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HDMI Audio Support For Intel G43/45 Chipsets
Published on 07 November 2008 07:40 AM EST
Written by
Michael Larabel
Comment On This Article
Initially the ATI R600 GPUs and later with the available open-source drivers (
) hadn't supported using the graphics card's integrated audio processor with
output. An end-user though dissatisfied with this had went on to reverse-engineer the support for
RadeonHD HDMI audio support
. The audio patch was then
merged to master
within the last two weeks that now enable ATI HDMI audio output support with that open-source driver.
Those using
Intel's driver
with the G35 or
series have too been without HDMI audio capabilities. Intel though has now stepped up to the plate and have sent along patches that enable this capability.
Intel's Wu Fengguang has posted three patches on the X.Org mailing list that bring forward this support (
, and
). A patch has also been posted on
the mailing list
for the
(Advanced Linux Sound Architecture) to support the audio codec with Intel's G45 and to report the monitor's ELD (EDID-Like Data).
These patches haven't yet made their way into the respective xf86-video-intel and ALSA driver development branches, but we imagine they will be soon.
Comment On This Article
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About The Author
Michael Larabel is the principal author of Phoronix.com and founded the web-site in 2004 with a focus on enriching the Linux hardware experience and being the largest web-site devoted to Linux hardware reviews, particularly for products relevant to Linux gamers and enthusiasts but also commonly reviewing servers/workstations and embedded Linux devices. Michael has written more than 10,000 articles covering the state of Linux hardware support, Linux performance, graphics hardware drivers, and other topics. Michael is also the lead developer of the
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Just Released: Panthera's June Newsletter
Read Panthera's June newsletter to learn about how Panthera's Leopard Program Coordinator made the 2011 Mail & Guardian 'Top 200 Young South Africans' List, the record-breaking work being done in Mongolia to uncover the secret lives of snow leopards, Panthera's Father's Day e-cards, the successful bust by Brazilian authorities of an illegal hunting operation in the Pantanal, and how Panthera's scientists' are using cougar conservation best practices to protect the leopards of South Africa. Also read up on Panthera's latest partnerships, events and publications.
Applications Now Being Accepted for Rabinowitz-Kaplan Prize for the Next Generation in Wild Cat Conservation
We would like to announce that Panthera is now accepting applications for the 2011 Rabinowitz-Kaplan Prize for the Next Generation in Wild Cat Conservation. Each year, Panthera's Cat Advisory Council awards a prize to a special individual who has made a significant contribution to conserving wild cats, and who represents the next generation of scientists, conservationists, policy makers, politicians and planners who will pave the future of wild cat conservation. The prize winner is someone who has and will continue to work tirelessly to contribute, in a significant way, to the conservation of wild cats.
Press Release: Panthera Applauds IBAMA & Brazil's Federal Police on Illegal Hunting Bust
Panthera applauds the Brazilian Institute of Environment and Renewable Natural Resources (IBAMA) and the Federal Police on successfully uncovering an illegal hunting operation using ecotourism as its cover, which organized illegal jaguar and puma hunts for tourists paying up to R$40,000 (24,748 USD). The regional office of IBAMA Corumbá fined the ranch owner and tour operator R$105,000 (65,016 USD) for the crime of illegally hunting wildlife for tourism purposes.
Read More in our official press release
Panthera Names Our Newest Junior Ambassador
Panthera has recently named our newest Junior Ambassador – a seven year old from White Plains, New York named Grace, who is dedicating her creative talents to wild cat conservation. According to her mom, Grace's fascination with the natural world started when she was just 3 or 4 years old when she insisted on saving every bug that fell into their pool. An afternoon of splashing around with her twin brother quickly turned into a massive rescue mission, with Grace trying to airlift every six-legged victim to safety.
Picking up Poop Builds a Roof
Panthera's field staff understand that while collecting cat scat falls under the less glamorous side of carnivore research, it can provide critical information that may be used to help conserve threatened species, like the lion. All feces contain epithelial cells that are shed from the intestinal lining as it passes through the animal's gut. Panthera has partnered with the Global Felid Genetics Programme (GFGP) at the American Museum of Natural History in New York City to extract DNA from scat collected in the field, and to use this material to create a 'genetic fingerprint' for individual cats.
Application Period Open – Postgraduate Diploma in International Wildlife Conservation Practice by WildCRU of Oxford University
We are excited to announce that the 2012 application period is now open for the Postgraduate Diploma in International Wildlife Conservation Practice, delivered by the Wildlife Conservation Research Unit (WildCRU) of the University of Oxford.
WildCRU was founded in 1986 by Professor David MacDonald, and since mid-2007 Panthera and WildCRU have partnered to offer the world's leading university center designed specifically for research in wild felid conservation.
Panthera Camera Trap Catches Poachers
Last December marked an exciting milestone for Panthera with the distribution of our new and enhanced camera trap model, which consists of a remarkably energy-efficient camera that snaps photos of passing wildlife in just three-tenths of a second. Given that wild tigers are very elusive and increasingly rare, these camera traps serve as a particularly valuable research tool that allow Panthera's scientists to identify individual tigers using their unique stripe patterns and learn more about the abundance, movements and behaviors of these endangered big cats.
DisneyNature Chooses Panthera as a Way to get Involved with Saving Wild Cats
We are proud to announce that DisneyNature has selected Panthera as one of its wild cat conservation partners, and is encouraging DisneyNature fans to support Panthera in order to get involved in the conservation of Africa's wild cats. DisneyNature kicked off Earth Day this year with the release of its latest nature film, African Cats. Narrated by actor Samuel L. Jackson, this film follows the life story of a cheetah and lion family, and the hardships and challenges they face just trying to survive in the wild savannas of Kenya's Maasai Mara region.
Just Released: Panthera's May Newsletter
Panthera has just released our May newsletter, and we've got a long list of exciting stories from the field and news about our latest partnerships. Read about how Panthera's camera traps helped bring poachers to justice in India, DisneyNature chose Panthera as a way to get involved in saving African Cats, a dedicated field assistant in Mozambique collected lion scat to help build himself a new roof, and more on Panthera's 'Let Lions Live' campaign, education opportunities for conservationists, and our latest partnerships with Velo Enterprise and David Mayer Sculpture!
April 28-May 5: Newport Beach Film Festival Featuring Panthera Film 'My Pantanal'
The Panthera produced film 'My Pantanal,' written and directed by Panthera's Managing Director, Andrea Heydlauff, has been accepted to the 12th annual Newport Beach Film Festival, which began April 28th and will last through May 5th.

