text:
January 17, 2022 | FDA approves trial for CBD-based drug to treat opioid addiction
January 13, 2022 | Two hemp compounds show promise in fighting covid-19 virus
January 12, 2022 | Beer, cannabis giants end joint venture that had planned to make drinks
January 10, 2022 | Stakeholders say amended law in Portugal wrongly targets flower producers
January 6, 2022 | Model supply chain in Paraguay starts with small farmers, ends with exports
CBD, News, North America, Regulatory, Retail, USA
Ban on delta-8 THC spreads as Colorado warns dispensaries
Colorado officials have moved to close a legal loophole and thereby banned sales of hemp-derived delta-8 THC. The state Marijuana Enforcement Division (MED) notified Colorado marijuana dispensaries of the decision in a letter sent out Friday.
MED raised safety concerns over the delta-8 compound, a form of THC distinguished from the more common delta-9 THC prevalent in marijuana plants. Delta-8 is produced by extracting CBD from industrial hemp and then using acetic acid to turn it into THC.
Colorado joins other states that have instituted similar bans: Alaska, Arkansas, Arizona, Delaware, Idaho, Iowa, Mississippi, Montana, Oregon, Rhode Island and Utah all have moved to block delta-8 THC sales. Other states are also considering bans.
Producers have argued that the product is legal under hemp provisions in the 2018 Farm Bill, which legalized hemp extracts and other hemp products among other fundamental changes that opened up the U.S. hemp market.
Defining hemp products
But in issuing the ban, the MED, a part of the Colorado Department of Public Health & Environment, said "chemically modifying or converting any naturally occurring cannabinoids from industrial hemp is non-compliant with the statutory definition of 'industrial hemp product'" in state laws.
"Insufficient evidence exists to determine whether or not any toxic or otherwise harmful substances are produced during these reactions and may remain in the regulated industrial hemp products ingested or applied/used by consumers," the health agency wrote in the letter. "Therefore, these tetrahydrocannabinol isomers are not allowed in food, dietary supplements or cosmetics."
Hemp processors over the past two years started turning out delta-8 THC from hemp for such products as vape liquids, edibles, and high-CBD hemp buds laced with the compound. Many legal marijuana dispensaries have stocked the products, which discriminating marijuana users say offers an alternative high. But delta-8 products have also shown up in convenience stores and independent smoke shops, which are not regulated by the MED.
Tighter rules were anticipated
Licensed marijuana vendors in Colorado can sell products with CBD and other natural cannabinoids if they are extracted directly from hemp plants, so-called natural extracts. That's not the case if those products are synthetic or were produced through a chemical process, the MED has now declared.
Delta-8 is not explicitly outlawed by the U.S. Controlled Substances Act, but the federal Drug Enforcement Administration (DEA) has said delta-8 THC from industrial hemp is a controlled substance because it is not a natural extract.
While a group of stakeholders led by the Hemp Industries Association have challenged the federal government's stance, analysts have repeatedly warned that delta-8 would likely come under tighter regulation by the DEA. Other hemp organizations have gone so far as to criticize producers who have put delta-8 products on the market.
Does delta-8 have potential in pharma?
While delta-8 THC may be restricted, it could still find a market in cannabis-based pharmaceuticals.
"It activates CB1 and other receptors and has therapeutic effects for sure," said leading Israeli cannabis researcher Dedi Meiri of Technion, the Israeli Institute of Technology.
Meiri said researchers in his lab have been studying delta-8 THC intensely for the past three months. He described it as "a very potent cannabinoid" that has psychoactive effects that are different from delta-9 THC.
"The question is how much different from delta-9 it will be," Meiri said.
Colorado's MED said health officials will convene meetings for stakeholder input to further clarify the situation in Colorado.
READ: Warning to Colorado dispensaries


It may at all times lower administrators bonuses and perks first, after which it may stop paying shareholders dividends. When cleansing and drying your automotive's home windows, you may virtually certainly come across an annoying streak on either the outside or the within of the glass. To make the process easier, get in the behavior of drying the exterior glass in one course and the interior in one other (horizontal and vertical as an example).
Among the checklist of tremendous automobiles which I will be reviewing here, the i8 (to be officially launched in choose dealerships together with Australia in 2014) is claimed to be probably the most gas-efficient car in its class, consuming, beggars belief, only 2.5 liters per one hundred km in Eco-modes. In the event you're looking to minimize the pain of your first tattoo, it is vital to contemplate where in your physique, that you're going to get your tattoo. Here's some ideas.
ABS brake problems might be triggered by unfastened wheel bearings on this model. They apparently eat wheel bearings that are unbelievably expensive to exchange. The particular person icon Worker Picture indicates that the reviewer is an worker of Dex Media, Inc. Dex Media operates and sells promoting on The views expressed in reviews are the opinion of every respective reviewer and don't essentially reflect the view of Dex Media.


18/04/2018 · New episodes of The Ultimate Fighter 27 air every Wednesday night featuring heavyweight and light heavyweight champions Stipe Miocic and Daniel Cormier as coaches. 16 undefeated fighters enter the... The pair, who have been involved in a bitter war of words since the UFC's summer kickoff press conference, will lock horns with one another in the main event of the season finale of the Ultimate Fighter, which takes place at the T-Mobile Arena in Las Vegas, Nevada.
The Ultimate Fighter Openload, Watch Full Episodes Online, The Ultimate Fighter Netflix Streaming online, 1080p Openload HD Download Free, The Ultimate Fighter Tv shows online, The Ultimate Fighter Watch series online, Watch tv series, primewire, 1channel, letmewatchthis, TVmuse, yesmovies, 123movies.


As we learnt how Dr Gita & Dr Arjun balance their professional and personal lives, without compromising on the quality of either one, it became apparent that it is the zest for perfection that simply weaves magic into the matrix called life. The same can be said for this delicious tomato soup recipe that Dr Gita shared with us.
4 cups hot stock (made with boiling water and 2 vegetable stock cubes).
1. Firstly, prepare your vegetables. Cut each ripe tomato into quarters and slice off any hard cores. Peel the onion and carrot and chop them into small pieces.
2. Pour the olive oil into a large heavy-based pan and heat it over a low heat. Once the oil is hot, add the onion and carrot and mix them together with a wooden spoon. At low heat, cook the vegetables until they're soft and just start changing colour. This should take about 10 minutes and you should stir them two or three times so they cook evenly and don't stick to the bottom of the pan.
3. Add 2 tsp of tomato purée, and stir it around so it turns the vegetables red. (You can use tomato ketchup instead of the puree but then you need not add sugar). Add the tomatoes, sprinkle in a good pinch of sugar and grind in a little black pepper. Add the bay leaves. Stir to mix everything together, put the lid on the pan and let the tomatoes stew over a low heat for 10 minutes until they shrink down in the pan and become mushy. From time to time, stir well.
4. Slowly pour in the stock, stirring at the same time to mix it with the vegetables.Turn up the heat as high as it will go and wait until everything is bubbling, then turn the heat down to low again and put the lid back on the pan. Cook gently for25 minutes, stirring a couple of times. At the end of cooking the vegetables will look like a stew.
5. Remove the pan from the heat, take the lid off and wait for the mixture to cool. Remove the bay leaves and discard. Pour the soup into a mixie and blend till you get a smooth mix. You can do it in batches.
6. Pour the puréed soup back into the vessel and reheat it over a medium heat for a few minutes, stirring occasionally until you can see bubbles breaking gently on the surface. Taste a spoonful and add a pinch or two of salt if you think the soup needs it, plus more pepper and sugar if you like. The stock cubes usually will have enough salt for the soup. 1-2 tsp of tomato puree can be added if you think the colour is not red enough.
This recipe was first featured in Soul Food and Soul Mates – a column in Harmony Magazine. Part-1 of this post is the interview with doctors Gita & Arjun Rajagopalan, a Tamilian couple from Chennai.


