text:
The past few days I officially realized that I am grown. I hung out with some college friends and caught up with old friends and heard real grown up issues happening to a lot of people in my past. Marriage, kids, divorce, health issues, death, life. All that I thought happens to grown ups are officially coming into my world. Even eating healthier has become important to me because of my age and the fact that I becoming curvy. Watching my oldest grow before my eyes with her cell phone and her tween friends on instagram. On top of all that I worked out to Beyonce's new song this morning Grown Woman and I had an Ah Ha moment... I am 34, married for going on 8 years, with 3 kids, with life stories, it is official I am Grown Woman.
1. my new form of sweats Caftan.
2. seeing that Topshop is too expensive.
3. Ndey getting food from Wholefoods.
4. my new H&M swimsuit
5. Hunter always demanding to press the elevator button.
6. me trying the Tracee Ellis Ross, no make up just lipstick..Riri Mac Heaux.
7. Hubby getting water
8. Hanging with Hunter at the pool.
9. At the grove in LA
10. unloading food
11. Sadie and Ndey at the pond.
12. Bathing suit shot again.
13. Cash wishing he was able to fit in the cart.
14. Hand and hand with Hunter at the grove.
15. Wholefoods Lunch.
16. Testing makeup for clients.
17. Kombucha my go two drink


text:
Tuesday, March 23, 2010
green curry chicken
This is last night's dinner of Green Chicken Curry. It's is one of several recipes from the Everyday Food book that I've made before. I stumbled across it last summer when I was going through back issues of EF magazine looking to try something new and different. I've made it several times since. It is such a great recipe! Simple, quick, healthy. I rate this one high on the 'must try' list.
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subset: commoncrawl


