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Australian Bureau of Statistics data estimates that 17,000 people across Australia suffer from a total loss of sight and a further 260,000 have reported a partial loss of sight. In the context of Australia's relatively small population, this represents a sizable proportion.
Further to this, a strong correlation between visual impairment and age is evident with more than 13 per cent of the total population aged 75 years or older affected by some form of visual impairment which cannot be corrected by glasses alone. Coupled with the now established understanding that we are a society that is aging quickly, designing with this population in mind is increasingly important.
The type of lighting provided, its location and application within a particular building, as well as the importance of factors such as selecting materials which reduce glare, are important factors to be considered. Changes to the relevant Australian Standards (AS 1428 parts 1 and 4.1 2009), however, have raised very specific requirements with regard to the concept of 'luminance contrast' and its application in the selection and placement of materials within particular situations.
Luminance contrast, as it applies to these Standards, is defined as the difference in the amount of light reflected from two adjacent building elements. According to the Standards, a suitable ratio in the Luminance Reflectance Value (LRV) of the two materials to be considered is 30 per cent or greater. For materials that are to be used outdoors, there is a need to test them in both wet and dry conditions is as values can vary significantly.
Building elements that must be considered include tactile ground surface indicators and the surfaces they are installed on; visual indication of glazing (decals) and the floor or wall finishes they will be viewed against through the glass; door finishes and their surrounding wall, frame, jambs or architraves; and the nosings of treads at steps and stairs.
An appendix to these Standards outlines a very prescriptive method of assessment as well as instrumentation to be used. Even though the instrumentation identified is relatively accessible in industry, the viewing geometry specified is far less so. A limited number of instruments meet the specifications documented. These instruments also tend to be significantly more expensive than other instruments without the capability of providing the required viewing geometry.
In many instances, building certifiers are requesting certificates confirming compliance to the relevant standard during their assessments. Designers, developers, building owners and managers should therefore exercise some diligence in selecting suitable assessors of luminance contrast and the instruments they are using. It has been reported that some assessors are using instruments which do not meet the specific requirements of the Standards. Even though some important information can be gained from alternative instruments, they do not accurately meet the requirements of the Standards and therefore present some risk to all parties.
The relevance and value of applying the principle of luminance contrast in the selection of materials of course goes well beyond that of the elements indicated above. Paths of travel can clearly be indicated by selecting finishes to walls and floors which provide effective contrast. Furniture and movable items which contrast with the finishes they are viewed against reduce the hazards associated with collisions, trips and falls. Bench tops and work surfaces in joinery can be better identified and more usable to people with low vision.
The implications for a broader group of people are also obvious. Steps and stairs are possibly the largest source of falls and fall-related injuries in the built environment. A study from the Monash University Accident Research Centre found that more than 19,000 such injuries were reported between 2002 and 2005. It may also be reasonable to suggest that the incidence of falls resulting in minor injuries which weren't reported and therefore not identified in studies such as this may be far higher. Providing appropriately contrasting nosings and including handrails present important strategies in mitigating this risk.
People colliding with large format glazing is another common source of injuries within buildings, regardless of ability and vision impairment. Applying suitably contrasting adhesive treatments and giving careful consideration to the finishes surrounding the glazing can contribute to reducing the associated rate of incidence.
It's important to note that testing is not always necessary when attempting to assess and apply luminance contrast effectively. Several paint manufacturers, for example, now publish LRVs for their products, which allows designers to perform the calculations themselves. Greater awareness of this area over time will hopefully also see manufacturers of other building materials routinely publish these values for generic use and application.


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Please have look at http://www.renaultownersclub.com to see events the ROC are planning next year. Some events you need to be a member, for insurance purposes. The Oulton Park Gold Cup is officially a joint ROC/RAOC effort, so look out for more details early next year.
I haven't heard anything about French Car Show yet, but if it happens we will have a parking area, and probably do a social event over the weekend
Feel free to pm or email me for details of any events
Rob (Events Secretary, ROC)

subset: commoncrawl


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The San Francisco Bay Area has become the most saturated place in the country for free dailies. But that hasn't stopped another one from starting. Today, the Palo Alto Daily Post began publishing, becoming that city's second free daily. It's the third paper in that town of 60,000 people if you include a weekly paper. And it doesn't have a website or an online, multi-platform strategy. Yikes!
At this point, you'd think the Palo Alto Daily Post would have two strikes against it -- a lot of competition and no desire to go online.
On the other hand, I can think of three reasons why the smart money would bet on the success of this paper:
- 1. The Post's publishers are entering a market already accustomed to the free daily concept.
2. This paper has figured out that the Internet doesn't help them. Think of all the readership printed newspapers have lost because they put their stories online. People now know that if they want to read a scoop, they should go online. But online advertising isn't working out for newspapers. Nobody is able to fund the costs of newsgathering with an online edition. Maybe the Post guys have figured that out.
3. And the Post guys are none other than Dave Price and Jim Pavelich, who have started several profitable free daily newspapers over the years in Colorado and California. They know what they're doing.
- In another act of brazen heresy against the prevailing dot-com culture here, the Palo Alto Daily Post, which published its first issue yesterday, has no Web site. At a time when most newspaper owners are looking to the Internet to revive their struggling industry, the new paper's owners, James Pavelich and David Price, brusquely dismiss the need for an online presence.
"We're a newspaper," Mr. Pavelich said in an interview yesterday as he returned from shuttling his inaugural edition to newsboxes around town. "The Internet is a form of broadcast to me. We're not broadcasters. We just don't have the time to run two businesses."
... Earlier this year, the Daily News moved its offices out of Palo Alto, to neighboring Menlo Park. Messrs. Pavelich and Price swooped in, tweaking the competition by renting space in the same building it just vacated. "It was kind of comical to us and we jumped at it," Mr. Pavelich said.
Executives at the Daily News did not return calls seeking comment.
... The Daily Post's inaugural issue featured articles about city volunteers quitting over mandatory fingerprinting and a physician facing charges for prescribing medicine over the Internet to a Stanford student who committed suicide. At 28 pages, the paper is just a tad thinner than the gaunt metropolitan dailies from San Francisco and San Jose.
- While Palo Alto is an economically and demographically succulent market where real estate prices continue to climb even to this day, the upscale community hardly seems like a place where multiple, profitable free newspapers would be likely to thrive.
OK, in a year or two we will see who is right. In his interview with the New York Sun, Dave Price points out that when he started the Palo Alto Daily News in 1995 "we had a number of people who were supposedly experts in the newspaper industry saying we wouldn't last six months ... We proved them wrong. Not only was the paper a success in a business sense, it won a tremendous number of awards."