text:
Bob Keller s Jazz Page
Midi Jazz Standards
Some songs have alternate tempos. Coltrane added several chords, making his version more harmonically sophisticated than Santamaria's original version.
Available for purchase at Amazon and many other books stores and music stores. Dan's Jazz Page - An alphabetical list of a mix of jazz standards and newer material, with most arrangements for a band as well as some solo piano pieces. This has been approved by the MuseScore team, and post your scores here when ready!
You are also welcome to submit improved versions of any songs that have already been done for the group. He also takes some requests for sequences - see the bottom of the page. Note that everything can be downloaded as.
Instead, we appeal to your sense of fair play and camaraderie. So, please, use the play-along tracks for yourself however you like.
What are play-along tracks? You Stepped Out of a Dream. The harmonic material of many standard tunes consists of nothing more than variations of turnarounds.
The backing track is for jazz musicians to practice songs that are in the Vanilla Book. Most of these files are multi-instrumental. The list is eclectic and comprehensive, with short descriptions of each song.
Beanfield Castle - MIDI files Jazz
Learning how to play jazz should be fun. Also recommended by jazz pianist and educator Billy Taylor and this group's Paul Ukena. Adios, Au Revoir, Auf Wiedersehn. Number after the title refers to the number of beats per minutes.
If you need some extra guidance and direction on learning jazz standards and jazz improvisation, songs pk list start here. The idea was to take the top jazz standards appearing on the jazzstandards. Index of Jazz Standards Welcome to our Index of Jazz Standards where you can choose from a large selection of common jazz standards to lear n.
Here is the alphabetical list of jazz standards lead sheets that are already done and available in our group. On the Street Where You Live. There's no big corporation behind the scenes here.
Jazz standards not currently in the collection of this group ranking from jazzstandards. On Green Dolphin Street in C. Download the file by clicking on the title. Frank Sinatra's version was published in by Maraville Music Corporation. Feel free to download them.
The Swing Machine - Mostly jazz, with a bit of funk and fusion thrown in for good measure. That doesn't mean it's not a great tune, but in most cases it means the tune is not widely performed. Advanced Topics Marc is responsible for coding many of the nice features currently available in MuseScore for creating jazz charts, including the software's jazz chord symbol features. All files can be heard using Windows Media Player or Quicktime programs.
Learn Jazz Standards - The Ultimate Jazz Musician Resource
It was introduced in the film The Joker Is Wild. Or, you can continue down the home page to the song titles, where you'll find links to individual song pages. Jazz Jazz and Blues at MusicStudents. Play-along tracks are pre-recorded accompaniments for jazz musicians.
Midi directory - Jazz
If you find a problem with a website that I have linked to, I would appreciate your letting me know at webma ster bean fieldcastle. Sinatra also had the best-selling recorded version of the song.
Perhaps a song previously submitted is missing lyrics, or missing the introductory verse, or has chord changes that are not widely used by musicians in performance. Each jazz standard page has all of the tools you need to learn a particular tune. Get help with practicing jazz. Jazz for Worship - This well-done site by Clyde McLennan has original arrangements of some Christian standards, as well as arrangements done of scripture passages, all done in a jazz style. They don't claim to have any kind of criteria for inclusion beyond the judgment of the editors unlike JazzStandards.
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redpajama_set_name: RedPajamaCommonCrawl


Magnetic Island residents and friends applauded the artistic talent of 13 local artists on Saturday whose designs had been chosen to be laser cut into the steel fins that will support the Magnetic Island Solar Park.
The presentation, held at the Solar City Smart Lifestyle Centre, honoured the creators of the iconic Magnetic Island, sporty and solar-inspired artwork.
It was a difficult task for the judges with almost 30 designs to choose from, submitted by artists from Magnetic Island and Townsville after three artistic workshops were held in various locations.
Four designs drawn by children were selected for the skate park which will host the biggest array of solar panels, over 90 kilowatts.
The four Solar Park pavilions include shade for the skate park, visitor sporting teams, home team and community stage and the new picnic pavilion. Foundation work commences in November and the steel fins containing the public art will be erected in February and March. The solar park will be complete and operational by May, 2011.
The Magnetic Island Solar Park is an important element of the Townsville Queensland Solar City project, an award winning initiative that is part of the Australian Government's Solar Cities Program.


text:
Q: Proving that $\mathbb{Z}_2\times \mathbb{Z}_2$ and $\mathbb{Z}_4$ are not isomorphic How can I show that $\mathbb{Z}_2$$\times$ $\mathbb{Z}_2$ and  $\mathbb{Z}_4$ are not isomorphic?
I don't even know how to start
Thanks for any help

A: Hint. A group isomorphism respects the order of the elements. Is there an element of order $4$ in $\mathbb{Z}_2\times\mathbb{Z}_2$?

redpajama_set_name: RedPajamaStackExchange


Rebirth Union is a turn based strategy card game brought to you by game designer company Ambition. Bringing back many characters from Ambition's previous game iterations, Rebirthunion introduces game mechanics that will enable new players to get the hang of things right from the get go. You'll have the opportunity to play as many kinds of characters whom's illustrations are imbued within the card itself providing an novel and refreshing experience!


text:
David II
Revision as of 00:46, 3 August 2005 by Simoncursitor (talk | contribs)
David II was the only surviving son (born 1324) of Robert the Bruce, and succeeded to the throne of Scotland on his father's death in 1329. His mother was Elizabeth, daughter of the Earl of Ulster.
His first wife was Joan or Joanna, daughter of the English king Edward II and of Isabella of France. He married her in 1328, when he was 4, but this marriage alliance did not prevent his father-in-law from supporting the English usurper Edward Balliol. David was crowned and annointed king in 1331, but by 1333 Balliol, backed by English armies, had advanced far enough for david and his Queen to be sent to France for safety.
There they were made welcome by Philip VI and housed in Richard I's Chateau-Gaillard. In Scotland Balliol squandered what little goodwill he had attracted and by 1341 David was back in Scotland. In 1346, in alliance with France, David invaded England, was defeated and taken prisoner, and spent 11 years in English imprisonment, until in 1357, for 100,000 marks he was ransomed. In fact Scotland was far too poor to pay (Edward III may have planned to seize the kingdom for failure to pay the debt, but David successfully distracted him by suggesting he could make Edwrad or one of his sons the successor to Scotland's throne (a proposal which would never have met with assent among the Scots nobility).
Joan died in 1361-2 and, widowed, David married Margaret, daughter of Malcolm Drummondand widow of Sir John Logie, from whom he was divorced in 1369-70. He had children by neither wife, and had had insufficient time to marry Agnes Dunbar, his mistress. This meant that the Scots succession passed from the House of Bruce, via his sister Marjorie to her husband, Walter, the 6th High Steward of Scotland, thus founding the House of the Stewards, or the Stuarts as they became.
On one hand, David lost almost everything that his father had gained for Scotland; on the other he had to cope with English kings determined to plough Scotland under, and managed to retain his country's independence, despite being first unseated, and then imprisoned.
Robert I Reigned
1329-1371 Succeeded by
Robert II
Retrieved from "https://cunnan.lochac.sca.org/index.php?title=David_II&oldid=10406"


At Illinois Emergency Management Agencies' Seventh Annual Radon Networking Day in Springfield, IL, on January 11, 2010, Cal Murphy made a presentation reporting the success of the Southern Illinois Radon Awareness Task Force's Awareness Initiative. In partnership with IEMA and the American Lung Association-UM, 1,000 radon test kits were offered free to the residents of a ten countywide area in Southern Illinois. The ten homes with the highest radon levels were mitigated free of charge. The materials were supplied by American Lung Association of the Upper MidWest, and the homes were tested and mitigated without charge by Southern Illinois Radon Awareness Task Force members, Dave Parkhill and Cal Murphy.


text:
Q: How can one prepend text to each line of a multi-line variable? I print all the variables with there values
echo "$val"

 mapreduce.map.memory.mb,3584
 mapreduce.map.java.opts,-Xmx2560m
 mapreduce.reduce.memory.mb,3584
 mapreduce.reduce.java.opts,-Xmx2560m
 mapreduce.task.io.sort.mb,1280

how to append the word - type_config in the beginning of each line
so output will be as the following
 type_config,mapreduce.map.memory.mb,3584
 type_config,mapreduce.map.java.opts,-Xmx2560m
 type_config,mapreduce.reduce.memory.mb,3584
 type_config,mapreduce.reduce.java.opts,-Xmx2560m
 type_config,mapreduce.task.io.sort.mb,1280

A: $ echo "$val" | sed 's/^/type_config,/g'

Output:
type_config,mapreduce.map.memory.mb,3584
type_config,mapreduce.map.java.opts,-Xmx2560m
type_config,mapreduce.reduce.memory.mb,3584
type_config,mapreduce.reduce.java.opts,-Xmx2560m
type_config,mapreduce.task.io.sort.mb,1280


text:
Lost on You è un singolo della cantautrice statunitense LP, pubblicato il 17 giugno 2016 come primo estratto dall'album omonimo.