text:
Applied Clinical Informatics
Number of Followers: 2
Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1869-0327
This journal is no longer being updated because:
RSS feed has been removed by publisher
- Providing Patients with Implantable Cardiac Device Data through a Personal
Health Record: A...
- Authors: Carly N. Daley (1; 2), Elizabeth M. Chen (1, 3), Amelia E. Roebuck (1), Romisa Rohani Ghahari (1), Areej F. Sami (4), Cayla G. Skaggs (1), Maria D. Carpenter (1), Michael J. Mirro (1, 4), Tammy R. Toscos (1, 2)
Abstract: Background Patients at risk for sudden cardiac death or having suffered cardiac arrest may receive an implantable cardioverter defibrillator (ICD). This device provides monitoring and therapy for life-threatening heart rhythms. Remote monitoring of ICDs has decreased the time between abnormal heart rhythm events and clinic follow-up. Currently, the data transmitted from the device are reviewed and stored by the clinic, but patients do not have access to the data. While connecting patients directly with their ICD data has potential to enhance engagement in their care and improve health outcomes, patient attitudes and perceptions about receiving ICD data have not been explored.Objective This research is the first demonstration of delivering ICD data to patients through a personal health record (PHR) using a novel technical framework. The objective of this study was to use a PHR interface as a technology probe to explore patients' experiences with directly receiving their ICD data from remote monitoring.Methods We enrolled 21 patients with an ICD undergoing remote monitoring at a large outpatient cardiology clinic in Indiana, United States. Participants received their ICD data from remote monitoring through a PHR over 3 months. In-depth, semistruc-tured interviews were conducted at 3 months and analyzed using thematic analysis.Results Participants were 36 to 90 years old, mean age (SD) of 67 (14) years, predominately male (76%), and white (95%). Key themes were ICD questions and concerns, experiences with remote monitoring, PHR use, and feedback about the ICD data summary. The findings showed that overall, patients desired information that provides reassurance, is easy to understand, and is presented in a meaningful way. Conclusion Sharing ICD data from remote monitoring requires adequate context and scaffolding to support patient understanding. Engaging patients with information that is useful and valuable to them through a PHR may require appropriate and individua-lized tailoring of information....
PubDate: 2017-11-22 20:55:59
- Authors: Carly N. Daley (1; 2), Elizabeth M. Chen (1, 3), Amelia E. Roebuck (1), Romisa Rohani Ghahari (1), Areej F. Sami (4), Cayla G. Skaggs (1), Maria D. Carpenter (1), Michael J. Mirro (1, 4), Tammy R. Toscos (1, 2)
- Usability Evaluation of Electronic Health Record System around Clinical
Notes Usage–An Ethnographic...
- Authors: Rubina F. Rizvi (1); Jenna L. Marquard (2), Gretchen M. Hultman (1), Terrence J. Adam (1, 3), Kathleen A. Harder (1, 4), Genevieve B. Melton (1, 5)
Abstract: Background A substantial gap exists between current Electronic Health Record (EHR) usability and potential optimal usability. One of the fundamental reasons for this discrepancy is poor incorporation of a User-Centered Design (UCD) approach during the Graphical User Interface (GUI) development process. Objective To evaluate usability strengths and weaknesses of two widely implemen-ted EHR GUIs for critical clinical notes usage tasks.Methods Twelve Internal Medicine resident physicians interacting with one of the two EHR systems (System-1 at Location-A and System-2 at Location-B) were observed by two usability evaluators employing an ethnographic approach. User comments and observer findings were analyzed for two critical tasks: (1) clinical notes entry and (2) related information-seeking tasks. Data were analyzed from two standpoints: (1) usability references categorized by usability evaluators as positive, negative, or equivocal and (2) usability impact of each feature measured through a 7-point severity rating scale. Findings were also validated by user responses to a post observation questionnaire.Results For clinical notes entry, System-1 surpassed System-2 with more positive (26% vs. 12%) than negative (12% vs. 34%) usability references. Greatest impact features on EHR usability (severity score pertaining to each feature) for clinical notes entry were: autopo-pulation (6), screen options (5.5), communication (5), copy pasting (4.5), error prevention (4.5), edit ability (4), and dictation and transcription (3.5). Both systems performed equally well on information-seeking tasks and features with greatest impacts on EHR usability were navigation for notes (7) and others (e.g., looking for ancillary data; 5.5). Ethnographic observations were supported by follow-up questionnaire responses.Conclusion This study provides usability-specific insights to inform future, improved, EHR interface that is better aligned with UCD approach....
PubDate: 2017-11-22 20:44:48
- Authors: Rubina F. Rizvi (1); Jenna L. Marquard (2), Gretchen M. Hultman (1), Terrence J. Adam (1, 3), Kathleen A. Harder (1, 4), Genevieve B. Melton (1, 5)
- Health Information Exchange for Continuity of Maternal and Neonatal Care
Supporting: A...
- Authors: M.R. Santos (1); T.Q.V. de Sá (1), F.E. da Silva (2), M.R. dos Santos Junior (1), T.A. Maia3 Z.S.N. Reis (1)
Abstract: Background Around the world, people receive care at various institutions; therefore, clinical information is recorded either on paper or distributed on different information systems with reduced capabilities for sharing data. One approach to handling the complex nature of the health information systems and making it interoperable is the two-level modeling, and the ISO 13606 standard is an option to support this model. A regionally governed EHR program in Brazil proposed to use the ISO 13606 standard and archetypes. This program includes an EHR repository for consolidating the longitudinal electronic record of patients´health. Objective This article aims to present the results and lessons learned from a proof-of-concept (POC) for integrating the Maternal and Neonatal Healthcare Information System (SISMater) developed by the Federal University of Minas Gerais (UFMG) with the EHR system developed by the Department of Healthcare for the State of Minas Gerais (SES/MG). Methods The design of the architecture and software development were driven by the content to be exchanged between the SISMater system and the EHR system and the usage of XML transformation to translate an ISO 13606 EHR extract and vice versa. This POC did not include tests related to revision objects according to ISO 13606 reference model. Results The software architecture and software components required for this POC were proposed and tested. The EHR system validated the syntax and semantic and persisted the extract in the EHR repository. Complete results can be accessed at https://github.com/pocppsus/repository. Conclusion The approach for using XML transformations could make easier the process for ISO 13606 noncompliant EMR systems to exchange EHR data with the SES/MG EHR system....
PubDate: 2017-11-15 17:30:42
- Authors: M.R. Santos (1); T.Q.V. de Sá (1), F.E. da Silva (2), M.R. dos Santos Junior (1), T.A. Maia3 Z.S.N. Reis (1)
- Patient Self-Management of Asthma Using Mobile Health Applications: A
Systematic Review of the...
- Authors: Mehrdad Farzandipour (1; 2), Ehsan Nabovati (1, 2), Reihane Sharif (2, 3), Marzieh Heidarzadeh Arani (4), Shima Anvari (2, 3)
Abstract: Objective The aimof this systematic reviewwas to summarize the evidence regarding the effects of mobile health applications (mHealth apps) for self-management outcomes inpatients with asthma and to assess the functionalities of effective interventions.Methods We systematically searched Medline, Scopus, and the Cochrane Central Register of Controlled Trials. We included English-language studies that evaluated the effects of smartphone or tablet computer apps on self-management outcomes in asthmatic patients. The characteristics of these studies, effects of interventions, and features of mHealth apps were extracted.Results A total of 10 studies met all the inclusion criteria. Outcomes that were assessed in the included studies were categorized into three groups (clinical, patientreported, and economic). mHealth apps improved asthma control (five studies) and lung function (two studies) from the clinical outcomes. From the patient-reported outcomes, quality of life (three studies) was statistically significantly improved, while there was no significant impact on self-efficacy scores (two studies). Effects on economic outcomes were equivocal, so that the number of visits (in two studies) and admission and hospitalization-relevant outcomes (in one study) statistically significantly improved; and in four other studies, these outcomes did not improve significantly. mHealth apps features were categorized into seven categories (inform, instruct, record, display, guide, remind/alert, and communicate). Eight of the 10 mHealth apps included more than one functionality. Nearly all interventions had the functionality of recording user-entered data and half of them had the functionality of providing educational information and reminders to patients.Conclusion Multifunctional mHealth apps have good potential in the control of asthma and in improving the quality of life in such patients compared with traditional interventions. Further studies are needed to identify the effectiveness of these interventions on outcomes related to medication adherence and costs....
PubDate: 2017-11-15 17:23:10
- Authors: Mehrdad Farzandipour (1; 2), Ehsan Nabovati (1, 2), Reihane Sharif (2, 3), Marzieh Heidarzadeh Arani (4), Shima Anvari (2, 3)
- Better Usability and Technical Stability Could Lead to Better Work-Related
Well-Being among...
- Authors: Suvi Vainiomäki (1; 2, Anna-Mari Aalto (3, Tinja Lääveri (4, 5, Timo Sinervo (3, Marko Elovainio (3, 6, Pekka Mäntyselkä (7, 8, Hannele Hyppönen (3
Abstract: Background and Objective Finnish physicians have been increasingly dissatisfied with poor usability of the electronic patient record (EPR) systems, which they have identified as an overload factor in their work. Our aim is to specify which factors in EPRs are associated with work-related well-being of physicians. Methods A web-based questionnaire was sent to Finnish physicians younger than 65 years; the responses (n ¼ 3,781) represent one-fourth of these. This was a repetition of a survey in 2010, where this questionnaire was used for the first time. In addition to statements assessing usability, there were questions measuring time pressure and job control. The relation between usability and work well-being was investigated with hierarchical multivariate regression analyses: With time pressure and job control as dependent variables, EPR usability assessments and physicians' back-ground information were used as independent variables.Results In the multivariate analyses, technical problems that are often experienced in the EPR were related to higher time pressure and lower job control. Active participation in the development of the EPR system was related to stronger time pressure and stronger job control. In addition, use of several systems daily and the experience of time-consuming documentation of patient information for statistical purposes (billing, national registries, and reporting) were related to higher time pressure, while those with longer experience with the EPR system and those experiencing easy-to-read nursing records reported higher job control.Conclusion To relieve time pressure and increase sense of job control experienced by physicians, usability, integrations, and stability of the EPR systems should be improved: fewer login procedures, easier readability of nursing records, and decreased need for separate documentation for statistical purposes. Physician participation in the EPR development would increase the feeling of job control, but would add the time pressure. Hence, time for developmental work should be arranged....
PubDate: 2017-11-08 18:49:35
- Authors: Suvi Vainiomäki (1; 2, Anna-Mari Aalto (3, Tinja Lääveri (4, 5, Timo Sinervo (3, Marko Elovainio (3, 6, Pekka Mäntyselkä (7, 8, Hannele Hyppönen (3
- Leveraging the Electronic Health Record to Get Value from Referrals
- Authors: Michael K. Poku (1; Nima A. Behkami (2, David W. Bates (3, 4
PubDate: 2017-11-08 18:38:25
- Authors: Michael K. Poku (1; Nima A. Behkami (2, David W. Bates (3, 4
- Clinical Practice Informs Secure Messaging Benefits and Best Practices
- Authors:
Jolie N. Haun (1; 2), Wendy Hathaway (1), Margeaux Chavez (1), Nicole Antinori (1), Brian Vetter (1), Brian K. Miller (4), Tracey L. Martin (5), Lisa Kendziora (6), Kim M. Nazi (7), Christine Melillo (1)
Abstract: Background Clinical care team members in Department of Veterans' Affairs (VA) facilities nationwide are working to integrate the use of Secure Messaging (SM) into care delivery and identify innovative uses. Identifying best practices for proactive use of SM is a key factor in its successful implementation and sustained use by VA clinical care team members and veterans.Objectives A collaborative project solicited input from VA clinical care teams about their local practices using SM to provide access to proactive patient-centered care for veterans and enhance workflow.Methods This project implemented a single-item cross-sectional qualitative electro-nic survey via internal e-mail to local coordinators in all 23 Veterans Integrated Service Networks (VISNs). Content analysis was used to manage descriptive data responses. Descriptive statistics described sample characteristics.Results VA clinical care team members across 15 of 23 VISNs responded to the questionnaire. Content analysis of 171 responses produced two global domains: (1) benefits of SM and (2) SM best practices. Benefits of SM use emphasize enhanced and efficient communication and increased access to care. Care team members incorporate SM into their daily clinical practices, using it to provide services before, during, and after clinical encounters as a best practice. SM users suggest improvements in veteran care, clinical team workflow, and efficient use of health resources. Clinical team members invested in the successful implementation of SM integrate SM into their daily practices to provide meaningful and useful veteran-centered care and improve workflow....
PubDate: 2017-10-11 12:46:32
- Authors: Jolie N. Haun (1; 2), Wendy Hathaway (1), Margeaux Chavez (1), Nicole Antinori (1), Brian Vetter (1), Brian K. Miller (4), Tracey L. Martin (5), Lisa Kendziora (6), Kim M. Nazi (7), Christine Melillo (1)
- A New EHR Training Curriculum and Assessment for Pediatric Residents
- Authors: Kathryn Stroup (1; 2), Benjamin Sanders (3), Bruce Bernstein (1, 2), Leah Scherzer (1, 2), Lee M. Pachter (4)
Abstract: Background Conventional classroom Electronic Health Record (EHR) training is often insufficient for new EHR users. Studies suggest that enhanced training with a hands-on approach and closely supported clinical use is beneficial.Objectives Our goals were to develop an enhanced EHR learning curriculum for Post Graduate Year 1 (PGY1) residents and measure changes in EHR skill proficiency, efficiency, and self-efficacy.Methods A novel three-phase, multimodal enhanced EHR curriculum was designed for a cohort of PGY1 residents. After basic training, residents began phase 1 of enhanced training, including demonstrations, live practice, and order set review. Phase 2 involved skills-oriented assignments, role playing, and medication entry. Phase 3 included shadowing, scribing histories, and supervised order entry. Residents' EHR skills and attitudes were measured and compared before and after the enhanced curriculum via proficiency test and a survey of efficiency and self-efficacy.Results Nineteen of 26 PGY1 residents participated in the study (73%). There was significant improvement in mean proficiency scores and two of the five individual proficiency scores. There were significant improvements in most efficiency survey responses from pre- to postintervention. For the self-efficacy presurvey, many PGY1s reported to be "very" or "somewhat confident" performing each of the five tasks, and perceptions did not improve or worsened on most postsurvey responses. The greatest resource was the time required to design and deliver the enhanced training.Conclusion An enhanced training curriculum along with a proficiency assessment was developed and described here. An enhanced training curriculum significantly improved PGY1 EHR efficiency and some measures of proficiency but not self-efficacy. This intervention may support improved EHR-related clinic workflows, which ultimately could enable residents and preceptors to prioritize patient care and time for clinical education....
PubDate: 2017-10-11 12:34:04
- Authors: Kathryn Stroup (1; 2), Benjamin Sanders (3), Bruce Bernstein (1, 2), Leah Scherzer (1, 2), Lee M. Pachter (4)
- A Qualitative Exploration of Nurses' Information-Gathering Behaviors
Prior to Decision Support Tool...
- Authors: Alvin D. Jeffery (1; Betsy Kennedy (2; Mary S. Dietrich (2; Lorraine C. Mion (3; Laurie L. Novak (4
Abstract: Background: Large and readily-available clinical datasets combined with improved computational resources have permitted the exploration of many new research and clinical questions. Predictive analytics, especially for adverse events, has surfaced as one promising application of big data, and although statistical results can be highly accurate, little is known about how nurses perceive this new information and how they might act upon it. Objectives: Within the context of recognizing patients at risk for cardiopulmonary arrest, this study explored the possibility of incorporating predictive analytics into clinical workflows by identifying nurses' current information gathering activities and perceptions of probability-related terms. Methods: We used a qualitative description approach for data collection and analysis in order to understand participants' information gathering behaviors and term perceptions in their own words. We conducted one-on-one interviews and a focus group with a total of 10 direct care bedside nurses and 8 charge nurses. Results: Participants collected information from many sources that we categorized as: Patient, Other People, and Technology. The process by which they gathered information was conducted in an inconsistent order and differed by role. Major themes comprised: (a) attempts to find information from additional sources during uncertainty, (b) always being prepared for the worst-case scenario, and (c) the desire to review more detailed predictions. Use of the words probability, risk, and uncertainty were inconsistent. Conclusions: In an effort to successfully incorporate predictive analytics into clinical workflows, we have described nurses' perceived work practices for gathering information related to clinical deterioration and nurses' beliefs related to probability-based information. Findings from our study could guide design and implementation efforts of predictive analytics in the clinical arena....
PubDate: 2017-09-27 12:38:08
- Authors: Alvin D. Jeffery (1; Betsy Kennedy (2; Mary S. Dietrich (2; Lorraine C. Mion (3; Laurie L. Novak (4
- The International Classification of Functioning, Disability and Health
(ICF) in Electronic Health...
- Authors: R. Maritz (1; 2, D. Aronsky (3, B. Prodinger (1, 2
Abstract: Background: The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization's standard for describing health and health-related states. Examples of how the ICF has been used in Electronic Health Records (EHRs) have not been systematically summarized and described yet. Objectives: To provide a systematic review of peer-reviewed literature about the ICF's use in EHRs, including related challenges and benefits. Methods: Peer-reviewed literature, published between January 2001 and July 2015 was retrieved from Medline®, CINAHL®, Scopus®, and ProQuest® Social Sciences using search terms related to ICF and EHR concepts. Publications were categorized according to three groups: Requirement specification, development and implementation. Information extraction was conducted according to a qualitative content analysis method, deductively informed by the evaluation framework for Health Information Systems: Human, Organization and Technology-fit (HOT-fit). Results: Of 325 retrieved articles, 17 publications were included; 4 were categorized as requirement specification, 7 as development, and 6 as implementation publications. Information regarding the HOT-fit evaluation framework was summarized. Main benefits of using the ICF in EHRs were its unique comprehensive perspective on health and its interdisciplinary focus. Main challenges included the fact that the ICF is not structured as a formal terminology as well as the need for a reduced number of ICF codes for more feasible and practical use. Conclusion: Different approaches and technical solutions exist for integrating the ICF in EHRs, such as combining the ICF with other existing standards for EHR or selecting ICF codes with natural language processing. Though the use of the ICF in EHRs is beneficial as this review revealed, the ICF could profit from further improvements such as formalizing the knowledge representation in the ICF to support and enhance interoperability....
PubDate: 2017-09-20 16:10:17
- Authors: R. Maritz (1; 2, D. Aronsky (3, B. Prodinger (1, 2
- Adaptation of Radiology Software to Improve Cardiology Results Reporting
- Authors: G. Webster (1; K. Ward (1, B. J. Deal (1, J. B. Anderson (2, S. Tsao (1
Abstract: Objective: Twenty-four hour ambulatory electrocardiograms ("Holter" monitors) are a key diagnostic test in cardiology. Commercial electronic medical record (EMR) tools have not been designed for pediatric Holter monitor reporting and paper-based methods are inefficient. Methods: Our tertiary pediatric hospital adapted a radiology EMR tool to a cardiology workflow in order to report Holter monitor results. A retrospective review was performed at 4 time points: prior to intervention, immediately post-intervention, at 6 months and at 12 months post-intervention. The primary outcome variable was time to reporting of Holter findings. Results: Holter reports were reviewed on 527 studies (patient ages: 1 day to 42 years). The time between the date the patient returned the Holter monitor until the date the referring physician received a final report improved from 19.8 days to 1.5 days (p<0.001). This result was durable over the next 12 months of follow-up. Physician interpretation time improved from 2.1 days to 0.6 days (p=0.01). Transcriptionist time and result scanning time were eliminated (removing 1.9 days and 14 days from the workflow, respectively). Conclusion: EMR systems are not typically designed for pediatric cardiology, but existing systems can be adapted, yielding important gains for patient care. In specialties like pediatric cardiology, there is insufficient volume nationally to drive development of commercial systems. This study demonstrates the general principle that creative adaptation of EMR systems can improve result reporting in pediatric cardiology and likely in other cardiology practices....
