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Council approves city budget amid education fight
The Boston City Council passed a nearly $3 billion budget, but some councilors said the increases for the city's schools were not enough.
The Boston City Council passed a nearly $3 billion budget, but some councilors said the increases for the city's schools were not enough.
"I want to thank our governor, our governor, I call him ours," said Donald Trump, who referred to the Maine governor simply as Paul.
Donald Trump swooped into the Financial District, where about 100 demonstrators filled the sidewalks to protest his visit.
A popular Cambridge art gallery and performance space fired its manager amid allegations that he sexually assaulted a musician there.
Four workers at Bridgewater State Hospital have been banned during an investigation into the April suicide of a Bridgewater patient.
The victim's friend allegedly said he was the one who shot the firefighter, believing the gun was not loaded while they were both drinking.
Inciting panic and then taking lethal advantage, three attackers unleashed bullets and bombs at Ataturk Airport, leaving 42 dead.
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Despite Sharieff Hester's medical conditions, his father was determined to help him lead a full life, including graduating from high school—with honors.
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Activists issued a plan to address concerns about racial inequalities at Boston Latin School and across the school system.
Walsh's coffee hour in the North End was supposed to be an idyllic neighborhood event. But these days, there are no peaceful events for the mayor.
A second member of Mayor Walsh's administration has been charged with allegedly forcing Boston Calling to hire unneeded union stagehands.
yvonne abraham
Will Bruins great Ray Bourque get special treatment after his arrest for driving drunk?Let's hope not.
Wildlife officials say vegetation is being decimated by a deer population more than four times the target size.
The celebrated author published predictions about culture, family, government, and the economy that were remarkably accurate.
The Celtics are about to start courting the NBA's marquee free agent, and we are here to help.
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The back story of "Harry Potter" author J.K. Rowling's latest saga is imbued with real-life figures in Massachusetts history.
Warren tweeted at "Harry Potter" author J.K. Rowling on Wednesday.
A second aide to Mayor Martin Walsh has been swept up in the Boston Calling investigation.
The state's plan to close psychiatric hospitals has had unintended consequences.
"Spotlight" is based on the stories and the reporters behind the investigation of sexual abuse in the Catholic Church.
Nine inches of rain fell in parts of West Virginia, creating widespread flooding.
Though dominant at times, the lefty had another midgame meltdown — an inexplicable, frustrating pattern.
The proposal is backed by Uber and Lyft, but questioned by taxi industry and law enforcement.
The state Senate is expected today to debate an Uber bill that's been the focus of extensive — and expensive — lobbying efforts.
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Plus, minivan options to replace a Chrysler Town & Country.
Suicide attackers armed with guns and bombs killed at least 42 people and wounded hundreds at Istanbul's busy Ataturk Airport.
For the public faces of Volkswagen — the dealers — the company's sweeping settlement actually settles very little.
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ground game
Maine is a state that hasn't voted for a Republican presidential candidate since 1988.
Design New England
Keith Leblanc and Kelly Monnahan create a haven for themselves, family, and friends in the piney hills of outer Cape Cod.
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On Second Thought is a one-hour, daily news talk show that airs at 9 a.m. ET weekdays.
Britcoms are back! Brew yourself a cuppa and settle in Saturday night beginning at 9 PM for your favorite classic British comedies.
National Signing Day is over and the reigning AAAAAA Champions, the Colquitt County Packers, had 25 players sign letters of intent on National Signing Day. I had a chance to go one-on-one with Head... MORE
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Wed., February 9, 2011 9:42am
Alabama Concerned over Georgia Water Decisions
Alabama officials have expressed concern over Georgia's push for reservoirs and its regulation of water transfers.
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Mashup: Tourism Dunedin
The official Tourism Dunedin (New Zealand) website using the MenuMania API. Allows site visitors to view and search for restaurants, shopping, nightlife, art, culture, history and find out what is going on in Dunedin.
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Microsoft this week released Python Tools for Visual Studio 2.1 Beta for developers. The expanded set of open source tools should ease the pain of web programming and technical computing, and are being offered for free under the Apache 2.0 license.
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Obama on Health Care: 'Do It for the American People'
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Laboratories add comments to reports, some of which are informative e.g. CRITICAL VALUE REPEATED and others that are interpretive e.g. explaining the meaning and utility of the MDRD estimated GFR equation. It is the latter that brought me to this current question.
Most doctors have little or no idea how results are generated. I think they assume that professional, trained staff under the supervision of a pathologist give them the best number possible. A GFR estimated from a creatinine, age, and sex alone is a perfect example. What if a doc assumes that this is accurate for dosing? It is not, generally, and will tend to overestimate GFR in the elderly, the infirm, and those otherwise with extremes in muscle mass. It is intended to be a screen for chronic kidney disease in a subset of patients with a normal to slightly elevated creatinine value.
The question is how much of this instruction needs to appear on a laboratory report? And will the physicians read it?
Second question first: no.
In my experience unless a result is completely obtuse or difficult to interpret physicians do not read comments for an explanation. They are conditioned (and we are too, when you really think about it) to respond in a knee-jerk fashion to flags generated by the information system. The nuances of utilizing a test are either a) well known by the physician, or he or she would not have ordered the test initially or b) lost in the comments. "Interpretive comments" exist to cover the laboratory.
The real issues here aren't covering the laboratory or informing the physician, which are two separate issues. The first relates to producing quality results and is boolean in nature: it is or isn't, regardless of comments. The second is an education issue that will never be resolved by a lengthy comment. And a lab that thinks so is doing a disservice to the patient. No, the real issue is, "How do I add value to the report?"
I had a conversation with a physician recently that brought this issue into sharp focus.
He said, "We can add a comment to any test, such as potassium. But should we? Unless it explains anything we need to know about the particular test, does it add anything?"
That is an excellent question that most laboratorians and many pathologists have difficulty answering. The only way to know for sure is to ask your medical staff what is helpful to them. And you might be surprised.
Glucose is another example. A fasting glucose <= 100 mg/dL is considered normal. But we report out many glucoses on samples drawn throughout the day. Should all laboratories add a comment that states "Glucose ranges are for fasting patients only?" What about non-fasting patients? What about diabetics? What about patients on steroids? There are far too many contingencies, most of which the attending physician is more than aware of, for any laboratory to address on a report. And it would be near crazy to try.
The litmus test (if there is one) is "Does this comment tell the docs something unique about this number?" And that can be a hard call. The best approach (in my experience) is to ask them. You could be surprised.
NEXT: To Cut Costs, Change
These days it's all about shortages. Shortages of techs, shortages of patients, and shortages of money. In small hospitals there are fewer of us working with fewer patients for less money. Those who are working are older than the average worker, are wondering who is replacing them, and are tired of hearing about doing more with less when new technology requires people to test, validate, and perform the assays. This is what I've been hearing for the last few years.
A few random thoughts on this.
A laboratory test menu is constantly in flux as tests are brought in house or sent out to reduce cost or improve quality, but what I hear now is, "If you send out that test can you reduce hours?" I find myself justifying what little staff I have more and more, and I suspect many managers would say the same thing.
Payroll is a huge portion of ongoing expenses, so that's understandable. I get that reducing expenses is crucial to managing a dwindling cash flow and can make or break a hospital in a competitive market. But the reality of managing laboratories is different from other departments.
Few benchmarks: there are benchmarking factors, but laboratories are so different in employee mix, services, and outreach that it's difficult to compare them in a meaningful way. I've been in labs with many phlebotomists, for example, and some where techs performed most of the phlebotomy. It all depends on how far away a phlebotomy station is, how versatile the information system is, and other factors. Equipment varies greatly from lab to lab, and not all instruments offer the same mix of quality and speed. "Efficiency" varies from lab to lab, often having little to do with the skill level of techs.
Make or buy issues: bringing in tests to justify staff is fine if it's cheaper to perform a test in house, but that can be a boondoggle if it requires new instrumentation, more maintenance, more training, and more competency. It's been my experience in general that people are poor multitaskers. Asking people already doing multiple tasks to do one more creates a drag on overall efficiency and a chance to increase errors that will drag a system down even more.
