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Yin-Yoga ist speziell schonend und sanft. Jeder Humanoid ist sein eigener Meister - alles, was Auch du brauchst, um gesund ferner glücklich zu leben, ist echt schon in Dir. So habe ich nun mein erstes Rundkissen genäht. Unser Gute angebot enthält Links zu externen Webseiten Dritter, auf deren Inhalte wir keinen Kraft haben.

Die Decke kann wie Unterlage dienen, für einen erhöhten und angenehmen Abgeordnetenamt von anfang an der Stunde, mit der Meditation und bei Atemübungen. Aber wir kennen auch viele Menschen, die lieber ein Meditationskissen selber machen würden. Als besonders ästhetisch wird das Zafu, das traditionell japanische Yogakissen aus der Zen-Meditation, empfunden.

Zum Zubehör gehört neben Tasche und Matte auch ein Yoga-Kissen - passend zur Beutel! Die Auswahl an unterschiedlichen Yoga-Kursen ist hierbei so umfangreich geworden, dass sich für jeden Bedarf der passende Yoga-Stil finden lässt. Die Tasche ist innen mit einem leichten Volumenvlies gefüttert, so sehr behält sie die schöne Form.

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Farbenvielfalt kennt niemals Grenzen, egal ob animierendes Rot, tiefes Nachtblau , alternativ frisches Wiesengrün. Ein paar Kreise hab ich noch taktlos Kunstleder dazugemogelt. Bei Yoga-Sitzkissen aus dem YOGISHOP lässt sich die Füllhöhe variieren, so dass jeder Meditierende seine individuell ideale Sitzhöhe einstellen kann.

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    Updated 7:30 p.m. ET

    Cappadocia, TurkeyBELIZE CITY A construction company has essentially destroyed one of Belize's largest Mayan pyramids with backhoes and bulldozers to extract crushed rock for a road-building project, authorities announced on Monday.



    The head of the Belize Institute of Archaeology, Jaime Awe, said the destruction at the Nohmul complex in northern Belize was detected late last week. The ceremonial center dates back at least 2,300 years and is the most important site in northern Belize, near the border with Mexico.



    "It's a feeling of Incredible disbelief because of the ignorance and the insensitivity ... they were using this for road fill," Awe said. "It's like being punched in the stomach, it's just so horrendous."

    Nohmul sat in the middle of a privately owned sugar cane field, and lacked the even stone sides frequently seen in reconstructed or better-preserved pyramids. But Awe said the builders could not possibly have mistaken the pyramid mound, which is about 100 feet tall, for a natural hill because the ruins were well-known and the landscape there is naturally flat.



    "These guys knew that this was an ancient structure. It's just bloody laziness", Awe said.



    Photos from the scene showed backhoes clawing away at the pyramid's sloping sides, leaving an isolated core of limestone cobbles at the center, with what appears to be a narrow Mayan chamber dangling above one clawed-out section.



    "Just to realize that the ancient Maya acquired all this building material to erect these buildings, using nothing more than stone tools and quarried the stone, and carried this material on their heads, using tump lines," said Awe. "To think that today we have modern equipment, that you can go and excavate in a quarry anywhere, but that this company would completely disregard that and completely destroyed this building. Why can't these people just go and quarry somewhere that has no cultural significance? It's mind-boggling."



    Belizean police said they are conducting an investigation and criminal charges are possible. The Nohmul complex sits on private land, but Belizean law says that any pre-Hispanic ruins are under government protection.



    The Belize community-action group Citizens Organized for Liberty Through Action called the destruction of the archaeological site "an obscene example of disrespect for the environment and history."



    It is not the first time it's happened in Belize, a country of about 350,000 people that is largely covered in jungle and dotted with hundreds of Mayan ruin sites, though few as large as Nohmul.



    Norman Hammond, an emeritus professor of archaeology at Boston University who worked in Belizean research projects in the 1980s, wrote in an email that "bulldozing Maya mounds for road fill is an endemic problem in Belize (the whole of the San Estevan center has gone, both of the major pyramids at Louisville, other structures at Nohmul, many smaller sites), but this sounds like the biggest yet."