PubDate: 2017-09-20 16:02:46
- Authors: G. Webster (1; K. Ward (1, B. J. Deal (1, J. B. Anderson (2, S. Tsao (1
- Designing An Individualized EHR Learning Plan For Providers
- Authors: L. A. Stevens (1; 2, Y. T. DiAngi (1, J. D. Schremp (1, M. J. Martorana (1, R. E. Miller (1, T. C. Lee (1, 2, N. M. Pageler (1, 2
Abstract: Electronic Health Records (EHRs) have been quickly implemented for meaningful use incentives; however these implementations have been associated with provider dissatisfaction and burnout. There are no previously reported instances of a comprehensive EHR educational program designed to engage providers and assist in improving efficiency and understanding of the EHR. Utilizing adult learning theory as a framework, Stanford Children's Health designed a tailored provider efficiency program with various inputs from: (1) provider specific EHR data; (2) provider survey data; and (3) structured observation sessions. This case report outlines the design of this individualized training program including team structure, resource requirements, and early provider response.
PubDate: 2017-09-06 14:39:11
- Authors: L. A. Stevens (1; 2, Y. T. DiAngi (1, J. D. Schremp (1, M. J. Martorana (1, R. E. Miller (1, T. C. Lee (1, 2, N. M. Pageler (1, 2
- Special Topic Interoperability and EHR: Combining openEHR, SNOMED, IHE,
and Continua as approaches...
- Authors: M. Beštek (1; 2), D. Stanimirović (1)
Abstract: Objectives: The main aims of the paper comprise the characterization and examination of the potential approaches regarding interoperability. This includes openEHR, SNOMED, IHE, and Continua as combined interoperability approaches, possibilities for their incorporation into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general. Methods: The paper represents an in-depth analysis regarding the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research and charting of existing experience in the field, and sources, both electronic and written, which include interoperability concepts and related implementation issues. Results: The paper will try to answer the following inquiries that are complementing each other: 1. Scrutiny of the potential approaches, which could alleviate the pertinent interoperability issues in the Slovenian eHealth context. 2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions. 3. Identification and charting the main success factors in the interoperability field that critically influence development and implementation of eHealth projects in an efficient manner. Conclusions: Provided insights and identified success factors could serve as a constituent of the strategic starting points for continuous integration of interoperability principles into the healthcare domain. Moreover, the general implementation of the identified success factors could facilitate better penetration of ICT into the healthcare environment and enable the eHealth-based transformation of the health system especially in the countries which are still in an early phase of eHealth planning and development and are often confronted with differing interests, requirements, and contending strategies....
PubDate: 2017-08-08 14:36:02
- Authors: M. Beštek (1; 2), D. Stanimirović (1)
- Barriers to Achieving Economies of Scale in Analysis of EHR Data
- Authors: M. P. Sendak (1); S. Balu (1), K. A. Schulman (2, 3)
Abstract: Signed in 2009, the Health Information Technology for Economic and Clinical Health Act infused $28 billion of federal funds to accelerate adoption of electronic health records (EHRs). Yet, EHRs have produced mixed results and have even raised concern that the current technology ecosystem stifles innovation. We describe the development process and report initial outcomes of a chronic kidney disease analytics application that identifies high-risk patients for nephrology referral. The cost to validate and integrate the analytics application into clinical workflow was $217,138. Despite the success of the program, redundant development and validation efforts will require $38.8 million to scale the application across all multihospital systems in the nation. We address the shortcomings of current technology investments and distill insights from the technology industry. To yield a return on technology investments, we propose policy changes that address the underlying issues now being imposed on the system by an ineffective technology business model....
PubDate: 2017-08-08 14:35:45
- Authors: M. P. Sendak (1); S. Balu (1), K. A. Schulman (2, 3)
- Long-term Patterns of Patient Portal Use for Pediatric Patients at an
Academic Medical Center
- Authors: B. Steitz (1; R. M. Cronin (1, 2, 3, S.E. Davis (1, E. Yan (4, G.P. Jackson (1, 3, 5
Abstract: Background: Patient portal adoption has increased over the last two decades. Most research about patient portals has focused on adult populations in the primary care and medical specialty settings. Objective: We describe initial and long-term portal use by pediatric patients and their caregivers in a broadly deployed patient portal at an academic medical center. Methods: We analyzed portal usage for pediatric patients and their caregivers from 2008 to 2014. We recorded usage events with time stamps; user role defined as self, surrogate (i.e., parent or guardian), or delegate; and functions accessed. Usage events were grouped into sessions to calculate descriptive statistics by patient age, user role, and active use over time. Results: From 2008 to 2014, the number of portal accounts increased from 633 to 17,128. 15.9% of pediatric patients had their own account; 93.6%, a surrogate account; and 2.2% a delegate account. During the study period, 15,711 unique users initiated 493,753 sessions and accessed 1,491,237 functions. Most commonly used functions were secure messaging (accessed in 309,204 sessions; 62.6%); test results (174,239; 35.3%) and appointments (104,830; 21.2%). Function usage was greatest for patients ages 0-2 years (136,245 functions accessed; 23.1%) and 15-17 years (109,241;18.5%). Surrogate users conducted 83.2% of logins for adolescent patients. Portal accounts were actively used for < 1 year for 9,551 patients (55.8%), 1-2 years for 2,826 patients (16.5%), 2–3 years for 1,968 patients (11.5%) and over 3 years for 2,783 patients (16.3%). Conclusion: Pediatric patients and caregivers have avidly used messaging, test result, and appointment functions. The majority of access was done by surrogates. Adolescent portal usage increased with age. Most accounts for pediatric patients were only used actively for a few years, with peak usage for patients in early childhood and late adolescence....
PubDate: 2017-08-01 20:24:48
- Authors: B. Steitz (1; R. M. Cronin (1, 2, 3, S.E. Davis (1, E. Yan (4, G.P. Jackson (1, 3, 5
- Comparison of EHR-based diagnosis documentation locations to a gold
standard for risk stratification...
- Authors: S. Martin (1; J. Wagner (1, N. Lupulescu-Mann (2, K. Ramsey (3, A. Cohen (1, P. Graven (2, N. G. Weiskopf (1, D. A. Dorr (1
Abstract: Objective: To measure variation among four different Electronic Health Record (EHR) system documentation locations versus 'gold standard' manual chart review for risk stratification in patients with multiple chronic illnesses. Methods: Adults seen in primary care with EHR evidence of at least one of 13 conditions were included. EHRs were manually reviewed to determine presence of active diagnoses, and risk scores were calculated using three different methodologies and five EHR documentation locations. Claims data were used to assess cost and utilization for the following year. Descriptive and diagnostic statistics were calculated for each EHR location. Criterion validity testing compared the gold standard verified diagnoses versus other EHR locations and risk scores in predicting future cost and utilization. Results: Nine hundred patients had 2,179 probable diagnoses. About 70% of the diagnoses from the EHR were verified by gold standard. For a subset of patients having baseline and prediction year data (n=750), modeling showed that the gold standard was the best predictor of outcomes on average for a subset of patients that had these data. However, combining all data sources together had nearly equivalent performance for prediction as the gold standard. Conclusions: EHR data locations were inaccurate 30% of the time, leading to improvement in overall modeling from a gold standard from chart review for individual diagnoses. However, the impact on identification of the highest risk patients was minor, and combining data from different EHR locations was equivalent to gold standard performance. The reviewer's ability to identify a diagnosis as correct was influenced by a variety of factors, including completeness, temporality, and perceived accuracy of chart data....
PubDate: 2017-08-01 20:00:16
- Authors: S. Martin (1; J. Wagner (1, N. Lupulescu-Mann (2, K. Ramsey (3, A. Cohen (1, P. Graven (2, N. G. Weiskopf (1, D. A. Dorr (1
- Comparison of secure messaging application (WhatsApp) and standard
telephone usage for consultations...
- Authors: U. Gulacti (1); U. Lok (1)
Abstract: Objective: Consultation, the process of an Emergency Physician seeking an opinion from other specialties, occurs frequently in the Emergency Department (ED). The aim of this study was to determine the effect of secure messaging application (WhatsApp) usage for medical consultations on Emergency Department Length of Stay (ED LOS) and consult time. Methods: We conducted a prospective, randomized controlled trial in the ED using allocation concealment over three months. Consultations requested in the ED were allocated into two groups: consultations requested via the secure messaging application and consultations requested by telephone as verbal. Results: A total of 439 consultations requested in the ED were assessed for eligibility and 345 were included in the final analysis: 173 consultations were conducted using secure messaging application and 172 consultations were conducted using standard telephone communications. The median ED LOS was 240 minutes (IQR:230-270, 95% CI:240 to 255.2) for patients in the secure messaging application group and 277 minutes (IQR:270-287.8, 95% CI:277 to 279) for patients in the telephone group. The median total ED LOS was significantly lower among consults conducted using Secure messaging application relative to consults conducted by telephone (median dif: -30, 95%CI:–37to-25, p<0.0001). The median consult time was 158 minutes (IQR:133 to 177.25, 95% CI:150 to 169) for patients in the Secure messaging application group and 170 minutes (IQR:165 to 188.5, 95% CI:170-171) for patients in the Telephone group (median dif: –12, 95%CI:-19 to-7,p<0.0001). Consultations completed without ED arrival was 61.8% in the secure messaging group and 33.1% in the Telephone group (dif: 28.7, 95% CI:48.3 to 66, p<0.001). Conclusions: Use of secure messaging application for consultations in the ED reduces the total ED LOS and consultation time. Consultation with secure messaging application eliminated more than half of in-person ED consultation visits....
PubDate: 2017-07-18 16:18:26
- Authors: U. Gulacti (1); U. Lok (1)
- A Web-based Game for Teaching Facial Expressions to Schizophrenic Patients
- Authors: K. Gülkesen (1); F. Isleyen (1), B. Cinemre (2), M. K. Samur (3), S. Sen Kaya (2), N. Zayim (1)
Abstract: Background: Recognizing facial expressions is an important social skill. In some psychological disorders such as schizophrenia, loss of this skill may complicate the patient's daily life. Prior research has shown that information technology may help to develop facial expression recognition skills through educational software and games. Objectives: To examine if a computer game designed for teaching facial expressions would improve facial expression recognition skills of patients with schizophrenia. Methods: We developed a website composed of eight serious games. Thirty-two patients were given a pre-test composed of 21 facial expression photographs. Eighteen patients were in the study group while 14 were in the control group. Patients in the study group were asked to play the games on the website. After a period of one month, we performed a post-test for all patients. Results: The median score of the correct answers was 17.5 in the control group whereas it was 16.5 in the study group (of 21) in pretest. The median post-test score was 18 in the control group (p=0.052) whereas it was 20 in the study group (p<0.001). Conclusions: Computer games may be used for the purpose of educating people who have difficulty in recognizing facial expressions....
PubDate: 2017-07-11 14:17:03
- Authors: K. Gülkesen (1); F. Isleyen (1), B. Cinemre (2), M. K. Samur (3), S. Sen Kaya (2), N. Zayim (1)
- A Picture is Worth 1,000 Words
- Authors: A. C. Ai (1); F. L. Maloney (2), T. Hickman (1), A. R. Wilcox (3), H. Ramelson (1, 4), A. Wright (1, 4)
Abstract: Objective: To understand how clinicians utilize image uploading tools in a home grown electronic health records (EHR) system. Methods: A content analysis of patient notes containing non-radiological images from the EHR was conducted. Images from 4,000 random notes from July 1, 2009 – June 30, 2010 were reviewed and manually coded. Codes were assigned to four properties of the image: (1) image type, (2) role of image uploader (e.g. MD, NP, PA, RN), (3) practice type (e.g. internal medicine, dermatology, ophthalmology), and (4) image subject. Results: 3,815 images from image-containing notes stored in the EHR were reviewed and manually coded. Of those images, 32.8% were clinical and 66.2% were non-clinical. The most common types of the clinical images were photographs (38.0%), diagrams (19.1%), and scanned documents (14.4%). MDs uploaded 67.9% of clinical images, followed by RNs with 10.2%, and genetic counselors with 6.8%. Dermatology (34.9%), ophthalmology (16.1%), and general surgery (10.8%) uploaded the most clinical images. The content of clinical images referencing body parts varied, with 49.8% of those images focusing on the head and neck region, 15.3% focusing on the thorax, and 13.8% focusing on the lower extremities. Conclusion: The diversity of image types, content, and uploaders within a home grown EHR system reflected the versatility and importance of the image uploading tool. Understanding how users utilize image uploading tools in a clinical setting highlights important considerations for designing better EHR tools and the importance of interoperability between EHR systems and other health technology....
PubDate: 2017-07-11 14:12:34
- Authors: A. C. Ai (1); F. L. Maloney (2), T. Hickman (1), A. R. Wilcox (3), H. Ramelson (1, 4), A. Wright (1, 4)
- Patient portal readiness among postpartum patients in a safety net setting
- Authors: D. Wieland (1); A. Gibeau (1), C. Dewey (1), M. Roshto (1), H. Frankel (2)
Abstract: Background: Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. Objectives: In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption. Methods: We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting. Results: Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments. Conclusions: Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting....
PubDate: 2017-07-05 18:00:16
- Authors: D. Wieland (1); A. Gibeau (1), C. Dewey (1), M. Roshto (1), H. Frankel (2)
- Electronic Health Record Alert-Related Workload as a Predictor of Burnout
in Primary Care Providers
- Authors: M. E. Gregory (1; 2), E. Russo (1, 2), H. Singh (1, 2)
Abstract: Background: Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been understudied. Objectives: To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload. Methods: A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States. Results: Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system. Conclusions: Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples....
PubDate: 2017-07-05 17:59:55
- Authors: M. E. Gregory (1; 2), E. Russo (1, 2), H. Singh (1, 2)
- Domain Modeling and Application Development of an Archetype- and XML-based
- Authors: S. Kropf (1; 2), C. Chalopin (1), D. Lindner (3), K. Denecke (4)
Abstract: Background: Access to patient data within the hospital or between hospitals is still problematic since a variety of information systems is in use applying different vendor specific terminologies and underlying knowledge models. Beyond, the development of electronic health record systems (EHRSs) is time and resource consuming. Thus, there is a substantial need for a development strategy of standardized EHRSs. We are applying a reuse-oriented process model and demonstrate its feasibility and realization on a practical medical use case, which is an EHRS holding all relevant data arising in the context of treatment of tumors of the sella region. In this paper, we describe the development process and our practical experiences. Methods: Requirements towards the development of the EHRS were collected by interviews with a neurosurgeon and patient data analysis. For modelling of patient data, we selected openEHR as standard and exploited the software tools provided by the openEHR foundation. The patient information model forms the core of the development process, which comprises the EHR generation and the implementation of an EHRS architecture. Moreover, a reuse-oriented process model from the business domain was adapted to the development of the EHRS. Results: The reuse-oriented process model is a model for a suitable abstraction of both, modeling and development of an EHR centralized EHRS. The information modeling process resulted in 18 archetypes that were aggregated in a template and built the boilerplate of the model driven development. The EHRs and the EHRS were developed by openEHR and W3C standards, tightly supported by well-established XML techniques. The GUI of the final EHRS integrates and visualizes information from various examinations, medical reports, findings and laboratory test results. Conclusion: We conclude that the development of a standardized overarching EHR and an EHRS is feasible using openEHR and W3C standards, enabling a high degree of semantic interoperability. The standardized representation visualizes data and can in this way support the decision process of clinicians....
PubDate: 2017-06-28 14:22:15
- Authors: S. Kropf (1; 2), C. Chalopin (1), D. Lindner (3), K. Denecke (4)
- Solving Interoperability in Translational Health
- Authors: A. M. Turner (1; J. C. Facelli (2, M. Jaspers (3, T. Wetter (4, D. Pfeifer (5, L. C. Gatewood (6, T. Adam (6, Y.-C. Li (7, M.-C. Lin (7, R. S. Evans (2, A. Beukenhorst (3, H. J. T. van Mens (3, E. Tensen (3, C. Bock (4, L. Fendrich (4, P. Seitz (4, J. Suleder (4, R. Aldelkhyyel (6, K. Bridgeman (6, Z. Hu (6, A. Sattler (6, S. Guo (7, I. Md. Mohaimenul (7, D. Anggraini Ningrum (7, H. Tung (7, J. Bian (2, J. M. Plasek (2, C. Rommel (2, J. Burke (1, H. Sohih (1
Abstract: Background: In the summer of 2016 an international group of biomedical and health informatics faculty and graduate students gathered for the 16th meeting of the International Partnership in Health Informatics Education (IPHIE) masterclass at the University of Utah campus in Salt Lake City, Utah. This international biomedical and health informatics workshop was created to share knowledge and explore issues in biomedical health informatics (BHI). Objective: The goal of this paper is to summarize the discussions of biomedical and health informatics graduate students who were asked to define interoperability, and make critical observations to gather insight on how to improve biomedical education. Methods: Students were assigned to one of four groups and asked to define interoperability and explore potential solutions to current problems of interoperability in health care. Results: We summarize here the student reports on the importance and possible solutions to the "interoperability problem" in biomedical informatics. Reports are provided from each of the four groups of highly qualified graduate students from leading BHI programs in the US, Europe and Asia. Conclusion: International workshops such as IPHIE provide a unique opportunity for graduate student learning and knowledge sharing. BHI faculty are encouraged to incorporate into their curriculum opportunities to exercise and strengthen student critical thinking to prepare our students for solving health informatics problems in the future....
PubDate: 2017-06-21 13:12:05
- Authors: A. M. Turner (1; J. C. Facelli (2, M. Jaspers (3, T. Wetter (4, D. Pfeifer (5, L. C. Gatewood (6, T. Adam (6, Y.-C. Li (7, M.-C. Lin (7, R. S. Evans (2, A. Beukenhorst (3, H. J. T. van Mens (3, E. Tensen (3, C. Bock (4, L. Fendrich (4, P. Seitz (4, J. Suleder (4, R. Aldelkhyyel (6, K. Bridgeman (6, Z. Hu (6, A. Sattler (6, S. Guo (7, I. Md. Mohaimenul (7, D. Anggraini Ningrum (7, H. Tung (7, J. Bian (2, J. M. Plasek (2, C. Rommel (2, J. Burke (1, H. Sohih (1
- Developing Mobile Clinical Decision Support for Nursing Home Staff
Assessment of Urinary Tract...
- Authors: W. Jones (1; C. Drake (1, D. Mack (1, B. Reeder (2, B. Trautner (3, H. Wald (1
Abstract: Background: Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiotic days. Objectives: We used Goal-Directed Design to: 1) Characterize information needs for UTI identification and management in NHs; 2) Develop UTI Decide, a mobile CDSS prototype informed by personas and scenarios of use constructed from Aim 1 findings; 3) Evaluate the UTI Decide prototype with NH staff. Methods: Focus groups were conducted with providers and nurses in NHs in Denver, Colorado (n= 24). Qualitative descriptive analysis was applied to focus group transcripts to identify information needs and themes related to mobile clinical decision support for UTI identification and management. Personas representing typical end users were developed; typical clinical context scenarios were constructed using information needs as goals. Usability testing was performed using cognitive walk-throughs and a think-aloud protocol. Results: Four information needs were identified including guidance regarding resident assessment; communication with providers; care planning; and urine culture interpretation. Design of a web-based application incorporating a published decision support algorithm for evidence-based UTI diagnoses proceeded with a focus on nursing information needs during resident assessment and communication with providers. Certified nursing assistant (CNA) and registered nurse (RN) personas were constructed in 4 context scenarios with associated key path scenarios. After field testing, a high fidelity prototype of UTI Decide was completed and evaluated by potential end users. Design recommendations and content recommendations were elicited. Conclusions: Goal-Directed Design informed the development of a mobile CDSS supporting participant-identified information needs for UTI assessment and communication in NHs. Future work will include iterative deployment and evaluation of UTI Decide in NHs to decrease inappropriate use of antibiotics for suspected UTI....
PubDate: 2017-06-21 13:09:25
- Authors: W. Jones (1; C. Drake (1, D. Mack (1, B. Reeder (2, B. Trautner (3, H. Wald (1
- The Obesity Epidemic and the Potential of Augmented Reality
- Authors: M. K. Poku (1); N. A. Behkami (2), D. W. Bates (3, 4)
PubDate: 2017-06-14 10:55:28
- Authors: M. K. Poku (1); N. A. Behkami (2), D. W. Bates (3, 4)