A manager caught in a feeding frenzy of cost cutting has to recognize benchmarking and other comparisons for what they are: an attempt to manage expenses using verifiable data. That can be a smart idea in a big picture sense. But a manager also has to use dwindling resources with a mindset that these issues aren't going away, necessitating new ways of thinking about old problems. Our futures in this industry will likely be shaped by more than "make it or buy it," outsourcing, or cost cutting. We can only do so much of this, and in the meantime the demand for faster, better laboratory results is increasing. What we do has never been more important.
This could mean different workflow models, consolidated platforms, software AI, or something completely different. Whatever it turns out to be for our individual labs, it has to be invented under constant pressure to do more with less. Inventing new ways to produce better care may be the best way to justify staff we have.
NEXT: Do Doctors Read Comments?
The CPT code 85004 (Blood count; automated differential WBC count) has many variations, each of which is charged instead of 85004 and including the work. These codes can be distinguished in the CPT code book, because they are indented. Examples:
In other words, performed a manual differential if a CBC with automated differential is performed is not billable in addition to the code 85004. All of these are "bundled" into 85004. Neither is a slide review, a spun hematocrit, or an automated reticulocyte count. All are considered iterations of a blood count with an automated diff, recognizing that the term "CBC" encompasses variations.
One of which is: should you reflex to a slide review or a manual differential?
The consensus rules from the ISLH (International Society for Laboratory Hematology) suggest the former. A slide review is a targeted review of a peripheral smear specific to the particular parameter or instrument flag. For example, a white blood cell count of >30 thousand reflexes to a "slide review" if it is the first time or a delta check failure within 3 days. That slide review logically involves checking for abnormal cells or cells that suggest a leukemoid reaction. A manual differential is necessary only to enumerate abnormal cells.
The slide review concept is an attractive idea in many ways: it takes advantage of technologist judgment, targets a review based on accurate instrument readings, and avoids the busy work of just reflexively banging out a 100-cell diff that may not add value to the report.
More significantly, a slide review reinforces what we already know: the instrument is much, much more accurate that we can ever be. Performing a manual differential to "prove" the instrument count is OK leads physicians down a path that doesn't trust our technology. Performing a slide review sends the message that we are using the instrument to guide our workflow and look for abnormalities.
In my experience that's been an easy sell for docs but much harder for staff. Almost all the techs I've known have had a knee jerk reaction that a slide review is more work. Why?
For one thing, after performing thousands of manual differentials it becomes second nature. It is comfortable, familiar, and repetitiously easy. Having said that, what is the first thing we all do when we finish? We compare the numbers to the automated differential. We might even repeat the manual differential if we think the numbers don't match, which is really nutty behavior when you think about it. This begs the question, "What are we really doing?"
This could just be the shock of the new. We have to use new technology to change our diagnostic techniques. As suggested by the ISLH, part of this is slide reviews designed to look for what the instrument suggests. But can we teach old techs new tricks?
NEXT: Justifying Staff
What is true for big labs eventually becomes true for small labs, mostly because volume discounts drive affordability. This is most recently true for PCR, a technology that has arrived in small laboratories for two platforms, the Meridian Illumigene and Nanosphere Verigene.
But is PCR ready for small labs?
I'm intrigued by this technology, and I can easily imagine it playing a role in small laboratories. This kind of platform offers rapid, definitive testing for infectious agents such as C. diff, pertussis, and bacterial agents in blood culture specimens. Testing a stool specimen for the C. diff toxin can eliminate the need for GDH antigen testing that detects non-toxin producing strains. Identifying bacteria sooner in a blood culture can give the physician a 24-hour head start. In theory this faster turnaround time with better results will reduce length of stay and assist antibiotic stewardship programs.
I wonder.
One reason I'm on the fence is expense. It's great to claim that a new instrument will reduce length of stay, but bean counters aren't impressed by soft cost savings that can't really be quantified. Unless one is testing for something completely new that changes a protocol - the introduction of BNP comes to mind - it can be hard to convince bean counters that a faster turnaround time equals fewer inpatient days.
Another reason is wondering how having these results will change treatment. Clinicians embrace technology at different rates. How many of you are still running cardiac troponin and CKMB, for example? How many are still reporting percentile differentials with absolutes? How many are still performing more ESRs than CRPs? It sounds great to me to give the docs a better, faster result, but clinicians have to buy into new technology and use it to its potential. As primary information consumers they always drive demand for technology.
Finally - and this is a big reason - new platforms with radically different technology require a lot of training and competency assessment to get off the ground. In a small lab staffing is often sparse, raising questions such as, "What happens on weekends?" and "What happens when a doc wants it done STAT in the middle of the night?" The advantages of rapid PCR testing imply STAT requests, after all. Labs with squeezed budgets and payroll will have a difficult time fitting anything new and different into their menus, no matter how wonderful. It all takes time, money, attention to detail, and bodies to run the tests. In the current healthcare climate it can be hard enough just to get the bread and butter tests done in a timely fashion as more and more labs adopt a rapid response model.
I don't know the answer, but I don't hear physicians beating down the door for in-house PCR just yet.
I'm interested in how this technology has affected your laboratory. Has it lived up to the hype, and what problems have you encountered? Is it worth the expense?
NEXT: Slide Review or Manual Diff?
One of the phrases I hear lately is "we need to move the needle," meaning enough effort has to be put into change to not just make it stick, but change what matters. This might be customer satisfaction scores, test volumes, or cost containment.
If there's one thing that change has taught me, it's that no matter how much things change they seem to stay the same. The needle almost never moves.
I've witnessed countless alphabet soup campaigns, LEAN initiatives, customer service gimmicks, changed hours, changed protocols, and new technology. It isn't so much that each change is filled with false promises or defeated by dashed hopes. In fact, we can all be easily convinced that any of these things can make a difference. They almost never do. Change is a constant in a world stubbornly set in the present rather than anticipating the future.
There are several good reasons. We are motivated by emotions, not numbers. Data is an excellent rationalization tool, but it won't convince people to change how they feel about something. We each have a gut feeling about what works and what doesn't based on the culture we work in. That is an extremely powerful force to try to overcome from within. Indeed, it may be impossible for a negative culture to change itself.
We are also motivated by leadership, a quality rare enough that we don't just know it when we see it - we are surprised. I think leadership is a skill like many others that can be acquired with a good working knowledge of what it is. Without good leaders who can articulate a vision and make decisions that cement values in place, change is just pointless change that has no lasting effects.
Finally, each of us views change as something different. The classic management wisdom is "people hate change," which is misleading. People love change if it means making their lives more convenient. What they don't like about change varies enormously. Some don't like change because they don't trust the motives behind it; others don't like it if they weren't included in the decision making; still others have too much stress in their life outside of work to deal with one more change. Management frequently forgets that change happens everywhere in life, and often a workplace is the most stable environment a person has.
So, how do we move that needle?
For me why people are "resistant" hints at the answer. We need leaders who are not afraid to motivate people with emotions and who understand that our work lives are but a part of whatever we are going through. We need leaders who can articulate in plain, blunt language the stakes. We need the values to be articulated honestly and plainly enough to be supported by human interest stories that really motivate people. Leadership needs to walk the talk.
But that's just me. What about your lab?
NEXT: Is PCR Ready for Small Labs?
One of the oft-quoted nuggets in The Elements of Style is "omit needless words." I've seen this rule praised and criticized with equal fervor. As a writer, pruning and trimming prose seems like a necessary path to clarity for the reader. It is also intensely personal and driven by one's own style. But in general, it's a good rule of thumb. If it takes 4 words to say the same thing in 15, use 4. (Have politicians read Strunk and White?)
Unfortunately as bench techs we don't have the option to rewrite and revise with time to mull over or forget what we've written. What we tell physicians has to be clear, concise, unequivocal, and reproducible. The more judgment that is involved in a test, the more difficult this can be and the more variation one encounters.