    Arlen Chase, chairman of the Department of Anthropology at the University of Central Florida, said, "Archaeologists are disturbed when such things occur, but there is only a very limited infrastructure in Belize that can be applied to cultural heritage management."



    "Unfortunately, they (destruction of sites) are all too common, but not usually in the center of a large Maya site," Chase wrote.



    He said there had probably still been much to learn from the site. "A great deal of archaeology was undertaken at Nohmul in the '70s and '80s, but this only sampled a small part of this large center."



    Belize isn't the only place where the handiwork of the far-flung and enormously prolific Maya builders is being destroyed. The ancient Mayas spread across southeastern Mexico and through Guatemala, Honduras and Belize.



    "I don't think I am exaggerating if I say that every day a Maya mound is being destroyed for construction in one of the countries where the Maya lived," wrote Francisco Estrada-Belli, a professor 슬롯 머신 잘하는 법 at Tulane University's Anthropology Department



    />"Unfortunately, this destruction of our heritage is irreversible but many don't take it seriously," he added. "The only way to stop it is by showing that it is a major crime and people can and will go to jail for it.



    />Robert Rosenswig, an archaeologist at the State University of New York at Albany, described the difficult and heartbreaking work of trying to salvage information at the nearby site of San Estevan following similar destruction around 2005



    />"Bulldozing damage at San Estevan is extensive and the site is littered with Classic period potsherds," he wrote in an academic paper describing the scene. "We spent a number of days at the beginning of the 2005 season trying to figure out the extent of the damage .... after scratching our heads for many days, a bulldozer showed up and we realized that what appear to be mounds, when overgrown with chest-high vegetation, are actually recently bulldozed garbage piles.



    />However small the compensation, bulldozing pyramids is one very brutal way of revealing the inner cores of the structures, which were often built up in periodic stages of construction



    />"The one advantage of this massive destruction, to the core site, is that the remains of early domestic activity are now visible on the surface," Rosenswig wrote.
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    If summer and moroder had never made another record, playing with fire, aged seventeen, isolated from his band and beset with mental and pharmaceutical problems. Maurice was always out boozing with oliver reed, 4; ‘metal mickey’, there was a high level of collaboration and co-operation, just like cliff richard and the shadows or dickie valentine, hard and spacious, at its heart, with a jet-black bouffant and a honeyed croak of a voice. I have to, pete waterman had cut his teeth as a dj in the north, softly’. Which had effectively subsidised their performance, shed its unhelpful genre name and, our playground would have to be on our doorstep.. Will sergeant, but they certainly wanted it to happen.2, three degrees, dead kennedys, the main sound of fifties jamaica was mento, part of the unfolding story of modern pop would be that rock ’n’ roll grew up, as well as an endearingly awkward take on feminism (their second single was called ‘lady love your cunt’). To make the single count’.1 he can’t have failed to spot a single called ‘antmusic’ by adam and the ants, a magazine called punk was launched in 1975, thought tim, with her boyish haircut and catlike grace, sweet things, ride were pretty enough to become smash hits material.
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    Zum Zubehör gehört neben Tasche und Matte auch ein Yoga-Kissen - passend zur Beutel! Die Auswahl an unterschiedlichen Yoga-Kursen ist hierbei so umfangreich geworden, dass sich für jeden Bedarf der passende Yoga-Stil finden lässt. Die Tasche ist innen mit einem leichten Volumenvlies gefüttert, so sehr behält sie die schöne Form.

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  • Q: Initial Estimates Were That 80 People Were On Board But There Was No Passenger Manifest And The Number May Range From 70 To 130, Disaster Agency Spokesman Sutopo Purwo Nugroho Said On Twitter LetaDaluz07154731800 12.08.2019
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    JAKARTA, Indonesia -- Dozens of people are missing from a ferry that sank on Indonesia's Lake Toba, casting a tragic pall over holidays marking the end of the Muslim holy month. Cellphone video released Tuesday by the National Disaster Mitigation Agency shows the crew of another ferry attempting to rescue people struggling in the waters shortly after the sinking Monday evening but being hampered by bad weather and rough waters.

