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>My Essay on Automotive Technology
Posted on 2009||03|20
>If you were talking about a "car" 3 years ago, you might have had referred to the resurgence of the muscle car, with larger, more powerful engines with hardly a mention of fuel economy. After the fuel crisis of the past summer though, everyone was looking at cars in a whole new light. They wanted fuel economy, and hybrid technology in their cars.
I believe we would have gone much further and faster too, if it weren't for the economic slowdown that inevitably followed. No one wanted to buy cars, even the specialty hybrids. Before the downturn the demand for hybrids was so high that Toyota had slated a plant in the US designed especially for their Prius line alone but by December of 2008 – they had halted construction (1).
The idea of a hybrid car is certainly not new, and neither is an entirely electric car. In the early 1900s electric and petroleum based cars were large rivals, but after some major technological breakthroughs – petroleum based vehicles became a more economically sound option. Where petroleum cars were roughly $650, electric cars sold for about $1750 (2).
In 1990 California passed a revolutionary new law, the zero-emission mandate which would require 10 percent of new vehicles sales in the state to be all electric by 2003. It based this on a goal of reducing greenhouse gas emissions to 80% of the 1990 level by 2050, so in order to reach this goal they would need to have at least 400,000 zero emission vehicles on the road by 2020 (3).
This early push "sparked" a major electric offering by all the major car companies, and especially by GM with the EV1. An all electric vehicle – it required a charging station placed in the home or garage. In addition, there were several public charge locations set up with taxpayer dollars throughout the state. The goal was to start creating the infrastructure to support this new automotive model. It would have succeeded, if not for a push by the car companies to declare the law unconstitutional. They said they could not do it and remain profitable in the state, proposing a lack of vehicles being available and with that, a lack of new car sales, and new car sales taxes.
The push worked, CA caved on their requirements and all the companies began taking back their vehicles from consumers. Offered only on limited 3 year leases, and not for purchase, there was not one person who owned their EV1 – they were all repossessed, in some cases by force. The EV1s (along with the other company models) were carted off to large lots behind the company headquarters, or hidden in fenced in areas. There they sat for years, with vigilant watch by many electric car proponents. When the cars were finally moved to their final resting place and crushed, police were called to escort the car carriers full of revolutionary cars to protect the trucks from the activists, many who protested by laying down in front of or blocking the trucks. (4)
We could have gotten to this place much faster, but the environment was never as much on the table as our hard earned cash.
1.) http://www.environmentalleader.com/2008/12/17/toyota-halts-construction-on-us-prius-plant/
2.) http://en.wikipedia.org/wiki/Electric_car
3.) http://www.hybridcars.com/news/california-air-cuts-electric-car-goal-again.html
4.) Who Killed the Electric Car?: http://www.youtube.com/watch?v=mA2u_KbCs6A
Netflix: http://www.netflix.com/Movie/Who_Killed_the_Electric_Car/70052424
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The value of connected health information: perceptions of electronic health record users in Canada
Sukirtha Tharmalingam ORCID: orcid.org/0000-0003-2666-35851,
Simon Hagens1 &
Jennifer Zelmer1
As health care becomes more complex, it becomes more important for clinicians and patients to share information. Electronic health information exchange can help address this need. To this end, all provinces and territories (PTs) in Canada have created interoperable electronic health records (iEHRs). These secure systems offer authorized users an integrated view of a person's healthcare history across the continuum of care. They include information such as lab results, medications, diagnostic images, clinical reports and immunization profiles. This study explores user experiences and perceived outcomes of iEHR use.
Surveys conducted between 2006 and 2014 asked iEHR users in six Canadian PTs about system, information and service quality; iEHR use and user satisfaction; and net quality and productivity benefits. The surveys had a core set of questions that used Likert-type scales. Results were synthesized across surveys for each evaluative dimension. Consensus among researchers and subject matter experts on whether to classify the outcomes as positive, mixed/neutral, or negative was established using a modified Delphi technique.
A total of 2316 iEHR users responded to the six surveys. Information quality was the most studied area. Results varied across PTs, but positive outcomes were more common than mixed/neutral or negative outcomes by a 19:1:1 ratio across this dimension. The next most frequently studied aspects were user satisfaction, the impact of iEHR use on quality of care, and the impact on productivity. In all three areas, there were more positive than mixed/neutral or /negative results (ratios of 13:1:1, 14:3:1, and 15:2:1respectively).
Overall, users of iEHRs that provide secure access to patient information collated from across the health system tend to report positive outcomes, including quality of care and productivity. This study is an important first step in understanding user perspectives on iEHRs and health information exchange more broadly.
The complexity of health care is growing. On average, we see more health care providers, take more medications, and access a broader range of health services than in the past. This means that it is increasingly important that health care providers who care for the same patient share information. As a result, electronic health information exchange is becoming more common around the world with the aim of supporting better access to care, quality, productivity, and patient experiences.
In Canada, the federal and provincial/territorial ('PT') governments began investments in the creation of interoperable electronic health records (iEHRs) more than a decade ago. These secure and private systems available to authorized users offer an integrated view of an individual's health and health care history. Information in iEHRs can come from PT databases, as well as point of care electronic systems in primary care, public health, hospitals, and elsewhere. Lab results, medications, diagnostic images, clinical reports, and immunization profiles are stored and shared by iEHRs. These iEHRs are closely related to what is often referred to as "health information exchange" (HIE) in other countries [1]. More specifically in the United States, HIE refers to the reliable and interoperable electronic sharing of patient's vital medical information securely among a variety of health care stakeholders (clinicians, laboratories, hospital, pharmacy, health plans, payers and patients) [2, 3].
Canada Health Infoway (Infoway) measures iEHR adoption across the country. This includes digitization of client and provider registries and four clinical components (diagnostic images, laboratory test results, dispensed drugs and clinical reports/immunizations) [4]. Twelve out of the thirteen PTs in Canada have fully digitized registries in place. The clinical components of iEHR are at varying levels of availability across Canada; all PT's have at least two clinical components available and five PTs have all four clinical components available. About 250,000 health professionals, approximately half of Canada's anticipated potential physician, nurse, pharmacist, and administrative users, indicate that they electronically access data from outside their main practice setting, such as those found in PT lab or drug information systems. As of January 2015, there were more than 91,000 active iEHR users accessing two or more of the clinical components in a given month [5]. Many more clinicians would access only one clinical component, such as a comprehensive medication profile.
Evaluation of the value of health information exchange is relatively new. A handful of reviews have been published from the US assessing the impact of HIEs. In 2010, a systematic review of the evidence of HIE was published but focused only on primary care. The authors found improvements in referrals and access to test results based on 3 articles but underlined the shortage of empirical evidence to draw conclusions [6]. Subsequently in 2011, a review on the impact of HIE on healthcare outcomes found 5 relevant studies that mostly focused on health care utilization. The authors did not find conclusive evidence on HIEs given the early stages of HIE operation and the paucity of well-designed published research [7]. In the following 3 years, there has been an increase in the published literature but limitations on the generalizability of the resulting evidence remain. A systematic review in 2014 found 85 relevant papers that addressed a mix of health outcomes, efficiency, utilization, costs, satisfaction, usage, sustainability, and/or attitudes and barriers related to HIEs [8]. Most focused on specific care settings and a few HIEs. This limited the generalizability of findings. The review reported low-quality evidence of reduced emergency department use or costs, but effects elsewhere were uncertain. The authors also indicated that "all stakeholders claim to value HIE, but many barriers to acceptance and sustainability exist." Another review published in 2015 focused on a narrower set of outcomes (costs, use, and quality). It identified 27 studies and came to similar conclusions, highlighting the lack of high quality studies comparable across settings to provide generalizable benefits of HIE [9]. The most recent systematic review of HIE to come out of the US, builds on the evidence from earlier studies identifying 34 studies reporting clinical, economic, population outcomes as well as patient and clinician perceptions of outcomes. The authors concluded there was low-quality evidence to support the value of HIE in reducing duplicate testing, emergency department costs, hospital admissions and improving public health reporting, ambulatory quality of care and disability claims processing. In addition, the review found that clinicians perceptions of the value of HIE were positive. The review also concluded that there was insufficient evidence on the impact of HIE on patient outcomes [10].
In Canada, a number of researchers have examined the iEHR and its components. A recent discussion paper summarizing the benefits of ehealth investments in Canada identified a number of studies that have studied the value of sharing specific types of information (components of iEHR clinical domains) across care settings [11]. For example, evaluations of the benefits of diagnostic imaging information systems (DI) have found that picture archiving communication systems (PACS) provide benefits for health providers such as better access to information, quicker turnaround time, reduced time searching for films, as well as better care, cost savings and productivity improvements for radiologists and technologists particularly in remote, rural locations [12]. Another study focusing on costs of DI found mixed evidence [13]. Similarly, pan-Canadian evaluations of drug information systems (DIS) across the country found benefits such as fewer adverse drug events, improved medication compliance, reduced medication abuse, reduced inappropriate prescription filling, enhanced quality of admission reconciliation practices, and increased productivity for providers [14–17]. DIS studies also found that benefit realization was driven by clinician efforts, sound change management, solution design, interoperability, and accuracy of medication histories [14, 16, 18]. These types of studies provide increasingly rich understanding of the value and success factors related to sharing of particular types of information among authorized clinicians, but the impact of iEHRs as an integrated approach to sharing many different types of clinical data has not been studied as extensively.