Variation dilutes quality, clinically significant or otherwise, and invites STAT abuse. If, for example, 95% of in-house chemistry tests are completed in a narrow time frame, there is less variation and the process creates consistent expectations for providers. They are less likely to order a test STAT to bump it to the top of a queue that has widely variable turnaround times. To a lesser extend, limiting variability in reporting non-numeric values builds similar expectations and can reduce telephone calls, repeats, and requests for further review.
I described a way to simplify urinalysis and reduce variation in a recent blog. While seemingly trivial, this kind of approach reduces the number of choices made by techs, another form of variation that increases the amount of work done.
One of the advantages information technology brings to the laboratory is the ability to reduce variation by defining result entry parameters. For numeric results this can mean entering a lower reportable limit in a test definition that causes the system to automatically change a value below the assay range to less than that range. For alphanumeric (text) values this can mean limiting the number of choices to a drop down list or selection box.
A simple example is limiting qualitative testing results to Positive or Negative. This can be improved in a few ways, perhaps. Positive can be offset with characters e.g. ***Positive, or these can be abbreviated to ***POS and NEG. One problem I have run into with fine-tuning what these look like on native reports is that usually formatting is lost in HL7 translation to another system such as Athena or the T-System. Something to think about.
Other examples: blood bank types, RBC morphology choices, urinalysis dipstick values, Gram stain morphology. Most information systems out there have this capability to limit input in the sense that only a few selections are available to result the test. From an IT perspective this makes sense when assigning SNOMED codes and uploading discrete data to central database systems. The fewer results listed in "comments," the better.
What about your lab? Have you limited input, and does this improve quality?
NEXT: Moving That Needle
The laboratory is a unique clinical department. The possible tests and their associated billable codes that are routinely ordered day in and day out can number in the thousands or even tens of thousands. The big moving target is referral lab testing, which may change according to where it is forwarded, reflex testing, or method changes. I spend a significant amount of time comparing bills to the charge master. If we don't get paid, we can't keep the doors open forever. Are you getting paid?
Some of the issues that make laboratory work complex include:
As a manager, you can tread dangerous ground stressing accurate billing. What we do is for the good of our patients. But if you don't get paid, you can't keep the doors open. And if you don't charge for everything accurately, you won't be able to justify the staff you have. Another lab with the same workload that bills for everything will look better.
I've puzzled over this idea of charge reconciliation - how do we know we have charged for everything? - for the past few months. It is not an easy problem for a laboratory to solve. Laboratory testing is complex.
One crucial strategy is to make sure your referral testing - easily the biggest target in terms of change - is accurate. Ask for an electronic version of your bill in Excel. From there it's easy to compare it to a download from your information system to make sure you're billing accurately.
Another strategy is to look at duplicates, missing tests, and things that don't look right from day to day. This is extraordinarily difficult and time consuming in anything but the smallest labs, even more so when short staffed. I've created a SQL report that pulls out CPT codes and totals them by test per account number. Anything that could be a panel missing CPT codes or is a duplicate is flagged as an error. This is a great report, but I have a history of computer programming. I've no idea how any other lab would do such a thing. But we have to get paid. And if you don't bill, you won't get paid.
NEXT: Limit Input
Urinalysis is one of the simpler screening tests laboratories perform. Modern dipstick readers have standardized and simplified the chemical analysis of urine. But what about the microscopic? Shouldn't that also be simplified?
Beckman Coulter and Sysmex offer instrumentation that performs cell counting. For many if not most labs, urine sediment is examined under light microscopy. White and red blood cells are reported as an average per HPF.
Sounds simple enough. Count the number of white cells in 10 fields, move the decimal point, and report that.
In fact what labs do is much more complicated and more difficult to reproduce with any precision. Cellular elements are reported as a range of cells and are only accurate to the degree where counting or estimating becomes cumbersome. In recent data mining I discovered a wide variation that implies the method is far more precise than possible e.g. 10-12, 15-17, 20-25, 50-60, 70-80, etc. This reflects more tradition than accuracy. More importantly, does it meet the needs of the ordering physician?
At a meeting I asked physicians about clinical efficacy. One replied, "It's pretty straightforward. I want to know are there a few, some, a lot, or too many to count?"
So we changed reporting as follows:
While a cutoff of 20 cells per HPF is arbitrary, it is also practical. It's easy to count 20 per HPF by counting the average per quarter of a field. And while 100 per field can be estimated accurately but counting cells along an arc of the field, a guesstimate works just fine for clinical purposes.
It's nice to have more reproducible results, even if some physicians may not notice. More importantly, consistent, reproducible results improve quality. To put it another way, when techs report microscopic elements with a wide degree of variation this dilutes quality. A physician may understand the imprecision of a method, but he or she will also guess that finer distinctions won't matter. "A few, some, a lot, or too many" is what they will read when they see the report. Why not make that easier for them?
Finally, while it may seem that 20-100 is too broad, it is consistent with implied imprecision. Assuming these are probable ranges, 5-20 is an expected 30% coefficient of variation and 20-100 33%. Thus, what we claim is consistently precise; it is easier to estimate 5-20 cells than any significant interval between 20-100 e.g. 50-75. 5 and 3 are cutoffs related to reflex culture criteria and microhematuria respectively.
Of course, arbitrary limits are just that. An implication that 30, 40, 60, and 80 mean the same thing to a clinician may or may not be true. There is also great variation among doctors. That's why I asked first.
NEXT: Are You Getting Paid?
A nursing paradigm has been the "working manager," a nurse who also works the floors and pitches in when needed. This model has been used in ancillary departments such as radiology and respiratory therapy. It makes sense to have a manager with first hand knowledge of the day to day workflow.
I don't know how common this is in laboratories, but I suspect not very. It seems odd in a small hospital laboratory to have a manager sitting in an office while three or four staff members process specimens, but it happens.
There are some good reasons for this separation of labor, however. One is the complexity of the laboratory. Managing a flow of information that includes ordering, contracts, quality control, proficiency testing, competency assessment, procedures, and a charge master ever in flux is time consuming. Add to that going to meetings, organizing meetings, scheduling, dealing with personnel issues, and handling complaints, and that's a busy job for anyone.
I've been in both kinds of roles. I've been a manager when very little bench work was needed and when 1-3 days a week was needed. If one is competent at managing information and people, being a working manager is advantageous.
Advantages: a first-hand knowledge of bench issues, giving credibility to changes that are suggested; greater respect from peers; for veterans, a (mostly welcome) break from the stress that the office often brings.
Disadvantages: can be extremely difficult for rookie managers; often means longer hours to get caught up on office work; sometimes difficult to concentrate fully on bench work with projects in mind; difficult to maintain skills not done as often.
A less obvious advantage is that working the bench can force a manager to delegate many tasks to others to have more time to get critical projects done. These might include submitting quality control, submitting proficiency testing online, scheduling, and even payroll. There isn't anything special about most office work, and spreading the wealth can make it all the easier when vacations roll around.
A political advantage that should not be overlooked is respect from management peers, especially those working managers who ask the obvious if you don't work the bench, "What makes you special?"
I wonder: have staffing shortages and cutbacks in small hospitals created more working managers? Do hospital administrations look at other departments and expect laboratories to follow suit? And what happens when someone who has been a manager for 20 or more years is suddenly asked to work the bench? Keep in mind lab managers are asked to do more and more all the time.
NEXT: Simplify Urinalysis
The Joint Commission National Patient Safety Goal 2 is to improve communication. For a laboratory, this means reporting critical results on a timely basis. Labs have to define critical results, by whom and to whom they are reported, and an acceptable length of time between "availability" and reporting.
Have computers lengthened our reporting window?
In all labs I've worked with an LIS, a critical value is called when the result appears on the screen across an interface. The results are on the screen, sometimes highlighted, and sometimes a hard stop forces the user to enter who was called, that a readback was performed, etc. That's great.