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Mark Featherstone
In the past I think it was more or less straightforward to discuss social inequality and debate the pros and cons of inequalities of wealth, opportunity, and position in society. While there were those who believed in the absolute value of equality of wealth, opportunity, and treatment of individuals, others would defend versions of inequality. So, for example, one might suggest that it is unjust to insist upon (absolute or relative) equality of wealth on the grounds that some people are more able than others and should be rewarded on the basis of their talents. However, on the back of this defence of inequality on the basis of ability, most would tend to agree, particularly in a liberal democracy, that equality of opportunity is not only just, but also necessary in a society that needs to allocate role by ability, rather than inherited position. Although everybody would recognise the existence of class, which effectively means historically produced advantage or disadvantage, the aim of a just society should surely be to work towards equality of opportunity.
Regarding inequality of treatment, most would agree that people should be treated fairly, but understand the complications involved in achieving this in a society where historically defined norms and values might mean that some need to be treated more than equally in order to achieve some sense of fairness in an otherwise unfair society. Of course, the rub here is that by treating some more than equally in order to address historical unfairness others might feel marginalised and poorly treated in comparison. The history of class, race, and gender politics in Britain provides evidence of the complications involved in these debates. Yet my sense is that in the past we generally understood what we meant when we spoke of and wrote about social inequalities. I think that this has now changed.
Consider Theresa May's keynote speech at the Conservative Conference in Birmingham this week, where she spoke of addressing social inequality. While I can understand May's attempt to appeal to the working classes from the point of view of political strategy, because Conservatives through the 1980s were very effective in finding ways to entice the working classes to vote them, what I find more difficult to understand is the way the new Prime Minister employs the idea of society, and beyond this social inequality. Let me explain why?
When Margaret Thatcher dissolved the idea of society in the 1980s – insisting that there is no such thing as society, but only families and individuals – what she achieved was the individualization of society. The idea here was that the individual would no longer be held back by social forces or historical forms of social identification and could make their own way in the world. On the basis of her appeal to the working classes, through policies such as 'Right to Buy' (where social housing tenants could buy their property at a reduced price), Thatcher and the Conservatives of the 1980s supported inequality of wealth on the basis of a vision of democratic equality of opportunity. So, everybody could make it. Regardless of whether or not this was true, and most sociologists would probably dispute that this was ever the case because of the history of class, patriarchy, and ethnic society, I think that British society from Thatcher through Blair up to Cameron was sustained by this idea. For example, consider the expansion of Higher Education. What was this about if not equality of opportunity and life chances? While there is no sense that the British people from the late 1970s onwards believed or believe in equality of wealth (either absolute or also, I would suggest, relative), it is possible to argue that they remain committed to the value of equality of opportunity or what we call meritocracy.
Of course, what happened through the Cameron years is that it became more and more difficult to believe in the myth of the individual which essentially says that you make your own future in society on the basis of your ability, attitude to work and so on. Social forces have impacted upon people's lives in such a way that makes it more or less impossible to sustain the Thatcherite fantasy that there is no such thing as society. It is clear that events taking place outside of an individual's immediate environment impact upon their situation. Alongside this, it seems equally clear that these events do not impact upon everybody equally, so some seem to benefit from particular events, while others suffer. In recent years, and particularly since the global economic crash, it is apparent that inequality has increased and that the rich have become richer and the poor have become poorer. Despite what Cameron and Osborne told people, there is a sense in which 'we were not all in it together'.
In recent social and economic history, then, we can say that the advantage of the advantaged has increased and the disadvantage of the disadvantaged has been reinforced. In other words, social mobility – how one moves through society – and social opportunity – the chance one has to improve one's situation – have taken a hit and what we call social structure has become more rigid. Against the social theorist, Zygmunt Bauman, who wrote of the liquid society in the late 1990s, we might say that we now live in a society that is far more structured and tightly defined than at any time since the 1980s when the credit based consumer society really took off. Enter May's stunning recognition of social inequality, which sounds like it might have come straight out of the mouth of a Labour leader, and proclamations about the Conservative Party being the party of the people. Strategically and cynically there is no doubt that it makes sense for May to take this turn, simply because she can no longer easily deny the reality of vast social inequalities in Britain, but on the other hand I was shocked that a Conservative Prime Minister would not seek to uphold the tradition of liberal individualism, insist upon the importance of hard work and self-responsibility, and essentially explain social inequality in terms of the individual problems of the lazy, the scroungers, and those who apparently want something for nothing. From a Conservative point of view, when you're in trouble there's only one way out - pull your socks up and get on your bike.
After listening to May's speech, which was no doubt written with one eye on taking the ground of Corbyn and stealing the thunder of his socialism for the 21st century, I think we have now entered a bizarre, surreal, world where the new political consensus in British politics appears to be somewhere to the left of the centre. Here, the kinds of social conditions sociologists write about critically, and usually attack politicians for their failure to recognise and address, are now mainstream truths. Of course, we would expect this of Corbyn, who has lived on the fringes of the Labour Party for many years, but it is hard to understand how a Conservative Prime Minister can speak of social inequalities. But is this real? Does May know what she's talking about when she talks about social inequalities?
Since she's on the ground of the sociologist here, I think this is good place to point out what she's actually saying, which is not simply that there are some rich people and some poor people and that we think the gap between the rich and poor people might be a little too big, but rather that the wealth, privilege, and position of the rich people has come about because of the poverty, lack of opportunity, and abandonment of the poor and the disadvantaged. Or alternatively, the reason things are the way they are for the majority, who are struggling to make ends meet, is because we have an over-blown, exorbitant, super rich class who have everything and refuse to pay their way to support the less fortunate. This is what social inequality really means. It means that wealth, poverty, advantage, and disadvantage are not simply individual attributes, but rather that they are social effects produced in interactions between people. While I would hazard a guess that this is nothing new to Corbyn, and the socialists of the 21st century, I would take a risk on the claim that May and the Conservative government would not understand social inequality in this way or really want to follow through on the implications of this understanding. Why?
The answer to this question is very simple. When we understand individuals in terms of social relations, and recognise that their fates are co-dependent, improvement in the condition of one person or one group of people cannot be achieved without modification of the position of others who they are bound to by virtue of their common social situation. In other words, if we want to address poverty, reduce disadvantage, and increase opportunity, we have to address the privilege of the few, the rich, the advantaged, and those who David Graeber called the 1%. In other words, tackling social inequality must come down to redistribution in some form or other.
Although I would like to believe that Theresa May will turn out to be the first socialist Conservative Prime Minister, I doubt this will be case and would imagine that she has instead appropriated the idea of social inequality in a post-Thatcherite sense where the individual is the alpha and omega of life. Coming at inequalities between rich and poor from this point of view is politically less explosive, and certainly less surrealistic for a Conservative leader, because what it effectively says is that it is a problem that some have so much and others have very little and that we should try to do something about this. What this view does not do though – and this is the key point – is invoke the sociological truth that some have everything because others have nothing and vice versa. This is the essential power relation that is immediately intelligible to sociologists, but that no Conservative Prime Minister or politician could easily recognise on pain of abandonment of the recent history of Conservative political ideology.
By contrast, what I think May actually means is that some have a lot, others have very little, this is bad, particularly for those who have very little, and that we must try to find ways to increase the wealth and advantage of everybody. In other words, we must become a richer, better off, society across the board. Who could argue with that idea? Nobody. Unfortunately, the problem with this vision is that it relies on a fantasy of limitless growth – a fantasy of an ever-expanding pie similar to something one might read about in a Roald Dahl story – that it was possible to believe back in the 19th century and the industrial age, but that it has become impossible to take seriously since the 1970s when we first became aware of the ecological limits of global economic growth. Moreover, it was this recognition of the limits of economy based in the finitude of the planet – there is only so much you can take from the earth, which is finite – that in many respects led to what we might call the neoliberal financial revolution and consequently the history of the Thatcher period, through Blair, to Cameron up to the present. What did Thatcher do if not dismantle British industry, unleash the City, and make finance the engine of the British economy?
The advantage of this financial turn in a period haunted by the spectre of low growth was, of course, that we could paradoxically have growth without growth based in finance (credit that would eventually become the dead weight of debt) and that equality of opportunity, some sense of equality of wealth, and most centrally some degree of equality of ability to consume could bought on the basis of finance. But what happened under Brown was that the system of global financialisation collapsed, because credit / debt was so far out of sync with productivity in the real economy, and Cameron was left to pick up the pieces. The result was the turn to austerity, the rolling back of the social state which was considered unaffordable in the wake of the bank bail outs, and the widening of the gap between rich and poor on the basis that conventional economic wisdom suggested that it would be a grave mistake to tax the rich to pay for the upkeep of the poor because it is the rich who are the motor of the economy. As a result, the poor, the disadvantaged, become a burden, and the Coalition was very effective in demonising the weakest members of society.
It is this situation that produced the Brexit 'protest' vote in June, where the have nots of British society sought to blame their situation on the European super state without recognising that the Conservative government they had elected a matter of months before was equally committed to punishing the poor for the failure of the global financial system, and eventually propelled May into power. While the architects of Brexit - Johnson, Gove, and Farage - vanished from the scene when it became clear that they had engineered a radical break with the neoliberal consensus without a real plan for what would happen next, the problem for May became how to move on. What comes next? While she seems keen to evade making everything about Brexit, the impact of the June vote is, in a sense, impossible to escape. What people voted for when they voted out of Europe is a different kind of Britain, where the divisions between distant elites and everybody else is less stark, and I think that it is this situation that May wants to respond to through her talk about reducing social inequality and so on.
However, I cannot believe that the Conservatives will actually be able to deliver on her talk, because this would effectively make her the first socialist Conservative leader, unless the plan is to return to the Blair years where easy credit was the order of the day. But while this will allow May to address the situation of the poor in the present, it will do nothing to tackle real social inequality, which remains a relation based in the power of those who have everything over those who really have nothing: simply increasing the debt burden of the poor in order to project their situation into the future is no real solution to the problem of inequality. The only other alternative I can foresee is that the power relation between the haves and have nots – and in this respect the matrix of social inequality – will become about insiders and outsiders, where this is understood in ethnic terms. Under these conditions, the problem of tackling social inequality will not become about the division between rich and poor, which would require thinking about routes to redistribution, but rather a politics of race where the white British majority attack others who have apparently condemned them to live precarious lives characterised by poverty, debt, and an inability to imagine a better future. This is, of course, a complete mis-understanding of the situation – inequality is first and foremost a problem of capitalism and only ever an ethnic problem for those who cannot see, or absolutely do not want to see, the naked truth of class division.


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I continue to be amazed at how many people with or without mental or physical challenges make their way through busy airports in large cities. This kind of spatial problem solving for finding one's way is known as wayfinding. Even the cues to steer one's way can be confusing. On occasions when I have asked for directions, I found myself thinking of better ways the information could have been conveyed. Signs, maps, and other graphic or audible methods can be very helpful if they are done to meet needs appropriately.
Wayfinding signs can help people identify objects and find locations. They can be particularly helpful in warning them about dangerous situations and where to locate safety. There are many aids available to assist people with Alzheimer's. In this video, a person with Alzheimer's explains how signs help him operate more independently in locating his clothes to dress himself.