This study targets this gap in the literature, with a particular focus on the Canadian experience. It synthesizes iEHR user views from six PTs assessed by surveys. The surveys include user perspectives on system, information, and service quality; iEHR use and user satisfaction; and net quality and productivity benefits. The goal is to improve understanding of how iEHR users perceive the effects of these information sources, with a view to helping advance future use, benefit, and evaluation of iEHRs.
This study synthesizes cross-sectional user surveys conducted as part of provincial/territorial iEHR evaluations. These evaluations were guided by a national Benefits Evaluation Framework (Fig. 1) [19]. This framework draws on work by Delone and McLean regarding evaluating information systems [20]. It describes the relationship between system, information, and service quality; use and user satisfaction; and net quality, access, and productivity benefits. Over time, a series of measurement tools and other resources have been developed based on the framework [21].
Infoway Benefit Evaluation Framework*
One of the measurement tools developed to assist with the evaluation of digital health solutions is a modular System and Use Survey [22]. Designed to be completed by system users, it consists of a core set of questions with Likert-type scales. Each question is aligned with a dimension of the benefit evaluation framework. The survey, and customized versions of it, has been used widely across the country [22].
PT's with surveys of iEHR users that met the following criteria were included in this study:
The iEHR was deployed for province/territory-wide use;
At the time of the survey, the iEHR shared at least two of the core types of clinical data (lab results, medication profiles, diagnostic imaging, clinical reports and immunization history) with authorized users; and
The System and Use survey (or a customized version of it) had been administered to users either as part of an Infoway project evaluation or by a PT.
Survey results were available by December 31, 2015.
Table 1 provides details on the six PT's with iEHR user surveys that met these criteria. In PTs with more than one iEHR System and Use Survey, the most recent data were used. Detailed evaluation results from two of the six PTs have been previously published [23, 24].
Table 1 Profile of PT iEHR user survey respondents (at time of evaluation)
While consistent with the same evaluation framework, each survey had specific focus areas. Not all questions from the standard System and Use survey were asked in all cases to reduce respondent burden. Questions to address issues of particular interest to the PT were also added in some cases. Common survey questions across the surveys assessed aspects of system quality (performance, reliability, security); service quality (training and support); overall quality of information (content and availability); user satisfaction and impact on provider productivity and patient quality.
First, quantitative questions from the six surveys that met the evaluation criteria were compared to identify commonalities. Each survey consisted of anywhere from 21 to 40 questions that were available for study. If a question was asked in two or more surveys, it was retained for further analysis, resulting in a total of 21 questions used in the study. Each of the 21 remaining questions were categorized using the national benefits evaluation framework dimensions. This grouped questions pertaining to system information, or service quality, iEHR use and user satisfaction, or net quality and productivity benefits for analysis.
We then adapted an approach developed by Buntin et al. to classify survey responses as positive, negative, or mixed/neutral [25]. This approach addresses the challenges of aggregating diverse and nuanced findings from a range of studies. It has been previously used in other syntheses of health information technology evaluations [26]. Its application in this study was validated, in advance, by two external subject matter experts.
Specifically, survey responses were classified as follows:
Positive: 50 % or more of survey respondents reported a satisfactory rating or experience in response to a given question, typically representing the top two response options on a five-item Likert-type scale;
Negative: 50 % or more of survey respondents reported a dissatisfactory rating or experience to a given question, typically representing the bottom two response options on a five-item Likert-type scale; and
Mixed/Neutral: Other combinations of responses.
A modified Delphi approach was used to achieve agreement on response classification. One researcher (ST) first conducted this exercise independently. She then met with two other researchers (SH, JZ) on the team to repeat the data classification and analysis exercise, reconciling results to reach consensus.
In addition to this quantitative analysis, qualitative responses to open-ended questions in the System and Use Survey were reviewed. They were used to inform the interpretation of results and discussion.
Six PTs in Canada had iEHR user surveys that met the inclusion criteria for this study. Together, they had a population of over 11 million in 2014, making up about one-third of the Canadian population [27]. All of the PT iEHRs shared laboratory test results and diagnostic imaging reports from across the jurisdiction with authorized users. Additional information was available in some cases, such as medications, clinical reports and immunization profiles. Users accessed this information in a variety of clinical settings. Acute care, emergency departments, and primary care were among respondents' most common practice settings at the time of the survey.
The evaluations synthesized in this study took place over an 8 year period, from 2006 to 2014. Together, the surveys had a total sample of 2318 respondents. Sample sizes for individual PTs ranged from 46 to 1027 (see Table 1). The largest groups of respondents were nurses/nurse practitioners, and physicians, ranging from 33 to 51 % and 12 to 49 % respectively. Administrative staff and allied health professionals also accounted for a notable share of respondents in some PTs. Only some surveys asked respondents about how long they had used the iEHR and how often they used it. In most cases, those surveyed had used the iEHR for a year or less, but in one PT, 89 % of respondents reported longer use.
User perspectives on the iEHR
Pooling the evaluations from the iEHRs in the six PTs yielded 21 items that were common to at least two surveys. They assess the following aspects of the benefits evaluation framework: system (2 items), service (1 item), and information (5 items) quality; user satisfaction (3 items); and net productivity (5 items) and quality (5 items) benefits. Table 2 shows a detailed analysis of results in terms of positive, mixed/neutral, and negative outcomes for sub-dimensions of the framework. Figure 2 summarizes results by framework dimension.
Table 2 Classification of outcomes measured by iEHR evaluations
Summary of User Perspectives on iEHR Outcomes
System & service quality
In the benefits evaluation framework, the system quality dimension looks at the performance, reliability, and security of iEHR systems. The service quality aspect looks at training and support for use of iEHR systems.
Four surveys assessed aspects of iEHRs system and service quality. In all cases, half or more respondents gave positive rankings to security and privacy. These results were classified as "positive" for the purposes of this analysis. When it came to performance and reliability of the iEHRs, there were three evaluations with positive outcomes and one with mixed/neutral outcomes. Similar results were found for training and support received by iEHR users.
All six evaluations asked users about the quality of information in the iEHR, including its content and availability. The most common question asked was whether the iEHR provided information quickly, sometimes also worded as information being available when needed. All surveys reported positive results in this regard. Likewise, there were consistently positive outcomes in the three surveys that asked about the overall quality of information and the three that asked whether the iEHR enables access to information previously available through another process. When it came to the layout and format of information in the iEHRs, three evaluations had positive outcomes but one had negative outcomes. Likewise, five evaluations looked at the accuracy of information available from iEHRs. Four had positive outcomes and one had mixed/neutral outcomes.
All surveys asked about at least some aspects of user satisfaction. The four evaluations that assessed ease of use reported positive outcomes. Overall user satisfaction was measured in five evaluations. Of those, four had positive outcomes and one had mixed/neutral outcomes. Similarly, the integration of an iEHR into workflow and its ability to make the user's job easier was measured in six evaluations. All but one (which was negative) had positive results.
Respondents in four surveys were asked about the impact of the iEHR on their productivity or efficiency. Overall, three PTs reported positive outcomes and one had negative outcome Only positive outcomes were found in the four evaluations that looked at the iEHR's impact on efficiency in accessing diagnostic imaging. This parallels findings of significant productivity gains related to digital imaging found in evaluations focused specifically on this question [12]. Similarly, the three evaluations that asked about efficiency in accessing lab results also had positive outcomes. In terms of reductions in duplication of lab tests and diagnostic imaging, three surveys had positive outcomes and one had a mixed/neutral outcome. However, in the three evaluations that asked whether the iEHR reduced the need to obtain information manually, there was only one positive outcome and two mixed/neutral outcomes. This may reflect the fact that many nurses, pharmacists, and physicians continue to report working in hybrid electronic and paper environments on national surveys [28–30].
Electronic sharing of patient information is often motivated by the potential to improve the quality of care and patient safety. Users in four PTs were asked whether iEHRs did so overall. Three had positive outcomes in terms of overall quality of care; one had a negative outcome. That said, outcomes from all surveys on the impact on sharing of information among providers (n = 4), the iEHR as a source of information on patient care provided by another provider/setting (n = 3), and on coordination of care (n = 2) reported positive outcomes. Survey results split in terms of clinical decision support. Three of five evaluations showed positive outcomes, with mixed/neutral outcomes in the remainder.
In summary, information quality was the most studied area among the evaluations of iEHRs. It had a high ratio of overall positive to mixed/neutral and negative outcomes (19:1:2 respectively). In other evaluative dimensions, there were also more positive than mixed/neutral or negative outcomes. The ratios for user satisfaction, productivity, and quality of care were 13:1:1, 14:3:1, and 15:2:1 respectively.
In Canada, as elsewhere, there is general agreement that health care providers caring for a patient should share relevant patient clinical information electronically in a privacy-sensitive way, regardless of where the patient obtained care [31, 32]. The potential value of doing so is also well understood. The country's provincial and territorial Health Ministers, for example, issued a joint statement in 2014 declaring that iEHRs are "one of the most transformational innovations in health care in a generation" [33].