subset: commoncrawl


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Welcome to Health Wonk Review, the bi-weekly blog carnival featuring the latest and greatest blogging by a staggeringly wonkish agglomeration of health care policy nerds. The last edition of Health Wonk Review was hosted at Wing of Zock. The story behind the name of that blog seems (to this health wonk, at least) oddly relevant to this edition's theme, given the recent news that the construction costs of the new presidential palace in Turkey seem to have doubled ... again.
Well, our frame this week is the other turkey, the turkey that will lull many of us into a stupor late next week, and the health care policy decisions (and decisionmakers) that sometimes make us wish we were in more of a stupor ... so as to lessen the pain. Top of mind in that department this week is #GruberGate:
I heard Zeke Emanuel give a speech this week at a conference in NYC, and when asked about Gruber (the reported "architect of Obamacare"), here's what he had to say, in classic Zeke-speak (per my live-tweeting):
Zeke: 'This is really simple. #Gruber is a talented economist. But politics is entirely different. Also, he was wrong on the facts.' #DHC14
— David Harlow (@healthblawg) November 18, 2014
Zeke: ' #Gruber wasn't part of the inner circle. He had a good model for use in analyzing the #ACA for #HHS' #DHC14
— David Harlow (@healthblawg) November 18, 2014
Which Side of the (Pumpkin) Bread is Buttered?
At InsureBlog, Patrick Paule presents the case that another sort of obfuscation has been perpetrated on the American people -- one regarding the true nature of ultimate payment for Obamacare.
Setting the Table for the Future
Louise Norris lays out her top five desired ACA fixes at Colorado Health Insurance Insider, though she readily acknowledges that the likelihood of the repeal-minded and the ACA-supporting congresspeople getting together and acting on them are slim.
John Graham, blogging at the National Center for Policy Analysis Health Policy Blog, thinks that PWC, RWJF and KFF reports, among other positive news on premiums in the exchanges for year 2 of Obamacare, are all pie-in-the-sky. He thinks low average premiums in year 2 will be achieved not by Obamacare saving money but by insurers getting better at attracting healthy applicants.
Whose Neck is on the Chopping Block?
The accountability thing has gotten to a couple of wonks this week. Roy Poses, writing at Health Care Renewal is concerned about the "Too Big to Jail" attitude taken by the powers that be in meting out mere wrist-slaps (fines) to Big Pharma in connnection with allegedly deceptive promotion of potentially dangerous drugs, with no personal consequences to executives, while putting an executive of a much smaller company through the wringer (personal felony conviction) for wastewater violations.
On another front, the former CEO of a large mining concern was indicted for "conspiring to cause willful violations of ventilation requirements and coal-dust control rules -- meant to prevent deadly mine blasts --during a 15-month period prior to the worst coal-mining disaster in a generation." Read all about it at Worker's Comp Insider.
Back to FDA-world for a moment: The benefits of generic drug legislation were extended to manufacturers of biosimilars in 2009 (see my post on the legislation and the legislative process before we got to the end of that story). Now that the first application has been filed using this new pathway for biosimilars, a competitor has filed suit alleging violations of state and federal law. See all the gory details in Jordan Paradise's post at the Health Affairs Blog.
Here at HealthBlawg, I wrote about the latest court ruling finding that HIPAA establishes a standard of care that may be used in a negligent disclosure of medical records case -- and the implications of that ruling.
Too Many Cooks?
Many interested parties continue to kibbitz about implementation of Meaningful Use. Personally, I am more focused now on the opportunities for real improvement once we get past Stage 3, and I am not alone. The eHealth Initiative, a coalition of interested parties (payors, providers, employers), launched its 2020 Roadmap to "enable coordinated efforts by public and private sector organizations to transform care delivery through data exchange and health information technology." See Peggy Salvatore's post at Health System Ed on the post-meaningful use possibilities painted in the roadmap and the likelihood that ONC is looking past Stage 3 already, too. Neil Versel observes at Forbes.com that the AMA just wants the federales to drop the Meaningful Use penalties that are due to kick in January 1. (They seem to get their way on things like ICD-10 implementation delays. Check out the "Struck by orca, initial encounter" illustration.)
Talking Turkey
No, there's no such thing as a talking turkey, but two wonks posted podcast interviews worth chewing on. Check out the Larry Levitt interview at healthinsurance.org wherein the KFF SVP waxes wonkish on ACA implementation post-midterm-elections, and at the Health Business Blog, David Williams' interview with Aron Boros, the Executive Director of the Massachusetts Center for Health Information and Analysis (CHIA) about the health data needed to power health reform (I know, it makes me think of Chia Pets, too).
Joe Paduda brings us a post-election wrap-up at Managed Care Matters with a focus on ACA implementation, including an important point about the pain points for hospitals that used to get "disproportionate share" payments. Those are gone under the ACA becuase they were supposed to be effectively replaced by payments under the Mediciaid expansion. Since the Supremes let states opt out of Medicaid expansion, and since many did, the former dispropotionate share hospitals in those states are hurting.
Jason Shafrin looks at both sides of the debate regarding boarding psych patients in hospital ERs over at the Healthcare Economist.
Anthony Wright breaks down the effect of the elections on health reform in California and other states at Health Access Blog.
Bradley Flansbaum channels Rodney Dangerfield in his post on being a hospitalist in The Hospital Leader.
Jordan Shlain channels Inigo Montoya in his rant at The Health Care Blog against using the word "reimbursement." -- "I do not think it means what you think it means."
The next edition will be hosted by Hank Stern at InsureBlog. For more information and links to the archives, see the Health Wonk Review home page.
Too much to keep straight? Well: "Don't fret about that, pilgrim." And don't forget: if you mess up, some turkeys are the beneficiaries of Presidential pardons.
There may be hope for us yet.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
This week, Connecticut joined at least nine other states (DE, KY, ME, MN, MO, NC, TN, UT, WV -- see cases cited in the opinion, linked to below) in recognizing that, while HIPAA does not create a private right of action for violation of privacy, it does constitute a standard against which the actions of a defendant in such a case will be judged. In other words, if a covered entity or business associate or downstream contractor releases PHI other than in accordance with HIPAA (i.e., for treatment, payment or health care operations purposes, or to or at the direction of the data subject or his or her legal representative), the breach of the HIPAA rule may be the basis for a finding of a breach of a duty of care in a state court negligence action.
As the Connecticut Supreme Court observed in its opinion in Byrne v. Avery Ctr. for OB GYN, which was released earlier this week:
[A]ssuming, without deciding, that Connecticut's common law recognizes a negligence cause of action arising from health care providers' breaches of patient privacy in the context of complying with subpoenas, we agree with the plaintiff and conclude that such an action is not preempted by HIPAA and, further, that the HIPAA regulations may well inform the applicable standard of care in certain circumstances . . . .
[T]o the extent it has become the common practice for Connecticut health care providers to follow the procedures required under HIPAA in rendering services to their patients, HIPAA and its implementing regulations may be utilized to inform the standard of care applicable to such claims arising from allegations of negligence in the disclosure of patients' medical records . . . .
The court also found that an action under state law was not pre-empted by HIPAA. In other words, the HIPAA standard of care may be used to judge the actions of the covered entity but that does not mean that HIPAA bars an individual from seeking redress for a breach under state law.
What does this mean for covered entities, business associates and downstream contractors? It is yet another reminder that exposure for violations of standards of care and conduct embodied in HIPAA regulations is not limited to indemnification clauses in business associate agreements or audits or enforcement actions brought by the OCR or a state attorney general. A data subject may bring suit if a covered entity, business associate or downstream contractor experiences a breach.
The Connecticut case involved responding to a subpoena. There are specific HIPAA rules about responding to subpoenas, and the provider in this case likely should have provided notice to the data subject and an opportunity to quash. The breach was not the result of an outside hack -- it was apparently the result of inadequate policies and procedures, and/or staff training, at a covered entity.
Other cases could involve breaches in other contexts. For example, a social media posting including PHI could be the basis of a state law claim, not just a complaint filed with OCR. And in fact, it is likely that the plaintiff bar will begin filing OCR complaints as part of their case preparation in breach of privacy matters; an OCR finding of a HIPAA violation could obviate the need for a trial on liability in a state court breach of privacy case -- the case would go straight to a trial or settlement discussions on the amount of the damages.
At one end of the spectrum, the liability under a state law claim may run into the hundreds of millions of dollars. (Consider the Johns Hopkins settlement; while not a HIPAA case, it provides a sense of the monetary damages that may be incurred through lax attitudes towards privacy.)
I urge covered entities, business associates and downstream contractors to take these lessons to heart and redouble their compliance efforts accordingly.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
photo: Flickr cc caliorg]]>

