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How AP reported in all formats from tornado-stricken regionsMarch 8, 2012 When the first serious bout of tornadoes of 2012 blew through middle America in the middle of the night, they touched down in places hours from any AP bureau. Our closest video journalist was Chicago-based Robert Ray, who dropped his plans to travel to Georgia for Super Tuesday, booked several flights to the cities closest to the strikes and headed for the airport. He’d decide once there which flight to take. He never got on board a plane. Instead, he ended up driving toward Harrisburg, Ill., where initial reports suggested a town was destroyed. That decision turned out to be a lucky break for the AP. Twice. Ray was among the first journalists to arrive and he confirmed those reports -- in all formats. He shot powerful video, put victims on the phone with AP Radio and played back sound to an editor who transcribed the interviews and put the material on text wires. He then walked around the devastation with the Central Regional Desk on the line, talking to victims with the phone held so close that editors could transcribe his interviews in real time. Ray also made a dramatic image of a young girl who found a man’s prosthetic leg in the rubble, propped it up next to her destroyed home and spray-painted an impromptu sign: “Found leg. Seriously.” The following day, he was back on the road and headed for Georgia and a Super Tuesday date with Newt Gingrich’s campaign. The drive would take him through a stretch of the South that forecasters expected would suffer another wave of tornadoes. To prevent running into THAT storm, Ray used his iPhone to monitor Doppler radar, zooming in on extreme cells and using Google maps to direct himself to safe routes. And then the journalist took over again. “When weather like that occurs, a reporter must seize the opportunity to get the news out and allow people to see, hear and read the power of nature so that they can take proper shelter,” Ray says. So Ray now started to use his phone to follow the storms. He attached a small GoPro camera to his steering wheel in case a tornado dropped down in front of the car somewhere, and took video of heavy rain and hail with his iPhone. Soon, he spotted a tornado and the chase was on. He followed an unmarked emergency vehicle to Cleveland, Tenn., where he was first on the scene of the storm's aftermath. Again, the tornadoes had struck in locations that were hours from the nearest AP bureau. Damage and debris, as well as a wickedly violent storm that made travel dangerous, slowed our efforts to get to the news. That wasn’t a problem in Tennessee, where our customers were well served by an all-formats report that included this text story. “CLEVELAND, Tenn. (AP) _ Fierce wind, hail and rain lashed Tennessee for the second time in three days, and at least 15 people were hospitalized Friday in the Chattanooga area.” The byline? Robert Ray. For being adept with technology, chasing after news as it literally dropped from the sky and setting a standard for all-formats reporting that put the AP ahead on the most competitive news story of the day, Ray wins this week’s $300 Best of the States prize. © 2013 The Associated Press. All rights reserved. Terms and conditions apply. See AP.org for details.

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Did you know you have two little yellow, nine-volt-battery-sized adrenal glands in your body, just chilling out, maxin’, relaxin’ all cool on top of your kidneys? Someone told me this and I checked it out. Turns out it’s true. It seems as though your adrenal glands are kind of like those British Royal Guards with the big, black fuzzy hats who stand like statues in front of Buckingham Palace. They just stand there quietly, not doing much really, just enjoying the brown, slippery beach that is your kidneys. However, if anything startling should happen that requires your attention — like say you’re about to give a speech at a wedding or your hear a twig crack outside your tent or your doorbell rings in the middle of the night — then they leap into action, jumping out of their peaceful slumber to squeeze out a big dose of adrenaline right into your body, pumping you up, and turning you into a primal, warrior-like version of yourself. When tension runs high and adrenaline is secreted into your body some crazy things can happen — sometimes called the fight-or-flight response: - Your heart rate increases. And specifically, your body starts sending blood to all your big muscles and diverts it away from “non-critical” parts of your body, like your brain, immune system, and digestive system. I guess someone figured you could digest the sandwich after you killed the bear. - Your pupils dilate and you get tunnel vision. Quite literally, adrenaline also reduces your peripheral vision, which together with your big, wide pupils helps you focus on what lies ahead. You can’t quite see through walls, but if a crow is diving at your eyes you might be able to swat it away better. - Your body gets ready to boot it. In addition to the rising heart rate, your body starts turning lots more stuff into sugar, raising your blood sugar level and filling you with energy. You might not even feel pain as easily, so the raspberry bushes that shred your legs when you’re running out of the forest won’t slow you down. But what’s also great about adrenalin is that, first of all, you don’t have to control it. It just sort of kicks it into high gear when it figures you could use a boost. I think it’s kind of cool knowing that your body will help you out when you need it most. Punch me in the face and suddenly my internal British Royal Guard tosses away his fuzzy, black cap, cracks his neck, and rolls up his sleeves. And really, isn’t it that little dose of adrenalin that helps you do a better job when you need it most? It’s a natural upper, helping you nail the big speech, ace the final exam, or perhaps flee both of those scenes. There’s a reason some people become adrenaline junkies. The boost you get from your adrenal glands waking up and getting out of bed is intoxicating. Sure, it fuzzes up your thinking a bit and sends your intestines on sabbatical, but it sure does pump you up. And remember: when something important in your life is about to happen, you can count on your good pal adrenaline to be there, juicing you up, helping you fight the good fight. Jian Ghomeshi is the host of my favorite radio show. It’s called Q and broadcasts across North America every morning. Jian is a big friend and fan of 1000 Awesome Things and The Book of Awesome and I’m really excited because he just released his first book. It’s called 1982 and is a beautifully written memoir about growing up in the suburbs of Toronto and trying to fit in. (My kind of book!) For those of you who love reading, I think he’s a fantastic writer and am really excited to recommend this book.

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In Suzanne Collins’s wildly popular Hunger Games books, children are chosen by lottery to serve as gladiators who fight to the death. The Games are televised for the entertainment of the general population. Collins models her games on ancient Rome, where gladiators fought to the death and slaves were fed to the lions. She even names her dystopian world Panem, after the Latin word for bread, as in bread and circuses, panem et circenses. Bread and circuses refers to the cheap trick of persuading the masses to cheer for a lion or a slave, for one gladiator or another, rather than participating in or observing or acting to change the political arena. Keep the general population fed with the most basic of food and keep their minds off of rebellion with the distractions of entertainment. As I read through Lenore Skenazy’s blog and watched her appearances on various chat shows, I kept thinking, “Bread and circuses.” There is so much air time to fill, so television producers and headline writers make news of the Mommy Wars. Free Range Parenting vs. Helicopter Parenting. Stay-at-home Mothers vs. Working Mothers. Breast vs. Bottle. Sleep Training vs. Attachment Parenting. Blah, blah, blah. In one blogger’s take on the issue, she asks, “Free range parenting versus helicopter parenting: which team are YOU on?” Really? We have to pick teams? These issues are so much more complex than x vs. y, but so much easier to digest if packaged in a familiar us vs. them format. In one clip, Skenazy and another parent appear on Anderson Cooper to replay how Skenazy was able to help this woman who is so much of the helicopter persuasion that in public washrooms she feels it necessary to go right into the bathroom stall with her daughter. “Doesn’t everybody?” this mother quips, when the audience gasps. They feed this woman to the lions, then they rescue her, undo her public shame with a public reformation of her extreme and errant ways. Unless it’s extreme, it’s not entertainment, so we have thown up on the screen all kind of wild and wacky folk on reality shows who hoard or dumpster dive for coupons for hundreds of free sticks of deodorant, saving up against Armageddon. What good does any of this do? Silly distractions from the reality lived in the murky middle ground. I respect Skenazy and her husband’s decision to let their son ride the subway alone. I respect her desire to move away from a culture where kids are kept bubble wrapped. I respect her initiative to create a television show that capitalizes on the buzz that her son’s subway ride generated. But I resent the circus atmosphere of telling the stories of bubble wrapped or free range kids. Why do mothers keep feeding each other to the lion of artificially polarized public opinion?

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40th Parliament, 3rd Session March 3, 2010 - March 26, 2011 About this Committee Like other standing committees, the Standing Committee on Health is appointed under the Standing Orders of the House of Commons for the life of a specific Parliament. It was first established in this form in 1994 to reflect the fact that the Department of Health and Welfare had been separated into two components: Health and Human Resources Development. By November 1995, this departmental restructuring was formally recognized in Bill C-95 (Department of Health Act). The House of Commons Standing Committee on Health is empowered to study and report on all matters relating to the mandate, management, and operation of Health Canada. This includes its responsibilities for the operations of the internal body called the Pest Management Regulatory Agency (PMRA). The Committee is also responsible for the oversight of five agencies that report to Parliament through the Minister of Health: - Canadian Institutes of Health Research (CIHR); - Patented Medicine Prices Review Board (PMPRB); - Hazardous Materials Information Review Commission (HMIRC); - Public Health Agency of Canada (PHAC); - Assisted Human Reproduction Canada (AHRC) The mandate of the Standing Committee on Health also includes reviewing and reporting on matters referred to it by Orders of Reference from the House of Commons relating to Health Canada and its associated agencies.

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Chang-an Jiang, Kim-leng Poh, and Tze-yun Leong It is a frequently encountered problem that new knowledge arrived when making decisions in a dynamic world. Usually, domain experts cannot afford enough time and knowledge to effectively assess and combine both qualitative and quantitative information in these models.Existing approaches can solve only one of two tasks instead of both.We propose a four-step algorithm to integrate multiple probabilistic graphic models, which can effectively update existing models with newly acquired models. In this algorithm, the qualitative part of model integration is performed first, followed by the quantitative combination. We illustrate our method with an example of combining three models. We also identify the factors that may influence the complexity of the integrated model. Accordingly, we identify three factors that may influence the complexity of the integrated model. Accordingly, we present three heuristic methods of target variable ordering generation. Such methods show their feasibility through our experiments and are good in different situations. Finally, we provide some comments based on our experiments results.