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We are going to try and keep this blog running with information about our enrichment meetings. We are going to have the Relief Society Birthday Enrichment meeting in February, so keep your eyes open for information on that fun night.
Tuesday, January 6, 2009
Keep you posted
Posted by Erin Edwards at 10:03 PM
0 comments:
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text:
I know, this is mean. I'm not mean though, right?
I have decided I'll just give you my Pampered Chef email, because it seems like it could be mildly entertaining and if you are here you might be bored. Are you bored?
You should be cooking. Too bad you aren't coming to my Pampered Chef party....or are you?
If you live in the Austin area, you should.
It might be fun. Or it might be lame. But there will be alcohol.
I promise to actually write soon.
Dear Pampered Chef Party Acceptor and/or Ignorer,
Congratulations! You have been elevated as one of my most favorite people on the planet by saying you will attend my Pampered Chef party and putting me one step closer to my coveted sharp knives. I just wanted to remind you that it's this Thursday night at 7:30 and it's going to be a JAM. Bring your A game people, because this is serious.
I have bought a bottle of Cristal for each of you and have arranged an appearance by JLo and P-Diddy, the two coolest people I know and regularly hang with late night.
Unfortunately, the last paragraph was a flat out lie.
I'm still excited to see you though!
Congratulations! You were invited by me to an awesome party that could change your life but you seem to be hesitating on your commitment. What are you doing? Why aren't you responding to my Pampered Chef party? Are you having a difficult time deciding whether or not a relaxing evening at my house with free wine, snacks, and tips on how to be a better cook/wife/mother/person of the world sounds good enough to say yes to?
Let me help you.
I know you might be concerned about the fact that my house is located near buffalo, donkeys, and Hutto, but this is really not something you should be worried about. The truth is this is a big opportunity for you. Buffalo are a vital part of a journey through life, ask any Native American and I think they can tell you the truth. No life is full without buffalo.
And donkeys? Donkeys are one of the most important animals for fighting wrinkles. Scientists aren't 100% sure how it works, but studies have shown that having a closer proximity to donkeys can actually erase fine lines. Estee Lauder has been trying to figure out how to include donkey's in their line for years now, but PETA is really a bitch to work through on this. This might sound fictitious, but I'm serious.
(Also, have seriously been around way too many children today, it may or may not be affecting my ability to make sense.)
You might be worried about snack options. There is nothing worse than putting on extra deodorant to go out at night, only to be met with tasteless, lame snacks, like popcorn or sesame sticks. (Not that there's anything inherently wrong with either one of them, I like them both, a lot, but I think we all know I'm classier than that after 5:00 pm.)
Fear not ladies, fear not.
I don't want to spoil any surprises or anything but today I bought cheese...and crackers. I could have just gone chips and salsa, it actually might pair better with the planned meal, but I think too highly of all of you to take the easy route.
I went complicated, I went cheese AND crackers. You might be thinking about cheese cubes or something pedestrian like that. Oh no, not out here by the life-giving buffalo. To give a hint, I did purchase some French cheese that rhymes with FREE, and some Spanish cheese. It's basically going to be an international dairy feast.
I even bought water crackers. You're probably thinking, "Leslie, you probably bought generic water crackers, that hardly counts." Which is true, these aren't Carr's, because I bought organic water crackers. That's how much I love you. I don't want to take any chances of serving any of you any pesticide laden crackers.
And more importantly, I bought almond crackers for all of my gluten challenged friends, because I am just that considerate.
(Lactose intolerant friends, I did not buy you any special cheese because that's too difficult. You can have some grapes. Sorry about your luck, brie is the best thing God ever invented.)
Now, I don't want to get you all excited this many days in advance, but if you are on the fence this might be the fact that tips you in the direction of "Hells YES!!!!"
I have boxed wine.
I know, you are probably trying to think of the last time you were invited to something this high brow. Or, perhaps you are trying to figure out if this was actually a black tie event. Box wine? I mean, I am clearly sparing no expense. It's not Franzia, I wasn't brave enough for that, but it is boxed and it will be spectacular. I promise.
I also have sparkling red blood orange Italian soda....just in case you fear the long, hard journey home after being out here near Hutto.
If none of that twists your arm, perhaps you will be interested in the large quantity of stolen Noonday goods I've lifted while working that I will be selling out of the back of my minivan to anyone purchasing a pizza cutter. I know it sounds cruel to steal from such a consciously good company, but really, what could be more important than a good turn out at a Pampered Chef party?
OK, that's a lie. There isn't any Noonday loot.
I once found a Hello Kitty lip gloss in Stella's stroller that we had inadvertently stolen from Old Navy TWO weeks prior, which costs a whopping $2.95 and I drove back and paid them for it. I'm just too honest to be a bad ass. It's a blessing and a curse.
The good news for you is that you are apparently friends with someone with a high moral code of conduct. Clearly I'm worth hanging out with, unless you were looking for some sort of partner in crime, then I'm probably not your gal...unless it involves meth, then my fascination might turn me.
Are you in? Are you scared?
This is awkward. Is this the first time you are hearing about this? Totally my oversight. I meant to invite you, obviously something snapped in my brain to make me forget. It's probably because I've been eating a lot of rice and I just got an article from my children's pediatrician about all the arsenic in rice. Stupid poison is making me be mean. I'm sure you understand.
So....want to come over and hang and talk about kitchen stuff? Yes?
love, Leslie