But before computers, I never called after I finished handwriting the result on a lab slip. I called when the repeat result printed on the instrument. That's where my feet were held to the fire, because that's when the result was available. (And still is.)
A casual review of our lab has shown a similar perception of "availability" as when it is electronically available. It could be a critical in a stack of routine results, a CBC waiting for a smear review, or something else. Modern analyzers will often autorepeat critical values, further distancing a bench tech from the instrument.
This leads me to think that a critical results policy must define what "availability" means. In the case of transcribed or manual methods, this is often when the result is entered into the LIS - unless your lab still tracks everything on paper. If, for example, a positive C. diff test is a critical result, is it available when you write it on a log sheet or after you go to the computer, log in, navigate to the record, and record the result? Labs typically don't write times on log sheets. But this is at least one good argument for getting rid of them and adopting real-time reporting.
For analyzers, availability is what it has always been: the time on the printout. As great as information systems are, it can sometimes take a while for results to appear in a queue. In the meantime, the result has been confirmed and available, just like in the days before computers. What I'm suggesting is that computer interfaces have conditioned us to rely on its electronic reporting as a redefinition of availability, when they are really a proxy reporting tool largely disconnected from the testing itself.
Of course many bench techs will telephone an extreme or critical result when it prints. But is this true for all critical results? I'm not sure, but the only way to know is to audit the printout to report time gap. Keep in mind when developing a policy that nursing also has a similar policy with a time limit; their clock starts ticking when they receive the call from the laboratory. If both times are at maximum defined by policy, this can add a significant delay to the treatment of the patient.
NEXT: Working Managers
A lab tech's job is very linear. Requisitions arrive, specimens are collected that match the tests that are checked off, the work is done, the tests are reported. We know what docs want. Right?
For the most part, yes. Most docs - especially younger ones - are not afraid to order lab tests. Many docs have favorite tests or favorite referral labs. But the sheer volume and variety of referral and esoteric testing is overwhelming. Even tests performed in-house can vary greatly from lab to lab in terms of sensitivity and specificity. Physicians are bombarded with information on all aspects of care and can't be expected to keep up on every new development in diagnostic testing.
In other words, docs don't always know what they want. Not exactly, anyway. That's where we come in.
We forget how much docs rely on our experience and expertise that can be extended to making suggestions and recommendations. A physician once told me, "You guys run the tests and are the experts. I figure if you tell me a result is good, I have to believe you, because I don't do what you do." We need to remember that our specialized knowledge is unique in the healthcare setting. It's true that docs interpret laboratory testing, but we often know what testing is best or what factors affect a result. As long as we are assertive in the best interests of the patient, the physician will not mind.
This goes clearly against the grain of the older, seasoned techs who learned to work in an environment where the physician was never questioned. It was a weird way to work, in which we were excluded from care plans and decision making and just left to perform the tests like robots.
These days the laboratory should be expected to take a much more active role. At my new position I attend an interdisciplinary team daily at which the hospitalist reviews inpatient cases with those in attendance. This includes nurses, social workers, physical therapy, dietary, pharmacy, and (since I have accepted this position) me. I have a sense it is unusual to have a lab person at these meetings. But I am often asked questions about cultures, sendouts, or blood bank. And if I can contribute, I will.
What's interesting from a lab tech standpoint is how often the nurses suggest ideas to be supportive. A nurse might say, "Should we order a swallow eval on that patient?" and the doctor will say, "Oh, great idea, let's do that." It is apparent to me that docs simply can't think of everything and remember everything at once. They appreciate help that comes from an interest in the best care of the patient.
This is completely different from the world I was trained in. Lab techs are not trained to be active participants in patient care, which is odd considering how much doctors and nurses rely on lab tests. But to know what the doctor wants, you have to pay attention, ask questions, and sometimes make suggestions.
NEXT: Critical Time Limits
According to one site, 1 in 40 adults (about 2.3% of the US population) suffer from obsessive-compulsive disorder. While it's a serious condition that can be treated and is no laughing matter, I can't help musing if the percentage of lab techs with OCD is higher. Most techs I've known joke about OCD, because the field requires a lot of learned behaviors that can appear compulsive.
On the Oscar to Felix scale of compulsiveness, for example, most lab techs are closer to Felix and the Oscars of the world drive them (OK, us) batty. Oscars make it difficult to step in and help on the bench, and even more difficult to follow work.
I know, I know. We are all different, we all have to get along, and one person's chaos is another's organization. I suppose. But it's also a patient safety issue. If we don't know what someone else has done, what someone else is working on, or what is pending, results can be delayed or incorrectly reported. Eventually, all techs get burned on an experience like this. We all know those on the bench we are happy to follow even if they leave work behind, and those we hope finish everything before they leave for the day.
Much of the compulsive behaviors I have observed involve checking pieces of paper or using paper to track a workflow, even though information systems are designed to do this with greater speed and accuracy. There isn't anything wrong with all this paper, but it can create a chaotic mess on the bench. I've seen techs put paper in piles, leave it as a trail wherever they go, hang it on multiple clipboards or hooks, create numerous forms to track miniscule details, and order stickers alphabetically by patient name. Some techs are just-so, and some are not.
This isn't a criticism. I understand the need to have a system that accurately tracks a large amount of information that must be accurate and timely. But our systems make it easier or harder to follow each other.
They are also time and space consuming. For example, if instrument tapes are compared to results in the information system, stickered for identification, saved with the day's work, bundled at the end of the month, and bundled at the end of the year for storage, that is five times paper is handled (and additional expense to store for at least two years) when it can be thrown out if there is an electronic record. Many instruments allow results to be stored on a thumbdrive, capturing repeats, which allows all paper to be discarded.
We bristle at criticism, especially when our habits reassure us that we aren't missing tests. But I've seen paper lost or misplaced countless times and work missed. It's a big reason for why information systems are designed to alert users when work is overdue in one way or another. While a computer interface is consistent - unlike our paper interfaces for tracking - the next question is can you follow the computer?
NEXT: Know What Docs Want
Do older techs hate change? It's a cliche that an old dog can't be taught new tricks. When someone is "resistant to change," ageism inevitably follows. "She's old and close to retirement," I'll hear. Conversely, young people are assumed to be champions of change, malleable, and willing.
All of which may be true to an extent, but adopting such a view dismisses experience as a variable. The reason "older" techs hate change is because they've been there, done that, and have a closet full of tee shirts. It's true that in time we all become tired of change for the sake of change, but it's worse to be ignored or dismissed. Decades of experience working the bench includes decades of change, large and small. That counts for something, surely.
And younger techs naturally embrace change because it levels the playing field. A lack of experience prevents you from seeing unintended consequences of change. And all change has unintended consequences, hopefully more good than bad.
As a manager, I've always taken the approach that resistance is information. "Why would we do that?" and "That is a waste of time," to mention two classics, should open a dialogue. And here is where it gets interesting.
Why would we do that? Decisions are based on values, whether we appreciate it or not. We value the patient experience, the support of employees, quality, the bottom line, etc. All managers approach their position with a set of values that overlap with those of the organization. Unpopular change involves unpopular or unknown values. Good managers are consistent in expressing their values through decisions. But when a decision doesn't make sense or is out of synch, it's natural for people to ask the question.
That is a waste of time. This is a clear clash of values and vision. As a manager you might see a change as important, and when challenged in this way there are several alternatives. You might, for example, attempt to explain why. You could invite the group to brainstorm alternatives to the change and possibly be surprised. Or you could just pull rank and tell everyone to suck it up. What you choose will be a reflection of your values.
The mantra in management training is that "resistance" is inevitable. I disagree. Like a trick, the acceptance is in the presentation. The last thing that any tech who works a hard 40 hours a week is that he or she will be asked to do more. Or less! Efficiency can be threatening to those worried about losing hours.
Do older techs hate change? I don't think so, at least not in any meaningful sense. Experience hones instincts and brings wisdom, two qualities any manager needs to succeed. Ask why people hate a change, and they are likely to tell you. Opening this kind of dialogue is a first step to success.