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No. 24; Updated March 2011 Click here to download and print a PDF version of this document. Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family. Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful. - Marked fall in school performance - Poor grades in school despite trying very hard - Severe worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child's age - Frequent physical complaints - Hyperactivity; fidgeting; constant movement beyond regular playing with or without difficulty paying attention - Persistent nightmares - Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures - Frequent, unexplainable temper tantrums - Threatens to harm or kill oneself - Marked decline in school performance - Inability to cope with problems and daily activities - Marked changes in sleeping and/or eating habits - Extreme difficulties in concentrating that get in the way at school or at home - Sexual acting out - Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death - Severe mood swings - Strong worries or anxieties that get in the way of daily life, such as at school or socializing - Repeated use of alcohol and/or drugs - Intense fear of becoming obese with no relationship to actual body weight, excessive dieting, throwing up or using laxatives to loose weight - Persistent nightmares - Threats of self-harm or harm to others - Self-injury or self destructive behavior - Frequent outbursts of anger, aggression - Repeated threats to run away - Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism - Strange thoughts, beliefs, feelings, or unusual behaviors See other Facts for Families: #25 Where to Seek Help for Your Child #52 Comprehensive Psychiatric Evaluation #57 Normal Adolescent Development, Middle School, and Early High School Years #58 Normal Adolescent Development, Late High School Year and Beyond #00 Definition of a Child and Adolescent Psychiatrist The American Academy of Child and Adolescent Psychiatry (AACAP) represents over 8,500 child and adolescent psychiatrists who are physicians with at least five years of additional training beyond medical school in general (adult) and child and adolescent psychiatry. Facts for Families© information sheets are developed, owned and distributed by AACAP. Hard copies of Facts sheets may be reproduced for personal or educational use without written permission, but cannot be included in material presented for sale or profit. All Facts can be viewed and printed from the AACAP website (www.aacap.org). Facts sheets may not be reproduced, duplicated or posted on any other website without written consent from AACAP. Organizations are permitted to create links to AACAP's website and specific Facts sheets. For all questions please contact the AACAP Communications & Marketing Coordinator, ext. 154. If you need immediate assistance, please dial 911. Copyright © 2012 by the American Academy of Child and Adolescent Psychiatry.

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Previous abstract Next abstract Session 40 - The Interstellar Medium. Display session, Tuesday, June 09 Gamma Ray Burst (GRB) explosions can make kpc-size shells and holes in the interstellar media (ISM) of spiral galaxies if much of the energy heats the local gas to above 10^7 K. Disk blowout is probably the major cause for energy loss in this case, but the momentum acquired during the pressurized expansion phase can be large enough that the bubble still snowplows to a kpc diameter. This differs from the standard model for the origin of such shells by multiple supernovae, which may have problems with radiative cooling, evaporative losses, and disk blow-out. Evidence for giant shells with energies of \sim10^53 ergs are summarized. Some contain no obvious central star clusters and may be GRB remnants, although sufficiently old clusters would be hard to detect. The expected frequency of GRBs in normal galaxies can account for the number of such shells. Program listing for Tuesday

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Everyone wishes for something. And lots of people believe they know how to make their wishes come true with magical thinking. What is it? "Magical thinking is a belief in forms of causation, with no known physical basis," said Professor Emily Pronin of Princeton. "So, for example, there's no known physical basis for how carrying a fluffy pink rabbit's foot in your pocket is going to increase your odds of winning the lottery." For magical thinkers, it's more about the power of their wishes, their feelings and their positive thinking to affect their lives directly. Twenty-seven-year-old aspiring actress Lindsay Lioz relies on magical thinking to further her showbiz career -- starting with visualizing every audition in advance. "It makes me feel like I've had rehearsal," she said. "It makes me feel prepared." Lioz also uses magical thinking to improve her love life. She's written a list of the qualities she wants in a man -- and she sleeps with that list under her pillow every night. How has it worked so far? "I have great men in my life, I do. I'm very happy with how it's working out." Magical thinkers call that idea "the law of attraction." It's a key element of the bestselling book "The Secret," which has been hailed by Oprah Winfrey and bought by millions worldwide. "'The Secret' is telling people that if you think positive thoughts, positive things will happen, even at a very specific level," Pronin said. "If you visualize getting a parking space, you will get one. If you want to get thin, just stop having fat thoughts." Magical thinking is not a religion. It's a different kind of faith -- a faith in the power of positive thoughts and feelings. Yet as unscientific as magical thinking sounds, Pronin said studies have shown there are times when it seems to have a real effect: "There was a study where people in their mid-20s were measured in terms of their optimism," she said, "and then, 50 years later, those who were more optimistic, were actually more likely to still be alive. So it's not always magical to believe that your positive thoughts are having a positive effect." Magical thinking starts in childhood. At the University of Texas, Professor Jacqui Woolley has examined how children who know the difference between what's real and what's not believe that wishing can cause a penny to appear in what has just been shown to be an empty box. "We find that, by about the age of 4, most of the kids we test seem to really believe that wishing works," said Woolley. "So that would be an example of magical thinking." Nick Barber spent his childhood wishing for riches, focusing on something his father gave him. "I was about 8 or 9 when my dad came home and gave me a fake million dollar bill," he said. "And that became something that represented my goals. I've hung on to it every since." Barber would even sleep with the bill under his mattress. Now, at 27, he runs a multimillion dollar real estate company in Dallas called UMoveFree, and he still has that million dollar bill in his wallet. How did that bill help him get to this point? "It allowed me to believe in myself at a very young age," Barber said, "not to pay attention to those that said you can't, and to always believe that I can."

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Do you drive a picop? Eat sándwiches de rosbif? Do you still own any cederrones? If these words don't sound familiar to you, that's because yesterday, the Associated Press released their first-ever Spanish language style guide, and set us all straight on the proper usage of some of Español's newest words. In case there's any confusion, picop is AP's official Spanish-language word for what many call a camioneta or pick-up truck, rosbif is their official spelling for "roast beef" in Spanish. And cederrón? That means CD-ROM. Duh. Gathered in the auditorium of the prestigious Columbia Journalism School, some of the leading Spanish-language journalists sat down on Monday evening to discuss the finer points of the "language of Cervantes" and the AP stylebook -- which they describe as the "journalist's bible." Debate over the AP's continued use of term "illegal immigrant" dominated much of the event. But the most lively part of the evening was the presentation of words with roots in modern-day English -- or "estadunidismos," as the new Stylebook calls them. If the Spanish-language style guide is to be our bible, then Monday evening's Moses was surely Argentine journalist Jorge Ignacio Covarrubias who has worked with the AP for more than 40 years and helped put together the new stylebook. The white-haired Covarrubias handed down to us such words as zapeo for channel surfing, cibersitio for website, pipermín for peppermint, ofimática for computer system for office management (like Word), and vermú for vermouth -- all in the form of a PowerPoint presentation. (Can we please call it a Powerrpoín?) But not all Spanglish words are fair game, according to Covarrubias. For example, the AP recommends against using parada to mean parade. The word "parada" has historically been used to mean "stop", but many modern-day Spanish speakers have started using it to also mean parade. The AP suggests that writers instead use "desfile." Many regionalisms are also discouraged. Autobús is the preferred term for bus, although some countries use guagua and others say colectivo. But, after lengthy discussion of the Spanish word for "drinking straw," (pajita vs. popote vs. canuto), no consensus has yet been reached, said Covarrubias. Not everybody was happy about all of the AP's decisions. Laura Martínez, a bilingual blogger who writes about Hispanic media, tweeted "Cervantes is probably revolcándose en la tumba tras escuchar el tema ése del "cederrón"," which translates to "Cervantes is probably turning over in his grave after hearing the thing about the 'cederrón'"

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Question: How is bipolar disorder different from unipolar depression or 'regular' depression? Answer: Both bipolar disorder and major depression are typically associated with depressive episodes. So both illnesses are accompanied by depressions. The difference is that in bipolar disorder people also have periods of elevation -- or severe irritability. We call these manic or hypomanic episodes.

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Nine people in South Korea have committed suicide in three separate incidents within two days. The latest was a 72-year-old man who hanged himself at a construction site in Hoengseong, Kangwon Province, Thursday, police said. Four women and one man -- in their 20s and 30s -- were found dead Wednesday in Hwaseong, just south of Seoul, after sealing a passenger car with plastics sheets and inhaling toxic fumes from burned coal briquettes. They left suicide notes saying, "I have no more hope and no more dreams" and "please find my identification card in my back pocket." Police were investigating their motive but assumed that the man recruited the four women on the Internet to participate in a group suicide. Earlier in another city east of Seoul, Chuncheon, three men in their 20s were also found dead at a private room-for-rent lodge using the same method and sealing the door and windows with dark masking tape from inside the room they were sharing. Police assumed that they, too, were driven by group suicide pacts cultivated online. Such news is common here where the suicide rate is the highest among members of the Organization for Economic Cooperation and Development group of developed countries. An average of 35.1 people killed themselves everyday in 2008, according to the health ministry. That's 24.3 for every 100,000 South Koreans, followed by 21 in Hungary, 19.4 in Japan, 16.7 in Finland and 15.8 in Belgium. The National Statistics Office reported that the suicides are related to the economic downturn, as well as rapid social change within the family and the community. Korean society in recent years has been plagued by continuous cases of suicide among celebrities, high-profile politicians and businessmen, teenagers and the elderly. Analysts say the most common cause is depression stemming from social and academic pressures or family troubles. "There's a huge gap in this country because the speed of materialism spreading is much faster than the speed of cultural maturity that must grow together. It all comes from stress of rapid modernization," said Jeung Taek-Hee, an expert and consultant at Lifeline Korea. Korean parents are having fewer children -- on average one per couple -- and more women are going into the workforce, which leaves the child alone. Although some corporations and government ministries are campaigning for workers to go home by 6 o'clock at least once a month to spend family time, Korean corporate culture still requires employees to participate in work-related dinners and stay late hours. "Naturally, these busy parents end up spoiling the child who ends up self-centered and incapable of dealing with competition," Jeung said. "But the reality is that this society is very, very competitive." Along with the miraculous rate of economic growth in the past decades, many South Koreans have become driven by materialism that has been passed on to their kids, Jeung said. He noted that most of the people who commit suicide, especially the young teenagers, find themselves dangerously distressed by not being able to keep up with others materialistically and eventually become anti-social. "The easiest place where they can meet friends who share the same pain is online through suicide communities or chat sites," Jeung said. Once they find each other, they become, "eternal comrades" who "must accompany each other to death," he said. According to the Ministry of Education, Science and Technology, 28.4 percent of young teenagers committed suicide in 2008 because of "disturbed family relations," mostly the result of parental divorce, 19.6 percent from pessimistic depression and 10.1 percent from academic pressure.

