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InterSystems Virtual Summit 2021: Part 1 Recap
Posted by Nathan Elliott on October 29, 2021
Summaries by Nathan Elliott, J2 Interactive
Formatting and editing by Madeline Rizzo, J2 Interactive
Paul Grabscheid, Vice President of Strategic Planning at InterSystems, starts out this year's Virtual Summit.
2021 marks the second year of InterSystems' Global Summit going virtual! We attended and are pleased to provide highlights from some of our favorite sessions. See more in part two!
Welcome Presentation & Analytics Anywhere, Insights Everywhere Keynote
Paul Grabscheid, Vice President, Strategic Planning, InterSystems
Terry Ragon, Founder and CEO, InterSystems
Overview: Paul Grabscheid opens Virtual Summit 2021 with a preview of the conference presentations, and Terry Ragon describes the overarching need for organizations to invest in building analytics and applications on a unified platform to power efficiency, user adoption, rapid innovation, and value in the coming years.
InterSystems' Vice President of Strategic Planning, Paul Grabscheid, opened Virtual Summit 2021 with a welcome message. InterSystems has been helping organizations solve their most critical data problems for over 43 years and prides itself on long-standing relationships with customers. As Grabscheid explained, we are now entering an era that will be driven by analytics. This year's Summit highlights the advances and new offerings that InterSystems expects to help its clients make their data far more accessible, useful, and ultimately, valuable.
Terry Ragon, Founder and CEO of InterSystems, thanked customers and InterSystems employees for rising to the new challenges of the past few years. Years ago, having an Enterprise Data Warehouse that was a month behind current activity was sufficient to be competitive. Today, rapidly growing data from many new sources and increasing demand for data in near real-time from many stakeholders is changing the landscape. We now need better, faster, and more accurate insights in many more places than before. Companies that can do this well will have a major competitive advantage.
Today's challenges center around finding ways to obtain useful insights from existing and recent data without causing major upheaval, re-engineering, or negative performance impact. Companies require a unified record database with consolidated views that is always up to date and has clean, healthy data. A complete data platform must provide messaging, efficient databases, and analytics capabilities. The future will require advanced analytics in many places across an organization/ecosystem and the ability to support rapid development of useful and innovative applications that solve problems where they are encountered.
Terry Ragon believes that trust is at the core of any organization's success. We must be able to trust our data, trust the insights that we derive from that data, and trust our partners. That trust has to be earned. InterSystems strives to build and reinforce the trust that its customers have on a daily basis.
(Re)Building Analytics Capabilities and Culture: Getting Actionable Insights Faster, Better & Cheaper
Moderator: Michael Schrage, Research Fellow, MIT Sloan School's Initiative on the Digital Economy (IDE)
Dave Anderson, AI Evangelist, Data Robot
Jana Eggers, CEO, Nara Logics
Waseem Kawaf, Global Vice President Of Digital Experience, STANLEY Security
Overview: Michael Schrage from MIT leads a panel discussion on what organizations need to do to turn their investments in analytics into real value for their stakeholders.
In this moderated panel discussion, MIT's Michael Schrage led viewers through a session focused on understanding the changing roles of those involved in analytics today. It is no longer enough to have a few data professionals locked away somewhere in an IT department trying to sift through data in isolation. Now, data scientists must engage with a broad (and growing) list of stakeholders to better understand the wider context for their organization's data and the real-world problems that the data can help to solve. It is no longer just about building out data warehouses or offering up data lakes for hoped-for value. Today, organizations must make intentional investments in treating their data teams (and the technology itself) as widely known organizational team members.
Still, organizations should not expect that an investment in a certain technology or simply introducing data professionals to others in the organization will be sufficient. Part of the investment is knowing that it will take time for both the relationships and the quality of the organization's data to mature. Some questions might not be easily answered today, but by having patience with the process, organizations that invest in analytics, and the people who make analytics happen, there will be results in the long term. Because of this timeline, organizations should be looking for short-term wins along the way to gradually build trust, confidence, and an interest among stakeholders in participating in the process of advancing analytics maturity.
In many cases, organizations will need to think about changing their culture to capitalize on analytics. Too often, organizations buy into technology and perhaps hire a few people to support the investment without making a true commitment to take action on what the investment starts to produce. An organization needs to prepare in advance with a plan for what actions they plan to take based on the answers that emerge from their data. Are they prepared to change workflow? Are they prepared to alter supply chain decisions? If not, investments in analytics are likely to be disappointing. One key tactic to successfully help move analytics forward is hiring the right people. According to the panelists, they are out there. Once the right people with the right skills and energy are hired, they need to be moved into more visible roles in the organization to build rapport, support, and commitment to taking action on analytics output.
The panelists believed it is important to partner with the right feeder programs, such as academic institutions, to secure talent with the "hunger" and energy your organization will need. A critical feature of that talent should be storytelling skills. Data teams should have at least a few user experience or similar types of professionals to help remind the organization of where today's seemingly smaller insights are likely to lead for the organization and the community it serves. Technical know-how is necessary, but the ability to distill all of the complexities into relatable stories is key. There is now a need to move from "explainable AI," for example, to "understandable AI."
In one example, an organization might be able to apply a risk score or an indicator of a patient's propensity to miss an appointment, but before building out a metric like this and publishing it on dashboards, an organization needs to be able to identify which workflows it is willing to change or enhance and articulate their confidence in actually taking action on the numbers that are produced. Organizations must be willing to take action for analytics to have real value.
Our Vision for Data Platforms: Why you need a Smart Data Fabric
Presenter: Scott Gnau, Head of Data Platforms, InterSystems
Overview: InterSystems' Head of Data Platforms, Scott Gnau, talks about InterSystems' response to the long-term threat of cobbling solutions together to try to meet near-term requirements and moving toward the concept of creating a Smart Data Fabric.
Currently, we have increasingly complex volumes of data from many new sources. Data is generated, collected, and stored at staggering rates. The combination of increasing demands, variable and changing regulatory requirements, and increasing amounts of data could lead us into thinking that cobbling together solutions for near-term answers is our best solution. However, we need to take a longer view of data quality and see our solutions through the lens of not introducing fragility with quick fixes and short-term customizations.
InterSystems' product vision is to provide easy-to-use tools to access data from any siloed source, in whatever form it is in, standardize and refine what matters most, and facilitate taking action.
An adaptable solution must work across on-premise environments, the cloud, and individual devices. New data never stops, so InterSystems expects meeting demands to require ongoing, iterative work. Solutions must be scalable, and focus areas must evolve without breaking down or outgrowing a centralized solution.
The concept of a data fabric means threading together data from multiple silos to connect the elements that matter most and refining both the highest value data and its quality overtime to produce a strong weave.
In Gnau's view, InterSystems' multi-model database is a core component to supporting this type of long-term flexibility and connections across data silos. A multi-model database enables scalability without adding latency and unnecessary complexity. Perhaps most importantly for customers, InterSystems is doing this within one technology footprint for purposes of stability and lower cost of ownership, which is the goal of InterSystems IRIS. Specifically, less hardware, less software, and fewer copies of data.
Analytics in Healthcare: Opening New Frontiers for Care
Moderator: Susan Dentzer, Senior Policy Fellow for the Robert J. Margolis Center for Health Policy, Duke University
Jaime Bland, DNP, RN, President & CEO, CynchHealth
Kevin Tabb, MD, President & CEO, Beth Israel Lahey Health
Alex MacLeod, Head of Global Healthcare Initiatives, InterSystems
Overview: Duke University's Susan Dentzer leads a panel of experts in a discussion about the challenges and opportunities for data use in healthcare, with a special focus on differences between the US healthcare system and healthcare data use in other countries.
Susan Dentzer, Senior Policy Fellow at Duke University, facilitated this session. Panel participants represented a major health system, InterSystems, and HIEs. The session began with each panelist describing their respective organizations and some of the challenges they are trying to solve with analytics.
Kevin Tabb talked about Beth Israel Lahey's challenges in the last year supporting COVID-19 vaccine efforts. When trying to identify higher-risk sub-populations, most people start with age groups, which is easy enough until expectations for patient cohort identification become more complex. For example, filtering populations (accurately) to those with certain combinations of comorbidities can be challenging when details, such as diabetes diagnoses, are not documented consistently or in the same fields, even within a single EHR, not to mention across settings and facilities within a system. Tabb's staff had to look elsewhere for proxies to identify the right patients, such as selecting patients based on BMI, test results, or other combinations of information.
For their part, HIEs like CyncHealth are helping to track indicators at a state or regional level, such as bed capacity, vaccination metrics, and lab test results in near real-time. Their goal—to support public health emergency planning and decision-making/funding, state mandates, and modify those state-directed decisions over time as conditions change.
Alex MacLeod from InterSystems (Europe) talked about programs underway in places, such as the UK, to integrate services in communities with healthcare to better coordinate mental health services, social care, and voluntary services. (E.g., helping patients to feel less isolated during COVID-19 and providing safe community activities to keep people feeling engaged.) MacLeod noted that the UK is finding interesting connections in their data. For example, they found a strong correlation between elderly frailty or fall risk and whether or not an individual had assisted garbage collection services. Those in certain age groups without assisted garbage collection had a higher risk of falls, based on the data.
The panelists discussed some of the key differences between healthcare in the US and other countries. According to today's panelists, one of the biggest differences is that the US lacks a cohesive federal approach to organizing healthcare. Organizations at the local level are left to figure things out themselves as a kind of cottage industry, which can result in a high degree of variation, a vast number of silos, and challenges with aligning to standards for improved data use and coordination at a larger scale. Europe experienced this same kind of uncertainty while coordinating vaccine responses.
According to Dr. Tabb, when thinking about bringing new solutions into the market, companies need to think about solving problems for organizations in more comprehensive ways. One of the big frustrations for leaders like Tabb is technology solutions that appear to solve one problem but actually create new workflows, efficiencies, or data problems in other places within the organization.
The panelists generally agreed that technology is not really the biggest barrier to progress today. The bigger challenges are standards and culture. We still need more education, awareness building, and alignment with standards, whether that is driven primarily at the federal level or by the industry. In most cases, the solution to these problems is not as simple as just making a certain field required in an EHR. Solutions must be more comprehensive and consider related data that can be generated in other settings in a health system and community.
Bland talked about the potential for interconnected data and offered the example of using data to identify populations living close to factories or meat-packing facilities, who, according to the data, are at higher risk of developing certain diseases. Researchers can begin to look at data from well-crafted, standard-compliant ADT messages to help identify and monitor these kinds of sub-groups. When coupled with census and social care data, we can begin to do much more in prospective analyses on topics such as exposure to pathogens or predicting inpatient stays.
MacLeod concluded the session by reminding viewers that we have made great advancements in individual care at the EHR level. We now need to produce value at a population level. MacLeod is encouraged by what she sees as providers begin to talk more about taking time to review population or panel-level information, not only individual patient charts. Now is the time to leverage that interest and willingness to capitalize on the broader data and interconnectedness that we have all been working on.
Our Vision for Healthcare: Getting Value from Data
Presenter: Don Woodlock, Head of Healthcare, InterSystems
Overview: InterSystems' Head of Healthcare, Don Woodlock, shares the results of an InterSystems survey on analytics adoption and talks about the company's approaches to removing the barriers identified in that survey. Woodlock also announces InterSystems' TrakCare Innovation Toolkit and InterSystems Client Connection.
Don Woodlock provided a summary of recent survey results among partner organizations. The results showed the following:
80% of respondents said their top strategic priority pertaining to analytics is to create and share high-quality analytics across the organization. Woodlock stressed the importance of "share" and the need to make insights available in more places.
51% said that data integration and interoperability is the most significant barrier to analytics in the next 12 months.
Respondents said that the analytics challenges they are facing create long lag times, the inability to scale, and the inability to democratize data.
Respondents said that they believe these constraints lead to poor decisions, the inability to make timely decisions, and the inability to effectively identify important gaps in care.
InterSystems is working with clients to find solutions for these challenges and remove as many barriers as possible to help move organizations' analytics strategies forward.
In the past, organizations tried to rely on solutions provided by EHR vendors. Increasingly, organizations have moved to using independent solutions that come as an empty shell and require a significant amount of data preparation and fine-tuning. InterSystems is working to provide a more comprehensive, end-to-end set of solutions that provide the best of both worlds.
InterSystems' approach is to centralize clean data, provide the built-in engine to make use of the data and derive insights, and then drive the results of those insights back into existing workflows for clinicians and decision-makers, including directly into EHRs.
One of the first major challenges is connecting to all of the data sources that contribute to the design described above. InterSystems has invested heavily in building a large connector library to make those data source connections as easy and efficient as possible. This ease of use means that InterSystems' solutions speak any language the data source does, making data extraction and aggregation easy. Data can also be mapped using pre-built data transformations to InterSystems' Healthcare Data Model, which is a unified "golden" patient record that can run on InterSystems IRIS or populate third party repositories and made available through any number of front-end tools such as Tableau or similar products.
While many solutions stop at dashboard or report creation, InterSystems offers three additional components to help push the results of data aggregation and analytics back into workflows.
Bidirectional integration. InterSystems has invested in making it easy to connect both to data sources and end-user destinations, such as EHRs.
Real-time notifications. InterSystems supports delivering notifications to end-users to help improve decision-making and avoid additional clicks/time spent navigating to traditional portals or dashboards. The intent is to move analytics from static or on-demand interactions to deeply integrated insights that appear as part of any number and type of workflows.
Unified Care Record (UCR). InterSystems leverages its UCR to place clinical data viewing technology into providers' and care team members' own EHRs.
Woodlock also presented a brief overview of InterSystems' new TrakCare Innovation Toolkit to accelerate value creation for clients. The TrakCare Innovation Toolkit:
Makes TrakCare data available for machine learning
Enables connection to third-party applications
Enables creation of new MS Teams solutions, such as chatbots
Extends TrakCare with SMART on FHIR applications
Supports development of an organization's own digital health applications
In addition to this Toolkit, InterSystems is launching InterSystems Client Connection, an online community platform intended to allow TrakCare customers to interact and share information. InterSystems Client Connection includes documentation from InterSystems that will be helpful to the community.
Woodlock encouraged viewers to attend other in-depth focus sessions this week on these topics and concluded this session with a drum solo. The analogy is that drum solos do not necessarily drive the rest of the band, just like analytics can become isolated. To transform your organization, make sure you position analytics as the drumbeat and driver for the rest of your organization, not just a solution for its own sake. Woodlock drove the analogy home by rocking out on the drums, one-upping last year's guitar solo and proving again that he's the coolest healthcare IT guy in the ecosystem.
Digital Enablement: A Launchpad for Better Care
Presenter: Jim Heiman, AVP, Clinical Information Systems, Northwell Health
Overview: Jim Heiman, AVP of Clinical Information Systems at Northwell Health, discusses the health system's investment in and strategy for developing its HIE, including examples of compelling rapid technology development successes during the pandemic.
Northwell Health is a prominent health system in New York, whose HIE represents over 14 million patient records. Jim Heiman, AVP of Clinical Information Systems, began this session by listing some of the reasons Northwell Health decided to invest in building their own HIE or aggregated data platform. There was a need for:
System growth and acquisitions support
Value-based care reform
Comprehensive data for care decisions
Structural and semantic normalization
Other goals included supporting post-care follow-up, care coordination, chronic disease intervention, optimizing throughput, and participating in clinical trials.
Heiman discussed the HIE's timeline:
2013 – Comprehensive Health Record
Released internal HIE, featuring the unified Comprehensive Health Records with embedded Clinical Viewer (CV) in enterprise EMRs
2014 – Clinical Event Notifications
Added intelligence on the integration wires to detect events a clinician would subscribe to
2015 – High-Value Document Exchange
Completed specific integration to facilitate acute to outpatient transitions of care, targeting the most beneficial clinical data
2016 – Patient List App
Built workflow optimization tool leveraging rules to create smart patient lists for follow-up and administer interventions
2017 – Active Analytics
Consolidated data platform to query data in bulk breaking down internal silos
2018 – Enterprise APIs & Java Messaging
Unlocked data for innovation enabling additional in-house development capabilities to emerge
2019 – Regional Interoperability Strategies
Achieved data interoperability between caregivers in each region, in advance of enterprise platforms, with stand-alone or integrated Clinical Viewer
Northwell Health employs a four-part HIE strategy that involves:
Unlocking data silos
Empowering organizational efficiency
Synchronizing enterprise data
Engaging with community
In recent years, the focus has been on internal growth and value creation. Now, Northwell Health is shifting its focus to engaging external stakeholders. Northwell Health's HIE represents 14 million patient records from 30 connected systems with over 300 interfaces and more than 28,000 users.
Heiman talked about Northwell's role in the pandemic response and shared a number of video clips highlighting the heroic work of frontline healthcare workers. Heiman expressed his thanks to all of those who provided great care during the pandemic and also thanked the support staff that helped behind the scenes.
Heiman discussed Northwell Health's efforts to support COVID-19 testing and the resulting work to optimize lab result delivery and critical pathway development. Northwell Health enhanced its tools and processes to ensure that both providers and patients had access to information as soon as it was finalized. Northwell Health delivered not only clinical information but guidance and education for patients as well.
Heiman discussed two other high-value offerings from Northwell Health. One includes MAB infusion referral patient list creation and notifications to keep ordering providers up to date on the completion of infusions. The other involves scheduling and rescheduling tools for patients related to vaccines that bridge back to billing systems on an automated basis.
Northwell Health developed and deployed 35 new critical workflows and released over 100 enhancements in response to COVD-19. Most of these were delivered within hours or days of the original request and were completed in seamless collaboration across teams that supported a shared mission.
The speed of development and value creation at Northwell Health during the pandemic is remarkable, but Heiman sees these advances as just the beginning of what is to come post-COVID. Heiman discussed plans to incorporate patient device data, automate scalability, further reduce waste and unnecessary interventions, and optimize continued system and infrastructure expansion.
Keynote Customer Success Parts 1 and 2
Lisa Ford, CSP, CPAE on Customers as Partners: Build Loyalty & Repeat Business
John Paladino, Head of Client Services, InterSystems
Overview: Customer experience (CX) is a top priority for InterSystems and many of its most successful customers. Lisa Ford, CSP, CPAE, discusses what separates companies that excel and enjoy great success from those that struggle. InterSystems VP of Client Services, John Paladino, shares his passion for customer success and the approaches he takes at InterSystems to create and maintain a model support organization.
Lisa Ford is an expert on customer experience, and managing customer relationships is a critically important theme of this year's Summit. Ford described real-life examples of organizations that had the right ideas about customer engagement and loyalty but had trouble taking specific action to operationalize those ideas, ultimately falling short of earning customers' trust. Everything that companies do can erode, maintain, or strengthen customer trust and loyalty.
Very often, dealing with customers devolves into "transactions." Ford argued, however, that the best and most successful companies find ways to give customers what they really want: relationships with companies and brands. Perhaps the most compelling story Ford offered during this session came from the convenience store chain 7-Eleven. The CEO visited a 7-Eleven store location near Chicago to learn what made that site sell more coffee than any other location. As the CEO took inventory of the potential factors leading to the store's success in selling coffee, he found a simple root cause—a woman who worked at that location named Dolores. She knew customers' names, asked about their families, stayed up to date on kids' sporting events, and was, in effect, a family member to many people in the community. Ford explained that customers were not just buying coffee from that store; they were coming to see Dolores and happened to buy coffee while they were there.
According to Ford, there are three main things companies should work on:
Customer experience deepens the relationship customers have with your organization.
In a Gartner study, company leaders were asked what they believe they need to compete on. A hefty 89% said they expect to compete mostly on customer experience. Just a few years ago, only 36% of respondents said the same thing.
Know the customer and show them that.
The 7-Eleven example above illustrates this point.
Successful companies consistently help customers solve their problems.
Amazon provides a helpful example here. The retail giant learned that customers weren't just going to their website to buy things—they were also there to research, compare, and look for recommendations. Amazon put tools in place to help guide customers with customer reviews, recommendations, related product choices, and information about products to help them compare options (e.g., price per unit, ounce, pound, etc.).
Ford concluded with an example of staff at Ritz-Carlton who organized daily standup meetings to help employees stay energized and focused on always looking for ways to improve the customer experience. Other companies attempt watered-down versions of these kinds of commitments, but they are often less successful and end up being abandoned. According to Ford, the secret to success is prioritizing action to put the customer first every day: "Your daily discipline will determine your destiny."
John Paladino, InterSystems' Vice President of Client Services, told viewers about the early influences that led to his career choices. At a young age, Paladino had a traumatic experience. In order to cope, Paladino found that helping others made him feel better. He turned this coping mechanism into a lifelong passion and found the perfect fit for a long-term career at InterSystems—in large part because of the company's clear passion for helping others.
Paladino provided a few examples of that commitment and passion. In one example, a client in the pharmaceutical industry made the decision to model their own organizational redesign after InterSystems and asked InterSystems to participate in their change efforts. In another example, a trading platform that uses InterSystems' products experienced potentially overwhelming growth. In order to make sure the company managed that growth successfully, InterSystems flew dedicated staff and Paladino himself to the customer over a period of time to stay ahead of that growth and lay the foundation for exceedingly rapid scaling. The company has, in fact, experienced tremendous success.
InterSystems continues to invest in support talent and will continue to do so to help clients solve their most pressing challenges. Paladino believes in hiring the right people, putting them in the right environment to be autonomous and succeed, and giving them the tools they need to do their best work. As a general rule, Paladino said he looks for the following traits when hiring someone new:
New hires should have a high aptitude, intelligence, and a high degree of initiative. Paladino looks for people who are not afraid of new things or taking action.
Successful applicants will have a clear passion and energy about something in life. For Paladino, this is easy to identify.
Professionalism is required. Paladino must be confident about putting any new hire in front of long-term and highly valued customers.
Paladino invited anyone who would like help shaping their support team to contact him directly. Great customer support is his passion, and he is always willing to share what he has learned.
Keynote TrakCare: What's New and Next
Presenter: Dimitri Fane, Product Director, InterSystems
Overview: Dimitri Fane, Product Directior at InterSystems, hosts a team-assisted demonstration of TrakCare features following an example patient journey and discusses new features for the solution.
If you have studied biological evolution, you know that it does not happen at a constant rate. Species exist in stasis for a while, then accelerate change to adapt to something like environmental disruptions. We have experienced such a punctuation event in the form of COVID-19. The pandemic has forced systems to change and change quickly.
Dimitri Fane, InterSystems' Product Director, said that InterSystems TrakCare highlights the core company belief that a truly unified platform must be built for a changing world, and he listed key factors that should be considered when developing a product strategy. These include:
Improving coordination of transitions of care
