As Indonesia has been experiencing impressive economic advancement and emerging as an upper-middle income country, it has also recorded important progress in enhancing food security and nutrition. Access to food increased and undernutrition continued to decrease over the last few years. However, the nutritional status of Indonesians is still low by international standards, and the variation across regions remains huge. While struggling to address long-standing food security and nutrition challenges, Indonesia is currently facing an unprecedented crisis triggered by the COVID-19 pandemic. Thus, new and enhanced strategies are needed for the country to achieve the 2030 Agenda, especially Sustainable Development Goal 2 (SDG 2), which states that by 2030 the country will end hunger, achieve food security and improved nutrition and promote sustainable agriculture.
This report is an update of the 2014–2015 Strategic Review. It was initiated in August 2019 and was extended until July 2020 to cover the initial impact of the COVID-19 pandemic on food security and nutrition. It is based on the latest secondary data available, updates on relevant policies and programmes related to food security and nutrition, the latest discourses, and emerging issues, including the impact of the COVID-19 pandemic. This report presents: (1) an update on the food security and nutrition situation since the 2014–2015 Strategic Review, mostly referring to data from 2013 to the most recent available and covering the three dimensions of food security (availability, access and utilization), the trend in nutritional status, the effects of disasters and climate change on food security and nutrition, and new challenges in nutrition; (2) an analysis of the latest development in policies and programmes that are aiming at improving the food security and nutritional status, both at national and sub-national levels; (3) the potential impact of the COVID-19 pandemic on food security and nutrition (through July 2020); and (4) conclusions and recommendations on measures to improve food security and nutrition in the country.
The situation analysis shows that Indonesia has made important progress in further improving food security and nutrition. Nevertheless, some challenges remain. First, the increases in the production of most food commodities, especially rice, have not caught up with the increase in consumption. The persistent dependency on rice imports could threaten food security during the COVID-19-induced crisis. Second, although insufficient food consumption is declining, in 2018, around 21 million people in Indonesia still had calorie intake below the minimum dietary requirement. Poverty and high food prices in relation to income remain major challenges in the effort to increase access to food. Third, the food consumption pattern of most Indonesians is still less than ideal, with carbohydrates continuing to dominate the food intake; insufficient consumption of sources of protein, fruits and vegetables; and the increasing trend in processed food consumption in both urban and rural areas. Fourth, even though the prevalence of stunting (low height for age), underweight and wasting (low weight for height) among children under 5 declined since 2013, the level of undernutrition is still high by international standards. In addition, the prevalence of overweight and obesity has steadily increased among children 6 to 12 years old, adolescents and adults. Evidence also suggests that micronutrient deficiencies prevail although representative data has not been collected for years. Indonesia is thus facing a triple burden of malnutrition in which undernutrition co-exists with overnutrition and micronutrient deficiencies. The current crisis caused by the COVID-19 pandemic and social distancing measures could erode the progress that has been achieved.
The policy analysis highlights significant progress as well as some policy gaps. Indonesia is still facing big challenges in increasing and diversifying food production that can support nutritional improvement toward more balanced diets. The focus on increasing rice production has not been able to meet the government ambition to significantly reduce import dependency, and it comes at the expense of less than sufficient effort to increase the production of fruit and vegetables, as well as sources of plant and animal protein, with the exception of fish. Thus, the Indonesian Government need not only increase productivity of food commodities, but also give more support to the production of a more diversified range of food commodities. In addition, there is also a need to further acknowledge women’s role in agriculture, and to provide support to women farmers to have full access to opportunities in this sector.
Regarding access to food, there has been significant progress in the development of social protection schemes as a vehicle to ensuring sufficient access to food for poor and vulnerable people. This is important as the price of various food commodities, particularly rice, in Indonesia is still relatively high. Furthermore, there have been commendable initiatives undertaken by the Government to make social protection schemes—particularly SEMBAKO and Program Keluarga Harapan (PKH)—more nutrition-sensitive. There are some implementation constraints that still need attention, particularly in improving the quality of the social welfare beneficiary database for better targeting, and further enhancement of the nutritional sensitivity of both regular social protection and social assistance provided during disaster or crises situations.
Indonesia is still facing challenges in various aspects of food utilization. Regarding food safety, there is a need to update the existing regulations, increase the capacity of the oversight organization and better educate the public. For the promotion of a balanced diet, the formulation of desirable dietary scores needs to be adjusted in order to target a lower proportion of carbohydrate intake, and higher proportion of fruit and vegetables in line with the latest Ministry of Health guidance on a balanced diet. With regard to further nutritional improvements, despite significant efforts to improve both nutrition-sensitive and nutrition-specific interventions, the effectiveness of these efforts needs to be enhanced by increasing awareness and knowledge of all stakeholders at all levels of the Government, and making the effort more holistic and integrated. In addition, it is also important to increase more attention to data availability on micronutrient deficiencies to have a basis for tackling all aspects of the triple burden of malnutrition, for example through food fortification.
Regarding institutional arrangements, the latest approach of assigning the leadership on improving nutrition under the Vice President is intended to strengthen coordination efforts, particularly related to stunting. However, the effort to link the production, access and utilization sides of food security with nutrition improvement efforts requires further attention. The fact that various related authorities in food security and nutrition-sensitive services are in the hands of district governments requires concerted efforts to translate central-level policies into effective local-level action. In this regard, the latest government approach to implement regional targeting and focus on an integrated approach to targeted districts and villages could potentially produce more effective results.
In 2020, the challenge of addressing food insecurity and malnutrition further increased due to the outbreak of COVID-19. The Central Bureau of Statistics revealed that as the Indonesian economy contracted by 2.4 percent (q-to-q) in the first quarter of 2020, around 1.6 million more people have fallen into poverty between September 2019 and March 2020 (BPS, 2020d, 2020e). The Government has responded swiftly with a scaling up of social protection programmes, but challenges with the social protection database remain, including the risk of missing many of the most vulnerable, including women-headed households and people with disabilities. As COVID-19 has also affected the implementation of government policies and programmes on health and nutrition, urgent measures are needed to ensure that these services continue.
Based on this analysis, some recommendations are made to decision-makers to deal with the impacts of COVID-19 on food security and nutrition. Addressing the effects of COVID-19 requires the Government to take a rather short-term perspective to prevent the pandemic from eliminating the progress made so far and ensuring that the country can continue its path to achieving SDG 2 by 2030. The recommendations are as follows.
- Food availability: The Government needs to closely monitor the rice stocks and pursue a flexible trade policy making timely import adjustments when necessary. They also should maintain farmers’ incentives to uphold food production by ensuring input supplies, concessions for loan repayment and links to the market. Improvements in the transportation and overall supply chain system are also required to ensure that food commodities remain available and prices do not rise.
- Food access: The Government needs to continue to ensure that all poor and vulnerable households receive social protection to cushion the impacts of COVID-19. Efforts to expand social assistance may need to involve sub-national governments and non-profit or community-based organizations.
- Food utilization: The Government needs to ensure that children and pregnant and lactating mothers can have access to basic health services again, especially in those village health posts (Posyandus) and community health centres (Puskesmas) that were closed in the last few months due to COVID-19—without compromising the safety of health workers or patients.
- Nutrition: To prevent an increase in wasting and stunting during the COVID-19 crisis, the Government needs to expand the provision of supplementary foods (e.g. fortified biscuits) to help children and pregnant and lactating mothers from vulnerable groups to meet their nutrition requirements.
Actions are required on many dimensions of food security and nutrition to address long-standing shortcomings in these policy domains as well as new challenges, especially the rise of the triple burden of malnutrition. It is very important for the Government to stay on track and ensure that SDG 2 can be achieved by 2030 with no one being left behind. Therefore, this review makes the following recommendations:
- Broaden the policy focus beyond stunting to address the triple burden of malnutrition. The Government should broaden its policy focus not only on stunting but also on other dimensions of malnutrition, especially wasting, obesity, overweight and micronutrient deficiencies. With regard to micronutrient deficiencies, a representative survey is required on the results of which respective supplementation and fortification plans can be based.
- Promote a balanced diet through social and behavioural change communication with the population. To promote a balanced diet, not only does the Government need to improve its mass communication strategies but they also need to further support the population to put the messages of such a campaign into practice. For example, a diversified diet needs to be affordable by all sectors of society, either directly or through social protection measures.