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World leaders from 47 nations convene this week in Washington, D.C., for the Nuclear Security Summit, a gathering that the Obama administration hopes will raise awareness about the threats of nuclear arms getting into the hands of terrorists or "rogue" nations. President Obama said Sunday the goal of the nuclear summit is to discuss the terrorist threat and getting countries to lock down their nuclear weapons in a specific time frame. The Obama administration itself has pledged to try to "secure all vulnerable materials" within four years and is hoping the summit will spark a case for preventive action among others. "If there was ever a detonation in New York City or London or Johannesburg, the ramifications economically, politically, and from a security perspective would be devastating," Obama said on the eve of the summit. "And we know that organizations like al Qaeda are in the process of trying to secure a nuclear weapon -- a weapon of mass destruction that they have no compunction of using." Secretary of State Hillary Clinton said last week that the nuclear summit would be the largest of its kind hosted by a U.S. president since the U.N. conference in 1945. But even as Obama brings the issue of nuclear security and disarmament into the spotlight -- first with the release of the new U.S. nuclear policy, and then the U.S.-Russia arms reduction agreement -- he faces significant challenges from two fronts. Internationally, U.S. allies such as India, Pakistan and Israel have been resistant to signing the Nuclear Nonproliferation Treaty, citing national security concerns. The view in many countries is that this week's treaty signing aside, if the United States and Russia -- which together account for 95 percent of the world's nuclear arsenal and material -- cannot cut their nuclear stockpile, why should they be forced to? "No one is willing to step up and say, 'Yea, I'm part of the problem here," said former national security official Ivan Oelrich, now vice president of the Strategic Security Program at the Federation of American Scientists. The "U.S. and Russia have to lead the way in major reductions." Participant countries will also likely be looking to the United States for accountability. Henry Sokolsi, executive director of the Nonproliferation Policy Education Center, argues that if the United States is going to try to persuade other countries, it needs to shift its own policy at home too. "I just think it's disrespectful to these countries," he said. "Each country has its own problems. If we're not helping them on that, how can we expect them to not rely on them [nuclear weapons] to feel secure? We rely on them. Why should they be any different?" Domestically, the partisan rift on Capitol Hill means possibly a tough fight ahead for Obama's nuclear agenda. Critics of the new nuclear policy released last week complain that it gives a free pass to countries such as Iran and North Korea, and Republican senators are already taking aim at the U.S.-Russia arms treaty that was signed last week, saying it hurts U.S. security interests. The general consensus is that the treaty will eventually be ratified by the end of the year, but the issue is likely to be the subject of a heated political debate for much longer.

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Recently I've been taking a deep dive into the Reactive Extensions for .NET. This is a wonderful project that comes out of Cloud Programmability Division at Microsoft. Rx helps do to really wonderful things with asynchronous and parallel programming in unreliable distributed world. Do you remember what LINQ did to the collections (and much more)? Well, Rx is going to do (and doing) the same to events, asynchronous and distributed programming. So if you have to deal anything that requires more than a single thread, process or machine to run - you'll be impacted in some way or the other. The thing I love the most about what Eric Meijer and his team are doing - the underlying logic which is simple plain and so beautiful. Even the entire IObservable/IObserver thing could be logically derived from IEnumerable by inverting the concepts logically. Just watch these videos, if you are interested in the details here (highly recommended): What does this have to do with CQRS, Domain-Driven Design and Event Sourcing? When I'm building some complex interactions and systems, I'm trying to follow the same principle. System design and evolution are not guided by the intuition or creativity. Pure logic and mathematical reason are the most reliable advisors here (it feels like proving a theorem). It's really hard to explain in words, but logically solid design can handle a lot of things with really little effort (and code) just because of it's nature. Basically it allows to say to new challenges: "we did not code for this, but since this is logical, it already is in the design, you just need to enable this". While I'm just learning CQRS/DDD/ES I want to do it in the logical way that will prevent me from doing bad and illogical things (which will impact my systems later in their lifecycle). Way of thinking that Eric Meijer shows, seems to help here. Besides, it helps to merge the ideas of Pat Helland (almost infinitely scalable systems) into the overall CQRS concepts. Reactive Extensions benefit a lot from the marble diagrams representing parallel processes and their interactions. So I've tried to re-apply these principles to my understanding of CQRS/DDD/ES. By mechanically reflecting the logic, here's what I've got for the command handler: Essentially this picture reflects the flow of commands (marked with D for Do) incoming into the handler. Commands can come as a single or as a batch (that's the marble or tick in this reality). Commands coming together either succeed or fail together. Each incoming tick translates into a new parallel reality for an aggregate (just like SelectMany in Rx, where you get observable of observable of T). Then we flatten successful commands onto the change stream (each change is a unit of work), while errors are flattened into the failure stream. There is a message dispatcher that catches up upon these streams and sends domain events, command failures and confirmations back to the message bus. This way subscribers will have logically complete information about what's happened in the business logic. Subscribers could include sagas and event handlers working with read models (which will be used to provide clients with feedback that includes potential command failures). Note a few differences upon the traditional CQRS with event sourcing approach as advocated by Greg Young: - Aggregate Root can react to incoming commands by providing a finite stream of events, optionally terminating with error (there is a direct translation from Rx observers here: OnError and OnComplete). - We save successful change (command(s) and resulting events) atomically as unit of work. Persisting commands will actually let us ensure command idempotency in the cruel world of scalable message queues (with "at least once" deliveries). Essentially this is reflection of Helland's activities that we need to have in the same scope with the aggregates that own them. - Command failures are also saved (although the stream could be different from the event source). We don't need to save the intermediate events though - just command(s) and the resulting failure. - Message dispatcher runs upon the failure and change streams, publishing domain events into the message bus. We have logically complete information here, that could eventually be provided for the client (sender) for the retrieval. - theoretically we can easily process commands for a single aggregate in multiple threads, serializing access to the change and failure streams. Things that do not fit in, yet: - In CQRS practice there are cases, when there would traditionally be a call to the domain service (in the command handler and before the aggregate root). This does not fit in here. In a Rx world this would probably be a separate async command handler. Yet this would require an additional layer of translation (another command handler and event handler). - events and commands are some sort of duals. They are both messages that bring along different intent and help to organize CQRS architecture (this comes from the DDD realm). Yet, this duality (and the rules coming out of it) brings additional complexity, when you need to chain multiple operations (first call unreliable operation, then pass the result to the aggregate, then do something else). I think I'm missing some aspect of commands and events that would help to lay out interactions in a clean and logical way. That's a theory and logic as I see them today. This means: - tomorrow perception might evolve into something different that better brings together known patterns and constraints. - in theory there is no difference between theory and practice. In practice - there is a difference. If I could bring in sagas, view event handlers and domain services into the picture in a logical way (and without breaking any existing scalability and consistency constraints), I'd be a happy man. We'll see how it goes (see xLim 4: CQRS in Cloud series for any latest materials on this topic). Meanwhile I'm really interested in your thoughts on this subject.

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If Superman had explored these issues instead of bashing unions and promoting charters, moviegoers might have walked away understanding a great deal about why the families it profiled and so many similar families across America face a bleak educational future. The movie certainly showed scenes of poverty, but its implications and the structural inequalities underlying that poverty were largely ignored. Devastating urban poverty was just there -- as if that were somehow the natural order of things but if we could only ‘fix’ schools it would disappear. While you’re reading it, keep this chart in mind (from Alex Knapp at Outside the Beltway): I’ve complained before about our schools’ obsession with behavior management at the expense of thought and inquiry. But I can see why the people in the blue slice above might be more interested in teaching the kids in the yellow slice to behave than in teaching them to question things. (h/t Balloon Juice)

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|HOME SCHEDULE AUTHOR INDEX SUBJECT INDEX| Partitioning of carbon, water, and energy fluxes between understory and canopy in a North Central Florida mature uneven aged pine flatwoods forest. Starr, Gregory*,1, Powell, Thomas1, Martin, Timothy1, Gholz, Henry1,2, 1 School of Forestry Resources and Conservation, Gainesville, FL2 National Science Foundation, Arlington, VA ABSTRACT- Of the 5.93 million ha of timberland within the state of Florida, only 19% are maintained under conditions classified as "natural" pine forest. While considerable attention has been focused on the carbon and water dynamics of managed pine plantations in the region, little attention has been given to these natural forests, which are an integral part of the complex mosaic of lands in the region. Based on this importance, it was our intention to quantify how environmental conditions affect ecosystem carbon, water, and energy exchange within a mature pine flatwoods forest and determine how specific components of the system, (i.e. leaf physiology, soil respiration, understory composition and canopy structure), contribute to these exchange rates. During the 2000-2001 field season, the natural pine flatwoods was a carbon sink with an annual net ecosystem exchange (NEE) of 183 g C m-2. The largest portion of this carbon was sequestered during the winter and spring when temperatures were cooler and canopy LAI was lowest. This could be attributed to a reduction in ecosystem respiration losses and a slight increase in understory photosynthetic rates caused by a larger portion of total radiation reaching the understory. Approximately 90% of the respiratory losses from the system could be accounted through soil respiration, which is highly correlated to soil water potential (r2=0.77, p<0.001). Comparison of eddy covariance measurements above and below the pine canopy indicated that 37% of the ecosystemís carbon, 51 % of its latent energy, and 56% of its sensible heat fluxes could be attributed to the understory. Preliminary results show that two species, Serenoa repens and Ilex glabra, comprise 95% of the understory vascular and both have relatively high leaf nitrogen concentration and photosynthetic capacities (~1.4% nitrogen and Amax ~ 4.0 mmol m-2 s-1) and account for ~ 90% of the carbon sequestered by the understory community. These initial assessments provide evidence that natural pine flatwood forest of Florida may be a small regional carbon sink. KEY WORDS: pine flatwoods, carbon and water exchange, eddy covariance

