text:
Bioethics News
How is measles still a problem in Washington?
A recent measles outbreak in southwest Washington escalated to over 50 confirmed cases. Despite the evidence behind vaccines, people usually stick to what they feel is true, says Dr. Douglas Diekema, an emergency physician at Seattle Children's. "It doesn't matter what the data shows," he says. "A story will always trump data."
Is refusing vaccine for child after near-death crisis parental abuse or neglect under Oregon law? What the experts say
Dr. Doug Opel, a pediatrician at Seattle Children's, deals with parents who are reluctant to vaccine their children all the time. "I guess I would say one could really argue that a parent's refusal of a recommended vaccine is on some level neglectful," said Opel. "But there's a separate question whether a state ought to get involved and remove their decision-making authority." That question quickly took center stage in the vaccination debate when Oregon doctors recently publicized the case of a 6-year-old boy who spent eight weeks in intensive care because he got tetanus.
Cambia Health Foundation announces 12 new Sojourns® Scholars
The Cambia Health Foundation has announced the selection of 12 new emerging palliative care leaders for its Sojourns® Scholar Leadership Program. Each Sojourns Scholar receives a two-year, $180,000 grant to conduct an innovative and impactful project tied to a leadership development plan that positions the scholar for growth as a national leader in the field of palliative care. Dr. Abby Rosenberg of Seattle Children's and UW received the grant for her project "Promoting Resilience in Adolescents and Young Adults with Serious Illness."
Officials in anti-vaccination "hotspot" near Portland declare an emergency over measles outbreak
A quickly escalating measles outbreak around Portland, Ore., has led health officials in nearby Clark County, Wash., to declare a public health emergency. The outbreak makes concrete the fear of pediatric epidemiologists that a citadel of the movement against compulsory vaccination could be susceptible to the rapid spread of a potentially deadly disease. "It's alarming," said Dr. Douglas Opel, a pediatrician at Seattle Children's. "Any time we have an outbreak of a disease that we have a safe and effective vaccine against, it should raise a red flag."
Compatible with life?
Dr. Benjamin Wilfond, a bioethicist and pediatric pulmonologist at Seattle Children's Hospital, is a longtime advocate for broader interventions for children with trisomy 13 and 18. Recently, one of Wilfond's trisomy 18 patients in Seattle had chronic respiratory failure and a heart defect. She received a tracheostomy and spent several months on a ventilator. Eventually, she could breathe on her own and was healthy enough to receive surgery. She's now 3.
Seeking greater inclusivity in genomics research
Forbes. 11.1.18
There have been a number of recent efforts, many led by indigenous scientists around the world, to draw attention and offer solutions to issues with research among under-represented communities. Dr. Nanibaa' Garrison, a bioethicist at Seattle Children's Research Institute and a member of the Navajo Nation, advocates for "increasing the training and capacity of Indigenous people so that they can bring a much-needed perspective to the interpretations of the results," she said.
The real problem with Elizabeth Warren's DNA test: Geneticists
ABC News. 10.18.18
Does Massachusetts Senator Elizabeth Warren really have Native American blood running through her veins? It's scientifically impossible to know for sure, according to a collection of leading geneticists, industry experts, research scientists with expertise in indigenous genetics and Native American leaders who spoke with ABC News. "It's hard to say that there is a definitive conclusion, especially if someone has such small amounts of Native American ancestry," said Dr. Nanibaa' Garrison, a faculty member in the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute. "When you're testing someone who might have an ancestor more than four or five generations back, that's when it becomes very hard to piece out that ancestor from all the other ancestors that the person has. It's not a yes or no answer."
To overcome decades of mistrust, a workshop aims to train Indigenous researchers to be their own genome experts
Science. 9.27.18
The Summer Internship for Indigenous Peoples in Genomics (SING) is a weeklong program funded by the NIH and the National Science Foundation, and held this year at UW. SING aims to train Indigenous scientists in genomics so that they can introduce that field's tools to their communities as well as bring a sorely needed Indigenous perspective to research. One pioneer is Dr. Nanibaa' Garrison, a member of the Navajo Nation. "I wanted to find a way to do it better. To do things right," she says. She's now a bioethicist at Seattle Children's Research Institute and UW, developing ethical approaches to research with Indigenous communities. "I wanted to see more people like me," in genetics, she says. "And I wanted to change the story."
Seattle Children's works to turn PRISM program into an mHealth app
mHealthIntelligence. 8.20.18
Physicians at Seattle Children's are working to turn a web-based coping program for children with serious illnesses into an mHealth app. The Promoting Resiliency in Stress Management (PRISM) program has helped young patients with health issues like cancer and type 1 diabetes – and their families – develop physical and emotional skills to better deal with the challenges that a chronic disease has thrown into their lives. Now Dr. Abby Rosenberg, who created PRISM with Dr. Joyce Yi-Frazier, wants to scale up the program and make it more accessible. That means creating a platform for the program on mobile devices like the smartphone and tablet. "This is the language that young people today speak," Rosenberg said. "We essentially need to translate what we have now into something that will live in the digital space.
The circumcision debate: A brief history
Crixeo. 6.25.18
In the U.S., there is controversy surrounding circumcision. In a 2012 policy statement, the AAP found that "preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure." The health benefits cited in the report included a slightly reduced risk (about 1%) of urinary tract infections during the first year of life, lower risk of HIV and other STDs, and lower risk of penile cancer. The risks of circumcision were more difficult to define. Dr. Douglas Diekema, a pediatrician with the Treuman Katz Center for Pediatric Bioethics at the Seattle Children's Research Institute, is a coauthor of the AAP policy statement. "There are risks, but the incidence of serious adverse events is very low when performed by an experienced practitioner using sterile technique," Diekema said. "The most common complications are minor and include bleeding, which stops with a few minutes of applied pressure, and minor skin infections."
- The circumcision debate: A brief history – Blogarama
Can we respectfully disagree? Navigating cultural differences in healthcare
On the Pulse, 6.20.18
Providers often must negotiate with patients and families, but how should disagreements be addressed when the discrepancy is rooted in the patient's culture or beliefs? Bioethics consultant Dr. Doug Diekema, director of education in the Treuman Katz Center, discussed how we should navigate ethical disagreements related to diversity in a Q&A.
Low vaccination rates in King County cause for concern
KING5.com, 6.15.18
King County had the third-highest number of parents claiming exemptions from vaccine requirements for their children last year, according to a new study. Experts warn that this may leave residents of Washington's most populous county vulnerable to outbreaks of deadly disease. While doctors can't say with certainty what causes any given outbreak, "there is good data to suggest that unvaccinated children are at risk for serious infections and can promote the spread of vaccine-preventable diseases in their community," said Dr. Doug Opel, general pediatrician at Seattle Children's and associate professor of pediatrics at the UW School of Medicine.
Vaccines work, whether or not you believe in them
TWiV (This Week in Virology), 6.3.18
Douglas Diekema is one of the experts interviewed about vaccine facts and fiction at the Vaccines in the 21st Century meeting at the University of California, Irvine.
Build resilience in kids to prevent suicide
KING5.com, 5.25.18
Suicide is the number one cause of death for children in Washington state between 10-14 years old. Building resilience is one way parents or caregivers can help their kids better navigate difficult times. Dr. Abby Rosenberg is a pediatric oncologist at Seattle Children's Hospital who studies resilience among young cancer patients, and she shared three findings on how we can build resilience in all children.
Deep Dive: Building resilience
KING5.com, 5.24.18
The number-one cause of death in children in Washington state between ages 10-14 is suicide. One of the major ways to prevent suicide is resilience, a person's ability to adapt to stress and change. Dr. Abby Rosenberg at Seattle Children's has studied resilience in kids who are facing cancer. Rosenberg said resilience can be developed and used for any type of adversity, and you can get it by developing resources. The three types of resources for building resilience are: individual, community and beliefs.