You should follow me on Twitter: @healthblawg

Many of us are waiting with bated breath for CMS to broaden its coverage of telemedicine services. Upon the release of the CY 2015 MPFS, the American Telemedicine Association got a little ahead of itself in the excitement over some changes in the physician fee schedule, and announced that CMS had added payment for remote patient monitoring of chronic conditions (99091). In fact, CMS's response to the proposal that this and other E&M codes should be payable if provided via telemedicine was: "These services are not separately payable by Medicare. It would be inappropriate to include services as telehealth services when Medicare does not otherwise make a separate payment for them." (79 FR at 67600.)This code is a "bundled" code; it is included within broader E&M codes and while a dollar value is assigned to it, no payment is made to a provider in that amount. I confirmed with CMS that my reading was correct. The ATA realized its initial error and pointed me to a presser with a correction about the physician fee schedule on its website.
While payment for remote patient monitoring of chronic conditions turned out to be a chimera - at least for now - payment for chronic care management services, previously discussed in the CY 2013 and 2014 MPFS Rules, has been finalized in the CY 2015 MPFS. CCM services provided by or on behalf of a primary care practice, to Medicare beneficiaries with two or more chronic conditions who opt in to the service, will be reimbursable at a payment rate of $42.60 PMPM. (If remote monitoring were also reimbursable, the payment would have been more than doubled, hence the excitement over the initially misunderstood regulation as a "Halloween telemedicine treat.")
In light of the perpetual need to fill white space, and an interest on the part of blogs and websites covering telemedicine reimbursement policy in reporting good news, the initial ATA presser received widespread coverage. (I found a dozen different websites and blogs that had cited the original presser by searching on a phrase it included.) Given the short news cycle and the general reluctance to revisit old news, the correction did not get the same sort of attention. (By my count, this post is only its second citation.)
I was reminded the other day of the advice given to me by an expert in legal ethics: Never post a tweet until it has been reviewed by your law partner. While implementing that advice may be impractical, there is an appropriate middle ground between immediate or rapid sharing of content and intensive peer review before publishing or re-publishing material.
Bottom line: If something seems too good to be true, it probably isn't. Act - and communicate - accordingly.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
]]>