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Pneumonia is a common cause for ED visits. How do you decide on whether the patient can be managed as an outpatient or inpatient? To supplement your clinical judgment, many clinicians use the Pneumonia Severity Index (PSI) score. Have you heard of CURB-65, supported by the British Thoracic Society? What about SMART-COP, which is meant to help you predict if your patient will need Intensive Respiratory or Vasopressor Support (IRVS)? It's worth a quick review. Feel free to download this card and print on a 4'' x 6'' index card. Presentations are traditionally given using Powerpoint. Keynote is prettier alternative to Powerpoint but is only Macintosh-compatible. Both have the same antiquated structure such that content is presented only linearly. The hottest presentation tool now is Prezi, a web-based tool, which allows the viewer to zoom in and out of sections. The visuals are more of a conceptual map of the content, where the viewer or speaker can zoom around any desired topic. Because it's online, you can easily embed YouTube videos. Take a look at this Prezi demo advocating it as a tool for teaching. To navigate, you can click on the gray arrows at the bottom to advance forward or backward, as pre-programmed. Alternatively, you can drag the display using your mouse. Or you can zoom in/out using the + or - tools on the right. Google Docs is constantly improving and growing. One of the cool features is that you can embed any document within your blog. Whenever you edit the Google Docs document, it automatically updates in your blog. How do I do this? Within your document in Google Docs, click on the upper right "Share" button and select "Publish to Web". In the pop-up screen, select "Start Publishing". Copy and paste the provided HTML code in your blog. With a little HTML editing, you can make the optimize the margins bigger than the teeny preset dimensions. To change the margins to 440-pixel width and 500-pixel height, add the extra text (in bold) into your code as follows: And ta-da! Embedded is my handout from a recent talk on mobile apps in Medicine. A new CME publication has emerged from the publishers of Emergency Medicine Practice and Pediatric Emergency Medicine Practice called EM Critical Care. This new publication is specifically geared towards manging critically ill patients in the ED. There will be 6 issues per year with each issue offering 3 AMA PRA Category 1 credits. Although it has not yet been released, it appears to have an impressive editorial board including Emanuel Rivers, Michael Gibbs, Benjamin Abella and Robert Arntfield. Oh, and did I not mention Scott Weingart from the EMCrit Blog? If it is anything similar to it's predecessors, it is guaranteed to be a hit! In a Research Letter in JAMA, Dr. Chretien et al describe the profile of physicians in the Twitter universe, specifically focusing on professionalism. Self identified physician At least 500 followers during May 1-31, 2010 (Whew, I only have 309 followers.) Posted a tweet within last 6 months A total of 260 physicians were studied. 6.2% were from Emergency Medicine. 15% (most) were from Surgery and its subspecialties. 76% were from the United States. Three physicians independently coded the 20 most recent tweets from each account (total n= 5,156) for unprofessional content. There were 144 (3%) unprofessional tweets from 27 users: 55 (1%) - possible conflict of interest, advocating for non-standard therapies 38 (0.7%) - potentially violation of patient privacy 33 (0.6%) - profanity 14 (0.3%) - sexually explicit material 4 (0.1%) - discriminatory statement 25 of 27 (92%) of users were identifiable The authors conclude that, although rare, there should be more physician accountability and guidelines in the age of social media. This is even more true, since I just discovered that all tweets are archived by the Library of Congress! Take a look at your most recent tweets. How would they have performed if you were included in this study? Reference Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA: The journal of the American Medical Association. 2011. 305(6), 566-8. PMID: 21304081 . Dr. Rob Orman of ERCast blog fame emailed me last week about creating a pocket card on Suicide Risk Stratification. In many community ED's, risk assessment is done by the emergency physician. I'm lucky where I work, because we have a 24/7 psychiatric ED, which consults on suicidal patients in the "medical ED". In the end, assessment is primarily based on physician judgment, because there's no great clinical decision tool, rules, or scores to assess risk. Rob has created his own mnemonic to help you ask the right questions in assessing a suicidal patient. This is a sneak peak into a larger article that Rob is planning to unleash on the world on suicide assessment. Based on his review of the literature and own clinical experience, the mnemonic is: TRAAPPED SILO SAFE. "Risk factors" which increase a patient's risk for committing suicide in the near future. "Protective factors"which decrease a patient's risk for committing suicide in the near future. Feel free to download this card and print on a 4'' x 6'' index card. * Updated 3/8/11: Added extra "A" to include "Access to Means" as a risk factor. Ever since my post about the top medical apps, I have been inundated with people asking me to review their apps. One has stood out. Medibabble is a real-time medical translation app and is now available for FREE. It was created by two innovative UCSF medical school graduates, Dr. Alex Blau and Dr. Brad Cohn. This app contains an extensive preset list of history questions and physical exam commands. When you click on a sentence, the app will translate and speak the sentence in one of 5 languages (Spanish, Cantonese, Mandarin, Russian, and Haitian Creole). Take a few minutes to download all of the free languages onto your device. It only comes with Spanish pre-installed. There is a FAQ page at www.medibabble.com. The app is only available for the iOS platform currently. Does your Emergency Department have computerized spectrophotometric catheters to measure continuous central venous oxygen saturation (ScvO2) in early goal directed therapy (EGDT) for severe sepsis? That's what was used in the original Rivers' EGDT study. I've never even seen one before. Many emergency physicians are getting around not having the specialized equipment issue by obtaining intermittent venous blood gas measurements off of a central venous line. But what if you had a 30 y/o woman with early pyelonephritis/urosepsis who has severe sepsis by definition? She's got 10 peripheral lines (I'm exaggerating, of course), a normalized blood pressure with early IV fluids, and appears non-toxic. Her lactate, however, is 9! Do you really need a central line? My gut says no, but the EGDT protocol says yes -- for the purpose of CVP and ScvO2 measurements. Trick of the Trade: Use a less-invasive approach where bedside ultrasound and serial venous lactate levels replace central venous lines and ScvO2 measurements, respectively. Last year, JAMA published a landmark study showing that lactate clearance of ≥10% over the first 2 hours is "not a worse measurement" than ScvO2≥70%. This double-negative statistical speak came about because it was a non-inferiority study. So how does this affect the original Rivers protocol? To review, here's the original protocol, which I posted about earlier: (click to view larger image) In the less invasive model: Fluid resuscitate through peripheral IV access instead of a central line. Follow volume status either with a bedside ultrasound or urine output. Follow venous lactate levels at time 0 and 2 hours. If the lactate clearance is ≥10% over these 2 hours, you should follow the algorithm as if the ScvO2≥70%. That means no need for immediate transfusion or vasopressor agents. How do you know when you have adequately volume-resuscitated a patient using bedside ultrasound? Measure the IVC diameter about 1-2 cm from the right atrium junction. If the IVC diameter ≤1.5 cm and has ≥50% collapse with inspiration, the patient has a very low CVP. If the IVC diameter is at least 1.5 cm and has minimal collapse with inspiration, the patient is euvolemic. Move to the next step -- assessing the MAP. This doesn't mean that all EGDT patient should have ONLY peripheral lines. Persistent hypotension, a non-clearing lactate level, and/or clinical toxicity warrant more invasive monitoring and management. Scott Weingart has an in-depth, 21-minute podcast about the JAMA article and noninvasive approach to sepsis: Podcast link. Scott also briefly interviews Dr. Alan Jones (Carolinas Medical Center), the first author of the study, in the podcast. Reference Jones AE, et al; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA : the journal of the American Medical Association.2010, 303(8), 739-46. PMID: 20179283 . In its third official year, the Clerkship Directors in Emergency Medicine (CDEM) organization is still growing strong. It all started with six of us at an informal dinner in Boston about 5 years ago. And now the organization has grown so large that it is now for the first time offering annual awards to its members. Know an award-worthy educator? Nominate him or her! CDEM Clerkship Director of the Year Award This award recognizes an Emergency Medicine Clerkship Director that has made significant contributions to either a 3rd or 4th year EM rotation. To be eligible for this award, the nominee must currently be a Clerkship Director of a mandatory, selective or elective rotation and have served in that role for a minimum of 5 years. This award is presented at the annual CDEM meeting. CDEM Young Educator of the Year Award This award recognizes a medical student educator at the Clinical Instructor or Assistant Professor level and less than 10 year from residency completion who has made significant contributions to teaching and educating medical students. This award is presented at the annual CDEM meeting. CDEM Distinguished Educator Award This award recognizes a medical student educator at the Associate Professor or Professor level who has made significant contributions to and has demonstrated sustained excellence in teaching and educating medical students for 10 or more years. This award is not presented annually; rather, it is bestowed on special occasions. CDEM Award for Innovation in Medical Education This award recognizes a medical student educator at any faculty rank who has made a significant and innovative contribution to undergraduate medical education. This award is presented at the annual CDEM meeting. By learning about our differences, we can learn to appreciate and better communicate with those who are different from us. The same falls true for working with residents and faculty from different "generations", as defined as traditionalists, baby boomers, generation Xers, and millennials. This literature review and consensus document is quite extensive and even comes in 2 parts in Academic Emergency Medicine. There is a great summary table of the generational differences in personal, work, and educational characteristics, communication styles, and technology. Think of faculty who fit in these age groups. Do they fit their generational stereotype? Traditionalists (born 1925-1945) Personal characteristics: Loyal, reluctant to change, dedicated, value honor and duty, patriotic Work characteristics: Value hierarchy, loyal "company man", job security Education characteristics: Process oriented Communication style: Formal Technology: Tend not to understand Baby Boomers(born 1945-1964) Personal characteristics: Optimistic, desire for personal gratification, highly competitive Work characteristics: Workaholic, competitive, consensus builder, mentor Education characteristics: Learner depends on educator, lecture format, process-oriented Communication style: Diplomatic Technology: Not particularly techno-saavy Generation Xers (born 1964-1980) Personal characteristics: Independent, self-directed, skeptical, resilient, more accepting of diversity, self-reliant Work characteristics: Value work-life balance, comfortable with change, question authority Education characteristics: Independent learners, problem-solvers, desire to learn on the job, outcome-oriented Communication style: Blunt Technology: Interested and facile Millennials (born 1980-1999) Personal characteristics: Optimistic, need for praise, collaborative, global outlook Work characteristics: Team-oriented, follows rules and likes having structured time, career changes Education characteristics: Team-based learning environment, turn to Internet for answers, outcome-oriented Communication style: Polite Technology: Very saavy, technology is a necessity The authors give multiple examples where generational differences come to light but none more so than in mentorship within the academic department. Traditionalists view mentorship as a more formal process, where feedback is necessary only to provide criticism or suggestions for improvement. Baby boomers also view mentorship as a "top down" process. They are ok with infrequent interactions. Generation Xers and Millennialsprefer mentorship as a more "peer to peer" process with more frequent interactions. They value the personal relationships and the opportunity to collaborate in creative solutions. Because of their stereotypical distrust of authority, however, they may inadvertently sabotage their relationship with their mentors. Distrust sometimes is misinterpreted as a general lack of respect. To overcome these differences, mentor-mentee pairings should take into consideration gender and shared views about goals, work/life balance, and experiences. Early discussions in a mentorship relationship should discuss generational differences and how each envisions the ideal mentor-mentee relationship to be. The pair should agree upon and adopt a collaborative, shared communication approach with frequent feedback. So much more in this article... Take a read. Mohr NM, Moreno-Walton L, Mills AM, et al. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I). Acad Emerg Med. 2011, 18:190-9, 10.1111/j.1553-2712.2010.00985.x . A 50 year-old woman, who presented to the ENT clinic for followup check of a facial fracture, has a blood pressure of 210/100. She is asymptomatic and in no pain. She gets referred immediately to the ED for care. Now you see her in your ED. What next? There is a lot of controversy whether you should treat or not treat asymptomatic hypertension in the ED. The ACEP Clinical Policy says that there is no need to immediately reduce an asymptomatic patient's blood pressure. With "close followup", they can be referred to their primary care physician. With so many patients being uninsured or unable to access their primary care physician on short notice, many emergency physicians like myself are slowly moving towards starting antihypertensive medications for them. If you do decide to start an antihypertensive, which medication do you choose? This Paucis Verbis card is based on a 2009 Cochrane Review, and summarized in American Family Physician in 2010. The blue numbers denote a Risk Ratio (RR) which cross 1, meaning that there is no benefit. The red numbers denote a RR < 1, meaning that there IS a benefit. A low-dose thiazide, such as hydrochlorothiazide 12.5-25 mg po daily, is a safe and effective choice. Feel free to download this card and print on a 4'' x 6'' index card. References Quynh B. Cochrane for clinicians. First-line treatment for hypertension. Amer Fam Phys. 2010, 81(11), 1333-5. Mensah G, Bakris G. Treatment and Control of High Blood Pressure in Adults. Cardiology Clinics. 2010, 28(4), 609-22. .. EMCast - Monthly podcast interviews with Dr. Amal Mattu through Emedhome.com ($99 annual subscription) CDEM Curriculum - Resource put together by CDEM for medical students which includes essentially an online textbook in EM (free). Rob even put in a plug for my Digital Instruction in Emergency Medicine (DIEM) online simulation cases. I'm not actually done with all the cases, as Rob suggests! Only the first case on Chest Pain is done thus far... Ack! I better get crackin' now. Spend a high-yield 25 minutes listening to Rob's take on need-to-know educational resources in EM. A health care worker hurried in to the ED after being poked with a needle. 'It was an old 18G needle with dried blood', she said. Her puncture had drawn blood. You discussed the very low risk of contacting HIV and the side effects of postexposure prophylaxis (PEP). She asked, 'What does very low risk mean?' Is there another way to covery risk for patients? Trick of the Trade: Convey probabilities with everyday risks. This article uses a risk stratifying tool to convey probabilities that compare to everyday risks such as flying, cancer diagnosis, having an MI, etc. Below is the calculation tool from the paper. Using this tool, the risk of contacting HIV for this patient would be: 5/ (1000 x 100 x 100) = 1/ 2,000,000 According to the everyday risk table in the article, this is similar to the risk of dying in the next 12 months from lightning. You left her to decide on PEP. As the author pointed out, the risks cited are probabilities instead of exact measurements. This is an important caveat. I find this helpful to provide context, especially for those who have difficulty deciding on PEP. Vertesi L. Risk Assessment Stratification Protocol (RASP) to help patients decide on the use of postexposure prophylaxis for HIV exposure. CJEM : Canadian journal of emergency medical care. 2003, 5(1), 46-8. PMID: 17659153 Many academic Emergency Departments are staffed by non-EM residents. Dr. Amer Aldeen and his super-star team from Northwestern created NURRC Modules (Northwestern University Rotating Resident Curriculum). These modules allow the off-service residents, who all have different schedules, to learn key EM-based topics at their own leisure and convenience. The positive effect of the curriculum on the off-service residents' medical knowledge was recently published in Academic Emergency Medicine: Read my review. NURRC Video Modules: ENT and Ophthalmology Emergencies Obstetrics and Gynecology Emergencies Trauma and Wound Care Thanks to the team for agreeing to make these videos free for everyone to use. I hope I wasn't too pushy or forward in asking for the videos... and then asking if I could post then all on YouTube! Such a great resource shouldn't live behind closed doors. I'll post the other 3 videos once I receive them from Amer. It is 2 a.m. You, the resident, have just spoken to your staff/attending, who told you to do a task. You have seen one, but don't feel comfortable doing one independently. Will you tell your staff/attending about how you feel? What if the patient did poorly after that? This study examines the perception of EM trainees of their competence and adverse events and how they feel about reporting them. Anonymous web-based survey sent to all trainees from 9 EM programs in Canada outside Quebec. 37.3% trainees responded. 40% trainees felt they had minimal supervision when doing a task that they did not feel safe about. Most 'unsafe' tasks included providing care overnight, admission decision or procedures. When feeling incompetent, a third of trainees will not report this to their staff. Barriers include worry about loss of trust, automony or respect. 64% trainees felt responsible for contributing to adverse events. Most relate to procedures - chest tubes, central lines, paracentesis. Majority, but not all, reported the most serious events to the staff. Barriers include fear of appearing incompetent and humiliation. How would I change my teaching practice Ensure trainees feel safe. Maybe do a dry run of central line insertion/break bad news prior. Encourage trainees to voice their discomfort. They are learning, not just working. Discuss adverse events and medical errors with trainees. Reference Friedman S, Sowerby R, Guo R, Bandiera G. Perceptions of emergency medicine residents and fellows regarding competence, adverse events and reporting to supervisors: a national survey. CJEM: Canadian journal of emergency medical care. 2010, 12(6), 491-9. PMID: 21073775 Medgadget annually hosts a contest for the best medical blogs. It's the Superbowl of blogs. Our blog was nominated for the Best New Medical Blog last year, but got our butt kicked. This year, we're honored to be a finalist in the Best Clinical Sciences Blog category. That's the great news. Unlucky for us, we are in the same category as the juggernauts EMCrit (also nominated in the overall Best Medical Blog category) and Resus.M.E. I do love the fact that the EM specialty is dominating with 3 finalists in this list of 5. With all of the amazing, sunny weather here in California, I feel (briefly) terrible for all those braving the snowpocalyptic conditions across the United States. So, in honor of all those bundled up and shivering, I wanted to review the management of accidental hypothermia. Tip: Avoid jostling the hypothermic patient too much because of myocardial irritability. Don't send your patient into an arrhythmia. Feel free to download this card and print on a 4'' x 6'' index card. In his talk (subtitled "School Sucks"), Northwestern University Physics Professor Dr. Tae describes how he would improve math and science education. While this is directed at college studies, some of the concepts are applicable to teaching Emergency Medicine. He shares a lot of great insight, but I wanted to focus on one concept in particular: The secret to learning = "Work your ass off until you figure it out." Dr. Tae demonstrates this as we watch him make 57 failed attempts trying to learn a new skateboarding trick before finally being able to successfully complete it on the 58th. In order to master this new skill, he had to actively struggle with it until he succeeded. He contrasts this with lectures where students "just sit there" passively, learning very little. Clinical decision making is a skill, much like skateboarding, and our job in teaching this may be to let the students do most of the work. We're only there to offer guidance and point them in the right direction when necessary. So how can we challenge our students to struggle and fail until they ultimately figure it out? Share your thoughts and ideas in the comments. Thanks! Patients with a hairy chest may require little patches of hair to be shaved when applying EKG leads. This allows the leads to stick firmly to the chest. Loose leads will result in either an artifactual signal or no signal at all on the EKG machine. How can you obtain an EKG without shaving little patches on the patient's chest? Trick of the Trade: Cover EKG leads with damp gauze Water maximes the contact surface area between the EKG lead and the patient's skin. The water easily conducts the cardiac electrical signal. Generously soak gauze with water. Apply gauze over each EKG lead where it contacts hairy skin. He is an Assistant Professor of Emergency Medicine and Clerkship Director at Rush University Medical Center in Chicago, IL. Rahul has led the charge in building CDEM's educational site at www.cdemcurriculum.org, which essentially is a free online textbook for students on their EM rotation. His amazing technological saavy and passion for education in EM make him a perfect fit on our blogging team. I've been begging him to join us for over a year. We're lucky to have him! Wednesday's post is his first (of hopefully many). Well I finally took the leap and am primarily relying on my iPhone to look up medication doses, which I don't know off the top of my head. Gone are the days of purchasing Tarascon's pocket Pharmacopoeia every few years or so. I still haven't settled on which I like more. Both are free. Both are available on multiple platforms, including iOS, Blackberry, and Android. Both have some unique features which I find useful. Common strengths for both apps: Easy to find drug you are looking for. Epocrates has a Search screen as the home page. Micromedex has a Search screen and alphabetical list of medications as the home page. Dosing adjustments based on renal and hepatic function Adult and pediatric dosing recommendations Safety information with preganancy and lactation Unique strengths of the apps: Includes toxicology information for all the medications (what to do in case of an overdose) I have heard that this Thomson Reuters app has been more peer-reviewed and accepted as a very reliable resource, especially for pediatric dosing. Free from obvious advertisements (which is sometimes seen in Epocrates via the Doc Alerts) Has pricing information Allows user to identify unknown pill based on pill characteristics (color, shape, etc) Ability for you to take notes on the app They both will likely answer 99% of what you are looking for from a drug-prescribing perspective. So, which do you prefer and why?