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I LOVE this stamp set, you can expect to see plenty more with it from me!
It's been a beautiful sunny day here today, we took the kids to the beach this morning and they dug holes to their hearts content. They've spent the afternoon outside swinging, jumping and playing pole tennis. I could get used to this, bring on Summer!!
Stamps: Apple Blossoms Level 2 Hostess set,On your Birthday.
Ink: Pear Pizazz, Blushing Bride, Chocolate Chip.
Cardstock: Crumb Cake, Very Vanilla, Blushing Bride, Pear Pizazz.
Big Shot: Vintage wallpaer embossing folder, Butterflies Embossilt Die.
Accessories: Certanly celery ribbon, Pearls, Sponge.
Stampin' Up! Demonstrator, teaching classes, creating greeting cards and designing event stationary to suit your needs.
Sunday, October 3, 2010
Apple blossoms and butterflies
Posted by Kate, Dave and the kiddlets at 4:01 PM
6 comments:
- Paula said...
SOOOOOO Pretty!! Love pinks and greens together. Those butterflies are so cute too! Lovely card Kate.
- October 3, 2010 at 4:33 PM
- Julia said...
this is sooooooo yummy!! love it! It was great crafting with you the other day!
- October 3, 2010 at 7:34 PM
- Karen Rogers said...
ohh that is seriously stunning - love your bow too
- October 3, 2010 at 9:58 PM
- Sharon Field / Created By You said...
Love how you used this stamp set, great idea! The butterflies and the colors are fabulous!
Hugs from across the ocean,
- October 3, 2010 at 11:19 PM
- Eileen said...
Love your card it is stunning. Would love you to join in our challenges
at http://letscreatechallenges.blogspot.com/
and anyone else you know that might want to.
- October 4, 2010 at 8:38 AM
You've used a lovely colour combo beautifully.
- October 10, 2010 at 2:43 PM
Subscribe to: Post Comments (Atom)


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Hello to anyone out there who might still be checking in here at Erdmania. I apologize for not writing anything of late, but I've been trying to figure out what to write about. I don't want this to turn into a journal of my day-to-day activities, not only because it would be boring but also because that would leave me very little to talk to people about on the phone or in person. Now that I'm not on the ship, with limited phone and email capabilities, it seems silly to keep you updated on my every move.
That being said, I miss posting things, so I'm going to take a stab at doing something at least. We'll see what happens.
First of all, to sum up the past week and a half since I've been home, it's been great to be back. I've loved getting to see friends and acquaintances again; I don't think I had appreciated all the great people and things to do in Chicago as much as I do now. I also started on mainstage last Wednesday. I was extremely nervous, more so than any time I'd understudied a show in the past, but it's been going well I think. The cast couldn't be nicer or more supportive. I'm really looking forward to working with them all and creating a show with them.
So what else have I been doing? Adjusting, I guess. It's been a little weird having all my stuff and my relatively huge apartment at my disposal once again. I don't seem to remember what I used to do with my free time at home, so I've spent days organizing photos from the cruise, sending a lot of emails, and finding errands to run. People have asked me if I miss the ship, and I do. I think it worked perfectly, that I got to leave at a time when I would still miss it, and that I got to come home to a wonderful new opportunity.
The day I got home, Rich noticed a bird's nest outside one of our living room windows (we're on the 3rd floor). There were 3 little blue eggs in it, and eventually a bird came and sat on them. A few days later, there was a 4th egg, and now we're checking in every few hours to see if the eggs have hatched. I did a little research (see "what else have I been doing," above), and found out that it's a robin (which we figured from the blue eggs, but I just had no idea what a robin actually looked like), and that the eggs take about 12 days to hatch. I've been home for about 10, so it could be any time now. I also read that robins like to eat grapes, cherries, and tomoatoes. We had some tomatoes which I wanted to set out on the window sill, but I was afraid the mother would chirp out some sort of call and my arm would get attacked by a swarm of robins.
And speaking of eggs hatching, my step-brother Brent and his wife Kim are the proud parents of Jorja Marie, born on Monday, May 23rd, which of course is Victoria Day in Canada. That poor kid's going to get a lot of joint Victoria Day/birthday gifts as she grows up.


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Ethernet LAN connected Data Collector
New RTR-500NW, an Ethernet LAN connected Data Collector for Wireless Data Loggers, acts as a Wireless Base Unit for any of TandD's RTR-500 Series Data Loggers as Remote Units. The RTR-500NW automatically downloads recorded data from the Remote Units via a 900MHz wireless link and transmits the data via e-mail or to an FTP server, without a PC, making it possible to share and manage data over a network.
In addition to automatically collecting and transmitting recorded data, the RTR-500NW can also send warning reports via e-mail or issue a warning via contact output when a Remote Unit has entered or recovered from a warning condition.
The RTR-500NW is fully compatible with TandD's free "WebStorage Service", which allows for storage of downloaded data, viewing of current monitoring readings, and monitoring of the battery status of the Remote Unit(s), all via a simple Web Browser from anywhere, anytime.
- automatically downloads recorded data
- transmits the data via e-mail or to an FTP server
- can also send warning reports via e-mail


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A range of luxury wood floors that evoke an impression of real age alongside more modern textured finishes which add an additional dimension. The aged, distressed and textured wood floors range is a real favourite amongst our clientele.
Luxury Wooden Flooring
Our aged distressed and textured engineered wood floors are all hand crafted by us and add another dimension to any finished floor.
We are masters in replicating genuine age on our new engineered planks. The major benefit of this over actual reclaimed wood is that we can provide a far more consistent product, have no problems with continuity of supply and all of our ranges are perfectly at one with under floor heating.
We find that these products work equally well in very old period properties and also in more contemporary installations. The juxtaposition of very old directly against very modern materials like glass and metal can be extremely effective.
To see our full range of quality wood floors please click here


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But automated patient workflow will still save the day.
By now, most practices realize that a patient portal will do little to streamline practice-patient workflow and communication.
The Government Accountability Office interviewed patients who tried to access their own medical information online. Their chief complaint: Wasted time. (Link below)
Let's take a moment and recap why this is – and why adding more features won't change this reality.
Regardless of specialty, all practices have a mix of patients – ranging from frequent fliers to "see you in a year" to single incident drive-through. Further, of the patients with regular needs, only some are interested in interacting through a portal.
It's all about mindshare – and routine
Think of yourself – after all, you are a patient too. Patients are inundated with portals from all the entities they interact with – utilities, banks, social media, shopping and medical – medical encompassing all the different doctors patients might see.
Each portal requires a registration process (and sometimes a manual process in the case of medical portals). Even if the patient gets past that, the hard part – ongoing usage – still has to happen. For patients, a single doctors' office represents a very small part of their daily mindshare, and unless they have reason to interact on a frequent basis, going through a portal will become an obstacle more than a solution. Since most portals were designed by software vendors to universally meet Meaningful Use requirements, they are rigid and tedious rather than intuitive and helpful.
The easy solution – instead of, or in addition to a portal
Given the challenges to successful adoption of portals by patients, it is essential to offer patient engagement that will be successful without requiring a patient to use a portal. If a patient wants to pay their bill, or request an appointment, the workflow must be effortless! Requiring a tedious login procedure is the first, most-likely place, for a patient to abandon their payment attempt.
The key is to offer a solution for everyone: a portal for those highly-engaged patients in your practice. And something easier for everyone else – an option that does not require a registration process. This mechanism is called Secure Forms Workflow.
Workflow for all patients, at every interaction point
PCG Secure Forms can be linked to your website. But even better, they can be links embedded within your pre- and post-visit patient communications (texting and email). Here are some things they facilitate:
- Pre-Registration
- Full New Patient Registration
- Confirming Address and Contact info
- Insurance Coverage Updates
- Uploads of insurance cards and IDs
- E-Signed releases
- Completing History information
- Satisfaction surveys
- Confirming/Updates to Medication lists
- Secure Test Results Delivery
- Registering secure payment methods
- Statement Delivery
- Paying balances with just a few clicks
Ask the minimum number of questions
Paper forms are one size fits all; there is no ability for paper to understand relevance or context. Secure Forms, on the other hand, can be "intelligent" and highly customizable. Each form will request exactly what is needed from the individual patient, and nothing more. Validation rules, drop-down lists, required fields and branching based on responses can all be included. Different forms can be created for different situations. As an example, if an invalid eligibility response was received, a form could prompt: "Your insurance states that you are not currently covered – please upload a current copy of your insurance card."
Best of all, these forms are extremely simple for patients to use, since each form is focused on just the relevant need for that patient, right now.
No Usernames or PINs
Secure Forms are just that – secure. They are able to use validation info that the patient knows (including birthdate), so no passwords or PINs need to be remembered. And the forms are logged and locked, giving them legal validity for e-signature purposes.
Unlike most portals, you can get started with Secure Forms quickly, and start seeing the benefits right away!
- Patients do not use portals, and portals do little to streamline practice work-flow. Portals generally throw up barriers to the very transactions they are supposed to support.
- Secure Forms provide easy workflow accessibility and high usage rates for the majority of patients
- A patient-focused practice needs multiple options, to streamline the workflow for all patients.
PCG Secure Forms are part of the PCG Total Patient Relationship Management Suite – the system that removes the barriers to smooth and successful practice/patient interaction.
If you would like to learn more about Secure Forms Workflow or our complete patient engagement product suite, Patient Communication Gateway (PCG) please visit us.
Read what the GAO found out when they asked patients about using a patient portal (from FierceHealthcare.com).