You should follow me on Twitter: @healthblawg

The first health system to announce that it had integrated HealthKit into its Epic EHR is Ochsner Health System in Louisiana. It is a 12-hospital, 40-clinic operation with over 900 physicians. I spoke recently with Dr. Richard Milani, Ochsner's Chief Clinical Transformation Officer. He was enthusiastic about the improvements in clinical outcomes realized to date through homegrown integrations of things like Withings scales, and sees significant expanded potential using the Epic-HealthKit integration including dissemination of data to clinicians for more efficient and effective management of care and presentation of data to patients in a way that may motivate behavior change to improve health status.
Ochsner is avoiding readmissions of CHF patients by monitoring weights at home (via Withings scales) and alerting docs and pharmacists when weights go up (water retention is often the culprit) so that titrating of medication dosages may be done without the need for an office visit. If these side effects were not monitored and managed, they could easily result in readmissions -- costly to the system and disruptive for the patient.
Ochsner is also trying to make adoption of useful health apps as easy as possible, by opening up their own take on the Apple Genius Bar -- the "O" Bar. Tablets preloaded with prescreened apps are available for hands-on patient demos, and staff are available to help get patients up and running with recommended health apps.
Given the difficulty with keeping folks engaged in long-term use of health apps, it is hard to say whether Ochsner's approach will prove to be successful. Adding the live in-person support may prove to be one ingredient of the secret sauce that seems to be missing from this sector in general.
Listen to the interview in the player below (it's about 20 minutes long); download or read the transcript below.
HealthBlawg: David Harlow HealthKit interview with Dr. Richard Milani, Ochsner Health System
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
HealthBlawg :: David Harlow's Health Care Law Blog
Interview with Dr. Richard Milani on the
Ochsner Health System Epic EHR – Apple HealthKit Integration
October 13, 2014
David Harlow: This is David Harlow with HealthBlawg and I'm speaking today with Dr. Richard Milani, Chief Clinical Transformation Officer at the Ochsner Health System, which has implemented HealthKit's integration with Epic Electronic Health Record System. I'm very interested to hear about this. Hello, Dr. Milani and welcome to HealthBlawg.
Richard Milani: Well hello back and thank you for inviting us.
David Harlow: Dr. Milani is at Ochsner Health System and as I said he is Chief Clinical Transformation Officer and Vice Chair of Cardiology, and, his experience in cardiology has been an asset to the kick off, of the Healthkit integration. I understand that you have begun with a beta test in congestive heart failure is that correct?
Richard Milani: Both congestive heart failure and in high blood pressure, hypertension.
David Harlow: I wonder if you could describe those briefly, and then we'll talk more about the broader integration?
Richard Milani: Well, I think to understand it we probably have to talk about the broader integration to some extent. We started back in this endeavor pre-HealthKit, early in the year. So, again the focus was on heart failure primarily to begin with, our plan all along was then towards of the end of the year to break into hypertension. We are an Epic client. We began by evaluating heart failure readmission, which is a nationwide problem for patients with congestive heart failure, as you may know it's the number one reason why patients in the United States are readmitted to hospitals. So, it certainly was a good one to go after, and we began by sending patients home -- well even before that we began by actually doing a very detailed evaluation of patients during their hospital stay, and to do this we had to create a variety of algorithms within Epic and some decision support tools.
Ultimately, by the time patients went home they would be going home with a wireless scale, where the data would be transmitted through interfaces into Epic and then in front of a pharmacist that would be managing any changes in their medication necessary to maintain the appropriate weight. So, again for the audience perspective, heart failure is a condition where if it's deteriorating it often can show up as a fluid accumulation with weight gain and so changes in weight can have significant meaning for us. So, it would prompt a phone call, we saw that and it could lead to a benefit. So, we've sort of been in this space already in terms of monitoring individuals. The difference was that we had to create our own interfaces to get that information into our systems and ultimately into Epic. So, when HealthKit, became available the support, that's the opportunity to not only expand into other areas and other modalities, but also to use the interface that HealthKit provides.
David Harlow: My first question then leading out from there is, can you describe the benefits of using the integration? I understand you're saying that you don't have to build it yourself, for each new application, and the question is, what other sorts of applications are available now, do you have a view into the future in thinking about what other kinds of applications you would like to see integrated with HealthKit? I mean the CHF use case is a very good use case and many of the other use cases that we have been hearing about in the general press around HealthKit seems to revolve around fitness trackers and so forth, and I'm wondering how useful that is in the clinical setting, and whether there are other applications that would be more useful in the clinical setting
Richard Milani: Let's move on to high blood pressure as an example. So, it's a common chronic disease, one out of three adults have it, and there are a lot of things that can impact hypertension. So, at the very basic we'd like to get your blood pressure, something we've been asking for for decades, it's not a new thing that we ask patients to buy blood pressure cuffs and take their readings, and having done this for quite for some time, patients then would have to write it down on a piece of paper and that sort of stuff, and then they forget the paper or it'll be very unclear sometimes, or they forget to write it down and they're taking the blood pressure. So, at the very basic, just having somebody go home with a wireless cuff that integrates in the system, that's effortless, it's not, there's no extra steps for the patient, improves compliance in doing so and obviously gives us more robust data to look at. But now we can talk about other aspects of care. So, for instance as you brought up fitness, again exercising more may be losing weight may be not, but certainly exercising more and hopefully losing weight, both those can lower blood pressure. So, a nice thing to be able to do would be to present patients their data and showing them, how when their activity went up, they saw a fall in their own blood pressure, and that's pretty self-reinforcing, so we think that that can lead to a greater level of patient engagement, a greater level of patient adherence, when patients can track the things that can influence their disease state.
David Harlow: That's great, yes and I think the feedback, I mean it's been established that the feedback to some patients at least will be valuable, and will move the needle in terms of adherence, to new regimens and so forth. One question that I have is sort of, whether clinicians are really interested in seeing all of this information and what you are doing on the clinician view end to filter the information, because I imagine my doctor doesn't want to see my step count everyday if I'm wearing a fitness tracker, but might want to see some higher level analytics of some sort. How do you digest this tremendous amount of data so that it yields some actionable information?
Richard Milani: Well, we agree that, data visualization for both provider as well as the patient is very important, in determining whether or not these kinds of programs will be successful. So, just giving back to patients, data like we do for lab reports, lab reports are horrible and I am sure you've seen what a typical lab report looks like. I mean it was built for doctors and poorly designed for somebody to try and understand if you aren't a physician, and then I think you may or may not have seen you know, several years ago Wired Magazine attacked that and came up with their own patient centered lab report, it's fabulous, and so we are strong believers, in how data is aggregated and visualized and there are lots of additional cues that one can provide in the data patients that can alter their adherence rates, and we can't get into that today, but the data presentation is what your question is about and I think it's very important. Likewise we have been as concerned as you are in term of how the data comes to providers. So, providers can have the opportunity to be able to choose how they want the data received. Do they want to see a monthly report or do they want a weekly report or do they want a quarterly report or that sort of thing, and we can, we put together a sort of report formats or alert, so to speak that alerts the physician in their inbox that there is a report available of Mr. Jones, it's the monthly frequency that they you have to see and here it is, and we try and present the way that's it doesn't take a long time to decipher what the answer is.
David Harlow: So, you're envisioning doing a lot of clinician based individual clinicians' customization of views, I mean, how does that work? You are large organization, a dozen hospitals almost 1000 clinicians, does going there need to be a standard? Would that be established at a department level? How do you see that working?
Richard Milani: I think… Yeah, I feel the way we are building reports will be fairly standard. The frequency by, which a physician wants them, will be determined by the physicians in terms of the frequency of the alert. So, we are not customary, we are not making 1000 different customized reports, it's just the frequency by, which one receives them is customized based on what the physician wants for that individual patient.
David Harlow: Sure, and then through HealthKit and the Epic integration, these data become a part of the EHR?
Richard Milani: Correct.
David Harlow: Okay. Is there a concern, have there been discussions about potential additional exposures to liability due to additional data being entered into the chart that may or may not lead to actions or recommendations on the part of the clinicians?
Richard Milani: Well, we've certainly discussed this like any good steward of health care with our legal department and thus far we have sort of organized ourselves in a way that they're comfortable with, but I mean an alert is an alert -- the physician ought to be able to determine how he or she wants the alert. Obviously most of this data for many of these patients is for instance in our hypertension program. We have an intermediary in between. So, again in the heart failure program we have an intermediary. So, the physician is going to get the data and the physician is going to get the reports, but if there is anything that is a, for lack of better term, a panic value, or something that's very risky to an individual, there is going to be some follow up done through the intermediary whether it be an APC or a Phram D, and that's going to get in front of them first, so that something can get done.
David Harlow: Okay. And do you see any particular barriers to patient adoption? We've talked a lot of about the physician end of things. This has been pushed out previously to patients with certain diagnoses or conditions, and how amenable have patients been to using these devices, what proportion of your patient population have the infrastructure at home, to use these things, or do you send somebody out to set them up.
Richard Milani: The answer is yes. So, let me give you more details. So, the first thing is --forget HealthKit and forget us -- is this a market that is organically growing? and the answer is, yeah, by a large degree. So, when you look at first of all apps in general you know, and I think there is a pretty healthy growth of general apps, and then when we look at health apps it doubles the growth rate of general apps. So, the point being is that the public is desirous by their actions of these kinds of activities, number one. Number two is so much so that we opened up a, sort of a, I hate to use the term 'retail', but that's exactly what is, so, but it's semi retail sort of space in our new primary care space, we call it the "O" bar, 'O' is Oschner. So, it's the "O" bar and it's much like a genius bar would be set and up and the concept behind it is simple. Number one is we offer two things both apps and devices. The apps are downloaded into, we have it's literally a bar where you can sit down and we have about six of these iPads that are on stands, and we've downloaded probably two or three hundred of the best apps that we've screened and they're on there and they can play with them at their leisure and we have a "genius" behind the bar, they can ask questions to, they can show them, walk them through, show how the apps works. A popular one just as an example is Fooducate -- I don't know if you know anything about Fooducate, but it is a great app with regards to knowing what you're eating and what might be better alternatives and you could just simply…
David Harlow: Yeah.
Richard Milani: I mean you're familiar with it, and so that's a popular one and things like that, and of course we sell devices too like FitBits and Jawbones and wireless blood pressure cuffs and scales and wireless glucose meters and so forth. Well, patients love this place, we've had several thousand visitors, we've only been open since April, we're getting a lot of positive feedback from patients that this is a wonderful thing and we make it easy, so that if you're intimidated -- So, let's go back to the patients that may not want to that sort of technology averse, they don't understand technology perhaps they might be older. This is an easy way where someone can show them how really simple this is, and they can ask what they think are dumb questions and not feel bad, and have someone who is very nice and knowledgeable, show them how they can use this to better themselves or help them understand better their chronic disease process. So, it's been very positive experience for patients.
So, to help answer your question, do you think patients are going to want to do this? Certainly not every patient, but many patients have really enjoyed the experience. With regards to the blood pressure thing as an example, we think that the best way to do this would be if a patient had a wireless blood pressure cuff and if they took their blood pressure a few times a week or once or twice a week that would be fabulous and that's way more data than what we're getting currently, but again back to the story about adherence, if you want to get best adherence, you can't ask the patient to do much more than that. The moment you asking them now take that information and go somewhere else and write it down, it drops off. Same thing with weight, I mean most people don't mind getting on the scale, in the morning, after they go to the bathroom, but now if you said okay take that number and go enter it somewhere or do something that's where you see a big drop off. So, we think that obviously starting with the best and working our way down that the most effective intervention or assessments are going to be where they just do the thing that they were doing do anyway and nothing else, and then magically you know we get the "data," but you know, not everybody is going to want to spend the money.
And certainly if they have the ability to text us, we can receive an SMS text using a short code. They can just put in BP and their blood pressure and that information will get to us, but unfortunately again that takes an extra step. The other thing is that one of the advantages of the HealthKit piece is that there's going to be lots of new products and better products that can integrate automatically and get to us. So, we're just looking at the products that are good today, but as you know better than anybody, these products are dynamic and there's new things coming out all the time that monitor various things and some of which could be very helpful to us. I can tell you we're embarking on a project now where we're looking at patients with obstructive sleep apnea and who are getting home CPAP, and the compliance rate is sort of intermediate, but we now have the data that can be transmitted to us directly and into the record that they used it six hours last night or not at all, and so, we can look at that and see how often that the CPAP is being used and it's all being done wirelessly without the patient having to do anything. So, I think more and more of this kind of information is going to be available to us and it could help us in making decisions about our patients and knowing our patients better, but I think the real value is going to be ultimately in being able to present data to patients about themselves, in a way that they can help themselves better.
David Harlow: Great. I think time will tell whether the adoption of these apps and uses will be long-lived, it sounds like you have been doing this for about six months through the "O" bar and so forth, and my understanding is that many users of health apps and other apps will sort of use them for three months or so and then the utilization drops off. So, I suppose if you maintain the level of engagement through some of your staff with the patients on particular uses then they'll be able to maintain that connection over the longer term.
Do you have any concerns about the privacy and security protections of putting health data over what to date has been really a consumer platform?
Richard Milani: Yeah, I mean to say we're not concerned with it would probably be rash, I mean of course we are concerned, and I think the most important thing to remember is that we don't act solely based on that data. We try to validate it independently. So, if we get, for instance back to the weight thing and if we get a weight that's you know, way out of whack, there's not going to be an automatic change in anything it's just going to prompt a phone call to talk to the patient to understand, what's going on. So, I think that that's reasonable, as long as a patient knows that, most patients recognize that there is a potential possibly of a security lapse, but again we are talking about weights, we're talking about blood pressures, we are not talking about a lot of other stuff at this point -- or fitness activity. Not that we should be cavalier about that. We shouldn't be, but at the end of the day I think the benefits currently outweigh what little risk that might be.
David Harlow: Well, thank you very much this has been a terrific education on the way you've rolling this out.
I have been speaking today with Dr. Richard Milani, Chief Clinical Transformation Officer of the Ochsner Health System in Louisiana. We have been talking about the rollout of HealthKit and the integration with the Epic EHR system at his institution. Thank you again, Dr. Milani.
Richard Milani: Thank you.
]]>