Measuring and improving quality
Reducing pharmacy stock waste
Making better-informed decisions
Caring for target populations
Engaging patients and driving loyalty
Deploying a new model of care
Streamlining care processes
Continuing to comply with new reporting or regulatory requirements
Identifying risk for early intervention
Organizations can experience pressure from any or all of these factors. For these reasons, digital systems need to evolve with organizations as they experience these kinds of pressures to varying degrees over time.
According to Fane, InterSystems employs three guiding principles or pillars of agility and resilience:
Significant investment in interoperability to aid ease of connecting to the best and most needed data sources.
A passion for customer experience to drive deeper adoption and satisfaction.
Responsive architecture to facilitate rapid innovation for today and the future.
Fane discussed some of the benefits of the new TrakCare Innovation Toolkit, including removing barriers to the rapid development of meaningful solutions, allowing data access through FHIR, and making it accessible to more organizations through low entry barriers, including IRIS Community Edition.
Fane and his team walked viewers through an example patient journey with team members playing the roles of a patient and various care team members. In this example, the following played out:
Care teams create custom patient lists based on criteria such as diabetes diagnoses or proxy indicators.
Providers and care team members use TrakCare to explore patient health factors that contribute to their inclusion in a given defined patient list to monitor; this includes viewing details, such as a family history of diabetes or recent blood glucose levels.
A care team member adds clinical notes, such as observations about weight change or other relevant information that the rest of the care team would benefit from knowing about the patient.
Based on inclusion criteria, a provider uses the software to invite a patient for specialized care, such as a diabetes clinic, by email, without leaving the application.
The patient then receives the email invitation and might click or tap a link to view the invitation.
The patient logs in and sees that no appointment is scheduled yet, but can check availability and book their appointment through the application.
Confirmations can then be handled by multiple modes such as phone or email.
A clinical supervisor logs into their view of the application prior to patient arrival and can manage provider schedules such as by moving blocks of patients between providers to smooth out overbooked providers with underbooked providers, which improves health system operations as well as improving the patient experience by reducing unnecessary additional wait time.
An endocrinologist then views the patient's information. They can look at the patient's diabetes history and clinical notes from other care team members, as well as previously ordered tests, results, and comments. The provider can easily find existing care plans or start a new one. Care plans can include patient education, screening, and prevention measures. Providers can also leverage order sets from defined critical pathways for diabetes based on the patient's risk profile and can interact with referral options, such as removing smoking cessation referrals if the patient does not have a history of smoking.
In today's example, the patient later visits the Emergency Department due to feeling faint and dizzy. The ED physician can see that the patient is enrolled in a critical pathway for diabetes and review notes from the care coordination and endocrinologist. The ED provider can place orders directly from the same user interface and use "Order Favorite" for frequently used orders. All of this activity is recorded in the medical record.
We then meet a pharmacist who sees the patient's record and performs medication reconciliation. The pharmacist knows that the average diabetic patient can be on eight or more active medications. TrakCare can import medication data from national databases using FHIR and can review prescribing and dispensing information. It can also record information, such as how the patient's compliance with taking the prescribed medications.
An ED nurse might then also log in to review the encounter record. The nurse can check the patient's history and open a new encounter record to begin documenting on the patient. The nurse might also use TrakCare's visual clinical timelines to see data plotted over time, such as blood glucose monitoring (different departments like Labor & Delivery and Pediatrics can have different clinical timelines to view). Users can move around the charts and interact with them to explore data in more detail. The nurse in this example can then enter another blood glucose reading to the encounter and to the timeline without leaving the application, as well as update other details such as an administered flu shot.
TrakCare also features Tasks, which can be assigned to care team members. Those members can follow up on Tasks until they are completed and can filter their view to see all patients where they have an open Task to complete.
For follow-up, a diabetes specialist can use the software to launch a virtual appointment with the patient (in this case, using MS Teams) and review and update documentation while speaking with the patient.
Today's demonstration uses a few new features for TrakCare, including the visual clinical timelines and FHIR for medication data. Both are significant investments in the future of interoperability.
Presenters also shared a demo of quickly creating a new SMART on FHIR app to link available TrakCare data to predesigned visual displays to organize and interpret trends.
Fane reminded viewers about the new InterSystems Client Connection community. Most viewers who are InterSystems clients can access this with their existing credentials. New accounts can be set up as needed. In order for organizations to take advantage of the technology shown in this session, however, IRIS 2020 or newer and staying current with patches is all that is required.
Keynote HealthShare: What's New and Next
Jonathan Teich, MD, Product Director, InterSystems
Lynda Rowe, Senior Advisor – Value Based Markets, InterSystems
Matt Spielman, Product Manager, InterSystems
Jeremy Davis, Product Manager, InterSystems
James Derrickson, Product Manager, InterSystems
Leah Goddard, Product Manager, InterSystems
Overview: Jonathan Teich, MD, hosts this update session on HealthShare. Five speakers cover multiple important aspects of enhancements for this core InterSystems solution, including compliance with CMS Interoperability requirements and No Surprise Billing, FHIR for the Unified Care Record, maintenance and cost reduction efforts, CareCommunity and forms enhancements, and information about the Provider Directory.
Dr. Teich opened the session with an overview of some of the factors influencing InterSystems' solution development and areas of focus, particularly for InterSystems HealthShare. Teich listed the following use cases:
Data sharing regulations
Care coordination and referrals
Social care and social determinants of health
Clinical quality measures with time to intervene
Risk and opportunity detection
High-quality big data from mergers, registries, genomics, CER, devices, and monitors
Clean data for analytics and machine learning
Community surveillance, telehealth, home care, and chronic conditions
Extended data, including supply chain, public data, and non-patient data
Multi-site clinical trials
InterSystems continues to work on solutions for Integrated Delivery Networks (IDN), Health Information Exchanges (HIE), Life Sciences, Government, and Payers as broad categories.
Lynda Rowe presented a summary of regulatory requirements and InterSystems' work to assure compliance for affected clients. The list of work includes:
CMS Interoperability Rules (9115-F):
Event Notification for Providers (May 2021)
Patient Access API (July 2021)
Provider Directory API via FHIR/PDex (July 2021)
Payer-to-Payer Exchange using USCDI (TBD 2022; requires replacing Common Clinical Data Set with USCDI)
No Surprises Billing:
Provider Directory Provisions (January 2022)
The goal of No Surprises Billing is to better track payer membership to avoid situations where providers are no longer in-network, which can generate bills that patients are not expecting.
InterSystems completed most of the work for the following responses to these requirements in 2020:
FHIR 4.0 – Support for US CORE profiles
USCDI data elements in SDA
CPCDS data elements in SDA
FHIR mappings added in 2021 include:
US CORE
CARIN for Blue Button (CPCDS Data Set)
PDex (InterSystems HealthShare version 2021.2)
Matt Spielman talked about InterSystems' efforts to modernize FHIR-related user interfaces, which included removing as many barriers as possible to FHIR adoption, streamlining storage, and adding profiles in a few clicks.
The most common use case for FHIR is still individual patient information. Tools exist at larger population levels, such as HealthShare Health Insight, but there is a level in-between that requires attention. Specifically, smaller sub-populations, panels, or registries of patients with common criteria that fit into lists. To support this missing piece, InterSystems has worked to support multi-patient FHIR queries without the need for SQL or detailed knowledge. With this functionality, organizations can begin to answer questions like, "Which patients with heart failure had an encounter within the past two weeks?"
Jeremy Davis described enhancements to InterSystems HealthShare to facilitate both importing and exporting shared care plans for patients, including the ability to view and track Tasks until they are complete as part of a collaborative care team approach.
James Derrickson shared updates about InterSystems' Provider Directory, which should serve as the source of truth for provider information and can be pushed to a FHIR repository or external systems.
Derrickson talked about increased control over Forms access, including role permissions to control the amount of information viewable to certain users. For example, some users might not need to see providers' background information or sanctions.
InterSystems knows that after a system is live, cost is always a major consideration. Leah Goddard spoke about what InterSystems is doing to help control both time to value and the total cost of ownership.
InterSystems is focused on three key areas:
Implementations – Using default data transformations such as default HL7 for faster onboarding of new data feeds
Maintenance – Lowering storage costs and improving performance and scalability
Upgrades – Improving guidelines and reducing downtime
The time it takes to work through transforms can be significant. InterSystems' goal is to standardize transforms to reduce up to 90% of the custom transform work required as part of many integrations. In the future, InterSystems also expects to simplify deployments with more automated background processes.
Goddard also highlighted an HL7v2 Data Profiling Tool, which analyzes messages for non-conformance to standards and allows users to quickly identify and drill into problem areas.
Overall, Teich believes that the drivers for change remain largely the same but are most assuredly accelerating. InterSystems is focused on making data actionable and designing solutions that are modular and configurable.
Keynote InterSystems IRIS: What's New and Next
Presenter: Jeff Fried, Product Director, InterSystems
Overview: InterSystems' Director of Product Management, Jeff Fried, leads a team presentation on InterSystems IRIS capabilities, new enhancements, and the speed and flexibility of IRIS, which includes major improvements, such as Embedded Python and tools for FHIR adoption.
InterSystems IRIS has been on the market for about three years, and its usefulness and efficiency are now well-proven. Jeff Fried, InterSystems' Director of Product Management, explained that IRIS is a unified data platform for high-performance applications. IRIS supports cloud, on-premise, and hybrid deployments.
For clients using Caché and Ensemble, InterSystems has worked to make migrating to IRIS an easy and efficient process. Fried listed the following features in IRIS 2021.1:
Analytics and AI – InterSystems IRIS Adaptive Analytics, IntegratedML (machine learning), Reports, BI & SQL enhancements
Cloud & Operations – InterSystems Kubernetes Operator and ARM support in cloud and on-premise
Better Development – Comprehensive client SDK and Gateway portfolio
Better Interoperability – InterSystems API Management v3.1 and significant FHIR enhancements
Fried cited significant release-on-release performance improvements from Cache 2016.2 to InterSystems IRIS 2019.1 to InterSystems IRIS 2021.1 based on customer information. InterSystems IRIS is now three times faster than Caché.
In the next release, 2021.2, IRIS provides the following updates:
Better Development – Embedded Python, Node js 14, and PeX for Python
Analytics & AI – Adaptive Analytics enhancements and SQL Loader
Cloud & Operations – New cloud services, including HMTS & FAS; Cloud connectors, including S3, SNS, Cloudwatch, and Healthlake; IKO enhancements, including quick scale-up recipes
Scale, Speed, & Security – Online shared rebalancing, dynamic SQL optimizer, journal compression, stream compression, TLS1.3, and OAuth2 support for email
InterSystems supports developers' ability to use the languages of their choice and features containerization and use of Kubernetes.
IRIS Adaptive Analytics allows data stewards or designers to create data models with intuitive naming conventions and put those in front of business analysts to use in their analytics work. Of note, Adaptive Analytics uses machine learning from all users to anticipate data needs and speed up responses over time. An analyst in one department who queries for certain data helps make the platform faster when an analyst in another department works with the same or similar data for other purposes. All of this is based on virtual data cubes and a centralized data model.
Adaptive Analytics supports any front-end BI tool of choice, whether that is Tableau, Qlik, MS Excel, or something else, making the technology valuable and accessible for as many organizations as possible. InterSystems has also made investments in embedded reporting and IRIS BI as a resource for organizations perhaps just starting out on their analytics journey.
Embedded Python taps into a community of over 8 million developers around the world and over 300,000 packages, accessible through IRIS. Presenters shared a short demonstration using a REACT UI and IRIS REST service to quickly visualize, organize, and profile a sample data set.
Examples of potential uses of Python include extracting information from images and generating MS Word documents through IRIS on the fly.
Fried's team also shared information and a short demonstration of the HealthShare Message Transformation Service, which gives users an intuitive UI to convert messages using older standards into FHIR resources. The tool allows users to see a summary of FHIR resources that are extracted from messages and expand and drill down to view details about data elements.