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- Meridian
- 1 update
Medal awarded to diabetes sufferers
Patients at a Surrey hospital are being awarded medals for living with diabetes.
Live updates
Diabetes patients presented with medals
Patients at a Surrey hospital who have lived with diabetes for a total of 418 years have been given special medals.
Frimley Park Hospital patients have been presented with Alan Nabarro medals at a celebration held to commemorate those living with diabetes for 50 years.
Dr Tringham from the hospital said: "It is great to see so many of you here today andonly you really know just how much an achievement it is living with diabetes,day in day out.
"When you first started you would probably have had glass syringes and thick needles to sterilise - now those things are in museums! Who knows what advances there will be in 50 years' time?"


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27-29 March 2018
Dusit Thani Hotel, Abu Dhabi, United Arab Emirates
With oil prices low, companies cannot afford any kind of obstacle in their current ongoing business operations. Cyberwars are increasing and cyber crime being ranked as the 2 most common economic crime in the Middle East, the 7th Annual Cyber Security for Energy and Utilities will focus on how to detect, prevent the cyber threats and if attacked how to recover from it with out affecting the on going business operations.
The 7th edition of the highly-successful cyber security conference for energy and utilities, will gather key stakeholders from oil, gas, power, and utility companies to create a platform to help detect and prevent cyber threats, and if attacked how to implement the best recovery management strategies for a smooth business continuity.
Featured Speakers
ADNOC Sour Gas
Change Manager - ITI
IT Compliance and Digital Transformation Specialist
Regulation and Supervision Bureau
Adviser and Chief Information Officer
Ministry of Environment, Water and Agriculture, Saudi Arabia
Head - Information Security Risk Monitoring
Saudi Aramco
Senior Real-Time System Specialist
Kuwait Oil Company
Independent Cyber Security Consultant
Cyber Security Advisor
Ministry of Justice, Saudi Arabia
Head of Telecommunications
Abu Dhabi Police GHQ
Chief Innovation Officer
Senior IT Security Specialist
Saudi Aramco
Why you should attend:
Discover the current trends and strategies implemented by corporations and government in case of cyberwars
Learn how to implement effective robust strategies for recovery management
Learn best practices implemented for user behavior management-Insider threat
Understand the challenges and benefits of IoT, cloud and big data
Who should attend?
- IT Security Advisor/Manager/Director/Consultant
- IT Director/Manager/Engineer
- CXOs/Presidents/VPs/Chief Risk Officers/Chief Security Officers/Chief Information Officer
- Network and Systems Security Administrators
- Enterprise Security Architects
- Data Network Engineers/Managers
- IT Auditors
- Security Analysts
- Web Masters
- Real-time Operations Engineer/Manager
- Head of SCADA/ Head of Automation/Smart Grids/Digital Oilfields/ICT
- Ethical Hackers
- Head of Planning, Governance, Risk
From the following industries:
- Oil
- Gas
- Petrochemical
- Power
- Water
- Utilities
Exceeding expectations…
"Excellent and easy to follow."
"I have never seen this versatility of speakers as well as attendees and this is an opportunity that I wouldn't like to miss. This is an exciting platform where I would like to see companies and experts working towards implementing best practices and overcoming challenges in the UAE."
"Investing in cyber security will definitely reduce business risk for the oil sector."