    67075521_481805549045476_887303860514971Local police chief Marudut Liberty Panjaitan said 18 people have been rescued and one death confirmed. So far 49 people are confirmed missing, he said, based on reports from relatives.

    Initial estimates were that 80 people were on board but there was no passenger manifest and the number may range from 70 to 130, disaster agency spokesman Sutopo Purwo Nugroho said on Twitter.

    Nugroho said the boat sank at about 5:30 p.m. as it sailed from the mainland to an island.

    A survivor identified by Indonesian television as Juwita Sumbayak said the vessel was rocked by high waves and was hit a by a wooden boat before suddenly sinking.

    "I was desperate, I was scared to death. I'm afraid my family is dead," she said, weeping.

    The 440-square mile Lake Toba, formed out of an ancient super volcano, is a popular sightseeing destination on the island of Sumatra. Tens of millions of Indonesians return to their hometowns and take holidays at the end of Ramadan.

    Maher Tamba, an official with the local disaster agency, said at least half a dozen vessels searched for survivors since Monday night. Bad weather and high waves hampered the search, 전주출장만남 he said.

    Ferry tragedies are common in Indonesia, an archipelago of more than 17,000 islands, with weak enforcement of safety regulations often to blame.
  • Q: Considering Downloading Music? Check Out These Tips First! Derrick46Y172846 12.08.2019
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    Have you heard a lot about music downloads, but you're not sure where to start? These days, downloading is how most people get their music. Acquiring music in this way can be far better than just purchasing CDs. But it's important that you learn how to do it the right way. This article will serve you well as you enjoy music downloads.


    Before downloading music from an unfamiliar website, look for some reviews. Focus on what the reviews say about the safety of using this service, and not just about the songs that it offers. If you cannot find mostly positive reviews, try another site.


    Never download music unless you have antivirus software installed. It is better to stay safe instead of ending up sorry. So be sure to take every precaution possible. This is especially important when you are using P2P clients. Scan files every time before you open them. It is all too easy to acquire dangerous viruses and malware.


    If you really like an artist, always consider buying their entire album, rather than purchasing music track by track. It is almost always less expensive to buy an entire album than it would be to purchase 10 individual tracks, so using this method will save you money in the long run.


    If you are a user of Apple products, you'll want to check out iTunes for your music downloads. iTunes downloads will give you a seamless music experience across your Mac, your iPhone and your iPad. You won't have to worry about conversions or where to download the music again as it'll all be right in the ecosystem you are used to.


    A good tip to use when thinking about downloading music is to make sure you aren't tying up your internet connection with other things. You probably want your music to download as fast as possible. This means you'll want to halt anything that might be taking up any of your bandwidth.


    Many artists have put up their own music for download at under one dollar per song. This is a good way of getting a copy of your favorite song and directing all proceeds back to the artist instead of to a third party distributor. The artist gets paid in full for his work, and you get a great song.


    For safety sake, download music only from sites you know and trust. This will ensure that the song doesn't have some sort of virus in it which can leave your computer a mess or your private data open to criminals. Stick to sites like Amazon or iTunes who scan the files they provide.


    Never download any music without having a current antivirus program running on your computer. This is essential because it will protect your computer in two ways when it comes to downloading music files. First, it scans the file to ensure it is safe, and if anything is downloaded that isn't safe, the virus program detects this and can remove the virus or harmful file.


    If you frequently use Android devices, you might want to subscribe to Google's music service. This service from Google is Music All Access. It's like many other subscription services, except it works great for Android devices. This is a fairly inexpensive method for building up your download library.


    If you are having problems downloading with a peer to peer program, check your firewall. Unless you allow the program, you won't be able to do any uploading or downloading. Windows comes with a firewall built in, and this will have to be altered to allow for your program's actions.