This study presents the first cross-jurisdictional assessment of the value of iEHRs from the perspective of their users. This provides unique insights based on the lived experience of those who use these types of systems to access shared patient information, often on a daily basis. By synthesizing survey results from different care settings and jurisdictions, based on different solutions introduced at different times, and that reside within different policy and clinical contexts, the study provides a broad perspective on experience with iEHRs. This diversity can also, as with most research syntheses, present challenges. While there was consistency in the evaluation framework used, surveys were customized to local needs and sample sizes and response rates varied. In addition, this analysis gives equal weight to all studies. This was done intentionally given the wide variation in settings, components of iEHR systems in individual PTs, duration of iEHR system availability, and time of survey. We relied on the actual results from the individual evaluations to classify results as positive, negative or mixed/neutral, rather than attempting to re-interpret them. Any weighting would have been subjective. Instead, we have reflected on some key potential drivers of results below.
One of the study's limitations is the response rates, which range from 15 to 73 % among the six PT surveys. These surveys were conducted as part of individual PT iEHR evaluation and as such they were all rapid-response surveys with short field times ranging from 1 to 2 months. The relatively low response rates in some evaluations do indicate the need for caution in interpreting the results. Clinician surveys are important in assessing knowledge, attitudes, practice and informing health services and policy research; however, the decline of response rates have been noted as a concern by other researchers [34–36] and echo our experience in this research. Others have found efforts such as reminders, method of survey administration, as well as monetary and non-monetary incentives that might improve declining response rates [34, 36]. Given the rapid nature of the surveys included in this study, such strategies were not utilized to full potential in this research and are a consideration for future evaluations.
There are also other limitations to a study of this type. For example, the included evaluations summarized in this study span an 8 year period from 2006 to 2014. They are not necessarily reflective of the current status of the PT iEHRs, all of which have progressed over time in scope, adoption, and maturity of use. There are also other PT iEHRs in Canada where we did not have similar survey data for comparison. The findings of the study may or may not reflect their users' views. Furthermore, while the majority of respondents to this survey, like the majority of iEHR users in 2015, access the iEHR through a viewer, the context does differ across provinces, settings and solutions. The association between these factors and the user perception of the system quality and net benefits thus have not been examined in this paper.
In this context, the degree of consistency in the findings across surveys is noteworthy. Overall, users in the six PTs included in this analysis tend to view iEHRs positively. This is true for both the systems themselves and for their effects on productivity and quality of care. For instance, most respondents in all six evaluations agreed that information from iEHRs is provided quickly and is available when needed. The four surveys that asked about information to be shared among care providers—key for coordination of care, particularly for those with chronic conditions cared for by multiple clinicians—also reported positive results. Users also tended to affirm the value of iEHRs in terms of improving productivity and the quality of care.
While results overall were positive, our analysis suggests that system and service quality are a foundation for user satisfaction and net productivity and quality benefits. For example, one PT that had mixed/neutral outcomes on the dependability of their iEHRs had negative findings for overall satisfaction, the ability of iEHRs to make users' jobs easier, and the impact of iEHRs on productivity and quality of care. Another PT whose users reported that their iEHR system was not well integrated to their workflow also gave poorer ratings for technical support, training, and impact on quality of care. In contrast, one PT stood out for having satisfaction levels far above our "positive" cut off of 50 %. On most dimensions included in the survey, nearly 80 % or more of users rated their iEHR highly, even though they had been using the system for a year or less. This PT had had a coordinated and cohesive approach to iEHR implementation, reflected in user ratings for training and support that met their needs.
This study suggests many directions for future evaluations of health information exchange. Early understanding of the components of the iEHR described a maturity model to benefit realization dependent on the breadth of adoption and richness of the solution [37]. Most of the users surveyed in this study had only been using iEHRs for a short time. Also users' access to clinical information varied. In some PTs clinicians had electronic access to multiple clinical components such as medication, diagnostic imaging, lab results, and clinical reports all at once. In other PTs, these individual pieces of information were added over time to iEHRs. Studies on sharing particular types of information and specific clinical settings suggest that benefits tend to grow over time, as adoption grows and users gain experience and functionalities or improvements in systems and workflows adapt to user needs [15, 38, 39]. Future studies could confirm if this applies in more complex information exchange environments and identify key enablers and barriers to progress. Future studies will also need to look at the impact of iEHRs for different types of clinician users. Likewise, it would be helpful to be able to compare experiences in Canada and elsewhere to identify best practices and opportunities for mutual learning on a broader scale.
In addition, complementary work to evaluate the effects of information exchange from perspectives other than user views is important. Usability assessment, workflow analysis, and time-and-motion studies are just a few of the approaches that can help to enrich understanding further. In addition, as identified by previous reviews on HIE value, robust study designs are needed to quantify outcomes such as the effect of such solutions on time required to obtain needed patient information; the extent of duplicate testing; changes in hospital readmissions; and improvements in access to care [7–9]. Some of these questions have been explored for particular care settings or types of information. For example, a study in ambulatory care clinics found that settings with more outside connectivity were less likely to report wasted physician and patient time, re-ordering of diagnostic images and lab tests, and being forced to proceed with incomplete patient information [19]. There is potential to build on these types of studies to enrich understanding of the effects of iEHRs and other approaches to health information exchange.
This study is a first step at providing a pan-Canadian view of user perceptions the effects of using iEHRs (solutions that offer authorized clinicians two or more types of clinical information from across a province/territory) and health information exchange more broadly. Users of iEHRs that provide secure access to patient information collated from across the health system tend to report positive outcomes, including quality of care and productivity.
We hope that its insights will inform future health information exchange efforts and that it will foster continued interest in complementary approaches to evaluation that offer complementary insights on how best to accelerate value through iEHR use.
*Reproduced with permission.
DI, diagnostic imaging; DIS, drug information system(s); HIE, health information exchange; iEHR, interoperable electronic health record(s); PACS, Picture Archiving Communication Systems; PT, Province (s) and Territory (ies)
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Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. Benefits of health information technology: a review of recent literature shows predominantly positive results. Health Aff(Millwood). 2011; doi:10.1377/hlthaff.2011.0178.
Lau F, Kuziemsky C, Price M, Gardner J. A review on systematic reviews of health information system studies. J Am Med Inform Assoc. 2010;17(6):637–45.
Statistics Canada. Population estimates and projections. http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo02a-eng.htm. Accessed 29 February 2016.
Canada Health Infoway. National Survey of Canadian Nurses: Use of Digital Health Technologies in Practice. https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/clinical-adoption/1913-national-survey-of-canadian-nurses-use-of-digital-health-technologies-in-practice (2014). Accessed 29 February 2016.
Canada Health Infoway. The National Survey of Canadian Community Pharmacists: Use of Digital Health Technologies in Practice. https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/clinical-adoption/2108-the-national-survey-of-canadian-community-pharmacists-use-of-digital-health-technologies-in-practice (2014). Accessed 29 February 2016.
Canada Health Infoway. 2014 National Physician Survey. https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/clinical-adoption/2163-2014-national-physicians-survey (2014). Accessed 29 February 2016.
Health Quality Council of Alberta. Continuity of Patient Care study. http://hqca.ca/studies-and-reviews/continuity-of-patient-care-study/. Accessed 29 February 2016.
HIMSS. The Business Case for Interoperability and Health Information Exchange. http://s3.amazonaws.com/rdcms-himss/files/production/public/2014-08-28-BusinessCaseforInteroperabilityandHIE.pdf (2014). Accessed 29 February 2016.
Provinces and Territories talk health care. http://www.prnewswire.com/news-releases/provinces-and-territories-talk-health-care-277671231.html (2014). Accessed 29 February 2016.
Vangeest JB, Johnson TP, Welch VL. Methodologies for improving response rates in surveys of physicians: a systematic review. Eval Health Prof. 2007;30(4):303–21.
Wiebe ER, Kaczorowski J, MacKay J. Why are response rates in clinician surveys declining? Can Fam Physician. 2012;58(4):e225–8.
Cunningham CT, Quan H, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015;15:32. doi:10.1186/s12874-015-0016-z.
Hagens S. Canadian EHR: Early benefits and journey ahead. Health Care Information Management and Communications. Canada: (HCIM & C). 4th Quarter; 2009.
Canada Health Infoway. A framework and Toolkit for Managing eHealth Change: People and Process. https://www.infoway-inforoute.ca/en/component/edocman/1659-a-framework-and-toolkit-for-managing-ehealth-change-2/view-document. Accessed 29 February 2016.
Adler‐Milstein J, Everson J, Lee SY. EHR Adoption and Hospital Performance: Time‐Related Effects. Health Serv Res. 2015; doi:10.1111/1475-6773.12406.
We wish to thank David Bates, Claude Sicotte, Robyn Tamblyn, Lydia Lee, Steve Edworthy, Sara Muttitt for their feedback on earlier versions of the results classification. We are grateful to Francis Lau for his thoughtful guidance and insights on the methodology. We also thank our colleagues at Canada Health Infoway, Bobby Gheorghiu and Jeff Green for their insights on the development of the manuscript.
ST, SH and JZ collaborated together on the design of the study. ST led the data analysis and manuscript development. All authors participated in the interpretation of the data, provided detailed feedback on the manuscript and approved the final manuscript.
Authors' information
Canada Health Infoway-Inforoute Santé du Canada, 150 King St. W., Ste 1300, Toronto, M5H 1 J9, ON, Canada
Sukirtha Tharmalingam, Simon Hagens & Jennifer Zelmer
Sukirtha Tharmalingam
Simon Hagens
Jennifer Zelmer
Correspondence to Sukirtha Tharmalingam.
Tharmalingam, S., Hagens, S. & Zelmer, J. The value of connected health information: perceptions of electronic health record users in Canada. BMC Med Inform Decis Mak 16, 93 (2016). https://doi.org/10.1186/s12911-016-0330-3