- Improve access to diversified food through the development of diversified, resilient and nutrition-sensitive food systems. It is also important for the Government to ensure the availability and accessibility of diversified food by developing a diversified agricultural system that is nutrition-sensitive and resilient to climatic shocks. Access to diversified food can also be improved by enhancing food affordability.
- Ensure social protection programmes are targeting those most in need, so that no one is left behind. Overall funding for social protection programmes is limited, so the Government needs to ensure that inclusion and exclusion errors are prevented as much as possible; they also need to be made more gender- and disability-responsive, nutrition-sensitive and adaptive to shocks.
- Ensure proper utilization of food. Only healthy bodies can appropriately utilize a diversified diet, so it remains fundamental that access to clean water and decent sanitation (including toilet facilities) be expanded, especially for poor and vulnerable groups. The coverage of health services, especially for children and pregnant and lactating mothers, is also to be ensured.
- Address gender inequality to improve food security and nutrition. The Government needs to address the various problems that contribute to maintaining or exacerbating gender inequality and support women’s access to information on nutrition and diversified diets, means of agricultural production and marketing, health services, social protection and access to education and economic opportunities in general.
- Strengthen the monitoring and evaluation system to enhance policies and programmes on food security and nutrition. Rigorous government monitoring and evaluation should be conducted, and a proper mechanism be put in place to ensure that the results of the monitoring and evaluation will loop back to policy or programme enhancement.
- Strengthen the governance of food security and nutrition or rather food systems as a whole through the development of an effective coordinating agency. The governance of food systems could be enhanced by strengthening policy coordination under the Vice President’s Office as an expansion of the efforts to accelerate the reduction of stunting (Stranas Stunting). Indeed, it remains highly relevant that the Government develop an effective institution to govern and coordinate the work of different stakeholders in the areas of food security and nutrition as parts of one food system.


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Summarize the physical, developmental and socioemotional changes that take place in...
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Early adulthood spans the ages of 18 to 25 years. Physically, young adults experience stabilization of physical characteristics. The wisdom teeth are usually fully developed by the end of early adulthood, and the rate of neural growth tapers off near the end of this developmental phase. Young adults reach a balanced and stable sexual hormone composition, as the adolescent flood of testosterone and estrogen begin to taper off as well.
Subjectively, young adults are very focused on their identities. They spend a great deal of cognitive and emotional resources on the question of who they are and what their place is in society. Early adulthood is marked by an experimental stance toward identity. Young adults often play with their gender identity, professional identity, and religious, social, and cultural identifies.
It is a time where individuals essentially "try on" different identities and then use social feedback and their own emotional experience to see which one "fits."
Posted by jpope1 on July 21, 2013 at 7:21 PM (Answer #1)
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Pokagon citizens have long sustained their culture and connection to their homeland; numerous place-names in northern Indiana and southwest Michigan continually reflect that connection. The Pokagon people have endured thanks in part to their values of Wisdom, Love, Respect, Truth, Honesty, Humility, and Bravery. Adapting these deeply-rooted ideals to contemporary circumstances has made the Band an engine for economic development and a model for sustainable living in the region.
Check out this video of Pokagons explaining and demonstrating their culture at the 2014 Living Earth Festival at the National Museum of the American Indian in Washington DC.
Pokagon Band citizens take great pride in the enormous strides the Band has taken to further economic development, to develop tribal infrastructure, resources, and to improve healthcare, housing, education, and Elders services to its citizens. In addition, the Pokagon Band has made it a priority to develop language and cultural programs for its citizens, through its Department of Language and Culture, in an effort to fully engage the Pokagon Band community in the cultural heritage and the traditional lifeways of the Pokagon people. They recognize their clan identity, and remember ancestors’ presence in modern-day gatherings like pow wows. Elders and youth alike come together to mark seasonal changes with ceremonies and feasts, practice such traditional arts as black ash basket making, and play age-old games.


The Ark is a wooden chest built by the Jews, under God's instruction to Moses at Mount Sinai. God gave Bezalel, son of Uri, son of Hur, a special talent to build and oversee the construction of the Ark.
The Ark was made of acacia wood and covered with gold. It was about three and one half feet long, and about two and one half feet in height and width. A cover was made for it out of gold. The Ark was placed in the Tabernacle when the Israelites were camped. As the tribes moved across the desert, the Ark was carried by the Levite tribe, using two long poles attached by rings to the sides. Inside the Ark, Moses placed the tablets of the 10 Commandments that were given to him by God on Mount Sinai.
God spoke to Moses from above the cover of the Ark, and gave Moses His commands and laws, thus the Ark is the most sacred object of Israel. When the Israelites left the desert and conquered Canaan, the Ark was first set up in Shiloh. At one time the Philistines captured the Ark, and placed it in their temple near the statue of their god, Dagon. The statue then fell off its pedestal. The Philistines replced Dagon on the pedestal and it fell off a second time, and broke into pieces.
Whatever city the Philistines moved the Ark to, the people were afflicted by a plague. Finally the Philistines returned the Ark to Israel. It was placed in the house of Abinadab in Kirjath Jearim. Later, after David defeated the Philistines and conquered Jerusalem, he decided to transfer the Ark to his new capitol. But disaster struck when Uzzah, a son of Abinadab, touched the Ark to keep it from falling, and died on the spot. David then left the Ark with Obed-Edom the Gittite.
Only when Obed-Edom was blessed, did David venture to bring the Ark to Jerusalem. During David's reign no temple was built, and the Ark remained in a tent, though it was taken out from time to time by the Levites to accompany David's armies in times of war. When Davids son Solomon became king, he built the Temple.
The Ark was placed in a room called the "Holy of Holies" When Solomons Temple was destroyed, the Ark disappeared. Whether it was removed earlier, or destroyed by the fire Nebuzaradan, captain of the bodyguard of Nebuchadnezzar, king of Babylon, set to destroy the Temple, is not known. But in 2 Maccabees 2:1-8 (from the Catholic Bible) the prophet Jeremiah is said to have taken the Ark "to the mountain which Moses climbed to see God's inheritance." He then hid the Ark in a cave and blocked up the entrance. In the New Testament, in the book of Hebrews and the book of Revelation, the Ark is mentioned as appearing in the heavenly temple.
There are many stories as to where the Ark is today. Some say its hidden under the Temple Mount in Israel. Some say it was hidden in Ethopia for many years and then brought back to Israel and stored away someplace. And some say it is still hidden in a cave in the mountain of Moses. But as Jeremiah states in 2 Maccabees 7-8, "The place is to remain unknown until God gathers His people together again and shows them mercy. Then the Lord will disclose these things...."
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The Industrial Internet is described as an “ecosystem of connected machines and software” designed to increase efficiency, minimize waste, and help people make better decisions. A recent GE white paper “Pushing the Boundaries of Minds and Machines” discusses the ways in which brilliant machines will transform our lives. The way intelligence is embodied in machines and devices used in the industrial sector is being revolutionized. The Industrial Internet is not a new separate Internet but much of it will be run on private secure networks.
The Industrial Internet will connect the world’s machines, facilities, fleets and networks with advanced sensors, controls and software applications. Using physics-based analytics, predictive algorithms, automation and deep domain expertise, workers anywhere will be connected 24×7 to providing support, and executing more intelligent decisions in operations, maintenance and safety.
The following chart shows savings in major sectors totaling $276 billion if only a 1 percent savings is achieved:
For example in commercial aviation, a 1% improvement in fuel savings would yield $30 billion over 15 years. A 1% efficiency improvement in global gas-fired power plants would yield about $60 billion in savings in fuel consumption over the same time.
New Innovation Leads to Increased Productivity
The following figure shows the Industrial Revolution that lasted from 1750 to 1900, the Internet Revolution which took place over 50 years from 1950 the year 2000 and the Industrial Internet which is just 10 years old and shows all signs of picking up steam.
A key driver of the Industrial Internet is costs of deployment of intelligent devices and instrumentation have dramatically fallen recently. Computing power and improved microprocessor chips are now allowing heretofore unseen levels of digital intelligence and advanced analytical techniques to be applied to “big data.” These trends are ushering in a new ways of thinking and working.
Applications of the Industrial Internet
We are beginning to witness the coming together of the industrial world and digital worlds leading to heretofore elusive synergies that are leading to improvements in network, fleet, facility, and asset optimization.