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On a recent evening at Harvard Medical School, the Primary Care Innovation Challenge and Pitch-Off brought together six finalists, primary care luminaries and trainees, and a host of hangers-on and camp followers for a couple of hours of demos and discussions. The tenor of the evening, which was in many ways a pep rally for primary care – not that there's anything wrong with that — was best captured by the rhetorical question posed by Asaf Bitton to the primary care practitioners and trainees in the hall, "Are you going to be a playwright or a critic?"
The hoots and hollers in response made clear that these are not your grandfather's primary care docs. The call to action was echoed by many of the speakers, notably community organizer turned primary care physician Andrew Morris Singer and Dennis Dimitri, both advocating for, well, advocating for primary care. Bitton's opening also included the exhortation that proved to be predictive of the winner of the top honors from among the six pitches: Innovation in primary care is not about the technology; it needs to enable better human care.
The projects presented by the finalists ranged (in order from the techiest to the least techie) from using natural language processing of free-text notes in EHRs to improve quality metric capture, to interventions combining app-based data collection with live clinicians and care managers interacting with patients in person or remotely (Heart Failure 2.0 and Twine), to studying "positive deviance" in patients and bottling their secret sauce, to significant re-jiggering of the primary care clinical education experience in medical school (Baystate/Tufts and Beth Israel Deaconess/Harvard). (For the completists among you, here's the full #PCC14 tweetstream.)
Here are some of the highlights:
The fact that in late 2014 an innovation showcase featured a project based on natural language processing of unstructured data in EHRs should cause, at the very least, widespread wailing, gnashing of teeth and rending of garments. I found it appalling to hear that primary care physicians couldn't be expected to put all patient data into the structured data fields – they complain, "too much point and click," according to Howard Haft – appalling because the EHR industry, this far into Meaningful Use, has not figured out how to make the workflow for PCPs work, so that more important patient information may be captured in structured data, or so that the EHR itself may be able to apply some NLP and logic to the free text entries in order to unlock their content for the benefit of the patient.
Twine Health, John Moore's startup, connects patient and provider – not just the data – thus empowering patients as apprentices, taking an active role in their own care. ("No one ever gave me the chance to be in charge," a patient using the platform said.) One arresting example of how this works: 100% of patients who were enabled to connect with case managers between appointments using the Twine Health platform were able to control their hypertension within three months. Only 25% of patients without these tools were able to control their hypertension – even after a full year. The connected patients were able to easily review side effects of their meds with their providers, who were able to start them on another med. Discontinuing meds because of side effects is apparently a key factor in low success rates in controlling hypertension.
Cole Zanetti, from Dartmouth Hitchcock, suggested that we need to keenly observe the patterns of successful behaviors among the "positive deviants," the cohort of patients who are able to maintain good health status despite dealing with high disease severity to figure out what social determinants of health - and other factors - keep them relatively healthy, and apply that learning to the care and coaching of the less healthy. He made a compelling case for this initiative.
The winning innovation, in the end, was one of the most low-tech and perhaps the most subversive, even though its initial roll-out has been supported by a HRSA PCRE grant. It is the Baystate Medical Center/ Tufts University School of Medicine internal medicine residency program, expanded under the grant, and also reimagined. Gina Luciano explained:
Upon graduation, residents are prepared for inpatient medicine but not for primary care (PC) careers in part due to limited ambulatory time and opportunities during training. [Under a] grant we created additional ambulatory time/experiences outside of the core ambulatory training clinic for our PC residents. We eliminated month-long inpatient electives and transformed them into year-long ambulatory continuity experiences. Residents spend 7-8 months a year in ambulatory rotations during which they participate in traditional continuity sessions as well as spending substantial time in subspecialty ambulatory electives and community advocacy projects. Residents commit to 4-5 subspecialty electives during each calendar year. Through extra ambulatory time, trainees enhance their learning of complex disease management from subspecialists, improve their ability to formulate appropriate consults and form collaborative networks with subspecialty providers.
A surgical rotation can happen in a month, because it consists of intensive, in-hospital patient encounters, with some pre-op and post-op care. Primary care – which requires long-term collaborations with other clinicians and with patients to be successful – has long been shoehorned into a training calendar that makes sense for other specialties. Now this is changing. After the grant runs out, the additional residency slots will have to be funded by the training program.
A mere schedule change winning an innovation pitch contest? You may ask why. Well, the focus on the internal medicine residency experience is in fact a big deal, given the historical emphasis placed on training physicians for careers in specialty care.
Marci Nielsen, CEO of the Patient-Centered Primary Care Collaborative (PCPCC) moderated the pitches. I asked her about the import of honoring this entry. She replied:
That the award went to a "low-tech" intervention focused on changing how we train primary care residents speaks to the importance of improving how we train the next generation of health professionals. As was stated in the IOM's recent report on Graduate Medical Education (GME), we should be training the US physician workforce in a way that is accountable to America's real population health needs: i.e. training physicians to treat patients and families "where they are," in community settings, helping to empower patients and their families to deal with chronic illness and one that values all of the health care team (from physicians to medical assistants and all the professionals in-between). This is difficult to do in the current training environment which links GME dollars to inpatient hospital settings.
I also asked Marci whether the changes in medical education for students interested in primary care will have a real effect on the cost, availability and quality of that care. Her take on this:
Yes, this is an innovative challenge, and one that is sorely needed. There is a growing body of evidence that when we treat patients and their families in advanced primary care settings (such as patient-centered medical homes) we have the capacity to improve on the care provided, as well as improve on provider and patient satisfaction. We see cost savings, largely as a result of keeping people out of the emergency department and the hospital. We also see improvements in overall health outcomes as a result of better managing chronic conditions in partnership with patients (see the PCPCC's annual report from last year). But none of this easy or simple. Asking primary care practices to transform and offer the kind of care that puts patients' needs first requires changes in reimbursement/payment (away from fee for service and towards fee for value) and — as Gina pointed out — a focus on how and where patients really live, work, and play: in the community.
Eric Weil, Associate Chief for Clinical Affairs, General Medicine, Massachusetts General Hospital, moderated a panel discussion following the pitches. Later, he agreed that innovation is not all about tech, noting that "technology will solve some of the problem – the rest is human factors." He ticked off three factors vital for the success of hi-tech innovations: they have to be (1) operationalized without negatively affecting workflow, (2) have broad application and (3) made affordable. Further, Weil observed that
it is changes in process and culture, changes in strategy and teaching, that will make the difference in the long run. The models in primary care and more broadly in medicine just aren't working any more. However, the underpinning values that represent the practice of medicine remain the same. If we want to preserve the values, the models of care delivery need to change.
The hi-tech entries, in the end, were not seen as being quite as innovative as the low-tech reinvention of physician training.
What do you think?
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
A version of this post first appeared on The Health Care Blog.]]>