Tracce

Classifiche

Note

Collegamenti esterni

Singoli al numero uno in Francia
Singoli al numero uno in Polonia
Singoli al numero uno in Ucraina

redpajama_set_name: RedPajamaWikipedia


text:
/* global Requester: true */
/* global moduleManager: true */

var better = require('../../libs/better');

/**
 * Character Requester
 */

module.exports = function(name, callback){
  var CharacterRequester;

  CharacterRequester = new Requester()
    .setName('Character')
    .setPath('community/')
    .setData('subtopic', 'characters')
    .setData('name', better.url(name))
    .setParser(moduleManager.loadParser('character'))
    .setCallback(callback)
    .request();
};

redpajama_set_name: RedPajamaGithub


text:
Nokia pioneers new multimedia retail experience, unveils first Flagship Store
WEBWIRE – Thursday, December 8, 2005
December 08, 2005, Moscow, Russia - Amidst an array of multimedia effects and interactive kiosks, Nokia today announced its intention to opening several Nokia Flagship Stores in "shopping capitals of the world." In addition to generating sales, a key objective of each Nokia Flagship Store will be to showcase Nokia's complete portfolio of products and services, offering consumers an opportunity to experience the full benefits of mobility in a comfortable, cutting-edge environment. The first Nokia Flagship store opened today in the prestigious Pushkin Square district of Moscow, Russia. The Nokia Flagship Stores will be opened in high-profile locations in major shopping destinations in the next couple of years.
"Through an innovative retail experience like the new Nokia Flagship Stores, Nokia aims to inspire and educate consumers to the benefits of mobility and broaden the appeal of the Nokia brand. It is a place for discovery and entertainment," said Olli-Pekka Kallasvuo, President and COO of Nokia, at the official unveiling in Moscow. "Whether it is demonstrating the features and capabilities of our latest multimedia smartphone or assisting a consumer with their mobile email settings, we want to offer a relaxing, interactive environment for consumers to truly experience the power of mobility."
At a Nokia Flagship Store, consumers can test the latest Nokia mobile devices and learn about new mobile services and technologies. Well-trained and knowledgeable staff will be on hand to help consumers find a product or service that reflects their lifestyle and individual needs. Interactive, multimedia displays will engage visitors as they visit the store, encouraging them to share images or send messages to friends. and connect with invididuals around the world. Of course, consumers will also be able to set-up their new devices, review service provider options and test the range of mobile enhancements related to their new phone.
One area of the Nokia Flagship Stores will be dedicated to mobile gaming with direct access to the N-Gage Arena, Nokia's global mobile gaming network. Visitors to the store will be able to experience the excitement of connected mobile gaming by playing Asphalt: Urban GT(TM) 2 and posting their best scores to the online rankings board shown on the display monitor. As more flagship stores open around the world, visitors will be able to compete directly against scores posted by those playing at other Nokia stores.
"Consumer focus is at the heart of our strategy and the Nokia Flagship Stores enable us to increase our focus at the retail level," explains Cliff Crosbie, Director, Global Retail and Trade Marketing. "Through the Flagship Stores we want to develop a close one-to-one relationship with consumers, listen to their feedback and find valuable consumer insights. This will be crucial information and allow us to faster respond with products and services that meet consumers' needs and desires. The concept behind the Nokia Flagship Stores represents something truly special in the retail world. It will be unlike anything consumers looking for a mobile phone have ever experienced."
Like Moscow, each Nokia Flagship Store will be located in the very best retail locations in high-traffic urban settings in major markets worldwide. Customer service will be the key driver. The Nokia Flagship Stores will be owned, managed and operated by Nokia to provide the best level of experience, education and inspiration in mobile device retailing.
The Nokia Flagship Stores will form the top end of Nokia's newly revised retail strategy that includes retail and operator partners and their more than 300,000 retail outlets globally. All of these customer outlets will remain essential to Nokia's ongoing success and continue to be the main sales channels in the future. The feedback and learnings received through the Flagship stores will be shared and implemented with Nokia's retail and operator partners.
About Nokia
Nokia is a world leader in mobile communications, driving the growth and sustainability of the broader mobility industry. Nokia connects people to each other and the information that matters to them with easy-to-use and innovative products like mobile phones, devices and solutions for imaging, games, media and businesses. Nokia provides equipment, solutions and services for network operators and corporations.
WebWireID6676


At Cambridge Dental Group we can restore a tooth with a minimally invasive procedure known as an Inlay, Onlay or Fillling.
Inlays, Onlays and Fillings are restorations that are made for teeth that have a mild to moderate amount of decay. They can be made of composite resin material, porcelain, or gold by a dental laboratory. Once completed, they will be bonded to the tooth.
Porcelain Inlay fills a hole inside the tooth.
Porcelain Onlay sits on top of the tooth, covering it, to build up its shape.
Composite (White) Filling like an inlay, it fills the hole inside the tooth. The difference is in the matierial used for filling the hole. Although durable, it is not as strong as porcelain.
Treatment involves isolating the tooth and removing any old fillings or damaged tooth structure under local anesthesia.
FillingThe hole in the tooth will be filled with a composite resin and cured. It is then bonded/cemented into the tooth and any necessary adjustments and filings are done to ensure comfort.
Inlay / OnlayAn impression of the tooth is made, then the inlay or onlay is created from porcelain material in a on site or off site lab. When the inlay or onlay is completed, it is placed into or onto the tooth and bonded securely into place. Adjustments may be made to ensure the tooth is comfortable to bite on.
In treating dental decay, inlays / onlays and fillings help to eliminate tooth sensitivity and eventual tooth loss.
Made from tooth-colored material, porcelain inlays / onlays and composite fillings are virtually invisible.
Unlike metal, porcelain inlays / onlays and composite fillings will not expand or contract in response to temperature changes caused by hot or cold foods diminishing the possibility of fracture.
They require less tooth reduction than metal fillings allowing the dentist to conserve more natural tooth structure.
The durable porcelain material from which inlays and onlays are made helps them last up to 30 years, much longer than that of conventional amalgam (silver) fillings. Although not as durable as porcelain, composite fillings last a long time.
Porcelain Inlays / onlays and composite fillings can replace silver fillings to create a healthier, more natural-looking smile.
By saving decayed teeth, porcelain inlays / onlays and composite fillings prevent the need for more extensive treatment later on.
Contact us today to schedule an appointment to get an opinion on your need for an inlay, onlay or filling.


Planning the perfect cruise holiday can quickly become hard work.
Picking the perfect destination, the right cruise line, the ideal cruise ship, drinks packages, and shore excursions can all be tricky. Get it wrong, and your dream experience can instantly shatter.
I have put together my top picks from my experiences as a customer and as a travel writer. I recommend the best cruise ships and itineraries for a range of holidaymakers, including solo travellers, couples, and families. I also suggest tips of things you should definitely book, tips on what is best avoided, and resources worth checking out before you book.


A rare opportunity to acquire a smallholding in a rural location.
Within commuting distance of Edinburgh and Glasgow.
Mountainblaw is an attractive property in a private yet accessible part of rural Lanarkshire. The farm is reached via a private road which leads from the public road. The property is accompanied by a block of land currently used for equestrian and livestock grazing. There is an excellent range of traditional buildings with a larger modern shed suitable for machinery storage and cattle housing, easily restored to its original purpose of indoor school. There are also a number of loose boxes with a former riding arena to the north of the steading. Mountainblaw is the highest residence in Lanarkshire and benefits from unspoilt panoramic views.


force in AB? (4) What is the internal force in BC?
See section 1.2 in text for complete static analysis and review of method of joints.
determine if a load can be safely supported?
F = resultant force over the end of the bar.
Normal Stress (σ): stress acting perpendicular to the cross-section.
Stress is measured far from the point of application.
Loads must act through the centroid of the cross-section.
the normal stress at the midsection of each rod.
Where Do Shearing Stresses Occur?
because this is not the case.
τ is the average shear stress.
than τave, which is important for design purposes.
Bearing stress is a normal stress, not a shearing stress.
Read section 1.8 in text for a detailed stress analysis of a structure.
The rod is in tension with an axial force of 50 kN.
cross-section (A = 314x10-6m2) is BC = +159 MPa.
and average normal stress of –26.7 MPa.
unstressed since the boom is in compression.
Total shear force on surface is (τ1)bc.
apply τ2 on top and bottom surfaces.
element to be in equilibrium.
magnitude and opposite in direction.
magnitude and both point towards or away from each other.
There are only 6 independent stress components.
stress in the rod and the plate.
bearing stress in the link and the shear stress in each of the pins.
Axial forces in a two-force member cause normal stresses.
are not perpendicular to the axis.
Consider an inclined section of a uniaxial bar.
must equal P to satisfy equilibrium.
section, F, and parallel to the section, V.
produces a combination of shear and normal stresses.
largest load which a material can hold before failing.
This load is called the ultimate load, Pu.
stress is denoted as τu.
It is a common design practice to use factor of safety.
P if an overall factor of safety of 3.2 is desired.


text:
Josef Franz Karl Amrhyn, właśc. Josef Franz von Sales Johann Baptist Karl Nikolaus von Flüe AmRhyn (ur. 11 lutego 1800 w Lucernie, zm. 7 kwietnia 1849 tamże) – szwajcarski polityk, kanclerz federalny w latach 1830 do 1847.

Życiorys
Urodził się 11 lutego 1800 w Lucernie.

Reprezentował kanton Lucerna. Sprawował urząd kanclerza federalnego Szwajcarii od 1830, kiedy to zastąpił na stanowisku Jean-Marca Moussona do października 1847. Jego następcą został Johann Ulrich Schiess.

Zmarł 7 kwietnia 1849 w Lucernie.