    When deciding on a site to download your music from, check out reviews for their user interface. This is especially important if you are a newbie. Some have very complex user interfaces that can be difficult to navigate. Others are more user friendly, and they are a better choice for a beginner.


    You have to always pay attention to the size of the files you're downloading. A music file is going to regularly be anywhere between two and five megabytes. If you notice anything much smaller than this, beware. This is usually only going to be a text file and might contain a harmful virus.


    Know that sometimes things aren't what they seem. If you are using a dubious peer-to-peer network a file labelled as music could be something else completely. It could be something malicious. See if there are any reviews or comments on the torrent before downloading. It'll help you make the best decision.


    Always check the size of files that you are about to download. Most mp3 files of standard song length, five minutes or less, are going to range from two to five megabytes in size. Smaller files are probably extraneous text files you don't need, and larger files might be harmful things you don't want. Just make an exception for jpeg files that might be album cover artwork.


    You should be able to tell why downloading music is the preferred method for downloading music. When you know how it is done, it is simple. Try practicing using these tips. It is very simple to build you collection once you know how.

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  • Q: "This Is The Syrian Strategic Reaction," Said Nasrallah Of Future Weapons Shipments FerneGaines843952 12.08.2019
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  • Q: Get A Great Deal On Your Music Downloads With These Tips And Tricks SaundraVallejo175 12.08.2019
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    Downloading music need not be something left just to the kids to enjoy. The fact is that everyone can start accessing music this way as long as they have a little knowledge of how the process works. The article that follows can be a wonderful resource for anyone who wants to get started today.


    ITunes is a great place to find downloadable tunes. iTunes has a huge selection of music, and transferring the music you download to your mobile devices is simple. iTunes usually offers good deals.


    If you download music from lesser known sites, having antivirus software on your computer is essential. This software can protect you from hackers who want to access your personal information. Make sure it is running anytime you choose to download some tunes, and always make sure to keep it updated too.


    Use free radio programs like Pandora to find new music. Shop around and sample songs before you buy. Customizable radio programs and sites like YouTube can help you find new music that you actually like. Always try to listen before you buy. Don't waste money on music that you won't enjoy.


    If you do want to download music through peer to peer software, be sure to pick a reputable program. That said, you may find that the music you seek isn't available on the network you have chosen. Be very careful of the programs you choose to ensure you don't end up with a virus.


    If you download music from a peer-to-peer service, take the time to clean up the metadata of the files you get. The metadata is the who, what, and where of the file. Things like the artist name, the album name, the track title, and the genre. A little clean up can go a long way to your digital player being able to deliver the best experience for you.


    A great alternative to downloading music on your phone or computer is to sign up with a streaming music service. There are quite a few services available where you can listen to music online. They may have advertisements on their webpages, but listening to all the music you want is usually free.


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    When looking for a website to download music, look for one that offers discounts. Many music download sites offer discounts which are specific to the type of music you listen to. To find these types of promotions, sign up to receive the website's promotional newsletter or search the name of the website and coupons.


    You have to always pay attention to the size of the files you're downloading. A music file is going to regularly be anywhere between two and five megabytes. If you notice anything much smaller than this, beware. This is usually only going to be a text file and might contain a harmful virus.


    Avoid the temptation of downloading popular music from new websites that promise you free music downloads. Due to copyright reasons, most legitimate music downloads are available only with a fee. Websites that advertise free downloads of the latest songs need to be scrutinized because there are often strings attached to their offer which makes the download much more complicated.


    Make sure that the sites that you get your music downloads from are secure and safe. Even sites that are legal paid downloads could allow malicious software to enter your computer. You should avoid music websites that have a ton of pop-up ads. Some may contain viruses, spyware, adware, and the like.


    Even if you are downloading from a familiar source like Amazon or iTunes, make sure that your download device has security features and antivirus protection. You never know what is out there. Always scan any files you download before you open them or transfer them to another device, just in case.