New ethics encourage engagement with indigenous community
Kansas Ag Connection, 5.9.18
A collaborative group of indigenous and nonindigenous scholars encourages scientists to meaningfully engage with indigenous communities on paleogenomics research in a new series of ethical guidelines published in the journal Science. Nanibaa' Garrison, a bioethics professor at Seattle Children's Research Institute and the University of Washington School of Medicine and a co-author of the report, said engaging communities at the outset is critical for understanding their concerns or questions about research involving ancient relatives.
Respect Indigenous ancestors: Scholars urge community engagement before research
Phys.org, April 26, 2018
A new article in the journal Science provides guidance for those intending to study ancient human remains in the Americas. The paper offers a clear directive: First, do no harm. "Engaging communities at the outset is critical for understanding their concerns or questions about research involving ancient relatives. Without feedback from the community, scientific interpretations remain one-sided and inherently biased," said Dr. Nanibaa' Garrison, a bioethics professor at Seattle Children's Research Institute and the UW School of Medicine, and a co-author of the article.
Commentary: Trying to learn the lesson of Kennewick Man
UW Medicine Newsroom, April 26, 2018
New ethical guidelines encourage scientists to engage with indigenous communities before studying ancient remains
KU News Service, April 24, 2018
An app for teaching kids to cope with chronic illness
Fast Co.Design, March 19, 2018
Dr. Abby Rosenberg and her colleague Dr. Joyce Yi-Frazier of Seattle Children's created the Promoting Resilience in Stress Management (PRISM) program – a set of exercises designed to help teenagers and young adults with cancer and type 1 diabetes cope with their diseases. And through randomized control trials, Rosenberg found that teens who had used PRISM described themselves as more resilient, had more hope for the future, had less clinical depression and had less need for formal psychological intervention like therapy or drugs. Rosenberg and Dr. Wendy Sue Swanson, a pediatrician and chief of digital innovation at Seattle Children's, turned to design firm Artefact to transform the paper PRISM framework into an app for teenage patients.
A cure for burnout?
AAP News, February 2, 2018
In a recently released article in Pediatrics, Dr. Abby Rosenberg of Seattle Children's Hospital discusses the importance of cultivating professional resilience as a means of combating physician burnout.
Abby R. Rosenberg, MD, on promoting resilience in young cancer patients: Results from the PRISM trial
The ASCO Post , November 2017
Dr. Abby Rosenberg of Seattle Children's Hospital discusses study findings on a skills-based intervention that helped teens and young adults with cancer manage stress to improve their quality of life and reduce distress.
Resilience intervention improves quality of life, lowers depression in young patients with cancer
Healio, October 25, 2017
Adolescents and young adults with cancer who participated in a one-on-one targeted intervention reported improvements in resilience, cancer-related quality of life and stress management, according to a study scheduled for presentation at the Palliative and Supportive Care in Oncology Symposium. "The experience of cancer is stressful in all realms, but we tend to focus more on physical symptoms than the equally important social and emotional challenges," said Dr. Abby Rosenberg, director of palliative care and resilience research at Seattle Children's Research Institute and the lead author of the study.
Navajo Nation reconsiders ban on genetic research
Nature, October 6, 2017
When the Navajo Nation opens its first oncology center next year in Tuba City, Arizona, clinicians there may be able to offer a service that has been banned on tribal lands for 15 years: analyzing the DNA of Navajo tribe members to guide treatments and study the genetic roots of disease. Still, some Navajo have lingering questions about whether the tribal government can protect the privacy of their genetic material and maintain control over its use. Such concerns helped to shape the current ban back in the early 2000s. "In the absence of a research code and lack of expertise at the time, they decided it was not a good time to move forward with genetic research until they were able to develop a research policy," says Dr. Nanibaa' Garrison, a member of the Navajo Nation who is a geneticist and bioethicist at Seattle Children's Hospital.
American Cancer Society awards new research and training grants
Press release, October 2, 2017
The American Cancer Society has approved funding for 78 research and training grants totaling $39,836,250 in the second of two grant cycles for 2017. Dr. Abby Rosenberg of Seattle Children's Hospital is a grant recipient. Rosenberg's work will examine whether a brief, one-on-one intervention targeting stress-management/mindfulness, goal-setting, positive reframing, and meaning-making can address poorer psychosocial outcomes seen among adolescent and young adult cancer patients.
Docs should be aware of family beliefs regarding nondisclosure
Medical Xpress, September 7, 2017
Physicians should be aware of societal codes of conduct that affect family beliefs and behaviors regarding information disclosure to pediatric patients, according to a study in JAMA Pediatrics. Dr. Abby Rosenberg from Seattle Children's Hospital and colleagues discussed the balance of obligations to respect individual patient autonomy, professional truth telling, and tolerance of multicultural values for pediatric clinicians treating seriously ill children.
The tragic Charlie Gard case and what we can learn from it
The Seattle Times, August 11, 2017
"Medical cases like Charlie Gard's ignite public debate about what should happen when hospitals and courts disagree with families about what is best for a child…We should strive to remember, at a minimum, that reasonable people disagree about the best way to proceed in cases like these," write op-ed authors Seema K. Shah and Drs. Abby Rosenberg and Doug S. Diekema. All three are faculty at the UW School of Medicine and at the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute.
Could Charlie Gard's case happen in the United States?
CNN, July 6, 2017
Although a Charlie Gard case could happen in the United States, "it seems unlikely," said one pediatric bioethicist from the University of Missouri-Kansas City School of Medicine. Similar cases in the U.S. tend to be resolved in favor of parental rights, he explained. Seema Shah, a lawyer and ethicist who is a faculty member at the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute, explained that U.S. courts consider "parental discretion," not parental responsibility. American parents have "discretion to make decisions" on behalf of their children, Shah said, "up to the point where their decisions are going to cause harm to their children."
'Intactivists' oppose circumcision of children
Houston Chronicle, April 14, 2017
Although the American Academy of Pediatrics has variously been in favor of and neutral toward circumcision, since 2012 the AAP's official position has been that the procedure's benefits outweigh the risks. Dr. Douglas Diekema, a Seattle Children's Hospital pediatrician who was on the AAP task force that issued the 2012 statement, was quick to qualify that. "From a personal perspective I would say better terminology is 'The benefits justify the risks,' " he said during an interview. "But different people weigh the risks differently."
In pausing human research on Zika, medical ethicists acknowledge a dark past
WBUR.org, March 21, 2017
The National Institutes of Health called for an ethics consultation on the study which involved deliberately infecting a small group of consenting adults with the Zika virus to learn about the disease and speed up the search for a vaccine. The NIH panel's answer, in short, was this: The research could be justified, but conditions must be met. The panel's chair – lawyer, ethicist and pediatrics professor Seema Shah, of the UW and Seattle Children's Research Institute – is mentioned in the article.
Doctors' Guidance on How to Talk to Terminally Ill Teens
CBS News, October 17, 2016
Speaking to terminally ill patients about their disease is always difficult especially when a child or teen is involved. To shield children from a devastating diagnosis, some parents may even go so far as to keep their child in the dark about the severity of their illness. A paper published in JAMA Pediatrics argues that while that strategy may be less painful initially, when it comes to adolescents or teens with a life-threatening illness, telling the truth is the best option. In the JAMA paper, Dr. Abby Rosenberg, medical director of Seattle Children's Adolescent and Young Adult Oncology Program, and her colleagues reviewed ethical justifications for and against having direct truth-telling conversations with adolescents.
Bioethicist Studies Native American Attitudes Toward Genetic Research
On the Pulse, September 29, 2016
Dr. Nanibaa' A. Garrison, a faculty member in the Treuman Katz Center for Pediatric Bioethics, studies ethical issues surrounding genetic research with Native American communities. She is also a member of the Navajo Nation, so her professional field of research is closely linked to her personal background. She sat down with On the Pulse for a Q&A about her bioethics research and clinical interests.