While the tool allows individual message exploration, it can also handle bulk message transformations at the rate of hundreds of thousands of messages per minute, which InterSystems estimates to be 200 times faster than other similar tools.
The team also described a new FHIR Schema Generator to project data as SQL tables using a simple, as well as an easy-to-use UI and a FHIR SQL Builder to analyze a FHIR repository, display resource/element counts, obtain user selections, generate SQL projections, and run maintenance scripts.
InterSystems is currently working on tools to simplify deploying IRIS services through AWS. The team provided a simple demo and mentioned that they are receiving feedback on this functionality at this time. It is not yet ready for production but is in development.
Fried ended the session by promising continued investment in customer-centric solutions like these and including customers in the discussion as these technologies are developed.
Thank you for joining us for this year's InterSystems Virtual Summit recap. Be sure to check out part two!
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text:
Oscar Pistorius granted bail
Bail for Olympic runner Oscar Pistorius set at 1 million South African rand (about $112,000).
Magistrate: State failed to show Pistorius is a flight risk, or that he would be a danger to society, or that his release would cause a public disturbance.
Pistorius charged with premeditated murder in February 14 shooting death of his girlfriend, Reeva Steenkamp, 29. Pistorius claims he thought she was an intruder.
Live updates below. Also, read the full story.
[Updated 10:40 a.m. ET] So, that's about it from the Pretoria courtroom. To sum up: A magistrate granted bail to Pistorius after giving a roughly 90-minute speech in which he covered the history and law of South African bail, summarized the case, criticized the police investigation and expressed skepticism about Pistorius' account.
Chief Magistrate Desmond Nair said the former chief investigator in the case, Hilton Botha, had made "several errors and concessions" during his testimony this week, and said prosecutors had failed to prove that Pistorius was a flight risk or had a propensity toward violence.
Pistorius will be free pending trial, as long as he meets the conditions listed below.
[Updated 10:35 a.m. ET] Pistorius' uncle, Arnold Pistorius, has told reporters the following on the behalf of the Pistorius family:
"We are in mourning over the death of Reeva, with her family. We also grateful for the ... magistrate to come to the conclusion, and for our legal team that has delivered extremely professional and legal (services) that led to the decision to give him bail today.
"As a family we know that Oscar's version of what happened at that tragic night, and we know that that is the truth, and that will prevail in the coming court cases."
[Updated 10:12 a.m. ET] A bit of reaction now from Steenkamp's housemate, Kim Myers:
"Very sad time for us. Somebody has lost a life."
Pistorius' lawyer Barry Roux says that "it's going to take some time before we get to the trial."
Roux says he might challenge some of the bail conditions, including the one that bars Pistorius from drinking alcohol.
"He will be freed today. I think it is fair that he is granted bail," Roux says.
[Updated 9:58 a.m. ET] Here's a fuller list of the bail conditions:
- Pistorius must pay 1 million South African rand (about $112,000). He must pay 100,000 rand in cash before the end of today, and the remaining 900,000 by March 1.
- He must surrender his passport and firearms.
- He cannot go near an airport.
- He will have no access to his house in Pretoria.
- He cannot drink alcohol.
- He must appear at a police station every Monday and Friday.
[Updated 9:49 a.m. ET] The magistrate has now raised the bail to 1 million South African rand, or roughly $112,000.
This raising of the bail - four times the initial amount announced just minutes earlier - happened after some discussion in the courtroom.
The next court date has been scheduled for June 4.
[Updated 9:43 a.m. ET] Here are the conditions: Bail has been set at 250,000 South African rand - the equivalent of roughly 28,500 U.S. dollars. Pistorius has to surrender his passport, and he is not allowed to return to his home.
[Updated 9:38 a.m. ET] CNN Senior Legal Analyst Jeffrey Toobin sums up the magistrate's decision this way:
The magistrate's main concern was whether Pistorius was a flight risk, and the state had no good refutation to the argument that "he's famous, he's disabled ... he's not going anywhere," Toobin says.
We're still waiting for the magistrate to announce bail conditions.
[Updated 9:35 a.m. ET] We expect the announcement of bail conditions to come next.
More on the courtroom reaction: CNN's Diane McCarthy reports Pistorius' relatives were hugging each other quietly under the glare of many cameras. As they wait for the bail conditions, they are quiet and not celebrating.
[Updated 9:29 a.m. ET] The magistrate, having indicated that Pistorius will be granted bail, is taking another break.
[Updated 9:24 a.m. ET] "I come to the conclusion that the accused has made a case to be released on bail," the magistrate says.
A "yes" is exclaimed in the courtroom. Not sure who said that yet. Pistorius is led away from the courtroom. His family members shake hand, looking tired and relieved rather than happy.
The magistrate, summarizing his decision in the last moments of his more-than-90-minute explanation, says that he couldn't find that Pistorius was a flight risk, or that he showed a propensity to commit violence, or that he'll interfere with state witnesses, or that the public would rise up in anger when he's released.
[Updated 9:21 a.m. ET] Regarding possibly denying bail because there could be public disorder if Pistorius is released, the magistrate says that the state hasn't established that there is that level of public outrage.
Again, so far, it doesn't appear that the magistrate has yet come upon grounds to deny the bail. The session continues.
[Updated 9:16 a.m. ET] The magistrate is citing more case history and law on bail. This session to announce whether to grant Pistorius bail, including a five-minute break, has gone on for about an hour an a half.
[Updated 9:13 a.m. ET] Magistrate Nair says that the potential grounds for withholding bail because Pistorius would be a danger "has not been established."
So far, Nair hasn't found any grounds to deny the bail. But he's still talking.
[Updated 9:10 a.m. ET] Magistrate Nair says he cannot rule that Pistorius is a flight risk.
Nair cast doubt on whether Pistorus would "duck and dive all over the world" given his assets in South Africa.
The magistrate is now talking about whether he should deny bail on the grounds that Pistorius might be a danger to society if he's released.
[Updated 9:07 a.m. ET] The magistrate says that the state cannot show that its case is so strong that Pistorius would necessarily come to the conclusion that he needs to flee or evade his trial. That seems to favor Pistorius.
Magistrate Nair now is talking about whether he believes he should deny bail based on any contention that Pistorius might flee because he doesn't have enough ties to South Africa.
As Nair mentions Pistorius' assets, Pistoriys puts his head in his hands.
[Updated 9:02 a.m. ET] The magistrate is now pointing out what he says are weaknesses in Pistorius' explanation that he thought he was shooting an intruder.
The magistrate says he has difficulty understanding why, for instance, Pistorius didn't try to ensure that Steenkamp was in bed before he shot into the bathroom. Or why Pistorius didn't ask who was in the bathroom.
[Updated 8:59 a.m. ET] "I cannot agree with contention that concessions and the credibility of a detective on the level on a warrant officer ... necessarily means that the state case is not strong," the magistrate says.
Pistorius is motionless as he listens. His family and friends are sitting still with hands clasped. All hanging on the magistrate's words.
[Updated 8:57 a.m. ET] The magistrate now shifts: He says that while it's important that former lead investigator Hilton Botha made concessions, "Botha is not the state case."
[Updated 8:52 a.m. ET] The magistrate continues to poke holes in the former lead investigator's testimony, and the manner in which he investigated the case.
"I feel that (former lead investigator Botha) could have done more to establish if (Pistorius) had other ... reported cases if violence was involved," the magistrate says.
The magistrate also points out Botha could have contaminated the crime scene by not wearing protective covers on his footwear, though the magistrate says that by the time Botha arrived, much of the scene would have processed.
[Updated 8:49 a.m. ET] The magistrate is now pointing to "errors and concessions" that the former lead investigator in the case, Hilton Botha, made during cross-examination in the multi-day bail hearing.
[Updated 8:44 a.m. ET] The magistrate is back. He's now talking about how the law gives possible grounds for denying bail in any case in South Africa.
[Updated 8:42 a.m. ET] So, the magistrate talked for about an hour as a preamble to the bail decision, which still is to come. In that hour, he gave a meticulous summary of law on televised access to courtrooms, a summary of the arguments by the prosecution and the defense, a look at the history of bail law in South Africa, and his determination that, when considering whether to grant bail, he'll indeed approach this case as one in which Pistorius is accused of premeditated murder.
Pistorius' family is conferring, looking unsure.
[Updated 8:38 a.m. ET] After all that, the magistrate has called for a five-minute break. He's not made the bail announcement yet.
[Updated 8:37 a.m. ET] The state has presented "enough ... to have met the threshold to establish ... (alleged) premeditated murder from which" to consider a bail application, the magistrate says.
The magistrate adds that he's not there to decide whether Pistorius premeditated murder, but that he'll consider the case as a premeditated murder accusation when considering whether to grant bail.
[Updated 8:34 a.m. ET] We might be getting to the bail decision shortly, as the judge is summing up the state's argument again.
[Updated 8:32 a.m. ET] The magistrate is going to great lengths to explain the history of and law regarding bail in South Africa.
[Updated 8:26 a.m. ET] Pistorius' father and uncle were messaging on their phones as the judge summed up the arguments, CNN's Diane McCarthy says from the courtroom.
The judge is now explaining law regulating bail in South Africa - such as the state can deny bail only if it provides convincing facts that show the accused should remain detained.
[Updated 8:12 a.m. ET] The magistrate still is outlining the case before announcing the bail decision. Pistorius started crying when the magistrate, reviewing the relationship between the Olympian and Steenkamp, said that Steenkamp "really (loved) Oscar."
[Updated 8:04 a.m. ET] Magistrate reading previous testimony about the relationship between Pistorius and his girlfriend. In the testimony, friends describe the relationship as close, loving.
[Updated at 8 a.m. ET] Hearing under way. Chief Magistrate Desmond Nair is outlining case before announcing the bail decision.
[Updated at 4:57 a.m. ET] Bail decision to come down at 2:30 p.m. local time (7:30 a.m. ET).
[Updated at 4:56 a.m. ET] Roux argues that Pistorius is not a flight risk, because he cannot go unnoticed through an airport due to his legs. His prostheses also need maintenance, and he requires regular medical treatment.
[Updated at 4:51 a.m. ET] Pistorius cried while the defense talked about him pulling Steenkamp out of the bathroom.
[Updated at 4:50 a.m. ET] Pistorius' defense attorney Barry Roux says the prosecution 'admits' his client was 'firing blindly,' which is inconsistent with murder. He says the charge is not wanting to kill Reeva but a burglar. The judge asks him if the intent was still to kill, even if he thought it was an intruder. What would the charge be then? Roux answers it would be culpable homicide.
[Updated at 4:34 a.m. ET] New investigating officer made an appearance in court today. Court is back in session.
[Updated at 4:29 a.m. ET] Pistorius' defense to deliver a response.
[Updated at 4:09 a.m. ET] The judge asks for 10 minutes pause. The prosecutor stands down. Pistorius looks dejected.
[Updated at 4:05 a.m. ET] Prosecutor Nel asks the court to refuse bail, argues the athlete is a flight risk. A discourse with the judge ensues. The judge asks what kind of life Pistorius would lead, if he fled. The prosecutor answers it would be a life of freedom. The judge counters it would be a life of ducking daily made more difficult due to his prostheses. Nel says that the court cannot give Pistorius special treatment because of his disability.
[Updated at 3:57 a.m. ET] The prosecutor says that although Pistorius is afraid of crime, his front was door unlocked.
[Updated at 3:54 a.m. ET] Nel calls the violence in this case is horrific, says it must have been terrifying for Steenkamp. Pistorius is silent, as the prosecutor says that he had gotten away in the past with making violent threats and discharging a firearm. Nel argues that many 'important' people have gotten bail and fled the country in the past.
[Updated at 3:49 a.m. ET] This is a very serious crime, Nel says. The state president has asked that crimes against women and children be prioritized. He says the court needs to ensure the suspect will stand trial.
[Updated at 3:45 a.m. ET] Nel questions why Pistorius fired four shots through the toilet door without asking himself were Steenkamp was. Why wouldn't someone realize that she was in there? He goes after the defense's previous criticism of the investigator.
[Updated at 3:36 a.m. ET] The prosecution acknowledges that Pistorius cried at the scene of the killing and told people he thought she was a burglar. But this should be seen in the light of an improbable defense. Pistorius' sister appears confused by this and is holding her hand to her mouth.
[Updated at 3:31 a.m. ET] Prosecutor Nel goes through Pistorius' version of events and points out that the accused elected to use an affidavit, which gives the prosecution a line of argumentation. He points out that the accused could have elected to talk, to just say: 'I've done nothing.'
[Updated at 3:19 a.m. ET] Pistorius in court wearing a dark suit. Court resumes. Prosecutor resumes argument.
[Updated at 2:58 a.m. ET] Many family members have now arrived in court. Oscar, his father and brother are expected soon. Photographers are snapping photos.
Post by: CNN's Ben Brumfield, CNN's Diane McCarthy, CNN's Ed Payne, CNN's Jason Hanna
Filed under: Crime • World
This aspect is considered to become the most effective value-adding aspects from the approach. Today, while using increasing usage of computers folks are deciding to save their writing on CD or floppy disk then sell the writing within this format.
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redpajama_set_name: RedPajamaCommonCrawl