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Kree Harrison Wows With Moving Delivery of 'Up to the Mountain' on 'American Idol'
Kree Harrison captured the hearts of judges and audience members alike on 'American Idol' tonight (Feb. 20). Her rendition of Patty Griffin's 'Up to the Mountain' was passionate and soulful, not to mention incredibly genuine.
Harrison blossomed with her delivery of Grace Potter's 'Stars' in last week's episode, during which she revealed having lost both of her parents. She possesses a dazzling spirit that shines through her onstage performances.
"It's so beautiful to watch you sing…not just to listen to you, to watch you," emphasized 'Idol' judge Keith Urban. He also commented that her talent for performing was effortless and authentic. "I would be very afraid if I was any of these other girls here tonight," Nicki Minaj chimed in. "Every time you sing a song, you make love to the song. I've never said that to anyone … Something about you is just so sexy when you sing!"
"Here is another natural-born singer," said Randy Jackson. Mariah Carey was quick to agree. "You're not trying to be any way, you're not putting on any type of thing. It's just incredibly organic," she praised. "You sang the hell out of that song, and it was amazing. I loved it."
"This is all I've ever wanted to do," Harrison admitted after her jaw-dropping performance – and it looks like she's going to keep on doing it. Needless to say, she's moving on to the next leg of the 'American Idol' competition.