How Much Should We Tell Kids About Their Own Health?
Reuters, August 25, 2016
When it comes to deciding whether and how to talk to children about their own health, there's no one-size-fits-all formula, some doctors argue. The best thing doctors can do is make the conversation about how to talk about health part of routine check-ups, because that will lay a foundation for having hard conversations when problems crop up in the future, said Dr. Abby Rosenberg, a pediatric oncology researcher at Seattle Children's Hospital and the University of Washington.
Teaching Resilience to Teens With Cancer, Diabetes
University of Washington Institute of Translational Health Sciences, July 6, 2016
The teenage years can be challenging under even the best of circumstances. But when serious illnesses like cancer and diabetes are introduced, those challenges multiply. Dr. Abby Rosenberg of Seattle Children's is studying if teaching resilience can help mitigate these outcomes and help adolescents and young adults better cope with stress. Her early career experiences led her to partnering with Dr. Joyce Yi-Frazier, research health psychologist at Seattle Children's Research Institute. Together they developed an intervention model called Promoting Resilience in Stress Management or PRISM, which is designed to teach patients resilience-building skills.
Sorry, Scott Brown: A DNA test can't tell us if Elizabeth Warren has Native American roots
The Washington Post, June 29, 2016
Before Scott Brown lost his Senate reelection bid to Elizabeth Warren in 2012, the race briefly centered on a weird topic: Warren's ancestry. Dr. Nanibaa' Garrison, a bioethicist and assistant professor of pediatrics at Seattle Children's Hospital, shares insight about Brown's recent suggestion to have Warren take a DNA test to prove her ancestry.
The spectrum of sex development: Eric Vilain and the intersex controversy
Scientific American, May 12, 2016
Dr. Eric Vilain, a pediatrician and geneticist at UCLA and one of the world's foremost experts on the genetic determinants of disorders of sex development, talks about his controversial research. Dr. Douglas Diekema of the Seattle Children's Research Institute is quoted in the article.
Foster Resilience in Adolescent and Young Adult Cancer Patients
Oncology Times, March 2, 2016
Resilience is broadly defined as an individual's ability to maintain physical and emotional well-being in the face of adversity. How to measure and promote resilience in clinical settings, however, is less clear. Dr. Abby Rosenberg authored the opinion piece.
Adolescent Stem Cell Donors: Benefits, Burdens, and Risks of Being a Lifeline for a Sibling
Oncology Nurse Advisor, October 20, 2015
A young person decides to donate stem cells to an HLA-matched sibling in need of a bone marrow transplant. It is such a selfless gift. But for an adolescent in the midst of the emotional turmoil that comes with that age, just how easy a decision is it to decide to give such a complex gift? A multidisciplinary team explored the conundrum with the goal of identifying how to help these generous persons through a very difficult decision. The team members were, from St. Jude Children's Research Hospital in Memphis, Tennessee, Meaghann S. Weaver, MD, MPH, from the Department of Oncology; Ashley Carr, CCLS, from the Child Life Program; and Brandon Triplett, MD, from the Department of Bone Marrow Transplantation and Cellular Therapy; and Dr. Douglas S. Diekema, attending physician and director of education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute in Seattle, Washington.
Survey Could Spot Parents Who Shun Child Vaccinations
MedicineNet.com, September 25, 2015
Parent responses on a survey about childhood vaccinations can help predict whether their youngsters will receive recommended immunizations, a new study finds. "Our results suggest that [survey] scores validly predict which parents will have under-immunized children," said Dr. Douglas Opel, of the University of Washington and Seattle Children's Research Institute, and colleagues in a journal news release.
Trump and Carson think it's okay to delay vaccines. Doctors say they're wrong.
Vox.com, September 17, 2015
Presidential contenders Donald Trump (a celebrity business tycoon) and Ben Carson (a pediatric neurosurgeon) both pushed the notion that kids these days may be getting too many vaccines too soon at Wednesday's Republican debate. Researchers point out that there's absolutely no science to this "too many, too soon" idea of stressing kids' systems with vaccines, and that the government-approved schedule is based on the best-available research about when kids are most at-risk for diseases and when their immune systems are most receptive to them. Also, the data that we have for routine vaccines suggests harms are infinitesimally remote. The totality of the research is stacked against alternative schedules, said Dr. Doug Opel, a Seattle pediatrician who studies vaccines. "There is just no science to this," he told Vox. "What gets lost a lot of the time is that there's an incredible amount of data underlying the recommended schedule."
Is There an Alternative Vaccine Schedule?
WebMD, September 4, 2015
There are no official alternative vaccine schedules. No major medical group approves of them. And there is no research to show that they are safe. Alternative schedules have not been formally studied, but there is some evidence that they may contribute to disease outbreaks. "States where a high number of parents opt out [of vaccines] show an increased risk of infectious diseases," says Dr. Doug Opel, a pediatrician at Seattle Children's. "It's significant and it's profound."
Carly Fiorina says parents should have the choice to vaccinate their kids – but it's doctors who wield the real influence
The New York Times Women in the World, August 20, 2015
At a town hall event in Iowa last week, aspiring Republican presidential candidate Carly Fiorina came out against mandatory vaccination for children. Fiorina believes parents have the right to decide whether or not to vaccinate their kids. Fiorina's beliefs are actually in line with policies in most states: Vaccination is required for enrollment in public schools, but parents can obtain exemptions on religious or personal grounds. While policy is obviously important, recent research shows that doctors can also play a role in convincing hesitant parents to let their kids get vaccinated. Last December, Dr. Doug Opel, a pediatrician at Seattle Children's, co-authored a paper in the journal Pediatrics that found that parents were much more likely to decline vaccines for their children when doctors presented the shots as a choice, rather than an expectation.
Ethics and Risks: Should Teens Be Donors for Siblings?
Surgical Products, August 12, 2015
In "Matched Marrow, Sibling Shadow: The Epidemiology, Experience, and Ethics of Sibling Donors of Stem Cells", Dr. Meaghann Weaver; Ashley Carr, CCLS; and Dr. Brandon Triplett, St. Jude Children's Research Hospital (Memphis, Tenn.) and Dr. Douglas Diekema of Seattle Children's focus on a range of issues unique to adolescents with siblings that require a hematopoietic stem cell transplant. Along with familial expectations, and positive feelings of altruism and self-worth, the scenario may include health risks, pain, and psychological burdens.
Nearly all states allow religious exemptions for vaccinations
Pew Research Center, July 16, 2015
Forty-six states currently allow children to be exempt from vaccinations due to religious concerns, including 17 states that also allow exemptions for "personal reasons," according to a Pew Research Center analysis. And even though 46 states allow religious exemptions for vaccinations, researchers and journalists have struggled to identify a single major U.S. religious group that currently advocates against vaccination for children. Some of these exemptions exist "at least in part owing to the lobbying efforts of the Christian Science Church," according to an article in the Annual Review of Public Health by Dr. Douglas Diekema, a doctor and bioethicist at Seattle Children's Hospital. But even though the church is well known for its belief in healing through prayer, it does not advocate that its members refrain from vaccinating children.
Washington Just Announced the First Measles Death in the United States in 12 Years. What's Wrong with Us?
The Stranger, July 8, 2015
Preventable diseases aren't supposed to be killing people in 2015. Yet the Washington State Department of Health recently had the unenviable task of announcing the first measles death in the United States in more than a decade. On July 2, the DOH revealed that a case of pneumonia brought on by measles had killed a woman from the Olympic Peninsula in the spring. The latest measles death wasn't related to the strain unleashed in Disneyland last winter. But, like the Disneyland outbreak, the new case highlighted the damage individual choices not to vaccinate can have on more vulnerable members of a community. Seattle Children's Dr. Doug Opel is featured in this article.