Industrial Internet Data Loop
The following chart shows the data loop including extraction and storage of proprietary data; creation of data systems, algorithms, and new forms of data analysis; big data analytics; data visualization and sharing; the integration of physical and human networks, and the flow of experience and ideas back into machines.
Data flows help operators understand the history of their operations and performance enabling them to tweak systems more effectively. Intelligent systems will be characterized by network and maintenance optimization, system recovery, and enhanced learning. More intelligent decisions will come about from the integration of all of the elements being tracked.
Effect on Global GDP
It is not often that we can get our minds around the meaning of “Global GDP” let alone how it might be affected by new technology or process. But according to the following chart “Industry” represents 30% of the $70 trillion world economy or $21 trillion.
Within developed countries Industry represents 24% of output while in developing economies Industry represents about 37% of GDP. Therefore about 46% of the global economy or $32.3 trillion in global out put can benefit from the Industrial Internet.
Global Energy Flows
The industrial Internet can affect both energy production and consumption in significant ways.
The industrial system is comprised of huge numbers of machines and systems. There are millions of machines across the world from electric motors to CT scanners, etc. All these machines have information from temperature, pressure, vibration, and other key indicators. Engineers will soon be able to understand the performance of a machine in relation to other machines and systems.
The following table shows major pieces of “rotating machinery” in key industry categories. In this list, there are currently over 3 million types of rotating equipment. Monitoring, measuring and modeling key metrics associated with these machines will lead to better efficiency, safety, productivity, and operational savings.
Global Power Plant Fleet
Commercial jet aircraft, combined cycle power plants, locomotives, oil refineries and healthcare are all areas that feed off of the global power system. The following chart shows the global power plant fleet by technology and fuel type.
These are the industries that will first be targeted for advanced monitoring and control.
Benefits of the Industrial Internet
One area as an example of where the industrial Internet will have a big impact is in aviation. An intelligent aircraft will tell maintenance crews which parts of it are likely to need replacement and when. Current maintenance schedules are based on the number of cycles; this will change to maintenance schedules based on actual need. This type of maintenance will be applied to rail transportation, power production, etc.
Healthcare Spending Per Capita
The digitization of healthcare will transform the way people think about healthcare, live, interact with their doctors and are diagnosed. Due to the critical need to reduce costs and improve performance, the Industrial Internet will enable safe and efficient operations in hospital and medical environments saving hundreds of millions dollars. Over time we should see a narrowing in the differences in medical costs per capita and outcomes as the Industrial Internet spreads.
Labor Productivity Growth
One of the great bellwethers of economic health is labor productivity and while it increased significantly from 1980 to 2005 it has recently fizzled. The 1990s saw an acceleration in productivity not seen since record levels of the mid-1960s. A recent rebound in labor productivity is believed to be tied directly to the Industrial Internet.
Industrial Internet Tidal Wave Arriving Now
According to General Electric, the industrial Internet will be much larger than the Internet Revolution. While there are currently about four and half billion people connected to the Internet there are as many as 10 billion devices connected with billions more to be added in coming decades.
If we think of how the Internet has affected business and interpersonal communication thus far it is exciting to think about how the Industrial Internet will help optimize and speed improvement of many economic activities.
Expected Productivity Improvements by 2030
Current thinking is that the Internet Revolution will boost productivity growth to levels not seen since 1996 to 2004 when labor productivity grew at an average annualized rate of 3.1%. The following chart shows the effects such a change would have on per capita GDP.
The Benefits of the Industrial Internet to the World Economy
The GE report focuses primarily on the US because it is the most advanced economy and is likely to help catapult the Industrial Internet forward globally. If the Industrial Internet has the same effect as the Internet Revolution the world would see $15 trillion in additional global GDP by 2030.
Keeping an Eye on the Industrial Internet
It is not clear how quickly the benefits of the Industrial Internet will spread. In coming months we will be looking at innovation and equipment, analytics, system platforms, business process infrastructure and cyber security to track the world’s progress.


The herpesvirus family contains several important human viral pathogens. Clinically, the herpesviruses exhibit a wide spectrum of diseases. Some have an extensive host-cell range, and others have a narrow host-cell range. The outstanding property of herpesviruses is their ability to establish lifelong persistent infections in their hosts and to undergo periodic reactivation. Their frequent reactivation in elderly and immunosuppressed patients causes serious health complications. Curiously, the reactivated infection may be clinically quite different from the disease caused by the primary infection. Herpesviruses possess a large number of genes, some of which have proved to be susceptible to antiviral chemotherapy.
The herpesviruses that commonly infect humans are numbered from human herpesvirus 1 (HHV-1) to HHV-8 but are commonly referred to by their individual virus names. In order, these are herpes simplex virus types 1 and 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpesvirus 6 (HHV-6), herpesvirus 7 (HHV-7), and herpesvirus 8 (HHV-8, also known as Kaposi sarcoma-associated herpesvirus [KSHV]). Herpes B virus of monkeys can also infect humans. There are nearly 100 viruses of the herpes group that infect many different animal species.
PROPERTIES OF HERPESVIRUSES
Important properties of herpesviruses are summarized in Table 33-1.
TABLE 33-1Important Properties of Herpesviruses |Favorite Table|Download (.pdf) TABLE 33-1 Important Properties of Herpesviruses
|Virion: Spherical, 150–200 nm in diameter (icosahedral) |
|Genome: Double-stranded DNA, linear, 125–240 kbp, reiterated sequences |
|Proteins: More than 35 proteins in virion |
|Envelope: Contains viral glycoproteins, Fc receptors |
|Replication: Nucleus, bud from nuclear membrane |
|Outstanding characteristics: |
|Encode many enzymes |
|Establish latent infections |
|Persist indefinitely in infected hosts |
|Frequently reactivated in immunosuppressed hosts |
|Some cause cancer |
Structure and Composition
Herpesviruses are large viruses. Different members of the group share architectural details and are indistinguishable by electron microscopy. All herpesviruses have a core of double-stranded DNA, in the form of a toroid, surrounded by a protein coat that exhibits icosahedral symmetry and has 162 capsomeres. The nucleocapsid is surrounded by an envelope that is derived from the nuclear membrane of the infected cell and contains viral glycoprotein spikes about 8 nm long. An amorphous, sometimes asymmetric structure between the capsid and envelope is designated the tegument. The enveloped form measures 150–200 nm; the “naked” virion, 125 nm.
The double-stranded DNA genome (125–240 kbp) is linear. A striking feature of herpesvirus DNAs is their sequence arrangement (Figure 33-1). Herpesvirus genomes possess terminal and internal repeated sequences. Some members can undergo genome rearrangements, giving rise to different genome “isomers.” The base composition of herpesvirus DNAs varies from 31% to 75% (G + C). There is little DNA homology among different herpesviruses except for HSV-1 and HSV-2, which show 50% sequence homology, and human herpesviruses 6 and 7 (HHV-6 and HHV-7), which display limited (30–50%) sequence homology. Treatment with restriction ...


Constitutional Amendment Rules: A Comparative Perspective
University of New South Wales (UNSW) - Faculty of Law
May 6, 2011
COMPARATIVE CONSTITUTIONAL LAW, Tom Ginsburg, ed., Edward Elgar, 2011
U of Chicago, Public Law Working Paper No. 347
Constitutional amendment rules are now a near universal feature of national constitutions, yet their function remains largely under-theorized. This chapter thus uses a comparative perspective to explore a number of different functions, as well as dangers, to formal procedures for constitutional amendment. It notes, for example, the historical role played by constitutional amendment procedures in Canada, India, South Africa and Australia in: (i) formalizing, or legalizing, major constitutional revisions or changes; (ii) allowing a polity to ‘update’ of various specific constitutional structures or procedure; and (iii) allowing legislatures to engage in more effective forms of ‘dialogue’ with courts, by both jump-starting new judicial interpretations of a constitution and trumping existing judicial interpretations. It also explores the dangers of overly flexible amendment, from the perspective of the role of constitutions in promoting valuable forms of political (pre-) commitment, settlement, and minority rights protection. In addition, the chapter concludes by providing a concise summary, and critique, of the existing empirical literature on the actual determinants of the difficulty of constitutional amendment, both cross-nationally as well as within the US.
Number of Pages in PDF File: 20
Date posted: May 9, 2011
© 2015 Social Science Electronic Publishing, Inc. All Rights Reserved.