redpajama_set_name: RedPajamaCommonCrawl


Parc Riviera is a brand new condominium development in West Coast Vale, District 05. The plot of land drew interest from 6 hopeful developers with our home grown EL Development emerging as winner. The successful bid by EL was $10 million above the second highest by Hoi Hup Realty who submitted $304.30m and $77.2 million higher than the lowest bid by Singland Homes. Parc Riviera psf basing on just the land cost translate to $551.15 on average. This is in fact lower than the sold out project Waterfront @ Faber right opposite at Faber Walk with a land cost of $687 per square foot per plot ratio(psf ppr).
The number of new projects in the west is scarce. After the selling out of Waterfront @ Faber, we are only left with Trilinq, Lakeville and Lake Grande with limited units to select from. This goes to show the demand in the West Region of Singapore is more than the supply, making Parc Riviera extraordinary!
Parc Riviera is a French name that means River by the Park. As its name implies, the development is one of the tallest in the vicinity at 36 storeys with spectacular view of the Pandan Reservoir and Sungei Ulu Pandan. Parc Riviera condo is meticulously positioned in a North South orientation for optimal wind flow and to avoid the afternoon sun. On top of that, the 2 staggering towers will only occupy 30% of the 18,908.7 square meters land while the rest will be facilities and landscaping, this will make the development less cluttered to live in.
Parc Riviera condo is nestled in among the west coast private residential estate. With a limited supply of 1 and 2 bedroom in the precinct coupled with the unblock views towards the landed area of Faber Walk and Pandan Reservoir, it is definitely an ideal choice for tenants to reside in this tranquil environment.
There are 2 facings for the units in Parc Riviera West Coast Vale. To avoid having units to face each other, the architect designed them to either face towards West Coast Road or Ayer Rajah Expressway(AYE) where the latter will have units starting from level 5.
The renowned developer has brought a number of successful developments to satisfied home owners. Some of their previous works include Rhapsody on Mount Elizabeth, Parc Centennial, Illuminaire, Rosewood Suites, SkySuites 17, Stevens Suites, La Fiesta at Sengkang, Symphony Suites in Yishun It is expected that the project will yield up to 752 units with unit mix of 1 bedroom, 2 bedroom, 3 bedrooms, 4 bedrooms unit in two 36 storey towers together with either town houses or cluster housing. Parc Riviera TOP date should be somewhere around mid of year 2020 or even earlier depending on the construction progress.
Please kindly fill in the Contact Us form or Call us @ 6100 8987 to register for an appointment to view the Parc Riviera showflat NOW!
Amenities – are just a short drive or a few bus stops away from Parc Riviera West Coast Vale. Residents get to enjoy shopping convenience from Clementi mall, CityVibe, JEM, JCUBE or IMM, Big Box, Westgate, West Coast Plaza, Sunset Way, you will be spoilt with choices! On top of that, Blk 415 and Blk 416 Pandan Gardens which has a number of shops are within walking distance to Parc Riviera too!
Connectivity – Parc Riviera location is excellent with major expressways Pan-Island Expressway(PIE), Ayer-Rajah Expressway(AYE) and West Coast highway to serve dwellers. For public transport commuters, you may take a shuttle bus from the new West Coast Vale condo to Clementi central that has a air-conditioned bus interchange and a MRT station. Alternatively, there are a number of buses that connects to town and CBD area at the bus stop within 2 minutes walk. In the near future, Clementi MRT station will also be linked to Tuas West Extension comprising of Gul Circle, Tuas Crescent, Tuas West Road and Tuas Link. In addition, there will be a future Jurong Region Line that connects Jurong Regional Hub with residential area of the west including Jurong West, Choa Chu Kang, Tengah, West Coast and Jurong Industrial Estate. This will greatly benefit residents who utilises the public transport and in turn assist the caiptal appreciation of Parc Riviera Clementi.
Attractively priced – Although the land might be lower than some nearby projects, the requirement to adopt prefabricated prefinished volumetric construction (PPVC) will generally increase construction costs by a fair bit. Market Analyst foresee the Parc Riviera price during launch be between $1200-$1300 psf. With the recent bidding of the land plot beside Parc Riviera Condo, it is definitely a safe entry for buyers here. China Construction Development bid the land with a winning bid at $292 million emerging winner out of the 9 bidders. It works out to be at $592 per square foot per plot ratio(psf ppr), translating to 7% higher than Parc Rivera.
Educational institutions – Parc Riviera is one of the few new residential developments in the Western region of Singapore. Being home to many good schools, parents can rest assure that their children has many choices such as National University of Singapore(NUS), Singapore Polytechnic, Ngee Ann Polytechnic, School of Science and Technology, INSEAD, Nan Hua primary and high school, Clementi Primary School, Pei Tong Primary School, Qifa Primary School, Clementi Town Secondary School, Clementi Woods Secondary School, NUS High School of Mathematics and Science, Tanglin Secondary School, International Community School, Yale-NUS College, ITE College West (Clementi Campus) are all within close proximity to Parc Riviera West Coast.
Medical facilities – Healthcare facilities are important consideration factors of our modern property buyers. With our increasing population and land size in Singapore, it is necessary that we have sufficient medical facilities to support. Parc Riviera is within close proximity to many of our largest hospitals and clinics. Besides the many clinics in the neighbourhood of Pandan Gardens and West coast road, we are near to National University Hospital(NUH), the brand new Ng Teng Fong Hospital and Jurong community hospital, all being within 10mins from Parc Riviera Singapore.
Future developments – to the Jurong Lake District will see the biggest commercial, leisure and medical hub outside of Singapore City. This will in turn be advantageous to the capital gain potential of Parc Riviera.
Second CBD – Parc Riviera is extremely near to Jurong Gateway. It is envisioned to be the second CBD with commercial hub, International Business Park, many malls and a High Speed Rail direct to Kuala Lumpur. The station is confirmed to be located around the current Science Centre road behind Genting Hotel Jurong. It will only take 1.5 hours from Singapore to Kuala Lumpur by train in future. With the Jurong Regional Centre being so close to Parc Riviera, it is expected that there will be more foreign interests in properties located in the West and thus a promising appreciation potential.
High rental potential – from the busy International business park(IBP), One-North at Buona Vista, Science Park I and II, National University of Singapore(NUS), the future Jurong Lake District, Jurong Regional Center, Parc Riviera condo will be one of the best choice available to tenants. Currently, the rental in J Gateway beside Jurong East MRT station is going at the range to $3200-$3500 for a 2 bedroom unit. So it is safe to assume the 2 bedroom of Parc Riviera to get anywhere between $2800 to $3000 being a mere 3 bus stops away.
Functional Layout – As seen from Parc Riviera floor plan, we know that EL Development has meticulously designed to cater to most investors and own-stay buyers locally. Unit mix includes 1 bedroom(463 – 667 sqft) / 2 bedrooms(603 – 926 sqft) / 2 bedrooms premium(646 – 1033 sqft) / 3 bedrooms executive (906 – 1335sqft) / 3 bedrooms premium (1012 – 1442 sqft) / 4 bedrooms(1152 – 1711 sqft). It can be seen that all unit types in Parc Riviera enjoy a luxurious space with no odd shapes. In this way, owners will find it much easier to place their furnitures to maximise the space within.
Parc Riviera 1 Bedroom – SOLD OUT !
Parc Riviera 2 Bedroom – SOLD OUT !
Parc Riviera 3 Bedroom – SOLD OUT !
Parc Riviera 4 Bedroom From $1,276,000 ONLY !
There are only a handful of new condominium and EC developments in the western district of Singapore. With the high demand sighted in Lakelife, Westwood Residences, Wandervale EC, Lake Grande, Lakeville, J Gateway, Trilinq, Sol Acres, The Parc Riviera Condo will be high demand too.
The Parc Riviera West Coast is also well connected to major expressways for the best driving convenience. It is also near to Clementi MRT and Bus Interchange for easy commuting. Located in one of the prestigious District 05, Parc Riviera is near to CBD and town area. It will only take about 15 minutes drive or 20 minutes by train to the city area.
As seen on the Parc Riviera site plan, the architect deliberately utilize a conservative 30% of land area for the 2 identical towers. The rest of the 70% space in Parc Riviera condo is used for landscaping and facilities. In this way, residents will get to enjoy more communal space with their family without feeling cluttered.
The 752 residential units in Parc Riviera condo are relatively North-South oriented with facings towards the Ayer Rajah Expressway(AYE) and the West Coast Road(Pandan Reservoir). EL Development did carefully plan for the position of the towers to present fully unblock units for Parc Riviera buyers.
The new Clementi condo will be featuring 752 residential units from 1-4 bedrooms. There are 2 facings within Parc Riviera Condo. Both will enjoy premium facings where North will be towards the landed area of Faber Walk with low rise homes on the low plot ratio land. Units facing southwards will get to see the Pandan Reservoir and Sungei Ulu Pandan.
The layout of Parc Riviera Condo should not deviate too much from their prior developments that gained many positive feedback. La Fiesta, Parc Centennial, Symphony Suites are just a few of their many successful developments.
There is ample living space in every unit of Parc Riviera. Developers and architects deliberately reduce the size of balconies to amplify the living rooms and bedrooms where most of the activities are. Kitchens are more compact and functional, catering to the metropolitan lifestyle of locals.
All common rooms are spacious enough to accommodate a queen sized bed. Please Contact Us to have a look at our Parc Riviera showflat now!