New way to tackle vaccine hesitancy tested, found wanting
Group Health Research Institute, June 1, 2015
Group Health Research Institute conducted the first randomized trial to test an intervention aimed at improving hesitancy about early childhood vaccines by working directly with doctors. Vax Northwest, a Washington state public-private partnership, developed the intervention. The results are reported in Pediatrics in Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial, with an accompanying editorial: Physician Communication with Vaccine-Hesitant Parents: The Start, Not the End, of the Story. The study found that vaccine hesitancy rates declined slightly in both the 30 intervention and 26 control clinics over the six-month study period – and did not differ significantly between them. The intervention did not change either mothers' vaccine hesitancy, or doctors' confidence in communicating about vaccines. Dr. Douglas Opel of Seattle Children's is quoted in this story.
How to win patients and vaccinate people
KevinMD.com, May 22, 2015
Pediatrician Dr. Douglas Opel at Seattle Children's is investigating the best ways to communicate with parents who are skeptical of vaccines. In a presentation at the Pediatric Academic Societies (PAS) meeting in San Diego in April, he reported that his research team is completing a study in which they videotaped pediatricians discussing vaccination with parents during well-child visits.
Study Shows Insurance Status Is Associated with Cancer Mortality in Teens and Young Adults
On the Pulse, April 15, 2015
About 70,000 young people ages 15 to 39 are diagnosed with cancer each year in the U.S., and cancer is leading cause of death from disease in this age group. While cancer survival continues to improve for children and older adults, outcomes have greatly lagged for teens and young adults. In recognizing this worrisome disparity, the medical community is working to identify the factors that may be contributing to this population's inferior survival outcomes. In a study featured today on the cover of Cancer, "Insurance status and risk of cancer mortality among adolescents and young adults," researchers have identified one of those factors: lack of health insurance and limited access to medical care. Dr. Abby Rosenberg is featured in this post.
Childhood Vaccination Rates May Be Lower for Military Kids
Reuters, April 13, 2015
Children with parents in the military may have lower vaccination rates than other kids, according to a large U.S. survey. Even with socioeconomic factors taken into account, parents' memories and doctors' records suggested that more military children under age three weren't up-to-date on their childhood vaccinations: 28%, compared with about 21% of other kids, researchers reported in Pediatrics. To ensure children are well-protected against vaccine-preventable diseases, a national vaccination registry would be ideal, Dr. Douglas Diekema, a pediatrician at Seattle Children's Research Institute, said by email. "Without that, families will need to try to keep a copy of each child's vaccination records and provide those to their child's new medical clinic when they move to a new home."
Anti-Vaccine Haven Digs In As Measles Outbreak Hands Science Crusaders an Edge
Huffington Post, March 6, 2015
Dr. Douglas Opel, a pediatrician at Seattle Children's and expert in bioethics at the University of Washington, has found that how doctors begin a vaccine discussion with parents can strongly steer decisions. In one study, when a doctor began with the recommendation a child was due for a certain vaccine, and then paused for the parent's reaction, Opel observed far less resistance than if the doctor began with an open-ended question. Still, if a parent does have an opinion or questions, Opel said, "it is inappropriate to close off discussion."
Nearly all states allow religious exemptions for vaccinations
Denver Post, March 2, 2015
Eliminating exemptions for religious and personal beliefs would certainly increase vaccination rates, said Dr. Douglas S. Diekema with the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute. But the strategy risks a backlash against vaccination requirements. "A better approach," Diekema said, "is to eliminate all barriers to vaccination. It should be easier to get vaccinated than it is to choose not to get vaccinated."
Nearly all states allow religious exemptions for vaccinations
Pew Research Center, February 25, 2015
Our analysis found wide variation in vaccination exemptions across the country. Some states have strict guidelines surrounding religious exemptions. Delaware, for instance, requires parents to submit a notarized affidavit stating that a sincere belief in "a Supreme Being" is the reason for the exemption request. And Oregon requires parents to obtain a "vaccine education certificate" either from a health care provider or by viewing an online seminar before their child can be exempted. And even though 46 states allow religious exemptions for vaccinations, researchers and journalists have struggled to identify a single major U.S. religious group that currently advocates against vaccination for children. Although the original reasons for religious exemptions to mandatory vaccines are unclear in many states, some exist "at least in part owing to the lobbying efforts of the Christian Science Church," according to an article in the Annual Review of Public Health by Dr. Douglas Diekema, a doctor and bioethicist at Seattle Children's.
Docs Seek New Ways to Tell Parents Just How Safe It Is to Vaccinate
Take Part, February 23, 2015
Pediatricians face growing numbers of parents who question or reject vaccinations for their children. Now, public health experts are working on new ways to help these doctors hone their pitches to families. A study of 111 patient discussions about vaccines involving 16 medical providers, published in the journal Pediatrics in December 2013, found that 83% of parents resisted vaccines for their children when the provider started off with "participatory" language, such as "What do you want to do about shots?" Lead study author Dr. Douglas Opel, a general pediatrician at Seattle Children's and assistant professor at the University of Washington, said that shared decision making with patients doesn't apply to vaccinations, because the recommended immunization schedule is the only medically acceptable choice. But he said it is important to address their concerns.
Can we nudge our way to higher vaccination rates?
Center for Health Journalism, February 20, 2015
When it comes to the media's coverage of the measles outbreak, Dr. Douglas J. Opel of the University of Washington is suddenly very much in the spotlight. That's largely because Opel, a pediatrician based at Seattle Children's and the University of Washington School of Medicine, conducts research that looks at how doctors talk to parents about vaccines. And as the media cycle looks for fresh angles on what's becoming an increasingly saturated beat, the topic of how doctors talk about vaccines has come to seem like the leading edge of the conversation over how to boost immunization rates (legislative efforts aside).
Some Parents Say Vaccines Violate Their Anti-Abortion Beliefs
Al Jazeera America, February 13, 2015
A series of measles outbreaks all over the country in recent weeks have drawn scrutiny to parents' decisions not to vaccinate their children. Before 2009, the measles vaccine was available as a stand-alone injection for parents who preferred it; this allowed parents to vaccinate their children against measles without using the rubella vaccine they view as problematic. Dr. Douglas Diekema of Seattle Children's is quoted in this article.
How to Get Silicon Valley's Anti-Vaxxers to Change Their Minds
Wired, February 12, 2015
There's been a lot of shaming and blaming of the anti-vaccination crowd in response to the Disneyland measles outbreak (even we did it). And when we released our investigation of vaccination rates at Silicon Valley preschools, people were justifiably angry: Every unvaccinated kid at those schools threatens the greater community's protection against disease. But yelling at anti-vaxxers won't change their minds – which is what we need most to prevent more outbreaks. That begs the question: What can turn them around? Dr. Doug Opel of Seattle Children's is quoted in this article.
Improve Vaccine Adherence by Presenting Immunization as Default Option
The Clinical Advisor, February 11, 2015
Evolving both immunization laws and provider practices is necessary to balance patients' individual choice and public health concerns, according to an editorial published in JAMA Pediatrics. In immunization practice, clinicians are left to decide how far to stray from the standard of care when parents request a revised vaccination schedule for their children. "Protecting individual choice and promoting public health are seemingly at odds. However, an impasse is not inevitable," wrote Dr. Douglas J. Opel, of Seattle Children's Research Institute, and colleagues.
Allow Only Valid Medical Exemptions to Measles Immunizations
The Seattle Times, February 10, 2015
As pediatricians, we have seen the benefit of immunization: the elimination of once-common diseases. Every day, we counsel parents about vaccines. We know they want to do what is best for their child. So do we. Most parents accept immunization, but not all. Un-immunized children can acquire and transmit measles – igniting outbreaks and endangering our community. Drs. Edgar K. Marcuse, Douglas S. Diekema and Douglas J. Opel of Seattle Children's co-authored this article.
The Surprising Reasons Behind The Growing Anti-Vaccine Movement
KUOW, February 10, 2015
Ross Reynolds talks with Dr. Douglas Diekema about why some parents don't vaccinate their children. Diekema is professor of pediatrics at the University of Washington and an emergency room physician at Seattle Children's.