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Acem Meditation is easy to learn. Personal instruction and guidance ensure that you get a good start. Group discussions help you to deal with beginner’s problems and to establish a meditation habit. A beginner's course usually consists of 2-4 sessions, each providing ample opportunity for personal practice followed by guidance and discussion. Groups of 5-15 participants meet for altogether 7-12 hours. Topics covered include: - Brief introduction and personal instruction - Applying the basic principles to your own practice - From stress relief to personal process - Scientific research and the psychology of meditation You learn how to use Acem Meditation for relaxation and stress management, and you lay the foundation for a fascinating process of personality development and self-understanding. The book Acem Meditation - An Introductory Companion is included in the course fee. While you cannot learn the technique from a book, a CD, or the Internet, the psychology of meditation stimulates your practice and provides a fuller understanding of the process. After the course, you can practise the technique on your own, whether you choose to become a regular meditator or to meditate whenever you feel the need. If you wish, you may continue to discuss your meditation practice with a qualified guide after the course. You may also choose between a number of follow-up activities, such as group meditations, talks and lectures, the follow-up courses M1 and M2, as well as weekend retreats where you can get away for a while and recharge your batteries. All instructors have been through several years of training and have long teaching experience. See details for each course in the right sidebar.

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Making the Case for Action This fact sheet(pdf) and slide deck provide essential state-specific information that addresses the economic imperative, the equity imperative, and the expectations imperative of the college- and career-ready agenda. These resources can be used on their own or serve as the foundation for a personalized presentation or fact sheet(word), which can be customized with state-specific details and examples. The PowerPoint, in particular, was developed with various users in mind and offers a wide range of case-making data that can be drawn from to support your own advocacy efforts. Advancing the Agenda As states continue their efforts to promote college and career readiness, Achieve regularly surveys the states to identify their progress in adopting critical college- and career-ready policies. Below is a summary of Idaho's progress to date: See Closing the Expectations Gap for more information State accountability systems focus the efforts of teachers, students, parents, administrators and policymakers to ensure that students and schools meet the established goals, including the goal of ensuring all students graduate ready for college and careers. Idaho has yet to begin to use any of the key college- and career-ready indicators in their accountability system. |Annual School-level Public Reporting||Statewide Performance Goals||School-level Incentives||Accountability Formula| |Earning a college- and career-ready diploma| |Scoring college-ready on a high school assessment| |Earning college credit while in high school| |Requiring remedial courses in college| For an explanation of the indicators, their uses and Achieve’s minimum criteria for college- and career-ready accountability, see here.

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Well, these are still some difficult questions to answer with pin-point accuracy, and at this point I don't believe anyone has the exact answer to all 3 of these questions. What I offer below is a mix of what I Think, What I know and what Appears to be.... Anyone currently attempting to answer these questions with some type of "Universal Knowledge" on the subject--is Full of BS--BEWARE! Yes, that includes Me. I don't have the Complete answer to these questions--and neither does anyone else. This is a subject that needs to be studied in-depth by someone that has all the resources to carry it out: Lab, veterinary knowledge/skills, Acrochordus snakes, What is it: At this point--I don't know, but here is what I believe based on experience, observation and research: The skin of the Acrochordus javanicus and arafurae is very impermeable. So, that makes it a very protective mechanism against the outside world. It is commonly understood that "Stress" causes a reduction in the ability of the immune system to do its job--in humans and other animals--including Acrochordus snakes. Stress appears to cause a decline in the immune system of Acrochordus snakes causing a decline in the effectiveness of the skin as a protective barrier against the outside world. This loss of effectiveness increases until Secondary Infections set in and ultimately kill the animal. Where does it come from: See the paragraph above and add: Improper Husbandry. Yes, it really is that simple. In the Wild, these animals have the ability to move from Habitat to Habitat--Microenvironment to Microenvironment. Even though the White Spot Fungus appears to be a "Captivity" Problem--the snakes in the Wild maybe be able to prevent it--not by some "Magical Bacteria", but, rather: by simply selecting Environments/Microenvironments that they are "Happy" with--i.e., minimum sustained stress level. In Captivity--the snakes don't have that choice. Plain and Simple. Additionally, it appears that the more acclimated to captivity that these snakes get--the more secretive and stress prone they become. How do We get rid of it: Proper Husbandry--Yes, it really is that simple. Reduction of "Stress" will reduce the Progression of the White Spot Fungus. I have seen it myself. Elimination of Stress will Halt the progression of White Spot Fungus. Note: I did not say anything about chemicals, medications, etc.--just eliminate the Stress and the progression of the White Spot will stop. What is there will remain until the next shed. After the next shed--the animal will be clean and remain that way--as long as all of the husbandry parameters are and remain in order. Its just that Simple. A new animal going through the acclimation process may need to shed 2, 3 or even 4 times before the White Spot relents completely. However, its progress should be visibly reduced with each So, what is "Proper Husbandry"? Well, that's what this website is about. No, I don't have all the answers right now, but I've come a long way in the last couple of yrs dedicated to these snakes. 1) If You are genuinely interested in these snakes--then read this website: Every page, every word, look at every picture. This website is not setup for those who are just mildly curious at best. Those folks are more then welcome here. But a lot of information is "Hidden" within the text for those who are serious about these animals. Nothing is truly "Hidden", but even this explanation is not sitting on the Front Page for the "Scanners" to see. 2) Spend the hours necessary researching these animals for Yourself. Right now, the more people that reach the same conclusions--based upon knowledge and experience--the Better. The Online Bibliography at the link is a Good place to start. 3) Acidic water (pH~6.0), Low TDSs (~200ppm), Low light--especially in the hide, Lack of vibrations, etc are Good key elements to the reduction of Stress and the furtherance of "Proper Recently (4/2007) I have seen a couple of "For Sale" ads for Acrochordus javanicus for one vendor that are wrought with misinformation--therefore: Misguidance on the keeping of these snakes. One ad was for CB Babies basically stating to put them in acidic water and because they are CB and White Spot free--You (the buyer) don't need to worry about any future "Bacterial Infections". Sorry, it just doesn't work that way. The current ad states: "I have adult specimens of Acrochordus javanicus, about 4' in length. Perfect specimens with no scrapes, scar, and most importantly NO SKIN BLISTERS! As many people know WC adult Acrochordus javanicus are very rarely offered for sale, primarily because of the high mortality rates due to improper packaging during transport which causes skin blisters (Pseudomonas bacteria which cause septicemia, aka "Blood Poisoning"). You won't have to worry about that here. These adults came in perfectly and there were transported correctly. I am only able to offer unsexed specimens. This species is usually female heavy. There are many reports of this species being able to be parthogenetic, with LTC females "cloning" themselves. A great display snake, they feed on fish. As with all Acrochordids, I reccomend great filtration and the regular addition of a product called "koi zyme." I am asking $250.00 per a specimen, quanities are limitied. Once these are gone I will be a few more years until such nice large animals come Information. Improper packaging/shipping is only one factor and most importantly: "You won't have to worry about that here." That's Pure Non-Sense. I am familiar with this particular individual. He claims to have "...many years of Experience with Aquatic Snakes." and apparently did a stint at a local zoo which I guess makes him a Guru in his own mind. His website is and has remained void of his Great claims of "accomplishments" (suddenly that's changing 6/07 LoL) and has been up for a few yrs now. Buy the snakes--just don't buy into the BS claims. Apparently this person thinks that you just need to buy the "Clean" animal from him, toss it into "acidic water" via peat moss, add Koizyme and Wha-La: Instant Acrochordus! Again, Sorry, it doesn't work that way. If it were that simple: Someone would have figured it out a Looong time ago. I have used Salt, Koizyme, Melafix and Pimafix. I have also researched those products and contacted the manufactures with any specific questions that I had. One thing that I can tell you is: None. Not One of those products are necessary to successfully keep an Acrochordus javanicus or arafurae, Or halt the White Spot Fungus. More importantly, in reference to the Ads,--Just because You receive a clean animal--doesn't mean that it is going to stay that way. That whole thought process is coming from a Total lack of Experience. If that were True--Plenty of people would be successfully keeping Javanicus. Am I being Hardcore: Maybe. But I don't think that I am. I am tired of seeing these snakes die--that's why I am working with them with the dedication that I am. That's why I put up this website--including all of the hours and hours of putting it together and the added expense. That's why I am willing to Openly call these so-called "Gurus" out here--and on the Forums. Sadly, they don't go "heads-up" with me in public any more. They just continue to hold onto their erroneous beliefs and pass along their Bad Information. These animals will always go to the skin trade. But let's get it together and get them established in captivity, so they will always be around, and so people will be able to experience and enjoy their unique presence. I'm no rocket scientist, but I am a guy that can do research and think my way through most problems. If Acrochordus husbandry was as simple as some make it sound: This website would not be here. And You can tell from reading this website that A) its not that simple, and B) its a lot more involved than the "Gurus" want You to believe. I have come across a number of individuals that all claim that they have kept Acrochordus snakes long-term. Notice: the Past tense of: HAVE! Strangely, None of them happen to be "Currently" keeping them. Always--Past Tense! Hmmm, I'll leave You to Your Own Conclusions on that one. Just Beware of the "Claims" out there. Follow the path that You feel is Best--but base it upon Research and, White Spot Fungus? Its caused by Stress and, basically, it appears to be a break-down in the skins ability to protect the animal from the Outside World, eventually leading to Secondary Infections that lead to the demise of the snake. There is No "Magical" Bacteria that Your snake was or was not exposed to in the wild--these snakes die in captivity from White spot all over the world--including captivity in Asia that contains water from their own natural environments. Improper Shipping is not the sole source of White Spot, Skin Blister, Whatever. Animals that Arrive in Your hands "Clean" Will develop White Spot if Housed Improperly and Will die from it if the Husbandry Parameters are not Corrected. Wild-caught, Captive Born, Captive Bred and Born--doesn't matter. Tolerance is the only difference between these animals--Environmental Imprints on their brain. Captive Bred and Born babies are always at least a bit easier then Captive Born babies. Captive Born babies are always a bit easier than Wild-Caught babies. Wild-Caught babies are always easier then Wild-Caught adults. Acrochordus snakes are no different. If You see White Spot fungus on Your animal--the First question is: Is it Progressing? If it is, then You probably need to fix something. If not, then the animal may just be acclimating (If new or just put into a new setup), or the source of stress was temporary and has already been corrected. Is it a "Death Sentence"? No, definitely Not. So, don't Freak-out and start adding Salt or any of that other stuff. Don't start ripping the snake out for Salt Baths, Melafix Dips or any of that non-sense. You will just be ADDING stress. Just step back and look at the Big Picture. Observe the snake's behavior. Try to calmly sort out what may be wrong. As stated in the Javanicus Caresheet: It could be something as simple as Your kid(s) or 150lbs Rottweiler bouncing around on the wood floor, or the Thumping from Your too cool Home Entertainment System. White Spot Fungus is just an indicator that let's You know that the snake is stressing about something. But it can kill Your snake--if You don't do Your Job. This Information is offered on the Acrochordus javanicus and Acrochordus arafurae Filesnakes as is. This Information is not offered in reference to any snakes other than the Acrochordus javanicus and Acrochordus arafurae Filesnakes and even so: use at You Own Risk! Additionally, this caresheet is obviously based upon admittedly limited experience! It is not intend to be a recipe of do this, do this, do this---Bam! You have a cake. It's intent is to offer more of a conceptual understanding of these fascinating creatures and their apparent needs both in the wild and in