Przypisy

Ludzie urodzeni w Lucernie
Szwajcarscy kanclerze federalni
Urodzeni w 1800
Zmarli w 1849


text:
Healthcare Policy 12(2) November 2016 : 19-32.doi:10.12927/hcpol.2016.24943
Stepping Up to the Plate: An Agenda for Research and Policy Action on Electronic Medical Records in Canadian Primary Healthcare
Amanda L. Terry, Moira Stewart, Martin Fortin, Sabrina T. Wong, Inese Grava-Gubins, Lisa Ashley, Patricia Sullivan-Taylor, Frank Sullivan and Amardeep Thind
Full Issue PDF
Building on a previous study, which identified gaps in primary healthcare electronic medical record (EMR) research and knowledge, a one-day conference was held to facilitate a strategic discussion of these issues. This paper offers a multi-faceted research agenda and suggestions for policy actions as a way forward in bridging the gaps. One facet focuses on the need for research. The second facet focuses on harnessing the knowledge of primary healthcare EMR stakeholders. Finally, the third facet focuses on policy actions. This paper offers consensus-based suggestions with a view to improving the overall primary healthcare EMR landscape in Canada.
Electronic medical records (EMRs) have the potential to be a transformational force in both primary healthcare research (PHC) and practice in Canada (Birtwhistle and Williamson 2015; Report of the Advisory Panel on Healthcare Innovation 2015). Despite mixed evidence regarding the impact of EMRs on clinical practice (Lau et al. 2012), levels of adoption continue to grow across Canada (Chang and Gupta 2015; College of Family Physicians of Canada et al. 2014; Schoen et al. 2012). Variability exists among provinces, however, with areas of lower physician EMR use (e.g., Newfoundland and Labrador) and areas with higher use (e.g., Alberta) (Chang and Gupta 2015). Positive signs include clinicians perceiving a benefit from EMRs (Bassi et al. 2012), particularly with increasing experience in their use and when the EMR supports advanced use (King et al. 2014). Benefits to be gained from EMR use are likely dependent upon the use of fully functional systems that are integrated into practice (Friedberg et al. 2009). Yet there is a small amount of research evidence, particularly in the Canadian context, to support this integration.
Given this reality, we conducted a pan-Canadian study, which identified 12 key gaps in research and knowledge facing PHC EMR stakeholders (Terry et al. 2014). Other work in the Canadian context has identified the need for research focused on EMR adoption and for initiatives that would aid advanced EMR use (Canada Health Infoway 2013; CMA 2015; Price et al. 2013; Rimmer et al. 2015). This prompts the question of how to bridge these gaps from both a policy and research perspective. Building on the findings of this initial study, this paper provides a strategic discussion of the identified gaps and identifies a way forward.
To facilitate this discussion, we held a one-day conference in Toronto, Canada (March 2012) in partnership with the Canadian Institute for Health Information (CIHI 2012). Prior to the conference, participants received an information package, which outlined the 12 gaps in EMR research and knowledge; participants were asked to self-select their preferred topic to discuss during small group discussions. We reviewed these selections, as well as those chosen by conference participants at the beginning of the day, and identified seven gaps of the original 12, which the majority of participants wanted to discuss. The small groups were guided by a facilitator; notes were recorded by a designated group member on a template that was provided to them.
Over 100 conference participants chose to discuss seven gaps in EMR research and knowledge (value of EMRs, EMR implementation and adoption, data entry and extraction procedures, data sharing, overarching framework for interoperability, define data elements and develop an ideal EMR design). In the following, we discuss how the ideas generated by participants might be addressed through research or policy initiatives. Though the conference occurred in 2012, the issues identified remain salient today (Canada Health Infoway 2013; CMA 2015; Pare et al. 2014; Price et al. 2013; Report of the Advisory Panel on Healthcare Innovation 2015; Rich 2015). Given that overall PHC EMR adoption in Canada has greatly advanced since 2012, some of the gaps discussed at the conference, such as EMR implementation and adoption, would be more relevant in parts of Canada where adoption rates are lower. Other gaps, including data sharing, may be more of a concern in areas where EMR adoption has occurred over a longer period of time and where levels of use are higher.
Conference Findings
The findings from each topic group are presented, followed immediately by a discussion regarding how the gap might be addressed through research or policy initiatives (Table 1).
TABLE 1. Summary of actions to address knowledge and research gaps
Gap in knowledge and research Summary of action points
1. Value of EMRs
Explore connection between maturity of use and accrued value
Understand trade-off: effort of adoption versus value
Create a value map/matrix (stakeholders on one axis, value EMR brings on other axis)
2. EMR implementation and adoption
Supply basic and advanced training, support and education for users
Understand value of implementation and adoption
Identify non-adopters – identify barriers to adoption and how to overcome them
Identify best practices of advanced users – success and supports, conduct economic analysis
Synthesize existing data and research reports
3. Data entry and extraction procedures
Create unified standards and capabilities across EMRs
Deliver incentives for data quality
Use improved data search technology
Test data entry interventions
Understand best practices leading to high optimization and data entry
4. Data sharing
Define standardized data sets and determine sharing rules
Work towards interprovincial consistency
Understand public attitudes
5. Overarching framework for interoperability
Implement overarching framework across Canada
Create a communication strategy for framework
6. Define data elements
Expand data collected in EMR, e.g., quality of life
Include data elements from different sources, e.g., patients
Design a data completeness score function
7. Develop ideal EMR design
Design needs to match PHC context
Include multiple disciplines
Research – inform existing and new EMR designs
EMR = electronic medical record; PHC = primary healthcare research.
Value of EMRs – findings
This theme focused on the value proposition of EMRs for a broad group of stakeholders, including clinicians, decision-makers and health system planners. Within this theme, participants offered three ideas for how to address this issue. The first was to explore the connection between practitioners' maturity of EMR use (for example, level of use of elements of the EMR, participation in peer-to-peer support networks) and the value that the practitioner accrued from the EMR. The second was to understand the possible trade-offs between the effort or cost of adoption and the value realized. Participants suggested there may be a point of diminishing returns in terms of EMR use, and they wanted to promote research that would search out when and where this might occur. The third idea was to create a value map or a matrix on which the stakeholders would be represented on one axis, while the type of value the EMR could bring to them (e.g., financial, satisfaction) would be noted on the other axis. This matrix would illustrate the type of value associated with EMR use that would apply to each stakeholder.
Value of EMRs – author discussion
Participants' suggestions of exploring the connection between maturity of use and accrued value, as well as the trade-off between effort of adoption and value, could be realized through health economics studies. Creating a value map should be completed by harnessing the input of primary healthcare EMR stakeholders in Canada. There is existing work in Canada regarding frameworks to assess the value of e-Health (Lau et al. 2014), EMR value (Canada Health Infoway 2013; Rubinowicz et al. 2016) and return on investment (Jang et al. 2014); other broader economic analyses and frameworks exist elsewhere in the literature (Bassi and Lau 2013; Payne et al. 2013). Despite mixed evidence of EMR effects on practice, we do know that the likelihood of positive impact is dependent upon optimal EMR use (Friedberg et al. 2009) and successful integration into workflow (Jang et al. 2014). Therefore, the next step in realizing the full value of EMRs is to better understand how to achieve optimal use by building on existing work focused on EMR optimization in Canada (CMA 2015; Price et al. 2013; Raymond et al. 2015), elsewhere (Ornstein et al. 2015; Pandhi et al. 2014) and the use of specific tools within the EMR such as electronic prescribing (e-prescribing) (Motulsky et al. 2013; Randhawa et al. 2013). The knowledge gained from this research should then be scaled up more broadly across the PHC setting to enable practitioners to advance their EMR use and to realize the potential full value of EMRs.
EMR implementation and adoption – findings
The main concept of this theme revolved around determining how and why primary healthcare practitioners are adopting or not adopting EMRs into practice. Participants offered a number of options for moving forward. On the policy side, a need to support basic EMR implementation was identified, as well as more advanced training, support and education for EMR users. Funding and incentives to facilitate implementation and adoption were also cited as examples of such support that would fall within the policy domain. From a research perspective, there were four areas that participants pinpointed: (1) understanding the value of EMRs from a patient outcome, financial, productivity and efficiency perspective; (2) seeking out EMR non-adopters to understand the barriers to adoption and how to overcome them; (3) analyzing best practices of existing successful EMR users over time, identifying the policies and procedures that support this type of use and conducting an economic analysis based on successful users; and (4) using existing data and research reports on implementation and adoption to inform this topic.
EMR implementation and adoption – author discussion
Addressing issues of EMR implementation and adoption would benefit from a series of studies focused on successful EMR users and those who do not use EMRs at all, as well as research synthesizing current information on this topic in Canada (Archer and Cocosila 2011; Greiver et al. 2011b; Lai et al. 2009; McGinn et al. 2012; Pare et al. 2014; Paterson et al. 2011; Price et al. 2013; Terry et al. 2009; Vedel et al. 2012) and elsewhere (Boonstra and Broekhuis 2010; Castillo et al. 2010; McGinn et al. 2011). Further work could be done on identifying the policy levers that best support EMR implementation and adoption. While barriers and facilitators to EMR implementation and adoption have been identified (Archer and Cocosila 2011; Boonstra and Broekhuis 2010; Castillo et al. 2010; Greiver et al. 2011b; Lai et al. 2009; McGinn et al. 2012, 2011; Pare et al. 2014; Paterson et al. 2011; Price et al. 2013; Terry et al. 2009; Vedel et al. 2012), this issue remains prominent in the EMR landscape in Canada, including consideration of longer-term adoption issues (Green et al. 2015; Terry et al. 2012). Recent work has identified exemplars of successful health information technology adoption (Jones and Wittie 2015; McAlearney et al. 2010; Ornstein et al. 2015; Ryan et al. 2014), provided guidance for the adoption of information technology at a broader level (Cresswell et al. 2013) and explored the adoption of e-prescribing in primary care (Sicotte et al. 2013). Best practices in implementation and adoption need to be explored and summarized, particularly as they relate to PHC EMRs. In addition, the structures supporting the application of these best practices in the PHC setting should be determined. These findings, when translated into supports and structures at the level of the healthcare system and the practice, would enable comprehensive implementation and adoption across Canadian PHC.
Data entry and extraction procedures – findings
This theme was centred on how to get data into the EMR, and how to get it out of the EMR, in the best possible way. A combined research and policy strategy discussed was to examine EMR vendor-specific structural differences across jurisdictions. This could be done with a view to creating unified capacity and mandated content standards to support high-quality data entry and extraction. From the policy perspective, participants thought it was important to have practitioner incentives in place to support the goal of complete and accurate data on specific topics such as preventive care tests. Three areas were identified that required further research: (1) technologies to search EMR data regardless of how the data were entered; (2) intervention programs for practitioners focused on data entry, which would consist of feedback and a peer-to-peer training approach; (3) best practices that lead to high optimization and data quality levels. Within these strategies, participants emphasized the need to strike a balance between the resources that would be required to support data entry and its ultimate usability.
Data entry and extraction procedures – author discussion
Recommended steps to address this gap include: (1) conducting a literature review to identify best practices leading to optimal use and data quality from other settings that are potentially transferable to PHC; and holding a series of policy dialogues focused on unified EMR capacity, implementation of rigorous content standards and priorities for EMR data entry supports. This would build on existing best practices, for example, in system design (Horsky et al. 2012) and the work of CIHI in developing and disseminating the "Pan-Canadian PHC Electronic Medical Record Content Standards" (CIHI 2012). Research in this area could focus on identifying existing and emerging data searching technologies to be tested in different EMRs in the PHC setting. Trials could be conducted to build on existing work and to test interventions focused on optimal data entry (Brouwer et al. 2006; Greiver et al. 2011a, 2015).
A problem central to this issue is the reality that different stakeholders often have different reasons for their interest in data entry and extraction. PHC practitioners may be interested because they want to be able to treat and track individual patients over time and examine their practice populations as a whole. Policy makers may be interested in the potential to have access to standardized PHC data for planning health system change. Researchers need high-quality PHC data for their studies. Vendors are concerned due to potential future requirements for EMR designs. The next step, therefore, is to understand these perspectives more thoroughly, prior to embarking on research or policy action. Identifying shared areas of focus and priority for most stakeholders would be a logical starting place for these actions.
Data sharing – findings
This theme reflects existing uncertainty about how EMR data can be shared, with whom, under what circumstances and for what purpose. There were three main strategies identified by participants regarding data sharing. The first two of these are policy-related: (1) define standardized data sets, and determine who should share them and under what circumstances they could be shared. Conference attendees thought that patients, policy makers and practitioners should all be engaged in this work; (2) work towards achieving interprovincial consistency in data sharing. The final strategy was research-related – polling the public regarding their attitudes and opinions about healthcare data sharing.
Data sharing – author discussion