You should follow me on Twitter: @healthblawg

A report on a survey regarding wearable fitness trackers arrived in the HealthBlawger's mailbox this week. An interesting dose of reality, after spending a few days in Silicon Valley recently with a cadre of early adopters.
Here are the highlights:
>> 74.9 percent of adults do not track their weight, diet, or exercise using a fitness tracking device or app
>> The most commonly cited reason for not tracking fitness or health is a general lack of interest (27.2 percent), followed by concerns over device cost (17.7 percent)
>> 43.7 percent respondents did not have a specific reason for not tracking their fitness
>> 57.1 percent of non-tracking adults said that the possibility of lower health insurance premiums would make them more likely to use a fitness tracking device
>> Less than half of respondents (44.3 percent) said that better healthcare advice from their physician would be an incentive to use a fitness tracker
The study's sponsor, TechnologyAdvice, posits:
This data, which reflects the acceptance of similar self-monitoring incentives now being offered by auto insurance providers, suggests that health insurance providers are in a better position to encourage the adoption of health fitness tracking than healthcare providers. However, both would benefit greatly from increased use of fitness tracking devices. Physicians would gain access to accurate, patient-generated data that could improve preventative [sic] care strategies, monitor patient outcomes, and analyze overall trends in patient populations. Meanwhile, it would allow health insurance providers to create more accurate risk profiles on individuals while gathering valuable data on risk factors and potential expenditures.
In recent weeks we've also seen the fitful start down the path of personal tracker data integration and delivery to health care providers by a major consumer electronics company, which has joined a few others already on this path.
A few key questions remain:
What questions do you have about personal tracker data collection and use?
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
Photo credit: Flickr CC Eddie Codel]]>

You should follow me on Twitter: @healthblawg

HealthCamp is heading back to Boston. Once again we will be at the Microsoft NERD in Cambridge, MA. This was the venue for the inaugural HealthCamp Boston in 2009 and for the second edition in 2012. We are excited to be returning to this fabulous facility.
Register now!
Our date is set. HealthCamp Boston will take place on Monday November 3, 2014.
This is the day before the Digital Healthcare Innovation Summit. So come a day early and really turbocharge your conference experience by joining other passionate healthcare innovation people at Health Care's leading unconference – HealthCamp.
HealthCamp Boston is a forum for people with interests in all areas of health and wellness to gather, to generate ideas, and to take practical steps towards building the future of healthcare. HealthCamps are different from traditional conferences where speakers talk at you. At HealthCamp Boston, an "unconference," attendees set the agenda, and all contribute to the event according to their interests. In essence, we move the hallway conversations -- often the best part of a conference -- into the meeting rooms.
Sponsors may sign up to give 4×4 presentation opportunities. Present 4 slides in 4 minutes to showcase the exciting innovations you are working on in health care and to invite collaboration on your thorny problems.
For more information, please contact David Harlow or Janice McCallum, and join the Twitter conversation at #hcbos.
Register now at HealthCamp Boston 2014.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
This post is part of the 'Think Further' series, sponsored by Fred Alger Management, Inc. Follow the link for more #ThinkFurther content.
It is human nature to think about the future, and to predict great advances. Fifty years from now – we say to each other – the world will be entirely different. But in what ways? Some futurists, including some great science fiction writers, get parts of the future right -- but the big picture is often elusive.In health care, there have been tremendous advances in the past fifty years, and we quite reasonably expect the pace of change to pick up and bring us into a profoundly improved future.
The science will surely advance, but far more complicated is the social milieu within which the science must develop.
Alzheimer's Disease and other chronic conditions now occupy most of our attention, as modern medicine has effectively eliminated most serious infectious disease. Social factors rather than scientific factors have kept us from calling a final end to polio and a handful of other infectious diseases – religious opposition to inoculation, economic hardships limiting the availability of reliable refrigeration for vaccines, cross-cultural fear of quarantines – but we are nearly there.
How will we be able to get to the next level in terms of control, or even prevention, of debilitating chronic diseases including Alzheimer's? Well, the model of personalized medicine is compelling, and is of a piece with the rapid advances in genomics that we have seen over the past decade and which are likely to continue into the future. The key challenge is making sure that we can achieve and exploit advances in personalized medicine in a cost-effective manner – bringing us back full circle to the social factors that determine health status of individuals and populations.
Some medical futurists predict that costs will fall as technological advances are made, but this is not an ineluctable conclusion.
As runaway health care costs in the U.S. are poised to shatter the 20% of GDP barrier, we have no choice but to work to ensure that health care is as efficient and cost-effective as possible, to create a paradigm shift that moves us away from overuse of health care resources, away from the "technological imperative," and away from a mindset that defaults to concluding that more expensive health care is by definition better quality health care.
It is my fearless prediction that in the future we will be more sensible, that the social contract around health care will be improved, so that the medical advances of tomorrow may be equitably shared with those who may reasonably expect to benefit from them – without breaking the bank and without continuing to mortgage the next generation's future.
Improved patient engagement, improved outcomes tied to patient self-determination, and improved partnerships between clinicians and patients that make the other improvements possible are the stepping stones to achieving the population-level goals of improved quality, improved cost-effectiveness and improved population health status.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
I recently read that the App Association (aka ACT) is lobbying Congress to promote clarity in HIPAA regulations for app developers, based in part on the experience that health care systems "don't understand the intersection of HIPAA and mobile, and their reaction is to say 'no', [which means that] apps that improve outcomes don't make it through the front door."
Blaming the government for a regulated industry's failure to understand regulations, and suggesting that the government should publish its regulations through channels other than the official channels are interesting strategies. It seems to me that there are more productive ways of engaging with the issues.
New regulations are not going to change the scope and applicability of HIPAA/HITECH. OCR has pushed out some regs and subregulatory guidance, and has sat on other pieces (e.g., the Accounting of Disclosures final rule). It's largely a question of resources and priorities. (I had an interesting window into this calculus thanks to a recent forum with Linda Sanches of OCR.) Ultimately, If we want a more friendly regulatory environment, it will require an act of Congress, and Congress is pretty unable to act these days, so I wouldn't hold my breath.
In an era of government consolidating and cutting back, I also won't be holding my breath waiting for more user-friendly explanations of regulations to emanate from DC. Meanwhile, we muddle through as best we can, no?
I've seen HIPAA confusion and its predecessors out there for decades. Before health systems were saying no to innovation because of unfounded fears regarding HIPAA, they were saying no because of unfounded fears regarding fraud and abuse, anti-kickback and Stark rules. Before then, it was something else. "Plus ca change, plus c'est la meme chose."
I work with innovative startups and innovative health systems that are building and implementing the tools that are needed to bridge the gap between the possible and the current reality of lackluster use and leverage of health data in order improve individual and population health. It's happening today.
Better guidance would be nice to have, but it is not a must-have.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
I spoke at this week's HIMSS Privacy and Security Forum in Boston on the privacy and security issues surrounding the use of social media by health care organization workforce members. My slides and a few tweets are here for your viewing pleasure, after the jump.