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Society of Consumer Protection S.O.S. Poprad from Slovakia is organisation fighting for straitening citizen, consumer and patients´ rights. In order to make basic European rules of consumer and patients ´protection more accessible to blind and purblind people Society of Consumer Protection S.O.S. Poprad has published in cooperation with Slovak Library for Purblind People first Consumer Protection Dictionary in Braille. This unique publication is now available in thirty libraries and eleven regional branches of Union of Blind and Partially Sighted Slovakia. This would be the wished outcome of a project fulfilled by a joint venture of Pain Alliance Europe (PAE), Active Citizen Network (ACN) and Grünenthal. A project designed to show the community how chronic pain patients experience the help they receive for the government and the healthcare professionals. But it is more than this. After the presentation to the Senate of our dossier in terms of fuel poverty, "Energy and chronically ill", made with Acquirente Unico, the Authority for Electricity and Gas has shown not only to be able to act very quickly on important issues, but also to carefully consider the "civic" information produced by the associations. - FUTURE ACTIVE CITIZENS: VOLUNTEERING AS AN EXERCISE OF DEMOCRACY - The patients’ involvement on Health policies in Europe: the citizens voice in Cancer Care decision making process - PAIN PATIENT PATHWAY RECOMMENDATIONS - Summer School for civic leader in HTA: the Italian experience - The Engagement of Cittadinanzattiva in the Fight against Useless Pain - Programme - 6th European Patients' Rights Day - 6th EUROPEAN PATIENT'S RIGHTS DAY - 5th EUROPEAN PATIENTS’ RIGHTS DAY - 4th EUROPEAN PATIENTS’ RIGHTS DAY - 3rd EUROPEAN PATIENTS’ RIGHTS DAY - 2nd EUROPEAN PATIENTS’ RIGHTS DAY - 1st EUROPEAN PATIENTS’ RIGHTS DAY - ASSESSING PATIENTS' RIGHTS IN EUROPE - MONITORING PATIENTS' RIGHTS IN EUROPE - EUROPEN CHARTER OF PATIENTS' RIGHTS Read all >

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Does Turkey offer a model that the Mideast can emulate? avril 13, 2012Posted by Acturca in Moyen Orient, Turquie. Tags: AKP, Arab Spring, foreign policy, Middle East, Neo-Ottomanism, Nora Fisher Onar, Turkey, Turquie The Daily Star (Lebanon) April 13, 2012, p. 7 Türkçe By Nora Fisher Onar * Turkey is often touted as an inspiration for the countries of the rest of the Middle East – a characterization it accepts and pursues. In recent years, Turkish policymakers have worked hard to establish “Turkey Inc.” as the model of a relatively free, stable and increasingly prosperous Muslim-majority country with great economic and foreign policy leverage. But what does the Turkish experience actually represent for the states of the Arab Middle East? How convincing is Turkey, Inc. – and as a model can it really be emulated? Perhaps the most attention has been paid to the free and fair rise to power of Turkey’s Justice and Development Party (AKP), which Islamist movements in Egypt, Tunisia, Morocco and Syria have heralded as a symbol of Muslim majoritarian democracy – even explicitly referencing it in the names and platforms of their own parties, movements and factions. To both domestic and international observers, this might signal that, like the AKP in Turkey, Islamist parties elsewhere do not seek to dismantle their states’ secular framework – at least for the time being. But in spite of its appeal to both traditional Islamists and “post-Islamists” – that is, those who fully reconcile their particular politico-religious commitments with globalization – the Turkish formula may not be replicable. Civil-military relations in Turkey have undergone a double-sided transformation over recent decades. As a consequence of the intermittent censure by the army, political Islamists had to moderate their demands and practices; simultaneously, the Turkish army – accustomed to the barracks and aware that interference in government hurt Turkey’s international standing – increasingly relied on civilian allies to pursue its agenda vis-à-vis the AKP. Eventually, the military relinquished control of crucial institutions (such as the National Security Council), and the final showdown over control of the presidency in 2007 was fought not with bullets and tanks, but with Web declarations, public rallies and court cases. A similar tipping point regarding civilian control of the state is hardly a foregone conclusion in countries still under transition, where national militaries continue to exert a dominant presence in political life. Other countries in the Middle East also lack the trajectory that Turkey has followed with regard to its economic development. This is particularly true of the export-driven rise of the middle class that has been experienced by religious constituencies across the Anatolian periphery. Such a trend has underpinned the AKP’s moderation, political success and interregional presence. Indeed, Turkey’s recent economic trajectory is a central component of its appeal in the Arab world. Over the past decade, Turkey has tripled its Gross Domestic Product and – excluding a dip to minus-4 percent real growth in 2009 – has managed to ride out the global economic crisis with relative equanimity. Commentators have argued that Turkey may be part of a second tier of rising economic powers (alongside such countries as South Korea, Mexico and Indonesia) that is hot on the heels of the Big Four (Brazil, Russia, India and China). This holds two implications: On a symbolic level, the Turkish experience (along with that of Indonesia and Malaysia) has dramatically undermined theories of Islam’s incompatibility with modernization, especially in the arena of economic governance. More tangibly, over the past decade Turkey has actively sought out partners for sustainable trade-driven growth in a region that has been long addled by the heady cocktail of oil wealth and chronic underdevelopment. Although economic partnerships were in no way guided by Turkish concerns for democratic governance – a reality that was attested to by Turkey’s once cozy ties with authoritarian leaders – they have had unintended consequences with positive implications for political reform. For example, the influx of cheaper, better quality Turkish goods in Syrian markets may have undermined a backbone of President Bashar Assad’s regime: namely the interests of the regime’s business cronies. To understand the parameters of Turkey’s role in the region, we should also acknowledge the sensitivities that have arisen from the Ottoman legacy. Some believe that Ankara seeks to reclaim its historical leadership of the Middle East, the Caucasus and the Balkans, something that can rub interlocutors the wrong way. Hence, Turkish foreign policymakers’ reluctance to employ Ottomanist frames of reference. However, at the domestic social level in Turkey, there remains a growing receptiveness to self-depiction as the benign heir to the Ottoman Empire. This is evident in the proliferation of cultural commodities that employ Ottoman referents. That is the case of the recent record-grossing film “Conquest 1453,” about what Western historiography calls the “fall” of Constantinople. In the film, Mehmet the Conqueror – played by an actor who bears a remarkable resemblance to a young Recep Tayyip Erdogan – is shown to be a forceful and compassionate protector of Muslims and Christians alike (though there is no mention in the film of Jews). The image of Turkey as a “big brother” to downtrodden Muslims in such places as Palestine, Nagorno-Karabakh, Kosovo, and Bosnia-Herzegovina – characterizes an emerging “neo-Ottomanist” national image that seems to drive Turkish aspirations of regional leadership within the country and amplify Erdogan’s profile abroad. Whether this is a matter of hubris or of genuine capacity remains to be seen. A final component that is crucial for evaluating Turkey’s example is that the country has yet to develop a framework for meaningful multiethnic, multisectarian co-habitation. Mounting violence on the part of militant Kurds and the Turkish state’s heavy-handed response has fueled hostility between ordinary citizens. For instance, recent court rulings suggest that vigilante terror toward prominent members of the Armenian and Alevi communities is permissible and will go unpunished. Disturbing numbers of journalists, scholars, and students who have expressed critical views on these fronts have been jailed. There is also deep concern in constituencies that embrace secular lifestyles that recent reforms in fields such as education will yield an ever more restricted Turkish society. Given the need to put its own house in order and the fact that inter-communal tensions across the Middle East are likely to become worse before becoming better, Turkey’s AKP government must take very seriously its mandate to write a new and inclusive Constitution. In the longer tem, Turkey must confront the standing challenge of the region – learning to live together despite differences – a challenge which also happens to be Turkey’s own. At the end of the day, the export of Turkey, Inc. needs stable and predictable conditions in which trade and investment can thrive; hence, the commitment to the “zero problems” policy that Turkey employed with neighbors in its economic and foreign agendas over the past decade. Due to last year’s upheavals in the Arab world, however, this policy is unsustainable. Once well-placed to broker a dialogue between Iran and Israel, Turkey is now more alienated from both countries than before as the two nemeses lock horns in what Graham Allison has called the “Cuban missile crisis in slow motion.” Should Israeli-Iranian antagonism spill over into war, the delicate balance in Iraq may unravel into protracted sectarian and ethnic conflict, just as Syria’s brewing civil war may spill over into neighboring Lebanon. But even without an Israeli-Iranian showdown and an intensified conflagration in Iraq and Syria, Turkey’s Kurdish question is, quite literally, kindling awaiting a flame, as attested to by recent clashes during Nevruz, or Nowruz, celebrations. All of this suggests that Turkey’s aspirations to regional leadership are tactically dependent on forestalling an Iranian-Israeli showdown – an end to which it should leverage all its diminished diplomatic capital in the two countries and in partnership with the United States. Before the AKP came to power and the Arab Awakening broke out, the received wisdom was that when it came to Islam, democracy and secularism, one could have any two but never all three. Similarly, doubts have long been expressed about whether political and economic liberalism can thrive simultaneously in a Muslim-majority setting. Taken together, it seems that if the purveyors of Turkey, Inc. can show that liberal economics goes hand-in-hand with liberal democracy in a country that is governed by pious Muslims, then the Turkish model-in-progress may achieve fruition and offer a timely example for the Middle East. * Nora Fisher Onar is an assistant professor of international relations at Bahcesehir University in Istanbul. She is also a Ronald D. Asmus Policy Entrepreneur Fellow with the German Marshall Fund and is a Visiting Fellow at the Centre for International Studies (CIS) at the University of Oxford. This commentary first appeared at Sada, an online journal published by the Carnegie Endowment for International Peace.