Doctors Work to Ease Vaccine Fears
The Wall Street Journal, February 9, 2015
Pediatricians face growing numbers of parents who question or reject vaccinations for their children. Now, public health experts are working on new ways to help these doctors hone their pitches to families. A study of 111 patient discussions about vaccines involving 16 medical providers, published in the journal Pediatrics in December 2013, found that 83% of parents resisted vaccines for their children when the provider started off with "participatory" language, such as "What do you want to do about shots?" Lead study author Dr. Douglas Opel, a general pediatrician at Seattle Children's and assistant professor at the University of Washington, said that shared decision making with patients doesn't apply to vaccinations, because the recommended immunization schedule is the only medically acceptable choice. But he said it is important to address their concerns.
Vaccines: Delays, Too, Pose Risks
The Wall Street Journal, February 9, 2015
A 2013 study in JAMA Pediatrics found a big risk of contracting pertussis or whooping cough with each delayed vaccine dose, said Jason Glanz, a vaccine researcher with Kaiser Permanente Colorado and a lead author of the study. The study looked at 323,247 children from eight managed-care organizations in six states. "For every dose that was delayed, the risk went up significantly," said Dr. Glanz. "At the highest it was a 28-fold greater risk." Dr. Douglas Opel, a pediatrician at Seattle Children's, finds himself once a month in negotiations with parents about vaccines. About half the time he is successful.
To Get Parents To Vaccinate Their Kids, Don't Ask, Just Tell
NPR, February 7, 2015
As California's measles outbreak continues to spread beyond state borders, many doctors nationwide are grappling with how best to convince parents to have their children vaccinated. Inviting a collaborative conversation doesn't work all that well, many are finding. Recent research by Dr. Doug Opel, a pediatrician at Seattle Children's and a researcher at the University of Washington suggests that being more matter-of-fact can work a lot better. In the study Opel and colleagues described in the December issue of Pediatrics, they enrolled 111 parents, some hesitant about vaccines and some not.
The vaccine delayers: They hate anti-vaxxers – but don't quite vaccinate on time
Vox.com, February 6, 2015
Researchers completely disagree with the vaccine-hesitant group: they think their worries also undermine the decades of research that almost unequivocally shows vaccines are safe, and that they imperil society's "herd immunity" – the fact that even those who can't or don't get vaccinated are protected because diseases can't spread very far when most people are immunized. "There is just no science to this," summed up Dr. Doug Opel, a Seattle Children's pediatrician who studies vaccines. "We immunize with this vaccine at this time because kids are most at risk at this point. They are most susceptible. What gets lost a lot of the time is that there's an incredible amount of data underlying the recommended schedule."
Politicizing the Vaccination Fight Could Make Things Worse
New York Magazine, February 5, 2015
As opposed to dealing with vaccinations as a political issue, how should they be addressed? The expert consensus at the moment seems to be: (1) Researchers haven't yet figured out which messages can bring anti-vaccine folks into the fold; and (2) to the extent any messages are effective, they have to come from local, trusted figures rather than dictates issued on high from politicians or national-level health authorities like the CDC. Pediatricians are one example. "We know, based on several studies now, that parents really look to their parents' pediatric adviser for important influence on their decision-making," said Dr. Douglas Opel, a pediatrician at Seattle Children's who is developing a protocol to better gauge parents' vaccination intentions. "There's a lot of reasons to try to optimize those relationships."
A Way Out of the Vaccine Wars
BloombergBusinessweek, February 4, 2015
As coverage of the outbreak of measles at California's Disneyland continues to grow, the conversations surrounding the anti-vaccination movement continue to ramp up. According to Dr. Douglas Opel of the Treuman Katz Center for Pediatric Bioethics at Seattle Children's, "Physicians can increase vaccine compliance by making clear that full and prompt vaccination is an expectation, not just an option." It's important, though, to show respect for the parents' opinions. "We, the public health community, should recognize that they're starting from the right place," agrees Emory University's Dr. Saad Omer. "All parents want to see their kids healthy and are looking out for their welfare."
Pediatric Oncologist Learns About Loss The Hard Way
Physicians News Digest, January 26, 2015
Pediatric oncology can be one of the most emotionally draining specialties for doctors and health care providers. On one hand, the sight of a child cured of cancer can create an exhilarating high and validation of the job. But on the other hand, losing a child to cancer – even when it's not your own family – can be devastating. Doctors are supposed to be immune from those emotions. They are supposed to avoid emotional ties to their patients, right? Dr. Abby R. Rosenberg is a pediatric oncologist at Seattle Children's Hospital. She had too often seen families experience those highs and lows that go along with their child's cancer treatment. She had seen entire communities mourn the loss of a neighborhood friend as they "sustain each other, supporting, bolstering, and protecting from within," she said.
Case Sparks Debate About Teen Decision Making in Health
U.S. News & World Report, January 22, 2015
Only months before turning 18, a Connecticut girl has been told by her state's supreme court that she must undergo chemotherapy against her wishes in a case that has drawn national headlines and raised questions about what rights minors truly have over their bodies. Laws for minors' access to health care vary by state and typically involve mental health and substance abuse treatment or care for sexually transmitted infections. Some have pointed to a political double standard at play in Connecticut, noting that the state is one of a handful in which teens are allowed to seek abortions without parental consent, yet Cassandra is not allowed to refuse medical treatment for cancer. Supporters of the court's action in Cassandra's case say reproductive, substance abuse and mental health services are different from cancer treatment. "In both cases the law is designed to help the teenager.... They are not laws that recognize a teen's maturity," says Dr. Douglas S. Diekema, clinical director of the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute.
Circumcision Linked To Autism In Controversial New Study
Huffington Post, January 20, 2015
A controversial new study from Denmark shows a link between circumcision and autism, but other experts pooh-poohed that hypothesis. "One has to be very careful drawing any conclusions from studies like this," Dr. Douglas S. Diekema, a pediatrician at Seattle Children's and the University of Washington in Seattle and one of the authors of an American Academy of Pediatrics policy statement that is broadly supportive of circumcision, told The Huffington Post in an email. "They raise questions for further study, but do not provide answers... Correlation does not imply or prove causation."
- Circumcision Linked To Autism In Controversial New Study – Genetic Literacy Project


text:
Seagull Coastline S12 Guitar Cedar Left "NOT MINT"
Delivery In Canada Only.
Coastline S12 Cedar Left
Twelve string guitars must endure a great deal of added stress on the neck. The Seagull neck design offers superior stability, even on the twelve string models tuned to concert pitch. The straight string pull of the tapered Seagull headstock is an especially big advantage when it comes to tuning a twelve string guitar and keeping it in tune.
Specs :
Top : Select Pressure Tested Solid Cedar
Back & Sides : Canadian Wild Cherry
Neck : Silver Leaf Maple Integrated Set Neck
Fingerboard & Bridge : Rosewood
Nut & Saddle : Compensated Tusq® by Graphtech
Truss Rod : Double Function
Finish : Semi-Gloss Custom Polished Finish
Options :
Quantum I Electronics
TRIC Case

subset: commoncrawl


text:
Losing a pet, for us, was the hardest thing we have ever dealt with. Emotionally, the process was exhausting. I learned there is no 'right way' to grieve, and that this is a cycle that will surface from time and time again. We miss our boy dearly; Humphrey Bogart, you are one magnificent dog who we miss so much.Read More
In a Hurting World
My door bell rang and I opened it to three wonderful little boys staring up at me. One was a sweet kiddo who I haven't seen in two years, since he moved to another part of town. The other two are brothers who live just two houses down.
"My brother got killed yesterday," one said.
Cars sped by, my own children were inside begging for snacks, our gigantic Lab burst out the door, and six pained eyes waited for my response.