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Talking of Michelangelo
12:00 AM, Aug 9, 1999 • By ALGIS VALIUNAS
Sculptor, painter, architect, and poet, Michelangelo Buonarroti (1475-1564) is probably the most famous artist ever to live, and his most famous works all depict man as a beautiful creature made for great things and deserving to rejoice in his own majesty. The heroic male nude was Michelangelo's lifelong preoccupation: Its most celebrated expressions are his fourteen-foot-tall marble David, which occupied the most prominent place in Florence's Piazza della Signoria for over three hundred years before it was moved indoors to the Accademia, and his painting Creation of Adam, which is the showpiece of the Sistine Chapel ceiling frescoes in the Vatican. The sheer physical beauty of David and Adam is unsurpassed, so that one wonders if people looking at them today see anything more than ripped abdomens and peerless proportions.
For Michelangelo, however, the body's beauty is the way into the soul. Rippling sinew bespeaks spiritual force; the breadth of chest and the contour of hip sketch a human endowment that is far richer than flesh alone. The heroic demonstrates what is possible for man and displays the full extent of his reach. Beauty of this order makes demands on the beholder. Rainer Maria Rilke ends his poem on the Belvedere Torso -- a mutilated but superb remnant of a male figure in marble from the first century -- with the sternest yet most joyous of imperatives: "You must change your life." Rilke was exhorting his readers not to up the weight on their bench presses but to live nobly.
Michelangelo, for his part, observed of the Belvedere Torso, "This is the work of a man who knew more than nature." Nature and antiquity were touchstones for Michelangelo. At least for a time, his supreme ambitions were to make something more beautiful than nature and to excel those artists of classical antiquity who showed it could be done.
From these ambitions emerged Michelangelo's most renowned works, which have come to embody the Renaissance. Reverence for and pleasure in the grandeur of man are Renaissance hallmarks. "Men can do all things if they will," declared Leon Battista Alberti, another Italian of many talents. Jacob Burckhardt's pathbreaking 1860 history, The Civilization of the Renaissance in Italy, is an inspired elaboration of Alberti's motto. Burckhardt shows the multiform vitality of a time that elevated individual greatness -- artistic, intellectual, military, political -- above all else. Michelangelo, who seemed able to do anything he willed, was -- along-side Leonardo da Vinci and Niccolo Machiavelli -- as great a man as the Renaissance produced.
Greatness is often a far cry from goodness, but, according to a new biography, Michelangelo was as good as he was great. James Beck's Three Worlds of Michelangelo takes the artist up to age thirty-eight and the completion of the Sistine ceiling. A professor of art history at Columbia, Beck writes "A handful of individuals in the history of Western culture have evolved into universal symbols for the entire civilization. They are, in effect, the civilization."
In today's academic world, which has no place for great men, these are fighting words, and it takes audacity even for a tenured professor to write them. To suggest, in addition, that such achievements might be the work of a man who should be called civilized -- that is, decent, humane, self-restrained, moral, good -- is to invite contempt. Everyone, inside and outside academia, knows that men of genius are ruthless, irascible, unloving, and demonic. Michelangelo's own reputation places him among that crowd, as a prototype of the Romantic artist-hero. Beck has his work cut out for him as he tries to rehabilitate Michelangelo's character.
To his contemporaries, Michelangelo was known for his terribilita, an untranslatable word that refers to both the awesome splendor of his work and the monumental crankiness of his life. Beck agrees entirely that there is terribilita in abundance in Michelangelo's art, but he prefers to think that the man who made such works was utterly different from the works he made. His Michelangelo was a thoroughly good man: devoted to his father and brothers, tender and loyal to friends, generous to fellow artists, chaste even in the face of strong erotic temptations, homosexual or heterosexual or both. For the most part, Beck makes a convincing case; the terribilita business, however, does not go away so easily.
The incident that really made Michelangelo's name as a terribile was a set-to he had with Pope Julius II. The pope had commissioned Michelangelo to make him a tomb like nobody else's; the artist's design contained some forty full-size sculpted figures, and he was bold enough to assert that the tomb would be the most extraordinary work of art ever made. Making it, however, proved more difficult than drawing it. When Michelangelo returned to Rome after eight months in the marble quarries of Carrara, he went to the pope in order to be reimbursed for delivery of a shipment of stone; the pope left him cooling his heels for a week, until finally a guard told him that he had been ordered not to admit him. Michelangelo told the guard that if the pope ever wanted him, he should look elsewhere than in Rome; the next morning, Michelangelo headed back to Florence. Papal couriers overtook him on the way, and presented him with a letter from the pope ordering him back to Rome. Michelangelo refused to go. It would be six months before Michelangelo asked the pope to forgive his stalking off. The tomb was never completed in anything like the planned form.
Beck argues, not without cogency, that Michelangelo left Rome out of fear that Julius had lost interest in the tomb, which was true, and that his life was in danger, which was not true. However, Beck's contention that Michelangelo simply behaved like "a cautious, sensitive person worried about his security and his career" is too much to swallow. It is far more likely that fear and anger both played their part in this episode, as Giorgio Vasari, Michelangelo's sometime apprentice and his first biographer, remarked in Lives of the Most Eminent Italian Architects, Painters, and Sculptors. By all accounts but Beck's, Michelangelo was a hothead. Vasari related that when someone -- possibly Pope Julius, in disguise -- sneaked into the Sistine Chapel as Michelangelo was still working on the ceiling, the painter hurled planks from the scaffolding down at the intruder.
On another occasion, the pope impatiently demanded to know when Michelangelo would finish the ceiling, and Michelangelo impatiently responded, "When I can, Holy Father." Furious at this insolence, the pope struck Michelangelo with a staff, and told him he would make him finish the job soon enough; however, Vasari wrote, Julius presently thought better of his outburst, and sent an emissary to the artist with an apology and a handsome sum of money "to calm him down, as he was afraid that he would react in his usual unpredictable way." Michelangelo forgave the pope, with a genial laugh, but he was not always so forgiving.
Pope Paul III's master of ceremonies, Biagio da Cesena, observed of Michelangelo's nearly completed Last Fudgment on the altar wall of the Sistine Chapel that, with its numerous nude figures, it would look better on the wall of a tavern or a bathhouse. Taking revenge as only an artist can, Michelangelo painted Biagio's face on the figure of Minos, Prince of Hell; a pair of ass's ears appear on the unfortunate churchman's head and a snake coiled about his legs clamps its mouth around his penis.
So Beck, who calls his book "an interpretation of the personality of Michelangelo," gets the proportions wrong in portraying his hero; his Michelangelo is positively swollen with goodness. Vasari, on the other hand, acknowledged his master's flaws and still honored him as the best of men: God "determined to give this artist the knowledge of true moral philosophy and the gift of poetic expression, so that everyone might admire and follow him as their perfect exemplar in life, work, behavior, and in every endeavor, and he would be acclaimed as divine."
Where the human and the divine meet in Michelangelo's art, both the glories and the limitations of the human condition are revealed. The Creation of Adam shows the recumbent man and the deity virtually in parallel, and it is plain that Adam is made in God's image; yet there can be no mistaking who is master here. God is both tender and fearsome; His extended, life-giving right arm is like a lightning bolt that strikes with the utmost delicacy. Adam is as yet mere inert matter -- already beautiful but lacking vital force -- about to receive a soul. One discerns the immeasurable distance between Creator and creature in so slight a detail as their hands, which do not quite touch. Adam's outstretched arm looks as powerful as God's own, but it is limp-wristed, and his fingers are diffidently curled. The tip of God's right index finger, by contrast, is the focus of a masterful energy that gathers strength in a long diagonal and is discharged in a commanding gesture: Fiat homo. It is a gesture that can destroy as well as create. One sees it in a subsequent panel on the ceiling, as the angel wielding a sword drives Adam and Eve from Paradise. Human magnificence owes everything to God, and, once that truth is forgotten, man is never far from coming to grief.
God, too, partakes of that grief. The drawing of the Crucifixion that Michelangelo did in 1539 for Vittoria Colonna, a saintly widow whom he loved with ardent purity and whom Burckhardt calls "the most famous woman of Italy," is the finest rendering of Christ on the Cross done during the Renaissance. Painted by Cimabue and Giotto and Grunewald, sculpted by Ghiberti and Donatello, Christ just hangs there, dead: The Resurrection may be coming, but for now there is only death -- decorous and peaceful in Donatello's portrayal, gruesome beyond description in Grunewald's, but death in any event. Michelangelo's drawing, in which Christ is alive, depicts not only Christ's triumph over death but also the human struggle with life at its most frightful.