text:
import { createGraphFrames } from './graphTransform';
import {
  testResponse,
  testResponseEdgesFields,
  testResponseNodesFields,
  toEdgesFrame,
  toNodesFrame,
} from './testResponse';
import { TraceResponse } from './types';

describe('createGraphFrames', () => {
  it('transforms basic response into nodes and edges frame', async () => {
    const frames = createGraphFrames(testResponse);
    expect(frames.length).toBe(2);
    expect(frames[0].fields).toMatchObject(testResponseNodesFields);
    expect(frames[1].fields).toMatchObject(testResponseEdgesFields);
  });

  it('handles single span response', async () => {
    const frames = createGraphFrames(singleSpanResponse);
    expect(frames.length).toBe(2);
    expect(frames[0].fields).toMatchObject(
      toNodesFrame([
        ['3fa414edcef6ad90'],
        ['tempo-querier'],
        ['HTTP GET - api_traces_traceid'],
        ['1049.14ms (100%)'],
        ['1049.14ms (100%)'],
        [1],
      ])
    );
    expect(frames[1].fields).toMatchObject(toEdgesFrame([[], [], []]));
  });

  it('handles missing spans', async () => {
    const frames = createGraphFrames(missingSpanResponse);
    expect(frames.length).toBe(2);
    expect(frames[0].length).toBe(2);
    expect(frames[1].length).toBe(0);
  });
});