A necessary precursor to work on defining data sets and working towards interprovincial consistency is the need to more fully understand the views of patients regarding data sharing, particularly in terms of EMRs in PHC. Studies in the Canadian context have examined the perspectives of individuals about health information privacy and the circumstances under which data may be shared (Perera et al. 2011; Willison et al. 2003, 2007, 2009), and Canada Health Infoway has offered guidance on information governance in relation to interoperable electronic health records (EHRs) (Canada Health Infoway 2007). Canadian opinion polls also exist, which have explored broader questions of privacy, protection of personal information and security and safety of personal health information (Angus Reid Public Opinion 2013; Ipsos Reid 2012; Phoenix Strategic Perspectives Inc. 2013). Given that the availability of data in electronic form will continue to grow and much uncertainty remains about data sharing, more clarity around this issue is required. This work is critically important as optimal EMR use depends, in part, upon information flows among providers (Friedberg et al. 2009). We know that in Canada, among adopters of EMRs in general (Schoen et al. 2012), and e-prescribing in particular, this is already a challenge (Motulsky et al. 2015). Therefore, a next step would be to conduct a review of the literature, which would summarize the state of current knowledge regarding patient views of data sharing and identify any remaining gaps for which further research is required. This improved understanding of the issues would inform a pan-Canadian effort towards achieving policy- and practice-level consistency, which is required to move forward.
Overarching framework for interoperability – findings
This theme focuses on interoperability or data flows among practitioners, parts of the healthcare system and among software types. Participants emphasized the need for an overarching framework in Canada, which could ensure interoperability. The framework should include elements relating to governance, infrastructure, privacy, the value of the data, implementation and technology. Furthermore, it was considered important to develop a communication strategy pertaining to the overarching framework and to leverage national bodies such as the College of Family Physicians of Canada to drive action forward on this topic.
Overarching framework for interoperability – author discussion
The complexity of creating an overarching framework for interoperability necessitates a multi-jurisdictional policy-related initiative; this could potentially build on models such as interoperability-defining use cases (Sittig and Wright 2015). This policy work will require strong links among those who set EMR standards, EMR vendors, patients, healthcare practitioners and other policy makers. Widespread adoption of CIHI's "Pan-Canadian Primary Health Care Electronic Medical Record Content Standards" is a necessary first step to the interoperability question. Canada Health Infoway coordinates pan-Canadian work on digital health standards and recently released the Clinical Interoperability Action Plan to foster collaboration on this issue. Much more remains to be done. Building upon this solid, already existing work, a pan-Canadian policy initiative is necessary to continue the work required towards achieving provincial implementation solutions for this issue.
Define data elements – findings
This theme was focused on primary healthcare practitioners defining the actual data elements in the EMR that would be needed for patient care and on researchers and policy makers suggesting what would be needed to answer questions about primary healthcare. Suggestions made by conference participants regarding defining data elements were policy-oriented: (1) include data in the EMR on the illness, not only the diagnoses, such as the patient's personal experience, health history, social determinants of health, death and quality of life; (2) include data elements such as those held by specialists, patients and what might be found in other data repositories; (3) build in a standard data element into each EMR which could calculate a "data completeness score."
Define data elements – author discussion
As the adoption of EMRs matures, questions about how to make these data even richer have arisen. A pre-requisite to ultimately deciding what might be included in an EMR would be a consensus list of prioritized data elements. The list could be developed by building upon existing work, such as the Institute of Medicine's EHR measures for social and behavioural determinants of health (Adler and Stead 2015). A consensus could be achieved through a Delphi process with Canadian PHC EMR stakeholders. This would enable policy-related steps to be taken, linked with existing work on content standards, and would facilitate discussions with EMR vendors regarding the consistency of data element inclusion. The development and testing of a data completeness scoring system should be undertaken within multiple EMRs. If testing was successful, such a system could be implemented in all EMRs for practitioner use. Thus, a next step would be to initiate two studies – one to create a consensus on data elements and the second to develop and test a data completeness scoring system that could be used by practitioners for self-assessment.
Develop an ideal EMR design – findings
Conference participants thought that EMRs should be designed to be reflective of the evolving interdisciplinary and team-based nature of primary healthcare. Additionally, it was suggested that individuals who may not usually be present for discussions of EMR design in primary healthcare, such as software engineers and pharmacists, should be included. In the research domain, participants thought it was important to build on the research that already exists in terms of EMR design in primary healthcare but that more research was needed specific to the Canadian context. This research should involve observing what is happening in primary healthcare practices to help inform ideal EMR design.
Develop an ideal EMR design – author discussion
An interdisciplinary network, where ideas to support EMR design could be exchanged and fostered with focused dialogues, could help address gaps in EMR design. This network would harness the existing research-based knowledge, as well as facilitate the emergence of new ideas, building on existing work examining EHR functionality in primary care (Krist et al. 2014). The group would also coordinate collaborative research ventures focused on informing ideal EMR design. There are existing networks across Canada, such as the Canadian Primary Care Sentinel Surveillance Network, eHealth Benefits Evaluation Knowledge Translation Community and the National Institutes of Health Informatics, which could inform this work. An important aspect of EMR design is the concept of the computer as a third party in the encounter (Pearce et al. 2011). A further dimension of EMR design should be focused on the organizational dimension of PHC practice – how does the EMR integrate into the functions of the practice (Beasley et al. 2011; Unertl et al. 2009)? Development of a multidisciplinary network of individuals across Canada interested in EMR design is an important next step.
The following limitations of these discussions are noted. For some topics, there were clearly identified areas where more research was needed, whereas in others, it was more self-evident that policy-related actions needed to occur. There were also some grey areas in which the two facets of research and policy intertwined for particular issues, such as data entry and extraction. In addition, although patient-specific gaps were not discussed, it should be acknowledged that the patient perspective is a foundational element that underpins all of these issues.
Synthesizing the results of the topic group discussions, this paper offers a multi-faceted research agenda and suggestions for policy actions as a way forward in bridging the gaps in PHC EMR knowledge and research in Canada. One facet focuses on the need for research in this area. The second facet focuses on harnessing the knowledge of PHC EMR stakeholders together into a network. Finally, the third facet focuses on EMR-related policy actions.
These facets obviously intertwine, with a network of PHC EMR stakeholders being involved with both the research agenda and policy actions. Finally, we suggest that Canada needs to further develop its capacity to conduct EMR research and to tackle policy-relevant PHC EMR issues. This paper offers consensus-based suggestions with a view to improving the overall PHC EMR landscape in Canada.
Passer à l'action: programme de recherche et suggestions d'orientation sur les dossiers médicaux électroniques dans les soins de santé primaires au Canada
En réponse à une première étude qui identifiait des lacunes dans la recherche et les connaissances concernant les dossiers médicaux électroniques (DME) dans les soins de santé primaires, une conférence a eu lieu afin de permettre une discussion stratégique sur cette situation. Cet article présente un programme de recherche multifacette et des suggestions d'orientation afin de combler ces lacunes. La première facette souligne le besoin de faire de la recherche. La seconde facette porte sur la canalisation des connaissances des parties prenantes liées aux DME dans les soins de santé primaires. Finalement, le troisième aspect soulève des suggestions d'orientation. Cet article présente un consensus sur la manière d'améliorer le portrait global des DME dans les soins de santé au Canada.
Amanda L. Terry, PhD, Assistant Professor, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, The University of Western Ontario, London, ON
Moira Stewart, PhD, Distinguished University Professor, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
Martin Fortin, MD, MSc, CMFC(F), Professor, Department of Family Medicine, Université de Sherbrooke, Sherbrooke, QC
Sabrina T. Wong, RN, PhD, Professor, UBC School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
Inese Grava-Gubins, MA, Research Consultant, Toronto, ON
Lisa Ashley, RN, CCHN(C), MED, Senior Nurse Advisor, Canadian Nurses Association, Academic Consultant Level 2, School of Nursing, University of Ottawa, Ottawa, ON
Patricia Sullivan-Taylor, BSCN, MPA, PMP, Director, Health System Funding Policy, Ontario Ministry of Health and Long-Term Care, Toronto, ON
Frank Sullivan, FRSE, FRCP, FRCGP, CCFP, Gordon F. Cheesbrough Research Chair and Director of UTOPIAN,, Professor, Department of Family & Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
Lynne Zucker, BASC, MASC, Vice President, Clinical Systems Integration, Canada Health Infoway, Toronto, ON
Amardeep Thind, MD, PHD, Professor, Department of Family Medicine, Department of Epidemiology & Biostatistics, Director, Schulich Interfaculty Program in Public Health, The University of Western Ontario, London, ON
Correspondence may be directed to: Amanda L. Terry, PhD, Assistant Professor, Schulich School of Medicine & Dentistry, The University of Western Ontario, Western Centre for Public Health and Family Medicine, 1151 Richmond Street, London, ON N6A 3K7; tel.: 519-661-2111 ext. 20049; e-mail: aterry4@uwo.ca
The authors thank the conference attendees. This study was funded by the Canadian Institutes of Health Research (CIHR) (#239664). Dr. Stewart is funded by the Dr. Brian W. Gilbert Canada Research Chair in Primary Health Care Research. Dr. Fortin holds a Chair in Chronic Diseases in Primary Care. Dr. Thind is a Canada Research Chair in Health Services Research. The authors acknowledge the contributions of Francis Lau to the conference and this paper.
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Perera, G., A. Holbrook, L. Thabane, G. Foster and D.J. Willison. 2011. "Views on Health Information Sharing and Privacy from Primary Care Practices Using Electronic Medical Records." International Journal of Medical Informatics 80(2): 94–101.
Phoenix Strategic Perspectives Inc. 2013. Final Report Survey of Canadians on Privacy-Related Issues, Prepared for the Office of the Privacy Commissioner of Canada. Ottawa, ON: Phoenix Strategic Perspectives Inc. Retrieved June 6, 2016. <www.priv.gc.ca/information/por-rop/2013/por_2013_01_e.asp>.
Price, M., A. Singer and J. Kim 2013. "Adopting Electronic Medical Records or Just Electronic Paper Records." Canadian Family Physician 59(7): e322–29.
Randhawa, G.K., F. Lau and M. Price. 2013. "Evaluating the Adoption of e-Prescribing in Primary Care." Healthcare Quarterly 16(4): 55–60.
Raymond, L., G. Pare, G.A. de Ortiz, P. Poba-Nzaou, M.C. Trudel, J. Marsan et al. 2015. "Improving Performance in Medical Practices through the Extended Use of Electronic Medical Record Systems: A Survey of Canadian Family Physicians." BMC Medical Informatics and Decision Making 15: 27.
Report of the Advisory Panel on Healthcare Innovation. 2015. Unleashing Innovation: Excellent Healthcare for Canada. Ottawa, ON: Health Canada. Retrieved June 6, 2016. <www.healthycanadians.gc.ca/publications/health-system-systeme-sante/report-healthcare-innovation-rapport-soins/alt/report-healthcare-innovation-rapport-soins-eng.pdf>.
Rich, P. 2015. "Edging Toward the Digital Future: National Physician Survey Findings Reveal Progress – But Also Gaps." Future Practice (March 2015): 3–7.
Rimmer, C., S. Hagens, A. Baldwin and C.J. Anderson 2015. "Measuring Maturity of Use for Electronic Medical Records in British Columbia: The Physician Information Technology Office." Healthcare Quarterly 17(4): 75–80.
Rubinowicz, A., I. Vedel, S. Sanche, M. Lortie, S. Law, J. Hughes et al. 2016. "A Portrait of Electronic Medical Record Use in Primary Care across Canada." Health Reform Observer 4(2): Article 1.
Ryan, M.S., S.C. Shih, C.H. Winther and J.J. Wang. 2014. "Does It Get Easier to Use an EHR? Report from an Urban Regional Extension Center." Journal of General Internal Medicine 29(10): 1341–48.
Schoen, C., R. Osborn, D. Squires, M. Doty, P. Rasmussen, R. Pierson et al. 2012. "A Survey of Primary Care Doctors in Ten Countries Shows Progress in Use of Health Information Technology, Less in Other Areas". Health Affairs (Millwood) 31(12): 2805–16.
Sicotte, C., L. Taylor and R. Tamblyn. 2013. "Predicting the Use of Electronic Prescribing Among Early Adopters in Primary Care." Canadian Family Physician 59: e312–21.
Sittig, D.F. and A. Wright. 2015. "What Makes an EHR 'Open' Or Interoperable?" Journal of the American Medical Informatics Association 22: 1099–101.
Terry, A.L., M. Stewart, M. Fortin, S.T. Wong, M. Kennedy, F. Burge et al. 2014. "Gaps in Primary Healthcare Electronic Medical Record Research and Knowledge: Findings of a Pan-Canadian Study." Healthcare Policy 10(1): 46–59.
Terry, A.L., J.B. Brown, L.D. Bestard, A. Thind and M. Stewart. 2012. "Perspectives on Electronic Medical Record Implementation after Two Years of Use in Primary Health Care Practice." Journal of the American Board of Family Medicine 25(4): 522–27.
Terry, A.L., G. Giles, J.B. Brown, A. Thind and M. Stewart. 2009. "Adoption of Electronic Medical Records in Family Practice: The Providers' Perspective." Family Medicine 41(7): 248–52.
Unertl, K.M., M.B. Weinger, K.B. Johnson and N.M. Lorenzi. 2009. "Describing and Modeling Workflow and Information Flow in Chronic Disease Care." Journal of the American Medical Informatics Association 16(6): 826–36.
Vedel, I., L. Lapointe, M.T. Lussier, C. Richard, J. Goudreau, L. Lalonde et al. 2012. "Healthcare Professionals' Adoption and Use of a Clinical Information System (CIS) in Primary Care: Insights from the Da Vinci Study." International Journal of Medical Informatics 81(2): 73–87.
Willison, D.J., K. Keshavjee, K. Nair, C. Goldsmith and A. Holbrook. M. 2003. "Patient Consent Preferences for Research Uses of Information in Electronic Medical Records: Interview and Survey Data." BMJ 326(7385): 373.
Willison, D.J., L. Schwartz, J. Abelson, C. Charles, M. Swinton, D. Northrup et al. 2007. "Alternatives to Project-Specific Consent for Access to Personal Information for Health Research: What Is the Opinion of the Canadian Public?" Journal of the American Medical Informatics Association 14(6): 706–12.
Willison, D.J., V. Steeves, C. Charles, L. Schwartz, J. Ranford, G. Agarwal et al. 2009. "Consent for Use of Personal Information for Health Research: Do People with Potentially Stigmatizing Health Conditions and the General Public Differ in Their Opinions?" BMC Medical Ethics 10: 10.
Commentary – Dear Federal Chief Nursing Officer: Why Canada Needs You
Angela Wignall
Federalism and Long-Term Care in Canada: A New Approach
Carolyn Hughes Tuohy
Excellent Long-Term Care for Canadians and Federal Legislation
Colleen M. Flood, Bryan Thomas and Kelli White
Canadian Journal of Nursing Leadership
Leadership in nursing management, practice, education and research