Michelangelo's Christ is tortured and haggard, but he is, nevertheless, unbroken. Brawnier than David, he looks as though he could wrench himself free of the nails. He twists his suffering body to relieve the terrible weight, yet he remains the image of heroic endurance. He casts his eyes toward heaven in agonized supplication, as a man, but in certainty of ultimate victory, as God. Most Renaissance crucifixions emphasize the defeated humanity of Christ, and leave his triumphant divinity to the viewer's pious imagination; Michelangelo's Christ suggests the promise of salvation, but also demonstrates the virtue most necessary for men as they struggle to be saved: fortitude. All men are to be strengthened by Christ's display of human strength. This Crucifixion is Michelangelo's subtlest heroic portrait: Human magnificence, exemplified by God become man, consists of the divine life good men will enjoy after death and the ability to endure the worst earthly trials undefeated.
Yet Michelangelo could not escape the fear that even heroic strength may not be enough; that fear is evident in the sculptures of the dead Christ that he carved in the 1540s and 1550s: the Florentine Pieta and the Palestrina Pieta. These are as different as can be from the signature piece that he made in his youth. In that early Pieta, Mary holds the dead Christ on her lap almost without effort; the effect is of an unearthly serenity.
In the Florentine Pieta, three people -- the Virgin seated, Mary Magdelene kneeling, and Nicodemus standing -- labor with all their might to keep the broken body of Christ from falling to the ground. A long, arcing, inexorably descending line runs from Christ's neck along his torso and thigh; his left arm plunges straight down from the shoulder; Mary's thigh and Christ's lower leg form a diagonal aimed sharply toward the earth. No human strength can long resist this downward pull; no human burden is heavier than that which man bears for having put God to death. In the Florentine Pieta, the holiest of human beings are on the verge of collapsing under the weight of human sinfulness. What, then, about the sinner? Not necessarily the wicked, but the good man with the usual failings -- what must he feel?
The answer is to be found in Michelangelo's poems. His poems can be so gnarled and knotty that even Italian editions provide paraphrases for the reader's benefit. Poets as great as Words-worth and Rilke have undertaken translations and given up. One is especially grateful then that John Frederick Nims, the author of eight books of poetry, former editor of the renowned magazine Poetry, who recently died at age eighty-five, saw the project of translating Michelangelo through to the end. In some 300 poems, mostly sonnets and madrigals, about 250 of them written during the last thirty years of his life, Michelangelo explored many aspects of the human condition, but always returned to what he considered its most significant feature: man's distance from God.
Much of Michelangelo's poetry can be characterized as thoughtfully erotic. Love, profane and sacred, is the predominant theme; passion provokes reflections on what sort of beings we are that we should have such feelings. Many of the poems are addressed to the hand-some and brilliant Roman nobleman Tommaso de' Cavalieri, whom Michelangelo met in 1532, when he was fifty-seven and Cavalieri twenty-three. others are addressed to Vittoria Colonna, and some to an unknown "lady beautiful and cruel." There are flashes of exuberant carnality, as in his aching to holdmy long desired sweet lord, / in my unworthy but eager arms, for ever. There are moments of disenchantment and even disgust with sensual pleasure, its core of ash and gall. There are intimations of love that transcends the strictly personal and lifts one heaven-ward: Drawn to each lovely thing, my doting eyes. / Drawn to its heavenly destiny, my soul. / Both with the one same goal, / no way, but in treasuring loveliness, to rise.
But, ultimately, all those lovely things get in the way of the poet's deepest longing, which is for God. In these poems, the greatest artist of the human body finds himself wishing he were not encumbered by a body of his own. Reminding one of John Donne's sonnet "Batter my heart, threeperson'd God," Michelangelo's sonnet "I wish I'd want what I don't want, Lord, at all" shows the poet's desire that God's love transform him into the kind of man who loves God as he should, without distraction or compromise.
Even art comes to seem a distraction, perhaps one fatal to the soul: Painting and sculpture soothe the soul no more, / its focus fixed on the love divine, outstretching / on the Cross, to enfold us closer, open arms. Life is short, and art is long; but eternity is a great deal longer, especially if you happen to be damned.
Michelangelo's own severity might seem unconscionable, miserable, or even mad; and one is relieved to find that Michelangelo continued to work on his sculpture almost to the last day of his long life. Still, the truth remains that one of the most remarkable of men found human magnificence simply not enough.
Jacob Burckhardt writes of the atrophy of religious feeling among the "intellectual giants" of the Renaissance: "The need of salvation thus becomes felt more and more dimly, while the ambitions and the intellectual activity of the present either shut out altogether every thought of a world to come, or else caused it to assume a poetic instead of a dogmatic form." Of Michelangelo, precisely the opposite was true. In this crucial respect, he was not a man of his time and place, but rather discovered in himself a need common to men of every time and place. And the answer to his need made even the David seem a slight thing.
Algis Valiunas is a writer living in Florida.


It dates from the 18th century, although its origins go back to the Carthaginian period. After the expulsion of the Arabs, the castle was abandoned.
Its reconstruction was tackled at a later date but not quite successfully until King Charles I of Spain (1530) ordered, by Royas Decree, ist rebuilding with the aim of guarding the coastal strip between Vera and Mazarrón, which was threatened by Turkish and Algerian raids.
The building work on this castle was tackled again in 1579, under the reing of Philip II. The Torre de las Aguilas (The Eagles Tower) was built in this period, in Saint John the Baptist¿s honour, the fortress becoming highly prestigious for the security it offered.
Its last remodelling would be undertaken under Charles III (in the 18th century), who decided to extend the fortress due to the town¿s incresing population and the constant Berber attacks to which the port and its population were subjected. This new remodelling turned it into one of the best fortified castles of this period.
Currently, there are very few remains of the splendour of this fortress. A coat of arms, where Castile¿s lions might be represented, can still be observed in one of the preserved façades. Recent excavations have revealed underground passages in the surrounding area, which, according to popular beliefs, used to connect this castle with another fortress of the municipality, the Castle of Tébar.
In addition to the fortress, also of tourist interest is the panoramic sight of the city of Aguilas that can be admired from its location.
It was restored in 2007 and opened as a museum in 2009
From Tuesday to Friday :
10.00 -13.30 & 16.00 -18.00 h.
Saturday, Sunday Bank Holiday:
10.00 -14.00 & 16.00 -18.00h.
24 y 31/12 Closed in the afternoon.
25/12 y 01/01 Closed.
Last visit: 30 min. before closing time
Children, students and pensioners: Free


A well-absorbed form of zinc in the form of a small tablet and can be dissolved in water if needed. Zinc Citrate is an economical form, useful where high doses of zinc are required.
Mineral citrates are formed by bonding mineral ions to citric acid. Citric acid is an organic acid widely found in fruits which effectively bonds to many minerals and trace nutrients acting as an efficient mineral transporter in the diet. Zinc citrate occurs naturally in human breast milk.
Features of Zinc Citrate:
- Zinc is an antioxidant mineral, essential for many vital enzymatic processes;
- Zinc is needed for a healthy reproductive and immune system, for tissue renewal, maintenance of the skin and for healthy bones and teeth;
- Zinc is necessary for the sense of taste and smell;
- Zinc is required for insulin formation and activity;
- Zinc helps maintain healthy liver function and releases vitamin A from the liver;
- Zinc is required for the development of the skeleton, nervous system and brain function in the growing foetus;
- Citrates have a high absorption rate and require little acidification prior to absorption;
- Suitable for individuals with low stomach acid and poor zinc status.


It's not a large news bulletin that tea leaf has some pretty spectacular health edges, however a replacement study, from scientists at Lancaster University and therefore the University of city, has known a particular compound found within the tea that would be recruited to dissolve the plaques that accumulate in blood vessels and result in heart attacks and upset.
The compound in question is epigallocatechin-3-gallate (EGCG). an excellent deal of analysis has targeted on this promising polyphenolcompound, revealing its spectacular medicinal drug effects furthermore as its compelling quality to act as a protecting component against neural harm. Some Alzheimer's analysis has targeted on EGCG's ability to inhibit the formulation of amyloid plaques within the brain.
This new study started to look at however EGCG affects the amyloid deposits which will build up in arteries. arteriosclerosis may be a upset that involves formations of amyloid deposits in blood vessels which will result in coronary failure or stroke. These deposits area unit just like people who area unit related to presenile dementia.