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Written by THE ASSOCIATED PRESS
HARVEYSBURG, Ohio (AP) — A southwest Ohio village mayor charged with sexual imposition involving a village employee has taken a leave of absence until mid-July.
Last Updated on Saturday, 31 May 2014
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Written by MARK GILLISPIE, Associated Press
CLEVELAND (AP) — A nighttime car chase in Cleveland that ended on a schoolyard where more than 100 shots were fired at the suspect's vehicle appeared to be over when an officer opened fire again, a prosecutor said in announcing charges against the patrolman and five police supervisors.
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Welcome to Our Parish
There are three goals that I have for our parish: that all of our parishioners would learn the faith more deeply; live that faith more ardently with the grace given through the sacraments and prayer; and that we would have a stronger and broader stewardship toward our parish. We have been doing these things, as does every parish, but it takes a deliberate and conscious effort to make these goals a living reality in the parish itself. A parish is made up of individuals, and the more each person takes these goals to heart, the more the parish as a whole can be a living witness of the Gospel and a brighter reflection of Christ Himself. People will be able to identify certain characteristics about that parish. It is my hope that our parish will exude the characteristics contained in the acronym HUG: Humility, Unity, and Gratitude.
Fr. Michael J. Miller
I invite you to learn more about the Church of St. Michael, visit our parish and worship with us.
Parish News, Events & Announcements
SCCS Middle School Open House
Spiritual Healing ~ November 3-6
St. Mary's and Church of St. Michael Parish Mission A parish mission is a time for each parishioner to be renewed in their personal relationship with Jesus, to revitalize the Parish in its mission to its parishioners, a time for healing, and to be sustained as a community by the mercy and love of Jesus. Father Emmerich, who you may remember lead a mission at our parishes last November, returns to St. Michael's and St. Mary's to continue expressing the principles that lead to recovery, recovery... [Read more...]
COUNCIL OF CATHOLIC WOMEN presents MERRY MALL 2014 on Nov. 8th
Come join us for Merry Mall–a celebration of food, fun, bingo, and activities to begin the holy season of Advent and Christmas. This year's event is scheduled for Saturday, November 8th from 10:00 a.m. to 3:00 p.m. in the St. Michael's Social Hall. Two exciting new activities have been added to make this truly, a parish community event: Book signings from parishioners/authors Anne Greenwood Brown, Stephanie Landsem and Laura Sobiech from 11:00 a.m. to 1:00 p.m. Preview of scenes... [Read more...]
Biomedical Ethics Conference Cancellation
Our parishes strive to offer relevant and important opportunities for adult formation and education throughout the year. We need parishioners to participate and bring their friends in order for us to continue to make these events available. The Biomedical Ethics Conference that was scheduled for October 11, was cancelled due to lack of registrations. A heartfelt thank you to those who had worked to put this event together including Karen Loome, Eileen Douglass, Leann Kaufenberg and Molly Druffner... [Read more...]
Merry Mall ~ Saturday, November 8th ~ 10:00 a.m. to 3:00 p.m.
As you look around your home and think about what you could change, update or clean out, please keep Merry Mall in mind. ATTIC TREASURES, our indoor rummage sale, is an adventure in second hand shopping. But in order for it to be successful we need your gently used, in good condition donations. We are looking for kitchen items, books, toys, holiday and seasonal items, craft items and supplies, baskets, framed wall art, tools, 'man stuff', knick-knacks, decorations for the home and more. Unfortunately... [Read more...]Read More News Articles...


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Ms. Brandan T. Lykens
Neurological Surgery, Lancaster Neuroscience & Spine Associates
- 1671 Crooked Oak Dr Ofc
Lancaster, PA 17601
- 1 Office Location
- (717) 569-5331
Ms. Brandan T. Lykens is a practicing physician. Ms. Lykens practices medicine in Lancaster, PA and specializes in Neurological Surgery. Ms. Lykens is affiliated with Lancaster Regional Medical Center, Lancaster General Hospital and Ephrata Community Hospital. Ms. Lykens speaks English, Spanish and Vietnamese.
Gender: Not Available
Years in Practice: Not Available
Languages Spoken: English, Spanish, Vietnamese
Medical School: Not Available
Graduation Date: Not Available
Hospital Affiliations: Lancaster Regional Medical Center, Lancaster General Hospital, Ephrata Community Hospital
Specialties: Neurological Surgery