export const singleSpanResponse: TraceResponse = {
  traceID: '3fa414edcef6ad90',
  spans: [
    {
      traceID: '3fa414edcef6ad90',
      spanID: '3fa414edcef6ad90',
      operationName: 'HTTP GET - api_traces_traceid',
      references: [],
      startTime: 1605873894680409,
      duration: 1049141,
      tags: [
        { key: 'sampler.type', type: 'string', value: 'probabilistic' },
        { key: 'sampler.param', type: 'float64', value: 1 },
      ],
      logs: [],
      processID: 'p1',
      warnings: null,
      flags: 0,
    },
  ],
  processes: {
    p1: {
      serviceName: 'tempo-querier',
      tags: [
        { key: 'cluster', type: 'string', value: 'ops-tools1' },
        { key: 'container', type: 'string', value: 'tempo-query' },
      ],
    },
  },
  warnings: null,
};

export const missingSpanResponse: TraceResponse = {
  traceID: '3fa414edcef6ad90',
  spans: [
    {
      traceID: '3fa414edcef6ad90',
      spanID: '1',
      operationName: 'HTTP GET - api_traces_traceid',
      references: [],
      startTime: 1605873894680409,
      duration: 1049141,
      tags: [
        { key: 'sampler.type', type: 'string', value: 'probabilistic' },
        { key: 'sampler.param', type: 'float64', value: 1 },
      ],
      logs: [],
      processID: 'p1',
      warnings: null,
      flags: 0,
    },
    {
      traceID: '3fa414edcef6ad90',
      spanID: '2',
      operationName: 'HTTP GET - api_traces_traceid',
      references: [{ refType: 'CHILD_OF', traceID: '3fa414edcef6ad90', spanID: '3' }],
      startTime: 1605873894680409,
      duration: 1049141,
      tags: [
        { key: 'sampler.type', type: 'string', value: 'probabilistic' },
        { key: 'sampler.param', type: 'float64', value: 1 },
      ],
      logs: [],
      processID: 'p1',
      warnings: null,
      flags: 0,
    },
  ],
  processes: {
    p1: {
      serviceName: 'tempo-querier',
      tags: [
        { key: 'cluster', type: 'string', value: 'ops-tools1' },
        { key: 'container', type: 'string', value: 'tempo-query' },
      ],
    },
  },
  warnings: null,
};

redpajama_set_name: RedPajamaGithub


Passenger rail service from Grand Rapids to Chicago could be in trouble without additional money from the state.
Amtrak contracts with the Michigan Department of Transportation to operate the Pere Marquette, which passes through Holland, as well as Blue Water line that runs from Chicago to Port Huron.
The company asked for $8.2 million for this fiscal year, but the state offered $5.7 million. Negotiations can last for several months, MDOT spokeswoman Janet Foran said.
In the last fiscal year — Oct. 1, 2008 to June 30, 2009 — Michigan doled out $6.4 million for service on the two rail lines, but supplemented that later with another $400,000.
If the company gets 80 percent of what it requested from the state, the shortage may cause the line to close, but Amtrak would have to give the state a six month notice, Macatawa Area Coordinating Council Transportation Director Steve Bulthuis said.
Holland receives about $2.5 million worth of benefits from passenger rail service including savings to travelers and non-travelers and local business revenues, according to a Grand Valley State University report released earlier this year.
The Pere Marquette is as busy as ever. In October, the passenger rail line wrapped up its third-highest year ever for ridership.
It is these busy times, Foran said, when rail service requires less subsidy from the state because of fares sold.


Acrylic stamps. Sheet size approx. 160mm x 100mm. 7 stamps per pack. Sizes range from 20mm to 85mm wide.
This patterned, die-cut paper is ready to use for that special page. It matches all other items in the Hummingbird range. Approx. size 30cm wide.
This gloss varnish paper is ready to use for that special page. It matches all other items in the Hummingbird range.


Join the Philadelphia Lawyer Chapter of the American Constitution Society for a discussion with Philadelphia District Attorney Larry Krasner on his efforts to institute significant criminal justice reform in the prosecutorial system. We will discuss local efforts as well as how they can be replicated on a wider scale.
Thanks to everyone who came out to our fantastic panel event "Navigating Your Career as a Diverse Attorney: What's Next?". Special thanks to our co-sponsor PECO, an Exelon Company, and our host Blank Rome LLP. We also thank our esteemed panelists Romulo Diaz, Sophia Lee, Diana Cortes, our City Solicitor Marcel Pratt, and Moderator Tony Gay.
Congratulations to HBA of PA board members James Faunes and Brenda Marrero on being recognized as emerging latino lawyers at the Al Dia Lawyers Forum!


text:
Home Indies Z2 Comics announces Henni by Miss Lasko-Gross for 2015
Z2 Comics announces Henni by Miss Lasko-Gross for 2015
Miss Lasko-Gross has gained attention for her two autobiographical comics, Escape from Special and A Mess of Everything, but her new book will be more of a fable. Henni is the tale of a young girl named Henni who lives in a structured society where religion is the last word of the law. She goes off on her own to discover truth and adventure. The story is drawn in s style reminiscent of classic children's books, contrasting carefree childhood with the struggle against dogma.
Lasko-Gross will be at SX this wekeend with an 8-page preview. In the meantime, here's a look at some pages. Henni will be out in January 2015.
Z2 Comics, which is run by Josh Frankel, previously published Paul Pope's Escapo and Dean Haspiel's Fear my Dear.
miss lasko-gross
z2 comics
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Great news for Z2!
Drnaso's ACTING CLASS makes PEN Literary Award longlist
EXTENDED PREVIEW: DARKWING DUCK #1 is almost here
PREVIEW: Check out pages from BEST OF 2000 AD VOL. 2
WEDNESDAY COMICS REVIEWS: A big return (?) in SAGA #61


text:
Internet Corporation for Assigned Names and Numbers - News, Features, and Slideshows
News about Internet Corporation for Assigned Names and Numbers
ICANN resets passwords after website breach
The overseer of the Internet's addressing system said Wednesday that someone obtained information related to user accounts for its public website, although no financial information was divulged.
ICANN seeks opinion on legality of '.sucks' registration process
The body that manages the Internet domain name system has asked regulators in the U.S. and Canada to comment on the legality of the high prices and procedures used by Vox Populi Registry for registrations of '.sucks' domain names by trademark owners.
How to stay ahead of threats to DNS servers
This vendor-written tech primer has been edited by Network World to eliminate product promotion, but readers should note it will likely favor the submitter's approach.
Exposing hidden domain registrations could hurt innocent users more than criminals
Banning the use of privacy and proxy services to hide details of domain name registrants would scarcely inconvenience criminals but would have privacy implications for lawful users of those services, according to a study.
.melbourne top-level domain moves closer to Web
The Victorian government has signed a registry agreement with the Internet Corporation for Assigned Names and Numbers (ICANN), moving the .melbourne domain one step closer to the Web. The first .melbourne domains are likely to come online in mid-2014, according to ARI Registry Services.