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Imagine the fun you'll have wearing these uniquely designed Slip Ons! Everything you need in a pair of shoes: magnificent design, comfortable and you can wear them for any occasion! Whether at the clinic, school, or out for a walk, you wouldn't want to take them off!
Elastic stretch in-step for easy on-and-off use.
Soft textile lining with lightweight construction for maximum comfort
All products are made to order. We do our best to proceed them as soon as possible! Production time is 2-7 days.3 days in Avarage.
Shipping time depends from the product and the location
Domestic:1 - 2 Weeks
International:2 - 4 Weeks


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IMPORTANT NOTE: In order to use SSL you NEED to run the latest Java SE Runtime Environment. If your copy of PC is older than 267.2/269 you
have to download the JRE from Oracle JRE Windows x64 and replace the contents of the <INSTALL_DIR>/runtime folder with the contents of the JRE. The reason is that the
required sunmscapi.dll is not shipped with the 64-bit JRE included in PC setup package.
So you have your SSL certificate in PFX format (*.pfx) and you want to use it in Performance Canvas.
For creation of Java Keystore (JKS) or .keystore file for Performance Canvas you need to use utility keytool.exe that can be found in your installation package of Performance Canvas.
Usually this tool located here:
C:\Program Files (x86)\Performance Canvas\runtime\bin\keytool.exe
1) import data from existing PFX store iisKeyStore.pfx file into JKS format:
keytool -importkeystore -srckeystore iisKeyStore.pfx -srcstoretype pkcs12 -destkeystore .keystore -deststoretype JKS
here you need to provide password once for source keystore iisKeyStore.pfx and create new password for new .keystore.
Lets assume the new password is dspJKSPassword, but please use yours.
By default .keystore file will be created in your current directory.
2) now you need to find the key alias in new created .keystore, for that list information from keystore with verbose option:
keytool -list -v -keystore .keystore -storepass dspJKSPassword > keystore-list.txt
3) in keystore-list.txt find line like which will correspond your key alias
"Alias name: le-c1f22c2f-e1c4ac43ea42"
4) Place newly generated .keystore file in your Performance Canvas folder. If you are using default installation path then it should be located here.
C:\Program Files (x86)\Performance Canvas\.keystore
5) Update ssl configuration in zenith.properties.
dsp.security.ssl.keyalias=le-c1f22c2f-e1c4ac43ea42 dsp.security.ssl.keystorepass=dspJKSPassword
6) Restart Performance Canvas Service


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Expert advice on recovering from a Cesarean section.
The percentage of babies delivered by Cesarean in the United States has increased for each of the past 10 years.
And it's a trend that shows no signs of slowing: In 2005, more than 30 percent of all babies in this country were delivered by C-section—an all-time high, according to the National Center for Health Statistics. Still, in many childbirth classes, a Cesarean delivery—and the recovery that follows—is not covered in much depth, if at all.
Here are four tips to help you prepare in case you deliver by C-section.
1. Plan to get up and about. "We suggest that patients get out of bed and start moving within 24 hours of a C-section because movement decreases the risk of blood clots and gets your digestive system functioning again," says Alison Edelman, M.D., M.P.H., an assistant professor of obstetrics and gynecology at Oregon Health & Sciences University in Portland. You'll need to start slowly—walking to and from the bathroom, for instance—and with help from your nurse, as you may be a bit dizzy when you first get up. Soon enough you'll be able to take a stroll around your hospital floor.
You also can shower within a day of your surgery; doing so helps reduce the risk of infection. "Don't scrub your incision, but let the soapy water run over it," Edelman says. (Your bandages will likely be removed about 24 hours after surgery and replaced with small sticky bandages called Steri-Strips; it's fine if these get wet.) Dry the area by gently patting it or using a blow-dryer set on cool. It's safe to take a bath when the incision has healed, generally seven to 10 days after surgery.
The need to get back on your feet is one reason you should take the pain medicine your doctor prescribes. "If you're in pain, you won't move," says Edelman.
2. Expect unexpected pain. Most women realize that they'll have pain after a C-section—it's major surgery, after all! But many are surprised by the intestinal spasms—OK, gas—they experience; this is a result of air becoming trapped in the abdomen during surgery.
"My nurses practically forced me to get out of bed and move in order to relieve the gas pains I had following my first C-section," says Maureen Connolly, a mother of three in Montclair, N.J. Your physician might also recommend taking simethicone tablets (Gas-X), which help alleviate gas and bloating. Also move your legs around while in bed—any bit of activity helps. "Even though my incision hurt, moving around brought the most relief," Connolly recalls.
For her second C-section, which was scheduled, Connolly was able to minimize post-op gas pains by following a pre-surgery diet recommended by her OB. "I started a semiliquid diet 48 hours before surgery," she says. "I found out that foods like yogurt and pasta soup are much easier for the intestines to digest than most others." Her doctor explained that these foods would help reduce the amount of air in her abdomen and intestines—and, hence, her post-surgery gas.
3. Prepare to take it easy at home. "Don't drive for at least one week after delivery, limit stair climbing, and avoid heavy housework," says Henry Lerner, M.D., an OB-GYN in Newton, Mass., and a clinical instructor at Harvard Medical School. Remember:You had major surgery, and you need to take it easy!
The age-old advice—don't lift anything heavier than your baby for two weeks—still stands. The staples that are commonly used to close the incision will probably be removed within three to seven days of delivery, but even then, it's important to avoid any strenuous activity for the first two weeks. Also pay attention to the following symptoms of infection; if you have any of them, call your doctor immediately:
- Fever above 100.4 °F
- Heavy vaginal bleeding
- Pain at the incision site that gets worse instead of better
- Blood or other fluid draining from your incision
- Reddened edges around your incision
4. Embrace your baby's birth. For women who planned and hoped for a vaginal delivery, having a C-section can be emotionally devastating and bring about feelings of failure. "You may be overjoyed at the birth of your child but still feel like you failed or your body failed you, and you may have trouble reconciling those feelings," Edelman says. If you just can't come to terms with your C-section, visit Postpartum Support International at postpartum.net. They'll guide you to support groups and even counselors who specialize in this area.


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This may be the most divisive album of 2006. It's certainly one of the most ambitious, with the biggest potential for either embarrassment or triumphant success and a wide rift between the two. Listeners will either love or loathe Joanna Newsom's pretensions: the album title named after an ancient city (pronounced "ees"), the swooping string arrangements courtesy of Beach Boys collaborator Van Dyke Parks, Newsom's harp accompaniment and petulant-sounding voice, her Ren Fest melodies and fantastical lyrics. At times, her seriousness can be unbearable and her storytelling tedious (as on the 10-minute "Bear & Monkey"), but the album nevertheless casts a particular spell, mainly because Newsom remains so fearlessly at the forefront, like an actress who appears in every frame of a movie. Her voice, pitched high and dramatic, leaves no room for overtures or even breaths but ebbs and tides from verse to verse, implying hooks where there are none. ("Emily," "Cosmia") -- Stephen Deusner
Grade: B+


text:
by J. Oren Stevens
He crunches through cool, wisping shadows of a slope rooted regiment of pines. Stepping out of the forest, he crosses a lonely backcountry road demarking conservation and forest product profiteering. Onto a hardscrabble fire road leading into barren clear-cut woodlands, a dead calf lay ripe in a cacophony of putridity. Beyond the swarm of flies lay a mangle of barbed wire the size of a car, and dozens of foreboding POSTED signs punctuating a fence line. The sun is summer hot in the shadeless acres of thorny brambles, while four black buzzards circle low, and piles of coyote scat tell a story of moonlit carnage. Turning back, he passes lemon Swallowtail butterflies, and purple moths dancing on the blooming carcass, and he drops his bag to dance with them, twisting back and forth across the road between shadow and light.
J. Oren Stevens survives Maine, finds beauty in the harsh reality of nature, and has learned to give humans the same latitude.


text:
Boot Airliner
The Snokart Boot Airliner is the perfect boot bag to take on all your travels.
The AIRLINER Boot Bag provides a unique smart lightweight, protective, lining bag for each boot that can be joined together!
Use these when popping your wet ski or snowboard boots into your ski or snowboard bag or general luggage, which is full of dry clothes.
These boot bags can be used individually for easy stowage or snapped together making for easy carriage of boots from bedroom to locker room, or locker room to lift.
They are eco friendly too as you no longer have to use horrible plastic supermarket carrier bags!
They are really light and roll down when not in use. They also make great bags in which to keep your boots when not in use during the summer months.
Price is for the pair!
- One bag for each boot makes easy packing
- Big access zip openings
- Soft rip-stop, waterproof fabric
- Quick press stud and velcro join-up option
- Suitable for ski or snowboard boots
- Excellent for weight distribution
- Eco friendly
300 grams


text:
Upholstery How-To DVD: "Tight Seats and Backs"
It sounds like the kind of workout tape I could really use — who doesn't want a tight seat and back? — but this DVD is even better. From the uber-talented Amanda Brown, owner of Austin's Spruce Home, this instructional video will take you through the basic steps of reupholstering, from stripping to coal-spring tying. If you've ever drooled at a Before & After and wished you had the skills, here is your chance.
We've marveled at Spruce Home projects in the past, especially when we saw this Before & After video. But all I could think after watching that was: Where do I even begin?
This DVD is an awesome start. You can buy it at Spruce Home's Esty shop, and while you're there, take a look at some of their amazing projects. Spuce Home may be gods of reupholstering, but they've put the powers well in reach of us mere mortals.
Image: Spruce Home


text:
Select a Category:
– this page is cool. Here we plan to publish the "secrets"
of happy family life. There is, true, have two constant conditions:
the first is love, the second - everything should be done together,
then so it is not boring, and time flies more rapidly. This relates
also to the culinary secrets.
Stuffed pepper to the new harmony
on 2 portions: 3 - 4 red sweet peppers, 200 gr. the ground cheese (better than Gauda), 1 large onion, 500 gr. meat stuffing (beef + pork), 2-3 d. spoon olive oil (or another oil), salt, pepper Peppers to cut in half and to clean seeds (from pedicle not to touch, will otherwise throw out stuffing), to wash, to lay out to the pan (in order not to rub off it for long and persistently, you will place on the pan foil, and to the foil - peppers). Onion to clean, it is in small particles to cut, to passage in the olive oil to the golden color, to add stuffing, to brown, to add salt and pepper, to mix. To lay out stuffing into the cut lobules of peppers, to on top strew by the ground cheese. The oven to heat up 200-220 degrees. In the hot oven to place to bake peppers (about 20 minutes). To give by hot with the soybean sauce and ketchup.
Copyright "SVETLANA'S FEISHN"©, 2004-2007