text:
English > About Us
Wanxin Media Profile
Anhui Xinhua Media Co.,LTD(hereinafter referred to as "Wanxin Media").The predecessor of it was Anhui Xinhua Bookstore.With the consent of the Anhui Provincial party committee and government and the approval of the Propaganda Department of the Communist Party of China and the General Administration of Press and Publication,Anhui Xinhua Bookstore group co,LTD was founded on the basis of the former Anhui Xinhu-a Bookstore and Anhui Foreign Language Bookstore.In February 2008, Anhui Xinhua Distribution group co., LTD., was ,as a w-hole,restructured into Anhui Xinhua Media Co.,LTD(hereinafter referred to as "the company"),which was officially listed on 18th Jan 2010,becoming the first mainboard listed stock in the publishing industry with the stock name "Wanxin Media" and the stock code "601801".
The company is a large scale state-owned cultural enterprise integrating cultural consumption, educational service, modern logistics and other business lines. It has more than 110 wholly-owned and substantial holdings and sharing holding co-mpanies with over 630 outlets spreading Anhui ,Jiangsu,Shanghai and other regions.A comprehensive publishing distribution and service system has formed within urban and rural areas across Anhui Province.
According to 2016 Press and Publishing Industry Analysis Report issued by the state administration of press ,publication, radio ,film,and television of the people's republic of China, th-e circulation market value of Wanxin Media ranked the 7th pl-ace among the 31 domestic and overseas listed publishing-distri-bution and printing companies and first place among the 6 domestic and overseas listed distribution companies.
The company has been awarded the honors of "Chinese Government Award (for printing)" ,"Advanced Collective of National Press and Publication System ","Advanced Unit for National Reading Activities " , "China Well-known Trademark" and has been conferred as " Key Support Demonstration Enterprise for Cultural Reform and Development in Anhui Province"by the leading group for building a culturally powerful Anhui Province.It has also been ranked among the "2015 China Top 100 most Investment Value of Listed Companies","China 100 Innovative Benchmark Enterprises for listed Companies" and "Well-known Trademark of China listed Companies".Wanxin is included in CSI300 Index ,SSE380 Constituent Index and Margin trading and stock trading in Shanghai Stock Exchange.Its practice on BSC(Balanced Score Card)was nominated as global "2015 BSC Hall-fame Outstanding Organization Award"and the practice has been compiled into the teaching case of Harvard Business School.
At present, the company is closely centered around the theme of "Reform, Innovation, Development", adhering to the core value of "Better oneself ,better the world".The company is fulfilling its strategies of traditional business transition and improving as well as realising driving the business through capital market and entity economy.Financial capital will be integrated to drive force the business.With cultural education as its core and by pushing the transition from a traditional cultural enterprise to a corporation that relies on internet platform,Wanxin Media is striving to become the collector and provider of learning material for people.