Loss is prevalent, and I know this first hand. I work at a children psychiatric facility where I teach lots of broken youth, all whom have incredibly traumatic backgrounds. But nothing could have prepared me for this.
Two days before this, my husband and I heard the loud blare of sirens flying down our street. All the first responders couldn't get to where they were going fast enough--which was to the location where a teenage boy had just been shot and killed. We heard the tears coming from our sidewalks, middle school-aged children crying and loudly mourning. Later that night we quietly entered our son's room and sat on his floor; we didn't even know yet what had happened or who it involved, we just knew something was terribly wrong. In the morning when we learned of the age and incident, our hearts just sank.
The very next day while I was at work, text message alerts came to our phones that there had been a shooting in our neighborhood: One was dead, the other in critical condition. In the middle of broad daylight, two young men shot each other; the one killed was the half-brother to my little neighbor boys.
What do you DO when young hearts ring your doorbell and bear such heart wrenching news?
Amongst the three children outside my door, my own kids inside, and my husband who wasn't yet on his way home from work--I needed to be packing for Tennessee, where I was supposed to be headed very soon; my world froze for a moment and I looked in to the eyes before me. "I am so sorry, Guys," I quietly said. "I love you all SO much, please be safe this weekend." I gave them all giant hugs and closed the door, where my world, for the most part, would be un-phased.
But what about theirs?
The whole weekend I spent out of state, my heart constantly thought about these families. I prayed often, and I thanked God for keeping my own family safe amidst the crime. I drove home 48-hours later and shortly before I got off the exit for our house my phone rang. My husband said the Vigil was happening at the park and that our road was blocked off--"Let me know when you're close and I'll ask the police to let you through," he said. When I pulled up to the house, my eyes shifted to the park. I saw the neighborhood children, their sad and somber faces, and my husband kneeling beside our little ones trying to keep them quiet. How do you explain to them what was going on? How much is too much for them to know? Later that evening we walked in our bare feet to their house, carrying a vase full of fresh flowers. Flowers? I asked myself. Is flowers a terribly insensitive idea? I just wanted them to know how much I love them.
The days continued to pass by, the boys always waved whenever they saw me. I was often greeted with warm hugs when I would pull up to the house or when they got home from school. We ordered them a pizza one night; a house full of kiddos and two hurting parents, I just wanted to be able to do something--anything.
Our two kids really didn't have a clue what was going on and at that point I was grateful. Explaining guns and violence to a three and four-year old just didn't seem pertitent. They probably thought we were just hanging out with friends at the Vigil and with the flowers, they assumed we were being nice neighbors. But flash forward a few months later, when my world was shaken even more...
Trolling Facebook mindlessly one evening, my eyes did a double take at someone's post. It was the gal we actually purchased this home from; she had shared a blog post and some sweet words of her own about a woman from this neighborhood that had passed away a few days prior. I clicked on the blog post and slowly read paragraph after paragraph, not even knowing yet that I actually knew her. I exited the link and decided to click on the profile of the woman who had passed away and my eyes just flooded with tears. I let out a horrified gasp and dropped the phone. Honest to God, I felt like I was in shock. I wasn't close friends of the woman, but I had met her several times at the park while at the playground with my kids. She was with her six kids, she had a friend with her, and both were talking and chatting so carefree amongst all the chaos. My kids played with hers--pretend kitchen is what they were doing, making dirt pies and desserts from underneath the slides. I introduced myself and went home to tell my husband all about her. My mom too, on the phone, I bragged about this woman. "Oh she'll be a great contact for you to get to know when you take time off with the kids," she said.
And now she's gone.
I don't know many details, except that she passed in her sleep. She has six children, three whom are adopted, and she homeschooled all of them. It was clear when I met her that she was a Believer, and while I should be assured that she is resting now with her Savior, I'm just not. At all.
I've prayed for her family daily, often multiple times a day. I sobbed uncontrollably after realizing who she was and thinking about how young, how much more life here on Earth she 'should have had.' It's not my place, right? To think something like that. None of us know the hour or the day of which we'll be called Home to our Creator, but six sweet children and a husband woke to their wonderful mom and wife, gone. Thinking about it honestly kind of haunts me, I have done the "what if" in my mind; what would my kids do? How would my husband react? Who would he call first? WHY would Jesus allow this to happen? I walked through the park with my kids last week and we passed her house. The dog was barking in the backyard and tears again immediately flooded my eyes.
I was alone with the kids and quietly asked, "Hey, Guys. Mama wants to pray. Is that okay? I just want to pray for the family who lives in that house." My 4-year old immediately said, "Why, Mom? Are you afraid they're going to die?" How he was that intuitive or immediately came to that concern is beyond me? But he continued to ask over and over and I felt like I was going to snap. I felt like I would be lying if I beat around the bush and avoided the question, so I answered honestly. "You know what, Buddy...? There are a lot of kids who live there and their mommy actually did die." Of course this brought a series of questions and a little bit of concern from my young son who cannot grasp the concept of death or his mommy no longer being here. And once again, my heart just broke. My son can't process it or understand, so how are her children doing?
The world is still spinning around and around, construction workers still working, basketball players playing ball on the courts, little kids riding their bikes... but a household is without their mother. A husband without his wife.
And the same for my neighbors... the world has continued to survive without their sweet boy; homework and school and sports and family dinners. But a giant piece of their heart is still missing. And what do we do about that?
Friends, I'm just immensely shaken. There is so much pain and hurt and suffering in this world. There are babies without their parents and parents without their babies. I don't have a solid answer on how to fix it and I know it's not my job to. But will you just pray with me? For the lives and hearts of Gods' children who all just need HIM to show up for them? To be their shoulder, their voice, their comfort, their song. It's times like this that I often begin to doubt the goodness of my Father, but I am fighting hard to hear Him through the tears. And the days for these families will be so much brighter if we can be in this together. Stand with me, pray with me, and remember that everyone, everywhere, is dealing with some hardship, so let's just LOVE.


text:
Do your KPIs Reflect Business Insights?
Obsolete KPIs can be Lethal
In the Aesopian fable of the one-eyed stag, a deer overcomes his visual handicap by grazing on a cliff near the sea with his good eye facing the land. Since all his known dangers were on land, this keeps him safe from predators for a very long time – until he is killed by a hunter in a boat.
The relevance of our KPIs can make or break our business. KPIs are often defined as static metrics for an enterprise and can easily become outdated. Economic uncertainty and competitive pressures are prompting questions on the validity of KPIs and performance management processes. To stay competitive requires a process of continually validating metrics with the business environment.
Another common challlenge with KPIs is that there are too many of them. Modern technology has gven us the ability to measure a very large number of parameters in the business. Some of these are more relevant than others. Jack Welch is known to have said, "Too often we measure everything and understand nothing". Monitoring some metrics and ignoring others are decisions we make based on our business perspective.
Relevance Enabled by Process
How do you decide on which KPI's are most relevant to success? An often overlloked first step is to understand that primary business goals before looking at the technology solution. Avinash Kaushik defines KPIs simply as "Measures that help you understand how you are doing against your objectives". This fundamental aproach is a good way of weeding out items which are not relevant to what we want as a business and avoid adverse surprises. At a more deeper level, building a robust Business Analytics solution requires answers to questions such as:
1. What events have the greatest impact on the busiens and how are they measured?
2. How often do you validate that you are measuring the right parameters ?
3. What instrumentation do you need to create the right dashbords for your KPI's ? Can this instrumentation be updatd as teh KPIs change?
4. What is the process for collecting, synthesizing, manipulating and presenting the data to represent thsese metrics? How does the process change when if the metric change?
5. What technologies and architecture are necessary to support those decision-making patterns? Is there need for a "single source of truth" or a federated model possible?
Centers of Excellence
Needless to say, this approach requires a tight inegration between the business owners and IT acrchitects. A recent study by Gartner says that "IT collaboration initiatives fail because IT leaders hold mistaken assumptions about basic issues…..rather than making technology the starting point, IT leaders should first identify real business problems and key performance indicators (KPIs) that link to business goals."