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Laparoscopy (also known as keyhole surgery) is a minimally invasive surgical procedure that allows surgeons to perform the procedures of traditional surgery using small incisions. Laparoscopic surgery has become quite popular for performing several general surgery procedures.
In Laparoscopy, a long flexible tube is used which is connected to a video camera. The surgeon will insert the tube through the small incision in the abdominal cavity. With the help of a monitor, the surgeon can visualize the abdominal cavity and control the movements of the laparoscope.
Laparoscopic surgery offers many benefits to surgeons and patients. Find out how Laparoscopic surgery should be preferred over traditional surgery:
Reason #1: The size of incisions made in Laparoscopy is quite small, the risk of bleeding is reduced during the surgery. This further reduces the possibility of blood transfusion that might be needed to compensate the blood loss.
Reason #2: Smaller incisions also result in less pain after surgery. In open surgery where large incisions are made, patients need long-term medication to relief their pain and heal the stitch lines. However, in laparoscopic surgery, the post-surgical wounds are smaller, and patients recover fast.
Reason #3: Laparoscopic surgery also offers the benefit of less or smaller scars. With small incisions, patients will get minor surgical scars.
Reason #4: The length of hospital stay in laparoscopic surgery is relatively shorter than traditional surgery. Fast recovery and smaller incisions result in shorter hospital stays. Many patients get the same-day or next-day discharge from the hospital. They can return to the normal daily routine within few days.
Reason #5: Laparoscopic surgery protects the immune function of the patient whereas open surgery can compromise the immune system.
So these were five reasons that show Laparoscopic surgery is better than traditional open surgery. Every patient should find a qualified colorectal surgeon who is trained and experienced in minimally invasive techniques. Consult your physician to find out if you are an eligible candidate for Laparoscopy. If you are based in Los Angeles, contact Dr. Karen Zaghiyan M.D., who is a reputed Laparoscopic surgeon in LA.


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Two years ago, a self-driving Car was launched by Google. However, it was only a few minutes later that it blew brains of the people by stopping in the middle of the street when it confronted a woman seated in a wheelchair while she was chasing a running duck with her broomstick. The car took a halt till the road became clear and then started making an advanced contribution to the worldwide traffic safety.
The products have been evolved into smart and intelligent devices with embedded systems that are connected on the broader level, reshaping the product design, radically, on the whole. As the car stopped in the middle, this particular information has been sent to all the Google car by which no car will ever make a mistake when someone in a wheelchair comes across the street chasing a duck with a stick.
Another example that displays the advancement of product design is the changing design of smart thermostats. Designed to control the home devices by transmitting the individual data of the house to the manufacturers, these intelligent machines will be connected to a network that autonomously optimizes through coordination. The data that has been streamed on the location, environment, and operation will be sent to the makers who process it and then make upgraded products that eliminate all the errors.


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Can it be cleaned easily without discoloring. The iPad Air case (red) got real dirty with smudges very fast and was impossible to clean.
1 Answer from the Community
I would suggest testing it with a leather Cleaner/Conditioner.
- Answered by Jeffrey S from Bristol
- Flag as inappropriate Answer 1
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Lisbon (Apr. 4)
At the last meeting of the General Assembly of the Jewish Committee of Oporto, Portugal, led by and largely made up of Marranos who have recently returned to Judaism, Captain Arthur C. de Barros Basto was elected President of the Board. Chief Rabbi Israel Levy of France, Baron Edmond de Rothschild, and Rev. Dr. D. de Sola Pool of New York, were elected honorary members of the community in recognition of the work which they have done in aiding the return to Judaism of the Portuguese Marranos.


text: On Mon, Jul 02, 2007 at 08:52:09PM -0400, Samuel Bronson wrote: > Mon Jul 2 20:47:22 EDT 2007 Samuel Bronson <naesten at gmail.com> > * Add foreign import "dynamic" support Thanks! I finally got a chance to look at this. looks good! I am thinking that a regression test that tests all the aspects of the FFI is in order... hopefully just using things from the standard libc so no external C file would be needed. John -- John Meacham - ⑆repetae.net⑆john⑈


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During Jesus' incarnation, the religious elite of His day, the scribes and Pharisees, would follow Him around and seek to trap Him, discredit Him and have Him arrested and killed.
The Pharisees honestly get a bad rap sometimes. During the 400 year silence prior to John the Baptist's arrival on the scene, these men saw the godlessness of their countrymen and wanted to do something about it. They wanted Israel to live according to the Law. So the strove to obey the Law as closely as possible; to obey God as His people. But then they started adding laws to the Law in order to help them obey the Law. The spirit of the law became the letter of the law and man's laws overtook God's Law and then they were left with something opposed to the Law.
Although there were many, a common example is found in the Sabbath. God had commanded that on the seventh day, all his people should rest. No work was to be done, for just as God had rested from his work of creation on the seventh day, so too would his people from theirs. They had a lot of extra rules about what to do, where to go, what you could carry and even whether or not someone could be healed. So one day, Jesus was at Bethesda and saw a man who has been an invalid for thirty-eight years.
When Jesus saw him lying there and knew that he had already been there a long time, he said to him, "Do you want to be healed?" The sick man answered him, "Sir, I have no one to put me into the pool when the water is stirred up, and while I am going another steps down before me." Jesus said to him, "Get up, take up your bed, and walk." And at once the man was healed, and he took up his bed and walked. (John 5:6-9)
Jesus performed an amazing miracle in the life of this man. An invalid for over 30 years, yet now he could walk. People should have been celebrating! Except, there was one small problem: "Now that day was the Sabbath" (v. 9b). The Sabbath—the same day on which the Pharisees had determined that people could not carry a mat because they considered that work.
So the Jews said to the man who had been healed, "It is the Sabbath, and it is not lawful for you to take up your bed." But he answered them, "The man who healed me, that man said to me, 'Take up your bed, and walk.'" They asked him, "Who is the man who said to you, 'Take up your bed and walk'?" Now the man who had been healed did not know who it was, for Jesus had withdrawn, as there was a crowd in the place. Afterward Jesus found him in the temple and said to him, "See, you are well! Sin no more, that nothing worse may happen to you." The man went away and told the Jews that it was Jesus who had healed him. And this was why the Jews were persecuting Jesus, because he was doing these things on the Sabbath. But Jesus answered them, "My Father is working until now, and I am working." (John 5:10-17)
The Pharisees sought to persecute Jesus because "he was doing these things on the Sabbath" (v. 16). They persecuted Jesus because he broke their rules. Rules they had equated with God's. And they became so blind with pride that they could not see who Jesus was or what he was doing.
This is something we all need to be careful of. There's a tendency among Christians to be afraid of grace—if we talk about it too much, or if we really believe in it, people might start thinking we don't care about obedience, or we think you can live however you want because "once saved always saved." Even when we don't do this, we add rules about what to wear, what to drink, what to say, what to think, how to pray, how to sing, whether to put our hands up (and how high)…
We love our rules, don't we?
And yet, they're the very things that might be choking the life out of us. When we substitute human effort for genuine affection for God, terrible things follow. I can't help but think of the seven churches of Revelation to whom Jesus sent warnings and encouragement. The Ephesians, for example, he commended for their uncompromising doctrine, and their unwillingness to bear with false teachers. Yet he warned that they had abandoned "the love [they] had at first. Remember therefore from where you have fallen; repent, and do the works you did at first. If not, I will come to you and remove your lamp stand from its place, unless you repent" (Rev. 2:4).
Jesus warned these Christians that he would put an end to their church not because they were following false teachers, but because their hearts were far off from him. Their right concern over protecting their doctrine was choking the life out of them because they'd forgotten the spirit in which it was to be pursued. Right doctrine was to lead to greater delight and devotion, not to a cold, "dead" orthodoxy (which is completely unorthodox).
One of the things I always want to be careful of in my own life—and I'll be honest, I chafe at it whenever certain things are imposed from the outside—is whether or not the rules and structures I've implemented in my own life and in my family are life-giving or if they are ultimately pushing me and others away from Jesus. If a "read the Bible in a year" plan is about little more than checking a box, it ought not be done. Bible reading should happen, but the form that takes needs to change. If prayer is rigidly structured and my words are rehearsed, there's a problem. Prayer should still happen, but the form is (generally) open by necessity. If "worship" only happens when hands are raised higher and voices are louder, well… you get the idea right?
Seeking to obey God in all of our lives is right of course. It is good and necessary and life-giving. However, we need to be careful of not adding rules that go beyond those found in Scripture lest we become proud, devoted and dead.
This post is based off a much earlier one from 2010.