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text:
Br J Clin Pharmacol. 2006 Apr;61(4):427-39.
Quantitative prediction of in vivo inhibitory interactions involving glucuronidated drugs from in vitro data: the effect of fluconazole on zidovudine glucuronidation.
Uchaipichat V1, Winner LK, Mackenzie PI, Elliot DJ, Williams JA, Miners JO.
Department of Clinical Pharmacology, Flinders University and Flinders Medical Centre, Adelaide, SA, Australia.
Using the fluconazole-zidovudine (AZT) interaction as a model, to determine whether inhibition of UDP-glucuronosyltransferase (UGT) catalysed drug metabolism in vivo could be predicted quantitatively from in vitro kinetic data generated in the presence and absence bovine serum albumin (BSA).
Kinetic constants for AZT glucuronidation were generated using human liver microsomes (HLM) and recombinant UGT2B7, the principal enzyme responsible for AZT glucuronidation, as the enzyme sources with and without fluconazole. K(i) values were used to estimate the decrease in AZT clearance in vivo.
Addition of BSA (2%) to incubations decreased the K(m) values for AZT glucuronidation by 85-90% for the HLM (923 +/- 357 to 91 +/- 9 microm) and UGT2B7 (478-70 microm) catalysed reactions, with little effect on V(max). Fluconazole, which was shown to be a selective inhibitor of UGT2B7, competitively inhibited AZT glucuronidation by HLM and UGT2B7. Like the K(m), BSA caused an 87% reduction in the K(i) for fluconazole inhibition of AZT glucuronidation by HLM (1133 +/- 403 to 145 +/- 36 microm) and UGT2B7 (529 to 73 microm). K(i) values determined for fluconazole using HLM and UGT2B7 in the presence (but not absence) of BSA predicted an interaction in vivo. The predicted magnitude of the interaction ranged from 41% to 217% of the reported AUC increase in patients, depending on the value of the in vivo fluconazole concentration employed in calculations.
K(i) values determined under certain experimental conditions may quantitatively predict inhibition of UGT catalysed drug glucuronidation in vivo.
Effect of fluconazole (10–2500 µm) on the activity of human UDP-glucuronosyltransferases (UGTs). Each bar represents the mean percentage activity relative to control from duplicate measurements. 10 µM (▪), 100 µM ( ), 500 µM (□), 1000 µM ( ), 2500 µM ( )
Quantitative prediction of in vivo inhibitory interactions involving glucuronidated drugs from in vitro data: the effect of fluconazole on zidovudine glucuronidation
Br J Clin Pharmacol. 2006 Apr;61(4):427-439.
Representative Eadie–Hofstee plots for zidovudine (AZT) glucuronidation by: (A) human liver microsomes (HL40) in the absence of bovine serum albumin (BSA); (B) human liver microsomes (HL40) in the presence of BSA; (C) UGT2B7 in the absence of BSA; and (D) UGT2B7 in the presence of BSA. Points are experimentally determined values, while lines/curves are from model-fitting
Representative Dixon plots for fluconazole inhibition of zidovudine (AZT) glucuronidation by: (A)human liver microsomes (HL40) in the absence of bovine serum albumin (BSA) 250 µM AZT (♦), 500 µM AZT (▪), 750 µM AZT (▴); (B) human liver microsomes (HL40) in the presence of BSA, 60 µM AZT (♦), 80 µM AZT (▪), 100 µM AZT (▴); (C) UGT2B7 in the absence of BSA, 200 µM AZT (♦), 400 µM AZT (▪), 600 µM AZT (▴); and (D) UGT2B7 in the presence of BSA, 25 µM AZT (♦), 50 µM AZT (▪), 75 µM AZT (▴). Points are experimentally determined values, while lines are from model-fitting
Alamethicin/pharmacology
Antifungal Agents/pharmacology*
Antimetabolites/metabolism*
Fluconazole/pharmacology*
Glucuronosyltransferase/antagonists & inhibitors
Microsomes, Liver/metabolism
Recombinant Proteins/antagonists & inhibitors
Serum Albumin, Bovine/pharmacology
Trifluoperazine/analysis
Uncoupling Agents/pharmacology
Zidovudine/metabolism*
Uncoupling Agents
Trifluoperazine
Serum Albumin, Bovine
UGT2B7 protein, human
Glucuronosyltransferase
Full text from the Univ. of Michigan Library - MLibrary (Deep Blue)
TRIFLUOPERAZINE - Hazardous Substances Data Bank
ZIDOVUDINE - Hazardous Substances Data Bank
FLUCONAZOLE - Hazardous Substances Data Bank