Many business executives believe that IT is unable to deliver results where it counts. At the same time, IT organizations spend an incredible amount of time, money and resources simply reporting obvious data within their business process and workflows.
An organizational solution to this problem is the creation of a Competency Center or Center of Excellence (CoE) with representation from from both business and IT and shared objectives. The CoE defines the blueprint for implementing BI, Performance Management and Analytics aligend with KPIs. Some of the obvious benefits include:
- Cost savings from eliminating Silos
- Better collaboration between Business and IT
- Joint ownership of corporate objectives
There are other aspects of the CoE which make it a practical approach to creating an effective vehicle for deploying analytics solutions. The sheer volume and texture of busienss data is much more complicated than it has ever been in modern busienss history. The world's data doubles every two years creating more opportunities for analyses. Understanding this data even at an aggregate level requires a business perspective combined with technological expertise. Furthernore, understanding technologies such as Big Data for unstrcutured data analysis requires business leaders and IT eimplementors to work together.
The CoE is the ideal structire to implement a Business Perspective Solution. A well implemented Business Perspective Solution takes into account the key objectives of the busienss, leverages sophisticated analytics technologies and focuses on sustainable processes to support decision making in an organization.
Superior decisions based on business perspective separate winners from losers.
Are your KPIs in sync with your business perspectives? Please share your comments below.
Further Reading
1. Six Web Metrics / Key Performance Indicators To Die For by Avinash Kaushik, Occam's Razor
2. Practical BI – What CEOs want from BI and Analytics by Ravi Kalakota, Business Analytics 3.0
3. The Stupidity of KPIs in Business Analytics by Mark Smith, Ventana Reasearch
Big Data, Analytics and KPIs in E-commerce and Retail Industry
- How to convert Lookers to Bookers…
- How to create unique and effective Digital Experiences that impact probability of purchase or likelihood of return.
- What offers might result in higher "take rates"
The change in consumer behavior and expectations that e-commerce, mobile and social media are causing is hugely significant – big data and predictive analytics will separate brand/retail winners from losers. This won't happen overnight but the transformation is for real.
Retail Industry makes up a sizable part of the world economy (6-7%) and covers a large ecosystem – E-commerce, Apparel, Department Stores, Discount Drugstores, Discount Retailers, Electronics, Home Improvement, Specialty Grocery, Specialty Retailers and Consumer Product Goods suppliers.
Retail is increasingly is looking like a barbell – a brand oriented cluster at the high-end, a very thin middle, and a price sensitive cluster at the low end. The consumerization of technology is putting more downward pricing pressure in an already competitive "middle" retail environment. The squeeze is coming from e-commerce and new "point, scan and analyze" technologies that give shoppers decision making tools — powerful pricing, promotion and product information, often in real-time. Applications in iPhones and Droid, like Red Laser can scan barcodes and provide immediate price, product and cross-retailer comparisons. They can even point you to the nearest retailer who can give you free shipping (total cost of purchase optimization). This will lead to further margin erosion for retailers that compete based on price (a sizable chunk of the market in the U.S, Europe and Asia).
Data analytics is not new for retailers. Point of sale transactional data obtained from bar-codes first appeared in 1970s. A pack of Wrigley's chewing gum was the first item scanned using Universal Product Code (UPC) in a Marsh Supermarket in Troy, Ohio in 1974. Since then, retailers have been applying analytics to get even smarter and speedup the entire industry value chain.
More recent use cases of retail analytics include: Read more


text:
Edited 4/20: And the winner is....... Ophelia Leong!! Thank you yet again to everyone who took the time to fill out the survey.
Here are the winning Fruits: Watermelon, Avocado, Fig, Dragon Fruit, Raspberry, Grape, Pear, Grapefruit, Blackberry, and Boysenberry.
Edited to add: Survey is now CLOSED. Thank you to everyone who voted!! Giveaway winner will be announced Monday April 20th at 3 pm EST.
Hello lovely people! I bring you the (drum roll please...) Fruit of the Day Survey! Now is the time to vote for all of your favorite fruit patterns from the past month and help me create my spring/summer collection! I will be turning the top pattern sketches into proper patterns that will be uploaded to my shops.
Below you will see a compilation of each Fruit of the Day numbered and labeled, as well as the survey to fill out at the bottom. You can vote for as many or as few as you want. If you would like to be added to my newsletter to be notified when the collection goes live, feel free to leave your email. The survey will remain open until Friday April 17th! Thank you for coming along this journey with me. I can't wait to see what y'all pick!
Giveaway Details:
Because you guys are awesome, each survey entry will be eligible for my very first giveaway! One person will win a 8" x 10" print of one of the final patterns (winner's choice). The winner will be announced on my Instagram, on this here blog, as well as contacted by email. Winner will be announced Monday April 20 at 3pm EST! One entry per person.
p.s. please be aware that some of the colors are not completely accurate in the below photos.


text:
In M. Night Shyamalan's Unbreakable, Samuel L. Jackson, playing the character of Elijah Price, states that comic books are an ancient way of passing on history. They are our version of the ancient mythologies. I've never been that avid a comic-book reader, and it's something I have some regret over, so I'm hoping that you all will help me out with comments, as you have in my past attempts to write about the media's coverage of comic books and religion. I will say that after watching Superman Returns I was somewhat impressed with level of religious imagery. But without that background, it would be easy to completely miss, which is why I believe many movie reviewers missed it.
But on to more comic-book news.
Saturday's Washington Post carried an excellent piece on the longstanding battle between the two comic-book titans, DC and Marvel. The article, written by Hank Stuever, makes many comparisons between the two publishers, but largely leaves out the subject of religion:
DC Comics, led by Superman, was for people who adored the fantasy, the Ubermensch triumphant. These readers loved skyscrapers and archvillains and sidekicks, billowing flags, unerring ethical strength.
Marvel, led by Spider-Man, was a place for the smart but troubled reader, the deeply weird. They loved the night, the underground, accidents in the lab. All that dialogue, so many thought balloons! The heroes always on some emotional ledge, and the hubris of it all -- a grittiness that came with saving the world.
DC was about younger kids in back yards, wearing bath towel capes, leaping from treehouses.
Marvel was about older kids in basements, possibly stoned, deconstructing Thor.
DC invented places to go -- Metropolis, Gotham City, Paradise Island.
In the Marvel universe, New York is New York, and it's nothing but trouble.
DC: It was always the Fourth of July.
Marvel: It was always Halloween.
DC: Comic books are a wonderful escape.
Marvel: Comic books are a dark refuge.
Does a discussion of religion in these two comic book empires have a place? I wouldn't be able to say for sure because, as I said, I am not an avaricious reader of comics. I would say, after seeing Superman Returns, that the folks over at DC Comics appear to be more in tune to the religious side of the world, but I don't see why that would be any different over at Marvel Comics.
So you tell me. Did this article miss something?


text:
The purasan waste treatment device is it a holding tank? I'm changing my holding tank and not sure what to go with. I have 1987 Aqua Sport 29ft. and dumping rules have changed since 1987. do you have any suggestions.
The Purasan Waste Treatment Device will treat each flush individually, when the next flush occurs the previous flush is pumped out sanitized. This is not a holding tank set up.


text:
Last week there was a small incentive program that would net us each $100 in cash if we brought in 10 orders each by Friday. Now the main reason I stayed with this job is for money as it is not in my highest and best spiritual good to be there. However, I decided not having enough money to live on was more stressful to me than spending so much time in the lower vibration energies in this job. That may change at any time.
So as the days went on and people were all excited about the extra $100 I found myself getting more and more stressed. I wanted the money too but I couldn't make it happen the way others were. One person turned out to be a great salesperson because he could turn around everyone's objections and talk them into buying. That sounds great but it was done with such lack of compassion and integrity that I actually hurt listening to him (think sleazy car salesperson – type selling cigars to people who are trying to quit or who are ill or don't have enough money etc). He is the only one who got the $100.