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NEA should pony up for Buckles film
One might suppose a documentary film about the last American veteran of World War I would arouse enormous interest from those in government with the financial power to support such a project. Apparently not.
As The Associated Press reported this week, producer David DeJonge still needs about $35,000 to complete his 90-minute documentary, "Pershing's Last Patriot." It is about West Virginian Frank Buckles, the last living veteran of World War I who died about three years ago at age 110.
DeJonge told the AP he already has spent about $200,000, much of it his own money, on the film. He needs more cash to interview a Yale University expert, purchase high-resolution archival footage, finish final editing and enter the documentary in film festivals.
DeJonge's plan sounds tailor-made for the National Endowment for the Arts, which hands out hundreds of grants each year. One example is a $40,000 award recommended for Allied Media Projects of Detroit, "to support a multimedia performance installation by hip-hop artist Invincible."
Surely a film such as DeJonge's has at least equal value.
Assuming DeJonge's plan meets NEA guidelines, someone from the agency should offer him a grant to finish and distribute his documentary about a truly great American.


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Picking through the pieces of the Turner Contemporary wreckage, it is hard to pin down when it all started to go wrong.
Last week, after nearly six years of design development, Kent County Council (KCC) 'nally decided to pull the plug on Snøhetta and Spence's ambitious proposals for a new art gallery off Margate pier.
Although there was no shortage of critics lining up to knock the sea-based scheme, the timing of the decision, blamed on ballooning costs, still came as a surprise.
It certainly shocked the project's architects, Stephen Spence and Snøhetta's Kjetil Thorsen, who remain unconvinced by the council's 'gures and rationale.
Less then four months ago, KCC had agreed to underwrite the cost of the project which, at the time, was estimated at around £29.5 million.
Then, the news broke that the council had decided to ditch the designs because the budget had spiralled up to £50 million and it needed to ensure 'the effective use of taxpayers' money'.
However, Thorsen has hit back: 'We are very surprised by the cost escalation of the building and cannot equate this with the reality of the situation.' The Norwegian is pointing his finger at the procurement process and the council's inability to find a commercially competitive construction company. He feels the project deserves one last chance.
He adds: '[We] can only regret that KCC has rejected our proposal to repackage and retender the project for the optimisation of cost.' Spence, on the other hand, believes the issue about recent cost increases is a clever smokescreen for local political manoeuvres. The architect says he has not worked on the designs since September 2004, and that KCC's decision was made before he even had time to look at the 'nal drawings from Nuttalls - the designand-build contractor.
What does seem unusual is that Hythe-based practice CTM was asked to draw up a new masterplan for the area - including resiting the centre on land - two weeks before the official decision to drop the existing designs was made.
Meanwhile, the £6.5 million of public cash which had already been spent on the proposed centre will now sink without a trace.
Throughout the whole process - from the moment Snøhetta and Spence won the original architectural competition by ignoring the brief for a land-based structure - the question has always been whether the scheme could be constructed in the unforgiving English Channel.
Maybe if more people had actually asked whether Turner Contemporary should be built in the sea, then perhaps the huge 'asco; the wasted time; and the millions of pounds worth of unnecessary costs could have been avoided.
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Brett Halliday wrote a series of popuar mystery novels back in the 1950s and 60s featuring detective Mike Shayne. Shayne is a tough, sexy redhead, and his books are full of naked women and murder. Of course there were a few films. Of course there was a television series. Of course hardly anyone remembers him now. Halliday was a pseudonym, and when he got good and sick of writing Shayne novels, he retired and the publisher got a few other people to carry on the franchise. Guilty as Hell is post-retirement.
I was in the mood for a little mystery, cheap and easy. That's exactly what this is. I know that I often go for the enduring and timeless, but the only reason this one has survived fifty years is that they used to print on higher-quality paper. But I enjoyed it, and I'm planning to look for more.
Mike Shayne is a private eye, the classic hard-boiled detective. The only thing that distinguishes him from any of the others is that after a gang beats him up, he has to wear a cast on his broken arm. The orthopedist implants brass knuckles and a scalpel blade in the cast so that Shayne can keep fighting. It seems like overkill, as ridiculous as anything out of Army of Darkness or that movie with the cyborg with the glowing blue cock that had to be started with a pullcord like a lawnmower or a chainsaw. People who feel guilty find him intimidating. Some women find him attractive, but he resists the naked teenager and finds her some clothes.
Candida Morse is the real antagonist, even though she's not the killer. Her official job is secretary to the president of a corporate recruiting agency, but she has all the brains and does all the work. Many of the executives funnel secrets back to her, so she's really running a city-wide ring of corporate spies. Candida knows that in Miami in the 1960s, women don't have a lot of power, directly. But if a girl is beautiful and intelligent, she can make a man do whatever she likes, so her indirect power is only limited by her ambition. She also knows that if a woman isn't that intelligent or ambitious, she can still be useful. Candida also employs a number of girls who get secrets by sleeping with the right men. I suppose this makes them sex workers, but they're not the streetwalking type. These ladies are by appointment only.
So, someone gets killed in a 'hunting accident' and the typical hard-boiled tropes ensue. Candida keeps trying to trap Shayne one way or another, but he slips out of all the traps and finds the real killer. He takes a page out of the hippies' book – he saw them having lock-ins, trust-building through forced physical proximity, kind of like churches have now only with lots of marijuana and sex. He forces all the suspects to stay in and talk, nobody sleeping, all night until the right someone confesses.
Well, well, Mr Bill of Rights in person, the guy who thinks queers and floozies are covered by the United States Constitution.
Wait, what? This minor character unexpectedly drags the book into contemporary issues. There's a vice cop with a rather small part, mainly because Shayne is so good at dodging him. Like many Americans, he believes that people who are suspected of crimes lose their rights. This is why we have the Bill of Rights – to protect citizens from a legal system that jumps to conclusions and is quick to be cruel and unusual.
Ever since I saw you tonight, I've been thinking about some of those uncalled-for remarks of yours about frame-ups. Somebody's a hooker, or a flagrant fag. Everybody knows it. They're guilty as hell, and we can't bring them in unless we catch them in the act.
It really bothers him that sex workers and homosexuals exist in the world without being in jail. I understand that it's his job, and the work we do shapes our thinking, but really. What harm are these people doing to society? You don't have to be gay or paid to pass along STDs, and the fact that they are available doesn't force innocent straight men away from their wives or girlfriends. I've never understood why homosexual activity was a crime punishable by law – how is it anyone else's business? I first considered the sex worker industry when I was in college, and I stand by the decisions I made then: the women are victims of an economic and education system that leaves them with few options for independent living, and social problems often leave women with little education, no income, and no safety at home. Don't imprison the women; imprison the men who objectify them and limit their access to the resources they need to be independent and successful.
It was the vice-squad detective named Vince Camilli. He was tieless, but he wore a jacket over his gun, which he used far too often. He had a handsome dark face, a loose mouth. He was the department's top scorer in both homosexual and prostitution arrests, and Shayne was sure that the total included many entrapment cases using fabricated evidence, as well as shakedowns that had failed to pay off.
Don't be like Camilli, whose job is to convince people to have sex with him and then arrest them for it. He also tries to extort money in exchange for their freedom. He's a bad guy, and he kind of symbolizes the hatred of average citizens for the people who are marginalized by the social systems the average citizen benefits from.
Just to be clear, there are no out-and-proud homosexuals in this book. They're only brought up to show how rotten Camilli is.
Another minor point is the carphone. Were this book not actually written in 1967, I would have screamed about anachronistic technology. However, people were putting telephones in automobiles in the 1940s, so the fact that a private detective has one in the 60s actually makes sense. You don't see them anymore because they can't be tracked by the 911 service. In the United States, 911 is the number for emergency services. They need to be able to position phones so that if there is an accident and the person calling can't speak or doesn't know where they are, they can still get help. If you dial 911 and set the phone on the floor and don't speak into it, the police will come directly to your home and assess the emergency, whether it's an intruder or a health crisis. They can globally position cell phones, but not carphones. Because they can't find where you are, you don't get to have one.
So. Sexism. Racism. Homophobia. Murder. Drugs. Statutory rape. It might seem that the only logical response to this type of a world is to burn it all down. I don't really fault Candida for her crimes; they seem the only reasonable way for a woman to get ahead. Things are different now, and I'm glad for that. Not necessarily better, but different. This was an entertaining little read, full of things that offend me now but were fairly normal at the time. Halliday's writing isn't especially beautiful, but it's clear and communicates the story well, which is what's required in this genre.


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A Place of My Own
For many people living with developmental disabilities, indepedence means living successfully in the community. Favarh offers two independent, community-based residential opportuniteis: Group Home living opportunities and Supported Independent Apartment living.
Favarh's eight group homes are fully staffed, 24 hours a day, providing support to people with a high level of need. Staff supervise activities of daily living and engage residents in social, recreational and community-based activities.
For people who can live more independently, Favarh leases multiple units in two affordable apartment complexes in the Farmington Valley. We support participants living in this setting with regular independent life skill support and training.
People who are not quite ready for independent living can participate in our In-Home Supports program, in which they receive independent skills training from Favarh staff in the comfort of their own home as well as in the community.