text:
November 27, 2014
WASHINGTON (AP) - The Supreme Court begins a new term Monday with a number of controversial issues.
They offer the court's conservative majority the chance to move aggressively to undo limits on campaign contributions, undermine claims of discrimination in housing and mortgage lending, and allow for more government-sanctioned prayer.
The term is short on the high-profile battles over health care and gay marriage that marked the past two years.
Several cases ask the court to overrule prior decisions - bold action in an institution that values precedent.
The justices will hear a case that goes to the heart of the partisan impasse in Washington: the president's power to use recess appointments to fill key positions without Senate confirmation.
There's no expectation that October arguments might need to be rescheduled because of the shutdown.
Copyright 2014 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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Data protection - threats to charities
3 Nov 2014
Mairead O'Reilly highlights some recent cases to explain why data protection is an increasingly important...
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Paul Gibson is a member of Littlehampton Quaker Meeting and very active in the Quaker movement nationally. His other passion is social enterprise which transforms communities. He has been treasurer of the Development Trusts Association (DTA) for ten years, working with 500 development trust members.
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If you have been charged VAT on the full value of the supply of agency staff, you may wish to submit a claim to the employment agency. Paul Gibson explains why.
Alastair Smith and Paul Gibson look at why some charities struggle more with financial viability than others and offer some practical advice.
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Mairead O'Reilly highlights some recent cases to explain why data protection is an increasingly important...
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Age UK and the drinks company Innocent first teamed up for the Big Knit over ten years ago. Their relationship...
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The Barrow Cadbury Trust works to achieve social justice and bring about change. Sara Llewellin, the trust's...
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The provider of group fitness classes Les Mills launched its Fund for Children in June this year, providing...
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Tina Allison advises the chair of a charity who is unsure about why staff are asking for a new bank account...
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23rd Annual High Sierra Music Festival : July 4-7, 2013 : Quincy, CA
Moderator: hsmusic
jason0525 wrote:anyone on the east coast hit any of the shows this past weekend?
SuperHappy wrote:We are keeping our fingers crossed.
phortin wrote:"accidentally" retweeted on LMB's twitter account.
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Get the latest details on Marlene Stainbrook by searching PeopleFinders.com. We provide an assortment of ways to track down people within our comprehensive database of public records, which includes their age, year of birth, prior addresses, aliases, and more. 75-year-old Marlene Stainbrook was born 1938.
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Volunteers for the Blind (VFB) is a non-profit organization almost four years ago, VFB moved to Fredericksburg. This area has much more of a community of professionals who are blind. Based on what she learned during VFB's first four years of operation, Miss Frisch thought the organization could better serve the population here and make a more meaningful contribution. VFB is a non-profit organization that works with the blind to provide needed assistance.
Miss Frisch is a member of the National Federation of the Blind, the Stafford Rotary Club and the Greater Falls Run Lions Club. She is a past president of the National Federation of the Blind of the District of Columbia and the Alexandria West End Rotary. Currently, she is the secretary of the Greater Fredericksburg Area chapter of the National Federation of the Blind of Virginia.
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Pooja Batra's eight years old marriage life hit the rock. She has filed a divorce from her LA based husband, Dr. Sonu Ahluwalia, an orthopedic surgeon. Says a highly placed source, "Pooja and her husband are separated and will be filing for divorce in Los Angeles. She moved out
Zulfi Syed's Wedding Reception
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Clint Dempsey interview
Clint Dempsey sits down with ESPN's Darrell Currie to discuss his start with his new club, Tottenham Hotspur, what it was like leaving Fulham and the current state of the United States Men's National Team.
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Martinez: Spurs a really dangerous side
Premier League: Everton manager Roberto Martinez explains he admires Tottenham and expects a tough test White Hart Lane.
(01:38) | Nov 28, 2014
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Koeman: Aguero makes the difference
Premier League: Southampton manager Ronald Koeman had nothing but praise for Manchester City striker Sergio Aguero, who single-handedly propelled his side past Bayern Munich in the Champions League.
(01:35) | Nov 28, 2014
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Shaw out, Falco in against Hull
Premier League: Manchester United fullback Luke Shaw is out of action against Hull, but Radamel Falcao could return to action.
(01:49) | Nov 28, 2014
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Weekend Bender: Southampton marches on
ESPN FC on TV: ESPN FC's Alison Bender delves deeper into Southampton's immense success in the Premier League this season, and their movement upwards of 66-places in English football in the past five years.
(02:45) | Nov 29, 2014
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Managerial merry-go-round at Spurs
ESPN FC on TV: The ESPN FC crew react to Christian Eriksen's comments that Tottenham are struggling to connect on the pitch, and Kasey Keller attributes this possible disconnect to the continued managerial changes at White Hart Lane.
(04:06) | Nov 29, 2014
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Davies: It's been a long road
ESPN FC on TV: The ESPN FC crew chat with the New England Revolution's Charlie Davies as he discusses his personal journey and the Revs' potential spot in the MLS Cup final.
(04:41) | Nov 29, 2014
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Ronaldo the clear favourite for the Ballon d'Or?
ESPN FC on TV: Kasey Keller responds to Michel Platini's comments that a German should claim the Ballon d'Or, but with Cristiano Ronaldo's goal-scoring run thus far, it appears he is the clear favourite.
(01:43) | Nov 28, 2014
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Keller: Who is going to step up?
ESPN FC on TV: ESPN FC's Kasey Keller believes both the LA Galaxy and Seattle Sounders were content with the first leg result, and that the second leg will come down to who can be more lethal in front of net.
(01:21) | Nov 28, 2014
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Donovan's career nearing its end
ESPN FC on TV: ESPN FC's Kasey Keller discusses the second leg between the Seattle Sounders and LA Galaxy, where Landon Donovan will need to be motivated if LA are to advance to the final once again.
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The festive earrings in this kit feature golden bells crowned with decorative bows. A red crystal swings merrily from each bell's center. The bells are connected to gold hook earring findings using a wrapped loop. You can buy this kit for yourself to create fun holiday earrings for a night out or give them as a gift to a jewelry lover. Be sure to look at the rest of our holiday jewelry kits.
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Urban chic meets old-school glamour at The Palace, thanks to its mix of contemporary decor & traditional elegance. The hotel has 149 bedrooms & eight suites, accompanied by an impressive
array of meeting spaces & three restaurants. The Royal Hall, with its beautiful Florentine chandeliers, accommodates 200 for a banquet & interconnects with The Tabloid restaurant if more
space is needed. The State Hall enjoys natural daylight, with guests able to enjoy breakouts or pre-event drinks in the Alexandra Garden. Four remaining rooms cater for smaller groups, from 10-85
people. The top floor of the hotel is dedicated to a spa & residents are invited to use the beach facilities at the local sports club. Neighbouring Palazzo Capua, a restored 19th-century palace
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Should we seize underwater mortgages?
We asked the U-T Housing Huddle, our group of 10 real estate experts
San Bernardino County is considering a novel, yet controversial plan to seize underwater mortgages by using eminent domain. Is this a good way for municipalities to deal with foreclosures?
•Paul Barnes, president of Shea Homes San Diego:
No. Although Rolling Stone magazine termed this plan "It's so crazy, it just might work," I have reservations. Every city in every state has complicated and varying implementation rules for eminent domain. Each city, for every house, will end up in court. Log jam, more delays, more pain for the borrower. Meaningful debt restructuring will only come about by tax policies that will motivate financial institutions to get their heads out of the sand and recognize the value of the collateral securing their debt. However, favorable tax policies for financial institutions in today's world are about as popular as getting a tooth pulled.
•Murtaza Baxamusa, directs planning and development for the Family Housing Corporation, of the San Diego Building Trades in Mission Valley:
Yes. Condemnation of properties that are at-risk of foreclosure stops the blighting of neighborhoods. Local governments are often stuck with the costs of disrepair, crime, neglect and loss in revenue from depressed property values. The overbearing rules and red tape that drowns underwater mortgages into foreclosures can be relieved by rewriting the rules, allowing a short sale, pooling the properties together and reselling them to investors who commit to reinvestment within the community. This plan could work only if tailored to rescue genuinely distressed properties, and if it generated community benefits such as affordable housing.
•Kurt Branstetter, loan officer and mortgage manager at W.J. Bradley Mortgage in San Diego:
No. Most government programs designed to assist homeowners have failed miserably and squandered taxpayer money. I don't expect a different result from this program. The devil is always in the details and governmental execution on these programs has been embarrassing to say the least. Even if they won a legal battle with the big banks, then who would set the value of the property and/or the principal balance for homeowners? If these homeowners could simply refinance their mortgages to current rates and lower their payments like other homeowners, then they would probably be pretty happy.
•Clemente Casillas, broker and president at South County Real Estate in Chula Vista:
No. Didn't (the city of) San Bernardino just announce that it was contemplating filing for bankruptcy? Now we want to give them the power of eminent domain to further destroy their own city... Kind of like giving a kid a loaded gun. The original intent behind the powers of eminent domain was supposed to be for a public good like the building of schools or freeways. It was not meant for investors or politicians to make real estate deals or turn a profit. The use eminent domain in this circumstance would be a gross abuse of power.
•Patricia Kramer, realtor with Kramer and Martin at Prudential California in Rancho Santa Fe:
No. The term eminent domain is offensive and the very idea of the taking of property by the government is disconcerting. Individual rights are extremely important and those rights are protected by our Constitution. Without understanding the justification for eminent domain for this particular county, it's difficult to comment.


text: multiple content place holders..1 with a text entry box and a submit button.. the second content place holder has several options in.. when i perform the submit the options from the 2nd place holder aren't getting passed through. can you suggest a method on how i can perform this submission passing all values to my controller? the values outside the 1st place holder are getting set to null.


text:
I'm a bit of a noob with Linux so this is a fairly hefty undertaking, yet confident enough in my google-fu to muddle round. However, any advice from those that have done it would be appreciatd.
We currently run Zimbra 7.2.x OSE on Ubuntu 8.04LTS. Runs perfectly well, except the mass upgrade to Internet Explorer 11 has caused issues (no folders or colour codes!) Staff have access to Chrome so that's not a major issue, so we're looking at long term plans. Also we have diminishing storage, and at the rate of growth we've 6 months left before we fill up.
1. Go to Office 365. Ugh!
2. Upgrade.
2. is my favoured approach. The plan would be to set up Ubuntu 12.04 (or 14.04 if a newer version of Zimbra allows this) with Zimbra 8.0.x (currently 8.0.7).
However, shifting settings and data over seems to be quite a large job, plus something I'd be a *lot*/ more comfy with if I could test it. So far, I can't see a way of doing this without JFDI, live. (thankfully it's on ESX so we can happily snapshot away)
Would there be a way to clone it and have it usable without it connecting to the network/pulling in any mail/clients connecting to it, so I could use it for testing?
And when it comes to it, the upgrade path would be:
Update to Zimbra 7.2.7
Upgrade Ubuntu to 10.04
Update to Zimbra 8.0.7
Upgrade Ubuntu to 12.04
Cross fingers it works!
Quite long winded it seems!


text:
General Purpose & Scope of Position: Deliver Nursing clinical courses as assigned. The adjunct faculty member will be responsible for creating a learning environment that assists students in reaching their goals and for providing effective instruction and assessment within the framework of common syllabi provided by the school.
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Count Your Blessings at Thanksgiving
5 Ways to Handle the Holidays When Your Life's in Chaos
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Movember: New Face of Men's Health
Соруright 2014Minority Nurse is Registered in the U.S. Patent and Trademark OfficeSpringer Publishing Company, LLC


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Our resident nutrition expert answers yo...
Despite all the negatives you've heard,...
10 creative spins on your favorite summe...
Perky Jerky is low-calorie, high-protein—and contains a common energy-drink ingredient that promises to keep you pepped up.
You may think your daily java is helping you focus, perform your best, and stay alert, but it could be doing the complete opposite.
The Atkins Diet might be making a comeback, men and women really are wired differently, and more stories we're reading this week.
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Our Diet Doctor explains if a caffeine buzz will help you power through your routine or just leave you dehydrated.
You drink it in your coffee, tea, and soda, but how much do you really know about America's favorite pick-me-up?
These 7 smoothies and store-bought bevvies are ideal for a quick pick-me-up, without a crash.
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Put the pep back in your step with these nutrient-boosting foods.