The analysis found that EGCG will alter the structure of amyloid fibrils fashioned by a supermolecule known as apolipoprotein A-1 (apoA-1). This supermolecule is key to the event of amyloid deposits seen in each Alzheimer's and arteriosclerosis. The hypothesis during this new study is that EGCG will effectively alter the shape of those amyloid fibrils, creating them less unhealthful.
"The health edges of tea leaf are wide promoted and it's been better-known for a few time that EGCG will alter the structures of amyloid plaques related to presenile dementia," says one amongst the researchers on the project, David dramatist. "Our results show that this intriguing compound may additionally be effective against the kinds of plaques which might cause heart attacks and strokes."
At this stage the analysis comes with a load of caveats. the foremost vital is that the concentrations of EGCG necessary for the results incontestible within the study area unit a lot of on top of one will collect from drinking a couple of cups of tea leaf. In fact, tea leaf has been found to confer some negative health effects once consumed in high volumes, as well as urinary organ stones, that the analysis doesn't recommend it's knowing drink over 5 cups every day.
Jeremy Pearson, from nation Heart Foundation says the analysis is promising however does not imply change to tea leaf simply however. "Our bodies area unit excellent at breaking down EGCG thus swapping your cupper for tea leaf is unlikely to form a giant distinction with relation to your heart health," says Pearson. "But by engineering the molecule slightly, we'd be able to create new medicines to treat coronary failure and stroke."
Tim Chico, from the University of metropolis, may be a bit additional skeptical of this new study. He notes that whereas the analysis is definitely fascinating, it's too early to recommend it'll result in any real future treatment in humans. "The researchers haven't however checked out whether or not EGCG makes any distinction to any type of sickness in animals or humans, and there was some suggestion that top concentrations of EGCG may scale back survival of vital human cells," says Leonard Marx.
This analysis might all right still be in its early stages, however it's associate undeniably encouraging piece of labor. whether or not EGCG will be effectively changed and changed into a person's treatment is however to be shown, however at the terribly least this is often another insight into the exciting effects of molecules that area unit still being discovered in easy old remedies like tea leaf. The analysis was revealed within the Journal of Biological Chemistry.
Green tea compound holds promise for preventing heart attacks
4/ 5Oleh HEALTH NEWS


As scientific knowledge grew, scientists had to develop new ways in which to record their discoveries and compare them with one another. Because different scientists had different tools, different backgrounds, and different goals, they came up with different systems.
How did we end up with both Fahrenheit and Celsius scales?
The Celsius scale is named after Swedish astronomer Anders Celsius, who developed it in 1742. Celsius measured the freezing and boiling points of water at sea level and divided the distance between the two into hundredths. He originally had the scale in the opposite order of the scale used today — 0°C was the boiling point of water, and 100°C was the freezing point — but other scientists later reversed the scale.
The Fahrenheit scale was first proposed in 1724 by the German physicist Daniel Gabriel Fahrenheit. Using a tube filled with mercury or alcohol, Fahrenheit determined his scale based on three points:
- He set the point at which water, ice, and ammonium chloride (a salt) stabilized as 0°F.
- He set the point at which still water just began to form ice on its surface as 32°F.
- He set the temperature of the human body taken in the mouth or under the arm as 96°F.
These may seem like odd numbers to choose, but consider that 64 degrees separate 32° and 96°. Because 64 is 26, Fahrenheit could simply bisect (divide in half) the distance between the two numbers six times in order to calibrate 1°.
Later, scientists noted that water boiled at nearly 180° higher than it froze, and readjusted the scale to make it exactly 180°. That's how human body temperature moved from 96°F to 98.6°F.
To convert degrees Celsius into degrees Fahrenheit, multiply the number by 1.8 and add 32. To convert from Fahrenheit to Celsius, subtract 32 and divide that number by 1.8.


Background and Objective: The nature of health communication is changing as people increasingly seek health information on the internet. The objective of this study was to investigate how hospital websites utilize a variety of e-health tools; online communication technologies such as social media, video, podcasts, and interactive formats.
Methods: An inductive content analysis was performed on the websites of 14 top-ranked US hospitals from January 5, 2011 to February 28, 2011. A total of 1,330 web pages were analyzed to identify the types of online communication technologies utilized by hospitals to provide e-patients with health information.
Findings: The findings provided an exploratory look at how hospitals provide web-based health information to patients. All hospitals used social media platforms such as Facebook, Twitter, or YouTube. Most hospitals offered web-based broadcasting of health information. Online health tools such as body mass index (BMI) calculators and health dictionaries were also a common website feature. Less frequently employed were mobile applications, hospital-patient interaction tools and health blogs.
Implications: The convergence of interactive media formats with web-based communication tools will likely enhance e-patient education and promote patient involvement in ways that alter traditional health care interactions, and may lead to enhanced levels of participatory medicine.
Keywords: Hospital websites, social media, podcasts, online tools, mobile applications, blogs, Facebook, Twitter, YouTube, e-health, health information.
Citation: Gallant LM, Irizarry C, Boone G, Kreps G. Promoting participatory medicine with social media: new media applications on hospital websites that enhance health education and e-patients’ voice . J Participat Med. 2011 Oct 31; 3:e49.
Published: October 31, 2011.
Competing Interests: The authors have declared that no competing interests exist.
The nature of health communication is changing as people increasingly rely on the internet for health information. Frydman asserted that patients have used the internet since its early inception “to share experiences, learn about diseases and treatments, and become advocates” for their own health care. A recent Pew Research Center study found that 80% of internet users look online for health information, making it the third most popular activity behind email and search. More than half of online health searches have had an impact on health decisions by e-patients. E-patients are internet-savvy users who seek online health information for education and decision making. Understanding web-based communication tool development that engages e-patients can better guide effective healthcare strategies and interventions and enhance participatory medicine.
While hospitals are cornerstones of public health information and health education, it is not known to what extent hospital websites are helping to achieve these important health goals. Past research has indicated that hospitals are just starting to use web 2.0 technologies to communicate and interact with e-patients. Thus, it is important to examine how hospitals use their websites to carry out their critical health care mission with various media and content delivery formats.
The current study examines how 14 top-ranked US hospitals serve the information needs of e-patients through online interactive media formats on their websites. Health organizations and professionals need to use social media channels to promote reliable and accurate health information to e-patients. Yet, there is little research regarding the nature of presentation of health information on hospital websites to guide this process. Knowledge about the use of new media by top-ranked US hospital websites may help health care administrators and other professionals assess and improve web-based health communication. The importance of web-based communication media formats for e-health leads to the following research question: How is health information represented in online media formats for e-patients on hospital websites?
This research employed an inductive content analysis to examine the websites of 14 top-ranked US hospitals, based on a national report published in 2010 by US News and World Report. Inductive content analysis is increasingly being used to study internet content. Since there is limited empirical work on hospital website content and virtually no research on hospital websites and online multimedia formats, an inductive analysis was appropriate to utilize for this study.
The 14 hospitals, ranked in order, include: (1) Johns Hopkins Hospital, Baltimore; (2) Mayo Clinic; Minnesota; (3) Massachusetts General Hospital, Boston; (4) Cleveland Clinic; (5) Ronald Reagan UCLA Medical Center, Los Angeles; (6) New York-Presbyterian University Hospital of Columbia and Cornell; (7) University of California, San Francisco Medical Center; (8) Barnes-Jewish Hospital/Washington University, St. Louis; (9) Hospital of the University of Pennsylvania; Philadelphia; (10) Duke University Medical Center, Durham, N.C.; (11) Brigham and Women’s Hospital, Boston; (12) University of Washington Medical Center, Seattle; (13) UPMC-University of Pittsburgh Medical Center; and (14) University of Michigan Hospitals and Health Centers, Ann Arbor.
As units of analysis, the authors first identified different types of online media formats utilized by each hospital (eg, blogs, instant-messaging, audio clips, and video clips etc.). After identifying media formats, patient health information content (eg, disease information, symptom checkers, and health education) was identified within each media format.
The total number of pages analyzed was 1,330, an average of 95 web pages per hospital website. The time frame for the content analysis of the 14 websites was January 5, 2011 to February 28, 2011. The first author identified six major content categories in the presentation of health information using hospital online media formats. These content categories include: social media; blogs; web-based broadcasting; web-enabled e-patient communication tools; mobile applications; and online health tools. These content categories and relevant sub-categories were corroborated by the second and third author. The analysis continued until saturation was reached.