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TBILISI, Georgia (Feb. 22, 2015) – Last night's dramatic and entertaining M-1 Challenge 55: In Memory of Guram Gugenishvilli featured just about everything except a knockout. Past M-1 Challenge heavyweight Denis Smoldarev (10-1-0), of Estonia, positioned himself for another title shot, defeating highly-regarded Croatian opponent Maro Perak (23-5-1) in the main event at the Sports Palace in Tbilisi, Georgia.
Coming off a loss last November to M-1 Challenge heavyweight champion Marcin Tybura at M-1 Challenge 53 in Beijing, China, Smoldarev bounced back with an impressive performance over Perak, who lost via an opening round submission by key-lock.
In another heavyweight match, former M-1 Challenge heavyweight champion Kenny "Deuce" Garner (15-8-0), fighting out of Port St. Lucie, Florida, also rebounded from a TKO loss in his last fight to Sergei Kharitonov in China, winning by second-round submission with arear-naked choke of Aslambek "Titan" Musaev (5-2-0), of Chechnya.
Rising middleweight star Nodar Kudukhashvili (8-1-0), a 2013 WMMAA champion, pleased his hometown fans with a three-round unanimous decision over American invader Luigi "The Italian Tank" Fioravanti (25-13-0).
In a battle between two of the top featherweight prospects in the world, German Max Coga (11-3-0) gave previously undefeated Pavel Vitruk (12-1-0) his first loss as a professional in a great fight. Coga locked-in a rear naked choke for a third-round submission victory over the talented Ukrainian.
Hometown favorite Artiom Damkousky (20-9-0) won his 20th career fight in a hard fought match with a three-round unanimous decision previously unbeaten Azerbaijan lightweight Heydar Mamedaliyev (7-1-0).
In another main card fight, Georgian giant Levan "Zangrief" Razmadze (5-1-0) suffered this first loss, by way of a first-round arm-bar submission to Russian heavyweight Arsen Abdulkerimov (8-2-0).
In preliminary fights, Spanish middleweight Enoc Solves Torres (16-8-0) defeated Russian foe Ibragim Tibilos (7-3-0) by third-round submission, using a rear-naked choke hold; Russian light heavyweight Batraz Agnaev (2-0-0) needed only a few minutes to lock-in a rear-naked choke to force his Polish opponent, Lukasz Borowski (3-3-0, into a first-round submission; Russian middleweight Artem Frolov (3-0-0) used a first-round rear-naked choke to submit Artur Oddilobekov (2-4-0), of Tajikistan; and local lightweight Raul Tutarauli (3-1-0), of Georgia, opened the show with a third-round submission (rear naked choke) of Russian Artur Aliev (1-1-1). In swing bouts held after the main event, featherweights Kurbanali Abdusalamov (4-2-0), of Russia, and Georgian pro-debuting Soso Nizharadze (1-0-0) won unanimous three-round decision over, respectively, Archil Tasziashvili (0-2-0), of Georgia, and Russian Shamil libekov (1-1-0).
Complete results and picture gallery below:
Denis Smoldarev (10-1-0), Estonia WSUB1 (Key-lock) Maro Perak (23-5-1), Croatia
Kenny Garner (15-8-0), USA WSUB2 (Rear Naked Choke – 2:50) Aslambek Musaev (5-2-0), Chechnya
Arsen Abdulkerimov (8-2-0), Russia WSUB1 (Armbar – 3:58) Levan Razmadze (5-1-0), Georgia
Nodar Kudukhashvili (8-1-0), Georgia WDEC3 Luigi Fioravanti (25-13-0), United States
Artiom Damkovsky (20-9-0), Belarus WDEC3 Heydar Mamedaliyev (7-1-0), Azerbaijan
Max Coga (11-3-0), Germany WSUB3 (Rear Naked Choke – 2:36) Pavel Vitruk (12-0-0), Ukraine
Batraz Agnaev (2-0-0), Russia WSUB1 (Rear Naked Choke – 2:09) Lukasz Borowski (3-3-0), Poland
Enoc Solves Torres (16-8-0), Spain WSUB3 (Rear Naked Choke – 1:35) Ibragim Tibilos (7-3-0), Russia
Artem Frolov (3-0-0), Russia WSUB 1 (Rear Naked Choke – 2:09) Artur Oddilobekov (2-4-0), Tajikistan
Raul Tutarauli (3-1-0), Georgia WSUB3 (Rear Naked Choke – 1:45) Artur Aliev (1-1-0), Russia
Soso Nizharadze (1-0-0), Georgia WDEC3 Shamil Alibekov (1-1-0), Russia
Kurbanali Abdusalamov (4-2-0), Russia WDEC3 Archil Taziashvili (0-2-0), Georgia


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Where Is My VIN?
Honda Parts Unlimited
701 W. Bell Rd
Phoenix, Arizona 85023
Phone: 1 (866) 493-1265
Phoenix, Arizona 85023
Phone: 1 (866) 493-1265
Store Hours
- Monday: 7:00 am - 5:00 pm
- Tuesday: 7:00 am - 5:00 pm
- Wednesday: 7:00 am - 5:00 pm
- Thursday: 7:00 am - 5:00 pm
- Friday: 7:00 am - 5:00 pm
- Saturday: Closed
- Sunday: Closed
Your Vehicle Identification Number (VIN) is located on numerous areas of your vehicle including the underside of each body panel. It is typically a 17 digit number, and is a mixture of numbers and letters. This number helps us identify specific information about your vehicle so we can verify that the parts you order fit your car. As seen below the VIN is most commonly found on the dashboard facing the front of the ve3hcile, which can be seen from the outside of the vehicle. It is also located on the firewall, and inside the dorr jam for easy reference.
Other important numbers associated with parts on your vehicle are the transmission number, as well as the engine number, or engine code. They are avialble in the above lcoations typically.


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set database: LEGO 1285 yellow tiger
image courtesy of peeronset number: 1285
set name: yellow tiger
theme: town, kabaya promotional, race
year: 2000
pieces: 22
price: us$na
minifig: 1
nice town set.
kabaya promotional set.
come with a yellow speedboat.
minifig included a rider minifig.
great playability.
overall design is great.


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Boo! Skout Scares Up Halloween Contest Winners/
Happy week-after-Halloween! Have you recovered from Halloween antics yet? Skout Buzz lit up this past week with Skouters' photos of themselves in their Halloween costumes. We saw it all: superheroes and villains, ghouls and fairies, exquisite Dia de los Muertos makeup, and, of course, sexy kitties.
Skouters who tagged #Monsters on photos of themselves with friends were entered into Skout's Halloween costume contest. Our very own FrankenSkouter chose the following winners to receive 500 Skout Points!
Congratulations to the winners, and please keep an eye out for future Skout contests!


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Ben Lovett denies that the band are feeling any pressure as they record the follow-up to 'Sigh No More'
Mumford & Sons have spoken about their much-anticipated second album and revealed that they're currently "finishing it up".
Speaking to NME in a video which you can see by scrolling up to the top of the page and clicking, multi-instrumentalist Ben Lovett said that the band were in the latter stages of getting the record together.
Asked how the album was progressing, he said: "We're just finishing up the album now, as anyone who's kept up to date on what we're doing will be fully aware of. Not much to report, it's the same stage as we were a year ago because there's still no record. But we're aware of what it is now and we're excited about getting it out there."
Then asked if the quartet were feeling the weight of expectation, Lovett replied: "There's no pressure. We're just a band from London. The fact that the first record did well was great, but it didn't make our lives. It's just a by-product of what we do, which is record music and play gigs."
The folk band's new album is due for release on September 24 and is set to feature tracks named 'Below My Feet', 'Whispers In The Dark', 'Ghosts That We Knew' and 'Lover's Eyes', which have all been debuted live.
To read a new interview with Mumford & Sons in which they open up about the follow-up to 'Sigh No More', pick up the new issue of NME, which is on newsstands now or available digitally.


