a chastity question. The woman is living in an 'irregular' way. But he doesn't begin the conversation with her about the moral problem. Instead, he talks with her about her interest – and more than her interest, her desire for God."
"So he engages her in a very personal way about something that is already resident in her heart…he speaks with her about God, and then he speaks with her about the life of God…(and) also about her desire for eternal life, which is something that we all have," Fr. Check continued.
Jesus "engages her in this very lovely sequence, and he keeps the conversation going with her until he reaches that point when it is appropriate to say, and when she can receive, what it is that she's about to hear about the irregular condition in which she's living, and she doesn't deny it."
"But he has established a relationship with her, and I think this is very much what our Holy Father is suggesting: that we are to walk with people, to get to know them, (although) of course, we don't have the benefit of knowing what's in someone's heart the way that Jesus does, so all the more reason that we have to take care," Fr. Check noted.
"I think that personal engagement, the walking with, is something that he is proposing," and "I think the Holy Father is very prudent and charitable in wanting to think about how people receive the message of the gospel today and to find ways in which that teaching can be announced in a way that people can receive it."
And what is the Church's teaching about homosexuality?
"We have to distinguish the person, from the inclination or the desire or the attraction; and thirdly, from the action," explained Fr. Check.
"The person is always good, because everyone is created in the image and likeness of God," he affirmed.
Homosexual activity itself is a "grave violation of chastity which means it's gravely contrary to the human good and cannot lead to joy, peace, and fulfillment because there is a human nature which guides us and directs us with regard to the expressions of physical intimacy."
Perhaps most difficult to understand is the Catholic position concerning "the (homosexual) inclination or the desire or the attraction," noted Fr. Check.
"This the Church terms, 'objectively disordered.' Those words are difficult words to hear, they can fall very hard on ears and understandably, but the phrase objectively disordered does not apply to a person."
"It means that the desire or the attraction in an erotic way, for a romantic, sexual encounter, relationship with a person of the same sex – that that desire is out of harmony with our human nature as we have been created by God, when we look at the complementarity of the sexes and the procreative power of the sexual faculty."
The phrase "'objectively disordered' relates to the appetite or the desire. It is not a moral judgment, let alone a moral condemnation of the person," he emphasized.
The priest then went on to add, "the soul of someone, because of their experiences, shapes or filters or understands messages in the way that it receives it."
"Every heart is made for fulfillment in Christ: some hearts just don't know that yet, or haven't been told that yet. Or haven't found a way in which they can move past some of the preconceptions and the misunderstandings and even some of the very real hurts that may have happened," he explained.
Thus, rather than the gospel message itself being changed, Fr. Check believes Pope Francis is offering a new emphasis on methodology.
"In that sense I think it's the question of the how of the announcing of the gospel, and we're certainly prepared to assist with that effort."
Courage International, which operates in over 100 diocese in the U.S. and 12 foreign nations, offers spiritual support and practical help for men and women experiencing same-sex attraction who want to lead chaste lives.
The apostolate holds private chapter meetings, conferences, days of recollection, and retreats, in addition to a 12-step program when it may be helpful.
"The most important aspect of the Courage apostolate is the relationship between the individual person and Jesus Christ," emphasized Fr. Check. "No one understands the struggles of all of us, whatever they may happen to be, more than Jesus Christ."
Courage "is that very particular, very concrete, very practical expression of the Church's pastoral concern" for persons with same-sex attraction.
The initiative aims for them "to know that they are not only not outside of the Church, not outside of the heart of Christ, but warmly embraced...and that all the means they need to live and to fulfill the deepest and most authentic desires of their heart, given to them by Christ are there for them."
Returning to another of the Pope's remarks in which he described the Church as a "field hospital," Fr. Check added, Courage is "like a wing in the Church's hospital. We are one of the rooms where those who are wounded by sin in a particular way can come and receive healing."
Tags: Same-sex Attraction, Courage Apostolate
You may also like »
Chinese youth moved to tears by Pope's informal remarks
A young man from Hong Kong was moved by Pope Francis' off-the-cuff remarks during the opening...
Pope Francis urges two-state solution in first remarks to Israel
Late Sunday afternoon Pope Francis arrived in Tel Aviv, where he urged Israeli President...
Pope Francis entrusts Holy Land trip to Virgin Mary
Pope Francis privately visited the Basilica of St. Mary Major in Rome this morning to pray...