Our faculty is dedicated to recognizing and nurturing your abilities. The portfolio review can be an early and informal review to help you build a better portfolio OR it can be final assessment of your abilities. We encourage students to have their first portfolio review early, even as high school juniors. It is an important step in helping to decide if we are the right school for you!
All applicants, whether applying for a major or minor at the Center for Art & Design, are required to complete a portfolio review. The review may be completed before or after your application is submitted. See details below.
Your portfolio should include 15 to 20 works, ideally produced within the last two years. Remember, your most recent work will be represent your abilities, ideas and interests.
50% Drawing- you should include a minimum of 5 drawings from direct observation (for example: self-portrait, still life, interior space and figure drawing). Other drawing examples can include work utilizing research and reference sources (including photo reference) and other self-directed drawing in a variety of media.
50% Personal Choice- Highlight your unique strengths and abilities. Include work you feel confident in and be prepared to talk about your process and decisions. This is your opportunity to share your ideas and insights, to introduce us to how you invent, create and experience the world around you. Any variety of media may be used.
Presentation- Work should be kept neat and flat, with a slipsheet between each work. Matting, mounting, or framing is not required and add unnecessary bulk to your portfolio. Large works can be rolled to protect the work and for ease of transport. Three-dimensional work may be presented as digital or photo documentation. Edit your portfolio to emphasize your personal strengths. If you keep a sketchbook or journal, please include it as supplemental.
On-Campus- You may schedule a weekly portfolio review by calling the Art Office at 518-485-3900. This is an opportunity for you to have an individual review, tour our facilities, view student work and meet with faculty and students. You may also choose to schedule your review on one of our Center for Art & Design Portfolio Review Days.
On the Road- You may also have your portfolio reviewed at select National Portfolio Review Days (check out the list here). In addition, we participate in local and regional portfolio days. Please call the Art Office to confirm.
Online- We work with the online portfolio admissions site Slideroom. You may click here to apply online.
By Mail- CD submissions are also acceptable. Please include a separate printed numerical inventory listing the size, media, and date completed for each of the works submitted. Digital images should be in jpg format with numbers corresponding to your list. Please do NOT send original artwork.


This topic contains 6 replies, has 0 voices, and was last updated by Spinal 9 years, 2 months ago.
I've got zeroshell running on a Dell server, freshly burnt beta12 livedisk. IP is the defaut 192.168.0.75.
On my vista laptop, I've set a fixed IP of 192.168.0.2.
I can ping zeroshell from the laptop, and the laptop from zeroshell no problems.
That said, going to https://192.168.0.75 doesn't find a service, and I get the "Internet Explorer cannot display the webpage".
update… just did a portscan on the server, and all I'm getting open is 749, which is for Kerberos… port 80 (http) and port 443 (https) don't respond as open….
Now I'm confused, as it seem like I'm the only person to get this problem!
Could you attach a monitor on the ZS to check if the system has come up correctly?
Will try burning the disk again tomorrow, I'm thinking maybe something got screwed in the download/burn process…. I've got to get to bed, have a client tomorrow that's quite far from where I live, so it's an early wakeup for me!
to verify that server is up and conclude if it is a firewall error.
You probably know about the Setup–>https tab–>Allow access only from (IP or subnet) settings. Of course, if these get set wrong, you can't get in to fix it.
Having incorrectly configured the firewall or the network in general I can no longer connect via the web interface. Even rebooting the system doesn't work. How can I resolve the problem?
From the ZeroShell console press the Z key. This enables the system to start the Fail-Safe procedure: you will be requested to select an Ethernet interface which can be attributed an IP address of your choice; any obstacles, such as firewall rules, belonging to a bridge, static routes or other will be removed. Once complete, you can access the interface via the IP address you attributed. To exit the Fail-Safe mode you must reboot, having removed the obstacle that blocked access.
This is my first whack at ZS, so I've never even seen the web-interface!
Below is the dump from nmap – I don't see anything on port 443… (oh, and I've tried reburning the disk).
EDIT2: rebooted into OsX just to see if it was indeed vista… still can't get anywhere… running OsXs built in portscan (which frankly is quite crappy) I get only 749 open.
Couldn't get ZS to get a dynamic IP from my ISP though, but I've had enough for a day… going out now!


text:
Q: Swing Java Employee Program When the user types an employee's first and last names (separated by a space) in a
JTextField, the employee's job title is displayed in a secondJTextField. Include
twoJLabels to describe theJTextFields used for data entry, and include a third
JLabel that holds the employee's title or an error message if no match is found for
the employee
Every thing works fine but when i include following part of code only error message "Employee not found" even if array matches.Without this statement code works fine.please help..thanks
 if(!(name.equalsIgnoreCase(empName[x]) ||    job.equalsIgnoreCase(jobName[x])))
    {
        errorortitle.setText("Employee not found");

    }

 package appletLesson;

import javax.swing.*;
import java.awt.*;
import java.awt.event.*;

import javax.swing.*;
import java.awt.*;
import java.awt.event.*;
import java.awt.Color.*;
public class JEmployeeTitle extends JApplet implements ActionListener
{
String[] empName = {"James", "Tom", "Steve", "Barack", "John"};
String[] jobName = {"Blunt", "Kites", "Jobs", "Obama", "Smith"};
String[] jobTitle = {"Actor", "Buisness men", "CEO", "President", "Painter"};

JLabel fnameLabel = new JLabel("Enter First Name:");
JLabel lnameLabel = new JLabel("ENter Last Name:");
JButton button = new JButton("Submit");
JLabel errorortitle = new JLabel(" ");
JTextField fnameField = new JTextField(20);
JTextField lnameField = new JTextField(20);

Container con = getContentPane();
public void init()
{
    con.setBackground(Color.YELLOW);

    con.add(fnameLabel);

    con.add(fnameField);
    con.add(lnameLabel);
    con.add(lnameField);
    con.add(button);
    con.add(errorortitle);
    con.setLayout(new FlowLayout());
    fnameField.addActionListener(this);
    lnameField.addActionListener(this);
    button.addActionListener(this);
}
public void actionPerformed(ActionEvent e)
{
    String name = fnameField.getText();
    String job = lnameField.getText();
    for(int x = 0; x < 5; x++)
    {
        if(name.equalsIgnoreCase(empName[x]) ||           job.equalsIgnoreCase(jobName[x]))
        {
            errorortitle.setText(jobTitle[x]);

        }
        if(!(name.equalsIgnoreCase(empName[x]) ||    job.equalsIgnoreCase(jobName[x])))
        {
            errorortitle.setText("Employee not found");

        }
            }
    validate();
}
}

A: Your problem is in this loop:
for(int x = 0; x < 5; x++)
{
    if(name.equalsIgnoreCase(empName[x]) || job.equalsIgnoreCase(jobName[x]))
    {
        errorortitle.setText(jobTitle[x]);

    }
    if(!(name.equalsIgnoreCase(empName[x]) || job.equalsIgnoreCase(jobName[x])))
    {
        errorortitle.setText("Employee not found");

    }
}

You should break out of the loop once you find a match, otherwise you'll just continue through all of the names and overwrite the correct jobTitle with "Employee not found". (I bet your original code works correctly with John Smith and nobody else -- try it.) So, e.g.:
for(int x = 0; x < 5; x++)
{
    if(name.equalsIgnoreCase(empName[x]) ||           job.equalsIgnoreCase(jobName[x]))
    {
        errorortitle.setText(jobTitle[x]);
        break; // stop checking
    }
    if(!(name.equalsIgnoreCase(empName[x]) ||    job.equalsIgnoreCase(jobName[x])))
    {
        errorortitle.setText("Employee not found");

    }
}

Also I wonder if you mean && instead of ||, but I don't know exactly what you're going for.
In situations like this it helps to just sit down and look at your code closely. Step through it in your head one line at a time (or use a debugger), and see if you can spot the problem. Write out iterations on paper if it helps.
Hope that helps.
By the way, yes, there are cleaner ways to write the above loops. I'll leave that as an exercise to the OP.