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It's interesting how much we have in common with our dogs and other animals. The brilliant neuroscientist, Robert Sapolsky did a behavior experiment with monkeys. He was looking at the pleasure centers of the brain and specifically the neurochemical dopamine. He explained how monkeys and humans commonly generate the highest levels of dopamine when pleasure is anticipated, not when pleasure is actually experienced.
To determine that, he had monkeys pushing levers. After a certain number of pushes a light would come on and then the next push would generate a food reward. He measured the dopamine output in the monkey's brain and discovered that it went up the highest when the light flashed. This was in anticipation of the pleasure of the reinforcement.
Here's where it gets really interesting. When the monkeys got the reward only 50% of the time the dopamine levels went through the roof. Evidently, the word, "maybe" is very addictive. The uncertainty of the reward makes the dopamine increase.
For those of you who are science-y, here's a short and very captivating video of Dr. Sapolsky on this topic:
This is why humans play slot machines. What happens when you put money into a slot machine and it doesn't pay out? You put more in. In fact, the longer you sit there, without winning, the more sure you are that the jackpot is coming. The slot machine strings you along with almost, but not quite, break even payouts and you keep playing because you're sure it's going to pay off. This is called variable reinforcement and it can make behaviors stronger in dogs too. By using variable reinforcement, the dog trainer becomes the slot machine. You can create a little gambling addict – a dog that keeps playing the game because he believes that the reward will come if he plays long enough. The dog will work harder for less reinforcement.
It sounds pretty good, right? Maybe. As Karen Pryor states, "Once a simple behavior has been learned, a long and unpredictable schedule can in fact maintain behavior that you DON'T want, with incredible power." (If you're interested in reading more about reinforcement schedules, click here. She is an author and educator specializing in behavioral psychology.) When your dog pulls you on walks and you move forward allowing him to do pull, you are reinforcing (strengthening) the behavior. If you decide to teach your dog not to pull and you stop moving when he pulls forward (or you go the other way) you will teach him to walk politely, right? Not so fast. To change the behavior, you will need to be very consistent, because if you allow him to pull occasionally, you are now using a variable reinforcement schedule and he will learn to pull you like a freight train. Oops!
As humans we often naturally train with variability. When our dogs respond to a cue slowly and reluctantly we tend to be disappointed and the dog is not reinforced well or at all. However, when our dog responds with enthusiasm and exhibits brilliance at the task, we become very excited, use high praise and give out many treats in a row (called a jackpot). In this way, our dogs learn what generates the greatest and most valued reinforcement.
The best way to build new behaviors is to reward your dog every time he does the behavior correctly. This is a continuous reinforcement schedule. Don't be stingy and don't be in a hurry to move to a variable schedule. Every time the behavior is performed you click and then treat. Reinforcement strengthens behavior. Your dog gets rewarded and he wants to do it again. Build the behavior in low distraction environment, and then build in more and more challenges.
We use a clicker to train new behaviors because it's extremely precise and dogs can learn 40% faster! Every time the behavior occurs you click and then follow with a treat. The click predicts the treat. The dog performs with better understanding. I believe the click might even create an anticipatory dopamine surge like when the light flashed for the monkeys.
Here is a short video demonstrating clicker training a dog to a new skill, in this case my Aussie mix Runi. The skill is interacting with the Staples Easy Button. We train mostly in silence, allowing her to process the information received by the click and treat, but sometimes when a dog does something really well it's hard not to also enthusiastically praise, a reinforcer that you'll see in a video later in this post that Runi really responds to.
You start teaching the dog in easy steps so he can be successful and has a desire to continue. When he gets good at that easy step you will raise the criteria to improve the behavior and make it a little harder. Now the reinforcement schedule is a little less predictable. The requirements are a little different and your dog will not be reinforced every time. Again, quoting Karen Pryor, "Reinforcement may go from predictable to a little unpredictable back to predictable, as you climb, step by step, toward your ultimate goal."
For the dog who is a new learner, this unpredictability can cause him to give up. That's why it's important to allow your dog to learn at his level and not make things too difficult too quickly. You can lower your criterion (go back a step in learning and make it easier), ask for something he knows how to do well, or wait and try again at a later time or day. Build up his confidence slowly to create a dog that loves to learn and learns quickly.
I often hear from frustrated owners how their dog does this or that behavior perfectly at home but acts like it's new in the classroom setting. For your dog, it just might be! Dogs don't generalize well so if all of their learning takes place in the kitchen at home, doing it at Lucky Dog might look completely new.
Every task we teach our dogs will have several different levels of complexity from very simple, to very difficult. One of the most common mistakes made by dog owners is to try and climb those levels too quickly.
The 3 Ds of dog training are known as Duration, Distraction, and Distance. They come into play in every context and all training exercises. Many people wonder how super-effective dog trainers get such amazing results. The truth is they follow a set of rules that you can follow just as easily. And one of them is the golden rule of 3 Ds. The golden rule of three Ds is to only increase ONE of the three Ds at any one time.
Remember that dogs need a lot of help to understand that a cue such as come or sit, given in one situation has the same meaning in another. As soon as you change the factors influencing the task, factors we call the 3 Ds, you affect your dog's chances of success. (Look for an upcoming article on how to adjust the 3 Ds effectively.)
The other factor to consider is the type of reinforcement you are using. Here's some homework for you. First, identify your dog's primary reinforcers, those things your dog wants and will work hard to attain. It could be a favorite toy, a specific kind of food (identify each one your dog likes and rank them), playing tug or fetch, social interaction such as petting and praise, or something he wants to do in the environment such as lizard hunting or foraging in the grass.
Second, rank from low to high, your list of reinforcers. Which ones have the highest value to your dog? Match the reward to the behavior being trained and the situation. For example, in a highly distracting environment and you know that your dog's focus will be different and more difficult to maintain, use a very high value reward. Sit down now and make a list, then number them from most favorite to least favorite. This will be helpful to know when you are training for different behaviors.
Here's a video of my dog, Runi, retrieving the newspaper. I always reinforce this behavior, every time she does it. Sometimes she gets a food treat and sometimes she gets praise and petting. Not all dogs value praise/petting. Runi values it highly. But I always reinforce the behavior and she does it joyfully. Check out this video.
One of my other dogs, Decker, does not really care for either praise or petting. Here he is doing a behavior that he knows and he is receiving a mid to lower level food reward, banana. His favorite reinforcement is something that is activity-related such as chasing a ball or playing tug. If we were working in a very distracting environment or I was asking for a difficult behavior I would choose one of those, or a high-value food reinforcer such as chicken.
So, according to Dr. Sapolsky, how do humans and monkeys (and dogs) differ? It's the lag time that makes the difference. How much lag time can there be between the work and the reward to still elicit the behavior? An extremely long lag time is uniquely human. Humans can maintain high anticipation levels for literally decades waiting for their reward. However, for your dog, keep 'em coming!


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Summary of Federal Laws
Miscellaneous Laws Affecting Students
Compliance Partners
|Dean of Students, AVP for Student Life
Related Policies
The Campus Sexual Assault Victim Bill of Rights (amends the Campus Security Act of 1990)
20 U.S.C. § 1092(f)(8); 34 C.F.R. § 668.46(b)(11)
The sexual assault provisions of the Campus Security Act require each institution of higher education to distribute as part of the Campus Security Report, a statement regarding the campus sexual assault prevention programs, the procedures following sex offenses, education programs aimed at preventing sex offenses, possible sanctions imposed for sex offenses, procedures for on-campus disciplinary action in cases of alleged sexual assault, notification of on- and off-campus counseling, mental health or other student services for victims of sex offenses, and notification to students that the institution will change a victim's academic and living situations after an alleged sex offense and the options for those changes. If a victim of campus crime alleges a sexual assault, both the accuser and the accused must be informed of the outcome of any campus disciplinary proceeding. The notification requirement in the regulations covers all allegations of "sex offenses." Compliance with this section does not violate the Family Educational Rights and Privacy Act (FERPA).
updated 12-30-17 mlo