NEXT: Who Can You Follow?
In my last blog, I described how to create a table in a database that stores blood bank index card file information. At a minimum, this should contain the patient name, date of birth, and a checkbox to indicate if the patient has antibodies. That's the easy part, and it can be done in a few minutes.
The other features of OpenOffice (and Access) are creating Queries (search filters), Reports (to print or view data), and Forms (to enter and view data). At a minimum you'll want a to create a form to make data entry easy. The good news is that creating a form is even easier that creating a table.
Here's how:
Once you open the form, it looks something like this:
It's nothing pretty, but it is functional and gets the job done. You can enter data, using Tab or Enter to go to the next field. At the bottom of the window are tools to search and page through your records.
For those of you who are database savvy or know someone in the building who is, it's possible to optimize this form by creating a date mask in the DOB field (so all you have to do is enter six digits) and skipping the Antibodies checkbox when routinely entering data. This will allow you to enter data as quickly as possible. If you are entering the data sequentially from the card file, you can also use Windows cut (Ctrl-C) and paste (Ctrl-V) shortcuts for last names.
Once all the cards are entered, then what? Here are ideas:
Entering demographic information is the hard part. Once data is entered you may, for example, decide to migrate card information as needed to the database, gradually eliminating your paper card system. You can begin by migrating those patients with antibodies or other unique needs that make misplacing their cards such a high risk.
NEXT: Do Older Techs Hate Change?
In building a blood bank cardfile mirror, the main element is the database table. A table is a collection of records that stores data in fields. In the case of OpenOffice Base, when you open the program (called Database in the OpenOffice main menu) a dialogue asks if you want to create or open a database. Then the screen looks something like this:
Create Table in Design View…
Use Wizard to Create Table…
Create View…
Your blood bank cardfile table is created in the [highlighted] tables tab, and all tables appear below. To create a new table, click Create Table in Design View and enter your field names and type of data. Free text the Field Name and choose Field Type from a drop down.
Field Name
Field Type
Integer [INTEGER]
Text [VARCHAR]
Date [DATE]
Yes/No [BOOLEAN]
The ID field indexes your table. It also allows you to link records to other tables. Right click the box to the left of the ID Field Name and select Primary Key. Then make sure AutoValue in the Field Properties tab on the bottom of the screen says Yes. Save and you're done.
It's easy enough to add fields to this table. For example, you may find it useful to add a blood type field. This would also be a Text [VARCHAR] type. Note that all this works very similar in Microsoft Access.
The hard part is always data entry. Blood bank history files are deceptively large. It's easy for a small hospital laboratory to collect thousands of cards over the years, but all the information has to be entered. It's something to think about when designing your table. You'll want to enter a minimal amount of data as quickly as possible. You can always add more later.
If you double click on your table, you can start entering data in what looks similar to a spreadsheet. But is there a better, easier way? Next, I'll describe how you can create a data entry form in minutes.
NEXT: Form and Function


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» Gemini-Cancer Compatibility
Gemini Man - Cancer Woman CompatibilityThis is not regarded as a good planetary disposition. Both will be strongly attracted, but deep down there will be nothing common. Understanding each other's perspective will be a big problem. Difference of opinions will become a part their routine. He will lack commitment what she will be looking for. Good amount of efforts are required from both the parties to sustain the relationship.
» Daily Gemini Horoscope
Saturday, June 25, 2016
Don't rebuke your child if he is unable to fair well in the exam. You should rather encourage him to do well next time. You m...
» Weekly Gemini Horoscope
Monday, June 20, 2016 - Sunday, June 26, 2016
Big financial benefits are coming your way. Your business will be flourished with huge profits or your income might increase....
» Weekly Gemini Love Horoscope
Monday, June 20, 2016 - Sunday, June 26, 2016
Geminis, a smooth love life is foreseen, but you are required to maintain transparency in your love relationship. Moreover, b...
» Monthly Gemini Horoscope
June, 2016
Problems related to income and luck which were going on since few months will get resolved now. Flow of income will remain g...
» Yearly Gemini Horoscope
Year 2016
2016 will begin with Saturn in Scorpio and Jupiter in Leo. After residing in their current signs till January 31, Rahu will m...
» Gemini Characteristics
Gemini symbolizes the dual nature. Our world comes in pairs: good and evil, male and female, yin and yang - and Gemini native...
» Gemini Facts
Lucky Numbers: 3 and 5
Lucky Colors: Yellow and green
Lucky day: Thursday and Wednesday
» Gemini Compatibility
I am :
This is a harmonious and mutually stimulating combination. They will be loving and caring toward each other and will share a ...
This is not regarded as a harmonious combination. This is Dwi-dwadash (2-12) disposition which is not regarded good for marri...
Both will be having many things in common and hence this is regarded as a good combination. Both will have similar approach t...
This is not regarded as a good planetary disposition. Both will be strongly attracted, but deep down there will be nothing c...
This is an excellent sign combination. They will be passionate, understanding and caring. The boy will be impressive, loyal ...
This is a combination indicating mutual intellectual, clarity of thoughts and effective communication. They will be attracte...
This combination is characterized by the basic difference in their ideologies and thought process. She will be simple and fol...
This combination shows fundamental differences in thinking and approach toward life.This combination shows fundamental diffe...
This is regarded as a good combination as far as sign compatibility is concerned. Both are intelligent, practical and spiritu...
This is called Shadashtak (6-8 combination) in Vedic astrology and disapproved in marriage. The boy may find girl boring and ...
This is not regarded as a good combination as far as sign compatibility is concerned.There will be huge communication gap du...
This is a good combination for love and relationship. He will be witty and entertaining, whereas she will be social and grace...
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DEFINITION of 'Capital Transfer Tax'
An inheritance tax levied in the United Kingdom on estates exceeding a certain value. The Capital Transfer Tax replaced the general estate duty in 1975, and was itself replaced by the Inheritance Tax (IHT) in 1986. The amount of tax was derived from the value of the deceased's assets transfered within a certain time of the death (both real estate and personal), less charitable gifts.
BREAKING DOWN 'Capital Transfer Tax'
Capital transfer taxes and other inheritance taxes make up a small portion of taxes collected in the United Kingdom. This is partially due to the nil rate band, which is the range of estate values that are excluded from the tax, as well as the various methods for avoiding its payment. Gifting an estate to charities or family members or creating a trust were two avoidance methods used.
Inheritance TaxIn some states in the U.S. (and in the United Kingdom), a tax ...
Transfer TaxAny kind of tax that is levied on the transfer of official documents ...
Estate TaxA tax levied on an heir's inherited portion of an estate if the ...
Death TaxesTaxes imposed by the federal and/or state government on someone's ...
Uniform Transfer TaxA combination of federal estate taxes and federal gift taxes. ...
EstateA person's estate is everything comprising the net worth of an ...
Personal Finance
Estate Taxes: Who's on the Hook?Inheritance taxes can be tricky. Most people have to deal with them at a very inconvenient time. It's better to learn the laws now so you're ready later.
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An in Depth Look at How Inheritances Are TaxedThe tax implications of an inheritance can be complex. Here's what beneficiaries need to know.
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8 States With Estate TaxesUnderstand the difference between the federal estate tax and state-specific estate taxes. Learn about some of the worst states with estate taxes.
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How Life Insurance Can Help Reduce Estate TaxesInheritance is a double-edged sword, as leaving money can create estate tax burdens. Opting for a life insurance plan can help mitigate those burdens.
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Estate Planning and Elderly and Passed ClientsBy keeping up with new estate tax rules, financial advisors can help elderly clients save big on tax costs.
Financial Advisor
A Quick Guide to High-Net-Worth Estate PlanningA quick estate planning guide for high-net-worth individuals to help minimize taxes and costs, protect assets and plan for care.
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How to Gift Your Way to Lower Estate TaxesEstate planning is not just for inheritance. High net-worth individuals, who plan properly, can gift their money and save on taxes.