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Serving diverse populations has never been a strong suit of the health-care system in general; there are huge disparities in the quality of care between whites and African Americans and Hispanics. The law calls for expanded initiatives to increase racial and ethnic diversity in the health-care profession, as well as improved cultural competency. But this will take time. Meanwhile, the existing force of health-care providers will have to adopt a more multicultural mindset -- and that includes increased multicultural intelligence in marketing communications. Insurance companies will face a different set of challenges. The law stipulates that by 2014 states must set up exchanges through which consumers can directly purchase health insurance, and all legal residents will be required to obtain insurance or pay a penalty. That will likely force a change in the traditional model of marketing health insurance from B2B to a more consumer-oriented approach. Several major insurers already are adding retail locations and kiosks in shopping malls, as well as sponsoring health fairs, The Miami Herald reports. Humana, for example, is offering its members a 5% savings at Walmart stores on purchases of fresh fruits, vegetables and other products that carry the retailer's "Great For You" label. Though many of the newly insured will be eligible for subsidized health insurance through Medicaid and the Children's Health Insurance Program, to be successful, insurance companies, like providers, will need to be ready to address the unique needs of a very different demographic than what they are used to. Then there are the pharmaceutical companies. According to Gregg DiPietro, in a blog for Pharm Exec, before the new health-care law, "pharma built its positioning platform almost entirely on two dimensions: efficacy and safety." He adds, "With the approval of the health care law, the conversation has moved ... to one of overall 'value.' ... Efficacy and safety ... are not enough to carry a product's positioning platform." Dorothy Wetzel, former VP-consumer marketing at Pfizer, offers five questions in a recent blog that any pharmaceutical brand needs to ask itself when considering beefing up its efforts to multicultural consumers: What is the size of the business opportunity? Do multicultural patients approach health issues differently than the general-market patients in their disease state? - Do the current messages in your communications resonate with the multicultural patient? - Does your current media and tactical plan reach the multicultural patient? - Are there organizations that could help accelerate access and the impact of your efforts? "You can't standardize diversity and say that all of our diverse populations need this," says Russell Bennet, Vice President of Latino Health Solutions at United Healthcare. "Each population may need different things." If we are to count ourselves among the great nations of the world, then Americans have a moral imperative to increase the quality of health care for all. As multicultural marketers, we can help. There is a need to educate about disparities. There is a need to get the word out to medically underserved folks as to how they can take best advantage of the new health-care options. And there is clearly a need for more research that looks into the impact of race, ethnicity and sexual orientation on how one navigates -- and is navigated -- through the health-care system. Perhaps the greatest challenge faced by advertisers will be to make Americans -- in and out of the health-care profession -- aware that we do indeed have a disparities problem. A study conducted last year found that only 59% of Americans were aware of racial and ethnic disparities in health care. Before the ad industry takes on this issue -- and it's a tough one, given the current political climate -- its first job will be to educate health-care providers as well as the general public. Once that 's accomplished, the industry can tackle the challenge of how best to reach multicultural patients as important consumers.

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This article was published in Australian Dictionary of Biography, Supplementary Volume, (MUP), 2005 Eleanor Constance (Ella) Greenham (1874-1957), medical practitioner, was born on 15 April 1874 at Ipswich, Queensland, second child and only daughter of John Greenham, an English-born draper, and his wife Eleanor, née Johnstone, from Ireland. John later established a general store, Greenhams Pty Ltd, in the business centre at Ipswich. Ella attended Ipswich Central Girls' and Infants' School then Brisbane Girls' Grammar School, where she won the English and the natural history prizes. On 1 February 1892 she was the first pupil to be enrolled at Ipswich Girls' Grammar School. There she won the silver medal for the top girl in science and four other prizes. Passing the senior public examination next year and winning six more prizes, she proceeded to advanced studies for university entrance. In 1895 Greenham went to Women's College within the University of Sydney (M.B., Ch.M., 1901), entering the faculty of arts as a necessary preliminary to her medical studies. She was the first Queensland-born woman to graduate in medicine. Registered to practise in Brisbane on 2 May 1901 as medical practitioner no.711, she began work as resident medical officer at the Lady Bowen Hospital, Brisbane, probably becoming the first woman to receive a residential position in a Queensland hospital. Choosing to work in private practice, in 1903 she took rooms in City Chambers, Queen and Edward Streets, Brisbane, moving in 1907 to 284 Edward Street. Although she met opposition from some male colleagues, her bright personality and attentive care gradually attracted patients and she built up a successful practice. Greenham was dedicated to her profession and, like many early medical women, she did not marry. She was an accomplished pianist, enjoyed attending the theatre and visiting flower shows and was described as 'a large lady, fond of flowing, floral garments'; at the lady mayoress's 'At Home' in 1904 she wore an Assam silk gown and a hat of blue chiffon. One of the earliest women car-owners in Queensland, she drove a Darracq in 1907 and later a Hupmobile. Indeed, she became a shareholder in the Hupmobile agency, Evers Motor Co. Ltd, Brisbane. She also became chairman of directors of Greenhams Pty Ltd. In 1945 the Queensland Medical Women's Society elected her to honorary membership for her contribution to women's health and in 1953 she was made honorary member of the British Medical Association (Queensland Branch) for fifty years uninterrupted membership. In her eightieth year she retired to 85 Oxlade Drive, New Farm, but she continued to treat her old patients. Greenham was a pioneer and a skilful, caring doctor. By her persistence and expertise, she swept away difficulties and opposition, helping to shape the future for women in medicine in Queensland. She died on 31 December 1957 at New Farm and was cremated with Anglican rites. Lesley Williams, 'Greenham, Eleanor Constance (Ella) (1874–1957)', Australian Dictionary of Biography, National Centre of Biography, Australian National University, http://adb.anu.edu.au/biography/greenham-eleanor-constance-ella-12951/text23407, accessed 18 May 2013. This article was first published in hardcopy in Australian Dictionary of Biography, Supplementary Volume, (MUP), 2005

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Q&A Series: What are the Addicks and Barker Dams and Reservoirs?Read more... News Release: USACE Galveston District monitors Addicks and Barker dams and reservoirsRead more... News Release: USACE Galveston awards contract for road repairs at Addicks, Barker damsRead more... News Release: USACE awards small business contract for environmental assessment at Addicks, Barker damsRead more... News Release: USACE awards contract for soil sample lab testing at Addicks, Barker damsRead more... Dam Safety Electronic Press Kit Dam Safety Video Updated November 2010! Learn all you need to know about the Addicks and Barker Dam Safety Program in this 20 minute video. Review the USACE Planning Process Check the Water Level in Your Area The Addicks Project Office 1042 Highway 6 South Houston, TX 77077 News Release: USACE Galveston awards small business contract to survey Addicks and Barker HOUSTON (March 4, 2011) – The U.S. Army Corps of Engineers, Galveston District, awarded a contract Feb. 17, 2011, to Landtech Consultants Inc., a small business, in the amount of $27,464.32 for a deformation survey of structures at the Addicks and Barker dams and reservoirs located in Harris and Fort Bend counties, Texas.

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