redpajama_set_name: RedPajamaStackExchange


text:
the black ewe
Animals, veterinary medicine and history, religion and more…
Archive for the 'chickens' category
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I.B. Singer and animals
Prior to researching a long paper I wrote for Veterinary Heritage on the history of antivivisectionism and the animal rights movement, the name Isaac Bashevis Singer barely registered for me. I was vaguely aware of his status as a renowned Yiddish storyteller, but I hadn't read a single one of his stories, and in fact I thought he wrote only folklore that I imagined as being very similar to the Ukranian peasant tales I had read as a child.
While I was researching the darkest period in the evolution of antivivisectionism/animal rights – the Cold War era, it was as if all the lights had gone out: I couldn't find any writers who cared about animals. Where were the Tolstoys, the Twains, the Bernard Shaws and all the other humanists who had expressed their deep concern for animals and their opposition to vivisection in the late 19th century? Instead, all I could see in the Cold War era was that the foundations were being laid for factory farming, and that animals were being used in massive, unprecendented numbers in research in just about every technological and scientific field under the sun – and very few voices were emerging in protest of animal suffering and consciousness. The ones who did speak up were treated like kooks and subversives.
And yet, it was during that time that one of the most powerful statements came through, one that did not escape the notice of the nascent animal rights movement in the early 1970s, and which can now be found on just about every AR website: the "eternal Treblinka" quote. More than a metaphor or an analogy, it really is just a straightforward description of animal experience in the hands of humans.
I.B. Singer was the author of the eternal Treblinka quote. He wrote it in a moving short story called "The Letter Writer". Herman, the protagonist, is an aging Jewish immigrant from Kalomin (Galomin, Poland), an editor, proofreader and translator living in New York City in the 1950s. His publishing company folds, he is out of work and immediately falls ill with severe pneumonia. A woman who had previously known him only through correspondence comes to care for him and saves his life. Herman had lost all of his family to the Nazis and lived alone with a house-mouse he named Huldah. When he recovers from pneumonia, he is afraid that Huldah is dead and gone as well, due to his "negligence". While he grieves for her, he speaks a eulogy for all animals:
What do they know – all those scholars, all those pilosophers, all the leaders of the world – about such as you? They have convinced themselves that man, the worst transgressor of all the species, is the crown of creation. All other creatures were created merely to provide him with food, pelts, to be tormented, exterminated. In relation to them, all people are Nazis; for the animals it is an eternal Treblinka. And yet man demands compassion from heaven."
(Herman later finds Huldah alive, when she emerges from her hole to drink from a saucer of milk.)
Singer's regard for animals emerges from time to time in other stories as well. In "The Slaughterer", a man designated against his will to be the ritual slaughterer in his community ends up going mad and sees no other way out besides self-slaughter. And my favourite story ever written about chickens: "Cockadoodledoo", a little gem of a story that gets as close to the experience of being a chicken as I have ever read.
Now that I've read more stories by and about I.B. Singer, I feel like I've discovered a bit of a link to my own family history. Although I'm not Jewish, there's enough nominal evidence in my family tree to show that there were a lot of people drifting in and out of Jewish, Catholic and Orthodox families to create quite a mix – but maybe that was just part of being Galician in the 19th and early 20th centuries: cultural tensions on one hand, and on the other, simply surviving with small hope for prosperity. My family seems to have a tradition of switching cultures and religions every generation or so, according to whatever is personally or politically expedient: we're obviously not the most tenacious of believers. My father emigrated with his family to North America from Galicia just a few years before Singer did in the early 1930s, and I've come to realise that many of Singer's stories provide the physical and geographical details of a place and way of life that was for all purposes obliterated during the Second World War. I was never given much information on Galicia, Poland or Ukraine as a child – the information was perhaps out there, but my father, aunts, cousins and grandparents mainly wanted to leave the Old Country and its bad memories behind. Stories and tales were only haphazardly translated to English, or they lacked some universal and meaningful context; they never felt very real to me, and faded into the background.
But Singer caught my attention with his attention to animals; in the barely industrialised world of Singer's and my grandparents' Galicia, animals lived side-by-side with humans in their yards and on their streets, and thankfully, they did not escape his notice. I'm grateful for that as much as for his descriptions of the culture and surroundings.
Dvorah Telushkin wrote a remarkable memoir of the time she spent as Singer's assistant during the last several years of his life with her book Master of Dreams.
She was there when Singer met Israeli Prime Minister Menachem Begin in the fall of 1978 in New York City, when Begin, U.S. President Jimmy Carter and Egyptian President Anwar Sadat had just announced that the Israeli and Egyptian leaders would meet at Camp David. Even though I was not even 10 years old at the time, I remember knowing about that meeting because a few months later I traveled with my mother and a group of evangelical tourists on one of the first Holy Land tours. We flew directly from Cairo to Tel Aviv, something that had previously been impossible; it was almost as if the agreement had been reached for the convenience of North American tourists – that's how I saw it anyways.
According to Telushkin's account, Singer was at first proud and impressed to meet with Begin in New York, but apparently the meeting did not go well. He voiced a meek complaint about the Israeli neglect of Yiddish in favour of Hebrew:
"you have taken the Hebrew language, vhich vas dead for these two thousand years and resurrected it. But vith Yiddish, you took a living language vhich vas alive for some eight or nine hundred years and managed to kill it."
"With Yiddish," Begin shouted, "we could have not created any navy; with Yiddish, we could have no army; with Yiddish, we could not defend ourselves with powerful jet planes; with Yiddish we would be nothing. We would be like animals!"
Isaac sat with his hands folded in his lap and shrugged his shoulders. "Nu," he said sweetly to the hushed crowd, "since I am a vegetarian, for me to be like an animal is not such a terrible thing."
I'm not sure what to make of that response, and I'm sure the small crowd of people present at that meeting didn't either. It's confusing and demoralising to bring the metaphor of animals into a human situation of power and conflict, but that's an instinctive human reflex built into us from thousands of years of considering animals as prey, burnt offerings, tools, and sustenance. Still, those aren't our only human interactions with animals, and sometimes I like to think, as Konrad Lorenz has written, that we are the missing link between hominid primates and some kind of truly moral species that for one thing doesn't consider itself superior to other animals.
I don't currently believe there's a god out there leading us toward this state. I like to think it's the thinkers and writers (and activists) on animal experience who are making the slow but necessary progress through statement, action and influence. I'm unable to decide whether to be an optimist or a pessimist on this, for now I'm just muddling through.
Categories: animal rights, chickens, history, human-animal bond, Israel, Jewish, politics, religion
Hens in peril
I was outside this afternoon, brushing my collie (colley?) Principessa with a currycomb, as she's been looking winter-ratty. I'm planning a makeover for her in the spring, complete with a bath, trim and furstyling. It should be a Great Event: she's 8 years old and has never experienced anything of the sort. She seems to enjoy the currycombing, as long as I don't pull on the tangles.
In general she's a very, very good dog. Nowhere near a Lassie standard of intelligence, but maybe that's a lack of training on my part. She's a responsive and trustworthy dog with no aggressive tendencies toward other dogs – and yet she won't be intimidated. Her approach to humans is 100% friendliness.
Cats: not so much. Even the cats who have befriended her still have to watch their backs, and are advised to walk away slowly, never, ever run.
But you can see where I'm going with this: it's the chickens that bring out the worst in her, and that's only relatively recently. It was only last spring that she decided to sample chicken, and she started small: one banty hen. At the time, I figured she mistook it for a pigeon, and forgave her. But then she reduced a young rooster to a pile of fluffy white feathers, and there is of course the unexplained sudden disappearance of the gentle Polish rooster. Then there were the systematic attacks on hens who we saved just before she finished them off. I had to make the difficult choice last summer: it was either the chickens or Principessa. Who would run free, that is. I tried a few days of alternating between the two: one day of freedom for Principessa, the next she remained tethered and the hens roamed free. (Technically, both freedoms are discouraged in municipal law or federal poultry guidelines, but I've disregarded both as unnecessary and harmful to animal welfare.) Finally, I came to a different compromise, siding heavily with the hens: they would be free from sunrise till sunset, and then Principessa could be off her tether without supervision. Once the snows came, the hens stayed inside everyday, and Principessa was once again free as a…bird.
So as I was combing her today, I noticed a small pile of brown feathers in the snow. Upon closer inspection, it was in fact the head of one of my six (now five) hens, who must've slipped out while I was feeding them. Principessa must have taken note of that and returned when I went into the house.
The warm season dilemma of dog versus hens is going to come again in a few months, and I'd love to find a way to stop the poultricide. If anyone has any suggestions, please tell.
Categories: animal relationships, chickens, dogs, Uncategorized
Ain't nobody here but us chickens
Just came back from the henhouse, where the chickens are starting to go stir crazy from the long winter. They have room to walk around, various shelves and objects to perch on, and they even have a new rooster (name's Chicken) to henpeck. I think they notice the light is returning – for one thing, they're laying more eggs these days.
But they've given up trying to find new and exciting places to lay, and they seem to be walking round in circles. A highlight of their day is when I drop an egg by accident and they take that as a sign from the gods, all evidence of which must be destroyed.