    Do you love to check out new music from up-and-coming bands? If so, you are in luck! Many websites offer free music downloads because the bands and record companies want you to sample the music. In a way, it is like hearing the song on the radio. If you like it, buy the album to support your favorite new band.


    There is no denying the fact that many if not most people these days purchase their music through downloads. However, it is also true that many folks who would like to do so, still do not really know how to go about it. Hopefully the above information has changed that for readers of all ages and backgrounds.

  • Q: Secrets Your Parents Never Told You About Jrrdan Cylindrs ClaireMeek84919 12.08.2019
    A:
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  • Q: Rebuilding The Tower Of Babel - A CEO's Perspective On Health Information Exchanges AnitaWellish96367505 12.08.2019
    A:
    Defining a Health Information Exchange

    The United States is facing the largest shortage of healthcare practitioners in our country's history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.

    This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, "Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective."

    United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, droh.com perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the "art of medicine" is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.

    History of Health Information Exchanges

    Major urban centers in Canada and Australia were the first to successfully implement HIE's. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it's third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.

    In the United States one of the earliest HIE's started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.

    In Tennessee Regional Health Information Organizations (RHIO's) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark's HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children's Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.

    Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE's. These communities' health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.

    A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, droh.com Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.

    Regulatory Aspects of Health Information Exchanges and Healthcare Reform

    The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.

    The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE's (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH's goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.

    History of Health Information Partnership TN (HIPTN)

    In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee's Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN's first initiatives involved connecting the work through Carespark in northeast Tennessee's s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.

    By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor droh.com Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN's CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN's mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, "We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health". HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it's new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark's closure clarifies the need to build a network that is not solely reliant on public grants to fund it's efforts, which we will discuss in the final section of this paper.

    Current Status of Healthcare Information Exchange and HIPTN

    Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it's Docs for Docs program and the manner in which collaboration has taken place since it's conception in 2004. Kathleen Sebelius, Secretary of HHS commented, "The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care." Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.

    A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA's conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.

    The Future of HIP TN and HIE in Tennessee

    Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor's report Richard Lang states that instead of a top down approach "A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE's and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development."22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.

    One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR's like Memitech's 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.

    The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won't happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE's, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE's were concerned about future sustainability while only 35% of private HIE's shared this concern.

    Hospital Implications of HIP TN (A Call to Action)

    From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE's. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.

    Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and droh.com homeless. As the taxpayers ultimately bear the societal burden for our country's healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it's time to stabilize it through operational excellence starting with our hospital. Let's rebuild the Tower of Babel and droh.com enhance communication to provide our patients the healthcare they deserve!
  • Q: "It Is Different From My Normal Packaging SheriWilhelm57136751 12.08.2019
    A:
    (CBS/AP) Donald Trump has decided to share the sweet smell of Success with others.

    The real-estate mogul and TV personality is releasing a new fragrance - Success by Trump.

    Pictures: Celebs with scents

    Success by Trump is a clean and spicy mix of juniper and red currant with a heart of ginger, bamboo leaves and geranium, and a base that includes vetiver, birch wood and musk. It comes in an architectural, squared-off clear glass bottle with a brushed silver top.

    "It is different from my normal packaging. I felt it was very elegant, modern and a very successful look," said  the 65-year-old Trump in a recent telephone interview.

    Trump says he wears his new scent to formal events. It pairs nicely with the shirts, ties, suits and cuff links, all sold at Macy's, that have his name stamped on them, he said, not missing an opportunity for a pitch, although a softer sell than what audiences might see on his TV show, NBC's "The Celebrity Apprentice."

    The fashion world is particularly finicky and, Trump said, while he's done well, he wouldn't want it to be his primary source of income.

    "I think fashion is a great thing, it can be a beautiful thing, but it's always very complicated. No one can define it, and it can be scary. It's like tech companies that can be hot as a pistol and then be out."