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State Taxes Retirees Should Know AboutState taxes plays a critical role in the quality of life of retirees. Here's what to consider.
Managing Wealth
Why It's So Important to Update Your Estate PlanAs rules and exemptions tied to the estate tax change, so should your estate plan. Here's why updating it is so important.
What would the estate tax be on life insurance policy of $25,000?$25,000 was paid to the beneficiary of a life insurance policy. What would the estate tax be and do you have to pay an estate ... Read Answer >>
If a parent transferred a house deed to their three adult children, do they need ...Currently, only the parents Read Answer >>
Are estate distributions taxable?Discover how estates are taxed, why estate distributions are generally tax-free, and circumstances that may require an heir ... Read Answer >>
How is cost basis calculated on an inherited asset?Understand how the cost basis for stocks, property and other inherited assets is calculated, and the resulting tax implications ... Read Answer >>
How can a trust lower federal transfer tax liability?A trust is an arrangement in which an individual or entity controls property or funds on behalf of someone else without actually ... Read Answer >>


text: Vok Multimedia Fireplace Ryan Feb 7, 2008 Video Entertainment Home Share Pin Email Share Pin Email (Image credit: Apartment Therapy ) Here is an answer to the always popular 'can I hang the TV over the fireplace' question. Yes, combine them both into an integrated unit including speakers, dvd and PC by Vok. (Image credit: Apartment Therapy ) - via Trendir Share Pin Email Related Articles Dress Up Fun: DIY 3-D Animal MasksMake Music Outside!iPad 3 Being Announced March 7th in San FranciscoNo, We're Not There Yet: DIY Travel Games for Kids


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Robin Williams had Parkinson's disease, wife reveals
15 August 2014 [16:05] -
Robin Williams was sober but was struggling with depression, anxiety and the early stages of Parkinson's disease when he died, his widow said Thursday.
The diagnosis of the progressive illness was "an additional fear and burden in his life," a person familiar with Williams' family told CNN on Thursday.
Williams was found dead in his Northern California home Monday from what investigators suspect was a suicide by hanging.
While fans and friends have looked for answers to why the 63-year-old comedy icon would take his own life, his wife, Susan Schneider, issued a written statement about Williams' health that he had kept a secret.
"Since his passing, all of us who loved Robin have found some solace in the tremendous outpouring of affection and admiration for him from the millions of people whose lives he touched," Schneider said. "His greatest legacy, besides his three children, is the joy and happiness he offered to others, particularly to those fighting personal battles.
"Robin's sobriety was intact and he was brave as he struggled with his own battles of depression, anxiety as well as early stages of Parkinson's disease, which he was not yet ready to share publicly.
"It is our hope in the wake of Robin's tragic passing, that others will find the strength to seek the care and support they need to treat whatever battles they are facing so they may feel less afraid."
What is Parkinson's disease?
Williams had been active as an actor in the last year of his life, performing in a CBS sitcom that was canceled this year and acting in four films that have yet to hit theaters.
It is not clear whether the early-stage Parkinson's disease affected his ability to work.
"Friends and family can usually detect changes in the Parkinson's patient including poor posture, loss of balance, and abnormal facial expressions," according to the National Parkinson Foundation. "During this initial phase of the disease, a patient usually experiences mild symptoms. These symptoms may inconvenience the day-to-day tasks the patient would otherwise complete with ease. Typically these symptoms will include the presence of tremors or experiencing shaking in one of the limbs."
Parkinson's disease "causes certain brain cells to die," according to the website of the National Institutes of Health. It is more likely to affect men than women and most often develops after age 50.
Williams used exercise and cycling to manage his stress and depression, and the prospect that the illness would prevent him from doing that was extremely upsetting, adding to the depression, the person familiar with his family said.
Fellow actor Michael J. Fox, who has Parkinson's and established the Michael J. Fox Foundation, said Thursday that he was unaware of his friend's condition.
"Stunned to learn Robin had PD. Pretty sure his support for our Fdn predated his diagnosis. A true friend; I wish him peace," Fox tweeted.
Investigators believe Williams used a belt to hang himself from a bedroom door sometime between late Sunday and when his personal assistant found him just before noon Monday, according to Marin County Assistant Deputy Chief Coroner Lt. Keith Boyd.
Boyd would not confirm or deny whether Williams left behind a letter, saying that investigators would discuss "the note or a note" later.
The coroner's investigation "revealed he had been seeking treatment for depression," Boyd said.
He spent time in a treatment facility in July, a time when his wife and representative have said he was battling depression.
Media reports at the time speculated that Williams had resumed drinking alcohol, but the statement from his wife appears to dispute those reports.
Williams entered rehab because of drug and alcohol addiction at least twice previously.
"Robin spent so much of his life helping others," his wife said. Whether he was entertaining millions on stage, film or television, our troops on the front lines, or comforting a sick child -- Robin wanted us to laugh and to feel less afraid."
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Our first six weeks of existence was a busy one with our kick-off Happy Hour on the 5 th, our Studio Training Meeting on the 12 th, and 15 photoshoots planned for July and August. Virtually all are full at this point, and frankly, I can't add any more, since I have to attend each one. It's my plan to get some of the other photographers in a position to lead some of the sessions.
I would like to thank Bob R for volunteering to organize a monthly get together to critique our shooting efforts. Bob has started a discussion group, and there is a page where you can upload your photos on the site. Bob is checking out locations and equipment now, and will be communicating with you soon.
Thanks also to Amy Medders who has also volunteered to organize our Mansfield reformatory trip in September. If you are not familiar with this place, you can go to www.ohiostatereformatory.org to take a look. I scouted it out a few weeks ago, and it should be a great place to shoot. There is a photo album on the site with a few of the shots I took that day. This is the prison where The Shawshank Redemption was filmed, and a great place to shoot some high fashion. Here is one of the shots:
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Mitsui O.S.K. Lines, Ltd. signed a contract to establish a joint terminal operation company with Saigon Newport Company, Hanjin Shipping Co., Ltd., and Wan Hai Lines, Ltd on February 4. The signing ceremony was held in Ho Chi Minh City. The terminal project will be located in Vietnam's Cai Mep region and is slated to start operation in 2011.
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Foreigners flood in for city rebuild
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Christchurch's international work force is ramping up.
Immigration figures released this month showed visas issued to workers helping rebuild the earthquake-hit city totalled 404 in the past six months, compared with 206 the first half of the year.
The rebuild workers are mostly from Britain, Ireland and the Philippines.
Since July last year, 719 skilled workers have received visas, including carpenters (97), quantity surveyors (72) and painters (69).
Some of the 12,000 British and Irish working-holiday visa-holders could also be working on the rebuild.
Canterbury Employment and Skills Board chairman Alex Bouma said the increase was not surprising, given the number of residential and commercial building projects and infrastructure repairs now under way.
"You can see there's definitely a real shortage [of workers] already starting to appear," he said.
"The positive sign is there are a lot of people in training. We're starting to see employers a lot more focused now on getting a good mix and providing opportunities."
The number heading to Christchurch was expected to grow significantly, Bouma said.
Accommodation constraints and some larger projects yet to start had kept the increase in check.
"There's still going to be some natural constraints that will make it speed up and slow down from time to time. Certainly, we're still worried about housing, but various solutions are being sought," he said.
British, Irish and Filipino workers would remain the "typical market".
"A big part of it is going to remain recognisable qualifications,'' he said.
"We're not just bringing unskilled labour through.
"That, to a certain degree, is going to limit the countries you can actually source, but at the end of the day, I think we will see that pool open up a little bit further as more work is done."
Scott Mathieson, the director of Auckland-based migration services business Working In, told The Press this month that up to 600 Irish and British workers were expected to head to Christchurch during the next six months.
The company held career expos in Dublin, Manchester and London last month and would repeat the effort in March, he said.
Kiwi recruitment firm Canstaff set up offices in Dublin and Northern Ireland to woo tradesmen to Christchurch.