They are definitely bored. No worms to scratch, no dirt for baths, no tiny pebbles to ingest, and no garden shade to enjoy. Winter sucks for them even more than it does for us humans.
At least we can sing and play to pass the time.
Here's the original version, made popular by Louis Jordan in 1946 (strangely, the video does not include a single chicken):
Categories: animal behaviour, chickens, music
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text:
"Underbanked" Report Shows Need For Postal Banking
Home / News / "Underbanked" Report Shows Need For Postal Banking
By Dave Johnson, October 27, 2016, in The Huffington Post.
Millions of Americans can't get bank accounts, so they can't even cash a check. Many millions more might have an account but can't get even a small loan. The numbers (below) are just outrageous.
These millions are forced to turn to predators like the payday loan and check cashing industry. Even those who can get full-service accounts are scammed by the likes of Wells Fargo.
Meanwhile We the people are prevented by our captured-by-Wall-Street Congress from setting up the obvious solution that would solve so many problems: Postal Banking.
Millions Can't Use Banks
The Atlantic reports on a new report and spells it out, in The Millions of Americans Without Bank Accounts
The number of American families without a bank account dropped to about 9 million in 2015, the lowest rate on record since the Federal Deposit Insurance Corporation started gathering data in 2009. Still, around 24 million households are considered underbanked, meaning that they have checking accounts but still rely on alternative services—such as pawn shops, check-cashing operations, and payday or auto-title loans—for their credit and cash needs. And that number, a new report finds, hasn't improved much at all in the past few years, which means that tens of millions of Americans still struggle without access to basic financial services.
… Around 7 percent of all households don't have a bank account, down from around 7.7 percent in 2013, according to the FDIC. The most common reason families cited was not having enough money to open and maintain a checking account at a mainstream bank.
9 million Americans without any bank account. (And they call that an improvement!) 24 million more Americans dependent on payday lenders and the like.
The new report referenced by The Atlantic is from the Federal Deposit Insurance Corporation (FDIC), FDIC National Survey of Unbanked and Underbanked Households.
Payday Lenders Feast On These Millions
The lack of bank accounts or an "underbanked" ability to get credit hits people hard. So these millions of Americans with nowhere else to turn have to turn to predatory "payday lenders" and expensive check cashing outlets.
Why is this industry called "predatory?" August's post, Help Stop The Payday Loan Debt-Trap Scam, explains:
Instead of evaluating risk in order to block loans to people who couldn't pay the loan back, the payday loan industry tries to find poor, desperate people, dangles loans in front of them, and then traps them into a cycle that drains them of everything.
The "debt trap" is the actual business model, and they say so.
One payday loan CEO said of their "customers": "The theory in the business is [that] you've got to get that customer in, work to turn him into a repetitive customer, long-term customer, because that's really where the profitability is."
Another payday lender even put out a training manual for new employees, saying to employees that their job is to push borrowers from one payday loan to the next.
The chairman of the payday lender‐supported Consumer Credit Research Foundation and president of the Payday Loan Bar Association wrote an email saying, "In practice, consumers mostly either roll over or default; very few actually repay their loans in cash on the due date."
Jacob Swenson-Lengyel, in A New Report Reveals The Real Story About Payday Lenders, explains the findings of a report from People's Action titled CAUGHT IN THE DEBT TRAP:
A new report from People's Action and Americans for Financial Reform details stories of everyday people who went looking for a short-term fix and got stuck in a seemingly endless cycle of debt.
Harold Carnes, who lives in Las Vegas, Nevada, is one of those borrowers. Carnes took out a loan after his hours working for McDonald's were cut. When his hours didn't improve, he took out a second loan from a different company. Soon Carnes was taking out a third loan. The debt trap had snapped shut.
"The fees and the interest alone were out of hand and completely unmanageable," Carnes said. "The loan companies went into my meager bank account, that left my bank account overdrafted with the fees, and my account ended up being closed."
Carnes' story lines up with the data. The CFPB's own study found that four out of five people who take out a payday loan are forced to roll over or renew the loan within 14 days. Payday and car title lenders may advertise their products as a solution for customers looking for short-term, small-dollar loans. But because lenders fail to assess a borrower's ability to repay, the reality is that people are saddled with long-term debt at soaring triple-digit interest rates. The impacts can be devastating.
Minorities Targeted
Guess who is hit hardest by this. (Hint: minorities.) The Atlantic article explains:
The fact that some feel banks aren't interested in serving their communities is troubling but unsurprising. The underbanked population is largely made up of Americans who are poor, black, or Hispanic. Many haven't finished high school or college. These are the same populations that the American banking system has willfully alienated for generations through concrete policies such as redlining and subprime-credit targeting.
The Atlantic explained how the inability to get a bank account or credit hits minorities especially hard. Richard Eskow connects the dots to the way payday lending scams also hit minorities hard, in Payday Lenders: How Wall Street's "Undercover Brothers" Exploit Minorities:
Payday loans hurt all their customers, of course, not just minorities. But studies have shown that payday lenders disproportionately exploit minority neighborhoods with loans that are issued at an average annual interest rate of 455%. The average number of loan each borrower takes out is nine pre year, according to one study, as these high rates lead to a cycle of indebtedness. The loans are secured with the borrower's next paycheck, so only people with jobs qualify. It's a vicious circle, designed by the banking industry to maximize profits at the expense of the economically vulnerable.
This pillaging is taking place against the backdrop of an ever-increasing racial/economic divide. A Brandeis University/Center for Responsible Lending study showed dramatic increases in the economic gap between white and African-American households, as the difference in their financial assets quadrupled between 1984 and 2007.
[. . .] American banks have a long and checkered racial history. Government intervention was required to stop "redlining," the practice of denying financial services (or charging more for them) to minority neighborhoods. The biggest banks play a major role in backing auto loans, which studies have also shown to charge higher interest rates to African Americans than Caucasians. HSBC settled a lawsuit accusing it of charging minority borrowers more. Do payday lenders really target minorities? As this study shows, these fringe bankers have disproportionately set up shop in minority neighborhoods. The study, "Race Matters," was conducted in North Carolina, where African-American communities had three times as many payday lenders per capita as white communities, even when adjusted for other factors.
Eskow explains, "It's a classic Rigged Game: The banks deny normal credit to lower-income people, then profit from usurious forms of alternative credit (or as it's known in economic circles, 'fringe banking')."
Postal Banking
There is a simple solution that would help millions of Americans, and it is right in front of us: Postal Banking.
There are post offices in every town and city in the country. Imagine if Americans were allowed to do what millions of people in countries around the world take for granted. Imagine if we could get a simple account at the post office that lets us take care of basic banking functions like saving money, cashing or depositing checks, paying bills and getting small loans. Imagine Postal ATM cards for people to use at local stores or to get cash from ATMs at the local Post Office.
Imagine if We the People were allowed to do all this without paying large fees or worrying about getting scammed Wells Fargo-style.
If We the People could be allowed to have a simple bank account at our Post Offices this would solve a problem for millions upon millions of Americans. This would help people. It would keep people away from the debt-trap clutches of the predatory payday lending industry.
This is not an out-of-the-mainstream idea. Lots of countries do it. This country used to do it. In fact, the Postal Service still issues money orders.
Sen. Bernie Sanders has been pushing for postal banking, saying:
"I want to see our post office be reinvigorated," Sanders said in a Fusion interview this week with Felix Salmon, and postal banking is "one of the ways that I think we can help not only the U.S. Postal Service, but help a lot of low-income people."
[. . .] In a 2014 Wall Street Journal op-ed on saving the USPS, Sanders wrote:
[T]he Postal Service should have the flexibility to provide new consumer products and services—a flexibility that was banned by Congress in 2006. It is now against the law for workers in post offices to notarize or make copies of documents; to cash checks; to deliver wine or beer; or to engage in e-commerce activities (like scanning physical mail into a PDF and sending it through e-mail, selling non-postal products on the Internet or offering a non-commercial version of Gmail).
Sen. Elizabeth Warren has been pushing for postal banking. In April, 2014, Warren wrote in, Coming to a Post Office Near You: Loans You Can Trust?
With post offices and postal workers already on the ground, USPS could partner with banks to make a critical difference for millions of Americans who don't have basic banking services because there are almost no banks or bank branches in their neighborhoods.
… If the Postal Service offered basic banking services — nothing fancy, just basic bill paying, check cashing and small dollar loans — then it could provide affordable financial services for underserved families, and, at the same time, shore up its own financial footing.
Postal banking is an idea whose time has come (back.) We the People should be able to use our post offices for basic banking functions like simple savings accounts, cashing and depositing checks, ATM cards and getting small loans. There is no reason not to do this.
This post originally appeared at Campaign for America's Future (CAF) at their Blog for OurFuture. I am a Fellow with CAF. Sign up here for the CAF daily summary and/or for the Progressive Breakfast.
How to get justice after the Wells Fargo scandalNews
Payday lenders concentrated in poor ZIP codesNews


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Janowo – wieś w Polsce położona w województwie kujawsko-pomorskim, w powiecie lipnowskim, w gminie Kikół.