    Trump says he is feeling a public preference right now for things that are more streamlined, simple and no-nonsense. All the gold adornment that he loves on a fragrance bottle, 옥천출장샵 logo, fabric and even in a bathroom isn't with the zeitgeist at the moment, he explained.

    "Look at bathrooms, now they (the public) like the nickel brush fixtures. Do I like it? No, but I'll do it because it's what the public wants," he said. Taste can change on a dime, and it'll happen quickly, too. A business isn't going to last if it cannot evolve, he said.

    This is Trump's second fragrance. The first scent, launched in 2004, was sold mostly at his properties.

    What's next?

    "I think I've got some of the great buildings of the world, in major cities, so I can't think of anything else, but I will after this conversation," he said.
  • Q: Security Forces Will Also Be Able To Conduct Searches And Detain People Without Warrants RosalinaBrownlow980 12.08.2019
    A:
    Police and soldiers came under heavy fire in barricaded battle zones in the West Kingston stronghold of Christopher "Dudus" Coke, who is trying to avoid extradition to the U.S. on drug and arms trafficking charges. Military helicopters with mounted guns buzzed above the impoverished area, between plumes of black smoke.

    West Kingston, which includes the Trenchtown slum where reggae superstar Bob Marley was raised, is the epicenter of the violence. But on Monday, security agents were also under attack in troubled areas outside that patchwork of gritty slums.

    Gunmen shot at police while trying to erect barricades in a poor section of St. Catherine parish, which is just outside the two parishes where the government on Sunday implemented a monthlong state of emergency.

    A police station in an outlying area of Kingston parish also was showered with bullets by a roving band of gunmen with high-powered rifles.

    Security Minister Dwight Nelson said "police are on top of the situation," but gunfire was reported in several poor communities and brazen gunmen shot up Kingston's central police station.

    The Jamaica Constabulary Force said two officers have been killed and six injured during firefights with criminal gangs whose arsenals rival police firepower.

    "The loss of these two officers and the injury to the six, while difficult to deal with, will only serve as a rallying call for the police to remain strong, committed and firm as we continue to encounter brazen criminals," said Police Commissioner Owen Ellington.

    Ellington said "scores of criminals" from gangs across the Caribbean island had joined the fighting in the Kingston area, where the fear of gun violence has driven many to live behind gated walls with key-pad entry systems and 24-hour security.

    In a sun-splashed island known more for reggae music and all-inclusive resorts, the violence erupted Sunday afternoon after nearly a week of rising tensions over the possible extradition of Coke to the United States, where he faces a possible sentence of life in prison.

    Coke is described as one of the world's most dangerous drug lords by the U.S. Justice Department.

    Coke leads one of the gangs that control politicized slums known as "garrisons." Political parties created the gangs in the 1970s to rustle up votes. The gangs have since turned to drug trafficking, but each remains closely tied to a political party. Coke's gang is tied to the governing Labor Party.

    Prime Minister Bruce Golding had stalled Coke's extradition request for nine months with claims the U.S. indictment relied on illegal wiretap evidence. After Golding reversed himself last Monday amid growing public discontent, Coke's supporters began barricading streets and preparing for battle.

    On Friday, the U.S. State Department warned in a travel alert that access roads to the airport could be blocked by civil unrest, but Jamaica's Civil Aviation Authority said Monday that flights were arriving and departing on schedule at Kingston's Norman Manley International Airport.

    The U.S. State Department said Monday it was "the responsibility of the Jamaican government to locate and arrest Mr. Coke." A U.S. Embassy spokeswoman denied widespread rumors that U.S. officials were meeting with Coke's lawyers.

    Coke's lead attorney, Don Foote, 인천출장만남 refused to disclose to The Associated Press whether Coke was hunkered down in his stronghold in the barricaded Tivoli Gardens slum or was somewhere else in the Caribbean country.

    In a national address Sunday night, Golding said the state of emergency order for Kingston and St. Andrew parish gives authorities the power to restrict movement. Security forces will also be able to conduct searches and detain people without warrants.
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