This exploratory look into how hospitals provide web-based health information to e-patients provides details on the presence of various online media formats such as social media platforms, text-based, video, and webinars. Six content categories emerged in the analysis: social media, blogs, web-based broadcasting, web-enabled e-patient communication tools, mobile applications, and online health tools. The categories are defined below. Because of the developing nature of online technologies, some areas are more mature than others. For example, mobile applications, as a newer technology, presented less content compared to other categories. However, this category represents an important type of online communication which will grow in the future and so we included it in this analysis.
Two levels of content analysis are reported for each category, as depicted in Tables 1-6. The left column reports how many websites have a particular format, whereas the right column provides the number of these online media formats that contain patient health information.
Category 1: Social Media Applications
Social media applications connect one group of people to another. More importantly, social media applications enable hospitals to target e-patients with health communication messages. Table 1 illustrates that the vast majority of top-ranked hospitals use Facebook, hospital sponsored YouTube videos, and Twitter to communicate with e-patients.
This study found that typical health information content on social media sites included a mixture of patients’ stories, expert opinions by medical professionals, and details about what to expect from a particular test or procedure. Some content provided health tips, eg, diet, pediatric care, and cancer prevention.
Johns Hopkins offered a comprehensive and interactive approach, using social media to provide health information and refer e-patients to needed online or offline resources. Johns Hopkins used Twitter to refer to its Facebook page, its clinical web pages and other hospital resources. Most hospitals, however, did not sync their social media platforms to each other. This means that a hospital employee must enter messages individually on each social media platform hosted by the hospital.
The degree to which social media platforms promoted interactivity varied. For example, of the 13 hospitals that included Facebook pages, nine featured a Facebook link on the landing page making it easily accessible to e-patients. Six of the 13 hospitals with Facebook pages offered a dedicated health discussion forum on the site to promote interaction between health care providers and e-patients. While inconclusive, review of each hospital’s Facebook wall revealed some degree of interaction between hospital staff and e-patient inquiries. Hospital staff normally referred patient health inquires to the appropriate clinical care website. Facebook wall posts appeared to promote interaction among e-patient Facebook users on matters regarding their health inquiries, hospital services and hospital events. Further, the Facebook wall also became a forum for e-patients to voice their concerns or complaints regarding hospital services.
Most of the hospitals reviewed also offered a YouTube channel featuring a comments function. However, the interactivity potential of such videos was minimal, with little to no e-patient comments noted. Duke disabled the commenting function. Eleven of the 14 hospitals reviewed offered a “share” function which allowed e-patients to exchange information from hospital websites with other e-patients. Share functions included sending content to another person via email or posting information on an individual’s social media account such as Facebook or Twitter. Twitter postings were used most often by hospitals to promote community health events and news. This function provided easy one click linkages for visitors to repost hospital tweets to their individual Twitter feeds.
Category 2: Blogs
Blogs are a web-based, text-heavy format. Typical blog content on the websites studied contained health communication messages from medical experts and personal stories from patients (see Table 2). Physicians provided specialty medical information and advice through blogging in five of the hospital websites reviewed. Allied health professionals, such as nutritionists, wrote blogs about health information for hospital audiences. In both physician and allied health professional blogs, comment functions were available for e-patients. Depending on the topic, e-patients would engage each other through the blog. Very little additional engagement was noted between e-patients and blogging health providers.
However, there were a number of hospitals hosting e-patient blogs on their websites. In general, e-patients wrote about their medical conditions and hospital experiences on the blogs. Moreover, specialized online social media platforms such as CaringBridge or CarePages were utilized by more than half of the hospitals to provide patients with a way to report their progress and well-being. It also allowed a patient’s friends and family members to view entries and to make comments on patient posts. Such patient-driven social media combined blogging and online community building around an individual patient’s medical journey.
Category 3: Web-Based Broadcasting
Web-based broadcasting uses the typical broadcast media formats in an online environment. As reported in Table 3, these formats included: online videos, podcasts, and webinars. All of these media were hosted directly on the hospital websites, rather than using YouTube and Facebook. The online videos reviewed presented a variety of health information from hospital physicians and allied health professionals. Similarly, podcasts (audio productions) were also produced to provide health information for e-patients. Webinars are slightly different in that the initial webinar can be live and allow audience members to interact online with other guests. After the live webinar, the productions may be posted for future viewing. In this study, eight webinars were identified, in which half were devoted to medical and support staff training and half provided health information to e-patients.
Category 4: Web-Enabled e-Patient Communication Tools
Web-enabled communication tools allow two-way communication between hospital health care providers and e-patients. E-patient web-enabled communication tools identified in this study included email, online chat, and text messaging, and online support groups. The occurrences are reported in Table 4. A standard email link to contact the hospital was available on the majority of hospital websites. Only the University of Washington Medical Center-Seattle website required that contact with the hospital occur via phone. More innovative web-enabled communication tools were found in online chat forums. For example, the Cleveland Clinic’s online health library offered e-patients an opportunity to chat with a health care provider to aid their search. The hospital also offered the ability to submit a question online throughout their site.
While most hospitals reviewed offered support group lists on their websites, only five hospitals provided web enabled links to online support groups. In most cases, hospitals simply listed the telephone number of local support groups.
Category 5: Mobile Applications
Mobile applications support health information and messages in a wireless format available through mobile devices like smartphones and web-based tablets such as the iPad. These applications included walking exercises, symptom checkers, and meditation exercises. Only Ronald Reagan UCLA Medical Center, offered the entire website in a mobile format. As indicated in Table 5, only five of the 14 hospitals had mobile applications available. However, all of the mobile applications reviewed offered patient health information content.
Category 6: Online Health Tools
Online health tools were provided for e-patients to learn more about their personal health needs. These tools ranged from static information such as health dictionaries, health topic guides, and event calendars, to more interactive information such as BMI calculators and an option to request a second opinion online (see Table 6).
The most interactive and personalized online tool available on hospital websites was the patient portal to access information from a hospital’s electronic health records. Patient portals are individualized, password protected accounts for which a patient must register. Unlike general health tools on hospital websites, a patient portal contains personal health information, which must be protected under healthcare privacy laws. Since privacy prevents direct examination of a patient’s portal web content, this research relied on hospital descriptions of their patient portal functions.
Of the 14 hospitals reviewed, 11 hospital websites provided patient portals through personalized accounts. Three types of online functions involved administrative tasks, accessing personalized medical information, and interacting with health professionals. Common tasks included:
- Making appointments;
- Requesting referrals;
- Requesting prescription refills;
- Making bill payments;
- Updating contact information;
- Updating insurance information; and
- Pre-registering and filing forms for appointments.
Common personalized medical information available to e-patients through portal access included attaining lab results, medical records to review health conditions, and managing medical information of family members, especially children. Interacting with health professionals allows users to send questions to their medical care team and receive health reminders.
Only four patient portal descriptions stated that users can search for general health and disease information from within the portal application. Further, the University of Pittsburgh Medical Center offered the only mobile patient portal. The mobile tasks offered allowed e-patients to check test results, review their medical history, conduct secure communication with doctors, and view upcoming appointments.
The current findings suggest that top-ranked US hospitals are utilizing many different forms of interactive web-based media to serve e-patients. These findings are consistent with reports that large hospitals with higher numbers of beds have more resources to develop websites containing consumer health information. Top-ranked US hospitals’ embrace of new media technology may help inform other medical institutions considering development of interactive web technologies that facilitate participatory medicine.
e-Health Information Seeking and Education
Finding reputable health information online allows e-patients to educate themselves and others to make informed medical decisions, stay healthy, and manage diseases. Hospital websites are seen as trusted sources of e-health information.
Interactive online communication tools on hospital websites, such as those in this study, allow e-patients to forward and share online health information. Social media “share” functions are also important for promoting participatory medicine because they extend online health searches beyond the individual user to wider populations. Research has determined that e-patients conduct online health information searches for themselves, family members, and friends20 on topics such as health improvement, medical treatments, family health, healthy eating, alternative medicine, and exercise.
Further, interactive formats may present opportunities to enhance e-patient health literacy. The change from text-based online information to more visual and interactive web-based media provides the opportunity for increased user engagement with health information. Engagement in e-health has been defined as “the process of involving users in health content in ways that motivate and lead to health behavior change.” Past research suggests that multimedia and interactive content increase people’s engagement with health information. All of the six content categories reported in this study (social media, blogs, web-based broadcasting, web-enabled e-patient communication tools, mobile applications, and online health tools) were interactive forms of online media.