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BOSTON HIE AND THE 'ERA OF EPIC'I have to say that, given that my particular REC project turf was almost exclusively small doc shop outpatient EPs, I've never gotten to kick the Epic tires or even watch it in action. It may be a perfectly fine, usable, featiure-rich project with great vendor support behind it for all I know.
In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic. Boston Medical Center is replacing Eclipsys (Allscripts) with Epic. Lahey Clinic is replacing Meditech/Allscripts with Epic. Cambridge Health Alliance and Atrius already run Epic. Rumors abound that others are in Eastern Massachusetts are considering Epic. Why has Epic gained such momentum over the past few years?
Watching the implementations around me, here are a few observations:
1. Epic sells software, but more importantly it has perfected a methodology to gain clinician buy in to adopt a single configuration of a single product. Although there are a few clinician CIOs, most IT senior management teams have difficulty motivating clinicians to standardize work. Epic's project methodology establishes the governance, the processes, and the staffing to accomplish what many administrations cannot do on their own.
2. Epic eases the burden of demand management. Every day, clinicians ask me for innovations because they know our self-built, cloud hosted, mobile friendly core clinical systems are limited only by our imagination. Further, they know that we integrate department specific niche applications very well, so best of breed or best of suite is still a possibility. Demand for automation is infinite but supply is always limited. My governance committees balance requests with scope, time, and resources. It takes a great deal of effort and political capital. With Epic, demand is more easily managed by noting that desired features and functions depend on Epic's release schedule. It's not under IT control.
3. It's a safe bet for Meaningful Use Stage 2. Epic has a strong track record of providing products and the change management required to help hospital and professionals achieve meaningful use. There's no meaningful use certification or meaningful use related product functionality risk.
4. No one got fired by buying Epic. At the moment, buying Epic is the popular thing to do. Just as the axiom of purchasing agents made IBM a safe selection, the brand awareness of Epic has made it a safe choice for hospital senior management. It does rely on 1990's era client server technology delivered via terminal services that require significant staffing to support, but purchasers overlook this fact because Epic is seen in some markets as a competitive advantage to attract and retain doctors.
5. Most significantly, the industry pendulum has swung from best of breed/deep clinical functionality to the need for integration. Certainly Epic has many features and overall is a good product. It has few competitors, although Meditech and Cerner may provide a lower total cost of ownership which can be a deciding factor for some customers. There are niche products that provide superior features for a department or specific workflow. However, many hospital senior managers see that Accountable Care/global capitated risk depends upon maintaining continuous wellness not treating episodic illness, so a fully integrated record for all aspects of a patient care at all sites seems desirable. In my experience, hospitals are now willing to give up functionality so that they can achieve the integration they believe is needed for care management and population health...
Critics are not difficult to unearth, though. Foremost among the high-profile target is the Epic CEO herself, an Uber-geek straight out of Central Casting, but all the more notable for her gender.
An Interview With The Most Powerful Woman In Health CareRead on...
Zina Moukheiber, Forbes Contributor
Judy Faulkner might not be a household name yet, but in the health care industry, she's simply known as Judy. She is the founder and chief executive officer of Epic Systems, a privately-held $1.5 billion (2012 revenue) company that sells electronic health records—a position that makes her one of the few self-made women on the Forbes billionaires list. Her customers are top medical centers, such as Cleveland Clinic, Geisinger Health System, and Johns Hopkins. She wields enormous influence. Almost half of the U.S. population will have its medical information stored in Epic digital records when hospitals finish installing them.
Faulkner, rarely, if ever, grants interviews. A year ago when I profiled her, she refused to speak. Because Epic shuns publicity and press releases, it is perceived as aloof; and criticism leveled at Epic regarding its business strategy is rarely challenged by the company. In a phone interview from Epic's seat in Verona, Wisconsin, Faulkner acknowledged that.
Forbes: A year ago, you declined to be interviewed, what made you decide to talk now?
Faulkner: I'm recognizing that when we were small, we could stay under the radar, but now it's harder. I get so many requests for interviews. If I talk to everyone, we can't do our job with our customers and work on our software. It would be hard to stay focused.
I was an undergrad math major, and a grad student in computer science. I'm hugely introverted, not atypical of math majors. It's not something I love [being in the public eye]; it's a personality thing. I like to go around, and people not knowing who I am. I like to keep some privacy, be a normal person.
Forbes: With success comes visibility, plus you're a woman who's a computer scientist, who coded the original software for Epic. It makes for a good story.
Faulkner: If you line up the CEOs of major [electronic health record] companies, the CHEESI group–I came up with that to remember them all: Cerner CERN -1.97%, HBOC (now McKesson MCK +5.29%), Eclipsys (now Allscripts), Epic, Siemens , IDX (now part of General Electric GE -0.16%), what's the primary difference? It's funny, visually I'm the one woman, but I'm the only one with a technical background. That's the main difference.
Forbes: Many things are said about Epic by competitors, but also by customers. One of them is that Epic is a closed system: it's difficult to exchange patient information with other electronic health records; it's hard for third-party vendors to integrate with Epic, and the technology is old. Is this totally wrong?
The hits just keep on coming.
Judy Faulkner: Criticism that Epic system stymies interoperability 'unfair'
May 17, 2013 | By Dan Bowman
Responding to criticisms that Epic's electronic health record systems are closed and, thus, difficult to integrate with third-party vendors, CEO Judy Faulkner, in a rare interview granted to Forbes, called such accusations "totally wrong."
In fact, Faulkner referred to Epic as "the most open system I know," saying it's designed as a database management system.
"Database management systems need to allow their users to mold it to what they need," Faulkner told Forbes. "We interface with speech recognition, imaging, medical devices, lab, patient education content, user authentication and hundreds of different vendor systems."
Faulkner said claims that the company does not value interoperability are "unfair," adding that Epic systems were interoperable before government regulation came into play.Faulkner referred to Epic as "the most open system I know," saying it's designed as a database management system. "Database management systems need to allow their users to mold it to what they need."
She also took a jab at the recently formed CommonWell Health Alliance in the Forbes interview.
Faulkner raised concerns about CommonWell at a Health IT Policy Committee meeting last month, saying that not initially being invited to be part of the alliance caused her to have doubts about its motives.
"What is it?" Faulkner, a policy committee member, asked rhetorically at the meeting. "Is it a competitive business? Is it a service? Will it be favoring those who started it and using those who did not start it as the means to feed the business? What components of business will be in it? Will it sell the data? Will there be patents?"...
OK, so, does this mean you'll share your RDBMS database dictionary with everyone?
Didn't think so.
Interesting Forbes article comment here in the wake of "Who Says Chief Information Officers Can't Lose By Choosing Epic?"
John Stokes: I think you are only beginning to scratch the surface of the difficulties providers and institutions face with regards to making a rational, informed decision about EHRs, and about the true, long-term total cost of ownership.Whatever one thinks of this commenter's views, they comprise a refreshing, considered respite from the endless onslaught of bumper sticker quality anti-Health IT naysayers.
For any new EHR installation there is at least some form of "double hit": The product cost and the lost productivity cost.
In contrast to the comment above that "there are literally thousands of other causes of decreased revenue immediately following ANY [EHR] implementation", Epic stands out as the only EHR for which there is now a track record of failing hospitals immediately following their EHR implementation. A mere coincidence? No. It is because Epic's execution and business strategy imposes and requires new, permanent, and massive increase in the fixed cost of operations of the organizations that they partner with. These are simply not sustainable. What are two of these "hits"?
The Epic product cost: The software and licensing is only a small part of this. The major costs come is in the massive time and funds spent on training, support, configuration, updates, and salaries of a large number of new full-time staff that the institution has to hire permanently (50 new FTE for a small hospital; 150+ new FTE for a large academic institution). At 100k with benefits, that is 5 to 15 million a year in new fixed operational costs.
The Epic productivity cost: No other EHR other than Epic requires 18 to 24 hours of full-time training for highly educated physicians to become 'basic' end users. This is a huge loss of time (two to four days) that physicians are not compensated, nor taking care of patients. As the prior commenter stated "Any responsible EMR vendor will suggest a lighter schedule in the first few weeks of a new system to allow staff to get acclimated". To be precise, Epic recommends a 50% reduction in clinical workload during this "acclimation", and then recommends a 25% reduction for at least several more weeks. Epic states that providers should be back to their baseline productivity after six months to one year. However, the reality is that after a year of using Epic, most physicians never recover their full level of efficiency, and are experiencing at least a 10% productivity hit. What are the financial costs of this?
A typical physician will see 40 to 50 patients a day, or 5-6 per hour in clinic. That leaves about ten minutes per patient for an entire encounter, including history, examination, prescription writing, and counseling the patient (including the new Meaningful Use required data entry requirements, etc.). So even as little as one or two minutes more per patient adds up quickly – lengthening the workday by one to two hours. With a loss of productivity of only one hour per day (above) at $100 per visit, that represents six patients, or $600 /day. At that rate the physician is losing $10k/month. Multiply that by the number of physicians working in your practice group or community hospital and you get millions in losses each month.
This loss of physician time may also be measured as an opportunity cost of seeing an additional five to ten patients per day. With all of the strains on the healthcare system, a shortage of primary care doctors (made acutely worse by an influx of 38 million newly 'insured' patients entering the system under the ACA) – can we really afford to waste the most valuable and essential asset of the entire healthcare system: physicians' time?
Note that most of the 5800 hospitals in the US are not large, well endowed academic medical centers with both alumni and government giving billions to prop them up. Epic's market is only those hospitals with at least 100 million to spend, which is some 200+ hospitals in the US. The remaining 5500 hospitals? They run on a razor thin margin of 1-2%, and where a few million here or there is enough to put them deep into the red. Epic is very selective in picking clients only that fit their one and only criteria: deep pockets.
It would be convenient to dismiss Epic's role in the financial demise of a growing list of hospitals in the United States. Unfortunately, these are not coincidences. This is a real and consistent pattern, and correlates the physicians comments and surveys on usability. [Ignore the trade association surveys sponsored by the vendors under HIMSS and KLAS - these are meaningless technical specifications and laundry lists of features].
The arguments that Epic provides for failure is that is was ultimately the end-users fault. Yes, those stubborn, unteachable doctors who went through 24 years of formal education – through college, graduate, and postgraduate study and training – who happily use their smartphone, tablet, and laptop to do manage virtually every aspect of their life on the web. But we can't get those doctors to learn how to use a 1992 vintage thick client with nested dropdown menus seven layers deep. Will Epic lead the way and take usability seriously? Or it will it continue to be a risk to the financial health of the institutions it is supposedly helping?
We live in dangerous times in HIT. In a few years, when the $27 billion subsidy program for EHRs dries up and the mad gold rush for EHR implementation is over – it will expose many more hospitals that over-extended themselves with their choice of Epic. I must concur with Ryan Champlin. That is a dangerous choice.
John Stokes: After reading my followup post here comparing the cost of two statewide hospital networks (Maine with Epic at $366 million; West Viginia with VistA at $8 million) there must be some fundamental reason that CIOs are willing to spend thirty times more for a product than another product.
Is Epic actually "better" than any other EHR? What do the end users have to say about Epic?
This survey on usability is directly from physicians (not via a vendor-sponsored surveys such as KLAS or HIMSS that emphasize vendor attributes such as ease of implementation, or length of feature lists).
These are ordered from lowest to highest rating.
EHR Overall Usability Rating (number of raters)
Siemens Soarian 2.73 (15)
Cerner 2.93
GE Centricity Enterprise 2.96 (57)
McKesson 3.1 (88)
Allscripts 3.06 (3)
Meditech 3.08
Partners Healthcare 3.34 (25)
EpicCare 3.51 (148)
Greenway 3.83 (69)
VistA: 4.06 (124)
This survey shows that usability of EHRs has gotten *worse* since Meaningful Use regulations came into effect in 2010. One factor may be that EHR vendors have focused their development efforts to satisfy these requirements rather than the requirements of their end users.
Note also that survey results of VistA were mostly from the VA, where they are using a non-Meaningful Use certified EHR. It appears that while commercial EHRs devote their energy to winning the buzzword compliance awards from KLAS, VistA remains steadfast on its commitment to its physicians.
Now, to your question. VistA is the #1 ranked EHR and more cost effective by a factor of twentyfold.
I can only guess that the reason CIO's choose any system over VistA:
(1) lack of information: the VA does not have a marketing department
and get and and publicize its system.
(2) lack of vision: an institution does not see the value in open-source, in taking ownership of their own intellectual property and information infrastructure, in building internal capacity to support this, and in supportin their own user-driven innovation. They would rather outsource this to a proprietary vendor.
(3) lack of name brand recognition: The CIO does not want to get blamed for a failure, so chooses a big name company. (This is obviously untrue: how can you say the VA and its 1400 clinics and hospitals running VistA is not a large enterprise)
(4) lack of clinical and technical expertise: The CIO does not have the combined technical and clinical knowledge to appropriately assess EHRs, and therefore has to depend on superficial demos, marketing materials, word of mouth, or responses to RFI (which are simply marketing brochures, sans slick pictures).
Again, these are only guesses, but based on many observations.
Epic's "Usability" assessment in the America EHR survey.
Interesting. a 4.01 high for "Document a progress note for each encounter."
You have to register an account with American EHR (free) to get at the full report for all surveyed systems.
Why Epic's market dominance could stifle EHR and health IT innovation
Brandon Glenn
Epic has attracted several notable critics, who warn that its market dominance could have harmful effects on the future of health information technology, EHRs and even patient care. Worse, these critics warn, Epic has achieved much of its market dominance on the backs of taxpayers.
Epic is the nearly undisputed king of the electronic health records world.
About 40% of the U.S. population has its medical information stored in an Epic electronic health record (EHR), and the company often sits atop research firm KLAS' rankings of best-available EHR systems.
Epic has plenty of big-name clients who've spent tons of money installing its expensive systems: $700 million from Duke University Health System; $700 million from Boston's Partners Healthcare; $150 million from the University of California, San Francisco; and $80 million from Dartmouth-Hitchcock Medical Center in New Hampshire, Forbes reported last year.
So it's not surprising that such a high-profile company has attracted several notable critics, who warn that its market dominance could have harmful effects on the future of health information technology, EHRs and even patient care. Worse, these critics warn, Epic has achieved much of its market dominance on the backs of taxpayers - courtesy of $35 billion in federal subsidies paid to hospitals and doctors to purchase EHR systems...
Aside from the taxpayer subsidies Epic has indirectly received, what really rankles the company's critics is Epic's lack of interoperability with other EHR systems, meaning that's it's a "closed" system that doesn't share patient data particularly well with doctors or hospitals who don't use Epic's software.
"If Epic (already based on an antiquated technology -- MUMPS) decides to maintain an essentially closed system, and to drive all innovation internally, this could prove stultifying, limiting the development of novel ideas, and forcing the many high-profile adopters of Epic to accept stagnation or pay the staggering costs of switching," wrote physician-scientist David Shaywitz in Forbes.
In other words, the "closed" nature of Epic's systems - coupled with its dominant market position - could mean that Epic ends up setting the defacto standards for EHR systems, effectively stifling innovations that its competitors might develop in the EHR market. That, in turn, could lead to Epic's big hospital customers - and those hospitals' patients - being frozen out from advances in EHR technology. ..
Then there's the question of to what extent American taxpayers are helping to subsidize Epic's market grab, courtesy of EHR incentive payments outlined in the Obama administration's 2009 stimulus bill. It's not a coincidence that the privately held company's sales have been skyrocketing in recent years, up to $1.2 billion in 2011, double what they were four years prior, according to Forbes.
It's also no coincidence that Epic and other major EHR players lobbied the federal government hard for the subsidies, and those companies "have reaped enormous awards because of the legislation they pushed for," The New York Times reported earlier this year.
Executives at smaller EHR companies say the legislation cemented the established companies' leading positions in the field, making it difficult for others to break into the business and innovate, according to The Times...
|??? Ya think? I don't think Judy does.
Helping enrich Faulkner is ... a piece of government legislation [Meaningful Use] that subsidizes the adoption of electronic medical records, by paying millions to qualifying hospitals... Faulkner is also the only head of a company to sit on a government-appointed policy committee that makes recommendations on standards for the exchange of patient information.__
- Epic Systems Tough Billionaire
Google "Epic EHR." Here are the first, above-the-fold responses I got.
Gotta love it. Paying for positioning. I bet Judy Faulkner could care less about all these ankle biters.
Below, gotta love this stuff as well (rolls eyes).
New on SBM
[T]he new CAM buzzword these days to explain why quackery "works" is epigenetics. Basically, whenever a proponent of alternative medicine uses the word "epigenetics" or "quantum" to explain why an alternative medicine treatment "works," what he really means is, "It's magic." This is a near-universal truth, and even the most superficial probing of such justifications will virtually always reveal magical thinking combined with an utter ignorance of the science of quantum mechanics or epigenetics.___
More to come...