By Thursday I realized I couldn't handle the energy any more and I made myself detach from the idea of the extra money and turn it all over to god. I opened to the faith and trust that I was creating the money I needed perfectly, whether it was this $100 or it came some other way. I relaxed and went back to having fun talking to people on the phone. I then proceeded to get 5 more orders in quick succession in a way that was fun and lighthearted. People who wanted the product ordered, I got back to my own energy.
That night I had an unexpected client and another one over the weekend, which brought me more than $100. I felt supported by the universe. It is more difficult to maintain my own authenticity, integrity and vibration now that I am working in a part time job that means nothing to me. I am hoping that this opportunity will teach me how to be who I truly am in any situation, not just the ones where I am alone or teaching others. I am also looking for a different job and maintaining some intense gratitude for the spiritual support that continues to sustain and amaze me.
Remember – refer 3 new clients who purchase time with me and you get a half hour for free.
Next Spiritual Boost Teleconference is June 17. These are VERY powerful and quite reasonable. Read More Here.
Enjoy a Quickie Email Reading – email me question(s) and I will answer all I can in 10 minutes for $11. You will be surprised how much information you can get!!
NEW CLASSES in Encinitas, CA – READ ALL ABOUT THEM HERE.


text:
The Horizon™ stove is a wood-burning, gasifying rocket stove that burns very efficiently with little or no smoke. Made of stainless steel and built to last but small and light enough to be portable with FREE DELIVERY!
Product Details...
Upload a photo of you, your friends and your EcoGrill to our Customer Memories Blog and we'll send you another EcoGrill COMPLETELY FREE!!!
Upload Now
Privacy Policy | Login | Sitemap | Terms & Conditions | Links
Eco Consumer Products Ltd. Reg No. 07650898. Peterhof, Bilton Hall Drive, Harrogate, HG1 4DW
Website Design Harrogate | Image Concepts


text:
South Africa level T20I series with thumping win
Top stories from around the world in our round-up
Mike Gatting's best red-ball XI
United Arab Emirates in Netherlands T20I Series 2019 - Fixtures and Results
Filter by:
Who's leading in every format
Ross Taylor: 'The camaraderie of this team is the best I've been part of'
Records index
Most runs, most wickets, and a whole lot more
Do I love to hate Dhoni? Or hate to love him?
Inbox: What's in a number? In cricket, quite a lot
The man who keeps New York cricket ticking
The cricket calendar
Schedule of upcoming international games
Nick Compton picks an XI of players he's played with
Longreads you don't want to miss


text:
What if your villain was your story's protagonist?
This is the question my super-amazing screenwriting friend Erik Martinez asked me over Skype last week and it exploded my brain. I was struggling with my YA Fantasy work-in-progress THE NEVERS. I knew I hadn't developed my villain the way I needed to. I knew I was sitting back on my laurels and letting my bad guy simply be "evil." And THAT attitude toward my antagonist is exactly what was holding up my writing progress.
Because evil isn't black and white.
Evil comes from a character who believes he's doing what is right. And my brain exploded with ideas when my friend Erik told me to think about my villain as the HERO of the story! What motivates my villain? What does he believe? Why does he believe it matters and is worth all the sacrifices and dark deeds he must do?
I was struggling to connect with my villain because I'd stopped seeing him as a real human being. I let him become an archetype, an idea. I'd let him fall into the stereotypical concept of "the monster." However, the moment I started to think about him as a real life human being with flaws and dreams and – get this – a heart…
This week's video is all about how I hit the wall with my WIP and the five pieces of advice Erik gave me on how to develop my villain. I spent memorial weekend journaling about these topics and BAM! I'm off to the races again … typing away!
Five ways to develop your story's villain:
If you have techniques and advice on how to develop your story's antagonist, please share them in the comments!
Happy writing everyone!


text:
Balance or Alignment?0
We're all heartily encouraged to find balance – whether it's balancing work with our lives, eating a balanced diet or balancing our mind, body and spirit.
It's dangled in front of us as the modern ideal. It's spoken of as if it's an attainable, rational goal instead of something that more accurately describes a logical mathematical equation or a well managed budget.
Expecting balance to be an achievable outcome of human lives is an unrealistic notion and can only lead to disappointment!
Human beings are not logical, neat or linear. We are inherently unbalanced – we focus on one thing, often obsessively, for periods of time. We lurch from one thing to another. We immerse ourselves in our latest project for extended periods of time. It could be raising our kids, completing the renovation, generating sales or winning a promotion. We spend extended periods on different things depending on our focus or responsibility. We may raise our heads for moments at a time to have dinner with our family, energise our bodies or take the dog for a walk, but then we go back to our latest project.
Rather than aspiring for balance, the goal should be to align what we do with what's important to us – RIGHT NOW.
People who feel most fulfilled and content are using their skills, experiences and talents to do what interests, stimulates or challenges them and provides an opportunity to make a difference or contribute in some way.
Instead of attempting to find balance, perhaps the goal is to know what you're good at, what interests you, what your values are and what difference you want to make. Then do it!


text:
Mrs. Vignaux's class at Portway Infant School, Andover has been busy drawing owls inspired by Wow! Said The Owl. I think their artwork is fabulous. I love the expressions and how the owls all look so different. The use of tissue paper collaged to create layers is very effective and so is the use of chalk and wax crayon on black sugar paper. I'm definitely going to try out this technique at my next school workshop.
All images uploaded with kind permission from Mrs. Vignaux, Portway Infant School, Andover.


text:
Day Four
Week Two - Day Four
Worship Jesus all times, in all circumstances
John 4:20-24 - "Our fathers worshiped on this mountain, but you say that in Jerusalem is the place where people ought to worship." Jesus said to her, "Woman, believe me, the hour is coming when neither on this mountain nor in Jerusalem will you worship the Father. You worship what you do not know; we worship what we know, for salvation is from the Jews. But the hour is coming, and is now here, when the true worshipers will worship the Father in spirit and truth, for the Father is seeking such people to worship him. God is spirit, and those who worship him must worship in spirit and truth."
1 Thessalonians 5:16-18 - Rejoice always, pray without ceasing, give thanks in all circumstances; for this is the will of God in Christ Jesus for you.
The woman at the well had a genuine desire to worship God, but she had conflicting instructions on how to do so. Jesus addressed her questions by explaining that worship happens with the whole of one's being (the heart) and flows out into life with actions and words. It was so beautiful to see Jesus redirect her from places and practices to a person, himself. She began to see that the object of her worship was standing right in front of her.
Now Jesus isn't on Earth any longer, but worship of him doesn't stop. Colossians 1 reminds us that he is still ruling and reigning. He is worthy of our worship at all times and in all places. In 1 Thessalonians we are told that God desires us to rejoice always and give thanks in all circumstances. Like the woman at the well, we are tempted to think of worship as an event that happens in certain circumstances; maybe it's when we are sitting in church on Sunday, when we are happy, or when we get what we want. But, God calls us to something more. He calls us to a life of worship, not a ritual of worship. In Acts 16 there is a story of Paul and Silas who were beaten and thrown into prison for casting a demon out of a woman. At about midnight, they are sitting on the ground with their feet locked in the stocks. The Bible records that they are singing worship songs (Acts 16:23-25). There's another story of a man named Job who had everything taken from him; even as he grieved over this loss, he still worshiped (Job 1:20-21). Worshiping Jesus ought not to occur in response only to our blessing. Jesus is worthy of our worship at all times and in all circumstances. Not only because of what he does but because of who he is.
• How will you worship God in your current circumstances?
• Today, how can your worship be contagious to others around you?
• For additional reading, walk through Psalms 95-100 and pray prayers of thankfulness and adoration.
• Record your responses in your journal or note taking app and share them with someone in your group or family.