The findings also suggest that hospital websites may also provide additional sources of quality health information by linking e-patients to other websites such as governmental, health care, and medical organizations. These types of website offer specialized knowledge for patients with particular disease concerns such as cancer and organ donation. Such linking enhances participatory medicine by allowing ready access to medical information that is tailored to the health needs of e-patients.
The current study’s findings continue to show that e-health opportunity gaps are being addressed by top US hospital websites. In 2004, Fulda, Kwasik, and Ische reported that top US hospital websites fill e-health opportunity gaps (what people are doing online in contrast to what they would like to be doing online). In particular, the increased use of interactive and multimedia based content, as found in this study, offered e-patients more ways to search, learn, and interact with online health information. Interactive media formats for e-health allow website users to retrieve health information in ways that best meet their needs and expectations. Plus, the choice of media formats may better match users’ specific and personalized learning styles.
With 11 out of 14 hospitals having patient portals, it is clear that there is a commitment by health care providers to communicate with patients online. The purpose of patient portals is to improve health outcomes by facilitating engagement in health care by patients and medical providers. However, such web-enabled technologies require additional research to assess their impact on participatory medicine. For example, Jones and colleagues argued that these applications need more standardization to improve “interoperability, transportability, and security” in order to enhance their uses for positive patient health outcomes.
This study’s findings, specifically three types of online functions e-patients can perform utilizing patient portals, are a step towards identifying similarities and differences across patient portals. These three types (administrative tasks, accessing personalized medical information, and interacting with health professionals) can guide future user-centered research to help determine what functions e-patients identify as most important. Further studies are needed to determine portal tasks that help patients understand and use their health information most effectively. Further, future usability studies of patient portals may also consider varying levels of health literacy. Patient portals that offer multimedia (video, audio, graphics), may reduce health literacy difficulties. Some patient portals charge users for certain applications, while others have fees paid by health providers, payors, or employers. Patient portal access issues, especially cost, calls attention to the issue of the economic “digital divide. ” Patients, principally those with lower incomes, may not have access to a health care provider, insurer, or employer that will provide and cover the cost. As the health care industry increasingly relies on information technology to manage health care, this problem is likely to become even more significant. Research in health policy may provide insight about ways to decrease economic barriers for the use of patient portals.
Social Media Applications
Social media applications provide convenient web-based interactive communication tools that may promote dialogue between health educators and e-patients. We agree with Friedman that “participatory medicine may be the most important driving force for new models and experiments in patient-centric practice, cost reform, and medical research….” Moreover, the use of social media applications could be better utilized by hospital staff to promote greater interaction between e-patients and health care providers. For example, while hospitals may use Facebook for marketing and public relations, the technology also allows e-patients to voice their questions and opinions with other e-patients and medical professionals.
Posting and updating social media content takes time and resources that may be difficult for hospital staff to manage. Utilizing applications that post the same content on multiple social media platforms can cut down on staff workload while increasing communication with wider e-patient audiences. Social media content can be posted to numerous social media platforms concurrently with such tools as TweetDeck and Hootsuite. These cross-platform tools allow content posted on one social media website to be simultaneously placed on other social media platforms, such as Twitter, Facebook, LinkedIn, Google Buzz, and Foursquare.
Less than half of the hospitals studied had any mobile application capabilities on their websites. While mobile communication is currently used most heavily by younger adults and teenagers, growth of these tools by all age groups is predicted for the future. Fox and Jones suggested that the spread of wireless devices, coupled with generational shifts, will require greater attention to mobile applications in e-health. They contend:
Adults between the ages of 18 to 49 are more likely than older adults to participate in social technologies related to health. As younger adults face more health care questions and challenges, they will turn to the tools they have sharpened in other contexts of their lives to gather and share health advice.
In fact, the current study’s findings revealed that health promotion is currently the most common use of mobile communication on hospital websites. Currently, mobile online health promotion for younger adults and teenagers can be an important part of participatory medicine.
Social Media Analytics & Practical Implications
Many web-based media formats provide instruments to track how content and information is being accessed and utilized by online consumers. With this feedback, hospital administrators responsible for website development can determine how to improve online health media for users. User data can help determine what information is being viewed, posted, and shared with others. Administrators have the ability to examine unique visitors, registrations, page views, satisfaction, engagement, return visits, shared posts, influencer posts, and other social interaction metrics. With this knowledge, websites may better advance strategic goals for e-health information that enhances participatory medicine.
Hospitals and other health care organizations can serve as a primary source for disseminating relevant health information to e-patients through strategic and effective utilization of online interactive media. For example, given the real-time nature of online communication, the use of hospital websites for informing e-patients of immediate health threats can be an important area for future study. For instance, a case analysis of patients from three Toronto hospitals discovered that after the SARS outbreak people were interested in using hospital websites to gather relevant health information during epidemics. Greater attention directed toward how online interactive media formats can help prepare and safeguard public health in crisis situations such as epidemics and natural disasters is warranted. Mobile communication, often used for instantaneous communication, is increasingly used by people for e-health concerns as stated by Fox.
Finding useful health information is also essential for a web-based participatory medicine model. Past research has shown that online health information should flow from general to specific paths. Research on the organizational structure of health websites should help determine how and where health information should be placed on websites for an optimal user experience and for most effectively educating e-patients. This may include identifying how e-patients conceptualize general to specific health information, then adapting websites to follow e-patients’ expected information flows.
Another important area for future research in participatory medicine and interactive online communication tools is the use of language. Research has called for health websites to be better designed to accommodate the various languages used by members of diverse communities, as well as to meet the health literacy levels of different groups of consumers. The concern about accommodating language and health literacy differences of diverse communities should extend to the development of language-appropriate online interactive tools for e-patients.
This study is limited in that only 14 hospital websites were reviewed. As top-ranked hospitals, they provided an instructive sample to review the technological capabilities available at this time. Although greater interaction with online media can increase participatory medicine, without direct observation, participant interviews, or participant surveys, information about which online interactive media tools best facilitates participatory medicine is limited.
As the National Action Plan to Improve Health Literacy calls for improvement of health websites to better promote health, the results of this study provide insights into how hospitals and other health-based websites can utilize various media in online environments for future health advocacy. Using online media formats bolsters e-patients’ engagement in health information while reinforcing health care institutions’ objectives in providing health care resources to improve health outcomes. More specifically, the findings present guidance on how six types of online interactive media (social media, blogs, web-based broadcasting, web-enabled e-patient communication tools, mobile applications, and online health tools) can be used to strategically manage health communication messages and information to strengthen participatory medicine.
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Copyright: © 2011 Linda M Gallant, Cynthia Irizarry, Gloria Boone, Gary Kreps. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.


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“Bringing it all Together: The Geometry of Golf”
Golf in Geometry?? No Way!
Geometry In The Game of Golf
For hundreds of years, golf has been an extremely popular and growing sport all around the world. Looking where golf is now, it is growing rapidly from the young to the elder population. The first round of gold was first played in the 15th century off the coast of Scotland, but it did not start to be played until around 1755. The standard rules of golf were written by a group of Edinburgh golfers. Today, people of the US, Scotland, and England, have been drawn to the game because it is fun, challenging, and hardly any athletic ability at all is required for amateurs. In breaking down the game, geometry plays a major role, and can influence a players score dramatically. Geometry plays a key role and influences aspects such as the ball, course, or golf swing.
First Geometry is important in the design of the golf ball. It is crucial that the golf ball is not a perfect sphere, but as close to a sphere as possible. Before man could create the perfect golf ball, the main idea was to create a close to perfect sphere without any implications that would mess up the distance and direction of the ball. If the ball is not a perfect sphere, without any davits, the ball would not get any spin on it and would go the wrong direction.
Furthermore geometry is used in creating and designing golf courses. When designing them, there are numerous types of holes. A hole may be straight, a dogleg left or right, or the hole can below or above the tee box. In the picture below for example is a dogleg left, and there are many different types of angles a golfer must take to put the ball onto the green.
Another way geometry is incorporated in golf is the golf swing. It is the most important way, and every golfer must use geometry in his/her swing. Perhaps the most important part of the swing is the pre-shot stance. It is important to bend from a strong angle...
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