text: hi guys i am currently working as an engineer and would want to take up a full culinary course and would shift into cooking as a profession. i am currently 24 years old and is planning to enroll myself in a diploma course for culinary arts good for 2 years, next year. i know ive heard a lot of aspiring cooks being in this situation, of being too "old" to start a culinary career. by the time i would graduate i would already be 27 years old and i would just like to ask if that would still be a good age to start a new career? you might ask as to why i suddenly would want to shift into a different field. well, back when i graduated high school i was asked what course i would like to take up in college, and i said to my parents culinary arts but then my parents being of the "older generation" decided to lead me down a "normal" path of a bachelors degree and told me that i could pursue cooking after i finish college. and so i did, finished college graduated as an industrial engineer and currently working in an american corporation. and so still wanting to pursue my passion in cooking i have saved up enough money to enroll myself in the best institution in our place (cebu,philippines)and would eventually decide to give up my current job. back to the question, is 27 too old to start a culinary career? honestly.... read on AB's book about forgetting it when your 32 years old. thanks, jed


text:
The Foot Drills
By Russ Ebbets, DC
<We did the six drills at the start of each practice. Five of the six drills are done barefooted or in stocking feet. The distance covered for each drill is about 25 meters. Each drill is done once daily. The walking is done at one's own pace. Total time for the drill with shoes off to shoes on is about four minutes. Pretty simple.
The six drills, illustrated above, are simply to walk on the outside of the foot (invert the foot), walk on the inside of the foot (evert the foot), walk with a toe-in, or pigeon-toed gain (adduct the foot), walk with the toes pointing out (a la Charlie Chaplin), and with the shoes back on, walk on the heels – this protects against bruising the heel. Done daily these six drills will eliminate shin splints, Achilles' tendonitis, plantar fasciitis, lessen the chance of a severe ankle sprain and virtually all knee problems. (The famous Rice Study done in the early 90s found that 79% of running injuries are from the knee down).
One of the reasons I had successful teams is that my athletes made it to the competition day healthy and ready to compete. Season after season was completed with virtually no injuries. It should be noted that there are three problems with the foot drills; they are simple, they are easy, and they are free. It doesn't involve more than taking off one's shoes and putting one foot in front of the other. But that is easier said than done. Why do the foot drills work? There is very little muscle in the foot.
- Most of the balance and proprioceptive sense we get comes from our muscles.
- The neuromuscular pathway (the communication line) from the brain to the foot is the longest and slowest in the body. This leads to bad, or at best, poor coordination of the foot. If you doubt that, put a pen between your toes and try to write your name.


text:
- Why Nursing
- About Nursing
- How to Become a Nurse
- Apply to Nursing School
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Find Nursing Schools > Resources > Download Career Guides > TEAS Prep Guide (PDF Download)
TEAS Prep Guide - Free PDF Download
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text:
My last post was about the Core Four. By using the Core Four, one can teach anyone practically anything! But what about critical thinking, you may ask?
This summer at the National conference, Coach B shared the Whole Brain Teaching Key. The key is composed of 3 essential elements: The Core Four, Critical Thinking, and The Super Improver's Wall.
Two easy tools for Critical Thinking are: the Because Clapper and Problem Solver.
When a student gives an answer, we want to challenge him/her to give evidence for the answer by using the word because (and giving a big clap). For example: "Julio was brave because he went into the dark forest alone in search of the lost princess." "I will do well on this test because I studied my notes."
The other tool for Critical Thinking is the Problem Solver.
Our gesture for Problem Solver is pretending to hold a key in your hand, and twisting your hand as if your are unlocking a chest or a door. You can use Problem Solver in academic content, as well as for social skills. For example: "What would be another good ending for this story? Problem Solver..." "Both of you want to swing at the same time. How can we work this out? Problem Solver..." "The computers aren't working today. We cannot take our test online. Problem Solver..."
The third component of the key is the Super Improvers Wall (SIW). We have a whole presentation on the Super Improvers Wall, presentation 503, on our website at wholebrainteaching.com. Check it out!!! It is an individualized motivator for students, where anyone and everyone can succeed! The only thing necessary to advance up the levels on the SIW is to improve!
My friends, unlock a successful, funfilled year with your Whole Brain Teaching Key!