Podział administracyjny
W latach 1975–1998 miejscowość należała administracyjnie do województwa włocławskiego.

Demografia
Według Narodowego Spisu Powszechnego (III 2011 r.) wieś liczyła 176 mieszkańców. Jest szesnastą co do wielkości miejscowością gminy Kikół.

Zobacz też
 Janowo

Przypisy

Kikół (gmina)

redpajama_set_name: RedPajamaWikipedia


Trandate (Labetalol) is used to treat severe high blood pressure (hypertension).
This medication is used to treat severe high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks and kidney problems.
Follow the directions for using this medicine provided by your doctor. Take this medicine with food or milk.
Trandate is a drug that is used for treating high blood pressure. It is related to carvedilol (Coreg). Nerves that are part of the adrenergic nervous system travel to most arteries where they release an adrenergic chemical norepinephrine. The norepinephrine attaches to receptors on the muscles of the arteries and causes the muscles to contract, narrowing the arteries, and increasing the blood pressure. Trandate blocks receptors of the adrenergic nervous system. When trandate attaches to and blocks the receptors, the arterial muscles relax, and the arteries expand, resulting in a fall in blood pressure. The FDA first approved Trandate in 1997.
If the dose is interrupted, contact the doctor immediately to re-establish dosing.
Store the vials at room temperature between 36 and 86 degrees F (2 to 30 degrees C) and away from light. Do not freeze. After dilution in the correct IV fluids, this product is stable for 24 hours refrigerated or at room temperature. Discard any unused liquid.
Fatigue, nausea, or tingling of the scalp/skin may occur. If any of these effects persist or worsen, notify your doctor promptly. Tell your doctor immediately if this potentially serious side effect occurs: dizziness. Tell your doctor immediately if these unlikely but serious side effects occur: fainting, leg pain, increased sweating, increased urination, unusual thirst. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: unusually slow or irregular heartbeat, persistent loss of appetite, stomach pain, persistent sore throat or fever, easy bleeding or bruising, vision changes, difficulty urinating, mental/mood changes. Rare, but possibly fatal, liver problems have occurred during labetalol use. Seek immediate medical attention if you develop: dark urine, yellowing eyes or skin. An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, call your doctor or pharmacist.
Laboratory and/or medical tests (e.g., liver function) may be performed to monitor your progress.
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Buy Story Seed Vault a Coffee. ko-fi.com/storyseedvault - Ko-fi ❤ Where creators get paid by fans, with a 'Buy Me a Coffee' button.
The Vault began as a collection of Twitter science-fiction based on research articles by Alex Massey, published @tinystoryseeds. Today, the Vault has grown into an independent publisher of micro-science fiction, with writers and readers from all over the globe.
Thank you for (at least thinking about) supporting the Vault! If you've made it this far, you might know a little about what we do - we publish science fiction based on real science. Who are we? The Vault began as a collection of Twitter science-fiction based on research articles by Alex Massey (me!), published @tinystoryseeds. Inspired by the Global Seed Vaults, I sought to create a collection of stories, sourced from the imaginations of a diverse collection of writer. Today, the Vault has grown into an independent publisher of micro-science fiction, with writers and readers from all over the globe. We're based online, so our fiction is easily accessible to all, and we're determined to keep it that way. But to do that - we need your help. Why are we on Ko-Fi? At this stage in our growth, the Vault finds ourselves at a point where we must plan for a sustainable future. Our costs are growing - we're paying for over 100 stories a year and with plans to publish an anthology in the works, we need to begin thinking about our income stream. We could add a paywall or ads to the site, but frankly - I hate both those options. They disrupt the reader's experience and don't fit our ethics of diverse and accessible fiction. So, we've decided to pursue two avenues: - Donations from Writers & Supporters: We already give writers the option to donate their fee to support the Vault. We want to provide that option to our supporters too! So, we've started a Ko-Fi so that our Writers and Supporters can contribute to running costs and know where their money is going. - Kickstarter: We'll be creating a Kickstarter next year to launch our anthology - watch this space!
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text:
c.500 AD First human inhabitants
25 Apr 1841 Mayotte annexed by France
1886 Remaining Comoros islands become a French protectorate
05 Sep 1887 Protectorate of Comoros
09 Apr 1908 - 23 Feb 1914 Subordinated to Madagascar
25 Jul 1912 Annexed by France
27 Oct 1946 Overseas terrirory of France
22 Dec 1961 Autonomy, State of Comoros
06 Jul 1975 Independence, recognised by France on 31 Dec 1975
24 May 1978 Federal and Islamic Republic of Comoros
21 Jan 2002 Union of the Comoros
06 Jul - 03 Aug 1975 Ahmed Abdallah Abderemane ...................... 1919-1989
03 Aug 1975 - 03 Jan 1976 Prince Said Mohamed Jaffar ..................... 1918-1993
(Chairman National Council of the Revolution)
03 Jan 1976 - 13 May 1978 Ali Soilih Mtsashiwa ........................... 1937-1978
13 May - 23 May 1978 Said Atthoumani
(Chairman Politico-Military Directorate)
23 May - 03 Oct 1978 Ahmed Abdallah Abderemane (2nd Time)
23 May - 22 Jul 1978 Mohamed Ahmed .................................. 1917-1984
(co-chairmen
03 Oct 1978 - 26 Nov 1989 Ahmed Abdallah Abderemane (3rd Time)
26 Nov - 27 Nov 1989 Haribon Chebani
27 Nov 1989 - 29 Sep 1995 Said Mohamed Djohar (1st Time) ................. 1918-2006
29 Sep - 02 Oct 1995 Ayouba Combo ................................... 19..-2010
(Coordinator Transitional Military Committee)
02 Oct - 05 Oct 1995 Mohamed Taki Abdoulkarim (1st Time) ............ 1936-1998
- Said Ali Kemal
05 Oct 1995 - 26 Jan 1996 Caabi El-Yachroutu Mohamed
26 Jan 1996 - 25 Mar 1996 Said Mohamed Djohar (2nd Time)
25 Mar 1996 - 06 Nov 1998 Mohamed Taki Abdoulkarim (2nd Time)
06 Nov 1998 - 30 Apr 1999 Tadjidine Ben Said Massounde ................... 1933-2004
30 Apr 1999 - 21 Jan 2002 Azali Assoumani (1st Time)
21 Jan - 26 May 2002 Hamada Madi "Boléro"
26 May 2002 - 26 May 2006 Azali Assoumani (2nd Time)
26 May 2006 - 26 May 2011 Ahmed Abdallah Mohamed Sambi ................... 1958-
26 May 2011 - 26 May 2016 Ikililou Dhoinine .............................. 1962-
26 May 2016 - Azali Assoumani 3rd Time)
Vice-president of the Government Council
13 Aug 1957 - 31 Dec 1961 Mohamed Ahmed
Presidents of the Government Council
01 Jan 1962 - 16 Mar 1970 Said Mohamed Cheikh ............................ 1904-1970
02 Apr 1970 - 16 Jul 1972 Said Ibrahim Ben Ali ........................... 1911-1975
16 Jul - 26 Dec 1972 Said Mohamed Jaffar
26 Dec 1972 - 06 Jul 1975 Ahmed Abdallah Abderemane
07 Jan 1976 - 22 Dec 1978 Abdallah Mohamed ............................... 19..-2000
22 Dec 1978 - 08 Feb 1982 Salim Ben Ali .................................. 1918-2002
08 Feb 1982 - 31 Dec 1984 Ali Mroudjae
01 Jan 1985 - 07 Jan 1992 Post Abolished
07 Jan - 15 Jul 1992 Mohamed Taki Abdoulkarim
01 Jan - 26 May 1993 Ibrahim Abderamane Halidi
26 May - 19 Jun 1993 Said Ali Mohamed
20 Jun 1993 - 02 Jan 1994 Ahmed Ben Cheikh Attoumane
02 Jan - 14 Oct 1994 Mohamed Abdou Madi
14 Oct 1994 - 29 Apr 1995 Halifa Houmadi
29 Apr 1995 - 27 Mar 1996 Caabi El-Yachroutu Mohamed
27 Mar - 27 Dec 1996 Tadjidine Ben Said Massounde
27 Dec 1996 - 09 Sep 1997 Ahmed Abdou
07 Dec 1997 - 30 May 1998 Nourdine Bourhane
22 Nov 1998 - 30 Apr 1999 Abbas Djoussouf
02 Dec 1999 - 29 Nov 2000 Bianrifi Tarmidi
29 Nov 2000 - 15 Apr 2002 Hamada Madi "Boléro"
15 Apr 2002 Post Abolished


The Flow Log is a feature that enables you to capture information about the flow while it's running in real time as well as after the flow has been executed. Flow log data is stored in the file system.
capturing console log must be enabled.
To monitor a flow in real time, wait until it has started running, then open the Flow Dashboard by clicking the Running link.
In the Flow Dashboard click the View Console link.
The tail of the log view will open.
Use the same link to access the flow log for flows which have already been executed or canceled.


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