text:
Home > Hearts at Work > Senior Center's Peter Thompson Given Leadership Award
Senior Center's Peter Thompson Given Leadership Award
January 28, 2013 By Elizabeth Swider 1 Comment
Peter Thompson, Executive Director of The Senior Center, Inc. in Charlottesville Virginia
Peter Thompson, Executive Director of Charlottesville's Senior Center, Inc. has been awarded the Leader's Leader Award from the Leadership Charlottesville Alumni Association.
How appropriate and well deserved! We are so very lucky to have this extraordinary man at the helm of our Senior Center for so many years, quietly but surely increasing its strength, size, and impact. Thank you Peter!
For those of you who don't know his amazing list of contributions, I will reprint here the acknowledgement given to Peter when he was presented with this award by Marc Johnsen, Associate Director, Center for Global Initiatives at Darden School of Business:
The Leaders' Leader Award is given annually to a graduate of the LC program who has demonstrated initiative, vision, and responsibility in service to the community, the Leadership Charlottesville program and/or the Leadership Charlottesville Alumni Association, exemplifying the ideals of Leadership Charlottesville.
This year's Leaders' Leader has shown incredible leadership in the community both personally and professionally. As a member of the Charlottesville community for more than 30 years, this LC grad has been tireless in service to the community as a volunteer leader on the Board of Directors of the Chamber of Commerce, Madison House and the Osher Lifelong Learning Institute at University of Virginia. He has worked to strengthen and build our community's nonprofit sector, helping to establish the non-profit council at the Chamber of Commerce and as a founding director of the Center for Nonprofit Excellence.
In his professional career he is characterized by service to others, leading the Senior Center to national accreditation and recognition as one of the top senior centers in the country. He has led as an advocate for the importance of community support for healthy aging, founding the Virginia Association of Senior Centers and chairing a national task force on New Models of Senior Centers for the National Institute of Senior Centers Delegate Council, a part of the National Council on Aging. The Leaders' Leader honors an individual who is an exemplar of the ideals of the Leadership Charlottesville program and I am pleased to present the 2013 Leaders' Leader Award to Peter Thompson, LC Class of 1996.
Filed Under: Hearts at Work, News and Events
Digging Ditches with Dad – the Art of the Family Visit
Managing Meds with Mom


text:
Kichesippi Announces Plans for Fall & Winter Seasonals
Tags : Kichesippi Beer, Ontario
OTTAWA, ON – Kichesippi Beer has announced details of the limited edition seasonal beers that it has lined up for the quickly approaching cooler months.
Returning in late September after taking last year off is Logger Pennsylvania Porter, a 5.2% abv beer named for the logging industry that was historically prevalent in the Ottawa region. The "Pennsylvania Porter" description refers to the fact that it's brewed with a lager yeast rather than ale yeast, a method that was common in Pennsylvania and other eastern states in the US in the late 19th and early 20th centuries.
Logger will be available in 473 ml cans and growlers at the Kichesippi retail store.
Following in mid-October will be the brand new Bristol Stout, a 4.8% abv milk stout described as follows:
Our inspiration for this beer comes from our family who have been farming in Bristol, Quebec since 1925. This 150 acre farm has seen a lot of change over the years but still remains in the family. We first started out with dairy cattle and now are farming soybeans and hay. This stout offers a balance of roasted malts and residual sweetness.
Bristol Stout will be released in cans, growlers and kegs.
December will see the return of Wuchak Black, the winter instalment in the brewery's seasonal Wuchak IPA series. A 6% abv and 77 IBU Cascadian dark ale, the "black, bitter and strong" Wuchak Black is the most popular seasonal brand in Kichesippi's line-up.
Wuchak Black will be available at the brewery store in cans, and will also be part of the Winter Beers promotion at select LCBO locations.
« Wellington Brewery & Pearl Diver Collaborate on Shellfish Bastard Saison
Canadian Beer Festivals – September 11th to 17th, 2015 »


text:
<?php
defined('BASEPATH') OR exit('No direct script access allowed');
/**
 * Created by PhpStorm.
 * User: NGUYENVU
 * Date: 1/30/2016
 * Time: 8:37 PM
 */
class MY_Controller extends CI_Controller {
    protected $data;

    private $NAME = "FOXES";

    public function __construct(){
        parent::__construct();
        // load initialize
        $this->initialize();

        $this->data['header'] = $this->setHeader();
        $this->data['footer'] = $this->setFooter();
    }

    private function initialize(){
    }

    private function setHeader(){
        $header = new stdClass();
        $header->title = $this->NAME;
        return $header;
    }

    private function setFooter(){
        $footer = new stdClass();
        $footer->title = $this->NAME;
        return $footer;
    }

}


text:
Q: merge guest quote with customer quote(if custommer log in) magento 2 rest api if 2 items in cart if customer login both item should need to add cart , Both quote (before login & after login) merge and create final quote which contain all item of customer quote
Refference links that i got in google
https://magento.stackexchange.com/a/62481
https://magento.stackexchange.com/a/30460

A: By default, Magento 2 in API side does not provide any API for Merge guest cart with customer card when the customer is login.
But you can replace the guest cart with customer cart.
API : (/V1/carts/:cartId)
File : vendor/magento/module-quote/Model/QuoteManagement.php
Function : public function assignCustomer($cartId, $customerId, $storeId)

But if you want to develop functionality Merge cart Live Magento web side you need to create custom API.

A: You need to create "Around" Plugin in your custom extension.
app/code/MageKnight/Quote/etc/module.xml
<config xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="urn:magento:framework:Module/etc/module.xsd">
    <module name="MageKnight_Quote">
        <sequence>
            <module name="Magento_Quote"/>
        </sequence>
    </module>
</config>

app/code/MageKnight/Quote/registration.php
<?php

use \Magento\Framework\Component\ComponentRegistrar;

ComponentRegistrar::register(ComponentRegistrar::MODULE, 'MageKnight_Quote', __DIR__);

app/code/MageKnight/Quote/etc/di.xml
<?xml version="1.0" ?>
<config xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="urn:magento:framework:ObjectManager/etc/config.xsd">
     <type name="Magento\Quote\Api\CartManagementInterface">
        <plugin name="mergeGuestCart"
                type="MageKnight\Quote\Plugin\Model\CartManagement"/>
    </type>
</config>

app/code/MageKnight/Quote/Plugin/Model/CartManagement.php
<?php

namespace MageKnight\Quote\Plugin\Model;

use Magento\Framework\Exception\StateException;

/**
 * Class CartManagement
 */
class CartManagement
{
    /**
     * @var \Magento\Quote\Api\CartRepositoryInterface
     */
    protected $quoteRepository;

    /**
     * @var \Magento\Customer\Api\CustomerRepositoryInterface
     */
    protected $customerRepository;

    /**
     * @var \Magento\Customer\Model\CustomerFactory
     */
    protected $customerModelFactory;

    /**
     * @var \Magento\Quote\Model\QuoteIdMaskFactory
     */
    private $quoteIdMaskFactory;

    /**
     * @param \Magento\Quote\Api\CartRepositoryInterface $quoteRepository
     * @param \Magento\Customer\Api\CustomerRepositoryInterface $customerRepository
     * @param \Magento\Customer\Model\CustomerFactory $customerModelFactory
     * @param \Magento\Quote\Model\QuoteIdMaskFactory $quoteIdMaskFactory
     */
    public function __construct(
        \Magento\Quote\Api\CartRepositoryInterface $quoteRepository,
        \Magento\Customer\Api\CustomerRepositoryInterface $customerRepository,
        \Magento\Customer\Model\CustomerFactory $customerModelFactory,
        \Magento\Quote\Model\QuoteIdMaskFactory $quoteIdMaskFactory
    ) {
        $this->quoteRepository = $quoteRepository;
        $this->customerRepository = $customerRepository;
        $this->customerModelFactory = $customerModelFactory;
        $this->quoteIdMaskFactory = $quoteIdMaskFactory;
    }

    /**
     * Around plugin to assign customer to guest cart
     *
     * @param \Magento\Quote\Api\CartManagementInterface $subject
     * @param callable $proceed
     * @param int $cartId The cart ID.
     * @param int $customerId The customer ID.
     * @param int $storeId
     * @return boolean
     */
    public function aroundAssignCustomer(
        \Magento\Quote\Api\CartManagementInterface $subject,
        callable $proceed,
        $cartId,
        $customerId,
        $storeId
    ) {
        $quote = $this->quoteRepository->getActive($cartId);
        $customer = $this->customerRepository->getById($customerId);
        $customerModel = $this->customerModelFactory->create();

        if (!in_array($storeId, $customerModel->load($customerId)->getSharedStoreIds())) {
            throw new StateException(
                __("The customer can't be assigned to the cart. The cart belongs to a different store.")
            );
        }
        if ($quote->getCustomerId()) {
            throw new StateException(
                __("The customer can't be assigned to the cart because the cart isn't anonymous.")
            );
        }
        try {
            $customerActiveQuote = $this->quoteRepository->getForCustomer($customerId);
        } catch (\Magento\Framework\Exception\NoSuchEntityException $e) {
            $customerActiveQuote = false;
        }
        if ($customerActiveQuote) {
            /** Merge carts */
            $quote->merge($customerActiveQuote);
            $this->quoteRepository->delete($customerActiveQuote);
        }
        $quote->setCustomer($customer);
        $quote->setCustomerIsGuest(0);
        $quote->setStoreId($storeId);
        $quote->setIsActive(1);
        /** @var \Magento\Quote\Model\QuoteIdMask $quoteIdMask */
        $quoteIdMask = $this->quoteIdMaskFactory->create()->load($cartId, 'quote_id');
        if ($quoteIdMask->getId()) {
            $quoteIdMask->delete();
        }
        $this->quoteRepository->save($quote);
        return true;
    }
}