text:
National Trust - Hunter & Newcastle Region
PO BOX 2151 Dangar 2309 NSW
Newcastle - 20 Years after the Earthquake
COMMEMORATION MEETING for the 1989 NEWCASTLE EARTHQUAKE
When: MONDAY 28th DECEMBER, 10.00 am
Where: National Park, Cnr. Union Street & Parkway Avenue
Everyone is welcome to attend this event.
To-morrow, on 28 December at 10 am on the 20th anniversary of the Newcastle Earthquake, some of the citizens who met 3 days after the quake will meet at National Park, on the corner of Union Street and Parkway Avenue, Cooks Hill.
The almost 200 people who turned up at the meeting 20 years ago told of homes, businesses, hospitals, hotels, schools and churches being demolished or being threatened with demolition or part demolition without proper assessment, right across the city.
As a result of this meeting, the Citizens Earthquake Action Group (CEAG) was formed to monitor and publicise what was happening across the city in the wake of the quake.
The 20th anniversary presents an opportunity to review how Newcastle has fared since the earthquake.
Immediately after the earthquake, comparatively modern buildings, like the extensions to the Newcastle Workers' Club and Hamilton businesses, where awnings had been removed, collapsed with a tragic loss of life.
Older buildings, notably the George Hotel, Carrington Chambers, King's Hall (former Newcastle RSL) and the Century Theatre, while damaged, were demolished immediately after the quake, without proper assessment. Many historic buildings, including the Anglican Cathedral and the Customs House were threatened with partial demolition.
The repair of homes and public buildings took years; some still await repair and restoration . While Hamilton's commercial centre recovered and flourishes, the Newcastle CBD has never recovered. This is more the result of opportunistic developers and neglectful governments at all levels - federal, state and local. Their actions and inaction have caused further damage to the city and its economy.
Since the earthquake, three wings of Royal Newcastle Hospital have been demolished; its services and personnel relocated to difficult- to- access John Hunter Hospital. The once thriving hospital has been replaced by a partly occupied building, a private public partnership, which includes a community health centre. The effect of the loss of the city-based hospital has been immeasurable.
High-rise luxury units on the former hospital site and on the beachfront have transformed Newcastle Beach coastline into a Gold Coast look- alike. The State Government is now proposing the privatising and commercialising of coastal Crown land reserves, like Empire and Tramway Parks.
The State Government is threatening to relocate the historic Court House and its facilities from the inner city, against the wishes of the legal community and residents. The threat to cut the rail line into the city remains in spite of 20 years of community opposition. These moves would compound the damage to the economy of the city caused by the abandonment of the hospital.
The local council and the State Government's part 3A legislation have ignored the height limits, which gave a human scale to the city. As developers pick off buildings, they are replaced by huge out -of -scale buildings.
Many iconic buildings like the Empire Palais and the Star Hotel were demolished or partially demolished years after the quake. Some, including two of the most historic theatres in Australia, the Victoria and the Royal remain derelict; some sites, notably at the Civic, are still empty 20 years after the earthquake.
The State Government's Honeysuckle (Hunter) Development Corporation has contributed to the gutting of the ailing CBD, as commercial and government enterprises have been encouraged to relocate out of the inner city on to its land. Its high-rise luxury apartments and office blocks have cut off the city from its harbour. The HDC and the development lobby campaign relentlessly to cut the rail line into the city to gain access to their properties.
The past 20 years have seen much of the remainder of the city's unique heritage and character demolished by neglect – including the historic Post Office and the inter- war Great Northern Hotel. The fate of historic former James Fletcher Hospital, Nobbys light – house, the city's former Museum and unique Merewether Surf House hang in the balance.
Newcastle, with the Hunter Valley, a lynch pin of the Australian economy, has been dealt a poor deal by governments and the development industry. The city still bears scars of the Newcastle Earthquake of 1989 – but the scars of greed and neglect are much more obvious 20 years later.
Margaret Henry
Posted by Hunter Regional Committee of the National Trust at 9:49 PM 2 comments:
Bye-Bye Bogey Hole
The Herald identified the Lands Department's real agenda for Crown Land Reserves when it stated that "authorities would be unwilling to spend money on repairs (at the Bogey Hole) with no prospect of financial return" (H, 24/12).
The Department uses spin and PR terms like "tourism, revitalise, attract investment," but it's all part of a strategy for a massive sell-off across the State that's been occurring since the Carr Government days and it has accelerated since the 2007 election.
Ironically only about a week ago a Sydney newspaper magazine featured the Bogey Hole as one of the State's iconic ocean pools and a tourist attraction.
The selloff ranges from high conservation value natural areas to playing fields and urban parks; and including Coffs Harbour, Wollongong (Killalea State park), Leichhardt, Port Macquarie and many other places. Commitments to add land to national parks have also been reneged on.
The coastal plan for Newcastle includes high rise apartments on Tramway Reserve, a pocket park and breathing space between high rise and the Ocean Baths in historic Newcastle East(what's that got to do with tourism?); and the commercialisation of part of Empire Park. Public open space areas are soft targets.
Since the last election, Lands Minister Kelly has reneged on his commitment to consolidate Merewether Surf House's (MSH) land tiles to offer a long term lease with a heritage agreement. Now this sensitive site is targeted for a massive commercial redevelopment.
The Bowling Club site adjacent to King Edward Park is to have a restaurant/reception centre on land Newcastle Council asked to be returned to parkland in 2002. They were ignored.
The Lands Department claims any income will be used to fund other Crown land management/improvements in the region. I'll wager, however, that none will be used to help maintain King Edward Park or the Bogey Hole.
In essence, this State Government is flogging off to private developers, land that the community values and uses for social, cultural, recreational, environmental reasons. What a disgrace!
Posted by Hunter Regional Committee of the National Trust at 9:21 PM No comments:
Newcastle and the Hunter is a significant area of NSW and the second oldest city in Australia. Our cultural heritage is increasingly under threat and unfortunately the Hunter does not always gain the support needed to protect heritage places. For this reason this blogspot has been established not only to raise community awareness of heritage conservation issues, but to also publicise and promote events organised by local National Trust members and the three historic homes managed by the Trust. These are:- Tomago House, Grosmann House & Miss Porters House
Join the National Trust of Australia (NSW) online at www.nsw.nationaltrust.org.au
Disclaimer: Opinions expressed in this publication are not necessarily those of the National Trust Australia (NSW)
Hunter Regional Committee of the National Trust
PO BOX 2151 DANGAR, New South Wales, Australia
Chair- Keith Parsons Dep Chair- John Carr Secretary- Ann Hardy ann-hardy@hotmail.com
Coal River Working Party
Notes on Aboriginal Place Names and People
Friends of King Edward Park - Newcastle, NSW Australia
Hidden Hamilton
Signing off...
Newcastle's Old Government Domain (1804)
'Empower a Women -Empower a Nation' International Women's Day – 2017
Parks and Playgrounds Movement Inc.
Adamstown - former rif
The Newcastle Gerald and Energy Innovator's Advocate
Understanding the Greek Crisis by Griff Foley
UoN Cultural Collections
On the other side of the trenches


Of course, nothing is ever that easy, and Dr Lutz experiences a few problems along the way. Even after he manages to finish the Time Machine, things are not exactly plain sailing, and he must overcome many obstacles. So will he ever witness the demise of the mighty dinosaurs? There's only one way to find out. Although I enjoyed this game immensely, I felt that the ending was a bit... unexpected. I won't tell you what happened, but the ending just felt very sudden after such an enjoyable game.
This is a hilarious game, and you will have plenty of laughs along the way. The whole game is mouse-controlled, and is very easy to play. Right-click to cycle through the various actions - Look, Take, Walk, Talk, etc - and then left-click to use that action. If you want to look at the door, simply right-click until you see 'Look', and then click on the door to get a description of it. You can Save or Load your game at any time by clicking on the appropriate buttons displayed at the bottom left of the screen. Your inventory is displayed at the bottom of the screen, and you can scroll through it by clicking on the Up and Down arrows.
Dr Lutz And The Time Travel Machine looks very similar to the old Lucas Arts adventure games, such as Day Of The Tentacle. Everything is very bright and colourful, and it makes the game fun to play. Backgrounds have a zany 'crooked' look to them which adds a lot of appeal. Nearly everything you look at will reward you with a witty comment. I especially love the giant candlesticks which are used as wall-lights in the past. There are even things happening through the windows, such as a boy on a bike, or a kite flying.
The music for this game is very appealing. It is quite suspenseful, and carries on throughout the game. I enjoyed all the different sound effects; Things like the sound of the fridge opening, Dr Lutz's footsteps, water pouring into the jug were all interesting to hear. I loved the 'swiping' noise as you pick things up, as well as all the beeps and buzzes from the Replicator at the end.
If you like the old Lucas Arts games, then you will love Dr Lutz And The Time Travel Machine. The story is well written, and the dialogue will make you laugh. Sometimes I wondered if he would ever get to see the dinosaurs. The game is controlled entirely by the mouse, which makes things nice and simple. The graphics are very cartoony, and add a lot of fun to the game. The music and sound effects are spot on, and some of them are quite funny to hear. I was slightly disappointed with the ending though. It felt a bit rushed, as though the author had run out of ideas. But don't let that put you off, this is an excellent game that I highly recommend.
Note: If the game is in Italian after download, it can be switched to English. To do this, open the game folder, double-click on WinSetup, and set the language to 'Game Default'.


text:
«Океан» — советский футбольный клуб из Владивостока. Основан не позднее 1966 года.

Достижения
 3-е место в зоне РСФСР класса «Б» (1966).
 Финал (зонального кубка 1967/68).