Irish carpenter John Mullin moved with his family to Christchurch in June after being recruited by Canstaff, and now works for construction firm Calder Stewart.
Christchurch and Canada were popular destinations because of the work shortage in Ireland, he said.
"It's pretty quiet back home with the recession. A lot of guys are definitely looking at going overseas," he said.
"It's a lot of money to get over here, but it's still worth it."
The numbers able to leave Ireland had decreased significantly, but tradesmen Mullin had spoken to were still keen to come to Christchurch.
- The Press
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Why Religious Liberty Matters DEACON FOR LIFE - June 28, 2016 Is It Ever Immoral Not to Practice NFP? By Dr. Mark Latkovic As science progresses, particularly ethical medical practices such as NaPro technology, the question arises whether it would ever be morally wrong not to practice NFP when one has a legitimate reason for such practice. For example, if you know that your baby's life or your ownhttp://feedproxy.google.com/~r/DeaconForLife/~3/RoMSo9sqnG4/why-religious-liberty-matters_28.html
Former Pope Benedict Makes Rare Appearance With Successor Francis SANCTE PATER - June 28, 2016 Former pope Benedict (R) is greeted by Pope Francis during a ceremony to mark his 65th anniversary of ordination to the priesthood at the Vatican June 28, 2016. Osservatore Romano/Handout via Reuters VATICAN CITY ( Reuters ) - Former pope Benedict made one of his rare public appearances on Tuesday to be feted by his successor Pope Francis, two days after Francis denied reports that Benedict was still exercising influence in the Vatican. Benedict, an 89-year-old German, ...http://www.sanctepater.com/2016/06/former-pope-benedict-makes-rare.html
There Is Only One "Real Jesus"; Accept No Substitutes NATIONAL CATHOLIC REGISTER BLOGGERS FEED FROM MARK SHEA - June 26, 2016 By Mark Shea Here's an email about a website called "New Covenant Ministries" (a self described "No-nonsense, Honest, Direct, Prophetic, Apostolic, Priesthood of All Believers [Men and Women], Post-Trib, Sabbatarian, Messianic-Israelite,...http://feedproxy.google.com/~r/NCRegister/MarkShea/~3/eewRMyq-F2Y/
Comfort in the Winds CATHOLIC LIGHT - RADICAL FAITH & TRUST - June 25, 2016 Comfort in the Winds Mark Malletthttp://tsahaylu.blogspot.com/2016/06/comfort-in-winds.html
Announcing Colloquium 2017 – University of St. Thomas, St. Paul, MN CHURCH MUSIC ASSOCIATION OF AMERICA - June 24, 2016 Save the date : Colloquium 2017 June 19 – 24, 2017 Univ. St. Thomas St. Paul, MN Colloquium 2017 will be held at the University of St. Thomas in St. Paul, Minnesota, June 19-24, 2017. The Center for Catholic Studies at the University has generously co-sponsored us and made it possible for us to offer the event at the lovely campus in the Archdiocese of St. Paul and Minneapolis . Three venues for liturgies: Chapel of ...http://musicasacra.com/2016/06/announcing-colloquium-2017-university-of-st-thomas-st-paul-mn/
Tradition, Mother of the Bible, Part Two NATIONAL CATHOLIC REGISTER BLOGGERS FEED FROM MARK SHEA - June 23, 2016 By Mark Shea Last time, in this space, we started looking at how doctrine develops in the life of the Church. Today, we will take a look specifically at how the Church's doctrine regarding "which books should we read in the liturgy?" developed....http://feedproxy.google.com/~r/NCRegister/MarkShea/~3/1lr4KQkdrTQ/
The House That Lasts CATHOLIC LIGHT - RADICAL FAITH & TRUST - June 23, 2016 The House That Lasts Mark Malletthttp://tsahaylu.blogspot.com/2016/06/the-house-that-lasts.html
Song Sung at Vatican: "Bend Over, Let Us See You Shake Your Tail Feathers" CONNECTICUT CATHOLIC CORNER - June 22, 2016 I'll let this speak for its self... *note the 2:23 mark Nothing like hearing "bend over, let us see you shake your tail feathers " sung at the Vatican for our Holy Father who then tells them " you are doing great things ". Hey, I'm all for wanting people to smile, but where is the DIGNITY and REVERENCE once known to the Vatican? I expect better from Christ's Holy Catholic Church. Perhaps I have my standards set too high for this papacy. God give me strength. In Christ, Julie ...http://connecticutcatholiccorner.blogspot.com/2016/06/song-sung-at-vatican-bend-over-let-us.html
That Pope Francis!… A Short Story CATHOLIC LIGHT - RADICAL FAITH & TRUST - June 20, 2016 That Pope Francis!… A Short Story Mark Malletthttp://tsahaylu.blogspot.com/2016/06/that-pope-francis-short-story.html
Tradition, Mother of the Bible, Part One NATIONAL CATHOLIC REGISTER BLOGGERS FEED FROM MARK SHEA - June 19, 2016 By Mark Shea It's still a jolt for some people to realize this, but the Bible did not fall down out of the sky, leather-bound and gold-monogrammed with the words of Christ in red, in 95 AD. Rather the canon of Christian Scripture slowly...http://feedproxy.google.com/~r/NCRegister/MarkShea/~3/7w0u2n8HhOU/
Be Careful IN HIM ALONE - June 17, 2016 ... my twice-a-day reading of the scriptures, the same theme cropped up -- first in Isaiah 6 and then in Mark 4. The passage in Isaiah explains why God dulls the spiritual eyes and ears of those who have already hardened themselves to truth. To them He says ominously, "Keep on listening, but do not perceive. Keep on looking, but do not understand. Render the hearts of this people insensitive, their ears dull, and their eyes dim." The New Testament passage repeats the same theme. ...http://thecontemplativecatholicconvert.blogspot.com/2016/06/be-careful.html
Well Said: What Gets Us Into Trouble ... HAPPY CATHOLIC* - June 17, 2016 What gets us into trouble is not what we don't know. It's what we know for sure that just ain't so. Mark Twainhttp://happycatholic.blogspot.com/2016/06/well-said-what-gets-us-into-trouble.html
A Brigettine Day... AUNTIE JOANNA WRITES - June 17, 2016 ...on Monday Sept 12th , at the Brigettine guest house at Iver Heath, Bucks . To mark the canonisation of St Eisabeth Hessleblad, the Association of Catholic Women is holding a Brigettine Day - come and enjoy the lovely surroundings of this delightful Guest House, and hear historian Fr Nicholas Schofield speak on the founding of the Brigettines in the early Middle Ages, their great house in England at Sion on the Thames,and more...and hear about Mothetr Elisabeth and the ...http://joannabogle.blogspot.com/2016/06/a-brigettine-day.html
Let's Not Get Bent Out of Shape Over 'Transcriptgate' - Crux WHERE THE RUBBER HITS THE ROAD - June 17, 2016 ... that is required to establish the validity of their sacramental union. I like Pope Francis... but I think he's off the mark with this one. Let's not get bent out of shape over 'Transcriptgate' - ...http://feedproxy.google.com/~r/blogspot/oOuOI/~3/mGAJB6vH2BI/lets-not-get-bent-out-of-shape-over.html
The Belief in Purgatory Is Much Older Than You Realize NATIONAL CATHOLIC REGISTER BLOGGERS FEED FROM MARK SHEA - June 16, 2016 By Mark Shea Last time, in this space, we left off with a common notion concerning Purgatory, namely: Wasn't Purgatory unheard of in Scripture and only invented in the Dark Ages? No. Just the term "Purgatory" arose after the time of the...http://feedproxy.google.com/~r/NCRegister/MarkShea/~3/07uV6BTQYdw/
More on the Gospel of Jesus' Wife PERSPECTIVE - June 16, 2016 ... Wife fragment has been in the news for a while - here's a post by NT scholar Mark Goodacre from 2014: The Jesus' Wife Fragment is Back . And ... Karen King Responds to 'The Unbelievable Tale of Jesus's Wife' This news doesn't prove Jesus didn't have a wife, of course, but it just means that there is no known credible proof that he dud. What bugs me about the response to the Jesus' Wife fragment is the way so many Catholics seem relieved that it's a forgery. It's as if they ...http://povcrystal.blogspot.com/2016/06/more-on-gospel-of-jesus-wife.html
So, You Saw Him Too? CATHOLIC LIGHT - RADICAL FAITH & TRUST - June 15, 2016 So, You Saw Him Too? Mark Malletthttp://tsahaylu.blogspot.com/2016/06/so-you-saw-him-too.html
1 Peter 1:3-9, Psalm 111:1-2, 5-6, 9-10, Mark 10:17-27 WHOM SHALL I SEND? SEND ME LORD - June 15, 2016 DAILY HOLY MASS READINGS 1 Peter 1:3-9, Psalm 111:1-2, 5-6, 9-10, Mark 10:17-27 1 Peter 1:3-9 My soul's beloved, St. Peter reminds us that we are given new life and a living hope because the Father raised You from death to life. All believers receive an inheritance that is worth far more than anything the world has to offer – for the things of earth fade, corrupt, and pass away but the gift of God is eternal. The Holy Spirit poured ...http://whomshallisend.blogspot.com/2016/05/1-peter-13-9-psalm-1111-2-5-6-9-10-mark.html
2 Timothy1:1-3, 6-12, Psalm 123:1-2, Mark 12:18-27 WHOM SHALL I SEND? SEND ME LORD - June 15, 2016 DAILY HOLY MASS READINGS 2 Timothy1:1-3, 6-12, Psalm 123:1-2, Mark 12:18-27 2 Timothy1:1-3, 6-12 My soul's beloved, St. Paul reminds us that the Law is good so long as it serves its purpose. It is useless to spend hours in fruitless discussions about things that do not matter. Our sole aim must be to focus all our energy on what saves, to make known the Gospel of love which unites us and not sin which places barriers and takes us away from You and cuts us ...http://whomshallisend.blogspot.com/2016/06/2-timothy11-3-6-12-psalm-1231-2-mark.html
2 Timothy 2:8-15, Psalm 25:4-5, 8-10, 13, Mark 12:18-27 WHOM SHALL I SEND? SEND ME LORD - June 15, 2016 DAILY HOLY MASS READINGS 2 Timothy 2:8-15, Psalm 25:4-5, 8-10, 13, Mark 12:18-27 2 Timothy 2:8-15 My soul's beloved, the one truth that can lift us up from despondency and anxiety is this, that death does not have the final word. You crushed it and have won a glorious victory over it. Death is not the end of live but is the gateway to life anew eternally with You in the Kingdom of God. All the little troubles and even big ones we endure with faith for we have ...http://whomshallisend.blogspot.com/2016/06/2-timothy-28-15-psalm-254-5-8-10-13.html


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It's a tee. It's a dress. It's the new Graphic T-shirt Dress.
I dunno……? haha
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Actually a really cool image Amy, more creative than it seems it should be :D
Thanks Jason :o)
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Hahaha Awesome Thanks Shoaib :o)
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This is realllyyyy cool :D well done xX
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me either.but it's funny, and the design element works :-)
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Lawrenceville Churches In
You're Christian. You're Single
Find your Match at ChristianMingle
1. Restoration of Faith Int'l Christian Church
A wonderful place where you feel like you matter... A great atmosphere for learning about God and His Word....
2. Central Baptist Church
CBC Preschool is great! They have a wonderful staff and a great cirrculum. I have sent my son and daughter there since nursery threw PreK. The Prek …
3. The Tabernacle International Church
Such an amazing church! The Pastor preaches the uncompromising Word. I have felt welcome since day one! I found out just a few weeks ago, within th…
4. Father's House Community Church
This is an awesome place to just be yourself.
5. Sunrise Baptist Church
3000 Sugarloaf PkwyLawrenceville, GA 30045
From Business: Sunrise Baptist Church exists to honor God by sharing the light of Jesus Christ - everyday we live, everywhere we go, with everyone we meet. We gather for worship e…
6. First Baptist Church Lawrenceville
165 N Clayton StLawrenceville, GA 30046
7. Lawrenceville First Baptist Church
165 S Clayton StLawrenceville, GA 30046
8. First Century Fellowship
120 S Perry StLawrenceville, GA 30046
9. Quinn House
120 S Perry StLawrenceville, GA 30046
10. Tabernacle of Christ Church International
161 S Perry StLawrenceville, GA 30046
11. Bethesda International Church
132 Buford DrLawrenceville, GA 30046
12. The Stone Church Inc
141 Buford DrLawrenceville, GA 30046
13. Oakland Road Baptist Church
311 W Oak StLawrenceville, GA 30046
14. Vision Of Life Ministries
458 N Chestnut StLawrenceville, GA 30046
From Business: Evangelical Misc
15. Tabernacle Baptist Church
50 Neal BlvdLawrenceville, GA 30046
16. Trinity Life Church
422 E Crogan StLawrenceville, GA 30046
17. The Universe Baptist
495 Perry StLawrenceville, GA 30046
18. World Life Church
495 Perry StLawrenceville, GA 30046
19. Creeksdie Fellowship Church
470 N Clayton StLawrenceville, GA 30046
20. City Of Zion Christian Ministries
271 S Culver StLawrenceville, GA 30046
21. Mount Calvary United Methodist Church
145 Neal BlvdLawrenceville, GA 30046
22. New Harvest Baptist Church
238 Buford DrLawrenceville, GA 30046
23. First United Methodist Church
395 W Crogan StLawrenceville, GA 30046
From Business: First United Methodist Church is located in Lawrenceville, Ga. It provides Biblical trainings and spiritual growth and Christian fellowship services. It offers a wi…
24. Elim Romanian Pentecostal Church
142 Scenic HwyLawrenceville, GA 30046
25. Church Of The Way
139 New Hope RdLawrenceville, GA 30046
26. Sanctified Inspiration Ministry
250 Langley DrLawrenceville, GA 30046
27. Sanctified Bethesda Baptist Church
250 Langley DrLawrenceville, GA 30046
28. Life Community Church International
250 Langley DrLawrenceville, GA 30046
29. All Nations Christian Fllwshp
377 W Pike StLawrenceville, GA 30046
30. Iglesia Tabernaculo De La Fe
377 W Pike StLawrenceville, GA 30046


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The women of St Matthias Episcopal Church of Waukesha will be hosting "Home for the Holidays: Sweets and Treats", this Saturday, December 15th, from 9:00am-1:00pm. A long-standing tradition at St. Matthias, the annual cookie sale has historically been used to support outreach ministries related to families in need and the homeless.
Assorted, delightfully delicious, homemade cookies and bars will be sold by the pound. Also available, you will find candies, snacks, quick breads and jar mixes, perfect for holiday gift giving.
St. Matthias Episcopal Church has a long history of relationship with The Hebron House, in Waukesha. A portion of the proceeds from this sale have been pledged to Hebron House, in order to support their homeless ministries in Waukesha County.
In recent winters, St. Matthias, located on the corner of East Avenue and Main Street in historic downtown Waukesha, was the host site for the Waukesha County Emergency Men's Homeless Overflow Shelter. While the shelter will not be located in the church this season, the parish welcomes this opportunity for continued support of this and other homeless ministries throughout Waukesha County.
The cookie sale will be held on Saturday, December 15th, from 9:00 am until 1:00 pm in the Fellowship Hall, located just inside the Pleasant Street entrance. During this special season of home and hearth, please help in reaching out to those who are less fortunate.
For more information call 262-547-4838, or visit our website at www. Stmatthiasonline.org and find us on facebook. St. Matthias Episcopal Church 111 E. Main Street, Waukesha WI.
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#1 posted 01-02-2013 11:47 PM
I have done both. I am improving my wooden slides and will try to use them more as I go along. Just have to be exact when building the drawers.
-- Mother Nature created it, I just assemble it.