Ссылки
 footballfacts
 Матчи клуба в базе Wildstat

Футбольные клубы СССР, прекратившие существование
Спортивные клубы Владивостока
Футбольные клубы Приморского края

redpajama_set_name: RedPajamaWikipedia


text:
Australian Men's 4 x 100 freestyle relay team will answer for their behaviour
At press conference later today all six members of Australia's men's 4 x 100 freestyle relay team will admit to...
by SwimSwam Staff 4
February 21st, 2013 Australia, International, News
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At press conference later today all six members of Australia's men's 4 x 100 freestyle relay team will admit to inappropriate behaviours and explain their actions to the entire country.
It has been confirmed through many publications that James Magnussen, Eamon Sullivan, James Roberts, Matt Targett, Cameron McEvoy and Tommaso D'Orsogna will join Daniel Kowalski, CEO of Australia's Swimmers Association and Barclay Nettlefold President of Australian Swimming at a press conference later this evening where they will admit to their use/abuse of prescription drugs and inappropriate behaviour at a staging camp in Manchester leading into the London Olympics.
Both the Independent Swimming Review and the Bluestone Review, which came out early this week, concluded that the culture within the Australian Olympic Team was unacceptable; with the Bluestone Review calling the culture 'toxic.'
Both reports described incidents of inappropriate behaviour, but neither report pinpointed the culprits. It is now clear who those swimmers were and they will answer for their actions later today.
The Sydney Morning Herald reported that earlier in the year D'Orsongna had already given a telling statement when asked about the use of the perscription drug Stilnox, "I'm not going to be the guy that stands up here and lies to Australia. But, at the same time, I'm just not going to comment. I'll leave it at that."
Earlier in the week when asked about the specific incident Head Coach Leigh Nugent told ABC Radio that he did not consider their behaviour serious enough to take action, "When we were in Manchester on the Saturday before we moved down to London, on the Sunday it was brought to my attention by a coach and an athlete that there had been some prank calls and some door-knocking," said Nugent.
"They didn't know who they were."
"At the time I sort of put it down to childish behaviour … it didn't raise alarm bells to me, but in hindsight it probably should have raised alarm bells."
"My regret now is I didn't follow it up."
In an interview with The Australian Olympian Jade Neilsen had a very different viewpoint of the incident that involved James Magnussen, James Roberts and Cameron McEvoy, "I will confirm that they were being inappropriate and it was towards (name withheld) and I," Neilsen said.
"I won't specifically say (what happened). It has sort of already come out pretty much what they've done."
"All I can say is their behaviour was completely inappropriate, it was so inappropriate it was not funny. That is all I can really say about that."
The article does go on to explain that the two girls involved were 'frightened' and had told their coaches who than reported the incident to Nugent.
Neilsen added, "It should have been handled in Manchester or as soon as we got into the village, but it just wasn't and unfortunately the boys have paid the price for that."
"Well, the whole team has paid the price for that, not just the boys."
In another report by The Australian a coach on the team, who did not want to be named, along with a senior swimmer told Nugent of the incident whose immediate reaction was, 'Your girls are flirting with the dream team.'
In the same article another anonymous coach made it clear that he did want a few swimmers ruining the reputation of team, "If you look at it, it was a handful of guys that (expletive) the whole thing up," the coach said.
"We don't want the public thinking we are 44 ratbags."
As reported by SwimSwam earlier today sources say that the athletes will reveal that they took a cocktail of stilnox and caffeinated drinks like Red Bull and Coca Cola, which sent them into a "rampage."
In a article published on the Wide World of Sports website Australian Swimming's President Barclay Nettlefold said he would take appropriate disciplinary action against both athletes and coaches, "We will be decisive, we will be firm and we will discipline athletes, coaches and staff accordingly, where such action is deemed appropriate and necessary," Nettlefold said.
"We want to stop talking about rumour and act on the facts of what did or did not actually occur."
« CIS Day 1 Prelims: Aspinall Downs Meet Record to Open CIS Championships, Allen Follows Suit
2013 SEC Championships: Georgia Women, Florida Men Extend Lead, Gendron Crashes Georgia's Party »
Cameron McEvoy
James Magnussen
James Roberts
To being favorite for gold to not even medaling. one of the biggest flops at the 2012 Games. a gold this summer will help, but it doesn't do any good for the disaster in London. maybe a WR by Magnussen will though.
If these guys can't handle their redbull and coca cola, I don't think they deserve to be Olympic champions. Sound like some pretty tame mates
Daniel Barth
Maybe a little kindness on James Magnussen's part could've given him the gold. What goes around comes around.
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Friedman Kaplan partner Mary E. Mulligan spoke at the two-day "White Collar Practice" conference hosted by the Pennsylvania Association of Criminal Defense Lawyers. Ms. Mulligan discussed contemporary white collar criminal defense strategies during a panel presentation called "The 'New' SEC Enforcement Priorities and Defense Strategies for 2013." The director of the SEC's Philadelphia field office, Daniel M. Hawke, presented a perspective from an SEC attorney, and the panel was moderated by Thomas H. Lee II of Dechert LLP.
Other panels during the conference covered recent criminal law trends, strategies for successful representations, and ethical considerations for white collar lawyers. Speakers included prosecutors, public defenders, and members of the private defense bar.
The conference was held on November 14-15, 2013, at the Ritz-Carlton in Philadelphia.


Boys of all ages enjoy wearing the latest jacket styles throughout the year. Whether it is to be seen on the playground or simply to stay warm when hanging out on the weekends, there are certain jacket trends that stand out. You can find jackets for boys in a wide range of styles, colors and prices. From classic jean jackets to trendy hoodies, there are plenty of jacket options to consider.
Whether you are looking for an added layer of warmth or want to add a stylish touch to an outfit, there are jackets for boys that can match any need. Boys can find rugged, durable jackets that look great and will hold up to any activity. Some of the most popular jacket styles are as follows.
There is nothing cooler for a boy to wear than a jean jacket. This style of jacket has been around forever and continues to be a favorite for boys of all ages and sizes. From classic blue denim to trendy washes and colors, you can find jean jackets in a range of styles. These jackets appeal to boys, no matter how old they may be, and remain popular and cool to wear year after year.
Levi's Trucker Jacket: This classic denim trucker jacket, priced around $40, is available in big boys' sizes S to XL, as well as in little boys' sizes four to 7X. This style is made from 100% cotton and is crafted in a medium weight denim designed to be rugged and durable. It features classic Levi's styling with silver-tone buttons and contrast-edge stitching.
Gap Denim Jacket: Made from soft, medium-wash premium denim and priced around $32, this adorable jacket is available in toddler boy sizes up to five years. This style features button cuffs at the sleeves, a full button-up front, and rear button tabs on each side of the jacket.
Whether it is for back-to-school or for playing outside, a rain jacket is a must for any young boy. Popular rain jacket styles are lightweight, water-resistant and done in bold colors and fun prints. Infants, toddlers and school-aged boys can enjoy wearing a rain jacket any time the weather is calling for some rain. The appeal of a rain jacket is that it is so lightweight that boys can easily pack it into their backpack when they aren't wearing it.
Lands' End Navigator Colorblock Rain Jacket: This fun rain jacket, priced under $30, is available in prints such as camo with solid navy contrast or berry basket with royal blue contrast. It comes in little boy sizes four to seven and big boy sizes eight to 20. What makes this jacket great for boys of all ages is the durable tear-resistant nylon and handy back pocket that turns into a storage pouch.
Zip-up hoodie jackets are both practical and trendy. A zipper hoodie is not only warm and ideal for layering but looks great when worn with jeans and a simple tee. These stylish jackets are a must have for boys, no matter what their age, and are sure to be seen throughout the school year. Younger boys will appreciate the added warmth, while older kids will love the stylish addition to their wardrobe.
You can find zip-up hoodies that are lined with fleece or faux fur for extra warmth. Solid colors are popular, as are styles that feature graphics and logos. Hoodie jackets are a staple for many boys and can be found at most department and sporting good stores, as well as discount stores. No boy will want to be without this must-have for the school year.
Old Navy Logo Zip-Front Hoodie: This classic hoodie is available in sizes extra small to XXL. It is priced around $25, making it an affordable and practical option. This style comes in colors such as black, blue and light gray and features a tone-on-tone logo. Made from soft fleece, this hoodie jacket has a full zip front and warm front pockets.
Abercrombie Kids Quilted Hoodie Jacket: Priced around $60, this hoodie jacket has gray sleeves with the Abercrombie patch and comes in your choice of black or navy for the quilted vest part. It is available in sizes XXS to XL and is a must for back to school, since it can be worn in the fall up until the weather turns colder.
Versatile fleece jackets are ideal for any active boy. Kids can wear a fleece jacket alone when the weather gets cool or use it as a liner for a ski jacket or parka when the temperatures really drop. Fleece jackets are super soft and comfortable, and you can find them in a variety of styles. This is why they are one of the most popular options to consider for your child.
The Children's Place Trail Jacket: This glacier fleece trail jacket comes in a wide variety of colors, such as solid black, solid navy, orange with navy and green with navy. It is priced around $18 and comes in sizes 3T to 5T. This fleece jacket has a full zip front and has elasticized trim at the sleeves, pockets and bottom hem.
Columbia Steen Mountain Zip Fleece: This warm fleece jacket is priced around $25. It is available in boys' sizes XXS to XL. It can be found in bold colors such as green, red and blue, as well as in classic colors such as black, navy and gray. This fleece jacket is done in a classic fit and features secure zipper-close pockets, cuffed sleeves and the Columbia logo on the side of the chest.
A puffer jacket is a must once the weather gets cooler. This style of jacket is made from nylon and lined with down for a quilted look. Puffer jackets are designed specifically to hold up to snow and low temperatures during the coldest months of the year. You will see these jackets popping up everywhere from school to the ski slopes.
C9 by Champion Puffer Jacket: Sold at Target, this puffer jacket is priced around $40 and comes in sizes extra small to extra large. It features a full length zipper in the front and is fully lined for added warmth. This style comes in colors such as ebony camouflage, green, blue and black with gray. This jacket is wind and water resistant and has a comfortable, regular fit that reaches to the hips.
Columbia Powder Light Puffer Jacket: This jacket is priced around $60 and comes in sizes XXS to XL. It is available in colors such as blue, black, gray, red and orange. This style is super lightweight, repels water and stains and has an adjustable storm hood that is permanently attached to the jacket.
A new jacket is a great investment, especially when you purchase one that is stylish and practical. Boys can keep warm in a jacket that looks great on and keep up with the season's latest trends at the same time.